[BNP measurement for perioperative management]

BACKGROUND

It is difficult to evaluate the tolerance to anesthesia of patients undergoing operations, who have risk factors of congestive heart failure, such as hypertension, old age or various cardiac diseases. BNP (B type natriuretic peptide) is a useful biomarker as a screening tool for LV dysfunction. Therefore we hypothesized that the measurement of BNP may be useful for perioperative management of these patients.

METHODS

Subjects were 101 (58 male and 43 female) gastro-intestinal cancer patients, aged 30 to 91 years (mean 63.9 +/- 12.4) scheduled for intraperitoneal surgery. All patients' plasma BNP concentrations were measured when the patient agreed to the operation. Forty-five patients were enlisted for remeasurements on 2 or 4 postoperative days. We checked patients' backgrounds, perioperative circulatory characteristics and cardiac events. The relationship of BNP to other characteristics and cardiac events were analyzed.

RESULTS

The preoperative mean BNP of patients under 55 years of age (n=20) was 20.4, in patients age 55 to 74 (n=60) it was 30.4, and in patients 75 years and over (n=21) it was 162.1. BNP in elderly patients was higher than in the younger. The mean BNP of the 44 patients with some complications (hypertension, ECG abnormality, cardiac disease etc.) was 97.8, as compared to 23.3 in the 57 patients without complications. The BNP was higher in patients who were elderly, had some cardiac disease, lower exercise capacity, chest X ray abnormality or who needed an echo cardiographic examination. Among the 45 patients who were checked pre and postoperatively, 19 patients' BNP increased postoperatively, while 26 patients showed no change or decrease. Excluding 2 patients, with newly onset congestive heart failure during the postoperative period, the preoperative mean BNP was 63.5, and the postoperative mean BNP was 54.6. During the perioperative period, there was no significant change of BNP. There was no relationship between the BNP and perioperative circulatory characteristics or cardiac events. There were 5 cases with high BNP levels (> 300). None of these patients had cardiac symptoms, and they had normal LV systolic function. It is probable that these patients had chronic heart failure due to LV diastolic dysfunction and risks of perioperative heart failure.

CONCLUSIONS

We cannot predict any circulatory characteristics and cardiac events from preoperative BNP measurement; however BNP measurement is useful for screening asymptomatic chronic heart failure due to LV diastolic dysfunction.

Laparoscopic gastrojejunostomy in patients with obstruction of the gastric outlet secondary to advanced malignancies

Surgical palliation is an important therapeutic goal in patients with gastric outlet obstruction from cancer. The use of laparoscopic approaches for this condition has not been well studied. Our objective is to compare surgical outcomes of laparoscopic and open gastrojejunostomies in patients with gastric outlet obstruction secondary to advanced malignancies. We did a retrospective review of 20 patients who underwent a palliative gastrojejunostomy as their primary surgical procedure. There were 10 patients in the laparoscopic group and 10 patients in the open one. We identified no significant difference between groups in mean surgery time (116 vs 116 minutes) (P = 0.99), blood loss (23 vs 142 mL) (P = 0.19), or length of stay (8 vs 14 days) (P = 0.14). We also identified no difference in median time to tolerate a regular diet (7 vs 8 days) (P = 0.49) and median survival (11.2 vs 9.0 months) (P = 0.83). Delayed gastric emptying was the most common complication occurring in four patients. There is no detectable difference in surgical outcomes between laparoscopic and open gastrojejunostomies in the management of patients with obstruction of the gastric outlet secondary to cancer. Laparoscopic gastrojejunostomy is a safe and feasible operation in this setting.

