# Vol 9, No 2 (2016)

## Original articles

### Early Diagnostics, Treatment and Prophylaxis of Cholelithiasis

Shulga A.F., Varzin S.A., Potashov L.V., Protasov A.A., Polyglottov O.V., Malin R.U.

#### Abstract

Relevance. The сholelithiasis frequency is high in Russia, many operations on bile system are carried out, however possibilities of
an ursotherapy are used not fully as there are no accurate diagnostic criteria for it.
The purpose of the research is searching for effective methods of diagnostics of a microcholelithiasis for a definition of indications
of medical tactics. The main task is practical realization of methods of an impedansometry and microscopy of bile in patients with
microcholelithiasis.
Materials and methods. Work is performed on material from 112 patients with various diseases of a bile system and 4 almost healthy
persons. The bile received at continuous fractional duodenal sounding and also the bile received by carrying out ERHPG from the
general bilious channel by its canulation was estimated. The analysis of bile was made on RGG9-01 reogastrograf; bile microscopy
was made by means of a usual and polarizing light microscope.
Results. Among all crystal structures of bile, crystals of monohydrate of cholesterol, a granule of a bilirubinat of calcium and
crystals of a carbonate of calcium have the greatest value. Corellation between types of crystals matches to components of gallstones
(microlithiasis).For various options of cholelithiasis current the impedance of bile and its coefficient of a lithogenicity of bile are
defined.
Conclusion. At a stage of increasing of a lithogenicity of bile and the appearing of biliary sludge the ursotherapy is pathogenetic
reasonable; at the emergence of bile destabilization and the emergence of crystal structures (microcholelithiasis) it is possible to put
indications to surgical treatment.
Key words: microlithiasis, impedancemetry and microscopy of bile.

Journal of Experimental and Clinical Surgery. 2016;9(2):92-96
92-96

### Treatment of Acute Colon Obstruction with Cancer

Orekhov A.A., Khitaryan A.G., Miziev I.A., Glumov E.A., Karpova I.O., Kovalev S.A.

#### Abstract

Relevance: There are some reports about stenting of the colon-cavity in cases with cancer colon-obstruction as a stage of treatment
for the last time. However, there are some data with high frequency of earlier postoperative complucations, such as a perforation of
the colon and tumor, the bleeding, the distal migration of the stent.
The purpouse of the study: identify the clinical and morphological parallels necrobiotic processes in the large intestine, as a
predictor of unfavorable course of acute obstructive intestinal tumor obstruction intraintestinal after stenting..
Materials and methods: In the article retrospective analysis of clinic-morphological connections of 100 cases subscribes. The biopsy
was taken during operation.
Results and their discussion: The clinical symptoms combined with the necrobiotic proses in the colons wall were identifycated.
They can be considered as a predictors of adverse outcome after stenting of colon-cavity in cases of the cancer colon-obstruction.
Conclusion: Сlinico-morfological connections as predictor of the complications after stenting in the cancer colon obstruction.
Key words: colorectal cancer, acute intestinal obstruction, stents, stenosis.

Journal of Experimental and Clinical Surgery. 2016;9(2):97-101
97-101

### Optimizing Endoscopic and Medical Therapy in Patients With Gastrointestinal Bleeding

Ovchinnikov I.F., Cherednikov E.F., Glukhov A.A., Deryaeva O.G., Maleev Y.V., Cherednikov E.E., Litovkin T.E.

