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Pain in the lower abdomen and groin can occur in athletes who perform sharp lower extremity movement during training or sports, make sharp turns and change direction of the trunk movement as well as lower extremity acceleration/deceleration. An excessive load during the sports game can disturb the biomechanics of the player's movements. A precise localization of damaged tissues can improve for the diagnosis, determining treatment and forecasting the time of return to sports. The aim was to estimate the importance of the football biomechanics movement for the anatomy of the groin and to determine the anatomical features of the groin in football players with sports hernia. We analysed the thickness and length measurements on MRI of the rectus abdominis muscle in 51 football players of professional and amateur clubs aged 17 to 33 years with groin pain who were treated at the Kyiv Clinical City Hospital №3 for the period 2014-2020. In the second stage of the study, we investigated the peak force of the abdominal muscles (rectus abdominis, external oblique abdominal muscles) and the adductor muscles of both lower extremities using the microFET2 dynamometer for 4 groups of football players. The first group of the study includes 15 football players of professional clubs with sports hernia who had received conservative treatment, the partipants of the second group are 36 football players after laparoscopic hernioplasty, the third group consisted of 54 healthy young football players and 11 teenage footballers. In the third stage of the study, a formula was substantiated, according to which we calculated the acceleration of the lower extremity when kicking the ball. The results of the study demostrate that the disruption of the lower extremity biomechanics during kicking the ball cause the appearance of sports hernia in football players. An axial MRI scan of groin areas of football players with sports hernia represented changes in the lateral edge of the rectus abdominis. The groin pain syndrome of football players with sports hernia includes three pathogenetic mechanisms of development: disruption of the biomechanics, muscle imbalance and microtrauma and inflammation.

OBJECTIVE The aim of the study is to compare the mesh implantation and the strength of the mesh fixation to the anterior abdominal wall by modelling the intraperitoneal onlay mesh repair (IPOM) with and without aponeurotic defect closure. PATIENTS AND METHODS Materials and methods: The experimental animals were randomly divided into 2 groups of 6 rabbits. In experimental group IPOM was modelled without hernia defect closure, in control group - with its suturing. The macroscopic assessment of the severity of adhesions, histological examination of the removed "anterior abdominal wall - mesh" complex and strength of the mesh fixation to the anterior abdominal wall were performed on the 90th day. RESULTS Results: In both groups, the displacement or complete separation of the mesh from the parietal peritoneum was not observed. The extent of adhesion formation in the abdominal cavity and strength of the mesh fixation are comparable in both groups (p > 0.05). In the experimental group, the mesh was surrounded by scar tissue, mesothelioma lining was not traced. There were also moderate signs of inflammation, which were not seen in the control group. CONCLUSION Conclusions: The strength of the mesh fixation to the parietal peritoneum and its implantation into the anterior abdominal wall is comparable with or without aponeurotic defect closure during the experimental modelling of IPOM.

Objective The aim of the study is to specify diagnostic MRI and ultrasound criteria for a sports hernia in order to verify its diagnosis in football players. Patients and methods Materials and methods: The study included 50 professional and amateur football players aged 15 to 34 from 2016 to 2019. The criteria for inclusion in the study were: the presence of groin pain in football players, which prevented them from continuing to actively participate in sports activities. Results Results: The findings of the study revealed that during MRI the two factors, which had the strongest influence, were "increased MR signal intensity on PDfs observed from the structures of the inguinal canal" and "increased MR signal intensity on PDfs observed from bone marrow of superior ramus of the pubic bone". During ultrasound of the inguinal area, the main criterion for a sports hernia diagnosis was "increased size of the inguinal canal". The verification of the diagnosis was carried out on the basis of the presence of a protrusion in the posterior wall of the inguinal canal. For a sports hernia diagnosis the MRI sensitivity is 91.67% (95% CI 77.5 - 98.2), specificity -78.57% (95% CI 49.2 - 95.3) and the sensitivity of ultrasound is 88.89% (95% CI 73.9 - 96.9), the specificity - 50% (95% CI 23.0 - 77). Conclusion Conclusions: The combination of MRI and ultrasound makes it possible to accurately detect the presence of a sports hernia in the football player. Based on the findings of our study, we formulated MRI and ultrasound criteria for a sports hernia diagnosis.

