[Serum ghrelin changes after bariatric surgery]

OBJECTIVE

To study the effect of bariatric surgery on serum ghrelin in patients with morbid obesity.

MATERIAL AND METHODS

We experimentally analyzed serum ghrelin in 96 rats. Of these, 84 rats underwent sleeve gastrectomy, and 12 rats comprised the control group (no surgery). We measured body weight and serum ghrelin using ELISA method after 1, 3, 7, 14, 21 and 30 days after surgery. Serum ghrelin was studied before and after bariatric surgery in 23 patients with morbid obesity.

RESULTS

Baseline serum ghrelin was lower in larger rats and obese patients compared to normal body weight. We found no decrease in serum ghrelin after resection of fundal ghrelin-releasing part of the stomach.

CONCLUSION

Stomach volume changes after restrictive bariatric surgery (sleeve resection or gastroplication) are accompanied by mild increase in serum ghrelin. This increment is greater after more significant body weight loss after surgery. Similar researches will help to find new treatment strategies for pathological obesity.

A CLINICAL CASE OF ABDOMINAL MORCELLOMAS

Aim of the study is to present a clinical case of abdominal morcellomas.

Methods: The technique of morcellation involves not only incisions, but also a significant crushing of tumor cells, which can eventually lead to the spread of the disease. Fibroids left in the abdominal cavity during morcellation continue their development and can reach tumors of considerable size. An observation of the detected parasitic uterine fibroids several years after laparoscopic myomectomy is presented.

Result: Histological examination of the removed preparation shows a microscopic picture of the uterine leiomyoma node of a typical structure in a thin fibrous capsule. It was received a normal postoperative course and a patient was discharged from hospital on the 4th day.

Conclusion: Abdominal morcellomas after laparoscopic interventions on the uterus is a rare complication associated with the parasitic persistence of myomatous tissue on the abdominal organs. The risks of such complications of endosurgery indicate the need for strict compliance with all technical aspects of using a devices for the evacuation of removed tissues, careful intraoperative monitoring and sanitation of the abdominal cavity.

EPIPLOIC APPENDAGITIS AS AN UNUSUAL CAUSE OF URGENT ABDOMINAL PATHOLOGY

Aim of the study is to present a clinical case of epiploic appendagitis as a rare acute abdominal pathology.Methods. This case demonstrates the prevalence of acute appendicitis symptoms in the clinical picture of the disease. During the operation was identified a necrotic changes in epiploic appendage of the ileocecal region with presence of secondary appendicitis.Result. The histological examination of the removed epiploic appendagitis gives a picture of tissues infarct with adipose necrosis and the presence of simple catarrhal appendicitis. It was received a normal postoperative course and a patient was discharged from hospital on the 8th day.Conclusion Epiploic appendagitis, due to the absence of pathognomonic symptoms, is an extremely difficult pathology for diagnosis. To establish the correct diagnosis, it is necessary to take into account a complex of data, including clinical and anamnestic, laboratory and instrumental diagnostic methods.

IS THERE A FUTURE FOR SINGLE PORT LAPAROSCOPIC SURGERY?

Aim. To identify a perspectives for using a single incision laparoscopic technologies in surgery.

Materials and methods: Today we have a several questions relating to a single incision laparoscopic surgery such as the possible spectrum of their application, safety and economic efficiency. The main is: does this technologies have a perspectives in future.

In paper was performed a retro and prospective analysis of the data of modern literature and authors own experience in surgical treatment using a single incision laparoscopic technologies.

Results: The study included 74 patients who underwent: cholecystectomy – 64 (86,5%), nephrectomy – 4 (5,4%), ovarian cyst removal – 4 (5,4%), kidney resection – 2 (2,7 %), using various kind of ports: “X-Cone Karl Storz” (28), “Covidien” (18), “PPP” (7), and 21 cases of multi-trocar access.

Conclusions: Our opinion that the perspectives for the development of single incision laparoscopy, is the further development of endoscopic devices, including robotic ones, and we believe that it will be a real future and endoscopic surgeons should be ready for this.

