The aim of the study was to analyse safety and benefits of laparoscopic common bile duct (CBD) exploration compared to open. Prospective randomized trial included a total of 256 patients with CBD stones operated from 2005 to 2009 years in a single center. There were two groups of patients: group I-laparoscopic CBD exploration (138 patients), group II-open CBD exploration (118 patients). Patient comorbidity was assessed by means of the American Society of Anesthesiology (ASA) score; i.e. ASA II-109 patients, ASA III-59 patients. Bile duct stones were visualized preoperatively by means of US examination in 129 patients, by means of ERCP in 26 patients, by magnetic resonance cholangiopancreatography in 72 patients. Preoperative evaluation was done through medical history, biochemical tests and ultrasonography. There was no statistical significant difference between 2 groups of patients. No mortality occurred. The mean duration of laparoscopic operations was 82 min (range, 40-160 min). The mean duration of open operations were 90 min (range, 60-150 min). Mean blood loss was much less in laparoscopic group than in open group (20 ± 2 vs. 285 ± 27 ml; p < 0.01). Postoperative complications were observed is nine patients of laparoscopic group and in 15 patients in open group (p < 0.01). There were 102 attempts to perform transcystic exploration of CBD. External drainage was used in 25 (32.8%) patients with transcystic approach. Conversion to laparotomy was performed in two patients. Open operations were performed in 118 patients with choledocholithiasis. External drainage was used in 85% of patients. Morbidity in open group was higher (12.7%) than in laparoscopic group (6.5%). Laparoscopic CBD exploration can be performed with high efficiency, minimal morbidity and mortality. Laparoscopic procedures have advances over open operations in terms of postoperative morbidity and length of hospital stay.

The authors advise routine measurement of HSA and use of relative classification, primary suturing as the optimal repair for small hernias, the original technique of sub-lay lightweight partially absorbable mesh repair as the apparent best treatment for large hernias, and the original technique for giant hernias, which provides results corresponding to those reported in the literature, although these results require improvement.

The short-term outcomes demonstrated equal effectiveness of the both procedures, but 2-year follow-up showed that LGCP is worse than LSG as a restrictive procedure for weight loss.

Мета. Покращити діагностику та результати лікування хворих з пухлинами прямої кишки шляхом застосування тран- санальної ендоскопічної мікрохірургії і вивчення «сторожових» лімфатичних вузлів. Матеріали і методи. За період з 2009 по 2017 р. у клініці трансанальні ендоскопічні операції виконані 115 хворим у віці від 29 до 82 років. У 92 пацієнтів була тубуловорсинчата аденома прямої кишки, із них у 26 гістологічним дослі- дженням видалених пухлин виявлено малігнізацію (TisN0M0). У 23 пацієнтів до операції виявлено ранній рак прямої кишки Т1–2N0M0.  Результати. У строки спостереження від 12 до 60 міс рецидив виявили у 2 (2,2%) хворих з аденомою і у 3 (13%) з раком прямої кишки. Рецидив раку виник у хворих, які відмовилися від хіміотерапії та променевої терапії. Висновки. Ідентифікація і прицільне дослідження «сторожових» лімфатичних вузлів при раку прямої кишки умож- ливлює вірогідну (чутливість=0,89, специфічність=0,99) оцінку стадії захворювання і застосування адекватної схеми комбінованого і комплексного лікування пацієнтів.

years (range 27 to 87 years). There were two groups of patients. Group I: laparoscopic CBD exploration (138 patients). Group II: open CBD exploration (118 patients). Patient comorbidity was assessed by means of the American Society of Anesthesiologists (ASA) classification; ASA II -109 patients, ASA III -59 patients. Bile duct stones were visualized preoperatively by means of US examination in 129 patients, by means of ERCP in 26 patients, and by magnetic resonance cholangiopancreatography (MRCP) in 72 patients. Preoperative evaluation was done through medical history, biochemical tests and ultrasonography. Results: The mean duration of laparoscopic procedures was 82 min (range 40-160 min). The mean duration of open procedures was 90 min (range 60-150 min). Mean blood loss was much lower in the laparoscopic