Page 15 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Despite the advances made in the prevention of IH, this still represents a common issue in general surgical practice. Non-surgical treatment for IH is mostly applied to patients that are un t for surgery, and consists of abdominal binders to reduce the hernia and support the abdominal wall. The vast majority of IHs are symptomatic and require repair(1). In contrast to asymptomatic inguinal hernias, a watchful waiting strategy might not be a safe option for IHs(24). The risk of incarceration is high, and emergency repair is associated with a greater incidence of intraoperative bowel perforations, the development of enterocutaneous stulas, and mortality(24). Elective surgical repair should be considered if: the hernia is symptomatic; the increased risk for incarceration outweighs the risk of the operation; when the size of the hernia complicates dressing or activities of daily living; or when decreased quality of life and perception of body image are a factor.
The surgical treatment of abdominal wall hernias has been performed since Hellenistic times, when Celsus performed hernial sac extirpations(18). Since then, many new surgical techniques, or modi cations of established techniques, have been introduced. These repair techniques can broadly be divided into repair techniques without mesh (suture repair and autoplasty), and repair with mesh reinforcement. In 1899, Mayo described a transverse overlapping technique for repair of umbilical hernias(25), which was soon adopted as the standard technique for closing incisional and umbilical hernias. This technique was well adopted, but recurrence rates continued to frustrate surgeons. These procedures could not be performed for large abdominal wall defects, and new surgical techniques needed to be developed. With the introduction by Albanese and Ramirez of releasing incisions of the external oblique muscle, there was development of the components separation technique (CST) for large abdominal wall defects(26, 27). Besides several surgical techniques, transplantations of autologous or homologous materials were also explored. However, recurrence rates for hernia repair remained unsatisfactory high, and surgeons started to realize that ventral hernia repair might require the use of a foreign body.
Since 1859, when Edwin Drake rst successfully obtained oil from the ground by drilling, the oil industry has ourished, and several new polymers have been developed and introduced to medicine. Perlon and nylon meshes (1944) were developed, and implanted during hernia repair. However, perlon was found to provoke an extreme in ammatory response, and nylon tended
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Introduction and outline of the thesis
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