Pancreatoduodenectomy as classic and pylorus-preserving variant: single center experience.

It is presented and discussed the experience of pancreatoduodenectomy for pancreatic head and ampullary tumors. Of 7 cases of pancreatoduodenectomy 3 were performed as classic Whipple procedure and 4 as modified pylorus-preserving variant (PPPD). It was observed 2 cases of mild pancreatic and biliary leak and 1 patient developed abdominal wall dehiscence after the surgical site infection. There was no operative mortality and overall postoperative morbidity rate was 42,8%. It is concluded,that "end-to-end" pancreaticojejunostomy with stent placement and the PPPD variant are the most optimal and preferred operative procedures at pancreatoduodenectomy cases.

Surgical services and transformation of civil hospital during "August War 2008" in Georgia.

Structural transformation of a civil hospital into a military one during "August War 2008" (August 8-12) in Georgia is presented. Damage-control principles, such as hemorrhage control, liver-packing and abdominal tamponade, gastrointestinal tract resection without formation of anastomoses, and other temporary interventions were prioritized. This provided a chance to empty the hospital in a short period to provide the admission of an increased number of combat casualties. There were soldiers from Georgian troops, civilians, and captives of war. The number of total admitted patients was 739. Fifty-two patients were operated on in the surgery department. The following operations were carried out: removal of foreign bodies from the neck region, 6 cases; isolated thoracotomy, pulmorrhaphy, and drainage, 2 cases; laparotomy, hepatorrhaphy, gastrorrhaphy, splenectomy, resection of small intestine, and colostomy, 18 cases; combined operations (thoracotomy plus laparotomy), 9 cases; extended debridement and dressing of wounds, 11 cases; angiosurgical operations, 4 cases; and coloplasty, 2 cases. There were 2 cases of mortality, 1 case of rethoracotomy, and 3 cases of relaparotomy: 2 because of intracavital bleeding and 1 because of sanation.

[Case of successful repair of penetrating cardiac injury].

The penetrating cardiac injury after the chest stab wound in 33 year old patient is described. The following clinical signs indicated suspected cardiac injury: localization of injury to the region of the heart, the signs of acute bleeding and cardiac tamponade, which was also confirmed by echocardiography. During urgent thoracotomy with additional sternotomy the right ventricle injury of 1,5 cm of length was found, which required 5 stitches for repair of defect and complete hemostasis. The temporary cardiac arrest (40-50 sec) has occurred during cardiography and internal cardiac massage was performed to restore the normal cardiac rhythm. Postoperative course was uneventful and patient on the 10th day after admission was discharged from the hospital. The successful outcome of treatment of this severe group of patients could be achieved by maintenance of the following fundamental principles: rapid transport of patients to the nearest hospital, maximum rapidity in establishment of diagnosis and highly qualified urgent surgical intervention. Echocardiography is the most informative and quick method of noninvasive diagnostics of penetrating cardiac injury.

[Current approaches to the surgical treatment of cancer of the cardioesophageal junction]. / Sovremennye podkhody k khirurgicheskomu lecheniiu raka kardioézofageal'noi oblasti.

Results of surgical treatment of 264 patients with carcinoma of the cardio-esophageal region are analysed. Operability was 89.0 +/- 1.9%, resectability was 64.3 +/- 3.1% in the group of patients who underwent operation and 57.2 +/- 3.1% in the group of patients admitted to the clinic. The total number of complications in the group of patients subjected to radical (151) operations came to 41.7 +/- 4.0% and the number of patients with complications 21.2 +/- 3.3%. Incompetence of sutures of the esophageal anastomosis was encountered in 9.3 +/- 2.4% of cases, total postoperative mortality was 5.1 +/- 1.4%, mortality in the group of patients who underwent radical operation was 7.9 +/- 2.2%. Operative interventions with extended lymphadenectomy were performed in 106 cases, histologically verified metastases in the lymph nodes were found in 79.2 +/- 3.9% of cases. Five-year survival was recorded in 27.8% of cases, patients treated by extended lymphadenectomy live twice longer than those not subjected to lymphadenectomy.

[The surgical and combined treatments of locally disseminated cardioesophageal cancer]. / Khirurgicheskoe i kombinirovannoe lechenie mestnorasprostranennogo kardioézofageal'nogo raka.

