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At least 19 recordsLinked to original sources
PubMed1997

[Abdominal wall hernias (inguinal hernia, incisional hernia)].

Within the range of treatment of inguinal hernias, the paper concentrates on the following procedures: Shouldice, the "tension-free" repairs of Lichtenstein, Rutkow, TIPP, and the laparoscopic procedures TAPP and TEP. An individual, selective approach tailored to the type of hernia, as well as the age and profession of the patient is recommended. A multicenter study comparing these procedures would be useful. Conventional repair of incisional hernias (simple closure, Mayo) has a depressing recurrence rate of 30%-40%. Better results are obtained by using a synthetic prosthesis, which can be implanted using the sublay inlay, or onlay technique.

Cicatrix↗
PubMed2003

Factors involved in abdominal wall closure and subsequent incisional hernia.

Incisional hernia is a frequent complication of abdominal wall closure with a reported incidence of between 5% and 15% following vertical midline incisions at one-year follow-up. Evidence from randomised clinical trials and meta-analysis indicate that a continuous running non-absorbable or slowly absorbed suture such as polydioxanone is the method of choice for abdominal wall closure. Continuous polydioxanone has a similar incisional hernia rate to its non-absorbable counterparts but causes less chronic pain and wound sinuses. Evidence from randomised clinical trials indicates that a lateral paramedian incision is associated with a lower incidence of incisional hernia when compared with other abdominal incisions. Transverse abdominal incisions have no advantage over midline incisions in reducing incisional hernia rate. Although experimental and clinical evidence indicate that a greater number of stitches with a suture length to wound ratio of at least 4:1 is associated with a lower incidence of incisional hernia, there is no evidence from randomised clinical trials to support this. Intuitively one may think that putting as little tension as possible on the closure is important, but there is no evidence for this. Clinical trials evaluating these factors would be difficult to undertake making it important that surgeons continue to audit incisional hernia rates following abdominal closure.

Abdominal Wall↗
PubMed2002

Laparoscopic repair of large incisional hernias.

Incisional hernias after abdominal operations are a significant cause of long-term morbidity and have been reported to occur in 3 to 20 per cent of laparotomy incisions. Traditional primary suture closure repair is plagued with up to a 50 per cent recurrence rate. With the introduction of prosthetic mesh repair recurrence decreased, but complications with mesh placement emerged ushering in the development of laparoscopic incisional herniorrhaphy. The records of patients who underwent laparoscopic incisional hernia repair between June 1, 1995 and September 1, 2001 were reviewed. Patient demographics, hernia defect size, recurrence, operative time, and procedure-related complications were evaluated. Fifty patients (22 male and 28 female, mean age 57 years with range of 24-83) were scheduled for laparoscopic incisional hernia repair between June 1, 1995 and September 1, 2001. The average patient was obese with a mean body mass index of 35.8 kg/m2 (range 16-57 kg/m2). Two patients (4%) had primary ventral hernias. Forty-eight patients (96%) had incisional hernias with 22 (46%) of these previously repaired with prosthetic mesh. Mean defect size was 206.1 cm2 (range 48-594 cm2). The average mesh size was 510.2 cm2 (range 224-1050 cm2). Gore-Tex DualMesh and Bard Composite Mesh were used in 84 and 16 per cent of the repairs, respectively. Mean operating time was 97 minutes. There were no deaths. Complications were seen in 12 per cent patients (six occurrences) and included two small bowel enterotomies, a symptomatic seroma requiring aspirate, a mesh reaction requiring a short course of intravenous antibiotics, and trocar site pain (two patients). There were no recurrences during a mean follow-up of 41 months (range 3-74 months). We conclude that laparoscopic incisional herniorrhaphy offers a safe and effective repair for large primary and recurrent ventral hernia with low morbidity.

Adult↗
PubMed1993

Incisional hernia.

