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Year 2019 Vol. 27 No 6

SCIENTIFIC PUBLICATIONS
GENERAL & SPECIAL SURGE

V.I. RUSYN, V.V. KORSAK, V.V. RUSYN, F.V. HORLENCO, V.M. DOBOSH

ANGIOARHITECTONICS AND MORPHOMETRY OF THE DEEP FEMORAL ARTERY

Uzhhorod National University, Uzhhorod,
Ukraine

Objective. To study the surgical anatomy of the deep femoral artery.
Methods. The study of angioarchitectonics of the deep femoral artery was carried out on 20 cadavers. On one side of the lower extremity, the deep femoral artery was isolated over 17 cm, all branches of the deep artery were taken on handles, their number was fixed as well as the diameter at the level of the main trunk and distal to 17 cm, variants of the union of the medial and lateral enveloping branches, variants of the anatomical structure of the deep femoral artery and the location of the orifice relatively to the common femoral artery. After that, the superficial femoral artery at the level of the orifice was ligated and puncture-catheter angiography of the deep femoral artery was performed on a PXP-40HF mobile unit (52-58 kV, 1.8-3.2 mas) at a focal length of 1 m. For an angiographic study, 20 ml of a 76% triombrast solution was used.
Results. Based on the data revision, three main options for the structure of the deep femoral artery trunk were determined. The first variant occurred in 11 (55%) cases, where the presence of the only one trunk of the deep femoral artery from which the lateral and medial circumflex femoral arteries clearly departed. In the second variant, the lateral and medial circumflex femoral arteries and the deep femoral artery diverged separately from the common femoral artery. A feature of the anatomical structure of the deep femoral artery for the third variant was the lack of a clear distinction between the main trunk of the deep femoral artery and its branches.
Conclusions. The deep femoral artery has three main options of formation and separation from the common femoral artery. According to the divergence of the deep femoral artery from the common femoral artery, it was found out that in 50% of observations the influx of the deep femoral artery is located on the lateral semicircle, in 25% of observations – on the posterior-lateral semicircle, in 15% – on the posterior semicircle and in 10% – on the posterior medial semicircle.

Keywords: chronic limb ischemia, deep femoral artery diameter, anatomy of the deep femoral artery; femoral artery/surgery; arterial occlusive diseases
p. 615-621 of the original issue
References
  1. Koval’chuk LIa, Goshchins’kii VB, Goshchins’kii PV. Rol’ vnutr³shn’oï klubovoï arter³ï, glibokoï arter³ï ta nizkh³dnoï arter³ï kol³na v revaskuliarizats³ï nizhn³kh k³nts³vok pri khron³chn³i kritichn³i ³shem³ï. Shpital’na kh³rurg³ia. 2006;2:32-5. (In Ukr.)
  2. Taurino M, Persiani F, Ficarelli R, Filippi F, Dito R, Rizzo L. The Role of the Profundoplasty in the Modern Management of Patient with Peripheral Vascular Disease. Ann Vasc Surg. 2017 Nov;45:16-21. doi: 10.1016/j.avsg.2017.05.018
  3. Cameron JL, Cameron AM. Current Surgical Therapy. 11th ed. Philadelphia, PA: Elsevier; 2014. 878 p.
  4. Georgakarakos E, Tasopoulou KM, Koutsoumpelis A, Georgiadis GS. The importance of profunda femoris artery justifies further the endovascular approach in critical limb ischemia. Ann Vasc Surg. 2018 May;49:318-19. doi: 10.1016/j.avsg.2017.11.048
  5. Gavrilenko AV, Kotov AE, Lepshokov MK. The role of deep femoral artery plasty in chronic critical lower limb ischemia treatment. Annaly Khirurgii. 2017; 22 (6): 321-28. doi: 10.18821/1560-9502-2017- 22-6-321-328 (In Russ.)
  6. Kovanov VV, Travin AA. Khirurgicheskaia anatomiia nizhnikh konechnostei. Moscow, RF: Kniga po trebovaniiu; 2012. 525 p. https://docplayer.ru/38428496-Hirurgicheskaya-anatomiya-nizhnih-konechnostey.html (In Russ.)
  7. Gubka VA, Voloshyn AN, Gordienko OS, Suzdalenko AV. The choice of lower extremities’ femoral-deepfemoral arterial segment reconstruction method founded on intraoperation doppler ultrasound information Patolog³ia. 2010;7(3):13-16. http://nbuv.gov.ua/UJRN/pathology_2010_7_3_4 (In Russ.)
Address for correspondence:
88000, Ukraine,
Uzhhorod, Kapushanskaya Str., 22,
Uzhhorod National University,
Department of Surgical Diseases.
Tel. +8 099 73-68-098,
e-mail: v.dobosh@gmail.com,
Viktoria M. Dobosh
Information about the authors:
Rusyn Vasyl I., MD, Professor of the Department of Surgical Diseases, Uzhhorod National University, Uzhhorod, Ukraine.
http://orcid.org/0000-0001-5688-9951
Korsak Vyacheslav V., MD, Professor of the Department of Surgical Diseases, Uzhhorod National University, Uzhhorod, Ukraine.
http://orcid.org/0000-0002-4866-1882
Rusyn Vasyl V., MD, Associate Professor of the Department of Surgical Diseases, Uzhhorod National University, Uzhhorod, Ukraine.
http://orcid.org/0000-0002-0794-6777
Horlenko Fedir V., PhD, Associate Professor of the Department of Surgical Diseases, Uzhhorod National University, Uzhhorod, Ukraine.
http://orcid.org/0000-0002-0496-2069
Dobosh Viktoria M., Post-Graduate Student of the Department of Surgical Diseases, Uzhhorod National University, Uzhhorod, Ukraine.
http://orcid.org/0000-0003-2485-8266

S.N. EROSHKIN 1, L.A. FRALOU 1, Y.I. RATOMSKI 2, S.P. BABKOV 3, K.G. TSYPLAKOV 4, K.O. CHEPIK 1

EFFICACY OF PERIPHERAL ARTERY DISEASE TREATMENT BY CRUS TUNNELING IN COMBINATION WITH BONE MARROW TRANSPLANTATION DEPENDING ON THE SEVERITY OF LOWER LIMB ISCHEMIA

Vitebsk State Medical University1,
Vitebsk Central City Clinical Hospital2,
Vitebsk Regional Clinical Hospital3,
Vitebsk Regional Clinical Specialized Centre4, Vitebsk,
The Republic of Belarus

Objective. To determine the effect of bone marrow auto transplantation combined with the limb soft tissues tunneling in treatment of peripheral artery disease depending on the grade of chronic limb ischemia.
Methods. 62 men with peripheral artery disease of the lower limbs were included in the study and they were divided into three groups according to the Pokrovsky-Fontaine classification: the 1st group – IIb (15 patients), the 2nd – III grade (27 patients), the 3rd – IV grade (20 patients). In all patients, bone marrow auto transplantation combined with tunneling of the crus soft tissues was used as method of indirect revascularization. Results were assessed by the amount of amputations in every group, distance increase of painless walking, temperature of the operated limb and ankle-brachial index. The data were collected 6 and 12 months after surgery.
Results. The number of high-level amputations in the third group was more than in the first and the second ones during examinations 6 and 12 months after surgery (p=0.0001). Distance increase of painless walking in the third group was reliably less than in other groups 6 months (p=0.001) and 12 months (p=0.0001) after treatment. Furthermore, during second half year of observation distance of painless walking increased in the first (ð=0.011) and the second (ð=0.009) groups but it decreased in the third group (ð=0.003). Temperature of the operated limb during the second half year of observation had similar dynamics: it increased in the first and second groups but did not change in the third one. Reliable changes of ankle-brachial index were absent in all examined groups 6 and 12 months after
Conclusions. Bone marrow auto transplantation combined with tunneling of the crus soft tissues is more effective in patients with IIb and III grades of limb ischemia and it may be applied in these categories of patients in the case when direct revascularization is impossible.

Keywords: revascularization, critical ischemia, peripheral artery disease, tunneling, bone marrow auto transplantation
p. 622-629 of the original issue
References
  1. Dua A, Lee CJ. Epidemiology of peripheral arterial disease and critical limb ischemia. Tech Vasc Interv Radiol. 2016 Jun;19(2):91-95. doi: 10.1053/j.tvir.2016.04.001
  2. Kharazov AF, Kalyev AO, Isaev AA. PAD prevalence in Russian Federation. Khirurgiia. Zhurn im NI Pirogova. 2016;(7):58-61. doi: 10.17116/hirurgia2016758-61 (In Russ.)
  3. Belov YuV, Vinokurov IA. The concept of surgical treatment of critical limb ischemia. Kardiologiia i Serdech-Sosudistaia Khirurgiia. 2015;8(5):9-13. doi: 10.17116/kardio2015859-13 (In Russ.)
  4. Kinlay S. Management of critical limb ischemia. Circ Cardiovasc Interv. 2016 Feb;9(2):e001946. doi: 10.1161/CIRCINTERVENTIONS.115.001946
  5. Farber A, Eberhardt RT. The current state of critical limb ischemia: a systematic review. JAMA Surg. 2016 Nov 1;151(11):1070-77. doi: 10.1001/jamasurg.2016.2018
  6. Aboyans V, Ricco JB, Bartelink MEL, Björck M, Brodmann M, Cohnert T, Collet JP, Czerny M, De Carlo M, Debus S, Espinola-Klein C, Kahan T, Kownator S, Mazzolai L, Naylor AR, Roffi M, Röther J, Sprynger M, Tendera M, Tepe G, Venermo M, Vlachopoulos C, Desormais I, Document Reviewers, Widimsky P, Kolh P, Agewall S, Bueno H, Coca A, De Borst GJ, Delgado V, Dick F, Erol C, Ferrini M, Kakkos S, Katus HA, Knuuti J, Lindholt J, Mattle H, Pieniazek P, Piepoli MF, Scheinert D, Sievert H, Simpson I, Sulzenko J, Tamargo J, Tokgozoglu L, Torbicki A, Tsakountakis N, Tuñón J, de Ceniga MV, Windecker S, Zamorano JL. Editor’s Choice – 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018 Mar;55(3):305-68. doi: 10.1016/j.ejvs.2017.07.018
  7. Qadura M, Terenzi DC, Verma S, Al-Omran M, Hess DA. Concise review: cell therapy for critical limb ischemia: an integrated review of preclinical and clinical studies. Stem Cells. 2018 Feb;36(2):161-71. doi: 10.1002/stem.2751
  8. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007 Jan;45 Suppl S:S5-67. doi: 10.1016/j.jvs.2006.12.037
  9. Fedzianin SD, Kovalenko AA, Kamiandrouskaya AA, Poluyanchik EA, Denisenko AG. Revascularizing automyelotransplantation in complex treatment for diabetic angiopathy of the lower limbs. Vestn VGMU. 2019;18(1):46-51. doi: 10.22263/2312-4156.2019.1.46 (In Russ.)
  10. Maufus M, Sevestre-Pietri MA, Sessa C, Pignon B, Egelhofer H, Dupas S, Nguyen P, Genty C, Pernod G. Critical limb ischaemia and the response to bone marrow-derived cell therapy according to tcPO2 measurement. Vasa. 2017 Jan;46(1):23-28. doi: 10.1024/0301-1526/a000590
  11. Ishenin YM. Doctrine of mechanical tunneling. Vestn Sovrem Klin Meditsiny 2010;3(2). 51-54. http://vskmjournal.org/images/Files/Issues_Archive/2010/Issue_2/VSKM_2010_N_2.pdf (In Russ.)
  12. Walter DH, Krankenberg H, Balzer JO, Kalka C, Baumgartner I, Schlüter M, Tonn T, Seeger F, Dimmeler S, Lindhoff-Last E, Zeiher AM. Intraarterial administration of bone marrow mononuclear cells in patients with critical limb ischemia: a randomized-start, placebo-controlled pilot trial (PROVASA). Circ Cardiovasc Interv. 2011 Feb 1;4(1):26-37. doi: 10.1161/Circinterventions.110.958348
Address for correspondence:
210027, The Republic of Belarus,
Vitebsk, Frunze Ave., 27,
Vitebsk State Medical University,
General Surgery Department.
Tel.: +375 33 611-19-75.
e-mail: sergionik2014@gmail.com,
Sergey N. Eroshkin
Information about the authors:
Eroshkin Sergey N., PhD, Associate Professor of the General Surgery Department, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0003-3617-8719
Fralou Leanid A., PhD, Associate Professor, Head of the General Surgery Department, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
http://orcid.org/0000-0003-3357-4409
Ratomski Yury I., Head of the Surgery Unit, Vitebsk Central City Clinical Hospital, Vitebsk, Republic of Belarus.
http://orcid.org/0000-0002-1175-3193
Babkov Siarhei P., Angiosurgeon of the Endovascular Surgery Unit, Vitebsk Regional Clinical Hospital, Vitebsk, Republic of Belarus.
http://orcid.org/0000-0001-6073-4629
Tsyplakov Konstantin G., Head of the Proctology Unit, Vitebsk Regional Clinical Specialized Centre, Vitebsk, Republic of Belarus.
http://orcid.org/0000-0001-7995-9019
Chepik Kiryl O., Assistant of the General Surgery Department, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
http://orcid.org/0000-0001-8499-0248

V.YA. KHRYSHCHANOVICH 1, 2, I.P. KLIMCHUK 1, 3, R. PROCZKA 4, N.À. ROGOVOY 1, 3, S.S. KALININ 1, 3, S. MAZUR 4, Å.V. NELIPOVICH 3

RESULTS OF TRUNCAL ENDOVENOUS MECHANO-CHEMICAL ABLATION IN VARICOSE DISEASE

Belarusian State Medical University 1,
City Clinical Emergency Hospital 2,
4th City Clinical Hospital named after N.E. Savchenko 3, Minsk,
The Republic of Belarus,
Center OF Cardiology and Vascular Surgery «Jozefow» 4, Warsaw,
The Republic of Poland

Objective. To study the long-term (12-months follow-up) results of endovenous mechano-chemical ablation (MOCA) with FlebogrifTM occlusion catheter system for varicose veins (VV) in three vascular centers.
Methods. The study is based on the treatment results of 139 patients with VV. Surgeries were performed using the FlebogrifTM catheter. 123 patients (88.5%) were operated on for incompetence of the great saphenous vein (GSV) on the one side, 6 (4.3%) for bilateral lesions of the GSV, and 8 (5.8%) for the small saphenous vein (SSV) and 2 (1.4%) due to reflux in GSV and SSV. The average diameter of the target GSV and SSV segments was 8.2±1.3 mm and 4.2±1.2 mm, respectively (M±σ). Control examinations of patients were carried out 1, 3, 6 and 12 months after surgery.
Results. One month after the operation, the GSV was completely occluded in 132/136 (97.1%) veins and SSV completely closed in 10/10 (100%) veins. Six months after the endovenous mechano-chemical ablation, the GSV was completely occluded in 99/111 (89.2%) veins and SSV completely closed in 5/6 (83.3%) veins. 12 months after surgery, GSV and SSV occlusion rates were 72/85 (84.7%) and 5/6 (83.3%). There were no significant thrombotic and neurological complications related to the procedure. Skin hyperpigmentation was found in 30/137 GSV treated (21.9%), and along the varicose tributaries in 22 legs (15.2%). Transient superficial phlebitis was reported in 7 of 145 (4.8%) legs. Ecchymosis from the puncture site was reported in 26/145 legs (17.9%).
Conclusions. FlebogrifTM MOCA device is safe and effective method to eliminate the truncal venous reflux for varicose veins, associated with low perioperative pain and minimal complication rate.

