The results of morphological evaluation of gaseus ozone cleansing effect in the experimental infected pancreatic necrosis treatment

• Teplyakova O.V.
• Vinnik Ju.S.
• Kirichenko A.K.
• Erguleeva A.D.
• Ponedelnik D.N.

Abstract

Background. The search for new drugs and approaches to the peritoneal cavity cleansing is still a serious problem against the background of the growing antimicrobial resistance of the surgical bacterial pathogens. This problem becomes particularly relevant in cases of infected pancreatic necrosis due to the difficulty in surgical control of the infection source.

Aim – to evaluate the histopathological changes of the pancreas, parietal peritoneum, liver and lung in an experimental model of infected pancreatic necrosis against the background of topical application of the directed gaseous ozone flow.

Material and methods. A prospective experimental study was conducted in 43 laboratory animals – adult male Soviet Chinchilla rabbits. In Group-1 (n=13), as well in Groups 2 and 3 (n=12 each), infected pancreatic necrosis was inducted. In 24 and 60 hours, all animals under anesthesia underwent repeated sanitation interventions. Group 1 – the peritoneal cavity was washed with 0,9% saline solution, Group 2 – the peritoneal cavity was washed with 0.02% chlorhexidine bigluconate solution, Group 3 – the peritoneal cavity was cleansed with the ozone-oxygen gas mixture. In the control Group (n=6) the animals were submitted for the sham operative procedure. In 96 hours after the first operation all animals were sacrificed and tissue specimens were harvested for analysis.

Results. Pancreatic specimens in Group 1 and 2 were characterized by the greatest severity of necrotic, inflammatory and hemorrhagic changes, while exocrine regeneration and fibrosis were predominant in Group 3. The intensity of edema, hemorrhages, neutrophil infiltration, mesothelial defects, fibrinous deposits in the parietal peritoneum specimens in Group 3 were significantly lower compared to the same indicators in Group 1 and 2. The extraabdominal histopathological changes were significantly lower in Group group-3 and sham operated animals.

Conclusion. The results determine the relevance of further studies of the safety and efficacy of topical application of the directed gaseous ozone flow in a treatment of infected pancreatic necrosis.

Keywords:acute pancreatitis; infected pancreatic necrosis; antiseptics; ozone; cleansing

References

1.     Miller S.V., Vinnik Yu.S., Teplyakova O.V., Per’yanova O.V. Dynamics of etiological structure and antibiotic sensitivity of microflora of infected pancreatonecrosis. Annaly khirurgii [Annals of Surgery]. 2011; (5): 54–61. (in Russian)

2.     Shlyapnikov S.A., Nasser N.R., Batyrshin I.M. Tertiary peritonitis and antibacterial therapy: solution approach (analytical review). Clinical and Experimental Surgery. Petrovsky Journal. 2013; 1 (1): 47–53. (in Russian)

3.     Cheng G., Wang D., Zhu P., Lin Z., Zhu S., Li J., et al. Clinical characteristics of acute pancreatitis patients with multidrug-resistant bacterial infection. Infect Drug Resist. 2022; 15: 1439–47. DOI: https://doi.org/10.2147/IDR.S354347  

4.     Vinnik Yu.S., Per’yanova O.V., Yakimov S.V., Anishina O.V., Petrushko S.I. Application of the ozonated sodium solution in complex with antibiotics in management and prophylacsis of the acute pancreatitis septic complications. Annaly khirurgicheskoy gepatologii [Annals of Surgical Hepatology]. 2002; 7 (1): 59–62. (in Russian)

5.     Tseymakh E.A., Bombizo V.A., Buldakov P.N., Averkina A.A. Pathogenetic approaches in the treatment of patients with severe acute pancreatitis. Clinical and Experimental Surgery. Petrovsky Journal. 2019; 7 (2): 60–5. DOI: https://doi.org/10.24411/2308-1198-2019-12008  (in Russian)

