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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Posted: 24.10.2021
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Current Issue

Vol 14, No 4 (2021)

Original articles

Application of Suture Material Impregnated with Miramistin in Diffuse Peritonitis: Experimental-Clinical Justification
Sukovatykh B.S., Mosolova A.V., Zatolokina M.A., Dubonos A.A., Zhukovsky V.A., Anuschenko T.Y.
Abstract

Introduction. In diffuse peritonitis, the incidence of intestinal suture incompetence ranges from 5 to 15%, and suppuration of the surgical wound from 15% to 30%.

The aim of research was to study experimentally the course of the wound process in the intestinal wall in diffuse peritonitis using suture material impregnated with miramistin, and to evaluate the effect of this material on the incidence of intestinal suture failure and suppuration of surgical wounds in a surgical practice.

Materials and methods. The experimental study involved 192 male Wistar rats divided into 2 groups, 96 animals each; the clinical study involved 20 patients with traumatic intestinal tube wounds, who were also divided into 2 groups. Peritonitis was simulated by introducing 10% fecal suspension into the abdominal cavity. A laparotomy was performed in 24 hours, then the abdominal cavity was washed with sterile saline and a wound 1 cm long was performed in the colon wall. In animals of the first (control) group the wound was sutured with polyglycolide suture material without an antibacterial coating, in animals of the second (experimental) group the wound was sutured with polyglycolide suture material covered with polymer solution containing 20% Miramistin based on the polymer weight. In 10 patients of the first clinical group, intestinal wounds were sutured with similar suture materials without antibacterial coating, and the abdominal wall was sutured using interrupted stitches with lavsan suture materials. In 10 patients of the second group, wounds of the intestinal tube and the abdominal wall were sutured with suture materials impregnated with 20% Miramistin.

Results. In animals of the first group, the pronounced phase of inflammation of the intestinal wall lasted 7 days, inflammation subsided and start of the proliferative phase was recorded in 14 days, restriction of the intestinal suture by the connective tissue elements was registered in 21 days of the experiment. In animals of the second group, the phase of inflammation lasted 3 days, the proliferative phase ended in 7 days, restriction of the intestinal suture by the new connective tissue with complete restoration of the architectonics of the intestinal wall was recorded in 14 days. In patients of the first clinical group, intestinal suture failure developed in 2 patients (20%), and surgical wound suppuration - in 4 patients (40%) with one lethal outcome. Inpatients of the second clinical group, intestinal suture failure, deaths and suppuration of surgical wounds were not registered.

Conclusion. The use of suture material impregnated with polymer solution containing 20% miramistin by the polymer weight in peritonitis was pathogenetically justified to be effective.

Journal of Experimental and Clinical Surgery. 2021;14(4):252-259
pages 252-259 views
An Infected Wound Simulation in Rats with Long-Term Diabetes Mellitus
Kulikova A.B., Kochetova L.V., Khapilina E.A.
Abstract

Introduction. The prevalence of infected wounds of the lower extremities combined with type II diabetes mellitus is 4-5 patients per 1000 population in industrialised countries. There is a steady trend towards an increase in this group of patients. It is necessary to study and evaluate the effectiveness of new treatment methods of purulent-necrotic complications in patients with diabetes mellitus complicated by diabetic foot syndrome (DFS).
The aim of study was to simulate a long-term diabetes mellitus and an infected wound.
Materials and methods. The article presents a technique for long-term diabetes mellitus (DM) and an infected wound simulation in long-term diabetes mellitus (DM) in Wistar rats. Long-term DM was simulated based on the technique described in the author's patent of the Russian Federation No. 2735708, 2020. Diabetes mellitus was simulated in 120 animals. The infected wound was simulated in 30 Wistar rats with alloxon-remaxol-induced long-term DM and in 5 healthy animals.
Results. Blood sugar in animals with diabetes mellitus was significantly higher compared to animals in the control group. A consistently high level of sugars throughout the experiment evidenced presence of DM in animals of the second and third groups. In 7 days of the experiment, an infected wound with histological signs of an infected wound was formed in the rats.
Conclusion. The effectiveness of remaxol application as a hepatoprotector and antioxidant in of alloxone DM simulation has been evidenced; this allows simulating the disorder with consistently high sugars and prolong life of experimental animals for the period necessary to fulfill scientific tasks set in the experiment.

Journal of Experimental and Clinical Surgery. 2021;14(4):260-264
pages 260-264 views
Posthypoxic Changes in Rat Offspring under the Intestinal Wall Transformation
Karpova I.Y., Bugrova M.L., Vasyagina T. ., Karpeeva D.V.
Abstract

The aim of research is to study posthypoxic transformation of the colon wall using light and electron microscopy in an experimental model of rat offspring.

