Vol 13, No 3 (2020)

Full Issue

Original articles

Results of the Use of Accelerated Rehabilitation Protocols after Surgery in Patients with Cystic Pancreatic Formations Undergoing Resection and Resection-Draining Interventions

Koshel A.P., Drozodv E., Klokov S.S., Dibina T.V., Kusakina O.E.


Introduction. The number of patients with cystic formations of the pancreas has increased significantly recently. Some of the patients need open or minimally invasive surgery. The implementation of ERAS (Enhanced recovery after surgery) protocols has been proved to be effective in orthopedics, bariatric and colorectal surgery. However, safety and feasibility of implementation of accelerated rehabilitation protocols in patients with cystic formations of the pancreas who underwent resection and resection-drainage interventions have not been sufficiently studied.
The aim of the study was to assess the effectiveness and safety of implementation of the developed accelerated rehabilitation protocol in patients with cystic pancreatic formations who have undergone resection and resection-draining interventions.
Material and methods. This research is a retrospective-prospective, single-center study. The study included 110 patients with cystic formations of the pancreas of various etiologies. All patients were divided into two groups: the control group consisted of 55 patients, their perioperative management was carried out according to standard protocols, and the experimental group consisted of 55 patients, their perioperative management was carried out according to the accelerated rehabilitation protocol developed in the clinic. All patients included in the study were exposed to surgery: resection and resection-draining interventions in various modifications were performed.
Results. Patients in the studied groups were comparable by gender, age, body mass index, ASA score, preoperative albumin level. No statistically significant differences were found in the duration of the operation, intraoperative blood loss, or the frequency of blood transfusions. The overall complication rate was significantly lower in the experimental group compared with the control group (38,2% versus 58,2%, p = 0,03). Postoperative recovery of the gastrointestinal function was also faster in the experimental group. Thus, in the experimental group, the average time to the gas discharge was 2,1 ± 0,8 days; in the control group - 3,1 ± 1,1 days (p = 0,01); the average time to the first stool was 3,2 ± 1,9 and 4,2 ± 1,2 days, respectively (p <0,001). The total duration of the postoperative hospital bed per day was significantly lower in the experimental group compared with the control group (11,8 ± 7,7 vs 16,2 ± 13,2 days, respectively, p = 0,02).
Conclusions. The study demonstrated safety and effectiveness of implementation of accelerated rehabilitation protocols in patients with cystic pancreatic formations who have undergone resection and resection-draining interventions. Implementation of the protocols allows reducing the duration of the postoperative hospital bed per day, incidence rate of complications, and also accelerating the gastrointestinal function recovery.

Journal of Experimental and Clinical Surgery. 2020;13(3):167-176
pages 167-176 views

C-Reactive Protein as a Diagnostic Tool for Infectious Complications and Esophagojejunal Anastomotic Leakage after Gastrectomy

Ilina O.V., Ruchkin D.V., Kozyrin I.A., Stepanova Y.A.


Introduction. The tendency to the wide implementation of the enhanced recovery after surgery (ERAS) protocol in the clinical practice leads to the increased requirement in surgical safety that can be provided with the possible earliest detection of postoperative complications and appropriate treatment. This requirement is the most acute in gastric cancer surgery, where despite the improvement of surgical techniques and complex treatment approach the rate of postoperative complications and esophagojejunal anastomotic leakage (EAL) is still high, making up 27% and 10%, respectively. The measurement of C-reactive protein (CRP) concentration in blood plasma is the simplest, most accessible and reliable method to detect infectious complications. However, CRP concentrations, which may indicate the development of postoperative complications, differ significantly in different studies.
The aim of the study was to specify the role of CRP as a predictive biomarker for infectious complications and esophagojejunal anastomotic leakage.
Materials and methods. This retrospective study included immediate outcomes of the planned radical gastrectomy in 130 patients. The CRP level was assessed depending on the complication type in the immediate postoperative period. Correlation between CRP levels and the incidence of postoperative infectious complications was analyzed. The severity grade of postoperative complications was registered according to the modified Clavien-Dindo classification. The statistical analysis was performed using parametrical and non-parametrical methods. The optimal cut-off CRP for infectious complications and anastomotic leakage was defined with the use of the ROC analysis. The multifactorial ANOVA was performed to detect the effect of contributing factors on the CRP level.
Results. An increase in CRP levels over 100 mg/L on the fourth day after surgery can be considered as a manifestation of infectious complications (AUC 0,866 ± 0,042, 95% CI: 0,798-0,934, p <0,001), and an increase in CRP levels over 167 mg/L on the fifth day is a predictor of the development of EAL (AUC 0,869 ± 0,081, 95% CI: 0,711-1,000, p = 0,001). Initial malnutrition and aggravated somatic status appear to be risk factors for the development of infectious complications (p <0,001).
Conclusion. Therefore, despite its low specificity, CRP is a sensitive marker of postoperative infectious complications starting from the first days of the postoperative period. Evaluation of the CRP concentration in dynamics allows identifying postoperative complications before the development of clinical manifestations.

