Abdominal Incisional Hernia Research Articles

Peritoneal flap hernioplasty for reconstruction of transverse incisional hernias.

Repair of transverse incisional hernias is a surgical challenge with current methods of abdominal wall reconstruction. The peritoneal flap hernioplasty addresses this problem using flaps of hernial sac to bridge the fascial gap and isolate the mesh from both the intraperitoneal contents and the subcutaneous space exploiting the retro-rectus space medially and the avascular plane between the internal and external oblique muscles laterally. The operative technique and long-term results of 80 consecutive cases with transverse incisional hernias undergoing repair with this method are reported. Patients undergoing elective peritoneal flap hernioplasty repair for transverse incisional hernias from Jan. 1, 2010 to Dec. 31, 2014 were identified from the Lothian Surgical Audit system, a prospectively-maintained computer database of all surgical procedures in the Edinburgh region of south-east Scotland. Patient demographics and clinical data were obtained from the hospital case-notes. Follow-up data were obtained in May 2019 from hospital records and telephone interview. 80 patients, (n = 53 male, 66%) were identified. Mean follow-up was 83months (range 55-114months) and mean postoperative stay was 6.4days (range 1-23days). Eleven repairs (14%) were for recurrent hernia. Mean mesh size applied (Optilene Elastic, 48g/m2, BBraun) was 747cm2 (ranged 150-1500cm2). Redundant skin excision was performed in 54% of cases. Altogether, seven patients (8.8%) presented with postoperative complications: five superficial wound infections (6.3%), one symptomatic seroma (1.3%) and one recurrence (1.3%) within the follow-up period. The peritoneal flap hernioplasty is associated with few complications and a very low recurrence rate. We propose this technique as the method of choice for reconstruction of transverse abdominal incisional hernias when primary fascial apposition is not possible.

Effects of CT examination in different body positions on the evaluation of abdominal incisional hernia volume

Objective To investigate the effects of computed tomography (CT) examination in different body positions on the evaluation of abdominal incisional hernia volume. Methods The retrospective case-control study was conducted. The clinical data of 23 patients with abdominal incisional hernia who were admitted to the Sixth Affiliated Hospital of Sun Yat-sen University from February to September in 2017 were collected. There were 14 males and 9 females, aged from 47 to 75 years, with an average age of 63 years. All patients underwent CT scan in supine position and lateral position. The volume of hernia sac, abdominal cavity and the volume ratio of hernia sac to abdominal cavity in different body positions were measured by multi-planar reconstruction and volume reappearance on the workstation. Observation indicators: (1) situations of CT examination of patients with abdominal incisional hernia in different positions; (2) correlation analysis of volume ratio increment of hernia sac to abdominal cavity between different positions by CT examination in patients with abdominal incisional hernia. Measurement data with normal distribution were expressed as Mean±SD, and comparison between groups was performed using the pared t test. Count data were expressed as absolute numbers or percentages. Pearson correlation was used to analyze the volume ratio increment of hernia sac to abdominal cavity between different positions by CT examination in patients with abdominal incisional hernia. Results (1) Situations of CT examination of patients with abdominal incisional hernia in different positions: CT examination of 23 patients with abdominal incisional hernia showed that the contents of hernia increased and the abdominal wall deformed in the lateral position compared with conventional supine position, with manifestations as shortened abdominal transverse diameter and longer vertical diameter. The volume of the hernia sac in supine position and in lateral position by CT examination was (623±293)mL and (869±425)mL, respectively, showing a significant difference (t=-7.959, P<0.05). The volume of abdominal cavity in supine position and in lateral position by CT examination was (6 445±1 438)mL and (6 283±1 348)mL, respectively, showing a significant difference (t=2.762, P<0.05). The volume ratio of hernia sac to abdominal cavity in supine position and in lateral position by CT examination was 0.096±0.040 and 0.138±0.061, showing a significant difference (t=-8.093, P<0.05). The volume ratio of hernia sac to abdominal cavity in lateral position increased by 0.042 compared with that in supine position, with an increasing rate of 43.8%. All the 23 patients had volume ratio of hernia sac to abdominal cavity less than 20% in supine position by CT examination, however, 4 patients had volume ratio of hernia sac to abdominal cavity more than 20% in lateral position by CT examination. (2) Correlation analysis of volume ratio increment of hernia sac to abdominal cavity between different positions by CT examination in patients with abdominal incisional hernia: results of Pearson correlation analysis showed a positive correlation of volume ratio of hernia sac to abdominal cavity between supine position and lateral position by CT examination (r=0.742, P<0.05). Conclusions The volume of incisional hernia is influenced by different body positions. Compared with supine position, lateral position by CT examination has a more accurate reflection of abdominal incisional hernia. Key words: Hernia; Incisional hernia; Body position; Computed tomography, X-ray; Hernia sac volume; Abdominal cavity volume; Volume ratio

