Treatment Of Postoperative Ventral Hernias Research Articles

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.

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.

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.

Postoperative ventral hernia: characteristics of researching the results of prevention and surgical treatment

Aim. To assess the methodological quality of non-randomized interventional studies of the outcomes of prevention and surgical treatment of postoperative ventral hernias using a systematic approach.Material and methods. We searched the indexed literature for non-randomized studies of VН surgery from January 1995 to December 2019. Each prospective study was combined with a corresponding retrospective study using predefined criteria to obtain comparable groups. The assessment of the following components was conducted: the choices of research methods, their rationale, design, inclusion criteria, reported results, and statistical methodsResults and discussion. 50 studies (17,608 patients) were selected: 25 prospective and 25 retrospective. In general, prospective studies showed slightly higher methodological quality scores than retrospective studies, with a mean score of 17 (IQR: 14-18) versus 15 (IQR 12-18). The studied subcategories of prospective studies obtained higher median scores for their “administration”, “design” and “participants”. 18 (36%) studies had a primary outcome, and only 2 studies (4%) described research power. None of the studies mentioned a standardized definition of VH recurrence, while methods for detecting recurrence varied widely. The methodological quality of the study did not depend on the year of publication or the increase in the impact factor of the magazine.Conclusion. Currently, non-randomized interventional studies of the results of surgical treatment of VH are methodologically ineffective. A clearer analysis of the research results and the establishment of a minimum standardized set of data is necessary.

Dermolipectomy and abdominoplasty in surgical treatment of hypogastric postoperative hernias in patients, suffering obesity

Objective. To improve clinico–esthetic results of surgical treatment of postoperative ventral hernias of infra–umbilico–hypoabdominal localization and hypogastric cicatricial deformities in patients, suffering obesity.
 Materials and methods. The work is based on the results of analysis of perioperative investigations, conducted in 37 patients. The main group was consisted of 26 patients, suffering postoperative ventral hernias after lower laparotomies or laparoscopic interventions. In 11 patients, forming a control group, there were present the soft tissue deformities without aponeurotic defects and hernias. All the patients have had general obesity Degrees I–III and/or abdominal obesity. In all the patients there was conducted a various volume calculated excision of excessive and cicatricial–fibrous tissues and, in necessity, – alloplasty of hernial gates.
 Results. Overall parahernial excess of tissues in formatted hypogastic postoperative ventral hernias have had predominantly supraaponeurotical localization and metric characteristics, determined by the hernial dimensions, emphasis of adjacent lipid–containing layers and fibrous–cicatricious components. While performing of hernioabdominoplasty in such patients it is expedient to apply a combined tactics of standard aponeurotic hernioplasty and dermolipectomy/fibrolipectomy with abdominoplasty. This permits to lower essentially (up to 3%) the rate of the local complications development.
 Conclusion. The calculated beforehand hernioabdominoplasty constitutes the most rational principle of surgical treatment for hypogastric postoperative ventral hernias in patients, suffering obesity.

Rives – Stoppa surgery – the foundation of the modern concept of treatment of patients with ventral hernias (55 years in surgery)

The treatment of ventral hernias in the history of surgery has always been an urgent problem. In the 90s of the XIX century, hernioplasty using metal threads and plates began, but the long-term results of treatment of patients remained unsatisfactory. A particularly urgent problem in herniology during the last century was the treatment of postoperative ventral hernias, and patients with large and even more giant hernias were often recognized as incurable. The great revolution in herniology was the introduction into practice of biologically inert mesh polymer materials. A fundamentally different method of endoprosthesis of the abdominal wall is retromuscular («sublay») hernioplasty, proposed by the French surgeon of Algerian origin Rene Stoppa in 1965. In 1966, a compatriot, colleague and friend R. Stoppa Jean Rives used the principles of this technique when eliminating postoperative median hernia by prosthetics of the anterior abdominal wall retromuscularly through the xiphopubic incision. Decades later, during the rapid development of endovideosurgery, the principle of operation Rives-Stoppa was the foundation for the development of modern minimally invasive and highly effective methods for eliminating inguinal and other ventral hernias. Thus, the method of prosthetics of the anterior abdominal wall proposed 55 years ago by Rives-Stoppa was an ideological breakthrough in herniology and significantly improved the results of operations for external abdominal hernias.