[The role of minimally invasive surgery in the diagnosis and treatment of tumors in children]

The paper aims to define the actual place and benefits of the minimal invasive techniques in the diagnosis and treatment of tumors in children. There are reviewed the indications, limits and complications of this method in digestive tract, liver, pancreatic, adnexal, testicular and renal tumors, in lymphomas, as well as in tumors with intra-thoracic location. The benefits of the minimal access approach, such as the decrease of the parietal complications as well as the negative impact of the surgical act upon the body have a particular significance in pediatric cancer patients. Their quicker recovery allows an early subsequent initiation of the chemo- or/and radiotherapy. Within the complex treatment of tumors in children, the minimal invasive surgery has a diagnostic value through inspection and directed biopsy. The laparoscopic inspection decreases the number of non-therapeutic laparotomies in non-operable patients with tumors that were not preoperatively diagnosed using imaging methods. The laparoscopic resection of the tumors within oncological limits is possible in the localized types (stage I). As a particular aspect of the laparoscopic approach in children, it is worth mentioning the difficulties related to the necessity of using adequate-size instruments and to the less favorable relation between the size of the tumor and the diminished working space.

[Hyponutrition prevalence among patients with digestive neoplasm before surgery]

OBJECTIVE

To analyze the prevalence and degree of hyponutrition among patients with resectable digestive neoplasm that will be submitted to surgery.

MATERIAL AND METHODS

Observational cross-sectional descriptive study carried out from november of 2005 to march of 2006, assessing the nutritional status of all patients aged > or = 18 years with resectable digestive neoplasm submitted to scheduled surgery at the General and Digestive Surgery Department of the Hospital Complex of Orense (Spain). Eighty patients were studied, 41 men and 39 women aged 27-92 years.

RESULTS

Diagnosis categorization was as follows: colonic neoplasm 27 patients, rectal neoplasm 24, gastric neoplasm 23, and pancreatic neoplasm 6. Fifty-three percent of the patients assessed had lost 5% of their usual weight within the previous 3 months. Serum albumin levels were lower than 3.5 mg/dL in 49% of the cases. Patient-Generated Subjective Global Assessment shows a hyponutrition prevalence of 50% (29% with moderate hyponutrition or at risk for hyponutrition and 21% with severe hyponutrition). Hyponutrition was related to age, increasing with increasing age (p < 0.05), and to the kind of digestive neoplasm (higher prevalence among patients with gastric neoplasm).

CONCLUSIONS

Hyponutrition prevalence among patients with resectable digestive neoplasm is high. There is a similarity between the relative data relating to percentage of weight loss, serum albumin levels, and nutritional assessment obtained by applying the Patient-Generated Subjective Global Assessment. Further studies on hyponutrition prevalence among oncologic patients at our setting would be desirable.

Treatment of gastroenteropancreatic neuroendocrine tumors

Neuroendocrine tumors are rare; thus, individual experience with the diagnosis and treatment of these tumors is mostly low, except in specialized centers. For histological diagnosis, standards have been described recently. Pathological classification and clinical staging influence diagnostic and therapeutic decisions. This chapter aims at demonstrating the importance of pathological and clinical classification of neuroendocrine tumors on therapeutic decisions, indicating the appropriate therapy for different stages of the disease. Surgical therapy will be discussed shortly, including palliative surgical strategies. However, the focus of the manuscript is medical therapy. Biotherapy, its effects, and remaining uncertainties are presented as well as different chemotherapeutic schemes. Finally, new options of palliative medical therapies like kinase inhibitors and anti-angiogenetic drugs will be discussed.

Interleukin-18 restores immune suppression in patients with nonseptic surgery, but not with sepsis

BACKGROUND

We investigated cellular immune responses, in particular interferon gamma (IFN-gamma) production, by peripheral blood mononuclear cells (PBMCs) in patients with septic and nonseptic surgical stress, focusing on interleukin (IL)-18 and its receptor (IL-18R).

METHODS

Thirty-two patients with alimentary tract carcinoma who underwent elective surgery (OP) and 26 septic patients (SP) with peritonitis were enrolled in this study. Blood was collected on the first postoperative day (POD1), POD5, POD10, and POD15 in the OP group and on the emergency admission in the SP group. Ten healthy volunteers served as controls. PBMCs were cultured in the presence of anti-CD3 antibody or IL-2 and IL-12, with or without additional IL-18 stimulation, to measure IFN-gamma production. IL-18R expression on CD56+ NK (natural killer) cells was evaluated by flow cytometry.

