mossjМосковский хирургический журналMoscow Surgical Journal2072-3180ООО «ПРОФИЛЬ – 2С»10.17238/2072-3180-2025-3-190-197mossj-1039Research ArticleЛИТЕРАТУРНЫЕ ОБЗОРЫLITERARY REVIEWSАктуальные методы лечения больных большими послеоперационными вентральными грыжами срединной локализацииCurrent methods of treating patients with large midline postoperative ventral herniashttps://orcid.org/0000-0003-2781-7080ОтманХ.OthmanH.

Отман Хассан – Аспирант 

117198, ул. Миклухо-Маклая, д. 6, Москва 

Othman Hassan – Phd student  

117198, Miklukho-Maklaj str., 6, Moscow 

hassanothmanov@gmail.comhttps://orcid.org/0000-0002-9218-6011Аль-АрикиМ.К.М.Al-ArikiM.K.M.

Аль-Арики Малик Киаед Мохаммед – кандидат медицинских наук, ассистент 

117198, ул. Миклухо-Маклая, д. 6, Москва, 8 977 685 10 28 

Al-Ariki Malik Kiaed Mohammed – Candidate of Medical Sciences, assistant professor

117198, Miklukho-Maklaj str., 6, Moscow , 8 977 685 10 28 

al_ariki_m@mail.ruhttps://orcid.org/0000-0002-1116-2529ЧиниковМ. А.ChinikovM. A.

Чиников Максим Алексеевич – доктор медицинских наук, профессор  

117198, ул. Миклухо-Маклая, д. 6, Москва 

Chinikov Maxim Alekseevich – Doctor of Medical Sciences, professor

117198, Miklukho-Maklaj str., 6, Moscow 

chinikovma@gmail.comКафедра госпитальной хирургии с курсом детской хирургии ФГАОУ ВО Российский университет дружбы народов имени Патриса ЛумумбыРоссияDepartment of hospital surgery with a course of pediatric surgery of the RUDN University named after Patrice LumumbaRussian Federation20252209202503190197Copyright © Отман Х., Аль-Арики М., Чиников М.А., 20252025Отман Х., Аль-Арики М., Чиников М.А.Othman H., Al-Ariki M., Chinikov M.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.mossj.ru/jour/article/view/1039

Введение. Вентральные грыжи представляют собой частое послеоперационное осложнение, особенно при срединной лапаротомии, где их частота превышает 30 %. Хирургическое лечение сопряжено со значительными трудностями, обусловленными выраженными анатомическими нарушениями, фиброзно-изменёнными тканями, тяжёлыми сопутствующими заболеваниями, а также сложностью планирования объёма и характера реконструктивных вмешательств на этапе предоперационной подготовки. В последние годы появились новые подходы к лечению больших послеоперационных вентральных грыж (ПОВГ) срединной локализации, требующие системного анализа и оценки эффективности.Цель работы. провести систематический анализ современных методов хирургического лечения больших ПОВГ, включая различные варианты сепарационной пластики, а также оценить эффективность предоперационного применения ботулотоксина типа А (БТА) в комплексном лечении данного заболевания.Результаты. Отмечено снижение частоты послеоперационных осложнений и рецидивов при применении задней сепарационной пластики (Transversus Abdominis Muscle Release – TAR-пластики). Предоперационное введение БТА у данной категории пациентов способствует увеличению мобильности боковых мышц передней брюшной стенки в среднем на 3,2–4,7 см с каждой стороны, что обеспечивает эффективное закрытие серединных дефектов и позволяет уменьшить объём сепарационной пластики.Заключение. Предоперационное применение БТА у пациентов с большими серединными грыжами позволяет уменьшить объём сепарационной пластики, снижая степень хирургической травматизации и риск развития компартмент-синдрома.

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 conditionResults. 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.

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The authors declare that there are no conflicts of interest present.