Simultaneous interventions in surgical gastroenterology and herniology: prediction and prevention of complications

The aim of the study - to improve the results of simultaneous surgical treatment of patients with large ventral hernias and incisional hernias W3 and concomitant surgical pathology of the abdominal organs. Material and methods. The article analyzes the results of surgical treatment of 450 patients with primary and postoperative hernias of the abdominal wall. 95 (21.1%) patients were urgently operated on. In 76 (16.9%) patients with large ventral and incisional W3 hernias, posterior separation hernioplasty was performed using TAP technology. In the presence of concomitant surgical pathology of the abdominal organs, simultaneous surgical interventions were performed. Results. In sublay and IPOM groups, 14 (3.7%) patients underwent laparoscopic sleeve resection of the stomach, 16 (4.3%) patients - laparoscopic cholecystectomy, and 4 (1.1%) patients -TAPP hernioplasty. In TAR group, 9 (11.8%) patients underwent open cholecystectomy, 12 (15.8%) - transverse abdominoplasty, 3 (3.9%) - open sleeve resection of the stomach, 2 (2.6%) - closure of the colostomy. The average duration of pain in the postoperative period was 4.5±0.9 days. The average duration of hospitalization was 9.7±1.1 days. In the postoperative period, 2 patients developed surgical site infection. There was no mortality. Conclusions. Modern simultaneous interventions in surgical gastroenterology and herniology with risk stratification of specific and nonspecific complications are an actuale social, medical and economic problem. An individual and differentiated approach to choice of simultaneous surgical intervention method taking into surgical and anesthetic risks and patients comorbidity, can reduce the percentage of postoperative complications and improve patient’s life quality.

abdominal wall hernias, hernioplasty, mesh, separation hernioplasty, abdominoplasty, simultaneous interventions

1. Parshikov V. V., Loginov V. I. An abdominal wall components separation technique in treatment of patients with ventral and incisional hernias (review). Sovremennye tehnologii v medicine. 2016;8(1): 182-194. (In Russ) doi: 10.17691/stm2016.8.1.24.@@ Паршиков В. В., Логинов В. И. Техника разделения компонентов брюшной стенки в лечении пациентов с вентральными и послеоперационными грыжами (обзор). Современные технологии в медицине. 2016;8(1): 183-194. doi: 10.17691/stm2016.8.1.24.

2. Ramirez O.M., Ruas E., Dellon A. L. «Components separation» method for closure of abdominal-wall defects: an anatomic and clinical study. Plastic and reconstructive surgery. 1990;86(3): 519-526. doi: 10.1097/00006534-199009000-00023.

3. Hultma C.S., Tong W. M., Kittinger B. J., Cairns B., Overby D. W., Rich P. B. Management of recurrent hernia after components separation: 10-year experience with abdominal wall reconstruction at an academic medical center. Annals of Plastic Surgery. 2011;66(5): 504-507. doi: 10.1097/SAP.0b013e31820b3d06.

4. Ko J.H., Wang E. C., Salvay D. M., Paul B. C., Dumanian G. A. Abdominal wall reconstruction: lessons learned from 200 «components separation» procedures. Archives of surgery. 2009;144(11): 1047-1055. doi: 10.1001/archsurg.2009.192.

5. Espinosa-de-los-Monteros A., de la Torre J. I., Marrero I., Andrades P., Davis M. R., Vásconez L. O. Utilization of human cadaveric acellular dermis for abdominal hernia reconstruction. Annals of Plastic Surgery. 2007;58(3): 264-267. doi: 10.1097/01.sap.0000254410.91132.a8.

6. Gonzalez R., Rehnke R. D., Ramaswamy A., Smith C. D., Clarke J. M., Ramshaw B. J.Components separation technique and laparoscopic approach: a review of two evolving strategies for ventral hernia repair. The American surgeon. 2005;71(7): 598-605.

7. Clarke J. M. Incisional hernia repair by fascial component separation: results in 128 cases and evolution of technique. The American Journal of Surgery. 2010;200(1): 2-8. doi: 10.1016/j.amjsurg.2009.07.029.

