[Scoring systems to predict pancreatic fistula after Whipple procedure]. / Shkaly prognoza pankreaticheskoi fistuly posle operatsii Uippla. Analiticheskii obzor literatury.

Specific complications is an «Achilles heel¼ of pancreaticoduodenectomy. Postoperative pancreatic fistula (POPF) is the most common specific complication. POPF prediction is an actual problem in pancreatic surgery. Analysis of statistically significant scoring systems to predict POPF is a modern trend in perioperative planning. Several prognostic scales (FRS, a-FRS, ua-FRS, Modified Fistula Risk Score) are recommended for clinical practice.

[Diagnostic and conservative treatment nuances in patients with obstructive jaundice: in the wake of Russian consensus].

The research was performed at the Loginov Moscow Clinical Scientific Center. It is based on Russian obstructive jaundice (OJ) consensus results, considered at the 45th annual Central Research Institute of Gastroenterology Scientific session Oncological issues in the gastroenterologist practice (1 March 2019). The article objective is to note the diagnostic and conservative treatment current issues in patients with OJ. The increase in the number of patients with OJ of different etiology provides problem actuality. In a large number of cases, medical treatment is delayed due to inadequate diagnostic and management, while correct patients routing today can be provided regardless of medical institution level. In this article the examination steps and conservative treatment role in patients with biliary obstruction management are presented.

[Treatment of severe post-resection liver failure. Analysis of the specialized center]. / Lechenie postrezektsionnoi pechenochnoi nedostatochnosti tyazheloi stepeni. Analiz spetsializirovannogo tsentra.

Posthepatectomy liver failure is one of the most serious complications of large liver resections. OBJECTIVE: The analyzes the management and results of treatment of patients with severe posthepatectomy liver failure (Grade C ISGLS) in a specialized hepatosurgical department. MATERIAL AND METHODS: In the period from January to December 2019, 175 liver resections were performed in the Department of liver and pancreatic surgery at the A.S. Loginov Moscow Clinical Scientific Center. Major-volume liver resections (hemihepatectomies and resections of more than three liver segments) were performed in 80 (45%) patients. In 125 (71%) cases liver resctions were performed for malignant liver and bile duct diseases. Laparoscopic liver resections were performed in 77 (44%) patients. RESULTS: Postresection liver failure developed in 18 (10.2%) patients. Severe (class C according to ISGLS) developed in 6 (3.4%) patients. In the postoperative period (90-day mortality), 4 patients (2.3%) died, while in two patients, mortality was not associated with liver failure. Hyperbilirubinemia was observed for more than 5 days in 2 (33.3%), coagulopathy in 4 (66.6%), ascites in 5 (83.3%), encephalopathy in 5 (83.3%), hypoglycemia in 3 (50%), and uncontrolled sepsis in 2 (33.3%) patients, respectively. Correction of surgical complications was required in 100% of cases, which consisted in drainage of abscesses and abdominal bylomas, and the the bilio-digestive anastomosis fistulas. Inotropic support was required in all 6 (100%) patients, invasive ventilation in 4(66.6%), and extracorporeal detoxification in 5 (83.3%). CONCLUSIONS: Posthepatectomy liver failure is a complex problem even in a specialized center. A comprehensive approach to treatment allows to achieve noticeable results and reduce mortality.

[Russian consensus on current issues in the diagnosis and treatment of obstructive jaundice syndrome]. / Rossiiskii konsensus po aktual'nym voprosam diagnostiki i lecheniya sindroma mekhanicheskoi zheltukhi.

The Russian consensus document on topical issues of the diagnosis and treatment of obstructive jaundice syndrome was prepared by a group of experts in various fields of surgery, endoscopy, interventional radiology, radiological diagnosis and intensive care. The goal of this document is to clarify and consolidate the opinions of national experts on the following issues: timing of diagnosis of obstructive jaundice, features of diagnostic measures, the need and possibility of conservative measures for obstructive jaundice, and strategy of biliary decompression depending on the cause and level of biliary block.

Important problems in the diagnosis and treatment of primary sclerosing cholangitis (based on the Russian consensus on diagnosis and treatment autoimmune hepatitis. Moscow, 2018).

