mossjМосковский хирургический журналMoscow Surgical Journal2072-3180ООО «ПРОФИЛЬ – 2С»10.17238/issn2072-3180.2020.4.101-111mossj-433Research ArticleКЛИНИЧЕСКИЕ СЛУЧАИCLINICAL CASEКЛИНИЧЕСКИЙ СЛУЧАЙ ЛЕЧЕНИЯ ПАЦИЕНТКИ С ПОСЛЕОПЕРАЦИОННОЙ ВЕНТРАЛЬНОЙ ГРЫЖЕЙ И ОСЛОЖНЕННЫМ ПОСЛЕОПЕРАЦИОННЫМ ТЕЧЕНИЕМ В ВИДЕ ИНФИЦИРОВАНИЯ СЕТЧАТОГО ПРОТЕЗАСLINICAL CASE OF TREATMENT OF A PATIENT WITH POSTOPERATIVE VENTRAL HERNIA AND COMPLICATION DURING THE POSTOPERATIVE PERIOD IN THE FORM OF MESH PROSTHESIS INFECTIONhttps://orcid.org/0000-0001-5519-0014КовалевА. А.KovalevA. A.

Ковалев Александр Андреевич — врач-хирург отделения хирургических методов лечения онкологических больных

197341, Санкт-Петербург, ул. Аккуратова, д. 2

Kovalev Aleksandr Andreevich — surgeon of the Department of surgical methods of treatment of cancer patients

2 Akkuratov street, 197341 St. Petersburg

yathr@mail.ruhttps://orcid.org/0000-0001-9540-7812ДаниловИ. Н.DanilovI. N.

Данилов Иван Николаевич — кандидат медицинских наук, заведующий отделением хирургических методов лечения онкологических больных

197341, Санкт-Петербург, ул. Аккуратова, д. 2

Danilov Ivan Nikolaevich — PhD in Meddicine, Head of the Department of surgical methods of treatment of cancer patients

2 Akkuratov street, 197341 St. Petersburg

ivandanilov75@mail.ruhttps://orcid.org/0000-0003-4600-865XНаседкинД. Б.NasedkinD. B.

Наседкин Дмитрий Борисович — врач-хирург отделения хирургических методов лечения онкологических больных

197341, Санкт-Петербург, ул. Аккуратова, д. 2

Nasedkin Dmitrii Borisovitch — surgeon of the Department of surgical methods of treatment of cancer patients

2 Akkuratov street, 197341 St. Petersburg

nasedkindim@gmail.comhttps://orcid.org/0000-0002-9530-3447СаловМ. А.SalovM. A.

Салов Максим Алексеевич — врач-хирург отделения хирургических методов лечения онкологических больных

197341, Санкт-Петербург, ул. Аккуратова, д. 2

Salov Maksim Alekseevich — surgeon of the Department of surgical methods of treatment of cancer patients

2 Akkuratov street, 197341 St. Petersburg

max.salov@mail.ruhttps://orcid.org/0000-0002-8029-3215КашерининовИ. Ю.KasherininovI. Yu.

Кашерининов Игорь Юрьевич — кандидат медицинских наук, заведующий отделением анестезиологии-реанимации №4

197341, Санкт-Петербург, ул. Аккуратова, д. 2

Kasherininov Igor Yur’evich — PhD in Medicine, Head of the Intensive care unit №4

2 Akkuratov street, 197341 St. Petersburg

iykash@gmail.comhttps://orcid.org/0000-0003-4925-0126НеймаркА. Е.NeimarkA. E.

Неймарк Александр Евгеньевич — к.м.н. eLibrary SPIN: 6554-3217

197341, Санкт-Петербург, ул. Аккуратова, д. 2

Neimark Aleksandr Evgen’evich — MD, PhD. eLibrary SPIN: 6554-3217

2 Akkuratov street, 197341 St. Petersburg

sas_spb@mail.ruhttps://orcid.org/0000-0003-4442-7228БасекИ. В.BasekI. V.

