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Modified onlay technique for the repair of the more complicated incisional hernias: single-centre evaluation of a large cohort.

Poelman MM, Langenhorst BL, Schellekens JF, Schreurs WH - Hernia (2010)

Bottom Line: There are various surgical methods to correct these hernias, with varying results.However, the gold standard has not yet been found.A seroma was reported in 27 of 101 patients (27%) and a wound infection in 22 patients (21%), of which seven patients had to be re-operated.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Medical Centre Alkmaar, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands. m.m.poelman@mca.nl

ABSTRACT

Background: The repair of incisional hernias remains a challenge for the general surgeon. Indications for surgery are severe bowel obstruction, as well as aesthetic problems. There are various surgical methods to correct these hernias, with varying results. However, the gold standard has not yet been found. Both laparoscopic repair and the component separation technique (CTS) have proven to be acceptable techniques; however, they are not always suitable for resolving the more complicated abdominal wall defects, i.e. after open-abdomen treatment or fascial necrosis. In our hospital, we developed a new onlay technique which we have evaluated in the following research.

Patients and methods: During a period of 10 years (1996-2007), 101 patients with an incisional hernia were corrected with the new onlay technique. A Marlex mesh of dimensions at least 10 x 20 cm was used, overlapping the fascia by at least 5 cm on each side. This mesh was stapled onto the fascia with skin staples. Of the 101 patients, there were 45 men and 56 women, with a mean age of 55 years. Nine patients died and 13 were lost during follow-up. Of the remaining 79 patients, eight refused to participate. The mean follow-up time was 64 months (normal distribution, standard deviation [SD] 34 months). This cohort of 101 patients was studied retrospectively.

Results: Seventy-one of the 101 patients were evaluated at our out-patient clinic. For 24 patients (25%), the operation was for a recurrence after an incisional hernia correction in the past. Twenty-one patients (20%) had an open-abdomen treatment in their medical history. The surgical procedure was technically possible in all patients and the mean operation time was 63 min. The median admission time was 4.5 days (quartiles 3-6.25). The mean follow-up time was 64 months (SD 35 months). A seroma was reported in 27 of 101 patients (27%) and a wound infection in 22 patients (21%), of which seven patients had to be re-operated. Only if a patient was evaluated at our out-patient clinic could reherniation have been scored; this occurred in 11 of 71 patients (16%).

Conclusion: This technique is an effective and simple procedure to correct incisional hernias with acceptable complication rates and is feasible even in the more complicated hernias.

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Related in: MedlinePlus

The mesh is fixed with skin staples
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Fig2: The mesh is fixed with skin staples

Mentions: All operations are performed under general anaesthesia. Patients are placed in the supine position with their arms tucked in at the sides. After disinfection, one doses of antibiotics was given prior to the start of the operation (cefuroxim 1,500 mg iv). The skin scar was sometimes excised and the subcutis opened. A de-epithelialisation was performed when the fascia was absent and the subcutis was spread until the borders of the remaining fascia were found. A plane of at least 5 cm was made in all directions over the fascia. The fascial edges were approximated as far as possible and closed using an absorbable Vicryl suture, putting the de-epithelialised part intra-abdominally without entering the abdominal cavity. After the hernia was successfully approximated and haemostasis was achieved, the Marlex mesh (Marlex©; C.R. Bard) was placed on the freed fascial edges and trimmed to fit. The mesh was never put directly on the intestines. Fascia, de-epithelialised tissue or omentum was always used to put in between the intestines and the mesh. The mesh was fixed with over 150 skin staples to the fascia (Figs. 1, 2). Two suction drains were placed on top of the mesh and the subcutis and skin were closed in layers.Fig. 1


Modified onlay technique for the repair of the more complicated incisional hernias: single-centre evaluation of a large cohort.

Poelman MM, Langenhorst BL, Schellekens JF, Schreurs WH - Hernia (2010)

The mesh is fixed with skin staples
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2908454&req=5

Fig2: The mesh is fixed with skin staples
Mentions: All operations are performed under general anaesthesia. Patients are placed in the supine position with their arms tucked in at the sides. After disinfection, one doses of antibiotics was given prior to the start of the operation (cefuroxim 1,500 mg iv). The skin scar was sometimes excised and the subcutis opened. A de-epithelialisation was performed when the fascia was absent and the subcutis was spread until the borders of the remaining fascia were found. A plane of at least 5 cm was made in all directions over the fascia. The fascial edges were approximated as far as possible and closed using an absorbable Vicryl suture, putting the de-epithelialised part intra-abdominally without entering the abdominal cavity. After the hernia was successfully approximated and haemostasis was achieved, the Marlex mesh (Marlex©; C.R. Bard) was placed on the freed fascial edges and trimmed to fit. The mesh was never put directly on the intestines. Fascia, de-epithelialised tissue or omentum was always used to put in between the intestines and the mesh. The mesh was fixed with over 150 skin staples to the fascia (Figs. 1, 2). Two suction drains were placed on top of the mesh and the subcutis and skin were closed in layers.Fig. 1

Bottom Line: There are various surgical methods to correct these hernias, with varying results.However, the gold standard has not yet been found.A seroma was reported in 27 of 101 patients (27%) and a wound infection in 22 patients (21%), of which seven patients had to be re-operated.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Medical Centre Alkmaar, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands. m.m.poelman@mca.nl

ABSTRACT

Background: The repair of incisional hernias remains a challenge for the general surgeon. Indications for surgery are severe bowel obstruction, as well as aesthetic problems. There are various surgical methods to correct these hernias, with varying results. However, the gold standard has not yet been found. Both laparoscopic repair and the component separation technique (CTS) have proven to be acceptable techniques; however, they are not always suitable for resolving the more complicated abdominal wall defects, i.e. after open-abdomen treatment or fascial necrosis. In our hospital, we developed a new onlay technique which we have evaluated in the following research.

Patients and methods: During a period of 10 years (1996-2007), 101 patients with an incisional hernia were corrected with the new onlay technique. A Marlex mesh of dimensions at least 10 x 20 cm was used, overlapping the fascia by at least 5 cm on each side. This mesh was stapled onto the fascia with skin staples. Of the 101 patients, there were 45 men and 56 women, with a mean age of 55 years. Nine patients died and 13 were lost during follow-up. Of the remaining 79 patients, eight refused to participate. The mean follow-up time was 64 months (normal distribution, standard deviation [SD] 34 months). This cohort of 101 patients was studied retrospectively.

Results: Seventy-one of the 101 patients were evaluated at our out-patient clinic. For 24 patients (25%), the operation was for a recurrence after an incisional hernia correction in the past. Twenty-one patients (20%) had an open-abdomen treatment in their medical history. The surgical procedure was technically possible in all patients and the mean operation time was 63 min. The median admission time was 4.5 days (quartiles 3-6.25). The mean follow-up time was 64 months (SD 35 months). A seroma was reported in 27 of 101 patients (27%) and a wound infection in 22 patients (21%), of which seven patients had to be re-operated. Only if a patient was evaluated at our out-patient clinic could reherniation have been scored; this occurred in 11 of 71 patients (16%).

Conclusion: This technique is an effective and simple procedure to correct incisional hernias with acceptable complication rates and is feasible even in the more complicated hernias.

Show MeSH
Related in: MedlinePlus