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Category: Volume 08 Issue 01 January 2020
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Title: Our Experience in Incisional Hernia Repair with Polypropylene mesh at VIMSAR, Burla

Authors: P. Hembram, B.C. Pal

 DOI: https://dx.doi.org/10.18535/jmscr/v8i1.47

Abstract

Introduction: A patient with Incisional hernia is a living document of failure of surgical skill. . They continue to be one of the more common complications of abdominal surgeries and a significant source of morbidity and loss of time from productive employment. The incidence of Incisional hernia varies from 2-11%. Most studies suggest that polypropylene mesh is still the most widely used prosthetic material for repair of incision hernias with satisfactory results and least recurrence. The present study on incisional hernia repair using polypropylene mesh was conducted in our institution and postoperative results are observed.

Aims and Objective

  • To perform repair of incisional hernia using polypropylene mesh.
  • To compile the results of the repair in terms of postoperative morbidity, wound infection, mesh rejection, return to normal activities, recurrence and patient compliance.

Materials and Methods: The present work was conducted in the Department of General Surgery VSSIMSAR, BURLA, Odisha during period from November 2016 to October 2019. Total 25 cases of incisional hernia were included in this study out of which 20 polypropylene mesh repair were done. In the 2 years study period patients were asked to report at 1st month, 6th month, 1st year and 2nd year to assess wound infection, status of ambulation, residual pain, mesh rejection and recurrence.

Observations: Out of total 25 patients 12 (48%) patients were male and 13 (52%) were female. Maximum no of incisional hernia cases were found in more than 50 years age (36%). We found large hernia 7 (28%), medium 10 (40%) and small in 5 (20%) of cases, 19 (76%) cases were symptomatic and 6 (24%) asymptomatic. In our series 50% patients could do their routine activity on the 2nd day of operation and only 4 (20%) patients required 4 days to resume their routine activities. 50 % of our patients resume full activities by the end of 3rd week., the post-operative complications have remained very low. Post-operative wound infection was 10%. Fifteen per cent patients had residual pain in the 1st month. Residual pain was controlled conservatively and none required removal of mesh. We have not encountered a single instance of mesh rejection.

Conclusion: It can be concluded that use of polypropylene mesh is a fairly easy procedure. Wound defects of different sizes could be properly patched. Tissue acceptance and pressure endurance of the graft is very good. Patient compliance is satisfactory. This procedure is complication free technically easy and recurrence free procedure hence is surely recommended for repair of incisional hernia.

References

  1. Matapurkar, B.G., Gupta, A.K. &Agarwal, A.K. A new technique of “Marlex®-peritoneal sandwich” in the repair of large incisional hernias. World J. Surg. 15, 768–770 (1991) doi:10.1007/BF01665314.
  2. Townsend RC, Beauchamp BD, Mattox MEK. Clinical surgery of hernia. Sabiston Textbook of Surgery, 19th Edition, Volume II, Elsevier. 2016:1128.
  3. Lamont PM, Ellis H. Incisional hernia in re‐opened abdominal incisions: An overlooked risk factor. British journal of Surgery. 1988 Apr;75(4):374-6.
  4. Molloy RG, Moran KT, Waldron RP, Brady MP, Kirwan WO. Massive incisional hernia: Abdominal wall replacement with Marlex™ mesh. British journal of surgery. 1991 Feb;78(2):242-4.
  5. Usher FC, Gannon JP. Marlex mesh, a new plastic mesh for replacing tissue defects: I. Experimental studies. AMA archives of surgery. 1959 Jan 1;78(1):131-7.
  6. Usher FC, Wallace SA. Tissue reaction to plastics: a comparison of nylon, Orlon, Dacron, Teflon, and Marlex. AMA archives of surgery. 1958 Jun 1;76(6):997-9.
  7. Usher FC, Gannon JP. Marlex mesh, a new plastic mesh for replacing tissue defects: I. Experimental studies. AMA archives of surgery. 1959 Jan 1;78(1):131-7.
  8. Larson GM, Harrower HW. Plastic mesh repair of incisional hernias. The American Journal of Surgery. 1978 Apr 1;135(4):559-63.
  9. George CD, Ellis H. The results of incisional hernia repair: a twelve year review. Annals of the Royal College of Surgeons of England. 1986 Jul;68(4):185.
  10. Lewis RT. Knitted polypropylene (Marlex) mesh in the repair of incisional hernias. Canadian journal of surgery. Journal canadien de chirurgie. 1984 Mar;27(2):155-7.
  11. Usher FC, Cogan JE, Lowry TI. A new technique for the repair of inguinal and incisional hernias. Archives of Surgery. 1960 Nov 1;81(5):847-54.
  12. Usher FC. Hernia repair with Marlex mesh: an analysis of 541 cases. Archives of surgery. 1962 Mar 1;84(3):325-8.
  13. Bucknall et al Burst abdomen and incisional hernia : A prospective study of 1129 major laparotomies. Br. Med. J. 284: 933.1982 Bendavid R et. All Incisional parapubic hernias. Surgery 1990 Nov: 108(5): 898-901
  14. Goonetilleke GC. Synthetic mesh in the repair of incisional hernia. The Ceylon medical journal. 1992 Sep;37(3):87-9.
  15. Ellis H, Gajraj H, George CD. Incisional hernias: when do they occur?. British Journal of Surgery. 1983 May;70(5):290-1.
  16. Mudge M, Hughes LE. Incisional hernia: a 10 year prospective study of incidence and attitudes. British Journal of Surgery. 1985 Jan;72(1):70-1.
  17. Read RC, Yoder G. Recent trends in the management of incisional herniation. Archives of Surgery. 1989 Apr 1;124(4):485-8.
  18. Stoppa RE. The treatment of complicated groin and incisional hernias. World journal of surgery. 1989 Sep 1;13(5):545-54.
  19. Kingsworth AN etal: Modern Hernia Managrment Recent Advances In Surgery No. 18,1995.
  20. Usher FC. Hernia repair with knitted polypropylene mesh. SurgGynecol Obstet. 1963;117:239-40.

Corresponding Author

P Hembram

Assistant Professor, Department of General Surgery, VIMSAR, Burla