Anastomosis Zone Research Articles

ОПЫТ ЛЕЧЕНИЯ ПАЦИЕНТОВ СО СВИЩАМИ ОБОДОЧНОЙ КИШКИ ДИВЕРТИКУЛЯРНОГО ПРОИСХОЖДЕНИЯ

Abstract. Introduction. In the 21st century, a massive increase was noted in the incidence of diverticular disease (DD) by more than 10 times with an increase in the frequency of its complications ranging from 5 to 25%. According to the literature, the colon fistulation frequency is 5-30%, over a half of such formations being colovesical fistulas. The problem of surgical approaches to the purulent-inflammatory complications of DD is far from being resolved. Despite the fact that diverticular disease is a benign pathology, inflammatory process often creates serious technical difficulties in surgery due to the violation of the anatomical relationship of the intestine with the surrounding organs, while surgeries often affect several organs with a high infection risk. Aim. Analysis of the results of the treatment of patients with diverticular colon fistulas in a specialized department of a multidisciplinary hospital. Materials and Methods. Treatment outcomes were analyzed retrospectively in 347 patients with diverticular colon disease complications for the period from 2013 to 2022. The study included 17 patients with diverticular fistulas: 14 (82.4%) patients with internal (intestinal-urinary (13) and intestinal-vaginal (1)) fistulas and 3 (17.6%) with external ones. Results and Discussion. The therapeutic and diagnostic algorithm for diverticular fistulas required a wide range of diagnostic methods and a multidisciplinary approach. Surgery remains the single treatment option for this pathology. The choice of the surgical procedure depended on the inflammatory process severity, its spread to the surrounding abdominal organs, and the largest diverticula accumulation in the gut. In the group of patients with intestinal-urinary fistulas, the resection was not limited to the removal of the colon segment only. In 9 (52.9%) cases, it was expanded to the anterior rectum resection due to the inflammation transition to its upper ampullary region. We are supporters of the one-stage surgical procedures with forming the primary anastomosis in patients with diverticular fistulas. We give preference to the Sigal-Ramazanov invagination anastomosis that allows avoiding the anastomosis due to creating a duplicate of the intestinal wall hiding the anastomosis zone. The paper identifies probable predictors of complicating diverticular disease with fistulation. Conclusions. Choosing the optimal treatment option for patients with diverticular disease complications is a difficult problem. It is better to operate on them in the coloproctology departments of multidisciplinary hospitals with the established good interaction among the members of a multidisciplinary team.

Experimental replacement of various bladder volumes with allogeneic tissue-engineered constructions

The results of experimental replacement of the bladder wall up to subtotal using multicomponent tissue-engineered structures are presented. Purpose. Development and experimental use of a tissue-engineered structure for replacing various volumes of the bladder wall. Material and methods. The original poly-L,L-lactide matrix is reinforced with silk fibroin. Mesenchymal cells were introduced into the constructs. 6 intact animals underwent filling cystometry. The maximum cystometric capacity was 11.2±0.97 ml. In these same 6 animals, the anesthetic capacity of the bladder was measured, which was 23.83±0.71 ml. 36 animals underwent reconstruction of the bladder using a prepared tissue-engineered construct after resection of the corresponding volume of the organ. Groups of 9 animals received bladder volumes of 5, 10, 15 and 20 ml. The observation period was 3 months. Results: According to computed tomography of the abdominal and pelvic organs (native study and with intravesical administration of a radiocontrast agent), 4, 8, 12 weeks after surgery, a bladder of physiological capacity is determined in all study groups, the implanted structure is visualized as a hyperintense signal in area of the apex of the bladder. no leakage of contrast agent is detected. Filling cystometry in 2 animals that underwent replacement of 20 ml of bladder volume (subtotal replacement) after 12 weeks showed that the capacity of the formed reservoir correlates with preoperative parameters. Macroscopically, the anastomosis zone is consistent in all groups of animals, the tissue-engineered structure is determined at the implantation site, lysis of the structure is noted by 12 weeks of observation with the preservation of small residual fragments at the implantation site. Conclusion. The experimental use of the developed tissue-engineered multicomponent structure turned out to be effective for replacing defects of the bladder wall of various volumes up to subtotal reconstruction. Further study of technologies for the use of tissue-engineered allogeneic constructs can significantly improve the results of treatment of urological pathologies for which obtaining autologous material is not possible.

