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Recurrent Ventral Hernia
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Recurrent Ventral Hernia | ||
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Related narrative: Giant Recurrent Ventral Hernia Repair Recurrent ventral hernia is a challenging problem. Adhesions put the patient at high risk for enterotomy during mobilization of adequate abdominal wall for repair. Contamination from enterotomy makes subsequent placement of mesh hazardous because of the potential for foreign material to harbor bacteria. A large size defect may incur loss of abdominal domain for the protruding viscera, and reduction can compromise pulmonary status. Such patients may require an extended period of post operative ventilation. The use of prosthetic mesh, particularly Marlex, directly against bowel can lead to fistula formation. It is essential to have a barrier of omentum available as in this case, or to use a less reactive material such as PTFE against the bowel. Numerous variations of giant mesh repair have been devised and reported. The method described here recreates solid medial borders to reapproximate residual abdominal wall without the risk of sutures pulling through from tension and pressure necrosis. References:
The historical development of prosthetics in hernia surgery.
Repair of complex giant ventral hernias with polypropylene and omentoplasty.
Repair of complex giant or recurrent ventral hernias by using tension-free intraparietal prosthetic mesh (Stoppa technique): lessons learned from our initial experience (fifty patients).
Management of large and giant postoperative ventral hernias.
Giant incisional hernia: staged repair using pneumoperitoneum and expanded polytetrafluoroethylene.
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