Preview

Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery

Advanced search

Scientific and practical peer-reviewed journal

The “Annaly khirurgicheskoy gepatologii” (Annals of HPB Surgery) has been published since 1996. The jornal is intended for a broad range of surgeons and related medical specialists, who deal with the surgical diseases of liver, pancreas and bile ducts in their work.

The jornal is published 4 times a year. It contains invited general articles on the current issues of surgical hepatology written by leading experts from different countries, reviews, original papers, individual case studies and the articles, containing experimental research data. In selecting articles, the editorial board pays special attention to the unified presentation of material and the statistical data processing methods being used, an essential condition for a modern research paper. The jornal hosts debates on pending issues of hepatobiliary surgery. Many outstanding professionals express their opinions during the debates. The editorial board considers debating an interesting and useful practice and plans to continue.  The jornal publishes conference reports and resolutions and abstracts from foreign jornals. Due to a broad range of issues being discussed, deep and easy-to-understand presentation of material, the jornal is attractive to both, experienced professionals in hepatobiliary surgery and beginning medical specialists.

Current issue

Vol 30, No 2 (2025)
View or download the full issue PDF (Russian)

MODERN TECHNOLOGIES OF VISUALIZATION AND INTRAOPERATIVE NAVIGATION IN HEPATOPANCREATOBILIARY SURGERY

13-22 26
Abstract

Aim. To summarize the experience of applying augmented reality technology in hepatopancreatobiliary surgery.

Materials and methods. From November 2021 to January 2024, 43 patients underwent surgery using augmented reality technology. These procedures included pancreatoduodenectomy, distal pancreatectomy, irreversible electroporation of neoplasms, pancreatic pseudocyst removal, resection of the common bile duct with biliodigestive anastomosis formation, atypical liver resections, right hemihepatectomy, and transarterial chemoembolization of hepatic tumor arteries.

Results. The use of augmented reality technology showed no significant increase in operative time. In minimally invasive liver procedures, augmented reality proved to be a convenient navigation tool, contributing to reduced fluoroscopy duration and overall operative time. Analysis of Likert scales completed as feedback forms for intraoperative use by the surgical team demonstrated that augmented reality technology was convenient and beneficial for enhancing visualization and navigation.

Conclusion. Augmented reality has proven to be an effective, reliable, and promising tool for hepatopancreatobiliary surgery. However, further technological advancements are required to fully realize its potential. Enhancing the performance of augmented reality systems – including their accuracy, stability, and adaptability to various clinical scenarios – will make them more dependable and versatile for a wide range of surgical procedures.

23-32 33
Abstract

Aim. To develop an artificial intelligence-based system for the diagnosis of focal liver lesions aimed at supporting clinical decision-making in surgical hepatology.

Materials and methods. An artificial intelligence-based technological service was developed for the automatic segmentation and classification of contrast-enhanced computed tomography (CT) images of four types of liver lesions: focal nodular hyperplasia, carcinoma, hemangioma, and simple cyst. The service was trained and tested on datasets comprising 725 CT images using the nnU-Net architecture. Diagnostic performance was evaluated by calculating the AUC-ROC, sensitivity, specificity, and accuracy.

Results. The service achieved high performance metrics. The AUC-ROC ranged from 0.847 to 0.928, with a maximum sensitivity of 0.940 for carcinoma and a specificity of 0.900 for focal nodular hyperplasia. Accuracy ranged from 0.883 to 0.922, which demonstrates the algorithm's ability to clearly differentiate between malignant and benign lesions.

Conclusion. The machine learning-based service demonstrated high diagnostic performance and shows promise for integration into clinical practice, offering improved detection and classification of liver lesions.

33-41 15
Abstract

Aim. To demonstrate the capabilities of intraoperative topical diagnosis of pancreatic neuroendocrine tumors using ultrasound.

Materials and methods. An analysis of surgical treatment in 436 patients with pancreatic neuroendocrine tumors was conducted. In 82 cases (control group), intraoperative exploration was performed through visual inspection and palpation. In the remaining 354 surgeries (main group), intraoperative ultrasound was additionally used following pancreatic mobilization, along with visual inspection and palpation.

Results. In the control group, the tumor could not be detected intraoperatively in 15% of cases. In the main group, the sensitivity of visual and palpatory assessment was 81%, while the sensitivity of intraoperative ultrasound was 98.8%during laparotomy and 95% during laparoscopic procedures. An enucleation technique for non-palpable pancreatic neuroendocrine tumors under intraoperative ultrasound guidance was developed.

Conclusion. Surgical interventions for pancreatic neuroendocrine tumors should be performed with intraoperative ultrasound. This not only allows for the detection of all tumors in the vast majority of cases but also enables the assessment of their anatomical relationship with ductal structures and vessels, which sometimes leads to timely adjustments in surgical strategy.

