Aim of study. To improve the results of treatment of patients with hepatic alveolar echinococcosis by developing and introducing into clinical practice a new classification of the disease, which determines the treatment strategy with all available treatment options, including transplant technologies.
Material and methods. A total of 323 patients with hepatic alveolar echinococcosis in three high-volume centers with liver transplantation programs were treated by a single protocol and included in the study.
Results and discussion. Radical (R0) hepatectomies and liver transplantation were performed in 312 patients. The patients were divided into groups, and the optimal treatment strategy was proposed for each group. In the group of resectable hepatic alveolar echinococcosis there were 79 patients who underwent hepatectomies without vascular reconstruction. In borderline-resectable group there were 168 patients with massive hepatic alveolar echinococcosis with the main liver vessels and (or) the inferior vena cava involvement. Hepatectomies were performed in combination with vascular reconstructions including cases of total vascular exclusion with normo- or hypothermic conservation in vivo or ex vivo. In 65 patients, the lesion was defining as non-resectable. They have hepatic alveolar echinococcosis with critical involvement of the liver parenchyma and (or) with vessels invasion without the possibility of their reconstruction, and (or) cirrhosis of the future liver remnant. The non-alternative method of treatment in this group was liver transplantation. Eleven patients with non-resectable metastases which determined the severity of the condition and made no sense of radical liver surgery were considered incurable. Palliative measures were carried out by such patients. Previously performed non-radical interventions in 43.03% of patients were associated with severe complications (Clavien–Dindo III–V) developed after radical hepatectomies and transplantations. Surgical strategy based on the new classification of hepatic alveolar echinococcosis was effective in 96.6% patients.
Conclusion. Routing patients according to the new classification of hepatic alveolar echinococcosis will improve the treatment results by avoiding non-radical surgery associated with the development of complications after further radical surgical treatment.

Objective. To study the features and results of biliary reconstruction in right lobe living donor liver transplantation. To propose a classification of biliary reconstruction, which allows reflecting all its existing and possible variants, taking into account the anatomy of the bile ducts of the graft and recipient and technical features of reconstruction.
Materials and methods. From May 2010 to June 2019 a retrospective and prospective analysis of the results of the right lobe living donor liver transplantation was performed for 256 recipients and their donors. One observation was excluded due to lack of data.
Results. When the right lobe liver transplantations were performed, grafts with two bile ducts requiring biliary reconstruction most often (52%) were observed, less often grafts with one duct (32%), three ducts (12%), four ducts (3%) and in one case five ducts (<1%) were observed. With the multiple nature of the ducts in 31 cases (12% of all operations) unification ductoplasty was used. Moreover, in the group of reconstructions with the presence of two ducts and in the group with the presence of three or more ducts ductoplasty was used with equal frequency – in 18% of cases. The duct-to-duct anastomoses was formed in 157 cases (61%), bilio-entero anastomoses – in 91 cases (36%) and the combined variant – only in 7 cases (3%). In the first variant (duct-to-duct) during reconstruction in 43 cases (27% of all formed duct-to-ducts, 17% of all transplants performed), the so-called high-order bile ducts (right or left lobar, as well as cystic bile ducts) were used. This article proposes a coding and classification system for the technical features of biliary reconstruction in right lobe living donor liver transplantation.
Conclusion. Right lobe living donor liver transplantation accompanied by high variability of the stage of biliary reconstruction, depending on the number of bile ducts in the graft, their condition and relative position. The analysis of our own material made it possible to propose a universal classification and coding method for the types of biliary reconstruction during right lobe living donor liver transplantation. The classification allows to reflect all existing options for biliary reconstruction, depending on the anatomy of the bile ducts of the graft and recipient, the technical features of its implementation. It also simplifies the analysis and statistical processing of the bile duct reconstruction stage in liver transplantation.

Aim. To evaluate results of liver transplantation and ex situ liver resection and autotransplantation in patients with unresectable parasitic and tumor liver lesions.
Matherial and methods. A total of 22 orthotopic liver transplants and 4 ex situ liver resection and autotransplantations were performed. Liver transplants performed in 10 cases of unresectable hepatocellular carcinoma, 8 cases of alveolar echinococcosis, 4 cases of hepatic epithelioid haemangioendothelioma. Ex situ liver resection and autotransplantation were performed in 3 cases of alveolar echinococcosis and in 1 case of cholangiocarcinoma.
Results. Postoperative complication developed in 38,4% patients. Mortality rate was 19.2%. Patients with alveolar echinococcosis were most complicated group with 36,3% early mortality rate. Mortality in hepatocellular carcinoma group was 10%. There were no early mortality in haemangioendothelioma and cholangiocarcinoma patients. Median overall survival for hepatocelluler carcinoma, alveolar echinococcosis and hepatic epithelioid haemangioendothelioma groups was 48, 36, 20 months respectively. Patient after ex situ liver resection for cholangiocarcinoma alive for 24 months and still disease free.
Conclusion. Liver transplantation and ex situ liver resection and autotransplantation is the only opportunity for radical treatment for unresectable alveolar echinococcosis and some oncological diseases of the organ. Patients with unresectable alveolar echinococcosis is a high risk group of postoperative complications due to initial poor physical status, long-time disease, chronically infections and parasitic invasion.

