Vol 16, No 4 (2023)

Cover Page

Full Issue

Original articles

Immediate Effects of the Self-Retaining Barbed Suture Material Application for Gastrojejunostomy During Mini Gastric Bypass Laparoscopic Surgery

Chaykin D.A., Chaykin A.A., Chaykin А.N., Vinnik Y.S., Teplyakova O.V., Beloborodov A.A., Ilinov A.V.

Abstract

Background. The safety of self-retaining barbed suture material application when closing wounds of hollow organs and forming anastomoses remains controversial. Data on the use of self-retaining barbed suture material at the stage of a single anastomosis formation during mini gastric bypass laparoscopic surgery (mini gastric bypass - MGB) in the treatment of morbid obesity is scarce and includes both examples of suturing a technological hole after the implementation of a hardware technique, and totally hand-sewn intracorporeal knotless formation of a gastrojejunostomy. 
The aim of the study was to evaluate the immediate effects of single-row continuous sutures performed with self-retaining barbed unidirectional suture material for intracorporeal hand-sewn gastrojejunostomy during MGB.
Methods. The study included 116 patients with grade II-III obesity who underwent MGB. The total duration of operations and the duration of the gastrojejunostomy stage, the volume of intraoperative blood loss, the frequency and severity of intra- and postoperative complications were prospectively studied in accordance with the unified classifications of Satava-Kazaryan and Accordion, respectively. The first group consisted of 56 patients; a conventional synthetic (polydioxanone) monofilament suture material was used for hand-sewn gastrojejunostomy in patients of this group. The second group consisted of 60 patients; gastrojejunostomy was performed with single-needle unidirectional self-retaining barbed absorbable polyester monofilaments in patients of this group. The study groups did not differ significantly in demographic characteristics, body mass index (BMI), the nature of comorbid pathology and the frequency of previous operations. 
Results. The use of unidirectional self-retaining barbed suture material for a hand-sewn intracorporeal single-row gastrojejunostomy in MGB was accompanied by a significant reduction in the total duration of interventions due to a reduced gastrojejunostomy stage if compared with the use of conventional synthetic monofilaments. The median volume of blood loss during operations did not exceed 50 ml and had no significant differences between groups. Intraoperatively, in patients of the study groups there were registered only complications of the first degree of severity, according to the Satava-Kazaryan classification, with a frequency of 6.7-8.9% (p = 0.737). In the postoperative period, the development of minor complications (first severity of the Accordion system) occurred in 19.6% and 16.7% of patients of the first and second groups, respectively (p = 0.810). The duration of hospital stay was 3.0 (2.5; 3.0) and 2.7 (2.7; 3.0) days in the first and second groups, respectively (р=0,790).
Conclusion. The achieved reduced duration of MGB due to the reduced stage of gastrojejunostomy with self-retaining barbed unidirectional suture material, and comparable immediate effects of surgical treatment in patients of the first and second groups demonstrate significant outcomes. Further study is necessary to investigate long-term effects of the knotless suture application for a single anastomosis formation during MGB surgery.

Journal of Experimental and Clinical Surgery. 2023;16(4):272-281
pages 272-281 views

A Comparative Study of Tissue Response to Implantation of Two-Component Hemostatic Sodium Salt of Carboxymethyl Cellulose Sponges in a Chronic in Vivo Test

Lipatov V.A., Panov A.A., Denisov A.A., Pokhozhay V.V.

Abstract

Background. Currently, cases of damage to parenchymal organs for various reasons remain widespread. Most often, damage results from trauma and various surgical interventions. In modern surgical practice, a wide range of application hemostatic agents is increasingly used to stop bleeding from parenchymal organs. Hemostatic sponges are most widely used for these purposes. The advantage of this technique to stop bleeding is that the porous structure provides a high degree of adhesion to the wound surface without additional fixation and trauma to surrounding tissues.
The aim of research was to comparatively study the body tissue response to implantation of two-component hemostatic sodium salt of carboxymethyl cellulose (Na-CMC) sponges in a chronic in vivo test.
Materials and methods. The study materials included: a two-component sponge hemostatic Na-CMC-based agent (No. 1) (an experimental sample developed in KSMU, Russia), a collagen hemostatic sponge (No. 2) (JSC "Zelenaya Dubrava", Russia), "TachoComb" ( No. 3) (Takeda, Austria), Surgicel Fibrillar (No. 4) (Johnson & Johnson, USA). Rabbits were subjected to a median laparotomy under inhaled anesthesia in the laboratory of experimental surgery and oncology at the Scientific Research Institute of Emergency Medicine, Federal State Budgetary Educational Institution of Higher Education KSMU, Ministry of Health of Russia; the animals were also simulated a superficial liver injury. This was followed by the application of tested samples of hemostatic products. In 1, 3, 7, 14 days after surgery, each animal underwent control-dynamic laparoscopy with the macroscopic assessment of the following parameters: the presence/absence and nature of pathological changes in the abdominal cavity (signs of inflammation, effusion, its nature and quantity), the severity of the adhesive process, the prevalence of adhesions, and the morphology of adhesions.
Results. The lowest prevalence and severity of the adhesive process were observed under hemostatic Na-CMC sponge application. Statistically significant differences were obtained when comparing the prototype with all the study groups.
Conclusion. After interventions two-component Na-CMC-based sponge application results in minimal manifestations of adhesions in the abdominal cavity of laboratory animals (1.3 times lower than in all comparison groups, p<0.05). In all cases, the authors detected cord-like adhesions; their morphological substrate was a strand of the greater omentum. However, in spite of the presence of adhesions in the abdominal cavity, there were no clinically supported data on the development of adhesive intestinal obstruction. No signs of local or widespread peritonitis were detected in any of the animals.

