Vol 14, No 1 (2021)

Original articles

Concomitant Liver Disease: Echinococcosis and Aspergillosis

Usmonov U.D., Nishonov F.N., Otakuziev A.Z., Stepanova Y.A., Vishnevsky V.A., Botiraliev A.S., Abdulkhaeva B.K.


Aspergillosis covers a wide range of diseases caused by the genus Aspergillus fungi. Aspergillus saprophytic mold is widespread in the environment; its spores are easily inhaled. However, despite the fact that most people inhale aspergillus spores daily, aspergillosis develops mainly in immunocompromised individuals (due to illness or during immunosuppressive therapy).
the lungs are affected most often, being the portal for the fungus penetration, but the naso-orbital sinus is also involved in the process. There are few reports on extrapulmonary aspergillosis. Even rarer in the literature are publications about the co-infection of a saprophytic fungus and a hydatid cyst. Only single clinical observations of the coexistence of aspergillosis and echinococcosis in the lungs have been described. No literature data are available on the coexistence of these two pathogens in the liver. The authors present a clinical case of a 54-year-old woman with two echinococcal cysts in the liver and Aspergillus revealed in their structure.
The co-infection of liver echinococcosis and aspergillosis is extremely rare. Preoperative verification of the presence of local aspergillosis in this case is practically impossible. However, early diagnosis and treatment are vital, preventing possible complications from becoming infected with these two pathogens. Treatment is based on an early morphological diagnosis and the detection of both pathogens.

Journal of Experimental and Clinical Surgery. 2021;14(1):10-18
pages 10-18 views

Abdominal Wall Endoscopic Extraperitoneal Reconstruction Technique in Patients with Primary Midline Hernias and Diastasis of the Rectus Abdominis Muscles

Rakintsev V.S., Yurasov A.V.


Introduction. The paper focuses on technical features of endoscopic extraperitoneal reconstruction (EER) of the anterior abdominal wall in patients with primary median hernias combined with diastasis of the rectus abdominis muscles, the nuances of the operating room equipment and preparation of patients for intervention.
The aim of the study was to analyze the stages and features of the technique for performing endoscopic extraperitoneal reconstruction of the anterior abdominal wall to ensure safe and qualified implementation of the operation in clinical practice.
Materials and methods. This research was a prospective study including 45 clinical cases of patients with primary median hernias of the anterior abdominal wall combined with diastasis of the rectus abdominis muscles, who were exposed to endoscopic extraperitoneal reconstruction. The study was performed in the surgical department of the private healthcare facility "Central Clinical Hospital “Russian Railways-Medicine" in 2019-2020. The median follow-up was 14 months (8 - 18 months), there were no complications estimated higher than type I according to the Clavien-Dindo classification and relapses.
Results and discussion. Successful EER requires thorough preoperative preparation: to connect a second monitor; to distance anesthetic equipment; to ensure the patient is in an extension position in the lumbar segment of the spinal column; to identify principle anatomical landmarks under ultrasound control. The main two stages of EER - mobilization and reconstruction - are performed extraperitoneally in a confined space, and therefore the localization of the ports must be anatomically validated. The major point at the stage of mobilization is to maintain the integrity of the parietal peritoneum, this solves visualization problems and helps to work in the required layer of the anterior abdominal wall. Adherence to the principles of open surgery, namely, orientation of the needle holder at an angle close to 0° to the suture line (white line), and the needles at a right angle; maintaining working angles between the instruments 30-60°, - allows effectively performing the reconstructive stage.
Conclusion. Thus, a topographic-anatomically based approach to each stage of the operation and adherence to a set of features of the surgical technique allows safely and effectively applying EER for the treatment of patients with primary midline hernias and diastasis of the rectus abdominis muscles.

Journal of Experimental and Clinical Surgery. 2021;14(1):19-24
pages 19-24 views

Unconventional Technique of Terminolateral Pancreatojejunostomy Formation

SiguA B.V., Zemlyanoy V.P., Zakharov E.A., Tsikoridze M.Y., Napalkov A.N.


