[Surgical strategy for acute biliary pancreatitis]. / Khirurgicheskaia taktika v ostroi stadii biliarnogo pankreatita.

OBJECTIVE: To develop a rational surgical strategy for acute biliary pancreatitis and its complications. MATERIAL AND METHODS: A 10-year follow-up enrolled 378 patients with acute biliary pancreatitis. Mild pancreatitis was diagnosed in 304 (80%) patients, moderate and severe course - in 74 (20%). Almost all patients with mild acute biliary pancreatitis underwent surgery within 3-7 days after the attack resolution. Patients with severe biliary pancreatitis had general and local complications that required differentiated treatment strategy. CONCLUSION: Strangulation of the calculus in the major duodenal papilla requires emergency endoscopic papillosphincterotomy. Choledocholithiasis, cholangitis and obstructive jaundice in acute biliary pancreatitis are indications for endoscopic papillosphincterotomy. Cholecystectomy should be performed after resolution of inflammatory changes in the gallbladder and pancreas in patients with severe biliary pancreatitis.

[Pancreatic pseudocysts in recurrent pancreatitis: traditional and mini-invasive surgery/endotherapy. Problems in the treatment strategy choice].

Introduction of methods of miniinvasive surgery/endotherapy have permitted to widen essentially the possibilities of treatment of complicated recurrent pancreatitis. Miniinvasive interventions on pancreatic gland and neighbor organs, as well as laparotomic interventions, must be regarded not as an alternative, but like interchangeable methods, permitting to improve significantly the treatment outcome in an acute destructive and chronic pancreatitis, including those, which is complicated by a pancreatic pseudocysts formation.

[Recurrent pancreatitis as a surgical problem]. / Retsidiviruiushchii pankreatit kak khirurgicheskaia problema.

Experience in the treatment of 1498 patients with alcoholic pancreatitis treated with laparotomic and mini-invasive surgeries both in acute and chronic phases of the disease is presented. In 742 patients surgical treatment was multistaged. Re-operations in 17 patients with "chronic purulent pancreatitis", reconstructive surgeries on the pancreas, pancreatic and bile ducts in 84 patients with "head" pancreatitis were most difficult. Percutaneous puncture-catheter procedures for liquid formations in acute phase of pancreatitis were effective as the first stage of treatment to reduce the danger of subsequent laparotomy. Catheterisation of chronic pseudocysts in alcoholic pancreatitis is associated with frequent complications and recurrences and can not be regarded as alternative to internal drainage surgeries. Pancreatic surgeries must guarantee effective correction of intrapancreatic hypertension for prevention of acute pancreatitis recurrences. In acute phase of pancreatitis surgical methods must ensure prevention of symptoms recurrences and pyoseptic complications of pancreatitis.

[Choice of bile-diverting operations in neoplastic obstruction of the distal common bile duct]. / Vybor zhelcheotvodiashchikh operatsii pri opukholevoi neprokhodimosti distal'nogo otdela obshchego zhelchnogo protoka]

Analysis of clinical material of 206 patients with tumor obstruction of the distal part of the common bile duct allowed the conclusion to be made on the expediency of applying endoscopic methods for jaundice correction as the first stage in preparation for the operation (122 patients) and also as the only and final operation (70 patients). Study of the immediate and late-term results of different variants of operations for bile diversion in obstruction of the distal choledochus (203 operations) showed the superiority of the Roux hepaticoejunoanastomosis in which recurrent jaundice due to obstruction of the cystic duct does not occur, as is encountered in creation of a cholecystoejunoanastomosis, and there are no conditions for the development of ascending cholangitis.

[Problems in the surgical treatment of pancreatic chronic diseases]. / Problemy khirurgii khronicheskikh zabolevanii podzheludochnoi zhelezy.

The work analyses the results of 999 operations on the pancreas conducted in 861 patients with chronic oncological and nonneoplastic diseases of the gland. Pancreatoduodenal resection (PDR) was performed in 171 patients (for tumors of the pancreaticoduodenal zone in 151 and for chronic pancreatitis of the head of the gland in 20) in 13 of them a modified operation with preservation of the stomach and pylorus was carried out. The late-term results were satisfactory in both groups of patients, the survival of oncological patients was much higher after radical operations then after palliative surgery. Total duodenopancreatectomy has no advantages over PDR and should be undertaken only when there are strict indications. In chronic pancreatitis, complicated also, preference was given to organ-preserving interventions, primarily to draining operations, which preserve more fully pancreatic exocrine and endocrine functions: longitudinal pancreatojejunostomy was conducted in 106 patients, internal drainage of pancreatic cysts in 184, and occlusion of external pancreatic cysts in 70 patients. It is advisable that the most complicated, particularly repeated and reconstructive, operations on the pancreas are carried out at specialized centers in which the problem of surgical diseases of the pancreas is studied more closely.

[Subtotal pancreatic resection in chronic pancreatitis]. / Subtotal'naia rezektsiia podzheludochnoi zhelezy pri khronicheskom pankreatite.

Eight patients with chronic pancreatitis were subjected to subtotal (95%) resection of the pancreas. The authors believe that such surgical intervention should be performed when the pathological process had involved the left half of the gland, while its head remained little changed or intact. Subtotal resection is indicated also in cases of primary pancreatitis when the organ parenchyma is changed and the major pancreatic duct is not dilated. In such cases it is not expedient to make a pancreato-digestive anastomosis.