Journal of Experimental and Clinical Surgery. 2020;13(3):177-189
pages 177-189 views

Impact of Laparoscopic Sleeve Gastrectomy on the Course of Non-Alcoholic Fatty Liver Disease

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


Introduction. Non-alcoholic fatty liver disease (NAFLD) is one of the most common pathologies in obesity, at the same time the impact of bariatric operations on the course of NAFLD remains unresolved and debatable, the issue determining the relevance of this work.
The aim of the study was to assess the effect of laparoscopic sleeve gastrectomy (LSG) on the course of NAFLD and determine the criteria that affect the dynamics of NAFLD after a performed bariatric intervention.
Materials and methods. The study included clinical outcomes of 64 patients who underwent LSG between 2014 and 2017. Intraoperative liver biopsy, laboratory and instrumental investigations, the calculation of FibroTest in dynamics were performed to all patients. The frequency of postoperative complications was assessed. Follow up examinations including 58 (90.6%) patients were carried out during 2 years.
Results. Initially, 29 (45,3%) patients manifested signs of fibrosis according to METAVIR, and 19 (29,7%) patients manifested signs of non-alcoholic steatohepatitis (NASH). Elevated transaminases were registered in 14 (21,9%) patients, elevated levels of gamma-glutamyl transpeptidase (GGTP) were registered in 47 (73,4%) patients, increased total bilirubin were registered in 12 (18,8%) patients, increased alkaline phosphatase (ALP) were registered in 21 (32,8%) patients. There was an increased level of trygliceride (TG) and decreased level of high density lipoproteins (HDL) in 54 (84,4%) patients. Ultrasound investigation of the liver revealed an increased liver size in 46 (71,9%) patients, diffuse heterogeneity of the liver in 61 (95,3%), hyperechogenicity in 60 (93,8%) patients. Manifestations of liver cirrhosis were registered in 1 (1,6%) patient.
There was a significant decrease in the excess body weight in the postoperative period, and hereat, the % EBMIL (Excess Body Mass Index Loss, percentage of overweight loss) in 1 year after laparoscopic sleeve gastrectomy achieved satisfactory values and amounted to 68,30 [58,67-78,77] %. ALT, AST findings were normal in 79,7% of operated patients, cholestasis parameters - in 76,5% of operated patients, FibroTest findings - in 42,2% of cases. In 6 months after surgery there was a deterioration of the clinical and biochemical properties of non-alcoholic fatty liver disease, which was transient and regressed in one year after surgery. The mortality rate during the entire follow-up period was 0%. The effect of the surgery on the signs of non-alcoholic fatty liver disease persisted for 2 years after surgery.
Laparoscopic sleeve gastrectomy demonstrated high effectiveness in patients under 45 years old compared to the patients over 45 years old, and in patients with initial stages of fibrosis F0-F2 by METAVIR compared to patients with stages F3-F4 by METAVIR. In addition, patients with BMI higher than 40 kg/m2 achieved higher FibroTest findings after 6 months compared to subjects with BMI lower than 40 kg/m2, and in fewer cases FibroTest findings normalized in 1 year after surgery, respectively.
Conclusions. Therefore, it was noted the efficacy of laparoscopic sleeve gastrectomy in patients with obesity and non-alcoholic fatty liver disease; at the same time, it was revealed a transient worsening of the course of the disease in 6 months after surgery.

Journal of Experimental and Clinical Surgery. 2020;13(3):190-200
pages 190-200 views

Clinical Outcomes of Surgical Treatment of Hypertrophic Pyloric Stenosis with Application of Various Operational Access

Gavrilyuk V.P., Kostin S.V., Statina M.I., Severinov D.A., Primov F.S.


Introduction. Treatment options of congenital hypertrophic pyloric stenosis (HPS) appear to be an acute issue nowadays due to the fact that this pathology is often detected in children of the first year of life - according to statistics, the incidence rate of congenital hypertrophic pyloric stenosis in children is 3:1000 live newborns. Since there are various treatment options of the given congenital pathology, there is no general consensus in the opinions of surgeons regarding the superiority of different treatment methods. Therefore, it is necessary to search for a single most relevant treatment technique for this pathology.
The aim of the study was to analyze clinical outcomes for treatment of congenital hypertrophic pyloric stenosis in children with application of various surgical techniques: open pylorotomy (transverse, circumbilical incision) and laparoscopic pylorotomy.
Materials and methods. The study included 67 patients, who received treatment in Kursk Regional Pediatric Hospital №2 in 2014-2018. Patients with congenital HPS were divided into 3 groups, depending on the performed surgical interventions. Group 1 included patients who underwent an open pylorotomy with transverse access, group 2 included patients who underwent an open pylorotomy with circumbilical access, and group 3 included patients who underwent laparoscopic pylorotomy. The following parameters were used to assess the efficiency of the treatment performed: the duration of the operative intervention, the duration of stay of a child in the ICU, the duration of stay of a child in the hospital, extubation time, initiation of enteral feeding, recovery rate of enteral feeding volume. The data were statistically performed using the Mann-Whitney test to determine the significance of differences between the mean values (p≤0.05).
Results. The study results demonstrated that the shortest duration of operational intervention was observed in patients of group 3, it constituted 41,4 ± 3,5 minutes. In addition, patients of this group spent the shortest average time in the ICU - 4,2 ± 0,3 days - and in the hospital in general - 12,1 ± 0,8 days; initiation of enteral feeding in patients of this group was registered in 10,8 ± 1,2 hours and the recovery rate of enteral feeding volume was 4,8 ± 0,5 days.
Conclusions. Having analyzed clinical outcomes for treatment of pilorostenosis in the studied groups of children, it is possible to conclude that laparoscopic pyloromyotomy is preferred to open surgical interventions not only for reasons of cosmetic result, but also according to the criteria of the postoperative course of the disease in patients.

