THE ROLE OF ONCOLOGICAL PROCESS IN OCCURRENCE OF POSTOPERATIVE EVENTRATION

Eventration is one of the rare but the most dangerous postoperative complications in the abdominal surgery registered in 0.5-2.35% of patients. Eventration occurs most frequently after urgent surgery on the abdominal organs of weakened patients of the old and elderly ages with a low immune-biological condition of the body. Examination of certain specific features of eventration occurrence with underlying oncological process will allow better understanding the latter in the development of the postoperative complication. Therefore, the objective of the research was to examine experimentally the effect of malignant neoplasm on the mechanical strength of the laparotomy wound postoperative scar on small laboratory animals, and to study clinically occurrence of postoperative eventration development in patients with malignant neoplasms of the abdominal organs. The experimental studies were carried out on 78 laboratory rats operated on by means of laparotomy 3,0 cm in length. Heren's carcinoma was preliminary grafted under the skin of the external femoral surface in the main group of animals. The mechanical strength of the laparotomy wound scar was determined on the 1st, 3rd and 5th days after surgery by means of measuring abdominal pressure at the moment of scar rupture. 140 were examined who underwent midline laparotomy for surgical treatment of abdominal diseases. The main group included 98 patients with malignant neoplasms of the abdominal organs who were divided into two groups depending on the stages of oncological process. The first subgroup included 46 individuals at the I-II stages of the disease, and the second subgroup of the main group included 52 patients at the II-IV stages of the disease. The group of comparison involved 42 patients with acute surgical non-oncological pathology of the abdominal organs. Both groups of patients were comparable by the age and gender. An average age of patients in both groups of the study was 60.1±0.95 years. An average length of the laparotomy wound was 27.1±0.25 cm. The obtained results were statistically processed on the personal computer by means of electronic tables Microsoft Excel and the package of statistical processing program IBM SPSS Statistics. The results of the experimental studies are indicative of the fact that malignant process in the body results not only in inhibited maturation of the granulation tissue in the laparotomy wound, but in reduced strength of the postoperative scar beginning with the 3rd day after surgery performed. Analysis of the results of our clinical study enables to admit reliable increase of occurrence of "local" postoperative complications including suppuration of the postoperative wound and eventration, especially when oncological process is at the late stages of the disease. This specific feature should be considered when sutures and drainage are applied on the laparotomy wound in this group of patients. Thus, oncological process at the late stages of the disease promotes reduced strength of the laparotomy wound postoperative scar and results in an increased occurrence of eventration and suppuration of the postoperative wound.