[Optimal dates of surgery for acute calculous cholecystitis]. / Vybor optimal'nykh srokov vypolneniia operativnogo vmeshatel'stva pri ostrom kal'kuleznom kholetsistite.

OBJECTIVE: To analyze the results of surgical treatment of acute calculous cholecystitis depending on dates of surgery. MATERIAL AND METHODS: There were 123 patients with acute calculous cholecystitis in 2017. The sample enrolled 111 females (90.2%) and 12 (9.8%) males. Mean age of patients was 63.4±5.7 years. Patients were divided into 4 groups depending on dates of surgery. Group A - 18 (16.2%) patients with destructive forms of cholecystitis. These patients underwent surgery after a short preoperative preparation. Group B comprised of 32 patients (28.8%) who were operated within 72 hours. Group C enrolled 34 patients (30.7%). These patients underwent operation within 7-12 days after clinical manifestation of disease. Group D enrolled 27 patients (24.3%). Delayed surgical strategy was applied in this group. Surgical treatment was scheduled 2-3 months later. Duration of surgery, intraoperative technical features, length of hospital-stay and postoperative morbidity were studied. RESULTS: Similar outcomes were observed in groups A and B. Group B was characterized by less duration of surgery and hospital-stay. The most significant technical difficulties arose in group C. The best results were achieved in group D. CONCLUSION: Surgical treatment of acute calculous cholecystitis within 72 hours after clinical manifestation is the most preferable. However, surgical treatment should be performed in few months if medication is effective.

[The results of endoscopic gastroduodenal, enteral and colorectal stenting for blastomatous stenosis: 8-year experience].

INTRODUCTION: Gastroduodenal, enteral and colorectal stenting of blastomatous stenosis is a reasonable alternative to operative treatment of unresectable tumors. Moreover in some cases it allows to gain time and to prepare the patient for radical surgery. MATERIAL AND METHODS: For the period from 2007 to 2015 in endoscopic department of acad. B.V. Petrovskiy Russian Research Center for Surgery 76 patients with piloroduodenal, enteral and colic stenoses successfully underwent self-expanding metal stents installation. There were 21 patients with malignant stenosis of the stomach and pilorobulbar area, 17 with secondary duodenal stenosis, 17 after gastrectomy and distal gastric resection; 2 with stenosing colorectal cancer, 4 patients with rectal cancer involving rectosigmoid junction, 7 with rectosigmoid junction cancer and 8 with sigmoid cancer. RESULTS: Ambulatory and hospital interventions were performed in 35.5% and 64.5% of cases respectively. Hospital-stay did not exceed 2 days. The total complication rate was 11.8% (9/76), 3 of 9 patients required surgical intervention. The attention is given to important technical aspects of intervention as well as to those clinical situations when stenting is inappropriate because of absence of favourable functional outcome. CONCLUSION: Stenting should be more actively implemented in clinical practice, especially in emergency surgical hospitals. However it requires adequate technical support of hospitals with different endoprostheses, because it provides simultaneous diagnostic survey and remedial procedure.

[Endoscopic treatment of advanced left colon cancer by stenting].

The aim of research is studying of technical capability of colorectal stenting, its clinical efficiency in permission of obstruction and an assessment of technique safety. Between October 2007 and January 2014 endoscopic stenting by self-expanding metal endoprostheses was successfully performed in 19 patients aged from 29 till 83 years with malig- nant stenoses of the left colon. Treatment was carried out in the endoscopic department of the Federal State Budgetary Institution "Petrovsky National Research Center of Surgery" under the Russian Academy of Medical Sciences. The colonic stent placement reached two intends: pre-operative decompression as the first stage of the treatment, allowing to prepare the patient safely to the surgical procedure without colostomy (6) and palliation in those cases in which the clin- ical condition is not feasible (13). In all patients stent insertion was technically successful. Common complication rate was 15.8% (3/19). Colorectal stenting in patients with bowel obstruction is absolutely justified due to allowing considerable life quality improving in inoperable patients and avoiding two-stage surgical treatment.

