[Intraoperative cholangioscopy]. / Intraoperatsionnaia kholangioskopiia.

Intraoperative fibrocholangioscopy (FCS) was used in 446 patients with cholelithic disease and acute cholecystitis. 399 (89.5%) of the patients were hospitalized urgently. The use of FCS in patients with choledocholithiasis, obturative jaundice, cholangitis and pancreatitis is analysed. The safety and diagnostic accuracy of the method are proved. The use of FCS has provided significant improvement of the immediate and long-term results of the biliary tract surgery.

[Surgical tactics in cholangitis in middle-aged and elderly patients]. / Khirurgicheskaia taktika pri kholangite u bol'nykh pozhilogo i starcheskogo vozrasta.

The authors analysed the results of examination and treatment of 399 elderly and old-aged patients in the period between 1971 and 1981. At that time cholangitis was managed in 146 (36.6%) patients mainly by surgical intracavitary operations, in 21.2% with a fatal outcome. The results showed the high risk of surgical methods for treatment of cholangitis. Since 1982 the authors have introduced into every-day practice endoscopic methods for the management of this disease. It was found that endoscopic papillosphincterotomy (EPST) is the most physiological and safe method for the treatment of choledocholithiasis, stenosis of the major duodenal papilla, and acute cholangitis. EPST undertaken in 253 (63.4%) patients ensured adequate decompression of the bile ducts in 187 (73.9%) of them and facilitated removal of cholangitis and recovery. With the use of EPST in the treatment of acute cholangitis not only was the number of surgical operations on patients of the older age group reduced, but the mortality decreased to 5.5% (which was 3.9 times lower than the mortality in management of cholangitis by surgical operations).

[Diagnosis and treatment of acute cholecystitis complicated by local peritonitis]. / Diagnostika i lechenie ostrogo kholetsistita, oslozhnennogo mestnym peritonitom.

The article analyses 610 patients with acute cholecystitis complicated by circumscribed peritonitis which determines the results of surgical treatment in many patients. The clinical manifestations of circumscribed peritonitis complicating destructive cholecystitis are discussed. It is shown that laparoscopy plays a role in the early diagnosis of atypical or asymptomatic course of this complication, particularly in elderly and old-aged patients. Data on the surgical treatment of acute cholecystitis complicated by localized circumscribed and ++non-circumscribed peritonitis are presented. The authors show the possibility of choosing the optimal operation--laparoscopic drainage of the gallbladder and abdominal cavity--in the first stage of treatment of patients with phlegmonous cholecystitis and localized ++non-circumscribed peritonitis in the presence of serious concomitant diseases.

[Treatment of nontumorous obstructive jaundice and cholangitis in middle-aged and elderly patients]. / Lechenie neopukholevoi obturatsionnoi zheltukhi i kholangita u bol'nykh pozhilogo i starcheskogo vozrasta.

On the basis of examination and treatment of 364 elderly and senile patients with obstructive jaundice and cholangitis, the authors conclude that the frequency of these complications is high and that cholangitis takes an atypical course in patients over 60 years of age. They determine the significance of the respiratory insufficiency syndrome in manifestation of the severity of the disease. In view of the high risk of surgery at the peak of jaundice and cholangitis, the authors suggest the wide use of endoscopic papillosphincterotomy according to indications for correcting biliary hypertension. It proved to be one of the most effective methods in the treatment of jaundice and cholangitis, contributed to reduction of the number of surgical operations on cavities and to a 4.4-fold decrease of postoperative death rates among this contingent of patients.

[Acute cholecystitis and its complications]. / Ostryi kholetsistit i ego oslozhneniia.

The results of operative treatment of 4,011 patients with acute complications of cholecystitis are analysed. Problems of diagnosis and tactics and the results of treatment are discussed. It is pointed out that the management of patients with acute complicated cholecystitis is a great and urgent problem in abdominal surgery in view of the diffuse character of the process.

[Bronchopulmonary and pleural complications in middle-aged and old patients operated on for acute cholecystitis]. / Bronkholegochno-plevral'nye oslozhneniia u bol'nykh pozhilogo i starcheskogo vozrasta operirovannykh po povodu ostrogo kholetsistita.

Broncho-pulmonary-pleural complications in elderly and senile patients operated for acute cholecystitis make 20,6%. The most effective means for prophylaxis and treatment of complications on the respiratory organs are considered to be ultrasonic inhalations in combination with sanitary-therapeutic fibrobronchoscopies.