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Query: UMLS:C0019270 (hernia)
 15,856 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The physical properties of polyglactin 910 (Vicryl) have been studied experimentally and clinically and compared with other synthetic and natural suture materials. Polyglactin 910 has a relatively high fluid absorption capacity but a low capillary capacity. The tensile strength is high and well comparable with, or superior, to other synthetic non-absorbable suture materials commonly used. The elongation at break is moderate. No unfavourable wound reaction to the suture material has been registered. The material has not increased the expected frequency of wound infections. The follow up of laparotomized patients 12-18 months after the operation showed a very low frequency of wound hernia. Neither was any recurrence noticed after repair of inguinal hernia. No clinical signs of leakage in the anastomoses of the gastrointestinal region was registrated. It is concluded that polyglactin 910 in a wide extent seems to be able to replace catgut and also non-absorbable suture materials when normal wound healing is to be expected.
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PMID:Experiences with polyglactin 910 (Vicryl) in general surgery. 59 92

Wound complications cause significant morbidity in patients undergoing gastric restrictive procedures. Two randomized, prospective trials were done evaluating suture technique and material. A subcutaneous suction catheter was used for 48 hours in all patients. In Trial I a Polyglactin-910 (Vicryl) suture, #1 in size, was used. Patients were randomized between interrupted Smead-Jones far-far-near-near sutures and running sutures. Because hernia formation appeared excessive in both groups of patients, a second study was done comparing running #1 polydioxanone (PDS) and #1 polypropylene (Prolene) suture. Hernia formation was excessive in this group as well. The authors conclude running and interrupted closures are of equal reliability. Hernia formation was excessive in both groups. The type of suture material used in these studies was inconsequential. A better method of closure is needed in morbidly obese patients to achieve less postoperative hernia formation.
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PMID:Incisional closure in morbidly obese patients. 249 14

A large abdominal wall hernia, not amenable to primary closure, may require insertion of a prosthesis. The ideal prosthesis maintains strength, is incorporated by surrounding tissues, and does not stimulate adhesions. These qualities vary among available synthetic prostheses. We tested tensile strength, bursting strength, and adhesion formation in response to six materials used in repair of abdominal wall hernias. Adult Sprague-Dawley rats (196) were randomly divided into a control group and six experimental groups. A 4 by 4 cm full-thickness resection of abdominal wall was closed with patches of polypropylene mesh (Marlex), polyglactin 910 mesh (Vicryl), expanded polytetrafluoroethylene (Gore-tex), Dacron-reinforced silicone rubber (Silastic), preserved human dura (PHD), or polypropylene mesh overlying gelatin film (Marlex and Gelfilm, respectively). In controls the 4 cm longitudinal full-thickness incisions were closed primarily. Seven rats randomly selected from each group were sacrificed after 1, 2, 4, and 8 weeks; bursting and tensile strength (tensiometer) and adhesion formation were assessed. There were no differences in bursting strength among the experimental groups at each testing period. Although bursting strength increased linearly with time it was significantly weaker than in controls at 1 and 8 weeks (P less than 0.05). Tensiometric data were inconclusive due to wide variability within the experimental groups. Adhesion formation was moderate to maximal at all evaluation periods for Marlex and Gore-tex. Early adhesion formation was minimal to moderate for both PHD and Vicryl, but later increased with PHD and decreased with Vicryl as this prosthesis was absorbed. No adhesions formed with Marlex and Gelfilm until the gelatin dissolved (1 week), after which the adhesion response was similar to that with Marlex alone. No adhesions formed after Silastic implantation, but graft extrusion and evisceration were common (75%). Controls had no adhesions at all evaluation periods. Wound strength was similar for all prosthetic materials. Absorbable prosthetic Vicryl provided the best long-term protection against adhesions.
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PMID:A comparison of prosthetic materials used to repair abdominal wall defects. 622 7

This study compares monofilament continuous absorbable sutures with multifilament interrupted absorbable sutures for abdominal closure. Before closure of an abdominal incision, 988 patients were randomized to receive either a monofilament polyglyconate (Maxon) or a multifilament polyglactin 910 (Vicryl) suture. At 1 year after operation, 684 patients (69 per cent) were examined for the presence of incisional hernia, sinus and other wound-healing problems; 179 (18 per cent) had died and 125 (13 per cent) did not attend for follow-up. Incisional hernia occurred in 8 per cent of patients receiving monofilament continuous sutures compared with 6 per cent of those having multifilament interrupted closure (P not significant). Wound dehiscence occurred in 1 per cent of both groups. The mean time for suturing was 7.1 min for monofilament continuous and 8.7 min for multifilament interrupted sutures (P < 0.001). It is concluded that closure of an abdominal incision can be effected by a monofilament continuous absorbable suture more quickly than by multifilament interrupted absorbable sutures without an increased risk of wound dehiscence or incisional hernia.
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PMID:Monofilament versus multifilament absorbable sutures for abdominal closure. 847 40

