Modern aspects of allohernioplasty of postoperative ventral hernias (a literature review)

Abstract

The aim. Based on the data of the publications of herniologists for the last 5 years to examine the effectiveness and safety of prosthetic materials used in hernioplasty of postoperative ventral hernias. According to surgeons, the incidence of postoperative ventral hernia is up to 20 % of performed laparotomies, and if risk factors are present – up to 70 %. This problem was considered solved by the use of prosthetic mesh that became the standard of surgical approach in hernia repair since a recurrence rate was reduced to 20 %. However, the results of histological examination and body biological responses to an implant showed chronic inflammatory processes due to use of prosthetic material, especially polypropylene, causing purulent-inflammatory complications and intraperitoneal adhesion in 20.0–45.8 %. To prevent adhesion, a special barrier layer was applied on the polypropylene mesh, a process of mesothelial epithelialization (formation of the neoperitoneum) was supposed to occur, thereby reducing the risk of adhesions. A temporary nature of the barrier coating, where adhesion may develop at any time after implantation resulting in complications, has proven to be a potential problem of composite prostheses. There has been an attempt to address the challenge by using biological meshes made of decellularised pig and bovine dermis. However, recurrence rates after repair of hernia using the biological meshes was 6.3–61.0 %, wound infection – 16.0 %. Conclusions. Thus, world publications have proved today that it is impossible to perform adequate hernioplasty of postoperative hernias without the use of prosthetic material. However, complications and recurrences of the disease remain quite high. In order to improve these indicators, a sufficient number of studies were conducted, the effect of various prosthetic meshes on the patient body and on the postoperative wound itself was examined. Nevertheless, all the results are often contradictory, without specific conclusions about the indications for the use of method and type of prosthetic material.

Keywords

• postoperative ventral hernia
• hernia recurrence
• surgical mesh