RESULTS

IL-2- and IL-12-induced IFN-gamma production by PBMCs was suppressed significantly in both the OP (POD5) and SP groups compared with that in healthy controls. Interestingly, additional IL-18 stimulation up-regulated IFN-gamma production by PBMCs in the OP group as well as the control group, but not in the SP group. IL-18R expression on CD56+ NK cells was maintained consistently in the OP group as well as the control group, but decreased in the SP group.

CONCLUSIONS

IFN-gamma production induced by cytokines (IL-2 and IL-12) was suppressed in PBMCs from both patients with sepsis and those who had undergone elective surgery. However, IL-18R expression on CD56+ NK cells was different between patients with sepsis and nonseptic surgical stress. Our results suggest that exogenous IL-18 administration may be effective in preventing immune suppression in patients with nonseptic elective surgery.

Hemorrhage after pancreaticoduodenectomy: when is surgery still indicated?

BACKGROUND

This study analyzed presentation and management of hemorrhage after pancreaticoduodenectomy (PD) to determine the respective role of surgery and embolization.

METHODS

From January 1992 to March 2005, 411 patients underwent PD and were analyzed with regard to postoperative hemorrhage.

RESULTS

Hemorrhage occurred in 27 patients (7%), either within the first 3 postoperative days ("early" hemorrhage, n = 11) or after day 8 ("delayed" hemorrhage, n = 16, including 4 with "sentinel" bleeding). At the time of bleeding, 12 patients (44%) (all with delayed hemorrhage) had associated abdominal complications. Two patients had successful conservative treatment. Two stable patients with pseudoaneurysm, diagnosed by computed tomography scan, underwent successful embolization. Four patients with active bleeding underwent unsuccessful angiography. Overall, 23 patients were reoperated on without any completion pancreatectomy, 3 rebled, and 3 (11%) died (including 2 with delayed hemorrhage).

CONCLUSIONS

Both embolization and surgery have a role in the management of hemorrhage after PD. For early hemorrhage, reoperation is appropriate. In case of sentinel bleeding, pseudoaneurysms can be detected by computed tomography scan and treated by embolization. For delayed active hemorrhage, reoperation is still indicated.

Distal pancreatectomy: risk factors for surgical failure in 302 consecutive cases

OBJECTIVE

The objective of this study was to identify potential risk factors for mortality and morbidity after distal pancreatectomy, with special focus on the formation of pancreatic fistula.

SUMMARY BACKGROUND DATA

Distal pancreatectomy can be performed with low mortality and acceptable morbidity rates. Pancreatic fistulas, occurring in 10% to 20% of cases, remain a problem that contributes significantly to morbidity, length of stay, and overall costs.

METHODS

From November 1993 to February 2006, perioperative and postoperative data of 302 consecutive patients were recorded. Univariate and multivariate analyses of potential risk factors for morbidity and for the formation of pancreatic fistula were performed. The surgical techniques used for closure were categorized into 4 groups: 1) anastomosis, 2) seromuscular patch, 3) closure by suture, and 4) closure using a stapling device.

RESULTS

Indications for resection were pancreatic tumors in 62% of patients, nonpancreatic tumors in 23%, chronic pancreatitis in 12%, and others in 3%. The spleen was preserved in 24% of patients. The morbidity and mortality rates for distal pancreatectomy in this series were 35% and 2%, respectively. The prevalence of pancreatic fistula was 12%. Univariate and multivariate analyses indicated that closure using a stapling device and an operating time >or=480 minutes were associated with a higher incidence of pancreatic fistula (odds ratio = 2.6 and 4.2, respectively). Overall morbidity was mainly influenced by the extent of resection (multivisceral vs. conventional; odds ratio = 1.7).

CONCLUSION

Pancreatic leak remains a common complication after distal pancreatectomy. Our series suggests that stapler closure of the pancreatic remnant is associated with a significantly higher fistula rate.

