The aim — to improve the system of traumatic disease diagnostic monitoring in patients with multiple cranio-abdominal trauma.

Materials and methods. For a comparative analysis of diagnostic monitoring schemes the two groups of victims with multiple cranioabdominal traumawere formed: the control — 138 injured with clinical and laboratory monitoring, and the main — 143 injured with diagnostic monitoring based on screening tools and hardware monitoring.

Results and discussion. The dynamic neuro-visualization CT revealed a negative trend in 11 (7.7 %) of injured in the main group, in sixfrom them the indications to deferred craniotomy were set. The measurement of intra-abdominal pressure was highly sensitive (87.5 %) in diagnosis of intra-abdominal complications (IAP increased by 43 — 88 % for 2 — 12 hours).Chest ultrasonography allowed to identify quickly complications that lead to pulmonary restriction (pneumothorax, fluid) — 30 (21 %) cases in the main group, which is 2 times higher than in the control — 14 (10.1 %) (p < 0.05).

Conclusions. The diagnostic monitoring is usedto identify the consequences and complications of trauma, stagingcorrection prognosis for life and set the indications for urgent, delayed operations and the second operation in the damage control tactic. Its content depends on the trauma severity and its anatomical features.

Keywords: cranio-abdominal trauma, monitoring, neuromonitoring, traumatic disease.

The aim — to evaluate the complex treatment results for acute moderate and severe necrotizing pancreatitis (ANP) in the early disease phase and to establish a correlation between ANP complications and target biochemical parameters changed after membrane plasmapheresis (PF).

Materials and methods. The study included 48 patients: 29 (60.4 %) men and 19 (39.6 %) women with moderate and severe ANP, according to the Atlanta classification (2012), treated in Surgery department from 2007 to 2009. PF was performed by the conventional method. On the 7th — 8th day the following parameters frequency were evaluated: enzymatic peritonitis, gastrointestinal bleeding, exudative pleurisy, citrate reactions, and acute fluid accumulation in the omental bursa, parapancreatic tissue, and retroperitoneal space. The correlation between complications rate and patients’ age, sex, Ranson scale scores, total plasma protein, seral total calcium, aPTT level has been determined.

Results and discussion. A gradual decrease in leukocyte index of intoxication LII, with an average of 4.99 ± 0.12 up to 3.31 ± 0.13 was revealed in all patients during the study period. Each PF session was associated with average increase of aPTT on 47.7 ± 2.1 %, decrease in TP level on average 0.02 ± 4.35 g/L and a decrease in total calcium in plasma on 10.45 ± 0.38 %. At the early phase end the presence of complications such as enzymatic peritonitis (in 25 (52.1 %) patients), pleural effusion (in 30 (62.5 %)), dynamic ileus (in 27 (56.3 %)) and an acute accumulation of fluid (in all patients), mainly in lesser sac (in 26 (54.2 %)), retroperitoneally (in 26 patients (54.2 %)), in several locations (in 25 (52.1 %)) were noted. Mortality in the early phase was 12.5 %. Complications correlated with the level of total protein and total serum calcium, aPTT.

Conclusions. It has been determined that a number of complications correlated to parameters which are influenced by plasmapheresis: the number of acute fluid accumulation sites — with the level of total serum protein (r = –0.31) and the level of total plasma calcium (r = –0.29) ; occurrence of bleeding (8.3 %) — with aPPT reductions (r = 0.32); exudative pleurisy — with total serum protein (r = –0.30); citrate reaction — with the total calcium level (r = –0.42).

Keywords: plasmapheresis, acute necrotizing pancreatitis, complications of acute pancreatitis

The aim — to improve the diagnosis and optimize treatment tactic for acute pancreatitis in pregnant.

Materials and methods. Treatment results of 16 pregnant women with acute pancreatitis (AP) have been analysed. Mild (mild acute pancreatitis) revealed in 10 women, 3 — average (moderately severe acute pancreatitis), three — severe degree (severe acute pancreatitis). Comprehensive conservative therapy has proved effective in 13 from 16 pregnancies. Caesarean section was performed in three patients after 38 gestation weeks. One patient died.

Results and discussion. In all 16 women with AP the nature of pain syndrome and increased amylase and lipase in the urine and blood have been sufficient to verify the diagnosis. AP was detected during the I pregnancy trimester in three, during the II trimester — in four, during the III trimester — in nine patients (including a three with severe AP).

