Social and economic aspects of treatment of patients with medium (W2) and large (W3) postoperative ventral hernias

The article describes social and economic aspects of the treatment of patients with medium and large postoperative ventral hernias. The study was based on the results of treatment of 181 patients operated by endovideosurgical and open methods for postoperative ventral hernias. The stratification of patients was carried out on the basis of the mod ern classification of postoperative hernias of the EHS approved in the national clinical guidelines. The first main group of patients who underwent laparoscopic hernioplasty using the IPOM+ technique (intraperitoneal onlay mesh) consisted of 47 people. The second main group included 12 patients operated using the preperitoneal eTEP technique (extended total extraperitoneal plasty). The control group consisted of 122 patients with postoperative ventral hernias who underwent traditional (open) hernioplasty: using the techniques of onlay – 35 patients, inlay – 12, sublay– 75. Preoperative examination before planned minimally invasive hernioplasty included routine laboratory and instrumental examinations. The exceptions were patients with stage II and III obesity, as well as large postoperative ventral hernias, patients who underwent computed tomography with abdominometry. The economic efficiency of the treated patients was calculated using standardized formulas. It has been established that the complete e- TEP operation statistically reliably allows to get a significant economic effect compared to the laparoscopic IPOM surgery. IPOM endovideohernioplasty can be used in patients with a combined surgical disease of the abdominal organs in the case of simultaneous intervention. Traditional hernioplasty in patients with large and giant hernias with reduction of abdominal volume are the operations of choice and significantly increase the economic efficiency of the medical hospital. A modern surgical hospital should be able to perform any variants of both traditional and endovideosurgical hernioplasty in order to provide effective medical care and achieve optimal economic performance in any of the existing health insurance systems. 

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