[Redoudenization with the formation of antireflux anastomosis in the surgery for operated stomach diseases].

This paper reports the results of surgical treatment of 39 patients with diseases of operated stomach including 26 (66.7%) men and 13 (33.3%) women aged 31-70 (mean 48.2 +/- 13.1) years. Their comprehensive examination revealed restoration of gastric stump tone and peristalsis by the end of the 6th month after surgery. The newly formed invagination canal became functionally active and peristaltic, did not hinder the natural food passage and prevented retrograde food and bile flow from lower to upper segments of the gastrointestinal tract.

[Proctectomy and sphincterolevatoroplasty in cancer of the inferioampular part of rectum with involvement of the anal canal].

Proctectomy with total mesorectumectomy, resection of the interior sphincter, deep parts of the external sphincter and bringing down were fulfilled according to an original authors' method in 7 patients aged from 38 to 78 years for cancer of the inferioampular part of the rectum with tumor located within the limits 8-35 mm from the anus (T3N1MO (n=1), T3NOM1 (n=1), T4N2M1 (n=1). Six months after operation conscious urge to defecation 1-2 times a day and containment of stools were noted and a year later it was possible to ignore urges during 15-30 min. In 5 patients T3NOM0--T3N1M0 relapse-free period for 3-5 years was noted.

[Transabdominal ultrasonic scanning in evaluation of liver parenchyma: new opportunities].

On suspicion of the diffusive liver lesions 117 patients have been performed a transabdominal ultrasound investigation with a visual estimate of the echogenicity of the structure of the liver's parenchyma in comparison with the echogenicity of the cortical substance of the kidney and with the determination of the homogeneity of the liver's structure on its different areas. For the purpose of the elevation of the self-descriptiveness and precision of diagnostics as well as for the reduction of the subjective estimation the authors carried out the evaluation of the structure of the liver's parenchyma and the cortical substance of the kidneys using the histography on the marked area. The elaboration of the efficient quantitative assessment of the changes of the liver's parenchyma allowed to relieve complications in differential diagnostics and to estimate the damage level of the organ's parenchyma objectively during the investigation.

[Delayed results of proximal gastrectomy in patients with esophageal and gastric varices].

An original method of proximal gastrectomy was used to eliminate hemorrhage from gastric and oesophagal varicose veins in 27 patients with portal hypertension. The follow up period varied from 1 to 23 years. The risk of hemorrhage and the degree of vein dilatation were assessed by endoscopy and endoscopic ultrasonography. It is concluded that the method used in the study may be recommended as the first-line surgery for the management of hemorrhage from gastric and oesophagal varicose veins with good functional results in the late postoperative period and rare complications.

[Low anterior resection of the rectum: a new method of forming the reservoir].

A method of forming the rectum reservoir after low anterior resection of the rectum has been developed, consisting in low anterior resection with mesorectumectomy, forming a reservoir from the colon, forming a rectosigmoid passage. The operation was made in 37 patients aged from 47 to 69 years for rectum cancer with the tumor localized in the middle and low ampular part. Complications in the early postoperative period appeared in 16.2% of the patients. There were no lethal outcomes. Mean time of staying at hospital after operation was 11.4 +/- 2.1 days. In the period from 3 to 5 years after operation the indices of fecal continence in patients of the main group and group of comparison (patients operated without forming the reservoir) by Wexner score were close to normal, making 4.6 +/- 0.4 and 3.1 +/- 0.5 scores.

[Antireflux hepaticojejunostomy in treatment of cancer of the head of pancreas or extrahepatic bile-ducts].

193 patients with obstructive jaundice were operated on during the period of 1987-2007 yy. Antireflux hepaticojejunostomy was performed in all cases. 124 (64,2%) patients experienced the radical treatment and 69 (35,8%) - palliative. Valve hepaticojejunoanastomosis was performed when hepatic duct length was 12-15 mm; weather hepatic duct was shorter then 12 mm, the valve was performed in efferent jejunal loop. Preoperative bile ducts decompression allowed decrease risk of hepatic failure and shorten the hospital-stay time after the major operation.

