Aim. To refine treatment of patients with liver hemangiomas with new minimally invasive method of surgical treatment (microwave ablation).
Material and Methods. The study included 64 patients with liver hemangiomas up to 5 cm in diameter. In 23 patients (35.9%) there was 2–2,5-fold increase of hemangioma's size within 1.5–4 years. The diagnosis of liver hemagioma was installed in all patients based on multispiral computed tomography (MSCT). Surgery was performed in X-ray operation theater under intravenous anesthesia. Inter- or infracostal approach was used depending on the location of hemangioma. Percutaneous transhepatic introduction of thermal probe was performed into hemangioma under ultrasound control
so that the tip of thermal probe has reached the opposite edge of the tumor. Then we applied microwave ablation for 15–20 minutes at temperature of 80–120 degrees. In the postoperative period within 2–3 days preventive antibiotic therapy as well as hepatoprotectors were administered. Effectiveness of method was evaluated at 3 (ultrasound) and 6 months (MSCT).
Results. 23 patients with liver hemangiomas were treated using percutaneous microwave ablation. Complications were not marked. In 21 (91.3%) patients one procedure was conducted, 2 patients (8.7%) required repeated ablation because of recurrence of tumor according to control MSCT. In patient with multiple hemangiomas simultaneous ablation of two the largest hemangiomas was performed. Patients were discharged at 3–5 days after surgery. The follow-up was 7–35 months (average period 24 months). Dynamic ultrasonic examination showed that within 2–3 months the patients

were able to form small liquid pockets in the site of ablation (7 patients), which independently regressed by the end of the 6th month followed by fibrosis. Presence of fibrous foci was confirmed by computed tomography at 6 months.
Conclusion. Percutaneous microwave ablation may be recommended for some patients with liver hemangiomas due to minimal invasiveness, efficiency, simplicity, safety and easy repeatability

Aim. The define possibility of minimally invasive and non-invasive techniques in treatment of patients with unresectable pancreatic tumors.
Materials and Methods. We have analyzed 18 ablations in 16 patients. There were 11 (69%) women and 5 (31%) men. Average size of tumor was 3.5±1.5 cm. In 50% of cases unresectable pancreatic tumor was complicated by obstructive jaundice. All patients had pain syndrome. 
Results. The pain decreased or disappeared in 72% of patients after operation. Decrease of tumor's size was confirmed in all cases. Pain syndrome disappeared in 7 of 11 patients and body mass increased during 48 months of follow-up.
Conclusion. Combined staged minimally invasive techniques including external bile ducts drainage, common bile duct stenting and non-invasive HIFU-ablation enhances complex treatment of patients with unresectable pancreatic tumors. It is accompanied by favorable prognosis and improves the quality of life

Aim. To estimate the efficacy of transarterial chemoembolization (TACE) in treatment of non-surgical patients with nodular cholangiocarcinoma.
Materials and Methods. TACE procedures have been performed in 33 non-surgical patients with cholangiocarcinoma. In 27 (81,8%) patients selective hepatic propria or lobar artery catheterization was apllied, while additional six patients underwent segmental or lobar hepatic arteries microcatheterization.
Results. There were no post-TACE mortality or severe morbidity. Twenty eight out of 33 treated patients were available for long-term survival analysis. Eight (28.6%) patients demonstrated partial response, 13 (46.4%) – stabilization and 7 – (25%) progressive disease. 1-, 2- and 3-survival rates were 34.7%, 15.2% and 11.6%, respectively. Two patients are still alive and under observation for 10 and 72 months. Median survival was 9.0 months in the general group and 12.0 months in the gemcitabin + mytomycin C group.
Conclusion. TACE is safe and effective procedure in management of non-surgical patients with peripheral cholnagiocarcinoma.

