Жизнеугрожающие осложнения после реконструкции брюшной стенки у трудного пациента с послеоперационной грыжей (анализ клинического случая)

Background . Among patients with incisional hernia, the most difficult category is represented  by persons with large, multiple defects  and loss  domain. The abdominal wall reconstruction  based  on components separation technique use, in some  situations intestinal resection procedures  are required. The frequency of complications in these  cases is significant, and the problem of their prediction, treatment and prevention is far from being resolved. Purpose of  the  study is the analysis of clinical example of difficult hernia patient with postoperative  complications, to consider the mechanisms of their development, to evaluate the effectiveness  of treatment  methods and to identify ways  of prevention. Materials  and methods . The  treatment  of a patient with a giant hernia operated  on  using  components separation  and  bowel resection  was  analysed.  In the  postoperative  period, intra-abdominal hypertension,  acute  respiratory failure, intestinal suture  failure, abdominal wall suppuration and destructive cholecystitis were observed. All vital  disturbances  managed  to stop. A clinical assessment of the listed life-threatening complications, measures of differential diagnosis and treatment algorithm is given. Discussion . A critical analysis of the clinical case  was carried out, the data were compared  with current literature sources taking into account possible errors and points of view. The data of clinics with the maximum accumulated experience of such operations in the world are presented, the results of meta-analyses with the highest levels of evidence are presented.  Conclusion .  For planning an operation, it is necessary the objective status of the hernia, its history, CT data. The range of possible surgical site events, respiratory failure and compartment syndrome during and after the surgery should be taken into account. Alternative surgical tactics, respiratory support and patient management in the postoperative  period in detail should be consider.