FEATURES OF THE DYNAMICS OF SYSTEMIC INDICES OF CYTOKINES FOR THE IMPLANTATION OF LIGHT AND HEAVY NETS IN THE CONDITIONS OF RETRO-MUSCULAR PLASTY IN PATIENTS WITH POSTOPERATIVE VENTRAL HERNIA

Abstract

The use of polypropylene mesh in the surgery of postoperative ventral hernias is undeniable. Their use is accompanied by a pronounced inflammatory reaction in the implantation area, contributes to the formation of a coarse connective tissue capsule, and as a result leads to a wrinkling of the mesh. The issue of postoperative exudative complications remains unresolved, which in turn complicates the postoperative course. The aim of the study – to make a comparative assessment of the results of the use of two polypropylene screens of the firm UKRTEHMED – “light” large-pored Omega-2 and “heavy” Omega-4, on the basis of studying the state of systemic indices of cytokines with a simultaneous comparative evaluation of the ultrasonic examination of the implantation zone Retromuscular allogernioplasty in patients with postoperative ventral hernia. Materials and Methods. 42 patients operated on the postoperative ventral hernia were examined. The first group included 20 (47.6 %) patients who used a “heavy” Omega-4 endoprosthesis and 22 (52.4 %) patients with a “light” Omega-2 mesh implanted in the second group. In both groups, a study was made of the systemic indices of cytokines. In the serum of peripheral blood, the ratio of pro-and antiinflammatory interleukins of TNF-α, IL-8 and IL-4 was determined on the 3rd; 5th; 7th; 9th and 11th days of the postoperative period to assess the staging and cascade of the immune response for implantation of the polypropylene mesh. All patients in the postoperative period were subjected to dynamic ultrasound monitoring to monitor the expression of the exudative reaction in the implantation area. Results and Discussion. It was noted that with the implantation of both types of endoprostheses an inflammatory reaction of local tissues arises, accompanied by a stepwise increase in proinflammatory and anti-inflammatory cytokines. About that, the earlier and prolonged increase in the concentration of proinflammatory cytokines TNF-α and IL-8 and a low concentration of anti-inflammatory cytokines IL-4 in patients with implantation of the “heavy” Omega-4 UKRTECHMED network, and as a result more pronounced and prolonged inflammation with prolonged exudative phase, which is confirmed by data obtained by conducted ultrasonic testing, compared with the group of patients who have used the “easy” Omega-mesh 2, which defines at its advantages on condition performing allogernioplasy postoperative ventral hernias. Conclusions. The use of lightweight polypropylene mesh in surgery of postoperative ventral hernias is accompanied by a slight inflammatory process and short exudative phase in the implantation zone, which in turn reduces the substantial amount of postoperative complications and promotes rapid rehabilitation of operated patients.

Keywords

• післяопераційна вентральна грижа
• цитокіни
• поліпропіленова сітка.