Mesh removal and reconstruction with posterior components separation technique for delayed mesh infection developed 10 years after abdominal incisional hernia repair: a rare case report

BackgroundVery few literatures can be found reporting cases and treatment strategies of late-onset mesh infection after abdominal incisional hernia reconstruction. Here, we report a rare case of delayed mesh infection developed 10 years after abdominal incisional hernia repair, which was successfully treated by mesh removal and reconstruction with posterior components separation technique.Case presentationA 66-year-old man, who underwent reconstruction of abdominal incisional hernia by retroperitoneal Composix mesh application 10 years prior, developed 12 × 6.0 × 2.5 cm subcutaneous abscess followed by methicillin-resistant Staphylococcus aureus (MRSA)-related mesh infection. The operation was performed excising the abscess wall without damaging peritoneum, and huge intermuscular defect was successfully reconstructed by posterior components separation technique application.ConclusionsAn early decision of excising contaminated mesh would be preferable to extensive conservative treatments when mesh infection is suspected. Components separation technique application can be of great help when designing reconstruction of huge intramuscular defect after removal of infected mesh.

Risk Factors for Incarceration in Patients with Primary Abdominal Wall and Incisional Hernias: A Prospective Study in 4472 Patients

BackgroundIncarceration of primary and incisional hernias often results in emergency surgery. The objective of this study was to evaluate the relation of defect size and location with incarceration. Secondary objectives comprised identification of additional patient factors associated with an incarcerated hernia.MethodsA registry-based prospective study was performed of all consecutive patients undergoing hernia surgery between September 2011 and February 2016. Multivariate logistic regression was performed to identify risk factors for incarceration.ResultsIn total, 83 (3.5%) of 2352 primary hernias and 79 (3.7%) of 2120 incisional hernias had a non-reducible incarceration. For primary hernias, a defect width of 3–4 cm compared to defects of 0–1 cm was significantly associated with an incarcerated hernia (OR 2.85, 95% CI 1.57–5.18, p = 0.0006). For incisional hernias, a defect width of 3–4 cm compared to defects of 0–2 cm was significantly associated with an incarceration (OR 2.14, 95% CI 1.07–4.31, p = 0.0324). For primary hernias, defects in the peri- and infra-umbilical region portrayed a significantly increased odds for incarceration as compared to supra-umbilical defects (OR 1.98, 95% CI 1.02–3.85, p = 0.043). Additionally, in primary hernias age, BMI, and constipation were associated with incarceration. In incisional hernias age, BMI, female sex, diabetes mellitus and ASA classification were associated with incarceration.ConclusionFor primary and incisional hernias, mainly defects of 3–4 cm were associated with incarceration. For primary hernias, mainly defects located in the peri- and infra-umbilical region were associated with incarceration. Based on patient and hernia characteristics, patients with increased odds for incarceration may be selected and these patients may benefit from elective surgical treatment.

One single drug combination of bromelain and Boswellia serrata casperome®: effects on postoperative Edema in open incisional abdominal hernia repair. Prospective randomized clinical trial

One single drug combination of bromelain and Boswellia serrata casperome®: effects on postoperative Edema in open incisional abdominal hernia repair. Prospective randomized clinical trial

Clinical effects of laparoscopic combined with open mesh repair for abdominal wall incisional hernia

