[Pathophysiologically advisable operations on the biliary-hepatic-pancreatic system]

Nowadays, the modern operative treatment of biliary-hepatic-pancreatic diseases is pathogenetically substantiated. In lithiasis and cholecystitis removal of the gallbladder should be undertaken only after assessment of the patency and output of the biliary tree (i.e. from the biliary canal) following visual, instrumental and if necessary--manometric and intraoperative cholangiographic study. To eliminate an obstacle--calculus or postampullar papillitis--it is necessary to perform papillotomy or papilloplasty using a balloon catheter introduced through the choledochus and electric knife if practicable. Since 1970, an operation of the kind is carried out in 79 patients, and with deperitonization (denervation and delymphatization)--in eleven patients presenting cholangiohepatitis and biliopancreatitis. In twelve patients, owing to pathological changes in the preampullar portion of choledochus, choledochoduodenostomy according to a modified technique, type "frog mouth", is done in the distal choledochus with formation of a distal convex flap from the anterior wall of te choledochus with an anti-reflux effect. In pre-combined with postampullar stenosis papillotomy and papilloplasty are performed, and if necessary dilatation or osteowirsungotomy plus drainage. In unobstructued cholangiohepatitis and biliopancreatitis, it is sufficient to supplement cholecystectomy with Kehr drainage. The ideal echinococcotomy is done according to a personal modification through hydraulic stratification of the fibrous capsule (1958). Segmental resection is necessitated in marginal, petrified and suppurated cysts in 28 patients, and lobectomy--in two. Resections are performed by hydraulic and instrumental division and hemostasis along the lines of anatomical separation or in the pericyst space.