scholarly journals Methods of improving treatment results for patients with postoperative ventral hernia

2014 ◽  
Vol 95 (4) ◽  
pp. 543-548 ◽  
Author(s):  
I S Malkov ◽  
Z M Mukhtarov ◽  
M I Malkova
Keyword(s):  
Cardiovascular Risk ◽  
Surgical Treatment ◽  
Ventral Hernia ◽  
Heart Surgery ◽  
High Efficiency ◽  
Risk Identification ◽  
Main Group ◽  
Wound Complications ◽  
Vacuum Therapy ◽  
Ventral Hernias

Aim. To improve the results of surgical treatment for patients with postoperative ventral hernia by improving complex preoperative physical examination and better prevention of wound complications. Methods. Results of surgical treatment of 160 patients [mean age - 64 years, females - 120 (75%), males - 40 (25%)] with postoperative ventral hernia treated from 2003 to 2012 were analyzed. The surgeries were performed routinely. All patients were distributed to 2 groups depending on postoperative wound complications prevention. The main group included 60 patients who underwent a vacuum therapy (authors’ technology) during postoperative period for preventing wound complications. Perioperative management of patients with large and huge hernias in this group was performed according to recommendations of the European Society of Cardiologists and All-Russian Scientific Cardiologic Society for cardiovascular risk assessment at surgeries excluding heart surgery. Comparison group included 100 patients who underwent surgery for postoperative ventral hernias using a conventional vacuum drainage and common methods of patient examination according to recommended standards. Results. Using vacuum therapy in patients of the main group limited the number of Redon-drainage procedures, reduced the rate of local pyoinflammatory complications by 4.2 times (p 0.05). Cardiovascular risk identification and proper preoperative preparation allowed avoiding unfavorable outcomes associated with cardiovascular complications in patients with high cardiovascular risk. Conclusion. High efficiency of a complex approach in preventing postoperative complications after ventral hernias surgical treatment allows to recommend its use in clinical practice.

scholarly journals PLASTICS OF THE ANTERIOR ABDOMINAL WALL IN POSTOPERATIVE VENTRAL HERNIA

2021 ◽  
pp. 91-97
Author(s):  
N. Sivets ◽  
◽  
D. Kluyko ◽  
A. Sivets ◽  
D. Holovach ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Plastic Surgery ◽  
Abdominal Wall ◽  
Ventral Hernia ◽  
Postoperative Period ◽  
Anterior Abdominal Wall ◽  
Treatment Efficiency ◽  
Ventral Hernias

Objective. Improving the postoperative ventral hernias surgical treatment efficiency. Authors of the article define the clinically developed method of plastic surgery of the anterior abdominal wall in postoperative ventral hernia. Operations with this technique were performed in 37 patients. The endoprosthesis used was a polypropylene net made by “Eticon”. In the postoperative period complications took place in 2 (5,4%) patients. Conclusion. The developed method of the anterior abdominal wall plastics effectiveness was established in the article.

scholarly journals Wound Complications After Multimodal Treatment of Soft Tissue Sarcomas

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 218s-218s
Author(s):  
M. Khanevich ◽  
A. Khazov
Keyword(s):  
Surgical Treatment ◽  
Soft Tissue ◽  
Radical Surgery ◽  
Soft Tissue Sarcomas ◽  
Endovascular Embolization ◽  
Main Group ◽  
Long Term Results ◽  
Wound Complications ◽  
Control Group ◽  
Quick Freezing

