Complex treatment of multiple high-output enterocutaneous fistulas (gastric, jejunum, transversum) after bariatric surgery.

Multiply high-output enterocutaneous fistulas (ECF) is a tragic postoperative complication. This report describes complex treatment of patient with multiple enterocutaneous fistulas after bariatric surgery, including a comprehensive preoperative preparation for 3 months (sepsis control, nutritional support and wound care) and reconstructive surgery (laparotomy, distal gastrectomy, resection of the small bowel with fistulas, Roux-gastrojejunostomy, transversostomy).

[Surgical treatment of enterocutaneous fistulas in patients with ventral incisional hernia].

Objective: To determine the optimal surgical treatment in patients with enterocutaneous fistulas combined with ventral incisional hernia.

Material And Methods: There were 24 patients with enterocutaneous fistulas combined with ventral incisional hernia. Enterocutaneous fistula was noted in 19 cases, enteroatmospheric fistula - in 5 patients.

[Pancreatic proinsulinoma].

Objective: To report own experience in the treatment of patients with proinsulinoma.

Material And Methods: There were 10 patients with increased proinsulin production and normal insulin level since 2017. Most of them were young women.

[Postpancreatectomy hemorrhage].

Surgical treatment of pancreatic diseases is always associated with a large number of complications. Postoperative hemorrhage is a specific complication of pancreatic surgery requiring a clear classification and surgical strategy. According to literature data, postoperative hemorrhage occurs in 3-30% of cases.

Successful surgical treatment of a patient with primary insulinoma of the liver.

Insulinoma is the most frequent functional neuroendocrine tumor of the pancreas, which causes organic hyperinsulinism with severe hypoglycemia. There are no cases of primary insulinoma of the liver described. A 63-year-old female was admitted to our center presenting symptoms of severe hypoglycemia due to confirmed endogenic hyperinsulinism.

Successful Surgical Treatment of a Patient with Synchronic Intraductal Papillary Mucinous Carcinoma and Solid Pseudopapillary Neoplasm of the Pancreas.

Intraductal papillary mucinous neoplasm (IPMN) and solid pseudopapillary neoplasm (SPN) are uncommon cystic tumors of the pancreas. The simultaneous occurrence of these 2 pancreatic neoplasms is extremely rare. We present a case of synchronous solid SPN and IPMN - carcinoma in a 44-year-old female patient.

[Predicting of pancreatic fistula after pancreatoduodenectomy].

Objective: Identifying the opportunity of objective prognosis of pancreatic fistula emergence after pancreatoduodenectomy.

Material And Methods: In the department of abdominal surgery in 2016-2019, 177 pancreatoduodenectomies for pancreatobiliary tumors were performed. 4 risk factors were identified: type of tumor, preoperative CT with an accumulation coefficient in the pancreas of more than 1, soft pancreas, the number of functioning acinar structures identified during intraoperative histological examination.

Robotic surgery in treatment of retroperitoneal tumors. Comparative single center study.

Retroperitoneal tumors (RT)-group of benign and malignant mesenchymal tumors without any specific organ affiliation. Surgery is the only effective treatment. Robotic surgery is becoming popular and an effective approach in abdominal surgery.

[Management of patients with enterocutaneous fistulae].

Enterocutaneous fistula (ECF) is the most serious postoperative life-threating complication of various abdominal surgical interventions. Treatment of patients with ECF is associated with life-threatening complications including sepsis and septic shock, intestinal failure and severe water-electrolyte disorders that causes high mortality rates (35-75% according to national authors and 6-33% according to foreign colleagues). This issue is especially relevant in the cases of enteroatmospheric fistulae and high ECF with loss of intestinal contents of more than 500 ml per day.

Diagnostic and treatment of the intraductal papillary mucinous tumor of pancreas.

Objective: Adjustment of diagnostics and management of the surgical treatment of patients with intraductal papillary mucinous tumor of pancreas.

Material And Methods: From 2012 to 2018, 45 patients with intraductal papillary mucinous tumor were observed. During the observation the ultrasound examination, contrast-enhanced computed tomography and magnetic resonance tomography with contrast were used.

Duodenopancreatectomy for pancreatic tumors - pros and cons.

Aim: To optimize surgical treatment of multiple and advanced pancreatic tumors.

Material And Methods: There were 852 patients with various pancreatic tumors for the period 2011 - September 2019. Duodenopancreatectomy (DPE) was performed in 18 patients.

Two-stage combined treatment of leiomyosarcoma of iliac vein using robotic surgery.

