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Khirurgii

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Year 2021 Vol. 29 No 2

SCIENTIFIC PUBLICATIONS
EXPERIMENTAL SURGERY

K.D. MOROZOV, O.L. MOROZOVA, L.O. SEVERGINA, T.D. MARCHUK, D.A. MOROZOV

THE CAUSES OF INTESTINAL ANASTOMOTIC LEAKAGE IN EXPERIMENTAL PERITONITIS

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

Objective. To determine the leading factor in the pathogenesis of intestinal anastomotic failure in peritonitis.
Methods. The experiment was carried out on non-linear white rats (n=40), divided into 4 equal groups: with peritonitis (group 1), with hypovolemia (group 2), with peritonitis in combination with hypovolemia (group 3) and comparison (group 4). Colonic “end-to-end” anastomosis was performed in all rats. Peritonitis caused by injection of 10% unfiltered feces into the abdominal cavity. Hypovolemia was modeled during the operation by creating bleeding from the branch of the iliocolic artery.The rats were taken out of the experiment on the 3rd day after the operation, the state of the anastomosis and the abdominal cavity was assessed.
The histological examination of the anastomotic sites was performed. The content of hypoxia biomarkers (HIF-1a, VEGF-C, VEGF-R1) in the intestinal tissue was also evaluated by ELISA. The experiment was approved by the local ethics committee.
Results. In group 1, anastomotic failure was detected in rats characterized by a severe general condition due to peritonitis. In groups 2 and 3 statistically significant relationship was found between a decrease of rectal temperature (>2 °C) due to bleeding and colonic anastomotic failure (p<0.05). Morphological analysis showed the most pronounced inflammatory and microcirculatory changes in the group 3. Statistically significant differences in the level of the VEGF-C (p=0.0034) and VEGF-R1 (p=0.04795) were found between groups. Maximal ischemia of the anastomotic zone was found in rats of group 3.
Conclusion. The leading factor in the pathogenesis of intestinal anastomotic failure is considered to be as a result of impaired blood supply of the anastomotic zone due to hypovolemia and depletion of mesenteric blood flow. Monitoring and successful correction of hemodynamic disturbances in the perioperative period may become a prospect for the treatment of patients with peritonitis requiring intestinal anastomosis under these conditions.

Keywords: intestinal anastomosis, peritonitis, hypovolemia, anastomotic failure, animal experiment
p. 137-145 of the original issue
References
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  15. Birindelli A, Tugnoli G, Beghelli D, Siciliani A, Biscardi A, Bertarelli C, Selleri S, Lombardi R, Di Saverio S. Emergency laparoscopic ileo-colic resection and primary intracorporeal anastomosis for Crohn’s acute ileitis with free perforation and faecal peritonitis: first ever reported laparoscopic treatment. Springerplus. 2016 Jan 6;5:16. doi: 10.1186/s40064-015-1619-x. eCollection 2016.
  16. Guelfand M, Santos M, Olivos M, Ovalle A. Primary anastomosis in necrotizing enterocolitis: the first option to consider. Pediatr Surg Int. 2012 Jul;28(7):673-76. doi: 10.1007/s00383-012-3092-8
  17. Hillyer MM, Baxter KJ, Clifton MS, Gillespie SE, Bryan LN, Travers CD, Raval MV. Primary versus secondary anastomosis in intestinal atresia. J Pediatr Surg. 2019 Mar;54(3):417-22. doi: 10.1016/j.jpedsurg.2018.05.003
Address for correspondence:
119991, Russian Federation,
Moscow, Trubetskaya Str., 8, 2,
I.M. Sechenov First Moscow State Medical University (Sechenov University),
the Pathologic Physiology Department,
tel. +7 (916) 532-54-81,
e-mail: morozova_ol@list.ru,
Morozova Olga L.
Information about the authors:
Morozov Kirill D., a Student of the International School “Medicine of the Future”, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University), Moscow, Russian Federation.
https://orcid.org/0000-0002-6300-1102
Morozova Olga L., MD, Professor of Pathologic Physiology Department, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University), Moscow, Russian Federation.
http://orcid.org/0000-0003-2453-1319
Severgina Lubov O., MD, Professor of Pathologic Anatomy Named after A.I.Strukov, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University), Moscow, Russian Federation.
http://orcid.org/0000-0002-4393-8707
Marchuk Tatyana D., Student of the Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University), Moscow, Russian Federation.
https://orcid.org/0000-0002-0608-479X
Morozov Dmitry A., MD, Professor, Head of the Pediatric Surgery and Urology-Andrology Department Named after L.P. Alexandrov, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University), Moscow, Russian Federation.
http://orcid.org/0000-0002-1940-1395

GENERAL & SPECIAL SURGERY

B.N. GUMENYUK, V.V. POPOV, V.V. LAZORISHINETZ

IRON CORRECTION DURING BLOODLESS SURGERY IN PATIENTS WITH MITRAL HEART DISEASES

Amosov National Institute of Cardio-Vascular Surgery NAMS Ukraine Kiev,
Ukraine

Objective. To study the effectiveness of the preoperative combined correction, using hydroxide of iron (III) and stimulation of hematopoiesis with erythropoietin on the postoperative anemia in patients, undergoning bloodless surgery (mitral valvere placement) in conditions of artificial blood circulation.
Methods. A single-center prospective non-randomized and retrospective study involving patients (n=80) undergoning the operation for mitral valve disease was carried out. There were 54 men (67.5%) and 26 women (32.5%) with an average age of 52.8±4.9 years (M±σ). The patients were divided into three groups. Group A consisted of patients with normal serum iron levels undergoning of the application of blood component preparations. Group B included patients with normal serum iron levels who were undergoning bloodless surgery. In group C the patients with initially low levels of iron in the blood serum, preoperative correction of the saturating dose iron hydroxide and stimulation with erythropoietin were carried out, and bloodless procedure was applied while the operation.
Results. The results of this study show that patients in group A require a sufficiently large volume of donor blood components during surgery. In group B, mitral valve replacement can be performed using bloodless technology without transfusion of donor blood components. Correction of a low preoperative serum iron level in group C increases its preoperative serum iron level by 7.4 times and Hb by 4.4% of the initial haemoglobin values. The level of postoperative anemia in group C (p>0.05) compared with group B (p>0.05) is 8.5% less (p>0.05).
Conclusion. Correction of low preoperative iron levels and stimulation of erythropoiesis in patients with mitral heart disease after mitral valve replacement using a bloodless surgery reduces the postoperative anemia level.

Keywords: mitral heart disease, mitral valve replacement, anemia, iron (III) hydroxide, bloodless technology
p. 146-153 of the original issue
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Address for correspondence:
03038, Ukraine. Kiev,
N.M.Amosov St., 6,
Amosov National Institute of Cardiovasculary
Surgery of NAMS of Ukraine,
Department of Anaesthesiology,
Intensive Care and Mechanical blood circulation tel.+308684859774,
e-mail: gumenyuk2007@ukr.net,
Gumenyuk Bogdan N.
Information about the authors:
Gumenyuk Bogdan N., MD, Senior Research Fellow Department of Anaesthesiology, Intensive care and Blood Circulation. Amosov National Institute of Cardio-Vascular Surgery NAMS Ukraine, Kiev, Ukraine.
https://orcid.org./0000-0002-7954-4769
Popov Vladimir V., MD, Head of the Department of Surgery for Acquired Heart Disease,Amosov National Institute of Cardio-Vascular Surgery NAMS Ukraine, Kiev, Ukraine
https://orcid.org./0000-0002-2851-5589
Lazoryshynetz Vasiliy V., Academician of NAMS of Ukraine, MD, Professor, Amosov National Institute of Cardio-Vascular Surgery NAMS Ukraine, Kiev, Ukraine
https://orcid.org/0000-0002-1748-561X

N.I. KHRAMTSOVA 1, YU.YU. ZAIAKIN 1, S.A. PLAKSIN 1, A.S. GLUSHENKOV 2, M.V. FADEEVA 2

SOME METHODOLOGICAL ASPECTS OF ASSESSMENT OF BODY IMAGE IN SURGICAL PATIENTS

E.A. Vagner Perm State Medical University 1, Perm,
Moscow State University of Food Production 2, Moscow
The Russian Federation

Objective. To identify the possibilities of using of the Russian-language versions of the BIQLI and ASI-R (T.F. Cash) questionnaires to study the body image and its components in healthy women and in surgical patients.
Methods. The study included 444 apparently healthy women, 40 patients of a surgical hospital and 40 clients of a plastic surgeon using BIQLI and ASI-R questionnaires to assess the quality of life due to the characteristics of self-perception.
Results. The average scores of the questionnaires were: BIQLI – 1.41±0.91 (CI 1.32; 1.49); ASI-R – 3.53±0.55 (CI 3.48; 3.59). Cronbach Alpha: BIQLI – 0.94; ASI-R – 0.84. For the self-esteem scale of the ASI-R questionnaire – 3.42±0.64 (CI 3.35; 3.48); Cronbach alpha – 0.82. For the ASI-R motivation scale – 3.71±0.58 (CI 3.65; 3.76); Cronbach alpha – 0.65. Pearson coefficients inside the questionnaires: BIQLI – 0.5-0.8; ASI-R – 0.3-0.7; motivation scale with a total score - 0.8; self-assessment scale with a total score - 0.9; scales of motivation and self-esteem among themselves – 0.5. 399 (89.8%) respondents had a positive body image. In surgical patients, the median BIQLI score was 1.5, in plastic surgeon clients – 1.5, a positive body image – in 33 (82.5%) and 32 (80 %), respectively. A statistically significant difference was revealed only on the issue of “relations with their family” (p=0.01).
Conclusion. High reliability and validity of the Russian-language versions of the BIQLI and ASI-R questionnaires were revealed in determining the quality of life associated with the perception of their own appearance in practically healthy women, which makes it possible to recommend them for use in scientific research. The developed version of BIQLI questionnaires can be recommended for widespread use and in practical research, including the surgical patients.

