[Predictors of external pancreatic fistulae after pancreatic resection]. / Prediktory vozniknoveniya naruzhnykh pankreaticheskikh svishchei posle rezektsii podzheludochnoi zhelezy.

Despite a significant decrease in postoperative mortality after pancreatic resections in recent years (5.2-15% after pancreatoduodenectomy and about 5% after distal pancreatectomy), incidence of postoperative complications remains high (30-50% and 22-50%, respectively). Postoperative pancreatic fistula is one of the most common and formidable complications. Currently, most authors use the classification proposed by the International Study Group for Pancreatic Fistula (biochemical failure, fistula type B and C). Prediction of the risk of postoperative fistula is still a complex and unresolved problem of modern surgical pancreatology. According to the literature, the main risk factors of postoperative pancreatic fistulae are obesity and high body mass index, concomitant cardiovascular diseases, no neoadjuvant chemo- and radiotherapy, soft pancreatic texture, narrow pancreatic duct, no fibrotic changes in parenchyma, adipose infiltration of the pancreas, advanced intraoperative blood loss, as well as center experience. Most often, magnetic resonance imaging, computed tomography, ultrasound elastography and various multivariate risk assessment systems are used to estimate the risk of pancreatic fistulae. However, a generally accepted technique does not exist. This manuscript is devoted to analysis of risk factors of postoperative pancreatic fistulae and diagnostic methods for assessment of this risk.

[Short- and long-term outcomes of laparoscopic interventions in patients with colon cancer: single-centre experience]. / Neposredstvennye i otdalennye rezul'taty laparoskopicheskikh vmeshatel'stv u patsientov s rakom obodochnoi kishki: opyt odnogo tsentra.

OBJECTIVE: To compare short- and long-term outcomes of treatment in patients with colon cancer undergoing laparoscopic and open surgery. MATERIAL AND METHODS: There were 281 patients with colon cancer. All patients underwent open (n=144, 51.2%) or laparoscopic (n=137, 48.8%) procedures. Short- and long-term outcomes of treatment were compared in both groups. RESULTS: There were no significant differences in sex, age, body mass index, location of tumors and tumor differentiation grade in both groups. Conversion was required in 10 (7.2%) cases. The median of duration of surgery was greater for laparoscopic procedures (150 min vs. 130 min; p<0.001). Intraoperative blood loss was significantly less in laparoscopic surgery (100 ml vs. 300 ml; p=0.001). Postoperative mortality was similar (3.5% vs. 2.5%; p=0.5) while incidence of postoperative complications was significantly lower after laparoscopic interventions (13.1% vs. 22.2%; p=0.04). There was earlier recovery of the gastrointestinal tract after laparoscopic procedures (2.1±0.9 days vs. 3.6±1.5 days, respectively; p<0.001). The postoperative hospital-stay was significantly less in the 2nd group (p<0.001). Two-year disease -free and overall survival was similar in both groups. CONCLUSION: Laparoscopic interventions for colon cancer are followed by similar overall and disease-free 2-year survival and better early outcomes.

[Outcomes of cardiac achalasia grade II-III management]. / Sposoblecheniia akhalazii kardii II-III stadii.

AIM: To analyze early and remote results of the new method of cardiac achalasia grade II-III management. MATERIAL AND METHODS: Original surgical approach was applied in 21 patients with cardiac achalasia grade II-III. RESULTS: There were no any specific postoperative complications and deaths. Exacerbation of chronic pancreatitis, acute stomach ulcer and biliary peritonitis were observed in 3 cases respectively. All patients were followed-up within the period from 1.5 months to 5 years after surgery. Recurrent disease was absent. All employable patients have backed to work. CONCLUSION: According to clinical and instrumental data original surgical repair completely cures the symptoms of cardiac achalasia and restores normal esophageal dimensions and structure early after intervention.

[Redoudenization with the formation of antireflux anastomosis in the surgery for operated stomach diseases].

This paper reports the results of surgical treatment of 39 patients with diseases of operated stomach including 26 (66.7%) men and 13 (33.3%) women aged 31-70 (mean 48.2 +/- 13.1) years. Their comprehensive examination revealed restoration of gastric stump tone and peristalsis by the end of the 6th month after surgery. The newly formed invagination canal became functionally active and peristaltic, did not hinder the natural food passage and prevented retrograde food and bile flow from lower to upper segments of the gastrointestinal tract.

[Functional status of the bile excretion system and upper gastrointestinal tract in patients with duodenal ulcer].

The research of functional condition of biliary tract in 35 patients suffered from gastroduodenal ulcers compared with 30 almost healthy patients was conducted. Disorders of motor function were found out in 13.2% patients in control group. The motor-evacuative function of biliary tract conformed to average scores of healthy patients group in only 8.6% cases. The accelerated gallbladder empting (11.4%), the hypermotoric biliary dyskinesia with the absence of latent period of biliary excretion (17.1%), the hypomotoric dysfunction of biliary tract (34.3%) were found out in the rest cases. The separate group of patients were patients with distortion of biliary excretion that was consisted in periodic increase and decrease of gall bladder volume during the contraction. We concluded that motor-evacuative function of biliary tract doesn't depend on the type of pathological process in the stomach or duodenum but correlates with gastric evacuation contents, the rate of cholagogic meal advancement along the duodenum and acid-productive function of the stomach.

