Search

The features of the clinical symptoms was studied, the possibility of laparoscopy in modern diagnosis and treatment of epiploic appendices torsion and necrosis of the large bowel was assessed in the article. It was done the retrospective analysis of the medical records of 87 patients with a diagnosis of epiploic appendices torsion and necrosis of the large bowel. The patients had laparoscopic operations in our hospital in the period from January 1995 to December 2012. The clinical picture, laboratory and instrumental datas in cases of epiploic appendices torsion and necrosis were scarce and nonspecific. An abdominal pain preferentially localized in the lower divisions was the main symptom (97.7%). The instrumental methods did not allow to diagnose the torsion and necrosis of epiploic appendices in the majority of cases and all these techniques were used for the differential diagnosis with other diseases. The assumption of the presence of appendices torsion and necrosis occured just in 34.5% of cases before the operation. Diagnosis of epiploic appendices torsion and necrosis present significant difficulties on prehospital and preoperative stages. The diagnostic laparoscopy is the method of choice in unclear situations and it allows to diagnose the torsion and necrosis of epiploic appendices in 96.6% of cases. Successful surgical treatment by using laparoscopic approach is possible in 90.8% of cases.

The article presents the use of laparoscopic interventions in 38 patients with Acute Adhesive Small Bowel Obstruction (AASBO) in patients without previous history of abdominal surgery. Clinical, radiological and ultrasound patterns of disease are analyzed. The use of laparoscopy has proved itself the most effective and relatively safe diagnostic procedure. In 14 (36.8%) patients convertion to laparotomy was made due to contraindications for laparoscopy. In 24 (63.2%) patients laparosopic adhesyolisis was performed and AASBO subsequently treated with complications rate of 4.2%.

Unlabelled: For the last years the role of endoscopic pancreatic stenting in the treatment of chronic pancreatitis and its complica- tions has significantly increased., Materials and Methods: In the clinic of abdominal surgery and endoscopy of Pirogov RNRMU based on the University Hospital 31 for the period from 01.1998 to 01.2014 Wirsung duct occlusion, which developed on the background of CP was the cause of performing of 215 endoscopic procedures in 95 patients: 34 (35.8%) women and 61 (64.2%) men. Mean age 49.8 ± 11.7 years. Study group consisted of 52 (54.7%) patients with strictures of MPD and 43 (45.3%) with pancreatic fistulas. We tried to perform pancreatic stenting in all the cases, as a method of treatment of pathological changes in the pancreatic ductal system., Results: Endoscopic stenting was successfully performed in 64 cases (67.4%), while in 45 (70.3%) cases, this intervention was the definitive method of treatment. Temporary Wirsung duct stenting was performed in 19 (29.7%) cases in which endoscopic retrograde step interven- tions were training to perform surgery. It is significant that the main causes of the technical impossibility of pancreatic stenting was the complete dissociation of Wirsung duct (8), distal localization of occlusive lesions (13), presence of severe angulation in stenotic changes (20) and the length of the scar stricture of the MPD more than 1 cm (17) and particularly a combination of several factors. Clinically significant complications after endoscopic interventions in our study occurred in 6 (2.8%) cases. Lethal outcome occurred in one patient (0.5%)., Conclusion: According to the results of our study pancreatic stenting was technically feasible in 67.4% of all cases. At the same time, endoscopic correction, if the possibility of its technical implementation, may be the final method of treatment in 70.3% cases. In this endoscopic pancreatic stenting has a low complication rate (2.8%) and mortality (0.5%). The main reasons for the failures and limitations of endoscopic stage treatment is a combination of factors: complete dissociation of the MPD, distal location of the Wirsung duct strictures with severe angulation in this area and a large length of strictures.

A retrospective analysis of treatment of 82 patients with torsion and necrosis of appendices epiploica was made. The video-laparoscopic surgery of these patients was performed. When the diagnosis is unclear, the differential diagnostics should be made between the appendices epiploica disease and other abdominal diseases using the video-laparoscopy. This method allowed the establishment of the correct diagnosis of torsion and necrosis of appendices epiploica in 95.1% of patients. The laparoscopic treatment was made in 87.8% of cases with minimal quantity of postoperative complications. The video-laparoscopy allowed the detection of accompanying pathology of abdominal organs and performance of the correction by low-invasive method. The need of conversion occurred in 12.2% of patients. Postoperative period was characterized by uneventful recovery, minimal usage of analgesics and antibiotics, early stages of rehabilitation, perfect cosmetic effect in majority of patients.

