Postoperative Ventral Hernias Research Articles

Robotics can decrease the rate of post-operative ventral hernia: a single centre retrospective cohort study.

Midline incision for extra-corporeal anastomosis is common with traditional laparoscopic right hemicolectomy. Incisional hernias develop in up to 20% of these patients within a year adding considerable morbidity and healthcare costs. Robotic assisted surgery (RAS) improves technical ease of intra-corporeal anastomosis, preventing midline extraction but its benefit over laparoscopy remains debated. We aimed to determine if robotic assisted surgery and Pfannenstiel extraction decreased the rate of radiologically detected incisional hernias compared to standard laparoscopy with extra-corporeal anastomosis. The secondary outcomes aimed to evaluate incidence of port site hernias in 8mm robotic ports for which routine closure is not followed. Our single centre retrospective cohort study included patients who had minimally invasive right hemicolectomy and had cross-sectional imaging at least 1-year later. Patient demographics, body mass index, history of smoking or previous surgery was recorded. At imaging, evidence of new extraction site or port site-site hernia, contents and clinical impact was noted. A total of 100 patients (50 robotic and 50 laparoscopic) were included. Baseline characteristics appeared equally distributed. 16% (8 patients) who had laparoscopic surgery developed midline extraction site hernias which was significantly higher to RAS group (0 patients). 3 patients developed hernias at the site of robotic ports and this was more commonly at the right iliac fossa port. RAS, by simplifying intra-corporeal anastomosis has potential to eliminate incisional hernias, particularly when Pfannenstiel extraction is used. The potential for 8mm robotic ports to develop clinically significant hernias cannot be ignored and meticulous closure can prevent patient harm.

Choice of hernioplasty method for large postoperative ventral hernias in thin and cachectic patients

Choice of hernioplasty method for large postoperative ventral hernias in thin and cachectic patients

The Clinic's first experience in treating large and giant postoperative ventral hernia using the posterior separation technique Transversus Abdominis Release

The Clinic's first experience in treating large and giant postoperative ventral hernia using the posterior separation technique Transversus Abdominis Release

PURULENT-INFLAMMATORY COMPLICATIONS AND POSTOPERATIVE HERNIAS AFTER CESAREAN SECTION

Any surgical intervention on the abdominal cavity, including caesarean section, is accompanied by several postoperative purulent-inflammatory complications, especially in patients with concomitant diseases. The most common purulent complications occur in the laparotomy area. They are suppuration of surgical wounds, necrotizing fasciitis, phlegmon and abdominal abscess. There are different opinions on the predictors of purulent complications. The most frequently mentioned are leukocyte count, C-reactive protein, procalcitonin, ferritin, and endocervical culture. Unfortunately, peritonitis and sepsis rates have not reduced recently. Still, these complications negatively affect treatment outcome. The paper discisses the effectiveness of drainage and lavage of the abdominal cavity during cesarean section. In this regard, preventive measures reducing the number and severity of purulent-inflammatory complications becomes relevant. First of all, this concerns intraoperative antibiotic prophylaxis, which should be carried out taking into account risk factors and the individual sensitivity of genital tract microorganisms to antimicrobial drugs. Obstetricians do not have a particular pattern to follow this technique. There is also ambiguous opinion on choosing an operative approach to reduce the number of postoperative ventral hernias. Both longitudinal and transverse laparotomies have certain advantages and disadvantages. Until now, the choice of postoperative ventral hernia repair, especially in the hypogastrium, is determined by many factors, which should be taken into account. These problems reveal the need for optimal measures aimed at reducing negative consequences of cesarean delivery. Articles from Cyberleninka, e-Library, disserCat, ResearchGate, JSTOR, PubMed, and Google Scholar were analyzed for the study.

Nissen fundoplication in a series of 53 consecutive patients

Hiatal hernia (HH) is often seen in surgery practice. The main feature of HH is the migration of abdominal viscera in the mediastinum via the esophageal hiatus. We performed - on 53 patients from November 2009 to June 2018 in the Department of General and Digestive Surgery of General Hospital of Villarobledo. Forty-one patients were diagnosed with hiatal hernia, 9 - with gastroesophageal reflux disease (GERD), and 3 - with Barrett’s esophagus. The average operative time was 89 ± 33 minutes, and the average follow-up was four years. The following complications were recorded: perforation of the distal esophagus in 1 patient (1.9%), postoperative spleen hemorrhage requiring emergency laparotomy in 1 patient (1.9%), dysphagia in 6 patients (11.3%) in the early postoperative period (treated conservatively), one patient had small bowel obstruction in the fourth postoperative year, three patients (5.6%) had radiological signs of HH recurrence and GERD despite the fundoplication. One patient (1.9%) was reoperated for stenosis of the distal esophagus and recurrent paraesophageal hiatal hernia one year after the first intervention. Postoperative ventral hernia (POVH) was seen in 2 patients (3.8%). All recurrence rate was 7.5%, recorded in 4 patients.