Incisional hernias are a relatively common occurrence after abdominal operations, having been reported to occur in 2% to 11% of all patients undergoing such procedures. Although many hernias become manifest early, others may not be noted until many years after the index procedure. Predisposing factors for incisional hernia have been well described, and several of these can be altered by the surgeon, including the technique employed for repair. For many years, the repair of incisional hernia was associated with a high recurrence rate. In more recent years, the introduction of synthetic prosthetic materials has provided the opportunity to perform a tension-free repair, thereby reducing the rate of recurrence.

Abdominal Muscles↗
PubMed1997

[Tension-free suture of incisional hernia].

Incisional hernias are a common complication following abdominal surgery. However, when performed correctly, the techniques utilized for direct hernia repair, Mayo's closure and plastic covering of the defect appear to be effective in the management of primary hernia closure. The recurrence rates of 30-50% continue to represent a significant challenge in the initial management of incisional hernia repair. Fortunately, there is evidence that, with correct preparation of the patient and with correct anatomical reconstruction, better results can be achieved. Also, the use of strictly applied technical skills in combination with standardized operative techniques may help to eliminate further complications and recurrences. In addition, the application of mesh or cutis transplantation to reinforce the attenuated tissue has also been shown to reduce the recurrence rate. With the diligent application of the above measures, as well as of new concepts, which at present include a promising technique called tension-adapted closure, there may be positive developments in the treatment and management of incisional hernias.

Abdominal Muscles↗
PubMed2002

[Prevention of incisional hernia].

Incisional hernia is the most frequent late complication of surgery; its incidence is constant and it has a high socio-economic impact. Possible preventive measures are analysed in this article on the basis of current clinical and experimental findings. An argument that is restricted strictly to the surgical and technical aspects does not do justice to the complexity of incisional hernia development. It has been proved that continuous mattress suturing after laparotomy is beneficial in terms of wound healing and also means significantly shorter operating times and smaller amounts of suture material are needed. Combined with a suture length-to-wound length ratio of at least 4:1, this technique is superior to single interrupted suturing as its bio-mechanical properties are better and it allows better collagen synthesis in the region of the incision. It is not possible to recommend any one particular suture material at present. The possibilities of influencing the endogenous risk factors connected with the patient and any co-morbidity is hampered by economic aspects and low efficiency, although precisely such endogenous factors have a high potential for influencing treatment in the future. Suture tension is a relevant parameter that has not yet been sufficiently fully evaluated. Better monitoring of suture tension might open up the possibility of devising new variants of laparotomy closure techniques that would reduce the incidence of incisional hernias. In view of the significance of impaired wound healing for the surgical specialties, suture tension and the search for possible ways of influencing and modulating collagen synthesis look like promising topics that would reward a more intense research effort in the future.

Hernia, Ventral↗
PubMedDate not supplied

[The use of autologous dermis in the treatment of incisional hernia].

Incisional hernia is a relatively frequent complication of laparotomy. In reconstruction of large abdominal wall defects prosthetic meshes have come to play a leading role. However, they carry a high risk of infection and are poorly effective in restoring perfect chest-wall function. In order to achieve a better result we treated two cases of incisional hernia with a combined technique, namely, abdominoplasty with subcutaneous implantation of in-vitro cultured autologous dermis (Hialograft 3D). As described in the literature, we noticed that this kind of implant integrates perfectly with the receiving tissues with no sign of rejection or reabsorbtion. It provides good support for the abdominal wall with excellent elastic properties that make for better restoration of chest-wall function compared to prosthetic implants. Two years after the operation there are no signs of recurrence. The high cost and the time needed for culturing the fibroblasts are the main drawbacks of this technique. Despite the very small sample size and short follow-up, the encouraging results obtained to date justify further study.

Aged↗
PubMedDate not supplied

[The meshes of polypropylene in emergency surgery for strangulated hernias and incisional hernias].

