Journal of Experimental and Clinical Surgery

Scientific and practical journal "Journal of Experimental and Clinical Surgery" is established by the Institute of Surgical Infection of N.N. Burdenko Voronezh State Medical Academy  in 2008.

The journal publishes original articles on clinical and experimental studies, literature reviews, brief reports on clinical observations, information on innovations, inventions and innovative projects, new methods of diagnosis and treatment, materials on the history of departments, clinics and surgical hospitals.

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Current Issue

Vol 15, No 3 (2022)

Original articles

Liposuction as a Stage of Abdominoplasty
Vinnik Y.S., Pakhomova R.A., Babadzhanian A.M., Kochetova L.V., Fedotov I.A., Sindeeva L.V.
Abstract

Introduction. Modern options of plastic surgery tend to improve clinical outcomes, introduce minimally invasive methods, increase the quality of the cosmetic effect, provide long-term preservation of the effect, and use the most efficient and safe procedures. In this paper, the authors reviewed the main options for performing liposuction as a stage of abdominoplasty. The aim of research was to study the clinical outcomes of abdominoplasties combined with liposuction performed in plastic clinics in Krasnoyarsk, and systematize their approaches.
Materials and methods. This prospective and retrospective study involved 172 patients who underwent abdominoplasty with liposuction or liposuction in the Center for Plastic Surgery and Outpatient Healthcare and the Department of Plastic and Reconstructive Surgery of the Clinical Hospital "RZD-Medicine", Krasnoyarsk. The average age of women was 38 years.
Results and discussions. The ways of combining liposuction and abdominoplasty are extremely diverse due to effect of liposuction on the clinical outcomes of abdominoplasty. The volume of liposuction, the terms of liposuction, the area and access of surgical intervention are the most important issues for providing an aesthetic result. According to our findings, 30 women (24%) were performed solely liposuction of the anterior abdominal wall, 10 (8%) women were performed mini-abdominoplasty combined with liposuction, 31 women underwent mini-abdominoplasty or abdominoplasty without liposuction (29%), abdominoplasty combined with liposuction was performed in 54 (42%), which was the largest proportion compared to other types of interventions.
Systematization of liposuction options used in plastic clinics in Krasnoyarsk allows developing a scheme for the major, most commonly used approaches to combine these types of operations. Local complications are more common in women with BMI=30-40. In the postoperative period, local complications were observed in 5.8% of cases; systemic complications were not detected in this study.
Conclusion. Effectiveness analysis of the results obtained demonstrated that the most effective way of the intervention is to perform liposuction during abdominoplasty. Liposuction as a stage of abdominoplasty with a competent and personalized approach improves the effectiveness of abdominoplasty and allows achieving an ideal aesthetic result.

Journal of Experimental and Clinical Surgery. 2022;15(3):192-197
pages 192-197 views
A method for determining the optimal technique of surgical intervention in patients with post-traumatic kyphotic deformity of the thoracolumbar spine in the late period of spinal injury.
Ptashnikov D.A., Magomedov S.S., Rominsky S.P., Mytyga P.G.
Abstract

Introduction. Spinal fractures account for 63.6 cases per 100,000 populations. Of these, the largest number falls on the Th10-L2 zone. Regardless of the choice of treatment tactics in the early period of spinal injury, a vast number of patients continue to complain of local pain and deformity. In these patients, surgical treatment may be indicated. At the preoperative stage, the operating surgeon faces the problem of choosing an intervention of sufficient volume.
The aim of the study was to determine the optimal amount of corrective surgical interventions in patients with kyphotic deformity that has developed as a result of a vertebral fracture.
Methods. Patients with a medical history of vertebral compression fracture and local kyphotic deformity greater than 11 degrees were enrolled in a single-centre, prospective, experimental study. All patients were divided into three groups according to the studied algorithm. Patients in group A underwent two-stage surgical treatment with corporectomy, implantation of a mesh interbody implant, and posterior transpedicular fixation from two approaches. Group B patients underwent one-stage surgical treatment with corporectomy and implantation of a mesh interbody implant from a single approach. Patients of group C underwent corrective vertebrotomy without the use of a mesh implant. The degree of deformity correction, the traumatism of surgical intervention, the stability of the metal structure, the formation of a bone block, and changes in the functional status of the patient were assessed. Patients were followed up for 24 months after surgical treatment.
Results. The study was completed by 114 patients. Surgical treatment options used allowed achieving good results in the correction of deformity in all groups, in groups B and C the traumatism of the operation was significantly (p=0.05) lower than in group A. A bone block was formed in all study groups. It is important to note that patients in group B had transient radicular pain in the early postoperative period, which probably associated with the traction of neural structures during the installation of an interbody mesh implant.
Conclusion. Application of the presented algorithm allowed us to achieve comparable beneficial results in patients of all study groups, however, a small sample and the absence of control subgroups do not allow us to extrapolate the study results to the entire population.

