Post-Operative Incisional Hernias Associated with Conditions that Requires Tissue Procedures

Background: In the case of repairing the abdominal wall without the prosthesis material, the pathological conditions that require tissue closure have been identified.This study aims to present practical recommendations regarding abdominal wall repair without using prosthetic material, for special cases. Material and method:The retrospective study carried out concerned the repair situations of the abdominal wall by tissue procedures in 384 patients out of a total of 1130 interventions of this kind, in a general surgery section of the Dr. Constantin Andreoiu County Emergency Hospital, Ploiesti, Romania, during January 2018 -December 2022.Patients who underwent tissue procedures to repair the abdominal wall after incisional hernias presented pathological conditions that claimed the non-use of allografts.From the set of pathological conditions identified in the 384 cases, the following was found: strangulation of the intestinal loop with borderline loop or perforation, peritonitis, acute lithic cholecystitis, entero-mesenteric infarction, neoplasms (peritoneal carcinoma, tumor occlusions, etc.), digestive hemorrhages that required intervention on the digestive tract, small-diameter eventration associated with important comorbidities such as heart failure, diabetes, liver cirrhosis, obesity, hypertension.These pathological conditions were identified singly or in different combinations.The surgical technique used in the given conditions varied depending on the case.In this sense, chelotomies, viscerolysis, partial or extensive resections, with or without anastomosis, tumorectomies, clean-up of septic foci, etc. were performed.In certain cases, it was necessary to perform gastrotomies and hemostasis in situ.The approach to parietal restoration was made taking into account the modern general principles: separation of components, reduction of parietal tension through relaxation incisions, extirpation of granulomas, careful hemostasis, restoration of the white line as much as possible in the case of median IH.Guarantee good muscle relaxation by the anesthetist team.The suture is made in anatomical planes, with separate, non-absorbable threads.In most cases, peritoneal drainage and sometimes supra-aponeurotic drainage were used. Results:From the studied group of 1130 HIs, 384 cases representing 33.98% were identified and were solved by tissue procedures, without prosthesis.The ratio of men: to women was on average 1:4 and from the perspective of age, the average age of men was 68 years while the average age of women was 65 years.From the set of pathological conditions, type (I) strangulation of the intestinal loop with the borderline or perforated loop represented 11.36% (128 patients), respectively type (II) peritonitis, represented 5.2% (59 patients) ), the other pathologies having an average value of 2.27%.The average length of hospitalization was 12 days.Post-operative monitoring was carried out in 1 month and 6 months, considering that the operations occurred in an emergency hospital.A case study of a 74-year-old patient followed oncologically, with metachronic neoplasm of the splenic angle of the colon and post-operative pan gastric eventration, returned after 5 years, was presented.After performing a complex intervention including viscerolysis, left hemicolectomy, splenectomy, corporeal-caudal pancreatectomy, colo -colo -Termino -Terminal anastomosis, the components were