Option of isolated pancreatic head resection in chronic pancreatitis

The paper presents two clinical observations of successful duodenum-preserving pancreatic head resection performed for chronic calcifying pancreatitis complicated by ductal hypertension. At the reconstructive stage, an isolated segment of jejunum, 20 cm from the ligament of Treitz, was used. It was placed behind the colon. The patients had pancreatojejunostomosis formed with the wound surface of the pancreatic head and duct, and duodenojejunostomosis with the lower horizontal part of the duodenum. The first patient had no complications in the postoperative period. After 6 months, the patient showed improvement in the external secretory function of the pancreas, with absence of pain syndrome. The second patient developed gastrointestinal bleeding on day 10 and underwent endoscopic hemostasis. In 1.5, the esophagogastroduodenoscopy revealed patent anastomosis, without signs of inflammation. The applied variant of surgery enables pancreatic juice to be secreted as close to anatomical and physiological conditions as possible. Furthermore, the method allows endoscopic hemostasis to be performed in case of bleeding from the anastomosis zone. Further study is required on the long-term results of the proposed option of surgery.

Transfistula antegrade interventions in the treatment of benign biliary strictures

Background. Primary reconstructive operations aimed at restoring the passage of bile are rather complicated due to the cicatricial process and in 1530% lead to a distant recurrence of the disease.
 Aim. To present the results of combined X-ray surgery and endoscopic transfistula antegrade interventions in the treatment of benign bile duct strictures.
 Material and methods. For the period from 2011 to 2019 31 patients with benign bile duct strictures were treated in the surgical departments of the City Clinical Hospital No. 14 in Yekaterinburg. The mean age of the patients was 60.312.7 years, the comorbidity index was 2.6. As follows from the presented data, in 13 patients the stricture developed in the area of biliodigestive anastomoses. Another 17 patients had stricture after surgery for cholelithiasis. In 1 case, there was a persistent narrowing of the lumen of the choledochus against the background of indurative pancreatitis. In 25 (80.6%) cases, the first step was percutaneous transhepatic cholangiostomy under ultrasound guidance. Another 6 (19.4%) patients had a T-shaped drainage of the choledochus.
 Results. For the treatment of strictures of the bile ducts, 97 operations were performed: an average of 3.1 operations per 1 patient. Lithoextraction with a wire basket was performed in 17 patients with calculi. 5 patients with stones larger than 10 mm required contact lithotripsy. Stricture was confirmed in 25 patients. Balloon dilatation was performed in 21 cases. In 8 cases, dilatation was supplemented with papillosphincterotomy. In 6 patients with deformation of the anastomosis zone, framed drainage was installed for 12 months. In 3 patients, bilioduodenal stenting with a nitinol stent was performed. It was not possible to recanalize the stricture in 4 (13%) cases. Complications were registered in 1 (3.2%) patient (IIIB degree according to ClavienDindo).
 Conclusion. Transfistula cholangioscopy is an effective endoscopic technology in the treatment of patients with benign bile duct strictures.

Functional condition of microcirculation in the zone of intestinal anastomosis during postoperative period upon stimulation of its regeneration (experimental study)

Objectives: to conduct a comparative assessment of the functional condition of microcirculation of the digestive anastomosis zone in the early and delayed postoperative period upon local usage of autogenic growth factors (PRP). The experiment was performed on 30 mature laboratory rabbits. All animals underwent the imposition of two digestive "end-to-end" intestinal anastomosis: the control one at a distance of 15 cm from the ileocecal angle and the experimental one retreating 30 cm from the imposed anastomosis. The experimental anastomosis differed from the control one by using a method of local stimulation of its regeneration via injecting of platelet-riched-plasm (PRP). A comparative assessment of the functional state of the microcirculation of the intestinal anastomosis zone was carried out on the 3rd, 7th, 14th days in the postoperative period using the method of laser doppler flowmetry (LDF). The obtained data determined the ability of the PRP method to improve the conditions of the regenerative process in the intestinal anastomosis zone by increasing the rate of basal blood flow and tissue perfusion, the rates of which have maximum values in the early postoperative period (3 day).

