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Short-term results of surgical treatment of 277 patients with hepatic echinococcosis associated with affection of bile ducts are analyzed. If it is impossible, additional drainage of bile ducts and residual cavity is indicated. Pericystectomy is recommended when hydatid cyst has calcified fibrous capsule. It is demonstrated that rational surgical policy permits to achieve favorable results: postoperative complications were seen in 25.9% cases, lethality was 1.4%.

The results of examination and surgical treatment of 277 patients with hepatic echinococcosis with bile ducts lesion are analyzed. Symptoms of bile ducts lesion serve the indication for direct roentgenocontrast methods of bile ducts examination (endoscopic retrograde pancreaticocholangiography, percutaneous transhepatic cholangiography, fistulography). Jaundice in anamnesis, dilatation of hepaticocholedoch, abundant outflow of bile from residual cavity after echinococcectomy require additional examinations during surgery (USE, cholangiography, chromatic reaction). Instant chromatic diagnosis of internal cystobiliary fistulas is highly informative, particularly in cases when complete revision and visualization of wall of residual cavity is impossible.

Results of surgical treatment in 116 patients with chronic calculous cholecystitis complicated by choledocholithiasis were studied. Introduction in clinical practice of endoscopic papillosphincterotomy (EPST) and laparoscopic cholecystectomy changed surgical policy for benign combined lesions of gall bladder and extrahepatic bile ducts. Complex endoscopic treatment is preferable if contraindications are absent. Complex endoscopic treatment was used in 26.7% cases, combined surgical and endoscopic (trans-papillar surgeries) - in 30.2%, conventional surgical - in 33.6%. Isolated EPST and endo-biliary procedures were performed in 9.5% patients. Complex endoscopic treatment is preferable for chronic calculous cholecystitis complicated with choledocholithiasis. Combined and conventional surgical policy is indicated when appliance of endoscopic technologies is not possible.

A 44-year-old woman who weighed 130 kg (height 158 cm, BMI 52) with a complicated psychiatric history was referred for obesity surgery because of severe sleep apnea, obesity hypoventilation syndrome with frequent pneumonias, arterial hypertension, diabetes mellitus, polyarthralgia and back pain, venous insufficiency, dysmenorrhea, severe heartburn, and incisional hernia. From childhood until 1983, she had undergone 106 operations, mainly for septic/pyemic and intra-abdominal abscesses, 86 of them under general anesthesia. In the 4 years before undergoing bariatric surgery, she had gained 40 kg, nonoperative attempts at weight reduction had failed. Some months before obesity surgery she could fall asleep while standing, and she noticed an entire loss of capacity for work. Respiratory disturbance index measured during sleep by Mesam-4 device was 68 events per hour. Preoperative controlled positive airway pressure (C-PAP) therapy was used. Vital indications for weight reduction were established. Bariatric surgical steps included six operations: (1) vertical banded gastroplasty (VBG); (2) relaparotomy with suspicion of peritonitis, no complications found; (3) hernioplasty simultaneously with panniculectomy; (4) revision and removal of additional flap because of marginal skin necrosis; (5) bilateral thigh dermatolipectomy simultaneously with right-side saphenectomy; and (6) removal of intramammary abscess. Twenty-four months after VBG, she had lost 39 kg (56.5 % EWL) and was doing rather well. Obesity-related diseases except back pain were relieved.

The effect of vertical banded gastroplasty (VBG) on the lipid profile in obese patients is considered. The antiatherogenic effect of VBG and of the following weight loss consists in significantly decreased plasma triglycerides, increased content of high-density lipoproteins and decreased atherogenic coefficient. Patients with hypercholesterolemia have significantly lower total plasma cholesterol by the period of the body mass stabilization. The effect of VBG is compared with that of other methods of correction of dyslipidemia. The possibility to improve this effect is also discussed.

