[Laparoscopic treatment of perforated ulcers].

It was done comparative analysis the results of different treatment options using of laparoscopic treatment of 331 patients with perforated ulcers. It was defined that postoperative complications frequency is increased to 1.6% in case of perforated ulcers suturing with diameter to 0.7 cm. This indication is increased to 7.1% in case of perforated ulcers suturing and plugging by greater omentum with holes diameter to 1.0 cm. The complications are absent in case of perforated ulcer excision with subsequent vagotomy and pyloroplasty.

[Treatment of patients with a high risk of gastrointestinal bleeding recurrence].

Of 1102 patients with gastrointestinal ulcer bleeding, 143 developed the recurrence during the hospital stay. 9 critical risk factors of the recurrence were distinguished. The optimal treatment strategies of gastrointestinal ulcer bleeding were worked out, which allowed to decrease the mortality rate from 6.4 to 2.4%.

[The differential approach to appendectomy after the appendicular infiltrate].

84 patients with the acute appendicitis, complicated by the appendicular infiltrate were divided in 2 grpups: the first group consisted of 49 (58,3%) patients with periappendicular abscess; the second group included 35 (41,7%) patients, treated conservatively and were recommended the delayed appendectomy. Of all 84 patients, included in the study, the delayed appendectomy could had been performed in 51 (61%) cases, though only 27 (53%) of patients had the procedure. The thorough analysis of the clinical presentation and pathomorphological data of 51 patients with the clinical presentation of the arrested appendicular infiltrate demonstrated, that only 14 (28%) of them had indications to the the delayed appendectomy. The pathogenetic feedback between the appendicolitis and appendicitis recurrence possibility was established. The necessity of differential approach to the delayed appendectomy in patients with appendicular infiltrate was determined. The safety and efficacy of the laparoscopic appendectomy by the disease was demonstrated.

[The prevention and treatment of the gastroduodenal ulcer bleedings].

The results of the complex prophylaxis and treatment of 33 458 patients with gastric or duodenal ulcer were analyzed. Of the analyzed group, 1002 (2,99%) patients experienced ulcer bleeding. The complex out-patient and stationary treatment of the ulcer disease allowed of bleeding frequency from 8,6 to 2,1%; the decrease of recurrent bleedings from 13,0% to 0; allowed to avoid major surgery (the previous frequency was as high as 14,5%) and decreased lethality rate from 9 to 1%.

[Antibiotic therapy by suppurative diseases of the abdominal cavity and soft tissues].

Microbial background of the departments of abdominal and septic surgery was monitored and analyzed. More the 950 samples from each department was worked out. Therefore, it was determined, that gram-negative bacteria were more typical for the abdominal pathology, whereas, soft tissue infection was represented by gram-positive strains. Compliant antibioticogramms were performed and analyzed. For achieving effective prophylactic and empiric antibiotic therapy, data-based formular lists of antibacterial drugs were performed.

[Non-tension abdominal wall plasty by incarcerated postoperative ventral hernias].

Treatment results of 31 patients with incarcerated postoperative ventral hernias were analyzed. Mesh hernia repair was used in all cases. Signs of hernia incarceration or intestinal obstructions were absolute indications for surgical treatment. Irreducible postoperative ventral hernia was considered as a relative indication for the operation. 16 (51,6%) operated patients had complications: 14 (45,2%) patients had seromas of the operative wound, in 11 of them seroma persisted more then 14 days. Seromas were punctured and evacuated in all of them, no suppurations were registered. 1 (3,2%) patient developed pneumonia postoperatively. Lethal pulmonary embolism occurred in one (3,2%) female patient on the first postoperative day. No hernia recurrences were registered.

[Laparoscopic appendectomy during pregnancy].

Results of diagnostic laparoscopy and laparoscopic appendectomy in 28 pregnant women are presented. Diagnostic laparoscopy was carried out in 9 women (32%), laparoscopic appendectomy--in 19 women (68%). Advantages of laparoscopic appendectomy are especially notable at late pregnancy. Due to small traumaticity amount of postoperative complications reduces, rehabilitation terms decrease, good conditions are formed for adequate self-independent birth activity and birth of healthy infants. Laparoscopic appendectomy application allows minimizing negative influence of carboxyperitoneum on pregnant uterus and fetus.

[Mechanical suture at the surgery of perforated ulcer].

Original spring clip for laparoscopic suturing of perforated ulcers was studied experimentally on rabbits. These clips were used at 26 patients. Mean time of surgery was 17 min, hospital stay -- 5,8 days, there was one complication. Suturing of perforated ulcer with spring clip and additional antiulcer therapy during 10-12 days led to ulcer healing at 96,2% cases.

[Laparoscopic resection of the stomach by Billroth-I technique]. / Laparoskopicheskaia rezektsiia zheludka po Bil'rot-I.

Laparoscopic resection of the stomach by Billroth-I technique is described. Previously different variants of laparoscopic Billroth-II resection and laparoscopy-assisted Billroth-I resection have been performed a complete variant of laparoscopic Billroth-I resection of the stomach the authors reported on Symposium of Endo-surgeons in 2004.

[Laparoscopic diagnosis and treatment of acute pancreatitis]. / Laparoskopicheskaia diagnostika i lechenie ostrogo pankreatita.

Laparoscopy and pancreatoscopy were performed in 2091 (62% of all hospitalized) patients with acute pancreatitis. High informative value of laparoscopy and pancreatoscopy in diagnosis of different morphologic forms of acute pancreatitis is demonstrated. Original fistula for pancreatoscopy was developed. It permits one to evaluate visually the dynamics of repair in the pancreas and surrounding tissues and to correct treatment policy.

[Possibilities in diagnostic laparoscopy of acute appendicitis]. / Vozmozhnosti diagnosticheskoi laparoskopii pri ostrom appenditsite.

Results of diagnostic laparoscopy in acute appendicitis suspects are presented. Laparoscopy allowed examination of the appendix in 96.5% cases, to make final diagnosis in 92.5% and to avoid surgery in 31.2% cases. Larger application of diagnostic laparoscopy in patients suspected of acute appendicitis will reduce significantly rate of diagnostic mistakes, complications and unwarranted appendectomies.

[Laparoscopic appendectomy in acute appendicitis]. / Laparoskopicheskaia appendéktomiia pri ostrom appenditsite.

Minimally-invasive operations were used in 156 patients with acute appendicitis. Laparoscopic appendectomy with ligature method by F. Gotz was performed in 64 (41%) patients (group 1), combined appendectomy--in 32 (20.5%) patients (group 2), laparoscopic operation with ligature method in the authors modification in combination with developed prophylactic complex--in 60 (38.5%) patients (group 3). Conversion to open operation was necessary in 6 (3.8%) patients. Intraoperative complications were seen in 5.1% operated patients, postoperative--in 6.4%, however rate of complications in each group ranged from 10.9 to 1.7%. Results of bacterial examination during different stages of laparoscopic appendectomy are provided. Programme of postoperative complications prophylaxis is described. Algorithm of differential approach to various methods of laparoscopic or minimally-invasive appendectomy in presented.