Басек Илона Владимировна — кандидат медицинских наук, доцент, заведующий отделом Лучевой диагностики

197341, Санкт-Петербург, ул. Аккуратова, д. 2

Basek Ilona Vladimirovna — PhD in Medicine, Docent, Head of the Department of Radiolody

2 Akkuratov street, 197341 St. Petersburg

Ilona.basek@mail.ruФГБУ «НМИЦ им. В. А. Алмазова» Минздрава РоссииРоссияAlmazov National Medical Research CentreRussian Federation20200903202104101111Copyright © Ковалев А.А., Данилов И.Н., Наседкин Д.Б., Салов М.А., Кашерининов И.Ю., Неймарк А.Е., Басек И.В., 20212021Ковалев А.А., Данилов И.Н., Наседкин Д.Б., Салов М.А., Кашерининов И.Ю., Неймарк А.Е., Басек И.В.Kovalev A.A., Danilov I.N., Nasedkin D.B., Salov M.A., Kasherininov I.Y., Neimark A.E., Basek I.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.mossj.ru/jour/article/view/433

Введение: каждый год во всем мире выполняется более 20 млн операций по поводу грыж различной локализации. Грыжи живота выявляются у 7% всего населения, в основном у людей трудоспособного возраста. Грыжа передней брюшной стенки — одна из наиболее частых хирургических проблем, затрагивающая значимую часть пациентов во всем мире. Основными причинами возникновения грыж являются нарушение соотношения уровня коллагена в рубцовой ткани и погрешности в технике закрытия лапаротомных ран, что приводит к формированию послеоперационных грыж.Клинический случай: в статье представлен клинический случай лечения пациентки с послеоперационной вентральной грыжей и «потерей домена», в послеоперационном периоде осложнившейся инфицированием сетчатого протеза. Отмечены трудности выбора оптимальной тактики лечения данной категории больных, таких как принятие решения об удалении сетчатого протеза или продолжения консервативных методик. Консервативные методы неизбежно увеличивают сроки лечения и пребывания в стационаре, что неблагоприятно сказывается не только на физическом состоянии пациента, но и на психологической составляющей длительной терапии. Сопоставлена выбранная стратегия в данном клиническом случае с ранее опубликованными материалами других авторов.Заключение: лечение данной категории больных должно проводиться в стационарах широкого профиля, имеющих в своем арсенале всё необходимое диагностическое оборудование, возможность оперативной консультации любого смежного специалиста при необходимости, а также возможность своевременной смены антибактериальных препаратов, если этого требует клиническая ситуация.

Introduction: more than 20 million hernia surgeries are performed worldwide each year. Abdominal hernias are detected in 7% of the total population, mainly in people of working age. Hernia of the anterior abdominal wall is one of the most common surgical problems affecting a significant proportion of patients around the world. The main causes of hernias are a violation of the level collagen ratio in the scar tissue and technical errors in the technique of closing laparotomic wounds, which leads to the formation of postoperative hernias.Clinical case: the article presents a clinical case of treatment of a patient with postoperative ventral hernia and «domain loss», complicated by infection of the mesh prosthesis in the postoperative period. Difficulties in choosing the optimal treatment tactics for this category of patients, such as making a decision to remove the mesh prosthesis or to continue conservative methods of treatment, have been noted.Conclusion: conservative methods inevitably increase the duration of treatment and hospital stay, which adversely affects not only the physical condition of the patient, but also the psychological element of long-term therapy. The chosen strategy in this clinical case was compared with previously published materials of other authors. Treatment of this category of patients should be carried out in hospitals of a wide profile, which have in their arsenal all the necessary diagnostic equipment, the possibility of operative consultation of any related specialist, if necessary, as well as the possibility of timely change of antibacterial drugs, if required by the clinical situation.

