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American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 04 ISSUE 01 PAGES: 46-55 

SJIF IMPACT FACTOR (2021: 5. 705) (2022: 5. 705) (2023: 6.534) 
OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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ABSTRACT 

The study is based on a clinical examination of 105 patients with postoperative ventral hernias who were operated on 

in the surgical department of the multidisciplinary clinic of Samarkand State Medical University for the period from 

2019 to 2023. Depending on the choice of operation, patients were divided into two groups:The first group (main 

group) consisted of 50 patients operated on laparoscopically, the second group, the comparison group included 55 

patients who underwent open (traditional) prosthetic hernioplasty. The use of the laparoscopic "ipom" technique can 

significantly reduce the number of early postoperative and general complications (by 3.6 times), the duration of 

hospitalization (from10.2 ± 1.8days before6.2 ± 0.8days), periods of temporary disability (from40.9 ± 5.6days 

before15.1 ± 1.8days), and also reduce the number of relapses (from 10.9% to 2.0%). 

KEYWORDS 

Postoperative ventral hernias, alloplasty, endovideosurgery. 

  Research Article 

 

RESULTS OF LAPAROSCOPIC AND LAPAROTOMIC INTERVENTIONS FOR 

POSTOPERATIVE VENTRAL HERNIA 
 

Submission Date: January 08, 2024, Accepted Date:  January 13, 2024,  

Published Date: January 18, 2024  

Crossref doi: https://doi.org/10.37547/ajbspi/Volume04Issue01-08 

 

 

Kurbaniyazov Z.B. 
Samarkand State Medical University, Samarkand, Uzbekistan 

 

Sayinaev F.K. 
Samarkand State Medical University, Samarkand, Uzbekistan 

 

Yuldashev P.A. 
Samarkand State Medical University, Samarkand, Uzbekistan 

 

Abdurakhmanov D.Sh. 
Samarkand State Medical University, Samarkand, Uzbekistan 

 

 

 

Journal Website: 

https://theusajournals.

com/index.php/ajbspi 

Copyright: Original 

content from this work 

may be used under the 

terms of the creative 

commons attributes 

4.0 licence. 

 

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Volume 04 Issue 01-2024 47 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 04 ISSUE 01 PAGES: 46-55 

SJIF IMPACT FACTOR (2021: 5. 705) (2022: 5. 705) (2023: 6.534) 
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INTRODUCTION

An increase in surgical activity associated with the 

improvement of surgical techniques and anesthesia 

methods has led to an increase in the number of 

patients with postoperative ventral hernias (POVH) by 

9-10 times over the past 25 years [7]. Every year, about 

20 million hernioplasties are performed in the world, of 

which approximately 700 thousand are performed in 

the USA, about 1 million in Europe, and up to 2 

thousand in Uzbekistan [4, 7, 10]. 

In this regard, the problem of surgical treatment of 

POVH remains an urgent task in abdominal surgery. 

These hernias take second place after inguinal hernias, 

and account for 20-22% of the total number of 

abdominal wall hernias. In approximately 50% of cases, 

POVH develops within the first two years after surgery, 

and 75% after three years [2, 5, 6]. 

The problem of effective treatment of POVH has not 

been fully resolved. Despite the large number (more 

than 200) of proposed methods for their surgical 

treatment, the rate of disease relapse remains high, 

amounting to 15-50%, and repeated operations are 

accompanied by its increase to 20-65% [1, 3, 8]. The 

inconsistency of assessments of the proposed 

methods of surgical treatment of POVH, the variety of 

traditional methods of hernia repair used and the 

emergence of new methods using various mesh 

implants make it difficult to choose the most rational 

method of plastic closure of the hernia defect. In 

modern conditions, various methods of tension-free 

hernioplasty using a variety of synthetic mesh implants 

are considered the operation of choice for POIG. 

Tension methods of hernioplasty using local tissues 

have practically ceased to be used due to the high 

frequency of relapses and remain in the arsenal of 

surgeons only for small POIGs [1, 9]. 

