Aim. To analyze clinical features and surgical results in patients with liver alveococcosis complicated by obstructive jaundice.
Material and Methods. 39 patients with liver alveococcosis complicated by obstructive jaundice were operated. 49 different interventions were carried out. General clinical diagnosis and modern instrumental methods of examination were used.
Results. The incidence of jaundice in liver alveococcosis was 14.1%, duration of the disease was over 10 years, duration of jaundice – from several months to several years. 3 types of clinical course were observed. 65.5% of patients had other complications of parasitic process, 30% – combination of several complications. 55.4% of patients have already been operated previously. 65% of patients had severe liver failure at admission. The main method of diagnosis was ultrasound. Nasobiliary drainage and percutaneous transhepatic cholangiostomy were used for preoperative biliary decompression. All patients underwent only drainage operations (within two stages as a rule). NiTi-stents were used for external drainage, fistuloenterostomy in 11 patients with good results. The mortality rate was 10.2%.
Conclusion. Obstructive jaundice in liver alveococcosis has three types of course depending on process localization. They have different duration and severity of cholestasis. Two-stage surgery is advisable and NiTi-stents are perspective. Drainage operations prolong life of inoperable patients for about 6.5 ± 1.2 years.

Aim. To explore the possibilities of “Avtoplan” computerized system for virtual modeling in preoperative planning and to evaluate its effectiveness in liver surgery.
Material and Methods. The survey of 50 patients with liver disease was analyzed. All patients underwent virtual modeling. The data were loaded into “Avtoplan” system. 3D models were created by radiologist with involvement of surgeon. At the planning stage the surgeon performed a virtual resection line and learned some anatomical features.
Results. Virtual modeling revealed following diseases: liver cyst and hemangioma (20 cases); hydatid liver cysts (7 cases); liver abscess (6 cases); hepatocellular carcinoma (5 cases); liver metastases (8 cases); portal thrombosis (4 cases). The operation was carried out in 31 patients. During surgery 3D-model was shown on the screen for interactive comparison with intraoperative situation. The use of virtual simulation allows the surgeon to confidently identify anatomical
structures and pathological changes, to form an optimum resection line, as well as to avoid damage of vascular trunks.
Conclusion. The developed algorithms of "Avtoplan" virtual simulation system provide the construction and analysis of the 3D-model of the abdominal cavity. Preoperative planning using virtual 3D-model confirmed effective evaluation of patient's anatomical features and necessary postoperative liver volume.

Aim. To improve the results of minimally invasive treatment of intrahepatic cholelithiasis.
Material and Methods. There were 37 patients with intrahepatic cholelithiasis under observation. In 12 cases intrahepatic cholelithiasis was isolated on background of biliodigestive anastomosis stricture. In 25 cases multiple cholelithiasis was diagnosed. Cholelithiasis was cured by percutaneous transhepatic pneumatic contact lithotripsy. We performed dislocation of stones from intrahepatic ducts through dilated biliodigestive anastomosis into duodenal papilla or
intestinal loop. In 25 patients with cholangiolithiasis there were combined antegrade and retrograde endovascular interventions in a consistent format or “rendezvous” format.
Results. 12 patients with multiple cholelithiasis underwent open surgery after relief of obstructive jaundice syndrome. In this group of patients intrahepatic cholangiolithotomy with lithoextraction and overlaing of choledochoduodenal anastomosis have been traditionally performed. Сholangiostomy was maintained perioperatively to control completeness of lithoextraction. In 4 patients residual stones of intrahepatic ducts were removed through the choledochoduodenal
anastomosis using cholangiostomy in postoperative period. In 13 high risk patients percutaneous lithotripsy and lithoextraction were the only acceptable way of cholelithiasis elimination. All cases of intrahepatic cholelithiasis on background of biliodigestive anastomosis stricture were treated using X-ray surgery after antegrade balloon dilatation of the anastomosis. Complications were observed in 5 (13.5%) patients. There were no motality. 

Conclusion. Antegrade percutaneous interventions for intrahepatic cholelithiasis can be considered as intervention of the “first line” due to predictable adequate biliary decompression and conditions for subsequent treatment. Antegrade minimally invasive interventions can be used as ultimate treatment and integrated into individual algorithm for gallstone
disease in conjunction with endoscopic techniques and conventional surgery.