For evaluation of functional status of hepatocytes in patients with benign volumetric growths of the liver (BVGL) of various genesis the authors performed radionuclide investigation with the use of Tc99m. At the same time the terms of maximal accumulation of the preparation Tmax' the period of half elimination from the liver (T1/2) and the time of entering of the drug into the bowel (T bowel) were evaluated. Basing on the results of the analysis of clinical examinations in 67 patients before and after operations (51 patients with BVGL and 16 patients of control group), the authors have revealed correlation between the size, site disposition of volumetric growth and function of hepatocytes of intact parenchyma of the liver. The results have evidenced that the rate of decrease in functional values of the liver in groups of patients with BVGL < 5 and > 5 cm in diameter significantly (p < 0.05) differed in parameters Tmax (33.3 and 78.3%) and T1/2 (50 and 95.7% of cases, respectively. It has been determined that the more is the size of the growth and the deeper it located in hepatic parenchyma the more significant is the decrease of function of hepatocytes. Comparison of the results of examination in patients with BVGL of various genesis before and after various surgical intervention of decompressive type has revealed significant (p < 0.05) improvement of functional capacity of hepatocytes, depending on the above factors. The results of investigation made it possible to substantiate differential approach to surgical policy in uncomplicated BVGL depending on the size of the tumor (< 5 and > 5 cm in d.), location and position of the growth in the organ, as well as adequately evaluate effectiveness of surgical intervention.

Results of surgical treatment of benign new growths of the liver (BVML) depend not only on timely diagnosis of local growth but on precise analysis of surgical risk factors (SR) as well as accurate definition of its significance. The proposed classification helps to evaluate factors of SR in these patients. Results of the investigation showed that in majority of patients (94.7%) with BVML without complications immune system was were not suppressed. The fact may be considered as a favourable sign, demonstrating potential immunologic safety of patients in definite period of BVML development. Patients with lowered parameters of immunologic status made up a group of a high risk to develop inflammatory and septic complications in postoperative period. Definite correlation between the extent of immunodeficiency and frequency of postoperative complications has established the necessity of action to prevent the provocation of immunological status disturbances.

From May 1994 to December 1996 the wound coat "Takhocomb" was used in surgical procedures in 23 patients with various diseases of the and the pancreas. "Takhocomb" was mostly applied in various anatomical resections of the liver. Initial hemostasis of the hepatic stump was carried out by careful suturing of bleeding vessels. "Takhocomb" was used in 3 patients during pancreatoduodenal resection for chronic pancreatitis, adenocarcinoma of papilla Vateri and adenocarcinoma of the pancreatic head. The application of the wound coat "Takhocomb" in various resections (12) an hepatic ruptures (2), as well as in echinococcectomies (3) and removal of hepatic hemangioma (1) contributed to favourable hemostatic effect in all the patients. In 2 cases formation of external biliary fistulas due to technical errors in liver resection was detected in postoperative period. The fluid accumulation at subhepatic space or at the bed of resected liver after rightsided liver resections was considered as the tissue fluid production frown retroperitoneal fat.

The experience of examination of 584 patients with volumetric masses of the liver (VML) of various origin is presented. For successful differential diagnosis of VML and definition of rational surgical policy the algorithm of examination was considered with due regard for diagnostic stages, each of them being characterized by definite complex of tests. It is thought necessary to begin examination with noninvasive and highly informative tests. Complex of radioimmunologic evaluation of tumor markers level is advisable to include in diagnostic algorithm of patients with VML. The use of invasive methods of diagnostics is justified in complicated diagnostic situation. For evaluation of regional function of the liver radionuclear examination should be used. Liver puncture are feasible only whenever parasitic nature of cystic masses of the liver is excluded. If it is found to be impossible to determine the character of VML the question of advisability of diagnosis laparotomy should be resolved in its favour. The most efficient use of various methods of examination in 584 patients with VML of various genesis made it possible to increase accuracy of diagnosis of hepatic hemangioma, in nonparasitic cysts--1.7 times and in parasitic cysts--1.2 times.

The paper summarizes the experience gained by the Department for Surgery of the Liver, Biliary Ducts, and Pancreas, Surgery Research Center, in treating patients with corrosive strictures and fistulas of the biliary ducts since 1967. It considers the causes of this abnormality, the nature of corrective operations on the great biliary ducts, complications due to the type of a surgical intervention. Analyzing the reasons for poor postoperative outcomes provides the optimal time of carcass drainages, the optimal diameter of the biliodigestive anastomosis made to have good results. Emphasis is laid on the specific features of biliary surgery if there are profound inflammatory and infiltrative or scarry and commissural changes in the hepatoduodenal ligament to prevent possible damage to the great biliary ducts.

