scholarly journals Clinical and Anatomical Substantiation of Access to the Splenic and Left Renal Veins in the Operation of Distal Splenorenal Anastomosis

2021 ◽  
Vol 10 (2) ◽  
pp. 293-302
Author(s):  
A. Yu. Anisimov ◽  
A. I. Andreev ◽  
R. A. Ibragimov ◽  
A. A. Аnisimov ◽  
I. A. Kalimullin
Keyword(s):  
Portal Hypertension ◽  
Bypass Surgery ◽  
Abdominal Cavity ◽  
Original Method ◽  
Retroperitoneal Space ◽  
Minimal Risk ◽  
Renal Veins ◽  
Study Results ◽  
Clinical Conditions ◽  
Operative Activity

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. 

Sonographic Evaluation of a Unique Meso-Rex Shunt: A Case Study

2020 ◽  
Vol 36 (6) ◽  
pp. 567-571
Author(s):  
Danielle E. Cain ◽  
Sharlette Anderson
Keyword(s):  
Portal Hypertension ◽  
Portal Vein ◽  
Bypass Surgery ◽  
Main Portal Vein ◽  
Extrahepatic Portal Vein Obstruction ◽  
Venous Flow ◽  
Sonographic Evaluation ◽  
Portal Vein Obstruction ◽  
Rex Shunt

Portal hypertension is a result of an increase in intrahepatic resistance in the main portal vein. The Meso-Rex shunt is used to bypass the obstructed portal vein and restore the venous flow into the liver. This procedure alleviates the need for a hepatic transplant. The Meso-Rex shunt has proven to be an effective treatment for extrahepatic portal vein obstruction, thus saving children from a complete transplant. There are variants to this bypass surgery, and sonography is commonly used to assess the condition pre- and postoperatively. In this case, the shunt was uniquely different from the typical Meso-Rex bypass surgery. Particular vasculature made it imperative for the sonographer to review the prior sonograms and review the chart information before preforming the examination. It should also be noted that sonographers must adapt the protocols to give the utmost treatment.

The original method for bypass surgery of the tympanic cavity to treat chronic dysfunction of the Eustachian tube

2015 ◽  
Vol 80 (3) ◽  
pp. 40 ◽  
Author(s):  
A. I. Kryukov ◽  
N. L. Kunel'skaya ◽  
E. V. Garov ◽  
G. Yu. Tsarapkin ◽  
N. G. Sidorina ◽  
...  
Keyword(s):  
Eustachian Tube ◽  
Bypass Surgery ◽  
Original Method ◽  
Tympanic Cavity

scholarly journals HugeNon-Organ Retroperitoneal Tumor inCombination with aCystoma of Uterine Appendages

2019 ◽  
Vol 4 (2) ◽  
pp. 140-143
Author(s):  
N. I. Bogomolov ◽  
A. G. Goncharov ◽  
N. N. Tomskikh ◽  
Y. Y. Goncharova
Keyword(s):  
Intestinal Anastomosis ◽  
Abdominal Cavity ◽  
Lymph Node Biopsy ◽  
Tumor Formation ◽  
Retroperitoneal Space ◽  
Abdominal Tumor ◽  
Mesenteric Vessels ◽  
Median Laparotomy ◽  
Horizontal Portion ◽  
The Right

The article describes the experience of successful diagnostics and treatment of giant non-organ extraperitoneal tumor combined with a cystoma of uterine appendages.Patient P., 43 years old, was hospitalized in the oncology department, diagnosed with “Abdominal tumor, right ovary?” The state was satisfactory, after palpation of the abdomen, a lumpy formation of a densely elastic consistency, from the womb to the epigastric region, was found. An ultrasound revealed a homogeneous tumor formation 30×28 cm from the border of the uterus to the liver. When performing median laparotomy, a dumbbell-shaped tumor (36×26×20 cm) was found in the retroperitoneal space with involvement of the mesentery of the small intestine, lower horizontal portion of the duodenum, mesentery of the transverse colon, superior mesenteric vessels, aorta and jejunum. In the right appendages, a cystoma 12–15 cm in diameter was found, with inversion and necrosis. Adnexectomy was performed. An express lymph node biopsy revealed cells suspicious for malignancy. The tumor was mobilized and removed as a single unit with retroperitoneal tissue, lymph nodes in combination with resection of 70 cm of the jejunum and fenestrated resection of the duodenum. The resulting gut defect 9×7 cm was sutured with a precision single-row suture. Inter-intestinal anastomosis “endto-end” was formed. Nasointestinal intubation was performed. The abdominal cavity was sutured, and two tubular drainages were installed. The postoperative period was uneventful. The histological conclusion: fibrous histiocytoma of the mesentery of the intestine with malignancy in the center of the node, in the ovary – total hemorrhagic infiltration of all layers, edema. The tumor conference consultation was recommended. After 1.5 years, the patient was admitted with the same clinical picture. During laparotomy, a tumor recurrence was discovered, the nodes of which were located in the retroperitoneal space, in the abdominal cavity with invasion to organs and large vessels. The case was recognized as inoperable, the laparotomic wound was closed completely. Sixteen days after surgery the patient was discharged.

