Postoperative Ventral Hernias Research Articles

Possibilities for improving the results of surgical treatment of postoperative ventral hernias

In order to improve the immediate long-term results of surgical treatment of postoperative ventral hernias, the abdominal cavity was prepared for increased pressure, special preparation of the skin in the area of the surgical field, local nutrition was supplied to the autodermal graft, and the optimal choice of the plasty method was carried out. The number of postoperative complications, relapses and postoperative mortality decreased.

Abdominal Midline Incision Closure-Reply

In Reply .—Many surgeons state that postoperative ventral hernia is a rarity. Ellis et al 1 believe that this is because patients are not examined carefully and are not followed up sufficiently. They add that the ideal method of midline incision closure has not been discovered yet and emphasize the necessity of prospective controlled studies to answer this question. Our article, which Dr Gray read with some alarm, reports such a randomized trial, comparing two widely used techniques of abdominal wall closure. Obviously, its results cannot be useful for surgeons who use both techniques and material with no complications. As far as we are concerned, scientific conclusions seem better than impression or certainty. I would like to thank Dr Gray for giving us the opportunity to recall this option.

Plasty of incisional ventral hernias using a mechanical suture

Developed and applied in patients with hernias of the anterior abdominal wall a method of plasty with own tissues using a mechanical suture. 109 patients with postoperative and recurrent ventral hernias were operated on. This method of ventral hernia repair allows to restore the anatomy and function of the abdominal wall, standardizes and simplifies the technique of the operation, reducing the time of its implementation, and gives 95.4% positive long-term results.

The use of polyvinyl sponge in the repair of abdominal wall hernias.

T HE use of foreign materials to reinforce or replace tissues in the repair of ventral and inguinal hernias has found wide acceptance in the field of surge.ry. Among the many materials, tantalum” and stainless steel mesh have found common usage. This paper describes the clinical experience with the use of polyvinyl sponge (Ivalon) in the repair of 6 recurrent; inguinal hernias, 3 femoral hernias, and 7 postoperative ventral hernias. Ivalon has been used in other fields of surgery, and attention was first called to it by Grindlay and Clagett3 and Grindlay and Waugh4 who have used it as a prosthesis following pneumonectomy and to reinforce the wall of abdominal aortic aneurysms. Cincotti and Harkenl have utilized it as a plombage in subcostal extraperiosteal type of therapeutic or space-filling thoracoplasty, and Cincotti has used our 2 mm. slices in a modification of the Allison-Collis repair of hiatal hernia. It is being used with increasing frequency in vascular surgery to replace resected vascular segments8

Utility of the Split Grafts as a Reenforcement Material in the Treatment of Postoperative Ventral Hernias

Utility of the Split Grafts as a Reenforcement Material in the Treatment of Postoperative Ventral Hernias

Axial torsion of full term uterus associated with postoperative ventral hernia.

The rarity of axial torsion of the pregnant or myomatous uterus prompts this report of an unusual case. Torsion of the gravid uterus as well as the nongravid uterus has been reported. When it occurs in the latter, it is usually associated with fibromyoma, ovarian masses or adhesions. 1 In 1937 McMurray and Gayden 1 reviewed the literature and discovered that approximately 143 such cases had been reported. Torsion of the gravid uterus has been reported in all trimesters of pregnancy. The infrequency of torsions of the pregnant uterus at term is manifested by the fact that Reis and Chaloupka 2 could find only 15 cases in 1935. Few have appeared since then. 3 In the normal nonpregnant uterus there is a physiological torsion that never amounts to more than a few degrees. Reis and Chaloupka 2 feel that the twist is to the right in 80 per cent of

Factors in the etiology and management of postoperative ventral hernias

From a survey of the records of 213 patients with postoperative ventral hernia we have been able to correlate the following etiologic factors. These hernias occur more often in the female than the male and more often in the white than the Negro race. Of this series of patients 95 per cent were overweight. The initial surgical procedure leading to the hernia was in the following order of frequency, namely, abdominal hysterectomy, appendectomy, recurrent incisional hernias, cholecystectomy, cesarean section, perforated peptic ulcer, umbilical hermorrhaphy and stab wounds. Vertical appendectomy incisions were followed by a relatively higher incidence of herniation. A detailed program of management of the patient with a postoperative hernia is given in the effort to lower an unduly high mortality rate and morbidity as seen in a charity hospital.