#### Abstract

Relevance It is well recognized that gastroduodenal bleedings continue to remain one of the most relevant problems of modern
emergency surgery. It is reasonable to make the best use of endoscopic hemostasis in treatment of patients with gastrointestinal
bleedings. In our opinion, local hemostatic agents as well as hydrophilic granular absorbents seem to be potentially effi cient for
endoscopic treatment of gastroduodenal hemorrhages.
Objective. The research objective is to improve outcomes of patients with gastrointestinal bleedings by means of optimization of
complex therapy and endoscopic hemostasis techniques.
Materials and methods. The study involved 107 patients with acute gastroduodenal bleedings who underwent medical treatment
at the specialized gastrointestinal center affi liated with the State-Funded Healthcare Facility «Voronezh City Clinical Emergency
Hospital #1». The treatment group (56 patients) received the experimental treatment based on optimization of local and systemic
hemostatic agents administration combined with endoscopic pneumo-insuffl ation of absorbents. The control group (51 patients)
received the treatment specifi ed by the established instructions meeting the standards accepted for gastroduodenal patients’ care.
Results and discussion. The treatment outcomes were assessed with reference to the following indices: fi nal hemostasis percentage,
recurrent bleedings rate, number of emergent operations, mortality rate.
Conclusions. The developed optimized program of treatment involving local and systemic hemostatic agents administration makes it
possible to lower the repeated hemorrhage rate from 11.9% to 7.1% (1.7 times), to reduce the number of emergent operations from
7.8% to 3.6% and to decrease postoperative mortality from 3.9% to 1.8% (2 times).
Key words: ulcerous gastrointestinal bleedings, optimization of treatment, local and systemic hemostatic agents, granular absorbents,
Diotevin, Diovin, NovoSeven, fi brinolysis inhibitors

Journal of Experimental and Clinical Surgery. 2016;9(2):102-107
102-107

### Epidemiological Aspects of Obstructive Ileus in Cancer the Left Parts of the Colon

Artyukhov S.V.

#### Abstract

The purpose of the study The research goal is to determine age and sex groups of patients, time when they were taken to the hospital,
whether they have some concomitant diseases and how severe they are, and also to find out if they have complications which can
make the clinical course of acute intestinal obstruction worse with underlying cancer of colon's left division. It must be based on
post-event and prospective analysis.
Materials and methods The study is based on the analysis of the treatment of 2200 patients with cancer of the left half of the colon in
10 years. Among patients men were 973 cases (44.2%), women – 1227 (55, 8%). Patients older than 60 years was 75.3 %
Results and their discussion The main number of patients (70,4%) delivered within 48 - 72 hours from the onset of the disease. In
88.7% of patients anesthetic risk corresponds to the IV - V degree. The severity of the 67% of patients evaluated in 16 points and
above. Various comorbidities independently or in combinations met the vast majority (97.7 per cent) patients. In addition to acute
intestinal obstruction different associated complications of cancer have occurred in 241 (23,7%) patient. Most often the tumor is
located in the sigmoid colon (39.4%).
Conclusions Majority of patients (75,3 %) are over 60 years old. They arrive with complex comorbidity. Active early pre-hospital
diagnosis may lead to prevention of development of advanced forms of acute intestinal obstruction.
Key words Colon cancer, intestinal obstruction, epidemiology.

Journal of Experimental and Clinical Surgery. 2016;9(2):108-113
108-113

### Tactical Issues of Treatment of Fluid Collections According to the Revised Atlanta Classifiction of Local Complications of Acute Pancreatitis

Firsova V.G., Parshikov V.V., Gradusov V.P.

#### Abstract

Relevance The tactics of fluid collections management in acute pancreatitis is controversial. Evaluation of treatment results based
on unified classification criteria will allow to define more clearly the indications for various surgical procedures in these patients.
Aim. Analysis of the results of treatment of patients with fluid collections in acute pancreatitis according to the revised Atlanta
classification.
Materials and methods 109 patients with acute pancreatitis and fluid collections formation were divided according to the revised
Atlanta criteria (2012). Interstitial pancreatitis was in 7 patients, necrotizing pancreatitis – in 102. Acute peripancreatic fluid

