Aim. To improve the efficiency of preoperative portal vein mbolization as a method of prevention of postoperative liver
failure after extensive resections.
Material and Methods. The study included 30 patients with isolated liver tumors in whom advanced liver resection was planned. 33 embolizations were performed. In 23 observations mechanical embolization and scleroobliteration of the right branch of portal vein were made, oily chemoembolization and mechanical embolization of the right branch of the portal vein – in 10 cases. In 8 cases preoperative portal vein embolization was performed after oily chemoembolization of hepatic artery. 3 patients underwent repeated portal vein embolization due to insufficient hypertrophy of the remaining liver parenchyma.

Results. Volume of remnant liver parenchyma increased by 41% after preoperative portal vein embolization on the average. In 5 cases insufficient volume of remnant liver was marked. The reasons of insufficient liver volume were partial recanalization of the embolized branches of the portal vein, the development of multiple intrahepatic portal collaterals (hemostatic spongeas as a embolic material in 3 cases), liver cirrhosis and 2 lines of previous chemotherapy in history (2 cases). In 3 patients repeated portal vein embolization using PVA particles and scleroobliteration with etoxisclerol foam was performed to achieve necessary hypertrophy. Extensive liver resection was performed in 24 patients. Postoperative mortality was noted in 2 cases. There was similar frequency of postoperative complications in patients with and without preoperative portal vein embolization.

Conclusion. Preoperative portal vein embolization is a minimally invasive technique for increase of remnant liver volume prior to advanced liver resection without augmentation of postoperative complications rate. The results and technique may be improved (segment IV branch embolization, the use of foam scleroobliteration, mechanical occlusion combined with chemoembolization, combination of portal vein embolization and hepatic artery chemoembolization). Repeated embolization procedures can provide necessary liver hypertrophy in some cases

Aim. To improve the efficiency of treatment of patients with liver malignancies.
Material and Methods. 27 patients with liver malignancies underwent preoperative portal vein embolization without previous hepatic arterial chemoembolization (group 1). Group 2 consisted of 42 patients in whom 1 – 6 hepatic arterial chemoembolizations were made before preoperative portal vein embolization. Hepatic arterial chemoembolizations was continued after portal vein embolization in all patients.
Results. In both groups preoperative portal vein embolization resulted in hypertrophy of the contralateral liver segments by 29.6% on the average; up to 30% of liver volume in normal organ function and up to 40% in case of impaired function. 38 (55%) patients were operated including 15 (55.6%) in group 1 and 23 (55%) in group 2. Among 12 patients without surgery in group 1 intrahepatic tumor progression was noted in 5 (18.2%) cases within 38–231 days. Among 19 nonoperated patients in group 2 tumor progression was also observed in 5 (11.9%) cases within 49–837 days. 

Conclusion. Preoperative portal vein embolization with previous hepatic arterial chemoembolization is an effective combination of neoadjuvant therapy of malignant liver tumors. This combination allows you to expect necessary hypertrophy during longer period after preoperative portal vein embolization with relatively low risk of intrahepatic tumor progression in 11.9% of patients versus 18.2% in patients without prior hepatic arterial chemoembolization

Aim. To assess an efficiency of modern methods of vicarious hypertrophy stimulation of the remnant liver after advanced
resection and to reduce the risk of postoperative liver failure.
Material and Methods. Programmed stimulation of liver vicarious hypertrophy was applied in 119 patients including ligation and transection of portal vein branches in 76 patients (64.8%), endovascular embolization of portal vein branches in 21 patients (17.6%), endovascular embolization of the portal vein combined with chemoembolization of the hepatic artery in 15 patients (12.7%), and split in situ liver resection in 7 patients (5.9%). Volume of remnant liver was measured using computerized tomography, magnetic resonance imaging and/or ultrasound prior to and in 2–4 weeks after occlusion of portal vein branches.

