Modern approaches to hernioplasty: pathogenesis, implantation materials and problems of personalization of treatment (analytical review)

Objective. Based on the analysis of literary data, to identify current issues of etiology, pathogenesis and methods of surgical treatment of abdominal hernias for the scientific justification of further research.

Materials and methods. The literature search was performed in PubMed, Google Scholar, Cochrane Library, and eLIBRARY, databases using keywords related to the pathogenesis, surgical treatment, and implants for abdominal hernias (2000–2025). The analysis included reviews, clinical guidelines, original studies, and meta-analyses.

Results. An abdominal hernia is a multifactorial disease based on the biomechanical failure of connective tissue associated with impaired collagen metabolism. The use of mesh implants, which has become the standard of care, initiates a complex tissue response that determines both the effectiveness of hernioplasty and the risk of complications. The analysis revealed the absence of a unified molecular-biological model of this interaction, as well as the lack of a universal, scientifically based algorithm for selecting a hernioplasty method and implant type at the preoperative planning stage. The dominance of subjective factors, insufficient use of objective criteria (such as bioimpedance analysis indicators for body composition assessment), and unsystematized data on the influence of biopolymer coatings on implant integration limit the possibilities of a personalized approach and outcome prediction.

Conclusion. The analysis of the literature revealed key gaps in scientific knowledge: the absence of a comprehensive model of the biological tissue response to implant materials depending on their structure and coatings, as well as an algorithm for selecting a surgical approach. The findings justify the necessity for comprehensive experimental and clinical studies aimed at investigating the relationship between implant characteristics, molecular markers of repair, and clinical outcomes. This will create the foundation for developing pathogenetically oriented and personalized criteria for selecting the hernioplasty method and the materials used.

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