Since the late 1990s, the development of laparoscopic 

technology and the introduction of new synthetic 

materials have pushed surgeons to develop and 

introduce into practice laparoscopic methods for the 

treatment of POVH. 

However, to this day, the following issues of 

laparoscopic hernioplasty remain unresolved: the 

rational choice of a mesh implant according to the 

quality/price criterion, the method of its placement and 

method of fixation, the problem of delimiting the mesh 

implant from the abdominal organs, determining the 

indications and contraindications for this type of 

plastic surgery [2] . 

The purpose of the study improving the results of 

laparoscopic hernioplasty for postoperative ventral 

hernias. 

METHOD 

The study is based on a clinical examination of 105 

patients with postoperative ventral hernias who were 

operated on in the surgical department of the 

multidisciplinary clinic of Samarkand State Medical 

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Volume 04 Issue 01-2024 48 

                 

 
 

   
  
 

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(ISSN – 2771-2753) 
VOLUME 04 ISSUE 01 PAGES: 46-55 

SJIF IMPACT FACTOR (2021: 5. 705) (2022: 5. 705) (2023: 6.534) 
OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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University for the period from 2019 to 2023. Depending 

on the choice of operation, patients were divided into 

two groups:The first group (main group) consisted of 

50 patients operated on laparoscopically, the second 

group, the comparison group included 55 patients who 

underwent open (traditional) prosthetic hernioplasty. 

Among the patients there were 58 men, 47 women. 

The location and size of the PIH were determined using 

the classification proposed by the European Society of 

Herniology (modified and based on the classification of 

J. Chevrel and A. Rath) and adopted by international 

consensus (Belgium, October 2-4, 2008) [10]. 

According to this classification, the following types of 

POVG are distinguished: 

I) By localization: 

M - medial hernia (borders of the midline of the region: 

cranially - the xiphoid process, caudally - the pubic 

bone, from the side - the lateral edges of the rectus 

abdominis muscle): 

M1 - subxiphoid hernia (from the xiphoid process to 3 

cm caudally); 

M2 - epigastric hernia (from 3 cm below the xiphoid 

process to 3 cm above the umbilical ring); 

M3 - umbilical hernia (from 3 cm above to 3 cm below 

the umbilical ring); 

M4 - infraumbilical hernia (from 3 cm below the 

umbilical ring to 3 cm above the pubis); 

M5 - suprapubic hernia (from the pubic bone to 3 cm 

cranially). 

L - lateral hernia (limits of the lateral surface area: 

cranially - the edges of the costal arches; caudally - the 

inguinal areas, medially - the lateral edges of the rectus 

abdominis muscle, laterally - the lumbar region): 

L1 - hypochondrium (from the anterior edge and 

horizontal line 3 cm above the umbilical ring); 

L2 - flank (on the side of the rectus muscle 3 cm above 

and below the umbilical ring): 

L3 - iliac region (between the horizontal line 3 cm below 

the umbilical ring and the groin area); 

L4 - lumbar region (latero-dorsal part from the anterior 

axillary line). 

Various defects in the anterior abdominal wall caused 

by one incision are considered as one hernia, two or 

more different surgical incisions are considered as two 

or more hernias. 

II). According to the size of the hernial orifice: 

W1 <4 cm; W2 ≥ 4-10 cm; W3 ≥ 10 cm. The width of the 

hernia defect is defined as the greatest horizontal 

distance in cm between the lateral edges 

hernia defect on both sides. In the case of multiple 

defects, the width of the hernia is measured between 

the most transversely located edges of the most 

laterally located defects on the same side. The length 

of the hernia defect is defined as the greatest vertical 

distance in cm between the most cranial and most 

caudal edges of the hernia defect. In the case of 

multiple hernia defects from one incision, the length is 

measured between the most cephalad defect and the 

most caudal defect. 

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VOLUME 04 ISSUE 01 PAGES: 46-55 

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III). By adjustability: 

1. Reducible, with or without obstruction; 2. 

Irreversible, with or without obstruction. 

