To demonstrate the possible difficulties in the diagnosis of hepatic echinococcosis, that a specialist in ultrasound diagnostics and a radiologist may encounter in everyday practice, russian and foreign literature as well as our own experience have been reviewed. With high accuracy and specificity of ultrasonography in the differential diagnosis of echinococcal cysts, incorrect interpretation is possible in the presence of mural hemorrhages and (or) hemorrhagic clots in a nonparasitic cyst, which aren’t also visible in ultrasonography and can imitate elements of the chitinous membrane. The degree of prevalence of the process, the exclusion of damage to the lungs and other organs of the abdominal cavity are important. In such cases CT scan is the most convenient and accurate diagnostic method due to its high spatial and temporal resolution, standardization and availability. In the most difficult cases the capabilities of MRI are used in the comparison of diffusion-weighted images and apparent diffusion coefficient, which also makes it possible to diagnose cystic neoplasms. Ultrasonography is a diagnostic technology that is still the most commonly used to differentiate cavity structures; however, all dubious clinical observations should be further examined by using CT or MRI.

Aim. The paper presents the experience of treatment of echinococcal cysts in children, which reflects most of the existing methods of treatment.

Materials and methods. From 2010 to 2021, 81 patients with hepatic echinococcosis aged from 3 to 17 years (average 14.3 ± 1.3) were treated at the bases of the Department of Pediatric Surgeons of the Pirogov Russian State Medical University. All patients were examined according to the standard procedure, including: general clinical examination, examination of liver function, ultrasonography, chest X-ray, CT scan, blood test for IgG to echinococcus antigens. All children were divided into 2 groups according to the type of the surgery: in the group 1, 27 (33.3%) children underwent laparoscopic surgery; in the group 2, 54 (66.7%) children – laparotomy.

Results. The treatment duration accounted 12.5 ± 3.1 days in group 1 and 9.2 ± 1.3 days in group 2 (p < 0.0067). In the group 1 the drainage duration was higher (6.8 ± 0.6) than in the group 2 (4.1 ± 0.3) (p < 0.03). Complications occurred in 7 patients, relapse of cysts – in 2 patients.

Conclusion. Children with echinococcal cysts in Central Russia occur with a constant frequency and require to apply modern approaches in diagnosis and treatment. The classification and treatment protocol of echinococcosis, adopted by WHO, are easy-to-use and proves its effectiveness. There is no significant difference in germicidal agents’ effect on echinococcus and the effect on the development of relapse. The method of selection in the treatment of solitary and superficial cysts is laparoscopic interference with the mandatory application of a PAIR and a high-power aspirator. An important stage of the interference is the treatment of the fibrous capsule of the cyst, if it is impossible to completely remove it, with an argon-plasma coagulator.

Aim. To study the long-term results of surgical treatment in patients with “complex” hepatic echinococcosis.

Materials and methods. The results of surgical treatment of 118 patients with hepatic echinococcosis from 2015 to 2020 at the A.V. Vishnevsky National Medical Research Center of Surgery were analyzed. The term “complex” hepatic echinococcosis has been proposed. A comparative analysis of the number and type of complications and surgical interferences 2 groups of patients was carried out: 66 patients with hepatic echinococcosis, 52 patients with complex hepatic echinococcosis.

Results. During the observation period, no any recurrence was recorded. 55 (44%) of 118 patients had complex hepatic echinococcosis. Isolated liver damage was found in 74% of cases, combined liver and lung damage in 20% cases and with other organs – in 6%. In most cases, pericystectomy was performed (82%), 8% of patients underwent atypical hepatectomy, 4% – segmental resection, 3% – laparoscopic intervention, 3% – hemihepatectomy. Postoperative complications were recorded in 22 (18,6%) of cases. Accumulations of bile and biliary fistulas formed in 45% of cases, pneumotothorax or hydrothorax – in 23%, wound abscess – in 18%, hematomas in the hepatectomy zone – in 14% of the cases.

Conclusion. Surgical treatment of complex hepatic echinococcosis requires an individual approach to the choice of the operation option. Preference should be given to parenchyma-preserving radical operations. When the liver lobe is totally replaced with a hydatid cyst and in case of cystobiliary fistulas hemihepatectomy should be performed, and it is acceptable to leave the fibrous capsule on large tubular structures.

