Repair of giant incisional abdominal wall hernias using open intraperitoneal mesh

Bernard, C.; Polliand, C.; Mutelica, L.; Champault, G

doi:10.1007/s10029-007-0222-7

Cited by 40 publications

(25 citation statements)

References 27 publications

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“…Staging of the ventral hernia has been helpful in surgical decision and in post-operative comparison of results [13]. The open intraperitoneal technique is appropriate for complex incisional hernias occurring in obese patients, but is contraindicated when laparoscopic access has been obtained; minimal access was shown to be feasible in patients with a larger mesh of 15 cm [14][15][16]. A cellular dermal matrix has been also suggested in this cases to resist to infection as well as porcine [3,17].…”

Section: Discussionmentioning

confidence: 99%

Component Separation or Mesh Repair for Ventral Hernia Repair - The Role of Mesh in Covering all the Abdominal Wall in the Component Repair

Frezza¹

2017

GHR

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Simple repair of the hernia opening, Ventral Hernia Repair (VHR) has been confronted by a more definitive goal of restoration of abdominal muscular strength and wall function accomplished by mobilizing abdominal wall muscles and closing with inlay mesh, Component Separation Repair (CSR). Our observation was based on the notion that shear forces cause herniation and therefore that is an affliction of the entire abdominal wall, not a localized event. We took that information and we compare a series of VHR patients with a series of CSR patients would provision evidence to improve the relative value of the techniques.Material: Retrospective comparison of 30 consecutive CSR patients and 30 consecutive VHR patients was obtained. All abdominal wall hernia defects were at least 10 cm 2 in size. T tests with unequal variances were used to evaluate differences in means of continuous variables and to estimate 95% confidence intervals of differences.Results: Although CSR patients were older, had higher BMI's and higher ASA scores than did VHR patients, the odds of recurrence for CSR patients were less than for VHR patients (P<0.0001). Differences in respects to ileus and wound complications, while they favored CSR patients, might have been due to chance (P>0.05 for each analysis). In VHR group 11 patients required CSR after 9-24 months, 14 patients have prolonged ileus. In the CSR group two patients were reoperated for removal of midline skin changes, two for severe seromas requiring wash up of the subcutaneous and fascia area and placement of a wound vacuum on top of the mesh. Conclusion:This study supports the notion that a ventral hernia reflects a defect in the abdominal wall not just the point at which the hernia forms. To avoid a point of rupture, we support highly the CSR technique, since hernia is an abdominal disease not just a hole.

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Section: Discussionmentioning

confidence: 99%

Component Separation or Mesh Repair for Ventral Hernia Repair - The Role of Mesh in Covering all the Abdominal Wall in the Component Repair

Frezza¹

2017

GHR

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“…Despite the cited protection of composite prosthetic against intestinal adhesions, it is recommended, whenever possible, bringing the greater omentum between the viscera and prosthesis 1 . Bernard, et al 1 showed in their series of 61 patients using polypropylene mesh coated on the intra-cavity face by PTFEe, satisfactory results with only 5% of recurrence and morbidity rates of around 5% 1.…”

Section: Operative Strategymentioning

confidence: 98%

“…Intent to increase the volume of the abdominal cavity, to enable the re-introduction of the hollow herniated viscera with mesenteric edema by decreasing the the volume of the hollow viscera, with respiratory therapy until cardiorespiratory function improves, the patient does not feel chest discomfort or dyspnea, normalizes blood gas, and intra-abdominal pressure remains lower than 15 cm H2O 11 . Other measures must be taken preoperatively, as the passage of a nasogastric tube with suction to reduce the distension of the bowel and mechanical preparation of the colon 1,11,24 .…”

Section: Preoperativementioning

confidence: 99%

“…There are several risk factors that include obesity, advanced age, malnutrition, multiple laparotomies, type of incision and technical care in closing the abdominal wall (including the quality and diameter of suture material used), postoperative infection of surgical wounds, illness chronic obstructive pulmonary disease and diabetes. The HIA arise, in general, the first five years after the operation 1 .…”

Section: Introductionmentioning

confidence: 99%

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Grandes hérnias incisionais

Speranzini¹,

Deutsch

2010

ABCD, arq. bras. cir. dig.

