Comparison of the clinical effectiveness of hepaticojejunostomy and self-expanding metal stents for bypassing the bile ducts in patients with unresectable pancreatic head cancer complicated by obstructive jaundice.

OBJECTIVE: Aim: To improve treatment outcomes of patients with unresectable pancreatic head cancer complicated by obstructive jaundice by improving the tactics and techniques of surgical interventions. PATIENTS AND METHODS: Materials and Methods: Depending on the treatment tactics, patients were randomised to the main group (53 people) or the comparison group (54 people). The results of correction of obstructive jaundice by Roux-en-Y end to side hepaticojejunostomy (main group) and common bile duct prosthetics with self-expanding metal stents (comparison group) were compared. RESULTS: Results: The use of self-expanding metal stents for internal drainage of the biliary system compared to hepaticojejunostomy operations reduced the incidence of postoperative complications by 29.9% (χ2=13.7, 95% CI 14.38-44.08, p=0.0002) and mortality by 7.5% (χ2=4.16, 95% CI -0.05-17.79, p=0.04). Within 8-10 months after biliary stenting, 11.1% (6/54) of patients developed recurrent jaundice and cholangitis, and another 7.4% (4/54) of patients developed duodenal stenosis with a tumour. These complications led to repeated hospitalisation and biliary restentation in 4 (7.4%) cases, and duodenal stenting by self-expanding metal stents in 4 (7.4%) patients. CONCLUSION: Conclusions: The choice of biliodigestive shunting method should be selected depending on the expected survival time of patients. If the prognosis of survival is up to 8 months, it is advisable to perform prosthetics of the common bile duct with self-expanding metal stents, if more than 8 months, it is advisable to perform hepaticojejunal anastomosis with prophylactic gastrojejunal anastomosis.

THE IMPORTANCE OF THE PROGNOSTIC SCORE FOR THE CHOICE OF CHIVA HEMODYNAMIC SURGERY AS A TREATMENT METHOD FOR VARICOSE VEINS OF THE LOWER EXTREMITIES.

OBJECTIVE: The aim: To work out the predictive system that can help to determine the group of patients to whom the hemodynamic surgery of varicose disease, CHIVA, is beneficial. PATIENTS AND METHODS: Materials and methods: Results of examination and treatment of 58 patients of the main group who underwent hemodynamic surgery and 65 patients of the comparison group who underwent stripping. Patients of both groups were evaluated in the preoperative period using an evaluation scale, and divided into three subgroups depending on the scores: 5- 8, 9 - 11, and 12 - 15 points. RESULTS: Results: The best treatment results with the lowest number of relapses were obtained in the subgroup of patients with low scores on the prognostic scale (5-8 points) after hemodynamic treatment and in the subgroup of patients with a high the number of points (12 -15 points) after the classic stripping (p < 0.05). The same subgroups received more improvement in the quality of life of patients according to CIVIQ 20 (p < 0.001). The subgroup of patients with a high number of points (12 -15 points) after the stripping received significantly more reduction in scores VCSS (p < 0,01). CONCLUSION: Conclusions: Comprehensive assessment of factors such as the anamnestic duration of the disease, the diameter of the great saphenous vein, the presence of skin complications, dilated varicose collaterals and previous surgical treatment using a prognostic preoperative assessment score allows the surgeon to be more clearly guided in choosing the optimal method of treatment for each patient and achieve the best treatment results.

PALLIATIVE SURGICAL TREATMENT OF PATIENTS WITH UNRESECTABLE CANCER OF THE HEAD OF THE PANCREAS COMPLICATED BY MECHANICAL JAUNDICE.

