[Strategy of treatment of acute intestinal obstruction in patients who had undergone resection of the stomach].

An analysis of results of examination and treatment of 75 patients with acute intestinal obstruction (AIO) who had undergone resection of the stomach has shown that the presence of a triad (the absence of colonic levels in AIO patients, previous resection of the stomach and the autumn time) has high probability of AIO diagnosis caused by phytobezoar. Sensitivity of a combination of these signs in the group under study was 78.6%, specificity--55.6%, the overall accuracy--67.1%. Conservative therapy in this group of patients was effective in 60% of cases; the rest of the patients had to be treated surgically.

[Acute intestinal obstruction after resection of the stomach and pylorus-destroying surgeries].

Results of examination of 55 patients with acute intestinal obstruction (AIO) who had undergone resection of the stomach (51) and trunk vagotomy with pyloroplasty (4) were analyzed. Among 29 operated patients AIO were caused by phytobezoars in 21 (72.4%) and comissures in 8 (27.6%) patients. Twenty-two were hospitalized in autumn. Twenty-six patients were treated conservatively, 12 of them were hospitalized in autumn. Small-intestine AIO due to phytobezoars is seen more often in patients with resected stomach. This pathology is characterized by triad of signs: the history of stomach resection, autumn (the season of haw), clinical picture of small-intestine obstruction.

[Endoscopic procedures in the treatment of residual and recurrent choledocholithiasis].

Results of endoscopic treatment of 124 patients with residual and recurrent choledocholithiasis after cholecystectomy were analyzed. It is demonstrated that endoscopic papillosphincterotomy with lithoextraction is the method of choice. Lithoextraction after mechanical lithotripsy is indicated in different sizes of the concrement and terminal part of the common bile duct. Conventional nasobiliary drainage (NBD) in incomplete evacuation of the concrements not always predicts repeated impaction of the stone. Original spiral-type catheter procedure for NBD permits one to prevent repeated impaction of the concrement and to perform operation after attenuation of acute purulent cholangitis.

[Choledochoduodenostomy using suturing device SPP-20]. / Kholedokhoduodenostomiia s ispol'zovaniem sshivaiushchego apparata SPP-20.

The article discusses the results of choledochoduodenostomy formed with the C[symbol; see text]-20 suturing instrument in 51 patients by a method developed by the authors. The late-term results were studied in 46 patients in follow-up periods of 3 months to 2 years. In the group of 46 patients who were examined 45 had no complaints, they returned to their previous occupation, and stopped adhering to the diet 3-6 months after the operation. One patient noted significant improvement of his condition but nonetheless complained of aching pain experienced from time to time in the epigastrium, a bitter taste in the mouth, and sometimes nausea, which was associated with chronic pancreatitis. Immediate and late-term complications directly connected with formation of the anastomosis with a mechanical suture (C[symbol; see text]-20 instrument) as well as fatal outcomes were not encountered.

[Results of transduodenal papillosphincterotomy and double internal drainage of the common bile duct using the SPP-20 device]. / Rezultaty transduodenalnoi papillosfinkteroplastiki i dvoinogo vnutrennego drenirovaniia obshchego zhelchnogo protoka, vypolnennykh apparatom SPP-20.

The authors discuss the immediate and late results of operations conducted with the [symbol: see text] suturing instrument of their design. It made possible one-stage transduodenal papillosphincteroplasty by application of two rows of tantalum staple sutures with division of the tissue between them--papillosphincterotomy. The authors conducted the operation on 242 patients for benign stenosis of the common bile duct by stones incarcerated in it. In 29 patients the intervention was complemented by the formation of supraduodenal choledochoduodenoanastomosis by means of the same suturing instrument, establishing in this was double internal drainage of the bile ducts. The suturing instrument made the operation easier and atraumatic and provided reliable hemostasis. Immediate postoperative mortality as 1.9%. Transduodenal papillosphincterotomy with the [symbol: see text] suturing instrument produced g od and satisfactory results in 95.2% and poor results in 4.8% of patients; poor late results of double drainage of the choledochus by the authors' method were not registered.

[Diagnosis and treatment of stenosis of the major duodenal papilla after cholecystectomy]. / Diagnostika i lechenie stenoza bol'shogo sosochka dvenadtsati- perstnoi kishki posle kholetsistéktomii.

The data of diagnosis and treatment of 59 patients with stenosis of the major duodenal papilla (MDP) revealed at different periods after cholecystectomy are analysed. In diagnosis of MDP stenosis, the following methods were employed: ultrasounds scanning of the liver and bile ducts, intravenous cholangiography, endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography. The surgical method of treatment was used in 24, an endoscopic method--in 28, a combined one--in 7 patients. The indications and contraindications for the use of different methods of treatment are presented. It is noted that the use of a complex of modern methods of diagnosis and treatment will permit to establish precisely MDP stenosis after previously performed cholecystectomy and eliminate it with minimal lethality.

[Clinical features and operative treatment of ampullary choledocholithiasis]. / Klinicheskaia kartina i operativnoe lechenie ampuliarnogo kholedokholitiaza.

The results of treatment of 72 patients with ampullary choledocholithiasis (16% of the total number of patients with choledocholithiasis) are presented. In 15 patients, bringing down a concrement was performed, in 3--its retrograde removal via the incision of the common bile duct with subsequent creation of choledochoduodenoanastomosis (CDA), in 24--endoscopic papillosphincterotomy (with subsequent cholecystectomy--in 6, with cholecystectomy and CDA creation--in 18), in 30--cholecystectomy with transduodenal papillosphincteroplasty. After the operation, 5 patients died.