Conclusions. Acute pancreatitis is a relatively rare but serious illness among pregnant women for both mother and fetus. US — the most valuable study, except for the III trimester of pregnancy. Drug therapy in pregnant and mothers should be based on the maximumsecurity principle for woman and child. Surgical treatment of pregnant should be performed for severe acute pancreatitis with fluid in the abdominal cavity, secondary infection, and pancreatic sequestration.

Keywords: pregnancy, acute pancreatitis, diagnostics, medical tactic.

The health care and in particular surgical care experience in contemporary armed conflicts and international peace-keeping operations under the UNO and NATO auspices has been analysed. The characteristic of medical support conventional levels has been highlighted. The military actions during anti-terrorist operation in Ukraine were compared to the system of medical support. Reorganization of the Medical Service of the Armed Forces of Ukraine on the basis of the NATO’s principles of the medical support implementation is the key to personnel’s health maintaining and medical aid according to the highest standards for wounds and injuries providing.

Keywords: battlefield surgery, medical care levels, medical support anti-terrorist operation.

The aim — to study the multimodal analgesia clinical efficacy in complex surgical treatment of patients with acute pancreatitis.

Materials and methods. The treatment results of 48 patients with acute pancreatitis who were treated at the city pancreatologic center in General surgery clinic have been analysed. Patients were aged from 46 to 58 years (mean age — 54.3 ± 5.2 years). Eleven (23 %) women and thirty-seven (77 %) men took part in the research. Patients were randomly divided into two groups: in the main group (n = 25) the treatment program, in addition to basic infusion therapy, a multimodal analgesia was provided; in the comparison group (n = 23) anesthesia was performed by analgesic non-opioid drugs appointment. Multimodal analgesia included coapplication of analgesics, Infulgan antipyretics (10 mg paracetamol contains in 1 ml) and NSAID Diclobru (diclofenacum).

Results and discussion. In the study group, in contrast to the comparison group a significant tendency to a pain decreased by its visual analog scale assessment and in the cortisol serum level was shown. The absence of significant positive analgesia result suggested the severe acute pancreatitis presence.

Conclusions. The proposed multimodal anesthesia method should be used in clinical practice due to its effectiveness and the modern fast track surgery principle relevance.

Keywords: multimodal analgesia, acute pancreatitis, Infulgan.

The aim — to explore the endoscopic techniques possibilities in the diagnosis and treatment of congenital pyloric stenosis (CPS) in children.

Materials and methods. 89 children with CPS were studied. Study group included 45 children, the control group — 44. In addition to objective, clinical, biochemical research all the patients had accessed ultrasound imaging before surgery. 28 (64 %) children in control group underwent сontrast X-rays gastrography, in 32 (71 %) children in study group the fibrogastroscopy was used. For all children a standard pyloromyotomy by Fredet — Weber — Ramstedt was performed. Also 37 cases of laparoscopic pyloromyotomy were analyzed.

Results and discussion. The results of gastric PHmetry indicate the presence of mainly hyperacidity (PH = 3.5 ± 0.8). For 12 patients (28 %) from study group the clinical evaluation and abdominal ultrasound examination’s results were quite informative, and in rest were doubtful that required fibrogastroscopy with pyloric patency assessment. During the study, the polymorphic changes were being revealed. The phenomenon of esophagitis and the antrum gastritis observed mainly in children after the age of 1 month and with III degree hypotrophy. In these children the polyurethane probe with a 1.0— 1.5 mm diameter was inserted in the duodenum during the study. Drip breast milk enteral administration in 1 ml per 1 kg of body weight per hour and parenteral homeostasis correcting drugs administration allowed ensuring adequate preoperative preparation within 24.0 ± 1.2 hours. Laparoscopic intervention results analysis proved more favourable early postoperative period, which allowed to restore the normal feeding amount quickly and to decrease the inpatient treatment period.

Conclusions. Fibrogastroscopy in congenital pyloric stenosis is indicated in case of objective and ultrasonography examination ineffectiveness and is a highly informative diagnostic method. Enteral tube feeding diet reduces the infusion therapy volume, shortens the preoperative preparation time, accelerates the physiological feeding amounts recovery in the postoperative period. The use of laparoscopic techniques for surgical treatment minimizes the trauma intervention, provides a good cosmetic effect and facilitates the postoperative period.

Keywords: congenital pyloric stenosis, children, endoscopic diagnosis, laparoscopic treatment.

The aim — to compare the treatment results inelderly and senile patients with complicated acute cholecystitis (AC) after the traditional cholecystectomy (TCE) technique, laparoscopic cholecystectomy(LCE) and LCE with bacteriophages therapy.

