Aim. To carry out a retrospective analysis of the treatment outcomes of the patients who underwent liver resection with angioplasty facilitated by transplantation techniques.

   Materials and methods. The sample of cases was divided into four groups: liver resection with total vascular isolation of the liver, ante situm liver resection, hepatic artery and portal vein reconstruction, cardiopulmonary bypass resection. The analysis was focused on surgery features and treatment outcomes.

   Results. The study involved 29 patients. The performed interventions included 11 liver resections with total vascular isolation, 6 ante situm liver resections, 7 resections with angioplasty, and 5 cardiopulmonary bypass resections. 5 patients (17 %) developed complications that required reoperation. Within 90 days, 4 patients (14 %) died. For patients with malignant neoplasms, one-, three-, and five-year overall survival rates accounted for 84.4 %, 58.4 %, and 51.1 %; one-year event-free survival rate comprised 57.1 %, and three- and five-year event-free survival was 41.7 %.
The study revealed no significant differences in the complication rates. The groups of ante situm liver resections and cardiopulmonary bypass resections significantly differed from the other groups by the higher incidence of tumor progression, invasion of adjacent organs, hemorrhagic complications, preoperative stay, and duration of cold perfusion of the liver. The cardiopulmonary bypass resections were noted to have higher duration of surgery, vascular isolation, heparin use, and the frequency of anticoagulant therapy before surgery.

   Conclusion. Liver resections with total vascular isolation, angioplasty and transplantation techniques are considered as the only possible treatment option for a number of patients. Further accumulation of results will reduce the risk of adverse outcomes.

   Aim. To evaluate the effectiveness of laparoscopic surgeries for diseases and malformations of the pancreas in children.

   Materials and methods. 53 laparoscopies were performed from 2005 to 2023. Enucleation was performed in 16 children, distal resection of the pancreas with spleen preservation – in 16, corpo-caudal resection of the pancreas – in 4, subtotal resection of the pancreas – in 9, central resection of the pancreas – in 5, head resection with duodenal preservation – in 1, pancreaticoduodenal resection with pyloric preservation – in 2 children. The age of the children ranged from 2 months to 17 years.

   Results. All surgeries have achieved the intended clinical effect. The average time of enucleation accounted for 88.1 ± 47.7 min., distal resection with spleen preservation – 100.3 ± 21 min., corpo-caudal resection – 113.3 ± 28.9
min., subtotal resection – 101 ± 21.7 min., central resection – 243.3 ± 81.1 min., head resection with duodenal preservation – 235 min., pancreaticoduodenal resection with pyloric preservation – laparoscopic and laparoscopically assisted – 435 and 415 min. Intraoperative bleeding was noted in 6 cases (11.3 %), in 2 (3.8 %) conversion was performed in 2 cases (3.8 %). The postoperative period revealed 6 (13.2 %) early and 8 (15.1 %) late complications. No fatal outcomes reported. The follow-up ranged from 1 to 10 years, no recurrences reported.

   Conclusion. Focal pancreatic lesions in children refer to heterogeneous diseases and malformations requiring various resection interventions. Laparoscopic enucleation and distal resection of the pancreas are considered as the most effective. Further clinical experience is required to explore the feasibility of using laparoscopy in children to perform central resection of the pancreas and pancreaticoduodenectomy.

   Aim. To improve treatment outcomes for acute biliary pancreatitis in children with cholecysto- and choledocholithiasis.

   Materials and methods. The authors conducted a retrospective analysis of the examination and treatment of 14 children aged 3–17 years with moderate and severe ABP. In 11 observations (78.5 %) the period from the onset of the disease to hospitalization comprised < 24 hours, in 3 observations (21.4 %) > 48 hours. All patients underwent a comprehensive examination including clinical, laboratory and instrumental diagnostics.

