Hernioplasty stands as one of the most common abdominal surgical interventions. The "gold standard" treatment for inguinal hernias remains Lichtenstein mesh hernioplasty. Nonetheless, clinical practice continues to grapple with issues concerning complications such as recurrence, chronic postoperative pain, and infection. The myriad types of surgery lead to conflicting opinions regarding the superiority and drawbacks of inguinal canal plastic surgery methods. This article presents current data on the surgical treatment of non-mesh inguinal hernias, delineating the most prevalent techniques while exploring their respective advantages and disadvantages. Additionally, the researchers' experiences are analyzed in detail.

BACKGROUND: Numerous methods of eliminating abdominal wall defects developed in the world today do not allow us to talk about solving the problem of hernias. In particular, the causes of chronic postoperative pain associated with the effect of scarring on the spermatic cord have not been fully studied. Testicular flow studies after hernia repair mostly showed different outcomes. AIM: Comparative assessment of blood flow parameters of the testicular, capsular and intratesticular arteries, as well as the diameter of the testicular artery after autoplasty with a displaced aponeurotic flap and Lichtenstein hernioplasty using ultrasound. MATERIALS AND METHODS: A new method of autoplasty was used in 35 patients (Group I). The comparison group (Group II) amounted to 35 patients with Lichtenstein hernioplasty surgery using partially absorbable mesh endoprosthesis (UltraPro). The dynamics of changes in blood flow in the arteries was assessed using color Doppler before surgery, in the early and late postoperative periods. RESULTS: The Wilcoxon paired test showed a significant difference between preoperative and immediately postoperative measurements in both groups. Statistically significant differences between the groups were found in the end-diastolic velocity and resistance index in the testicular, capsular and intratesticular arteries 6 months and 1 year after surgery. The difference in peak systolic velocity was significant in the testicular artery also in the late stages after hernioplasty. The diameter of the testicular artery tended to increase in dynamics, but there was no any statistically significant difference between the groups. CONCLUSIONS: The method of autoplasty in the inguinal canal with a displaced aponeurotic flap does not significantly affect testicular perfusion. In Group II, arterial blood flow indicators 6 months and 1 year after surgery were lower than basal values and had statistically significant differences compared to Group I.

Введение. Несмотря на достаточное количество работ по проблеме использования ксеноимплантатов при герниопластике в мировой науке, следует признать неоднозначность приводимых данных разными учёными, а отсутствие в этих работах исследований применения внеклеточного матрикса ксенобрюшины в реконструкции передней брюшной стенки определяет актуальность данного исследования. Цель исследования: изучить структурные изменения зоны имплантации внеклеточного матрикса ксенобрюшины с тканями передней брюшной стенки в отдаленные сроки эксперимента. Материалы и методы:Проведено сравнительное экспериментальное исследование по изучению отдаленных результатов применения нового биологического имплантата – внеклеточного матрикса ксенобрюшины для реконструкции передней брюшной стенки на 16 белых нелинейных короткошерстных половозрелых крысах обоего пола, массой 180 – 220 г. на базе вивария РГП на ПХВ «Карагандинский государственный медицинский университет» в период с 2016-2017 годы. С помощью методов описательной морфологии и морфометрии дана характеристика течения раневого процесса после имплантации исследуемого материала. Статистический анализ полученных данных проводился с помощью вычисления группового среднего арифметического ( ), среднеквадратичного отклонения (SD). Достоверность различий между исследуемыми группами определялась с помощью непараметрических критериев: критерий Mann-Whitney для сравнения независимых групп («опыт-контроль»), критерий Х2 для оценки различий между долями в группах. Результаты: изучены особенности течения раневого процесса в отдаленные сроки эксперимента после применения нового материала. Морфологически определено, что к 180 дню послеоперационного периода наблюдается формирование состоятельного соединительно-тканного рубца без признаков постимплантационного воспаления. Количественный состав клеточного инфильтрата к 180 суткам после имплантации, статистически значимо изменяется в сторону увеличения числа структурных стромальных клеток с обратно пропорциональным снижением клеток экссудативной и пролиферативной фаз воспалительно-регенераторного процесса в сравнении с начальными сроками наблюдения. Выводы: внеклеточный матрикс ксенобрюшины демонстрирует адекватную биосовместимость с макроорганизмом, с формированием зрелого, состоятельного контакта с тканями передней брюшной стенки без признаков хронического постимплантационного воспаления. Introduction.Despite the sufficient number of works on the problem of the use of xenogeneic implants in hernioplasty in the world science, it is necessary to recognize the ambiguity of the data presented by different scientists, and the absence in these studies of the use of extracellular xenograft matrix in abdominal wall reconstruction determines the relevance of this study. The aim was to study the structural changes in the implantation area of the extracellular bovine-derived peritoneum matrix with the tissues of the anterior abdominal wall in the long term of the experiment. Materials and methods. In the period of 2016-2017yy a comparative experimental study was carried out to study the long-term results of the application of a new biological implant, the extracellular bovine-derived peritoneum matrix, for abdominal wall reconstruction on 16 white nonlinear short-haired rats of both sexes, weighing 180-220g on the basis of the vivarium of the Karaganda State Medical University. Using the methods of descriptive morphology and morphometry, a characteristic of the wound process after test material implantation is given. Statistical analysis of the obtained data was carried out by calculating the group mean ( ), standard deviation (SD). The reliability of the differences between the groups studied was determined using nonparametric criteria: the Mann-Whitney criterion for comparing independent groups ("experience-control"), the X2 criterion for estimating the differences between the shares in the groups. Results. The...

