[Combination of endoscopic methods in diagnostics and surgical treatment of perforative duodenal ulcer].

AIM: To present the results of perforative duodenal ulcer surgical management using combination of endoscopic methods. MATERIAL AND METHODS: The study included 279 patients with perforative duodenal ulcer who were operated for the period from 1996 to 2012. Diagnostics and medical tactics were based on developed in our clinic algorithm that includes use of both esophagogastroduodenoscopy and laparoscopy. CONCLUSION: Presented technique confirmed correct diagnosis, defined medical tactics and choice of surgery in 100% of cases. 67 patients had contraindications for laparoscopic suturing and underwent conventional operations. Herewith postoperative complications and death were observed in 25 (37.3%) and 9 (13.4%) patients respectively. Laparoscopic suturing was performed in 212 patients. Complications were diagnosed in 19 (8.9%) cases including 8 (3.7%) intraoperative and 11 (5.2%) postoperative. Deaths were absent.

[Laparoscopic diagnosis and treatment of acute early adhesive intestinal obstruction].

AIM: To estimate the role of emergency laparoscopic interventions in diagnosis and treatment of acute early adhesive intestinal obstruction. MATERIAL AND METHODS: It is presented the results of diagnostic and curative laparoscopic interventions in 58 patients with suspected acute early adhesive intestinal obstruction after abdominal surgery. Complex clinical-instrumental, non-invasive diagnosis does not always reveal this complication in early postoperative period. Diagnostic laparoscopy was the most informative method to assess state of abdominal cavity, to establish and characterize acute early adhesive intestinal obstruction, to determine following treatment and choice of surgery in all patients. RESULTS: Diagnosis of intestinal obstruction was not confirmed in 15 (25.9%) patients based laparoscopic checkup. Acute early adhesive intestinal obstruction was established in 43 (74.1%) patients. Small intestine injuries were observed in 2 (4.5%) cases during laparoscopy. Contraindications to laparoscopic treatment of obstruction were determined in 18 (41.9%) patients in whom conventional operations were performed with complications and death in 7 (38.8%) and 3 (16.6%) cases respectively. Curative laparoscopy was applied in 23 (53.4%) patients with successful resolving of intestinal obstruction and complications in 19 (82.7%) and 4 (17.4%) cases respectively.

[Laparoscopic diagnosis and treatment of early adhesive small bowel obstruction after gynecological surgery].

It is presented the results of diagnostic and curative laparoscopic interventions in 33 patients with acute early adhesive small bowel obstruction. Ileus developed after surgical treatment (laparotomy) of different gynecological diseases. Laparoscopy appeared as the most informative diagnostic method to confirm diagnosis in all patients, to estimate state of abdominal cavity and small pelvis organs what can help to determine method of surgical treatment. Contraindications for laparoscopic surgery were identified in 12 (36.4%) patients and conversion to laparotomy was applied in this group. Postoperative complications were diagnosed in 1 (8.3%) patient. 2 (16.6%) patients died. Early adhesive ileus was resolved laparoscopically in 21 (63.6%) of 33 patients. Recurrent acute early adhesive ileus was detected in 1 (4.7%) patient.

[Torsion and necrosis of epiploic appendices of the large bowel].

The features of the clinical symptoms was studied, the possibility of laparoscopy in modern diagnosis and treatment of epiploic appendices torsion and necrosis of the large bowel was assessed in the article. It was done the retrospective analysis of the medical records of 87 patients with a diagnosis of epiploic appendices torsion and necrosis of the large bowel. The patients had laparoscopic operations in our hospital in the period from January 1995 to December 2012. The clinical picture, laboratory and instrumental datas in cases of epiploic appendices torsion and necrosis were scarce and nonspecific. An abdominal pain preferentially localized in the lower divisions was the main symptom (97.7%). The instrumental methods did not allow to diagnose the torsion and necrosis of epiploic appendices in the majority of cases and all these techniques were used for the differential diagnosis with other diseases. The assumption of the presence of appendices torsion and necrosis occured just in 34.5% of cases before the operation. Diagnosis of epiploic appendices torsion and necrosis present significant difficulties on prehospital and preoperative stages. The diagnostic laparoscopy is the method of choice in unclear situations and it allows to diagnose the torsion and necrosis of epiploic appendices in 96.6% of cases. Successful surgical treatment by using laparoscopic approach is possible in 90.8% of cases.

[Laparoscopy as a method of final diagnosis of acute adhesive small bowel obstruction in a previously unoperated patients].

The article presents the use of laparoscopic interventions in 38 patients with Acute Adhesive Small Bowel Obstruction (AASBO) in patients without previous history of abdominal surgery. Clinical, radiological and ultrasound patterns of disease are analyzed. The use of laparoscopy has proved itself the most effective and relatively safe diagnostic procedure. In 14 (36.8%) patients convertion to laparotomy was made due to contraindications for laparoscopy. In 24 (63.2%) patients laparosopic adhesyolisis was performed and AASBO subsequently treated with complications rate of 4.2%.

[The use of endoscopic techniques in acute strangulated adhesive small bowel obstruction, proceeded under the guise of acute pancreatitis].

