Vol 16, No 4 (2023)

Background. The safety of self-retaining barbed suture material application when closing wounds of hollow organs and forming anastomoses remains controversial. Data on the use of self-retaining barbed suture material at the stage of a single anastomosis formation during mini gastric bypass laparoscopic surgery (mini gastric bypass - MGB) in the treatment of morbid obesity is scarce and includes both examples of suturing a technological hole after the implementation of a hardware technique, and totally hand-sewn intracorporeal knotless formation of a gastrojejunostomy. 
The aim of the study was to evaluate the immediate effects of single-row continuous sutures performed with self-retaining barbed unidirectional suture material for intracorporeal hand-sewn gastrojejunostomy during MGB.
Methods. The study included 116 patients with grade II-III obesity who underwent MGB. The total duration of operations and the duration of the gastrojejunostomy stage, the volume of intraoperative blood loss, the frequency and severity of intra- and postoperative complications were prospectively studied in accordance with the unified classifications of Satava-Kazaryan and Accordion, respectively. The first group consisted of 56 patients; a conventional synthetic (polydioxanone) monofilament suture material was used for hand-sewn gastrojejunostomy in patients of this group. The second group consisted of 60 patients; gastrojejunostomy was performed with single-needle unidirectional self-retaining barbed absorbable polyester monofilaments in patients of this group. The study groups did not differ significantly in demographic characteristics, body mass index (BMI), the nature of comorbid pathology and the frequency of previous operations. 
Results. The use of unidirectional self-retaining barbed suture material for a hand-sewn intracorporeal single-row gastrojejunostomy in MGB was accompanied by a significant reduction in the total duration of interventions due to a reduced gastrojejunostomy stage if compared with the use of conventional synthetic monofilaments. The median volume of blood loss during operations did not exceed 50 ml and had no significant differences between groups. Intraoperatively, in patients of the study groups there were registered only complications of the first degree of severity, according to the Satava-Kazaryan classification, with a frequency of 6.7-8.9% (p = 0.737). In the postoperative period, the development of minor complications (first severity of the Accordion system) occurred in 19.6% and 16.7% of patients of the first and second groups, respectively (p = 0.810). The duration of hospital stay was 3.0 (2.5; 3.0) and 2.7 (2.7; 3.0) days in the first and second groups, respectively (р=0,790).
Conclusion. The achieved reduced duration of MGB due to the reduced stage of gastrojejunostomy with self-retaining barbed unidirectional suture material, and comparable immediate effects of surgical treatment in patients of the first and second groups demonstrate significant outcomes. Further study is necessary to investigate long-term effects of the knotless suture application for a single anastomosis formation during MGB surgery.

Background. Primary and secondary malignant neoplasms and liver damage affect more than 500 million people worldwide; one million of these people die annually. Secondary malignant neoplasms of the liver occur in every fourth cancer patient, 60% of them require liver resection. As reported, post-resection liver failure occurs in 32–60% of cases. Thus, at the current stage of medicine development, the search for novel options to stimulate reparative liver regeneration remains a challenging issue in surgery. 
The aim of the study was to stimulate post-resection liver regeneration by intraoperative intrahepatic and intraperitoneal administration of cyanocobalamin and ademetionine in an experiment.
Materials and methods. This research is a prospective randomized study carried out at the Research Institute of Experimental Biology and Medicine, N.N. Burdenko Voronezh State Medical University (VSMU), Ministry of Health of the Russian Federation. Experiments involved 192 mature male Wistar rats, who underwent conventional liver resection (CLR) equal approximately to 70% of the initial liver volume, according to the approach proposed by G. Higgins and R. Anderson. The effect of intraperitoneal administration of ademetionine and cyanocobalamin on post-resection liver regeneration was investigated in the first block of the study. The effect of intraoperative intrahepatic injections and intrahepatic administration of drugs on post-resection liver regeneration was tested in the second block of the study. The combined use of ademetionine and cyanocobalamin and their effect on post-resection liver regeneration was studied in the third block of the study. Physical examination and laboratory findings were used to assess reparative processes. The data were processed statistically using the STATGRAPHICS Centurion 18 software package, version 18.1.12 (Statgraphics Technologies, Inc., USA). The analysis of variance (ANOVA) was applied to compare mean values for eight different group.
Results. The study detected that intraperitoneal administration of ademetionine helps to normalize the general condition and biochemical parameters in 77.78% of animals. Intraperitoneal administration of cyanocobalamin does not have a significant effect on biochemical parameters, including oxidative stress. Intrahepatic administration of cyanocobalamin helps to increase the reparative liver potential, results in decreased rates of cytolysis and cholestasis syndromes, restoration of carbohydrate and fat metabolism, and increased expression of growth factors. Intrahepatic administration of ademetionine leads to decreased regenerative liver potentials, disruption of its functional activity, and decreasd protective antioxidant properties. 
Conclusion. Thus, the optimal intraoperative option to stimulate reparative liver regeneration in the experiment is the intrahepatic administration of cyanocobalamin supplemented by intraperitoneal administration of ademetionine. In 7 days after liver resection, this helps normalize biochemical parameters, relieves oxidative stress, and increases IL-1β and TGF-β1. In 14 days after resection, the abovementioned events  lead to restoration of 95.04% of the initial liver weight, if compared with intraperitoneal administration of cyanocobalamin and ademetionine (p<0,05).

Background. Long-term non-healing wounds are one of the common complications of multiple diseases, injuries and surgical interventions. In order to optimize their treatment options, experimental simulation of the wound process are created and improved.
The aim of study was to develop an experimentally simulated trophic purulent wound, and to evaluate the potential of its use to study the impact of various factors on the wound process.
Materials and methods. The trophic purulent wound simulation was performed on 80 nonlinear albino rats. Experimental wounds were formed using a silicone disk, the inner edges of which were sutured to a round wound formed in the interscapular region of the animal. Next, the silicone disc was sutured to the skin along the outer edge and additional sutures were placed around the disc to enhance tissue ischemia. The fascia at the bottom of the wound was incised, the bottom of the wound was crushed with a clamp, and a bacterial culture was injected into the wound defect. The developed model was evaluated visually, using thermometry, luminescent analysis, planimetry, microbiological, cytological and morphological tests.
Results. The features of the simulated wound allowed achieving the size and protection similar to experimental wounds, and forming trophic disorders in the tissues, In 48 hours, a picture of a complicated purulent process was observed in most animals. The data obtained during the analysis of the proposed experimental model confirmed its quality, simplicity and reproducibility.
Conclusion. The proposed approach can be recommended to study protracted wound processes and various factors affecting them.