Clinical features and etiology of postpartum endometritis in women with a high risk of purulent-septic complications

2021 ◽  
Vol 69 (6) ◽  
pp. 23-30
Author(s):  
Tatyana V. Batrakova ◽  
Irina E. Zazerskaya ◽  
Yulia V. Dolgo-Saburova ◽  
Elena Yu. Vasilyeva ◽  
Darya O. Saprykina
Keyword(s):  
Risk Factors ◽  
Escherichia Coli ◽  
Antibiotic Resistance ◽  
Species Composition ◽  
Enterococcus Faecalis ◽  
Postpartum Period ◽  
Comparison Group ◽  
Main Group ◽  
Postpartum Women ◽  
Septic Complications

Hypothesis/Aims of study. Postpartum purulent-septic complications continue to rank third in the structure of maternal mortality. In the etiology of postpartum endometritis, the key role is played by opportunistic microflora, including associations of microorganisms, as well as a history of chronic urogenital infection, bacterial vaginosis, and sexually transmitted infections. Despite numerous studies, the question of which microorganisms colonizing the birth canal are potentially dangerous in relation to the development of infectious and inflammatory pathology of the postpartum period is still a subject of discussion. The aim of this research was to study the etiology and identify the clinical features of postpartum endometritis in puerperas with risk factors for the development of purulent-septic complications. Study design, materials and methods. This retrospective comparative study included 199 puerperas, who were divided into two groups: the main group consisted of women who developed postpartum endometritis (n = 72), and the comparison group comprised women with the physiological course of the postpartum period (n = 127). Bacteriological examination of lochia was performed on the third day of the postpartum period, as well as with the development of postpartum endometritis before empirical antibiotic therapy was started. Results. During the bacteriological study of lochia in the main group of patients, potentially pathogenic microorganisms were observed in 68 % of puerperas, with the pathogen of endometritis not detected with repeated crops of lochia in 32 % of postpartum women. In the comparison group, this proportion was only 15 % (p 0.005). During pregnancy, the release of microorganisms from the cervical canal was observed in 26.4 % of cases in the main group and in 7 % of cases in the comparison group of puerperas (p 0.005). Despite the absence of clinical symptoms, all patients received systemic antibacterial therapy. Subsequently, 90 % of maternity patients in the main group revealed the ineffectiveness of empirical therapy due to antibiotic resistance of the identified microflora. When analyzing the species composition of microorganisms, intestinal microflora in monoculture was more often isolated in the patients of the main group: Escherichia coli (40 % vs. 2.4 % in the comparison group) and Enterococcus faecalis (25 % vs. 4.7 % in the comparison group). In 10 % of postpartum women with severe purulent-septic complications (sepsis, parametritis, pelvioperitonitis), the composition of the released microflora in lochiae did not differ from that of maternity women with endometritis without severe purulent-septic complications, and microbial associations were only detected in two cases. Conclusion. The etiological cause of postpartum endometritis in puerperas with risk factors for the development of purulent-septic complications is intestinal bacteria (Escherichia coli, Enterococcus faecalis) more often detected as a monoculture. The species composition of microorganisms that cause severe forms of postpartum purulent-septic complications does not differ in principle from the pathogens of uncomplicated forms of postpartum infection. Unreasonable antibacterial therapy during pregnancy is associated with antibiotic resistance of microorganisms that cause postpartum endometritis, which poses significant difficulties in the selection of antibacterial drugs for its treatment.

Optimization of prevention measures of septic complications in women with high infectious risk

2018 ◽  
pp. 108-113
Author(s):  
Yu.R. Feyta ◽  
◽  
V.I. Pyrohova ◽  
Keyword(s):  
High Risk ◽  
Postpartum Period ◽  
Comparison Group ◽  
Infectious Complications ◽  
Main Group ◽  
Septic Complications ◽  
Effective Prevention ◽  
Vaginal Gel ◽  
Infectious Risk ◽  
Treatment Techniques

