MINI-INVASIVE TECHNIQUES FOR LATERAL VENTRAL HERNIA TREATMENT

After surgical interventions with approaches through abdominal oblique muscles, we could observe lateral ventral hernias in 40% patients. They are less frequent in the structure of postoperative ventral hernias as such surgical approaches are not often employed. However, technical difficulties of abdominal wall repair and unsatisfactory immediate and long-term treatment results are to be observed by surgeons. Recurrence rate of lateral hernias after autoplasty is 20–30%, and following meshed explants application – 5%. These unsatisfactory outcomes in the operated on patients necessitate analysis of complication and recurrence causes and search for their possible ways of solutions.

Objective. Improve results of surgery in patients with lateral postoperative ventral hernias.

Material and Methods. For 2012–2017 we have operated on 36 patients with postoperative lateral ventral hernias: 15 with open approaches and 21 with laparoscopy. To analyse treatment results we have been monitoring early postoperative period for 7–10 days, analysed pain syndrome and complications – seromas, hematomas and wound complications. In 6 months and 1 year postoperatively we observed presence of chronic pain syndrome, satisfaction of patients with surgery results and lack of hernia recurrence.

Results. After open surgery we observed 4 cases with seromas, pain syndrome according to VAS was from 7 to 8 points for 3–4 days. Hospital stay was 9 ± 2 days. Two patients complained pain syndrome in 6 months postoperatively and in a year after conservative treatment none of those suffered any pain syndrome. In an early postoperative period after laparoscopy there were no complications observed. Pain syndrome was 4–5 points according to VAS. Due to minor pain syndrome and lack of wound complications mean period of hospital stay was 5 ± 2 days. No pathological events in long term period linked to mesh transplant were not registered.

Conclusion. Treatment of lateral hernias is complicated by lateral abdominal wall structure, presence of four nerve trunks and neuropathic element with hernia formation with denervation and lateral abdominal wall laxity. Laparoscopy has several advantages for surgical treatment of these type of hernias. Application of mini-invasive techniques for lateral ventral hernia treatment has impact on reduction of early postoperative complication rate and hospital stay and possible risk of pain syndrome development in a long-term postoperative period. This application is limited only by presence of adhesions or unfavourable comorbidities that increase risk of intraoperative complications related to necessitated intra-abdominal pressure elevation. In cases with contraindications for mini-invasive techniques one should perform open intramuscular or preperitoneal hemioplasty.

1. Ботезату A.A., Монул С.Г. Хирургическое лечение боковых и поясничных грыж живота. Вестник Приднестровского университета. Медико-биологические и химические науки. 2016;2(53):12–7.

2. Федосеев A.B., Муравьев С.Ю., Бударев B.H., Инютин А.С., Зацаринный В.В. Некоторые особенности белой линии живота как предвестники послеоперационной грыжи. Российский медико-биологический вестник им. акад. И.П. Павлова. 2016;1:109–15.

3. Суковатых Б.С., Валуйская H.M., Праведникова H.B., Нетяга A.А., Касьянова А.А., Жуковский В.А. Профилактика и лечение послеоперационных грыж боковых стенок живота при помощи полипропиленового эндопротеза. Вестник хирургии. Вопросы общей и частной хирургии. 2011;3:53–7.

4. Patel РР, Warren JA, Mansour R, Cobb 4th WS, Carboneil AM. A large single-center experience of open lateral abdominal wall hernia repairs. Am Surg. 2016;82(7):608–12. PMID: 27457859.

5. Chevrel JP, Rath AM. Classification of incisional hernias of the abdominal wall. Hernia. 2000;4(1):7–11.

6. Tatay FC, Egea AM, Latifi R. Management of Flank Complex Hernia 17. Surgery of Complex Abdominal Wall Defects: Practical Approaches. 2017; 167 p.