Journal of Experimental and Clinical Surgery

Backgraund. Formation of pancreatoenteroanastomosis is a decisive stage of the whole operation, as the frequency of complications leading to death remains high.
Aims. Improving the results of surgical interventions on pancreas by choosing the method of pancreatoenteroanastomosis formation.
Materials and methods. A retrospective-prospective study on the basis of the departments of the Center of Liver, Pancreas and Biliary Tracts Surgery of the Ryazan State Medical University was performed.
The retrospective stage included the analysis of 270 operation protocols and case histories of patients underwent pancreatic resection. Based on this, a method of pancreaticojejunoanastomosis formation by using of through U-shaped sutures (a modification of the Blumgart’s method) was suggested by the Department of Hospital Surgery of the Ryazan State Medical University.
Prospective stage - analysis of 98 case histories and operation protocols of patients underwent pancreatic resection. The number of patients with chronic pancreatitis was 73, with cancer of the head of the pancreas - 25. Groups were formed uniformly according to etiological characteristics.
Statistical analysis methods:
1. Multivariate correlation analysis using the contingency coefficient (φ);
2. Shapiro-Wilk-W test;
3. Criterion χ2 - Pearson;
4. One-way analysis of variance and multiple comparison method with Student's t-test with Bonferroni correction.
Results. Correlation between the infiltrated pancreas and the frequency of complications - φ = 0.517.
The frequency of anastomosis failure with a diameter of PP>3 - φ = 0.167, with PD≤3mm - φ = 0.358.
The infiltrated parenchyma of the pancreas and the diameter of the PP≤3 mm affect the incidence of postoperative complications - φ = 0.387 (PP > 3 mm, the incidence of postoperative complications - φ = 0.254).
At the reconstructive stage, patients underwent: in group No. 1 – pouch-invagination pancreatoenteroanastomosis end to side, in group No. 2 – pancreaticoenteroanastomosis using nodular sutures, in group No. 3 - pancreaticoejunoanastomosis using through U-shaped sutures, which is a modification of the Blumgart method. In group No. 1 complications were observed in 58% of cases, No. 2 - 45.4%, No. 3 - 20.5% (p=0.010). PEA failure in group No. 1 -29%, No. 2 - in 21.2%, No. 3 - no PEA failure was observed (p = 0.003). Gastrostasis - 9.7% in group No. 1, 9.1% - No. 2, 8.8% - No. 3 (p = 0.1). Postoperative pancreatitis - 12.9% in group 1, 9.1% in group 2, 5.9% in group 3 (p=0.015). Repeated surgical interventions in group No. 1 were required in 29% of cases, in group No. 2 - in 18.1%, in group No. 3 - 2.9% of cases.
Conclusions. Repeated surgical interventions requiring pancreatojejunoanastomosis with the use of through U-shaped sutures were necessary in 2.9% of cases, the rate of postoperative complications was 20.5%, anastomosis failure was not observed.
Pancreaticojejunoanastomosis using through U-shaped sutures has proven to be more effective in comparison with other methods of pancreaticoenteroanastomoses forming in clinical practice and can be used in educational and pedagogical activities and research works in higher medical institutions.

Introduction. Diseases accompanied by a violation of the blood supply to the intestinal wall occupy one of the main places in urgent surgery of the abdominal organs. Intraoperative assessment of intestinal viability is one of the most difficult tasks and plays a leading role in determining the volume of surgical aid, predicting the course of the postoperative period.
Aim. To study the possibility of using contrast imaging using a controlled polychrome LED light source to assess the viability of the intestinal wall of a model animal in conditions of acute ischemia.
Materials and methods. The work is based on the results of experimental studies conducted on 15 clinically healthy sexually mature laboratory rats. The simulation of acute small intestine ischemia lasting from 15 minutes to 12 hours was performed by ligation of the major vessels. Each animal underwent a relaparotomy after a corresponding time interval. The intestine was extracted from the abdominal cavity and visual parameters of wall necrosis were assessed using the Kerte method and using a polychrome LED light source for contrast imaging of biological tissues during surgery. After determining the visual signs of necrosis, intestinal fragments were submitted for pathomorphologic examination. The study was ended by removing the animal from the experiment according to the protocol approved by the Ethics Committee.
Results. The spectral composition of the light source providing the most reliable detection of necrosis of the intestinal wall is represented by two spectral bands with maximum wavelengths of λpeak = 503 nm, λpeak = 594 nm and an approximate ratio of band intensities of 2:1. By morphological study, the following intervals were found to be significant when simulating small intestinal ischemia in the experiment: 1 hour after ligation - time of onset of ischemia, 6 hours - time when ischemia is reversible, and 12 hours - time when small intestine necrosis is recorded.
Conclusions. The use of a controlled shadowless semiconductor light source for contrast imaging of biological tissues during surgery in the selected mode improves the definition of visual parameters of intestinal viability.

