[Surgical policy in echinococcosis of the liver with affection of bile ducts].

Short-term results of surgical treatment of 277 patients with hepatic echinococcosis associated with affection of bile ducts are analyzed. If it is impossible, additional drainage of bile ducts and residual cavity is indicated. Pericystectomy is recommended when hydatid cyst has calcified fibrous capsule.

[Surgical policy in patients with chronic calculous cholecystitis complicated by choledocholithiasis].

Results of surgical treatment in 116 patients with chronic calculous cholecystitis complicated by choledocholithiasis were studied. Introduction in clinical practice of endoscopic papillosphincterotomy (EPST) and laparoscopic cholecystectomy changed surgical policy for benign combined lesions of gall bladder and extrahepatic bile ducts. Complex endoscopic treatment is preferable if contraindications are absent.

[Diagnosis of bile ducts lesions in echinococcosis of the liver].

The results of examination and surgical treatment of 277 patients with hepatic echinococcosis with bile ducts lesion are analyzed. Symptoms of bile ducts lesion serve the indication for direct roentgenocontrast methods of bile ducts examination (endoscopic retrograde pancreaticocholangiography, percutaneous transhepatic cholangiography, fistulography). Jaundice in anamnesis, dilatation of hepaticocholedoch, abundant outflow of bile from residual cavity after echinococcectomy require additional examinations during surgery (USE, cholangiography, chromatic reaction).

[The lipid profile in patients with obesity who have undergone vertical gastroplasty].

The effect of vertical banded gastroplasty (VBG) on the lipid profile in obese patients is considered. The antiatherogenic effect of VBG and of the following weight loss consists in significantly decreased plasma triglycerides, increased content of high-density lipoproteins and decreased atherogenic coefficient. Patients with hypercholesterolemia have significantly lower total plasma cholesterol by the period of the body mass stabilization.

Successful bariatric surgery in a patient who underwent more than 100 various operations.

A 44-year-old woman who weighed 130 kg (height 158 cm, BMI 52) with a complicated psychiatric history was referred for obesity surgery because of severe sleep apnea, obesity hypoventilation syndrome with frequent pneumonias, arterial hypertension, diabetes mellitus, polyarthralgia and back pain, venous insufficiency, dysmenorrhea, severe heartburn, and incisional hernia. From childhood until 1983, she had undergone 106 operations, mainly for septic/pyemic and intra-abdominal abscesses, 86 of them under general anesthesia. In the 4 years before undergoing bariatric surgery, she had gained 40 kg, nonoperative attempts at weight reduction had failed.

[Functional reserve in benign volumetric lesions].

For evaluation of functional status of hepatocytes in patients with benign volumetric growths of the liver (BVGL) of various genesis the authors performed radionuclide investigation with the use of Tc99m. At the same time the terms of maximal accumulation of the preparation Tmax' the period of half elimination from the liver (T1/2) and the time of entering of the drug into the bowel (T bowel) were evaluated. Basing on the results of the analysis of clinical examinations in 67 patients before and after operations (51 patients with BVGL and 16 patients of control group), the authors have revealed correlation between the size, site disposition of volumetric growth and function of hepatocytes of intact parenchyma of the liver.

[Treatment and prevention of cicatricial strictures and fistulas of biliary ducts].

The paper summarizes the experience gained by the Department for Surgery of the Liver, Biliary Ducts, and Pancreas, Surgery Research Center, in treating patients with corrosive strictures and fistulas of the biliary ducts since 1967. It considers the causes of this abnormality, the nature of corrective operations on the great biliary ducts, complications due to the type of a surgical intervention. Analyzing the reasons for poor postoperative outcomes provides the optimal time of carcass drainages, the optimal diameter of the biliodigestive anastomosis made to have good results.

[The surgical risk factors in patients with nonmalignant space-occupying lesions of the liver and the importance of immunological studies in assessing their extent].

Results of surgical treatment of benign new growths of the liver (BVML) depend not only on timely diagnosis of local growth but on precise analysis of surgical risk factors (SR) as well as accurate definition of its significance. The proposed classification helps to evaluate factors of SR in these patients. Results of the investigation showed that in majority of patients (94.

[Vertical gastroplasty as a treatment method in morbid obesity].

Since November 1992 in the RRCS. RAMS 38 patients aged 16-61 years (mean body mass 149.9 kg) for obesity of 3-4 grade underwent operation of vertical gastroplasty (VGP) by E.

[An algorithm for differential diagnosis searching in space-occupying lesions of the liver].

The experience of examination of 584 patients with volumetric masses of the liver (VML) of various origin is presented. For successful differential diagnosis of VML and definition of rational surgical policy the algorithm of examination was considered with due regard for diagnostic stages, each of them being characterized by definite complex of tests. It is thought necessary to begin examination with noninvasive and highly informative tests.

[Application of wound coat "Tachocomb" in surgical interventions on liver and pancreas].

From May 1994 to December 1996 the wound coat "Takhocomb" was used in surgical procedures in 23 patients with various diseases of the and the pancreas. "Takhocomb" was mostly applied in various anatomical resections of the liver. Initial hemostasis of the hepatic stump was carried out by careful suturing of bleeding vessels.

[Surgical treatment of chronic calculous cholecystitis and its complications].

Introduction of endoscopic and laparoscopic methods in surgical treatment of chronic calculous cholecystitis and its complications has changed not only the character of surgical interventions, but the surgical policy as well. The operation of choice in uncomplicated calculous cholecystitis is laparoscopic cholecystectomy, which whenever indicated, is advisable to be combined with other surgical interventions allowing the recovery from the concomitant surgical diseases. In complicated calculous cholecystitis in dependence on the character of bile ducts disorder and patient's condition, 3 versions of surgical interventions are possible: one stage radical correction of all pathologic changes of the biliary tract and surgical treatment, including 2-3 separate, less traumatic and more tolerable procedure.

