METHOD OF LAPAROSCOPIC OMENTOPERITONEOPEXY AS A MEANS FOR PROLONGING EFFECTIVE FILTRATION IN PERITONEAL DIALYSIS

Kebkalo A. B., Reiti A. O., Hrianyla V. V

METHODS AND METHODOLOGIES

Scentific article

Although the peritoneum has a significant reparative potential, it should be remembered that the effect of dialysate in case of peritoneal detoxification on the average within 5-6 years leads to irreversible process, namely, total peritoneal sclerosis. Therefore, limiting the part of peritoneum from aggressive effects of dialysis solution for its further use is an important task of the present-day nephrology. The authors of research have developed hermetic limiting models of the upper and lower floors by means of omentoperitoneopexy, as well as strong and hermetic connection applying proper tissues. Omentoperitoneopexy has been technically performed by two methods: ligation or bioelectric welding of tissues. The operation part of the research has been carried out under aseptic operating conditions with inhalation ETH. The control group included 21 patients with classical method application for placement of peritoneal drainage for dialysis. The comparison group consisted of 8 patients with laparoscopic sac formation of the peritoneal upper floor which was planned to be involved in the dialysis process after the possibilities of the lower floor have been exhausted. Sac formation was carried out in 4 patients by fixing a greater omentum to the parietal peritoneum; omentoperitoneopexy with bioelectric welding was performed in 4 other patients. Modified peritoneal double-probe drainage was introduced in patients with peritoneopexy. One canal was used for dialysis itself; another was placed in the upper floor to control hermeticity (if dialysate appears along the upper drainage – hermeticity does not occur). The level of urea, creatinine and potassium was compared directly before and after dialysis. The average weekly dynamics of changes in indicators as well as the average monthly indicators have been also determined in the study. The effectiveness of hermeticity in omentoperitoneopexy was compared and evaluation of early and late postoperative results was carried out. Wound suppuration in the postoperative period was observed in 1 patient of the control group which was eliminated with antibiotic therapy and did not require drainage removal. The episodes of suppuration were not observed in the comparison group, but drainage migration was determined in 2 cases in patients of this group with ligation. In 1 case, the drainage with a gas cylinder migrated to the lower floor; in one more case, the dialysis drainage migrated to the area above omentoperitoneopexy. It should be noted that in both cases the loss of hermeticity of the abdominal cavity floors was determined. Drainage migration in the first case (shifting above the line of omentoperitoneopexy) made it impossible to continue detoxification stage, because it was not possible to evacuate dialisate completely. It was caused by formation of small sac around the drainage. When the drainage was applied again, the areas of damaged peritoneum forming the sac around the drainage were observed. The histological examination of material has determined the absence of surface epithelium, thickened basement membrane and abundant fibrous deposits in the form of lymphocytes, fibrocytes, fibrous and elastic fibers. The model of hermetic limiting the upper and lower floors of the abdominal cavity by means of bio-welding was proposed in the study. Delimited peritoneum floor which was actively used for dialysis provided sufficient and adequate level of detoxification and was not statistically different from the control group. Early postoperative histological data did not determine the difference in the comparison groups; however, the issue on «peritoneum ageing» rate in group with a smaller dialysis area requires the further study.

omentoperitoneopexy, peritoneal dialysis, peritoneum, peritoneal sclerosis.

