Wound dehiscence: outcome comparison for sutured and mesh reconstructed patients

Petersson, P.; Montgomery, Agneta; Petersson, Ulf

doi:10.1007/s10029-014-1268-y

Cited by 21 publications

(40 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The aims of abdominal hernia surgery include repair of the abdominal defects, enforcement of the abdominal wall, and prophylaxis of recurrence. The primary repair of incisional and parastomal hernias has unacceptably high recurrence rate [ 12 , 13 ]. Mash repair can significantly decrease the abdominal tension and complication rate, and has been the first choice for the repair of abdominal hernias.…”

Section: Discussionmentioning

confidence: 99%

Repair of Concomitant Incisional and Parastomal Hernias Using a Hybrid Technique: A Series of 32 Patients

Zhu

Tian

et al. 2015

Med Sci Monit

View full text Add to dashboard Cite

Background:Concomitant incisional and parastomal hernias is a challenging condition. We used a hybrid technique of sublay and onlay to treat patients with this condition. Material/Methods:The clinical data of 32 consecutive patients treated from February 2008 to April 2014 for concomitant incisional and parastomal hernias were retrospectively reviewed. The mean diameter was 9 (range 4-13) cm of the incisional hernias, and 6 (range 4.5-8) cm of the parastomal hernias. Results:The mean operative time was 247 (range 220-290) min. The mean hospital stay was 20 (range 14-27) days. All surgical wounds healed by primary intention. Seven patients had postoperative seroma and were well managed with puncture and compression. All 32 patients were followed up for a mean of 48 (range 5-68) months. Four patients recurred with parastomal hernias and were treated with secondary surgery. No further recurrence occurred until the last follow-up. Conclusions:This hybrid technique of sublay and onlay is only suitable for the repair of complex incisional and parastomal hernias.

show abstract

Section: Discussionmentioning

confidence: 99%

Repair of Concomitant Incisional and Parastomal Hernias Using a Hybrid Technique: A Series of 32 Patients

Zhu

Tian

et al. 2015

Med Sci Monit

View full text Add to dashboard Cite

show abstract

“…The traditional repair methods consisted of primary closure by open suture techniques. However, these techniques are no longer recommended since they are related to high recurrence and wound dehiscence rates [6,7] that could eventually lead to evisceration, especially in the event of large defects [7]. The placement of mesh as an alternative technique in abdominal wall repair offers some advantages over the suture closure [8].…”

Section: Biomaterials In Abdominal Wall Repairmentioning

confidence: 99%

Biomaterial Implants in Abdominal Wall Hernia Repair: A Review on the Importance of the Peritoneal Interface

2019

View full text Add to dashboard Cite

Biomaterials have long been used to repair defects in the clinical setting, which has led to the development of a wide variety of new materials tailored to specific therapeutic purposes. The efficiency in the repair of the defect and the safety of the different materials employed are determined not only by the nature and structure of their components, but also by the anatomical site where they will be located. Biomaterial implantation into the abdominal cavity in the form of a surgical mesh, such as in the case of abdominal hernia repair, involves the contact between the foreign material and the peritoneum. This review summarizes the different biomaterials currently available in hernia mesh repair and provides insights into a series of peculiarities that must be addressed when designing the optimal mesh to be used in this interface.

show abstract

“…A deiscência total envolve todas as camadas da ferida operatória. Nesse caso, as vísceras podem ser exteriorizadas da cavidade abdominal (evisceração) ou ficar contidas (evisceração contida) [7][8][9] . A deiscência parcial envolve uma ou mais camadas da ferida operatória e pode ser subclassificada da seguinte forma 6,10 :…”

Section: Conceitos Iniciaisunclassified

“…A incidência de deiscência da aponeurose varia entre 0,4% e 3,5% na população geral submetida a laparotomia mediana. No entanto, em pacientes de alto risco para o evento, submetidos a cirurgia de emergência, a incidência aumenta, variando de 12,3% a 14,9% 7,9,13,16,17,23,[27][28][29] . A deiscência da aponeurose é considerada uma complicação grave, associada a elevada mortalidade no período perioperatório, cujas taxas variam entre 3% e 35% 18,23,26 .…”

