Annals of HPB Surgery

Aim . To determine optimal timing for laparoscopic cholecystectomy in elderly and senile patients with cholecystostomy. Materials and methods . Treatment results of 37 patients aged 60 years and over at different terms after cholecystostomy formation were analyzed. The degree of senile asthenia, concomitant diseases, technical features of surgical aid, dynamics of the postoperative period, as well as morphological features of inflammatory changes in the gallbladder wall were assessed. Results . Pre-asthenia was detected in 12 (32%) patients, mild senile asthenia – in 14 (38%) patients, and moderate senile asthenia – in 11 (30%) patients. Polymorbidity was determined in all patients, with 23 patients having four or more diseases. In 3 (8%), 15 (40.5%), 15 (40.5%), and 4 (11%) cases, laparoscopic cholecystectomy was performed 3–9 days, 10–30 days, 2–6 months, and 6 months or more (1 conversion) after cholecystostomy. Conclusion . In elderly and senile patients, laparoscopic cholecystectomy performed 10–30 days after cholecystostomy is optimal, safe, and affordable. Radical intervention in this period is not associated with technical difficulties. Reduced terms of external drainage of the gallbladder contribute to improving the elderly patient’s quality of life and their social adaptation, while shortening the period of postoperative recovery. When planning surgical interventions in a patient over 60 years old, account should be taken of comorbidities, polypragmasy, and senile asthenia.

P. S. Vaganova

G. G. Melkonyan

I. M. Buriev

S. A. Kachurin

V. V. Pchelin

Annaly khirurgicheskoy gepatologii = Annals of HPB surgery

Optimization of cholecystectomy timing during staged treatment of acute cholecystitis in elderly and senile patients with cholecystostomy

老年及高龄急性胆囊炎患者分期治疗中胆囊切除术时机的优化

Aim . Evaluation of the first distant results of the combined experience of liver transplantation for unresectable portal cholangiocarcinoma from two large specialized clinical centers. Materials and methods . In total, 23 attempts at liver transplantation for unresectable Klatskin tumor were undertaken. Out of them, 10 were conducted at the A.M. Granov Russian Research Center for Radiology and Surgical Technologies (Granov Center), and 13 were conducted at the Minsk Scientific and Practical Center for Surgery, Transplantology, and Hematology (Minsk Center). The maximum tumor size was 5 and 3 cm in patients operated at the Granov and Minsk Centers, respectively. In the Granov Center, neoadjuvant therapy included a combination of endobiliary photodynamic therapy, regional and systemic chemotherapy. Patients were included in the waiting list only in cases of decreased tumor marker levels and in the absence of disease progression and acute cholangitis. In the Minsk Center, stereotactic radiotherapy was used for neoadjuvant treatment in the absence of active cholangitis; the first 3 patients underwent liver transplantation without prior neoadjuvant treatment. Results . Due to disease progression, six patients were excluded. In three patients at the Mink Center, the diagnosis was not morphologically confirmed after liver transplantation. A total of 14 liver transplantations were performed for unresectable hilar cholangiocarcinoma. After neoadjuvant treatment at the Granov Center, normalization of the CA19-9 marker was observed in four patients, its decrease by 3–4 times was observed in two patients. Liver transplantation was performed in six patients. The average time from the onset of treatment to transplantation was 9.1 months (6–14). Out of the six patients, one was alive for 34 months, with the median overall survival being 22.2 months. Progression was the cause of death in only one patient. Out of the three patients without neoadjuvant treatment at the Minsk Center, two were alive at 16 and 134 months without progression. One patient died after transplantation from disease progression at 24 months. Stereotactic radiotherapy achieved normalization of CA19-9 in four patients; its twofold reduction was observed in one patient. The average time from the onset of treatment to transplantation was six months (3–12). The average CA19-9 tumor marker level by the time of transplantation was 11.3 IU/mL. At 20–26 months, three patients were alive without evidence of disease progression; two patients died of progression after 9 and 59 months. Conclusion . Liver transplantation for unresectable portal cholangiocarcinoma after neoadjuvant treatment regardless of the methods used is highly promising in carefully selected recipients.

