[BILIARY HYPERTENSION IN CHRONIC PANCREATITIS AND PECULIARITIES OF ITS DIAGNOSIS].

Possibilities of various diagnostic methods for biliary hypertension detection in chronic pancreatitis were analyzed. Biliary hypertension was revealed in 163 (31%) patients, suffering chronic pancreatitis. The laboratory investigations data, ultrasonographic investigation, computer tomography, endoscopic retrograde cholangiopancreatography, magnet-resonance cholangiopancreatography, intraoperative measurement of the biliary ducts width, intraoperative measurement of biliary pressure were applied for diagnosis. Endoscopic retrograde cholangiopancreatography, magnet-resonance cholangiopancreatography and intraoperative measurement of biliary pressure are considered the most sensitive methods for chronic pancreatitis diagnosis.

[ROBOTIC PANCREATECTOMY. TECHNICAL ASPECTS].

Robotic surgery (RS) constitutes a modern stage of the general surgery development, giving evident advantages to surgeons incomplex stages of such durable operation, as pancreaticoduodenal resection (PDR). This method introduction was very slow in pancreatic surgery because of lack in training and skills of specialists. First 10 observations of robotic PDR application were analyzed together with colleagues from Ukraine, who have visited Hospital P. Jakkone of Palermo University (Іtaly). Possible advantages of robotic platform (RP) were analyzed, and comparison of robotic and laparoscopic approaches was made in countries with small experience in RS, such as Ukraine. Albeit high cost of RS, we consider, that more rapid learning curve and shorter patients' hospitalization may give better results. Impact of robotic operative access on oncological results needs further investigations conduction.

[SURGICAL TACTICS IN CHRONIC PANCREATITIS WITH SIGNS OF BILIARY HYPERTENSION].

The results of treatment of 84 patients for chronic pancreatitis with the biliary hypertension signs were depicted. In 83 patients operative interventions were performed, and in 1--positive results were achieved after pancreatic cyst puncture under ultrasonographic control. In 51 patients the conduction of Frey operation have permitted to achieve a lower pressure inside biliary system, in 25--the additional procedures were applied for a biliary hypertension elimination. In 20 patients a method of pressure measurement in biliary system was used.

[Surgical treatment of chronic pancreatitis complicated by biliary hypertension].

The results of 29 patients treatment, suffering chronic pancreatitis, complicated by biliary hypertension, in whom operative interventions in Department of Surgery of Regional Ivano-Frankivsk clinical hospital in 2009 - 2014 yrs, were analyzed. The drainage, resectional and combined interventions were performed. Direct intervention on pancreatic gland was not applied in 5 (17.2%) patients. Operation to Frey was performed in 7 (24.1%) patients, in 4--it was added by choledochojejunoanastomosis formation, longitudinal pancreatojejunostomy--in 13 (44.8%). In 4 (14.8%) patients while functional disorders of adjacent organs present a pancreaticoduodenal resection to Whipple was done. For biliary hypertension diagnosis (including the occult one) the method of intraoperative pressure measurement in common biliary duct (CBD) was proposed. The operation was added by biliodigestive anastomosis formation, using choledochoenterostomy to Roux method if while operations to Frey or Beger after intervention on pancreatic head with the intrapancreatic CBD freeing the intraductal pressure witnessed the biliary hypertension presence. In all the patients good and satisfactory results of operative treatment were noted.

[THE PLACE OF PANCREATICODUODENAL RESECTION IN SURGICAL TREATMENT OF COMPLICATED FORMS OF CHRONIC PANCREATITIS].

Results of surgical treatment of 120 patients, suffering complicated forms of chronic pancreatitis, were analyzed. In 5 patients pancreaticoduodenal resection in accordance to Whipple method have constituted the operation of choice. The indications for operation were: impossibility to exclude completely the malignant process inside pancreatic head; enhancement of the pancreatic head, causing duodenal, common biliary duct and the pancreatoduodenal zone vessels compression; cystic changes of pancreatic head with several episodes of hemorrhage inside the cyst and duodenum. The immediate, short-term and intermediate results of the operation were estimated as good and satisfactory.

[Modern insights into the problem of surgical treatment of chronic pancreatitis].

Results of surgical treatment of 290 patients, suffering chronic pancreatitis, were ana- lyzed. Frey's operation was performed in 125 patients, and in 11 - the biliodigestive anastomoses formation was added for biliary hypertension. Pancreaticoduodenal resection was performed in 8 patients, the Bern's modification of Beger's operation and distal pancreatic resection - in 6 for each, longitudinal pancreaticojejunostomy - in 69. In 46 patients, suffering ripe pancreatic pseudocysts, a cystojejunostomy and cystopancreatojejunostomy were performed, in 6 - endoscopic cystogastrostomy and cystoduodenostomy, in 7 - external drainage of the cyst. In 17 patients, suffering duodenal or the biliary system impassability, a bypass anastomoses were formatted.

[Endoscopic transpapillary interventions in chronic pancreatitis].

The results of treatment of 12 patients, suffering complicated forms of chronic pancreatitis (CHP), in a General Surgery Department of Ivano-Frankivsk regional clinical hospital in 2011 - 2013 yrs, were analyzed. There were 10 (83.3%) men and 2 (16.7%) women, ageing 22-57 yrs old. Previously 6 (50%) patients were treated for an acute necrotic pancreatitis. The changes in a pancreatic duct (PD) type IV in accordance to Cambridge classification was established in 7 patients, type III--in 3, type IIa--in 2, type IIb--in 1. Virsungolitoextraction with previous pneumodilatation without stenting of PD was accomplished in 4 patients, stenting with pneumodilatation for stricture of PD--in 6, stenting for defect in PD--in 2. Good and satisfactory results were achieved in all the patients. The pain syndrome was absent in 10 (83.3%) patients, 2 (16.7%)--suffered from periodic moderate pain in epigastric region. Endoscopic interventions on the PD must be considered the first stage of surgical treatment in patients with CHP. They must be applied wider due to their reduced invasiveness than open procedures. Open operative intervention must be considered as a second stage of surgical treatment in patients with previous unfair or ineffective endoscopic treatment.