OBJECTIVE:To analyze genome-wide studies devoted to polymorphisms of factors of anterior abdominal wall hernias, to study the association of the most common polymorphism In Russian population. MATERIAL AND METHODS:Searching for literature data was carried out in the RSCI and PubMed databases. We enrolled national and foreign reports. The study on Russian population included 577 people. RESULTS:We found 5 genome-wide studies performed by foreign authors. We identified the loci responsible for genetic predisposition to inguinal hernias: WT1, EFEMP1, EBF2 and ADAMTS6. The Japanese scientists revealed an important role of loci TGFB2, RNA5SP214/VGLL2, LOC646588, HMCN2, ATP5F1CP1/CDKN3. In other studies, loci 1q41 (ZC3H11B), 2p16.1 (EFEMP1), 6p22.1 (MHC region), 7q33 (CALD1) and 11p13 (WT1) determined different hernias. The EFEMP1 gene polymorphism was among genes most associated with anterior abdominal wall hernias in all studies. Analysis of this polymorphism In Russian population revealed significant association with anterior abdominal wall hernias. CONCLUSION:The obtained data on target correction of DNA chains can significantly reduce the incidence of anterior abdominal wall hernias. In turn, this will significantly reduce the cost of surgical treatment and risk of complications with recurrences of hernias. Moreover, identifying the most associated polymorphisms may be valuable to determine the most appropriate surgical treatment.

AIM:To study neocollagenogenesis after implantation of polypropylene endoprosthesis and polypropylene combined with polylactic acid endoprosthesis on background of «potassium orotate» administration.MATERIAL AND METHODS:We used two different types of endoprosthesis in the experiment. The first type was made of just polypropylene, the second type was made of polypropylene combined with polylactic acid. Histological examination was performed using polarizing microscopy. Collagen types I and III ratio in connective tissue around the prosthesis was analyzed according to the color that was individual for each type.RESULTS:The results were significantly better in case of collagenogenesis stimulation with Potassium orotate within 30 days and later for one type of endoprosthesis. Also we revealed that collagenogenesis and paraprosthesis capsule formation were more active in case of combined endoprosthesis. We revealed stimulating action of «Potassium Orotate» for collegenogenesis process, this fact was proved by increased collagen I/III ratio.CONCLUSION:Optimization of collagenogenesis was based on persistent 1,37-fold increase of collagen I/III ratio in case of combined endoprosthesis after 90 days. It was manifested by accelerated formation of connective tissue capsule and facilitated early isolation of the implant from surrounding tissues.

AIM:To analyze collagen types ratio in skin and aponeurosis in order to predict postoperative ventral hernias.MATERIAL AND METHODS:The trial included 141 patients for the period 2012-2015. Group I (n=65) of patients without ventral hernias was divided into subgroup AI (primary operation, n=41) and BI (re-operation, n=24). Group II consisted of 76 patients with ventral hernias. We performed histological examination of skin and aponeurosis to define the collagen structure of connective tissue.RESULTS:There were significant differences between collagen type I/III ratio in skin (2.81±0.52 in group I vs. 1.13±0.48 in group II) and aponeurosis (2.69±0.41 vs. 1.09±0.21, respectively, p≤0.05). We revealed strong direct correlation (r=+0.92) between aponeurosis and skin specimens in one group. Collagen type I level was 73.81±2.74% in subgroup AI and 72.03±2.47% in subgroup BI. Collagen type I was predominant (p≤0.05).CONCLUSION:In patients with ventral hernias collagen type I/III ratio in skin is 2.54 times lower than in patients without hernias. Significant correlation of collagen types in skin and aponeurosis (r= +0.92) allows to predict the risk of postoperative ventral hernias on basis of skin fragment.

Цель.Сравнить в эксперименте динамику образования соединительнотканной капсулы вокруг полипропиленового эндопротеза и самофиксирующегося протеза на фоне применения препарата, стимулирующего синтез коллагена.Материал и методы.Экспериментальное исследование выполнено на 185 половозрелых особях сингенных белых лабораторных мышей средним весом 45-50 г.Все животные были разделены на 4 серии в зависимости от используемого эндопротеза и применения оротовой кислоты.В гистологических препаратах передней брюшной стенки с фрагментом эндопротеза, окрашенных гематоксилином и эозином, подсчитывали количество клеток фибробластов, лимфоцитов, макрофагов и нейтрофилов.На основании данных соотношения клеток оценивали регенераторные процессы и формирование парапротезной капсулы.Результаты.При добавлении в кормовой рацион животных оротовой кислоты относительное количество фибробластов в 1,43 и 1,06 раза было выше после имплантации полипропиленового и композиционного эндопротезов в сравнении с сериями, в которых препарат не применялся.Динамика относительного увеличения количества механоцитов в капсуле при имплантации композиционного эндопротеза на сроках 30, 60 и 90 суток превышала значения в аналогичной серии исследования с полипропиленовым протезом в 1,03, 1,14 и 1,10 раза соответственно.На сроках наблюдения от 30 до 90 суток после имплантации вокруг композиционного эндопротеза, с одновременным добавлением оротовой кислоты в рацион животных, быстрее происходило формирование зрелой, двуслойной соединительнотканной капсулы с одновременной элиминацией из нее клеток-нерезидентов.Полученные данные свидетельствовали о лучшей биосовместимости композиционного эндопротеза, состоящего из полипропилена и полимолочной кислоты, проявляющейся более ранним началом фазы пролиферации.Заключение.Использование нового композиционного синтетического эндопротеза, состоящего из полипропилена и полимолочной кислоты, в сочетании с оротовой кислотой позволяет снизить интенсивность асептического воспаления в области имплантации и оптимизировать коллагеногенез в парапротезной капсуле.