Backgraund. Pancreatoduodenal resection (PDR) is the only radical treatment for malignant tumors of the periampullary zone. The development of postoperative pancreatic fistula (POPF) is the most common complication of PDR. The main risk factors for the development of POPF are the narrow main pancreatic duct and the soft, "juicy" pancreatic parenchyma. Thus, it is the stage of formation of a pancretodigestive anastomosis that is of decisive importance for the course of the postoperative period.
The aim of the study was to improve immediate surgical treatment outcomes of patients suffering from oncological diseases of the periampullary zone with a soft pancreas and a narrow pancreatic duct.
Methods. A novel method to form terminolateral reservoir invagination pancreatojejunostomy has been developed and introduced into clinical practice. The results of treatment of 94 patients with tumors of the periampullary zone were analyzed. Based on preoperative radiological diagnosis and intraoperative findings, such factors of a high risk of POPF development as a soft pancreas and a narrow major pancreatic duct (≤ 3 mm) were detected in 23 patients (24.4%). In 11 patients who were treated in 2018-2019, a novel method of pancreato-jejunoanastomosis formation was applied. The comparison group consisted of 12 patients who received treatment in 2014-2017; a differentiated approach to the formation of a pancreatodigestive anastomosis was not applied.
Results. In patients of the main group, there was a tendency to an increase in the proportion of pylorus-saving PDRs. The only statistically significant difference was the use of reservoir terminolateral pancreatojejunostomy at the reconstructive stage of surgery. Complicated postoperative course was observed in 7 (63.6%) patients of the main group and in all patients of the comparison group (p <0.05). There was also a decrease in the incidence of postoperative pancreatic fistulas from 66.6 to 18.2% (p <0.05) in the study group. Repeated surgery was required in 3 (27.2%) patients of the main group and 7 (58.3%) patients in the comparison group (p> 0.05). The lethal outcome was recorded in 2 (18.2%) patients of the main group and in 3 (25%) in the comparison group (p> 0.05).
Conclusion. A soft, loose pancreas and a narrow main pancreatic duct are the most significant risk factors for complications in the postoperative period. Management of this condition requires a differentiated approach to the treatment option of pancreatodigestive anastomosis formation, depending on the characteristics of the pancreas of an individual patient. The proposed technique for the reservoir terminolateral pancreatojejunoanastomosis formation allowed statistically significantly reducing the incidence of complications from 100 to 63.6% and the incidence of postoperative pancreatic fistulas from 66.6 to 18.2% in high-risk patients..

Journal of Experimental and Clinical Surgery. 2021;14(1):25-32
pages 25-32 views

WHO Surgical Complication Prevention Checklist: a Comparative Analysis of Two Clinics

Timerbulatov M.V., Timerbulatov S.V., Nizamutdinov T.R., Timerbulatov V.M., Grushevskaya E.A.


The aim of the study was to examine the effectiveness of the adherence to the WHO surgical safety checklist.
Material and methods. A comparative analysis of the performance of the surgical departments in two clinics was carried out: in the first clinic the WHO checklist was applied to control the performance of the surgical department; in the second clinic these recommendations were not used. The results of 3012 (first clinic) and 3527 surgical interventions (second clinic) were analyzed. The authors studied the frequency of postoperative complications, the effectiveness when using all the points of the recommendations.
Results. The frequency of antibiotic prophylaxis during general surgical operations in clinic I was 89.3%, in clinic II - 63.7%, the frequency of infection in the area of ​​surgical intervention was by 13.2% and up to two times higher in clinic II, mortality rates after surgery were also significantly higher in clinic II; consequently, the duration of inpatient treatment was 8.7 in clinic I versus 16.4 days in clinic II.
Conclusion. The adherence to the surgical safety checklist can effectively reduce the number of postoperative complications, mortality, and reduce the time of inpatient treatment.

Journal of Experimental and Clinical Surgery. 2021;14(1):33-41
pages 33-41 views

Simultaneous Bariatric Surgeries in Females with Neoplasm of the Reproductive System and Morbid Obesity

Samoilov V.S., Popov V.V., Moshurov I.P., Redkin A.N.


