[BALLOON DILATATION IN COMBINATION WITH A DOSED PAPILLOTOMY IN THE TREATMENT OF DIFFICULT FORMS OF CHOLEDOCHOLITHIASIS].

Results of treatment was studied in 2008 - 2015 yrs in 57 patients, suffering "difficult stones" (choledocholithiasis), in whom a dosed papillotomy in combination with the balloon dilatation. The advantages of application of combined dosed endoscopic papillosphincterotomy and balloon dilatation, comparing with complete endoscopic papillosphincterotomy, while treating "difficult stones" of common biliary duct, were established. Application of the procedure have guaranteed a good access through the duodenal papilla magna and have permitted to perform the calculi extraction in a less traumatic way, what have promoted its function preservation, and reduction of a postoperative complications rate, the patients' stationary treatment duration, and the remote complications rate. Using questionnaire SF-36, the quality of life was analyzed in patients, in whom in remote period the duodenal papilla magna function was preserved.

[THE RISK OF CHOLANGITIS OCCURRENCE AFTER ENDOSCOPIC INTERVENTIONS ON PAPILLA MAGNA OF DUODENUM].

Results of treatment of 72 patients, suffering choledocholithiasis, using transpapillary endoscopic interventions, were analyzed. In patients of the first group a complete endoscopic papillosphincterotomy was performed, and in the second group ­ a partial endoscopic papillosphincterotomy in combination with balloon dilatation of duodenal papilla magna. The rate of occurrence of late and immediate complications in the groups was compared.

[Changes of the hemostasis system in patients with obturation jaundice caused by choledocholithiasis, and possibilities of their correction with the help of miniinvasive operative interventions].

Changes in the hemostasis system in choledocholithiasis, taking into account the obturation jaundice severity and possibility of the correction conduction, using miniinvasive operative interventions, were studied. Dynamic of changes in the hemostasis system in patients preoperatively, in 1 and 3 days after endoscopic papillosphincterotomy were monitored, using the method of a low--rate piezoelectric thromboelastography. Basing on analysis of the results, the changes in hemostasis in obturation jaundice were classified, taking into account its degree of severity, what have permitted to select a correct tactics for prophylaxis of hemorrhagic complications intraoperatively and postoperatively.

[Prophylaxis of injuries of biliary ducts in laparoscopic cholecystectomy: clinical recommendations of Ukrainian association of specialists for miniinvasive, endoscopic and laser technologies].

Wide introduction of laparoscopic cholecystectomy (LCHE) caused during last 20 years a significant enhancement of rate of the biliary ducts injuries (BDI). Taking into account the experience gained in performing of more than 40,000 operations of LCHE in a leading clinics, including such in a technically complex situations, as well as experience of more than 500 operations performance for BDI, clinical recommendations, based on principles of a substantiality medicine were elaborated. More than 100 sources of foreign and domestic literature were analyzed, summarizing the results of more than 150,000 operations of LCHE, special attention was drawn to the sources I (meta-analysis and prospective randomized investigations) and II (systematic reviews, thoroughly planned prospective comparative investigations) levels of substantiality. Every paragraph is accompanied by a certain level of a recommendation strength (RS, A-C). It is necessary to follow these recommendations strictly today.

[Diagnosis and correction of hemostasis disorder during surgeries for bile duct diseases].

The aim of the study was to reduce the frequency of hemorrhagic complications in the surgical treatment of patients for diseases of bile ducts. Hemostatic state before, immediately after and on the following day after the operation was controlled by the data of frequency piezoelectric thromboelastography. It is established, that the application of tranexamic acid to promote incidence of hemorrhagic complications are reduced by 38.65%.

Laparoscopic common bile duct exploration versus open surgery: comparative prospective randomized trial.

The aim of the study was to analyse safety and benefits of laparoscopic common bile duct (CBD) exploration compared to open. Prospective randomized trial included a total of 256 patients with CBD stones operated from 2005 to 2009 years in a single center. There were two groups of patients: group I-laparoscopic CBD exploration (138 patients), group II-open CBD exploration (118 patients). Patient comorbidity was assessed by means of the American Society of Anesthesiology (ASA) score; i.e. ASA II-109 patients, ASA III-59 patients. Bile duct stones were visualized preoperatively by means of US examination in 129 patients, by means of ERCP in 26 patients, by magnetic resonance cholangiopancreatography in 72 patients. Preoperative evaluation was done through medical history, biochemical tests and ultrasonography. There was no statistical significant difference between 2 groups of patients. No mortality occurred. The mean duration of laparoscopic operations was 82 min (range, 40-160 min). The mean duration of open operations were 90 min (range, 60-150 min). Mean blood loss was much less in laparoscopic group than in open group (20 ± 2 vs. 285 ± 27 ml; p < 0.01). Postoperative complications were observed is nine patients of laparoscopic group and in 15 patients in open group (p < 0.01). There were 102 attempts to perform transcystic exploration of CBD. External drainage was used in 25 (32.8%) patients with transcystic approach. Conversion to laparotomy was performed in two patients. Open operations were performed in 118 patients with choledocholithiasis. External drainage was used in 85% of patients. Morbidity in open group was higher (12.7%) than in laparoscopic group (6.5%). Laparoscopic CBD exploration can be performed with high efficiency, minimal morbidity and mortality. Laparoscopic procedures have advances over open operations in terms of postoperative morbidity and length of hospital stay.

[Laser vagotomy in the treatment of duodenal ulcer]. / Lazernaia vagotomiia v lechenii iazvennoi bolezni dvenadtsati- perstnoi kishki.

In 79 patients with duodenal ulcer disease, the selective proximal vagotomy (SPV) with the use of the "Scalpel-1" CO2-laser was performed. In the experiment, it is shown that after dissection of the nerve trunks by the laser scalpel, no regeneration of neural tissue is observed. After laser SPV, the suppression of gastric acid production is more stable than after conventional vagotomy, the number of ulcer recurrences is lower.