Vol 9, No 1 (2016)

Original articles

The Medical Economic Approaches to the Choice of Method of Surgical Treatment of Inguinal Hernias in Modern Conditions of Insurance Medicine

Ivanov J.V., Panchenkov D.N., Afonina N.S., Chugunov V.S., Zinovskyi M.V.


Hernias of abdominal wall stay the most widespread disease, which requires planned surgical treatment. Every third or fi fth inhabitant
of the planet has such disease. There are more than 20 million surgical operation are carried out in the world, and 10-15% of them
are herniatomies. They take the third place in the structure of surgical operations behind appendectomy and cholecystectomy.
Inguinal hernias are diagnosed in 80% of total number of patients with ventral hernias. There are 5-30% of observations with
relapses after the plasty of oblique inguinal hernias, and 10% are after the plasty of rectus hernias. Probability of repetitive relapses
after the plasty of inguinal hernia is 40%.
In the current conditions the peration of choice of inguinal hernias is the nonstrain hernioplasty of posterior wall of inguinal canal
with the use of diff erent reticulate implants, which can be completed both traditional (opened) and laparoscopic methods. Only if
there is no ability to do nonstrain hernioplasty because of some reasons strain methods are used.
The purpose of the work is the choice of the most eff ective and economically rational methods of hernioplasty of inguinal hernia
between the most frequently used methods of current surgical operations.
Materials and methods. One hundred medical histories of hospital patients, who were operated because of inguinal hernias in
surgical ward of FCRC of Russia in 2013-2015 years, were subjected to retrospective analysis. Average patients age was 51, 4 ± 3, 7
years old, and 83 patients of them were men and 17 were women. 53 patients had right-sided inguinal hernia, 39 of them had oblique
inguinal hernia and 14 had rectus inguinal hernia. 40 patients had left-sided inguinal hernia: 28 patients had oblique inguinal
hernias and 12 patients had rectus inguinal hernias. 7 patients had bilateral inguinal hernia. Operations, which were perfomed
to the analyzable patients routinely, was: hernioplasty by method Lichtenstein with the use of polypropylene reticulate implant of
company “Eticon” (USA), 53 patients, hernioplasty by method Onstep with use of polypropylene reticulate implant of company “C.R.
Bardinc.”(USA), 21 patients, and laparascopic intraperitoneal hernioplasty with use of polypropylene reticulate implant of company
“Eticon” (USA), 26 patients.
Results. The duration of unilateral inguinal hernia operation was almost the same at the groups of patients, who were operated with
laparoscopic method and with Lichtenstein method, respectively 42,8 ± 12,4 min. и 39,7 ± 8,9 min. (р ˃ 0,05). Total time, which were
taken to the operation implementation by Onstep method, was signifi cantly less, than time of another two methods, and it was 25,3 ±
4,7 min. (р ˂ 0,05). From an economic point of view, prime cost of the anesthetic support of patients with laparoscopic intraperitoneal
hernioplasty was appreciably more than another one of pateints, who was operated by Lichtenstein or Onstep methods – 3500 rubles
against 2000 rubles. Laparoscopic intraperitoneal hernioplastic had, as it was explained, the highest total cost of consumables
because of the use instrument for fi xation reticulate implant (herniostapler). Postoperative management of the patients was the same
and didn’t depend of the methods surgical treatment of the hernia. The basic complications of hernioplasty in the postoperative period
are: seroma or hematoma in the region of postoperative wood, neuralgia, scrotal edema, the feeling of foreign body, dropsy or atrophy
of the testicle, orchitis, orchiepididymitis, wood infection or fi stula formation. In our observation we got following complications: for
laparoscopic intraperitoneal hernnioplasy – 1 acute retention of urine, which is needed the catheterization of the urinary bladder; for
hernioplasty by Lichtenstein method – in one case there was lingering neuralgia, and in two cases there were complaints of patients
of the feeling of foreign body in the region of postoperative hem. There was not any complications after the operations by Onstep
method. In the experimental group (one hundred patients), time of the observation was from 6 months to two years. Two patients had
relapse of the hernia after one year and one and half year after the operation, after laparoscopic intraperitoneal hernioplasty and
hernioplasty by Lichtenstein method.
Conclusions. 1. High eff ect eff ectiveness of the treatment, easy in the use and reliability against the risk of nascency of relapses
of disease make possible to recommend herniotomy by Onstep method for plasty almost for every patients with inguinal hernia. 2.
Hernioplasty by Onstep method is especially indicated for elderly and senile patients with attendant diseases, and it can be done with
local anesthetization. 3. for the hernioplasty by Onstep method it is necessary to use polypropylene reticulate implant “Polysoft”
by the company “C.R. Bardinc” (USA), its size is 14 х 7,5 cm., или 16 х 9,5 cm. 4 . during the obtaining access to the hernia sac it
necessary to get his full mobilization and separation from the spermatic cord. In cases of obliaue inguinal hernias it is expedient to
excise the hernia sac, and in cases of rectus hernias it is acceptably to immerse hernia sac into the abdominal cavity. 5. No later than
after two hours after the operation it is necessary to activate patients, because it stimulates their early rehabilitation and propitious
postoperative period.
Key words Inguinal hernia, medico-economic standard of treatment, method "ONSTEP", the inguinal implant, medical insurance.

