Aim. The clinical assessment of safety and hemostatic effect of «Haemoblock» hemostatic solution for arresting active bleeding from abdominal cavity tissues at open and laparoscopic surgeries.Methods. A total of 26 patients underwent surgeries. In 11 cases of acute calculous cholecystitis the drug was delivered to the bleeding surface during laparoscopic surgery by gauze soaked in «haemoblock» solution, which was introduced through 5 mm laparoscopic port (the first group). In 15 cases of acute adhesive intestinal obstruction, the drug was applied to the wound surface by moistened gauze during the open surgery (the second group).Results. In 23 (88.5%) cases of 26, stable hemostatic effect was obtained. Mean hemostasis time was 2.09±0.2 minutes in the first group and 2.53±0,15 minutes in the second group. The first group of patients, hemostasis occurred within 1-3 minutes in 10 (90.9%) of 11 patients, no secondary bleeding and suppuration was noticed. One patient (9.1%) of the first group developed recurrent bleeding from the gallbladder bed, requiring repeated surgery. Two (13.3%) patients of the second group had recurrent bleeding, requiring additional re-use of the drug with an exposure of 4 min. After using «Haemoblock», no postoperative complications such as fistula formation of adhesions, as well as reactive abdominal cavity effusions, were observed. No toxic of allergic reactions, irritating effect on the surrounding tissues no influence on systemic hemostasis were reported.Conclusion. «Haemoblock» is an effective local hemostatic that could be used as additional treatment to control parenchymal bleeding at abdominal and laparoscopic surgery.

Реферат. Изложены современные представления об этиологии, патогенезе, классификации, методах диагностики кровотечений из варикозно-расширенных вен пищевода и желудка при различных вариантах портальной гипертензии. Проведен сравнительный анализ современных методов лечения пациентов с синдромом портальной гипертензии различной этиологии. Обобщен собственный клинический опыт лечения 115 пациентов с синдромом портальной гипертензии различного генеза, осложненный кровотечениями из варикозно-расширенных вен пищевода и желудка. У 77 больных (группа сравнения) лечебная программа предусматривала выжидательную консервативную тактику. В этой группе прошивание варикозно-расширенных вен в качестве «операции отчаяния» было выполнено только 13 (16,9%) пациентам. У 38 больных (основная группа) была применена активная хирургическая тактика с как можно более ранним до наступления декомпенсации функции печени использованием операции М.Д. Пациора. Включение в лечебную программу больных с компенсированным (класс А) и субкомпенсированным (класс В) циррозом печени, осложненным кровотечением из варикозно-расширенных вен пищевода и желудка, с помощью активной хирургической тактики позволило уменьшить общее количество осложнений с 97,4 до 23,0%, в том числе число рецидивов кровотечений-с 31,2 до 6,8%, частоту развития печеночной недостаточности-с 89,6% до 33,7%, снизить госпитальную летальность с 76,6 до 32,2%. Ключевые слова: кровотечение, варикозное расширение вен пищевода и желудка, портальная гипертензия.

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Aim of study. Development in an anatomical experiment of a technique for operative access to the splenic and left renal veins during distal splenorenal bypass surgery with justification of the possibility of its successful application in clinical conditions.Material and methods. In the conditions of an anatomical experiment on 40 unfixed corpses of adults of both genders, objective volumetric and spatial indicators in surgical wounds were studied in two variants of exposure of retroperitoneal space vessels, as the first stage of distal splenorenal anastomosis. In clinical conditions in 40 patients with portal hypertension of various genesis, during the operation of distal splenorenal anastomosis, the wide exposure of the anterior surface of the pancreas, spleen, left renal veins and most of their branches was performed using the original method of partial left — sided medial visceral rotation, followed by an objective assessment of the volume-spatial parameters of access. Measurements were performed using a medical goniometer in relation to the mobilized areas of the left renal and splenic veins. Statistical processing of the study results was carried out using the method of variation statistics. To identify statistically significant differences, the Student’s t-test was used for disjoint samples.Results. An original method of operative access to the splenic and left renal veins was developed during the operation of distal splenorenal bypass by lifting the internal organs of the left flank of the abdominal cavity from the posterior abdominal wall and diverting them to the right. In the anatomical experiment in the original method of partial left-sided medial visceral rotation, all indicators were better (depth of the wound is less and the angles of operative activity and the inclination of the axis of operative activity — larger) than with a classic approach of intraoperative intraperitoneal access via transverse incision in the mesentery of the transverse colon. Despite the various variants of vascular architectonics and various anthropometric indicators of patients, there were no any forced refusal of distal splenorenal bypass surgery or unintentional damage to both the vessels themselves and the pancreas, specific complications associated with the implementation of the proposed operative approach to the vessels of the left retroperitoneal space, including damage to the spleen and ischemia of the descending colon, in any of 40 clinical cases.Conclusion. The suggested option of operative access to the splenic, left renal veins and their branches at the first stage of performing distal splenorenal anastomosis in patients with portal hypertension of various genesis provides convenient spatial relations in the operating wound; creates comfortable conditions for performing the main surgical technique — applying vascular anastomosis; has a minimal risk of developing specific complications associated with the approach to the vessels of the left retroperitoneal space.

Aim of study. Presentation of our own first clinical experience of venous reconstruction in portosystemic bypass surgery with the use of autologous vascular prostheses of the falciform ligament of the liver in the splenorenal position in a patient with portal hypertension syndrome in the outcome of liver cirrhosis of viral etiology.Material and methods. Clinical observation of a patient born in 1978 with a diagnosis of cirrhosis of the liver of viral etiology (HCV) Child-Pugh A (6). MELD 10 points. Inactive phase. Intrahepatic portal hypertension syndrome. Esophageal varices grade III according to A. G. Scherzinger, gastric varices type I (GOV1) according to Sarin. Condition after repeated recurrent esophageal-gastric bleeding. Due to the high risk of another bleeding, as a secondary prevention of esophageal-gastric bleeding, partial splenorenal anastomosis of “H” - type was performed with the use of an autologous vascular prosthesis of the falciform ligament of the liver in the splenorenal position.Results. A flap measuring 60.0x20.0 mm was cut from the falciform ligament of the patient’s liver. From the latter, after adjusting the size of the graft to the individual needs of the patient, an autologous conduit was formed. It was used as an insert in the formation of an “H” - type splenorenal anastomosis with the imposition of two end-to-side anastomoses between the splenic vein and one end of the conduit and between the left renal vein and the other end of the conduit. The patency of the anastomosis was checked using intraoperative sonography. In a satisfactory condition, the patient was discharged for outpatient follow-up treatment at the place of residence. At the moment of writing the article, the follow-up period was 8 months. The bleeding did not recur. No varicose veins were found in the esophagus and stomach during control endoscopic examinations. The patency of the splenorenal shunt was confirmed by ultrasound dopplerography.Conclusion. The first clinical experience of venous reconstruction with portosystemic bypass surgery using as a possible replacement of autologous vascular prostheses of the falciform ligament of the liver in the splenorenal position in a patient with portal hypertension syndrome in the outcome of cirrhosis of the liver of viral etiology gives hope for the possibility of further successful testing of this method of splenorenal bypass surgery to reduce the risk of bleeding from varicose veins.