[Perioperative prevention of complications in surgery of ventral hernias]

OBJECTIVE

To improve perioperative algorithm of prevention of complications in patients with ventral and incisional hernias via differentiated choice of mesh implants and hernia repair technique.

MATERIAL AND METHODS

The study included 144 patients with abdominal wall hernia, who were divided into two representative groups.

RESULTS

Original algorithms for choosing the method of hernia repair depending on type and position of mesh implant, as well as methods of perioperative prevention of complications are proposed.

CONCLUSION

These algorithms significantly reduced the incidence of postoperative wound complications after sublay hernia repair and posterior separation with TAR.

SIMULTANEOUS SURGICAL INTERVENTION IN PATIENT WITH INCISIONAL HERNIA W3 AND HIGH OPERATIONAL RISK. A CLINICAL CASE

The paper covers the clinical case of successful simultaneous intervention in a patient with acute calculous cholecystitis, incisional hernia M2-5W3, Obese (Class III) (BMI 42 kg/m2), IV-degree ptosis of the anterior abdominal, pulmonary embolism in the anamnesis with a cava filter installed and high operational risk. After preoperative preparation, a simultaneous surgical intervention (laparoscopic cholecystectomy, transverse abdominoplasty, separation hernioplasty) was performed. The patient was discharged from hospital on the 10th day of the postoperative period. Long-term results were evaluated after 2 months. A cardiovascular, thromboembolic and wound complications was not recorded.

METHODS FOR ASSESSING THE RISKS OF COMPLICATIONS IN PATIENTS WITH HERNIAS OF THE ANTERIOR ABDOMINAL WALL. REVIEW

The work is based on the analysis of literature data devoted to the problem of assessing postoperative complications in patients with primary and incisional hernias of the anterior abdominal wall. The main purpose of this review is identifying existing methods for assessing local, general perioperative complications and determining of the most reliable prognostic scales and methods for assessing risk factors among the existing ones.

The first part of the article is devoted to the assessment of the general condition of patients with hernias of the anterior abdominal wall. The existing scales for assessing modifiable risk factors (MFR), methods of preventing complications, including abdominal bandage, are considered. The main risk factors were determined: CDC wound class, patient age, hernia size, smoking, diabetes, risk 3 and higher according to ASA.

In the second part, the assessment of risk factors for complications from the surgical site is considered. The problem of terminology standardization, the difference between surgical site infection (SSI), adverse surgical events (SSO) and surgical site occurrences requiring procedural interventions (SSOPI) is described. Scales for assessing the risks of perioperative complications are presented. The evolution of SSO assessment methods from a four level to a three level scale is described. The Russian experience in assessing the combination of MFR is presented.

The third part describes the importance of evaluating post traumatic stress disorder in patients as a risk factor for an unfavorable course of the postoperative period. The European EuraHS QoL Questionnaire, recommended for use in the European Hernia Registry, is presented. The section also highlights the relevance of the selection of patients with hernias in outpatient surgery and one day hospitals.

The main idea of developing modern methods for assessing complications after hernioplasty is a comprehensive assessment of the patient's individual profile before operations for primary and incisional hernias in different risk groups. Priority should be given to tailored specific electronic questionnaires.

[Risk factors of abdominal wound dehiscence in abdominal surgery]

OBJECTIVE

To evaluate the role of various perioperative risk factors on the incidence of abdominal wound dehiscence.

MATERIAL AND METHODS

A retrospective controlled randomized trial of the risk factors of abdominal wound dehiscence was conducted in 62 patients for the period 2013- 2018. The research was performed at the Perm City Clinical Hospital No. 4. All patients were divided into two groups: the main one (n=31) with abdominal wound dehiscence in early postoperative period and the control group (n=31) without this event. Both groups were comparable by gender, age and surgical abdominal diseases. Between-group differences in numerical indicators were analyzed using Mann-Whitney U-test, qualitative variables were analyzed using contingency tables. Differences were significant at p-value <0.05.

RESULTS

Incidence of abdominal wound dehiscence was similar in patients who admitted in emergency and elective fashion (p=0.54). Anemia upon admission (p=0.71), diabetes mellitus type 2 (p=1.00), COPD (p=0.13) and obesity (p=0.76) were not significant predictors of abdominal wound dehiscence. There were significant between-group differences in CRP level (p=0.04). Among intraoperative risk factors, duration of surgery (p=0.78), surgical approach (p=1.00), aponeurosis suturing technique (p=0.39) and stoma (p=0.71) did not significantly affect the incidence of abdominal wound dehiscence. In early postoperative period, abdominal wound dehiscence correlated with peritonitis (p=0.04), SSI (p<0.01) and redo laparotomy (p=0.02).

