[Predictors of external pancreatic fistulae after pancreatic resection]. / Prediktory vozniknoveniya naruzhnykh pankreaticheskikh svishchei posle rezektsii podzheludochnoi zhelezy.

Despite a significant decrease in postoperative mortality after pancreatic resections in recent years (5.2-15% after pancreatoduodenectomy and about 5% after distal pancreatectomy), incidence of postoperative complications remains high (30-50% and 22-50%, respectively). Postoperative pancreatic fistula is one of the most common and formidable complications. Currently, most authors use the classification proposed by the International Study Group for Pancreatic Fistula (biochemical failure, fistula type B and C). Prediction of the risk of postoperative fistula is still a complex and unresolved problem of modern surgical pancreatology. According to the literature, the main risk factors of postoperative pancreatic fistulae are obesity and high body mass index, concomitant cardiovascular diseases, no neoadjuvant chemo- and radiotherapy, soft pancreatic texture, narrow pancreatic duct, no fibrotic changes in parenchyma, adipose infiltration of the pancreas, advanced intraoperative blood loss, as well as center experience. Most often, magnetic resonance imaging, computed tomography, ultrasound elastography and various multivariate risk assessment systems are used to estimate the risk of pancreatic fistulae. However, a generally accepted technique does not exist. This manuscript is devoted to analysis of risk factors of postoperative pancreatic fistulae and diagnostic methods for assessment of this risk.

[Outcomes of cardiac achalasia grade II-III management]. / Sposoblecheniia akhalazii kardii II-III stadii.

AIM: To analyze early and remote results of the new method of cardiac achalasia grade II-III management. MATERIAL AND METHODS: Original surgical approach was applied in 21 patients with cardiac achalasia grade II-III. RESULTS: There were no any specific postoperative complications and deaths. Exacerbation of chronic pancreatitis, acute stomach ulcer and biliary peritonitis were observed in 3 cases respectively. All patients were followed-up within the period from 1.5 months to 5 years after surgery. Recurrent disease was absent. All employable patients have backed to work. CONCLUSION: According to clinical and instrumental data original surgical repair completely cures the symptoms of cardiac achalasia and restores normal esophageal dimensions and structure early after intervention.

[Functional status of the bile excretion system and upper gastrointestinal tract in patients with duodenal ulcer].

The research of functional condition of biliary tract in 35 patients suffered from gastroduodenal ulcers compared with 30 almost healthy patients was conducted. Disorders of motor function were found out in 13.2% patients in control group. The motor-evacuative function of biliary tract conformed to average scores of healthy patients group in only 8.6% cases. The accelerated gallbladder empting (11.4%), the hypermotoric biliary dyskinesia with the absence of latent period of biliary excretion (17.1%), the hypomotoric dysfunction of biliary tract (34.3%) were found out in the rest cases. The separate group of patients were patients with distortion of biliary excretion that was consisted in periodic increase and decrease of gall bladder volume during the contraction. We concluded that motor-evacuative function of biliary tract doesn't depend on the type of pathological process in the stomach or duodenum but correlates with gastric evacuation contents, the rate of cholagogic meal advancement along the duodenum and acid-productive function of the stomach.

[Method of selective proximal vagotomy]. / Sposob selektivnoi proksimal'noi vagotomii.

A method of selective proximal vagotomy has been developed experimentally. It provides additional parasympathetic denervation of an acid-producing zone of the stomach by means of circular transsection of gastric and esophageal muscular membranes above and below cardial sphincter with forming of are flux esophageal-gastric valve. Clinical use of this method in 75 patients confirmed experimental data about a good function of the created valve and adequate decrease of acid production. This improved short and long-term results and reduced the time of temporary disability.

[Surgical treatment of complicated duodenal ulcer: experience and prospects]. / Khirurgicheskoe lechenie oslozhnennykh duodenal'nykh iazv: opyt i perspektiva.

