Wound defects in the elderly: our experience

Patients and methods To assess the safety and efficacy of laparoscopic [1-5] primary inguinal and incisional repair we reviewed the records of our patients of over 70 years old, who underwent such a procedure from June 2007 to September 2010: hernia defect size, recurrence, operative time, and procedure-related complications [6] were evaluated and a laparoscopic approach was attempted in all patients who required a mesh repair. We scheduled 42 patients (32 M 10 F, with 53 wound defects totally) for laparoscopic incisional [7] and primary inguinal hernia repair and we performed 17 surgical repair for incisional hernia and 36 for primary hernia. Of those, 13 were done for incisional hernias with a single defect (24.5% recurrence hernias), 4 with multiple defects (7.54% recurrence hernias), 12 were performed for unilateral inguinal hernias (22.56 % recurrence hernias), 16 for bilateral inguinal hernias (30.08 % recurrence hernias), 4 for umbilical hernias (1 recurrence hernias), 2 for epigastric and linea alba’s hernias, and 2 for rectum diastasis. The majority of the patients were normal weight with a mean BMI of 25 kg/m2 (45%), 38% 25 > BMI > 30 (overweight), 17% BMI > 30 (obesity). There was no conversion to an open procedure. The mean operative time was 128 minutes (range: 50 – 325). In all the patients only mesh was used (37.5% polypropylene not reabsorbable, 42.5% tridimensional polyestercollagen composite mesh, 20% lightweight multifilament mesh partly reabsorbable) [8]. The meshes were fixed in 82.5 % with absorbable fixation device, in 5% with a non-absorbable device and in 12.5 % with fibrin glue [9]. In contrast to other authors [10-13], major complications were 14.24% (6/42: 2 chronic inguinal pain, 4 recurrences). Minor complications were 5/42 (11.90%) and included only asymptomatic seromas that were aspirated. The mean hospital stay was 4.7 days (range: 1-18 days).