THE "SANDWICH" TECHNIQUE - OPTION FOR TREATING LARGE INCISIONAL HERNIA COMPLICATED WITH ACUTE INTESTINAL OCCLUSION (CASE REPORT)

Abstract

Introduction. The incidence of giant incisional hernia varies from 0,35% to 1,5% of cases. Statistics reveal a high strangulation rate, of 16-48% cases, in large and giant incarcerated incisional hernias. The compromise of vascularization of the hernia sac contents is associated with reversible and nonreversible morphological changes of the strangulated organs. Surgical solvation presents difficulties in both cases.

Aim. Evaluation of the effectiveness of the "SANDWICH" technique in the reconstruction of the abdominal defect in giant postoperative hernia associated with acute intestinal obstruction syndrome

Case presentation. The surgical solvation of a case of giant incarcerated incisional hernia, treated in Municipal Clinical Hospital ”St. Archanghel Michael”, which was hospitalized for an acute intestinal occlusion syndrome in the hernia sac with congestive compromise of the small intestine loops adhered to the sac, is presented. Anamnesis: - 15 years ago operated for acute destructive appendicitis complicated with total peritonitis - median laparotomy, appendectomy, cleaning of the abdominal cavity. Now, feels sick for 5 hours, accusations and data of acute intestinal occlusion caused by giant strangulated incisional hernia, negative symptoms of peritoneal irritation. Complex investigations used: clinical examination, laboratory tests, abdomen X-ray, ultrasonography.

Were assessed data of acute intestinal occlusion by strangulation with an adhesion in the hernia sac, confirmed clinically, by X-ray and ultrasonography. Surgical intervention - urgent laparotomy. Intraoperative: in the sac - serous fluid, multiple adhesions of the intestinal loops with the hernia sac, looped intestinal loop - ileum, strangulated by adhesion, evaluated with signs of congestive changes. To close the hernia defect, was used the "TENSION-FREE" hernioplasty technique following the substitution method. The applied "SANDWICH" technique including two polypropylene prostheses using for double closure of the hernia defect. The first layer with dimensions of 30.0 x 30.0 cm, fixed on a new plateau formed by the great omentum that was fixed to the parietal peritoneum, the second layer 17x11 cm - On-lay was fixed to the free edges of the rectus muscle aponeurosis, with a free opening in the subcutaneous space. Monitoring for 5 years, no recurrence data.

Conclusions. The method of repairing giant abdominal wall hernias in the case of associated intestinal occlusion by strangulation in the hernial sac depends on the morphological changes of the compromised organ. In the case of congestive changes, to close the defect and prevent recurrence, the hernial defect can be reconstructed successfully using the "sandwich" technique.