CLINICAL EXAMPLES OF INTESTINAL FORM OF CORONAVIRUS INFECTION

The work is based on the analysis of clinical cases of the incidence of intestinal coronavirus infection in the conditions of the clinic of the Bashkir State Medical University for the period from April to November 2020. The aim of the study is to elucidate the pathogenetic mechanisms of development, the peculiarities of the clinical course and effective methods of treating this disease. In these clinical cases, the positive effect of conservative therapy is noted, which confirms the absence of the need for aggressive surgical tactics.

WAYS TO IMPROVE RESULTS OF ENDOSURGICAL TREATMENT OF ACHALASIA

Aim. To improve the method of Heller cardiomyotomy for best immediate and long-term results of treatment of esophageal achalasia.Materials and methods. Analyzing the results of surgical treatment of 280 patients with esophageal achalasia who were treated in the Department of Surgical Diseases and New Technologies of the Bashkir State Medical University (Ufa) and the Department of Surgery and Stomach of the Republican Clinical Oncology Center (Kazan) for a period from 2000 to 2019. We conducted a cohort retrospective study in 2 groups (laparoscopic esophagocardiomyotomy according to Heller, supplemented by anterior modified hemifundoplication according to Dor (n = 74) and traditional laparoscopic interventions (n = 206).Results. The authors have developed an original method of laparoscopic esophagocardiomyotomy, including the use of devices that facilitate the mobilization of cardia and the formation of fundoplication cuffs. Patients were examined by performing esophagogastroduodenoscopy, contrast X-ray scopy of the esophagus and stomach, esophagomanometry, pH-measurement in distal part of esophagus. Long-term results of up to 2 years were tracked. Surgically treated patients were tested by special application forms. Received results showed the restoration of quality of life in most of the subjects.Conclusion The developed technique of laparoscopic esophagocardiomyotomy, including the use of intra-esophageal transillumination and a device for measuring the esophagus, prevents damage to the esophagus wall and postoperative complications associated with insufficient or excessive narrowing of the esophagus. Of the 74 patients, 66 (89.2 %) rated the result as excellent and good, 6 (8.1 %) as satisfactory, and 2 (2.7 %) as unsatisfactory.

Stomach wall changes after gastroplication in patients with morbid obesity

Morbid obesity is a distinct disorder which leads to metabolic disorders and to the development of many severe chronic diseases, therefore, the effective treatment of the disorder is an urgent problem of modern medicine. Currently, morbid obesity and the corresponding disorders are a growing problem associated with a significant risk of morbidity and mortality. The study was aimed to assess the morphological and functional changes in the stomach wall after gastroplication performed by the new method worked out in the Clinic of the Department of Surgical Diseases and New Technologies of the Bashkir State Medical University. Gastroplication was performed in 15 male rabbits of the Gray Giant breed aged 12–16 months weighting 3050–5380 g. The animals were withdrawn from the experiment 3, 6 and 12 months after surgery, followed by histological examination of the stomach wall plicated section. Changes in the mucous membrane and the muscle layer of the stomach wall after gastroplication were adaptive and associated with no severe morphological impairment. That made it possible to use the method in clinical practice in 15 patients with morbid obesity, 9 women and 6 men aged 42 ± 2.1. In most patients (13 people, 86.7%), a steady decrease in the body weight was achieved during the first 2–12 months. Long-term treatment results had been tracked during two years. It has been confirmed, that the new laparoscopic gastroplication technique does not lead to pathological changes in the stomach wall plicated section, therefore, the simple and cost-effective method may be used in clinical practice for treatment of patients with morbid obesity.

[Surgical treatment of gallbladder polyps]

OBJECTIVE

To study the incidence of gallbladder polyps and the possibilities of modern methods of diagnosis and surgical treatment of this disease.

