Closure Of Fascial Defect Research Articles

Outcomes after concurrent inguinal hernia repair and robotic-assisted radical prostatectomy.

Inguinal hernias occur more frequently following radical prostatectomy. Simultaneous inguinal hernia repair during open and laparoscopic radical prostatectomy for prostate cancer has been described previously. The emergence of robotic-assisted radical prostatectomy (RALP) has necessitated the evaluation of concomitant herniorrhaphy in this new setting. We report the outcomes of this operation in our series of patients. Retrospective review was performed on 700 patients with localised prostate cancer who underwent RALP performed by a single surgeon from 2004 to 2009. Details of cases where concurrent inguinal hernia repair was performed were recorded and compared with the remainder of the cohort. Hernia repair was performed using a monofilament knitted polypropylene cone mesh plug and fascial defect closure with Hem-o-Lok clips. A total of 38 inguinal herniorraphies were performed in 37 patients as a simultaneous procedure during transperitoneal RALP. The hernia repair on average added 5-10min to the total procedure time. One patient underwent a bilateral repair. Across this group, mean age was 62.9years, average body mass index was 27.1, and median follow-up was 29months. There were no complications at the time of mesh placement. There were no cases complicated by wound infection, fluid collection, or chronic pain. Recurrence of an inguinal hernia occurred in one patient due to migration of the mesh. We conclude that concomitant inguinal hernia repair during RALP is safe, feasible, and effective. The herniorrhaphy can be performed quickly, adds little to the overall procedure time and avoids a further operative procedure for the patient.

A simple technique for trocar site closure after laparoscopic surgery.

Hernias have been reported to occur at trocar sites and small anterior wall defect has been casually identified during laparoscopic surgery. The aim of this article is to describe a simple, fast, and cheap technique for the safe closure of trocar sites in laparoscopic surgery. Closure is accomplished with a #0# absorbable suture, which is applied in a pursestring manner using 15 gauge spinal cord needle. This procedure is also suitable for the laparoscopic repair of uncomplicated small hernias or fascial defects of the anterior abdominal wall; a mesh prosthesis in case the defect is > cm(2). This technique allows a secure closure of umbilical or fascial defects of the anterior abdominal wall. It is a useful method for large trocar sites closure and is recommended for small uncomplicated hernias or fascial defects of the anterior abdominal wall. In case of > cm(2) defects the technique could be an optimal laparoscopic alternative for patch tension free repair.

Dermal autografts for fascial repair after TRAM flap harvest.

To find an alternative to synthetic mesh closure of abdominal fascial defects after transverse rectus abdominis musculocutaneous (TRAM) flap harvest, dermal autografts were removed from tissue to be discarded and used for fascial closure. Dermal grafts have been used for herniorrhaphy and fascial repair after TRAM harvest previously, but have never been systematically studied. The dermal autograft technique was used in 24 patients to repair or reinforce anterior rectus sheath or external oblique fascia after TRAM harvest for breast reconstruction. During the same period, 25 other patients underwent TRAM breast reconstruction with abdominal wall closure by other methods. All patients were followed by serial physical examinations given by the operating surgeon. Average follow-up in the dermal autograft group was 12.6 versus 12.0 months in the second group. In the dermal autograft group, two patients complained of bulging of the anterior abdominal wall; one developed a true hernia, away from the location of the dermal autograft. In the second group, two patients experienced bulging. Wounds and infectious complications were similar in both groups. Dermal autografts are a useful alternative to mesh repair or direct closure of fascial defects after TRAM flap harvest.

Synthetic graft placement in the treatment of fascial dehiscence with necrosis and infection

Objective: The objective of this study was to describe the use of synthetic grafts in repairing fascial dehiscence complicated by fascial necrosis and infection after obstetric and gynecologic operations. Study Design: A retrospective review of the operating room records at Hutzel Hospital (Detroit, Mich) was performed to find all cases of fascial dehiscence repaired during a 6-year period between January 1, 1991, and December 31, 1996. Patients with partial or complete disruption of the fascia with evidence of fascial necrosis and infection were included in this study. Demographic information; the initial surgical procedure, including type of incision; suture material; use of synthetic graft and closure technique for repair of dehiscence; postoperative complications, microbiologic results; antibiotic therapy; subsequent operations; length of hospital stay; and late complications were recorded. Results: During the study period 52 patients underwent repair of fascial dehiscence; 36 of these had concurrent fascial necrosis and infection, including 4 women with necrotizing fasciitis. Eighteen patients were from the obstetric service and 18 were from the benign or cancer gynecology service. Ninety-one bacterial isolates were recovered from the infected wounds. Extensive fascial resection precluded closure without tension in 18 cases and necessitated synthetic graft placement to prevent evisceration. Graft materials included polypropylene (11 cases) and polyglactin (7 cases). Late complications of graft placement included extrusion of the graft in 3 patients and incisional hernia in 1. Conclusions: Extensive fascial débridement with resection prevents primary closure of wound dehiscence. Synthetic grafts permit primary closure of large fascial defects and can be used with extensive débridement in the presence of infection. (Am J Obstet Gynecol 1998;179:1430-5.)

A method for the closing up of abdominal trocar wound

SummaryLaparosocpic surgical techniques are widely used with many advantages. However, herniation through trocar wounds is observed as a complication. We present a new instrument and a new method for the secure closure of fascial defects of trocar wounds.

Extracorporeal suturing of trocar-induced defects and vascular injuries in the abdominal wall during laparoscopy using a modified Veress needle

Anterior wall bleeding and incisional hernias are two frequent complications of laparoscopic surgery. The inside of the retractable blunt tip of a Veress needle modified by a slit (0.5 mm wide x 0.5 mm deep) functions as a ligature carrier. Extracorporeal ligation of vessels or closure of fascial or peritoneal defects is achieved easily and rapidly by this technique.

Etiology, pathophysiology and anatomical location of the compartment syndrome

Tissue pressure elevation may be caused by diminution of the compartment (operative closure of fascial defects, the presence of tight bandages or air-splints or by prolonged localized external pressure, as in unconscious patients), and/or by an increase in its contents (hemorrhage or the various conditions causing increased capillary permeability, e.g. postischemic swelling, fractures, surgical orthopedic procedures) or increased capillary pressure, e.g. after exercises. Additional elevation of an injured limb may cause a compartmental syndrome by lowering capillary pressure, especially in shock patients.