title: Fixation-free incisional hernia repair in the elderly: our experience with a tentacle-shaped implant.
abstract: BACKGROUND
  Incisional hernia in aged patients represents a challenge even for experienced surgeons. Besides increased risk of complications due to comorbidities, mesh fixation and assuring a sufficient mesh overlap of the defect are the main issues in carrying out the repair.
  
  
  OBJECTIVE
  In order to assure broader coverage of the abdominal wall and a tension- and fixation-free repair, a specifically designed prosthesis was developed for the surgical treatment of incisional hernias. The results of a fixation-free incisional hernia repair carried out in elderly patients using a tentacle-shaped implant are reported herewith.
  
  
  METHODS
  A tentacle-shaped flat mesh with a large central body and integrated arms was used to repair incisional hernia in 23 elderly patients. The mesh was placed fixation-free and secured in place through the friction exerted by the tentacles. All tentacle straps were positioned with a special passer needle. Implant placement was preperitoneal in 18 patients and retromuscular sublay in five.
  
  
  RESULTS
  In a follow-up of 18 to 59 months (mean 36 months), four seromas occurred. Postoperative fast track helped avoid the typical complications affecting this patient subset. No infection, hematoma, chronic pain, mesh dislocation or recurrence have been reported to date.
  
  
  CONCLUSIONS
  The tentacle strap system allowed for reduced skin incision thus minimizing surgical trauma and ensuring easier and faster implant placement.
  
  
  CONCLUSIONS
  The tentacle arms of the implant ensured mesh stability and broad defect overlap. Besides a very low complication rate, none of the typical postoperative complications of aged patients occurred.
authors.affiliation: Department of General Surgery and Emergency, University of Palermo, Palermo, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Romano
authors.affiliation: Department of General Surgery, University of Cagliari, Cagliari, Italy.
authors.forename: Pier Giorgio
authors.initials: PG
authors.lastname: Calò
authors.affiliation: Department of General Surgery, University of Cagliari, Cagliari, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Erdas
authors.affiliation: Department of General Surgery, University of Cagliari, Cagliari, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Medas
authors.affiliation: Department of General Surgery, University of Cagliari, Cagliari, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Gordini
authors.affiliation: Department of General Surgery, University of Cagliari, Cagliari, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Podda
authors.affiliation: Postgraduate School of General Surgery, University of Cagliari, Cagliari, Italy. amatomed@gmail.com.|, via M. Rapisardi 66, 90144, Palermo, Italy. amatomed@gmail.com.
authors.forename: Giuseppe
authors.identifier: http://orcid.org/0000-0002-1352-9291
authors.initials: G
authors.lastname: Amato
mesh_terms: D058107:Abdominal Wound Closure Techniques / Q000009:adverse effects / Q000295:instrumentation; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D000069290:Incisional Hernia / Q000601:surgery*; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000601:surgery*; D019736:Prostheses and Implants; D012008:Recurrence; D013526:Surgical Mesh
keywords: Friction; Incisional hernia; Sublay; Surgical fixation devices; Technique; Tentacle mesh; Ventral hernia