   Results. Ultrasound signs of acute cholecystitis were detected in 10 children (83.3 %), biliary hypertension – in 12 (85.7 %). Laparoscopic cholecystectomy was performed in 1 patient (7.14 %) within 72 hours from the onset of the disease; 1 child underwent open cholecystectomy with lithoextraction and drainage of the common bile duct according to Kerr technique. Open cholecystostomy with drainage of purulent-necrotic parapancreatitis was performed in 1 case. Endoscopic papillosphincterotomy, lithoextraction and cholangiography were performed in 4 children (28.6 %), 1 child additionally underwent stenting of the common bile duct and pancreatic duct. All patients were diagnosed with necrotizing pancreatitis and various types of parapancreatitis. Drainage of parapancreatitis in the Vladimirsky Moscow Regional Research Clinical Institute was performed in 5 (35.7 %) children: 2 (14.3 %) by open technique, in 2 (14.3 %) by laparoscopic sanation and in 1 by US-guided percutaneous drainage.

   Conclusion. Emergency endoscopic papillosphincterotomy with lithoextraction refers to a method of choice for the elimination of biliary hypertension in choledocholithiasis. Delayed or elective cholecystectomy is considered preferable for children with severe or moderately-severe acute biliary pancreatitis. The choice of drainage technique for infected parapancreatitis depends on the spread and sanation quality of purulent process.

   Aim. To improve treatment outcomes for children with common bile duct cysts.

   Materials and methods. The study enrolled children with common bile duct cysts (n = 84) examined from January 2010 to November 2023. All patients underwent cyst excision, Roux-en-Y hepaticojejunostomy laparoscopically or from a minilaparatomy access. A comparative analysis of the treatment outcomes was carried out to select the optimal access. The timing of surgery, as well as early and late postoperative complications were analyzed.

   Results. The timing of surgery from the minilaparotomy access was shorter. Defecation in children of the minilaparotomy subgroup appeared 3 times earlier than in children after laparoscopic hepaticojejunostomy, largely due to earlier enteral load. A good treatment outcome was observed in 92 % of patients who underwent intervention from a minilaparotomy access compared to 52.2 % of patients who underwent laparoscopic surgery.

   Conclusion. Currently, laparoscopic access is a non-optimal method for treatment of children with common bile duct cysts. Minilaparotomy appears to be a promising surgical access in children and may be proposed as a standard for common bile duct cysts.

   Aim. To evaluate the efficacy of laparoscopic interventions and to carry out a comparative analysis of various options for biliodigestive anastomoses in children with cystic dilation of bile ducts.

   Materials and methods. The results of laparoscopic interventions were retrospectively analyzed in 110 children aged 2 months – 17 years with cystic bile duct dilation. Conversion was required in 3 observations (2.7 %). Laparoscopically assisted or total laparoscopic extirpation of dilated bile ducts with hepaticojejunostomosis was performed in 83 patients (75.5 %), laparoscopic surgery with hepaticoduodenostomosis – in 24 patients (21.8 %).

   Results. The duration of surgery was significantly shorter when hepaticoduodenoanastomosis was formed. After laparoscopic interventions, early complications were revealed in 10 observations (9.3 %), including 7 cases (6.5 %) of hepatico-duoduodenoanastomosis failure in which relaparotomy was performed with reconstruction of both interintestinal and biliodigestive anastomosis. Late postoperative complications (anastomotic stenosis and adhesive intestinal obstruction) developed in 11 patients (10.2 %). In 5 observations (4.6 %), percutaneous transhepatic cholangiostomy with staged balloon dilation of hepaticojejunostomosis (n = 3) and endoscopic balloon dilation of hepaticoduodenostomosis with stenting (n = 2) were performed with a positive effect.

   Conclusion. Resection of bile ducts with cystic dilations with the formation of biliodigestive anastomosis can be performed both via video-assisted surgery and completely laparoscopically. Laparoscopic interventions in children with different variants of cystic dilation of the bile ducts prove to be effective and safe.

   Aim. To increase the efficiency of surgical treatment for children with pancreatic malformations and diseases using endoscopic interventions.

   Materials and methods. The study enrolled 39 children aged 3–17 years who underwent 58 endoscopic interventions.

