| Title |
Pooperacinių pilvo sienos išvaržų plastika alotransplantatu / |
| Translation of Title |
Incisional ventral hernia repair by alloplastic mesh. |
| Authors |
Tamulis, Sigitas ; Stanaitis, Juozas ; Gaidamonis, Edmundas Vladas ; Lunevičius, Raimundas |
| DOI |
10.15388/LietChirur.2003.1.2439 |
| Full Text |
|
| Is Part of |
Lietuvos chirurgija.. Vilniaus universiteto leidykla. 2003, t. 1, Nr. 1, p. 32-43.. ISSN 1392-0995. eISSN 1648-9942 |
| Keywords [eng] |
postoperative ventral hernia ; hernia repair ; synthetic mesh ; complications ; recurrent hernia |
| Abstract [eng] |
Background / objective Factors strongly associated with all types of postoperative complications after implantation of synthetic mesh due to postoperative (incisional) ventral hernia have not yet been determined definitely. Therefore, the aim of this study was to evaluate early results, hernia recurrence rate and the factors that might be associated with early as well as late postoperative complications. Methods There were 221 patients operated on for postoperative abdominal wall hernia in Vilnius University Emergency Hospital during 2000–2002. Synthetic mesh was inserted in 82 (37%) of patients. Age, sex, the size of the hernia according to Stoppa classification, the type of the biomaterial, the position of the mesh, antibiotic prophylaxis, wound drainage were considered as the factors that might influence early postoperative complications and hernia recurrence rate. Results Early postoperative complications were detected in nine patients (11%): wound seromas – in 5 (6.1%), wound infection – in 2 (2.4%), postoperative infiltration without puss collection – in one (1.2%). The overall rate of infectious complications was 3.6%. Relatively more numerous postoperative local wound complications were observed in cases of the Stoppa grade III postoperative hernia (16% versus 9.7%). Antibiotic prophylaxis reduced the postoperative infection complication rate (2.8% with antibiotics versus 9.1% without antibiotics). The postoperative complication rate in cases of Prolene mesh implantation was by 5.1% lower than with Mersilene mesh. Wound drainage reduced the postoperative local wound complication rate by 7.5%. However, no factors were strongly associated with early postoperative complications. Overall hernia recurrence rate was 10.9%. There were 4.5 times more recurrences in patients younger than 60 years. The recurrence rate in male was 2.4 times higher than in female. Recurrent postoperative hernias occurred by 3.6% more frequently than after first time operated incisional hernias. The recurrence rate in cases of Stoppa I–II grade of hernia was 22.7% versus 0 in cases of Stoppa grade III–IV (p < 0.05). The proportion of recurrences in cases of Prolene and Mersilene meshes was 18.75% and 6.9%. Antibiotic prophylaxis and wound drainage obviously reduced the recurrence rate (7.5% versus 33.3%, and 9.7% versus 20%, respectively). Conclusions Employment of alloplastic biomaterials four times reduced the recurrence rate, which after the “Sublay” implantation of mesh was 11%. Antibiotic prophylaxis reduced the rate of postoperative complications three times and the rate of recurrence four times. The type of the biomaterial (Prolene or Mersilene) had no influence on the local postoperative complication rate. The size of mesh must be sufficient to replace the musculoaponeurotic defect and by 5 cm should overlap the musculoaponeurotic tissue. Drainage of the wound prevented seroma formation. Hernia recurrences are more frequent in male population aged under 60 years. The size of hernia was a statistically proven factor associated with a higher recurrence rate. This is probably associated with implatation of too small pieces of Prolene mesh. |
| Published |
Vilniaus universiteto leidykla |
| Type |
Journal article |
| Language |
Lithuanian |
| Publication date |
2003 |
| CC license |
|
