Eight-point Compass Rose Underlay Technique in 72 Consecutive Elderly Patients with Large Incisional Hernia
Background: Repair of incisional hernia (IH) in the elderly is a challenge for the surgeon. Primary closure is preferable but is not always possible because of high recurrence rates of IH repaired without a prosthesis and/or possible respiratory and cardiovascular complications due to extreme tensio...
Main Authors: | , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Taiwan Society of Geriatric Emergency and Critical Medicine (TSGECM)
2011-09-01
|
Series: | International Journal of Gerontology |
Subjects: | |
Online Access: | http://www.sciencedirect.com/science/article/pii/S1873959811001037 |
id |
doaj-a642d9933c2e4fd78da979077cda3841 |
---|---|
record_format |
Article |
spelling |
doaj-a642d9933c2e4fd78da979077cda38412020-11-24T23:19:56ZengTaiwan Society of Geriatric Emergency and Critical Medicine (TSGECM)International Journal of Gerontology1873-95982011-09-015316116510.1016/j.ijge.2011.09.032Eight-point Compass Rose Underlay Technique in 72 Consecutive Elderly Patients with Large Incisional HerniaAttilio Ignazio Lo Monte0Giuseppe Damiano1Vincenzo Davide Palumbo2Carmelo Zumbino3Gabriele Spinelli4Antonino Sammartano5Maurizio Bellavia6Giuseppe Buscemi7Department of Surgical and Oncological Disciplines, ItalyDepartment of Surgical and Oncological Disciplines, ItalyDepartment of Surgical and Oncological Disciplines, ItalyDepartment of Surgical and Oncological Disciplines, ItalyDepartment of Surgical and Oncological Disciplines, ItalyDepartment of Surgical and Oncological Disciplines, ItalyDepartment of Surgical and Oncological Disciplines, ItalyDepartment of Surgical and Oncological Disciplines, ItalyBackground: Repair of incisional hernia (IH) in the elderly is a challenge for the surgeon. Primary closure is preferable but is not always possible because of high recurrence rates of IH repaired without a prosthesis and/or possible respiratory and cardiovascular complications due to extreme tension of the margins. We report our experience with underlay mesh placement in elderly patients with large IH. Methods: A total of 72 patients from January 2003 to December 2009 underwent IH repair involving placement of an intraperitoneal Gore® DualMesh® prosthesis. The prosthesis was first anchored at eight points in a compass rose pattern using a Gore® suture passer and then firmly secured to the abdominal wall with a 360° internal crown running suture. Results: Two intraoperative intestinal tears occurred during debridement and were immediately sutured. Postoperative complications included seven seromas, four hematomas, and two infections, one of which was resolved with conservative treatment while one required prosthesis removal. Conclusion: This surgical procedure, like laparoscopic treatment, allows the surgeon to avoid dissection of the abdominal layer and improves prosthesis adhesion with reinforcement of the incisional area near the abdominal defect. The reduction in operation time is remarkable. Despite good results in terms of safety and minimal recurrence for laparoscopy in the management of IH, the use of minimally invasive techniques for large incisional wall defects, especially in elderly patients, is still controversial and practiced by few surgeons. This open technique avoids cardiopulmonary complications arising from pneumoperitoneum in the elderly.http://www.sciencedirect.com/science/article/pii/S1873959811001037ePTFE meshhigh-risk elderly patientslarge ventral herniasuture passertension-free technique |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Attilio Ignazio Lo Monte Giuseppe Damiano Vincenzo Davide Palumbo Carmelo Zumbino Gabriele Spinelli Antonino Sammartano Maurizio Bellavia Giuseppe Buscemi |
spellingShingle |
Attilio Ignazio Lo Monte Giuseppe Damiano Vincenzo Davide Palumbo Carmelo Zumbino Gabriele Spinelli Antonino Sammartano Maurizio Bellavia Giuseppe Buscemi Eight-point Compass Rose Underlay Technique in 72 Consecutive Elderly Patients with Large Incisional Hernia International Journal of Gerontology ePTFE mesh high-risk elderly patients large ventral hernia suture passer tension-free technique |
