Preventive plasty of the abdominal wall with endoprosthesis "Esfil" in operations on organs of the abdominal cavity

An analysis of clinical and US investigations of the abdominal wall in 210 patients with different surgical diseases of the abdominal cavity allowed division of the patients into three groups: without clinical and ultrasonic alterations, with a mild degree and with a severe degree of the anatomo-functional weakness of the abdominal wall. Indications for preventive endoprosthesis of the abdominal wall were determined using the method of quantitative evaluation of risk factors of postoperative hernias developed by the authors. Preventive endoprosthesis of the abdominal wall with a polypropylene endoprosthesis "Esfil" was fulfilled during operation on organs of the abdominal cavity in 11.9% of the patients by absolute indications. The number of postoperative hernias was reduced to 0.9%.     

Indications and results of preventive endoprosthezing of the abdominal wall during operations on organs of the abdominal cavity and retroperitoneal space

Complex examination and treatment of 120 patients with anatomo-functional insufficiency of the abdominal wall was made after operations on organs of the abdominal cavity and retroperitoneal space. In the 1st group (60 patients) the abdominal wall was sutured by traditional methods. In the 2nd group (60 patients) laparotomy was followed by implantation of polypropylene endoprosthesis by over-aponeurotic method, and suturing of the lateral wall--by sub-aponeurotic method. At the long-term postoperative period the postoperative ventral hernias were formed in 21.6% of patients of the 1st group, in the 2nd group of patients hernias were not detected. Physical component of quality of life of the 2nd group was 1.5 times, and mental component 1.7 times higher than in the 1st group.     

Plastic surgery of postoperative abdominal hernias with polypropylene endoprosthesis

One hundred and twenty-one patients with postoperative abdominal hernias of different size and location were treated, 103 of them underwent surgery with polypropylene endoprosthesis. Size of hernia was objectively assessed with an original method of X-ray-computed hernioabdominometry. The parameter presents as percentage of relative volume of hernia. Based on this index, hernias were classified by size in the following way: small -- relative volume 1.0 - 5.0%, middle-sized -- 5.1 -14,0%, large -- 14.1 - 18%, gigantic -- over 18.0%. Choice of a hernioplasty method depended on relative volume of postoperative hernia. Middle-sized hernias were indications for reconstructive surgery (complete adaptation of muscular and aponeurotic layers of abdominal wall), gigantic hernias - for correcting surgery (specified diastasis of muscular and aponeurotic layers was maintained). In large hernias the method of hernioplasty was individual depending on compensatory abilities of the patient. Postoperative complications (6.6%) were local and seen in 6.6% cases. There were no lethal outcomes and complications associated with endoprosthesis. Recurrences of hernia were not revealed in all 103 patients examined from 6 months to 2.5 years after surgery.     

Management of large and giant postoperative ventral hernias

The experience of the Department for Plastic Surgery of the A.V. Vishnevsky. Institute of Surgery of RAMS in surgical treatment of 262 patients with postoperative hernias of the anterior abdominal wall has been summarized for the period from 1993 to 1998. 138 patients (test group) had large and giant hernias, 124 (control group)--small and middle-sized postoperative hernias. In large and giant hernias more frequently (46.1%) combined plastic reconstruction of the anterior abdominal wall was used rather than in small and middle-sized hernias (21.5%). In the majority of patients in control group (78.5%) autoplasty of the abdominal wall defect was carried out. In the long term period relapses developed in 9 (7.0%) patients of the test group. In 7 cases the relapse developed after the autoplasty (10.1%), and in 2 cases--after the use of combined method (3.4%). This supports perspectiveness of the method of postoperative hernioplasty by the combined method. Lethality rate after hernioplasty in the test group made up 2.3% (3 patients).     

Surgical treatment of postoperative and recurrent ventral hernia

One of the causes of the appearance of ventral hernias, postoperative and recurrent ones included, is noncomplete fixation of internal organs to the posterior abdominal wall in the prenatal period. For the radical treatment of hernias as a disease operative procedures must include in addition to strengthening of the hernia hilus, removal of the pathologically altered organs, correction of fixation of organs to the posterior lateral surface of the abdominal wall.     

