Hernia : the journal of hernias and abdominal wall surgery
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The effect of suturing with a very short stitch on the development of wound complications in midline incisions was investigated. Three hundred sixty-eight patients were analysed. ⋯ At 12-month follow up, incisional hernia was present in 3% (two of 76) of patients sutured with a mean stitch length of less than 4 cm and in 12% (25 of 215) sutured with a longer stitch ( P=0.043). In midline incisions closed with a suture length to wound length ratio of at least 4, a short stitch is associated with a lower rate of both wound infection and incisional hernia.
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Incisional hernias develop in 2%-20% of laparotomy incisions, necessitating approximately 90000 ventral hernia repairs per year. Although a common general surgical problem, a "best" method for repair has yet to be identified, as evidenced by documented recurrence rates of 25%-52% with primary open repair. The aim of this study was to evaluate the efficacy and safety of laparoscopic ventral and incisional herniorrhaphy. ⋯ There have been 11 recurrences (2.9%) during a mean follow-up time of 47.1 months (range 1-141 months). Laparoscopic ventral and incisional hernia repair, based on the Rives-Stoppa technique, is a safe, feasible, and effective alternative to open techniques. More long-term follow-up is still required to further evaluate the true effectiveness of this operation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Primary closure of laparotomies with high risk of incisional hernia using prosthetic material: analysis of usefulness.
Incisional hernia continues to be a serious postoperative complication in abdominal surgery. We present a prospective randomised study to evaluate the usefulness of placement of a supra-aponeurotic polypropylene mesh in the primary closure of laparotomies with a high risk of incisional hernia. ⋯ No incisional hernia was detected in the group in which closure was made using the mesh (P=0.02). Use of prosthetic material (polypropylene mesh) in the primary closure of laparotomies with a high risk of incisional hernia is useful for reduction of the rate of incisional hernias.
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The traditional approach to pediatric inguinal pathologies has been the suprapubic transverse inguinal incision. Alternative incisions for better cosmetic results may be considered. ⋯ All children ended with excellent cosmetic and functional results. There were no complications or morbidity apart from a recurrence of an inguinal hernia in a 7 year-old boy. In addition to the series of girls reported earlier, this novel surgical incision has further been employed in boys with excellent results.
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The study aims to demonstrate the presence of a fibrous or fibromuscular ring structure within the wall of the sacs of inguinal hernia in children and its importance in the development of incarceration as a direct cause of this complication. A case series study of 784 children with unilateral inguinal hernias operated on over a period of 9 years (1992-2000) in two teaching hospitals (Mosul, Iraq). All underwent herniotomy. ⋯ Incarcerations of inguinal hernia in children are usually caused by the inguinal rings. Another cause for incarceration being studied is a fibrous or fibromuscular ring structure identified within the wall of the hernial sac, causing the incarceration in 5.6% of elective (nonincarcerated) hernias and 16% of incarcerated hernia patients. Patients with these hernia sac rings are three times more liable to incarceration than others.