Vol 14, No 2 (2021)

Original articles

The Impact of Combined Bariatric Interventions on the Course of Non-Alcoholic Fatty Liver Disease

Mitsinskaya A.I., Evdoshenko V.V., Fishman M.B., Sokolov A.Y., Samoilov V.S., Mitsinskiy M.A., Varzin S.A., Akhmetov A.D.


Background. Obesity is widely recognized as a disease that acquires the scale of an epidemic and is accompanied by a number of comorbidities, one of which is non-alcoholic fatty liver disease (NAFLD), while the issue of the impact of bariatric interventions on its course remains a subject of discussion, which determines the relevance of this study.
Aims. Тo evaluate the impact of combined bariatric interventions - laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic mini-gastric bypass (LMGB-OAGB), - on the course of NAFLD and to determine the criteria that affect the dynamics of NAFLD after thеsе bariatric interventions.
Materials and methods. The study included 56 patients who had one of 2 types of bariatric interventions performed between 2014 and 2017: LRYGB (26 (46,4%) patients) and LMGB-OAGB (30 (53,6%) patients). All patients underwent intraoperative liver biopsy, a range of laboratory and instrumental studies, FibroTest were calculated in dynamics. The frequency of complications in the postoperative period was estimated. The period of observation was 2 years.
Results. In the group of laparoscopic Roux-en-Y gastric bypass 12 (46.2%) patients showed signs of liver fibrosis according to histological research, and 8 (30.8%) - signs of non - alcoholic steatohepatitis (NASH). There was an increase in transaminases in 5(19,2%), gamma-glutamyltranspeptidase (GGTP) in 19 (73.1%), and total bilirubin in 8 (30.8%) subjects. 20 (76.9%) participants had increased alkaline phosphatase (ALP), 22 (84.6%) had reduced high – density lipoproteins (HDL) and increased triglycerides (TG). According to the results of ultrasound examination of the liver, 19 (73.1%) patients had enlarged liver size, 26 (100%) - diffuse heterogeneity, and 25 (96.2%) - hyperechogenicity.
In the group of laparoscopic mini-gastric bypass, there were signs of liver fibrosis in 14 (46.7%) and NASH - in 14 (46.7%) patients. An increase in tranasminases was observed in 8 (26.7%), GGTP – in 22 (73.3%), and total bilirubin – in 6 (20%) patients. 9 (30%) of participants had increased ALP, 26 (86.7%) patients had reduced HDL and increased TG. 21 (70%) patients had enlarged liver size, 29 (96.7%) - diffuse heterogeneity, and 28 (93.3%) - hyperechogenicity.
6 months after both types of interventions, there was a decrease in the clinical and biochemical characteristics of non-alcoholic fatty liver disease, which was transient and regressed by 1 year after surgery.
After laparoscopic Roux-en-Y gastric bypass %EBMIL in 1 year was 75.25 [65.85-84.36] %. Normalization of transaminases was observed in 84.6%, cholestasis indicators – in 87.2%, and FibroTest -in 46.2% of cases. % EBMIL 1 year after laparoscopic mini-gastric bypass was 74.77 [67.28-78.89] %. Normalization of transaminases was observed in 83.3%, cholestasis indicators – in 78.9%, and FibroTest -in 43.3% of cases.
Combined bariatric interventions were shown to be more effective in participants under 45 years of age compared to those over 45 years of age and in patients with initial stages of fibrosis F0-F2 by METAVIR compared to participants with stages F3-F4 by METAVIR. Patients with a BMI of more than 40 kg / m2 achieved higher FibroTest values after six months compared to subjects with a BMI of up to 40 kg/m2 and in fewer cases - FibroTest normalization by 1 year after surgery, respectively. The effectiveness of operations on the course of NAFLD was comparable.
The results of the intervention on signs of non-alcoholic fatty liver disease were preserved for 2 years of postoperative follow-up. The mortality rate during the entire follow-up period was 0%. 47 (83,9%) patients were followed up to 2 years.
Conclusion. Тhere was a high efficiency of RYGB and MGB-OAGB in patients with non-alcoholic fatty liver disease, while a transient aggravation of the course of non-alcoholic fatty liver disease was detected 6 months after the operation.
Keywords: non-alcoholic fatty liver disease; obesity; metabolic syndrome; bariatric surgery; LRYGB; LMGB-OAGB; FibroTest; surgical intervention

Journal of Experimental and Clinical Surgery. 2021;14(2):92-106
pages 92-106 views

Experimental Modeling of the Ultra-Necrotic Stage of Critical Ischemia of the Lower Limbs

Sukovatykh B.S., Feyziev E.E., Belous A.S., Trubnikova E.V., Sukovatykh M.B., Orlova A.Y.