Neutrophil elastase inhibitor (sivelestat) preserves antitumor immunity and reduces the inflammatory mediators associated with major surgery

PURPOSE

To examine the effects of the administration of perioperative sivelestat, a selective neutrophil elastase inhibitor, on tumor immunity and inflammatory mediators in patients who undergo major surgery.

METHODS

Thirteen patients admitted to the hospital for elective surgery were equally randomized into one of two groups: the Sivelestat group (n = 6) and the control group (n = 7). Thereafter, the immunosuppressive acidic protein (IAP), serum interleukin-6 (IL-6), and type 1/type 2 T-helper cell balance were all assessed at several time points before and after surgical intervention.

RESULTS

The serum IL-6 values at 1 and 12 h after surgery and on postoperative days 1 and 3 were all significantly lower in the sivelestat group than in the control group. The IAP values at postoperative days 7 and 28 in the sivelestat group were also significantly lower than those in the control group. There was a significant correlation between the IL-6 level at 1 h after surgery and the IAP level at postoperative days 7 and 28.

CONCLUSIONS

In this preliminary study, the perioperative administration of sivelestat was thus suggested to reduce surgical stress by decreasing the cytokine release and preserving the antitumor immunity.

The role of echo-laparoscopy in abdominal surgery: five years' experience in a dedicated center

BACKGROUND

For more than 20 years intraoperative ultrasonography (IOUS) has been considered an important diagnostic tool in abdominal surgery. In the last few years, with the spread of laparoscopic surgery, echo-laparoscopy (LIOUS) has gradually replaced open ultrasonography, aiming to achieve similar results.

METHODS

LIOUS was performed using an ALOKA 5.500 device, provided with a linear flexible laparoscopic probe that was compatible with a 10-mm port. IOUS was performed by means of a linear side-view, T-shaped or microconvex probe. The probes were sterilized with hydrogen peroxide. No water bath was used during the surgical examination, but full contact of the probe with the surface of the involved organ was always attempted. From 2001 to 2005, 36 liver resections, 40 pancreas procedures, 203 procedures for suspected common bile duct calculi, 541 colon and 82 stomach resections, and 82 adrenal surgery procedures were performed. IOUS or LIOUS was performed in 432 patients (43.8%). All livers and pancreases underwent intraoperative ultrasound, while biliary, colonic, gastric, and adrenal pathologies were selectively studied when there were doubts about the location and extension of the disease.

RESULTS

IOUS and LIOUS were valuable diagnostic procedures, supplying relevant clinical information in 65.1% of the patients and modifying the surgical approach in 17.2%. LIOUS was used instead of cholangiography to study bile ducts when lythiasis was suspected, achieving high diagnostic specificity (98%) and accuracy (100%). Surgical anatomy of the bile ducts was correctly identified by LIOUS in every case.

DISCUSSION

In our experience IOUS and LIOUS were of the utmost importance in better defining staging of disease, infiltration of neighboring structures, number and size of nodular lesions, and anatomy of the hepatic pedicle and intrahepatic structures, thus making it possible to more accurately plan surgical procedures.

[Erythropoietin levels in perioperative period in cancer patients]

Anemia is frequent in cancer patients, is the result of decreased erythropoietin production. In fact in cancer, alteration of immune system alters iron metabolism and inhibits erythropoietin production. In this study we proposed to determine the profile of erythropoietin secretion in anaemic cancer patients in the pre and postoperative period. Our prospective study from January to March 2005 included 41 anemic cancer patients from 30 to 79 years old and 31 healthy individuals with iron deficiency anemia. A measure of erythropoietin, CRP, ferritin, iron levels and hemoglobin were released in healthy individuals and in cancer patients in preoperative period (J0) and postoperative period (J3, J8, J21). In preoperative period, the increase of serum erythropoietin was significantly lower in patients than in healthy individuals. In postoperative period, the levels of erythropoietin at J3 and hemoglobin's at J8 and J21 were significantly higher than in preoperative period (J0) (p < 0.05). In conclusion, despite the presence of inflammatory syndrome caused by surgery, cancer patients with anaemia increase their erythropoietin production in immediate postoperative period.