Плановые лапароскопические резекции кишечника у детей с болезнью Крона

Currently, laparoscopic operations are widely used in pediatric surgical practice (both emergency and elective surgery). Separately, it is worth noting the difficulty of performing reconstructive surgical interventions using endovideosurgical technologies in pediatric coloproctology and surgery of inflammatory bowel diseases (Crohn's disease, ulcerative colitis, etc.). Objective. Present the experience of performing laparoscopic reconstructive surgical interventions in pediatric patients with Crohn's disease. Patients and methods. For the period from 2005 to 2023, 64 children with various forms of Crohn's disease on the basis of the FNCC of children and adolescents of the FMBA of Russia (Moscow), Morozovskaya DGKB (Moscow) underwent planned reconstructive laparoscopic interventions: ileocecal resection, resection of the small and large intestine with equipment side-to-side anastomosis, rectal resection with manual low colorectal anastomosis, subtotal colectomy. Results. The average surgery time was 150 minutes. In the postoperative period, complications developed in 6 children (9.4%). The duration of postoperative hospitalization averaged 7 days. In 6 cases, postoperative complications were noted, in 4 cases (inflammatory changes from the umbilical wound and the formation of the intestinal fistula here) it was possible to resolve them conservatively through antibacterial therapy and local treatment. But in the 2 remaining cases, repeated interventions were required due to the failure of the hardware suture and the formed stricture in the anastomosis zone. Conclusion. Treatment of children with complicated forms of Crohn's disease should be carried out in specialized centers with the participation of a multidisciplinary team of specialists at all stages of treatment. With the correct selection of patients and the timing of surgery, the laparoscopic technique allows efficient and safe resection and restoration of intestinal continuity at any location and length of strictures. Key words: Crohn's disease, inflammatory bowel disease, apparatus anastomosis, children, laparoscopy, laparoscopic resection

Иммунный статус в развитии рестеноза у пациентов с окклюзионно-стенотическим поражением бедренно-подколенного артериального сегмента после бедренно-подколенного шунтирования

Objective: to assess the immune status of systemic and local blood flow after femoral-popliteal bypass surgery in patients with and without restenosis. Materials and methods. The analysis of the treatment of 82 patients who underwent femoral-popliteal bypass surgery was carried out. Depending on the condition of the reconstruction zone after 12 months, the patients were divided into two groups: group I - 21 patients without restenosis, group II - 61 patients with the development of restenosis. The analysis of IgA, IgM, IgG, circulating immune complexes (CIC), interleukin (IL)-6, IL-1 in the systemic and local blood flow before and after surgery was performed. Results. In patients with the development of restenosis of the reconstruction zone, the level of IgA in the systemic and IgA, IgM in the local bloodstream was initially lower, the level of CIC, IL-1, IL-6 in the systemic and IgG, IL-1, IL-6 in the local bloodstream was higher, after surgery, the level of IgA in the local bloodstream was lower, higher - IgM in systemic and IL-6 in local blood flow in comparison with patients without restenosis. The correlation between the immune status and the development of restenosis was established: before surgery in the systemic circulation - IgA (r=-0.31, p<0.01), CIC (r=0.39, p<0.001), IL-6 (r=0.25, p<0.05), IL-1 (r=0.26, p<0.05), in the local bloodstream - IgA (r=-0.26, p<0.05), IgM (r=-0.30, p<0.01), IgG (r=0.26, p<0.05), IL-6 (r=0.30, p<0.01), IL-1 (r=0.29, p<0.01); after surgery in the systemic circulation - IgM (r=0.33, p<0.01), in the local - IgA (r=-0.24, p<0.05), IL-6 (r=0.40, p<0.001). The relationship between the degree of chronic arterial insufficiency (r=0.22, p<0.05), the ankle- brachial index after surgery (r=-0.27, p<0.05) with the development of restenosis was revealed. Conclusion. The interrelation of the immune status of the systemic and local blood flow before and after surgery and restenosis in the anastomosis zone after femur-popliteal bypass surgery has been shown. The study of the immune status will make it possible to develop an algorithm for restenosis prevention.

Subtotal replacement of the bladder with tissue-engineered structures using allogeneic mesenchymal cells in an experiment

The article presents the results of bladder reconstruc-tion up to subtotal replacement using multicomponent tissue-engineered structures in an experiment. Aim:Experimental subtotal bladder replacement using a tis-sue-engineered construction. Materials and methods: The authors used a poly-L,L-lactide matrix as a scaffold; it was developed in early experiments, reinforced with silk fibroin and seeded with allogeneic mesenchymal stem cells. A filling cystometry was performed in 6 intact ani-mals to determine the maximum cystometric and anes-thetic capacity of the bladder. The maximum cystometric capacity was 11.2±0.97 ml, the anesthetic capacity was 23.83±0.71 ml. 36 animals underwent resection of vari-ous volumes of the bladder, followed by reconstruction of the organ using a prepared tissue-engineered con-struct of the appropriate volume. Groups of 9 animals were formed, depending on the volume of reconstruc-tion: 5 ml, 10 ml, 15 ml and 20 ml. The observation period was 3 months. Results: 4, 8, and 12 weeks after surgery, according to computed tomography of the abdominal and pelvic organs with intravesical injection of X-ray con-trast agent, no leaks of contrast agent were observed. The implanted structure in the form of a hyperintense signal is located in the area of the apex of the bladder. The pre-served physiological capacity of the bladder was deter-mined in all study groups. In 2 animals that underwent subtotal replacement (20 ml volume) of the bladder after 12 weeks, filling cystometry confirmed the correlation of the physiological capacity of the formed reservoir with preoperative parameters. Macroscopically, the anasto-mosis zone is consistent in all groups of animals; by the 12th week of observation, lysis of the tissue-engineered structure is noted with the preservation of small residual fragments. Conclusion: The experimental application of the developed tissue-engineering multicomponent scaf-fold proved to be effective for replacing various bladder wall defects up to subtotal reconstruction. Further study of technologies for the use of tissue-engineered alloge-neic constructs can significantly improve the results of treatment of urological pathologies, in which it is not possible to obtain autologous material

