M A Joshi1, M B Singh, M A Gadhire. 1. Department of General Surgery, LTMGH, Sion, Mumbai, 400022, Maharashtra, India.
Abstract
AIMS AND OBJECTIVES: To study the efficacy and short-term sequelae of modified shoelace repair for midline incisional hernias. MATERIALS AND METHODS: A prospective non-randomized study of 30 cases of midline incisional hernias was carried out at a public hospital from May 2009 to Oct 2012. Patients underwent modified shoelace repair which comprises reconstruction of linea alba along with the use of polypropylene mesh to reinforce the facial layer. A proforma was maintained for each patient documenting patient details, nature of previous surgery and complications if any, postoperative course, and complications postincisional hernia repair. RESULTS AND DISCUSSION: Thirty patients underwent this repair with no complications and no recurrence for minimum follow-up period of 12 months. Our technique is a simple extra-peritoneal procedure with no extensive tissue dissection and avoids the potential complications of bowel injury and adhesions with the mesh. The principle involved is that during straining, the recti shorten by tonic contraction and approximate toward the midline. An incisional hernia weakens the midline and causes the recti to move laterally with contraction as medial pull is lost. By reforming a strong new linea alba, there is restoration of medial pull on recti. This is further buttressed by the mesh. CONCLUSION: Modified shoelace repair is a simple and safe extra-peritoneal procedure and can be used for all midline incisional hernias.
AIMS AND OBJECTIVES: To study the efficacy and short-term sequelae of modified shoelace repair for midline incisional hernias. MATERIALS AND METHODS: A prospective non-randomized study of 30 cases of midline incisional hernias was carried out at a public hospital from May 2009 to Oct 2012. Patients underwent modified shoelace repair which comprises reconstruction of linea alba along with the use of polypropylene mesh to reinforce the facial layer. A proforma was maintained for each patient documenting patient details, nature of previous surgery and complications if any, postoperative course, and complications postincisional hernia repair. RESULTS AND DISCUSSION: Thirty patients underwent this repair with no complications and no recurrence for minimum follow-up period of 12 months. Our technique is a simple extra-peritoneal procedure with no extensive tissue dissection and avoids the potential complications of bowel injury and adhesions with the mesh. The principle involved is that during straining, the recti shorten by tonic contraction and approximate toward the midline. An incisional hernia weakens the midline and causes the recti to move laterally with contraction as medial pull is lost. By reforming a strong new linea alba, there is restoration of medial pull on recti. This is further buttressed by the mesh. CONCLUSION: Modified shoelace repair is a simple and safe extra-peritoneal procedure and can be used for all midline incisional hernias.
Authors: R W Luijendijk; W C Hop; M P van den Tol; D C de Lange; M M Braaksma; J N IJzermans; R U Boelhouwer; B C de Vries; M K Salu; J C Wereldsma; C M Bruijninckx; J Jeekel Journal: N Engl J Med Date: 2000-08-10 Impact factor: 91.245