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Panminerva Medica 2002 June;44(2):141-4

lingua: Inglese

Surgical treatment for incisional hernias

Trombetta F., Scamuzzi M., Moscato R., Mussa B., Goss M.

From the University of Turin, UOADU Surgical Oncology,ASO S. Giovanni Battista, Molinette Hospital, Torino, Italy


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Background. A ­great ­variety of sur­gical tech­niques ­have ­been pro­posed to ­repair ­large abdom­inal inci­sional her­nias, but the ­best ­results are ­achieved ­using syn­thetic ­grafts as in the Rives’ or Ramirez’ pro­ce­dure.
Methods. During the ­period September 1993-May 2001, a ­total of 145 ­patients, 54 ­males and 91 ­females, ­mean age 52 (­range 16-88) ­with ­large inci­sional ­hernia ­were ­observed. Ninety-two her­nias ­were ­bigger ­than 10 cm. The ­average ­follow-up was 3 ­years (1-72 ­months). All suc­cess­fully under­went sur­gery ­using the fol­lowing tech­niques: 19 (13.1%) ­simple fas­cial ­sutures, 68 (46.9%) ­implants of ret­ro­mus­colar poly­pro­py­lene ­grafts (Rives’ or Ramirez’ tech­nique), 24 (16.5%) sub­cu­ta­neous ­meshes, 17 (11.7%) pre­per­it­o­neal ­meshes (14 poly­pro­py­lene, 2 gly­colic ­acid, 1 Goretex), 4 (2.75%) intra­per­it­o­neal ­implants of poly­pro­py­lene ­meshes, 13 (9.05%) intra­per­it­o­neal gly­colic ­acid ­grafts ­plus ret­ro­mus­cular poly­pro­py­lene ­graft.
Results. One ­patient ­died in post­op­er­a­tive for ­heart ­failure. Morbidity was 8 sub­cu­ta­neous hemor­rhagic suf­fu­sions, 10 ser­omas ­which ­were ­resolved by ­repeated per­cut­aneous ­drainage, 4 sup­pu­rating ­wounds ­that did not ­require ­graft ­removal, 2 ­little recur­rences ­treated by a new ­mesh ­repair ­under ­local ­anaesthesia, 2 ­sinus for ­mesh intol­ler­ance and 1 fis­tula ­requiring a new inter­ven­tion.
Conclusions. In ­this ­report we dis­cuss the tol­er­ability and reli­ability of ­mesh ­repair, espe­cially in Rives’ and Ramirez’ tech­nique.

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