Review of technique for combined closed incisional hernia repair and panniculectomy status post-open bariatric surgery.

BACKGROUND: After open bariatric surgery, many patients develop incisional hernia. Patients who were once morbidly obese provide a unique challenge to hernia repair, given the larger nature of their fascial defects and the concomitant problem of extreme amounts of abdominal wall laxity. We reviewed a technique for surgical repair of incisional hernias combined with panniculectomy. METHODS: A retrospective review of 50 consecutive patients status post-open bariatric surgery who underwent incisional hernia repair with overlay mesh and combined panniculectomy between 2000 and 2003. RESULTS: Hernia repair and panniculectomy were performed 18 months after open bariatric surgery. The patients had an average weight loss of 58.6 kg. Mean follow-up after hernia repair and panniculectomy was 18 months. Patients underwent prefascial hernia repair with plication of the fascial edges followed by midline anchoring of overlay mesh. The averave amount of excess tissue excised via panniculectomy was 3,001 g. The average hospital stay was 4 days. Minor wound problems (eg, suture abscess, seroma) occurred in 20 patients. Seromas were treated with serial aspiration in the office. There were no intra-abdominal complications or recurrences of the incisional hernias. CONCLUSION: Closed hernia repair with prefascial plication and overlay mesh is a safe, effective alternative to traditional incisional hernia repair. It provides adequate hernia repair without recurrence and eliminates intra-abdominal complications. It is our belief that combining the hernia repair and panniculectomy minimizes the risk of hernia recurrence through alleviation of stress on the repair by removing excess abdominal wall tissue.     

Abdominal lipectomy and mesh repair of midline periumbilical hernia after bariatric surgery: How to spare the umbilicus

Background: Abdominal lipectomy is becoming an increasingly common surgical procedure in patients with esthetic deformities resulting from massive weight loss induced by bariatric surgery. Sometimes a midline incisional hernia coexists with the pendulus abdomen. Herein presented is a technique to perform a retromuscular mesh repair of the incisional hernia while sparing the umbilicus. Methods: The abdominal lipectomy with concomitant retro-muscular mesh repair of a midline incisional hernia is done sparing the vascular supply of the umbilicus on one side only. Results: 5 consecutive women with pendulus abdomen resulting from bariatric surgery-induced massive weight loss and concomitant midline incisional hernia underwent abdominal lipectomy and incisional hernia mesh repair. Mean BMI was 28.6 kg/m² (range 26–35), one patient was a smoker, and another had type 2 diabetes requiring oral hypoglycemic agents. Two patients had had a previous incisional hernia repair with intraperitoneal mesh. One patient had partial necrosis of the umbilicus and another experienced necrosis of only the epidermis that recovered fully. Conclusions: The umbilicus can be safely spared during abdominal lipectomy with concomitant midline incisional hernia mesh repair. Recurrent incisional hernia and common risk factors for wound healing such as diabetes and obesity increase the risk of umbilical necrosis.     

The partial underlay preperitoneal with panniculectomy repair for incisional abdominal hernia in the morbidly obese

BackgroundBecause of high frequency, high morbidity, and difficulty of repair, incisional hernias in obese patients represent a particularly vexing and common problem for surgeons. The objective of this study was to describe a highly selective technique for incisional hernia repair with panniculectomy in the morbidly obese. We also describe perioperative characteristics and preliminary outcomes for a limited series of patients who underwent this procedure.MethodsWe performed a preperitoneal partial mesh underlay with a panniculectomy (PUPP) on 10 patients with incisional hernias and a body mass index (BMI)>40 kg/m². The hernia repair was performed by a general surgery team, and the panniculectomy was performed by a plastic surgery team. We retrospectively analyzed perioperative variables for each patient. Phone interviews were conducted to obtain follow-up.ResultsMean patient age was 53 years (range 32–75 yr) with mean BMI of 46 kg/m² (range 41–60 kg/m²). Patients had a history of 3.4 average prior abdominal operations, and a median of 3 prior hernia repairs. The average operative time was 371 minutes with a mean estimated blood loss of 162 ccs. Three patients experienced a minor wound complication. There were no major wound complications, and the 30-day mortality rate was zero. At a median and average follow-up time of 805 and 345 days, respectively, one patient developed a hernia recurrence. Patients were satisfied with their appearance and the hernia repair, with mean satisfaction scores of 4.3 and 4.9 out of 5 (very satisfied), respectively.ConclusionThe PUPP hernia repair is a viable option for incisional herniorrhaphy and concurrent panniculectomy in the morbidly obese.     