Journal of Experimental and Clinical Surgery. 2020;13(3):201-205
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Long-Term Outcomes and the Quality of Life in Patients with Postoperative Ventral Hernias after Various Surgical Options

Tarasova N.К., Dynkov S.М., Osmanova G.S., Pozdeev V., Teterin A.Y.


Introduction. Clinical outcomes of surgical treatment of postoperative ventral hernias are to be investigated not only in the nearest but also in the long-term postoperative period.
The aim of research was to study the effectiveness of various methods of hernioplasty and the patients' quality of life in the long-term surgical treatment of postoperative ventral hernias.
Materials and methods. The authors analyzed the results of surgical treatment of 76 patients with postoperative ventral hernias in the late postoperative period after various methods of hernioplasty during 2006-2017. The average term of follow up examination was 5.7 years. The patients’ quality of life was assessed using the SF-36 questionnaire; the anterior abdominal wall and the surgical area examination was performed in all patients; the patients were interviewed on adherence to recommendations in the postoperative period.
Results. The average physical health index (PH) was 47,27±1,05, while mental health index (MH) was 52,86±1,04. These parameters were low due to the age of the patients (60, 23±1,29 old), as well as the presence of concomitant diseases of the cardiovascular system (80,3%) and obesity (75%). Index of physical health component in sublay and corrective plastics was significantly lower than in autoplastic and onlay disposition of the prosthesis (р<0,001). However, the onlay method as well as the corrective technique and autoplasty revealed a high risk of hernia recurrence, and as a result, a decrease in physical and mental health indexes. According to the survey, it was found that more than 50% of the patients did not adhere to the recommendations for restricting physical exertion and wearing a bandage, which also contributed to the hernia recurrence. In 28% of patients reherniation or diastasis recti abdominis was detected in the surgical area. However, the patients did not notice these changes or did not believe in the success of repeated interventions.
Conclusion. Thus, the sublay technique proved to be a preferred method of various hernioplasty options. However, a search for more functional prostheses is needed to improve the quality of patients’ life. To prevent reherniation, patients are strongly recommended to adhere to the terms of wearing the bandage and restricting physical activity. Follow-up examinations of the patients should be performed by healthcare providers to timely reveal and treat recurrent postoperative ventral hernias.

Journal of Experimental and Clinical Surgery. 2020;13(3):206-213
pages 206-213 views

Renal Cancer with Tumor Thrombus of the Inferior Vena Cava and the Right Atrium

Stepanova Y.A., Gritskevch A.A., Revishvili A.S., Kadirova M.V., Malyshenko E.S., Morozova M.V., Chekhoeva O.A., Shirokov V.S.


ntroduction. A distinctive feature of kidney cancer is a frequent, compared with other tumors, spread of the tumor through the venous collectors (in the renal and inferior vena cava up to the right atrium), along the path of least resistance to invasive growth.
The aim of the study was to present a clinical case of radical treatment of kidney cancer involving extensive IVC thrombosis.
Materials and methods. The study describes a clinical case of radical treatment of patient M. with kidney cancer involving extensive IVC thrombosis, extending to the right atrium (written informed consent for patient information and images to be published was obtained prior to the study). During preoperative examination, the patient was diagnosed with renal cell carcinoma with non-occlusive hypervascular tumor thrombus of the renal vein, the inferior vena cava and the right atrium based on the findings of ultrasound examination (transabdominal and transthoracic, and transesophageal), multislice computed tomography (MSCT) and magnetic resonance imaging (MRI).
Results and discussion. Surgical treatment remains the main method of treatment of renal cell cancer, moreover, the inferior vena cava thrombosis cannot serve as a cause for refusing surgical treatment. The thrombus spreading along the venous collectors is an important factor in determining the tactics of surgical treatment. The length of the tumor thrombus, as well as the degree of its fixation and ingrowth into the vein wall is of great significance for planning surgical techniques and predicting clinical outcomes. Based on various methods of radiological examination, patient M. was diagnosed with cancer of the right kidney, 3 stage T3cNxM0, IVC tumor thrombus, paraneoplastic syndrome (hyperthermia), right-sided nephrectomy with aortocaval lymphadenectomy, thrombectomy from the IVC, vascular isolation of the liver, resection of the IVC, thrombectomy from the right atrium combined with cardiopulmonary bypass.
Conclusion. Despite the technical complexity of nephrectomy with thrombectomy from the IVC, especially in the presence of a massive supradiaphragmatic thrombus, these interventions have no alternatives if a radical treatment is to be achieved. Step-by-step support using radiological methods of investigation is an important aspect of patients’ preparation; this allowing determining the exact volume of the damage and non-invasively assessing clinical outcomes of surgical treatment.