Aim. Improvement of cholelitiasis surgical management effectiveness.
Material and Methods. Antegrade transhepatic papillodilatation and dislocation of bile stones into duodenum were performed in 22 patients with cholelitiasis and stones size not more than 10–12 mm via percutaneous transhepatic or transvesical approach. Percutaneous transhepatic approach was used also in case of external common biliary duct drainage (T-tube) presence. Papillodilatation was realized by balloon catheters with diameter 8–14 mm, length 4–6 сm and working pressure 2–6 atm and intrapapillary exposure about 5 minute. Bile duct stones were dislocated using distent endobiliary balloon sliding along transpapillary introduced conductor or between bile duct wall and partially distent balloon.
Results. Antegrade transhepatic balloon papillodilatation and dislocation of bile duct stones into duodenum were successfully realized in 22 patients. Postoperative mortality was absent. Transitory amylazemia was diagnosed in 9 patients. There were no severe complications.
Conclusion. Antegrade transhepatic balloon papillodilatation and lithoextraction is effective and safe method of cholelitiasis surgical management in case of ineffectiveness or inability of traditional retrograde endoscopical technique.

Aim. To estimate and improve outcomes in elderly patients with hepatopancreatoduodenal diseases.
Material and Methods. 221 minimally invasive drainage interventions were performed as the first stage of treatment in 193 patients with obstructive jaundice. At the second stage pancreatoduodenectomy was performed in 4 patients, biliodigestive anastomosis – in 27, percutaneous transhepatic endoprosthesis – in 28, antegrade stenting with nitinol stents – in 12, endoscopic stenting – in 6 cases. After endoscopic lithoextraction cholecystectomy, holedocholitotomy
via minimal access was performed in 7 patients, through laparotomy – in 3 cases.
Results. There were 72 complications at the first stage of treatment, 44 in percutaneous group and 28 in endoscopic interventions. In group of cancer patients cholangitis was the most common, in case of benign diseases – bleeding from the papilla after papillotomy. 10 (4.8%) deaths were observed after minimally invasive interventions. Total number of deaths – 42 patients (20.3%). Overall incidence of postoperative complications at both stages of treatment in cancer
patients was 34.3% (32 patients).
Conclusion. Percutaneous and endoscopic methods of biliary tract decompression is effective treatment of obstructive jaundice in elderly patients. Percutaneous transhepatic cholecystostomy is preffered in absence of intrahepatic hypertension. In high risk patients stenting or extrahepatic biliary endoprosthesis are recommended as a final treatment. Percutaneous transhepatic cholangiostomy with stricture recanalization and placement of distal drainage proximal to papilla is indicated to prevent postoperative pancreatitis in case of extrahepatic bile ducts cancer and intact area of papilla. The use of nitinol stents is indicated in patients with neoplastic lesion of middle and proximal third of common bile duct.

Modern aspects of pathogenesis, diagnostics and treatment of larval hydatid disease as actual problem of medical parasitology and surgery are reviewed. Authors' opinion for diagnostics and treatment in modernconditions is presented. The article focuses on surgical treatment approaches including the possibilities of minimally invasive surgery

Aim. Determination of optimal method and study of results of minimally invasive biliary decompression in neoplastic obstructive jaundice.
Materials and Methods. Biliary decompression was performed in 59 patients who were divided into groups of percutaneous drainage (n = 33) and transpapillary stenting (n = 26). In the second stage priority tactic of transpapillary biliary decompression was used in the prospective group of patients (n = 159).
Results. Transpapillary and/or percutaneous biliary drainage was performed in all patients. There was high efficiency of cholestasis syndrome relief (serum bilirubin levels decreased by 39.2%, 53.9% and 77.0% at 3, 7 and 14 day after surgery respectively). Lower incidence of complications was revealed in patients after transpapillary decompression (n = 2; 7.7%) compared with percutaneous technique (n = 10; 30.3%, p = 0.032). Herewith clinical effectiveness and mortality were similar (p = 0.316). In the prospective group of 159 patients transpapillary stenting (n = 107; 63%) was ineffective in 31 case (29.9%), that required additional endoscopic treatment (n = 12) or percutaneous biliary drainage (n = 19). Mortality rate was 13.8% (22 patients).
Conclusion. Endoscopic transpapillary stenting can be recommended in malignant obstructive jaundice management because of low incidence of complications and equal effectiveness and mortality. Percutaneous biliary drainage with primary or delayed recanalization of malignant stricture should be done if transpapillary stenting is impossible due to technical or anatomical aspects. The algorithm provides differentiated approach to choice of biliary decompression
method and improves treatment outcomes.

