Fecal incontinence risk factors and pregnancy.

MATERIALS AND METHODS: We conducted an analysis on 231 pregnant women. A proctologist examined the patients three times: in the 1st trimester (within the first 15 weeks), in the 3rd trimester (29-40 weeks), and 12 months after childbirth. RESULTS: The total number of fecal incontinence observations among women included in the study was 66 cases (28.6%), detected at the final visit. Risk factors for fecal incontinence with a high probability were age over 36 years (P = 0.001), low physical activity (P = 0.034), three or more pregnancies resulting in childbirth (P = 0.022), history of hemorrhoids (P = 0.027), perianal discomfort on the first visit (P = 0.045), and constipation on the first visit (P = 0.006). Factors such as being overweight, marital status, education, living conditions, living area, and infant size did not have significance for fecal incontinence. DISCUSSION: Pregnancy- and obstetric-related risk factors contributing to fecal incontinence are multifactorial, including factors such as multiple childbirths with trauma to the pelvic muscles or anal sphincter muscles, chronic constipation, age, and vaginal deliveries. However, currently, there is no clear concept for the prevention of fecal incontinence in pregnant women. CONCLUSION: The prevalence of fecal incontinence among pregnant women is 12.9%, which increases to 28.6% one year after childbirth. The most common complaint was involuntary passage of intestinal gas. Risk factors for fecal incontinence with a high probability included being over 36-years old, low physical activity, three or more pregnancies resulting in childbirth, a history of hemorrhoids, perianal discomfort, and constipation in the 1st trimester of pregnancy.

The history of inguinal hernia surgery.

The article reviews the history of inguinal hernia surgery. At various times, different procedures and diverse materials were used for hernia repair. However, the effectiveness and safety of inguinal hernia repair emerged only after the anatomic features of the inguinal region had been elucidated in a monograph by Henri Fruchaud "Anatomie des hernies de l'aine" published in 1956. The Italian surgeon Edoardo Bassini began a new era in herniology. For a longtime, his classic procedure with its modifications was the most popular in surgical practice. In 1959, Lloyd M. Nyhus proposed inguinal hernia repair according to the concept of the pre-abdominal (posterior) approach that later became the basis for developing the transabdominal preperitoneal hernia repair (TAPP). In 1992, M. Arregui performed the first ТАРР using a prolene mesh. In 1986, Irving Lichtenstein proposed the concept of "tension-free repair". Basing on his concept, Lichtenstein described an open technique of inguinal hernia repair, which now bears his name and is popular in surgical practice. In 1993, the term "extraperitoneal hernia repair" first appeared in an article by Edward H. Phillips. However, J. Dulucq developed the modern ТЕР technique. Currently, three tension-free inguinal hernia repairs (TAPP, ТЕР and Lichtenstein procedure) and one tension inguinal hernia repair (Shouldice procedure) dominate in inguinal hernia surgery.

[The choice of hernioplasty method in elderly and senile patients with noncomplicated inguinal hernia].

Complex examination and surgical treatment was performed in 220 elderly and senile patients for various types of inguinal hernia (IH) in accordance to Nyhus classification. In 103 patients (the main group) hernioplasty was performed according to Lichtenstein method or using modifications, proposed by us; in 117 (the comparison group)--the tension hernioplasty, using the patient's tissues. According to data of morphological investigation of the inguinal channel musculo-aponeurotic structures in 24 patients there was established, that in the oblique IH formation a biochemical instability of the connective tissue structures plays a leading role, while in a direct type of IH--the reduction of muscular fibrils quantity, lowering their elasticity and a contractile answer velocity. Application of a tension-free methods of plasty in elderly and senile patients is pathogenetically substantiated, it permits to reduce the hospital stay, the physical rehabilitation duration, the complications and recurrences rate, and to improve quality of life in remote follow-up period after operative intervention.

[Characteristic of hepatorenal perfusion in patients with acute appendicitis].

Analysis of hepatorenal perfusion was conducted in 44 patients, suffering an acute appendicitis. In 22 of them laparoscopic appendectomy was conducted, in 22--appendectomy, using a standard access in accordance with Volkovich-Dyakonov or Mac-Burney method. There was established more favourable impact of laparoscopic appendectomy conduction on hepatorenal postoperative perfusion, what is connected with lesser pain syndrome severity, influencing common hemodynamics, and more rapid elimination (or prophylaxis) of postoperative paralytic ileus, as well as better physical state of the patients.