Brek O. Clinical morphological basis of the choice of hernioplasty technique for postoperative ventral hernias.

Considering the carried clinical research the dissertation presents the theoretical and practical grounds to solve a topical problem: improvement of the results of surgical treatment of the patients with postoperative ventral hernias (POVH) by means of the predictive risk factors identification, prediction and reduction of the postoperative complication frequency, as well as elaboration and introduction into practice the new combined techniques of hernioplasty for hernia gate. The study presents the materials of retrospectively analyzed examination of 135 patients with POVH who underwent surgery in clinics during the period of 2011 to 2014. The main group consisted of 85 POVH patients undergone surgeries according to our own developed and introduced techniques for hernia gate plasty. At that, the preoperative preparation efficiency and the POVH plasty technique choice were determined by the elaborated algorithm for the surgical procedure choice in view of the predictive complications risk factors. The comparison group consisted of 50 POVH patients undergone the classical surgical procedures for the hernia gate plasty with allograft. The study of the connective tissue collagen-forming function in POVH patients has been done, its predictive value for diagnosis of the degree of the anterior ventral wall degenerative changes has been established. The role of the liposoluble vitamins A, E and ascorbic acid metabolic disorders in POVH formation pathogenesis and their concentration impact on the postoperative complications development have been proved. Surgical tactics algorithm for choice of the hernia gate plasty by introduction of the score evaluation of perioperative criteria system has been elaborated considering the connective tissue structural metabolic disorders and structural functional changes in POVH patients, that allowed to determine the optimal value and method of surgical treatment. Application of the developed techniques for the hernia gate plasty (modified "In Lay" and "On Lay" techniques) allowed to reduce postoperative wound complications from 34 % and 26 % to 9.6 % and 13.9 % compared to the classical inlays and onlays techniques.