Intraoperative assessment of the Whipple resection specimen

Intraoperative consultation for the Whipple resection procedure has evolved due to the increasing influence of imaging techniques in surgical planning and decision-making. The indications and utilisation of this service vary, at least to some degree, from one institution to the other. The following discussion is a single institutional approach, which is hoped to provide assistance to the practising pathologists in this field. Special emphasis is given to the relevant anatomical considerations and the most common indications for an intraoperative consultation.

Can pretreatment CT perfusion predict response of advanced squamous cell carcinoma of the upper aerodigestive tract treated with induction chemotherapy?

BACKGROUND AND PURPOSE

Treatment of advanced stage squamous cell carcinoma of the upper aerodigestive tract with nonsurgical organ preservation protocols demonstrates improved cure rates with fewer comorbidities compared with surgery and radiation. The purpose of this study was to prospectively assess whether pretreatment evaluation of the primary site with quantitative CT perfusion measurements predicted response to induction chemotherapy and to create a prediction model to predict the response to induction chemotherapy in future patients.

METHODS

Seventeen patients who were enrolled in a prospective trial assessing surgical intervention versus a nonsurgical protocol underwent a pretreatment CT perfusion followed by direct laryngoscopy. After induction chemotherapy, tumor response was determined by the surgeon's estimate of tumor volume. The CT perfusion parameters were correlated with the clinical response using a Wilcoxon rank-sum analysis. A logistic regression model was used to create a prediction based on the most significant CT perfusion parameter.

RESULTS

Elevated values of blood volume (P = .004) and blood flow (P = .03) were significantly correlated with >50% reduction in tumor volume after chemotherapy. A prediction model based on tumor blood volume demonstrated 91.7% sensitivity and 80.0% specificity, with an area under the receiver operating characteristic curve of 0.95.

CONCLUSION

Our preliminary data imply that tumors with elevated blood volume and blood flow were statistically associated with response to induction chemotherapy. These results suggest that pretreatment CT perfusion may be able to identify patients who will successfully respond to induction chemotherapy, which could potentially eliminate this step for subsequent patients when deciding on the appropriate treatment regimen.

The effect of stress-reducing, low-dose ethanol infusion on frequency of bleeding complications in long-term alcoholic patients undergoing major surgery

Perioperative low-dose ethanol infusion is a feasible option for stress reduction and prophylaxis of alcoholism-associated complications. Because alcohol has inhibitory effects on hemostasis, our study focused on the effect of perioperative low-dose ethanol infusion on bleeding complications, defined as transfused blood units and reoperations, in alcoholic patients undergoing major surgery. We included 44 long-term alcoholic patients scheduled for tumor resection of the aerodigestive and gastrointestinal tract. Patients were randomly assigned to the ethanol or control group. Ethanol infusion (0.5 g ethanol/kg body weight/24 hours) started before surgery and was continued until the postoperative Day 3. Regarding all patients, there was no statistically significant difference in the amount of transfused blood between the ethanol and control groups. However, the effect of ethanol infusion on bleeding complications depended on the site of surgery. Ethanol infusion resulted in an increased number of transfused blood units in gastrointestinal patients and a decreased number of transfused units in patients undergoing tumor resection of the aerodigestive tract. In conclusion, perioperative ethanol infusion in long-term alcoholic patients with tumor resections of the aerodigestive tract is an option for stress reduction without increased risk for blood transfusion. In contrast, ethanol infusion in patients with tumor resections in the gastrointestinal tract could increase the risk for bleeding complications.

Pancreaticojejunostomy versus pancreaticogastrostomy: systematic review and meta-analysis

OBJECTIVE

Pancreaticojejunostomy (PJ) and pancreaticogastrostomy (PG) are the commonly preferred methods of anastomosis after pancreaticoduodenectomy (PD). The ideal choice of anastomosis remains a matter of debate.