Journal of Experimental and Clinical Surgery. 2020;13(3):214-226
pages 214-226 views

Immediate and Long-Term Results of the Spleen-Preserved Operations in the Surgical Treatment of Gastric Cancer

Rogozianskaia M.I., Redkin A.N., Moshurov I.P.


ntroduction. Currently, total gastrectomy with D2 lymphadenectomy is the standard surgical treatment for proximal gastric cancer at the resectable stages (I-III). The issue of advisability of splenectomy as a component of lymphadenectomy remains a controversial one, especially when the tumor is localized in the region of the body or cardiac region of the stomach.
The aim of the study was to compare immediate and long-term outcomes, including the quality of life, between spleen preserving and spleen removing surgeries.
Methods. The study included 363 patients with gastric cancer II-III stages, localized in the upper and/or the middle third of the stomach, who underwent surgery at the Voronezh Regional Clinical Oncology Hospital and the Voronezh Clinical Hospital of the Russian Railway-Medicine in 2015-2017. All patients were conditionally divided into 2 groups for comparative retrospective analysis. All patients of the first (experimental or spleen-preserved) group (144 patients) were performed R0 total gastrectomy with D2 lymphadenectomy, including splenic hilar nodes (№ 10,11) removal without splenectomy. Patients of the second (control or splenectomy) group (219 patients) were performed R0 total gastrectomy with D2 lymphadenectomy and prophylactic splenectomy (for splenic hilar nodes removal).
Results. The average duration of the operation and the volume of blood loss did not differ in both groups. The incidence of early postoperative surgical complications was lower in the spleen-preserved group. Splenectomy was associated with more severe complications of class 4 and 5 according to the Clavien-Dindo classification.
Conclusion. Parameters of the 1- and 3-year overall survival rate did not differ in both groups. The results of the GSRS questionnaire were similar in both groups, excluding reflux-esophageal symptoms scale. The reflux scale demonstrated a statistically and clinically significant advantage of spleen preservation.

Journal of Experimental and Clinical Surgery. 2020;13(3):227-232
pages 227-232 views

Effects of Ciprofloxacin on the Dynamics of Biofilm Formation by Staphylococcus Epidermidis Strains Isolated from Implant-Associated Infection

Babushkina I.V., Mamonova I.A., Ulyanov V.Y., Shpinyak S.P., Bondarenko A.S.


Introduction. The formation of a microbial biofilm in implant-associated infection after arthroplasty of large joints reduces the informative value of traditional microbiological diagnostic methods and limits the range of effective antimicrobial drugs. When prescribing etiotropic therapy for periprosthetic joint infection, it is necessary to take into account not only the antibacterial effect of the drug, but also its effect on biofilm formation. Ciprofloxacin therapy may be a risk factor for the development of biofilm periprosthetic infection caused by multidrug-resistant staphylococcal strains.
The aim of research was to study the effect of sub-inhibiting and therapeutic doses of ciprofloxacin on biofilm formation by Staphylococcus epidermidis strains isolated from implant-associated infection.
Materials and methods. The authors studied the effect of various concentrations of ciprofloxacin on 15 strains of St. epidermidis isolated from 83 patients with deep periprosthetic joint infection after primary knee arthroplasty, treated at NIITON SSMU in 2018-2019. The effect of the calculated concentrations of ciprofloxacin on the planktonic culture, forming and preformed biofilms was investigated. Biofilm simulation was performed according to the method described by G.D. Christensen under in vitro conditions with determination of the optical density of alcohol eluates of gentian violet in polystyrene microplates.
Results. It was demonstrated that ciprofloxacin in a dose 0.01 μg/ml inhibits the growth of planktonic forms by 50% and statistically significantly (p = 0.001) stimulates formation of microbial biofilms as compared to the control without antibiotic addition. Concentration of ciprofloxacin equal 0.03 μg/ml inhibits the growth of planktonic forms by 90%, statistically significantly (p = 0.001) stimulates formation of biofilms and activates further increase in the mass of pre-formed microbial biofilms. An increase in the concentration of ciprofloxacin to 0.05 μg/ml completely inhibits the growth of planktonic forms and statistically significantly stimulates further growth of preformed biofilms.
The use of ciprofloxacin at concentrations equal 1-3 μg/ml statistically significantly (p = 0.001) inhibits the formation of microbial biofilms, but does not affect the preformed biofilm.
Conclusions. Thus, there has been found a dose-dependent effect of ciprofloxacin towards clinical strains of St. epidermidis: subinhibitory and therapeutic concentrations of the drug have a stimulating effect on the formation and further increase in the mass of the preformed microbial biofilms. This fact must be taken into account when prescribing etiotropic therapy for implant-associated complications following large joint replacements.

Journal of Experimental and Clinical Surgery. 2020;13(3):241-247
pages 241-247 views

Simulation of Acute Destructive Pancreatitis with Damage to the Adjacent Adipose Tissue in Pigs

Alfiya I.K., Mustafin T.I., Georgiy B.V., Rakhimov R.R., Sharifgaliev I.A.


