[Variants of choice of surgical treatment of chronic pancreatitis in consideration of morphological changes in the pancreas].

The results of examination and treatment of 445 patients with chronic pancreatitis were analyzed. It was established, that 298 (67%) patients had indications for treatment in the conditions of surgical hospital. The patients were divided into three groups according to the modified pancreatitis classification of Marseilles-Rome 1988. There were the calcifying form (n = 78), obstructive form (n = 81), inflammatory form (n = 139). The application of modern methods of diagnostics and treatment of chronic pancreatitis allowed modifying the classification by selection of subgroups for each form of the disease. It was stated, that the substantiation of variants of surgical treatment of chronic pancreatitis in consideration of morphological changes in the pancreas could improve the possibilities of medical care plan for patients with minimal complications and good quality of life in long-term period of time.

[Features of chronic pancreatitis pathomorphism in the validity of surgical approaches].

The results of examination and surgical treatment of 298 patients with chronic pancreatitis and the original morphological investigations of material of the pancreas were studied. The data allowed the detection of additional criteria features of inclusion of the patients with chronic pancreatitis to be made in groups according to foreign Marseilles-Roman classification (1988). It is shown, that the basis of study of morphogenesis of chronic pancreatitis is immunohistochemical method, which let the authors diagnose not only the pathological changes of exo- and endocrine sections of pancreas, but at the same time the structural features of nervous apparatus and vessels of microcircular bed. The revealed morphological features of different forms of chronic pancreatitis vs clinical finding characteristics and the data of instrumental and laboratory methods of research allow the substantiation of surgical treatment version to be made.

[Mesh hiatal closure in antirelux surgery].

The article analyzes the experience of application of polymeric (mesh) implants for hiatal closure in patients with gastroesophageal reflux disease (GERD). The authors showed the main principles of the choice of mesh implants and recommendations to their usage. Principal technical stages of surgery are described. It is noted, that the application of prostheses had the high efficiency and safety in antireflux surgery.

[The combined treatment of peptic esophagus strictures in patients with gastro-esophageal reflux].

The clinical picture of peptic esophagus strictures in 16 patients with gastro-esophageal reflux was analyzed. The strategy of the combined treatment, including surgery, has been thoroughly substantiated. The method of endoscopic dysphagia elimination has been described. The possibilities and technical features of antireflux gastroesophageal reconstructions were analyzed. Early and long-term follow-up results were obtained and used in practical recommendations.

[Columnar-celled metaplasia and adenocarcinoma of the esophagus in inhabitants of the Leningrad oblast (by the data of esophagogastroduodenoscopy)].

The article presents an analysis of results of 24 384 endoscopic examinations of the upper gastrointestinal tract in population of the Leningrad oblast with symptoms of gastric dyspepsia during the period from 2007 to 2011. The detection of the columnar-celled metaplasia was 1.1%, adenocarcinoma of the esophagus--0.045%. Esophageal adenocarcinoma occurred in 3.95% of cases of the column-celled esophagus. Barrett's esophagus was revealed in males more often than in women (56.5% and 54.5% respectively). The peak incidence of esophageal adenocarcinoma in males was at the age from 46 to 60 years (36.4% of patients), in females--from 61 to 75 years (27.3% of patients). Intestinal metaplasia was detected in 72.7% of cases with esophageal adenocarcinoma: The diagnosis of long and short segment of column-celled esophagus revealed no significant difference in the development of esophageal adenocarcinoma.

[Injury to the liver in patients with severe combined traumas].

Experience with treatment of 220 patients with a severe combined trauma who were subjected to surgical intervention on abdominal organs was analyzed. In 164 of them (74.8%) there was a closed trauma, in 56 (26.2%) abdominal wounds were diagnosed. Injuries of the liver resulting from the closed trauma of the abdomen were revealed in 41 (25.6%) patients. For the assessment of severity of the injury and determination of the strategy of treatment the authors have developed a classification of liver injuries.

[To the question of indications for surgical treatment of gastroesophageal reflux disease and its complications].

