[Poorly differentiated stomach adenocarcinoma combined with jejunal stromal tumour. Clinical study].

Gastrointestinal stromal tumours (GIST) first described in 1983 are the commonest mesenchymal neoplsams of the digestive tract. The main pathogenetic mechanism is hypersecretion of tyrosin kinase receptor c-kit (CD-117) by GIST cells and its hyperactivation. A rare clinical case of GIST measuring 1.2 CM with concomitant stomach cancer (poorly differentiated carcinoma) is reported. The tumours were discovered intraoperatively. To our knowledge, data on such cases are practically lacking in the literature.

[Delayed results of proximal gastrectomy in patients with esophageal and gastric varices].

An original method of proximal gastrectomy was used to eliminate hemorrhage from gastric and oesophagal varicose veins in 27 patients with portal hypertension. The follow up period varied from 1 to 23 years. The risk of hemorrhage and the degree of vein dilatation were assessed by endoscopy and endoscopic ultrasonography. It is concluded that the method used in the study may be recommended as the first-line surgery for the management of hemorrhage from gastric and oesophagal varicose veins with good functional results in the late postoperative period and rare complications.

[Antireflux hepaticojejunostomy in treatment of cancer of the head of pancreas or extrahepatic bile-ducts].

193 patients with obstructive jaundice were operated on during the period of 1987-2007 yy. Antireflux hepaticojejunostomy was performed in all cases. 124 (64,2%) patients experienced the radical treatment and 69 (35,8%) - palliative. Valve hepaticojejunoanastomosis was performed when hepatic duct length was 12-15 mm; weather hepatic duct was shorter then 12 mm, the valve was performed in efferent jejunal loop. Preoperative bile ducts decompression allowed decrease risk of hepatic failure and shorten the hospital-stay time after the major operation.

[The function of gastric stump and duodenum after proximal gastric resection in patients with esophageal and gastric varicose veins dilatation].

The authors had developed the technique of proximal gastric resection with cardiac orifice plasty. 21 patients with esophageal and varicose veins dilatation were operated on using the technique. Follow-up period came from 2 to 23 years. Results of the operation allow proximal gastric resection with cardiac orifice plasty to be considered the effective way of prevention and treatment of gastric bleedings of portal hypertension aetiology.

[Surgical treatment of haemorrhoids].

The new improved modification of haemorrhoidectomy was warked out. The mucosa is dissected 0,5-0,7 sm above the node basis, it is separated sharply from the mucosa, whereupon the vascular pedicle is ligated. After cutting the haemorrhoid node off, a continuous submucosal suture is used to submerge the stump in the submucosal space. In comparison with the traditional technique, the method provides prophylaxis of bleedings and inflammatory complications; reduces the postoperative pain and dysuria. Submucosal haemorrhoidectomy facilitates the primary wound healing, early recovery of microcirculation, perceptibility and neuromuscular rectum coordination. Full recovery was achieved after 18,1+/-4,7 days after the operation.

[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.

[Optimization of prognosis and surgical prophylaxis of bleedings from esophageal varicose veins].

New methods of prediction of bleeding from the esophageal varicose veins improve treatment outcomes. These methods consist of endoscopic assessment of varicose vein and mucous membrane with determination of thickness of the vein wall and mucosa, and also assessment of reflux-esophagitis with endoscopic ultrasonography. Original operation of azigoportal disconnection was performed in 13 patients followed-up after surgery from 1 to 4 years. The results obtained demonstrate high efficacy of this surgery for prophylaxis of repeated bleedings from esophageal varicose veins.

[Prophylaxis and treatment of complications after resection of the stomach with Roux anastomosis]. / Profilaktika i lechenie oslozhnenii rezektsii zheludka s anastomozom po Ru.

One hundred and seventy-eight subtotal distal resections of the stomach with creation of the valve in an outflowing part of the small intestine were analyzed. There was no postoperative lethality due to the method of surgery. One (0.6%) patient died on day 18 after surgery for acute cardiac insufficiency. General surgery complications were seen in 3 (1.7%) cases. In 2 (1.1%) patients Roux syndrome developed, it was treated conservatively on day 12 - 18. Repair of tonisity, peristalsis of the gastric stump and diverting intestinal loop was registered late after surgery. Mild forms of damping-syndrome were diagnosed in 2.8% cases, superficial gastritis of the gastric stump -- in 33.3%, atrophic gastritis -- in 11.1%. The intestinal valve provided physiological evacuation and impeded reflux into the gastric stump.

[Prophylaxis and treatment of reflux cholangitis]. / Profilaktika i lechenie refluks-kholangita.

A method of creation of choledochojejunoanastomosis (CJA) was developed experimentally on 12 dogs. The method lies in creation of valvular CJA using walls of the common bile duct and submucosous-mucosous membrane of the small intestine mobilized by Roux. According to this method 103 patients with obstructive jaundice due to lesion of distal part of common bile duct were operated. Postoperative complications were seen in 6 (5.8%) patients, 3 (2.9%) patients died. In the period from 3 months to 10 years after operation 63 patients were examined, there were no cases of reflux-esophangitis.

[The surgical aspects of the treatment of stomach cancer]. / Khirurgicheskie aspekty lecheniia raka zheludka.

The authors made an analysis of surgical treatment of 348 patients with different localizations and morphological forms of gastric cancer. It was shown that the formation of areflux anastomoses allowed the frequency of postoperative complications to be reduced to 13.2% and lethality to 2.4%.

[Method of primary jejunogastroplasty after gastrectomy and subtotal resection of the distal stomach for cancer]. / Sposob pervichnoi eiunogastroplastiki posle gastrèktomii i subtotal'noi distal'noi rezektsii zheludka po povodu raka.

Post-gastrectomy and post-resection conditions are occurring more frequently due to the growing number of radical operations carried out for stomach cancer. The available procedures for restoring the natural continuity of the gastrointestinal tract are either too sophisticated or ineffective. A new technique of primary jejunogastroplasty following subtotal distal resection of the stomach is suggested. Application of newly-devised esophagoen-terostomy and enteroduodenostomy makes possible storage and passage of chyme into the duodenum and prevents refluxesophagitis and reflux-jejunitis from developing. A 3 month-3 year follow-up of 35 surgical patients showed that a number of grave post-gastrectomy complications could be avoided if the procedure had been used.