Duodenum-preserving pancreatic head resection or pancreatoduodenectomy for the surgical treatment of paraduodenal pancreatitis: a retrospective cohort study.

Purpose: Paraduodenal pancreatitis (PDP) is an uncommon yet well-described type of focal chronic pancreatitis. The aim of our study was to compare the outcomes of surgical treatment of patients with PDP using pancreatoduodenectomy and duodenum-preserving pancreatic head resection (DPPHR).

Methods: A retrospective analysis of 153 consecutive patients with PDP was performed.

EFFICACY OF THE ALGORITHMIC STEP-UP APPROACH OF INTERVENTIONAL TREATMENT OF PATIENTS WITH ACUTE NECROTIZING PANCREATITIS.

Aim - to estimate the efficacy of the algorithmic step-up approach of interventional treatment of acute necrotizing pancreatitis (ANP).; We performed a prospective observational cohort study of the efficacy of the developed approach of surgical treatment of 317 patients with different morphological forms of ANP. The following parameters were collected for each episode: length of hospital stay, mortality rate, occurrence of organ failure and local complications.

[Prophylaxis of complications in patients after pancreaticoduodenal resection].

Experience of pancreaticoduodenal resection performance was summarized in 163 patients in 2005-2009 yrs. Duodeno(gastro)enterostomy was formed in anterior position, taking an objective to reduce the risk of postoperative gastrostasis occurrence; and formation of invagination ductojejunal anastomosis--for prophylaxis of pancreatogenic complications. External pancreatic duct drainage and medicinal therapy conduction do not guarantee reduction of the postoperative complications occurrence risk.

[Pancreatic resection using laparoscopic access].

Experience of their own on performance of pancreatic resection interventions, using laparoscopic access, conducted in the clinic in 2009 - 2013 yrs, was presented. In 8 patients laparoscopic distal pancreatic resection was conducted, in 5--laparoscopic enucleation of pancreatic tumor, in 1--laparoscopic pancreaticoduodenal resection. The results were compared with such after open operations, performed in this period of time.

[Ultrastructural peculiarities of mononuclear macrophages of the demarcation zone in an acute necrotic pancreatitis and elaborating of methods for the disease course prognosis and treatment].

Results of the electron microscopic investigation of the pancreatic tissues biopsies, obtained intraoperatively from the demarcation inflammation focus, while operating 42 patients for an acute necrotic pancreatitis (ANP), were summarized. No less than two populations of mononuclear macrophages, the cells, owing raised or lowered functional activity, were revealed in inflammatory focus of demarcation area. Determination of absolute quantity of monocytes in a peripheral blood was used as a prognostic criterion for the disease course.

[Principles of direct surgical procedures on the pancreas in surgical treatment of chronic pancreatitis].

An analysis of treatment of 584 patients with complicated forms of chronic pancreatitis operated during 2000-2100 years was carried out. Quality of life of postoperative patients was estimated according to a technique of calculations of modules EORTC QLQ-C30 and EORTC QLQ-PAN26. The indicators of quality of life have improved by 19.

[Application of thermostream method in the surgical treatment of infectious pancreatic diseases].

Application of thermostream method secures a safe sterilization in infected pancreatic affection. It was confirmed by the results of 9 operations, performed on pigs with follow-up to 270 days. Thermal influence toward infected pancreatic tissue was delivered using hot air stream during 20 sec for 1 cm2 area in temperature 140 degrees C.

[Intraoperative possibilities of reduction of postoperative complications frequency in pancreaticoduodenal resection on its reconstructive stage].

Experience of pancreaticoduodenal resection (PDR) performance in 81 patients in 2007-2008 yrs was summarized. There were studied up the risk of postoperative gastrostasis occurrence and factors, promoting such a risk lowering. In 24 patients (the main group) gastro- and duodenoenteroanastomosis were formatted in antecolic position, while in 57 (the control group) the gut continuity was restored according to standard method.

[Application of ozone therapy in complex treatment of patients with acute necrotizing pancreatitis].

Examination and treatment of 32 patients was done, in whom an acute necrotic pancreatitis was diagnosed. In 16 patients (the main group) ozonotherapy, according to scheme, elaborated in the clinic, was added to conventional treatment. The ozonotherapy application had permitted to reduce the rate of performance of "open" operative interventions.

[Lumbotomic videocontrolled sanation of retroperitoneal space in patients, suffering an acute necrotizing pancreatitis].

During 2007-2008 yrs 55 patients, suffering an acute necrotic pancreatitits, were followed up. In the main group 7 patients were included, in the complex treatment of whom the lumbotomy transcutaneous sanation of necrotic foci, using nephroscope, was done. In patients of a control group the conventional operative interventions were performed.

