Objective. To develop a method of organ-saving operation aimed at preservation of the physiological function of the pylorus and the normal physiological functioning of the pyloroduodenal area in patients with combined perforated, stenotic pyloroduodenal ulcers. Materials and methods. The study included 60 patients who faced surgery treatment in relation to complicated combined perforated, stenotic pyloroduodenal ulcers. Depending on diagnostic and surgical tactics applied, patients were conditionally divided into two groups. The control group consisted of 30 patients who underwent standard suturing methods. The main group also consisted of 30 patients in whom the developed method was applicated. Results. In the control group at the postoperative period of 30 patients operated in different ways complications occurred in 12 persons or in 40% of cases. In the main group of 30 patients operated according to the proposed method, complication in the form of anastomositis occurred in 1 patient only. Conclusions. The obtained results substantiate recommendation to clinical application the suggested method of organ-saving operation aimed to preserve the physiological function of the pyloroduodenal area, which excludes perforated ulcers suturing without pyloric stenosis elimination and gastrectomy on the background of peritonitis.

Aim. To identify the frequency of gallstone ileus based on the surgical experience of the Kiev region in patients with acute calculous cholecystitis and acute intestinal obstruction. To evaluate the capabilities of the gallstone ileus diagnosis algorithm for correct topical diagnosis before surgery.Materials and methods. For 2004–2018, 13713 patients with acute cholecystitis and 3609 patients with acute intestinal obstruction were hospitalized. In 0.64% of cases, gallstone ileus was diagnosed in patients with acute calculous cholecystitis, in 0.41% in choledocholithiasis, and in 2.4% in its complex forms. In 0.73% gallstone ileus was detected during operations for acute intestinal obstruction and in 1.12% for its obstructive form.Results. A total of 25 patients with gallstone intestinal obstruction underwent surgery. In the topical diagnosis of gallstone intestinal obstruction, X-ray contrast methods dominate. During surgical procedure, only with pyloroduodenal variants of obstruction, cholecystectomy is performed simultaneously with the elimination of obstruction. In other situations, cholecystectomy is performed after 3–8 months. Of the 25 patients, 4 patients died due to ascending cholangitis, peritonitis due to bile leakage, and severe co-morbidities.Conclusion. The use of the algorithm of advanced diagnostic methods allows you to receive a diagnosis in most patients. The most valuable in topical diagnostics are contrast methods. New in gallstone ileus is the migration of gallstone after endoscopic papillosphincterotomy with mechanical lithotripsy for choledocholithiasis, especially with its complex forms. In our opinion, all types of gallstone ileus can be combined into Bartolin-Bouveret syndrome, which first described this variant of mechanical intestinal obstruction.

Background. In laparoscopic cholecystectomy (LCE), general anesthesia has its own characteristics due to the creation of pneumoperitoneum, changes in body position and adsorption of insufflated gas, which causes the occurrence of perioperative complications and requires improvement of anesthesiology programs. Objective: to determine the efficacy and safety of combined low opioid anesthesia based on dexmedetomidine in complex anesthesia in patients undergoing laparoscopic surgery for acute cholecystitis. Materials and methods. In total, the study included 163 patients undergoing LCE under general anesthesia. All patients were divided into 3 groups according to the anesthetic care scheme. In Group 1 (n=56), low-opioid anesthesia (dexmedetomidine, lidocaine, fentanyl 1–2 μg/kg/h) and artificial ventilation were performed; Group 2 (n=52): propofol with fentanyl (4–6 μg/kg/h) and artificial ventilation. In Group 3 (n=55): anesthesia with sevoflurane in combination with fentanyl and artificial ventilation. Results. Hyperdynamic reactions were observed in Group 2 and Group 3 at the beginning of the operation: heart rates and BP values after induction, with intubation in the 3rd, 5th and 7th minute of pneumoperitoneum, were slightly higher in Group 2 and 3 than in Group 1. However, moderate bradycardia was observed in Group 1 more often – in 5 patients (8.92%) than in patients in Group 2 and Group 3 – 2 cases (3.84%) and 2 cases (3.64%), respectively. The total number of injected analgesics during LCE was: in Group 1 – 141.52±23.64 μg, in Group 2 – 426.92±39.41 μg, in Group 3 – 354.75±28.63 μg (p <0.01). Only one patient in Group 1 required ondansetron for the treatment of PONV compared to 5 and 4 in Group 2 and Group 3, respectively (p <0.05). None of the patients in all groups reported “feeling” intraoperative events or “awakening during surgery”. Conclusions. The use of dexmedetomidine with lidocaine infusion three times reduced the use of opioids in the intraoperative period and to refuse their use in the postoperative period. With the use of low-opioid anesthesia in the postoperative period, the frequency of hypertensive reactions and tachycardia did not increase, but in the postoperative period, these p

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Aim of study is to suggest a scientifically based pathogenetic classification of acute cholecystitis, corresponding to the classical R. Virchow triad “etiology, pathogenesis, outcome”. Materials and methods.Comparative assessment of the classical classifications by H. Kehr (1907), L. Aschoff (1909), S. P. Fedorov (1934) and modern disease schemes, combining the signs of the three ones, is conducted. Results and discussion.The proposed improved classification of acute cholecystitis (AC) corresponds to research principles, taking into account the etiology, pathogenesis and predicted outcome of the disease. There are 4 groups of AC variants: I — Acute calculous cholecystitis with all options and combinations (cholangitis, choledocholithiasis, Opie syndrome — papillary ileus, Mirizzi syndrome, Bouveres — acute gallstone ileus, hemobilia (80–85%)). II — Acute non-calculous cholecystitis without stones (8–15%) — no obstruction of the cystic duct of the gallbladder. III —Special AC forms. The dominant factors are enzymatic, vascular, non-productive anaerobic microflora, stress factors (severe injury, burns or surgery, childbirth). These forms require urgent surgeries and occur in 2–15% of all cases of AC destructive forms. IV — Специфические формы ОХ.Specific AC forms. Caused by specific microflora: typhoid, salmonella, dysentery, and parasitic (opisthorchosis, alveococcosis, amebiasis, ascariasis, less often — giardiasis). Rare forms are characteristic of endemic zones and in violation of generally accepted sanitary standards. Conclusion.Use of ultrasound, CT, SCT, MRI, endoscopic and endovascular interventions allows to diagnose almost all the AC various forms in the pre-operative period and individualize therapeutic and surgical tactics by taking into account the possible outcome. The proposed pathogenetic classification of AC can serve as a scheme for general practitioners, physicians, surgeons, anesthesiologists, and intensive care workers.