Vatamanuk V. Complications after aloplasty of incisional abdominal hernias, treatment and prevention

There was performed the analysis of surgical treatment of 335 patients with incisional abdominal hernias large and giant sizes. Main group 167 patients with general postoperative complications after abdominal hernias alloplastic large and giant sizes divided into 4 groups for elaboration of criteria for the selection process operations and our method of anatomical separation of abdominal wall components in conjunction with alloplasty. Comparsion group of 168 patients. The results of treatment were studied retrospectively according to medical records. Local complications were studied in 81 patients, including seroma in 41 (50,6%), chronic inflammatory infiltrate in 12 (14,8%), abdominal wall fistulas in 20 (24,7%), intestinal fistulas - in 3 (3,7%). Prevention of local complications of alloplastic of incisional abdominal hernias large and giant sizes achieved by antibiotic prophylaxis using third generation cephalosporin, low vacuum drainage tissue spaces near the mesh implant and subcutaneous tissue, using nonsteroidal anti-inflammatory drugs, treatment - by puncture seroma under ultrasound, excision of fistulas, chronic inflammation of the muscular aponeurotic tissue, sections explantation mesh which is not overgrown connective tissue, conducting antibacterial therapy sensitivity of microorganisms respectively. Developed algorithm method selection alloplastic incisional abdominal hernias large and giant size and separation techniques of anatomical components of abdominal wall in conjunction with alloplasty substantially reduces the incidence of general and local complications (abdominal compartment syndrome from 7,1% to 0,6% (p<0,001), from 15,5% seroma to 4,8%, chronic infiltrate from 4,8% to 2,4%, fistula anterior abdominal wall from 4,2% to 0,6%, chronic pain from 7,1% to 1,2% recurrence from 5,4% to 0,6%.