No abstract

Objective. Improvement of results of treatment in patients, suffering insufficiency of anastomotic sutures in the gut hollow organs, using determination of role for the connective tissue undifferentiated dysplasia (CTUD) in development of this complication, estimation of the phenomena spreading and elaboration of informative criteria for the CTUD diagnosis. Маterials and methods. Retro- and prospective trial was based on data about 42 patients, suffering insufficiency of anastomotic sutures, who were treated in the National Institute of Surgery and Transplantology named after О. О. Shalimov of NAMS of Ukraine, and 20 practically healthy persons (the comparison group), comparable for age and gender with the investigated patients. The procalcitonin of the blood serum and C-reactive protein analysis were used for special laboratory investigation. The status of the connective tissue metabolism was estimated in accordance to content of free oxyprolene in the blood serum and the level of glycosaminoglycans in urine. Results. There was revealed, that the most informative phenotypical markers of CTUD in patients, suffering insufficiency of anastomotic sutures of the gut hollow organs, are visceral (78.6%), vascular (73.8%) and arythmical (54.7%) syndromes. There was established, that direct correlation between the level of biochemical markers of the collagen biodegradation and the CTUD degree may be applied for prognostication of development and course of complications in patients, suffering insufficiency of the anastomotic sutures of the gut hollow organs. Severe degree of CTUD in the patients, suffering insufficiency of interintestinal anastomoses, complicated by extended peritonitis, constitutes unfavorable prognostic sign and enhances the mortality by 87.5%. Conclusion. The presence of CTUD in the patients, suffering insufficiency of anastomotic sutures of the gut hollow organs constitutes the unfavorable factor of comorbidity, which must be taken into account, choosing the adequate surgical tactics and complex pathogenetically substantiated treatment.

The aim: There have been investigated the specific features of pancreatic resection with the use of electrosurgical methods on experimental models of clinical operations. Pancreatic tissue regeneration at the surgical site have been studied when employing monopolar, bipolar, electric welding methods as compared with standard surgical technique. Materials and methods: The study was performed on 40 white laboratory rats. Pancreatic resection was conducted by standard surgical technique or by welding with electrocoagulation device “Patonmed EWD-300”, high-energy electrosurgical device in bipolar mode and in monopolar mode. The pancreatic tissue was examined immediately after the surgery and at 3, 7 and 21 days postoperatively. Results: In early terms following standard surgery there was seen more severe inflammation and the volume of newly formed connective tissue got increased faster than after the electrosurgical technique. Pancreatic ducts developed in newly formed tissue after the use of each type of electroresection, whereas that event was not observed following standard surgery. When using electrosurgery in monopolar mode, the area of coagulative necrosis was found to be less dense than after resection performed in bipolar mode. Conclusions: Based on the findings, we can conclude that each of the above types of electroresection reduces surgery time, lowers bleeding risks, contributes to formation of the more adequate sealing on the resection surface with no complications of the recovery process.

Objective. To improve the results of treatment in patients with insufficiency of duodenal sutures. Materials and metods. Retrospective and prospective investigation was accomplished on 17 patients, suffering insufficiency of sutures, injuries and fistulas of duodenum, who were admitted for treatment into Shalimov National Institute of Surgery and Transplantology during 2010-2020 yrs. In all the patients a complex examination, including a general clinical one, special laboratory and instrumental methods of investigation, was conducted. Results. Miniinvasive endoscopic method for the treatment of the duodenal sutures insufficiency was elaborated with a patent obtaining, which consists of endoscopic placement of a covered nitinol self-expanding stent into the defect zone. In presence of the complication, constituting a duodenal fistula, there was proposed to place a covered nitinol self-expanding stent into the defect zone together with vacuum-therapy from the side of the fistula external aperture. Due to application of the treatment method elaborated, it have become possible to reduce the morbidities quantity and to shorten the patients’ stationary stay by 36% - from (38.1 ± 4.16) to (25.4 ± 3.7) bed-days (p < 0.05). General mortality in the investigated group have constituted 9%, what was in two times lower, than the mortality index in a control group - 16%. Conclusion. The method, investigated by us, have constituted a combined approach with endoscopic placement of a self-expanding stent into the defect zone together with vacuum therapy from the external aperture of fistula, promoting improvement of the treatment results of the duodenal sutures insufficiency, accompanied by shortening of the patients’ stationary stay and reduction of morbidity and mortality.

Annotation. The aim of the study is to improve the treatment outcomes of patients with duodenal fistulas. The object of retro- and prospective study were 14 patients with external unformed high-flow duodenal fistulas, who were treated in the Shalimov National Institute of Surgery and Transplantology during 2016–2019. All patients were performed a complex examination, which included general clinical, laboratory, instrumental and statistical research methods. We have developed and patented a minimally invasive method of treatment of duodenal fistulas, which involves endoscopic placement of a nitinol-coated self-healing stent in the area of the defect and VAC therapy from the outer opening of the fistula. Statistical processing of research results was performed using spreadsheets Microsoft® Office Excel (2017) and statistical processing program Statgraphics Professional 16.0.03. Student's test and Wilcoxon-Mann-Whitney test were used. The use of the developed method of treatment allowed reducing the number of postoperative complications by 32%, to reduce the duration of treatment (from 41,16±5,14 to 27,2±4,7 days, p>0.05). The overall mortality in the experimental group decreased by 43% compared with the mortality of the comparison group. Our proposed minimally invasive method of treatment of duodenal fistulas helps to improve the results of treatment of patients, namely to reduce the duration of treatment and reduce the number of complications and mortality rate.