Long-Term Outcomes and the Quality of Life in Patients with Postoperative Ventral Hernias after Various Surgical Options

Introduction. Clinical outcomes of surgical treatment of postoperative ventral hernias are to be investigated not only in the nearest but also in the long-term postoperative period. The aim of research was to study the effectiveness of various methods of hernioplasty and the patients' quality of life in the long-term surgical treatment of postoperative ventral hernias.Materials and methods. The authors analyzed the results of surgical treatment of 76 patients with postoperative ventral hernias in the late postoperative period after various methods of hernioplasty during 2006-2017. The average term of follow up examination was 5.7 years. The patients quality of life was assessed using the SF-36 questionnaire; the anterior abdominal wall and the surgical area examination was performed in all patients; the patients were interviewed on adherence to recommendations in the postoperative period. Results. The average physical health index (PH) was 47,271,05, while mental health index (MH) was 52,861,04. These parameters were low due to the age of the patients (60, 231,29 old), as well as the presence of concomitant diseases of the cardiovascular system (80,3%) and obesity (75%). Index of physical health component in sublay and corrective plastics was significantly lower than in autoplastic and onlay disposition of the prosthesis (р0,001). However, the onlay method as well as the corrective technique and autoplasty revealed a high risk of hernia recurrence, and as a result, a decrease in physical and mental health indexes. According to the survey, it was found that more than 50% of the patients did not adhere to the recommendations for restricting physical exertion and wearing a bandage, which also contributed to the hernia recurrence. In 28% of patients reherniation or diastasis recti abdominis was detected in the surgical area. However, the patients did not notice these changes or did not believe in the success of repeated interventions. Conclusion. Thus, the sublay technique proved to be a preferred method of various hernioplasty options. However, a search for more functional prostheses is needed to improve the quality of patients life. To prevent reherniation, patients are strongly recommended to adhere to the terms of wearing the bandage and restricting physical activity. Follow-up examinations of the patients should be performed by healthcare providers to timely reveal and treat recurrent postoperative ventral hernias.

