Vol 7, No 4 (2014)

Relevance The approaches to surgical treatment of patients with a combination of umbilical hernia and diastasis recti, remain controversial and need further investigation. The purpose of the study To improve the results in surgical treatment of patients with a combination of umbilical hernia and diastasis recti. Materials and methods We assessed the recurrence rate and development during a three year period after surgical treatment of 262 patients with combined umbilical hernia and diastasis recti. The patients were divided into 9 groups according to the size of the diastasis recti and the applied surgical procedure: a novel method of extraperitoneal prosthetic correction of the diastasis recti and umbilical hernia, autogenous umbilical hernioplasty without correction of the diastasis and simultaneous autogenous hernioplasty and correction of the diastasis using Championniere’s or Askerkhanov’s methods. Results and their discussion There were no cases of recurrence reported, when the novel method was used. After autogenous umbilical hernioplasty without correction of the diastasis relapses occurred in 9 (15,25%) and 29 (70,73%) patients with grade 1 and 2 diastasis, respectively. After simultaneous autogenous hernioplasty and correction of the diastasis a relapse occurred in 12 (30,77%) patients with a grade 2 diastasis and in 15 (93,75%) patient with a grade 3 diastasis. All cases of relapse occurred within the first year after the surgical treatment. Conclusion 1) In the presence of rectus diastasis isolated umbilical hernioplasty leads to a high recurrence rate (15,25% in patients with grade I diastasis and 70,73% in grade II), no matter how large the diastasis was. 2) Surgical procedures combining umbilical hernioplasty and autogenous correction of the diastasis are more effective (recurrence rate 30,77%) than isolated umbilical hernioplasty (recurrence rate 70,73%), but are considerably inferior to the method of extraperitoneal prosthetic correction of the diastasis recti and umbilical hernia (no recurrences at all). The effectiveness of autoplastic procedures considerably decreases with an increasing degree of diastasis (recurrence rate 30,77% in grade II diastasis, 93,75% in grade III diastasis). 3) Extraperitoneal prosthetic correction of the diastasis recti and umbilical hernia is considerably superior to both the isolated autogenous umbilical hernioplasty (recurrence rate 15,25% in patients with grade I diastasis and 70,73% in case of grade II diastasis) and the combined autogenous diastasis correcting methods (recurrence rate 30,77% in patients with grade II diastasis, 93,75% in case of grade III)

Relevance Insufficiency of the ileocecal valve is one of the most frequent and completely unsolved pathologies in the ileocecal area. It is characterized bu reflux of the contens in the large intenstine into the ileum vihich in its turn leads to the development of secondary enteritis, intestines dysbacteriosis, the emergence of syndrome of malabsorption. Conservative treatment of this pathology is symptomatic and has a short character. The existing methods of surgical correction of the ileocecal valve insufficiency aren't numerous, the are carried out extraluminally and don't eliminate the direct cause of the large intestine reflux. The use of microsurgical technique can become one of the ways of improving the results of interventions on the elements of the ileocecal valve. Howerer, the data on the use of microsurgery for restorative operation in the incompetens of the ileocecal valve are absent. Microsurgical technique reduces traumatizing of the sutured tissues, enabless to avoid the disturbance of blood supply and to use microanatomic features of the organs. The purpose of the study The aim of the present study was anatomo-experimental basing and the development of restorative intraluminal microsurgical operation on the ileocecal valve in its insufficency. Materials and methods 151 objects (21 dogand 130 corpses of people) were studied. The section on the anatomical basis of restorative microsurgery of the ileocecal valve was performed on the organocomplexes takeu from 130 corpses of people of bothsexes aged from 21 till 82. Morphological and histotopographic investigation of the ileocecal valve in norm and in pathology was carried out. The experimental part of studies was made on 21 nonpurebred dogs of both sexes weighing from 5 to 12 kg. 2 series of experiments were carried out using different surgical restorative methods/ Results and their discussion Based on these data a mode of intraluminal correction in ileocecal valve insufficiency was worked out bu using microsurgical technique. New data on the dynamics of the ileocecal sphincter in different terms after restorative operation were obtained bu microsurgical technique. Morphological and functional characteristics of the ileocecal sphincter in different terms after the operation were defined. Conclusion The data obtained during the experiments show that the use of microsurgical technique in performing restorative operation on the ileocecal sphincter allows to improve both the nearest, and remote results of the operation thanks to the restoration of sphincter and antireflyx properties. The risk of the development of the incompetent sutures is minimized owing to favourably proceeding reparative processes

