Bondarenko O. Alloplasty of the large complicated postoperative ventral hernias

Subject of inquiry - large postoperative ventral hernias (LPVH) with concomitant somatic diseases and overweight; the aim of the research - to improve the results of surgical treatment of patients with LPVH complicated with concomitant somatic pathology, due to a differentiated approach to the selection of improved methods of surgical treatment, development of diagnostics and prevention program of intraabdominal hypertension and wound complications; methods - clinical, instrumental, cytological, microbiological, topographoanatomical, statistical; scientific novelty – it is proved and introduced a differentiated approach to the choice of surgical treatment method of patients with LPVH including the features of collateral vascularization of the abdominal wall, the variation of intraabdominal pressure and the mechanisms of recurrences; it is improved the index of the compartment syndrome severity, which was used for the diagnosis of compartment syndrome; it is developed a two-steps algorithm suboperative assessment of hernioplasty contraindications for patients with LPVH, which includes an assessment of the degree of concomitant diseases compensation and the definition of compartment syndrome degree with primary level of intraabdominal pressure; it is developed an algorithm for prevention of wound complications after abdominal wall alloplasty based on study of wound exudates; results – elaborated complex of surgical rehabilitation of the patients with complicated LPVH made it possible to improve quality of patents life, increase the rate of positive functional results by 33,6%, decrease the rate of recurrences from 7,3 % to 3,3%, decrease the risk of critical intraabdominal hypertension by 22,1% and the risk of wound complications by 15,1%; it is inculcated - in medical practice, in an educational process; sphere - medical practice.