1. Savitskiy IV, Chipovyaz SV, Belash OV, Vastyanov RS, Znamerovskiy SG, Lenik RG, i dr. Issledovanie gematologicheskih pokazateley pri eksperimentalnom peritonite. Klinicheskaya hirurgiya. 2018;85(6):63-6. [in Russiаn].
2. Garosi G. Different aspects of peritoneal sclerosis. In: RoncoC. (eds). Contributions to nephrology 2003; 140. Peritoneal dialysistoday: 18-29. Karger.
3. Vakalopoulos KA. Sutureless closure of colonic defects with tissue adhesives: an in-vivo study in the rat. Am J Surg. 2016;213(1):151-8. DOI: 10.1016/j.amjsurg.2016.05.009
4. Wu Z, Boersema GS, Vakalopoulos KA. Critical analysis of cyanoacrylate in intestinal and colorectal anastomosis. J Biomed Mater Res B Appl Biomater. 2014;102(3):635-42. DOI: 10.1002/jbm.b.33039
5. Alonso JM, Alves AL, Watanabe MJ, Rodrigues CA, Hussni CA. Peritoneal response to abdominal surgery: the role of equine abdominal adhesions and current prophylactic strategies. Vet Med Int. 2014;2014:279730. DOI: 10.1155/2014/279730
6. Saed GM, Fletcher NM, Diamond MP. The Creation of a Model for Ex Vivo Development of Postoperative Adhesions. Reprod. Sci. 2016 May;23(5):610-2. DOI: 10.1177/1933719115607997
7.  Kraemer B, Scharpf M, Planck C. Randomized experimental study to investigate the peritoneal adhesion formation of conventional monopolar contact coagulation versus noncontact argon plasma coagulation in a rat model. Fertil Steril. 2014;102(4):1197-202. DOI: https://doi. org/10.1016/j.fertnstert.2014.07.007
8.  Poroyskiy SV, Poroyskaya AV, Bulyicheva OS. Morfometricheskaya harakteristika parietalnoy i vistseralnoy bryushinyi v dinamike posle naneseniya operatsionnoy travmyi razlichnogo ob’ema. Vestnik VolgGMU. 2014;51(3):102-7. Dostupno: https://cyberleninka.ru/article/n/ morfometricheskaya-harakteristika-parietalnoy-i-vistseralnoy-bryushiny-v-dinamike-posle-naneseniya-operatsionnoy-travmy-razlichnogo [in Russiаn].
9. Kosovskih AA, Kan SA, Churlyaev YuA. Korrektsiya narusheniy mikrotsirkulyatsii pri rasprostranennom gnoynom peritonite. Hirurgiya. Zh-l im. N.I. Pirogova. 2013;6:41-4. Dostupno: http: //www.fesmu.ru/elib/Article.aspx?id=261788 [in Russiаn].
10.  Tabibian N, Swehli E, Boyd A. Abdominal adhesions: a practical review of an often overlooked entity. Annals of Medicine and Surgery. 2017;15:9-13. DOI: 10.1016/j.amsu.2017.01.021
11.  Ruben RM Vogels, Joanna WAM Bosmans, Kevin WY van Barneveld, Vincent Verdoold, Selwyn van Rijn, Marion JJ Gijbels, et al. A new poly (1,3-trimethylene carbonate) membrane provides effective adhesion reduction after major abdominal surgery in a rat model. Surgery. 2015;6(157):1113-20. DOI: https://doi.org/10.1016/j.surg.2015.02.004
12. Bosmans JW, Moossdorff M, Al-Taher M, van Beek L, Derikx JP, Bouvy ND. International consensus statement regarding the use of animal models for research on anastomoses in the lower gastrointestinal tract. Int J Color Dis. 2016;31(5):1021-30. DOI: 10.1007/s00384-016-2550-5
13.  Pawar AY, Biswas SK. Postoperative spine infections. Asian Spine J. 2016;10(1):176-83. DOI: 10.4184/asj.2016.10.1.176
14. Lipatov VA. Kontseptsiya profilaktiki posleoperatsionnogo spaechnogo protsessa bryushnoy polosti s primeneniem barernyih sredstv [avtoreferat]. Kursk; 2013. 35 s. Dostupno: http://medical-diss.com/medicina/kontseptsiya-profilaktiki-posleoperatsionnogo-spaechnogoprotsessa-bryushnoy-polosti-s-primeneniem-bariernyh-sredstv-eksp [in Russiаn].
15. Boyko VV, Evtushenko DA. Sposob profilaktiki spaykoobrazovaniya u ranee operirovannyih bolnyih na organah bryushnoy polosti. «Innovatsii v nauke»: sbornik statey po materialam XХV mezhdunarodnoy nauchno-prakticheskoy konferentsii. 2013. s. 22-7. Dostupno: https://elibrary. ru/item.asp?id=20316012 [in Russiаn].
16.  Kondratovich LM. Osnovyi ponimaniya formirovaniya spaechnogo protsessa v bryushnoy polosti, intraoperatsionnaya profilaktika protivospaechnyimi barernyimi preparatami (obzor literaturyi). Vestnik novyih meditsinskih tehnologiy. 2014;21(3):169-73. Dostupno: https:// cyberleninka.ru/article/n/osnovy-ponimaniya-formirovaniya-spaechnogo-protsessa-v-bryushnoy-polosti-intraoperatsionnaya-profilaktikaprotivospaechnymi [in Russiаn].
17.  Zhura AV, Tretyak SI, Hryischanovich VYa, Makarevich ZhA. Eksperimentalnaya model peritonealnyih spaek. Eksperimentalnaya hirurgiya. 2017;25(4):333-9. DOI: 10.1484/2305-0047.2017.4.333 [in Russiаn].
18. Nasretdinov IG, Ishkinin RE, Garipov II. Protivospaechnyie sposobyi obrabotki bryushnoy polosti. Novaya nauka: problemyi i perspektivyi. 2016;4-2:30‑3. Dostupno: https://elibrary.ru/item.asp?id=25779768 [in Russiаn].
19. Tihonov VI, Plotnikov MB, Logvinov SV, Grischenko MYu, Shkatov DA. Vliyanie antioksidantnogo kompleksa na protsessyi spaykoobrazovaniya v eksperimente. Voprosyi rekonstruktivnoy i plasticheskoy hirurgii. 2014;48(1):31-40. Dostupno: http://journals.tsu.ru/plastic_surgery/&journal_page=archive&id=1150&article_id=21524&page=&sort=otherInfo&sort_napr=asc [in Russiаn].
20. Viglino G, Neri L, Feola M. Peritoneal ultrafiltration in congestive heart failure-findings reported from its application in clinical practice: a systematic review. J Nephrol. 2015 Feb;28(1):29-38. DOI: 10.1007/s40620-014-0166-9

«Bulletin of problems biology and medicine» Issue 1 Part 2 (149), 2019 year, 250-254 pages, index UDK 616-036.12

10.29254/2077-4214-2019-1-2-149-250-254