Incisional hernia.

Department of Surgery, Medical College of Pennsylvania, Philadelphia.
Surgical Clinics of North America (Impact Factor: 1.93). 07/1993; 73(3):557-70.
Source: PubMed

ABSTRACT 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.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We sought to measure the strength of tissue attachment to mesh after laparoscopic ventral hernia repair in a porcine model. Twelve swine had two 10-cm x 16-cm sheets of ePTFE and polypropylene/ePTFE composite mesh fixated to the abdominal wall laparoscopically. Animals were euthanized at 2, 4, 6, and 12 weeks. The strength of tissue ingrowth was measured using a lap-shear method. Data are reported as mean force in pounds. Average surface area of adhesions to percentage of surface area was not statistically significant between the composite and ePTFE materials. For the composite material, there was a 98.7% posterior probability that the force required at 2 weeks was less than that required at 12 weeks. There was no difference in graft-abdominal wall interface strength between week 2 and week 12 for ePTFE material. Both prosthetics achieved the majority of their strength from tissue ingrowth by 2 weeks, but the composite prosthesis continued to gain strength while the strength of the ePTFE plateaued. Composite mesh demonstrated a statistically significant increase in strength between the lap-shear force, whereas no statistically significant difference occurred in the ePTFE graft. For the composite material, there was complete cellular infiltration through the entire thickness of polypropylene (approximately 500 microm) to the ePTFE layer at 2 weeks. At 2 weeks for ePTFE, the cells did not penetrate into the graft on the visceral side. On the abdominal wall side, the grooves filled with tissue, but no cellular penetration into the ePTFE occurred. No histological difference existed in cellularity. This study demonstrates that the strength of tissue ingrowth is significantly higher (P<0.05) for the composite grafts relative to the ePTFE grafts at each time point. Approximately 74% of tissue ingrowth and strength occurs by 2 weeks postoperatively for the composite prosthesis. The ePTFE graft tissue strength peaked and plateaued by 2 weeks. This may have clinical implications for human ventral hernia repair by partly addressing the issue of graft fixation to the abdominal wall during laparoscopic ventral hernia repair.
    JSLS: Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons 11(4):415-21.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The contemporary results of open incisional and ventral hernia repair are unsatisfactory because of high recurrence rates and morbidity levels. Laparoscopic repair of ventral and incisional hernias (LIVH) can be accomplished in a simple, reproducible manner while dramatically lowering recurrence rates and morbidity. One hundred consecutive patents underwent laparoscopic repair of their ventral and incisional hernias over a 27-month period. Composix mesh and Composix E/X mesh (Davol Inc., Cranston, RI) were utilized for the repairs. Transfixion sutures were not used. All repairs were completed laparoscopically. No conversions to open techniques were necessary. No postoperative infections have been observed. One recurrent hernia was identified and subsequently repaired with the same technique. LIVH can be accomplished with a dramatic reduction in recurrence rates and morbidity. The technique for this repair is still in a state of evolution. The construction and handling characteristics of this particular type of mesh have allowed us to eliminate transfixion sutures and to simplify the repair technique while maintaining a very low recurrence rate.
    JSLS: Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons 6(4):315-22.
  • [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study was to determine whether detection of bacterial contamination of ventral midline incisions was predictive of postoperative incisional complications in horses undergoing exploratory celiotomy for colic. Prospective study. Horses that had ventral median celiotomies for colic at Colorado State University between May 1, 1991 and April 30, 1993 were studied prospectively. Complete information was obtained on 66 horses. Bacterial cultures were obtained from ventral midline incisions at surgery. Information regarding the type of surgery performed (celiotomy vs celiotomy plus enterotomy or enterectomy), preoperative total nucleated cells and presence of a left shift, postoperative fever (> 38.5 degrees C), incisional drainage, incisional herniation, and outcome were obtained from medical records. Additional information concerning incisional drainage, herniation, and survival was obtained at a minimum of 18 months after surgery. Examination of odds ratio (ORs) and confidence intervals (CIs) revealed that a celiotomy plus enterotomy or enterectomy was positively, but not significantly, associated (OR > 1) with positive culture results, presence of incisional drainage and incisional herniation. A significant association between incisional drainage and hernia formation was found; odds of incisional herniation were 62.5 times greater in horses that had incisional drainage. Incisional drainage and herniation were negatively associated with patient survival. The later association was significant (OR = 0.18, P = .04). This study indicated that detection of bacterial contamination at incisional closure by the swab culture technique was not beneficial in the prediction of postoperative incisional problems in horses undergoing colic surgery. Incisional drainage or infection appeared to be associated with hernia formation. Immediate treatment of incisional drainage or method to prevent incisional infections may decrease hernia formation.
    Veterinary Surgery 01/1997; 26(1):7-13. DOI:10.1111/j.1532-950X.1997.tb01456.x