Skip to main content
SpringerLink
Log in

Incisional Hernias

  • Chapter
  • First Online:
Surgical Management of Elderly Patients

  • 587 Accesses

Abstract

The incisional hernia is an ever more frequent complication of laparotomy which frequently occurs in elderly people. The main problems in the management of incisional hernia are discussed.

Special attention is paid to the surgical approach. The classic Rives–Stoppa technique is described as well as modern laparoscopic methods. The feasibility of these in the elderly is demonstrated.

The use of prosthetic meshes is the gold standard for the repair of incisional hernias. The main materials are described with their advantages and problems.

The therapeutic and physiopathological problems are emphasized, especially with respect to the large incisional hernias and their clinical implications in the elderly.

The importance of systemic impairments such as hypertension, diabetes, respiratory disease, and obesity, which are both etiologic and risk-increasing factors, is underlined.

The advances in the knowledge of both loco-regional abdominal wall impairment and distant troubles (initially respiratory) are emphasized.

Finally, the care in preoperative preparation and postoperative observation is pointed out together with the closing of the wall defect with restoration of a correct abdominal pressure.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  1. Caglià P, et al. Incisional hernia in the elderly: risk factors and clinical considerations. Int J Surg. 2014;12(Suppl 2):S164–9.

    Article  Google Scholar 

  2. Langer C, et al. Prognosis factors in incisional hernia surgery: 25 years of experience. Hernia. 2005;9:16–21.

    Article  CAS  Google Scholar 

  3. Deerenberg EB, et al. Small bites versus large bites for closure of abdominal midline incisions (STITCH): a double-blind, multicenter, randomised controlled trial. Lancet. 2015;26:1254–60.

    Article  Google Scholar 

  4. Ohira G, et al. Synthetic polyglycomer short-term absorbable sutures vs. polydioxanone long-term absorbable sutures for preventing incisional hernia and wound dehiscence after abdominal wall closure: a comparative randomized study of patients treated for gastric or colon cancer. Surg Today. 2015;45:841.e–5.e.

    Article  Google Scholar 

  5. Tandon A, et al. Parietex™ composite mesh versus DynaMesh®-IPOM for laparoscopic incisional and ventral hernia repair: a retrospective cohort study. Ann R Coll Surg Engl. 2016;98:568–73.

    Article  CAS  Google Scholar 

  6. Zhang Y, et al. Laparoscopic versus open incisional and ventral hernia repair: a systematic review and meta-analysis. World J Surg. 2014;38:2233–40.

    Article  Google Scholar 

  7. Al Chalabi H, et al. A systematic review of laparoscopic versus open abdominal incisional hernia repair, with meta-analysis of randomized controlled trials. Int J Surg. 2015;20:65–74.

    Article  Google Scholar 

  8. Kössler-Ebs JB, et al. Incisional hernia rates after laparoscopic or open abdominal surgery. A systematic review and meta-analysis. World J Surg. 2016;40:2319–30.

    Article  Google Scholar 

  9. Le Blanc K. Proper mesh overlap is a key determinant in hernia recurrence following laparoscopic ventral and incisional hernia repair. Hernia. 2016;20:85–99.

    Article  Google Scholar 

  10. Pawlak M, et al. Comparison of two different concepts of mesh and fixation technique in laparoscopic ventral hernia repair: a randomized controlled trial. Surg Endosc. 2016;30:1188–97.

    Article  Google Scholar 

  11. Abet E, et al. Laparoscopic incisional hernia repair: long term results. J Visc Surg. 2014;151:103–6.

    Article  CAS  Google Scholar 

  12. Ahonen-Siirtola M, et al. Complications in laparoscopic versus open incisional ventral hernia repair. A retrospective comparative study. World J Surg. 2016;39:2872–7.

    Article  Google Scholar 

  13. Bondre IL, et al. Suture, synthetic, or biologic in contaminated ventral hernia repair. J Surg Res. 2016;200:488–94.

    Article  Google Scholar 

  14. Wantz GE. Atlas of hernia surgery. New York: Raven Press; 1991.

    Google Scholar 

  15. Chevrel JP. Classification of the incisional hernia of the abdominal wall. Hernia. 2000;4:7–11.

    Article  Google Scholar 

  16. Romano G, et al. Fixation-free incisional hernia repair in the elderly: our experience with a tentacle-shaped implant. Aging Clin Exp Res. 2016;29(Suppl 1):173–7.

    PubMed  Google Scholar 

  17. Klinge U, et al. Development and pathophysiology of abdominal wall defects. Chirurg. 1997;68:304–9.

    Article  Google Scholar 

  18. Franz MG. The biology of hernias and the abdominal wall. Hernia. 2006;10:462–71.

    Article  Google Scholar 

  19. Trivellini G, et al. Traitement chirurgical des grandes eventrations. Etude d’une technique adaptée aux troubles de la compliance respiratoire. Chirurgie. 1984;110:116–22.

    CAS  PubMed  Google Scholar 

  20. Jensen KK, et al. Abdominal wall reconstruction for large incisional hernia restores expiratory lung function. Surgery. 2017;161:517–24.

    Article  Google Scholar 

  21. Goni Moreno I. Les pneumopéritoines dans la reparation pré-opératoire des grandes éventrations. Chirurgie. 1970;9:581–5.

    Google Scholar 

  22. Rives J, et al. Major incisional hernias. New York: Springer; 1987. p. 116–44.

    Google Scholar 

  23. Munegato G, et al. Respiratory physiopathology in surgical repair of large abdominal hernias. In: Crovella F, et al., editors. Incisional hernia. New York: Springer; 2008. p. 57–70.

    Chapter  Google Scholar 

  24. Renard Y, et al. Management of large incisional hernias with loss of domain: a prospective series of patients prepared by progressive preoperative pneumoperitoneum. Surgery. 2016;160:426–35.

    Article  Google Scholar 

  25. Elstner KE, et al. Preoperative progressive pneumoperitoneum complementing chemical component relaxation in complex ventral hernia repair. Surg Endosc. 2016;31(4):1914–22.

    Article  Google Scholar 

  26. Angelici AM, et al. Measurement of intra-abdominal pressure in large incisional hernia repair to prevent abdominal compartmental syndrome. G Chir. 2016;37:31–6.

    CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Geriatric Surgery Unit, University of Padua, Padua, Italy

    Carmelo Militello MD

  2. General Surgery, Treviso Hospital, Treviso, Italy

    Franco Mazzalai MD

Authors
  1. Carmelo Militello MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Franco Mazzalai MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carmelo Militello MD .

Editor information

Editors and Affiliations

  1. Department of General and Mininvasive Surgery, Cristo Re Hospital, Rome, Italy

    Antonio Crucitti

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Cite this chapter

Militello, C., Mazzalai, F. (2018). Incisional Hernias. In: Crucitti, A. (eds) Surgical Management of Elderly Patients. Springer, Cham. https://doi.org/10.1007/978-3-319-60861-7_26

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-60861-7_26

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-60860-0

  • Online ISBN: 978-3-319-60861-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation