Randomized clinical trial of postoperative hernia prophylaxis in open bariatric surgery

BACKGROUND: Postoperative hernia following bariatric procedures is more common than in other groups of surgical patients, and remains a serious problem. Gastric bypass is the most often performed bariatric procedure and, despite the increasing popularity of a laparoscopic approach, many morbidly obese patients are still offered open procedures. The aim of this study was to assess the effects of prophylactic polypropylene mesh in morbidly obese patients undergoing gastric by-pass surgery. METHODS: The study randomized 74 patients undergoing open Roux-en-Y gastric bypass into two groups: wound closure with (n = 36) or without (n = 38) a polypropylene mesh. Mean(s.d.) body mass and body mass index in the mesh group were 137.3(24.5) kg and 46.2(7.1) kg/m(2) and in the non-mesh group were 139.0(24.9) kg and 46.8(7.6) kg/m(2) respectively. In the non-mesh group, the wound was closed with a polypropylene suture. Patients in the mesh group had in addition a polypropylene mesh inserted in a sublay manner. RESULTS: Patients were followed up for at least 6 (range 6-38) months. Hernia developed in eight patients in the non-mesh group but in none in the mesh group. The duration of hospital stay was similar in both groups: mean(s.d.) 8.4(3.2) and 10.3(5.9) days (P = 0.092). There were no serious complications in either group. CONCLUSION: The use of a mesh prevented hernia development and did not lengthen hospital stay.     

Late results of mesh wound closure after elective open aortic aneurysm repair.

INTRODUCTION: Incisional hernia is a common late complication after abdominal aortic aneurysm (AAA) repair. We examined the outcome after prophylactic placement of a pre-peritoneal polypropylene mesh during abdominal closure in consecutive patients having elective AAA repair. REPORT: At least 30 months after surgery, 28 patients underwent clinical and ultrasound examination of their surgical wound for incisional hernias. Only one patient had a hernia in the original surgical scar. No patients had late mesh-related wound problems. DISCUSSION: Pre-peritoneal polypropylene mesh placement is a simple, safe and effective method to decrease the incidence of incisional hernia after AAA repair.     

Prophylactic prosthetic reinforcement of midline abdominal incisions in high-risk patients

Background/aim  Incisional hernia is one of the major elements of morbidity after abdominal surgery, with high incidence in vertical midline abdominal incisions. However, the risk of developing an incisional hernia can be increased due to the patient’s related factors; therefore, more consideration has to be given to the choice of incision, wound closure and wound healing to protect against incisional hernia, especially in high-risk patients. In this study, we used prophylactic subfascial non-absorbable mesh reinforcement of midline closure in high-risk patients to detect whether fixing the wound with mesh is risky on a short-term basis and whether it is protective on a long-term basis. Patients and methods  From October 2000 to December 2002, 40 high-risk patients liable to develop postoperative incisional hernia underwent elective abdominal operations through midline abdominal incisions at the Department of Surgery, Gastroenterology and Laparoscopic Unit, Tanta University Hospital, Egypt. They were randomly divided into two groups; group A: patients for whom the midline abdominal incisions were closed by conventional method and reinforced by subfascial polypropylene mesh (20 patients); and group B: patients for whom the midline abdominal incisions were closed by conventional method only (20 patients) with a follow up period of more than 20 months. Results  There was no significant difference (P = 0.075) in both groups regarding the age, sex and the average risk factor. Twenty-three patients (57.5%) presented with more than one risk factor (11 in group A and 12 in group B). The upper midline abdominal incisions were reported in 33 patients (19 upper and 14 extended upper). There was no significant difference between the overall local and systemic complications in both groups (P = 0.4082). However, the subcutaneous seroma and chronic wound pain were greater in patients with prophylactic mesh than those without mesh. One group A patients (5%) and three group B patients (15%) developed postoperative incisional hernia during the follow up period. Conclusion  Prophylactic subfascial non-absorbable mesh reinforcement of midline closure in high-risk patients can be used safely and effectively to provide extrinsic strength of the wound without relying too much on the defective development of its own intrinsic strength and to prevent subsequent incisional hernia. There was no risk in the use of the mesh regarding local and systemic complication. However, the final statement should await the outcomes of the long-term follow up of the studied cases.     

