Abdominal Wall In Patients Research Articles

Peculiarities of the botulinum toxin type A injection technique and its effectiveness in the surgical treatment of large ventral hernias

Ventral hernias (VH) continue to be one of the most common surgical pathologies in planned and emergency surgery. Surgical treatment of large VH (≥10 cm) requires the use of traumatic surgical techniques in order to align the edges of the hernia defect and restore the integrity of the anterior abdominal wall. Objective — to assess the effectiveness of the botulinum toxin type A (BTA) injections and to study the peculiarities of their administration into the muscles of the anterior abdominal wall in patients with large VH in the preoperative period. Materials and methods. A prospective cohort study included 66 patients with large VH, primary (PVH), and incisional (IH). From June 2017 to August 2024, all patients underwent treatment and received injections of 100 units of BTA into the anterior abdominal wall muscles in the preoperative period. The patients’ average age was 58.98±9.48. There were 23 men (34.8%) and 43 women (65.2%). Before BTA, the average width of the hernial defect in PVH patients was 12.29±1.93 cm, whereas IH was 13.46±2.06 cm. All patients underwent surgical intervention for their hernias 4—5 weeks after the injection of BTA. Results. No complications were detected throughout the BTA administration or the 4—5 weeks of observation before the surgical hernia repair. After injection, the length of the anterior abdominal wall muscles increased by an average of 1.7 cm (min 0.1 cm, max 4.01 cm) on each side. Patients with PVH had an average hernial defect width reduction of 4.17±0.68 cm, whereas those with IH had an average reduction of 5.14±0.75 cm (p <0.001). After BTA administration, the volume ratio of the hernia sac to the abdominal cavity decreased from 4.97±3.55% to 3.70±2.77% in patients with PVH (p=0.008) and from 5.59±3.71% to 4.21±2.88% in patients with IH (p=0.008). Conclusions. The administration of 100 units of botulinum toxin type A in the preoperative period consistenly increases the length of the abdominal wall muscles, reduces the width of the hernial defect, and enhances the possibilities of further surgical treatment of large VH using laparoscopic technologies.

Choice of Alternative Method of Surgical Intervention in Abdominal Rectus Diastasis with Concomitant Midline Hernias

INTRODUCTION: To date, no consensus has been achieved on the most appropriate surgical method for the treatment of abdominal rectus diastasis concomitant with midline hernias. AIM: Study of the results of three original methods of surgical treatment of patients with abdominal rectus diastasis concomitant with midline hernias. MATERIALS AND METHODS: The results of treatment of 74 patients have been analyzed. The patients were divided into three comparable groups: in the first group (n = 25), repair with local tissues with formation of aponeurotic duplication was performed, in the second group (n = 24), autodermal de-epithelialized graft was used, in the third group (n = 25) — mesh sub-lay implants. The following parameters were evaluated: duration of narcotic analgesia in the postoperative period, period of activation of patients, periods of inpatient treatment and results on Clavien-Dindo and EuraHSQoL scales. The follow-up period was from 1 to 10 years after surgery. RESULTS: The period of postoperative use of narcotic analgesics was 1.08 ± 0.38 days in the first group, 0.98 ± 0.33 days in the second group, 2.13 ± 0.93 days in the third group. The period of activation was 3.00 ± 1.53 days in the first group, 0.89 ± 0.36 days in the second group, 1.5 ± 0.48 days in the third group; the duration of inpatient treatment was 9.24 ± 1.88 bed-days, 6.34 ± 3.04 bed-days and 8.36 ± 2.14 bed-days, respectively. Postoperative complications in the first group were CDI class 6, CDII class 3, in the second group CDI class 1, in the third group CDI class 6, CDII class 3. At 12 months after the operation, painful sensations and functional discomfort on EuraHSQoL scale were absent in the second group, in the first and third groups, limitations in physical activity were noted (р ≤ 0.05; differences between the first and third groups were statistically insignificant, p ≥ 0.05). There were no statistically significant differences in the cosmetic discomfort between the groups (p ≥ 0.05). CONCLUSION: A safer and more effective method of repair of the anterior abdominal wall in patients with concomitant abdominal rectus diastasis and midline hernias is plastic surgery with application of de-epithelialized autodermal graft.