The article is published based on the results of the Russian Consensus on the diagnosis and treatment of primary sclerosing cholangitis (PSC), discussed at the 44th annual Scientific Session of the CNIIG "Personalized Medicine in the Era of Standards" (March 1, 2018). The aim of the review is to highlight the current issues of classification of diagnosis and treatment of patients with PSC, which causes the greatest interest of specialists. The urgency of the problem is determined by the multivariate nature of the clinical manifestations, by often asymptomatic flow, severe prognosis, complexity of diagnosis and insufficient study of PSC, the natural course of which in some cases can be considered as a function with many variables in terms of the nature and speed of progression with numerous possible clinical outcomes. In addition to progression to portal hypertension, cirrhosis and its complications, PSC can be accompanied by clinical manifestations of obstructive jaundice, bacterial cholangitis, cholangiocarcinoma and colorectal cancer. Magnetic resonance cholangiography is the main method of radial diagnostics of PSC, which allows to obtain an image of bile ducts in an un-invasive way. The use of liver biopsy is best justified when there is a suspicion of small-diameter PSC, autoimmune cross-syndrome PSC-AIG, IgG4-sclerosing cholangitis. Currently, a drug registered to treat primary sclerosing cholangitis which can significantly change the course and prognosis of the disease does not exist. There is no unified view on the effectiveness and usefulness of ursodeoxycholic acid and its dosage in PSC. Early diagnosis and determination of the phenotype of PSC is of clinical importance. It allows to determine the tactics of treatment, detection and prevention of complications.

[Early outcomes of robot-assisted liver resection]. / Robot-assistirovannye rezektsii pecheni. Otsenka blizhaishikh rezul'tatov.

AIM: To assess an experience of robot-assisted liver resection using CUSUM-test. MATERIAL AND METHODS: The results of 46 robot-assisted liver resections were retrospectively analyzed by using of CUSUM-test. RESULTS: There were 3 periods in development of the technology. The 1st period - procedures with the lowest index of difficulty (n=16), the 2nd period - expansion of the indications for difficult resections (n=18) and the 3rd period - stabilization of the results (n=12). The dynamics of difficulty index, intraoperative blood loss, duration of procedure and morbidity (Clavien-Dindo Grade II-V) were evaluated. Five liver resections were needed to decrease blood loss and duration of the procedure. Expansion of indications was feasible after 16 procedures. Stable results were obtained after 34 liver resections.

[Intrahepatic cholangiocarcinoma followed by vascular invasion: is surgical treatment justified?] / Vnutripechenochnaia kholangiokartsinoma s invaziei v sosudy: opravdano li khirurgicheskoe lechenie?

Intrahepatic cholangiocarcinoma (ICC) is one of the most aggressive tumors associated with poor prognosis. Radical surgery is still the main method of treatment in resectable cases. Certain difficulties are observed in case of locally advanced tumors followed by inferior vena cava (IVC) and portal vein (PV) invasion. AIM: To analyze safety of advanced liver resections combined with great vessels repair for locally advanced large and multiple cholangiocellular carcinoma. MATERIAL AND METHODS: Since January 2014 till April 2017 eighty ICC patients have undergone advanced liver resection. There were 62 patients with portal cholangiocarcinoma and 18 with ICC. 4 ICC patients required vascular repair: IVC replacement in 2 cases (i.e. under venous bypass in 1 of them), tangential and circular resection of portal vein bifurcation - in 2 cases. RESULTS: Postoperative complications Clavien-Dindo IIIa developed in all cases. There were no vascular complications. The length of hospital-stay was 14 - 35 days. There were no lethal outcomes. Annual survival was 50%, 2-year - 25%. Adjuvant chemotherapy was used in all patients. CONCLUSION: Advanced liver resection followed by IVC and PV repair for locally advanced ICC may be safely performed and subsequently allows chemotherapeutic treatment.

Russian consensus on exo- and endocrine pancreatic insufficiency after surgical treatment.

The Russian consensus on exo- and endocrine pancreatic insufficiency after surgical treatment was prepared on the initiative of the Russian "Pancreatic Club" on the Delphi method. His goal was to clarify and consolidate the opinions of specialists on the most relevant issues of diagnosis and treatment of exo- and endocrine insufficiency after surgical interventions on the pancreas. An interdisciplinary approach is provided by the participation of leading gastroenterologists and surgeons.

[The Russian consensus on the diagnosis and treatment of chronic pancreatitis: Enzyme replacement therapy]. / Rossiiskii konsensus po diagnostike i lecheniiu khronicheskogo pankreatita: zamestitel'naia fermentnaia terapiia.

