[Preventive abdominal wall reconstruction in patients with risk factors of eventration undergoing emergency abdominal surgery]. / Preventivnoe endoprotezirovanie bryushnoi stenki u ekstrennykh bol'nykh s riskom razvitiya eventratsii.

OBJECTIVE: To prevent eventration via preventive abdominal wall reconstruction in patients with risk factors of eventration undergoing emergency abdominal surgery. MATERIAL AND METHODS: Treatment results in 120 patients with risk factors of eventration undergoing emergency abdominal surgery were retrospectively analyzed. Patients were divided into 2 groups by 60 people. In the first group, traditional layer-by-layer suturing of the abdominal wall was performed. Preventive abdominal wall reconstruction with a standard polypropylene prosthesis was applied in the second group. We assessed postoperative complications and mortality. RESULTS: The following risk factors of eventration were detected: elderly and senile age (82.5%), long laparotomy (72.5%), decompensated comorbidities (62.5%), widespread peritonitis (52.5%), intestinal obstruction (42.5%), severe internal bleeding (12.5%), disseminated cancer (12.5%), obesity grade 3-4 (10%). In the first group, postoperative morbidity and mortality were 61.7% (n=37) and 13.3%, in the second group - 25% (n=15) and 8.3%, respectively. CONCLUSION: Preventive abdominal wall reconstruction is advisable in patients with risk factors of eventration.

[Free autovenous graft with destructed valves in treatment of severe ischemia of lower extremities]. / Lechenie kriticheskoi ishemii nizhnikh konechnostei s ispol'zovaniem svobodnogo autovenoznogo transplantata s razrushennymi klapanami.

AIM: to improve treatment of patients with severe atherosclerotic lesion of lower extremities arteries followed by critical ischemia by optimization of femoropopliteal bypass surgery. MATERIAL AND METHODS: Treament and survey of 60 patients with severe atherosclerotic lesion of femoropopliteotibial segment and critical lower limb ischemia were analyzed. Patients were divided into 2 groups depending on technique of femoropopliteal bypass. Conventional in situ autovenous technique was used in group 1. In the second group we used original method of free autovenous graft with destructed valves. RESULTS: Technique of free autovenous graft with destructed valves decreases incidence of early postoperative complications by 13.3%, remote thrombosis of graft by 13.3%. Also it increases physical and mental components of health by 7.9% and 3.1% respectively. CONCLUSION: Use of free autovenous graft with destructed valves is reasonable and improves results of treatment.

[Perforating veins insufficiency in patients with varicose disease].

MATERIAL AND METHODS: It was analyzed the results of complex survey and treatment of 181 patients with varicose disease CEAP degrees C3-C6. Ultrasonic scanning was applied to define localization, severity and extension of blood reflux in venous system. RESULTS: Superficial reflux was revealed in all patients, perforating--in 59.7%, deep--in 22.8% of cases. We concluded that high-intensive total-subtotal blood reflux in superficial veins was main hemodynamic factor resulted perforating insufficiency in 42% of patients, high-intensive deep reflux--in 17.7% of cases additionally. In patients with subcompensated course of disease superficial reflux removal and large perforating veins (diameter 4.5±0.5 mm) ligation are advisable. Small perforating veins insufficiency (diameter 3.5±0.5 mm) is eliminated independently after superficial reflux removal. Two-staged treatment should be used in patients with decompensated course of disease and trophic disorders ofshin. Perforating veins sclerotherapy under ultrasonic control is advisable secondarily after superficial reflux removal.

[Endoprosthetic replacement with lifting of abdominal wall in treatment of umbilical and postoperative ventral hernias].

The results of complex clinical and ultrasonic investigation of abdominal wall and following surgical treatment in 60 women with umbilical and postoperative large ventral hernias combined with abdomen ptosis were analyzed. Patients were divided into 2 groups with 30 people per group. Endoprosthetic replacement of abdominal wall defect using standard polypropylene prosthesis was applied in the 1st group, endoprosthetic replacement with musculoaponeurotic tissues lifting in hypogastric area using original super lightweight polypropylenepolyvinylidenefluoride prosthesis--in the 2nd group. Polypropylene endoprosthesisconsist of main flap 15×15 cm with roundish edges and additional flap 5×40 cm in the form of wide stripe placed at the lower edge of main flap transversely to its direction. It was revealed increased physical health component in 1.8 times, psychic--in 2.5 times in the 2nd group. Thus number of excellent results increased on 33.3% and amount of satisfactory outcomes reduced on 30%.