Aim. To determine surgical tactics in patients with chronic pancreatitis complicated by pancreaticopleural fistula.
Material and Methods. The study is founded on the analysis of surgical treatment of 7 patients with chronic pancreatitis complicated by pancreaticopleural fistula. The choice of sequence and amount of surgical treatment depended on timely diagnostics, severity of pancreatitis, pleural and pericardial complications. Pleural aspiration was carried out in all patients before pancreatic surgery. In 2 cases simultaneous thoracoscopy with pleural aspiration and pancreatic surgery
were performed. Distal hemipancreatectomy with splenectomy was carried out in 1 case. Puestow procedure with external drainage of pancreatic pseudocyst was carried in all other cases.
Results. Complementary pleural aspirations were required for 3 patients in postoperative period. Patients treated by videothoracoscopy did not undergo complementary pleural aspirations. Pleural drains were removed in 6 and 8 days. There were no lethal outcomes. Within 1 year diabetes developed in 1 patient after distal pancreatectomy.
Conclusion. Early diagnosis and timely consistent treatment provide better results in these patients.

Aim: to present the first experience of using of microwave ablation in management of functioning pancreatic neuroendocrine tumors.
Material and Methods. We present treatment of 350 patients with hormone-producing pancreatic tumors. Five of them with symptoms of organic hyperinsulinism underwent microwave ablation (MWA) of tumors.
Results. Sustained remission of clinical manifestations was achieved in all patients with insulinomas after microwave ablation. There were no complications after manipulation in 2 cases. 2 patients had complications Clavien-Dindo degree 1–2, in 1 case readmission was required (Clavien–Dindo degree 3).
Conclusion. The role of microwave ablation in pancreatic neuroendocrine tumors management is not defined. Local destruction is indicated in selected cases, so assessment of large number of cases and long-term outcomes is difficult. However, the microwave ablation allows controlling the symptoms of hormones overexpression in patients with high risk
of postoperative complications

Aim. To define the prognostic value of intra-abdominal pressure monitoring in the treatment of patients with pancreatic necrosis in aseptic and infectious phases.
Material and Methods. The article shows the results of measurements and dynamics of intra-abdominal pressure in 78 patients with pancreatogenic peritonitis.
Results. It was established that pancreatogenic peritonitis was complicated by increased intra-abdominal pressure and the development of intra-abdominal hypertension in 97.8%. A correlation between IAP and severity of abdominal and retroperitoneal inflammation (p < 0.05), as well as between IAP and APACHE II score was determined (p < 0.05).
Conclusion. Prolonged abdominal hypertension promotes the development of multiple organ failure and requires a laparotomy in order to reduce the intra-abdominal pressure via abdominal and retroperitoneal spaces sanitation

Aim. To evaluate an improved method of percutaneous transhepatic biliary drainage (PTBD) with the Y-type catheter system for patients with post-traumatic recurrent bile duct stricture.
Material and Methods. A retrospective analysis examined management of 11 patients with recurrent hepatico-jejunal anastomosis stricture after iatrogenic injury of bile ducts during laparoscopic cholecystectomy. Recurrent stricture was observed in 5 patients after 1 reconstructive biliary intervention, in 4 patients after 2 operations and in 2 patients after 3 operations. 9 patients from group I were treated with a conventional long-term single drainage technique with continuous daily flushing. Repeated balloon dilatation of stricture and biliary drain exchange were performed every

3 months. 4 patients from group II (including 2 patients with unsuccessful conventional treatment from group I) were treated with the Y-type drainage catheter system achieving permanent dilatation of bile duct stricture. An exchange of this drainage system was done once every 3 months without flushing or fixation to the skin.
Results. Patients from group I demonstrated the residual biliary stricture confirmed by a deformation of balloon catheter within average period of 7.3 months (6–12 months). Cholangitis due to dislocation and obstruction of the drain was observed in 4 patients. Mean overall drainage time was 13.8 months (12–17 months) with clinical follow-up from 4 to 10 years after drain elimination. Symptoms of recurrent stricture were observed in 2 patients after 3 and 4.5 years.
Patients from group II demonstrated complete resolution of cholangiographic signs of stricture within 3 months after PTBD using Y-type catheter system. There were no complications. Mean drainage time was 10.5 months (9–12 months). There were no recurrences in 2, 13, 14 and 16 months after PTBD removal.
Conclusion. PTBD with the Y-type catheter system may be an effective alternative to open reconstructive surgery for some patients with multiple recurrent benign bile duct strictures. In comparison with conventional method, the improved method of PTBD results permanent dilatation of bile duct stricture, reduces risks of treatment-related complications and duration of treatment as well as improves quality of life.

