Postoperative Ventral Hernias Research Articles

Reconstruction of the anterior abdominal wall with postoperative ventral hernias by a modeled implant

The method of “sublay” plastics is the most common in comparison with other types of plastics in postoperative ventral hernias. Unfortunately, the frequency of relapses according to literature data exceeds 10%. Surgeons’ dissatisfaction with the results of operations makes it necessary to look for new ways of operations, types of plastics, implants and possible ways of fixing. The study was conducted on the basis of 85 clinical hospitals (Moscow) and included 66 patients aged from 18 to 83 years. Patients were operated using a self-locking implant ProgripTM with the location of the implant according to the “sublay” method. The material from which the implant is made met all the requirements of an “ideal” implant. However, for a long time, patient monitoring revealed relapses. To reduce the number of relapses, a new modeled Implant ProgripTM was developed and introduced into the clinic.

Optimized approach to the surgical treatment of patients with large and giant postoperative ventral hernia

To optimize surgical approach in patients with large and giant postoperative ventral hernias through an analysis of early and long-term results of modern techniques of hernia repair. There were 680 patients with postoperative ventral hernia over a 15-year period who underwent surgery in the Sklifosovsky Research Institute for Emergency Care and Medical Unit of the Ministry of Internal Affairs (445 (65.4%) women, 235 (34.6%) men). Mean age of patients was 63.2±14.2 years. Middle and elderly (employable) age patients (45-74 years) prevailed in the study (n=510, 75%). Hernia repair using «sublay» technique was performed in 490 (72%) patients without severe comorbidities and relative volume of hernial protrusion up to 18%. Submuscular-inlay technique was used in 95 (14%) patients with significant comorbidities and those over 50 years old or with a relative volume of hernial protrusion over 18%. We have applied a modified repair technique for the last 3 years in 5 (0.75%) patients with a giant postoperative ventral hernia and anterior abdominal tissue deficiency (partial or complete absence of some anatomical structures, for example, rectus muscle). A hybrid technology was applied in 12 patients with severe concomitant diseases, hernias W2 according to European qualifications or recurrent hernias, significant adhesions in the abdominal cavity or hernial sac. Early postoperative wound complications occurred in 27 (5.5%) patients including hematoma (n=12, 2.5%), infiltration (n=7, 1.4%), wound suppuration (n=8, 1.6%). Other complications were observed in 6 (1.2%) patients: pneumonia, pulmonary embolism, intestinal obstruction. Lethal outcomes were absent. Recurrences in long-term period were found in 18 (3.7%) patients. Submuscular-inlay technique of hernia repair was followed by early postoperative wound complications in 5 (5.1%) patients including hematoma (n=3, 3.2%), infiltration (n=1, 1%), wound suppuration (n=1, 1%). There was no mortality. No other early postoperative complications were observed. Recurrences were detected in 5 (5.2%) patients. Preoperative intra-abdominal pressure was 7-10 mm Hg in all patients with tissue deficit. This value did not exceed 12 mm Hg after repair due to creation of a «specified diastasis». Lethal outcomes were absent. There were no early and long-term recurrences or wound complications. Analysis of early and long-term results of the modified hybrid repair of the anterior abdominal wall did not reveal recurrences, local and systemic complications. Persistent minor diastasis between rectus muscles reinforced with a mesh implant was observed in 3 (25%) out of 12 patients. Thus, optimized and personalized approach in patients with large and giant postoperative ventral hernias considers all intra- and postoperative risk factors.

Endoscopic extraperitoneal approach in the treatment of patients with primary and postoperative ventral hernias

Endoscopic extraperitoneal approach in the treatment of patients with primary and postoperative ventral hernias

Comparison of anesthesia and perioperative analgesia in simulty hernioplasty and abdominoplasty in patients with obesity