CONCLUSION

Despite the variety of pre-, intra- and postoperative risk factors, only infectious postoperative complications (SSI, peritonitis) and redo surgical interventions influenced the development of abdominal wound dehiscence. Thus, the concept of abdominal wound dehiscence prevention should be inextricably associated with the concept of prevention of postoperative infectious complications from the abdominal wall and abdominal cavity.

INTRAABDOMINAL HYPERTENSION SYNDROME: CURRENT STATE OF THE PROBLEM

Syndrome of intra-abdominal hypertension (SIAH) is a dangerous complication that can occur in patients with a surgical profile after surgery in the abdominal cavity. Only in the past 25 years has the SIAH been recognized. According to W. Ertel et al., In one third of patients with peritonitis, pancreatic necrosis, injuries of the abdominal cavity and after extensive surgery, there is an increase in intra-abdominal pressure (IAP), while SIAH develops in 5.5% of such patients. Mortality in SIAH is 42–68%. The reason for the development of so many deaths is the presence of diagnostic, preventive and therapeutic measures, as well as differences in the interpretation of terms. Today, much attention is paid to the study of SIAH, official attempts are being made to standardize and define terms and recommended methods of treatment, but this problem needs further study. The review presents data on the current state of the problem, current trends in the diagnosis, prevention and treatment of patients with IAP and SIAH, their use in practical research.

ETIOLOGICAL STRUCTURE AND DIFFERENTIAL DIAGNOSTICS OF SALMONELLOSIS OF BIRDS

The article presents the results of a study of the etiological structure and differential diag-nostic signs of avian salmonellosis. When identifying bacteria isolated from 128 blood samples of chickens with the use of rapid test "Salmonella latex kit" established the dominance of cultures of the microorganisms Salmonella spp. - of 10.94% (14 samples); 10 strains (71,43%) were attributed to Salmonella gallinarum, 4 (of 28.57%) to Salmonella pullorum. The overall level of resistance of Salmonella to ampicillin - 57,58%; tetracycline - 60,61%; streptomycin - 66,67%; had to 57,58%; 60,61% and 66,67% are sensitivity to norfloxacin amounted to 69,70%, to ceftazidime - 78,79%, enrofloxacin - 57,58%, ciprofloxacin - 69,70% of the tested strains. At postmortem examination the most frequently detected signs of pericarditis, hemorrhagic pneumonia, aeroscout, catarrhal-hemorrhagic enteritis, perihepatitis, hyperplasia of the spleen. The most frequently detected signs of pericarditis, aeroscout, catarrhal-hemorrhagic gastroenterocolitis, perihepatitis, inflam-mation of the ovaries, hyperplasia of the spleen. Revealed signs of congestive hyperemia, macrophage reaction, hyperplasia and plasmocytomas of lymphocyte transformation, increase the permeability of microcirculatory vessels, lymphoid-cellular infil-tration of loose fibrous connective tissue, perivascular oedema, disseminated thrombosis, proliferation of lymphocytes from lymph nodes, spleen, liver, and pancreas. In violation of the porosity of the blood vessels of serous membranes of organs were observed extensive serous oedema, the output of the formed elements of blood and the loss of fibrinogen.

[Radiofrequency ablation of the great saphenous vein in lower-limb varicose disease]

The authors herein share their experience gained in comprehensive treatment of patients diagnosed with lower-limb varicose disease treated by means of one the most state-of-the-art technologies, i. e., radiofrequency ablation. The work deals with the outcomes of managing a total of seventy-eight patients suffering from lower-limb varicose diseases with valvular insufficiency of the great saphenous vein. All the patients were subjected to radiofrequency ablation of the compromised great saphenous vein by means of the portable radiofrequency device "Surgitron" manufactured by the Company "Ellman International" (USA). Examination included ultrasonographic duplex and triplex scanning of the veins of the lower extremities. Intraoperative radiofrequency ablation of the great saphenous vein was performed by means of an original appliance consisting of a metallic probe whose length corresponded to that of the lower extremity concerned, with a figure-of-eight olive at the distal end and external plastic tube catheter. The construction of the probe made it possible to maximally free the great saphenous vein from blood through the lateral ports of the catheter, to reduce the risk of complications, to diminish the duration of the intervention, and to increase its effectiveness. Efficacy of radiofrequency ablation of the great saphenous vein amounted to 93.6%, with recanalization of the greater saphenous vein being established in five (6.4%) patients. Good functional and cosmetically pleasing therapeutic outcomes were observed in the majority of the patients (87.2%).

