Aim. To develop the system assessing degree of disease compensation and the algorithm for selection of method of surgical treatment.
Material and Methods. Main parameters of nutritionally – metabolic status, central hemodynamics, porto-hepatic circula tion, oxygen regime of tissues and major clinical syndromes (ascites, jaundice, hepatic encephalopathy) depending on severity and degree of disease compensation were studied in 166 patients with liver cirrhosis and portal hypertension.

Results. Intensity of catabolism and amino-acid disorganization amplifies accordingly to increased severity of disease
in groups A, B and C by Child. It is accompanied by increased protein deficit in somatic and visceral protein parts of body
and formation of moderate and severe malnutrition. In parallel with these changes there are compensatory changes
in central hemodynamics including transition from normorkinetic type of circulation in the group A to hyperkinetic
circulation in group B, “breaking” of compensation with formation of hypokinetic circulation in group C. It is accompanied
by changes in porto-hepatic circulation and reflected on functional state of liver. The hypothesis of liver failure
progression with formation of five functional classes is suggested. Violations of “trophic homeokinesis” supporting “vicious circle” play important role in pathogenesis of liver failure. Based on obtained data additional groups characterizing the transition from one class to another are determined. We presented quantitative objectification of changes of main parameters which characterize the severity of disease. It allows to modify the system assessing reserve potential in patients with liver cirrhosis and portal hypertension. Based on this classification the algorithm for selection of surgical treatment in these patients is poposed. Conclusion. The suggested classification assessing degree of disease compensation in patients with liver cirrhosis and portal hypertension is not an alternative to popular forecasting Child’s system but complements it in clinical situations which are difficult to assess the reserve potential and to choose surgical treatment. The classification will allow to compare obtained results in evaluation of effectiveness of different treatment strategies.

Aim. To evaluate the results of distal splenorenal shunts (DSRS) in elderly patients with liver cirrhosis. Material and Methods. 285 patients of three age groups with liver cirrhosis (LC) and portal hypertension were enrolled: up to 30 years, 31–49 years and over 50 years. Selective portosystemic shunting was performed in all cases. Results. The study showed that there was no significantly greater risk of specific postoperative complications in patients
over 50 years if indications for bypass surgery were observed. The incidence of moderate and severe liver failure was 7.6% and 13.6% in patients aged up to 50 years and over 50 years respectively. Latent and clinical forms of hepatic encephalopathy were found in 57.1% and 66.7% of cases respectively. Incidence of ascites augmentation differed slightly – 14.1% versus 13.6%. Bleeding from esophageal varices in early postoperative period after DSRS developed in 5.7% of patients aged up to 50 years and in 4.5% of patients aged over 50 years. Conclusion. At present time DSRS is dominant surgery and performed in more than 50% of cases. In elderly patients or due to low compensatory reserve of hepatocytes this type of bypass surgery remains priority and sometimes unique way for portal system decompression

Aim. To study the peculiarities of portosystemic hemodynamics in patients with cirrhotic portal hypertension before and after TIPS procedure and to identify its influence on the development of typical complications of portal hypertension including bleeding from gastric and esophageal varices, ascites and hepatorenal syndrome.
Material and Methods. The TIPS procedure was performed in 136 patients with complicated cirrhotic portal hypertension. Surgical anatomy of liver vascular system and porto-hepatic hemodynamics have been studied using CT-splenoportography, Doppler ultrasonography of portal vein system and CT- angiography portal and hepatic veins. The surgical results were evaluated on various dates postoperatively with the period rate of 3–6 months. Results. Portal vein’s and hepatic veins’ angioarchitecture in a context of TIPS procedure was studied. Algorithm of intrahepatic portosystemic canal creation with the direction determined by surgeon is developed. It gives the opportunity to reach the optimal parameters of shunt’s hemodynamics. It is established decrease of portal pressure and portosystemic venous pressure gradient after surgical intervention. Consideration of anatomic features while forming the intrahepatic
portosystemic shunt makes it possible to achieve stable portal decompression even in the environment of significant cirrhotic process. Conclusion. TIPS procedure enables to effectively decrease portal vein system pressure, normalize portosystemic hemodynamics indicators and significantly promote prevention of complications induced by portal hypertension.