Aim. To identify opportunities for endoscopic retrograde biliary stenting for malignant obstructive jaundice and to compare long-term results of stenting using plastic and self-expanding metal stents.
Material and Methods. We analyzed the results of endoscopic methods of di-agnostics and treatment of inoperable patients with malignant obstructive jaundice, as well as incidence of early and late complications of biliary stenting as the final treatment. Total number of patients were 160 people which were divided into 2 groups by 80 patients. In the 1st group plastic biliary stents with the diameter of 3–3.5 mm (10–11.5 Fr) were used for bile ducts drainage. In the
2nd group covered self-expanding metal stents with the diameter of 10 mm (28–30 Fr) were applied. All patients underwent a comprehensive diagnostic program including traditional ultrasound (US), computer tomography (CT), EUS (EUS) and endoscopic retrograde cholangiopancreaticography (ERCP).
Results. Early postoperative complications were observed in 7 (8.7%) and 5 (6.7%) patients in the 1st and 2nd group respectively. Remote complications such as recurrent obstructive jaundice and/or cholangitis in various time periods after discharge occurred 2 times more often in the 1st group (28 out of 80 patients) than in the 2nd group (12 out of 80 patients) that required repeated hospitalizations and re-stenting. Malignant duodenal stenosis arose in 20 (12.5%)
patients. Average time was 8.2 months.
Conclusion. Endoscopic retrograde stenting can be used as an effective final method of bile ducts decompression in patients with inoperable pancreatobiliary tumors complicated by obstructive jaundice. The term of plastic biliary and self-expanding metal stents function was 119.9 ± 131.4 days (4 months) and 257.5 ± 91.3 days (8.6 months) respectively. Improvement of equipment and tools, use of antegrade techniques combined with EUS-guided interventions,

pyloroduodenal self-expanding stents allow to bypass pre-existing limitation with duodenal neoplastic stenosis.

Purpose. Correction of complications of percutaneous transhepatic endobiliary interventions in patients with periampullar tumors and mechanical jaundice using minimally invasive techniques.
Material and Methods. We have analyzed the results of treatment of 453 patients with periampullary tumors complicated by mechanical jaundice. Patients were divided depending on stage of liver failure. All patient underwent percutaneous transhepatic cholangiostomy to eliminate mechanical jaundice.
Results. The best results were observed in patients with compensated liver failure. There were no fatal outcomes in this
group, 2 (0.44%) patients had gematobilia stopped conservatively. The greatest number of complications were observed in case of sub- and decompensated liver failure including gematobilia, migration of cholangiostoma and advanced liver failure in 4 (0.88%), 5 (1.1%) and 12 (2.6%) patients respectively. The complex of developed actions improved results of treatment and reduced total of complications to 12.6% and mortality rate to 0.4%.
Conclusion. Conservative therapy combined with minimally invasive interventions improves the remote results of transhepatic interventions.

Aim. To develop more effective methods of surgical treatment of patients with purulent-necrotic parapancreatitis.
Material and Methods. Treatment of 819 patients with purulentnecrotic parapancreatitis was analyzed. The volume of
pancreatic necrosis and extent of purulent-necrotic parapancreatitis were determined according to multispiral computed tomographic angiography or magnetic resonance imaging, as well as during surgery or autopsy. Different surgical methods were compared depending on time and type of surgery. Effectiveness was estimated according to incidence of complications, severe sepsis and mortality rate.
Conclusion. Minimally invasive drainage under x-ray guidance with step-by-step replacement of drains to larger diameter followed by aspiration and/or instrumental necrosectomy is preferable in treatment of purulent-necrotic parapancreatitis. Laparotomy with necrosectomy are ad-visable if minimally invasive procedures are ineffective.

