Classification and surgical treatment of incisional hernia

Korenkov, Michael; Paul, Andreas; Sauerland, Stefan; Neugebauer, E.; Arndt, M.; Chevrel, J. P.; Corcione, Francesco; Fingerhut, Abe; Jb, Flament; Kux, M.; Matzinger, A.; Myrvold, H. E.; Rath, Ana; Simmermacher, R. K. J.

doi:10.1007/s004230000182

Cited by 262 publications

(144 citation statements)

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“…In 2001, Korenkov et al 25 published the results of a randomized controlled trial of incisional hernia repair. Korenkov et al 25 concluded that suture repair of incisional hernia was safe and did not result in higher recurrence rates. However, the trial was discontinued due to the severity of mesh infections.…”

Section: Discussionmentioning

confidence: 99%

“…14 Unfortunately, there have not been randomized trials of incisional hernia repair since, and some authors have even suggested that there may still be a place for suture repair of incisional hernia. 15,24,25 Disconcerting data indicate that surgeons are still performing suture repair, in spite of clinical evidence. In 1997, in Germany, 85% of incisional hernias repairs was still performed without prosthetic mesh, 26 while in 1999, in Washington state, 35% of incisional hernias was repaired without mesh.…”

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confidence: 99%

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Long-term Follow-up of a Randomized Controlled Trial of Suture Versus Mesh Repair of Incisional Hernia

Burger¹,

Luijendijk²,

Hop³

et al. 2004

Annals of Surgery

1,391

807

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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 Ͻ 0.001). Abdominal aneurysm (P ϭ 0.01) and wound infection (P ϭ 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 ϭ 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 ϭ 0.17). Abdominal pain was more frequent in suture repair patients (P ϭ 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. (Ann Surg 2004;240: 578 -585)

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Long-term Follow-up of a Randomized Controlled Trial of Suture Versus Mesh Repair of Incisional Hernia

Burger¹,

Luijendijk²,

Hop³

et al. 2004

Annals of Surgery

1,391

807

View full text Add to dashboard Cite

show abstract

“…The results of repair techniques vary widely. High recurrence rates have been reported for suture techniques, whereas mesh placement can reduce recurrence (5)(6)(7)(8)(9)(10). In mesh repair, one of the most important problems is the placement of the mesh.…”

Section: Introductionmentioning

confidence: 99%

Randomized prospective comparison of long-term results of onlay and sublay mesh repair techniques for incisional hernia

Sevinç

Okuş

et al. 2018

Turk J Surg

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Objective: Incisional hernia is a significant problem after laparotomy, and there is still no consensus on an ideal treatment method. The aim of this study was to compare the results of onlay and sublay mesh repair techniques. Material and Methods:In this randomized prospective trial, 100 patients were divided into two groups: onlay and sublay groups. Recurrences were evaluated by performing a physical examination. Results:The median follow-up was 37.1 (26.6 to 46.5) months. In the onlay group, the mean operation time was significantly shorter. However, in terms of postoperative pain and wound complications, the sublay group had significantly better results. The recurrence rates were found to be similar in both groups (6% in the onlay group and 2% in the sublay group). Conclusion:In the treatment of incisional hernia, sublay mesh repair is superior to onlay mesh repair in terms of postoperative pain and wound complications. Both techniques have similar recurrence rates. Keywords:Incisional hernia, mesh repair, onlay, sublay INTRODUCTIONIncisional hernia is a significant complication after laparotomy; its incidence ranges between 10% and 20% (1-4). This common problem can result in bowel strangulation, pain, and enterocutaneous fistula, and it affects the quality of life. The results of repair techniques vary widely. High recurrence rates have been reported for suture techniques, whereas mesh placement can reduce recurrence (5-10). In mesh repair, one of the most important problems is the placement of the mesh. Some techniques are reported to be associated with particularly high rates of some complications, such as recurrence, wound infection, and fistula (11,12). In the literature, several studies compare mesh and suture repair techniques, open and laparoscopic repair techniques, and mesh type as well as the plane in which the mesh should be placed. Currently, there is no consensus regarding the abdominal plane in which the mesh should be placed (13).The aim of this study was to compare the early and late results of onlay and sublay mesh repair techniques. , an American Society of Anesthesiologists score (ASA) of 4, or severe pulmonary or cardiac disease were not included. The remaining patients who agreed to be involved and signed the informed consent form were randomized into two groups: onlay group and sublay group. After the initial evaluation, 100 patients were included and were randomized to each group by the closed envelope method. The patients' demographic data, BMI, diameter of fascial defects, operation time (from first incision to dressing), visual analog scale (VAS) scores at the second and 24 th hours, length of hospital stay, drain takeoff time, postoperative complications, and recurrences were recorded. The fascial defect diameter was measured intraoperatively and is presented in cm 2 . All operations were performed according to the elective standard. There were no emergency operations. MATERIAL AND METHODS Operative TechniqueAll operations were performed under general anesthesia, and no antibioti...

