Experience in performing posterior separation plasty in giant postoperative ventral hernias

Abstract

Aim. To present the experience in performing posterior separation plasty according to Yu. Novitskiy, to evaluate the efficacy and safety of the technique. 
 Methods. The results of treatment of 22 patients with giant middle postoperative ventral hernias, treated in the surgical department №1 of Kazan City clinical hospital №7 in 2013-2016, were analyzed. 9 patients had open posterior separation plasty of the abdominal wall in Yu. Novitskiy’s modification performed (study group). Comparison group included 13 patients who had standard tension-free inlay-plasty. 
 Results. The average duration of surgery in the study group was 143.9±10.7 min, in comparison group - 136.6±12.1 min. In the study group there were no serious complications in the immediate postoperative period. In 3 cases at control ultrasound examination clinically insignificant seromas were found which did not require additional treatment and self-resolved within the period of 3 weeks. In one case there was lymphorrhea from the wound for 9 days. Healing of a surgical wound in all cases was by primary intention. Average hospital stay was 10.2±0.6 days. There were no lethal outcomes. Recurrence of the disease in the observed period was not registered. 
 Conclusion. Posterior separation plasty of the abdominal wall in Yu. Novitskiy’s modification is a safe and effective technique that allows recommending this surgery to the surgeons operating patients with giant postoperative ventral hernias.

Axioms and theorems in the treatment of large and giant postoperative hernias

“…The main methods are IPOM, onlay, inlay, and sublay (sublay preperitoneal -SPP and sublay retromuscular -SRM) [28,30]. The correlation of relapses/complications with the use of onlay and inlay techniques in patients with large hernial orifice sizes has been proven [26,33]. Regarding IPOM technology, there is evidence of the development of a pronounced adhesive process in the abdominal cavity in the early stages, even with composite anti-adhesive materials.…”

“…A variant of the SRM prosthetic plastic contains the individual elements of the CST. At the same time, in the case of hernial defects W3-W4 with a significant loss of the SRM domain, plastic surgery is not enough to repair AAW in compliance with the tension-free principle [33,35,37]. The Rives-Stoppa technique, despite its durability, is limited by the lateral border of the posterior vagina of the rectus abdominis muscle and, therefore, is not always applicable for large defects of the AAW [38].…”

“…Several modifications of this technique have been developed based on separating anatomical components of the abdominal wall [36,37]. In principle, the described methodological approaches can be classified into the technique of anterior component separation (ACS) and the technique of posterior component separation (PCS) [31,33,39]. The ACS technique was suggested by Ramirez et al at the end of the last century to close the abdominal wall defect along the midline without using prosthetic material [36,37,40].…”