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Open Underlay Mesh Reinforced Large Incisional Hernia Repair—Prospective Observational Hospital Based Study

DOI: 10.4236/ss.2019.103013, PP. 94-105

Keywords: Hernia, Mesh, Necrosis

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Abstract:

Introduction: Incisional hernias frequently complicate abdominal surgeries with a varied incidence as reported to be 2% - 20%. The risk factors of development of incisional hernias include immunocompromised state, diabetes mellitus, smoking, obesity, wound infection at the index surgery, emergency surgery. Materials and Methods: The study design was prospective and included 62 patients with incisional hernias. The patients were evaluated preoperatively on OPD basis with history, clinical examination, baseline investigation, ultrasound abdomen and computed tomogram. Results: The mean age was 48.9 years with male:female ratio of 1:1.4. Mean BMI was 30.1 kg/m2. Out of 62 patients in the study 61.2% had concomitant hypertension and were on treatment for the same. 30.6% were clinically hypothyroid, 38.7% were diabetic and 54.8% were smokers. There were multiple factors present in patients in the current study which were observed to be possible to have risked the patients to incisional hernias after an abdominal surgery. 21 patients had defect size ranging from 5 to 10 cm and 41 patients were bearing a hernia of the defect size of 10 cm or more. The mean operative time was 221.7 minutes. Conclusion: Incisional hernias are a part of surgical practice that would probably glue to it to the end of time. A progression from primitive suture repair with recurrence rates of over 65% to modern day mesh reinforced repairs with recurrences aimed at 0% is always welcome. But still then the placement of mesh in different positions or layers of abdominal wall yields different results.

