Year 2023 Vol. 31 No 6

SCIENTIFIC PUBLICATIONS

I.V. MAKAROV, A.G. SONIS, B.D. GRACHEV, V.V. TIMOSCHUK

COMPARATIVE ANALYSIS OF COMNONENTS SEPARATION TECHNIQUES IN THE TREATMENT OF MEDIAN VENTRAL HERNIAS

Samara State Medical University, Samara,
Russian Federation

Objective. To compare the immediate and long-results of the technique of anterior and posterior components separation of abdominal wall.
Methods. 237 cases of treatment of patients with median ventral hernias W3 and W4 in one surgical department were analyzed. The technique of front separation (group 1, n=62) was implemented by the methods of V.I. Belokonev. Rear separation (group 2, n=175) were produced by A. M. Carbonell, Y. W. Novitsky, and V. N. Yegiiev. Long-term results were studied in terms of more than one year in 70.1% of patients.
Results. There were no deaths. The frequency of early complications in group 1 was 38.7%, in group 2 – 9.7%.The average bed day in group 1 was 16.8, in group 2 – 10.2. Chronic paraprosthetic infection in group 1 developed in 4 (6.5%), in group No. 2 – in 4 (2.3%).Recurrence of hernia in group №1 was revealed in 4 (6,5%), in group 2 – in 5 (2,9%) patients. Functional recovery of the abdominal wall in both groups was achieved in more than 90% of patients.
Conclusion. Technology as a front separation of the first and second method V. I. Belokonev and rear separation technique in options M. A. Carbonell, Y.W. Novitsky and V.N. Yegiiev give good results in the treatment of median postoperative ventral hernia large sizes. In the absence of recurrence of hernia, they provide functional recovery of the anterior abdominal wall, significantly improving the quality of life. With the complete destruction of one of the straight muscles or subtotal destruction of both straight muscles, the use of anterior separation technique is not rational. It is preferable to use the rear separation technique. It was found that both options give good results, however, the use of posterior separation plastic surgery reduced the number of postoperative complications by 4 times (from 38.7 to 9.7%), reduced the time of drainage of subcutaneous tissue and wounds from 10.3 to 5.8 days and reduced the length of hospital stay from 16.8 to 10,2 days. At the same time, the number of relapses in the long-term period decreased from 6.5% to 2.9%. Anterior separation is easier and can be recommended to surgeons who do not know the technique of posterior separation. This technique requires careful postoperative management with daily monitoring of drainage patency and drainage period of at least 7-10 days. Rear separation can be recommended for implementation only to surgeons of high qualification, and while technically correct performance provides faster postoperative rehabilitation.

Keywords: incisional hernia; repair of hernia; anterior components separation technique, posterior anterior components separation technique, polypropylene mesh implant, post-operative rehabilitation
p. 458-467 of the original issue
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Address for correspondence:
443079, Russian Federation,
Samara, Karl Marx Ave., 165, B;
Clinics of Samara State Medical University,
Clinic of Propaedeutic Surgery,
tel.: +7 927 000 41 50,
e-mail: v.v.timoschuk@samsmu.ru,
Timoshchuk Vladislav V.
Information about the authors:
Makarov Igor Valerievich, MD, Professor, Head of the Department of General Surgery and Surgical Diseases, Samara State Medical University, Samara, Russian Federation.
http://orcid.org/ 0000-0002-1068-3330
Sonis Alexander Grigorievich, MD, Professor, Professor of the Department of General Surgery and Surgical Diseases of Samara State Medical University? Samara, Russian Federation.
https://orcid.org/0000-0002-2148-6754
Grachev Boris Dmitrievich, PhD, Associate Professor of the Department of General Surgery and Surgical Diseases of Samara State Medical Samara University, Samara, Russian Federation.
http://orcid.org/ 0000-0002-4778-9518
Timoshchuk Vladislav Vladimirovich, Full-time Graduate Student (2 years), Department of General Surgery and Surgical Diseases, Samara State Medical University Samara, Russian Federation.
http://orcid.org/ 0000-0002-6733-8327
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