Laparoscopic preperitoneal alloplasty of postoperative ventral hernias

Objective. To raise the efficacy of surgical treatment of postoperative ventral hernias, performing laparoscopic preperitoneal allohernioplasty.
 Materials and metods. Analysis of the surgical treatment results was conducted in 126 patients, suffering postoperative ventral hernias, ageing from 30 to 75 yrs old, who were operated on in the Clinic of Department of Surgery and Proctology of Shupyk National Medical Academy of Postgraduate Education in 2012 - 2019 yrs, was conducted. There were 80 (63.5%) women-patients, and 46 (36.5%) men-patients. Average age of the patients have constituted (54.7 ± 3.3) yrs old.
 In accordance to classification of European Association of Surgeons-Herniologists (The European Hernia Society - EHS, Gent, Belgium, 2008 yr) distribution of postoperative hernias was following: hernias M1W1R0 were diagnosed in 6 (4.8%) patients, M2W1R0 - in 12 (9.5%), M2W2R0 - in 14 (11.1%), M3W1R0 - in 10 (7.9%), M3W2R0 - in 11 (8.7%), M3W3R0 - in 8 (6.3%), M4W1R0 - in 7 (5.6%), M4W2R0 - in 3 (2.4%), M4W3R0 - in 5 (4.0%), M5W1R0 - in 8 (6.3%), M5W2R0 - in 4 (3.2%), M2-3W2R0 - in 19 (15.1%), M3-4W2R0 - in 8 (6.3%), M3-4W3R0 - in 4 (3,2%), M1-4W3R0 - in 4 (3.2%), M3-5W3R0 - in 3 (2.4%). The patients with large POVH (W3) and diastasis of abdominal rectal muscles more than 5 cm were not included in the investigation. Depending on procedure of allohernioplasty performed for postoperative ventral hernias the patients were distributed into two Groups. In Group I in 63 (50%) patients the improved laparoscopic preperitoneal allohernioplasty with transfascial suturing of the abdominal wall defect edges was performed. In Group II in 63 (50%) patients open preperitoneal allohernioplasty was done. In both Groups of the patients light polypropylene nets were used for allohernioplasty.
 Results. Laparoscopic alloplasty of postoperative ventral hernias with transfascial sutures, which were applied in Group I, have had essential advantages: significant lesser intensity of postoperative pain, reduction of the seroma rate by 94% - relative risk 0.06 (0.01 - 0.28), p<0.001; risk of suppuration in postoperative wound by 90% - relative risk 0.10 (0.01 - 1.98), p=0.211; risk of chronic infiltrate occurrence by 86% - relative risk 0.14 (0.01 - 2.70), p=0.369. In general, concerning morbidity (immediate results), the risk lowering for their occurrence have enhanced by 93% - relative risk 0.07 (0.02 - 0.28), p<0.001 in patients of Group I in comparison with patients of Group II. Late results of surgical treatment of postoperative ventral hernias also confirms the advantage of laparoscopic preperitoneal allohernioplasty with transfascial suturing of the defect edges over open preperitoneal alloplasty: reduction of risk in chronic pain development in part of anterior abdominal wall by 68% - relative risk 0.32 (0.03 - 3.18), p=0.617 and risk of the recurrent hernia development by 87% - relative risk 0.13 (0.01 - 2.67), p=0.367.
 Conclusion. Performance of laparoscopic preperitoneal allohernioplasty for postoperative ventral hernias (Group I of patients) due to minimization of surgical dissection of the abdominal wall tissues is accompanied by significantly lesser intensity of postoperative pain and lesser rate of morbidity, comparing with open preperitoneal allohernioplasty (Group II), especially: in Group I a seroma rate have constituted 3.2%, in Group II - 34.9%, in Group I suppuration of postoperative wound was not noted, inflammatory infiltrate of abdominal wall, in Group II a rate of these complications have constituted 6.4 and 4.8% accordingly, in Group I chronic postoperative pain was noted in 2.1% of patients, in Group II - in 6.3%, in Group I hernia recurrence was absent, in Group II hernia recurrence rate have constituted 6.3%.

ОСОБЕННОСТИ ПРОТЕЗИРОВАНИЯ ГРЫЖЕВОГО ДЕФЕКТА ПРИ ХИРУРГИЧЕСКОМ ЛЕЧЕНИИ ПОСЛЕОПЕРАЦИОННЫХ ВЕНТРАЛЬНЫХ ГРЫЖ

The article provides an overview of literature on the surgical treatment of postoperative ventral hernias (POVH), development trends and controversial questions of the problem. Today, according to many researchers, the frequency of POVH is up to 20-26% of the total number of external hernias of the abdomen, which give way to the primacy only to groin hernias. The recurrence rates of POVH remain high, reaching between 4.5-90% after the use of autoplasty methods and 3-19.5% after alloplasty methods. Incomplete satisfaction with the results of surgical treatment of POVH has helped to find new ways of hernioplasty using prosthetics, which allows increase the effectiveness of surgical treatment and reduces the incidence of complications. Increased intraabdominal pressure is the most common etiological factor in the development of purulent-inflammatory complications, leads to relapse, and increases the numbers of fatalities among patients with large POVH. The great interests among abdominal surgeons are issues of improving the quality of hernioplasty using prosthetic materials and methods of prevention of development inflammatory complications in the area of surgical wound. Keywords: Postoperative ventral hernia, hernioplasty, laparotomy, purulent complications.

Treatment of postoperative ventral hernias with the use of mesh implants made of titanium thread

Study of the results of the use of titanium thread mesh implants in the treatment of postoperative ventral hernias. The study included 84 patients with postoperative ventral hernias. All performed open-access prosthetic hernioplasty. 2 groups were formed: the main group consisted of 32 patients who used a mesh implant made of titanium thread as an implant, the comparison group consisted of 52 patients whose hernioplasty was performed using a polypropylene mesh implant. There were no statistically significant differences between groups of patients by age, gender, average body mass index, risk class of anesthesia (ASA), size and location of hernias. The frequency of postoperative complications in the main group was 6.2%, in the comparison group - 3.8%. There were no statistically significant differences in this indicator between the groups. At the time of discharge from the hospital, the level of plasma C-reactive protein in patients of the main group was significantly lower than in patients of the comparison group. The use of titanium thread mesh implants in the treatment of postoperative ventral hernias is accompanied by a less inflammatory response of the body to the implant and does not lead to an increase in the frequency of postoperative complications.

