Relevance. It is relevant to develop new technological solutions for palliative surgical treatment of patients with unresectable pancreatic head cancer (UPHC), since the incidence of postoperative complications in such patients reaches 25 %, and mortality – 20 %. Objective. To improve the diagnosis and immediate results of palliative surgical treatment of patients with UPHC complicated by obstructive jaundice, duodenal obstruction, and carcinomatous pancreatitis. Materials and methods. At the first stage of the study, criteria for the diagnosis of PHC complications, tactics and methods for their surgical correction were evaluated (group I, 159 patients). After analyzing the results, a new technology for the surgical treatment of patients is formulated, the clinical testing of which was carried out in the second stage. An open, prospective, randomized study included 112 patients with UPHC complicated by obstructive jaundice (group II), who underwent palliative surgical treatment using patented surgical procedures. A comparative analysis of the results of surgical treatment of patients of both groups was carried out. Results. The safety and effectiveness of the simultaneous implementation with biliodigestive gastrodigestive shunting has been proven. The advantages of the tactics of two-stage surgical treatment of patients with signs of liver failure are shown. In patients with high anesthetic and surgical risk, the replacement of open surgery with endoscopic prosthetics of the biliary system and duodenal obstruction is justified. In severe forms of carcinomatous pancreatitis with expansion of the main pancreatic duct, a technique for combined bilio- and pancreatodigestive shunting is proposed. When multiple organ dysfunctions with hepatic-renal, hemorrhagic syndromes are formed in patients with obstructive jaundice, decompression of the biliary system by minimally invasive techniques is shown in the first stage, and the main stage of surgical intervention in the second. As a result, the incidence of postoperative complications was 9,8 %, mortality – 3,7 %. Conclusions. In patients with UPHC cancer complicated by obstructive jaundice, performing instead of traditional biliodigestive bypass surgery combined bilioastrodigestive bypass surgery is a safe procedure that does not increase the frequency of postoperative complications, prevents the need for repeated gastro-digestive interventions, improves the quality of life of patients in the long-term postoperative period. The operation of choice in the surgical treatment of patients with UPHC complicated by obstruction of the biliary system and duodenum with high surgical and anesthetic risk is endoscopic interventions with endoscopic prosthetics of the bile ducts and duodenum.

The aim — to improve the diagnostic and surgical palliative treatment results in patients with unresectable pancreatic head cancer, complicated by obstructive jaundice with the canceromatous pancreatitis.Materials and methods. A comparative analysis of the various surgical techniques aimed on the bile duct obstruction syndrome correction by biliodigestive shunting in the palliative surgical treatment of patients with unresectable pancreatic head cancer and mechanical jaundice was done. The analysis of the archival material (1st group, n = 155) was performed at the first stage. It was established that although the pancreatic tumour causes obstruction of both the common bile duct and the main pancreatic duct, however, mechanical jaundice was developed in all patients, and obstructive canceromatous pancreatitis only in 8.8 % of patients. The mild forms of pancreatitis were effectively eliminated by routine methods of intensive care. However, in cases of moderate severe pancreatitis (according to the Atlanta‑92 classification, third revision), the state of patients’ health progressively deteriorated, as the mechanical jaundice background developed a life‑threatening multiorgan failure and the biliodigestive bypassing was not sufficient to avoid a postoperative complications and unsatisfactory results in all cases. Based on the obtained results analysis it was concluded that modernization is need to both surgical tactics and techniques in such patients. Therefore, it was planned and carried out original trial with the optimized treating technology approbation for such patients. To this end, 112 patients with pancreatic head cancer, complicated by mechanical jaundice (Group 2), treated in the surgical department for the period of 2007 — 2018 were included in an open, prospective, randomized study.An approbation of the original algorithm for the carcinomatous pancreatitis verification was performed; the effectiveness evaluation of the proposed tactics and the technique of surgical treatment, including the developed method of combined bilio‑ and pancreaticodigestive bypass surgery was done.Results and discussion. The safety and clinical efficacy of simultaneous with biliodigestive pancreatodigestive bypass was established in patients with locally advanced pancreatic head cancer complicated by obstructive jaundice and carcinomatous pancreatitis. The tactics of a two‑stage surgical treatment was described, which involves first performing external cholangiostomy with minimally invasive techniques or endoscopic transpapillary stenting in patients with signs of liver failure or carcinomatosis pancreatitis, and then the main stage of surgical intervention.Conclusions. The proposed tactics of two‑stage surgical treatment in patients with nonresectable pancreatic head cancer complicated by mechanical jaundice and pancreatic cancer, which includes a two stage technology of surgical interventions with the use of minimally invasive operations in the first stage of treatment and one‑step combined bilio‑ and pancreaticodigestive bypass surgery on the second one, contributes to the reduction of postoperative complications, mortality and improves the patients’ life quality.

Summary. The development of new technological solutions for palliative surgical treatment of patients with unresectable pancreatic cancer is relevant because the frequency of postoperative complications in such patients reaches 25 % and mortality — 20 %. Objective. Improve the diagnosis and immediate results of palliative surgical treatment of patients with unresectable pancreatic cancer complicated by mechanical jaundice and duodenal obstruction. Materials and methods. A comparative analysis of the results of surgical treatment of two groups of patients (11 patients in the first and 27 in the second) for unresectable pancreatic cancer complicated by mechanical jaundice and gastric evacuation disorders due to duodenal obstruction. Patients of group I performed only biliodigestive shunting by open surgery. Patients in group II obstruction of the bile ducts and duodenum was removed by endoscopic stenting of the biliary system and duodenum with nitinol stents. Results. It is proved that endoscopic stenting of the biliary system and duodenal obstruction by nitinol stents, compared with open surgery, is accompanied by a lower frequency of postoperative complications (72.7 % vs. 22.2 %, p < 0.05), mortality (27.3 % vs. 0 %, p < 0.001) and reduction of hospital stay (from (24.3 ± 3.74) to (8.7 ± 0.91) days, p <0.001). Conclusions. The operation of choice of palliative surgical treatment of patients with unresectable pancreatic cancer complicated by mechanical jaundice and evacuation disorders from the stomach, with a high risk of surgery (ASA III), is to perform endoscopic transpapillary stenting of the bile ducts and duodenum.