First clinical application of Permacol biological mesh in Ukraine. Case report

Abstract

The article presents the first clinical experience in Ukraine of using the Permacol biological implant in the surgical treatment of a giant postoperative ventral hernia in a patient with morbid obesity and an external fistula of the anterior abdominal wall. The study is relevant due to the high incidence of postoperative ventral hernias, particularly after open surgical interventions, and the considerable risk of infectious complications in contaminated surgical fields. Additionally, the absence of standardized guidelines for the combined approach to hernioplasty and bariatric surgery in obese patients remains a significant clinical challenge. A detailed clinical case is presented involving a 63-year-old patient with сlass III obesity, a giant defect of the anterior abdominal wall aponeurosis, and a chronic external fistula, along with a complicated surgical history that included peritonitis and postoperative wound suppuration. Preoperative management involved intramuscular administration of botulinum toxin type A to relax the anterior abdominal wall muscles, reduce the risk of tissue tension, and prevent abdominal compartment syndrome. The patient underwent herniolaparotomy, viscerolysis, hernioplasty with intra-abdominal placement of the Permacol biological implant using the open intraperitoneal onlay mesh (IPOM) technique, mini-gastric bypass, excision of the anterior abdominal wall fistula, and drainage of both the abdominal cavity and postoperative wound according to Redon. The postoperative period was uneventful, with no evidence of intra-abdominal hypertension or infection. These findings support the feasibility and safety of the Permacol biological implant in patients with complex anterior abdominal wall defects and a high risk of infectious complications.