Anales de la Facultad de Ciencias Médicas (Asunción)
Print version ISSN 1816-8949
SAGUIER GONZALEZ, GO and HOSPITAL DE CLINICAS / FCM-UNA. Primera Cátedra de Clínica Quirúrgica (Sala X). Analysis of the use of prosthetic mesh in incisional hernias. An. Fac. Cienc. Méd. (Asunción) [online]. 2009, vol.42, n.2, pp. 19-32. ISSN 1816-8949.
ABSTRACT Incisional hernia, with a reported incidence of 2 to 20%, is a surgical complication that acquires importance by its morbidity, the high costs of health services and the recurrence rate, that magnify the initial problems. The use of a mesh for its correction changes the perspective of the therapeutic analysis. Objectives: The objective of this study was to analyze the short term results of the use of a mesh in the treatment of incisional hernia compared with those of another group that did not use it, as well as to study the type of treatment applied to the different types of incisional hernia. Material and Method: Between 1993 and 2005, a retrospective descriptive study with analytical component was performed, based on the database of the First Chair of Surgical Clinic of the Hospital de Clínicas (FCM-UNA). Two hundred patients with incisional hernia were divided into two groups. The first group patients were operated using mesh repair while the second group patients were operated on using open suture repaired technique (without mesh) and then both groups were compared. The clinical characteristics were analyzed as well as the surgical treatment. Results: A total of 200 patients (24 males, 176 females) with incisional hernia were operated, with an average of 15 cases per year. The midline incisional hernia represented more than half of the cases. The strangled incisional hernias were 12% and the recurrence incisional hernia operated was 14.5%. A pneumoperitoneum was used in a 4.5% and a mesh was used in 35% of cases while another concomitant surgery was made in a third of the patients. The morbidity was 11.5%, mainly in the group that used a mesh and null mortality. The most frequent complication was the infection, but in the group that used a mesh, it was the seroma. Conclusions: The mesh was used in 1 of each 3 patients and a simple closure was used in half of the cases, a behavior that should be changed. The post-surgery results were good with a low rate of complications and null mortality. The complications occurred most frequently when a mesh was used. Wound infections was the most frequent complication, being sufficient the usual treatment. These results stimulate the use a mesh in almost all cases of incisional hernia. However, morbidity is higher when the mesh is used, but complications are not serious and respond to the usual treatment
Keywords : Incisional hernia; eventration; mesh.