Keywords: body image, surgery, quality of life, questionnaire, appearance, self-esteem
p. 154-166 of the original issue
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Address for correspondence:
614000, Russian Federation,
Perm, Petropavlovskaya Street, 26,
E.A. Vagner Perm State Medical University,
the dan’s Office of the Medical Faculty,
tel. +7 342 217-20-30,
e-mail: renelve@gmail.com,
Khramtsova Natalia I.
Information about the authors:
Khramtsova Natalia I., PhD, Associate Professor of the Department of Public Health and Health Care No1, E.A. Vagner Perm State Medical University, Perm, Russian Federation.
http://orcid.org/0000-0001-6097-6855
Plaksin Sergey A., MD, Professor of the Surgery Department with the Course of Cardiovascular Surgery and Invasive Cardiology, E.A. Vagner Perm State Medical University, Perm, Russian Federation.
http://orcid.org/0000-0001-8108-1655
Zaiakin Yury Yu., PhD, Associate Professor of the Department of Psychiatry, Narcology and Medical Psychology,E.A. Vagner Perm State Medical University, Perm, Russian Federation.
http://orcid.org/0000-0002-9089-7821
Glushenkov Andrey S., Clinical Intern, Moscow State University of food production, Moscow, Russian Federation.
https://orcid.org/0000-0003-3353-9742
Fadeeva Maya V., Clinical Intern, Moscow State University of Food Production, Moscow, Russian Federation.
https://orcid.org/0000-0003-0249-4772

O.L. TKACHUK, R.L. PARAKHONIAK

ARGON APPLICATION FOR CREATION OF PNEUMOPERITONEUM IN LAPAROSCOPIC SURGERIES

Ivano-Frankivsk National Medical University, Ivano-Frankivsk,
Ukraine

Objective. To advance the patients’ rehabilitation after laparoscopic surgeries by using insufflation with argon gas for pneumoperitoneum formation.
Methods. The given study is the investigation of sequentially admitted 360 patients with gallstone disease (cholelithiasis). The patients have been randomly divided into 4 groups: Group 1 – uncomplicated gallstone disease, carboxyperitoneum (n=192); Group 1a – acute cholelithiasis (n=37), carboxyperitoneum; Group 2 – uncomplicated gallstone disease, argonperitoneum (n=102); Group 2a – acute cholelithiasis (n=29), argonoperitoneum. All the patients have undergone laparoscopic cholecystectomies. Subjective assessment of the pain syndrome intensity has been studied on the basis of patient-reported outcomes questionnaire according to the visual analogue scale (VAS), need for analgesic injections, presence and intensity of the shoulder pain syndrome as well as the duration of in-patient treatment.
Results. In accordance with patient-reported outcomes (with argonperitoneum application) subjective pain sensation has proved to decrease by 1.5-2 fold. On the first day of the postoperative period both in uncomplicated gallstone disease and in acute cholelithiasis, argonperitoneum has statistically significantly reduced the need for analgesics. Pain in the shoulder girdle (omalgia) was observed in 48.9% of the patients having been applied carboxyperitoneum whereas it was noticed in only 5.3% of the patients having been applied argonperitoneum during the operation. Argonperitoneum application statistically significantly reduces in-patient treatment period by 30% (from 2.3 - to 1.6 days) in uncomplicated gallstone disease and by 23% (from 4.3 - to 3.3 days) in gallstone disease complicated by acute cholelithiasis.
Conclusion. Application of argon for pneumoperitoneum formation in laparoscopic cholecystectomies reliably reduces pain syndrome intensity in the postoperative period. The number of postoperative omalgia cases is reduced by 42% in patients having undergone cholecystectomies with argonperitoneum application. Application of argonperitoneum in management of patients with cholelithiasis may reduce the hospitalization period by 25-30%.

Keywords: cholecystitis, laparoscopic cholecystectomy, artificial pneumoperitoneum, argon, postoperative period, postoperative pain
p. 167-174 of the original issue
References
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  2. Speicher PJ, Ganapathi AM, Englum BR, Vaslef SN. Laparoscopy is safe among patients with congestive heart failure undergoing general surgery procedures. Surgery. 2014 Aug;156(2):371-78. doi: 10.1016/j.surg.2014.03.003
  3. Zhang WP, Zhu SM. The effects of inverse ratio ventilation on cardiopulmonary function and inflammatory cytokine of bronchoalveolar lavage in obese patients undergoing gynecological laparoscopy. Acta Anaesthesiol Taiwan. 2016 Mar;54(1):1-5. doi: 10.1016/j.aat.2015.11.001
  4. Förster S, Reimer T, Rimbach S, Louwen F, Volk T, Bürkle H, Benecke C, Carus T, Türler A, Wullstein C, Ludwig K. CAMIC Recommendations for Surgical Laparoscopy in Non-Obstetric Indications during Pregnancy. Zentralbl Chir. 2016 Oct;141(5):538-44. doi: 10.1055/s-0035-1545904 [Article in German]
  5. Neogi P, Kumar P, Kumar S. Low-pressure Pneumopertioneum in Laparoscopic Cholecystectomy: A Randomized Controlled Trial. Surg Laraposc Endosc Percutan Tech. 2020 Feb; 30(1):30-34. doi: 10.1097/SLE.0000000000000719
  6. GurusamyKS, Koti R, Davidson BR. Abdominal lift for laparoscopic cholecystectomy. Cochrane Database Syst Rev. 2013 Aug;31(8):CD006574. doi: 10.1002/14651858.CD006574.pub4
  7. Zeeni C, Chamsy D, Khalil A, Abu Musa A, Al Hassanieh M, Shebbo F, Nassif J. Effect of postoperative Trendelenburg position on shoulder pain after gynecological laparoscopic procedures: a randomized clinical trial. BMC Anesthesiol. 2020 Jan 29;20(1):27. doi: 10.1186/s12871-020-0946-9
  8. Wada S, Fukushi Y, Nishimura M, Matsumoto S, Takimoto K, Imai K, Ota H, Tsuzuki Y, Nakajima A, Fujino T. Analysis of risk factors of postlaparoscopic shoulder pain. J Obstet Gynaecol Res. 2020 Feb;46(2):310-13. doi: 10.1111/jog.14156
  9. Ljunggvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg. 2017 Mar 1;152(3):292-98. doi: 10.1001/jamasurg.2016.4952
  10. Yu T, Cheng Y, Wang X, Tu B, Cheng N, Gong J, Bai L. Gases for establishing pneumoperitoneum during laparoscopic abdominal surgery. Cochrane Database Syst Rev. 2013 Jan 31;(1):CD009569. doi: 10.1002/14651858.CD009569
  11. Menes T, Spivak H. Laparoscopy: searching for the proper insufflation gas. Surg Endosc. 2000 Nov;14(11):1050-56. doi: 1007/s004640000216
  12. Neuhaus SJ, Gupta A, Watson DI. Helium and other alternative insufflation gases for laparoscopy. Surg Endosc. 2001 Jun;15(6):553-60. doi: 10.1007/s004640080060
  13. Wolthuis AM. Veress needle creation of a pneumoperitoneum: is it risky? Results of the first belgian group for endoscopic surgery-snapshot study. J Laparoendosc Adv Surg Tech A.2019 Aug;29(8):1023-26. doi: 10.1089/lap.2019.0243
  14. Pantoja Garrido M, Frias Sánchez Z, Zaradiel Gutiérrez I, Torrejón R, Jimenez Sánchez C, Polo Velasco A, MárquezMaraver F, Rodriguez Jiménez I, Jiménez Gallardo J, Fernández Alba JJ. Direct trocar insertion without previous pneumoperitoneum versus insertion after insufflation with Veress needle in laparoscopic gynecological surgery: a prospective cohort study. J Obstet Gynaecol. 2019 Oct;39(7):1000-5. doi: 10.1080/01443615.2019.1590804
Address for correspondence:
76000, Ukraine,
Ivano-Frankivsk, Halytska Str., 2,
Ivano-Frankivsk National Medical University,
the Surgery Department of Postgraduate Education,
tel. +38 (066) 592 95 89,
e-mail: rostykpar@gmail.com,
Parakhoniak Rostyslav L.
Information about the authors:
Tkachuk Oleh L., MD, Professor, Head of the Surgery Department of Postgraduate Education, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine.
http://orcid.org/0000-0002-9216-4605
Parakhoniak Rostyslav L., Postgraduate Student of the Surgery Department of Postgraduate Education, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine.
http://orcid.org/0000-0002-3230-9331

S.V. TARASENKO, P.V. TARAKANOV, A.A. NATALSKIY, A.V. PAVLOV, N.A. PRONIN, A.YU. BOGOMOLOV

THE CHOICE OF THE OPTIMAL LEVEL OF INTERSECTION OF THE PANCREAS TAKING INTO ACCOUNT VARIANTS OF THE TOPOGRAPHY OF ARTERIAL VESSELS AND PANCREATIC DUCT