Materials and methods.Treatment results of 517 elderly and senile patients with concomitant сoronary artery disease after surgical treatment for complicated AC have been analyzed. Patients were divided into three groups depending on the surgical treatment method: first comparison group (n = 178) included patients after TCE, sanitation of the abdominal cavity with saline and decasane solutions, second comparison group (n = 214) – patients after LCE, sanitation of the abdominal cavity with saline solution and decasane, gallbladder extraction in rubber sterile container through subxiphoideus wound; the main group (n = 125) included patients after laparoscopic cholecystectomy and sanitation of the abdominal cavity with saline with therapeutic bacteriophages (TB) irrigation in the amount of 50 — 100 ml. TB were also applied into subxiphoideus wound and injected through drainage tube into the abdominal cavity in the postoperative period in the amount of 20 ml each 8 hours.The incidence of general, intra and postoperative wound complications were studied.

Results and discussion. After TCE, the following general postoperative complications were registered: pneumonia – in two (1.1 %) cases, venous thrombosis of lower extremities — two (1.1 %), enteroplegia — 34 (19.1 %) cases. In comparison group only basic enteroplegia was observed respectively in 18 (8.4 %) and 6 (4.8 %) cases. The incidence of cholerrhea, postoperative bileperitonitis, and bileomas did not differ much in all groups: in the main group — 2.4 %, in the comparison group one — 1.8 %, in the comparison group two — 2 %. Intraperitoneal inflammatory complications in the early postoperative period in patients after TCE were found in 6.7 % of cases, wound complications were observed in 24.7 % patients, in the study group — 0.8 % (from the wound — 1.6 %) in comparison group two — 2.8 % (from the wound — 4.2 %).

Conclusions. Laparoscopic cholecystectomy in elderly and senile patients with complicated acute cholecystitis allowed to reducethe incidence of common complications from 23.0 tо 8.9 %, inflammatory complications from 31.4 до 7 % in comparison with TCE. Application of adapted bacteriophage allowed to reduce the incidence of intra-inflammatory abdominal complications from 2.8 tо 0.8 %, wound complications — from 4.2 tо 1.6 % after laparoscopic cholecystectomy.

Keywords: complicated acute cholecystitis, laparoscopic cholecystectomy, adapted bacteriophages.

The aim — to study the «early» relaparotomy role in patients treatment with acute diffuse purulent peritonitis.

Materials and methods. The treatment results of 35 patients aged from 26 to 90, operated for acute diffuse purulent peritonitis, have been analyzed. The patients were operated in Regional Hospital during 2013 — 2014. There were 27 men (77.14 %), and 8 women (22.86 %). The peritonitis was caused by duodenal perforation in 9 (25.7 %) patients, small intestine perforation — 5 (14.3 %), acute appendicitis — 11 (31.4 %), unknown etiology abdominal abscess poured into the abdominal cavity — 2 (5.7 %), acute adhesive intestinal obstruction with small intestine necrosis — 1 (2,85 %), sigmoid colon diverticulum perforation — 3 (8.6 %), strangulated ventral hernia with small intestine necrosis— 1 (2,85 %), closed abdomen injury with sigmoid colon rupture — 3 (8.6 %).

Results and discussion. All the patients had urgent surgery with consequent abdominal closure. In case of complications, relaparotomy was performed «as required». 15 patients (42.86 %) had complications. Relaparotomy «as required» was performed in eight cases (22.85 %). 17 (48.57 %) patients have died. Among eight patients after relaparotomy 6 (75 %) survived, two (25 %) died.

All the patients with relaparotomy performed after 72 hours died. Two (11.76 %) patients of 17 died were operated via relaparotomy.

Conclusions. For all patients with diffuse purulent peritonitis and tightly sutured abdomen, the prognostic relaparotomy index (PRI) and Manheim peritonitis index (MPI) have been calculated. All the patients who had PRI more than 15 points in 72 hours after operation, must be reoperated. «Early» relaparotomy can decrease the lethality in patients with acute diffuse purulent peritonitis up to 11.76 %.

Keywords: acute diffuse purulent peritonitis, relaparotomy.

The aim — to evaluate the effectiveness of different laparoscopic appendectomy methods using comparative analysis.