[Intraductal papillary-mucinous tumors as a variant of cystic pancreatic tumors. The problems of diagnosis and surgical treatment].

Retro- and prospective investigation of the diagnosis and treatment results of 6 patients, suffering intraductal papillary-mucinous neoplasms (IPMN), was conducted. In 2 patients the central type malignant IPMN were diagnosed, in 1 - the central type of IPMN without malignization signs, in 2 - the IPMN of lateral type without malignization signs, in 1 - the multiple malignized IPMN of lateral type. The magnet resonance cholangiopancreatography, permitted to determine the pancreatic ductal system tumoral involvement, had constituted the main method of instrumental diagnosis.

[Application of preparations--analogues of somatostatin in surgical pancreatology].

The experience of application of shortly acting and durably acting preparations--analogues of somatostatin in complex therapy of various pancreatic diseases was summarized. There was established similar efficacy of the preparations in blockade of the pancreatic external secretion and the various duration of their inhibiting influence on the blood flow. The trustworthy differences in the complications frequency and lethality while application of various preparations--analogues of somatostatin were not revealed.

[Preoperative biliary decompression in patients with malignant tumor of duodenal major papilla].

Experience of surgical treatment of 241 patients with malignant tumor of duodenal major papilla in 1992-2005 yrs was analyzed. In 95 patients the treatment was conducted in two stages, the first of which have had included biliary decompression. There were analyzed 18 potential risk factors for postoperative complications occurrence.

[Effect of cerulloplasmin on natural factors of defense in patients with an acute necrotic pancreatitis].

In 81.25% patients with an acute necrotic pancreatitis and in 50% of healthy persons the blood neutrophils are sensitive to cerulloplasmin in metabolic activity. In 62.

[An acute necrotic pancreatitis as a complication of cystic pancreatic tumor].

The peculiarities of the cystic pancreatic tumor morphogenesis were studied up. Possibility and probability of the anastomosis existence between mucinous cystic tumor and pancreatic duct with its secondary mucinous dilatation were confirmed, causing the complications occurrence, an acute pancreatitis in particular. Selecting the surgical tactic in mucinous cystic tumor it is necessary to take into account the probability of the intraductal malignization foci formation, what precludes application of extended pancreatic resection using adjuvant chemotherapy and the postoperative serological control conduction.

[Main principles of antibiotic prophylaxis and antibacterial therapy in abdominal surgery].

The principles of antibioticoprophylaxis and antibacterial therapy in abdominal surgery were expounded. There are adduced the most frequently revealed pathogenic microorganisms, inducing intraabdominal infection, the ways of lowering of the antibacterial therapy expenses, new approaches to application of immunocorrection and directed transport of antibiotics in surgery as well as empirical and etiotropic treatment, basing on the taking account of the spread and antibioticosensitivity of pathogenic microorganisms of nosocomial infections. There was shown, that concentration of interleucin-1beta and tumor necrosis factor-alpha in the blood serum is connected with the severity of patient state.

[The application efficacy of immunomodulators in complex of treatment of an acute necrotic pancreatitis].

Analysis of efficacy of the immunomodulators application, thymalin in particular, in complex treatment algorhythm in 18 patients with an acute necrotic pancreatitis was conducted. Efficacy of immunocorrecting therapy in the immune state improvement, purulent-septic complications prophylaxis, the abortive course of the disease promotion was established In 12 (66.7) patients the disease regression was noted, in 2 (11.

[Modern strategies in surgical treatment of acute necrotic pancreatitis].

The experience of surgical treatment of acute necrotic pancreatitis (ANP) in 172 patients in 1997-2002 were summarized. We started therapy from conservative treatment. In 43 (25%) patients with ANP video laparoscopic intervention in enzyme-toxic period were performed.

[Pancreatic-jejuno-duodenostomy by a small isolated intestinal segment: the function-preserving surgery for complicated forms of chronic pancreatitis].

Results of treatment of 26 patients with calcinous fibrous-degenerative chronic pancreatitis, operated in clinic in 2001-2002 years, were analyzed. Standard method, using longitudinal pancreatojejunostomy on excluded loop of small intestine according to Roux, was performed in 12 patients (first group). In 14 (second group) operation of pancreatojejunoduodenostomy was performed, using isolated segment of small intestine according to method proposed by the authors.

[Use of compressive biliary-digestive anastomoses in surgical treatment of chronic pancreatitis complicated by biliary hypertension and obstructive jaundice].

For the 1996-2000 yrs period 47 patients with complicated forms of chronic pancreatitis and signs of obturation jaundice were operated on in the clinic. In 23 (49%) patients the intervention on biliary ducts was performed: in 4 (8.5%)--hepaticojejunoanastomosis was formatted, in 3 (6.