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Raymond C. Read, MD, PhD; Gordon Yoder, PAC

Arch Surg. 1989;124(4):485-488.

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)

Author Affiliations
From the Departments of Surgery, John L. McClellan Memorial Veterans Hospital and the University of Arkansas for Medical Sciences, Little Rock.

Footnotes
Accepted for publication Oct 4, 1988.

Read in part before the 12th Annual Surgical Symposium of the Association of Veterans Administration Surgeons, Minneapolis, May 13, 1988.

Reprints not available.

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