Justification. Among patients with large postoperative ventral hernias, the most common are patients with varying degrees of obesity. This group of patients presents a certain complexity for anesthesia in connection with a number of anatomical and physiological changes and a high risk of complications in the early postoperative period in connection with which this study was conducted. Purpose of trial. Study of the influence of various anaesthetic management and perioperative analgesia with simultaneous hernioplasty and abdominoplasty of major postoperative incisional hernia (PIH) in patients with obesity during the perioperative period. Materials and methods. A randomized trial of 59 patients with a body mass index > 30 kg /m2 was performed. Depending on the type of anesthesia, patients are divided into two groups. In the 1st group (n = 30), the operation was performed on low-flow inhalation of desflurane based anaesthesia in combination with prolonged epidural analgesia (PEA) with ropivacaine, in the 2nd group (n = 29), the operation was performed on low flow inhalation of desflurane anesthesia based in combination with blockade of transverse abdominal plane (TAP) with 0.5% solution of ropivacaine, in the 3rd group (n = 31) the operation was performed under combined anesthesia based of low flow desflurane and opioids as main perioperative analgesic. The indicators adequacy of anesthesia parameters investigated, central and peripheral hemodynamics were monitored neuromuscular conduction, evaluated the efficacy of recovery after surgery and postoperative analgesia quality, postoperative critical incident were studied. Results. It was found that surgical intervention in low-flow inhalation desflurane anaesthesia based combined with PEA ropivacaine promotes faster recovery after surgery and effective postoperative analgesia and fewer complications in the early postoperative period, which contributed to significantly shorter hospital lengths of stay for patients in group 1 — 82,5 hours (95% CI 76–93,5) compared with group 2 — 94 hours (95% CI 85,5–113) (p = 0,015). Conclusions. Combined desflurane-based anesthesia in combination with regional methods is an effective method of anesthesia and analgesia in the perioperative period and contributes to faster recovery after surgery and shorter surgical treatment with simultaneous hernio- and abdominoplasty of large (PIH) in obese patients.

Preventative repair of postoperative ventral hernia considering the markers of connective tissue dysplasia

To define the indication for preventive mesh implantation in patients scheduled for laparotomy. There were 108 patients divided into the control (52 patients without anterior abdominal wall hernia) and the main (56 patients with ventral hernia) groups. Predominance of collagen type III over type I was observed in patients older 60 years in the main group. The maximum ratio of collagen types I and III was 1.4 in the main group. The minimum number of inter-fiber spaces (n=5) was noted in patients aged 30-40 years. The maximum density of connective tissue was 250 pixels per inch. Analysis of connective tissue structures revealed some important age-related features and markers of connective tissue dysplasia in the main group. An indication for preventive mesh implantation in patients scheduled for laparotomy was determined.

Preventive abdominal wall repair in high-risk groups of postoperative ventral hernia

To identify the most important predictors of postoperative hernia and to determine the indications for preventive surgical repair of abdominal wall. Prospective analysis included 398 medical records of patients who underwent median laparotomy. Experimental tensiometry was applied to determine strength of intact fascia. The main predictors of postoperative hernia are age over 60 years, obesity, upper median laparotomy, connective tissue insufficiency. Combination of factors increases the risk of hernia. The most 'intense' foci of aponeurosis is middle portion of epigastric and initial part of mesogastric areas. You need to consider this features during laparotomy closure. Preventive repair may be an effective method for prophylaxis of postoperative hernia after median laparotomy.

Analysis of the causes of recurrent postoperative ventral hernias

To study the causes of recurrent postoperative ventral hernias and methods for their prevention. There were 58 patients with recurrent postoperative ventral hernias after various methods of abdominal wall repair for the period 2005-2017. The main causes of recurrent postoperative ventral hernias were identified. Local tissue rearrangement resulted recurrent hernia in 21 (36.2%) patients, that was observed even in patients with small hernia. Size discrepancy between endoprosthesis and hernial orifice caused a recurrence in 20 (34.5%) patients. In 11 (19%) patients, implant detachment followed by recurrent hernia occurred. Postoperative wound complications followed by recurrent hernia were diagnosed in 6 (10.3%) patients. Non-compliance with recommendations for wearing a bandage and restricting physical exertion also contributed to the development of recurrent hernia. Moreover, recurrent hernia occurred mainly in obese patients. Mean body mass index was 34.27±2.2 kg/m2. Recurrent hernia was again detected in 12 out of 35 patients in long-term period after surgical treatment. It is necessary to abandon local tissue rearrangement and to select a correct size of synthetic material for prevention of recurrent postoperative hernia. Preoperative body weight control is essential in patients with obesity. Wearing a bandage and restricting physical exertion are obligatory in postoperative period. Annual examination during 3-5 years after surgery is essential for timely diagnosis of recurrent hernia.

