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350 patients with medial ventral hernias were operated on. 307 of them had various concurrent diseases; 177 required simultaneous surgery on that account. Endoprosthesis (synthetic mesh) was fixed using an "inlay-sub-lay" technique. Local complications were detected in 19.4% of patients, 5.4% developed common complications. 1.1% of patients had died. Long-term hernia recurrence was registered in 1.1%.

Among 88 patients with ventral hernias of the lateral and anteriolateral localization in 32 patients tension methods were used, in 56 patients non-tension combined methods of plasty with the lay-sub lay-on lay position of the implant. In the first group local and general complications were diagnosed in 2 (6.3%), in the second in 6 (10.7%) patients. Recurrent hernias in the long-term periods developed in the 1st group in 20 (62.5%) patients, in the 2nd--in 3 (5.4%). There were no lethal outcomes. The non-tension combined methods of plasty of the abdominal wall are thought to be preferable.

Overall 605 patients with postoperative ventral hernia underwent plasty of anterior abdominal wall by combined methods and on-lay or in-lay disposition of synthetic implant. Concomitant diseases were diagnosed 432 (71.4%) patients that required 495 simultaneous operations at 283 (43.8%) patients. Wound complications after surgery were seen at 21 (3.47%) patients. Long-term results were followed-up to 11 years: recurrences of hernia were diagnosed at 12 (1.9%) patients, 3 (0.5%) patients died due to pulmonary embolism. It is concluded that the treatment of patients with postoperative ventral hernia requires complex approach and leads to good short- and long-term results.

Two methods of combined plasty of postoperative abdominal wall hernia (PAWH), based on biochemical conception of pathogenesis of the disease, were proposed. Application of the methods had allowed to close the defect of any size of anterior abdominal wall. For the 1996-2001 period 221 patients with large, huge and giant PAWH were operated. Local and general complications in 29 (13.1%) patients had occurred, one patient died. Result of treatment in term up to 6 years was studied, recurrency of the disease was not revealed.

616 patients with postoperative abdominal hernias (AH) were treated, 124 (20%) of them had lateral hernias. By M. Yatsentyuk classification, there were 41 (33.1%) patients with small hernias, 37 (29.8%)--with middle-size, 35 (28.2%)--with big, 6 (4.3%)--with very large, 5 (4%)--with giant hernias. Two operative techniques for lateral AH based on an original method of combined plastic surgery were applied in 37 patients. Good immediate and long-term results were achieved in all the patients. There were no recurrences.

Experience of treatment of 975 patients with postoperative and recurrent abdominal wall hernia (AWH) and of 1473 patients with inguinal hernia was summarized. Intraoperative classification of Shevrel and Rets for AWH and of Gilbert and Rutkov for inguinal hernia were applied. The conventional methods of plasty, using local tissues, were performed up to 1998 in 648 patients with AWH and in 983--with inguinal hernia. Synthetic implants were used since 1999 in 327 patients with AWH and in 181--with inguinal hernia. In application of conventional methods recurrency had occurred after plasty for AWH in 26.6% and for inguinal hernia--in 5.8% of observations; hernial recurrency was not noted after usage of the modern plasty methods.

There were examined 525 patients with postoperative abdominal hernia, in 47.3% of them big, vast and giant hernia was revealed. There were operated 436 patients using local tissues with duplicature formation--according to Mayo, Sapezhko, Napalkov and Yanov method.

A combined mode of abdominal wall plasty in ventral middle-point hernia is presented. The principle of this method is to close the defect with hernial sac tunica, to dissect rectus sheath anterior layers and suture the medial margins of aponeurotic flaps. The defect formed between the lateral layers of aponeurosis are replaced either by an autodermal perforated flap treated by Yanov's procedure or by synthetic graft (polypropylene net). It is concluded that the combined mode of hernioplasty corresponds to the biomechanical conception of the pathogenesis of ventral hernia. This approach may expand indications for surgery in patients with serious concomitant diseases. The rate of early and late complications decreased.

A biomechanical concept of pathogenesis of incisional ventral hernias is presented. The main point is that during the formation of a defect along the abdomen medium line, the lateral muscles of the abdominal wall loose the medial point of attachment. The function of the muscles is disturbed and there appears a myogenic contracture. Thus, the contraction ability is gradually slowing down. Special morphological, ultrasonographic and electromyographic researches were made. The authors consider that all types of surgery when the muscle-aponeurotic elements of the hernial hilus become closer under tension result in a less volume of the abdominal cavity and compression of the fascial muscles which gives rise to pathogenetic mechanisms for the development of early and late postoperative complications.