[The influence of anatomical and functional failure of the abdominal wall on the prognosis of postoperative ventral hernias].

It was analyzed the results of clinical and ultrasound examination of the abdominal wall in 180 patients with different surgical diseases of the abdominal cavity. All patients were divided into 3 groups of 60 persons on the basis of the preoperative examination results. The first group included patients without clinical and ultrasound disorders, the second and the third - with mild and severe anatomical and functional failure of the abdominal wall. 20% of patients from the first group had single strain of the abdominal wall after operation without the development of postoperative hernias. 3.3% of patients in the second group had defects and 15% of patient from the same group had severe thinning of the abdominal wall. 45% of patients in the third group had postoperative hernias. Relative and absolute indications for preventive replacement of the abdominal wall were defined.

[Influence of lifting of muscular aponeurotic tissues of the hypogastrium area on quality of life in abdominoplasty patients].

An analysis of complex clinical and ultrasonic investigations of the abdominal wall and the following surgery in 42 women with ventral hernia of big size accompanied by the ptosis of the abdomen was made. The patients were divided into two groups, each consisting of 21 patients.The endoprosthesis replacement of defect of the abdominal wall was made with standard polypropylene implant in the first group. The endoprosthesis replacement was complemented by lifting of muscular aponeurotic tissues of the hypogastrium using the implant of the original construction in the second group. The polypropylene endoprosthesis includes the main flap (15 x 15 cm) with rounded corners and the additional flap (5 x 40 cm) as a broad band situated at the lower edge of main flap in across-track direction. The increase of physical component of health was noted in 1.8 times in the second group patients and psychological component raised in 2.5 times.

[The choice of polypropylene endoprosthesis for abdominal wall plasty].

The study (on 27rabbits) of postponed tissue reaction of abdominal wall was done after web space plasty of standard, light and superlight polypropylene endoprostheses on 30th, 60th and 120th days. It was stated, that the standard polypropylene prosthesis was the most suitable for endoprosthesis replacement of abdominal wall in strangulated ventral hernia. The light polypropylene endoprosthesis should be used in the uncomplicated hernia. The superlight polypropylene prosthesis should be applied for preventive endoprosthesis replacement of abdominal wall in its anatomico-functional insufficiency.

[Indications and results of preventive endoprosthezing of the abdominal wall during operations on organs of the abdominal cavity and retroperitoneal space].

Complex examination and treatment of 120 patients with anatomo-functional insufficiency of the abdominal wall was made after operations on organs of the abdominal cavity and retroperitoneal space. In the 1st group (60 patients) the abdominal wall was sutured by traditional methods. In the 2nd group (60 patients) laparotomy was followed by implantation of polypropylene endoprosthesis by over-aponeurotic method, and suturing of the lateral wall--by sub-aponeurotic method. At the long-term postoperative period the postoperative ventral hernias were formed in 21.6% of patients of the 1st group, in the 2nd group of patients hernias were not detected. Physical component of quality of life of the 2nd group was 1.5 times, and mental component 1.7 times higher than in the 1st group.

[Prophylactics and treatment of postoperative hernias of the lateral abdominal walls using polypropylene endoprosthesis].

An analysis of complex examination and treatment of 151 patients after planned and performed surgical interventions on organs of the retroperitoneal space was made. The patients were divided into 4 groups. The first group (of comparison) included 46 patients who were treated by lumbotomy for different diseases of organs of the urinary system. In 35 patients of the second group (prophylactics) the indications were determined and in 20 patients preventive endoprosthesis of the lateral abdominal wall using polypropylene endoprosthesis was fulfilled. Herniotomy with plasty of the lateral abdominal wall using local tissues was fulfilled in 30 patients. Prosthesing hernioplasty of the lateral abdominal wall was fulfilled in 40 patients of the main group. It was found that preventive endoprosthesis of the lateral abdominal wall allowed prevention of progressing anatomo-functional i/isufficiency and the appearance of postoperative hernias. The application of polypropylene endoprosthesis for the treatment of postoperative hernias allows obtaining 36.4% more good results as compared with the control group, 21.7% decreased number of satisfactory results and no recurrent hernias.

[Comparative assessment of national and foreign endoprostheses for hernioplasty].

