Postoperative Complications After Echinococcectomy

Echinococcosis remains a widespread disease in our country. Analysis of its incidence over the past five years shows that the average age of the patients has decreased significantly despite the relative decrease in the overall morbidity. The aim of this study is to present and analyze the postoperative complications that we cаme upon after the echinococcectomy. During the period 1992-2016, 471 patients with abdominal localization of hydatid cysts were admitted to our clinic - 273 women and 198 men. All of them underwent surgical treatment. Following diagnostic and therapeutic algorithm, the probability of developing postoperative complications decreased dramatically. The most important steps in order to anticipate the postoperative complications were accurate preoperative diagnosis and experience of the surgical team

Mirizzi Syndrome

First described in 1948 by Pablo Luis Mirizzi as `functional liver syndrome in jaundiced patients` and bearing his name, Mirizzi syndrome is a rare but serious complication of the gallstones, requiring careful approach in patients.For the period 2010-2015 in the Second Department of Surgery, 22 patients with Mirizzi syndrome are hospitalized. The ratio of women:men = 2.1:1. The age of the patients ranged from 19 to 78, all of them with long-established history and clinical presentation of gallstones.The patients had both planned and emergency surgeries, various types and sizes of surgical interventions were performed, including laparoscopical ones - cholecystectomy, cholecystectomy with drainage Kehr, cholecystectomy with biliary enteric anastomosis, reconstruction of the common bile duct

Complications of Acute Cholecystitis in Elderly Patients

Acute cholecystitis is a pathological condition involving cholelithiasis with acute pain lasting 4 to 6 hours or clinical manifestation with prolonged biliary colic, accompanied by fever, laboratory evidence of inflammation or cholestasis. The frequency of acute cholecystitis in patients up to 50 years of age is about 6%, while in patients over 50 is up to 21%. 5-10% of all cases are about acalculous cholecystitis. In a ten-year period, between 2006-2015, 424 patients diagnosed with acute cholecystitis over the age of 60 were hospitalized in the Second Department of Surgery. Of these patients, 291 are women and 133 are men. Complications were recorded in 296 of all hospitalized patients. There are no typical clinical symptoms in most of the patients and only a prevalence of vague general complaints with a single expression of right-sided abdominal weight and history of cholelithiasis. The atypical clinical manifestation is expressed most often with a rapid progression to complicated forms of acute cholecystitis - hydrops, empyema, gangrene, perivesical and/or subhepatic abscess, cholangitis, perforation. About 75% of these patients suffer from concomitant diseases (cardiovascular, respiratory, neurological, diabetes, etc.). Added to that, the acute cholecystitis proceeds unpredictably with a high risk of developing complications - 40-77% chance of perforation of the gall bladder, and also with a high frequency of mortality - 7-8% develop biliary sepsis. The gold standard in the treatment of acute cholecystitis is laparoscopic cholecystectomy but it is still not performed routinely everywhere, because of the controversy regarding timing and surgical approach to patients with acute cholecystitis. Based on the prevalence of complicated forms of acute cholecystitis and comorbidity in the elderly patients, the treatment requires open cholecystectomy in earlier periods

Acute Necrotizing Pancreatitis (ANP)

Necrosis of the pancreas and the peripancreatic tissue is present in 10-20% of patients with acute pancreatitis (AP) and is the reason for the high levels of morbidity and mortality rate in these cases. In the initial phase of acute necrotizing pancreatitis (ANP), the most important moments in the treatment are permanent correction of fluid and electrolyte imbalance, early enteral nutrition, ERCP in patients with cholangitis and increased pressure in the biliary tract, and patient admission in intensive care unit. When pancreatic and peripancreatic necroses become infected, surgical treatment is an optimal option, which, if possible, should be delayed till the fourth week after the onset of the disease. The type of surgery also experienced changes - from a classic open approach, with the introduction of wide drainage for postoperative lavage, through half-open techniques with subsequent repeated laparotomy, to a percutaneous drainage with a subsequent access to the retroperitoneum to perform minimally invasive necrectomy