Journal of Experimental and Clinical Surgery. 2022;15(3):198-205
pages 198-205 views
Long-Term Conditioning of a Donor Heart by Autoperfusion
Zhulkov M.O., Zykov I.S., Sirota D.А., Agaeva H.A., Sabetov A.K., Poveschenko O.V., Bozorov S.S., Fomichev A.V., Chernyavsky A.M.
Abstract

The aim of research was to study parameters of homeostasis and conditions for stable operation of the autoperfused heart-lung complex ex vivo.
Materials and methods. A series of acute experiments (n-3) was carried out to create a functioning heart-lung complex and study parameters of homeostasis ex vivo. A large mammal (mini-pig weighed 20-30 kg) was used as an experimental model. During the experiment, invasive blood pressure in the aortic root, pulmonary artery, central venous pressure, temperature of the left ventricle of the heart, gas composition of arterial blood (in the aortic root) and venous blood flowing from the coronary sinus was monitored.
Results. The series of experiments evidenced the fundamental possibility of an isolated heart-lung complex ex vivo stable functioning. During 4-hours autoperfusion of the "heart-lung" complex, the parameters of hemodynamics, gas and biochemical blood composition remained within the reference values.
Conclusion. The analysis of literature data and the results of experiments on laboratory animals allow us to state that the autoperfusion can be successfully used as an option of safe and long-term conditioning of a donor heart. This technique can be used to improve the results of heart transplantation with prolonged ischemia of the donor organ. Extending the survival of a donor heart ex vivo functioning will significantly expand the geography of donor bases, reducing the ischemic period to a minimum.

Journal of Experimental and Clinical Surgery. 2022;15(3):214-220
pages 214-220 views
The prevention of leakage of ileo-colonic anastomosis in an experimental peritonitis
Vajner J.S., Atamanov K.V., Beljakova T.S.
Abstract

Introduction. In colon surgery, intestinal anastomotic leaks are the main contributor to postoperative mortality. The incidence of this complication in the formation of small-colonic anastomoses in urgent surgery reaches 12% or more. It is required to develop simple and reliable techniques of intestinal suturing in conditions of peritonitis.
The aim of the study was to investigate the morphological events occurring in the small-colonic anastomosis formed using various options under simulated peritonitis.
Materials and methods. An experimental study involved 2 groups of Wistar white rats (25 animals - the control group and 25 - the main one). Peritonitis was simulated by dissecting the ileum into ¼ circles in 5-6 cm from the ileocecal angle. A day later, a relaparotomy was performed, a section of the intestine with a defect was excised, the distal loop was tied up, a small-colonic anastomosis was formed with a proximal loop: in “the end-to-side” study group the intervention was performed according to the author's method (RF patent No. 2709253 dated 12/17/2019), in the control group – using side-to-side anastomosis. In 6 days, anastomosis was taken from the survived animals for histological examination. Histological examination was carried out at a magnification x400 and x630. Micromorphometry was performed with the count of neutrophils, fibroblasts and measurement of the relative area of ​​blood vessels in the anastomotic suture. Fisher's exact test, Mann-Whitney test were used for statistical data processing, quantitative data were described in the median and interquartile interval format.
Results. An original end-to-side anastomosis resulted in a greater number of fibroblasts and blood vessels in the muscular and submucosal layers of the intestinal wall in the suture zone than in the side-to-side anastomosis. The number of anastomotic leaks in the study group was 4 times less than in the control group.
Conclusion. The use of the authors’ end-to-side anastomosis technique improves blood supply and repair of the suture area in a small-colonic anastomosis under 1-day simulated peritonitis; this being accompanied by a decreased incidence of anastomosis failure.