Keywords: varicose veins, treatment, endovenous mechano-chemical ablation, truncal reflux, Flebogrif
p. 630-639 of the original issue
References
  1. Kanwar A, Hansrani M, Lees T, Stansby G. Trends in varicose vein therapy in England: radical changes in the last decade. Ann R Coll Surg Engl. 2010 May;92(4):341-46. doi: 10.1308/003588410X12518836440649
  2. Rasmussen LH, Lawaetz M, Bjoern L, Vennits B, Blemings A, Eklof B. Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Br J Surg. 2011 Aug;98(8):1079-87. doi: 10.1002/bjs.7555
  3. Marsden G, Perry M, Kelley K, Davies AH; Guideline Development Group. Diagnosis and management of varicose veins in the legs: summary of NICE guidance. BMJ. 2013 Jul 24;347:f4279. doi: 10.1136/bmj.f4279
  4. Gloviczki P, Comerota AJ, Dalsing MC, Eklof BG, Gillespie DL, Gloviczki ML, Lohr JM, McLafferty RB, Meissner MH, Murad MH, Padberg FT, Pappas PJ, Passman MA, Raffetto JD, Vasquez MA, Wakefield TW. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2011 May;53(5 Suppl):2S-48S. doi: 10.1016/j.jvs.2011.01.079
  5. Lane T, Bootun R, Dharmarajah B, Lim CS, Najem M, Renton S, Sritharan K, Davies AH. A multi-centre randomised controlled trial comparing radiofrequency and mechanical occlusion chemically assisted ablation of varicose veins – Final results of the Venefit versus Clarivein for varicose veins trial. Phlebology. 2017 Mar;32(2):89-98. doi: 10.1177/0268355516651026
  6. Ciostek P, Kowalski M, Wozniak W, Miłek T, Myrcha P, Migda B. Phlebogriffe – a new device for mechanochemical ablation of incompetent saphenous veins: a pilot study. Phlebological Review. 2015;23(3):72-77. doi: 10.5114/pr.2015.57466
  7. Zubilewicz T, Terlecki P, Terlecki K, Przywara S, Rybak J, Ilzecki M. Application of endovenous mechanochemical ablation (MOCA) with Flebogrif™ to trea varicose veins of the lower extremities: a single center experience over 3 months of observation. Acta Angiologica. 2016; 22(4):137-42. doi: 10.5603/AA.2016.0012
  8. Tessari L, Cavezzi A, Frullini A. Preliminary experience with a new sclerosing foam in the treatment of varicose veins. Dermatol Surg. 2001 Jan;27(1):58-60. doi: 10.1097/00042728-200101000-00017
  9. Shepherd AC, Ortega-Ortega M, Gohel MS, Epstein D, Brown LC, Davies AH. Cost-effectiveness of radio frequency ablation versus laser for varicose veins. Int J Technol Assess Health Care. 2015 Jan;31(5):289-96. doi: 10.1017/S0266462315000537
  10. Witte ME, Zeebregts CJ, deBorst GJ, Reijnen MMPJ, Boersma D. Mechanochemical endovenous ablation of saphenous veins using the ClariVein: A systematic review. Phlebology. 2017 Dec;32(10):649-57. doi: 10.1177/0268355517702068
  11. Khor SN, Lei J, Kam JW, Kum S, Tan YK, Tang TY. ClariVein™ - One year results of mechano-chemical ablation for varicose veins in a multi-ethnic Asian population from Singapore. Phlebology. 2018 Dec;33(10):687-694. doi: 10.1177/0268355518771225
  12. Sullivan LP, Quach G, Chapman T. Retrograde mechanico-chemical endovenous ablation of infrageniculate great saphenous vein for persistent venous stasis ulcers. Phlebology. 2014 Dec;29(10):654-57. doi: 10.1177/0268355513501301
  13. Deijen CL, Schreve MA, BosmaJ, de Nie AJ, Leijdekkers VJ, van den Akker PJ, Vahl A. Clarivein mechano-chemical ablation of the great and small saphenous vein: early treatment outcomes of two hospitals. Phlebology. 2016 Apr;31(3):192-97. doi: 10.1177/0268355515600573
  14. Tang TY, Kam JW, Gaunt ME. ClariVein® - Early results from a large single-centre series of mechano-chemical endovenous ablation for varicose veins. Phlebology. 2017 Feb;32(1):6-12. doi: 10.1177/0268355516630154
  15. Sun JJ, Chowdhury MM, Sadat U, Hayes PD, Tang TY. Mechano-chemical ablation for treatment of truncal venous insufficiency: a review of the current literature. J Vasc Interv Radiol. 2017 Oct;28(10):1422-31. doi: 10.1016/j.jvir.2017.07.002
Address for correspondence:
220116, The Republic of Belarus,
Minsk, Dzerzhinski Ave., 83,
Belarusian State Medical University,
2nd Department of Surgical Diseases.
Tel.: +375 17277-11-55,
e-mail: scienceprorektor@bsmu.by,
Vladimir Ya. Khryshchanovich
Information about the authors:
Khryshchanovich Vladimir Ya., MD, Professor, Vice-Rector for Scientific Work, Professor of the 2nd Department of Surgical Diseases, Belarusian State Medical University, Angiosurgeon, City Clinical Emergency Hospital, Minsk 4th City Clinical Hospital named after N.E. Savchenko, Minsk, Republic of Belarus.
http://orcid.org/0000-0001-5353-205X
Klimchuk Ivan P., PhD, Head of the Department of Vascular Surgery, Minsk 4th City Clinical Hospital named after N.E. Savchenko, Assistant of the General Surgery Department, Belarusian State Medical University, Minsk, Republic of Belarus.
http://orcid.org/0000-0001-9793-0084
Proczka Robert, MD, Head of Centre of Cardiology and Vascular Surgery «Jozefow», Warsaw, Poland.
http://orcid.org/0000-0003-2910-2951
Rogovoy Nickolay A., PhD, Assistant of the General Surgery Department, Belarusian State Medical University, Angiosurgeon of the Department of Vascular Surgery, Minsk 4th City Clinical Hospital named after N.E. Savchenko, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-8386-1791
Kalinin Siarhei S., PhD, Angiosurgeon of the Department of Vascular Surgery, Minsk 4th City Clinical Hospital named after N.E. Savchenko, Assistant of the General Surgery Department, Belarusian State Medical University, Minsk, Republic of Belarus.
http://orcid.org/0000-0003-3180-0409
Mazur Stanislaw, Angiosurgeon, Centre of Cardiology and Vascular Surgery «Jozefow», Warsaw, Poland.
http://orcid.org/0000-0002-0747-9363
Nelipovich Evgenij V., Angiosurgeon of the Department of Vascular Surgery, Minsk 4th City Clinical Hospital named after N.E. Savchenko, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-2921-6601

I.A. KRYVORUCHKO 1, V.V. BOYKO 1, 2, N.N. HONCHAROVA 1, I.A. TARABAN 1, O.V. ARSENYEV 3, JU.V. IVANOVA 1, 2, D.A. SMETSKOV 4, 5, A.G. DROZDOVA 5

EVALUATION OF INTESTINAL BARRIER BIOMARKER I-FABP AND SEVERITY OF PATIENTS IN ACUTE PANCREATITIS

Kharkiv National Medical University 1,
V.T. Zaytsev Institute of General and Emergency Surgery 2,
National University of Pharmacy 3,
Kharkiv Regional Clinical Hospital 4,
Kharkiv Medical Academy of Postgraduate Education 5, Kharkiv,
Ukraine

Objective. To determine the possibility of using I-FABP together with indicators of the abdominal cavity perfusion pressure to diagnose damages of digestive tract and to assess the acute pancreatitis severity.
Methods. A prospective, single-center controlled study was conducted in 58 patients. The dynamics of clinical and laboratory parameters, APACHE II score, AGI grade and parameters of the abdominal perfusion pressure in all patients were evaluated as well as I-FABP changes in 27 (46.6%) on admission and 48 hours after their complex treatment.
Results. The level of I-FABP in the serum after 48 hours increased by 69.8% on average, showed good accuracy for predicting the damage severity to the digestive tract after 48 hours compared with the initial level of AGI grade (area under the ROC curve 0.913) at the threshold value I-FABP 1350 pg/ml with a sensitivity of 0.95 and a specificity of 0.9. A good predictive value was found between the APACHE II score and the level of perfusion pressure in the abdomen when patients were admitted (area under the ROC-curve 0.889) and after 48 hours (the area under the ROC-curve 0.929) for complex treatment. It is established that the severity of the patient’s condition on the APACHE II scale can be predicted by the level of perfusion pressure when patients are admitted (threshold value 72.1 mm Hg, sensitivity 0.82, specificity 0.83) and after 48 hours of complex treatment (threshold 62 mm Hg, sensitivity 0.86, specificity 0.92).
Conclusions. Serum I-FABP is a valuable, convenient, objectively early predictor of the digestive tract damage in acute pancreatitis. The severity of patient’s condition can be predicted not only by using the APACHE II score, but also by evaluating the perfusion pressure in the abdominal cavity in the course of complex intensive therapy.

Keywords: acute pancreatitis, I-FABP, APACHE II score, AGI grade, abdominal perfusion pressure, surgery
p. 640-649 of the original issue
References
  1. Reintam A, Parm P, Kitus R, Kern H, Starkopf J. Gastrointestinal symptoms in intensive care patients. Acta Anaesthesiol Scand. 2009 Mar;53(3):318-24. doi: 10.1111/j.1399-6576.2008.01860.x
  2. Piton G, Belon F, Cypriani B, Regnard J, Puyraveau M, Manzon C, Navellou JC, Capellier G. Enterocyte damage in critically ill patients is associated with shock condition and 28-day mortality. Crit Care Med. 2013 Sep;41(9):2169-76. doi: 10.1097/CCM.0b013e31828c26b5
  3. Reintam A, Parm P, Kitus R, Starkopf J, Kern H. Gastrointestinal failure score in critically ill patients: a prospective observational study. Crit Care. 2008;12(4):R90. doi: 10.1186/cc6958
  4. Reintam A, Parm P, Redlich U, Tooding LM, Starkopf J, Köhler F, Spies C, Kern H. Gastrointestinal failure in intensive care: a retrospective clinical study in three different intensive care units in Germany and Estonia. BMC Gastroenterol. 2006 Jun 22;6:19. doi: 10.1186/1471-230X-6-19
  5. Blaser A, Malbrain M, Starkopf J, Fruhwald S, Jakob S, De Waele J, Braun J, Poeze M, Spies C. Gastrointestinal function in intensive care patients: Terminology, definitions and management. Recommendations of the ESICM Working Group on Abdominal Problems. Intensive Care Med. 2012;38:384-94. doi: 10.1007/s00134-011-2459-y
  6. Grootjans J, Thuijls G, Verdam F, Derikx JP, Lenaerts K, Buurman WA. Non-invasive assessment of barrier integrity and function of the human gut. World J Gastrointest Surg. 2010 Mar 27;2(3):61-69. doi: 10.4240/wjgs.v2.i3.61
  7. Schroeder F, Jolly CA, Cho TH, Frolov A. Fatty acid binding protein isoforms: structure and function. Chem Phys Lipids. 1998 Mar;92(1):1-25. doi: 10.1016/S0009-3084(98)00003-6
  8. Pelsers MM, Hermens WT, Glatz JF. Fatty acid-binding proteins as plasma markers of tissue injury. Clin Chim Acta. 2005 Feb;352(1-2):15-35. doi: 10.1016/j.cccn.2004.09.001
  9. Li H, Chen Y, Huo F, Wang Y, Zhang D. Association between acute gastrointestinal injury and biomarkers of intestinal barrier function in critically ill patients. BMC Gastroenterology. 2017;17:45 doi: 10.1186/s12876-017-0603-z
  10. Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, Tsiotos GG, Vege SS. Classification of acute pancreatitis – 2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013 Jan;62(1):102-11. doi: 10.1136/gutjnl-2012-302779
  11. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Working Group IAP/APA Acute Pancreatitis Guidelines. Pancreatology. 2013 Jul-Aug;13(4 Suppl 2):e1-15. doi: 10.1016/j.pan.2013.07.063
  12. Kron IL, Harman PK, Nolan SP. The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration. Ann Surg. 1984 Jan;199(1):28-30. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1353253/
  13. Boiko VV, Krivoruchko IA, Shevchenko RS, Smachilo RM, Pesotskii ON. Ostryi pankreatit. Patofiziologiia i lechenie. Khar’kov, Ukraina: Tornado; 2002. 258 p. http://www.booksmed.com/hirurgiya/515-ostryj-pankreatit-patofiziologiya-i-lechenie.html (In Ukr.)
  14. Kitai T, Kim YH, Kiefer K, Morales R, Borowski AG, Grodin JL, Tang WHW. Circulating intestinal fatty acid-binding protein (I-FABP) levels in acute decompensated heart failure. Clin Biochem. 2017 Jun;50(9):491-95. doi: 10.1016/j.clinbiochem.2017.02.014
  15. Grimaldi D, Guivarch E, Neveux N, Fichet J, Pène F, Marx JS, Chiche JD, Cynober L, Mira JP, Cariou A. Markers of intestinal injury are associated with endotoxemia in successfully resuscitated patients. Resuscitation. 2013 Jan;84(1):60-65. doi: 10.1016/j.resuscitation.2012.06.010
  16. Sekino M, Funaoka H, Sato S, Okada K, Inoue H, Yano R, Matsumoto S, Ichinomiya T, Higashijima U, Matsumoto S, Hara T. Intestinal fatty acid-binding protein level as a predictor of 28-day mortality and bowel ischemia in patients with septic shock: A preliminary study. J Crit Care. 2017 Dec;42:92-100. doi: 10.1016/j.jcrc.2017.07.012
Address for correspondence:
61022, Ukraine,
Kharkiv, Nauki Ave., 4,
Kharkiv National Medical University,
Surgery Department ¹ 2.
Tel.: +38-050-301-90-90,
+38-057-705-02-45,
e-mail: ikryvoruchko60@gmail.com,
Igor A. Kryvoruchko
Information about the authors:
Kryvoruchko Igor A., MD, Professor, Head of the Surgery Department ¹ 2, Kharkiv National Medical University, Kharkiv, Ukraine.
https://orcid.org/0000-0002-5525-701X
Boyko Valeriy V., Corresponding Member of NAMS of Ukraine, MD, Professor, Director of V.T. Zaytsev Institute of General and Emergency Surgery, Head of the Surgery Department ¹ 1, Kharkiv National Medical University, Kharkiv, Ukraine.
https://orcid.org/0000-0002-3455-9705
Honcharova Natalya N., MD, Associate Professor, Professor of the Surgery Department ¹ 2, Kharkiv National Medical University, Kharkiv, Ukraine.
http://orcid.org/0000-0001-5031-7311
Taraban Igor A., MD, Professor of the Surgery Department ¹ 1, Kharkiv National Medical University, Kharkiv, Ukraine.
https://orcid.org/0000-0002-5842-2551
Arsenyev Îleksandr V., PhD, Associate Professor of the Pharmacokinetics Department, National University of Pharmacy, Kharkiv, Ukraine.
https://orcid.org/0000-0002-9807-0853
Ivanova Julia V., MD, Leading Researcher, V.T. Zaytsev Institute of General and Emergency Surgery, Professor of the Surgery Department ¹1, Kharkiv National Medical University, Kharkiv, Ukraine.
https://orcid.org/0000-0001-8773-6827
Smetskov Dmytro A., PhD, Head of the Operative Unit of Kharkiv Regional Clinical Hospital, Associate Professor of the Department of Endoscopy and Surgery of Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine.
https://orcid.org/0000-0002-5004-2255
Drozdova Anastasiya G., Post-Graduate Student of the Surgery Department ¹ 2, Kharkiv National Medical University, Kharkiv, Ukraine.
https://orcid.org/0000-0002-4401-8048

YU.S. VINNIK, R.A. PAKHOMOVA, L.V. KOCHETOVA, G.E. KARAPETYAN

ELECTRONIC MICROSCOPY OF ERYTHROCYTES IN PATIENTS WITH SEVERE OBSTRUCTIVE JAUNDICE OF BENIGN GENESIS

Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetski, Krasnoyarsk,
The Russian Federation

Objective. To study chemical composition and morphology of an erythrocyte in patients with severe obstructive jaundice.
Methods. Erythrocyte electron microscopy was performed on Hitachi 5500 scanning electron microscope (Japan), the spectral analysis of the peripheral blood erythrocyte composition was calculated using the QUANTAX 70 program in 17 patients with the severe obstructive jaundice and 14 conditionally healthy individuals. The severity of obstructive jaundice was determined by E.I. Halperin (2012). The study included the patients with severe obstructive jaundice, with clinical signs of endotoxemia and hepatic cell failure. The level of bilirubin in the studied patients was higher than 180 μmol / L, the level of alanine and aspartic transaminases was 2-3 times higher than normal.
Results. In patients with severe obstructive jaundice, the erythrocyte cytoskeleton changed: from a biconcave spherocyte, it turned into a domed stomatocyte. The oxygen concentration in the cell significantly decreased and reached its minimum value, 14.9%. Hypokalemia increased inside the cell, the content of sodium increased to 7.1% and calcium ions to 2.9%, which “made the cell heavier”, retaining water in it and, most likely, led to a change in the shape of the red blood cell and its functional capabilities. Significant changes in the concentration of carbon and nitrogen inside the cell were not detected.
Conclusions. In patients with severe obstructive jaundice with marked phenomena of endogenous intoxication, a cascade of biochemical reactions is launched. An increase in the content of chemical elements inside the cell holding water, apparently, leads to a change in the morphology of the red blood cell, its molecular structure and functional capabilities. A change in the erythrocyte cytoskeleton disrupts its oxygen transport function, and a decrease in the oxygen content in the cell exacerbates tissue hypoxia.