Aim. To improve the results of surgical treatment of patients with syndrome of portal hypertension. Material and Methods. One hundred and sixty nine patients with syndrome of portal hypertension who underwent elective surgery were examined. 100 patients had liver cirrhosis and 69 patients – extrahepatic portal vein obstruction. Portocaval shunting was scheduled for all patients. Selective portocaval shunting was preferred in cirrhotic patients;
maximal shunting using “side to side” or “H-type” mesentericocaval or splenorenal anastomoses was chosen for those who had extrahepatic portal vein obstruction. Results. Selective portocaval shunting was performed in 26 of 100 patients with liver cirrhosis. Seventy six patients underwent gastrotomy with direct oesophagogastric varices ligation. In case of extrahepatic portal vein obstruction portocaval shunting was applied in 69 patients and direct oesophagogastric varices ligation – in 26 patients. Shunt
surgery was rejected due to high activity of the pathological process in liver, presence of hepatic encephalopathy, heart failure; and also according to ultrasonography and computed tomography of portal system. Satisfactory short-term results were obtained in 97% of patients. Overall mortality was 0,8%. Conclusion. Phased preoperative examination protocol should be applied for the optimization of surgical management in patients with portal hypertension: patients’ selection based on clinical and laboratory data, assessment of central hemodynamics and neurological status. It is necessary to determine hemodynamic and topographic features using ultrasonography and 3D computed tomography of portal and caval systems to forecast the ability to perform different types of portocaval shunting; to define type and extent of surgical intervention depending on intraoperative data

Extrahepatic portal vein thrombosis is the second most frequent cause of portal hypertension after liver cirrhosis. Risk factors of the thrombosis are divided into systemic: hereditary and acquired thrombophilia (60–70%); and local: abdominal inflammation, trauma, surgery, etc. (20–40%). Acute thrombosis episode is often olygo- or asymptomatic and remains undiagnosed until the development of portal hypertension and its complications: gastroesophageal variceal bleeding, portal biliopathy, etc. Early onset of anticoagulation is recommended and should be prescribed at least for 3 months. In patients with portal cavernoma a long-term (even lifelong) anticoagulation is directed to prevent recurrence and extension of thrombosis, especially in case of thrombophilia. Portocaval shunting is the most radical way to correct portal hypertension and to deliver a patient from variceal bleedings and other complications of the disease. Hepatic encephalopathy is a rare
condition and generally subclinical. Endoscopic band ligation and sclerotherapy are effective in acute variceal bleeding, primary and secondary prophylaxis of bleeding and should be supplied by non-selective β-adrenoblockers administration. Patients with extrahepatic portal vein thrombosis are well tolerated to variceal bleeding episodes and have high rates of survival during long-term follow-up due to normal liver function. Mortality in these patients is low (5-year mortality is less than 10%) and generally is associated with comorbidities rather complications of portal hypertension

Aim: to evaluate the immediate and remote results of liver transplantation (LT) for portal hypertension syndrome in the
Republic of Belarus. Material and Methods. 256 primary liver transplantation for portal hypertension were included into retrospective study. 30 operations for fulminant hepatic failure (n = 14), unresectable alveococcosis (n = 6) and neoplasms (n = 10) were included into comparison group. Results. There were no differences in incidence of vascular, biliary and infectious complications in both groups. It was revealed that the acute rejection incidence in case of portal hypertension was 8.6% (22 out of 256) vs. 20% (6 out of 30) (р = 0.05) in comparison group. 3-year survival was 88.4% in the main group and 90% in the control group. Conclusion. Liver transplantation is an effective method of treatment for portal hypertension. Portal vein thrombosis in cirrhotic patients is not contraindication for liver transplantation