Objective To explore the clinical effects of laparoscopic combined with open mesh repair for abdominal wall incisional hernia. Methods The retrospective cross-sectional study was conducted. The clinical data of 41 patients with abdominal incisional hernia who were admitted to the Fujian Medical University Union Hospital between September 2011 and June 2017 were collected. All the patients underwent laparoscopic combined with open mesh repair, with the sequence from laparoscopic surgery to open surgery and then to laparoscopic surgery. Observation indicators: (1) intra- and post-operative situations; (2) follow-up situation. Follow-up using outpatient examination and telephone interview was performed to detect postoperative long-term complications and hernia recurrence up to November 2017. Measurement data with normal distribution were represented as ±s. Results (1) Intra- and post-operative situations: forty-one patients underwent successful laparoscopic combined with open mesh repair for abdominal wall incisional hernia. Diameter of hernia ring and defect area of abdominal wall were respectively (10±3)cm and (75±34)cm2. Among 41 patients, 25 underwent laparoscopic combined with open mesh repair due to tight intestinal adhesion induced difficult laparoscopic separation; 16 underwent laparoscopic combined with open mesh repair due to the larger diameter of the hernia ring induced difficulty of closing hernia ring under laparoscope. Operation time, cases with indwelling drainage-tube, time of drainage-tube removal and duration of postoperative hospital stay were respectively (188±71)minutes, 33, (14±3)days and (4.5±2.6)days. Of 41 patients, 2 with postoperative incomplete intestinal obstruction were cured by symptomatic treatment; 2 with incisional infection were cured by antibiotic therapy, irrigation and dressing change. (2) Follow-up situation: 41 patients were followed up for (29±17)months. The postoperative chronic pain of 2 patients was occasional and cannot affect the normal life. There was no occurrence of seroma, mesh infection, intestinal fistula, abdominal compartment syndrome and hernia recurrence during the follow-up. Conclusion The laparoscopic combined with open mesh repair has a better clinical effect for patients of incisional hernia with large hernia ring and tight intestinal adhesion, and surgical methods should be chosen seriously according to the condition of the patients in clinical application. Key words: Incisional hernia, abdominal wall; Hernia repair; Mesh repair; Polypropylene mesh; Intestinal adhesion; Incisional hernia, giant; Recurrence; Complications; Laparoscopy

Clinical value of component separation technology reducing postoperative recurrence after giant abdominal wall incisional herniorrhaphy

How to repair and reconstruct giant abdominal wall incisional hernia effectively, is still a difficult problem for surgeons of hernia and abdominal wall surgery. Component separation technology based on mesh reinforcement provides an excellent method to repair and reconstruct giant abdominal wall incisional hernia in anatomy and function, and possesses an lower recurrence rate than primary suture and bridged mesh repair. Standardized component separation technology plays an important role in improving the therapeutic effect of giant abdo-minal wall incisional hernia. Key words: Abdominal wall incisional hernia, giant; Component separation technology; Repair; Reconstruction; Recurrence

Current status of hernia and abdominal wall surgery and innovation research and development of repairing materials

Nowadays, hernia and abdominal wall surgery developes rapidly in China. Tension-free repair for inguinal hernia and abdominal wall incisional hernia is popular, and laparoscopic and even Da Vinci robotic hernia repair have been promoted rapidly. Due to the unbalanced development in diffe-rent areas of China, there is still existence of irregular diagnosis and treatment in hernia. Registry system of hernia and abdominal wall surgery and quality control standards are urgently needed. A few etiology, genetics and molecular epidemiology studies have been reported, although basic research of hernia is weak in the whole world. The exact pathogenesis and inheritance pattern are worthy of further study. The progress of hernia and abdominal surgery is inseparable from the development of repairing materials. At present, the repairing materials are mainly composed of synthetic materials and biomaterials. Although prosthetic repair can reduce postoperative hernia recurrence rate, mesh related adverse events in the long term should not be ignored, including common complications such as mesh shrinkage, erosion, adhesion, infection and so on. There is no ideal repairing material yet, but the innovative research and development of materials is worthy of the expectation in hernia and abdominal wall surgeons. Key words: Hernia; Inguinal hernia; Incisional hernia; Quality control specification; Repairing material

Safety and efficacy of neoadjuvant chemotherapy with bevacizumab in advanced-stage peritoneal/ovarian cancer patients

