Особливості сучасного підходу до діагностики та лікування пацієнтів з післяопераційними вентральними грижами після багатоетапного хірургічного лікування відкритих вогнепальних поранень живота

Abstract

SummaryObjective. To develop a therapeutic algorithm for preoperative preparation andsurgical treatment of patients with postoperative ventral hernias (PVH) after multi-stagesurgical treatment of open gunshot wounds. Another rationale for the research is toimprove the results of surgical treatment of patients with PVH by developing, justifyingand implementing a new method of surgical treatment.Materials and methods. Treatment results of 42 patients with postoperative ventralhernias after multi-stage surgical treatment of open gunshot wounds of the abdomenwere analyzed. Surgical treatment was performed in the Department of abdominalsurgery of the National Military Medical Clinical Center «Main Military ClinicalHospital» in the period from 2014 to 2020. Surgical intervention was performedaccording to the developed method of allohernioplasty of postoperative ventral herniasby the open hernioplasty with onlay mesh placement. The early postoperative resultsand long-term morpho-functional consequences were tracked in terms up to 1 year after.Results. In the early operative period, only 5 patients have complications such as:hematoma – 1 (1.2%), seroma – 3 (3.5%), inflammatory infiltrate – 1 (1.2%), othercomplications were not detected. In the main group of patients the recurrences ofventral hernias were not diagnosed when using a polypropylene allograft according tothe developed method of tension-free alohernioplasty. Restriction of mobility of musclesof an anterior abdominal wall, changes of sensitivity, sensations of a foreign body in aplastic zone were noted in all patients irrespective of a choice of a surgical technique ofPVH treatment. These manifestations can be primarily explained by the large size of thehernia defect, pathomorphological and pathophysiological processes that occur in thetissues due to combat trauma.Conclusion. Method of open tension-free allohernioplasty with onlay mesh placement is areliable method for surgical treatment of PVH after multistage surgical treatment of the openabdominal gunshot wounds, which allows us to reduce the frequency of postoperativecomplications of surgical treatment and recurrence of the disease.