Background. Previously, we developed and described two technologies for angiographically-assisted percutaneous argon-helium cryoablation (PCA) of metastatic liver tumors and kidney cancer using flat-detector computed tomography (FD–CT) for visualization, navigation, monitoring, and assessment of the immediate treatment response. Furthermore, we have used FD–CT imaging and FD–CT navigation to perform PCA of metastatic lung and bone tumors, as well as cryoneurolysis. However, we have not yet presented either immediate or long-term results of using these new technologies.

Aim. To study the immediate and long-term results of using the technology of angiographically-assisted FD–CT-guided PCA of hypovascular liver metastases, kidney tumors and FD–CT-guided PCA of lung metastases. Materials and methods. Between February 2017 and February 2021, 345 sessions of argon-helium PCA were performed in 256 patients: in 216 cases due to liver metastases, in 14 due to kidney tumors, in 7 due to lung metastases, in 19 due to pain syndrome.

Results. The technical success of angiographically-assisted FD–CT-controlled PCA was 98.7 % for liver metastases, 92.9 % for kidney tumors, 100 % for lung metastases. The technical success and clinical effectiveness of interventions aimed at treating pain syndrome were 100 %. All complications were grade I–III per the CIRSE (Cardiovascular and Interventional Radiological Society of Europe) classification and were successfully eliminated either directly during the cryoablation procedure or in the early postoperative period. After angiographically-assisted FD–CT-controlled PCA of liver metastases, median overall survival was 37.0 months, 1-, 2-, 3- and 5-year survival rates were, respectively, 93.0, 69.1, 51.7 and 27.9 %; after the procedures for kidney tumors the values were 73.5 months and 100, 100, 100 and 100 %; after the procedures for lung metastases, 26.0 months and 85.7, 71.4, 28.6 and 28.6 %, respectively.

Conclusion. The developed technologies of argon-helium PCA under FD–CT control are safe and effective for curative treatment of malignant tumors of the liver, kidneys and lungs, as well as for palliative treatment of bone metastases and cryoneurolysis. To confirm the obtained results and further develop angiographically-assisted FD–CT-guided PCA technologies with their possible inclusion in the standards of medical care, it is necessary to conduct additional large prospective multicenter studies.

Background. Hepatic inflammatory pseudotumor (IPT) is a rare benign lesion that morphologically mimics a malignant neoplasm, posing significant diagnostic challenges.

Aim. To demonstrate criteria of differential diagnosis and management tactics of patients with IPT using a clinical case.

Clinical case. At the outpatient stage, IPT was diagnosed as cholangiocarcinoma. The final diagnosis of IPT was established after minimally invasive surgical intervention based on the results of histological examination.

Conclusion. Hepatic IPT is a rare disease which must be included in differential diagnosis during detection of lesions in the liver. Final diagnosis can be established only based on the results of comprehensive pathomorphological and immunohistochemical examinations.

Neuroendocrine tumors (NETs) occur at a frequency of 2 to 5 new cases per 100,000 people per year. Among the NETs of the gastrointestinal tract, about 70–80 % are pancreatic neoplasms. In 40–50 % of cases, NETs are functional tumors of the pancreas most often represented by insulinomas and gastrinomas, less common are VIPomas, glucagonomas and somatostatinomas.

The incidence of multiple endocrine neoplasia type 1 (MEN-1) is approximately 1–10 cases per 100,000 population. MEN-1 is an autosomal dominant disorder characterized by combined occurrence of pancreatic NETs with tumors of the parathyroid glands and pituitary gland. In patients with MEN-1 syndrome, pancreatic lesions occur in 30–80 % of cases.

The main tasks in diagnostics of NETs are establishment of syndromic and topographic diagnosis, exclusion of MEN-1 syndrome. To establish topographic diagnosis, the following are methods are used: ultrasound, including endoscopic, computed tomography, magnetic resonance imaging, angiography and arterial blood sampling with hormone measurement, scintigraphy of somatostatin receptors with octreotide, Ga-68 positron emission tomography, single-photon emission tomography with Tс-99m combined with computed tomography.

The next task for doctors is the choice of therapy for NET. Currently, the following types of treatment are used: radical surgeries, including extensive resections, organ-sparing interventions, minimally invasive interventions (microwave and radiofrequency ablation), cytoreductive surgeries (including minimally invasive), treatment of liver metastases of pancreatic NETs, as well as therapy within the framework of MEN-1 such as radio-, chemo-, bio- and immunotherapy. It should be noted that more than half of the patients require more than one therapy, i. e. combination therapy.

Aim. To compare outcomes of stone retraction and incision at the level of Hartmann’s pouch during laparoscopic cholecystectomy in patients with a stone impacted in the gallbladder neck.