Aim: to perform comparative analysis of opisthorchosis and non-parasitic liver abscesses. Material and Methods. 46 patients with opisthorchosis and 43 patients with nonparasitic liver abscesses were treated. Results. Opisthorchosis liver abscesses occur 3 times more frequent than non-parasitic (2.65 and 0.85%, respectively) in the Tomsk region that is hyperendemic for opisthorchiasis. They develop because of prolonged (13.2 ± 2.4 years) and massive invasion due to suppuration of cholangiectasis and liver cysts. In 58.1% of cases it happens on background of extrahepatic cholestasis, in 93.5% has cholangiogenic character. They are preferably multiple – 58.1% (including military in 7%), have small size (65.1%), localized in SVII and SVI. Jaundice (53.5%), hepatomegaly (88.4%), acute renal
failure (30.2%), skin rash (86%), eosinophilia are more often (p < 0.05) observed in patients. Abscesses were recurrent in 15.2% of cases. Ultrasound as the main method of diagnosis allows to verify pathognomonic signs of opistorchosis (accuracy 96–100%), number, size, location of abscesses, their types depending on the prevalence of infiltrative or destructive processes, absence of capsule.
Intraportal infusion of antibiotics and other drugs, nasobiliary or transcapillary sanation of biliary system were used in case of infiltrative and miliary abscesses. Minimally invasive methods of treatment in case of formed abscesses are inefficient. Incision and drainage, as well as liver resection are indicated. Two-thirds of patients required cholecystectomy, bile passage restoration into duodenum by choledochoduodenostomy because of specific extended strictures of common bile duct and major duodenal papilla, external drainage of ducts from infection and helminths.Conclusion. Cholangiogenic opisthorchosis liver abscesses are more often multiple. Their clinical course is more severe. Open methods including liver resection are mainly indicated in the treatment 

Aim: to assess morphofunctional changes in rats' liver after left lobe resection using cold plasma hemostasis. Material and Methods. Research was performed on 6 experimental groups with 30 laboratory rats. There were 5 intact animals in control group and 5 animals in each group on the 3rd, 5th, 7th, 14th, 30th day after liver left lobe resection and coagulation with cold plasma coagulator. The biochemical analysis, coagulogram control and morphological study
of rats’ liver were performed. Results. Analysis of biochemical markers revealed that activity of AST, α-amylase, alkaline phosphatase and levels of glucose, urea are increased in early period what indicates on liver damage. AST is reduced by the 30th day. It indicates on repair of liver parenchyma. Slight increase of α-amylase and alkaline phosphatase levels by the 30th day is associated
with continued overall reaction to surgery. There is increase of specific volume of hepatocytes with signs of degeneration, the number of cells with necrotic changes in 1 mm2, infiltrate density in 1 mm2 and specific volume of connective tissue in early period followed gradually reduce by the 30th day. These changes point out destructive process in early period and its gradual reduction by the 30th day. Specific volume of binucleated hepatocytes in early period is reduced and increased by the 30th day as a sign of reduction and further stimulation of regenerative process by the 30th day.

Aim. To improvethe efficiency of X-ray treatment of postoperative complications (duodenal and biliary fistulae, intraabdominal iatrogenic bile collections). Material and Methods. Percutaneous transhepatic biliary drainage was carried out in 11 patients with nondilated intrahepatic bile ducts. Failure of duodenal stump after previous stomach resections in 5 patients, presence of external
biliary fistulae after surgery on gall bladder and common biliary duct in 3 patients and severe pancreonecrosis in 3 cases led to need of antegrade transhepatic cholangiostomy. Results. Antegrade transhepatic cholangiostomy gives an ability to close duodenal fistulae in 5 patients and biliary fistulae in 3 patients with iatrogenic injury of common biliary duct. Percutaneous transhepatic biliary drainage was used in treatment of 3 patients with severe pancreonecrosis. There were 2 complications of antegrade transhepatic cholangiostomy such as hepatic subcapsular hematoma and porto-biliary fistula which were cured effectively using
minimally invasive methods (percutaneous drainage of hematoma and disintegration of porto-biliary fistula by filling
of intrahepatic canal). Conclusion.  Antegradetranshepaticcholangiostomy in case of nondilated intrahepatic bile ducts differs from traditional technique. Often it assumes contrasting of biliary tree using any available way and demands strict compliance of manipulation technology