Section: Conceitos Iniciaisunclassified

“…Nas décadas de 1970 e 1980, o uso de tela para reforço da ressutura da parede abdominal após DA era considerado uma atitude "heroica e extrema" 22,145 , mas a tendência atual é que sua utilização seja cada vez mais frequente. Nessas circunstâncias, a tela está associada a maior número de ocorrências de sítio cirúrgico (SSO), mas também resulta em baixa reincidência de deiscência da aponeurose e redução de índices de hérnia incisional, sendo assim recomendada 9,11,12,18,140 16,28,29 .…”

Section: Tela Profilática Em Deiscência Da Aponeuroseunclassified

See 1 more Smart Citation

Prevenção de deiscência da aponeurose com uso profilático de tela pré-aponeurótica em laparotomias de emergência: ensaio clínico randomizado

Lima¹

View full text Add to dashboard Cite

INTRODUCTION: Emergency laparotomies have a high risk of complication with reports of fascial dehiscence (FD) in up to 14.9% of cases. The use of onlay mesh in the closure of abdominal wall reduces incidence of incisional hernia after elective surgeries without increased morbidity. However, there are no studies demonstrating its benefit in FD prevention and its use is controversial in emergency laparotomies and in contaminated or infected surgeries. OBJECTIVES: To evaluate whether the use of onlay mesh in the closure of the abdominal wall reduces the incidence of FD in patients submitted to emergency laparotomy, as well as the morbidity of its application. METHODS: A randomized clinical trial was conducted at the Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo. Patients at high risk for FD and indication of emergency midline laparotomy were randomized either to the suture group (running suture with polidioxanone thread and 36 mm needle size, aiming to achieve suture-to-wound length ratio of 4:1) or to the prophylactic mesh group (fascial closure as in the suture group, reinforced with polypropylene onlay mesh). High risk was defined according to the adapted Rotterdam preoperative risk model. The surgical team was blinded to the groups during the intraoperative period (randomization occurred only after complete fascial suture). RESULTS: From June 2015 to February 2018, 145 patients were randomized, 30 of whom were excluded (20.7%) because of death or reoperation, not related to the mesh procedure, in the first 30 days; 52 were allocated in the suture group and 63 in the prophylactic mesh group. Both groups were equivalent for demographic data and clinical characteristics, except for age, whose mean was higher in the suture group (66.1 years vs 61.0 years, p = 0.03). Patients were classified as ASA III or IV in 44 (38.3%) cases. Among the operations, 49 (42.6%) were contaminated or infected, 63 (54,8%) involved ostomy formation and 89 (77.4%) were colorectal surgeries. Hospital length of stay (LOS) and intensive care unit LOS were similar. Mean operative time was 50.8 minutes longer in the prophylactic mesh group (p = 0.01). FD occurred in seven cases of the suture group (13.5%) and none in the prophylactic mesh group (p = 0.003). There was no statistical difference between the groups regarding the number of patients with surgical site occurrence (SSO) [15 (28.8%) vs 27 (42.9%), p = 0.12], or surgical site occurrences that required procedural interventions (SSOPI) [9 (17.3%) vs 14 (22.2%), p = 0.51]. However, some SSO were more frequent in the prophylactic mesh group: seroma [3 (5.8%) vs 12 (19.0%), p = 0.03], surgical site infection (SSI) [4 (7, 7%) vs 13 (20.6%), p = 0.05] and superficial wound dehiscence [3 (5.8%) vs 15 (23.8%), p = 0.008)]. Seven cases of the prophylactic mesh group had superficial wound dehiscence with mesh exposure, treated with local dressings and healing by second intention, with complete resolution in less than 90 days. No case required complete removal of mesh. Of ...

show abstract

Wound dehiscence: outcome comparison for sutured and mesh reconstructed patients

Cited by 21 publications

References 27 publications

Repair of Concomitant Incisional and Parastomal Hernias Using a Hybrid Technique: A Series of 32 Patients

Repair of Concomitant Incisional and Parastomal Hernias Using a Hybrid Technique: A Series of 32 Patients

Biomaterial Implants in Abdominal Wall Hernia Repair: A Review on the Importance of the Peritoneal Interface

Prevenção de deiscência da aponeurose com uso profilático de tela pré-aponeurótica em laparotomias de emergência: ensaio clínico randomizado

Contact Info

Product

Resources

About