INTRAPERITONEAL ALLOPLASTY COMBINED WITH THE ANTERIOR COMPONENT SEPARATION TECHNIQUE IN GIANT INCISIONAL HERNIAS

Abstract

The use of the anterior technique of the abdominal wall components separation combined with ‘onlay’ aloplasty (ACST + onlay) in giant incisional hernias (IH) may pose a surgical challenge as it does not exclude increased intra-abdominal pressure (IAP) and the occurrence of abdominal compartment syndrome (ACS). There remains a high incidence of the surgical site complications. In our view, the use of intra-abdominal aloplasty combined with the anterior separation of the anterior abdominal wall components (ACST + IPOM) will contribute to the improvement of surgical outcomes in giant IH. Purpose: to improve the results of surgical treatment of giant IH by the use of ACST + IPOM. Materials and methods. Analysis of surgical treatment of 164 patients with giant IH aged 30 to 75 years (mean age 54.7 ± 3.3). Depending on the surgery, the patients were divided into 2 groups. Group I (82 patients) consisted of patients who underwent our modified technique, including ACST + IPOM. The surgery in group II (82 patients) involved ACST + onlay. Results and discussion. As compared with ACST + onlay, ACST + IPOM surgery contributes to a significantly reduced incidence of ACS [6.1% (group II) versus 0 (group I), (p <0.05)], seroma [25.6% versus 7.3%, p <0.05], surgical site infection (SSI) [4.9% versus 2.4%, p> 0.05], meshoma [3.7% versus 0] and hernia recurrences [6.5% versus 1.6%, p> 0.05]. Conclusions. IAP value equal or exceeding 9.1 mmHg (1.2 kPa) during the surgery in approximated rectus muscles is prognostic for ACS occurrence and requires intraoperative preventive measures. Utilization of ACST + IPOM in giant IH ensures an optimal volume of abdominal cavity without a substantial increase in IAP and reduces the probability of ACS, whereas the use of ACST + onlay results in ACN in 6.1% (p <0.05) patients. A reduced contact of the mesh with the subcutaneous tissue in ACST + IPOM contributes to a significantly lower incidence of seroma [7.3% vs 25.6% (p <0.05)], surgical site infection (SSI) [2.4% vs 4.9% (p> 0.05)], postoperative wound infiltrate [2 (2.4%) vs 11 (13.4%) (p <0.05)], chronic postsurgical pain [1 (1.6%) vs 5 (8.1%) (p> 0.05)] and recurrent IH [1 (1.6%) vs 4 (6.5%) (p> 0.05)] as compared with ACST + onlay technique.