References

[1]  Mudge, M. and Hughes, L.E. (1985) Incisional Hernia: A 10-Year Prospective Study of Incidence and Attitudes. British Journal of Surgery, 72, 70-71. https://doi.org/10.1002/bjs.1800720127
[2]  Lewis, R.T. and Wiegand, F.M. (1989) Natural History of Vertical Abdominal Parietal Closure: Prolene versus Dexon. Canadian Journal of Surgery, 32, 196-200.
[3]  Sugerman, H.J., Kellum Jr., J.M., Reines, H.D., et al. (1996) Greater Risk of Incisional Hernia with Morbidly Obese Than Steroid-Dependent Patients and Low Recurrence with Prefascial Polypropylene Mesh. American Journal of Surgery, 171, 80-84.
https://doi.org/10.1016/S0002-9610(99)80078-6
[4]  Hodgson, N.C., Malthaner, R.A. and Ostbye, T. (2000) The Search for an Ideal Method of Abdominal Fascial Closure: A Meta-Analysis. Annals of Surgery, 231, 436-442.
https://doi.org/10.1097/00000658-200003000-00018
[5]  Hoer, J., Lawong, G., Klinge, U., et al. (2002) [Factors Influencing the Development of Incisional Hernia: A Retrospective Study of 2,983 Laparotomy Patients over a Period of 10 Years. Chirurg, 73, 474-480.
[6]  van't, R.M., De Vos Van Steenwijk, P.J., Bonjer, H.J., Steyerberg, E.W. and Jeekel, J. (2004) Incisional Hernia after Repair of Wound Dehiscence: Incidence and Risk Factors. American Surgeon, 70, 281-286.
[7]  Read, R.C. and Yoder, G. (1989) Recent Trends in the Management of Incisional Herniation. Archives of Surgery, 124, 485-488. https://doi.org/10.1001/archsurg.1989.01410040095022
[8]  Manninen, M.J., Lavonius, M. and Perhoniemi, V.J. (1991) Results of Incisional Hernia Repair: A Retrospective Study of 172 Unselected Hernioplasties. European Journal of Surgery, 157, 29-31.
[9]  Paul, A., Korenkov, M., Peters, S., et al. (1998) Unacceptable Results of the Mayo Procedure for Repair of Abdominal Incisional Hernias. European Journal of Surgery, 164, 361-367.
https://doi.org/10.1080/110241598750004391
[10]  Anthony, T., Bergen, P.C., Kim, L.T., et al. (2000) Factors affecting Recurrence Following Incisional Herniorrhaphy. World Journal of Surgery, 24, 95-100.
https://doi.org/10.1007/s002689910018
[11]  Luijendijk, R.W., Hop, W.C., van den Tol, M.P., et al. (2000) A Comparison of Suture Repair with Mesh Repair for Incisional Hernia. New England Journal of Medicine, 343, 392-398.
https://doi.org/10.1056/NEJM200008103430603
[12]  Korenkov, M., Sauerland, S., Arndt, M., et al. (2002) Randomized Clinical Trial of Suture Repair, Polypropylene Mesh or Autodermalhernioplasty for Incisional Hernia. British Journal of Surgery, 89, 50-56. https://doi.org/10.1046/j.0007-1323.2001.01974.x
[13]  Luijendijk, R.W., Lemmen, M.H., Hop, W.C., et al. (1997) Incisional Hernia Recurrence Following “Vest-over-Pants” or Vertical Mayo Repair of Primary Hernias of the Midline. World Journal of Surgery, 21, 62-65. https://doi.org/10.1007/s002689900194
[14]  Ammar, S.A. (2009) Management of Giant Ventral Hernia by Polypropylene Mesh and Host Tissue Barrier: Trial of Simplification. Journal of Clinical Medicine Research, 1, 226-229.
https://doi.org/10.4021/jocmr2009.10.1268
[15]  Mommers, E.H.H., Leenders, B.J.M., Leclercq, W.K.G., de Vries Reilingh, T.S. and Charbon, J.A. (2017) A Modified Chevrel Technique for Ventral Hernia Repair: Long-Term Results of a Single Centre Cohort. Hernia, 21, 1-10. https://doi.org/10.1007/s10029-017-1602-2
[16]  Fitz Gerald, J.F. and Kumar, A.S. (2014) Biologic versus Synthetic Mesh Reinforcement: What Are the Pros and Cons? Clinics in Colon and Rectal Surgery, 27, 140-148.
[17]  van der Linden, F.T. and van Vroonhoven, T.J. (1988) Long-Term Results after Surgical Correction of Incisional Hernia. The Netherlands Journal of Surgery, 40, 127-129.
[18]  Muysoms, F.E., Miserez, M., Berrevoet, F., Campanelli, G., Champault, G.G., Chelala, E., Dietz, U.A., Eker, H.H., El Nakadi, I., Hauters, P., Hidalgo Pascual, M., Hoeferlin, A., Klinge, U., Montgomery, A., Simmermacher, R.K., Simons, M.P., Smietański, M., Sommeling, C., Tollens, T., Vierendeels, T. and Kingsnorth, A. (2009) Classification of Primary and Incisional Abdominal Wall Hernias. Hernia, 13, 407-414.
[19]  Cobb, W.S., Warren, J.A., Ewing, J.A., Burnikel, A., Merchant, M. and Carbonell, A.M. (2015) Open Retromuscular Mesh Repair of Complex Incisional Hernia: Predictors of Wound Events and Recurrence. Journal of the American College of Surgeons, 220, 606-613.
[20]  Rosen, M.J., et al. (2017) Multicenter, Prospective, Longitudinal Study of the Recurrence, Surgical Site Infection, and Quality of Life after Contaminated Ventral Hernia Repair Using Biosynthetic Absorbable Mesh. Annals of Surgery, 205-211.
[21]  Jaykar, R.D., et al. (2017) A Clinical Study of Ventral Hernia. International Surgery Journal, 4, 2326-2329.
[22]  Kockerling, F., et al. (2018) Treatment of Large Incisional Hernias in Sandwich Technique—A Review of the Literature. Frontiers in Surgery, 5, 37.
[23]  Nasajpour, H., Leblanc, K.A. and Steele, M.H. (2011) Complex Hernia Repair Using Component Separation Technique Paired with Intraperitoneal Acellular Porcine Dermis and Synthetic Mesh Overlay. Annals of Plastic Surgery, 66, 280-284.
https://doi.org/10.1097/SAP.0b013e3181e9449d
[24]  Leber, G.E., Garb, J.L., Alexander, A.I., et al. (1998) Long-Term Complications Associated with Prosthetic Repair of Incisional Hernias. The Archives of Surgery, 133, 378-382.
https://doi.org/10.1001/archsurg.133.4.378
[25]  Olmi, S., Magnone, S., Erba, L., Bertolini, A. and Croce, E. (2005) Results of Laparoscopic Versus Open Abdominal and Incisional Hernia Repair. Journal of the Society of Laparoendoscopic Surgeons, 9, 189-195.
[26]  Jacobus, W.A., Burger, M.D., et al. (2004) Long-Term Follow-Up of a Randomized Controlled Trial of Suture versus Mesh Repair of Incisional Hernia. Annals of Surgery, 240, 578-585.

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