Keywords: obstructive jaundice, intoxication, electron microscopy of a red blood cell, chemical elements, oxygen-transport function of a red blood cell
p. 650-655 of the original issue
References
  1. Mamoshin ÀV, Alyanov AL, Borsukov AV. Miniinvasive technologies in the treatment of patients with the syndrome of obstructive jaundice. Uchenye Zap Orlov Gos Un-ta. 2013;(6):228-231. http://oreluniver.ru/public/file/archive/201306.pdf (In Russ.)
  2. Vishnevsky VA, Efanov MG, Ikramov RZ, Varava AB, Trifonov SA. Modern surgical tactics for benign biliary strictures. trends and unresolved issues. Annaly Khirurgicheskoy Gepatologii = Annals of HPB Surgery. 2017;22(3):11-18. doi: 10.16931/1995-5464.2017311-18 (In Russ.)
  3. Galperin EI, Momunova ON. The classification of obstructive jaundice severity. Khirurgiia Zhurn im NI Pirogova. 2014;1:5-9. https://www.mediasphera.ru/issues/khirurgiya-zhurnal-im-n-i-pirogova/2014/1 (In Russ.)
  4. Garcea G, Ngu W, Neal CP, Dennison AR, Berry DP. Bilirubin levels predict malignancy in patients with obstructive jaundice. HPB (Oxford). 2011 Jun;13(6):426-30. doi: 10.1111/j.1477-2574.2011.00312.x
  5. Braet F, Taatjes DJ, Wisse E. Probing the unseen structure and function of liver cells through atomic force microscopy. J Nanosci Nanotechno. 2018;73:3-30. doi: 10.1016/j.semcdb.2017.07.001
  6. Pakhomova RA, Vinnik YS, Kochetova LV, Voronova EA, Nagornov YS. Atomic force microscopy of the erythrocyte in various severity of obstructive jaundice (experimental study). Annaly Khirurgicheskoy gepatologii = Annals of HPB Surgery. 2017;22(1):82-87. doi: 10.16931/1995-5464.2017182-87 (In Russ.)
  7. Papakostas C, Bezirtzoglou E, Pitiakoudis M, Polychronidis A, Simopoulos C. Endotoxiemia in the portal and the systemic circulation in obstructive jaundice. Clin Exp Med. 2003 Sep;3(2):124-28. doi: 10.1007/s10238-003-0015-y
  8. Skorkina MIu, Cherniavskikh SD, Fedorova MZ, Zabiniakov NA, Sladkova EA. Metodika otsenki morfometricheskikh parametrov nativnykh kletok krovi s ispol’zovaniem atomno-silovoi mikroskopii. Biul Eksperim Biologii i Meditsiny. 2010;150(8):238-40. (In Russ.)
Address for correspondence:
660022, The Russian Federation,
Krasnoyarsk, Partizan Zheleznyak Str., 1,
Krasnoyarsk State Medical University
Named after Prof. V.F. Voino-Yasenetski,
Department of General Surgery.
e-mail: yuvinnik@yandex.ru,
Yurii S. Vinnik
Information about the authors:
Vinnik Yurii S., MD, Professor, Head of the Department of General Surgery named after Prof. Gulman, Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetski, Krasnoyarsk, Russian Federation.
https://orcid.org/0000-0002-8995-2862
Pakhomova Regina A., MD, Assistant of the Department of General Surgery named after Prof. Gulman, Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetski, Krasnoyarsk, Russian Federation.
https://orcid.org/0000-0002-3681-4685
Kochetova Lyudmila V., PhD, Professor of the Department of General Surgery named after Prof. Gulman, Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetski, Krasnoyarsk, Russian Federation.
https://orcid.org/0000-0001-5784-7067
Karapetyan Georgii E., MD, Professor of the Department of General Surgery named after Prof. Gulman, Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetski, Krasnoyarsk, Russian Federation.
https://orcid.org/0000-0002-1216-2029

I.R. TERLETSKYI 1, M.R. VERKHOLA 1, I.V. TYMCHUK 2, V.S. ZHYKOVSKIY 2, YU.H. OREL 2

VACUUM-ASSISTED THERAPY FOR PATIENTS WITH DIABETES MELLITUS AND CHRONIC FOOT ULCERS

Lviv Regional Clinical Hospital 1,
Danylo Halytsky Lviv National Medical University 2, Lviv,
Ukraine

Objective. To determine the bacterial load of wounds at the application of vacuum-assisted therapy for patients with diabetes mellitus and chronic foot ulcers.
Methods. The object of the research was patients with diabetes mellitus with chronic superficial (skin, subcutaneous tissues) wounds of the foot with the signs of mild infection according to the classification for determination of presence and severity of infection of IWGDF/IDSA. Oncopathology, heavy concomitant pathology and lesions of the osteoarticular apparatus were the criteria of exception. Patients were treated as out-patients and did not get system antibiotic therapy. Therapy of wounds was conducted by negative pressure – 125 mm Hg in the continuous mode. The first stage of work was conducted to find out the level of the bacterial load of wounds before and 3 days after the vacuum-assisted therapy (the group was of 10 patients). The second group (10 patients) was selected to determine the dynamics of changes of the wound bioburden level after every 24 hours of vacuum-assisted therapy, the observation was performed during 96 hours of the bandage exposure. The level of the bacterial load was controlled according to the changes of index of colony-forming units in the gram of tissue (CFU/g) of the wound biopsy material.
Results. The average bioburden level of wounds for the 1st group patients after the removal of bandage was 8.11±1.27 lg CFU/g, this exceeds the initial level by 31.9 % (ð<0.05). The investigation of the material from the wounds of the 2nd group patients established a considerable increase of the average bioburden level of wounds in 24, 48, 72 and 96 hours after the beginning of the therapy, 10.8 %, 16.4 %, 38.9 % and 58.6 % accordingly (ð<0.05).
Conclusions. In patients with diabetes mellitus and chronic wounds of the foot with signs of infection, vacuum-assisted therapy does not provide essential control of the bioburden level and should be used in combination with systemic antibiotic therapy.

Keywords: vacuum-assisted therapy, diabetes, wound, bacterial load, infection
p. 656-661 of the original issue
References
  1. Miller C. The history of negative pressure wound therapy (NPWT): From “Lip Service” to the modern vacuum system. J Am Coll Clin Wound Spec. 2012 Sep;4(3):61-62. doi: 10.1016/j.jccw.2013.11.002
  2. Hatch DC, Sauciuc V, Wagler EC, Schenavar B, Armstrong D. Negative pressure wound therapy: past, present, and future. J Foot Ankle Surg (Asia-Pacific). 2016 Jul-Dec;3(2):80-87. doi: 10.5005/jp-journals-10040-1053
  3. Ubbink DT, Westerbos SJ, Nelson EA, Vermeulen H. A systematic review of topical negative pressure therapy for acute and chronic wounds. Br J Surg. 2008 Jun;95(6):685-92. doi: 10.1002/bjs.6238
  4. Gregor S, Maegele M, Sauerland S, Krahn JF, Peinemann F, Lange S. Negative pressure wound therapy: a vacuum of evidence? Arch Surg. 2008 Feb;143(2):189-96. doi: 10.1001/archsurg.2007.54
  5. Suissa D, Danino A, Nikolis A. Negative-pressure therapy versus standard wound care: a meta-analysis of randomized trials. Plast Reconstr Surg. 2011 Nov;128(5):498e-503e. doi: 10.1097/PRS.0b013e31822b675c
  6. Kim YH, Hwang KT, Kim JT, Kim SW. What is the ideal interval between dressing changes during negative pressure wound therapy for open traumatic fractures? J Wound Care. 2015 Nov;24(11):536, 538-40, 542. doi: 10.12968/jowc.2015.24.11.536
  7. Lambert KV, Hayes P, McCarthy M. Vacuum assisted closure: A review of development and current applications. Eur J Vasc Endovasc Surg. 2005 Mar;29(3):219-26. doi: 10.1016/j.ejvs.2004.12.017
  8. Morykwas MJ, Argenta LC, Shelton-Brown EI, McGuirt W. Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg. 1997 Jun;38(6):553-62. doi: 10.1097/00000637-199706000-00001
  9. Argenta LC, Morykwas MJ. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg. 1997 Jun;38(6):563-76; discussion 577.
  10. Glass GE, Murphy GRF, Nanchahal J. Does negative-pressure wound therapy influence subjacent bacterial growth? A systematic review. J Plast Reconstr Aesthet Surg. 2017 Aug;70(8):1028-37. doi: 10.1016/j.bjps.2017.05.027
  11. Lipsky BA, Peters EJ, Berendt AR, Senneville E, Bakker K, Embil JM, Lavery LA, Urbančič-Rovan V, Jeffcoate WJ. Specific guidelines for the treatment of diabetic foot infections 2011. Diabetes Metab Res Rev. 2012 Feb;28(Suppl 1):234-35. doi: 10.1002/dmrr.2251
  12. Lipsky BA, Aragón-Sánchez J, Diggle M, Embil J, Kono S, Lavery L, Senneville E, Urbančič-Rovan V, Van Asten S. IWGDF guidance on the diagnosis and management of foot infections in persons with diabetes. Diabetes Metab Res Rev. 2016 Jan;32(Suppl 1):45-74. doi: 10.1002/dmrr.2699
  13. Gardner SE, Hillis SL, Frantz RA. Clinical signs of infection in diabetic foot ulcers with high microbial load. Biol Res Nurs. 2009 Oct;11(2):119-28. doi: 10.1177/1099800408326169
  14. Ferringer T, Miller F. Cutaneous manifestations of diabetes mellitus. Dermatol Clin. 2002 Jul;20(Is 3):483-92. doi: 10.1016/S0733-8635(02)00018-9
  15. Gardner SE, Haleem A, Jao Y-L, Hillis SL, Femino JE, Phisitkul P, Heilmann KP, Lehman SM, Franciscus CL. Cultures of diabetic foot ulcers without clinical signs of infection do not predict outcomes. Diabetes Care. 2014;37(10):2693-2701. doi: 10.2337/dc14-0051
  16. Yusuf E, Jordan X, Clauss M, Borens O, Mäder M, Trampuz A. High bacterial load in negative pressure wound therapy (NPWT) foams used in the treatment of chronic wounds. Wound Repair Regen. 2013 Sep-Oct;21(5):677-81. doi: 10.1111/wrr.12088
  17. Yang C, Goss SG, Alcantara S, Schultz G, Lantis Ii JC. Effect of negative pressure wound therapy with instillation on bioburden in chronically infected wounds. Wounds. 2017 Aug;29(8):240-46.
  18. Patmo ASP, Krijnen P, Tuinebreijer WE, Breederveld RS. The effect of vacuum-assisted closure on the bacterial load and type of bacteria: a systematic review. Adv Wound Care (New Rochelle). 2014 May 1;3(5):383-89. doi: 10.1089/wound.2013.0510
Address for correspondence:
79010, Ukraine,
Lviv, Chernihivska Str., 7,
Lviv Regional Clinical Hospital,
Surgical Department ¹1.
Tel. mobile: +380 98 449-11-61,
e-mail: teriva86@gmail.com,
Ivan R. Terletskyi
Information about the authors:
Terletskyi Ivan R., Surgeon, the Surgical Department ¹1, Lviv Regional Clinical Hospital, Lviv, Ukraine.
http://orcid.org/0000-0002-8751-0489
Verkhola Markiian R., Surgeon, the Surgical Department ¹1, Lviv Regional Clinical Hospital, Lviv, Ukraine.
http://orcid.org/0000-0002-9762-4236
Tymchuk Iryna V., PhD, Assistant, Microbiology Department, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
https://orcid.org/0000-0002-9290-2954
Zhykovskiy Volodymyr S., PhD, Assistant, Department of Disaster Medicine and Military Medicine, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
https://orcid.org/0000-0002-0594-5316
Orel Yuriy H., MD, Professor, the Surgery Department ¹ 2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
http://orcid.org/0000-0002-2283-7843

UROLOGY

Y.A. NAKONECHNYI 1, A.M. HAVRYLYUK 1, A.Y. NAKONECHNYI 1, V.V. CHOPYAK 1, M.Ì. KURPISZ 2

IMMUNOPATHOGENETIC PROGNOSTIC MARKERS OF THE FERTILE POTENTIAL IN MEN WITH LEFT-SIDED VARICOCELE

Danylo Halytsky Lviv National Medical University 1, Lviv,
Ukraine,
Institute of Human Genetics Polish Academy of Sciences 2, Poznan,
Poland

Objective. To determine immunopathogenetic prognostic markers of the fertile potential in men with varicocele by the nature of changes in the induces of congenital and acquired immunity, to assess their trends after varicocelectomy in the context of maintaining the risk of infertility development.
Methods. 36 patients with the left-sided varicocele grade II-III and 25 patients after laparoscopic varicocelectomy underwent an immunological study. The control group consisted of 23 healthy men. The participants’ age was 19-33 years. The cytokines concentration in the blood and seminal fluid were determined by ELISA. Flow cytometry was used for immunophenotyping of peripheral blood lymphocytes (absolute and relative numbers).
Results. In patients with the left-sided varicocele grade II-III concentration of cytokines in the peripheral blood and seminal fluid significantly differed from the subjects of the control group. Statistically significant differences were found in the concentration of various cytokines and quantitative indicators of the cellular level of acquired immunity in comparison to practically healthy men. Levels of the most cytokines in the serum of the peripheral blood and seminal fluid, quantitative indicators of lymphocyte populations, subpopulations of T-lymphocytes and their activation markers in the peripheral blood normalized three months after laparoscopic varicocelectomy.
ROC analysis of cytokine levels in the peripheral blood serum and seminal fluid in patients with varicocele grade II-III revealed a number of patterns. Significant immunopathogenetic prognostic markers of the fertile potential could be an increase of IFN-γ levels more than 12.4 pg/ml in the peripheral blood serum, as well as levels of interleukins in the seminal fluid: for spIL-1β 50.4 pg/ml and less, for spIL-6 more than 49.5 pg/ml.
Conclusions. Cytokine regulation changes in the reproductive and immune systems, determined by the imbalance in concentrations of the pro/anti-inflammatory cytokines at the local and peripheral levels, synthesized by T-lymphocytes and macrophages is a crucial immunopathogenetic factor in the development of immune-depended infertility in patients with varicocele.

