Authors
Lukoyanychev E.E., Izmailov S.G., Evsyukov D.A., Bodrov A.A., Rotkov A.I., Panyushkin A.V.
City Clinical Hospital №7 of the Leninsky District of Nizhny Novgorod named after E.L. Berezova, Nizhny Novgorod
Abstract
Objective. Despite the spread of the laparoscopic method of hernia treatment, which provides a reduction in the duration of the hospital stage, a quick and comfortable rehabilitation period, the incidence of complications is estimated at 7–12%. One of the main causes of complications is an inadequate local and general reaction of the body to foreign material. The severity of the inflammatory reaction to the implant is determined by an imbalance in the system of pro-inflammatory and anti-inflammatory cytokines, which leads to a change in reactivity in the leukocyte cell system. Taken together, these disorders lead to a deviation from the norm of cytochemical and immunocytochemical parameters. Solving the problems of treatment and prevention of hernias of the anterior abdominal wall has a significant potential for increasing the working capacity of the population and reducing the financial costs of healthcare, improving the patient’s quality of life and cosmetic effect.
Material and methods. On the basis of SBIH NO «City Clinical Hospital №7 named after E.L. Berezov» of the city of Nizhny Novgorod prospectively analyzed the results of treatment of 74 patients aged 18 to 80 years, inclusive, who underwent prosthetic repair of an aponeurosis defect of an unstrapped hernia of the anterior abdominal wall with a standard polypropylene mesh implant. Patients of group I (groups of scientific control, n = 38) did not receive additional treatment. In group II (n = 36), patients from the first day after surgery received hydroxyethyldimethyldihydropyrimidine per os at a dose of 0.5 g 3 times a day before meals for 5–7 days. Blood sampling was performed before surgery and on days 3 and 5 after surgery. The study of the cytokine profile was performed using ELISA kits on the enzyme immunoassay analyzer “Lazurit” (Dynex, USA) by the Gemohelp laboratory (Nizhny Novgorod).
Results. The level of C-reactive protein is characterized by a significant rise on the 3rd day after surgery (p<0.001, Wilcoxon’s test) in both groups. By day 5, C-reactive protein continued to increase by 2 times in the control group (p<0.001, Wilcoxon test), and in the main group, the level decreased by 3 times, with a significant difference between the groups (p<0.0014, U-test). TNF-a in the main group after surgery decreased by 100% from the initial level (p<0.001, Wilcoxon test), in the control group, this indicator stably remained within the initial values. The level of IL-6 after surgery increased 3.4 times (p<0.001, Wilcoxon test) and 3.2 times (p = 0.022, Wilcoxon test) in groups I and II, respectively. In the control group on the 5th day its further growth was recorded, and in the main group it decreased, with a significant difference between the groups by 63% (p = 0.005, U-test). Interleukin 8 significantly differed between the groups on the 3rd and 5th day after surgery, significantly prevailing in group II by 96% (p = 0.016, U-test) and 94% (p = 0.048, U-test), by day, respectively. IL-10 on day 3 after surgery prevailed in group II by 103% (p<0.001, U-test), significantly exceeding the initial value by 56% (p = 0.030, Wilcoxon test). However, on day 5, its concentration was lower than in group I by 20% (p<0.049, U-test).
Conclusion. The pyrimidine drug hydroxyethyldimethyldihydropyrimidine has a significant effect on the concentration of C-reactive protein and cytokines (IL-4, IL-6, IL-10 and TNF-a) in the acute phase of inflammation as part of the pharmacological support of planned hernioplasty of the anterior abdominal wall, which may be associated with a decrease in the production of acute phase proteins, an increase in the processes of cell and tissue proliferation and angiogenesis.
Keywords: pharmacological support, hernioplasty of the anterior abdominal wall, regulation of inflammation, lymphocytes, C-reactive protein, hydroxyethyldimethyldihydropyrimidine.
References
1. Timerbulatov MV, Timerbulatov SV, Gataullina SV, Valitova ER. Postoperative ventral hernias: current state of the problem. Medical Bulletin of Bashkortostan. 2013; 8(5): 101-107. (In Russ.)
2. Fedoseev AV, Muravyov SY, Budarev VN, Inyutin AS, Zatsarinny VV. Some features of the white line of the abdomen, as harbingers of postoperative hernia. Academician I.P. Russian Medical and Biological Bulletin Pavlova. 2016; 1: 109-115. (In Russ.)
3. Itani KM, Hur K, Kim LT, Anthony T, Berger DH, Reda D, et al. Comparison of laparoscopic and open repair with mesh for the treatment of ventral incisional hernia: a randomized trial. Arch. Surg. 2010; 145(4): 322-328.
4. Muysoms FE, Antoniou SA, Bury K., Campanelli G, Conze J, Cuccurullo D, et al. European Hernia Society guidelines on the closure of abdominal wall incisions. Hernia. 2015; 19(1): 1-24.
5. Parshikov VV, Petrov VV, Khodak VA, Samsonov AA, Romanov RV, Gradusov VP, et al. Modern technologies in the surgery of hernias of the anterior abdominal wall. Bulletin of new medical technologies. 2009; 1: 32-38. (In Russ.)
6. Yurasov AV, Ettinger AP, Shestakov AL. The main trends in the surgical treatment of hernias. Resolution of the XII Scientific Conference «Actual Issues of Herniology». M., 2015. (In Russ.) [URL] Accessed 03.02.2022.
