[Laparoscopy in emergency surgery of rare atypical diseases]. / Videolaparoskopiya v ekstrennoi khirurgii redko vstrechayushchikhsya, atipichnykh zabolevanii.

OBJECTIVE: To analyze the capabilities of laparoscopy in the diagnosis and treatment of atypical diseases. MATERIAL AND METHODS: Laparoscopy was performed in 5188 patients with established, suspected and unclear diagnosis of acute surgical diseases for the period from 2008 to 2018. Rare atypical diseases were diagnosed in 114 (2.2%) patients. These diseases simulated established and suspected clinical diagnoses in 100 (87.7%) cases, and the diagnosis was unclear in 5 (4.4%) cases. In 9 (7.9%) patients, atypical diseases were concomitant. In 7 cases, atypical diseases competed with the underlying disease and required emergency surgery. Conservative treatment was required in 2 cases. Seventy (61.4%) patients with atypical diseases needed emergency surgery, and 44 (38.6%) patients required conservative treatment. Laparoscopic operations were performed in 61 (87.1%) patients including simultaneous procedures in 8 cases and video-assisted interventions in 2 (2.9%) patients. Laparotomy was applied in 7 (10.0%) patients. RESULTS: Histological examination confirmed laparoscopic diagnosis in 66 out of 68 specimens. Cells of mucus-forming adenocarcinoma were detected in one resected epiploic appendix, carcinomatosis - in one segment of resected omentum. CONCLUSION: Video-assisted laparoscopy was valuable to establish a diagnosis and determine surgical strategy, detect competing and concomitant diseases, perform operations including simultaneous procedures.

[Laparoscopy in emergency abdominal surgery]. / Videolaparoskopiya v ekstrennoi khirurgii organov bryushnoi polosti.

OBJECTIVE: To evaluate the possibilities of laparoscopy in the diagnosis and treatment of acute abdominal surgical diseases. MATERIAL AND METHODS: A retrospective analysis of laparoscopic procedures in 4655 patients with confirmed or suspected acute abdominal surgical diseases for the period 2008-2017 was performed. Laparoscopy was applied to confirm or to determine unclear diagnosis. RESULTS: Diagnosis was established and confirmed in 4526 (97.2%) patients. Advisability of laparoscopic surgery was confirmed in 3091 (68.3%) patients, laparotomy - in 491 (10.8%) patients. Surgical treatment was not required in 944 (20.9%) patients. Laparoscopic procedures were performed in 3050 (98.7%) patients, 41 (1.3%) patients required conversion to laparotomy. Laparoscopic approach failed to define diagnosis in 129 (2.8%) patients that required conversion to diagnostic laparotomy. CONCLUSION: Laparoscopic was valuable to establish the diagnosis and determine surgical strategy, diagnose concomitant diseases, perform operations including simultaneous ones.

[Laparoscopy for perforated gastroduodenal ulcers]. / Videolaparoskopiia pri perforativnykh gastroduodenal'nykh iazvakh.

AIM: To assess laparoscopy in diagnosis and treatment of patients with perforated gastroduodenal ulcers. MATERIAL AND METHODS: There were 273 patients with perforated gastroduodenal ulcers who underwent laparoscopy at the Sklifosovsky Research Institute for Emergency Care in 2010-2016. Sample included patients with clinical and instrumental diagnosis of perforated gastroduodenal ulcers, suspected hollow organ perforation including perforated ulcer and other acute abdominal diseases followed by perforated ulcer. RESULTS: Laparoscopy confirmed diagnosis of perforated gastroduodenal ulcer in 82.5% of patients with clear preoperative diagnosis and in 54.2% of patients with suspected perforated ulcer. Video-assisted closure of the ulcer is possible in 81.7% of patients. Any endoscopic procedure should be started from diagnostic measures. Diagnostic laparoscopy followed by curative laparotomy in 14.6% of patients was able to clarify diagnosis, suture technically difficult perforated ulcer and prevent possible complications.

[Videolaparoscopy in diagnosis and treatment of diseases simulating acute appendicitis]. / Vozmozhnosti videolaparoskopii v diagnostike i lechenii zabolevanii, simuliruiushchikh ostryi appenditsit.

AIM: To analyze videolaparoscopic diagnosis and treatment of abdominal pathology simulating acute appendicitis (AA). MATERIAL AND METHODS: For the period 2008-2015 at Sklifosovsky Research Institute of Emergency Care 2784 patients with suspected AA underwent clinical, laboratory and ultrasonic examination. Depending on survey results patients were divided into 2 groups. Group I included 1352 (48.6%) patients with AA, group II - 1432 (51.4%) patients with suspected AA. All of them underwent videolaparoscopy. RESULTS AND DISCUSSION: Videolaparoscopy confirmed AA in 1308 (96.7%) patients of group I and 856 (59,8%) patients of group II. In the 1st group 36 (2.7%) patients had pathology simulating AA and 8 (0.6%) patients had not organic changes; in the 2nd group these values were 462 (32.3%) and 114 (7.9%) respectively. Absence of organic changes was explained by functional bowel disorders. In 95 (3.4%) out of 498 (17.9%) patients of both groups with simulating diseases videolaparoscopy was made and in 49 (1.8%) cases indications for laparotomy were established. In 354 (12.7%) patients with simulating diseases and 122 (4.4%) patients without organic changes operations were not carried out. CONCLUSION: Videolaparoscopy in patients scheduled for appendectomy or with unclear clinical picture allows to diagnose various forms of AA, simulating diseases and to perform necessary surgery.

