Repair of a large abdominal wall incisional hernia is a difficult surgical problem with recurrence being a common complication. In addition, other complications such as hematomas, seromas, and sinus formation result from the use of foreign material. A new technique to obviate these complications was used in 60 patients with large incisional hernias repaired over the last 15 years. Marlex polypropylene mesh was used for repair, sandwiched between 2 layers of peritoneum of the overstretched hernia sac. There was no operative mortality and no recurrence in follow up from 3 years to 7 years. Postoperative complications encountered could be managed conservatively, without necessitating any major surgical procedure or mesh removal.

Loss of abdominal wall substance is a major cause of incisional hernia formation. It makes repair of this iatrogenic human ailment a difficult surgical problem. The abdominal wall substance loss has compelled the world's surgical community dealing with this condition to substantiate the repair with extra material such as skin, fascia, wire mesh, and lately biocompatible synthetic mesh. Even though the synthetic mesh is compatible and well tolerated by body tissues, it is not without complications. Regenerative repair in the region of the abdominal wall with substance loss is probably the best repair if it can be achieved. With reasonable success in animal experiments and the positive regenerative capacity of stem cells to transform the peritoneum into an aponeurotic layer, the new technique using a Marlex peritoneal sandwich for repair of large incisional hernias was attempted but was not reported in the article published in the World Journal of Surgery in 1991. The present study is based on experiments on seven mongrel dogs. A suitable embryonal segment of autogenous peritoneum was excised and transferred to the rectus sheath region. The gross appearance of the grafted membrane 3 months after operation revealed tough, thick tissue formation. The histology confirmed the presence of collagen fiber tissue in layers similar to the aponeurosis in the grafted peritoneal membrane. The use of this regeneration in the Marlex peritoneal sandwich technique of repair of large incisional hernias and the scientific rationale of tissue regeneration by desired metaplasia is discussed.

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INTEREST in the radiographic visualisation of the distal spermatic tract described as vaso-seminal vesiculography has varied during the past six decades. Belfield in 1913 first attempted radiography of the spermatic tract by cannulation of the vas deferens. Peruretheral catheterisation of the ejaculatory ducts for therapeutic purposes and for seminal-vesiculography was popularised by McCarthy and Ritter (1927). During the next two decades, several workers modified the technique of vaso-seminal vesiculography and advocated its use in the study of congenital and inflammatory lesions of the spermatic tract. With the advent of antibiotics and successful treatment of gonococcal urethritis and tuberculosis the incidence of prostato-vesiculitis diminished considerably. Consequently the indications and the need for vaso-seminal vesiculography did not arise so frequently. The technical difficulties in catheterisation of the ejaculatory ducts and its complications further discouraged its use.In the early 1950's several Latin-American and Scandinavian workers revived this procedure by cannulation of the vas deferens through a vasotomy. Pereira (1953) from Brazil discussed in detail the anatomical variations and changes in the spermatic tract induced by pathological lesions like tuberculosis, congenital anomalies and prostatic disease. Gerner-Smidt (1958), Vestby (1958) from Scandinavia, and other continental urologists pointed out the role of vasoseminal vesiculography as an adjunct to other methods of differentiating carcinoma from benign hyperplasia of the prostate. Nylander et al. (1961) described the results in congenital lesions like cryptorchism and testicular aplasia and, in addition, inflammatory lesions and prostatic enlargement. These authors advocated its use in congenital and inflammatory lesions but did not find it useful in differentiating carcinoma from benign hyperplasia of the prostate.The limitations and pitfalls encountered in conventional methods of diagnosing carcinoma of the prostate on the basis of the findings of rectal examination, X-ray, serum acid phosphatase estimation and biopsy are widely appreciated. The work of these Scandinavian workers stimulated urologists elsewhere to undertake vaso-seminal vesiculography at the time of routine vasligation as a prelude to prostatic surgery. Elliot et al. (1964) and Fetter and his co-workers (1962) described the results of their findings from the United States. Similar studies were made in certain centres in India (Khashu, 1966;Prasad and Kataria, 1966; Saha, 1966).A review of the reported series reveals conflicting opinions regarding its role in differentiating carcinoma and benign hyperplasia of the prostate. While Vestby reported 90 per cent positive results in carcinoma of the prostate, other observers failed to obtain more than 70 to 80 per cent positive results. Further, there is lack of unanimity regarding the criteria used for the various studies, and conclusions have apparently been drawn on the basis of limited data. In the present series an a...