IV). Based on the presence of symptoms: 

1. Asymptomatic; 2. Symptomatic. 

In terms of age composition, body mass index, 

presence of concomitant pathology, location, size and 

area of the hernia defect, both groups of patients did 

not differ significantly from each other (Table 1).

Table 1. 

Distribution of patients between study groups 

Sign 
Laparoscopic 

hernioplasty (n=50) 

Open hernioplasty 

(n=55) 

floor 
husband 26 32 

wives 24 23 

Average age (years) 52.7±3.2 56.1±5.3 

Average period of occurrence of POVG (years) 0.7±0.1 0.9±0.2 

Body mass index (kg/m2) 32.1 ± 1.2 30.2 ± 2.3 

Presence of 

concomitant 

pathology (abs., %) 

Diseases of the heart 

and blood vessels 
8 9 

Lung diseases 5 6 

Kidney diseases 2 2 

Gastrointestinal 

diseases 
4 6 

Diabetes 3 4 

Distribution of POVG 

according to the EOG 

classification of 2008 

(abs., %) 

M – medial hernia 
M (45): M1-1; M2-17; 

M3-19; M4-7; M5-1 

M (47): M1-2; M2-20; 

M3-18; M4-5; M5-2 

L – lateral hernia 
L(5): L1-2; L2-1; L3-

1; L4-1 

L(8): L1-3; L2-2; L3-

2; L4-1 

W – size of the 

hernial orifice 

W1 - 4; W2 - 35; W3 

- 11 

W1 - 4; W2 - 39; W3 

- 12 

 

 

POIG in patients of both groups arose after the 

following previous operations: after cholecystectomy, 

suturing of a perforated gastric or duodenal ulcer, 

gastric resection for complications of gastric or 

duodenal ulcer (perforated ulcer, gastrointestinal 

bleeding, gastric outlet stenosis) from the traditional 

upper midline laparotomy access - in 40 patients, after 

midline surgical approaches for acute surgical 

pathology and injuries of the abdominal organs - in 21, 

lower midline incisions for gynecological diseases - in 

15, lumbotomy approaches for urolithiasis - in 13, 

cesarean section for obstetrics – in 13, appendectomy 

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VOLUME 04 ISSUE 01 PAGES: 46-55 

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from a typical approach – in 3 patients. The occurrence 

of POVH in patients was observed within a period of 2 

months to 4 years after the last previous operation. 

In the main group of patients who underwent 

laparoscopic hernioplasty using the “ipom” method 

(Laparoscopic Intra Peritoneal Onlay Mesh), 

composite mesh implants “Physiomesh” or “Prosid” 

(Ethicon) were used. All laparoscopic operations were 

performed under general anesthesia using a Karl Shorz 

video complex. The main working instruments for 

laparoscopic prosthetic hernioplasty were: ultrasonic 

scalpel “Harmonic” (Ethicon) and 5 mm endoscopic 

herniostapler “ProTack™” (Covidien). 

Surgical intervention was performed according to 

standard techniques. 

Stage I – insertion of the first trocar in conditions of 

POVH, as far as possible from the hernia, in an area free 

from adhesions. Typically, entry into the free 

abdominal cavity was carried out in the left 

hypochondrium or in the left iliac region using a special 

optical trocar “Visiport™” (Covidien) or under visual 

control using the Hasson technique. 

Stage II of the operation - after the introduction of the 

first trocar with optics and revision of the abdominal 

cavity, 2 or 3 working trocars were introduced. The 

sites for trocar insertion in patients with POIG are not 

standardized and were chosen where it was more 

convenient and safe. At the same time, we tried to 

observe the principle of interaction of two 

laparoscopic instruments at an angle to each other of 

at least 45° (Fig. 1). 