collections were in 5 cases, pancreatic pseudocysts – in 2. Acute necrotic collections were in 93 persons. 9 patients were admitted
with walled-off necrosis. Indications for surgery were suppuration of fluid collections, in absence of pancreatic infection – persistence
of pain, rapid growth of the volume of the collections. Comparison of the groups was performed using two-tailed Fisher's exact p, χ2
test, the level of significance of differences was ≤0.05.
Results. Conservative treatment in interstitial pancreatitis resulted in regression of fluid collections in 2 cases including pancreatic
pseudocyst, a significant reduction in the size – in 2 cases. External drainage led to resorption of peripancreatic fluid collections in 2
patients, the recurrence of the pancreatic pseudocyst happened after removal of a drainage. Conservative treatment in acute necrotic
collections resulted in their regression in 20% patients, formation of the walled-off necrosis – in 40%, suppuration or rapid growth
of the volume – in 36%, reduction in the size – in 4%. External drainage of acute necrotic collections using real time ultrasound (US)
guidance was performed in 16 patients, by means of open access – in 17. The comparison of the results of US-guided drainage and
opened procedures did not reveal significant differences in lethality (р=0.224) and regression rate (р=0.728). Walled-off necrosis
(46) was drained by open extraperitoneal access in 12 patients, by US-guidance – in 10. The regression rate was higher in open
surgery compared to US-drainage (p=0.027). Conservative treatment in 24 patients with walled-off necrosis (52%) resulted in
stabilization or decrease in size of the collection, pain and inflammation signs disappearance; of these walled-off necrosis regressed
in period of 4 months to 1 year in 8 patients.
Conclusions. Formation of fluid collections in acute pancreatitis requires continued conservative measures. Surgical treatment is
indicated in most of cases in suppuration. External US-guided drainage is preferred for acute necrotic collections. In walled-off
necrosis open extraperitoneal drainage is more effective.
Key words: acute pancreatitis, fluid collections, conservative treatment, ultrasound-guided drainage, open extraperitoneal access.

Journal of Experimental and Clinical Surgery. 2016;9(2):114-123
114-123

### Damage Сontrol Surgery: Indications Criteria for Relaparotomy (Clinical and Experimental Study)

Timerbulatov V.M., Gareev R.N., Fayazov R.R., Timerbulatov S.V., Khabibullin L.D., Yarmukhametov I.M.

#### Abstract

The aim of the study was to identify criteria on which to rely when choosing the timing of relaparotomy in staged treatment of patients
with severe abdominal trauma.
Materials and methods The article highlights the results of the experiment on 24 pigs which show a progression of abdominal cavity
organs ischemia and, as a result, a growth of blood lactate level with an increase of intraabdominal pressure indicators.
The clinical material has been composed of 42 victims with a severe abdominal injury (an average rate on military surgery-condition
on admission scale is 28,28±3,37). The clinical material has been divided into 2 groups. Considering the experiment results as
criteria we have used blood lactate and intraabdominal pressure indicators of 19 victims in the experimental group to determine
a relaparotomy term. The indication for reoperation has become an increase or a maintenance in the dynamics of intraabdominal
pressure on 20 mm of mercury and above and of a blood lactate indicator at 7 mmol/L and higher within 12 hours. The relaparotomy
of 23 victims of the control group has been postponed until a total stabilization of patients conditions.
Results. After the reoperation out of 42 victims of the whole clinical material 20 (47.6 %) patients died, where 6 (31.6%) are of the
experimental group and 14 (60.9%) of the control group (φ=1,926, р<0,05). The authors conclude that while fulfilling the 3d stage
of a surgery treatment of victims with a severe abdominal injury according to the Damage Control concept one should follow the
intraabdominal pressure and blood lactate indicators as a marker of abdominal cavity organs ischemia.
Conclusion: when choosing the timing of the third stage of surgical treatment of casualties with severe injuries of the abdomen under
the concept of Damage Control, should also be guided by the indicators of the IAD and blood lactate level
Keywords Intraabdominal injury, Damage Control

Journal of Experimental and Clinical Surgery. 2016;9(2):124-128
124-128

### Immediate Results of Open Surgery for Subclavian Artery Atherosclerotic Lesions Treatment Complicated by Internal Carotid Artery Stenosis

#### Abstract

Methods: 104 patients with atherosclerotic subclavian artery stenosis received surgical treatment in the Centre of Cardiac and
Vascular Surgery of the Chelyabinsk Region Hospital from March 2007 till December 2012. 30 of them were diagnosed with a
significant ipsilateral carotid artery stenosis. Patients were divided into two groups. A simultaneous subclavian and carotid artery
surgery was performed on the first group of 29 patients. 75 patients from the second group had only an isolated subclavian artery plastic
surgery .In the first group several types of operations were performed : the subclavian carotid transposition (SCT) with concomitant
carotid endarterectomy (CEA) in 13 of cases; carotid subclavian bypass grafting (CSB) with concomitant CEA in 16 cases. 39 CSTs
and 36 CSBs were performed in the second group. Statistic analysis was performed with STATISTICA 6.0 and Microsoft Excel 5.0
Results: There were no deaths or myocardial infarction in the first group. One patient had an ipsilateral ischemic stroke (2,9%), and
another one had a contralateral ischemic stroke (2,9%). In the second group there were no strokes or deaths. In one case the myocardial
infarction occurred (2,5%) on the second day of the postoperative period. There were no significant differences between groups (P>0,05).
Conclusion: concomitant carotid and subclavian surgery is a safe, feasible and effective method of treatment and
could be recommended in such groups of patients. For patients with a significant contralateral subclavian and carotid

