[Classification, differentiated and topic diagnosis, and treatment of hepatic cystic lesions].

Accumulated in 2004-2014 yrs in Department of laparoscopic surgery and choledocholithiasis experience of treatment in patients, suffering parasitic and nonparasitic hepatic cysts, was analyzed. Own improved classification of hepatic cystic lesions was proposed. Peculiarities of performance of open operations, of the puncture miniinvasive operations and interventions for hepatic cysts, using laparoscopic approach, were enlighten. Main indications for surgical treatment of hepatic cysts were adduced, depending on their kind, size, localization and clinical signs.

[The trocar hernia after laparoscopic operative interventions. classification, treatment, prophylaxis].

Own experience of treatment of patients, suffering trocar hernias, occurred after laparoscopic operative interventions, was analyzed. Classification of trocar hernias was proposed, the main factors of risk and prognostic criteria of a trocar hernias formation were analyzed. The main methods of the trocar hernias correction are adduced.

[Laparoscopic surgery performed for focal liver pathology of various etiology].

The own experience on surgical treatment of more than 400 patients, suffering parasytic and nonparasitic hepatic cysts, benign and malignant hepatic tumors, using laparoscopic technologies, was summarized. Indications for laparoscopic operations, the main technical aspects, immediate and late follow-up results were analyzed. Advantages of laparoscopic operations in comparison to open operative interventions in thoroughly selected patients were noted.

[Simultaneous laparoscopic operations for biliary calculous disease, inflammatory and cystic diseases of abdominal organs].

The results of treatment in patients, in whom biliary calculous disease and inflammatory and cystic diseases of abdominal organs were diagnosed simultaneously, were analyzed. Main aspects of diagnosis and prognostication of efficacy of simultant operations conduction, technical rules of surgical interventions were presented. In such patients there were elaborated indications for performance of simultant completely laparoscopic and laparoscopic combined operations.

[Simultant laparoscopic operations for biliary calculi disease and hernia of the anterior abdominal wall].

The results of treatment of patients, in whom biliocalculous disease and hernia of anterior abdominal wall were diagnosed, were analyzed. The main aspects of diagnosis and prognosis of simultant operations in such patients, some technical procedures of operative interventions were depicted. Indications for performance of simultant completely laparoscopic and simultant laparoscopic combined operations in these patients were determined.

[Endosonography in diagnosis of distal biliary stenosis].

Diagnostic validity of endoscopic ultrasonography (EUS) was estimated retrospectively in 34 patients, suffering distal biliary stenosis, revealed during endoscopic retrograde cholangiopancreatography or magnet resonance cholangiopancreatography, in whom the cause of the block was not revealed in accordance to the CT data obtained. Nontumoral stenosis was diagnosed, when normal in layers structure of the biliary ducts walls was safe, not depending on a new tumor presence. In other situations stenosis was considered having tumoral genesis. The definite diagnosis of stenosis was established after morphological investigation in 18 patients--postoperatively and during dynamic follow-up--in 16. Diagnostic validity of EUS while determining the stenosis cause have had constituted: sensitivity--94.1%, specificity--82.3%, accuracy--88.2%. In a tumoral stenosis in accordance to the EUS data there was revealed hypoechogenic mass of irregular form, causing the common biliary duct obstruction and the surrounding tissues infiltration. EUS constitutes an effective method of the biliary stenosis estimation, it permits to determine the diagnosis on the early stages.

[Estimation of endosonography method in the patients with moderate risk for choledocholithiasis].

Efficacy of endoultrasonography application in conditions of moderate risk for choledocholithiasis occurrence was estimated in 33 patients, in whom ultrasonography (US) did not reveal the common biliary duct concrements. Sensitivity, specificity, accuracy, positive and negative prognostic values of the method in suspicion for choledocholithiasis presence while US performance have had constituted 78.6, 94.7, 82.0, 98.2 and 54.5%; vs for endoultrasonography--100, 94.4, 97, 93.8 and 100% accordingly. Endoultrasonography constitutes a safe and highly effective method of investigation in patients in suspicion of the biliary ducts disease presence, it permits to reveal choledocholithiasis in significant part of patients after ineffective US. This diagnostic option permits to reduce the need for performance of diagnostic endoscopic retrograde cholangiopancreaticography.