Laparoscopic preperitoneal alloplasty of postoperative ventral hernias

Keywords: postoperative ventral hernia; laparoscopic preperitoneal allohernioplasty; open preperitoneal allohernioplasty; seroma; suppuration of postoperative wound; chronic pain; recurrent hernia.

Abstract

Objective. To raise the efficacy of surgical treatment of postoperative ventral hernias, performing laparoscopic preperitoneal allohernioplasty.

Materials and metods. Analysis of the surgical treatment results was conducted in 126 patients, suffering postoperative ventral hernias, ageing from 30 to 75 yrs old, who were operated on in the Clinic of Department of Surgery and Proctology of Shupyk National Medical Academy of Postgraduate Education in 2012 - 2019 yrs, was conducted. There were 80 (63.5%) women-patients, and 46 (36.5%) men-patients. Average age of the patients have constituted (54.7 ± 3.3) yrs old.

In accordance to classification of European Association of Surgeons-Herniologists (The European Hernia Society - EHS, Gent, Belgium, 2008 yr) distribution of postoperative hernias was following: hernias M1W1R0 were diagnosed in 6 (4.8%) patients, M2W1R0 - in 12 (9.5%), M2W2R0 - in 14 (11.1%), M3W1R0 - in 10 (7.9%), M3W2R0 - in 11 (8.7%), M3W3R0 - in 8 (6.3%), M4W1R0 - in 7 (5.6%), M4W2R0 - in 3 (2.4%), M4W3R0 - in 5 (4.0%), M5W1R0 - in 8 (6.3%), M5W2R0 - in 4 (3.2%), M2-3W2R0 - in 19 (15.1%), M3-4W2R0 - in 8 (6.3%), M3-4W3R0 - in 4 (3,2%), M1-4W3R0 - in 4 (3.2%), M3-5W3R0 - in 3 (2.4%). The patients with large POVH (W3) and diastasis of abdominal rectal muscles more than 5 cm were not included in the investigation. Depending on procedure of allohernioplasty performed for postoperative ventral hernias the patients were distributed into two Groups. In Group I in 63 (50%) patients the improved laparoscopic preperitoneal allohernioplasty with transfascial suturing of the abdominal wall defect edges was performed. In Group II in 63 (50%) patients open preperitoneal allohernioplasty was done. In both Groups of the patients light polypropylene nets were used for allohernioplasty.

Results. Laparoscopic alloplasty of postoperative ventral hernias with transfascial sutures, which were applied in Group I, have had essential advantages: significant lesser intensity of postoperative pain, reduction of the seroma rate by 94% - relative risk 0.06 (0.01 - 0.28), p<0.001; risk of suppuration in postoperative wound by 90% - relative risk 0.10 (0.01 - 1.98), p=0.211; risk of chronic infiltrate occurrence by 86% - relative risk 0.14 (0.01 - 2.70), p=0.369. In general, concerning morbidity (immediate results), the risk lowering for their occurrence have enhanced by 93% - relative risk 0.07 (0.02 - 0.28), p<0.001 in patients of Group I in comparison with patients of Group II. Late results of surgical treatment of postoperative ventral hernias also confirms the advantage of laparoscopic preperitoneal allohernioplasty with transfascial suturing of the defect edges over open preperitoneal alloplasty: reduction of risk in chronic pain development in part of anterior abdominal wall by 68% - relative risk 0.32 (0.03 - 3.18), p=0.617 and risk of the recurrent hernia development by 87% - relative risk 0.13 (0.01 - 2.67), p=0.367.

Conclusion. Performance of laparoscopic preperitoneal allohernioplasty for postoperative ventral hernias (Group I of patients) due to minimization of surgical dissection of the abdominal wall tissues is accompanied by significantly lesser intensity of postoperative pain and lesser rate of morbidity, comparing with open preperitoneal allohernioplasty (Group II), especially: in Group I a seroma rate have constituted 3.2%, in Group II - 34.9%, in Group I suppuration of postoperative wound was not noted, inflammatory infiltrate of abdominal wall, in Group II a rate of these complications have constituted 6.4 and 4.8% accordingly, in Group I chronic postoperative pain was noted in 2.1% of patients, in Group II - in 6.3%, in Group I hernia recurrence was absent, in Group II hernia recurrence rate have constituted 6.3%.

Author Biographies

Ya. P. Feleshtynsky, Shupyk National Academy of Postgraduate Education, Kyiv

Feleshtynsky Yaroslav, MD, DSci(Med), Professor,
Head of the Department of Surgery and Proctology
Shupyk National Medical Academy of Postgraduate Education
9 Dorohozhytska Str., Kyiv, 04112 Ukraine
e-mail: feleshtynsky@yahoo.com
Orcid: 0000-0003-4376-4265

O. M. Lerchuk, Shupyk National Academy of Postgraduate Education, Kyiv

Lerchuk Orest, MD, Surgeon,
Lviv Regional Clinical Hospital
44/2 Lysenka Str., Lviv,79004 Ukraine
e-mail: Lerchuk.orest@gmail.com
Orcid: 0000-0002-0585-3315

V. V. Smishchuk, Shupyk National Academy of Postgraduate Education, Kyiv

Smishchuk Vitalii, MD, PhD(Med), assistant
Department of Surgery and Proctology
Shupyk National Medical Academy of Postgraduate Education
9 Dorohozhytska Str., Kyiv, 04112 Ukraine
+38(044) 424-98-27; (063) 262-04-19
smvitaliy@i.ua
Orcid: 0000-0003-2305-6122

Ya. M. Hudyma, Shupyk National Academy of Postgraduate Education, Kyiv

Hudyma Yaroslav, MD, surgeon,
Director of Mediterra LLC
12A Vishneva Str, Kyiv region,
Kyiv-Sviatoshynskyi district, Sofiivska Borshchahivka 08131, Ukraine
+38(044) 338-01-07, +38(067) 408-01-07
office@mediterra.com.ua
Orcid: 0000-0003-1237-132X

References

Feleshtynskyi YP. Pisliaoperatsiini hryzhi zhyvota: Monohrafiia. Kyiv: Biznes-Lohika: Bizes-Intelekt; 2012. 199 p. ISBN 978-966-1653-07-7. [In Ukrainian].

