[Prophylaxis of injuries of biliary ducts in laparoscopic cholecystectomy: clinical recommendations of Ukrainian association of specialists for miniinvasive, endoscopic and laser technologies].

Wide introduction of laparoscopic cholecystectomy (LCHE) caused during last 20 years a significant enhancement of rate of the biliary ducts injuries (BDI). Taking into account the experience gained in performing of more than 40,000 operations of LCHE in a leading clinics, including such in a technically complex situations, as well as experience of more than 500 operations performance for BDI, clinical recommendations, based on principles of a substantiality medicine were elaborated. More than 100 sources of foreign and domestic literature were analyzed, summarizing the results of more than 150,000 operations of LCHE, special attention was drawn to the sources I (meta-analysis and prospective randomized investigations) and II (systematic reviews, thoroughly planned prospective comparative investigations) levels of substantiality. Every paragraph is accompanied by a certain level of a recommendation strength (RS, A-C). It is necessary to follow these recommendations strictly today.

[Laparoscopic therapy of organic hyperinsulinism].

The results of laparoscopic treatment were analyzed in 9 patients, suffering pancreatic insulinoma, in the clinic in 2008-2012 yrs. Tumoral enucleation was performed in 6 patients, distal pancreatic resection--in 3. In 1 (11.1%) patient postoperative external pancreatic fistula have developed. All the patients are alive. Laparoscopic treatment of the patients, suffering insulinoma is effective and secure.

[Peculiarities of diagnosis and surgical treatment of nonfunctioning neuroendocrine pancreatic tumors].

The results of diagnosis and treatment in 2004-2012 yrs period of 79 patients, suffering nonfunctioning neuroendocrine pancreatic tumors (NNPT), were analyzed. Effective diagnostic tactic while preoperative predilection on the NNPT presence for the diagnosis verification was proposed, permitting to determine the optimal method of surgical treatment, to introduce organpreserving and laparoscopic interventions, to widen indications for surgery for the NNPT extended forms.

[Combined injuries of bile ducts and hepatic artery branches in cholecystectomy].

Results of treatment of 25 patients with combined injuries of bile ducts and the common hepatic artery in performing cholecystectomy were studied. In 19 (73.1%) patients the injuries were noted during open and in 7 (26.9%) patients during laparoscopic cholecystectomy. The patients needed multimodal strategy of treatment with reference to the time when the diagnosis was made and to the characteristics of clinical course. Positive results of treatment were obtained in 84.6% of cases, lethality made up 3.9%.

[Combined injury of biliary ducts and vessels during cholecystectomy: peculiarities of clinical course and surgical tactics].

The results of treatment of 56 patients, in whom in 1984-2010 yrs, while performing cholecystectomy, a biliary duct injury have occurred, were analyzed, including 26 (main group)--with combined injury of biliary ducts and brunches of common hepatic artery, 30 (control group)--with isolated complete biliary ducts. High hepaticojejunostomy have constituted the main method of operation in a control group. In the main group in 2 patients there were attempts made to restore the arterial blood flow with subsequent performance of reconstructive intervention on biliary ducts. In 16 (61.5%) patients, due to adequate collateral blood supply presence, the bile outflow was restored using hepaticojejunostomy formation, and in 8 (30.8%)--hepatic resection of various volume was needed, because of hepatic abscesses formation. The results of treatment of patients in these groups have differed not essentially, while applying differentiated approach (positive results were achieved in 93.3 and 84.6% of patients, accordingly). So, in patients with combined injury of biliary ducts and branches of hepatic artery, while performance of cholecystectomy, it is necessary to apply multimodal tactics of treatment, taking into account the peculiarities of clinical course.

[Mini-invasive interventions for cystic formations of the spleen].

The data of complex clinical examination and surgical treatment of 89 patients, having splenic cysts (SC), are analyzed. Indications and contraindications for miniinvasive methods of treatment (laparoscopic and puncture-draining procedures under ultrasonographic control) application are substantiated, taking into account their size, localization, pathogenesis and presence of SC complications. Diagnostic efficacy of abdominal ultrasonography, computer tomography for SC was estimated, the significance of these methods, while choosing a rational tactics of treatment, was determined. There were elaborated and introduced into clinical practice the stages of endosurgical procedures, including performance of organpreserving operations for SC. Introduction of the elaborated diagnostic algorithm and tactics of treatment of SC have permitted to reduce postoperative complications rate and the patients stay in hospital, improving their quality of life as well.

[Peculiarities of postoperative complications in laparoscopic surgery].

Retrospective analysis of postoperative complications, occurred in patients, to whom laparoscopic interventions were performed in the Department of Laparoscopic Surgery and Cholelithiasis, was conducted. The rate of inflammatory and thromboembolic complications have constituted 2.2 and 0.1%, accordingly.

[Rational technique of pancreatoduodenal resection and transplantation technology use as the basis of favourable outcome].

Outcomes of pancreatoduodenectomies performed during the period from 1996 to 2008 in 110 patients with malignant diseases of pancreaticoduodenal zone and complicated forms of chronic pancreatitis with predominant changes of the pancreatic head were presented. Age of patients ranged from 17 to 73 years, on average (52.0 +/- 9.97) years. Primary aspects of pancreatoduodenal complex dissection and technique of reconstructive stage of the procedure are given. Use of transplantational technologies allowed significant decrease in complications total rate from 30.3 to 18.2%, and pancreatic anastomosis insufficiency one--from 24.2 to 5.2%. Total duration of the procedure decreased from (510.7 +/- 66.12) to (352.9 +/- 50.05) min, intraoperative blood loss--from (860.6 +/- 167.59) to (480.4 +/- 163.61) ml and postoperative hospital stay - from (30.12 +/- 24.32) to (18.2 +/- 9.98) days. After the operation all the patients are alive.