 

 
Rice. 1. Places for installing 10 mm and 5 mm trocars for the laparoscope and working instrument 

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Stage III was adhesiolysis. Separation of adhesions 

between the hernial sac, anterior abdominal wall and 

nearby organs was performed using endoscissors or an 

ultrasonic scalpel “Harmonic” (Ethicon) (Fig. 2). 

  
Rice. 2. Stage separation of adhesions between the anterior abdominal wall and liver using an ultrasonic 

scalpel “Harmonic” (Ethicon) 

Stage IV – identification of the aponeurosis defect, 

determination of the true size of the hernial orifice, 

selection of a mesh implant of the appropriate size 

(Fig. 3). 

 

 
Rice. 3. General view of the defect of the aponeurosis of the anterior abdominal wall after separation of 

the adhesions 

Stage V – cutting out and modeling the mesh implant 

(if necessary), marking the hernial orifice and points of 

fixation of additional ligatures, stitching the edges of 

the mesh implant with 2 or 4 ligatures for its intra-

abdominal straightening and pressing to the anterior 

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VOLUME 04 ISSUE 01 PAGES: 46-55 

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abdominal wall before final fixation with an 

endoherniostapler. 

 
Rice. 4. Final fixation of the mesh implant to the anterior abdominal wall using an endoherniostapler 

Stage VI – insertion of a mesh implant into the 

abdominal cavity, straightening and pressing it to the 

anterior abdominal wall using ligatures tied along the 

edges of the implant, final fixation using an 

endoherniostapler (Fig. 4). The number of fixation 

staples depended on the size of the hernia defect, the 

volume of the hernia sac and the size of the mesh 

implant (usually after 3-4 cm). 

Stage VII - control of hemostasis, desufflation of gas, 

removal of trocars and suturing of 10 mm punctures of 

the anterior abdominal wall, application of intradermal 

absorbable sutures to the skin incisions and aseptic 

dressings. 

Open prosthetic hernioplasty (comparison group) was 

performed under general anesthesia or epidural 

anesthesia, which depended on the location and size of 

the PIH. When performing prosthetic hernioplasty 

using a laparotomic approach (comparison group), a 

Prolene mesh implant (Ethicon) of the appropriate size 

was used in all patients. In this case, the mesh implant 

was fixed with a polypropylene thread to the 

aponeurosis using the “onlay” method (supra-neurotic 

location) in 16 patients, and the “inlay” method 

(subaponeurotic, preperitoneal location) in 39 

patients. All patients underwent active aspiration of 

wound exudate for 1-3 days. 

Patients in both groups, in addition to analgesics 

(Ketorolac 50 mg/ml, intramuscularly 2 ml 2 times a 

day, or Ketoprofen 30 mg/ml, intramuscularly 1 ml 2 

times a day) and infusion therapy, received standard 

anticoagulant and antibacterial drugs. The active 

regimen was prescribed by the end of the first day of 

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the postoperative period with mandatory banding. In 

addition to limiting physical activity, wearing a 

bandage was recommended for patients in the main 

group for 1 month, and for patients in the comparison 

group for 3-4 months after surgery. 

The results of surgical treatment were assessed based 

on the clinical picture, local status and ultrasound 

examination in the postoperative period for up to 2 

years. The immediate results of operations in patients 

with POIG were assessed according to the following 

criteria: postoperative local complications; general 

complications; duration of taking analgesics; duration 

of inpatient treatment; periods of temporary disability. 

Long-term results of operations and quality of life were 

assessed using a questionnaire - the SF-36 

questionnaire, filled out by patients 2 years after 

surgery. The 36 questionnaire items were grouped into 

eight groups, characterizing: physical functioning, i.e. 

ability to withstand physical activity; role physical 

functioning, which reflects the impact of physical 

condition on daily activities; pain intensity and impact 

of pain on daily activities; general health; general 

activity, energy; social functioning; role-emotional 

functioning, which characterizes the influence of the 

emotional state on everyday activities; mental health. 

The first 4 groups of questions of this scale 

characterized the patients’ assessment of their 

physical health, and the 5-8 groups of questions reflect 

the main parameters of mental health. 

