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<p>To assess the surgical treatment outcomes of complex incisional hernias of moderate and major severity classes meeting the criteria established by Slater et al. in the early and long-term postoperative period. A total of 121 patients with complex incisional hernias (hernia ≥ 10&#xa0;cm in width) following surgical treatment at the A.V. Vishnevsky National Medical Research Center of Surgery in the period from 2015 to 2022 were enrolled in the study. Hernias meeting the criteria established by Slater et al. (2014) were considered complex. 71 (58.6%) patients underwent reconstructive repair (i.e. with matching the edges of the hernia orifice and achieved midline fascial approximation). Due to the impossibility of bringing the edges of the hernia orifice together in 50 (41.3%) cases were performed bridged repair. Common general complications in the early postoperative period were observed in 48 (40.5%) patients, including 38 (31.4%) cases of seroma, 5 (4.1%) cases of skin dehiscence, 3 (2.4%) cases of wound suppuration, 2 (1.6%) cases of skin necrosis, and 1 (0.8%) case of bleeding from the mesh placement. The mean follow-up was 3.12 ± 0.15&#xa0;years (from 1 to 7&#xa0;years) after the surgery. Hernia recurrence was recorded in 9 (7.4%) patients, ligature fistula of the anterior abdominal wall – in 3 (2.4%) patients, pseudocyst of the anterior abdominal wall – in 3 (2.4%) cases. Reconstructive repair was superior to bridged repair in terms of lower rate of local wound complications (32.3% versus 52.0%, <i>p</i> = 0.048) and long-term complications (5.6% versus 22.0%, <i>p</i> = 0.016), the last included hernia recurrence (2.8% vs. 14.0%, <i>p</i> = 0.021). The “Sandwich” bridging technique demonstrated optimal outcomes in terms of hernia recurrence. Reconstructive repair for complex incisional hernias have shown better outcomes compared to bridged repair. The “Sandwich” bridging repair is recommended, if there is no opportunity to perform reconstructive repair.</p>

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Surgical Treatment Results of Complex Incisional Hernia

  • 期刊论文

  • 发表日期：

    2025年9月24日

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  • Badri Sh Gogia,
  • Anastasia Dm Struchkova,
  • Rifat R Aljautdinov

摘要

To assess the surgical treatment outcomes of complex incisional hernias of moderate and major severity classes meeting the criteria established by Slater et al. in the early and long-term postoperative period. A total of 121 patients with complex incisional hernias (hernia ≥ 10 cm in width) following surgical treatment at the A.V. Vishnevsky National Medical Research Center of Surgery in the period from 2015 to 2022 were enrolled in the study. Hernias meeting the criteria established by Slater et al. (2014) were considered complex. 71 (58.6%) patients underwent reconstructive repair (i.e. with matching the edges of the hernia orifice and achieved midline fascial approximation). Due to the impossibility of bringing the edges of the hernia orifice together in 50 (41.3%) cases were performed bridged repair. Common general complications in the early postoperative period were observed in 48 (40.5%) patients, including 38 (31.4%) cases of seroma, 5 (4.1%) cases of skin dehiscence, 3 (2.4%) cases of wound suppuration, 2 (1.6%) cases of skin necrosis, and 1 (0.8%) case of bleeding from the mesh placement. The mean follow-up was 3.12 ± 0.15 years (from 1 to 7 years) after the surgery. Hernia recurrence was recorded in 9 (7.4%) patients, ligature fistula of the anterior abdominal wall – in 3 (2.4%) patients, pseudocyst of the anterior abdominal wall – in 3 (2.4%) cases. Reconstructive repair was superior to bridged repair in terms of lower rate of local wound complications (32.3% versus 52.0%, p = 0.048) and long-term complications (5.6% versus 22.0%, p = 0.016), the last included hernia recurrence (2.8% vs. 14.0%, p = 0.021). The “Sandwich” bridging technique demonstrated optimal outcomes in terms of hernia recurrence. Reconstructive repair for complex incisional hernias have shown better outcomes compared to bridged repair. The “Sandwich” bridging repair is recommended, if there is no opportunity to perform reconstructive repair.