Aim. To determine the indications for cryotherapy and to evaluate its effectiveness in surgery for liver alveococcosis.
Material and Methods. 169 patients with liver alveococcosis were enrolled. Morphological study of liver specimens was carried out before and after cryotherapy to assess cold exposure on parasitic tissue.
Results. We have developed original devices which are protected by patents. They were used for radical (9) and palliative (25) liver resections, liver stump management after resection (43), marsupialization of the cavity with partially uninhabited parasitic tissue (62), cryodestruction of parasitic nodes and decay cavities (20), including in case of mechanical jaundice (14).
It is proved that cold exposure (−196 °C) leads to death of the germinal elements of the parasite, stops bleeding from vessels with diameter ≤ 1 mm and causes necrosis and sequestration of the parasitic nodes.
Conclusion. The use of cryoinstruments in liver resections for alveococcosis is aimed at preventing of recurrent disease and reduction of parenchymatous bleeding. Cryodestruction of parasitic nodes contributes to increase of life expectancy in inoperable patients.

Aim. To improve the outcomes in patients with pancreatic cancer by improving of surgical techniques and adjuvant therapy administration.
Material and Methods. 529 pancreatic cancer patients underwent surgical treatment. Standard gastro pancreaticoduodenectomy was performed in 85 patients, extended gastropancreaticoduodenectomy – in 7 cases, modified standard gastropancreaticoduodenectomy – in 263, pancreatectomy – in 25, distal pancreatectomy – in 107, cryodestruction of еру tumor in 42 patients. 161 (33%) patients underwent simultaneous resection of great vessels. Adjuvant therapy was carried out in 335 patients.
Results. Morbidity varied from 19% after cryodestruction up to 100% after pancreatectomy, while mortality was 2% after cryodestruction and distal pancreatectomy and 12% after pancreatectomy. Modified standard pancreaticoduodenectomy (GPDR) was followed by morbidity 54% and mortality 6%. GPDR with great vessels resection had significantly higher blood loss, time of surgery, morbidity and mortality. The highest rates of survival were achieved in case of adjuvant therapy.
Herewith, adjuvant chemotherapy was associated with the most favorable survival: 5-year survival and median survival after modified standard GPDR followed by adjuvant chemotherapy were 21 ± 4% and 20 months. Independent prognostic factors of overall survival were: low differentiated tumor, histologically confirmed vascular invasion, adjuvant chemotherapy.
Conclusion. Most of patients with pancreatic cancer undergoing pancreatectomy have metastases in lymph nodes, perineural invasion, while surgery is R1 resection. So, surgery followed by adjuvant chemotherapy is needed.

Aim. Retrospective analysis of conventional and endoscopic surgical treatment of patients with chronic pancreatitis complicated by pancreatic pseudocysts.
Material and Methods. For the period from 2011 to May 2017 two hundred and eighty-two patients were treated for chronic pancreatitis. In 91 (32.3%) patients disease was complicated by post-necrotic pancreatic cysts. 38 patients underwent conventional or laparoscopic surgical treatment. Minimally invasive surgical treatment including endosonography-assisted cystogastro-/ cystoduodenostomy was offered to 38 patients. 15 patients with symptomless pancreatic pseudocysts ≤ 5 cm are under follow-up.
Results. Mean hospital-stay was 11.2 and 6.4 days after cystojejunostomy and endoscopic drainage respectively.
Postoperative morbidity was 10.5% (n = 4) per each group. There were more severe complications after conventional procedures: Clavien–Dindo grade II in 1 patient, grade IIIb in 3 patients. At the same time endoscopic surgeries were followed by complications grade II in 3 patients and grade IIIb in 1 patient. Mean life quality score was 70.2 and 74.3 after traditional and endoscopic interventions respectively. Postoperative follow-up was 3 years for all patients.
Conclusion. Internal endosonography-assisted endoscopic drainage of pancreatic pseudocysts may be preferable in patients with chronic pancreatitis.

Aim. To determine the most active hemostatic agent in pancreatic surgery and the possibility of plastic closure of pancreatic duct system.
Material and Methods. The experiment was performed on 12 mongrel dogs. Comparative analysis of haemostatic capabilities of the drugs “Hemostatic collagen sponge” (Russia), “Tabotamp-Surgicel” (USA), “Gelaspon” (Germany) and fibrin-collagen substance “Tachocomb” (Austria) was performed in an acute experiment with model of distal pancreatectomy. There were 6 animals. In a chronic experiment (6 animals) we examined the possibility of plastic closure of the pancreatic duct system after distal resection and morphological processes occurring in the fibrin-collagen substance application zone after 7 and 14 days. In clinical conditions fibrin-collagen substance was used to stop bleeding
from pancreatic tissue in 49 cases.
Results. Acute experiment data has shown more effective stopping of bleeding from pancreatic tissue after proximal resection due to FCC application. Other haemostatic drugs (hemostatic collagen sponge, gelaspon, tabotamp) showed less pronounced effect. In chronic experiment the possibility of pancreatic duct system sealing with two plates of fibrincollagen substance without prior ligation or suturing was indicated. Morphological investigation revealed stimulation of angiogenesis and fibroblastic reaction. Hemostatic biopolymer fibrin-collagen substance was successfully used in 49 patients for pancreatic procedures.
Conclusion. Fibrin-collagen substance is the most effective hemostatic agent. Clinical use of this agent confirmed experimental data about high hemostatic efficacy of the drug.