Materials and methods The results of experimental study of destructive pancreatitis modeling which have carried out on 45 outbread dogs were analyzed in this thesis. Modeling of destructive pancreatitis in animals has been achieved via canalicular-hypertensive model by S.A.Shalimov. 4 series of experimental study were made to achieve the targeted goal. The first series 10 dogs without treatment, the second series 10 dogs in which conventional conservative therapy was used for the treatment of acute experimental destructive pancreatitis in animals, the third series 12 dogs that underwent intravenous ozone therapy in the complex together with medication therapy, in the forth series the effectiveness of combined administration of intravenous ozone therapy and small doses of direct current in 13 dogs was evaluated. Results and their discussion The animals of first series without treatment died after 1-3 days after modeling of disease. In pancreatic tissue after 1 day from the moment of modeling of destructive pancreatitis discovered augmentation of generation rate of hyperoxide outputs for 10%. Revealed the decreased activity of glutathione reductase (GR) in pancreatic tissue which achieves the critical level in the 3rd day (3 times lower than the basal value). In the second series of experiment died 6 dogs (60%) among 10 within the first week. In the third series in the process of experiment survived 8 animals from 12. Mortality 33,3%. In the forth series of the experiment by the 2 day was diagnosed the activity of glutathione reductase of pancreatic tissue, showings of which increased in 1,8 times at significant decrease of potency of glutamyltransferase in 2,2 times. Further showings of glutamine-dependent ferments stabilized and after 5 days didn’t differ from the initial data. The content of malondialdehyde in erythrocyte after 5 days decreased to 1,1 times more in comparison with control group. At the same time determined the decrease of malondialdehyde in pancreatic tissue – to 10 times in comparison with control group. In this series survived 10 animals from 13. Mortality 23%. Conclusion Therefore combined administration of small doses of DC and intravenous ozone therapy in the complex treatment shows antiphlogistic action, improves antioxidant function of organ, arrests the process of lipid peroxidation, favors accelerated rejection of necrotic tissue with the reduction of focus of inflammation, accelerating compensatory adaptive possibilities with activation of regeneration process in pancreas which allows to decrease mortality of experimental animals from 60% to 23%.

Currently installed neuroprotective properties of erythropoietin(EP)associated with anti-apoptotic and antihypoxic action. Along with this, it is known that the influence of the laser radiation in the middle infrared range increases microcirculation, increase the functional activity of endothelial cells that leads to activation of neoangiogenesis. The purpose of the study To develop a method of treating ischemia in the cerebral cortex(GM) on the basis of studies of behavioral and vascular reactions, pathological changes in animals with the introduction of recombinant EP and the influence of the laser radiation. Materials and methods An experiment was conducted at 130 outbred adult rats of both sexes weighing 220-250g. Animals are divided into 5 series of experiments: 1-series - modeling cerebral cortex GM (n=30). 2-I series - ischemia crust GM and the introduction of intraperitoneal recombinant EP (n=30). 3 series - ischemia crust GM and cutaneous laser irradiation region of the ischemic lesion(n=30. 4-series - ischemia crust GM treated with EP in conjunction with cutaneous laser irradiation(n=30). 5 series(control) rats with craniotomy, but without modeling the cerebral cortex GM (n=10). Animals were taken from experiment 7, 14, 30 days. Results and their discussion It is shown that the introduction of recombinant EP in combination with laser radiation in cerebral cortex GM increases in the early stages of the experiment, the tolerance of neurons to hypoxic damage, improves microcirculation. This is probably due to anti-apoptotic and antihypoxic action EP, and increased functional activity of endothelial cells under laser irradiation. Сonclusion 1. The combined effect of recombinant EP and laser radiation significantly reduces the area of the heart, enhances proliferation of endothelial cells with the development of new vasculature in the early stages of the experiments. 2. These structural changes are accompanied by an earlier regression of neurological disorders and improving behavioral reactions in experimental animals

