Open mesh repair of incisional hernias with significant loss of domain
| Autor: | S. Wong, M. Butler, Andrew N. Kingsnorth, N. Sivarajasingham |
|---|---|
| Rok vydání: | 2004 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Significant tissue loss Muscle flap Laparotomy Secondary Prevention medicine Humans Aged Retrospective Studies Mesh repair Abdominoplasty business.industry General surgery General Medicine Middle Aged Surgical Mesh medicine.disease Hernia Ventral Surgery Pulmonary embolism Clinical trial Plastic surgery surgical procedures operative Female business Research Article |
| Zdroj: | Annals of The Royal College of Surgeons of England. 86:363-366 |
| ISSN: | 1478-7083 0035-8843 |
| DOI: | 10.1308/147870804236 |
| Popis: | Background: Incisional hernias develop in up to 13% of laparotomy incisions: the most difficult to repair are complex, multiply recurrent hernias with significant loss of domain (> 15-20% of the abdominal contents). Methods: Retrospective analysis by standard proforma of a series of 52 patients operated on at a single institution between 1996 and 2002. All patients received pre-operative CT and anaesthetic assessment. Patients with significant tissue loss were assessed by a plastic surgeon. Cardio-respiratory status was optimised and trophic skin ulcers treated before operation. Results: Sublay repair was applied in 33 patients, onlay in 16 patients, one patient received inlay repair and two patients the Ramirez abdominoplasty. Additional procedures of stoma closure, muscle flap or abdominoplasty were carried out in 7 patients. Complications occurred in 18 (34.6%) patients, 5 of whom required further surgery for haematoma, infection or fistulisation. One patient died from pulmonary embolism after postoperative complications. Three recurrences were apparent after follow-up of 6 months to 6 years. Conclusions: Complex incisional hernias are a challenging surgical problem. Careful patient selection and surgical technique with a team involving anaesthetists and plastic surgeons is required. Post-operative management may require facilities in HDU and ITU. Clinical trials are required to identify techniques and materials which give the best results. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|