The history of inguinal hernia surgery.

The article reviews the history of inguinal hernia surgery. At various times, different procedures and diverse materials were used for hernia repair. However, the effectiveness and safety of inguinal hernia repair emerged only after the anatomic features of the inguinal region had been elucidated in a monograph by Henri Fruchaud "Anatomie des hernies de l'aine" published in 1956. The Italian surgeon Edoardo Bassini began a new era in herniology. For a longtime, his classic procedure with its modifications was the most popular in surgical practice. In 1959, Lloyd M. Nyhus proposed inguinal hernia repair according to the concept of the pre-abdominal (posterior) approach that later became the basis for developing the transabdominal preperitoneal hernia repair (TAPP). In 1992, M. Arregui performed the first ТАРР using a prolene mesh. In 1986, Irving Lichtenstein proposed the concept of "tension-free repair". Basing on his concept, Lichtenstein described an open technique of inguinal hernia repair, which now bears his name and is popular in surgical practice. In 1993, the term "extraperitoneal hernia repair" first appeared in an article by Edward H. Phillips. However, J. Dulucq developed the modern ТЕР technique. Currently, three tension-free inguinal hernia repairs (TAPP, ТЕР and Lichtenstein procedure) and one tension inguinal hernia repair (Shouldice procedure) dominate in inguinal hernia surgery.

[FORMATION OF BILIODIGESTIVE ANASTOMOSES BY THE METHOD OF HIGH-FREQUENCY ELECTRIC WELDING].

The aim of the study was to develop a new method of formation of biliodigestive anastomoses, which would make it possible to form anastomoses both on unchanged bile ducts and in conditions of their inflammation. An experimental study was carried out on 50 rabbits of the "Chinshila" breed, which formed biliodigestive and interintestinal anastomoses by the method of high-frequency (HF) electric welding using the "Patonmed EKVZ-300" coagulator. Anastomoses were formed both on non-inflamed tissues and under conditions of biliary peritonitis. In different terms after the operation macro- and microscopic examination of the formed anastomoses was carried out, their patency, tightness and strength were determined. With HF-electric welding the connection of biological tissues is achieved due to thermal adhesion, the mucous and serous layers in the area of the anastomosis are almost completely destroyed under the influence of electricity and the connection occurs due to the submucosal layer. The suture is well-established, hermetically sealed, the anastomoses have sufficient strength (40-100 mm Hg). The coagulation scar is narrow, thermal damage to the membranes is local (within 2700-3000 microns), the epithelialization of the suture was completed after 3 months and the maturation of the scar after 6 months. The method of HF-electric welding equally allows the formation of reliable biliodigestive and interintestinal anastomoses, both in conditions of unchanged and inflamed tissues. The everting weld connection prevents the occurrence of anastomotic strictures in the future.

[PRINCIPLES OF THE HEPATICO-JEJUNOANASTOMOSIS FORMATION, USING METHOD OF THE SOFT-TISSUES HF-ELECTRIC WELDING IN CLINICAL PRACTICE].

Hepatico-jejunoanastomosis (HJA) was formed in accordance to the high-frequency electric welding method: in 14 patients ­ for the main bile outflow disorders, in 8 of them ­ as a consequence of the periampullar zone malignances, in 6 ­ stricture of a common hepatic duct, HJA earlier formatted, purulent cholangitis, iatrogenic damage of biliary ducts. In all the patients the welded averting one-layered termino-lateral or latero-lateral HJA were formatted. The welded anastomoses have appeared hermetic, sufficiently hard, immediately after the formation and further.

[ESTIMATION OF FORMATION OF HEPATICOJEJUNOANASTOMOSES, USING METHOD OF THE HF-ELECTRIC WELDING OF BIOLOGICAL TISSUES].

Hepaticojejunoanastomosis (HJА), using the HF-еlectric welding method, was formatted in 14 patients, suffering the bile outflow disorders along main biliary ducts, in 6 of them - with a common hepatic duct stricture, the HJA stricture, purulent cholangitis, iatrogenic injury of biliary ducts, and in 8 ­ with malignant tumours of periampullary zone. In all the patients the welding averting one-layer termino-lateral or latero-lateral HJА were formatted. Welding anastomoses were hermetic, quite hard, immediately after formation and so on. Comparative analysis of clinic-laboratory postoperative indices has confirmed the best results achievement of the method proposed.

[REOPERATIONS IN PATIENTS, SUFFERING CYSTIC TRANSFORMATION OF COMMON BILIARY DUCT].

Own experience of treatment of the common biliary duct cysts was analyzed in the patients, to whom earlier noneffective operative procedures for this purpose were performed. The main causes of the operations faults were unmasked, the proposed treatment-diagnostic algorithm was proposed, immediate and remote results of operative treatment were analyzed.

[Classification, differentiated and topic diagnosis, and treatment of hepatic cystic lesions].

Accumulated in 2004-2014 yrs in Department of laparoscopic surgery and choledocholithiasis experience of treatment in patients, suffering parasitic and nonparasitic hepatic cysts, was analyzed. Own improved classification of hepatic cystic lesions was proposed. Peculiarities of performance of open operations, of the puncture miniinvasive operations and interventions for hepatic cysts, using laparoscopic approach, were enlighten. Main indications for surgical treatment of hepatic cysts were adduced, depending on their kind, size, localization and clinical signs.

