Morphological Substantiation for the Effectiveness of the Proposed Method of Gastrostomy using a Polypropylene Endoprosthesis

International Journal of Biomedicine 10(1) (2020) 45-49 http://dx.doi.org/10.21103/Article10(1)_OA6 ORIGINAL ARTICLE INTERNATIONAL JOURNAL OF BIOMEDICINE Experimental Surgery Morphological Substantiation for the Effectiveness of the Proposed Method of Gastrostomy using a Polypropylene Endoprosthesis Sergey N. Shurygin, PhD, ScD1; Alexey G. Vaganov2; Archil S. Tsulaya1; Sarkis A. Asratyan, PhD1; Ilya V. Sazhin, PhD1; Aleksandr N. Alimov, PhD, ScD3; Leonid V. Safonov, PhD4*; Dmitriy A. Volkov1 State Budgetary Institution of Healthcare «Clinical Hospital V.M. Buyanova» State Budgetary Institution of Healthcare of the City of Moscow «City Clinical Hospital No. 29» 3 Pirogov Russian National Research Medical University 4 Federal Scientific Center for Physical Culture & Sports Moscow, the Russian Federation 1 2 Abstract The article discusses the morphological changes in the area of gastrostomy performed by the proposed original method of gastrostomy using an implant in laboratory animals (rabbits). Morphological changes in the tissues at gastrostomy sites were studied on Days 10 and 20 after the proposed method of gastrostomy, in comparison with the classical Witzel gastrostomy and Depage-Janeway gastrostomy using the GIA stapler. Negative morphological changes in the tissues around gastrostomy sites were revealed in the form of necrosis of the microenvironment and disturbance in microcirculation according to the stagnant type, caused by the damaging effect of the surgical suture material at the microscopic level, the least pronounced when using a polypropylene implant. (International Journal of Biomedicine. 2020;10(1):45-49.) Key Words: gastrostomy • original method • polypropylene mesh • histology Introduction Currently, there are about 100 different modifications of gastrostomy. However, the expansion of indications for gastrostomy increases the frequency of its use, which leads to the need for an improvement in technique.(1) Thus, the development of new gastrostomy methods is still relevant, on the one hand contributing to improving the quality of life of patients, and on the other, reducing the risk of complications. Despite the fact that the complication rate for surgical gastrostomy is from 2% to 8%, and the complication rate for endoscopic gastrostomy is only 1% to 3%, surgical gastrostomy continues to be used, since the absolute contraindications for performing endoscopic gastrostomy are decompensated stenosis of the stomach, complete obstruction of the pharynx *Corresponding author: Leonid V. Safonov, PhD. Federal Scientific Center for Physical Culture & Sports; Moscow, Russia.. E-mail: and esophagus, obesity grade 3, severe coagulopathy, and other morbidities.(2) At the same time, the expansion of indications for gastrostomy requires the development of new methods for its implementation and assessment of the effectiveness of interventions. The purpose of the work was to characterize the morphological changes in the tissues around gastrostomy sites in the original method of operation using a polypropylene mesh, in comparison with the classical Witzel gastrostomy and Depage-Janeway gastrostomy using the GIA stapler. The experiment was performed on rabbits. Materials and Methods For the experiment, we selected 18 sexually mature male rabbits (3 months old) of the Chinchilla breed, weighing 2500–3400g. The animals were divided by the method of pair analogues into 3 groups (6 animals each).(3) Group 1 included rabbits that underwent the Witzel’s gastrostomy; 46 S. N. Shurygin et al. / International Journal of Biomedicine 10(1) (2020) 45-49 Group 2 included rabbits that underwent the Depage-Janeway gastrostomy using the GIA apparatus; Group 3 included rabbits that underwent the original method of gastrostomy using a polypropylene endoprosthesis (Patent RU No. 2691924 dated 06/18/2019 Bulletin No. 17).(4) For the original method of gastrostomy, we used the synthetic polymer Esfil - Standard of the Lintex company. Esfil is a classic mesh endoprosthesis made from monofilament polypropylene for soft tissue repair, mainly used in herniology. This endoprosthesis combines high rates of biological inertness, resistance to infection and mechanical strength. One of the main disadvantages of the polypropylene implant, which excludes its use in the intraperitoneal plastic of hernias of the anterior abdominal wall, is the development of a massive adhesive process, due to the expressed adhesive properties of the implant, with the possible formation of intestinal fistulas.(3) In our model, this “negative” property of polypropylene material becomes a key advantage, providing a tight attachment of the stomach with a gastrostomy to the anterior abdominal wall (AAW). The rabbit was chosen for the experiment because it is a standard laboratory animal in the development of new surgical methods.(5) In addition, the rabbit is phylogenetically closer to primates than rodents(6) and is a large enough laboratory animal to monitor physiological changes without euthanasia. The animals were kept in a vivarium in isolated cages with a 12-hour light cycle at a temperature of 18-21ºC. The method of gastrostomy using a polypropylene mesh was implemented as follows: A median laparotomy was performed; the stomach wall was pulled up to AAW and was taken on two Babcock clamps. A GIA type stapler was placed perpendicular to the greater curvature of the stomach, and a gastric tube (GT) was formed from the stomach wall. From a polypropylene mesh, 2 polypropylene mesh implants were modeled. The first was formed as an oval plate with a central hole. The second implant was formed as a single-layer mesh clutch covering GT. GT was passed through the hole of the first implant, then a second implant was put on it in the form of a clutch. The first implant was fixed to the gastric wall and the second implant to GT, then the two implants were sutured together. Through a hole of 1.5–2 cm in size, GT was pulled out onto AAW to the left of the midline incision in the projection of the left rectus abdominis muscle. GT was fixed with sutures to the parietal peritoneum and the muscular aponeurotic layer. The GT end was dissected, 3 fixing sutures were placed, stitching the AAW through, as well as the wall of the stomach together with the first implant attached to it in three places with polypropylene 1/0 thread, ensuring gastropexy. The threads were tied with a knot on the skin, hemostasis was carried out, and then layer-by-layer the laparotomy wound was sutured. Further, in the postoperative period, after 3 weeks, as the implants germinated with connective tissue, which provided an increasingly tight attachment of the stomach wall to AAW, the gastric-fixing sutures were gradually removed. The animals were withdrawn from the study on Days 10 and 20 after surgery. Tissue fragments were taken from the gastrostomy zone and fixed for at least 2 hours in a 10% solution of neutral formalin. Further sample processin (...truncated)