Experimental Substantiation for the Effectiveness of Gastrostomy using a Polypropylene Endoprosthesis Based on a Comparative Morphological Assessment of the State of the Hollow Organs of the Gastrointestinal Tract

International Journal of Biomedicine 10(3) (2020) 251-256 http://dx.doi.org/10.21103/Article10(3)_OA10 ORIGINAL ARTICLE INTERNATIONAL JOURNAL OF BIOMEDICINE Experimental Surgery Experimental Substantiation for the Effectiveness of Gastrostomy using a Polypropylene Endoprosthesis Based on a Comparative Morphological Assessment of the State of the Hollow Organs of the Gastrointestinal Tract Sergey N. Shurygin, PhD, ScD1; Alexey G. Vaganov2; Archil S. Tsulaya1; Dmitriy A. Volkov1; Ilya V. Sazhin, PhD1; Aleksandr N. Alimov, PhD, ScD3; Leonid V. Safonov, PhD4*; Sarkis A. Asratyan, PhD1 Budgetary Institution of Health «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 & Sport Moscow, the Russian Federation 1 2 Abstract The article discusses the morphological changes in the mucous membrane of the stomach, duodenum, small intestine and large intestine after gastrostomy performed by the proposed original method of using an implant, in comparison with the classical Witzel gastrostomy and Depage-Janeway gastrostomy using the GIA stapler in laboratory animals (rabbits). Morphological changes were studied on Days 10 and 20 after surgery. It has been shown that gastrostomy causes adaptive-compensatory changes of a various nature, developing along the conveyor principle (along the passage of the food bolus), the morphological picture of which is represented by lymphohistiocytic infiltration and hemocirculatory disorders of a congested origin. The study revealed that the proposed original method of gastrostomy is characterized by a minimal damaging effect on the lower gastrointestinal tract, in comparison with the studied analogues. (International Journal of Biomedicine. 2020;10(3):251-256.) Key Words: gastrostomy • gastrointestinal tract • morphology • polypropylene mesh Abbreviations GC, goblet cells; SI, small intestine; LI, large intestine; LGT, lower gastrointestinal tract Introduction Gastrostomy, in its various modifications, remains the only way to organize enteral nutrition in patients with tumor lesions of the upper gastrointestinal tract. However, this breaks down the conveyor principle of the organization of digestion, which *Corresponding author: Leonid V. Safonov, PhD. Federal Scientific Center for Physical Culture & Sport; Moscow, Russia. E-mail: consists in the sequential effect of enzymes from different parts of the gastrointestinal tract on the food bolus, which ultimately leads to morphofunctional transformations of various parts of the gastrointestinal tract, reducing the efficiency of digestion and becoming a risk factor for the development of a number of diseases. Studies carried out in adult patients present, as a rule, complications of gastrostomy, primarily as a result of technical errors in the performance of the operation, considered in isolation from micro- and macrostructural rearrangements of the lower gastrointestinal tract (LGT) and a complex of metabolic disorders associated with them.(1,2) 252 S. N. Shurygin et al. / International Journal of Biomedicine 10(3) (2020) 251-256 The purpose of this work was to evaluate the morphofunctional changes in the gastrointestinal mucosa in the original method of gastrostomy using a polypropylene mesh, in comparison with the classical Witzel gastrostomy and Depage-Janeway gastrostomy using the GIA stapler. Results On Days 10 and 20 after surgery, morphological changes in the wall of the stomach and duodenum in Groups 1 and 2 progressively increased (Fig.1). 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). The work with animals was carried out in accordance with the principles of humanism laid down in the directives of the European Community (86/609/ЕЕС) and the Declaration of Helsinki, in accordance with the “Animal experimentation legislations”. Group 1 rabbits underwent the Witzel’s gastrostomy; Group 2 rabbits underwent the Depage-Janeway gastrostomy using the GIA apparatus; Group 3 rabbits underwent the original method of gastrostomy using a polypropylene mesh (Patent RU No. 2691924, Priority date: 06/18/2019, Bulletin No. 17).(3) The animals were withdrawn from the study on Days 10 and 20 after surgery. The fragments of the membrane of the wall of the gastric fundus, the duodenum, and the initial part of the small intestine (SI) and large intestine (LI) were fixed for at least 2 hours in a 10% solution of neutral formalin. Further sample processing was carried out by intermediate Blick mixtures. Subsequently, paraffin sections 5–7 μm thick were made, which were stained with H&E. To identify acidic glycosaminoglycans, which are of particular importance in formation of connective tissue, staining with Alcian blue (pH 2.5) was used.(4) Morphometry was performed using the ImageJ-1.45s. On sections of the gastric mucosa, the following was determined: the number of mucous cells in one fundic gland. the number of goblet cells (GC) of the surface epithelium, the number of of crypt epithelium, lymphocytes in the infiltrate (per 1 mm2 of the stroma), and the height of the mucous membrane glands of the fundus (μm). On sections of the mucous membrane of the duodenum, the following was determined: the total number of the cells of the epithelial layer per 1mm, the number of GC per 100 epithelial cells, the height of the microvilli of the apical plasmatic membrane (μm), the height of the villi (μm), and the depth of crypts (μm). On sections of the mucous membrane of the SI, the following were determined: the height of the villi (μm), the depth of crypts (μm), the thickness of the brush border of epithelial cells and the number of GC per crypt. On sections of the mucous membrane of the LI, the following were determined: the number of GC of the surface epithelium, the number of GC of crypt epithelium and lymphocytes in the infiltrate (per 1 mm2 of the stroma). Statistical analysis was performed using the statistical software «Statistica». (v10.0, StatSoft, USA) and Microsoft Excel 2007. Baseline characteristics were summarized as frequencies and percentages for categorical variables and as mean±SEM for continuous variables. The Mann-Whitney (U Test) was used to compare the differences between the two independent groups. A probability value of P≤ was considered statistically significant. Fig.1. Mucous membrane of the stomach and duodenum. Day 20 after surgery, staining with Alcian blue (pH 2.5). Group 1 (1.1, 1.2, 1.3) (Witzel’s gastrostomy); Group 2 (1.4, 1.5, 1.6) (Depage-Janeway gastrostomy); Group 3 (1.7, 1.8, 1.9) (Original method of gastrostomy). 1.1. Lens 40. The apical part of the glands of the gastric mucosa. 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