BIOLOGICAL TISSUES HIGH-FREQUENCY ELECTRIC WELDING IN BILIODIGESTIVE ANASTOMOSES FORMATION IN THE EXPERIMENTAL AND CLINICAL CONDITIONS
Keywords:high-frequency electric welding, hepaticojejunic anastomose, bile ducts, hepatopancreatoduodenal area, strictures, bile peritonitis, tumors, chronic pancreatitis, pancreatoduodenal resection
The aim of the study - to improve the treatment results of patients with main bile duct disturbances, using the modern method of tissues high-frequency electric welding (HFEW) for the hepaticojejunic anastomoses formation.
Material and methods. The formation of 15 models of termino-lateral hepaticojejunic anastomoses were performed experimentally. The modelings were done using “bioimitators” in the form of both hepaticocholedochus and small intestine fragments, removed during pancreatoduodenal resections. The HFEW method was used in 14 patients with the main biliary outflow disturbances for hepaticojejunic anastomoses formation: 6 patients were operated as the result of a periampular zone malignant tumor complicated by mechanical jaundice, 2 patients with chronic pancreatitis presented tubular stenosis of the distal part of the common bile duct, 6 patients presented scars and bile ducts iatrogenic lesions. The control group consisted of 60 patients in whom hepaticojejunic anastomoses was formed traditionally.
Results. Hepaticojejunic anastomoses formed by biological tissues radio-frequency (RF)-welding method were passable, completely sealed and had sufficient strength (706.9±70.0 H2O mm). The primary narrowing of anastomoses lumen, formed by the HFEW method, was smaller (13.6±2.1%), compared to the same in the anastomoses formed by the suture method (49.1±3.4%). It was proved histologically that a coagulation suture was formed during electrowelding, and tissue joining was due to changes in the protein conformation of the intercellular substance and the destructed cells. The
comparative analysis of clinical and laboratory data in patients of both main and control groups, provided during the postoperative period, revealed better results in the main group patients compared to the control group – the duration of anastomoses formation in case of RF-welding was averagely by 19 minutes (43.2%) shorter comparing to the duration in case of ligature use; the total bilirubin level throughout the postoperative period decreased quicker in the main group (40.4±6.2 μmol/l) comparing to the decrease in the control group (55.0±8.0 μmol/l); one could register both AlAT and AsAT levels quicker. Ultrasound investigation and Magnetic Resonance Cholangiopancreatography, performed at different times of the postoperative period, also proved HFEW anastomoses good patency and tightness.
Conclusions. HFEW method for soft biological tissues in clinical practice allows to create reliable biodigestive anastomoses, especially in conditions of inflammation. One could see decrease in early postoperative complications frequency and both bilirubin and transaminases levels faster normalization while using HFEW methods, which indicates liver function rapid recovery.