A randomized, double-blind, placebo-controlled trial to determine effectiveness of antibiotic prophylaxis for tension-free mesh herniorrhaphy

BACKGROUND: In recent years, use of prosthetic material for inguinal hernia repair has increased dramatically. Tension-free repairs have gained popularity not only for recurrent or complicated hernias, but for primary hernia repairs as well. Although routine use of prophylactic antibiotics is not recommended in the Philippines for open nonimplant herniorrhaphy, there is little direct clinical evidence on which to base recommendations when implantable mesh is used. STUDY DESIGN: We conducted a prospective, randomized, double-blind, placebo-controlled trial comparing wound infection rates in 360 patients (180 received prophylactic antibiotics, 180 received a placebo) undergoing primary inguinal hernia repair electively using polypropylene mesh. Age, gender, American Society of Anesthesiologists class, type of hernia, type of anesthesia, and duration of operation were recorded. Infections were evaluated 1 week, 2 weeks, and 1 month after operation by an independent surgeon. All complications were recorded. Results were assessed using chi-square, Fisher's exact test, and Student's t-tests as appropriate. RESULTS: Groups were well matched for all preoperative variables studied, including comorbid conditions. Six patients from the antibiotic group and four from the placebo group failed to followup after the second week. Superficial surgical site infection developed in 3 patients (1.7%) from the antibiotic group and 6 (3.3%) from the placebo group (p = 0.50). One from each group developed deep surgical site infection. Both patients were readmitted and underwent repeated debridement, which eventually resulted in graft loss. CONCLUSIONS: Preoperative administration of single-dose antibiotic for tension-free inguinal mesh herniorrhaphy did not markedly decrease risk of wound infection in this patient population. Our results do not support use of antibiotic prophylaxis for tension-free mesh herniorrhaphy.     

Mesh repair for postoperative wound dehiscence in the presence of infection: is absorbable mesh safer than non-absorbable mesh?

Objective In patients with postoperative wound dehiscence in the presence of infection, extensive visceral oedema often necessitates mechanical containment of bowel. Prosthetic mesh is often used for this purpose. The aim of the present study was to assess the safety of the use of non-absorbable and absorbable meshes for this purpose. Method All patients that had undergone mesh repair of abdominal wound dehiscence between January 1988 and January 1998 in the presence of intra-abdominal infection were included in a retrospective cohort study. All surviving patients had physical follow-up in February 2001. Result Eighteen patients were included in the study. Meshes consisted of polyglactin (n = 6), polypropylene (n = 8), polyester (n = 1), or a combination of a polypropylene mesh with a polyglactin mesh on the visceral side (n = 3). All patients developed complications, consisting mainly of mesh infection (77%), intra-abdominal abscess (17%), enterocutaneous fistula (17%), or mesh migration through the bowel (11%). Mesh removal was necessary in eight patients (44%). Within four months postoperatively, six patients (33%) had died because of progressive abdominal sepsis. The incidence of progressive abdominal sepsis was significantly higher in the group with absorbable polyglactin mesh than in the group with nonabsorbable mesh (67 vs. 11%, p = 0.02) After a mean follow-up of 49 months, 63% of the surviving patients had developed incisional hernia. Absorbable meshes did not yield better outcomes than nonabsorbable meshes in terms of complications and mortality rate. Conclusion Synthetic graft placement in the presence of intra-abdominal infection has a high risk of complications, regardless of whether absorbable (polyglactin) or non-absorbable mesh material (polypropylene or polyester) is used, and should be avoided if possible.     

Collagen tampons as aminoglycoside carriers to reduce postoperative infection rate in prosthetic repair of groin hernias.