   Results. Transpapillary interventions were performed in 14 children with pancreatic duct abnormalities. Stenosis of the proximal pancreatic ducts was revealed in 5 observations – stenting was performed. Lithiasis of Wirsung's duct was confirmed in 4 observations, an abnormality in the form of an incomplete pancreas divisum was revealed in 3 of them. Pancreas divisum was detected in 1 patient, sphincterotomy of the minor duodenal papilla was performed. Transmural interventions were carried out in 24 observations: puncture – in 10 patients with intra- or parapancreatic cystic formations, drainage – in 14 patients with pseudocysts. Combined transpapillary and transmural surgery was performed in a child with traumatic pancreatic disruption.

   Conclusion. Transpapillary interventions prove to effectively eliminate hypertension in the pancreatic ducts in children. Transmural procedures can be used to drain pancreatic pseudocysts in children.

   The paper describes a clinical observation of extrahepatic cholestasis in a 10-year-old child. Anatomical features required complex endoscopic surgery. The patient with jaundice and pain syndrome was hospitalized in the state of moderate severity with the history of the disease for more than a month. The study presents stages of outpatient and clinical laboratory and instrumental diagnostics. As a result, obstructive jaundice was revealed. Multi-stage endoscopic treatment was successfully performed. It revealed no signs of choledocholithiasis, but detected compression of the pancreatic part of the common bile duct without pathological changes in the head of the pancreas. Endoscopic stenting of the common bile duct and pancreatic duct was performed. Biliary hypertension was eliminated. Endoscopic methods of biliary decompression can be applied to older children. Pancreatic duct stenting can be performed to prevent postoperative pancreatitis. Atypical sphincterotomy provides access to the bile ducts.

   Aim. To study the causes and consequences of bile leakage in liver injury and determine the potential ways for its elimination.

   Materials and methods. The study involved a retrospective analysis of 204 liver injuries of various types. 26 % of cases were detected with isolated abdominal trauma, 74 % – with concomitant abdominal injury. According to the AAST grading scale, 15.7 % of patients got grade II liver injuries, 44.6 % – grade III, 34.3 % – grade IV, and 5.4 % – grade V. Since concomitant injuries predominated, surgical treatment was initially performed in the overwhelming number of cases. 14 % of cases received non-operative management.

   Results. The incidence of bile leakage amounted to 28.4 % for all liver injuries and reached 54.9 % for III–V grade injuries (AAST). Small bile leakage prevailed, while active leaking was observed in 36.2 %. Damage to peripheral parts of the biliary tract was noted in most cases (68 %). Conservative management of patients with small bile leakage associated with damage to peripheral parts of the biliary tract appeared successful in 48.5 % of cases. Endoscopic biliary drainage of bile ducts proved effective in case of active bile leakage and (or) injuries of the central bile ducts.

   Conclusion. Endoscopic biliary drainage of bile ducts is considered the most effective for elimination of active biliary leakage in the absence of biliary peritonitis and communication of biliary tract with pleural cavity.

   Aim. To compare treatment outcomes and quality of life in patients undergoing pancreatoduodenectomy and pancreatectomy with risk of postoperative pancreatic fistula > 50 % according to the UA-FRS scale.

   Materials and methods. The study involved the results of treatment of 14 patients with neoplasms of the hepatopancreaticoduodenal zone, who were intraoperatively chosen to undergo pancreatectomy instead of pancreatoduodenectomy. In all patients, the risk of forming a pancreatic fistula after surgery was ≥ 50 % (UA-FRS). The experimental group consisted of 14 patients comparable in diagnosis, age, and comorbidities, who underwent pancreatoduodenectomy with the same risk of pancreatic fistula.

   Results. Complications ≥ IIIa according to Clavien–Dindo were observed in 6 patients (42.8 %) in the pancreatectomy group and in 8 patients (51.7 %) in the resection group. 5 patients (35.7 %) in the resection group revealed postoperative pancreatic fistula of class B and C, according to ISGPS. Length of hospital stay after surgery and 30-day mortality did not differ between groups. Quality of life after surgery had no pronounced differences between the groups according to most scales. Symptoms related to digestive disorders in those who underwent pancreatoduodenectomy were more pronounced. Patients in the pancreatectomy group were more susceptible to symptoms associated with diabetes mellitus, and experienced greater financial difficulties.