Keywords: varicocele, varicocelectomy, infertility, immunophenotyping, cytokines
p. 662-673 of the original issue
References
  1. Shiraishi K, Takihara H, Matsuyama H. Elevated scrotal temperature, but not varicocele grade, reflects testicular oxidative stress-mediated apoptosis. World J Urol. 2010 Jun;28(3):359-64. doi: 10.1007/s00345-009-0462-5
  2. Shiraishi K, Matsuyama H, Takihara H. Pathophysiology of varicocele in male infertility in the era of assisted reproductive technology. Int J Urol. 2012 Jun;19(6):538-50. doi: 10.1111/j.1442-2042.2012.02982.x
  3. Majzoub A, Esteves S, Gosálvez J, Agarwal A. Specialized sperm function tests in varicocele and the future of andrology laboratory. Asian J Androl. 2016 Mar-Apr:18(2):205. doi: 10.4103/1008-682X.172642
  4. Pastuszak AW, Wang R. Varicocele and testicular function. Asian J Androl. 2015 Jul-Aug;17(4):659-67. doi: 10.4103/1008-682X.153539
  5. Fraczek M, Kurpisz M. Cytokines in the male reproductive tract and their role in infertility disorders. J Reprod Immunol. 2015 Apr;108:98-104. doi: 10.1016/j.jri.2015.02.001
  6. Bozhedomov VA, Lipatova NA, Alexeev RA, Alexandrova LM, Nikolaeva MA, Sukhikh GT. The role of the antisperm antibodies in male infertility assessment after microsurgical varicocelectomy. Andrology. 2014 Nov;2(6):847-55. doi: 10.1111/j.2047-2927.2014.00254.x
  7. Sarkar O, Bahrainwala J, Chandrasekaran S, Kothari S, Mathur PP, Agarwal A. Impact of inflammation on male fertility. Front Biosci (Elite Ed). 2011 Jan 1;3:89-95. doi: 10.2741/e223
  8. Golab J, Jakobisiak M, Lasek W, Stoklosa T. Immunologia (nowe wydanie). Warszawa: Wydawnictwo Naukowe PWN; 2015. 498 ð.
  9. Agarwal A, Prabakaran S, Allamaneni SS. Relationship between oxidative stress, varicocele and infertility: a meta-analysis. Reprod Biomed Online. 2006 May;12(5):630-33. doi: 10.1016/S1472-6483(10)61190-X
  10. Moretti E, Collodel G, Mazzi L, Campagna M, Iacoponi F, Figura N. Resistin, interleukin-6, tumor necrosis factor-alpha, and human semen parameters in the presence of leukocytospermia, smoking habit, and varicocele. Fertil Steril. 2014 Aug;102(2):354-60. doi: 10.1016/j.fertnstert.2014.04.017
  11. Jarazo-Dietrich S, Jacobo P, Pérez CV, Guazzone VA, Lustig L, Theas MS. Up regulation of nitric oxide synthase-nitric oxide system in the testis of rats undergoing autoimmune orchitis. Immunobiology. 2012 Aug;217(8):778-87. doi: 10.1016/j.imbio.2012.04.007
  12. Wang H, Lv Y, Hu K, Feng T, Jin Y, Wang Y, Huang Y, Chen B. Seminal plasma leptin and spermatozoon apoptosis in patients with varicocele and leucocytospermia. Andrologia. 2015 Aug;47(6):655-61. doi: 10.1111/and.12313
  13. Duan YG, Yu CF, Novak N, Bieber T, Zhu CH, Schuppe HC, Haidl G, Allam JP. Immunodeviation towards a Th17 immune response associated with testicular damage in azoospermic men. Int J Androl. 2011 Dec;34(6 Pt 2):e536-45. doi: 10.1111/j.1365-2605.2010.01137.x
  14. Havrylyuk A, Chopyak V, Kril I, Kurpisz M. The types of populations and subpopulations of t-lymphocytes in peripheral blood of men with disturbances their fertility function. ²munolog³ia ta Alergolog³ia: Nauka ³ Praktika. 2014;(1):14-26. http://nbuv.gov.ua/UJRN/Ita_2014_1_4 (In Ukr.)
  15. Jacobo P, Pérez CV, Theas MS, Guazzone VA, Lustig L. CD4+ and CD8+ T cells producing Th1 and Th17 cytokines are involved in the pathogenesis of autoimmune orchitis. Reproduction. 2011 Feb;141(2):249-58. doi: 10.1530/REP-10-0362
  16. Moretti E, Cosci I, Spreafico A, Serchi T, Cuppone AM, Collodel G. Semen characteristics and inflammatory mediators in infertile men with different clinical diagnoses. Int J Androl. 2009 Dec;32(6):637-46. doi: 10.1111/j.1365-2605.2008.00911.x
Address for correspondence:
79010, Ukraine,
Lviv, Pekarskaya Str., 69,
Danylo Halytsky Lviv National
Medical University,
Department of Urology
Of the Post-Graduate Education Faculty.
Tel. mobile +38 097 633-57-27,
e-mail: nyosyf@ukr.net,
Yosyf A. Nakonechnyi
Information about the authors:
Nakonechnyi Yosyf A., Post-Graduate Student of the Department of Urology of the Post-Graduate Education Faculty, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
https://orcid.org/0000-0002-6872-1889
Havrylyuk Anna M., MD, Associate Professor of the Department of Clinical Immunology and Allergology, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
http://orcid.org/0000-0001-9808-8896
Nakonechnyi Andrii I., MD, Professor of the Pediatric Surgery Department, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
http://orcid.org/0000-0003-1402-6642
Chopyak Valentyna V., MD, Professor, Head of the Department of Clinical Immunology and Allergology, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
http://orcid.org/0000-0003-3127-2028
Kurpisz Maciej M., MD, Professor, Head of the Department of Immunobiology, Reproduction and Stem Cells, Institute of Human Genetics Polish Academy of Sciences, Poznan, Republic of Poland.
http://orcid.org/0000-0003-3275-3245

NEUROSURGERY

V.A. BYVALTSEV 1, 2, 3, 4, I.A. STEPANOV 1, V.E. BORISOV 1, M.A. ALIEV, V.V. SHEPELEV 1

RISK FACTORS FOR SURGICAL SITE INFECTIONS AFTER POSTERIOR LUMBAR FUSION IN ELDERLY PATIENTS

Irkutsk State Medical University 1,
Irkutsk Scientific Center of Surgery and Traumatology 2,
Irkutsk State Medical Academy of Continuing Education 3,
Irkutsk Railway Clinical Hospital at Irkutsk-Passazhirskiy Station 4, Irkutsk,
The Russian Federation

Objective. To identify risk factors for the development of surgical site infections in elderly patients after posterior lumbar fusion surgery, by analyzing the preoperative, intraoperative, and postoperative parameters.
Methods. An open non-randomized single-center retrospective study was performed. The medical records analysis of patients who underwent surgery of the posterior lumbar fusion in the period from February 2012 to May 2018 was performed. According to the criteria of compliance, 437 (192 women, 245 men, the average age was 57.6±9.3 years (data are presented as M±σ)) elderly patients were included in the retrospective study. To compare the differences between groups of patients with diagnosed cases of surgical site infections and without them, the study included patients of the older age group without postoperative adverse events.
Results. In 11 (2.5%) cases, surgical site infections were verified (4 women, 7 men, the mean age was 59.9±10.1 years. The risk factors for the development of surgical site infections after performing the operation of the posterior lumbar fusion in the study group of patients are: diabetes mellitus (p=0.031), low preoperative calcium level of blood plasma (p=0.008), low preoperative and postoperative albumin levels (p=0.019 and p=0.027), a high glucose concentration in the early postoperative period (p=0.036), a low postoperative hemoglobin level (p=0.013), a posterior lumbar fusion in three or more spinal segments (p=0.005), and the duration of surgery of more than 3 hours (p=0.036), the amount of blood loss over 1000 ml (ð=0.014) and long-term drainage of the postoperative wound (ð<0.001).
Conclusions. These risk factors must be taken into account by a neurosurgeon, when conducting posterior lumbar fusion surgery in patients of the older age group, in order to minimize them and reduce the risk of surgical site infections developing.

Keywords: surgical site infections, elderly patients, risk factors, lumbar spine, posterior lumbar fusion, minimally invasive techniques
p. 674-682 of the original issue
References
  1. Byvaltsev VA, Stepanov IA, Borisov VE, Kalinin AA. Local administration of vancomycin powder in posterior lumbar fusion surgery. Khirurgiia Zhurn im NI. Pirogova. 2019;(2):58-64. doi: 10.17116/hirurgia201902158 (In Russ.)
  2. López Pereira P, Díaz-Agero Pérez C, López Fresneña, Las Heras Mosteiro J, Palancar Cabrera A, Rincón Carlavilla ÁL, Aranaz Andrés JM. ‘Epidemiology of surgical site infection in a neurosurgery department. Br J Neurosurg. 2017;31(1):10-15. doi: 10.1080/02688697.2016.1260687
  3. Petherick ES, Dalton JE, Moore PJ, Cullum N. Methods for identifying surgical wound infection after discharge from hospital: a systematic review. BMC Infect Dis. 2006 Nov 27;6:170. doi: 10.1186/1471-2334-6-170
  4. Fei Q, Li J, Lin J, Li D, Wang B, Meng H, Wang Q, Su N, Yang Y. Risk factors for surgical site infection after spinal surgery: a meta-analysis. World Neurosurg. 2016;95:507-15. doi: 10.1016/j.wneu.2015.05.059
  5. Janssen DMC, Kramer M, Geurts J, Rhijn L, Walenkamp GHIM, Willems PC. A retrospective analysis of deep surgical site infection treatment after instrumented spinal fusion with the use of supplementary local antibiotic carriers. J Bone Jt Infect. 2018;3(2):94-103. doi: 10.7150/jbji.23832
  6. Cizik AM, Lee MJ, Martin BI, Bransford RJ, Bellabarba C, Chapman JR, Mirza SK. Using the spine surgical invasiveness index to identify risk of surgical site infection: a multivariate analysis. J Bone Joint Surg Am. 2012 Feb 15;94(4):335-42. doi: 10.2106/JBJS.J.01084
  7. Geffers C, Gastmeier P. Nosocomial infections and multidrug-resistant organisms in Germany: epidemiological data from KISS (the Hospital Infection Surveillance System). Dtsch Arztebl Int. 2011 Feb;108(6):87-93. doi: 10.3238/arztebl.2011.0087
  8. Williams JR. The Declaration of Helsinki and public health. Bull World Health Organ. 2008 Aug;86(8):650-52. doi: 10.2471/BLT.08.050955
  9. Koutsoumbelis S, Hughes AP, Girardi FP, Cammisa FP Jr, Finerty EA, Nguyen JT, Gausden E, Sama AA. Risk factors for postoperative infection following posterior lumbar instrumented arthrodesis. J Bone Joint Surg Am. 2011 Sep 7;93(17):1627-33. doi: 10.2106/JBJS.J.00039
  10. Lim S, Edelstein AI, Patel AA, Kim BD, Kim JYS. Risk factors for postoperative infections after single-level lumbar fusion surgery. Spine (Phila Pa 1976). 2018 Feb 1;43(3):215-22. doi: 10.1097/BRS.0000000000000608
  11. Klemencsics I, Lazary A, Szoverfi Z, Bozsodi A, Eltes P, Varga PP. Risk factors for surgical site infection in elective routine degenerative lumbar surgeries. Spine J. 2016 Nov;16(11):1377-83. doi: 10.1016/j.spinee.2016.08.018
  12. Olsen MA, Nepple JJ, Riew KD, Lenke LG, Bridwell KH, Mayfield J, Fraser VJ. Risk factors for surgical site infection following orthopaedic spinal operations. J Bone Joint Surg Am. 2008 Jan;90(1):62-69. doi: 10.2106/JBJS.F.01515
  13. Chesney RW, McCarron DM, Haddad JG, Hawker CD, DiBella FP, Chesney PJ, Davis JP. Pathogenic mechanisms of the hypocalcemia of the staphylococcal toxic-shock syndrome. J Lab Clin Med. 1983 Apr;101(4):576-85.
  14. Skeie E, Koch AM, Harthug S, Fosse U, Sygnestveit K, Nilsen RM, Tangvik RJ. A positive association between nutritional risk and the incidence of surgical site infections: A hospital-based register study. PLoS One. 2018 May 15;13(5):e0197344. doi: 10.1371/journal.pone.0197344. eCollection 2018.
  15. Liu JM, Deng HL, Chen XY, Zhou Y, Yang D, Duan MS, Huang SH, Liu ZL. Risk Factors for Surgical Site Infection After Posterior Lumbar Spinal Surgery. Spine. 201815;43(10):732-37. doi: 10.1097/BRS.0000000000002419
  16. Mujagic E, Marti WR, Coslovsky M, Zeindler J, Staubli S, Marti R, Mechera R, Soysal SD, Gürke L, Weber WP. The role of preoperative blood parameters to predict the risk of surgical site infection. Am J Surg. 2018;215(4):651-57. doi: 10.1016/j.amjsurg.2017.08.021
Address for correspondence:
664003, The Russian Federation,
Irkutsk, Krasnogo Vosstaniya Str., 1,
Irkutsk State Medical University,
Department of Neurosurgery
And Innovative Medicine.
Tel. +7 (3952) 638 528,
e-mail: vadimabyvaltsev@gmail.com,
Vadim A. Byvaltsev
Information about the authors:
Byvaltsev Vadim A., MD, Professor, Head of the Department of Neurosurgery and Innovative Medicine of Irkutsk State Medical University; Chief Neurosurgeon of Irkutsk Railway Clinical Hospital at Irkutsk-Passazhirskiy Station, Deputy Director for International and Innovative Activities of Irkutsk Scientific Center of Surgery and Traumatology; Professor of the Department of Traumatology, Orthopedics and Neurosurgery of Irkutsk State Medical Academy of Continuing Education, Irkutsk, Russian Federation.
http://orcid.org/0000-0003-4349-7101
Stepanov Ivan A., Post-Graduate Student of the Department of Neurosurgery and Innovative Medicine, Irkutsk State Medical University, Irkutsk, Russian Federation.
https://orcid.org/0000-0001-9039-9147
Borisov Vladislav E., Post-Graduate Student of the Department of Neurosurgery and Innovative Medicine, Irkutsk State Medical University, Irkutsk, Russian Federation.
https://orcid.org/0000-0001-7409-2196
Aliev Marat A., PhD, Doctoral Student of the Department of Neurosurgery and Innovative Medicine, Irkutsk State Medical University, Irkutsk, Russian Federation.
https://orcid.org/0000-0002-7676-1127
Shepelev Valeriy V., PhD, Doctoral Student of the Department of Neurosurgery and Innovative Medicine, Irkutsk State Medical University, Irkutsk, Russian Federation.
https://orcid.org/0000-0001-5135-8115

EXCHANGE OF EXPERIENCE

SH. V. TIMERBULATOV, M.V. TIMERBULATOV, A. R. GAFAROVA, V. M. TIMERBULATOV

EFFECTIVENESS EVALUATION OF THE WHO SURGICAL SAFETY CHECKLIST

Bashkir State Medical University, Ufa,
The Russian Federation

The article presents the literature review concerning the results of applying the surgical safety checklist recommended by the World Health Organization in 2008 (SSC WHO). These recommendations are aimed primarily at the prevention of so-called preventable complications, and also can significantly affect the reduction of mortality. The influence of the checklist on the reduction of surgical complications (surgical infections, bleeding, cardiorespiratory complications), inpatient treatment terms, treatment cost is studied. The use of the checklist improves communication, preparedness for the operation, teamwork of the operations and anesthesiology staff, increases responsibility for security issues. The review notes the exceptional importance of the implementation of all three stages of the checklist, the preliminary conduct of the educational program for its implementation. The results of the recommendations use are mainly associated with the implementation strategy, not its formal implementation. It is noted that the checklist is an effective method of reducing intra- and postoperative complications and contributes to improving the quality of surgical care. In a number of publications, there was a decrease in the postoperative mortality from 1.9 to 0.2%, the frequency of surgical complications by 40% or more, infection of the surgical area (from 7.4 to 3.6%), hospitalization periods, the frequency of intra- and postoperative bleeding (from 2.6 to 1.0%), respectively, with a decrease in the cost of blood transfusion, plasma by 40%.

