COMPARATIVE ANALYSIS OF GASTRIC WALL MORPHOLOGICAL FEATURES DURING EXPERIMENTAL USE OF SUTURELESS METHODS FOR PERFORATION CLOSURE
Abstract
Background. Perforation is the second most common complication of gastric and duodenal ulcers after bleeding. Due to the widespread introduction of various materials into modern surgical practice, the question of choice of surgical
approaches for perforated gastroduodenal ulcers remains open. Objective. To evaluate morphological changes in the gastric wall during experimental use of sutureless methods for perforation closure. Material and Methods. Perforated gastric ulcer was induced in laboratory rats. Depending on the material used for plastic closure of the perforation, the experimental animals were divided into three groups. In the control group, the defect was closed with single-row interrupted sutures and peritonized with a pedicled flap of the greater omentum. In the first experimental group, the perforation was sealed with a 2 mm thick piece of highly porous fluoroplast-4 (in the form of felt) and adhered with Fibrinostat fibrin glue. In the second experimental group, the perforation was sealed with a piece of oxidized regenerated cellulose (Surgitamp) using Fibrinostat fibrin glue. After the rats were withdrawn from the experiment, a specimen from surgical site was collected for histological preparations and examination using light microscopy. A morphometric study with statistical processing of the obtained data was conducted. Results. In an experimental study of sutureless closure of a gastric ulcer perforation using fluoroplast-4 and Fibrinostat fibrin glue or oxidized regenerated cellulose (Surgitamp) and Fibrinostat fibrin glue, local changes in the periulcer region of the stomach on the seventh day were characterized by a low degree of cellular infiltration as compared to suturing of the perforated ulcer. On the 28th day after gastric perforation closure using fluoroplast-4 in combination with Fibrinostat fibrin glue, the connective tissue specific surface area in the periulcer site was 1.85 times lower than that with suturing alone (p=0.01). Conclusion. Morphological changes developing in the perforated ulcer area, as well as in the periulcer zone after sutureless closure with fluoroplastic-4 and Fibrinostat fibrin glue or oxidized cellulose "Surgitamp" and Fibrinostat fibrin glue reflect successive stages of inflammation, all the stages being reversible.
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