Aim. To evaluate retrospectively the results of post-ERCP сomplications treatment.
Material and Methods. 2688 ERCPs were performed for the period from 2008 to 2014. Bleeding, acute pancreatitis and retroduodenal perforation occurred in 5 (0.2%), 34 (1.26%) and 12 (0.45%) patients respectively.
Results. In all cases of delayed post-ERCP bleedings adequate hemostasis has been achieved by epinephrine injection into edges of dissected papilla and monopolar electrocoagulation. There were no recurrent bleeding and bleeding-related deaths. Endoscopic treatment of ERСP-associated (“retroduodenal”) perforation was applied in 6 cases and was effective in 5 cases (83.3%). Overall mortality was 25% (3 patients) including 2 after surgery and 1 after failed endoscopic treatment. Stenting of main pancreatic duct was applied in 24 cases with successful result in 22 (91.7%) patients followed by full recovery. No complications of stenting procedure were observed. In other 12 observations medical therapy and/or surgical interventions were performed with mortality rate 16.7% in this group.

Conclusion. Treatment of patients with ERCP-assotiated complications is durable, laborious and expensive process. Timely diagnosis of complications, assessment of their severity, choice of adequate curative method are very important. Anyone should keep in mind all possible risk factors, clearly define the indications for ERCP, follow the technique of procedure strictly to reduce number of complications. We believe that post-ERCP complications should be predominantly treated endoscopically because surgery leads to higher postoperative mortality and increases duration and cost of treatment.

Aim. To improve the results of treatment of patients with pancreatic diseases.
Materials and Methods. For the period from 2010 to 2014 it was performed 59 robot-assisted pancreatic operations. There were distal pancreatectomy in 30 cases and pancreaticoduodenectomy in 12 cases including total pancreatoduodenectomy (1), central resection (5), tumor enucleations (12). The study included 48 (81.4%) females and 11 (19.6%) males. Median age was 48.4 ± 14.5 years.
Results. Average operation time in case of ancreaticoduodenectomy, distal pancreatectomy, central resection and tumor enucleation was 463.1 ± 111.1, 218.0 ± 68.2, 253.0 ± 37.7 and 150.0 ± 49.0 minutes respectively. Postoperative complications arose in 24 (40.7%) cases including external pancreatic fistula in 19 patients, delayed gastric empty in 3 and arrosive hemorrhage in 2 cases. There was one death after robot-assisted pancreaticoduodenectomy.
Conclusion. Indications for robot-assisted pancreatic surgery are malignant tumors T1–T2, neuroendocrine neoplasms and benign tumors with size not more than 5–6 cm. The use of robotic complex doesn’t prevent from specific postoperative complications definitive for pancreatic surgery.

Aim. To improve the results of benign diseases and injures of pancreatic ducts management.
Material and Methods. 71 patients with benign diseases and injures of pancreatic ducts underwent combined surgery under ultrasound, endoscopic and X-ray control. There were 49 males and 22 females. Mean age was 41.8 years. Minimally invasive surgery were performed for pancreatolithiasis, injures of pancreatic duct due to acute destructive pancreatitis and stricture in 32, 18 and 21 patients respectively.
Results and Discussion. In case of pancreatolithiasis following interventions were applied: antegrade lithoextraction with balloon catheter, antegrade lithoextraction with special bougie, endoscopic retrograde lithoextraction and combined lithoextraction. In case of pancreatic duct stricture and postpancreatonecrosis damage we performed endoscopic retrograde pancreatic duct stenting, combined restoration of damaged duct’s patency, antegrade percutaneous internal-external stented drainage or stenting of pancreatic duct, antegrade restoration of injured duct’s patency via pancreatic cyst. Mortality rate was 2.04%.
Conclusion. Above-mentioned minimally invasive techniques allows performing pancreatic duct’s lithoextraction, restoration of injured duct’s patency, pancreatic duct’s decompression for hypertension. These methods are perspective and alternative to open surgery in benign pancreatic disorders patients treatment

Aim. To examine the effectiveness of minimally invasive interventions for infected pancreatic necrosis (purulent necrotic
parapancreatitis).
Material and Methods. A simple comparative multicenter study included 270 patients with infected pancreatic necrosis who were treated for the period from 2004 to 2013. Paients were divided into three groups: 1 group – 90 patients who underwent only remedial laparotomy. 2 group – 90 patients who had minimally invasive drainage as the first stage followed by subsequent remedial
laparotomy. 3 group – 90 patients with only minimally invasive drainage. Patients distribution by age, comorbidities, severity of purulent necrotic parapancreatitis and therapeutic medical complex was homogeneous.
Results. There were maximal incidence of complications (digestive fistula, bleeding, RDS, severe sepsis) and mortality rate in group 1. In group 2 there was a tendency to decrease of morbidity and mortality in infected pancreatic necrosis patients although their level remained high. Minimally invasive interventions (3 group) for infected pancreatic necrosis resulted significant reduction of morbidity and mortality.