OBJECTIVE: To find out whether collagen tampons treated with gentamicin would prevent postoperative infections in patients operated on for groin hernias by insertion of prostheses. SETTING: University hospital, Italy. DESIGN: Prospective randomised trial. PATIENTS: 595 patients who required prosthetic repair of a groin hernia. INTERVENTIONS: All repairs were by our standard surgical technique including prophylactic ceftriaxone, local anaesthesia, and insertion of a polypropylene mesh. 301 patients also had a gentamicin laced collagen tampon placed in front of the prosthetic mesh before the aponeurosis of external oblique muscle was sutured. RESULTS: 1/301 patients in the gentamicin group (0.3%) developed a postoperative wound infection compared with 6/294 in the control group (2.0%), (p = 0.04 Fisher exact test). CONCLUSIONS: Gentamicin-laced collagen tampons are effective in reducing the postoperative infection rate in patients operated on for groin hernia by insertion of a prosthesis.     

Incisional hernia repair after orthotopic liver transplantation: a technique employing an inlay/onlay polypropylene mesh

Background: The literature provides no data on the incidence and operative management of incisional hernias developing after orthotopic liver transplantation. The use of high-dose immunosuppressive agents results in an appreciable delay in wound healing. There is thus a need for a procedure for the reconstruction of the abdominal wall for patients on immunosuppression. The aim of this retrospective study was to establish the incidence of incisional hernias and an analysis of the results after implantation of a polypropylene mesh in inlay–onlay technique after liver transplantation is given.Methods: The basis for the present retrospective investigations was a total of 207 liver transplantations carried out in 192 patients (15 re-transplantations). After performing tensiometry, a polypropylene mesh (Marlex) was implanted to close the hernias using the inlay/onlay technique or a direct closure of the fascia was done. All treated hernias were followed up for a median of 18 months.Results: Among 184 patients, 17 developed incisional hernias after primary direct closure of the abdominal wall, giving an incidence of 9%. In an additional 8 patients an incisional hernia was seen where an absorbable mesh was used to close the abdominal wall after liver transplantation. In addition, there were 25 incisional hernias after 207 liver transplantations (12%). One of 15 (7%) of the surgically repaired hernias with implantation of a polypropylene mesh (Marlex) developed a recurrence. All the 3 patients after direct apposition of the fascia without using a polypropylene mesh suffered a recurrence (3 of 3; 100%). Significant risk factors for developing an incisional hernia were the amount of ascites and the stay in the ICU after transplantation. Neither severe deep nor superficial wound infection nor bowel fistulas were observed after implantation of a inlay/onlay mesh.Conclusion: In patients after liver transplantation, the implantation of a polypropylene mesh proved to be an efficient and safe method of treating incisional hernias. Implantation of a mesh was not associated with an increased infection rate, despite the use of immunosuppression. In view of the high recurrence rate associated with primary closure, mesh implantation should be given preference.     

Use of Permacol in complicated incisional hernia

Polypropylene mesh repair is the gold standard for primary inguinal hernia and incisional hernia. Wound infection and small bowel fistulas are contraindications to polypropylene mesh repair. In addition, synthetic meshes are known to cause severe peritoneal adhesions and enteric fistulas if located close to the bowel. Porcine intestinal submucosa has been used successfully in experimental studies in dogs and rats to repair large abdominal wall defects. A new porcine dermal collagen graft has been used in man for groin hernia repair, incisional hernia repair and other surgical procedures without complications. We describe 6 cases of complicated incisional hernia operated in emergency using porcine dermal collagen grafts. In one woman the incisional hernia was associated with an enterovaginal fistula. Three cases presented severe wound infections, two of which related to a previous polypropylene mesh repair, while another had an irreducible recurrent incisional hernia and one woman presented complete evisceration. None of the patients had postoperative or porcine-graft-related complications. Over a follow-up period of 3-24 months we have had no recurrence or wound infection. The results of these few cases confirm the safety and efficacy of the porcine dermal collagen mesh also in incisional hernia repair.     