The aim of the study was to develop a model of acute destructive pancreatitis with damage to the extra-organ adipose tissue.
Materials and methods. Simulation of acute destructive pancreatitis with damage of the extra-organ adipose tissue was performed in 22 white breed boars aged 3 months. The animals were divided into groups in accordance with two series of studies, where the control (first) group included 15 animals with the pancreas and extra-organ adipose tissue remained intact. Acute destructive pancreatitis was simulated in 7 pigs of the experimental (second) group based on the proposed technique (patent for an invention No. 2668201). Ultrasound examination of the abdominal cavity and retroperitoneal region was applied to confirm the development of expected pathology in experimental animals. Intensity of blood supply was assessed using contrast radiography by injecting a contrast medium into the superior mesenteric artery. Complete blood count and biochemical assay were performed. In addition, during autopsy tissue samples were taken for histological and immunohistochemical investigations to assess changes in the internal organs.
Results. Acute destructive pancreatitis with damage to the extra-organic adipose tissue was regarded as achieved when clinical manifestations of apathy, lethargy, feed refusal were registered in animals. Biochemical blood tests revealed a significant increase in the concentration of alkaline phosphatase and alpha-amylase enzymes. Nitrogenous toxins, in particular, creatinine, were accumulated in the body of the experimental animals. Complete blood count revealed leukocytosis, the fact supporting the onset of the expected inflammatory process in the pancreas and adjacent adipose tissue. The development of necrotic and inflammatory processes in the organ was evidenced by a sharp increase in the level of amylase, creatinine and alkaline phosphatase in the blood of animals. Ultrasound examination revealed a picture of the blurring of pancreatic contours, heterogeneity of the organ structure, increased echogenicity, and enlargement of the duct. Intensification of the vascular pattern and increase in pancreatic contours were detected during the contrast examination of the abdominal vascular system. At autopsy, there were signs of enzymatic peritonitis, namely, serous-hemorrhagic exudate in the abdominal cavity and the cavity of the omental bursa, increased pneumatization of the intestinal tube with a thinning of its wall and foci of small hemorrhages. The pancreatic tissue in all cases was edematous, full-blooded, with multiple foci of fatty necrosis and purulent inflammation. Similar changes were found in the adjacent adipose tissue. At the light-optical level, vascular congestion, small foci of steatonecrosis and micro-abscesses were determined in the pancreas. Immunohistochemical studies largely evidenced the onset of acute destructive pancreatitis with damage to the extra-organ adipose tissue.
Conclusion. Thus, the proposed technique allows simulating acute destructive pancreatitis with damage to the extra-organ adipose tissue in pigs, the event frequently occurring in the clinical practice. In animals the disease is accompanied by clear clinical manifestations correlating with findings of instrumental and laboratory investigations, and autopsy results. Investigations of the pancreatic and extra-organ adipose tissue samples at the light-optical and molecular levels evidence the fact that the authors have simulated a model of acute destructive pancreatitis with involvement of the adipose tissue adjacent to the organ in the pathological process.

Journal of Experimental and Clinical Surgery. 2020;13(3):233-240
pages 233-240 views


Gastroduodenoanastomotic Technique in Penetrating Stenosing Duodenal Ulcers

Afanasyev D.V., Afanasyev V.N., Pleshkov V.G., Danilenkov N.V., Rodin A.V., Zabrosaev V.S., Moskalev A.P.


Introduction. Pyloroduodenal stenosis is one of the most common complications and indication for surgical treatment of peptic ulcer in 10-84% of patients. Gastric resection with Billroth-1 (B-1) or Billroth-2 (B-2) techniques is the basic surgical intervention in this pathology. However, these interventions are accompanied by a high rate of postoperative complications (7.2-35%), mortality (2-5%), and development of postresection syndromes in the long term period in 15-60% of patients.
The aim of the study was to improve the technique of gastroduodenal anastomosis creation in patients with penetrating stenosing duodenal ulcers.
Materials and methods. The authors analyzed clinical outcomes of gastric resection with a plasma scalpel (PS) using B-1 technique with single-row serous-muscular-submucosal sutures in 136 patients with penetrating stenosing duodenal ulcers. The techniques of «longitudinal dissection of the anterior wall of the duodenum» and «extraduodenization of the ulcer» were presented. B-1 technique of modified gastric resection was described in details. Clinical outcomes were assessed based on the incidence rate of complications in the early postoperative period. In 30 patients fibrogastroduodenoscopy was performed postoperatively to assess anastomotic healing.
Results. Due to the proposed techniques, it was possible to avoid intraoperative complications. Postoperative complications developed in 8.8% of patients. These included: violation of the motor-evacuation function of the stomach in 4.4% of patients, pneumonia in 2.2% of patients, suppuration of the postoperative wound in 1.5% of patients, internal bleeding in 0.7% of patients. There was no any gastroduodenoanastomosis (GDA) failure. Postoperative mortality was 0.7% of the internal bleeding. After plasma resection of the stomach using B-1 technique with single-row serous-muscular-submucosal sutures, the edges of the mucous membrane along the wound of the stomach and gastroduodenal anastomosis were visually regenerated by primary intention.
Conclusion. The presented method of gastric resection performed with plasma scalpel using B-1 technique of gastroduodenal anastomosis creation with single-row serous-muscular-submucosal sutures did not result in failure of the GDA sutures; the number of anastomositis and post-resection pancreatitis, as well as the damage to the bile ducts, was reduced. The techniques of "longitudinal dissection of the anterior wall of the duodenum" and "extraduodenization of the ulcer" reduce traumatization and simplify the operation technique.