Creating of the universal doctrine of the treatment of gastroesophageal reflux disease is one of the main problems of theoretical and practical gastroenterology. From the standpoint of modern concepts of the pathogenesis of GERD, the variety of its clinical manifestations detail the pros and cons of its pharmacological influence and antireflux surgery. Reflected tactical approaches to address the combined complications of gastroesophageal reflux. We demonstrated the efficacy of medical and surgical treatments for disease. Based on the literature analysis were performed the indications for surgical correction of individual variants of the disease.

[Tactical and technical aspects of current treatment of patients with Mirizzi syndrome (communication 2)].

The results of treating 29 patients with Mirizzi syndrome are analyzed: 17 patients underwent traditional surgery, 11 patients--laparoscopic procedures, and endoscopic sphincterotomy with nasobiliary drainage was performed in a type I patient. Laparoscopic operations were performed in patients with types I and II syndrome, patients with types III and IV had only open surgery. In 2 cases operations were complicated by iatrogenic injury to the hepaticocholedochus, in 4 cases--by residual bile duct stones. Pronounced inflammatory alterations and scarring of the hepaticocholedochus, III and IV types of the syndrome were considered as indications for prolonged temporary stenting with plastic stents in 12 patients. Long-term results were studied with follow-up from 1.5 to 9 years. No patients out of 29 suffered cholangitis or biliary strictures.

[The diagnosis and treatment of chromaffinomas].

The results of examinations and surgical treatment of 117 patients with chromaffin tumors are shown: one-sided localization in the adrenal in 88% of the patients, bilateral localization in 4.3%, and extraadrenal in 7.7%. An analysis of the possibilities of the laboratory-instrumental diagnosis of chromaffinomas has shown that the method should be used in case of valid need. The absence of changes to the level of catecholamines and their metabolites in urine does not exclude the presence of chromaffinomas. The optimal access for the ablation of chromaffinoma of the adrenal larger than 5 cm in diameter is thoracofrenotomy in the tenth intercostal space. Endovideosurgical interventions in the adrenals can be used for the size of chromaffinoma less than 5 cm in diameter and with the absence of signs of malignisation and marked hemodynamic disorders. The superior medial laparotomy is expedient for extraadrenal pheochromocytoma of the abdominal area and for bilateral localization in the adrenals.

[Laparoscopic surgery in colorectal tumors]. / Laparoskopicheskaia khirurgiia pri opukholiakh priamoi i obodochnoi kishki.

The authors describe their first experience with using less invasive laparoscopic methods in patients with tumors of the rectum and the colon. Twelve operative interventions were performed. The method and technique of endovideosurgical operations on the colon are described. The intraoperative and postoperative complications are analyzed. The authors not rich experience with performing laparoscopic interventions on the colon shows the necessity of stepwise and thorough mastering the method and of using strictly individual indications for such operations.

[The combined endoscopic surgery of gallstones complicated by diseases of the terminal common bile duct]. / Kombinirovannaia éndoskopicheskaia khirurgiia zhelchnokamennoi bolezni, oslozhnennoi zabolevaniiami terminal'nogo otdela obshchego zhelchnogo protoka.

The article deals with combined endoscopic treatment of cholelithiasis complicated by pathological changes of the terminal part of the common bile duct in 104 patients: in 81 of them there was choledocholithiasis (5 of them had the Mirizzi syndrome). 15 patients had choledocholithiasis and papillostenosis, 8 patients had papillostenosis. Papillosphincterotomy with laparoscopic cholecystectomy was performed in 50 patients, in 4 senile patients only papillosphincterotomy was performed. Laparoscopic cholecystectomy and interventions on the common bile duct were fulfilled in 46 patients; in 27 cases the duct was drained by the method of Holsted-Pikovskii, in 13 cases--after Kehr, in 3--after Vishnevskii. In 2 cases the concrements were removed through the cystic duct, the common bile duct was not drained. The supraduodenal choledochoduodenoanastomosis was made in one patient. The open operation was performed in 4 cases (3.9%). One patient died (1%). The experience shows that the modern endoscopic technique allows the whole program of intraoperative revision and sanitation of the hepaticocholedochus and its drainage to be realized. Advantages of the combined endoscopic treatment of the cholelithic disease complicated by a lesion of the terminal part of the common bile duct as compared with traditional surgery are evident. They are: decreased postoperative pain syndrome, less amount of complications, good cosmetic affect, shorter period of reconvalescence, high economic effect.