[Classification, differentiated and topic diagnosis, and treatment of hepatic cystic lesions].

Accumulated in 2004-2014 yrs in Department of laparoscopic surgery and choledocholithiasis experience of treatment in patients, suffering parasitic and nonparasitic hepatic cysts, was analyzed. Own improved classification of hepatic cystic lesions was proposed. Peculiarities of performance of open operations, of the puncture miniinvasive operations and interventions for hepatic cysts, using laparoscopic approach, were enlighten. Main indications for surgical treatment of hepatic cysts were adduced, depending on their kind, size, localization and clinical signs.

[The trocar hernia after laparoscopic operative interventions. classification, treatment, prophylaxis].

Own experience of treatment of patients, suffering trocar hernias, occurred after laparoscopic operative interventions, was analyzed. Classification of trocar hernias was proposed, the main factors of risk and prognostic criteria of a trocar hernias formation were analyzed. The main methods of the trocar hernias correction are adduced.

[Laparoscopic surgery performed for focal liver pathology of various etiology].

The own experience on surgical treatment of more than 400 patients, suffering parasytic and nonparasitic hepatic cysts, benign and malignant hepatic tumors, using laparoscopic technologies, was summarized. Indications for laparoscopic operations, the main technical aspects, immediate and late follow-up results were analyzed. Advantages of laparoscopic operations in comparison to open operative interventions in thoroughly selected patients were noted.

[The modern approach to endoscopic drainage of pancreatic pseudocysts].

The results of endoscopic surgical procedures performed in 72 patients over postnecrotic pseudocysts (PPC) of the pancreas. Complications occurred in 9 (12.5%) patents, recurrence PPC pancreas after endoscopic procedures were observed in 6 (8.3%).

[Experience of high frequency electric welding in endocrine surgery].

The comparative analsis of the effectiveness of surgical interventions performed by the standard method and using electric welding technology in endocrine surgery was hold. Compared duration of surgery, amount of intraoperatve blood loss, frequency of intra- and early postoperative complications. Found that the use of weding technology ensures shorter duration of surgery, on average by 30%, amount of blood loss--by 20-50%, the frequency of intra- and early postoperative complications.

[Simultaneous laparoscopic operations for biliary calculous disease, inflammatory and cystic diseases of abdominal organs].

The results of treatment in patients, in whom biliary calculous disease and inflammatory and cystic diseases of abdominal organs were diagnosed simultaneously, were analyzed. Main aspects of diagnosis and prognostication of efficacy of simultant operations conduction, technical rules of surgical interventions were presented. In such patients there were elaborated indications for performance of simultant completely laparoscopic and laparoscopic combined operations.

[Simultant laparoscopic operations for biliary calculi disease and hernia of the anterior abdominal wall].

The results of treatment of patients, in whom biliocalculous disease and hernia of anterior abdominal wall were diagnosed, were analyzed. The main aspects of diagnosis and prognosis of simultant operations in such patients, some technical procedures of operative interventions were depicted. Indications for performance of simultant completely laparoscopic and simultant laparoscopic combined operations in these patients were determined.

[Laparoscopic therapy of organic hyperinsulinism].

The results of laparoscopic treatment were analyzed in 9 patients, suffering pancreatic insulinoma, in the clinic in 2008-2012 yrs. Tumoral enucleation was performed in 6 patients, distal pancreatic resection--in 3. In 1 (11.1%) patient postoperative external pancreatic fistula have developed. All the patients are alive. Laparoscopic treatment of the patients, suffering insulinoma is effective and secure.

[Endosonography in diagnosis of distal biliary stenosis].

Diagnostic validity of endoscopic ultrasonography (EUS) was estimated retrospectively in 34 patients, suffering distal biliary stenosis, revealed during endoscopic retrograde cholangiopancreatography or magnet resonance cholangiopancreatography, in whom the cause of the block was not revealed in accordance to the CT data obtained. Nontumoral stenosis was diagnosed, when normal in layers structure of the biliary ducts walls was safe, not depending on a new tumor presence. In other situations stenosis was considered having tumoral genesis. The definite diagnosis of stenosis was established after morphological investigation in 18 patients--postoperatively and during dynamic follow-up--in 16. Diagnostic validity of EUS while determining the stenosis cause have had constituted: sensitivity--94.1%, specificity--82.3%, accuracy--88.2%. In a tumoral stenosis in accordance to the EUS data there was revealed hypoechogenic mass of irregular form, causing the common biliary duct obstruction and the surrounding tissues infiltration. EUS constitutes an effective method of the biliary stenosis estimation, it permits to determine the diagnosis on the early stages.