Objective. So far, no experimental model of the necrotic ulcerative stage of critical limb ischemia has been created.
Aim. Development of a method for modeling the necrotic ulcerative stage of critical lower limb ischemia.
Materials and methods. The experimental study was carried out on 120 rats - males of the "Wistar" line, divided into 4 groups of 30 animals each. In the first group (intact), the level of microcirculation in the muscles of the hind limb was determined. In the second (sham-operated) group, ischemia was not simulated, but the neurovascular bundle of the thigh was isolated and the wound was sutured. In the third group (comparison), the modeling of chronic ischemia of the leg muscles was performed by removing the femoral, popliteal, anterior and posterior tibial arteries. In the fourth (experimental) group, to simulate chronic critical ischemia of the leg muscles, the femoral, popliteal, anterior and posterior tibial arteries and veins were removed, and the peripheral nerve was damaged.
In the postoperative period, the dynamics of symptoms of limb ischemia was monitored. Animals were taken out of the experiment, 10 animals in each group by an overdose of anesthesia on the 10th, 21st and 28th days. Before hatching, the level of microcirculation was determined using laser Doppler flowmetry. To study the morphological picture at the same time in the third and fourth groups, the ischemic gastrocnemius muscle of the leg was excised and a standard histological examination was performed.
Results. Trophic disorders in animals of the third group developed in 13.3%, and in the experimental group - in 100%. In the experimental group, the level of microcirculation at all periods was significantly less than in the comparison group: on the 10th and 21st by 1.3 times, on the 28th day by 1.2 times, and the area of ​​muscle necrosis was greater by the same days by 21.2%, by 8.2% and by 6.8%.
Conclusion. The developed experimental model corresponds to the necrotic ulcerative stage of critical ischemia in humans.

Journal of Experimental and Clinical Surgery. 2021;14(2):107-111
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Laboratory Signs of Enteric Failure - Predictors of Pressure Ulcers in Traumatic Spinal Cord Disease

Baleev M., Ryabkov M., Perlmutter O., Fraerman A., Smirnov I., Leontiev A., Sheiko G., Efanov O.


Relevance. Among the complications of traumatic spinal cord disease (SCD) pressure ulcers occupy a special place, with incidence reaching 68% and showing no tendency for decreasing. Literature reviews one of the main reasons for the formation of decubital ulcers is enteral insufficiency, the timely detection of which is still a common problem for many medical specialties, and laboratory indicators pointing to its manifestation remain in the zone of a controversial issue. New knowledge regarding laboratory predictors of pressure ulcer formation in the acute period of trauma will reduce the risk of decubital ulcerative defects.
Purpose of the study. Based on the analysis of laboratory blood levels in the acute and early periods of hip joint injury, to identify predictors of the formation of pressure ulcers in patients with spinal trauma.
Materials and methods. 68 case histories of adult patients with hip injury were retrospectively analyzed. The victims were treated in the City Clinical Hospital No. 39 of the Kanavinsky District of Nizhny Novgorod for the period from 2013 to 2020.
Results and discussion. A comparative analysis of blood levels on the first day after injury showed that patients with subsequently developed bedsores at the early stages of treatment got hypoproteinemia and a decrease in serum creatinine levels more often than patients without bedsores. In addition, white blood cell count in patients with pressure ulcers was elevated, compared to normal values and patients without pressure ulcers white blood cell count. For a year creatinine and total protein values in patients of the main group tended to be or completely became normal, which is most likely associated with adequately administered enteral nutrition. The white blood cell count of the study group decreased to the normal range.
Conclusion. Increased white blood cell, a decrease creatinine levels and total protein values in patients with HSC in the first hours after injury confirms the catabolic orientation of metabolism in the acute period of spinal cord injury, so it leads to conclusion that the early intensive therapy aimed at arresting protein losses and inflammation is needed, which in turn will prevent the formation of pressure ulcers in the early period of traumatic spinal cord disease.

Journal of Experimental and Clinical Surgery. 2021;14(2):112-118
pages 112-118 views

Option of staged treatment of a patient with a gunshot wound to the duodenum.

Zuykevich D.V., Semenov D.Y., Kulikov D.V., Chekmasov Y.S., Did-Zurabova E.S., Lazareva I.D.


