Сurrent methods of treating patients with large midline postoperative ventral hernias

Introduction. Ventral hernias are a common postoperative complication, particularly following midline laparotomy, with an incidence exceeding 30%. Surgical treatment presents significant challenges due to pronounced anatomical abnormalities, fibrotic tissue changes, severe comorbidities, and the complexity of planning the extent and nature of reconstructive interventions during preoperative preparation. In recent years, new approaches to treating large postoperative midline ventral hernias (POVH) have emerged, requiring systematic analysis and evaluation of their effectiveness. Objective. To conduct a systematic analysis of modern surgical techniques for treating large POVH, including various separation-based repair techniques, and to assess the efficacy of preoperative botulinum toxin type A (BTA) in the comprehensive management of this condition Results. A reduction in postoperative complications and recurrence rates was observed with the use of posterior separation-based repair (Transversus Abdominis Muscle Release, TAR). Preoperative BTA administration in these patients contributed to an average increase in lateral abdominal wall muscle mobility of 3.2–4.7 cm on each side, facilitating effective closure of midline defects and reducing the extent of separation-based repair. Conclusion. Preoperative BTA administration in patients with large midline hernias allows for a reduction in the extent of separation-based repair, thereby decreasing surgical trauma and the risk of compartment syndrome.