Background: Surgical removal of the tumor remains the only 1 radical treatment of patients with soft tissue sarcomas of the extremities. However, the parameters of total and disease-free survival after this type of treatment cannot be considered satisfactory. Currently the active search and introduction into clinical practice of additional impact methods that can improve the immediate and long-term results of treatment of such patients is being conducted. Aim: To evaluate the risk of the wound process complications after surgical treatment of soft tissue sarcomas using endovascular embolization and cryosurgery. Methods: We have assessed the quantity and quality of postoperative complications of wound process in 199 patients with soft tissue sarcomas and their recurrences. The study group consisted of 53 patients, who underwent radical surgery with selective preoperative endovascular embolization and intraoperative cryosurgery. The control group consisted of 146 patients who had radical surgery without any additional methods. Preoperative embolization and cryosurgery on the wound bed after tumor removal was used to prevent local recurrence of soft tissue sarcomas. Preoperative angiography with selective embolization of vessels feeding the tumor was performed 1-1.5 hours before the main surgical treatment. Cryosurgery was carried out by the method of “Olympic rings” with 3 minutes duration. The temperature of exposure was −186°C. In the course of cryosurgery we adhere to the principle of “quick freezing - an independent slow thawing”. All postoperative wounds tightly sutured with silicone drains by Redon, if necessary. Results: Complications of wound healing have been diagnosed in 15 (28.3%) patients of the main group and in 34 (23.3%) control group patients. Inflammatory-suppurative complications were observed in the remaining 8 (15.1%) patients of the main group and in 18 (12.3%) control group patients ( P > 0.05). Long lymphorrhea was observed in 6 (11.3%) patients of the main group and 11 (7.5%) control group patients. Bleeding in the postoperative period was observed in 1 (1.9%) case of main group patients and in 5 (3.4%) cases of control group. Conclusion: The additional using of selective preoperative endovascular embolization and cryosurgery is safe and does not worsen immediate results of surgical treatment of soft tissue sarcomas.

scholarly journals Prevention of large and giant postoperative ventral hernia prosthetic hernioplasty postoperative complications

2013 ◽  
Vol 94 (3) ◽  
pp. 417-420
Author(s):  
O T Alishev ◽  
R S Shaimardanov ◽  
Y R Makhmutova
Keyword(s):  
Ventral Hernia ◽  
Comparison Group ◽  
Subcutaneous Tissue ◽  
Main Group ◽  
Wound Complications ◽  
Control Group ◽  
Abdominal Pressure ◽  
Narcotic Analgesics ◽  
Wound Irrigation ◽  
Average Pain

Aim. To evaluate the effectiveness of regional prolonged irrigation with ropivacaine ozonated solution at large and giant postoperative ventral hernia prosthetic hernioplasty. Methods. 77 patients who underwent a planned surgery for large and giant postoperative ventral hernia from 2010 to 2012 were examined. All patients were distributed to two groups. The main group included 26 patients in whom a polyvinyl chloride catheter was installed in periprosthetic tissue for the wound irrigation using anesthetic (ropivacaine) ozonated solution for regional prolonged anesthesia and wound complications prevention as well as for preoperative preparation and intra-abdominal pressure monitoring for abdominal compression syndrome prevention using the technique developed by authors. The comparison group consisted of 51 patients in whom prevention of wound complications was carried out conventionally, and who received narcotic analgesics. Ultrasonography of postoperative wound area was used for local inflammation intensity assessment. Pain was assessed using numeric visual analogue scale in both groups. Results. 4 (15.4%) patients of the main group developed subcutaneous tissue seroma at the 5-6th day. In comparison group wound complications were registered in 15 (29.4%) patients, including 11 cases of seromas, 2 cases of suppurative inflammation, 1 case of ischemic necrosis of the wound edges, and also an isolated case of limphorrhea which occurred on the first day. The observations showed that the average pain level among patients of the main group was 3.8±0.4 points, compared to the control group - 5.3±0.4 points. Conclusion. Periprosthetic irrigation with ropivacaine ozonated solution provides adequate anesthesia, reduces the number of wound complications and promotes early rehabilitation.

scholarly journals INCREASING SAFETY OF SURGICAL INTERVENTIONS IN PATIENTS WITH VENTRAL AND INCISIONAL HERNIA UNDER COMORBIDITY CONDITIONS WHEN PERFORMING DIFFERENT TYPES OF OPEN HERNIOPLASTY