грыжи передней брюшной стенкипредоперационный пневмоперитонеуминфицирование сетчатого протезавакуумная система дренированияabdominal wall herniaspreoperative progressive pneumoperitoneuminfection of the meshvacuum–assisted closureReferencesКириенко А.И., Шевцов Ю.Н., Никишков А.С., Селиверстов Е.И., Андрияшкин А.В., ТатаринцевА.М., Золотухин И.А. Распространенность грыж передней брюшной стенки: результаты популяционного исследования. Хирургия, 2016. № 8. С. 61–66. https://doi.org/10.17116/hirurgia2016861-661. Kirienko A.I., Shevtsov Y.N., Nikishkov A.S., Seliverstov E.I., Andriyashkin A.V., Tatarintsev A.M., Zolotuhin I.A. Rasprostranennost’ gryzh perednei bryushnoi stenki: rezul’taty populyatsionnogo issledovaniya [Incidence of abdominal wall hernias: the results of population study]. Khirurgiia, 2016, (8), pp. 61–66. https://doi.org/10.17116/hirurgia2016861-66 (In Russ.)Чистяков Д.Б., Мовчан К.Н., Русакевич К.И., Яковенко Т.В., Сеньков Р.Э. Основные статистические параметры оказания медицинской помощи жителям Санкт-Петербурга при грыжах живота в формате обязательного медицинского страхования. Современные проблемы науки и образования, 2016. № 5. С. 97–97.Chistjakov D.B., Movchan K.N., Rusakevich K.I., Jakovenko T.V., Sen’kov R.Je. Osnovnye statisticheskie parametry okazanija medicinskoj pomoshhi zhiteljam Sankt-Peterburga pri gryzhah zhivota v formate objazatel’nogo medicinskogo strahovanija. [Introduction: the main statistical parameters of providing medical care to residents of St. Petersburg for abdominal hernias in the format of compulsory medical insurance]. Sovremennye problemy nauki i obrazovanija, 2016, 5, p. 97–97. (In Russ.)Grant A.M., EU Hernia Trialists Collaboration. Open mesh versus non-mesh repair of groin hernia: meta-analysis of randomised trials based on individual patient data [corrected]. Hernia: the journal of hernias and abdominal wall surgery, 2002, No. 6(3), pp/ 130–136. https://doi.org/10.1007/s10029-002-0073-1Grant A.M., EU Hernia Trialists Collaboration. Open mesh versus non-mesh repair of groin hernia: meta-analysis of randomised trials based on individual patient data [corrected]. Hernia: the journal of hernias and abdominal wall surgery, 2002, No. 6(3), pp/ 130–136. https://doi.org/10.1007/s10029-002-0073-1Gillion J.F., Palot J.P. Abdominal wall incisional hernias: infected prosthesis: treatment and prevention. Journal of visceral surgery, 2012, No. 149(5), pp. 20–31. https://doi.org/10.1016/j.jviscsurg.2012.04.003Gillion J.F., Palot J.P. Abdominal wall incisional hernias: infected prosthesis: treatment and prevention. Journal of visceral surgery, 2012, No. 149(5), pp. 20–31. https://doi.org/10.1016/j.jviscsurg.2012.04.003Shankar V.G., Srinivasan K., Sistla S.C., Jagdish S. Prophylactic antibiotics in open mesh repair of inguinal hernia - a randomized controlled trial. International journal of surgery (London, England), 2010, No. 8(6), pp. 444–447. https://doi.org/10.1016/j.ijsu.2010.05.011Shankar V.G., Srinivasan K., Sistla S.C., Jagdish S. Prophylactic antibiotics in open mesh repair of inguinal hernia - a randomized controlled trial. International journal of surgery (London, England), 2010, No. 8(6), pp. 444–447. https://doi.org/10.1016/j.ijsu.2010.05.011Edwards C., Angstadt J., Whipple O., Grau R. Laparoscopic ventral hernia repair: postoperative antibiotics decrease incidence of seroma-related cellulitis. The American surgeon, 2005, No. 71(11), pp. 931–936.Edwards C., Angstadt J., Whipple O., Grau R. Laparoscopic ventral hernia repair: postoperative antibiotics decrease incidence of seroma-related cellulitis. The American surgeon, 2005, No. 71(11), pp. 