Vol 13, No 4 (2020)

Full Issue

Original articles

Recurrent Serous Carcinoma of the Right Fallopian Tube Involving the Dome of Cecum and Rectum

Yurcovskaya A.I., Stepanova Y.A., Kalinin D.V., Kozlov I.A.


Cancer of the fallopian tube is a rare and difficult condition to be treated. It is often clinically simulated by ovarian epithelial cancer or primary ovarian and peritoneal carcinomas. Most of relapses in these tumors are observed in the small pelvis. Extrapelvic relapses and metastases to other organs are rather uncommon. Surgical cytoreduction and platinum-based chemotherapy are the mainstay of treatment.
The authors present a rare and noteworthy clinical case of recurrence of high-grade serous carcinoma of the right fallopian tube involving the caecum dome and rectum in a 65-year-old female patient. There was demonstrated the choice of surgical treatment tactics in this clinical case that allowed obtaining a 62-month survival result.

Journal of Experimental and Clinical Surgery. 2020;13(4):304-311
pages 304-311 views

Efficacy of Miramistin-Metronidazole Combination in the Treatment of Purulent-Inflammatory Processes of Soft Tissues

Sukovatych B.S., Blinkov Y.Y., Tiganov S.I., Grigoryan A.Y., Bezhin A.I., Pankrusheva T.А., Chekmaryova M.S.


Importance of the topic. The patients with purulent-inflammatory processes of soft tissues are the most common category of surgical patients, since the effectiveness of their treatment decreases due to the development of microorganism resistance to antibiotics and antiseptics.
The aim of research was to study the clinical efficacy of topical application of miramistin-metronidazole combination immobilized on sodium salt of carboxymethyl cellulose in the treatment of purulent-inflammatory processes of soft tissues.
Materials and methods. The study included 60 patients with purulent-inflammatory diseases of soft tissues. They were divided into 2 groups, 30 people in each group. All patients were exposed to partial surgical treatment of the purulent focus. In the first group, the treatment consisted of local application of dioxomethyltetrahydropyrimidine ointment with the antibiotic chloramphenicol, and in the second group – with miramistin-metronidazole combination immobilized on the sodium salt of carboxymethylcellulose. The course of the wound process was assessed by the dynamics of the local wound temperature, the percentage of reduction of the wound size and volume and the rate of its healing; the terms of edema and purulent discharge elimination, the onset of the appearance of mature granulations and epithelialization of wounds, the cessation of the microflora growth in wounds, the average number of inpatient days were also registered.
Results. Measurements of the local wound temperature demonstrated that the inflammatory process in patients of the first group lasted for 10 days, and in patients of the second group – for 5-6 days. Prior to discharge from the hospital, the wound area was 16.1% and the volume of wounds was 14% less in patients of the second group compared with similar findings in patients of the first group. The edema of the tissues surrounding the wound eliminated within 1.5 days, and the exudation from the wound stopped 2 days earlier in patients of the second group. Granulation in the wound appeared 2 days, and marginal epithelialization 1 day earlier in patients of the second group. With bacterial culturing of the wound discharge, the growth ceased 1 day earlier in patients of the second group compared to patients in the first group. Such dynamics of the course of the wound process led to a 3 bed-day decrease in the hospital stay of patients of the second group.
Conclusion. Local treatment of purulent-inflammatory diseases of soft tissues with miramistin-metronidazole combination allowed optimizing the course of the wound process, reducing duration of inpatient stay.

Journal of Experimental and Clinical Surgery. 2020;13(4):312-318
pages 312-318 views

Efficacy of the New Hemostatic Composite Based on Sodium Gel Carboxymethylcellulose and Aminocaproic Acid: Experimental Application after Partial Splenectomy in Rats

Soldatova D.S., Begin A.I., Ishunina T.A.


