Simplified technique for incisional hernia repair with mesh prosthesis (original) (raw)
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Combined fascia and mesh repair of incisional hernias
Hernia : the journal of hernias and abdominal wall surgery, 2006
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 ten...
3- Outcome of Large Incisional Hernia Repair with Polypropylene Mesh
Basrah Journal of Surgery
Incision hernia remains a frequent complication of abdominal surgeries with a reported incidence of (2-20%). Repair of large incision hernia is a difficult surgical problem with short and long term complications, severity of these complications are related in part to the type of operative technique adopted. The aim of this study is to evaluate the outcome of repair of large incision hernia with the (onlay tension free) mesh technique. This is a retrospective study includes 46 patients who underwent mesh repair for large incision hernia during the period from January 1997 to December 2004. The operations were done by the same surgeon and by the same procedure (i.e; onlay tension free polypropylene mesh with two points fixation). Data regarding relevant patients with big ventral incision hernia with (onlaymesh repair) in Basrah teaching hospital and private hospital were revised. The presenting condition, hernia description, associated systemic and local factors, procedure of repair and follow up duration were all taken in consideration. Possible complications like; hematoma, seroma, wound infection, intestinal obstruction and enterocutaneous fistula were recorded and discussed once they occurred. The follow up period ranged from 4 to 21 months. Forty six patients were included in the study: 20 females and 26 males with median age of 50.5 year (range 35-68 year). Eleven patients (23.91%) were overweight and had body mass index "BMI" equal to more than 30, four patients (8.69%) had controlled diabetes mellitus, five (10.86%) had controlled hypertension and two (4.34%) suffered from chronic obstructive air way disease, there were eleven smokers (23.91%). Sixteen patients made regular visits that extended up to 12 months, 12 patients made regular visits up to 6 months, one made regular visits up to 18 month mainly due to partial intestinal obstruction., one patient was followed-up to 17 month because of multiple wound sinuses while 8 patients made irregular visits up to 21 month due to causes other than the hernia, eight patients lost from follow-up after 4 months. The original operation was bowel related in 18 cases, gynecological in twelve, hepatopancreatobiliary in 10, repair of paraumbalical hernia in six patients. The old incisions were long midline in 23 cases, paramedian in 17 and transverse in six patients. The main postoperative complications were seroma formation (13.04 %), wound haematoma (6.52 %), wound infection (4.34 %). no recurrence of hernia and no enterocutanous fistula were reported during our follow-up period. In conclusion, tension free onlay mesh repair is a feasible operative procedure for repair of large incision hernia with no significant major morbidity.
A Retropsective Study of Laparoscopic Intraperitoneal Onlay Mesh Repair of Incisional Hernias
IOSR Journals , 2019
Introduction: A hernia is defined as an area of weakness or complete disruption of the fibro muscular tissues of the body wall. Hernias are among the oldest known afflictions of humankind. The word "hernia" is derived from a Latin term meaning "a rupture". The earliest reports of abdominal wall hernias date back to 1500 BC. During this early era, abdominal wall hernias were treated with trusses or bandage dressings. Despite the high incidence, the technical aspects of hernia repair continue to evolve. Materials and methods: All patients attending at Osmania General Hospital OPD with ventral hernia were approached and counseled for laparoscopic IPOM hernioplasty, but only those who agreed were included in this study. Fifty consecutive patients underwent IPOM hernioplasty, over a time period of 20 months (January 2018-December 2018). All cases were done by a single surgeon in Osmania general hospital, Hyderabad. Preoperative evaluation was done by clinical assessment. Abdominal ultrasonogram was done in selected cases where there was confusion about the defect especially in obese patients. Location of the hernia was traced, position of the ports marked and expected location of mesh mapped, just before the patient is mounted on operation table (Fig 1). IPOM was performed using three puncture technique. Pneumoperitoneum was established by placement of a Veress needle into left subcostal area in mid-clavicular line (Fig 2). A 10mm port was introduced in left anterior axillary line at the level of the defect, and two 5mm ports on either side a little in front of the previous one. Results: In this series, out of 50 cases, 11 cases were male, 39 female (M: F=1:3.5) (Table I). 35 (70%) cases were diabetic, 15 (30%) were non-diabetic. Mean age of the patients were 47.7yrs (male 47.7+9.5 years, female 47.7-2.6 years, diabetic patients 47.7+ 2.5yrs, Non-diabetic patients 47.7-5.9yrs). Indications for IPOM (Table II) was paraumbilical hernia 29cases (58%), incisional hernia 14 cases (28%), multiple incisional hernia (Swiss cheese hernia) 2 cases (2 large defect in one case, 5 defects of varying size in another patient), umbilical port hernia 2 cases, parumbilical along with incisional hernia 1case, epigastric hernia 1 case, lumber hernia 1 case. Conclusion: Laparoscopic intraperitoneal onlay mesh (IPOM) repair was observed to be an effective surgical procedure for ventral hernia repair. It provides many benefits with low complications and recurrence in experienced hands. Hence it can be considered as primary procedure for ventral hernia repair.