8. Saulis A.S., Dumanian G. A. Periumbilical rectus abdominis perforator preservation significantly reduces superficial wound complications in «separation of parts» hernia repairs. Plastic and reconstructive surgery. 2002;109(7): 2275-2280. doi: 10.1097/00006534-200206000-00016.

9. Pauli E.M., Rosen M. J. Open ventral hernia repair with component separation. Surgical Clinics of North America. 2013;93(5): 1111-1133. doi: 10.1016/j.suc.2013.06.010.

10. Rives J., Pire J. C., Flament J. B., Palot J. P., Body C. Treatment of large eventrations. New therapeutic indications apropos of 322 cases. Chirurgie. 1985;111(3): 215-225.

11. Stoppa R., Petit J., Abourachid H., Henry X., Duclaye C., Monchaux G., Hillebrant J. P. Original procedure of groin hernia repair: interposition without fixation of Dacron tulle prosthesis by subperitoneal median approach. Chirurgie; memoires de l’Academie de chirurgie. 1973;99(2): 119-123.

12. Stoppa R. E. The treatment of complicated groin and incisional hernias. World journal of surgery. 1989;13(5): 545-554. doi: 10.1007/BF01658869.

13. Wantz G. E. Giant prosthetic reinforcement of the visceral sac: the Stoppa groin hernia repair. Surgical Clinics of North America. 1998;78(6): 1075-1087. doi: 10.1016/S0039-6109(05)70370-4.

14. Jin J., Rosen M. J. Laparoscopic versus open ventral hernia repair. Surgical Clinics of North America. 2008;88(5): 1083-1100. doi: 10.1016/j.suc.2008.05.015.

15. Novitsky Y.W., Elliott H. L., Orenstein S. B., Rosen M. J. Transversus abdominis muscle release: a novel approach to posterior component separation during complex abdominal wall reconstruction. The American Journal of Surgery. 2012;204(5): 709-716. doi: 10.1016/j.amjsurg.2012.02.008.

16. Carbonell A.M., Cobb W. S., Chen S. M. Posterior components separation during retromuscular hernia repair. Hernia. 2008;12(4): 359-362. doi: 10.1007/s10029-008-0356-2.

17. Israelsson L.A., Smedberg S., Montgomery A., Nordin P., Spangen L. Incisional hernia repair in Sweden 2002. Hernia. 2006;10(3): 258-261. doi: 10.1007/s10029-006-0084-4.

18. Novitsky Y.W., Porter J. R., Rucho Z. C., Getz S. B., Pratt B. L., Kercher K. W., Heniford B. T. Open preperitoneal retrofascial mesh repair for multiply recurrent ventral incisional hernias. Journal of the American College of Surgeons. 2006; 203(3): 283-289. doi: 10.1016/j.jamcollsurg.2006.05.297.

19. Paajanen H, Hermunen H. Long-term pain and recurrence after repair of ventral incisional hernias by open mesh: clinical and MRI study. Langenbeck’s Archives of Surgery. 2004;389(5): 366-370. doi: 10.1007/s00423-003-0440-0.

20. Kron I.L., Harman P. K., Nolan S. P. The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration. Annals of Surgery. 1984;199(1): 28-30. doi: 10.1097/00000658-198401000-00005.

21. Tarasova I. A., Lidzhieva E. A., Elifkhanova Kh.U., Shestakov A. L., Oettinger A. P. Enhanced recovery after surgery programs in herniology.Russian Journal of Evidence-based Gastroenterology. 2021;10(4): 57-66. (In Russ.). doi: 10.17116/dokgastro2021100 4157.@@ Тарасова И. А., Лиджиева Е. А., Элифханова Х. У., Шестаков А. Л., Эттингер А. П. Программа ускоренного выздоровления хирургических больных в герниологии. Доказательная гастроэнтерология. 2021;10(4): 57-66. doi: 10.17116/dokgastro2021100 4157.