[Proctectomy and sphincterolevatoroplasty in cancer of the inferioampular part of rectum with involvement of the anal canal].

Proctectomy with total mesorectumectomy, resection of the interior sphincter, deep parts of the external sphincter and bringing down were fulfilled according to an original authors' method in 7 patients aged from 38 to 78 years for cancer of the inferioampular part of the rectum with tumor located within the limits 8-35 mm from the anus (T3N1MO (n=1), T3NOM1 (n=1), T4N2M1 (n=1). Six months after operation conscious urge to defecation 1-2 times a day and containment of stools were noted and a year later it was possible to ignore urges during 15-30 min. In 5 patients T3NOM0--T3N1M0 relapse-free period for 3-5 years was noted.

[Transabdominal ultrasonic scanning in evaluation of liver parenchyma: new opportunities].

On suspicion of the diffusive liver lesions 117 patients have been performed a transabdominal ultrasound investigation with a visual estimate of the echogenicity of the structure of the liver's parenchyma in comparison with the echogenicity of the cortical substance of the kidney and with the determination of the homogeneity of the liver's structure on its different areas. For the purpose of the elevation of the self-descriptiveness and precision of diagnostics as well as for the reduction of the subjective estimation the authors carried out the evaluation of the structure of the liver's parenchyma and the cortical substance of the kidneys using the histography on the marked area. The elaboration of the efficient quantitative assessment of the changes of the liver's parenchyma allowed to relieve complications in differential diagnostics and to estimate the damage level of the organ's parenchyma objectively during the investigation.

[Low anterior resection of the rectum: a new method of forming the reservoir].

A method of forming the rectum reservoir after low anterior resection of the rectum has been developed, consisting in low anterior resection with mesorectumectomy, forming a reservoir from the colon, forming a rectosigmoid passage. The operation was made in 37 patients aged from 47 to 69 years for rectum cancer with the tumor localized in the middle and low ampular part. Complications in the early postoperative period appeared in 16.2% of the patients. There were no lethal outcomes. Mean time of staying at hospital after operation was 11.4 +/- 2.1 days. In the period from 3 to 5 years after operation the indices of fecal continence in patients of the main group and group of comparison (patients operated without forming the reservoir) by Wexner score were close to normal, making 4.6 +/- 0.4 and 3.1 +/- 0.5 scores.

[Study of gastroduodenal complex wealthy with help of transabdominal ultrasonography].

In the present work we report the results of gastroduodenal complex transabdominal sonography in grayscale mode with Doppler techniques in 237 patients. Sonographic criteria for normal and abnormal intensity of contents outflow from stomach to duodenum were defined, that can be applied in diagnostic algorithm for proximal gastrointestinal tract functional disorders.

[Current technology of surgical treatment of II-III stage esophageal achalasia].

Original method of surgical treatment of patients with II-III stage esophageal achalasia -- total demuscularisation of affected esophageal part, selective proximal vagotomy, and formation of invaginated valve from autologous tissues -- is analysed. Overall 39 patients aged 23 to 62 years with II (6) and III (33) stage esophageal achalasia have been operated. There were no specific postoperative complications. Mean hospital stay was 6,5 +/- 1,2 days. Long-term results evaluated from 1.5 months to 5 years after surgery demonstrated good anatomic and functional results confirmed with special methods of examination and CIQLI scale of life quality.

[Reconstructive jejuno-gastroplasty in the treatment of operated stomach disease].

The results of treatment of 205 patients with operated stomach disease were analyzed. Conservative therapy was effective in 71.7% patients. Surgical treatment was used in 58 (28.3%) patients. Reoperation was performed less than a year after primary surgery in 5.2% patients, 1 to 3 years later -- in 41.4%, 3 to 5 years -- in 36.2%, more than 5 years later - in 17.2% patients. Early after operation complications were observed in 24.1% patients. Clinical and device examinations demonstrate that surgical reconstruction significantly reduces intensity of pathological symptoms in all the patients.

[Surgical treatment of stage IV cardial achalasia].

An original method of surgical treatment of patients with stage IV cardial achalasia was developed. Seven patients aged 42 to 59 years underwent surgery according this method. Objective methods of examination and life quality study with GIQLI carried out 3 months to 5 years after surgery demonstrate satisfactory anatomic and functional results.

[Correction of the motor-evacuation function of the postoperative stomach in the early postoperative period].

We conducted the analysis of the results of surgical treatment of 255 patients with duodenal ulcers. In the early postoperative period the evacuation and motility function of the postoperative stomach was corrected with the use of the autonomous electrostimulator of the gastrointestinal tract (EAS GT) in all patients - in the main group (n = 125) and drug stimulation (cerucal 2.0 intramuscularly twice a day) and in the control group (n = 130). The use of EAS GT-3 certainly reduces symptoms of dyscoordination of the motor function of the gastrointestinal tract.

[Choice of radical surgical method in patients with sutured perforated gastroduodenal ulcers].

Long-term results of suturing of perforated gastroduodenal ulcer in 364 patients were analyzed. Within 16 years after surgery recurrence of ulcer was seen in 215 (62.9%) patients. Radical elective surgeries were performed in 197 (54.1%) from 2 mos to 16 years after perforation of ulcer. Indications for radical surgery were determined on the basis of the disease duration, presence and nature of complications, level of acid-production, etc., and also data of endoscopic ultrasonography. In early postoperative period 1 (0.5%) patient died. Long-term results were followed from 2 mos to 11 years in 168 (85.3%) patients. Recovery of reservoir and motor-evacuation function of the operated stomach was demonstrated with special examinations. The mean gastrointestinal index (GIQLI) in long-term period was 124.6 after resection surgeries and 120 after organ-retaining surgeries.

[Method of treatment of reflux-esophagitis after gastrectomy].

A new method of treatment of reflux-esophagitis developed for patients after gastrectomy has a distinctive moment: the formation of a restraining mechanism in the field of esophago-gastric anastomosis, without opening the intestinal tube lumen. The carried on trials of clinical application of the method have shown its high effectiveness for prophylactics ofjejuno-esophageal reflux both in the early and distant terms after operation. The method of operating was given a patent of the Russian Federation.

[Restoration of nutritional status in patients with complicated course of ulcer during preoperative period]. / Vosstanovlenie pitatel'nogo statusa u patsientov s oslozhnennym techeniem iazvennoi bolezni v predoperatsionnom periode.

The comparative analysis of the efficiency of the enteral tube feeding and parenteral feeding in 52 patients with the subcompensated stenosis of the pylorus was carried out. Satisfactory results were received in all groups of patients taking enteral and parenteral feeding. Consequently, the differences in the parameters of the catabolic index and general protein in the patients taking balanced food mixes rich in calories and 'usual feeding' were statistically significant. Complications caused by enteral tube feeding were observed in 23.3%. None of the patients having such complications required food suspension. The frequency and significance of such complications were higher (54.5%) in the group of the patients taking parenteral feeding. This study has shown that the enteral tube feeding is just as efficient as the parenteral feeding. Besides, the enteral tube feeding is characterized by less significant side effects and is more cost-efficient.

[Surgical treatment of gastroesophageal reflux]. / Khirurgicheskoe lechenie refliuks-ezofagita.

One hundred and seventy-five patients with gastroesophageal reflux disease (GERD) were treated, 144 (82.2%) of them underwent surgery. In 106 (73.6%) patients laparotomy was used, in 38 (26.4%) -- laparoscopic surgeries. Transabdominal USE of the esophagus, stomach and duodenum, endoscopic ultrasonoraphy (EUS) of the esophagus were used for diagnosis of GERD in addition to standard tests. Based on EUS data, classification of severity of reflux-esophagitis was proposed. New method of laparoscopic creation of artificial lower esophageal sphincter (LES) with super thin (95, 45 mm) and super elastic filaments made of nikelid-titan alloy was developed in experiment and introduced into clinical practice. Thirty-four laparoscopic surgeries were performed, 26 (76.4%) of them -- with creation of artificial LES. In this group 94.4% of patients demonstrated excellent and good results in long-term period. Pressure in the area of LES in these patients increased by 70%, on the average, after surgery.

[Enteral tube feeding at the early postoperative period (stomach surgery)]. / Enteral'noe (zondovoe) pinanie v rannie sroki poslle operatsii na zheludke.

The article describes a comparative analysis of the efficacy of various variants of nutritive support in 115 patients with complicated gastroduodenal ulcers at the early postoperative period. 95 patients received enteral tube feeding, 50 of them receiving balanced isocaloric formulas and 45 of them receiving broths and decoctions as a nutritious substrate. The control group comprised 20 patients who received full parenteral feeding. The results were assessed on Day 5 after the beginning of feeding. Satisfactory results were received in all of the groups. The main advantages of balanced formulas are their easy dosage, smaller number of complications and lower price (as compared to parenteral feeding) as well as better (as compared to "ordinary" products) indexes of the nutritious status recovery.

[Contribution to the methods of formation of pancreatojejunal anastomosis during pancreatoduodenal resection]. / K metodike formirovaniia pankreatoeiunoanastomoza pri pankreatoduodenal'noi rezektsii.

A method preventing a contact of the intestinal content and bile with the wound surface of the stump and pancreatic juice in the pancreatic ducts was proposed in order to prevent reflux of the infected intestinal content in the ducts of the pancreas. The work was fulfilled in experiment and in clinic. The article is well illustrated and recommended for publication as having a scientific and practical value.