Results. According to CT/MRI data remnant liver volume increased from 28.4% to 48.7% (by 38.9 ± 5.5% on the average). 72 patients (60.5%) were operated: right-sided or extended right-sided hemihepatectomies were performed in 49 cases (68%), atypical liver resection – in 21 cases (29.2%). Postoperative complications were registered in 16 cases (22%). Mortality due to post-resection hepatic failure was 2.8%. Liver resection was not performed in 47 cases (39.5%) due to insufficient increase of liver fragment, newly diagnosed intrahepatic metastases or local recurrence of colorectal cancer.
Conclusion. Preoperative programmed stimulation of liver fragment is a perspective method that increases percent of operable patients with liver tumors and reduces the risk of hepatic failure after extensive liver resection. Surgical and endovascular methods of preoperative programmed stimulation of liver vicarious hypertrophy are technically feasible and safe.

Aim. To clarify the indications for preoperative portal vein embolization using CT-volumetry and indocyanine green clearance as predictors of post-resection liver failure.
Material and Methods. The results of 179 liver resections were analyzed. There were 128 hemihepatectomies and 51 partial resections. In 24 cases preoperative portal vein embolization was used. Indocyanine green clearance test was applied for a quantitative assessment of liver function. Plasma disappearance rate and residual concentration of indocyanine green during the first 15 minutes were determined. CT-volumetry was used to calculate the future remnant liver volume. Posthepatectomy liver failure severity was evaluated in accordance with the recommendations of the
International Study Group of Liver Surgery (ISGLS) and taking into account “50–50" criteria.
Results. The frequency of posthepatectomy liver failure after extensive resections was 42.5%: grade A – 38.7%; grade B –41.9%, grade C – 19.4%. The future remnant liver volume as a predictor of posthepatectomy liver failure had moderate predictive power (c-statistic = 0.71, p = 0.04) with sensitivity and specificity about 84.6% and 61%, respectively. Indocyanine green elimination was significantly worse in patients with chronic liver disease or after previous repeated courses of chemotherapy (plasma disappearance rate 15.6%/min vs 18.6%/min, p = 0.004; indocyanine green residual concentration after 15 minutes 19.6% vs 6,1%, p = 0.003). Clearance test with indocyanine green was characterized by
high sensitivity (92.3%) and specificity (71.4%) in the definition of liver function and excellent predictive power (c-statistic = 0.82, p = 0.0001) in determining of posthepatectomy liver failure. Risk factors of posthepatectomy liver failure were future remnant liver volume <372 cm3/m2 and plasma disappearance rate of indocyanine green <10%/min. The indications for preoperative portal vein embolization are future remnant liver volume <372 cm3/m2 at plasma
disappearance rate of indocyanine green >15%/min or plasma disappearance rate of indocyanine green >10%/min but
<15%/min and future remnant liver volume <550 cm3/m2. These criteria allowed to reduce the incidence of posthepatectomy liver failure (25.6%) and to avoid the development of severe liver dysfunction.
Conclusion. The future remnant liver volume and indocyanine green clearance test are highly sensitive methods to predict posthepatectomy liver failure. Application of the developed diagnostic and treatment algorithm with updated indications for preoperative portal vein embolization can reduce the frequency of posthepatectomy liver failure.

Aim. To compare different surgical methods for liver failure prevention after major hepatectomies with small future liver
remnant.
Material and Methods. For prevention of post-resection liver failure, different variants of two-stage procedures were applied in 31 pts with small future liver remnant. The following methods were used: portal vein embolization with subsequent major hepatectomy (23), ALPPS (1), minimally invasive variants of ALPPS with partial radio-frequency destruction of the liver parenchyma in the plane of the future resection without separation of the parenchyma (RALPPS)