INTRODUCTION: The Authors present their experience on the use of meshes of polypropylene in septic surgery of the abdominal wall defects. MATERIALS AND METHODS: From April 1999 to October 2003, 23 patients underwent intestinal resection (20 small intestine, 3 large intestine) for ischemic necrosis strangulation caused by defects in the abdominal wall (inguinal hernia 8, crural hernia 4, umbilical hernia 3, post-incisional hernia under umbilicus 3, post-incisional hernia epigastric 3, giant post-incisional hernia 2). RESULTS: No patient died and the removal of the mesh was never required in cases of infection of the surgical wound; 2 surgical wounds festered, with the reopening of the cutaneous wound and showing of the prosthesis, 5 hygromas were all treated in a conservative way. DISCUSSION: The macroporous structure of the meshes of polypropylene, with pores of diameter larger than 70 microns, allows contact among the bacteria, which measure one micron in diameter, and the cells of the immune system, granulocytes and macrophages, with a diameter of 15-20 microns, allowing the recovery from infections, and determining an high resistance rate to infections. CONCLUSIONS: Polypropylene prostheses, thanks to their macroporous structure, are sufficiently resistant to infections and therefore may be safely used in the surgery of the defects of the abdominal wall, when, following ischemic necrosis, an intestinal resection is necessary.

Adult↗
PubMed2006

Combined fascia and mesh repair of incisional hernias.

Incisional hernia is a relatively common complication following abdominal operations. Due to high recurrence rates following primary suture, a prosthetic mesh is now usually used to repair the hernia. Several different types of repair are described. A combined fascia and mesh technique avoids opening the peritoneal cavity and potential damage to bowel. This study describes results of this technique. Consecutive patients undergoing the operation were contacted to assess freedom from recurrence and satisfaction with results. Some 34 patients underwent 36 incisional repairs. Of the 34 patients 21 were men and 13 were women with a median age of 69 years (range 31-86 years). The causative incisions were midline (30), Kochers (2), Pfannesteil (2) and transverse (2). The median time spent in hospital was three nights (range 1-14 days). Two patients developed seromas, another complained of pain soon after operation, one patient developed a superficial wound infection another developed a tender drain site which required exploration. One patient with significant co-morbidity died 13 days postoperatively from multiorgan failure. Freedom from recurrence of the hernia was 91% at 5 years. However patient survival was only 70% at 5 years. This technique is associated with low postoperative morbidity and a low recurrence rate. Patients presenting with incisional hernias have a poor long-term prognosis which needs to be borne in mind when planning intervention.

Adult↗
PubMed1997

[Incisional hernias].

Incisional hernias are a common complication following abdominal surgery. Surgical treatment as a whole has the disadvantage of having a high recurrence rate. Far better results are obtained by tension-free closure, if necessary backed up by a synthetic prosthesis (PTFE, polypropylene). However, even then, a recurrence rate of about 10% can be expected.

Abdominal Muscles↗
PubMed2001

Repair of incisional hernias.

Incisional hernias develop in up to 11% of surgical abdominal wounds with a possible recurrence following repair of 44%. We describe our experience with a combined fascial and prosthetic mesh repair. Thirty-five patients (16M:19F) have been treated. The original operation was bowel related in 19 cases, gynaecological in 8, hepatopancreaticobiliary in 3 patients, aortic aneurysm repair in 2 and involved a thoraco-laparotomy in 3. The incisions were midline in 26 cases, transverse in 6, paramedian in 2 and rooftop in one patient. The hernias were considered subjectively to be large in 15, medium in 14 and small in 6 of the patients. A proforma was completed for each patient noting intra-operative and post-operative complications, post-operative hospital stay and analgesic requirements. Post-operative complications included seroma formation in 6 patients, deep vein thrombosis in one and a non-fatal pulmonary embolism in another. One patient developed a wound haematoma and one had a superficial wound infection. Post-operative in-hospital stay ranged from 1 to 27 days with a mean of 6.2 days. Of the 35 patients 33 were available for follow-up. Follow-up was for a median of 20.3 months (range 6.0 to 54.1 months). Two of these (6%) patients reported a persistent lump and one (3%) reported persistent pain but none of the remaining 33 was found to have a recurrence. We advocate this technique because it is applicable to all hernias, most of the mesh is behind the rectus sheath and has 2 points of fixation, it is relatively pain-free allowing early mobilisation, has a modest complication rate and a low recurrence rate.