MATERIAL AND METHODS

There were 42 laparoscopic cholecystectomies in patients with diagnosed gallbladder polyps. The polyps were diagnosed preoperatively. Intraoperative diagnosis during surgery for gallstone disease was observed in 3 cases. A comparative analysis of preoperative examination did not reveal any advantages of certain diagnostic approach.

RESULTS

Hyperplastic polyp was the most common type (n=20, 47.6%), adenomatous polyps occurred in 19 (45.3%) cases, cholesteric polyps - in 3 (7.1%) patients. All patients had signs of chronic inflammation of the gallbladder wall with its infiltration by lymphocytes and histiocytes.

CONCLUSION

Further studies with clear criteria for the diagnosis of gallbladder polyps including ones for determining true polyps, precancerous and malignant polyps are required.

[Gastric plication in treatment of patients with overweight and obesity]

AIM

To present the new method of gastric plication in treatment of patients with overweight and obesity.

MATERIAL AND METHODS

There were 132 different bariatric interventions in patients with overweight and obesity.

RESULTS

It is described an original technique of laparoscopic gastric placation characterized by reduced postoperative morbidity, simplicity, low traumatism, and economic efficiency. The method was applied in 12 patients with morbid obesity. The majority of patients (83.3%) achieved a persistent decrease in body weight.

CONCLUSION

The prospects of the method are seen in determining surgical indications and selection of patients for the operation. Further assessment of laparoscopic gastric plication will make it possible to determine its place among restrictive methods for weight loss.

[Creative surgery for hiatal hernia]

AIM

To present an experience of surgical treatment of hiatal hernia.

MATERIAL AND METHODS

An experience of more than thousand laparoscopic fundoplications in various modifications has been accumulated in the Clinic of Bashkir State Medical University for the period 2001-2016.

RESULTS

An original device for intraoperative measurement of hiatal orifice is described. Hiatal orifice repair was indicated in case of its dimension over 3.5 cm. 310 patients underwent hiatal orifice repair including diaphragmocrurorrhaphy in 189 cases, hiatal orifice replacement by using of mesh implant in 121 cases. Simultaneous interventions were performed in 211 cases due to hiatal hernia combined with other abdominal diseases.

CONCLUSION

Thus, selection of hiatal hernia patients for antireflux surgery should be clearly indicated according to clinical and instrumental data in the context of health care system reforming and widespread use of minimally invasive technologies. Laparoscopic operations for hiatal hernia are preferable and contribute to decrease of morbidity and improvement of outcomes.

[SYNDROME OF DIABETIC FOOT: MODERN APPROACHES OF COMPLEX TREATMENT]

The article presents the results of treatment of 201 patients with neuroischemic form of diabetic foot syndrome. The research included 158 women and 43 men of the middle age of 62.5 ± 11.2 years. The complex approach was applied in treatment including medicamentous treatment, revasculization of extremity, an application of modern combined collagenous coating and foot relieving using silicone insoles and orthopedic footwear. The endovascular and open reconstructive operations were performed in order to obtain the revasculization of extremity. Given complex approach allowed reducing the terms of hospital stay, the rate of ulcerous defects recurrences and relapses of ischemia of lower extremities during one year after endovascular interventions.

[The surgical treatment of the combined diseases of the pelvis]

167 women were simultaneously operated on gynecological disease and the combined other surgical diseases. Novel methods of laparoscopic surgery, allowing to decrease intra- and postoperative complications were represented. Authors proved the efficacy and necessity of simultaneous operations.

[Investigation of antioxidant properties of preparations for local treatment of pyo-inflammatory diseases of soft tissues]

Antioxidant properties of different medicinal agents for purulent diseases were studied.The indices of luminol-depending chemiluminescence of whole blood in donors and in patients with purulent wounds, indices of chemiluminescence of homogenates of the purulent wounds tissues before and after treatment were studied. A comparative characteristic of the influence of medicinal agents "Poliderm", "Voscopran", "Polisorb", "Levomekol" is given, which are used in local treatment of purulent wounds, on free-radical oxidation in model systems in vitro.