I.P.Pavlov Ryazan State Medical University, Ryazan,
The Russian Federation

Objective. To determine the optimal level of intersection of the pancreas based on the features of the topography of the arterial vessels and the pancreatic duct of the isthmus and the body of the pancreas.
Methods. 44 complexes of the upper floor of the abdominal cavity were studied. An injection mass with the subsequent fixation complexes in a formalin solution was introduced into the arterial vessels. The pancreatic tissue was crossed over the superior mesenteric vein along vertical lines drawn on one, two, three, four, and five cm to the left of the superior mesenteric vein. Depending on the diameter, the arteries were divided into the following types: 1 type (diameter - 0.5 - 1.0 mm); 2 type (diameter - 1.1 - 1.5 mm); 3 type (diameter more than 1.6 mm). The sections were used to assess the topography of the main tubular structures, the number and diameter of arterial vessels greater than 0.5 mm, the number of vessels of a certain type and the mean vessel diameter of this type.
Results. On the cross - section above the superior mesenteric vein, as well as on the section made 1 cm to the left of it, vessels of type 1 (0.5-1.0 mm) prevailed. At the same time, two more pronounced arterial vessels were noted. These arteries were located, as a rule, extra-organically and had a relatively constant topography. The location of the pancreatic duct corresponded to the central part of the section. On transverse sections of the pancreas made along lines located from 2 cm to 5 cm to the left of the superior mesenteric vein; up to 5 arterial vessels were recorded.The location of the arterial vessels was inconsistent and did not have limited topographic zones. On sections from 2 to 5 cm to the left of the superior mesenteric vein, damage to the dorsal pancreatic artery was noted, and on sections 4 and 5 cm to the left of the superior mesenteric vein, a peripheral location of the pancreatic duct was found.
Conclusion. The optimal level of intersection of the pancreas is the area above the superior mesenteric vein and 1 cm left of the superior mesenteric vein.

Keywords: isthmus of the pancreas, pancreatic artery, dorsal pancreatic artery, pancreatic duct, pancreatic resection, level of intersection
p. 175-182 of the original issue
References
  1. Datta J, Vollmer CM Jr. Advances in surgical management of pancreatic diseases. Gastroenterol Clin North Am. 2016;45(1):129-44. doi: 10.1016/j.gtc.2015.10.002
  2. Kopp WH, Verhagen MJ, Blok JJ, Huurman VA, de Fijter JW, de Koning EJ, Putter H, Baranski AG, Schaapherder AF, Braat AE, Ringers J. Thirty Years of Pancreas Transplantation at Leiden University Medical Center: Long-term Follow-up in a Large Eurotransplant Center. Transplantation. 2015 Sep;99(9):e145-51. doi: 10.1097/TP.0000000000000604
  3. Tarakanov PV, Sudakova IYu, Pavlov AV. Distinguishing features of the formation and topography of the pancreatic isthmus arterial trunks. Science of the Young (Eruditio Juvenium). 2018;6(2):225-32. doi: 10.23888/HMJ201862225-232 (In Russ.)
  4. Piras C, Paulo DN, Paulo IC, Rodrigues H, Silva AL. Venous drainage from the tail of the pancreas to the lienal vein and its relationship with the distal splenorenal shunt selectivity. Acta Cir Bras. 2010 Feb;25(1):105-10. doi: 10.1590/s0102-86502010000100021
  5. Ome Y, Seyama Y, Doi M, Muto J. Laparoscopic distal pancreatectomy for left-sided pancreatic cancer using the “caudo-dorsal artery first approach”. Ann Surg Oncol. 2019 Dec;26(13):4464-65. doi: 10.1245/s10434-019-07789-8
  6. Baranski AG, Lam HD, Braat AE, Schaapherder AF. The dorsal pancreatic artery in pancreas procurement and transplantation: anatomical considerations and potential implications. Clin Transplant. 2016 Oct;30(10):1360-64. doi: 10.1111/ctr.12814
  7. Lermite E, Sommacale D, Piardi T, Arnaud JP, Sauvanet A, Dejong CH, Pessaux P. Complications after pancreatic resection: diagnosis, prevention and management. Clin Res Hepatol Gastroenterol. 2013 Jun;37(3):230-39. doi: 10.1016/j.clinre.2013.01.003
  8. Covantev S, Mazuruc N, Belic O. The arterial supply of the distal part of the pancreas. Surg Res Pract. 2019 Mar 20;2019:5804047. doi: 10.1155/2019/5804047. eCollection 2019.
  9. Ridolfi C, Angiolini MR, Gavazzi F, Spaggiari P, Tinti MC, Uccelli F, Madonini M, Montorsi M, Zerbi A. Morphohistological features of pancreatic stump are the main determinant of pancreatic fistula after pancreatoduodenectomy. Biomed Res Int. 2014;2014:641239. doi: 10.1155/2014/641239
Address for correspondence:
390026, Russian Federation, Ryazan,
9, Vysokovoltnaya str.,
I.P.Pavlov Ryazan State Medical University,
the Department of Hospital Surgery,
tel. +7 910 578-97-07,
e-mail: lorey1983@mail.ru,
Natalskiy Alexandr A.
Information about the authors:
Tarasenko Sergey V., MD, Professor, Head of Hospital Surgery Department, I.P. Pavlov Ryazan State Medical University, Ryazan, Russian Federation.
http://orcid.org/0000-0002-1948-5453
Tarakanov Pavel V., Assistant of the anatomy Department, I.P. Pavlovyazan State Medical University, Ryazan, Russian Federation.
http://orcid.org/0000-0002-8358-6603
Natalskiy Alexandr A., MD, Associate Professor, Professor of the Hospital Surgery Departyment, I.P. Pavlov Ryazan State Medical University, Ryazan, Russian Federation.
http://orcid.org/0000-0003-1590-9818
Pavlov Artem V., MD, Associate Professor of the Anatomy Department, Head of the Anatomy Department, I.P. Pavlov Ryazan State Medical University, Ryazan, Russian Federation.
http://orcid.org/0000-0002-8224-824X
Pronin Nikolay A., PhD, Senior Lecturer of the Anatomy Department, I.P. Pavlov Ryazan State Medical University, Ryazan, Russian Federation.
http://orcid.org/0000-0002-6355-8066
Bogomolov Aleksei Yu., Assistant of the Hospital Surgery, I.P. Pavlov Ryazan State Medical University, Ryazan, Russian Federation.
http://orcid.org/0000-0001-8095-3968

I.V. SHIPITSYNA, E.V. OSIPOVA

SPECIES COMPOSITION OF ASSOCIATIONS AND RELATIONSHIPS BETWEEN MICROORGANISMS ISOLATED FROM OSTEOMYELITIS FOCUS

National Ilizarov Scientific Center for Traumatology and Orthopedics, Kurgan,
The Russian Federation

Objective. To determine the species composition of the associations isolated from osteomyelitis foci and to study the character of associate relationships based on the biofilm-forming ability data.
Methods. The microbiological study included clinical isolates (n=184) obtained from associations (n=88) during primary inoculations from wounds and fistulas of patients (n= 88) with chronic osteomyelitis of long tubular bones. In order to obtain an associative biofilm in vitro, the cultures of competing bacterial strains were daily mixed in 1:1 ratio. The biofilms were grown on the surface of polystyrene plates with subsequent determination of the level of biofilm formation in 24 and 48 hours. The coefficient of relationship (CR) was calculated to evaluate the synergistic, neutral and antagonistic relationships between bacteria in the biofilms.
Results. The associations of staphylococcus with gram-negative bacteria were most frequently recovered from osteomyelitis foci. On the 1st day of the experiment, 38,6 % of associations had a moderate biofilm-forming ability, and besides, associations of gram-positive + gram-negative bacteria were observed in 36,4%; 42,1% of associations had a low biofilm-forming ability; 19,3% – had a high biofilm-forming ability. After 48 hours the percentage of mild adhesive strains remained at the same level – 38,6%, as for the low adhesive ones it decreased to 36,4%, high adhesive – increased up to 25%. Most bacterial associations manifested antagonistic relationships. Synergism in biofilm-formingby the association of S. aureus + P. aeruginosa was observed in 2 cases,while the level of film-forming was high as on the first and the second day of the study. In several associations it transformed from antagonistic to synergistic or neutral relationships.
Conclusion. It has ben established that among the identified associations, the largest specific weight falls on the associations of gram-positive + gram-negative bacteria , while S. aureus is one of the most common components. These associations were noted to have high and mild activity of biofilm -forming on the surface of polystyrene plates. Relationships between the microorganisms isolated from osteomyelitis foci in associations, as a rule, are antagonistic.

