Anatomical and Experimental Substantiation of a New Method of Mid-Lateral Postoperative Ventral Hernia Repair

Postoperative ventral hernias (PVH) account for up to 22% and occupy the second place in frequency after inguinal hernias. The incidence of POVH following emergency surgeries ranges from 18.1% to 58.7%, and after elective surgeries, from 4.0% to 18.1% [4,6,9]. A large number of techniques for the reconstruction of the anterior abdominal wall in POVH are known, depending on their size and location. Clinical guidelines, as well as modern publications, outline the methodological foundations for the reconstruction of midline and lateral POVHs. However, only a few publications describe the methodology and contemporary aspects of the reconstruction of ventral postoperative hernias with mid-lateral localization [11,12,13]. At the Department of General Surgery and Surgical Diseases, Samara State Medical University, Ministry of Health of Russia, a new method for reconstructing mid-lateral hernias has been developed. The method involves forming an implant bed in the space behind the rectus abdominis muscle and beneath the aponeurosis of the external oblique muscle. The study examined the anatomical features of the space under the aponeurosis of the external oblique muscle, finding optimal access options to it. A series of experiments on 20 unfixed cadavers, while adhering to ethical standards, studied the tension of the tissues of the anterior abdominal wall and the volumes of gas insufflated into the abdominal cavity when modeling different methods of hernioplasty. A comparative analysis was conducted of the developed method for the reconstruction of postoperative ventral mid-lateral hernias (Patent RU № 2825698 from 28.08.2024) with Novitsky's hernioplasty technique. The results of the study proved that hernioplasty by Novitsky's technique significantly increases the volume of the abdominal cavity more than the proposed method. However, the new method for reconstructing postoperative ventral mid-lateral hernias is less traumatic, easier to implement, and can be used in the treatment of postoperative ventral hernias of small and medium size.