[Minimally invasive methods for treatment of cholelithiasis, complicated by choledocholithiasis]. / Maloinvazivnye metody lecheniia zhelchnokamennoi bolezni, oslozhnennoi zabolevaniem obshchego zhelchnogo protoka.

Disease of the common bile duct (choledochal duct) was revealed in 18 from 531 patients with bile tract lithiasis (3.4%), who underwent laparoscopic cholecystectomy and in 3 of 72 patients (5.4%), who underwent cholecystectomy through minilaparotomy approach. Stenosis of the large duodenal papilla was observed in 14 patients, choledocholithiasis in 9 patients. Endoscopic papillosphincterotomy (EPST) was performed in all cases. There were no complications. In 2 cases moderate amylasemia was detected. Laparoscopic cholecystectomy was performed 5 days after the procedure on the large duodenal papilla (5.1 days mean). Intervention with the use of mini-approach after EPST was carried out in patient with concrement of gall bladder duct stump, which was revealed 3 months after laparoscopic cholecystectomy. Mini-approach made it possible to perform reconstructive operations on bile ducts in combination with cholecystectomy in 3 patients. At present there are many tools which enable combined treatment of the bile tract lithiasis complicated by bile ducts pathology with low-invasive technique.

[Treatment and prevention of cicatricial strictures and fistulas of biliary ducts]. / Lechenie i profilaktika rubtsovykh striktur i svishchei zhelchnykh protokov.

The paper summarizes the experience gained by the Department for Surgery of the Liver, Biliary Ducts, and Pancreas, Surgery Research Center, in treating patients with corrosive strictures and fistulas of the biliary ducts since 1967. It considers the causes of this abnormality, the nature of corrective operations on the great biliary ducts, complications due to the type of a surgical intervention. Analyzing the reasons for poor postoperative outcomes provides the optimal time of carcass drainages, the optimal diameter of the biliodigestive anastomosis made to have good results. Emphasis is laid on the specific features of biliary surgery if there are profound inflammatory and infiltrative or scarry and commissural changes in the hepatoduodenal ligament to prevent possible damage to the great biliary ducts.

[Vertical gastroplasty as a treatment method in morbid obesity]. / Vertikal'naia gastroplastika kak metod lecheniia morbidnogo ozhireniia.

Since November 1992 in the RRCS. RAMS 38 patients aged 16-61 years (mean body mass 149.9 kg) for obesity of 3-4 grade underwent operation of vertical gastroplasty (VGP) by E. Mason's method. In 78.9% of patients uncomplicated course of early postoperative period was observed. One patient died due to thromboembolism of pulmonary artery. Two patients underwent regastroplasty due to tearing away of the staples of vertical mechanical suture and restoration of body mass (BM). Up to now stabilization of BM was detected in 19 patients. In this group mean values of surplus BM lowering made up 54.1% and maximal--60.1%. Positive influence of performed operations on the course of majority of the concomitant diseases in the absence of serious metabolic after-effects was observed. Initial results of operations seemed to be favourable, but for final conclusions about the effectiveness of VGP in far off period the accumulation of the experience and prolongation of follow-up period together with standardization of operation procedure are necessary.

Vertical banded gastroplasty: first experience in Russia.

BACKGROUND: The first experience of vertical banded gastroplasty (VBG) in the Russian National Research Center of Surgery is presented. METHODS: From November 1992 to October 1996, 24 morbidly obese patients (mean body weight 147.7 kg, BMI 52.1 kg/m2) underwent VBG according to Mason. RESULTS: The early complication rate was 20.8%. The mean excess weight loss (EWL) after weight stabilization (first 12 patients) was 48.0% in the whole group and 53.9% (range 36.0-73.0%) in 10 patients without staple-line disruptions. Significant positive changes in obesity related diseases were noted. Nine of 23 patients presented with incisional hernias some months after operation. CONCLUSION: The impression of VBG is favorable; however, gaining further experience with the standard techniques and increasing the long-term results are necessary.

