[Experience of performance of laparoscopic adrenalectomy using lateral transabdominal approach].

In 2002-2008 yrs. in the Department of Laparoscopic Surgery and Cholelithiasis in 52 patients laparoscopic adrenalectomy (LA) was accomplished, performed for different diseases of suprarenal glands. Incidentaloma was diagnosed in 8, fibroma--in 4, pheokhromocytoma--in 10, aldosteroma--in 11, adrenocortical cancer--in 3, corticosteroma--in 13, suprarenal gland cyst--in 3 patients. The operation time in right-sided and left-sided LA had constituted accordingly 85 and 118 minutes. Intraoperative blood loss had constituted 60 ml at average. Hemotransfusion was not done. In 1 (2.4%) observation hemoperitoneum had occurred as a result of traumatic damage of spleen during performance of left-sided LA. Intraoperative complications were absent. The stationary treatment duration was 2.6 days at average.

[Laparoscopic interventions for adrenal gland tumor].

Clinical course, hormonal characteristics and efficacy of rehabilitation were studied by the authors in 12 patients with suprarenal gland tumor, operated, using minimally invasive endoscopic intervention--laparoscopic adrenalectomy (LA). Efficacy, indications, contraindications, role of LA in the treatment of surgical adrenal diseases were analyzed. LA is characterized by invasiveness and traumaticity, adequate radicalism, quick rehabilitation, and good remote results. LA is indicated for the treatment of majority of hyperplastic and tumoral diseases of suprarenal glands: it is possible to operate 60% of patients with surgical diseases of suprarenal glands using endoscopic technology.

[Multifactorial analysis of results of the open and endo-biliary surgical treatment of patients with obstructive jaundice due to the distal obstruction of the bile ducts]. / Mnogofaktornyi analiz rezul'tatov otkrytogo i éndobiliarnogo khirugicheskogo vmeshatel'stva u bol'nykh s obturatsionnnoi zheltukhoi, obuslovlennoi distal'noi obstruktsiei zhelchevyvodiashchikh putei.

The were analyzed the results of treatment of patients with the obstructive jaundice (OJ) due to obstruction of the biliary ducts distal part using surgical and endobiliary decompression using the variation statistics methods (distribution of patients on groups depending on the values of the investigated parameters, calculation of the mean values, evaluation of the authenticity of the indexes distinction), the multifactoral correlative-regressive analysis, the complex evaluation of indexes and probit-analysis. The dependence of results of treatment from value of clinical parameters was established, their prognostic significance was determined. The content of the bilirubin more than 300 mmol/l in distal level of affection of biliferous ducts cause high probability of the postoperative complications occurrence (coefficient of determination 34.8%), determining necessity of performance of draining endobiliary intervention on the first stage of surgical treatment. The dependence of lethality from age of patients and duration of the OJ was noted.

[Clinical signs, diagnosis and surgical treatment of extrahepatic biliary duct tumors]. / Klinika, diagnostika i khirurgicheskoe lechenie opukholei vnepechenochnykh zhelchnykh protokov.

Experience of surgical treatment of 271 patients the extrahepatic biliary ducts tumor for the 1992-1999 yrs period is presented. Indirect signs of extrahepatic biliary ducts tumor were revealed in 84% of observations. Depending on the tumor localization the trustworthiness of the endoscopic retrograde pancreatocholangiography method had constituted from 79.8 to 96.4%. Correct diagnosis was established before the operation in 94.3% of patients. Radical operation was done in 93 (34.3%) of patients, including 22 with proximal localization of tumor, 13--with central one, 10--distal, 48--terminal. Palliative operation was performed in 178 patients, in 76 of them biliodigestive anastomosis was done. Total postoperative mortality was 14.8%.

[Diagnoses and treatments by transcutaneous transhepatic approach in patients with obstructive jaundice]. / Vypolnenie diagnosticheskikh i lechebnykh vmeshatel'stv s ispol'zovaniem chreskozhnogo chrespechenochnogo dostupa u bol'nykh s obturatsionnoi zheltukhoi.

In 298 patients with obstructive jaundice, including 271 (90.9%) with tumoral genesis, endobiliary interventions were performed: transcutaneous transhepatic cholecystectomy--in 76, external cholangiostomy--in 155, external-internal cholangiostomy--in 97, endoprosthesis of biliary ducts (BD)--in 23. Of 155 patients, to whom external drainage of BD was done, recanalization of obstructed portion was performed in 53. Of 102 patients, to whom external drain was adjusted, in 23.1% the complications occurred. Hospital mortality had constituted 22%. The BD perforation was noted in 8 observations. The patients life span, in whom the external-internal BD drainage was done, was 7.8 months, an efficacy of endoprosthesis had constituted 97.3%. The life span of such patients was (9.2 +/- 2.4) months at average.

[The application of extracorporeal shock-wave lithotripsy in the treatment of choledocholithiasis]. / Primenenie ékstrakorporal'noi udarnovolnovoi litotripsii v lechenii kholedokholitiaza.

