[Improvement of acute destructive pancreatitis management]. / Stentirovanie glavnogo pankreaticheskogo protoka v kompleksnom lechenii patsientov s ostrym destruktivnym pankreatitom.

OBJECTIVE: To reduce the incidence of complications in acute destructive pancreatitis via stenting of the main pancreatic duct in complex treatment of these patients. MATERIAL AND METHODS: There were 182 patients aged 31-76 (mean 42.8±11) years with acute destructive pancreatitis. All patients admitted to the 1st and the 2nd surgical departments of the Kazan City Hospital No. 7 for the period from 2017 to 2019. There were 78 (43%) men and 104 (57%) women. Two groups of patients were distinguished in order to compare the effectiveness of stenting of the main pancreatic duct in acute pancreatitis: main group (34 patients including 14 men and 20 women) - stenting of the main pancreatic duct, control group (50 patients including 20 men and 30 women) without stenting. RESULTS: Complex diagnosis and treatment of acute pancreatitis in intensive care unit with percutaneous drainage of fluid accumulations under ultrasound control and stenting of the main pancreatic duct reduce postoperative mortality from 16% in the control group (n=50) to 9.2% in the main group (n=34). Moreover, this approach is valuable to localize the foci of pancreatic necrosis in 79% of cases. the An efficiency of endoscopic decompression of the main pancreatic duct was 42% in patients with alcoholic pancreatitis. CONCLUSION: Endoscopic stenting of the main pancreatic duct is effective for pathogenetic treatment of patients with biliary pancreatitis, aimed at reducing intraductal hypertension in the early stages of disease.

[The factors affecting the results of mechanical jaundice management]. / Faktory, vliyayushchie na rezul'taty lecheniya bol'nykh s mekhanicheskoi zheltukhoi.

AIM: To improve the results of obstructive jaundice management by rational diagnostic and treatment strategies. MATERIAL AND METHODS: Outcomes of 820 patients with obstructive jaundice syndrome were analyzed. RESULTS: Diagnostic and tactical mistakes were made at pre-hospital stage in 143 (17.4%) patients and in 105 (12.8%) at hospital stage. Herewith, in 53 (6.5%) cases the errors were observed at all stages. Retrospective analysis of severe postoperative complications and lethal outcomes in patients with obstructive jaundice showed that in 23.8% of cases they were explained by diagnostic and tactical mistakes at various stages of examination and treatment. CONCLUSION: We developed an algorithm for obstructive jaundice management to reduce the number of diagnostic and tactical errors, a reduction in the frequency of diagnostic and tactical errors. It reduced the number of postoperative complications up to 16.5% and mortality rate to 3.0%.

[Correction of bile outflow in complicated calculous cholecystitis]. / Korrektsiia zhelcheottoka pri oslozhnennom kal'kuleznom kholetsistite.

The method of low-traumatic atypical endoscopic papillosphincterotomy (EPST) with an antegradely inserted probe which permits to correct simultaneously bile outflow in choledocholithiasis and strictures of the terminal part of the common bile duct was used in 26 patients with cholelithiasis. Advantage of this surgical policy in complicated forms of calculous cholecystitis is possibility of one-stage treatment. Comparative analysis of one-stage and routine two-stage treatment policies was carried out in 52 patients. EPST permits to avoid stage of retrograde pancreatocholangiography and papillosphincterotomy. Absence of technical difficulties due to EPST and a protective role of the probe which minimizes risk of acute pancreatitis are demonstrated.

[Autodermal-monophylic plasty of postoperative ventral hernias]. / Autodermal'no-monofil'naia plastika posleoperatsionnykh ventral'nykh gryzh.

In the clinic of general and urgent surgery of Kazan Medical Academy in the period 1998-2002 operations were performed on 160 patients with great and giant postoperative ventral hernias. Four variants of autodermal-monophyl plasty were used: contact suturing of the hernia defect margins with strengthening the line of sutures with a autodermal-monophyl flap, autodermal lacing, skin flap armoured with an monophyl thread, and a skin flap crimped with an monophyl thread. The results of the operative treatment were complicated by lymphorrhea in 8 patients, thromboembolism in 4 patients (with lethal outcome in 2 cases). Recurrences were noted in 11% of the patients.

[Methodological aspects of laparoscopic sanitation in patients with diffuse peritonitis]. / Metodologicheskie aspekty laparoskopicheskoi sanatsii pri razlitom peritonite.

In 60 patients with acute diffuse peritonitis 103 laparoscopic sanitations of the abdominal cavity were performed. The personal experiences, investigation of hydrodynamic parameters and peculiarities of redistribution of liquid in the abdominal cavity affected by pneumoperitoneum were used by the authors for developing a method of the sanitation using an irrigation-aspiration device "Brusan". Experimental investigations in 50 rats were carried out for studying the degree of traumatic action on the stomach of different variants of sanitation of the abdominal cavity. They have shown advantages of the apparatus method. The indications and contraindications for using the method were developed. The working classification of the sanitation laparoscopy is proposed.

[Laparoscopic sanitation of the abdominal cavity in combined treatment of peritonitis]. / Laparoskopicheskie sanatsii briushnoi polosti v kompleksnom lechenii peritonita.

Standard methods of treatment were analyzed in 228 patients with general peritonitis of different etiology: sanitation and drainage of abdominal cavity, peritoneal lavage, programmed laparotomy compared with laparoscopic sanitation (LS) performed in 60 patients. A significant decrease in the number of purulent-inflammatory complications, intestinal fistulas and broncho-pulmonary complications were seen after LS. It was most effective for treatment of peritonitis with Mannheim peritoneal index from 16 to 29 points (lethality 11.8%) compared with conventional treatment (p < 0.05). Indications and contraindications for LS, original device "BRUSAN" were developed. Abdominal LS is a highly effective and mini-invasive method of local treatment in general peritonitis.

[Device for treatment of wounds and abdominal cavity]. / Ustroístvo dlia obrabotki ran i briushnoí polosti.

An original device for the wound and abdominal cavity pretreatment has been proposed. It has the following advantages: high rate of effectiveness in wound pretreatment, simplicity in usage, economical use of a washing solution. The device may be used in clinical practice for the wound and abdominal cavity cleansing.

[Laparoscopic cholecystectomy: possibilities, shortcomings, prospects]. / Laparoskopicheskaia kholetsistostomiia: vozmozhnosti, nedostatki, perspektivy.

The results of surgical treatment of acute cholecystitis in 350 patients have been analysed. The role of concomitant diseases and age of a patients in choosing the method of surgical treatment is stressed. The advantages and shortcomings of the low-traumatic surgical methods are discussed. The way of choosing the proper surgical method in treatment of acute cholecystitis is proposed.

[Comparative assessment of methods of extracorporeal detoxication in obstructive jaundice]. / Sravnite'naia otsenka metodov ékstrakorporal'noi detoksikatsii pri mekhanicheskoi zheltukhe.

Comparative analysis of the methods of extracorporeal detoxification in 168 patients was conducted. Endoscopic and surgical methods of treatment were applied in 40 patients without extracorporeal detoxification. Various types of extracorporeal detoxification were used along with endoscopic and operative methods in 168 patients: plasmapheresis (PP) in 72, thoracic duct (TD) drainage in 45, and hemosorption in 41 patients. In another 10 patients various types of detoxification were combined. TD drainage is indicated in prolonged obstructive jaundice, particularly when attended with cholangitis. TD drainage or PP is advisable in concomitant renal failure, PP and hemosorption have a good effect in obstructive jaundice as methods of emergency detoxification. Their efficacy increases if they are applied after endoscopic detoxification of the biliary tract.