Desmoid Tumor of the Abdominal Wall: About 3 Cases

Desmoid tumours of the abdominal wall are a rare entity that presents a therapeutic challenge, particularly for large tumours. MRI is the preferred radiological examination for suggesting the diagnosis, detailing the depth of extension, and defining the excision margins of the tumour. We present three cases of desmoid tumours of the abdominal wall in patients who underwent tumour resection followed by abdominal wall reconstruction with a bifacial mesh. The postoperative course was uncomplicated.

Combined Double-breasted Full-thickness Abdominal Flap Plication and Acellular Dermal Matrix in Prune-belly Syndrome Reconstruction.

Reconstruction of the abdominal wall in patients with prune-belly syndrome (PBS) following previous intra-abdominal procedures is a challenging problem with a high incidence of revision due to persistent bulging or herniation. The abdominal wall flaccidity not only produces a severe psychological and aesthetic discomfort for the patient but often determines functional disabilities, including inability to cough properly, impaired bowel and bladder function, and delay in posture and balance. The authors describe three cases of reconstruction of abdominal wall using a modified double-breasted abdominoplasty fascial plication with additional acellular dermal matrix interposition and review the literature for innovations in the use of abdominal repair for reconstruction of these difficult cases. Three children with PBS at a mean age of 7.3 years achieved successful reconstruction of the abdominal wall, using the modified double-breasted abdominoplasty fascial plication with acellular dermal matrix interposition. Patients underwent previous procedures, including orchiopexy in two patients and bilateral nephrectomy in one patient. No postoperative complications have been found, apart from superficial skin dehiscence along the abdominal incision treated conservatively in one child. At mean follow-up of 42 months (range 28-56 months), no patient presented incisional hernia, persistent or recurrent fascial laxity with abdominal bulging. All patients achieved significant aesthetic and functional improvements, including children's ability to cough, spontaneous gain of abdominal tonus, balance, and ambulation. Modification of the original vertical, two-layer plications of the deficient abdominal interposing biological mesh has the purpose of improving strength, aesthetics, and function of the abdominal wall in pediatric patients with PBS.

Results of surgical treatment of hernias of the anterior abdominal wall in patients with connective tissue dysplasia syndrome