Применение уретероуретеростомии при удвоении почки. Обзор литературы.

Introduction. Kidney duplication is one of the most common urological developmental anomalies, the incidence of which is 0.8%. At the same time, various types of obstructive uropathy can be a concomitant pathology in such a situation. There are various methods for correcting obstructive uropathy. Currently, more and more often in the treatment of obstructive uropathy of one of the segments of the doubled kidney, a method such as ureteroureterostomy is used. However, there is still no consensus on which treatment tactics in this case is the most optimal. The aim of our work was to analyze literature about using ureteroureterostomy in patients with obstructive uropathies of a duplicated kidney, as well as to compare this technique with others. Materials and methods. Search results were analyzed in the scientific databases e-Library, PubMed, Medline, Web of Science, Embase, Cochrane Library and PEDro according to the following. keywords: «renal duplication», «heminephrectomy», «ureteroureterostomy», «obstructive uropathies». In total it was found 157 publications, after analyzing the literature, 33 papers were selected for review, most fully reflecting the topic. Results. Heminephrectomy is still popular for severely reduced or absent duplex kidney function, but it has complications such as decreased function of the remaining segment, pseudocyst formation, stump, urinoma, segmental hematoma, ureteral stricture, and vesicoureteral reflux into the remaining segment. Ureteroureterostomy, as an alternative method for correcting obstructive uropathies of a double kidney, has been recognized as effective and safe in many studies. Data are presented to prove that ureteroureterostomy is applicable for any function of the affected segment. In this article, various techniques for ureteroureterostomy are consecrated, from open intervention to robotic one. In addition, research data on the safety of ureteroureteroanastomosis in case of a pronounced discrepancy between the diameters of the ureters are presented. Among the complications of ureteroureteroanastomosis, cultitis, urine leakage in the anastomosis zone, urinoma, and stenosis of the anastomosis can be noted. The predictors of an unfavorable outcome of the proposed method were identified. These include ectopic ureterocele, hydronephrosis of both segments of the duplex kidney, as well as simultaneous ureteroureterostomy and reimplantation of the recipient ureter. Conclusions. Ureteroureterostomy in patients with various pathologies inherent in duplication of the kidney is an effective and safe technique that allows preserving the function of the segment and adequately draining it. The use of this technique does not depend on the presence of a decrease or lack of function of one of the segments.

Evaluation of the functional results and safety of early removal of the urethral catheter after laparoscopic radical prostatectomy

Background. Currently, there is no single point of view on the timing of safe removal of the urethral catheter in patients who have undergone laparoscopic radical prostatectomy.Objective of the study: to evaluate the safety and functional results of early removal of the urethral catheter after laparoscopic radical prostatectomy.Materials and methods. In the period from January 2020 until April 2021, the study included 100 patients with a diagnosis of prostate cancer who underwent laparoscopic radical prostatectomy by one surgeon. Patients were divided into 2 groups. Group A (n = 50) included patients with the urethral catheter removed on the second day after surgery. Group B (n = 50) – the control group – included patients with standard catheter removal (14 days).Results. According to the results of cystography, in group A extravasation of a contrast agent from the zone of urethrovesical anastomosis was determined in 3 (6 %) cases. Seven (14 %) patients developed acute urinary retention after the removal of the urethral catheter. Among 2 patients acute urinary retention occurred immediately after catheter removal. In 5 cases acute urinary retention developed 2–7 days after catheter removal. These patients underwent repeated catheterization for a period of 2–3 days. In our study, removal of the urethral catheter on the second day increased the dynamic of restoring urinary continence in the postoperative period. The frequency of complete recovery of urinary continence (0–1 pad per day) in the groups A and B, respectively, was: after 1 month – 22 and 16 %, after 6 months – 64 and 54 %, after 12 months – 78 and 78 %. Urinary incontinence in the groups A and B was as follows: mild (2–3 pads per day): after 1 month – 40 and 34 %, after 6 months – 30 and 32 %, after 12 months – 20 and 18 %; moderate (4–5 pads per day): after 1 month – 20 and 26 %, after 6 months – 6 and 10 %, after 12 months – 2 and 2 %; severe (6 pads or more): after 1 month – 18 and 24 %, after 6 months – 0 and 4 %, after 12 months – 0 and 2 %.Conclusion. Early removal of the urethral catheter (2 days) in patients who underwent laparoscopic radical prostatectomy is a relatively safe method that improves the restoration of urinary continence.

