Postoperative Ventral Hernias Research Articles

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.

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%).

Operative accesses to the abdominal aorta from the perspective of prevention of postoperative ventral hernias (literature review)

Operative accesses to the abdominal aorta from the perspective of prevention of postoperative ventral hernias (literature review)

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.

Comparative Evaluation of Biomechanical Characteristics of Acellular Dermal Matrix for Hernioplasty

Background. With the introduction of synthetic mesh implants into clinical practice, the recurrence rate of postoperative ventral hernias was signifi cantly reduced. The extensive use of synthetic implants led to the development of specifi c complications. The development of biological implants, based on extensively purifi ed decellularized collagen matrix of xenogeneic origin is highly relevant due to the fact that, unlike synthetic analogues, they have a biological origin and biodegrade in a natural way, gradually being replaced with newly formed connective tissue. The use of bioprostheses reduces the risk of complications.Objectives. To conduct a comparative evaluation of the biomechanical characteristics of acellular dermal matrix, obtained by detergent-enzymatic decellularization, and commercially distributed Permacol™ matrix.Methods. Acellular dermal matrix (ADM) was created by using samples of native skin of pig of Landras breed aged 4 months. The dermis was processed by means of detergent-enzymatic method. In order to evaluate and compare the mechanical properties of acellular dermal matrix, the biological samples were divided into 2 groups of 15 samples each. The fi rst group included acellular dermal matrix samples, the second group — native samples of pigs unprocessed dermis. The control group consisted of samples of PermacolTM Surgical Implant, xenotransplant for hernioplasty approved for use in the Russian Federation (Covidien, France). All samples were tested wet using universal testing instrument Instron 1122. MedCalc Statistical Software (Belgium) was used for statistical processing of the study results.Results. In the present study, pig dermis was processed using a detergent-enzymatic method to produce ADM. Routine histological examination confi rmed the removal of all cellular elements, and at the same time it was proven that the native structure of the dermis remained intact during its processing. The mechanical characteristics of xenogenic ADM were further determined. Its tensile strength was 9.1 ± 0.6 MPa (910 N/cm2 ), elongation to break was 21.1 ± 2.3%, and elastic modulus was 50.0 ± 1.6 MPa. These characteristics largely corresponded to the strength characteristics of native pig dermis and far exceeded the necessary physiological parameters. PermacolTM control was tested in two directions (longitudinal and transverse). In the longitudinal direction, the sample had higher mechanical characteristics: strength — 12.0 ± 1.7 MPa, elongation to break — 29.7 ± 2.4%, stiffness modulus — 47.2 ± 6.5 MPa. In the transverse direction, all indicators were 1.5–2 times lower.Conclusion. The developed xenogeneic biological implant in the form of ADM demonstrates rather good characteristics of plasticity, tensile strength and elasticity, to be used as a biological endoprosthesis for plasty of hernia defects of the abdominal wall of any size and shape.

P-087 ANALYSIS OF COMPLICATIONS AND QUALITY OF LIFE IN PATIENTS AFTER 5 YEARS OF ANTERIOR SEPARATION HERNIOPLASTY

Abstract Aim To assess the treatment results, complications and the quality of life of patients after anterior separation hernioplasty. Material & Methods comparative analysis of complications and quality of life of 96 patients with giant postoperative ventral hernias after anterior separation plastic by using polypropylene mesh endoprosthesis. Description of method of implant fixation is given, analysis of complications and quality of life of patients is given. The Clavien-Dindo scale and the EuroHS QoL score by EHS were used to investigate complications in the first 30 days. Results wound complications were observed in 11.4% (p < 0.01), general complications 4.2% (0.05), hernia recurrence rate1.0% (p < 0.01), death 1.0% (p < 0.05). Most patients (n = 71, 74%) experienced a significant reduction in pain intensity, increased physical activity, and satisfaction with appearance at 3 months post-surgery. Conclusions study results showed low percentage of wound complications, relapses, and the significant improvement of the quality of patient's life.

The Use of Inlay Bridge of the Posterior Fascia as Adjuvants to a Modified Rives-Stoppa Repair for Difficult Abdominal Wall Hernias.

Major abdominal wall defects remain a highly morbid complication. Occasionally a fascial defect is encountered, that despite all surgical efforts, is unable to completely approximate at the midline. Here we describe our method and outcomes of using a bridging mesh when the posterior fascia was unable to be approximated during the repair of large postoperative ventral hernias using the modified Rives-Stoppa technique. A retrospective review was conducted looking at all the open abdominal wall hernia repairs between 2014 and 2020. The cohort of patients who had a bridge placed in addition to the traditional open modified Rives-Stoppa repair were used for this study. Nineteen patients had a mesh inlay bridge placed in addition to a modified Rives-Stoppa repair with a sublay (retrorectus) Ultrapro mesh. For the inlay mesh 13 Symbotex composite meshes were placed and 6 Vicryl meshes used. The average surface area of the defect was 358.1cm^2. The average length of hospitalization was 8.8days with a range of 3-24days. During the immediate postoperative course there were 6 minor complications. During the follow-up period there were 2 recurrences. The use of inlay mesh bridge as an adjuvant to a modified Rives-Stoppa repair with a sublay ultrapro mesh is an effective technique for difficult abdominal wall repairs where the posterior fascia is unable to be approximated without tension.