Despite the introduction of modern diagnostic technologies, prophylaxis and treatment techniques in obstetrical practice, the incidence of postpartum purulent-septic complications (PPSC) remains rather high and is an important medical and social problem, as they take one of the leading places in the structure of maternal morbidity and mortality. The objective: to improve the management of parturient womenwith a perineal birth injury in anamnesis, as part of an effective prevention of purulent-septic complications of puerperium. Materials and methods. The study included 77parturient women. Main and comparative groups were formed by women with a violation of the integrity of the perineum in the previous labor and with a high risk of developing infectious complications in puerperium. Women of the main group (n = 24) during each vaginal examination in labor (and an additional injection in 15-30 minutes after the rupture of the membranes) and twice a dayat a dose of 5 ml for 5 days postpartum, an antiseptic agent in the form of a vaginal gel, which consists of: 0.02% decamethoxin (antiseptic component), 0.5% hyaluronic acid (regenerating component) and lactate buffer (regulatory component). The comparison group included 27 women, without using vaginal gel in laborand using traditional wound treatment techniques in the postpartum period. The control group consisted of 26 women with uncomplicated somatic status, physiological course of pregnancy and labor. The evaluation of the effectiveness of the prescribed treatment was based on subjective symptoms (pain, discomfort, burning in the region of the perineal sutures), clinical data (swelling, hyperemia, nature of suturing healing), generally accepted indicators in dynamics (bacterioscopy of vaginal contents, pH-metry of the vaginal environment). Results. At the background of the use of three-component vaginal gel in the main group, the level of injury of soft tissues of the birth canal in these deliveries was lower by 19.9% than in the comparison group, prevalence of the 1st degreeperineumruptures, decreased the need for repeated episio- and perineotomy, which reduced the duration stay at hospital and improved postpartum rehabilitation in relation to the comparison group. On the third day of puerperium, hyperemia and edema of the wound area in women of the main group were observed almost three times less compared with the comparison group. On the fifth day of the puerperium in the main group the complaints were insignificant and appeared on the average 5 times less often, the healing was by the primary tension without infectious complications. The use of vaginal gel reduced the number of leukocytes in wound secretions by shortening the time of wound epithelization (1.5 times faster than in the parous from the comparison group). On the fifth day of using vaginal gel, 2/3 of the patients observed normalization of the vaginal microflora, the restoration of pH was observed. The results indicate the benefits of early onset of prophylactic measures and high effectiveness of topical antiseptic therapy in women with high infectious risk. Conclusions.In order to prevent antibiotic resistance tactics of prevention of PPSC in the group of high-risk septic complications provides one of the elements of anintegrated approach to use local antiseptics. Inclusion of the latter into a complex of prophylactic and treatment measures in the management of a high-riskwomen in puerperium contributes to the reduction of traumatic and infectious complications and provides more favorable course of labor and the postpartum period. Key words: labor traumatism, postpartum purulent-septic complications, local antiseptic.

Clinical value of c-reactive protein level in predicting the development of postpartum endometritis

2020 ◽  
Vol 69 (2) ◽  
pp. 5-14
Author(s):  
Tatyana V. Batrakova ◽  
Irina E. Zazerskaya ◽  
Tatyana V. Vavilova ◽  
Vitaly N. Kustarov
Keyword(s):  
Postpartum Period ◽  
Comparison Group ◽  
Threshold Value ◽  
Main Group ◽  
C Reactive Protein ◽  
Clinical Value ◽  
Septic Complications ◽  
Reactive Protein ◽  
Diagnostic Threshold ◽  
Wide Range

