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Suprapyloric transversal resection of the stomach is one of relatively sparing methods of surgical treatment for ulcerative disease. In Medical Centre of "VAZ", suprapyloric resection of the stomach was carried out as a method of treatment of gastric ulcer in 181 patients (study group) and 139 patients underwent resection 2/3 of the stomach by Billroth-1 (control group). The ulcer located in cardial and mediogastric regions (1 type by Johnson). Among the patients of study group postoperative lethality made up 1.1%. Follow-up results of operative treatment was quite favourable in 96.3% of cases and unsatisfactory--in 3.7% (persistent pylorospasm). In control group follow-up results of surgical treatment in 86.4% were appraised as excellent and good, in 13.6%--satisfactory due to postoperative development of damping-syndrome. Comparison of results of follow-up examination in two groups of operated patients has evidenced of the best functional results after performance of suprapyloric resection of the stomach.

The authors analysed the immediate and late results of selective proximal or truncal vagotomy with excision of the ulcer from the gastric lumen or wedge resection of the stomach in patients with various localization of the gastric ulcers. The best results were produced (Visick I-II) in patients after selective proximal vagotomy with excision of the ulcer from the gastric lumen (in 93%), the results were poorer in selective proximal vagotomy with wedge resection of the stomach and in truncal vagotomy with excision of the ulcer or wedge resection of the stomach (only in 20%, 38%, and 30% of patients, respectively). The results were unsatisfactory (Visick IV) mainly after vagotomy with wedge resection of the stomach due to recurrences and postvagotomy functional disorders. The authors claim only limited use of organ-preserving operations to be admissible.

74 patients with GSU are studied. These ulcers occur more frequently than ordinary ulcers in aged persons against the background of various diseases. "True" GSU are localized mainly in the proximal regions. GSU combined with duodenal ulcers have a course with grave complications requiring urgent surgery. GSU located in the central parts are characterized by chronic ulcer symptoms, and those located at the periphery by the symptoms of acute ulcers (centrifugal progression). Confluence of adjacent ulcers occurs at the centripetal progression. Epithelization is lacking at the edges of the majority of GSU this indicating the predominance of the destructive processes.

Postoperative reflux gastritis in persons who were operated on for peptic ulcer occurs much more frequently after resection of the stomach (68.6%) than after organ-preserving operations on the stomach (39.4%). The incidence of reflux gastritis after gastric resection depends on the type of gastroenteroanastomosis. It is encountered much less frequently after Roux' operation (9.2%). The pronounced character and frequency of reflux gastritis after organ-preserving operations on the stomach are determined by the type of stomach-draining operations, the localization of the ulcer before the operation, whether in the stomach or the duodenum, the existence of duodenogastric reflux (DGR) before the operation. Measures for the prevention of postoperative reflux gastritis in the management of peptic ulcer are as follows: (a) wide introduction of organ-preserving operations, preferably SPV by itself or in combination with duodenoplasty; (b) formation of Roux' gastroenteroanastomosis when resection of the stomach is indicated. Reflux gastritis must be treated by nonoperative methods, including medicinal, dietetic, and spa therapy. Surgery is indicated in reflux gastritis combined with other diseases of a stomach which had been operated on, for which an operation is necessary, and in occasional cases of erosive reflux gastritis.