Laparoscopic incisional hernia repair -- an alternative to the conventional procedure?

INTRODUCTION: Tension-free incisional hernia repair using alloplastic material increasingly replaces conventional repair techniques. The aim of the present study was to evaluate the early and long-term complications as well as patients' satisfaction. METHODS: Laparoscopic hernia repair with intraperitoneal mesh implantation (PTFE) was performed on 28 patients at the Klinikum Grosshadern between 2000 and 2003 (16 males, 12 females, average age 61.2). Intra- and postoperative complications were registered retrospectively. In addition, 25 patients were evaluated for recurrence, postoperative pain and patient contentment (median follow-up 383 days). RESULTS: A low complication rate was observed in our patient collective. One trocar bleeding occurred. 2 patients presented with wound hematoma. The recurrence rate was 8 % (2/25). 60 % of the patients were free of pain postoperatively. 88 % would once again choose the laparoscopic approach for incisional hernia repair. DISCUSSION: The laparoscopic technique was associated with a low recurrence rate, a small rate of wound infections and high patient comfort. Thus, the laparoscopic approach for mesh implantation appears to be a safe and effective method for the treatment of incisional hernias. The efficiency of laparoscopic intraperitoneal mesh implantation, however, should be evaluated within a prospectively randomized multicenter trial.     

Laparoscopic ventral hernia repair: an initial institutional experience

BACKGROUND: Ventral and incisional hernias remain a problem for surgeons with reported recurrence rates of 25-50% for open repairs. Laparoscopic approaches offer several theoretical advantages over open repairs. MATERIALS AND METHODS: All patients undergoing a laparoscopic ventral hernia repair from April to December 2000 were prospectively entered in a database. Patients underwent repair with expanded polytetrafluoroethylene dual mesh. Full-thickness abdominal wall nonabsorbable sutures and 5-mm tacks were placed circumferentially. RESULTS: Of 32 patients, 15 underwent incisional repair, 13 had repair of a recurrent incisional hernia, and 4 had repair of a primary abdominal wall defect. Two procedures [2/32; 6.3%] were converted to open, one for loss of abdominal domain and one for neovascularization due to cirrhosis. There were two early recurrences [2/30; 6.7%]. Both of these failures occurred in patients with hernia defects extending to the inguinal ligament, preventing placement of full-thickness abdominal wall sutures inferiorly. Average operating time was 128 +/- 42 min (range 37-225 min). Average length of stay was 1.8 days [range 0-7 days]. There were no transfusion requirements or wound infections. One patient underwent a small bowel resection after completion of repair. One patient required drainage of a seroma 4 weeks after the procedure. CONCLUSIONS: Laparoscopic ventral hernia repair can be safely performed with an acceptable early recurrence rate, operative time, length of stay, and morbidity. Securing the mesh with full-thickness abdominal wall sutures in at least four quadrants remains a key factor in preventing early recurrence.     

Operative Therapie der Narbenhernie

Secondary ventral hernia or incisional hernia occurs in at least 20?% of cases after laparotomy and most patients are symptomatic. The pathogenesis of incisional hernia is believed to be based on a defect in collagen synthesis indicating the necessity of covering the whole original incision with a non-resorbable, macroporous mesh. These meshes can be used on top of the fascia (onlay), in a retromuscular fashion (sublay) or intraperitoneally (IPOM). The IPOM technique is the preferred procedure during laparoscopic repair of ventral hernias. The clear advantage of the laparoscopic approach is the dramatically reduced rate of wound complications, especially infections. Major defects of the abdominal wall require plastic reconstruction with the component separation technique in both anterior and posterior approaches. The component separation technique must be combined with retromuscular mesh augmentation enabling a recurrence rate of less than 10 % and an acceptable morbidity to be achieved.     