ObjectiveThe aim of this study was to evaluate the outcomes of neoadjuvant chemotherapy (NAC) with bevacizumab (Bev) at our institute. Materials and methodsEleven patients with stage IIIC or IV peritoneal/ovarian cancer who underwent interval debulking surgery (IDS) after NAC with Bev between December 2014 and December 2016 were enrolled retrospectively (TCB group). As a control group, we enrolled 13 patients evaluated between December 2012 and December 2014 who underwent IDS and received NAC without Bev (TC group). Both the TCB and TC groups received combination chemotherapy consisting of paclitaxel (175 mg/m2) or docetaxel (70 mg/m2) and carboplatin (area under the curve 6 mg/mL/min) administered intravenously every 3 weeks (cycles 3–6). ResultsAll patients in both groups underwent IDS. There were 7 (63.6%) and 8 (61.5%) cases with stage IIIC disease and 4 (36.3%) and 5 (30.7%) with stage IV disease in the TCB and TC groups, respectively. The complete resection rate was 81.8% in the TCB group and 69.2% in the TC group. The rate of achieving either complete or optimal resection was 100% in the TCB group and 69.2% in the TC group (p = 0.043). Hematoxicity (grade 3 or higher) was observed in 9 patients (81.8%) in the TCB group and 12 (92.3%) patients in the TC group. One patient (9%) in the TCB group experienced abdominal incisional hernia due to a fascial defect. ConclusionIDS after NAC with Bev is safe, with a similar efficacy as that after NAC without Bev.

Acute Intrathoracic Stomach: Complicated Paraesophageal Hernia associated with Distal Gastrointestinal Obstruction. Report of Two Cases and Review

The intrathoracic or upside-down stomach (UDS) is associated with the risk of incarceration and volvulus, which can be complicated by acute gastric obstruction and strangulation, leading to sepsis. Two cases of complicated UDS are reported, with a review of the relevant literature, to highlight the diagnostic challenges and management of this devastating condition. Two case reports are presented and the literature from 1995 to the present is reviewed regarding the etiology, incidence, presentation, diagnosis and treatment of complicated large paraesophageal hernia (PEH) and acute UDS. Two patients with cases of known large PEH and severe comorbidities, a man aged 88 years (case I) and a woman aged 78 years (case II), underwent emergency operation for volvulus and strangulation of UDS, after intense resuscitation. Case I had a prepyloric lesion revealed by gastroscopy. Case II also had an incarcerated abdominal incisional hernia producing bowel obstruction, and was in septic shock. X-ray and CT of the chest and abdomen helped the diagnosis of complicated PEH. Operative findings: In Case I, the entire stomach was found in the mediastinum with volvulus and distal ischemia; distal gastrectomy, gastrojejunostomy, cruroraphy and fundopexy were performed. In Case II, after freeing the incarcerated viable bowel, UDS was identified in the mediastinum, with ischemic antrum and necrotic, ruptured gastric fundus; total gastrectomy was performed with esophageal and duodenal stapling, and a feeding jejunostomy was constructed. Both patients were transferred intubated to the intensive care unit (ICU). Case I was extubated on day 4 and discharged on day 28; histology revealed antral ischemia and obstructive prepyloric pT2 adenocarcinoma. Case II was never stabilized, and died 50 hours after surgery; histology demonstrated gastric necrosis. Obstructive conditions distal to large PEHs may cause life-threatening complications in the contents of the hernial sac. In patients who are in unstable condition, with complicated large PEH or UDS with gastric compromise, emergency open surgery is required for reduction and resection of the necrotic parts of the stomach and possibly other organs. In other patients, who respond well to resuscitation after endoscopic gastric decompression, semi-urgent or early elective repair may be programmed.

Recurrence Rates and Mesh Shrinkage After Polypropylene vs. Polyester Mesh Hernia Repair in Complicated Hernias

Prosthetic mesh implants in hernia repair are frequently used based on the fact that lower recurrence rates are detected compared to anatomic repair. In latest years, researchers tried to answer weather there is an ideal mesh material for abdominal hernia repair. The studies tried to compare resistance, bio-tolerance, rates of recurrence and infection of several materials used in alloplasty. The results are far from pointing an unique ideal chemical structure of mesh. In our study, we compared the results of a cohort of 265 patients operated in 2010 and 2011 in our clinic for complicated abdominal incisional hernias. We compared the results of polypropylene mesh vs. polyester. Polypropylene mesh proved significantly better for preventing hernia recurrence and showed a lower shrinkage rate.

Laparoscopic repair of multiple incisional hernias in a single midline incision by double composite mesh.

Laparoscopic repair of ventral incisional hernia with intraperitoneal onlay mesh (IPOM) technique by anti-adhesion mesh has been widely adopted. Due to clinical heterogenicity in location, quantity and size of abdominal incisional hernia, strategy of such repair can be challenging. We hereby present the video of a patient with multiple swiss-cheese hernias in a single long midline incision repaired with double anti-adhesion mesh by IPOM technique. Patient demographics, technical details and clinical tips & tricks are discussed.