Relevance Pancreonecrosis remains a challenge due to abdominal surgery increase morbidity and continuing high mortality, primarily from septic complications. To date, timely diagnosis of infected pancreonecrosis often causes problems, and the use of methods of efferent therapy in the postoperative period remains controversial. The purpose of the study By the method of gas liquid chromatography to improve early diagnosis of infected pancreonecrosis and evaluate the effectiveness of continuous veno-venous hemodiafiltration (CVVHDF) in its complex treatment. Materials and methods The results of treatment of 52 patients with infected pancreonecrosis. All patients were additionally determined blood concentration and dynamics of volatile fatty acids (acetic, propionic, butyric and isovaleric) by gas liquid chromatography. 23 patients in the postoperative period was conducted sessions CVVHDF on gemoprotsessor «Prismaflex» (Gambro-Hospal). In the remaining 29 patients, the control group, in the postoperative period CVVHDF not used. Results and their discussion The possibility of the use of volatile fatty acids in the differential diagnosis and evaluation of the effectiveness of complex treatment of infected pancreonecrosis. All 52 patients in the event of infectious complications of pancreonecrosis acetic acid concentration in the blood was more 0,11 mmol/l. This is because the acetic acid is a common metabolite of aerobic and anaerobic flora. In 29 (55.8%) people diagnosed with anaerobic flora found a significant increase in the concentration of propionic, butyric and isovaleric acids. CVVHDF after surgical interventions for septic complications of pancreonecrosis to improve outcomes and reduce mortality from 27,6% to 17,4%. The effectiveness of the method is confirmed by a significant reduction of indicators of volatile fatty acids. Conclusion Performance evaluation of volatile fatty acids is an additional means of diagnosis of infected pancreonecrosis. In complicated forms of infected pancreonecrosis operation, supplemented hemodiafiltration, to improve outcomes and reduce mortality. Dynamic determination of volatile fatty acids in the blood is the criterion of control and effectively apply the tactics.

Relevance Various methods of abdominal adhesive disease treatment are applied in clinical practice. In certain cases, they show low level of evidence on the impact on the forming collagen namely. The method of postoperative anti-adhesion therapy is developed and introduced into the Hospital of Pediatric Surgery (Patent for Invention No2348415 dated March 10th, 2009, Russia). Adhesion prevention should be started at the intraoperative period and prolonged to the period of adhesion formation, proved by morphologists. The purpose of the study Was to develop experimental peritonitis model and approve methods of intra- and postoperative antiadhesion therapy on its basis. Materials and methods 30 white laboratory male rats were involved into the study. 1-1.5mL of 1015 E.coli suspension was used for artificial peritoneal contamination. Contaminated rats developed peritonitis which was clinically close to human diffuse peritonitis and manifested in rapidly progressed intoxication, intestinal dysmotility, severe microcirculatory disorder. All the experimental animals were divided into 6 groups controlled for basic peritonitis model, drug used for sanitation of the abdominal cavity, and postoperative treatment. Intraoperative anti-adhesion therapy included sanitation with the Thiazole/Dioxidine solution, postoperative therapy included application of Thiazole/Lidase 128U composition on the anterior abdominal wall. Results and their discussion Experimental animals developed clinical symptoms of peritonitis in 30 minutes after the injection of infectious agent into the abdominal cavity. Rats from the groups I and II showed no pathological processes at revision of abdominal cavity. Rats from the groups III-VI manifested in severe signs of diffuse purulent peritonitis in one day after contamination. All the studying groups were monitored for severity and incidence rate of adhesions. Animals from the group V received staged Thiazole based anti-adhesion therapy and showed no adhesions. Conclusion Development of diffuse peritonitis model has made possible to carry out the experimental study on application of titanium glycerosolvate (Thiazole) aqua-complex in the treatment. Aqua-complex appeared to show high efficiency in sanitation of the abdominal cavity in combination with Dioxidine and inhibition of adhesion formation in combination with transcutaneous administration of Lidase.

