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Scripcariu V,Timofte D,Timofeiov S,Lefter L
Jurnalul de Chirurgie , 2006,
Abstract: Incisional hernia is an important complication of abdominal surgery. Procedures for the repair of these hernias with sutures and with mesh have been reported, but there is no consensus about which type of procedure is the best. We have performed a retrospective analysis on 1128 patients operated on in our unit between 1994 and 2004 for simple or recurrent incisional hernias. The polypropylene mesh has been used in a number of 138 patients. The mesh has been placed either intraperitoneal, extraperitoneal/ subfascial or onlay. Median follow-up was 36 months. There were 1 enterocutaneous fistula and 5 wound sinus developed. The mesh had to be removed in 6 cases. All of these complication developed when the mesh has been placed either extraperitoneally/subfascial or onlay. We note 5 recurrent incisional hernias after a period of up to 24 months. The recurrence rates after open mesh repair are less then after primary closure. The intraperitoneal use of polypropylene mesh with omental coverage is a good procedure with less complications.
The Surgical Results of Onlay Mesh Repair for Incisional Hernia  [PDF]
Bülent Kaya,Yal?m U?tum,Cengiz Eris,Orhan Bat
Journal of Clinical and Analytical Medicine , 2012, DOI: 10.4328
Abstract: Aim: ncisional hernia after abdominal surgery is an important problem. We aimed to evaluate the longterm recurrence rate as well as surgical complications in patients operated with onlay mesh repair technique for incisional hernia. Material and Method: We studied a serial of 139 patients retrospectively, operated due to incisional hernia in between January 2001 to November 2009 in Vak f Gureba Training and Research Hospital General Surgery Department. The patient’s age, sex, location and size of the defect, operation findings, duration of hospitalization, early and late complications and recurrences were recorded. Result: There were 56 men and 83 women inour serial. The mean age was 55 (age range, 30-85 years). The most commonincisions that hernia had been developed were upper midline incision (51 patients) and lower midline incision (37 patients). The size of the hernia defect was 0-5 cm in 118 patients , 6-10 cm in 5 patients 11-15 cm in 12 patients, and above 15 cm in 4 patients. The postoperative complications were wound infection in 22 patients, seroma in 12 patients. The mean duration of hospital stay was 4.53 (range 1-10 days). The recurrence was detected in 6 patients. Discussion: It seems to be that onlay mesh repair is safe and effective technique for incisional hernia repair.
Incisional Hernia after Renal Transplantation and Its Repair with Propylene Mesh
Reza Mahdavi,M Mehrabi
Urology Journal , 2004,
Abstract: Purpose: Kidney recipients are susceptible to incisional hernia. We studied predisposing factors for incisional hernia in our patients and the results of its repair with propylene mesh. Materials and Methods: From 1989 to 2002, 589 patients had undergone kidney transplantation in our hospital. Of these, patients who developed incisional hernia were evaluated in this study. The following data were collected from their records: age, gender, weight, age at graft rejection, surgical complications, treatment method, and the treatment results with propylene mesh. Results: Of 589 recipients, 16 (3%) developed incisional hernia in surgical site. The median interval between kidney transplantation and developing of incisional hernia was 48 (range 12 to 425) days. Predisposing factors were overweight, age over fifty years, and female gender (P < 0.005). In four patients, hernia was small, and the repair was performed without using mesh. Three patients were reluctant to hernia repair, and in 9, due to the large size of hernia, repair was done using propylene mesh. Having these 9 patients treated with propylene mesh, 2 developed serous collection in surgical site, which were managed successfully with multiple punctures. Hernia recurrence or infection was not noted in these patients during 3 to 36 months follow-up periods. Conclusion: Incisional hernia is not a rare entity after kidney transplantation. Predisposing factors, such as overweight, age over 50 years, and female gender have a role in its development. Also, repeated surgeries in kidney recipients can increase the risk of incisional hernia. Managing this complication with propylene mesh is a safe and effective method.
