DIFFERENTIATED CHOICE OF POSTERIOR METHODS OF DISCONNECTION OF ANATOMICAL COMPONENTS OF THE ABDOMINAL WALL IN COMBINATION WITH ALLOPLASTY IN POSTOPERATIVE VENTRAL HERNIAS OF GIANT SIZE.

OBJECTIVE: The aim: The aim of the article is to increase the effectiveness of the treatment of postoperative ventral hernias of giant size by a differentiated approach to the selection of the posterior technique of dissection of the anatomical components of the anterior abdominal wall in combination with alloplasty. PATIENTS AND METHODS: Materials and methods: An analysis of the surgical treatment of 312 patients with giant postoperative ventral hernias (PVH). The main group consisted of 232 patients who underwent a differentiated approach to the selection of component separation in combination with alloplasty, taking into account intra-ab¬dominal pressure (IAP) when simulating hernioplasty during surgery. In the second control group (80 patients), surgical treatment of PVH of giant sizes was performed using only the posterior Carbonell technique. RESULTS: Results: In 78 patients of the 1st subgroup, IAP was 9.1±1.2 mm Hg. the posterior technique of separating anatomical components according to Carbonell was performed in combination with sublay alloplasty. In 80 patients of the II subgroup with IAP from 11.1 to 14.1±1.2 mm Hg - the TAR technique was performed with sublay alloplasty. In 74 patients of III subgroups with IAP from 16 to 20.1±1.2 mm Hg, performed the TAR technique, we improved in combination with IPOM alloplasty. CONCLUSION: Conclusions: An increase in the effectiveness of surgical treatment was achieved in patients of subgroup I, reducing the probability of intra-abdominal hypertension to 5.1% versus 11.2%, in patients of subgroup II to 5% versus 11.2%, and in patients of subgroup III to 1.4% versus 11.2% of the control group.

Surgical View of Morphological and Pathogenetic Identity of Pilonidal Cysts and Acne Inversa.

<b>Introduction:</b> As a rule, the treatment of pilonidal cysts is based on a surgical approach. Surgical treatment depends on the form of the disease and surgeon's preferences regarding the method. The treatment process does not consider preoperative treatment that would affect the structural components of the skin involved in the pathological process. The results of surgical treatment remain unsatisfactory, leading to a significant number of recurrences and long-term healing of the postoperative wound. </br></br> <b> Materials and methods:</b> Morphological examination of the pieces of skin with altered sacrococcygeal tissues after radical surgical treatment of 46 patients with pilonidal cyst of the sacrococcygeal region was performed, and 46 patients with acne inversa of the intergluteal cleft, groin and scalp were selected. The sex distribution of patients with pilonidal cysts was as follows: 43 (91.3%) male patients, 3 (6.5%) female patients. Among 46 patients with acne inversa and dissecting cellulitis, the distribution was as follows: 32 (69.6%) male patients and 14 (30.4%) female patients. Patients with pilonidal cysts of the sacrococcygeal region underwent surgical treatment according to the developed method of economical median resection using sutures with internal fixation. </br> </br> <b> Results:</b> Considering and comparing the morphological picture observed in the pathomorphological examination of histological specimens in patients with pilonidal cysts, acne inversa, dissecting cellulitis, the similarity of changes in most patients is noteworthy. "Acne inversa" was first described in 1839 by Velpeau, who originally called the disease "hydradenitis suppurativa", believing that inflammatory changes occur in the sweat glands [1-3]. In 1854, surgeon Verneuil described this disease, and later it was named after him. We observed chronic proliferative inflammation in different layers of the dermis and subcutaneous tissue (the main focus is in the subcutaneous tissue, but closely related to the dermis and epidermis). </br></br> <b>Discussions:</b> Pilonidal cyst of the sacrococcygeal region, especially without hair in the cavity of the cyst, can be considered as a type of acne inversa with appropriate location. We believe that the use of local and systemic retinoids, namely isotretinoin, in the treatment of patients with this disease other than surgery, together with other groups of drugs traditionally used in the treatment of pilonidal cysts, may be promising in the treatment of pilonidal cysts.

