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. Cardiorespiratory 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.
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. Cardiorespiratory 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.
Authors: Y Yurtkap; M M J van Rooijen; S Roels; J M L Bosmans; O Uyttebroek; J F Lange; F Berrevoet Journal: Hernia Date: 2020-06-03 Impact factor: 4.739
Authors: Kristen E Elstner; John W Read; Omar Rodriguez-Acevedo; Kevin Ho-Shon; John Magnussen; Nabeel Ibrahim Journal: Surg Endosc Date: 2016-08-29 Impact factor: 4.584
Authors: Christoph Seiler; Petra Baumann; Peter Kienle; Andreas Kuthe; Jens Kuhlgatz; Rainer Engemann; Moritz V Frankenberg; Hanns-Peter Knaebel Journal: BMC Surg Date: 2010-07-12 Impact factor: 2.102
Authors: Andrew N Kingsnorth; M Kamran Shahid; Aby J Valliattu; Robert A Hadden; Christine S Porter Journal: World J Surg Date: 2008-01 Impact factor: 3.352