肌后间隙修补法治疗腹壁切口疝患者的疗效

目的探讨肌后间隙修补法（Sublay）在腹壁切口疝患者治疗中的手术效果。 方法回顾性分析2015年1月至2017年8月,首都医科大学附属北京朝阳医院疝和腹壁外科107例行Sublay手术的腹壁切口疝患者的临床资料,分析患者的一般资料、手术方法、并发症及术后转归情况,随访其有无切口疝复发及补片相关并发症发生情况。 结果本组患者均顺利完成手术,平均手术时间（60.3±7.8）min,平均住院时间（17.6±5.3）d,所有患者术后恢复良好,2例患者出现脂肪液化,经换药后伤口愈合;1例患者出现皮下血肿,1例患者出现血清肿,经局部加压保守治疗后治愈,无伤口感染及局部异物感,无死亡患者。随访时间6～38个月,平均随访时间（22.7±10.8）个月,无切口疝复发,无死亡患者,无补片感染、慢性疼痛及局部异物感等补片相关并发症发生。 结论肌后间隙修补手术（Sublay）治疗腹壁切口疝结果满意,手术疗效较好。     

Incisional hernia treatment with progressive pneumoperitoneum and retromuscular prosthetic hernioplasty

BACKGROUND AND AIM: Major incisional hernias of the abdominal wall often pose a serious surgical problem. The choice between simple suture repair and mesh repair remains uncertain. METHODS: Seventy-seven patients underwent surgery to repair large abdominal incisional hernias, i.e., with parietal defects of 10 cm or more, by retromuscular prosthetic hernioplasty between 1996 and 1999. All patients were treated preoperatively by progressive pneumoperitoneum and were followed up for 2-5 years (mean 38.3 months). RESULTS: Almost all patients tolerated the pneumoperitoneum; no postoperative death occurred. Six patients developed a subcutaneous infection but none of them required removal of the mesh. Two patients (2.6%) had recurrent incisional hernia. CONCLUSIONS: This study shows that pneumoperitoneum is useful in preparing patients for incisional hernioplasty. Retromuscular mesh repair represents an appropriate surgical procedure, particularly in view of its low rate of recurrence.     

Retrofascial mesh repair of ventral incisional hernias

BACKGROUND: Recurrence rates after ventral incisional hernia repair are reported to be as high as 33% and are associated with considerable morbidity and lost time. The purpose of this study was to determine if retrofascial mesh placement reduces the incidence of recurrence as well as the severity of wound infections. METHODS: A prospective database covering the period from January 1995 to June 2003 was maintained. All patients underwent a standardized technique by a single surgeon. Polypropylene mesh was placed between the fascia and the peritoneum with the fascia closed over the mesh. RESULTS: There were 150 patients (126 women, 24 men) with a mean age of 55 years. Their average weight was 88 kg, with an average body mass index of 32. Sixty-three (42%) of the hernias were recurrences of a previous repair. The average size of the hernia was 8 x 14 cm. There was 1 postoperative mortality. There was a 9% postoperative infection rate with 2 patients (1%) requiring mesh removal. Long-term follow-up evaluation has revealed 3 recurrences (2%) and 3 readmissions for bowel obstruction with 1 patient requiring surgical release. There were no fistulas noted. CONCLUSIONS: Incisional hernia repair with mesh placed in the retrofascial position decreases both the risk for recurrence and the severity of wound infection without significant problems from bowel obstruction or enteric fistula.     

Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia

OBJECTIVE: The objective of this study was to determine the best treatment of incisional hernia, taking into account recurrence, complications, discomfort, cosmetic result, and patient satisfaction. BACKGROUND: Long-term results of incisional hernia repair are lacking. Retrospective studies and the midterm results of this study indicate that mesh repair is superior to suture repair. However, many surgeons are still performing suture repair. METHODS: Between 1992 and 1998, a multicenter trial was performed, in which 181 eligible patients with a primary or first-time recurrent midline incisional hernia were randomly assigned to suture or mesh repair. In 2003, follow-up was updated. RESULTS: Median follow-up was 75 months for suture repair and 81 months for mesh repair patients. The 10-year cumulative rate of recurrence was 63% for suture repair and 32% for mesh repair (P < 0.001). Abdominal aneurysm (P = 0.01) and wound infection (P = 0.02) were identified as independent risk factors for recurrence. In patients with small incisional hernias, the recurrence rates were 67% after suture repair and 17% after mesh repair (P = 0.003). One hundred twenty-six patients completed long-term follow-up (median follow-up 98 months). In the mesh repair group, 17% suffered a complication, compared with 8% in the suture repair group (P = 0.17). Abdominal pain was more frequent in suture repair patients (P = 0.01), but there was no difference in scar pain, cosmetic result, and patient satisfaction. CONCLUSIONS: Mesh repair results in a lower recurrence rate and less abdominal pain and does not result in more complications than suture repair. Suture repair of incisional hernia should be abandoned.     