Evaluation of retro muscular mesh repair technique for treatment of ventral hernia

Ventral hernias commonly encountered in surgical practice account for 15-20% of all abdominal wall hernias. Results of tissue repair have been disappointing. The optimal approach for abdominal incisional hernias is still under discussion. The aim of the study was to evaluate the retro muscular mesh repair technique in the treatment of ventral hernia as one of the standard techniques for treatment of such cases. This prospective study on 50 consecutive patients was performed from July 2016 to July 2017. Patients were prepared to be operated by the retro muscular mesh repair technique. All patients were evaluated with respect to operative time and postoperative complications. Results were documented and statistically analysed. In this study on 50 patients, there were 30 female patients (60%) and 20 male patients (40%). The age of the studied patients ranged between 26 and 65 years with mean age of 49.8 years. The mean operative time was 88.5±15.3 min. The mean period of drainage was 2.3±1.3 days. Seroma was encountered in one case only 2%. No recurrence was reported in the studied patients during the period of follow-up (12months). On the basis of this study, we conclude that retro muscular (sublay) mesh repair is the ideal technique for incisional hernia repair.

Reconstruction of abdominal wall defects using extended trilobed rectus abdominis musculocutaneous flap

Reconstruction of extensive abdominal wall defects is difficult in many cases. We performed peritoneal reconstruction by free fascia lata transplantation and abdominal wall reconstruction with an extended trilobed rectus abdominis musculocutaneous flap. Firstly, the peritoneum is closed by free fascia lata transplantation. Then, the rectus abdominis musculocutaneous flap is prepared adjacent to the abdominal wall defect and centering on the rectus abdominis muscle body on the contralateral side. The rectus abdominis musculocutaneous flap is elevated with the first flap toward the xiphoid process on the cranial side, the second flap toward the middle axillary line on the lateral side, and the third flap toward the lower abdominal region on caudal side as an extended trilobed rectus abdominis musculocutaneous flap with a deep inferior epigastric arteriovenous pedicle and transposed to the abdominal wall defect. This method was applied to a full-thickness abdominal wall defect produced by colon cancer resection in two patients. Case 1 was a 10 × 15-cm full-thickness right abdominal wall defect, and case 2 was an 8 × 14-cm full-thickness left abdominal wall defect. The postoperative course was favorable, and no complication, such as abdominal incisional hernia, developed. The rectus abdominis musculocutaneous flap could be collected from the same surgical field, and its preparation as an extended musculocutaneous flap widely beyond the range of the muscle body was possible. By preparing a trilobed flap, the flap-donor region could also be easily closed. This method may be useful for reconstruction of extensive full-thickness abdominal wall defects.

The abdominal wall incisional hernia repair in cirrhotic patients.

The incidence of abdominal wall hernia in cirrhotic patients with ascites is between 20 and 40%. Controversies regarding the treatment modality and surgical timing of abdominal wall incisional hernia repair in cirrhotic patients remain. The study proposed wants to analyze the abdominal incisional hernia repair in cirrhotic patients with ascites performed in a single center to determine post-operative morbidity, mortality and complication rate. Cirrhotic patients with abdominal incisional hernia that underwent surgical operation for abdominal wall hernia repair at the "Policlinico Paolo Giaccone" at Palermo University Hospital between January 2015 and December 2016 were identified and the data collected were retrospectively reviewed; patients' medical and surgical records were collected from charts and the surgical and ICU registries. The degree of hepatic dysfunction was classified using Child-Pugh classification. Post-operative mortality was considered up to 30-days after surgery. A follow-up period of 6 months at least was performed to evaluate hernia recurrence and complications. Mortality rate is of 18.5% (p 0.002). Recurrence rate (p 0.004) and seroma formation rate (p 0.001) are most frequent in urgency group. The elevated ASA score and the prediction of a complicated post-operative course is higher in urgency group (p 0.004) as higher is the in-hospital stay (p 0.001) and the ICU stay (p 0.001). Elective surgery for abdominal wall hernia repair in cirrhotic patients seems to be successful and associated with lower mortality/morbidity rate and recurrence rate than urgency.

