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Chirurgia 2011 April;24(2):61-5

Copyright © 2011 EDIZIONI MINERVA MEDICA

language: Italian

Large eventrations: personal series, retrospective analysis and proposal of onlay’s technique

Battistini G., D’Amato M., Abete M., Ronchetti V., Casano, Cesaro S., Cappuccio G., Savelli A.

Struttura Complessa di Chirurgia Generale, Polo Ospedaliero di Imperia, Imperia, Italia


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Aim. Incisional hernias occur in 2% to 11% of primary laparotomic interventions. Mesh techniques represent the treatment of choice for parietal defects larger than 2.5 cm in diameter. Several trials yielded insufficient evidence as to which type of mesh or which mesh position (on- or sublay) should be used. The authors present a retrospective study comparing a personal onlay approach with the sublay prosthesis.
Methods. The author presents a retrospective analysis of 48 patients with a “permagna” (larger than 15 cm in diameter) incisional hernia, who underwent a prosthetic reconstruction: 23 with an onlay prosthesis approach (authors’ personal technique) and 25 with a sublay prosthesis approach; the latter had a Rives plasty in 17 cases and a Chevrel plasty in 8 cases. The patients were followed up by physical examination at 1 and 3, 6, 12 and 24, 36 months by phone interview.
Results. The onlay repair was superior with regard to mean operation time (75 min vs. 118 min), hospital stay (4.2 days vs. 5.1 days), postoperative pain (VAS 6.5 vs. 7.8), need for explantation for sepsis (2 vs. 4) and recurrences at 36 months (2 vs. 3=7.4% vs. 12%). The sublay repair was superior with regard to the median drains’ output (360 cc vs. 410 cc) .
Conclusion. In this series the onlay repair of major incisional hernias demonstrated to be quicker and more feasible and presented a lower recurrence rate if compared to the sublay repair.

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