Differentiated approach to drainage of postoperative wounds using synthetic prostheses in patients with postoperative ventral hernia

The OBJECTIVE was to determine the indications and timing of wound drainage in patients with postoperative ventral hernias using mesh prostheses. METHODS AND MATERIALS. A retrospective analysis of 137 patients underwent elective prosthetic mesh hernioplasty for postoperative ventral hernias during 2020 – 2023 was carried out. Patients were divided into 2 groups: 55 patients without wound drainage (group 1) and 82 patients who had vacuum-aspiration drainage of the wound (group 2). RESULTS. In group 1, W3 hernias were diagnosed in 15 (27 %) patients, with significantly higher frequency in group 2 – 44 (54 %) patients (p=0.002). In group 1, simultaneous operations were performed in 10 (18 %) patients, and 46 (56 %) patients underwent simultaneous operations in group 2 (p<0.001). Rives-Stoppa hernioplasty was performed in all patients of group 1. In group 2, 62 (76 %) patients underwent hernioplasty using Rives-Stoppa method, 15 (18 %) patients had corrective hernioplasty, and in 5 (6 %) patients, posterior separation hernioplasty was done. Both groups had significant difference in used methods of hernioplasty (p=0.013). In group 1, 30x30 cm prostheses were used in 23 (42 %) patients; in group 2, the same size mesh was used in 52 (64 %) patients (p=0.027). Both groups did not differ significantly in frequency of wound complications (p=0.527). The term of drainage removal did not exceed 9 days in patients of group 2 with uncomplicated wound healing. The average postoperative in-hospital stay in group 1 was 7.6±0.3 days versus 13.3±1.2 days in group 2 (p<0.001). CONCLUSION. Indications for drainage of postoperative wound in patients with POVH are: the width of hernial defect of 10 cm or more, implantation of large mesh, using of separation methods of hernioplasty, as well as simultaneous operations. The period of wound drainage should not exceed 9 days.