The choice of the posterior method of dissection of the anatomical components of the abdominal wall in postoperative ventral hernias of giant sizes

November 20, 2023
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The aim: to increase the effectiveness of surgical treatment of postoperative ventral hernias of giant sizes (PVHGS) by using the improved TAR technique.

Materials and methods. An analysis of the surgical treatment of 154 patients with post-operative abdominal PVHGS, who underwent posterior methods of disconnection of the anatomical components of the abdominal wall in combination with alloplasty, was performed in the period from 2014 to 2022. The age of the patients is from 33 to 77 years (average age 56.4±1.3). There were 89 (57.8%) women, 65 (42.2%) men. The main group consisted of 74 patients with PVHGS, who underwent the improved TAR technique in combination with intra-abdominal alloplasty of IPOM, taking into account the intra-abdominal pressure indicators determined during surgery contact adduction of the rectus muscles (hernioplasty simulation). The comparison group consisted of 80 patients with PVHGS who underwent the classic posterior method of component separation according to Carbonell in combination with retromuscular alloplasty.

Results. In 74 patients of the main group, who performed the improved TAR technique in combination with IPOM alloplasty, a decrease in the frequency of intra-abdominal hypertension to 1.4% versus 11.2% of the comparison group was achieved (p<0.05), a decrease in the frequency of recurrence of PVHGS — to 1.4% versus 12.5% (р<0.05). Local postoperative complications in patients of the main group tend to have better results compared to the control group, namely, the frequency of seroma decreased to 8.1% versus 12.5% of the comparison group, postoperative wound infection to 1.4% versus 3.8%, necrosis of skin edges wounds up to 1.4% versus 3.8%.

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