Materials and methods. Chronic hypobaric hypoxia at different stages of pregnancy was simulated experimentally in 24 female white mongrel rats using a vacuum flow chamber with a rise to a height of 5000 m at a speed of 25 m/sec for 40 minutes. After delivery, the offspring were examined, subjected to hexenal anesthesia, and then removed from the experiment using decapitation. For light microscopy, resected sections of the small intestine and colon were stained with hematoxylin-eosin, and studied on Topic (Belgium, 2000) and Bio Blue (the Netherlands, 2013). Electron microscopic analysis was performed in a Morgagni 268D transmission electron microscope (FEI, USA).

Results. Chronic hypoxia, simulated in the first trimester of pregnancy, led to significant changes in the intestinal mucosa in combination with the growth of the connective tissue component in the muscle layer. The risk of developing dynamic intestinal obstruction occurred in the offspring of all groups, this was supported by an increase in the fibrous tissue of the intestinal wall. Pronounced changes in the microcirculatory bed were detected in animals of groups II and III, as they were predisposed to develop pre-ulcer and ulcerative defects in the wall of the small intestine. At the submicroscopic level, it was detected that both adaptive and destructive processes occurred in the wall ultrastructure of the descending colon of the rat offspring after hypoxic exposure in the prenatal period in animals of all experimental groups. In the microcirculatory bed, there was an increased venous congestion, with the most pronounced changes observed in the third trimester.

Conclusion. Thus, the study of hypoxia in the experiment allows investigating more about all the mechanisms of the pathological process and to translate theoretical knowledge into practical medicine.

Journal of Experimental and Clinical Surgery. 2021;14(4):265-271
pages 265-271 views
Features of Diagnostics and Treatment of Acute Appendicitis in Patients of Infectious Hospital
Zemlyanoy V.P., Melnikov V.A., Nakhumov M.M., Letina Y.V.
Abstract

Introduction. Acute appendicitis occupies one of the leading positions in terms of incidence among urgent surgical diseases of the abdominal organs in Russia and in the world. Despite the accumulated experience in the diagnosis and treatment of the disease, a number of challenges still remain, leading to delayed diagnosis and, as a consequence, the development of destructive and complicated forms and deterioration of treatment outcomes. One of these "stumbling blocks" is the differential diagnosis of acute appendicitis and infectious diseases. In addition, acute appendicitis frequently develops together with existing acute and chronic infectious diseases, and appears to be also their complication. In our opinion, the absence of a specific algorithm of actions when dealing with this category of patients may be one of the reasons for unsatisfactory results. In this regard, there is a need to develop such an algorithm.
Aim. Improvement of the therapeutic and diagnostic algorithm in relation to patients with OA admitted to infectious diseases hospitals, as well as evaluation of the results of its application.
Materials and methods. The article presents diagnostics and treatment results of patients with acute appendicitis hospitalized in an infectious disease hospital, and compares their outcomes before and after implementation of the developed diagnostic and treatment algorithm. The study included 102 patients. The retrospective group included 55 patients with acute appendicitis, which developed together with acute or chronic infectious diseases, treated before implementation of the algorithm. The prospective group consisted of 47 patients treated using the developed algorithm.
Results. . Gangrenous forms developed in 25 (45,5%) patients of the retrospective group, and in 8 (17%) patients of the prospective group. Peritonitis complicated the course of acute appendicitis in 53 (96,4%) patients of the retrospective group, while in patients of the prospective group this complication was noted in 25 (53,5%) cases. Purulent forms of peritonitis were noted in 20 (36,4%) patients of the retrospective group, and only in 3 (6,4%) patients of the prospective group. There was also a significant difference in the incidence of appendicular infiltration / abscess. This complication was registered in 11 (20%) patients of the retrospective group, in the prospective group it was noted in 2 (4,3%) patients. Postoperative complications were recorded in 8 (14.5 %) patients of the retrospective group. There were no postoperative complications in patients of the prospective group.
Conclusion. The data obtained allow assuming that use of the proposed treatment and diagnostic algorithm in patients with acute appendicitis admitted to an infectious diseases hospital can positively affect timeliness of diagnosis and treatment and, as a consequence, improve treatment outcomes for this category of patients.

