Aim. To describe new data and to complement the existing information about the anatomic features of the hepatic vein structure in the donor of the right hepatic lobe, to formulate the principles of donor selection proceeding from vascular anatomy.

Materials and methods. 306 liver transplantations from living related donors were performed at A.I. Burnazyan Federal Medical Biophysical Center of Federal Medical and Biological Agency of Russia from 2009 to 2021. The vascular anatomy of 518 potential donors was analyzed. The prevalence of different vein structures of the right hepatic lobe was assessed.

Results. The authors identified 14 subtypes of anatomy of efferent vessels. They were classified into 3 types depending on the contribution of the median vein to the blood outflow from the right hepatic lobe: caval (67.3%), cava medial (semi-separate, 29%), and separate (3.6%).

Conclusion. The anatomy of the efferent vessels of the right lobe graft is characterized by variability and complexity. It requires accurate assessment at the preoperative stage (CT scanning) to be ready for reconstruction of any complexity.

Aim. To evaluate the effectiveness of percutaneous ALPPS as a method for preventing post-resection liver failure.

Materials and methods. The methodology involved a retrospective study of the results of portovenous embolization and percutaneous radiofrequency assisted liver partition with portal vein embolization (PRALLPS), in case of the future liver volume <40% . The degree of hypertrophy of the future liver remnant and its rate were assessed in two groups. Complications of manipulation and frequency of postresection hepatic failure were studied.

Results. In the first stage, portenous embolization was successfully performed in 38 patients and PRALLPS was successfully performed in 47 patients. In the second stage, liver resection was performed in 27 (71.1%) and 33 (70%) patients. The most frequent complication of PRALLPS was bile accumulation in the radiofrequency ablation area (13.1%). The incidence of other complications of the first stage did not differ between groups. No differences in blood loss or incidence of liver failure were reported after the second stage. No fatal outcomes reported. The mean degree of hypertrophy and growth did not differ between the groups. The mean time of hypertrophy of the future liver remnant after percutaneous radiofrequency assisted partition of the parenchyma with portal vein embolization and portenous embolization was 13 ± 5 and 18 ± 7 days (p = 0.008).

Conclusion. The results of percutaneous radiofrequency assisted liver partition with portal vein embolization are comparable in terms of safety with those of portenous embolization. Radiofrequency partition of the parenchyma with portal vein embolization enables optimal hypertrophy of the future liver remnant to be achieved faster.

Aim. To present the results of repeated liver transplantations performed in a federal center.  

Materials and methods. The results of 268 orthotopic full-liver postmortem transplantations in 248 patients since 1998 were analyzed. Retransplantation was performed in 20 patients (8.1%) – 10 men and 10 women, 18-64 years old (median age 44.4 years). The median MELD score was 21 (19-24). Observations before 2006 were analyzed retrospectively. Early hepatic artery thrombosis and late biliary complications due to insufficient arterial blood supply to the graft indicated the retransplantation in the majority of patients.  

Results. The duration of preservation stages was comparable to the primary transplantation. Significant differences were found in the duration of the anhepatic period, the volume of hemotransfusion, the duration of the surgery, the rate of complications and the hospital mortality rate. Currently, 9 of the 20 patients (45%) are alive, with a follow-up period of 7-140 months. Graft function was satisfactory in most recipients. Hospital mortality accounted for 35%.  

Conclusion. Liver retransplantation is accompanied by considerable technical difficulties, as well as by an increase in surgery duration, volume of blood transfusion, time of stay in the intensive care unit, and incidence of postoperative complications. Infectious complications were the main cause of death. With successful retransplantation, long-term results and survival rates were comparable to those of primary transplantation. 

Aim. To compare the results of laparoscopic and open resections in children with hepatic neoplasms. 

Materials and methods. A retrospective analysis of the immediate and long-term results of laparoscopic and open liver resections for the period from 2018 to 2021 was performed. In order to apply pseudorandomization, the observations were compared according to 10 cofounders, taking into account anamnestic data, anatomical and physiological features.  

Results. 30 children were operated on laparoscopically and 77 – by the open method. After pseudorandomization, 26 pairs of comparable observations were obtained. Statistically significant differences were identified in the period of safety drainage removal, duration of analgesic therapy and postoperative period with the advantage of laparoscopic access both before and after pseudorandomization. The authors reported no significant differences in the incidence of postoperative complications, lethal outcomes and long-term treatment results.  