Aim. Optimization of the surgical tactics in hepatic echinococcosis.

Material and methods. From 2009 to 2021, 56 patients with hepatic echinococcosis have been operated: 6 patients underwent PAIR, 7 – open echinococcectomy, 18 – pericystectomy (“ideal echinococcectomy”) and 16 – anatomical hepatectomy (S2/3, S6/7 bisegmentectomy) or atypical resection. In 7 cases hemigepatectomy has been performed, in 2 – combined interventions have been performed for echinococcosis relapse of the abdominal cavity.

Results. The duration of minor hepatic resection was shorter than pericystectomy and major hepatic resection. The smallest blood loss was noted in patients who underwent open echinococcectomy, anatomical and atypical hepatectomy. No complications after PAIR were noticed. The lowest incidence of postoperative complications, including biliary complications, was found after hepatic resection interventions. The lenths of hospital stay after hepatic resections was significantly shorter compared to ecinococcectomy and pericystectomy. The reccurence of hepatic echinococcosis relapse was detected in 4 (66.7%) patients after PAIR and 2 (28.6%) patients after ecinococcectomy.

Conclusion. Organ-preserving techniques should be a priority in the surgical treatment of hepatic echinococcosis. The best results in terms of the early postoperative complications frequency in the hepatic echinococcosis treatment were demonstrated by minor hepatic resections. Open echinococcectomy should be performed only for central location of large cysts and (or) their massive contact with the liver vessels. Minimally invasive resection technologies demonstrate optimal short- and long-term results. Major hepatectomy should be performed very selectively and only in those cases when they have advantages over other methods, and their implementation does not lead to a loss of more than 20% of healthy hepatic parenchyma. The best long-term results showed pericystectomy and hepatectomy in comparison with echinococcectomy.

Aim. To identify factors influencing effectiveness of surgical approaches in hepatic echinococcosis, depending on the location, size and stage of development of the cyst.

Material and methods. From 2015 to 2017 the experience of surgical treatment of 98 patients with liver echinococcosis who underwent percutaneous (PAIR – 23 and PEVAC – 29 patients) and laparoscopic (46 patients) interventions was considered.

Results. After the PAIR, a complication was noted in 1 (16.7%) case of isolated use with a CE3 cyst. Various complications were noted in 3 (60%) cases with a cyst puncture of more than 4 cm, and in 2 of them with CE2 and CE3. The average time for evacuating the cysts contents when performing the PEVAC technique was 5 days. Hemorrhagic fluid in drainage was noted in 6.9% of cases, biliary fistula – in 13.8%. Accumulation of fluid and suppuration in the residual cavity were identified in 34.5%. Taking into account the size of the cysts, the complication rate after PEVAC was 9.1% for cysts ≤6 cm vs 50% for cysts >6 cm. Various difficulties with manipulations during laparoscopic echinococcectomy were noted more often with CE2–4. So, difficulties with aspiration or removal of cyst contents more often arose with CE4. The incidence of complications after drainage removal was 17.9%, of which fluid accumulation was in 14.3% and residual cavity suppuration in 3.6% of cases.

Conclusion. The US criteria, main indications and tactical and technical aspects for performing PAIR and PEVAC methods, as well as for performing laparoscopic echinococcectomy, and criteria for assessing the required volume of percytectomy for an adequate abdominalization of fibrous capsule have been clarified.

Aim. To analyze the effectiveness of PAIR in comparison with traditional surgical methods.

Materials and methods. A retrospective analysis of 199 patients who underwent surgical treatment of hepatic echinococcosis was carried out. Pericystectomy was performed on 95 (47.7%) patients (1st group), traditional echinococcectomy – 55 (27.6%; 2nd group), PAIR – 49 (24.6%; 3rd group). All patients received antihelmintic therapy for 2 months in the postoperative period.