Aim. To analyze the incidence and nature of biliary injuries during laparoscopic cholecystectomy within 10 years in a single hospital.
Material and Methods. From 2007 for 2017 at the V.V. Veresayev City Hospital 1787 patients underwent laparoscopic
cholecystectomy for benign gallbladder disease including calculous cholecystitis and polyps of the gallbladder. Elective and emergency procedures were carried out in 68.8% and 31.2% of cases respectively. Females were predominant. Mean age was 46.32 ± 4.64 years. Various types of biliary injuries were determined according to Strasberg (1995) classification.
Results. Iatrogenic biliary injuries were revealed in 8 (0.45%) patients including 4 (0.72%) cases of acute cholecystitis and 4 (0.33%) cases of elective management.
Conclusion. In our opinion, the main requirement for safe laparoscopic cholecystectomy is careful and laborious preparation in Calot`s triangle zone. We consider expedient video fixing of operation for the analysis of surgeon’s technique and mistakes and for assessment of interesting observations in the training process of personnel and cadets of the clinic.

Aim. To improve the results of treatment of patients with intrahepatic cholangiolithiasis for hepaticojejunostomy stricture by using of minimally invasive methods.
Material and Methods. For the period from 2002 till 2016 fifty-eight patients with hepaticojejunostomy strictures have been treated. 13 of them had coexisting intrahepatic cholangiolithiasis. 46 (79.3%) patients underwent redo hepaticojejunostomy. Minimally invasive interventions were applied in 12 patients: laser recanalisation with double balloon enteroscopy (7) and lithoextraction with double balloon enteroscopy(1), transhepatic cholangioscopy (2) including laser lithotripsy in 1 case. Also, there were balloon dilatation of redo hepaticojejunostomosis stricture (4), lithoextraction (4) including with double balloon enteroscopy (“randevoux” procedure) (1), stenting (2).
Results. We observed several complications such as cholangitis (5); recurrent cholangiolithiasis (1); recurrent stricture of hepaticojejunostomy (2).
Conclusion. Minimally invasive management of cholangiolithiasis in hepaticojejunostomy strictures have shown good results.

Aim. To improve surgical treatment of high posttraumatic biliary strictures.
Material and Methods. The study included 17 patients with high scarry strictures of the bile ducts (SSBD) complicated by recurrent cholangitis and biliary cirrhosis. All of them underwent 3–8 various reconstructive surgeries. The cause of SSBD was iatrogenic injury of the bile ducts in all cases. E.I. Galperin and H. Bismuth classification was used to describe the type of strictures.
Results. Various types of liver resection were carried out in 14 out of 17 cases: atypical resection of segment IV followed by bihepaticoenterostomy (4), left-sided (n = 6) and right-sided (n = 4) hemihepatectomy followed by biliodigestive anastomosis with lobar hepatic duct (4), three (3) and two (3) segmental ducts. Postoperative complications were observed in 3 cases with 1 death. Additionally, related right liver lobe transplantation (LT) was performed in 3 cases.
Conclusion. Thus, resection and transplantation surgical interventions improve the outcomes in patients with high SSBD complicated by biliary cirrhosis and recurrent cholangitis.

Aim. To analyze the results of surgical treatment of patients with biliary opisthorchiasis and to develop the complex of pathogenically substantiated measures aimed at preventing complications and unfavorable outcomes.
Material and Methods. The peculiarities of treatment have been studied on the basis of the analysis of medical documentation of 384 patients with opisthorchiasis cholangitis. If peritonitis was absent, the curative program was begun with medication; surgical treatment was performed in 317 (82.6%) patients. Interventions included cholecystectomy (112), external (78) or internal drainage of common bile duct (38), cholecystostomy (93), percutaneous transhepatic cholangiostomy (2), endoscopic balloon dilatation of the sphincter of Oddi (126) and endoscopic papillosphincterotomy (56). The effectiveness of treatment was assessed by the number of complications and deaths.
Results. Surgical activity was 82.6%. Postoperative complications developed in 26 (8.2%) people. According to Clavien–Dindo classification type I was absent, complications type II were noted in 2 (0.6%) cases, IIIa – in 2 (0.6%), IIIb – in 3 (1.0%), IVa – was not observed, IVb – in 1 (0.3%), V – in 18 (5.8%) patients. Postoperative mortality was 5.7%.
Conclusion. In order to improve the outcomes the choice of tactics and surgical techniques should be determined taking into account pathophysiologic and pathomorphological features of biliary opisthorchiasis including chronic biliary hypertension, high incidence of cholangioectasis under the liver capsule and in gallbladder bed, development of sclerosis of ducts and gallbladder walls followed by loss of elasticity and high risk of bile leakage during their drainage, phasicity of the pathological processes in the field of major duodenal papilla and the presence of concomitant chronic disorders of duodenal patency.