Conclusion. Shorter postoperative period indicates further study of the results of laparoscopic liver resections with specialized institutions to be involved. This will enable indications for such interventions to be finally formulated. 

Aim. To evaluate the effectiveness of negative air ions in eliminating hepatic dysfunction in mechanical jaundice.  

Materials and methods. Experiments on 30 rats were carried out in two series. In the first experiment series, the mechanical jaundice was simulated with subsequent decompression of common bile duct and injection of 0.9% sodium chloride solution in the volume of 40 ml/kg. In the second experimental series, negative air ions (3 mln particles per 1 cm3 ) were exposed for 60 min once a day over the course of 12 days. The levels of bilirubin, malondialdehyde, ALT and AST, alkaline phosphatase and catalase were studied.  

Results. The use of negative air ions in mechanical jaundice contributed to significant correction of the liver functional activity. Concentration of total and direct bilirubin decreased to 84.4 ± 7.6 and 42.1 ± 5.4 μmol/l, which is 25% and 56% lower than in the control series. The activity of AST, ALT, and alkaline phosphatase, as well as the concentration of malondialdehyde were reported to be lower in than control series (by 17%, 22%, 18%, 47%, correspondingly), while the catalase activity was 3.6 times higher.  

Conclusion. Application of negative air ions in treatment of mechanical jaundice stimulates production of own antioxidative enzymes which protect hepatocytes from free radical damage. 

Aim. To explore the potential of perfusion CT for predicting deep pancreatic necrosis and duct injury as well as for determining treatment strategy.  

Materials and methods. The prospective study included 74 patients hospitalized within 1–2 days of acute pancreatitis. They were exposed to perfusion CT and examination of their arterial blood flow velocity. In 37 observations, a standard CT was also performed on day 3–9 to study the depth and configuration of the necrosis. The severity of acute pancreatitis was assessed according to standard integral scoring systems, organ failure and severity of peripancreatitis. The alfa-amylase activity in fluid collections was examined.  

Results. Necrosis was detected in 20 patients: deep necrosis – in 11 cases, shallow – in 9. 17 patients did not reveal necrosis. Necrosis configuration of type 1 was detected in 16 patients, type 2 – in 4. Deep necrosis was preceded by a significant decrease in the arterial blood flow velocity: 39–52 ml/min/100 ml. This rate was greater in patients with shallow necrosis and without necrosis: 72–100 and 95–117 ml/min/100 ml (p < 0.001). In cases of deep necrosis, advanced peripancreatitis was formed, organ failure was noted in 9 patients, 3 patients died. Internal pancreatic fistula was detected in 7 out of 9 patients with deep necrosis and in 1 out of 6 patients with shallow necrosis and type 1 configuration. In cases of necrosis type 2 configuration the pancreatic fistula was not noted. Minimally invasive interventions and transformation of the internal fistula into the external one were performed in 12 out of 20 patients: percutaneous drainage of fluid collections – in 9 observations, stenting of the pancreatic duct – in 3.  

Conclusion. Perfusion CT can be used to predict pancreatic necrosis on day 1–2 of the disease. A decrease in the arterial blood flow velocity in the range of 39–52 ml/min/100 ml is associated with the risk of parenchyma deep necrosis and duct injury. This parameter can be taken into account when determining indications for early minimally invasive interventions. 

Aim. To describe the experience of using augmented reality system in abdominal surgery at one clinical center.

Materials and methods. In 2021–2022, five patients underwent laparoscopy with augmented reality technology. The interventions included echinococcectomy with resection of IV, V, VI liver segments, pancreaticoduodenal resection for pancreatic head cancer, excision of mesostenium cyst, resection of pancreas body and tail for neuroendocrine tumor.

Results. Application of 3D models requires putting on glasses, scaling and setting a model on the screen image, which sometimes prolonged surgery time to 25 minutes. In a number of operations the use of augmented reality navigated the surgeon when working near vascular structures. After looking through the AR model, a surgeon felt more confident in terms of individual anatomy.

Conclusion. Augmented reality can become a reliable and promising tool in abdominal surgery. However, further technological development in augmented reality systems is needed to increase their performance.

