Reconstruction of complex abdominal wall defects
Year: 2014
Type: dissertation
Abstract: Incisional hernia is by far the most common complication after laparotomies, occurring in 10 – 20%. Its occurrence is secondary to insufficient healing of the postoperative scar, resulting in wound dehiscence and protrusion of abdominal contents through an opening in the musculo-fascial layer of the abdominal wall. The mainstay of treatment for small and simple incisional hernias is the placement non-absorbable synthetic mesh to bridge the defect, the focus of most literature. The current thesis focusses on the more complex cases of incisional hernia. These include parastomal hernias, very large and contaminated hernias. The modes of treatment are more elaborate and patient-tailored, as synthetic bridging usually does not suffice.\nAn autologous method of abdominal wall repair, ‘Component Separation Technique’, was investigated. Large contaminated midline abdominal wall defects can be repaired with this method, but this coincides with a high recurrence rate when synthetic mesh is not additionally used. In contrast with the paradigm that synthetic mesh is contraindicated in contaminated wound environment, it seems that in selected cases this is a safe and durable option for reconstruction, provided modern mesh materials and surgical technique and adequate perioperative measures are taken. The use of more expensive biologic mesh does not result in superior results compared to synthetic mesh, although they may be salvaged more often when infection occurs. For parastomal hernia repair, the Sugarbaker underlay technique is superior to the keyhole technique regarding recurrence rate and also results in low infection rate.
Author: Nicholas J. Slater
Language: English
Topic: Hernia repair and management
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W814076411