Method of prevention of postoperative gray allohernioplasty in laparoscopic ventral hernia

The authors have developed a new method of seroma formation prevention after laparoscopic allohernioplasty in patients with postoperative ventral hernias. The results of the study showed that trans- position of hernia sac into the abdominal cavity and fixation to the unmodified abdominal wall around the perimeter of the hernial orifice can reliably eliminate Grajewo cavity and thereby to eliminate the possibility of seroma formation in the postoperative period. Federal service for intellectual property (Rospatent) decided to grant a patent for this method of seroma formation prevention at the surgery of postoperative ventral hernias as for the invention “Method of laparoscopic plasty of ventral hernias” (№2017120227/14(035085) from 17.01.2018).

SIMULTANEOUS OPERATIONS TACTICS IN PATIENTS WITH VENTRAL HERNIAS

Objectives - to improve treatment results in patients with ventral hernia and the concurrent surgical diseases by means of the designed surgery tactics. Material and methods. The treatment of 834 patients with ventral hernia, aged from 18 up to 82 years, was analyzed. The group consisted of 196 men (23.5%) and 638 women (76.5%). According to the European Hernia Society (EHS) classification of postoperative ventral hernias the gate types were distributed in patients as follows: W1 - in 132 patients (15.8%), W2 - in 397 (47.6%), W3 - in 305 (36.6%), in 243 (29.1%) cases the hernias were recurrent. 394 (47.2%) patients had 597 simultaneous interventions. The treatment tactics for the patients with hernias and associated diseases was defined according to the designed classification. For the abdominal wall repair the 2 variants of the "tension-free" mesh repair technique were used. Results. Forced simultaneous interventions were performed in 34 patients when the intestinal loops adherent to the scar were situated in the hernia sac. In 27 cases the postoperative ventral hernia was combined to the intestinal fistulas, located out of the hernia area. 12 patients underwent herniolaparotomy conditioned by the intra-abdominal intestinal fistulas closure and small hernias size. To prevent the compartment syndrome in 3 patients with splanchnoptosis the right part of the colon was resected. 103 patients had the planned simultaneous operations including the laparoscopic cholecystectomy in 19 cases, 114 patients underwent the panniculectomy. The preventional appendectomy was performed in patients with the recurrent large hernias. In 140 cases the omentum resection was done due to the signs of the chronical strangulation and omentitis. Postoperative pulmonary artery thromboembolia was the death cause for 3 (0.4%) patients. Only 8 (0.9%) patients suffered the partial hernia recurrence. Conclusion. In patients with hernias the simultaneous operations are conditioned by the pathogenesis and do not affect the severity and frequency of wound complications in the postoperative period. A condition for the simultaneous interventions in patients with hernias is the necessary implementation of the combined techniques of the ventral tension-free mesh hernioplasty.

The features of surgical treatment of ventral hernias after gunshot wounds of the addomen.

The results of treatment of 21 patients with postoperative ventral hernias, formed as a result of surgical treatment for gunshot wounds of the abdomen were analyzed. All patients are men aged 21-48 years. 3 patients underwent laparoscopic allohernioplasty according to the IPOM method with Teflon allograft, 10 patients underwent allohernioplasty with a prolenic mesh graft by the sub lay method, 7 patients underwent alloplasty using the on lay method and 1 – autoplastywith local tissues. Suppuration of wounds was not noted. The average bed-day after laparoscopic hernioplasty was 9.5 days, after open operations - 16.2 days. The advantage of laparoscopic hernioplasty over open operations was noted.

