Introduction. Seromas and hematomas of the implantation area are among the most common complications in prosthetic repair of a hernia defect with a mesh implant. The adequate tissue inflammation response to prosthesis implantation is achieved by the local protective role of pro-inflammatory cytokines. With suppression of the body's immune system combined with existing comorbidities, mesh implants result in even greater suppression of the immune system, which is manifested by an inadequate inflammatory response, both local and systemic, leading to the development of complications.Previously, the authors studied the effect of pyrimidine preparation "Xymedon" (INN - hydroxyethyldimethyldihydropyrimidine) on the systemic inflammatory process after prosthetic repair of anterior abdominal wall hernias. Based on the results of the interim study, it was hypothised: Regulation of the inflammation response to prosthesis implantation in hernioplasty manifested by changes in cytokine concentration in the blood can reduce postoperative complications. The aim of the study was to reduce the number of postoperative complications in prosthetic hernioplasty by regulating inflammatory reactions that occur after mesh implants.Materials and methods. Experimental part of the study. The experiment involved 66 rats, both sexes, pure line, which were implanted with mesh prostheses. Animals in group I (n=33) the control one - received 1 ml of 0,9% sodium chloride solution, i.e. received no specific treatment. Animals in group II (n=33) - the main one - received "Ximedon" 21 mg/day as pharmacological support. Blood sampling to determine inflammation markers was performed on the 5th day after the intervention. Animals were withdrawn from the experiment and the implantation site was taken for histological and histomorphometric investigations on the 5th day of the study. The study was carried out in the SPF vivarium at the laboratory of the Center for Genetic Collections of Laboratory Animals, Lobachevsky State University of Nizhny Novgorod. The study consisted of 4 series of experiments (2018-2021). Clinical part of the study. Prospectively (2018 - February 2022), we analyzed clinical outcomes of 101 patients with prosthetic repair (by Liechtenstein, TAPP, eTAR, "sublay") of an aponeurosis hernia defect of the anterior abdominal wall who received treatment in the City Clinical Hospital №7 named after E.L. Berezow. Patients of the "control" group (n=33) received only conventional treatment; patients of the "Ximedon" group (n=68) received 0.5 mg of ximedon 3 times a day for 10 days orally from the first day after the operation. Blood sampling was carried out on the 5th day after surgery. The data obtained were processed and structured using Microsoft Excel 2019 (64 bit), and statistical values were calculated in StatSoft Statistica 12,5 (64 bit).Results. Xymedon has a significant effect on the increase in the area of ​​the vessels of the implantation area in the experiment. Its use is associated with a lower level of C-reactive protein and blood IL-6 on day 5 in the experimental group compared to the control group. In the clinical study ximedon has a significant effect on the cytokine concentration in the blood: C-reactive protein, TNF-a, interleukins 6, 8 and 10. In the experimental study the dynamic of C-reactive protein, blood interleukins 6 and 10 does not significantly differ from the clinical one. In the clinical study, xymedon intake was associated with fewer postoperative complications. Conclusion. The studies performed allow us to consider "ximedon" as a means of pharmacological support for prosthetic repair in external abdominal hernias due to a significant reduction in postoperative complications provided by the ability to regulate inflammation reactions and stimulate reparative regeneration.

Importance. Surgical procedures have a lot of stress, causing significant violation of the non specific defense mechanisms of the body and the immune system, which requires the use of different pharmacological agents in order to increase natural resistance to infection.Purpose. An analytical review of experimental and clinical research in the direction of studying the effectiveness of the impact of enteral xymedon on reparative process of surgical wounds and tissue non-specific resistance of the organism to infection for the prevention of inflammatory wound complications.Materials and methods. The analysis of experimental and clinical data, dealing with the question of studying the effect of enteral and topical xymedon to repair tissue in the area of the surgical wound and the non-specific resistance to infection.The criteria for the effectiveness of the drug were clinical and laboratory parameters, and statistic methods.Results and their discussion. The analysis of experimental and clinical studies have shown that enteral and topical use xymedon in surgical patients stimulates wound healing surgical site and increases nonspecific resistance to infection by increasing the functional activity of neutrophils, their backup potentials normalize the concentration of a bioactive and immunoreactive fibronectin in blood plasma, improve antimicrobial activity of wound.Conclusions. Xymedon is recommended as an effective means of pharmacological support of wound healing in surgical patients to prevent postoperative wound complications.