Results. Patients of the group 3 had significantly more CE1 cysts compared with the groups 2 and 1 – 38 (77.5%) versus 19 (34.5%) and 44 (46.3%; p < 0.05) respectively. In group 2, CE2 and CE3 cysts were predominant. The duration of the operation in group 3 was significantly shorter than in group 1 and 2 – 58.2 (25–170), 194.8 (85–440) and 217 (75–540) minutes (p < 0.05). In group 1, intraoperative blood loss was higher than in group 2 – 165.4 ml (10–1000) and 106.7 ml (10–500; p < 0.05). There were no statistically significant differences between the groups in postoperative complications according to Clavien–Dindo. The duration of postoperational hospital stay of patients from the group 3 was shorter than for 1 and 2 groups – 4.3 (2–11) days, 8.03 (5–16) days and 8.08 (4–20) days (p < 0.05) respectively. There was no disease recurrence during the follow-up period.

Conclusion. The optimal treatment should be based on the stage of the disease. In CE1, the most effective method is PAIR, which is characterized by a shorter postoperational hospital stay and early recovery. In multivesicular cysts (CE2-CE3b), traditional methods of treatment are effective.

Aim: to evaluate the short- and long-term outcomes of laparoscopic and open operations in the treatment of hepatic echinococcosis.

Materials and methods. The results of laparoscopic and open echinococcectomies performed from 2013 to 2020 were retrospectively studied. Laparoscopic operations were considered the method of choice. Open operations were performed in cases with contraindications to the laparoscopic approach.

Results. In total, 57 patients were operated: 47 laparoscopically (including robotic approach in 4 cases), 9 patients underwent open surgery. Radical procedures prevailed among laparoscopic cystectomies: 46 (98%). In the groups of laparoscopic/open cystectomies, partial pericystectomy was performed in 1/3 of patients, subtotal – in 24/4, total – in 13/0, and liver resection – in 9/2 patients, respectively. Laparoscopic procedures were performed mainly for types 1 and 3 of cysts, open procedures – for type 2 (WHO), recurrent and extrahepatic abdominal cysts were indication for open surgery. The frequency of severe complications did not differ between the groups. In the laparoscopic group, 1 (2%) patient died. After laparoscopic cystectomies, the mean (median) hospital stay (8 vs 10 days) and duration of abdominal drainage (10 vs 12 days) were significantly shorter. Relapse occurred only after conservative cystectomies, in one patient in each group.

Conclusion. Laparoscopic radical surgery for liver hydatid cysts may be the method of choice if performed in a specialized HPB center. Patient selection criteria should be based on the center's experience in laparoscopic liver surgery.

Echinococcosis remains one of the most common parasitic diseases in the world. The primary treatment for echinococcosis is surgical. Qualified surgical intervention, intraoperative use of germicide with proven efficiency and prescription of post-operative anti-relapse pharmacological therapy are keys to effective treatment. Minimally invasive technologies are increasingly being used in clinical practice, with open interventions generally being used late in the onset of complications. However, there are still reports of unduly radical surgery and use of germicide without proven efficiency. The authors were the first in the country to use percutaneous treatment for hydatid cyst in 1986, with a cumulative experience of over 600 cases. The article generalizes and presents modern approaches to the treatment of patients with echinococcosis, with an emphasis on the application of minimally invasive technologies.

The literature review presents the world and russian experience in the surgical treatment of patients with hepatic echinococcosis over the last two decades. The most important aspects of the epidemiology and biology of echinococcus for the surgeon have been considered. Special attention is paid to the modern diagnosis of the disease, to the choice of volume and method of surgical treatment, according to WHO classification. The approaches to minimally invasive, laparoscopic and robotic operations of liver echinococcosis had been reviewed.

Aim. To evaluate the reproducibility and safety of the developed pancreatogastric anastomosis with various surgical approaches during pancreatoduodenectomy.

Materials and methods. The experience of surgical treatment of 47 patients with malignant tumours of the periampullary zone, who underwent pancreatoduodenectomy, was considered. The proposed variant of anastomose was performed to 14 (29.8%) patients: in 7 cases with a minimally invasive approach to perform pancreatoduodenectomy; and in 7 cases with an open approach. To compare retrospectively 33 (70.2%) patients who underwent pancreatogastric anastomosis according to the Bassi technique: 9 – with minimally invasive surgery, 24 – with open surgery. The frequency of pancreatic fistulas, the number of repeated interferences, and hospital mortality were taken into account.