The purpose of the study To justify different types of surgical approaches at damages "hard" segments of the liver, taking into account topographic and constitutional human features by using X-ray method computer model. Materials and methods For the study developed a software product for determining the optimum surgical access to "difficult areas" segments of liver, that consists of four modules: _, processing of computer tomograms (CT), classification of 3D models and analyze information. For objectification research results, was decided to use quantitative criteria to be met by surgical approach proposed by A.Iu. Sozonov-Iaroshevich (1954). Results and their discussion The reconstruction of 243 simultaneously performed CT examinations thoracic and abdominal cavities with intravenous contrast were obtained model chest and abdomen _ with vascular system. Then, simulation of damage done "hard» (VII-VIII) and hepatic vein segments by marking them. Conclusion The data, which suggest that the majority (67.5%) patients optimal access to "difficult areas" segments of the liver is torakofreno laparotomy through IX intercostal space

The purpose of the study To study long-term results endovenous laser coagulation in patients with varicose veins lower extremities. Materials and methods Results of treatment of 241 patients with varicose veins lower extremities by endovenous laser treatment (EVLT). EVLT used for laser diode domestic "Creole" company "Technology-pro", a wavelength is 980 nm., The power used for EVLT - 10-12 watts. EVLT performed 10-20 sec by 1 position, depending on the thickness of veins, traction the optical fiber 1-2 cm. The criterion for adequacy obliteration of of the great saphenous vein (GSV) had ultrasound signs of vein occlusion, collaterals were treated from separate punctures. Smooth running PFS was not a determining factor during EVLT. In case complications during angiographic catheter performs additional puncture or install additional catheter. In addition, there have been rare detected by ultrasound several trunks GSV in the leg or thigh. Each detected a barrel treated separately. Results and their discussion The technical success of Operation was achieved in all cases, which was confirmed by color duplex scanning. Intraoperative complications were absent. Regression of chronic venous insufficiency was noted in all patients. In patients with clinical classes C4 and C5 was a decrease area of foci lipodermo sclerosis and skin hyperpigmentation. Negative dynamics was observed in 2 (4.2%) patients and 2 C2 (5.1%) patients with clinical group at C3 CEAR. An objective study of the deterioration of the limbs was not. Long-term outcome was studied in 174 (72.2%) patients in the period up to 5 years. Signs GSV occlusion throughout detected in 168 (96.4%) patients, signs of partial recanalization of GSV were detected in 6 (3.5%) patients. Patients with partial recanalization of GSV re EVLT required in 4 (2.4%) patients. Conclusion EVLT is a highly effective, low-impact treatment and allows you to replace the traditional methods of surgical treatment in most patients.

The purpose of the study To develop a new method to minimize the risk of postoperative supravesicular hernias formation after laparoscopic surgery of bilateral inguinal hernia. Materials and methods The clinical supervision after own practice demonstrates the successful application of the developed method in a patient with bilateral inguinal hernia and mesentery cystic formation and the performance of simultaneous laparoscopic surgery. Results and their discussion The figure clinical case demonstrated a new method laparoscopic surgery of bilateral inguinal hernia. Conclusion Developed and successfully tested a method of laparoscopic transabdominal preperitoneal hernia repair with single mesh endoprosthesis was perfomed for reinforcing of both inguinal and femoral areas and fossa supravesicularis, and minimize the risk of postoperative supravesicular hernias

Many open surgical procedures are not possible to use in high surgical risk patients with acute obstructive cholecystitis, because rates of comorbidity (0-43%) and mortality (0-10%) are very high in this group of patients. Rate of mortality is very high in patient older than 70 years old and reaches up to16%. Miniinvasive decompression procedures in treatment of acute obstructive cholecystitis are associated with positive results in high surgical risk patients in compare with cholecystectomy. But in many studies tells about some negative sides of this manipulations, for example morbidity and mortality after US-guided percutaneous transhepatic cholecystostomy. Therefore, we have basis to show you different technique, which may reduce rates of morbidity and mortality in high surgical risk patients.

At the present stage of development of Traumatology and Orthopaedics, there are many methods on the surgical treatment of fractures, but none of them is not an absolute solution and is capable of to ensure a satisfactory result. The most common of all methods continues to maintain metalosteosynthesis using plates and screws. After analyzing all the stages of development and focusing on the modern forms of plates used in traumatology and orthopedics, was record the main directions of development of these technologies. On examples dismantled most popular designs used on different segments. Formulated the basic framework and requirements predetermine the desired effect. However, with all the variety of technologies, throughout the lifetime of these methods of osteosynthesis, and remains an unsolvable problem concomitant intraoperative adverse effect on the regeneration of bone tissue this the application of any of the most modern implants. That does not eliminate the risk of delayed or absent fracture healing.