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 1 (2022)

Original articles

Features to Prevent Failed Hardware Colorectal Anastomoses in Laparoscopic Rectal Resections
Ivanov Y.V., Panchenkov D.N., Lomakin I.A., Istomin N.P., Velichko E.A., Danilina E.S.
Abstract

The aim of research was to study proper results of laparoscopic anterior rectal resection using intraoperative measures to prevent failure of hardware colorectal anastomoses in patients with rectal tumor.
Material and methods. Out of 68 patients included in the study, colorectal anastomotic leakage occurred clinically only in 2 cases (2.9%, class A and B) and required no further surgical interventions. When evaluating the risk of colorectal anastomosis failure in each specific case, it is necessary to consider pre- and intraoperative risk factors. Formation of colorectal anastomosis with one angular end of the rectal stump followed by immersion; additional strengthening of the anastomosis zone with interrupted serous-muscular sutures; adequate drainage of the pelvic cavity (the most effective - transperineal presacral) are intraoperative methods that reduce the risk of failed hardware colorectal anastomoses.
Results. Out of 68 operated patients, colorectal anastomosis failure occurred clinically only in 2 cases (2.9%, class A and B) and did not require repeated surgical intervention. When assessing the risk of colorectal anastomosis failure in each specific case, it is necessary to take into account pre-and intraoperative risk factors. Formation of a colorectal anastomosis with one angular end of the rectal stump, followed by its immersion; additional strengthening of the anastomosis zone with nodular serous-muscular sutures; adequate drainage of the pelvic cavity (most effectively - trans-interventional presacral) - intraoperative methods that reduce the risk of failure of hardware colorectal anastomoses.
Conclusion. Reasonable doubts in the intraoperative evaluation of the blood supply to the end section of the descending colon, viability of the colorectal anastomosis, presence of 3 or more risk factors, low position of anastomosis (less than 10 cm from the outer end of the anal canal) indicate the necessity to form preventive transversostomy.

Journal of Experimental and Clinical Surgery. 2022;15(1):10-17
pages 10-17 views
Minimally Invasive Osteosynthesis in Patients with Severe Combined Trauma and Polytrauma
Khromov A.A., Gumanenko E.K., Linnik S.A.
Abstract

Introduction. Treatment of patients with combined trauma and polytrauma is one of the most difficult issues in traumatology characterized by high mortality, long-term disability and high level of disability. In recent decades, there has been an increase in combined injuries in Russia, primarily associated with an increased number of road accidents (crashes) - up to 53.19 %, - and industrial injuries - about 23.4% of cases. Apparently, this trend will only increase in the coming decades.
Such injuries are accompanied by formation of traumatic foci, which are the trigger mechanism of pathologies such as traumatic diseases, multiple organ dysfunction and multiple organ failure. Even when it is possible to bring the patient out of shock and avoid multiple organ failure – a multi-month period of delayed convalescence or a period of trophic disorders of traumatic disease often results in the disability of the rescued patient. These circumstances, on the one hand, force surgeons to choose an active, more” aggressive" tactic for osteosynthesis to early activate a patient; on the other hand, - to search for less "aggressive" methods of osteosynthesis. In recent years, new, specially designed minimally invasive systems for surgical treatment of fractures have been developed in Russia; this being the reason for the revision of traditional osteosynthesis expanding the possibility of active surgical tactics in patients with severe combined trauma and polytrauma.
The aim of the study was to improve clinical outcomes of patients with severe combined trauma and polytrauma, to develop a model of early trauma care.
Materials and methods. The study included clinical findings of 636 patients with severe combined trauma and polytrauma, 223 patients in the control group, and 413 patients in the main group. Long-term anatomical and functional and labor outcomes, the quality of life from 3 to 5 years after injury were studied. Immediate results of treatment were studied in all 497 patients, long-term results in 414. The effectiveness of fracture treatment was evaluated according to the Neer-Grantham-Shelton scale, which is based on a score of 5 clinical and 1 X-ray signs. During the study, the developed intraosseous, bone fixators and methods of osteosynthesis were applied.
Results. The study demonstrated that the proposed tactics for treating patients with severe combined trauma and polytrauma, which included the application of new methods and devices developed for minimally invasive osteosynthesis, resulted in the improved clinical outcomes: an increased number of positive outcomes by 14.2%, a decreased number of satisfactory outcomes by 10.24%, and unsatisfactory outcomes by 4.02 %.
Conclusions. Thus, high operational activity in the acute period of traumatic disease based on the objective criteria for the severity of the patient's condition and prognosis of shock is a must in the treatment of patients with severe combined trauma and polytrauma. The time, volume and method of operational assistance depend on the patient’s condition, which prognostic group the patient is included, the result of dynamic prognosis. Early fixation of injuries performed by minimally-traumatic methods (with external fixators), closed intramedullary osteosynthesis with locking screws contributes to the prevention of complications of early and subsequent periods of traumatic illness.

