[Classification of an acute pancreatitis: revision by international consensus in 2012 of classification, adopted in Atlanta].

In 1992 on symposium in Atlanta the general classification of an acute pancreatitis, adopted by world medical society for practical application, was proposed. Due to results of multiple investigations there were enhanced the data about an acute pancreatitis pathophysiology, the organs insufficiency, and improvement of the noninvasive and invasive methods of visualization and treatment, what caused necessity to revise the classification. Web-consultations were conducted in 2007 yr to guarantee a wide participation of pancreatologists. After first meeting the working group have directed the document project to 11 national and international associations of pancreatologists. In 2012 yr the definite conclusions, concerning consensus, were published.

[State of specific and natural immunobiological resistance in patients with colorectal cancer in conditions of obturation of the colon].

Estimation of the immune state was performed in 57 patients, suffering colorectal cancer (CRC) with impassability of large bowel (ILB) in compensated stage (in 30) and subcompensated (in 27). In all the patients immunosuppression was revealed, in ILB in a compensation stage activation of proinflammatory and antiinflammatory citokines--mediators of immune system, while in LIL in a subcompensation stage and in progressing of CRC--inhibition of antiblastomic mediators on background of significant rising of the problastomic citokines, what may have a prognostic significance for optimization of pathogenetic therapy in such patients.

[Surgical treatment of patients for abdominal sepsis].

Results of surgical treatment of 201 patients, suffering abdominal sepsis (AS), which have occurred after operations on abdominal organs, were analyzed. Expediency of application of modern scales for the patients state severity estimation, prognostic sign-posts and dynamic of the pathological process course in every patient was substantiated. Existing systems of prognostication (APACHE II, SOFA, MODS) are applied restrictedly for diagnosis of infection in patients, what demands relaparotomy performance in presence of clinical signs of intraabdominal infection, which persists. For prognostication of the treatment result and determination of indications for relaparotomy conduction in patients, suffering severe AS and infectious-toxic shock (ITSH), the most informative is application of the Manheim's index of peritonitis together with analysis of clinico-laboratory indices for formation of groups of patients in risk, to whom reoperation is indicated. Advantages of relaparotomy "on demand" conduction were proved in comparison with "programmed" relaparotomy during the staged surgical treatment of patients, suffering severe AS and ITSH. Complex surgical treatment with substantiation of indications and choice of adequate method of intervention secures improvement of the treatment results in these severely ill patients.

[Prognostic significance of indices of endogenous intoxication and of a monooxygenase system on the stages of surgical treatment in patients, suffering abdominal sepsis].

Some indices of endogenous intoxication and lymphocytic monooxygenase activity in the blood of patients, suffering abdominal sepsis (AS), were investigated, their prognostic significance was determined. In 28 patients the signs of AS were revealed, in 14 of a severe sepsis, in 11--of a septic shock. For peritoneal AS there were operated 37 patients, and for a pancreatogenic one--15. Relaparotomy "on demand" was performed in 12, and "the programmed" one--in 15 patients. A 30-days lethality in AS was 10.7%, in severe shock--28.6%, and in a septic one--63.6%. While AS occurrence a rising of metabolic activity of the monooxygenase system were registered in certain terms, and significant inhibition of this index--while severe state of the patients in a refractory shock occurrence. A safety correlational connections of indices in the blood and the lymphocytic monooxygenase system activity were determined in patients, who died.

[Intraabdominal hypertension syndrome in patients with abdominal sepsis].

Investigations were conducted in 53 patients, operated on in 2013 yr for abdominal sepsis (AS). The patients state severity was determined in accordance to the systemic inflammatory reaction and the polyorgan insufficiency severity. In 28 patients (group I) AS was diagnosed, in 14 (group II)--severe AS, in 11 (group III)--a septic shock. Tactics of surgical management of the patients have included two main measures: the infection origin control (source control), and control of the affected organ function and systemic defense mechanisms (damage control). In all the patients in AS the intraabdominal pressure rising was revealed. Syndrome of intraabdominal hypertension was noted in 10 (18.9%) patients (in 4--while presence of severe AS, and in 6--in septic shock). Lethality was the highest in intraabdominal hypertension degrees III and IV (11 of 25 patients have died).