Backgraund. Spleen surgery is mainly aimed to achieve effective hemostasis. The increasing popularity of topical hemostatic drugs is limited by their common side effect associated with the development of adhesions.
The aim of study was to develop a new hemostatic drug with anti-adhesion activity. To achieve this, the authors have investigated 6% sodium carboxymethylcellulose gel with the addition of 5% aminocaproic acid.
Materials and methods. The efficacy of the sample was studied experimentally in laboratory animals (rats, n = 87). The time of bleeding arrest, the amount of blood loss, the severity of the adhesion process, morphological and histological changes in tissues in the area of material implantation were assessed.
Results. The study results evidenced that the new hemostatic drug reduced bleeding time by 68% (222.27 sec) and blood loss by 69% (285.6 mg) (p <0.01) after partial splenectomy, and prevented the development of adhesive process compared to the results obtained in the animals of the control group. On the 3rd day of the experiment application of the sample demonstrated that adhesions were completely absent, the coefficient of the severity of the adhesive process was 0 points; on the 7th and 14th days it was minimal - 0.481 and 0.486 points, respectively (p <0.05). A morphological study showed that the use of the new composite reduced the white pulp immunological reactivity associated with postoperative inflammatory processes, which is manifested by smaller lymphoid follicles and lower CD4 + T-lymphocytes expression.
Conclusions. Thus, 6% sodium carboxymethylcellulose gel with the addition of 5% aminocaproic acid is an effective combined hemostatic and anti-adhesion agent that can be effectively applied in spleen surgery.

Journal of Experimental and Clinical Surgery. 2020;13(4):319-325
pages 319-325 views

Use of Upper-Posterior Thoracoplasty in the Treatment of Patients with Fibrous-Cavernous Pulmonary Tuberculosis

Belov S.A.


Introduction. SSurgical care for patients with fibrous-cavernous and cavernous pulmonary tuberculosis (TB) most often ends with thoracoplasty due to impossibility to use resection methods of treatment.
The aim of study was to assess results of application of various upper-posterior thoracoplasty options in the treatment of patients with fibrous-cavernous pulmonary TB.
Materials and methods. The author analyzed results of 233 thoracoplasties performed in patients with fibro-cavernous pulmonary TB in 2012-2018. Group 1 (n = 70) consisted of patients with selective extrapleural upper-posterior thoracoplasty with polypropylene mesh; Group 2 (n = 60) consisted of patients with osteoplastic thoracoplasty according to Bjork; Group 3 (n = 103) consisted of patients with traditional selective extrapleural upper-posterior thoracoplasty. The following parameters were analyzed: elimination of the destruction cavity, stabilization of the specific process and termination of the excretion of Mycobacterium tuberculosis during the year. The results were summarized in groups based on good clinical effect, satisfactory clinical effect, worsening, death.
Results. Thoracoplasty treatment option with a compression device (mesh) application resulted in the increased degree of compression in the intervention area by 30%, compared with the traditional upper-posterior thoracoplasty option and osteoplasty according to Bjork (p <0.05), and reduced the number of bronchopulmonary complications by 15% (p <0.05).
Conclusions. The use of a mesh prosthesis leads to an increased effective compression of the destruction cavity, creates conditions for healing of the pulmonary tissue defect and reduces the risk of developing bronchopulmonary complications

Journal of Experimental and Clinical Surgery. 2020;13(4):326-330
pages 326-330 views

Modified Method for Correction of Pectus Excavatum in Children

Slizovskiy G.V., Kuzhelivskiy I.I., Kozyrev A.A., Shikunova Y.V., Sigareva Y.A.


Background. Chest deformities occur in 7% of the population, of them funnel deformation of the thorax constitutes more than 80%. Surgical correction appears to be the only way to change the configuration of the chest. The Nuss procedure is the "gold standard" to correct this deformity. This technique was modified in the clinic of the Department of Pediatric Surgical Diseases, Siberian State Medical University, Tomsk. The necessity to compare the Nuss procedure and its modified option has arisen due to accumulated experience in surgical interventions performed.
The aim of the study was to describe a modified technique of the funnel deformation of the thorax and assess its effectiveness compared to the classical Nuss procedure.
Material and methods. The study included results of surgical treatment of 94 children, both sexes, aged 10 to 17 years, who had the funnel deformation of the thorax. All patients were divided into two groups: the main group (45 patients), where a modified technique of surgical correction was applied, and the comparison group (49 patients), where the classical Nuss procedure was applied for the deformity correction. For the surgical correction of the funnel deformity of the thorax, improved plates made of smooth titanium nickelide were used to fix the sternocostal complex in children of the main group. The following criteria were selected to compare the effectiveness of two surgical options of the funnel deformation correction: intraoperative parameters, Gizycka index, the scale of role functioning SF-36, VAS of pain and the number of complications. The arithmetic mean number was derived based on the above criteria - the total efficiency coefficient; clinical results were defined depending on this coefficient - good, satisfactory and unsatisfactory.
Results. The number of good results in patients of the main group, where modified surgery technique was applied, was 62.3% compared to 38.8% in patients who were exposed to the Nuss procedure. The number of satisfactory results in patients of the main group was 35.5% compared to 34.7% in patients of the comparison group. It should be noted that the use of the modified technique had unsatisfactory results in 2.2% of cases (in 1 patient), while the use of the conventional Nuss procedure resulted in unsatisfactory outcomes in 26.5% of cases.
Conclusions. Clinical outcomes of surgical correction performed using modified technique of the Nuss procedure are more beneficial in terms of the duration of intervention, the volume of blood loss, and the number of postoperative complications. This technique allows minimizing invasiveness of the procedure and starting early rehabilitation.

