This research work is devoted to increasing the effectiveness of treating and
preventing methods of mesh-related complications after allohernioplasty (mesh
hernia repair) by studying the causes of seroma, wound infection, ligature fistula,
and hernia recurrences, as well as developing algorithms for their treatment and
prevention.
Despite the constant improvement of operative technique, properties of mesh
materials and methods of mesh fixation, the frequency of complications associated
with mesh implantation remains high. According to the authors, the main
complications after allohernioplasty are seroma, wound infection, ligature fistula,
haematoma, infiltration, chronic postoperative pain, necrosis of the wound edges,
mesh rejection and mesh migration.
The frequency of postoperative complications varies depending on different
surgical techniques. For example, after complex ventral hernia repair using
components separation due to the contact of the large area of the mesh with the
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subcutaneous tissue local postoperative complications are more frequent, such as
seroma (30.8-60.4%), infection (1.5-4.8%), ligature fistula (1.2-3%), meshoma
(0.06-1.6%), which causes incisional hernias recurrence (10-15%). Giant incisional
hernias mesh repair is assotieted with the high frequency of postoperative
complications (11.8-30%), in particular, hernia recurrence (15-35%). [14, 19]
Known treating and preventive measures do not have the expected
effectiveness and worse the postoperative results, which determines the
expediency of increasing the effectiveness of complex surgical treatment and
prevention of mesh-related complications after mesh repair of abdominal hernias,
by studying the causes of complication occurrence and developing new algorithms
of treatment and prevention.
To achieve the goal, the following tasks were formulated: to determine the
main causes of complications occurrence after open and laparoscopic
allohernioplasty; to investigate the morphological features of tissues and the
spectrum of microflora of infected wounds and ligarure fistula after mesh hernia
repair; to justify the use of the polyurethane glue with an antiseptic to fix the mesh
implant to abdominal wall tissues in laboratory animals; to develop an algorithm
for the treatment of infected wounds and recurrent hernias combined with ligature
fistula of the abdominal wall after mesh hernia repair; to evaluate the effectiveness
of the algorithm for the treatment and prevention of complications after
allohernioplasty and compare them with traditional methods.
Clinical and experimental research was carried out to fulfill the tasks. The
clinical study was conducted at the clinical base of the Department of Surgery and
Proctology in the surgical department of the KNP "KMKL № 5" from 2019 to
2023 year. The clinical study involved 106 patients with infected wounds after
allohernioplasty (the average age was 57±5.2 years, there were 54 (50.9%) women
and 52 (49.1%) men), and 86 patients with recurrent hernias combined with
ligature fistulae of the anterior abdominal wall (the average age was 56.6±4.4
years, there were 44 (51.2%) women and 42 (48.8%) men.
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In order to study the causes of local complications after mesh hernia repair,
we analysed medical cards of 106 patients with infected wounds after
allohernioplasty and 86 patients with recurrent hernias in combination with ligature
fistulas of the anterior abdominal wall after allohernioplasty, who participated in a
clinical study. According to the results of a detailed anamnestic study of the
medical cards, it was found that among the causes of infected wounds after
allohernioplasty, in which mesh was at the wound bottom, wound infection of the
in the early postoperative period was determined in 41 patients (38.7%), long-term
suppurating seroma in 35 (33.0%), haematoma in 13 (12.3%), long-term
lymphorrhea in 6 (5.7%) and postoperative infiltrate in 10 (9.4%) patients. Among
patients with recurrent hernias associated with ligature fistulas of the anterior
abdominal wall, the main causes of that comlication was seroma, which was
diagnosed in 52 (60.5%) patients (in 41 (47.7%) patients seroma lasted more than 1
month, in 16 (18.6%) patients suppurating seroma was determined), wound
infection in early postoperative period was observed in 19 (22.1%) patients,
postoperative infiltrate in 5 (5.8%) patients, haematoma in 6 (7.0,%), long-term
lymphorrhea in 2 (2.3%) patients. Among the risk factors described in the literature
in patients with infected wounds and recurrent hernias in combination with ligature
fistulas of the anterior abdominal wall after allohernioplasty, obesity was observed
in 21 (10.9%) patients, diabetes mellitus in 13 (6.8%) patients, smoking in 65
(33.9%), the use of steroids in 1 (0.5%), in 56 (29.2%) patients urgent
allohernioplasty was performed, in 35 (18.2%) patients the surgery lasted more
than 3 hours.