Journal of Experimental and Clinical Surgery. 2022;15(1):18-25
pages 18-25 views
Comparative Analysis and Options to Improve the Immediate and Long-Term Effects of Gastric Cancer Surgical Treatment
Rogozianskaia M.I., Moshurov I.P., Redkin A.N., Gavrilov V.I., Danilov V.M.
Abstract

Introduction. Currently, there are absolute and relative indications for splenectomy in the surgical treatment of gastric cancer.
The aim of the study was to improve clinical outcomes of treatment in patients with gastric cancer identifying risks associated with splenectomy, and developing options to correct them.
Methods. The study included clinical findings and parameters of the quality of life of 380 patients with gastric cancer who were treated at the Voronezh Regional Clinical Oncological Hospital in 2013-2019. All patients were conventionally divided into 2 groups. The patients of the first group (study group, 172 people) underwent gastrectomy with D2 lymphadenectomy, including splenectomy. The patients of the second group (comparison group, 208 people) underwent spleen-preserving gastrectomy with dissection of lymph node groups 10 and 11. The average follow-up was 39.6 months. In the postoperative period, all patients were examined according to the Clinical Recommendations of the Russian Federation. The SF-36, GSRS questionnaires were used to assess quality of life.
Results. Splenectomy increased the incidence of early postoperative complications, including severe complications grades 3 - 5 according to the Clavien-Dindo classification, contributed to the development of reflux esophagitis and, in general, a worsen quality of life in the late postoperative period, but did not affect the patients’ survival.
Conclusion. The data obtained evidence a significantly worse and generally unfavorable safety profile of patients undergoing splenectomy compared to patients who underwent spleen-preserving gastrectomy. Reduced indications for splenectomy appear to be the option to solve this problem. Measures for correction of postoperative complications have been developed for patients with absolute indications for splenectomy.

Journal of Experimental and Clinical Surgery. 2022;15(1):26-33
pages 26-33 views
Retrospective Study of Outpatient Treatment of Acute Mesenteric Circulatory Disorders
Sukharukov A.S., Narezkin D.V., Bezaltynnykh A.A., Sergeev A.V., Avchinnikova D.A.
Abstract