Journal of Experimental and Clinical Surgery. 2020;13(4):331-337
pages 331-337 views


Multiple Primary Advanced Metachronous Cancer of Abdominal Organs with Multifocal Obstructive Syndrome: a Clinical Case of Successful Complex Treatment

Redkin A.N., Ustinova E.Y., Popov S.S., Manukovskaya O.V., Konoplina J.S., Vdovin V.V.


Impaired patency of the gastrointestinal and urinary tract, and bile ducts is one of the essential problems in oncological practice in patients with tumors of various localizations. Stenoses are one of the most severe complications of the course of tumor diseases.
Obstruction is a polyetiological condition that can result from a primary tumor lesion and specific neoplastic processes of nearby organs and structures. Sometimes narrowing of the lumen of organs and ducts can occur as a result of reactive scar tissue changes along the periphery of tumors. In some cases stenosis manifests itself as a complication of certain stages of treatment (surgical, radiation).
The development of stenoses of the large intestine, the pylorus, the bile and urinary tracts significantly reduces the quality of life of patients due to the increasing obstruction of the above structures. Elimination of this syndrome is the main aim of treatment, regardless of the presence of tumor or non-tumor complications that have arisen.

Journal of Experimental and Clinical Surgery. 2020;13(4):338-343
pages 338-343 views

Pediatric Lymphoma Complicated by Intussusception

Shidakov I.K.


Intestinal intussusception is rare in children over the age of 6 years and, in most cases, is due to the presence of anatomical reasons. Tumors of the gastrointestinal tract are one of the etiological factors in the development of ileus in older children. The paper presents the case of a 7-year-old child who was admitted to the clinic with the abdominal pain syndrome that resolved on its own. With a repeated pain attack, intestinal intussusception was diagnosed, the patient was urgently operated. Laparoscopic complete reduction of intussusception failed, which required conversion of the access. After straightening the intussusception of the small intestine, there was detected a tumor of the ileum, which practically blocked the intestinal lumen. The segment of the intestine with the tumor was resected with an end-to-end anastomosis. In the postoperative period, the patient was diagnosed with intestinal lymphoma based on the test studies of the operating material. After stabilizing the condition, the child was transferred to an oncological center.
Journal of Experimental and Clinical Surgery. 2020;13(4):344-347
pages 344-347 views

Treatment of Foot Deformities in Children under 3

Krestyashin I.V., Razumovskiy A.Y., Krestyashin V.M., Kuzhelivskiy I.I.


Introduction. The choice of treatment options of foot deformity in children is the most acute in the first years of life. In this regard, the need for hospital stay of a child is debatable today. A number of interventions in the treatment of foot pathology can be performed on an outpatient basis.
The aim of this study was to improve clinical outcomes of pes equino-varus treatment using the Ponseti procedure, and the Dobbs vertical talus correction combined with massage, physiotherapy and exercise therapy on the outpatient and inpatient basis in pediatric population.
Methods. The study included 106 children who were examined and treated at N.F. Filatov Children's City Clinical Hospital in 2015-2020.
Results. The study revealed that, if left untreated, the orthopedic pathology of the feet in children is often accompanied by pain, functional changes and a high risk of disability, the fact evidencing high social significance of the studied nosology. In all examined children a congenital deformity of the foot was completely eliminated after a comprehensive assessment and a combination of conservative and surgical correction techniques.
Conclusions. Careful adherence to the Ponseti procedure is required to achieve a complete pes equino-varus correction. Early beginning of correction is the most beneficial due to its effectiveness.

