[AN EXPERIMENTAL STUDY OF THE HISTOLOGICAL FIBRO GENESIS ABILITIES IN THE AREA OF IMPLANTATION OF ALOTRANSPLANTATES APPLYING INTRAABDOMINAL AND PREPERITONEAL PLASTIC SURGERY].

The histological fibro genesis abilities in the area of implantation of allotransplantates applying intraabdominal and preperitoneal plastic surgery were examined during experimental research. The experiment involved 12 Russian chinchilla rabbits. The animals were spitted into two groups: I group--operated using IPOM methodology (intraperitonealonlaymesh, n = 6) with the installation "Proceed" mesh made by "Ethicon", group II--modeling preperitoneal plastics with the installation of "Ethicon's Ultrapro" mesh (n = 6). After removing the animals from the experiment, the implants with adhering musculo-aponeurotic tissue layer were excised and sent for histological examination. At the same time the severity of the inflammatory process were rated, the composition of the inflammatory infiltrate, germination of the connective tissue through the pores of the prosthesis and neovascularization. Analyzing the research data of histological connective abilities complexes formed in the area of the allotransplants implantation using intra-abdominal and pre-peritoneal plastic during the experiment, we can conclude that intra-abdominal installation of mesh prostheses reduces the severity of inflammatory changes surrounding tissues and reduces the probability of seroma formation in comparison with the placement of the pre-peritoneal implant.

[Research of the durability of connective tissue complexes formed in the implantation area of various types of allograft during the experiment].

The aim of the study is to examine in the experiment on the animals the mechanical properties of connective tissue complexes formed in alloplasty area using the intraperitoneal on lay mesh and sublay methodologies with further comparison of them. The experiment has been conducted on 12 rabbits of Russian chinchilla breed. Animals were distributed in the following way: the first group--operated by intraperitoneal on lay mesh methodology (n = 6) through implantation of composite grid Proceed with one-side celullose coating produced by "Ethicon" company. The second group--performed modeling of preperitoneal plastic using two-component composite grid with large-pores Ultrapro produced by "Ethicon" company (n = 6). For the tensometric evaluation of the strength of implant integration into the red wall was used entire area of anterior red wall together with the implanted transplant. According to the deflection diagrams and dynamometer rates defined the maximum burden rates which is equivalent of muscular tissue budge against polymeric matrix. Statistically significant distinctions during 14 days were not detected; however strength during 30 days in the first group was 3 times higher than in the second group. We consider that the methodology of intraperitoneal on lay mesh can be considered as operation of choice of surgery treatment of the umbilical hernias.

[Laparoscopic gastric shunting as the surgery of choice in patients with morbid obesity and concomitant methabolic syndrome].

Experience of laparoscopic gastric shunting application in accordance to the Fobi - Capello procedure in 15 patients, suffering morbid obesity (MO), was adduced. The surgical intervention technique was adduced, first results were analyzed, which are witnessing the effective lowering of the excessive body mass while followup to 6 mo postoperatively.

[Surgical treatment of duodenal fistulae].

The experience of surgical treatment of 10 patients with external intestinal fistulae was analyzed. The plot of the operation was to exlude the duodenum from the digestion by performing the retrocolic gastroenteroanastomosis after Roux or on the ultrashort loop. Early operation prevent septic complications and electrolyte disbalance. Duodenal fistulae, developed on the background of pancreonecrosis or after endoscopic retrograde cholangiopancreaticography, necessitate the external choledochial drainage.

[Surgical treatment of the patients, suffering alimentary--constitutional obesity].

The results of surgical treatment of 105 patients, suffering alimentary-constitutional obesity, using intragastric balloon placement. operative procedures of regulated gastric banding, longitudinal gastric resection, gastric and biliopancreatic shunting, were analyzed. The changes dynamics in the carbohydrate and lipid metabolism indices was estimated. Algorithm of the obesity surgical treatment, depending on the body mass index and concomitant diseases presence, was elaborated.

[Treatment of biliary cysts of the liver].

75 patients with biliary liver cysts has been operated on since 1992. 49.3% (n=37) had solitary liver cysts, 50.7% (n=38)--multiple cysts. All patients were divided in 2 groups. Destruction of the functioning intraparenchymatous cyst wall was performed in patients, included in the first group (n=40; 53.3%); no destruction of the epithelial lining was performed in in the second group (n=35; 46.7%). 60 (80%) patients were laparotomized, 12 (16%) were operated on laparoscopically, ultrasound-guided puncter was performed in 3 (4%) patients. Postoperative complications were registered in 6 (8%) patients after laparotomy; 2 (2.7%) patients after laparoscopic treatment and 1 (1.3%) after US-guided manipulations. Recurrence was registered in 2 (3.2%) patients of the first group. There were no cyst recurrences among patients of the second group. Therefore, laparoscopic management of of biliary liver cysts is considered to be the method of choice. When latter is impossible, maximal cystic wall resection with destruction of the epithelial lining should be performed.