[Prognostication of efficacy of simultant laparoscopic operations in accordance to the risk estimation scale, and the method of establishing of indications and contraindications].

Experience of surgical treatment was summarized and its results were analyzed in patients, suffering biliary calculous disease, coexistent with other surgical diseases of abdominal organs. Main aspects of diagnosis and prognosis for efficacy of simultant operations were presented, and there were also adduced the method of prognosis of the operative treatment results in such patients, the proposed principle of determination of indications and contraindications for performance of simultant laparoscopic operations, a scale of the risk estimation for performance of such operative interventions.

[The trocar hernia after laparoscopic operative interventions. classification, treatment, prophylaxis].

Own experience of treatment of patients, suffering trocar hernias, occurred after laparoscopic operative interventions, was analyzed. Classification of trocar hernias was proposed, the main factors of risk and prognostic criteria of a trocar hernias formation were analyzed. The main methods of the trocar hernias correction are adduced.

[Laparoscopic surgery performed for focal liver pathology of various etiology].

The own experience on surgical treatment of more than 400 patients, suffering parasytic and nonparasitic hepatic cysts, benign and malignant hepatic tumors, using laparoscopic technologies, was summarized. Indications for laparoscopic operations, the main technical aspects, immediate and late follow-up results were analyzed. Advantages of laparoscopic operations in comparison to open operative interventions in thoroughly selected patients were noted.

[Simultant laparoscopic operations for biliary calculi disease and hernia of the anterior abdominal wall].

The results of treatment of patients, in whom biliocalculous disease and hernia of anterior abdominal wall were diagnosed, were analyzed. The main aspects of diagnosis and prognosis of simultant operations in such patients, some technical procedures of operative interventions were depicted. Indications for performance of simultant completely laparoscopic and simultant laparoscopic combined operations in these patients were determined.

[Endosonography in diagnosis of distal biliary stenosis].

Diagnostic validity of endoscopic ultrasonography (EUS) was estimated retrospectively in 34 patients, suffering distal biliary stenosis, revealed during endoscopic retrograde cholangiopancreatography or magnet resonance cholangiopancreatography, in whom the cause of the block was not revealed in accordance to the CT data obtained. Nontumoral stenosis was diagnosed, when normal in layers structure of the biliary ducts walls was safe, not depending on a new tumor presence. In other situations stenosis was considered having tumoral genesis. The definite diagnosis of stenosis was established after morphological investigation in 18 patients--postoperatively and during dynamic follow-up--in 16. Diagnostic validity of EUS while determining the stenosis cause have had constituted: sensitivity--94.1%, specificity--82.3%, accuracy--88.2%. In a tumoral stenosis in accordance to the EUS data there was revealed hypoechogenic mass of irregular form, causing the common biliary duct obstruction and the surrounding tissues infiltration. EUS constitutes an effective method of the biliary stenosis estimation, it permits to determine the diagnosis on the early stages.

[Estimation of endosonography method in the patients with moderate risk for choledocholithiasis].

Efficacy of endoultrasonography application in conditions of moderate risk for choledocholithiasis occurrence was estimated in 33 patients, in whom ultrasonography (US) did not reveal the common biliary duct concrements. Sensitivity, specificity, accuracy, positive and negative prognostic values of the method in suspicion for choledocholithiasis presence while US performance have had constituted 78.6, 94.7, 82.0, 98.2 and 54.5%; vs for endoultrasonography--100, 94.4, 97, 93.8 and 100% accordingly. Endoultrasonography constitutes a safe and highly effective method of investigation in patients in suspicion of the biliary ducts disease presence, it permits to reveal choledocholithiasis in significant part of patients after ineffective US. This diagnostic option permits to reduce the need for performance of diagnostic endoscopic retrograde cholangiopancreaticography.

[Simultant laparoscopic operative interventions for cholelithic disease].

Experience of simultant laparoscopic operations was analyzed. The main diagnostic aspects were determined in patients with concomitant pathology of abdominal organs, retrospective analysis of the results obtained was conducted. There was elaborated algorithm of a surgeon activities while doing intraoperative diagnosis of concomitant surgical diseases, which may be eliminated by the usage of simultant operative intervention.

[Peculiarities of postoperative complications in laparoscopic surgery].

Retrospective analysis of postoperative complications, occurred in patients, to whom laparoscopic interventions were performed in the Department of Laparoscopic Surgery and Cholelithiasis, was conducted. The rate of inflammatory and thromboembolic complications have constituted 2.2 and 0.1%, accordingly.

[Mepenam application for prophylaxis and treatment of purulent complications of an acute destructive pancreatitis].

The experience of meropenem (Mepenam, manufactured by 'Arterium", Ukraine Corporation) application as a measure for conduction of empirical therapy and for prophylaxis of an acute destructive pancreatitis complications, was summarized. Efficacy of the preparation on different stages of the purulent complications treatment (while applied solely as well as in combination with various kinds of miniinvasive and open operative interventions) was estimated. The recommendations, concerning Mepenam application for various forms of an acute pancreatitis, were elaborated.