Relevance. The problem of surgical treatment of hernias of the anterior abdominal wall remains relevant. Despite the introduction of new technologies, the results of surgical interventions cannot be considered satisfactory. The development of hernias and their relapses is facilitated by connective tissue dysplasia syndrome, which manifests as phenotypic signs, disorders of the autonomic nervous system, and morphological changes in the structure of the connective tissue.Objective. To improve the results of surgical treatment of hernias of the anterior abdominal wall in patients with connective tissue dysplasia syndrome.Materials and methods. The study was based on clinical observations and studies of 497 patients with hernias of the anterior abdominal wall. Inguinal (29 %) and postoperative hernias (21 %) predominated. In the structure of recurrent hernias, postoperative (47 %) and inguinal (42 %) hernias were more often observed. Hernioautoplasty was performed in 31 %, plastic surgery using a mesh endoprosthesis — in 54 %, endoscopic hernioplasty — in 15 % of patients. The severity of the clinical, morphological, and metabolic signs of connective tissue dysplasia syndrome was assessed. The concentration of free hydroxyproline in the blood was determined as a marker of connective tissue metabolism. The state of the autonomic nervous system was assessed using variational pulsometry. To assess the state of collagen in connective tissue, a morphological study of the aponeuroses of the muscles of the anterior abdominal wall was performed in the clinic and experiment.Results. The overall incidence of dysplasia in hernias of the anterior abdominal wall was 48 %. The highest incidence of connective tissue dysplasia was detected in recurrent hernias (70 %). Studies of the level of free hydroxyproline in abdominal hernias have shown the dependence of this marker on the degree of connective tissue dysplasia. In cases of recurrent hernias, the highest intensity of collagen biodegradation was observed. A study of the functional state of the autonomic nervous system revealed a predominance of sympathetic activity in abdominal wall hernias with an increase in the tension index by more than 4 times. An increase in the severity of dysplasia is accompanied by an increase in sympathetic activity. Histological studies in patients with abdominal hernias revealed characteristic changes in the morphological structure of the connective tissue. The average thickness, specific area, brightness of staining, and orientation of collagen fibers in postoperative and recurrent hernias were significantly different compared to the group with primary hernias (p˂0.05). Additionally, an experiment was performed on 30 laboratory animals (white rats) to determine the optimal conditions for healing of the aponeurosis of the anterior abdominal wall. The activating effect of prozerin on the process of histogenesis in the wound was revealed. Based on the results of the study, the surgical treatment of hernias was assessed depending on the type of hernioplasty and the severity of connective tissue dysplasia. It has been established that with increasing severity of dysplasia, the frequency of relapses increases by 2.2–3.4 times. With the progression of dysplasia, the frequency of relapses increased by more than twice. The use of the endoscopic hernioplasty method reduced the risk of recurrent hernias by 9 times.Conclusion. In externally localized hernias, the incidence of connective tissue dysplasia ranges from 34 % to 70 %. In patients with connective tissue dysplasia syndrome after hernia autoplasty, the frequency of hernia recurrence is 3.4 times higher. Drug correction of sympathetic activity along with alloplasty increased collagen synthesis intensity by 36 %. The choice of hernia repair method should be determined by the type of hernia, the age of the patient, and the severity of connective tissue dysplasia.

Prevention of purulent and inflammatory complications of the soft tissues of the abdominal wall in patients with peritonitis

Objective. To learn about measures to prevent purulent and inflammatory complications of the soft tissues of the abdominal wall in patients with peritonitis.
 Materials and methods. Based on the purpose of the study, 2 groups of patients were formed. The main group included 23 patients in whom a variable–height polyurethane wound dilator in combination with an application sorbent was used intraoperatively to prevent surgical wound suppuration. The control group included 27 patients who were treated with polyurethane wound dilator alone.
 Results. Suppuration of the surgical wound occurred in 2 (8.7%) patients of the main and 6 (22.2%) patients of the control group, seroma – in 1 (4.3%) and 2 (7.4%) patients, respectively, haematoma – in 1 (3.7%) patient of the control group, inflammatory infiltration – in 2 (8.7%) patients of the main and 3 (11.1%) patients of the control group.
 Conclusions. The use of a polyurethane wound dilator in combination with an application sorbent for the prevention of postoperative wound suppuration in patients with spilled and general peritonitis in the toxic and terminal stages allowed to reduce the number of purulent and inflammatory complications of the soft tissues of the abdominal wall in the main group by 2 times compared to the corresponding indicator in the control group.

Results of surgical treatment of patients of fertile age planning pregnancy with hernias of the anterior abdominal wall

BACKGROUND: Currently, there is no consensus and approved tactics for choosing the method of hernioplasty in the surgical treatment of patients of fertile age planning pregnancy with hernias of the anterior abdominal wall. The study is devoted to the comparative analysis of surgical treatment of these patients.
 AIM: To determine the algorithm of surgical treatment of hernias of the anterior abdominal wall in the patients of fertile age planning pregnancy.
 MATERIALS AND METHODS: The analysis of the treatment results of fertile age patients with hernias of the anterior abdominal wall in the period from 2010 to 2019 has been carried out. The inclusion criteria were as follows: patients of fertile age who underwent surgical treatment of hernias of the anterior abdominal wall, who did not have a relapse before pregnancy. Thus, 252 patients have been included in the study.
 RESULTS: The surgical tactics and optimal timing of the operation in patients of fertile age with hernias of the anterior abdominal wall have been determined.
 CONCLUSIONS: When planning surgical treatment of hernias of the anterior abdominal wall in patients of fertile age, it is necessary to clarify information about pregnancy planning. The most favorable period for planning pregnancy and childbirth is 3 years or more after hernioplasty. When planning a pregnancy in the next 12 years after surgical treatment of a ventral hernia, it is necessary to give preference to hernioplasty with local tissues, which has fewer complications in the long-term postoperative period as well as fewer relapses after childbirth compared with open prosthetic surgery. When planning a pregnancy 3 or more years after surgical treatment, preference should be given to prosthetic hernioplasty. When analyzing the results of treatment of the patients of fertile age with inguinal and femoral hernias, planning pregnancy, clinical experience has shown that there are no contraindications to performing laparoscopic transabdominal preperitoneal prosthetic hernioplasty.