Aged↗
PubMedDate not supplied

Incisional hernia: a review.

BACKGROUND: Otherwise known as post operative ventral hernia, incisional hernia is a common complication following abdominal surgery and is a significant cause of morbidity. This review examines incisional hernia from its historical perspective to the present. METHOD: A Literature review of the topic was carried out using manual library search of journal articles on the topic published both locally and internationally. The search also made use of intemet material from Pubmed and Medline on relevant parts of the topic. All relevant articles from the reference lists of these papers were also studied. RESULT: Incisional hernia is a common complication of abdominal surgery. Its incidence is about 1% following primary healing and increasing to about 11% with postoperative wound infection. The most consistent causative factor is wound infection and the incidence may rise to 30% after abdominal wound dehiscenece and resuture. It may be difficult to repair and a wide range of surgical procedures have been developed for such repair. The repair may be direct suture or prosthetic mesh using the open or laparoscopic technique. Prosthetic mesh has revolutionized the repair of incisional hernias. Laparoscopic repair, which was introduced in the 1990's, has been adjudged feasible, safe and as effective as the open methods of repair. Recurrence rates of up to 49% with direct suture repair have been reported. Open and laparoscopic mesh repair have recurrent rates of 0-10% and 0-9% respectively. CONCLUSION: Despite improved surgical techniques and the use of prosthetic mesh incisional herniation remains a major problem for the general surgeon.

Hernia, Abdominal↗
PubMedDate not supplied

[Recurrent parastomal hernia and middle incisional hernia: surgical treatment through midline incision with wide prosthetic mesh].

Parastomal hernia is a frequent complication of stoma surgery. The results of parastomal hernia repair however are poor, showing an high incidence of postoperative recurrences. In the last years, hernia repair with prosthetic mesh has given better postoperative results. The parastomal hernia, however, is associated with middle incisional hernia. The authors review the problem of surgical repair of parastomal hernia and report a case of recurrent parastomal hernia associated to middle incisional hernia. The technique of surgical repair using, through midline incision, one, wide, prosthetic polypropylene mesh, in sublay position, according to Rives' technique, is described. The mesh has been incised in a trasverse direction for the stoma crossing. At 6 years follow-up the patient does not show postoperative recurrence. According literature and the authors' results, the parastomal hernia might be considered an incisional hernia and, therefore, a sing of diffuse abdominal wall disease. The Rives' surgical technique might be the gold standard for treatment of parastomal hernia, even if not associated to incisional hernia. The more complexity of Rives' technique compared to local fascial mesh repair is compensated by the result of total abdominal wall reinforcement.

Aged↗
PubMedDate not supplied

Laparoscopic ventral incisional hernia repair: a more effective alternative to conventional repair of recurrent incisional hernia.

Conventional repair of recurrent ventral incisional hernia is associated with a higher recurrence rate (30%-50%) than repair of primary incisional hernia (11%-20%). Laparoscopic incisional hernia repair (LIHR) can significantly reduce the recurrence rate of primary hernia to less than 5%. In this study, we evaluate the efficacy of repairing recurrent incisional hernia laparoscopically. One-hundred and seventy consecutive patients undergoing LIHR between January 1995 and December 2002 were prospectively reviewed. Patients with recurrent incisional hernia (n=69) were compared to patients with primary incisional hernia (n=101). Patient demographics and perioperative and postoperative data were recorded prospectively. Follow-up was obtained from office visits and telephone interviews. Statistical analysis was performed using the Student t test and the chi(2) test. Results are expressed as means +/- standard deviation. The patients with recurrent incisional hernia had a mean of 1.9 +/- 1.3 previous repairs, higher body mass index (BMI) (34 +/- 6 kg/m(2) vs. 33 +/- 8 kg/m(2), P=0.46), larger defect size (123 +/- 115 cm(2) vs. 101 +/- 108 cm(2), P=0.06), and longer operative time (119 +/- 61 minutes vs. 109 +/- 44 minutes, P=0.11). The complication rate was higher in the recurrent group (28% vs. 11%, P=0.01), but the recurrence rate was not different (7% vs. 5%, P=0.53). The mean time to recurrence was significantly shorter in the recurrent group (3 +/- 2 months vs. 14 +/- 7 months, P < 0.0001). The mean follow-up interval was 19 +/- 18 months in the recurrent group and 27 +/- 20 months in the primary group. Although laparoscopic repair of recurrent incisional hernia resulted in a higher recurrence and complication rate than laparoscopic repair of primary incisional hernia, the rates were lower than those reported for conventional repair of recurrent incisional hernia. Laparoscopic repair of recurrent incisional hernia is an effective alternative to conventional repair.

