Komarchuk I. Hernia repair in patients with syndrome of non-differentiated system dysplasia of connective tissue

The manuscript presents the results of clinical trial including 314 patients with small or medium sized ventral hernias. Study group encountered 161 patients, the control group - 153 patients. Identification of phenotypic peculiarities in patients of the study group allowed to diagnose mild (37.3%), moderate severe (31.7%) and severe (31.0%) types of undifferentiated connective tissue dysplasia (UCTD). The study of the initial anatomical and functional state of the anterior abdominal wall and respiratory function revealed additional risk factors for herniation (diastase of the rectus muscles (6%), chronic abscesses of postoperative scar (4.3%), pseudocysts (2.5%), scar changes in the muscle tissue (7.2%), additional hernia rings (3.5%), decreased pulmonary ventilation (36.0%), even for small and medium-sized hernias reduces the adaptive capacity of the musculo-aponeurotic carcass for UCTD background. Basing on the studies a differentiated approach to the choice of surgical methods was developed. It is depending on the adaptive capacity of the anterior abdominal wall and allowed to reduce the recurrence rate from 9.1% in I-III comparison subgroup to 2.5% in the main group (p < 0.05), increase the number of autoplasty with a lower rate of complications and recurrences in the main group (90% vs. 71.4%, p < 0.05), and reduce the number of specific complications after the use of mesh by a rational choice of the method of hernia repair. The presence of specific complications reduces the quality of life per the 15.4-21.5% (p < 0.05) in terms of general and mental health, physical perfomance, and pain intensity.