[Laparoscopic repair for perforated ulcer]. / Videolaparoskopicheskii sposob ushivaniya perforativnoi yazvy.

OBJECTIVE: To improve the immediate postoperative results in patients with perforated ulcers. MATERIAL AND METHODS: The study enrolled 25 patients with perforated peptic ulcer (diameter of perforation <8 mm). Mean age of patients was 39 years (range 24-56), perforation size - 5.92 mm (range 3-8). RESULTS: Mean surgery time was 59.8 min (range 50-85). There were no intraoperative and postoperative complications. All patients were discharged. CONCLUSION: The proposed method of repair for perforated gastric ulcers is simple, effective, safe and may be recommended for clinical practice.

[Pancreatic isthmus intersection with preliminary suturing of arteries in this area]. / Sposob peresecheniya peresheika podzheludochnoi zhelezy s predvaritel'nym proshivaniem arterial'nykh sosudov dannoi oblasti.

OBJECTIVE: To analyze the early results of pancreatoduodenectomies with different methods of pancreatic isthmus transection. MATERIAL AND METHODS: There were 82 pancreatoduodenectomies for cancer of pancreatic head or major duodenal papilla for the period 2010-2019. The control group comprised 38 patients with pancreatic isthmus transection and no preliminary suturing of local vessels. The study group consisted of 44 patients who underwent preliminary intersection of pancreatic isthmus vessels. Inclusion/exclusion criteria were used for grouping. We evaluated total intraoperative blood loss and blood loss following pancreatic isthmus transection, incidence and structure of postoperative complications. RESULTS: Total intraoperative blood loss was 755.12±108.61 vs. 698.45±92.87 ml, respectively (p>0.05). Intraoperative blood loss following pancreatic isthmus transection was 48.21±9.11 vs. 7.83±1.72 ml, respectively (p<0.01). Incidence of postoperative complications and redo surgeries was similar. Postoperative bleeding occurred in 5 (13.15%) patients of the 1st group (class A - 2.63%; B - 5.26%; C - 5.26%) and 2 (4.54%) patients of the 2nd group (A - 4.54%; B and C - 0%). There were no significant differences in the incidence of other complications and postoperative mortality. CONCLUSION: Pre-stitching of arterial vessels of the pancreatic isthmus reduces blood loss following intersection (p<0.01), as well as the incidence of postoperative bleeding class B and C (p<0.05).

[Modern aspects of the complex treatment of perforated gastric and duodenal ulcer]. / Sovremennye aspekty kompleksnogo lecheniya perforativnoi yazvy zheludka i dvenadtsatiperstnoi kishki.

OBJECTIVE: To study the effectiveness of pharmacotherapy for perforated gastric ulcer in a surgical hospital. MATERIAL AND METHODS: A retrospective analysis of the treatment of 693 patients with perforated gastric and duodenal ulcers was carried out. Laparoscopic and open surgeries were performed. Statistical analysis was performed using the Statistica and MS Excel software packages. Student t-test was applied for independent samples and Fisher's F-test was calculated. RESULTS: Combined therapy included surgical treatment (suturing of the ulcer as a rule) and medication with proton pump inhibitors, antibacterial drugs. Over the past 5 years, postoperative quality of life has been significantly improved in patients with perforated ulcers. Stomach resection and vagotomy for perforated ulcers will become historical in the near future. Laparoscopic and open procedures ensure similar periods of ulcer closure. CONCLUSION: Currently, successful treatment of perforated gastric and duodenal ulcers requires an integrated approach at all levels of specialized care and is impossible without modern pharmacotherapy.

[Surgical treatment of a patient with liver endometriosis]. / K voprosu ob endometrioze pecheni.

Endometriosis is a functioning endometrial tissue outside the inner layer of the uterine wall. Liver endometriosis is one of the rarest forms of atypical endometriosis. In this article, we report a patient with this disease. A 59-year-old patient complained of heaviness and periodic pain in the right hypochondrium for more than a year. Previous contrast-enhanced CT revealed signs of cystic-solid hypovascular mass lesion in the right liver lobe. Histological examination revealed no reliable signs of tumor growth. According to control CT after 8 months, no significant changes were observed. Surgical treatment was indicated and atypical liver resection was performed. Histological examination revealed cystic endometrioid lesion. Liver endometrioma is a rare disease with unclear pathogenesis. Diagnosis is difficult due to uncharacteristic clinical manifestations and no specific markers. Liver endometriosis should be considered in differential diagnosis of liver lesion. Surgical treatment is preferable due to the risk of malignant transformation.

[Technique of invaginative pancreatojejunostomy in pancreatectomy]. / Pogruzhnoi kisetnyi invaginatsionnyi anastomoz pri rezektsionnykh operatsiiakh na podzheludochnoi zheleze.