Opsite skin closure without skin suture was compared with subcuticular Vicryl in a randomized trial in children undergoing day-case surgery for hernia, hydrocele or undescended testis. Ninety-nine groin closures were randomized, 47 to Opsite and 52 to subcuticular Vicryl. There was no difference in the duration of operation or in the cosmetic appearance of the wounds. Complications were all minor and similar in both groups. Opsite alone is suitable as a skin closure for the groin wounds in children.
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PMID:Opsite skin closure in day case paediatric surgery: is a subcuticular suture necessary? 899 43

Despite a reported incidence of up to 11 percent of incisional/ventral hernias following celiotomies, there is no universally applicable preventive or reconstructive technique in practice. Among patients undergoing repair of ventral incisional herniation, the reported recurrence rates are typically in the 30- to 50-percent range. This study concentrates on the patient with a large, recurrent abdominal incisional hernia in whom conventional surgical repair has failed. We report our recent 4-year experience with the use of "components separation" of the myofascial layers of the abdominal wall for repair of these recurrent herniations. During 4-year period, 35 patients with large, recurrent ventral hernias underwent repair by the same surgeon (J. H. M.) using the method described below. Abdominal defects as large as 875 cm2 were repaired, with a median defect size of 255 cm2. The repair was based on the compound flap of the rectus muscle with its attached internal oblique-transversus abdominus muscle with advancement to the midline to recreate the linea alba. Any repairs that were attenuated were supported with either ePTFE (8.6 percent) or Vicryl mesh (34 percent). The study group consisted of 35 patients, 34 percent male and 66 percent female; mean age was 55 years. Length of follow-up ranged from 1 to 43 months, with a mean follow-up of 22 months. Overall recurrence rate for herniation was 8.5 percent (3/35). Additional complications, namely seroma, wound infection, and hematoma, occurred at rates of 2.8, 5.7, and 5.7 percent, respectively. There were no mortalities. The compound flap of the rectus and internal oblique-transversus can be advanced medially to recreate the linea alba to provide dynamic, stable support for defects as large as 875 cm2. A recurrence rate of 8.5 percent was achieved in a relatively high-risk population with acceptable morbidity and no mortalities. In our 4-year experience, the sliding rectus abdominus myofascial flap has proved to be a safe and effective tool for dealing with patients in whom conventional means of repair have failed.
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PMID:Sliding myofascial flap of the rectus abdominus muscles for the closure of recurrent ventral hernias. 870 Sep 83

Encouraged by the results in abdominal wall defects, the authors used the collagen-coated Vicryl mesh (CCVM) in repair of diaphragmatic defects in two patients. In a patient with recurrent diaphragmatic hernia, CCVM was used to reinforce the anterior abdominal muscle flap. The hernia recurred after 8 months. In another patient, it was used to repair a large diaphragmatic defect. This patient had a recurrence of the hernia in 10 weeks. The results suggestthat CCVM is not a good material for repairing the diaphragmatic defect. However, it can be used to reinforce other types of repairs.
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PMID:Collagen-coated Vicryl mesh is not a suitable material for repair of diaphragmatic defects. 943 3

Prosthetic material to repair a hernia is indicated for large defects, attenuated muscle, or tension avoidance on a repair. Biological, absorbable, and permanent material can be used to repair a hernia. Absorbable substances such as Dexon (Davis & Geck, Wayne, NJ) and Vicryl (Ethicon, Inc, Somerville, NJ) are useful in infected areas but have a high recurrence rate. Nonabsorbable material such as polyethylene, polypropylene, and polytetrafluoroethylene (PTFE) are the most commonly used materials for mesh repair of a hernia. The properties of these meshes are determined not only by their composition but also by the size of the fibrils and interstices. Marlex (Bard Vascular, Billerica, MA) has a thicker fibril diameter and large interstices that allow ingrowth of surrounding material but has some stiffness in handling. PTFE has small fibrils and interstices that result in less ingrowth of tissue but ease in handling. Prolene (Ethicon, Somerville, NJ) has intermediate size fibrils and interstices and moderate ingrowth of tissue and ease of handling.
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PMID:Technology of Prosthetic Material. 1040 Oct 47