Background. Minimally invasive radical surgery for perihilar cholangiocarcinoma is in its early stages.
Aim. A comparative analysis of the initial experience of robot-assisted and open resections for perihilar cholangiocarcinoma.
Material and methods. The single-center experience, accumulated over the period from 2014 to 2018, is analyzed. Robot-assisted procedures included major liver resection and caudate lobectomy with extrahepatic bile duct resection and lymphadenectomy. The need for vascular reconstruction was considered a contraindication to surgery.
Results. Thirteen robot-assisted resections were performed. The perihilar cholangiocarcinoma was confirmed by pathologic examination in 10 patients. The immediate outcomes were compared with that in 88 open procedures. There were no significant differences in blood loss, the rate of severe morbidity, mortality, and hospital stay. The duration of the robot-assisted surgical resections was significantly longer.
Conclusion. Analysis of initial experience justifies the robotic approach for radical resection in highly selected patients.

Aim. To report a rare case of split liver transplantation in two urgent recipients treated in hospitals that are very far from each other.
Material and methods. Partial liver grafts were obtained by controlled full-right/full-left in situ splitting. The left lobe was transplanted in a 7-year-old child with severe hepatic failure (PELD score 39) resulting, probably from an progressive intrahepatic familial cholestasis in Novosibirsk. The right lobe was used for re-transplantation in a 28-year-old patient with hepatic artery thrombosis (UNOS status 1A) after living donor right lobe liver transplantation in Moscow.
Results. The course of the early post-operative period in recipient 1 was complicated by infected total pancreatonecrosis with the development of limited biliary leakage and the formation of a stricture, which required reconstructive cholangiojejunostomy 12 months after transplantation. Recipient 2 consistently underwent biliary leakage, arrosive arterial bleeding, graft artery thrombosis, all of which could become fatal. Complications were successfully eliminated by the consistent use of surgical and endovascular interventions.
Conclusion. The presented observation is, firstly, an example of effective inter-center cooperation, and secondly, a demonstration of the existing problems of postmortem organ donation, which determine the need for such extreme surgery in critical situations.

Aim: to compare features of hepatocellular carcinoma (HCC) in children and adult patients and to assess the possibility of translating the experience of adult patients treating  in pediatric oncology.

Мethods: the literature dedicated to pediatric and adult HCC investigation and treatment has been analyzed. Pathomorphology, molecular-genetic features of disease, the drug and surgical  treatment approaches, in particular immunotherapy and liver transplantation  were carefully compared in both groups.

Results: for pediatric HCC the analysis revealed that: fibrolamellar subtype as well as large size of primary tumor are more common; typical molecular-genetic markers are presented. It is advisable to use the adopted adults treatment methods such as targeted and immunotherapy in children. In particular, the HCC surgery, and the indications for liver transplantation in children should be different from adults.

Conclusion: further translation of the adult patients treating experience will help to improve outcome in children with HCC. In order to optimize the treatment of pediatric HCC it is necessary to continue the investigations in international research groups.

Aim. Optimization of the tactics of management of patients with liver cirrhosis who underwent Transjugular Intrahepatic Portosystemic Shunt – TIPS based on own experience and literature data.
Materials and methods. From 2014 to 2019 years 51 Transjugular Intrahepatic Portosystemic Shunt procedures were performed.
Results. The indications for Transjugular Intrahepatic Portosystemic Shunt procedure were detailed. The tactics of treatment in post-operative period was assessed. Shot-term and long-term results of the treatment were discussed. Especial attention was put to persons who included in patient list of liver transplantation.
Conclusion. Transjugular Intrahepatic Portosystemic Shunt allows obtaining stable decompression in portal system that reduces frequency of bleeding relapse from gastric and esophageal veins. The mortality was decreased, and patients can wait till liver transplantation.

