ABSTRACT
BACKGROUND: Incisional hernia is a serious complication after abdominal surgery and occurs in 11-23% of laparotomies. Repair can be done, for instance, with a direct suture technique, but recurrence rates are high. Recent literature advises the use of mesh repair. In contrast to this development, we studied the use of a direct suture repair in a separate layer technique. The objective of this retrospective observational study is to assess the outcomes (recurrences and complications) of a two-layered open closure repair for primary and recurrent midline incisional hernia without the use of mesh. METHODS: In an observational retrospective cohort study, we analysed the hospital and outpatient records of 77 consecutive patients who underwent surgery for a primary or recurrent incisional hernia between 1st May 2002 and 8th November 2006. The repair consisted of separate continuous suturing of the anterior and posterior fascia, including the rectus muscle, after extensive intra-abdominal adhesiolysis. RESULTS: Forty-one men (53.2%) and 36 women (46.8%) underwent surgery. Sixty-three operations (81.8%) were primary repairs and 14 (18.2%) were repairs for a recurrent incisional hernia. Of the 66 patients, on physical examination, three had a recurrence (4.5%) after an average follow-up of 2.6 years. The 30-day postoperative mortality was 1.1%. Wound infection was seen in five patients (6.5%). CONCLUSIONS: A two-layered suture repair for primary and recurrent incisional hernia repair without mesh with extensive adhesiolysis was associated with a recurrence rate comparable to mesh repair and had an acceptable complication rate.
Subject(s)
Hernia, Ventral/diagnosis , Hernia, Ventral/surgery , Surgical Procedures, Operative/methods , Suture Techniques , Aged , Chi-Square Distribution , Cohort Studies , Female , Follow-Up Studies , Hernia, Ventral/etiology , Humans , Incidence , Laparotomy/adverse effects , Male , Middle Aged , Probability , Recurrence , Reoperation , Retrospective Studies , Risk Assessment , Severity of Illness Index , Surgical Mesh , Surgical Procedures, Operative/adverse effects , Surgical Wound Infection/epidemiology , Tensile Strength , Time Factors , Treatment Outcome , Wound Healing/physiologyABSTRACT
BACKGROUND: The objective of this study is to determine the reliability and validity of ultrasonography (US) in diagnosing incisional hernias in comparison with computed tomography (CT). The CT scans were assessed by two radiologists in order to estimate the inter-observer variation and twice by one radiologist to estimate the intra-observer variation. Patients were evaluated after reconstruction for an abdominal aortic aneurysm or an aortoiliac occlusion. METHODS: Patients with a midline incision after undergoing reconstruction of an abdominal aortic aneurysm or aortoiliac occlusion were examined by CT scanning and US. Two radiologists evaluated the CT scans independently. One radiologist examined the CT scans twice. Discrepancies between the CT observations were resolved in a common evaluation session between the two radiologists. RESULTS: After a mean follow-up of 3.4 years, 40 patients were imaged after a reconstructed abdominal aortic aneurysm (80% of the patients) or aortoiliac occlusion. The prevalence of incisional hernias was 24/40 = 60.0% with CT scanning as the diagnostic modality and 17/40 = 42.5% with US. The measure of agreement between CT scanning and US expressed as a Kappa statistic was 0.66 (95% confidence interval [CI] 0.45-0.88). The sensitivity of US examination when using CT as a comparison was 70.8%, the specificity was 100%, the predictive value of a positive US was 100%, and the predictive value of a negative US was 69.6%. The likelihood ratio of a positive US was infinite and that of a negative US was 0.29. The inter- and intra-observer Kappa statistics were 0.74 (CI 0.54-0.95) and 0.80 (CI 0.62-0.99), respectively. CONCLUSIONS: US imaging has a moderate sensitivity and negative predictive value, and a very good specificity and positive predictive value. Consistency of diagnosis, as determined by calculating the inter- and intra-observer Kappa statistics, was good. The incidence of incisional hernias is high after aortic reconstructions.
Subject(s)
Endosonography/methods , Hernia, Abdominal/diagnostic imaging , Tomography, X-Ray Computed/methods , Aged , Female , Follow-Up Studies , Hernia, Abdominal/epidemiology , Humans , Incidence , Male , Netherlands/epidemiology , Postoperative Complications , Reproducibility of Results , Retrospective StudiesABSTRACT
BACKGROUND: Abdominal wall repair can be performed with synthetic or biological materials. Biological materials may reduce the risk of infections and fibrosis. The aim of this study was to evaluate two acellular human dermis products. MATERIALS AND METHODS: A rat model was used to compare the two materials. One was prepared using low concentrations of NaOH; the other material was SureDerm, which is commercially available. Full thickness defects were prepared in the abdominal wall and closed with the materials. Rats were sacrificed at 1 or 4 months after operation and the numbers of adhesions to the bowels were scored. Samples were taken for histological analysis and to measure the breaking strength. RESULTS: In both groups a good functional integration of the implants with the abdominal wall was observed. There was no adhesion formation with the bowels in the group with the NaOH prototype. In the SureDerm group, 4 out of 7 rats showed only small adhesions at 4 months after operation. Breaking strength of the healed tissue was significantly higher in the NaOH prototype group at 4 months after operation (p < 0.0026). CONCLUSIONS: The results indicate that both human acellular dermis products may be used in clinical trials for closure of abdominal wall defects.
