STUDYING THE REASONS FOR THE FORMATION OF SKIN-PROSTHETIC FISTULAS AFTER HERNIOPLASTY OF THE ABDOMINAL WALL

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.