Vol 10, No 1 (2017)

Original articles

Allohernioplasty Laparoscopic Postoperative Ventral Hernias

Ivanov Y.V., Panchenkov D.N., Terehin A.A., Shablovsky O.R.

Abstract

Relevance. Currently, the problem of effective treatment of postoperative ventral hernias is still not completely solved. The recurrence rate of the disease ranges from 15% to 50%, and repeat surgery causes increasing of the rate up to 20-65%.

The purpose of the study is to evaluate the results of laparoscopic hernioplasty in patients with postoperative ventral hernias.

Materials and methods. A retrospective analysis of the immediate and remote results of surgical treatment of 140 patients with postoperative ventral hernias. Patients of the main group (63) laparoscopic hernia repair method "ipom" patients in the comparison group (73) – open hernioplasty by the method of "onlay" and "inlay".

Results. The use of laparoscopic hernioplasty by the method of "ipom" allow to significantly reduce the number of early and overall postoperative complications (3.7%), duration of hospitalization (from 9.8 ± 1.3 per day to 5.4 ± 0.7 per day), the period of temporary incapacity (from 28.9 ± 3.4 days to 17.2 ± 2.3 days), as well as reduce the number of relapses (from 8.2% to 3.0%).

Discussion Laparoscopic hernioplasty is an effective method of treatment of postoperative ventral hernias. The obvious advantages of laparoscopic hernioplasty are: low invasiveness, fewer complications, rapid medical and social rehabilitation of patients. There is an undoubted advantage of laparoscopic hernioplasty over an open operation with the patient several postoperative ventral hernias.

Conclusion. In modern conditions, laparoscopic hernia repair can be recommended as the operation of choice in patients with postoperative ventral hernia.

 

Journal of Experimental and Clinical Surgery. 2017;10(1):10-20
pages 10-20 views

Results of the Endoscopic Stenting in Palliative Treatment of Cardioesophageal Cancer

Strusskiy L.P., Nizamxodjayev Z.M., Ligay R.Y., Khusanov A.M., Omonov R.R., Tsoy A.O., Adjimuratov M.T.

Abstract

he article describes experience of treating 232 patients with unresectable cardioesophageal cancer. Of these, minimally invasive endoscopic procedures: endoscopic diatermotunnelization, endoscopic bougienage and endoscopic stenting was performed in 101 patients. Currently, the method of endoscopic stenting is preferred, which was performed in 84 patients, own-developed model of a silicone tube stent was used in all patients. Main early and late complications of using this method were described.
Key words: Тumours of the proximal part of the stomach, of surgical treatment, un-resectability, of minimally invasive technologies, diathermotunnelization, endoscopic bougienage and endoscopic stenting

Journal of Experimental and Clinical Surgery. 2017;10(1):21-25
pages 21-25 views

Topographic-Anatomic Justification of Various Methods Reducing Tissue Tension at Prosthetic Incisional Hernia Repair by «Sublay»

Zakurdaev E.I., Chernyh A.V., Cherednikov E.F., Zakurdaeva M.P.

Abstract

Purpose. To develop a new relaxing incision on the anterior wall of rectus sheath and to compare its efficiency with the classical counterparts in the experiment.

Materials and methods. We measured tension nodal seam with the help of a spring dynamometer on 24 cadavers. This seam was overlaid on the inner edge of the rectus abdominis in the region of the umbilical ring before and after relaxing incision. The objects of study were divided into four groups randomly. We studied the proposed wavelike relaxing incision in the first group and classical methods in other groups.

Results.  Maximum relaxation nodal seam (56%) was observed when using a wavelike relaxing incision of anterior wall of  rectus sheath. Vertical relaxing incision of aponeurosis of the external oblique abdominal muscles along the lateral edge of the rectus abdominis (by O. M. Ramirez) was close in efficiency to the proposed method. It is possible to reduce tension of the nodal seam at 48%. Relaxing effect arc-shaped relaxing incision of anterior wall of rectus sheath by V.I. Belokonev was 39%. Vertical relaxing incision in a staggered pattern by U.Z. Zagirov showed minimal relaxing effect – 25%.

