The Modern Concept of Surgical Treatment of Patients with Postoperative Hernias of the Anterior Abdominal Wall

Abstract

Relevance The advantages of prosthetic methods of postoperative ventral hernia correction are now recognized by most domestic and foreign surgeons. But there still remains a considerable controversy concerning the indications for prosthetic abdominal wall surgery, optimal prosthetic method operative approach and technique of hernioplasty. The purpose of the study Research objectives were to analyze our own experience of treating patients with postoperative hernias of the anterior abdominal wall and data from publications on this issue. Materials and methods Our approach to ventral hernia surgery is based on the experience of treating 550 patients with hernias of the anterior abdominal wall. Results and their discussion Prosthetic methods are undoubtedly superior to autoplastic surgery. Among the prosthetic methodsthe one with submuscular mesh placement (“sublay”) is to be preferred. If this technique fails to be applicable due to a too large abdominal wall defect not allowing to join the aponeurotic margins without tension, the abdominal wall should be restored by an “inlay” operation. If the latter technique is not applicable, a Ramirez operation is to be performed. The “inlay” technique is the least profitable prosthetic method of hernioplasty as far as functionality is concerned, because it does not restore the linea alba. For patients with large medial abdominal wall defects, when high-quality physical recovery is needed, the Ramirez technique is also indicated because it allows translocating the vagina m. recti abdominis medially. Conclusion Among prosthetic techniques optimal use of combined methods of plastics. Laparoscopic hernioplasty still remains intervention performed by only in specialized institutions, although the first results of its application are encouraging