7 patients with biliary ileal obstruction were operated on during the past 2 years. The article focuses on the features of the clinical presentation and the efficacy of diagnostic means. The surgical tactics and volume of the intervention is suggested. Recommendations on the prevention of the biliary ileus were worked out.

For the period of 6 years we have 110 patients with recurrent bile duct stones (BDS). Were evaluated the changes of the bile duct and bile papilla (BP), predisposing to the recurrence of BDS; the causes of recurrent BDS after endoscopic papillosphincterotomy (EPST). To improve the treatment results in patients with recurrent BDS is necessary: at the primary operation to estimate the changes of the BP and periampulyarnuyu area, in patients with completed EPST to prescribe litolitic therapy; in patients with a complex BDS after unsuccessful attempt of EPST to do holedoholitotomy with a blind stitch or in combination with the drainage of Pikovsky.

The treatment results of 174 patients with the acute pancreatitis were analyzed. 51 (29.5%) patients were on total parenteral feeding (the 1st group); 93 (53%) patients received the early enteral feeding through the nasoenteral tube (the 2nd group); 30 (17.5%) patients received the enteral feeding together with the selective intestinal decontamination ( the 3rd group). The combination of enteral feeding together with the selective intestinal decontamination proved to have the positive influence and prevent the infectious complications of the acute pancreatits. Therefore, they should be used in the treatment of such patients.

The article is devoted to a problem of diagnosis and treatment of postcholecystectomy syndrome caused by benign neoformations of the major duodenal papilla. The material of study was formed by 76 patients; among them 53 ones had isolated benign neoformations of the major duodenal papilla. The medical-diagnostic algorithm applied by authors for the examination of patients with postcholecystectomy syndrome is presented. It's been defined, that benign neoformations of the major duodenal papilla take an essential place in the structure of postcholecystectomy syndrome and make 13.5% of the reasons of its occurrence. Thus, the most widespread morphological substratum of these benign neoformations is the hyperplastic polyp.

The treatment results of 69 patients with the altered bilioduodenal anatomy and choledocholithiasis, complicated by the obstructive jaundice, were analyzed. The anatomic changes were determined by the previous gastric resection or gastrectomy, biliodigestive anastomosis, bile duct strictures, pyloric stenosis, duodenal diverticulum or the Mirizzi syndrome. The surgical approach depended on the type and extent of anatomic changes. The endoscopic common bile duct decompression was possible in 82,6% of patients. The endoscopic bile duct stone removal was achieved only in 44,9% of patients, the other 8,7% with non-removable stones had the endoscopic bile duct stenting as a means of palliative surgery. Percutaneous transhepatic lithoextraction was performed in 1,5% of cases. The differential approach provided the decrease of postoperative complication rate and lethality to 14,5 and 2,9%, respectively.

The authors analyze their experience of 62 video-laparoscopic operations for perforating duodenal ulcer from January 1998 to May 1999. The optimal algorithm of the patients' preoperative examination and substantiation of the used technique are given. Basic steps and technical aspects of the operation are designated. Basic approaches to the postoperative anti-ulcerous treatment are specified. Basic indications and contraindications to video-laparoscopic-closure of duodenum opening in perforating ulcer are indicated.

Comparative analysis of the results of microscopic examination of ductal bile was carried out in 2 groups of patients with clinical manifestations of the disease of extrahepatic bile ducts (choledocholithiasis, mechanical jaundice, cholangitis). In group 1 (17 patients) choledocholithiasis was diagnosed on the basis of ultrasound examination (USE) and direct contrast examination of the bile ducts at retrograde pancreatocholangiography (RPCG). In group 2 (17 patients) USE and RPCG proved to be uninformative and only polarizable microscopy of ductal bile taken by the method of direct endoscopical catheterization of the major duodenal papillae was able to reveal microcholedocholithiasis. It served an indication for endoscopical papillosphincterotomy performance. Thus polarizable microscopy of ductal bile is a reliable method of diagnosis of microcholedocholithiasis, which makes it possible to establish indications for correction of the major duodenal papilla.

The paper presents pilot results of clinical application of developed experimintally method of treatment for acute cholecystitis based on demucosation of the gall-bladder followed by obliteration of its lumen. Two modifications of the method-treatment of mucous membrane of the gall-bladder by phenol emulsion (16 patients) and electrocoagulation of the mucosa (49 patients)--were used with good clinical results in patients with high operation risk. Follow-up results are available for up to 3.5 years.