The article discloses the results of the surgery of 696 patients with completed duodenal ulcers. The organ-preserving treatment was provided for 31.8% of patients, and stomach resection was performed on 68.2% of patients. Postoperative mortality was found to be 0.6% and was not related to the surgery nature. The postoperative term of hospital treatment made up 11.8 +/- 2.4 days. A complex hospital examination of patients during early and late postoperative periods showed that methods for treatment of complicated duodenal ulcers with the use of new surgical technologies allow choosing an optimum operation providing a high level of life quality.

[Prophylaxis and treatment of reflux cholangitis]. / Profilaktika i lechenie refluks-kholangita.

A method of creation of choledochojejunoanastomosis (CJA) was developed experimentally on 12 dogs. The method lies in creation of valvular CJA using walls of the common bile duct and submucosous-mucosous membrane of the small intestine mobilized by Roux. According to this method 103 patients with obstructive jaundice due to lesion of distal part of common bile duct were operated. Postoperative complications were seen in 6 (5.8%) patients, 3 (2.9%) patients died. In the period from 3 months to 10 years after operation 63 patients were examined, there were no cases of reflux-esophangitis.

[The surgical aspects of the treatment of stomach cancer]. / Khirurgicheskie aspekty lecheniia raka zheludka.

The authors made an analysis of surgical treatment of 348 patients with different localizations and morphological forms of gastric cancer. It was shown that the formation of areflux anastomoses allowed the frequency of postoperative complications to be reduced to 13.2% and lethality to 2.4%.

[Prevention of dumping syndrome after distal gastrectomy in peptic ulcer]. / Profilaktika demping-sindroma posle distal'noi rezektsii zheludka po povodu iazvennoi bolezni.

Operations were performed on 386 patients with peptic ulcer by a method suggested by the authors for gastric resection with formation of a sphincter in the region of the anastomosis. In 18 patients a Billroth II anastomosis was reconstructed into a Billroth I anastomosis by the authors' modification in severe dumping syndrome. Complex examination was conducted in late-term postoperative periods in 324 patients after primary resection and in 18 after reconstructive operation. A mild dumping syndrome was found in 9 (2.8%) and 3 patients, respectively. The results of the study show that if the authors' requirements regarding the volume and method of gastric resection are abided by, there is no doubt that the suggested method has advantages over the classical method in that the reservoir function of the stomach is maintained, hydrochloric acid secretion reduces to a state of hypo- or normoacidity, and the peristaltic component of evacuation is preserved due to the formed functionally active anastomosis.

[Prevention of reflux gastritis after distal resection of the stomach in peptic ulcer]. / Profilaktika refliuks-gastrita posle distal'noi rezektsii zheludka po povodu iazvennoi bolezni.

A complex pre- and postoperative examination of 181 patients with ulcer disease of the stomach (86) and duodenum (95) was performed. The patients were operated on by an original authors' method with the formation of artificial sphincter in the anastomosis area. The investigations performed have shown that the method of gastric resection with the formation of functionally active anastomosis allows to considerably decrease probability of the appearance of duodenogastric reflux and reflux gastritis.

[Surgical treatment of stomach ulcer]. / Khirurgicheskoe lechenie iazvennoi bolezni zheludka.

Operated on were 168 patients with gastric ulcer disease. The preference was given to Billroth-I gastric resection with the artificial sphincter formation at the site of anastomosis and proximal gastric resection with the antireflux gastroesophageal anastomosis creation. The introduction of the developed techniques of gastric resection permitted to improve considerably the long-term functional results of treatment.

[Prevention of early and late complications after gastrectomy]. / Profilaktika nekotorykh rannikh i pozdnikh oslozhnenii posle gastréktomii.

A procedure for making esophago-intestinal anastomosis was experimentally developed and integrated with clinical practice. The method consists in formation of a muscular constrictor in the distal part of the gullet and a mucosa valve. Surgery was performed in 52 patients: gastric cancer--50 (stage II--3, III--44 and IV--3) and subcardial ulcer--2 cases. Extended combined gastrectomy was used in 14 patients (27.0%). Neither anastomotic failure nor lethality was observed. Late-onset 2. reflux-esophagitis was diagnosed in 2 out of 39 (5.1%) endoscopically examined patients.