Subcutaneous injection of trastuzumab into the thigh versus abdominal wall in patients with HER2-positive early breast cancer: Pharmacokinetic, safety and patients' preference - Substudy of the randomised phase III GAIN-2 study

BackgroundTrastuzumab given intravenously in combination with chemotherapy is standard of care for patients with early HER2-positive breast cancer (BC). Different randomised studies have shown equivalent efficacy of a subcutaneous injection into the thigh compared to the intravenous formulation. Other body regions for injection have not been investigated but might be more convenient for patients. MethodsAfter surgery, patients were randomised to receive either subcutaneous trastuzumab into the thigh or into the abdominal wall (AW). Patient preferences were evaluated using validated questionnaires (PINT). Primary objectives of this multicentre, non-blinded, randomised substudy of the GAIN-2 study were to investigate pharmacokinetics of the injection into the thigh versus AW and to determine patients' preferences of either administration site versus the previously received intravenous application. Results226 patients were randomised and 219 patients (thigh: N = 110; AW: N = 109) formed the modified intent-to-treat (mITT). Overall, 83.5% (out of N = 182 with information about patients’ preference) preferred subcutaneous over previous intravenous application or had no preference. Preference was similar between both administration sites (thigh: 80.6%; AW: 86.5; p = 0.322). Pharmacokinetic analysis included 30 patients. Geometric means of Cmax and AUC0-21d were higher in thigh than in AW group (geometric mean ratio with body weight adjustment: Cmax: 1.291, 90%-CI 1.052–1.584; AUC0-21d: 1.291, 90%-CI 1.026–1.626). Safety profile was in line with previous reports of subcutaneous trastuzumab. ConclusionSubcutaneous trastuzumab into the thigh showed an approximately 30% higher bioavailability. Injections were well tolerated and preferred over intravenous administration. The subcutaneous injection into the thigh should remain the standard of care.

Spontaneous atypical muscle bleeding of the anterior abdominal wall in patient with COVID-19 – case report

COVID-19 is an unpredictable disease that can lead to multiorgan dysfunctions. There is a high frequency of venous and arterial thrombosis, among other symptoms,. Spontaneous bleeding in COVID-19 patients has also been described, but rarely, whether or not they are on anticoagulant therapy. We report a case of a 65-year-old female COVID-19 patient treated in our hospital. During the hospitalisation, she experienced sudden, severe pain in the lower part of the abdomen and had signs of hemorrhagic shock. CT of the abdomen and pelvis revealed a spontaneous giant haematoma of the anterior abdominal wall. A surgical procedure was done. We identified spontaneous bleeding in the muscles of the anterior abdominal wall. The patient recovered well. Rapid diagnosis and timely intervention are crucial to ensure a good patient outcome.

