[Plastic surgery of postoperative abdominal hernias with polypropylene endoprosthesis].

One hundred and twenty-one patients with postoperative abdominal hernias of different size and location were treated, 103 of them underwent surgery with polypropylene endoprosthesis. Size of hernia was objectively assessed with an original method of X-ray-computed hernioabdominometry. The parameter presents as percentage of relative volume of hernia. Based on this index, hernias were classified by size in the following way: small -- relative volume 1.0 - 5.0%, middle-sized -- 5.1 -14,0%, large -- 14.1 - 18%, gigantic -- over 18.0%. Choice of a hernioplasty method depended on relative volume of postoperative hernia. Middle-sized hernias were indications for reconstructive surgery (complete adaptation of muscular and aponeurotic layers of abdominal wall), gigantic hernias - for correcting surgery (specified diastasis of muscular and aponeurotic layers was maintained). In large hernias the method of hernioplasty was individual depending on compensatory abilities of the patient. Postoperative complications (6.6%) were local and seen in 6.6% cases. There were no lethal outcomes and complications associated with endoprosthesis. Recurrences of hernia were not revealed in all 103 patients examined from 6 months to 2.5 years after surgery.

[Endoscopic removal of isolated gastrinoma of the duodenum after Billroth II gastric resection]. / Endoskopicheskoe udalenie izolirovannoi gastrinomy dvenadsatiperstnoi kishki posle rezektsii zheludka po Bil'rot-II.

Duodenal carcinoma is a rare disease and is encountered in no more than 10% of cases of the Zollinger-Ellison syndrome. The article discusses a rare case in which an isolated duodenal gastrinoma was removed endoscopically with subsequent recovery from the Zollinger-Ellison syndrome. Study of the serum gastrin concentration with provocative tests allowed the Zollinger-Ellison syndrome to be diagnosed and the radicality of duodenal gastrinoma removal to be controlled. Retrograde duodenoscopy conducted after resection of the gastric stump by the Billroth II method localized the source of hypergastrinemia and made possible radical removal of the duodenal gastrinoma, which was confirmed by normalization of the blood serum gastrin concentration. The work includes a brief literature reference on the subject.

[Acute peptic lesions of the gastroduodenal mucosa in patients with obstructive jaundice]. / Ostrye pepticheskie porazheniia slizistoi gastroduodenal'noi zony u bol'nykh s obturatsionnoi zheltukhoi.

Complex study of the gastric acid-producing activity, the condition of the gastroduodenal mucosa, and the serum gastrin concentration in 80 patients with obstructive jaundice showed that the appearance of acute erosive-ulcerative injuries of the mucosa of the gastroduodenal zone depended on the increase of activity of the peptic factor of the gastric medium. Peptic complications occurred in 27.1% of patients with initial normo and hyperacidity and a high level of blood gastrin. The absence of bile in the duodenum (obstructive jaundice, by-pass biliodigestive anastomoses) stimulated the peptic factor. This is evidently linked with secretin deficiency (absence of the effect of bile on the secretin producing S-cells) leading to weakened inhibiting effect of secretin on the serum gastrin content, which results in hypergastrinemia and hyperacidity.

[Association of stomach and duodenal ulcers and diaphragmatic hernia]. / Sochetanie iazvennoi bolezni zheludka i dvenadtsatiperstnoi kishki s gryzhei pishchevodnogo otverstva diafragmy.

On the basis of complex examination of 83 patients with the ulcer disease including ionomanometry 25 of them were found to have hiatal hernia. Specific features of the clinical picture of this combination are described. The detection of hiatal hernia in patients with the ulcer disease allows the correction of the valve mechanism of the esophago-gastric transition to be simultaneously fulfilled during the operation.