[Comprehensive outpatient treatment of varicose disease of the lower limbs]

The article deals with the findings obtained in examining a total of 8,000 people presenting with varicose disease of the lower extremities. The examination included a clinical (physical) examination and coloured duplex scanning of the lower-limb veins. The examination was carried out in outpatient conditions, whereas surgical treatment was performed either out-patiently, or at a <<one-day>> hospital. Revealing complete valvular insufficiency of the great saphenous vein was followed by surgical treatment - intraoperative stem catheter scleroobliteration (SSO) or short-term screening and postoperative puncture sclerotherapy. Detecting partial valvular insufficiency of the greater saphenous vein (pathological sapheno-femoral reflux only in the vertical position) was managed by applying the principle of the so-called <<incremental radicalism>>: i. e. the patients were subjected to the procedure of puncture sclerotherapy of varicose veins on the crus in ambulatory conditions to be followed by secondary ultrasonographic scanning with permanent dynamic follow-up. The cases of preserved reflux along the greater saphenous vein were subjected to sclerosurgical management. Valvular insufficiency of perforating veins was coped with by minimally invasive surgical interventions: subtotal endoscopic dissection of incompetent perforating veins, suprafascial ligation from a miniaccess and echosclerotherapy of the perforating veins. Also performed were histological and histochemical studies of the portions the greater saphenous vein and surrounding tissues procured during cross-ectomy of the sapheno-femoral anastomosis in 43 patients, who had endured preliminary puncture sclerotherapy on the crus. Good functional and cosmetically pleasing outcomes were achieved in the majority of cases. In 75% of the patients with partial valvular insufficiency of the greater saphenous vein, we managed to avoid operations since repeat ultrasonographic study revealed no pathological veno-venous shunts.

[Clonorchiasis in the Upper Amur region: biology, epidemiology, clinical presentation]

Results of studies of clonorchiasis in the region of the Upper Amur and its tributaries are presented. Biological features of the pathogen and its epidemiology are outlined. Clinical symptoms were studied in 112 patients. In case of death, a pathoanatomic picture is given.

[Surgical treatment of patients with critical ischemia of the lower limbs of atherosclerotic etiology]

The authors analyze the results of conservative and operative treatment of 546 patients. The results of operative treatment (reconstructive operations on the arteries, osteo-trepanation) were shown to be considerably better in cases of critical ischemia than those of conservative treatment (infusion therapy, hemodilution, plasmapheresis).

[Extra-peritoneal operations in arteriosclerotic lesions of the abdominal aorta and its branches]

The study is based on the analysis of the results of examination and operative treatment of 692 patients with atherosclerotic lesions of the aorta, its branches, and the limb arteries. The advantages of the extraperitoneal approach to the aorta over the transperitoneal approach in aorto-femoral reconstructions is proved. Stable postoperative intestinal paresis, peritonitis, intraabdominal bleeding, eventration, and adhesive disease do not occur with this approach. Such operations are not attended by a high incidence of coronary and cerebral vascular complications during and after the operation. The work gives the first appraisal of the results of postoperative plasmapheresis (21 patients) applied for normalization of hemorheological and lipoprotein disorders in different periods after the operation. The suggested complex approach to the treatment of atherosclerosis obliterans facilitates improvement of the immediate and late-term results of reconstructive operations on the vessels.

[Reconstructive surgery in isolated and concurrent atherosclerotic occlusive lesions of the main blood vessels]

The article discusses the choice of operative methods and the stages in the treatment of patients with atherosclerosis of the abdominal aorta and lower limb arteries with consideration for the involvement of the coronary and cerebral arteries in the process. A total of 749 reconstructive operations were conducted on the abdominal aorta, its unpaired branches, arteries of the lower limbs, and coronary and extracranial arteries in 676 patients. The principle of extraperitoneal operations on the abdominal aorta was regarded as the basis in improving the results of treatment of patients with concurrent lesions. The authors substantiate the choice of a one-stage or many-stage type of operations on the vessels of different regions with due account for the localization of the affection, the degree of vascular insufficiency in each channel, and the life prognosis.

[Surgical treatment of aneurysm of the abdominal aorta]

Specific features of the course of the process, diagnosis and treatment of 40 patients with aneurysm of the abdominal part of the aorta were studied. Surgical methods used in different groups of the patients were substantiated with special reference to the character of the pathological process. The operation technique permitting to shorten the time of ischemia of tissues of the pelvic organs and extremities is described.

[Characteristics of the anthrax vaccinal strain STI-1 preserved for 30 years in the form of lyophilized spores]

A study was made of the biological properties of the spore culture of anthrax vaccine strain STI-1 lyophilized in 1944 and kept for 30 years without any passages. This dry culture contained not less than 29% of live spores; the culture growth in the nutrient broth and on the agar medium was typical for the strain. Immunogenicity tested in experiments on guinea pigs and rabbits was not reduced and corresponded to that of the reference STI-1 vaccine.