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  • 1
    ISSN: 1248-9204
    Keywords: Incisional hernia ; Preperitoneal prosthesis ; Absorbable mesh ; Postoperative complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The surgical approach for the treatment of abdominal incisional hernias is a difficult problem. Only the use of prosthetic materials can provide a solution, yet their use in case of abundant loss of peritoneum can involve complications due to direct contact between the mesh and the intestine. The use of prosthetic materials in reconstruction of the abdominal wall highlights two closely connected problems: the kind of mesh to be used and the best implant site The prosthesis should be positioned only in the pre-peritoneal space or in the retromuscular prefascial plane. We report our experience with a surgical technique in which the peritoneum is integrated with an absorbable prosthesis and the nonabsorbable prosthesis is positioned in the neo-preperitoneal plane. From January 1992 to January 2000 65 patients underwent surgery for large incisional hernias. The follow-up period ranged from 6 to 60 months. There were 15 (23.1%) early complications (seromas, hematomas and infections) and 2 (3.1%) late complications: a fistula between the skin and the prosthesis and a subacute infection of the abdominal wall. No recurrence was noted. In patients with abundant loss of substance there is no real pre-peritoneal space; therefore a new one must be created to restore the mechanical and functional structure of the peritoneum. The prosthetic Vicryl® mesh permits good tissue repair with almost no involvement of the intestinal loop. Follow-up studies confirm the efficacy of this method.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1248-9204
    Keywords: Hernioplasty ; Outpatient surgery ; Prosthetic materials
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Since the first hernioplasty performed by Edoardo Bassini in 1884, all surgical reconstruction techniques have suffered from a common defect: tension on the suture line. This represents the main etiologic factor for recurrent hernia. With the introduction of modern prosthetic materials (meshes and plugs) it is possible to perform all hernia repairs without altering the normal anatomy, as well as avoiding undesired suture line tensions. Between January 1992 and December 1998 1405 open sutureless tension-free repairs were performed for primary inguinal hernia in 1317 patients. The number of patients treated with local anesthesia was 1235 (93.8%), with 63 (4.8%) treated under general anesthesia, and 19 (1.4%) with epidural anesthesia. In this series only 4 (0.3%) cases of intra-operative complication occurred (vagal crisis without consequences for the patients). Nine (0.6%) cases of early postoperative complications were noted, of which 8 involved vagal crisis and 1 hemorrhage. Forty six (3.4%) late postoperative complications occurred: 32 seromas accompanied by 3 massive inguino-scrotal edemas, 4 hematomas, and 10 wound infections without the necessity to remove the mesh in all cases. Six recurrences (0.4%) were noted after primary surgical repair. Mean follow-up time was 4 years (range 1–7 years). The proposed technique is simple, safe, and characterized by a rapid performing procedure giving an excellent outcome. The data presented confirms the experience of others reported in the world literature, with a low complication rate and lower cost for the community.
    Type of Medium: Electronic Resource
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