Operative treatment of hydatid disease is the only radical method at present. According to the data in the literature, the incidence of postoperative complications in patients with hydatid disease of the liver ranges from 14.32 to 64%. The work generalizes the results of operations in 278 patients with hepatic hydatid disease. Closed echinococcectomy was conducted in 168 (65.87%) patients, partly closed--in 34 (12.23%), open echinococcectomy--in 14 (5.04%), pericystectomy--in 21 (7.55%), ideal echinococcectomy--in 17 (6.12%), resection of the liver with removal of the hydatic cyst--in 15 (5.4%), and percutaneous transhepatic drainage of the cyst--in 9 (3.2%) patients. Postoperative complications occurred in 32 (11.51%) cases. Among them were suppuration of the residual cavity in 19, external biliary fistula in 11, and subdiaphragmatic abscess in 2 patients. The least number of complications was encountered after closed echinococcectomy--in 5 (2.97%) patients. One patient died after partly closed echinococcectomy as the result of development of multiple cholangiogenous hepatic abscesses. The results of the authors' observations provide evidence that the character and frequency of postoperative complications are determined by timely diagnosis of echinococcosis of the liver before the development of complicated forms, correct choice of the type of the operation, and the techniques of the operation and the operative approach.

A clinicomorphological analysis was performed of the gastric antrum mucous membrane of 60 patients after selective proximal vagotomy because of stenosing duodenal ulcer. The patients were subdivided into two randomized groups depending on the type of the draining operation. The first group had a gastroduodenoanastomosis for the gastric drainage and the second group underwent duodenum plasty (drainage of the duodenum). Discontinuation of the pylorus function in the gastric drainage operation resulted in higher incidence and intensity of duodenum-gastric reflux and made more severe antrum gastritis; reflux-gastritis developed frequently. Morphological signs of reflux-gastritis in 95% of cases coincided with the results of the radionuclide method. Duodeno-gastric reflux decreased as a rule Helicobacter pylori (HP) contamination of the mucous membrane but did not eliminate it completely in all cases. The combination of these two factors resulted in more severe gastritis than that provoked by each of them separately. The etiology of gastritis and its intensity may be determined only by morphological examination of gastric mucous membrane. The results of endoscopic and histologic methods coincided in 70% of cases. Duodenal-gastric reflux, HP and high acid production play a certain role in ulcer recurrence.

The article deals with the new possibilities of bloodless management of parasitic cysts of the liver by means of ultrasonic examination and computed tomography. The authors suggest a puncture-aspiration method of goal-oriented percutaneous drainage of a hydatid cyst which prevents possible complications. The method was applied in four patients with hydatid cysts of the right hepatic lobe. The outcomes in two cases were successful, the death of one patients was associated with the use of the method.

In the period from 1980 to 1990 operations were carried out on 412 patients with echinococcosis of the liver. Complicated forms were encountered in 108 patients. Rupture of the hydatid cyst into the biliary tract occurred in 72 patients. Among the patients with this complication 14 had changes of the bile ducts with the development of obstructive jaundice, 14 had a history of short-term jaundice, in 35 patients the cystobiliary fistula was discovered only during the operation. Percutaneous transhepatic and retrograde cholangiography proved to be the most informative diagnostic methods in rupture of the hydatid cyst into the biliary tract with the development of obstructive jaundice. Echinococcectomy with one-stage operative intervention on the biliary tract was conducted in 14 patients. Along with echinococcectomy, 7 underwent cholecystectomy and drainage of the common bile duct, 2 were subjected to choledochoduodenostomy, 1 to papillosphincterotomy, in 4 patients echinococcectomy was preceded by percutaneous transhepatic cholangiostomy.

The authors studied the efficacy of directed transport of antibiotics in autologous blood shadows in the complex treatment of 73 patients with acute cholecystitis (the main group) in comparison with the traditional nonoperative treatment of 67 patients with the same disease (the control group). The directed transport of antibiotics in autologous blood shadows makes it possible to arrest adequately the clinico-laboratory manifestations of acute cholecystitis, thus preventing the development of infectious complications of the disease, shorten by 4.5 times the terms for arresting the clinico-laboratory manifestations of acute cholecystitis, and to optimize planned operative treatment. The suggested method increases the quality and the economy of management of surgical patients.