Conclusion. Wavelike relaxing incision of anterior wall of rectus sheath which was proposed allows reducing tissue tension in hernioplasty compared to the classical methods.

Journal of Experimental and Clinical Surgery. 2017;10(1):26-31
pages 26-31 views

Relapse Bullous Emphysema Complicated by Spontaneous Pneumothorax, after Radical Bullectomy

Temirbulatov V.I., Ivanov I.S., Okunev O.A., Kletkin M.E., Sarychev A.V.

Abstract

Actuality The social significance of spontaneous pneumothorax due to the fact that in recent years a growing number of patients with pulmonary bullous emphysema and, accordingly, with spontaneous pneumothorax, as well as the fact that the structure is dominated by patients of working age persons. To date, some difficulties persist in choosing the adequate diagnostic and treatment tactics in this disease.

Objective In a clinical example to show the importance of an integrated approach to of surgical treatment for spontaneous pneumothorax, caused bullous emphysema.

Materials and methods A clinical case of recurrent bullous emphysema complicated by recurrent spontaneous pneumothorax in a patient 32 years old, six years earlier underwent radical surgery - bullectomy on the first episode of spontaneous pneumothorax.

Journal of Experimental and Clinical Surgery. 2017;10(1):32-35
pages 32-35 views

The Morphology of the Spinal Cord after Traction Injuries

Larkin I.I., Akulinin V.A., Stepanov S.S., Sitko L.A., Preobrazhensky A.S., Zlobin S.B.

Abstract

ActualityTraction spinal cord injuries in children are of particular interest to researchers at present. Tractional damage associated not only with the trauma (SCIWORA syndrome), but can occur during elimination of deformation of the spine.

The purpose of the study was to study the peculiarities of morphological disorders of the spinal cord in traction mechanism of injury. Materials and methods. Performed 3 series of experiments on test machine AL-7 LA10. Dosed stretching of the spine of experimental animals (n=12) varied at 5, 10 and 20% of its original length. After 72 hours animals were removed from the experiment and carried out a histological study of the spinal cord.

Results and their discussion. It was found that after traction cyto - and myeloarchitectonic the cord was changed depending on the degree of stretching of the spine. If a strong tension (20%) of the neurons was exposed to irreversible changes. The recovery of the functional modules was probably due to the reorganization of surviving neural networks.

Сonclusion. The obtained data can be taken into account when planning the operations to eliminate kyfo-scoliosis spinal deformities in children.

Journal of Experimental and Clinical Surgery. 2017;10(1):36-43
pages 36-43 views

Bone Subdestructive Kryoapplicaton in the Experiment

Kuzhelivskiy I.I., Slizovskiy G.V., Sitko L.A.

Abstract

Relevance. Trend of modern surgery in the implementation of new methods of treatment is to develop all phases of the proposed method of treatment in an experimental model. In this paper, comparative studies have been performed in laboratory animals, aimed at studying the bone tissue reaction at subdestruktion cryotherapy.

Purpose. Identify the optimal exposure of the refrigerant to achieve kryoregenerative action ultralow temperatures.

Materials and methods. An experimental study was conducted on rabbits "Chinchilla" by cryotherapy in the cavity osteoperforation with different exposure refrigerant (liquid nitrogen). After 10 days after the removal of the animal from an experiment conducted morphological study.

Results. It was found that the exposure of 3 seconds is observed active regeneration, while kryoosteonekrosis observed during long-term exposure. The experimental results allow differentiated recommend them for use in clinical practice.

Conclusion. Light microscopy kryoregeneration with a three-second exposure shows the refrigerant is very active calcification regenerate. Primary callus composed of fibrous tissue and retikulofibrosis. Reclaimed presented osteoblasts chain. The proposed regime is advisable to apply cryotherapy with degenerative diseases of the bone in order to increase osteoreparative properties of bone.

Journal of Experimental and Clinical Surgery. 2017;10(1):44-48
pages 44-48 views

Experimental Method of Fixing Testicle

Komarova S.Y., Valamina I.E., Isaikin A.I.