A clinical case of treatment of 57-year-old patient suffering from the irreducible giant inguinal-scrotal hernia is presented. On admission the patient complained on the marked abdominal wall defects, abnormal enlargement of the scrotum and inability to care for self. For the first time hernia protrusion appeared 11 years ago and has been gradually increased. The patient noticed the most intensive growth of the hernia within last 1,5 years. The left-side inguinal-scrotal herniotomy, Liechtenstein’s plastics, endoprosthetics of the anterior abdominal wall with the polypropylene surgical net (in-lay method combined with the elements of Ramirez operation) have been performed. There were no complications in the post-operation period. The excision and plastics of the scrotum are planned to perform as the second step in six months. Taking into consideration the peculiarity of the case (giant size of the hernia protrusion and difficulties in surgical treatment) it was decided to use a complex of surgical methods while treating this pathology. Thus the development of compartment syndrome and post-operative complications has been avoided. As a result the efficacy improvement of the performed treatment was achieved. The presented case is interesting as the demonstration option of an operative repair of the giant irreducible inguinal-scrotal hernia.

One of the problems of modern surgery is treatment of ventral hernias. It is important to study the process of wound healing in the area of implantation of prosthesis depending on the drugs use that improve the processes of regeneration and repair, in particular ascorbic acid. We carried out the experimental study of 200 white mice with the implanted prosthesis Esfil and ProGrip whose diet included ascorbic acid. The inflammatory response was less pronounced after using ascorbic acid and reached its minimum with endoprosthesis material ProGrip. There was significantly higher content of fibroblasts in the connective tissue capsule after the combined use of the endoprosthesis ProGrip and ascorbic acid.

The disorders of collagen development and collagen type ratio in the connective tissue play the major role in developing hernia. To investigate the peculiarities of the collagen structure 134 patients divided into 2 groups were examined. The first group consisted of 85 patients, suffering from anterior abdominal wall hernias, and 49 patients of the second group showed neither signs of hernia nor connective tissue dysplasia. The investigation of the collagen fiber structure revealed that the bands of fibers are heterogeneous; each of them possesses longitudinal fibrillation. The collagen fibers of aponeurosis in patients with hernias are porous that leads to the anterior abdominal wall weakness and contributes to hernias development.

Relevance Disorder of the connective tissue remodeling in patients after surgical treatment of ventral hernias is the great problem of modern herniology. Pathology of the connective tissue is considered as the main cause of this disorder, and is closely connected with the disturbance of collagen metabolism in the zone of post operation scar. The purpose of the study Study the relationship between collagen type I and III of the connective tissue in skin and aponeurosis in patients with hernia disease and with another surgical pathology. Materials and methods Comparative investigation of the skin and aponeurosis connective tissue structure was performed in 95 patients, suffering from ventral hernias, with the help of polarization microscopy. All patients were divided into two groups: 46 patients with ventral hernias and 49 patients with another surgical pathology. Results and their discussion In patients with hernias had significantly lower ratio of TC (p≤0,001) as in the preparation of the skin, and aponeurosis compared with patients without hernia. It was revealed strong direct correlation dependence between the connective tissue structure of skin and of aponeurosis, which makes the prognosis of ventral hernia development possible with the help of investigation of the skin structure. Conclusion In patients with WG had significantly (P ≤ 0,001) lower ratio of TC in the skin and aponeurosis. Collagen composition of the connective tissue of the skin and aponeurosis are in a strong direct correlation (r=0,72), which makes it possible to judge the changes in the structure of the aponeurosis in terms of the ratio of collagen in the skin. The use of polarization microscopy to determine the proportion of collagen types I and III in the preparations of the skin and aponeurosis is highly informative in the verification of hernia disease