Keywords: osteomyelitis, associations of bacteria, biofilms, antagonism, synergism, coefficient of relationship
p. 183-190 of the original issue
References
  1. Sakovich NV, Andreev AA, Mikulich EV, Ostroushko AP, Zvyaginn VG. Modern aspects of etiology, diagnostics and treatment of osteomyelitis. Vestn Eksperim i Klin Khirurgii. 2018;11(1):70-79. doi: 10.18499/2070-478X-2018-11-1-70-79 (In Russ.)
  2. Leonova SN, Rekhov AV, Kameka AL. Bacteriologic examination of wound exudate in patients with local and disseminated chronic osteomyelitis. Acta Biomedica Scientifica (East Siberian Biomedical Journal). 2016;1(4):91-94. doi: 10.12737/22975 (In Russ.)
  3. Daher SR. The association analysis of microorganisms osteomyelitis of tubular bones. Integrativnye Tendentsii v Meditsine i Obrazovanii. 2016;(4):30-31. https://www.elibrary.ru/title_about.asp?id=53604 ( In Russ.)
  4. Petukhov VI, Bulavkin VP, Okulich VK, Plotnikov FV. Ratsional’noe ispol’zovanie antibiotikov v lechenii posttravmaticheskogo osteomielita s uchetom dinamiki izmeneniia rezistentnosti. Novosti Khirurgii. 2012;20(1):71-79. http://www.surgery.by/pdf/full_text/2012_1_13_ft.pdf ( In Russ.)
  5. Shipitsyna IV, Osipova EV, Ovchinnikov EN, Leonchuk DS. Zavisimost‘ bioplenkoobrazuiushchei sposobnosti ot antibiotikochuvstvitel‘nosti klinicheskikh shtammov Pseudomonas aeruginosa, vydelennykh u patsientov s khronicheskim osteomielitom. Klin Lab Diagnostika. 2020;65(1):37-41. https://www.medlit.ru/journalsview/lab/view/journal/2020/issue-1/ ( In Russ.)
  6. Terekhova RP, Mitish VA, Paskhalova YuS, Skladan GE, Prudnikova SA, Blatun LA. Osteomyelitis agents of the long bones and their resistance. Wounds and Wound Infections. 2016;3(2):24-30. doi: 10.17650/2408-9613-2016-3-2-24-30 (In Russ.)
  7. Gordinskaya NA, Sabirova EV, Abramova NV, Dudareva EV, Mitrofanov VN. Resistance of main pathogenic organisms in the department of purulent osteology. Vopr Travmatologii i Ortopedii. 2012;(1):14-17. https://www.elibrary.ru/item.asp?id=18231216 (In Russ.)
  8. Fadeev SB. The dynamics of species structure of microflora of foci surgical soft tissue infection in the course of the disease. Biul Orenburg Nauch Tsentra UrO RAN. 2013;(3):4. https://cyberleninka.ru/article/n/dinamika-vidovogo-sostava-mikroflory-ochagov-hirurgicheskoy-infektsii-myagkih-tkaney-v-techenie-zabolevaniya (In Russ.)
  9. Slatina NM, Plotkin LL, Belov VV. Microbiological and clinical significance of biofilm infections (review). Ural Med Zhurn. 2014;(4):106-12 https://www.elibrary.ru/item.asp?id=22002684 (In Russ.)
  10. Rybtke M, Hultqvist LD, Givskov M, Tolker-Nielsen T. Pseudomonas aeruginosa Biofilm Infections: Community Structure, Antimicrobial Tolerance and Immune Response. J Mol Biol. 2015 Nov 20;427(23):3628-45. doi: 10.1016/j.jmb.2015.08.016
  11. van Vugt TA, Geurts J, Arts JJ. Clinical Application of Antimicrobial Bone Graft Substitute in Osteomyelitis Treatment: A Systematic Review of Different Bone Graft Substitutes Available in Clinical Treatment of Osteomyelitis. Biomed Res Int. 2016;2016:6984656. doi: 10.1155/2016/6984656
  12. Chebotar IV, Lazareva AV, Masalov YaK, Mikhailovich VM, Mayanskiy NA. Acinetobacter: Microbiological, Pathogenetic and Resistant Properties. Vestn RAMN. 2014;69(9-10):39-50. doi: 10.15690/vramn.v69i9-10.1130 ( In Russ.)
  13. Mironov SP, Tsiskarashvili AV, Gorbatiuk DS. Chronic post-traumatic osteomyelitis as a problem of contemporary traumatology and orthopedics (literature review). Genii Ortopedii. 2019;25(4):610-21. doi: 10.18019/1028-4427-2019-25-4-610-621 ( In Russ.)
  14. Masadeh MM, Mhaidat NM, Alzoubi KH, Hussein EI, Al-Trad EI. In vitro determination on the antibiotic susceptibility of biofilm-forming Ps. aeruginosa and S. aureus: possible role of proteolytic activity and membrane lipopolysaccharide. Infect Drug Resist. 2013;6:27-32. Published online 2013 Mar 6. doi: 10.2147/IDR.S41501
  15. Grant SS, Hung DT. Persistent bacterial infections, antibiotic tolerance, and the oxidative stress response. Virulence. 2013 May 15;4(4):273-83. doi: 10.4161/viru.23987
Address for correspondence:
640014, Russian Federation,
Kurgan, M.Ulyanovoy Str., 6,
National Ilizarov Scientific Center for Traumatology and Orthopedics, Ministry of Health of Russia, Research Clinical Laboratory
of Microbiology and Immunology
tel.mob. +7 909 179-26-01,
å-mail vschimik@mail.ru
Shipitsyna Irina V.
Information about the authors:
Shipitsyna Irina V., PhD, Researcher of the Research Clinical Laboratory of Microbiology and Immunology, National Ilizarov Scientific Center for Traumatology and Orthopedics of the Ministry of Health of the Russian Federation, Kurgan,Russian Federation.
http://orcid.org/0000-0003-2012-3115
Osipova Elena V., PhD, Senior Researcher of the Research Clinical Laboratory of Microbiology and Immunology, National Ilizarov Scientific Center for Traumatology and Orthopedics of the Ministry of Health of the Russian Federation, Kurgan,Russian Federation.
http://orcid.org/0000-0003-2408-4352

ONCOLOGY

L.V. NAUMENKO 1, G.F. MALINOVSKIY 2, S.A. KRASNY 1, E.P. ZHYLIAYEVA 1, A.N. BARASH 3, I.YU. ZHERKA 1

THE USE OF ALLOTRANSPLANT FROM THE SUBCUTANEOUS FAT WITH PLANTAR APONEUROSIS FOR THE MUSCULOSKELETAL STUMP FORMATION DURING ENUCLEATION

N.N. Alexandrov National Cancer Center of Belarus 1,
Belarusian Medical Academy of Postgraduate Education 2,
Gomel State Medical University 3,
The Republic of Belarus

Objective. To develop a method for the formation of a musculoskeletal stump for an ocular prosthesis during enucleation using an allograft from subcutaneous fat with a plantar aponeurosis was developed
Methods. The study included patients with the diagnosed choroid melanoma (n=15), and retinoblastoma (n=2). The orbital cavity was replenished with the section of subcutaneous adipose tissue with the sole aponeurosis, preserved by cryopreservation. The orbital cavity was filled with a section of subcutaneous adipose tissue with plantar aponeurosis, preserved by cryopreservation. The immediate effect was assessed 3 and 6 months after the treatment according to the following criteria: the presence of the orbital tissues edema, the mobility of the supporting stump with the prosthesis, the position of the stump with the prosthesis in the orbit, and the position of the upper eyelid.
Results. In all cases, a positive result was obtained: after 3 months, the orbital tissue edema was absent in 7 patients, in 7 – it was mild, in 3 – it was moderately pronounced. After 6 months, the orbital tissue edema was absent in all patients. After 3 months the mobility of the supporting stump was moderately marked in 10 patients, and in 7 – it was feeble marked. After 6 months, the mobility of the stump was marked moderately in all patients. After 3 months in 7 patients, the position of the stump with the prosthesis had a symmetrical position; there was hypereffect in 10 patients. By 6 months, all patients had a symmetrical arrangement of the healthy eye and prosthesis.
Conclusion. The designed method for the formation of the functional stump for an ocular prosthesis during enucleation using the allograft from subcutaneous fat with the plantar aponeurosis makes it possible to obtain good anatomical, cosmetic and functional results of the operation due to the achievement of a sufficient range of prosthetic movement of the ocular prosthesis. The introduction of the designed method of the functional stump formation into clinical practice increases the medical, social, economic efficiency of the rehabilitation of patients with malignant neoplasms of the eyeball membranes.

