Aim to present a new midline approach technique with dissection of the navel and umbilical ring, that allows to reduce the number of postoperative ventral hernias after median laparotomy. Material and methods. The study involved 230 patients operated using the median approach with the transumbilical technique and with the traditional technique of midline laparotomy with a bypass of the umbilical ring on the left. The observation period lasted from 2016 to 2021. Results. The observation helped to assess the course of the postoperative period and the long-term outcome in the area of the surgical intervention on the abdominal wall. The advantages of the proposed technique were determined. Conclusion. When performing an access with a dissection of the umbilical ring, a strict compliance with the sequence of actions of suturing the laparotomic wound is of great importance. For the prevention of postoperative ventral hernias, it is important to combine the methods of access and suturing of the median laparotomic wound.

The problem of postoperative ventral hernias remains relevant due to the high frequency of their development — in 7–24% of patients. Aim. To evaluate the effectiveness of prevention of postoperative ventral hernias using a new technique of access to the abdominal cavity in comparison with traditional laparotomy. Materials and methods. The proposed new technique of access to the abdominal cavity along the midline of the abdomen with dissection of the navel and umbilical ring was carried out in accordance with the method developed by us, registered by the patent of the Russian Federation. For the final analysis, 134 patients were selected, divided into group 1 (n = 67), in which the median access was performed using a new technique, and group 2, in which the traditional median access was performed with the left umbilical ring bypass (n = 67). The initial parameters of patients, characteristics during and after surgery were evaluated. The duration of follow-up after surgery was 24 months. Results. Groups 1 and 2 were comparable by gender, age, body mass index, and the presence of comorbidities. In 79% of patients in group 1 and in 67% of patients in group 2 (the difference is not significant), indications for surgery were malignancies of the abdominal cavity. The groups did not differ in the types of median laparotomy, the time of surgery, the amount of blood loss, the time of removal of postoperative sutures, and the duration of hospitalization. All patients were followed up for 24 months. Postoperative ventral hernia developed in one patient (1.5%) in group 1 and in 5 (7.5%) patients in group 2 within 12 to 24 months after surgery. There were no statistically significant differences in the frequency of hernia development (Mantel — Cox test, p = 0.100) Conclusion. A new method of median laparotomy in the treatment of patients with planned surgical pathology of the abdominal cavity is characterized by a low rate of postoperative hernia development.

Objective: the development and assessment of endoscopic hemithyroidectomy technique improving visualization of anatomical structures and excluding the so-called conflict of instruments in the operative field. Materials and methods. We analyzed the treatment results of 103 patients who underwent hemithyroidectomy with endoscopic or traditional approaches during 2014-2018 at the S.R. Mirotvortsev Hospital of Saratov State Medical University. In terms of approach mode, patients were divided into two groups. The compression syndrome, functional autonomy of a thyroid, and results of a punch biopsy were indications to operation. Results. Unilateral vocal cord paralysis (UVCP) was diagnosed in one patient after traditional intervention, diminishing after 1.5 months; and in three patients after endoscopic hemithyroidectomy, diminishing anywhere between 7 days and 1.5 months. Signs of hypoparathyroidism were not found in any of the patient groups. There were no complications associated with the introduction of carbon dioxide. No conversion was required in any of the cases. Conclusion. Development, application and assessment of a new endoscopic hemithyroidectomy technique, which proved itself feasible, safe and provisioning highly esthetic outcome were conducted.

Objective: method development for preventing postoperative ventral hernias based on experimental assessment of the stress-strain properties of aponeurosis in various types of a midline laparotomy. Materials and methods. We evaluated 42 fascia muscular aponeurotic complexes of the anterior abdominal wall. Based on the technique for dissecting the aponeurosis and its suturing, the complexes were divided into two groups (each containing 21 samples): Group 1 with a bypass of the umbilical ring on the left, and Group 2 with umbilical ring dissection. Results. Fascia aponeurotic complexes dissected and sutured through the umbilical ring (Group 2) had, on the average, higher values of mechanical characteristics. E.g., mean values of tensile stress (S), tensile stress at a maximum load (Smax), Young’s modulus (E), aponeurotic tensile strain (D), aponeurotic tensile strain at a maximum load (Dmax), and maximum load level (Load) were higher in Group 2 by 35.4; 39.8; 14.9; 34.6; 30.2 and 40.2 (%), respectively. Conclusion. We conducted the development, experimental application and evaluation of a novel method for preventing postoperative ventral hernias after a midline laparotomy based on the assessment of the stress-strain properties of aponeurosis.