[Modern concept of endoscopic treatment of cicatrical esophageal anastomotic strictures].

Authors analyze their 25-year experience of endoscopic treatment of benign cicatrical strictures of esophagus and esophageal anastomotic strictures. Special attention is paid to technical aspects of bouginage of critical (diameter up to 2 mm) and substantial (3-5 mm of esophagus lumen) esophageal strictures. The advantages of the bouginage in comparison with balloon dilatation are substantiated. Basic principles of jatrogeny prevention are formulated, together with demonstration of complications, caused by too long stenting of the esophagus. The important role of planned sustaining bouginage for restenosis prevention is marked. Treatment tactics by excessive long esophagus strictures is defined.

[Treatment of cicatricial esophageal strictures and esophageal anastomoses by using flexible endoscopes]. / Lechenie rubtsovykh striktur pishchevoda i pishchevodnykh anastomozov s ispol'zovaniem gibkikh éndoskopov.

The paper presents the results of endoscopic treatment of benign esophageal strictures of various origin in 294 patients and of scar stenosis of esophageal anastomoses in 157 patients. The basic endoscopic techniques of expansion are balloon hydrodilatation by using catheters, 10-30 mm in diameter and bouginage of Savary's (maximum outside diameter 40 Fr) and Eder-Puestow's (with olives, 15-20 mm in diameter) bougies. Good and excellent direct results were obtained in 57.1% of patients with esophageal strictures and in 87.8% of patients with stenoses of digestive anastomoses. Esophageal perforation occurred in 1.03% of patients with esophageal strictures. There were no serious complications after endoscopic treatment of postoperative stenoses. To prevent restenoses, endoscopic treatment should include regular outpatient maintaining dilatations by using dilatators at longer intervals during 3-6 months.

[The immediate and late results of the endoscopic treatment of strictures of the esophageal anastomoses after esophagoplasty]. / Neposredstvennye i otdalennye rezul'taty éndoskopicheskogo lecheniia striktur pishchevodnykh anastomozov posle ézofagoplastiki.

The article summarizes 11 years' experience (1986-1997) of endoscopical treatment for scar strictures of esophageal anastomoses in 13 patients after various types of esophagoplasty. In 65% of patients the diameter of the anastomosis did not exceed 5 mm. For distension of the anastomoses bouginage, balloon dilation and both of them were used. All sorts of dilators were introduced through an endoscopically inserted guide. In one patient introduction of the guide was a failure. Endoscopical procedures were performed in 112 patients. The diameter of the anastomosis 14 mm and more was achieved in 40 (35.7%) patients, 10-13 mm--56 (50,0%), less than 10 mm--in 18 (14.3%). In one half of the patients restenosis developed 1-3 months after the treatment. As a prophylactic measure it is necessary to maintain regular treatment in outpatient clinic with increasing interval during 3-6 months using any available dilators of a large diameter.

[Vascular neoplasms of the mediastinum]. / Sosudistye novoobrazovaniia sredosteniia.

During a period of 42 years the authors had 44 patients with various vascular neoplasms of the mediastinum--angiomas. Experience in the treatment of 6 of them is discussed in B. V. Petrovsky's monograph Surgery of the Mediastinum (1960). The other 38 cases were distributed as follows: hemangiomas 28 (14 mature and 14 immature) and lymphangiomas 10 (all mature). The patients' ages ranged from 11 to 63 years, the duration of the anamnesis from 4 weeks to 40 years. Mediastinal angiomas are mainly encountered in children and young people, with equal frequency among females and males. Their clinico-radiological picture is diverse and unspecific, the diagnosis is established with difficulty. Surgery is the principal method of treatment. Radical removal of the tumor must be attempted. Radiologically-guided endovascular occlusion of the vessel supplying the tumor is possible in some cases. The late results of surgical treatment are good in cases of mature angiomas and depend on the radicalism of the operation in immature forms.