DATA SOURCES

Articles published until end of March 2006 comparing PJ and PG after PD were searched.

STUDY SELECTION

Two reviewers independently assessed quality and eligibility of the studies and extracted data for further analysis. Meta-analysis was performed with a random-effects model by using weighted odds ratios.

DATA EXTRACTION AND SYNTHESIS

Sixteen articles were included; meta-analysis of 3 randomized controlled trials (RCT) revealed no significant difference between PJ and PG regarding overall postoperative complications, pancreatic fistula, intra-abdominal fluid collection, or mortality. On the contrary, analysis of 13 nonrandomized observational clinical studies (OCSs) showed significant results in favor of PG for the outcome parameters with a reduction of pancreatic fistula and mortality in favor of PG.

CONCLUSIONS

All OCSs reported superiority of PG over PJ, most likely influenced by publication bias. In contrast, all RCTs failed to show advantage of a particular technique, suggesting that both PJ and PG provide equally good results. This meta-analysis yet again highlights the singular importance of performing well-designed RCTs and the role of evidence-based medicine in guiding modern surgical practice.

[Surgery]

Indications for minimal invasive surgery are increasingly numerous. The treatment of oesophageal cancer presents a significant example. New multidisciplinary modalities allow, from now on, to push back the limits and to improve the results of hepatobiliary surgery. Several studies show a decrease in the significance of age but underline the importance of comorbodities among elderly patients, and therefore significantly increase indications to pancreatic, hepatic or colorectal surgery in this age group. Elective laparoscopy is now accepted without age limit. Sacral nerve stimulation is an important alternative to classical treatment of fecal incontinence. Peripheral transcutaneous neuromodulation for this condition is effective on both continence and quality of life.

Interventional pancreaticojejunostomy after pancreatoduodenectomy

BACKGROUND

Leakage from the pancreaticoenteric anastomosis after pancreatoduodenectomy (PD) is closely associated with intra-abdominal hemorrhage with ensuing high mortality.

METHODS

Interventional pancreaticojejunostomy was performed in 10 patients with external drainage of pancreatic juice after two-staged PD or leakage from pancreaticojejunostomy after PD. The jejunum was punctured using a 22-gauge needle into the pancreatic fistula during endoscopic observation of the jejunal lumen, followed by the insertion of two 0.35-inch guide-wires into the jejunum and pancreatic fistula. Finally, a stenting tube was placed between the jejunum and pancreatic fistula.

RESULTS

No severe complications developed. Oral intake was instituted the following day in 8 of 10 patients, and on the 7th day in the remaining two patients.

CONCLUSION

This interventional procedure is considered to be safe and easy to perform, and in the future, it may permit a reduction in the number of second laparotomies in pancreatic fistula.

[Influence of blood transfusion on development of infection in patients with malignant neoplasms of the digestive system]

BACKGROUND

Anemia affects up to 90% of cancer patients, with more than 60% requiring blood transfusion during or after treatment.

AIM

To determine the influence of the allogeneic blood transfusion as a possible related factor to infection in patients with malignant neoplasms of the gastrointestinal system.

PATIENTS AND METHOD

Charts of 400 oncological patients were randomly selected and divided into two groups: group 1 (n = 200)--patients submitted to allogeneic blood transfusion and group 2 (n = 200)--non transfused patients. Both groups were evaluated and compared according to the presence and type of infection and a possible association with age, sex, types of tumors and therapeutics approach.

RESULTS

The relation between infection and blood transfusion, as well as age, sex, management and type of presented tumors were not significant. There was no difference in the incidence of infection between the non transfused patients (28) and those submitted to allogeneic blood transfusion (31).

CONCLUSIONS

In the present investigation allogeneic blood transfusion was apparently not related to development of infection in patients with malignant gastrointestinal tumors.

