Large defects
For defects of 10 cm or more, it is important not just to “seal” the hole, but to restore the function of the abdominal wall: the edges are brought together with sutures or component separation (with E-TAR/TAR, the transverse muscle is dissected, which allows mobilization of up to 8–10 cm on the side), a mesh of 25x30 cm or more covers the entire zone. Before the operation, MSCT is performed to measure the defect and volumes (in case of “loss of domain” - preparation), weight, diabetes, and smoking cessation are optimized. Hospital stay 2–3 days with drainage, bandage 8 weeks, loads after 2–3 months; relapses with correct technique are 5–8%.
Indications
- postoperative (ventral) hernia in the scar after previous operations;
- hernia of the white line of the abdomen, diastasis with hernia;
- hernia growth, episodes of irreducibility - risk of strangulation;
- recurrent ventral hernias after repair without mesh.
IPOM and E-TAR techniques
During laparoscopic IPOM repair, a composite mesh with an anti-adhesion coating is installed from the inside of the abdominal cavity, covering the defect by 5 cm in all directions and fixing it around the perimeter; If possible, the defect is sutured over a mesh (IPOM-plus). With the E-TAR/eTEP technique, the mesh is placed in the layers of the abdominal wall without contact with the intestine, with restoration of the midline - anatomical reconstruction for medium and large hernias. The choice depends on the size and location of the defect, the condition of the tissues; The cost of the implant is included in the price list. Relapses with mesh techniques are 3–5% versus 30–50% with simple suturing.
Benefits of laparoscopy
Laparoscopic access is the standard of modern abdominal surgery: instead of a 10–20 cm incision, 3–4 punctures are left, the pain after surgery is much less, the patient gets up on the day of surgery and is discharged after 1–2 days, the risk of wound infection, hernias in the scar and adhesions is several times lower, and the enlargement of the camera allows you to operate more accurately. In the clinics below, operations are performed by surgeons with extensive laparoscopic experience; hospital (SKD) is included in the price according to the price list.
