[Surgical strategy for acute biliary pancreatitis].

Objective: To develop a rational surgical strategy for acute biliary pancreatitis and its complications.

Material And Methods: A 10-year follow-up enrolled 378 patients with acute biliary pancreatitis. Mild pancreatitis was diagnosed in 304 (80%) patients, moderate and severe course - in 74 (20%).

[Pancreatic pseudocysts in recurrent pancreatitis: traditional and mini-invasive surgery/endotherapy. Problems in the treatment strategy choice].

Introduction of methods of miniinvasive surgery/endotherapy have permitted to widen essentially the possibilities of treatment of complicated recurrent pancreatitis. Miniinvasive interventions on pancreatic gland and neighbor organs, as well as laparotomic interventions, must be regarded not as an alternative, but like interchangeable methods, permitting to improve significantly the treatment outcome in an acute destructive and chronic pancreatitis, including those, which is complicated by a pancreatic pseudocysts formation.

[Recurrent pancreatitis as a surgical problem].

Experience in the treatment of 1498 patients with alcoholic pancreatitis treated with laparotomic and mini-invasive surgeries both in acute and chronic phases of the disease is presented. In 742 patients surgical treatment was multistaged. Re-operations in 17 patients with "chronic purulent pancreatitis", reconstructive surgeries on the pancreas, pancreatic and bile ducts in 84 patients with "head" pancreatitis were most difficult.

[Choice of bile-diverting operations in neoplastic obstruction of the distal common bile duct].

Analysis of clinical material of 206 patients with tumor obstruction of the distal part of the common bile duct allowed the conclusion to be made on the expediency of applying endoscopic methods for jaundice correction as the first stage in preparation for the operation (122 patients) and also as the only and final operation (70 patients). Study of the immediate and late-term results of different variants of operations for bile diversion in obstruction of the distal choledochus (203 operations) showed the superiority of the Roux hepaticoejunoanastomosis in which recurrent jaundice due to obstruction of the cystic duct does not occur, as is encountered in creation of a cholecystoejunoanastomosis, and there are no conditions for the development of ascending cholangitis.