Introduction of endoscopic and laparoscopic methods in surgical treatment of chronic calculous cholecystitis and its complications has changed not only the character of surgical interventions, but the surgical policy as well. The operation of choice in uncomplicated calculous cholecystitis is laparoscopic cholecystectomy, which whenever indicated, is advisable to be combined with other surgical interventions allowing the recovery from the concomitant surgical diseases. In complicated calculous cholecystitis in dependence on the character of bile ducts disorder and patient's condition, 3 versions of surgical interventions are possible: one stage radical correction of all pathologic changes of the biliary tract and surgical treatment, including 2-3 separate, less traumatic and more tolerable procedure. The choice of optimal policy of treatment reduces the risk of operation, decreases postoperation mortality rate and complications.

Since November 1992 in the RRCS. RAMS 38 patients aged 16-61 years (mean body mass 149.9 kg) for obesity of 3-4 grade underwent operation of vertical gastroplasty (VGP) by E. Mason's method. In 78.9% of patients uncomplicated course of early postoperative period was observed. One patient died due to thromboembolism of pulmonary artery. Two patients underwent regastroplasty due to tearing away of the staples of vertical mechanical suture and restoration of body mass (BM). Up to now stabilization of BM was detected in 19 patients. In this group mean values of surplus BM lowering made up 54.1% and maximal--60.1%. Positive influence of performed operations on the course of majority of the concomitant diseases in the absence of serious metabolic after-effects was observed. Initial results of operations seemed to be favourable, but for final conclusions about the effectiveness of VGP in far off period the accumulation of the experience and prolongation of follow-up period together with standardization of operation procedure are necessary.

The paper presents some experience with surgical treatment of 183 patients with complicated forms of chronic pancreatitis. The type of a surgical intervention depended on the pattern of pancreatic morphological changes. Operations of internal drainage of the pancreas in 103 patients with ductal hypertension provide the largest percentage (92.4%) of good and satisfactory results. Resectional methods of surgical treatment for chronic pancreatitis (n = 36) without signs of intraductal hypertension and with the prevalence of predominant lesions in some portions of the gland yield 80% good and satisfactory results. The incidence of postoperative complications following pancreatic resections is higher than those after drainages (16.2 versus 11.6%). The paper gives a concept of combined operations on the pancreas and bile ducts in chronic pancreatitis complicated by stricture of the distal common bile duct, revealed in 24.4% of cases.

127 cases of gallbladder cancer are analysed. Among them there were 99(78%) women and 28(22%) men. The majority of the patients were at the age from 61 to 70 years; 19 (15%) patients were younger than 50 years. Mean average age of the patients was 61.7 years. Chronic calculous cholecystitis was detected in 116 (91.3%) patients. In 75 (59%) patients the duration of the disease exceeded 5 years. Women suffer more frequently than men because of higher rate of calculous cholecystitis in women. Radical surgery was possible only in 51 of 97 (52.7%) patients as a result of late diagnosis of the cancer. Cholecystectomy was performed in 32 patients, cholecystectomy in combination with liver resection in 9 patients, tumor removal in borderes of the healthy tissues in 10 patients. Palliative operations were performed in 46 (36.2%) patients. Long-term results of the surgery were followed up in 93 patients. 5 year survival after the radical surgery was 40%, 10 year survival--20%. Mean survival after the palliative surgery was 7 months. Gallbladder cancer is difficult for diagnosis and the results of its treatment are unsatisfactory. Timery surgery of chronic calculous cholecystitis is important in prevention of gallbladder cancer.

The paper presents 30-year experience in treating 158 patients with congenital cystic diseases of the liver and bile ducts. Depending on the pattern of hepatobiliary lesions, the diagnostic value of techniques, such as ultrasound, computerized tomography, scintigraphy of the liver duodenoscopy with THCG was defined. Analyzing the late outcomes provided recommendations for the most optimal surgical management: cystic fenestration and tunneling in hepatic polycystosis, pericystectomy in solitary cysts of the liver, different varieties of bile draining operations in choledochal cysts and Caroli's disease.