2020 ◽  
pp. 135-139
Author(s):  
V. I. Piatnochka ◽  
I. Ya. Dziubanovskyi ◽  
A. M. Prodan
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Abdominal Wall ◽  
Ventral Hernia ◽  
Polypropylene Mesh ◽  
Immunosuppressive Agents ◽  
Technical Improvement ◽  
Surgical Interventions ◽  
Duration Of Surgery ◽  
Ventral Hernias

Abstract. In the period from 2001 to 2017, 1419 patients with ventral and postoperative ventral hernia were operated on. The unsatisfactory results of the surgical treatment of this pathology were due to a number of disadvantages: the choice of an inadequate method of hernioplasty in a specific clinical situation, an incomplete revision of the muscle-aponeurotic layer of the anterior abdominal wall, especially in patients with postoperative veterinary hernias, concomitant syndrome of undifferentiated connective tissue dysplasia and obesity, and weak points, the wrong choice of the type of mesh implant (“light” or “heavy” polypropylene mesh) and its size, the choice of an inappropriate type of suture material, as well as the high invasiveness of surgical intervention. Based on the given causes of complications in the operated patients with a high risk of their development, we have made a technical improvement of the existing methods of hernioplasty and development of new ones, which significantly reduced the number of postoperative complications and increased the safety of performing surgical interventions in patients with ventral and postoperative ventral hernia. Purpose. Based on the results of the analysis of surgical treatment of patients with comorbid conditions for primary and incisional ventral hernias to develop technical prerequisites for improving the safety of surgical interventions in this category of patients. Methods. Іn the period from 2001 to 2017, an in-depth comprehensive clinical-instrumental and laboratory examination of 1419 patients with primary ventral hernia (PVH) and postoperative ventral hernia (PVH) was conducted. The patients were divided into groups according to the periods of surgical treatment of patients. For this purpose, two periods were formed: from 2001 to 2009 and from 2010 to 2017. At the first period, 597 (42.07%) patients were examined and operated on. These patients formed a comparison group. The main group corresponding to patients who were treated in the period from 2010 to 2017 was 822 (57.93%) people. Results. Developed techniques for performing retromuscular allogernioplasty, which were based on controlled visualization of suturing when fixing polypropylene mesh to the posterior leaf of the vagina of the rectus muscle, allowed us to reliably and safely place and secure the implant in the retromuscular space, significantly reduce the trauma and duration of surgery. Kind of treatment using the mesh allograft with a liposomal complex with included antibacterial and immunosuppressive agents during the operation on the "onlay" method significantly reduced the number of local infectious complications. The location of the PRF membrane over the polypropylene mesh during retromuscular allogernioplasty improved neoangiogenesis at the mesh implantation site, increased fibroblast activity and the formation of collagen fibers around the mesh material, which provided maximum integration of the "light" abdominal wall with polypropylene tissue. Conclusion. These features of the dynamics of the used methods of surgical interventions and types of polypropylene nets with an individualized approach to each patient were reflected in a significant reduction in the number of both early local and general late postoperative complications, which improved the effectiveness of surgical treatment of patients with primary postoperative ventral hernias.

scholarly journals SIMULTANEOUS OPERATIONS TACTICS IN PATIENTS WITH VENTRAL HERNIAS

2018 ◽  
Vol 3 (4) ◽  
pp. 54-58
Author(s):  
A I Fedorin ◽  
V I Belokonev ◽  
S Yu Pushkin ◽  
Z V Kovaleva ◽  
D S Pushkina
Keyword(s):  
Ventral Hernia ◽  
Wound Complications ◽  
Hernia Sac ◽  
Tension Free ◽  
European Hernia Society ◽  
Simultaneous Operations ◽  
Intestinal Fistulas ◽  
The Right ◽  
Ventral Hernias