Keywords: enucleation, prosthesis, intraocular tumors, functional stump, orbital socket reconstruction
p. 191-197 of the original issue
References
  1. Yousef Yacoub A. Enucleation Surgery – Orbital Implants and Surgical Techniques. US Ophthalmic Review. 2016 Jan;09(01):46. doi: 10.17925/USOR.2016.09.01.46
  2. Shah RD, Singa RM, Aakalu VK, Setabutr P. Evisceration and enucleation: a national survey of practice patterns in the United States. Ophthalmic Surg Lasers Imaging. 2012 Sep-Oct;43(5):425-30. doi: 10.3928/15428877-20120725-01
  3. Baino F, Perero S, Ferraris S, Miola M, Balagna C, Verné E, Vitale-Brovarone C, Coggiola A, Dolcino D, Ferraris M. Biomaterials for orbital implants and ocular prostheses: overview and future prospects. Acta Biomater. 2014 Mar;10(3):1064-87. doi: 10.1016/j.actbio.2013.12.014
  4. Shah CT, Hughes MO, Kirzhner M. Anophthalmic syndrome: a review of management. Ophthalmic Plast Reconstr Surg. 2014 Sep-Oct;30(5):361-65. doi: 10.1097/IOP.0000000000000217
  5. Schellini SA, El Dib R, Limongi RM, Mörschbächer R. Anophthalmic socket: choice of orbital implants for reconstruction. Arq Bras Oftalmol. 2015 Jul-Aug;78(4):260-63. doi: 10.5935/0004-2749.20150068
  6. Wladis EJ, Aakalu VK, Sobel RK, Yen MT, Bilyk JR, Mawn LA. Orbital implants in enucleation surgery: a report by the american academy of ophthalmology. Ophthalmology. 2018 Feb;125(2):311-17. doi: 10.1016/j.ophtha.2017.08.006
  7. Chalasani R, Poole-Warren L, Conway RM, Ben-Nissan B. Porous orbital implants in enucleation: a systematic review. Surv Ophthalmol. 2007 Mar-Apr;52(2):145-55. doi: 10.1016/j.survophthal.2006.12.007
  8. Schmitzer S, Simionescu C, Alexandrescu C, Burcea M. The anophthalmic socket - reconstruction options. J Med Life. 2014;7 Spec No. (Spec Iss 4):23-29. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4962761/
  9. Alwitry A, West S, King J, Foss AJ, Abercrombie LC. Long-term follow-up of porous polyethylene spherical implants after enucleation and evisceration. Ophthalmic Plast Reconstr Surg. 2007 Jan-Feb;23(1):11-15. doi: 10.1097/01.iop.0000249429.02757.6b
  10. Perry AC. Integrated orbital implants. Adv Ophthalmic Plast Reconstr Surg. 1990;8:75-81.
  11. Shoamanesh A, Pang NK, Oestreicher JH. Complications of orbital implants: a review of 542 patients who have undergone orbital implantation and 275 subsequent PEG placements. Orbit. 2007 Sep;26(3):173-82. doi: 10.1080/01676830701555204
  12. Yoon JS, Lew H, Kim SJ, Lee SY. Exposure rate of hydroxyapatite orbital implants a 15-year experience of 802 cases. Ophthalmology. 2008 Mar;115(3):566-72.e2. doi: 10.1016/j.ophtha.2007.06.014
  13. Muldashev ER, Muslimov SA, Salikhov AIu. Allotransplantaty dlia oftal’mokhirurgii. Ufa: Gilem; 1987. (In Russ.)
Address for correspondence:
223040 Republic of Belarus,
Minsk region, ag Lesnoy,
N.N. Alexandrov National Cancer
Center of Belarus, the Laboratory of the Head
and Neck Oncopathology with the Group
of the Central Nervous System Oncopathology
tel. +37529620-59-92,
e-mail: larisanau@mail.ru
Naumenko Larisa V.
Information about the authors:
Naumenko Larisa V., PhD, Leading Researcher of the Laboratory of the Head and Neck Oncopathology with the Group of the Central Nervous System Oncopathology, N.N. Alexandrov National Cancer Center of Belarus, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-1875-9176
Malinovskiy Grigory F., MD, Professor of the Ophthalmology Department, Belarusian Medical Academy of Postgraduate Education, Minsk, Republic of Belarus.
http://orcid.org/0000-0001-9664-9805
Krasny Sergey A., MD, Professor, Corresponding Member of the National Academy of Sciences of Belarus, N.N. Alexandrov National Cancer Center of Belarus, Minsk, Republic of Belarus.
http://orcid.org/0000-0003-3244-5664
Zhyliayeva Ekaterina P., Ophthalmologist of the Department of the Head and Neck Tumors, N.N. Alexandrov National Cancer Center of Belarus, Minsk, Republic of Belarus.
http://orcid.org/0000-0003-2964-6895
Barash Alisa N., PhD, Assistant of the Department of Public Health and Healthcare with the Course of the Advanced Training and Retraining, Gomel State Medical University, Gomel, Republic of Belarus.
http://orcid.org/0000-0002-2397-3986
Zherka Irina Y., Ophthalmologist, N.N. Alexandrov National Cancer Center of Belarus, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-5134-3666

ANESTHESIOLOGY-REANIMATOLOGY

V.A. ZHIKHAREV 1, A.M. BOSTANOVA 1, A.S. BUSHUEV 1, V.A. KORYACHKIN 2, V.A. PORKHANOV 1

INTRAVENOUS INFUSIONS OF LIDOCAINE IN SURGERY OF THE TRACHEA

Research Institute - Krasnodar Regional Clinical Hospital No1 Named by Professor S. V. Ochapovsky 1, Krasnodar
Saint-Petersburg State Pediatric Medical University 2, Saint-Petersburg,
The Russian Federation

Objective. To evaluate the possibility of using intravenous infusion of lidocaine in tracheal surgery.
Methods. The analysis of case histories of patients (n=19) operated on for tracheal stenosis was carried out. Depending on the perioperative analgesia, the patients were divided into two groups: the 1st group (n=9) – intravenous infusion of lidocaine; the 2nd – (n = 10) – narcotic analgesics. Tracheal resection was carried out using the cervical access. Before tracheal transection and after tracheal anastomosis was applied, protective mechanical ventilation of the lungs was performed. The stage of tracheal resection and formation of anastomosis is high-frequency jet ventilation (HFJV). Anesthesia was maintained with sevoflurane, and after opening the tracheal lumen – with propofol 6-8 mg/kg/h. In the first group, an intravenous bolus of lidocaine 1.5 mg / kg was added to the induction, followed by a continuous infusion of 1.5 mg / kg / h during surgery. The concentration of lidocaine was determined 15 minutes after the bolus and 24 h after surgery. Hemodynamics, acid-base state, glycemia, response to the endotracheal tube, time of extubation, occurrence of postoperative nausea and vomiting were assessed. Pain syndrome was assessed using a visual analogue scale every 15 minutes for an hour, and then every 4 hours until the end of the first day, the consumption of opioids was recorded.
Results. Group 1 patients were extubated without agitation; the pressor response to extubation was less pronounced. Mean arterial pressure, blood gas composition and glycemia did not differ between these groups. There were no signs of systemic toxicity of lidocaine. Group 1 patients did not need promedol and tramadol, and the median and percentiles in group 2 patients, both for promedol and tramadol, were 60 [30; 60] and 400 [200; 400] mg, respectively. Four patients in group 2 had postoperative nausea and vomiting.
Conclusion. Intravenous infusion of lidocaineis considered to be an alternative to perioperative opioid analgesia in tracheal surgery performed from the cervical approach.

Keywords: intravenous infusion of lidocaine, thoracic surgery, tracheal surgery, tracheal stenosis, tracheal resection, postoperative analgesia, post-operative nausea and vomiting
p. 198-206 of the original issue
References
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  4. Camilleri M, Lembo A, Katzka DA. Opioids in Gastroenterology: Treating Adverse Effects and Creating Therapeutic Benefits. Clin Gastroenterol Hepatol. 2017 Sep;15(9):1338-49. doi: 10.1016/j.cgh.2017.05.014
  5. Mehran RJ, Martin LW, Baker CM, Mena GE, Rice DC. Pain Management in an enhanced recovery pathway after thoracic surgical procedures. Ann Thorac Surg. 2016 Dec;102(6):e595-e596. doi: 10.1016/j.athoracsur.2016.05.050
  6. Zvara DA. Enhanced Recovery for thoracic surgery. Revista Mexicana de Anestesiología. 2017;40(Supl 1):S340-S344. https://www.medigraphic.com/pdfs/rma/cma-2017/cmas171ct.pdf
  7. Hayhurst CJ, Durieux ME. Differential Opioid Tolerance and Opioid-induced Hyperalgesia: A Clinical Reality. Anesthesiology. 2016 Feb;124(2):483-88. doi: 10.1097/ALN.0000000000000963
  8. Foldes FF, Molloy R, McNall PG, Koukal LR. Comparison of toxicity of intravenously given local anesthetic agents in man. J Am Med Assoc. 1960 Apr 2;172:1493-98. doi: 10.1001/jama.1960.03020140029007
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  11. Taniguchi T, Shibata K, Yamamoto K, Mizukoshi Y, Kobayashi T. Effects of lidocaine administration on hemodynamics and cytokine responses to endotoxemia in rabbits. Crit Care Med. 2000 Mar;28(3):755-59. doi: 10.1097/00003246-200003000-00025
  12. Truesdale K, Jurdi A. Nebulized lidocaine in the treatment of intractable cough. Am J Hosp Palliat Care. 2013 Sep;30(6):587-89. doi: 10.1177/1049909112458577
  13. Ahn E, Kang H, Choi GJ, Park YH, Yang SY, Kim BG, Choi SW. Intravenous lidocaine for effective pain relief after a laparoscopic colectomy: a prospective, randomized, double-blind, placebo-controlled study. Int Surg. 2015 Mar;100(3):394-401. doi: 10.9738/INTSURG-D-14-00225.1
  14. Kim TH, Kang H, Choi YS, Park JM, Chi KC, Shin HY, Hong JH. Pre- and intraoperative lidocaine injection for preemptive analgesics in laparoscopic gastrectomy: a prospective, randomized, double-blind, placebo-controlled study. J Laparoendosc Adv Surg Tech A. 2013 Aug;23(8):663-68. doi: 10.1089/lap.2012.0542
  15. Dungan K, Braithwaite SS, Preiser JC. Stress hyperglycemia. Lancet. 2009 May 23-29;373(Is 9677):1798-807. doi: 10.1016/S0140-6736 (09) 60553-5
  16. Kranke P, Jokinen J, Pace NL, Schnabel A, Hollmann MW, Hahnenkamp K, Eberhart LH, Poepping DM, Weibel S. Continuous intravenous perioperative lidocaine infusion for postoperative pain and recovery. Cochrane Database Syst Rev. 2015 Jul 16;(7):CD009642. doi: 10.1002/14651858.CD009642.pub2
  17. Terkawi AS, Tsang S, Kazemi A, Morton S, Luo R, Sanders DT, Regali LA, Columbano H, Kurtzeborn NY, Durieux ME. A clinical comparison of intravenous and epidural local local anesthetic for major abdominal surgery. Reg Anesth Pain Med. 2016 Jan-Feb;41(1):28-36. doi: 10.1097/AAP.0000000000000332
Address for correspondence:
350081, Russian Federation, Krasnodar,
1 May Str., 167 Research Institute-Regional Clinical Hospital No1 Named after Professor
S. V. Ochapovsky, the Department
of Anesthesiology and Resuscitation
tel. mob.:+7 903450-77-56
vasilii290873@yandex.ru
Zhikharev Vasilij A.
Information about the authors:
Zhikharev Vasilij A., PhD, Senior Clinical Intern, the Department of Anesthesiology and Resuscitation No1, Research Institute - Regional Clinical Hospital No1 Named after Professor S.V. Ochapovsky, Krasnodar, Russian Federation.
http://orcid.org/0000-0001-5147-5637
Bostanova Alina M., Clinical Intern, the Department of Anesthesiology and Resuscitation No1, Research Institute-Regional Clinical Hospital No1 named after Professor S.V. Ochapovsky, Krasnodar, Russian Federation.
http://orcid.org/0000-0002-2151-0611
Porkhanov Vladimir A., MD, Professor, Academician of RAS, Head Physician, Research Institute-Regional Clinical Hospital No1 Named after Professor S. V. Ochapovsky, Head of the Oncology Department with the Course of Thoracic Surgery of the Faculty of Advanced Training and Retraining of Specialists, Krasnodar, Russian Federation.
http://orcid.org/0000-0003-0572-1395
Koryachkin Viktor A., MD, Professor of the Department of Anesthesiology, Resuscitation and Urgent Pediatrics Department of Faculty of Postgraduate and Additional Professional Education, Saint-Petersburg State Pediatric Medical University, Saint-Petersburg, Russian Federation.
http://orcid.org/0000-0002-3400-8989
Bushuev Alexander S., Clinical Intern, the Department of Anesthesiology and Resuscitation, Research Institute-Regional Clinical Hospital No1 named after Professor S. V. Ochapovsky, Krasnodar, Russian Federation.
http://orcid.org/0000-0002-1427-4032