ENDOSCOPIC HEMOSTASIS IN ULCERATIVE GASTRODUODENAL BLEEDING USING HIGH-FREQUENCY BIOLOGICAL WELDING ELECTROLIGATION.

OBJECTIVE: The aim: To increase the efficiency of endoscopic hemostasis in ulcerative gastroduodenal bleeding using high-frequency biological welding electroligation. PATIENTS AND METHODS: Materials and methods: The evaluation of endoscopic hemostasis in 160 patients aged 40 to 85 years with ulcerative gastroduodenal bleeding for the period from 2017 to 2020 was carried out. The patients were divided into two groups: the first (treatment) group involved 80 patients who underwent high-frequency biological welding electroligation, the second (experimental) group consisted of 80 patients who underwent monopolar thermal argon plasma coagulation. RESULTS: Results: In the first (treatment) group of patients with ulcerative gastroduodenal bleeding, who underwent endoscopic hemostasis using high-frequency biological welding electroligation, primary hemostasis was achieved in 77 cases (96.25%). In the first group, an early recurrence of bleeding was registered in 3 patients (3.75%). In the second (experimental) group of patients with ulcerative gastroduodenal bleeding, who underwent endoscopic hemostasis using monopolar thermal argon plasma coagulation, primary hemostasis was achieved in 66 cases (82.5%). In the second group, a recurrence of bleeding was observed in 14 patients (17.5%). CONCLUSION: Conclusions: The use of high-frequency biological welding electroligation for endoscopic hemostasis in ulcerative gastroduodenal bleeding provides a more reliable permanent hemostasis compared to the use of monopolar thermal argon plasma coagulation (77 (96.5%) and 66 (82.5%) cases, respectively). The frequency of bleeding recurrence is reduced to 3.5% and 17.5%, respectively, and the number of surgical interventions for acute bleeding in case of recurrence is decreased to 3 (3.5%) and 7 (8.75%), respectively.

Morphological features of pilonidal cysts of the sacrococcygeal region.

INTRODUCTION: Despite the fact that the pilonidal cyst of the sacrococcygeal region is a long-known disease, the mechanism of accumulation or absence of hair in the cyst remains unclear, which affects the accuracy of the name of the disease, as well as understanding of its pathogenesis. AIM: Aim to perform morphological examination of pilonidal cysts of the sacrococcygeal region, to determine the nature of the cysts, the frequency of hair in the cyst cavity and to determine the causes and mechanism of its accumulation in cysts. MATERIALS AND METHODS: A morphological study of skin areas with altered tissues of the sacrococcygeal region after radical surgical treatment of 235 patients with a coccygeal cyst of the sacrococcygeal region was carried out. The gender distribution of patients with pilonidal cysts was as follows: 220 (93.4%) male patients, 15 female patients (6.6%). RESULTS: Among 235 patients who underwent radical surgical treatment, the absence of hair shafts was recorded in 112 (46.8%) cases, hair in the cyst structure - in 123 male patients (53.2%), both visually and under a microscope, and in 4 of them (0.9%) only under a microscope. Among 15 patients, hair in the cyst cavity was found in 1 case (0.4%), in 14 patients they were not detected either visually or by microscopic examination. DISCUSSION: Having observed the formation of foreign body granuloma and the accumulation of polynuclear histiocytes of foreign bodies around the hair in the pilonidal cyst cavity, a proportional increase in histiocytes depending on the number of hairs, that is, the body's reaction to the foreign body was registered. However, multinucleated histiocytes in lower numbers were also observed in cases in which hair shafts were not found either microscopically or macroscopically, which may indicate both completed phagocytosis and formation of a cyst without a hair component, registering the reaction of histiocytes to inflammatory changes in the cyst cavity. The detection of atypically located pilonidal cysts (cheek, navel) provides additional confirmation of the formation of pilonidal cyst as a result of disturbance of hair growth through the hair funnel due to inflammatory changes in the hair follicle and their accumulation subcutaneously.