Journal of Experimental and Clinical Surgery. 2016;9(1):10-18
pages 10-18 views

Ways to Improve the Results of Treatment of Patients with Acute Mesenteric Circulation

., ., .


The purpose of our research was improvement of results of an extensive resection of a small intestine at patients with sharp violation of mesaraic blood circulation due to the rational choice of a way of completion of this operation.
Materials and methods. Research includes 44 patients with sharp violation of mesaraic blood circulation, who has executed an extensive resection of a small intestine against the background of purulent peritonitis. The resection was completed with formation of a temporary terminal eyunostoma or an eyunostomy by Maydl. Factors was identified, which reveals statistically significant impact on a lethality at this group of patients (values on integrated scales of MIP and SAPS).
Results and their discussion. It is established that length of the remaining part of a small intestine can't be the factor constraining formation of a temporary terminal eyunostoma. On the basis of the received results the surgical algorithm which is successfully applied at 28 patients of the main group that has allowed to lower a lethality from 86,4% to 68% is developed.
Conclusion. After a resection of a small intestine at patients with peritonitis owing to sharp violation of mesaraic blood circulation the preference should be given to a temporary terminal eyunostoma.

Journal of Experimental and Clinical Surgery. 2016;9(1):19-23
pages 19-23 views

The Algorithm for the Diagnosis and Treatment of Patients with Chronic Opisthorchiasis Complicated with Obstructive Jaundice

Ilkanich A.J., Darvin V.V., Klimova N.V., Vardanyan T.S.


Relevance The chronic opisthorchiasis is endemic parasitic disease of the West Siberian region. Сhronic opisthorchiasis in 41.6%
of cases, followed by biliary hypertension. Creating a diagnostic and treatment algorithm of surgical complications of chronic
opisthorchiasis is actual.
The purpose of the study Development and evaluation of the effectiveness of treatment and diagnostic algorithm at patients with
chronic opisthorchiasis complicated with obstructive jaundice.
Materials and methods. The study included 91 patients with chronic opisthorchiasis complicated with obstructive jaundice. Patients
are divided into study and control groups. In the study group we applied developed diagnostic and treatment algorithm. We used
ultrasound, magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography
(ERCP). In order to decompress the biliary tract used endoscopic, percutaneous transhepatic and surgical drainage of the bile ducts.
Results and their discussion Determined five types of architectonic biliary tract in chronic opisthorchiasis. MRCP sensitivity was
97.7%, specificity 83.3% overall accuracy of 96%. The sensitivity of ERCP in the study group was 97.4%, specificity of 100%, the
overall accuracy of 97.7% in the control group 92.1%, 100% and 92.7%, respectively. Endoscopic decompression was effective in
84.0% of patients of study group and 80.6% of control group.
Conclusions The analysis indicate high information of MRCP and ERCP. Developed diagnostic and treatment algorithm improves
the efficiency of endoscopic methods of diagnosis and treatment.
Key words Chronic opisthorchiasis, obstructive jaundice, magnetic resonance cholangiopancreatography

Journal of Experimental and Clinical Surgery. 2016;9(1):24-32
pages 24-32 views

Comparative evaluation of interleukin-6 in the liver tissues, bile duct, blood serum and urine in patients with obstructive jaundice of benign etiology

Hajiyev J.M., Taghiyev E.G., Hajiyev N.J.


