Laparoscopic removal of concrement in Bouveret syndrome

Laparoscopic removal of concrement in Bouveret syndrom

Simulated model of obesity and immediate metabolic disorders after gastric shunting with anastomosis in small laboratory animals

Objective. To study metabolic changes and peculiarities of mineral balance depending on the common loop length while constructing of the simulated model of gastric shunting with one anastomosis during 60 days. Materials and methods. Experimental simulation of gastric minishunting with one anastomosis of various length of bilio-pancreatic loop was constructed on the rats. In 10 rats the anastomosis was formatted on level of half of total length of small intestine (Group I), and also in 10 - a third part of general length of small intestine (Group II). Control Group consisted of 5 rats. The indices of the extra body mass loss and metabolic changes were compared. Results. In the rats of Group I the index of the body mass loss have constituted 16.6% (41.7 gm), and of the Group II -20.6% (53.2 gm). Lowering of indices of mineral and prion metabolism, comparing preoperative values, was observed in both Groups. Dystrophic changes in osseous tissue of vertebral bodies of lumbar vertebral column were noted in animals of both Groups, more pronounced - in Group II. Conclusion. The protein and mineral metabolism disorders may be observed not only in large resection volume, but in exclusion of half and more segment of small bowel from general transit, using gastric shunting, what lacks significant advantages in the extra body mass loss, but leads to more profound metabolic disorders

Miniinvasive method of treatment of the duodenal sutures insufficiency

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