Hernioplasty technique in wound complications prevention

Background: The issues of prevention of wound complications in the surgical treatment of postoperative ventral hernias (POVG) remain relevant due to the increase in the number of surgical interventions on the abdominal organs and the development of postoperative ventral hernias in the aftermath. Despite the large number of proposed hernioplasty techniques for postoperative ventral hernias, the rates of wound complications remain high. The use of synthetic materials did not provide a reduction in the amount of infection in the area of surgical intervention. In this connection, the improvement of surgical treatment of patients with postoperative ventral hernias, aimed at the prevention of wound complications, is becoming even more relevant. Wound complications prevention in the surgical treatment of postoperative ventral hernias remains relevant due to the increase in the number of operative abdominal interventions. Therefore, improving surgical rehabilitation of patients in the postoperative period in order to minimize wound complications acquires special practical importance.

Functional alloplasty of recurrent postoperative hernias of the anterior abdominal wall

Aim. To optimize the surgical treatment of recurrent postoperative ventral hernias using synthetic alloplastic materials. Material and methods. The study was conducted among 139 patients with recurrent postoperative ventral hernias. According to the indications, all patients underwent abdominoplasty using mesh biologically inert alloprostheses using the “onlay” method and according to the original method with the displacement of the vaginal leaves mm. recti abdominis. Results and discussion. Recurrence of ventral hernias after the first year of follow-up was detected in 6 (4.3 %) patients. The causes of relapses in large hernias are dystrophic processes in the soft tissues of the anterior abdominal wall, caused both by the activation of fibroblasts upon contact with the polypropylene mesh, and directly by the defect of the mesh as a result of its rupture. In the event of a recurrence, reconstructive surgeries were performed in the scope of a modified technique with component separation to eliminate additional tissue tension. Conclusion. The developed method of surgical treatment of postoperative ventral hernias involves dissection of the anterior walls of the sheath of the rectus abdominis muscles along the the muscles, suturing the aponeurotic edges of the defect, connecting the rectus muscles along the midline, followed by fixing the mesh implant to the outer edges of the dissected aponeurosis of the rectus abdominis muscles, which makes it possible to prevent the occurrence of cicatricial degeneration and defect of functional activity, as demonstrated by monitoring the function of the rectus abdominis muscles.

Enterocutaneous fistula in postoperative ventral hernia - clinical case

Introduction: Postoperative ventral hernias are one of the most common complications of abdominal surgery. Synthetic meshes aim to reduce the complication rates and the incidence of reccurent hernias. Case report: We present the case of a 42-year-old patient after emergency surgery for volvulus of the sygmoid colon and diverticulitis. Resection of the sygmoid colon with descenso-recto anastomosisand protective supraumbilical transversostomy was performed. 5 months following the surgery relaparotomy and restitution of the gastrointestinal tract was performed. During the surgery, massive adhesions and a significant postoperative ventral hernia were found. After adhesiolysis and anastomosis of the colon, a two-component mesh was sutured on the hernia defect. A month after the surgical intervention several fistulas were observed and the patient was febrile. Revision of the wound and excision of the fistulas was performed. Conclusion: Entero-cutaneous fistulas are on of the most common and serious complications following surgery of the abdominal wall due to ventral hernia. Surgical treatment is the most important step and includes resection of the enteral segment involved in the fistula and correction of the metabolic abnormalities.

Features of Drainage of the Implant Placement Area in Patients with Incisional Ventral Hernias

Introduction. There are different and sometimes conflicting points of view regarding the drainage of the implant placement area in patients with postoperative ventral hernias. This is due to the variability of drainage methods and the commitment of surgeons to one or another technique. In addition, the results of surgical treatment and features of the postoperative period differ in these patients. Current contradictions in the drainage techniques and management of patients with seromas after hernioplasty for PVH determine the relevance of this issue and the need to obtain additional data on benefits and drawbacks of one method or another.The aim of the study was to analyse clinical outcomes of patients with postoperative ventral hernias depending on the drainage technique of the implant placement area.Methods. The study included 392 patients diagnosed with postoperative ventral hernia, who were treated in GBUZ "Samara Regional Clinical Hospital named after V.D. Seredavin" in 2017-2020. Patients clinical outcomes were compared and analysed. Group I included 110 patients with passive drain of the surgical wound, group II included 282 patients with active drain. The groups were assessed based on major parameters of the drainage impact on the surgical treatment outcomes. Non-parametric values were compared by calculating the chi-square (2), parametric - by calculating the Student's t-score. Results. In group I, the average duration of hospitalization was 22,564,45 bed-days. The average terms of drainage were 2,020,69 days. Clinically significant seroma was diagnosed in 35 (32%) patients. The average number of US-guided puncture-drainage interventions was 1,870,89 procedures. Suppuration of the surgical wound was diagnosed in 16 (14,5%) patients. The postoperative mortality rate in the group was 3,6%, 4 patients died. In group II, the average duration of hospitalization was 13,572,92 bed-days. The average terms of drainage were 6,332,12 days. Clinically significant seroma was diagnosed in 42 (14,9%) patients. The average number of US-guided puncture-drainage interventions was 0,650,39 procedures. Suppuration of the surgical wound was diagnosed in 21 (7,4%) patients. The postoperative mortality rate was 2,1%, 6 patients died.Conclusion. Active drain of the implant placement area in patients with postoperative ventral hernias statistically significantly reduces the duration of patients stay in hospital (Student t-score = 11,51 p0,01), frequency of clinically diagnosed seromas (2 = 14,36, p0,01), frequency of suppuration of postoperative wounds (2 = 4,665, p0,05). When choosing the drainage option for the implant placement area, preference of choice should be given to active penetrating open drain or active penetrating closed drain.