Materials and methods. The study included 480 patients with acute appendicitis, 376 of them (78.3 %) were men and 104 (21.7 %) — women, aged 17 to 65 years (mean age — 28.2 ± 0.3 years). Patients were divided into three groups: 378 patients who underwent standard laparoscopic appendectomy (SLA), 36 patients who underwent single-port appendectomy (SPA), and 66 patients who underwent dualport appendectomy (DPA). The groups were compared in terms of age, sex ratio, forms of appendicitis. surgery results Evaluation was performed on the following parameters: surgery duration, the number of pain-relief medication doses in the postoperative period, the peristalsis recovery period duration, inpatient length of stay, disability term, the surgical site infection incidence (SSI), the post-operative hernias incidence, cosmetic effect (total the scar length).

Results and discussion. The SPA group the average surgery duration was 61.8 ± 1.3 min (all p < 0.05), the average number of painkillers doses — 2.75 ± 0.09 dose (all p < 0.05) the motility recovery period duration — 2.30 ± 0.02 days (all p < 0.05). SSIs occurred in 18 (3.8 %) patients. In groups of SLA and DPA the proportion of patients with SSIs were 2.9 and 3.0 %, respectively and was significantly lower than in the SPA group — 13.9 % (p = 0.004). The disability period in SLA and DPA groups did not differ significantly — 8.9 ± 0.1 and 9.2 ± 0.1 days (p = 0.218), respectively and was lower than that one in the SPA group — 10.2 ± 0.2 days (p = 0.001). Postoperative hernia during the year after appendectomy occurred in eight (1.7 %) patients: in the SLA group — 3 (0.8 %) in the SPA group — 5 (13.9 %) (p = 0.001). The total scars length was lowest in the DPA group (1.60 ± 0.02 cm) compared with other groups, and in the SLA group was less than in patients at SPA (2.1 ± 0.1 in comparison with 0.02 ± 3.50 cm), all p < 0.001.

Conclusions. DPA is different from SLA and SPA significantly by fewer painkillers doses (0.36 ± 0.01 dose), faster peristalsis recovery (1.1 ± 0.0 days), less inpatient length of stay ((2.4 ± 0.1) days), total length of post-operative scarring. For the disability period duration, SSI and postoperative hernias incidence the DPA and SLA did not vary (all p > 0.05) and were better compared to the SPA (all p < 0.05).

Keywords: laparoscopic appendectomy, results.

The aim — to develop a model for postoperative complications and mortality predicting based on antibiotic susceptibility determination of E. coli strains, isolated from peritoneal fluid in patients with generalised peritonitis.

Materials and methods. To determine the proposed method of the abdominal cavity sanitation effectiveness the antibiotic sensitivity test of E. coli strains, isolated from peritoneal fluid, was performed in dynamic.

Results and discussion. A model predicting postoperative complications and mortality in patients with generalized peritonitis with intra-abdominal sorption-transmembrane dialysis has been developed. The model has high sensitivity and low specificity for the individual prediction. The development of more accurate systems for forecasting requires further research.

Conclusions. One of the promising directions in research is creating a model for predicting postoperative complications and mortality in patients by determining the E. coli sensitivity to the antibiotics groups such as: carbapenems, protected penicillins, cephalosporins, aminoglycosides.

Keywords: generalised peritonitis, dialysis.

The aim — to study the frequency and dynamics of exit-site infection (ESI) in patients with end-stage chronic renal disease during peritoneal dialysis (PD).

Materials and methods. The three-year prospective study in 73 patients treated with renal replacement therapy by PD from 2007 to 2010 has been performed. 46.6 % of them were women and 53.4 % men, mean age was (46.63 ± 1.26) years. Stratification of patients by catheter infection category was carried out according to international recommendations. ESI treatment was not differentiated, the local and systemic antibiotic therapy were used, and catheter was removed if necessary.

Results and discussion. Three-year cumulative incidence of doubtful ESI was 28.8 % of cases, acute — 28.8 %, chronic — 16.4 %, cuff infections — 6.8 %. Due ESI the catheter was removed in 17.8 % of the patients. In the presence of microorganisms associations in patients with ESI the catheter was removed at 60.0 % of the patients, the causative agent monoculture — at 24.1 %. The main reason for the catheter to be removed was acute ESI — in 7 (53.8 %) of patients.

Conclusions. The annual cumulative rate of ESI was 21.9 %, two-year — 42.5 %, three-year — 56.2 %. The rate of equivocal ESI was 41.0 %, acute — 17.9 %, chronic — 28.2 %, cuff infections — 12.8 %. The most common ESI pathogen was S. aureus —in 74.4 % of cases. The second revealed infection was caused by S. epidermidis — in 35.9 % of patients. Pathogens monoculture was presented in 73.2 % of patients, in the rest 26.8 % — the microorganisms association. The three-year cumulative percentage of Tenckhoff catheter removal due to ESI was 17.8 %, due to acute ESI — 53.8 %, due to chronic and cuff infection — in 23.1 % each.

