Technologies of Prosthetic Plasty of Strangulated Hernia

Abstract

Summary. Surgical treatment of hernia with the use of prosthetic plasty methods is a pressing problem of modern surgery and herniology. The use of mesh implants for strangulated hernias needs further development and improvement.
 Material and methods. 375 strangulated hernias of various localization were subjected to analysis (12.8 % of all hernias (2926) for the period 2005-2018), of which inguinal — 138 (36.8 %), femoral — 31 (8.3 %), umbilical — 112 (29.9 %), white line of the abdomen — 31 (8.3 %), postoperative — 63 (16.8 %). Autohernioplasty was performed in 134 (35.7 %), prosthetic plasty — in 241 (64.3 %) (on lay — 5, sub lay — 121, in lay — 7, Liechtenstein’s operation - 102).
 Results. For the periods 2005-2010. and 2011-2018. the relative amount of autohernioplasty decreased 2.6 times (from 57.3 % to 22.4 %) (p <0.0001, χ2 = 32.605), and prosthetic plasty increased 1.8 times (from 42.7 % to 77.6 %) (p <0.0001, χ2 = 59.784). The resection of the intestine was performed when the hernia was strangulated in 31 cases, and in with autohernioplasty - in 17 cases (54.8 %) and allohernioplasty - in 14 (45.2 %). Opportunities for the use of a mesh implant, even with bowel resection, were found in 45.2 % of patients. Postoperative mortality was 0.53 % (2 patients).
 Conclusion. 1. The use of mesh implants for strangulated hernias is characterized by an increase in the frequency of their use by a factor of 1.8. 2. When resecting the intestine for strangulated hernia, prosthetic plasty can be performed in 45.2 % of patients. 3. The developed technologies of implant fixation at reference points, the use of two-layer prosthetic plasty can reduce the number of relapses and improve the results of surgical treatment of strangulated abdominal wall hernia.