Use of Upper-Posterior Thoracoplasty in the Treatment of Patients with Fibrous-Cavernous Pulmonary Tuberculosis

Introduction. SSurgical care for patients with fibrous-cavernous and cavernous pulmonary tuberculosis (TB) most often ends with thoracoplasty due to impossibility to use resection methods of treatment.The aim of study was to assess results of application of various upper-posterior thoracoplasty options in the treatment of patients with fibrous-cavernous pulmonary TB.Materials and methods. The author analyzed results of 233 thoracoplasties performed in patients with fibro-cavernous pulmonary TB in 2012-2018. Group 1 (n = 70) consisted of patients with selective extrapleural upper-posterior thoracoplasty with polypropylene mesh; Group 2 (n = 60) consisted of patients with osteoplastic thoracoplasty according to Bjork; Group 3 (n = 103) consisted of patients with traditional selective extrapleural upper-posterior thoracoplasty. The following parameters were analyzed: elimination of the destruction cavity, stabilization of the specific process and termination of the excretion of Mycobacterium tuberculosis during the year. The results were summarized in groups based on good clinical effect, satisfactory clinical effect, worsening, death.Results. Thoracoplasty treatment option with a compression device (mesh) application resulted in the increased degree of compression in the intervention area by 30%, compared with the traditional upper-posterior thoracoplasty option and osteoplasty according to Bjork (p 0.05), and reduced the number of bronchopulmonary complications by 15% (p 0.05).Conclusions. The use of a mesh prosthesis leads to an increased effective compression of the destruction cavity, creates conditions for healing of the pulmonary tissue defect and reduces the risk of developing bronchopulmonary complications

A peritoneal defect covered by intraperitoneal mesh prosthesis effects an increased and distinctive foreign body reaction in a minipig model

Background The incidence of incisional hernia is with up to 30% one of the frequent long-term complication after laparotomy. After establishing minimal invasive operations, the laparoscopic intraperitoneal onlay mesh technique (lap. IPOM) was first described in 1993. Little is known about the foreign body reaction of IPOM-meshes, which covered a defect of the parietal peritoneum. This is becoming more important, since IPOM procedure with peritoneal-sac resection and hernia port closing (IPOM plus) is more frequently used. Methods In 18 female minipigs, two out of three Polyvinylidene-fluoride (PVDF) -meshes (I: standard IPOM; II: IPOM with modified structure [bigger pores]; III: IPOM with the same structure as IPOM II + degradable hydrogel-coating) were placed in a laparoscopic IPOM procedure. Before mesh placement, a 2x2cm peritoneal defect was created. After 30 days, animals were euthanized, adhesions were evaluated by re-laparoscopy and mesh samples were explanted for histological and immunohistochemichal investigations. Results All animals recovered after implantation and had no complications during the follow-up period. Analysing foreign body reaction, the IPOM II mesh had a significant smaller inner granuloma, compared to the other meshes (IPOM II: 8.4 µm ± 1.3 vs. IPOM I 9.1 µm ± 1.3, p < 0.001). The degradable hydrogel coating does not prevent adhesions measured by Diamond score (p = 0.46). A peritoneal defect covered by a standard or modified IPOM mesh was a significant factor for increasing foreign body granuloma, the amount of CD3+ lymphocytes, CD68+ macrophages and decrease of pore size. Conclusion A peritoneal defect covered by IPOM prostheses leads to an increased foreign body reaction compared to intact peritoneum. Whenever feasible, a peritoneal defect should be closed accurately before placing an IPOM-mesh to avoid an excessive foreign body reaction and therefore inferior biomaterial properties of the prosthesis.

PREVENTION OF POSTOPERATIVE VENTRAL HERNIAS AND PREDICTORS OF HERNIATION

The issue of predicting and preventing postoperative ventral hernias is relevant. 450 patients were examined to identify and determine the significance of risk factors, and 71 patients underwent MRI of the anterior abdominal wall to assess the morphology of the anterior abdominal wall. Large and small predictors of herniation are identified. MRI revealed aponeurosis defects that are not physically determined, which is a high risk of postoperative ventral hernias. Based on the risk level of postoperative ventral hernias, their surgical prevention was performed. Patients at low risk should undergo laparorrhaphy with a staggered strengthening suture, at high risk - preventive using a mesh prosthesis, and if it is impossible - laparorrhaphy using a thread from a mesh polypropylene implant according to the developed technique.

Possibilities of using the SMARTXIDE2 V2LR laser system after reconstructive plastic surgery with use mesh prostheses for genital prolapse