AGE-RELATED STRUCTURAL CHANGES IN APONEUROSES OF THE RECTUS ABDOMINAL MUSCLES IN PATIENTS WITH POSTOPERATIVE VENTRAL HERNIAS

AbstractObjective of the study. To determine the structural differences of aponeuroses in different age groups of patients with postoperative ventral hernias.Material and methods. Comparative morphological studies of aponeuroses in 36 patients aged 40-76 years, operated by reason of postoperative ventral hernias in hospitals 1, 2 of Samarkand State Medical Institute for postoperative ventral hernias, were conducted by us. Patients are divided into 3 groups according to the WHO age classification: Group I included patients at the age of 45-59 years old; Group II 60-74 years old; and the Group III included patients aged 75-90 years old. The biopsy specimens of the anterior abdominal wall, obtained during hernioplasty were subjected to histological examination. Standard pieces of aponeurotic abdominal wall tissues taken during surgery were fixed in a 10% formalin solution on phosphate buffered saline for light microscopy examinations. Paraffin sections were stained with hematoxylin and eosin (H&E).Results. Investigation of biopsy specimens of aponeuroses and adjacent muscle tissue in patients of different age groups have revealed significant structural differences that can determine the frequency of hernias of the anterior abdominal wall and their recurrences.Conclusions. The studies have shown that with advancing age significant structural disturbances occur at aponeurosis of the abdominal rectus muscles. The nature of these changes, especially the disruption of the collagen fiber arrangements, suggests that these structural changes are responsible for the weakening of the aponeurosis.

Application of endovideosurgery in the treatment of ventral hernias after gunshot wounds of the abdomen

Gunshot wounds of the abdomen are often accompanied by a significant destruction of the abdominal cavity with the development of peritonitis, and in the future — various complications (failure of anastomoses, abscess formation, repeated bleeding, etc.), which requires repeated surgical interventions, and as a consequence — the formation of postoperative ventral hernias. The aim of the study is to improve the results of surgical treatment of ventral hernias after gunshot wounds of the abdomen due to the use of laparoscopic techniques. The analysis of treatment of 21 patients with postoperative ventral hernias formed as a result of operations concerning gunshot wounds of the abdomen was carried out. 14 wounded suffered one operation on the abdominal organs in the past (66.7%), 5 — two operations (23.8%), 1 — three operations (4.8%), 1 — five operations (4.8%). The dimensions of the hernial gates and the risk of recurrence were determined according to the SWE classification: W1 — 9 patients (42.9%), W2 — 8 (38.1%), W3 — (9.5%), W4 — 2 (9.5% ). The third patients underwent laparoscopic allogernioplasty according to the IROM technique with a Teflon allograft, which was fixed in 2 cases with the help of a herniostepler, in the 1st — with transdermal separate seams with Teflon filament. Complications after laparoscopic operations were not. The use of laparoscopic techniques can significantly reduce bed-day, avoid the development of abdominal compartment syndrome, previously to activate the patient. Laparoscopic allogernioplasty according to the method of IPOM by the Teflon graft is considered to be the operation of choice.

Laparoscopic retro-muscular abdominal wall repair with posterior component separation And self-tacking Parietene Progrip mesh for the diastasis rectus abdominis. the first experience

Retromuscular repair of large postoperative ventral hernias and diastasis rectus abdominis may improve the results of these procedures compared to IPOM, and therefore becomes more and more popular last time. A 33-year-old woman with a postpartum 6 cm wide diastasis was operated. Six trocars were used: four 5-mm, and two 10-mm, symmetrically placed at the both flanks. After separation of posterior rectus sheath from rectus muscles on the both sides, the diastasis and the incision of the sheath was sewn. In the retromuscular space, Parietene Progrip Mesh (Covidien, USA) was fixated to the rectus muscles. The operation time was 5 hours. There were no postoperative complications, including confirmed by postoperative ultrasound. The patient was discharged on the 4th postoperative day. Laparoscopic retro-muscular repair allows to mobilize the rectus abdominis muscles, and placement of self-tacking mesh eliminates the need for transfascial sutures and tackers. These principles reduce the risk of recurrence and development of chronic pain.