ORGANIZATION OF SURGICAL CARE

A.P. TRUKHAN 1, D.V. ALKHOVIK 2, I.G. KOSINSKY 1

REPUBLICAN CENTER FOR TREATMENT OF GUNSHOT WOUNDS AND MINE-EXPLOSIVE INJURIES: 3 YEARS OF EXPERIENCE AND TRENDS OF DEVELOPMENT

432 Main Military Clinical Medical Center of the Armed Forces of the Republic of Belarus 1,
Military Medical Department of the Ministry of Defense of the Republic of Belarus 2

Objective. To evaluate the results of organizational measures for improving the efficiency of the Republican Center for the treatment of gunshot wounds and mine-explosive injuries.
Methods. The study is based on an analysis of the work of the Republican Center for the treatment of gunshot wounds and mine-explosive injuries and includes patients (n=54) who were treated from November 1, 2016 to October 31, 2019. Gunshot wounds were detected in 42 patients (77.8%). Explosive trauma was detected in 12 patients (22.2%). The most common causes of injuries were personal carelessness (20 cases (37.0%)), carelessness of others (16 cases (29.6%)), suicidal attempts (9 cases (16.6%)). In accordance with the purpose of the survey, three equal time intervals (three periods) each being equal to one year were studied. The following indicators were analyzed: the number of patients, the time from the moment of injuring to hospitalization, the type of patient’s transportation, the quality of surgical care at the hospitalization stages.
Results. Implementation of the proposed organizational measures allowed increasing the number of patients hospitalized into the Republican Center for the treatment of gunshot wounds and mine-explosive injuries during the third year of work by 66.7% and 78.6%, respectively, compared with the previous time intervals. The frequency of hospitalization of patients within 24 hours after receiving an injury increased from 66.7% to 72.7%, and among patients who are not military personnel – from 45.5% to 69.2%. The proportion of errors in the treatment of patients with gunshot wounds and explosive injuries decreased by 34.0%.
Conclusion. The proposed organizational measures allowed increasing the efficiency of the Republican Center for the treatment of gunshot wounds and mine-explosive injuries. In the future, it is advisable to continue close cooperation with healthcare organizations and to improve the regulatory framework for the treatment of gunshot wounds of various localization.

Keywords: gunshot wounds, blast trauma, peacetime, treatment, specialized center
p. 207-212 of the original issue
References
  1. Baryshev AG, Blazhenko AN, Shevchenko AV, Mukhanov ML, Polyushkin KS, Sholin IYu, Shkhalakhov AK, Porkhanov VA. Optimization of activity of regional trauma system in arrangement of medical care for patients with polytrauma.Politravma. 2018;(4):6-13.https://www.elibrary.ru/item.asp?id=36646802 (In Russ.
  2. Goncharov SF, Bystrov MV, Kudryavtsev BP, Savvin YuN. The problem of multiple and associated injury (polytrauma), the ways of solution and the role of disaster medicine service. Politravma. 2016;(2):6-10. https://www.elibrary.ru/item.asp?id=26235560 (In Russ.)
  3. Haverkort JJ, de Jong MB, Foco M, Gui D, Barhoum M, Hyams G, Bahouth H, Halberthal M, Leenen LP. Dedicated mass-casualty incident hospitals: An overview. Injury. 2017 Feb;48(2):322-26. doi: 10.1016/j.injury.2016.11.025
  4. Badalov VI, Zhumanazarov BJ, Ozeretskovsky LB, Grebnev DG, Golovko KP, Samokhvalov IM. Features of peaceful time modern gunshot wounds in the big city. Skoraia Med Pomoshch’. 2016;17(2):49-56. https://elibrary.ru/item.asp?id=26138310 (In Russ.)
  5. Abghari M, Monroy A, Schubl S, Davidovitch R, Egol K. Outcomes following low-energy civilian gunshot wound trauma to the lower extremities: results of a standard protocol at an urban trauma center. Iowa Orthop J. 2015;35:65-69. https://www.ncbi.nlm.nih.gov/pubmed/26361447
  6. Lichte P, Oberbeck R, Binnebösel M, Wildenauer R, Pape HC, Kobbe P. A civilian perspective on ballistic trauma and gunshot injuries. Scand J Trauma Resusc Emerg Med. 2010 Jun 17;18:35. doi: 10.1186/1757-7241-18-35
  7. Karaca MA, Kartal ND, Erbil B, Öztürk E, Kunt MM, Şahin TT, Özmen MM. Evaluation of gunshot wounds in the emergency department. Ulus Travma Acil Cerrahi Derg. 2015 Jul;21(4):248-55. doi: 10.5505/tjtes.2015.64495
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  9. Maslyakov VV, Barsukov VG, Kurkin KG. Direct treatment results of chest gunshot wounds in civilian trauma patients under conditions of local military conflicts. Novosti Khirurgii. 2016;24(4):379-84. doi: 10.18484/2305-0047.2016.4.379 (In Russ.)
  10. Livingston DH, Lavery RF, Lopreiato MC, Lavery DF, Passannante MR. Unrelenting violence: an analysis of 6,322 gunshot wound patients at a Level I trauma center. J Trauma Acute Care Surg. 2014 Jan;76(1):2-9; discussion 9-11. doi: 10.1097/TA.0b013e3182ab19e7
  11. Stefanopoulos PK, Pinialidis DE, Hadjigeorgiou GF, Filippakis KN. Wound ballistics 101: the mechanisms of soft tissue wounding by bullets. Eur J Trauma Emerg Surg. 2017 Oct;43(5):579-86. doi: 10.1007/s00068-015-0581-1
Address for correspondence:
220123, Republic of Belarus,
Minsk, Masherov Avenue, 26,
432 Main Military Clinical Medical Center
of the Armed Forces of the Republic of Belarus,
mob. tel. 8-044-7331058,
e-mail:aleksdoc@yandex.ru,
Trukhan Alexei P.
Information about the authors:
Trukhan Alexei P., PhD, Associate Professor, Leading Surgeon of the 432 Main Military Clinical Medical Center of the Armed Forces of the Republic of Belarus, Minsk, Republic of Belarus.
http://orcid.org/0000-0001-7422-8014
Alkhovik Dmitry V., Head of the Military Medical Department of the Ministry of Defense of the Republic of Belarus, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-3948-8969
Kosinsky Igor G., Head of the 432 Main Military Clinical Medical Center of the Armed Forces of the Republic of Belarus, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-8679-343X

INFORMATION TECHNOLOGIES IN SURGERY

G.P. KOTELNIKOV, A.V. KOLSANOV, A.S. PANKRATOV, S.V. ARDATOV, D.A. OGURTSOV, P.M. ZELTER, A.A. RUBTSOV

A PREOPERATIVE PLANNING METHOD FOR LONG TUBULAR BONE OSTEOSYNTHESIS

Samara State Medical University, Samara,
The Russian Federation

Objective. To compare the shape and size of human contralateral humerus bones based on the «Autoplan» program to justify the possibility of using healthy bone in a preoperative planning for bone osteosynthesis (on the example of the humerus).
Methods. 20 patients underwent computed tomography of the chest, shoulder girdleand upper extremities. Two-dimensional medical imaging of separate layers were converted into three-dimensional models of the humerus bone STL format, which is used for 3D printing in all 3D printers. Preliminary registration to superimpose the mirrored left humerus bone on the right one was carried out for at least 4 key points; their matching in shape and size was analyzed. A comparison was made of the contralateral humerus bones of one patient according to computed tomograms of 20 people. The main anatomical landmarks of the humerus bones and the distance between adjacent points were selected for comparison when the bones were superimposed on each other. Superimposed humeral bones were compared using the Hausdorff distance calculation algorithm, which is used to measure the difference between scanned models and the ground-truth model separately. To visualize the result of calculating of Hausdorff distance, that is, the difference between the bones, color mapping of the latter was performed, where the proximity to red color means the difference tends to zero, the proximity to blue – to 1 cm (the maximal obtained difference).
Results. The greatest difference was recorded in humeral heads – up to 6.8 mm, and in the epicondyle: the medial epicondyle – up to 4.5 mm, the lateral epicondyle – up to 4.4 mm. Color mapping allowed to see that the difference between the heads of the humerus increases from the center of the articular surface to the attachment points of the capsule. At the level of the diaphysis, from the anatomical neck to the condyles, the size differences among all bones in 20 patients was no more than 1.5 mm.
Conclusion. Thereby, the comparison of the shape and size of the contralateral bones of the human humerus based on the «Autoplan» program will allow applying a three-dimensional model of healthy contralateral bone in the preoperative planning for bone osteosynthesis: thus reducing the surgical risks and injury for the patient.

