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Inflammatory Complications of the Abdominal Wall Prosthetic Repair: Diagnostics, Treatment, and Prevention (Review)

Inflammatory Complications of the Abdominal Wall Prosthetic Repair: Diagnostics, Treatment, and Prevention (Review)

Parshikov V.V.
Key words: hernia; prosthetic repair; mesh; abdominal wall reconstruction; endoprosthesis; complications of prosthetic repair; paraprosthetic infection; NPWT.
2019, volume 11, issue 3, page 158.
DOI: https://doi.org/10.17691/stm2019.11.3.19

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A number of issues in diagnosis, treatment, and prevention of purulent and septic complications in implantation of mesh are currently very far from being resolved. Patients with acute or chronic inflammatory processes associated with a mesh are of special concern, as this situation can completely discredit the possibilities of the abdominal wall reconstruction and the use of synthetic materials for this purpose, casting doubt on the accumulated knowledge, experience of the clinic and the surgeons’ qualification.

Hereinafter the most up-to-date and clarified classifications of inflammatory complications are demonstrated. A systemic approach to the problem of clear stratification of patients depending on the risk of complication is provided. Differences and controversial opinions regarding terminology, latest concepts and definitions in the surgery of abdominal wall hernias are presented.

Possibilities of anticipating potential complications are specified. Identification of a special group of patients with large and complex, multiple defects of the abdominal wall is justified. The most effective methods of diagnosing the complications and the results of their application are assessed.

The definitions of an acute inflammatory process associated with endoprosthesis implantation and of a chronic paraprosthetic infection are given. The modern approaches to treatment including generally accepted methods and controversial opinions are described. Options of mesh excision, repeated prosthetic repair of the abdominal wall are presented; successes and failures depending on the chosen strategy are shown. The strategy of endoprosthesis saving is grounded; the underlying methods (NPWT — negative pressure wound therapy), their benefits and drawbacks are described. The most important areas of prevention of purulent and septic complications in herniology are specified.

Technical issues including the comparison of surgical methods, a certain range of techniques that can objectively eliminate the existing risks are provided. A specificity of endoprosthesis choice depending on the accumulated findings about mesh material, its manufacturing methods and properties is emphasized. The concept of implant prophylaxis is disclosed.

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