[Videolaparoscopic and morphological parallels in diagnosis of different forms of acute appendicitis].

AIM: To compare results of macroscopic assessment and materials of histological examination of 1635 appendices removed using videolaparoscopy in patients with acute appendicitis. All patients have been treated in N.V.Sklifosovsky Research Institute of Emergency Care for the period from 2002 to 2014. MATERIAL AND METHODS: Intraoperative macroscopic assessment of appendix's inflammatory changes was performed using some conventional signs. Сatarrhal, phlegmonous and gangrenous changes were suspected in 77 (4.7%), 1432 (87.5%) and 126 (7.7%) cases respectively. RESULTS: Histological examination revealed catarrhal, phlegmonous and gangrenous changes in 86 (5.3%), 1338 (81.8%) and 115 (7.0%) cases respectively. In 65 (4.0%) patients changes were estimated as chronic, 31 (1.9%) patients had not inflammation. Intraoperatively suspected diagnosis of different forms of appendicitis was confirmed by histological survey in 94.1%. Most cases of matched intraoperative and histological diagnosis were observed in case of phlegmonous appendicitis (88.2%). Only 5.9% of patients had not acute inflammation of appendix that may be explained by overdiagnosis and excess of indications for appendectomy.

[Mini-invasive technologies in treatment of acute cholecystitis in patients with high operational and anesthetic risk].

The treatment results of 769 patients with acute calculous cholecystitis and high operational and anesthetic risk at admission are presented in the retrospective study. High risk was determined by expressed comorbidities, diseases' terms, the complications of acute cholecystitis, age, which was more than 60 years in most cases. The patients were divided into 2 groups depending on the severity of comorbidity and the possible effects of its correction. The first group included 617 perspective patients for cholecystectomy. And the second group included 152 patients unpromising for this. Concept of stage treatment was used in the first group including primary decompression of the gallbladder by using of percutaneous transhepatic micro-cholecystostomy under ultrasound guidance. Cholecystectomy was performed after correction of comorbidities, complications of acute cholecystitis, and readjustment of extrahepatic bile ducts by endoscopy if necessary. Laparoscopic cholecystectomy was successfully performed in 587 patients. There was open cholecystectomy in 11 cases. Cholecystectomy was done in 19 patients as a result of conversion. Cholecystostomy from minimal access with extraction of stones under local anesthesia was performed in the second group for decompression and as definitive treatment. There was not observed deaths in patients with high operational and anesthetic risk as a result of such tactics. Postoperatively 1.7% of patients had complications that were successfully resolved.

[Hepato-bilio scintigraphy in the examination of patients with acute cholecystitis before laparoscopic cholecystectomy]. / Gepatobilistsintigrafiia v obsledovanii bol'nykh ostrym kholetsistitom pered laparoskopicheskoi kholetsistéktomiei.

The role of hepato-bilio scintigraphy in examination of 47 patients with acute cholecystitis was evaluated. Laparoscopic cholecystectomy was performed in all the patients. The existence of a functionally "dead" gallbladder in most cases presupposes the existence of marked inflammatory and infiltrative alterations of the neck of the gallbladder, a chronic decline of liver function in patients with calculous cholecystitis complicated with mechanical jaundice and pancreatitis. The effectiveness of hepato-bilio scintigraphy in detection of extra liver biliary tracts obstruction is proved. Hepato-bilio scintigraphy is a highly informative method of diagnosis in acute cholecystitis that makes it possible to evaluate functional status of the liver, gallbladder, cystic duct, extra liver biliary tracts.

[Acute phase response and plasma proteins in acute cholecystitis]. / Ostrofaznyi otvet i belki plasmy krovi pri ostrom kholetsistite.

Changes in the levels of plasma proteins albumin, transtiretine, transferrin, C-reactive protein, orosomucoid, and alpha 1-antitrypsin were followed up in patients with acute cholecystitis. Acute-phase response develops in acute cholecystitis; its development is most accurately characterized by the concentrations of C-reactive protein. The content of this protein together with the concentrations of transtiretine, orosomucoid, and alpha 1-antitrypsin can be regarded as an indicator of the severity of inflammation of the gallbladder and helps predict the disease course and define the terms of an intervention by the least invasive methods of treatment.

[Hepatobiliscintigraphy in the diagnosis of obstructive jaundice].

The authors show the role of hepatobiliscintigraphy (HBSG) in cholelithiasis as a screening technique in evaluating the patency of the common bile duct, which allows cholecystectomy to be performed if there are normal values, without resorting to additional studies. They have reprospectively analyzed the results of clinical and instrumental studies in 101 patients with cholelithiasis and obstructive jaundice of various etiology in whom the diagnosis was verified by endoscopic cholangiopancreatography (ERCPG). The sensitivity, specificity, and diagnostic efficiency of the scintigraphic technique were 96.5, 36.3, and 86.1%, respectively. It is recommended that invasive diagnostic techniques, such as ERCPG and other direst X-ray contrasting methods, should be used after having a positive result of two techniques: ultrasonography and HBSG (in the above order).