Comparative analysis of separation techniques in the treatment of medial ventral hernias

Relevance. Tension-free herniolasty of the anterior abdominal wall is currently the accepted standard for large ventral hernia repairing. The implementation of this approach has been marked by a significant improvement in treatment outcomes. The issues of improving the quality of life of patients after surgery and their effective rehabilitation through the application of the optimal technique of tension-free hernioplasty are now at the forefront.Objective. To compare the immediate and long-term results of treatment of patients with large postoperative midline ven­tral hernias using anterior and posterior techniques of separation of abdominal wall components.Object and methods. 114 patients with large postoperative midline ventral hernias were divided into two groups: the patients of the first group (38 patients) underwent hernioplasty using the anterior separation technique, and the patients of the second group (76 patients) - posterior separation. We evaluated the immediate (complica­tions in the area of surgery, duration of surgical wound drainage and duration of hospitalization) and long-term (functional restoration of the abdominal wall) results of treatment with subsequent comparative analysis of data between the groups using descriptive statistics methods.Results. The present study is the first to compare the immediate and long-term results of using anterior and posterior techniques for separation of anterior abdominal wall components during surgery for midline ventral hernias. It was found that both variants demonstrate good immediate and long-term results in the treatment of patients with median postoperative ventral hernias of large size. At the same time, the anterior separa­tion technique is accompanied by a significantly higher number of complications and, accordingly, is characterized by a higher risk of their de­velopment, as well as requires a longer stay of the patient in the hospital.

Clinical and experimental parallels in the substantiation of the method of hernioplasty of postoperative ventral hernias of median localization

Objective: development, clinical application of a new original method of hernioplasty of median postoperative ventral hernias and biomechanical experimental substantiation of the effectiveness of this method.Materials and methods: the method of hernioplasty of median postoperative ventral hernias with strengthening of fascial-aponeurotic structures of the anterior abdominal wall was developed and clinically tested on 63 patients. An anatomical experiment was performed in which the biomechanical parameters of the reinforced scar-altered structures of the median parts of the anterior abdominal wall were studied according to the method developed by us.Results: an increase in the biomechanical parameters of the median structures reinforced by the original method with a frame thread was found: the strength limit of the fascia — by 59.4%, and the modulus of elasticity — by 40.2%, compared with the scar-altered fascia in herniators. These results suggest a confident prevention of recurrence of herniation when using this technique. This assumption was confirmed after the introduction of the technique into clinical practice. In all 63 observed patients, there is no recurrence of herniation for 1-5 years. There were no significant complications of the course of the early postoperative period associated with the applied method of plastic surgery. The method is characterized by material and financial accessibility, the absence of complex technical manipulations that increase the duration of hernioplasty.Conclusions: the effectiveness in preventing recurrence of herniation, accessibility and simplicity of the proposed method of surgical treatment of postoperative and recurrent ventral hernias allows us to recommend it for wide clinical use.

Reducing an operational access for cholecystectomy on overweight patients

The development of laparoscopic surgery, based on technological progress, and the accumulation of clinical experience makes it possible to reduce operating access, reducе the postoperative complications. Material and methods. SILS cholecystectomy were performed in 27 patients with overweight and obesity. All operations were done as planned for chronic calculousis cholecystitis. Results and discussion. We used assistive technologies for organ traction (Patent N 103722 Russian Federation) in the event of a “conflict” of instruments, which made it possible to reduce the intervention time. The mean intervention time was 55.5±6.9 minutes. In 10 patients with risk factors for the formation of trocar hernias (obesity, advanced age, functional insufficiency of the connective tissue), the access area was preventively strengthened by an implant placed over the aponeurosis. All patients were discharged in a satisfactory condition 3-4 days after surgery. Subsequently, during observation and re-examinations up to 7 years after surgery, patients did not complain about surgical intervention, felt well, and not a single case of postoperative ventral hernia was recorded. Conclusion. The advantages of cholecystectomy in overweight and obese patients using the SILS technique are obvious, associated with a reduction in the invasiveness of the operation, an excellent cosmetic result, and the achievement of a fundamentally different quality of life for patients.