Features to Prevent Failed Hardware Colorectal Anastomoses in Laparoscopic Rectal Resections

The aim of research was to study proper results of laparoscopic anterior rectal resection using intraoperative measures to prevent failure of hardware colorectal anastomoses in patients with rectal tumor.Material and methods. Out of 68 patients included in the study, colorectal anastomotic leakage occurred clinically only in 2 cases (2.9%, class A and B) and required no further surgical interventions. When evaluating the risk of colorectal anastomosis failure in each specific case, it is necessary to consider pre- and intraoperative risk factors. Formation of colorectal anastomosis with one angular end of the rectal stump followed by immersion; additional strengthening of the anastomosis zone with interrupted serous-muscular sutures; adequate drainage of the pelvic cavity (the most effective - transperineal presacral) are intraoperative methods that reduce the risk of failed hardware colorectal anastomoses.Results. Out of 68 operated patients, colorectal anastomosis failure occurred clinically only in 2 cases (2.9%, class A and B) and did not require repeated surgical intervention. When assessing the risk of colorectal anastomosis failure in each specific case, it is necessary to take into account pre-and intraoperative risk factors. Formation of a colorectal anastomosis with one angular end of the rectal stump, followed by its immersion; additional strengthening of the anastomosis zone with nodular serous-muscular sutures; adequate drainage of the pelvic cavity (most effectively - trans-interventional presacral) - intraoperative methods that reduce the risk of failure of hardware colorectal anastomoses.Conclusion. Reasonable doubts in the intraoperative evaluation of the blood supply to the end section of the descending colon, viability of the colorectal anastomosis, presence of 3 or more risk factors, low position of anastomosis (less than 10 cm from the outer end of the anal canal) indicate the necessity to form preventive transversostomy.

INVESTIGATION OF MICROCIRCULATION PECULIARITIES IN THE ZONE OF DIGESTIVE ANASTOMOSIS DURING EARLY AND DELAYED POSTOPERATIVE PERIOD AS A PREDICTOR OF ITS INSUFFICIENCY

The aim of the research is to evaluate the condition of blood flow in the area of digestive anastomosis in the early and delayed postoperative period in an experiment. The experiment included 30 sexually mature laboratory rabbits-males of the breed Soviet Chinchilla. The animals were done laparotomy, enterotomy, followed by the imposition of a digestive single-row nodular anastomosis "edge to edge", then the evaluation of local blood flow condition in the zone of digestive anastomosis was performed in the early (3 days) and delayed (7, 14 days) postoperative period using the method of Laser Doppler Flowmetry (LDF). The data received demonstrated a decrease of local blood flow in the early postoperative period in the area of digestive anastomosis, that forms the most vulnerable period for the development of its insufficiency. In the delayed postoperative period, there is an improvement in the indicators of local blood flow in the anastomosis zone, with an approximation of their values to the condition of the intact intestinal tract.

Prevention of The Development of Postoperative Complications and Their Treatment in The Surgery of Duedenal Purpose

The authors analyze various degrees of physiological anastomositis in 131 patients, and conclude that for the treatment of late anastomositis after surgical interventions on the stomach and duodenum, it is recommended to include the laser action of the anastomosis zone with two types of low-energy lasers in the complex program. The authors argue that the combined use of low-energy laser exposure through endoscopic and percutaneous irradiation will improve the effectiveness of the treatment of late anastomositis.