From February 1995 to July 1996 pancreato-duodenal resection has been performed in 12 patients in RCS (7 men and 5 women, mean age 53.6 years). The operation was indicated in malignant tumors of the pancreatic head, big duodenal papilla, distal part of common bile tract (9 patients); benign diseases of pancreas (3 patients). Sandostatin (0.3 mg/day for 4-7 days) was used in all cases to prevent postoperative pancreatitis and pancreato-jejuno-anastomosis incompetence. The levels of alphfa-amylase, blood glucose, leucocytes were monitored, as well as the duration of pancreato-jejuno-anastomosis drainage use, rate and seriousness of postoperative complications and duration of in-patient treatment. The results were compared to a control group, consisting of 6 men and 6 women (mean age 53.8 years) with malignant tumours of big duodenal papilla, head of the pancreas, common bile tract. The use of Sandostatin has decreased the level of alphfa-amylase in the first postoperative day to 292.8 +/- 152.2 u/l vs. 594.9 +/- 368.79 in a control group (p > 0.05), duration of the drainage use: 6.1 +/- 1.5 days vs. 12.9 +/- 7.2 days (p < 0.05). The number and rate of severity of postoperative complications were significantly less: 58.3% vs. 100%. The frequency of pancreato-jejuno-anastomosis incompetence has decreased 3 times; the rate of abdominal cavity abscesses has decreased by 30%, the number of bile tract complications has decreased too (1 vs. 2). The rates of postoperative mortality were 8.3% in both groups. The use of Sandostatin made it possible to decrease the frequency and severity of postoperative complications and decrease the duration of in-patient treatment.

The results of surgical treatment of more than 600 patients with liver echinococcosis are analysed. The accuracy of ultrasound in diagnosis of the character of the damage is 88%; the combination of ultrasound methods with serology tests and computer tomography has increased the accuracy to 98-100%. New treatment approaches have been proposed depending on a character, location and extent of liver damage. The improvement of surgical technique made it possible to decrease the frequency of postoperative morbidity to 17.4% and mortality-to 3%.

The results of the treatment of 430 patients with benign tumors of the liver (BTL), including hemangiomas (41), nonparasitic solitary cysts (49), polycystosis (65) and parasitic hepatic lesions (alveococcosis-91, echinococcosis-184). To determine the character of a volume structure the accuracy of ultrasound and duplex sonography was tested (87.1-91.7%), as well as the accuracy of computer tomography (91.4-96.8%), angiography (90.6-96.3%), serological and radioimmunoassays. The use of these methods has increased the accuracy of diagnosis 2.2 times (in hemangiomas), nonparasitic cysts-to 1.2 times. The proposed methods of differential diagnosis and choosing of a proper treatment policy in patients with BTL made it possible to formulate indications and contraindications for the surgery, work out an optimal treating policy, depending on a character, location of BTL. The improvement of the surgical technique has decreased the rate of morbidity and mortality (2.5 and 1.5 times respectively).

A special device has been designed to provide safe and convenient placing of a ligature to the dissector or clamp in a deep wound. The device contains fork-shaped working part and a handle. The handle has an obtuse-angle curve and is connected with the working part by a hinge. It also has a handler-spring for fixing a ligature. The device prevents a chance of damaging nearby tissues in placing the ligature that makes it possible to hasten surgery.

The authors propose the mode of treatment of volumetric masses of the liver which provides possibility to perform ablastic and atraumatic removal of the tumor with prophylaxis of bleeding by creation of the coagulation pellicle in the bed of the removed tumor. The method is based on the rational combination of cryodestruction, mechanical excision and laser coagulation: evaporation by the disfocused laser beam of the frozen bed of the tumor after its cryodestruction and mechanical excision, the principles of the ablastics are being completely kept; at the surface of the hepatic tissue the coagulation scab is being formed. Bleeding and biliary leakage are absent. This is prophylaxis of abscess, fistulas and haematomas after surgery.

The operation vertical gastroplasty is used to treat the so-called morbid obesity. It ends with the formation of a small stomach. Some experience gained with X-ray of the stomach is analyzed in 17 patients undergone vertical gastroplasty. X-ray evaluates the status of the small stomach arranged as a tube in the upper portions in the vicinity of the lesser curvature of the stomach. The shape, sizes, outlet of the small stomach, as well as emptying rates and the state of an internal vertical suture of the stomach are to be studied.