   Conclusion. Pancreatectomy fails to provide a significant reduction in the incidence of postoperative complications and mortality. In exceptional situations, increasing the extent of surgery to pancreatectomy may be the right solution, with comparable results, without compromising quality of life. Prior to surgery, pancreatectomy should not be considered as the main planned extent of surgery. The final decision on the extent of intervention should be made intraoperatively by a multidisciplinary team. Preserving part of the pancreas is essential, if possible.

   Aim. To study the features of correction of carbohydrate metabolism disorders and nutritional deficiency in patients after total pancreatoduodenectomy; to develop a unified protocol for managing patients after total pancreatoduodenectomy.

   Materials and methods. From 2007 to 2022, 62 patients underwent total pancreatoduodenectomy in the Hepatopancreatic Surgery Unit of the Botkin Hospital. The patients were divided into two groups, comparable in terms of basic parameters. The first group included patients (n = 32) who underwent “classical” total pancreatoduodenectomy with gastric resection and splenectomy. The second group consisted of patients (n = 30) who underwent total pancreatoduodenectomy in the modification of Botkin Hospital. In the perioperative period, patients of both groups were examined for carbohydrate metabolism with the selection and assessment of the average daily dose of short-acting and long-acting insulin, assessment of enzyme and protein deficiency with the selection of enzyme replacement therapy and nutritional support. For a more accurate assessment of carbohydrate metabolism disorders, all patients underwent continuous monitoring of the level of glycemia intraoperatively and in the early postoperative period (FreeStyle Libre flash monitoring system, Abbott). The glycated hemoglobin level was assessed on day 90 and body mass index – on days 30, 60 and 90 after surgery.

   Results. The mean level of glycemia in patients after total pancreatoduodenectomy in the modification of the Botkin Hospital accounted for 8.0 mmol/l and the variability (daily fluctuations in glycemia) comprised 39 %, which was significantly lower compared to the group of “classical” total pancreatoduodenectomy with 7.6 mmol/l and 48 %, respectively. Seven patients (21.9 %) after total pancreatoduodenectomy in the modification of the Botkin Hospital experienced a severe hypoglycemic episode, while a similar severe hypoglycemic episode was noted in 25 patients (80.6 %) after pancreatectomy in its “classical” variant, of which 18 patients (60 %) required hospitalization in the endocrinology unit in order to correct the sugar-lowering therapy. In turn, only three patients (9.4 %) after total pancreatoduodenectomy modified by the Botkin Hospital required hospitalization due to severe hypoglycemia. The mean level of glycated hemoglobin in patients of the first and second groups on day 90 accounted for 7.2 % and 7.7 %, respectively (p = 0.789). The average body mass index on day 90 after surgery was higher in the group of organ-preserving total pancreatoduodenectomy: 24 kg/m2, compared to the “classical” pancreatectomy with 21.2 kg/m² (p = 0.001). The daily dose of both short-acting and long-acting insulin was higher in the organ-preserving total pancreatoduodenectomy group of 17.4 ± 5.6 U/day and 12 ± 4.6 U/day, respectively, compared to the group of “classical” total pancreatoduodenectomy of 13.8 ± 4.6 U/day and 10.8 ± 2.7 U/day, respectively. This can be attributed to the faster normalization of the patient's body weight and the preserved function of physiological digestion due to the pylorus-preserving variant of total pancreatoduodenectomy.

   Conclusion. Management of patients after total pancreatoduodenectomy is claimed to be an extremely complex task that requires a multidisciplinary approach involving surgeons, intensivists, endocrinologists and gastroenterologists at all stages of patient management. Organ-preserving modification of total pancreatoduodenectomy with preservation of the stomach, spleen and splenic vessels in the modification of the Botkin Hospital improves treatment results and simplifies the selection of insulin therapy for this group of patients.

   Aim. To evaluate the clinical efficacy of a new method for drainage of pancreatic head cysts.

   Materials and methods. The results of treatment of 3 patients with pancreatic head cysts were analyzed in a new way. In all patients, cysts developed against the background of recurrent pancreatitis; the etiology of pancreatitis was alimentary. All cysts were located in the pancreatic head, mainly on its posterior surface, communicating with the ductal system.

