[Minimally invasive surgery in treatment of pancreas pseudocysts].

Results of treatment of 68 patients with cystic formations of a pancreas are presented. Minimally invasive methods -- US-guided transcutaneous puncture (d < 5 cm; I group) and drainage (d > 5 cm; II group) and use of Ivshin's tools has allowed to achieve positive results. For small intrapancreatic pseudocysts (d < 5 cm), it was applied transcutaneous puncture with replacement of contents by protease inhibitors. The obtained material was subjected to cytological, biochemical and bacteriological examination. High level of diastase indirectly indicated to the presence of connection with the main pancreatic duct. For cysts of large sizes (d > 5 cm), transcutaneous drainage with subsequent cystography for definition of the possible connection of a cyst cavity with a pancreatic duct was carried out. When the communication with the main pancreatic duct was absent, drainage of the cavity was carried out. Presence of connection of formations with the main pancreatic duct was the indication of US and endoscope-guided introduction drainage in the cystic formation through a stomach -- transgastric drainage. The mean follow-up period ranged from 6 months till 2.5 years. Excellent results were obtained in 69.2% cases and good -- in 30.8% in the I group of patients. In the II group there were received excellent results in 51.7% cases, good results -- in 41.4% and satisfactory -- in 6.9. The level of quality of life approached to maximal index in both groups. Patients promptly came back to habitual social and intellectual activity.

[Minimally invasive surgery for the treatment of pancreatic fistulas].

Results of treatment of 6 patients with pancreatic fistula by US-, radioscopy-, and endoscopy-guided formation of transcutaneous pancreatogastric anastomosis are presented. The procedure of pancreatogastric anastomosis is described. The causes of formation of fistulas were: operations due to pancreatitis - 4 cases, trauma of a pancreas -- 1 case, percutaneous drainage of a cyst -- 1 case. By application of the given procedure, complete closure of a fistula without relapses (maximal term of observation 1 year) was possible. The complications linked to performance of transcutaneous manipulation have not been noted. Lethality was not observed. It may be assumed, that the developed original procedure and using the Ivshin's device for the drainage of cavity formations can become a method of a choice in the treatment of patients with non-perishable outside pancreatic fistulas. Assessment of the parameters of the quality of life has shown that patients were quickly reverted to social and intellectual activity.