At present, pancreaticoduodenoctomy causes the high incidence of complications. However, it is associated with an acceptable level of postoperative mortality. With this regard and taking into consideration a significant increase in survival in pancreatic cancer, it is highly relevant to study the negative functional outcomes of surgery and develop methods for their surgical prevention. The bibliographic review focuses on the features of three main postsurgical syndromes: gastric stasis, pancreatic exocrine and endocrine insufficiency. The study shows the dependence of these syndromes on pathomorphological characteristics of pancreatic stump, preservation of the pyloric, the variant of pancreatodigestive anastomosis and other features of reconstructive stage of the surgery.

Aim. To evaluate the potential of neoadjuvant chemotherapy in resectable pancreatic cancer based on the results of randomized clinical trials and meta-analyses.  

Materials and methods. PubMed, Сochrane, EMBASE, GoogleScholar databases were used for bibliographic search with keywords MESH “neoadjuvanttherapy” in combination with “pancreaticcancer”, “resectable”, “pancreaticoduodenectomy”.  

Results. At the beginning of the 21st century the understanding of pancreatic cancer biology changed. A tumor should be considered a systemic disease even in its early stages, with small size and without lymph node involvement. The necessity for application of neoadjuvant polychemotherapy in patients with resectable tumors is an important issue. The efficacy and safety of the method has been proved. However, a number of questions are still to be answered. Whether neoadjuvant polychemotherapy in patients with resectable pancreatic cancer will be a new achievement of chemotherapy and the standard of care is a matter for future clinical research.  

Conclusion. Neoadjuvant polychemotherapy in patients with resectable pancreatic cancer is a promising therapy that can improve oncological outcomes of treatment. However, the evidence for this argument is currently insufficient. 

Minimally invasive procedures have been increasingly used in the surgical treatment of patients with pancreatic necrosis. They are widely applied abroad as the main method of surgical treatment and considered a proper alternative to traditional (open) interventions for purulent-necrotic parapancreatitis. A number of methods using minimally invasive surgeries have been developed, which involved various options for drainage of purulent-necrotic formations as well as subsequent removal of necrotic masses (necrosequestrectomy) with different methods of visual control. The authors analyzed technology, its advantages and disadvantages, as well as the effectiveness of the proposed methods of minimally invasive surgical interventions for purulent-necrotic parapancreatitis. 

The present paper describes clinical observation of successful treatment of a patient with chronic calcifying pancreatitis complicated by an external pancreatic fistula. Abdominal surgery after laparotomy and cholecystectomy had to be limited to bursoomentostomy due to the bleeding tissues and severe blood loss. Combined endoscopic intervention through the external pancreatic fistula was used for the treatment. The performed interventions included stone extraction in Wirsung’s duct, dilation and stenting of the distal stricture of the pancreatic duct. The fistula closed, a pain-free period lasted for 3 years. Similar transfistula interventions were performed in 7 patients with chronic pancreatitis and external pancreatic fistulas, lithiasis in Wirsung's duct (n = 5) and pancreatic duct strictures (n = 6). A total of 17 procedures were performed, 7 of 8 fistulas were closed. Complications developed in 3 observations, no lethal outcome was registered.

Conclusion. Transfistula interventions in pancreatic ducts with combined X-ray guidance, oral and transfistula endoscopy can be used to remove stones, dilate strictures and restore natural passage of pancreatic secretions as an independent treatment or preparation for planned abdominal surgery.

The paper presents clinical observation of a patient with cholelithiasis and so-called “difficult” choledocholithiasis. Considering the developed complications – mechanical jaundice and purulent cholangitis, as well as large operative risk, it was decided to refrain from open surgical intervention. Traditionally-performed endoscopic stone extraction did not provide any success. Contact electro-impulse lithotripsy and lithotomy were performed. This enabled choledocholithiasis and cholangitis to be eliminated, bile ducts patency to be restored, and ensured the possibility of safe elective surgical intervention for chronic calculous cholecystitis.

The paper presents a clinical case of successful staged endoscopic treatment for giant multiple choledocholithiasis. Conventional surgery was contraindicated in the patient due to significant comorbidities and high anaesthetic risk. Contact lithotripsy was the basic minimally invasive treatment method. It was combined with balloon dilatation of the endoscopic papillosphincterotomy area and mechanical intraductal lithotripsy. Contact lithotripsy in oral transpapillary cholangioscopy, in combination with other modern methods for endoscopic treatment of choledocholithiasis, has a good technical and clinical effect even with giant calculi.