Objective To evaluate effect of massive and complex incisional hernia or defect of abdominal wall by using prosthetic mesh. Method The clinical data of 112 patients with massive and complex incisional hernia or defect of abdominal wall from February 2003 to February 2016 were analyzed retrospectively. Results Sixty-three cases were repaired by placing artificial mesh between the peritoneum and the musculus rectus abdominis and 49 cases by opening intraperitoneal mesh placement. The primary healing occurred in 108 cases, the incision infection occured in 4 cases, the seroma occurred in 7 cases. The stretched feeling was found in 39 cases and the mild pain occurred in 17 cases in the operative area at early term after operation. One hundred and two patients were followed up for 9–156 months (mean 78.6 months), the recurrence was observed in 3 cases (2.94%). Conclusion Repair of massive and complex incisional hernia or defect of abdominal wall by using prosthetic mesh has some advantages of minimal invasiveness, rapid convalescence, and low recurrent rate.
Objective To summarize the surgical technique and the effectiveness of CK Parastomal patch in laparoscopic repair of parastomal hernia. Methods The cl inical data were retrospectively analysed from 24 patients who received laparoscopic repair of parastomal hernia using CK Parastomal patch between June 2006 and March 2010. There were 15 males and 9 females with a median age of 55 years (range, 47-80 years). Among them, 19 patients were with colon parastomalhernia in the left lower quadrant and 5 patients with ileum parastomal hernia in the right lower quadrant. The parastomal hernia duration was 1 to 4 years (mean, 2.4 years). The maximal diameter of the hernia ring was 3 to 7 cm (mean, 5.2 cm). All patients did not receive hernia repair. Results Laparoscopic repair of parastomal hernia was successfully performed in 18 cases, and open repair was used in 6 cases because of extensive adhesion. The average operating time was 121 minutes (range, 78 to 178 minutes). All wounds healed by first intention. Wound seroma occurred in 8 cases at 3 to 7 days after operation and disappeared by aspiration. Eleven patients complained of pain in the operative area within 1 month after operation and it disappeared without intervention. All patients were followed up 6 to 39 months (mean, 27 months). One recurrence occurred at 3 months after operation, and no recurrence occurred in the other patients. Conclusion Laparoscopic repair of parastomal hernia using CK Parastomal patch is a safe and feasible procedure with a satisfactory short-term effectiveness, but the long-term effectiveness should be further observed.
Objective To compare the efficacy of retromuscular repair of incisional hernia by using ProGrip self-gripping mesh and conventional polypropylene mesh. Methods A retrospective analysis was made on clinical data of 83 cases of incisional hernia between May 2012 and May 2016. Of 83 cases, ProGrip self-gripping mesh was used in 46 cases (self-gripping mesh group) and conventional polypropylene mesh (conventional mesh group) in 37 cases. There was no significant difference in gender, age, body mass index, types of incision hernia, hernia ring diameter, course of disease, and associated disease between 2 groups (P>0.05). The operative time, hospital stays, and visual analogue scale (VAS) were recorded and compared between 2 groups. Results The self-gripping mesh group was significantly lower than conventional mesh group in operative time and hospital stays (t=2.977,P=0.004;t=2.270,P=0.026). Primary healing of incision was obtained in 2 groups, with no seroma and mesh infection. The VAS score of self-gripping mesh group was significantly lower than that of conventional mesh group at 24 hours, 7 days, and 30 days after operation (P<0.05). The follow-up time was 5-53 months (mean, 25.8 months) in 43 patients of self-gripping mesh group, and was 7-54 months (mean, 27.4 months) in 33 patients of conventional mesh group. No chronic pain or hernia recurrence was found in both groups during follow-up time. Conclusion It is a safe and feasible curative way to use ProGrip self-gripping mesh for retromuscular repair of incisional hernia as it can reduce operative time, hospital stays, and postoperative pain.
