Intraperitoneal alloplasty combined with the anterior separation technique in giant incisional hernias

The use of the anterior technique for abdominal wall components separation combined with "onlay" alloplasty (ACST + onlay) in giant incisional hernias (IH) may pose a surgical challenge as it does not exclude increased intra-abdominal pressure (IAP) and the occurrence of abdominal compartment syndrome (ACS). There remains a high incidence of surgical site complications. In our view, the use of intra-abdominal alloplasty combined with anterior separation of the anterior abdominal wall components (ACST + IPOM) will contribute to the improvement of surgical outcomes in giant IH.

Purpose: to improve the results of surgical treatment of giant IH using ACST + IPOM.

Materials and methods: Analysis of surgical treatment of 164 patients with giant IH aged 30 to 75 (mean age 54.7 ± 3.3). Depending on the surgery, the patients were divided into two groups. Group I (82 patients) consisted of patients who underwent our modified technique, including ACST + IPOM. The surgery in group II (82 patients) involved ACST + onlay.

Results and discussion: As compared with ACST + onlay, ACST + IPOM surgery contributes to a significantly reduced incidence of ACS [6.1% (group II) versus 0 (group I), (p <0.05)], seroma [25.6% versus 7.3%, p <0.05], surgical site infection (SSI) [4.9% versus 2.4%, p> 0.05], meshoma [3.7% versus 0] and hernia recurrences [6.5% versus 1.6%, p> 0.05].

Conclusions: IAP value equal or exceeding 9.1 mmHg (1.2 kPa) during surgery in approximated rectus muscles is prognostic for ACS occurrence and requires intraoperative preventive measures. Utilization of ACST + IPOM in giant IH ensures an optimal abdominal cavity volume without a substantial increase in IAP and reduces the probability of ACS, whereas the use of ACST + onlay results in ACN in 6.1% (p <0.05) patients. Reduced contact of the mesh with the subcutaneous tissue in ACST + IPOM contributes to a significantly lower incidence of seroma [7.3% vs 25.6% (p <0.05)], surgical site infection (SSI) [2.4% vs 4.9% (p> 0.05)], postoperative wound infiltrate [2 (2.4%) vs. 11 (13.4%) (p <0.05)], chronic postsurgical pain [1 (1.6%) vs. 5 (8.1%) (p> 0.05)] and recurrent IH [1 (1.6%) vs. 4 (6.5%) (p> 0.05)] as compared with ACST + onlay technique.