42-49 33
Abstract

Aim. To evaluate short- and long-term outcomes of percutaneous sclerotherapy in patients with non-parasitic hepatic cysts and polycystic liver disease.

Materials and methods. Between 2016 and 2023, 106 patients with non-parasitic hepatic cysts underwent interventions. Multiple cysts were observed in 38 patients (35%) and polycystic liver disease was diagnosed in 24 patients (23%).

Results. Complications were observed in 10 patients (9%). In six of them, cyst cavity infection occurred, which required repeat drainage (Clavien–Dindo grade IIIA); other complications were managed conservatively (grades I and II). Long-term outcomes were followed up in 98 patients (92%) over a period ranging from 6 months to 8 years. After drainage of solitary and multiple hepatic cysts, no recurrence of clinical symptoms was noted. In five patients (25%) with polycystic liver disease, recurrence of pain syndrome was reported.

Conclusion. The accumulated experience with percutaneous sclerotherapy supports its recommendation as a first-line treatment for solitary and multiple non-parasitic hepatic cysts as well as the treatment of choice for polycystic liver disease.

50-56 15
Abstract

Aim. To assess the initial experience of peroral cholangioscopy with thulium laser lithotripsy in complicated choledocholithiasis.

Materials and methods. Between 2021 and 2024, 14 patients underwent peroral cholangioscopy with thulium laser lithotripsy. The largest stone size was 2.35 ± 0.33 cm. Multiple stones were present in 8 (57.1%) patients. Obstructive jaundice was observed in 6 (42.9%) patients and cholangitis in 4 (28.6%).

Results. The overall effectiveness of the method was 93%. Two sessions were required for 4 (28.6%) patients. The procedure duration was 88.5 ± 23.7 minutes. No complications were observed.

Conclusion. Peroral cholangioscopy with thulium laser lithotripsy can be considered a method of choice for patients with bile duct stones >2 cm or multiple stones >1 cm. Further studies are required to improve the technique, clarify the indications for its use, and determine the clinical and economic effectiveness.

57-64 18
Abstract

Aim. To evaluate the effectiveness of integrating ICG-cholangiography into the safety system during laparoscopic cholecystectomy for the prevention of extrahepatic bile duct injuries by improving the accuracy of anatomical navigation and reducing the risk of cognitive biases in surgeons.

Materials and methods. An analysis of current literature was conducted, with a particular focus on improving the accuracy of intraoperative identification of anatomical structures during laparoscopic cholecystectomy using fluorescent ICG-cholangiography. Step-by-step photographic documentation of key stages was performed in 76 surgical procedures, followed by expert evaluation using a scoring system aimed at objectively assessing compliance with surgical safety criteria.

Results. The implementation of the Critical View of Safety (CVS) concept demonstrated high effectiveness in preventing iatrogenic injuries. However, achieving complete CVS is not always possible due to anatomical variability and adhesions. Navigation-assisted surgical methods, particularly ICG-cholangiography, represent promising tools for enhancing surgical safety. Their use facilitates the identification of hepatobiliary structures by influencing key cognitive mechanisms underlying surgical errors. An algorithm for a typical cholecystectomy meeting CVS criteria and incorporating intraoperative ICG-fluorescent cholangiography is presented.

Conclusion. Strict compliance with the principles of safe laparoscopic cholecystectomy, including the Critical View of Safety (CVS), significantly improves the accuracy of identification of anatomical structures. The use of ICGcholangiography enhances the detection of key anatomical landmarks, facilitates the surgeon’s spatial orientation, and reduces the likelihood of error. Thus, ICG-cholangiography is a valuable tool within the CVS concept and should be considered an important component of a multi-level system for preventing extrahepatic bile duct injuries.

LIVER

65-71 27
Abstract

Aim. To compare the early and long-term outcomes of open and laparoscopic parenchyma-sparing liver resections for colorectal cancer metastases.

Materials and methods. A retrospective analysis of the outcomes of parenchymal liver resections performed from 2015 to 2024 in 54 patients with colorectal cancer metastases is carried out using the inverse probability of treatment weighting (IPTW). Variables included the tumor burden score, chemotherapy-related liver injury, location in liver segments 7 or 8, a simultaneous operation, bilobar involvement, and the number of metastases.

Results. Standard statistical analysis revealed no significant differences in the early postoperative outcomes between the compared groups. The duration of laparoscopic surgeries and hospital stay after these operations were shorter but differed insignificantly. Binary logistic regression analysis using the IPTW demonstrated that laparoscopic access (OR 0.754; p = 0.039) and location in liver segments 7 or 8 (OR 1.294; p = 0.027) statistically significantly influenced the likelihood of complications. Survival analysis using the IPTW showed no statistically significant differences in overall survival and recurrence-free survival.