Introduction. The frequency of occurrence of morbid obesity and neoplasms of the female reproductive system is very high and these conditions aggravate each other. Therefore, it is relevant to simultaneously perform laparoscopic bariatric operations and radical interventions for benign and malignant tumors of the female reproductive system in such cases. The experience of such simultaneous interventions is still small and in the available literature is limited to the description of single cases. The primary issues are the fundamental possibility of combining the two stages in one operation, the technical aspects of such interventions, and the assessment of perioperative safety and immediate results.
The aim of the study was to create a technique of simultaneous surgical treatment of the pelvic organs neoplasms and morbid obesity in females, to assess the perioperative safety and immediate results of such simultaneous operations.
Methods. The authors present their experience and the first results of simultaneous laparoscopic sleeve gastrectomy and hysterectomies in 9 women with malignant and benign neoplasms of female genitals, suffering from morbid obesity. A method of simultaneous combined surgical treatment of neoplasms of female genitals and morbid obesity has been developed and described.
Results. The proposed technique allowed performing two interventions during one procedure in a minimum time, technically in the simplest way without additional complications and risks. The duration of simultaneous operations averaged 162.7 ± 21.8 min., the average blood loss was 247.6 ± 31.0 ml, the pain syndrome on the first day was moderately expressed, no serious complications were observed.
Conclusions. The results obtained demonstrated that the morbidity and perioperative safety of simultaneous operations are comparable to those with separate performance of such operations with certain benefits.

Journal of Experimental and Clinical Surgery. 2021;14(1):42-46
pages 42-46 views

Hemostasis in Liver Injuries: An Experimental Study

Tkachenko A.N., Savitskiy D.S., Khromov A.A.


Introduction. Bleeding in liver injuries is observed during natural disasters, massive injuries, in military field conditions and under other circumstances. The vital need for surgical treatment in these cases is obvious. As a rule, time for assistance is limited, and operations are performed by surgeons who do not have sufficient experience. Intraoperative hemostasis methods are not always effective. The search for intraoperative hemostasis methods has not stopped for many decades. Experimental study of the effect of new agents that allow for reliable hemostasis in liver damage is relevant for medical science and practice.
Materials and methods. The experimental study included 116 white Wistar rats of both sexes weighed 230 ± 25 g and 30 Chinchilla rabbits of both sexes weighed 2.5-3.5 kg. The following parameters were identified in experiments in vivo: the duration of bleeding in simulated liver injury without the use of hemostatics and with the use of alufer and viscostat preparations. A morphological study of the regenerative process in the liver was carried out on the 1st - 14th day after the injury. The biopsy material was fixed in 10% formalin solution. Staining of histological sections was carried out with hematoxylin and eosin, as well as Prussian blue (according to Max Perls) to detect iron compounds in tissues.
Results. It was revealed that the implementation of hemostasis with the use of the alufer preparation is accompanied by a decrease in circulatory disorders (edema, hemorrhages); characterized by a more pronounced formation of the connective tissue in the area of drug ​​application, which is partially retained (taking into account the time interval of the study) at the site of application.

Journal of Experimental and Clinical Surgery. 2021;14(1):47-52
pages 47-52 views

Experimental Validation of the Use of Immobilized Form of Miramistin in the Treatment of Advanced Peritonitis

Sukovatykh B.S., Zatolokina M.A., Mosolova A.V.


Introduction. Mortality in generalized peritonitis ranges from 16% to 30%.
The aim of research was to experimentally study the effect of the immobilized form of 0.01% miramistin on the basis of sodium salt of carboxymethylcellulose on the course of the inflammatory process in generalized purulent peritonitis.
Materials and methods. The experimental study included 288 male Wistar rats, divided into 3 groups, 96 animals each. Animals of the 1st group (control) were exposed to laparotomy and lavage of the abdominal cavity with saline under aseptic conditions 24 hours after the introduction of fecal suspension into the abdominal cavity. Simultaneously, animals of the 2nd group (comparison) underwent a thorough sanitation of the abdominal cavity with saline with removal of purulent effusion and fibrin films at the first stage, and at the second stage, they were injected 5 ml of an aqueous solution of 0.01% miramistin. In animals of the 3rd (experimental) group, 5 ml of 0.01% miramistin gel was evenly distributed over the entire surface of the peritoneum after laparotomy and sanitation of the abdominal cavity with saline solution. The anti-inflammatory activity of the dosage forms was assessed by the dynamics of leukocytosis and the leukocyte index of intoxication, and the anti-inflammatory activity was assessed by the dynamics of the number of microorganisms in the abdominal exudate. The lethality of animals in each group was estimated. The following areas were taken for histological examination: small and large intestine, parietal peritoneum, pancreas, liver.
Results. The anti-inflammatory activity of the immobilized form of 0.01% miramistin on the basis of sodium carboxymethylcellulose was superior to the aqueous solution of miramistin 0.01% on the 1st day - 1.3 times, on the 3rd day - 1.6 times, on the 7th day - 1.5 times. Antimicrobial activity in animals of the experimental group was 1.3 times higher on the 1st day, 1.9 times higher on the 3rd day, and 1.7 times higher on the 7th day than in the comparison group. The mortality rate in animals of the experimental group was 1.5 times lower on the 1st day, and 1.4 times lower on the 3rd and 7th days than in animals of the comparison group. On the first day, the morphological picture of peritonitis in animals of the experimental and comparison groups had no significant differences. On the 3rd day in animals of the comparison group, the inflammatory process in the abdominal cavity was pronounced, and in the experimental group, the intensity of peritonitis began to decrease, and by the 7th day it was completely eliminated.
Conclusion. The results of the study allow recommending the use of the immobilized form of 0.01% miramistin based on sodium carboxymethylcellulose in the treatment of generalized peritonitis.