The method of extracorporal shockwave biliary lithotripsy was introduced in the clinic since 1993 yr in patients with residual choledocholithiasis. The method was applied in 25 patients. Cholecystectomy with external drainage of common biliary duct was performed in all patients beforehand. Positive result was noted in 16 observations. All patients are alive.

[Lessons on laparoscopic cholecystectomy (summary of the experience]. / Uroki laparoskopicheskoi kholetsistéktomii (obobshchenie opyta)].

The experience of laparoscopic cholecystectomy conduction in 6524 patients with nontumoral diseases of gallbladder (chronic calculous cholecystitis, an acute calculous cholecystitis, chronic noncalculous cholecystitis, the gallbladder polyposis) was summarized. While comparing the initial seizing experience in laparoscopic cholecystectomy in the clinic the tendency was noted, trusting the skills improvement in management of laparoscopic technique, permitting to reduce the contraindications quantity for laparoscopic cholecystectomy. Several principles were elaborated, which is necessary to follow doing laparoscopic cholecystectomy for improvement of results of treatment in patients and for complications reduction.

[Laparoscopic interventions on choledochus: 5 year experience]. / Laparoskopicheskie vmeshatel'stva na obshchem zhelchnom protoke: piatiletnii opyt.

Complex examination of 69 patients with complicated cholelithic disease was performed. The elaborated in the clinic algorithm for preoperative examination of the patients was applied to reveal the main bile ducts pathology. Indications for the laparoscopic interventions on choledochus performance were substantiated.

[The use of endobiliary interventions for purulent cholangitis in patients with obturation jaundice]. / Primenenie éndobiliarnykh vmeshatel'stv po povodu gnoinogo kholangita u bol'nykh s obturatsionnoi zheltukhoi.

Endobiliary interventions--external cholangiostomy, external-internal drainage, the biliary ducts endoprosthesis--were done in 156 patients with obturational jaundice of various genesis, complicated by purulent cholangitis. The method of the dosed decompression after transcutaneous transhepatic cholangiostomy, which was performed one day before, being applied in 37 patients, was proposed. Application of the method in complex with antibacterial therapy and the extracorporeal detoxication methods had permitted to lower the mortality down to 12.6%, in patients with the abscesses formation cholangitis--to 28.5%. After the stabilization of general status occur 72 patients were operated on.

[Transcutaneous transhepatic cholangiography and endobiliary interventions in patients with obstructive jaundice]. / Chreskozhnaia chrespechenochnaia kholangiografiia i éndobiliarnye vmeshatel'stva u bol'nykh s obturatsionnoi zheltukhoi.

Complex of rational investigation and treatment of the patients with hepatic portal tumor, including transcutaneous transhepatic cholangiography, was proposed. In 285 patients with obstructive jaundice various endobiliary interventions were performed. External cholangiostomy was done to 98 patients, external-internal drainage--in 92, endostenting--in 18, cholecystostomy--in 76. Endobiliary intervention was applied solely in 31.5% of patients, and in the rest--as the preparation to laparotomy.

[The use of x-ray contrast methods in the differential diagnosis of the causes of ascites]. / Primenenie rentgenokontrastnykh metodov v differentsial'noi diagnostike prichin astsita.

Transcutaneous transhepatic lymphography was conducted in 116 patients with hepatic cirrhosis 127 times in total to study up the type of plasma flow. An inguinal nodulolymphography was performed additionally in several patients. Peripheral type of the plasma flow with the lymphatic vessels net arrangement on periphery of hepar was revealed in 46 patients, the lymphatic ducts blockade on the level of lig. gastroduodenalis, LI-LII vertebral bodies, forming the cisterns--in 24 and without them--in 7 thoracic duct blockade close to its outfall--in 48, and in 11 of them--extended type of the duct outfall. The choice of operative procedure--hepatic extraperitonealization, intraperitoneal and peripheral lymphovenous anastomosis conduction--was accomplished according to the type of the plasma flow present.

[Tactics for treating multiple liver abscesses formed after creation of a biliodigestive anastomosis]. / Taktika lecheniia mnozhestvennykh abstsessov pecheni, obrazovavshikhsiaposle nalozheniia biliodigestivnykh anastomozov.

The authors treated 18 patients with multiple cholangiogenic hepatic abscesses, which developed after creation of the biliodigestive anastomoses due to digestive-biliary reflux with prolonged retention of food masses in the bile ducts, duodenostasis and stenosing of the anastomosis. Puncture of the abscesses under guidance of sonography in combination with complex antibacterial therapy, timely correction of digestive-biliary reflux contributed to achieving the satisfactory result of treatment.

[The complex diagnosis of high obstruction of the bile ducts]. / Kompleksnaia diagnostika vysokoi obturatsii zhelchnykh protokov.

On the basis of the results of examination of 275 patients with high obstruction of the bile ducts of different genesis, it is shown, that ultrasound diagnosis permits correct establishment of the nature of jaundice in 96%, level of obstruction in 75.8% of cases. In use of combination of the direct methods of ante- and retrograde cholangiography and sonography, the precise diagnosis permits to determine the possible volume of operative intervention.