Incisional hernia and its repair with polypropylene mesh in renal transplant recipients

PURPOSE: We evaluate the incidence of incisional hernia after kidney transplantation, predisposing factors and the results of surgical repair with polypropylene mesh. MATERIALS AND METHODS: We reviewed the records of 371 consecutive kidney transplants performed between April 1995 and February 2000. Patients with clinical signs of hernia at the transplant incision site were included in the study. Predisposing factors for incisional hernia were also reviewed. A prospective protocol of surgical correction was established using polypropylene mesh and patient outcome was studied. RESULTS: We identified 14 patients (3.8%) with an incisional hernia at the transplant incision site. Hernias developed 3 to 840 days after transplant surgery and were significantly more common in white (p = 0.019) and cadaveric graft (p = 0.02) recipients. Predisposing factors in 11 cases included complications of transplant surgery in 7, bladder obstruction in 2, large polycystic kidneys in 1 and chronic pulmonary disease in 1. Surgical repair was performed by primary fascial approximation and polypropylene mesh reinforcement in 13 cases and by pre-peritoneal mesh placement in 1. Minor subcutaneous wound infection developed in 1 patient. No relapses were noted at a mean followup of 17.8 months. CONCLUSIONS: In the majority of cases incisional hernia develops in the first 3 months after transplant surgery. The incidence is significantly higher in white patients and after cadaveric donor transplantation. Surgical complications of transplant surgery are important predisposing factors for incisional hernia after kidney transplantation. Surgical repair using polypropylene mesh is safe and effective in this group of patients.     

Mesh incisional herniorrhaphy increases abdominal wall elastic properties: a mechanism for decreased hernia recurrences in comparison with suture repair

BACKGROUND: An improved understanding of load-bearing soft tissue repair suggests that the mechanism for the improved outcomes after alloplastic incisional herniorrhaphy involves more than simple tissue replacement or material strength. We test the hypothesis that postrepair abdominal wall elastic properties are most predictive of successful abdominal wall reconstruction. METHODS: A rodent model of chronic incisional hernia formation was used. Midline incisional hernias were repaired primarily with suture (n = 24) or polypropylene mesh (n = 24). Rodents were sacrificed at serial postoperative time points over 60 days. Intact abdominal wall strips were cut perpendicular to the wound for tensiometric analysis. Biopsies of wound provisional matrix were obtained for biochemical analysis. RESULTS: Recurrent incisional hernia formation was significantly decreased in the mesh-repair group, compared with the suture-repair group (5/24 vs 14/24, P = .02). Mesh-repaired abdominal walls demonstrated significantly more elongation (P < .01) and less stiffness (P < .01). Toughness was equal between wounds, although the suture-repaired wounds had increased recovery of tensile strength (P < .01). There were no significant differences in collagen deposition after postoperative day 7. CONCLUSIONS: Mesh incisional herniorrhaphy increases abdominal wall elastic properties as measured by increased elongation and reduced stiffness. Increased abdominal wall elasticity after incisional hernia repair in turn results in lower recurrence rates.     

Repair of giant incisional hernias with polypropylene mesh: a retrospective study.

The aim of the present study was to evaluate the long term results of repair of ventral incisional hernias or of defects in the abdominal wall using polypropylene mesh. Eighty-eight patients were operated on from 1979-1996, inclusive. Abdominal protrusion was found in 78 patients. Fifty-one of these patients had previously had an incisional hernia repaired and the remaining 10 patients had an abdominal wall defect as a result of excision of a malignant tumour. The polypropylene mesh was placed extraperitoneally and sutured with two rows of interrupted stitches, using non-absorbable sutures. Recurrence of the hernia was found in 10 of the 67 patients with incisional hernia. Eight patients had a relaxation of the muscles of the abdominal wall. Perioperative complications consisted of infection (n = 4), embolism (n = 1), haematoma (n = 1), and pneumonia (n = 3, one fatal), and one fatal bowel perforation. Median follow up time was 5.7 years (range 0-17). It is therefore possible to obtain acceptable results after repair of larger incisional hernias even if they had been repaired before.     

