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.

1. Mirzabekyan Yu. R. Prediction and prophylaxis of wound complications after abdominal plasty due to postoperative ventral hernia. Pirogov Russian Journal of Surgery. 2008;(1):66‒71. (In Russ.).

2. Sonis A. G., Grachev B. D., Stolyarov E. A., Ishutov I. V. Prevention and treatment of infection wound complications at prosthetic hernia repair. Wounds and wound infections. 2014;1(2):16‒23. (In Russ.). https://doi. org/10.25199/2408-9613-2014-1-2-16-23.

3. Kukosh M. V., Vlasov A. V., Gomozov G. I. Prevention of early post operative complications at endoprosthesis of ventral hernias. Novosti Khirurgii. 2012;20(5):32‒37. (In Russ.).

4. Sahm M., Pross M., Hukauf M. et al. Drain versus no drain in elec tive open incisional hernia operations: a registry-based analysis with 39,523 patients. Hernia. 2024;28(4):1077‒1091. https://doi.org/10.1007/s10029-023-02862-4. EDN: RZPDJK.

5. Krpata D. M., Prabhu A. S., Carbonell A. M. et al. Drain Placement Does Not Increase Infectious Complications After Retromuscular Ventral Hernia Repair with Synthetic Mesh: an AHSQC Analysis. J Gastrointest Surg. 2017;21(12):2083‒2089. https://doi.org/10.1007/s11605-0173601-0. EDN: ASWRHE.

6. Marcolin P., de Figueiredo S. M. P., Constante M. M. et al. Drain place ment in retromuscular ventral hernia repair: a systematic review and meta-analysis. Hernia. 2023;27(3):519‒526. https://doi.org/10.1007/s10029-023-02792-1. EDN: FVTDTV.

7. Gurusamy K. Wound drains after incisional hernia repair. The Cochrane Database of Sys-tematic Reviews. 2013;12:CD005570. https://doi.org/10.1002/14651858.CD005570.pub4.

8. Westphalen A. P., Araújo A. С. F., Zacharias P. et al. Repair of large incisional hernias. To drain or not to drain. Randomized clinical trial. Acta Cir Bras. 2015;30(12):844‒851. https://doi.org/10.1590/S0102865020150120000009.

9. Mohamedahmed A. Y. Y., Zaman S., Ghassemi N. et al. Should routine surgical wound drainage after ventral hernia repair be avoided? A sys tematic review and meta-analysis. Hernia. 2023;27(4):781‒793. https://doi.org/10.1007/s10029-023-02804-0. EDN: AAZCQE.

10. Coletta D., Del Basso C., Giuliani G., Guerra F. Subcutaneous suc tion drains do not prevent surgical site infections in clean-contaminated abdominal surgery-results of a systematic re-view and meta-analysis. Langenbeck’s Archives of Surgery. 2019;404(6):663‒668. https://doi.org/10.1007/s00423-019-01813-x. EDN: KMYERU.

11. Idrees M., Mare H., Lester L., Kariyawasam S. Large ventral herni as: to drain… And what to drain… That is the question! ANZ J Surg. 2021;91(10):2081‒2085. PMID: 34467637. https://doi.org/10.1111/ans.17171 EDN: VCYOUI.

12. Kushner B., Smith E., Han B. et al. Early drain removal does not in crease the rate of surgical site infections following an open transversus abdominis release. Hernia. 2021;25(2):411‒418. https://doi.org/10.1007/s10029-020-02362-9. EDN: EZOBIT.

13. Rivera-Buendía F., Franco-Cendejas R., Román-López С. G. et al. Randomized controlled trial to reduce bacterial colonization of surgical drains with the use of chlorhexidine-coated dressings after breast cancer surgery. Annals of Surgical Oncology. 2019;26(12):3883‒3891. https://doi.org/10.1245/s10434-019-07631-1. EDN: MGSFCS.

14. Kuznetsov A.V., Kostina L. Yu., Novikova A. I. et al. Selection of an adequate method of drainage of the paraprosthetic cavity in the treatment of postoperative ventral hernias. Sibirskii meditsinskii vestnik. 2021;(3):44‒47. (In Russ.). https://doi.org/10.31549/2541-8289-2021-3-44-47.

15. Plymale M. A. Abdominal wall reconstruction: The uncertainty of the impact of drain duration upon outcomes. Am. Surgery. 2016;82(3):207‒211. https://doi.org/10.1177/000313481608200312.

16. Meyer A. M., Hu A., Liu A. T. et al. Retromuscular drain output at removal does not influence adverse outcome rate in open ventral hernia repairs. Surg Endosc. 2024;38(1):356‒362. https://doi.org/10.1007/s00464-023 10428-9. EDN: EHSGXN.