OBJECTIVE: The aim: To improve the results of palliative surgical treatment of patients with unresectable cancer of the head of the pancreas, complicated by obstructive jaundice, disturbances of evacuation from the stomach, cancerous pancreatitis by improving surgical tactics and techniques of surgical interventions.. PATIENTS AND METHODS: Materials and methods: There were 277 patients with unresectable cancer of the head of the pancreas participated in the study, who were divided into control (n=159) and main (n=118) groups depending on treatment tactics. RESULTS: . Results: The operation of choice in the surgical treatment of patients with unresectable cancer of the head of the pancreas, complicated by obturation of the biliary system and duodenum with a high surgical risk is endoscopic stenting of the bile ducts and duodenum with nitinol stents, which is accompanied by a decrease in the frequency of postoperative complications from 72.7 to 29.6% (χ2=5.8, 95% CI 8.26-65.39, p=0.01), mortality from 36.4% to 0.0% (χ2=10.69, 95% CI 11.8- 64.65, p=0.001). The patient's formation of biliodigestive and prophylactic gastrodigestive anastomosis is an effective and safe procedure, which, in comparison with only biliodigestive shunting, reduces the frequency of postoperative complications by 16.2% (χ2=6.61, 95% CI 3.69-30.89, p=0.01), improves quality of life and prevents repeated surgical operations to restore evacuation from the stomach. CONCLUSION: Conclusions: The use of the proposed surgical tactics and technique of surgical interventions in patients with unresectable cancer of the head of the pancreas, complicated by obstructive jaundice, disturbances of evacuation from the stomach, cancerous pancreatitis made it possible to reduce the frequency of complications by 9.3% (χ2=3.94, 95% CI 0.09-17.86, p=0.04) and fatal cases by 5.8% (χ2=4.5, 95% CI 0.42-12.72, p=0.03).

WAYS TO IMPROVE THE RESULTS OF SURGICAL TREATMENT OF PATIENTS WITH ATYPICAL FORMS OF ACUTE APPENDICITIS.

OBJECTIVE: The aim: To search for new and improvement of known methods of diagnosis and surgical treatment of atypical forms of acute appendicitis. PATIENTS AND METHODS: Materials and methods: There were analyzed the results of diagnosis and surgical treatment of 852 patients with atypical course of acute appendicitis, which amounted to 25.3% of the total number of patients in this category. Depending on the chosen diagnostic and treatment tactics, patients with acute atypical appendicitis were divided into two groups: control (n=423) and main (n=429). RESULTS: Results: It was found that among atypical forms of acute appendicitis retrocecal location of the appendix is 61.2% of cases, pelvic - 24.3%, medial - 11.2%, subhepatic - 3.4%. Destructive forms of atypical acute appendicitis occurred in a total of 92.5% of cases, 77.7% of patients had various types of peritonitis. CONCLUSION: Conclusions: Authors improved and tested a number of diagnostic (rectal thermometry, ethanol test) and operative methods for destructive forms of acute appendicitis complicated by typhoid (including laparoscopic). The proposed diagnostic and treatment algorithm allowed to optimize the treatment tactics of this category of patients and reduce the incidence of complications in the early postoperative period from 9.9% to 3.5% (p<0.001).

INTRABDOMINAL PRESSURE AND ITS CORRECTION IN ACUTE SURGICAL PATHOLOGY.

OBJECTIVE: The aim: Improving the results of treatment of patients with acute surgical pathology of the abdominal cavity by correcting intra-abdominal hypertension (IAH). PATIENTS AND METHODS: Materials and methods: The results of examination and treatment of 187 patients with acute surgical pathology, which was accompanied by elevation of IAP. To compare the results, depending on the chosen diagnostic and treatment tactics, patients were divided into two groups: comparison and main. The comparison group (85 people (45,5%) included patients who have been treated with traditional approaches in diagnosis and treatment according to existing treatment protocols. The main group (102 people (54,5%) included patients in whose treatment we additionally used our proposed step-by-step approach in the treatment of IAH. RESULTS: Results: Systemic complications occurred in 12 patients of the main group (11,8%) and in 46 patients of the comparison group (54,1%), while in the second group the frequency of systemic complications was significantly higher (χ2 = 38,6, CI 29,3-53,6, p <0,0001). 20 patients (10,7%) died (2 patients of the main group (1,96%) and 18 patients of the comparison group (21,2%) (χ2 = 17,85, CI 10,4-29,18, p <0,0001). CONCLUSION: Conclusions: Use in the complex treatment of patients with acute surgical pathology of the abdominal cavity, accompanied by IAH, the proposed step-by-step approach has improved treatment outcomes by reducing the incidence of systemic complications from 54,1% to 11,8%, total mortality from 21,2% to 1,96% and postoperative mortality - from 22,4% to 2,4%.