Conclusion. Laparoscopic parenchyma-sparing liver resection provides an effective alternative to open resection, having no influence on long-term outcomes and the potential to improve immediate ones.

PANCREAS

72-82 19
Abstract

Aim. To evaluate the early and long-term outcomes of multivisceral surgery for ductal adenocarcinoma of the pancreatic head.

Materials and methods. Group 1 (main group) included 63 patients who underwent multivisceral surgery for ductal adenocarcinoma of the pancreatic head. Group 2 (control group) consisted of 442 patients with ductal adenocarcinoma of the pancreatic head who underwent standard pancreatoduodenectomy. Patients with stage IV tumors were excluded.

Results. Immediate outcomes were comparable between the groups, except for a higher incidence of intra-abdominal abscesses in Group 1 (12.7% vs. 2.1%; p < 0.001). Postoperative mortality differed insignificantly (6.3% vs. 4.3%; p = 0.465). The median overall survival in Group 1 was 22 months compared to 33 months in Group 2, and the 5-year overall survival rates were 9.1% and 20.4%, respectively (p = 0.001). The frequency of adjuvant chemotherapy administration (p = 0.285) and the median number of chemotherapy cycles (p = 0.446) differed insignificantly between the groups. The 5-year overall survival among patients who received adjuvant chemotherapy was 13.3% in Group 1 and 19.4% in Group 2. The median overall survival in these groups was 30 and 35 months, respectively (p = 0.108). In Group 2, the median overall survival without neoadjuvant chemotherapy was 35 months, compared to 31 months with neoadjuvant chemotherapy (p = 0.411).

Conclusion. Multivisceral resections involving pancreatoduodenectomy for ductal adenocarcinoma of the pancreatic head are associated with comparable immediate outcomes to standard pancreatoduodenectomy without adjacent organ resection. These outcomes are comparable only when the procedures are performed in specialized centers and when adequate adjuvant chemotherapy is administered; without it, survival rates following multivisceral surgery were significantly lower. Indications for multivisceral procedures require a personalized approach that takes into account all prognostic factors.

BILE DUCTS

83-92 30
Abstract

In memory of L.I. Kurmanseitova, the initiator of this patient registry

 In 2016, an initiative group, in coordination with the leadership of the Hepato-Pancreato-Biliary Association of Commonwealth of Independent States, established the "Registry of Patients with Post-Traumatic Bile Duct Strictures" with the aim of assessing long-term treatment outcomes and developing unified approaches to the management of patients with benign bile duct strictures and biliodigestive anastomoses. The registry was officially registered as a federal database. From 2016 to 2024, data on 426 patients were entered into the registry. In 72.8% of patients, the stricture developed after surgeries on the gallbladder and bile ducts. According to the registry data, 33.2% of patients underwent surgical treatment, 33.9% received interventional radiology procedures, 14.4% were treated endoscopically, and 17.8% underwent combined treatment methods. Long-term outcome data were available for 47.3% of patients. This work presents an analysis of treatment outcomes in this patient population based on the registry data. Further development of the registry with an expanded and more detailed database is planned, which will enable more in-depth and high-quality analysis, including the use of artificial intelligence.

93-97 15
Abstract

Aim. To evaluate the diagnostic accuracy of visual assessment using the SpyGlass system in patients with biliary strictures of unknown origin.

Materials and methods. From January 2021 to December 2023, 33 transpapillary cholangioscopies were performed using the SpyGlass system. All patients had a history of obstructive jaundice and required visual assessment of changes in the bile ducts. The primary equipment used included the OLYMPUS EXERA III endoscopic video system and the TJF-Q180V video duodenoscope. The SpyGlass DS II system was used as an accessory device.

Results. Of the 33 patients, 16 (48.4%) were women and 17 (51.6%) were men. Patient age ranged from 45 to 71 years. The main indications for cholangioscopy were the need for targeted biopsy of biliary tract tumors and strictures of unknown origin. Strictures were classified as malignant based on the following visual criteria: irregular vessel dilation and vascular tortuosity (neovascularization), contact bleeding, and intraductal masses. The sensitivity and specificity of visual assessment using the SpyGlass system were 100% and 85.7%, respectively.

Conclusion. Peroral cholangioscopy demonstrates high sensitivity and specificity in the visual interpretation of indeterminate biliary lesions, which proves its utility in routine clinical practice.

ABSTRACTS

Announcements

2024-12-23

ЧИТАТЕЛЯМ ЖУРНАЛА

Уважаемые читатели журнала и члены Ассоциации гепатопанкреатобилиарных хирургов стран СНГ, дорогие коллеги и друзья!

2024-12-21

Подписка на журнал на 2025 год

Редколлегия и редакция журнала «Анналы хирургической гепатологии» приглашают Вас оформить подписку на журнал на 2025 год.

More Announcements...


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.