Surgical treatment of giant incisional ventral hernias with modified polypropylene mesh

Abstract

The aim — to improve the results of surgical treatment of giant incisional ventral hernias (GIVH) with the Ramirez operation in combination with modified polypropylene mesh.Materials and methods. The surgical treatment analysis of 142 patients with GIVH has been performed. Depending on the type of mesh used during surgical treatment, patients were divided into 2 groups. In 71 (50 %) of group I patients, the component separation technique by Ramirez in combination with the «onlay» alloplasty with the modified polypropylene mesh was performed. In the 2nd group in 71 (50 %) patients the component separation technique by Ramirez in combination with «onlay» alloplasty using the classic polypropylene mesh was used.Results and discussion. Statistically significant better results were obtained in patients of group І compared to group II: seroma revealed in 23 (32.4 %) in group II compared to 5 (7.0 %) in group I (p < 0.05), respectively, the suppuration of the postoperative wound — from 6 (8.5 %) to 1 (1.4 %) (p < 0.05), inflammatory infiltrate — from 9 (12.7 %) to 1 (1.4 %) (p < 0.05). The terms of stay of patients of group ІІ on inpatient treatment — 12 ± 2.3 days, group ІІ — 7 ± 1.2 days. Long­term results: ligature fistulas of the anterior abdominal wall were detected in 4 (6.3 %) patients of group II, in patients of group I of the ligature fistulas were not detected (p < 0.05), meshoma — in 2 (3.2 %) of patients in group ІІ, in group І there was no stir (p > 0.05). Chronic pain in the abdominal wall in 6 — 8 months after surgery was observed in 5 (7.9 ± 0.5 %) patients in group ІІ and in 1 (1.6 %) group І (p > 0.05), recurrences of hernia were found in 6 (9.5 %) patients of group ІІ, in group І — in 1 (1.6 %) (р < 0.05).Conclusions. Surgical treatment of GIVH by the anterior method of the anatomical abdominal wall components separation in combination with the onlay technique using a modified polypropylene mesh is more effective than using the classic polypropylene mesh, as evidenced by a decrease in seroma frequency from 32.4 ± 1.0 to 7.0 ± 0.4 %, suppuration of the postoperative wound — from 8.5 ± 0.4 to 1.4 ± 0.2 %, inflammatory infiltrate — from 12.7 ± 0.5 to 1.4 ± 0.2 %, ligature fistulas of the anterior the abdominal wall — from 6.3 ± 0.4 to 0 %, meshoma — from 3.2 ± 0.3 to 0 %, chronic postoperative pain — from 7.9 ± 0.5 to 1.6 ± 0.2 %, hernia recurrence — from 9.5 ± 0.5 to 1.6 ± 0.2 %.