D. A. Granov

V. N. Zhuikov

I. I. Tileubergenov

A. V. Moiseenko

I. O. Rutkin

A. R. Sheraliev

A. A. Polikarpov

O. O. Rummo

A. E. Shcherba

I. P. Shturich

S. V. Korotkov

L. V. Kirkovsky

T. M. Chernishov

Liver transplantation for unresectable Klatskin tumor: experience of two centers, first distant results

不可切除的Klatskin肿瘤肝移植：两家中心的首批远期结果

Aim . To determine specific features, frequency, and structure of complications, immediate and long-term results of liver transplantation in elderly patients. Materials and methods. Data on 529 liver transplantations performed consecutively in one medical center from 2010 to 2023 were analyzed. In 386 (73%) cases, the right lobe of the liver of related donors was used for transplantation. At the time of surgery, the patient age ranged from 18 years to 71 years, with 57 (11%) patients being over 60 years old, 215 (40%) patients aged 44–59 years, and 257 (49%) patients aged 18–44 years. Results . Prior to operation, elderly patients were statistically significantly more often diagnosed with arterial hypertension (n = 19; 33%), diabetes mellitus (n = 12; 21%), and on average a reduced glomerular filtration rate (82 ml/min/1.73m2 ). The most frequent indication for transplantation in this group was hepatocellular carcinoma in the setting of cirrhosis (n = 19; 33%). No statistically significant differences in other preoperative characteristics, parameters of donors and operations, peculiarities of the course of the early postoperative period, frequency, structure of complications and lethal outcomes were found. The one-, five-, and ten-year survival rates for recipients over 60 years old were 82%, 72%, and 36%; for recipients aged 44–59 years old – 88%, 79%, and 70%; and for recipients aged 18–44 years old – 86%, 80%, and 74%, respectively. Conclusion . In the studied cohort, older age was not associated with excessive risks of complications and early postoperative mortality. Given the higher prevalence of comorbidities in this group, preoperative examination should be aimed at, among other things, diagnostics of possible (hidden) cardiovascular and oncologic diseases. The development and introduction of new cardio-, nephro-, and oncoprotective regimens of immunosuppressive therapy seems to be an important measure not only for the surgical treatment of elderly patients, but also for recipients living with a transplanted liver for a long time.

S. E. Voskanyan

A. I. Sushkov

V. S. Rudakov

I. Yu. Kolyshev

M. V. Popov

E. V. Naydenov

D. S. Svetlakova

A. S. Lukyanchikova

A. N. Pashkov

M. Muktarzhan

A. E. Kalachyan

V. E. Syutkin

A. I. Artemiev

Specifics and results of liver transplantation in elderly patients

老年患者肝移植的细节与结果

Aim . To evaluate immediate and long-term results of surgical reconstruction of the biliary system in various types of benign obstructive jaundice. Materials and methods . The study enrolled 110 patients with choledocholithiasis, iatrogenic biliary strictures, common bile duct strictures, as well as strictures of biliodigestive and biliobiliary anastomoses. Patients were divided into 3 groups. Group 1 included 43 patients with multiple choledocholithiasis and bile duct dilatation &gt;15 mm. Group 2 enrolled 35 patients with multiple choledocholithiasis and hepaticolithiasis who were intraoperatively diagnosed with stricture, injury, or pressure ulcers of the common bile duct wall. Group 3 included 32 patients with cicatricial and iatrogenic biliary strictures. The immediate and long-term results of surgical treatment were compared. Results . In group 1, the survival rate comprised 89.4%, the average duration of surgery amounted to 137 minutes, complications involved wound infection, bile leakage, bile peritonitis. In group 2, the survival rate accounted for 91.4%, the average duration of surgery comprised 192 minutes; strictures of biliodigestive anastomosis were detected in the remote period, and reconstructive surgeries were performed. Group 3 revealed the survival rate of 100%, the average duration of surgery of 215 minutes, and no complications in the long term. Conclusion . The diameter of the common bile duct, its wall changes, size of gallstones, signs of cholangitis, patency of the bile papilla, and localization of biliary stricture determine the surgical tactics, when performing biliary reconstruction in patients with non-cancerous obstructive jaundice. In case minimally invasive surgery is found impossible under conditions of multiple choledocholithiasis, common bile duct diameter &gt;15 mm, and preservation of its wall, choledocholithotomy with Kerr drainage is considered to be optimal. In case of damage to the CBD wall and patency of the bile papilla, preference shall be given to hepaticoenterostomy. Bile duct reconstruction with stent drainage is indicated for treatment of cicatricial and iatrogenic biliary strictures.