and portal vein embolization (5), right portal vein ligation (2).
Results. ALPPS led to hypertrophy rate of the future remnant liver of 71%, however, due to severe complications and fatal outcome method was not used further. Intervals to achieve hypertrophy of the future liver remnant after first stage of RALPPS and portal vein embolization were 14 and 29 days respectively (p < 0.05). The average increase of the future liver remnant after RALPPS and portal vein embolization consisted of 66.3% and 27.2% respectively. The progression of the disease after portal vein embolization was observed in 7 (30%) pts, after RALPPS – in 2 pts (29%; p > 0.05).
Nevertheless, tumor progression did not influence the rate of complete resection (completeness of the second stage) in RALPPS (100%) in contrast to portal vein embolization (70%). Liver failure according to ISGLS criteria was revealed in 7 (26%) pts including 5 (22%) pts after portal vein embolization (grade А, В), 1 patient after ALPPS (grade С), 1 (14%) patient after RALPPS (grade В) without significant differences (p > 0.05).
Conclusion. Minimally invasive variants of ALPPS can lead to lower rate of morbidity comparable with two-stage hepatectomies with the same high rate and short term hypertrophy as for classical ALPPS.

Aim. To estimate early and remote outcomes of portal vein embolization and ALPPS for prevention of post-hepatectomy
liver failure.
Material and Methods. 358 liver resections were performed for the period 2008–2016. There were 132 (36.9%) advanced
resections (over 4 segments). Cholangiocelullar carcinoma was diagnosed in 48 cases (36.4%), hepatocellular carcinoma – in 23 (17.4%) cases, colorectal liver metastases – in 19 (14.4%), parasitic liver diseases (hydatid disease, alveococcosis) – in 31 (23.5%) cases and others – in 11 (8.3%) cases. Vascular resection was performed in 42 (31.8%) patients, common bile and (or) common hepatic duct resection – in 76 (57.6%) cases. In this article 41 cases of portal
vein embolization with staged liver resection and 6 cases of ALPPS are described. Control group included 85 advanced liver resections without portal vein embolization.

Results. Portal vein embolization was effective in 41 (66%) cases: FLR growth was 52% (33;61) within average terms of 5.0 (4.0; 6.5) weeks. In ALPPS FLR growth was 70% (60; 77) after 11 (7; 17) days, in 1 case it was uneffective (FLR% – 30% after 24 days). The grade B+C of post hepatectomy liver failure was observed in 66 (50%) cases, infectious complications – in 39 (29.5%) cases, biliary complications – in 29 (21.9%) cases, post hepatectomy bleeding (grade C, ISGLS) – in 5 (3,8%) cases. In-hospital mortality was 8,3 %. Portal vein embolization decreased grade C post hepatectomy
liver failure (7.3% vs 20%) (p = 0.07).
Conclusion. Two-stage liver resection with primary embolization or ligation of the portal vein can reduce the frequency of post-resection liver failure. For certain patients ALPPS is the only method that allows to perform radical surgery and preserve necessary amount of hepatic parenchyma. However long-term results are unpredictable

Aim. To determine the effectiveness of the basic techniques of magnetic resonance imaging in differential diagnosis of focal liver lesions.
Material and Methods. 256 patients with 414 focal liver lesions were examined (Siemens: Magnetom Symphony, Magnetom Sonata – 1,5 T).
Results. The effectiveness of traditional native MRI without contrast is low (efficiency of mathematical model – 58%). The basis of differential diagnosis of the most of nosological forms is dynamic contrast enhancement with model's efficiency about 67%. The greatest opportunities are provided by the study with Gd-EOB-DTPA (model's efficiency 80%). MR diffusion is effective for detection of hepatic focal lesions, but its capabilities are limited in differential diagnosis.
Conclusion. Magnetic resonance imaging is a highly informative method of detection and differential diagnosis of focal liver lesions.

Aim: to develop a new predictive method for post-resection liver failure prior to surgery and in early postoperative period.
Material and Methods. Diagnostically significant risk factors for post-resection liver failure were determined based on 286 advanced liver resections. The prognostic scale was created taking into account prognostic significance of each parameter. International Study Group of Liver Surgery classification was used to assess quality of liver failure prediction.
Results. It was defined the formula for calculation of liver failure incidence after hepatic resection. The probability of various classes of liver failure was received depending on the values of calculated criterion.
Conclusion. Multi-factor modeling systems are perspective for prognosis of postoperative liver failure. Therefore curative tactics may be determined.

