ANALYSIS OF LOCAL AND GENERAL COMPLICATIONS IN THE TREATMENT OF PRIMARY AND POSTOPERATIVE VENTRAL HERNIAS FOR THE PERIOD OF 2001–2017

Abstract

The introduction of modern methods and alloplastic materials into surgical practice has significantly improved the results of surgical treatment of patients with ventral and postoperative ventral hernia. However, the implantation of synthetic material in the tissue of the anterior abdominal wall is not without drawbacks in their application, as it is accompanied by different local tissue response, especially when implanting "heavy" networks, which leads to the development of complications, the frequency of which is from 7.9 to 49.2 %. Analysis of the results determines the relevance of this study.

The aim of the study – to analyze the main causes of local and general complications in the treatment of patients with primary and postoperative ventral hernias.

Materials and Methods. There were formed two periods of the study of the number of the 1419 operated: from 2001 to 2009, 597 (42.07 %) patients – comparison group and from 2010 to 2017; 822 (57.93 %) patients – main group. Among the patients of the comparison group 286 (47.91) % persons were with primary ventral hernia, and 344 (41.85 %) patients – in the main group with primary hernia. There were 311 (52.09 %) people in the control group, and 478 (58.15 %) in the main group.

Results and Discussion. Of all 1.419 operated patients, local early postoperative complications were diagnosed in 522 (36.78 %) patients. Common early complications were found in 76 (5.36 %) patients. In the comparison group, local complications occurred in 311 (52.09 %) patients, and in the main group in 211 (25.67 %) patients. The same trend was observed in the distribution of common complications: 53 (8.88 %) and 23 (2.79 %), respectively. We observed seroma in 124 (23.75 %), infiltrates – in 156 (28.88 %), hematoma – in 102 (19.54 %), suppuration – in 34 (6.51 %), prolonged lymphorrhea – in 65 (12.45 %) patients. Common complications among 1419 patients of both groups were diagnosed in 76 (5.35 %) persons. In the comparison group there were 53 (8.87 %) cases, in the main group – 23 (2.79 %). Among late local complications, ligature fistulas were most often observed, especially in the period of 2001–2009 – 27 (4.52 %). In the main group, this complication was detected only in 3 (0.36 %) patients. PPS rejection was diagnosed in 15 (2.51 %) cases. During the clinical study, a mesh appeared in 10 (1.67 %) of the comparison group and in 7 (0.85 %) – in the main group; mesh migration was detected in 9 (1.0 %) and 5 (0.61 %) persons of the comparison group and the main group. In 250 (17.62 %) patients, after various types of surgical interventions, a hernia recurred.

Conclusion. The introduction of modern and improvement of existing methods of surgical treatment of patients with primary and postoperative ventral hernias, reduced the number of early local and general as well as late complications by almost 2 times.