Objective: to conduct a comparative analysis of the effectiveness of two methods - endoscopic band ligation (EBL) alone and in combination with nonselective beta blockers (NSBB) - used for prevention of variceal bleeding (VB); to evaluate their impact on patient survival in severe ascites during long-term stay on the liver transplant waiting list (LTWL).Materials and methods. A retrospective comparative study of two groups of patients with decompensated liver disease, ascites and varices included in the LTWL, who received EBL (n = 41, group 1) and EBL + NSBB (n = 45, group 2).Results. The groups being compared did not differ in demographics, clinical parameters, MELD and Child-Turcotte-Pugh scores. There were no significant differences in the incidence of severe ascites, particularly diuretic-resistant ascites. The study groups did not differ in the incidence of medium-and large-sized varices. Incidence of bleeding did not differ in both groups. Overall mortality was significantly higher in the EBL + NSBB group than in the EBL group. Patient survival was lower, while mortality was higher in the EBL + NSBB group. The combined therapy group had a significantly higher number of acute kidney injury (AKI) than the EBL group.Conclusion. The compared methods are equivalently effective in preventing VB in patients with decompensated cirrhosis with a prolonged stay on the waiting list. Survival rate is significantly lower, while mortality is significantly higher in the EBL + NSBB group than in the EBL group.

Objective: valuation of diff erent duodenal perforation surgical management following endoscopic retrograde transpapillary manipulations. Materials and methods: thirty-one patients with duodenal perforation following transpapillary manipulations (17 own observations, 14 — admission from other hospitals). Th e 14 (45.2 %) cases had a diagnosis less than 24 hours, 17 (54.8 %) — more than 24 hours aft er injury. Twenty patients had the primary reconstruction of duodenum with various drainage options of zone of injury. Sixteen patients had a two-stage surgery procedure: 5 cases aft er of primary reconstruction of duodenum and 11 — like a primary surgery (more than a day aft er injury). Results: aft er primary of duodenum reconstruction 11 patients (55.0 %) had no complications, 5 (25.0 %) — were re-operated, 4 (20.0 %) — were died. Aft er two-stage surgery procedure 9 patients (56.3 %) had no complications, fi ve (31.2 %) had surgical complications, 2 (12.5 %) were died. Conclusion: the primary of duodenum reconstruction can be performing, when the duodenal perforation there is less than a day. When there is a clinic of septic complication of retroperitoneum and abdominal cavity, two-stage surgery procedure is justifi ed.

Background:Surgery for chronic pancreatitis and pancreatic neoplasms is associated with a  risk of acute destructive pancreatitis and pancreaticojejunal anastomotic leakage in the early postoperative period. Despite the availability of multiple surgical and pharmaceutical approaches to prevent these complications, they continue to be associated with high mortality.Aim:To evaluate the efficacy of the clinical use of our original preventive methods of postoperative pancreatitis and diffuse inflammatory and septic complications in patients undergoing pancreatic resection due to its benign and malignant diseases.Materials and methods: We retrospectively analyzed the results of surgical treatment of 524  patients following pancreatic resection. All patients underwent pancreatic surgery in the Rostov Regional Clinical Hospital (Rostov-on-Don, Russia) from February 2005 to April 2018 for the following indications: complicated chronic pancreatitis in 221 patient, pancreatic and major duodenal papilla tumors in 303 patients. Organ-preserving procedures were performed in 250 patients, and radical extended resections of the pancreas in 274  patients. In 489  patients, the procedures were finalized with the formation of anastomosis between the pancreatic duct and jejunum. In 373  patients, the reconstruction step included enterostomal drainage of the pancreatic duct. To prevent acute postoperative pancreatitis and diffuse septic and inflammatory complications, in 298 patients we used our original techniques, while 226 patients underwent conventional procedures.Results:Among 226  patients, who had underwent conventional procedures, the complications occurred in 75 (33.19%), with septic complications in 29.33% (22 patients). Of 298 patients, in whom any of the original prevention techniques had been used, the complications were seen in 67 (22.48%), with septic complications in 13.43% (9 patients). Seventeen (17, or 11.97%  of the total number) patients had to be re-operated, with 15 (6.64%) having been initially operated without additional preventive measures, and 2 (0.67%) with the use of the original prevention techniques. Overall postoperative mortality was 2.48%. The causes of death were: peritonitis in 4 patients, arrosive bleeding from visceral arteries in 4, bleeding from pancreatic head stump into the omental sac in 2, bleeding at the pancreaticojejunal anastomosis in 1, and cardiac disorders in 2.Conclusion:The study results have shown that the use of techniques to prevent the spread of inflammation and septic in the abdominal cavity and decreasing the rates of postoperative necrotic pancreatitis in pancreatic resections allows for a reduction of these complications and related mortality.