The purpose of the study - The comparative assessment analyzes of IL-6 content in the liver tissue, serum and bile duct in the
dynamics of the surgical treatment of 67 patients with obstructive jaundice. In all patients, the cause of obstructive jaundice was
Materials and metods - The degree of hepatic dysfunction was determined based on blood markers of cholestasis and cytolysis of
hepatocytes. The I degree hepatic dysfunction was observed - in 21 patients, II degree hepatic dysfunction - in 14, III degree hepatic
dysfunction - in 10, and IV degree hepatic dysfunction – in 9 patients. In 13 patients on the background of obstructive jaundice were
observed purulent cholangitis.
Results and discussion - Comparison of IL-6 in the liver tissue, ductal bile, blood, serum and urine in patients with varying degrees
of hepatic dysfunction showed that serum characterized the lower their levels of this indicator than in the liver tissue, bile and urine,
and most of this cytokine defi ned in bile . In the presence of purulent cholangitis greatest observed accumulation of IL-6, liver tissue,
bile and urine compared to serum.
Conclusion - Local and systemic levels of IL-6 may serve as markers for assessing the severity of the pathological process,
conservative therapy planning, monitoring of treatment effi cacy, and clinical course.
Key words obstructive jaundice, choledocholithiasis, interleukin - 6, hepatic dysfunction.

Journal of Experimental and Clinical Surgery. 2016;9(1):33-38
pages 33-38 views

Diagnosing and Treatment of the Gallstone Intestinal Obstruction

Glukhov A.A., Koshelev P.I., Leybels V.N., Boev S.N., Enkova V.V.


The purpose of the study. To analyze the results of diagnostics and surgical treatment of 15 patients operated about obstructive
gallstone intestinal obstruction.
Material and methods. 15 patients, from 58 to 84 years of age, were operated from 2 to 27 hours after admission to the clinic.
Operation volume: laparotomy, enterotomy, removal of gall stones from the intestinal lumen. Intervention in the biliary tract was
not carried out.
Methods of diagnosis: esophagogastroscopy, ultrasound, radiography of the abdominal cavity.
Results and their discussion. Such kind of postoperative period was observed in 14 cases. An average duration of the postoperative
period included 12 bed-days. Postoperative complications developed just in a single case (a brief excerpt from the case history is
given below). In 13 cases the removal of stone from the intestinal lumen was performed distantly from the obstruction point. In 2
cases the stone removal was executed just after its proximal displacement on 10-15 cm, because it could not be brought down.
Conclusions. The gallstone intestinal obstruction can occur atypically having an intermittent character, making it difficult to
diagnose, and leading to surgical treatment delay.
Key word gall stone, intestinal obstruction, surgical treatment.

Journal of Experimental and Clinical Surgery. 2016;9(1):39-42
pages 39-42 views

The Clinico-Rheological Status of the Soft Tissue Surgical Infection

Larichev A.B., Muravyov A.V., Komlev V.L., Chistyakov A.L., Ryabov M.M., Dylenok A.A.


Relevance The problem of treatment of the soft tissue infection is connected with features of the hemorheological status. Its
multicomponent assessment will allow proving the pathogenetic importance of the haemo corrective means allowing to make a
positive impact on effectiveness of surgical treatment of patients with such pathology.
The purpose of the study Is to represent a comparative assessment of the clinico-rheological status at treatment of the soft tissue
surgical infection of the anterior abdominal wall and maxillofacial area.
Materials and methods Results of treatment of 73 patients with pyoinflammatory pathology of the anterior abdominal wall (36
cases) and on the face and neck (37 cases) are analyzed. To assess the wound process clinico-laboratory indicators were used, and
also there were used the hemorheological profile including viscosity of blood at high and low speeds of shift, viscosity of plasma,
corpuscular volume, viscosity of coarse dispersion and the indicator of aggregation of erythrocytes, indexes of their lengthening and
rigidity, and also the index of oxygen transport efficiency.