Day surgery for laparoscopic repair of abdominal wall hernias

Laparoscopic repair of abdominal wall hernias is still a controversial and nongeneralized therapeutic option. The aim of this paper is to evaluate the results of laparoscopic surgery on abdominal wall hernias at a day-surgery unit and to describe our procedure protocol. Prospective analysis of 300 patients undergoing laparoscopic surgery for abdominal wall hernias was conducted: 260 preperitoneal and 40 intraperitoneal. The patients' clinical features, hernia type, intraoperative and postoperative complications, and follow-up are studied for both types of surgery. All the patients receiving surgery with extraperitoneal laparoscopy were completed as a day-surgical procedure with a rate of conversion to open surgery of 2.3%. Twelve (30%) of the 40 patients operated on for ventral hernias using intraperitoneal laparoscopy required hospitalization: five for perioperative complications and seven for pain (16%). There was no case of infection or mesh rejection. The recurrence rates were 0.78% (two cases) for the inguinal hernias and 2.5% (one case) for the ventral hernias. In conclusion, laparoscopic repair of abdominal wall hernias in a day-surgery setting is an efficient alternative to open surgery. Electronic Publication     

The experimental grounds and clinical application of domestic endoprosthesis "Esfil" for plasty of the abdominal wall

An investigation of physico-mechanical properties and a histological examination of meshed endoprostheses "Esfil" ("Lintex" St.Petersburg) and nets "Prolene" ("Ethicon") implanted into the abdominal wall of 66 Chinchilla rabbits was carried out under experimental conditions. The comparative experimental investigation has shown that both materials possess sufficient physico-mechanical properties to resist intra-abdominal pressure and when implanted they cause an inconsiderable inflammatory reaction followed by the formation of a solid connective tissue capsule. The endoprosthesis "Esfil" was used for plasty of the abdominal wall in 51 patients with postoperative ventral hernias. The endoprosthesis "Esfil" was found to meet all the requirements made to endoprostheses for plasty of the abdominal wall. Its use in clinical practice allows the restoration of quality of life of such patients.     

Surgical treatment of postoperative incisional hernias by intraperitoneal insertion of dacron mesh and an aponeurotic graft: a report on 250 cases.

BACKGROUND: The therapeutic problems of giant incisional hernias of the abdominal wall are often difficult to resolve. The technique of repair must make up for the loss of abdominal wall substance and reestablish the interplay of the abdominal musculature. The use of prosthetic materials complies with these 2 imperatives. HYPOTHESIS: The results of surgical treatment of postoperative incisional hernias by intraperitoneal insertion of Dacron mesh and an aponeurotic graft were evaluated. DESIGN AND SETTING: Retrospective study of 250 patients in a university hospital. RESULTS: Postoperative mortality was 0.8%. Five patients (2%) developed a subcutaneous infection that did not affect the prosthesis. Another 5 patients (2%) developed a deep-seated infection that necessitated removal of the mesh in 3 cases. Eight patients (3.2%) had recurrence of incisional hernia. CONCLUSION: This retrospective study shows that giant abdominal wall hernias can be efficiently treated by the intraperitoneal positioning of Dacron mesh and an aponeurotic graft.     

Treatment of postoperative ventral hernias

The experience with 248 operations for postoperative hernias of the abdominal wall is analyzed. Defects in the aponeurosis in 182 patients with not great hernias were eliminated by plasty with adjacent tissues. In 66 patients with extensive, giant and recurrent hernias herniatomy with skin autografts was performed. Recurrences in the first group of patients were noted in 12% of cases, in the second group--in 4,3%. The autodermal reconstruction is thought by the authors to be a promising method to improve further results of the treatment of postoperative hernias and must be given deserving attention in restorative surgery.     

Surgical treatment of large incisional hernias by an intraperitoneal Dacron mesh and an aponeurotic graft

BACKGROUND: The therapeutic problems of giant incisional hernias of the abdominal wall are difficult to resolve. The technique of repair must make up for the loss of abdominal wall substance and reestablish the interplay of the abdominal musculature. The use of prosthetic materials complies with these two imperatives. The aim of this prospective study was to evaluate the results of surgical treatment of postoperative incisional hernias by intraperitoneal insertion of Dacron (DuPont) mesh and an aponeurotic graft. STUDY DESIGN: We prospectively studied 350 consecutive patients who were operated on for giant postoperative incisional hernia. RESULTS: Postoperative mortality was 0.6%. Seven patients (2%) developed subcutaneous infections that did not affect the prostheses. Another seven patients (2%) developed deep-seated infections that necessitated removal of the mesh in five cases. Eleven patients (3.1%) had recurrence of incisional hernia. CONCLUSIONS: This prospective study shows that the intraperitoneal positioning of Dacron mesh and an aponeurotic graft can efficiently treat giant abdominal wall hernias.     

