[Treatment of bile ducts injuries after laparoscopic cholecystectomy].

Features of bile ducts injuries after laparoscopic cholecystectomy were analyzed at 54 patients. High level of lesions (H. Bismuth III-IV type) was revealed at 80% cases. Along with mechanical (transsection, excision, clipping) thermal injury of the bile ducts is usual at laparoscopic cholecystectomy. The injury was diagnosed during the operation at 21 (37.7%) cases, in 2-30 days after operation--at 30 (56.6%), and in 3 months--2 years--at 3 (5.7%) patients. Surgical tactics depended on level and terms of injury, state of bile duct wall and complications. Biliodigestive anastomosis with Roux techniques and transhepatic drainages was the main surgical method (76% cases). Peritonitis and other severe complications required two-stage treatment. Overall 40 (74.1%) patients followed-up more 3 years; there were no cases of stricture recurrence.

[Complications after endoscopic interventions on the major duodenal papilla]. / Oslozhneniia posle éndoskopicheskikh vmeshatel'stv na bol'shom duodenal'nom sosochke.

An analysis of 83 cases of complications following endoscopic procedures on the major duodenal papilla was made: 62 cases after 2110 retrograde cholangiopancreatographies (RChPG) and 21 after 620 endoscopic papillosphincterotomies (EPST). Among most frequent complications there were acute pancreatitis (49 cases), purulent cholangitis (11 cases), suppurations of the pancreatic cysts and purulent pancreatitis (8 cases). Bleedings took place after EPST in 11 patients. Risk factors of the development of acute pancreatitis were established: the presence of scarry stenosis of the papilla, chronic pancreatitis with the last exacerbation less than 1 month before the examination, more than 3 cannulations and contrasts of the pancreatic duct of the 2nd order or its acini, little (less than 10 mm) cuts of the papilla in EPST. Acute obturative pancreatitis is not a contraindication for EPST. On the opposite, after the procedure a rapid regression of the disease takes place. Asymptomatic hyperamylasuria observed in 329 patients (238 patients after RChPG and 91 after EPST) is considered to be a manifestation of flaccid pancreatitis, suggests a complication of the endoscopic procedure and is considered to be an indication for the corresponding treatment. Operations for the complications were performed on 21 patients. Four patients died because of complications of RChPG (0.2%) and two from complications of EPST (0.5%). Pancreonecrosis and purulent pancreatitis were causes of the deaths.

[Pancreatic juice peptides as possible regulators of reparative processes in the pancreas in acute and chronic pancreatitis]. / Peptidy podzheludochnogo soka kak vozmozhnye reguliatory reparativnykh protsessov v podzheludochnoi zheleze pri ostrom i khronicheskom pankreatite.

The experiments were performed on 34 dogs. The subcutaneous injection of boiled pancreatic juice was established to increase the survival of dogs in acute destructive pancreatitis (p < 0.001) and to decrease the specific volume damage to acinar (p < 0.01) and interstitial (p < 0.05) pancreatic tissue. It was also shown that boiled pancreatic autojuice exerted the therapeutic effect in chronic pancreatitis complicated by pancreatic fistulas. Five peptide components with a molecular mass from 4168 D to 1000 were discovered in the canine boiled pancreatic juice by liquid high pressure chromatography. Fractions with a molecular mass between 2187 and 1348 D were found to correspond to biologically active peptides, in particular to somatostatin. It is assumed that the therapeutic effect of boiled pancreatic juice used in acute pancreatitis may be due to somatostatin. Apparently pancreatic juice may turn an efficient therapeutic agent in acute pancreatitis and pancreatic fistulas.

[The importance of endoscopic papillosphincterotomy in biliary tract surgery]. / Znachenie éndoskopicheskoi papillosfinkterotomii v khirurgii zhelchnykh putei.

Based upon 129 endoscopic operations in 98 patients with choledocholithiasis and stenosis of the major duodenal papilla the authors came to a conclusion on an increasing significance of endoscopic papillosphincterotomy (EPST) in the surgery of bile ducts. EPST was shown to be followed by less amount of complications and less lethality as compared with surgical papillosphincterotomy. The intrahospital lethality after EPST was 1%. EPST allowed to elevate efficiency of the treatment in elderly and senile patients. It may be considered as an alternative surgical intervention after preceding cholecystectomy and can be used as an emergency procedure for acute obstructive purulent cholangitis and pancreatitis. In patients with little operative risk and preserved bile duct the indications for EPST must be restricted.

[Surgical treatment of congenital cysts of the common bile duct]. / Khirurgicheskoe lechenie vrozhdennykh kist kholedokha.