Keywords: surgical safety checklist, World Health Organization, surgical complications, quality of surgical care, postoperative mortality, treatment terms
p. 683-690 of the original issue
References
  1. Finks JF, Osborne NH, Birkmeyer JD. Trends in hospital volume and operative mortality for high-risk surgery. N Engl J Med. 2011 Jun 2;364:2128-37. doi: 10.1056/NEJMsa1010705
  2. Gawande AA, Thomas EJ, Zinner MJ, Brennan TA. The incidence and nature of surgical adverse events in Colorado and Utah in 1992. Surgery. 1999 Jul;126(1):66-75. doi: 10.1067/msy.1999.98664
  3. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009 Apr 2;360(14):1418-28. doi: 10.1056/NEJMsa0803563
  4. Pearse RM, Moreno RP, Bauer P, Pelosi P, Metnitz P, Spies C, Vallet B, Vincent JL, Hoeft A, Rhodes A. Mortality after surgery in Europe: a 7 day cohort study. Lancet. 2012 Sep 22;380(9847):1059-65. doi: 10.1016/S0140-6736(12)61148-9
  5. Ghaferi AA, Birkmeyer JD, Dimick JB. Variation in hospital mortality associated with inpatient surgery. N Engl J Med. 2009 Oct 1;361(14):1368-75. doi: 10.1056/NEJMsa0903048
  6. Davis P, Lay-Yee R, Briant R, Ali W, Scott A, Schug S. Adverse events in New Zealand public hospitals I: occurrence and impact. N Z Med J. 2002 Dec 13;115(1167):U271. https://www.researchgate.net/publication/10930999_Adverse_Events_in_New_Zealand_Public_Hospitals_I
  7. de Vries EN, Ramrattan MA, Smorenburg SM, Gouma DJ, Boermeester MA. The incidence and nature of in-hospital adverse events: a systematic review. Qual Saf Health Care. 2008 Jun;17(3):216-23. doi: 10.1136/qshc.2007.023622
  8. Kable AK, Gibberd RW, Spigelman AD. Adverse events in surgical patients in Australia. Int J Qual Health Care. 2002 Aug;14(4):269-76. doi: 10.1093/intqhc/14.4.269
  9. Arriaga AF, Bader AM, Wong JM, Lipsitz SR, Berry WR, Ziewacz JE, Hepner DL, Boorman DJ, Pozner CN, Smink DS, Gawande AA. Simulation-based trial of surgical-crisis checklists. N Engl J Med. 2013 Jan 17;368:246-53. doi: 10.1056/NEJMsa1204720
  10. Bliss LA, Ross-Richardson CB, Sanzari LJ, Shapiro DS, Lukianoff AE, Bernstein BA, Ellner SJ. Thirty-day outcomes support implementation of a surgical safety checklist. J Am Coll Surg. 2012 Dec;215(6):766-76. doi: 10.1016/j.jamcollsurg.2012.07.015
  11. de Vries EN, Prins HA, Bennink MC, Neijenhuis P, van Stijn I, van Helden SH, van Putten MA, Smorenburg SM, Gouma DJ, Boermeester MA. Nature and timing of incidents intercepted by the SURPASS checklist in surgical patients. BMJ Qual Saf. 2012 Jun;21(6):503-8. doi: 10.1136/bmjqs-2011-000347
  12. de Vries EN, Prins HA, Crolla RMPH, den Outer AJ, van Andel G, van Helden SH, Schlack WS, van Putten MA, Gouma DJ, Dijkgraaf MGW, Smorenburg SM, Boermeester MA. Effect of a comprehensive surgical safety system on patient outcomes. N Engl J Med. 2010 Nov;363:1928-37. doi: 10.1056/NEJMsa0911535
  13. Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP, Herbosa T, Joseph S, Kibatala PL, Lapitan MC, Merry AF, Moorthy K, Reznick RK, Taylor B, Gawande AA. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009 Jan 29;360(5):491-99. doi: 10.1056/NEJMsa0810119
  14. van Klei WA, Hoff RG, van Aarnhem EE, Simmermacher RK, Regli LP, Kappen TH, van Wolfswinkel L, Kalkman CJ, Buhre WF, Peelen LM. Effects of the introduction of the WHO “Surgical Safety Checklist” on in-hospital mortality: a cohort study. Ann Surg. 2012 Jan;255(1):44-49. doi: 10.1097/SLA.0b013e31823779ae
  15. Weiser TG, Haynes AB, Dziekan G, Berry WR, Lipsitz SR, Gawande AA. Effect of a 19-item surgical safety checklist during urgent operations in a global patient population. Ann Surg. 2010 May;251(5):976-80. doi: 10.1097/SLA.0b013e3181d970e3
  16. Weiser TG, Haynes AB, Lashoher A, Dziekan G, Boorman DJ, Berry WR, Gawande AA. Perspectives in quality: designing the WHO Surgical Safety Checklist. Int J Qual Health Care. 2010 Oct;22(5):365-70. doi: 10.1093/intqhc/mzq039
  17. Borchard A, Schwappach DL, Barbir A, Bezzola P. A systematic review of the effectiveness, compliance, and critical factors for implementation of safety checklists in surgery. Ann Surg. 2012 Dec;256(6):925-33. doi: 10.1097/SLA.0b013e3182682f27
  18. Fudickar A, Hörle K, Wiltfang J, Bein B. The effect of the WHO Surgical Safety Checklist on complication rate and communication. Dtsch Arztebl Int. 2012 Oct;109(42):695-701. doi: 10.3238/arztebl.2012.0695
  19. Kearns RJ, Uppal V, Bonner J, Robertson J, Daniel M, McGrady EM. The introduction of a surgical safety checklist in a tertiary referral obstetric centre. BMJ Qual Saf. 2011 Sep;20(9):818-22. doi: 10.1136/bmjqs.2010.050179
  20. Nilsson L, Lindberget O, Gupta A, Vegfors M. Implementing a pre-operative checklist to increase patient safety: a 1-year follow-up of personnel attitudes. Acta Anaesthesiol Scand. 2010 Feb;54(2):176-82. doi: 10.1111/j.1399-6576.2009.02109.x
  21. Takala RS, Pauniaho SL, Kotkansalo A, Helmiö P, Blomgren K, Helminen M, Kinnunen M, Takala A, Aaltonen R, Katila AJ, Peltomaa K, Ikonen TS. A pilot study of the implementation of WHO surgical checklist in Finland: improvements in activities and communication. Acta Anaesthesiol Scand. 2011 Nov;55(10):1206-14. doi: 10.1111/j.1399-6576.2011.02525.x
  22. Böhmer AB, Kindermann P, Schwanke U, Bellendir M, Tinschmann T, Schmidt C, Bouillon B, Wappler F, Gerbershagen MU. Long-term effects of a perioperative safety checklist from the viewpoint of personnel. Acta Anaesthesiol Scand. 2013 Feb;57(2):150-57. doi: 10.1111/aas.12020
  23. Böhmer AB, Wappler F, Tinschmann T, Kindermann P, Rixen D, Bellendir M, Schwanke U, Bouillon B, Gerbershagen MU. The implementation of a perioperative checklist increases patients’ perioperative safety and staff satisfaction. Acta Anaesthesiol Scand. 2012 Mar;56(3):332-38. doi: 10.1111/j.1399-6576.2011.02590.x
  24. Helmiö P, Blomgren K, Takala A, Pauniaho SL, Takala RS, Ikonen TS. Towards better patient safety: WHO Surgical Safety Checklist in otorhinolaryngology. Clin Otolaryngol. 2011 Jun;36(3):242-47. doi: 10.1111/j.1749-4486.2011.02315.x
  25. Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP, Dziekan G, Herbosa T, Kibatala PL, Lapitan MC, Merry AF, Reznick RK, Taylor B, Vats A, Gawande AA. Changes in safety attitude and relationship to decreased postoperative morbidity and mortality following implementation of a checklist-based surgical safety intervention. BMJ Qual Saf. 2011 Jan;20(1):102-7. doi: 10.1136/bmjqs.2009.040022
  26. Russ S, Rout S, Sevdalis N, Moorthy K, Darzi A, Vincent C. Do safety checklists improve teamwork and communication in the operating room? A systematic review. Ann Surg. 2013 Dec;258(6):856-71. doi: 10.1097/SLA.0000000000000206
  27. Birkmeyer JD. Strategies for improving surgical quality--checklists and beyond. N Engl J Med. 2010 Nov 11;363(20):1963-65. doi: 10.1056/NEJMe1009542
  28. Lauvrak V, Jeppesen E, Krogstad U. Method alert for the WHO Surgical Safety Checklist. Norwegian Knowledge Centre for the Health Services Web site. Available ftrom: http://www.kunnskapssenteret.no/publikasjoner/who-sjekkliste-for-trygg-kirurgi. Published 2010. Accessed February 4, 2014.
  29. Haugen AS, Søfteland E, Eide GE, Sevdalis N, Vincent CA, Nortvedt MW, Harthug S. Impact of the World Health Organization’s Surgical Safety Checklist on safety culture in the operating theatre: a controlled intervention study. Br J Anaesth. 2013 May;110(5):807-15. doi: 10.1093/bja/aet005
  30. Haugen AS, Søfteland E, Almeland SK, Sevdalis N, Vonen B, Eide GE, Nortvedt MW, Harthug S. Effect of the World Health Organization checklist on patient outcomes: a stepped wedge cluster randomized controlled trial. Ann Surg. 2015 May;261(5):821-28. doi: 10.1097/SLA.0000000000000716
  31. Pronovost P, Berenholtz S, Dorman T, Lipsett PA, Simmonds T, Haraden C. Improving communication in the ICU using daily goals. J Crit Care. 2003 Jun;18(2):71-75. doi: 10.1053/jcrc.2003.50008
  32. Semel ME, Resch S, Haynes AB, Funk LM, Bader A, Berry WR, Weiser TG, Gawande AA. Adopting a surgical safety checklist could save money and improve the quality of care in U.S. hospitals. Health Aff (Millwood). 2010 Sep;29(9):1593-99. doi: 10.1377/hlthaff.2009.0709
  33. Weiser TG, Haynes AB, Lashoher A, Dziekan G, Boorman DJ, Berry WR, Gawande AA. Perspectives in quality: designing the WHO surgical safety checklist. Int J Qual Health Care. 2010 Oct;22(5):365-70. doi: 10.1093/intqhc/mzq039
  34. Russ S, Rout S, Sevdalis N, Moorthy K, Darzi A, Vincent C. Do safety checklists improve teamwork and communication in the operating room? A systematic review. Ann Surg. 2013 Dec;258(6):856-71. doi: 10.1097/SLA.0000000000000206
  35. Thomassen Ø, Storesund A, Søfteland E, Brattebø G. The effects of safety checklists in medicine: a systematic review. Acta Anaesthesiol Scand. 2014 Jan;58(1):5-18. doi: 10.1111/aas.12207
  36. Haynes AB, Edmondson L, Lipsitz SR, Molina G, Neville BA, Singer SJ, Moonan AT, Childers AK, Foster R, Gibbons LR, Gawande AA, Berry WR. Mortality Trends After a Voluntary Checklist-based Surgical Safety Collaborative. Ann Surg. 2017 Dec;266(6):923-29. doi: 10.1097/SLA.0000000000002249
  37. Russ SJ, Sevdalis N, Moorthy K, Mayer EK, Rout S, Caris J, Mansell J, Davies R, Vincent C, Darzi A. A qualitative evaluation of the barriers and facilitators toward implementation of the WHO surgical safety checklist across hospitals in England: lessons from the “Surgical Checklist Implementation Project”. Ann Surg. 2015 Jan;261(1):81-91. doi: 10.1097/SLA.0000000000000793
  38. Haugen AS, Bakke A, Løvøy T, Søfteland E. Preventing Complications: The Preflight Checklist. Eur Urol Focus. 2016 Apr;2(1):60-62. doi: 10.1016/j.euf.2016.01.014
  39. Haynes AB, Berry WR, Gawande AA. What do we know about the safe surgery checklist now? Ann Surg. 2015 May;261(5):829-30. doi: 10.1097/SLA.0000000000001144
  40. Mayer EK, Sevdalis N, Rout S, Caris J, Russ S, Mansell J, Davies R, Skapinakis P, Vincent C, Athanasiou T, Moorthy K, Darzi A. Surgical Checklist Implementation Project: The Impact of Variable WHO Checklist Compliance on Risk-adjusted Clinical Outcomes After National Implementation: A Longitudinal Study. Ann Surg. 2016 Jan;263(1):58-63. doi: 10.1097/SLA.0000000000001185
  41. Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP, Herbosa T, Joseph S, Kibatala PL, Lapitan MC, Merry AF, Moorthy K, Reznick RK, Taylor B, Gawande AA. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009 Jan 29;360(5):491-99. doi: 10.1056/NEJMsa0810119
  42. Haugen AS, Søfteland E, Almeland SK, Sevdalis N, Vonen B, Eide GE, Nortvedt MW, Harthug S. Effect of the World Health Organization checklist on patient outcomes: a stepped wedge cluster randomized controlled trial. Ann Surg. 2015 May;261(5):821-28. doi: 10.1097/SLA.0000000000000716
  43. Urbach DR, Govindarajan A, Saskin R, Wilton AS, Baxter NN. Introduction of surgical safety checklists in Ontario, Canada. N Engl J Med. 2014 Mar 13;370(11):1029-38. doi: 10.1056/NEJMsa1308261
  44. van Klei WA, Hoff RG, van Aarnhem EE, Simmermacher RK, Regli LP, Kappen TH, van Wolfswinkel L, Kalkman CJ, Buhre WF, Peelen LM. Effects of the introduction of the WHO “Surgical Safety Checklist” on in-hospital mortality: a cohort study. Ann Surg. 2012 Jan;255(1):44-49. doi: 10.1097/SLA.0b013e31823779ae
  45. Haugen AS, Wæhle HV, Almeland SK, Harthug S, Sevdalis N, Eide GE, Nortvedt MW, Smith I, Søfteland E. Causal analysis of World Health Organization’s surgical safety checklist implementation quality and impact on care processes and patient outcomes: secondary analysis from a large stepped wedge cluster randomized controlled trial in Norway. Ann Surg. 2019 Feb;269(2):283-90. doi: 10.1097/SLA.0000000000002584
  46. Chaudhary N, Varma V, Kapoor S, Mehta N, Kumaran V, Nundy S. Implementation of a surgical safety checklist and postoperative outcomes: a prospective randomized controlled study. J Gastrointest Surg. 2015 May;19(5):935-42. doi: 10.1007/s11605-015-2772-9
  47. Semel ME, Resch S, Haynes AB, Funk LM, Bader A, Berry WR, Weiser TG, Gawande AA. Adopting a surgical safety checklist could save money and improve the quality of care in U.S. hospitals. Health Aff (Millwood). 2010 Sep;29(9):1593-9. doi: 10.1377/hlthaff.2009.0709
Address for correspondence:
450008, The Russian Federation,
Ufa, Lenin Str., 3,
Bashkir State Medical University,
Surgery Department with the Course
Of Endoscopy of the Institute of Continuing Professional Education.
Tel.: +79173577544,
e-mail: timervil@yandex.ru,
Vil M. Timerbulatov
Information about the authors:
Timerbulatov Shamil V., MD, Professor of the Surgery Department with the Course of Endoscopy of the Institute of Continuing Professional Education, Bashkir State Medical University, Ufa, Russian Federation.
http://orcid.org/0000-0002-4832-6363
Timerbulatov Makhmud V., MD, Professor, Head of the Faculty Surgery Department, Bashkir State Medical University, Ufa, Russian Federation.
http://orcid.org/0000-0002-6664-1308
Gafarova Aigul R., Post-Graduate Student of the Surgery Department with the Course of Endoscopy of the Institute of Continuing Professional Education, Bashkir State Medical University, Ufa, Russian Federation.
http://orcid.org/0000-0003-2874-7213
Timerbulatov Vil M., MD, Professor, Corresponding Member of RAS, Head of the Surgery Department with the Course of Endoscopy of the Institute of Continuing Professional Education, Bashkir State Medical University, Ufa, Russian Federation.
http://orcid.org/0000-0003-1696-3146

R.E. MAGOMEDBEKOV, M.M. MAGOMEDOV

INGUINAL HERNIAS AND HERNIOTOMY AS A CAUSE OF REPRODUCTIVE FUNCTION DISORDERS IN MALE PATIENTS

Dagestan State Medical University, Makhachkala,
The Russian Federation

The aim of the review is to describe tension and tension-free hernioplasty and its impact over the reproductive function in young men. Recently Russian and foreign authors have confirmed the need in advancing the traditional and new hernioplasty methods for more speedy social rehabilitation. Advances in surgery, development of new medical tools and improvements in new surgery methods haven’t reduced the percentage of reproductive complications. Use of modern implants in herniology and their impact on the reproductive system makes the problem a relevant one for fertile men. It is known that in almost half of cases, infertility in a marriage is due to a male factor, described in the medical literature as “male sterility”. A huge number of modern scientific publications demonstrate that a lot of researchers admit the effect of tension hernioplasty on the reproductive function in males. A positive impact of the tension hernioplasty on the reproductive function is shown. Literature sources contain more and more evidences of negative effects in the spermatic duct where it contacts prosthesis and of misperfusion causing venous hypertension. Contemporary literature analysis reveals a lot of problems associated with hernioplasty and confirms the need in comprehensive randomized studies in order to clarify all pathogenic mechanisms of the reproductive disorders in men. It is worth mentioning that the problem of inguinal hernia surgery in fertile men is far from drastic resolution.