The article discusses four operations for vertical gastroplasty performed for the first time in Russia at the Research Centre of Surgery, RAMS, for degree IV obesity (the body weight of the patients ranged from 115 to 183 kg). The suturing instruments CEEA-28, TA-90, and CIA-90 manufactured by Auto Suture Instruments, USA, were used. Subsequent examination of patients in follow-up periods of as long as 4 months showed a favorable effect of the operations: body weight reduced, the patient's health and the course of concomitant diseases was milder.

YAG-Nd impulse-periodic laser scalpel in elimination of major duodenal papilla stenosis was tested experimentally. The direct damaging influence of the laser was tested in acute experiments and the optimal power of irradiation (5 W) was chosen. The processes of regeneration of the wound inflicted by laser irradiation were tested in chronic experiments. It is shown, that regeneration was accompanied with minimal leucocyte infiltration and complete healing of the wound is achieved in 28 days.

The radioimmunological method was used to determine the content of tumor markers APP, REA, CA 19-9, and CA 72-4 in 53 patients with nonmalignant three-dimensional structures in the liver (hemangioma, nonparasitic cysts, alveococcosis, hydatid cysts), in 9 patients with primary carcinoma of the liver, and in 24 healthy individuals. The significance of APP determination and complex study of tumor markers in the recognition and differential diagnosis of benign and malignant structures in the liver is shown. It allowed the percentage of disparity between the laboratory and the verified diagnosis to be reduced to 4.8%.

Fifty-three operations were conducted on 48 patients for tumors of the extrahepatic bile ducts and the major duodenal papilla. Early diagnosis of this pathological condition is very difficult, which affects directly the results of treatment; 18% of patients underwent radical operations. Modern diagnostic methods--computer tomography, ultrasonic examination, and endoscopic retrograde pancreatocholangiography made it possible to detect neoplastic diseases in all of the examined patients. Radical surgical treatment is expedient in distal localization of the neoplastic process and in the absence of metastases. Endoscopic and puncture methods of decompression of the bile ducts are indicated in diffuse forms of the disease.

Benign pancreatic cystic tumors (BPCT) is a rare and little studied pathological condition. By the end of the eighties approximately 500 registered cases of BPCT were described in the world literature, which were those of different morphological variants of cystadenomas (CA). Many scientists note the high probability of malignant degeneration of some CA types. The diagnostic signs and surgical tactics in BPCT are treated ambiguously. The authors systematized the most characteristic signs of pancreatic CA and revealed the possibility of accurate preoperative recognition of these tumors. From rich clinical material (21 cases) the authors show that complications resulting from an erroneous choice of the operation are inevitable. Postoperative complications occurred in 8 patients. The late-term results of the operation were followed-up in 11 patients and were found to be good and satisfactory in complete removal of the tumor. According to foreign authors, cystic carcinomas of the pancreas account for 1-2% ot all primary carcinomas of the organ. Timely radical operation dictated by the specific features of pancreatic cystadenoma is one of the measures of carcinoma prevention.

The work analyses 141 patients who were operated on for primary chronic pancreatitis which was caused by alcohol abuse in 84.4% of cases. The patients were divided into 2 subgroups according to the damage to the pancreas: 1--with dilatation of the pancreatic duct (49.6%), 2--without dilatation of the pancreatic duct (50.4%). Internal drainage of the duct system and their associated cysts was the main method of management of patients of the first group (52 patients). Patients of the second group were subjected to various resections of the pancreas (24) and occlusion of the ducts with a polymeric composition (19). In 38 cases the operation on the pancreas was complemented by operations on the biliary tract, stomach, and duodenum. Various postoperative complications were encountered in 27 (19.1%) patients, mortality was 5.7%. The results were most favorable after operations for internal drainage, resection of the organ, and external drainage of the cysts. Irrespective of the type of the operation, progressive fibrous degenerative changes of the gland with a statistically significant (p < 0.05) reduction of its size was noted in the late-term period. The method of occlusion of the duct system was marked by the greatest number of poor results. Strict argumentation of the indications for the use of each type of operation makes it possible to obtain good and satisfactory late-term results in 85.6% of cases.