Abdominal wall metastases due to a squamous cell carcinoma of the lung: Case report and literature review

Abstract Introduction: At the time of diagnosis, most patients with lung cancer are in an inoperable stage, with distant metastases. Most often, these patients have metastases to the brain, adrenal glands, liver, or bones. This article presents the case of a patient with non-small-cell lung cancer (NSCLC) metastases in the abdominal wall. Case presentation: A 67-year-old patient came to our service reporting the existence of a tumor 5 cm in diameter, located at the level of the abdominal wall, without other clinical symptoms. Surgical excision of the tumor was performed. The postoperative evolution was favorable, with the patient discharged on the third postoperative day. Histological examination of the resected specimen revealed metastasis of squamous cell carcinoma of the lung. Conclusions: The appearance of a tumor in the abdominal wall of patients with NSCLC may raise the suspicion of metastasis at this level.

31. THE PEDICLED VPAP FLAP ALLOWS FOR PRESERVATION OF THE ABDOMINAL WALL IN THE RECONSTRUCTION OF APR DEFECTS

PURPOSE: Abdominoperineal resections (APR) often leave large cavitary defects that have historically been reconstructed with vertical rectus abdominus muscle (VRAM) flaps. We present a case series and surgical technique for a novel approach to reconstructing complex defects with a fasciocutaneous flap, the pedicled vertical profunda artery perforator (VPAP) flap, which was first performed for reconstruction of robotic and minimally invasive APR defects in order to preserve the functional abdominal wall. METHODS: A total of 13 patients underwent immediate or delayed reconstruction of APR defects using a pedicled VPAP. Seven patients underwent a minimally invasive APR, with six robotic-assisted and one laparoscopic-assisted procedure, leaving the abdomen completely intact. One patient had a previously failed VRAM, thus the abdomen was unavailable for reconstruction. One patient had bilateral ostomies. Five reconstructions were performed secondarily due to post-operative infection and dehiscence. RESULTS: Of the 13 cases, 2 patients required take back to the operating room for venous congestion. The major complication rate (15.4%) in this series was similar to historically reported rates described for VRAM reconstruction of APR defects. There were no total flap losses or donor site complications. All patients ultimately had successful wound closure. CONCLUSION: The pedicled VPAP presents a viable solution for reconstruction of APR defects while simultaneously preserving the functional abdominal wall in patients who have undergone minimally invasive ablative procedures. Additionally, this technique offers a reconstructive solution in patients that experience post-operative infection and dehiscence, or in whom the abdominal donor site is not available due to bilateral ostomies.

Fitz-Hugh-Curtis syndrome

Fitz-Hugh-Curtis syndrome is characterized by inflammation of the liver capsule and the production of adhesions, leading in pain in the right upper quadrant. It´s a rare chronic form of pelvic inflammatory disease that affects women of childbearing age. Curtis described adhesions between the anterior surface of the liver and the abdominal wall in patients with unusual gallbladder episodes during laparotomies in 1930. Similar cases of right upper quadrant abdominal pain were described by Fitz-Hugh, Jr. in 1934. A 40-year-old Caucasian male presented with a progressively abdominal right quadrant pain and left side quadrant pain. He had no medical history but he referred a follow-up for colon diverticulosis from 3 years. He referred satiety and abdominal pain without weight loss fever, nausea and vomiting. Vital signs were within normal limits. Laboratories showed a haemoglobin of 14g/dl, white blood cells (WBC) 8.5x103/ul, platelets 130x103/ul. Liver function tests were normal. CT SCAN showed a diffuse colon diverticulosis and no signs of chlecystitis or other pathologies. A Clisma Abdomen demonstrated sub-stenosis due to inflammatory diverticulitis. He was referred to operating room.During laparoascopic left colectomy,we found adhesions between the anterior surface of the liver and the abdominal wall violin-string like perihepatic adhesions as Fitz-Hugh-Curtis syndrome that justified the right upper quadrant pain too.

Percutaneous Endoscopic Gastrostomy Tubes Can Be Considered Safe in Children: A Single-Center 11-Year Retrospective Analysis.

