[NONSPECIFIC ULCERATIVE COLITIS COMPLICATED WITH MULTIPLE REPETITIVE PERFORATIONS AND DIFFUSE FECALIC PERITONITIS (CASE REPORT)].

Nonspecific ulcerative colitis is disease with complicated and not fully studied etiology and pathogenesis, and treatment of its complications is very difficult. Especially complicated is disease course with repetitive bleeding, toxic megacolon and perforation. We present a quite rare case of complication with multiple, especially repetitive perforations of transverse colon. After 13 days from the performance of subtotal colectomy, the patient underwent to the relaparotomy because of secondary perforation of sygmoid colon 2-3 cm lower from its cult and iliac intestine 0.2-0.3 cm distance from nearby ileostoma. The full eventration took place on the 6th day and was performed repetitive laparotomy. On the 8th day patient was released from artificial ventilation of lungs and on the 66th day from hospitalization patient was discharged from the hospital with satisfactory status. Such kind of serious course of the treatment process was determined by the late hospitalization and developed serious complications. Situation mentioned above more impressively underlines the value of the positive result of presented case.

Pancreatoduodenectomy as classic and pylorus-preserving variant: single center experience.

It is presented and discussed the experience of pancreatoduodenectomy for pancreatic head and ampullary tumors. Of 7 cases of pancreatoduodenectomy 3 were performed as classic Whipple procedure and 4 as modified pylorus-preserving variant (PPPD). It was observed 2 cases of mild pancreatic and biliary leak and 1 patient developed abdominal wall dehiscence after the surgical site infection. There was no operative mortality and overall postoperative morbidity rate was 42,8%. It is concluded,that "end-to-end" pancreaticojejunostomy with stent placement and the PPPD variant are the most optimal and preferred operative procedures at pancreatoduodenectomy cases.

[Surgical treatment for complicated forms of colorectal cancer].

The aim of the study is to evaluate surgical options in complicated forms of colorectal cancer. It was found that radical single-stage surgery as alternative to two- and three stage procedures is the optimal surgical approach in treatment of complicated forms of colorectal cancer. An important role in the prognosis of the rectal cancer patients plays surgeon and his specific interest in colorectal surgery.

[Inguinal hernia repair: classification and the choice of adequate anaesthesia techniques].

In spite of the great achievements in herniology, the problem of inguinal hernia is not solved. The adequate classification is a step to its proper treaty. The classification of the disease is presented in the article. The study confirms the benefits of local anaesthetic-based techniques over both general and spinal anaesthesia for inguinal hernia repair and presents new methods of treatment. The direct and indirect costs of anaesthesia for inguinal hernia repair are lowest when using local anaesthesia with or without sedation. Local anaesthesia-based techniques with conscious sedation fulfil all the requirements for the ideal ambulatory anaesthetic.

[Social aspect of inguinal herniotomy].

This article reviews current concepts of inguinal hernia repair--one of the most common operations in a surgery practice. The social-economic problems of repair of inguinal hernia are also discussed. There is much variation in the time when a patient returns to work after inguinal hernia repair. Factors such as patient expectations are strongly associated with return to work after inguinal hernia repair. Depression significantly delayed return to work. The management of plastic surgery on posterior wall of inguinal canal is recommended as promoting earlier return to work. The problems of Georgia on the way to insurance medicine are also discussed.

[Contemporary surgical interventions and technologies in inguinal hernia].

The aim of the study was the wide-scale implementation of the Sholdais's operation and retinal prosthesis on the territory of Georgia and the countries of the former Soviet Union instead of conventional methods characterized by the high rate of complications. For the treatment of primary hernia in most of cases we were using classical, or more frequently modified Sholdais's method. Operation by Likhtenshtein corresponds to all demands of hernioplastics and it should be implemented as the predominant method in nonspecialized surgical clinics. For elderly patients with wide inguinal space modified Wilky's operation is proposed. In this case the tissue stretching is totally excluded from the procedure.

[Trend of development of groin hernia surgery in Georgia].

According to the data of different authors, despite of evident progress in inguinal herniology, percentage of relapses in non-specialized clinics of general surgery stays rather high (5-15%). In Georgia as well as in other CIS countries 10-15 years ago majority of inguinal hernias were operated by method of Jirair-Spasokukocki using Kimbarovsky sutures. All above mentioned, of course, had an influence on treatment's results, and recurrence rate achieved in 20-45% cases. Since 90-ies method of Shouldice gained ground in Georgia, and already in two years the classical multi-row mode has been modified into the double-row. Also changes underwent the operation technique by Postempsky. Georgian surgeons also worked out several modifications of Bassini, Shouldice methods which are worth to notice. After the second half of 90-ies operation by Lichtenstein has been implemented into the surgical practice. Operations of Nyhus, Stoppa, "Plug and Putch" and PHS-system, and also laparoscopic hernioplasty are gaining popularity noticeably slower. But results of such operations are very promising.