Vol 16, No 3 (2023)

Full Issue

Original articles

The Choice of the Method of Pancreatoenteroanastomosis Formation in Patients with Chronic Pancreatitis and Malignant Neoplasms of Pancreas

Tarasenko S.V., Peskov P.D., Zhuchkova U.V., Glotov D.A., Bakonina I.V.


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.

Journal of Experimental and Clinical Surgery. 2023;16(3):204-211
pages 204-211 views

Immediate and delayed complications of transarterial chemoembolization with drug-saturable microspheres in unresectable liver tumors

Zvezdkina E.A., Kedrova A.G., Lebedev D.P., Panchenkov D.N., Аstakhov D.A., Stepanova Y.A.


Backgraund: For many years of world experience in the use of transarterial chemoembolization (TACE) on liver tumors, data have appeared on immediate and delayed complications, which, however, represent a description of clinical observations or literature reviews compiled on their basis. There are currently no systematic studies that study the timing of complications and risk factors.
Aims: to evaluate immediate and delayed complications of transarterial chemoembolization with drug-saturable microspheres in the treatment of unresectable malignant liver tumors.
Materials and methods: A retrospective observational uncontrolled study that included 75 patients with unresectable liver disease (65 patients with metastases, 10 patients with primary malignant tumors) who underwent 102 transarterial chemoembolizations with drug-saturable microspheres. The antitumor effect of TACE was assessed according to abdominal computed tomography (CT) and magnetic resonance imaging of the hepatobiliary zone (MRI) with intravenous contrast, performed within a limited time frame: no later than 2 weeks before (control 0), after 8–9 weeks (control 1) and 16–17 weeks after TACE (control 2). In the event of complications, diagnostic studies were performed as clinically necessary.
Results: 3 patients developed lesions of the biliary tree. The process began on days 2–11 after TACE with dilatation of the bile ducts in single segments; changes in 2–3 weeks took on a bilobar character, leading to the formation of bilomas (2 patients) and necrosis of the periductal liver parenchyma (1 patient). Before TACE, all three patients underwent bile duct stenting due to existing biliary hypertension. Two patients developed pancreatitis 1–2 weeks after TACE; at the same time, there were no features of vascular anatomy, non-target embolization. In 17 patients after 2-4 months after TACE according to CT and MRI, the phenomena of cholecystitis were noted. The changes were asymptomatic, leading to the formation of small stones in the gallbladder lumen after 6–10 months.
Conclusions: The immediate complications of TACE with drug-saturated microspheres (1-3%) in the treatment of unresectable liver tumors are associated with the pathology of the bile ducts and pancreas, appear in the first month, have a staging, affect the somatic condition of patients and require specific treatment. Long-term complications (23%) are associated with the reaction of the gallbladder, develop after a few months, while they are asymptomatic and do not require correction.

Journal of Experimental and Clinical Surgery. 2023;16(3):212-221
pages 212-221 views

Method of Objective Assessment of Intestinal Viability Using “Smart Light” Polychrome LED Light Source for Contrast Imaging of Biological Tissues During Surgical Operations

Adamenkov N.A., Kozlov I.O., Palalov A.A., Aladov A.V., Chernyakov A.E., Potapova E.V., Mamoshin A.V., Dunaev A.V.


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.

Journal of Experimental and Clinical Surgery. 2023;16(3):222-229
pages 222-229 views

The Use of Alginate Polymer Polysaccharide Hemostatic Hydrogel in the Treatment of Simulated Bleeding Stomach Defects

Cherednikov E.F., Баранников S.V., Yuzefovich I.S., Chernykh A.V., Banin I.N., Deryaeva O.G., Shkurina I.A.


The aim of the study was to develop in vivo and study the possibility of using alginate polymer polysaccharide hemostatic hydrogel in the treatment of experimental bleeding stomach ulcers.
Materials and methods. The in vivo experiment was conducted on the basis of the Laboratory of Experimental Surgery of the Research Institute of Experimental Biology and Medicine of the N.N. Burdenko Voronezh State Medical University. 12 healthy laboratory animals (dog) weighing from 7 to 10.5 kg were selected for the study. Two experimental bleeding stomach defects were reproduced for each animal at once, one of which was experimental, and the other was control. Stopping bleeding in the experimental group of animals was carried out by insufflation of powdered alginate polymer polysaccharide hemostatic for a bleeding defect (Patent RF №2762120). Control stomach defects were not subjected to endoscopic treatment. The results of the experimental study were evaluated according to the following indicators: the time of stopping experimental bleeding, the presence of repeated bleeding, the timing and quality of healing of the simulated defects.
Results. Experimental studies have shown that the use of alginate polymer polysaccharide hemostatic hydrogel in the endoscopic treatment of simulated bleeding stomach defects can significantly (P=0.000001) reduce the time of stopping experimental bleeding from 26.5 (25.3-32.0) sec to 6.0 (4.0-8.0) sec and helps to reduce the regeneration time of experimental defects from 14.5 (13.5-16.5) days up to 8.0 (7.5-8.5) days (P=0.000001), while improving the quality of their healing.
Conclusion. Thus, the use of alginate polymer polysaccharide hemostatic hydrogel is an effective method of treating simulated bleeding stomach defects.