Keywords: inguinal hernia, reproductive function, intratesticular blood flow, Desarda method, Doppler ultrasonography
p. 691-699 of the original issue
References
  1. Gvenetadze TK, Giorgobiani GT, Archvadze VSh, Gulbani LO. Prevention of male infertility development after different methods of inguinal hernia repair with the mesh explant. Novosti Khirurgii. 2014;22(3):379-85. doi: 10.18484/2305-0047.2014.3.379 (In Russ.)
  2. Vnukov PV. Is the groin hernia repair whith method Postempski alternative for tension-free approach? Uspekhi Sovrem Estestvoznaniia. 2006;(10):104. https://www.natural-sciences.ru/ru/article/view?id=11668 (In Russ.)
  3. Desyatkin VB, Pavlenko VV. Starchenkov SB. Oorzhak OV. Podtyachkina TA. Outcomes in patients with inguinal hernia different ways plasty. Meditsina v Kuzbasse. 2010;9(3):12-16. https://cyberleninka.ru/article/n/rezultaty-lecheniya-bolnyh-s-pahovymi-gryzhami-razlichnymi-sposobami-plastiki (In Russ.)
  4. Egiev VN, Liadov K, Voskresenskii P. Atlas operativnoi khirurgii gryzh. Moscow, RF: Medpraktik; 2003. 228 p. http://kingmed.info/knigi/Hiryrgia/Abdominalnaa_hiryrgia/book_1974/Atlas_operativnoy_hirurgii_grij-Egiev_VN_Lyadov_KV_Voskresenskiy_PK-2003-pdf. (In Russ.)
  5. Štula I, Družijanić N, Sapunar A, Perko Z, Bošnjak N, Kraljević D. Antisperm antibodies and testicular blood flow after inguinal hernia mesh repair. Surg Endosc. 2014 Dec;28(12):3413-20. doi: 10.1007/s00464-014-3614-7
  6. Akramov N.R., Omarov T.N. Gimadeeva L.R., Galliamova A.N. Male reproductive status after the classical inguinal hernia repair performed in childhood. Kazan Med Zhurn. 2014;95(1):7-11. https://kazanmedjournal.ru/kazanmedj/article/view/1446 6. (In Russ.)
  7. Bakirov IS. Inguinal hernia and the reproductive systems of men. Kreativnaia Khirurgiia i Onkologiia. 2016;(3):45-47. doi: 10.24060/2076-3093-2013-0-1-2-45-48 (In Russ.)
  8. Ridgway PF, Shah J, Darzi AW. MaIe genital tract injuries after contemporary inguinal hernia repair. BJU Int. 2002;90(3):272-76. doi: 10.1046/j.1464-410X.2002.02844.x
  9. Valenti G, Baldassare E. Vasal obstruction after hernioplasty: the importance of surgical strategy in preventing azoospermia. Ann Surg. 2006;244(1):160. doi: 10.1097/01.sla.0000226469.97993.02
  10. Belokonev VI. Patogenez pakhovoi gryzhi i obosnovannost’ primeneniia nenatiazhnykh sposobov plastiki pri ee lechenii. Annaly Plast. Rekonstrukt i Estet Khirurgii. 2008(3):49-54. URL: https://elibrary.ru/download/elibrary_11742790_44386880.pdf 10.
  11. Rosemar A, Angeras U, Rosengren A. Effect of body mass index on groin hernia surgery. Ann Surg. 2010;252(2):397-401. doi: 10.1097/SLA.0b013e3181e985a1
  12. Vinnik IuS. Operativnoe lechenie gryzh perednei briushnoi stenki. Krasnoiarsk, RF; 2011. 260 p. (In Russ.)
  13. Kirillov IuB, Astrakhantsev AF, Zotov IV. Morfologicheskie izmeneniia iaichka pri pakhovykh gryzhakh. Khirurgiia Zhurn im NI Pirogova. 2003;(2):28-31. (In Russ.)
  14. Schouten N, van Dalen T, Smakman N, Elias SG, van de Water C, Spermon RJ, Mulder LS, Burgmans IP. Male infertility after endoscopic Totally Extraperitoneal (Tep) hernia repair (Main): rationale and design of a prospective observational cohort study. BMC Surg. 2012 May 21;12:7. doi: 10.1186/1471-2482-12-7
  15. Chen XF, Wang HX, Liu YD, Sun K, Zhou LX, Huang YR, Li Z, Ping P. Clinical features and therapeutic strategies of obstructive azoospermia in patients treated by bilateral inguinal hernia repair in childhood. Asian J Androl. 2014 Sep-Oct;16(5):745-48. doi: 10.4103/1008-682X.131710
  16. Sheynkin YR, Hendin BN, Schlegel PN, Goldstein M. Microsurgical repair of iatrogenic injury to the vas deferens. J Urol. 1998 Jan;159(1):139-41. doi: 10.1016/s0022-5347(01)64036-9
  17. Matsuda T. Diagnosis and treatment of post-herniorrhaphy vas deferens obstruction. Int J Urol. 2000 May;7(Suppl):S35-8. doi: 10.1046/j.1442-2042.2000.00171.x
  18. Baulin VA. Puti uluchsheniia rezul’tatov lecheniia pakhovykh gryzh u muzhchin. Izv Vysshikh Ucheb Zavedenii. Povolzh region. Med Nauki. 2011;(3):49-56. https://cyberleninka.ru/article/v/puti-uluchsheniya-rezultatov-lecheniya-pahovyh-gryzh-u-muzhchin. (In Russ.)
  19. Moore JB, Hasenboehler EA. Orchiectomy as a result of ischemic orchitis after laparoscopic inguinal hernia repair: case report of a rare complication. Patient Saf Surg. 2007 Nov 7;1(1):3. doi: 10.1186/1754-9493-1-3
  20. Lel’chuk S, Antonenko F. Prichiny muzhskogo besplodiia. Andrologiia i Genital’naia Khirurgiia. 2009;10(2):95-951. https://elibrary.ru/item.asp?id=12- 838140 (In Russ.)
  21. Protasov AV, Smirnova ED, Titarov DL, Kaitova ZS, Shemyatovsky ÊA,
    Mikhaleva LM. The influence of mesh implants on the reproductive function after inguinal hernioplasty. [Elektronnyi resurs]. Zdorov’e i Obrazovanie v XXI veke. 2014;16(4):19-29. https://cyberleninka.ru/article/n/vliyanie-setchatyh-implantatov-na-reproduktivnuyu-funktsiyu-pri-pahovoy-gernioplastike (In Russ.)
  22. Pavlenko V, Starchenkov S, Desiatkin VB. Sravnitel’nyi analiz rezul’tatov lecheniia bol’nykh s pakhovymi gryzhami s ispol’zovaniem gernioplastiki po Likhtenshteinu i preperitoneal’noi gernioplastiki. Al’m Klin Meditsiny. 2007;(16):147-51. https://cyberleninka.ru/article/n/sravnitelnyy-analiz-rezultatov-lecheniya-bolnyh-s-pahovymi-gryzhami-s-ispolzovaniem-gernioplastiki-po-lihtenshteynu-i-preperitonealnoy (In Russ.)
  23. Nikiforov OA, Lomeyko EA, Lomaka SV, Lavysh IA. Male infertility: actual questions of physiology, pathogenesis and diagnosis of disorders of the reproductive system in male. Zaporozh Med Zhurn. 2014;(4):69-76. http://zmj.zsmu.edu.ua/article/view/27404/24551 (In Russ.)
  24. Bulus H, Dogan M, Tas A, Agladıoglu K, Coskun A. The effects of Lichtenstein tension-free mesh hernia repair on testicular arterial perfusion and sexual functions. Wien Klin Wochenschr. 2013 Feb;125(3-4):96-99. doi: 10.1007/s00508-013-0321-7
  25. Vnukov PV. Life quality and man reproductive sphere in remote postoperative period after groin hermoplasty. Postempski-Kirshner and Lichtenshtein. Ros Med-Biol Vestn im Akad IP Pavlova. 2007;(2):59-64. https://cyberleninka.ru/article/n/kachestvo-zhizni-i-reproduktivnaya-sfera-u-muzhchin-v-otdalyonnom-posleoperatsionnom-periode-posle-pahovoy-gernioplastiki-postempski (In Russ.)
  26. Emel’ianov SI, Protasov AV, Rutenburg GM. Endokhirurgiia pakhovykh i bedrennykh gryzh. Sankt-Peterburg, RF: Foliant; 2000. p. 156-60. https://www.twirpx.com/file/1004287/ (In Russ.)
  27. Sheptunov IuM, Vnukov PV. Izmeneniia iaichka posle natiazhnoi i nenatiazhnoi pakhovoi gernioplastiki. Fundam Issledovaniia. 2006;(6):47-48. http://fundamentalresearch.ru/ru/article/view?id=5112 (In Russ.)
  28. Fedoseev AV, Muravyev SY, Uspenskiy II. Optimization of hernioplasty choice method in patients with inguinal hernia in view of the spermatic cord blood flow. Novosti Khirurgii. 2012;20(6):41-44. http://www.surgery.by/pdf/full_text/2012_6_6_ft.pdf (In Russ.)
  29. Ramadan SU, Gokharman D, Tuncbilek I, Ozer H, Kosar P, Kacar M, Temel S, Kosar U. Does the presence of a mesh have an effect on the testicular blood flow after surgical repair of indirect inguinal hernia? J Clin Ultrasound. 2009 Feb;37(2):78-81. doi: 10.1002/jcu.20516
  30. Shin D, Lipshultz L, Goldstein M, Barmé GA, Fuchs EF, Nagler HM, McCallum SW, Niederberger CS, Schoor RA, Brugh VM 3rd, Honig SC. Herniorrhaphy with polypropylene mesh causing inguinal vasal obstruction: a preventable cause of obstructive azoospermia. Ann Surg. 2005 Apr;241(4):553-58. doi: 10.1097/01.sla.0000157318.13975.2a
  31. Skawran S, Weyhe D, Schmitz B, Belyaev O, Bauer KH. Bilateral endoscopic total extraperitoneal (TEP) inguinal hernia repair does not induce obstructive azoospermia: data of a retrospective and prospective trial. World J Surg. 2011 Jul;35(7):1643-48. doi: 10.1007/s00268-011-1072-0
  32. Ersin S, Aydin U, Makay O, Icoz G, Tamsel S, Sozbilen M, Kill R. Is testicular perfusion influenced during laparoscopic ingu?nal hernia surgery? Surg. Endosc. 2006 Apr;20(Is 4):685-89. https://link.springer.com/article/10.1007/s00464-005-0210-x
  33. Davis CJ, Arregui ME. Laparoscopic repair for groin hernias. Surg Clin North Am. 2003 Oct;83(5):1141-61. doi: 10.1016/S0039-6109(03)00122-1
  34. Khorava VG, Torgunakov AP, Demidov DG, Mamedov YZ. Sashkî AA. Results of preperitoneal prosthetics of abdominal wall from semij lunar pararectal approach at primary and recurrent inguinal hernias. Meditsina v Kuzbasse. 2014;13(4):28-33. http://mednauki.ru/index.php/MK/issue/viewIssue/116/116 (In Russ.)
  35. Uzzo RG, Lemack GE, Morrissey KP, Goldstein M. The effects of mesh bioprosthesis on the spermatic cord structures: a preliminary report in a canine model. J Urol. 1999 Apr;161(4):1344-49. doi: 10.1016/S0022-5347(01)61681-1
  36. Peiper C, Junge K, Klinge U, Strehlau E, Ottinger A, Schumpelick V. Is there a risk of infertility after inguinal mesh repair? Experimental studies in the pig and the rabbit. Hernia. 2006 Mar;10(1):7-12. doi: 10.1007/s10029-005-0055-1
  37. Junge K, Binnebösel M, Rosch R, Öttinger A, Stumpf M, Mühlenbruch G, Schumpelick V, Klinge U. HerniaInfluence of mesh materials on the integrity of the vas deferens following Lichtenstein hernioplasty: an experimental model. Hernia. 2008;12(6):621-26. doi: 10.1007/s10029-008-0400-2
  38. Berndsen FH, Bjursten LM, Simanaitis M, Montgomery A. Does mesh implantation affect the spermatic cord structures after inguinal hernia surgery? An experimental study in rats. Eur Surg Res. 2004 Sep-Oct;36(5):318-22. doi: 10.1159/000079918
  39. Sajid MS, Leaver C, Baig MK, Sains P. Systematic review and meta-analysis of the use of lightweight versus heavyweight mesh in open inguinal hernia repair. Br J Surg. 2012 Jan;99(1):29-37. doi: 10.1002/bjs.7718
  40. Zhong C, Wu B, Yang Z, Deng X, Kang J, Guo B, Fan Y. A meta-analysis comparing lightweight meshes with heavyweight meshes in Lichtenstein inguinal hernia repair. Surg Innov. 2013 Feb;20(1):24-31. doi: 10.1177/1553350612463444
  41. Peeters E, Spiessens C, Oyen R, De Wever L, Vanderschueren D, Penninckx F, Miserez M. Sperm motility after laparoscopic inguinal hernia repair with lightweight meshes: 3-year follow-up of a randomised clinical trial. Hernia. 2014 Jun;18(3):361-7. doi: 10.1007/s10029-012-1028-9
  42. Kolbe T, Hollinsky C, Walter I, Joachim A, Rülicke T. Influence of a new self-gripping hernia mesh on male fertility in a rat model. Surg Endosc. 2010 Feb;24(2):455-61. doi: 10.1007/s00464-009-0596-y
  43. Aliev SA. Evoliutsiia metodov khirurgicheskogo lecheniia pakhovykh gryzh. Vestn khirurgii im II Grekova. 2010;(5):109-13. https://cyberleninka.ru/article/n/evolyutsiya-metodov-hirurgicheskogo-lecheniya-pahovyh-gryzh (In Russ.)
  44. Jeng S, Dobrovolsky SR, Smirnov NV. Analysis of early complications after lichenstein orshouldice herniorraphy: a retrospective comparison Vestn RUDN, ser Meditsina. 2014;(4):58-62. URL: http://journals.rudn.ru/medicine/issue/view/229 (In Russ.)
  45. Miserez M, Peeters E, Aufenacker T, Bouillot JL, Campanelli G, Conze J, Fortelny R, Heikkinen T, Jorgensen LN, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietanski M, Weber G, Simons MP. Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2014 Apr;18(2):151-63. doi: 10.1007/s10029-014-1236-6
  46. Desarda MP. Physiological repair of inguinal hernia: a new technique (study of 860 patients). Hernia. 2006 Apr;10(2):143-46. doi: 10.1007/s10029-005-0039-1
  47. Mitura K, Romańczuk M. Comparison between two methods of inguinal hernia surgery – Lichtenstein and Desarda. Pol Merkur Lekarski. 2008 May;24(143):392-95. [Article in Polish]
  48. Szopiński J, Dabrowiecki S. Desarda versus Lichtenstein technique for primary inguinal hernia treatment: 3-year results of a randomized clinical trial. World J Surg. 2012 May;36(Is 5):984-92. doi: 10.1007/s00268-012-1508-1
Address for correspondence:
367000, The Russian Federation,
Makhachkala, Pirogov Str., 3,
Dagestan State Medical University,
Department of Surgery of the Faculty of Advanced Training
And Professional Training of Specialists.
Tel. office +79282308646,
e-mail: muxuma@mail.ru,
ramazan.magomedbekov@mail.ru,
Muchuma M. Magomedov
Information about the authors:
Magomedbekov Ramazan E., Post-Graduate Student of the Department of Surgery of the Faculty of Advanced Training and Professional Training of Specialists, Dagestan State Medical University, Makhachkala, Russian Federation.
https://orcid.org/0000-0003-4391-3099
Magomedov Muchuma M., MD, Professor of the Department of Surgery of the Faculty of Advanced Training and Professional Training of Specialists, Dagestan State Medical University, Makhachkala, Russian Federation.
https://orcid.org/0000-0002-3335-525X

A.M. OVECHKIN, S.V. SOKOLOGORSKIY, M.E. POLITOV

OPIOID-FREE ANAESTHESIA AND ANALGESIA – TRIBUTE TO FASHION OR THE IMPERATIVE OF TIME?