TANTALUM GAUZE IN THE REPAIR OF LARGE POSTOPERATIVE VENTRAL HERNIAS

THE RESULTS of the conventional methods of repair of large postoperative ventral hernias have been disappointing. These hernias are usually the result of concealed or manifest wound disruption and are characterized by loss of tissue substance, in particular by loss of fascial tissue, of the abdominal wall. This tissue deficiency together with the developmental scantiness of the musculofascial structures of the obese abdominal wall in which these hernias so often occur creates a problem of repair which is seldom solved successfully with the common surgical methods. The problem in reality is to replace and reconstruct the missing portion of the abdominal wall. Many of the popular procedures of repair merely aim at closing the hiatus by whatever means will allow it to approximate its edges. Thus, often these repairs amount to no more than the suturing together under great tension of scarred and attenuated fascial margins. Where attempts are made

Treatment of Postoperative Ventral Hernia

Treatment of Postoperative Ventral Hernia

The operative treatment of hernia by living sutures

1.(1) A series of fifty patients with sixtythree hernias all operated upon by living suture method is reported from the Second Surgical (Cornell) Division of Bellevue Hospital.2.(2) The majority of these hernias were either direct, recurrent inguinal or ventral in type, and the age of this group averaged a decade above that of simple adult herniotomies.3.(3) The operation as performed by us is described in full with illustrations.4.(4) There were six recurrences in 34 traced hernias, the period of observation ranging from three to twenty-one months.5.(5) Postoperative wound infection was a complicating factor in 14 cases and was undoubtedly responsible for three of the recurrences, but did not seem to affect the end result in the other 11 cases. The presence of fascial sutures renders wound infection more likely to occur.6.(6) Barring wound infection, the postoperative course does not differ materially from that observed in simple herniotomy.Statistics show an apparent increase in mortality. Whether this would be maintained in a larger series of living suture operations is doubtful. Care should be taken in the selection of cases for this more prolonged operative procedure.7.(7) The operation is indicated in recurrent inguinal hernia, direct inguinal hernia, and large scrotal hernia associated with poor musculature. It is a valuable aid in dealing with postoperative ventral and large umbilical hernia. We regard it as a major procedure and reserve it for cases in which we feel it is distinctly indicated. The results of the operation should be judged with due consideration to the type of complicated hernia upon which it was used.

ROENTGENOLOGIC ASPECTS OF VARIOUS TYPES OF HERNIA

Here and there in our routine work, we have encountered cases of hernia in which the roentgen-ray examinations have been very interesting, and at times life saving. Some of these experiences have occurred with ordinary inguinal and postoperative ventral hernia and others with umbilical hernia; but the most striking have been found with diaphragmatic and intra-abdominal herniations. Relatively few of the cases have been studied definitely on account of the hernia; indeed, in many, especially in the small diaphragmatic and retroperitoneal hernias, there has been little in the clinical history or physical examination to suggest the existence of such an abnormality. It is also true that when these cases were worked out, it became evident that there was a definite relation between the hernia and the symptoms, which at first seemed so slightly related. The fact that these types of hernia are very rare should not discourage their study with

Transactions of the Michigan State Medical Society.

These "Transactions" are for the thirty-third annual meeting at Detroit, May 5 and 6, 1898. The papers presented at the session and included in the volume are grouped under the heads of: "Septic Diseases of the Abdomen and Pelvis," "Obstetrics and Gynecology," "General Medicine," "Surgery and Ophthalmology." Under the first heading are papers on: "Etiology," "The Blood," "Septic Infection of the Peritoneal Cavity, its Diagnosis and Treatment from a Medical Standpoint." "The Medical Treatment of Septic Peritonitis," "The Treatment of Septic Diseases of the Pelvis," "The Haughey Suture." Other papers are: "Bottini's Operation," "Nephrectomy," "May a Rapid Pulse in Appendicitis Contraindicate Operation?" "Reflections on the Treatment of Appendicitis," "The Frequency, Causes and Prevention of Post-operative Ventral Hernia," "Transillumination of the Stomach with Demonstration on the Person," "The Four Tonsils," "Practical Value of Diagnosis of Presentation in Instrumental Delivery," "Some Anomalies of the Kidneys," "Kraurasis Vulvæ," "Physical Training an Essential Factor