Ultrasonic excision of infected mesh implants after hernioplasty

Abstract

Relevance. Infection of mesh implants ("mesh") is a serious problem during hernioplasty, which does not have an unambiguous approach to its solution. Having decided on surgical intervention associated with the removal of the failed implant, the surgeon will face certain technical difficulties associated with the presence of fibrous-granulation fusions that do not allow performing the operation without injuring healthy surround tissue implants. Goal. Improve the results of surgical interventions associated with the removal of reticular implants with ultrasonic cavitation. Methods. We have analyzed our own experience in the treatment of patients who under the conditions of the Republican Clinical Hospital named after. G.G. Kuvatova, Ufa from 2000 to 2017, surgical interventions were carried out related to the removal of infected mesh implants, previously established for ventral hernias of different locations. Almost all patients "prosthetic" hernioplasty was performed in other medical organizations - central district and city hospitals (CRH and TSGB) of the Republic of Bashkortostan. The study included 89 patients who were divided into two groups: the main one (41 patients) where ultrasound and a comparison group (48 people) were used during the implant separation stage from the abdominal wall tissue and subsequent treatment of the wound surface in which all steps of the surgical manual were performed only with the help of conventional surgical instruments. Results. The study showed that the use of ultrasound cavitation of the antiseptic solution allows to achieve a delicate separation of infected mesh implants from the abdominal wall without damaging it with a good bactericidal effect, and to reduce the occurrence of recurrent hernias. Conclusions. Thus, the separation of the "mesh" without damaging the underlying abdominal wall tissue allows to preserve their skeleton, and hence to prevent the subsequent recurrence of hernia formation.