STUDYING THE REASONS FOR THE FORMATION OF SKIN-PROSTHETIC FISTULAS AFTER HERNIOPLASTY OF THE ABDOMINAL WALL
Keywords:
prosthetic repair, skin prosthetic fistula, prolene mesh, paraprosthetic infectionAbstract
Object: study of the causes of skin prosthetic fistulas after implantation of prosthetic mesh and methods of treatment of this category of patients.
Methods: The study included a retrospective analysis of 13 patients who underwent prosthetic repair in the supra-aponeurotic position in the department from 2007-2021, who later developed a picture of a skin-prosthetic fistula.
Results: The main cause of skin-prosthetic fistulas is infection. In all 13 patients, the previous operation was complicated by wound suppuration and the development of a paraprosthetic infection, which prevented the prosthesis from integrating into the surrounding tissue. 12 patients were reoperated in the late postoperative period. In 6 patients with a formed fibrous capsule over the prosthesis and no recurrence, the operation ended with drainage and complete wound closure. Another 5 patients underwent re-implantation of the prosthesis, with preliminary irradiation of the surface with a laser. Of the twelve operated patients, eleven had a complete recovery, only one patient developed a new fistula after 3 months, which successfully closed after conservative treatment.
Conclusions: The problem of infectious complications of prosthetic repair is currently far from being resolved. Planning for preventive measures should begin at the preoperative stage as part of an elective approach, careful stratification of the patient, a detailed assessment of risk and the objective status of the patient. Antibiotic prophylaxis should be carried out in accordance with international guidelines, while target decisions should correspond to the data on a particular patient, that is, after determining the sensitivity of the flora to antibiotics, both local and ouциde the area of the upcoming operation, history and current state.
References
Birolini C., de Miranda J.S., Utiyama E.M., Rasslan S. A retrospective review and observations over a 16-year clinical experience on the surgical treatment of chronic mesh infection. What about replacing a synthetic mesh on the infected surgical field? Hernia 2015; 19(2): 239–246.
Birolini C., de Miranda J.S., Utiyama E.M., Rasslan S., Birolini D. Active Staphylococcus aureus infection: is it a contra-indication to the repair of complex hernias with synthetic mesh? A prospective observational study on the outcomes of synthetic mesh replacement, in patients with chronic mesh infection caused by Staphylococcus aureus. Int J Surg 2016; 28: 56–62.
Deerenberg E.B., Timmermans L., Hogerzeil D.P., Slieker J.C., Eilers P.H., Jeekel J., Lange J.F. A systematic review of the surgical treatment of large incisional hernia. Hernia 2015; 19(1): 89–101.
Hodgkinson J.D., Maeda Y., Leo C.A., Warusavitarne J., Vaizey C.J. Complex abdominal wall reconstruction in the setting of active infection and contamination: a systematic review of hernia and fistula recurrence rates. Colorectal Dis 2017; 19(4): 319–330.
Jensen K.K. Recovery after abdominal wall reconstruction. Dan Med J 2017; 64(3): B5349.
Narkhede R., Shah N.M., Dalal P.R., Mangukia C., Dholaria S. Postoperative mesh infection — still a concern in laparoscopic era. Indian J Surg 2015; 77(4): 322–326.
Payne R., Aldwinckle J., Ward S. Meta-analysis of randomised trials comparing the use of prophylactic mesh to standard midline closure in the reduction of incisional herniae. Hernia 2017; 21(6): 843–853.
Vorst A.L., Kaoutzanis C., Carbonell A.M., Franz M.G. Evolution and advances in laparoscopic ventral and incisional hernia repair. World J Gastrointest Surg 2015; 7(11): 293– 305.
Бабажанов А.С., Тоиров А.С., Ахмедов Г.К., Ахмедов А.И. Аллопластика при послеоперационных вентральных грыжах. // «Проблемы биологии и медицины» Самарканд 2017 №3(96) Стр. 45-47.
Белоконев В.И., Пономарева Ю.В., Пушкин С.Ю., Мелентьева О.Н., Гуляев М.Г. Возможные предикторы и морфологические аспекты развития серомы после пластики грыжи передней брюшной стенки. Новости хирургии 2014; 22(6): 665–670.
Деговцов Е.Н., Колядко П.В. Серомы как осложнение хирургического лечения послеоперaционных передней брюшной стенки с использованием сетчатых имплантов: современное состояние проблемы. Новости хирургии 2018; 26(1): 96–102.
Мамараджабов, С. Э. Роль и место сероэпидемиологического обследования населения в ранней диагностике эхинококкоза в Самаркандской области / С. Э. Мамараджабов, Ж. А. Ризаев, С. Р. Баймаков // Актуальные аспекты медицинской деятельности : сборник статей I Международной научно-практической конференции, Киров - Самарканд, 21 июня 2021 года. – Киров: Федеральное государственное бюджетное образовательное учреждение высшего образования "Кировский государственный медицинский университет" Министерства здравоохранения Российской Федерации, 2021. – С. 209-212. – EDN DOETDC.