author_facet |
Attilio Ignazio Lo Monte Giuseppe Damiano Vincenzo Davide Palumbo Carmelo Zumbino Gabriele Spinelli Antonino Sammartano Maurizio Bellavia Giuseppe Buscemi |
author_sort |
Attilio Ignazio Lo Monte |
title |
Eight-point Compass Rose Underlay Technique in 72 Consecutive Elderly Patients with Large Incisional Hernia |
title_short |
Eight-point Compass Rose Underlay Technique in 72 Consecutive Elderly Patients with Large Incisional Hernia |
title_full |
Eight-point Compass Rose Underlay Technique in 72 Consecutive Elderly Patients with Large Incisional Hernia |
title_fullStr |
Eight-point Compass Rose Underlay Technique in 72 Consecutive Elderly Patients with Large Incisional Hernia |
title_full_unstemmed |
Eight-point Compass Rose Underlay Technique in 72 Consecutive Elderly Patients with Large Incisional Hernia |
title_sort |
eight-point compass rose underlay technique in 72 consecutive elderly patients with large incisional hernia |
publisher |
Taiwan Society of Geriatric Emergency and Critical Medicine (TSGECM) |
series |
International Journal of Gerontology |
issn |
1873-9598 |
publishDate |
2011-09-01 |
description |
Background: Repair of incisional hernia (IH) in the elderly is a challenge for the surgeon. Primary closure is preferable but is not always possible because of high recurrence rates of IH repaired without a prosthesis and/or possible respiratory and cardiovascular complications due to extreme tension of the margins. We report our experience with underlay mesh placement in elderly patients with large IH.
Methods: A total of 72 patients from January 2003 to December 2009 underwent IH repair involving placement of an intraperitoneal Gore® DualMesh® prosthesis. The prosthesis was first anchored at eight points in a compass rose pattern using a Gore® suture passer and then firmly secured to the abdominal wall with a 360° internal crown running suture.
Results: Two intraoperative intestinal tears occurred during debridement and were immediately sutured. Postoperative complications included seven seromas, four hematomas, and two infections, one of which was resolved with conservative treatment while one required prosthesis removal.
Conclusion: This surgical procedure, like laparoscopic treatment, allows the surgeon to avoid dissection of the abdominal layer and improves prosthesis adhesion with reinforcement of the incisional area near the abdominal defect. The reduction in operation time is remarkable. Despite good results in terms of safety and minimal recurrence for laparoscopy in the management of IH, the use of minimally invasive techniques for large incisional wall defects, especially in elderly patients, is still controversial and practiced by few surgeons. This open technique avoids cardiopulmonary complications arising from pneumoperitoneum in the elderly. |
topic |
ePTFE mesh high-risk elderly patients large ventral hernia suture passer tension-free technique |
url |
http://www.sciencedirect.com/science/article/pii/S1873959811001037 |
work_keys_str_mv |
AT attilioignaziolomonte eightpointcompassroseunderlaytechniquein72consecutiveelderlypatientswithlargeincisionalhernia AT giuseppedamiano eightpointcompassroseunderlaytechniquein72consecutiveelderlypatientswithlargeincisionalhernia AT vincenzodavidepalumbo eightpointcompassroseunderlaytechniquein72consecutiveelderlypatientswithlargeincisionalhernia AT carmelozumbino eightpointcompassroseunderlaytechniquein72consecutiveelderlypatientswithlargeincisionalhernia AT gabrielespinelli eightpointcompassroseunderlaytechniquein72consecutiveelderlypatientswithlargeincisionalhernia AT antoninosammartano eightpointcompassroseunderlaytechniquein72consecutiveelderlypatientswithlargeincisionalhernia AT mauriziobellavia eightpointcompassroseunderlaytechniquein72consecutiveelderlypatientswithlargeincisionalhernia AT giuseppebuscemi eightpointcompassroseunderlaytechniquein72consecutiveelderlypatientswithlargeincisionalhernia |
_version_ |
1725576176998547456 |