APPLICATION OF TENSION-FREE PLASTIC OF ABDOMINAL WALLS AND SYNTHETIC ENDOPROSTHESIS UNDER CONDITIONS OF BACTERIAL CONTAMINATION

Introduction. Prosthetic plastic with the use of polymeric materials has become main practice in modern herniology. Issues of application of synthetic endoprosthesis under condition of bacterial contamination are the point at discussion. The potential and justification of such approach are arguable, while the closest and more remote outcomes are actively being examined.

Aim of the work is to study the opportunities of synthetic materials application under conditions of compromising area interference of patients with urgent surgery pathology. Materials and methods. 2152 patients have been operated on hernia and prosthetic plastics of abdominal wall have been carried out to 1537 patients with the use of synthetic materials in Surgery of Municipal Hospital № 35 in Nizhny Novgorod. Moreover, the outcomes of constricted hernia treatment of 445 persons have been reviewed. Patients with constricted hernia were included to the main group and were carried out prosthesis plastics (n = 281). Patients, who were carried out plastics with their own tissue, have been ascribed to the control group (n = 164). The groups were comparable by sex, age, characteristic of the main and concomitant pathology. Potential for application of synthetic materials for open abdomen for widespread peritonitis (n = 82) has also been analyzed. Two options have been used – polyethylene perforated film and polymeric coating made of reperen by patent RF № 102192. The findings of treatment of patients with eventration (n = 57), including with application of filigree, have been examined. Findings and their discussion. Frequency of complication of the disease after hernia surgery was significantly higher among persons with urgent pathology. There were no considerable differences in this regard between the categories of persons with ventral and inguinal hernia. Frequency of complications didn’t have clear correlation with age. During the treatment of patients with constricted hernia this indicator didn’t differ significantly in the main and control groups. The application of prosthesis plastics didn’t impact significantly on the frequency of infections in the area of surgical interference. Utilization of special polymeric coating for open abdomen while treating patients with widespread peritonitis enabled to exclude contact of suture with knuckle, provide adequate drainage of abdominal space, sustain allowed limits of abdominal pressure, observe the character and quantity of exudate and assess the situation dynamically prior to performing regular revision and sanitation, and timely make tactical decisions. The usage of synthetic materials of eventration treatment allowed to fully exclude the development of occasional eventrations. Increase in frequency of pyoinflammatory complications and formation of intestinal fistula were not observed. Conclusion. Application of tension-free technique for constricted hernia allows to perform reconstruction and correction, fast and firmly close hernia defect, and at the same time frequency of systematic complications decreases, whereas pyoinflammatory complications don’t increase. The usage of synthetic materials for open abdomen for widespread peritonitis allows to provide exudate outflow, control abdominal pressure, and avoid a number of complications or timely reveal them. Implantation of filigree for final closure of abdominal space and tension-free plastic on eventration are possible on availability of experience and under a number of conditions.

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