Single-photon emission computed tomography in the screening for postoperative pulmonary embolism

The aim of the study was to evaluate the usefulness of serial lung perfusion scintigraphy prospectively using single-photon emission computed tomographic image (SPECT) in screening for pulmonary embolism (PE) after elective surgery for gastrointestinal malignancy. PE was examined pre- and postoperatively with SPECT. Diagnosis of PE was based on segmental perfusion defect visualization in at least two of three planes on a SPECT image compared with preoperative SPECT images. Final diagnosis was determined by detection of embolus with multidetector helical CT (MDCT). No perioperative anticoagulant was used. Thirty-four patients were enrolled. One patient was excluded because of thrombophilia. In preoperative scans, nonsegmental defects were detected in 11 and a segmental defect in 1 patient, who was then diagnosed as PE preoperatively. Among 21 patients with normal preoperative SPECT, 2 had nonsegmental and 5 had segmental defects postoperatively. Among 11 patients with nonsegmental preoperative SPECT, 7 had nonsegmental and 4 had segmental defects postoperatively. Postoperative segmental defects were differentiated by their shape only and there was no need to compare pre- and postoperative SPECT. MDCT confirmed four patients with PE among nine with segmental defects postoperatively. Our results of screening for PE by visualization at least two planes of SPECT images suggest that postoperative SPECT scan is suitable for the diagnosis of postoperative PE.

Intrahepatic cholangiojejunostomy following hepatobiliary resection

Background

Although intrahepatic cholangiojejunostomy is technically difficult, with recent improvements in surgery it should be possible to perform the anastomosis safely. The aim of this study was to evaluate the incidence of anastomotic leak after intrahepatic cholangiojejunostomy and to identify risk factors for such leakage.

Methods

Intrahepatic cholangiojejunostomy was performed in 423 patients undergoing hepatobiliary resection between January 1991 and December 2005. Anastomotic leak was proven radiographically by leakage from the anastomosis of contrast medium introduced via a biliary drainage tube placed during surgery.

Results

Anastomotic leak occurred in 27 patients (6·4 per cent), and was not related to the number of bile ducts reconstructed. The leak rate decreased significantly from 9·5 per cent (19 of 199) in the first 10 years to 3·6 per cent (eight of 224) in the last 5 years. Anastomotic leak was often followed by infections such as wound infection, intra-abdominal abscess and bacteraemia. Multivariable analysis identified age and intraoperative blood loss as independent risk factors for anastomotic leak. All leaks were treated by maintaining a prophylactically placed drain near the cholangiojejunostomy; neither repeat laparotomy nor percutaneous transhepatic biliary drainage was required.

Conclusion

Although demanding, intrahepatic cholangiojejunostomy can be performed successfully with a relatively low failure rate. Routine use of prophylactic drains and anastomotic stenting allows safe management of anastomotic leak with conservative therapy.

[Role of antisecretory therapy in prophylaxis and treatment of postoperative stress ulcers of the digestive tract in patients with malignant tumors using preparation omez]

The prophylaxis and treatment methods of the gut stress ulcers and gastrointestinal bleeding in early postoperative period in patients suffering malignant tumors of abdominal cavity organs were presented. High efficacy of proton pump inhibitor Omez in the injection form was noted for prophylaxis of the gut stress ulcers and gastrointestinal bleeding in early postoperative period. There was shown, that Omez constitutes one of the main components of complex antisecretory therapy of the gut stress ulcers and gastrointestinal bleeding in persons, operated on for oncologic disease.

[Anemia in patients with resectable tumour of periampullar zone organs as a risk factor of postoperative complications occurrence and its complex correction]

Results of treatment of 39 patients, to whom pancreatoduodenal resection was performed for periampullar zone tumour, were analyzed. Anemia, revealed before the operation, had constituted the factor, which trustworthily increased the postoperative complications occurrence risk. Therapeutic course, using recombinant erythropoietins, was conducted for correction of anemia in 7 patients. This had promoted the hemoglobin level raising, the risk of postoperative complications occurrence lowering, but did not influence the intraoperative blood loss severity and perioperative hemotransfusion volume.