Experimental study of fine-grained reticulated titanium nickelide in the near-defective tissues of the palate

Aim. To study the peculiarities of regeneration of fine-gauge reticulated titanium nickelide in near-defective tissues of the palate.Material and methods. The work was carried out on 10 female rabbits of the Shin Shila breed weighing 2,7-3,0 kg; an experimental investigation was carried out in the Central Research Laboratory of the Avicenna Tajik State Medical University. As the implantation material, we used a fine mesh titanium nickelide with a thickness of 40-50 microns threads and the size of 50x50 microns cells.Results and discussion. The morphological study revealed that after the surgery the mucous membrane covering the implant was edematous with foci of hyperemia and hemorrhages. Vessels were dilated and full-blooded, small and medium caliber vessels were constricted. In the zone of anastomosis, there were prevailing changes of inflammatory character with slight activation of local immunity. Fifteen days later the mucous membrane in the anastomosis zone partially recovered. Local immunity activation contributes to the restoration of normal structures in the implant area. Later it was noticed that as soon as blood supply to the implant zone was restored almost immediately from the areas bordering the operation zone the sprouting of the covering epithelium cells began.Conclusion. Regeneration processes in the artificially created defective areas of the palate, at the use of the titanium fine mesh nickelide begin on the border of the implant material contact with the tissues of the peri-defective zone at the expense of the local immune reactions activation with the following gradual transition to the other areas.

Effect of a liquid with a negative redox potential on the indicators of blood and humoral immunity after resection thin gut

An experimental study was conducted to establish changes in blood indices and humoral immu1nity in rats in the postoperative period with the use of catholyte and anolyte. The experiments were carried out on 45 male rats weighing 290–320 g, which were distributed equally into 3 groups: group 1 — intact animals, group 2 and 3 — animals which underwent surgery in the amount of resection of the small intestine (1.5 cm) with anastomosis end to end.After surgery, rats used catholyte as a drink, instead of drinking water. The surgical wound was treated with anolyte. Blood and the wall of the small intestine in the anastomosis zone were used as a biological substrate. The material was studied on days 5 and 15. A study of the composition of blood and the walls of the small intestine was carried out on days 5 and 15 4. An analysis of the materials showed that the use of catholyte (a liquid with negative AFP-leads to positive changes in blood counts, humoral immunity and phagocytic activity, impaired after resection of the small intestine. The use of anolyte antiseptic (liquid with positive AFP) prevents bacterial contamination of the surgical wound. The studied parameters indicate that catholyte positively affects humoral immunity, and anolyte prevents bacterial insemination of the surgical wound.

Diagnostic capabilities of magnetic resonance imaging in assessing the state of the large and small intestines

Purpose of the study. Purpose of the work is to show the possibilities of radiation diagnosis of the normal anatomy of the small and large intestine, as well as their pathological changes through the use of MRI (Hydro-MRI).
 Materials nad methods. Thirty patients were examined by the method of Hydro-MRI. All patients underwent magnetic resonance imaging on a device with a magnetic induction of 1,5 T. To carry out Hydro-MRI, we used T2-weighted sequences, such as a one-time fast spin echo signal obtained in several planes, STIR sequences in three mutually perpendicular sequences, so that edema wall edema can be estimated with additional diffusion-weighted images.
 Results. Twentypatientswiththemanifestations of Crohn's disease in the form of terminal ileitis, presence of interlope fistulous passages, paraproctitis (fistulous form) were detected. Colon tumors were detected in 8 patients, recurrence of gastrointestinal stromal tumor (GIST) of the small intestine in the anastomosis zone was detected in one patient, and no pathological changes were detected in one patient.
 Conclusion. Hydro-MRI allows visualizing the mass of the small, large intestine and determining the degree of invasion of the intestinal wall and surrounding tissues. Enterography using magnetic resonance enterography has become the most effective methods for visualizing the small intestine in patients with Crohn's disease and can visualize inflammation of the intramural or proximal small intestine in about 50% of patients with Crohn's disease who have undergone endoscopically normal studies. Hydro-MRI is indicated for Crohn's disease and for determining the degree of inflammatory activity. Recent evidence suggests that cross-section visualization may be useful in determining response to therapy, assessing bowel healing and monitoring disease progression. Also, according to researchers at the Medical Imaging Center, University College London, the quantitative motility of the small intestine is an objective biomarker of endoscopic and histopathological inflammatory activity in Crohn's disease and is comparable to previously confirmed estimates of MRI activity enhanced by gadolinium. The final ileal mobility indicator showed a good correlation with endoscopic and histopathological activity in Crohn's disease. The study is painless, no radiation load. Hydro-MRI is a method of choice, when it is impossible to conduct an X-ray examination of the intestine, the inability/ uninformativeness of an endoscopic examination of the small, large intestine. Along with video capsular endoscopy, it allows visualization of all departments of the small and large intestine.

