Long-term follow-up after incisional hernia repair: Dynamics of recurrence and patient-reported outcome.

Background: Incisional hernia (IH) is common and recurrence rates remain high. Although the goal of treatment should be to improve quality of life, studies addressing this aspect are notably absent. We aimed to evaluate the long-term recurrence rate of open mesh repair of IH, investigate the burden of persisting discomfort, explore patient satisfaction, and identify risk factors for negative outcomes.

Trocar Site Hernia After Gastric Bypass.

Background: The 5.2% rate of trocar site incisional hernia (TSIH) reported appears low in view of the proportion of TSIH repairs being performed. Detecting TSIH by clinical examination may be difficult in the obese.

Detecting Incisional Hernia at Clinical and Radiological Examination.

Purpose: In clinical studies, incisional hernia is usually diagnosed by clinical examination. No other modality has been proven an aid in the diagnosis. The aim was to investigate the correlation between findings at clinical examination and at computed tomography when detecting incisional hernia after midline incisions.

Closure of midline laparotomies by means of small stitches: practical aspects of a new technique.

Randomized studies support the closure of midline incisions with a suture length to wound length ratio (SL:WL) of more than 4, accomplished with small tissue bites and short stitch intervals to decrease the risk of incisional hernia and wound infection. We investigated practical aspects of this technique possibly hampering the introduction of this technique. Patient data, operative variables and SL:WL ratio were collected at two hospitals: Sundsvall Hospital (SH) and Erasmus University Medical Center (EMC).

Prevention of incisional hernias: how to close a midline incision.

The development of wound complications is closely related to the surgical technique at wound closure. The risk of the suture technique affecting the development of wound dehiscence and incisional hernia can be monitored through the suture length to wound length ratio. Midline incisions should be closed in one layer by a continuous-suture technique using a monofilament suture material tied with self-locking knots.

Closing midline abdominal incisions.

Background: The most important wound complications are surgical site infection, wound dehiscence and incisional hernia. Experimental and clinical evidences support that the development of wound complications is closely related to the surgical technique at wound closure.

Results: The suture technique monitored through the suture length-to-wound length ratio is of major importance for the development of wound complications.

Experiences with a prophylactic mesh in 93 consecutive ostomies.

Background: Parastomal hernia may be present in half of patients after one year. A prophylactic low-weight prosthetic mesh in a sublay position at the index operation reduces the risk of parastomal hernia, without increasing the rate of complications.

Material: Between April 2003 and November 2006 all patients with an ostomy created at an open laparotomy were followed for at least one year.

Effect of stitch length on wound complications after closure of midline incisions: a randomized controlled trial.

Hypothesis: In midline incisions closed with a single-layer running suture, the rate of wound complications is lower when a suture length to wound length ratio of at least 4 is accomplished with a short stitch length rather than with a long one.

Design: Prospective randomized controlled trial.

Setting: Surgical department.

Improved outcome after laparoscopic cholecystectomy with ultrasonic dissection: a randomized multicenter trial.

Background: In conventional laparoscopic cholecystectomy, dissection with electrocautery starts at the triangle of Calot. In a randomized single-center trial, the fundus-first method (dome down) using ultrasonic dissection was faster, involved less pain or nausea, and had a shorter postoperative sick leave. This may relate to the fundus-first method or to the ultrasonic dissection.

Preventing parastomal hernia with a prosthetic mesh: a 5-year follow-up of a randomized study.

Background: Parastomal hernia is a major clinical problem. In a randomized, clinical trial, a prosthetic mesh in a sublay position at the index operation reduced the rate of parastomal hernia at 12-month follow-up, without any increase in the rate of complications. This study was designed to evaluate the rate of complications after 5 years.

Perforated colonic diverticular disease: the importance of NSAIDs, opioids, corticosteroids, and calcium channel blockers.

Purpose: Perforated colonic diverticular disease is associated with a high rate of late sequel and mortality. The risk of colonic perforation may relate to intracolonic pressure and mucosal barrier function in the wall of diverticula. The use of substances affecting these parameters may therefore be associated with the risk of developing a perforation.

Parastomal hernias.

The incidence of parastomal hernias is probably 30% to 50%. Suture repair of a parastomal hernia or relocation of the stoma results in a high recurrence rate, whereas with mesh repair recurrence rates are lower. Several mesh repair techniques are used in open and laparoscopic surgery, but randomized trials comparing various techniques and with long-term follow-up are needed for better evidence.

Preventing and treating parastomal hernia.

Parastomal hernia represents a major surgical challenge. There is no uniform definition of parastomal hernia, and the true rate is therefore difficult to establish, although it is probably higher than 30%. Many surgical techniques have been tried to prevent and treat parastomal hernia; but despite these efforts, herniation continues to be a problem.

Preventing parastomal hernia with a prosthetic mesh.

Hypothesis: Parastomal hernia is a common complication following colostomy. The lowest recurrence rate has been produced when repair is with a prosthetic mesh. This study evaluated the effect on stoma complications of using a mesh during the primary operation.

[Closure of midline incisions. A lot of small, same-size stitches in the aponeurosis improve wound healing].

The most important risk factor for the development of wound dehiscence and incisional hernia is the suture technique that is totally in the hands of the surgeon. A continuous suture line in one layer with a monofilament material should close midline incisions. Self-locking knots should be used for the anchor knots.