腹壁切口疝补片修补术后复发的再手术治疗

目的总结腹壁切口疝补片修补术后复发再次手术治疗的经验。方法回顾性分析我院2007年1月至2010年12月期间收治的16例腹壁切口疝补片修补术后复发再次手术患者的资料。结果所有患者均再次采用补片进行修补,其中13例除去旧补片置入新补片修补,2例新补片与原补片重叠并扩大范围修补,1例在原补片上直接重叠新补片修补。术后所有患者切口均Ⅰ期愈合,3例发生补片上方积液,经穿刺加压后治愈。术后住院时间7～16 d,平均9 d。术后引流管拔除时间2～7 d,平均4 d。所有患者均获随访,随访时间5～36个月,平均20个月,1例有轻微腹壁异物感,无修补区慢性疼痛,无疝复发。结论补片修补术后复发性切口疝再次手术时需综合考虑复发疝的位置以及既往选用的补片类型和修补方法,再次手术需选用合适的补片及修补方法方可取得满意效果。     

Narbenhernie – Wie ist zu verfahren?

Various techniques for repair of an incisional hernia are available for the surgeon. Conventional suture techniques are quick and easy to perform but they are associated with an unacceptable rate of recurrence and therefore should only be used in exceptional cases. An underlying systemic disturbance of collagen metabolism is assumed to exist in patients with an incisional hernia. In such patients the mechanisms of wound healing and remodeling of the abdominal wall following laparotomy are insufficient, which necessitates reinforcement of the abdominal wall with a non-resorbable alloplastic mesh prosthesis to enable a long-term cure. The implantation of such meshes can be carried out laparoscopically or by an open approach. The gold standard of open repair techniques is the retromuscular placement of a mesh prosthesis. The retromuscular mesh placement as a reinforcement of the abdominal wall (augmentation) must be categorically differentiated into the abdominal wall replacement by mesh bridging. In this technique the mesh is likewise placed in the retromuscular space, however a complete closure of the ventral fascia is not necessary. Retromuscular augmentation enables an extra-peritoneal placement of the prosthesis, an optimization of tissue integration by plane coverage of the prosthesis by well vascularized muscular tissue and a sufficient overlap in cranio-caudal and lateral directions. Mesh fixation is best made with absorbable suture material but is better suited for technical simplification. The use of a prophylactic drainage should be decided depending on the individual patient’s risk factors, because sufficient evidence-based data are currently not available. If augmentation is not possible bridging is necessary and then the mesh has to be fixed without underlying support. Current data reveal that the recurrence rate following incisional hernia repair by retromuscular mesh augmentation has decreased promisingly in comparison to simple suture techniques. In total the recurrence rate following retromuscular mesh placement ranges between 2 and 12%. Current results of prospective randomized multicentre trials are not available. However, it is to be expected that further development of mesh materials as well as improvement of surgical techniques with avoidance of typical pitfalls will lead to further reduction of the recurrence rate with an improvement in patient satisfaction.     

GS05SINGLE SURGEON EXPERIENCE WITH RETROMUSCULAR (PREPERITONEAL) MESH REPAIR OF INCISIONAL AND VENTRAL HERNIAS

Objective Repair of incisional (and large ventral) abdominal hernias pose a challenge for many surgeons. Numerous techniques have been described. This series reports a single surgeon’s experience using the retromuscular (pre‐peritoneal) mesh repair technique. Method Data was collected on 70 consecutive incisional (n = 23) and ventral (n = 47) hernia repairs using retromuscular (pre‐peritoneal) lightweight polypropylene mesh. Results The median follow‐up was 26 months (range 10 – 66 months). Overall recurrence rate was 1.4%. There were seven major (10%) and four minor (7%) post‐operative infections. One patient developed post‐operative seroma requiring percutaneous aspiration, and one patient had chronic pain. Conclusion Retromuscular mesh repair is a good alternative to traditional onlay mesh repairs. Morbidity and outcomes are acceptable and comparable with literature, with lower rates of seroma formation and hernia recurrence.     