Journal of Experimental and Clinical Surgery. 2020;13(3):248-255
pages 248-255 views

New in surgery

Test Procedure for a New Type of a Ventricular Assist Device Based on a Viscous Friction Pump

Zhulkov M.O., Golovin A.M., Grenaderov A.S., Tsirikhov V.R., Sabetov A.K., Agaeva H.A., Alsov S.A., Chernyavskiy A.M.


Introduction. Currently, the possibility of effective correction of multiple organ failure and increasing the life expectancy of patients with critical heart failure using the ventricular assist devices (VAD) is absolutely evidenced. The development of alternative analogues of such devices produced within the country has been an urgent problem for many decades. The design of this machine requires the development of a protocol for carrying out complex biomedical studies on the biocompatibility and safety of the new device.
The aim of the study was to develop a protocol for testing and conducting comprehensive biomedical biocompatibility studies of a new ventricular assist device in an acute animal experiment.
Materials and methods. The study to develop a technique for implanting a left-ventricular assist device (LVAD) in an acute experiment included female mini-pigs, weighed 40-60 kg. In a series of acute experiments, 5 implantations of a disk pump as a LVAD were performed with a maximum observation period equal 6 hours.
Results. In the series of acute experiments, an implantation technique was developed and the fundamental possibility of a viscous friction pump application as a ventricular assist device was evidenced. In all experiments (n = 5), the average level of free hemoglobin did not exceed 2.6 mg%, which supports safety of performance of the viscous friction pump regarding blood erythrocytes. None of the experiments recorded episodes of pump shut-off or breakdown.
Conclusions. The series of acute experiments on mini-pigs helped reveal a number of anatomical and physiological features of this animal species that significantly complicated implementation of persistent observation. However, the developed experimental LVAD test methodology can be recommended for use in further chronic experiments on large laboratory animals (calves).

Journal of Experimental and Clinical Surgery. 2020;13(3):256-261
pages 256-261 views

Review of literature

Current Views on the Use of Bariatric Surgery in Patients with Extreme Obesity

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


Currently, the prevalence of obesity and its extreme forms is progressively increasing throughout the world. The article presents analysis of different approaches to the surgical treatment of super and “super-super” obesity. The range of methods varies from one-stage restrictive interventions to the use of multi-component combined operations with long-term preoperative preparation. In general, the opinions of the experts seem to be different, so at the present time there are no uniform recommendations for treating patients with extreme obesity, the fact determining the need for further research

Journal of Experimental and Clinical Surgery. 2020;13(3):262-267
pages 262-267 views

Intraoperative Tactics of Local Surgical Hemostasis in Injuries and Planned Operations on the Parenchymal Organs of the Abdominal Cavity

Severinov D.A., Bondarev G.A., Lipatov V.A., Saakyan A.R.


Currently, mortality rate in the liver and spleen injuries remains high, despite the present-day level of advances in the diagnosis and treatment of surgical diseases. Damage to parenchymal organs leads to the development of intra-abdominal bleeding. The severity of bleeding depends on the anatomical features of the blood supply to the damaged organ and the massiveness of the lesion, the type of traumatic agent. Intraoperative provision of reliable hemostasis is a significant problem in liver and spleen injuries. This paper summarizes the experience of Russian and foreign experts on surgical treatment of various types of parenchymal organ injuries. Stitching, adhesive compositions, biological and synthetic films, non-contact methods are used to achieve the final intraoperative hemostasis for parenchymal organ injuries; electrocoagulation is also very popular. Currently, the issues of surgical treatment tactics of spleen and liver injuries are not fully resolved. The search for optimal options, as well as technical advancement of organ-preserving operation techniques involving parenchymal organs, remains relevant. This depends on the structural features of these organs, availability of the methods of local hemostasis listed in this paper and surgeon's knowledge and manual skills. Moreover, at present, hemostatic application agents are widely introduced into clinical practice, parenchymal bleeding caused by superficial planar injuries of parenchymal organs being the main indication for the use of these agents.

Journal of Experimental and Clinical Surgery. 2020;13(3):268-278
pages 268-278 views

Application of Hydrogel Wound Dressings Combined with Bacteriophages

Beschastnov V.V., Yudanova T.N., Begun S.M., Luzan A.S., Shirokova I.Y., Belyanina N.A., Pavlenko I.V., Tulupov A.A., Leontiev A.E.


Treatment of soft tissue wound defects, especially those with a tendency to a prolonged chronic course, is a serious problem. The increase in the number of local infectious complications after surgical interventions, including orthopedic and trauma ones, requires to search for new opportunities in solving the problem of prevention and treatment of acute and chronic surgical infection. The increase in the number of multi-resistant nosocomial microflora resistant to a wide range of modern antibacterial drugs, as well as the ability of some bacterial agents to form structured biofilm colonies under certain conditions, significantly complicates the work of surgeons. Phage therapy is a promising field in the treatment of infections that is being actively developed in Western Europe, the Asian region, and the United States. Based on the experience of foreign experts, the article describes possible options of bacteriophage interaction with hydrogels, ways of fixing phage particles in hydrogel-based wound dressings, and possible effective combinations of phages with other substances.