Keywords: exit-site Tenckhoff catheter infection, prevention, treatment.

The aim — to improve symptomatic results of abdominoplasty (dermolipectomy) in patients with obesity and to determine the priority to choose the right method of anesthesia.

Materials and methods. In the period between 2005—2014 years, 37 patients with the third degree adiposity which manifested by the anterior abdominal wall deformation in a form of significant skin-fat flap increasing and lower body parts were treated in the surgical department. Depending on the anesthesia type, patients were divided into two groups: in the first group (n = 18) a combined intubation anesthesia with propofol, fentanyl and pipecuronium bromide was used, in the second group (n = 19) — spinal anesthesia (anesthetic marcaine hyperbaric 0.5 % at a dose of 2 — 4 mL).

Results and discussion. Five (13.5 %) patients had complication such as subcutaneous fat seroma. Seromas were successfully eliminated by punction. During extubation in 6 (33.3 %) patients, it was observed a long apnea. In an early postoperative period in 2 (10.5 %) patients pneumonia had occurred, 6 (33.3 %) patients complained about throat sore, hoarseness of voice, in 4 (22.2 %) patients nausea and vomiting had occurred. In 3 (15.9 %) patients after spinal anesthesia in the early postoperative period there was a moderate aching pain in the occipital region, which greatly intensified after the sudden change in body position from horizontal to vertical.

Conclusions. Symptomatic abdominoplasty (dermolipectomy) isn’t a radical treatment method for obesity, it only represents the way of the anterior abdominal wall defect cosmetic correction. Conducting the combined intubation anesthesia to patients with third degree of adiposity is accompanied by a high risk of complications after extubation and in the early postoperative period. Spinal anesthesia is an alternative method for patients during abdominoplasty. Once it has been performed, there are no side effects such as apnea and postoperative period proceeds more favorable. Precondition the success of this anesthesia type is the high professional qualifications of the doctor-anesthetist.

Keywords: obesity, abdominoplasty, anesthesia.

The aim — to increase the treatment effectiveness in patients with pulmonary tuberculosis with new methods for the respiratory complications prevention during surgery.

Materials and methods. The results of the respiratory complications prevention in 179 patients who underwent different surgical treatment types (lung resection, lung resection with corrective thoracoplasty, primary thoracoplasty) have been analyzed.

Results and discussion. In patients who were gone through prevention of respiratory complications, the treatment effectiveness after lung resection had increased from 80.0 to 96.6 %, after lung resection with corrective thoracoplasty — from 71.9 to 93.1 % and after the primary thoracoplasty — from 73, 5 to 93.1 %.

Conclusions. Complex prevention methods application for respiratory complications increases the effectiveness of surgery in patients with pulmonary tuberculosis.

Keywords: lung tuberculosis, respiratory complications, surgery treatment, effectiveness.

The aim — to study the immediate and long-term results of Duplex ultrasonography-guided sclerotherapy for incompetent perforator veins in patients with varicose veins C6.

Materials and methods. Surgical treatment was performed in 42 patients with varicose veins CEAP class C6. Venous ulcers were typically localized, on the tibial medial surface. Area ulcers ranged from two to 30 cm². Duplex ultrasonography-guided sclerotherapy was performed on perforator veins Cockett II and Cockett III. Diameter of perforator veins ranged from 4 to 10 (4.3 ± 0.5) mm. 54 sclerotherapy procedures was performed on 42 incompetent Cockett group perforator veins.

Results and discussion. During the 4 years observation period the full occlusion of incompetent perforator veins was achieved in 38 (90.48 %) of 42 patients. After Duplex ultrasonography-guided sclerotherapy venous ulcers healing was noticed after 12.4 ± 2.1 days for 2 — 10 сm² size, after 32.6 ± 15.4 and 48.2 ± 21.6 days for 10 — 20 cm² and 20 — 30 cm² size respectively. in all patients After 1 month the overall quality of life by CIVIQ2 scale significantly exceeded its preoperative level — 63.22 ± 3.21 vs 32.03 ± 1.13 points (p < 0.001). 1 year after this level was 26.89 ± 1.14 (p < 0.001) 4 years after — 24.15 ± 1.12 (p > 0.05).