Clinical characteristics and assessment of the frequency of complications after surgical treatment of patients with free and strangulated hernias using synthetic implants

Objective. To give a clinical assessment and conduct a comparative analysis of the frequency of postoperative complications in patients with free and strangulated hernias of various localizations after tension-free hernioplasty using synthetic implants.Materials and methods. A retrospective analysis of 965 medical records of inpatient patients who underwent tension-free hernioplasty for hernias of various localizations in the period from 2018 to 2022 was carried out. The results of the study were processed using applied statistics using MS Excel and a software package for statistical analysis “Statistica v. 10.0”. Statistically significant differences were considered at p < 0.05.Results. The study revealed that in the postoperative period after tension-free hernioplasty in patients with strangulated hernias, the complication rate was 15.8%. At the same time, the frequency of complications was higher after “onlay” hernioplasty in patients with strangulated hernias than in patients with free hernias. The frequency of postoperative complications in patients with impaired postoperative ventral hernias is 8.3 times higher than in patients with free postoperative ventral hernias. In the postoperative period, complications such as seroma and infiltration of the postoperative wound were detected in 10.5 and 5.2% of cases in patients with strangulated hernias. The duration of inpatient treatment for patients with complications after hernioplasty is 2.6 times longer compared to patients without complications (p < 0,05).Conclusion. In the postoperative period, in patients with strangulated hernias, the incidence of complications was observed in 15.8% of cases, and in patients with free and irreducible hernias in 1.5% of cases. Clinically, such postoperative complications as seromas, infiltrates of the postoperative wound, ligature fistulas, scrotal hematoma, orchitis, abscess of the postoperative wound were identified.

ЭКСПЕРИМЕНТАЛЬНОЕ ИССЛЕДОВАНИЕ ПРИМЕНЕНИЯ ОРИГИНАЛЬНОГО ФИБРИНОВОГО КОМПОЗИТА В ХИРУРГИЧЕСКОМ ЛЕЧЕНИИ БОЛЬНЫХ С БОЛЬШИМИ ПОСЛЕОПЕРАЦИОННЫМИ ГРЫЖАМИ

Introduction. The increase in the number of abdominal surgeries with laparostomy formation in recent years has been accompanied by an increase in the number of postoperative ventral hernias. Mortality in this category of patients ranges from 0.1 to 2.9% for planned surgeries and from 10 to 26% for strangulated hernias. One of the reasons is implant suppuration in the postoperative wound with subsequent septic complications and increasing antibiotic resistance of pathogenic microorganisms. Objective. To experimentally study the effectiveness of using the original fibrin composite to improve the adaptation of the mesh implant in the tissues of the anterior abdominal wall in the treatment of postoperative ventral hernias. Material and methods. The experimental in vitro study included studying the process and mechanisms of fibrin clot formation when various components to human plasma cryoprecipitate. The second stage of the study was to study the effect of surgical trauma and the introduced components of the fibrin composite on the formation of fibrous tissue. In a bacteriological laboratory, the risk of infection of a mesh implant treated with cryoprecipitate and its effect on E growth. Coli, St. Aureus, and P. Aureginosa colonies were studied. In the clinic, 60 patients with large postoperative ventral hernias were operated on, including 39 women and 21 men. In the main group, 30 patients underwent herniotomy and implant installation, and the original fibrin composite was applied. In the comparison group, 30 patients underwent a herniotomy in a modification of the Belokonev operation. The average age of the patients in both groups was 63±2.8 years. Results. When thrombin is added to the cryoprecipitate in in vitro experiments, a dense clot is formed which in the early stages is well modeled on a polypropylene mesh, subsequently forming a fibrin coating. The fibrin composite has a bacteriostatic effect, which helps to prevent infection and suppuration of the implant in the future. In the patients operated in the main group, the immediate postoperative period was without complications. In the comparison group, a long period of leukocytosis was observed in the postoperative period. Conclusions. The original fibrin composite has a bacteriostatic effect and prevents active microflora growth of microflora in the postoperative wound. The original fibrin composite covers the mesh implant, promoting rapid fibrous tissue. The use of this technology in the clinic is available in surgical practice and is not accompanied by the occurrence of complications.

