[THE PROBLEM OF CHOOSING A METHOD FOR RECURRENT INGUINAL HERNIA REPAIR].

Inguinal hernia repair is the most popular surgery performed by general surgeons around the world. The recurrence rate with various inguinal hernia repair techniques is 15%. The use of laparoscopic techniques in the treatment of inguinal hernias has significant advantages over open surgery, since it can significantly reduce pain, achieve excellent cosmetic results and shorten the duration of hospitalizations. At the same time, the recurrence rate after using laparoscopic techniques reaches 8.9%. The aim of this work is to determine the optimal method of surgical intervention for recurrent inguinal hernias. In the period from 2007 to 2011, a comparative randomized study was conducted, included 82 patients with recurrent inguinal hernias. Initially, all 82 patients were operated using Liechtenstein method with polypropylene mesh. All 82 patients with recurrent inguinal hernias were divided into two groups, patients in group I were operated on using laparoscopic methods (TAPP), in group II, repeated hernioplasty was performed using a modified Lichtenstein technique. In group I, the duration of the operation was 87±12 minutes. There were no serious intraoperative complications in group I. In group II, the average duration of the operation was 112±15 minutes. Complications in group II: severe pain syndrome was observed in 29 patients (69%), seroma developed in 15 patients (35.7%), in 4 patients (9.5%) hernia recurrence was revealed. Thus, patients who have been operated on using laparoscopic methods have certain advantages in terms of the duration of the operation, the number of postoperative complications, the presence of pain syndrome, and most importantly, these patients do not have a recurrent hernia. The results of repeated interventions in patients with recurrent inguinal hernias who did not use mesh implants were analyzed. The results obtained show the advantage of laparoscopic methods in reoperations, which was accompanied by fewer complications and reccurences. A rather difficult problem of choosing the optimal method of re-interventions in patients with relapses after laparoscopic hernioplasty. In 16.7% of patients, repeated laparoscopic hernioplasty turned out to be impossible due to technical difficulties and they had to switch to open Lichtenstein plasty. At the same time, in almost half of patients with recurrent inguinal hernias, it was possible to successfully perform repeated laparoscopic hernioplasty with good immediate and long-term results.

STUDY OF INTRAOPERATIVE INDOCYANINE GREEN ANGIOGRAPHY EFFECTIVENESS FOR IDENTIFICATION OF PARATHYROID GLANDS DURING TOTAL THYROIDECTOMY.

Postoperative hypocalcemia is a common complication of thyroidectomy. This problem is most often associated with accidental devascularisation or excision of the parathyroid glands (PG). Aim was study near-infrared fluorescent imaging with intraoperative parathyroid gland indocyanine green angiography to help identify and preserve parathyroid glands during total thyroidectomy in order to avoid postoperative hypocalcemia. For period from 2017 to 2019 years, 58 patients in Odessa regional hospital were underwent total thyroidectomy. Indications for surgery were multinodular goiter (n=42), thyroid cancer (n=11) and Graves' disease (n=5). By randomization all patients were divided into two groups: in the first group, 28 patients underwent standard total thyroidectomy, in the second group 30 patients underwent near-infrared-assisted total thyroidectomy with indocyanine green (ICG) angiography. Parathyroid autofluorescence was detected using a near infrared/indocyanine green endoscopic system (Karl Storz, Germany). Serum calcium and parathyroid hormone levels were compared between the two groups of patients in 1, 7 -15 days after surgery and then 3, 6 months later. In the first group, on based of a visual assessment of the PG, autotransplantation the PG were conduct in only 4 cases (in 3 cases - one gland, in one case - 2 glands). In the second group, autotransplantation was performed in 11 patients (in 8 cases - one gland, in 2 cases - two, in one case - 3). The transient postoperative hypocalcemia was observed in 5 patients of the first group (17,86%) and in the 2 patients of second group (6,67%) on 5-10 postoperative days. In the first group 1 patient at 3 months after surgery had permanent hypocalcemia. Near-infrared fluorescent imaging with intraoperative parathyroid gland indocyanine green angiography is a safe and an easily repeatable method. This technique provides improved detecting and assessment of the perfusion of the PG. The need for autotransplantation of the PG can be determined more objectively using ICG imaging than simple visualization.