Hypothesis/aims of study. In the Russian Federation, postpartum septic complications are third among the causes of maternal mortality, along with obstetric bleeding and preeclampsia. A wide range of methods for predicting postpartum endometritis has been proposed. However, none of these methods has sufficient clinical efficacy. The lack of information and the lack of clear criteria highlight the difficulties in the early diagnosis and prognosis of postpartum endometritis. The aim of this study was to evaluate the role of C-reactive protein (CRP) in the prediction of postpartum endometritis in puerperas with a high risk of developing septic complications. Study design, materials and methods. The study included 135 puerperas, who were retrospectively divided into two groups. The main group consisted of women with developed postpartum endometritis (n = 72), and the comparison group comprised individuals with physiological course of the postpartum period (n = 63). Serum CRP levels were determined for all puerperas on days 1 and 3 of the postpartum period using the immunoturbodimetric method. Results. On day 1 of the postpartum period, the diagnostic threshold value for CRP levels was 69 mg / ml. The sensitivity and specificity of the method were low: 62% (95% CI 5074) and 65% (95% CI 5176), respectively. The predictability at a CRP level above 69 mg / ml was 67% (95% CI 5477). Thus, in puerperas on day 1 of the postpartum period at a CRP level above 69 mg / ml, the probability of developing postpartum endometritis was 67%, the chances of developing postpartum endometritis being extremely low, increasing by 1.76 times. There were no statistically significant differences when comparing CRP levels in the study groups of puerperas on day 1 of the postpartum period. On day 3 of the postpartum period, CRP level was significantly higher in the main group of puerperas 148 mg / ml (95% CI 126171), and in the comparison group 43 mg / ml (95% CI 3849) (p = 6 1014). On the 3rd day of the postpartum period, the diagnostic threshold value for CRP levels was 60 mg / ml. The sensitivity of the method was moderate 79% (95% CI 6886), the specificity of the method being high 93% (95% CI 8598). The predictability at a CRP level above 60 mg / ml was 93% (95% CI 8496). Thus, in postpartum women on day 3 of the postpartum period at a CRP level above 60 mg / ml, the probability of developing postpartum endometritis was 93%, with the chances of developing postpartum endometritis increased by 10 times (95% CI 530). In addition, determining CRP level on day 3 of the postpartum period is clinically informative, as evidenced by the standardized effect size (SES) equal to 1.4 (p = 6 1014). This is confirmed by the ROC analysis data: the clinical significance value (AUC indicator) was 0.89 (CI 0.810.93), according to which CRP determination is evaluated as a method with high clinical informativity. Conclusion. The determination of CRP on day 3 of the postpartum period is a clinically informative method. An increase in CRP level above 60 mg / ml is a predictor of postpartum endometritis with a sensitivity of 79% and a high probability (93%).

scholarly journals Ocular Risk Factors in the Primary Formation of Diabetic Macular Edema in Patients with Type 2 Diabetes Mellitus

2019 ◽  
Vol 16 (2) ◽  
pp. 225-229
Author(s):  
M. V. Pshenichnov ◽  
O. V. Kolenko ◽  
E. L. Sorokin ◽  
Ya. E. Pashentcev
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Macular Edema ◽  
Comparison Group ◽  
Mean Value ◽  
Main Group ◽  
The Mean

Purpose. Revealing of the ocular risk factors in the formation of diabetic macular edema (ME) in type 2 diabetes mellitus (DM2).Patients and methods. A 3.5-year research of 80 patients (160 eyes) with DM2 without signs of ME at the beginning of the research was performed. The main group consisted of 46 patients with ME symptoms on one or both eyes during the research period, the comparison group included 34 patients without ME symptoms to the end of the research. The initial ocular characteristics were retrospect compared in groups.Results. The mean value of the axial lengths (AL) in the eyes of the main group was 23.12 ± 0.75 mm compared to 23.82 ± 0.62 mm in the comparison group (significant difference, p < 0.01). AL was less than 23.5 mm in 66 % of the eyes in the main group and only in 22 % of the eyes in the comparison group (p < 0.01). The mean value of the initial macular retina volume in the main group was significantly higher than in the comparison group — 7.51 ± 0.22 mm3 and 7.21 ± 0.12 mm3, respectively (p < 0.01). Initial background diabetic retinopathy (DR) was noted in 73 % of the eyes in the main group, which significantly differed from the comparison group, where this index was noted only in 13 % of the eyes (p < 0.01).Conclusion. Significant ocular risk factors for the formation of ME in patients with DM2 are: the initial macular retina volume more than 7.3 mm3, the value of the AL less than 23.5 mm; the initial background DR. The use of the detected morphometric parameters of eye and retina in combination with an adequate assessment of the risk factors in human organism makes it possible to assume with high degree of probability a high risk of the primary formation of diabetic ME in patients with DM2. 

scholarly journals The higher prevalence of extended spectrum beta-lactamases among Escherichia coli ST131 in Southeast Asia is driven by expansion of a single, locally prevalent subclone

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Swaine L. Chen ◽  
Ying Ding ◽  
Anucha Apisarnthanarak ◽  
Shirin Kalimuddin ◽  
Sophia Archuleta ◽  
...  
Keyword(s):  
Risk Factors ◽  
Escherichia Coli ◽  
Antibiotic Resistance ◽  
South America ◽  
Southeast Asia ◽  
Sequence Type ◽  
Beta Lactamases ◽  
Extended Spectrum Beta Lactamases ◽  
Mlst Type ◽  
Excess Resistance