Aim. To evaluate the effectiveness of reducing postoperative pain in the first days after surgery in accelerating postoperative recovery of patients and reducing the length of stay in hospital. Materials and methods. In the period from September 2011 to May 2019 we performed 569 scheduled surgeries using the Fast­track surgery principles, including MMA. Depending on the type of surgery, we defined VAS pain impulses indicators and the average stay in hospital. Results. Analyzing the impulses of pain after laparoscopic cholecystectomy in the first postoperative day (POD) VAS level was 2.87 ± 0.74, the second POD – 2.01 ± 0.50 (p < 0.001). The average hospital stay was 1.72 days. In laparoscopic hernioplasty, the results of the study of the level of pain according to VAS were as follows: the first POD – 3.44 ± 0.67, the second POD – 2.06 ± 0.51 (p < 0.001). The average hospital stay was 1.43 days after surgery. Analyzing laparoscopic bariatric interventions and interventions on the large intestine the first POD level according to VAS was 4.24 ± 0.75 and 4.39 ± 0.84 respectively; the second POD – 3.48 ± 0.57 and 3.48 ± 0.77, the third POD – 2.79 ± 0.67 and 2.84 ± 0.69. When comparing the first and second PODs after bariatric interventions, the level of pain impulsion decreased to 3.48 ± 0.57 (p < 0.001), and to the third POD – to 2.79 ± 0.67 (p < 0.001). A similar tendency was observed after laparoscopic interventions on the large intestine: the second POD – the level of pain impulsion decreased 3.48 ± 0.77 (p < 0.001), the third POD – 2.84 ± 0.69 (p < 0.001). The average hospital stay was 4.99 ± 0.45 and 4.10 ± 0.60, respectively. Conclusions. The effectiveness of reducing postoperative pain in the first days after surgery directly affects the rate of recovery of the patient and the length of stay in hospital., Цель. Оценить эффективность редукции послеоперационной боли в первые сутки после хирургического вмешательства в ускорении послеоперационного восстановления больных и уменьшении продолжительности пребывания на стационарном лечении. Материалы и методы. В период с сентября 2011 по май 2019 нами выполнено 569 плановых оперативных вмешательств с использованием принципов Fast­trackхирургии, в том числе – с применением ММА. В зависимости от вида оперативного вмешательства определились показатели болевой импульсации по ВАШ и среднее время пребывания на стационарном лечении. Результаты. При анализе болевой импульсации после лапароскопической холецистэктомии в первые послеоперационные сутки (ПОС) уровень по ВАШ составил 2,87 ± 0,74, во вторые – 2,01 ± 0,50 (p < 0,001). Средний койко­день – 1,72 суток. При лапароскопической герниопластике результаты исследования уровня боли по ВАШ были следующие: в первые ПОС – 3,44 ± 0,67, во вторые – 2,06 ± 0,51 (p < 0,001). Средний койко­день – 1,43 суток после операции. При анализе после лапароскопических бариатрических вмешательств и вмешательств на толстой кишке в первые ПОС уровень по ВАШ составил 4,24 ± 0,75 и 4,39 ± 0,84 соответственно; во вторые ПОС – 3,48 ± 0,57 и 3,48 ± 0,77, третьи – 2,79 ± 0,67 и 2,84 ± 0,69. При сравнении первых и вторых ПОС после бариатрических вмешательств уровень болевой импульсации уменьшился до 3,48 ± 0,57 (p < 0,001), а в третьи ПОС – до 2,79 ± 0,67 (p < 0,001). Аналогичная тенденция отмечена нами и после лапароскопических вмешательств на толстой кишке – на вторые ПОС уровень болевой импульсации уменьшился до 3,48 ± 0,77 (p < 0,001), на третьи ПОС – до 2,84 ± 0,69 (p < 0,001). При этом среднее время пребывания в стационаре составило 4,99 ± 0,45 и 4,10 ± 0,60, соответственно. Выводы. Эффективность уменьшения послеоперационной боли в первые сутки после хирургического вмешательства напрямую влияет на скорость восстановления организма пациента и длительность пребывания на стационарном лечении., Мета. Оцінити ефективність редукції післяопераційного болю в перші доби після хірургічного втручання в пришвидшенні післяопераційного відновлення хворих та зменшенні тривалості перебування на стаціонарному лікуванні. Матеріали і методи. У період з вересня 2011 р. по травень 2019 р. нами виконано 569 планових оперативних втручань з використанням принципів Fast­track­хірургії, в тому числі – із застосуванням ММА. Залежно від виду оперативного втручання визначились показники больової імпульсації за ВАШ та середній час перебування на стаціонарному лікуванні. Результати. При аналізі больової імпульсації після лапароскопічної холецистектомії в першу післяопераційну добу (ПОД) рівень за ВАШ склав 2,87 ± 0,74, на другу – 2,01 ± 0,50 (p < 0,001). Середній ліжко­день – 1,72 доби. При лапароскопічній герніопластиці результати дослідження рівня болю за ВАШ були наступні: у першу ПОД – 3,44 ± 0,67, у другу – 2,06 ± 0,51 (p < 0,001). Середній ліжко­день – 1,43 доби після операції. При аналізі після лапароскопічних баріатричних втручань та втручань на товстій кишці в першу ПОД рівень за ВАШ склав 4,24 ± 0,75 та 4,39 ± 0,84 відповідно; у другу ПОД – 3,48 ± 0,57 та 3,48 ± 0,77, у третю – 2,79 ± 0,67 та 2,84 ± 0,69. При порівнянні першої та другої ПОД після баріатричних втручань рівень больової імпульсації зменшився до 3,48 ± 0,57 (p < 0,001), а на третю ПОД – до 2,79 ± 0,67 (p < 0,001). Аналогічну тенденцію відзначено нами й після лапароскопічних втручань на товстій кишці – на другу ПОД рівень больової імпульсації зменшився до 3,48 ± 0,77 (p < 0,001), на третю ПОД – до 2,84 ± 0,69 (p < 0,001). При цьому середній час перебування в стаціонарі склав 4,99 ± 0,45 та 4,10 ± 0,60, відповідно. Висновки. Ефективність зменшення післяопераційного болю в перші доби після хірургічного втручання прямо впливає на швидкість відновлення організму пацієнта і тривалість перебування на стаціонарному лікуванні.