Introduction. Acute violation of mesenteric blood circulation is one of the most severe urgent diseases of the abdominal cavity. The number of patients, and the mortality rate resulted from this pathology, is steadily increasing every year. The number of patients has only increased during the pandemic of new coronavirus infection COVID-19.
The aim of study was to develop options to prevent severe outcomes of this pathology at the pre-hospital stage identifying patients with high risk of developing mesenteric thrombosis.
Materials and methods. The study was a retrospective analytical study that included 279 (100%) patients and their outpatient records. All patients were diagnosed with acute mesenteric circulation disorder and treated at the hospital surgery clinic in Smolensk in 2013-2020. When conducting a thorough analysis of patients’ findings, special attention was paid to: past medical history, in particular, the presence of abdominal pain syndrome, features, localization and intensity of pain; the nature of labour activity during life; existing comorbidity; surgical interventions of the abdominal organs, objective examination findings, and laboratory and instrumental test findings. The data obtained were processed using methods of statistical analysis described in the book "Statistics in biology and medicine" by Medik V.A., Tokmachev M.S., Fishman B.B. (2001), and MS Excel 2019.
Results. A retrospective analysis revealed that 63 (22.5%) patients had a burdened anamnesis of acute mesenteric circulatory disorders in close relatives. An increased number of "bad" lipoproteins of low and very low density was noted, this being an unfavorable factor in the development of atheromatous lesion of the mesenteric vascular bed followed by the manifestation of acute mesenteric circulatory disorders. The analysis revealed a group of patients with ischemic colitis that included 139 patients (49.1 %). The diagnosis was supported by fibrocolonoscopy. In addition, it was found that 4 ± 0.7 years (from 3 to 4.5 years) passed from the onset of symptoms to hospitalization for acute mesenteric circulatory disorders in patients with abdominal symptoms.
Conclusions. All patients with acute mesenteric circulatory disorders had manifested clinical signs of the disorder 3-4.5 years before it was diagnosed; this allowed suspecting violations along the mesenteric bed. Patients with a burdened anamnesis of the cardiovascular system (coronary heart disease-93.7%, arterial hypertension – 86.1%, various forms of atrial fibrillation – 83.4%) were mostly at risk. Identification of a risk group at the outpatient stage for potential occurrence of acute mesenteric circulatory disorders can help reduce incidence of this pathology.

Journal of Experimental and Clinical Surgery. 2022;15(1):34-40
pages 34-40 views
Acute Issues of Lactation Mastitis Therapy
Yakovenko O.I., Akimov V.P., Tkachenko A.N., yakovenko T.V.
Abstract

Introduction. Lactation mastitis can complicate the course of the postpartum period in every tenth case. Under lactation abscess, the tactic of performing wide incisions to drain the breast abscess and complete lactation by medications is common. International studies report that the treatment of lactational purulent mastitis complicated by an abscess is possible in a minimally invasive way - by puncture or drainage of an abscess under ultrasound navigation. The current trend in the treatment of lactational breast abscess also includes preservation of breastfeeding.
The aim of the study was to develop a modern approach to the complex treatment of purulent lactation mastitis.
Materials and methods. We treated 64 breast abscesses that were complications of lactation mastitis with minimally invasive methods in 2018-2020. Most of the patients preserved lactation.
Results and discussion. The average age of patients was 24.9 years. In the first group of patients (puncture techniques for treating abscesses), the diameter was 24 mm on average, in the second group (drainage technique for treating abscesses) the diameter was 53 mm on average. All procedures were performed under local anesthesia. The average score of the severity of pain syndrome was 4.4 points on the day of surgery. The average duration of drainage was 4.4 days. None of patients had a relapse of the disease or formation of a chronic fistula within 2 months followed by the operation. No negative evaluation of satisfaction with the cosmetic result was received. Breastfeeding continued in 78-87.5% of patients after surgery.
Conclusion. Minimally invasive surgical techniques in the treatment of breast abscesses (punctures and drainage under ultrasound navigation) are the operations of choice. The optimal treatment of lactation mastitis complicated by a breast abscess, in addition to surgical treatment, includes effective expression of breast milk, administration of antibacterial drugs, non-steroidal anti-inflammatory drugs, and preservation of breastfeeding.