[Application of combined bandaging material with antioxidant activity for suppurative diseases of soft tissues]

Role of <<immunomodulating perforated atraumatic germicidal plaster>> in complex treatment of patients with suppurative diseases of soft tissues was analyzed. It is estimated that application of <<immunomodulating perforated atraumatic germicidal plaster>> allows normalizing of free radical peroxidation processes in the blood, increases tissue antioxidant activity compared with traditional methods of treatment.

[Experimental assessment of reparative regeneration of anastomoses of hollow organs of the gastrointestinal tract using preparation "enterosan"]

The article gives an experimental assessment of processes of healing anastomoses of hollow organs using preparation "Enterosan". "Enterosan" decreases inflammatory alterations and accelerates processes of reparative regeneration in the anastomosis zone.

[Endoscopic treatment of gastric polyps]

Data of 258 patients with gastric polipi is analyzed. Endoscopic polypectomy with further microscopical analysis was performed in 218 patients. The method of preoperative submucosal drug injection is proposed. It allowed to decrease the number of postoperative bleedings and recurrences.

[The membrane allotransplantate use in surgery for hygroma]

Reparative processes in calcaneal tendon after the use of new repair technique were studied in two animal series. In both groups the calcaneal tendon was incised to the half of its width. In control group no further manipulations were performed and in the experimental group the defect was covered with allotransplantate of dura mater (membrane stop). The control group demonstrated less active tendon reaction, whereas the experimental group demonstrated stimulation of reparation with the rapid change of inflammatory stages. The membrane stop serves as a modeling frame for new fibers of the regenerate. The obtained results permit recommending the membrane stop in treatment of hand hygromas for the cover of weak tendon areas.

[The role of lipid peroxidation in gall bladder stone formation]

Bile stones formation prognostification method, based on the chemical analysis of bile of patients with chronic cholecystitis, is developed. The method employs the phenomenon of chemiluminescense of the investigated bile in comparison with the model system. Hence, bile in chronic cholecystitis possess antioxidative qualities, whereas bile in chronic cholecystitis combined with cholelithiasis, is oversaturated with free radicals.

[Endoscopy in the diagnosis and treatment of gastric polyps]

The authors present a clinico-statistical analysis of results of endoscopic polypectomy and dynamic observation of 258 patients with gastric polyps. The aim of the investigation was to determine a true histological diagnosis of gastric polyps using excisional biopsy. An endoscopic investigation has revealed 475 polyps in the stomach of 258 patients. Endoscopic polypectomy by the method of electroexcision and preliminary submucous administration of solutions was used for 218 polyps having the size more than 0.5 cm. Patients with formations located submucously and malignant tumors of the stomach (polypoid cancers included) were not investigated. Metaplastic and dysplastic alterations characteristic of adenomatous polyps were detected by the method of chromoscopy.

[The prevention of anastomosis failure in gastrointestinal surgery (an experimental study)]

The analysis of enterosan influence on intestinal anastomosis healing in 90 rats was carried out. The medication is highly active as a regeneration stimulator. The use of enterosan decreases inflammation and activates regeneration in anastomosis area.

[Association of surgical treatment and oxygen active forms with fertility at patients with varicocele]

Study group consisted of 115 patients with varicocele undergone laparoscopic clipping of left seminal vein, control group--121 patients after Ivanisevich's operation. Chemiluminescence of seminal fluid with detection of oxygen active forms were studied at all the patients before surgery, in 14 and 72 days after it. Volume of ejaculate, concentration, mobility and morphology of spermatozoa were also examined. It is demonstrated that level of oxygen active forms may be regarded as criteria of efficacy of surgical treatment. Laparoscopic clipping of left seminal vein demonstrates better results (less postoperative complications and recurrences) compared with Ivanisevich's operation.

[New technologies in the treatment of gastroesophageal reflux disease]

Surgical treatment of 298 patients with gastroesophageal reflux disease with both laparotomy and mini-invasive technologies is analyzed. New method of anti-reflux surgeries using synthetic implants is described. Short- and long-term results are analyzed. Advantage of laparoscopic procedures is demonstrated in long-term period. Excellent and good results were achieved at 82.3% patients.