Retrospective research on initiative content reduction technique for obesity patients with huge abdominal incisional hernia

OBJECTIVE: The objective of this study is to assess the prophylactic and therapeutic effects of initiative content reduction on intra-abdominal hypertension in obesity patients with huge abdominal incisional hernia. MATERIALS AND METHODS: In this study, the retrospective cohort/descriptive research methods were applied. We collected the clinical data of a total of 62 obesity patients with single-onset huge abdominal incisional hernia who were admitted to Beijing Chaoyang Hospital of Capital Medical University for treatment between January 2011 and December 2015. In the operation, the initiative content reduction was performed. Following observation indexes were recorded as follows: (1) Surgical condition: surgical duration, length of resected intestinal tract, and length of stay (LOS) in hospital; (2) postoperative recovery: cardiac, pulmonary, hepatic and renal functions, and and intravesical pressure; (3) incidence of postoperative complications: infection of incision and intestinal fistula; and (4) patients' condition in follow-up. Return visits in outpatient service were required respectively at 1 week, 1 month, 3 months and 6 months after surgery, and 1 year after follow-up, the follow-up was carried out through telephone. Recurrences of hernia and late-onset infection were the question to be asked in follow-up, and June 2016 was set as the deadline of follow-up. RESULTS: (1) Surgical condition: The surgeries were successfully carried out for 62 patients, in which surgical duration was (115 ± 22) min, the length of resected intestinal tract was (207 ± 64) cm, and LOS was (14.5 ± 1.9) d. (2) Postoperative recovery: the intravesical pressure of patients was decreased in comparison with the level before operation, and after surgery, no hepatic, renal and respiratory dysfunctions were observed. (3) Incidence of postoperative complications: There were four patients with infection of incision; however, no intestinal fistula was found in any patients. (4) Follow-up: follow-up was performed for 62 patients, and the average length of follow-up was 35 months, during which three patients suffered recurrence of incisional hernia. CONCLUSION: For obesity patients with huge abdominal hernia, the application of initiative content reduction can effectively prevent the postoperative intra-abdominal hypertension, which is considered as an effective and feasible therapeutic procedure.

Laparoscopic transversus abdominis release for the treatment of complex ventral hernia

BACKGROUND: Posterior component separation through transversus abdominis muscle release (TAR) is an increasingly accepted technique worldwide for complex ventral hernia repair. Recently, researchers have attempted to perform the TAR procedure using minimally invasive approaches. In this study, we present our experience of laparoscopic TAR (Lap-TAR). The procedure will be described in detail and its feasibility evaluated. PATIENTS AND METHODS: To learn and be proficient in the procedure through soft cadaver workshop practice, we accumulated the necessary knowledge and minimally invasive surgery skills for the Lap-TAR procedure. We selected an appropriate patient and performed a Lap-TAR operation to treat complex ventral hernia. RESULTS: The Lap-TAR operation was successfully performed in a 73-year-old female patient with a giant lower abdominal incisional hernia, without open conversion. The estimated blood loss was 60 mL and the operative time was 365 min. The postoperative pain was mild, and the visual analog pain scale score was 3 on postoperative day (POD) 2. The patient was discharged on POD 7. All subfascial drains were removed before patient discharge. On an initial follow-up period of 3 months, there was no evidence of wound complication, bulging, or hernia recurrence. CONCLUSIONS: The Lap-TAR operation is technically feasible with a deliberate preparation. It could be an alternative for complex abdominal wall reconstruction with the potential to reduce pain, facilitate recovery, and decrease the length of hospital stay of patients.

腹壁瘢痕ヘルニア修復術後9年で発症した小腸穿通を伴うメッシュ感染の1例

腹壁瘢痕ヘルニア修復術後9年で発症した小腸穿通を伴うメッシュ感染の1例

Traitement Chirurgical Des Eventrations Abdominales Avec Pose De Prothese: Experience A Court Terme Du Chu Yalgado Ouedraogo

Title: Surgical management of abdominal incisional hernia with mesh placement: short- term experience of the University Hospital Yalgado Ouedraogo Introduction: The incisional hernia repair has several variants depending on the implantation site of the mesh. It may be intraperitoneal, preperitoneal, pre-mucosal or pre-musculoskeletal. Objective: The aim of the work was to report at short term the experience of the general and digestive surgery service of the Yalgado Ouédraogo University Hospital Center for the surgical management of abdominal incisional hernia with mesh placement in retro-muscular prefascial Patients and methods: This was a cross-sectional and descriptive study with a review of the files and a survey of 17 patients operated on for voluminous abdominal incisional hernia (diameter greater than 10 cm) from September 1, 2014 to August 31, 2015. Results: The mean duration of hospitalization was 7 days with extremes of 4 and 15 days. The dressings lasted on average 7 days with extremes of 4 and 15 days. The suction drains remained in place on average 8.56 days with extremes of 5 and 14 days and the mean duration of the abdominal wall contusion was 24.5 days with extremes of 10 and 40 days. The early postoperative complications were minor: 8 seromas, 1 hematomas, 1 superficial infection of the wall. Patients were followed for an average duration of 9.47 months with extremes of 4 and 14 months. The complications during this period were: 3 minor residual pain (limited to the scar) and 1 recurrence. Thirteen patients (76.5%) were satisfied with the intervention. Mortality was zero. Conclusion: Short time complications related to the surgical management of abdominal incisional hernia with mesh placement in retro-muscular prefascial in CHUYO are mainly minor.