Pancreatoenterostomy is one of the key moments in pancreatic surgery. It was proposed invaginative pancreatojejunostomy in end-to-side fashion by using of two continuous single-row purse-string sutures. This technique may be used in pancreatoduodenectomy and Beger's procedure. This method will be useful in cases of edematous and erupting pancreatic parenchyma and hard-to-differentiate lumen of pancreatic duct. It is followed by reduced trauma of tissue and bleeding, allows to avoid sutures failure and to achieve sealed anastomosis.

[THE DIAGNOSTIC AND TREATMENT ALGORITHM FOR PATIENTS WITH OBSTRUCTIVE JAUNDICE SYNDROME].

The article presents a comparative analysis of therapeutic and diagnostic measures aimed at eliminating jaundice complicating diseases hepatopancreatoduodenal zone as tumor and benign etiology. Patients with obstructive cholestasis were represented by two groups: the main and control, including 858 and 869 patients, respectively. Therapeutic and diagnoctic tactics in the study group was based on the principles of the proposed algorithm. Using the proposed diagnostic and treatment algorithm led to better outcomes: significantly lower mortality and the incidence of postoperative complications

[Tetrahepaticojejunostomy for the treatment of the high biliary strictures].

The article highlights various techniques of biliodigestive anastomises, used for the treatment of high-level blockages of biliary ducts. The novel author method of tetrahepaticojejunostomy, possessing less insufficiency risk and less traumaticity was suggested. 38 patients have been operated on using the hepaticoenterostomy; 5 patients received the described method of tetrahepaticojejunostomy with positive outcome.

[Surgical strategy for juxtapapillary ulcers of the duodenum].

Results of surgical treatment of 89 patients with ulcer of the duodenum with postbulbar localization were studied. A classification of postbulbar ulcers was proposed taking into consideration the degree of involvement of bile-excreting pathways and major duodenal papilla into the periulcerous process. In extrapapillary ulcers without involvement of bile-excreting pathways in the cicatricial-ulcerous process resection of the stomach after Bilroth I is recommended with performing gastroduodenal anastomosis with a single layer suture. Resection of the stomach supplemented with biliodigestive anastomosis is recommended in cases with suprapapillary ulcers with the involvement of choledochus. Mechanical jaundice complicated by juxtapapillary ulcer can be cut off by endoscopic papillosphincterotomy. Fulfillment of pancreatoduodenal resection is possible in cases of deep injury of the pancreatic head.

[Analysis of classifications of chronic pancreatitis and criteria determining the strategy of surgical treatment].

The authors made an analysis of most widespread classifications of chronic pancreatitis and results of the retrospective distribution of 120 patients in them. A conclusion is made that the volume of surgical interventions in most cases is determined by morphological alterations in the pancreas. The most important of them are thought to be changed pancreas parenchyma (criterion "P"), large cavities (criterion "C") and dilatation of Wirsung's duct (criterion "H"). Such morphology is an indication for transferring the patient to the surgical department. The clinical picture and morphological analysis determine expediency of surgery. The method of surgical treatment depends on the localization and combination of morphological alterations.

[Surgical treatment of "difficult" duodenal ulcers]. / Khirurgicheskoe lechenie "trudnykh" iazv dvenadtsatiperstnoi kishki.

So-called "difficult" ulcers have a significant occurrence among complicated duodenal ulcers. Scar process and anatomic disturbances in the zone of duodenal bulb lead to technical difficulties during resection of the stomach with Gofmeister-Finsterer method. Eighty-nine resections of the stomach by Bilrot-I with creation of end-to-end one-row gastro-duodeno-anastomosis were performed under conditions of "difficult" duodenal ulcer with good early and long-term results.

[Diagnostic and prognostic significance of membranodestructive process in mechanic jaundice and phlegmonous cholecystitis in patients with diabetes mellitus]. / Diagnosticheskaia i prognosticheskaia znachimost' membranodestruktivnykh protsessov pri mekhanicheskoi zheltukhe i flegmanoznom kholetsistite u bol'nykh sakharnym diabetom.

Investigations performed in 96 patients with diabetes mellitus and acute biliary pathology (phlegmonous cholecystitis, mechanic jaundice) have found the relationships between plasma lypoperoxidation, degree of hepatodepression and kind of inflammation in the gall bladder. The level of glycemia and degree of transferasemia (cytolytic syndrome) are not reliable criteria of acute hepatic insufficiency and pyoinflammatory process in the biliary tracts. The choice of the complex of membrane-stabilizing drugs should be based on the severity and pattern of endotoxicosis.