Modified technique for repairing large incisional hernias.
نویسندگان
چکیده
About 1.7% of all abdominal wall hernias are incisional hernias and they have an expected incidence of 2–5% in uncomplicated abdominal operations which rises to 10%–15% in operations complicated by infection. It is estimated that incisional hernias will complicate 9% of all major abdominal operations and 30% of these hernias show thenselves within the rst 30 postoperative months (1, 5). Risk factors for hernia occurrence are infection and wound dehisence, length of the primary incision, and the use of corticoids during primary operation; in addition, obesity, postoperative cough or high intra-abdominal pressure, and technical errors all predispose to the development of a postoperative incisional hernia (3, 6). Large incisional hernias, apart from physical discomfort and deformity, are the cause of “Eventration Disease” according to Rives (8), which induces multiple symptoms from different systems. Important symptoms derive from pulmonary dysfunction, but symptoms from the gastrointestinal tract, skeletal pain and abdominal skin atrophy are not to be underestimated. Patients operated on for a large abdominal wall hernia face a high incidence of postoperative morbidity, mainly from pulmonary dysfunction, wound infection and the sudden rise in intra-abdominal pressure (10), despite the use of “progressive pneumoperitoneum”, which is a useful technique for preparing patients with large abdominal hernias. Many techniques have been used for repairing these large hernias but recurrence rates remain high, reaching 50% for the Mayo procedure (2, 7). The use of synthetic materials improved the recurrence rates but the results are not yet wholly satisfactory (4). Large incisional hernias pose a challenge in their repair technique and demand a thorough preoperative evaluation of the patient as regards respiratory function, prophylaxis of deep venous thrombosis and infection. Any postoperative complication might jeopardise the outcome. METHODS
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ورودعنوان ژورنال:
- The European journal of surgery = Acta chirurgica
دوره 167 6 شماره
صفحات -
تاریخ انتشار 2001