Complications of Laparoscopic Hernioplasty

A.V. Syvozhelezov, M.A. Sykal, V.V. Chuhai, V.P. Kolesnyk

Abstract


Solving the problem of effective treatment for abdominal hernias is currently relevant because of the prevalence of this disease among people of working age, and quite a high percentage of complications, relapse and mortality. The improvement in hernia surgery is due to the minimally invasive laparoscopic technique. Using laparoscopic techniques can significantly reduce postoperative complications and disability. However, this method is not perfect and has a number of specific complications.
Objective: to study the impact of various methods of laparoscopic plasty using mesh implants on the results of abdominal hernia repair in clinical investigation.
Materials and methods. During the period from 2011 to 2015, hernia repair with mesh was performed in 1,546 patients aged 19–84 years with abdominal hernia. For the purpose of the survey, we used ultrasound investigation and computer diagnostics of abdominal cavity. We applied several methods of «first shot». In all cases of adhesions in abdominal cavity, it is desirable to use either the optical trocar, or Hassan technique. The choice of method for laparoscopic plastic surgery depended on the location and size of the hernia ring. In cases of inguinal hernia, we performed transabdominal preperitoneal repair, in cases of incisional and umbilical hernias — intraperitoneal onlay mesh procedure. For the implantation of mesh implants, we used Ultrapro (Ethicon) and Parieten Light (Covidien) with its fixation by Protak stapler, as well as self-fixating ProGrip (Covidien) and restoration of the peritoneum with suturing. 20 patients underwent simultaneous operations on the abdominal organs.
Results and Discussion. Our findings suggest that using laparoscopic repair in the surgical treatment of abdominal hernias is an effective alternative to open operations. Of the intraoperative complications, we often registered bleeding (trocar injuries, damage of inferior epigastric vessels in all cases occurred in patients with obesity), bruising groin, neuralgia and paresthesia, frozen shoulder pain, subcutaneous emphysema. We consider it essential to conduct a thorough hemostasis, even with little intensity and duration of bleeding. Hemostasis is achieved in all cases laparoscopically — by stitching or coagulation. In the immediate postoperative period, seroma was observed, which was liquidated conservatively by punctures. The average length of inpatient treatment was 2.4 days and ranged from 12 hours to 4 days.
Conclusions. Experience in the use of laparoscopic repair in the surgical treatment of abdominal hernias showed that it is an effective alternative to traditional operations. The advantages of laparoscopic hernia repair over traditional methods — it is possible to inspect the abdominal cavity, the simultaneous closure by the graft of all the weaknesses of the anterior abdominal wall, reducing the duration of hospital stay. Surgeries using laparoscopic techniques are effective, pathogenetically justified in recurrent inguinal hernias and ventral hernias of medium size, whereas the large and giant hernias indicated for open technique.


Keywords


abdominal hernia; surgical interventions; laparoscopic hernioplasty; mesh implant; complications

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DOI: https://doi.org/10.22141/1997-2938.1-2.28-29.2015.80867

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