The article deals with the experience in the treatment of more than 1,000 patients with cardioesophageal carcinoma in 1965-1989. The authors note increase of surgical activity and widening of indications for operative treatment at the cost of patients of the old age groups and those with locally-extending forms of the neoplastic process. In distinguishing the term cardioesophageal carcinoma the authors insist on the community of the surgical tactics and operative methods in carcinoma of the cardia extending to the esophagus and in esophageal carcinoma spreading to the stomach. Improvement of the results of tre treatment the authors attribute to the perfection of the methods of lymphodissection and formation of esophageal anastomoses. The authors claim that the development of effective methods of combined treatment underlies the prospects of improving the late-term results. Experience in preoperative hypoxyradiotherapy, adjuvant postoperative chemotherapy, and preoperative regional intraarterial polychemotherapy is analysed.

[The treatment of the sequelae of penetrating injuries to the esophagus]. / Lechenie posledstvii pronikaiushchikh povrezhdenii pishchevoda.

On the basis of experience in the treatment of the sequelae of penetrating esophageal injuries in 79 patients the authors divided the patients into 3 groups: those in whom the perforation healed and stricture of the esophagus developed; patients with incurable purulent complications and esophageal fistulas; patients who underwent various operative interventions for acute perforation or its sequelae and needed a reconstructive operation. Recommendations on the choice of adequate therapeutic tactics for each group are given. The method of examination of the patients and the peculiarities of surgical treatment are described in detail. The most frequently encountered complications and the produced results are analysed. It is concluded that patients with sequelae of esophageal perforation must be treated at specialized clinics experienced in the management of this severe condition.

[Extensive lymph node excision in the surgical treatment of esophageal and gastric cancer]. / Rasshirennaia limfadenéktomiia v khirurgicheskom lechenii raka pishchevoda i zheludka.

Experience with 100 operations for carcinoma of the esophagus and stomach with expanded lymphadenectomy is analysed. The operative techniques are described and the necessity and expediency of expanded lymphadenectomy, the method of its performance, classification of the group of lymph nodes which must be removed are discussed. The postoperative mortality was 2%, complications in the postoperative period 25%. Metastases in the lymph nodes were confirmed histologically in 69% of cases. It is concluded that expanded lymphadenectomy is a necessary measure in surgical intervention in patients with carcinoma of the esophagus and stomach and improves the results of management of this group of patients.

[Combined gastrectomy with extensive lymph node excision in the surgical treatment of cancer of the stomach]. / Kombinirovannaia gastréktomiia s rasshirennoi limfadenéktomiei v khirurgicheskom lechenii raka zheludka.

The authors discuss experience in combined gastrectomy in 206 patients with gastric carcinoma. They encountered 72 various postoperative complications which were not fatal. Fourteen patients died, which made up a total postoperative mortality of 6.8%. The most frequent and threatening complication was incompetence of the esophago-intestinal++ anastomosis, which occurred in 17 cases (8.3%) and was the cause of death of 6 patients (42.9%). The incidence of purulent and pleuropulmonary complications was 19.9 and 3.4%, respectively. Extensive lymphadenectomy was performed in combined gastrectomy in 40 cases, which accounted for 42.6% of all combined interventions. The incidence of complication was lowest in this group of patients (15%), and there were only 2 fatal outcomes (5%). The authors believe that total gastrectomy with omentectomy, splenectomy, resection of the lower esophagus, and extensive lymphadenectomy is the method of choice in surgical treatment of gastric carcinoma.

[Reconstruction of the cervical part of the esophagus using a free revascularized segment of the jejunum and microsurgical technic]. / Rekonstruktsiia sheinogo otdela pishchevoda svobodnym revaskuliarizirovannym segmentom toshchei kishki s primeneniem mikrokhirurgicheskoi tekhniki.

The article analyses the experience in 11 reconstructions of the pharynx and cervical esophagus with a free vascularized jejunal segment employing microsurgical technique for squamous cell carcinoma of the upper digestive tract. The operative technique is described. It is noted that this operative procedure is a difficult method of surgical management of defects in the pharynx and cervical esophagus and is attended in some cases with complications. From personal experience and review of the literature, the authors conclude that autotransplantation of a free vascularized jejunal segment with the use of microsurgical technique is the best method for reconstruction of defects in the pharynx and cervical esophagus.