Dynamic suture less repair of incisional hernia.
OBJECTIVE
An incisional hernia is represented by the escape of organs from their physiologic position through an area of weakness on the surgical scar. An original technique, based on a Rives intervention, which is the golden standard in the treatment of incisional hernias, is presented in this study.


METHODS
From January 1995 to December 2003, 93 patients underwent surgery for incisional hernia in our Division. The intervention was performed in 52 cases (Group A) with a classic Rives technique, with apposition of a prolene mesh in the subaponeurotic space, and fixation of the mesh with transcutaneous stitches. In 41 cases (Group B) the intervention was performed with a personal technique, with apposition of an "Hertra 0", a rigid and memory controlled mesh between the rectum abdomini muscle and its posterior fascia, tension free without fixation with stitches.


RESULTS
The mean follow-up was of 23 months. In Group A we observed immediately 3 postoperative cases (5%) of intraparietal haematoma, 2 (4%) of subcutaneous haematoma, 4 (7%) of retrofascial haematoma, 4 (7%) of wound infection (in 1 it was necessary to remove the prosthesis), 3 (6%) of respiratory complications, and 1 case (2%) of cardiovascular complication. In Group B we observed only 3 cases (7%) of subcutaneous seroma. The mean postoperative stay was 6 days in both groups. There was no postoperative mortality or relapses.


CONCLUSIONS
The presented technique seems to offer advantages in the management of incisional hernia; the use of "Hertra 0" mesh simplifies Rives technique, improving its resistance to infections.
Docimo
Ludovico
L
Facoltà di Medicina e Chirurgia, Insegnamento di Clinica Chirurgica, 11 Divisione di Chirurgia Generale e dell'Obesità, Seconda Università degli Studi di Napoli, Napoli. ludovico.docimo@unina2.it
Manzi
Fulvio
F
Sparavigna
Luigi
L
De Rosa
Massimo
M
Granato
Felice
F
Amoroso
Vincenzo
V
Docimo
Giovanni
G
Ferraraccio
Franca
F
D000368:Aged; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011027:Pneumoperitoneum; D012189:Retrospective Studies; D013526:Surgical Mesh; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000379:methods; D013537:Sutures; D016896:Treatment Outcome