Актуальность Нарушение ремоделирования соединительной ткани после операции у пациентов с грыжами живота, явля- ется одной из важнейших проблем современной герниологии. Основной причиной таких нарушений, считается патология соединительной ткани, что неотделимо от изменений коллагенового обмена в зоне образования послеоперационного рубца. Цель исследования Изучить соотношение коллагена I и III типов соединительной ткани в коже и апоневрозе у больных с вентральными грыжами и у пациентов с другой хирургической патологией. Материалы и методы С использованием поляризационной микроскопии проведен сравнительный анализ структур соеди- нительной ткани в коже и апоневрозе у 95 пациентов, позволяющий выявить достоверно более низкое соотношение кол- лагена I и III типов у пациентов с вентральными грыжами. Все больные разделены на 2 группы: 46 пациентов с вентраль- ными грыжами и 49 с другой хирургической патологией. Результаты и их обсуждение У больных с наличием грыж отмечается достоверное более низкое соотношение типов коллагена (p≤0,001) как в препарате кожи, так и апоневроза, в сравнении с больными без грыж. Определена сильная прямая корреляционная зависимость между коллагеновым соотношением соединительной ткани кожи и апоневроза, позволяющая прогнозировать возможность образование вентральных грыж при исследовании структуры кожи. Выводы 1) У больных с вентральными грыжами отмечается достоверное (p≤0,001) более низкое соотношение типов коллагена в коже и апоневрозе. 2) Коллагеновый состав соединительной ткани кожи и апоневроза находятся в сильной прямой корреляционной зависимости (r=0,72), что дает возможность судить об изменениях в структуре апоневроза по показателям соотношения коллагенов в коже. 3) Использование метода поляризационной микроскопии для определения со- отношения коллагена I и III типов в препаратах кожи и апоневроза имеет высокую информативность в прогнозировании вентральных грыж

Modern herniology presents innovational field of surgery. Among the causes of hernia development the disturbance of collagen metabolism plays a great role, and leads to heterogeneous maturation of the connective tissue and disorder of its structural characteristics. The investigation of the collagen contents of the connective tissue with the help of the polarization microscopy reveals Type I to Type III Collagen ratio in skin and aponeurosis in patients with and without hernial disease. The presented investigation makes prognosis and prophylactics of hernial disease possible in the early post operation period.

One of the most actual problems of herniology is the disturbance of collagen metabolism, and as the result the delayed maturation of the connective tissue with worsening its structural characteristics and recidivation of hernia. Implantation of the foreign material inevitably leads to the development of inflammation. All these problems force us to look for the ways to facilitate the formation of stable connective tissue capsule around endoprosthesis in order to prevent recidivation. The experiment on mice with using Sirius Red dye and polarization microscopy was performed to investigate the influence of exogenous embryonic fibroblasts, and the quantity of their using upon the dynamics of collagen metabolism in application of endoprosthesis “Ecophlon” – polytetraphtorethilen depending on the orientation of endoprosthesis sides. Using the polarization microscopy managed to approve an increase in contents of Collagen Type I in intermediate and late time after the onset of experiment with using the fibroblasts.

Objectives. To study the impact of the site of the ectogenous embryonic fibroblasts introduction in regard to endoprosthesis on the collagen metabolism dynamics. Methods. The experiment was conducted on 150 mice. The sterile polytetrafluoroethylene prosthesis was placed above the aponeurosis. The animals were divided into 3 groups numbering 50 animals: the 1 group without fibroblasts introduction; the 2 a single introduction of fibroblasts on the 7 day; the 3 group the fibroblasts were injected twice on the 7 and 10 days. Cultivated fibroblasts were obtained from the embryos of white mice. Ectogenous fibroblasts were injected in the paratransplant zone only on the side of prosthesis inverted to the skin and subcutaneous tissue. Animals were derived from the experiment on the 10, 30 and 60 days. The sections were stained with Sirius Red. Results. It has been revealed that at early terms the introduction of fibroblasts and repetition factor of the introduction dont influence the collagen types correlation depending on the spatial orientation of the prosthesis. Further a reliable increase of the collagen type I is registered. Introduction of the ectogenous fibroblasts accelerates the increase of collagen correlation of I and III types more in the case of repeated introduction. On the 30 and 60days of the experiment reliable differences in the collagen correlation of I and III types have been registered and the increase of the collagen type I content has been observed on the side of prosthesis inverted to the skin. Deposition of the ectogenous fibroblasts due to the structure of the polytetrafluoroethylene prosthesis material and their further participation in the collagen metabolism is considered to be a critical factor in the process of connective tissue capsule formation and prevalence of the collagen type I at the late terms of the experiment. Conclusions. The application of the ectogenous fibroblasts has a reliable modifying effect on the dynamics of the collagen type I formation on the introduction side.