Summary. Relaparotomy in the treatment of postoperative complications of abdominal surgery remains a complex problem in modern surgery. Purpose: to study the causes of relaparotomy after surgical operations on the abdominal organs, depending on the nature of the first surgical intervention. Material and Methods: A retrospective analysis of the performance of 74 relaparotomies after surgical treatment of abdominal pathology was performed. The first surgical intervention was performed because of acute cholecystitis (11 patients), choledocholithiasis (4), acute destructive appendicitis (8), perforated stomach or duodenal ulcers (8), strangulated hernia (5), adhesive intestinal obstruction (9), perforation of thin or colon (7), obstruction of the colon of tumor origin (19). Indications for relaparotomy were peritonitis, early adhesive intestinal obstruction, intraperitoneal bleeding. Conclusions: Complications associated with intra-abdominal infection — peritonitis, peritonitis due to insolvency of anastomotic sutures, is the most common cause of relaparotomy after operations on the abdominal organs, requires improvement of both technology of operations and antibacterial therapy. Relaparotomy is a life-saving surgery in the development of intra-abdominal complications, but it is associated with a greater risk of mortality.

Background: Mirizzi syndrome is a rare complication of longgoing cholelithiasis, commonly accompanied by variety of structural changes in hepatopancreatoduodenal region. Methods: 34 patients underwent surgical treatment. There were 9 (26,4%) male patients and 25 (73,6%) female patients. Median age of 67.3 AE 1,8, ranging from 40 to 83. All patients classified according Beltran and Csendes 2008. Results: Dominant symptom: in 14 cases majority of symptoms indicates on acute cholecystitis , in 18 cases e obstructive jaundice and cholecystitis, in 2 cases eacute small bowel obstruction. Pathological process in patients with initial stages of Mirizzi syndrome (I-II) corrected by cholecystectomy with external drainage of common bile duct, in one case with choledohoduodenoanastomosis . Roux-en-Y hepaticojejunostomy performed in two patients with Mirizzi syndrome III and one -type IV. Optimal treatment for patients with Mirizzi syndrome IV-Va was cholecystectomy with common bile duct repair using gallbladder tissue. Only symptomatic surgery for bowel obstruction performed for patient with Mirizzi syndrome Vb due the severity of patients condition in both cases. Conclusion: With prolongation of disease severity of anatomical changes increases. Surgical treatment of patients with Mirizzi syndromethat requires precise surgical technique and individualized tactics.

respectively. Of the total procedures, 79.6% (129/162) were therapeutic and 20.4% (33/162) diagnostic; 92% (n = 149) had successful biliary cannulation rate; 9.9% (16/162) were re-admitted with abdominal pain and 6.2% (10/162) had post-procedure pancreatitis. From the study cohort, the success rate of combined therapeutic and diagnostic procedures was recorded at 92% (149/162). None of the patients from the study cohort suffered from bowel perforation, bleeding or death. The structure and staffing levels of the unit were found to be adequate and complied with the recommended standards. A variance was noted in the prophylactic antibiotics usage between the endoscopists in the unit. Conclusions: Findings from the audit showed that our local ERCP practice complied with most of the national standards. However, a few areas of improvement included strategies to reduce post-ERCP pancreatitis, standarisation of antibiotic prophylaxsis use and reduction of ERCP for diagnostic purposes. Corrective measures were suggested based on the audit findings.

Introduction: Xanthogranulomatous cholecystitis is an uncommon inflammatory disease of gall bladder with HPB 2018, 20 (S2), S685eS764Electronic Posters (EP03A-EP03F) e Biliary S715

CA19.9-103 IU/l.. Diagnostic laparoscopy that ruled out intraperitoneal disease followed by cholecystectomy and wedge resection of liver. Intraoperatively, gall bladder was found to be hard, elongated, densely adhered to GB fossa with multiple calculi in it. Histopathologically greyish-yellow streaks in the gallbladder wall, transmural inflammation with dense lymphoplasmacytic infiltration and fibrosis, perineural plasma infiltrate, one of the areas showing storiform fibrosis, suggesting xanthogranulomatous or IgG4 cholecystitis. No malignancy present. Serum IgG levels were raised but IgG4 levels were normal. Immunohistochemistry for IgG4 plasma cells in the specimen was negative. Conclusion: Xanthogranulomatous cholecystitis is a perfect mimicker of carcinoma gall bladder and diagnosis is difficult, both pre and intraoperatively. It is a differential for IgG4 cholecystitis also which though rare isolated entity, is usually a part of spectrum of IgG4 related sclerosing diseases.