Meshed implants of polyvinylidene fluoride in treatment of abdominal wall hernias

The authors analyze the results of experimental and clinical investigations for comparative studying a new meshed implant of polyvinylidene fluoride as an endoprosthesis of the anterior abdominal wall with postoperative hernias. It was shown that the polyvinylidene fluoride prosthesis is a good alternative of polypropylene prosthesis. Its physico-chemical properties allow reliable prostheses of the abdominal wall, and its biological compatibility is higher as compared with polypropylene prosthesis.     

The tension-free hernioplasty with a polypropylene endoprosthesis "Esfil" in patients with incarcerated abdominal hernias of great and giant size

In experiments in 24 rabbits it was found that endoprosthesis had no negative effects on the course of the wound process and did not prevent elimination of infection from the wound. "Esfil" was used for plasty of the abdominal wall in 38 patients with incarcerated postoperative, umbilical and inguinal hernias of great and giant sizes. No patient had rejections of the synthetic material, no recurrent hernias during the first year after operation.     

Experience with hernioplasty after Lichtenstein in inguinal hernias

The presented method of hernioplasty was used in 1242 patients with different types of inguinal hernias. In 428 patients plasty of the inguinal canal was performed by the classical method of Lichtenstein, in 814 patients the method was modified. The method modified by the authors is described in detail. Improved results of treatment are associated by the authors with reduced ischemization of the sutured tissues with reticulate endoprosthesis. Recurrent hernias were noted in 0.2% in the main group, and 1.8% in the control group.     

A new approach to treatment of the intraabdominal hypertension syndrome in patients with diffuse peritonitis

Results of treatment of 49 patients with diffuse purulent peritonitis were analyzed. The patients were divided into two statistically similar groups. The control group of patients consisted of 27 patients treated using traditional methods. Patients of the main group (22) were treated by the same method, but the defect of the abdominal wall was closed using wide-meshed reticular polypropylene endoprosthesis with total size of the meshes not less than 70% of the general square surface. During every programmed sanation the prosthesis was cut longitudinally along the whole length and sutured so that the level of intraabdominal pressure was not more that 15 mm Hg. In the nearest postoperative period the main group patients had endotoxicosis 1.3 less, and the motor-evacuatory function of the intestine was 2.2 times higher which resulted in 1.3 times less postoperative lethality. In the long-term postoperative period excellent results of treatment became 13.3% more often, good results were 12.7% as compared with the control group.     

Laparoscopic repair of low abdominal wall hernias by tack fixation to the cooper ligament

Laparoscopic repair of low abdominal wall hernias present a challenge in mesh fixation, especially in the obese patient. Few reports have suggested repair by tack fixation to the Cooper ligament. Thirteen women, mean age 54.7 years, range 27 to 93 years, presented with 14 low abdominal wall hernias. Body mass index averaged 31.5, range 21 to 50.6. Twelve hernias were diagnosed clinically. Twelve hernias were incisional (7 midline, 5 lateral); 1 recurrent spegelian; and 1 primary midline. All hernias were repaired using laparoscopic transabdominal preperitoneal dissection, mesh fixation to an exposed Cooper ligament using the Protack, inferior edge or total mesh coverage by peritoneal-bladder flap elevation and fixation. Five small midline and lateral hernias were repaired transabdominal preperitoneally with polypropylene mesh. Nine large lower abdominal wall hernias (6 midline, 3 lateral) were repaired with Bard Composix E/X mesh. Follow-up averaged 17.5 months (range 5 to 30 mo). No hernias recurred. In conclusion, although suture versus tack fixation of mesh with laparoscopic repair of ventral hernias remains controversial, tack fixation of mesh to an exposed Cooper ligament in midline and lateral low ventral hernias has proven to be a successful repair. This technique is also efficacious in the obese patient.     