Journal of Experimental and Clinical Surgery. 2022;15(3):221-227
pages 221-227 views
Surgical Aspects of Treatment of Hilar Cholangiocarcinoma
Abdullaeva A.Z., Medzhidov R.T., Murtuzalieva A.S.
Abstract

Introduction. Treatment of hilar cholangiocarcinoma remains one of the most complicated issues of surgical hepatology. As known, hilar cholangiocarcinoma is resistant to chemotherapy and radiation therapy, and only a surgical option is an effective way to improve patient survival.
The aim of the study was to improve clinical outcomes of patients with cholangiocarcinoma by evaluating the efficiency of various options for resection and reconstructive and restorative stages of surgical treatment.
Methods. The study involved clinical findings and outcomes of 68 patients with hilar cholangiocarcinoma. Biliary decompression was performed in 61 (89.7%) cases. Radical surgical interventions were performed in 35 (51.4%) cases, and palliative surgical interventions were performed in 33 (48.6%) cases.
Results. Specific complications at the stage of biliary decompression were noted in 4 (6.5%) cases, inadequate drainage of the biliary tract occurred in 5 (8.2%) cases. The syndrome of "rapid decompression of the biliary tract" was recorded in 14 (23.0%) cases, cholangitis - in 12 (19.7%). Intraoperative complications were noted in 2 (15.3%) cases, postoperative - in 6 (17.1%) cases. Mortality rate was 8.5%. In the long-term period, stenosis of the biliodigistic anastomosis was recorded in 11.4% of cases, tumor recurrence occurred in 28.6% of cases. The five-year survival rate was 17.0%.
Conclusion. Resection of the bile ducts combined with hemihepatectomy is an operation accompanied by high risks, especially at the height of jaundice and in the elderly patients. Performing a sparing hiatal resection of the liver and bile ducts provides an acceptable survival rate. The proposed method to form a biliodigistic anastomosis is effective in terms of preventing insolvency and stenosis of the anastomosis.

Journal of Experimental and Clinical Surgery. 2022;15(3):206-213
pages 206-213 views

Experience

Combined Treatment of a Patient with High Bile Duct Stricture
Semenov D.Y., Morozov V.P., Bogdanov P.I., Did-Zurabova E.S., Rebrov A.A., Melnikov V.V., Kulikov D.V., Babazada R.I.
Abstract

Minimally invasive percutaneous techniques, staged as part of the combined treatment of high stricture complications of the biliary tract, demonstrated high efficiency in the short term. On the other hand, the use of self-expanding nitinol stents as a definitive treatment for non-tumor stricture of the biliary tract in long-term life prognosis cannot be recommended as a routine intervention. The use of stents in these cases can only be justified in the absence of alternative treatment options, subject to frequent monitoring of the biliary tract.

Journal of Experimental and Clinical Surgery. 2022;15(3):228-231
pages 228-231 views
High-Dose Brachytherapy in Chemoradiation Schemes of Patients with Oral Mucosa Cancer
Moshurov I.P., Korotkikh N.V., Kamenev D.Y., Tsurikova A.V., Kulikova I.N.
Abstract