The article makes an analysis of the surgical tactics used in 9 patients with congenital cysts of the choledochus. In 3 patients the cysts were removed, in 1 patient internal drainage of the cyst was performed, in 4 patients the cysts were excised and hepato-jejunal or hepatocholedochoduodenal anastomoses were formed. There were no lethal outcomes after the operation. Long-term results were followed-up during the period of from several months to 18 years. In none of the cases there were symptoms of cholangitis or disturbance of the bile outflow.

[Replantation of the major duodenal papilla]. / Replantatsiia bol'shogo duodenal'nogo sosochka.

The authors describe 3 observations of replantation of the major duodenal papilla after its dissection from the duodenum. The results were favorable. There were no chronic pancreatitis or cholangitis. Follow-up observations continued for 66, 40 and 6 months after operation. The operation technique is described.

[Chronic pancreatitis and cancer of the pancreas]. / Khronicheskii pankreatit i rak podzheludochnoi zhelezy.

A microscopic study of 93 preparations of the pancreas from patients with a primary chronic pancreatitis allowed the authors to conclude that the primary chronic pancreatitis is a background favourable for the development of carcinoma, carcinoma of the pancreas being practically always accompanied by an acute inflammatory process. The presence of pancreatitis in patients with carcinoma of the pancreas is responsible for incompetence of pancreatoenteroanastomosis frequently developing in the postoperative period. The application of external controlled trans-anastomosis drainage of the common bile duct and pancreatic ducts resulted in more than 3 times less incidence of this complication.

[Surgical treatment of primary chronic pancreatitis]. / Khirurgicheskoe lechenie pervichnogo khronicheskogo pankreatita.

Surgical methods of treatment of chronic alcoholic pancreatitis must be chosen with special reference to the state of the duct and parenchyma of the pancreas. Treatment of alcoholic patients should be performed with the participation of psychiatrists.

[Causes of fatal outcomes in acute pancreatitis]. / Prichiny letal'nykh iskhodov pri ostrom pankreatite.

An analysis of case histories of 142 patients dead from acute pancreatitis has been made. The most frequent cause of death at early terms was the syndrome of endogenous intoxication and bleeding from upper portions of the gastro-intestinal tract. Death at later terms was usually caused by pyo-septic complications and arrosive bleedings. It was established that in the recent years acute pancreatitis made its appearance against the background of chronic inflammatory alterations in the pancreas.

[Reasons for relaparotomies following operations on the biliary tract in nontumorous lesions]. / Prichiny relaparotomii posle operatsii na zhelchnykh putiakh pri ikh neopukholevykh porazheniiakh.

According to the authors' data the incidence of relaparotomies after 1500 operations for non-tumor diseases of bile ducts was 2.5%. Causes of relaparotomies at early and late terms of the postoperative period were different. The dependence of results of the treatment on the amount of relaparotomies and the presence of such complications as jaundice, cholangitis and pancreatitis has been established. In such complications and increased amount of relaparotomies lethality was considerably higher. General lethality after relaparotomies was 49%. Complex of prophylactic and curative measures of the complications resulting in relaparotomies has been developed.

[Disorders of the coagulation, fibrinolytic and kallikrein-kinin systems of the blood in mechanical jaundice]. / Narusheniia svertyvaiushchei, fibrinoliticheskoi i kallikrein-kininovoi sistem krovi pri mekhanicheskoi zheltukhe.

A clinico-experimental investigation of the state of the coagulating, fibrinolytic and Kallikrein-Kinin systems of blood in the mechanical jaundice syndrome and different methods of its operative treatment has shown activation of these systems. In jaundice resulting from tumor of the pancreas head and Vater papilla activation of the coagulating system was prevailing while activation of the fibrinolytic and Kallikrein-Kinin systems prevailed in non-tumorous jaundice. The operative treatment aimed at the recovery of choledynamics resulted in normalization of the coagulating, fibrinolytic and Kallikrein-Kinin systems. Continuous bile loss through an external biliary fistula leads to their progressive suppression.

[Prevention of acute postoperative pancreatitis]. / Profilaktika ostrogo posleoperatsionnogo pankreatita.

Results of an analysis of 4287 operations on organs of the abdomen have shown the frequency of acute pancreatitis after different surgical interventions to be 0,9%. This complication was more frequent after operations on the stomach (4,24%), less frequent after operations on biliary ducts (1,3%). Decompression of the biliary ducts and the gastro-intestinal tract reduced the frequency of acute pancreatitis after operations on the abdominal organs from 1,13% to 0,6%.