Abstract • There is a high incidence of risk factors for incisional herniation in hospitalized veterans. Almost half the defects appear more than 12 months after celiotomy. "Buttonholing" of the rectus sheath by a sawing motion of the continuous nonabsorbable suture may be responsible for this later herniation. Suturing with synthetic, slowly absorbed monofilament may reduce delayed herniation. The recurrence rate after primary repair was 24.8% (n=206), and after a second repair the recurrence rate was 41.7% (n=36). Plastic prostheses, used only in difficult cases (18% of the sample), were associated with a recurrence rate similar to that associated with sutures because of protrusion around the edge. The use of larger and better fixed ("sandwich") polypropylene mesh (Marlex) is indicated. Subxiphoid epigastric hernias following sternotomy do not require prosthetic herniorrhaphy. (Arch Surg 1989;124:485-488) References 1. Goligher LC, Irvin TT, Johnston D, et al: A controlled clinical trial of three methods of closure of laparotomy wounds . Br J Surg 1975;62:823-829.Crossref 2. Norris JD: A review of wound healing and the mechanics of dehiscence . Surgery 1939;5:775-786. 3. Jones TE, Newell ET, Brubaker RE: The use of alloy steel wire in the closure of abdominal wounds . Surg Gynecol Obstet 1941;72:1056-1059. 4. Schoetz DJ, Coller JA, Veidenheimer MC: Closure of abdominal wounds with polydioxanone: A prospective study . Arch Surg 1988;123:72-74.Crossref 5. Ellis H, Heddle R: Does the peritoneum need to be closed at laparotomy . Br J Surg 1977;64:733-736.Crossref 6. George CD, Ellis H: The results of incisional hernia repair: A 12 year review . Ann R Coll Surg Engl 1986;68:185-187. 7. Usher FC, Oschsner J, Tuttle LL Jr: Use of Marlex mesh in the repair of incisional hernias . Am Surg 1958;24:969-974. 8. Usher FC, Allen JE Jr, Crosthwait RW, et al: Polypropylene monofilament: A new biologically inert suture for closing contaminated wounds . JAMA 1962;179:780-782.Crossref 9. Harding KG, Mudge M, Leinster SJ, et al: Late development of incisional hernia: An unrecognised problem . Br Med J 1983;286:519-520.Crossref 10. Cohen MJ, Starling JR: Repair of subxiphoid incisional hernias with Marlex mesh after median sternotomy . Arch Surg 1985;120:1270-1271.Crossref 11. Adloff M, Arnaud J-P: Surgical management of large incisional hernias by an intraperitoneal mersilene mesh and an aponeurotic graft . Surg Gynecol Obstet 1987;165:204-206. 12. Krukowski ZH, Matheson NA: 'Button hole' incisional hernia: A late complication of abdominal wound closure with continuous non-absorbable sutures . Br J Surg 1987;74:824-825.Crossref 13. Akman PC: A study of five hundred incisional hernias . J Int Coll Surg 1962;37:125-142. 14. Ponka JL: Hernias of the abdominal wall , in Ponka JL (ed): Incisional Hernias . Philadelphia, WB Saunders Co, 1980, pp 369-396. 15. Mudge M, Hughes LE: Incisional hernia: A 10 year prospective study of incidence and attitudes . Br J Surg 1985;72:70-71.Crossref 16. Ellis H, Gajraj H, George CD: Incisional hernias: When do they occur . Br J Surg 1983;70:290-291.Crossref 17. Playforth MJ, Sauven PD, Evans M, et al: The prediction of incisional hernias by radio-opaque markers . Ann R Coll Surg Engl 1986;68:82-84. 18. Ghahremani GG, Jimenez MA, Rosenfeld M, et al: CT diagnosis of occult incisional hernias . AJR 1987;148:139-142.Crossref 19. Bucknall TE, Ellis H: Abdominal wound closure: A comparison of monofilament nylon and polyglycolic acid . Surgery 1981;89:672-677. 20. Fischer JD, Turner FW: Abdominal incisional hernias: A ten-year review . Can J Surg 1974;17:202-204. 21. Pollock AV, Greenall MJ, Evans M: Single-layer mass closure of major laparotomies by continuous suturing . J R Soc Med 1979;72:889-893. 22. Lewis RT: Knitted polypropylene (Marlex) mesh in the repair of incisional hernias . Can J Surg 1984;27:155-157. 23. Usher FC: New technique for repairing incisional hernias with Marlex mesh . Am J Surg 1979;138:740-741.Crossref 24. Rubio PA: New technique for repairing large ventral incisional hernias with marlex mesh . Surg Gynecol Obstet 1986;162:275-276. 25. Larson GM, Vandertoll DJ: Approaches to repair of ventral hernia and full-thickness losses of the abdominal wall . Surg Clin North Am 1984;64:335-349. 26. Blomstedt B, Welin-Berger T: Incisional hernias . Acta Chir Scand 1972;138:275-278.
Archives of Surgery – American Medical Association
Published: Apr 1, 1989
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