Laparoscopic repair of incisional and parastomal hernias after major genitourinary or abdominal surgery

BACKGROUND AND PURPOSE: Abdominal wall or parastomal hernias following major genitourinary or abdominal surgery are a significant surgical problem. Open surgical repair is difficult because of adhesion formation and poor definition of the hernia fascial edges. Laparoscopic intervention has allowed effective correction of these abdominal wall hernias. PATIENTS AND METHODS: From November 1997 to June 2000, 14 male and 3 female patients underwent laparoscopic abdominal wall herniorrhaphy at our institution. Of these, 13 patients received incisional and 4 parastomal hernia repair. All hernia defects were repaired using a measured piece of Gore-Tex DualMesh. A retrospective review of each patient's history and operative characteristics was undertaken. RESULTS: All repairs were successful. No patient required conversion to an open procedure, and there were no intraoperative complications. The average operative time was 4 (range 2.5-6.5) and 4.3 (range 3.75-5.5) hours in the incisional and parastomal group, respectively. The average hospital stay was 4.9 days (range 2-12) for the incisional group and 3.8 (range 3-4) days for the parastomal group. To date, two patients experienced a recurrence of incisional hernias, at 5 and 8 months postoperatively. No recurrences have developed in the parastomal hernia repairs at 2 to 33 months. CONCLUSION: Laparoscopic repair of abdominal wall incisional or parastomal hernias provides an excellent anatomic correction of such defects. Adhesions are lysed under magnified laparoscopic vision, and the true limits of the fascial defects are clearly identified. The DualMesh is easy to work with and has yielded excellent results. A comparison with open repair with respect to perioperative factors and long-term success is currently under way.     

Qualitative and quantitative evaluation of total and types I and III collagens in patients with ventral hernias

Aim The purpose of this study was to evaluate the amount of total and types I and III collagens of samples from the linea alba in patients with hernias (epigastric, umbilical, and incisional) on the anterior wall of the abdomen, comparing them to findings obtained from a cadaver control group without hernias. Materials and methods Samples of the linea alba aponeurosis from 26 patients with hernias on the anterior abdominal wall and from 32 cadavers without hernias were analyzed and compared for qualitative and quantitative evaluation of the total and the types I and III collagens. Sirius-red staining was used to evaluate the total collagen, and for types I and III collagens, immunohistochemistry was used with monoclonal antibody anticollagen types I and III, respectively. Results The amount of total collagen was 18.05% smaller in patients with hernias than in cadavers (p<0.05). Type I collagen was 20.50% smaller in patients than in cadavers (p<0.05). There was no significant difference in the amount of type III collagen between cases and controls (p=0.383). Conclusion The results of this study indicate a relationship between hernias of the anterior abdominal wall and smaller amounts of total and type I collagens.     

Sodium hypochlorite in the treatment of the suppurative-septic complications in patients with strangulated hernias

The article presents an analysis of surgical treatment of 2155 patients with incarcerated hernias of the anterior abdominal wall. Pyo-septic complications took place in 24.3%. A comparison of results of treatment by traditional methods with those using solution of sodium hypochlorite (indirect electrochemical oxidation of blood) has shown that in the group of patient treated with sodium hypochlorite lethality was reduced from (18.8 +/- 0.2)% to (11.2 +/- 0.2)%, the amount of suppuration of the operative wound was 1.8 times less and the average number of bed-days was (4.5 +/- 0.2) less.     

Variants of surgical treatment of lateral postoperative abdominal hernia by a combined method

616 patients with postoperative abdominal hernias (AH) were treated, 124 (20%) of them had lateral hernias. By M. Yatsentyuk classification, there were 41 (33.1%) patients with small hernias, 37 (29.8%)--with middle-size, 35 (28.2%)--with big, 6 (4.3%)--with very large, 5 (4%)--with giant hernias. Two operative techniques for lateral AH based on an original method of combined plastic surgery were applied in 37 patients. Good immediate and long-term results were achieved in all the patients. There were no recurrences.     

Complications of endovideosurgical repair of inguinal and femoral hernias

On the basis of an experience with 1800 operations of endovideosurgical hernioplasty in patients with inguinal and femoral hernias, the authors analyze the frequency and character of complications after such operations. Complications were noted in 37 (2.05%) patients. The most frequent complication was injury of the vessels. It could be liquidated in all the cases using laparoscopic technology. In three cases hollow organs were injured. In these cases laparotomy was used. The laparoscopic hernioplasty, if all details are fulfilled thoroughly, is a minimally invasive and effective method of treatment of inguinal and femoral hernias. The frequency of recurrences after these interventions is considerably less than that after traditional operations.