Experimental Substantiation New Ways of Spleno- and Mesorenal Anastomosis

Abstract


Relevance Portocaval shunting is one of the main methods for prevention of gastroesophageal bleedings at patients with a portal hypertension syndrome. From proposed methods portocaval shunting most frequently used anastomosis with the roots of the portal vein - the splenic and superior mesenteric veins. However, the vascular anastomosis with the roots of the portal vein are often accompanied by complications, including thrombosis of fistulas and recurrence of gastroesophageal bleeding. This is caused by a small caliber of shunted vessels. In addition recurrent gastroesophageal bleeding is caused by excessive high portal pressure, arising as a result of hydrodynamic resistance at the mouth of the anastomosis, flutter blood flow, collapsing walls of the blood vessels, deformation of the inosculate vessels. For improving portocaval shunting results may be the introduction of microsurgical techniques and the operating methods of external fixation the vascular wall, creating a frame mechanism for the prevention of anastomotic valve structures. The purpose of the study The aim of the study was an experimental anatomical study and development of new microsurgical frame end-to-end splenorenal and mesorenal anastomosis in portal hypertension. Materials and methods The section on anatomy justification of microsurgical spleno- and mesorenal anastomosis performed on a section material (54 human cadavers). The study of topography and anatomy features of splenic, renal and superior mesenteric veins were conducted, their morphological characteristics, the histology characteristics of vascular anastomosis, the parameters of their tightness and mechanical strength. Experimental studies carried out on 48 mongrel dogs. There have been five sets of experiments. The analyses of morphological and functional status of improved vascular anastomosis in the short and long periods after surgery were accomplished. Results and their discussion There are developed new ways of microsurgical organ-save splenorenal and mesorenal anastomosis. New data on the dynamics of the vascular healing at various periods after reconstructive surgery, their morphological and functional characteristics were received. Conclusion Results of the study show that the use of microsurgical techniques in combination with an external frame of demineralized bone can create portocaval anastomosis with preservation of the kidney and spleen, to ensure good functioning of the anastomosis without the use of anticoagulants

Orenburg State Medical Academy, 6 Sovetskaia Str., Orenburg, 460000, Russian Federation

Author for correspondence.
Email: author@vestnik-surgery.com
 MD, professor, head of Orenburg medical academy surgery department

Orenburg State Medical Academy, 6 Sovetskaia Str., Orenburg, 460000, Russian Federation

Email: author@vestnik-surgery.com
MD, professor of S.S. Mikhaylov's operational surgery and clinical anatomy department.

Orenburg State Medical Academy, 6 Sovetskaia Str., Orenburg, 460000, Russian Federation

Email: pvnagornov@pochta.ru
assistant of chair hospital surgery, urology

Orenburg State Medical Academy, 6 Sovetskaia Str., Orenburg, 460000, Russian Federation

Email: author@vestnik-surgery.com
 surgeon, graduate student chair of surgery ORGMA.

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