Incision hernia remains a frequent complication of abdominal surgeries with a reported incidence of (2-20%). Repair of large incision hernia is a difficult surgical problem with short and long term complications, severity of these complications are related in part to the type of operative technique adopted. The aim of this study is to evaluate the outcome of repair of large incision hernia with the (onlay tension free) mesh technique. This is a retrospective study includes 46 patients who underwent mesh repair for large incision hernia during the period from January 1997 to December 2004. The operations were done by the same surgeon and by the same procedure (i.e; onlay tension free polypropylene mesh with two points fixation). Data regarding relevant patients with big ventral incision hernia with (onlaymesh repair) in Basrah teaching hospital and private hospital were revised. The presenting condition, hernia description, associated systemic and local factors, procedure of repair and follow up duration were all taken in consideration. Possible complications like; hematoma, seroma, wound infection, intestinal obstruction and enterocutaneous fistula were recorded and discussed once they occurred. The follow up period ranged from 4 to 21 months. Forty six patients were included in the study: 20 females and 26 males with median age of 50.5 year (range 35-68 year). Eleven patients (23.91%) were overweight and had body mass index "BMI" equal to more than 30, four patients (8.69%) had controlled diabetes mellitus, five (10.86%) had controlled hypertension and two (4.34%) suffered from chronic obstructive air way disease, there were eleven smokers (23.91%). Sixteen patients made regular visits that extended up to 12 months, 12 patients made regular visits up to 6 months, one made regular visits up to 18 month mainly due to partial intestinal obstruction., one patient was followed-up to 17 month because of multiple wound sinuses while 8 patients made irregular visits up to 21 month due to causes other than the hernia, eight patients lost from follow-up after 4 months. The original operation was bowel related in 18 cases, gynecological in twelve, hepatopancreatobiliary in 10, repair of paraumbalical hernia in six patients. The old incisions were long midline in 23 cases, paramedian in 17 and transverse in six patients. The main postoperative complications were seroma formation (13.04 %), wound haematoma (6.52 %), wound infection (4.34 %). no recurrence of hernia and no enterocutanous fistula were reported during our follow-up period. In conclusion, tension free onlay mesh repair is a feasible operative procedure for repair of large incision hernia with no significant major morbidity.
2018
Objective The aim of the study is to evaluate the efficiency and safety of mesh repair in emergent complicated midline incisional hernias as well as the impact on the early postoperative (PO) morbidity and mortality to implement the best patient management procedure. Patients and methods The study includes 60 patients with emergent midline incisional hernias. Patients were divided according to the type of closure of hernia defect into two groups, group A (30 patients) was managed with a prosthetic mesh repair and group B (30 patients) was managed by primary suture repair. We used the alternation method as an allocation process. Patients in both groups were monitored during operations and along the PO period. The data collected include the patients’ condition at presentation, coexisting disease, operative data and PO complications, length of hospital stay, surgical site infection (SSI) and recurrence rates. Results A total of 60 patients underwent operations for emergent midline inci...
Hernia, 2006
The aim of this study is to establish the indications, safety, efficacy, feasibility and reproducibility of the laparoscopic technique in treating defects in the abdominal wall, including those of large dimensions, to standardise the surgical technique and to confirm the performance of the composite prosthesis used (Parietex, Sofradim). The study encompassed the period from January 2001 to December 2004 and included 178 nonselected patients (108 women and 70 men), with an average age of 56 years (range: 26-77 years) and an average body mass index (BMI) of 30 (range: 26-40). These patients were treated for either abdominal hernia (156 patients; 89.7%)or a primary defect (22 patients; 10.3%). The dimensions of the abdominal hernias treated varied from 4 to 26 cm (average: 12.1 cm). All patients were treated using the laparoscopic technique, and all meshes were placed in the intraperitoneal position. Eleven (7%) postoperative complications arose after an average follow-up period of 29 months (range: 1-48 months): seven seromas (4.4%) lasting for 4 weeks, with one becoming infected after being punctured repeatedly; we removed the infected prosthesis by laparoscopy; three (1.9%) patients with persistent neuralgia, which were resolved after 2 months with a prescription for FANS; one patient with a haematoma at the trocar site. There were also four recurrences (2.5%), all of which occurred between 1 and 3 months postsurgery: one in the 'small' group of abdominal hernias (less than 9 cm) and three in the 'large' group of abdominal hernias. With the exclusion of any primary defects, an adhesiolysis was carried out in 99.3% of the patients. In seven cases (4.4%) we carried out a raphe for speritonealisations of loops in the small intestine; in four patients (2.5%), following tenacious adhesion (one patient) and loops fixed to the previous scar by stitches (three patients), we carried out an intestinal perforation (ileus) which was sutured by laparoscopy. The average operating time was 65.6 min (range: 28-130 min), with an average postoperative period in the hospital of 2.1 days (range: 1-5 days). No conversion was observed, and mortality was zero. The results obtained during the clinical trial demonstrate the safety and efficacy of the laparoscopic technique and of the mesh used as well as the reproducibility of the technique in the intraperitoneal treatment of congenital and postincision defects in the abdominal wall, including those of large dimensions.
Incisional Hernia Prevention and Use of Mesh. A Narrative Review
Cirugía Española (English Edition), 2018
Incisional hernias are a very common problem, with an estimated incidence around 15%-20% of all laparotomies. Evisceration is another important problem, with a lower rate (2.5%-3%) but severe consequences for patients. Prevention of both complications is an essential objective of correct patient treatment due to the improved quality of life and cost savings. This narrative review intends to provide an update on incisional hernia and evisceration prevention. We analyze the current criteria for proper abdominal wall closure and the possibility to add prosthetic reinforcement in certain cases requiring it. Parastomal, trocarsite hernias and hernias developed after stoma closure are included in this review.