[Results of use of sandostatin in pancreatoduodenal resections]. / Rezul'taty ispol'zovaniia sandostatina pri pankreatodyodenal'nykh rezektsiiakh.

From February 1995 to July 1996 pancreato-duodenal resection has been performed in 12 patients in RCS (7 men and 5 women, mean age 53.6 years). The operation was indicated in malignant tumors of the pancreatic head, big duodenal papilla, distal part of common bile tract (9 patients); benign diseases of pancreas (3 patients). Sandostatin (0.3 mg/day for 4-7 days) was used in all cases to prevent postoperative pancreatitis and pancreato-jejuno-anastomosis incompetence. The levels of alphfa-amylase, blood glucose, leucocytes were monitored, as well as the duration of pancreato-jejuno-anastomosis drainage use, rate and seriousness of postoperative complications and duration of in-patient treatment. The results were compared to a control group, consisting of 6 men and 6 women (mean age 53.8 years) with malignant tumours of big duodenal papilla, head of the pancreas, common bile tract. The use of Sandostatin has decreased the level of alphfa-amylase in the first postoperative day to 292.8 +/- 152.2 u/l vs. 594.9 +/- 368.79 in a control group (p > 0.05), duration of the drainage use: 6.1 +/- 1.5 days vs. 12.9 +/- 7.2 days (p < 0.05). The number and rate of severity of postoperative complications were significantly less: 58.3% vs. 100%. The frequency of pancreato-jejuno-anastomosis incompetence has decreased 3 times; the rate of abdominal cavity abscesses has decreased by 30%, the number of bile tract complications has decreased too (1 vs. 2). The rates of postoperative mortality were 8.3% in both groups. The use of Sandostatin made it possible to decrease the frequency and severity of postoperative complications and decrease the duration of in-patient treatment.

[Congenital cystic diseases of liver and extrahepatic bile ducts]. / Vrozhdennye kistoznye porazheniia pecheni i vnepechenochnykh zhelchnykh protokov.

The paper presents 30-year experience in treating 158 patients with congenital cystic diseases of the liver and bile ducts. Depending on the pattern of hepatobiliary lesions, the diagnostic value of techniques, such as ultrasound, computerized tomography, scintigraphy of the liver duodenoscopy with THCG was defined. Analyzing the late outcomes provided recommendations for the most optimal surgical management: cystic fenestration and tunneling in hepatic polycystosis, pericystectomy in solitary cysts of the liver, different varieties of bile draining operations in choledochal cysts and Caroli's disease.

[Low-invasive interventions in abdominal surgery]. / Maloinvazivnye vmeshatel'stva v abdominal'noí khirurgii.

Low-invasive interventions have now become the usual practice of a surgical unit. Nowadays operations on abdominal and small pelvic organs can be made by using the Russian equipment. In all, more than half the patients with cholelithiasis and its complications, chronic appendicitis, inguinal hernias were operated on by employing video endoscopic equipment (Endomedium, Kazan) and miniaccess-intervention instruments (SAN, Yekaterinburg). The outcomes of surgical treatment are summarized in the paper. The benefits and drawbacks of low-invasive intervention procedures, the advantages of various operation in different groups of patients are dealt with. The feasibility of combined operations and treatment in patients with cholelithiasis is discussed.

[X-ray study of the stomach after vertical gastroplasty in the treatment of morbid obesity]. / Rentgenologicheskoe issledovanie zheludka posle vertikal'noi gastroplastiki pri lechenii morbidnogo ozhireniia.

The operation vertical gastroplasty is used to treat the so-called morbid obesity. It ends with the formation of a small stomach. Some experience gained with X-ray of the stomach is analyzed in 17 patients undergone vertical gastroplasty. X-ray evaluates the status of the small stomach arranged as a tube in the upper portions in the vicinity of the lesser curvature of the stomach. The shape, sizes, outlet of the small stomach, as well as emptying rates and the state of an internal vertical suture of the stomach are to be studied.