Journal of Experimental and Clinical Surgery. 2021;14(4):272-281
pages 272-281 views
Early Diagnosis and Prognosis of Surgical Sepsis with Simple Laboratory Criteria in the Elderly Patients: Clinical and Laboratory Substantiation
Ykovenko T. ., Movchan K.N., Tkachenko A.N., Yakovenko O.I.
Abstract

Introduction. Clinical and laboratory criteria of the 2nd Consensus on Sepsis do not consider manifestations of the organ dysfunction and compensatory anti-inflammatory response in septic complications.

The aim of study was to develop laboratory parameters that reflect presence of sepsis at different stages of its course based on a detailed complete blood count; take into account the degree of pro-inflammatory response to infection, an anti-inflammatory component, presence of a particular sign of the multiple organ failure.

Materials and methods. This was a statistical study involving 152 patients with clinical and laboratory manifestations of surgical sepsis who underwent inpatient treatment at the surgical department of the NWSMU clinical hospital. In patients with signs of edogenic intoxication, whose diagnosis sepsis was not confirmed, septicopyemia was verified on autopsy in every 4 cases. The patterns of the score assessment of the sepsis process were determined in accordance with the complete blood count parameters.

Results. The degree of correlation between “the level of procalcitonin and the “scores" was noted at the level of 0.5019309, the degree of correlation between “the level of blood lactate and the “scores” did not exceed 0.542726115.

Conclusions. If the total score is more than 7, the diagnosis of severe sepsis is highly probable. If the total score is less than 4 - presence of severe sepsis including the development of septicopiemia is improbable. If the total score is at the level of 5 -6 combined with long-term disease, the search for distant foci of septicopiemia and assessment of the prognosis of secondary sepsis is a priority.

In our opinion, the score assessment of simple laboratory parameters (detailed complete blood count), reflects, though indirectly, presence and stages of septic complications. The use of the score assessment in practical health care can improve screening of patients with surgical infection complicated by the sepsis development at all stages of medical care.

Journal of Experimental and Clinical Surgery. 2021;14(4):282-287
pages 282-287 views
Laparoscopic Surgery for Hernias of the Anterior Abdominal Wall
Teuvov A.A., Baziev A.M., Tlakadugova M.H., Pshukova E.M., Sardiyanov A.I.
Abstract

Introduction. Surgical interventions for hernias of the anterior abdominal wall are among the most common in pediatric surgical clinics. In newborns, especially premature infants, the frequency of hernias of the anterior abdominal wall is inversely proportional to gestational age and significantly exceeds the rates in older children.

The aim of the study is to compare outcomes of laparoscopic treatment using the Percutaneous Internal Ring Suturing (PIRS) method and conventional methods in newborns with hernias of the anterior abdominal wall.

Materials and methods. Laparoscopic interventions in children older than 2-3 years are gradually becoming the standard of treatment, while in newborns, conventional “open” methods are more often used to treat hernias of the anterior abdominal wall, which is associated with complexity of the surgical technique, presence of concomitant pathology and a high anesthetic risk. Timing (early or delayed) of hernia surgical correction of the anterior abdominal wall in these patients remains the issue under discussion.

Results. According to the study results, the duration of PIRS surgery was shorter than that of an open surgery. The long duration of laparoscopic surgery, which some surgeons note, is explained by the laparoscopic correction technique – the imposition of an intracorporeal suture requires more time and experience of a surgeon. Furthermore, an inverse relationship was found between the weight of a child and the time of laparoscopic intervention.

Conclusion. Laparoscopic treatment of hernias of the anterior abdominal wall with PIRS method in newborns is not easier for the surgeon, but also safer for the patient.

Journal of Experimental and Clinical Surgery. 2021;14(4):288-294
pages 288-294 views
Analysis of the Major Factors Affecting the Course of the Immediate Postoperative Period with Stab and Cut Wounds of the Heart in a Multidisciplinary Surgical Hospital
Maslyakov V.V., Pavlova O.N., Dorzhiev P.S., Urjadov S.E., Kurkin K.G., Gezali A.J., Akmalov N.A.
Abstract

Introduction. Heart injury can be attributed to one of the most severe traumas. According to the data presented in the literature, such wounds are not common and account for 5-7% of the total number of wounds that penetrate the pleural cavity. However, despite rare incidence, such injuries are accompanied by a fairly large number of complications reaching 47.9%, and lethality at the level of 34.1%. This is due to the fact that diagnosis of such injuries causes some difficulties, and various methods including thoracoscopy are currently proposed to solve them. The issue of diagnostics and treatment of heart injuries has received much attention in the literature, but this problem has not been completely solved, since there are many factors that influence the course of the immediate postoperative period with such injuries.

The aim of the study was to analyse major factors that affect the course of the immediate postoperative period in patients with stab-cut heart injuries.