Conclusion. Minimally invasive techniques should be preferred for primary drainage of infected pancreatic necrosis (purulent necrotic parapancreatitis). Laparotomy with necrosectomy is necessary in case of ineffectiveness of minimally invasive drainage or appearance of complications that can not be treated using minimally invasive interventions

Aim. To analyze the effectiveness of percutaneous minimally invasive technology of pancreatroсystgastrostomy formation
on the stent.
Material and Methods. The study group consisted of 37 patients with symptomatic single pancreatic pseudocysts type 2 (according to the D'Egidio classification) more than 5 cm in diameter. Modified minimally invasive technique (percutaneous transgastric pancreatoсystogastrostomy followed by stenting of anastomosis under ultrasound and endoscopic guidance) was applied. The control group consisted of 55 patients who underwent traditional surgical
methods (pancreatoсystogastrostomy, pancreatoсystojejunostomy). Duration of surgery, postoperative hospital-stay and incidence of complications were analyzed. Follow-up examinations were performed at 6, 12 and 24 months.
Results. The use of modified technique reduced duration of surgery from 135 minutes (110; 170) in the control group to 15 minutes (12; 22) in the study group (p < 0.0001), postoperative hospital stay to 4 (3, 5) days (vs. 14 days (11; 18) in the control group, p < 0.0001). Postoperative complications occurred in 2 (5.4%) and 12 (21.8%) patients of main and control groups respectively (p = 0.048). Recurrence of pseudocyst was detected in 7 (12.7%) patients in the control group while in the study group recurrence was absent (p = 0.039). There were no deaths in both groups.
Conclusion. Percutaneous transgastric pancreatoсystogastrostomy is an effective treatment for patients with pancreatic pseudocysts type 2 according to D'Egidio classification

Aim. To study the possibility of using minimally invasive  interventions for pancreatic pseudocysts complicated by
perforation and diffuse enzymatic peritonitis.
Material and Methods. We analyzed the results of treatment of 298 patients with pancreatic pseudocysts inclyding 119 cases of pancreatic pseudocysts complicated by perforation and diffuse enzymatic peritonitis. To determine the most effective surgical method in treatment of pancreatic pseudocysts complicated by perforation and diffuse enzymatic peritonitis combination of minimally invasive procedures (laparocentesis, laparoscopy) for the relief of enzymatic peritonitis followed by ultrasound-assisted pseudocysts drainage and traditional laparotomy with external drainage of pancreatic pseudocyst were compared.
Results. In order to optimize the diagnostic search 57 diagnostic features (clinical, laboratory, instrumental) recorded in 119 patients were selected. After correlation analysis features having moderate or strong association with the occurrence of pancreatic pseudocyst complicated by perforation were selected. Diagnostic scale was developed based on these symptoms. Effectiveness of different methods of surgical treatment of pancreatic pseudocysts complicated by perforation and diffuse enzymatic peritonitis was evaluated according to incidence of sepsis and mortality rate. The use of minimally invasive techniques has reduced the incidence of sepsis from 18.8% to 5.9%, mortality from 9.4% to 2.9%.

Conclusion. Diagnostic scale consisting of 5 signs that allows to verify pancreatic pseudocyst perforation with the probability near 95.8% was developed. Method of choice for treatment of enzymatic peritonitis is remedial laparoscopy (laparocentesis). External drainage of pancreatic pseudocysts is advisable to carry out under ultrasound guidance. Remedial laparotomy is indicated if minimally invasive approach is ineffective.

We present clinical observation of liver echinococcosis with lesion of retroperitoneal space and mediastinum in patient with recurrent echinococcosis. Literature review and difficulties of timely diagnosis, examination and minimally invasive treatment of these patients are showed.