[Technology of hernioplasty of inguinal hernia using miniapproach].

A new method of treatment of inguinal hernias is proposed. The method is based on projecting the inguinal ring onto the skin under the USI control and using suprainguinal preperitoneal oblique-transverse miniapproach, dissection of the hernia sac, fixing the mesh explant in the preperitoneal space by pi-shaped sutures, thus making the operative trauma minimal and improving the rehabilitation of the operated patients. The clinical topographic-anatomical and ultrasonic methods of investigation were used. The technology was applied in the operative treatment of 89 patients with inguinal hernias. Six episodes of recurrence were noted in the 1-4 year period following the displacement of the mesh explant because of the absence of fixation and little size of the mesh. The proposed technology is an alternative to video-laparoscopic methods of treatment.

[Experimental and clinical grounds for using 30% solution of ethyl alcohol for chemical denervation of the gastric acid-producing zone].

Experiments were performed in 18 male rats followed by a histological investigation of the obtained material. The application of the 30% solution of ethyl alcohol was proved to cause irreversible dystrophic alterations of nerve fibers in the gastric wall when injected subserously and there were no irreversible destructive alterations in other organ tissues. Results of treatment of 82 patients with perforated pyloro-duodenal ulcers after suturing the perforated opening in combination with chemical denervation of the gastric acid-producing zone with 30% solution of ethyl alcohol injected subserously were analyzed. Reliably decreased acid-proteolytic activity of the gastric body was found to result in stable remission and low percentage of recurrent diseases. The method can be recommended for wide practical use due to its simplicity and low percentage of recurrences of ulcer disease of the duodenum against the background of preserved helicobacteriosis of the stomach.

[Optimization of endosurgical treatment of women with stress urine incontinence]. / Optimizatsiia éndokhirurgicheskogo lecheniia zhenshchin s nederzhaniem mochi pri napriazhenii.

Stress urine incontinence was treated in 79 women with Burch laparoscopic colposuspension, 75 (94.9%) of them had chronic urinary infection. 42 females of group 1 received postoperative extracorporeal hemocorrection, 37 females of group 2 received conventional postoperative therapy. In group 1 the treatment reduced leukocyturia, bacteriuria was detected in 9 (21.4%) patients, recurrent incontinence occurred in 2 (5.9%) women. In group 2 leukocyturia enhanced, bacteriuria and incontinence recurrence were observed in 23 (62.2%) and 8 (23.5%) patients, respectively. The results of the study show that combined use of laparoscopic colposuspension by Burch and extracorporeal hemocorrection improves the results of the treatment of stress urine incontinence.

[Helicobacteriosis of the operated stomach in peptic ulcer]. / Gelikobakterioz operirovannogo zheludka pri iazvennoi bolezni.

After Billorth-II resection of the stomach for ulcer the contamination of the stump with Helicobacter pylori (HP) was detected in 73.7% of the cases, for ulcer of the duodenum--in 81.8% of the patients. At later terms after selective proximal vagotomy (SPV) all the patients were HP-positive, after SPV with draining operations 92.3% of the patients were HP-positive. The degree of inflammatory alterations in the mucosa was proportional to the degree of its bacterial dissemination. The HP contamination of the gastric mucosa after operation had no marked influence on the clinical course of the remote postoperative period. Spontaneous elimination of HP was observed in 42.9% of the patients with the developing achlorhydria of the operated stomach.

[The pathogenesis of achlorhydria of the operated stomach and the functionally optimal volumes for distal resection in areflux gastrointestinal anastomosis]. / Patogenez akhlorgidrii operirovannogo zheludka i funktsional'no optimal'nye ob''emy distal'noi rezektsii pri arefliuksnom zheludochno-kishechnom anastomoze.

Examinations of 68 patients after operations of selective proximal vagotomy and 59 patients after the Billroth-II and Roux resections were performed within the periods of about 16 years. It was found that reflux was of main significance in the genesis of achlorhydria of the operated stomach. Gastric changes caused by Helicobacter pylori did not result in so rapid suppression of functional activity of the operated stomach. Hemiresection is thought to be optimal for the areflux Roux gastrojejunal anastomosis with hypersecretion. In patients with normal secretion a resection of 2/3 of the stomach is expedient. In cases with hypersecretion and unknown boundaries of the antrum a resection of 50-60% of the stomach must be supplemented with vagotomy.

[Intragastric proteolysis after vagotomy in perforative duodenal ulcer]. / Vnutrizheludochnyí proteoliz posle vagotomii pri perforativnoí iazve dvenadtsatiperstnoí kishki.

The examination of intragastric proteolysis in patients operated on the perforative duodenal ulcer has been performed in 80 patients in the period up to 16 years after the surgery. The selective proximal vagotomy was performed in 65 of the patients, the trunk vagotomy--in 15 of the patients. In 55 patients the vagotomy was combined with ulcerrraphy, in 25 patients--with draining operations. The 30-35% decrease of the intragastric pepsin proteolysis was detected in patients after the vagotomy. There was no any signs of restoration of the suppressed proteolytic activity in the time period up to 16 years after the surgery. The draining operations lead to suppression of pepsin proteolysis in long-term period after the surgery and to its substitution with digestion with the pancreatic proteinases.

[A comparative analysis of transverse and longitudinal gastrojejunostomies in the late period after a Bilroth-II gastric resection]. / Sravnitel'nyi analiz poperechnoi i prodol'noi gastroeiunostomii v pozdnie sroki posle rezektsii zheludka po Bil'rot-II.

A dynamic observation of 48 patients with the longitudinal gastrojejunal anastomoses and 41 patients with the transverse ones was performed at the period up to 7 years after the Billroth-II resection for ulcer disease of the duodenum. It was found that the functional value of the gastric stump mucosa was similarly decreased after the operation independent of the type of anastomosis. The difference of the rate of reducing the acidity and changes of proteolysis is not reliable. No substantial difference was found in the development of the disorders after the gastric resection.

[Long-term results of selective proximal vagotomy in perforating pyloroduodenal ulcers]. / Otdalennye rezul'taty selektivnoi proksimalnoi vagotomii pri perforativnykh piloroduodenal'nykh iazvakh.

The authors set forth the indications for operation of selective proximal vagotomy (SPV) combined with closure of perforating pyloroduodenal ulcer and note the peculiarities of SPV technique which they apply. They examined 71 persons in periods of up to 7 years after surgery and 41 patients in periods of up to 16 years. The regional acid-proteolytic activity of the stomach was studied. It was established that SPV lowered the aggressiveness of the gastric contents to a safe level. The digestive activity of the gastric juice did not increase in the studied periods. Operation for suturing of a perforating ulcer in the pyloroduodenal zone in combination with SPV causes a high frequency of stable recovery of patients in the late-term periods. The incidence of recurrent peptic ulcer in follow-up periods of up to 16 years was 5.4%.

[The digestive activity of the chymus in the gastric stump in postgastrectomy peptic ulcers]. / Perevarivaiushchaia aktivnost' khimusa kul'ti zheludka pri postgastrorezektsionnykh pepticheskikh iazv.

Forty-two patients with postgastroresection peptic ulcers of the zone of gastrojejunal anastomoses were examined. The cause of the appearance of the ulcers was the action of aggressive content of the gastric stump on the jejunum in the area of anastomosis. "Vagal" peptic ulcers were found by the gastrocepin test. After operations reducing the stump acidity healing of all the ulcers was noted. In achlorhydria of the stump the digestion in it is realized due to reflux at the expense of pancreas proteinases.