Efficacy of regional analgesia techniques in abdominal surgery patients with obesity

The use of regional anesthetic techniques in abdominal surgery is an essential component of the multimodal approach to perioperative analgesia, yet data on their use in obese patients remains limited. The aim of this study is to determine the effectiveness of the epidural analgesia (EA) and the transversus abdominis plane block (TAP-block) in laparoscopic obese patients, as well as to evaluate the possibility of using the rectus sheath block (RSB) as a “rescue” anesthetic technique after laparotomy in obese patients. Materials and methods. The data on the 102 obese patients operated on esophageal hiatal diaphramgmatic hernia, colon tumor, postoperative ventral hernia, morbid obesity and choledocholithiasis were analyzed. In laparoscopic surgery 20 patients received EA (EA group), 21 patients – TAP-block (TAP group), 21 patients – opioids and non-steroidal anti-inflammatory drugs (NSAIDs) without any regional anesthesia techniques (group TIVA 1 ). In laparotomic surgery 16 patients received RSB (RSB group) and 24 patients – only opioids and NSAIDs (TIVA 2 group). After the surgery the following was estimated: the time of extubation, the total dose of opioids, the level of pain according to the 10-point numeric range score (NRS), the incidence of dyspnea using the monitor Utas 300 (Ukraine), the incidence of postoperative nausea and vomiting (PONV), the time of active patient mobilization, and the level of satisfaction with analgetic regimen. For the RSB group, the complexity of the RSB and the mean time to achieve adequate analgesia (pain intensity ≤3 points per NRS) were determined additionally. The statistical analysis was performed using the Statistica for Windows version 6.0 software. Results . In the EA group, the intraoperative dose of fentanyl was twice lower, and patients were extubated two times faster than in the TAP, TIVA 1 , RSB, TIVA 2 groups (P < 0.05). At the same time, none of the patients in the EA group required the restoration of neuromuscular conduction with neostigmine (P < 0.05). After the surgery, the pain level was 2–3 times higher in the TIVA 1 , RSB, and TIVA 2 groups than in the EA and TAP groups (P < 0.05). “Rescue” analgesia in the RSB group was performed from the first attempt in all the patients in 5–10 minutes and provided an adequate effect in 3 (2–4) min. The complexity level of RSB was defined as “easy” in 12 (75 %) patients, as “average” in 4 (25 %) patients (P < 0.05). The incidence of dyspnea and opioid doses after surgery in the EA, TAP and RSB groups of patients were 2 times lower, and the incidence of PONV was 3 to 4 times lower than in the TIVA 1 and TIVA 2 patients’ groups (P < 0.05). In the EA and TAP groups, patients became mobile after 8–13 hours after surgery, in the group TIVA 1 – after 16–22 hours, in the group RSB – after 18–36 hours, in the group TIVA 2 – after 48–96 hours (P < 0.05). 100 % of the respondents from the EA, TAP and RSB groups were satisfied with the analgesic regimen at the “excellent – good” level. In the TIVA 1 and TIVA 2 groups, 20–25 % of respondents identified analgesic comfort as “good”, 60–65 % of respondents – as “satisfactorily”, about 15 % of respondents – as “unsatisfactorily” (P < 0.05). Conclusions . In laparoscopic surgery the use of EA or TAP-block in obese patients significantly reduces the level of postoperative pain, the need for opioids, the incidence of dyspnea and PONV, which leads to the possibility of patients’ mobilization within 8–13 hours after surgery. After laparotomic surgery in obese patients RSB effectively “rescues” from pain and prevents excessive use of opioids, which reduces the number of adverse reactions and increases satisfaction with the quality of analgesia.

