Chapters authored
Significance of Autologous Tissues in the Treatment of Complicated, Large, and Eventrated Abdominal Wall Hernias
Repair of complicated, large, or eventrated abdominal wall hernias poses a considerable challenge. Not infrequently, synthetic grafts implanted earlier become infected, entero- or subcutaneous fistulas appear, or emergency conditions like mechanical ileus or peritonitis develop. In such cases, direct closure of the abdominal wall with sutures or reinforcement with synthetic grafts is not recommended. Not many surgical techniques are capable of creating a low tension state. One is bridging of the abdominal wall defects; another is mobilization of the musculo-aponeurotic elements of the abdominal wall (components separation). In this chapter, the use of autologous double-layer dermal grafts and the technique of bilateral rectus muscle turnover allowing reconstruction of eventrated hernias in a tension-free way are discussed. In both procedures, only autologous tissues are used for reconstruction. With autologous dermal grafts, the rate of surgical complications is 4%, recurrence in the first 24 months is 11%, and the quality of life is significantly improved. With bilateral rectus muscle turnover, surgical complications occur at a rate of less than 2%, 24-month recurrence is 0%, and the quality of life is significantly improved. The technique of the interventions, their indications and contraindications, as well as their feasibility, advantages and disadvantages are described.
Part of the book: Hernia