Hernia : the journal of hernias and abdominal wall surgery
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Incisional hernia is a long-term complication of laparotomy. Its exact frequency varies according to different authors, but is always around 10-15%. There are patients who present with systemic associated diseases [chronic obstructive pulmonary disease (COPD), obesity, severe cardiopathies, immunodeficiencies, etc.] that favour or increase the risk of appearance of an incisional hernia. The aim of the present study was to assess whether the prophylactic placement of a polypropylene mesh in patients at risk can reduce or avoid the appearance of an incisional hernia. ⋯ Prophylactic use of a low-molecular-weight polypropylene mesh in abdominal surgery may be useful for the prevention of incisional hernia.
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Establishing the existence of inguinal neuritis, and defining patterns of nerve involvement in primary inguinal hernia repair. ⋯ The overall incidence of inguinal neuritis was 34% in primary inguinal hernia repairs. The ilioinguinal nerve was most commonly affected in these primary inguinal hernia repairs, and inguinal neuritis was most likely to occur at the external oblique neuroperforatum.
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Randomized Controlled Trial Comparative Study
Risk factors for wound complications in midline abdominal incisions related to the size of stitches.
Midline abdominal incisions should be closed continuously with a suture length (SL) to wound length (WL) ratio above 4 using small stitches. The effect on the rate of wound complications of a very high ratio and other potential risk factors when closure is performed with small stitches is unknown. ⋯ In midline abdominal incisions closed with small stitches, no risk factors for surgical site infection or incisional hernia were identified. Increasing the ratio very much above 4 had no adverse effects on the rate of wound complications. The higher rates of infection and herniation with an SL to WL ratio over 5 and in overweight patients in previous reports were probably related to wounds being closed with large stitches.
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Randomized Controlled Trial Multicenter Study
The design of an industry-sponsored randomized controlled trial to compare synthetic mesh versus biologic mesh for inguinal hernia repair.
Biologic prostheses are designed to support tissue regeneration rather than just result in a strong scar plate, as is the case with synthetic mesh. It is not known if these newer materials will result in earlier return to normal activities and/or less post-herniorrhaphy groin pain. METHOD/STUDY DESIGN: A prospective, randomized, controlled, third-party-blinded multicenter trial was designed to compare the use of a non-cross linked porcine dermis biologic graft [Strattice(TM) Reconstructive Tissue Matrix (RTM), LifeCell, Branchburg, NJ] versus light weight, large pore polypropylene mesh (UltraPro(TM), Ethicon, Somerville, NJ). The study design called for recruitment of 170 men. These men are being followed for a minimum of 2 years. The primary aim of this study is to compare the safety and effectiveness of the two materials in a Lichtenstein inguinal hernia repair as measured by resumption of activities of daily living. Secondary outcomes include chronic pain, postoperative complications and the incidence of re-herniation at 12 and 24 months. ⋯ We report the design of a multi-center, third-party blinded, randomized clinical trial comparing a new surgical device with existing technology in the repair of inguinal hernias. We believe this investigator-designed and conducted trial could serve as a model for similar trials examining surgical devices performed in collaboration with industry.