Results and discussion In the setting of the purulent process in the anterior abdominal wall significant changes of the
haemorheological profile concern strengthening of erythrocyte aggregation, the expressed increase of blood viscosity at rather low
speeds of the shift, reduction in deformability of red blood counts and the index of oxygen transport efficiency in blood. Within 7
days the tendency of stabilizing indicators is observed, however, macrorheological characteristics are not normal, and it testifies
that there are suppurative changes of the homeostasis. In cases of septic diseases in the face and neck, qualitative and quantitative
indicators of the estimated criteria are comparable to parameters of the rheological status of patients of the previous group. The
traditional complex of remedial actions is followed with the greatest correction by the indicator of erythrocyte aggregation. It
concerns, in a less degree, the blood viscosity at high and low speeds of the shift, and also viscosity of erythrocyte coarse dispersion
and the index of oxygen transport efficiency in blood (p>0,05).
Summary The surgical infection of soft tissues is characterized by changes of all indicators of the haemorheological profile. In
the course of treatment they are corrected without achieving the norm and that increases the risk of the development of local
complications. When there is a septic disease of the cell areas of the face and neck, rheological shifts have smaller expressiveness,
and their correction has a prolonged character.
Key words nfection of soft tissues, haemorheology, surgical service.

Journal of Experimental and Clinical Surgery. 2016;9(1):43-52
pages 43-52 views

Ultrastructure of the Bone Tissue in Chronic Recurrent Hematogenous Osteomyelitis in Children

Zayniev S.S.


One of the actual problems of purulent-septic surgery of the child age is chronic recurrent hematogenous osteomyelitis developed
after having chronic hematogenous osteomyelitis. In spite of the successes reached by the modern medicine in particular surgery is
still left the high prevalence unsatisfactory treatment results (42-50%) and recurrences of the disease (58-78%). In connection with
it patients sometimes are exposed to repeated surgical interventions (73,9-80%) remaining untreated during ten years. Orthopedic
complications were the most unfavorable outcomes of the chronic osteomyelitis which present according literature data in 31-71%
of cases. Invalidity after such complications is from 16,2 to 53,7%.
Pathomorphological changes in osteomyelitis, particular in acute and chronic types in the present time have been studied
significantly well. However the demands to diagnostic and treatment of the recurrent type of the disease dictate the necessity of the
new understanding of this problem. The investigations with the use of the complex morphological methods with the use electronic
transmission and scanning microscopy and study of semithin sections have not been carried out.
With the morphological point of view chronic osteomyelitis is characterized by the presence of isolated purulent focuses with
sequesters, pathological granulations lined with sclerotic tissue of the internal and external walls of the sequestered capsule.
The scientific work is devoted to the study of the morphological structure of the bone tissue in children with chronic recurrent
hematogenous osteomyelitis with the use of light-optic, electronic transmission and scanning microscopy.
Key words. osteomyelitis, bone tissue, children, surgical treatment.

Journal of Experimental and Clinical Surgery. 2016;9(1):53-57
pages 53-57 views

Evaluation of Results of Rehabilitation After Childrens Cochlear Implantation in Voronezh Region

Petrova I.P., Balashova E.A., Tavartkiladze G.A.


Aim: the improvement of the efficiency of candidate’s selection for CI, improving the quality of rehabilitation implanted patients,
determination of prognostic criteria for clinical trialsusing decision-making support system (DSS) based on artificial neural networks
The purpose of the study: improving the efficiency of selection of candidates for KI, improving the quality of rehabilitation
proinvestirovany patients determination of prognostic criteria KEY by using artificial neural networks.
Materials and methods. The study was conducted in 110 children (age10 months - 17 years). All patients underwent clinical and
audiological examination, psychological and educational testing, based on tests of Nottingham implant profile.
Results and discussion. TheANNs was builtfor the classification of patients to clinical trials, before CI and at 3, 6, 12, 18 and 24
months after it and received four cluster data structure. Depending on the average values of tests each cluster was given a name and
an analysis of the age structure and the availability of hearing aid experience at the time of surgery
Conclusions. 1. Children implanted at the age older than 5 years oldcould receive good results of rehabilitation after CI. 2. The
experience of hearing aids to CI has a positive effect on the results of clinical trials. 3. The using of artificial neural networks is
suitable for determining the prognosis of the results of clinical trials at any stage of rehabilitation
Key words cochlear implantation, artificial neuronic networks, rehabilitation.