Journal of Experimental and Clinical Surgery. 2023;16(3):230-235
pages 230-235 views

Cases from practice

Radical Surgical Treatment of a Patient with an Extended Burn Stricture Complicated by an Esophageal-Bronchial Fistula

Ruchkin D.V., Khamidov M.M., Okonskaya D.E., Kovalerova N.B.


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.

Journal of Experimental and Clinical Surgery. 2023;16(3):236-243
pages 236-243 views

A Clinical Case of an Extrapulmonary form of Generalized Sarcoidosis in the Practice of a Surgeon

Tarasenko S.V., Zhuchkova U.V., Glukhovets I.В.


The aim of the study is to present a clinical case of generalized sarcoidosis with no involvement of the lungs and intrathoracic lymph nodes.
Materials of the study. The literature and data of clinical observation, surgical treatment and results of autopsy of a patient with generalized sarcoidosis were analyzed.
Results. In this article the authors would like to draw attention to the case of generalized sarcoidosis with no lesions of the lungs and intrathoracic lymph nodes, which is 5% in the structure of morbidity, and present the clinical case of patient A., who was hospitalized in the surgical department of the Emergency Hospital. The patient was admitted with suspicion of urgent surgical pathology with extrapulmonary manifestations of the disease (polyserositis) and granulomatous lesions of the parietal and visceral peritoneum, extrapulmonary pleura, characteristic of sarcoidosis, and peritonitis, progression and development of a rare clinical form of this disease, neurosarcoidosis, which also amounts to no more than 10 % of all cases of this disease.
Conclusions. This clinical case could draw the attention of specialists to this multisystem disease and the need for a multidisciplinary approach to treatment and diagnosis, which may be difficult due to the absence of typical manifestations of this pathology, as in the presented clinical case. The team of authors hopes that our experience will be interesting and will allow residents to avoid diagnostic and tactical errors in the management of such patients, since we have encountered a truly unusual and rare manifestation and complication of sarcoidosis in a patient, who ended up not in a specialized therapeutic or pulmonological department, but in surgical department of a multidisciplinary hospital.

Journal of Experimental and Clinical Surgery. 2023;16(3):244-250
pages 244-250 views

Endovascular Treatment Of Paget-Schretter Disease

Sukovatykh B.S., Bolomatov N.V., Gordov M.Y., Larina n.V.


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.

Journal of Experimental and Clinical Surgery. 2023;16(3):251-255
pages 251-255 views

Difficulties in Diagnosing Volumetric Formations of the Spleen on the Example of a Clinical Case

Aralova M.V., Alimkina Y.N., Chernyh A. ., Brezhneva V.S.


Differential diagnosis of bulk splenic neoplasms, despite good visualization in ultrasound, computed tomography and magnetic resonance imaging of the abdominal cavity, causes difficulties due to the lack of a unified classification, the extremely rare occurrence of some tumors and the difficulty of preoperative morphological identification. The article describes a case of making an erroneous preoperative diagnosis in a spleen mass: the data of instrumental studies determined the presence of multiple cysts. The latter among all the neoplasms of this organ are the most common and are represented by a variety of forms, subdivided by origin, histogenesis and content features. According to some classifications, cysts are classified as tumors or tumor-like diseases, other sources classify them as non-tumor formations of the spleen. Often it is not possible to fully exclude the parasitic nature of the cyst before the morphological study of the removed organ. Surgeons of the Voronezh Regional Clinical Hospital No. 1 encountered this problem during the treatment of a 34-year-old patient with a neoplasm of the spleen. As a result of surgical treatment and pathomorphological findings, a diagnosis of lymphangioma was made. The analysis of this clinical case shows the justification of splenectomy both as a method of final diagnosis and as the final stage of treatment for benign tumors and will allow not to miss a malignant tumor.

Journal of Experimental and Clinical Surgery. 2023;16(3):256-260
pages 256-260 views

Review of literature

Immune diagnostics and immunotherapy of burn sepsis

Kozlova M.N., Zemskov V.M., Alekseev A.A.


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.

Journal of Experimental and Clinical Surgery. 2023;16(3):261-271
pages 261-271 views

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