[The function of gastric stump and duodenum after proximal gastric resection in patients with esophageal and gastric varicose veins dilatation].

The authors had developed the technique of proximal gastric resection with cardiac orifice plasty. 21 patients with esophageal and varicose veins dilatation were operated on using the technique. Follow-up period came from 2 to 23 years. Results of the operation allow proximal gastric resection with cardiac orifice plasty to be considered the effective way of prevention and treatment of gastric bleedings of portal hypertension aetiology.

[Surgical treatment of haemorrhoids].

The new improved modification of haemorrhoidectomy was warked out. The mucosa is dissected 0,5-0,7 sm above the node basis, it is separated sharply from the mucosa, whereupon the vascular pedicle is ligated. After cutting the haemorrhoid node off, a continuous submucosal suture is used to submerge the stump in the submucosal space. In comparison with the traditional technique, the method provides prophylaxis of bleedings and inflammatory complications; reduces the postoperative pain and dysuria. Submucosal haemorrhoidectomy facilitates the primary wound healing, early recovery of microcirculation, perceptibility and neuromuscular rectum coordination. Full recovery was achieved after 18,1+/-4,7 days after the operation.

[Surgical treatment of gastroesophageal reflux disease combined with duodenal ulcer].

Operations for ulcer disease of the duodenum were performed on 696 patients. In 112 (16.1%) patients there were symptoms of insufficient obturating function of the cardia, which was considered to be an indication to antireflux simultaneous operation on the cardia. The indications were worked out for the decision on operative methods in patients with ulcer disease of the duodenum in combination with gastroesophageal reflux disease. Methods of resection were used in 88 (78.5%) patients, videolaparoscopic selective proximal vagotomy with an original means of fundoplication--in 24 (21.5%) patients. Good and excellent long-term results after operation were noted in 95.5% of the patients.

[Current technology of surgical treatment of II-III stage esophageal achalasia].

Original method of surgical treatment of patients with II-III stage esophageal achalasia -- total demuscularisation of affected esophageal part, selective proximal vagotomy, and formation of invaginated valve from autologous tissues -- is analysed. Overall 39 patients aged 23 to 62 years with II (6) and III (33) stage esophageal achalasia have been operated. There were no specific postoperative complications. Mean hospital stay was 6,5 +/- 1,2 days. Long-term results evaluated from 1.5 months to 5 years after surgery demonstrated good anatomic and functional results confirmed with special methods of examination and CIQLI scale of life quality.

[Modeling of rectal ampulla and rectosigmoid sphincter mechanism in anterior resections of various level].

Original technologies of modeling of rectal ampulla and rectosigmoid sphincter mechanism have been developed for improvement of short- and long-term results after anterior resection of the rectum. The study group consisted of patients after upper resection (n=54) where rectosigmoid mechanism was formed as valve flap on 4-5 cm distally to anastomosis with recovery of pelvic peritoneum at this level, and of the patients after lower resection (n=47) where modeling of rectal ampulla and rectosigmoid mechanism was performed with serosomyotomy of intestinal portion between sphincter and anastomosis. The control group consisted of patients with direct anastomoses at the distance of 6-12 cm (n=12) and 5-1 cm from the anus. 4-6 months later the ampulla-shaped dilatation of intestinal portion after serosomyotomy and formation of functionally active sphincter mechanism were detected in patients of the study group. Developed technologies reduced the number of patients with multi-moment evacuation and incapable to hold the stool for 15 min.

[The potential for endoscopic dissection of the leg perforating veins].