轻量型网片和普通聚丙烯补片在腹股沟疝修补术中的对比研究

目的探讨轻量型网片（强生UPP）在腹股沟疝无张力修补中的作用。方法回顾分析90例次腹股沟疝无张力修补患者的临床资料,其中47例次行普通聚丙烯材料修补,43例次行强生UPP修补。结果强生UPP修补组与普通聚丙烯材料修补组比较,早期并发症发生率（切口疼痛、切口积液、伤口感染、肺部感染、尿道损伤以及尿潴留等）和住院时间差异无统计学意义。在6个月时强生UPP修补组其局部切口疼痛、异物感的患者明显少于普通聚丙烯材料修补组,腹壁顺应性明显好于普通聚丙烯材料修补组,在6个月时两组均没有复发。结论轻量型网片在腹股沟疝无张力修补中,其后期并发症明显减少,有望成为腹股沟疝无张力修补的首选材料。     

Is parastomal hernia repair with polypropylene mesh safe?

BACKGROUND: Concern over the safety of polypropylene mesh in parastomal hernia repairs has led some to avoid its use. We reviewed our rate of complications and outcomes with polypropylene mesh. METHODS: From January 1988 through May 2002, 58 patients underwent parastomal hernia repair with polypropylene mesh. After closure of the fascia, the stoma was pulled through the center of the mesh, which was placed either above or below the fascia. Multivariate analysis was performed to determine independent predictors for the development of complications. RESULTS: There were 31 end colostomies, 24 end ileostomies, and 3 loop transverse colostomies. Mean follow-up with 50.6 months. Overall complications related to the polypropylene mesh was 36% (recurrence 26%, surgical bowel obstruction 9%, prolapse 3%, wound infection 3%, fistula 3%, and mesh erosion 2%). None of the patients had extirpation of their mesh. Complications were significantly associated with younger age (59.6 versus 67 years, P = 0.04). Cancer patients with stomas had fewer complications (P = 0.02, odds ratio 0.34). Inflammatory bowel disease, stomal type, mesh location, urgent procedures, steroid use, and surgical approaches were not significantly associated with an increased complication rate. Of the 15 patients with recurrence, 7 underwent successful repair for an overall success rate of 86%. CONCLUSIONS: Parastomal hernia repair with polypropylene mesh is safe and effective.     

应用聚丙烯和e-PTFE复合补片修补腹壁巨大切口疝

目的回顾性分析应用聚丙烯和e鄄PTFE复合补片修补腹壁巨大切口疝的效果,介绍腹腔内应用复合补片的方法和经验。方法1999年5月至2003年12月应用复合补片修补腹膜难以对合的腹壁巨大缺损22例,其中补片置于皮下12例,腹腔内10例。平均随访期39个月。结果手术后切口并发症的发生率为41%(9/22),1例修补术后复发,占4.6%。应用皮下法发生切口感染3例,其中1例因严重感染而将补片取出;切口处皮下积液2例。应用腹腔内法者中仅2例发生切口皮下少量积液。结论腹壁巨大切口疝,特别是难以关闭腹膜的病例,可应用聚丙烯和e鄄PTFE复合补片进行修补。应用腹腔内置补片法并辅以正确的术后处理可使局部并发症明显减少。     