Over 10 years operations were conducted in 28 patients with hydatid disease with concurrent involvement of the liver and lungs, which accounted for 5.76% of all patients with hydatid disease of the thoracic and abdominal organs. The following variants were encountered: uncomplicated echinococcosis of the right lung and right hepatic lobe (13 patients); uncomplicated echinococcosis of the left lung and liver (3); suppurative hydatid cyst of the liver with rupture into the pleural cavity and the development of pyothorax (9); rupture of a hepatic hydatid cyst into the bronchial tree of the right lung with the development of a cysto-bronchial fistula (3 patients). In the group of 28 patients with concurrent involvement of the liver and lung 18 were operated on through a thoraco-phreno-laparotomic approach, 9 through a transpleural approach, and one patient underwent a two-stage operation. The success of the treatment is determined by early recognition of the concurrent echinococcosis and the choice of the optimal surgical tactics. One-stage echinococcotomy from the liver and lung is the operation of choice in concurrent affection of the liver and right lung.

The article analyses the efficacy of extracorporeal lithotripsy by a LT-01 piezoelectric lithotriptor (EDAP, France). A total of 72 lithotripsy sessions were performed on 37 patients, in 2 of them who suffered from chronic calculous cholecystitis the procedure was conducted on the day before the operation. As a method for treatment, extracorporeal lithotripsy was applied in 35 patients for the following indications: solitary and multiple stones measuring in sum no more than 3 cm in the satisfactory functioning of the gallbladder and patency of the bile ducts. In 35 patients the stones were crushed to fragments of various size. In 29 patients extracorporeal lithotripsy produced a marked effect and was the final method of treatment. Six patients were operated on (cholecystectomy) due to exacerbation of chronic cholecystitis in 4 patients, pancreatitis in one patient; total destruction of calcinated large stone fragments could not be achieved after 6 sessions in one patient.

Experience in the treatment of 70 patients with stenotic duodenal ulcer by surgery is generalized. In addition to SPV the patients underwent duodenoplasty as a draining operation. There were 61 (87.1%) males and 9 (12.9%) females. Their ages ranged from 18 to 70 years. The stenosis was compensated in 21 (30%), ++non-compensated in 32 (45.7%), and decompensated in 17 (24.3%) patients. To determine the possibility of performing SPV, the maintenance of the gastric contractile activity was studied by noninvasive methods: computed peripheral electrogastrography and computed gastro-scintigraphy. Involvement of the pylorus into the cicatricial-ulcerous inflammatory infiltration is the main contraindication for duodenoplasty. In view of that, intensive 2-3 week preoperative antiulcer therapy acquires particular significance; it removes or reduces significantly the inflammatory infiltration in most cases and raises the possibility of conducting duodenoplasty. Only intraoperative inspection of the pyloroduodenal segment allows the possibility and type of pylorus -preserving duodenum draining operation to be determined. This operation can be undertaken if the proximal boundary of the stenotic cicatricial-ulcerous deformity is at a distance of at least 1 cm from the pyloric sphincter, whatever the degree and length of the narrowing. A total of 43 operations form the Heineke-Mikulicz Mikulicz duodenoplasty, 17 for Finney's pyloroplasty, and 10 for bulbo-duodenostomy were carried out. The authors consider excision of the duodenal ulcer to be expedient and safe only when it is located on the anterior wall; it was carried out in 9 cases.(ABSTRACT TRUNCATED AT 250 WORDS)

In the past five years, 16 adults (10 females, age 25-61 years, mean 48) with giant cavernous hemangioma of the liver measuring 15-31 cm (mean-19) underwent surgery in a single Institution. Diagnosis was made with the help of multimodal investigations- ultrasound (US), computed tomography (CT), hepatic angiography, hepatic scintigraphy and fine needle biopsy. Ultrasound and CT had sensitivities of 69% and 82% respectively. Fourteen had preoperative selective hepatic artery embolization to study its effect on operative blood loss. Indication for surgery in all cases was a large abdominal mass with varying severity of pain. In addition, 5 had hemetological and/or coagulation abnormalities, hemobilia in 1 and pyrexia in 1. Seven left lobectomies, 3 left lateral segmentectomies, 2 right lobectomies, 2 right trisegmentectomies and 4 non-anatomical resections of 1 to 3 segments were performed. Postoperative complications developed in 25% with no operative mortality. Preoperative selective hepatic artery embolization helped to decrease the operative hemorrhage in 13 (mean blood loss- 1146 ml). In two cases severe bleeding required use of Cell-saver and massive donor blood transfusion. Our results suggest use of preoperative selective hepatic artery embolization and Cell-saver as an adjunct to the liver resection for these vascular tumors.