The aim of the study was to improve clinical outcomes of oral mucosa cancer in case of surgical treatment failure.
Materials and methods. A clinical case of combined radiation treatment of a patient with oral floor mucosa cancer St III T3N1M0 was presented. Pathogistological diagnosis # xxxxxx was: highly differentiated squamous cell carcinoma. A treatment plan was developed. Chemoradiotherapy at the first stage included 3 courses of intra-arterial chemotherapy (Selective (superselective) embolization (chemoembolization) of tumor vessels in the basin of the left and right facial and left lingual arteries, cisplatin 150 mg, combined with a daily infusion of 5-fluorouracil 4000 mg), with an interval 21 day. Chemoradiotherapy at the second stage included volume modulated arc therapy (VMAT) on the area of ​​the primary tumor (oral floor mucosa) and the regional metastasis pathways (total boost dose 60 Gy to the area of ​​regional lymph flow, otal boost dose 50 Gy to the oral cavity). Chemoradiotherapy at stage 3 included interstitial radiation therapy. A single boost dose (SBD) for the primary focus was 3 Gy/per fraction, 2 times a day, with an interval of 6 hours until total boost dose reached 21 Gy, 7 fractions.
Results. After treatment, a complete regression of the tumor was noted. No pathological accumulation of radiopharmaceuticals, features of the tumor process was detected on PET/CT 48 months after treatment.
Conclusions. Chemoradiotherapy combined with brachytherapy can be considered as an equal alternative to surgical treatment of patients with oral mucosa cancer.

Journal of Experimental and Clinical Surgery. 2022;15(3):232-235
pages 232-235 views
Application of the Developed Mechanical Methods for the Treatment of Patients with Wound Complications of Postoperative Ventral Hernias Prosthetic Repair
Izmailov S.G., Lukoyanychev E.E., Leontev A.E., Izmailov A.G., Mezinov A.V., Panushkin A.V., Koloshein N.A., Abdulkerimov E.M., Tsyrenzhapov A.Z.
Abstract

Introduction. Until now, the treatment of postoperative ventral hernias and their complications remains a difficult task of abdominal surgery. Patients with extensive wound defects of the abdominal wall complicated by a purulent-inflammatory process of soft tissues are of particular difficulty for treatment; an attempt to stitch these tissues together in the II phase of the wound process using conventional options results in unnecessary trauma and makes it much more difficult, and sometimes impossible, to accurately match homogeneous layers.
The aim of the study was to demonstrate the potential of successful use of the developed adaptive instruments for mechanical treatment of the wound surface and closure of a large defect in the soft tissues of the anterior abdominal wall, formed during suppuration of the surgical wound and rejection of the endoprosthesis after prosthetic repair of the hernia ring.
Results. Two clinical cases of successful use of the developed adaptive instruments for mechanical treatment of the wound surface and hardware decompression suturing of wounds in the treatment of deep wound infection in postoperative ventral hernias prosthetic repair were presented. Healing of wound defects after wound suppuration and implant rejection was achieved in both cases.
Conclusion. The data obtained demonstrated the safety and clinical efficacy of a staged surgical treatment with mechanical debridement of the wound, followed by vacuum therapy and the implementation of a hardware decompression technique for closing the wound defect; this creating optimal conditions for wound healing according to the type of primary intention.

Journal of Experimental and Clinical Surgery. 2022;15(3):236-243
pages 236-243 views

Review of literature

Ultrasonic Diagnostics at the Stages of Liver Echinococcois Treatment
Stepanova Y.A., Goncharov A.B., Zhao A.V.
Abstract

Cystic echinococcosis is a chronically severe parasitic disease of humans and animals caused by parasitism of the larval stage of Echinococcus unicameral.
Ultrasound (ultrasound) being the most widely used option of visual diagnostics is the leading method of radiological diagnosis of echinococcosis of the liver and other organs. The technique is generally available and allows diagnosing echinococcosis at a stage when parasitic cysts are still small in size, starting from 1.5-2 cm. However, with the high accuracy and specificity of ultrasound in the differential diagnosis of echinococcosis cysts, there are certain disadvantages of the approach.
Due to constant study and, accordingly, changes in knowledge about the course of the disease, methods for its diagnosis and treatment, there is no unified and stable ultrasound classification of liver echinococcosis. The paper analyzes the criteria that justify various classifications of echinococcus, substantiates forming trends. The standardized ultrasound classification of hydatid echinococcosis of the liver, which was adopted by the World Health Organization in 2003 and revised in 2010, is discussed.
The potential and advantages of dynamic ultrasound monitoring of echinococcal cysts and postoperative characteristics of the residual cavity after echinococcectomy are demonstrated.

