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Results of treatment of 66 patients with non-formed lateral fistulas of the duodenum by the methods of active external and double (external and internal) drainage of the fistula zone, and more rarely--by passive drainage or obturation were analyzed. Lethality of the patients was 35.4%. The lethality of the patients was shown to directly depend on the spreading of purulent complications of fistulas of the duodenum up to 87.5% with a combination of diffuse peritonitis and retroperitoneal phlegmon. The immediate causes of death of the patients with lateral fistulas of the duodenum were severe abdominal sepsis due to spacious purulent lesions of the abdominal cavity and retroperitoneal fat, more rarely--profuse erosive bleedings from the fistula zone.

An analysis of surgical treatment of 124 patients with "difficult" gallbladder has shown that in most cases (59.7%) the causes impeding surgical procedures were massive commissural processes in the gallbladder zone and stony infiltrates of the hepato-duodenal ligament with shrunken or sclerosed gallbladder as well as earlier operations on the gallbladder, a combination of echinococcosis and liver cirrhosis with acute calculous cholecystitis, cholecystodigestive fistulas, Mirizzi syndrome and intrahepatic location of the gallbladder. Videolaparoscopic operations in such cases are extremely difficult, so open laparotomic operations should be preferred.

An original operation is proposed for localization of the diverticulum in the descending portion of the duodenum which excludes traumas of the pancreas. Clinical observations are described.

The work analyzes surgeon's tactics for associated ulcer disease with duodenal diverticula. Operations were performed on 51 patients with these diseases. The operation of choice is gastric resection after Hofmeister-Finsterer which is sufficiently effective in treatment of ulcer disease and when excluding the duodenum creates conditions for the prevention of inflammation of the diverticulum.

Diverticula of the stomach and duodenum were revealed in 21 (2.3%) of the examined patients with ulcer disease. Resection with radical interventions on the diverticulum were fulfilled in 8 patients, with by-passed duodenum in 7 patients, with selective proximal vagotomy associated with invagination of the diverticulum in 6 patients, among them 1 patient with a subpyloric Y-shaped bypass of the duodenum. There were no lethal outcomes.

An experience with the treatment of 106 patients with pyloroduodenal stenosis of ulcerous etiology by vagotomy with draining operations has shown high efficiency of these measures resulting in lower rate of postoperative lethality. Selective proximal and stem vagotomy does not aggravate gastric atony in patients with stenosis. Electro-stimulation was found to be an effective method of treatment of this complication in the postoperative period of patients with gastric atony.

The authors describe 3 observations of replantation of the major duodenal papilla after its dissection from the duodenum. The results were favorable. There were no chronic pancreatitis or cholangitis. Follow-up observations continued for 66, 40 and 6 months after operation. The operation technique is described.

The work is based on the examination of 106 patients, operated in the clinic for acute cholecystitis associated with choledocholithiasis and strictures of Vater's papilla. The operation of choice is a removal of pathologically changed gallbladder, elimination of the cause of cholestasis with restoration of bile passage in the bowel. The technic of choledochoduodenostomy adopted in the clinic is described. The immediate mortality was observed in 2.8%. Choledochoduodenostomy yielded good results in 81.1%, external drainage -- in 70.6%.

Mallory--Weiss syndrome was diagnosed in 153 of 1373 patients subjected to endoscopy for acute gastroduodenal and esophageal bleeding. Besides, this syndrome was first diagnosed at operation in 10 cases, at roentgenoscopy in 8 cases and at autopsy--in 8 cases. A classification of Mallory--Weiss syndrome with regard to the localization of fissures of the organ mucous membrane, the depth of the injury to the organ wall, the degree of the acute blood loss, and to the forms of manifestations of the syndrome has been devised. The classification has a practical importance for it helps the surgeon to choose the method of the treatment of the patients with Mallory--Weiss syndrome.

The authors share their experience with the treatment of 18 patients. Most of them (10) sought medical aid for complications. The authors consider resection of the stomach to be ineffective for the exclusion of the diverticulum of the duodenum. The operation of choice is thought by them to be an exclusion of the duodenum from the passage of food. Stomach resection after Ridiger is thought to be effective for a combination of the diverticulum and duodenal ulcer. There were no complications or immediate lethal outcomes.

The authors' experience with 45 papillosphincterotomies, performed for diseases of bile passages and chronic pancreatitis, is reported. The details of the operative technic, employed by the authors, are described. The technic of papillosphincterotomy on a conus-shape sound by means of a "laser scalpel" proved to be the most perfect one. Careful observation of the surgical technic made it possible to gain favourable results--only 1 of 45 operated patients died. Papillosphincterotomy is largely advocated in stenoses and concretions in the large duodenal papilla, strictures of choledocho-duodenoanastomoses, care should be taken not to overwiden indications to the operation concerned.

Depending on peculiarities of the duodenum fixation to the posterior abdominal wall, normal (normoduodenum), dolichoduodenum and duodenoptosis variants are distinguished. The m. suspensoris duodeni (ligament of Treits) in each variant has its peculiarities. At the normoduodenum and dolichoduodenum, the ligament of Treitz contains a considerable amount of striated muscle tissue. At the duodenoptosis--it consists of a loose fibrous connective tissue with single smooth (non-striated) muscle fibers. As demonstrate anatomical experiments for dissection of the normal ligament of Treitz and of its two variants, dissection of the ligament of Treitz at duodenoptosis eliminates essential anatomical prerequisites of duodenostasis.

The authors have shown that remote results of draining operations in combination with truncal vagotomy in ulcerous pyloroduodenal stenosis proved to be similar to results of their combination with selective proximal vagotomy in practically all the parameters. Advantages of the selective proximal vagotomy due to somewhat less amount and less degree of postoperative functional disorders observed after this intervention become practically levelled down by a considerably greater amount of recurrences of ulcers after it as compared with truncal vagotomy and drainage of the stomach.

The work generalized an experience with the treatment of 747 patients with diverticula of the duodenum. Operations were performed on 326 of them (43.6%). In 172 patients the diverticula were associated with other diseases of organs of the abdominal cavity. Such patients were subjected to associated operations. The dependence of the clinical picture of inflamed diverticula on their localization is described. The author determines the surgeons' strategy, indications and volume of the surgery in different localizations of the diverticula. A new operation of exclusion of the duodenum allowing the postoperative lethality to be decreased from 5.5% to 1% was developed and introduced into practice.

Experience with the treatment of 137 patients with spontaneous internal biliary fistulas of different etiology is presented. Questions of clinical course, preoperative diagnoses and operative technique are discussed.

Nineteen cases when the patients had different combinations of gastric disease with calculous cholecystitis are described. All the patients were subjected to simultaneous operations. No complications were noted. A conclusion is made that the simultaneous operation is the most rational method in such a combination of diseases. The authors believe that calculous cholecystitis can be responsible for postoperative complications after any operation.

On the basis of the experience with the treatment of complicated periampular diverticulum of the duodenum in 12 patients the authors recommend to perform diverticulectomy in combination with transduodenal papillosphincteroplasty, wirsungduodenoplasty and septectomy, which allows reliable suturing of the cervix of the diverticulum ablated and eliminates narrowing of the terminal portions of the common bile duct and Wirsung's duct. The long-term results (from 1 to 3 years) were good.

Under consideration were results of treatment and causes of the appearance of gastric and duodenal fistulas in 37 patients. Two patients died (one of them had external gastric fistula, the other had a duodenal fistula). Complex conservative therapy gave positive effects in most cases. Operative treatment was used in patients having external fistulas with purulent abscesses and leakage compartments in the abdominal cavity. Lethality was 5.4%.