The dissertation is devoted to the solution of the actual task of improving the
results of surgical treatment of patients with postoperative ventral hernias of giant
size by optimizing the choice of the method of separation of anatomical components
of the abdominal wall in combination with alloplasty and the development and
implementation of the algorithm for choosing the method based on the intracranial
pressure determined during the operation.
10
The implementation into surgical treatment of postoperative ventral hernias
(PVH) of the abdomen of gigant size of methods of separation of anatomical
components of the abdominal wall in combination with alloplasty significantly
improved both immediate and long-term treatment results. The use of a mesh
implant as a factor that significantly reduces the risk of hernia recurrence compared
to outdated autoplastic techniques does not cause doubts in any surgeon.
The basic principle on which most modern techniques of surgical treatment of
postoperative ventral hernias are based is to minimize the degree of tension in the
restoration of the abdominal wall, that is, a minimal decrease in the volume of the
abdominal cavity. Methods of separation of anatomical components of the
abdominal wall in combination with alloplasty in case of PVH of giant size on the
one hand ensure the creation of an optimal volume of the abdominal cavity and
reduce the likelihood of intraabdominal hypertension, and on the other, due to the
widest possible overlap of the musculoaponeurotic tissues of the abdominal wall
with a mesh implant, reduce the likelihood of recurrence PVH. However, in some
patients, the results of treatment remain unsatisfactory due to inadequate choice of
methods for separating the anatomical components of the abdominal wall, due to the
incorrectly selected alloplasty method and the significant development of
postoperative local and general complications.
According to the authors, among the local wound complications, the incidence
of seromas is 30.8-60.4%, purulent inflammation of the postoperative wound - 1.5-
4.8%, abdominal wall fistulas - 1.2-3%, chronic postoperative pain - 4.5-6%,
recurrent giant PVH - 10-25%.
Among the common complications, in particular with PVH of giant size, the
occurrence of intraabdominal hypertension is dominant - 25-60%. The occurrence
of intraabdominal hypertension of III and IV degrees, in particular with intracranial
pressure of more than 20 mm Hg in the postoperative period, it can lead to an
abdominal compartment of the syndrome, which is 2.4-6.8%. In such cases, this
complication can threaten the patient's life due to multiple organ failure and requires
11
an urgent decompressive relaparotomy. Mortality in the surgical treatment of PVH
of giant size remains in the range of 1.2-3.4%.
The presence of a large number of relapses, postoperative general and local
complications mean that the question of choosing the method of operation in the
treatment of postoperative ventral hernias of giant size is far from being resolved
and prompts us to search for a special technique for closing a giant defect of the
abdominal wall, which would not be accompanied by significant tissue interference
and would not increase intra-abdominal pressure (IAP). That is why, in our opinion,
a differentiated approach to the choice of the method of separation of anatomical
components of the abdominal wall in combination with alloplasty based on
monitoring of intra-abdominal pressure will reduce the likelihood of intraabdominal hypertension, and the improvement of the posterior method of separation
of anatomical components of the abdominal wall transversus abdominis muscle
release (TAR) by combining with intra-abdominal alloplasty (IPOM) will reduce
tissue tension, create optimal abdominal volume and improve the results of treatment
of PVH of giant-size.
