Hernia : the journal of hernias and abdominal wall surgery
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Comparative Study
Low recurrence rate of a two-layered closure repair for primary and recurrent midline incisional hernia without mesh.
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. ⋯ 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.
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Randomized Controlled Trial Comparative Study
Incisional hernia after upper abdominal surgery: a randomised controlled trial of midline versus transverse incision.
To determine whether a transverse incision is an alternative to a midline incision in terms of incisional hernia incidence, surgical site infection, postoperative pain, hospital stay and cosmetics in cholecystectomy. Incisional hernias after midline incision are commonly underestimated but probably complicate between 2 and 20% of all abdominal wall closures. The midline incision is the preferred incision for surgery of the upper abdomen despite evidence that alternatives, such as the lateral paramedian and transverse incision, exist and might reduce the rate of incisional hernia. A RCT was preformed in the pre-laparoscopic cholecystectomy era the data of which were never published. ⋯ In light of our results a transverse incision should, if possible, be considered as the preferred incision in acute and elective surgery of the upper abdomen when laparoscopic surgery is not an option.
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A rare case of transverse testicular ectopia (TTE) in a 3-year-old child presenting to the department as bilateral undescended testis along with inguinal hernia is described. The patient was misdiagnosed at a peripheral health centre as a case of inguinal hernia and intersex. As TTE in such a condition is very uncommon, hence, it is being reported with a brief review of the relevant literature.
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Randomized Controlled Trial
Prophylactic prosthetic reinforcement of midline abdominal incisions in high-risk patients.
Incisional hernia is one of the major elements of morbidity after abdominal surgery, with high incidence in vertical midline abdominal incisions. However, the risk of developing an incisional hernia can be increased due to the patient's related factors; therefore, more consideration has to be given to the choice of incision, wound closure and wound healing to protect against incisional hernia, especially in high-risk patients. In this study, we used prophylactic subfascial non-absorbable mesh reinforcement of midline closure in high-risk patients to detect whether fixing the wound with mesh is risky on a short-term basis and whether it is protective on a long-term basis. ⋯ Prophylactic subfascial non-absorbable mesh reinforcement of midline closure in high-risk patients can be used safely and effectively to provide extrinsic strength of the wound without relying too much on the defective development of its own intrinsic strength and to prevent subsequent incisional hernia. There was no risk in the use of the mesh regarding local and systemic complication. However, the final statement should await the outcomes of the long-term follow up of the studied cases.
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Randomized Controlled Trial Multicenter Study
Prolene Hernia System, Lichtenstein mesh and plug-and-patch for primary inguinal hernia repair: 3-year outcome of a prospective randomised controlled trial. The BOOP study: bi-layer and connector, on-lay, and on-lay with plug for inguinal hernia repair.
Dissection requirements differ between various methods for inguinal hernia repair, which may affect operation times, pain response and possibly recovery time. The objectives of this study were to establish if any differences concerning these aspects could be detected following three principally different techniques for primary inguinal hernia repair. ⋯ All of the techniques are suitable for operation under local anaesthesia. The PHS and P techniques can be performed with shorter operation times than the L method. Early and late outcomes are, however, comparable, with no significant differences concerning complication rates, return to full functional status and/or pain response.