[Endovascular interventions in true and false aneurysms of hepatic, splenic and renal arteries].

A false aneurysm of visceral arteries is a life-threatening pathology sufficiently difficult to treat. Open operations are characterised by a large scope, considerable surgical injury and accompanied by a high rate of serious complications. The development of the technology of superselective catheterization of blood vessels, creation of specialized microcatheters, glue composites and various types of spirals made it possible to treat this severe pathology without resorting to open operations. The work deals with a brief literature review concerning epidemiology, methods of diagnosis and treatment of pseudoaneurysms of visceral arteries, followed by presenting three clinical case reports concerning successful treatment of posttraumatic false aneurysms of the right hepatic and splenic arteries, as well as an aneurysm of the renal artery. Both immediate and remote results of endovascular interventions in these patients are followed up, demonstrably showing possibilities of endovascular technologies in treatment of the pathology involved.

[Treatment of pancreonecrosis with lesion of retroperitoneal adipose tissue]. / Lechenie pankreonekroza s porazheniem zabriushinnoi kletchatki.

The results of treatment of 122 patients with pancreonecrosis (PN) with lesion of retroperitoneal fat tissue (RFT) were analyzed. Twenty-four patients underwent emergency and urgent surgery, drainage of RFT through lumbotomy was performed. Nine (37,5%) patients died. Sixty-six patients with aseptic PN were treated conservatively, 7 (10,6%) of them died. Thirty-two patients treated conservatively with infection of RFT underwent surgery with minimally invasive methods - retroperitoneoscopy with sequestrectomy, minilumbotomy, sequestrectomy. 5 (15,6%) patients died. In sterile PN conservative treatment should be carried out. Recent fluid formations in RFT are indications for thin-needle puncture, their drainage is contraindicated. Prognosis of the disease is favorable when 1-3 regions of RFT are affected, more advanced process is prognostically unfavorable. Infected PN should be treated surgically. Ultrasound-assisted drainage of purulent cavities must be performed as the first stage. Flow aspiration drainage may be a final procedure when 1-2 (rarely 3) regions of RFT are affected and large RFT sequesters are absent. Formation of large RFT sequesters requires removing with retroperitoneoscopy or through mini-approach.

[Diagnosis and treatment of postoperative intraabdominal complications]. / Diagnostika i lechenie posleoperatsionnykh vnutribriushnykh oslozhnenii.

Postoperative complications after 8168 reoperations were seen in 143 (1.8%) patients. Clinical symptoms, laboratory tests, results of x-ray and ultrasound examinations were taken into account in diagnosis of the complications. Differential diagnosis of postoperative peritonitis, stable paralytic intestinal obstruction, early adhesive obstruction and intraabdominal bleeding based only on clinical data is difficult in many cases. Ultrasonic examination and laparoscopy permitted to reduce number of unjustified relaparotomies. In the majority of cases relaparotomy was considered as a method of choice in treatment of these complications. Mini-invasive surgeries may be performed only in mild complications. Lethality in the treatment of postoperative complications after relaparotomy was 39.4%, after laparoscopic surgeries--8.8%, after US-assisted drainage--0. General lethality was 29.4%.

[Results and prospects of treatment of general forms of peritonitis]. / Rezul'taty i perspektivy lecheniia rasprostranennykh form peritonita.

956 patients with general peritonitis were operated: 596 patients--for diffuse peritonitis, 360--for general peritonitis. The causes of peritonitis were: perforating gastroduodenal ulcers (454), acute destructive appendicitis (190), acute destructive cholecystitis (82), perforation of small intestine and colon (96), postoperative peritonitis (80), other diseases (54). In low degree of bacterial contamination of abdominal cavity (not more Ig 5 CFU/g) operations were completed without abdominal drainage, laparoscopic variant of the operation being optimal. In postoperative period, out of 691 patients with low degree of bacterial contamination wound infection was in 7.9%, intraabdominal infection--in 2.5%, polyorganic insufficiency--in 1.0%; lethality was 5.9%. In high degree of bacterial contamination (more Ig 5 CFU/g) and massive unremovable fibrinous patch on the peritoneum the programmed revisions and sanations of abdominal cavity were performed, sometimes--control laparoscopic revisions. In postoperative period of 256 patients with high degree of bacterial contamination wound infection arose in 6.0%, intraabdominal infection--in 4.2%, polyorganic insufficiency [symbol: see text] in 42.6%; lethality was 18.1%.

[Diagnosis and treatment of acute adhesive small intestine obstruction]. / Diagnostika i lechenie ostroi spaechnoi tonkokishechnoi neprokhodimosti.

Experience of treatment of 162 patients with acute adhesive intestinal obstruction (AAIO) is described. These patients had most often (23.3%) appendectomy in anamnesis. Conservative treatment was effective in 23 (14.2%) patients only. Surgical treatment was performed in 139 (85.8%) patients including traditional open operation in 79 (56.8%) patients, laparoscopic and laparoscopy-assisted in 60 (43.2%). Advanced adhesive process with formation of single intestinal conglomerate, neglected forms of AAIO with paralytic ileus were indications to open operations; lethality in these operations was 17.7%. Laparoscopic operation was indicated in AAIO due to isolated commissure as well as in early adhesive obstruction; lethality was 1.7%. If diagnostic laparoscopy showed that AAIO is caused by intestinal deformation in small intestinal conglomerate or intestinal resection is required, laparoscopy-assisted operations were performed.

[Laparoscopic operations in emergency surgery]. / Laparoskopicheskie operatsii v neotlozhnoi khirurgii.

582 laparoscopic operations for various urgent diseases of the organs of abdominal cavity were made. 190 of them were performed for acute appendicitis, 266--for acute cholecystitis and its complications, 33--for pancreonecrosis, 39--for perforated gastro-duodenal ulcers, 32--for acute bowel obstruction and 22--for other pathological conditions. The necessity of conversion to conventional open surgery has arose in 41 (7.0%) patients. Intraoperative complications were detected in 7 (1.3%) patients. Postoperative complications developed in 18 (3.3%) patients. 2 patients (0.4%) died. The obtained results of treatment made it possible to recommend laparoscopic operations in acute abdominal diseases.

[Technical aspects of nasointestinal intubation]. / Tekhnicheskie aspekty nazointestinal'noi intubatsii.

According to the authors' opinion nasointestinal intubation have some advantages over "open" methods of decompression of the small bowel in paralytic intestinal obstruction resulted from peritonitis and mechanical obstruction of the small bowel. The authors' experience with more than 500 their own cases indicates, that application of nasointestinal intubation is not only necessary, but safe as well if keeping strictly to the established technique. Technical aspects of the method, possible errors which could occur during the performance of nasointestinal intubation and introduction of the probe are described. Complications which made up 2.6% are analysed.