Operative accesses to the abdominal aorta from the perspective of prevention of postoperative ventral hernias (literature review)

• Frolov D.V.
• Pletnev A.V.
• Kovaleva Yu.S.
• Linkenko A.A.

Abstract

Background. Cardiovascular diseases rank first in the annual structure of mortality, with the number of reconstructive operations for these diseases growing steadily. Thus, according to the data of A.V. Pokrovsky, approximately 70 thousand arterial reconstructions were performed over 2018 alone. The traditional open surgery by the number of arterial reconstructions continues to hold a leading position. One of the possible remote complications after laparotomy, a frequently performed access to the abdominal aorta, is the development of postoperative ventral hernias. Reducing the incidence of this complication remains a challenging task for several decades.

Objective. The purpose of this study was to assess the possibility of primary prevention of postoperative ventral hernias after various accesses to the abdominal aorta.

Material and methods. We analyzed the data published in the Russian and English languages – PubMed, Scopius, Web of Science, eLibrary.

Results and discussion. The article describes all possible types of accesses to the abdominal aorta, of laparotomic ones – the transverse and midline approaches. Based on Russian and international sources, discussed are advantages and disadvantages of each of them from the point of view of the biomechanics of the anterior abdominal wall, organization of the access, anesthesia, suture materials, postoperative wound suturing technique, use of meshes, and prevention of postoperative complications.

Conclusion. Continuous suture with a monofilament long-term absorbable thread used in the small-bite stitching technique with a suture length to wound length ratio of not less than 4:1 is currently a highly recommended method for closing the abdominal cavity. Among the transperitoneal accesses, the transverse one is less often complicated by hernia formation. In patients at high risk for developing postoperative ventral hernias, especially in a longitudinal access, a polypropylene mesh may be used.

Funding. The study had no financial support.

Conflict of interest. The authors declare no conflicts of interest.

Authors’ contribution. Study conception and design – Frolov D.V.; data collection and handling – Kovaleva Yu.S., Linchenko A.A.; statistical processing – Linchenko A.A.; draft manuscript preparation – Kovaleva Yu.S.; manuscript revision – Frolov D.V., Pletnev A.V.

For citation: Frolov D.V., Pletnev A.V., Kovaleva Yu.S., Linchenko A.A. Operative accesses to the abdominal aorta from the perspective of prevention of postoperative ventral hernias (literature review). Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2024; 30 (1): 131–7. DOI: https://doi.org/10.33029/1027-6661-2024-30-1-131-137

Keywords:ventral hernia; herniation; complication; laparotomy