The used foreign endoprostheses have redundant strength, and great number and stiffness of implanted material might be a cause of complications and result in patients' discomfort associated with decreased mobility of the anterior abdominal wall. Less material consumption of endoprostheses results in increased porosity and less thickness facilitating rapid integration of the grid into the elastic and strong connective tissue scar. Company "Lintex" has developed and produced endoprostheses from polypropylene and polyvinylenfluoride monothreads in heavy, standard and light version, which allows their choice with a glance to the particular surgical situation.

[The application of immobilized forms of sodium hypochlorite in complex treatment of diffuse purulent peritonitis].

Complex examination and the following treatment of 380 patients with diffuse purulent peritonitis were analyzed. The patients were divided into 2 groups. The first group included 245 patients to whom the sanitization of the abdominal cavity used traditional antiseptics. The main group included 135 patients to whom the immobilized form of sodium hypochlorite in the carboxymethyl cellulose was introduced instead of aqueous solution. An original method of sanitization of the abdominal cavity allows 1.2-1.5 times decreased degree of endotoxicosis, 2-2.5 times improved the motor-evacuatory function of the intestine in different forms of treatment of peritonitis. In the main group of patients the number of postoperative complications was 10% less, lethality was 8.2% less.

[A new approach to treatment of the intraabdominal hypertension syndrome in patients with diffuse peritonitis].

Results of treatment of 49 patients with diffuse purulent peritonitis were analyzed. The patients were divided into two statistically similar groups. The control group of patients consisted of 27 patients treated using traditional methods. Patients of the main group (22) were treated by the same method, but the defect of the abdominal wall was closed using wide-meshed reticular polypropylene endoprosthesis with total size of the meshes not less than 70% of the general square surface. During every programmed sanation the prosthesis was cut longitudinally along the whole length and sutured so that the level of intraabdominal pressure was not more that 15 mm Hg. In the nearest postoperative period the main group patients had endotoxicosis 1.3 less, and the motor-evacuatory function of the intestine was 2.2 times higher which resulted in 1.3 times less postoperative lethality. In the long-term postoperative period excellent results of treatment became 13.3% more often, good results were 12.7% as compared with the control group.

[Quality of life after operations in the abdominal and retroperitoneal cavities: the influence of the abdominal wall anatomic-functional insufficiency].

120 patients with abdominal wall anatomic-functional insufficiency were examined and treated. All patients were divided in 2 similar groups 60 patients each. Patients of the first group had traditional laparotomy wound closure, whereas patients of the second group overcame polypropylene mesh implantation. 21.6% of patients from the first group revealed postoperative ventral hernias at follow-up, none of the second group faced such a problem. Physical component of the quality of live was 3.2 times, and psychological component - 2,6 times higher in patients of the second group.

[The efficiency of antiadhesive means with "mezogel" having a barrier effect after dissection of the adhesions in patients with acute adhesive intestinal obstruction].

An antiadhesive absorbable means "Mezogel" produced by the firm "Lintex" (St. Petersburg) after intraperitoneal administration to animals in experiments was shown to reliably effectively reduce the degree of a recurrent adhesion process, and in 40% of the cases to completely prevent repeated formation of adhesions in the abdominal cavity. The use of "Mezogel" for intraperitoneal administration after dissection of adhesions in patients with acute adhesive intestinal obstruction results in relieving the course of the nearest and long term postoperative periods and reducing the number of recurrences, thus improving quality of life of the patients.

[Meshed implants of polyvinylidene fluoride in treatment of abdominal wall hernias].

The authors analyze the results of experimental and clinical investigations for comparative studying a new meshed implant of polyvinylidene fluoride as an endoprosthesis of the anterior abdominal wall with postoperative hernias. It was shown that the polyvinylidene fluoride prosthesis is a good alternative of polypropylene prosthesis. Its physico-chemical properties allow reliable prostheses of the abdominal wall, and its biological compatibility is higher as compared with polypropylene prosthesis.

[Prophylaxis of postoperative ventral hernias with polypropylene endograft].

Results of clinical examination of abdominal cavity at 450 patients with various abdominal surgical diseases are analyzed. Special scale has been developed for risk assessment of postoperative hernia, identification of absolute and relative indications for abdominal endografting. Overall 47 patients according to absolute indications underwent preventive plastic surgery with polypropylene endograft during abdominal operations. There were no cases of postoperative hernia during 1-3 years of follow-up.

