The thesis is devoted to improving the results of treatment of patients with postoperative ventral hernias after multistage surgery treatment of gunshot wounds of the abdomen. It based on the analysis of clinical and experimental sections. An experiment was conducted on 30 adult chinchilla rabbits, which had undergone implantation of sterile pieces of a polypropylene mesh (PROLEN, Ethicon) of size 1,0 ? 1,0 cm in the lateral divisions of the anterior abdominal wall. All studied animals were divided into 3 groups depending on the place of the mesh implantation. The groupІ included preperitoneal mesh placement (10 rabbits), group II - intramuscular location of a mesh (10 rabbits) and the group III - subaponeurotic mesh placement (10 rabbits). The tissues of the anterior abdominal wall with size 1,5 ? 1,5 cm were sampled on the 7, 14, 21, 28 and 35 days after implantation from all groups. A morphometrical study was performed and included the following parameters: relative area of collagen fibers, relative amount of collagen fibers with a fiber thickness more than 10 µm and less than 10 µm, the relative area of the cell component. We performed a series of morphological studies showed that the formation of scar tissue after the mesh implantation has significant differences depending on its localization. In the area of the peritoneum and the muscle mesh implantation induces reactive changes, manifested by formation of granulation tissue, rich in non-differentiable vessels, the structure of which is dominated by fibrocytes and fibroblasts. Up to 21 days the connective tissue scar is formed from dense bundles of collagen fibrils. Up to 28-35 days there is a further maturation of the connective tissue, reduced number of fibroblasts, increases the number of fibrous structures. More significant differences were observed between the animals with the meshes implanted by the subaponeurotic technique. Up to 7 days in the area near aponeurosis expressed phenomena of swelling and formation of fibrous structures around the threads and between them. Up to 21 days formed the powerful connective-tissue layer, which is a massive connective tissue with a large number of fibers and fibrocytes. The thickness of the scar is more than in the area of muscle and peritoneum in 5-6 times. The subaponeurotic mesh placement observed the predominance of the fibrillar component of scar tissue on a cellular to the 21st day of the experiment. Tissue section examination revealed an earlier launch and greater speed periimplant reparative-proliferative processes in subaponeurotic location of a mesh, compared with preperitoneal and intramuscular localization. The obtained experimental data allow to speak about a better morphometric and histological characteristics of the scar formation process in subaponeurotic mesh placement that is important when choosing the surgical approach. The study results pose the morphological basis for the development of new method of treatment the patients with a considerable distraction of the aponeurotic edges with postoperative ventral hernias, as a distant complications of surgical treatment of gunshot peritonitis. The analysis was performed for results of surgical treatment of the 86 patients with postoperative ventral hernias after multistage surgical treatment of the open abdominal gunshot wounds, which were divided into 2 groups. The first subgroup of the comparison group included 18 patients who underwent open traditional allohernioplasty ("Onlay", "Sublay" та "Inlay"); and the second subgroup of the comparison group included 26 patients who underwent laparoscopic method with the composite mesh installation. The main group included 42 patients in whom surgical treatment was carried out according to the developed method of the tension-free abdominal wall repair for postoperative ventral hernia after multistage surgical treatment of the open abdominal gunshot wounds (Patent of Ukraine № 127369 dated 25.07.19). The diagnostic program included: laboratory and instrumental research methods. Using laboratory methods determined: general clinical blood test, general clinical urine test, determination of blood group and rhesus factor, biochemical blood test (bilirubin with fractions, ALT, AST, protein and its fractions, urea, creatinine, blood electrolytes - sodium, potassium, calcium, chlorine, glucose level), coagulogram, determination of the main fractions of lipids (phospholipids, free cholesterol, free fatty acids and triglycerides). Mandatory for all patients were determined antibodies to markers of viral hepatitis, HIV tests. Instrumental methods of research included carrying out: electrocardiography, fluorography or X-ray of the chest, ultrasonic research of abdominal organs and an abdominal wall, fibrogastroduodenoscopy, duplex examination of the vessels of the anterior abdominal wall and lower extremities, computed tomography of the abdominal cavity. Among 11 patients of the first subgroup of the comparison group early postoperative complications were recorded: in 3 (16,7 %) patients hematoma was observed, in 4 (22.2 %) patients - peri-implant seroma, in 3 (16,7 %) patients -postoperative wound infiltrate, in 1 (5.6 %) operated - necrosis of the skin edges of the wound. Among 12 patients of the second subgroup of the comparison group early postoperative complications were obtained: in 5 (19,2 %) patients peri-implant seroma, in 2 (7,7 %) patients - postoperative wound infiltrate, in 3 (11,5 %) operated - necrosis of the skin edges of the wound and in 2 (7,7 %) cases -postoperative wound suppuration. Among 5 patients of the main group, early postoperative complications wereobserved: in 1 (2,3 %) patient hematoma, in 3 (7,1 %) patients peri-implant seroma, in 1 (2,3 %) patient - postoperative wound infiltrate. There were no cases of postoperative wound suppuration, necrosis of skin edges and failure of postoperative wound sutures in the main group of patients. The recurrences of ventral hernias were obtained in 4 (22,2 %) patients from the first subgroup of the comparison group and in 2 (7,7 %) patients from the second subgroup of the comparison group whereas in the main group of patients cases of postoperative ventral hernia recurrence were not diagnosed (p < 0.05). The obtained results confirm the high efficiency of surgical treatment of patients with postoperative ventral hernias according to the developed method of tension-free hernioplasty and allow to improve the quality of life of patients in the postoperative period.