Objective. To estimate the efficacy of postoperative pain reduction in first days after surgical intervention in acceleration of postoperative restoration in patients and reduction of the stationary treatment duration. Materials and methods. In Sept. 2011 - May 2019 yrs period there were performed 569 elective operative interventions, using principles of a Fast Track Surgery program, including those with application of multimodal analgesia. Depending on the kind of operative intervention the indices of pain impulses were determined in accordance to visual-analogous scale and median duration of stationary treatment. Results. On the first day after laparoscopic cholecystectomy the pain impulsation level have constituted 2.87 ± 0.74, on the second day - 2.01 ± 0.50 (p < 0.001). Median duration of the patients’ stationary stay have constituted 1.72 days. After laparoscopic hernioplasty the results of the pain level investigation were: on the first day - 3.44 ± 0.67, on the second day - 2.06 ± 0.51 (p < 0.001). Median duration of postoperative treatment have constituted 1.43 days. After laparoscopic bariatric interventions on large bowel during the first postoperative day the pain level have constituted 4.24 ± 0.75 and 4.39 ± 0.84 accordingly, on the second day it have reduced to 3.48 ± 0.57 (p < 0.001) and 3.48 ± 0.77 (p < 0.001), on the third day - to 2.79 ± 0.67 (p < 0.001) and 2.84 ± 0.69 (p < 0.001). At the same time a median duration of the patients’ stationary stay have constituted (4.99 ± 0.45) and (4.10 ± 0.60) days, accordingly. Conclusion. Efficacy of reduction of postoperative pain in first days after surgical intervention immediately impacts the speed of restoration of the patients’ organism and duration of stationary treatment.

