FACTOR OF INTRA-ABDOMINAL HYPERTENSION IN VENTRAL HERNIA REPAIR

Rationale. Modern techniques of abdominal wall reconstruction based on incisions of rectus abdominis and oblique muscles aponeurosis, in combination with the use of polypropylene endoprostheses allow to significantly increase the residual volume of the ab-dominal cavity, but do not completely eliminate the need to control the level of intra-abdominal pressure. Materials. Analysis of the results of the treat-ment of 35 patients with postoperative ventral hernia (PVH) was performed. Among the patients, there were 22 women (62,9%) and 13 men (37,1%), the average age was 57,8±6,4 years. The size of the hernia gate according to the classification of the European Hernia Society (2009) corresponded to W2 - in 8 cases (22,9%), W3 - in 17 cases (48,6%), W4 - in 10 cases (28,5%). PVH was most often formed after midline laparotomy - (54,3%), with the predominant localization of hernia defects in the meso- and (or) epigastrium. Purulent complications of the postoperative wound preceded the formation of hernia in 15 (42,8%) cases, premature significant physical activity at home or at work - in 8 (22,8%) cases, relaparotomy – in 2 (5,7%) cases. In other cases, the factors that contributed to hernia formation could not be clearly identified. During the preparation of the patient for surgery, an ultrasound of the musculo-aponeurotic structures of the abdomen was performed to assess the size of the hernia gate, the content and fluid presence in the hernia sac, the degree of blood flow disorders in the affected organs. Results. All patients underwent combined hernia repair using local tissues and mesh polypropylene endo-prostheses with onlay fixation. Before suturing the edges of the hernia defect, in order to prevent abdominal com-partment syndrome, intra-abdominal pressure (IAP) by Kron I.L. et al.,1984 was measured. Suturing was consid-ered acceptable at IAP level not exceeding 150 mm Hg, which was possible for 12 patients (W2-W3). 15 patients (W3-W4) with IAP above this value underwent additional dissection of the vagina anterior leaf of the rectus ab-dominis, not less than 4 cm from the edge of the hernia gate, which allowed to achieve an increase in the width of the vagina posterior leaf. Additional IAP measurement was performed after aponeurosis edges connection, and at the IAP level not higher than 150 mm Hg aponeurotic leaves were sutured and the white line of the abdomen as an anatomical structure was restored. IAP level after surgery did not depend on its ini-tial value and surgery type and lay in a range of 132,5-129,5±5,1-6,2 mm Hg. A clear tendency of IAP to de-crease was observed already on the second day in most cases (30), as peristalsis was restored and patients were activated. In order to control the wound process, an ultra-sound of the postoperative wound was performed. There was a hypoechoic band between the sutured aponeurotic leaves, which in complicated course showed hyperecho-genicity, indicating an active process of scar tissue for-mation and decrease of the infiltrative processes in the wound. On the contrary, when the thickness of the hy-poechoic interaponeurotic band tended to increase reach-ing 3,5-4 mm or more, it was regarded as fluid formations (seroma) and a high risk of purulent-inflammatory com-plications of the wound. Conclusions. The research showed that in-traoperative control of IAP in PVH repair reduces the risk of abdominal compartment syndrome. Postoperative ultrasound monitoring of the hernia repair surgery area allows to diagnose signs of wound inflammatory compli-cations in a timely manner.