[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.