Demographic changes associated with the aging population mean that surgeons increasingly have contact and make decisions about treating patients from the oldest age groups. the aim of the study was to review the literature concerning the treatment of acute appendicitis in patients over the age of 60 years old. material and methods. A review of the literature published in the years 2000-2015 has been carried out using the PubMed database. The initial number of results corresponding to the query in English, "appendicitis (MeSH) AND elderly (MeSH)" was 260. Selection based on the titles, abstracts, and eventually whole articles, ultimately resulted in 11 papers concerning the treatment of appendicitis in patients above 60 years of age. Results. Nine papers were retrospective and 2 were prospective. In total, the studies included 82,852 patients. Laparoscopic appendectomy was associated with a lower mortality rate, a smaller number of postoperative complications and a shorter length of hospital stay, which led to it being recommended by most authors. Four of the ten papers demonstrated that the patients who were qualified for laparoscopic surgery had less comorbidity and were in a lower ASA (American Society of Anaesthesiology) category. Antibiotic therapy as an independent method was assessed in one study in a group of elderly people, on a selected group of 26 patients, and its effectiveness was shown to be 70%. Most studies, however, are highly heterogeneous which significantly hindered comparisons. conclusions. Currently, laparoscopic appendectomy seems to be the treatment of choice in the elderly with acute appendicitis. Antibiotic therapy, as an independent method of treatment of acute appendicitis, cannot currently be recommended. However, further, prospective, and better-designed studies are needed, involving a larger number of patients, and primarily dedicated to the elderly.

Objective. To improve clinico–esthetic results of surgical treatment of postoperative ventral hernias of infra–umbilico–hypoabdominal localization and hypogastric cicatricial deformities in patients, suffering obesity. Materials and methods. The work is based on the results of analysis of perioperative investigations, conducted in 37 patients. The main group was consisted of 26 patients, suffering postoperative ventral hernias after lower laparotomies or laparoscopic interventions. In 11 patients, forming a control group, there were present the soft tissue deformities without aponeurotic defects and hernias. All the patients have had general obesity Degrees I–III and/or abdominal obesity. In all the patients there was conducted a various volume calculated excision of excessive and cicatricial–fibrous tissues and, in necessity, – alloplasty of hernial gates. Results. Overall parahernial excess of tissues in formatted hypogastic postoperative ventral hernias have had predominantly supraaponeurotical localization and metric characteristics, determined by the hernial dimensions, emphasis of adjacent lipid–containing layers and fibrous–cicatricious components. While performing of hernioabdominoplasty in such patients it is expedient to apply a combined tactics of standard aponeurotic hernioplasty and dermolipectomy/fibrolipectomy with abdominoplasty. This permits to lower essentially (up to 3%) the rate of the local complications development. Conclusion. The calculated beforehand hernioabdominoplasty constitutes the most rational principle of surgical treatment for hypogastric postoperative ventral hernias in patients, suffering obesity.

Objective. To formulate clinic-morphological substantiation for application of calculated excision of excessive and pathologically changed parahernial tissues together with performance of improved abdominoplasty in surgical interventions in patients with hernias in conditions of ventral obesity. Materials and methods. The investigation is based on data of paraoperative examinations and own results of surgical treatment of 58 herniological patients. Rational methods of their operating are substantiated by patho- and morphometric characteristics, determined in accordance to the observed dimensions of ventral hernia deformation, and content of the fat-containing, fibrous-cicatricial and inflammatory-pathological components in it. Results. The program set «Statistica 6.1»  was applied for elaboration of the results obtained. In accordance to own algorithm of the ventro- and sonometric investigations there was established, that the parahernial tissues extras in the patients with external hernias are localized and originated supraaponeurotically. Preoperative considerations concerning determination of optimal volumes of conduction of dermo- and fibro-lipectomies, performed before hernio-abdominoplasties on various hernias with signs of ventral obesity, have permitted to prevent the local purulent-inflammatory complications and to improve the indices of quality of life in the patient operated on. Conclusion. Application of the «with no surpluses» operating principle constitute a practical base for improvement of reconstructive-plastic  interventions results in external abdominal hernias and a real component of the problem decision in medic-social and esthetic rehabilitation of herniological patients with obesity.

Objective. Clinical assessment of combined application of the calculated dermolipectomy with improved hernioabdominoplasty in treatment of patients, suffering hernias and external abdominal deformities, who have excessive tissues of abdominal wall. Materials and methods. The investigation is based on data of paraoperative examinations and own results of surgical treatment of 67 patients with hernias and external abdominal deformities. Rational methods of their operating were substantiated on background of morphometric characteristics, determined in accordance to the ventral deformity dimensions, and percentages of adipose-containing, fibrous-cicatricial and pathological components content. Results. The program unit «Statistica 6.1» was applied for statistical elaboration of the results obtained. Algorithm of quantitative investigations of the ventral tissues excessives, which have had predominantly supraaponeurotic localization, was elaborated for the first time. Preoperatively calculated volumes of preventive dermo- and fibrolipectomies, which were performed together with hernio- and abdominoplasties in accordance to new principle «without excesses of parahernial tissues» in various hernias and venral deformities, have reduced essentially the local complications rate - to 2% (р < 0.05) and improved the indices of quality of life and the patients’ health. Conclusion. Practical application of the «tension-free» and «nonrebundant» principles in operating of hernias constitute the base for further elaborations of reconstructive-plastic interventions and a real component of the problem decision in medico-social and esthetic rehabilitation of certain herniological patients.

Аnotation. The relevance of improvements in the performance of herniotomy-hernioplastycs in patients with abdominal obesity is determined by a significant frequency of their postoperative complications, which reaches 25-30%. The аim is to evaluate the clinical effectiveness of simultaneous dermlipectоmy with hernio-abdominoplasty during surgical interventions in patients with hernias and ventral excess tissues. The work was performed based on the own results of paraoperative examinations and treatments of 67 adult patients. The rational principles of their surgery are substantiated on the basis of metric characteristics determined by the size of the ventral deformation, the severity of fat-containing, fibrotic-scarring and pathological components in it. The results were processed by the software package "Statistica 6.1". For the first time, an algorithm for quantitative studies of ventral tissue excesses with predominantly supra-neurotic localization was developed. The preoperatively calculated volumes of preventive dermo-fibrolipectomies, which were performed together with hernio- and abdominoplasties according to the new principle "without excess paragerneal tissue" in various hernias and ventral deformities, significantly reduced the incidence of local complications (up to 2%, p < 0.05) and improved the quality of life and health. The practical application of "tension-free" and "redundant" principles of surgery is the basis for further development of reconstructive and plastic interventions and a real component of solving the problem of medical, social and aesthetic rehabilitation of the relevant herniological patients.