Damage control laparotomy for life-threatening abdominal conditions has gained wide acceptance in the management of exsanguinating trauma patients as well as septic patients with acute abdomen. Survivors considered too ill to undergo definitive abdominal wall closure are temporized, often with skin grafting on granulated viscera. These maneuvers compromise the integrity of the anterior abdominal wall and result in a subset of patients with loss of abdominal domain and massive, debilitating ventral hernias. A retrospective review was conducted of 21 such patients (16 men, five women) who underwent elective abdominal wall reconstruction at the Hospital of the University of Pennsylvania between November of 1998 and October of 2000. The purpose of this study was to report the authors' experience with these complex abdominal wall reconstructions. A double-layer, subfascial Vicryl mesh buttress was used in all repairs to aid in reestablishing abdominal wall integrity. The mean hernia size was 813 cm2 (range, 75 to 1836 cm2), and the average interval to definitive repair was 24.4 months (range, 3 weeks to 11 years). Mean follow-up was 13.5 months (range, 1 month to 40 months). Twenty patients (95 percent) had successful ventral hernia repair. Four patients with massive hernias (924 to 1836 cm2) required submuscular Marlex mesh implantation. Two patients (10 percent) developed abdominal compartment syndrome that required surgical decompression. One patient (5 percent) developed an incisional hernia at a prior colostomy site. Four patients (19 percent) had superficial skin dehiscence that healed secondarily with daily wound care. There were no mesh infections. In most cases, successful single-stage repair of large ventral hernias following damage control laparotomy can be achieved using a subfascial Vicryl mesh buttress in combination with other established reconstructive techniques. Massive defects exceeding 900 cm2 typically require permanent mesh implantation to achieve fascial closure and to minimize the risk of postoperative abdominal compartment syndrome and recurrent herniation. This technique represents an improved solution to a complicated problem and optimizes the aesthetic and functional outcome for these debilitated patients.
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PMID:The use of a subfascial vicryl mesh buttress to aid in the closure of massive ventral hernias following damage-control laparotomy. 1296 Aug 57

Closure of the abdominal wall after trauma or major surgery may be difficult due to visceral edema or fascial weakness; thus, the risk of developing a ventral hernia (VH) is high. Commonly, these hernias are repaired using a prosthetic mesh. Complications following mesh repair can develop. We hypothesize that the type of prosthetic material affects outcome. This is a retrospective chart review of patients admitted from 1996 to 2002 undergoing VH (> or = 20 x 10 cm) repair with prosthetic mesh. Data collected included age, sex, and race. Patients were stratified by prosthetic material as follows: Gore-Tex (GR), Marlex + Gore-Tex (MG), Marlex (MR), and Marlex + Vicryl (MV). For the purpose of clinical analysis, the groups were collapsed into subgroups: Gore-Tex exposure (GT) or non-Gore-Tex exposure (NG). Outcome measures were hernia recurrence (HR), wound infection (WI), and fistula formation (FF). Statistical analysis utilized chi2 test and Fisher's exact test. There were 55 VH repairs in 37 patients. The mean age was 43.9 (+/- 16.3), males out-numbered females 22 (59.5%) to 15 (40.5%). The majority of the patients were Caucasian (29; 78.4%). There were 30 trauma patients (81.1%), and 7 general surgery patients (18.9%). The HR for the study (n = 55) was 20 (36.4%), the WI was 17 (30.9%), and the FF was 3 (5.5%). GR group (6; 66.7%) had a significant higher wound IF rate than MR group (8; 26.7%) (Chi P = 0.02, Fisher P = 0.047). All other group comparisons (HR, WI, and FF) were N.S. The Gore-Tex versus non-Gore-Tex subgroup comparison results were as follows: GT (n = 18) had a WI 8 (44.4%), HR 6 (33.3%), and FF 0 (0%). NG (n = 37) had a WI 9 (24.3%), HR 14 (37.8%), and a FF 3 (8.1%). There was a trend toward a higher wound infection in the GT versus NG, but it did not reach statistical significance. We conclude that 1) the wound infection rate was higher in the Gore-Tex versus the Marlex group (Chi P = 0.02, Fisher P = 0.047). Wound infection in the presence of Gore-Tex usually mandates the removal of the mesh resulting in a hernia recurrence. 2) There was a trend toward a higher wound infection in the GT (44.4%) versus NG (24.3%), but it did not reach statistical significance.
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PMID:Repair of giant abdominal hernias: does the type of prosthesis matter? 1515 46


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