Treatment of large incisional abdominal wall hernias, using a modified preperitoneal prosthetic mesh repair.

Very large and complex incisional hernias, especially those with loss of abdominal wall, can be a very interesting and perplexing problem, which present a particular challenge to the surgeon. The reported technique was developed and refined by one of our surgeons, between 1998 and 1999 for the repair of incisional hernias in a selected group of patients with large defects, often with a major loss of abdominal wall, overweight and previous attempts for incisional hernia repair. The technique involves a modified preperitoneal approach and was used on 43 eligible patients between 1999 and 2002. There were 30 females and 13 males at a mean age of 61 years. The median ASA score of the group was 2, with a mean BMI of 30.4 and a mean hernia surface area of 162 cm(2). One-third of the patients had one or more previous incisional hernia repair. Mean operating time was 190 min with an average hospital stay of 5.7 days. Postoperative complications occurred in 28% of the patients, most of which were minor and did not necessitate admission to the intensive care unit. None of the patients died. Wound infections occurred in 9.3%, was associated with an increased risk for cutaneous sinus formation, but not for mesh removal or hernia recurrence. A recurrence rate of 12.5% was found after a mean follow-up period of 46 months. We advocate this procedure for the repair of large, complex incisional hernias with loss of abdominal domain in patients with significant risk factors for recurrence.

Silastic ring vertical gastroplasty- long-term results and complications.

BACKGROUND: Silicone ring vertical gastroplasty (SRVG) in some reports is associated with significant morbidity and a tendency to regain weight in the late postoperative period. The present study aims to evaluate our long-term results, along with early and late postoperative complications. METHODS: The early and late postoperative complications of 300 patients undergoing SRVG and followed for an average of 3.2 years, were reviewed retrospectively. The pre- and post-operative weight and body mass index (BMI) were recorded in a subgroup of 131 patients with an average follow-up of 5.2 years. RESULTS: Early postoperative complications occurred in 99 patients (33.1%), with mortality of one patient (0.3%). Vomiting was the most common late complication, occurring in 49.3%. Re-operation was performed in 19.7% of the patients, mostly for the repair of postoperative ventral hernia. Long-term results following SRVG showed a decrease in weight from 131 +/- 25 kg to 94 +/- 23.2 kg, and BMI decreased from 46.1 +/- 8.1 kg /m(2) to 32.9 +/- 7.4 kg/m(2). Excess body weight loss was 58.5 +/- 39.8%. CONCLUSIONS: Most patients (76%) reported their satisfaction following SRVG. Long-term results revealed a significant and sustained weight loss, mild complications and low mortality rate.

[Tension-free repair of inguinal hernia with properitoneal mesh (by the method of Stoppa): results and conclusions].

The results of properitoneal mesh repair of inguinal hernia were evaluated in 38 of 43 consecutive patients operated by Stoppa's technique. In 33 patients the hernia was bilateral and in 10 unilateral; in 20 it was recurrent. In 33/43 patients the mesh was fixed either by sutures or metal clips. The overall recurrence rate after 22 (14-36) months of follow-up, was 10.5%. This result was composed of a 3.0% recurrence rate in the fixated-mesh group, and 30.0% among those with non-fixated mesh. The outcome following the Stoppa method for tension-free properitoneal mesh repair of inguinal hernia, compares favorably with those of other methods, provided proper attention is paid to adequate mesh placement and fixation. Further prospective studies are needed to define the role and indications for this technique in the laparoscopic era.