Theobjectiveof the study was to detect the frequency and sources of hemorrhagic complications in patients with pancreatitis, evaluate the tactics and effectiveness of methods of hemostasis.Material and methods.A retrospective analysis of hemorrhagic complications of pancreatitis was carried out in 40 patients.Results.Bleeding developed mainly on the background of infected acute necrotic collections (77.8 %), the main source of bleeding was the splenic artery (37.0 %). Emergency laparotomy for bleeding was performed in 9 (22.5 %) patients, selective angiography was performed in 10 patients, it was effective only in 5 (50 %) cases. 12 (44.4 %) deaths were recorded in cases of arrosive bleeding.Conclusion.The preferred tactics in case of bleeding from the retroperitoneal space during minimally invasive treatment is crossclamping of drains and endovascular hemostasis.

Relevance. There is a discussion about the prevalence of early or late mortality and the main causes of death in different phases of acute pancreatitis. Analysis of mortality is important for the determination of ways to improve the results of treatment of pancreatic necrosis. Aim of the research is analysis of the structure, timing characteristics and causes of deaths in pancreatic necrosis, the effect of the configuration of parapancreatitis and surgical tactics on the outcome of the disease. Materials and methods. Retrospective single-center study of lethal outcomes in acute pancreatitis was performed, the structure of mortality, cases of discrepancies in diagnoses, the timing of the onset and causes of deaths of patients were studied. The lethal outcomes were compared in the operated patients, the frequency of the mesentery root involvement, the indications and the timing of the interventions were assessed. Results. The ratio of early and late mortality was 45,2% to 54,8%, respectively. The main causes of early mortality – endotoxin shock and multi-organ failure, late one – infectious complications. In 9,6% of the patients, the diagnosis was made only with an autopsy. The prognostic value of the SOFA and SAPS II scales is characterized as low. The tactics of surgical treatment has changed in favour of minimally invasive surgery. The average conversion time for ineffective percutaneous procedures was 21,4 days. The involvement of mesentery in parapancreatitis was often accompanied by a breakthrough of the abscess into the abdominal cavity. Conclusion. The surgical component of the reduction in mortality is the rejection of unreasonable surgical interventions, the earlier conversion to "traditional" operations in case of ineffective minimally invasive treatment and the allocation of "central" localization of parapancreatitis as a serious prognostic factor of the course of severe pancreatitis.

The article presents a clinical case of successful hybrid minimally invasive treatment of acute severe biliary necrotizing pancreatitis complicated by acute infected necrotic and fluid collections, abdominal sepsis. Endoscopic transgastric sequestrectomy in combination with polypositional percutaneous drainage and staged sanitation and drainage interventions allowed to avoid the traditional surgical treatment.

Aim of the study is to evaluate efficacy of different methods of minimally invasive treatment of pancreatic pseudocysts (PPC). Methods. A single center retrospective study of patients with pancreatic pseudocysts (n = 17): 90 males (76.9 %), 27 females (23.1 %) aged 25 to 72 years. The patients underwent external percutaneous drainage (group 1, n = 96) or internal drainage (group 2, n = 21). The diagnosis of pseudocysts included clinical, laboratory (biochemical and bacteriological) and special investigation methods: radiological, endoscopic, ultrasound examination of hepatobiliary zone, computer tomography. Results. Complications in the early postoperative period were observed in patients from both groups 1 and 2. They were related to inefficacy of cystodigestive anastomosis, which required percutaneous drainage in 2 cases (9.5 %), or to formation of pancreatic fistula. Lethal outcomes were not observed. Readmission to surgical department for removal of the drainage was required in 28 (23.9 %) patients from group 1. Internal drainage is considered more advantageous for PPC decompression compared to external one due to persistence of pancreatic fluid passage through gastrointestinal tract. External drainage is associated with frequent external pancreatic fistulae formation as well as prolonged hospital stay and treatment in an outpatient setting worsening the quality of life, but it is an intervention of choice in somatically severely ill patients, in fast growing cyst, imperfectly formed wall and threatening cyst rupture into abdominal cavity or abscess. These aspects prevent from refusal from external drainage for PPC treatment. Conclusion. When choosing the optimal time and type of surgical intervention in PPC, the surgeon should evaluate localization, sizes, maturation of PC wall and its relation to pancreatic duct, somatic state and patient’s individual features.