Nizhny Novgorod State Medical Academy, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russian federationThe review considers in detail the most important aspects of open abdominal wall prosthetic repair techniques applied in surgical treatment of ventral and incisional hernias according to contemporary foreign and domestic experience. we have presented the views of leading researchers on the use of synthetic endoprostheses. The authors have suggested a modern classification of primary ventral and incisional hernias indicating its variation from the previous classification SwR (Chevrel and Rath) and others. we have assessed and interpreted the English terms compared to those used in Russia. The review has traced the change of the term "tension-free plasty" in its historical perspective.The work has presented the main up-to-date techniques for mesh endoprostheses implantation, their advantages and drawbacks. There have been estimated the key points of prosthetic repair surgeries in median abdominal wall closure. we have considered correct names of variants of surgeries depending on mesh placement in relation to hernia orifices, anatomical layers of abdominal wall, and self-tissue displacement.we have clarified some peculiarities of operative techniques relying on intra-abdominal pressure control, and estimated the advantages and disadvantages of these techniques.The review has specified the most urgent problems of modern herniology, and presented one of promising directions of surgical technique improvement in the treatment of patients with large ventral and incisional hernias. we have shown the necessity of proper usage and understanding of the implication of terms standing for operative interventions, as well as correct use of corresponding classifications and terminology for adequate comparison of our research results with those of our colleges.

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Controlling infection is crucial in treating patients with acute pancreatitis (AP). The infectious process in AP often predisposes to subsequent sepsis by damaging not only the pancreas, but retroperitoneal tissues as well. Among other AP-associated factors, are the rapidly developing immune imbalance, the poor penetration of antimicrobial agents into necrotic tissue, and the impossibility of a single surgical debridement. Antibacterial and antifungal therapy for patients with infected necrosis and AP-associated extra-pancreatic infections remains a complex and largely unresolved problem, partially due to the high occurrence of multiresistant pathogens. The preventive use of antimicrobial agents has been discussed in the literature; however, the lack of consistent results makes it difficult to develop a unified strategy and clinical guidelines on this specific issue. Recent meta-analyses provide no conclusive evidence that antibacterial prophylaxis reduces the infection rate, mortality, or the need for surgical treatment in patients with necrotizing pancreatitis. We found only two studies indicating the benefits of using carbapenems for prophylactic purposes and one meta-analysis indicating a reduction in mortality under antibiotic treatment started no later than 72 h after the onset of the attack. Selective bowel decontamination is considered as one of the preventive anti-infection measures, although the available data may not be fully reliable. The main indications for antibacterial therapy in patients with AP are confirmed infected necrosis or extra-pancreatic infection, as well as clinical symptoms of suspected infection. Intra-arterial administration or local treatment with antibiotics can increase the efficacy of antibacterial therapy. No randomized studies on antifungal prophylaxis in AP are available; some reports though recommend using such therapy among patients at high risk of invasive candidiasis.

The application of ultra-lightweight materials for abdominal wall hernia repair has not been controlled so far, and the capabilities of synthetic and titanium-containing endoprostheses, as well as the peculiarities and possible differences in connective tissue development in an implantation area are not adequately investigated.The aim of the investigation was to study in experiment strength properties of connective tissue formation in the area of synthetic and titanium-containing endoprostheses implanted during abdominal wall prosthetic repair.Materials and Methods. Abdominal wall prosthetic repair was simulated in rabbits. The first series animals underwent retromuscular (sublay retromuscular, SRM) implantation, the second series -intraperitoneal (intraperitoneal onlay mesh, IPOM). We used the model including implantation of two meshes situated in close proximity to each other. Group 1 animals were implanted synthetic lightweight polypropylene meshes (90 µm fiber), group 2 -ultra-lightweight titanium-containing meshes (made of lightweight polypropylene titanium-coated, 65 µm fiber), group 3 were implanted titanium (65 µm fiber) endoprostheses. 30 and 60 days later the animals were sacrificed, their abdominal wall strength being studied in the contact area of meshes. Intact abdominal wall areas were control.Results. Connective tissue strength in group 2 was higher (13.12 N/cm) compared to group 1 (9.2 N/cm) in both series, p=0.001. In group 3 the parameter under study was maximal (15.89 N/cm), which differed significantly from that in group 1 (p=0.0000) and 2 (p=0.002). The comparison showed connective tissue strength after SRM to be higher (13.32 N/cm) than after IPOM (12.88 N/cm); p=0.976. The parameter was significantly higher on day 60 of the experiment (13.9 N/cm) compared to that on day 30 (12.4 N/cm); p=0.008. On day 30 the abdominal wall strength along the implantation perimeter was significantly lower (12.4 N/cm) compared to inrtact areas (14.84 N/cm); p=0.0004. No significant differences in strength between the areas under study and intact areas (13.9 N/cm) were found by the 60 th postoperative day; p=0.08.Conclusion. The application of lightweight and ultra-lightweight synthetic and titanium-containing endoprostheses for abdominal wall repair is accompanied by the formation of connective tissue of adequate strength. The abdominal wall along the implantation perimeter has satisfactory parameters of tensile strength comparable with intact abdominal wall strength, and by day 60 after surgery the parameters are For contacts: Vladimir V. Parshikov,

The aim of the investigation was to study the course of the reparative process in the early postoperative period after the abdominal wall prosthetic repair using light and ultra-light materials in bacterial contamination in experiment. Materials and Methods. Retromuscular abdominal wall repair was modeled on rats using light (ultra-light) endoprostheses contaminated by Staphylococcus aureus and Escherichia coli in the Central Research Laboratory of Nizhny Novgorod State medical Academy. The course of the early postoperative period has been studied, characteristic features of the inflammatory reaction depending on the microorganism cultures and mesh used have been evaluated with the help of the original rating scale. Results. Prosthetic repair in bacterial contamination in experiment is accompanied by a marked inflammatory reaction. Changes are statistically more significant after infecting by E. coli culture. The most intensive inflammation is observed on day 3 (S. aureus) and day 5 (E. coli) after the intervention with the regression of the process by day 14. on day 3-7 after the operation in group E. coli the inflammatory reaction was more expressed after Timesh implantation relative to PP Light application, whereas in group S. aureus it was more significant in case of PP Light application. Conclusion. Using light and ultra-light mesh in a compromised area of surgical intervention in abdominal wall prosthetic repair is possible by stringent indications taking into account potential usefulness and high risk, possessing adequate experience, and observing a number of conditions. Endoprosthesis should not be placed in contact with the zone of maximum contamination.