Materials and methods. The study involves a retrospective analysis of the immediate postoperative period of 86 patients operated for a penetrating chest wound with the heart and pericardium wound. Patients were treated in the surgical department of "Emergency Medical Hospital of Engels" from 1988 to 2019. Of the total number of patients, 76 (88,3%) were male and 10 (11,6%) were female. It should be noted that the majority of males - 47 - were in a state of alcoholic intoxication of varying severity.

Results. According to the analysis, out of 86 patients admitted to the medical facility on an emergency basis, 73,2% were included in group A, 26.7% of the wounded were included in group B. The data demonstrated that the vast majority of the wounded were delivered as soon as possible from the moment of injury, which could not but affect the course of the immediate postoperative period. It should be noted that 72,1% of the wounded were delivered by ambulance, 27,9% of patients by the meeting traffic. In the group of wounded who were delivered by the meeting transport, and who were provided first aid by non-medical workers, the results were significantly worse. In patients of this group, first aid was provided to only 13,9% of the wounded, in all cases it was wound processing and the aseptic bandage application, and in 10.5% of cases the first aid can be described as inadequate. When analyzing the course of the immediate postoperative period, we found that the development of complications was noted in 45,3% of patients. The distribution of the number of complications by groups showed that the largest number was 25,6% in group B, in group A complications were noted in 19,8% of cases. Further analysis showed that the number of complications in two groups directly depends on the severity of the condition of the wounded at the time of admission. The main complication that developed in the postoperative period in operated patients was purulent septic complications, noted in 22,1% of the wounded. The largest number of complications - 12.8% - was detected in group A, in group B such complications developed in 9.3% of cases. Of the total number of patients admitted with heart injuries, 23.2% of patients died. The mortality rate was 6.9% in group A, and 16.3% in group B.

Conclusion. Based on the analysis, it can be concluded that the heart injury is accompanied by a large number of complications in the immediate postoperative period - 45.3% and deaths - 23.2%. Among the major factors contributing to the development of complications and deaths are the following:

  1. Timely, complete and competent assistance at the pre-hospital stage.
  2. The condition and severity of damage to the wounded at the time of delivery.
  3. The use of Damage Control tactics in cases where the condition of the wounded person at the time of admission is severe or extremely severe.
Journal of Experimental and Clinical Surgery. 2021;14(4):295-302
pages 295-302 views
Neural Network System for Diagnosing Liver Failure in Surgery
Solomakha A.A., Gorbachenko V.I.
Abstract

Clinical decision support systems are rapidly developing along with digital technologies nowadays. Neural network methods have become more common in solving practical problems in healthcare. Today, clinical decision support systems are significant medical tools. The authors have developed a neural network system to diagnose liver failure. The "Neurodiagnost" system was tested in 270 patients with liver failure due to viral hepatitis B or C. As a result, clinical testing of the "Neurodiagnost" system demonstrated coincidence of neural network and laboratory diagnostics with a probability equal 91.5 % (247 patients). The use of the "Neurodiagnost" program can help reduce the risk of developing liver failure in surgery.

Journal of Experimental and Clinical Surgery. 2021;14(4):303-306
pages 303-306 views

Review of literature

Esophageal Stenting - a Modern Resource of Surgery for Various Perforations
Korymasov E.A., Benian A., Medvedchikov-Ardiia M., Zhdanov A.V.
Abstract

Currently, stenting is an innovative part of the surgical treatment strategy of patients with various types of the esophagus damage and perforation. This article highlights historical aspects of the use of esophageal stents, main indications for their placement in various esophageal defects. The technology of esophageal stenting is described in detail. The analysis of literature data on the effectiveness of stent placement and complications was carried out. It is concluded that there is a need for wider introduction of the stenting technique into clinical practice as an alternative or additional method to the existing conventional surgical treatment of the esophagus damage and perforation, in case a medical facility is technically able to perform it.

 

Journal of Experimental and Clinical Surgery. 2021;14(4):307-315
pages 307-315 views
Epigenetic Markers of Colorectal Cancer: Clinical Data Analysis
Bagryantsev M.V., Samoylenko V.M., Ryabkov M.G., Bazaev A.V., Desortsev I.L., Bunova S.S., Batanov M.A., Kiseleva E.B.
Abstract

The aim of the study was to systematize the results of clinical application of epigenetic biomarkers "microRNA" and "DNA methylation" in early diagnosis and prognosis in patients with colorectal cancer.

