Surgical treatment of common bile duct cysts

The practice observation is given - surgical treatment of the patient with the cyst of the common bile duct. 34 years old patient was received with complaints of recurrent paroxysmal pain in the upper abdomen, nausea, vomiting, chills and fever up to 39 оС. During the process of examination, the cyst of the common bile duct was detected. The following procedures were performed for the patient: laparotomy, cyst of the common bile duct resection, Roux-en-Y bilio - jejuna anastomosis, Felker drainage

PREDICTIVE RISK ASSESSMENT SCALE OF ISCHEMIC COLITIS DEVELOPMENT IN PATIENTS WITH ELECTIVE INFRARENAL AORTIC ANEURISM REPAIR

The article presents the scale developed by authors of prognostic assessment of ischemic colitis evolution in patients after planned resection of infrarenal aortic aneurism. A retrospective analysis of medical histories of 201 operated patients and statistical data manipulation were made at the period from 1985 to 2016. It was stated, that score less than 2 points represents patients of high risk group of ischemic colitis development. The scale of sensitivity consisted of 80% and scale of specificity - 63,4%. The score of developed scale depended of passability and blood flow condition in the inferior mesenteric, the right and left internal iliac arteries being evaluated during surgery. The aim of surgeons is to increase the number of points in the scale using revascularization of the inferior mesenteric and at least one of internal iliac artery in patients of the high risk group of ischemic colitis development

RISK STRATIFICATION IN SELECTIVE SURGERY OF ABDOMINAL AORTIC ANEURYSM

A retrospective analysis of data of 188 patients, who underwent a selective surgery for abdominal aortic aneurism showed, that all the patients had a cardiac pathology. Ischemic heart disease and arterial hypertension had 175 (93,0%) and 177 (94,1%) of patients, respectively. Chronic nonspecific lung disease was noted in 65,4% patients and kidney disease — in 48,9%. Different complications developed in early postoperative period in 47 (25%) patients, that resulted in fatal outcome in 20 (10,6%). The most frequent complication was an acute renal insufficiency, which led to fatal outcome in 40% patients. Myocardial infarction and pneumonia took the second place in the structure of postoperative complications, one half of the fatal cases was due to these. Retrospective risk stratification assessment of the development of early postoperative complications and lethality was made by Glasgow Aneurysm Score (GAS) and angiosurgical model scale V-POSSUM. It was stated, that score was up to 84 according to GAS scale and up to 28 (V-POSSUM ). That fact is the evidence of high risk of the operation. On the basis of ROC curves building, the conclusion was made about greater predictive ability of V-POSSUM scoring system

SURGICAL STRATEGY IN PATIENTS WITH ABDOMINAL AORTIC ANEURYSM AND COINCIDENTAL MALIGNANCY OF DIFFERENT LOCALIZATION

Abdominal aortic aneurysm was detected in 269 patients and 26 (9,6 %) of them had a coincidental malignancy. There were 25 (96,2 %) men and 1(3,8 %) woman of age from 46 to 88 years (on the average 67,9±1,7 years old). All of them had different accompanying diseases, influencing the choice of treatment strategy. More than half of patients (16 (61,5 %) had the advanced stage III or IV (3H) of cancer and three of them occupied the first place due to their wide occurrence: tumors of lung — 42,3 %, of stomach — 19,2 %, of large intestine — 11,5 %. The operations were performed in 8 patients with malignancy and in 2 patients with abdominal aortic aneurysm. Two-step operations were performed in 4 patients, the simultant operation — in one patient

RESPIRATORY AND RENAL INSUFFICIENCY AS RISK FACTORS OF SURGICAL TREATMENT OF PATIENTS WITH AORTIC ANEURYSM OF THE INFRARENAL SEGMENT