Component separation hernioplasty in treatment of postoperative ventral hernias

The presence of large defects in the anterior abdominal wall in patients is an important problem for surgeons, due to the complexity of the hernioplasty implementation, the need to use large mesh, high frequency of postoperative complications. Nowadays, widely used laparoscopic hernioplasty include the use of mesh materials. In patients with large hernias, laparoscopic techniques are associated with a number of technical difficulties during operations and a high frequency of postoperative relapses (up to 30 %). The problem of choosing the treatment method for postoperative ventral hernias of large and gigantic still remains unsolved. Currently, the main trend is to restore the anterior abdominal wall anatomical integrity with the reduction of the anterior abdominal wall muscles to the white abdominal line and open component separation. Since the development of laparoscopic and endoscopic technologies, the technique of endoscopic separation of the anterior abdominal muscles has been improved to improve the quality of life of patients and to reduce the incidence of postoperative complications and recurrences. The use of endoscopic methods makes it possible to prevent a wide tissue dissection, reduce the risk of necrosis of the skin and aponeurotic flap through the preservation of perforant vessels in the anterior abdominal wall. The result comparison between the use of open and laparoscopic methods of component separation showed that the use of open separation methods leads to a significantly greater number of both intraoperative and postoperative complications associated with the development of 30 % of necrosis of the skin and aponeurotic flap, and relapses. The results of the studies indicate some advantages in reducing the frequency of postoperative wound complications with endoscopic component separation methods in patients with postoperative large size ventral hernias.

Goal-directed use of balanced solutions for laparoscopic surgery in obese patients

Modern guidelines for infusion therapy in laparoscopic surgery of patients with obesity are ambiguous due to insufficient number of clinical researches. The aim of our work was to evaluate the effect of goal-directed infusion therapy with balanced solutions on hemodynamics, electrolyte balance, renal function and incidence of perioperative complications of laparoscopic surgery in obese patients. Materials and methods. The study included 54 obese patients (BMI >30 kg/m 2 ) who were performed laparoscopic surgery in case of the diaphragmatic hernia, colon tumors, postoperative ventral hernia and morbid obesity. In the group A (n = 26) goal-directed infusion therapy by balanced solutions Gelaspan and Sterofundin (B. Braun, Germany) was used. Impedance measuring technology using the monitor Utas 300 (Ukraine) was used to determine the target stroke volume (SV). In the group B (n = 28) infusion therapy was performed by unbalanced solutions (6 % HES and 0.9 % NaCl), focusing on fluid deficiency according to changes in blood pressure (BP), heart rate (HR), and diuresis. The incidence of hypotension and total volume of infusion therapy (TVIT) were evaluated intraoperatively, changes in BP and HR were compared. After surgery diuresis, blood Na + , K + , Cl – and creatinine concentrations, diuretic use frequency and incidence of cardiac, respiratory, hemorrhagic and infectious complications were controlled. Statistical analysis was performed using the Statistica for Windows software version 6.0. Results. The incidence of hypotension in the group B was almost 2 times more than in the group A (P 0.05). Intraoperative TVIT in the group B was 23 % higher due to crystalloid, and diuresis intensity was twice less than in the group A (P < 0.05). Concentrations of electrolytes and creatinine blood level did not change significantly in the study groups. After surgery in the group B 25 % of patients were prescribed diuretic and in the group A diuretic was not prescribed in any case (P < 0.05). In-hospital mortality in both groups was zero, no serious complications were observed. Conclusions. Goal-directed infusion therapy with balanced solutions in laparoscopic surgery in obese patients halved the incidence of intraoperative hemodynamic instability, reduces the volume loading of crystalloids by 23 % during surgery and provides adequate perioperative diuresis without additional stimulation.

Improvement of safety of surgical interventions in patients with ventral and postoperative ventral hernia under conditions of different types of hernioplasty

Improvement of safety of surgical interventions in patients with ventral and postoperative ventral hernia under conditions of different types of hernioplasty

Experimental-morphological justification of the effectiveness for the connective tissue carcass formation in the anterior abdominal wall depending on the topographic-anatomical graft implant location