The aim of this article is to describe the modern surgical approaches for hilar cholangiocarcinoma management.
R0-resection should be the main goal of treatment. At present time resection of the caudate lobe and the part of segment IV combined with right- or left-sided hepatectomy, bile duct resection, lymphadenectomy of the hepatic hilum and sometimes vascular resection is the standard surgical procedure for Klatskin tumors. More recently minor liver resections have been proposed for treatment of this tumor. However, the safety and effectiveness of this approach are controversial. Moreover, there is no consensus for patients with locally advanced hilar cholangiocarcinoma.

Gallbladder adenocarcinoma is 30–40% of all malignant tumors of the bile ducts. The tumor is characterized by an aggressive course and low sensitivity to chemotherapy, that leads to poor long-term outcomes. The key of improved survival is R0-resection. Standard surgicalvolume including IV–V liver segments resection and D2-lymphadenectomybesides cholecystectomy is an adequate intervention only at the early stages of disease. There is no consensus for advisability of advanced surgery with resection of extrahepatic bile ducts, vessels and adjacent organs in patients with locally advanced tumors including those after previous interventions for mechanical jaundice and cholangitis.
In view of this there are various unresolvedissues of surgical tactics for gallbladder cancer which are discussed in this review.

Severe liver injury in victims with abdominal trauma is followed by high rate of complications and mortality. Technical equipment of the operating rooms, highly skilled surgeons and modern resuscitation aids allow to use resection technique with high frequency of favorable outcomes and form an ambiguous attitude to the perihepatic packing. The results of severe liver injuries management by using of different surgical approaches were reviewed. Also, an evolution of the views on the problem of liver tamponade for severe trauma was presented. We have tried to allocate the current role of perihepatic packing in liver injuries management.

It is a literature review for the use of continuous regional arterial infusion of protease inhibitors and antibacterial drugs in acute pancreatitis management. The technique of drug administration and the results of randomized clinical trial are described.

We have described a clinical case of multiple endocrine neoplasia I (MEN I) syndrome with 9-year history.Comprehensive survey revealed multiple neuroendocrine tumors of the pancreas and duodenum, organic hyperinsulinism, Zollinger-Ellison syndrome, as well as metastases of neuroendocrine tumors into celiac axis lymphatic nodes. Moreover, adenomas of the right lower and left upper parathyroid glands, endocellar pituitaryadenoma and left adrenal gland adenoma were diagnosed. A detailed description of robot-assisted intervention and literature review were carried out.

Acute kidney injury (AKI) is a serious complication after major liver resection. It may be caused by post-hepatectomy liver failure (PLF). ALPPS (Associating Liver Partition and Portal Vein Ligation for Staged hepatectomy) procedure is an effective way for PLF prevention in cases of small future remnant volume or bilobar liver lesions, but the risk of AKI following this procedure is unknown.
Herein we present and discuss the case of a 23-year-old man with hepatic alveococcosis who underwent ALPPS procedure. Despite absence of any risk factors AKI (RIFLE-F) followed by renal replacement therapy (RRT) has occurred within few hours after the first surgical stage. Only the combination of albumin and terlipressin resulted function improvement and RRT with drawal after three weeks of AKI onset.
Renal dysfunction didn’t affect the liver regeneration and the second stage of ALPPS has been performed in six days after the first one. There were no signs of serious liver synthetic function deterioration, coagulopathy, jaundice or encephalo pathy.
The mechanisms of AKI progression as well as the portal and systemic circulatorychanges after the first stage of ALPPS seem to be similar with hepatorenal syndrome type I. Intra- and postoperative maintenance of physiologic hemodynamics may be the key point for AKI prevention. Norepinephrine and/or terlipressin could be considered as the drugs of choice.

It is presented case report of 60-years-old man with necrosis of pancreatic body and tail, pancreatic abscess and necrosis of the back wall of the stomach. A rare remote complication of pancreatic necrosis has led to the choice of non-standard for similar clinical situations surgery in difficult conditions.