[A new method of surgical correction of hiatal hernias]

The authors propose a new method of surgical treatment of hiatal hernias by a laparoscopic method. The method was used in the clinic in 29 patients with good long-term results.

[A new method of surgical treatment of morbid obesity]

The article presents results of surgical treatment of 48 patients with morbid obesity and concomitant metabolic disorders in the clinic of Faculty Surgery of the Bashkir state medical university. A new means of vertical gastroplasty is described allowing to prevent the early development of reflux-esophagatis and to reduce the number of postoperative complications. Stable reduction of the body mass was obtained in 7 patients with morbid obesity by using the method in the clinical practice.

[Choice of plastic surgery in ventral hernias]

Morphological changes in the zone of plastic surgery with polypropylene graft were studied in experiment. Results of treatment of 195 patients with ventral hernias were analyzed. Study group consisted of 86 (44.1%) patients who underwent hernioplasty with subaponeurotic localization of the graft. Subaponeurotic hernioplasty was performed in 109 (55.9%) patients (control group). Algorithm of choice of plastic surgery's method in ventral hernia was developed with consideration of localization and size of hernia that permitted to reduce rate of early postoperative complications and to improve long-term results.

[Surgical treatment of patients with colostoma]

Results of treatment of postcolostomy patients are analyzed. In 74.7% cases colostoma was created due to tumor of the rectum or colon, in 6.5% -- due to diverticulosis, in 3.5% -- due to nonspecific ulcerative colitis, Krohn's and other diseases. Complications were diagnosed in 15.2% patients. Surgical treatment was carried out in 714 (43.6%) patients, 568 (79.5%) of them underwent reconstructive surgeries, 146 (20.4%) were operated for stoma complications. New methods of rectal stump preparation for surgery were used: method of differentiation of rectal stump and urether during surgeries, methods of delayed anastomosis. Laparoscopic mobilization of the colon during reconstructive surgeries led to a decrease of surgical trauma and number of complications.

[Associated laparoscopic interventions for gallstones]

Since 1994 till 2000 the authors have performed 1152 laparoscopic cholecystectomies. Coexistent diseases of the organs of the abdominal cavity were diagnosed in 13.02% of the patients operated on by using laparoscopic techniques. In parallel the simultaneous interventions were performed for hiatal hernias, ulcer of the duodenum, commissural disease of the peritoneum, chronic duodenal obstruction, ventral hernias, diseases of the genital organs, liver and chronic appendicitis. The greater volume of the operations when performing the associated operations by the laparoscopic method does not make the course of the postoperative period more severe and gives good results in 89.3% of the patients.

[Choice of surgical method in patients with inguinal hernias]

Results of surgical treatment of 310 patients with inguinal hernias were analyzed depending on hernioplasty method. Advantages of hernioplasty methods without tissues tension over traditional ones were demonstrated. Indications and contraindications of each method were determined. Algorithm of individual choice of surgery method for inguinal hernias has been developed.

[Use of "regeneration stimulator" in surgical treatment of postoperative ventral hernia]

During experimental hernioplasty with the application of the "Regeneration stimulator" in 38 dogs it was discovered that the rehabilitation period of the abdominal walls after the operation was considerably shorter. An experience with surgical treatment of 42 patients with postoperative ventral hernias is described. To remove the defect of the anterior abdominal wall by different intraoperative methods "the regeneration stimulator" was used in the zone of plasty. Recurrent hernias were noted in 1 of 42 patients. The method can be recommended for treatment of this category of patients.

[Surgical treatment of inguinal hernia]

Results of experimental hernioplasty with "Regeneration stimulator" in 38 dogs are presented. Reduction of postoperative period of abdominal wall reparation, stimulation of muscular-aponeurotic regeneration were revealed. Experience of surgical treatment of 49 patients with inguinal hernias is presented where surgical technique combined repair of anterior abdominal wall defect by different methods with intraoperative introduction of "Regeneration stimulator" in the zone of plastic reconstruction. There were no recurrences of hernias in the period from 1 to 3 years that permits to recommend wide use of this method.