肌后筋膜前补片植入手术治疗腹壁切口疝28例临床分析

目的：探讨应用肌后筋膜前补片植入手术（retromuscular prefascial,Sublay）修补法对腹壁切口疝的治疗。方法：2002年1月-2009年7月应用聚丙烯补片修补切口疝28例,其中男10例,女18例,年龄47～78岁,平均年龄65.2岁。疝环直径3～28cm,平均15.5cm。均采用肌后筋膜前补片植入手术修补法。结果：全部患者顺利完成手术,无严重并发症,手术时间75～140min,平均100min,术后住院时间9～21d,平均12.8d,随访3～60个月,平均35个月,无肠梗阻,无复发。结论：应用聚丙烯补片肌后筋膜前补片植入手术修补法修补切口疝是一种安全、有效的方法。     

Retromuskuläre Netzplastik in Deutschland

Since the onset of an incisional hernia is caused by the biological problem of forming stable scar tissue, the mesh techniques are now the methods of choice for incisional hernia repair. Polypropylene is the material most widely used for open mesh repair. New developments have led to low-weight, large-pore polypropylene prostheses, which have been adapted to the physiological requirements of the abdominal wall and permit a reliable tissue integration. These meshes make it possible for a scar net to form rather than a stiff scar plate, thus helping to avoid the complications encountered with the use of earlier meshes. The ideal position for the mesh seems to be the retromuscular underlay position, in which the force of abdominal pressure holds the prosthesis tightly against the deep surface of the muscles. The retromuscular underlay repair technique has yielded the lowest incidence rates for recurrence: around 10% even after long-term follow up. Analysis of the failures after open mesh repair suggests that inadequate size of the mesh with insufficient overlap at the edges is the main reason for recurrence. An overlap of at least 5–6 cm all round must therefore be considered mandatory for successful reinforcement of the abdominal wall. Open mesh repair, particularly with modern low-weight polypropylene meshes applied by the retromuscular underlay technique, offers excellent results in the treatment of incision hernias, even in long-term follow-up studies.     

Laparoscopic mesh repair of incisional hernia: an alternative to the conventional open repair?

Background Tension-free incisional hernia repair using alloplastic material increasingly replaces conventional repair techniques. This change resulted in a decreased recurrence rate (50% vs. 10%, respectively). Recently, laparoscopic approaches for the intraperitoneal tension-free mesh application have been introduced. The decreased trauma at the incision site and the reduction in wound infections appear to be the main advantages. The aim of the present study was to evaluate the early and long-term complications as well as patients’ contentment. Methods Laparoscopic hernia repair with intraperitoneal polytetrafluroethylene (PTFE) mesh implantation was performed on 62 patients at the Klinikum Grosshadern between 2000 and 2005 (29 males, 33 females age 60.7). Intra- and postoperative complications were registered prospectively and retrospectively analyzed. In addition, 57 patients were evaluated for recurrence, postoperative pain and patient contentment (median follow-up 409 days). Results A low complication rate was observed in our patient collective. One trocar bleeding occurred. Three patients presented with wound hematoma. The recurrence rate was 8% (2/25). Sixty-two percent of the patients were free of complaints postoperatively. Eighty-five percent would once again choose the laparoscopic approach for incisional hernia repair. Conclusion The laparoscopic technique was associated with a low recurrence rate, a small rate of wound infections and high patient comfort. Thus, the laparoscopic approach for mesh implantation appears to be a safe and effective method for the treatment of incisional hernias. The efficiency for laparoscopic intraperitoneal mesh implantation, however, should be further evaluated within a prospectively randomized multicenter trial. M. Stickel and M. Rentsch contributed equally.     

Concurrent Gastric Bypass and Repair of Anterior Abdominal Wall Hernias

Background: Many patients seeking surgical treatment for morbid obesity present with anterior abdominal wall hernias. Although principles of hernia repair involve a tension-free repair with the use of prosthetic mesh, there is concern about the use of mesh in gastric bypass surgery due to potential contamination with the contents of the gastrointestinal tract and resultant mesh infection. We report our series of patients undergoing Roux-en-Y gastric bypass (RYGBP) and simultaneous anterior abdominal wall hernia repair. Methods: All patients who underwent simultaneous RYGBP surgery and anterior abdominal wall hernia repair were reviewed. Results: 12 patients underwent concurrent RYGBP and anterior wall hernia repair. There were 5 women and 7 men with average age 54.9 ± 8.5 years (range 35 to 64) and average body mass index (BMI) 50.4 ± 10.3 kg/m² (range 38 to 70). Two open and 10 laparoscopic RYGBP operations were performed. Nine patients (75%) underwent incisional hernia repairs and 3 patients (25%) underwent umbilical hernia repair concurrent with gastric bypass. Average size of defect was 14.7 ± 13.4 cm². One patient had primary repair and 11 patients had prosthetic mesh repair: polypropylene in 3 patients (25%) and polyester in 8 patients (67%). With a 14.1 ± 9.3 month follow-up, there have been no mesh infections and 2 recurrences, one in the patient who underwent primary repair and one in a patient repaired with polyester mesh but with two previous failed incisional hernia repairs. Conclusion: Concurrent RYGBP and repair of anterior abdominal wall hernias is safe and feasible. In order to optimize success, tension-free principles of hernia repair with the use of prosthetic mesh should be followed since no mesh infections occurred in our series.     

