[Possibilities and limitations of retrograde transpapillary stenting of the main pancreatic duct in the treatment of chronic pancreatitis and its complications].

UNLABELLED: For the last years the role of endoscopic pancreatic stenting in the treatment of chronic pancreatitis and its complica- tions has significantly increased. MATERIALS AND METHODS: In the clinic of abdominal surgery and endoscopy of Pirogov RNRMU based on the University Hospital 31 for the period from 01.1998 to 01.2014 Wirsung duct occlusion, which developed on the background of CP was the cause of performing of 215 endoscopic procedures in 95 patients: 34 (35.8%) women and 61 (64.2%) men. Mean age 49.8 ± 11.7 years. Study group consisted of 52 (54.7%) patients with strictures of MPD and 43 (45.3%) with pancreatic fistulas. We tried to perform pancreatic stenting in all the cases, as a method of treatment of pathological changes in the pancreatic ductal system. RESULTS: Endoscopic stenting was successfully performed in 64 cases (67.4%), while in 45 (70.3%) cases, this intervention was the definitive method of treatment. Temporary Wirsung duct stenting was performed in 19 (29.7%) cases in which endoscopic retrograde step interven- tions were training to perform surgery. It is significant that the main causes of the technical impossibility of pancreatic stenting was the complete dissociation of Wirsung duct (8), distal localization of occlusive lesions (13), presence of severe angulation in stenotic changes (20) and the length of the scar stricture of the MPD more than 1 cm (17) and particularly a combination of several factors. Clinically significant complications after endoscopic interventions in our study occurred in 6 (2.8%) cases. Lethal outcome occurred in one patient (0.5%). CONCLUSION: According to the results of our study pancreatic stenting was technically feasible in 67.4% of all cases. At the same time, endoscopic correction, if the possibility of its technical implementation, may be the final method of treatment in 70.3% cases. In this endoscopic pancreatic stenting has a low complication rate (2.8%) and mortality (0.5%). The main reasons for the failures and limitations of endoscopic stage treatment is a combination of factors: complete dissociation of the MPD, distal location of the Wirsung duct strictures with severe angulation in this area and a large length of strictures.

[The enteral tube feeding and selective intestinal decontamination for the treatment of the acute pancreatitis].

The treatment results of 174 patients with the acute pancreatitis were analyzed. 51 (29.5%) patients were on total parenteral feeding (the 1st group); 93 (53%) patients received the early enteral feeding through the nasoenteral tube (the 2nd group); 30 (17.5%) patients received the enteral feeding together with the selective intestinal decontamination ( the 3rd group). The combination of enteral feeding together with the selective intestinal decontamination proved to have the positive influence and prevent the infectious complications of the acute pancreatits. Therefore, they should be used in the treatment of such patients.

[Recurrent choledocholithiasis. Diagnosis, prevention and treatment].

For the period of 6 years we have 110 patients with recurrent bile duct stones (BDS). Were evaluated the changes of the bile duct and bile papilla (BP), predisposing to the recurrence of BDS; the causes of recurrent BDS after endoscopic papillosphincterotomy (EPST). To improve the treatment results in patients with recurrent BDS is necessary: at the primary operation to estimate the changes of the BP and periampulyarnuyu area, in patients with completed EPST to prescribe litolitic therapy; in patients with a complex BDS after unsuccessful attempt of EPST to do holedoholitotomy with a blind stitch or in combination with the drainage of Pikovsky.

[The surgical tactics of treatment of the choledocholithiasis, complicated by the obstructive jaundice, in patients with the altered bilioduodenal anatomy].

The treatment results of 69 patients with the altered bilioduodenal anatomy and choledocholithiasis, complicated by the obstructive jaundice, were analyzed. The anatomic changes were determined by the previous gastric resection or gastrectomy, biliodigestive anastomosis, bile duct strictures, pyloric stenosis, duodenal diverticulum or the Mirizzi syndrome. The surgical approach depended on the type and extent of anatomic changes. The endoscopic common bile duct decompression was possible in 82,6% of patients. The endoscopic bile duct stone removal was achieved only in 44,9% of patients, the other 8,7% with non-removable stones had the endoscopic bile duct stenting as a means of palliative surgery. Percutaneous transhepatic lithoextraction was performed in 1,5% of cases. The differential approach provided the decrease of postoperative complication rate and lethality to 14,5 and 2,9%, respectively.