The immunologic parameters were studied in 38 patients with hydatid disease of the liver and abdomen before and after a single hemoexfusion (HE) in a volume of 400 ml. Among the patients who were examined there were those with uncomplicated hydatid disease of the liver (group I, second clinical stage, 25 persons), patients with suppuration of hydatid cysts (group 11, 10 persons), and two patients with multiple hydatid cysts complicated by their suppuration and calcification with involvement of large areas of the liver. Comparative analysis of immunological parameters in patients before and in the first 24 hours after HE showed a difference between the groups of patients and the controls. The parameters were restored to their initial values in patients of both groups 3-5 days after HE. The results of the study allow the conclusion that in screening patients with hydatid disease of the liver and abdominal cavity for preoperative HE a strict individual approach is necessary with the patient's general condition, the clinical form of the disease, and complications on the part of the cysts being taken into account.

The results of clinical observations of 60 patients with polycystosis of the liver who had been treated or examined by the authors in the period from 1964 to 1989 were summarized. The clinical course of the disease was featured by scanty clinical signs: pains in the upper half of the belly and hepatomegaly were most frequent. The combination of diagnostic techniques for verification of surgical intervention necessity was established. Besides, it was stated that the diagnosis of polycystosis of the liver should be complex and based on anamnestic data and the results of clinical, laboratory and instrumental investigations. Preference should be given to ultrasonography and computed tomography. Cysts with diameter of 5 cm and more, complicated polycystosis of the liver (bleeding, suppuration, malignancy) and cystic compression of the extrahepatic bile ducts and vessels (portal and cava inferior veins) were found to be indicative signs for surgical treatment of hepatic polycystosis. A total of 41 patients were subjected to surgical treatment with 49 operational procedures employed. Fenestration of hepatic cysts (42), that were organosparing operations, predominated. Resection of the liver was performed in 2 patients who had total cyst substitution for the whole of the left lobe. The improvement registered in 85.7% of operated on patients evidenced the favorable results of surgical treatment.

Postoperative infectious complications in planned surgery are a pressing problem. The preoperative condition of the patient and his immune system play an important role in their development. Fifty patients of the "risk" group were selected from the standpoint of classification of the etiological factors of secondary immunodeficiency states. Fifteen patients who had no symptoms classified as SIDS risk factors formed the control group. The immune status was examined before and on the third day after the operation in all patients of the main and control groups. Various infectious complications developed after the operation in 23 patients of the risk group. No such complications occurred in the control group. The preoperative immune status of the risk group patients differed significantly from that of the controls in 13 of 19 parameters. The patients of the main and control groups formed the instructing selection. An expert system of preoperative clinico-immunological prognostication of postoperative infectious-inflammatory complications was created on oasis of the methods of the theory of image recognition and instructing selection. The system was tested in a direct clinical experiment on 66 patients. The prognoses were correct in 89% of cases. It was thus proved that symptoms classified as SIDS risk factors influence the initial immunity status and the course of the postoperative period in planned surgery. An accurate, sensitive, and specific method for prognosticating postoperative infectious complications is suggested.

In use of the laser (CPPLS) and microwave (MWS) scalpels, the reliability of arrest of bleeding and bile leakage has been proved not only at studies on the intact liver but on the models of jaundice with impaired coagulative blood properties as well. After hepatic resection by means of CPPLS and MWS, the impairement in its functional state lasts for a short time. In use of CPPLS, disturbance in tissue blood flow is less than in use of MWS. Healing of the wounds inflicted by CPPLS and MWS occurs in absence of pronounced exudative and inflammatory reactions. In a wound inflicted by a laser scalpel, the necrotic layer is not pronounced. It is expedient to use the CPPLS and MWS in patients with hepatic masses in technically difficult cholecystectomy as they contribute to decrease in intraoperative blood loss and prevention of the development of complications after the operation.

The article analyses the results of operative treatment of 455 patients for hydatid disease of the abdominal organs, in particular the errors and hazards of surgical management of hydatid disease of the liver. Difficulties occur in the differential diagnosis in suppuration of hydatid cysts which had not been operated on, as well as in residual cavities in patients who had undergone surgery for this disease. The authors dwell on the diagnostic algorithm and the surgical tactics depending on the size and location of the hydatid cysts. Some problems of the operative techniques and intraoperative measures for the prevention of recurrences in complicated forms of hepatic hydatid disease are discussed. The suggested diagnostic algorithm and the surgical tactics allowed the authors to reduce diagnostic errors in this pathological condition to 3.5% and surgical mortality rates to 3.07%.

