THE INFLUTNCE OF DRUG CORRECTIONOF METABOLIC SYNDROME IN PATIENTS AFTER ALLOPLASTIC OF SRTANGULATED VENTRAL HERNIAS ON WOUND COMPLICATIONS DEVELOPMENT

There were 57 patients with strangulated hernia of abdomen and metabolic syndrome examined which was urgent made plastic of hernia defect by polypropylene mesh Linteks-Esfil (St. Petersburg). The patients divided on 2 clinical groups: 1st clinical group (20) – patients in postoperative period received traditional complex of conservative treatment, 2nd clinical group (37) – except traditional, mentioned above patients treated by 2,5%-2ml solution of thiotriazolin intramuscular and metformin 500 mg/per day for correction of metabolic syndrome. The filling of hernia bag in 61,4% of parients was strand of the great omentum, in 33,4% - loop of small intestine, in 5,2% - colon. Plastic of postoperative hernias performed – by techniques "onlay" - to 8,7%, "sublay" - at 87,8%, "inlay" - 3.5%. Intraoperative in patients were symptoms of serous inflammation, which manifested like edema, infiltration of hernia bag walls, and also missing of purulence and fibrin in hernia water. In 17.8% (5 patients), with overweight and the risk of respiratory distress syndrome for the prevention of small abdominal cavity performed plastic of hernia by a joint (inlay). Semi-closed method of hernia plastic performed in 78% of patients of 1st clinical group and only in 23% in 2nd clinical group. The wounds were actively drained by vacuum system “Redon”. The average body weight of patients ranged from 87 to 138 kg. BMI amounted 33,63 ± 3,55 kg / m2 for women and 35,47 ± 4,25 kg / m2 for men. In 97.5% of patients detected laboratory lipid spectrum violation of the blood. In 59,2% patients of 2nd clinical group improved lipid metabolism on day 7, patients with clinical group 1 only in 15%. Postoperative wound complications as seroma, infiltrations developed in 6,3% of patients, which was eliminated by conservative methods of treatment. Patients of clinical group 2 were better tolerated of postoperative period, average length of stay in hospital was reduced to 2,03 ± 0,2 l/d. In the postoperative period from wounds complications following were observed in patients with clinical group 1: seroma (14.3%), infiltration (21.4%), hematoma (3.6%), suppurating wounds (10.7%), ligature fistula (7.1%); 2 clinical groups: seroma (8.8%), infiltration (11.7%), hematoma (2.9), suppurating wounds (5.8%), ligature fistula (2.9%). In 12 patients after removal drainage continued exudation through the drain to 15 days. In 2 patients successfully completed the puncture of seroma in the area of surgical wound after ultrasound confirmation. Consequently, the treatment of patients with strangulated hernias of anterior abdominal wall should be in complex with plastic of hernia defect by polypropylene mesh and drag correction of lipid metabolism violations. The treatment of wounds is effective by using of conservative methods. Conclusions. 1. The using of polypropylene mesh in strangulated ventral hernia cases shows high effectiveness of the method and it is advisable to use in emergency surgery of hernia. 2. Treatment of such patients should be integrated with the mandatory diagnosis of metabolic syndrome and drug correction. 3. Complications from surgical wounds effectively treated by conservative methods with using of punctures, drainages, physiotherapy.