The paper is not available in DUO due to thesis restrictions. Clinical seroma was defined as a visible bulge or fluctuation without signs of infection, subclinical seroma was defined as the absence of detectable abnormalities on physical examination but the presence of any volume of fluid collection on abdominal wall ultrasound, and seroma was defined as all occurrences of fluid collection detected on ultrasound. Five seromas were detected at the late ultrasound assessment only and were not accompanied by clinical changes. George CD, Ellis H. In , Janis, from the University of Texas, suggested to using the progressive tension suture technique in large incisional herniorrhaphy procedures
The most widely mentioned mechanisms for seroma formation are blood and lymphatic vessel injury during dissection, dead-space formation, shear forces among layers and the release of inflammatory mediators. Randomized clinical trial 1. South medical journal, , Vol. Am J Surg ; A 5 mm, degree laparoscope was often used to assist in visualization and dissection of adhesions. Technological improvement created coated meshes with absorbable layers to inhibit adhesions formation.
Repair of large incisional hernias. To drain or not to drain. Randomized clinical trial
An extension of Fisher’s exact test was done to compare the adhesion score and histological evaluation; the Variance Analysis with a Fixed Value to compare the total score between the groups with meshes, from the percentage reduction of the mesh area and usage of Tukey’s method whenever necessary. Statistical analysis An extension of Fisher’s exact test was done to compare the adhesion score and histological evaluation; the Variance Analysis with a Fixed Value to compare the total score between the groups with meshes, from the percentage reduction of the mesh area and usage of Tukey’s method whenever necessary.
The average body mass index BMI of the sample was National Center for Biotechnology InformationU. Have outcomes of incisional hernia repair improved with time? The average time elapsed from hernia diagnosis to surgery was 42 months, varying from three to months.
In our study, the PPL group showed higher presence of eosinophils in relation to the other groups, representing an acute phase and or hypersensibility in relation to the other groups. Operative Technique As with the open repair, there is still significant variation in patch material selection, in the description of patch fixation to the abdominal wall and in the amount of patch overlap to the defect Table 6.
ANALYTICAL STUDY ON INCISIONAL HERNIA.
Have a very low threshold to return to the operating room to search for an occult enterotomy in the non-improving postoperative patient. Ann Roll Coll Surg Eng.
A thesiz test for the comparison of the two proportions was used to compare the occurrence of seroma between the groups with drains Use minimal energy—none if possible—during adhesiolysis; repair any questionable serosal tears. The fixation of the subcutaneous tissue to aponeurosis, which seemingly reduces the dead space and minimises the shear forces, was originally described by Baroudi and Ferreira in for abdominoplasty without drainage 6.
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The presence of seroma was considered as the main outcome. Concerning the giant cells it was clear a larger number of them in the three groups with meshes, it was observed globules in the negative image involved by a gigantocellular reaction of the foreign body type.
These findings agree with the results reported by other authors, according to which the peak incidence of seroma formation occurs approximately two weeks after surgery, when prophylactic drains would be useless 621 In vivo study of meshes implanted over the inguinal ring and external iliac vessels in uncastrated pigs.
Journal of Shaheed Suhrawardy Medical College,? A patient with a primary ventral wall hernia can be hednia to have far fewer adhesions, particularly versus an IVH where previous mesh closure has been attempted.
Lysis of adhesions is arguably the most challenging part of LIVH. Hernia Aug;13 4: This process minimize the dead space and and stabilizes the flap. Surg Clin North Am ; 73 3: In two jernia from the PCD group it was observed the presence of yellowish nodules located between the mesh and the viscera, suggesting a reaction against a foreign body.
Therefore, the shearing force on the patch, and the degree of mobility of the anterior abdominal wall musculature, both combine to make a far more dynamic relationship between patch and abdominal wall than that seen in the groin. In the present study, many seromas were detected by ultrasound only inciional Repair of large incisional hernias.
Analytical Study On Incisional Hernia.
Address reprint request to: No participant died or exhibited recurrence of hernia along the day postoperative follow-up. For the four types it was observed the equivalence in the adhesions of these materials in this animal model.
The PPL group displayed a median shrinkage of Share Email Print Feedback Close. In the presence of large flaws in the abdominal wall, it is not always possible to separate the viscera from the meshes, so they are placed in the intraperitoneal position 5.
Five seromas were detected at the late ultrasound assessment only and were not accompanied by clinical changes. The participants were randomised immediately after mesh fixation by a computer-based random number generator and allocated to the two intervention groups. In individuals with multiple defects, the length between the cranial margin of the most cranial defect and the caudal margin of the most caudal defect was considered