Keywords: long tubular bone, diaphysis, preoperative planning, bone osteosynthesis, Autoplan program, 3D model, 3D printer, color mapping
p. 213-220 of the original issue
References
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Address for correspondence:
443099, Russian Federation,
Samara, Chapayev Street, 89,
Samara State Medical University,
the Department of Traumatology, Orthopedics
and Emergency Surgery Named
after RAS Academician A.F.Krasnov
tel. +7 927 903-59-95,
e-mail: pas76@mail.ru
Pankratov Alexandr S.
Information about the authors:
Kotelnikov Gennady P., MD, Professor, Academician of RAS, Head of the Clinic and the Department of Traumatology, Orthopedics and Emergency Surgery Named after RAS Academician A.F.Krasnov, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0001-7456-6160
Kolsanov Alexandr V.,MD, Professor, Academician of RAS, Rector of the University, Head of the Department of the Operative Surgery and Clinical Anatomy with the Course of Innovative Technologies, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0002-4144-7090
Pankratov Alexandr S., PhD, Associate Professor of the Department of Traumatology, Orthopedics and Emergency Surgery Named after RAS Academician A.F.Krasnov, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0002-6031-4824
Ardatov Sergey V., PhD, Associate Professor of the Department of Traumatology, Orthopedics and Emergency Surgery Named after RAS Academician A.F.Krasnov, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0002-2644-5353
Ogurtsov Denis A., PhD, Associate Professor of the Department of Traumatology, Orthopedics and Emergency Surgery Named after RAS Academician A.F.Krasnov, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0003-3830-2998
Zelter Pavel M., PhD, Assistant of the Department of Radiation Diagnostics and Radiation Therapy with the Course of Medical Informatics, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0003-1346-5942
Rubtsov Artemy A., Clinical Intern of the Department of Traumatology, Orthopedics and Emergency Surgery Named after RAS Academician A.F.Krasnov, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0002-9004-7018

REVIEWS

A.V. SAZHIN, V.A. PETUKHOV, T.V. NECHAY, G.B. IVAKHOV, E.A. STRADYMOV, A.I. AKPEROV

MICROBIOLOGICAL AND IMMUNOLOGICAL ASPECTS OF PATHOGENESIS OF ACUTE APPENDICITIS

Pirogov Russian National Research Medical University, Moscow,
The Russian Federation

Obstruction of the lumen of the appendix is still considered to be the main cause of acute appendicitis (including feces), followed by the increased intraluminal pressure, the development of ischemia and mucosal hypoxia of the appendix, ulceration, violation of the mucous barrier and the development of necrosis. A sufficient number of scientific facts have been accumulated completely refuting this postulate. Current fundamental achievements in molecular biology, biochemistry, etc. did not become the basis for a clinical revision of the ancient well-established theories and concepts of the etiopathogenesis of many diseases in almost all medical specialties. Surgery isn’t an exception in this context. The review considers the etiopathogenesis of acute inflammation of the appendix from the current point of view of the hypothesis of epithelial-endothelial dysfunction and epithelial-endothelial distress syndrome, since it most fully characterizes the integration of the etiopathogenesis of almost all common diseases of organs with mucous membranes and the recent fundamental research their structures and functions. It is based on general and local factors of violation of the lymphoid apparatus and the integumentary epithelium barrier functions. Thus, this work presents a new concept of the etiopathogenesis of acute appendicitis, which in turn will allow the surgery of acute appendicitis to reach new levels of understanding.

Keywords: acute appendicitis, etiopathogenesis of appendicitis, a new concept, epithelial-endothelial distress syndrome, microbiota
p. 221-233 of the original issue
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Address for correspondence:
117997, Russian Federation,
Moscow, Ostrovityanov Str.,
Pirogov Russian National Research Medical University, the Faculty Surgery Department No1,
tel.: +7 (916) 223-46-60,
å-mail: egr.stradymov@mail.ru,
Stradymov Egor A.
Information about the authors:
Sazhin Aleksandr V., MD, Professor, Corresponding member of RAS, Head of the Faculty Surgery Department No1 Pirogov Russian National Research Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0001-6188-6093
Petukhov Vitalii A., MD, Professor of the Faculty Surgery Department No1 PirogovRussian National Research Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0003-1807-9864
Nechay Taras V., PhD, Associate Professor of the Faculty Surgery Department No1 Pirogov Russian National Research Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0003-0769-5282
Ivakhov Georgii B., PhD, Associate Professor of the Faculty Surgery Department No 1 Pirogov Russian National Research Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0002-9773-4953
Stradymov Egor A., Assistant of the Faculty Surgery Department No 1 Pirogov Russian National Research Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0001-9414-7588
Akperov Aliverdi I., Clinical Intern of the Faculty Surgery Department No 1 Pirogov Russian National Research Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0002-8792-6804

E.V. BOYKO 1, R.M. TILLYASHAYKHOVA 2, SH.T. KHASANOV 1

SURGICAL MANAGEMENT OF RECURRENCES OF RENAL CELL CARCINOMA

Republican Specialized Scientific Practical Medical Center of Oncology and Radiology 1,
Tashkent City Branch of the Republican Specialized Scientific Practical Medical Center of Oncology and Radiology 2, Tashkent,
The Republic of Uzbekistan

In recent decades the detection of new cases of renal cell carcinoma (RCC) has remained unchanged. This tumor accounts for 2-3% of all cancer diagnoses in humans. Standard methods of surgical treatment are being improved towards less invasive resection methods; this let’s achieving the outcomes comparable to traditional nephrectomy in oncological practice. In some cases the risk factor of developing locoregional recurrence still remains after surgical treatment for renal cancer. The limited role of systemic therapy and radioresistance sets hopes on surgical removal of the recurrent tumor. Unfavorable prognostic factors such as the volum of recurrence, the presence of sarcomatoid histological elements, an increased level of serum alkaline phosphatase and lactate dehydrogenase were identified in the materials of several recent studies. The time of recurrence appearance and a forehand surgeries should be defined as one of the independent predictors as it reported by other several studies. The open laparotomic, laparoscopic and robotic methods of tumor removal, as well as the extents of renal segments of repeated resection are discussed depending on the size of the recurrent tumor and the extent of the previous opetations. At the present stage of the development of minimally invasive surgery, with its problem-solving abilities which are very essential in treating the relapsed high-risk patients.

Keywords: renal cell carcinoma, kidney cancer, recurrence of renal cell carcinoma, renal cell carcinoma surgery, nephrectomy, segmental kidney resection
p. 234-241 of the original issue
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Address for correspondence:
Republic of Uzbekistan, Tashkent,
Farobiy Street, 383,
Republican Specialized Scientific Practical Medical Center of Oncology and Radiology,
the Urological Department,
tel. +998 90 120-09-30,
e-mail: joker789987@mail.ru,
Boyko Elena V.
Information about the authors:
Boyko Elena V., PhD, Research Manager of the Urologic Department, Republican Specialized Scientific Practical Medical Center of Oncology and Radiology, Tashkent, Republic of Uzbekistan.
https://orcid.org/0000-0001-7266-5704
Tillyashaykhova Rano M.,PhD, Physician of the Urologic Department, Tashkent City Branch of the Republican Specialized Scientific Practical Medical Center of Oncology and Radiology, Tashkent, Republic of Uzbekistan.
https://orcid.org/0000-0003-3559-4913
Khasanov Sherali T., Head of the Urologic Department, Republican Specialized Scientific Practical Medical Center of Oncology and Radiology, Tashkent, Republic of Uzbekistan.
https://orcid.org/0000-0002-0607-4014

CASE REPORTS

T.V.KOZLOVA, Ì.S. MATVIEIENKO, I.V. BELOZOROV, E.YA. NIKOLENKO

PULMONARY EMBOLISM IN POLYTRAUMA: DIAGNOSIS AND TREATMENT

V.N. Karazin Kharkov National University, Kharkov,
Ukraine

Treatment of patients with polytrauma is a difficult problem for surgeons and physicians of intensive care units due to the fact that a multiple and complex lesion often serves as a trigger for the development of a number of life-threatening complications, such as pulmonary embolism (PE). Despite the existing methods of prevention and treatment of pulmonary embolism, the development of this complication in patients with polytrauma accompanied by massive hemorrhage is still remains an unsolved problem. This article presents a clinical case of the development of isolated PE during performing osteosynthesis of the patient with polytrauma and in stable condition achieved after the intensive therapy within the week. The analize of studies considering the problem of thrombus formation in various parts of the vascular bed and considering of pathophysioliogycal mechanisms of the systemic inflammatory response has been performed. Risk factors for pulmonary embolism and methods of prophylaxis are studied. Taking into consideration the currently available research data dedicated to this issue, the idea about the generalized nature of the pathological process which can be manifested as deep vein thrombosis such as PE or their combination has been expressed. In respect the insufficient effectiveness of thromboprophylaxis, the need to work out the other or additional laboratory and diagnostic methods of blood coagulation system assessment and responsively therapeutic methods is being considered.

