EFFECTIVENESS OF A STRATEGY BASED ON RADIOLOGICAL PARAMETERS IN THE TREATMENT OF INCISIONAL HERNIAS

Abstract

Introduction: The repair of incisional hernias, the selection of hernioplasty method and prosthetic material still remain relevant for general surgeons and herniologists. The problematic issue is due to various reasons, including the incomplete consensus between the size of the hernia and the depth of the operation, as well as the possible connection of incisional hernias with metabolic disorders, which is a predisposing risk factor for hernia formation or subsequent recurrence. A differentiated approach, taking into account the size of the hernia and the parameters of the muscular-aponeurotic structures of the anterior abdominal wall, may allow for the selection of optimal methods of hernioplasty.

Methods: The study included 216 patients with hernias of various sizes and locations. Group I - 136, Group II - 80 patients. Patients underwent preliminary radiological examinations, patients in group I underwent computed tomography and ultrasonography to assess the ratio of the rectus muscle to the defect, the thickness and density of the rectus muscle, and other clinical and laboratory examinations. However, later, due to the coincidence of the data of computed tomography and ultrasonography, due to financial and medical aspects (radiation load), we performed only the ultrasonographic examination and preliminarily selected the hernioplasty method and the type and size of the prosthetic material. Patients in group II (control) were included in whose case the diagnosis was made on the basis of clinical data and the exact size and localization of the hernia were not determined; the hernioplasty method was selected intraoperatively. Follow-up period 12 months.

Results: In group I, patients with a high rectus-to-defect ratio (>1.4) and radiologically dense and thick rectus abdominis muscle (>14.4 mm) underwent hernia repair using the Onlay technique. Patients with a rectus-to-defect ratio <1.4 and >1.28, and a rectus abdominis muscle thickness >14.4 mm underwent hernia repair using the Onlay technique. Patients with a rectus muscle thickness <14.4 mm and/or a rectus-to-defect ratio <1.39 underwent hernia repair using the Sublay technique only. In the control group, the appropriate method of hernia repair was determined intraoperatively. The average duration of the operation in group I was significantly less than in group II (group I 60±6, group II 90±8). The number of postoperative bed days was: in group I 4±0.3, in group II 5±0.2. Postoperative complications (wound infection, seroma, chronic pain, granuloma formation, etc.) were assessed daily during hospitalization, 1 month, 3 months, 6 months and 12 months after the operation; the incidence of complications and recurrence was lower in the study group than in the control group.

Conclusion: A differentiated approach to the treatment of incisional hernias allows for the preoperative selection of the hernioplasty method and the type and size of the prosthetic material. A differentiated approach to hernioplasty allows for the reduction of postoperative complications and hernia recurrence. It reduces the duration of surgery and the length of hospital stay, reduces financial costs, which ultimately contributes to the timely recovery and rehabilitation of patients.