Journal of Experimental and Clinical Surgery. 2020;13(3):279-284
pages 279-284 views

Intraoperative Diagnostics of Ischemic Damage to the Small Intestine: Current Opportunities and Unsolved Challenges

Baleev M.S., Sizov M.A., Romanov I.N., Mokeev O.A., Vorobiev A.N., Baleeva M.V., Kozharinov V.S.


Management of patients with acute intestinal ischemia remains a serious challenge for specialists involved in urgent surgery. The paper presents current trends review on the intraoperative assessment of the intestinal microvasculature during its ischemic damage, including the initial intervention and re-examination operations. The pros and cons of X-ray angiography, spiral computed tomography (CT), magnetic resonance imaging (MRI), laser Doppler flowmetry, methods based on the use of exogenous fluors and photosensitizers are described in details. The features of second-look operations in open and laparoscopic modes, their advantages and disadvantages, possible complications, indications and contraindications to each of these methods are closely examined. Particular attention is paid to the perspectives of using optical coherence tomography in surgery. However, despite all the achievements of modern surgery in the treatment of patients with acute intestinal ischemia, the problem of surgical tactics has not been completely resolved. Novel knowledge about the development of necrosis in the intestinal wall will reduce the volume of its resection and the incidence rate of postoperative complications.

Journal of Experimental and Clinical Surgery. 2020;13(3):285-292
pages 285-292 views

Experimental Modeling of Necrotizing Enterocolitis: Pathogenesis, Predictors, Prevention of the Disease

Karpova I., Molchanova D., Ladygina T.


Introduction. The incidence rate of necrotizing enterocolitis is 2.4:1000 of newborns. The number of complications reaches 51-68%, and mortality rate varies from 4 to 80%.
The aim of the study was to present current data of Russian and foreign experimental studies related to necrotizing enterocolitis in children.
Results. Currently, infants with low and very low body weight constitute the most proportion of patients with enterocolitis; the development of the disease in this cohort of patients has its distinctive features. In this regard, the issues of pathogenesis, the impact of risk factors and methods of prevention of the pathological process remain underinvestigated. Experimental models were used to study the features of the toll-interleukin 1 receptor domain containing adapter protein (TIRAP), the etiology of Toll-like receptor 4 expression, and the reasons for the increased levels of inflammatory mediators. The mechanism of intestinal-brain reciprocal communication was confirmed. The role of the bacterial flora and effectiveness of the antibacterial drug effect on this flora was also determined. Biomarkers of enterocolitis, such as an epidermal growth factor, interleukins, claudins 2, 3, 4, were detected using experimental modeling. Various options for disease prevention ranging from ischemic preconditioning to probiotics application and breastfeeding were analyzed, the latter ones having beneficial ability to form natural defenses in newborns.
Conclusions. Thus, necrotizing enterocolitis is a severe systemic disease. Experimental modeling allows analyzing the most complex, unsolved problems and introducing novel knowledge into clinical practice.

Journal of Experimental and Clinical Surgery. 2020;13(3):293-300
pages 293-300 views


Alexander Nikolaevich BAKULEV - Soviet surgeon-scientist, the founder of cardiovascular surgery in the USSR (to the 130th of birthday)

Andreev A.A., Ostroushko A.P.


Alexander Bakulev was born in the village Nebankovskaya Vyatka province. He studied first at the parish school, and then at the Vyatka theological Seminary. In 1911 he entered the medical faculty of Saratov University. In 1918, he passed the exams for a doctor's degree ahead of schedule and remained in the hospital surgery clinic of the University. In 1926 A. N. Bakulev entered the residency at the Department of surgery of the 2nd Moscow medical Institute. In 1928 he successfully defended his thesis and was sent for a one-year internship in Germany. For the first time in the domestic practice, he proposed the introduction of radiopaque substances in the brain tissue, a method of ureteral transplantation, improved methods of x-ray examination of vessels, kidneys and ureters, developed methods of plastic esophagus (1935), surgery on the biliary tract, methods of surgical treatment of peptic ulcer, for the first time in the world surgically eliminated the fixation of the heart muscle to the heart bag with pericarditis, developed new methods of treatment of brain abscesses. A. N. Bakulev is considered a pioneer of intubation anesthesia in the USSR, the founder of thoracic and radical pulmonary surgery. He performed a successful lobectomy for chronic abscess (1938) and lung actinomycosis (1939). In 1943 A. N. Bakulev became head of the Department. During the great Patriotic war A. N. Bakulev - front, and then chief surgeon of the evacuation hospitals of Moscow, head of the surgical Department of the hospital medical and sanitary Department of the Kremlin. He successfully removed a lung from a patient with chronic suppurative process (1945), for the first time carried out a successful operation in nezaradene known to inhibit the Bayou (1948), have developed a method comissurotomy. In 1949, A. N. Bakulev was awarded the Stalin prize (1949). He was the first to impose an anastomosis between the superior Vena cava and pulmonary artery, performed surgery for aneurysm of the thoracic aorta, created a technology of heart operations in hypothermia, for the first time in the world he began to operate on children suffering from congenital heart defects. In 1955 on the initiative of A. N. Bakuleva was established Institute of thoracic surgery (now the Institute of cardiovascular surgery. A. N. Bakuleva), the first Director of which he became. Among his developments can be noted the method of electrocardio-stimulation, intended for the treatment of heart rhythm disorders, a method of plasty of coronary vessels in acute myocardial infarction. In the mid-fifties A. N. Bakulev lays the foundations of shunting operations on the vessels of the heart. In 1957 he was awarded the Lenin prize. In 1959 A. N. Bakulev performed a successful operation for valvular stenosis of the pulmonary artery. In 1958, the scientist was elected a full member of the USSR Academy of Sciences. From 1953 to 1960 – President of the USSR Academy of Sciences. A. N. Bakulev was awarded three orders of Lenin, the order of the red banner of Labor and the red Star, was awarded the highest international award of surgeons – the award "Golden scalpel". On March 31, 1967, Alexander Bakulev died suddenly from cardiac arrest and was buried at Novodevichy cemetery. In memory of Alexander Nikolaevich in 2005, a documentary film "the Key to the heart" was shot in front of the Institute of cardiovascular surgery named after A. N. Bakulev monument to the scientist, and the building – a plaque.