Abstract The ST131 multilocus sequence type (MLST) of Escherichia coli is a globally successful pathogen whose dissemination is increasing rates of antibiotic resistance. Numerous global surveys have demonstrated the pervasiveness of this clone; in some regions ST131 accounts for up to 30% of all E. coli isolates. However, many regions are underrepresented in these published surveys, including Africa, South America, and Asia. We collected consecutive bloodstream E. coli isolates from three countries in Southeast Asia; ST131 was the most common MLST type. As in other studies, the C2/H30Rx clade accounted for the majority of ST131 strains. Clinical risk factors were similar to other reported studies. However, we found that nearly all of the C2 strains in this study were closely related, forming what we denote the SEA-C2 clone. The SEA-C2 clone is enriched for strains from Asia, particularly Southeast Asia and Singapore. The SEA-C2 clone accounts for all of the excess resistance and virulence of ST131 relative to non-ST131 E. coli. The SEA-C2 strains appear to be locally circulating and dominant in Southeast Asia, despite the intuition that high international connectivity and travel would enable frequent opportunities for other strains to establish themselves.

scholarly journals Pregnancy-associated arterial dissections: a nationwide cohort study

2020 ◽  
Vol 41 (44) ◽  
pp. 4234-4242
Author(s):  
Sebastian E Beyer ◽  
Andrew B Dicks ◽  
Scott A Shainker ◽  
Loryn Feinberg ◽  
Marc L Schermerhorn ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Mortality ◽  
Postpartum Period ◽  
Primary Outcome ◽  
Gestational Hypertension ◽  
Postpartum Women ◽  
Multiple Gestation ◽  
Secondary Outcomes ◽  
Peripartum Period ◽  
Traditional Risk Factors

Abstract Aims Pregnancy is a known risk factor for arterial dissection, which can result in significant morbidity and mortality in the peripartum period. However, little is known about the risk factors, timing, distribution, and outcomes of arterial dissections associated with pregnancy. Methods and results We included all women ≥12 years of age with hospitalizations associated with pregnancy and/or delivery in the Nationwide Readmissions Database between 2010 and 2015. The primary outcome was any dissection during pregnancy, delivery, or the postpartum period (42-days post-delivery). Secondary outcomes included timing of dissection, location of dissection, and in-hospital mortality. Among 18 151  897 pregnant patients, 993 (0.005%) patients were diagnosed with a pregnancy-related dissection. Risk factors included older age (32.8 vs. 28.0 years), multiple gestation (3.6% vs. 1.9%), gestational diabetes (14.3% vs. 0.2%), gestational hypertension (6.0% vs. 0.6%), and pre-eclampsia/eclampsia (2.7% vs. 0.4%), in addition to traditional cardiovascular risk factors. Of the 993 patients with dissection, 150 (15.1%) dissections occurred in the antepartum period, 232 (23.4%) were diagnosed during the admission for delivery, and 611 (61.5%) were diagnosed in the postpartum period. The most common locations for dissections were coronary (38.2%), vertebral (22.9%), aortic (19.8%), and carotid (19.5%). In-hospital mortality was 3.7% among pregnant patients with a dissection vs. &lt;0.001% in patients without a dissection. Deaths were isolated to patients with an aortic (8.6%), coronary (4.2%), or supra-aortic (&lt;2.5%) dissection. Conclusion Arterial dissections occurred in 5.5/100 000 hospitalized pregnant or postpartum women, most frequently in the postpartum period, and were associated with high mortality risk. The coronary arteries were most commonly involved. Pregnancy-related dissections were associated with traditional risk factors, as well as pregnancy-specific conditions.

scholarly journals Intraocular Risk Factors in the Primary Formation of Diabetic Macular Edema in Patients with Diabetes Mellitus Type II

2019 ◽  
Vol 16 (1) ◽  
pp. 63-69
Author(s):  
M. V. Pshenichnov ◽  
O. V. Kolenko ◽  
E. L. Sorokin ◽  
Yu. E. Pashentcev
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Comparison Group ◽  
Mean Value ◽  
Main Group ◽  
Type Ii ◽  
Diabetes Mellitus Type Ii ◽  
The Mean