Journal of Experimental and Clinical Surgery. 2022;15(3):244-253
pages 244-253 views
Methods for Assessing the Severity of Adhesions in the Experiment and Clinical Setting
Sergeev A.N., Morozov A.M., Epifanov N.Y., Rachek A.M., Kerimova M.
Abstract

The paper highlights major known approaches for an objective assessment of the severity of the adhesive process in the abdominal cavity. The scales used in experimental studies in vivo and in the clinic are considered separately. Considering various goals and objectives of experimental study, a wide range of scales has been proposed, taking into account the type of animals, the degree of the surgical zone involvement in the adhesive process, deformation of a hollow organ, degree of prevalence of the process in the abdominal cavity, adhesion density and shape, their vascularization, or a combination of the above criteria. The most universal scale applied in the clinical setting is Peritoneal Adhesion Index (PAI), which takes into account the severity and prevalence of the adhesive process, and the physical properties of peritoneal adhesions. To satisfy the objectives of a clinical study, simplified (Nair et al.) or more detailed scales (Ayushinova N.I. and co-authors) characterizing an adhesive process can be applied with a high degree of objectivity and informative.

Journal of Experimental and Clinical Surgery. 2022;15(3):254-261
pages 254-261 views
Modern Approaches to the Study of Liver Failure on Biological Models
Laptiyova A.Y., Glukhov A.A., Andreev A.A., Verlyanko M.S., Ostroushko A.P.
Abstract

Introduction. To date, according to WHO, liver failure (LF) is one of the ten leading causes of death in the elderly in developing countries. In developed countries, LF occurs in 0.03% of the population, but mortality and complication rate remain high. WHO predicts that in the next 10-20 years, mortality from liver diseases will increase by 2 times. In this regard, prevention and treatment of liver failure is of great medical and social significance, remains relevant and requires in-depth study on biological models.
The aim of the study was to systematize the data on modern approaches to study liver failure on biological models.
Material and methods. The authors reviewed data in PubMed, Cochrane Library, ScienceDirect, eLIBRARY. The search was conducted on the keywords "liver failure", biological model, "liver surgery", "liver failure", "modeling of liver failure", "biological model" and limited to the period 2010-2021. In addition, a manual search of papers in the peer-reviewed journals was carried out. Criteria for exclusion were: description of individual clinical cases, data from books and documents, comparison of clinical outcomes. Out of 109 initially identified sources, 40 sources were included in the final analysis.
Results. To date, there are several ways to simulate acute liver failure: surgical, toxic and combined. Chronic liver failure is also simulated diversely: toxically (tetrachloromethane, thioacetamide, dipin, sovtol-1, etc.); surgically (ligation of the bile ducts); dietarily (choline-deficient, etc.); genetically (introduction of exogenous genes into the germ line, combination of hepatotoxins with hepatocarcinogens). As stated, LF simulation has features associated with a high rate of regenerative processes in the liver; the fact allowing it to compensate for damage relatively quickly.
Conclusion. There are many techniques to simulate hepatic pathology, differing in damaging factors, the degree of damage and the reversibility of the process, different manifestations of biochemical and morphological changes. When choosing an option to reproduce liver failure, the researcher should take into account the advantages and disadvantages of the model, the conditions for conducting and the expected result of the experiment, and also choose the model that most accurately illustrates the clinical picture of this pathological condition.

