Surgical treatment strategies for giant anterior abdominal wall hernias
Objective: To improve surgical treatment of giant hernias of the anterior abdominal wall (AAW). Methods: For 152 patients with giant hernias of the AAW, various hernioplasty options were selected. Primary hernias occurred in 56 (36.8%), postoperative - in 59 (38.9%) and recurrent - in 37 (24.3%) patients. In most cases, hernias occurred in females (124), accounting for 81.5%. Postoperative (59) and recurrent (37) hernias were of large sizes. Recurrent hernias developed after conventional (28), tension-free (6) and combined (3) hernioplasty techniques, postoperative hernias were a consequence of traditional (open) cholecystectomy (51%), hysterectomy (17%), as well as after laparotomy for various abdominal organs diseases (32%). Results: Conventional hernioplasty was performed in 72, tension-free - in 32, and combined method - in 48 patients. The choice of the operational technique depended on the hernia orifice size, the structural integrity of the musculoaponeurotic layer of the anterior abdominal wall. Onlay mesh placement was performed in 57, sublay - in 13, and inlay - in 10 patients. In the postoperative period, wound suppuration after conventional hernioplasty was noted in 3 patients, after tension-free surgery methods - in 5 patients. Hernia recurrence was recorded in one case. Conclusion: Appropriate preoperative preparation of patients with giant hernias of the AAW prevents the development of several undesired and, sometimes, severe complications in the immediate postoperative period. Achievement of satisfactory functional results after hernioplasty largely depends on a proper choice of surgery and the structural integrity of the musculoaponeurotic layer of the AAW. Large-sized hernia orifices, especially in recurrent hernias, require the use of tension-free methods of surgery.