Relevance. Duodenal ulcer is complicated by perforation in 5-15% of patients. The priority area of abdominal surgery is the introduction of minimally invasive methods. Laparoscopic surgeries are becoming an alternative to standard technologies. Objective: to analyze the effectiveness of open and laparoscopic palliative and conditionally radical surgical interventions in patients with perforated duodenal ulcer in the early and late two-year periods. Materials and methods. The efficacy of open and laparoscopic palliative and conditionally radical surgical interventions was studied in 181 patients with perforated duodenal ulcer in the early and late two-year periods. The patients were divided into two groups: 92 patients who underwent laparoscopic surgery and 89 patients who underwent open surgery. The groups are comparable in age, time from the onset of the disease, and the diameter of the ulcer. After the operation, the intensity of pain was assessed in points using a visual analog scale, the rate of healing. Complications in the early postoperative period were analyzed (wound suppuration, pneumonia, extrasystole, atrial fibrillation, abscesses, suture failure). Analyzed the development of peritonitis and its characteristics (serous-fibrinous, fibrinous-purulent; local, general). Results. Laparoscopic operations take less time than open ones. In the first four days after surgery, the average pain score was significantly lower (p<0.05) in patients after minimally invasive surgery. There was a tendency towards earlier activation of patients in the group of laparoscopic operations. The duration of hospital stay after laparoscopic operations averaged 5.11±0.08 days (from 3 to 7 days) and was significantly less (p<0.05) for that in patients who underwent open surgery. The two-year cumulative incidence of ulcer recurrence in the group of laparoscopic operations was 16.3% (15 patients), in the group of open operations - 19.1% (17 patients). Conclusions. Laparoscopic palliative and conditionally radical surgeries in patients with perforated ulcers have advantages in the early postoperative period, which is associated with minor pain syndrome and earlier activation of patients and, as a consequence, a decrease in the length of hospital stay. In the long-term two-year postoperative period, the results of palliative and conditionally radical operations in the laparoscopic and open versions did not differ significantly.

The aim of the work – to analyze modern scientific and practical achievements in the effectiveness of implants in planned and emergency hernia surgery and to identify promising areas for further research. The literature review presents modern views on the assessment of biocompatibility, effectiveness and appropriateness of the use of implants in planned and urgent hernia surgery. The importance of determining the main factors of ventral hernia occurrence, assessing the prognostic components of the reparative process course in the field of hernioplasty and methods of correction has been substantiated. Physicochemical characteristics of implants, which both historically and on an up-to-date level are used according to planned or urgent conditions for performing surgical intervention in patients with ventral hernias, are given. The necessity of using an integrated approach to choosing a method for correction or reconstruction of the abdominal wall, taking into account the biological and dynamic conditions of its state, is shown. The need for a selective approach to the choice of therapeutic tactics in patients, especially if hernia repair is necessary in conditions of a clean-contaminated or infected surgical wound, is emphasized. Conclusions. In order to improve the consequences of hernioplasty, it is necessary to assess patient's reserves and risks more thoroughly and comprehensively, as well as to make absolute indications for the use of implants. An improvement in the results of urgent and planned repair of ventral hernias is to perform surgical interventions only in surgery departments constantly provided with modern world achievements.

The aim of the work. To analyze the world achievements in modern diagnostic and treatment tactics in patients with strangulated ventral hernias, as well as to outline promising and pragmatic directions for further research. The literature review presents current trends and views on the choice of individual components of the integrated diagnostic approach in patients with strangulated ventral hernias, and focuses on various principles of therapeutic tactics. The need to further improve the examination methods of abdominal organs, anterior abdominal wall, hernia contents (polypositional roentgenoscopy or roentgenography, ultrasound, CT, MRI) is emphasized and prospects of allohernioplasty and videolaparoscopic technologies with an integrated approach in choosing the method for correction or reconstruction of abdominal wall depending on the prognostic risk factors of postoperative complications are substantiated. Comparison of individual priorities of planned hernia surgery provided the opportunity to define the main directions in terms of urgent medical treatment features for patients with strangulated ventral hernias, taking into account a phasal nature of the pathological process and the availability and applicability of various synthetic implants. The literature analysis allowed for enough critical evaluation of the current state of tension-free allohernioplasty – the main fundamental principle of modern urgent surgery for ventral hernias and determining the main pragmatic directions of a selective approach in choosing the therapeutic tactics for patients with infected surgical wound. Conclusions. Urgent surgery of strangulated ventral hernias requires adequate and timely provision of individual and differentiated approaches in choosing the volume and method of surgery. Improvement of methods for predicting and preventing complications in patients with strangulated ventral hernias will expand the indications for the use of advanced types of tension-free hernioplasty.

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