[Preventive plasty of the abdominal wall with endoprosthesis "Esfil" in operations on organs of the abdominal cavity].

An analysis of clinical and US investigations of the abdominal wall in 210 patients with different surgical diseases of the abdominal cavity allowed division of the patients into three groups: without clinical and ultrasonic alterations, with a mild degree and with a severe degree of the anatomo-functional weakness of the abdominal wall. Indications for preventive endoprosthesis of the abdominal wall were determined using the method of quantitative evaluation of risk factors of postoperative hernias developed by the authors. Preventive endoprosthesis of the abdominal wall with a polypropylene endoprosthesis "Esfil" was fulfilled during operation on organs of the abdominal cavity in 11.9% of the patients by absolute indications. The number of postoperative hernias was reduced to 0.9%.

[Choice of a method of plasty of the anterior abdominal wall in patients with postoperative ventral hernias].

The individual characteristics of the structure of the anterior abdominal wall were studied for revealing the anatomical preconditions for the formation of postoperative ventral hernias in order to substantiate efficient methods of surgical treatment. It was established that patients with brachiomorphous build had anatomical features facilitating the formation of ventral hernias. The greatest strength of the fascio-aponeurotic complex of the anterior abdominal wall is characteristic of patients with a dolichomorphous constitution, while the least strength of the fascio-aponeurotic complex of the anterior abdominal wall is characteristic of patients with brachiomorphous constitution. Patients with the dolicho- and mesomorphous constitution having postoperative ventral hernias can undergo plasty of the hernial gates with the local tissues. Patients with brachiomorphous constitution after elimination of the postoperative ventral hernias need the strengthening of the anterior abdominal wall with cellular explants.

[The tension-free hernioplasty with a polypropylene endoprosthesis "Esfil" in patients with incarcerated abdominal hernias of great and giant size].

In experiments in 24 rabbits it was found that endoprosthesis had no negative effects on the course of the wound process and did not prevent elimination of infection from the wound. "Esfil" was used for plasty of the abdominal wall in 38 patients with incarcerated postoperative, umbilical and inguinal hernias of great and giant sizes. No patient had rejections of the synthetic material, no recurrent hernias during the first year after operation.

[The experimental grounds and clinical application of domestic endoprosthesis "Esfil" for plasty of the abdominal wall]. / Eksperimental'noe obosnovanie i klinicheskoe primenenie otechestvennogo éndoproteza "Esfil" dlia plastiki briushnoi stenki.

An investigation of physico-mechanical properties and a histological examination of meshed endoprostheses "Esfil" ("Lintex" St.Petersburg) and nets "Prolene" ("Ethicon") implanted into the abdominal wall of 66 Chinchilla rabbits was carried out under experimental conditions. The comparative experimental investigation has shown that both materials possess sufficient physico-mechanical properties to resist intra-abdominal pressure and when implanted they cause an inconsiderable inflammatory reaction followed by the formation of a solid connective tissue capsule. The endoprosthesis "Esfil" was used for plasty of the abdominal wall in 51 patients with postoperative ventral hernias. The endoprosthesis "Esfil" was found to meet all the requirements made to endoprostheses for plasty of the abdominal wall. Its use in clinical practice allows the restoration of quality of life of such patients.

[In vitro activity of surgical suture materials containing cephalosporin antibiotics]. / Issledovanie in vitro aktivnosti khirurgicheskikh shovnykh materialov, soderzhashchikh tsefalosporinovye antibiotiki.

Surgical threads containing cefazolin and cefoperazone were studied comparatively. Cefazolin was shown to incorporate into the structure of caproamide threads in an amount of 20 per cent by the thread weight while the cefoperazone incorporation amounted only to 3.7 per cent. The dynamics of the antibiotic release from the threads was investigated in detail and it was found that cefazolin had no advantages over cefoperazone. In spite of the equal value with respect to the antibiotic release, cefoperazone proved to be a better drug, its use was more economic and the spectrum was broader. Therefore, the threads containing cefoperazone could be considered more promising for the prophylaxis of surgical infections.