I.M. Sechenov First Moscow State Medical University, Moscow,
The Russian Federation

Opioid analgesia continues to be the “gold standard” of postoperative analgesia in most developed countries. At the same time, in recent years, evidence has been accumulated indicating the negative impact of opioids on the course of the early postoperative period. In addition to the traditional side effects of these drugs (depression of consciousness, excessive sedation, nausea, etc.), their ability to form opioid-induced hyperalgesia, to have an immunosuppressive effect, to reduce the power of local anesthetics is considered. In addition, opioid analgesia prevents the implementation of the concept of accelerated postoperative patient rehabilitation (fast-track surgery and ERAS). The review examines the modern possibilities of conducting free or low-opioid anesthesia, mainly during laparoscopic surgery. The concept of multimodal analgesia makes it possible to refuse the use of opioid analgesics or to minimize their dosage in the perioperative period. Multimodal analgesia involves the simultaneous administration of two or more drugs that affect different levels of the formation of acute pain. The characteristics of the main components of opioid-free anesthesia and analgesia (NSAIDs, paracetamol, dexmedetomidine, gabapentin, ketamine, lidocaine, dexamethasone) are described from the standpoint of evidence-based medicine. The schemes of opioid-free anesthesia and analgesia in a number of surgeries are presented, in particular, with laparoscopic cholecystectomy and laparoscopic hemicolectomy.

Keywords: opioid-free anesthesia, analgesia, multimodal analgesia, NSAID, dexmedetomidine, gabapentin, lidocaine, ketamine, dexamethasone
p. 700-715 of the original issue
References
  1. Oderda GM, Gan TJ, Johnson BH, Robinson SB. Effect of opioid-related adverse events on outcomes in selected surgical patients. J Pain Palliat Care Pharmacother. 2013 Mar;27(1):62-70. doi: 10.3109/15360288.2012.751956
  2. Clark DJ, Schumacher MA. America’s Opioid Epidemic: Supply and Demand Considerations. Anesth Analg. 2017 Nov;125(5):1667-74. doi: 10.1213/ANE.0000000000002388
  3. Wheeler M, Oderda GM, Ashburn MA, Lipman AG. Adverse events associated with postoperative opioid analgesia: a systematic review. J Pain. 2002 Jun;3(3):159-80. doi: 10.1054/jpai.2002.123652
  4. Oderda GM, Said Q, Evans RS, Stoddard GJ, Lloyd J, Jackson K, Rublee D, Samore MH. Opioid-related adverse drug events in surgical hospitalizations: impact on costs and length of stay. Ann Pharmacother. 2007 Mar;41(3):400-6. doi: 10.1345/aph.1H386
  5. Pizzi LT, Toner R, Foley K, Thomson E, Chow W, Kim M, Couto J, Royo M, Viscusi E. Relationship between potential opioid-related adverse effects and hospital length of stay in patients receiving opioids after orthopedic surgery. Pharmacotherapy. 2012 Jun;32(6):502-14. doi: 10.1002/j.1875-9114.2012.01101.x
  6. Kessler ER, Shah M, Gruschkus SK, Raju A. Cost and quality implications of opioid-based postsurgical pain control using administrative claims data from a large health system: opioid-related adverse events and their impact on clinical and economic outcomes. Pharmacotherapy. 2013 Apr;33(4):383-91. doi: 10.1002/phar.1223
  7. Larcher A, Laulin JP, Celerier E, Le Moal M, Simonnet G. Acute tolerance associated with a single opiate administration: involvement of N-methyl-D-aspartate-dependent pain facilitatory systems. Neuroscience. 1998 May;84(2):583-89. doi: 10.1016/S0306-4522(97)00556-3
  8. Laulin JP, Maurette P, Corcuff JB, Rivat C, Chauvin M, Simonnet G. The role of ketamine in preventing fentanyl-induced hyperalgesia and subsequent acute morphine tolerance. Anesth Analg. 2002 May;94(5):1263-69, table of contents. doi: 10.1097/00000539-200205000-00040
  9. Singleton PA, Moss J. Effect of perioperative opioids on cancer recurrence: a hypothesis. Future Oncol. 2010 Aug;6(8):1237-42. doi: 10.2217/Fon.10.99
  10. Gupta GP, Massagué J. Cancer metastasis: building a framework. Cell. 2006 Nov 17;127(4):679-95. doi: 10.1016/J.Cell.2006.11.001
  11. Beilin B, Shavit Y, Hart J, Mordashov B, Cohn S, Notti I, Bessler H. Effects of anesthesia based on large versus small doses of fentanyl on natural killer cell cytotoxicity in the perioperative period. Anesth Analg. 1996 Mar;82(3):492-97. doi: 10.1097/00000539-199603000-00011
  12. Vosoughian M, Dabbagh A, Rajaei S, Maftuh H. The duration of spinal anesthesia with 5% lidocaine in chronic opium abusers compared with nonabusers. Anesth Analg. 2007 Aug;105(2):531-33. doi: 10.1213/01.Ane.0000268496.46141.4f
  13. Hashemian AM, Omraninava A, Kakhki AD, Sharifi MD, Ahmadi K, Masoumi B, Mehrpour O. Effectiveness of local anesthesia with lidocaine in chronic opium abusers. J Emerg Trauma Shock. 2014 Oct;7(4):301-4. doi: 10.4103/0974-2700.142765
  14. Liu Q, Gold MS. Opioid-induced Loss of Local Anesthetic Potency in the Rat Sciatic Nerve. Anesthesiology. 2016 Oct;125(4):755-64. doi: 10.1097/ALN.0000000000001239
  15. Ulbricht W. Sodium channel inactivation: molecular determinants and modulation. Physiol Rev. 2005 Oct;85(4):1271-301. doi: 10.1152/physrev.00024.2004
  16. Ferrini F, Trang T, Mattioli TA, Laffray S, Del’Guidice T, Lorenzo LE, Castonguay A, Doyon N, Zhang W, Godin AG, Mohr D, Beggs S, Vandal K, Beaulieu JM, Cahill CM, Salter MW, De Koninck Y. Morphine hyperalgesia gated through microglia-mediated disruption of neuronal Cl? homeostasis. Nat Neurosci. 2013 Feb;16(2):183-92. doi: 10.1038/nn.3295
  17. Sun EC, Darnall BD, Baker LC, Mackey S. Incidence of and risk factors for chronic opioid use among opioid-naive patients in the postoperative period. JAMA Intern Med. 2016 Sep 1;176(9):1286-93. doi: 10.1001/jamainternmed.2016.3298
  18. Kehlet H, Dahl JB. The value of “multimodal” or “balanced analgesia” in postoperative pain treatment. Anesth Analg. 1993 Nov;77(5):1048-56. doi: 10.1213/00000539-199311000-00030
  19. Schug S, Palmer G, Scott D, Hallivell R, Trinca J. Acute Pain Management: Scientific Evidence. Australian and New Zeland College of Anaesthetists. 4-th ed. Melbourne; 2015. 647 p. http://fpm.anzca.edu.au/documents/apmse4_2015_final
  20. Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T, Carter T, Cassidy CL, Chittenden EH, Degenhardt E, Griffith S, Manworren R, McCarberg B, Montgomery R, Murphy J, Perkal MF, Suresh S, Sluka K, Strassels S, Thirlby R, Viscusi E, Walco GA, Warner L, Weisman SJ, Wu CL. Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain. 2016 Feb;17(2):131-57. doi: 10.1016/j.jpain.2015.12.008
  21. Hakkarainen TW, Steele SR, Bastaworous A, Dellinger EP, Farrokhi E, Farjah F, Florence M, Helton S, Horton M, Pietro M, Varghese TK, Flum DR. Nonsteroidal anti-inflammatory drugs and the risk for anastomotic failure: a report from Washington State’s Surgical Care and Outcomes Assessment Program (SCOAP). JAMA Surg. 2015 Mar 1;150(3):223-28. doi: 10.1001/jamasurg.2014.2239
  22. Kotagal M, Hakkarainen TW, Simianu VV, Beck SJ, Alfonso-Cristancho R, Flum DR. Ketorolac Use and Postoperative Complications in Gastrointestinal Surgery. Ann Surg. 2016 Jan;263(1):71-5. doi: 10.1097/SLA.0000000000001260
  23. Graham GG, Davies MJ, Day RO, Mohamudally A, Scott KF. The modern pharmacology of paracetamol: therapeutic actions, mechanism of action, metabolism, toxicity and recent pharmacological findings. Inflammopharmacology. 2013 Jun;21(3):201-32. doi: 10.1007/s10787-013-0172-x
  24. Volkov PA. Churadze BT, Sevalkin SA. Volkova YN, Guryanov VA. Dexmedetomidine as a part of analgesic component of general anesthesia for laparoscopic operations. Anesteziologiia i Reanimatologiia. 2015;60(1):4-8. https://cyberleninka.ru/article/n/deksmedetomidin-kak-sostavlyayuschaya-analgeticheskogo-komponenta-obschey-anestezii-pri-laparoskopicheskih-operatsiyah (In Russ.)
  25. Le Bot A, Michelet D, Hilly J, Maesani M, Dilly MP, Brasher C, Mantz J, Dahmani S. Efficacy of intraoperative dexmedetomidine compared with placebo for surgery in adults: a meta-analysis of published studies. Minerva Anestesiol. 2015 Oct;81(10):1105-17. doi: 10.1007/s40122-016-0045-2
  26. Davy A, Fessler J, Fischler M, LE Guen M. Dexmedetomidine and general anesthesia: a narrative literature review of its major indications for use in adults undergoing non-cardiac surgery. Minerva Anestesiol. 2017 Dec;83(12):1294-1308. doi: 10.23736/S0375-9393.17.12040-7
  27. Grewal A. Dexmedetomidine: New avenues. J Anaesthesiol Clin Pharmacol. 2011 Jul;27(3):297-302. doi: 10.4103/0970-9185.83670
  28. Kimura M, Saito S, Obata H. Dexmedetomidine decreases hyperalgesia in neuropathic pain by increasing acetylcholine in the spinal cord. Neurosci Lett. 2012 Oct 31;529(1):70-74. doi: 10.1016/j.neulet.2012.08.008
  29. Lee C, Kim YD, Kim JN. Antihyperalgesic effects of dexmedetomidine on high-dose remifentanil-induced hyperalgesia. Korean J Anesthesiol. 2013 Apr;64(4):301-7. doi: 10.4097/kjae.2013.64.4.301
  30. Schnabel A, Meyer-Frießem CH, Reichl SU, Zahn PK, Pogatzki-Zahn EM. Is intraoperative dexmedetomidine a new option for postoperative pain treatment? A meta-analysis of randomized controlled trials. Pain. 2013 Jul;154(7):1140-49. doi: 10.1016/j.pain.2013.03.029
  31. Epshtoin SL, Azarova TM. Storozhev VYu, Vduvin VV, Sablin IA, Romanov BV, Martynov AN. General anesthesia without opioids in surgery for morbid obesity. What for and how? Regionarnaia Anesteziia i Lechenie Ostroi Boli. 2016;10(1). doi: 10.18821/1993-6508-2016-10-1-47-54 (In Russ.)
  32. Balandin VV, Gorobec ES. Opioid-free anesthesia, analgesia and sedation in surgery of head and neck tumors. Anesteziologiia i Reanimatologiia. 2015;60(6):39-42. https://cyberleninka.ru/article/n/bezopioidnaya-anesteziya-analgeziya-i-sedatsiya-v-hirurgii-opuholey-golovy-i-shei (In Russ.)
  33. De Kock M, Lavand’homme P, Waterloos H. ‘Balanced analgesia’ in the perioperative period: is there a place for ketamine? Pain. 2001 Jun;92(3):373-80. doi: 10.1016/S0304-3959(01)00278-0
  34. McCartney CJ, Sinha A, Katz J. A qualitative systematic review of the role of N-methyl-D-aspartate receptor antagonists in preventive analgesia. Anesth Analg. 2004 May;98(5):1385-400. doi: 10.1213/01.ane.0000108501.57073.38
  35. Bell RF, Dahl JB, Moore RA, Kalso E. Perioperative ketamine for acute postoperative pain. Cochrane Database Syst Rev. 2006 Jan 25;(1):CD004603. doi: 10.1002/14651858.CD004603.pub2
  36. Tiippana EM, Hamunen K, Kontinen VK, Kalso E. Do surgical patients benefit from perioperative gabapentin/pregabalin? A systematic review of efficacy and safety. Anesth Analg. 2007 Jun;104(6):1545-56, table of contents. doi: 10.1213/01.ane.0000261517.27532.80
  37. Clivatti J, Sakata RK, Issy AM. Review of the use of gabapentin in the control of postoperative pain. Rev Bras Anestesiol. 2009 Jan-Feb;59(1):87-98. 10.1590/S0034-70942009000100012 [Article in English, Portuguese]
  38. Lauretti GR. Mechanisms of analgesia of intravenous lidocaine. Rev Bras Anestesiol. 2008 May-Jun;58(3):280-86. doi: 10.1590/S0034-70942008000300011 [Article in English, Portuguese]
  39. Finnerup NB, Biering-Sørensen F, Johannesen IL, Terkelsen AJ, Juhl GI, Kristensen AD, Sindrup SH, Bach FW, Jensen TS. Intravenous lidocaine relieves spinal cord injury pain: a randomized controlled trial. Anesthesiology. 2005 May;102(5):1023-30. doi: 10.1097/00000542-200505000-00023
  40. Hollmann MW, Gross A, Jelacin N, Durieux ME. Local anesthetic effects on priming and activation of human neutrophils. Anesthesiology. 2001 Jul;95(1):113-22. doi: 10.1097/00000542-200107000-00021
  41. Biella G, Sotgiu ML. Central effects of systemic lidocaine mediated by glycine spinal receptors: an iontophoretic study in the rat spinal cord. Brain Res. 1993 Feb 19;603(2):201-6. doi: 10.1016/0006-8993(93)91238-n
  42. Cohen SP, Mao J. Is the analgesic effect of systemic lidocaine mediated through opioid receptors? Acta Anaesthesiol Scand. 2003 Aug;47(7):910-11. doi: 10.1034/j.1399-6576.2003.00163.x
  43. McCarthy GC, Megalla SA, Habib AS. Impact of intravenous lidocaine infusion on postoperative analgesia and recovery from surgery: a systematic review of randomized controlled trials. Drugs. 2010 Jun 18;70(9):1149-63. doi: 10.2165/10898560-000000000-00000
  44. Marret E, Rolin M, Beaussier M, Bonnet F. Meta-analysis of intravenous lidocaine and postoperative recovery after abdominal surgery. Br J Surg. 2008 Nov;95(11):1331-38. doi: 10.1002/bjs.6375
  45. Sawyer J, Morningstar B, Chung F, Siddiqui N, McCluskey S. Enhanced Recovery after Surgery Guideline: Perioperative Pain Management in Patients Having Elective Colorectal Surgery. A Quality Initiative of the Best Practice in General Surgery Part of CAHO’s ARTIC program [Internet]. Toronto; 2013. Available from: https://www.sages.org/wpcontent/uploads/2013/09/toronto-iERAS_Pain_Mangement _Guideline_March_2014.pdf
  46. Holte K, Kehlet H. Perioperative single-dose glucocorticoid administration: pathophysiologic effects and clinical implications. J Am Coll Surg. 2002 Nov;195(5):694-12. doi: 10.1016/S1072-7515(02)01491-6
  47. Chin R Jr. Corticosteroids. In: Chernow B, ed. The pharmacologic approach to the critically ill patient. United States: Williams and Wilkens; 1988. p. 559-83.
  48. Buvanendran A, Kroin JS. Useful adjuvants for postoperative pain management. Best Pract Res Clin Anaesthesiol. 2007 Mar;21(1):31-49. doi: 10.1016/j.bpa.2006.12.003
  49. Batistaki C, Kaminiotis E, Papadimos T, Kostopanagiotou G. A Narrative Review of the Evidence on the Efficacy of Dexamethasone on Postoperative Analgesic Consumption. Clin J Pain. 2017 Nov;33(11):1037-46. doi: 10.1097/AJP.0000000000000486
  50. Ovechkin AM, Iavorovskii AG. Bezopioidnaia analgeziia v sovremennoi khirurgii – ot teorii k praktike. Moscow, RF: GEOTAR-Media; 2019. 234 p. http://www.geotar.ru/lots/NF0013030.html (In Russ.)
Address for correspondence:
119991, The Russian Federation,
Moscow, Trubetskaya Str., 8-2,
I.M. Sechenov First Moscow
State Medical University,
Department of Anesthesiology and Resuscitation
Tel.: +7 (916) 143-96-21,
e-mail: ovechkin_alexei@mail.ru,
Àlexei M. Ovechkin
Information about the authors:
Ovechkin Àlexei M., MD, Professor of the Department of Anesthesiology and Resuscitation, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0002-3453-8699
Sokologorskiy Sergey V., MD, Professor of the Department of Anesthesiology and Resuscitation, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0001-6805-9744
Politov Mikhail E., PhD, Associate Professor of the Department of Anesthesiology and Resuscitation, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0003-0623-4927