931–936.Brown R.H., Subramanian A., Hwang C.S., Chang S., Awad S.S. Comparison of infectious complications with synthetic mesh in ventral hernia repair. American journal of surgery, 2013, No. 205(2), pp. 182–187. https://doi.org/10.1016/j.amjsurg.2012.02.023Brown R.H., Subramanian A., Hwang C.S., Chang S., Awad S.S. Comparison of infectious complications with synthetic mesh in ventral hernia repair. American journal of surgery, 2013, No. 205(2), pp. 182–187. https://doi.org/10.1016/j.amjsurg.2012.02.023Sharma R., Fadaee N., Zarrinkhoo E., Towfigh S. Why we remove mesh. Hernia: the journal of hernias and abdominal wall surgery, 2018, No. 22(6), pp. 953–959. https://doi.org/10.1007/s10029-018-1839-4Sharma R., Fadaee N., Zarrinkhoo E., Towfigh S. Why we remove mesh. Hernia: the journal of hernias and abdominal wall surgery, 2018, No. 22(6), pp. 953–959. https://doi.org/10.1007/s10029-018-1839-4Stremitzer S., Bachleitner-Hofmann T., Gradl B., Gruenbeck M., Bachleitner-Hofmann B., Mittlboeck M., Bergmann M. Mesh graft infection following abdominal hernia repair: risk factor evaluation and strategies of mesh graft preservation. A retrospective analysis of 476 operations. World journal of surgery, 2010, No. 34(7), pp. 1702–1709. https://doi.org/10.1007/s00268-010-0543-zStremitzer S., Bachleitner-Hofmann T., Gradl B., Gruenbeck M., Bachleitner-Hofmann B., Mittlboeck M., Bergmann M. Mesh graft infection following abdominal hernia repair: risk factor evaluation and strategies of mesh graft preservation. A retrospective analysis of 476 operations. World journal of surgery, 2010, No. 34(7), pp. 1702–1709. https://doi.org/10.1007/s00268-010-0543-zErdas E., Medas F., Pisano G., Nicolosi A., Calò P.G. Antibiotic prophylaxis for open mesh repair of groin hernia: systematic review and metaanalysis, Hernia, 2016, No. 20(6), pp. 765–776. https://doi.org/10.1007/s10029-016-1536-0Erdas E., Medas F., Pisano G., Nicolosi A., Calò P.G. Antibiotic prophylaxis for open mesh repair of groin hernia: systematic review and metaanalysis, Hernia, 2016, No. 20(6), pp. 765–776. https://doi.org/10.1007/s10029-016-1536-0Bueno-Lledó J., Torregrosa-Gallud A., Sala-Hernandez A., Carbonell-Tatay F., Pastor P. G., Diana S. B., Hernández J. I. Predictors of mesh infection and explantation after abdominal wall hernia repair. American journal of surgery, 2017, No. 213(1), pp. 50–57. https://doi.org/10.1016/j.amjsurg.2016.03.007Bueno-Lledó J., Torregrosa-Gallud A., Sala-Hernandez A., Carbonell-Tatay F., Pastor P. G., Diana S. B., Hernández J. I. Predictors of mesh infection and explantation after abdominal wall hernia repair. American journal of surgery, 2017, No. 213(1), pp. 50–57. https://doi.org/10.1016/j.amjsurg.2016.03.007Mavros M.N., Athanasiou S., Alexiou V.G. et al. Risk Factors for Mesh-related Infections After Hernia Repair Surgery: A Meta-analysis of Cohort Studies. World J. Surg., 2011, 13. No. 35, p. 2389. https://doi.org/10.1007/s00268-011-1266-5Mavros M.N., Athanasiou S., Alexiou V.G. et al. Risk Factors for Mesh-related Infections After Hernia Repair Surgery: A Meta-analysis of Cohort Studies. World J. Surg., 2011, 13. No. 35, p. 2389. https://doi.org/10.1007/s00268-011-1266-5Díaz-Godoy A., García-Ureña M.Á., López-Monclús J. et al. Searching for the best polypropylene mesh to be used in bowel contamination. Hernia, 2011, No. 15, pp. 173–179. https://doi.org/10.1007/s10029010-0762-0Díaz-Godoy A., García-Ureña M.