It is shown that the coagulation of bile passages does not prevent the outfrow of bile from them in postoperative period which is connected with real threat of the formation of bile flows with consequences of every description. The drainage of subhepatic space is an obligatory stage of the completion of laparoscopic cholecystectomy.

The article provides a clinical observation with an assessment of biochemical indicators and changes in liver volume in the patient after liver resection. A peculiarity of this clinical observation is that intraoperative (during liver resection) administration of autologous mesenchymal stem cells was performed on this patient. In the postoperative period, the patient was not given protein and hepatotropic preparations. As a result of the use of cellular technologies, on the 15th day after the operation, the patient recovered protein function of the liver; 10 days after the operation, the level of prothrombin time and transaminases normalized; on day 5 after the operation, alkaline phosphatase and GGTP were normalized. Previously, we proved that autologous mesenchymal stem cells introduced through the portal vein of the liver are fixed directly in the liver tissue. These results were confirmed by magnetic resonance imaging. The introduced cell structures were visualized by pre-labeling them with iron oxide nanoparticles. The search for new ways to restore liver function after resections is a significant task in liver surgery, which in the future will help to improve the postoperative results of treatment of patients and reduce the bed-day.

Objectives to reveal the clinical, morphological and hormonal characteristics of patients operated on for isolated adrenal myelolipoma and myxoid adenomas with adrenal myelolipoma. Material and methods.The study was based on the results of examination of patients operated on for adrenal myelolipoma in the period from 2000 to 2015. During the study, the hormonal activity in patients with isolated and myxoid adrenal myelolipomas was analyzed. A pathomorphological and immunohistochemical study of the removed formations of the adrenal gland was performed. The article presents rare clinical observations of patients undergoing treatment in the clinic of E.E. Eichwald, North-Western State Medical University named after I.I. Mechnikov, with accidentally detected neoplasms, which were a combination of adenoma and myelolipoma of the adrenal gland. Results.The occurrence of isolated myelolipomas and myxoid adenomas with myelolipoma among incidentalomas was 6.3% and 4.9%, respectively. The average age of patients with adrenal myelolipoma is 54.5 years. The ratio of women to men was 2:1. According to our data, four types of hormonal activity have been identified among myxoid formations of the adrenal gland. Type 1 is associated with Cushing's syndrome, type 2 is associated with Conn's syndrome, type 3 is associated with autonomic cortisol secretion, type 4 has no hormonal activity. Based on the results obtained by high-performance liquid chromatography (HPLC), 11-hydroxylase deficiency was noted, and according to the study of the urine steroid profile by gas chromatography-mass spectrometry (GCMS), the signs of type 2 11-hydroxysteroid dehydrogenase deficiency and an increase in 5-reductase activity in patients with isolated adrenal myelolipoma were obtained. Conclusion.The combination of adenoma with myelolipoma, as well as of adenoma, myelolipoma and cavernous hemangioma is a rare pathology, the diagnosis of which is based on the pathomorphological examination of the removed tumor. Myelolipoma as a part of adrenal adenoma is an incidentaloma, which can be of different sizes and is accompanied by hormonal dysfunction of the cells of the adrenal cortex. An uncertain intrascopic phenotype and hormonal activity of myxoid formations are the decisive factors in favor of surgical intervention.

Laparoscopic adrenalectomy is the «gold standard» in adrenal neoplasm surgery. However, in the case of bilateral lesions or lesions of the only adrenal gland, it leads to the need for lifelong hormone replacement therapy. Thus, organ-preserving operations are becoming more and more in demand today. The article presents the results of laparoscopic and laparotomic resection of the adrenal gland in 32 patients with various benign adrenal neoplasms. The possibilities of organ-preserving operations on the adrenal gland were determined. Reflected approaches in the choice of partial resection of the adrenal gland.

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