Aim. To compare the outcomes after transverse and midline laparotomy for infected pancreatic necrosis and to evaluate
the safety and adequacy of drainage via transverse laparotomy.
Material and Methods. Surgical treatment of 47 cases of infected pancreatic necrosis was analyzed. We compared two groups: 13 patients underwent transverse laparotomy (group 1), 34 patients underwent midline laparotomy (group 2). In the first group anterior and posterior sheets of rectus sheath were stitched on both sides of the transverse incision. Omentobursostomy (OBS) was formed by stitching of gastrocolic ligament with sewn edges of the rectus sheath. Intraoperative blood loss, intensive care unit (ICU)/hospital stay, postoperative complication rate and mortality were
compared and analyzed.
Results. Necrosectomy was performed in all patients. In group 1 OBS was performed in 12 (92.3%) cases, in group 2 – in 22 (64.7%) cases. In 12 patients of group 2 OBS was not made. There was less intraoperative blood in group 1 compared with group 2 (178.0 ± 31.2 ml vs. 317.1 ± 38.7 ml )(p < 0.05). Purulent complications rate outside the surgical area was significantly less in group 1 (7.7% vs. 41.2%, p < 0.05). The incidence of pancreatic and biliary fistula were 7.7% (1 case) and 38.3% (13 cases) in both groups respectively (p < 0.05). ICU stay was 5.2 ± 1.6 days and 11.4 ± 1.8 days in groups 1 and group 2 respectively (p < 0.05). Postoperative mortality rate was 2 cases (15.4%) in group 1 and 12 cases
(35.2%) in group 2 (р > 0.05).
Conclusion. Necrosectomy through transverse laparotomy was accompanied by less intraoperative blood loss, fewer complications and provides adequate drainage that reduces ICU-stay.

Aim. To investigate the pathogenesis of cystic inflammatory transformation of duodenal wall in patients with chronic
pancreatitis (CP), described as a “duodenal dystrophy” (DD), and to improve clinical efficiency of surgical treatment.
Material and Methods. 532 patients with CP were examined for the period 2004–2016. Eighty two (15.4%) patients with DD were retrospectively included over 12 years. The diagnosis of DD was established by transabdominal ultrasound, CT, MRI and endosonography. Initially, all patients were treated conservatively. 74 patients required surgical treatment subsequently after conservative treatment with a median duration of 2 years. 34 patients underwent pancreaticoduodenectomy (PD), 21 patients underwent duodenal resection, 15 – duodenum-preserving pancreatic head resection of (DPPHR). 4 patients underwent palliative operations. CP and DD were verified by histological study of surgical specimens. Not operated patients (8) are under observation. Long-term results of surgical treatment were evaluated in 47 patients with a median follow-up 49.9 months.

Results. Histological examination resulted that in 69.9% DD was related with groove pancreatitis, with ectopic pancreatic tissue – in 30.1%. DD was associated with CP in 92.6% of cases. Clinical presentation of DD was not related with etiology and showed typical symptoms of CP: abdominal pain occurred in 98.8% of patients, body weight loss – 61.7%, duodenal obstruction – 35.8%, biliary hypertension – 34.6%. The overall morbidity was 35.6%. Overall

postoperative mortality was 1.37% (1 patient). 66% of patients had no clinical symptoms postoperatively, a significant improvement – 32%, no effect – 2%.
Conclusion. The most cases DD is related with groove pancreatitis, less frequently – with ectopic pancreatic tissue in the duodenal wall. Typically DD occurs in patients with CP. Treatment of patients with CP and DD should be started with conservative therapy. Surgery is indicated for persistent abdominal pain and presence of CP complications. Procedures of choice are PD and DPPHR.