stenosis the staged strategy should be chosen with performing CEA as the first step. In our opinion, the subclavian
carotid transposition is the method of choice in subclavian artery surgery with good immediate and long term results.
Key words: carotid artery, subclavian artery, carotid endarterectomy, subclavian carotid transposition, carotid subclavian bypass
grafting.

Journal of Experimental and Clinical Surgery. 2016;9(2):129-137
129-137

### The role of retroperitoneal hemorrhage in the development of enteroparesis (clinical and experimental study)

Gareev R.N., Fayazov R.R., Khabibullin I.D.

#### Abstract

In the article the authors reflected the results of the experiment on 20 mongrel rabbits. During the experiment in the animals
retroperitoneal space the authors infused rabbits blood according to the developed by themselves procedure carrying out blood
sampling from the ear vein and thereby simulating the retroperitoneal hemorrhage. The experiment was conducted under the ether
anesthesia in compliance with all the rules of aseptic and antiseptic. In the experiment the authors infused 5% of circulating animals
blood into the retroperitoneal space, 10 rabbits were injected with 10% of the calculated blood volume. 7 % of the animal body
weight was suggested as a circulating blood volume. After 3 days the test animals were sacrificed by lethal doses of narcotic drug.
The autopsy revealed that in the group of test animals infused with 5% of a blood volume the enteroparesis developed in 1 (10%)
animal, and in the group infused with 10% of a blood volume paresis developed in 6 (60%) animals. Thus, the authors showed a
direct involvement of the retroperitoneal hemorrhage in the development of enteroparesis. Moreover, the paresis incidence rate
directly depended on the blood volume infused into the animals retroperitoneal space. The analysis of the clinical data of 156
patients with traumatic retroperitoneal hemorrhage showed that the retroperitoneal hemorrhage complicates a closed abdominal
injury in more than half of the cases and is followed by the intraabdominal hypertension of various degrees of severity up to the
development of intraabdominal hypertension syndrome in 68.6% of cases.
Key words. Retroperitoneal hemorrhage, enteroparesis

Journal of Experimental and Clinical Surgery. 2016;9(2):138-140
138-140

### Morphofunctional Changes of the Spleen after Hemostasis by «Nonequilibrium Plasma»

Semichev E.V., Shevcova N.M., Baikov A.N., Bushlanov P.S., Gereng E.A., Aleynik A.N.

#### Abstract

Actuality: Introduction: heavy bleeding is developed in case of spleen injury. It often leads to death. At present method of coagulation
by "nonequilibrium plasma" is developed.
Aim: study the effect of "non-equilibrium plasma" on the hemostatic system and morphofunctional state of the spleen.
Materials and Methods: The experiment was carried out on 45 male rabbits weighing 3000 - 3200 g. 1st group (control; n=5) -
intact animals without surgery; 2nd group (experimental, n=40) - animals after atypical resection of the spleen and hemostasis
by "nonequilibrium plasma". The volume of blood loss, FBC, histological data (specific volume of red and white pulp, vessels,
connective tissue, the density of the cellular infiltrate), splenogram analysis (microscopy of spleen impression smears) data were
assessed at defined periods (60 min, 3rd, 5th, 7th, 14th, 30th, 90th, 180th days) after surgery. Them were compared with data of the
control group.
Results and discussions: The volume of blood loss during the resection of the spleen with hemostasis by "nonequilibrium plasma"
was 16,6 [15,98;17,22] ml. Increase of neutrophil to 38 [24; 39] (control group 17 [13, 18], p=0,009), monocytes to 15 [14, 18]
(control group 8 [6, 11], p=0,036) is revealed in the FBC in the early period after hemostasis with nonequilibrium plasma. It is
reduced to the norm on 30 day. Histological examination revealed leukocyte infiltration, edema, microvascular stasis, dilatation of
vessels in the early period. At long-term period structure of the organ is normalized. Splenogramm analysis revealed a statistically

