Aim. To analyze the short-term outcomes of сentral segments liver resection in children, according to the initial experience.

Мethods. The data of patients with different centrally located liver neoplasms were analyzed. This retrospective study included three patients with hepatoblastoma, one observation of mesenchymal hamartoma of the liver and one patient with hepatocellular carcinoma. Different types of central liver resections were carried out in these patients between March and October 2018. The technical aspects and the short-term results are described.

Results. Median age of patients was 78 months (9 months – 12 years). Patients underwent: segmentectomy 4b, bisegmentectomy 4b, 5, threesegmentectomy 4, 5, 6, mesohepatectomy (anatomical segmentectomy 4, 5, 8) with biliary reconstruction for posterior liver segments, mesohepatectomy with anatomical segmentectomy 6 and atypical S2, 3 resection. Dindo–Clavien grade IIIa postoperative complication developed in one patient. Vascular complications and posthepatectomy liver failure were absent. The hospital stay ranged between 9 to 14 days. The median follow-up period came to 8 months (7–14 months). The overall and event free survival at the time of writing is 100%.

Conclusion. Resections of central liver segments in children are feasible and should be carried out in experiences in liver surgery centers.

Aim. To evaluate short- and long-term results of surgical treatment of the liver metastases from kidney cancer, to identify prognostic factors.

Materials and methods. The retrospective study included 67 patients who underwent surgical treatment for liver metastases from kidney cancer from 1990 to 2019. A total of 71 operations on the liver were performed (53 economical resections, 15 extensive resections, 3 radiofrequency thermoablation). Four of them were repeated for the development of metastases in the liver remant.

Results. Postoperative morbidity was 30%. There was one (1,5%) intraoperative death. Within 90 days after surgery, all patients were alive. The 5-year overall survival was 64%, median was 73 months. Univariate analysis revealed factors that significantly worsened overall survival: stage III and IV kidney cancer at the time of nephrectomy; nonclear cell histological type of metastases; synchronous liver metastases; intraoperative blood loss more than 2000 ml. Gender, age (≥ 65 years) at the time of surgery, number of metastases, maximum diameter of the metastases, presence of extrahepatic disease and major liver resection did not have a statistically significant impact on overall survival.

Conclusions. Surgical treatment allows to achieve long-term overall survival of patients with liver metastases from kidney cancer. Higher indicators of overall survival were noted in the clear-cell variant of kidney cancer, stage I–II, and the metachronic nature of hepatic metastases. Patients with large (≥4 cm) and multiple resectable liver metastases, having solitary and single metastases in other organs, provided that they are radically removed, can also be considered as candidates for surgical treatment.

Aim. To present the first Russian experience in the management of portal hypertension of various etiology by creating a selective portosystemic shunt between left gastric vein and inferior vena cava (leftgastric vein caval bypass).

Material and methods. “Left gastric vein to inferior vena cava” bypass was performed in 6 patients with portal hypertension: 4 men and 2 women (mean age 40.4 years). The follow-up period ranged from 10 to 36 months.

Results. “Left gastric vein to inferior vena cava” bypass was effective in the management of portal hypertension and its complications in 5 out of 6 patients. Complete eradication of esophagogastric varices and no variceal bleeding were observed in long-term period. These patients demonstrated no clinical or laboratory signs of hepatic encephalopathy and/or hepatic failure within the follow-up. One patient with thrombophilia and extrahepatic portal vein obstruction (factor V Leiden mutation) had thrombosis of the shunt and recurrent variceal bleeding in 6 months after surgery because of unauthorized abandonment of the anticoagulation.

Conclusion. “Left gastric vein to inferior vena cava” bypass is an effective procedure for prevention of variceal bleeding (or recurrence) in patients with portal hypertension. The limitation of this technique is insufficient diameter of left gastric vein in many patients. This procedure has certain pathophysiological advantages over other types of portosystemic anastomoses due to highly selective nature of the shunt. Thus, this approach should be introduced into surgical treatment of these patients.