Results. A significant advantage of the new method of forming an anastomosis in the duration of the operation was noted in comparison with the Bassi technique. There were no statistically significant differences in blood loss while various types of anastomoses (p > 0.05). When using the proposed technique, the formation of pancreatic fistulas was not revealed. The development of pancreatic fistula was observed in 4 (16.7%) patients after open surgery and in 7 (77.8%) patients after minimally invasive Bassi anastomose formation. Reoperations were performed after open surgery in 3 (12.5%) cases and in 4 (44.4%) cases of minimally invasive surgery according to the Bassi technique. There were 2 (22.2%) deaths in the minimally invasive group.

Conclusion. The proposed pancreatogastric anastomosis is applicable in clinical practice. This method allows to create relatively fast and less challenging anastomosis, including with a minimally invasive approach. The use of this technique makes it possible to reduce mortality and postoperative complications in patients with a “complex” pancreas.

Aim. To demonstrate the first results of the work on database created to assess long-term results of treatment of patients with posttraumatic biliary strictures and to develop a unified approach to the management of these patients.

Materials and methods. “The register of patients with post-traumatic strictures of the bile ducts in Russia and the CIS countries” was created in 2016. It is a software for a computer that provides the opportunity for detailed registration and data analysis of a large number of patients.

Results. From 2016 to 2021, the data of 132 patients were entered into the register. Long-term results were traced in 49 (60.5%) patients with the minimum and maximum follow-up periods of 3 and 44 months.

Conclusion. The first registry results demonstrate its capabilities in generalization and analysis of treatment data for the patients with cicatrical posttraumatic biliary strictures. It also showed the necessity for wider participation of different specialists in work of database.

This study aimed to review latest investigations concerning early biliary complications following major pancreatic surgery. 127 original articles in English language were found via PubMed literature search using key words over the last 5 years. After application of exclusion criteria (full-text in English not available, duplicating paper, age of paper over 5 years) a total of 29 articles were included in this study. Herein we review epidemiology and classification of early biliary complications after pancreatoduodenectomy, current views on pathogenesis, prophylaxis, diagnostics and treatment of early biliary complications. In early postoperative course of pancreatoduodenectomy patients may develop transient jaundice, cholangitis, early biliary strictures and post-procedural bile leak. Frequency of these conditions range from 3 to 24% and depends on epidemiological features of population, statistics and combined conditions. A number of patient- and surgery-dependent risk factors have been described. Modern interventional radiology offers a wide range of procedures for diagnostics and treatment of early biliary complications after pancreatoduodenectomy which showed to be safe and effective when endoscopic manipulations are contraindicated due to high risk. Well-timed diagnosis and treatment allow to avoid severe early biliary complications, re-interventions and reoperations which provides a good prognosis and lowers medical and financial burden.

Clinical case demonstrates successful treatment of a pregnant woman, who had multiple giant splenic artery aneurysms with a high risk of spontaneous rupture. Pregnancy proceeded along with hereditary thrombophilia, thrombosis and cavernous transformation of the vena cava, extrahepatic portal hypertension, esophageal and gastric varices II–III. The surgical and obstetric tactics, surgical intervention, appropriate salvage and multidisciplinary pregnancy follow-up ensured a successful Cesarean delivery at 38 weeks, saving the life of the child and mother.

The article presents a clinical observation of a patient with type 1 Multiple Endocrine Neoplasia syndrome (MEN 1). During the diagnostic search, a combination of primary hyperparathyroidism, parathyroid adenoma and hormonally inactive pancreatic head tumor was found. Simultaneous transoral parathyroidectomy and laparoscopic resection of the pancreatic head was performed. We haven`t found the literature data describing such kind of operations for MEN 1 syndrome. An original solution was applied to perform intraoperative ultrasonography monitoring. The results of 1-year postoperative follow-up are presented. This observation demonstrates the possibilities of endoscopic technologies in the treatment of MEN 1 syndrome.