   Results. No intra- and postoperative complications were revealed. Patients were discharged from hospital on the 8–12^th day after surgery. In all observations, good results were obtained: no pain syndrome reported; psychological status and food intake normalized. α-amylase in urine and plasma has not increased. No recurrence of cysts and no hospitalizations for acute pancreatitis were reported.

   Conclusion. The developed method for treating pancreatic head cysts communicating with the ductal system proved to be physiological, low-traumatic and can be used in surgical practice.

   Aim. To study reoperations after cholecystectomy in terms of their incidence, reasons, peculiarities and their significance when evaluating quality of medical care for patients with cholecystolithiasis.

   Materials and methods. Cholecystectomy was performed in 1272 cases, repeated interventions – in 18 (1.4 %). The study involved determination of their structure, peculiarities, terms, and outcomes, as well as stratification of their severity. The electronic database of the clinic for 2016–2022 was used for the study.

   Results. 1101 operations (86.6 %) were performed laparoscopically, 171 cases (13.4 %) involved open surgery. Repeated laparoscopic and open surgeries were performed in 10 (0.9 %) and 8 (4.8 %) cases. Following cholecystectomy, 11 patients (61.1 %) underwent surgery for chronic cholecystitis, 7 (38,9 %) – for acute cholecystitis; laparoscopy was used in 11 cases, traditional intervention – in 7. The reasons for repeated interventions included bleeding – in 11 cases (0.8 %), bile leakage – in 4 (0.31 %), and purulent-septic complications – 3 (0.23 %). In order to stop bleeding, the
operation was performed in 18 hours on average. No fatal outcomes reported.

   Conclusion. The sufficient experience of the clinic in providing medical care to patients with cholecystolithiasis was proven by the prevalence of laparoscopic cholecystectomy, acceptable incidence of reoperations, as well as their timely and adequate performance.

   Aim. To review the comparative studies into robot-assisted and open surgeries for hilar cholangiocarcinoma.

   Materials and methods. Search for the comparative studies into the results of robot-assisted and open surgeries in patients with hilar cholangiocarcinoma was performed using electronic databases Embase, MEDLINE, Web of Science and Google Scholar by keywords “robotic” AND “hilar cholangiocarcinoma” OR “perihilar cholangiocarcinoma” OR “Klatskin tumor” published by December 31, 2023.

   Results. The meta-analysis involves the results of 169 resections, including 53 robot-assisted and 116 open surgeries. Robot-assisted interventions revealed longer surgery duration (weighted mean difference (WMD) = 157.49, CI = 95 % [102.85; 212.12], р < 0.00001), less amount of intraoperative blood loss, close to statistically significant (WMD = −76.41, CI = 95 % [−159.90; 7.08], р = 0.07). Robot-assisted and open surgery groups appear comparable in terms of their perioperative parameters, including blood transfusion rate, number of R0 resections, number of lymph nodes removed, rate of postoperative complications, length of hospital stay, in-hospital mortality, as well as overall and event-free survival rates.

   Conclusion. Meta-analysis of short-term and long-term outcomes of robot-assisted and open surgeries for hilar cholangiocarcinoma of the liver and bile ducts proves the potential and possibility for using robotic technologies in selective patients.

   Aim. To improve the efficiency of radiofrequency ablation for large tumors by computer-aided modeling and planning of robotic surgery.

   Materials and methods. A set of algorithms for planning robotic electrode insertion was developed.

   Results. The evaluation of the technique proved its potential for achieving complete tumor processing and trajectory building with all feasible constraints.

   Conclusion. The set of algorithms provides computer-aid planning for sequential placement of radiofrequency ablation needles during intervention.

   The paper presents a clinical observation of successful X-ray endovascular intervention performed in a patient with colorectal cancer metastases in the liver in order to prevent post-resection hepatic failure. Traditional embolization of the right branch of the portal vein was supplemented by occlusion of the right hepatic vein. Venous deprivation enabled a rapid growth of the future liver remnant to be achieved as indicated by CT volumetry results and SPECT-CT data that showed a significant increase in hepatic clearance. The first results demonstrate that liver venous deprivation is to be investigated further in clinical practice.