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An analysis of treatment results was made in 26 patients with postnecrotic cysts of different degree of maturity. The laparotomy with trans-gastral cystogastrostomy on the external drainage were performed on 11 patients. A new modified operation underwent 15 patients. This operation was transgastric cystogastrostomy on the external drainage from mini-access, which was developed in 2011. The laparotomy of 4–5 cm was made in pseudocyst projection of the pancreas using a standard set of tools «mini-assistant». Postoperative period have passed without complications in all the patients. The drainage was removed on 30–40 days of postoperative period. The terms of hospital stay reduced from (14,4±0,9) bed/ days to (10,8±0,5) bed/days due to application of proposed method of treatment.

The article presents the results of surgical treatment of 58 patients with pancreatic cysts. An analysis of efficiency of various current miniinvasive surgical methods of treatment is given. Criteria of differential approach to the choice of the kind of miniinvasive intervention in pancreatic and parapancreatic cysts were formulated.

Treatment of 10 patients with bleedings from the pancreatic cysts was analyzed. Angiography with endovascular occlusion of the source of bleeding was used in 4 patients. Hemostasis was achieved in 2 patients. Emergency operations were made on 7 patients with continuing and repeated bleedings, and unsuccessful attempts of roentgen-endovascular treatment. Two patients after correction of anemia were subjected to planned operations according to the indications accepted for chronic cystic pancreatitis. The operation allows reliable liquidation of the source of bleeding and the symptoms of chonic pancreatitis.

A comparative analysis was made of preoperative computer diagnostics and intraoperative findings in 151 patients operated at various periods of chronic pancreatitis (CP) (n=76) with exacerbation of pancreatitis (or relapsed acute against the background of chronic) and 75 patients without exacerbation. Ninety (59.6%) patients have arrived with complications. Sensitivity of the method of computer tomography in patients with pancreatic exacerbation is 97.4%, without exacerbation is 98.7%. Dilatation of the main pancreatic duct is divided into three degrees. The dilatation of the 2nd and 3d degrees was diagnosed in 78 patients. All the patients were operated on the pancreas in the volume of direct interventions including external drainage which was performed in 69, internal in 56, separately resectional operations in 19, isolated cystectomy in 7 patients, In the group of patients operated out of exacerbation a correlation between the degree of the internal pancreas duct hypertension according to the data of preoperative computed diagnostics and the number of operations of internal drainage was followed. The presence of pancreatitis exacerbation (or relapsed acute against the background of chronic) in 27.5% (n=21) did not allow lateral pancreaticojejunostomy to be performed. In 23 patients the presence of exacerbation, complications of CP due to proper cystic formation (suppuration) and from adjoining organs was not considered contraindication to longitudinal and bilateral pancreaticojejunostomy. Low indices of postoperative lethality (0.7%) and of the number of postoperative complications (6%) confirmed the possibility to liquidate intraductal hypertension in complicated CP at earlier terms that protects the patients from many stages of surgical treatment.

The authors analyzed results of treatment of 87 patients with cystic formations of the pancreas. According to an experience with treatment the puncture-catheterization of non-formed and complicated cysts is thought by the authors to be the method of choice. For non-complicated well formed cysts the method of choice is operation of internal drainage using different organs. When the puncture-catheterization intervention is not possible the external drainage of the cyst and complex conservative therapy can be the method of choice for complicated cysts. Radical operations (resection of the pancreas) were used for benign cystic tumors. The greatest number of complications were observed after the external drainage of the cyst, cystogastrostomy, resection for cystadenoma and cystadenocarcinoma. Postoperative lethality was 6.8%.

A more than 10 year experience of using operative interventions under the control of ultrasound has shown that in order to solve the task of improving the results of surgical treatment of cysts of the pancreatic gland it is necessary to improve a number of diagnostic and organizational measures allowing to perform the early and effective diagnosis of the cysts and their timely treatment. The percutaneous puncture-drainage operations with sclerotherapy are indisputably considered to be highly effective in treatment of cysts of the pancreas. In most patients, however, the clinical and ultrasonic signs of pancreatitis are still retained. These patients need permanent dynamic observation and conservative therapy.

