Application of dye leak test for gastrointestinal tract tightness control in bariatric surgery

Проблема ожирения широко распространена как в Республике Беларусь, так и в мировом масштабе. Так по данным ВОЗ ожирением страдают 640 млн человек в мире. В Республике Беларусь в 2015–2016 г. распространенность ожирения среди взрослого населения составляла 24,5 % . Морбидное ожирение при ИМТ >40 кг/м2, или >35 кг/м2 при наличии сопутствующей патологии, часто оказывается рефрактерным к консервативным методам лечения и наиболее эффективным способом устойчивого снижения массы тела пациентов является именно хирургическое вмешательство. Среди выполняемых бариатрических операций преобладают вмешательства, предусматривающие резекцию или шунтирование желудка. Так в мире доля гастрошунтирования на петле по Ру составляет 41,9 %, рукавной резекция желудка – 32,6 %, а на долю минигастрошунтирования приходится 5,0 %. Одним из наиболее частых осложнений после перечисленных бариатрических вмешательств является несостоятельность линии швов желудка или анастомозов. После рукавной резекции желудка частота этого осложнения достигает 3,9 %, а после гастрошунтирования на петле по Ру – до 8 %. The problem of obesity is widespread both in the Republic of Belarus and on a global scale. So, according to the WHO, 640 million people in the world suffer from obesity [6]. In the Republic of Belarus in 2015–2016.rasprostranennost' ozhireniya sredi vzroslogo naseleniya sostavlyala 24,5 %. Morbidnoye ozhireniye pri IMT >40 kg/m 2 , ili >35 kg/m 2 pri nalichii soputstvuyushchey patologii, chasto okazyvayetsya refrakternym k konservativnym the prevalence of obesity among the adult population was 24.5 %. Morbid obesity with a BMI >40 kg/m 2 , or >35 kg/m 2 in the presence of concomitant pathology, is often weight loss in patients is precisely surgical intervention. Among the performed bariatric operations, interventions involving gastric resection or bypass surgery prevail. Thus, in the world, the share of gastric bypass surgery on a Roux-type loop is 41.9 %, sleeve gastrectomy is 32.6 %, and the share of mini-gastric bypass is 5.0 %. One of the most common complications after the listed bariatric procedures is the failure of the gastric suture line or anastomoses. After gastric sleeve gastrectomy, the incidence of this complication reaches 3.9 %, and after Roux-en-Y loop gastric bypass surgery – up to 8 %

Diagnosis and treatment in chronic pancreatitis: an international survey and case vignette study

Background: The aim of the study was to evaluate the current opinion and clinical decision-making process of international pancreatologists, and to systematically identify key study questions regarding the diagnosis and treatment of chronic pancreatitis (CP) for future research.Methods: An online survey, including questions regarding the diagnosis and treatment of CP and several controversial clinical case vignettes, was send by e-mail to members of various international pancreatic associations: IHPBA, APA, EPC, ESGE and DPSG.Results: A total of 288 pancreatologists, 56% surgeons and 44% gastroenterologists, from at least 47 countries, participated in the survey. About half (48%) of the specialists used a classification tool for the diagnosis of CP, including the Mayo Clinic (28%), Mannheim (25%), or Buchler (25%) tools. Overall, CT was the preferred imaging modality for evaluation of an enlarged pancreatic head (59%), pseudocyst (55%), calcifications (75%), and peripancreatic fat infiltration (68%). MRI was preferred for assessment of main pancreatic duct (MPD) abnormalities (60%). Total pancreatectomy with auto-islet transplantation was the preferred treatment in patients with parenchymal calcifications without MPD abnormalities and in patients with refractory pain despite maximal medical, endoscopic, and surgical treatment. In patients with an enlarged pancreatic head, 58% preferred initial surgery (PPPD) versus 42% initial endoscopy. In patients with a dilated MPD and intraductal stones 56% preferred initial endoscopic +/- ESWL treatment and 29% preferred initial surgical treatment.Conclusion: Worldwide, clinical decision-making in CP is largely based on local expertise, beliefs and disbeliefs. Further development of evidence-based guidelines based on well designed (randomized) studies is strongly encouraged

Diagnosis and treatment in chronic pancreatitis: an international survey and case vignette study

Background The aim of the study was to evaluate the current opinion and clinical decision-making process of international pancreatologists, and to systematically identify key study questions regarding the diagnosis and treatment of chronic pancreatitis (CP) for future research. Methods An online survey, including questions regarding the diagnosis and treatment of CP and several controversial clinical case vignettes, was send by e-mail to members of various international pancreatic associations: IHPBA, APA, EPC, ESGE and DPSG. Results A total of 288 pancreatologists, 56% surgeons and 44% gastroenterologists, from at least 47 countries, participated in the survey. About half (48%) of the specialists used a classification tool for the diagnosis of CP, including the Mayo Clinic (28%), Mannheim (25%), or Büchler (25%) tools. Overall, CT was the preferred imaging modality for evaluation of an enlarged pancreatic head (59%), pseudocyst (55%), calcifications (75%), and peripancreatic fat infiltration (68%). MRI was preferred for assessment of main pancreatic duct (MPD) abnormalities (60%). Total pancreatectomy with auto-islet transplantation was the preferred treatment in patients with parenchymal calcifications without MPD abnormalities and in patients with refractory pain despite maximal medical, endoscopic, and surgical treatment. In patients with an enlarged pancreatic head, 58% preferred initial surgery (PPPD) versus 42% initial endoscopy. In patients with a dilated MPD and intraductal stones 56% preferred initial endoscopic ± ESWL treatment and 29% preferred initial surgical treatment. Conclusion Worldwide, clinical decision-making in CP is largely based on local expertise, beliefs and disbeliefs. Further development of evidence-based guidelines based on well designed (randomized) studies is strongly encouraged