RESULTS OF LAPAROSCOPIC AND LAPAROTOMIC INTERVENTIONS FOR POSTOPERATIVE VENTRAL HERNIA

The study is based on a clinical examination of 105 patients with postoperative ventral hernias who were operated on in the surgical department of the multidisciplinary clinic of Samarkand State Medical University for the period from 2019 to 2023. Depending on the choice of operation, patients were divided into two groups:The first group (main group) consisted of 50 patients operated on laparoscopically, the second group, the comparison group included 55 patients who underwent open (traditional) prosthetic hernioplasty. The use of the laparoscopic "ipom" technique can significantly reduce the number of early postoperative and general complications (by 3.6 times), the duration of hospitalization (from10.2 ± 1.8days before6.2 ± 0.8days), periods of temporary disability (from40.9 ± 5.6days before15.1 ± 1.8days), and also reduce the number of relapses (from 10.9% to 2.0%).

Оперативные доступы к брюшному отделу аорты с позиции профилактики послеоперационных вентральных грыж (обзор литературы)

Оперативные доступы к брюшному отделу аорты с позиции профилактики послеоперационных вентральных грыж (обзор литературы)

Optimization of the posterior method of dissection of the anatomical components of the abdominal wall for postoperative ventral hernias of giant sizes

The aim of the work - to increase the effectiveness of surgical treatment of PVH of giant size by using the improved TAR technique.
 Materials and methods. An analysis of the surgical treatment of 150 patients with post-operative abdominal hernias of giant size, who underwent posterior techniques of disconnection of the anatomical components of the abdominal wall TAR in combination with alloplasty, was performed in the period from 2016 to 2022. The main group consisted of 74 patients with post-operative ventral hernias of giant size who underwent advanced TAR technique in combination with IPOM alloplasty. The comparison group consisted of 76 patients with giant PVH who underwent the classic posterior technique of component separation TAR in combination with retromuscular alloplasty.
 Results of the studies and their discussion The results of ICP measurement in patients of the main group showed that after 6-24 hours after the operation in 73 (98.6%) patients, ICP was within 7.1 ± 1.3 mmHg and only 1 (1.4%) patient had IAH of the first degree, which was caused by intestinal paresis. After conservative treatment and elimination of intestinal paresis, after 48 hours ICP was 5.7 mmHg which was normal.
 In 76 patients of the comparison group who underwent classic TAR with retromuscular alloplasty, IAH of varying degrees of severity was diagnosed in 6 (7.9%) patients. Among them, 3 (3.9%) patients developed IAH of the I degree, 2 (2.6%) had IAH of the II degree and 1 (1.3%) patient had IAH of the III degree.

Modern approaches to the treatment of postoperative hernias

One of the most common surgical pathologies are external abdominal hernias. The share of postoperative ventral hernias (POVH) accounts for up to 15-18% of the total number of patients with abdominal hernias. More than 1.5 million surgical interventions for ventral hernias are performed annually in the world, in the CIS countries this figure exceeds 200,000 operations. Modern studies have shown that the surgical treatment of patients with POVH should be based on a personalized approach, taking into account the existing concomitant pathologies, risk factors, surgical potential of the operating go doctor and hospital.

BASING THE SELECTION CRITERIA FOR HERNIOALLOPLASTY IN POSTOPERATIVE VENTRAL HERNIAS

According to the World Health Organization, hernia of the anterior abdominal wall is one of the most common surgical diseases, it is observed among 3-7% of the population, and the disease is observed mainly among the population of working age. ( ) More than 5% of all laparotomies are complicated by the formation of postoperative ventral hernias. , in addition, their frequency depends on the nature and urgency of the surgical intervention( ). About 10% of all surgical interventions are the operative approach to eliminate ventral hernias (VH). Existing traditional hernioplasty methods are not always effective in treatment. In this case, the recurrence varies from 4.3% to 46%, with wide and large defects, the frequency can be repeated up to 60%. In this regard, at present, various variants of allogenioplasty are the preferred method of surgical treatment, which allowed to significantly improve long-term results. However, ongoing research in this direction, on the basis of existing diseases in patients, the selection of the optimal method as a result of the comparative approach of the operative method, the size and location of hernias, and other factors, indicate the unsatisfactory results of the treatment of such patients and indicate the relevance and social importance of this problem.

