The dissertation is devoted to solving the urgent task of improving the results of surgical treatment of patients with postoperative ventral hernias by optimizing the differentiated choice of advanced laparoscopic and open methods of algernioplasty, taking into account the size of the abdominal wall defect, rectal diastase and intrauterine abdominal diastasis.
The analysis of surgical treatment of 508 patients with HPV, mean age
54.7 ± 3.3 years. The main group of 255 (50.1 %) patients chose the method of alloplasty according to the developed algorithm. In the comparison group
253 (49.9 %) the choice of operations was traditional.
In group I, 109 (21.5 %) patients with small and medium–sized PVG with a diastase of up to 5 cm underwent laparoscopic algernioplasty, in particular,
63 patients underwent laparoscopic preperitoneal (Ukrainian patent for utility model № 142342 dated 25.05.2020) and in 46 laparoscopic retromuscular alloplasty. The comparison group Ia consisted of 108 (21.2 %) patients who underwent open retromuscular allogeneic plastic surgery.
In group II, 64 (12.6 %) patients with large PVG and diastase of the rectus abdominis muscles from 5 to 10 cm underwent open allohernioplasty by sublay. Comparison group IIa consisted of 63 (12.4 %) patients who performed the open method "onlay".
In group III, 82 (16.1 %) patients with giant PVG and diastase of rectus abdominis more than 10 cm performed the anterior technique of separation of anatomical components of the abdominal wall in combination with alloplasty with intra–abdominal placement of a mesh implant with anti–adhesive coating way. Comparison group IIIa consisted of 82 (16.1 %) patients who underwent anterior separation of the anatomical components of the abdominal wall in combination with alloplasty onlay.
For small and medium–sized PVG and diastase of the rectus abdominis up to
5 cm, laparoscopic allogernioplasty with preperitoneal and retromuscular placement of the mesh implant and elimination of diastase is optimal, which in comparison with open retromuscular allogernio plastics 3 often contributes to significant 7 %, suppuration of the postoperative wound – from 6.5 % to 0 %, inflammatory infiltrate – from 4.6 % to 0 %, chronic postoperative pain – from 6.4 % to 2.6 %, recurrence
of hernia – from 6, 4 % to 0 %.
In patients with large PVG and diastasis of the rectus abdominis from 5 to
10 cm is optimal open technique "sublay", which provides in comparison with the open method "onlay" to reduce the incidence of seroma from 23.8 % to 6.3 %, postoperative wound suppuration – from 4.8 % to 1.6 %, infiltrate in the postoperative wound from 7.9 % to 1.6 %, chronic postoperative pain – from 4.8 %
to 1.6 %, recurrence of hernia – with 7.9 % to 3.1 %.
Giant–sized PVG using an advanced combined anterior technique to separate the anatomical components of the abdominal wall combined with IPOM in patients of group III compared with the use of separation of anatomical components in combination with "onlay" achieved a significant improvement in treatment results, namely the absence of ACS in patients Group III versus 6.1 % in patients of group IIIa (p < 0.05), respectively, a decrease in the frequency of seroma – from 21 (25.6 %)
to 6 (7.3 %) (p < 0.05), postoperative infection wounds – from 4 (4.9 %) to 2 (2.4 %) (p > 0.05), postoperative wound infiltrate – from 11 (13.4 %) to 2 (2.4 %) (p < 0, 05), chronic postoperative pain – from 5 (8.1 %) to 1 (1.6 %) (p > 0.05), recurrence of PVG – from 4 (6.5 %) to 1 (1.6 %) ) (p > 0.05).