Aim. To study the early postoperative outcomes of duodenum-preserving total pancreatic head resections in benign, premalignant tumors of the pancreatic head and chronic pancreatitis complicated by duodenal dystrophy in comparison with the results of pylorus-preserving pancreaticoduodenectomy.
Materials and methods. From 2006 to 2019, 54 patients underwent duodenum-preserving total pancreatic head resection for chronic pancreatitis complicated by duodenal dystrophy, benign or premalignant tumors of the pancreatic head. At the same time, in 25 cases, the operation was performed in an isolated version, in 29 – with a resection of the duodenum. As a comparison group, we used data from 89 patients who underwent pyloruspreserving pancreaticoduodenectomy during the same period.
Results. Compared to pancreaticoduodenectomy, duodenum-preserving total pancreatic head resection exhibits significantly longer times for surgery (420 and 310 minutes, respectively). There was no statistically significant difference in the volume of intraoperative blood loss. There are no differences between groups in hospital morbidity (the frequency of pancreatic fistulas, delayed gastric emptying, bile leakage and post-resection bleeding). The frequency of postoperative complications for Clavien-Dindo III and higher did not differ significantly in the groups. There is no hospital mortality after duodenum-preserving total pancreatic head resection; three patients died after pancreatoduodenectomy.
Conclusion. Early postoperative outcomes following duodenum-preserving total pancreatic head resection and pylorus-preserving pancreaticoduodenectomy are comparable. However, to develop a full-fledged concept of surgical treatment of pancreatic head benign, premalignant neoplasms and chronic pancreatitis with duodenal dystrophy, it is necessary to analyze the long-term outcomes of treatment.

Aim. To evaluate the informational content of endoscopic ultrasound in pediatric patients with pancreatobiliary diseases.
Materials and methods. The study included 16 patients with pancreatobiliary diseases, who were examined with 17 endoscopic ultrasounds within 14 months. The follow-up was 12 months.
Results. Endoscopic ultrasound was informative in all 16 patients and in 14 patients it had an impact on the management. The main diseases that were indications for the examination included choledocholithiasis, pancreatobiliary abnormalities, relapsing pancreatitis, pancreatic cysts, as well as a combination of these diseases. There were no complications during the diagnostic examination as well as during the procedure done under the control of endoscopic ultrasonography.
Conclusion. Endoscopic ultrasound is promising, effective and safe not only in adults but also in pediatric patients.

The aim of this study was to develop a hemostatic agent with anti-adhesive properties and to study its effect on liver morphology, metabolic activity and hepatocyte regeneration in experimental liver injury.
Methods. In 60 rats following experimental resection liver injury, the time of bleeding and the volume of blood loss were determined. Histological preparations were used to study the size of hepatocytes and their nuclei, the content of glycogen (PAS-reaction), the number of binucleated hepatocytes and the expression of Ki-67.
Results. Compared with the control, an agent based on 6% sodium carboxymethylcellulose gel and 5% aminocaproic acid effectively and reliably reduces the bleeding time by 72% (217.91 s), the volume of blood loss by 74.7% (372.85 mg) (p ≤ 0.01) and the degree of blood filling of the sinusoid liver capillaries. In addition, the use of the novel gel prevents the adhesion formation. It stimulates mitotic activity of hepatocytes, accompanied by an increase in the number of binucleated hepatocytes and Ki-67 expression. By the 14th day, this activity significantly decreases. Hypertrophy of hepatocytes and their nuclei is observed by the 7th and 14th days of the experiment. This indicates both an increase in the metabolic activity of hepatocytes and intracellular regeneration. The use of the hemostatic gel does not alter the glycogen-storing function of hepatocytes, which indicates the lack of pronounced hypoxia due to effective control of bleeding.
Conclusion. The local hemostatic gel based on 6% sodium carboxymethylcellulose gel and 5% aminocaproic acid can be recommended for local bleeding control in liver injuries and surgery.

The paper presents basic information about the styles of written scientific speech. The basic requirements for the completeness and unambiguity of written speech are revealed, which turn out to be much stricter than oral speech. Varieties of scientific style are highlighted - academic style, popular scientific style, scientific and educational, scientific and business. The work is based on examples, the most frequent and typical speech errors and inaccuracies. These were collected by the authors during many years of work in the editorial boards of medical journals and cooperation with publishing houses. The emphasis is given on the typical shortcomings found in written scientific speech, stylistic errors and inaccuracies in wording. The article is intended to help authors with understand the features of the scientific style of speech and, ultimately, improve the quality and value of their own publications.

In the present paper we show a rare case of choledocal cyst type IVa according to T. Todani classification in a 46-yearold patient. Four years after cystoenterostomy without cyst excision, a severe cholangitis developed. Multiple small abscesses of the right lobe of the liver were identified. Puncture-drainage and antibacterial treatment was started, diagnostic laparotomy was performed, but the patient's condition progressively worsened. So the patient was admitted to the Vishnevsky National Medical Surgery Research Center, where the diagnosis was confirmed. According to vital indications, a right hepatectomy was performed, a large cyst was removed, and Roux-en-Y hepaticojejunostomy was formed with the left lobar duct. In early postoperative period the patient developed biliary leakage. Late complications include anastomotic stricture with obstructive jaundice and episode of cholangitis, which was resolved by percutaneous transhepatic cholangiography and external-internal biliary drainage. The analysis of literature data, etiology, classification, pathogenesis of cystic transformations of extra- and intrahepatic bile ducts is presented. An assessment of the methods of surgical treatment of the disease and its complications is given. Surgical treatments of choledochal cysts and its complications were evaluated.