[Mirizzi syndrome management (in Russian only)]. / Lechenie sindroma Mirizzi.

AIM: To assess an effectiveness of complex preoperative diagnosis, conservative treatment, minimally invasive biliary decompression for Mirizzi syndrome and to analyze surgical outcomes depending on the effectiveness of minimally invasive biliary decompression. MATERIAL AND METHODS: There were 67 patients with Mirizzi syndrome aged 27-96 years (mean age -64.8 years). The diagnosis was established on the basis of complaints, objective data, laboratory survey, abdominal X-ray, ultrasound (US), endoscopic gastroduodenoscopy (EGDS), computed tomography (CT) and magnetic resonance imaging (MRI). Extrahepatic bile duct visualization in case of suspected biliodigestive fistula was achieved by using of percutaneous transhepatic cholangiography, endoscopic retrograde cholangiopancreatography, cholecystocholangiography, intraoperative cholangiography. RESULTS: The analysis of the diagnosis and treatment of patients with Mirizzi syndrome and mechanical jaundice with and without symptoms of cholangitis was carried out. It should be noted that percutaneous transhepatic cholangiography and cholecystocholangiography with antegrade contrasting were able to confirm Mirizzi syndrome type 1 without complications. Retrograde cholangiopancreatography in patients with Mirizzi syndrome type 2 reduced the diagnostic value of contrast-enhancement with complications in every fifth patient. Percutaneous drainage for Mirizzi syndrome type 1 was effective in all patients. There was low effectiveness of medication for Mirizzi syndrome. Medication combined with antegrade biliary decompression was 7 times more effective than retrograde decompression. All patients underwent surgery. Mortality depended on surgical emergency and effectiveness of biliary decompression. So, emergency interventions were followed by mortality rate near 60% while there were no deaths after elective procedures. Overall mortality was 11.9%.

[Intussusception followed by intestinal obstruction in adults]. / Invaginatsionnaia kishechnaia neprokhodimost' u vzroslykh.

AIM: To evaluate the effectiveness of complex preoperative diagnostics and medication of intussusception followed by intestinal obstruction in adults with the choice of surgical repair and analysis of the outcomes depending on the causes of intussusception. MATERIAL AND METHODS: 15 intussusception patients aged 19 - 86 years were enrolled. Mean age was 52.7 years. Patients were hospitalized within 12 hours - 1-2 weeks after onset of the disease. Diagnosis was established on the basis of complaints, anamnesis, objective and additional survey. All patients underwent abdominal X-ray and ultrasound. Intestinal obstruction at admission was diagnosed in all patients, and only 1 (6.7%) of them had intussusception. RESULTS: Medication and additional survey contributed to detection of intussusception followed by intestinal obstruction in 13 (86.7%) out of 15 patients prior to surgery. All patients underwent urgent or delayed surgery. Small intestine resection was performed in 9 patients, 2 patients underwent resection of small intestine with submucosal tumor (1) and Meckel's diverticulum (1) after intussusception repair. Right-sided hemicolectomy was performed in 3 patients, sigmoid colon resection with lymph nodes dissection - in 1 patient. The cause of intussusception followed by intestinal obstruction were epithelial and stromal tumors (9), less often metastasis of melanoma (2), Meckel's diverticulum (1) and functional bowel disorders (1). Postoperative complications arose in high risk patients hospitalized after 24 hours from onset of the disease and present concomitant diseases and malignancies. 1 (6,7%) patient died.

[Diagnostics and surgical treatment of the tumor obturative intestinal obstruction].

The study summarize the results of diagnostics and treatment of 536 patients aged 37-97 years with colon cancer stage II-IV, complicated by bowel obstruction. Patients with subcompensated and decompensated bowel obstruction prevailed. The dependence of the clinical picture from the tumor localization and the severity of the obstruction were identified. The authors pose that the decision about the median laparotomy needs the preoperative diagnosis of the obturative obstruction without verification of its causes. Decision about the delayed radical operation and minimizing the treatment to colon decompression should be based on additional diagnostic data (X-ray, irrigoscopy and colonoscopy). Surgical interventions with the median laparotomy showed the mortality rate of 30.7% and morbidity of 57.5%. The miniinvasive decompression of the colon reduces these rates to 1.8 and 7.1%, respectively.

[Extended, combined, and concurrent surgery in patients with neoplastic obturation large bowel obstruction].

The study included 552 patients (mean age 68.9 +/- 1.0 years) with neoplastic obturation large bowel obstruction (NOLBO). They were allocated to 3 groups depending on the character of surgical intervention. Group 1 comprised 172 patients (31.2%) operated under endotracheal anesthesia (ETA) through a medial approach for the resection of the segmented intestine and its tumours with colostomy or ileostomy (n = 154) and primary interintestinal anastomoses (n = 18). Group 2 of 56 patients (10.1%) with neglected NOLBO in very severe condition underwent medial laparotomy under ETA with internal or external colonic decompression without tumour resection. Minimally invasive decompressive ileotsomy or colostomy depending on localization of the tumor was performed under local anesthesia after premedication in 324 (58.7%) patients of group 3. The grave clinical condition of the patients was due to polyorgan insufficiency (POI). Postoperative lethality in groups 1, 2, and 3 following surgery in the acute phase of NOLBO was 26.9, 39.3, and 1.8% respectively. The condition of patients of group 1 and 2 with indications for urgent extended, combined or concurrent surgery was too serious to allow for an adequate intervention; it was possible only in 7 (14.6%) of the 48 patients. Diminution of POI manifestations by restoration of segmented intestine patency by low-invasive intervention in patients of group 3 and their preoperative preparation by balanced diet during 3-4 weeks made possible extended combined surgery in all 50 patients of this group without a fatal outcome.

[Valvular pyloroplasty in the treatment of pyloroduodenal ulcers]. / Klapannaia piloroplastika v lechenii oslozhnennykh piloroduodenal'nykh iazv.

Original method of treatment of complicated pyloroduodenal ulcers is proposed. The results of different organ-saving operations in complicated pyloroduodenal ulcers were analyzed in 136 patients aged from 15 to 89 years. Evaluation of the results was based on the data obtained during study of secretory and motor-evacuatory function of the stomach, state of gastric and duodenal mucous membrane, degree of duodenogastric reflux. Gastroscopy in remote period after organ-saving operations enabled visual evaluation of state of anew formed pyloric canal. Results of treatment of complicated pyloroduodenal ulcers by different methods of pyloroplasty demonstrate the advantages of valvular pyloroplasty.