Abstract

In the following experiment proved the possibility of the use of medical adhesive "Sulfacrylate" for efficient seamless testicular fixation to the tissues of the scrotum. Rabbits were di vided into 2 groups. 3 rabbits (6 testicles) were the control group. The adhesive was spread on the whole surface of the rabbits' testis in this group Experimental group consisted of 13 rabbits (26 testes), in which the adhesive is applied in dot and control conducted in 15, 30, 90 and 180 days. Macroscopic and microscopic picture of the local area of the testis' adhesive fixing is characterized by a strong fixation of the scrotum and the absence of adhesions in the surrounding tissues. By 30 days fixation spot is presented with granulation tissue with organization signs, and by 90 and 180 days compounds zone has the form of a mature connective tissue with clearly limited size and without any adhesions in the surrounding tissues.

Key words: testicles, fixation method, experiment

Journal of Experimental and Clinical Surgery. 2017;10(1):49-53
pages 49-53 views

Rehabilitation Methods after Surgical Treatment of the Static Foot Deformities

Ilchenko D.V., Kardanov A.A., Karandin A.S., Korolev A.V.

Abstract

Background

The issue of rehabilitation after surgical treatment of the foot deformities is not sufficiently covered in the contemporary literature. In spite of diversity of certain approaches used in the rehabilitation process, there is no consistency in their application. In addition, there is no consensus on the effectiveness of various techniques, on the quantity and quality of the procedures and the timing of their introduction in the rehabilitation process.

The objective of this article is to analyze the effectiveness of the techniques used in the rehabilitation of patients after surgical treatment of the foot deformities.

Methods

The article describes methods that are, in our opinion, the most effective and well-established in the post-operative recovery of patients. The  principles of complex usage of conservative treatment methods, including lymph drainage massage, manual therapy and therapeutic physical training, are covered.

Results

The introduction of the protocols we have developed in the rehabilitation of patients after surgical treatment of the foot deformities helped to organize the recovery process, to clarify the timing of rehabilitation measures, to improve the final result of treatment.

Conclusions

The use of pathogenetically justified methods of rehabilitation, which include massage, manual therapy and therapeutic physical training, promotes the most rapid and complete recovery of motor functions in patients after surgical treatment of the foot deformities.

 

Journal of Experimental and Clinical Surgery. 2017;10(1):54-63
pages 54-63 views

Reparative Processes in Soft Tissues. Influence of Acidity

Andreev A.A., Ostroushko A.P., Chuyan A.O., Karapityan A.R.

Abstract

Wound treatment is one of the most actual problems of modern surgery due to the increase of degree of injury, and also due to a sharp increase in quantity of emergencies of natural and technogenic disasters. Injuries of soft tissues of various etiology are annually diagnosed in the USA more than for 30 million people. To date there is a deep theoretical base developed for understanding of a pathophysiology of wound healing process, however still many questions remain debatable. The regeneration process is characterized by high metabolic activity and is based on biochemical reactions for which the pH value is of great importance. Changes of pH values of a wound during wound healing process are reflected in article. The authors noted the influence of pH on proteases and its inhibitors activity, expression of vascular endothelial growth factor (VEGF), fibroblast activity, keratinocytes proliferation, microbial expansion, and also on wound oxygenation; in response to invasion and dissemination of microorganisms. Materials of the researches that determined pH influence degree on the skin graft survival are represented. Generalizing, following conclusions can be done: pH performs as a modulator in healing both acute chronic wounds; acidic milieu in the inflammation phase and the first half of the proliferation phase occurs to the most conducive, positively affecting on necrolysis and granulation formation; alkaline milieu in the second half of inflammation phase and in phase of epithelization  promotes early closing of the tissue defect.

Journal of Experimental and Clinical Surgery. 2017;10(1):64-71
pages 64-71 views

Training Method of Split-thickness Skin Grafts to Hypoxic Conditions Due to the Compromised Microcirculation

Beschastnov V.V., Bagryancev M.V., Ryabkov M.G., Izmajlov S.G., Shchelchkova N.A., Peretyagi P.V.