Цель. Определить факторы, предсказывающие развитие рекомпенсации (предикторы) с последующим делистингом, на момент включения пациентов в лист ожидания трансплантации печени. Материалы и методы. Проведено проспективное исследование по типу «случай-контроль». В когорту «случай» вошли 19 взрослых пациентов с декомпенсированными заболеваниями печени различной этиологии, включенных в лист ожидания трансплантации печени и в последующем выбывших из него вследствие рекомпенсации. Когорту «контроль» составили пациенты (n = 61) с декомпенсированными заболеваниями печени, включенные в тот же период времени в лист ожидания, умершие в период декомпенсации. Результаты. Для определения независимых предикторов делистинга вследствие рекомпенсации использовалась логистическая регрессионная модель. Значимыми предикторами рекомпенсации стали параметры альбумина плазмы крови и лейкоцитов крови при включении в лист ожидания (р = 0,024 и р = 0,019 соответственно). Предсказательная ценность выявленных предикторов была подтверждена с помощью ROC-анализа (Receiver Operating Characteristic). Площадь под ROC-кривой (Area Under Curve-AUC) для концентрации альбумина оказалась равной 0,938 [95% доверительный интервал (ДИ) 0,882-0,995; p < 0,001]. AUC ROC для количества лейкоцитов оказалась равной 0,924 [95% ДИ 0,865-0,982; p < 0,001]. Отношение шансов для исхода рекомпенсации, при условии если количество лейкоцитов при включении в лист ожидания ≥3,1 × 10 9 /л, оказалось равным 14,639 (95% ДИ 2,16-99,12). Отношение шансов для исхода рекомпенсации, при условии если концентрация альбумина плазмы крови при включении в лист ожидания ≥39,1 г/л, оказалось равным 3,06 (95% ДИ 1,58-5,95). Заключение. Исследование показало возможность обратимости по врежде ний печени после прекращения действия факторов, вызывающих ее декомпенсацию. Независимыми предикторами развития рекомпенсации и последующего делистинга пациентов оказались количество лейкоцитов крови ≥3,1 × 10 9 /л и концентрация альбумина плазмы крови ≥39,1 г/л на момент включения пациентов в лист ожидания трансплантации печени. Ключевые слова: лист ожидания трансплантации печени, делистинг вследствие рекомпенсации функции печени, предикторы делистинга.

Objectives of the study: to analyze the survival rate of patients who received and did not receive various drugs of the class of non-selective beta-blockers (NSBB) while waiting for liver transplantation (LT) on the waiting list for liver transplantation (WLLT), depending on the presence or absence of a "therapeutic window" for the appointment of NSBB; to determine risk factors for death when prescribing various representatives of the NSBB class in patients with refractory ascites (RA). Material and methods. The retrospective case-control study was conducted. The "case" group included 278 adult patients with decompensated liver diseases of various etiologies included in the WLLT, who were treated with NSBB while waiting for LT. The "control" group consisted of 72 patients with decompensated liver diseases of various etiologies included in the WLLT, who did not receive NSBB therapy during the waiting period for LT. For the subsequent analysis, the group of patients receiving NSBB (n = 278) was divided into two subgroups: with the presence of a "therapeutic window" (n = 175), and without it (n = 103). The survival rate of patients was determined by the Kaplan - Mayer method. Predictors of mortality of patients receiving NSBB in the absence of a" therapeutic window "for NSBB were determined using the Cox proportional hazards model in the groups of patients with RA (n = 103) and non-RA (n = 175). Results. The survival rate of patients receiving NSBB in the presence of a" therapeutic window "for NSBB is significantly higher than in the group of patients receiving NSBB in WLLP while waiting for LT in the absence of a" therapeutic window " for NSBB (Log-Rank < 0.0001). The risk of death in patients with RA treated with NSBB was significantly higher than in patients with non-RA (HR = 2.285; CI 1.237 4.220; p = 0.008). The risk of death for patients treated with propranol was significantly different from carvedilol (HR = 2,152 and HR = 0.765; p = 0.042, respectively). Conclusion. The results of the study confirmed the hypothesis that there is a "therapeutic window" for NSBB when they are prescribed to patients with decompensated cirrhosis of the liver and included in the WLLP. The use of NSBB contributes to an increase in the mortality of patients with RA, regardless of the type of drug, in the case when the "closed therapeutic window" phase develops. In order to reduce the mortality of patients waiting for LT for several years due to acute organ deficiency, doctors who lead patients to WLLT should assess the risk and benefit of using NSBB