K. O. Semash

T. A Dzhanbekov

M. M. Akbarov

T. Z. Gaybullaev

Reconstructive interventions on bile ducts in patients with benign obstructive jaundice

良性梗阻性黄疸患者胆管的重建干预

Aim . Establishment of versatile mechanisms behind liver damage in mechanical jaundice of non-tumor genesis combined with acute obstructive cholangitis or acute biliary pancreatitis. Materials and methods . In total, 64 cases of mechanical jaundice developed against the background of cholelithiasis were studied. Group 1 included 30 patients with mechanical jaundice combined with cholangitis; group 2 included 34 patients with acute biliary pancreatitis. Bile duct reconstruction was performed by an open method followed by standardized treatment. The intensity of membrane lipid peroxidation was determined by the level of diene conjugates, malonic dialdehyde, superoxide dismutase activity, and the activity of phospholipase A2. The severity of endotoxemia was estimated; a molecular-genetic test of the polymorphism of antioxidant system genes was performed. Results . The significance of the gene polymorphism of antioxidant enzymes in the formation of systemic alterative phenomena and severity of liver damage in mechanical jaundice complicated by cholangitis or acute pancreatitis was determined by allocation of patient subgroups depending on the presence of mutant allele T in the gene of superoxide dismutase SOD2 (C1147T). The groups of patients with the presence of such polymorphism, regardless of the combined diseases, demonstrated more pronounced and prolonged liver functional disorders and homeostasis disorders after restoration of biliary tract patency. Conclusion . The presence of mutant alleles of the SOD2 gene (C47T) in patients with non-tumor mechanical jaundice combined with acute cholangitis or pancreatitis is associated with an increase in the intensity of damage mechanisms at the systemic level, primarily with membrane lipid peroxidation, which correlates with the severity of liver damage (r = 0.834–0.967; p &lt; 0.05).

I. P. Vlasov

V. A. Trofimov

T. I. Vlasova

N. S. Sheiranov

Sh. S. Al-Kubaisi

C. M. Dukhovnova

O. Yu. Rubtsov

N. A. Okunev

Metabolic and genetic basis of liver damage in mechanical jaundice of non-tumor genesis in obstractive cholangitis or biliary pancreatitis

非肿瘤性梗阻性胆管炎或胆汁性胰腺炎机械性黄疸中肝损伤的代谢和遗传基础

G. G. Akhaladze

D. G. Akhaladze

Abstracts of foreign publications

外国出版物摘要

Article Editorial

Resolution of XXX International Congress of Hepato-Pancreato-Biliary Association of Commonwealth of Independent States 4–6 October 2023, Dushanbe, Tajikistan

XXX国际肝胰胆协会独立国家联合体大会决议 2023年10月4-6日 塔吉克斯坦杜尚别

Publication Information	Publisher: VIDAR Publishing House，Publishing cycle: ，Journal Type: journal，Open Access Journals: No
Basic data	Year of publication: 2019，Proportion of original research papers: 0.00%，Self Citation Rate:N.A.， Gold OA Rate: 0.00%

Annals of HPB Surgery

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Optimization of cholecystectomy timing during staged treatment of acute cholecystitis in elderly and senile patients with cholecystostomy

Liver transplantation for unresectable Klatskin tumor: experience of two centers, first distant results

Specifics and results of liver transplantation in elderly patients

Reconstructive interventions on bile ducts in patients with benign obstructive jaundice

Metabolic and genetic basis of liver damage in mechanical jaundice of non-tumor genesis in obstractive cholangitis or biliary pancreatitis

Abstracts of foreign publications

Resolution of XXX International Congress of Hepato-Pancreato-Biliary Association of Commonwealth of Independent States 4–6 October 2023, Dushanbe, Tajikistan

Optimization of cholecystectomy timing during staged treatment of acute cholecystitis in elderly and senile patients with cholecystostomy

Liver transplantation for unresectable Klatskin tumor: experience of two centers, first distant results

Specifics and results of liver transplantation in elderly patients

ISSN	1995-5464, 2408-9524
h-index	6