significant (p = 0,023) decrease in the relative number of small lymphocytes by 28% in animals after hemostasis with nonequilibrium
plasma as compared to control (23.3 [17.9; 26.7] versus 30.8 [29.25; 34.3] in the control group).
Conclusion: treatment of bleeding surface by plasma flow for 1.5-2 min is required order to achieve effective hemostasis during
surgery of spleen injuries in the experiment. After hemostasis by "nonequilibrium plasma" there is minimal damage of the spleen
parenchyma, which manifests itself as "activation reaction" in the first minutes after exposure. At long-term period parenchyma of
the spleen completely regenerates with the formation of cicatrical tissue that does not affect the functioning of organ.
Key words: haemostasis of spleen, nonequilibrium plasma, spleen trauma, morphofunctional changes.

Journal of Experimental and Clinical Surgery. 2016;9(2):141-148
141-148

### Clinical Observation of Several Complications at Different Stages Perform Bariatric Procedures

Samoilov V.S., Glukhov A.A.

#### Abstract

Relevance: In the wake of rising of bariatric surgery increases the number of patients with complications after these surgeries and manipulations. The most dangerous surgical implications are accompanied by a high percentage of failures. A common surgical approach in such situations have not yet been accepted, most of the works are descriptive in nature. Objective: The description of the medical case of emergence of dangerous complication under the consistent conduction of bariatric manipulations with the patient with obesity and the successfully improvement of these complications. Materials and Methods: Represented the clinical observation of the patient with second-degree and secondary infertility. After installation of lap band and the weight loss after 4 months, despite strong recommendation the patient became pregnant. During pregnancy and after delivery the patient fall be the care, came to remove the lap band only after almost 3 years, given that lap band or its fragments were not found. Taking into account the refatness and weight gain with excess, the next stage of the treatment was laparoscopic lateral gastrectomy. By emergency readmissions at 10 days after surgery diagnosed proximal failure of staple-line with the widespread fibropurulent 24 hours duration. Surgical approach was aimed primarily at combating peritonitis. To increase the temporary occlusion of insolvency, sufficient for the relief of peritonitis, at place of sealing additionally laid on glue "Sulfacrylate". Seepage and the fistula shaping were resumed only on the 4th day, which made it possible to get on with peritonitis. Later on, for the purpose of filling the deformity there was the attempt of esophageal stent, which migrate by resistant vomit with the back-set of seepage and fistula shaping. The last one was fully closed within 3 months. Conclusions: The compliance of bariatric patient plays an important role in the success of surgical treatment and reducing the risk of rise of unforeseen situations. Late presentation by the abnormal situation leads to serious complications, which include widespread peritonitis by the staple-line failure. Relief of peritonitis requires maximum delay of resumption of the leak. The strengthening of the area with glue sealing makes it possible. After the peritonitis elimination further treatment is aimed at closing the fistula.
Journal of Experimental and Clinical Surgery. 2016;9(2):149-155
149-155

### The Use of Laser Technology and Aquacomplex Titanium Glitserosolvat in the Treatment of Chronic Osteomyelitis

Novomlinsky V.V.

#### Abstract

Chronic osteomyelitis remains one of the most difficult problems of purulent surgery, which is associated with a high frequency of
occurrence, up to 6% in the structure of the pathology of the skeletal system and 6,8-12% in the structure of septic diseases, the
development of septic complications and relapses, disability, reaching 55% of cases.
The aim of the study was to improve the results of treatment of chronic osteomyelitis by applying laser technology and aquacomplex
titanium glitserosolvata.
Materials and methods: Experimental studies conducted in 5 groups with 175 white rats with chronic osteomyelitis: 2 controls and
3 experimental. In the 1st control group consisted of untreated animals. In the 2 nd control and experimental groups underwent
surgical sanitation of purulent focus. In the 1st test group reorganization of the bone cavity was complemented by the use of lowintensity
laser irradiation. In the 2nd test group performed the introduction into the bone cavity aquacomplex titanium glitserosolwool.
In the third experimental group - treatment bone cavity laser radiation of low intensity, followed by a titanium glitserosolvata
aquacomplex it. During the execution of the work we studied the clinical, haematological, microbiological and radiological studies.
Results: Simulation of chronic osteomyelitis using the developed technique allows to 31 th day form a pathological process with
fistulas with purulent discharge, which was confirmed by clinical, microbiological and radiological examinations.
Conclusion: The developed method of complex treatment of chronic osteomyelitis, based on the combined use of laser technology
and aquacomplex titanium glitserosolvata contributed to the closure of the wound defect to 14 days; how to reset the general
condition, appetite and motor activity to the 28 days of the study; normalization of hip circumference to the injured limb 90 th day of
observation, indicators of free radical oxidation, these biochemical investigations.
Key words: Laser Technology, Aquacomplex Titanium Glitserosolvat, сhronic osteomyelitis