Pancreatology Club Professional Medical Community, 1A.S. Loginov Moscow Clinical Research and Practical Center, Moscow Healthcare Department, Moscow; 2A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow; 3Kazan State Medical University, Ministry of Health of Russia, Kazan; 4Kazan (Volga) Federal University, Kazan; 5Far Eastern State Medical University, Ministry of Health of Russia, Khabarovsk; 6Morozov City Children's Clinical Hospital, Moscow Healthcare Department, Moscow; 7I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia, Saint Petersburg; 8Siberian State Medical University, Ministry of Health of Russia, Tomsk; 9M.F. Vladimirsky Moscow Regional Research Clinical Institute, Moscow; 10Maimonides State Classical Academy, Moscow; 11V.I. Razumovsky State Medical University, Ministry of Health of Russia, Saratov; 12I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow; 13S.M. Kirov Military Medical Academy, Ministry of Defense of Russia, Saint Petersburg; 14Surgut State Medical University, Ministry of Health of Russia, Surgut; 15City Clinical Hospital Five, Moscow Healthcare Department, Moscow; 16Nizhny Novgorod Medical Academy, Ministry of Health of Russia, Nizhny Novgorod; 17Territorial Clinical Hospital Two, Ministry of Health of the Krasnodar Territory, Krasnodar; 18Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia, Saint Petersburg; 19Rostov State Medical University, Ministry of Health of Russia, Rostov-on-Don; 20Omsk Medical University, Ministry of Health of Russia, Omsk; 21Russian Medical Academy of Postgraduate Education, Ministry of Health of Russia, Moscow; 22Novosibirsk State Medical University, Ministry of Health of Russia, Novosibirsk; 23Stavropol State Medical University, Ministry of Health of Russia, Stavropol; 24Kemerovo State Medical University, Ministry of Health of Russia, Kemerovo; 25N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow; 26A.M. Nikiforov All-Russian Center of Emergency and Radiation Medicine, Russian Ministry for Civil Defense, Emergencies and Elimination of Consequences of Natural Disasters, Saint Petersburg; 27Research Institute for Medical Problems of the North, Siberian Branch, Russian Academy of Sciences, Krasnoyarsk; 28S.P. Botkin City Clinical Hospital, Moscow Healthcare Department, Moscow; 29Tver State Medical University, Ministry of Health of Russia, Tver The Russian consensus on the diagnosis and treatment of chronic pancreatitis has been prepared on the initiative of the Russian Pancreatology Club to clarify and consolidate the opinions of Russian specialists (gastroenterologists, surgeons, and pediatricians) on the most significant problems of diagnosis and treatment of chronic pancreatitis. This article continues a series of publications explaining the most significant interdisciplinary consensus statements and deals with enzyme replacement therapy.

[Comparative analysis of static scintigraphy and computerized tomography in assessment of remnant liver volume after advanced hepatic resection]. / Cravnitel'nyi analiz staticheskoi stsintigrafii i komp'iuternoi tomografii v otsenke ob''ema ostatochnoi parenkhimy pri obshirnykh porazheniiakh pecheni.

AIM: To perform a comparative analysis of computerized tomographic volumetry and scintigraphic liver volumetry in assessment of remnant liver volume after advanced hepatic resection. MATERIAL AND METHODS: Static hepatobiliary scintigraphy and CT volumetry were performed in 45 patients with various liver tumors who underwent advanced hepatectomies (more than three segments). RESULTS: There were no any significant differences in volumetric parameters obtained by CT and scintigraphic volumetry. CONCLUSION: Scintigraphic volumetry data are similar to those of CT volumetry in evaluation of future remnant liver volume. Scintigraphic volumetry may be used as an alternative in assessment of future remnant liver volume after advanced hepatic resections.

[Reconstruction of hepatic veins in liver resection. Technique and possibility of prophylaxis of posthepatectomy liver failure].

BACKGROUND: Invasion of hepatic veins by liver tumor limits parenchyma-preserving liver resection. We analyzed different technique of hepatic vein reconstruction and possibility of prophylaxis of post hepatectomyliver failure in patients with compromised liver function. METHODS AND CLINICAL DATA: From 2010 to 2015 performed 199 liver resections. Reconstruction of hepatic veins performed in 9 (4.5%). Among them 3 patients was with hepatocellular carcinoma and 6 patients with colorectal liver metastases. Resections of segment 7, 8 was performed in 2 patients, resection of segments 4, 5, 8 - in 3 patients, right hepatectomy in 2 patients, left hepatectomy in 1 patient, resection of segment 4A, 8 - in one patient. Reconstruction of right hepatic vein was performed in 6 patients (Gortex), middle hepatic vein in three patients (2 - gonadal vein, 1 - inferior mesenteric vein). RESULTS: Blood lost was estimated from 150 1700 ml. All patients had R0 radical resection There was no mortality. One patient had severe hepatic failure. Thrombosis of reconstructed of hepatic vein happened in one patient on 9(th) day post operation. CONCLUSION: Reconstruction of hepatic veins allow to safely perform radical parenchyma-preserving liver resection in patients with compromised liver function due to liver cirrhosis, fibrosis or steatosis.