Journal of Experimental and Clinical Surgery. 2022;15(1):41-45
pages 41-45 views
Experimental Simulation of Compression Anastomosis in Double-Barreled Enterostomy Using a Titanium Nickelide Memory Shape Device
Ivanov S.D., Slizovskiу G.V., Shikunova Y.V., Vtorushin S.V., Vasilchenko D.V., Gunther V.E., Khodorenko V.N., Anikeev S.G.
Abstract

Introduction. Enterostomy remains a relevant option of staged treatment of small intestine diseases in children. T-anastomosis with stoma (Bishop-Koop) and double-barreled enterostomy with compression anastomosis (Mikulicz) are among the most widely accepted ones. Disadvantages of compression anastomosis can be eliminated by using a NiTi-clip with shape memory.
The aim of the study was to perform an experimental study to detect effectiveness and advantages of NiTi-clip application in formation of a compression anastomosis in a double-barreled enterostomy compared with manual T-anastomosis.
Methods. The study included 24 rabbits of the "Serebristyi" breed, aged 2.5-3 months, weighed 2790-3100 g; they were divided into two equal groups. Autopsy was performed in 10, 14, 21 days with pneumopression and histological examination. Differences were considered statistically significant at p-value <0.05.
Results. The duration of the Mikulicz operation (group A) was significantly shorter than that of Bishop-Koop`s (group B) (p = 0.000). Significant differences in weight were found in 14. 21 days, with a predominance in group A (p = 0.029). Complications included wound suppuration, eventration, peritonitis, evagination, dermatitis, and anastomotic leakage. In 10 days, compression anastomosis had a lower anastamotic pressure, but in 21 days, it was more stabile than in manual anastomosis (p = 0.019). In 14 days, inflammatory changes in the mucosa with fibrosis in the muscle layers and lesions were detected in the area of ​​manual anastomosis, they were accompanied by inflammation around sutures. In 21 days, fibrotic changes spread in all layers. Proliferation prevailed over inflammation in the area of ​​the compression anastomosis.
Conclusions. Double-barreled stoma formation with NiTi-clip application took less time than T-anastomosis. Animals with a double-barreled stoma and compression anastomosis had a larger weight gain. Compression anastomosis with NiTi-clip in the stoma was stabile than manual anastomosis. With compression anastomosis, layer-by-layer regeneration from serous to mucous membrane occurs, healing occurred faster, with a predominance of proliferation processes, the risk of stenosis decreased. The use of NiTi-clip in the surgical treatment of children with double-barreled enterostomy can be recommended for practical use.

Journal of Experimental and Clinical Surgery. 2022;15(1):46-57
pages 46-57 views
Therapeutic Angiogenesis in the Experimental Ulcerative-Necrotic Stage of Critical Lower Limb Ischemia
Sukovatykh B.S., Feyziev E.E., Zatolokina M.A., Belous A.S., Sukovatykh M.B.
Abstract

Introduction. The effectiveness of therapeutic angiogenesis in the ulcerative-necrotic stage is insufficient to preserve the limb.
The aim of research was to study the effectiveness of therapeutic angiogenesis with "Udenafil", mononuclear fraction of autologous bone marrow and their combination in the experimental ulcerative-necrotic stage of critical lower limb ischemia.
Materials and methods. Lower leg muscle ischemia was simulated on Wistar rats. All animals were divided into 4 groups, 20 animals in each group: with simulated critical ischemia without treatment (control group); with critical ischemia and monotherapy with udenafil (udenafil, orally, 8.6 mg/kg for 28 days, the first experimental group); with critical ischemia and monotherapy with mononuclear fraction of autologous bone marrow (a single paravasal injection of a mononuclear fraction of autologous bone marrow in 7 days after critical ischemia simulation, the second experimental group); with critical ischemia and combined therapy (udenafil orally, 0.86 mg/kg, once a day, for 28 days, and a single paravasal injection with a mononuclear fraction of autologous bone marrow, similar to the group with monotherapy, the third experimental group). The level of blood microcirculation in the lower leg muscles was measured in 21 and 28 days; after that, histological examination was performed.
Results. In the control group, the regional blood flow rate in the ischemic shin muscle was 2.1 times less than in intact animals in 21 days and 1.8 times less in 28 days after simulated critical ischemia. In the first experimental group, the regional blood flow rate increased by 1.6 times in 21 days and 28 days after udenafil administration; in the second experimental group, the regional blood flow rate increased by 1.6 times and 1.7 times, respectively, after the mononuclear fraction of bone marrow was administered to animals; and in the third experimental group, the regional blood flow rate increased 1.8 times, compared with the animals of the control group after the combined use of bone marrow cells and udenafil. In 28 days after the start of the experiment, histological tests detected foci of necrosis with perifocal inflammation in the ischemic muscles of the lower leg in animals of the control group. In the first and second experimental groups, a decreased size and number of necrosis sites was registered due to formation of young connective tissue and new capillaries. None of newly formed microcirculatory bed was detected. In the third experimental group, the severity of necrotic changes was minimal, a large number of newly formed blood vessels (arterioles) were visualized in wide layers of the connective tissue (capillaries, venules); this was a new microcirculatory bed.
Conclusion. Application of udenafil combined with the mononuclear fraction of the bone marrow results in an increased perfusion of ischemic tissues and development of a new microcirculatory bed.

