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OBJECTIVE: To optimize surgical approach in patients with large and giant postoperative ventral hernias through an analysis of early and long-term results of modern techniques of hernia repair. MATERIAL AND METHODS: There were 680 patients with postoperative ventral hernia over a 15-year period who underwent surgery in the Sklifosovsky Research Institute for Emergency Care and Medical Unit of the Ministry of Internal Affairs (445 (65.4%) women, 235 (34.6%) men). Mean age of patients was 63.2±14.2 years. Middle and elderly (employable) age patients (45-74 years) prevailed in the study (n=510, 75%). Hernia repair using «sublay¼ technique was performed in 490 (72%) patients without severe comorbidities and relative volume of hernial protrusion up to 18%. Submuscular-inlay technique was used in 95 (14%) patients with significant comorbidities and those over 50 years old or with a relative volume of hernial protrusion over 18%. We have applied a modified repair technique for the last 3 years in 5 (0.75%) patients with a giant postoperative ventral hernia and anterior abdominal tissue deficiency (partial or complete absence of some anatomical structures, for example, rectus muscle). A hybrid technology was applied in 12 patients with severe concomitant diseases, hernias W2 according to European qualifications or recurrent hernias, significant adhesions in the abdominal cavity or hernial sac. RESULTS: Early postoperative wound complications occurred in 27 (5.5%) patients including hematoma (n=12, 2.5%), infiltration (n=7, 1.4%), wound suppuration (n=8, 1.6%). Other complications were observed in 6 (1.2%) patients: pneumonia, pulmonary embolism, intestinal obstruction. Lethal outcomes were absent. Recurrences in long-term period were found in 18 (3.7%) patients. Submuscular-inlay technique of hernia repair was followed by early postoperative wound complications in 5 (5.1%) patients including hematoma (n=3, 3.2%), infiltration (n=1, 1%), wound suppuration (n=1, 1%). There was no mortality. No other early postoperative complications were observed. Recurrences were detected in 5 (5.2%) patients. Preoperative intra-abdominal pressure was 7-10 mm Hg in all patients with tissue deficit. This value did not exceed 12 mm Hg after repair due to creation of a «specified diastasis¼. Lethal outcomes were absent. There were no early and long-term recurrences or wound complications. Analysis of early and long-term results of the modified hybrid repair of the anterior abdominal wall did not reveal recurrences, local and systemic complications. Persistent minor diastasis between rectus muscles reinforced with a mesh implant was observed in 3 (25%) out of 12 patients. CONCLUSION: Thus, optimized and personalized approach in patients with large and giant postoperative ventral hernias considers all intra- and postoperative risk factors.

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Testing confirmed that the applied brush washing methods developed in the 1970s could provide the adequate representativeness of a sample and full information on the actual presence of helminth eggs in the objects under study. An instrumental study was found to increase the probability of helminth egg detection by up to 3.1 times due to the representativeness of a sample, to reduce the labor- and time-consumption to have analysis results, as well as to unify a procedure for sanitary parasitological studies of washouts, and to enhance the efficiency of the equipment already used in parasitology laboratories.

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Developed parasitological passports for sewage treatment works have been issued in the subjects of the Southern Federal District. Its some regions have areas inadequately covered by centralized water drainage. New waste treatment technologies and disinvasion agents have not been virtually introduced. No proper significance is attached to the parasitological studies of epidemiologically significant substrates, such as waste waters and their sludge. The positive results of dehelmintization and disinvasion are stated from the absence of helminth eggs rather than from the comparative results of sewer clearing from the invasion principle and their viability loss. Standard guides corresponding to the profile of objects are inadequately used in day-to-day work.

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The relative uniformity of helminthic eggs has been noted in the wastewaters of the Rostov Region, Krasnodar Territory, and the Republic ofAdygea. An ovogram is mainly presented by the eggs of Ascaris, Toxocaras, and whipworms. By taking into account incomplete dehelmintization during waste treatment, 5,000 to 1,080,000 helminth eggs may annually come into the water reservoirs where purified wastewaters are discharged, 33% remaining viable. Irrespective of the efficiency of dehelmintization, wastewaters and their precipitations continue to remain epidemiologically dangerous substrates and to create prerequisites for the spread of an invasive source in the environment, by risking the infection of the population with parasitic diseases.

