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The aim of the investigation was to compare the results of using different techniques of combined prosthetic repair in median incisional ventral hernias, and develop the assessment criteria for the risk of postsurgical wound complications. Materials and Methods. We studied the effect of four combination prosthetic repair techniques in 152 patients with median incisional ventral hernias W2, W3 and W4: two restorative techniques — onlay (n=38) and sublay (n=17), a reconstructive Belokonev-I technique (n=49) and a reparative technique suggested by the authors (n=48). To determine risk factors of postsurgical wound complications we used a multiple correlation analysis. Results. There were no fatal cases. Long-term wound exudation was found in 19 of 38 patients (50%) after onlay technique, and in 12 of 49 (24.5%) — after Belokonev-I technique. The same groups of patients were observed to develop seromas — 12 (31.6%) and 2 (4.1%) cases respectively. The best life quality levels were found in patients after sublay technique (it was used in W2 hernias only), the lowest — after onlay technique. The life quality levels after Belokonev-I repair and the authors’ technique had no significant differences; they were comparable to sublay technique. The developed method for risk assessment of postoperative wound complications enables a surgeon to assess adequately the risk level and deal with controllable prognostic factors, namely endoprosthesis type and alloplasty technique. Conclusion. Combination prosthetic repair by restorative techniques is inappropriate for median incisional ventral hernias W3–W4 since it causes intra-abdominal pressure increase. An adequate choice of prosthesis type and plasty technique reduces the risk of wound complications.

sovremennye tehnologii v medicine

The Assessment of Different Combination Prosthetic Repair Techniques and Prognostic Criteria for Early Wound Complications in Median Incisional Ventral Hernias