Material and methods. Data review was conducted by the keywords "colorectal cancer" with "miRNA" or "methylation" in PubMed, Cochrane Library, ScienceDirect, ELECTRONIC LIBRARY and was limited by the period 2016-2021. In addition, a manual search for articles in peer-reviewed journals was performed. Exclusion criteria were: description of separate clinical cases; books and documents; experimental oncology in laboratory animals, comparison of therapeutic results of patients receiving chemotherapy. Out of 139 initially identified, 37 sources were included in the final analysis, of which 20 meta-analyzes, 1 randomized clinical trial, 14 systematic reviews and 2 practical guidelines.

Results. Based on the analysis of clinical data, it has been established that the optimal environment for miR isolation for early diagnosis of colorectal cancer is the intestinal wall, furthermore, miR-139 has a proven diagnostic value. At the later stages of tumor development, fecal miRs, namely miR-21, can also be used as a screening method. MiR-181a, miR-181b, miR-20a, miR-10b and miR-145 are highly sensitive predictors of overall survival in colorectal cancer patients. They can potentially be considered as prognostic biomarkers and as decisions when administering adjuvant chemotherapy. miR21, miR106a, miR143, miR 150 and miR215 are most commonly used in clinical practice to determine the prognosis of treatment. Tumor and paratumor tissues can also be differentiated from the normal colon tissue in a healthy person by methylation of the SFRP2, SFRP1, TFPI2, BMP3, NDRG4, SPG20, BMP3 and NDRG4, SFRP1, 2, 4, 5, hMLH1 and RASSF1A genes. The analysis of methylated SEPT9 genes is the most informative of them: an increased weight of the mitylated SEPT9 gene directly correlates with progression and low tumor differentiation in patients with colorectal cancer.

Conclusion. Literature data confirm that changes in the concentration of microRNA and methylated DNA in the environments of the human body correlate with the risk of oncogenesis, progression and invasion of colorectal cancer. It is reasonable to use a diagnostic algorithm differentiated by the analyzed tissues (blood, intestinal tissue, feces, urine), the expected stage of tumor development, diagnostic tasks (screening, survival prognosis) for the effective use of epigenetic markers of colorectal cancer in the clinical practice.

Journal of Experimental and Clinical Surgery. 2021;14(4):316-324
pages 316-324 views
Atlanta 2012 Classification: Terminology and Definitions in the Diagnosis of Acute Pancreatitis
Ektov V.N., Khodorkovsky M.A., Skorynin O.S., Minakov O.E.
Abstract

The progress achieved in recent years in the treatment of acute pancreatitis (AP) is largely associated with the general views on understanding the key mechanisms of the disease development. The development of modern diagnostic and treatment technologies are based on the Atlanta 2012 classification of acute pancreatitis, which has received a global reach and widespread professional support. The review presents the key provisions of the Atlanta - 2012 classification according to the principles of AP diagnosis, classification of the disease, peculiarities of the radiation methods of examination in determining local complications and their morphological features. The publication emphasized the importance of timely stratification of the severity of AP based on the assessment of organ failure using a modified Marshall scale. Currently, the Atlanta 2012 classification has become a generally accepted international standard for assessing acute pancreatitis, which allows for effective multidisciplinary interaction of various specialists to optimize the results of treatment of this disease.

Journal of Experimental and Clinical Surgery. 2021;14(4):325-333
pages 325-333 views

Memorials

Development of the Olympiad Student Surgical Movement at the N. N. Burdenko Voronezh State Medical University
Chernykh A.V., Glukhov A.A., Shevtsov A.N., Magomedrasulova A.A., Neverov A.V.
Abstract

The Olympiad Student Surgical movement historically arose from the activities of student scientific societies at the surgical departments of medical universities and, foremost, departments of operative surgery with topographic anatomy.  This is the first department where students are taught future surgical manual skills of a medical specialist. The history of the largest Moscow (All-Russian) Student Olympiad in surgery named after an academician M. I. Perelman, held under the authority of First Sechenov Moscow State Medical University, is more than 30 years. Olympiad Student Surgical movement at Voronezh N. N. Burdenko State Medical University appeared in 2008. A long and difficult path has been covered since then. The teams under the guidance of various lecturers and student leaders experienced ups and downs, repeatedly won victories in the qualifying stages of the All-Russian Olympiad and took prizes in the Finals of the All-Russian Olympiad. In 2015, the tradition of holding an intra-university student Olympiad in surgery was started. Since then, 6 intra-university Olympiads have already been held. This allows annually updating the staffing of the team and encouraging students to even better results. The Olympiad surgical movement has a great pedagogical and educational potential and, undoubtedly, is an important stage in training future medical specialists of a surgical profile.

Journal of Experimental and Clinical Surgery. 2021;14(4):334-340
pages 334-340 views

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