Postoperative ventral hernia treatment considering hernia size and localization

Abstract

Ventral hernia repair is one of the most common surgical procedures worldwide; The aim of the study is to review the ventral hernia operations performed by us.

Material and Methods: The study included 96 patients (2015-2022) with a diagnosis of postoperative ventral hernia, of whom 32 were men and 64 were women, aged 30-70 years. Patients were distributed according to localization as follows: above the umbilicus 42 (M1 and M2), below the umbilicus 54 (M4 and M5); Cases above the umbilicus were most common in men (26 (61.9%), women (16 (38.1%), below the umbilicus in women (48 (88.9%), men (6 (11.1%).

Results: The frequency of ventral hernias was distributed according to size in our material as follows: small 16 W1 (16.7%), medium 31 W2 (32.3%), large and giant 49 W3 (51%). The length of stay of patients in the hospital was: 2 days for small hernias, 3-4 days for medium hernias, and 4-6 days for large and giant hernias. Outpatient follow-up was performed for all patients from 1 to 5 years. Complications were noted in 9 (9.4%) cases, recurrence in 1 (1.04%) case (giant postoperative ventral hernia after surgery for malignant tumor of the colon with concomitant chronic obstructive pulmonary disease, diabetes mellitus, GID). Seroma in 6 (6.25%) cases. W2 2 (33.3%), W3 4 (66.7%) in cases of large and giant ventral hernia below the navel, when the On Lay technique was used. Among them, 1 (1.04%) patient underwent repeated surgery without removal of the prosthesis, when the In Lay technique was used. All other cases ended with puncture-based evacuation of the seroma. Suppuration in 2 (2.1%) cases, of which 1 (3.4%) after the Sub Lay technique and 1 (2.1%) after the On Lay technique (comorbid diabetes mellitus type 2). In this case, repeated surgery and removal of the prosthetic material were necessary.

Conclusions:

• In the case of small hernias, the operation is performed using the Sub lay (gold standard) technique in almost all cases;
• In the case of medium hernias localized above the umbilicus, the Sub Lay technique is most often possible
• In the case of large and giant hernias, hernia repair using the Sub lay technique is impossible without significant “rupture” of the muscular-aponeurotic layer, therefore, On lay and, less frequently, In lay technique repair is most often used