[Peculiarities of diagnosis and surgical treatment of nonfunctioning neuroendocrine pancreatic tumors].

The results of diagnosis and treatment in 2004-2012 yrs period of 79 patients, suffering nonfunctioning neuroendocrine pancreatic tumors (NNPT), were analyzed. Effective diagnostic tactic while preoperative predilection on the NNPT presence for the diagnosis verification was proposed, permitting to determine the optimal method of surgical treatment, to introduce organpreserving and laparoscopic interventions, to widen indications for surgery for the NNPT extended forms.

[Estimation of endosonography method in the patients with moderate risk for choledocholithiasis].

Efficacy of endoultrasonography application in conditions of moderate risk for choledocholithiasis occurrence was estimated in 33 patients, in whom ultrasonography (US) did not reveal the common biliary duct concrements. Sensitivity, specificity, accuracy, positive and negative prognostic values of the method in suspicion for choledocholithiasis presence while US performance have had constituted 78.6, 94.7, 82.0, 98.2 and 54.5%; vs for endoultrasonography--100, 94.4, 97, 93.8 and 100% accordingly. Endoultrasonography constitutes a safe and highly effective method of investigation in patients in suspicion of the biliary ducts disease presence, it permits to reveal choledocholithiasis in significant part of patients after ineffective US. This diagnostic option permits to reduce the need for performance of diagnostic endoscopic retrograde cholangiopancreaticography.

[Peculiarities of the blood microcirculation in the anterior abdominal wall in patients with excessive body mass].

Investigation was conducted, using laser Doppler flowmetry (LDF) with the help of LAKK-02 analizator, with the objective to improve the results of surgical treatment and prophylaxis of complications in the postoperative wound healing in patients, suffering concomitant obesity. Characteristic disorders of microcirculation in soft tissues of the anterior abdominal wall in the operative intervention region were analyzed. There were examined 31 patients, suffering obesity stages I-III, their body mass index was (39.11 +/- 0.79) kg/m2 at average. Microcirculation disorders in soft tissues of the anterior abdominal wall have caused worsening of the postoperative period course in the patients. LDF is a highly informative noninvasive method, which have to be used trustworthy for estimation of a microcirculation bed state in the patients, suffering obesity.

[Peculiarities of postoperative complications in laparoscopic surgery].

Retrospective analysis of postoperative complications, occurred in patients, to whom laparoscopic interventions were performed in the Department of Laparoscopic Surgery and Cholelithiasis, was conducted. The rate of inflammatory and thromboembolic complications have constituted 2.2 and 0.1%, accordingly.

[Mepenam application for prophylaxis and treatment of purulent complications of an acute destructive pancreatitis].

The experience of meropenem (Mepenam, manufactured by 'Arterium", Ukraine Corporation) application as a measure for conduction of empirical therapy and for prophylaxis of an acute destructive pancreatitis complications, was summarized. Efficacy of the preparation on different stages of the purulent complications treatment (while applied solely as well as in combination with various kinds of miniinvasive and open operative interventions) was estimated. The recommendations, concerning Mepenam application for various forms of an acute pancreatitis, were elaborated.

[Treatment of nonparasitic hepatic cyst in experiment].

Experimental investigation was conducted in two stages. During the first stage there was planned to create a nonparasitic hepatic cyst simulation and during a second one--various methods of physical processing of the cyst residual cavity with the objective to estimate their efficacy and traumaticity. After fulfillment of the second stage of experiment euthanasia of the laboratory animals was performed during the determined term, histological investigation of preparations was conducted.

[Ultrasonographic diapeutics of the hepatic abscess. Possibilities and achievements].

Transcutaneous interventions (TI) under ultrasonographic control were applied in 163 patients (the main group) for primary pyogenic hepatic abscess (PPHA). For comparative group 31 patients were included, in whom an operative intervention was done (disclosure, sanation and external drainage of the focal lesions). While treating PPHA in 91 patients the TI punctures under ultrasonographic control were made and in 72--transcutaneous drainage was performed. The puncture treatment appeared effective in 88 (96.7%) patients, drainage--in 70 (97.2%), summarized efficacy of TI had constituted 96.9%. The morbidity ratio after miniinvasive treatment of PPHA was lesser than after routine operative treatment. The TI application for PPHA is an effective method of the patients treatment, not dependent on their foci size and the patient general state, it permit to lower morbidity, lethality and period of hospitalization significantly, and to improve the results meaningfully. TI under ultrasonographic control constitutes the method of choice in PPHA treatment, excluding posttraumatic abscesses, chronic hepatic abscesses and intracavitary sequesteres presence.