[First experience with vertical gastroplasty in the treatment of patients with 4th-degree obesity]. / Pervyi opyt vertikal'noi gastroplastiki v lechenii bol'nykh ozhireniem IV stepeni.

The article discusses four operations for vertical gastroplasty performed for the first time in Russia at the Research Centre of Surgery, RAMS, for degree IV obesity (the body weight of the patients ranged from 115 to 183 kg). The suturing instruments CEEA-28, TA-90, and CIA-90 manufactured by Auto Suture Instruments, USA, were used. Subsequent examination of patients in follow-up periods of as long as 4 months showed a favorable effect of the operations: body weight reduced, the patient's health and the course of concomitant diseases was milder.

[Initial experience with laparoscopic appendectomy]. / Pervyi opyt laparoskopicheskoi appendéktomii.

On the basis of analysis of their personal experience and the literature data, the authors claim that appendectomy under control of a laparoscope is an alternative to the traditional operation. Laparoscopic appendectomy was conducted in patients with acute and chronic appendicitis. The indication for appendectomy in chronic form of the disease is determined by the results of complete clinical examination and laparoscopic inspection of the region of the right iliac fossa, which is undertaken before each operative intervention. The authors performed laparoscopic appendectomy with the use of a monitor which made it possible for the operating team to watch the operation. The base of the process was ligated with an endoligature or compressed with clips, and then cutoff by means of high frequency current. The stump of the process was not buried in the cupula of the cecum. Laparoscopic appendectomy for chronic appendicitis was performed, as a rule, as a simultaneous intervention in laparoscopic cholecystectomy or operations undertaken for other diseases. The authors did not encounter in the postoperative period any complications associated with appendectomy. The postoperative period was somewhat easier than after the traditional intervention. The motor activity of the patients was completely restored as early as the second-third day. Experience shows competence of such operations.

[Diagnosis and treatment of neoplastic diseases of extrahepatic bile ducts and major duodenal papilla]. / Diagnostika i lechenie opukholevykh porazhenii vnepechenochnykh zhelchnykh protokov i bolshogo sosochka dvenadtsatiperstnoi kishki.

Fifty-three operations were conducted on 48 patients for tumors of the extrahepatic bile ducts and the major duodenal papilla. Early diagnosis of this pathological condition is very difficult, which affects directly the results of treatment; 18% of patients underwent radical operations. Modern diagnostic methods--computer tomography, ultrasonic examination, and endoscopic retrograde pancreatocholangiography made it possible to detect neoplastic diseases in all of the examined patients. Radical surgical treatment is expedient in distal localization of the neoplastic process and in the absence of metastases. Endoscopic and puncture methods of decompression of the bile ducts are indicated in diffuse forms of the disease.

[Laparoscopic cholecystectomy]. / Laparoskopicheskaia kholetsistéctomiia.

The techniques of laparoscopic cholecystectomy is described. The operation was carried out on 37 patients with various diseases of the gallbladder. The indications and contraindications for this operation are discussed. The authors did not encounter serious postoperative complications. Infiltration developed in the region of the umbilical incision in one case. All patients were discharged from the clinic on the 2nd to 11th day. The authors believe expedient the organization of special centers for training in laparoscopic cholecystectomy.

[Benign cystic tumors of the pancreas]. / Dobrokachestvennye kistoznye opukholi podzheludochnoi zhelezy.

Benign pancreatic cystic tumors (BPCT) is a rare and little studied pathological condition. By the end of the eighties approximately 500 registered cases of BPCT were described in the world literature, which were those of different morphological variants of cystadenomas (CA). Many scientists note the high probability of malignant degeneration of some CA types. The diagnostic signs and surgical tactics in BPCT are treated ambiguously. The authors systematized the most characteristic signs of pancreatic CA and revealed the possibility of accurate preoperative recognition of these tumors. From rich clinical material (21 cases) the authors show that complications resulting from an erroneous choice of the operation are inevitable. Postoperative complications occurred in 8 patients. The late-term results of the operation were followed-up in 11 patients and were found to be good and satisfactory in complete removal of the tumor. According to foreign authors, cystic carcinomas of the pancreas account for 1-2% ot all primary carcinomas of the organ. Timely radical operation dictated by the specific features of pancreatic cystadenoma is one of the measures of carcinoma prevention.