Journal of Experimental and Clinical Surgery. 2023;16(4):282-293
pages 282-293 views

Intraoperative Options to Stimulate the Reparative Liver Regeneration in the Experiment

Laptiyova A.Y., Andreev A.A., Glukhov A.A., Shishkina V.V., Ostroushko A.P., Antakova L.N.

Abstract

Background. Primary and secondary malignant neoplasms and liver damage affect more than 500 million people worldwide; one million of these people die annually. Secondary malignant neoplasms of the liver occur in every fourth cancer patient, 60% of them require liver resection. As reported, post-resection liver failure occurs in 32–60% of cases. Thus, at the current stage of medicine development, the search for novel options to stimulate reparative liver regeneration remains a challenging issue in surgery. 
The aim of the study was to stimulate post-resection liver regeneration by intraoperative intrahepatic and intraperitoneal administration of cyanocobalamin and ademetionine in an experiment.
Materials and methods. This research is a prospective randomized study carried out at the Research Institute of Experimental Biology and Medicine, N.N. Burdenko Voronezh State Medical University (VSMU), Ministry of Health of the Russian Federation. Experiments involved 192 mature male Wistar rats, who underwent conventional liver resection (CLR) equal approximately to 70% of the initial liver volume, according to the approach proposed by G. Higgins and R. Anderson. The effect of intraperitoneal administration of ademetionine and cyanocobalamin on post-resection liver regeneration was investigated in the first block of the study. The effect of intraoperative intrahepatic injections and intrahepatic administration of drugs on post-resection liver regeneration was tested in the second block of the study. The combined use of ademetionine and cyanocobalamin and their effect on post-resection liver regeneration was studied in the third block of the study. Physical examination and laboratory findings were used to assess reparative processes. The data were processed statistically using the STATGRAPHICS Centurion 18 software package, version 18.1.12 (Statgraphics Technologies, Inc., USA). The analysis of variance (ANOVA) was applied to compare mean values for eight different group.
Results. The study detected that intraperitoneal administration of ademetionine helps to normalize the general condition and biochemical parameters in 77.78% of animals. Intraperitoneal administration of cyanocobalamin does not have a significant effect on biochemical parameters, including oxidative stress. Intrahepatic administration of cyanocobalamin helps to increase the reparative liver potential, results in decreased rates of cytolysis and cholestasis syndromes, restoration of carbohydrate and fat metabolism, and increased expression of growth factors. Intrahepatic administration of ademetionine leads to decreased regenerative liver potentials, disruption of its functional activity, and decreasd protective antioxidant properties. 
Conclusion. Thus, the optimal intraoperative option to stimulate reparative liver regeneration in the experiment is the intrahepatic administration of cyanocobalamin supplemented by intraperitoneal administration of ademetionine. In 7 days after liver resection, this helps normalize biochemical parameters, relieves oxidative stress, and increases IL-1β and TGF-β1. In 14 days after resection, the abovementioned events  lead to restoration of 95.04% of the initial liver weight, if compared with intraperitoneal administration of cyanocobalamin and ademetionine (p<0,05).

Journal of Experimental and Clinical Surgery. 2023;16(4):294-302
pages 294-302 views

Potentials of Endoscopic Combined Treatment of Esophageal Variceal Bleeding in Patients with Liver Cirrhosis

Cherednikov E.F., Yuzefovich I.S., Barannikov S.V., Chernykh A.V., Banin I.I., Bolkhovitinov A.E.