Introduction. Prolapse of pelvic organs is a polyetiological disease, manifested by a displacement of the uterus and he vaginal walls to the genital slit and/or by going beyond it. The urgency of the problem of prolapse of pelvic organ is associated with a tendency for an increase of morbidity in both elderly women due to increased expectancy of life and women of the reproductive period. Material and methods. The study included 62 patients, age of them was 4275 years. All women were underwent surgical correction with a transvaginal installation of the front mesh implant Gineflex with intraoperative extraction of fragments of the mucous membrane of the anterior wall of vagina with subsequent histological examination, as well as fragments of the mesh prosthesis after its installation and processing of the vaginal mucosa of the SmartXide2 V2LR laser system. Patients were separated on the two group taking into account the operating mode parameters of the fractional CO2 laser. In the 1st group, with a total laser energy of exposure 8.13 J/cm2, included 32 patients, in the 2nd, with a total laser energy of impact 1.48 J/cm2, 30 patients. Transvaginal installation of the anterior mesh prosthesis Gineflex was complemented such the surgical interventions as extraperitoneal ligature hysterosuspension, posterior colporography, colpoperineoplasty, installation of Urosling, Manchester operation, supravaginal uterine amputation, adnexectomy in depending on the accompanied pathology. Results. In the patients were determined IIIV stages of genital prolapse with using the POP-Q assessment system. During histological examination of a sample of biopsy of the vaginal mucosa, the thickness of walls ranged from 155 to 628 m. During microscopy on fragments of mesh prostheses in the 1st group, fragmentary destruction of the fibers of all formed was noted, which not have been detected in the examination of a samples of patients of the 2nd group, where the total laser energy was less on 6.65 J/m2. Conclusion. In patients with surgical correction of genital prolapse with using of a mesh implant upon the using the certain characteristics of SmartXide2 V2LR laser system for the exposure of the vaginal mucosa occurs partial destruction of the fibers of the mesh prosthesis, which allows to reduce the degree of tissue tension and consequently allows to reduce the level of complications after surgical diseases is associated with implantation a mesh prosthesis that does not reduce the effectiveness of this surgical treatment. This technique is safe, has no restrictions on the age and somatic status of patients, increases the tolerance of the postoperative period of surgical correction.

EXPERIENCE IN APPLYING A NEW APPROACH TO INSTALLING A MESH PROSTHESIS TRANSVAGINALLY IN SURGERY FOR GENITAL PROLAPSE

The article presents a retro and prospective analysis of 173 cases of surgical treatment of genital prolapse since June 2013. - June 2019. Their 75 of them were operated according to the concept developed by us and 92 cases of laparoscopic access for control. The new concept is to model the prosthesis intraoperatively, with a mesh size of 4 * 4 cm with a shoulder length of 10 cm on each side, which is optimal for eliminating cystocele and, in some cases, apical prolapse. The number of repeated interventions during reposition of the pubo-cervical fascia was in 4 cases, with the development of stress urinary incontinence de novo (5.3%, Pearson’s criterion, X² = 0.053 / P> 0.05). Vaginal mesh erosion was statistically significant in number (8 cases (10.6%), F = 0.035799 / OR = 7.88 / ξ2 = 5.02 /), however, only 6 cases had to be excised (F = 0.119886 / OR = 5.74 / ξ2 = 3.2 / P> 0.05). Thus, the new concept of using prostheses for transvaginal treatment of prolapse can be considered effective and safe.

JUSTIFICATION AND DIRECT RESULTS OF ENDOSCOPIC GYNRYOPLASTICS WITH TAPP AND TEP TECHNIQUES

Inguinal hernioplasty is one of the most common planned surgical interventions. With the advent of minimally invasive technologies in herniology, a new page in the field of inguinal hernia surgery has opened. The emergence of laparoscopic techniques (TAPP) and fully pre-peritoneal surgery using the TEP method allowed us to achieve good long-term results. However, there remain unresolved questions of justifying the choice of a particular method of minimally invasive intervention in patients with inguinal hernias, as well as minimal information about the comparison of long-term results of treatment of this category of patients. As a result of the study, the results of treatment of 987 patients with inguinal hernias, operated from 2014 to 2018, were evaluated. in the clinic by the endoscopic method (319 by the laparoscopic method TAPP and 668 patients operated by the TEP method). The criteria for the comparison of endoscopic techniques of hernioplasty were: the duration of the operation, the intensity of the pain syndrome, the postoperative bed-day, the economic costs for one treated herniological patient. It was established that in the absence of significant contraindications, the operation of choice was hernioplasty according to the TER method due to the lower risk of damage to internal organs and its greater economic efficiency, while maintaining all the positive qualities of minimally invasive intervention. The average bed-day after surgery according to the TAPP method was 3.8 ± 0.2, and according to the TEP method - 2.6 ± 0.3. The complications, the frequency and the cause of relapses after endoscopic hernioplasty were studied. Analyzing long-term results, in 3 cases (0.9%) after laparoscopic hernioplasty, a relapse of the disease was diagnosed. After hernioplasty using the TEP method, relapse was diagnosed in 2 cases (0.3%). In 2 patients, the hernia recurred was due to the small size of the established mesh prosthesis (less than 10x15 cm), in 3 patients it was caused by turning the lower edge of the mesh prosthesis and was observed at the stage of mastering the technique. As a result of the study, it was found that the TEP technique, in contrast to laparoscopic hernioplasty TAPP, leads to a reduction in the postoperative hospital bed, is accompanied by a significantly lower pain syndrome and recurrence rate of the disease, and also has greater economic efficiency.

Bilateral Sacrospinous Colposuspension (BSC) for the treatment of vaginal vault prolapse – description of a novel method

Vaginal vault prolapse is observed with increasing frequency in the era of large ageing populations. Various surgical techniques have been established, varying in performance, difficulty and outcome, specifically complications. A bilateral sacrospinous colposuspension technique (BSC) with a corresponding mesh prosthesis was developed using a direct I-Stitch fixation of the 38 micro-gram mesh from the vaginal apex or uterine cervix to the sacrospinous ligament or the para-sacral tendinous region for the treatment of an anatomical central pelvic floor defect. As a minimally invasive approach with the potential for conservation of the uterus, this technique should be applicable to all age groups including the increasingly frequent elderly patient with significant comorbidities.