scholarly journals Use of occlusal digital splint for treating the patients with temporomandibular joint dysfunction and planning orthopedic treatment

2020 ◽  
Vol 9 (2) ◽  
Author(s):  
Mikhail A. Postnikov ◽  
Dmitry A. Trunin ◽  
Aleksandr M. Nesterov ◽  
Mukatdes I. Sadykov ◽  
Vladimir P. Potapov ◽  
...  
Keyword(s):  
Temporomandibular Joint ◽  
Analogue Scale ◽  
Original Method ◽  
Orthopedic Treatment ◽  
Temporomandibular Joint Dysfunction ◽  
Occlusal Contact ◽  
Study Results ◽  
Mandibular Position ◽  
Pre Treatment ◽  
Mandibular Movements

Objective of the study: to develop and assess the occlusal digital splint for treating patients with temporomandibular joint dysfunction (TMJD). Material and Methods — 17 patients between the ages of 30 and 49 diagnosed with TMJD were admitted for treatment. To normalize mandibular position, an occlusal digital splint for all patients was manufactured in accordance with our original method. An intensity of pain sensations in all patients prior to, and after, the treatment was assessed by a visual analogue scale, along with the changes in the mandibular movements’ amplitude, and the signs of splint wear and stability of occlusal contacts. Results — Patients have adapted themselves well to the splint and found it convenient in use. The study results showed that it was sufficiently effective in treatment of TMJD. Reduction in pain intensity and restoration of mandibular movements’ amplitude were detected with certainty. Only in 2 (11.7%) cases, the signs of wear on the splint were found, as evidenced by the changes in pre-treatment occlusal contacts. In all other cases throughout the study, a stable occlusal contact has been encountered. Conclusion — Our results indicated that proposed occlusal digital splint may be considered as a treatment option for the patients with TMJ disorders.

Revascularization surgery for symptomatic non-moyamoya intracranial arterial stenosis or occlusion

2020 ◽  
Vol 132 (2) ◽  
pp. 415-420 ◽  
Author(s):  
Manuri Gunawardena ◽  
Jeffrey M. Rogers ◽  
Marcus A. Stoodley ◽  
Michael K. Morgan
Keyword(s):  
Neurological Deficit ◽  
Bypass Surgery ◽  
Arterial Occlusion ◽  
Arterial Stenosis ◽  
Minimal Risk ◽  
Complication Rates ◽  
Intracranial Arterial Stenosis ◽  
Anterior Circulation ◽  
Poor Outcome ◽  
Revascularization Surgery

OBJECTIVEPrevious trials rejected a role of extracranial-to-intracranial bypass surgery for managing symptomatic atheromatous disease. However, hemodynamic insufficiency may still be a rationale for surgery, provided the bypass can be performed with low morbidity and patency is robust.METHODSConsecutive patients undergoing bypass surgery for symptomatic non-moyamoya intracranial arterial stenosis or occlusion were retrospectively identified. The clinical course and surgical outcomes of the cohort were evaluated at 6 weeks, 6 months, and annually thereafter.RESULTSFrom 1992 to 2017, 112 patients underwent 127 bypasses. The angiographic abnormality was arterial occlusion in 80% and stenosis in 20%. Procedures were performed to prevent future stroke (76%) and stroke reversal (24%), with revascularization using an arterial pedicle graft in 80% and venous interposition graft (VIG) in 20%. A poor outcome (bypass occlusion, new stroke, new neurological deficit, or worsening neurological deficit) occurred in 8.9% of patients, with arterial pedicle grafts (odds ratio [OR] 0.15), bypass for prophylaxis against future stroke (OR 0.11), or anterior circulation bypass (OR 0.17) identified as protective factors. Over the first 8 years following surgery the 66 cases exhibiting all three of these characteristics had minimal risk of a poor outcome (95% confidence interval 0%–6.6%).CONCLUSIONSProphylactic arterial pedicle bypass surgery for anterior circulation ischemia is associated with high graft patency and low stroke and surgical complication rates. Higher risks are associated with acute procedures, typically for posterior circulation pathology and requiring VIGs. A carefully selected subgroup of individuals with hemodynamic insufficiency and ischemic symptoms is likely to benefit from cerebral revascularization surgery.

