Clinical efficiency of POEM operation in patients with achalasia of cardias

In Regional Clinical Hospital no. 2 POEM was performed in 47 of these patients: 24 men, 23 women aged 18 to 80 years (average age = 54.4 ± 13.8 years) for 2017–2019. According to the severity of achalasia, the patients were divided as follows: with I–II degree – 12 patients (25.5%), with II–III degree – 20 patients (42.5%), with III–IV degree – 10 patients (21.3%), with IV degree – 5 patients (10.6%). POEM results: 42 (88.4%) patients had a positive result, and 5 (11.6%) patients had a negative result

Surgical treatment of portal hypertension complications in patients with liver cirrhosis

Objective: Improving the results of surgical treatment of portal hypertension complications in patients with liver cirrhosis.Material and methods: The results of medical care for 328 patients with liver cirrhosis, who were treated in the surgical departments of the central district and city hospitals of the Krasnodar Region, were analyzed. The effectiveness of minimally invasive surgical treatment of portal hypertension complications in 832 patients with liver cirrhosis treated at the Regional Clinical Hospital no. 2 of the Ministry of Health of the Krasnodar Region were also evaluated.Results: The mortality rate in patients with liver cirrhosis, admitted in first-level institutions of medical care due to acute bleeding from esophageal varices, reached 26.3%. In conditions of surgical treatment of complications of portal hypertension in a third-level institution of specialized care it did not exceed 4.7%.Conclusion: The optimal approach to the surgical treatment of patients with liver cirrhosis is to stop the bleeding from esophageal varices at the first stage of medical care and to treat portal hypertension complications using minimally invasive technologies in a multidisciplinary clinic involving a multidisciplinary team of doctors

Electrohydraulic Lithotripsy in the Treatment of the Mirizzi Syndrome. A Clinical Case

Aim. To present an interesting case of treating cholelithiasis in the setting of the Mirizzi syndrome.Materials and methods. This paper presents a clinical case of patient A. (62 years old) who was admitted to hospital with the following diagnosis: cholelithiasis, cholecysto-choledocholithiasis, obstructive jaundice. Drawing on the medical history and complaints of the patient, as well as on the results of physical, laboratory, instrumental and preliminary examination, the patient was diagnosed with choledocholithiasis in the setting of the Mirizzi syndrome. Endoscopic retrograde cholangiopancreatography (ERCP) was prescribed. The ERCP was performed in four stages. The first stage included a typical endoscopic papillotomy, a retrograde cholangiopancreatography, as well as an attempt at endoscopic mechanical lithoextraction; however, the calculus could not be removed. During the second stage, the calculus was visually localized, and its size was determined. The third stage consisted in performing electrohydraulic lithotripsy (EHL) and mechanical lithoextraction of calculus fragments. The final, fourth stage involved follow-up direct cholangioscopy, which revealed that the common bile duct was patent and there were no calculi.Results. EHL constitutes a high-tech method of crushing calculi, which provides an opportunity to carry out minimally invasive treatment in patients with complicated cases of choledocholithiasis, when standard methods of mechanical lithoextraction are not effective