The textbook is devoted to the etiology and pathogenesis of recurrent postoperative ventral hernias after autoplastic and prosthetic hernioplasty. The paper describes the surgical anatomy of the abdomen, clinical manifestations, diagnosis of recurrent hernias, classification of ventral hernias, tactics and possible treatment options for patients depending on the previous method of hernioplasty, and describes the technique of reconstructive operations. Meets the requirements of the federal state educational standards of higher education of the latest generation. It is intended for surgeons, postgraduates, undergraduates and teachers of medical universities.

The monograph is devoted to the pathogenesis, clinic and treatment of patients with femoral hernia. The anatomy of the formed femoral canal, hernia location options, classifications, clinic and diagnosis of uncomplicated and complicated femoral hernia are described. Data on the possibility of instrumental methods (X-ray, ultrasound, CT, as well as laser spectroscopy) for assessing the state of the periosteum of the pubic bone are presented. A historical review of operations in patients with femoral hernia is given. A method for the treatment of uncomplicated femoral hernia with a description of a new variant of femoral canal plastic surgery in the destruction of the periosteum of the pubic bone is proposed. The tactics and technique of operations in patients with a strangulated hernia with a simple and complicated course are described. The results of treatment are presented depending on the methods used and options for completing operations. Designed for surgeons, students, residents, postgraduates and researchers engaged in the study of problems of experimental and clinical herniology.

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Цель. Обосновать показания, объем и технику выполнения операций у пациентов с первичным и третичным гиперпаратиреозом при сочетании с патологией в щитовидной железе.Материал и методы. Проанализировано лечение 63 пациентов с гиперпаратиреозом в возрасте от 20 до 80 лет. У 23 был первичный, у 40 -третичный гиперпаратиреоз. Мужчин было 20 (31,7%), женщин -43 (68,3%). Диагноз устанавливали на основании жалоб пациентов на боли в костях, мышцах, кожный зуд, по уровню общего и ионизированного кальция, неорганического фосфора и показателям паратиреотропного гормона (иПТГ>300 пг/мл). Операции выполняли из доступа по Кохеру, по передней поверхности шеи. При повторных вмешательствах использовали односторонний доступ по В.И. Разумовскому. Операции у пациентов с первичном гиперпаратиреозом были направлены на удаление аденомы паращитовидной же-лезы, а при третичном гиперпаратиреозе -на тотальное удаление паращитовидных желез. При сочетании с патологией в щитовидной железе проводили тиреоидэктомию, реже -ее субтотальную резекцию.Результаты. Из 23 пациентов с первичным гиперпаратиреозом у 14 выполнено удаление аденомы и тиреоидэктомия, у 3 -удаление аденомы и субтотальная резекция щитовидной железы. Из 40 пациентов с третичным гиперпаратиреозом удаление гиперплазированных паращитовидных желез сочеталось у 18 с тиреоидэктомией, у 7 -с резекцией щитовидной железы. Сравнение УЗИ и КТ с операционными дан-ными показало, что эти методы ориентировочно указывают на количество и места расположения аденом паращитовидных желез. У 23 пациентов с первичным и у 37 пациентов с третичным гиперпаратиреозом результат лечения хороший, у 3 развился рецидив.Заключение. Лечение пациентов с первичным гиперпаратиреозом направлено на удаление аденомы, с третичным -на тотальное удаление паращитовидных желез. Ключевые слова: первичный и третичный гиперпаратиреоз, особенности лечения, объем операций, доступ по Кохеру, рецидив, аденома околощитовидной железы, тиреоидэктомияObjective. To substantiate the indications, volume and operation technique in patients with primary and tertiary hyperparathyroidism in combination with the pathology of the thyroid gland.Methods. The treatment of patients (n=63) with hyperparathyroidism aged 20-80 years has been analyzed. 23 patients suffered from primary and 40 -tertiary hyperparathyroidism. There were 19 males (31,7%) and 41 females (68,3%). The diagnosis was made on the basis of patients complaints of pain in the bones, muscles, skin itching, the level of total and ionized calcium, inorganic phosphorus and value of parathyrotrophic hormone (PTH > 300 pg/ml). The operations were carried out via a Kocher's incision on the anterior surface of the neck. In repeated interventions unilateral access according to V.I. Razumovsky was used. Surgeries in patients with primary hyperparathyroidism were aimed to remove the parathyroid adenoma, and with tertiary hyperparathyroidism -to complete removal of the parathyroid glands. Thyroidectomy was performed in combination with the thyroid disease and more rarely its subtotal resecti...

Introduction. Among patients with primary and postoperative ventral hernias, obesity of various degrees is observed in more than 50 % of patients. A severe complication of obesity is the development of panniculus – a skin-subcutaneous apron of varying severity. The hernia surgeon often performs a panniculectomy, which requires justification, taking into account both the positive and negative consequences.The objective was to improve the results of treatment of patients with hernias who are obese by developing a mathematical algorithm of indications for removing the skin-subcutaneous apron.Methods and materials. The analysis of surgical treatment of 253 obese patients with hernia aged 20 to 90 years was performed. There were 44 males (17.4 %) and 209 females (82.6 %). There are 2 groups: the first (comparison group) included 129 patients whom the hernia excision was performed without removing the skin-subcutaneous apron; the second (main group) – 124 patients who had the excision of the skin-subcutaneous apron during surgery. Indications for panniculus removal were based on the proposed mathematical algorithm, which took into account the size, clinical manifestations, associated complications, and possible consequences after surgeries while preserving it.Results. When considering the abdomen in patients with hernias and obesity from the side surface, the hanging apron in relation to the abdominal wall forms a truncated cone, or two conjugated cones that form significantly different moments of forces acting on the abdominal wall at different stages of development of the panniculus, and, therefore, can serve as the basis for the development of classification. Based on this mathematical model, the following classification of changes in the anterior abdominal wall in hernias and obesity is proposed: saggy belly; cutaneoussubcutaneous apron I, II, III degrees, which are based on calculated mathematical indicators and clinical manifestations of the disease. When treating patients with hernias and obesity during operations, the following tactical algorithms were followed: with a saggy stomach and panniculus of the 1st degree, the removal of the skin-subcutaneous apron can be refused; with the 2nd and 3rd degrees, its preservation contributes to the recurrence of the hernia due to the action of moments of forces that shift and pull the abdominal wall down.Conclusions. Clinical observations of patients with hernias and obesity have shown that the removal of the skinsubcutaneous apron did not lead to an increase in the frequency of wound and systemic complications, and therefore it should be considered a necessary stage of surgery.