[Living related liver transplantation in the Republic of Uzbekistan: current status and development prospects]. / Rodstvennaya transplantatsiya pecheni v Respublike Uzbekistan: nyneshnee sostoyanie i perspektivy razvitiya.

OBJECTIVE: To analyze primary results of living related liver transplantation in the Republic of Uzbekistan. MATERIAL AND METHODS: There were 44 living related transplantations of the right liver lobe in patients with decompensated liver failure between February 2018 and February 2023. RESULTS: Uneventful postoperative period was observed in 17 (38.6%) recipients. Other 27 patients (61.4%) developed 47 various postoperative complications (1-3 events per a patient). Of these, 8 (18.2%) patients required early postoperative re-laparotomy. Among 44 patients, 9 (20.5%) ones died in early postoperative period, and one patient died in long-term period (3 years after transplantation) from chronic rejection under refusal to take immunosuppressive drugs. Early satisfactory results were obtained in 79.5% of patients, long-term favorable outcomes - in 77.3% of cases. CONCLUSION: Engraftment rates and survival of recipients to a large extent depend on surgical strategy, baseline disease and clinical severity. The so-called "center effect" is essential at initial stages of implementation of the program.

[Immediate outcomes of pancreatoduodenectomy after different digestive reconstruction procedures]. / Blizhaishie rezul'taty pankreatoduodenal'noi rezektsii posle razlichnykh variantov rekonstruktsii pishchevaritel'noi sistemy.

OBJECTIVE: To study the immediate results of pancreatoduodenectomy depending on digestive reconstruction procedure. MATERIAL AND METHODS: We analyzed 242 patients who underwent pancreatoduodenectomy for the period from January 2013 to December 2019. There were 32 combined procedures: 28 (11.6%) with portal vein resection and 8 (3.3%) simultaneous operations (right-sided hemicolectomy - 4, right-sided adrenalectomy - 2, gastrectomy with splenectomy - 2). Pancreatic stump was inserted into the jejunum in 156 (64.5%) patients, into the stomach - in 86 (35.5%) cases. RESULTS: Postoperative period was uneventful in 180 (74.4%) patients. Eighty postoperative complications were observed in 62 (25.6%) patients; 221 (91.3%) patients were discharged, 21 (8.7%) patients died. Pancreatic necrosis was the most common postoperative event and provoked 65 (82.5%) various complications (38 (72.1%) in patients with pancreaticojejunostomy and 20 (71.5%) in those with pancreaticogastrostomy). Incidence of complications was similar in both groups. However, pancreaticojejunostomy was followed by severe pancreatic fistula type C in 12 (23.1%) patients, type B in 24 (46.1%) cases. In case of pancreaticogastrostomy, pancreatic fistula type C occurred in 4 (14.3%) cases, type B - in 8 (28.6%) patients. CONCLUSION: Pancreatic necrosis was the most common postoperative event after pancreatoduodenectomy. Fewer severe pancreatic fistulae (type C) were recorded after pancreaticogastrostomy although these patients had lower density of the pancreas and unclear pancreatic duct. Choice of pancreatic-digestive anastomosis should be determined by features of pancreatic parenchyma, pancreatic duct diameter. Nevertheless, final decision is a prerogative of surgeon. Pancreaticogastrostomy is especially advisable in minimally invasive PDEs that will simplify inclusion of the pancreas into digestive system and reduce the incidence of complications and mortality.

[Early outcomes of open, laparoscopic and robot-assisted pancreatoduodenectomy]. / Blizhaishie rezul'taty otkrytykh, laparoskopicheskikh i robot-assistirovannykh pankreatoduodenal'nykh rezektsii.

AIM: To study immediate results of open, laparoscopic and robot-assisted pancreatoduodenectomy for malignancies. MATERIAL AND METHODS: There were 158 patients with cancer of biliopancreatoduodenal area. Open procedures were performed in 118 cases, laparoscopic in 17, robot-assisted pancreatoduodenectomy - in 23. RESULTS: After 'standard' pancreatoduodenectomy 31 (62.0%) complications were registered, after laparoscopic - 12 (24.0%) and aWfter robot-assisted surgery - 7 (14.0%) complications. Relationship between probability of complications was absent (correlation coefficient 0.10491), however, significant differences in incidence of complications after various surgical approaches were observed (c2=6.8832; df=0.9679; p<0.05). CONCLUSION: Laparoscopic and robot-assisted pancreatoduodenectomy was not followed by advanced early postoperative morbidity. Moreover, minimally invasive approach was associated with improved outcomes.

[Diagnostics of stenosis of the major duodenal papilla in patients with choledocholithiasis].

The article presents results of treatment of 63 patients with cholecystocholedocholithiasis from a minilaparotomic access without a preliminary endoscopic papillosphincterotomy (EPST). The method of revision of the common bile duct is described and the diagnostic algorithm after the detection of impaired patency of its terminal part. Stenosis of the major duodenal papilla (MDP) was diagnosed in 7 patients (11.1%) in whom the operation was followed by successful EPST. Based on the data of personal investigations and analysis of literature the authors made a conclusion that preoperative diagnostics of stenosis of MDP was problematical. This diagnosis must be made using a complex of intraoperative diagnostic methods among which the probe of MDP is of main significance.