Incisional Hernia in Women: Predisposing Factors and Management Where Mesh is not Readily Available
EA Agbakwuru, JK Olabanji, OI Alatise, RO Okwerekwu, OA Esimai
Libyan Journal of Medicine , 2009,
Abstract: Background / Aim: Incisional hernia is still relatively common in our practice. The aim of the study was to identify risk factors associated with incisional hernia in our region. The setting is the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria during a period when prosthetic mesh was not readily available. Patients and Methods: All the women who presented with incisional hernia between 1996 and 2005 were prospectively studied using a standard form to obtain information on pre-hernia (index) operations and possible predisposing factors. They all had open surgical repair and were followed up for 18-60 months. Results: Forty-four women were treated during study period. The index surgeries leading to the hernias were emergency caesarian section 26/44 (59.1%), emergency exploratory laparotomy 6/44 (13.6%), and elective surgeries 12/44 (27.3%). Major associated risk factors were the use of wrong suture materials for fascia repair, midline incisions, wound sepsis, and overweight. Conclusion: For elective surgeries, reduction of weight should be encouraged when appropriate, and transverse incisions are preferred. Absorbable sutures, especially chromic catgut, should be avoided in fascia closure. Antibiotics should be used for complicated obstetric cases.
M. Micl?u?,Codru?a Micl?u?,C. Mircu,Romani?a Glaja
Jurnalul de Chirurgie , 2011,
Abstract: Incisional hernia is the most important complication after surgical treatment on anterior abdominal wall. The purpose of surgical treatment is to build a resistant abdominal wall with normal local and general physiology. In medium and large incisional hernia a synthetic mesh is used for abdominal wall reconstruction. The synthetic mesh can be placed in several positions in the deep of the abdominal wall. The aim of this study is to find the best placement for synthetic mesh starting from an experimental study. The experimental study was performed on small lab animals (Wistar rats) in 6 groups of 6 animals each. The synthetic meshwas pleaced deep as well as superficial in the abdominal wall on different levels. The results were evaluated histologically on the 45-th day from the procedure. Retromuscular and preaponevrotical site were the best for placement of the synthetic mesh. At this level we observed the disappearing of the fibroblastic cells, but with the presence of the collagen fibers that pass through and integrate the mesh. The strength of the abdominal wall is based on the cross-linked collagen fibers.
Comparative study between two techniques of incisional hernia repair with polypropylene mesh in rabbits
Minossi, José Guilherme;Caramori, Carlos Antonio;Leite, Celso Vieira de Souza;Naresse, Luiz Eduardo;
Acta Cirurgica Brasileira , 2010, DOI: 10.1590/S0102-86502010000500007
Abstract: purpose: to compare two different incisional hernia repair techniques (repair with a polypropylene mesh reinforcement on the peritonium-aponeurosis versus polypropylene mesh sutured to the borders of the hernial ring as a bridge) in rabbits. methods: incisional hernia was experimentally developed through a 4-cm median incision in 60 rabbits. after 30 days, half of the animals were operated for primary wall closure and placement of a polypropylene mesh reinforcement, while the other half had a polypropylene mesh sutured to the borders of the hernial ring as a bridge. clinical development, scar breaking strength, as well as gross, microscopic and morphometric parameters were evaluated in all animals 30, 60, and 90 days after repair. results: no significant differences in breaking strength or histological parameters were observed between groups at any time point studied. no statistical difference regarding complications was detected, although denser and firmer adhesions to the abdominal wall were seen after the mesh was placed as a " bridge" . conclusions: no significant differences between the incisional hernia repair techniques assessed were observed regarding breaking strength, and histological and morphometric parameters. the number of complications was similar in both study groups. however, adhesion of abdominal cavity organs to the scar area was much denser after the placement of a mesh to bridge the defect.