Objectives - to improve treatment results in patients with ventral hernia and the concurrent surgical diseases by means of the designed surgery tactics. Material and methods. The treatment of 834 patients with ventral hernia, aged from 18 up to 82 years, was analyzed. The group consisted of 196 men (23.5%) and 638 women (76.5%). According to the European Hernia Society (EHS) classification of postoperative ventral hernias the gate types were distributed in patients as follows: W1 - in 132 patients (15.8%), W2 - in 397 (47.6%), W3 - in 305 (36.6%), in 243 (29.1%) cases the hernias were recurrent. 394 (47.2%) patients had 597 simultaneous interventions. The treatment tactics for the patients with hernias and associated diseases was defined according to the designed classification. For the abdominal wall repair the 2 variants of the "tension-free" mesh repair technique were used. Results. Forced simultaneous interventions were performed in 34 patients when the intestinal loops adherent to the scar were situated in the hernia sac. In 27 cases the postoperative ventral hernia was combined to the intestinal fistulas, located out of the hernia area. 12 patients underwent herniolaparotomy conditioned by the intra-abdominal intestinal fistulas closure and small hernias size. To prevent the compartment syndrome in 3 patients with splanchnoptosis the right part of the colon was resected. 103 patients had the planned simultaneous operations including the laparoscopic cholecystectomy in 19 cases, 114 patients underwent the panniculectomy. The preventional appendectomy was performed in patients with the recurrent large hernias. In 140 cases the omentum resection was done due to the signs of the chronical strangulation and omentitis. Postoperative pulmonary artery thromboembolia was the death cause for 3 (0.4%) patients. Only 8 (0.9%) patients suffered the partial hernia recurrence. Conclusion. In patients with hernias the simultaneous operations are conditioned by the pathogenesis and do not affect the severity and frequency of wound complications in the postoperative period. A condition for the simultaneous interventions in patients with hernias is the necessary implementation of the combined techniques of the ventral tension-free mesh hernioplasty.

scholarly journals FEATURES OF PROSTHETIC REPAIR FOR POSTOPERATIVE VENTRAL HERNIA

2020 ◽  
Vol 22 (1) ◽  
pp. 134-140
Author(s):  
Rakhimdzhon Rakhmatulloev ◽  
◽  
Shukurullo Polvonov ◽  
Shokhin Nazarov ◽  
◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Ventral Hernia ◽  
Etiological Factor ◽  
Intraabdominal Pressure ◽  
Surgical Wound ◽  
Prosthetic Repair ◽  
Recurrence Rates ◽  
Groin Hernias ◽  
Ventral Hernias

The article provides an overview of literature on the surgical treatment of postoperative ventral hernias (POVH), development trends and controversial questions of the problem. Today, according to many researchers, the frequency of POVH is up to 20-26% of the total number of external hernias of the abdomen, which give way to the primacy only to groin hernias. The recurrence rates of POVH remain high, reaching between 4.5-90% after the use of autoplasty methods and 3-19.5% after alloplasty methods. Incomplete satisfaction with the results of surgical treatment of POVH has helped to find new ways of hernioplasty using prosthetics, which allows increase the effectiveness of surgical treatment and reduces the incidence of complications. Increased intraabdominal pressure is the most common etiological factor in the development of purulent-inflammatory complications, leads to relapse, and increases the numbers of fatalities among patients with large POVH. The great interests among abdominal surgeons are issues of improving the quality of hernioplasty using prosthetic materials and methods of prevention of development inflammatory complications in the area of surgical wound. Keywords: Postoperative ventral hernia, hernioplasty, laparotomy, purulent complications.

scholarly journals THE USE OF MESH ENDOPROSTHESIS IN SURGICAL TREATMENT OF VENTRAL HERNIA

2019 ◽  
Vol 21 (1) ◽  
pp. 122-125
Author(s):  
V A Ragimov ◽  
Sh I Ragimli
Keyword(s):  
Surgical Treatment ◽  
Polypropylene Mesh ◽  
Long Term Results ◽  
Wound Complications ◽  
Linea Alba ◽  
Inguinal Hernias ◽  
Mesh Endoprostheses ◽  
Mesh Endoprosthesis ◽  
Ventral Hernias

