THE NPWT USE IN PATIENTS WITH PURULENT COMPLICATIONS AFTER PROSTHETIC REPAIR OF ABDOMINAL WALL

Abstract

Aim: to evaluate the prospects of using systems with negative pressure in purulent-inflammatory complications of prosthetic abdominal wall repair.
Materials and methods: 51 patients were observed with purulent - inflammatory complications of prosthetic repair performed for abdominal wall hernias. Group I included 32 patients who developed an acute para-prosthetic inflammatory process (abscesses, phlegmon, infarction of the abdominal wall with infection, suppuration of the wound) up to 30 days after the intervention, group II included 19 patients with signs of chronic infection associated with with a previously implanted mesh (purulent fistulas, chronic abscesses of the abdominal wall). All patients underwent revision and debridement of the purulent site, if necessary, necrectomy, for some individuals complete or partial excision of endoprostheses, some patients used negative pressure therapy (NPWT), others performed only standard procedures generally accepted for purulent infection.
Results: It was found that in individuals with acute inflammatory process (group I), the use of NPWT made it possible in all cases to preserve the network in situ. The need for repeated operations using this technology in acute surgical infection was significantly less (p = 0.00063, Fisher). The strength of the link between the risk factor (refusal to use NPWT) and the outcome (repeated intervention) is relatively strong (C = 0.514, Pearson, V = 0.599, Cramer). In a chronic purulent process, a decrease in the need for repeated interventions was not significant (Fisher, p = 0.26213), and the strength of the relationship between the risk factor and outcome was average (Pearson, C = 0.325, Cramer, V = 0.344).
Conclusion: using of NPWT in chronic mesh infection involves partial excision of the endoprosthesis, and the possibilities of the technique require further study.