Keywords: polytrauma, pulmonary embolism, thrombosis, systemic vascular reaction, inflammation, coagulation
p. 242-249 of the original issue
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  23. Shupkin YuG, Seliverstov PA, Skripal EA, The phenomenon of “second hit” after operations of osteosynthesis in case of poly-trauma. RMZh. 2017;23 (6):331-36 doi: 10.18821/0869-2106-2017-23-6-331-336 (In Russ.)
Address for correspondence:
61022, Ukraine, Kharkov,
Svoboda Square, 6,
V.N. Karazin Kharkov National University,
the Department of Surgical Diseases,
Operative Surgery and Topographic Anatomy
tel.: +38-050-161-98-36
E-mail: mariia.matvieienko@karazin.ua
Matvieienko Mariia S.
Information about the authors:
Kozlova Tatiana V., MD. Associate Professor, the Department of General and Clinical Pathology. V.N. Karazin Kharkov National University, Kharkov, Ukraine.
https://orcid.org/0000-0003-0432-6967
Matvieienko Mariia S., Assistant of the Department of Surgical Diseases, Operative Surgery and Topographic Anatomy, V.N. Karazin Kharkov National University, Kharkov, Ukraine.
http://orcid.org/0000-0002-0388-138X
Belozorov Igor V., MD, Professor of the Department of Surgical Diseases, Operative Surgery and Topographic Anatomy, V.N. Karazin Kharkov National University, Kharkov, Ukraine.
https://orcid.org/0000-0002-4102-3220
Nikolenko Evgene Y., MD, Professor of the Department of General Practice and Family Medicine, V.N. Karazin Kharkov National University, Kharkov, Ukraine.
https://orcid.org/0000-0002-7653-0644

EXCHANGE OF EXPERIENCE

S.V. MSHAR, V.N. ZASIMOVICH, V.A. ASANOVICH

HYBRID INTERVENTIONS IN EMERGENCY ANGIOSURGERY

Brest Regional Clinical Hospital, Brest, Republic of Belarus

Objective. To improve the results of treatment of patients with multilevel atherosclerotic lesions and aortic dissection.
Methods. In 2019 year 16 hybrid surgical interventions on arteries of lower extremities and 1 hybrid intervention for aortic dissection type B were made in Brest Regional Hospital. Most of the patients were men (15 out of 16), the average age was 60.2±6.4 (M±σ) years. Disease was staged according to the Fontaine–Pokrovsky classification: 4 patients (25%) – IIb, 8 (25%) – III, 4 (25%) – IV. The type of surgery was determined by the level of occlusion / stenosis (according to Doppler ultrasound and angiographic examination) and the state of the outflow tract. According to the TASC II classification, all patients were class C or D. Four groups of hybrid interventions on the arteries of the lower extremities were identified: hybrid on the ilio-femoral segment (n=9), hybrid on the femoral-popliteal segment (n=4), hybrid on the femoral segment (n=1), hybrid on the aorto-iliac segment (n=2).
Results. Technical success was achieved in 100% of cases. In 1 case thrombosis of the superficial femoral artery occurred, which did not require reconstruction due to compensated collateral blood flow, and 1 case of death from acute heart failure. Primary patency was achieved in 93.75% of cases. Duration of hybrid surgery 174.2±67.3 (M±σ) min. Duration of the open stage of the operation – 72.85±30.3 (M±σ) min. The augmentation of the ankle-brachial index (ABI) was 0.26±0.15 (M±σ). Hybrid interventions were performed in the X-ray operating room and always from one vascular access. The amount of iodine-contrasting substance used is 150.8±68 (M±σ) ml.
Conclusion. The use of hybrid interventions provides complete revascularization of lower extremities and minimizes risks of perioperative complications during implantation of aortic stent grafts in type B aortic dissection. Hybrid operations should be considered as the most perspective direction in the development of angiosurgery.

Keywords: hybrid intervention, multilevel atherosclerotic lesion, aortic dissection, endarterectomy, angioplasty, stenting
p. 250-256 of the original issue
References
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Address for correspondence:
224027, Republic of Belarus,
Brest, st. Meditsinskaia, 7,
Brest Regional Clinical Hospital,
Angiography Room,
tel .: +375 162 27-22-12,
e-mail: sergei.mshar@gmail.com,
Mshar Sergey V.
Information about the authors:
Mshar Searhei V. Physician, X-ray Endovascular Surgeon, Angiography Office, Brest Regional Clinical Hospital, Brest, Republic of Belarus.
http://orcid.org/0000-0002-6972-3915
Zasimovich Vladimir N., Head of the Department of Vascular Surgery, Brest Regional Clinical Hospital, Brest, Republic of Belarus.
http://orcid.org/0000-0002-0759-4628
Asanovich Valentin A. Head of the Angiographic Office, Brest Regional Clinical Hospital, Brest,
Republic of Belarus.
http://orcid.org/0000-0002-4124-0655

HANS G. BEGER 1, 2, KARL-HEINZ LINK 3

DUODENUM-PRESERVING PANCREATIC HEAD RESECTION FOR CHRONIC PANCREATITIS, BENIGN AND PREMALIGNANT TUMORS OF THE PANCREAS

The University of Ulm 1, Ulm
Center of Oncology, Endocrine and Minimally Invasive Surgery, The Danube Clinic, Neu-Ulm 2,
Clinic Asklepios Paulinen 3, Wiesbaden,
Germany

Objective. To report the institutional experience of the evolution of duodenum-preserving pancreatic head resection (DPPHR) as a surgical treatment for chronic pancreatitis with an inflammatory tumor as well as cystic and benign, premalignant neoplasms and neuroendocrine tumors of the pancreatic head.
Methods. DPPHR is associated with preservation of gastric antrum, common bile duct and duodenum/upper jejunal loop, contrary to Kausch-Whipple resection, which is a multivisceral procedure, including duodenectomy. Duodenum-preserving pancreatic head resection was first established in clinical setting in Berlin in 1969.
Results. For chronic pancreatitis with an inflammatory infiltrat in the pancreatic head, duodenum-preserving pancreatic head resection has become a standard surgical treatment with worldwide acceptance. In a series of 603 patients with chronic pancreatitis following DPPHR, the frequency of pancreatic fistula was 3.3 %, intra-abdominal abscess 2.8 %, hemorrhage 2.8 %, frequency of reoperation 5.6%, in-hospital mortality 0.82 % and 90-day rehospitalisation 8 %. DPPHR for benign and premalignant cystic neoplasms of the pancreatic head is used predominantly for IPMN, MCN and SPN tumors. In a review of international publications comprising 503 patients, the general morbidity was 38.2 %, severe surgery-related complications 12.7% of them pancreatic fistula B+C 13.6 %, resurgery 2.7 % and 90-day mortality 0.4 %. When pancreatic neuroendocrine tumors of pancreatic head are treated with DPPHR, a local lymph node dissection is additionally recommended. The long-term morbidity following DPPHR revealed new onset of diabetes mellitus and exocrine dysfunctions in only 5-7 % of patients.
Conclusion. Kausch-Whipple resection is associated with considerable high metabolic complications. Duodenum-sparing pancreatic head resection for inflammatory tumor, benign and premalignant neoplasms, and neuroendocrine tumors of the pancreatic head has the advantage of the duodenum preservation and maintenance of the pancreatic endocrine and exocrine functions.

Keywords: benign pancreatic head tumors, cystic neoplasms, pancreatic neuroendocrine tumor, chronic pancreatitis, duodenum-sparing head resection, early and late postoperative morbidity
p. 257-265 of the original issue
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  19. Beger HG, Poch B, Mayer B, Siech M. New Onset of Diabetes and Pancreatic Exocrine Insufficiency after Pancreaticoduodenectomy for Benign and Malignant Tumors: A Systematic Review and Meta-analysis of Long-term Results. Ann Surg. 2018 Feb;267(2):259-70. doi: 10.1097/SLA.0000000000002422
Address for correspondence:
c/o Universitätsklinikum Ulm
Albert-Einstein-Allee 23,
89081 Ulm Germany,
Phone: +49(731)71576-101,
Fax: +49(731)71576-255,
E-mail: hans@beger-ulm.de,
Hans G. Beger MD.
Information about the authors:
Hans G. Beger, MD, professor, the University of Ulm, Ulm, Germany, Center of Oncology, Endocrine and Minimally Invasive Surgery, the Danube Clinic, Neu-Ulm, Germany.
https://orcid.org/0000-0002-6278-7692
Karl-Heinz Link, MD, Clinic ASKLEPIOS Paulinen, Wiesbaden, Germany.
https://orcid.org/0000-0003-2335-8411
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