The aim is to study the incidence of acute pancreatitis on background of major duodenal papilla stone and to evaluate its
clinical course. Material and Methods. Signs of major duodenal papilla stone have been found in 189 patients aged 22–94 years.
Incarcerated calculus was diagnosed in 121 patients. 14 patients suffered from icterus previously. Also 14 patients were treated at the hospital for acute pancreatitis (2 of them were treated for pancreatonecrosis). Pain syndrome was present in each case. Contact ultrasonic and duodenoscopy were obligatory stages of patient’s examination. Results. Major duodenal papilla stone was successfully visualized using contact ultrasound only in 58.4% of cases, two or more pathological features of the papilla and para-ampullar area were endoscopically confirmed in 92.6% of patients.
The course of disease was complicated by acute pancreatitis in 112 cases (59.3%), by pancreatonecrosis – in 33 cases, by confirmed clinical and instrumental signs of biliary stasis – in 133 (70.4%) observations, by cholangitis – in 62 (32.8%) cases. Acute pancreatitis developed due to incarcerated calculus in 79 patients. In 21 of 33 cases of pancreatitis (63.6%) subtotal and total lesion of pancreatic gland was found. Suppurative complications and signs of multiple organ failure were diagnosed in 13 (39.4%) and 21 (63.6%) of 33 patients respectively. Overall mortality from pancreatonecrosis on background of major duodenal papilla stone was 36.4%. Conclusion. Major duodenal papilla stone is complicated by acute pancreatitis in more than half of cases and nearly one of five patients had pancreatonecrosis. More than half of patients suffered from severe course of disease. In view of this it is necessary to improve the quality of diagnosis and to carry out immediate resolution of acute block of major duodenal papilla 

Aim. To assess the possibility of TurboHawk atherectomy catheter to produce material for histological examination and to restore patency of the previously installed biliary stents. Material and Methods. 5 patients underwent biopsy of the bile ducts with TurboHawk atherectomy catheter. Attempt to restore patency of obturated biliary stents was applied in two patients. 2 patients earlier underwent hemihepatectomy. In two observations previous biopsy was not informative. Results. Sufficient amount of material for histological and immunohistochemical studies was obtained in all cases. Ductal adenocarcinoma was diagnosed in three patients. Patients with previously established stents were failed to obtain
adequate passage of bile. Conclusion. TurboHawk: atherectomy catheter allows to fence sufficient amount of material for histological study and is an alternative method to endoscopic biopsy if it is not possible to do it.