Use of an absorbable mesh to repair contaminated abdominal-wall defects

When polypropylene mesh (Marlex) is used to repair contaminated abdominal-wall hernias, a high incidence of mesh-related chronic infection, drainage, erosion, and bleeding is noted. As an alternative to placing polypropylene mesh in a contaminated field, in the past 18 months we have used an absorbable polyglycolic acid mesh (Dexon) to repair contaminated abdominal-wall defects in eight patients--three with necrotizing abdominal-wall infections, one with an extensive electrical burn of the abdominal wall, three with infected polypropylene mesh from a previous repair, and one whose hernia was covered by a chronically infected scar. In seven of the eight cases, a single sheet of polyglycolic acid mesh was sewn to the fascial margins. In four cases, skin was closed over the mesh; wound packing and subsequent skin grafting were required in the other four. In follow-up studies that ranged from three to 18 months, six of the eight patients developed abdominal-wall hernias at the site of absorbable mesh placement. None of the patients required an abdominal binder. Postoperative hernia development is probable in patients whose defects are repaired with absorbable mesh. However, this complication is balanced against the more serious complications of fistula, bleeding, skin erosion, drainage, and chronic infection, which require removal of the more rigid nonabsorbable meshes in 50% to 90% of cases when the latter are placed under contaminated conditions. Placement of absorbable mesh for temporary abdominal-wall support until wound contamination resolves enhances the likelihood of subsequent successful placement of a permanent mesh.     

Effect of single-dose prophylactic ampicillin and sulbactam on wound infection after tension-free inguinal hernia repair with polypropylene mesh: the randomized, double-blind, prospective trial

OBJECTIVE: To assess the value of single-dose, intravenous, prophylactic ampicillin and sulbactam (AS) in the prevention of wound infections during open prosthetic inguinal hernia repair by a double-blind, prospective, randomized trial. SUMMARY BACKGROUND DATA: The use of antibiotic prophylaxis during open prosthetic inguinal hernia surgery is controversial, and no prospective trial has been conducted to examine this issue. METHODS: Patients undergoing unilateral, primary inguinal hernia repair electively with the Lichtenstein technique using polypropylene mesh were randomized to receive 1.5 g intravenous AS before the incision or an equal volume of placebo according to a predetermined code of which the surgeons were unaware. Patients with recurrent, femoral, bilateral, giant, or incarcerated hernias or any systemic diseases were excluded. Age, sex, body mass index, American Society of Anesthesiologists score, type of hernia, type of anesthesia, duration of surgery, and use of drains were recorded. Infection was defined according to the criteria of Centers for Disease Control. Patients were evaluated 1 week, 1 month, 6 months, and 1 year after surgery by an independent surgeon. All complications were recorded. Results were assessed using chi-square, Fisher's exact, and Student t tests as appropriate. RESULTS: Between September 1996 and July 1998, 280 patients (140 AS, 140 placebo group) entered the protocol. Four patients from the AS group and seven from the placebo group were excluded because of inadvertent antibiotic administration or follow-up problems. Groups were well matched for all the variables studied and postoperative complications, excluding wound infections, which occurred at a rate of 0.7% in the AS group and 9% in the placebo group (P =.00153). Twelve patients in the placebo group developed wound infections, requiring five repeat hospital admissions in three patients. These three patients suffered deep infections reaching the graft, which resulted in graft loss in two. The single infected patient in the AS group had his graft removed as well because of deep persistent infection. CONCLUSIONS: This study documented a significant (10-fold) decrease in overall wound infections when single-dose, intravenous AS was used during Lichtenstein hernia repair. Deep infections and wound infection-related readmissions were also reduced by the use of AS. Proponents of mesh repairs may therefore be advised to use prophylactic single-dose intravenous antibiotic coverage in the light of the results of this trial. AS proved to be an effective antimicrobial agent.     

