Relevance The approaches to surgical treatment of patients with a combination of umbilical hernia and diastasis recti, remain controversial and need further investigation. The purpose of the study To improve the results in surgical treatment of patients with a combination of umbilical hernia and diastasis recti. Materials and methods We assessed the recurrence rate and development during a three year period after surgical treatment of 262 patients with combined umbilical hernia and diastasis recti. The patients were divided into 9 groups according to the size of the diastasis recti and the applied surgical procedure: a novel method of extraperitoneal prosthetic correction of the diastasis recti and umbilical hernia, autogenous umbilical hernioplasty without correction of the diastasis and simultaneous autogenous hernioplasty and correction of the diastasis using Championniere’s or Askerkhanov’s methods. Results and their discussion There were no cases of recurrence reported, when the novel method was used. After autogenous umbilical hernioplasty without correction of the diastasis relapses occurred in 9 (15,25%) and 29 (70,73%) patients with grade 1 and 2 diastasis, respectively. After simultaneous autogenous hernioplasty and correction of the diastasis a relapse occurred in 12 (30,77%) patients with a grade 2 diastasis and in 15 (93,75%) patient with a grade 3 diastasis. All cases of relapse occurred within the first year after the surgical treatment. Conclusion 1) In the presence of rectus diastasis isolated umbilical hernioplasty leads to a high recurrence rate (15,25% in patients with grade I diastasis and 70,73% in grade II), no matter how large the diastasis was. 2) Surgical procedures combining umbilical hernioplasty and autogenous correction of the diastasis are more effective (recurrence rate 30,77%) than isolated umbilical hernioplasty (recurrence rate 70,73%), but are considerably inferior to the method of extraperitoneal prosthetic correction of the diastasis recti and umbilical hernia (no recurrences at all). The effectiveness of autoplastic procedures considerably decreases with an increasing degree of diastasis (recurrence rate 30,77% in grade II diastasis, 93,75% in grade III diastasis). 3) Extraperitoneal prosthetic correction of the diastasis recti and umbilical hernia is considerably superior to both the isolated autogenous umbilical hernioplasty (recurrence rate 15,25% in patients with grade I diastasis and 70,73% in case of grade II diastasis) and the combined autogenous diastasis correcting methods (recurrence rate 30,77% in patients with grade II diastasis, 93,75% in case of grade III)

Relevance The advantages of prosthetic methods of postoperative ventral hernia correction are now recognized by most domestic and foreign surgeons. But there still remains a considerable controversy concerning the indications for prosthetic abdominal wall surgery, optimal prosthetic method operative approach and technique of hernioplasty. The purpose of the study Research objectives were to analyze our own experience of treating patients with postoperative hernias of the anterior abdominal wall and data from publications on this issue. Materials and methods Our approach to ventral hernia surgery is based on the experience of treating 550 patients with hernias of the anterior abdominal wall. Results and their discussion Prosthetic methods are undoubtedly superior to autoplastic surgery. Among the prosthetic methodsthe one with submuscular mesh placement (“sublay”) is to be preferred. If this technique fails to be applicable due to a too large abdominal wall defect not allowing to join the aponeurotic margins without tension, the abdominal wall should be restored by an “inlay” operation. If the latter technique is not applicable, a Ramirez operation is to be performed. The “inlay” technique is the least profitable prosthetic method of hernioplasty as far as functionality is concerned, because it does not restore the linea alba. For patients with large medial abdominal wall defects, when high-quality physical recovery is needed, the Ramirez technique is also indicated because it allows translocating the vagina m. recti abdominis medially. Conclusion Among prosthetic techniques optimal use of combined methods of plastics. Laparoscopic hernioplasty still remains intervention performed by only in specialized institutions, although the first results of its application are encouraging

Актуальность Преимущества применения протезирующих методик пластики послеоперационных грыж признаны в на- стоящее время абсолютным большинством отечественных и зарубежных хирургов. Однако налицо существенные раз- личия в показаниях к протезированию брюшной стенки, выбору оптимальной протезирующей методики и операционного доступа, технике выполнения герниопластики. Цель исследования Обобщить накопленный собственный опыт лечения больных с послеоперационными грыжами перед- ней брюшной стенки и данные литературы по данной тематике. Материалы и методы На основании опыта лечения 550 больных с грыжами передней брюшной стенки выработана так- тика оперативного лечения больных с данной патологией. Результаты и их обсуждение Протезирующие методики герниопластики имеют неоспоримое преимущество перед пла- стикой местными тканями. Из числа протезирующих методик наиболее предпочтительна реконструкция передней брюш- ной стенки с субмускулярным размещением протеза (“sublay”). В случае, если данная методика невыполнима из-за обшир- ности дефекта брюшной стенки, не позволяющей свести края апоневроза без натяжения, стоит выполнять коррекцию передней брюшной стенки (“inlay”). Если и последняя методика не может быть осуществлена, стоит воспользоваться способом Ramirez. Коррекция брюшной стенки (“inlay”) – функционально наименее выгодный вариант протезирующей гер- ниопластики, поскольку не восстанавливается белая линия живота. Поэтому у лиц трудоспособного возраста с широки- ми срединными дефектами брюшной стенки, когда полноценная физическая реабилитация принципиально важна, также имеются показания к технике Ramirez, позволяющей переместить влагалища прямых мышц медиально. Выводы Среди протезирующих методик оптимально применение комбинированных способов пластики. Лапароскопиче- ская герниопластика пока остается вмешательством, выполняемым лишь в специализированных учреждениях, хотя пер- вые результаты ее применения являются обнадеживающими

Myofascial defects of lateral abdominal wall and lumbar region occur chiefly after lumbotomy--the most popular access in urosurgery. Meanwhile lumbotomy remains one of the most traumatic accesses through the lateral abdominal wall. Myofascial defects were diagnosed in 48,9% of operated patients with lumbotomy. Of them true postoperative hernias were found in 35,3%; neuropathic hernias - in 13,6%. Since 2002 the originally developed method of lateral abdominal wall reconstruction had been used for the treatment of such patients. The immediate and long-term results (maximal follow-up period 5 years) showed no hernia recurrence or complications in 26 operated patients.