Aim. Compare the short-term and long-term results of the traditional and original methods of terminoterminal pancreaticojejunostomy with subtotal resection of the pancreatic head.

Materials and methods. The results of subtotal resection of the pancreatic head in 20 patients with chronic pancreatitis with pancreatic duct obstruction at the level of the head are analyzed. In 10 cases at the final stage of the operation, the traditional terminoterminal pancreaticojejunostomy was performed, in 10 – in the original way.

Results. Biliary tract decompression was performed in 65% of patients. The average duration of operation from original terminoterminal pancreaticojejunostomy operation was 170 min. [165; 180], intraoperative blood loss – 210 ml [200; 240], the average duration of postoperative hospital stay – 16 days [14; 17]; there were no mortality. After 5 years, in all patients who underwent the original terminoterminal pancreaticojejunostomy, the expressiveness of pain according to the developed ten-point scale was <4 points. Frequency for the first time diagnosed diabetes was 50–60%. The need for enzyme drugs was noted in 37.5–40% of cases. The frequency of complications requiring repeated surgical interventions is 12%, persistent disability – 50%. The quality of life indicators for Medical Outcome Study Short Form-36 and European Organisation for Research and Treatment of Cancer quality of life questionnaire – C30 exceeded those of the traditional method of completing the surgery by 3.9–8.4% and 9.3–16.7%.

Conclusion. The original way of a single-row terminoterminal pancreaticojejunostomy with subtotal resection of the pancreatic head allows to reduce averages operative time and postoperative hospital stay. The risk of hemorrhagic complications from the resected pancreatic head does not decrease (10%). After 5 years, an insignificant advantage of the original method of terminoterminal pancreaticojejunostomy compared with the traditional one was noted. The incidence of permanent disability was 15% less, the quality of life indicators for the Medical Outcome Study Short Form-36 and European Organisation for Research and Treatment of Cancer quality of life questionnaire – C30 were better.

Aim. To improve the results of surgical treatment of patients with cholelithiasis complicated by cholangiolithiasis and obstructive jaundice, using percutaneous technologies.

Materials and methods. The results of treatment of 50 patients with cholelithiasis complicated by cholangiolithiasis and obstructive jaundice, which was not possible to use the endoscopic retrograde method of treatment was analyzed. Two representative clinical groups were formed according to the para-copy method: patients of the 1st group used the percutaneous method of treatment of cholangiolithiasis, patients of the 2nd group used the rendezvous technique.

Results. The duration of the operation in the first clinical group was 85.60 ± 8.50 minutes, in the second – 64.80 ± 6.41 minutes. Intraoperative blood loss in both groups is minimal. The duration of postoperative hospital stay was: in the first group – 12.10 ± 1.25 days, in the second – 12.00 ± 1.25 days. In the first clinical group, the complication rate is 12%, in the second – 16%. No deaths were observed. The use of percutaneous laser lithotripsy allowed us to achieve the effectiveness of treatment of cholangiolithiasis in all patients in both clinical groups. The average consumption of a contrast agent per patient in the first group is 250.00 ml ± 25.00 ml, in the second – 370.00 ml ± 35.00 ml. Repeated debridement interventions in the first group were required by 2 (8%) patients, in the second – 8 (32%) patients.

Conclusion. The frequency of complications, the duration of hospital stay and the effectiveness of treatment are comparable in both groups. If there is percutaneous access, hardware, instrumental and personnel support for percutaneous lithoextraction, there is no need to switch to a retrograde method for resolving cholangiolithiasis. The percutaneous method is an alternative minimally invasive method for treating patients with cholangiolithiasis and obstructive jaundice, which is impossible to perform “traditional” interventions or is associated with a high risk.

Aim. To determine the dependence of the formation of vascular-biliary fistula with the bile ducts bleeding and along the drainage channel on the diameter of the puncture needle and access to the biliary tract.