Social and economic aspects of treatment of patients with medium (W2) and large (W3) postoperative ventral hernias

The article describes social and economic aspects of the treatment of patients with medium and large postoperative ventral hernias . The study was based on the results of treatment of 181 patients operated by endovideosurgical and open methods for postoperative ventral hernias . The stratification of patients was carried out on the basis of the mod ern classification of postoperative hernias of the EHS approved in the national clinical guidelines . The first main group of patients who underwent laparoscopic hernioplasty using the IPOM+ technique ( intraperitoneal onlay mesh ) consisted of 47 people . The second main group included 12 patients operated using the preperitoneal eTEP technique ( extended total extraperitoneal plasty ). The control group consisted of 122 patients with postoperative ventral hernias who underwent traditional ( open ) hernioplasty : using the techniques of onlay – 35 patients , inlay – 12, sublay – 75. Preoperative examination before planned minimally invasive hernioplasty included routine laboratory and instrumental examinations . The exceptions were patients with stage II and III obesity , as well as large postoperative ventral hernias , patients who underwent computed tomography with abdominometry . The economic efficiency of the treated patients was calculated using standardized formulas . It has been established that the complete e- TEP operation statistically reliably allows to get a significant economic effect compared to the laparoscopic IPOM surgery . IPOM endovideohernioplasty can be used in patients with a combined surgical disease of the abdominal organs in the case of simultaneous intervention . Traditional hernioplasty in patients with large and giant hernias with reduction of abdominal volume are the operations of choice and significantly increase the economic efficiency of the medical hospital . A modern surgical hospital should be able to perform any variants of both traditional and endovideosurgical hernioplasty in order to provide effective medical care and achieve optimal economic performance in any of the existing health insurance systems .

Hernia Surgical Treatment; Multi-options and Paucity of Statistical Conformation for the Preferred Surgical Option

Background: Hernia is a common pathology in the globe and reported more frequently, particularly, inguinal hernia. Aims: To identify the surgery of choice for the treatment of hernias by evaluating the required postoperative hospitalization time, as no other complications have been reported according to data from Mordovian Republic hospital. Material and Methods: A retrospective cohort study involved 790 patients for the period 2017-2022 treated surgically for various types of hernia; inguinal hernia, umbilical hernia, spontaneously reduced strangulated post-operative ventral hernia, incarcerated post-operative ventral hernia, and hernia of the Lina Alba. The T-test was used for statistical analysis, and a one-way ANOVA test and Pearson correlation test were conducted using the Statistica program. Results: The hospitalization period after Liechtenstein surgery is statistically less than Postemsky surgery (mean 6.88 days, 7.43 days, respectively, t value -2.29593, p<0.02) and laparoscopic surgery (mean 6.88 days, 8.19072 days, respectively, t value 4,206817, p<0,000031). At the same time, laparoscopic surgery has a shorter post-operative hospitalization than Postemsky surgery (t value -2.19326, p<0.02). According to the surgical approach, the patient’s post-operative hospitalization days differ (mean days: min. days; max. days, 7.50192: 0.00; 30.00). According to Postemsky (M ± m; 7.43262, ±0.167012), according to Martynov (M ± m; 8.37500, ±0.113440), according to Liechtenstein (M ± m; 6.88153, ±0.146845), according to Mayo (M ± m; 7.51282, ±0.280156), according to Bassini (M ± m; 8.77778, ± 2.379179), laparoscopically (M ± m; 8.19072, ± 0.268434), according to Sapezhko (M ± m; 8.25000, ± 1.380074), and another type of surgery (M ± m; 11.40000, ± 2.501999). Women (mean 8.525114 days) were hospitalized longer than men (mean 7.065371 days), t value 5.871044, p< 0.001. A statistically significant correlation has been found between age and postoperative hospitalization time (Pearson Rank Order Correlations r=0.215561, p <0.05). Conclusion: The study shows that the Lichtenstein surgery is the surgery of choice in terms of hospitalization time after the surgery. Straight association between sex and age with postoperative hospitalization days.

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.

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.

