Functional alloplasty of recurrent postoperative hernias of the anterior abdominal wall

Abstract

   Aim. To optimize the surgical treatment of recurrent postoperative ventral hernias using synthetic alloplastic materials.   Material and methods. The study was conducted among 139 patients with recurrent postoperative ventral hernias. According to the indications, all patients underwent abdominoplasty using mesh biologically inert alloprostheses using the “onlay” method and according to the original method with the displacement of the vaginal leaves mm. recti abdominis.   Results and discussion. Recurrence of ventral hernias after the first year of follow-up was detected in 6 (4.3 %) patients. The causes of relapses in large hernias are dystrophic processes in the soft tissues of the anterior abdominal wall, caused both by the activation of fibroblasts upon contact with the polypropylene mesh, and directly by the defect of the mesh as a result of its rupture. In the event of a recurrence, reconstructive surgeries were performed in the scope of a modified technique with component separation to eliminate additional tissue tension.   Conclusion. The developed method of surgical treatment of postoperative ventral hernias involves dissection of the anterior walls of the sheath of the rectus abdominis muscles along the the muscles, suturing the aponeurotic edges of the defect, connecting the rectus muscles along the midline, followed by fixing the mesh implant to the outer edges of the dissected aponeurosis of the rectus abdominis muscles, which makes it possible to prevent the occurrence of cicatricial degeneration and defect of functional activity, as demonstrated by monitoring the function of the rectus abdominis muscles.