Optimal choice of component separation technique for large and giant incisional hernias and prevention of complications

Authors

  • Ya. P. Feleshtynsky P. Shupyk National Medical Academy of Postgraduate Education, Kyiv
  • V. V. Smishchuk P. Shupyk National Medical Academy of Postgraduate Education, Kyiv
  • O. S. Marshtupa P. Shupyk National Medical Academy of Postgraduate Education, Kyiv
  • V. F. Vatamaniuk P. Shupyk National Medical Academy of Postgraduate Education, Kyiv
  • S. A. Svyrydovsky P. Shupyk National Medical Academy of Postgraduate Education, Kyiv

DOI:

https://doi.org/10.11603/2414-4533.2020.1.10735

Keywords:

incisional hernia, component separation technique, intraabdominal pressure, alloplasty

Abstract

The aim of the work: to optimize the choice of the method of component separation technique of the abdominal wall in case of large and giant incisional abdominal hernias.

Materials and methods. The analysis of surgical treatment of 215 patients with large and gigantic incisional hernias of age from 30 to 75 years (mean age (54.7±3.3)) for the period from 2012 to 2019 was conducted. There were 137 women (63.7 %), 78 (36.3 %) men. The choice of the component separation technique (CST) in combination with alloplasty for large and gigantic incisional hernias was performed during surgery with monitoring intraabdominal pressure (IAP) when contacting the abdominal muscles. The comparison group consisted of 82 patients who underwent ACST+onlay between 2008 and 2011 without monitoring IAP.

Results and Discussion. Optimization of the choice of the CST option for large and gigantic incisional hernias can be achieved by monitoring IAP when contacting the abdominal muscles. Thus, at an IAP of (5.4±2.1) mm Hg (0.7±0.3) kPa ACST is the best option, at (9.1±2.3) mm Hg. (1.2±2.3) kPa – PCST, at ​(​14.1±2.3) mm Hg (1.9±0.3) kPa – TAR.

The use of a differential approach to the choice of the CST option in combination with alloplasty for large and gigantic incisional hernias with monitoring IAP contributes to the improvement of treatment results, namely decreasing the rate of abdominal compartmet syndrome to 0.5 % versus 4.9 % in the comparison group, seroma – to 15.8 % versus 25.6 %, infection of the postoperative wound – to 1.4 % versus 4.9 %, chronic postoperative pain – to 4.2 % versus 8.1 %, recurrence of hernia – to 1.4 % versus 8.1 %.

References

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Lerchuk, O., Feleshtynskyi, I.P., Smishchuk, V.V., Vatamaniuk, V.F., & Svyrydovskyi, S.A. (2018). Intraperitoneal alloplasty combined with the anterior separation technique in giant incisional hernias. Polski Przeglad Chirurgiczny, 91 (1), 1-5. DOI: 10.5604/01.3001.0012.7798. DOI: https://doi.org/10.5604/01.3001.0012.7798

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Published

2020-01-16

How to Cite

Feleshtynsky, Y. P., Smishchuk, V. V., Marshtupa, O. S., Vatamaniuk, V. F., & Svyrydovsky, S. A. (2020). Optimal choice of component separation technique for large and giant incisional hernias and prevention of complications. Hospital Surgery. Journal Named by L.Ya. Kovalchuk, (1), 40–45. https://doi.org/10.11603/2414-4533.2020.1.10735

Issue

No. 1 (2020)

Section

ORIGINAL INVESTIGATIONS

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