Infectious and inflammatory complications after endoscopic hernioplasty in patients with postoperative ventral hernias: features of diagnosis and treatment strategies

Abstract

An algorithm for the diagnosis and treatment of infectious and inflammatory complications after endovideosurgical hernioplasty in patients with postoperative ventral hernias using traditional and minimally invasive methods of therapy was proposed. The study was based on the treatment results of 177 patients who underwent endovideosurgery for postoperative ventral hernias. Despite the perioperative antibiotic prophylaxis according to the accepted at the S.M. Kirov Military Medical Academy, according to the protocol scheme (first-generation cephalosporin at a dose of 1 g once parenterally 30 min before the operation, followed by repeated administration in case of operation duration of > 3 h), course of the early postoperative period on days 3–5 in 8 (4,5%) patients after endovideosurgical hernioplasty was complicated by suppuration in the intervention area. When analyzing the causes of infectious and inflammatory complications, in both the main and control groups of observations, all suppuration in the area of surgical interventions was diagnosed in patients with metabolic syndrome (stages II–III obesity and type 2 diabetes mellitus). The use of the “negative pressure wound therapy” resulted in wound cleansing for 4.1 ± 2.5 days (p < 0.05) and was comparable with the traditional method of treatment, but more active growth of granulation tissue prevailed in the wound, which contributed to its accelerated healing. The “negative pressure wound therapy” is effective in the systemic infectious and inflammatory process, especially after prosthetic hernioplasty of large W3-postoperative hernias. Drainage of abscesses under ultrasound navigation is possible with small (S ≤ 10 cm²) delimited purulent processes in the area of the polypropylene implant with the preservation of the latter.

Keywords

postoperative hernias / infectious and inflammatory complications / laparoscopic hernioplasty with a mesh implant Intraperitoneal onlay mesh / Enhanced view total extraperitoneal plasty / drainage of abscesses under ultrasound navigation / Negative pressure wound treatment / polypropylene implant

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RIGHTS & PERMISSIONS

Semenov V.V., Prudyeva S.А., Kurygin A.A.