Complications of ventral hernia alloplasty: treatment and prevention

Background. Postoperative ventral hernias (PVH) account for 22.4-25.0 % of the total number of abdominal hernias. Complications of PVH alloplasty are divided into general (abdominal compartment syndrome (ACS), acute intestinal obstruction, pneumonia, pulmonary embolism) and local (seroma, hematoma, suppuration, marginal skin defect, calcification, fistula). Objective. To describe the treatment and prevention of complications of PVH alloplasty. Materials and methods. Analysis of literature data on this topic. Results and discussion. ACS occurs after alloplasty of giant PVG as a result of a steady increase in intra-abdominal pressure (IAP) >12 mm Hg within 6-12 hours after surgery. ACS is caused by the excessive tension of the supporting structures of the abdominal wall and a decrease in the volume of the abdominal cavity. The growth of IAP leads to compression of large vessels, kidneys, increased intrathoracic pressure with the development of heart and lung failure, so during and after surgery it is necessary to monitor this parameter with the help of Foley catheter. Prevention of ACS is carried out by the optimal choice of the method of compartment separation. In the postoperative period, anesthesia (paracetamol – Infulgan, “Yuria-Pharm”), oxygen therapy, abdominal bandaging, nonsteroidal anti-inflammatory drugs (NSAID), medications for the correction of water-electrolyte metabolism (Reosorbilact, “Yuria-Pharm”) are prescribed. Among wound complications seroma is the most common (30.8-60.4 %). Methods of its treatment include vacuum drainage, puncture, antibiotics and NSAID. In presence of localized limited infection in the tissues of the abdominal wall around the mesh, excision of the mesh area with granulomas within healthy tissues, washing of the wound with Dekasan solution (“Yuria-Pharm”) and defect plastics are indicated. Antibiotic therapy is performed according to sensitivity. In the presence of a widespread infection in the tissues of the abdominal wall along the perimeter of the mesh, its explantation is indicated. Repeated direct alloplasty in such cases is contraindicated. Prevention of wound complications includes antibiotic prophylaxis (ceftriaxone 2 g), adequate choice of alloplasty, washing of the surgical wound with Dekasan solution at the different stages of surgery, vacuum drainage and ultrasound monitoring. Conclusions. 1. Optimization of prevention of wound complications during non-purulent surgical interventions is reached by washing of the surgical wound with Dekasan solution. 2. Optimization of prevention of wound complications during conditionally clean (non-purulent) surgical interventions is reached by antibiotic prophylaxis and washing of the surgical wound with Dekasan solution at various stages of surgical dissection.