744 THE USE OF IMMUNOFLUORESCENCE TO EVALUATE THE PERFUSION OF THE GASTRIC PLASTY DURING OESOPHAGECTOMY.

Abstract Anastomotic leakage in oesophageal cancer surgery is one of the most serious complications and occurs mainly at the cervical level between 10–30% according to series. The use of immunofluorescence could help to select a better vascularized area in which to perform the anastomosis more safely. We present the initial experience (between July and December 2020) of our group. Methods Prospective and descriptive study of patients with oesophageal neoplasia who underwent a 3 stage oesophagectomy with cervical anastomosis using immunofluorescence with indocyanine green (dose: 7,5 mg) for quick evaluation of vascularization in the theoretical anastomosis zone in gastric plasty. Intravenous injection of the indocyanine green dilution was performed intraoperatively in a peripheral line, once the plasty was positioned in place to perform the anastomosis. The route of ascent was transmediastinal in all cases. 9 patients with a mean age of 61 ± 7.6 years were included in the study. Results The mean heart rate was 83 ± 16 bpm, the mean systolic blood pressure was 111 ± 17 mmHg. The time and mean speed it took for the fluorescence to reach the marked area to perform the anastomosis was 30 ± 28 seconds and 1.83 cm/sec; and at the apex of the plasty it was 93 ± 79 seconds and 0.75 cm/sec. In all patients in whom the anastomosis was performed in the area where ICG arrived between 30 and 90 seconds, there was no leakage. In two patients, due to anatomical needs, the anastomosis was performed in areas where ICG took more than 100 seconds and in the postoperative period leaked. Conclusion Immunofluorescence is a technique that allows an immediate visual image to evaluate the vascularization of the gastric plasty during an esophagectomy. It allows characterizing the adequate vascularization of the future anastomotic area, being able to help decide the best place to carry out the anastomosis. Studies with a larger number of cases are needed to be able to define the range in which to establish the anastomosis or change the surgical strategy.

MP56-09 HISTOMORPHOLOGICAL ANALYSIS OF THE REGENERATIVE POTENTIAL OF PLATELET-RICH PLASMA DURING URETHROPLASTY (IN AN EXPERIMENTAL MODEL)

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) III (MP56)1 Sep 2021MP56-09 HISTOMORPHOLOGICAL ANALYSIS OF THE REGENERATIVE POTENTIAL OF PLATELET-RICH PLASMA DURING URETHROPLASTY (IN AN EXPERIMENTAL MODEL) Sergey Kotov, and Mikhail Iritsyan Sergey KotovSergey Kotov More articles by this author , and Mikhail IritsyanMikhail Iritsyan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002086.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Reconstructive plastic surgery is the gold standard for the treatment of primary urethral strictures, but the effectiveness of these methods does not reach 100%. In cases of recurrent urethral strictures, the effectiveness of standard operations is lower than in primary strictures, which requires the search for methods to improve the results of surgical treatment. To evaluate changes in the structure of the intercellular matrix, the cellular composition of the spongiose body, and the regenerative potential of platelet-rich plasma after urethroplasty on a biological model. METHODS: The experiment was performed on male rabbits of the breed "Burgundy" weighing 3.0-4.5 kg (18 individuals). Two groups of animals were formed: experimental (9 individuals) and control (9 individuals). All animals in each group underwent end-to-end anastomotic plasty of the bulbous urethra according to the standard procedure. In the control group, an isotonic solution of 0.9% NaCl was injected into the spongy body in the anastomosis zone; in the experimental group, autologous plasma enriched with platelets was administered. Routine hematoxylin-eosin staining was performed to visualize the histoarchitectonics of the tissues. Van Gieson staining to identify the collagen fibers and correct their orientation. In order to detail the inflammatory and regenerative changes, an additional immunohistochemical study was performed with antibodies: CD79a, CD43, CD31 (PECAM1), MMP1, MMP9. The expression level of MMP1, MMP9 was evaluated by counting positive cells in the submucosal and muscle layers. The level of angiogenesis in micro-preparations was estimated by counting the number of vessels, and reliable endothelial imaging was performed using CD31(PECAM1) expression. RESULTS: The local application of platelet-rich plasma in the suture zone contributes to a reduction in the zone of necrotic changes and the severity of inflammation, accelerated migration of macrophage-histiocyte cells to the focus of alteration, and increased blood supply due to enhanced angiogenesis. Also, in the experimental samples, there was a higher expression of metalloproteinases (collagenases) of type 1 and 9, reduced collagen production, and correct orientation of collagen fibers during the repair processes. CONCLUSIONS: According to the results of the experiment, the use of platelet-rich plasma promotes the acceleration of reparative processes in the spongy body after urethroplasty. In clinical practice, this may reduce the duration of lower urinary tract drainage and, consequently, the risk of infectious complications. In turn, the expression of metalloproteinases and a decrease in collagen production, the correct orientation of collagen fibers can reduce the amount of pathological fibrous-scar tissue in the surgical area, which reduces the risk of recurrence of urethral stricture after surgical treatment in clinical practice. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e972-e972 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sergey Kotov More articles by this author Mikhail Iritsyan More articles by this author Expand All Advertisement Loading ...