Comparative analysis of autodermal graft and polypropylene mesh use in large incisional hernia defects reconstruction  [PDF]
Stojiljkovi? Danilo,Kova?evi? Predrag,Vi?nji? Milan,Jankovi? Irena
Vojnosanitetski Pregled , 2013, DOI: 10.2298/vsp1302182s
Abstract: Background. Large defects of the abdominal wall caused by incisional hernia still represent a challenging problem in plastic, reconstructive, and abdominal surgery. For their successful tension-free repair a proper selection of reconstructive material is essential. In the last decades, the use of synthetic meshes was dominant while biological autodermal grafts were rarely used. The aim of the study was to comparatively analyse efficacy and safety of autodermal graft and polypropylene mesh in surgical treatment of large abdominal wall defects. Methods. This prospective comparative clinical study enroled 40 patients surgically treated for large incisional hernia repair in a 10-year period. The patients were divided into two equal groups consisting of 20 subjects and treated either by biological autodermal graft or by synthetic polypropylene mesh. The surgical techniques of reconstruction, duration of surgery, the occurrence of early, minor, and major (severe) and delyed complications and hospital stay were analyzed. The average follow-up took 2 years. Results. Statistically significant differences in demographic characteristics of patients and in size of defects were not found. The surgical technique of reconstruction with an autodermal graft was more complicated. The duration of surgery in patients treated with autodermal grafts was significantly longer. There was no statistically significant difference regarding occurrence of early, minor postoperative complications and hospital stay in our study. Two severe complications were registered in the synthetic mesh group: intestinal obstruction and enterocutaneous fistula. The recurrence rate was 10% in the autodermal graft group and 15% in the group with a synthetic mesh. Conclusion. Tension-free repair of large incisional hernia with autodermal grafts was unjustly neglected despite the fact that it is safe and effective. It can be applied in all cases where synthetic mesh are not indicated (presence of infection, immunodeficient patients, after radiotherapy). They are especially important in war surgery and in lack of funds when commercial grafts cannot be purchased.
Evisceración por ruptura espontánea de hernia incisional: Reparación con malla Mesh repair for spontaneous rupture of incisional hernia and evisceration: Report of one case
Revista Chilena de Cirugía , 2006,
Abstract: Introducción. Las hernias incisionales son una de las complicaciones más frecuentes de la cirugía abdominal. Las hernias incisionales primarias se presentan en 2% a 20% de los pacientes operados mediante laparotomía. Las complicaciones de estas hernias son la incarceración y estrangulación. La ruptura espontánea de la piel que cubre la hernia y consiguiente evisceración de los intestinos a través del defecto, actualmente es una complicación inusual de la hernia incisional. Reporte de caso. Reportamos el caso de una paciente con ruptura espontánea de una hernia incisional y evisceración, la cual fue tratada con éxito mediante el uso de prótesis de polipropileno sobre el defecto en posición supra-aponeurótica. La paciente, de 81 a os de edad, se presentó en la Unidad de Emergencias de nuestra institución debido a la ruptura espontánea del saco herniario y la piel que lo cubría, de una hernia incisional gigante de la línea media infraumbilical; a través del defecto protruían asas intestinales. La reparación primaria y cierre de la aponeurosis de los músculos rectos anteriores del abdomen no fue posible. Después de la resección de todo el tejido de mala calidad del saco herniario y de toda la piel da ada, se cerró el saco herniario con puntos en "U". Una malla de polipropileno fue fijada sobre la aponeurosis de los músculos recto anterior del abdomen. La paciente se recuperó satisfactoriamente. En el seguimiento y control 2 a os después de la cirugía la paciente se encuentra asintomática Incisional hernias are some of the most common complications of abdominal surgery. Primary incisional hernia occurs in 2% to 20% of patients who had undergone laparotomy. The morbidity reported for these hernias is related to incarceration and strangulation. Spontaneous rupture of the skin and evisceration of the intestines through the defect is an uncommon complication. Mesh repair is the preferred technique for incisional hernia repair. We report a 81-year-old woman who presented to the emergency unit of our institution with spontaneous rupture of the skin overlying a giant midline infra-umbilical incisional hernia, and the small bowel protruding through the defect. Repair and closure of the rectus abdominal muscles were not possible. After excising the poor quality tissue of the hernia sac and the damages skin overlying the defect, the sac was closed overlapping the borders and suturing with "U" stitches. A polypropylene mesh was placed over the defect. The postoperative course was uneventful, and the patient recovered. Two years after surgery, the patient is free of com
