[Collis gastroplasty in surgical treatment of hiatal hernia]. / Primenenie gastroplastiki po Kollisu v khirurgicheskom lechenii gryzh pishchevodnogo otverstiya diafragmy.

OBJECTIVE: To analyze the early and long-term postoperative outcomes after Collis gastroplasty in the treatment of patients with hiatal hernia complicated by gastroesophageal reflux disease and shortening of the esophagus. MATERIAL AND METHODS: Postoperative outcomes after Collis gastroplasty were analyzed in 22 patients with hiatal hernia and shortening of the esophagus. The control group consisted of 166 patients after simple repair of hiatal hernia without Collis procedure. RESULTS: In case of Collis gastroplasty, surgery time was 185 (160-250) min. Intraoperative complications were observed in 3 (13.6%) patients, incidence of postoperative complications - 18.2%. There were no lethal outcomes in this group of patients. Mild functional dysphagia was observed in 2 (9.1%) patients. Length of hospital stay was 7.8±2.4 days. Mean follow-up was 34 (6-52) months. There were no anatomical recurrences. A relapse of gastroesophageal reflux was noted in 1 (4.6%) case. GERD-HRQL score was 4.8±2.2 points. Additional Collis gastroplasty did not affect the immediate and long-term results of surgical treatment in comparison with simple cruroraphy and fundoplication. CONCLUSION: Unreduced shortening of the esophagus may be followed by high incidence of recurrent hiatal hernia and GERD in long-term period. In case of shortening of the esophagus, surgery should include Collis gastroplasty. This effective and safe procedure does not impair treatment outcomes. Indications and optimal technique of Collis gastroplasty require clarification and further research.

[Cancer of terminal part of common bile duct in a patient with heterotaxy syndrome]. / Rak terminal'nogo otdela obshchego zhelchnogo protoka u patsienta s sindromom geterotaksii.

Case report is devoted to successful pancreatectomy for cancer of terminal part of common bile duct in a patient with heterotaxy syndrome. The main difficulties during dissection of pancreaticoduodenal complex arose due to anatomical disorientation and the lack of standard topographic and anatomical landmarks. Preoperative computed tomography with assessment of visceral vessel anatomy is essential in all patients with biliopancreaticoduodenal tumors. If heterotaxy syndrome is suspected, additional examination is required to detect other potential abnormalities and prepare for unusual situation.

[Anatomic variants of hepatic artery in metastatic affection of the liver].

On 39 nonfixed cadavers of patients, in whom hepatic metastatic affection was diagnosed in abdominal cavity tumors, there were studied up a hepatic artery anatomic variants and possible accesses. In 22 observations there was noted a typical variant of hepatic artery branching from a. hepatis communis, in 9--isolated blood supply of the left and right hepatic lobes, in 4--additional branches of various diameter from a. gastrica sinistra to the left hepatic lobe, in 2-- additional branches toward the right hepatic lobe, branching from a. mesenterica superior, in 1--the blood supply of the left hepatic lobe by arterial branch from splenic artery, while a lienalis-hepatic trunk have branched from truncus coeliacus. In one observation there was revealed the common hepatic artery branching on three trunks, while the median one have supplied a hepatic quadrate lobe. It is expedient in all observations perform en bloc lymph node dissection of hepatic hilus with the truncus coeliacus structures opening. The proposed order of activities while conduction of selective intraarterial polychemotherapy permits to take into account the anatomic variants as well and to eliminate the possible faults and complications occurrence.

[The results of palliative locoregional chemotherapy of primary and metastatic hepatic cancer].

There was elaborated and introduced into the practice the method of locoregional intrahepatic chemotherapy conduction with the objective to enhance the efficacy of palliative treatment of nonresectable primary and metastatic hepatic cancer. The immediate and late results of treatment are presented in 173 patients. Application of the method elaborated have had permitted in the main group of patients to reduce the systemic toxic reactions severity, to achieve partial response and the process stabilization in (71.2 +/- 5.6)% of them, to enhance the survival median up to 16.2 mo, to achieve the four-year survival in 6.7% of the patients.

[Prophylaxis of complications of intra-arterial polychemotherapy in patients with metastases of colorectal cancer].

Selective intraarterial polychemotherapy is one of the most important components of treatment in patients, suffering colorectal cancer metastases. With the objective to enhance its efficacy and to lower toxicity there was elaborated the prophylactic measures scheme, permitting to lower essentially the risk of undesirable consequences occurrence while application of cytostatic preparation in high concentration towards regional organs and tissues, incorrect procedure of infusion and general systemic influence of the preparation on the patient's organism.