Abstract

Background. Treatment of variceal esophageal-gastric bleeding in patients with portal hypertension is an acute challenge in urgent surgery. 
The aim of study was to develop a technique and evaluate the immediate and long-term effectiveness of endoscopic ligation (EL) with the use of cytoprotective treatment. 
Materials and methods. The study included 106 patients who were treated at the City Clinical Emergency Hospital No. 1, Voronezh, Russia. The main group consisted of 54 patients who were treated using a developed technique of combined endoscopic ligation of esophageal varices combined with the polymer alginate hemostatic sorbent (PAHS) application on ligated nodes and post-ligature defects. The comparison group consisted of 52 patients who underwent endoscopic ligation without PAHS application. 
Results. In the main group, total hemostasis was achieved in 52 of 54 (96.3%) patients, p = 0.027; recurrent bleeding was observed in 2-3 days after combined ligation in two (3.7%) patients. No operations were performed; two (3.7%) patients died in this group. In the comparison group, total hemostasis was achieved in 43 of 52 (82.6%) patients, p=0.027. Recurrent bleeding was observed in nine (17.3%) patients. In the comparison group, one (1.9%) patient with massive bleeding was operated on, and seven (13.5%) patients died. 
Conclusion.  Endoscopic ligation combined with cytoprotective treatment using a polymer alginate hemostatic sorbent increases the effectiveness of local hemostasis and reduces the rate of recurrent hemorrhage from 17.3% to 3.7%, p = 0.027. Insufflation of PAHS onto ligature nodes and defects helps relieve pain, accelerates the processes of postligature defect epitheliation from 7.7% to 94.4%, p=0.0001; it also prolongates the remission of the underlying disease.

Journal of Experimental and Clinical Surgery. 2023;16(4):303-309
pages 303-309 views

Experience

Simulation of a Trophic Purulent Wound: an Experimental Study

Zaitsev A.E., Asanov O.N., Miasnikov N.I.

Abstract

Background. Long-term non-healing wounds are one of the common complications of multiple diseases, injuries and surgical interventions. In order to optimize their treatment options, experimental simulation of the wound process are created and improved.
The aim of study was to develop an experimentally simulated trophic purulent wound, and to evaluate the potential of its use to study the impact of various factors on the wound process.
Materials and methods. The trophic purulent wound simulation was performed on 80 nonlinear albino rats. Experimental wounds were formed using a silicone disk, the inner edges of which were sutured to a round wound formed in the interscapular region of the animal. Next, the silicone disc was sutured to the skin along the outer edge and additional sutures were placed around the disc to enhance tissue ischemia. The fascia at the bottom of the wound was incised, the bottom of the wound was crushed with a clamp, and a bacterial culture was injected into the wound defect. The developed model was evaluated visually, using thermometry, luminescent analysis, planimetry, microbiological, cytological and morphological tests.
Results. The features of the simulated wound allowed achieving the size and protection similar to experimental wounds, and forming trophic disorders in the tissues, In 48 hours, a picture of a complicated purulent process was observed in most animals. The data obtained during the analysis of the proposed experimental model confirmed its quality, simplicity and reproducibility.
Conclusion. The proposed approach can be recommended to study protracted wound processes and various factors affecting them.

Journal of Experimental and Clinical Surgery. 2023;16(4):310-315
pages 310-315 views

Treatment of a Patient With Closed Liver Injury Using Interventional Methods: a Case Study

Gavrishuk Y.V., Manukovsky V.A., Tulupov A.N., Demko A.E., Kolchanov E.A., Kiselev M., Pravosud M.N.

Abstract

Background. Mechanical injury occupies a leading position among the causes of mortality in the working-age population. Diagnosis and treatment of isolated and combined abdominal traumas accompanied by bleeding appear to be a specific challenge. Due to difficulties in diagnosis and treatment, they are characterized by frequent complications and an increased mortality rate.
Currently, there is no uniform tactics for diagnosing and treating patients with liver damage. In Russia and globally, new approaches are being actively introduced for the treatment of patients with closed liver traumas using minimally invasive techniques.
The aim of study was to present a clinical case of a patient with a closed liver injury treated using interventional methods, such as angiography and embolization.
Materials and methods. According to conventional techniques, the patient had to undergo laparotomy with complex manipulations to stop intra-abdominal bleeding from a ruptured liver, which would inevitably worsen her condition in the context of a presenting severe injury.
Multiple studies reported that the number of postoperative complications after laparotomy is up to 41%, and in case of combined trauma 10-35% of complications can be one of the causes of death [6, 7, 8]. In order to avoid more traumatic treatment approaches, we applied tactics using minimally invasive high-tech diagnostic and treatment options.
Results. To stop intra-abdominal bleeding from a liver rupture, which was previously diagnosed during multislice computed tomography (MSCT) with intravenous contrast, using interventional options, selective embolization of the segmental branch of the right hepatic artery was performed with an adhesive composition. The post-traumatic period proceeded without complications; in 14 days after the injury, the patient was discharged in satisfactory condition.
Conclusion. Minimally invasive and conservative treatment of patients with closed abdominal traumas using interventional radiology can be successfully applied in specialized trauma centers.

Journal of Experimental and Clinical Surgery. 2023;16(4):316-320
pages 316-320 views

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