Effect of additional strengthening of colonic anastomosis on abdominal contamination severity

Purpose of the study. To investigate the effect of additional strengthening of the colonic anastomosis (CA) using modern adhesive materials on the severity of abdominal contamination in patients with insulin resistance (IR).
 Materials and methods. The study involved 80 patients with IR, who underwent surgery with the CA imposition (median age of the patients – 64 (57; 71) years). All patients were divided into 2 groups, depending on the method of strengthening the CA suture: 1 group – 40 patients who underwent the application of a onerow continuous suture (OCS) of the CA (median age of patients – 65 (57; 75) years, 2 group – 40 patients to whom OCS CA was applied, and in order to seal and strengthen the anastomosis zone a modern Nbutylcyanoacrylate tissue adhesive was added (median age of patients – 63,5 (58,5; 70,5) years. The spectrum of microbial flora of secretions from drains near the anastomosis was determined.
 Results. The additional use of modern Nbutylcyanoacrylate tissue adhesive to strengthen the area of CA with the imposition of a OCS in patients with IR contributes to a reliable reduction of number of patients with associations consisting of two types of microorganisms compared to the patients without additional strengthening (2 (5,0%) versus 9 (22,5%) of patients, respectively) (χ2 = 5,17, df = 1; р < 0,05), the greater number of patients with no growth of microorganisms in crops from the anastomotic zone ((11 (27,5%) of patients versus 3 (7, 5%) of patients, respectively), as well as fewer cases of high degree of anastomosis zone contamination (3,48 times (χ2 = 7,68, df = 1; р < 0,05)), with prevalence of mild contamination (3, 35 times (χ2 = 15,24, df = 1; р < 0,05)).
 Conclusion. The additional use of modern Nbutylcyanoacrylate tissue adhesive to strengthen the area of CA with the imposition of a onerow continuous suture in patients with IR contributes to a reliable reduction of contamination of the area around the anastomosis compared to the patients without additional strengthening.

Carotid endarterectomy with extended lesion: formation of a new bifurcation according to A.V.Pokrovsky or autoarterial reconstruction according to A.A.Karpenko?

Purpose of the study.Comparison of hospital and long-term results of autoarterial reconstruction of carotid artery bifurcation and the formation of a new bifurcation with an extended atherosclerotic lesion of the internal carotid artery (ICA).Materials and methods.In the period from January 2018 to May 2020, this cohort, comparative, prospective, open-label study included 279 patients with an extended atherosclerotic lesion of the ICA operated on in the Alexandr Hospital. Depending on the implemented strategy of surgical correction, all patients were divided into two groups: group 1 (n=132) — autoarterial reconstruction of bifurcation of the carotid arteries; Group 2 (n=147) — the formation of a new bifurcation. Complications were recorded in the hospital and long-term postoperative periods. The total follow-up period was 16.4±9.3 months. The endpoints of the study were such adverse cardiovascular events as death, myocardial infarction (MI), stroke, thrombosis / restenosis of the anastomosis zone, combined endpoint (death from stroke / IM + IM + stroke).Results.The ICA clamping time in group 1 was 32.6±3.3 minutes, in group 2 – 31.7±3.5 minutes, which did not receive statistically significant differences (р=0.81). In the hospital postoperative period, adverse cardiovascular events were not recorded. In the long-term follow-up, the groups were comparable in the frequency of all complications. Identified lethal outcomes developed as a result of the formation of MI in patients with multiple lesions of the coronary arteries and a history of myocardial revascularization. The likely cause was shunt / stent thrombosis with subsequent coronary insufficiency and an increase in ischemic heart damage. The causes of stroke, recorded in each group in isolated cases, were the presence of atrial fibrillation. Patients did not comply with the recommended regimen of anticoagulant therapy, which provoked the development of cerebral catastrophe. In turn, the identified restenoses of the reconstruction zone were asymptomatic and were also observed in isolated cases in each group in the period 12 months after CEE.Conclusion.Autoarterial reconstruction of carotid bifurcation and the formation of a new bifurcation are comparable in safety and effectiveness methods of surgical treatment of an extended atherosclerotic lesion of the ICA. Operation techniques differ in the choice of an artery that is cut off from bifurcation — the external carotid artery or ICA. Further, the reconstruction progress is absolutely identical. Hospital and long-term follow-up results showed minimal indicators of the development of cardiovascular and hemodynamic changes due to the type of operation. Thus, both reconstruction techniques can be the operation of choice for an extended ICA lesion.