Comparative analysis of autodermal graft and polypropylene mesh use in large incisional hernia defects reconstruction

Abstract

Background. Large defects of the abdominal wall caused by incisional hernia still represent a challenging problem in plastic, reconstructive, and abdominal surgery. For their successful tension-free repair a proper selection of reconstructive material is essential. In the last decades, the use of synthetic meshes was dominant while biological autodermal grafts were rarely used. The aim of the study was to comparatively analyse efficacy and safety of autodermal graft and polypropylene mesh in surgical treatment of large abdominal wall defects. Methods. This prospective comparative clinical study enroled 40 patients surgically treated for large incisional hernia repair in a 10-year period. The patients were divided into two equal groups consisting of 20 subjects and treated either by biological autodermal graft or by synthetic polypropylene mesh. The surgical techniques of reconstruction, duration of surgery, the occurrence of early, minor, and major (severe) and delyed complications and hospital stay were analyzed. The average follow-up took 2 years. Results. Statistically significant differences in demographic characteristics of patients and in size of defects were not found. The surgical technique of reconstruction with an autodermal graft was more complicated. The duration of surgery in patients treated with autodermal grafts was significantly longer. There was no statistically significant difference regarding occurrence of early, minor postoperative complications and hospital stay in our study. Two severe complications were registered in the synthetic mesh group: intestinal obstruction and enterocutaneous fistula. The recurrence rate was 10% in the autodermal graft group and 15% in the group with a synthetic mesh. Conclusion. Tension-free repair of large incisional hernia with autodermal grafts was unjustly neglected despite the fact that it is safe and effective. It can be applied in all cases where synthetic mesh are not indicated (presence of infection, immunodeficient patients, after radiotherapy). They are especially important in war surgery and in lack of funds when commercial grafts cannot be purchased.Uvod. Veliki defekti trbusnog zida kod incizionih kila jos uvek su veliki izazov u plasticno rekonstruktivnoj i abdominalnoj hirurgiji. Za njihove uspesne bestenzione rekonstrukcije, kojim se postizu najbolji rezultati, pored adekvatnih indikacija i hirurske tehnike presudan je i pravilan izbor rekonstruktivnog materijala. U poslednjim decenijama dominirala je primena sintetskih graftova dok su bioloski autodermalni graftovi retko korisceni. Cilj rada bio je da se uporedi efikasnost i bezbednost sintetickih i autodermalnih graftova u rekonstrukcijama velikih defekata trbusnog zida. Metode. Ova prospektivna, randomizirana, komparativna klinicka studija obuhvatila je 40 bolesnika hospitalizovanih i operativno lecenih u periodu od 10 godina primenom bioloskih autodermalnih i sintetskih polipropilenskih graftova. Bolesnici su bili podeljeni u dve brojcano jednake grupe. Formirane grupe bile su slicne u odnosu na osobine defekata i opste stanje bolesnika. Analizirana je hirurska tehnika izvodjenja rekonstrukcija, trajanje operacija, nastanak lakih ranih i teskih, kao i kasnih postoperativnih komplikacija i duzina hospitalizacije. Bolesnici su prospektivno praceni prosecno dve godine. Rezultati. Nije bilo statisticki znacajne razlike u demografskim karakteristikama ispitivanih bolesnika niti velicine defekata. Hirurska tehnika rekonstrukcije primenom autodermalnih graftova bila je slozenija. Duzina operacija u grupi bolesnika operisanih primenom autodermalnih graftova bila je statisticki znacajno veca. Nije bilo statisticki znacajne razlike u ucestalosti lakih, ranih postoperativnih komplikacija u ispitivanim grupama. U grupi sa sintetskim graftovima registrovane su dve teze komplikacije u obliku enterokutane fistule i adhezionog ileusa. Ucestalost kasnih komplikacija u obliku recidiva iznosila je 10% u grupi sa autodermalnim graftom, a 15% u grupi sa sintetskim graftom. Zakljucak. Bestenziona rekonstrukcija autodermalnim graftovima iako bezbedna i efikasna, neopravdano je zapostavljena metoda. Ona se moze primeniti u svim slucajevima gde su sintetski graftovi kontraindikovani (prisustvo infekcije, imunodeficijentni bolesnici, stanje posle radioterapije), u vanrednim situacijama, kao sto su ratovi ili elementarne katastrofe, i u nedostatku finansijskih sredstava, kada se industrijski proizvedeni graftovi ne mogu nabaviti.