Á., López-Monclús J. et al. Searching for the best polypropylene mesh to be used in bowel contamination. Hernia, 2011, No. 15, pp. 173–179. https://doi.org/10.1007/s10029010-0762-0Prieto-Borja L., Pérez-Tanoira R., Levano-Linares D.C., Celdrán A., Mahillo-Fernández I., Esteban J. Sonication of Abdominal Drains: Clinical Implications of Quantitative Cultures for the Diagnosis of Surgical Site Infection. Surgical infections, 2016, No. 17(4), pp. 459–464. https://doi.org/10.1089/sur.2015.268Prieto-Borja L., Pérez-Tanoira R., Levano-Linares D.C., Celdrán A., Mahillo-Fernández I., Esteban J. Sonication of Abdominal Drains: Clinical Implications of Quantitative Cultures for the Diagnosis of Surgical Site Infection. Surgical infections, 2016, No. 17(4), pp. 459–464. https://doi.org/10.1089/sur.2015.268Kao A.M., Arnold M.R., Augenstein V.A., Heniford B.T. Prevention and Treatment Strategies for Mesh Infection in Abdominal Wall Reconstruction. Plastic and reconstructive surgery, 2018, No. 142(3), pp.149–155. https://doi.org/10.1097/PRS.0000000000004871Kao A.M., Arnold M.R., Augenstein V.A., Heniford B.T. Prevention and Treatment Strategies for Mesh Infection in Abdominal Wall Reconstruction. Plastic and reconstructive surgery, 2018, No. 142(3), pp.149–155. https://doi.org/10.1097/PRS.0000000000004871Guillaume O., Pérez-Tanoira R., Fortelny R., Redl H., Moriarty T.F., Richards R.G., Eglin D., Petter Puchner A. Infections associated with mesh repairs of abdominal wall hernias: Are antimicrobial biomaterials the longed-for solution? Biomaterials, 2018, No. 167, pp. 15–31. https://doi.org/10.1016/j.biomaterials.2018.03.017Guillaume O., Pérez-Tanoira R., Fortelny R., Redl H., Moriarty T.F., Richards R.G., Eglin D., Petter Puchner A. Infections associated with mesh repairs of abdominal wall hernias: Are antimicrobial biomaterials the longed-for solution? Biomaterials, 2018, No. 167, pp. 15–31. https://doi.org/10.1016/j.biomaterials.2018.03.017Alston D., Parnell S., Hoonjan B., Sebastian A., Howard A. Conservative management of an infected laparoscopic hernia mesh: A case study, International Journal of Surgery Case Reports, 2013, 4(11), pp. 1035–1037. https://doi.org/10.1016/j.ijscr.2013.08.008Alston D., Parnell S., Hoonjan B., Sebastian A., Howard A. Conservative management of an infected laparoscopic hernia mesh: A case study, International Journal of Surgery Case Reports, 2013, 4(11), pp. 1035–1037. https://doi.org/10.1016/j.ijscr.2013.08.008Trunzo J.A., Ponsky J.L., Jin J., Williams C.P., Rosen M.J. A novel approach for salvaging infected prosthetic mesh after ventral hernia repair. Hernia: the journal of hernias and abdominal wall surgery, 2009, 13(5), pp. 545–549. https://doi.org/10.1007/s10029-009-0470-9Trunzo J.A., Ponsky J.L., Jin J., Williams C.P., Rosen M.J. A novel approach for salvaging infected prosthetic mesh after ventral hernia repair. Hernia: the journal of hernias and abdominal wall surgery, 2009, 13(5), pp. 545–549. https://doi.org/10.1007/s10029-009-0470-9Meagher H., Clarke Moloney M., Grace P.A. Conservative management of mesh-site infection in hernia repair surgery: a case series. Hernia: the journal of hernias and abdominal wall surgery, 2015, 2, pp. 231–237. https://doi.org/10.1007/s10029-013-1069-8Meagher H., Clarke Moloney M., Grace P.A. Conservative management of mesh-site infection in hernia repair surgery: a case series. Hernia: the journal of hernias and abdominal wall surgery, 2015, 2, pp. 231–237. https://doi.org/10.1007/s10029-013-1069-8Kingsnorth A.N., Sivarajasingham N., Wong S., Butler M. Open mesh repair of incisional hernias with significant loss of domain. Annals of the Royal College of Surgeons of England, 2004, 86(5), pp. 363–366. https://doi.org/10.1308/147870804236Kingsnorth A.N., Sivarajasingham N., Wong S., Butler M. Open mesh repair of incisional hernias with significant