Various parameters (from 15 to 40 W) of the thermo-acoustic contact YAG: Nd-laser scalpel were tested in experiments on 70 rabbits to choose the optimal operating regimens in resection of the liver. A power of 25-30 W proved to be effective. The reliability of hemo- and cholestasis was studied by means of hydro-pressure, reparation processes were studied by histological, electron microscopic, and radioautographic examination in periods of 3 hours to 30 days. The results of the study bear evidence that the use of the thermo-acoustic contact solid-body laser scalpel makes it possible to increase the rate of cutting with minimal injury to the peripheral areas of the hepatic tissue, significantly increases the reliability of hemostasis, produces fine homogeneous coagulation for the whole length, and facilitates a favourable course of the reparative processes. Besides, the contact method of laser division is controllable with regard to the depth of the beam effect and increases the surgeon's tactile sense.

The authors analyse 60 cases of polycystic disease of the liver; 41 patients underwent operation, 19 were kept under dynamic follow-up. The diagnosis of polycystic disease of the liver is based on the results of ultrasonic examination and computed tomography; serological tests are conducted for differential diagnosis with hydatid disease. Twenty (33.3%) patients had affection of the kidneys, pancreas, ovaries, and brain. As the result of surgery the condition improved in 30 (85.7%) and became worse in 5 (14.3%) patients in follow-up periods of 6 months to 23 years. Complications occurred in the postoperative period in 10 patients, the mortality rate was 4%. Fenestration of the cysts is the main type of intervention, which allows maximum preservation of the functioning hepatic parenchyma. The left hepatic lobe was resected in only 2 patients with its complete cystic degeneration. Defocused laser beam and bipolar rotor electrocoagulator were used for ++de-epithelialization of the cystic walls. Experience shows the expediency of surgical treatment for decompression of the maintained hepatic parenchyma.

Two hundred and eighty one patients with cicatricial biliary strictures were examined to reveal external biliary fistulas in 72 of the patients. The strictures and fistulas developed after surgery on the stomach and biliary ducts due to an accidental surgical injury to these organs, or at later terms after a ++hepato-choledochal intervention. The biliary lesions were repaired with 149 operations with formation of a biliodigestive anastomosis without tube drainage, 117 with tube drainage (mostly transhepatic), six plastic operations with reconstruction of the ++hepato-choledochal integrity, and 47 ++radio-endoscopically guided interventions. Complications after cavitary++ operations were observed in 36.9 per cent cases with the fatal outcome in 13 of the patients (4.7 per cent). ++Radio-endoscopically guided interventions included: radioendobiliary prosthetics of the biliary ducts, recanalization, balloon dilatation of short strictures with endoscopic guidance, elimination of concretions by means of external drainage, and endoscopic papillosphincterotomy in distal choledochal strictures. Long-term findings were related to the level of the biliary lesion, the period that had elapsed since the stricture formation, and the number of operations in the medical history. Good or satisfactory results were achieved in 87.9 per cent cases. Considering the results of treatment for biliary strictures and fistulas disappointing, the main effort should be aimed at their prophylaxis. With this purpose, measures to prevent surgical injury to the biliary tract have been elaborated.

The article discusses the results of one of the first studies conducted in the Soviet Union on the use of various types of fibrinous glue in operations on the parenchymatous organs. The data of 67 experiments on rabbits and 20 clinical cases are reported. The experiments were carried out to test the efficacy of fibrinous glue application for arresting parenchymatous bleeding and appraise the air-tightness of wounds of the liver, spleen, and kidney by the method of hydropressure with morphological control. The effect of fibrinous glue made of Soviet-produced components was also tested in experiment. In the clinic, fibrinous glue was used for arresting bleeding from wounds of the liver and spleen and for ensuring air-tightness of anastomoses and filling residual cavities after removal of hepatic cysts. The hemostatic effect of various types of fibrinous glue was found to be high both in experiments and in the clinic. Essential advantage over synthetic cyanoacrylate glues was proved. It was noted that the use of fibrinous glue in operations on the parenchymatous organs is promising.