Journal of Experimental and Clinical Surgery. 2020;13(4):348-352
pages 348-352 views

Review of literature

Treatment Options for Chronic Hemorrhoids

Ektov V.N., Somov K.A., Kurkin A.V., Muzalkov V.A.


The paper provides an overview of various treatment options for chronic hemorrhoids based on current national and international recommendations. The publication describes the basic principles of effective conservative therapy of the disease. Methods of minimally invasive treatment options for chronic hemorrhoids are given in details: sclerotherapy, infrared coagulation, latex ligation; advantages and disadvantages of each of these methods are highlighted. Literature data indicate that surgical removal of hemorrhoids remains an effective method of treatment for patients with hemorrhoids stage III – IV, who underwent unsuccessful minimally invasive procedures. The characteristics of possible complications after hemorrhoidectomy and the frequency of their occurrence are also given. The authors analyze results of using stapler hemorrhoidopexy and the technique of Doppler-controlled ligation of hemorrhoidal arteries. Despite the variety of techniques, it remains relevant to search for further treatment options for chronic hemorrhoids in order to choose an effective individual treatment tactics for each patient, taking into account various manifestations of hemorrhoidal disease.

Journal of Experimental and Clinical Surgery. 2020;13(4):353-361
pages 353-361 views

A Modern View on the Diagnosis and Treatment of Necrotizing Enterocolitis in Newborns

Karpova I.Y., Molchanova D.V., Ladygina T.M.


The aim of the study is to present modern methods of diagnosis and treatment of necrotizing enterocolitis (NEC) in newborns.
According to Russian and foreign literature, up to 7.2% of newborns with NEC are admitted to intensive care units. The overall mortality rate in enterocolitis remains at the level of 15%, and in the surgical stages of the disease ranges from 26 to 31%.
It is known that the transferred hypoxia and asphyxia lead to vascular disorders. In addition, colonization of the intestine by pathogenic flora takes the leading place in the progression of the process.
In order to diagnose NEC, an overview X-ray of the abdominal organs is performed, which reveals such typical changes as: pneumatosis intestinalis, pneumoperitoneum, gastric dilatation, and the presence of a static bowel loop. Ultrasound examination of the abdominal organs confirms enterocolitis in 90% of cases. If necessary, instrumental examination findings are assessed in dynamics. Quantitative changes in the parameters of procalcitonin, calprotectin, cathelicidin, alkaline phosphadase are detected with the help of laboratory diagnostics. It is noted that TGF-β1, FXIII factors, thymic index (TI), proteins (FABP2, claudin-2, GFAP) parameters vary at different stages of the disease.
Researchers highlight the importance of NEC prevention, a special role is given to breastfeeding. Treatment of necrotizing enterocolitis depends on the stage of the disease and the severity of symptoms, and consists of conservative therapy and surgical correction. The timeliness and necessity of prescribing antibiotics is being actively discussed. Most surgeons emphasize the therapeutic and diagnostic role of laparocentesis; the imposition of preventive intestinal stomas is considered the operation of choice. The medical periodical publications present the experience of using laparoscopy in newborns with the surgical stage of NEC. In addition to the generally accepted methods of treatment, researchers suggest options aimed at improving the clinical outcome of disease correction (vacuum therapy, the introduction of an "oxygen cocktail").

Journal of Experimental and Clinical Surgery. 2020;13(4):362-370
pages 362-370 views


Nina Viktorinovna BOBROVА The living force of traditions

Cherednikov E.F., Glukhov А.А., Polubkova G.V., Visockaya A.T.



Journal of Experimental and Clinical Surgery. 2020;13(4):371-372
pages 371-372 views

Peter Ivanovich DYAKONOV – the leader of the national surgery(to the 165th of birthday)

Andreev A.A., Ostroushko A.P.



Journal of Experimental and Clinical Surgery. 2020;13(4):373-373
pages 373-373 views

Alexander Alekseyevich BOBROV-surgeon, organizer of the Society of Russian surgeons (to the 170th of birthday)

Andreev A.A., Ostroushko A.P.



Journal of Experimental and Clinical Surgery. 2020;13(4):374-374
pages 374-374 views

Ambroise PARE - the first surgeon of the four French kings (to the 510th of birthday)

Andreev A.A., Ostroushko A.P.



Journal of Experimental and Clinical Surgery. 2020;13(4):375-375
pages 375-375 views

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