Porcine dermal collagen (Permacol) for abdominal wall reconstruction

OBJECTIVE: A review of Eisenhower Army Medical Center's experience using Permacol (Tissue Science Laboratories, Covington, Georgia) for the repair of abdominal wall defects. METHODS: Retrospective review of medical records of patients undergoing abdominal wall reconstruction with Permacol. RESULTS: From July 30, 2003 to February 12, 2005, 9 patients underwent repair of complicated fascial defects with Permacol. Indications for surgery included reoperative incisional hernia repair after removal of a infected mesh (3 patients), reconstruction of a fascial defect after resection of an abdominal wall tumor (2 patients), incisional hernia repair in a patient with a previous abdominal wall infection after a primary incisional hernia repair (1 patient), incisional hernia repair in a patient with an ostomy and an open midline wound (1 patient), emergent repair of incisional hernia with strangulated bowel and multiple intra-abdominal abscesses (1 patient), and excision of infected mesh and drainage of intra-abdominal abscess with synchronous repair of the abdominal wall defect (1 patient). At a median follow-up of 18.2 months, 1 recurrent hernia existed after intentional removal of the Permacol. This patient developed an abdominal wall abscess 7 months after hernia repair secondary to erosion from a suture. Overall, 1 patient developed exposure of the Permacol after a skin dehiscence. The wound was treated with local wound care, and the Permacol was salvaged. Despite the presence of contamination (wound classification II, III, or IV) in 5 of 9 patients (56%), no infectious complications occurred. CONCLUSION: Complex reconstruction of the abdominal wall can be associated with a high complication rate. Placement of a permanent prosthetic mesh in a contaminated field is associated with a high rate of wound infections and subsequent mesh removal. Permacol becomes incorporated by tissue ingrowth and neovascularization. Permacol is a safe and acceptable alternative to prosthetic mesh in the repair of complicated abdominal wall defects.     

Combined prosthetic incisional hernioplasty and panniculectomy—a 5-year single-centre experience

Background

Ventral incisional hernia patients develop limitation in physical activities as the hernia enlarges, leading to alteration in their lifestyle, quality of life, aesthetic deformities, and occasionally to complications. Cosmetic improvement of the abdomen, an important objective of hernia repair, can be achieved when hernia repair is combined with panniculectomy. The authors undertook this study to review their experience of the integration of hernia repair and panniculectomy to improve the understanding and treatment of this condition.

Methods

A retrospective analysis of the records of patients who underwent abdominal hernia repair with panniculectomy from 2005 to 2010 was undertaken. The records were reviewed for patient demographics, hernia etiology, risk factors for recurrence, previous surgeries, previous approach, type of repair, incision approach, complications, length of hospital stay, and duration of follow-up. Surgical management included mesh hernia repair and pannus excision.

Results

Of the total 45 patients, mean age was 42.37 years and mean follow-up was 24.4 months. Twelve patients had recurrent hernias. Most of the patients underwent retrorectus underlay mesh repair [39 (86.67 %)], while 6 (13.33 %) underwent onlay mesh technique. Six (13.33 %) patients developed minor skin necrosis, while one (2.22 %) had skin flap necrosis requiring debridement and skin grafting, three (6.67 %) hernias recurred, one (2.22 %) had seroma formation, and one (2.22 %) developed sacral pressure sore.

Conclusion

This technique provides both functional and aesthetic benefits and generally meets the needs of the patients. It is safe, with a low risk of postoperative complications. Level of Evidence: Level IV, therapeutic study.     

Late results of mesh wound closure after elective open aortic aneurysm repair.

INTRODUCTION: Incisional hernia is a common late complication after abdominal aortic aneurysm (AAA) repair. We examined the outcome after prophylactic placement of a pre-peritoneal polypropylene mesh during abdominal closure in consecutive patients having elective AAA repair. REPORT: At least 30 months after surgery, 28 patients underwent clinical and ultrasound examination of their surgical wound for incisional hernias. Only one patient had a hernia in the original surgical scar. No patients had late mesh-related wound problems. DISCUSSION: Pre-peritoneal polypropylene mesh placement is a simple, safe and effective method to decrease the incidence of incisional hernia after AAA repair.