Background and Objectives: When the human body is disabled to naturally ingest food through the mouth, enteral or parenteral nutritional support should be started. Percutaneous gastrostomy (PEG) is a flexible feeding tube that is inserted into the stomach through the abdominal wall in patients who will need long-term enteral nutrient intake. The aim of this study is to analyze clinical characteristic of children at the time of PEG placement as well as to determine indications, complications and outcomes associated with PEG at the Department of Pediatrics of the University Hospital of Split. Materials and Methods: Retrospective analysis of the medical records of patients treated from 2010 to 2020 was performed. The following data were collected from medical records: age, gender, information about nasogastric feeding before PEG placement, indication for PEG insertion, duration of PEG, procedure-related complications and treatment outcomes. Malnutrition was determined according to the z-score range for BMI for age and sex. According to the indication for PEG placement, patients were divided into five categories: central nervous system (CNS) diseases, neuromuscular diseases, genetic disorders, metabolic diseases, and group of children with polytrauma. Results: A total of 40 patients with median age of 110 months were included in study. At the time of PEG placement, most patients had deviations in body weight and height compared to expected values for age and sex. The most common underlying diagnoses were diseases of the central nervous system. Minor complications were found in 13 (35%) of patients. One patient (2.7%) developed major complication (gastrocolic fistula) and consequently underwent reoperation. The median duration of PEG in patients with complications before the need for replacement was 27 months, and in patients without complications, 43 months. Conclusions: Negative deviations of z-score body weight, body height, and body mass index could indicate the need for possible earlier placement of PEG. PEG can be considered as a safe therapeutic option in children since PEG-related complications, mostly in minor forms, were found in a small number of patients.

General views on treatment technologies for patients with incisional ventral hernia

Nowadays, the problem of surgical treatment of incisional ventral hernia (IVH) still remains significant. According to the statistical data, the number of patients with postoperative ventral hernias has increased by more than 9 times over the past 25 years. Experts offer many solutions to this problem every year and the surgeon have to find the best method of postoperative rehabilitation in the flow of information. Academic research databases Google Scholar, CyberLeninka and others were used to search for the relevant literature. The following conclusions were drawn from this review. The etiology of IVH is multifactorial. There is no generally accepted evidence-based gradation of risk factors. There is no unified system for selecting the method of hernia repair of the anterior abdominal wall in patients with IVH. The choice of allotransplant material and the method of hernia repair are often individual. The value of the critical level of intraabdominal pressure have not been specified, however, all authors agree that its monitoring should become routine. The sublay technique remains the "gold standard" of plastic surgery by aponeurotic flap, inlay should be used when sublay is impossible to perform. Onlay should be used as a reserve method. In some situations, combinations of techniques are required. More and more laparoscopy is being introduced in the treatment of IVH as an assistance and in therapy. The introduction of new methods of hernia repair based on the uncontrolled separation of the anatomical structures of the abdominal wall imposes special requirements on surgical technology: plastic material, instrumental and technical support, wound closure and pharmacological support, especially in conditions of increased intra-abdominal pressure and tissue tension. We can use medication of pyrimidine’s row (xymedon) for a better implantation of the mesh implant and to increase the resistance of local tissues.

Application of diophantine equations for practical problems solution in biology

Identifying the alterations occurred in the bacteriology of the dermic layer of the abdominal wall in patients who underwent a colostomy, through the qualitative and quantitative determination of the pericolostomic colonization.

Abdominal Wall Endoscopic Extraperitoneal Reconstruction Technique 
 in Patients with Primary Midline Hernias and Diastasis 
 of the Rectus Abdominis Muscles