Surgical treatment of patients with ventral hernias remains an urgent problem in abdominal surgery. More than 20 million operations are performed annually in the world for hernias. The urgency and complexity of the problem is based on the fact that inadequately performed surgery leads to a recurrence of the disease in 14-54% of cases. The aim of the work is to study the results of surgical treatment of patients with ventral hernias using mesh endoprostheses. The results of a retrospective analysis of 437 hernioplasty performed with hernias of various localizations for the period from 2010 to 2014 were used. Patients were classified by hernia localization and divided into groups depending on the methods of alloplasty. The duration of observation of patients operated by using polypropylene mesh ranged from 6 month to 3 years. An analysis of the complications that developed after alloplasty of the inguinal, postoperative, umbilical hernias and hernias of the linea alba was carried out. Our clinical experience confirms that the operation of Liechtenstein is rightly considered to be the “gold standart” for the treatment of inguinal hernias. However, the use of polypropylene mesh in the treatment of inguinal hernias leads to the development of postsurgical wound complications. Placed next to the polypropylene mesh peritoneum flap plays the role of internal drainage, prevents the development of seromas in the wound. The use of a new inguinal alloplasty technique reduced the number of postoperative complications. Also, the best immediate and long-term results are obtained by alloplasty using a sublay method. In patients with postoperative hernias operated by sublay method, no recurrences were observed and they showed the best quality of life.

scholarly journals Surgical treatment of wounded persons with complicated thoracic damages

2020 ◽  
Vol 87 (11-12) ◽  
pp. 3-9
Author(s):  
Ya. L. Zarutskyi ◽  
S. A. Aslanyan ◽  
O. V. Borzykh ◽  
V. G. Hetman ◽  
V. E. Saphonov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Thoracic Trauma ◽  
Soft Tissues ◽  
Pleural Empyema ◽  
Main Group ◽  
Thoracic Wall ◽  
Vacuum Therapy ◽  
Medical Support ◽  
Gun Shot ◽  
Analysis Of Results

Objective. To improve the results of complex surgical treatment of wounded and injured persons with thoracic trauma, complicated by bronchopleural fistulas, pleural empyema and defects in the thoracic wall soft tissues, basing on introduction of the proposed procedure of vacuum therapy in combination with bronchoscopic obturation of certain bronchus. Materials and methods. Analysis of results of the complex surgical help delivery for 54 wounded persons with defects of the thoracic wall soft tissues, broncho-pleural fistulas and pleural empyema, caused by the combat thoracic trauma, on ІІІ and ІV levels of medical support while conduction of the Antiterrorist operation/Operation of the Joined Forces (the main group) and 73 injured persons with thoracic trauma of the peace period (the comparison group) in the 2014 - 2019 yrs period was conducted. Results. Improvement of complex surgical treatment of the wounded and damaged persons with thoracic trauma and defects of the thoracic wall soft tissues have permitted to reduce the complications frequency by 6.7%, and lethality - by 9.2% in the main group. Conclusion. There was proposed a procedure of vacuum therapy, ultrasound cavitation together with bronchoscopic bronchial obturation for its fistula, which have proved its efficacy in complex surgical treatment of severely wounded persons with the gun-shot thoracic damages and presence of combination of pleural empyema, bronchial fistula and defects of soft tissues.