Journal of Experimental and Clinical Surgery. 2021;14(1):53-60
pages 53-60 views

Effect of Deproteinized Dialysate from Vealers’ Blood on the Collagenogenesis in the Area of Polypropylene Hernioendoprosthesis ​​Implantation: аn Experimental Study

Obedkov E.G., Ivanov S.V., Ivanov I.S., Ivanova I.A., Denisenko A.I., Plohotina A.Y.


Introduction. The choice of the optimal type of hernia endoprosthesis, as well as introduction of drugs with a collagen-forming effect into clinical practice, will improve the quality of treatment in patients with ventral hernias due to the formation of the full-fledged connective tissue both in the area of ​​the postoperative scar and in the area of ​​the hernia endoprosthesis placement.
The aim of the study was to identify the effect of deproteinized dialysate from vealers’ blood on neocollagenesis in the area of endoprosthetics.
Materials and methods. The experimental study included 80 laboratory white mice, Wistar line. All animals were divided into two groups (control and experimental). A polypropylene hernioendoprosthesis was implanted in animals of both groups. The division into groups was due to the use of deproteinized dialysate from the vealers’ blood.
Results. The use of a polypropylene hernioendoprosthesis for abdominal wall plasty combined with the use of deproteinized dialysate created the necessary conditions for accelerating the processes of proliferation and maturation of fibroblastic cells.
Conclusion. The maximum value of the ratio of collagen fibers of types I and III was achieved on the 90th day of the study, the difference between the value of this parameter was 1.24 times greater in the group of animals where deproteinized dialysate was used.

Journal of Experimental and Clinical Surgery. 2021;14(1):61-68
pages 61-68 views


The Use оf Intraoperative Colonic Irrigation in Surgical Treatment of Obstructing Cancer of the Left Colon

Ektov V.N., Shamaeva T.E., Kurkin A.V., Muzalkov V.A.


Purpose. Study of technical options and immediate results of primary anastomoses using intraoperative colonic irrigation in the surgical treatment of left-sided colonic tumor obstruction.
Material and methods. Of the 128 patients with left-sided colonic obstruction, 20 patients underwent surgery with intraoperative colonic lavage and the formation of a primary colonic anastomosis. The mean age was 61.7 ± 1.4 years. In 5 patients, the compensated stage of colonic malignant obstruction was detected, in 8 patients - subcompensated, in 7 patients - decompensated. Colon icirrigation was carried out by means of antegrade jet injection of 8 -10 liters of isoosmolar solution of electrolytes and was terminated by the introduction of enterosorbent microsorb-P. In 11 cases left-sided hemicolectomy was performed in patients and in 9 cases - resection of the sigmoid colon with primary anastomosis.
Results. After surgical interventions various complications were observed in 7 patients. In 2 patients afailure of anastomosis was revealed, the successful treatment of which did not require repeated surgical procedures. In the postoperative period 1 (5.0%) patient died on the 4th day after surgical intervention from cardiopulmonary insufficiency on the basis of concomitant pathology.
Conclusion. In the conditions of specialized surgical hospitals after careful evaluation of operational risk with obstructing cancer of the left colon it is possible to use segmental resections of the colon with the imposition of a primary anastomosis with mandatory use of intraoperative colonic lavage . This tactic helps to increase the effectiveness of surgical interventions and provides early rehabilitation of operated patients.

