[Acute cholecystogenic suppurative cholangitis]. / Ostryi kholetsitogennyi gnoinyi kholangit.

The authors discuss the results of clinical, instrumental, and microbiological examinations of 240 patients suffering from purulent cholangitis in acute cholecystitis. Choledocholithiasis was the main cause of the development of purulent cholangitis in 90.8% of patients. A classification of cholangitis and the clinical signs of the disease are dwelt upon. Endoscopic decompression of the biliary tract in the preoperative period is an obligatory condition for performing laparotomic operation. A complex of detoxification measures and general and local (prolonged flow dialysis of the biliary tract) antibacterial therapy are indicated in the postoperative period. All the measures led to decrease of mortality rates in cholecystogenic purulent cholangitis from 19.5 to 6.2%.

[Diseases of the major duodenal papilla as a cause of post-cholecystectomy syndrome]. / Zabolevaniia bol'shogo duodenal'nogo sosochka kak prichina postkholetsistéktomicheskogo sindroma.

Analysis of 460 patients suffering from the postcholecystectomy syndrome (PCS) revealed an abnormality in the major duodenal papilla (MDP) in 32.4% of them. The development of PCS in this group of patients was caused by coexistence of several pathological processes, which was established in 71% of patients with diseases of the MDP. The most frequently encountered conditions were papillitis (59.1%), cicatricial stenosis (56.3%), and stones (14.7%). Papillitis plays a double cause-effect role in PCS: as a primary chronic disease it may lead to cicatricial stenosis of the MDP, and, on the other hand, it may be a consequence of choledocholithiasis, cholangitis, and other diseases. Endoscopic papillosphincterotomy is the most effective method for the treatment of PCS caused by MDP diseases; it makes it possible to reduce significantly the number of repeated abdominal operations.

[Diagnosis and treatment of post-cholecystectomy syndrome]. / Diagnostika i lechenie postkholetsistéktomicheskogo sindroma.

The authors analyse the results of examination of 154 patients who were admitted for the postcholecystectomy syndrome, 130 of them underwent retrograde cholangiopancreatography. The most common cause of the postcholecystectomy syndrome was residual or recurrent choledocholithiasis (38.5%), stricture of the major duodenal papilla or terminal part of the choledochus (34.6%). Treatment of the syndrome was differentiated and three methods were applied: operative--43 patients, endoscopic--45 patients, and combined--3 patients. Nasobiliary drainage was conducted in 63 patients in preparation for a surgical or endoscopic operation. Indications for the use of different methods of treatment are shown. With the use of the endoscopic techniques and combination of laparoscopic and endoscopic methods of surgical treatment, the number of laparotomies in patients with the postcholecystectomy syndrome reduced by one half and the operative intervention became less injurious.

[Echosonography and retrograde cholangiopancreatography in selecting surgical tactics in mechanical jaundice]. / Ekho-sonografiia i retrogradnaia Kholangiopankreatikografiia v opredelenii khirurgicheskoi taktiki pri mekhanicheskoi zheltukhe.

The results of the diagnosis and treatment of 134 patients with obstructive jaundice are analyzed. The diagnostic potentialities of the ultrasonic method and endoscopic retrograde cholangiopancreatography (ERCPG) are compared. ERCPG has been found more effective for the diagnosis of the causes, localization, and severity of the bile duct obstruction in patients with mechanical jaundice. Endoscopic papillosphincterotomy is an effective treatment modality that helps eliminate or reduce the jaundice, remove the concrements from the duct, and reduce the scope of abdominal cavity surgery in cholelithiasis.