Evaluation of the effectiveness of negative pressure wound therapy in the complex treatment of patients with infected mesh endoprostheses of the anterior abdominal wall

Abstract

Introduction. Wound complications after the placing of various implants of the abdominal wall after hernia repair account for up to 15 % of all hospitalizations with purulent diseases. Their treatment is often accompanied by a high frequency of explantation of a mesh endoprosthesis with a risk of recurrent hernias in this category of patients.The objective of the study was to improve the results of surgical treatment of patients with infected implants of the abdominal wall after herniaplasty based on the assessment of the effectiveness of the negative pressure wound therapy (NPWT).Methods and materials. A retrospective analysis of the treatment results of patients with infected mesh endoprostheses of the anterior abdominal wall (n=68) was carried out. We formed for comparison two homogeneous representative groups of patients, who underwent adequate debridement of a purulent wound with empirical antibiotic therapy. Patients from the study group (n=38) received local therapy using NPWT, patients from the control group (n=30) received traditional local therapy. The evaluation of the treatment results was carried out according to a number of criteria: the course of the systemic inflammatory reaction, the dynamics of reparative processes in the wound of the anterior abdominal wall, evaluation of the clinical outcomes of treatment of patients.Results. The use of vacuum therapy was accompanied by a positive effect on the course of the systemic inflammatory reaction, stimulation of reparative processes in the wound due to the rapid elimination of bacterial agents from the wound cavity (p= 0.003), as well as significant retraction of the wound cavity (p=0.004) compared to traditional methods of wound treatment. Patients from the study group had more favorable treatment outcomes such as a reduction in the duration of hospitalization (p=0.005) and the number of surgical interventions (p=0.003). Due to the NPWT, it was possible to save implants in 30 patients out of 38 (78.9%) with infected mesh endoprostheses of the anterior abdominal wall, which prevented the formation of recurrent hernias and helped to avoid reoperations in this category of patients.Conclusion. The use NPWT is a safe and effective method for treating wounds of the anterior abdominal wall with infected mesh endoprostheses after hernioplasty.