Abstract

Relevance. One of the main reasons for the existence of non-healing wounds is defeated microvasculature and tissue hypoxia develops against the background of systemic diseases.

Purpose of the study. Develop a method for the preparation of split-thickness skin grafts by increasing the concentration of endogenous cytokine HIF-1α on the background of the local circulatory compensated hypoxia to increase the effectiveness of treatment of patients with nonhealing wounds of soft tissues.

Materials and methods. The hypothesis was that when a skin graft hypoxic preconditioning is an increase in the concentration of HIF-1α, which provides the best conditions for the survival of skin graft in the compromised microcirculation. Criteria to assess the correctness of the hypothesis, data were linked immunosorbent assay and results of clinical trials. In an experiment carried out on rats slit and mobilizing skin graft in animal hip controlled microcirculation to simulate hypoxic preconditioning donor area. After exposure for 30 minutes and 24 hours was performed immunoassay skin samples were subjected to hypoxic preconditioning symmetrical sections and samples of the animal's body. In the clinical part of the study analyzed the surgical treatment of 38 patients with diabetic foot. Patients underwent surgery with split-thickness skin grafts in the traditional way in the control group (20 patients), developed method used in the study group 18 patients.

Results. The concentration of HIF-1α after 30 minutes in the mobilized flap is significantly more in comparison with those obtained from the symmetrical region of the left thigh. After 24 hours concentration HIF-1α increase. According to the results of clinical research data developed method of hypoxic preconditioning of the split-thickness skin grafts its effective adaptation to the conditions of compromised microcirculation, which leads to a statistically significant increase in the area of engraftment 72 (65; 79) to 84% (78; 93)% (p = 0.012).

Conclusions. According to the immunoassay conditions in the local circulatory hypoxia at lower index of microcirculation to 50% of the original concentration of an increase in HIF-1α donor tissue area has a positive effect on graft survival.

Journal of Experimental and Clinical Surgery. 2017;10(1):72-78
pages 72-78 views

Brachytherapy is a Promising Treatment for Prostate Cancer

Kamenev D.Y., Moshurov I.P., Kravets B.B., Korotkikh N.V.

Abstract

Abstract – prostate Cancer is one of the most common cancers among men. Incidence is second only to tumors of the broncho-  pulmonary system. In recent years significantly increased the interest in contact radiation methods of treatment of this disease (brachytherapy). In the treatment of prostate cancer there is experience of application of different source of dose-rate  used sources of low dose (isotopes of iodine (125I), palladium (103Pd) and cesium (131Cs) and sources used for high dose rate (iridium Ir192 or cobalt 60 Co). In Russia the greatest popularity is the use of isotope Ir192 andI125 for brachytherapy. Given indentichnost the indications for treatment, equivalent figures cancerspecifically and relapse-free survival, the question of the choice of treatment is very important. A brief review of the literature on the use of brachytherapy for prostate cancer sources of different dose. Presents comparative characteristics of treatment results, complications, early and late toxic reactions when used brachytherapy isotopes different dose.

Journal of Experimental and Clinical Surgery. 2017;10(1):79-85
pages 79-85 views

Memorials

Vladimir Aleksandrovich VISHNEVSKIY (to the 80-anniversary from birthday)

Andreev A.A., Ostroushko A.P.

