Results of surgical treatment of cysts of the pancreas

The authors analyzed results of treatment of 87 patients with cystic formations of the pancreas. According to an experience with treatment the puncture-catheterization of non-formed and complicated cysts is thought by the authors to be the method of choice. For non-complicated well formed cysts the method of choice is operation of internal drainage using different organs. When the puncture-catheterization intervention is not possible the external drainage of the cyst and complex conservative therapy can be the method of choice for complicated cysts. Radical operations (resection of the pancreas) were used for benign cystic tumors. The greatest number of complications were observed after the external drainage of the cyst, cystogastrostomy, resection for cystadenoma and cystadenocarcinoma. Postoperative lethality was 6.8%.     

Surgical treatment of cysts and cyst-like formations of pancreas

Results of treatment of 87 patients with cystic pancreatic formation were analyzed. In 38 patients pancreatic cyst had formatted after destructive pancreatitis, in 28--after pancreatic trauma, in 6--due to virsungolithiasis, in 9--cystadenoma was revealed, in 6--cystadenocarcinoma. In 29 patients operation of internal drainage of cyst was performed. Basing on accumulated experience the authors recommend to perform puncture-cathetherizational intervention under ultrasonic investigation and computeric tomography control, when nonformated or complicated pancreatic cyst is present; in the treatment of uncomplicated nonformated pancreatic cyst the operation of internal drainage, using different organs, stomach, duodenum, small intestine, constitutes the method of choice. When it is impossible to perform puncture-cathetherizational intervention, external drainage of cyst and complex conservative therapy may become the method of choice for the treatment of complicated pancreatic cyst. In the presence of benign cystose tumor it is necessary widely apply radical operation--pancreatic resection. The largest frequency of complications occurrence have been noted after external drainage of cyst, performance of cystogastrostomy, pancreatic resection for cystadenoma and cystadenocarcinoma. The principal of them are: the external pancreatic fistula occurrence (in 9.1% of observations), the cyst recurrency (in 5.7%), erosive hemorrhage (in 4.6%), pancreatitis (in 5.4%), suppuration of postoperative wound (in 8%), stenosis of cystodigestive anastomosis (in 2.3%). Postoperative mortality was 6.8%.     

Diagnosis and treatment of recurrent peptic ulcers after vagotomy

Under analysis were case histories of 41 patients with recurrent ulcer. An effective method of diagnostics is the endoscopic examination with an additional X-ray examination of the stomach and duodenum and secretory function of the organ. Gastric resection which is supplemented with selective gastric vagotomy depending on the state of gastric secretory function is the main method of surgical treatment of recurrent and peptic ulcers after vagotomy.     

Results of drainage operations for the destructive pancreatitis

Results of treatment of 189 patients with destructive pancreatitis were analyzed. The surgical tactics improvement in 1999-2002 yrs in wide-spreading forms pancreonecrosis had constituted the substantiated active excision of all the pancreatic destruction foci present as well as in retroperitoneal fat and peritoneal cavity, individual performance of "closed", "open" and "combined" operative intervention. Application of the staged programmed sanation interventions have permitted to achieve the postoperative complications frequency occurrence from 41 to 17.9% and mortality from 31 to 11.5%.     

On the improvement of surgical treatment of destructive pancreatitis

Results of treatment of destructive pancreatitis during the recent 20 years have been analyzed. Among 189 patients with this disease there were 54.5% of women and 45.5% of men aged from 20 to 80 years. The main principle of the surgical treatment was active ablation of all foci of destruction in the pancreas, abdominal cavity and retroperitoneal fat. "Closed", "open" and "combined" operations were used according to individual indications established by highly informative methods of diagnostics such as ultrasound, CT, retrograde pancreatocholangiography, laparoscopy. Combined use of the operations, flow lavage of bursa omentalis and retroperitoneum, complex therapy using intraarterial laserotherapy have allowed to reduce postoperative complications from 41 to 17% and mortality from 31 to 11.5%.