[Method of treatment of volumetric liver masses].

The authors propose the mode of treatment of volumetric masses of the liver which provides possibility to perform ablastic and atraumatic removal of the tumor with prophylaxis of bleeding by creation of the coagulation pellicle in the bed of the removed tumor. The method is based on the rational combination of cryodestruction, mechanical excision and laser coagulation: evaporation by the disfocused laser beam of the frozen bed of the tumor after its cryodestruction and mechanical excision, the principles of the ablastics are being completely kept; at the surface of the hepatic tissue the coagulation scab is being formed. Bleeding and biliary leakage are absent.

[Gallbladder cancer in chronic calculous cholecystitis].

127 cases of gallbladder cancer are analysed. Among them there were 99(78%) women and 28(22%) men. The majority of the patients were at the age from 61 to 70 years; 19 (15%) patients were younger than 50 years.

[Basic principles of surgical policy in complicated chronic pancreatitis].

The paper presents some experience with surgical treatment of 183 patients with complicated forms of chronic pancreatitis. The type of a surgical intervention depended on the pattern of pancreatic morphological changes. Operations of internal drainage of the pancreas in 103 patients with ductal hypertension provide the largest percentage (92.

[Congenital cystic diseases of liver and extrahepatic bile ducts].

The paper presents 30-year experience in treating 158 patients with congenital cystic diseases of the liver and bile ducts. Depending on the pattern of hepatobiliary lesions, the diagnostic value of techniques, such as ultrasound, computerized tomography, scintigraphy of the liver duodenoscopy with THCG was defined. Analyzing the late outcomes provided recommendations for the most optimal surgical management: cystic fenestration and tunneling in hepatic polycystosis, pericystectomy in solitary cysts of the liver, different varieties of bile draining operations in choledochal cysts and Caroli's disease.

[The device for placing ligature in deep wounds].

A special device has been designed to provide safe and convenient placing of a ligature to the dissector or clamp in a deep wound. The device contains fork-shaped working part and a handle. The handle has an obtuse-angle curve and is connected with the working part by a hinge.

[Results of use of sandostatin in pancreatoduodenal resections].

From February 1995 to July 1996 pancreato-duodenal resection has been performed in 12 patients in RCS (7 men and 5 women, mean age 53.6 years). The operation was indicated in malignant tumors of the pancreatic head, big duodenal papilla, distal part of common bile tract (9 patients); benign diseases of pancreas (3 patients).

[Diagnosis and surgical treatment of liver echinococcosis].

The results of surgical treatment of more than 600 patients with liver echinococcosis are analysed. The accuracy of ultrasound in diagnosis of the character of the damage is 88%; the combination of ultrasound methods with serology tests and computer tomography has increased the accuracy to 98-100%. New treatment approaches have been proposed depending on a character, location and extent of liver damage.

[Diagnosis and surgical policy in benign lesions of liver].

The results of the treatment of 430 patients with benign tumors of the liver (BTL), including hemangiomas (41), nonparasitic solitary cysts (49), polycystosis (65) and parasitic hepatic lesions (alveococcosis-91, echinococcosis-184). To determine the character of a volume structure the accuracy of ultrasound and duplex sonography was tested (87.1-91.

[X-ray study of the stomach after vertical gastroplasty in the treatment of morbid obesity].

The operation vertical gastroplasty is used to treat the so-called morbid obesity. It ends with the formation of a small stomach. Some experience gained with X-ray of the stomach is analyzed in 17 patients undergone vertical gastroplasty.

[The use of contact impulse-periodic YAG-ND laser in surgery of major duodenal papilla].

YAG-Nd impulse-periodic laser scalpel in elimination of major duodenal papilla stenosis was tested experimentally. The direct damaging influence of the laser was tested in acute experiments and the optimal power of irradiation (5 W) was chosen. The processes of regeneration of the wound inflicted by laser irradiation were tested in chronic experiments.

[First experience with vertical gastroplasty in the treatment of patients with 4th-degree obesity].

The article discusses four operations for vertical gastroplasty performed for the first time in Russia at the Research Centre of Surgery, RAMS, for degree IV obesity (the body weight of the patients ranged from 115 to 183 kg). The suturing instruments CEEA-28, TA-90, and CIA-90 manufactured by Auto Suture Instruments, USA, were used. Subsequent examination of patients in follow-up periods of as long as 4 months showed a favorable effect of the operations: body weight reduced, the patient's health and the course of concomitant diseases was milder.

[Use of tumor markers in the differential diagnosis of voluminous formations of the liver].

The radioimmunological method was used to determine the content of tumor markers APP, REA, CA 19-9, and CA 72-4 in 53 patients with nonmalignant three-dimensional structures in the liver (hemangioma, nonparasitic cysts, alveococcosis, hydatid cysts), in 9 patients with primary carcinoma of the liver, and in 24 healthy individuals. The significance of APP determination and complex study of tumor markers in the recognition and differential diagnosis of benign and malignant structures in the liver is shown. It allowed the percentage of disparity between the laboratory and the verified diagnosis to be reduced to 4.

[Diagnosis and treatment of neoplastic diseases of extrahepatic bile ducts and major duodenal papilla].

Fifty-three operations were conducted on 48 patients for tumors of the extrahepatic bile ducts and the major duodenal papilla. Early diagnosis of this pathological condition is very difficult, which affects directly the results of treatment; 18% of patients underwent radical operations. Modern diagnostic methods--computer tomography, ultrasonic examination, and endoscopic retrograde pancreatocholangiography made it possible to detect neoplastic diseases in all of the examined patients.