M Rogers1, R McCarthy, J J Earnshaw. 1. Gloucestershire Vascular Group, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN, UK.
Abstract
BACKGROUND: Incisional hernia is a common late complication of elective abdominal aneurysm (AAA) repair. This paper describes a technique that could prevent the development of this condition. METHODS: Since Jan 2001, a polypropylene mesh has been sutured prophylactically in the pre-peritoneal space during abdominal closure after elective AAA repair. RESULTS: Twenty-eight consecutive elective procedures were performed. One patient died from a myocardial infarct 13 days after operation. Four patients (14%) had a wound infection (1 deep methicillin resistant Staphylococcus aureus (MRSA) infection and 3 superficial) that were treated successfully with antibiotics and dressings. One additional patient had a positive MRSA wound swab but required no treatment. Two patients required late re-operations. One, who was on warfarin, required an urgent laparotomy for a leaking false aneurysm of the distal anastomoses 3 months after elective repair. A second patient had an anterior resection 18 months after aneurysm repair. Both re-operations were uneventful. No patient has yet developed a clinically evident incisional hernia. CONCLUSIONS: These early data suggest that this mesh technique is a simple, safe and potentially effective method to decrease the incidence of incisional hernia following aortic aneurysm repair.
BACKGROUND: Incisional hernia is a common late complication of elective abdominal aneurysm (AAA) repair. This paper describes a technique that could prevent the development of this condition. METHODS: Since Jan 2001, a polypropylene mesh has been sutured prophylactically in the pre-peritoneal space during abdominal closure after elective AAA repair. RESULTS: Twenty-eight consecutive elective procedures were performed. One patient died from a myocardial infarct 13 days after operation. Four patients (14%) had a wound infection (1 deep methicillin resistant Staphylococcus aureus (MRSA) infection and 3 superficial) that were treated successfully with antibiotics and dressings. One additional patient had a positive MRSA wound swab but required no treatment. Two patients required late re-operations. One, who was on warfarin, required an urgent laparotomy for a leaking false aneurysm of the distal anastomoses 3 months after elective repair. A second patient had an anterior resection 18 months after aneurysm repair. Both re-operations were uneventful. No patient has yet developed a clinically evident incisional hernia. CONCLUSIONS: These early data suggest that this mesh technique is a simple, safe and potentially effective method to decrease the incidence of incisional hernia following aortic aneurysm repair.
Authors: Henry D I De'Ath; Richard E Lovegrove; Mahsa Javid; Noel Peter; Timothy R Magee; Robert B Galland Journal: Ann R Coll Surg Engl Date: 2010-09-06 Impact factor: 1.891