Average postoperative hernias
The main stage is careful adhesiolysis: the intestine and omentum, sealed to the scar and sac, are separated without coagulation at the intestinal wall; then, if possible, the defect is sutured with transfascial sutures (restoring the function of the rectus muscles and preventing seroma) and covered with a 15x20–20x25 cm mesh with double fixation. For multi-chamber “Swiss cheese” defects, one mesh covers the entire scar line. Drainage is usually not necessary; seroma above the mesh in the first weeks is normal and resolves on its own. Control after 1 and 3 months.
Indications
- postoperative (ventral) hernia in the scar after previous operations;
- hernia of the white line of the abdomen, diastasis with hernia;
- hernia growth, episodes of irreducibility - risk of strangulation;
- recurrent ventral hernias after repair without mesh.
IPOM and E-TAR techniques
During laparoscopic IPOM repair, a composite mesh with an anti-adhesion coating is installed from the inside of the abdominal cavity, covering the defect by 5 cm in all directions and fixing it around the perimeter; If possible, the defect is sutured over a mesh (IPOM-plus). With the E-TAR/eTEP technique, the mesh is placed in the layers of the abdominal wall without contact with the intestine, with restoration of the midline - anatomical reconstruction for medium and large hernias. The choice depends on the size and location of the defect, the condition of the tissues; The cost of the implant is included in the price list. Relapses with mesh techniques are 3–5% versus 30–50% with simple suturing.
Benefits of laparoscopy
Laparoscopic access is the standard of modern abdominal surgery: instead of a 10–20 cm incision, 3–4 punctures are left, the pain after surgery is much less, the patient gets up on the day of surgery and is discharged after 1–2 days, the risk of wound infection, hernias in the scar and adhesions is several times lower, and the enlargement of the camera allows you to operate more accurately. In the clinics below, operations are performed by surgeons with extensive laparoscopic experience; hospital (SKD) is included in the price according to the price list.