Journal of Experimental and Clinical Surgery. 2022;15(3):262-267
pages 262-267 views
Application of Autological Adipose Tissue and its Products in the Treatment of Infected Wounds of Different Genesis
Koloshein N.A.
Abstract

Introduction. Transplantation of autologous adipose tissue and its products to stimulate the wound process is a rapidly developing area of ​​regenerative medicine. Adaptation of the technology to the conditions of infected wound treatment is a great challenge.
The aim of the study was to determine the most effective and safe technologies for obtaining, processing and transplanting autologous adipose tissue used to treat infected wounds.
Material and methods. The authors searched for relevant papers published in 2011 to 2021 in electronic databases PubMed, eLIBRARY, Embase, Cyberleninka, Web of Science. The analysis included 30 sources: 5 RCTs, 16 clinical studies, 3 case reports, 1 systematic review, 2 literature reviews, and 4 sources published before 2011 due to their fundamental and practical significance for the scope of the issue.
Results and discussions. Although the lipoaspiration procedure in patients with infected wounds is described as standard conventional one, it still has a number of significant features that distinguish it from the standard technology of aesthetic surgery. To treat lipoaspirate, both enzymatic and mechanical options were used with the same frequency. The main technique of introducing adipose tissue products was local intradermal injections into the edges and under the wound bed; in a few cases, applications on the wound surface were used, or a combination of these options. As recorded, the cellularity index of adipose tissue products ranged from (min) 1x104/ml to (max) 50x106/ml. It should also be noted that a unified terminology for adipose tissue products used for wound treatment has not yet been adopted, but the most common term is “stromal-vascular adipose tissue fraction”.
Conclusions. Systematization of literature data on the use of autologous adipose tissue products for wound treatment has shown that at present this technology is safe, provided with an accessible instrumental base, has positive results and is being actively developed. Further randomized clinical trials, involving extensive and multiple wounds, are required to determine the minimum effective and maximum tolerable dose in the treatment of wounds with adipose tissue products. In addition, it is promising to develop new means and approaches for delivering adipose tissue products in the treatment of infected wounds of various origins.

Journal of Experimental and Clinical Surgery. 2022;15(3):268-277
pages 268-277 views

History of surgery

Israil Perelman: the shore of his life, or the corners of childhood and adolescent. To the 130th of birthday
Larichev A.B.
Abstract

The fate of Professor Israil Moiseevich Perelman (1892-1954) is inextricably linked with the history of the Minsk Medical University and the Minsk Provincial Hospital, the Borisov Regional Hospital and the surgical service in Gorki, Gomel and Mogilev. He stood at the origins of the formation of medical universities in Vitebsk, Ordzhonikidze, Novosibirsk and Yaroslavl. It all started with the fact that among the many settlers who came to the promised land of White Russia was Moses Perelman. He was the same Jewish poor who were not allowed to cross the limits of the "Pale of Settlement". Without any preferences for choosing a place of permanent residence, Perelman chose the factory outskirts of Minsk – Lyakhovka. This place is unattractive, but here, along with many thousands of the same "new settlers", starting from zero, it was possible to make plans for the future and vigorously implement them. An artistic and documentary review of the origins of this settlement, its description of everyday life allows us to imagine the atmosphere of the daily life of those who settled there, took root and gave birth to a new generation. It is this close relationship between the past and the future that makes it possible to understand that in any conditions there is a potential for the formation of good abilities and talents, which, in particular, Israil Perelman possessed. Undoubtedly, the parents were the determining factor in this. They, being guardian angels, provided everything possible and impossible for the upbringing of a purposeful personality in the son, and the difficulties only helped to maintain a sense of gratitude for everything that made the childhood of one of the many boys of the Minsk outskirts carefree - that same factory outback, his small homeland – Lyakhovka.

Journal of Experimental and Clinical Surgery. 2022;15(3):278-285
pages 278-285 views

Memorials

Viktor Ivanovich Bulynin - Professor, Chairman of the Voronezh Regional Society of Surgeons, Honorary Citizen of Voronezh. To the 90th of birthday
Glukhov A.A., Andreev A.A., Ostroushko A.P.
Abstract

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Journal of Experimental and Clinical Surgery. 2022;15(3):286-287
pages 286-287 views

ANNIVERSARY

Alexander Artemyevich Matchin - Professor, Honored Maxillofacial Surgeon. To the 80th of birthday
Gubin M.A.
Abstract

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Journal of Experimental and Clinical Surgery. 2022;15(3):288
pages 288 views

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