Muraviov P. Improvement of differential diagnosis, surgical tactics and methods of correction of mechanical jaundice due to diseases of the biliopancreatoduodenal area of benign and malignant origin

Presented Manuscript is a clinical study that presents a new direction in solving the current scientific and practical problem of modern surgical hepatopancreatology – improving the results of surgical treatment of patients with focal pathology of the pancreatobiliary zone, complicated by mechanical jaundice, by improving and scientific justificating of the program of differential diagnosis, surgical tactics and methods of its correction. With the help of an original mathematical model, the severity of the course of the postoperative period in patients with mechanical jaundice was predicted on the basis of a multifactorial analysis of indicators of their condition in the preoperative period. The method of express- detoxification was proposed and applied in patients with mechanical jaundice syndrome in order to compensate their condition and prepare for such radical surgical intervention as pancreatoduodenal resection. The scientific data on the role of genetic mutations in the development of focal diseases of the organs of the pancreatobiliary zone, which cause the development of the syndrome of mechanical jaundice were expanded. The expediency of carrying out genetic analysis of the buccal epithelium for the purpose of differential diagnosis and forecasting the risk of complications origin of the indicated surgical intervention as pancreatoduodenal resection is scientifically substantiated. It has been scientifically proven that the immediate results of such radical surgical intervention as pancreaticoduodenal resection in the postoperative period depend on the type of preoperative preparation. The concept of improving the results of complex surgical treatment of patients with mechanical jaundice syndrome depending on the diagnostic findings and the patient's condition at the time of hospitalization were improved and scientifically confirmed. The algorithm for surgical assistance providing to patients with mechanical jaundice of benign and malignant genesis was improved by carrying out the comparative analysis of their condition under the conditions of various options for preparation for radical surgical treatment, as well as existing algorithms for preoperative preparation of patients for pancreatoduodenal resection due to the introduction of a new detoxification method. Indications regarding the choice of certain methods of pancreatodigestive anastomoses applying during radical surgical interventions on the organs of the pancreatobiliary zone have been clarified.