CASE REPORTS

K.V. LIPATOV 1, V.K. GOSTISHCHEV 1, A.G. ASATRYAN 1, G.G. MELKONYAN 3, A.V. KIRILLIN 2, I.V. GORBACHEVA 1, E.S. SOLODOVNIKOV 1

SURGICAL TREATMENT OF THE LOWER EXTREMITY EXTENSIVE PURULENT AND NECROTIC SOFT TISSUE LESIONS IN A PATIENT WITH SYSTEMIC SCLERODERMA

I.M. Sechenov First Moscow State Medical University 1,
I.V. Davidovsky Moscow Clinical Hospital 2,
The 4th Moscow Clinical Hospital 3, Moscow,
The Russian Federation

Systemic scleroderma is an autoimmune condition that is characterized by fibrosis of the skin and visceral organs. Microangiopathy, which is one of the key features of systemic scleroderma, is one of the causes of formation of skin necrosis and ulcers. Widespread suppurative necrotic inflammation of integumentary tissues is quite rare in systemic scleroderma, but it creates significant complications in treatment of the disease. This observation presents the experience of surgical treatment of a patient with extensive suppurative necrotic inflammation of the soft tissues of the lower limb with systemic scleroderma as an underlying disease for which she received immunosuppressive medications. The disease was marked by fast progression and was accompanied by progressive necrosis of the skin and subcutaneous adipose tissue. The signs of systemic inflammation were diagnosed. Emergency surgical debridement was performed with subsequent necrectomyies on the 2, 5, 7, 9 and 15th days of hospitalization. The pathogens isolated from the wound were Staphylococcus aureus, Streptococcus pyogenes. Additionally to the surgical treatment, complex pharmacological therapy, including antimicrobial, detoxification, vascular and immunotherapy, was carried out. This complex treatment led to the wound cleaning and regression of inflammation by the 20th day of hospitalization. Autologous skin grafting was later performed with no complications after a year of follow-up. This case report illustrates a severe bacterial soft tissue infection in a patient with a diffuse form of systemic scleroderma against the background of immunosuppression caused by chemotherapy and glucocorticoids. This complex treatment allowed us eliminating the infection and performing the autologous skin grafting with the extensive wound closure.

Keywords: systemic sclerosis, soft tissue infection, surgical treatment, skin grafting, soft tissue necrosis
p. 716-722 of the original issue
References
  1. van den Hoogen F, Khanna D, Fransen J, Johnson SR, Baron M, Tyndall A, Matucci-Cerinic M, Naden RP, Medsger TA Jr, Carreira PE, Riemekasten G, Clements PJ, Denton CP, Distler O, Allanore Y, Furst DE, Gabrielli A, Mayes MD, van Laar JM, Seibold JR, Czirjak L, Steen VD, Inanc M, Kowal-Bielecka O, Müller-Ladner U, Valentini G, Veale DJ, Vonk MC, Walker UA, Chung L, Collier DH, Csuka ME, Fessler BJ, Guiducci S, Herrick A, Hsu VM, Jimenez S, Kahaleh B, Merkel PA, Sierakowski S, Silver RM, Simms RW, Varga J, Pope JE. 2013 classification criteria for systemic sclerosis: an American College of Rheumatology/European League against Rheumatism collaborative initiative. Arthritis Rheum. 2013 Nov;65(11):2737-47. doi: 10.1002/art.38098
  2. Giuggioli D, Manfredi A, Lumetti F, Colaci M, Ferri C. Scleroderma skin ulcers definition, classification and treatment strategies our experience and review of the literature. Autoimmun Rev. 2018 Feb;17(2):155-164. doi: 10.1016/j.autrev.2017.11.020
  3. Denton CP, Khanna D. Systemic sclerosis. Lancet. 2017 Oct 7;390(10103):1685-1699. doi: 10.1016/S0140-6736(17)30933-9
  4. Valenzuela A, Baron M; Canadian Scleroderma Research Group, Herrick AL, Proudman S, Stevens W; Australian Scleroderma Interest Group, Rodriguez-Reyna TS, Vacca A, Medsger TA Jr, Hinchcliff M, Hsu V0, Wu JY, Fiorentino D, Chung L. Calcinosis is associated with digital ulcers and osteoporosis in patients with systemic sclerosis: a scleroderma clinical trials consortium study. Semin Arthritis Rheum. 2016 Dec;46(3):344-49. doi: 10.1016/j.semarthrit.2016.05.008
  5. Baron M, Pope J, Robinson D, Jones N, Khalidi N, Docherty P, Kaminska E, Masetto A, Sutton E, Mathieu JP, Ligier S, Grodzicky T, LeClercq S, Thorne C, Gyger G, Smith D, Fortin PR, Larché M, Abu-Hakima M, Rodriguez-Reyna TS, Cabral-Castaneda AR, Fritzler MJ, Wang M, Hudson M. Calcinosis is associated with digital ischaemia in systemic sclerosis-a longitudinal study. Rheumatology (Oxford). 2016 Dec;55(12):2148-55. doi: 10.1093/rheumatology/kew313
  6. Giuggioli D, Manfredi A, Colaci M, Lumetti F, Ferri C. Scleroderma digital ulcers complicated by infection with fecal pathogens. Arthritis Care Res (Hoboken). 2012 Feb;64(2):295-97. doi: 10.1002/acr.20673
  7. Giuggioli D, Manfredi A, Colaci M, Lumetti F, Ferri C. Osteomyelitis complicating scleroderma digital ulcers. Clin Rheumatol. 2013 May;32(5):623-27. doi: 10.1007/s10067-012-2161-7
  8. Matucci-Cerinic M, Krieg T, Guillevin L, Schwierin B, Rosenberg D, Cornelisse P, Denton CP. Elucidating the burden of recurrent and chronic digital ulcers in systemic sclerosis: long-term results from the DUO Registry. Ann Rheum Dis. 2016 Oct;75(10):1770-6. doi: 10.1136/annrheumdis-2015-208121
  9. Leaper DJ, Schultz G, Carville K, Fletcher J, Swanson T, Drake R. Extending the TIME concept: what have we learned in the past 10 years? Int Wound J. 2012 Dec;9(Suppl 2):1-19. doi: 10.1111/j.1742-481X.2012.01097.x
  10. Schultz GS, Sibbald RG, Falanga V, Ayello EA, Dowsett C, Harding K, Romanelli M, Stacey MC, Teot L, Vanscheidt W. Wound bed preparation: a systematic approach to wound management. Wound Repair Regen. 2003 Mar;11(Suppl 1):S1-28. doi: 10.1046/j.1524-475x.11.s2.1.x
  11. Boateng J, Catanzano O. Advanced Therapeutic Dressings for Effective Wound Healing – A Review. J Pharm Sci. 2015 Nov;104(11):3653-80. doi: 10.1002/jps.24610
Address for correspondence:
119991, The Russian Federation,
Moscow, Bolshaya Pirogovskaya Str., 2-4,
I.M. Sechenov First Moscow
State Medical University,
General Surgery Department.
Tel. mobile +7 (916) 635-89-88,
e-mail: k_lipatov@mail.ru
Konstantin V. Lipatov
Information about the authors:
Lipatov Konstantin V., MD, Professor of the General Surgery Department, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
http://orcid.org/0000-0002-9902-2650
Gostishchev Victor K., MD, Professor, Academician of RAS, Professor of the General Surgery Department, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
http://orcid.org/0000-0002-8140-7931
Asatryan Artur G., PhD, Assistant of the General Surgery Department, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
http://orcid.org/0000-0002-8409-2605
Melkonyan George G., MD, Professor, Head Physician of the 4th Moscow Clinical Hospital, Moscow, Russian Federation.
http://orcid.org/0000-0001-7234-4185
Kirillin Alexey V., PhD, Deputy Head Physician for Surgery, I.V. Davidovsky Moscow Clinical Hospital, Moscow, Russian Federation.
http://orcid.org/0000-0003-0585-9941
Gorbacheva Irina V., PhD, Associate Professor of the General Surgery Department, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
http://orcid.org/0000-0002-1060-1163
Solodovnikov Egor S., 4th year student, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
http://orcid.org/0000-0002-7006-6641

EXCHANGE OF EXPERIENCE

A.E. MURZICH

ARTHROSCOPY IN THE DIAGNOSIS AND TREATMENT OF HIP JOINT PATHOLOGY

Republican Scientific and Practical Center of Traumatology and Orthopedics, Minsk,
The Republic of Belarus

Objective. To estimate the possibilities and results of arthroscopy in different hip joint pathologies in young patients.
Methods. The results of 32 hip joint arthroscopy in cases of “cam” and “pincer” types of femoroacetabular impingement, chondromatosis and synovitis of the hip joint, osteoid osteoma of the acetabulum, osteonecrosis of the femoral head were analyzed. In 70% of cases, surgery was performed in adult patients aged 25 to 44 years. Hip arthroscopy was conducted in the patient’s supine position under general anesthesia through 3 ports: anterolateral, anterior, proximal anterolateral. 30° and 70° telescopes, 180 mm bone drills and aggressive cutters were used.
Results. A positive clinical effect due to the relief of pain and increase range of motion in the hip joint was obtained by arthroscopic treatment of femoroacetabular impingement. In one case the progression of coxarthrosis was observed, which required the total hip replacement in terms of 1.5 years after arthroscopy. In two cases the heterotopic soft tissue ossification in the projection of m. Iliopsoas was noted. Resection of the osteoid osteoma of the acetabulum under arthroscopic control is an effective less traumatic treatment for subchondral localization. Arthroscopic joint debridement in cases of coxarthrosis and osteonecrosis of the femoral head in some cases improves the clinical outcome of treatment by reducing the effusion in the joint and capsular tension. Intraosseous osteoscopy of the femoral head allowed visualizing the site of necrosis and monitoring the process of intraosseous osteoperforation.
Conclusions. The primary analysis of the results of hip arthroscopy showed its high efficiency as a minimally invasive method of diagnosis and treatment in a number of pathological conditions. The development of this direction of arthroscopy is possible only with the availability of specialized equipment and the improvement of surgical skills.

Keywords: hip arthroscopy, femoroacetabular impingement, osteonecrosis, femoral head, osteoid osteoma
p. 723-731 of the original issue
References
  1. Byrd JWT. Hip arthroscopy, the supine approach: technique and anatomy of the intraarticular and peripheral compartments. Tech Orthop. 2005 Mar;20(1):17-31. doi: 10.1097/01.bto.0000152172.34187.bf
  2. Joan C. Monllau, F. Reina-de la Torre, Lluis Puig, A. Rodrı'guez-Baeza. Arthroscopic Approaches to the Hip Joint. Tech Orthop. 2005 Mar;20(1):2-8. doi: 10.1097/01.bto.0000152170.52739.9a
  3. Burman M. Arthroscopy or the direct visualization of joints. JBJS. 1931 Oct;13(4):669-95.
  4. Konyves A. Editorial Commentary: International Society for Hip Arthroscopy Surgeons! Time for a Rethink on Rehabil Arthroscopy. 2017 Nov;33(11):2006. doi: 10.1016/j.arthro.2017.08.272
  5. Marin-Pena O, Tey-Pons M, Perez-Carro L, Said HG, Sierra P, Dantas P, Villar RN. The current situation in hip arthroscopy. EFORT Open Rev. 2017 Mar;2(3):58-65. doi: 10.1302/2058-5241.2.150041
  6. Milyukov AY. Arthroscopy of hip joint. Politravma. 2006;(2):22-25. https://cyberleninka.ru/article/n/artroskopiya-tazobedrennogo-sustava (In Russ.)
  7. Orletskii AN, Malakhova SV, Ogarev EV. Artroskopicheskaia khirurgiia tazobedrennogo sustava. Moscow, RF; 2004. 104 p. http://www.booksmed.com/ortopediya/2079-artroskopicheskaya-xirurgiya-tazobedrennogo-sustava-mironov-prakticheskoe-posobie.html (In Russ.)
  8. Sampson T.G. Arthroscopic treatment of femoroacetabular impingement. Techniques in Orthopaedics. 2005;20(1):56-62. http://hiparthroscopy.net/wp-content/uploads/2017/11/Techniques_in_Orthopaedics_2005_publication.pdf
  9. Jäger M, Wild A, Westhoff B, Krauspe R. Femoroacetabular impingement caused by a femoral osseous head-neck bump deformity: clinical, radiological, and experimental results. J Orthop Sci. 2004;9(3):256-63. doi: 10.1007/s00776-004-0770-y
  10. Byrd JWT. Evaluation and management of the snapping iliopsoas tendon. Techniques in Orthopaedics. 2005 Mar;20(1):45-51. doi: 10.1097/01.bto.0000152171.09968.1d
  11. Ilizaliturri VM, Reveles-Castillo R, Ramos-Aviña C, Camacho-Galindo J. Arthroscopy for hip dysplasia: indications and limitations. Tech Orthop. 2005 Mar;20(1):52-55. doi: 10.1097/01.bto.0000152165.81193.ee
  12. Khan M, Ranawat A, Williams D, Gandhi R, Choudur H, Parasu N, Simunovic N, Ayeni OR. Relationship between the alpha and beta angles in diagnosing CAM-type femoroacetabular impingement on frog-leg lateral radiographs. Knee Surg Sports Traumatol Arthrosc. 2015 Sep;23(9):2595-600. doi: 10.1007/s00167-014-3182-3
  13. Bouma H, Slot NJ, Toogood P, Pollard T, van Kampen P, Hogervorst T. Where is the neck? Alpha angle measurement revisited. Acta Orthop. 2014 Apr;85(2):147-51. doi: 10.3109/17453674.2014.899841
  14. Casartelli NC, Brunner R, Maffiuletti NA, Bizzini M, Leunig M, Pfirrmann CW, Sutter R. The FADIR test accuracy for screening cam and pincer morphology in youth ice hockey players. J Sci Med Sport. 2018 Feb;21(2):134-138. doi: 10.1016/j.jsams.2017.06.011
  15. Mochizuki Y, Kokubo Y, Yamazaki T. The prevalence of radiographic signs of pincer type morphology in a population based cohort study of asymptomatic Japanese. Hip Int. 2016 Jul 25;26(4):404-8. doi: 10.5301/hipint.5000358
  16. Gille J, Krueger S, Aberle J, Boehm S, Ince A, Loehr JF. Synovial chondromatosis of the hip: a case report and clinicopathologic study. Acta Orthop Belg. 2004 Apr;70(2):182-88. http://www.actaorthopaedica.be/acta/download/2004-2/17-gille%20et%20al.pdf
  17. Papavasiliou A, Yercan HS, Koukoulias N. The role of hip arthroscopy in the management of osteonecrosis. J Hip Preserv Surg. 2014 Oct 8;1(2):56-61. doi: 10.1093/jhps/hnu011
  18. Benyass Y, Chafry B, Koufagued K, Chagar B. Osteoid osteoma of the acetabular roof: a case report. J Med Case Rep. 2016;10(1):232. Published online 2016 Aug 24. doi: 10.1186/s13256-016-1016-2
Address for correspondence:
220024, The Republic of Belarus,
Minsk, Kizhevatov Str., 60/4,
Republican Scientific and Practical
Center of Traumatology and Orthopedics,
Laboratory of Joint Pathology
And Sports Injury.
Tel. +375 17 212 32 88,
e-mail: mae77@list.ru,
Alyaksandr E. Murzich
Information about the authors:
Murzich Alyaksandr E., PhD, Head of the Laboratory of Joint Pathology and Sports Injury, Republican Scientific and Practical Center of Traumatology and Orthopedics, Minsk, Republic of Belarus.
https://orcid.org/0000-0003-1625-7321
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