[Liver resection in patient with hcc and right atrium thrombosis].

Presented herein is a case report concerning tumorous thrombosis of the inferior vena cava and right atrium, which is rather an uncommon but severe complication of primary hepatic cancer. The purpose of the article is to demonstrate successful surgical management of locally disseminated hepatic carcinoma complicated by tumorous thrombosis of the inferior vena cava and portal vein, as well as thrombosis of the right atrium. The patient was subjected to dextral hemihepatectomy with thrombectomy from the right portal vein, resection of the right cupola of the diaphragm, marginal resection of the lower lobe of the right lung, thrombectomy from the inferior vena cava and right atrium. The outcome of our case report, as well as literature data suggest that in case of resectability of hepatic tumour complicated by thrombosis of major vessels and even the heart, surgical intervention is justified if there is a possibility to completely remove thrombotic masses along with the primary tumour.

[Robotic-assisted abdominal surgery].

Since March 2009 10 operations were performed using the DaVinci robotic complex. Five liver resections were performed for nonparasitic hepatic cyst or fibronodular hyperplasia, one case of splenectomy - for nonparasitic spleen cyst abscess, distal pancreatic resection - for cystocarcinoma of the pancreas, adrenalectomy, gastric fundal resection - for gastrointestinal stromal tumor and one case of left hemicolectomy - for adenocarcinoma of the descending colon. The first robotic-assisted operations proved the need for exact preoperative localization of the operative area. It provides adequate disposition of the instruments and devices of the operative complex. The use of the robotic complex provides a precisional surgical technique, excludes physiological hand tremor and allows a minor traumaticity of the operation. The successful use of the DaVinci complex requires, though, certain skills of handling the instruments, using the robotic console.

[Enlarged sinistral hemihepatectomy and prosthetic repair of the inferior vena cava in locally disseminated hepatic alveococcosis].

High risk of surgical management for disseminated forms of alveococcosis appears to be associated with invasive growth of the parasite and the related necessity to perform vast resections of the liver and adjacent organs, as well as resections and prosthetic repair of the major vessels. The only alternative method of treatment could be liver transplantation. The purpose of this study was to demonstrate successful prosthetic reconstruction with the an allograft of the hepatic segment of the inferior vena cava in the course of enlarged hemihepatectomy for locally disseminated hepatic alveococcosis with the involvement of the inferior vena cava. The "Goretex" prosthesis was used as an allograft. The immediate postoperative period was accompanied and followed by mild-degree postresection liver insufficiency. During 6 months of dynamic follow up, the prosthesis was patent, with no relapses of the disease on the background of antiparasitic chemotherapy being noted. The use of allografts in vascular prosthetic repair in hepatic alveococcosis appears justified, requiring, however, further investigation.

[Hilar glissonean access to vascular-secretory elements in anatomical segmental liver resections].

It still remains unclear which patients with hepatic tumors can favour anatomical segmental liver resections instead of major liver resection. Short term results of anatomical segmental liver resection are evaluated and analyzed. Ten patients underwent the anatomical segmental liver resection performed by posterior approach with taping of anterior right hepatic vein. Seven patients had liver metastases of colorectal cancer, one had primary hepatic carcinoma and two had benign lesions, anatomical segmental liver resection were performed without Pringle maneuver. There was no significant difference in blood loss, duration of the procedure, postoperative hospital stay and morbidity in comparison with the segmental liver resection performed by anterior approach. Multiple, large and deep-embedded lesions were removed completely, with tumor-free resection margins. Anatomical segmental liver resection performed by hilar glissonean approach is recommended in patients with compromised liver function "unfavourable" liver anatomy to replace major liver resection provides removal of only affected part of the liver accordingly to its true anatomical borders.

[Diagnosis and treatment in polypous lesions of the gallbladder]. / Diagnostika i lechenie pri polipovidnykh obrazovaniiakh zhelchnogo puzyria.

Experience in observation and treatment of 193 patients with polypous lesions of the gallbladder (PLGB) was analyzed. The patients were divided into 2 groups: group 1 consisted of 102 operated patients including ones with polypous cholesterosis (59), hyperplastic polyps (21), adenomatous polyps (19), polyform cancer (3). Group 2 consisted of 91 non-operated patients. The structure of the disease was studied. Clinical and morphological classification of PLGB, indications for surgery and follow-up were developed. Proposed algorithm of diagnostic and treatment policy permits to reduce surgical activity in PLGB by 68.6% without detriment for diagnosis and treatment of polyform cancer of the gallbladder.