Journal of Experimental and Clinical Surgery. 2020;13(3):301
pages 301 views

Rudolf MATAS-the father of modern vascular surgery (to the 160th of birthday)

Andreev A.A., Ostroushko A.P.


Рудольф Матас родился в 1860 году в США. В 1880 году Матасу окончил медицинский колледж университета Луизианы со степенью доктора медицины. Он работал хирургом, профессором анатомии, редактором новоорлеанского медицинского и хирургического журнала. Он разработал и осуществил в 1888 году операцию по поводу травматической артериальной аневризмы (операция Матаса), за что его сегодня часто называют “отцом современной сосудистой хирургии”. В 1888 году Рудольф Матас, с целью купирования послеоперационного гиповолемического шока, использовал внутривенный физиологический раствор. В 1894 Г.. стал профессором и заведующим кафедрой хирургии в Тулане, которую возглавлял в течение 33 лет. В 1899 году он опубликовал доклад об успехах спинномозговой анестезии с использованием кокаина, став первым хирургом в Соединенных Штатах, который использовал спинномозговую анестезию. Он был первым хирургом в мире, который использовал субарахноидальное введение опиатов в спинномозговой анестезии. В 1906 году он разработал зажим для контроля скорости вливания внутривенных растворов. Рудольф Матас был избран президентом Американской коллегии хирургов и Американской ассоциации торакальной хирургии, получил шесть почетных степеней, был признан почетным членом и награжден медалями хирургических обществ двенадцати стран. В 1908 году он перенес энуклеацию правого глаза. В возрасте 92 лет почти полностью ослеп. Он умер в 1957 году. В 1937 году его именем была названа библиотека медицинской школы Тулейнского университета штата Луизиана.

Journal of Experimental and Clinical Surgery. 2020;13(3):302
pages 302 views

Bernhard Rudolf Conrad von LANGENBECK - founder and first Chairman of the German society of surgeons(to the 210th of birthday)

Andreev A.A., Ostroushko A.P.


  1. Langenbek was born in 1810 in the family of a rural pastor. At 19, he entered the medical faculty of the University of Göttingen, where he graduated with the title of doctor. In 1834, Mr .. He received a doctorate in medicine and after doing scientific practice in Belgium, France and England. In 1838, Bernhard Langenbeck received the title of Privatdocent, in 1841 he was elected extraordinary professor of the Department of Pathological Anatomy of the University of Göttingen, becoming an assistant clinic. B. Langenbek, is developing a number of surgical interventions that bring him wide popularity in the surgical world. Since 1841, B. Langenbek - head of the Department of Surgery in Kiel, then in Berlin. He is the pioneer of German scientific surgery, ensuring its rapid scientific progress in Germany.

Langenbek operates a lot on bones and joints, performs plastic surgeries, pharynx and larynx extirpation, resection of the tongue, removal of the uterus, ovariotomy, etc. Today, more than 20 surgical methods associated with the name of B. Langenbek are known, and a retractor proposed by B. Langenbek is used; hemostatic tourniquet developed by F. Esmarch and Langenbeck.

Langenbeck advocated regular postgraduate education, the establishment of a higher educational institution for military doctors, created the Red Cross Society committee in Germany, the scientific society of military doctors, founded the scientific journal Archive of Clinical Surgery, the German Society of Surgeons, whose first chairman was from 1872 to 1885 Langenbek was awarded the title of Major General and the rank of Actual Privy Councilor. September 29, 1887 Langenbek "suddenly died of a blow." On June 8, 1892, the grand opening of the Langenbeck House, which became the property of the German Society of Surgeons, took place in Berlin. Bernhard Langenbeck remains the first magnitude star among the luminaries of German surgery.

Journal of Experimental and Clinical Surgery. 2020;13(3):303
pages 303 views

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