Saratov JOURNAL of Medical and Scientific Research

Artemiev A.I.

Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Surgery and Transplantation Center, Head of Department of Surgery, Candidate of Medical Sciences

Effect of different pancreatic stump closure techniques during distal pancreatectomy to the frequency and severity of acute postoperative pancreatitis

Year: 2018, volume 14 Issue: №2 Pages: 260-265
Heading: Surgery Article type: Original article
Authors: Voskanyan S.E., Naydenov E.V., Uteshev l.Yu., Artemiev A.l.
Organization: State Scientific Research Center n.a. A.I. Burnasyan — Federal Medical Biophysical Center of Federal Medical Biological Agency
Summary:

The Aim: to study the effect of different pancreatic stump closure techniques, including depending on the diameter of the main pancreatic duct to frequency and severity of acute postoperative pancreatitis after distal pancreatectomy. Material and Methods. Distal pancreatectomies were performed in 126 patients with neoplasms of the body and/or tail of the pancreas. Patients were divided into 4 groups depending on the pancreatic stump closure techniques. Group 1 (control): isolated suturing of the main pancreatic duct of the pancreatic stump with its sealing by gastrocolic omentum or hemostatic sponge; group 2: isolated suturing of the main pancreatic duct of the pancreatic stump with its sealing by biological glue 2-octylcyanoacrylate; group 3: pancreatic stump closure were performed by Endoscopic Linear Cutter; group 4: after distal pancreatectomy were performed external transduodenal transnasal drainage of the enlarged main pancreatic duct of pancreatic stump. Results. The frequency of acute postoperative pancreatitis in the control group of patients was 45.8%, in the group 2 of patients — 44.4%, in the group 3 of patients — 9.7%, in the group 4 of patients — 15.0%. The use of the proposed pancreatic stump closure techniques after distal pancreatectomy resulted in a decrease of the frequency of moderate form of acute postoperative pancreatitis. The use of Endoscopic Linear Cutter and external transduodenal transnasal drainage of the enlarged main pancreatic duct resulted in decrease of frequency of acute postoperative pancreatitis in patients with a diameter of the main pancreatic duct of the pancreatic stump up to 5 mm. Conclusion. The use of the proposed pancreatic stump closure techniques after distal pancreatectomy resulted in the decrease of frequency and severity of acute postoperative pancreatitis.

AttachmentSize
2018_2_260-2651.pdf652.22 KB

Results of application of the PTFE-conduits in the reconstruction of the main veins of the abdominal cavity mesenteric-portal system in locally advanced pancreatic cancer

Year: 2015, volume 11 Issue: №4 Pages: 668-672
Heading: Surgery Article type: Original article
Authors: Voskanyan S.E., Artemiev A.l., Naydenov E.M., Shabalin M.V., Zabezhinsky D.A., Kolyshev l.Yu.
Organization: State Scientific Research Center n.a. A.I. Burnasyan — Federal Medical Biophysical Center of Federal Medical Biological Agency
Summary:

Aim: study of immediate and long-term results of the surgical treatment of the locally advanced pancreatic cancer with tumor invasion of the main veins of the abdominal cavity. Material and methods. Pancreaticoduodenectomy with resection and plasty of the main veins of the abdominal cavity were performed 315 patients. 143 patients underwent for prosthetics of the main veins at their reconstruction of different vascular prosthesis. Patients have been divided into three groups. Group I (basic) — PTFE-conduits have been used in the reconstruction of the main veins (82 patients). Group II — FLL-conduits have been used in the reconstruction of the main veins (36 patients). Group III — autovenous
conduits have been used in the reconstruction of the main veins (25 patients). Comparison of the duration of operation and its reconstruction stage, the quantity of blood loss, frequency of venous thrombosis in the early postoperative period and long-term patency of the reconstructed veins traced ultrasonic method in a period of 6 months, 1, 2, and 3 years after surgery have been carried. The morbidity, the frequency of the infectious complications, the hospital mortality, the mean postoperative hospital stay, median of survival have been studied after surgery. Results. Application of the PTFE-conduits resulted for decrease of the duration of the reconstruction stage of the operation, as well as the duration of the surgery and the amount of intraoperative blood loss. Decrease of the morbidity, of the postoperative hospital stay and the mortality have been noted in the I group of patients compared to groups II and III patients. Thrombosis of the prosthesis after reconstruction of the veins that led for fatal outcome has been marked in 2 patients (5.5%) in group II of the patients. The long-term patency of vascular PTFE-conduits and reconstructed veins in group 1 has been 100% in all period's observations in the postoperative period. Conclusion. PTFE-conduits are universal plastic material. Application of the PTFE-conduits for the reconstruction of the main veins of the mesenteric-portal system can reduce the duration of the reconstruction vascular stage and the operation as a whole. Applications of the PTFE-conduits reduce the morbidity, the frequency of infectious complications, postoperative hospital-stay, hospital mortality, as well as improved performance patency of the reconstructed vessels.

AttachmentSize
2015_04-01_668-672.pdf518.3 KB

. Effect of the venous outflow ways from pancreatic transplant on carbohydrate metabolism after autotransplantation of pancreas in the experiment

Year: 2013, volume 9 Issue: №4 Pages: 951-954
Heading: Surgery Article type: Original article
Authors: Voskanyan S.E.., Degtyarev V.S., Korsakov I.N., Naydenov E.V., Artemiev A.I.
Organization: State Scientific Research Center n.a. A.I. Burnasyan — Federal Medical Biophysical Center of Federal Medical Biological Agency
Summary:

The aims: to compare the state of carbohydrate metabolism in animals after pancreatectomy with autotransplantation of the pancreatic segment and with organization of the venous outflow in the inferior vena or portal vein. Material and methods. Proximal resection of the pancreas (group 1), pancreatectomy with autologous transplantation of the pancreas and with reconstruction of the venous outflow from the transplant into the inferior vena cava (group 2) and pancreatectomy with autologous transplantation of the pancreas and with reconstruction of the venous outflow from the transplant into the portal vein (group 3) were performed in 45 animals in the experiment. Examining the status of carbohydrate metabolism was performed by intravenous test for glucose tolerance. Results. Primary higher increase in glucose concentrations as compared to the values obtained at the intact animals and its slower decrease have been observed in animals after pancreatectomy with autotransplantation of the segment of the pancreas on iliac vessels (group 2), as well as on the mesenteric vessels (group 3). Higher blood glucose compared to animals subjected proximal pancreatectomy after 40 minutes after administration of glucose was detected in animals undergoing autotransplantation of the pancreas on iliac vessels (group 2) and in animals after autotransplantation of the pancreas on mesenteric vessels (group 3)— 11.82 (11,39-12,26) mmol/l and 10.65 (10,03-11,32) mmol/l, respectively. The glucose concentration in the blood plasma was lower in the animals of groups 2 and 3 below in comparison with the animals in group 1 to 120 minutes of the experiment. Significant differences in plasma glucose concentration between animals of groups 2 and 3 were not found. Conclusion. Significant effects of the ways of organization of the venous outflow from pancreatic transplant on the concentration of the glucose in the blood plasma by the carbohydrate load after pancreatectomy with autotransplantation of the pancreas were not found.

AttachmentSize
2013_04-01_951-954.pdf570.35 KB