Aygun Gadirova’s scientific contributions

Secondary CBD stones are identified in 12-15% of cases of gallbladder stones. Treatment approach in such cases is cholecystectomy and extraction of stones from the CBD. Historically four treatment periods are distinguished. In 70-80-ies laparotomy and cholecystectomy + choledocholithotomy was performed. Since the 90's of last century endoscopic sphincterotomy with open cholecystectomy was performed. In the past 20 years diagnosis of choledocholithiasis were performed by MRCP, treatment consist of ERCP and laparoscopic cholecystectomy. In recent years one-step approach is being employed: laparoscopic cholecystectomy and CBD exploration or laparoscopic cholecystectomy and intraoperative endoscopic choledocholithotomy. In comparison with the classical two¬-stage approach one-stage one decreases length of hospital stay, treatment costs and complications.

The article contains modern information about the severity, diagnosis and treatment principles of intra-abdominal surgical infections.

In a patient with myasthenia gravis and vasculitis, thrombosis of the upper mesenteric artery and necrosis of the small and large colon were observed. Subtotal small bowel and right-sided hemicolectomy and primary anastomosis was performed, after 24-48 hours relaparoscopy was performed and the completeness of the anastomosis and intestine were confirmed.

The aim of the study is to assess the results of laparoscopic choledochoduodenostomy. During the period from 1998-2009 21 patients have undergone laparoscopic choledochoduodenostomy. The indication was a stricture of the distal common bile duct. In 9 patients, along with distal stricture choledocholithiasis had been revealed . In 8 cases, stricture had been diagnosed before surgery in the MRI, and in others as a result of intraoperative cholangiography. With 18 patients choledochoduodenostomy has been conducted simultaneously with cholecystectomy, and with 3 patients after cholecystectomy. Thus for the stricture of the distal common bile duct, laparoscopic choledochoduodenostomy is an alternative to sphincterotomy method of treatment.

The aim of this study was to compare preoperative MRCP and intraoperative cholangiog­raphy (IOCG) in patients with gallstone disease Material and methods. A total of 186 patients with gallstone disease and its complications enrolled for study. Three risk groups for common bile duct pathology were identified by standard preoperative date: high, middle and low risk groups. Results. There were 82 patients in the high risk group, 41 in middle and 63 in the low _risk group. CBD pathology was found in the 89 patients. The incidence CBD pathology in the high group was 72 (87, 8%), in the middle group was 10 (24, 3%) and in the low risk group was 7(11%). Results showed that by decreasing of risk from high to low degree the sensitivity of MRCP decrease (93%, 80% and 57%) but specifity increase (90%, 96%, 98%). MRCP showed low sensitivity and specifity in demonstration of the distal choledocheal stricture. Conclusion. Intraoperative cholangiography is indicated in all patients with high and middle risks for CBD pathology, its use in low risk patients depends on intraoperative findings. MRCP have low sensitivity and specifity for detection of distal choledocheal pathology.

Formation of fistula between the gallbladder and the gastrointestinal tract occurs as a complication of gallstone disease in 3-5% of cases. There are cholecysto-gastric, cholecysto-duodenal, cholecysto-jejunal and cholecysto-colic fistulas. Manifestation of thise pathology has no characteristic signs. We present rare case of cholecysto-colic fistula and the development of multiple liver abscesses.

Statistical parameters used in diagnostics are discussed in the article: sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy.

The outcomes of a retrospective analysis of 199 patients aged 14 to 76 having undergone simultaneous laparoscopic interferences for 2000 – 2009 are presented. Mini-invasive methods applied for managing patients of the 1st group (simultaneous pathology having been corrected laparoscopically in eighty nine patients) and the 2nd group (simultaneous pathology having been corrected both laparoscopically and traditionally in twenty six patients) allowed obtain positive results. The advantage of those mini-invasive methods application for diagnosis and management of gynecological patients having in addition abdominal pathologies consisted in a reduction of the patients staying in hospital, social and labor rehabilitation, optimal possibility for organ preserving surgeries performance, pain syndrome intensity and postoperative complications reduction thus resulting in the quality of life enhancement and combined operations carrying out within a single anestesiological provision.

A literature review shows that simultaneous laparoscopic operations reduce postoperative complications and recovery time, but many unsolved problems remain.

An analysis of randomized (1990-2008) and non-randomized (2007) studies of recent years shows that anastomotic leakage in the esophageal, pancreatic, biliary tract, and anorectal regions still occurs with high frequency. No means have been found to accelerate anastomotic healing, and the main focus is on eliminating local and general risk factors that impede anastomotic healing or their adverse effect. To avoid infection, inflammation, ischemia, necrosis, trauma, tension, compression and foreign bodies and connecting healthy and identical tissues remain the primary and absolute conditions for the prevention of anastomosis leakage.