Health Technology Assessment of laparoscopic compared to conventional surgery with and without mesh for incisional hernia repair regarding safety, efficacy and cost-effectiveness  [cached]
Friedrich, Meik,Müller-Riemenschneider, Falk,Roll, Stephanie,Kulp, Werner
GMS Health Technology Assessment , 2008,
Abstract: Introduction: Incisional hernias are a common complication following abdominal surgery and they represent about 80% of all ventral hernia. In uncomplicated postoperative follow-up they can develop in about eleven percent of cases and up to 23% of cases with wound infections or other forms of wound complications. Localisation and size of the incisional hernia can vary according to the causal abdominal scar. Conservative treatment (e. g. weight reduction) is only available to relieve symptoms while operative treatments are the only therapeutic treatment option for incisional hernia. Traditionally, open suture repair was used for incisional hernia repair but was associated with recurrence rates as high as 46%. To strengthen the abdominal wall and prevent the development of recurrences the additional implantation of an alloplastic mesh is nowadays commonly used. Conventional hernia surgery as well as minimally invasive surgery, introduced in the early 90s, make use of this mesh-technique and thereby showed marked reductions in recurrence rates. However, there are possible side effects associated with mesh-implantation. Therefore recommendations remain uncertain on which technique to apply for incisional hernia repair and which technique might, under specific circumstances, be associated with advantages over others. Objectives: The goal of this HTA-Report is to compare laparoscopic incisional hernia repair (LIHR) and conventional incisional hernia repair with and without mesh-implantation in terms of their medical efficacy and safety, their cost-effectiveness as well as their ethical, social und legal implications. In addition, this report aims to compare different techniques of mesh-implantation and mesh-fixation as well as to identify factors, in which certain techniques might be associated with advantages overothers. Methods: Relevant publications were identified by means of a structured search of databases accessed through the German Institute of Medical Documentation and Information (DIMDI) as well as by a manual search. The former included the following electronic resources: SOMED (SM78), Cochrane Library – Central (CCTR93), MEDLINE Alert (ME0A), MEDLINE (ME95), CATFILEplus (CATLINE) (CA66), ETHMED (ED93), GeroLit (GE79), HECLINET (HN69), AMED (CB85), CAB s (CV72), GLOBAL Health (AZ72), IPA (IA70), Elsevier BIOBASE (EB94), BIOSIS Previews (BA93), EMBASE (EM95), EMBASE Alert (EA08), SciSearch (IS90), Cochrane Library – CDSR (CDSR93), NHS-CRD-DARE (CDAR94), NHS-CRD-HTA (INAHTA) as well as NHSEED (NHSEED). The present report includes German and English lit
A randomised, multi-centre, prospective, double blind pilot-study to evaluate safety and efficacy of the non-absorbable Optilene? Mesh Elastic versus the partly absorbable Ultrapro? Mesh for incisional hernia repair
Christoph Seiler, Petra Baumann, Peter Kienle, Andreas Kuthe, Jens Kuhlgatz, Rainer Engemann, Moritz v Frankenberg, Hanns-Peter Knaebel
BMC Surgery , 2010, DOI: 10.1186/1471-2482-10-21
Abstract: In this prospective, randomised, double blind study, eighty patients with incisional hernia after a midline laparotomy will be included. Primary objective of this study is to investigate differences in the physical functioning score from the SF-36 questionnaire 21 days after mesh insertion. Secondary objectives include the evaluation of the patients' daily activity, pain, wound complication and other surgical complications (hematomas, seromas), and safety within six months after intervention.This study investigates mainly from the patient perspective differences between meshes for treatment of incisional hernias. Whether partly absorbable meshes improve quality of life better than non-absorbable meshes is unclear and therefore, this trial will generate further evidence for a better treatment of patients.NCT0064633470.000 incisional hernia repairs were performed in Germany in 2006 [1]. Incisional hernias can cause serious complications such as incarceration or strangulation, resulting in substantial costs for further treatment (~ 128 Million €). Optimal treatment has not yet been defined [2,3].Currently, the surgeon usually implants a mesh to reinforce the abdominal wall. The use of a mesh prosthesis for incisional hernia repair results in a lower recurrence rate than suture repair [4-11]. Creating a tension free repair with a mesh reduces the recurrence rate to 5-10%. Studies performed by Israelsson et al. in 2006 [12] and Kingsnorth et al. in 2004 [13] showed that the sublay technique seems to result in a lower recurrence rate (3-7%) compared to the onlay technique (12-19%). In order to achieve a sufficient reinforcement of the abdominal wall, the mesh should overlap the defect more than 5 cm in all directions [13-15]. Several meshes are available which differ in material, textile structure, pore size, weight, elasticity, tissue reaction, biocompatibility, and absorption [16-22]. Patients react differently to the mesh and the materials cause different complications
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