Component separation hernioplasty in treatment of postoperative ventral hernias

Abstract

The presence of large defects in the anterior abdominal wall in patients is an important problem for surgeons, due to the complexity of the hernioplasty implementation, the need to use large mesh, high frequency of postoperative complications. Nowadays, widely used laparoscopic hernioplasty include the use of mesh materials. In patients with large hernias, laparoscopic techniques are associated with a number of technical difficulties during operations and a high frequency of postoperative relapses (up to 30 %). The problem of choosing the treatment method for postoperative ventral hernias of large and gigantic still remains unsolved. Currently, the main trend is to restore the anterior abdominal wall anatomical integrity with the reduction of the anterior abdominal wall muscles to the white abdominal line and open component separation. Since the development of laparoscopic and endoscopic technologies, the technique of endoscopic separation of the anterior abdominal muscles has been improved to improve the quality of life of patients and to reduce the incidence of postoperative complications and recurrences. The use of endoscopic methods makes it possible to prevent a wide tissue dissection, reduce the risk of necrosis of the skin and aponeurotic flap through the preservation of perforant vessels in the anterior abdominal wall. The result comparison between the use of open and laparoscopic methods of component separation showed that the use of open separation methods leads to a significantly greater number of both intraoperative and postoperative complications associated with the development of 30 % of necrosis of the skin and aponeurotic flap, and relapses. The results of the studies indicate some advantages in reducing the frequency of postoperative wound complications with endoscopic component separation methods in patients with postoperative large size ventral hernias.