[Immune status of patients after splenectomy, performed for the spleen traumatic injury in remote terms and choice of preparations for its correction].

Immune status was analyzed in 28 patients in remote period after splenectomy. In accordance to immunological data obtained in splenectomy patients, inhibition of cellular chain of speciphic and natural immunity was noted on background of hyperactivation of its humoral chain with signs of autoimmune processes. In such patients, while immunomodulators selection, the mostly pronounced stimulating impact was noted in immunoglobulin; of sorbents the most binding capacity has rheopolyglukin. This opens further perspectives of postsplenectomy patients treatment, using immunomodulating and elimination correction of the disorders revealed. Expediency of application of rheopolyglukin and immunoglobulin in contents of eliminating amed immunomodulating therapy was substantiated. Studying of peculiarities of immune status constitute a perspective way in the patients, in whom various variants of organpreserving tactics while surgical interventions on spleen were applied.

[Time of surgical treatment performance in patients with acute necrotic pancreatitis complicated by secondary pancreatic infection].

Retrospective and prospective analysis of the surgical treatment results was conducted in 445 patients, suffering secondary pancreatic infection, ageing 18-83 yrs. Correlation connection was established between the terms of the operative intervention conduction and the patients mortality (r = -0.95, t = -18.7, P = 0.000). After the operation in 30 days from the admittance to the hospital the patients mortality was lesser.

[Surgical treatment of cardial achalasia].

There was analyzed a 35-years experience of surgical treatment of 683 patients, suffering achalasia of cardia. Comparative analysis of different methods of operative interventions efficacy, including those, using laparoscopic access, was conducted. There was established, that esophagocardiomyotomy together with partial widening fundoplication guarantees good late results achievement in 96.6% of patients. Application of laparoscopic esophagocardiomyotomy and anterior widening fundoplication permits to secure all advantages of miniinvasive access and efficacy, comparable with such of the open access.

[Remote results of the treatment of patients for Barrett's esophagus].

Prospective analysis of the results of clinic-laboratory investigations in patients, treated for Barrett's esophagus (BE) in 2000 - 2006 yrs, was conducted. In some of the patients BE was diagnosed together with other complications of gastroesophageal reflux disease. Statistical analysis of remote results concerning the patients surgical and conservative treatment, using mathematic method, according to the rule 3s and 3s(1), was performed. Higher efficacy of surgical method was established concerning the treatment of hiatal hernia, shortened esophagus, reflux-esophagitis, gastroesophageal and duodenogastric refluxes, duodenal ulcer and esophageal epithelium dysplasia.

[Surgical treatment of persisting chylothorax].

Results of surgical treatment of 8 patients, suffering chylothorax, persisting during 1-14 months are presented. The desease have appeared also resistant to complex conservative treatment trial. This kind of treatment was conducted with simultaneous intensive preoperative preparation, surgical intervention consisted of open thoracotomy with thoracic duct suturing and ligature. The operative treatment had appeared primarily ultimately successful in 5 (62.5%) patients, and after postoperative pleurodesis conduction--in 3 (37.5%). One week of intensive conservative therapy trial with simultaneous preoperative preparation and subsequent shift to surgical intervention constitutes an optimal tactical principle in the persisting chylothorax treatment.

[Shunting esophagocolonoplasty in the treatment of postburn cicatricial esophageal stricture].

The prospective analysis of the results of treatment of postburn cicatricial esophageal stricture (PCES) in 338 (32%) patients, using shunting retrosternal esophagocolonoplasty (SRECP), constituting 76.1% of esophagoplasties performed, was conducted. Postoperative mortality was 4.7% (16 patients died). Early postoperative complications had occurred in 116 (34.5%) patients and the late--in 68 (24.9%). SRECP constitutes the method of first choice in patients, suffering tubular PCES and in formation of fistula, diverticulum and false ways. The standard variant of the procedure includes the performance of wide one-raw esophago-colonoanastomosis in end-to-end fashion with isoperistaltic passage of transplant. Such a tactic owes significant advantages, such as the lower risk of specific severe early and late postoperative complications occurrence, and also secures the esophagoplasty functional adequacy.

[Diagnosis and treatment of primary peptic stricture of the esophagus].

