Smishchuk V. Intraabdominal alloplasty of incisional ventral hernias of big and huge sizes

The thesis consists of two parts - experimental and clinical. Experimental study in 80 mature rats (males) showed advantages of intraabdominal alloplasty in comparison with "onlay" method. Intraabdominal alloplasty allows to close abdominal cavity avoiding rectus abdominis muscle approximation, which enlarges the abdominal wall area and abdominal cavity space. The reduction of retinal implant contact with subcutaneous base decreases the frequency of complications in postoperative wound. The analysis was performed for results of surgical treatment in 164 patients with incisional ventral hernias (IVH) of big and huge sizes. In the main group I (82 patients) we used intraabdominal alloplasty in combination with component separation technique (CST). In comparative group ІІ (82 patients) - "onlay" in combination with CST. The results showed that the abdominal compartment syndrome was observed only in 6,1% patients in group II. Complications in postoperative wound in group I: seroma in 7,3% patients, infection - in 2,4%, infiltration - in 2,4%, necrosis of cutaneous margins of the wound - in 3,7%, chronic postoperative pain - in 1,6%, hernia relapse - in 1,6%. In patients of group II, respectively: seroma - in 25,6% patients, infection - in 4,9%, infiltration - in 13,4%, necrosis of cutaneous margins of the wound - in 4,9%, chronic postoperative pain - in 8,1%, hernia relapse - in 6,5%. The obtained results confirm higher efficacy of surgical treatment for big and huge IVH using combined intraabdominal alloplasty in comparison with combined method "onlay".