[Mini-invasive approach in the treatment of acute necrotizing pancreatitis].

OBJECTIVES: The study aims to evaluate the efficacy of percutaneous necrosectomy performed under ultrasound control and endoscopic necrosectomy trough secondary sinus track (ENTSST) using nephroscope and cystoscope. MATERIAL AND METHOD: Puncture of fluid collections in the pancreas was performed under ultrasonographic control to 23 patients with acute necrotizing pancreatitis (ANP). ENTSST using nephroscope and cystoscope was performed to 47 patients after open or percutaneous necrosectomy and persistent sepsis (without satellite collection of CT). RESULTS: Seventeen (74%) patients treated with percutaneous necrosectomy recovered without open surgery. Two of this group died. The average hospital stay was 42 days. Twenty-three patients required an average of two (from 1 to 4) ENTSST. CONCLUSIONS: Based on our initial results we believe that the percutaneous necrosectomy and ENTSST in well selected patients might be the better choice than the open necrosectomy and postoperative lavage. Common solution of these methods has not been reached yet.

[Peritonitis in cases of complicated diverticulosis of the gastrointestinal tract].

Within the period 2002 - 2007, a total of 29 patients with diverticulosis of the gastrointestinal tract have been treated at the surgery clinic: 26 (89,66%) male and 3 (10,34%) female patients. Their average age amounted to 65,7 years (22 y. - 81 y.). A total of 25 (86,21%) patients have had a complicated form of disease and 6 (24%) of them have had peritonitis. The operative interventions included: resection of small-intestine diverticulitis and primary anastomosis with 2 patients, Hartmann's type resection of the sigmoid colon with 2 patients, suture of sigmoid colon perforation with protective colostomy with 1 patient and resection of the sigmoid colon with primary anastomosis with 1 patient. No mortality in the postoperative period. 2 complications have been observed - suppuration and dehiscence of the operative wound.

[Colorectal localization in Crohn's disease--diagnostics and surgical treatment]. / Kolorektalna lokalizatsiia pri bolestta na CROHN--diagnostika i khirurgichno lechenie.

During the last years there is an increase in the number of cases with Crohn's disease. According to different statistic data the localizations are arranged as follows depending on the frequency of occurrence: ileocolic segment localization is the first--41%, followed by colorectal localization--30% and small intestinal one--29%. For a period of five years 12 patients with Crohn's disease, including 7 women and 5 men, were treated in the clinic. Regarding the localization the cases were as follows: 7 in the sigma-rectum transition area, 4 in the cecal area and 1 in the rectal area. All patient were operated and they were in a serious acute form of the disease. The operative intervention, which were made, differed in number: Hartman resection of the sigma--4, sigma resection with primary anastomosis--2; left hemicolectomy--1, right hemicolectomy--3, ileotransverzoanastomosis--1, resectio recti anterior--1. The final diagnosis was given after histological examination.

[Surgical interventions on the stomach during a glucagon-induced decrease in its tonus]. / Operativnye vmeshatel'stva na zheludke v usloviiakh snizheniia ego tonusa gliukagonom.

Different operations were performed on 15 patients with the Glucagon decreased tonus of the stomach and intestine. The drug was injected in doses 0.2, 0.3 and 0.5 mg. The resulting hypotonia of the stomach and duodenum facilitated performing the operations. No complications were noted.