Aim. To improve the results of palliative surgical treatment of malignant obstructive jaundice by selection of optimal biliary decompression in distal obstruction.
Material and Methods. In the main group (n = 80) choledochojejunostomy was predominantly performed. Gallbladder bypass was used only if choledochodigestive anastomosis was impossible. In the comparison group (n = 92) the method of biliary decompression was determined by surgeon's preferences. Herewith cholecystodigestive anastomosis was also applied in cases when common bile duct bypass was possible.
Results. Choledohodigestive anastomoses were made in 63 (78.8%) and 34 (37%) cases in both groups respectively (p < 0.001). Herewith choledochojejunostomy was performed in 48 (60%) cases in the main group and in 20 (21.7%) patients in the comparison group (p < 0.001). Cholecystodigestive anastomosis was applied significantly less frequently in the main group than in the comparison group (7.5% vs 47.8%, p < 0.001). Morbidity and mortality rates were
comparable in both groups: 23.8% vs 23.9% (p = 0.87) and 8.8% vs 12% (p = 0.67) respectively. In remote postoperative period recurrent jaundice followed by reoperation developed in 1 patient of the main group and in 8 cases of the comparison group (p = 0.029). In 6 patients of the comparison group jaundice was observed after cholecystodigestive
anastomosis. Patients of the comparison group had nausea and vomiting more frequently according to EORTC QLQ C30 questionnaire (40.6 ± 21.3 vs 30.8 ± 17.5, p = 0.012). Itching (8 ± 2.6 vs 9.5 ± 1, p = 0.018) was also more frequent in the comparison group by the visual-analogue scale.

Conclusion. Choledochojejunostomy is advisable for adequate biliary decompression that provides better quality of life. Less efficient operations including cholecystodigestive anastomosis should be applied if other methods are impossible.

The purpose of this review is analysis of cirrhosis influence on the results of abdominal operations, the role of the offered predictive systems to define the risk of postoperative complications and mortality. Careful preoperative examination and selection of patients based on objective assessment of surgical risk can promote reduction of postoperative complications and mortality.

Draining techniques for complicated chronic pancreatitis were analyzed. The efficiency of draining methods in terms of pancreatic ductal hypertension elimination was assessed. The new classification of pancreatic hypertension is offered that defines the approaches for its surgical correction.

The review presents key data of the world literature about the results of surgical and combined treatment of patients ith major duodenal papilla cancer and immunophenotypic heterogeneity. This causes the difference in the prognosis and treatment. These data are correlated in some degree with authors' own experience that is the largest in the world

This publication presents an overview of modern diagnostic methods (ultrasound, spiral computed tomography, magnetic resonance imaging, positron emission tomography) for liver tumors including hepatocellular carcinoma, cavernous hemangioma, colorectal cancer metastases

The review is devoted to surgical treatment of pancreatic pseudocysts including history of surgery, choice of surgery and conservative treatment, advantages and disadvantages of open and minimally invasive surgical methods

Gallstone ileus is an uncommon complication of cholelithiasis, that occurs due to gallbladder stones dislocation into intestinal tract as a rule because of an internal fistula between gallbladder and duodenum. Terminal ileum obstruction is the most common. Laparoscopy has significant difficulties to resolve such complication of gallstone disease. We demonstrate a case of successful laparoscopic treatment of gallstone ileus.

Aim. To substantiate the advantages and possibilities of an uniform presentation of the material for recurrent echinococcosis after surgical treatment.
Material and Methods. The article has debatable character. We presents simulated results of a statistic study of recurrence echinococcosis. The frequency and probability to avoid recurrent echinococcosis are presented.
Results. The frequency of recurrence and the likelihood to avoid recurrent echinococcosis are distinct indicators which complement each other. The probability to avoid recurrence defines more accurately long-term results of echinococcectomy and allows to calculate prognostic value of the frequency of recurrence within different terms after intervention.
Conclusion. Common methodological approaches to the presentation of the material for recurrent echinococcosis through the rate and the probability to avoid recurrence are necessary to achieve a common understanding of the effectiveness of measures against recurrence and to summarize materials of various publications.