Operations were carried out on 41 patients with carcinoma of the gallbladder. Coexistent cholelithiasis was encountered in all cases. Ultrasonic examination (USE) and computed tomography (CT) are the most informative methods of preoperative diagnosis. With the use of both methods the correct diagnosis was made in 100% of cases. The true diagnosis was made before the operation in 73% of cases. In 9 patients the correct diagnosis was established only during the operation. Two patients underwent operation for calculous cholecystitis, stage I gallbladder carcinoma was identified during planned histological study. Among 32 patients 2 were found to have stage I, one--stage II, 17--stage III, and 12 patients--stage IV of the disease. Radical operations were carried out on patients with stages I and II and on 7 patients with stage III of the disease. Nine patients (28%) died in the immediate postoperative period. Cholecystectomy with careful removal of the elements of the gallbladder bed should be considered the radical operation for stage I of the disease; in stage II the operation should be supplemented by lymphadenectomy along the course of the hepatoduodenal ligament. Hemihepatectomy or atypical resection of the liver is indicated in stage III of the disease.

It is shown that in acute cholecystitis patients versus chronic cholecystitis ones and donors, the total glutathione in blood is lower while the activity of glutathione metabolism enzymes in red blood cells inhibited. Enzymological findings correlate with clinical symptoms of intoxication. Surgery aggravates disturbed activity of the enzymes. Conventional conservative therapy is not effective in normalizing the enzymes activity either. A good therapeutic response can be achieved by a directed transport of antibiotics in autologous blood ghosts which promotes recovery of normal activity of glutathione metabolism enzymes, routine glutathione level, early stabilization of hepatocytic membranes beneficial for surgical patients.

During 1975-88 the staff of the Vishnevskiĭ+ Institute of Surgery performed 95 pancreatoduodenal resections (PDR) and 23 total duodenopancreatectomies (TDPE) in malignant tumors of the head of the pancreas (49), major duodenal papilla (30), terminal choledochus (12), duodenum (12), and in 15 patients with chronic pancreatitis. In 13 cases PDR and TDPE were undertaken as a second operation after creation of biliodigestive anastomoses: after laparoscopic cholecystostomy in 24 and after various abdominal operations in 20 cases. In 30 cases PDR was carried out with the formation of a pancreaticojejunal+ anastomosis, by the longitudinal techniques in 7 of them, in 47 cases with occlusion of the pancreatic duct, and in 6 with the formation of a "occlusive" pancreaticojejunal anastomosis++ suggested by the authors. PDR was performed in 3 cases with maintenance of the stomach and in 4 in combination with vagotomy. The mortality rate was 20% after PDR and 39.1% after TDPE.

The authors operated on 20 patients with the Zollinger-Ellison syndrome and on 3 patients with Wermer's syndrome. The clinical picture of the disease and the findings of laboratory tests and special methods of examination allow the Zollinger-Ellison syndrome to be diagnosed in most cases and a niveau diagnosis of gastrinoma to be established in some cases. Intraoperative ultrasonic examination is significant in making the niveau diagnosis. The authors claim that the operation of choice in the Zollinger-Ellison syndrome is total gastrectomy (extirpation of the gastric stump) with esophagojejunoduodenoplasty as well as one-stage removal of the revealed tumor by resection of the pancreas or enucleation of the tumor. The application of the group of H2-receptor blocking agents cannot be a substitute for operative treatment, but is expedient as a measure of preoperative management.

