DIFFERENTIATED CHOICE OF POSTERIOR METHODS OF DISCONNECTION OF ANATOMICAL COMPONENTS OF THE ABDOMINAL WALL IN COMBINATION WITH ALLOPLASTY IN POSTOPERATIVE VENTRAL HERNIAS OF GIANT SIZE.

Abstract

The aim: The aim of the article is to increase the effectiveness of the treatment of postoperative ventral hernias of giant size by a differentiated approach to the selection of the posterior technique of dissection of the anatomical components of the anterior abdominal wall in combination with alloplasty. Materials and methods: An analysis of the surgical treatment of 312 patients with giant postoperative ventral hernias (PVH). The main group consisted of 232 patients who underwent a differentiated approach to the selection of component separation in combination with alloplasty, taking into account intra-ab¬dominal pressure (IAP) when simulating hernioplasty during surgery. In the second control group (80 patients), surgical treatment of PVH of giant sizes was performed using only the posterior Carbonell technique. Results: In 78 patients of the 1st subgroup, IAP was 9.1±1.2 mm Hg. the posterior technique of separating anatomical components according to Carbonell was performed in combination with sublay alloplasty. In 80 patients of the II subgroup with IAP from 11.1 to 14.1±1.2 mm Hg - the TAR technique was performed with sublay alloplasty. In 74 patients of III subgroups with IAP from 16 to 20.1±1.2 mm Hg, performed the TAR technique, we improved in combination with IPOM alloplasty. Conclusions: An increase in the effectiveness of surgical treatment was achieved in patients of subgroup I, reducing the probability of intra-abdominal hypertension to 5.1% versus 11.2%, in patients of subgroup II to 5% versus 11.2%, and in patients of subgroup III to 1.4% versus 11.2% of the control group.