Recent trends in the management of incisional herniation
R. C. Read and G. Yoder
Department of Surgery, John L. McClellan Memorial Veterans Hospital, Little Rock.
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.
