Lutkovskyi R. Rationale for the development and use of nanomodified mesh implants for open and laparoscopic alloplasty of abdominal hernias (experimental and clinical research)

The dissertation is devoted to the development of nanomodified polypropylene mesh with polymeric antiseptic of the biguanidine group of polyhexamethyleneguanidine chloride, experimental substantiation of the use of nanomodified polypropylene mesh with antiseptic and study of clinical efficiency of modified polypropylene mesh. The study of tissue response to implantation of the developed mesh implant was performed in two series of experiments on 140 laboratory rats (70 animals in each group). In the first group of experiments – 70 animals were implanted with classic polypropylene mesh implants. In the second group – 70 animals were implanted with developed nanomodified polypropylene mesh implants. In the clinical part of the work the analysis of surgical treatment is carried out 1340 patients with abdominal hernias of different types using the developed nanomodified polypropylene mesh and classic polypropylene mesh. Patients were divided into 2 groups: 1 group (main) 676 patients who underwent surgery using the developed nanomodified polypropylene mesh; Group 2 (comparison) 664 patients who underwent surgery using a classic polypropylene mesh. The effectiveness of the use of experimental nanomodified polypropylene mesh in experimental animals was shown, which showed a significant reduction in complications in animals of the main group: 3 (4.3 %) animals developed seroma and 2 (2.9 %) developed purulent wound inflammation in contrast to the comparison group. where seroma occurred in 30 (42.9 %) animals and purulent wound inflammation occurred in 25 (35.7 %). In the surgical treatment of primary hernias of the anterior abdominal wall (inguinal hernia, umbilical hernia, femoral hernia, hernia of the white line of the abdomen) using the developed nanomodified polypropylene mesh there is a significant reduction in postoperative complications due to the pronounced sorption, antimicrobial and anti-inflammatory properties in comparison with the use of classical polypropylene mesh: there was a decrease in seroma from 11.3 % to 2.6 %; purulent inflammation of the wound from 4.1 % to 0.3 %; the frequency of inflammatory infiltration decreased from 6.2 % to 1.5 %; there was a decrease in chronic pain from 5.2 % to 1.8 % and recurrence of hernia from 5.9 % of patients in the comparison group to 1.7 % of patients in the main group; ligature fistulas of the anterior abdominal wall were observed in 3.2 % of patients in the comparison group in contrast to the main group of patients where such complications were not observed. It should also be noted that when using the developed nanomodified polypropylene mesh in the surgical treatment of postoperative ventral abdominal hernias due to the pronounced sorption, antimicrobial and anti-inflammatory properties in comparison with the use of classical polypropylene mesh there is a significant reduction in postoperative complications: a decrease in the frequency of seroma was observed from 32.4 % to 7.4 %; purulent inflammation of the wound from 12.7 % to 1.4 %; the frequency of inflammatory infiltration decreased from 12.7 % to 2.9 %; there was a decrease in chronic pain from 7.9 % to 3.2 % and recurrence of hernia from 9.5 % of patients in the comparison group to 3.1 % of patients in the main group; ligature fistulas of the anterior abdominal wall were observed in 6.3 % of patients in the comparison group in contrast to the main group of patients where such complications were not observed.