[Ways of stump processing of appendix vermiformis in modern conditions].

The authors analyzed the experience of 517 appendectomies during last three years. There weren't any differences in postoperative course in patients with immersion and ligature methods of stump processing of appendix vermiformis. The ligature method should be considered as leading method in appendectomy in consideration of long-term experience in surgery. The immersion method would be used in presence of contraindications to the ligature method.

[Possible causes of thrombus-related hazard of a distal splenorenal venous anastomosis].

A distal splenorenal venous anastomosis (DSRVA) is used as a method to decompress the portal system in hypertension and as a method to treat type 1 diabetes mellitus. The essence of the operation consists in establishing an «end-to-side¼ anastomosis between the distal end of the transected close to the ostium splenic vein with the left renal vein. Possible shortcomings of this operation include but are not limited to high thrombus-related hazard both in case of using it in portal hypertension and in diabetes mellitus. In the latter, thrombosis of the anastomosis is observed to develop in 27% of diabetic patients within 7-8 postoperative months. The causes of this complication were not studied. The present communication presents the findings of studying the natural pattern of confluence of the portal-system veins performed on a total of 111 cadavers and in 50 patients suffering from chronic hepatitis and undergoing surgery in order to form a left-sided renoportal venous anastomosis. It was demonstrated that DSRVA is associated with impaired natural confluence of the veins and the width of the two veins forming an anastomosis exceeds the width of the blood-outflowing vein more than 1.5-fold. This is followed by analysing the results of studying removability of the pancreas and left kidney in the vertical position by means of excretory urography and probe-assisted duodenography in 54 patients with chronic hepatitis. Removability of the pancreas in 57.4% of cases was greater than that of the left kidney, which is the condition for kinking of the splenic vein in the DSRVA zone. In order to choose an optimal anastomosis and to prevent DSRVA thrombosis it is advisable to preoperatively examine the venous pressure in the left renal vein, removability of the pancreas relative to the left kidney, and during establishing the anastomosis to observe the natural pattern of confluence of veins by the width.

[Left-side venous anastomosis as a method correcting blood outflow from the kidney].

Case histories and surgical protocols of 50 patients who were treated for chronic hepatitis by creating left-side renoportal venous anastomosis (RPVA) were analysed retrospectively. Early after surgery 75% patients had microhematuria, proteinuria to 0.033-0.066 g/l, leucocyturia. At discharge from the hospital these abnormalities were not registered in the majority of the patients. Three months after operation these indices were at the preoperative level. Significant shifts in parameters of urine were associated with an anomalous condition of the left renal vein (annular, retroaortal), its compression, portal hypertension and creation of RPVA without legation of the splenic vein. In a cositive compression test RPVA was created without arrest of arterial inflow for 45 min. This can be a criterion of feasibility of left renal vein ligature if left-side RPVA cannot be performed for preservation of the left kidney. Validity of left-side RPVA use for correction of blood outflow from the left kidney is proven by functional improvement and normal side of the kidneys in long-term postoperative follow-up.

[Anatomic and surgical background for splenorenal venous transposition].

Unilateral portalization of adrenal and renal blood is used in clinical practice for arterial hypertension, chronic hepatitis and type 1 diabetes mellitus management. Left-sided renoportal venous anastomosis (RPVA), spleen vessel ligation and unilateral adrenalectomy (if indicated) are the technical backbone of the intervention. This operation was used for 50 patients with chronic hepatitis. Ten of them were investigated 15-19 years postoperatively. Positive effect on the disease progression was found in the absence of negative consequences for liver, kidneys and spleen. Ultrasonography has demonstra-ted patent anastomosis in all patients. In early postoperative period hyperthermia and epigastrial pain were registered in 14.3% of cases as a consequence of thrombosis in ligated spleen vein stump. The paper describes the development of splenorenal venous transposition (SRVT) technique as an improved variant of adrenal and renal blood unilateral portalization, in which spleen vessel ligation is replaced by splenorenal end-to-end anastomosis. The study included 111 cadaveric experiments. The technique of surgical intervention is described, its clinical requirements and potential obstacles. It is shown that SRVT can be fulfilled in 52.1% of cases with autovein graft. SRVT is more laborious and rare intervention, then single left-sided RPVA and must be initially practiced on cadavers. Indications for SRVT may include arterial hypertension, chronic hepatitis and type 1 diabetes mellitus.

[Experience with unilateral portalization of the adrenal and renal blood in chronic hepatitis]. / Opyt odnostoronnei portalizatsii nadpochechnikovoi i pochechnoi krovi pri khronicheskom gepatite.

An experience with treatment of 46 patients with chronic hepatitis and liver cirrhosis with the help of left-sided renoportal venous anastomosis is described. Unsuccessful therapeutic treatment is an indication to operation. In remote period after operation from 50 to 100% of clinical symptoms disappeared in 80% of the patients. Positive dynamics of the results of biochemical analyses and scanning of the liver was noted. The operation is not indicated in patients with formed cirrhosis, portal hypertension over 240 mm water column, decompensation of the liver functions.

[New approach to surgical treatment of diabetes mellitus]. / Novye podkhody k khirurgicheskomu lecheniiu sakharnogo diabeta.

Results of palliative operations in three patients with diabetes mellitus were analyzed. Operations were directed to a decrease of activity of counterinsular hormones--glucagon, glucocorticosteroids, catecholamines. In one patient with a coexistent chronic hepatitis a positive effect was obtained after left-side renoportal venous anastomosis with ligation of splenic vessels. The ligation of splenic vessels and unilateral adrenalectomy were performed in 2 patients with I and II type diabetes mellitus associated with arterial hypertension. A hypoglycemic and hypotensive result was obtained.

[Oblique-transverse approach to the extrahepatic bile ducts]. / Kosopoperechnyi dostup k vnepechenochnym zhelchnym protokam.

A new access to extrahepatic bile ducts is proposed which keeps the lateral abdominal muscles and intercostal vascular-nervous plexuses intact. The spatial conditions of the access were studied experimentally in 108 corpses. The clinical assessment was tested in 102 operations in comparison with the Kocher access. The oblique-transversal access was found to have advantages from the clinico-physiological viewpoint as well (the development of the postoperative period, restoration of the external respiration function and the function of the abdominal wall muscles).