Surgical Treatment of Recurrent Postoperative Ventral Hernias

A.N. Lembas, I.I. Tampey, M.V. Kuchinsky, A.V. Baulin, V.A. Baulin, V.V. Ivanchenko, L.N. Velishko, S.I. Velishko, I.B. Pigovich

Abstract


Objective: to study the outcomes of surgical treatment of recurrent postoperative ventral hernias (POVH) with synthetic endoprosthesis.
Material and Methods. A retrospective uncontrolled study of treatment outcomes in 24 patients (22 women and 2 men), operated in the State institution «Kamenka central Regional hospital» for recurrent POVH from 01.01.04 till 31.01.13 has been carried out. The average age of patients — 62.5 ± 2.8 years. Patients were allocated according to Chevrel — Rath classification (1999).
Previously performed surgery for POVH: plastic with local tissues — 22 patients; 1 patient (R2): plasty with local tissues — 1, hernia repair with mesh endoprosthesis — 1 operation; in 1 patient (R4): plasty with local tissues — 2 operations; deepithelialized skin flap plasty by V.N. Yanov — 1; hernia repair with mesh endoprosthesis — 1 operation.
Results and Discussion. Intermuscular location of endoprosthesis — in 8 out of 24 patients (sublay placement — 5; inlay — 3 patients); in the preperitoneal space — in 6 (sublay — in 4; inlay — in 2 patients), intraabdominal location — in 10 patients (sublay — in 5; inlay — in 5 patients). Specific wound complications we have not detected. Postoperative wound drainage wasn’t performed.
The duration of postoperative period — 8.5 ± 1.9 days.
Results. Follow-up terms varied from 4 months to 9 years. POVH relapses— in 2 (8.3 %) patients. The cause of relapses — detachment of endoprosthesis edge from the place of its fixation. Repeated operations were carried out. In the early postoperative period 1 female patient died. Cause of death — acute myocardial infarction.
Conclusions
1. The development of anatomical and morphological changes in hernial orifice make intermuscular and intraabdominal location of the endoprosthesis in recurrent POVH most reasonable and technically feasible.
2. Prosthetic hernia repair using mesh implants remains a reliable method in the treatment of recurrent POVH and is accompanied by a sufficiently low (8.3 %) incidence of recurrent relapses in the late and long-term periods.


Keywords


recurrent postoperative ventral hernia; hernia repair prosthesis; endoprosthesis

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DOI: https://doi.org/10.22141/1997-2938.4.23.2013.86696

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