PRISE EN CHARGE DES EVENTRATIONS PAR PROTHESE RETROMUSCULAIRE. A PROPOS DE 29 CAS

Abstract

Introduction: In our context, incisional hernia are particular by to the volume, the seniority, the high rate of recurrence after alloplasty. We report through a series of 29 patients, our experience in incisional hernia treatment by prosthesis in retromuscular position. Material and method: This is a retrospective study from January 2011 to June 2017 about patients treated by retromuscular prosthesis for medial or lateral postoperative incisional hernia. The indication of the prosthesis was retained for diameter greater than 6 cm. Mortality and morbidity were analyzed with a mean follow-up of 28 months (range: 4 months - 78 months). Results: The series included 22 women and 7 men with a sex ratio of 3/1 for women. The average age was 46 years (range 24 years - 63 years). The primary intervention was gynecological in 72% of cases. Moderate and severe obesity was noted in 34%. Postoperative infection was noted in 16cas. The site was under and umbilical in 23cas (79%). The diameter of the defect was between 6 and 10cm in 13% and greater than 10cm in 25cas (86%). The postoperative morbidity consisted of superficial infection in 6 cases (20%), hematoma in 2 cases (8.6%), seroma in 4 cases (17%), chronic pain in 4 cases (13.7%). No recurrence was recorded among the 22 patients followed. Conclusion: The placement of a prosthesis in a tensionfree procedure has drastically reduced the rate of recurrence and improved patient postoperative comfort. The retro-muscular implantation site is a method of choice as reflected into the results obtained in our series. Keys words : incisional hernia, abdominal wall, prothesis, retromuscular site