A retrospective analysis of the causes of postoperative ventral hernia recurrence
Keywordsventral hernia, postoperative ventral hernia, polypropylene mesh, relapse, complication
Considering the results of surgical treatment of postoperative ventral hernia, a significant number of recurrences of 4.3–46 % should be noted, and in case of large and giant postoperative ventral hernias reaches up to 80 %, which is associated with demographic imbalance that is an increase in the number of persons of old and senile age with comorbidity typical for them. Excessive obesity, especially in women, requires a revision of the main surgical approaches in the choice of methods of hernioplasty. Failure to take into account the present syndrome of undifferentiated connective tissue dysplasia (UCTD) in the performance of hernioplasty and allohernioplasty in 60 % of cases leads to postoperative relapse.
Objective. On the basis of the analysis of the performed surgical treatment of patients with ventral and postoperative ventral hernia, to study the main causes of the development of recurrent hernia, which would improve the results of surgical treatment of this category of patients.
Materials and methods. The clinical section of the work is based on a retrospective analysis of the results of surgical treatment of 1419 patients who underwent surgery on the anterior abdominal wall for primary ventral and postoperative ventral hernias. The distribution of patients into groups was according to the periods of surgical treatment of patients: from 2001 to 2009 and from 2010 to2017. In the first period, 597 (42.07%) patients who made the comparison group were examined and operated. The main group (2010–2017) amounted to 822 (57.93 %) patients.
To determine the localization, size and extent of hernial bulging in defects of the anterior abdominal wall, we used the classification of the European Association of Surgeons-Herniologists (EHS-classification, 2008).
In the comparison group, R1 was observed in 123 (93.18 %) patients, R2 – in 6 (4.55 %), R3 – in 2 (1.51%), R4 and more – in 1 (0.76 %). In the main group: R1 was observed in 63 (71.59 %) patients, R2 – in 18 (20.45 %), R3 – in 5 (5.68 %), R4 and more – in 2 (2.28 %).
Results. In 250 (17.62 %) patients, recurrent hernia developed after various types of surgery. The highest recurrence rate was observed in patients after own tissue hernioplasty, which was 36.07 % of all operated patients according to this procedure. In second place, by the frequency of relapse were patients after performed allohernioplasty using inlay technique – 19.63 %. The recurrence rate after allohernioplasty by the onlay technique is, according to our study, 10.58 %. After performing the sublay technique, the results obtained differ significantly with a low percentage of relapses compared to other methods of hernioplasty. Thus, the recurrence was only in 6.01 % of cases. The only method of surgical treatment of POVH with no recurrence was the method of hernioplasty with anatomic separation of the components of the anterior abdominal wall (CST), which was performed in two variants – without the use of polypropylene mesh (PPM) by Ramirez and combined one using PPM. Such data may be explained by the small number of completed surgery interventions (45 (3.17%)) and short observation periods (4 years).
Conclusions. Analyzing the causes of recurrence, it can be argued that the main ones are the choice of inadequate method of hernioplasty to a specific clinical situation, incomplete revision of the musculo-aponeurotic layer of the anterior wall, especially in patients with postoperative ventral hernias and concomitant undifferentiated connective tissue dysplasia and obesity, the presence of hidden (small in size and clinically intact) defects and weaknesses, incorrect choice of mesh implant type (“light” or “heavy” polypropylene mesh) and its size, choice of inappropriate material thickness.
Holihan JL, Nguyen DH, Nguyen MT, Mo J, Kao LS, Liang MK (2016) Mesh location in open VH repair: a systematic review and network meta-analysis. World J Surg 40:89–99.
Venclauskas L, Maleckas A, Kiudelis M (2010) One-year follow-up after incisional hernia treatment: results of a prospective randomized study. Hernia 14:575–582.
Breuing K, Butler CE, Ferzoco S, Franz M, Hultman CS, Kilbridge JF et al (2010) Incisional VHs: Review of the literature and recommendations regarding the grading and technique of repair. Surgery 148(3):544–558.
Novitsky YW, Orenstein SB (2013) Effect of patient and hospital characteristics on outcomes of elective VH repair in the United States. Hernia 17:639–645.
Kohler G, Weitzendorfer M, Kalcher V, Emmanuel K (2015) Synthetic mesh repair for incisional hernia treatment in high-risk patients for surgical site occurrences. Am Surg 81(4):387–394.
Luijendijk R, Hop WCJ, van den Tol P, de Lange DCD, Braaksma MMJ, Ijzermans JNM et al (2000) A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 343(6):392–398.
Piatnochka V. (2019) Outcomes of surgical treatment of obese patients with ventral and incisional hernias. Archives of the Balkan Medical Union vol. 54, no. 1: 104-109.
Dziubanovskyi I, Piatnochka V. (2009) Early complications after allogernioplasty of postoperative hernia of abdominal wall. Clinical Surgery. (11/12):33-4.
Bansal VK, Misra MC, Babu D, Singhal P, Rao K, Sagar R et al (2012) Comparison of long-term outcome and quality of life after laparoscopic repair of incisional and VHs with suture fixation with and without tacks: a prospective, randomized, controlled study. Surg Endosc 26:3476–3485.
Rickert A, Kienle P, Kuthe A, Baumann P, Engemann R, Kuhlgatz J et al (2012) A randomised, multi-centre, prospective, observer and patient blind study to evaluate a non-absorbable polypropylene mesh vs. a partly absorbable mesh in incisional hernia repair. Langenbecks Arch Surg 397:1225–1234.
Iqbal CW, Pham TH, Joseph A, Mai J, Thompson GB, Sarr MG (2007) Long-term outcome of 254 complex incisional hernia repairs using the modified rives-stoppa technique. World J Surg 31(12):2398–2404.
Wassenaar E, Schoenmaeckers E, Raymakers J, van der Palen J, Rakic S (2010) Mesh-fixation method and pain and quality of life after laparoscopic ventral or incisional hernia repair: a randomized trial of three fixation techniques. Surg Endosc 24:1296–1302.
How to Cite
The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
Number of views and downloads: 58
Number of citations: 0