Differentiated Approach in Treatment of the Postoperative Ventral Hernias

Relevance The incidence of postoperative ventral hernias (POVH) after laparotomy reaches according to different authors 4.0 - 18.1% . Results of surgical treatment POVH remain unsatisfactory because of the high recurrence rate, reaching 10 - 45.5%, and according to some authors 50-54 % . Questions of individual choice method of abdominal wall plasty in patients with POVH and the prevention of intra-abdominal hypertension syndrome are not yet fully resolved [2, 7, 9] .
The purpose of the study To improve outcomes in patients with postoperative ventral hernias by a differentiated approach to the choice of operation, based on the investigations of prognostic factors influencing to the occurrence of disease.
Material and methods The results of treatment of 288 patients with postoperative ventral hernias. Men were 92 ( 31,9 %), women - 196 ( 68,1 %). Depending on the applied treatment, all patients were divided into 2 equivalent in number, sex, type of pathology groups - control and basic. In selecting the method of surgical treatment of patients in the control group took into account the localization of hernias, size and shape of hernial ring. To close the hernia rings applied: in 76,4 % of the patients own tissue, at 9.4% - allomaterials, only 8,6% of cases, the defect sutured "edge - to - edge ." Patients of the main group selection method plastics hernial performed taking into account the risk factors POVH, controlled phases surgery tissue and intra-abdominal pressure . Local fabrics with plastic - abolished in 19,4% of patients using allomaterials - in 80,6 %. Comparison group consisted of 106 patients who had postoperative hernia was not. Methods: type definition acetylation of tissue pressure measurement, monitoring intra-abdominal pressure , Quetelet index calculation , the study of phenotypic traits external connective tissue dysplasia syndrome.
Results and their discussion Implemented a differentiated approach to the choice the method of plastic the hernias. Along with the size, shape hernia ring in choosing the method of surgical treatment into account , intra-abdominal pressure developed by the authors and prognostic factors of recurrence of the disease. Indications for auto-and alloplasty was identified. The proposed set of therapeutic and diagnostic measures have reduced the number of early postoperative complications in 2,4 times, recurrence of the disease is 8,5 times, mortality - 3 times.
Conclusions 1. Patients with postoperative ventral hernias W1,W2 when the sum of the scores of the risk factors for recurrence of the disease less than 4.5, the increase in AP test flattening the edges of the aponeurosis of not more than 10% and reaches up to 15 mm RT. column shows autoplastic hernia gate. 2. Patients with postoperative ventral hernias W1,W2 when the sum of the scores of the risk factors for recurrence of the disease more than 4.5 in converging edges of the aponeurosis, shows the stress hernia gate. 3. Patients with postoperative ventral hernias W3,W4 shows the non-pulling stress hernia gate.

Hernia, prognosis, tissue pressure, abdominal pressure, surgical treatment