Incidence Of Postoperative Hernia Research Articles

Topographical-anatomical and clinical aspects of the assessment of Merzlikin-Paramonova's approach to liver surgeries

The purpose of the study was to assess results of Merzlikin-Paramonova's approach in liver surgeries. Material and Methods . The topographical-anatomical and spatial relationships were studied on 20 corpses, taking into account assessment criteria according to A.Yu. Sozon-Yaroshevich. In clinical settings, Merzlikin-Paramonova's approach was applied in the treatment of 81 patients with hepatic diseases (cancer, hemangioma, alveococcosis), who underwent radical and palliative surgeries. Short-and long-term treatment outcomes during a 5 year follow-up were analyzed. Merzlikin-Paramonova's approach provided a sufficient overview of the liver, easy manipulation in the area of large bile ducts and blood vessels, as well as the ability to perform lymphodissection and combined operations. Results. The Merzlikin-Paramonova's approach to liver surgeries has significant advantages over traditional surgical approaches, providing a good overview for revision of both primary and recurrent liver lesions. This surgical approach allowed the number of postoperative complications to be reduced due to less wound tension, rapid relief of pain and reduction in intra-abdominal hypertension, thus shortening the treatment time for patients. In the long-term postoperative period, the incidence of postoperative hernias decreased due to less damage to the nerve terminals of the anterior abdominal wall. Conclusion. Merzlikin-Paramonova's approach is slightly traumatic due to innervation and muscle structure of the abdominal wall, is more physiological for the patient, and has a low rate of complications. This approach provides a good access to the organ requiring surgery and is able to perform radical cytoreductive surgeries. Merzlikin-Paramonova's approach to liver surgeries can be recommended for active implementation in clinical practice.

Surgical Treatment of Inguinal Canal Hernias in Boys: an Analysis of Five Years’ Experience

Introduction.Currently the surgical treatment of inguinal hernias in children is usually a high ligation of the hernia sac without the separation of its distal portion or plastic reconstruction of the inguinal canal. This technique is considered the treatment of choice as it has brought down the incidence of post-operative hernias and testicular atrophy. However, the issues of approach to the selection of a conservative treatment strategy and the role played by instrumental examination methods used to determine indications for surgical treatment remain controversial.Materials and methods.This paper presents a retrospective analysis of 684 clinical cases followed up at the Yaroslavl Regional Children’s Teaching Hospital. The study included boys aged one month to 17 years who were treated for inguinal and inguinoscrotal hernias in 2011-2015.Results and discussion.89 patients (10.3%) were hospitalised with incarcerated inguinal and inguinoscrotal hernias in the period under review. Of these, in 86 patients, when the incarceration lasted under 12 hours, conservative treatment attempts were undertaken. Hernia reduction was achieved without any direct manipulation on the hernia sac in 10 boys (11.6%). Attempts of manual hernia reduction were undertaken in the remaining 56 children (65.1%); these resulted in successful outcomes in 47 patients (83.9%). Emergency surgical repair of incarcerated hernias was performed in 23 cases (3.1%). No patients with incarcerated hernias were older than seven years. 45 out of 183 boys (29.5%) had scrotal oedemas and haematomas in the early post-operative period following planned hernia repair surgeries.Conclusion. In the majority of patients hospitalised early the conservative hernia reduction approach was effective and resulted in fewer emergency hernia repair surgeries. Ultrasound examination of inguinal canal may be considered as a method of screening for asymptomatic hernias.

Long-term Outcome with the Prophylactic Use of Polypropylene Mesh in Morbidly Obese Patients Undergoing Biliopancreatic Diversion

The use of prosthetic material to prevent incisional hernia in clean-contaminated procedures as bariatric surgery remains controversial. We present our experience on 45 consecutive morbidly obese patients undergoing biliopancreatic diversion that was closed using a polypropylene mesh. Moreover, we reviewed the outcome of the 50 previous consecutive obese patients who underwent biliopancreatic diversion and conventional closure of the abdomen in order to compare the outcome between the two groups after a minimum follow-up of 2years. Between January 2006 and February 2010, 95 morbidly obese patients underwent open biliopancreatic diversion at our department. During the first 2years of our experience, there were 50 obese patients whose open biliopancreatic diversion was closed conventionally (without mesh). Starting on February 2008 and until February 2010, 45 patients received prophylactic midline reinforcement by the positioning of retrorectal muscle polypropylene mesh. The outcome at 3, 6, 12, and 24months was analyzed comparing the two groups of patients. No mesh infection occurred. Minor local complications occurred similarly in both groups. The incidence of postoperative hernia was significantly higher in the group conventionally closed (30%) than in the mesh group (4.4%) at 2-year follow-up (p < 0.05). The prophylactic use of mesh in open bariatric surgery is safe and effective at 2-year follow-up.

ROLE OF ALLERGY IN DELAYED HEALING AND IN DISRUPTION OF WOUNDS

The general incidence of disruption of wounds has been estimated to be from 1.5 to 2 per cent following abdominal operations. 1 Over 1,400 cases of such disruption have been recorded. 2 Since approximately 35 per cent of patients suffering such disruption of wounds die, 3 it can be seen that this complication presents a major surgical problem and accounts for a considerable number of postoperative deaths. The increased morbidity which attends breakdown or delayed healing of wounds is obvious. Not only is the time of hospitalization and of recovery greatly prolonged, but the incidence of postoperative hernia is greatly increased. In order to understand the mechanism of dehiscence of wounds it is necessary to understand the processes which normally occur to bring about the healing of surgical wounds. The reader is referred to the excellent review article of Arey 4 and to the papers of Carrel, 5 Harvey, 6

INCIDENCE AND PREVENTION OF INCISIONAL HERNIAS

Incisional hernias continue to remain serious surgical problems. Countless procedures have been advocated for the cure of them; numerous suggestions have been offered to prevent them. It seems reasonable to presume that though considerable time and concentration are utilized in the performance of the operation within the abdomen, often a too hurried and careless closure is effected by a weary operator or an inexperienced assistant. INCIDENCE The incidence seems variable according to the reports. In hospitals where many hernias are operated on, incisional hernias are less frequent than other types of ruptures. B. L. Coley, 1 in 3,000 consecutive herniotomies performed at the hospital for the ruptured and crippled in New York, reported only a 1.5 per cent incidence of postoperative hernias. During a four year period (1923 to 1927, inclusive) at the Boston City Hospital 2 there were 304 patients with this condition operated on. Stanton 3 noted 24