Intraperitoneal alloplasty combined with the anterior separation technique in giant incisional hernias.

The use of the anterior technique for abdominal wall components separation combined with "onlay" alloplasty (ACST + onlay) in giant incisional hernias (IH) may pose a surgical challenge as it does not exclude increased intra-abdominal pressure (IAP) and the occurrence of abdominal compartment syndrome (ACS). There remains a high incidence of surgical site complications. In our view, the use of intra-abdominal alloplasty combined with anterior separation of the anterior abdominal wall components (ACST + IPOM) will contribute to the improvement of surgical outcomes in giant IH. PURPOSE: to improve the results of surgical treatment of giant IH using ACST + IPOM. MATERIALS AND METHODS: Analysis of surgical treatment of 164 patients with giant IH aged 30 to 75 (mean age 54.7 ± 3.3). Depending on the surgery, the patients were divided into two groups. Group I (82 patients) consisted of patients who underwent our modified technique, including ACST + IPOM. The surgery in group II (82 patients) involved ACST + onlay. RESULTS AND DISCUSSION: As compared with ACST + onlay, ACST + IPOM surgery contributes to a significantly reduced incidence of ACS [6.1% (group II) versus 0 (group I), (p <0.05)], seroma [25.6% versus 7.3%, p <0.05], surgical site infection (SSI) [4.9% versus 2.4%, p> 0.05], meshoma [3.7% versus 0] and hernia recurrences [6.5% versus 1.6%, p> 0.05]. CONCLUSIONS: IAP value equal or exceeding 9.1 mmHg (1.2 kPa) during surgery in approximated rectus muscles is prognostic for ACS occurrence and requires intraoperative preventive measures. Utilization of ACST + IPOM in giant IH ensures an optimal abdominal cavity volume without a substantial increase in IAP and reduces the probability of ACS, whereas the use of ACST + onlay results in ACN in 6.1% (p <0.05) patients. Reduced contact of the mesh with the subcutaneous tissue in ACST + IPOM contributes to a significantly lower incidence of seroma [7.3% vs 25.6% (p <0.05)], surgical site infection (SSI) [2.4% vs 4.9% (p> 0.05)], postoperative wound infiltrate [2 (2.4%) vs. 11 (13.4%) (p <0.05)], chronic postsurgical pain [1 (1.6%) vs. 5 (8.1%) (p> 0.05)] and recurrent IH [1 (1.6%) vs. 4 (6.5%) (p> 0.05)] as compared with ACST + onlay technique.

[Differentiated approach to preperitoneal alloplasty for complex recurrent inguinal hernias].

The results of surgical treatment of complex recurrent inguina hernias in 138 patients (all of them are men), ageing 30-82 yrs old, were analyzed. In 75 patients, suffering unilateral inguinal hernia and destroyed inguinal ligament, the preperitoneal alloplasty method, elaborated in the clinic, was applied, using operative access through inguinal channel with prolene mesh fixation to lacunar ligament. In 18 patients the mesh was sutured, using herniostapler with spiral-like fixation devices. In 47 patients the modified operation according to Stopa method was used for bilateral inguinal hernia recurrences, and in 16 patients--transabdominal preperitoneal laparoscopic hernioplasty for bilateral recurrences. The pain syndrome after the operation for unilateral recurrent inguinal hernia was observed in 5.9% patients, and for bilateral hernias - in 11.4% patients. The recurrences had occurred in 3.1% patients, suffering one-side inguinal hernia recurrence, and in 3.9% patients with bilateral recurrent inguinal hernias, in whom the net was sutured using prolene threads.

[Optimization of surgical treatment of median postoperative abdominal hernias].

The analysis surgical treatment results in 1187 patients. ageing 30-80 yrs old, in 2000-2009 period, for median postoperative abdominal hernia (MPOAH) is presented. Autoplasty was performed in 43 (3.6%) patients, suffering MPOAH of small and middle size without mm. recti abdomini diastasis. The "sub lay" method constitutes an optimal variant of alloplasty for MPOAH of small and middle size with mm. recti abdomini diastasis and of big size, and for giant MPOAH - the operations according to Ramirez method in our modification together with the net implants application. Intraabdominal hypertension was noted in 2 (0.8%) of 231 patients, suffering giant MPOAH, seroma--in 86 (7.2%), the wound suppuration - in 16 (1.3%). Pulmonary thromboembolism had constituted the cause of death in 2 (0.8%) patients, suffering giant MPOAH. Late results in terms 1-5 yrs were studied up in 520 patients. Chronic pain in the abdominal wall portion was noted by 17 (3.2%) patients and the hernia recurrence--7 (1.3%).