EXPERIENCE OF ERAS PROTOCOL IMPLEMENTATION IN THE SURGICAL PRACTICE FOR THE TREATMENT OF POSTOPERATIVE VENTRAL HERNIA

Aim: to study the experience of introducing elements of the protocol for enhanced recovery after surgery (ERAS) in the surgical treatment of postoperative ventral hernias.
 Materials and methods: This article presents the results of surgical treatment of 122 patients with postoperative ventral hernias, in whom in 24 (20%) cases operations on the anterior abdominal wall were performed laparoscopically (study group), in 98 (80%) - by “open” method (control group).
 Results: The average duration of the “open” operations was 135 ± 45 min., laparoscopic one - 120 ± 30 min. After laparoscopic hernioplasty patients became active within 1.5-2 hours after extubation. After the operation according to the sublay method, in 61.2% of cases the patient was verticalized and became active within the chamber after 5-6 hours, and in 38.7% of cases- during the first days after operation. Postoperative stay in hospital among patients in the control group after “open” hernioplasty was 7.3 ± 1.5, after laparoscopic surgery - 2.6 ± 1.2.
 Conclusions: Based on the analysis of the obtained results, it is possible to argue about the feasibility of introducing elements of the ERAS protocol for the surgical treatment of postoperative ventral hernias, especially when performing laparoscopic hernioplasty.

PECULIARITIES OF MORPHOLOGICAL CHANGES OF TISSUES AFTER HERNOPLASTIC DURING RECURRENCE OF POSTOPERATIVE VENTRAL HERNIAS

Considering the results of surgical treatment of postoperative ventral hernias, a significant number of relapses, comprising 4.3-46 %, should be noted, and for large and giant postoperative ventral hernias reaches 80 %. The lack of clear criteria for assessing the local response of the tissues of the anterior abdominal wall to the implantation of various types of mesh implants and the associated early wound postoperative complications and relapses prompts further study of the morphological features of the anterior abdominal wall tissue responses in patients with primary and postoperative ventral hernias. Aim of the study: to establish morphological patterns of the restructuring of the tissues of the anterior abdominal wall in patients with recurrent ventral hernia. Material and methods. An in-depth comprehensive clinical, instrumental and laboratory examination of 1419 patients with primary and postoperative ventral hernia was performed. There were 250 patients with recurrent ventral hernia (17.62 %). Results and conclusions. The use of a “light mesh” in patients with recurrent postoperative ventral hernia in the presence of concomitant NDCT appears to be significantly less lymphohistiocytic and leukocyte infiltration for the surrounding tissue, and reduces the likelihood of postoperative complications. Morphological changes in the tissue of the anterior abdominal wall with NDCT strongly indicate a disorder of its architectonics. It is clinically reflected in the formation of postoperative and recurrent hernias. Separate muscle fibers lose cross striation. In the muscular aponeurotic component without signs of connective tissue dysplasia, the application of various types of nets leads to the formation of elastic and collagen fibers, with minor changes in their architectonics and minimal cell infiltration of the immune inflammation of the extracellular matrix. Disintegration, destructive-dystrophic changes in the architectonics of the connective tissue were observed in patients with signs of NDCT in relapses. When using the “heavy” mesh, significant disorientation, collagenolysis, reduced synthesis of all types of collagens, the phenomenon of thickening of elastic fibers and elastolysis were observed. Inflammatory infiltration, triggered by immune inflammation cells, increased mucoid and fibrinoid edema, which led to homogenization, local lysis, and focal tissue destruction.