Journal of Experimental and Clinical Surgery. 2022;15(1):58-63
pages 58-63 views

Experience

Perforation of the Esophageal Wall due to Large-Sized Foreign Body Entering the Esophagus
Kletkin M.E., Temirbulatov V.I., Tarabrin D.V.
Abstract

Foreign bodies entering the esophagus may result from rapid food intake, reduced sensitivity of the mucous membrane of the oral cavity in some neurological diseases, under mental illness, in individuals of certain professions. In 3-4% of cases, this results in perforations of the esophagus due to either presence of acute traumatic margins of the foreign body, or by a long-term presentation of a foreign body in the esophagus and, consequently, the development of a pressure injury. Considering the above, timely and complete diagnosis and adequate surgical treatment in the first hours after diagnosed esophageal perforation by a foreign body is a must.

The patient was admitted to the department of thoracic surgery with complaints of a foreign body in the throat, hypersalivation, subcutaneous emphysema of the neck. He felt sick 2 hours ago, when during sleep he had swallowed a denture. The patient was examined and diagnosed with a foreign body of the upper third of the esophagus with perforation. He was urgently administered: 1. fibroesophagoscopy + reduction of the foreign body in the stomach; 2. Left-sided colotomy, suturing of the upper thoracic esophagus, drainage of the prevertebral space; 3. Upper median laparotomy, gastrotomy, removal of a foreign body, gastrostomy according to Kader’s method. The patient was discharged with a gastrostomy from the hospital in a satisfactory condition, he was recommended follow-up observation by a local surgeon in the outpatient clinic. The gastrostomy was closed conservatively 3 weeks after the discharge. In 2 weeks after the closure of gastrostomy, the patient returned to a full life and working activity.

Journal of Experimental and Clinical Surgery. 2022;15(1):64-69
pages 64-69 views
Surgical treatment of a complex fracture of the lower jaw
Turahanov S.V., Khramova N.V., Machmudov A.A.
Abstract

The aim of the study was to improve the effectiveness of surgical care for patients with complex jaw fractures by combining modern methods of fixing bone fragments. A plan of surgical treatment was formed, which is illustrated in this article on the example of a clinical case. The complex included several stages: examination, planning, preparation for surgery, surgery, patient rehabilitation. For complex fractures of the lower jaw, especially in the area of ​​the articular process, a combination of several surgical methods is recommended to achieve full contact of fragments in the area of ​​the fracture.

Journal of Experimental and Clinical Surgery. 2022;15(1):70-73
pages 70-73 views

Review of literature

Surgical Treatment of Patients with Acute Pancreatitis in Sterile Stage and in Biliary Etiology of the Disease
Firsova V.G.
Abstract