Introduction: Modern herniology relies heavily on synthetic mesh prostheses, which have markedly reduced recurrence rates and improved outcomes. However, the use of tension-free repair in infected or highly contaminated fields remains insufficiently studied. Biologic implants based on the extracellular matrix (ECM) may attenuate the inflammatory response and reduce the risk of infection. This study evaluates the behavior of different implant types under experimental bacterial contamination. Materials and methods: Three implants were investigated: an extracellular bovine-derived peritoneum matrix, preserved dura mater (DM), and the composite mesh prosthesis UltraPro. The study was conducted on 78 rats. After the creation of a standardized anterior abdominal wall defect, the defect was repaired using one of the studied implants and subsequently inoculated with MRSA or E. coli. Animals were observed for 10 and 20 days. Microbiological, immunological (circulating immune complexes), hematological, and macroscopic parameters were evaluated. Results: MRSA contamination induced a pronounced local inflammatory response, including abscess formation on day 10, whereas E. coli was rapidly cleared from the implantation zone. No statistically significant differences in MRSA persistence or semi-quantitative titers were observed between ECM, UltraPro, and DM. Systemically, CIC patterns and hematological changes were similar between ECM and UltraPro, while DM—particularly under MRSA contamination—was associated with a more pronounced inflammatory response. Conclusions: Under conditions of experimental bacterial contamination, the extracellular bovine-derived peritoneum matrix demonstrated local and systemic inflammatory profiles comparable to those of the synthetic UltraPro mesh and more favorable than those of preserved dura mater. All implants elicited a controlled inflammatory reaction without evidence of systemic septic complications. These findings support further research, including clinical trials, on the use of extracellular bovine-derived peritoneum matrix for reconstructive surgery of anterior abdominal wall defects in contaminated and potentially contaminated fields.

ОЦЕНКА КАЧЕСТВА ЖИЗНИ У ПАЦИЕНТОВ ПОСЛЕ АУТОПЛАСТИКИ ПАХОВОГО КАНАЛА ПЕРЕМЕЩЕННЫМ АПОНЕВРОТИЧЕСКИМ ЛОСКУТОМ

Background: The study suggests that the use of the extracellular bovine-derived peritoneum matrix as a new biological implant opens up new prospects for nephropexy. Materials and Methods: Experimental nephropexy was performed in 64 white shorthaired adult rats, divided for 2 groups: extracellular bovine-derived peritoneum matrix, UltraPro mesh. Implants were 1,5*1,5cm per one animal. Observation periods were 7, 21, 30 and 180 days. The tissue was stain with H&E, Van Gieson’s with pikro-fuchin. Cellular infiltrate was evaluated by counting granulocytes, mononuclear cells, and foreign-body giant cells on five high-magnification images for each stained section (×400). Results: The use of the extracellular bovine-derived peritoneum matrix induced less intense and less prolonged chronic inflammatory response, as well as intense production of new collagen fibers more similar to the native connective tissue in terms of their histologic structure. The UltraPro mesh induced moderately persistent chronic inflammatory response throughout the 6- month study period. Conclusion: Histologic evaluation demonstrates high biocompatibility of both the extracellular bovine-derived peritoneum matrix, and the UltraPro mesh implants.The results of using new biological material are not worse than synthetic mesh. The data obtained justify further research of the extracellular bovine-derived peritoneum matrix as a plastic material for nephropexy.