The article presents a method of treatment of patients with multiple duodenal injuries, which consists in implanting a section of the duodenum with a Vater papilla into the small intestine, which avoids complex and traumatic operations on the biliary tract and related complications. We present a clinical case with a follow-up period of 7 years. No data were obtained for the presence of complications in the long-term period.

Journal of Experimental and Clinical Surgery. 2021;14(2):119-123
pages 119-123 views

Influence of polypropylene mesh on local and systemic production of cytokines during thoracoplasty in experiment

Belov S., Grigoryuk A.А.


Introduction. The question of the body's immune reactivity when using mesh implants for plastic surgery of the chest frame remains not fully understood.
Aims. The effect of the polypropylene mesh endoprosthesis "Surgipro" on systemic and local cytokine production after reconstruction of the chest frame was evaluated.
Materials and methods. The work was performed on male Wistar rats weighing 250 ± 50 grams (n=21). The main group consisted of rats with musculo-aponeurotic plasty (n=9), the comparison group consisted of animals that underwent chest plasty after removal of the posterior segment of the IV rib measuring 1.0 cm and overlapping over the mesh (n=9). Healthy rats without surgery served as control (n=3). The animals were taken out of the experiment on days 1, 10 and 30 after the operation. Determination of cytokines TNF-α, IFN-γ and IL-10 in the blood serum and biopsy of the postoperative scar was performed by the method of enzyme-linked immunosorbent assay.
Results. It was found that in the experiment, the plastic of the chest frame affects the systemic and local production of cytokines TNF-α, IFN-γ and IL-10. A more intense increase in serum and local anti-inflammatory cytokines was recorded with the use of the implant (p˃0.05). At the same time, the production of anti-inflammatory IL-10 was recorded at values below the control (p˃0.05).
Conclusions. The conducted experimental study revealed that the use of a mesh endoprosthesis in the restoration of a defect in the thoracic frame causes more pronounced systemic and local production of cytokines TNF-α, IFN-γ and reduces the production of IL-10.

Journal of Experimental and Clinical Surgery. 2021;14(2):124-127
pages 124-127 views

The Role of Prehabilitation in Patients Undergoing Pancreatoduodenal Resection

Koshel' A.P., Drozdov E.S., Topolnitskiy E.B., Klokov S.S., Shefer N.A.


Background. Currently, the introduction of pre-rehabilitation programs has shown its effectiveness in various sections of abdominal surgery, however, its role in surgical pancreatology is still not entirely clear
Aim. To study the effectiveness of the implementation of pre-rehabilitation programs (preoperative exercises and diet therapy) during the waiting period for surgery and their effect on the physical and nutritional status, as well as postoperative complications and the duration of hospital stay in patients who underwent pancreatoduodenal resection.
Material and methods. A prospective study was carried out including 44 patients who underwent pancreatoduodenal resection. The patients included in the study were divided into two groups. The control group (23 patients) preoperative preparation, which was carried out according to the standard method. The main group consisted of 21 patients who underwent pre-rehabilitation.
Results. Among the patients in the compared groups, there were no statistically significant differences in age, gender, ASA and body mass index, concomitant diseases, and basic laboratory parameters. In the group of patients who underwent pre-rehabilitation, there was a statistically significant increase in the 6-minute walk test (p = 0.02), as well as the prognostic nutritional index (p = 0.01). There was no statistically significant difference between the compared groups in the incidence of major postoperative complications (Clavien - Dindo III / IV) (p = 0.8), clinically significant pancreatic fistulas (p = 0.5), and mortality (p = 0, 6), however, in the pre-rehabilitation group there was a significant decrease in the incidence of gastric evacuation disorders in comparison with the control group (9.5% versus 34.8%, p = 0.04). The average postoperative bed-day was 16.1 ± 5.6 days in the pre-rehabilitation group and 19.8 ± 6.2 days in the control group (p = 0.04).
Conclusion. The introduction of pre-rehabilitation in patients undergoing pancreatoduodenal resection is effective and allows improving the physical and nutritional status of the patient, reducing the postoperative bed day and reducing the frequency of delayed gastric evacuation.

Journal of Experimental and Clinical Surgery. 2021;14(2):128-135
pages 128-135 views


Evaluation of the Possibility of Fixation of Autologous Mesenchymal Stem Cells in Liver Tissue Introduced into the Portal Vein of the Liver in a Patient Suffering from Cirrhosis

Kotkas I.E., Asadulaev S.M., Enukashvili N.I.


