Yatsentyuk V. . Paracolostomy Hernia Surgical Treatment with the Use of Allotransplant.

The thesis deals with the problem of paracolostomy hernia surgical treatment with the use of allotransplant. The main cause of paracolostomy hernia formation is proved to be progressive dystrophic and cicatricial degenerative changes in musculoaponeurotic tissues at the colostomy site. The diagnostic algorithm offered gives the possibility to perfectly study pathological changes caused by paracolostomy hernia development, as well as to make the optimal choice of surgical treatment mode. Improved paracolostomy hernia classification allows ensuring a full description of each paracolostomy hernia case and gives a surgeon all the information necessary for planning the surgical treatment and choosing the case management approach. Being necessary, complex preoperative preparation of a patient suffering from paracolostomy hernia should include measures aimed at respiratory and cardiovascular system adaptation to a high intracranial pressure, maximal intestine depletion and comorbidity correction. The most radical mode of paracolostomy hernia surgical treatment is considered to be the large intestine regenerative and reparative operation followed by the preperitoneal alloplasty of anterior abdominal wall without tissue tension. If it is impossible to eliminate colostomy, better results can be achieved by preperitoneal hernioplasty with the use of polypropylene mesh with a hole for colostomy. If paracolostomy and median postoperative hernias are combined, it is reasonable to cover both hernial defects by one mesh with a hole for colostomy. After paracolostomy hernia hernioplasty with the use of synthetic prostheses it was observed a 29.52% decrease in early postoperative complications in comparison with traditional autoplasty. In the remote period after allohernioplasty it was noticed a 23.34% decrease in relapses in comparison with the one after autoplasty.