RESULTS AND DISCUSSION 

The general results of surgical treatment of patients 

with POVH are presented in Table 2. 

Table 2. 

Results of surgical treatment of patients with POVH 

Sign 
Laparoscopic 

hernioplasty (n=50) 

Open hernioplasty 

(n=55) 

Operation duration (min.) 85.4 ± 8.4* 102.4 ± 9.7 

Activation time for patients after surgery 

(hours) 
10.2 ± 1.2* 27.4 ± 1.8 

Duration of taking analgesic drugs (days) 3.6 ± 1.5* 5.4 ± 1.8 

Postoperative local 

complications 

(abs.,%) 

- seroma 4 (8.0%)* 14 (25.4%) 

- hematoma 1 (2.0%)* 6 (10.9%) 

- infiltrate 1 (2.0%)* 3 (5.4%) 

- suppuration - 1 (1.8%) 

General complications (abs., %) 1 (2.0%)* 6 (10.9%) 

Duration of inpatient treatment (days) 6.2 ± 0.8* 10.2 ± 1.8 

Duration of temporary disability (days) 15.1 ± 1.8* 40.9 ± 5.6 

Recurrence of hernia abs., % 1 (2.0%) 6 (10.9%) 

Note: * - differences between groups are statistically significant (P < 0.05). 

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The average duration of laparoscopic hernioplasty was85.4 ± 8.4min., which turned out to be less than with open 

hernioplasty -102.4 ± 9.7min. (p ˂ 0.05). We associate the reduction in operation time with laparoscopic access with 

the absence of the following stages, standard for open hernioplasty: 1) incision of the skin and subcutaneous tissue, 

2) wide detachment of subcutaneous tissue from the aponeurosis along the entire perimeter of the hernial orifice, 3) 

thorough hemostasis along the course of the hernial sac and hernial orifice, 4) manual fixation of the mesh using 

interrupted or continuous sutures, 5) layer-by-layer suturing of the skin wound. 

Postoperative local wound complications were detected in 6 patients (12.0%) of the main group, while in the 

comparison group they were recorded in 24 (43.6%), which is 3.6 times more than in the main group. All wound 

complications were eliminated by conservative measures and puncture methods under ultrasound guidance. The 

results obtained confirm the minimal trauma of the endovideosurgical approach to performing hernioplasty and 

demonstrate a reduction in the incidence of postoperative local complications by 31.6% compared to similar results in 

patients operated on by laparotomy. In our opinion, this is directly related to minimizing the size of the surgical 

approach and reducing the area of the wound surface, the absence of lymphorrhea and tissue exudation, the absence 

of a postoperative cavity between the skin and the aponeurosis, as well as the location (intraperitoneal) of the mesh 

implant during laparoscopic hernioplasty. 

CONCLUSIONS 

• The supraponeurotic placement of the mesh 

implant using the “onlay” method is associated 

with a large number of wound complications 

(grays, hematomas, infiltrates, purulent 

complications) and a high risk of relapse of POIG. 

• With the “inlay” technology, the risk of developing 

wound complications and the likelihood of relapse 

of POIG is significantly lower, but this method is 

more technically complex and is not always 

possible. 

• The use of the laparoscopic “ipom” technique can 

significantly reduce the number of early 

postoperative and general complications (by 3.6 

times), the duration of hospitalization (from10.2 ± 

1.8days before6.2 ± 0.8days), periods of temporary 

disability (from40.9 ± 5.6days before15.1 ± 1.8days), 

and also reduce the number of relapses (from 10.9% 

to 2.0%). 

• In modern conditions, the method of laparoscopic 

hernioplasty can be recommended as the 

operation of choice in patients with PVH. 

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(ISSN – 2771-2753) 
VOLUME 04 ISSUE 01 PAGES: 46-55 

SJIF IMPACT FACTOR (2021: 5. 705) (2022: 5. 705) (2023: 6.534) 
OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Pathogenesis and surgical treatment of 

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lecheniya/ 

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