Results of treatment of 271 patients, suffering primary peptic stricture of the esophagus (PPSE), were analyzed. Application of antireflux operation on esophagogastic junction with forceful esophageal bougienage had permitted to achieve recovery in majority of them. Esophageal resection is indicated in PPSE, which do not submit instrumental dilatation and in presence of high-grade dysplasia, situated within the organ segments, affected by metaplasia.

[Surgical treatment of patients suffering esophageal cancer and stomach cancer spreading to the esophagus using abdominocervical access].

Radical operative interventions using abdominocervical access were performed in 145 patients for esophageal and gastroesophageal cancer. Of them in 99 (68.3%) patients isoperistaltic esophagoplasty was performed: in 54 (54.5%)--using isoperistaltic tube, formatted from gastric big curvature, in 23 (23.2%)--portion of jejunum, in 18 (18.2%)--portion of colon and in 4 (4.1%)--ileocecal angle. Retrosternal way of transplant transposition toward the neck was choused in 86 (86.9%) patients, via the resected esophagus bed--in 10 (10.1%) and subcutaneous one, presternal--in 3 (3%). Postoperative mortality had constituted 10.3%. For locally advanced cancer, affecting thoracic esophagus or gastroesophageal one the performance of subtotal-total esophageal resection is indicated. Application of abdominocervical access owes essential advantages for the patient and surgeon, comparing with lateral thoracotomy, because it secures less traumatic, adequately wide and visually controlled approach to mediastinal structures in esophageal cancer, and is characterized by oncological loyalty and surgical utility.

[Diagnosis and treatment of esophageal leyomyoma].

Radical operations for benign esophageal leyomyoma were performed in 50 patients in 1976-2006 in the clinic. Highly informative roentgenologic, endoscopic and ultrasonographic (including intraesophageal) methods were applied in the disease diagnosis, permitting to establish the diagnosis, as a rule, accurately before the operation. The diagnosis was verified definitely, basing on intraoperative revision data and the results of express-histologic investigation of the tumor excised. Extramucosal enucleation of benign leyomyoma with plastic closure of esophageal muscle defect or its suturing was done in 33 (66%) patients. Subtotal esophageal resection was performed in 11 (22%) patients, reconstructive operations--in 10 (20%), including in 5 (10%)--retrosternal esophagocolonoplasty, in 2 (4%)--intrathoracic esophagogastroplasty and in 1 (2%)--retrosternal esophagojejunoplasty. In 2 (4%) patients with small benign leyomyoma the esophageal wall portion resection was performed using suturing apparatus and in 1 (2%)--gastrostomy. Postoperative mortality had constituted 2%. Results of treatment were studied in 46 (92%) patients in 1-18 yrs, 4.8 at average. There were no recurrences. The result was estimated as good in 39 (78%) patients and fair--in 7 (14%).

[Diagnosis and surgical treatment of gastroesophageal reflux disease with motor disorders]. / Diahnostyka ta khirurhichne likuvannia refliuksnoï khvoroby stravokhodu z rozladamy motoryky.

There were performed examination and surgical treatment of 93 patients with chronic gastroesophageal reflux disease (GERD) and motor disorders of gastroesophageal junction, esophageal and gastric bodies. In 49 (52.7%) of patients the total fundoplication was done, in 44 (47.3%)--incomplete one. After the operation all the patients had survived. In 5 years and more there were examined 71 (76.3%) of patients, in all of them good and fair results were obtained.

[A new sorbent used for preparing the intestines for a surgical intervention]. / Novyi sorbent, zastosovannyi dlia pidhotovky kyshechnyka do operatyvnoho vtruchannia.

A new sorbent with a high sorptive capacity and antimicrobial properties against different species of microorganisms (aerobic and anaerobic) is suggested. Its effectiveness has been proved both in vitro and in vivo. The authors consider that the sorbent can be recommended for clinical trials with the aim of its use in preparation of the intestine for the operation.

[An agent imparting antimicrobial properties to woven materials]. / Ahent dlia nadannia antymikrobnykh vlastyvostei tkanym materialam.

The proposed agent for the woven materials impregnation gives them antibacterial properties concerning gram-negative and gram-positive microflora, and have also the fungicidal activity. It high effectiveness testifies the vast resources of an agent in the treatment and prophylaxis of surgical pyo-inflammatory infection.