SURGICAL TREATMENT OF INCISIONAL VENTRAL HERNIAS OF GREAT SIZES USING POLYPROPYLENE MESH MODIFIED BY CARBON NANOTUBES AND AN ANTISEPTIC

Lutkovskyi R. A.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

In surgical treatment of incisional ventral hernia (IVH) of great sizes, modified surgical technique Ramirez in combination with alloplasty using polypropylene mesh, buth this is accompanied by a fairly high freguency of postoperative complications from the postoperative wound. In our view, the use of a polypropylene mesh modified by carbon nanotubes and an antiseptic of polyhexamethleneguanidme chloride in combination with the surgical technique Ramirez will improve the results of surgical treatment of IVH. Aim – to improve the results of surgical treatment of incisional ventral hernias of great proportions by using the surgical technique Ramirez in alloplasty «sublay» in combination with modified polypropylene mesh. Object and methods. The analysis of surgical treatment of 164 patients with IVH of great sizes has been performed. Depending on the type of mesh used during surgical treatment, patients were divided into 2 groups. In 82 (50%) of Group I patients, the component surgical technique Ramirez in combination with the «sublay» aloplasty with the use of a modified polypropylene mesh. In the 2nd group, 82 (50%) patients used the component surgical technique Ramirez in combination with the «sublay» aloplasty with the use of a classic polypropylene mesh. Results and discussion. Statistically significant results were obtained in patients of Group I compared to Group II: seroma was in 25 (30.5±1.2%) in Group II compared to 6 (7.3±0.5%) in Group I (p<0.05),respectively, the suppuration of the postoperative wound – 8 (9.8±0.5%) to 1 (1.2±0.2%) (p<0.05). The terms of stay of patients of group II on inpatient treatment – 12±2,2 days group II – 7±1 days. Long-term results: ligature fistulas of the anterior abdominal wall were detected in 5 (6.7±0.5%) patients of group II, in patients of group I of the ligature fistulas were not detected (p<0.05), meshoma – in 3 (4±0.3%) of patients in group II, in group I there was no stir (p>0.05). Chronic pain in the abdominal wall in 6 – 8 months after surgery was observed in 6 (8±0.6)% patients in group II and in 1 (1.3±0.2%) group I (p>0.05), recurrences of hernia were found in 7 (9.3±0.6%) patients of group II, in group I – in 1 (1.3±0.2)% (p<0.05). Conclusion. Surgical treatment of IVH of great size using the component surgical technique Ramirez in combination with the «sublay» aloplasty with the use of a modified polypropylene mesh is more effective compared with the use of the classical polypropylene mesh, namely, reducing the freguency of seroma from 30.5±1.2% in the II group of patients to 7.3±0.5% in group I, respectively, suppurations of postoperative wounds – from 9.8±0.5% to 1.2±0.2%, inflammatory infiltrates – from 12.2±0.6% to 1.2±0.2%, ligaturial fistulas of the anterior abdominal wall – from 6.7±0.5% to 0%, meshoma – from 4±0.3% to 0%, chronic postoperative pain – from 8±0.6% to 1.3±0.2%, recurrence of hernia – from 9.3±0.6% to 1.3±0.2%.

incisional ventral hernia, modified polypropylene mesh, postoperative wound complications

1. Feleshtynskyy YaP. Pislyaoperatsiyni hryzhi zhyvota. Kyyiv: TOV «Biznes-Lohika»; 2012. 200 s. [in Ukrainian].
2.  Mishalov VH, Burka AO, Teslyuk II. Khirurhichne likuvannya khvorykh z pislyaoperatsiynymy hryzhamy poperekovo-bokovykh dilyanok zhyvota. Khirurhiya Ukrayiny. 2015 Ber;1(25):99-105. [in Ukrainian].
3. Cheatham ML, White MW, Sagraves SG. Abdominal perfusion pressure: a superior parameter in the assessment of intra-abdominal hypertension. J. Trauma. 2000;49(4):621-6.
4. Krpata DM, Blatnik JA, Novitsky YW, Rosen MJ. Posterior end open anterior components separations: a comparative analysis. Am. J. Surg. 2012;203:318-22. Available from: https: // doi.org / 10.1016 / i.amjsurg. 2011.10.009
5.  Sanders DL, Kingsnorth AN. From ancient to contemporary times: a concise history of incisional hernia repair. Hernia. 2011;16:1-7.
6.  Mirzabekyan YuR, Dobrovolskiy SR. Prognoz i profilaktika ranevykh oslozhneniy posle plastiki peredney bryushnoy stenki po povodu posleoperatsionnoy ventralnoy gryzhi. Khirurgiya. 2008 Yanv;1:66-71. [in Russian].
7. Millbourn D, Cengiz Y, Israelsson LA. Risk factors for wound complications in midline abdominal incisions related to the size of stitches. Hernia. 2011;15:261-6.
8. Lutkovskyy RA. Reaktsiya tkanyn na polipropilenovi sitchasti implantaty. Visnyk morfolohiyi. 2017;23(2):295-9. [in Ukrainian].
9.  Lutkovskyy RA. Morfolohichnyy ta morfometrychnyy analiz zmin v tkanynakh pry implantatsiyi sitchastykh implantativ z polipropilenu modyfikovanoho vuhletsevymy nanotrubkamy ta antyseptykom. Visnyk Vinnytskoho natsionalnoho medychnoho universytetu. 2018;22(1):19- 23. [in Ukrainian].

«Bulletin of problems biology and medicine» Issue 1 Part 2 (149), 2019 year, 167-170 pages, index UDK 616-007.43-089:546.26:539.5+615.28

10.29254/2077-4214-2019-1-2-149-167-170