Ventral hernia repair surgery after abdominal gunshot wound

Gunshot wounds to the abdomen frequently result in significant damage to the abdominal organs, which is accompanied by peritonitis and the further development of different complications (anastomotic leakage, formation of abscesses, repeated bleeding, etc.), which require repeated surgical interventions that contribute to the formation of postoperative ventral hernias. The surgical management of ventral hernias is challenging due to severe adhesion in the abdominal cavity (irrespective of the time period since the injury and the last surgical interventions), the difficulties in closing massive defects of the muscle‑aponeurotic component of the anterior abdominal wall, contracture of the anterior abdominal wall, and the development of the abdominal compartment syndrome in the postoperative period. As a result, there is still some debate over the best surgical treatment for postoperative ventral hernias. Objective — to carry out a comparative analysis of open and video‑assisted laparoscopic operations for the selection of the most optimal surgical strategy for the management of ventral hernias after gunshot wounds to the abdomen. Materials and methods. We analyzed the surgical treatment of 45 wounded patients with postoperative ventral hernias that developed after operations for abdominal gunshot wounds. The patients were treated at the Military Medical Clinical Center of the Southern Region (Odesa) from 2014 to 2021; 32 of them had penetrating gunshot wounds, and 13 patients had a closed gunshot wound to the abdomen with injuries to the abdominal organs. 66.7 % of those injured had one operation on their abdominal organs, 22.2 % had two operations, 6.7 % had three operations, and 4.4 % had five operations. The size of the hernia orifices and severity of recurrence risk were determined according to the SWE classification: W1 (width of the hernia orifices up to 4 cm) — 28.9 %, W2 (from 4 to 10 cm) — 44.4 %, and W3 (over 10 cm) — 26.7 % of patients. The patients who had laparoscopic hernia repair (LHR) (IPOM‑Plus method — 17 patients, sIPOM — 2 patients) belonged to the LHR group (n = 19). The patients who had open hernia repair (OHR) (IPOM‑Plus method — 7 patients, sublay technique — 11 patients, onlay technique — 8 patients) were added to the OHR group (n = 26). The patients of both groups did not statistically differ by age, nature of a gunshot injury, number of operations before hernia repair, or hernia parameters (all p > 0.05). Results. Postoperative hernias after gunshot wounds are associated with pronounced adhesions in the abdominal cavity. The mean value of the peritoneal adhesion index averaged 11.7 ± 0.7 points (from 5 to 23 points) and did not statistically differ between groups: in the OHR group — 12.4 ± 0.9 points, in the LHR group — 10.8 ± 0.9 points (p = 0.339). Laparoscopic and open hernia repair in injured patients did not differ in the frequency of intraoperative complications — 19.2 % and 15.8 %, respectively (p = 0.766). There were fewer postoperative complications (10.5 % vs. 38.5 %, p = 0.036), a shorter operation duration — 79.5 ± 6.8 min vs. 105.9 ± 4.7 min, p = 0.002, a shorter bed‑day — 8.6 ± 0.4 days vs. 10.8 ± 0.5 days, p = 0.004, and fewer patients required narcotic analgesics within the first two days after surgery (p < 0.05). During the one‑year follow‑up, no hernia recurrence or adhesion signs were detected in the groups. Conclusions. In the structure of postoperative ventral hernias after gunshot wounds to the abdomen, patients with open gunshot injuries predominate and amount to 71.1 % (р = 0.007). Among them, patients with combined and multiple wounds make up 65.6 %, while those with isolated wounds make up 34.4 % (р = 0.112); 33.3 % of patients require more than one operation before hernia repair. The laparoscopic IPOM‑Plus technique should be considered the operation of choice in the treatment of hernias after gunshot wounds to the abdomen. At the same time, for extensive cosmetic defects of the anterior abdominal wall, open operations are preferable, especially the IPOM‑Plus technique. If this is technically impossible, a sublay or onlay hernia repair using the tension‑free allohernioplasty technique should be performed.

Application of the Developed Mechanical Methods for the Treatment of Patients with Wound Complications of Postoperative Ventral Hernias Prosthetic Repair

Introduction. Until now, the treatment of postoperative ventral hernias and their complications remains a difficult task of abdominal surgery. Patients with extensive wound defects of the abdominal wall complicated by a purulent-inflammatory process of soft tissues are of particular difficulty for treatment; an attempt to stitch these tissues together in the II phase of the wound process using conventional options results in unnecessary trauma and makes it much more difficult, and sometimes impossible, to accurately match homogeneous layers.The aim of the study was to demonstrate the potential of successful use of the developed adaptive instruments for mechanical treatment of the wound surface and closure of a large defect in the soft tissues of the anterior abdominal wall, formed during suppuration of the surgical wound and rejection of the endoprosthesis after prosthetic repair of the hernia ring.Results. Two clinical cases of successful use of the developed adaptive instruments for mechanical treatment of the wound surface and hardware decompression suturing of wounds in the treatment of deep wound infection in postoperative ventral hernias prosthetic repair were presented. Healing of wound defects after wound suppuration and implant rejection was achieved in both cases.Conclusion. The data obtained demonstrated the safety and clinical efficacy of a staged surgical treatment with mechanical debridement of the wound, followed by vacuum therapy and the implementation of a hardware decompression technique for closing the wound defect; this creating optimal conditions for wound healing according to the type of primary intention.