Retrospective analysis of data in 188 patients showed, that chronic nonspecific pulmonary disease was diagnosed in 65,4 % of all. Disorders of bronchial patency of different degrees of manifestation were noted in 61,2 % and 19,7 % of patients had a hypoxemia. Renal diseases were found in 59 % of patients, resulting in the development of chronic renal insufficiency in 17 %. The data obtained indicate, that the presence of coexisting pulmonary pathology directly influences the frequency and severity of respiratory complications after surgery, which can be the cause of fatal outcome. The presence of renal diseases results in three times higher risk of the development of postoperative renal complications

CHOLESTEROL CRYSTAL EMBOLISM AS THE REASON OF ACUTE NON-OCCLUSIVE MESENTERIC ISCHEMIA AFTER INFRARENAL AORTIC ANEURISM REPAIR

OBJECTIVE. According to the analytical data, the acute non-occlusive mesenteric ischemia after infrarenal aortic aneurism repair occurs in 0.2–1 % of cases. This complication is difficult to diagnose and associated with unfavorable prognosis and high mortality. MATERIAL AND METHODS. The retrospective analysis included 112 case histories of patients with infrarenal aortic aneurism repair in the period from 2007 to 2017. RESULTS. During the early postoperative period, 2 patients (1.8 %) had an acute non-occlusive mesenteric ischemia with lethal outcome. In these cases, the complication developed with safety patency of main mesenteric arteries and was followed by developing early multiorgan failure and thrombocytopenia. The autopsy showed generalized atherosclerosis, infarctions of kidneys, spleen and liver, caused by cholesterol crystal embolism of microvascular bed, which was found after histological research. CONCLUSION. The clinical presentation of acute non-occlusive mesenteric ischemia after infrarenal aortic aneurism repair is low-specific. One of the etiological factors of this complication is cholesterol crystal embolism in microvascular bed of visceral arterie

ISCHEMIC HEART DISEASE AND ARTERIAL HYPERTENTION AS RISK FACTORS OF SURGICAL TREATMENT OF PATIENTS WITH INFRARENAL SEGMENT OF AORTIC ANEURYSM

A retrospective analysis of the data of 188 patients with the infrarenal segment of the aortic aneurysm (ISAA) showed, that ischemic heart disease and arterial hypertension were diagnosed practically in all patients — 175 (93.0%) and 177 (94.1%) patients respectively. A decreased retractor function of the myocardium was noted in 88 (46.8%) of patients. According to the findings of echocardiography 134 (71.3%) patients had the arterial hypertension of third degree. For the assessment of the influence of the accompanying cardiac pathology on the results of planned surgical treatment and systematization of postoperative cardiac complications the classification, which was proposed by R. B. Rutherford et al. and modified by A. V. Pokrovsky et al. was used. The obtained data point at a direct proportional relationship between the degree of the initial cardiac status, frequency and severity of postoperative cardiac complications in patients after resection of ISAA in 1.6–2.3 times

METHODS FOR PRESERVATION THE PATENCY OF THE INTERNAL ILIAC ARTERIES DURING INFRARENAL AORTIC ANEURISM RESECTION

OBJECTIVE. The purpose of this study was to evaluate the methods for preservation the patency of the internal iliac arteries during infrarenal aortic aneurysm resection.MATERIAL AND METHODS. The retrospective review was conducted in 200 patients who had undergone infrarenal aortic aneurysms resection between 1998 and 2017. The group 1 consisted of 8 patients who underwent the antegrade internal iliac arteries flow restoration by bypass or prosthetics. The group 2 consisted of 25 people who did not undergo restorating the patency of these arteries. The results were compared in both groups during the intraand early postoperative period.RESULTS. During the statistical analysis, there were no significant differences in duration of operation postoperative period, blood loss between two groups. Among the patients of the group 2, a transient ischemic colitis developed in one case, a prosthesis thrombosis developed in 5 patients. The complications described above have never been noted in the group 1.CONCLUSION. Direct revascularization of the internal iliac arteries during infrarenal aortic aneurism resection is an important factor of preventing the ischemic disorders of the pelvic organs and the left half of the colon do not significantly affect the volume of blood loss and the duration of the operation and the postoperative period