[Modern approaches to the treatment of patients with a complicated form of gallstone disease in the Botkin hospital]. / Protokol lecheniya bol'nykh s oslozhnennoi formoi zhelchnokamennoi bolezni v khirurgicheskoi klinike Botkinskoi bol'nitsy.

OBJECTIVE: To determine the optimal timing of laparoscopic cholecystectomy in patients with gallstone disease complicated by cholelithiasis after endoscopic retrograde papillosphincterotomy with lithoextraction. MATERIAL AND METHODS: We analyzed treatment outcomes in 229 patients with gallstone disease complicated by cholelithiasis between 2016 and 2020. Simultaneous surgery was performed in 31 patients, early cholecystectomy (after 1-3 days) - in 78 cases, delayed cholecystectomy (after 4-7 days) - in 35 cases and delayed cholecystectomy in 14-30 days after endoscopic retrograde papillosphincterotomy with lithoextraction in 85 cases. RESULTS: Simultaneous laparoscopic cholecystectomy and surgery in early period after endoscopic retrograde papillosphincterotomy with lithoextraction are followed by less surgery time, few postoperative complications and less hospital-stay. CONCLUSION: Simultaneous laparoscopic cholecystectomy and early surgery after endoscopic retrograde papillosphincterotomy with lithoextraction are preferred for patients with complicated gallstone disease. However, this requires adherence to strict criteria for patient selection.

[Minimally invasive surgical interventions in the treatment of severe acute pancreatitis]. / Mini-invazivnye khirurgicheskie vmeshatel'stva v lechenii patsientov s ostrym pankreatitom tyazheloi stepeni.

OBJECTIVE: To improve the outcomes in patients with severe destructive pancreatitis undergoing minimally invasive surgery. MATERIAL AND METHODS: There were 482 patients with acute destructive pancreatitis for the period from 2007 to 2016. Non-infected acute destructive pancreatitis was diagnosed in 58% (n=280) of patients, infected pancreatic necrosis - in 42% (n=202) of patients. Minimally invasive technologies were used in the treatment of purulent complications of destructive pancreatitis: endoscopic papillotomy, percutaneous puncture of fluid accumulations, ultrasound- and X-ray-assisted drainage of abscesses and retroperitoneal phlegmon. RESULTS: There were 688 drainage surgeries in 92 patients with infected pancreatic necrosis: US-assisted Seldinger drainage - 599 (87%), single-stage drainage - 89 (13%) cases. Percutaneous transfistular retroperitoneal interventions were made in 72 patients (one intervention - 29 patients, redo procedures - 43 patients). Complications associated with minimally invasive procedures developed in 2.7% (19) of cases. Six patients required laparotomy. Mean length of hospital-stay was 36.5 days. Mean rate of restitution of post-necrotic areas was 37.7 days. CONCLUSION: Minimally invasive procedures reduce overall mortality up to 6% in patients with acute pancreatitis and up to 14% in those with destructive forms of inflammation.

[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.

Selection of biliary decompression method for treatment of obstructive jaundice in patients of older age groups.

OBJECTIVE: Introduction: The development of minimally invasive techniques allowed to expand the indications and possibility of performing surgeries in patients of elderly and old age with obstructive jaundice (OJ). However, the criteria for the selection of minimally invasive and open surgeries in patients with OJ remain undefined. The aim: To study the efficacy of single or multiple-stage methods of biliary decompression for treatment of OJ in patients of older age groups. PATIENTS AND METHODS: Materials and methods: We have analyzed the results of surgical treatment in 140 patients with OJ of benign origin. The patients were divided in two groups: group I (n = 70) where two-stage minimally invasive methods were used and group II (n = 70) where single-stage minimally invasive and open surgeries were used. The average age was 75 ± 6.0 years. The average duration of OJ was 22 ± 3.7 days. RESULTS: Results: The patients in group I were subjected to two-stage minimally invasive surgeries in 70 (50.0%) cases. The patients in group II were subjected to single-stage minimally invasive surgeries in 16 (11.4%) cases and to open surgeries in 54 (38.6%) cases. The average duration of hospital stay in patients of group I made 7.1 ± 1.5 days, and 11.2 ± 1.2 days in patients of group II. The patients of group I experienced complications in 5 (7.1%) cases and patients of group II experienced complications in 10 (14.3%) cases. 1 (1.4%) patient died. CONCLUSION: Conclusions: Stepwise approach to minimally invasive surgeries in patients of elderly and old age with bile duct obstructions allows to reduce the frequency of postoperative complications down to 7.2% (p< 0.05). Single-stage correction is recommended for patients with hyperbilirubinemia of less than 100 mcmol/l and the duration of OJ of less than 14 days, with presence of compensated or subcompensated co-occurring pathology as well as in the absence of purulent cholangitis and biliary pancreatitis.

Simultaneous surgical treatment tactics of acute destructive cholecystitis combined with choledocholithiasis: A case report.

INTRODUCTION: The widespread development of minimally invasive treatment methods have expanded the choices and options available to surgeons to manage patients suffering from cholelithiasis and its complications, including choledocholithiasis. As new surgical strategies are developed and become widely available, there is an ongoing debate as to which surgical strategies are optimal for the management of acute cholecystitis and concomitant choledocholithiasis. The treatment of patients in this category should be carried out according to clear criteria, taking into consideration the patient's condition, concomitant diseases, the size of calculi in the common bile duct as well as the resources of the medical institution. CASE PRESENTATION: We present the clinical case of a 65-year-old female with cholelithiasis, acute gangrenous cholecystitis, choledocholithiasis, and obstructive jaundice. She was treated with endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic papillosphincterotomy (EPST) and laparoscopic cholecystectomy (LCE) in a one-stage operation. DISCUSSION: Several sources recommended performing LCE after ERCP with EPST in acute cholecystitis when complicated by choledocholithiasis to reduce the conversion rate and the risk of recholedocholithiasis. CONCLUSION: Simultaneous resolution of acute destructive cholecystitis complicated by choledocholithiasis in a one-stage operation is accompanied by a decrease in emotional and psychological trauma, also leads to early rehabilitation of patients and, thereby, reduces overall postoperative disability and morbidity.