LeBlanc AK, Kingsnorth A, Sanders LD. Management of abdominal hernias. Cham, Switzerland: Springer International Publishing AG; 2018. 541 p. ISBN 978-3-319-63250-6, ISBN 978-3-319-63251-3 (eBook). doi: 10.1007/978-3-319-63251-3.

Novitsky WY. Hernia surgery. Cham, Switzerland: Springer International Publishing; 2016. 530 p. ISBN 978-3-319-27468-3, ISBN 978-3-319-27470-6 (eBook). doi: 10.1007/978-3-319-27470-6.

Lerchuk OM, Feleshtynskyi YP, Smishchuk VV, Vatamaniuk VF, Svyrydovskyi SA. Intraperitoneal alloplasty combined with the anterior separation technique in giant incisional hernias. Polski Przeglad Chirurgiczny. 2018;91(1):1-5. doi: 10.5604/01.3001.0012.7798.

Huang H. Treatment experiences for complications of abdominal incisional hernia repair. In: Abstract book. 1st World conference on abdominal wall hernia surgery. Milan, Italy April 2015. Hernia. 2015;19 (Suppl 1). S. 52.

Millbourn D. Risk factors for wound complications in midline abdominal incisions related to the size of stitches. Hernia. 2011;15(3):261-6. doi: 10.1007/s10029-010-0775-8.

Albino FP, Patel KM, Nahabedian MY, Sosin M, Attinger CE, Bhanot P. Does mesh location matter in abdominal wall reconstruction? A systematic review of the literature and a summary of recommendations. Plast Reconstr Surg. 2013;132(5):1295-304. doi: 10.1097/PRS.0b013e3182a4c393.

Sosin M, Nahabedian MY, Bhanot P. The Perfect Plane: A Systematic Review of Mesh Location and Outcomes, Update 2018. Plast Reconstr Surg. 2018;142(3 Suppl):107S-116S. doi: 10.1097/PRS.0000000000004864.

Gokcal F, Morrison S, Kudsi OY. Short-term comparison between preperitoneal and intraperitoneal onlay mesh placement in robotic ventral hernia repair. Hernia. 2019;23(5):957-67. doi: 10.1007/s10029-019-01946-4.

Raakow J, Schulte-Mäter J, Callister Y, Aydin M, Denecke C, Pratschke J, Kilian M. A comparison of laparoscopic and open repair of subxiphoid incisional hernias. Hernia. 2018;22(6):1083-8. doi: 10.1007/s10029-018-1815-z.

Meyer R, Häge A, Zimmermann M, Bruch HP, Keck T, Hoffmann M, Schlöricke E. Is laparoscopic treatment of incisional and recurrent hernias associated with an increased risk for complications? Int J Surg. 2015;19:121-7. doi: 10.1016/j.ijsu.2015.05.046.

Yang GPC. From intraperitoneal onlay mesh repair to preperitoneal onlay mesh repair. Asian J Endosc Surg. 2017;10(2):119-27. doi: 10.1111/ases.12388.

Gronnier C, Wattier JM, Favre H, Piessen G, Mariette C. Risk factors for chronic pain after open ventral hernia repair by underlay mesh placement. World J Surg. 2012;36(7):1548-54. doi: 10.1007/s00268-012-1523-2.

Cherla D, Hope W, Liang MK. Recurrence and Mesh-Related Complications After Incisional Hernia Repair. JAMA. 2017;317(5):536-7. doi: 10.1001/jama.2016.20112.

Muysoms FE, Miserez M, Berrevoet F, Campanelli G, Champault GG, Chelala E, et al. Classification of primary and incisional abdominal wall hernias. Hernia. 2009;1 (4):407-14. doi: 10.1007/s10029-009-0518-x

Feleshtynskyi YP, Lerchuk OM, Smishchuk VV, vynakhidnyky; Shupyk National Medical Academy of Postgraduate Education, patentovlasnyk. Sposib laparoskopichnoho likuvannia pisliaoperatsiinoi ventralnoi hryzhi. Patent Ukrainy 142342. 2020 Trav 25. [In Ukrainian].

Kliger M, Stahl S, Haddad M, Suzan E, Adler R, Eisenberg E. Measuring the intensity of chronic pain: are the visual analogue scale and the verbal rating scale interchangeable? Pain Pract. 2015;15(6):538-47. doi: 10.1111/papr.12216.

Published
2020-07-24
How to Cite
Feleshtynsky, Y. P., Lerchuk, O. M., Smishchuk, V. V., & Hudyma, Y. M. (2020). Laparoscopic preperitoneal alloplasty of postoperative ventral hernias. Klinicheskaia Khirurgiia, 87(5-6), 50-54. https://doi.org/10.26779/2522-1396.2020.5-6.50
Section
General Problems of Surgery