[Treatment of large postoperative hernias using intraperitoneal meshes]

Abstract

Most common hernias among men and women are inguinal hernias (75-80%) and postoperative (incisional) hernias (8-10%). Management of large incisional hernias (hernia gate bigger than 10 cm) both primary and recurrent could be an encounter for a surgeon. In surgical repair of large hernia use of synthetic materials (mesh) is being prefered. Using mesh can significantly decrease recurrence rate (<10%), compare to operations without synthetic grafts where risk of recurrence can reach 50%. One of the methods of surgical treatment of large abdominal hernias is intraperitoneal placing of implants. For such purpose complex meshes (multi-layered) should be used to prevent adhesion of the mesh to the intestines and avoid dangerous complications such as migration of the mesh through the tissues, perforation of the urine bladder, small and large intestine, forming fistulas and blocking intestines.

The aim: Presentation of own experience in dealing with patients with large postoperative abdominal hernias using composite meshes: Bard--Composix Mesh, Parietex--Composite Sofradim and Proceed Ethicon.

Material and methods: Since 2003 to 2006 were performed 7 surgical repairs of large abdominal hernia via an open aproach.

Patients: 3 male, 4 female, average age 47 years old. Every hernia gate was wider than 15 cm. Bard mesh was used three times, Sofradim and Ethicon two times. Mesh was implanted without tension with single sutures and overlap of more than 5 cm from the edge of the hernia gate. Mesh was separated from intestines with greater momentum if it was possible. Anticoagulant and antibiotic preventive therapies were applied as a rule.

Results: Average time of operation was 140 minutes; average time of postoperative hospitalization was 8 days. Only one case was complicated with seroma which was treated with transcutaneous punctures with good result.

Conclusions: (1) Surgical treatment of large abdominal hernia using composite mesh (intraperitoneal). in selected cases has good results. (2) The limiting factor of using presented method is not enough refunding by NFZ of costs of this procedure.