ХІРУРГІЧНЕ ЛІКУВАННЯ ВЕЛИКИХ ВЕНТРАЛЬНИХ ПІСЛЯОПЕРАЦІЙНИХ ГРИЖ У ХУДИХ ТА КАХЕКТИЧНИХ ПАЦІЄНТІВ З ВИКОРИСТАННЯМ ПОЛІПРОПІЛЕНОВОЇ СІТКИ, МОДИФІКОВАНОЇ ВУГЛЕЦЕВИМИ НАНОТРУБКАМИ ТА АНТИСЕПТИКОМ

Surgical treatment of large postoperative ventral abdominal hernias (PVAH) using classical allogernioplasty techniques (sublay, onlay) is often accompanied by increased intra-abdominal pressure (IAP) and decreased abdominal volume, which can lead to abdominal compartment syndrome (ACS) in 2.4–3.6% of cases and mortality in 1.2–3.4% [1,2]. Therefore, closing a large abdominal wall defect requires a technique that does not elevate IAP. The use of anatomical component separation of the anterior abdominal wall by the modified Ramirez technique combined with sublay alloplasty helps restore optimal abdominal volume and improves outcomes, particularly by reducing ACS incidence [3–5]. However, combined surgery with a classical polypropylene mesh is associated with a high rate of postoperative wound complications—seroma (30.8–60.4%), wound suppuration (4.8–6.4%), ligature fistula (1.2–3.0%), and meshoma (0.06–1.60%) [6,7]. A key cause is aseptic inflammation of abdominal wall tissues due to contact with the polypropylene mesh. We believe that using a modified polypropylene mesh impregnated with polyhexamethylene guanidine chloride and carbon nanotubes will improve outcomes in thin and cachectic patients with large PVAH.Aim. To improve the results of surgical treatment of large postoperative abdominal hernias (PVAH) in thin and cachectic patients using a modified polypropylene mesh.Material and methods. The surgical treatment of 152 patients with large inguinal hernia was analyzed. Depending on the type of mesh implant used during surgical treatment, the patients were divided into two groups. In 76 (50%) patients in group I, hernia excision and hernioplasty were performed using a modified polypropylene mesh, in group II, 76 (50%) patients underwent surgery using a classic polypropylene mesh.Results and discussion. Statistically significantly better results were obtained in patients of group I compared to group II. The duration of inpatient treatment in group I was (7.0±1.0) days, in group II – (12.0±2.2) days.Conclusion. Surgical treatment of large PVAH in thin and cachectic patients using a modified polypropylene mesh is much more effective compared to the use of a classic polypropylene mesh, as evidenced by a decrease in the frequency of postoperative complications.