Aim. The study the results of surgical treatment of internal biliary fistulas.
Material and Methods. During the period from 2000 till 2015 fifty nine patients with internal biliary fistulas were examined including 36 cases of Mirizzi syndrome and 23 patients with biliodigestive fistulas.
Results. Mirizzi syndrome type I and type II were observed in 22 and 12 patients respectively. Laparoscopic cholecystectomy was performed in 9 cases (for type I), hepaticojejunostomy with Roux intestinal loop – in 25 cases, choledochoduodenostomy – in 4 cases. In 23 patients with biliodigestive fistulas predominant surgery was the elimination of fistula with hollow organ repair, biliodigestive anastomosis – in 6 cases. 3 patients did not require operation due to
spontaneous recanalization of the fistula.
Conclusion. Mirizzi syndrome and biliodigestive fistulas are rare and complex pathology with difficult early diagnosis. Surgical tactics should be generally limited by reconstructive surgery.

Aim. To improve the results of minimally invasive treatment of choledocholithiasis by antegrade endobiliary transvesical
interventions.
Material and Methods. Minimally invasive access into bile ducts through the cystic duct was successfully implemented in 36 (70.6%) patients after prior contact lithotripsy and antegrade lithoextraction for relief of acute obstructive cholecystitis in high risk patients. Different manipulative angiographic catheters (5 Fr) and hydrophilic guidewires (0.018'', 0.025'', 0.035'') were used for cystic duct catheterization. Was considered that cystic duct intubation with
proportionate introducer with radiopaque marker is optimal for subsequent manipulations on common bile duct.
Results. In 12 cases externally-internal drainage or guidewire for endoscopic papillotomy were deployed after transvesical
catheterization of common bile duct. In 24 cases papillodilatation by antegrade balloon catheter, dislocation of stones fragments and biliary sludge into duodenum and antegrade balloon examination of distal common bile duct were performed. There were no complications after the procedure.

Conclusion. Transvesical X-ray surgical access into common bile duct can be successfully used as an element of “rendezvous” technology for antegrade transpapillary navigation of guidewire followed by conventional endoscopic procedure. The method provides balloon dilatation of major duodenal papilla, externally-internal drainage of common bile duct and also dislocation of stones from common bile duct into duodenum in clinically difficult cases

Aim. To research the influence of intraductal photodynamic therapy (PDT) on the duration and life quality in patients with inoperable hilar cholangiocarcinoma.
Material and Methods. 39 patients aged 34–75 years with Klatskin tumor (Bismuth type IV) underwent one hundred and eighteen PDT procedures for the period 2008–2015. All patients had 1–4 percutaneous bile duct drains. The second generation of chlorin sensitizers were administrated intravenously two to four hours prior to the consecutive intraductal laser irradiation. Irradiation of affected ducts were performed using flexible optical fiber injected by original method under X-ray control. Laser irradiation was performed in a pulsed mode, the radiation dose was determined individually

depending on lesion severity. Diagnosis of tumors and dynamic control were performed using morphological examination, cholangiography and MRI.
Results. Follow-up was 2–47 months. There was no postoperative mortality. Three patients had post-procedural complications including liver abscess in one and gallbladder empyema in two cases that required minimally invasive interventions. The intraductal PDT reduced incidence of cholangitis exacerbation and improved quality of life. The median survival was 16 months (2–47), after the first PDT procedure and 31 months (5-69) after diagnosis. 1-, 2-,
3-, 4- and 5-year survival rates were 88%, 68%, 39%, 14,8% and 5% respectively.
Conclusion. Intraductal PDT is perspective to improve both survival rate and quality of life in inoperable patients

It is presented a case report of long persisting gallstone disease in elderly patient followed by acute calculous cholecystitis and Mirizzi syndrome type I, arrosive bleeding from cystic artery, hemobilia and secondary bile-passage block. PubMed, Google Scholar and Cochrane Database data were examined. Literature review and case report are presented in the article