Features of surgical treatment of patients with postoperative ventral hernias

Aim. improvement of POVH hernioplasty methods by using endo-mesh with various separation plastics (SP).

Material and methods. Operations were performed on 148 patients with POVH. Patients are divided into 3 groups. Group I included 58 (39,2) patients who underwent anterior SP. Group II included 44 (29,7%) patients who underwent posterior SP. The remaining 46 (31,1%) patients made up group III, who underwent standard “stretch” methods of hernioplasty of the Onlay (n=28) and sublay (n=18) types. Causes of POVH: non-compliance with the work regime in 36 (24.3%); a history of relaparotomy in 25 (16.9%); suppuration of wounds in 18 (12.2); ligature fistulas in 11

(7.4%); causes were not identified in 58 (39,2%) patients. 15 (10.1%) patients underwent CT, while determining the ratio of the size of the hernial sac to the volume of the abdominal cavity, in order to predict and identify the degree of risk of developing the abdominal compartment syndrome.

Results. The choice of the operation method was influenced by the indicators of intraoperative intra-abdominal pressure (IP). In patients of group I, in the immediate postoperative period with the use of an anterior SP, complications from the wound occurred in 10 (17.2%), in group II, in whom a posterior SP was used, a similar complication was noted in 4 (9.1%) patients. In group III, in which tension methods were used, complications from the wound were observed in 7 (15.2%) cases. Relapse within 1 month to 4.5 years was noted in 12 operated patients. Moreover, the frequency of hernia recurrence was high in the first group in 5 (8.6%) and in the third group in 6 (13.0%) patients. In group II, where posterior SP was used, recurrence was observed in 1 (2.3%) patient. Reason: suppuration of wounds, obesity and concomitant diseases. Mortality occurred in 2 (1,3%) patients: 1 patient from the first group (1.7%) and 1 from the third group (2,3%). The latter was caused by the development of abdominal compartment syndrome with the development of PON.

Conclusion. POVH in 25% of cases remains a complication of laparotomy, especially in patients with varying degrees of obesity. The recurrence of hernias and lethality with standard tension methods remains high compared with the proposed variants of the joint venture using endonets.

1. Abdullayev Dzh.A. Novyye podkhody v diagnostike i lechenii oslozhneniy gryzh zhivota / Dzh.A. Abdullayev, K.M. Kurbonov // Gerniologiya. -2004.-№3.-S-4.

2. Tarasova N.K. Analiz prichin retsidiva posleoperatsionnykh ventral’nykh gryzh /N.K.Tarasova // Zhurnal im N.I. Pirogova.-2019.-№10.-S.36-42.

3. Vlasov V.V. Analiz nespetsifi heskoy displazii soyedinitel’noy tkani u bol’nykh s pakhovoy gryzhey /V.V. Vlasov, I.V. Babiy // Materialy KH konferentsii «Aktual’nyye voprosy gerniologii». – Moskva.-2013. –S.37-38.

4. Kuliyev S.A. Faktory riska vliyayushchiye na razvitiye oslozhneniy u patsiyentov s gigantskimi posleoperatsionnymi gryzhami /S.A. Kuliyev, A.V. Protasov, M.A. Kosovich // Zhurnal imeni akademika B.V.Petrovskogo.-2020.-Tom 8.№1. -S.7-11.

5. Yegiyev V.N. Gryzhi /V.N. Yegiyeev, P.K. Voskresenskiy //Moskva. -2015. -480 s.