The method selected to treat surgically the patients with CP that involves adjacent organs and causes their dysfunction is duodenum-preserving resection surgeries on pancreas head, which in some cases should be supplemented by application of biliodigestive anastomosis or biliopancreatic diversion in the area of pancreas resection to eliminate the BH.

Surgical treatment was applied in 145 patients with complicated forms of chronic pancreatitis (CP) at the department of surgery of the Ivano-Frankivsk Regional Clinical Hospital in 2009–2016. Fourty-nine (33.7 %) patients had symptoms of biliary hypertension (BH); in five (3.4 %) of them BH was combined with chronic duodenal obstruction (CDO), the other 5 (3.4 %) patients had a combination of BH+CDP and local venous hypertension of pancreaticobiliary area vessels. Resection-type surgeries were applied in 28 (57.1 %) patients with CP complicated by BH. Intraoperative monitoring of biliary pressure was used in 17 patients in the process of duodenum-preserving resections of the pancreas. Frey’s procedure was applied to 20 (71.4 %) patients, in whom BH persisted after the resection stage of the surgery; Frey’s procedure was supplemented by interventions on bile ducts: hepaticoenteroanastomosis was applied in 12 patients, excision of pancreas lingula was applied in one patient, internal biliopancreatic anastomosis was applied in one patient. Berne modification was used in 2 (7.2 %) patients, and pancreaticoduodenal resection (PDR) according to Whipple – in 6 (21.4 %) patients. Remote results were studied in 19 (67.8 %) patients. Patients after duodenum-preserving resections had the best quality of life indicators, for BH signs were absent.

Surgical inpatient care is one of the most capital-intensive types of care. Therefore, the health care system task is to ensure public access to this type of care, to guarantee the safety and quality of its provision on the background of resources rational use.The objective of the research was to analyze the basic parameters of inpatient surgical care quality provided at Ivano-Frankivsk region health care facilities. Materials and methods. The data of statistical reports (17 and 20) of health care facilities in Ivano-Frankivsk region for 2005-2015 were analyzed. Sociological survey of 530 patients treated at the surgical units of inpatient facilities was conducted. Results of the research. Resources for surgical inpatient care in terms of quantity in Ivano-Frankivsk region including beds and staff were determined to be higher than the average national level. However, the quality of staffing of the regional health care facilities (secondary employment coefficient is less than one point, one third of surgeons is with the second qualifying category or is not certified) does not meet modern requirements. Low-duty health care facilities were detected to be characterized by low operational activity (60.6%, 114.0 operations per surgeon per year on average), insufficient relevance of hospitalization (40% of operations may be performed on an outpatient basis), low attractiveness for a significant per cent of patients (46.2%).Conclusions. Regional program for optimization of surgical care provision should be developed.

Forming a patient-oriented health care system, patients’ participation in health care quality assessment has become the imperative of our time.The objective of the research was to analyze the impact of doctors’ and health care system credibility on satisfaction with health care.Materials and methods. Sociological survey of 530 patients was conducted. The patients completed their treatment in the surgical departments of inpatient facilities in Ivano-Frankivsk region. According to its results the patients were divided into two groups: satisfied (372 people) and not satisfied (158 people) with the level of health care services in the department and the hospital as a whole.Results of the research. Nearly 60% of the surveyed patients were determined not to trust their doctors and one third of respondents did not know their primary care physician. This significantly increased the chances of dissatisfaction with health care (OR= 4.11; 95% CI: 1.67–10.14, p<0.001 and OR=1.96; 95% CI: 1.33–2.90 respectively; p<0.001) and promoted inefficient use of the health care system resources as a result of unreasonable hospitalization (in 18.8% cases). Conclusions. Patients who do not trust doctors in general and do not know their general practitioner remain dissatisfied with inpatient care by 1.5-10 times more often.