Surgical Treatment of Large Contaminated Abdominal Wall Defects

Geffen, H. J. A. A. van; Simmermacher, R. K. J.; Vroonhoven, Theo J. M. V. van; Werken, Christiaan van der

doi:10.1016/j.jamcollsurg.2005.03.030

Cited by 69 publications

(38 citation statements)

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“…The correction of incisional hernias by primary suture of the musculoaponeurotic edges of the defect is related to a high recurrence rate 4 . This fact is largely due to excess tension in the suture line.…”

Section: Discussionmentioning

confidence: 99%

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Mapping traction strength of the anterior rectus sheath in cadaver

et al. 2010

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Purpose:The tension at the aponeurotic edges of abdominal wall defects is an important factor of dehiscence and incisional hernia formation. The purpose of this study is to map and compare the traction force necessary for medial mobilization in various levels of the anterior rectus sheath in cadavers. Methods: Twenty four adult male cadavers, raging from 22 to 59 years old, with the abdominal wall intact and without prior preservation techniques, were dissected. A complete excision of the linea alba was performed. Traction loops of 10 mm in diameter were made in the anterior rectus sheath and were placed: 2, 4, 6 and 8 cm below the lower edge of the umbilicus and 3, 6 and 9 cm above the upper edge of the umbilicus. Each loop was mobilized 10 mm in the medial direction, using an analog dynamometer. The values obtained in each level were compared using Friedman's analysis of Variance for p < 0.05. Results: The average traction values obtained at the various levels were compared and there was no statistical significant difference. Conclusion: There is no variation in tension along the whole extension of the anterior rectus sheath. Key words: Hernia, Ventral. Tensile Strength. Cadaver. RESUMO Objetivo:A tensão na margem da aponeurose de um defeito da parede abdominal é um importante fator de deiscência e formação da hérnia incisional. O objetivo deste estudo é mapear e comparar a força de tração necessária à mobilização medial em vários níveis da lâmina anterior do músculo reto do abdome em cadáveres. Métodos: Vinte e quatro cadáveres adultos masculinos, com idade entre 22 e 59 anos, com a parede abdominal intacta e sem técnicas prévias de conservação, foram dissecados. Uma excisão completa da linha alba foi realizada. Alças de tração de 10 mm de diâmetro foram realizadas na lamina anterior do músculo reto do abdome e estavam localizadas: 2,4,6 e 8 cm abaixo da margem inferior do umbigo e 3,6 e 9 cm da margem superior do umbigo. Cada alça foi mobilizada 10 mm em direção medial, usando um dinamômetro analógico. Os valores obtidos em cada nível foram comparados usando a analise de variância de Friedman com p < 0,05. Resultados: Os valores de tração obtidos nos vários níveis foram comparados e não apresentaram significância estatística. Conclusão: Não há variação de tensão por toda lamina anterior do músculo reto do abdome. Descritores: Hérnia Ventral. Resistência à Tração. Cadaver.

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Section: Discussionmentioning

confidence: 99%

“…Laparotomy is one of the most common surgical procedures in medical practice [1][2][3][4][5][6] . Median incision is the main access to the abdominal cavity.…”

Section: Introductionmentioning

confidence: 99%

Mapping traction strength of the anterior rectus sheath in cadaver

et al. 2010

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“…2 Modifikationen der CS mit ihren Besonderheiten. Als weitere exemplarisch angeführ-te, netzfreie Modifikation wird hier noch die "open-book"-Variation von Ennis et al [19] vorgestellt, wobei die vorderen Blätter der Rektusscheiden nahe der Linea semilunaris längs durchtrennt und nach innen geschlagen und in der Mittelinie im Sinne einer Fasziendoppelung vernäht werden, wobei an 10 Patienten Mittelinienverschlüsse erreicht wurden, die z. T. 20 cm Defektbreite überstiegen [28]. Wir würden bei dieser Technik doch ein klinisch relevantes "bulging", also Protrusionen der Rektusmuskulatur, befürchten.…”

Section: Modifizierende Techniken Der Komponentenseparationunclassified

Die Komponentenseparation zum Verschluss komplexer Bauchwandhernien: Entwicklung einer Technik von 1990 bis heute

et al. 2014

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“…8) and finally attempting definitive reconstruction; or (ii) in a one-stage operation using the components' separation method. 52,53 The adoption of either of these methods, however, requires advanced skills in abdominal wall reconstruction and should only be undertaken by skilled teams of surgeons.…”

Section: Contaminated Woundsmentioning

confidence: 99%

The Management of Incisional Hernia

Kingsnorth

2006

annals

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Ann R Coll Surg Engl 2006; 88: 252-260 252Medline and Embase were searched using the search terms 'hernia' and 'incisional' alone and in combination. Publications were selected mostly in the past 5 years, but did not exclude commonly reference and highly regarded older publications. The reference list of articles was also searched, identified by the search strategy and those selected that were relevant. Selected review articles and metaanalyses were included because they provide comprehensive overviews that may be beyond the scope of this article. OverviewThe introduction of prosthetic mesh revolutionised the treatment of groin hernia but, to date, has had little impact on the treatment of incisional hernia.1 The risk factors for the development of incisional hernia include obesity, diabetes, emergency surgery, postoperative wound dehiscence, smoking and postoperative wound infection. 2,3The risks of repairing an incisional hernia which should be explained to the patient when obtaining consent include seroma formation, wound infection, injury to intraabdominal structures and recurrence. 4 Major complications which can occur in repair of large incisional hernias include mesh infection and enterocutaneous fistula which may result in prolonged morbidity and require re-operation (Fig. 1). It is now accepted that only the smallest (less than 3 cm) incisional hernias should be repaired with primary tissue approximation with sutures and this topic will not be discussed further.5 Small incisional hernias with time develop into larger incisional hernias due to the continuous presence of intra-abdominal hydrostatic pressure of 15 cm of water, diaphragmatic contractions occurring with respiration, increases in abdominal pressure occurring with coughing and straining realising pressures of over 80 cm of water and myofascial retraction of the lateral muscles. As a result, the abdominal cavity contracts and the right of domicile for the herniated visceral mass is lost. 6 Due to several previous operations, many of these patients have poor-quality abdominal wall musculature which, coupled with multiple co-morbid medical problems, present a surgical and anaesthetic challenge.Surgeons appear to have a reluctance to operate on incisional hernias perhaps because of the poor general condition of the patients but perhaps also due to lack of knowledge of how to deal with the various defects occurring as a result of incisions of the anterior abdominal wall and the operative techniques required. For instance, although it is estimated that 13% of laparotomy incisions fail in The Netherlands, only 4% of patients undergoing a laparotomy will go through additional surgery to repair an incisional hernia.7 Suture repair is likely to produce results twice as bad as mesh repair and the current techniques that surgeons are using to repair incisional hernias with prosthetic mesh continue to yield recurrence rates of greater than 20%. Many thousand laparotomy incisions are created each year and the failure rate for closure of these abdominal wou...

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Surgical Treatment of Large Contaminated Abdominal Wall Defects

Cited by 69 publications

References 34 publications

Mapping traction strength of the anterior rectus sheath in cadaver

Mapping traction strength of the anterior rectus sheath in cadaver

Die Komponentenseparation zum Verschluss komplexer Bauchwandhernien: Entwicklung einer Technik von 1990 bis heute

The Management of Incisional Hernia

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