Abstract

7 Feb 2017 80 years the famous surgeon, one of the founders of the national surgical Hepatology and pancreatic-ogy, Professor Vladimir Alexandrovich Vishnevsky.
After graduating with honors in 1960 in Kyiv medical Institute Vladimir Aleksandrovich worked as a surgeon and chief surgeon of CRH in the Luhansk region. Since 1966 works at the Institute of surgery named. A.V. Vishnevsky, starting with the graduate student, then as a Junior, senior, leading researcher, head of the Department. In 1969 V. A. Wisniewski defended his thesis on "Galeotti anastomoses in the surgery of inflammatory diseases of the biliary tract". In 1991 Vladimir defended his doctoral thesis "Improvement of methods of surgical treatment of focal liver formations" and in the same year, he headed the Department of surgery of the liver and pancreas.
V. A. Vishnevsky is one of the founders of the national surgical Hepatology, reconstructive surgery of injuries and a high strictures of the bile ducts. With the scientific and organizational activity of V. A. Vishnevsky associated with the formation of modern ideology in the domestic surgery of primary and metastatic-ing lesions of the liver, tumors of the gate and parasitic lesions of the liver, surgical treatment of pancreatic diseases. He developed and introduced into practice methods of radical surgical treatment of cancer of the proximal bile ducts. Under the leadership of V. A. Vishnevsky developed and introduced minimally invasive percutaneous and laparoscopic methods of treatment of cysts, abscesses of the liver and radical surgery for hydatid cyst of the liver. He was the first in the country made pancreatectomy, one of the first in Russia has accumulated great experience pancreaticoduodenal resections, and other types of interventions on the pancreas. V. A. Wisniewski is the author of over 500 scientific papers and 6 monographs, textbooks and manuals, including: "Postoperative biliary tract disease", "Benign liver tumor", "pancreatic Cancer", "Surgery PA liver", etc.
He has supervised 11 doctoral and 21 candidate's dissertation. For outstanding merits in development of domestic science, training of highly qualified medical and scientific personnel Professor V. A. Vishnevsky was awarded the order "badge of Honor" and the medal of Honor, medals. Vladimir is a laureate of the State prize of Russia, prize of the RF Government. Recognition of authority of the V. A. Vishnevsky among colleagues was his election in 2003 the President of the Association of surgeons-hepatologists of Russia and CIS countries. Professor V. A. Wisniewski is the Deputy editor-in-chief of the journal "Annals of surgical Hepatology", a member of the International and European Association of surgeons-hepatologists, a member of the editorial Board of three surgical journals, academic boards of universities. Vladimir Aleksandrovich honorary Professor and academician of several foreign academies and scientific centers of Kazakhstan, Uzbekistan and Belarus, awarded with award of the International Association of surgeons, gastroenterologists and oncologists (IASGO) "For outstanding contribution in the field of treatment of liver diseases and surgical Hepatology".
The editorial staff of the journal "Vestnik of experimental and clinical coy surgery" congratulates Vladimir Alexandrovich on the occasion of significant Anniversary and wishes him strong health and further success in clinical and scholarly activities.

Journal of Experimental and Clinical Surgery. 2017;10(1):86
pages 86 views

Vasili Ivanovich RAZUMOVSKY (to the 160th anniversary since the birth)

Andreev A.A., Ostroushko A.P.

Abstract

Vasili Ivanovich Razumovsky, a Russian and Soviet surgeon, doctor of medicine (1884), Professor (1887), Honored scientist of the RSFSR (1934), one of the founders and the first rector of Saratov (1909-1912), Tbilisi (1918) and the Baku state University (1919), Hero of Labor (1923), holder of the order of St. Prince Vladimir III and IV degrees, St. Anne's I, II and III degree, St. Stanislaus 3 degrees.

Vasili Ivanovich Razumovsky was born March 27, 1857. In 1875, after graduating from high school with a gold medal goes to the medical faculty of Kazan University, from which he graduated in 1880. In 27 years he successfully defended his doctoral thesis on the topic: "the question of atrophic processes in the bones after cutting the nerves."

In 1885 he was appointed prosector in 1886 – assistant Professor, in 1887, is an extraordinary Professor in the Department of operative surgery, in 1894 – ordinary Professor, Department of hospital surgery, in 1896 – was transferred to the Department of faculty surgical clinic, 1905 – Dean of the medical faculty of Kazan University. In the years 1909-1912, the first rector of the organized Imperial Saratov University. After the February revolution V. I. Razumovsky was appointed the chief surgeon of the Caucasian front. In 1917 he organized in Tiflis was one of the first in the USSR, the trauma of the institutions involved in the organization and construction of the Caucasian-Russian (Tbilisi) and Azerbaijan University (Baku) and becomes its first rector. In 1920 V. I. Razumovsky returned to Saratov and head of the Department of General surgery of medical faculty of Saratov University. In 1923 received the Title of Hero of Labor (1923). In 1930 V. I. Razumovsky retired and lived in the Philippines, working as a consultant. In 1934 he became the Honored science worker of the RSFSR.

