Advantages of using nanomodified polypropylene mesh in the surgical treatment of postoperative large abdominal hernia

Lutkovskyi Ruslan. Advantages of using nanomodified polypropylene mesh in the surgical treatment of postoperative large abdominal hernia. Journal of Education, Health and Sport. 2022;12(6):384-392. eISSN 2391-8306. DOI http://dx.doi.org/10.12775/JEHS.2022.12.06.038

https://apcz.umk.pl/JEHS/article/view/40804

https://zenodo.org/record/7303086

The journal has had 40 points in Ministry of Education and Science of Poland parametric evaluation. Annex to the announcement of the Minister of Education and Science of December 1, 2021. No. 32343.

Has a Journal's Unique Identifier: 201159. Scientific disciplines assigned: Physical Culture Sciences (Field of Medical sciences and health sciences); Health Sciences (Field of Medical Sciences and Health Sciences).

Punkty Ministerialne z 2019 - aktualny rok 40 punktów. Załącznik do komunikatu Ministra Edukacji i Nauki z dnia 1 grudnia 2021 r. Lp. 32343. Posiada Unikatowy Identyfikator Czasopisma: 201159.

Przypisane dyscypliny naukowe:Nauki o kulturze fizycznej (Dziedzina nauk medycznych i nauk o zdrowiu); Nauki o zdrowiu (Dziedzina nauk medycznych i nauk o zdrowiu).

© The Authors 2022;

This article is published with open access at Licensee Open Journal Systems of Nicolaus Copernicus University in Torun, Poland

Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited.

The authors declare that there is no conflict of interests regarding the publication of this paper.

Received: 16.05.2022. Revised: 15.06.2022. Accepted: 30.06.2022.

UDК:616-007.43-089.168.1-06:615.468.74

Advantages of using nanomodified polypropylene mesh in the surgical treatment of postoperative large abdominal hernia

Ruslan Lutkovskyi

Vinnitsa National Pirogov Memorial Medical University, Ukraine

Ph.D., Associate Professor, Department of General Surgery

Abstract

Surgical treatment of large postoperative abdominal hernias (PAH) with the use of classic techniques of allogeneoplasty (sublay, onlay) is often accompanied by an increase in intra-abdominal pressure (IAP) and a decrease in the volume of the abdominal cavity, which in the postoperative period leads to abdominal compartment syndrome (ACS). 2.4 - 3.6% of cases and mortality in 1.2 - 3.4% of observations [1, 2]. This requires a special method of closing a large defect of the abdominal wall, which would not increase IAP. The use of the method of dividing the anatomical components of the anterior abdominal wall according to the modified technique of Ramirez operation in combination with sublay alloplasty contributes to the creation of the optimal volume of the abdominal cavity and improves the results of treatment, in particular, the frequency of ACS decreases [3, 4, 5]. However, the use of a combined operation with a classic polypropylene mesh leads to a high frequency of complications from the postoperative wound, such as seroma (30.8 - 60.4%), suppuration of the postoperative wound (4.8 - 6.4%), ligature fistula (1 .2 - 3.0%), meshoma (0.06 - 1.60%) [6, 7]. One of the causes of postoperative wound complications is the development of aseptic inflammation of the tissues of the abdominal wall as a result of their contact with the classic polypropylene mesh. Long-term aseptic inflammation of the subcutaneous base, muscles, aponeurosis, and fascia inhibits the process of germination of the polypropylene mesh by the connective tissue, which leads to its shrinkage, and in the case of infection, to the migration of the mesh and recurrence of the hernia. In our opinion, the use of a modified polypropylene mesh with an antiseptic of polyhexamethyleneguanidine chloride and carbon nanotubes in combination with a modified technique of the Ramirez operation will make it possible to improve the results of operative treatment of PAH.

Aim – to improve the results of surgical treatment of large postoperative abdominal hernias (PAH) by using a modified technique of the Ramirez operation in combination with «sublay» alloplasty using a modified polypropylene mesh.

Materials and methods. An analysis of the surgical treatment of 164 patients with large-sized PAH was performed. Depending on the type of mesh implant used during operative treatment, the patients were divided into two groups. In 82 (50%) patients of group I, surgery was performed according to the modified Ramirez technique in combination with «sublay» alloplasty using a modified polypropylene mesh, in group II, 82 (50%) patients underwent surgery according to the modified Ramirez technique in combination with «sublay   alloplasty using classic polypropylene mesh.

Results and discussion. Statistically significantly better results were obtained in patients of group I compared to group II. The duration of inpatient treatment in group I was (7.0±1.0) days, in group II – (12.0±2.2) days.

Conclusion. Operative treatment of large PAH using the modified technique of the Ramirez operation, combined with the «sublay» technique using the modified polypropylene mesh, is much more effective compared to the use of the classic polypropylene mesh, which was evidenced by a decrease in the frequency of postoperative complications.

Key words: abdominal hernia; nanomodified polypropylene mesh; postoperative wound complications.