Journal of Experimental and Clinical Surgery. 2016;9(2):156-164
156-164

### The comparative strain characteristics of the subcutaneous tissue longitudinal and transverse paraumbilical wounds (experimental research)

Sheptunov Y.M., Vnukov P.V.

#### Abstract

Relevance: In the surgical treatment of umbilical hernia localization are the longitudinal and transversal accesses. Data about the
advantages and disadvantages of each incision, including the seroma formation are discrepant.
Materials and methods: Conducted biomechanical investigation of the longitudinal and transverse wounds of the umbilical region
of the abdomen for 15 non-fixed cadavers. Performed a longitudinal incision of 2 cm from the umbilicus to the left and transverse
above the umbilicus on the same 2 cm. Length and depth of the wounds was made 3cm at a thickness of subcutaneous fat in
paraumbilical region of 3.5-4 cm. Later in the wound was placed in a polyethylene balloon 4ml is connected to a flow inclined liquid
manometer. The skin over it was closed by continuous intradermal suture. The balloon was gradually introduced air, at the same
time recorded the pressure in it. The volume of a balloon and the corresponding range of values of pressure is selected based on the
literature described in pressure in the lymph vessels (1-10mmHg).
Results: It was found that the increase in system pressure when administered for every 0.2 ml of air in the range from 0 to 2
ml averaged 149,1±28.4 Pa for a longitudinally oriented wound and 128,4±22.5 Pa for transversely oriented wound. Described
indicators are statistically significantly higher in the longitudinal wound at the significance level p≤0.01. Used to evaluate paired
t-test. That is, when the accumulation in the subcutaneous layer of the wound some additional volume increase in pressure occurs
in a more marked extent in a longitudinal wound. This fact can be associated with the orientation of connective tissue fibers of the
tissue and the dermis.
Conclusions: Thus, it is concluded the data obtained during the study can be used to predict the probability of a postoperative
seroma formation at the umbilical region of the longitudinal and transverse access.
Keywords: longitudinal incision, transverse incision, paraumbilical, pressure.

Journal of Experimental and Clinical Surgery. 2016;9(2):165-168
165-168

### Experience of the Plastic Surgery Center of Ngha "Railway Clinical Hospital at the

Novomlinskii V.V., Sokolov A.P., Lynov P.A., Ostroushko A.P.

#### Abstract

Plastic surgery is a versatile, very extensive surgery, includes many different areas and subspecialties interacting with the many
related areas of medicine. In 2010, Road clinical hospital at the station Voronezh-1 on the basis of the Department of surgery №2
was established Department of plastic surgery, a reconstructive surgery was done surgery aesthetic direction for correction of agerelated
and congenital and acquired anatomic changes and deformations of the body. In 2015, the Centre was established plastic
surgery who United together and gave the opportunity to maintain continuity in the provision of specialized care to patients in the
section of plastic, reconstructive and aesthetic, as well as bariatric surgery. A special focus of our work is reconstructive breast
surgery after a previous surgery for cancer of the breast. An important role in the rehabilitation process played by the continuity of
our work with cosmetologists. Plastic surgery center actively collaborates with the bariatric surgeons. Over the past 5 years, have
accumulated rich experience in operative interventions concerning morbid obesity. Good results are the experience of joint work of
the two directions of surgery and demonstrate that there is rich potential for further development.
Keywords: plastic surgery, plastic surgery center

Journal of Experimental and Clinical Surgery. 2016;9(2):169-173
169-173