Basic principles of surgical treatment of recurrence of postoperative abdominal hernia after alloplasty
DOI:
https://doi.org/10.11603/2414-4533.2021.1.11959Keywords:
postoperative abdominal hernia, alloplasty, recurrent hernia, choosing a method of reconstruction, implant, prevention of inflammatory complicationsAbstract
The aim of the work: to study the causes of relapse of postoperative abdominal hernia (PAH) after alloplasty and development of practical recommendations for improving the results of surgical treatment of patients with this pathology.
Materials and Methods. During the period from 2004 to 2019, 133 patients underwent surgery at the Kyiv City Center of Abdominal Hernia Surgery of recurrent PAH after allohernioplastic surgery. Men were 23 (17.3 %), women – 110 (82.7 %). The average age of patients was (59.4±0.8) years. Patients with PAH by SWR classification [8] were distributed as follows: patients with M2-3W1R1 were 80 (60.15 %), M3-5W2R1 – 40 (30.1 %), M3-5W3R2 – 3 (2.25 %), L3W2R1 – 6 (4.5 %), L4W2R2 – 4 (3 %). In 41 (30.8 %) patients the recurrence of hernia occurred in the 1st year after surgery, in 62 (46.6 %) – in the 2nd year and in 30 (22.6 %) – in 3 or more years 91 (68.4 %) patients had concomitant pathology
Results and Discussion. The causes of recurrence of hernia were: the diastase of direct moves of the abdomen, which was not eliminated when performing a preliminary operation, a small size of the implant relative to the hernia defect, technical errors in its fixation, "cutting" fixing seams with the formation of defects in the support tissues of the anterior abdominal wall (AAW), a breakdown of the mesh from dystrophic changed support tissues of the AAW, a severe course of an early postoperative period with a prolonged increase in intra-abdominal pressure, and inflammatory complications in the postoperative period with a sequestration of the mesh, the formation of ligature fistula, separation and "twisting" mesh.
When choosing a method for re-reconstruction of the AAW, we took into account the morpho-functional changes in the tissues of the anterior abdominal wall, the presence of the diastasis of the abdominal tissues, the size and correctness of the placement of previously sewn implants, the size of the hernia defect and the size of the hernial bulging.
In the postoperative period, 3 (2.25 %) patients had clinical signs of pulmonary heart failure that occurred 2–3 days after surgery and were eliminated by standard conservative measures. Inflammatory complications occurred in 6 (4.5 %). Long-term results of treatment of recurrent PAH were studied by repeated examinations in 102 patients in the period from 1 to 10 years, no recurrence of hernia was detected.
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