Primary and Recurrent Repair of Incisional Hernia Based on Biomechanical Considerations to Avoid Mesh-Related Complications

Aim: Mechanical principles successfully guide the construction of polymer material composites in engineering. Since the abdominal wall is a polymer composite augmented with a textile during incisional hernia repair we ask: can incisional hernia be repaired safely and durably based on biomechanical principles?Material and Methods: Repair materials were assessed on a self-built bench test using pulse loads to elude influences on the reconstruction of the abdominal wall. Tissue elasticity was analyzed preoperatively as needed with computed tomography at rest and during Valsalva's maneuver. Preoperatively, the critical retention force of the reconstruction to pulse loads was calculated and a biomechanically durable repair was designed based on the needs of the individual patient. Intraoperatively, the design was adjusted as needed. Hernia meshes with high grip factors (Progrip®, Dahlhausen® Cicat) were used for the repairs. Mesh sizes, fixation elements and reconstructive details were oriented on the biomechanical design. All patients recieved single-shot antibiosis. Patients were discharged after full ambulation was achieved.Results: A total of 163 patients (82 males and 81 females) were treated for incisional hernia in four hospitals by ten surgeons. Primary hernia was repaired in 119 patients. Recurrent hernia was operated on in 44 cases. Recurrent hernia was significantly larger (median 161 cm2 vs. 78 cm2; u-test: p = 0.00714). Re-do surgery took significantly longer (median 229 min vs. 150 min; p < 0.00001) since recurrent disease required more often transversus abdominis release (70% vs. 47%). GRIP tended to be higher in recurrent repair (p = 0.01828). Complication rates (15%) and hospital stay were the same (6 vs. 6 days; p = 0.28462). After 1 year, no recurrence was detected in either group. Pain levels were equally low in both primary and recurrent hernia repairs (median NAS = 0 in both groups at rest and under load, p = 0.88866).Conclusion: Incisional hernia can safely and durably be repaired based on biomechanical principles both in primary and recurrent disease. The GRIP concept provides a base for the application of biomechanical principles in incisional hernia repair.

ONE OF THE METHODS OF PREVENTING THE OCCURRENCE OF POSTOPERATIVE VENTRAL HERNIAS

Снижение количества коллагена первого типа, существенно влияет на развитие ПВГ. Снизить частоту развития послеоперационных вентральных грыж можно вследствие раннего диагностирования факторов риска снижения коллагена на амбулаторном этапе подготовки к лапаротомии. Чем раньше сделана операция, тем меньше выражены изменения в тканях и органах, а само хирургическое вмешательство является менее сложным и более эффективным. При гладком течении и заживлении после первой операции можно оперировать послеоперационную грыжу спустя 6-8-10 месяцев в зависимости от вида и обширности первого вмешательства, общего состояния больного, величины и динамики роста грыжевого выпячивания. При склонности к ущемлению, а также при развивающемся синдроме спаечной непроходимости следует оперировать в возможно ранние сроки. Если в анамнезе есть указания на тяжело протекавший послеоперационный период в связи с обширным нагноением в ране, длительной тампонадой брюшной полости, тяжелой интоксикацией, перитонитом либо весьма длительным пребыванием в стационаре по поводу релапаротомии, следует выждать больший срок, примерно 12-18 месяцев. На это время надо назначить больному определенный режим, принять меры к улучшению общего состояния, уменьшению страданий в связи с развитием спаечного процесса в грыжевом мешке и в брюшной полости. По показаниям следует рекомендовать ношение хорошо прилаженного бандажа. Тhe decrease in the amount of collagen of the first type significantly affects the development of PVG. It is possible to reduce the incidence of postoperative ventral hernias due to early diagnosis of risk factors for collagen loss at the outpatient stage of preparation for laparotomy. The earlier the operation, the less pronounced changes in tissues and organs, and the surgery itself is less complex and more effective. When you smooth over and heal after the first operation can be operated incisional hernia after 6-8-10 months depending on the type and extensiveness of the first intervention, the patient's General condition, size and growth of hernial protrusion. With a tendency to infringement, as well as with the developing syndrome of adhesive obstruction, it is necessary to operate as early as possible. If in the history there are indications of a difficult postoperative period due to extensive suppuration in the wound, prolonged tamponade of the abdominal cavity, severe intoxication, peritonitis or a very long stay in the hospital for relaparotomy, you should wait a longer period, about 12-18 months. At this time, it is necessary to assign the patient a certain regime, take measures to improve the General condition, reduce suffering in connection with the development of adhesions in the hernia SAC and in the abdominal cavity. According to the indications, it should be recommended to wear a well-adjusted bandage.

Long-term follow-up of full-thickness skin grafting in giant incisional hernia repair: a randomised controlled trial

Purpose Conventional repair of a giant incisional hernia often requires implantation of a synthetic mesh (SM). However, this surgical procedure can lead to discomfort, pain, and potentially serious complications. Full-thickness skin grafting (FTSG) could offer an alternative to SM, less prone to complications related to implantation of a foreign body in the abdominal wall. The aim of this study was to compare the use of FTSG to conventional SM in the repair of giant incisional hernia. Methods Patients with a giant incisional hernia (> 10 cm width) were randomised to repair with either FTSG or SM. 3-month and 1-year follow-ups have already been reported. A clinical follow-up was performed 3 years after repair, assessing potential complications and recurrence. SF-36, EQ-5D and VHPQ questionnaires were answered at 3 years and an average of 9 years (long-term follow-up) after surgery to assess the impact of the intervention on quality-of-life (QoL). Results Fifty-two patients were included. Five recurrences in the FTSG group and three in the SM group were noted at the clinical follow-up 3 years after surgery, but the difference was not significant (p = 0.313). No new procedure-related complication had occurred since the one-year follow-up. There were no relevant differences in QoL between the groups. However, there were significant improvemnts in both physical, emotional, and mental domains of the SF-36 questionnaire in both groups. Conclusion The results of this long-term follow-up together with the results from previous follow-ups indicate that autologous FTSG as reinforcement in giant incisional hernia repair is an alternative to conventional repair with SM. Trial Registration The study was registered August 10, 2011 at ClinicalTrials.gov (ID NCT01413412), retrospectively registered.