ОСОБЛИВОСТІ МОРФОЛОГІЧНИХ ЗМІН ТКАНИН ПІСЛЯ ІМПЛАНТАЦІЙНОЇ ГЕРНІОПЛАСТИКИ ПРИ РЕЦИДИВАХ ПІСЛЯОПЕРАЦІЙНИХ ВЕНТРАЛЬНИХ ГРИЖ

Considering the results of surgical treatment of postoperative ventral hernias, a significant number of relapses, comprising 4.3-46 %, should be noted, and for large and giant postoperative ventral hernias reaches 80 %. The lack of clear criteria for assessing the local response of the tissues of the anterior abdominal wall to the implantation of various types of mesh implants and the associated early wound postoperative complications and relapses prompts further study of the morphological features of the anterior abdominal wall tissue responses in patients with primary and postoperative ventral hernias. Aim of the study: to establish morphological patterns of the restructuring of the tissues of the anterior abdominal wall in patients with recurrent ventral hernia. Material and methods. An in-depth comprehensive clinical, instrumental and laboratory examination of 1419 patients with primary and postoperative ventral hernia was performed. There were 250 patients with recurrent ventral hernia (17.62 %). Results and conclusions. The use of a “light mesh” in patients with recurrent postoperative ventral hernia in the presence of concomitant NDCT appears to be significantly less lymphohistiocytic and leukocyte infiltration for the surrounding tissue, and reduces the likelihood of postoperative complications. Morphological changes in the tissue of the anterior abdominal wall with NDCT strongly indicate a disorder of its architectonics. It is clinically reflected in the formation of postoperative and recurrent hernias. Separate muscle fibers lose cross striation. In the muscular aponeurotic component without signs of connective tissue dysplasia, the application of various types of nets leads to the formation of elastic and collagen fibers, with minor changes in their architectonics and minimal cell infiltration of the immune inflammation of the extracellular matrix. Disintegration, destructive-dystrophic changes in the architectonics of the connective tissue were observed in patients with signs of NDCT in relapses. When using the “heavy” mesh, significant disorientation, collagenolysis, reduced synthesis of all types of collagens, the phenomenon of thickening of elastic fibers and elastolysis were observed. Inflammatory infiltration, triggered by immune inflammation cells, increased mucoid and fibrinoid edema, which led to homogenization, local lysis, and focal tissue destruction.

MORPHOLOGICAL RESPONSE TO IMPLANTATION OF A POLYPROPYLENE MESH WITH A PRF MEMBRANE IN PATIENTS WITH POSTOPERATIVE VENTRAL HERNIA AND UNDIFFERENTIATED CONNECTIVE TISSUE DYSPLASIA

Background. Current herniology promotes the widespread usage of mesh implants in the primary treatment and, especially, in the for postoperative ventral hernias.
 Objective. The aim of the research was to study the morphological response of the tissues of muscular aponeurotic layer to implantation of a polypropylene mesh with using PRF membrane-enriched platelets in the patients with postoperative ventral hernia and concomitant undifferentiated dysplasia of connective tissues.
 Methods. The research involved 98 patients with postoperative ventral hernia, who underwent retro-muscular alogernioplasty by the Sublay technique of implantation of ‘light’ meshes, and a ‘light’ polypropylene mesh (PPM) in combination with a platelet-rich fibrin (PRF) membrane. The patients were divided into experimental groups according to the presence of undifferentiated connective tissue dysplasia syndrome.
 Results. Microscopic studies carried out after the implantation of a polypropylene mesh with a PRF membrane has proved that structural changes in connective tissues are like those of a polypropylene mesh, but they are less significant. There was a leukocyte infiltration near the mesh material, but its area was small. The enlargement and blood filling of the vessels of microcirculatory channel was a manifestation of the increased vascularization of this area.
 Conclusions. The usage of a polypropylene mesh in combination with a PRF membrane in the surgical treatment of postoperative ventral hernias reduces inflammatory changes in the tissues significantly and increases the activation of fibroblasts and signs of collagen fibers around the mesh material that is relevant especially for the patients with connective tissue pathology.

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.