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“…2 Incisional hernia is defined as any abdominal wall gap with or without a bulge in the area of a postoperative scar perceptible or palpable by clinical examination or imaging. 3 More often than not the problem is recurrent and tests the abilities of even the most experienced surgeons. 4 Unlike other abdominal wall hernias, which occur through anatomical points of weakness, incisional hernias occur through a weakness at the site of abdominal wall closure.…”

Section: Introductionmentioning

confidence: 99%

Clinical study and management of incisional hernias: a prospective monocenter experience

2017

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Background: Incisional hernia is the most frequent postoperative complication following abdominal surgery. Several studies have shown that incisional hernias have different etiologies which are related to the patient, the surgical technique, the suture material, and experience of the surgeon. Aim of present study was to assess the magnitude of problem, analyse various factors leading to development of this condition, different modalities of treatment practiced, postoperative complications, various factors affecting surgical outcome in these patients. Methods: This prospective descriptive study was conducted in department of surgery at a tertiary care teaching hospital at Solapur, Maharashtra, India from January 2014 to December 2016. All the patients, regardless of age and gender, admitted with diagnosis of incisional hernia were included in the study. Depending upon the size of defect treatment was carried out. Postoperatively patients were followed up for detection of possible complications and their treatment. Results: Total 50 patients of incisional hernia were studied. Mean age was 46 years with male to female ratio 4.5:1 wound infection in the post-operative period was the commonest etiology noted followed by obesity. Conclusions: Wound infection following previous surgery was the most important risk factor associated with incisional hernia. The other risk factors were obesity and COPD. Polypropylene mesh repair is superior to anatomical repair as it has less recurrence. Deshmukh SN et al. Int Surg J. 2017 May;4(5):1657-1661 International Surgery Journal | May 2017 | Vol 4 | Issue 5 Page 1658 treatment of incisional hernia is still an unanswered problem. Keywords 9The introduction of prosthetic mesh revolutionised the treatment of groin hernia but, to date, has had little impact on the treatment of incisional hernia. 10 The present study entitled is undertaken to assess the magnitude of problem, analyse various factors leading to development of this condition and different modalities of treatment practiced, postoperative complications and their management, various factors affecting surgical outcome in these patients. METHODSAfter obtaining the institutional ethics committee approval, present prospective descriptive study was carried out in the department of surgery at a tertiary care teaching hospital at Solapur, Maharashtra, India. Present study was carried out for a period of 2 years (January 2014 to December 2016) on 50 patients. Inclusion criteria• All the patients of incisional hernia having age of 18 years and above18 years and less than 70 years, irrespective of sex, will be included in this study.• Both electively and emergency operated cases of incisional hernia will be included in this Exclusion criteria• Patients of incisional hernia with co-morbidities like abdominal malignancy, cirrhosis with end stage liver disease.• Pregnant patients with incisional hernia.• Patients less than 18 years and more than 70 years of age.• Patients with recurrent incisional hernia.On admission detailed his...

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Classification and surgical treatment of incisional hernia

Abstract: The management of incisional hernia is currently not standardised. In order to answer relevant questions of incisional hernia surgery, an international hernia register should be established.

Cited by 262 publications

References 33 publications

Long-term Follow-up of a Randomized Controlled Trial of Suture Versus Mesh Repair of Incisional Hernia

Long-term Follow-up of a Randomized Controlled Trial of Suture Versus Mesh Repair of Incisional Hernia

Randomized prospective comparison of long-term results of onlay and sublay mesh repair techniques for incisional hernia

Clinical study and management of incisional hernias: a prospective monocenter experience

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