REDO LAPAROSCOPIC ANTIREFLUX SURGERY IN PATIENTS WITH HIATAL HERNIA.

The purpose was to study the features and results of redo laparoscopic antireflux surgery. For the period from 2008 to 2019, in Odessa Regional Hospital laparoscopic antireflux operations were performed in 1164 patients. 57 patients underwent laparoscopic reoperation during the study period based on the following indications: recurrence of hiatal hernia (n=37), recurrent reflux (n=4), dysphagia (n=8), severe pain (n=5), esophageal stricture (n=3). All patients underwent repeated examinations in our clinic, telephone interviews, mailing of special questionnaires. All complaints were recorded, the quality of life was determined according to the GERD-HRQL questionnaire. All redo operations were performed laparoscopically without conversion to laparotomy. Intraoperative complications were observed in 11.11% of patients. Long-term follow up from 6 months to 6 years was observed in 90.74% of patients. The quality of life of patients according to the GERD-HRQL questionnaire significantly improved in long-term follow-up (p<0.001). Good results were observed in 91.84% of patients after redo operations. The third operation was needed in 5.6% of patients. Redo laparoscopic antireflux operations are technically difficult surgical interventions and provide good long-term results in 90% of patients.

[LIVER CYSTIC ECHINOCOCCOSIS LAPAROSCOPIC TREATMENT EFFECTIVENESS].

The main goal of the research was to study echinococcosis liver cyst laparoscopic treatment's effectiveness. The retrospective analysis of liver echinococcosis cyst surgical treatment in the period from 2003 to 2013 years was conducted. 348 patients underwent surgical treatment, among them 283 patients - laparoscopic procedure, 65 - open surgery. Medial age was 42,3±7,9 years. Female - 214, male - 134. 249 patients underwent laparoscopic partial (conservative) cystectomy, 34 - laparoscopic radical cystectomy with liver resection, 3 (1%) - conversion. 47 patients underwent partial (conservative) cystectomy using open approach. 18 - radical cystectomy using either typical or atypical hemihepatectomy. A long term analysis of 226 (79,8%) patients in a period from 6 month to 7 years was conducted. Comparison of the results revealed the advantage of laparoscopic operations. It was manifested in less blood loss, duration of the procedure, pain syndrome, and a smaller number of bed-days. Infections of the residual cavity after open surgery were twice as much comparing to ones after laparoscopic surgery. Complications after open surgery were significantly higher than after laparoscopic procedures due to postoperative wound infections. After open surgery frequency of echinococcosis recurrence was higher than after laparoscopic one (8,5% vs 2,5%) (р<0,05). Nowadays it is possible to say that treatment of choice of noncomplicated liver echinococceal cysts is laparoscopic one. Correctly made laparoscopical procedure has a good long term results, few postoperative compications, less frequent recurrences and the excellent cosmetic effect. From the principles of radical surgical treatment's point of view laparoscopic approach is the same as an open surgery.

[Using surgical mesh of a new construction in laparoscopic treatment of inguinal hernias. Comparative study].

The results of laparoscopic transabdominal (transabdominal preperitoneal--TAPP) hernioplasty, using conventional polypropylene nets in 28 patients (group I) and nets, manufactured by firm MMDI in 22 patients (group II), were analyzed. The operation duration in group I had constituted (56 +/- 18) min at average and in group II--(38 +/- 7) min. The pain syndrome severity was lesser in group II patients by 40-50%. The patients of group I were discharged in 24-48 h and of group II--in 12-18 h. While following up in 3, 6 and 12 months the recurrence of hernia was revealed in 2 patients of group I. Application of nets, manufactured by firm MMDI opens new perspectives in laparoscopic herniology. Cosy unfolding and installation in preperitoneal space without additional fixation constitutes their advantage.