TREATMENT METHODS OF PATIENTS WITH POSTOPERATIVE VENTRAL HERNIAS AND CREATED INTESTINAL FISTULAS

Abstract

Objective. To substantiate the methods of surgical treatment in patients with postoperative ventral hernias and created intestinal fistulas based on the comparison of the outcomes of one-stage and two-stage operations. Methods. The analysis of patients (n=40) with postoperative ventral hernias and created intestinal fistulas imposed for therapeutic purposes or created as the treatment outcomes of uncreated fistulas has been performed. Jejunal fistulas were present in 7 patients (17.5%), ileal fistulas in 18 (45%), and colonic fistulas in 15 (37.5%) patients. The patients of group 1 (n=15, 37.5% ) underwent the two-stage operations. First, the fistula was closed with the access to the site of its location, and then after 3-6 months, the excision of hernia was performed. In patients of group 2 (n=25, 62.5%) fistula was simultaneously removed and hernia was excised. The «tension-free»techniquesinhernia orifice repair in those groups was performed. The outcomes were evaluated by the number of local and general complications in the period from 10 days to 6 months. Results. Wound complications after the first operation developed in 2 (13.3%) patients in the 1st group. There were no complications after the second stage of hernioplasty. In group 2, wound complications developed in 3 (12%) patients. There was no anastomotic failure in the groups. In the long terms, good results were obtained in 15 patients in group 1 and in 25 patients in group 2. The use of anterior prosthetic «tension-free»techniques of plastic surgery by the combined methods in one-stage allows obtaining results comparable to two-stage operations. Conclusion. In patients with hernias and intestinal fistulas, the method of treatment in one-stage or two-stages depends on the possibility of the gastrointestinal restoring patency from minimally invasive access in the site of the fistula location. What this paper adds For the first time, the indications for performing operations with postoperative ventral hernias and intestinal fistulas in one-stage and two-stage operations have been substantiated. Treatment option for patients with hernias and intestinal fistulas has been found to depend on the possibility of the gastrointestinal patency restoring from minimally invasive access in the site of the fistula location.