Choice of the method of allohernioplasty in patients with primary ventral hernias in combination with diastasis of the rectus abdominal muscles under the conditions of the metabolic syndrome

Abstract

The purpose of the work. Based on the analysis of the surgical treatment of patients with primary ventral hernias in combination with diastasis of the rectus abdominis under the conditions of the metabolic syndrome, develop technical prerequisites for increasing the safety of surgical interventions in this category of patients.Materials and methods. In the period from 2016 to 2022, an in-depth comprehensive examination of 283 patients operated on for primary ventral hernia, primary ventral hernia with concomitant diastasis, and isolated diastasis of rectus abdominis muscles was conducted. Patients were divided into groups according to the periods of surgical treatment of patients. For this purpose, two periods were formed: from 2016 to 2019 and from 2020 to 2022. In the first period, 174 (61.48%) patients were examined and operated on. These patients formed the comparison group. The main group corresponding to patients who were treated in the period from 2020 to 2022 consisted of 109 (38.52%) people. Patients were examined according to standard protocols. The number and nature of early postoperative complications were studied in both groups according to the types of surgical interventions performed.The results. It has been proven that local complications significantly prevailed in the comparison group, which is explained by a significant number of performed native tissue and onlay hernioplasty. Thus, prolonged lymphorrhea in the period from 2016 to 2019 was observed in 11 people and mainly after onlay operations, the number of which was twice that of the main group. In the period after 2020, this complication occurred only within 3.67%. The best results were obtained in the group of patients who underwent Sublay hernioplasty - "Capromesh" mesh in combination with PRP. Performance of video-assisted E-Milos operation in the main group was characterized only by the presence of a hematoma in the area of the postoperative wound. The highest recurrence rate was noted in patients after performing proper tissue hernioplasty, and under the conditions of performing onlay hernioplasty. When laparoscopic hernioplasty was performed, only 1 recurrence was observed. No relapses were observed in the group of patients who underwent video-assisted E-Milos surgery with "Capromesh" mesh in combination with PRP.Conclusions. For patients with a primary ventral hernia in combination with diastasis of the rectus abdominis under conditions of the metabolic syndrome, the use of the "Capromesh" mesh in combination with PRP during the Sublay operation and the video-assisted E-Milos operation is the most promising in view of the most favorable features of the remodeling of the structures of the anterior abdominal wall. Performance of laparoscopic hernioplasty and video-assisted E-Milos surgery using the "Capromesh" mesh in combination with PRP should be prioritized especially in groups of patients with existing metabolic syndrome, which allows to significantly reduce the number of postoperative complications.