[Strategy for maintaining mesh implants in infected postoperative wounds of anterior abdominal wall]. / Strategiya sokhraneniya setchatykh implantatov pri infitsirovannykh posleoperatsionnykh ranakh perednei bryushnoi stenki.

Treatment of infected mesh implants of anterior abdominal wall is a complex problem in the absence of a unified approach. Traditional method involving surgical debridement of the site of infection with removal of mesh implant is associated with many risks and potential complications. This review is devoted to peculiarities of paraprosthetic infection, possible preserving the implant and methods of treating wound infection avoiding removal of endoprosthesis. Requirements for preservation of mesh implant and key role of vacuum therapy are emphasized.

[Diagnosis and treatment of patients with abdominal trauma]. / Puti sovershenstvovaniya diagnostiki i lecheniya postradavshikh s sochetannoi travmoi zhivota.

OBJECTIVE: To improve the results of diagnosis and treatment of patients with abdominal injuries through a wider introduction of laparoscopic methods. MATERIAL AND METHODS: We analyzed 3556 patients with concomitant abdominal injuries. All patients had damage to several organs and systems. Laparoscopy was performed in 1962 patients, laparotomy without previous laparoscopy - in 1594 patients. RESULTS: Laparoscopy found no abdominal injuries in 25.7% of patients, other 13.7% of patients required no surgery and follow-up was indicated. In 60.7% of patients, injuries required surgical correction. Among these lesions, 26.6% of injuries were successfully eliminated using laparoscopic approach. In some cases, more than one injury was corrected. Indications for laparotomy were overestimated in 30.2% of patients who underwent open surgery without previous laparoscopy. CONCLUSION: There is a tendency to decrease in the number of open and laparoscopic procedures for concomitant abdominal trauma over time that is associated with widespread introduction of modern diagnostic methods and accumulation of experience. Laparoscopy should be preferred for diagnosis of abdominal injuries in patients with concomitant trauma and no contraindications. This approach diagnoses no injuries or their mild nature in 39.3% of cases. Moreover, laparoscopy effectively eliminates certain lesions in 26.6% of cases.

[Anatomical features and biomechanical properties of the diaphragm in pathogenesis of hiatal hernia]. / Anatomicheskie osobennosti i biomekhanicheskie svoistva diafragmy v patogeneze razvitiia gryzh pishchevodnogo otverstiia diafragmy.

OBJECTIVE: To study changes of diaphragm and esophageal-diaphragmatic junction depending on age and constitutional features. MATERIAL AND METHODS: We studied changes of diaphragm and esophageal-diaphragmatic junction depending on age and constitutional features by using of 40 cadaveric specimens (people aged 19-75 years). RESULTS: Esophageal-aortic ligament is observed rarer with age. This ligament is poorly developed in brachiomorphic body type while diaphragmatic-cardiac ligament is generally absent as a rule. This is a predisposing factor for weakening this area. It was revealed that reduced strength and elasticity (especially esophageal-aortic and esophageal-diaphragmatic ligaments) is one of the key factors in the development of hiatal hernia. It is especially relevant for brachiomorphic body type, the 2nd mature and elderly age. The 2nd mature period is associated with reduced diameter and kinking of great arteries, that leads to 1.5-2 times decrease of arterial capacity of the diaphragm. Therefore, hiatal hernia repair using own tissues may be insufficient and accompanied by recurrence in persons with brachiomorphic body type in the 2nd mature period. CONCLUSION: Analysis of biomechanical data and anatomical features of the diaphragm may be useful to predict recurrent hiatal hernia.

[Vacuum-therapy in complex treatment of epithelial coccygeal course]. / Vakuum-terapiia v kompleksnom lechenii épitelial'nogo kopchikovogo khoda (s kommentariem).

AIM: To analyze the outcomes in patients with epithelial coccygeal course (ECC) after original vacuum-therapy. MATERIAL AND METHODS: The study included 61 patients with ECC. Patients were divided into 3 groups: 22 patients underwent ECC excision followed by wound closure by Donati, ECC excision with following wound management with ointment swathes was used in 19 cases, vacuum-therapy of open wound was conducted in 20 patients. RESULTS: In group 1 hospital-stay was 11±1.9 days (ranged 3-20, Me=11), time of complete wound healing - 14.9±4.9 days (ranged 8-49, Me=12.5), early postoperative complications were observed in 5 (22.7%) patients, recurrence - in 3 (13.6%) cases. In group 2 hospital-stay was 13.7±2.6 days (ranged 3-25, Me=15), time of complete wound healing - 74±5,7 days (ranged 35-112, Me=57,0), early postoperative complications were observed in 2 (10.5%) patients, recurrence - in 1 (5.3%) case. In group 3 hospital-stay was 13.9±2.3 days (ranged 5-24, Me=15), time of complete wound healing - 31.1±2.7 days (ranged 15-39, Me=31.0), complications and recurrences were absent. CONCLUSION: Vacuum therapy improves surgical results compared with conventional treatment.