Materials and methods. A retrospective analysis of the results of treatment of 3786 cases of percutaneous transhepatic cholangiostomy using needles 17.5-18 G under Amplatz 0.035’ conductor with a safe J-tip was carried out. In the cholangiostomy in the bile ducts was installed biliary tree drainage shape memory No 8 Fr. In benign lesions of the bile ducts 2066 (54.6%) interventions were performed, 1720 (45.4%) for malignant ones. Central access to the bile ducts was performed in 2442 cases (64.5%), peripheral – in 1344 cases (35.5%).

Results. Significant hemobilia was observed in 21 (0.55%) cases: in 8 (0.47%) with a obstructive jaundice of malignant etiology, in 13 (0.63%) – benign etiology. In 3 cases, the cause of hemobilia was arteriobiliary fistula, in 16 – portobiliary, in 2 – biliovenous fistula. Central access was complicated by significant hemobilia in 10 patients, peripheral – in 11.

Conclusion. The low frequency of significant hemobilia – 0.55% – when using puncture needles 17.5–18 G for primary access to the bile ducts proves the validity of their use in radiological practice, and also does not allow to consider central access critical for the development of hemorrhagic complications in percutaneous transhepatic biliary drainage.

Aim. To identify the frequency of gallstone ileus based on the surgical experience of the Kiev region in patients with acute calculous cholecystitis and acute intestinal obstruction. To evaluate the capabilities of the gallstone ileus diagnosis algorithm for correct topical diagnosis before surgery.

Materials and methods. For 2004–2018, 13713 patients with acute cholecystitis and 3609 patients with acute intestinal obstruction were hospitalized. In 0.64% of cases, gallstone ileus was diagnosed in patients with acute calculous cholecystitis, in 0.41% in choledocholithiasis, and in 2.4% in its complex forms. In 0.73% gallstone ileus was detected during operations for acute intestinal obstruction and in 1.12% for its obstructive form.

Results. A total of 25 patients with gallstone intestinal obstruction underwent surgery. In the topical diagnosis of gallstone intestinal obstruction, X-ray contrast methods dominate. During surgical procedure, only with pyloroduodenal variants of obstruction, cholecystectomy is performed simultaneously with the elimination of obstruction. In other situations, cholecystectomy is performed after 3–8 months. Of the 25 patients, 4 patients died due to ascending cholangitis, peritonitis due to bile leakage, and severe co-morbidities.

Conclusion. The use of the algorithm of advanced diagnostic methods allows you to receive a diagnosis in most patients. The most valuable in topical diagnostics are contrast methods. New in gallstone ileus is the migration of gallstone after endoscopic papillosphincterotomy with mechanical lithotripsy for choledocholithiasis, especially with its complex forms. In our opinion, all types of gallstone ileus can be combined into Bartolin-Bouveret syndrome, which first described this variant of mechanical intestinal obstruction.

This work is based on analysis of publications devoted to the problem of surgical approach to treatment of acute pancreatitis over the last 30 years. The main aim of this review is to identify the key steps of evolution of surgical approach to treatment of infected pancreatic necrosis and also to determine the most promising approach among existing methods. The analysis of the most modern clinical recommendations adopted in different countries of the world, as well as the search for such problems, the solution of which will be the main task of world medical science in the near future, is carried out. It has been established that medical communities of different countries give preference to minimally invasive methods of debridement: percutaneous and transluminal endoscopic drainage. According to the most advanced recommendations, the method of choice for surgical treatment of infected pancreatic necrosis is transluminal endoscopic drainage, with inefficiency – percutaneous puncture drainage. The main idea that defines the search vector for treatment methods for the disease is the recognition of the fact that all surgical approaches are aimed at achieving one goal – removing the maximum possible volume of necrotic masses with minimal damage to surrounding tissues. Only a method that satisfies both requirements can be recognized as leading.

The aim of the work is to highlight the main components of the enhanced rehabilitation programs, to compare the results of traditional pancreas operations performed under these programs, and also to present possible prospects for this area. The number of operations performed in patients with various pathologies of the pancreas has increased significantly. Despite a significant reduction in postoperative mortality, the frequency of postoperative complications remains significant, even in specialized centers. The full restoration of the quality of life after surgery takes considerable time. The concept of accelerated rehabilitation after surgery, based on the principles of evidence-based medicine, has been shown to be effective in specific areas of abdominal surgery. However, the role of this concept in surgical pancreatology is not specified. Non-randomized studies and individual randomized studies have shown that the use of accelerated rehabilitation protocols for pancreatic surgery is safe, allowing you to reduce the duration of postoperative hospital stay without increasing the number of complications and mortality.