Vascular leiomyosarcoma is a rare tumor originating from the vascular smooth muscle cells. Leiomyosarcomas of the external iliac vein are extremely rare. Only single observations of this tumor are reported.

Proinsulin-Secreting Neuroendocrine Tumors of the Pancreas: A Single-Centre Experience.

Background: Proinsulinoma is a neuroendocrine tumor (NET) of the pancreas that produces prohormone proinsulin. These tumors are very rare. In the literature, they are most often presented in the form of case reports.

Surgical treatment of neurofibromatosis type I followed by retroperitoneal tumor (in Russian only).

Aim: To determine the optimal surgical approach in patients with abdominal and retroperitoneal manifestations of Recklinghausen's disease.

Material And Methods: There were 4 patients (3 women and 1 man) with neurofibromatosis type I who were treated at Vishnevsky National Medical Research Center of Surgery.

Results: There were 3 robot-assisted procedures: excision of retroperitoneal tumors (plexiform neurofibroma and schwannoma) in 2 cases and right adrenal pheochromocytoma in 1 patient.

Combination of laparoscopy and endoscopy as an option for treatment patients with gastric neuroendocrine tumors.

Background: Neuroendocrine tumors (NETs) are relatively rare neoplasms with the increasing survival due to the development of early diagnostics. There is no universal position in treatment and follow up of small (~20 mm) gastric NETs.

Clinical Cases: Two female patients 51 and 66 y.

[Wirsungorrhagia in cystic mucinous pancreasic tumor].

A rare case of virsungorrhagia in a 65 y/o patient with a mucinous tumor of the tail of the pancreas is presented. Recurrent gastrointestinal bleeding was associated with an arrosis of the splenic artery adjacent to the tumor, which required a two-step treatment - endovascular occlusion of the splenic artery and distal resection of the pancreas.

[Current issues in pancreatic surgery].

Aim: To present own experience of pancreatic surgery and to analyze literature data for this issue.

Material And Methods: We have analyzed work of abdominal surgery department over the last 5 years. Moreover, MEDLINE and RSCI databases regarding surgical treatment of pancreatic diseases were assessed.

[Intrapancreatic accessory spleen].

Background: Accessory spleen is the human growth anomaly, which appears in embryogenesis and frequently becomes an accidental finding during prophylactic medical examination. Pancreatic tail - the second frequent localization after the splenic hilus. Intrapancreatic accessory spleen can mimic the pancreatic tumor.

[Endovascular procedures in pancreatic surgery].

Aim: To evaluate an effectiveness of endovascular techniques in pancreatic surgery.

Material And Methods: For the period 1995-2017 at Vishnevsky Institute of Surgery endovascular treatment (EVT) was applied in 51 patients with chronic pancreatitis complicated by false aneurysms (FA) and postoperative hemorrhage after pancreatectomy. Various methods of embolization and stenting were used in 24 and 11 cases respectively in order to exclude FA of celiac trunk and superior mesenteric artery from blood flow.

Comparative analysis of learning curve in complex robot-assisted and laparoscopic liver resection.

Background: There is no comparative analysis of the learning curves for robot-assisted and laparoscopic liver resection. We aimed to compare learning curves in complex robotic and conventional laparoscopic liver resections with regards to estimation of the difficulty index score.

Methods: The results of 131 consecutive liver resections were analyzed retrospectively (40 robot-assisted and 91 laparoscopic).

[Surgical treatment of retroperitoneal masses].

Aim: To improve the results of treatment of patients with retroperitoneal tumors.

Material And Methods: The study included 83 patients with retroperitoneal tumors including 57 cases of benign tumors and 26 patients with malignancies. Laparotomy (Lt), robot-assisted (RA) and laparoscopic (Ls) techniques were used in 35, 34 and 14 patients respectively.

[Diagnosis and treatment of duodenal dystrophy in patients with chronic pancreatitis].

Aim: to define optimal treatment of duodenal dystrophy in patients with chronic pancreatitis.

Material And Methods: 515 patients with chronic pancreatitis have been treated for the period 2004-2015 in A.V.

[Risk factors and prevention of postoperative pancreatitis after pancreatectomy].

Aim: to improve the results of pancreatic resections through decrease of postoperative pancreatitis incidence.

Material And Methods: It was analyzed 207 patients who underwent pancreatic surgery for pancreatic tumor (n=137) or chronic pancreatitis (n=70). 22 risk factors of postoperative pancreatitis were analyzed in 112 patients retrospectively.