Employment of computer-aided tomography and ultrasonic scanning in 74 patients with liver abscesses helped rapidly detect the condition and identify its type. The sensitivity of ultrasonic scanning in the diagnosis of liver abscesses has made up 90.77 percent, specificity 86.44 percent, in computer-aided tomography these values have been the same and made up 97.96 percent. Closed transcutaneous interventions monitored by computer-aided tomography and ultrasonic scanning in these patients helped reduce the number of complications from 48.78 to 27.27 percent, mortality rates from 29.27 to 3.03 percent, hospitalization periods by 13.21 days, i. e. by 20.6 percent, as against the patients treated by traditional surgical methods.

A female patient of 18 with Peutz-Jeghers syndrome and gastric cancer was found to have in macroscopically intact areas of gastric mucosa cysts of the body of the gastric mucosa glands (the first observation in the national literature) which were characterized by glandular structures of various sizes lined with clear columnar epithelium with basally located nucleus and with production of the PAS-positive substance. Some of the cysts extend into the gastric lumen, some form polyps. They should be regarded as hamartomas. When the cystic epithelium undergoes malignant transformation, the trend for mucus formation is not lost.

Histological and electron microscopic study of the pancreas and biochemical determination of pancreatic enzymes in blood serum were performed in animals with experimental pancreonecrosis and after the treatment with 5-fluorouracil. The treatment resulted in the decreased secretion of pancreatic acinus tissue, diminution of destructive and inflammatory lesions and the decreased levels of trypsin, alpha-amylase and transamidinase. It is suggested that 5-fluorouracil may be used in the combined treatment of acute pancreonecrosis.

In the experiment on 200 rats with acute pancreatitis, it was revealed that in administration of dalargin at a dose of 10 mg/kg of the mass, the activity of xanthinoxidase and lipid peroxidation in the pancreas was suppressed, at the same time, the activity of trypsin, amylase and transamidinase in the blood serum decreased. In 48 patients, who underwent the intravenous administration of dalargin at a dose of 50 mg/kg at operation on the pancreas and after it, the incidence of acute postoperative pancreatitis development decreased 4.16-fold when compared to the use of protease inhibitors, and 2.4-fold when compared to the use of fluorouracil.

An analysis of causes of the development of dumping-syndrome after selective proximal vagotomy (SPV) has been made. Dumping-syndrome most frequently developed after SPV with draining operation (12.9%). The dumping-syndrome was rare and of light degree after SPV without drainage. The authors consider that disturbed motor-evacuatory function of the stomach and small intestine is responsible for the development of dumping-syndrome after SPV as well as the width of gastroduodenal anastomosis in draining operation which must be not more than 2-2.5 cm.

A technique for creation of occlusive pancreatojejunoanastomosis (OPJA) in pancreatoduodenal resection was used in 7 patients. Uncomplicated course of the postoperative period was noted in 6 of them. The indications for formation of the OPJA are substantiated by the experience with 32 pancreatoduodenal resections with pancreatojejunoanastomosis formation, and 47--with occlusion of the pancreatic stump.

The effect of 5-fluorouracil on the activity of pancreatic enzymes was studied in rats with acute pancreatitis. 5-Fluorouracil was injected intraperitoneally in a dose of 4.5 mg per 100 g body weight. Pancreatic transaminidase as well as serum alpha-amylase and trypsin levels decreased starting from 3--6h after the induction of acute pancreatitis. 5-Fluorouracil inhibited RNA and DNA synthesis and blocked the synthesis of pancreatic enzymes.

Patients with chronic pancreatitis and complicated calculous cholecystitis are known to have considerable disturbances of the immune status of the organism. The complex of preoperative management and postoperative treatment of such patients should include drugs mainly influencing the cell immunity indices.