ObjectiveTo summarize the method and experience in surgical treatment for mesh infection after prosthetic patch repair of ventral hernia. MethodsThe clinical data of 16 patients with mesh infection after ventral hernia repair accepted surgical treatment in our department from June 2007 to May 2010 were analyzed retrospectively. There were 10 males and 6 females, the age range from 24 to 73 years with an average 45.2 years. The patients with mesh infection included 11 cases of infection after incisional hernia repair, 4 cases of infection after abdominal wall defects repair caused by abdominal wall tumor resection, 1 mesh infection combine with urinary fistula caused by parastomal hernia of ileal neobladder repaired by using prosthetic patch. Clinical manifestation included mesh exposion, abscess, chronic sinus, and enterocutaneous fistula. All patients accepted local treatment of change dressing by primary operative surgeon, but the wounds didn’t heal about 3 to 24 months. Then the patients performed radical removal of infected mesh and abdominal wall reconstruction. ResultsAll patients accepted affected mesh removal successfully. Five patients performed abdominal wall reconstruction by using components separation technique. Four cases accepted abdominal wall repair by using polypropylene mesh. Five patients performed abdominal wall repair by using human acelluar dermal matrix. One case accepted change dressing and vacuum aspiration on the infected wound surface without reconstruction. And one case closed the wound immediately after infected mesh removal. The postoperative hospitalization time was 9 to 25 d (average 14 d). Thirteen patients recovered with primary wound healing. The other 3 cases recovered with second healing by local change dressing. All patients were followed up from 6 to 34 months (average 22 months), no abdominal wall hernia recurrence occurred. ConclusionsIt is very difficult to deal with mesh infection after prosthetic patch repair of abdominal wall hernia or defect. The surgical treatment should be done according to specific condition of each individual so as to acquire satisfied results.
Objective To summarize the experiences and methods on reoperation of recurrent incisional hernia after mesh repair with prosthetic patch. Methods Sixteen patients who got reoperation from January 2007 to December 2010 because of recurrent incisional hernia after mesh repair were analyzed retrospectively. Results All patients received prosthetic patch repair for reoperation. Thirteen patients received new mesh repair accompanied with old mesh removal, repair conducted by suturing new mesh with old mesh together in two patients, and repair performed by new mesh overlapping the old mesh in one patient. All patients recovered with primary wound healing. Fluid upon the mesh occurred in 3 patients and cured by percutaneous puncture and pressure dressing. Postoperative hospital stay was 7 to 16 days and the average 9 days. The drainage was removed 2 to 7 days after operation and the average was 4 days. All the 16 patients were followed up. And during a follow-up range of 5 to 36 months and the average 20 months, there was slight foreign body sensation in one patient, no chronic pain in wound area occurred. And no abdominal wall hernia recurrence occurred. Conclusions Reoperation of recurrent incisional hernia after mesh repair need to consider the recurrent position, material of the previous mesh, and the previous surgical methods, and should select appropriate prosthetic patch and surgical procedure, then could gain satisfied results.
Objective To summarize the surgical technique and curative effect of laparoscopic repair for suprapubic incisional hernia using composite patch. Methods The clinical data of 25 cases performed laparoscopic repair of suprapubic incisional hernia using composite patch from March 2007 to October 2010 were reviewed retrospectively. There were 13 males and 12 females， and aged 35-83 years （median age was 52 years）. Among them 2 patients were recurrences. The distance between the lower margin of hernia defect and pubic arc was less than 5 cm. The composite patch was fixed to the abdominal wall using spiral tacks （Protack） in direct vision. The lower margin of the patch was lower to the pubic arc in 2 cm， and to be fixed to the pubic arc and bilateral pectineal ligament， and it should be extended. Results Laparoscopic repair were successfully performed in all patients without convert to open repair. The max diameter of the hernia ring was 6.1-12.5cm and the average was 9.5 cm. The average operating time was 128 min （ranging from 90 to 180 min）. And the total complication rate was 28% （7/25）， including bladder damage during operation in 1 case， wound seroma upon the patch in 4 cases and cured by aspiration， pain in the operative area and disappeared within one month without intervention in 1 case. Twenty-two patients were followed-up with a follow-up rate of 88%. During a follow-up range of 6-48 months（average 30 months）， one case recurrence occurred in 2 months after the repair with the recurrent rate of 4%. Conclusions Laparoscopic repair of suprapubic incisional hernia is a safe and feasible technique， and the patch should cover and exceed the margin of the defect for 5 cm in all direction. The lower margin of the patch should be fixed to the bilateral pectineal ligament so as to strengthen the fix， and lower the recurrence rate.