The main indication for surgical treatment in acute pancreatitis (AP) is infected necrosis in the late phase of the disease. However, some patients require surgery in the sterile stage including the earliest period. In sterile necrosis interventions are associated with the risk of infection and increased mortality, being the responsibility of a surgeon. Patients with biliary AP often require early interventions and specific tactic regarding the pathology of the biliary tract. The review analyses recent studies and modern practical recommendations on the surgical treatment of patients with AP in the sterile stage and in biliary etiology. Obstruction of bile duct and cholangitis, enzymatic peritonitis, abdominal compartment syndrome caused by ineffective conservative measures, massive pancreatogenic accumulations with the threat of a rupture into the abdominal cavity, pain syndrome, compression of the adjacent organs often resulted from the disconnected pancreatic duct syndrome require invasive interventions to prevent the development of infectious necrosis. A number of questions have an ambiguous solution. The threshold level of intra-abdominal pressure, the rate of its increase, or other apparent criteria for the implementation of surgical decompression and the choice of decompression technique for abdominal compartment syndrome have not been stated. The optimal timing and the priority method of drainage in the disconnected pancreatic duct syndrome remain uncertain. The management of patients with biliary acute pancreatitis regarding prophylactic endoscopic papillotomy is controversial. Further, well-designed research studies involving surgical treatment of patients with acute pancreatitis are needed.

Journal of Experimental and Clinical Surgery. 2022;15(1):74-84
pages 74-84 views
Interleukin-2 in the Complex Treatment of Surgical Patients
Andreev A.A., Donchenko V., Gluhov A.A., Novomlinsky V.V., Ostroushko A.P., Laptiyova A.Y.
Abstract

Immunotherapy for surgical diseases remains one of the urgent scientific and clinical issues. Immunodeficiency is manifested in patients with purulent wounds, pancreatic necrosis, osteomyelitis, oncological diseases, echinococcosis, gastroduodenal ulcers and other pathology. Drugs inducing interleukin-2 synthesis have shown high efficacy for the correction of immunodeficiency status. Clinical effects of rIL-2 are due to its ability to activate clonal proliferation of T- and B-lymphocytes, to enhance the effector potential of cytotoxic T-lymphocytes (CTL cells) and natural killer cells (NK cells), functional activity of mononuclear phagocytes and antigen-presenting cells, synthesis of specific immunoglobulins of most isotypes by plasma cells and to reduce apoptosis of mononuclears. This cytokine is a key link determining the development of cellular and humoral immunity. Interleukin-2 provides antitumor, antiviral, antibacterial and antifungal protection, being able to stimulate the processes of tissue regeneration and repair. The high clinical activity of the drug was revealed in the treatment of endotoxicosis, immunological insufficiency, inflammatory diseases in patients with surgical, oncological, traumatological, combustiological, resuscitation profiles, involving abdominal organs, pelvis and retroperitoneal space. It is rational to use recombinant interleukin-2 in case of previous inefficient conventional treatment and the process chronization. The drug has a number of positive aspects: rapid effect; reduced terms of treatment, frequency of infectious complications and sepsis; reduced mortality rate. The negative side of its administration is its high cost. Thus, immunosuppressive conditions are manifested in multiple surgical diseases. High clinical efficacy of recombinant interleukin 2, absence of complications, adverse reactions and undesirable effects, and favourable tolerability of the drug allow recommending it for wider use in surgical practice.

Journal of Experimental and Clinical Surgery. 2022;15(1):85-91
pages 85-91 views
Microbial Biofilm in the Development of Wound Process
Sukovatykh B.S., Grigoryan A.Y., Begin A.I.
Abstract

The article reviews data from Russian and international literature highlighted the effect of microbial biofilms on the course of the wound process. The composition of biofilms of various microorganisms and their relations within the polysaccharide matrix are given in detail. The role of biofilms in the development of microorganism resistance to antibacterial therapy and prolongation of the inflammatory process is emphasized. It is evidenced that they cause transition of the acute phase of the wound process into the chronic one.

Journal of Experimental and Clinical Surgery. 2022;15(1):92-96
pages 92-96 views

ANNIVERSARY

Vladimir Alexandrovich Vishnevsky is 85 years old!
Glukhov A.A., Andreev A.A., Ostroushko A.P.
Abstract

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Journal of Experimental and Clinical Surgery. 2022;15(1):97
pages 97 views

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