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-Background -The correction of abdominal hernias remains one of the most common surgical procedures since it occurs in about 11% of laparotomies. There are several risk factors. Arise, in general, the first five years after the operation and their management is controversial. Aim -Update the means and methods for surgical repair of giant abdominal hernias. Method -Literature review based on PubMed, Lilacs and Scielo with crossing the keywords "abdominal hernia, prostheses, surgical techniques and complications", and adding its own contribution based on the authors' experience in handling this condition. Conclusion -Even the successful correction with the use of large prostheses, may happen procedure inconvenient, because the abdominal wall does not resume its elasticity and compliance at the normal. For this reason, it is important that the patient be advised of the possibility of their expectations regarding the outcome, both aesthetic and functional, not be achieved.RESUMO -Introdução -A correção de hérnias incisionais abdominais permanece como um dos procedimentos cirúrgicos mais comuns uma vez que ela ocorre em cerca de 11% das laparotomias. Vários são os fatores de risco. Surgem, em geral, nos primeiros cinco anos após a operação e seu manuseio ainda é controverso. Objetivo -Atualizar os meios e métodos empregados para a correção cirúrgica das hérnias abdominais gigantes. Método -Revisão da literatura com base no Pubmed, Scielo e Lilacs com cruzamento dos descritores "hérnia abdominal, próteses, complicações e técnicas cirúrgicas", e adicionando contribuição própria baseada na experiência dos autores no manuseio desta afecção. Conclusão -Mesmo as correções bem sucedidas, com a utilização ou não de grandes próteses, não são os procedimentos isentos de inconvenientes, pois a parede abdominal não retoma a sua elasticidade e complacência normais. Por este motivo, é importante que o paciente seja alertado da possibilidade da sua expectativa em relação ao resultado, tanto estético quanto funcional, não ser alcançada.

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“…The increased physiological stress of the greater operative duration on a patient who often has multiple co morbidities seems to place a significant role in predicting the recurrences outcome [9,10]. This physiological stress seems to be directly correlated with the physic and tensile strength and it is an important concept because in this case, the authors pointed out that the physiological stress during the surgery but forgot to mention the physiological stress of the patient before the surgery that creates the situation that brought the patient to surgery [11][12][13].…”

Section: The Clinical Issuesmentioning

confidence: 99%

A Physic Tensile Forces Experiment to Possible Explain the Reason of Failing Ventral Hernia Repair

Frezza¹

2017

GHR

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IntroductionVentral Hernia Repair (VHR) has been a challenging surgery during years. Matters moved to mobilizing muscle and closing the abdominal wall. Component Separation Repair (CSR), which required dissection of the fascia of the rectus muscle and closure of the midline linea alba [1]. The goal of ventral hernia repair is to restore abdominal muscle strength and abdominal wall function [2,3]. The muscle component of the ventral hernia is one of many variables affecting the abdominal wall to contribute to ventral hernia. In this paper we focus on that issue understanding the complexity of the pathology. We hypothesized that evaluating the maximal stress on a set of artificial tensile structures, rubber bands, might open a different view on the effects of daily forces affecting the strength of varied abdominal walls. Materials and MethodsFour sets of six rubber bands were evaluated (Table 1).In the first comparison, we matched rubber band based on their thickness of 0.1x0.35 cm: A) short (4.2 cm), high strength rubber bands (red bands) (modeled the young person with much muscle strength and flexibility, B) long (7 cm), high strength rubber bands of longer length (white bands) modeled abdominal walls with fully stretched muscle, but with similar strength, such as occurs after pregnancy or with obesity. In the second comparison, we match the length (4.2 cm) and change the thickness: A) thick (0.1x0.35 cm), rubber bands (red bands) as above and C) thin (0.1x0.1 cm), rubber bands (yellow bands) modeled elderly or protein deficit patients, obese patient who had experienced an operation. We then use for final comparison a D) thin and short band (0.1x0.1x2 cm).Thickness, width and length of the bands were measured using a vernier caliper. The four bands were then stressed with progressively increasing weights at 20 g increments. Weight at the time of failure was recorded for each of six trials of each band type (Table 1).The Tensile strength was measured in force per cross-sectional area. All the data is reported and compared in table 1. The units of force were derived by multiplying mass (kg) by the acceleration of gravity (9.81 m/sec 2 ) per Newton's second law of motion (F=m x a). This results in a force unit of Newton. The tensile strength was measured by taking the weight (Newton) and dividing it by the cross-sectional area (cm 2 ). Tension and shear forces were summarized to create the condition to apply the log regression (Tables 2 and 3). Ventral hernia repair, a challenging procedure. We consider rubber bands, evaluating the strength of bands of differing length and thickness to see how changes in these parameters affect the elastic materials to try to mimic how abdominal muscle get affected by tensile forces.

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Repair of giant incisional abdominal wall hernias using open intraperitoneal mesh

Abstract: Open intraperitoneal mesh repair appears to be a good option for the treatment of complex incisional hernia (at least 10 cm in diameter or multiorificial) in obese patients contraindicated for laparoscopy.

Cited by 40 publications

References 27 publications

Component Separation or Mesh Repair for Ventral Hernia Repair - The Role of Mesh in Covering all the Abdominal Wall in the Component Repair

Component Separation or Mesh Repair for Ventral Hernia Repair - The Role of Mesh in Covering all the Abdominal Wall in the Component Repair

Grandes hérnias incisionais

A Physic Tensile Forces Experiment to Possible Explain the Reason of Failing Ventral Hernia Repair

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