We report an unusual case of AASBO presenting like postcholecystectomy syndrome and acute pancreatitis. Diagnostic and therapeutic scope of laparoscopic interventions and endoscopic nasointestinal decompression in AASBO management is demonstrated.

[Video-laparoscopic interventions in diagnostics and treatment of torsion and necrosis of appendices epiploica].

A retrospective analysis of treatment of 82 patients with torsion and necrosis of appendices epiploica was made. The video-laparoscopic surgery of these patients was performed. When the diagnosis is unclear, the differential diagnostics should be made between the appendices epiploica disease and other abdominal diseases using the video-laparoscopy. This method allowed the establishment of the correct diagnosis of torsion and necrosis of appendices epiploica in 95.1% of patients. The laparoscopic treatment was made in 87.8% of cases with minimal quantity of postoperative complications. The video-laparoscopy allowed the detection of accompanying pathology of abdominal organs and performance of the correction by low-invasive method. The need of conversion occurred in 12.2% of patients. Postoperative period was characterized by uneventful recovery, minimal usage of analgesics and antibiotics, early stages of rehabilitation, perfect cosmetic effect in majority of patients.

[Balloon-assisted enteroscopy in surgical practice].

The authors analyze their experience with video-capsular enteroscopy and balloon-assisted enteroscopy in 184 patients. High diagnostic significance of enteroscopy and the possibility to perform minimally invasive operations are shown.

[The experience of modern methods of enteroscopy in the diagnosis of Crohn's disease].

UNLABELLED: The aim of the study is to evaluate the possibilities of videocapsule endoscopy (VCE), single and double balloon enteroscopy in diagnosis of small bowel Crohn's disease. MATERIAL AND METHODS: From V.2003 to IV.2011 we observed 52 pts. with suspected small bowel Crohn's disease; 8 (15.4%) of them were operated urgently because of complications. Another 44 pts (m-23, f-21, ranged from 15-72 years, mean age 37.5 +/- 12.0 years) underwent complex examination including 19 VCE and 49 BAE in 32 pts.(incl. 7 after VCE). RESULTS: Typical Crohn's disease appearance was found in 15 (34.1%) pts (incl. 4pts after VCE) from 44 who were examined endoscopically. In 8 pts we've revealed stenosis, in 4 of them we've passed through the ileocecal valve stenosis by bouginage with the enteroscope and were able to examine superior area. After performing target biopsy from the small bowel mucosal lesions Pirogov - Langhans cells were found in 5 (33.3%) pts. We haven't found any signs of Crohn's disease in 17 pts. (no abnormalities found-6, enteritis-9, celiac disease-1, NSAID-ulcers-1). Conservative treatment has been applied in 10 (66.7%) pts., surgical intervention - in 5 (33.3%) pts. There was a capsule retention in 2 (10.5%) pts. There were no any complications in BAE. CONCLUSION; The use of the new enteroscopic techniques substantially improves the diagnosis of small bowel

[Possibility of modern methods of enteroscopy in diagnosing and treating of small intestine diseases].

The novel techniques of enteroscopy provide stable access into difficult for accessing parts of the small intestine, guarantee high quality diagnostics and topmost the possibility for getting biopsy and to treat small bowel diseases. The paper discusses the benefits and possibilities of video capsule and balloon-assisted enteroscopy: the main directions of usage, indications and contraindications, methodological aspects of jejunoileo- and colonoileoscopy. We presented our own experience in video capsule endoscopy and single balloon enteroscopy (128 procedures in 92 patients) in diagnostics and treatment of small bowel diseases.

[Enteroscopy in the diagnostics of the jejunum and ileum tumors].

Small bowel tumors are very uncommon and account for 3% to 6% of all gastrointestinal neoplasms. Practical application of videocapsule endoscopy and balloon-assisted enteroscopy have allowed to investigate and reveal neoplasmatic leasions in deep parts of gastrointestinal tract which earlier were hard to access. The modern techniques allow to evaluate the macroscopic picture of tumors more clearly, to determine its nature and location, take biopsy sample, to prescribe reasonable chemotherapy, to remove a tumor endoscopically or define indications for a planned surgical intervention. This article presents a widely overview over epidemiology, classification, clinical aspects, methods and diagnostic possibilities of different diagnostic techniques of revealing small bowel tumors, and own results of diagnosis and treatment of patients (n = 48) with small bowel tumors (2003-2010).

[Endoscopic treatment of bleeding due to Mallory-Weiss syndrome]. / Endoskopicheskoe lechenie krovotechenii, obuslovlennykh sindromom Mellori-Veissa.

Experience in diagnosis and treatment of 276 patients with Mallory--Weiss syndrome (MWS) is presented. Definition of the syndrome and brief historical review (from first description of disruption of esophageal-gastric connection to first report of successful hemostasis through endoscope) are given. Particular attention is devoted to etiology and pathogenesis of this syndrome. Clinical material and picture of disease, results of endoscopic diagnosis are analyzed, efficacy of endoscopic hemostasis and prophylaxis of hemorrhage is demonstrated. Indications to various methods of endoscopic hemostasis are regarded, results of treatment and lethal outcomes are analyzed. It is demonstrated that endoscopic procedures are the method of choice in the treatment of this disease reducing emergency surgery rate to 0.4%.