Application value of the preoperative multi-slice spiral computed tomography for the repair of huge abdominal incisional hernia

Objective To explore the application value of the preoperative multi-slice spiral computed tomography (MSCT) for the repair of huge abdominal incisional hernia. Methods The retrospective cross-sectional study was conducted. The clinical data of 61 patients with huge abdominal incisional hernia who were admitted to the Xinjiang Uygur Autonomous Region People′s Hospital from January 2012 to February 2016 were collected. All patients underwent preoperative MSCT and three-dimensional reconstruction to measure the percentage of volumes of the hernia sac and abdominal cavity and then selected the individualized surgical methods according to the percentage, and length of small intestine resected was calculated in patients undergoing initiative volume reduction combined with onlay repair. Observation indicators: (1) pre- and post-operative situations: percentage of volumes of the hernia sac and abdominal cavity, duration of preoperative hospital stay, surgical procedure, length of small intestine resected in patients undergoing initiative volume reduction combined with onlay repair, operation time and volume of intraoperative blood loss; (2) postoperative recovery situation: intra-abdominal pressure at postoperative 48 hours, recovery time of postoperative gastrointestinal function, removal time of postoperative abdominal drainage-tube, postoperative complications and duration of postoperative hospital stay; (3) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect the postoperative hernia recurrence and long-term complications up to March 2017. Measurement data with normal distribution were represented as ±s and measurement data with skewed distribution were described as M (range). Results (1) Pre- and post-operative situations: percentage of volumes of the hernia sac and abdominal cavity in 61 patients was 19%±4%, and duration of preoperative hospital stay was (7±5)days. All the 61 patients underwent successful operation, including 48 receiving onlay repair and 13 receiving initiative volume reduction combined with onlay repair, without conversion to other surgery. Length of small intestine resected in 13 patients undergoing initiative volume reduction combined with onlay repair was (48±8)cm. Operation time and volume of intraoperative blood loss in 61 patients were (2.6±0.8)hours and (82±50)mL. (2) Postoperative recovery situation: intra-abdominal pressure at postoperative 48 hours, recovery time of postoperative gastrointestinal function and removal time of postoperative abdominal drainage-tube in 61 patients were (9.6±2.9)mmHg (1 mmHg=0.133kPa), (2.1±0.9)days and (3.5±1.1)days, respectively. Twelve patients had postoperative complications, and grade Ⅰ intra-abdominal hypertension, grade Ⅱ intra-abdominal hypertension, incisional effusion, incisional infection, incisional sinus, mesh infection and urinary retention were respectively detected in 4, 2, 4, 2, 1, 1, 1 in patients undergoing the onlay repair and 2, 1, 1, 0, 0, 0, 0 in patients undergoing initiative volume reduction combined with onlay repair. Some patients had 2 or more of complications. There was no occurrence of abdominal compartment syndrome and perioperative death. Patients with complications were cured or improved by symptomatic treatment. Duration of postoperative hospital stay in 61 patients was (8±4)days. (3) Follow-up: all the patients were followed up for 6-36 months, with a median time of 19 months. During follow-up, 2 patients with recurrence of huge abdominal incisional hernia received tentative follow-up, and were suggested to treat risk factors of recurrence firstly and then undergo reoperations. Other patients didn′t have long-term complications. Conclusion MSCT can provide the accurate data of percentage of volumes of the hernia sac and abdominal cavity before repair of huge abdominal incisional hernia, it also has the important clinical value of choosing the individualized surgical method, preserving the maximum out of normal organs in initiative volume reduction combined with onlay repair and increasing surgical outcomes. Key words: Abdominal incisional hernia, huge; Hernia repair; Multiplanar reconstruction; Tomography