Izrailov R.E.

Laparoscopic Beger procedure for patient with chronic pancreatitis

Laparoscopic Beger procedure for patient with chronic pancreatitis
Izrailov R.E. and Andrianov A.V. is performing an operation (2018).

Moscow Clinical Scientific Centre, Moscow, Russia

Laparoscopic Beger procedure was performed in patient (male) with chronic pancreatitis type C (classification of M.Buchler). The age of the patient was 54 years. The size of the pancreatic head was 34 mm, the diameter of the main pancreatic duct was 9 mm. And patient had regional portal hypertension as a result of the pancreatic head compression of the portal vein. Superior mesenteric vein under the low margin of the pancreas head was visualized. Stay sutures were placed for the traction. The anterior gastroduodenal artery was identified and ligated close to the common hepatic artery. The pancreas was transected on the level of the neck. The subtotal resection of the pancreas was performed. The resection finished when the distance of the cut-line from the pancreas to the duodenal wall was ventral 5 mm and dorsal 2–3 cm. The main pancreatic duct was opened longitudinally in the distal part of the pancreas. A side-to-end pancreaticojejunostomy and a side-to-side pancreaticojejunostomy were formed with single-layer continuous sutures using nonabsorbable materials (Ti-cron 2.0). Hepaticojejunostomy was formed in one case.

The operating time was 680 minutes. Blood loss was 250 ml. There was no conversion and complications in post-operative period. The length of postoperative days was 5 days.

Laparoscopic pancreatoduodenal resection with preserving of pylorus

Laparoscopic pancreatoduodenal resection with preserving of pylorus.
Professor Israilov R.E. is performing an operation.

Video of operation starts with the observation of the surgical site by fixing liver to the anterior abdominal wall, using the round ligament and needles for stitching troacar wounds. After transection of the gastrocolic ligament by an ultrasonic scalpel adhesioviscerolysis in omentum sac is performed. Then mobilization of the inferior edge of pancreas is performed with the visualization of the superior mesenteric vein (SMV). Then transection of the right gastroomental vessels (GOV) and the initial part of the duodenum is performed. After mobilization of duodenum according to Kocher its transection is done in the proximal part. After that mobilization of the elements of the hepatoduodenal ligament (HDL) is performed. After clipping the gastroduodenal artery is transected. Then small colon is transected, mobilization of the uncinate process is done, lymphadenectomy along the superior mesenteric artery is performed. Choledoch is transected by scissors, the edges of the bile duct and pancreas are sent for urgent histological investigation. 3 anastomoses have been formed in a consecutive order: invaginational pancreatoenteroanastomosis, is stitched by the interrupted suture, using TiCron 2-0 thread, and hepaticojejunoanastomosis, stitched by the continuous suture and duodenoenteroanastomosis, stitched, using two-layer intestinal technique. 2 drains have been placed into the abdominal cavity: to hepaticojejunoanastomosis and pancreatojejunoanastomosis.

Laparoscopic Distal pancreatectomy combined with Frey procedure

Laparoscopic Distal pancreatectomy combined with Frey procedure
Izrailov R.E., Andrianov A.V. (2016)

Moscow Clinical Scientific Centre, Moscow, Russia

Women with chronic pancreatitis, 55 years old, with chronic abdominal pain and completed bleeding in cyst of the tail of the pancreas. The size of the pancreatic head was 60 mm, the diameter of the main pancreatic duct was 8 mm. The procedures were performed through the 5 trocar accesses. Intraoperativelly were used following instruments: harmonic scalpel, monopolar coagulation, 5-10 mm trocars, Endo GIA Universal stapling system. After the pancreas mobilization and visualization vena mesanterica superior and splenic vein distal part of the pancreas was resected. The head of the pancreas was stitched with the stay sutures on the border of resection. The main pancreatic duct was opened with an active branch of the Harmonic scalpel. Ventral part of the head of pancreas was resected. A side-to-side pancreaticojejunoanastomosis was formed with single-layer continuous sutures using nonabsorbable materials. The pancreaticojejunoanastomosis was covered additionally with a strand of greater omentum.

The operating time was 660 minutes. Blood loss was 600 ml. There was no complication. The postoperative stay period was 6 days. The follow-up is 2 months. Patient is pain free.

Laparoscopic cystojejunostomy

Laparoscopic cystojejunostomy
Izrailov R.E., Andrianov A.V. (2016)

Moscow Clinical Scientific Centre, Moscow, Russia

Laparoscopic cystojejunostomy was performed in patient (male) with post necrotic cyst of the pancreas with necrosis. The diameter of the cyst was 11 cm. The wall of the cyst was resected. All necrosis was removed. After that cystojejunostomy was formed with single-layer continuous sutures using nonabsorbable materials. The operating time was 220 minutes. Blood loss was 20 ml. There was no conversion and complications in post-operative period. The length of postoperative days was 4 days.

Laparoscopic Frey procedure for patient with chronic pancreatitis

Laparoscopic Frey procedure for patient with chronic pancreatitis
Izrailov R.E. and Andrianov A.V. is performing an operation (2016)

Moscow Clinical Scientific Centre, Moscow, Russia

Laparoscopic Frey procedure was performed in patient (male) with chronic pancreatitis type C (classification of M.Buchler). The age of the patient was 46 years. The size of the pancreatic head was 32 mm, the diameter of the main pancreatic duct was 8 mm. After the pancreas mobilization and visualization vena mesanterica superior the head of the pancreas was stitched with the stay sutures on the border of resection. The main pancreatic duct was opened with the unipolar coagulator or an active branch of the Harmonic scalpel. Ventral part of the head of pancreas was resected. A side-to-side pancreaticojejunoanastomosis was formed with single-layer continuous sutures using nonabsorbable materials. The pancreaticojejunoanastomosis was covered additionally with a strand of greater omentum in nine cases.

The operating time was 320 minutes. Blood loss was 20 ml. There was no conversion and complications in post-operative period. The length of postoperative days was 4 days.

Laparoscopic longitudinal pancreaticojejunostomy

Laparoscopic longitudinal pancreaticojejunostomy
Izrailov R.E., Andrianov A.V. (2014)

Moscow Clinical Scientific Centre, Moscow, Russia

Laparoscopic longitudinal pancreaticojejunostomy was performed in patient (male) with chronic pancreatitis type C (classification of M.Buchler). The size of the pancreatic head was 24 mm, the diameter of the main pancreatic duct was 8 mm. After the pancreas mobilization and visualization vena mesanterica superior the pancreas was stitched in the isthmus zone with the stay sutures for the traction. The main pancreatic duct was opened with the unipolar coagulator. A side-to-side pancreaticojejunoanastomosis was formed with single-layer continuous sutures using nonabsorbable materials. The operating time was 290 minutes. Blood loss was 30 ml. The length of postoperative days was 5 days.