6.     Revishvili A.Sh., Kubyshkin V.A., Zatevakhin I.I., Bagnenko S.F., Polushin Yu.S., Maystrenko N.A., et al. Acute pancreatitis. Practice guidelines [Electronic resource]. Moscow: Ministerstvo zdravookhraneniya Rossiyskoy Federatsii, 2020: 66 р. URL: https://cr.minzdrav.gov.ru/recomend/326_4  (date of access June 20, 2022). (in Russian)

7.     Leppäniemi A., Tolonen M., Tarasconi A., Segovia-Lohse H., Gamberini E., Kirkpatrick A.W., et al. 2019 WSES guidelines for the management of severe acute pancreatitis. World J. Emerg. Surg. 2019; 14: 27. DOI: https://doi.org/10.1186/s13017-019-0247-0  

8.     Baron T.H., DiMaio C.J., Wang A.Y., Morgan K.A. American gastroenterological association clinical practice update: management of pancreatic necrosis. Gastroenterology. 2020; 158 (1): 67–75.e1. DOI: https://doi.org/10.1053/j.gastro.2019.07.064  

9.     Grigor’ev E.G., Krivtsov G.A., Plotkin L.L., Pribytkova O.V., Sovtsov S.A. Acute peritonitis. Practice guidelines [Electronic source]. Moscow: Ministerstvo zdravookhraneniya Rossiyskoy Federatsii, 2017: 91 p. URL: http://xn----9sbdbejx7bdduahou3a5d.xn--p1ai/stranica-pravlenija/unkr/urgentnaja-abdominalnaja-hirurgija/ostryi-peritonit.html  (date of access June 20, 2022). (in Russian)

10. Zerem E., Omerović S. Successful percutaneous drainage with iodine irrigation for pancreatic fistulas and abscesses after necrotizing pancreatitis. Med Princ Pract. 2012; 21 (4): 398–400. DOI: https://doi.org/10.1159/000336594   

11. Baron T.H. Hydrogen peroxide as an adjunctive therapy for walled-off pancreatic necrosis during direct endoscopic necrosectomy: A solution to the problem or a problematic solution? Am J Gastroenterol. 2021; 116 (4): 666–8. DOI: https://doi.org/10.14309/ajg.0000000000001090  

12. Mohan B.P., Madhu D., Toy G., Chandan S., Khan S.R., Kassab L.L., et al. Hydrogen peroxide-assisted endoscopic necrosectomy of pancreatic walled-off necrosis: A systematic review and meta-analysis. Gastrointest Endosc. 2022; 95 (6): 1060–6.e7. DOI: https://doi.org/10.1016/j.gie.2022.01.018  

13. Vinnik Yu.S., Teplyakova O.V., Per’yanova O.V., Tyapkin S.I., Sosedova E.V. Microbial adhesion activity on choosing drainage polymer and local antiseptics in patients with pancreonecrosis and local antiseptics in patients with pancreonecrosis. Annaly khirurgicheskoy gepatologii [Annals of Surgical Hepatology]. 2013; 18 (4): 100–8. (in Russian)

14. Law S.K.K., Tan H.S. The role of quorum sensing, biofilm formation, and iron acquisition as key virulence mechanisms in Acinetobacter baumannii and the corresponding anti-virulence strategies. Microbiol Res. 2022; 260: 127032. DOI: https://doi.org/10.1016/j.micres.2022.127032  

15. Zheng Y., Lu X., Liu B., Li B., Yang C., Tang W., et al. Novel FabI inhibitor disrupts the biofilm formation of MRSA through down-regulating the expression of quorum-sensing regulatory genes. Microb Pathog. 2022; 163: 105391. DOI: https://doi.org/10.1016/j.micpath.2022.105391  

16. Mokeev O.A., Zaytsev A.B., Mukhin A.S. The experience of application of ozone therapy in patients with infected pancreatic necrosis. Bioradikaly i antioksidanty [Bioradicals and Antioxidants]. 2018; 5 (3): 205–7. (in Russian)

All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)