Introduction. The paper focuses on technical features of endoscopic extraperitoneal reconstruction (EER) of the anterior abdominal wall in patients with primary median hernias combined with diastasis of the rectus abdominis muscles, the nuances of the operating room equipment and preparation of patients for intervention.The aim of the study was to analyze the stages and features of the technique for performing endoscopic extraperitoneal reconstruction of the anterior abdominal wall to ensure safe and qualified implementation of the operation in clinical practice.Materials and methods. This research was a prospective study including 45 clinical cases of patients with primary median hernias of the anterior abdominal wall combined with diastasis of the rectus abdominis muscles, who were exposed to endoscopic extraperitoneal reconstruction. The study was performed in the surgical department of the private healthcare facility "Central Clinical Hospital Russian Railways-Medicine" in 2019-2020. The median follow-up was 14 months (8 - 18 months), there were no complications estimated higher than type I according to the Clavien-Dindo classification and relapses.Results and discussion. Successful EER requires thorough preoperative preparation: to connect a second monitor; to distance anesthetic equipment; to ensure the patient is in an extension position in the lumbar segment of the spinal column; to identify principle anatomical landmarks under ultrasound control. The main two stages of EER - mobilization and reconstruction - are performed extraperitoneally in a confined space, and therefore the localization of the ports must be anatomically validated. The major point at the stage of mobilization is to maintain the integrity of the parietal peritoneum, this solves visualization problems and helps to work in the required layer of the anterior abdominal wall. Adherence to the principles of open surgery, namely, orientation of the needle holder at an angle close to 0 to the suture line (white line), and the needles at a right angle; maintaining working angles between the instruments 30-60, - allows effectively performing the reconstructive stage.Conclusion. Thus, a topographic-anatomically based approach to each stage of the operation and adherence to a set of features of the surgical technique allows safely and effectively applying EER for the treatment of patients with primary midline hernias and diastasis of the rectus abdominis muscles.

Biologically active peptides from marine proteobacteria: Discussion article

Identifying the alterations occurred in the bacteriology of the dermic layer of the abdominal wall in patients who underwent a colostomy, through the qualitative and quantitative determination of the pericolostomic colonization.

The sigmoidostomy as a determining factor in the change of cutaneous bacterial colonization

Identifying the alterations occurred in the bacteriology of the dermic layer of the abdominal wall in patients who underwent a colostomy, through the qualitative and quantitative determination of the pericolostomic colonization.

Endoscopic transversus abdominis release separation in the treatment of patients with midline incisional hernias

Abstract. The issues of reconstruction of the anterior abdominal wall in patients with median postoperative ventral hernias remain relevant for many years. The paradigm of their treatment is gradually shifting towards functional minimally invasive reconstructions of the anterior abdominal wall. The indications and technical aspects of endoscopic posterior separation surgery are considered. The analysis of 70 transversus abdominis release was carried out. The average age of patients with postoperative ventral hernias was 61,210 years. The median follow-up was 14,28,2 months and the anaesthesia risk was 2,80,5. The mean hernia width was 151,773,7 cm2 and the implant size was 832,9243,3 cm2. In the early postoperative period complications were observed in 7 (10%) patients, including the one with retromuscular hematoma, four with retromuscular space infection and two with superficial vein thrombophlebitis. Late complications were observed in 6 (8,7%) patients, there were persistent seroma (3) and chronic pain (3). No hernia recurrence was detected during this period. Thus, the use of endoscopic abdominal wall separation reduces the risk of local complications compared to similar open surgery. At the same time, there is a low level of hernia recurrence and a satisfactory quality of life. In total there were 70 (100%) transabdominal preperitoneal plastic transversus abdominis release and endoscopic totally extraperitoneal transversus abdominis release operations performed, among them 14 (77,8%) were bilateral transversus abdominis release and 32 (61,5%) were unilateral transversus abdominis release 4 (22,2%) and 20 (38,4%) respectively were transabdominal preperitoneal plastic transversus abdominis release and endoscopic totally extraperitoneal 10 (14,3%) operations with combined access were performed: 3 (16,7%) and 7 (1,5%) respectively transabdominal preperitoneal plastic transversus abdominis release and endoscopic totally extraperitoneal transversus abdominis release. In 13 (18,6%) cases simultaneous operations occurred, including 7 (10%) laparoscopic cholecystectomy and 6 (8,6%) endoscopic inguinal hernioplasty.

Rationale for Simultaneous Operations on The Abdominal Organs and The Abdominal Wall in Patients with A Ventral Hernia

Rationale for Simultaneous Operations on The Abdominal Organs and The Abdominal Wall in Patients with A Ventral Hernia