ПРОГРЕС У ТЕХНІЦІ АЛОПЛАСТИКИ БЕЗ НАПРУЖЕННЯ ДЛЯ ЛІКУВАННЯ ВЕНТРАЛЬНИХ ГРИЖ У ПАЦІЄНТІВ З ОЖИРІННЯМ

Ventral hernias remain one of the most prevalent and socially significant challenges in contemporary abdominal surgery. Patients with obesity present unique difficulties due to specific pathological anatomy, diminished tissue regenerative capacity, and an elevated risk of postoperative complications.Objective. To enhance the safety and efficacy of ventral hernia treatment in obese patients by optimizing the technical aspects of open non-tension hernia alloplasty.Materials and Methods. This prospective study included 121 patients with ventral hernias and concurrent obesity treated surgically at the Samarkand Branch of the Republican Center for Emergency Medical Care from 2016 to 2025. Patients were allocated into two groups: a control group (54 patients) underwent hernioplasty using the Devlin method with Zhebrovsky’s modification, while the primary group (67 patients) received a novel non-tension hernia alloplasty technique involving U-shaped suture fixation of the hernia defect edge and on-lay endoprosthesis placement. Preoperative preparation included cardiology and pulmonology consultations and pulmonary function tests Preoperative preparation included cardiology and pulmonology consultations and pulmonary function tests, including the Stange test, vital capacity, maximum voluntary ventilation, and other assessments. The novel technique involved meticulous tissue dissection and endoprosthesis fixation without aponeurotic tension to minimize organ injury and complications risk. All procedures were conducted in accordance with the World Medical Association's Declaration of Helsinki (2000 amendments).Results. Postoperative complications occurred in 6 (8.9%) patients in the primary group versus 8 (14.8%) in the control group, demonstrating a statistically significant reduction with the novel technique (p=0.045). Complications included wound-related issues and bronchopulmonary complications, with rare cardiovascular events and one case of abdominal compartment syndrome in the control group. Gastrointestinal function was preserved in 119 (98.4%) patients. Long-term follow-up (1–5 years) in 98 (76.8%) patients showed no recurrences in the primary group, unlike the control group. Mean hospital stay was 7 days in both groups, with reduced pain and faster return to work in the primary group.Conclusions. The novel non-tension hernia alloplasty technique, utilizing U-shaped sutures and on-lay endoprosthesis, proved highly effective in obese patients, significantly reducing postoperative complications and eliminating long-term hernia recurrence. This method minimizes surgical trauma, accelerates recovery, and improves clinical outcomes, offering a promising approach for managing ventral hernias in this high-risk population.

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