[Long-term results in surgical treatment of chronic pancreatitis]. / Otdalënnye rezultaty khirurgicheskogo lecheniia khronicheskogo pancreatita.

The work analyses 141 patients who were operated on for primary chronic pancreatitis which was caused by alcohol abuse in 84.4% of cases. The patients were divided into 2 subgroups according to the damage to the pancreas: 1--with dilatation of the pancreatic duct (49.6%), 2--without dilatation of the pancreatic duct (50.4%). Internal drainage of the duct system and their associated cysts was the main method of management of patients of the first group (52 patients). Patients of the second group were subjected to various resections of the pancreas (24) and occlusion of the ducts with a polymeric composition (19). In 38 cases the operation on the pancreas was complemented by operations on the biliary tract, stomach, and duodenum. Various postoperative complications were encountered in 27 (19.1%) patients, mortality was 5.7%. The results were most favorable after operations for internal drainage, resection of the organ, and external drainage of the cysts. Irrespective of the type of the operation, progressive fibrous degenerative changes of the gland with a statistically significant (p < 0.05) reduction of its size was noted in the late-term period. The method of occlusion of the duct system was marked by the greatest number of poor results. Strict argumentation of the indications for the use of each type of operation makes it possible to obtain good and satisfactory late-term results in 85.6% of cases.

[Diagnosis and therapeutic tactics in polycystic liver]. / Diagnostika i lechebnaia taktika pri polikistoze pecheni.

The results of clinical observations of 60 patients with polycystosis of the liver who had been treated or examined by the authors in the period from 1964 to 1989 were summarized. The clinical course of the disease was featured by scanty clinical signs: pains in the upper half of the belly and hepatomegaly were most frequent. The combination of diagnostic techniques for verification of surgical intervention necessity was established. Besides, it was stated that the diagnosis of polycystosis of the liver should be complex and based on anamnestic data and the results of clinical, laboratory and instrumental investigations. Preference should be given to ultrasonography and computed tomography. Cysts with diameter of 5 cm and more, complicated polycystosis of the liver (bleeding, suppuration, malignancy) and cystic compression of the extrahepatic bile ducts and vessels (portal and cava inferior veins) were found to be indicative signs for surgical treatment of hepatic polycystosis. A total of 41 patients were subjected to surgical treatment with 49 operational procedures employed. Fenestration of hepatic cysts (42), that were organosparing operations, predominated. Resection of the liver was performed in 2 patients who had total cyst substitution for the whole of the left lobe. The improvement registered in 85.7% of operated on patients evidenced the favorable results of surgical treatment.

[The use of the contact periodic-pulse laser and microwave scalpels in liver surgery]. / Primenenie kontaktnogo impul'sno-periodicheskogo lazernogo i mikrovolnovogo skal'pelei v khirurgii pecheni.

In use of the laser (CPPLS) and microwave (MWS) scalpels, the reliability of arrest of bleeding and bile leakage has been proved not only at studies on the intact liver but on the models of jaundice with impaired coagulative blood properties as well. After hepatic resection by means of CPPLS and MWS, the impairement in its functional state lasts for a short time. In use of CPPLS, disturbance in tissue blood flow is less than in use of MWS. Healing of the wounds inflicted by CPPLS and MWS occurs in absence of pronounced exudative and inflammatory reactions. In a wound inflicted by a laser scalpel, the necrotic layer is not pronounced. It is expedient to use the CPPLS and MWS in patients with hepatic masses in technically difficult cholecystectomy as they contribute to decrease in intraoperative blood loss and prevention of the development of complications after the operation.