Background. Wounds inflicted by the teeth of animals and humans take a special place and have a number of characteristic features. There is still no generally accepted surgical tactics for the bite wounds treatment, and the issues of choosing the timing of wound closure, depending on their localization, remain unresolved. Aim. To analyze the clinical experience of bite wounds surgical treatment by applying primary and secondary sutures. Material and methods. From 2008 to 2018 409 patients with bite wounds of various localizations (289 female and 120 male) aged 16 to 84 years were under our supervision. The average age of the victims was 52.510.17 years. All patients were prescribed combined therapy, which was based on an urgent surgical care, since we attach a decisive role in the prevention and local treatment of wound infection to full primary or secondary surgical treatment. The analysis of the obtained data was performed using the statistical calculations in R 3.6.3 (R Foundation for Statistical Computing). To compare the average treatment time for primary and secondary sutures nonparametric MannWhitney test was used. Results. Analysis of the obtained clinical data showed that the largest number of bite wounds were dog bites (95%), which occured most often in spring (38%) and summer (38.1%), and, as a rule, at home (68%), these results were comparable with statistical data from other sources. The average duration of patients treatment with a primary suture was 13.2 days, and with a secondary suture 19.3 days. The authors proposed a differentiated approach to the choice of surgical tactics in the treatment of patients with bite wounds, depending on the timing of their admission to the hospital and the local status of the wound defect. Conclusion. The primary or primary delayed blind suturing should be used in the early stages (not later than in 12 hours after getting a bite), and secondary sutures are shown in late stages (more than 12 hours).

Background. The ultrasound method of examination is often used to detect liquid formations of a postoperative wound. For this reason, the search for new criteria for assessing the course of the wound process is currently relevant. Aim. To study the possibility of using the ultrasound method of research to determine the severity of postoperative wound complications according to the ClavienDindo classification and further optimal tactics, diagnosis and treatment. Material and methods. 255 patients after surgery for various urgent diseases of the abdominal organs, as well as patients with elective surgeries were examined. All patients underwent complex clinical, laboratory and instrumental studies. Continuous values that do not have a normal distribution were processed using non-parametric methods the values were presented in the format Me [Q1; Q3], the difference in unrelated groups was assessed by the MannWhitney U test, and in related groups, by the Wilcoxon test. Results. The postoperative period in 58 (22.7%) of 255 patients was complicated by postoperative wound complications, which had I, II, III severity according to the ClavienDindo classification. On the 5th day of ultrasound examination of the surgical site with the III degree of severity of postoperative wound complications, there was a statistically significant increase in the echogenicity width of tissues in the area of the wound defect compared with the III severity of complications. Conclusion. The ultrasound method of research allows to evaluate the effectiveness of reparative processes in damaged tissues and the development of complications, as well as to determine the severity of their course in the postoperative period for planning further surgical tactics.

Purpose of the study. was to improve the technology of prosthetic repair of the anterior abdominal wall patients with hernias by means of pharmacological regulation of the local and systemic inflammatory response and stimulation of reparative regeneration.Materials and methods. The study was carried out on 52 pure line rats in vivarium. All animals have on-lay implantation of a polypropylene mesh imlantant. Group I have no specific pharmacological treatment receive (0.9 % sodium chloride solution); group II – receive solution of xymedon, group III – potassium orotate, group IV – methyluracil.Results. Identified that all investigated drugs of the pyrimidine series (xymedon, potassium orotate, methyluracil) have a significant effect on the local and systemic inflammatory process. The growth of IL 10 and TNF-a are associated with an increase in the area of liquid inclusions. The use of potassium orotate and methyluracil in the postoperative period is inappropriate, as it is associated with an increased risk of hemorrhage and acute paraprosthetic fluid accumulations. Taking xymedon after surgery is associated with an accelerated growth of blood vessels and granulation tissue, a decrease in fluid inclusions, but is associated with an insignificant increase in the risk of tissue hemorrhage.Conclusion. Pharmacological regulation of inflammatory and regenerative processes with xymedon in the perioperative period of prosthetic repair could guide the development of surgical treatment of patients with abdominal hernias, which requires further clinical study.