Journal of Experimental and Clinical Surgery. 2021;14(1):69-74
pages 69-74 views

Review of literature

Instrumental Non-Invasive Diagnostics of the Depth of Skin Burn: Current Opportunities and Unsolved Problems

Petrova K.S., Nemirova S.V., Ryabkov M.G., Karpenko A.A., Pogodin I.E.


Introduction. Burns of various etiologies are on the 3-4 place in frequency among all injuries, they are associated with a high percentage of complications, disability and mortality. Currently, a single algorithm for objective verification of the depth of skin damage has not been developed. Numerous diagnostic technologies used to solve this problem require systemic analysis.
The aim of study was to analyze current literature data on technologies for instrumental diagnostics of the depth of thermal damage to the skin.
Materials and methods. A search for literary sources in databases was conducted using eLIBRARY.RU, PubMed, Cyberleninka databases. The period of publications was limited to 2011-2020.
Results. The method of objective "gold standard" verification of thermal damage to the skin remains a biopsy followed by morphological examination, but the method's traumaticity does not allow it to be used for monitoring the course of the process in dynamics, for multi-focal studies. Among non-invasive methods, dermatoscopy and video microscopy are noted, but the small imaging area and the need for direct contact of the device with the skin surface limit the use of these methods. Laser Doppler flowmetry and imaging are fairly accurate non-contact methods that allow assessing the condition of a burn wound in real time. The method is not applicable to wounds with blisters, insufficient sanitation. Laser speckle contrast imaging is used to evaluate blood flow and is based on the analysis of speckle structure fluctuations. The method allows determining the degree of burn damage depending on changes in the blood flow. However, the method is difficult to apply with a vessel diameter sized 40 microns. The method is sensitive to movement and internal factors. Infrared and Raman spectroscopy are technique for evaluating vibrational patterns in a particular spectrum, these can be used to identify a molecule or determine its structure. Simultaneous use of spatial frequency visualization and speckle imaging demonstrated a high level of correlation with the results of histological research, which makes the use of these methods promising. Ultrasound also provides a proper correlation with histological data, but it is an imperfect method due to inaccuracies in determining the thickness of the epidermis, dermis, and scar condition. Optical coherence tomography (OCT) is a non-invasive optical method that allows obtaining high-resolution images of skin architecture in real time. The high level of compliance of the visualized structures, in particular, layers, appendages and vessels of the skin, with histological findings, gave this method a name "optical biopsy". Anatomical congruence of normal and damaged skin was established in an experiment between histology and OCT.
Conclusion. Early assessment of the depth of thermal damage to the skin is crucial for choosing a personalized treatment strategy for the burned. None of the modern diagnostic methods is universal. Multimodal approaches to diagnostics are the most effective.

Journal of Experimental and Clinical Surgery. 2021;14(1):75-84
pages 75-84 views

Collagen and Use Its in the Treatment of Wounds

Ostroushko A.P., Andreev A.A., Laptiyova A.Y., Glukhov A.A.


Wounds take the main places of among surgical diseases, and the problem of developing new methods of their treatment remains relevant today. In recent years, the use of collagen has been widely used in the treatment of wounds. Collagen modulates the flow of fluid from the wound, facilitates the migration of fibroblasts and the formation of microvessels, helps in the synthesis of neodermal collagen matrices, forms complexes with biologically active substances and minimizes the formation of scars.
Currently, collagen is used in the treatment of soft tissue wounds in the form of several pharmaceutical forms. Collagen sponges are used in the treatment of thermal and mechanical wounds, for local delivery of medicines. Collagen gels can be used for injections. Collagen can also be implemented in the form of a collagen shield. There are also collagen granules that have been developed for various compounds.
Thus, the use of collagen is promising in the development of new medicinal preparation. However, for a wider disclosure of its clinical potential, it is necessary to thoroughly study all types of collagen and reveal their role at different stages of soft tissue repair.

Journal of Experimental and Clinical Surgery. 2021;14(1):85-90
pages 85-90 views

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