Purpose. Revealing of the intraocular risk factors in the diabetic macular edema (ME) formatis in diabetes mellitus type II (DM2). Patients and methods. A 3.5-year research of 80 patients (160 eyes) with DM2 without signs of ME at the beginning of the research was performed. The main group consisted of 46 patients with ME symptoms on one or both eyes during the research period, the comparison group included 34 patients without ME symptoms to the end of the research. The initial ocular characteristics were retrospectively compared in groups.Results. The mean value of the axial lengths (AL) in the eyes of the main group was 23.12 ± 0.75 mm compared to 23.82 ± 0.62 mm in the comparison group (significant difference, p < 0.01). AL was less than 23.5 mm in 66 % eyes in the main group and only in 22 % of the eyes in the comparison group (p < 0.01). The mean value of the initial macular retina volume in the main group was significantly higher than in the comparison group — 7.51 ± 0.22 mm3 and 7.21 ± 0.12 mm3, respectively (p < 0.01). Initial background diabetic retinopathy (DR) was noted in 73 % eyes in the main group, which significantly differed from the comparison group, where this index was noted only in 13 % of the eyes (p < 0.01).Conclusion. Significant ocular risk factors for the formation of ME in patients with DM2 are: the initial macular retina volume more than 7.3 mm3, the value of the AL less than 23.5 mm; the initial background DR. The use of the detected morphometric parameters of eye and retina in combination with an adequate assessment of the risk factors in human organism makes it possible to assume a high risk of the primary formation of diabetic ME in patients with DM2 with high degree of probability.

Reproductive anamnesis of women with postpartum purulent-septic complications

2017 ◽  
pp. 65-68
Author(s):  
V.I. Pyrohova ◽  
◽  
Y.R. Feyta ◽  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Cesarean Section ◽  
Postpartum Period ◽  
Preventive Measures ◽  
Control Group ◽  
Study Group ◽  
Negative Consequences ◽  
Septic Complications ◽  
Significant Percentage

Postpartum purulent-septic complications are considered to be one of the main causes of maternal loss, hence, this is why they continue to maintain their relevance and priority in modern obstetrics. The incidence of this disease remains high and aggravates the extension of the postpartum period in 5–26% of cases. Mostly postpartum purulent-septic complications are caused by not one, but a combination of several reasons that can act simultaneously or sequentially and are often caused by a combination of medical and social factors. These factors require the necessity of diligent analysis of the reproductive anamnesis of women who suffered from complications of septic nature during the postpartum period, in order to highlight the risk factors for these complications. The objective: to explore the possibility of formation of high-risk groups based on the analysis of reproductive anamnesis in women with postpartum purulent-septic complications as part of preventive measures. Patients and methods. According to the purpose of this research a detailed retrospective analysis was made of anamnesis histories of 89 women (study group) with postpartum septic complications, namely, 58 women with postpartum purulent-septic complications who bore through natural birth canal; 31 women with postpartum purulent-septic complications after cesarean section. The control group consisted of 40 women recently confined within uncomplicated maternal postpartum process. Results. It was investigated that in the group of women with postpartum complications prevailed women who were pregnant for the second time (especially after cesarean section).It is important to highlight the fact that significant percentage of menstrual disorders and the commencement of early sexual live of women in the study group. Analysis of an illness revealed a significant incidence of inflammatory diseases of the female reproductive organs, cervical pathology, chronic tonsillitis, chronic pyelonephritis, cystitis, anemia clinical history in the main group. Significant percentage is noticed of the women with thyroid disorders. Significantly higher frequency was noticed with regards to pregnancies that had negative consequences in anamnesis, the presence of gynecological pathology, surgery and vaginal microbiota disturbances before and during pregnancy in women with postpartum purulent-septic complications. A combination of two or more selected factors, especially in women with extragenital pathology and transferred infectious diseases in anamnesis, greatly increases the risk of septic complications in the postpartum period. Conclusions. Current analysis has provided implicit evidences to ensure that it is important to select a separate group at high risk of postpartum septic complications on the stage which precedes pregnancy for the development of an individual plan for diagnostic and preventive measures to prevent this disease. Key words: postpartum purulent-septic complications, risk factors, reproductive anamnesis.

scholarly journals Medical-social risk factors of cervical cancer development among women of reproductive age

2019 ◽  
Keyword(s):  
Risk Factors ◽  
Cervical Cancer ◽  
Comparison Group ◽  
Main Group ◽  
Reproductive Age ◽  
Control Group ◽  
Social Risk ◽  
Social Risk Factors ◽  
Sociological Study ◽  
Female Population