To date, there are quite a large number of reports of the use of stem cells in the treatment of various diseases in humans. However, the authors do not provide credible evidence that the introduced stem cells come directly into the target organ. Without a clear understanding of the location of the introduced stem cells, it is difficult to reliably assess the effect of their use. The article gives its own observation about the possibility of imaging in the human body autologous mesenchymal stem cells introduced through the portal vein of the liver to a patient suffering from cirrhosis. Iron oxide nanoparticles were used as labels. A rather simple question was previously solved: how to create a label of such size that the viability of the stem cell was preserved and it could be visualized in the human body when performing magnetic resonance imaging of abdominal organs. Following in vitro studies, the most appropriate stem cell marking embodiment was chosen to provide both adequate imaging and cell viability. After administration of marked table cells, magnetic resonance imaging of abdominal organs was performed to the patient. The introduced stem cells were visualised only in hepatic tissue. According to clinical and biochemical blood tests - no deviations were detected. There were no complications against the background of this procedure. The patient was discharged for outpatient treatment in satisfactory condition.

Journal of Experimental and Clinical Surgery. 2021;14(2):136-139
pages 136-139 views

Removal of fibroadenoma of the breast augmentation and breast implants. Analysis of the possibility of simultaneous and delayed execution of these operations

Dzhuganova V., NOVOMLINSKY V.V., Sokolov A.P., Lynov P.A., Sokolova M.G., Ostroushko A.P., Kutsuradis A.F., Chugunova A.V., Laptiyova A.Y.


Introduction. Fibroadenomas (FA) are the most common benign breast neoplasms that are diagnosed in 25% of women. Dissatisfaction with the size of the breast and the desire to increase it occurs in 40%. For this reason, in the practice of a plastic surgeon, there are cases when the patient wants to remove fibroadenomas (FA) and increase the size of the breast. In this situation, there are two options for managing the patient- the simultaneous execution of two operations and the delayed one.
Aim. To evaluate the possibility of simultaneous FA removal and augmentation mammoplasty, to analyze possible complications and methods of their correction.
Materials and methods. We have analyzed the experience of simultaneous interventions of FA removal and augmentation mammoplasty on the example of 10 cases performed in the period from 2014-2019, as well as FA removal after implant placement-3 cases.
Results. Performing a simultaneous operation has advantages due to the minimization of injuries (the ability to perform from a single access - submammary or periareolar), reducing psychological stress and better cosmetic effect. Two patients had postoperative complications in the form of capsular contracture, manifested in the asymmetry of the mammary glands, corrected by performing capsulotomy and forming a new submammary fold. When performing invasive diagnostic tests and surgical intervention in three patients after endoprosthesis augmentation mammoplasty, extreme caution was required due to the risk of violating the integrity of the implant. It was found that the incision of the posterior leaf of the MJ capsule with a large number of removed neoplasms in the postoperative period leads to the development of breast asymmetry. The fact of FA recurrence was also confirmed (2 patients), who subsequently underwent repeated surgical intervention.
Conclusion. Performing simultaneous operations for benign breast tumors can be surely practiced by plastic surgeons, including as one of the options for simultaneous treatment of breast FA and augmentation mammoplasty. The occurrence of FA in the long-term period after breast augmentation surgery is associated with difficulties in diagnostics (mammography and fine needle aspiration biopsy under the control of ultrasound), as well as in the course of surgery itself, due to the presence of the implant and the risk of violation of its integrity.

Journal of Experimental and Clinical Surgery. 2021;14(2):140-146
pages 140-146 views

Minimally Invasive Method of Treatment of Biliary Tract Strictures

Semenov D.Y., Did-Zurabova E.S., Kulikov D.V., Gonchar M.V.


The article presents a minimally invasive method for treating strictures of a biliodigestive anastomosis, which consists in creating access to the intestinal lumen without entering the abdominal cavity. A guideline in this is the scar on the anterior abdominal wall, which remained after the removal of the circular drainage or Volker's drainage. In this way, in our clinic, 10 patients were operated on after an operation to form a biliodigestive anastomosis on a disconnected RF loop. A clinical case with a follow-up period of more than 10 years is presented. There was no recurrence of strictures, and according to the data of clinical, echographic and biochemical examinations, all of them had a good long-term result.

Journal of Experimental and Clinical Surgery. 2021;14(2):147-151
pages 147-151 views

Review of literature

Prophylactic "Xymedon" in Abdominal Surgery

Koloshein N.A., Izmailov S.G., Lukoianychev E.Е., Leontev A.Е., Bodrov A.А., Rotkov A.I.