Materials and methods. A retrospective single-center comparative study included 104 patients with calculous cholecystitis and an intraoperatively confirmed impacted stone in the gallbladder neck. Stone retraction without opening the gallbladder wall was performed in 62 patients, while 42 underwent incision of the gallbladder wall at the level of Hartmann’s pouch with stone extraction followed by continuation of cholecystectomy. Clinical, demographic, intraoperative characteristics and postoperative outcomes were analyzed, including complications graded according to the Clavien–Dindo classification.

Results. Baseline characteristics were comparable between groups. The overall complication rate was higher in the stone retraction group compared to the Hartmann’s pouch incision group (40.3 and 23.8 %, respectively; p = 0.044). Clinically significant complications (grade ≥IIIa per the Clavien–Dindo classification) occurred more frequently after stone retraction (22.6 % and 4.8 %, p = 0.014). No mortality was observed.

Conclusion. An impacted stone in the gallbladder neck may render standard dissection within the Calot’s triangle unsafe. Stone retraction is a reasonable initial step; however, early transition to incision at the level of the Hartmann’s pouch is advisable when it is ineffective. A stepwise algorithmic approach allows to decrease the rate of clinically significant complications and improve safety of the surgery.

Introduction. One-anastomosis gastric bypass (OAGB) is a bypass bariatric procedure that combines restrictive and malabsorptive components and is associated with anatomical changes in the upper gastrointestinal tract. After this operation, the food stream bypasses the duodenum and the proximal jejunum, which may affect the absorption of oral medications, including semisynthetic penicillins.

Objective. To assess the potential effect of OAGB on the bioavailability of oral semisynthetic penicillins and to define clinical pharmacology approaches to their use in patients after this type of bypass bariatric procedure.

Materials and methods. A review and clinical pharmacology analysis of published data were performed. The search included studies on anatomical and physiological changes after bariatric surgery, mechanisms of intestinal absorption of amoxicillin, ampicillin, amoxicillin with clavulanic acid, and penicillinase-resistant isoxazolyl penicillins, primarily oxacillin, as well as studies on the pharmacokinetics of oral antibiotics after bypass bariatric procedures. The literature search was conducted in international and Russian scientific databases, including PubMed, Cochrane Library, Google Scholar, Crossref, eLibrary.ru, and CyberLeninka, as well as on the websites of scientific journals and publishers. Publications with verifiable digital object identifiers and Russian sources on bariatric surgery were additionally analyzed.

Results and discussion. No direct clinical pharmacokinetic studies of oral semisynthetic penicillins specifically after one-anastomosis gastric bypass were identified in the available literature. Most evidence comes from studies after Roux-en-Y gastric bypass and suggests that systemic exposure to amoxicillin may be unpredictable, especially when solid dosage forms are used. Potentially relevant factors include exclusion of the proximal small intestine, changes in gastric pouch acidity, accelerated intestinal transit, dosage form, hypoalbuminemia, and signs of malabsorption.

Conclusion. Oral penicillins after OAGB should not be considered inherently ineffective. However, their use requires assessment of infection severity, dosage form, preserved oral intake, and early clinical response. In severe infection, systemic inflammatory manifestations, or signs of unreliable oral exposure, parenteral administration is preferable.

Background. Congenital duodenal obstruction (CDO) is a rare malformation. Since laparoscopic repair was introduced in 2001, issues of reproducibility and optimal perioperative management in neonates remain debated. Aim. To analyze our experience of implementation of laparoscopic duodenoduodenostomy in neonates with CDO, to assess the impact of technical modifications and perioperative management on early outcomes, and to analyze technical difficulties and complications.

Materials and methods. We retrospectively reviewed 27 neonates treated for CDO from September 2017 to December 2021. Prenatal diagnosis was established in 17 (63 %) cases; postnatal confirmation was based on X-rays, with upper gastrointestinal tract contrast study when necessary. Four infants underwent open repair via circumumbilical incision; 23 underwent laparoscopic repair. Group I (n = 13) included children who underwent surgery without modification of the technique, Group II (n = 10) included children who underwent modified surgery.

Results. Group II demonstrated a significant reduction in operative time, duration of inotropic support, mechanical ventilation, intensive care unit stay, and time to initiation of enteral feeding (p <0.05). Prolonged epidural analgesia was used more frequently in Group II (p = 0.019), while the need for systemic opioids did not differ. Differences in intraoperative complications, postoperative complications, and mortality were not statistically significant. Intraoperative complication was reported in 1 patient (injury of an atypically located pancreatic duct). Anastomotic leak was observed in 2 patients, and duodenal perforation was reported in 2 patients. Mean hospital stay was 29 ± 10.5 days; mean follow-up was 34 ± 11.2 months, with no clinically significant late anastomotic obstruction detected.

Conclusion. Implementation of laparoscopic duodenoduodenostomy in neonates is feasible and is associated with improved early resource-related outcomes when the technique and perioperative management are standardized. The effect of technique modification on decreasing complication rate and unfavorable outcomes requires confirmation through larger studies.