On the basis of 15-year experience in the treatment of patients with chronic pancreatitis, among which 236 patients underwent operation, the authors describe the examination scheme and discuss the indications and various methods for treatment of the disease. Particular attention is bestowed upon morphological changes of the pancreas, including ultrastructural analysis, as well as on the study of the functional condition by evaluation of the pure pancreatic secretions. The importance of the extrasecretory function of the pancreas in choosing the method of direct intervention on the organ is shown. The indications for nonoperative, endoscopic, and surgical treatment of chronic pancreatitis are determined according to the morphofunctional changes.

The results of examination and treatment of 162 patients with clinically suspected choledocholithiasis were analysed. The high significance of ultrasonic examination in the diagnosis of a calculous nature of the affection of the biliary tree with a record of its echosemeiotics is shown. The wide use of ultrasonic examination yields better information. Study of the results of complex examination of 110 patients with verified choledocholithiasis confirmed the high rarefying capacity of the ultrasonic method in the detection of stones in the extrahepatic biliary tree (85.8% accuracy of the examination) both when it is applied for the first time and when it is used during the treatment. Obligatory performance of ultrasonic examination in diseases of the extrahepatic biliary ducts is suggested.

The authors examined 42 patients with obstructive jaundice of various severity. Comparison of the findings of radiohepatography with intoxication values according to the medium-weight molecule test and the biochemical parameters revealed statistically significant differences of some quantitative indices depending of the severity of jaundice. The results of the study made it possible to recommend the use of the values of blood clearance, time of maximum accumulation of a radiopharmacological agent in the liver, hepatic and blood retention index, and the medium-weight molecule test for objective quantitative appraisal of the severity of obstructive jaundice. Study of the time course of changes of the above parameters showed that normalization of hepatic function in resolving jaundice begins only from the second week after decompression of the biliary tract, which must be borne in mind in choosing the optimal time for the operation.

On the basis of complex examination of 54 patients with obstructive jaundice, the authors show the diagnostic value of testing the level of middle-mass molecules for qualitative appraisal of the severity of the intoxication as well as for determination of the rational tactics in the management of patients with obstructive jaundice. With the use of the test for middle-mass molecules, the volume of nonoperative therapy and the time for the operative interventions will be determined more rationally, as the result of which the results of treatment of this severe disease will improve.

On the basis of complex examination and treatment of 167 patients with obstructive jaundice of various etiology, the authors suggest a differentiated approach to the choice of the volume, method, and duration of detoxification therapy as well as the time and volume of an operative intervention. The necessity of preoperative correction of cholestasis by nonoperative measures and instrumental methods of decompression of the biliary tract is substantiated. It is shown that intraarterial regional infusion therapy must be applied in patients whose condition is most serious.

The possibilities of various methods of examination in 22 patients with nonorganic retroperitoneal tumors were evaluated on the basis of complex diagnosis. The importance of ultrasonic examination for determining the tactics of the management of patients is shown. The method improves the results of examination of patients with nonorganic retroperitoneal tumors and allows the volume of radio-endoscopic studies to be reduced.

During a 20-year period among 513 patients, subjected to surgery for acute intestinal obstruction, the intestinal obstruction with bile stones was noted in 10 cases. The clinical picture of cholelithic intestinal obstruction is characterized by an intermittent course, that would result in late hospitalization and a delayed surgical therapy. Among 10 patients under treatment there were 5 lethal issues. Despite a comparatively not infrequent spontaneous cure in this lesion, it is felt that active surgical measures should be employed. An initiated operative intervention should be as minimum as possible, i. e. be limited by a liquidation of the obstruction by means of removing a cholelith from the intestinal lumen.

The article analyses certain indicators of immune reactivity in 67 patients with different forms of pancreatitis. Lower reactivity of the organism in destructive pancreatitis determines the necessary use of immune modulating therapy in the complex treatment of this disease and purulent complications. In patients with high risk of pyo-septic complications the administration of cytostatics is not indicated.

On the basis of examination of 320 patients with mechanical jaundice the authors recommend to begin the examination by performing retrograde cholangiopancreatography and if necessary to add transcutaneous transhepatic cholangiography. In all the cases an attempt should be made to resolve the jaundice before operation by means of nasobiliary drainage of bile ducts, endoscopic papillotomy, transhepatic cholangiostomy. In aggravating nonresolved jaundice the examination and attempts to resolve the jaundice by conservative measures should not take more than 4-5 days.