Kholodov I. Improving the efficiency of surgical treatment of abdominal wall hernias in patients using alloplasty (experimental clinical trial)

The dissertation is devoted to improvement of results of surgical treatment of patients with hernias of the anterior abdominal wall by application to frame hernia plastics in combination with the use of the preparation of "collagen hydrolyzate" to optimize the process of forming connective tissue around mesh prostheses. In the experimental laboratory animals, the response of periprosthetic connective tissue to implantation of mesh prostheses was investigated and adequate methods of drug correction of collagen formation processes were developed, the effect of collagen hydrolyzate on the formation, maturation and modeling of connective tissue along the connective tissue was studied in the experiment. It was found that collagen hydrolyzate in the experiment enhances neoangiogenesis (19,6% more than in the control and 17,4% more than in the comparison group, p <0,05) with significantly less inflammation around the mesh implant, which determines better biocompatibility of mesh endoprosthesis, stimulates synthesis and accelerates the maturation of collagen in the periprosthetic capsule. It has been established that allogernyoplasty of ventral hernias with mesh structures of Rebound HRD is characterized by less occured postoperative pain syndrome, a significant decrease in the incidence of local periprosthetic complications such as seroma and meshoma from 42,8% in the control group to 10% in the control group. Collagen-stimulating effect of collagen hydrolyzate in the performance of endoprosthesis causes the formation of a qualitatively more complete periprosthetic capsule, which further determines the number of relapses from 5% in the control group to 1,5% at the depth of observations up to 3 years. Long-term results of surgical treatment of ventral hernias showed that the quality of life of patients on a scale of SF-36 in the postoperative period against the background of stimulating neocollagenogenesis therapy, significantly improved by most of the criteria (5 out of 8) and did not deteriorate by other criteria. Based on achieved results, recommendations on the choice of pathogenetically sound method and scheme of medication correction of collagen formation in external abdominal hernias in the postoperative wound in girnosia have been developed.