Aim. To reduce the incidence of postoperative infectious complications after pancreatoduodenal resection using targeted perioperative antibiotic therapy. Materials and methods . The retrospective study included patients who had undergone pancreatoduodenal resection between 2019 and May 2023. The inclusion criterion was bacteriological examination of bile obtained both before and during surgery. Of the 249 patients who had undergone surgery, 108 were included in the study. The patients were divided into two groups: those with antibiotic-sensitive flora and those with resistant flora. Infectious complications were determined according to the criteria of the Russian National Association of Healthcare-Associated Infection Control Professionals. The probability of developing an infection and the need for repeat surgery or hospital readmission was assessed. Results . The probability of developing infectious complications in the group of patients with resistant flora was 57.5%, compared to 15% in the group with sensitive flora (p < 0.0001). The multivariate analysis found that baseline antibiotic resistance of bile bacterial flora and body mass index are independent predictors of the risk of infectious complications after pancreatoduodenal resection: HR = 5.17 (95% CI 2.15–12.5, p < 0.001) and 1.10 (95% CI 1.03–1.18, p = 0.007). Conclusion . Targeted perioperative use of antibiotics, taking the sensitivity of the bacterial flora of bile into account, contributes to a reduction in the frequency of infectious complications of pancreatoduodenal resection.
Intrahepatic bile duct disorders represent a serious problem for surgical doctors. The main reason for this is the access difficulties, which require great accuracy in biliary puncture drainage and subsequent lithoextraction. The considered clinical case demonstrates the complex desicion on antegrade access, lithotripsy, and lithoextraction X-ray surgery for the treatment of a patient with long-term cholangiolithiasis and liver segment VIII ductal stricture.
Objective . Analysis of the possibility and effectiveness of integrating intraoperative augmented reality into pancreatic surgery. Materials and methods . A search and selection of publications was conducted in peer-reviewed databases using the key phrases “augmented reality”, “3D modeling”, “surgical visualization”, and “intraoperative technology”. The search was limited to peer-reviewed publications in the English language. The analysis was supplemented by the authors’ own clinical observations of a mucinous cystadenoma of the tail of the pancreas with malignancy. During surgery, the technology of augmented reality with data recording in the Medgital Vision software and hardware complex was used. Results . Intraoperative augmented reality ensures the possibility of creating a “transparent” anatomy by forming 3D models of the pancreas, neoplasms, and vascular structures in real time. According to most authors, the use of augmented reality improves the visualization of the vascular bed in the surgical field. However, it does not significantly affect the duration of the operation and the amount of blood loss in all situations, which is confirmed by the results of the authors’ own observations. Conclusion . In order to increase the informative value of augmented reality technology and ensure its widespread application in surgical practice, studies involving large groups of patients are required for selecting markers for accurate spatial registration of 3D models. Augmented reality should be considered an important component of the emerging set of technologies for safe and accurate operations.
Aim. To evaluate the prognostic significance and clinical efficacy of preoperative risk scores in pancreatic fistula after pancreatic duodenal resection. Material and methods . The study included 60 patients with pancreatic and periampular malignancies who underwent pancreatoduodenal resection with Blumgart pancreato-jejunal anastomosis from 2022 to 2024. Postoperative pancreatic fistulas were diagnosed according to the criteria of the International Study Group of Pancreatic Surgery (ISGPS). The ROC analysis and diagnostic efficacy indicators were used to assess the prognostic accuracy. Results. Ten patients (16.67%) were diagnosed with postoperative pancreatic fistula. The ROC analysis showed comparable areas under the curve (AUC): alternative Fistula Risk Score (a-FRS) – 0.692; updated alternative FRS (ua-FRS) – 0.636; Kantor score – 0.656; Lapshyn score – 0.649. Lapshyn and a-FRS scores demonstrated the highest sensitivity (70%); while the ua-FRS score had the highest specificity (82%). The positive prognostic value of all scores remained low, with wide confidence intervals. Conclusion. Preoperative stratification of pancreatic fistula risk using scores may be a useful tool for individualizing surgical tactics. Despite moderate prognostic accuracy, their use promotes clinical alertness and a personalized approach. Prospective studies in large patient groups are needed to further improve prediction models.
Aim . To assess complications after percutaneous treatments for patients with liver hydatid echinococcosis. Material and methods . From 2004 to 2024, 102 patients with hepatic hydatid echinococcosis were treated with percutaneous therapy. Recurrent and complicated echinococcal cysts were reported in 9 (8.8%) and 6 (5.8%) patients, respectively. Results . Percutaneous treatments were successful in 100 (98%) patients. Postoperative complications developed in 28 (27.4%) patients, including residual bleeding, residual cavity infection, and cystobiliary fistula in 3 (2.9%), 4 (3.9%), and 21 (20.6%) cases, respectively. In 13 patients, cystobiliary fistulas closed spontaneously; in 6 patients, they closed after changing the drainage type. The presence of cystobiliary fistula significantly prolonged the duration of external drainage. The duration of external drainage in case of echinococcal cyst complicated by cystobiliary fistula was 87.0 ± 3.6 days; without cystobiliary fistula, the duration was 32.0 ± 2.8 days. Echinococcal cysts >70 mm were significantly more likely to develop cystobiliary fistula after surgery (p < 0.05). Conclusion. Cystobiliary fistula is the leading postoperative complication diagnosed in 20.6% cases. Its development affects the treatment policy and significantly increases the duration of external drainage. The size of an echinococcal cyst is a significant predictor of cystobiliary fistula formation after surgery.