Journal of Experimental and Clinical Surgery. 2016;9(1):58-62
pages 58-62 views

Modeling and Experimental Study of Polytrauma

Shapkin Y.G., Seliverstov P.A.


Modern experimental models of combinations of polytrauma reproduce the most common and clinically significant damage to the
head, chest, abdomen, extremities, and mimic the complex pathological processes that occur in patients with severe multiple trauma.
Standard models polytrauma animals allow experiments with accurate repeatability of the results and explain the variability of many
of the clinical data. Meanwhile, experimental modeling polytrauma has a number of limitations associated with animal species
differences, artificial reproduction damage, assessed the influence of anesthesia on the physiological indicators. The possibilities of
studying late posttraumatic period in the experiment limits the short duration of observation of the animals in most studies.
Experimental studies have focused on the study of polytrauma local and systemic inflammatory reactions, coagulopathy, metabolic
disorders caused by shock, multiple organ dysfunction of the mechanisms of development and post-traumatic complications. Playing
in different groups of animals isolated and different variants of combined injuries allows you to set the pathogenetic significance
of each individual injury and to determine the mechanisms of their mutual influences in polytrauma. In an experiment carried out
testing and comparing the effectiveness of therapies, assessment of the impact of different surgical procedures on the physiological
and morphological parameters in polytrauma.
Key words polytrauma, multiple trauma, experimental model, inflammatory response, multiple organ failure, shock, coagulopathy.

Journal of Experimental and Clinical Surgery. 2016;9(1):63-71
pages 63-71 views

Oxidative status of pancreatic tissue on the background of the antioxidant and antihypoxic therapy

Suslov A.V.


The purpose of the study Analyzing the antioxidant and energy status of pancreatic tissue to study the mechanisms of influence of
antioxidant and antihypoxic therapy in acute pancreatitis.
Materials and methods Experimental work 46 animals, which were modeled edematous form of acute pancreatitis. In the control
and study periods (1, 3 and 5 days) animals relaparotomy was performed in pancreatic tissue intraoperatively examined the redox
potential and diffusion coefficient of oxygen, microcirculation was evaluated and morphological conditions. Performed a biopsy of
pancreatic tissue for the purpose of studying the processes of lipid peroxidation. Animals of the first experimental series (n=12) in
the postoperative period was carried out antioxidant therapy toxicol (10 mg/kg). Animals of the second experimental series (n=12)
in the postoperative period was antihypoxic therapy remaxol (15 ml/kg).
Results and their discussion Obtained during the execution of the research evidence shows that a certain "isolation" of the formation
energy shortage and development of processes of lipid peroxidation. Recovery of tissue respiration in the pancreas does not reduce
the intensity of the processes of lipid peroxidation.
Conclusions The intensity of lipid peroxidation in pancreatic tissue is limited by other, additional mechanisms, eliminating the
violation of the energy status of the tissue.
Key words Acute pancreatitis, antioxidant, antihypoxic drug, tissue respiration, lipid peroxidation, mechanisms of influence

Journal of Experimental and Clinical Surgery. 2016;9(1):72-75
pages 72-75 views

Some Strain Characteristics of the White Lne of the Abdomen in the Median Laparotomic Wound (Experimental Study)

Vnukov P.V., Sheptunov Y.M.


