Современные технологии в хирургии грыж передней брюшной стенки
The aim of work is a study of the non-intentional plasty possibility depending on material, a method of endoprosthesis fixation, the patient age, a clinical situation.
Materials and Methods. 1081 operations on occasion of hernias have been made since 2002 to 2009 in the MTPI ″City hospital N 35″; 665 operations — with a use of endoprostheses from polypropylene and reperene. The Liechtenstein’s method, a herniosystem implantation, was used in patients with inguinal hernias. The inlay, sublay, onlay, sutureless plasty methods are used at postoperative hernias. A life quality of patients was assessed with a use of the MOS SF-36 questionnaire.
Results and discussion. It is established during analysis of the reperene (n=68) and polypropylene (n=240) use results at inguinal hernias, that the infiltrates are twice frequently observed (5,8%) at a polypropylene use, than in cases of a reperene use (2.9%; p=0.13). A reperene plasty at the ventral hernias (n=22) doesn’t lead to suppurations and infiltrates; a suppuration was developed in 4 patients ((1.47%; p=0.02) at a polypropylene use (n=273), an infiltrate — in 10 patients (3.66%; p=0,0007). A non-intentional plasty use at the strangulated hernias decreases a number of systemic complications (from 17.65 to 5.95%; p=0,02) and lethality (from 11,76 to 3,57%; p=0,04). A number of purulent wound complications is not trustworthy increased. A postoperative wound suppuration is developed in 1,47% of cases at the local tissue use, in 1,53% — at alloplasty, p=0,49. There were no complications and lethality (p<0,01) at the sutureless methods of plasty use. A reperene use at inguinal hernias decreases a chronic pain syndrome from 33 to 20% (p<0,01).
Conclusion. The reticular endoprosthesis use doesn’t increase a rate of purulent complications. A non-intentional plasty decreases a number of syatemic complications and hospital lethality and is a selection method at strangulated hernias. Both polypropylene and reperene can be used as the endoprosthesis materials. The trustworthy higher values of a life quality are observed after a reperene plasty at inguinal hernias.