Relevance. Fast Track surgery concept provides for a significant reduction of patient’s stress response to surgical intervention. The main task is a quick rehabilitation, quick return to a normal quality of life and significant reduction for an in-patient stay, thereby reducing medical costs. Objective: To assess the efficacy of the lack of pre- and postoperative fasting in accelerating postoperative recovery of patients and the reduction of patient’s stress response to operative injury. Materials and methods. We performed 564 surgical interventions under Fast Track approach. In particular, we used adapted, high-caloric sipping (drinking as small sips through a straw) feed manufactured at a medical enterprise and does not include dietary fibre — Nutricomp Drink Plus (BBraun). Results. Early oral feeding within the first hours after surgery accelerates recovery of productive intestinal motility. In 73.5 % of patients, the passage of flatus (spontaneous) is reported to the end of the first postoperative day that is about 8-fold higher than in patients who were not on such diet. General weakness, hunger and thirst reduced 2.5, 3 and 2.5-fold, respectively, in patients on Fast Track approach compared with the conventional perioperative management. Conclusion. The lack of pre- and postoperative fasting is one of the cornerstones of this program that proved the efficacy in terms of reduced stress response to surgical injury. Key Words: Fast Track approach, surgical intervention, pre- and postoperative nutrition.

Objective Introduction: Morbid obesity (MO) has a significant impact on mortality, health and quality of life of patients. Type 2 diabetes mellitus (T2DM) is a common comorbidity in patients with MO. The aim is to study T2DM remission and to develop a prediction model for T2DM remission after two-stage surgical treatment of patients with MO. Patients and methods Materials and methods: The study included 97 patients with MO. The mean BMI was 68.08 (95% CI: 66.45 - 69.71) kg/m2. 70 (72,2%) patients with MO were diagnosed with T2DM. The first stage of treatment for the main group (n=60) included the IGB placement, for the control group (n=37) - conservative therapy. In the second stage of treatment the patients underwent bariatric surgery. The study addresses such indicators as BMI, percentage of weight loss, percentage of excess weight loss, ASA physical status class, fasting glucose level, HbA1c, C-peptide. Results Results: Two-stage treatment of morbidly obese patients with T2DM promotes complete T2DM remission in 68.1% of patients. The risk prediction model for failure to achieve complete T2DM remission 12 months after LRYGB based on a baseline C-peptide level has a high predictive value, AUC = 0.84 (95% CI: 0.69-0.93), OR = 0.23 ( 95% CI: 0.08-0.67). Conclusion Conclusions: Two-stage treatment of patients with MO promotes improvement of carbohydrate metabolism indicators. With a C-peptide level > 3.7 ng/ml, prediction of complete T2DM remission 12 months after Laparoscopic Roux-en-Y Gastric Bypass is favorable.

Obesity leads to increased morbidity, disability, mortality and, crucially – decrease in the quality of life. As a tool for analyzing the quality of life, general nonspecific and specific questionnaires, preferring the latter are widely used. 97 patients with morbid obesity of III-IV class of operative-anesthetic risk according to the scale of the American Society of Anaesthesiologists were examined and treated. Two-stage treatment of patients was carried out as follows: in the patients of the main group intragastric balloon was used as the first stage for 6 months, patients of the control group were administered conservative therapy which included diet, physical activity and behavioral therapy. The quality of life was assessed using the Obesity and Weight-Loss Quality-of-Life Instrument (OWLQOL) -17 questionnaire. At the first stage, the mean percent of excess body weight loss % EWL in the main group was 22.69±5.87% being statistically significantly (p

Мета. Обґрунтувати доцільність двохетапного хірургічного лікування морбідного ожиріння (МО) з використанням внутрішньошлункового балона (ВШБ) як першого етапу. Матеріали і методи. Обстежено та проліковано 97 пацієнтів з МО, а саме з суперожирінням та високим операційно-анестезіологічним ризиком (ІІІ-ІV клас за шкалою ASA РS – American Society of Anaesthesiologists Physical Status Classification System 2014). Хворих лікували в два етапи. Як перший етап використовували встановлення ВШБ на 6 міс (основна група, n = 60) та консервативну терапію впродовж 6 міс, яка включала дієту, фізичну активність та поведінкове консультування (контрольна група, n = 37). На другому етапі хворим обох груп проводили хірургічне лікування МО. Результати. Середній відсоток втрати надлишкової маси тіла (%EWL – excess weight loss) у хворих основної групи становив 22,69 ± 5,87 та статистично значуще (p < 0,001) перевищував зазначений показник у хворих контрольної групи. Рівень операційно-анестезіологічного ризику за шкалою ASA PS у хворих основної групи статистично значущо (p