[Differential diagnosis of hemorrhagic fever with renal syndrome and acute surgical diseases of abdominal organs]

The results of differential diagnosis of hemorrhage fever with renal syndrome and acute surgical diseases of abdominal organs in 1250 patients were analyzed. It was revealed that the course of the disease was similar to acute abdomen in 13.2% of them. The combination of fibrogastroduodenoscopy and diagnostic laparoscopy is optimal for differential diagnosis and permits to reveal typical symptoms of hemorrhage fever with renal syndrome.

[Minimally invasive technologies in the surgical treatment of patients with mechanical jaundice and suppurative cholangitis]

Minimally invasive technologies were used in treatment of 89 patients with cholelithiasis complicated by mechanical jaundice and purulent cholangitis. Advantages of the two-stage operative treatment of such patients were shown. The first stage is decompression of the bile duct, the second stage is a radical operation either by laparoscopic or minilaparotomic methods. It allows to avoid extensive and traumatic operations and secures better immediate and long-term results of treatment.

[Surgical treatment of patients with purulent cholangitis in cholelithiasis]

Results of treatment of 89 patients with cholelithiasis complicated by obstructive jaundice and purulent cholangitis using the minimally invasive technologies are analyzed. The advantages of two-stages surgical treatment of these patients are demonstrated. The decompression of biliary tract are performed as the first stage, radical operations by laparoscopy or minilaparotomy--as the second stage. This method permits to refuse the large and traumatic operations and to improve significantly the nearest and long-term results of treatment.

[Method of surgical treatment of hiatal hernia]

A method of hiatal hernia surgery providing an opportunity to decrease postoperative complications has been proposed. The method eliminates the development of a pathologic hiatal narrowing during diaphragmocrurorraphy. The method has been used in 65 patients. The advantages of the method are demonstrated.

[Combined surgical interventions in gastroduodenal ulcers]

Diagnosis and treatment of gastroduodenal ulcers combined with abdominal pathology are discussed. The results of combined operations in 158 patients are analysed. Most often gastroduodenal ulcers were combined with hiatal hernia (62%), peritoneal adhesions (17.7%), cholecystitis (17.7%), abdominal wall hernia (10.1%). Good long-term results were achieved in 69.7% of the patients, satisfactory results-in 26.9%, unsatisfactory-in 3.4%. Combined operations are effective in treatment of peptic ulcers and concomitant disorders.

[Clinical and morphological aspects of Helicobacter pylori invasion in reflux esophagitis]

The mucosal biopsies morphological investigation of the lower third of esophagus were conducted for Helicobacter pylori detection in 43 patients with reflux-esophagitis. Helicobacter pylori were detected in 66.7%, gastric metaplasia-in 83.3% of patients. Helicobacter pylori plays an important role in reflux-esophagitis pathogenesis. Surgical treatment is indicated if the combined antireflux and antibacterial therapy is ineffective.

Surgical management of gastroduodenal ulcer associated with hiatal hernia

The problem of surgical management of gastric and duodenal ulcers associated with the hiatal esophageal hernias is reported. The authors have summed up the results of simultaneous surgical treatment of 97 patients. Good follow-up results were obtained in 69.2 percent of the patients, satisfactory in 26.9 percent and unsatisfactory in 3.9 percent of the patients. Of the 28 patients with reflux esophagitis who had previously undergone gastric resection, it was noted that nonresection of the associated hiatal hernia during the primary operation for ulcer disease decreased the effect of surgical treatment. A new method of surgical management of reflux esophagitis of the resected stomach is presented. The authors conclude that simultaneous operation for gastroduodenal ulcers associated with hiatal hernia is a promising area of surgical treatment and ensures high medical, social and economic efficiency.