loss of domain. Annals of the Royal College of Surgeons of England, 2004, 86(5), pp. 363–366. https://doi.org/10.1308/147870804236Mcadory R.S., Cobb W.S., Carbonell A.M. Progressive preoperative pneumoperitoneum for hernias with loss of domain. The American surgeon, 2009, 75(6), pp. 504–509.Mcadory R.S., Cobb W.S., Carbonell A.M. Progressive preoperative pneumoperitoneum for hernias with loss of domain. The American surgeon, 2009, 75(6), pp. 504–509.Bueno-Lledó J., Carreño-Saenz O., Torregrosa-Gallud A., PousSerrano S. Preoperative Botulinum Toxin and Progressive Pneumoperitoneum in Loss of Domain Hernias-Our First 100 Cases. Frontiers in surgery, 2020, 7, рр. 3. https://doi.org/10.3389/fsurg.2020.00003Bueno-Lledó J., Carreño-Saenz O., Torregrosa-Gallud A., PousSerrano S. Preoperative Botulinum Toxin and Progressive Pneumoperitoneum in Loss of Domain Hernias-Our First 100 Cases. Frontiers in surgery, 2020, 7, рр. 3. https://doi.org/10.3389/fsurg.2020.00003Tang F.X., Zong Z., Xu J.B., Ma N., Zhou T.C., Chen S. Combination of Preoperative Progressive Pneumoperitoneum and Botulinum Toxin A Enables the Laparoscopic Transabdominal Preperitoneal Approach for Repairing Giant Inguinoscrotal Hernias. Journal of laparoendoscopic & advanced surgical techniques. 2020, A, 30(3), pp. 260–266. https://doi.org/10.1089/lap.2019.0669Tang F.X., Zong Z., Xu J.B., Ma N., Zhou T.C., Chen S. Combination of Preoperative Progressive Pneumoperitoneum and Botulinum Toxin A Enables the Laparoscopic Transabdominal Preperitoneal Approach for Repairing Giant Inguinoscrotal Hernias. Journal of laparoendoscopic & advanced surgical techniques. 2020, A, 30(3), pp. 260–266. https://doi.org/10.1089/lap.2019.0669Mancini A., Mougin N., Venchiarutti V., Shen Z., Risse O., Abba J., Arvieux C Goni Moreno progressive preoperative pneumoperitoneum for giant hernias: a monocentric retrospective study of 162 patients. Hernia: the journal of hernias and abdominal wall surgery, 2020, 24(3), pp. 545–550. https://doi.org/10.1007/s10029-019-02113-5Mancini A., Mougin N., Venchiarutti V., Shen Z., Risse O., Abba J., Arvieux C Goni Moreno progressive preoperative pneumoperitoneum for giant hernias: a monocentric retrospective study of 162 patients. Hernia: the journal of hernias and abdominal wall surgery, 2020, 24(3), pp. 545–550. https://doi.org/10.1007/s10029-019-02113-5Bueno-Lledó J., Torregrosa A., Jiménez R., Pastor P.G. Preoperative combination of progressive pneumoperitoneum and botulinum toxin type A in patients with loss of domain hernia. Surgical endoscopy, 2018, 32(8), pp. 3599–3608. https://doi.org/10.1007/s00464-018-6089-0Bueno-Lledó J., Torregrosa A., Jiménez R., Pastor P.G. Preoperative combination of progressive pneumoperitoneum and botulinum toxin type A in patients with loss of domain hernia. Surgical endoscopy, 2018, 32(8), pp. 3599–3608. https://doi.org/10.1007/s00464-018-6089-0Gonzalez-Urquijo M., Estrada-Cortinas O.J., Rodarte-Shade M., Bermea-Mendoza J.H., Gil-Galindo G. Preoperative progressive pneumoperitoneum: The answer for treating giant inguinal hernias while avoiding morbidities? Hernia: the journal of hernias and abdominal wall surgery, 2020, 24(4), pp. 781–786. https://doi.org/10.1007/s10029-020-02155-0Gonzalez-Urquijo M., Estrada-Cortinas O.J., Rodarte-Shade M., Bermea-Mendoza J.H., Gil-Galindo G. Preoperative progressive pneumoperitoneum: The answer for treating giant inguinal hernias while avoiding morbidities? Hernia: the journal of hernias and abdominal wall surgery, 2020, 24(4), pp. 781–786. https://doi.org/10.1007/s10029-020-02155-0

The authors declare that there are no conflicts of interest present.