First experience of autovenous femoropoplietal bypass surgery in situ using original method of ligation of venous tributaries

2021 ◽  
Vol 14 (5) ◽  
pp. 386
Author(s):  
N.V. Krepkogorskiy ◽  
I.M. Ignatev ◽  
R.A. Bredikhin ◽  
R.K. Dzhorzdzhikiya ◽  
I.N. Illarionova
Keyword(s):  
Bypass Surgery ◽  
Original Method

scholarly journals Prediction of stable clinical conditions after elective coronary bypass surgery

2007 ◽  
Vol 22 (4) ◽  
pp. 346
Author(s):  
Kristien Van Loon ◽  
Fabian Guiza ◽  
Geert Meyfroidt ◽  
Jean-Marie Aerts ◽  
Hendrik Blockeel ◽  
...  
Keyword(s):  
Bypass Surgery ◽  
Coronary Bypass ◽  
Coronary Bypass Surgery ◽  
Clinical Conditions

scholarly journals Prevention of Reflux Disease After Operations On Gastric And Intestinal Tract

2020 ◽  
Vol 2 (01) ◽  
pp. 01-09
Author(s):  
Martynov V.L.
Keyword(s):  
Reflux Disease ◽  
Abdominal Cavity ◽  
Clinical Results ◽  
Intestinal Wall ◽  
Retroperitoneal Space ◽  
Intestinal Lumen ◽  
Greater Omentum ◽  
Intestinal Fistula ◽  
Internal Drainage ◽  
Postoperative Reflux

Creating anastomoses between the hollow organs of the abdominal cavity, abdominal formations of the retroperitoneal space and the jejunum always raises the question of preventing reflux from the jejunum into the drained cavity of the esophagus, stomach, gallbladder, external hepatic ducts, cysts of the liver and pancreas. After surgery, any reflux becomes pathological. Reflux is an obligate precancer. Thus, the reflux of bile and pancreatic juices in the stomach, the stump of the stomach and esophagus contributes to the occurrence of reflux esophagitis, reflux gastritis, ulcers and gastric cancer or its stump. After internal drainage of the cavity formation in the jejunum, postoperative reflux disease develops, which is caused by the actions of the surgeon who tried to help the patient sincerely. This allowed such states to be defined as “iatrogenic postoperative reflux disease”. The purpose of this work was to develop and introduce into practice the “plug” on the resulting loop of the jejunum, which does not migrate into the lumen of the intestine, with internal drainage of the hollow organs of the abdominal cavity and abdominal formations of the retroperitoneal space and evaluate the clinical results. As a result, the authors have developed a method for creating a “plug” on the jejunum loop, which is used for drainage, studies are being conducted on its safety, adequacy of functioning, general accessibility, and clinical situations are analyzed. For drainage of the abdominal formation impose a fistula between it and the jejunum loop 40–50 cm from the ligament of Treitz. We form an inter-intestinal fistula according to Brown, above which the length leading to a drained formation of the area of ​​the jejunum is about 10 cm, in the middle of which we impose a “plug”. The length of the small intestine section which diverts from the drained formation to the inter-intestinal brown anastomosis is about 30 cm. To form a “plug”, we use the free area of ​​the greater omentum, through which we perform a ligature of non-absorbable polypropylene material by vcol-vykola. The developed method of forming a "plug" does not cause abrupt ischemic changes in the area of ​​operation, followed by necrosis of the intestinal wall and migration of the "plug" into the intestinal lumen, and its effectiveness has been proven using clinical observations, microcirculation studies, water test results and X-ray examination. The method of creating a "stub" is promising for the internal drainage of abdominal cavity formations and retroperitoneal space, for the formation of areflux nutrient eunostoma.

scholarly journals Surgical Treatment for Septic Complications in Patients with Duodenal Perforation Following Endoscopic Retrograde Transpapillary Interventions

2019 ◽  
Vol 14 (2) ◽  
pp. 13-20
Author(s):  
V. L. Korobka ◽  
S. V. Tolstopyatov ◽  
A. M. Shapovalov
Keyword(s):  
Surgical Treatment ◽  
Abdominal Cavity ◽  
Abdominal Sepsis ◽  
Original Method ◽  
Duodenal Perforation ◽  
Symptomatic Therapy ◽  
Primary Reconstruction ◽  
Two Stage ◽  
Septic Complications ◽  
Primary Surgery

Background The most severe clinical cases following transpapillary endoscopic interventions are duodenal perforation with damage to the common bile duct and pancreatic duct, entrance into the abdominal cavity and retroperitoneum the aggressive contents of intestine and the infections. They usually lead to higher mortality. Aim Evaluation of the optimal management for duodenal perforation in patients who have undergone transpapillary endoscopic interventions. Material and Methods A retrospective analysis of surgical treatment in thirty-two patients with duodenal perforation after transpapillary endoscopic interventions from the year 2007 to 2018 in one center was carried out. Nineteen cases (59.4%) were diagnosed less than 24 hours, 13 (40.6%) – more than 24 hours after injury. Twenty patients had the primary reconstruction of duodenum with various drainage options of injury area. In 19 cases there were a two-stage surgical procedure according the original method: 12 had a primary surgery, 7 were reoperated. Results After primary reconstruction of duodenum 11 patients (55.0%) had complications, seven (63.6%) – were re-operated, in four we have applied efferent treatments and symptomatic therapy. Three patients (15.8%) died. After two-stage surgery procedure 7 patients (36.8%) had surgical complications, five (26.3%) – were re-operated. Three patients (15.8%) – were died. Conclusion Primary duodenum reconstruction can be performed if the injury occurred less than 24 hours before surgery. Two-staged surgery is justified in cases with purulent inflammation in abdominum and reproperitoneal cavity because procedure allows reducing mortality from abdominal sepsis

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