This paper describes the results of endoscopic dissection of the leg perforating veins in patients suffering from different forms of chronic venous insufficiency of the lower limbs. Varicosity was present in 54 (88.4%) and postthrombophlebitis in 7 (11.6%) patients. Before operation the patients were provided ultrasound Doppler and duplex scanning. Microcirculation was examined by laser Doppler flowmetry. The study evidences decreased perfusion of the superficial skin layers during the growth of arteriolo-venular blood shunting that occurs because of phlebohypertension. For endoscopic dissection of the leg perforating veins an original titanium nickelide clips was employed, which allowed ligation of the veins measuring over 5 mm via a standard endoscopic canal. The use of the given technique made it possible to minimize the time of operation, to decrease traumatic injury of intervention due to the exclusion of incisions in the area of trophic disorders. The mean time required for ulcerous defect healing accounted for 32.3+/-1.7 days. Regulation of lower limb microcirculation was restored 3 months after surgical treatment.

[Optimization of prognosis and surgical prophylaxis of bleedings from esophageal varicose veins].

New methods of prediction of bleeding from the esophageal varicose veins improve treatment outcomes. These methods consist of endoscopic assessment of varicose vein and mucous membrane with determination of thickness of the vein wall and mucosa, and also assessment of reflux-esophagitis with endoscopic ultrasonography. Original operation of azigoportal disconnection was performed in 13 patients followed-up after surgery from 1 to 4 years. The results obtained demonstrate high efficacy of this surgery for prophylaxis of repeated bleedings from esophageal varicose veins.

[Reconstructive jejuno-gastroplasty in the treatment of operated stomach disease].

The results of treatment of 205 patients with operated stomach disease were analyzed. Conservative therapy was effective in 71.7% patients. Surgical treatment was used in 58 (28.3%) patients. Reoperation was performed less than a year after primary surgery in 5.2% patients, 1 to 3 years later -- in 41.4%, 3 to 5 years -- in 36.2%, more than 5 years later - in 17.2% patients. Early after operation complications were observed in 24.1% patients. Clinical and device examinations demonstrate that surgical reconstruction significantly reduces intensity of pathological symptoms in all the patients.

[Functional results of the surgery of esophageal opening hernia].

The article presents an original method of laparoscopic anti-reflux surgery, immediate and long-term results of the treatment of 132 patients with esophageal opening hernia. It also describes the analysis of the life quality of patients with the gastroesophageal reflux disease before and after the surgery.

[Surgical treatment of stage IV cardial achalasia].

An original method of surgical treatment of patients with stage IV cardial achalasia was developed. Seven patients aged 42 to 59 years underwent surgery according this method. Objective methods of examination and life quality study with GIQLI carried out 3 months to 5 years after surgery demonstrate satisfactory anatomic and functional results.

[Correction of the motor-evacuation function of the postoperative stomach in the early postoperative period].

We conducted the analysis of the results of surgical treatment of 255 patients with duodenal ulcers. In the early postoperative period the evacuation and motility function of the postoperative stomach was corrected with the use of the autonomous electrostimulator of the gastrointestinal tract (EAS GT) in all patients - in the main group (n = 125) and drug stimulation (cerucal 2.0 intramuscularly twice a day) and in the control group (n = 130). The use of EAS GT-3 certainly reduces symptoms of dyscoordination of the motor function of the gastrointestinal tract.

[Clinical, endoscopic and morphological criteria for assessing function of esophageal anastomosis].

UNLABELLED: Clinical and endoscopic data on 115 patients after surgery with creation of esophageal anastomosis was analyzed. Functional status of esophageal anastomosis was studied with x-ray, endoscopic, morphological, and US-assisted endoscopic METHODS: The findings provided information for development of functionally effective esophageal anastomosis criteria. Potential of US-assisted endoscopy was demonstrated. Objective and early diagnosis of the depth and intensity of inflammatory infiltration in early postoperative period allowed conduction of adequate treatment. The study of tissue structure in the zone of esophageal anastomosis in a late postoperative period discovers the cause of functional insufficiency of esophageal anastomosis.