Complex surgical treatment of recurrent abdominal wall hernias with abdominal wall fistula | Український Медичний Часопис

The aim: to evaluate the effectiveness of surgical treatment of recurrent abdominal wall hernia with abdominal wall fistula after mesh hernia repair.

Object and methods of the research. We analyzed results of treatment of 66 patients with recurrent abdominal wall hernia with abdominal wall fistula, who were divided into 2 groups. In 1st group (n=34) рatients were treated according to the developed algorithm, in 2nd group (n=32) — to the traditional one. We compared the frequency of postoperative complications (seroma, wound infection) and wound healing period.

Results. Seroma occurred in 2 (5.9%) patients of 1st group and in 8 (25.0%) patients of 2nd group (p=0,030), wound infection was observed in 1 (2.9%) patient vs 6 (18.7%) (p=0.037), the wound healing period was 6 (5–7) vs 14 (12–15) days (p=0.0001). No evidence of fistula or hernia recurrence was observed in 1st group, but in 2nd group abdominal wall fistula occurred in 3 (9.4%) patients and recurrent hernia in 2 (6.2%).

Conclusion. The treatment algorithm of recurrent abdominal hernia with abdominal wall fistula, which includes fistula excision with mesh explantation, hernia repair with mesh fixation with polyurethane glue, increases the effectiveness of treatment by decreasing the frequency of seroma, wound infection and the duration of wound healing.

References

1. Aiolfi A., Cavalli M., Micheletto G. et al. (2020) Open mesh vs. suture umbilical hernia repair: systematic review and updated trial sequential meta-analysis of randomized controlled trials. Hernia, 24: 707–715.
2. Christoffersen M.W., Henriksen N.A. (2023) Treatment of primary ventral and incisional hernia. BJS, 110 (11): 1419–1421. DOI: 10.1093/bjs/znad137.
3. Nguyen M.T., Li L.T., Hicks S.C. et al. (2013) Readmission following open ventral hernia repair: incidence, indications, and predictors. Am. J. Surg., 206(6): 942–949.
4. Parker S.G., Mallett S., Quinn L. et al. (2021) Identifying predictors of ventral hernia recurrence: systematic review and meta-analysis. BJS Open: 1–9.
5. Ramos D., O’Brien W.J., Gupta K. et al. (2022) Events, care, and outcomes after hernia mesh explantation for infection. Am. J. Surg., 224(1): 174–176.
6. Rosen M.J., Krpata D.M., Ermlich B., Blatnik J.A. (2013) A 5-year clinical experience with single-staged repairs of infected and contaminated abdominal wall defects utilizing biologic mesh. Ann. Surg., 257: 991–996.
7. Plymale M.A., Davenport D.L., Walsh-Blackmore S. et al. (2020) Costs and Complications Associated with Infected Mesh for Ventral Hernia Repair. Surg. Inf., 21(4): 344–349.
8. Birolini C., de Miranda J.S., Tanaka E.Y. et al. (2020). The use of synthetic mesh in contaminated and infected abdominal wall repairs: challenging the dogma-A long-term prospective clinical trial. Hernia, 24: 307–323.
9. Galatenko N.A., Rozhnova R.A., Kuliesh D.V. et al. (2020) Response of soft tissues and abdominal organs of rabbits and rats to implanting albucid-containing cross-linked polyurethane composite. Oftalmol. Zhurn., 6: 30–37.
10. Lebedev Ye.V., Galatenko N.A., Rozhnova R.A., Kulesh D.V. (2016) Orhanizatsiia seriinoho vyrobnytstva vitchyznianoho biolohichno aktyvnoho kleiu dlia vykorystannia v medytsyni. Nauka ta innovatsii, 12(1): 61–65. DOI: 10.15407/scin12.01.061.
11. Clancy C., Jordan P., Ridgway P.F. (2019) Polypropylene mesh and systemic side effects in inguinal hernia repair: current evidence. Irish J. Med. Sci., 188(4): 1349–1356.
12. Alhussini M.A., Awad A.T., Kholosy H.M. (2019) Using quilting sutures in decreasing seroma formation after managing large ventral hernias: a comparative study. Hernia, 23: 717–722. DOI: 10.1007/s10029-018-1850-9.
13. Massey L.H., Pathak S., Bhargava A. et al. (2018) The use of adjuncts to reduce seroma in open incisional hernia repair: a systematic review. Hernia, 22: 273–283.
14. Cobb W.S., Warren J.A., Ewing J.A. et al. (2015) Open retromuscular mesh repair of complex incisional hernia: predictors of wound events and recurrence. J. Am. Coll Surg., 220: 606–613. DOI: 10.1016/j.jamcollsurg.2014.12.055.
15. Hodgkinson J.D., Worley G., Warusavitarne J. et al. (2021) Evaluation of the Ventral Hernia Working Group classifcation for long-term outcome using English Hospital Episode Statistics: a population study. Hernia, 25(4): 977–984.