Extended burn strictures of the esophagus belong to the category of complex benign strictures that are difficult to instrumental expansion. The result is mostly ineffective, leading to rapid and frequent relapses and, accordingly, to dysphagia. Despite the benign development of burn strictures, long-term and protracted treatment worsens the nutritional status and quality of life of the patient; there is a risk of developing severe complications during the expansion of strictures, as well as a risk of malignant strictures in the long term in patients with a long life expectancy.
This clinical observation presents the experience of radical surgical treatment of a patient with an extended burn stricture complicated by an esophageal-bronchial fistula against the background of esophageal perforation as a result of prolonged and ineffective instrumental expansion of the esophageal stricture. Due to the impossibility of adequate food intake, the patient had previously had a gastrostomy, which complicated the formation of a graft from the gastric tube. At the time of hospitalization, the patient was in a state of nutritional insufficiency and water and electrolyte disorders. The patient underwent surgery in the following volume: separation of the esophageal-bronchial fistula, transthoracic subtotal esophagectomy, suturing of the gastrostomy defect, gastric tube esophagoplasty. The postoperative period on the 6th day was complicated by suppuration of the wound of the anterior abdominal wall. On the 11th day of the postoperative period, there was a divergence of the aponeurotic layer of the laparotomic wound. Urgently performed relaparotomy, revision of the abdominal cavity, repeated suturing of the anterior abdominal wall. This complication did not affect the healing time of the esophageal anastomosis: according to the data of contrast X-Ray at 5th and 7th days of the postoperative period, no leakage of CV outside the anastomosis was detected. The patient was discharged for 18 days in a satisfactory condition with good nutrition through the mouth.
Conclusion. This radical approach to the treatment of this category of patients makes it possible to simultaneously remove the pathologically altered esophagus and restore a full meal, while maintaining the natural passage of food through the gastrointestinal tract.

The article describes a case of endovascular treatment of a patient with Paget - Schretter's disease, who had verified thrombosis of the brachial, axillary and subclavian veins. The main etiological factor of venous thrombosis was hyperabduction syndrome – compression of the subclavian vein by the pectoralis minor muscle during arm withdrawal. The indication for endovascular treatment was acute venous insufficiency of the upper limb with the development of the threat of blue phlegmasia. Regional catheter thrombolysis was performed using alteplase. There was a lysis of thrombotic masses with a good long-term result of the patient's treatment.

The article analyzes the literature data and our own experience in the study of immunopathogenesis and immunodiagnosis of burn sepsis, discusses the issues of effective use of immunocorrection in the complex treatment of severely burned patients.
Diagnosis of sepsis after severe burn injury is challenging due to the overlap of signs and clinical manifestations of the hypermetabolic reaction of thermal injury and sepsis. The systemic inflammatory response caused by burns can mimic the manifestation of sepsis and complicate its early diagnosis. In this aspect, modern immunodiagnostics can serve as an effective tool in identifying damaged key immune markers in burns, determining the severity of immune status disorders in burn disease and the risk of developing septic complications for timely immunocorrection and providing appropriate complex therapy for patients with extensive burns.
At the same time, the problem of immunocorrective therapy in severely burned patients remains extremely relevant, debatable and not fully resolved. It is a personalized approach in the immunotherapy of burn sepsis based on immune analysis and clinical recommendations for the complex treatment of burn injury that will improve the results of treatment and, possibly, prevent the development of sepsis in patients with severe burn injury.