Surgical report, patient B. Operation as of January 17, 2014 Resection of liver segment VI. Plugging the subhepatic space with a tampon. Surgical Procedure The abdomen was opened in layers in the right hypochondrium by Fedorov's incision. There is no effusion. In the sixth liver segment a destructive process in the form of detritus is detected (possibly tumor), no other seedings in the liver are observed. Taking into account the
localization and the character of affection, the resection of liver segment VI was performed using LigaSure. A gauze plug with Haemoblock was used. The laparotomy incision was closed in layers, followed by iodine and gauze dressing application.
Tissue specimen: a fragment of liver tissue with detritus for histopathological examination. Post-surgical diagnosis: Abscess (tumor destruction?) of liver segment VI.
Surgical report, patient M. Operation dd. March 31, 2014 Enucleation of a giant
cyst in the left hepatic lobe. Drainage and tamponing of abdominal cavity.
Surgical Procedure The skin and subcutaneous tissue were intersected by an incision in the right upper quadrant (with excision of an old post-operative scar) with transition to
the left upper quadrant. Hemostasis. Abdomen opening. Abdominal exploration. Due to an adhesive process in the subhepatic space and in the area of surgical approach the
full abdominal exploration is impossible. No signs of severe pathology are observed. Right and left hepatic lobes, gallbladder and extrahepatic bile ducts are located. Blunt
dissection helped to move away from the choledoch, hepaticus, right and left hepatic ducts. A liver cyst is located in the left hepatic lobe, on the border with the right lobe and
a fragment of normal liver tissue, over the diaphragmatic surface leftwards. The cyst size is about 12 to 14 cm. Taking into consideration its large size and previous oncotomy, a
radical cystectomy and the fibrous capsule removal are required. Enucleation of the cystic lesion was performed using the LigaSure device, though its spontaneous opening
with pyorrhea with sweetish odor could not be avoided. The cyst was removed within healthy tissues. Loose interrupted stitches are put in the gallbladder bed involving the
gastrocolic omentum and a tampon with Haemoblock. The haemostatic swab is applied over the liver, drainage is placed into the subhepatic area. Sanitation. Control of
hemostasis. The incision is closed in layers around drainage and tampons, followed by iodine and gauze dressing application. Tissue specimen: a cyst of the hepatic left lobe sized about 12 to 14 cm in diameter, the wall is about 2 to 3 mm. The cavity contains several subcavities, sent for histopathological examination. Post-surgical diagnosis: Infected multilocular cyst of the hepatic left lobe. During the videolaparoscopic operation the technique was slightly different. Irrigation of the gallbladder bed was performed with 5% chlorhexidine, the fluid was aspirated, and then through a pre-attached 5 mm tube a gauze pad soaked in Haemoblock (20-25 ml) was introduced to the gallbladder bed by a clamp and held it there for about 2 - 3 minutes. In all cases a stable hemostasis was achieved. It may be noted that as a result of Haemoblock application no recurrent bleeding occurred. At the same time, one can note a certain reduction in complications such as infiltration of the gallbladder area, subhepatic abscess and coagulative hyperthermia.
2. The Surgical Center of NGHCI Central Clinical Hospital No1 of Russian Railways, Moscow, a group led by M.V. Lysenko, Doctor of Medical Sciences, Professor, Honoured Doctor of the Russian Federation. Haemoblock was used in 27 patients aged from 30 to 76
years. 16 people among them suffered from cancer pathology (advanced cancer), 11 patients had the acute surgical pathology of abdominal organs, major vessels and
skeleton bones. As a result of clinical trials, in 23 cases a stable hemostatic effect was achieved, in 2 cases recurrent bleeding occurred: one of the patients required the repeated surgical intervention, whereas in another case a repeated application of Haemoblock with an exposure of 5 minutes was used. Haemoblock was ineffective twice: one patient had septic shock against the background of chronic cholangitis, with low and unstable blood pressure, the bleeding continued from abdominal adhesions, it was
arrested by application of Tachocomb plates and gauze tampons. And another patient had the bleeding from ureter continued despite the introduction of 10 ml of Haemoblock
(with the 5 min. exposure) to the ureter, as the ureter was connected with aortic aneurysm. Consequently nephrectomy and patch graft aortoplasty were performed .
3. The Endoscopy Department of the State Budgetary Institution of Health "Chelyabinsk regional clinical hospital No 3" , O.Y. Sitnikova, E.A. Tryasenogova, V.Y. Podshivalov
In modern endoscopic practice the techniques of endoscopic arrest and prevention of gastrointestinal bleedings are broadly demonstrated. They include electro coagulation, argon plasma coagulation, injection therapy, ligation, and clipping. All of them are indicated in the presence of local, specific source of bleeding (erosion, ulcers, arteriovenous fistula, etc.). The disadvantages of these methods include the high
cost of equipment and the difficulties in localizing the source of bleeding in less accessible areas. In the everyday endoscopic practice there are cases with sufficiently large area of lesions in the form of capillary, diffuse bleeding (Forrest IB bleeding), consequently the above-mentioned techniques of endoscopic hemostasis
cannot be applied (hemorrhagic gastropathy, chemical burn of the esophagus, chemical burn of stomach etc.) or when the source of bleeding is covered by a blood clot (Forrest IIB bleeding). The easiest and the most accessible endoscopic manipulation method in regard to such areas of bleeding is irrigation with hemostatic agents. Due to the
interaction of hemostatic agent with blood the blood clot is formed and tightly fixed to the wall of the organ. This method is effective in cases of continuous capillary bleeding and arrested bleeding. Currently in clinical practice there is a new hemostatic agent of topical application - Haemoblock - which has a non- specific mechanism of action. It interacts with blood proteins (mainly albumin) and forms a polymer complex that arrests
bleeding. The possibility of using this hemostatic agent in endoscopy in cases of Forrest IB and IIB bleedings was evaluated.
To this end, the irrigation of hemostatic agent through a catheter to the area of bleeding was applied to in 11 patients using a gastroduodenoscopic method. A bleeding site or
blood clots were irrigated with 20 ml of Haemoblock. All patients were males aged 44 to 77 years. Characteristics of sources and types of bleeding, effect of Haemoblock are presented in Table 2.