Importance. Surgical procedures have a lot of stress, causing significant violation of the non specific defense mechanisms of the body and the immune system, which requires the use of different pharmacological agents in order to increase natural resistance to infection.
Purpose. An analytical review of experimental and clinical research in the direction of studying the effectiveness of the impact of enteral xymedon on reparative process of surgical wounds and tissue non-specific resistance of the organism to infection for the prevention of inflammatory wound complications.
Materials and methods. The analysis of experimental and clinical data, dealing with the question of studying the effect of enteral and topical xymedon to repair tissue in the area of the surgical wound and the non-specific resistance to infection. The criteria for the effectiveness of the drug were clinical and laboratory parameters, and statistic methods.
Results and their discussion. The analysis of experimental and clinical studies have shown that enteral and topical use xymedon in surgical patients stimulates wound healing surgical site and increases nonspecific resistance to infection by increasing the functional activity of neutrophils, their backup potentials normalize the concentration of a bioactive and immunoreactive fibronectin in blood plasma, improve antimicrobial activity of wound.
Conclusions. Xymedon is recommended as an effective means of pharmacological support of wound healing in surgical patients to prevent postoperative wound complications.
Journal of Experimental and Clinical Surgery. 2021;14(2):152-160
pages 152-160 views

Features of the Management of Surgical Patients in the Context of the Covid-19 Pandemic

Ostroushko A.P., Aralova M.V., Menshikova S.S., Alexeevich A.A., Glukhov A.A.


he number of confirmed cases of COVID-19 exceeded 35 million, and the number of deaths amounted to 770 thousand cases, and this data is setting new records every day. According to the decree of the Government of the Russian Federation of 31.01.20 No. 66, SARS-CoV-2 is included in the list of diseases that pose a danger to others, along with particularly dangerous infections. The article presents the latest data on the properties of the virus, its resistance, transmission routes, and mechanisms of action. Attention is focused on the features of collecting anamnesis, conducting diagnostics, and complex treatment of patients with suspected COVID-19. The authors conclude that when treating these patients in a surgical hospital, it is necessary to take into account the increasing complexity of the work of medical personnel, the conduct of thorough disinfection of all equipment, it is recommended to use remote consultations and monitoring of the condition of patients, suspend programs of face-to-face monitoring of treated persons, reduce the number of visits to patients by medical staff, take into account the likelihood of a significant decrease in tissue oxygenation, body defenses, the development of water-electrolyte disorders, exacerbation of chronic diseases, activation of "dormant" foci of infection, mutual aggravation of viral infection, pneumonia and surgical pathology, administration of glucocorticosteroids and low-molecular-weight heparins.

Journal of Experimental and Clinical Surgery. 2021;14(2):161-167
pages 161-167 views

Possibilities and Prospects of Application of Bacteriophages in the Treatment of Chronic Soft Tissue Wounds

Pogodin V., Samoylenko V., Kirgintsev A., Luzan A.


Currently, the problem of antibiotic resistance of the most pathogenic microorganisms is very relevant, and therefore it is necessary to search for new ways to eliminate pathogens of the infectious process in chronic soft tissue wounds. The article presents generalized data from published scientific studies that substantiate the clinical potential of using bacteriophages for the rehabilitation of chronic soft tissue wounds. The results of domestic and foreign studies confirm the safety and effectiveness of the use of bacteriophages in the treatment of chronic soft tissue wounds. The main problems limiting the spread of phage therapy are the high specificity of phages and the technical complexity of their immobilization in the area of clinical interest. Further research is needed and promising in the field of phage therapy in order to improve the results of treatment of chronic soft tissue wounds.

Journal of Experimental and Clinical Surgery. 2021;14(2):168-174
pages 168-174 views

Role of Hemostatic Agents in Simultaneous Surgical Interventions in the Nasal Cavity

Shaumarov A.Z., Shaikhova H.E., Normurodov B.K., Akhmedov S.E., Djuraev J.A.


Modern medical advances allow us to expand a range of combined surgical interventions. The literature to this day does not cover issues regarding the implementation of typical options for combined operations with deformities of the nasal septum, structures of the lateral wall of the cavity, nose, pathological processes in the hole of the paranasal sinuses; with perforated odontogenic maxillary sinusitis; racemose, sprains of the paranasal sinuses, combined with damage to the orbit. Since during combined operations the mucous membrane in various parts of the nasal cavity is injured to one degree or another, the problem of prevention and treatment of postoperative traumatic rhinitis is extremely important.

Journal of Experimental and Clinical Surgery. 2021;14(2):175-180
pages 175-180 views

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