Challenges and perspectives of surgical treatment of liver failure. Current status and last achievements in Georgia.

Liver transplantation is considered to be the last hope of treatment for irreversible liver failure caused by different diffuse and/or space-occupying lesions of this organ. The strict limitation of the donor organs stipulates for development of alternative approaches for the solving this problem. The presented review of literature and our experience aims to discuss the modern aspects of management of different hepatic pathologies causing liver failure with the view of creation of the auxiliary, bioengineer-based functional tissues and/or organs and innovative surgical interventions allowing to conduct the operations in cases, which were up to date considered as inoperable.

Porta-caval fibrous connections - the lesser-known structure of intrahepatic connective-tissue framework: A unified view of liver extracellular matrix.

Knowledge about the connective-tissue framework of the liver is not systematized, the terminology is inconsistent and some perspectives on the construction of the hepatic matrix components are contradictory. In addition, until the last two decades of the 20 century, the connective-tissue sheaths of the portal tracts and the hepatic veins were considered to be independent from each other in the liver and that they do not make contact with each other. The results of the research carried out by Professor Shalva Toidze and his colleagues started in the 1970s in the Department of Operative Surgery and Topographic Anatomy at the Tbilisi State Medical Institute have changed this perception.

LIVER EXTRACELLULAR MATRIX PECULIARITIES IN MAMMALS AND AVIANS.

Analysis of liver matrix studies makes it obvious that knowledge about the connective tissue skeleton of the liver is not systematized, the terminology is contradictory, and the question of the construction of some components sometimes causes controversy. We set a goal to study the features of the construction of the connective tissue matrix of the liver of various mammals and birds in order to identify and systematize general and specific patterns of this structure. The liver of mammals with a gallbladder (pigs, sheep) and without a gallbladder (rats) and birds (domestic chickens with a gallbladder) was studied by the methods of anatomical preparation, histology, histochemistry, histotopography, immunohistochemistry, scanning electron microscopy of corrosion replicas and fluorescence microscopy.

[; ADAPTATION OF THE BILE DUCTS OF THE PORTAL TRIAD IN CASE OF MECHANICAL CHOLESTASIS (REVIEW)].

In case of mechanical cholestasis, along with stagnation in the veins and bile ducts, lymph production increases, which contributes to the accumulation of ascitic fluid. In the peribiliaryareas, where the extramural biliary glands are located, an accumulation of lymphatic vessels has been observed in all the preparations.In these same areas, a contrast-enhanced microtomography showed transition of the ink-gelatin contrast agents (using gelatin and India ink) from the extramural part of the mucous glands to the lumen of the lymphatic capillaries and blood vessels.

The posterior intrahepatic approach to the left portal pedicle using the ligamentum venosum: anatomical basis.

Purpose: Prevention of blood loss in liver resections is essential for reducing postoperative morbidity. The main method to control bleeding during surgery of the left hemiliver is occlusion of the left portal pedicle. This may be accomplished by hilar, fissural or posterior intrahepatic techniques.