Conclusions. Duplex ultrasonography-guided sclerotherapy for incompetent perforator veins in patients with varicose veins CEAP class C6 with reflux in superficial veins system allows achieving complete and stable veins occlusion in 90.48 % patients in the 4 years observation period. Applying such technology in the trophic disorders area is pathogenetically proved to be effective and leads to complete venous ulcers ranging from 2 to 30 cm² healing in the period from 12.4 ± 2.1 to 48.2 ± 21.6 days.

Keywords: varicose veins, incompetent perforator veins, Duplex ultrasonography-guided sclerotherapy, quality of life.

In this review the current issues of metastasis as the main cause of death in patients with cancer pathology is explicated. The lack of the mechanisms understanding in this process is associated with a variety of tumour cells characteristics. The mechanisms of haematogenous metastases have been revealed and the platelets involvement during all stages of haematogenous metastasis has been studied. The role of the antiplatelet agents and unfractionated or low molecular weight heparins is marked according to the haemostatic interactions mechanisms understanding in the context of therapeutic strategies range expanding in the oncologic patients (tumour dissemination reduce). The current research on the heparin properties to prevent the tumour — platelet and tumour-endothelial cells interaction, which are the main mechanism for metastasis prevention. The way for further research of new properties and well-studied drugs available support is outlined, through that, the health care quality provided to oncologic patients, and consequently the quality of their lives should be improved.

Keywords: cancer, metastasis, heparin.

D₂ lymph node dissection for gastric cancer is the «gold standard» of the surgical treatment around the world, but some of its aspects are far from being resolved. Therefore, the question of prophylactic splenectomy for cancer of the upper and middle third of the gastric remains open. The analysis of randomized prospective and retrospective studies on this issue is given. There are three randomized clinical trials, where the authors noted a tendency for overall 5-year survival rate improving in patients with gastric cancer after splenectomy. Only in one retrospective studies improving in the overall 5-year survival by spleen resection was reported. Nine retrospective studies showed better survival for patients with spleen preserving procedure, and seven more showed significant differences in the comparison groups. The result of the randomized clinical trial by T. Sano et al. dedicated to this issue was published in 2015. The authors deny the splenectomy necessity for the cancer of upper and middle third of the stomach without involvement of the greater gastric curvature, or without spread of the tumor on the spleen. There still remains an unsolved question of splenectomy for more adequate removal of the 10 and 11 lymph node collectors in patients with advanced tumors in the greater curvature of the stomach or if there is clinical evidence of metastasis in lymph node groups № 4sb and/or № 10.

Keywords: gastric cancer, splenectomy, overall survival, complications, mortality.

Inferior vena cava is the main venous trunk that carries deoxygenated blood from the lower parts of the body to the right atrium. Anomalies of the inferior vena cava are the result of embryogenesis violations and fetal venous system persistence. Most cases are subclinical and are detected during the surgery or by additional methods. Although the IVC anomalies frequency are rare but vascular architectonics knowledge is very important in planning and performing surgery on retroperitoneal space organs. The paper describes the case of complete inferior vena cava transposition and gives the literature review.

Keywords: the inferior vena cava, anomalies, complete transposition.

Тwo clinical cases of successful laparoscopic abdominal surgery with combined spinal anesthesia (spinal anesthesia with target sedation level maintaining) in the same patient with severe bilateral bullous pulmonary emphysema comorbidity is described in the paper. Possible ventilatory and respiratory complications and their prophylactic ways have been concerned.

Keywords: spinal anesthesia, sedation, bullous emphysema, laparoscopic surgery, case report.

The clinical case of treating a 75 years old patient with acute necrotizing pancreatitis is described. The patients was treated at the intensive care unit after being hospitalized for 6 days. Regarding acute postnecrotic liquid clusters and delineated postnecrotic liquid clusters in retroperitoneal fat the minimally invasive surgical technology — puncture and drainage under ultrasound guidance are applied on the first stage. The laparotomy with necrsequestrectomy was performed because of its effectiveness lack on the 62nd day after the disease onset. During postoperative period postnecrotic pancreatic cysts were formed, the patient underwent surgery for pancreatic cyst after 17 months from the disease onset. Because of patient`s acute necrotizing pancreatitis a severe form of exocrine pancreatic insufficiency and diabetes have developed. Treatment of patients with necrotizing pancreatitis requires close cooperation of resuscitators, surgeons and gastroenterologists.

Keywords: acute necrotic pancreatitis, surgical techniques, postoperative complications.