Aim. Comparative evaluation of immediate results of ancreatoduodenectomy taking into account the chosen method
of reconstructive phase and options of pancreatojejunoanastomosis.
Material and Methods. It is analyzed surgical treatment of 206 patients with obstructive diseases in pancreatoduodenal area who underwent pancreatoduodenectomy (PDE) for the period from 1991 to 2014. Reconstructive phase was performed using two techniques: forming pancreatojejunostomy, biliodigestive anastomosis and gastrointestinal anastomosis on single jejunal loop and on individual loops. Choice of pancreatojejunoanastomosis in  pancreatoduodenectomy depended on the diameter of pancreatic stump and jejunal lumen as well as on the state of pancreatic parenchyma and main pancreatic duct. Results. Reconstructive stage of pancreatoduodenectomy with anastomoses on the single loop was applied among 198 (96.1%) patients. Developed technique with formation of anastomoses on individual loops was used in 8 (3.9%) patients. End-to-end pancreatojejunostomy was formed among 183 (88.8%) patients, end-to-side anastomosis – in 19 (9.2 %)
cases, anastomosis with gallbladder and pancreatic stump – in 4 (1.9 %) patients. Pancreatojejunoanastomosis with suture line covering using sickle ligament was applied among 4 (1.9 %) patients. Conclusion. Differentiated approach to selection of pancreatojejunoanastomosis reduces number of complications
caused by its incompetence. Pancreatojejunoanastomosis with suture line covering using sickle ligament is preferred in case of soft, “juicy” pancreas and high risk of pancreatojejunostomy incompetence

Solid pseudopapillary pancreatic tumor (SPT) is a rare highly differentiated malignant neoplasm associated with relatively favorable clinical course. Most frequently it is met in 20–30 years old women. SPT has no specific clinical manifestations. Radiologic diagnosis (US, CT, MRI) reveals characteristic for this tumor features like heterogenicity and hypovascularicity, reflects solid and cystic components of the neoplasm. Sporadic reports describe extraorgan location of pancreatic SPT. Main method of treatment is surgery. Extent of pancreatic resection depends on location and size of the tumor. In case of malignant clinical course chemotherapy and radiotherapy should be discussed

It is presented rare observation of biliary papillomatosis causing bile duct confluence stricture with following obstructive jaundice. The differentiated diagnosis and features of interventional procedures are discussed in detail. The authors also suggest never previously mentioned method of biliary papillomatosis therapy consisting of systemic and local intraductal prospidine (alkylating anticancer drug) application. Thanks to this therapeutic approach stricture was cured followed by drainage removal. Favorable long-term results were obtained

Aim. To show the difficulties in identification of pathogenic organisms of catheter-associated biliary infection and to demonstrate the differences in antibiotic sensitivity of microbes in biofilms and planktonic form. Materials and Methods. The patient with pancreatic head pseudocyst complicated by obstructive jaundice underwent
two-stage surgery. Ultrasound-assisted cholecystostomy was performed followed by cholecystectomy. Further there were
pancreatic head resection with cystopancreato- and hepaticojejunal anastomosis on excluded jejunal loop and common bile duct drainage through the cystic duct. The postoperative period was complicated by recurrent cholangitis. We carried out the microbiological analysis of drainage discharge with the assessment of antibiotic sensitivity according to conventional technique. The drainage surface was studied using scanning electron microscopy. Mass spectrometry was applied for microorganisms’ identification. Biofilms were modeled based on isolates obtained from the catheter;
antibiotic sensitivity of microorganisms in biofilm was determined.
Results. Pseudomonas aeruginosa and Candida аlbicans were isolated in the discharge from cystic duct drainage. The biofilm found on drainage surface consisted of Streptococcaceae strains except for those mentioned above. P. aeruginosa strain could not form biofilm, though it could be built in the biofilm formed by C. albicans. P. aeruginosa and C. аlbicans as part of biofilm lost their sensitivity to antimicrobial agents they had when being in plankton. Conclusion. Bile ducts drainage is associated with biofilm formation on catheter surface. Routine microbiological study does not always enable to evaluate the range of microbial pathogens. Traditionally determined antibiotic sensitivity of planktonic forms does not correspond that when microorganisms are in biofilm. External bile draining eliminates
cholestasis rather than bacteriocholia. Adequate treatment of biliary infection should take into consideration all the above mentioned factors; restoration of bile outflow in small intestine is the most important condition 

The article presents a chronological review of developments in bile ducts surgery. It gives an account of authors, their approaches to the management of diseases of these organs, development and introduction of surgical procedures that represent milestones in the history of hepato-pancreato-biliary surgery.