The use of the anterior technique of the abdominal wall components separation combined with ‘onlay’ aloplasty (ACST + onlay) in giant incisional hernias (IH) may pose a surgical challenge as it does not exclude increased intra-abdominal pressure (IAP) and the occurrence of abdominal compartment syndrome (ACS). There remains a high incidence of the surgical site complications. In our view, the use of intra-abdominal aloplasty combined with the anterior separation of the anterior abdominal wall components (ACST + IPOM) will contribute to the improvement of surgical outcomes in giant IH.
Purpose: to improve the results of surgical treatment of giant IH by the use of ACST + IPOM.
Materials and methods. Analysis of surgical treatment of 164 patients with giant IH aged 30 to 75 years (mean age 54.7 ± 3.3). Depending on the surgery, the patients were divided into 2 groups. Group I (82 patients) consisted of patients who underwent our modified technique, including ACST + IPOM. The surgery in group II (82 patients) involved ACST + onlay.
Results and discussion. As compared with ACST + onlay, ACST + IPOM surgery contributes to a significantly reduced incidence of ACS [6.1% (group II) versus 0 (group I), (p <0.05)], seroma [25.6% versus 7.3%, p <0.05], surgical site infection (SSI) [4.9% versus 2.4%, p> 0.05], meshoma [3.7% versus 0] and hernia recurrences [6.5% versus 1.6%, p> 0.05].
Conclusions. IAP value equal or exceeding 9.1 mmHg (1.2 kPa) during the surgery in approximated rectus muscles is prognostic for ACS occurrence and requires intraoperative preventive measures. Utilization of ACST + IPOM in giant IH ensures an optimal volume of abdominal cavity without a substantial increase in IAP and reduces the probability of ACS, whereas the use of ACST + onlay results in ACN in 6.1% (p <0.05) patients. A reduced contact of the mesh with the subcutaneous tissue in ACST + IPOM contributes to a significantly lower incidence of seroma [7.3% vs 25.6% (p <0.05)], surgical site infection (SSI) [2.4% vs 4.9% (p> 0.05)], postoperative wound infiltrate [2 (2.4%) vs 11 (13.4%) (p <0.05)], chronic postsurgical pain [1 (1.6%) vs 5 (8.1%) (p> 0.05)] and recurrent IH [1 (1.6%) vs 4 (6.5%) (p> 0.05)] as compared with ACST + onlay technique.
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