The aim — to study morphometric characteristics of the formation of connective tissue skeleton, depending on the location of the mesh between the different anatomical structures of the anterior abdominal wall.Materials and methods. An experiment was performed with 30 adult chinchilla rabbits, which had undergone implantation of a polypropylene mesh sterile pieces (PROLEN, Ethicon) of size 1.0 ´ 1.0 cm in the anterior abdominal wall lateral area. All studied animals were divided into 3 groups depending on the place of the mesh implantation: preperitoneal (n = 10), intramuscular (n = 10) and subaponeurotic (n = 10). The tissues of the anterior abdominal wall sized 1.5 ´ 1.5 cm were sampled on the 7th, 14th, 21st, 28th and 35th day after implantation. To assess the effectiveness of the connective tissue framework formation, depending on the topographic location of the implant, a morphometric study with following parameters was performed: relative area of collagen fibers, relative amount of collagen fibers with a fiber thickness more than 10 µm and less than 10 µm, the relative area of the cell component.Results and discussion. It was established that the scar tissue formation after the mesh implantation has significant differences depending on its localization. In the area of the peritoneum and the muscle the mesh implantation induced reactive changes, manifested by granulation tissue formation, rich by non­differentiable vessels, the structure of which fibrocytes and fibroblasts was dominated. Up to 21 day the connective tissue scar is formed from dense bundles of collagen fibrils. Up to 28th — 35th day a further connective tissue maturation processed, fibroblasts number reduced, the fibrous structures number increased. The mesh threads were embedded in connective tissue fibers, the strands of mature connective tissue formed between the threads, but thinner than in the filaments locations. Aponeurotic mesh implantation caused a somewhat different reaction. The signs of edema and the fibrous structures formation around and between the threads were expressed on the 7th day in the aponeurosis area. A solid layer of mature connective tissue with a large fibers and fibroblasts number was formed on the 21st day. The thickness of the scar was 5 — 6 times higher than in the muscle and peritoneum. The predominance of the fibrillar component of scar tissue over the cell, mature collagen fibers over the young fibrous structures was observed on the 21st day of the experiment, that confirmed the earlier initiation and high rate of peri­implant reparative­proliferative processes for the subaponeurotic mesh implant in comparison with preperitoneal and intermuscular ones.Conclusions. The obtained experimental data allow to postulate a better morphometric and histological characteristic of the scar formation in case of subaponeurotic mesh placement that is important for the surgical approach choice. The study results substantiate the morphological improvement of existing treatment methods in patients with a considerable distraction of aponeurotic edges with postoperative ventral hernias, as a remote complications of gunshot peritonitis surgical treatment.

Modern technology in the treatment of patients with postoperative ventral hernias

The analysis of results of treatment of 113 patients with postoperative ventral hernias was carried out patients divided into two groups. 74 patients have received treatment (II (control) group) from 2013 to 2014 year. Patients of the control group were examined according to the accepted diagnostic algorithms, in addition to physical examination algorithm include chest and abdominal x-ray examination, ultrasound diagnosis of abdominal organs and fibro-esophagogastroduodenoscopy. Plastic by reticular endoprostheses was carried out in various methods. Methods have been chosen directly by surgeon during the operation. The draining of the postoperative wound was mandatory. Main (I) group included 39 patients who received treatment from 2015 to 2016. The diagnostic algorithm was supplemented with fibrocolonoscopy and spiral computed tomography, and the plastic method was predominantly sub-lay. Hypoderma treatment by high-temperature oscillating plasma flow energy according to the original technique for the prevention of lymphorrhea was provided to all patients. Maims were mostly sutured tightly. This approach allowed to reliably reduce frequency complications from 13.4% (14) to 1.8% (2) and, as a consequence, the length of stay of the patient in the hospital.

SAFETY AND EFFICACY IMPROVEMENT IN RECONSTRUCTIVE ESTHETIC SURGERIES OF THE ANTERIOR ABDOMINAL WALL

Effectiveness of the prevention of complications in wounds following reconstructive surgeries performed on the anterior abdominal wall in 84 patients with postoperative ventral hernias using the suggested comprehensive pharmacotherapy was analyzed. The method is based on the use of Mexidol, an antihypoxantantioxidant, to prevent postoperative wound complications in patients who underwent reconstructive surgeries of the anterior abdominal wall against the background of the use of bioflavonoid. The use of Mexidol was evidenced to decrease reliably the duration of serous exudation by 1.76 times, which contributes to the prevention of wound complications, and reduces the duration of inpatient treatment by almost 6 days. Such postoperative complications as hematomas, postoperative wound suppuration, ligature fistulas, rejection of reticular implant were not observed. All this made it possible to significantly improve surgical treatment in patients who undergo reconstructive surgery on the anterior abdominal wall.