engleski

Modified "open intraperitoneal mesh” technique of postoperative ventral hernia repair – a pilot study on 40 patients

Ventral hernias, primary and recurrent, are major surgical challenge. Intraperitonealy placed synthetic material (mesh) introduced a huge advancement in repair of postoperative hernias. Here we present a modified technique of ventral hernias repair: an "open intraperitoneal mesh” technique. During 41 months period we operated 17 man and 23 women aged (mean±SD) 65±9 yrs (16 primary and 24 recurrent postoperative hernias), of body mass index median 27 kg/m2, range 18-34 kg/m2, with intraoperative hernia sizes from 5-49 cm (median 25 cm). We performed an "open” intraperitoneal mesh technique in all patients: we placed PROCEED™ surgical mesh of appropriate size intraperitonealy with transfascial fixation and drainage. After the drainage removal, patients were discharged (median) 7days (range 6-20 days) after the surgery, and subsequently monitored as outpatients for early postoperative complication and the recurrence of hernia, during the next (mean±SD) 12±7 months. We analyzed the association of both hernia size and BMI of patients with early postoperative complications (wound infections, seromas, hematomas), and the recurrence of hernia. In early postoperative period we recorded 6 wound infections (15% of patients), 10 seromas (25%), and one wound hematoma (3% ; patient with coagulopathy). In the long-term follow up we recorded 10 (25%) recurrent hernias, and 5 (56%) of these patients had early postoperative complications. Compared to primary hernias, recurrent hernias were larger (mean±SD: 20±10 cm vs. 31±8 cm, respectively ; P<0.001) ; patients with larger hernias had more recidives (P=0.013). Hernia recurrence was associated with previous wound infection (P=0.026), but primary (4 of 16) and recurrent (6 of 24) hernias had same rate of recidives (P=1.000). Modified "open intraperitoneal mesh” technique is reliable technique for managing postoperative hernias that reduced recidives of recurrent hernias to the level of primary hernia recidives. For definitive evaluation, this technique needs further investigation.

hernia; mesh; intraperitoneal techique

nije evidentirano