Chi-Square Distribution↗
PubMed2003

[Twenty-five years of experience in incisional hernia surgery. A comparative retrospective study of 432 incisional hernia repairs].

INTRODUCTION: Incisional hernia surgery in Germany is changing from conventional techniques to mesh implantation. The relevance of different factors such as surgical technique, mesh material, and patient-related parameters concerning the outcome following mesh repair is still under debate. METHODS: In a comparative retrospective study of 432 incisional hernia operations on 348 patients we analyzed 11 autodermic hernioplasties, 241 Mayo procedures,and 180 mesh repairs over a 25-year time period. In addition to the quality of life following mesh implantation,the prognostic relevance of demographic, pre- and intraoperative parameters, surgical technique, mesh material, and the surgeon's experience were subjected to both univariate and multivariate analysis. RESULTS: With a mean follow-up of 9.7+/-8.8 years, the rate of major complications following mesh repair was 9% in contrast to 3% after the Mayo procedure (p=0.091). The sublay technique revealed less complications compared to the onlay procedure (p=0.016). The total recurrence rate following the overlapping Mayo repair was 37% in contrast to 15% after mesh implantation (p=0.001), with a significant superiority of the sublay technique over the inlay technique (p=0.043). The rate of recurrences and complications after autodermic hernioplasty was 72% and 36%,respectively. After mesh repair, 86% of the patients were better satisfied with the results after Marlex mesh compared to GoreTex (p=0.016). Mesh size was the only significant prognostic factor concerning quality of life following mesh implantation. The complication rate was determined significantly by the patients' risk factors, size of hernia, surgical technique, and the surgeon's experience, whereas the rate of recurrences was significantly influenced by the parameters obesity (BMI >25), size of hernia,and surgical experience. The recurrence rate decreased significantly with the surgeon's experience: a minimum of 16 mesh repairs led to a recurrence rate of less than 10%. CONCLUSIONS: Only the mesh repair revealed acceptable recurrence rates with high patient comfort. The sublay technique is superior to onlay concerning the complication rate, whereas the autodermic hernioplasty and inlay techniques are obsolete. The material of choice is polypropylene. The most important prognostic factor following mesh repair is the surgeon's experience.

Adult↗
PubMedDate not supplied

Use of an absorbable polyglactin mesh for the prevention of incisional hernias.

Nowadays, incisional hernias are still one of the more common complications of abdominal surgical procedures. A population, at high risk of developing an incisional hernia, has been chosen for this study, namely patients suffering from morbid obesity. The aim of the study was to compare prospectively the incidence of incisional hernias in 2 groups of patients operated upon for morbid obesity (Vertical Silicone Ring Gastroplasty) with or without intraperitoneal polyglactin mesh. Patients were randomly assigned in the 2 groups. For this preliminary study, 112 patients operated upon before 01/04/1992 were selected; the mean follow-up period was 28.3 months (S.D.:5.7); 81 patients have been reviewed personally, 31 interviewed by phone call or mail. The 2 groups of patients were not significantly different as regarding age, sex, weight, body mass index, diabetes and wound infection. Sixteen incisional hernias were observed in the group with mesh and 17 in the group without mesh. According to these preliminary results, there is no argument for recommending the use of the polyglactin mesh in the prevention of postoperative incisional hernias, in obese patients.

Adult↗