Relevance. The tension of the aponeurosis in surgical treatment of midline hernia occurs when the different ways of hernioplasty. At
the same time, the standards of this indicator and limit values date to be determined and therefore not used in herniology.
Materials and methods. The article describes the results of experimental biomechanical studies of the white line of the abdomen
for 15 non-fixed cadavers. Produced a median laparotomic incision. Selected white line in 12cm above umbilicus and at the same
distance below it. Made 6 a longitudinal incision of the aponeurosis at 4cm in length each. Using digital electronic dynamometer,
and the pincer mechanism defined force (N) necessary for the closing of the edges of the aponeurosis. Similarly, the measurements
are made for three sections the white line of the abdomen length 8cm (above the umbilicus, at the level of the umbilicus and below it),
and upper and lower middle sections of 12cm. Accordingly, the obtained parameters the calculated tension forse (N/cm2).
Results and their discussion. It was found that the tension in the incision of the aponeurosis above the umbilicus (1,82±0,46 N/cm2)
has a statistically higher rate than below the umbilicus (0,96±0.40 N/cm2) with a significance level of p≤0.05. The highest rates
were observed in subxiphoidal region (2,66±1.2 N/cm2) and the smallest in the middle third of the lower midline incision (0,68±0.5
N/cm2) (p≤0.01). It is hypothesized that this fact is due to the more horizontal position of the body. On the assumption that the
biophysical model of the anterior abdominal wall may be thin-walled cylinder made a mathematical justification of the hypothesis.
The estimated change in the tension was 2.4 N/cm2, which is very close to empirical – 2.0 N/cm2.
Conclusion. It is concluded that in the horizontal position of the body tension of the aponeurosis in the lower-middle laparotomic
wound is smaller than in upper-middle, largely leveled in the orthostasis.
Keywords: White line, aponeurosis, tension.

Journal of Experimental and Clinical Surgery. 2016;9(1):76-80
pages 76-80 views

A Method for Preventing Scarring from Surgical Treatment of Glaucoma

Zakharova I.A., Makhmutov V.Y., Avdeev R.V., Varakina I.S., Chernyh E.N.


Relevance The urgency of improving the technical aspects of performing surgery in glaucoma led to the reduction of intraocular
pressure in the early postoperative period, as well as reducing the incidence of postoperative complications. Relevant is the question
of excessive scarring in the area of surgery, which resulted in reduced hypotensive effect of the operation, and in the late postoperative
period, in some cases, nullifies the results of the operation.
Purpose of the study Develop a way to improve the efficiency of antiglaucomatous operation in which for the prevention of scarring
is a synthetic material Gore-tex.
Materials and Methods The experiment was performed on 30 animals that have been under-us into two groups. The control - 15
animals operated by the standard method for deep sclerectomy S N Fedeorovu (DSE), and development of 15 animals that in the
performance of DSE under the superficial scleral flap was packed strip, a cut from the membrane Gore-tex.
Results and their discussion The research results of implantation of synthetic material Gore-tex during the DSE showed reduction
in the incidence of recurrence rise in intraocular pressure (IOP) in the late postoperative period, reduction of scarring processes.
Morphological investigations showed that in the control group after 6 months in the zone of surgery determined proliferation fibrous
connective tissue with few fibroblasts and newly formed vessels, the level of intraocular pressure (IOP) in the control group after
6 months was 11.0 mm rt st. He returned to the preoperative level. While in the experimental group of animals at 6 months after
surgery, the im-plant is surrounded by a thin fibrous capsule around around the implant has a cavity to 20 mm, filled with liquid,
which communicates with the suprachoroidal and subtenon. There were addi-tional cavities between the individual collagen fibers
as well filled with fluid. The level of IOP after 6 months of after surgery on the proposed methodology, was 9.0 mm rt st. It shows mor-phological changes in the zone of interference. Conclusion The results indicate that the use of Gore-tex membranes processes reduces scarring in the area of surgical treatment and enhances the antihypertensive effect of the existing surgery.

Key words glaucoma, prevention of scarring, surgical treatment.

Journal of Experimental and Clinical Surgery. 2016;9(1):81-88
pages 81-88 views


ЗАТЕВАХИН Игорь Иванович (к 80-летию со дня рождения)

., .
Journal of Experimental and Clinical Surgery. 2016;9(1):89-90
pages 89-90 views
pages 91 views

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