Components Separation Technique and Laparoscopic Approach: A Review of Two Evolving Strategies for Ventral Hernia Repair

2005 ◽  
Vol 71 (7) ◽  
pp. 598-605 ◽  
Author(s):  
Rodrigo Gonzalez ◽  
Robert D. Rehnke ◽  
Archana Ramaswamy ◽  
C. Daniel Smith ◽  
John M. Clarke ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Ventral Hernia ◽  
Lower Incidence ◽  
Separation Technique ◽  
Wound Complications ◽  
Short Term ◽  
Components Separation ◽  
Components Separation Technique ◽  
Ventral Hernias

When faced with large ventral hernias, surgeons frequently must choose between higher incidence of recurrence after primary repair and higher incidence of wound complications after repair with mesh. The aim of this study is to compare early outcomes between laparoscopic repair (LR) and components separation technique (CST), two evolving strategies for the management of large ventral hernias. We reviewed 42 consecutive patients who underwent CST and 45 consecutive patients who underwent LR of ventral hernia defects of at least 12 cm2. Demographics, hernia characteristics, and short-term outcomes were compared between groups. Patients in the LR group were younger (53 ± 2 vs 68 ± 2 years, P < 0.0001), had greater body mass index (34 ± 2 vs 29 ± 1 kg/m2, P = 0.02), and had larger hernia defects (318 ± 49 vs 101 ± 16 cm2, P < 0.0001) than patients in the CST group. The LR resulted in shorter length of hospital stay (4.9 ± 0.9 vs 9.6 ± 1.8 days, P < 0.0001), lower incidence of ileus (7% vs 48%, P < 0.0001), and lower incidence of wound complications (2% vs 33%, P < 0.001) than the CST. Both techniques resulted in similar operative times, transfusion requirements, and mortality. Recurrences occurred in 7 per cent of patients at mean follow-up of 16 months in the CST group and 0 per cent at mean follow-up of 9 months after LR. The LR may have a short-term advantage over the CST in terms of incidence of ileus, wound complications, and hospital stay. Because of their unique advantage over traditional hernia repairs, both techniques may play a significant role in the future treatment of large ventral hernias. Adequate training will be essential for the safe and effective implementation of these techniques within the surgical community.

scholarly journals Initial UK experience with transversus abdominis muscle release for posterior components separation in abdominal wall reconstruction of large or complex ventral hernias: a combined approach by general and plastic surgeons

2017 ◽  
Vol 99 (4) ◽  
pp. 265-270 ◽  
Author(s):  
ND Appleton ◽  
KD Anderson ◽  
K Hancock ◽  
MH Scott ◽  
CJ Walsh
Keyword(s):  
Abdominal Wall ◽  
Ventral Hernia ◽  
Abdominal Wall Reconstruction ◽  
Transversus Abdominis ◽  
Fascial Closure ◽  
Wound Complications ◽  
Components Separation ◽  
Aesthetic Appearance ◽  
Ventral Hernias ◽  
Transversus Abdominis Muscle

Introduction Large, complicated ventral hernias are an increasingly common problem. The transversus abdominis muscle release (TAMR) is a recently described modification of posterior components separation for repair of such hernias. We describe our initial experience with TAMR and sublay mesh to facilitate abdominal wall reconstruction. Methods The study is a retrospective review of patients undergoing TAMR performed synchronously by gastrointestinal and plastic surgeons. Results Twelve consecutive patients had their ventral hernias repaired using the TAMR technique from June 2013 to June 2014. Median body mass index was 30.8kg/m2 (range 19.0–34.4kg/m2). Four had a previous ventral hernia repair. Three had previous laparostomies. Four had previous stomas and three had stomas created at the time of the abdominal wall reconstruction. Average transverse distance between the recti was 13cm (3-20cm). Median operative time was 383 minutes (150–550 minutes) and mesh size was 950cm2 (532–2400cm2). Primary midline fascial closure was possible in all cases, with no bridging. Median length of hospital stay was 7.5 days (4–17 days). Three developed minor abdominal wall wound complications. At median review of 24 months (18–37 months), there have been no significant wound problems, mesh infections or explants, and none has developed recurrence of their midline ventral hernia. Visual analogue scales revealed high patient satisfaction levels overall and with their final aesthetic appearance. Conclusions We believe that TAMR offers significant advantages over other forms of components separation in this patient group. The technique can be adopted successfully in UK practice and combined gastrointestinal and plastic surgeon operating yields good results.

Sign in / Sign up

Export Citation Format

Share Document