Use of negative pressure wound therapy in the management of infected abdominal wounds containing mesh: an analysis of outcomes

The purpose of this study was to examine the clinical outcomes of negative pressure wound therapy (NPWT) using reticulated open-cell foam (ROCF) in the adjunctive management of abdominal wounds with exposed and known infected synthetic mesh. A non randomised, retrospective review of medical records for 21 consecutive patients with infected abdominal wounds treated with NPWT was conducted. All abdominal wounds contained exposed synthetic mesh [composite, polypropylene (PP), or knitted polyglactin 910 (PG) mesh]. Demographic and bacteriological data, wound history, pre-NPWT and comparative post-NPWT, operative procedures and complications, hospital length of stay (LOS) and wound healing outcomes were all analysed. Primary endpoints measured were (1) hospital LOS prior to initiation of NPWT, (2) total time on NPWT, (3) hospital LOS from NPWT initiation to discharge and (4) wound closure status at discharge. A total of 21 patients with abdominal wounds with exposed, infected mesh were treated with NPWT. Aetiology of the wounds was ventral hernia repair (n = 11) and acute abdominal wall defect (n = 10). Prior to NPWT initiation, the mean hospital LOS for the composite, PP and PG meshes were 76 days (range: 21-171 days), 51 days (range: 32-62 days) and 19 days (range: 12-39 days), respectively. The mean hospital LOS following initiation of NPWT for wounds with exposed composite, PP and PG mesh were 28, 31 and 32 days, respectively. Eighteen of the 21 wounds (86%) reached full closure after a mean time of 26 days of NPWT and a mean hospital LOS of 30 days postinitiation of NPWT. Three wounds, all with composite mesh left in situ, did not reach full closure, although all exhibited decreased wound dimensions, granulating beds and decreased surface area exposure of mesh. During NPWT/ROCF, one hypoalbuminemic patient with exposed PP mesh developed an enterocutaneous fistula over a prior enterotomy site. This patient subsequently underwent total mesh extraction, takedown of the fistula and PP mesh replacement followed by reinstitution of NPWT and flap closure. In addition to appropriate systemic antibiotics and nutritional optimisation, the adjunctive use of NPWT resulted in successful closure of 86% of infected abdominal wounds with exposed prosthetic mesh. Patient hospital LOS (except those with PG mesh), operative procedures and readmissions were decreased during NPWT compared with treatment prior to NPWT. Future multi-site prospective, controlled studies would provide a strong evidence base from which treatment decisions could be made in the management of these challenging and costly cases.     

善愈聚丙烯补片在小切口疝的临床应用

目的探讨总结善愈聚丙烯补片在腹部小切口疝的临床应用经验。方法对我院2007年1月至2009年2月收治的26例腹壁小切口疝临床资料进行回顾性分析。结果本组患者均治愈,手术时间30—70min,患者术后疼痛轻,未使用止痛药,无切口感染,无术后慢性疼痛,平均手术费用4100元,随访3～25个月,无并发症,异物感不明显。结论善愈补片修补腹壁小切口疝是一种安全、可靠的手术方式。     

巨大腹壁切口疝的补片修补治疗(附23例报告)

目的：总结临床治疗巨大腹壁切口疝的经验和方法。方法：回顾性分析23例巨大腹壁切口疝病人的年龄，手术方法，引流放置，抗生素应用及预后。结果：发生巨大腹壁切口疝平均年龄是65．3％，均采用人工合成材料进行修补，术后放置引流，并使用预防性抗生素。治愈21例，复发2例。结论：常见于老年病人腹部手术后巨大腹壁切口疝，可使用人工合成材料进行修补，并获得良好疗效。     

Massive incisional hernia: abdominal wall replacement with Marlex mesh

Marlex (polypropylene) mesh was used to replace the abdominal wall in massive incisional herniation in 50 patients. Seventeen unsuccessful attempts at primary repair had previously been made on nine patients. Patient follow-up ranged from 6 to 120 months (mean = 45 months). There was minor hernia recurrence in four (8 per cent) patients. In each instance it was due to partial detachment of the peripheral fixation of the patch. Complications were: wound infection, four (8 per cent); wound seroma, two (4 per cent); wound haematoma, one (2 per cent); and wound sinus, six (12 per cent). Complications did not necessitate removal of the patch in any case. Inadequate peripheral attachment of the patch has been the only cause of hernia recurrence and should be avoidable.