The authors observed 136 patients with pancreatic cysts. Complicated forms of the disease were found in 26 patients. It was established that despite apparent signs of disturbed functioning of the pancreas for a long time there was not a single case of correct diagnosis in local hospitals. The greatest amount of errors were made in surgical interventions in patients with pancreatic cysts.

Analysis of 96 operations in 79 patients with complicated forms of chronic pancreatitis is presented. Various changes in the pancreas itself and associated complications require an individual method of surgery. Necessary elimination of both pancreatic and bile hypertension is stressed. During operation on the pancreas the external drainage of the pancreatic duct was used.

The results of the treatment of 18 cases with complicated pancreatic cysts (11 men and 7 women) were studied. Good results were obtained after cystectomy and resection of the pancreas together with the cyst, when the latter was uncomplicated. With complications, external and more seldom internal drainage were preferred. In the postoperative period 3 patients developed persistent pancreatic fistula, one patient developed malignization of the cyst and another one -- thrombosis of the splenic vein.

A model of the pancreatic cyst was elaborated in experiments in dogs. The conditions for its appearance were maximally approximated to real conditions of the formation of a cyst in the patient. On its grounds a pathogenetically based method of the surgical treatment of pancreatic cysts in clinic is proposed.

The results of combination of the internal and external drainage of pancreatic cysts in 9 patients are presented. Four variants of the external drainage of cysts after cysto-gastrocystojejunostomy are described. A prolonged washing of the cyst in early postoperative period results in the rapid diminishing of the cyst and in prevention of complications and recurrence of the disease.

On the basis of an analysis of the treatment of 51 patients with complications of acute destructive pancreatitis (parapancreatic infiltrations with or without suppurations, intestinal fistulas, arrosive bleedings) the authors find it necessary to fulfil an adequate drainage of the pathological focus, permanent continuous washing with antiseptic solutions and active aspiration of the content.

Near and late results of the surgical treatment of 158 patients with chronic pancreatitis are presented. The authors believe that it is only the complex examination before operation and the data revealed during the operation which enable the correct choice of surgery to be made. Variants of surgical measures in the patients examined are described, their rationality being substantiated by good and satisfactory results of the surgery.

The removal or internal drainage of complicated cysts of the pancreas can be performed but in 17-20% of the patients. The external aspiration-irrigation draining of the cyst in most of the patients is thought to be a saving method of treatment allowing to reduce lethality to 9% and achieve the elimination of the cyst and external pancreatic fistula in 78% of the patients. Different methods of surgery depending on the pathological process allow liquidation of the cyst and external pancreatic fistula in 87% of the patients and obtaining complete socio-labour rehabilitation in 90% of the patients.

The authors observed 103 cases of pancreatic cysts caused by acute pancreatitis, aggravation of chronic pancreatitis (81.0%) and trauma to the pancreas (12.0%). The posttraumatic cysts were more common in children and young adults (86.0%). The use of the complex method of diagnosis (x-ray examination of the gastrointestinal tract, celiacography, and upper mesentericography, endoscopic pancreatography, ultrasound echolocation of the pancreas) allowed to establish the diagnosis in 91.6% of cases. The external drainage of the cysts was carried out in cases of infected cysts with poorly formed walls. In case of a dilated and deformed main pancreatic duct with disorder of its patency (21 cases) the longitudinal cystopancreatojejunostomy was performed. The lethality after internal drainage constituted 2.4%. 80.8% of patients showed good long-term results of the treatment and 14.4%--showed fair results. 2 patients (2.1%) developed the recurrence of the cyst.

The authors have generalized the experience with the treatment of 11 cases of pancreatic cysts and 4 cases of external pancreatic fistulas. The anastomosis with hollow organs (7 cases) has proved to be a method of choice in the surgery of pseudocysts. In authors' opinion, the internal drainage creates favourable conditions for persistent decompression of the duct system, promotes the obliteration of the cyst and the attenuation of inflammatory process in the pancreas, while the external drainage of the cyst is indicated in fresh cysts with a loose easily tearing capsule, when anastomosis is impossible for technical reasons.