Aim. A critical analysis of modern scientific publications on the application in complex treatment program of patients with acute bleeding from esophageal varices endoscopic hemostasis with self-expanding nitinol Danish stents.

Methods. Literature data are presented on the results of treating patients at the height of esophageal bleeding or with a high risk of recurrence by installing self-expanding nitinol Danish stents.

Results. The advantages of Danish stent include low trauma; good tolerance; physiological saliva drainage and the possibility of receiving fluid and food through the mouth; repeated endoscopic examination of the esophagus and stomach after the introduction of the stent; reducing the risk of aspiration pneumonia; the impossibility of removal or displacement by the patient in a state of excitement. The disadvantages of self-expanding nitinol Danish stents, in addition to the risk of migration from the esophagus to the stomach with loss of its plugging function, include the limitation of the therapeutic effect only to varicose veins of the esophagus, the development of small erosions or ulcers on the mucous membrane of the esophagus after stent removal.

Conclusion. The extent to which endoscopic hemostasis with self-expanding nitinol Danish stents will take a strong place in the treatment of patients with variceal bleeding is not clear. In the recommendations of the Baveno VI Consensus the method is considered as an attractive alternative to Sengstaken–Blackmore balloon tamponade, however, the need for confirmation of the initial clinical results by further comparative randomized controlled trials is indicated.

The small remnant liver volume remains an urgent problem in liver resection surgery. The use of the method of twostage liver resection – the Associated Liver Partition and Portal vein ligation for Staged hepatectomy in most cases allows to solve this problem. However, this method is associated with a number of complications and limitations. The presented clinical observation shows the effectiveness of an alternative version of this technology – radiofrequency ablation of the liver parenchyma in the plane of the proposed resection with ligation of the right branch of the portal vein to increase the volume of the estimated liver remnant in intrahepatic cholangiocellular cancer.

A description of a rare clinical observation of pancreatic VIPoma is presented. Submitted literature review. The difficulties of preoperative diagnosis, as well as the effectiveness of surgical treatment are shown.

Clinical observation of choledocholithiasis followed by a large calculus of the common bile duct is presented. Endoscopic retrograde cholangiopancreatography with an attempt of lithotripsy was failed. Subsequent shock-wave lithotripsy was followed by fragmentation of a large stone. Balloon dilatation of major duodenal papilla with subsequent extraction of fragments of the stone were performed. Complex approach allowed us to successfully eliminate “difficult” choledocholithiasis and restore an adequate biliary passage.

A case report of the patient at week 21 of pregnancy with Mirizzi type 2 syndrome complicated by acute cholangitis is described. During the examination, the level and cause of the biliary obstruction (cholecystocholedocheal fistula and gallstone of the common bile duct) were revealed. A detailed description of the surgical procedure is presented: subtotal laparoscopic cholecystectomy, choledochotomy, choledochoscopy, lithoextraction, drainage of the common bile duct. The analysis of information from literature sources is carried out.

In this paper, important scientific achievements of S.P. Fedorov as a surgeon and organizer of health care were noted. Little-known facts from the life of the Professor S.P. Fedorov were covered. S.P. Fedorov is the author of over 120 scientific works. He is rightly called the father of russian bile duct surgery. The main directions of scientific research S.P. Fedorov was urinary and biliary tract surgery. He summarized extensive experience in widely known monographs and guides. An important merit of S.P. Fedorov was the organization of the surgical journal “New Surgical Archive”. He was the editor of the first edition of “Big medical encyclopedia”, edited the multivolume “Manual of Practical Surgery”. He created a large domestic surgical school, from which dozens of specialists, heads of surgical departments of medical universities in various cities of the USSR, graduated.