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Results of treatment of 145 patients with acute diseases of colon's right half are analyzed. Hartman's operation was performed at all the patients: original Hartman's operation -- at 83 patients, left-sided hemicolectomy like Hartman's operation -- at 42, and combined Hartman's operation -- at 20. Various complications were seen at 51% cases; insufficiency of rectum distal stump and paracolostoma complications were the main of them. Postoperative lethality was 6,9% (10 of 145 operated patients died). All the complications were classified on laparotomic wound, paracolostomic, intraabdominal and extraabdominal complications.

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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.

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Development of surgery of cholelithiasis is regarded. Classic surgical interventions on the gall bladder and bile ducts in complicated disease (acute cholecistitis, jaundice, cholangitis), postcholecistectomy syndrome, surgical trauma of the bile ducts are substantiated. To 1980s modern views on pathogenesis of the disease have been formed. However, unresolved problems of surgical policy, traumatism of open surgeries in complicated forms of the disease (postoperative lethality in acute cholecistitis was 37% and over) made results of treatment unsatisfactory. Correction of policy's problems, application of mini-invasive procedures, diapeutic approach and precision technique opened up-to-date period in surgery of cholelithiasis. It permitted to reduce postoperative lethality in acute and chronic course of the disease to 0.08 - 0.1%.

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Results of combined treatment of 314 patients with acute pancreatitis, including 58 (15.1%) with pancreonecrosis were analyzed. Etiologic factors of acute pancreatitis were alcohol (59% patients), diseases of the bile ducts (31.5%), surgery (2.5%). Up-to-date diagnostic criteria of severe pancreatitis are presented, character of complications is analyzed. Treatment policy in acute edematous pancreatitis was conservative. In calculous cholecystitis cholecystectomy was performed after regress of acute pancreatitis. Fermentative ascitis-peritonitis was the indication for laparoscopy in aseptic phase of pancreonecrosis. US- and CT-guided puncture and drainage were often used. Surgeries were performed only for complications of pancreonecrosis, more often through mini-approaches. General lethality in acute pancreatitis was 1.9%, in pancreonecrosis - 10.7%, postoperative lethality in pancreonecrosis was 16.6%.

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Experience in observation and treatment of 193 patients with polypous lesions of the gallbladder (PLGB) was analyzed. The patients were divided into 2 groups: group 1 consisted of 102 operated patients including ones with polypous cholesterosis (59), hyperplastic polyps (21), adenomatous polyps (19), polyform cancer (3). Group 2 consisted of 91 non-operated patients. The structure of the disease was studied. Clinical and morphological classification of PLGB, indications for surgery and follow-up were developed. Proposed algorithm of diagnostic and treatment policy permits to reduce surgical activity in PLGB by 68.6% without detriment for diagnosis and treatment of polyform cancer of the gallbladder.

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A complex plan of enterobiasis control measures for a sharp and stable decrease of the prevalence level at nursery schools in new buildings is presented. This complex plan allows one to reduce the extent of investigations 3-4-fold. A trial of the complex plan proposed on territories with foci of different types should be expedient with its subsequent introduction into the practice.

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The defense properties of the gastroduodenal mucosa (lymphoid system cells secreting immunoglobulins A, M, and G, as well as the secretory component IgA) were studied in 85 patients with duodenal ulcer. The acid-producing function of the stomach was tested at the same time according to the pH value and the basal and maximal acid production. Various types of vagotomy were conducted in 52 patients and resection of the stomach in the remaining patients. The results were followed-up before and after the operation. Peptic ulcer was characterized by secondary immunodeficiency. Selective proximal vagotomy restored the tissue immune defense of the mucosa, gastric resection preserved and even increased immunodeficiency.

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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.

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The method of autodermal plasty was used in 299 patients with postoperative ventral hernias. Among them great and giant hernias made up 62,8%. The autodermal method of plasty results in less amount of complications in the wound which can be explained by an increased concentrations of humoral non-specific defense factors in the operation field due to the effect of the skin flap. Remote results were followed in 84% of the patients during 2-6 years. Recurrences were detected in 3,2%.

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