7. Belokonev VI, Ponomareva YV, Pushkin SY, Melentyeva ON, Gulyaev MG. Possible predictors and morphological aspects of the development of seroma after plastic surgery of a hernia of the anterior abdominal wall. Surgery News. 2014; 22(6): 665-670. (In Russ.)
8. Ivanov YV, Panchenkov DN, Chaykin RS, Zinovsky MV, Avdeev AS. A method for the prevention of postoperative seromas with laparoscopic allogeneioplasty of ventral hernias. Clinical practice. 2018; 1: 3-9. (In Russ.)
9. Degovtsov EN, Kolyadko PV. Seroms as a complication of surgical treatment of postoperative hernias of the anterior abdominal wall using mesh implants: current status of the problem. Surgery News. 2018; 26(1): 96-102. (In Russ.)
10. Degovtsov EN, Kolyadko PV. Diagnosis and treatment of seroma after hernioplasty of the anterior abdominal wall using a mesh implant. Surgery. 2018; 1: 99-102. (In Russ.)
11. Mikhin IV, Kukhtenko YV, Panchishkin AS. Large and giant postoperative ventral hernias: surgical options. Volgogr. Gos. Med. University. 2014; 2: 8-16. (In Russ.)
12. Nelyubin PS, Galota EA, Timoshin AD. Surgical treatment of patients with postoperative and recurrent ventral hernias. Surgery. 2007; 4: 69-74. (In Russ.)
13. Beschastnov VV, Ryabkov MG, Bagryantsev MV, Spiridonov AA, Tikhonova OA, Dezortsev IL, et al. Features of oxygen homeostasis in the process of reparative regeneration in patients with diabetes mellitus (literature review). Reconstructive and plastic surgery issues. 2017; 3(62): 59-66. (In Russ.)
14. Gorbunova EA. Purulent-inflammatory complications after ventroplasty. Issues of prevention and treatment. News of higher educational institutions. Volga region. Medical sciences. 2011; 1(17): 73-79. (In Russ.)
15. Beschastnov VV, Izmailov SG, Lukoyanychev EE, Bagryantsev MV, Orlinskaya NY, Mironov AA. The activity of the processes of reparative regeneration in the conditions of local circulatory hypoxia of the near-cranium region. Surgery News. 2015; 23(6): 612-618. (In Russ.)
16. Mathes SJ, Steinwald PM, Foster RD. Complex abdominal wall reconstruction: A comparison of flap and mesh closure. Ann. Surg. 2000; 232(4): 586-682.
17. Zhebrovsky VV, Puzako VV. Microflora of the abdominal cavity in patients with extensive and giant postoperative hernias on the background of adhesive disease. Modern methods of treatment of postoperative hernias and events: materials of a scientific-practical conference with international participation. Alushta. 2006: 91-94. (In Russ.)
18. Karakozov MR. Abdominal Syndrome The results of the discussion of the problem «Abdominal Syndrome» in the club Russian Surginet. May 2003. (In Russ.) [URL] Accessed 27.01.2022.
19. Alishev O.T., Shaimardanov R.S. Current state and problems of treatment of large postoperative ventral hernias // Practical medicine. 2013; 2: 16-21. (in Russ.)
20. Parakhonsky AP, Tsyganok SS. Leukocyte immunocytochemistry with inflammation. Basic research. 2004; 1: 74-75. (In Russ.)
21. Kalinina NM, Sosyukin AE, Vologzhanin DA, Kuzin AA, Knyazev PS. Trauma: inflammation and immunity. Cytokines and inflammation. 2005; 4(1): 28-35. (In Russ.)
22. Fedorov VD, Adamyan AA, Gogia BS. Treatment of large and giant postoperative ventral hernias. Surgery. 2000; 1: 11-14. (In Russ.)
23. Vinnik YS, Chaykin AA, Nazaryants YA, Petrushko SI. A modern view of the problem of treating patients with postoperative ventral hernias. Siberian Medical Review. 2014; 6: 5-13. (In Russ.)
24. Hartog D, Dur AH, Tuinebreijer WE, Kreis RW. Open surgical procedures for incisional hernias. Cochrane Database Syst. Rev. 2008; 16(3).
25. Parshikov VV, Mironov AA, Anikina EA, Zaslavskaya MI, Alekhin AI, Kazantsev AA. Prosthetics with ultra-lightweight nets under conditions of bacterial contamination. Modern technologies in medicine. 2015; 7(4): 64-71. (In Russ.)
26. Ivanov SV, Ivanov IS, Mamedov RA, Katunina TP, Tsukanov AV. The dynamics of the cytokine profile in patients with postoperative hernias of the abdominal wall during prosthetics using polytetrafluoroethylene and polyvinylidene fluoride. Clinical Surgery. 2012; 7: 37-41. (In Russ.)
27. Kokotovic D, Burcharth J, Helgstrand F, Gögenur I. Systemic inflammatory response after hernia repair: a systematic review. Langenbecks Arch. Surg. 2017; 402(7): 1023-1037.
28. Dobrokvashin SV, Izmailov AG, Shakirova DKh, Vasilkin DA. The use of the drug Xymedon in surgical practice (practical recommendations). Kazan. 2017: 47. (In Russ.)
29. Pochhammer J, Scholtes B, Keuler J, Müssle B, Welsch T, Schäffer M. Serum C-reactive Protein Level After Ventral Hernia Repair With Mesh Reinforcement Can Predict Infectious Complications: A Retrospective Cohort Study. Hernia. 2020; 24(1): 41-48.
