INFECTIOUS AND INFLAMMATORY COMPLICATIONS AND THEIR PREVENTION IN VENTRAL HERNIOTOMY WITH THE USAGE OF MESH ENDOPROSTHESES

A.N. AYDEMIROV, ​​ V.I. MYSNIK, E.A. CHUHRYAEV

Stavropol State Medical Academy, Regional Clinical Center of the specialized types of medical care; Stavropol, RUSSİA

930 operations for hernias of anterior abdominal wall were carried out in our hospital during the period from 2003 to 2009. For postoperative ventral hernias were operated 348 (37.4%) patients, including 82 males and 266 females. The average age was 51.7 years. Plasty with mesh prosthesis was used in 169 (48.6%) patients with postoperative ventral hernias, in 73 (43.2%) of them with - dermapolipectomy. Polypropylene meshes of “Linteks "and "Braun" firms were used as allotransplant. In patients operated with the use of mesh prostheses in the early postoperative period were observed the following complications: hematomas - 2 (1.2%), seromas - 8 (4.7%), suppuration of wounds - 3 (1.7%), organ damage (of small intestine - 1, of transverse colon - 1) - 2 (1.2%), infiltration of the wound - 3 (1.7%). Most complications were eliminated by conservative measures. Suppuration of wound in 3 patients was limited by subcutaneous tissue and was eliminated after taking of several sutures by appropriate conservative measures. In one patient we observed the suppuration of deep layers of anterior abdominal wall with infection of mesh prosthesis, requiring the removal of the latter. Relapses of hernia were observed in 2 (1.2%) patients - after the plasty by allotransplant, including 1 patient after the removal of polypropylene mesh. Subsequently, patients with recurrent hernias were operated successfully with the using of mesh prosthesis. After the plasty with allotransplant has died 1 (0.6%) patient. The cause of the death was pulmonary embolism on the 6th day of operation. The experience in the use of mesh prostheses has allowed to define the basic principles of prevention of infectious and inflammatory complications and their treatment, which include: strict adherence to aseptic technique, preoperative antibiotic prophylaxis, precise handling, careful hemostasis, non-tension principle of tissue matching, mandatory isolation of mesh prosthesis from subcutaneous fat layer and intestine, ultrasonography of operational area and in revealed seromas their removing by puncture under ultrasound control and conservative treatment. In suppuration of deep layers of abdominal wall with infection of the prosthesis it is necessary to remove the latter.

CORRELATION BETWEEN SYNCHRONOUS OBVIOUS LIVER METASTASES AND “OCCULT” LIVER METASTASES IN PATIENTS WITH GASTROINTESTINAL CANCER: A PHENOMENON THAT CAN INDEPENDENTLY AFFECT ON SURVIVAL

R.B. BAYRAMOV

Azerbaijan Medical University, Baku, AZERBAIJAN

Background: Distant metastases of gastrointestinal cancers (GICs) most commonly develop in the liver and liver meta­sta­­ses (LM) are the main cause of the failure in radical surgery (RS) for long-term results. Routinely used imaging diagnostic methods can not detect LM less than 3-4 mm in size. Laparoscopy can only detect subcapsular LM. So in a significant percent of pts with GIC “undetectable” micrometastases (MM) of any size exist. Adjuvant chemotherapy (ACT) is essential for this part of pts for decreasing the frequency of metachronous obvious metastases.

Method: We tried to estimate theoretically the likelihood of liver MM in pts with GIC who are candidate for RS. According to my opinion the frequency of liver MM (F_m) is correlated with frequency of obvious synchronous LM (F_o) in a taken large patient group. The F_m in pts without obvious metastases can be calculated by the formula F_m = kF_o, where k is constant. Arithmetically the k constant roughly can be found as following.

Results: We know that cancer cells double in some period of time and increase their number by geo­metrical progression. Theoretically 10 times cell doubling is needed for MM of 300 μm to reach 3 mm detectable metasta­ses (2¹⁰ =1024, as the volume of 3 mm metastases is 1000 times greater than the volume of 300 μm MM). Similarly, 10 times cell doubling is needed for can­cer cell group of 30 μm to reach 300 μm MM. If we take into account that in pts with pancreatic carcinoma the mean size of obvious LM is approximately 30 mm (32 mm according to our pts’ data) at first atten­dance (also 10 times cell doubling is needed for metastases of 3mm to reach 30 mm meta­stases), then we can find that the k constant is roughly equal to 2. Knowing the malignant cell size, threshold of detectable LM and the mean size of synchronous LM the k constant can be calculated more correctly. If suppose 40% of pts with pancreatic carcinoma have obvious syn­chronous LM (according to our pts’ data) at first attendance, then the rough F_m will be 80% in pts without obvious metastases, including the pts who are candidates for RS. So without ACT 80% of pts are expected to develop metachronous obvious LM in taken patient group after RS. Therefore routinely used ACT is justified for those pts. Taking into account that the incidence of obvious synchronous LM differs significantly for different GICs, it also will be reflected in likelihood of “occult” metastases.

Conclusions: Concluding all we report that the lesser the F_o in pts with GIC at first attendance, the grater the percent of curative resection in taken a large patient group. I suggest that the F_o can be accep­ted as an indicator for estimating and comparing the chance of cure for patient groups with GIC in jobs of health care professionals. So this phenomenon can be a real factor that can affect on survival of pts with GIC.

Date: 2014-12-28; view: 1016