7 July 1935 Razumovsky died. Was a knight of the order of St. Prince Vladimir III and IV degrees, St. Anne's I, II and III degree, St. Stanislaus 3 degrees.

In honor named after V. I. Razumovsky Saratov state medical University (2009), to which it is a monument (2009), 2nd city clinical hospital, street in the resort of Essentuki, street in Baku, the ship "Surgeon Razumovsky" (1961). Plaques installed in Essentuki and Baku. In Essentuki historical Museum to them. V. P. Shpakovsky created a memorial room of the scientist.

Journal of Experimental and Clinical Surgery. 2017;10(1):87
pages 87 views

Russian surgeon and public figure, Academician Nikolai Nikolaevich BLOKHIN (to the 105th anniversary of birthday)

Andreev A.A., Ostroushko A.

Abstract

N. Blokhin was born in 1912 in the town of Lukoyanov in the Nizhny Novgorod region now. In 1934 he graduated from the Gorky medical Institute. From 1934 to 1937 – postgraduate, 1937 assistant Professor of the Gorky medical Institute. From 1941 to 1946 – the leading surgeon of evacuation hospitals. From 1946 to 1947, head of the clinic of the Gorky research Institute of reconstructive surgery, traumatology and orthopedics. From 1948 to 1951, Director of the Institute of reconstructive surgery, traumatology and orthopedics, Ministry of health of the RSFSR, and then from 1951 to 1952 – Director of the Gorky medical Institute. S. M. Kirov. At the same time from 1948 to 1950 – Professor, Department of surgery, University hospital and from 1950 to 1951 – head of the Department of General surgery of the Gorky medical Institute. S. M. Kirov. Since 1952 Director of the Institute of experimental pathology and therapy of the USSR Academy of medical Sciences. In 1953 N. N. Blokhin was elected a corresponding member, and in 1960 a full member, 1960-1968 from 1977 to 1987 and was the President of the USSR AMS. In 1966 N. N. Blokhin was elected President, since 1970, former President, since 1974 – life member of the Council of the International anticancer Union. Since 1975, academician N. N. Blokhin was Director of the all-Union oncological scientific center, Academy of medical Sciences of the USSR (now the Russian oncological scientific center named. N. N. Blokhin of the RAMS). In 1979 he was elected academician of the USSR. From March 1988 — honorary Director of the Russian oncological scientific center, Academy of medical Sciences of the USSR, since 1991 — the adviser of the Presidium of the USSR AMS. He died on 16 may 1993 in Moscow.

Blokhin – President of RAMS, academician of (1960) and the Academy of Sciences of the USSR (1979), RAS (1991), Honored scientist of the RSFSR (1975), Chairman of the Committee on international Lenin prize, President of the society "USSR – USA", honorary member of several foreign academies of Sciences and scientific societies, honorary citizen of the city of Gorky (1983), and Texas (1970), Hero of Socialist labor (1972), laureate of the State prize of the USSR (1982) and the prize of the Presidium of the Academy of medical Sciences of the USSR (1956), awarded with orders of red Star (1942), the Lenin (1961, 1962, 1972, 1982), the red banner of Labour (1969), the October revolution (1987), was a Deputy of the Supreme Soviet of the seven convocations, a delegate to three congresses of the CPSU. Academician N. N. Blokhin is the author of over 300 scientific papers and several monographs. Under his leadership, has trained more than 60 doctors and candidates of Sciences.

The name of academician N. N. Rated Blokhin Russian cancer research center RAMS (1993), Diveevsky district Central hospital. A memorial plaque with his name was set on the buildings of the Nizhny Novgorod state medical Academy and Nizhny Novgorod scientific research Institute of traumatology and orthopedics.

Journal of Experimental and Clinical Surgery. 2017;10(1):88
pages 88 views

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