Cervical cancer is one of the widespread diseases that have a negative impact on the reproductive health. However, medical-social risk factors which provoke this pathology aren't studied sufficiently yet. We have identified the most significant medical-social risk factors of cervical cancer's development and progression based on data analysis of a sociological study. Thus, it was found that cervical cancer can't be associated with predominantly late reproductive age of women in conditions of the Republic of Belarus: most of the patients with this pathology (more than 53%) were under the age of 35 years old. The group of patients suffered from cervical cancer was quite homogeneous in their social status, which was average and relatively stable in a large majority of them (more than 90%), despite employment in various sectors of the national economy. Social functioning of these patients wasn't significantly different from the main population of women in reproductive age. Thus, early sexual activity and random early sexual relations weren't characteristic for the majority of them: 86.1±4.46% (the control group – 87.3±5.51%, the comparison group – 78.2±3.96%) and 83.5±4.72% (the control group – 89.1±4.28%, the comparison group – 75.2±2.36%). Moreover, the married patients of the main group had the most ordered sexual behavior (p<0.01; tau=0.572) which determined the low prevalence of artificial abortions among them, including menstrual cycle regulation (less than 8%). However, the revealed different defects of health-saving behavior in the main group of patients (more than 70%), including an insufficient level of valeological knowledge, the presence of common harmful habits and low medical activity, indicate that there are significant reserves for improvement of the preventive activities of medical stuff in the field of primary medical care for the development of a healthy lifestyle among female population of reproductive age and providing clinical examination among this contingent of females in reproductive age with the purpose of cervical cancer prevention.

scholarly journals Unconventional Technique of Terminolateral Pancreatojejunostomy Formation

2021 ◽  
Vol 14 (1) ◽  
pp. 25-32
Author(s):  
Badri Valerievich SiguA ◽  
Vyacheslav Petrovich Zemlyanoy ◽  
Evgeny Alekseevich Zakharov ◽  
Malkhaz Yurievich Tsikoridze ◽  
Anatoliy Nikolaevich Napalkov
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Pancreatic Duct ◽  
Main Pancreatic Duct ◽  
Comparison Group ◽  
Main Group ◽  
Soft Pancreas ◽  
Significant Difference ◽  
Pancreatic Fistulas ◽  
Novel Method

Backgraund. Pancreatoduodenal resection (PDR) is the only radical treatment for malignant tumors of the periampullary zone. The development of postoperative pancreatic fistula (POPF) is the most common complication of PDR. The main risk factors for the development of POPF are the narrow main pancreatic duct and the soft, "juicy" pancreatic parenchyma. Thus, it is the stage of formation of a pancretodigestive anastomosis that is of decisive importance for the course of the postoperative period.The aim of the study was to improve immediate surgical treatment outcomes of patients suffering from oncological diseases of the periampullary zone with a soft pancreas and a narrow pancreatic duct.Methods. A novel method to form terminolateral reservoir invagination pancreatojejunostomy has been developed and introduced into clinical practice. The results of treatment of 94 patients with tumors of the periampullary zone were analyzed. Based on preoperative radiological diagnosis and intraoperative findings, such factors of a high risk of POPF development as a soft pancreas and a narrow major pancreatic duct ( 3 mm) were detected in 23 patients (24.4%). In 11 patients who were treated in 2018-2019, a novel method of pancreato-jejunoanastomosis formation was applied. The comparison group consisted of 12 patients who received treatment in 2014-2017; a differentiated approach to the formation of a pancreatodigestive anastomosis was not applied.Results. In patients of the main group, there was a tendency to an increase in the proportion of pylorus-saving PDRs. The only statistically significant difference was the use of reservoir terminolateral pancreatojejunostomy at the reconstructive stage of surgery. Complicated postoperative course was observed in 7 (63.6%) patients of the main group and in all patients of the comparison group (p 0.05). There was also a decrease in the incidence of postoperative pancreatic fistulas from 66.6 to 18.2% (p 0.05) in the study group. Repeated surgery was required in 3 (27.2%) patients of the main group and 7 (58.3%) patients in the comparison group (p 0.05). The lethal outcome was recorded in 2 (18.2%) patients of the main group and in 3 (25%) in the comparison group (p 0.05).Conclusion. A soft, loose pancreas and a narrow main pancreatic duct are the most significant risk factors for complications in the postoperative period. Management of this condition requires a differentiated approach to the treatment option of pancreatodigestive anastomosis formation, depending on the characteristics of the pancreas of an individual patient. The proposed technique for the reservoir terminolateral pancreatojejunoanastomosis formation allowed statistically significantly reducing the incidence of complications from 100 to 63.6% and the incidence of postoperative pancreatic fistulas from 66.6 to 18.2% in high-risk patients..

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