Muhammad Israr, Nisar Ali, Muhammad Hussain, Hidayat-ur Rahman.
Prosthetic mesh repair of incisional hernia.
Pak J Surg Jan ;26(1):84-8.

Objective. Th e objective of this prospective study was to determine the best outcome of incisional hernia treatment taking in to account recurrence, complications and patient’s satisfaction. Design: A retrospective study. Patients and method: Th e study was conducted in the surgical unit of Saidu Teaching Hospital Swat from August 2002 to February 2006.A total number of 50 patients with incisional hernia were evaluated and operated under general anaesthesia. In all patients, polypropylene mesh was used. Aft er general anaesthesia the patient was scrubbed and draped. Th e previous operation scar was excised then the defect margins was clearly dissected, rectus sheath and muscle also clearly dissected. Th en the rectus sheath was incised at a distance from the margin according to the size of the defect so that the lateral margin of the medial leaf of rectus sheath of both side can be approximated over the inverted hernial sac without tension. Th e medial leaf of the anterior rectus sheath was then elevated and aft er inverting the sac, the lateral margin of the medial leaf was approximated over the inverted sac and sutured without tension with 2/0 polypropylene. Th en the medial margin of the lateral leaf was elevated and the polypropylene mesh was placed over the rectus muscle and was sutured to the under surface of the lateral leaf of rectus sheath. Results: Out of 50 patients with incisional hernia, 33 were women and 17 men. Th e median age was 58 years for men and 50 years for women. Th e original incision was midline in 38; transverse in 10 and right lower paramedian in two patients. Th irty nine patients had primary incisional hernia and eleven had a fi rst recurrence of incisional hernia, out of these eleven patients three had a previous att empt of hernial repair with mesh. In 24 patients, the original operation was bowel related, in 16 gynaecological,in 6 billiary surgery, in 3 renal surgery and aortic aneurysm in one. Post operative complication like seroma formation, superfi scial wound infection and wound haematoma were noted in eight,two and one patient respectively. All patients received antibiotics and analgesic. Aft er three years of follow up, no recurrence was found. Conclusion: We recommend that all defects in the abdominal wall, independent of the size of the defect should be repaired with prosthetic mesh.

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