[Methods of Barrett disease diagnostics].

Chromoesophagoscopy and photodynamic diagnosis are objective methods for diagnostic Barrett disease. Those methods can give us more detailed information about morphological changes in mucosa of esophagus.

[Surgical tactics in the ulcer pyloroduodenal stenosis in decompensation stage].

In the ulcer pyloroduodenal stenosis the stages of complete and noncomplete decompensation are suggested. In 73% of observations, while performing an adequate preoperative preparation it was possible to convert pyloroduodenal stenosis from the stage of complete decompensation into the stage of noncomplete decompensation, in which the performance of organpreserving operation is possible. In the patients, suffering pyloroduodenal stenosis in the stage of noncomlete decompensation, resection of 2/3 of stomach is performed.

[One-stage combined operations on kidney and other organs]. / Odnomomentnye sochetannye operatsii na pochke i drugikh organakh.

Patients with combined diseases of the kidney, organs of abdominal cavity and retroperitoneal space require original decisions in the choice of surgical approach and sequence of interventions on different organs. The experience of one-stage combined nephrectomies and kidney resections in 36 patients with lung, stomach, intestine, liver and other organs' diseases are presented. 11 patients had primary renal carcinoma, the kidneys were affected by other malignant tumors in 15 patients. Primary benign processes in the kidneys were found in 3 patients and also in 7 patients these processes were the consequence of earlier performed operations. Interventions on 3-6 organs were necessary in 11 cases. It makes sense to begin one-stage combined transperitoneal interventions with "clean" stages--without section of gastrointestinal tract's lumen. 1 patient died because of peritonitis due to insufficiency of sutures of colon anastomosis. The follow-up ranged from 6 months to 12 years. The recurrences and metastases were found in 9 operated patients within 7 to 20 months, and there were no symptoms of diseases in 24 patients. It is concluded that extended radical one-stage operations on the organs of abdominal cavity and retroperitoneal space combined with operations on the kidney are endurable and effective if the surgical technique is thorough.

[Major resections of the liver in patients with high surgical risk]. / Obshirnye rezektsii pecheni u bol'nykh s vysokim khirurgicheskim riskom.

Experience with 75 major anatomic resections of the liver in patients with high surgical risk due to low functional reserve of the liver, spontaneous disruption of hepatic tumor, chronic purulent infection in patients with hepatic abscesses, posttraumatic sequestration of the liver with hemobilia, giant hepatic hemangiomas, old age and severe concomitant diseases was analyzed. General postoperative lethality was 14.7% which was determined mainly by unfavorable outcomes in postoperative patients in spontaneous disruption of tumor and massive intraabdominal bleeding, and also by severe postoperative hepatic insufficiency in patients after right-sided hemihepatectomy for hepatocellular carcinoma with postnecrotic cirrhosis of the liver. Immediate results of surgery in patients with obstructive jaundice and biliary hepatic cirrhosis were better that ones of patients with postnecrotic cirrhosis. There were no lethal outcomes in group of patients after surgery for giant hemangiomas, abscesses and posttraumatic sequestration of the liver. Thorough selection of patients based on detailed study of functional hepatic reserves and also volume of removed hepatic parenchyma is necessary for improvement of immediate results of surgical treatment. It is valid to perform portal venous embolization before right-sided hemihepatectomy in patients with postnecrotic, biliary cirrhosis, and also in old patients to decrease the risk of postresection hepatic insufficiency. Roentgenondovascular occlusion of the hepatic artery, Cell-Seiver use for intraoperative blood reinfusion and in some cases--use of methods of complete vascular isolation of the liver are indicated for patients with giant hepatic hemangiomas.

[Radio-frequency ablation appliance in resection of the liver]. / Ispol'zovanie apparata radiochastotnoi ablatsii pri rezektsii pecheni.

Pilot experience with "Radionics Cool-Tip RF System" appliance for radio-frequency ablation (RFA) in hepatic resection in the patients with focal lesions of the liver is presented. Advantages of RFA as an alternative method for hemostasis are demonstrated. With this technique bisegmentectomy (II - III) was performed in 4 patients, right-sided hemihepatectomy - in 2 patients. RFA permitted to minimize intraoperative blood loss without increase of surgery time. There were no severe complications during surgery and in early postoperative period. The method permits to perform combined surgeries without a significant increase of surgical risk.