Treatment of postoperative ventral hernias in recipients of solitary organs

To perform retrospective analysis of treatment of postoperative ventral hernias (PVH) in kidney and extrarenal organs recipients, to assess its safety and effectiveness. Hernia repair has been performed in 84 PVH patients for the period from May 2006 to November 2017. The main group consisted of 41 patients (24 males, 17 females, mean age 55 (44; 59)) years with PVH due to previous transplantation. The control group included 43 PVH patients (21 males, 22 females, mean age 51 (50, 56)) years without previous transplantation. Incidence of surgical complications was similar in two groups: 63.4% in group 1 vs. 53.5% in group 2 (p>0.05). There were no significant differences in the incidence of surgical complications depending on immunosuppressive therapy and synthetic endoprosthesis deployment technique. Treatment of postoperative ventral hernias using synthetic endoprostheses in recipients of solid organs is effective and safe and should be considered as a preferable in treatment of this pathology.

Postoperative ventral hernia - unsolved issues of surgical tactics

Currently, there is no unified opinion on some problematic issues of surgical treatment of postoperative ventral hernias. Current approaches and surgical aspects of primary and recurrent postoperative ventral are reviewed in the article.

THE CHOICE OF IMPLANT FOR HERNIOPLASTY OF POSTOPERATIVE VENTRAL HERNIAS

According to the literature, up to 50% of laparotomies end with herniation. Therefore, postoperative ventral hernias will not lose their relevance for a long time. The appearance of non-tension hernioplasty by means with synthetic implants helped to solve some issues of hernia: the frequency of relapses in the late postoperative period significantly decreased. However, the number of the complications associated with suppuration of postoperative wounds and seroma in the early postoperative period increased. This leads in the increase of number days of hospital treatment, the need for antibiotic therapy, and accordingly the cost of treatment. In this regard, new types of implants that have the necessary biocompatibility properties are constantly being developed. Also, implants with the possibility of self-griping to the tissues have become more and more relevant in recent years. Self-gripping implants are not only convenient for the operating surgeon - reducing the time of operation, but also don’t cause of the chronic pain in the area of operation. However, the problem of surgical treatment of postoperative ventral hernias remains unresolved. The aim of study was to improve the quality of life of patients with postoperative ventral hernias. Was surgery with implants ProgripTM 65 patients. Patients were divided into two groups, taking into account the use of standard implant shape and simulated. The frequencies of surgical complications, duration of surgery and inpatient treatment were compared. The relapse developed in 14.7% and 3.2% of cases, respectively. There were no other significant complications. Conclusion: the simulated implant is anatomically correct and reduces the risk of detachment of the implant from the tissue during stretching.

Allohernioplasty Laparoscopic Postoperative Ventral Hernias

Relevance. Currently, the problem of effective treatment of postoperative ventral hernias is still not completely solved. The recurrence rate of the disease ranges from 15% to 50%, and repeat surgery causes increasing of the rate up to 20-65%.
 
 The purpose of the study is to evaluate the results of laparoscopic hernioplasty in patients with postoperative ventral hernias.
 Materials and methods. A retrospective analysis of the immediate and remote results of surgical treatment of 140 patients with postoperative ventral hernias. Patients of the main group (63) laparoscopic hernia repair method "ipom" patients in the comparison group (73) – open hernioplasty by the method of "onlay" and "inlay".
 Results. The use of laparoscopic hernioplasty by the method of "ipom" allow to significantly reduce the number of early and overall postoperative complications (3.7%), duration of hospitalization (from 9.8 ± 1.3 per day to 5.4 ± 0.7 per day), the period of temporary incapacity (from 28.9 ± 3.4 days to 17.2 ± 2.3 days), as well as reduce the number of relapses (from 8.2% to 3.0%).
 Discussion Laparoscopic hernioplasty is an effective method of treatment of postoperative ventral hernias. The obvious advantages of laparoscopic hernioplasty are: low invasiveness, fewer complications, rapid medical and social rehabilitation of patients. There is an undoubted advantage of laparoscopic hernioplasty over an open operation with the patient several postoperative ventral hernias.
 Conclusion. In modern conditions, laparoscopic hernia repair can be recommended as the operation of choice in patients with postoperative ventral hernia.