Wound defects in the elderly: our experience
© Ferrarese et al; licensee BioMed Central Ltd. 2011
Published: 24 August 2011
We report our experience on clinical outcomes of elderly patients who have undergone laparoscopic repair for incisional and primary inguinal hernias.
Patients and methods
To assess the safety and efficacy of laparoscopic [1–5] primary inguinal and incisional repair we reviewed the records of our patients of over 70 years old, who underwent such a procedure from June 2007 to September 2010: hernia defect size, recurrence, operative time, and procedure-related complications  were evaluated and a laparoscopic approach was attempted in all patients who required a mesh repair.
We scheduled 42 patients (32 M - 10 F, with 53 wound defects totally) for laparoscopic incisional  and primary inguinal hernia repair and we performed 17 surgical repair for incisional hernia and 36 for primary hernia. Of those, 13 were done for incisional hernias with a single defect (24.5% recurrence hernias), 4 with multiple defects (7.54% recurrence hernias), 12 were performed for unilateral inguinal hernias (22.56 % recurrence hernias), 16 for bilateral inguinal hernias (30.08 % recurrence hernias), 4 for umbilical hernias (1 recurrence hernias), 2 for epigastric and linea alba’s hernias, and 2 for rectum diastasis.
The majority of the patients were normal weight with a mean BMI of 25 kg/m2 (45%), 38% 25 > BMI > 30 (overweight), 17% BMI > 30 (obesity).
There was no conversion to an open procedure. The mean operative time was 128 minutes (range: 50 – 325).
In all the patients only mesh was used (37.5% polypropylene not reabsorbable, 42.5% tridimensional polyester-collagen composite mesh, 20% lightweight multifilament mesh partly reabsorbable) . The meshes were fixed in 82.5 % with absorbable fixation device, in 5% with a non-absorbable device and in 12.5 % with fibrin glue .
In contrast to other authors [10–13], major complications were 14.24% (6/42: 2 chronic inguinal pain, 4 recurrences). Minor complications were 5/42 (11.90%) and included only asymptomatic seromas that were aspirated. The mean hospital stay was 4.7 days (range: 1-18 days).
Laparoscopic repair of primary inguinal and incisional ventral hernias with transabdominal placement of composite mesh in the elderly achieves excellent results with low morbidity in comparison with open surgical approaches(2,4,5). In our experience, adequate fixation of the mesh, extension to cover the entire previous incision and standardization of the placement interval of the sutures are crucial to the success of the repair.
- Bezsilla J: Laparoscopic repair of abdominal wall hernia. Magy Seb. 2010, 1 (63(5)): 327-332.View ArticleGoogle Scholar
- Misra MC, Bansal VK, Kulkarni MP, Pawar DK: Comparison of laparoscopic and open repair of incisional and primary ventral hernia: results of a prospective randomized study. Surg Endosc. 2006, 20 (12): 1839-45. 10.1007/s00464-006-0118-0.View ArticlePubMedGoogle Scholar
- Martorana G, Carlucci M, Alia C, Barrianco G, Iacopinelli SM, Labruzzo C, Noto N, Restivo FP, Viola M, Mastrandrea G: Laparoscopic incisional hernia repair: our experience and review of the literature. Chir Ital. 2007, 59 (5): 671-7.PubMedGoogle Scholar
- Lagares-Garcia JA, Bansidhar B, Moore RA: Benefits of laparoscopy in middle-aged patients. Surg Endosc. 2003, 17 (1): 68-72. 10.1007/s00464-002-8823-9.View ArticlePubMedGoogle Scholar
- Lomanto D, Iyer SG, Shabbir A, Cheah WK: Laparoscopic versus open ventral hernia mesh repair: a prospective study. Surg Endosc. 2006, 20 (7): 1030-5. 10.1007/s00464-005-0554-2.View ArticlePubMedGoogle Scholar
- Mathonnet M, Mehinto D: Indications for inguinal hernia repair. J Chirb (Paris). 2007, 144 (4): 5S11-4.Google Scholar
- Tonouchi H, Ohmori Y, Kobayashi M, Kusunoki M: Trocar site hernia. Arch Surg. 2004, 139 (11): 1248-56. 10.1001/archsurg.139.11.1248.View ArticlePubMedGoogle Scholar
- Dabić D, Cerović S, Azanjaç B, Marić B, Kostić I: Prolene hernia system, ultrapro hernia system and 3D patch devices in the treatment of inguinal, femoral, umbilical and small incisional hernias in outpatient surgery. Acta Chir Iugosl. 2010, 57 (2): 49-54. 10.2298/ACI1002049D.View ArticlePubMedGoogle Scholar
- Stefano O, Giovanni C, Luca S, Claudio P, Giuseppe V, Enrico C: Laparoscopic incisional hernia repair with fibrin glue in select patients. JSLS. 2010, 14 (2): 240-5. 10.4293/108680810X12785289144359.PubMed CentralView ArticlePubMedGoogle Scholar
- Rogers FB, Guzman EA: Inguinal hernia repair in a community setting: implications for the elderly. Hernia. 2010, 9:Google Scholar
- Genç V, Ensari C, Ergul Z, Kulacoglu H: A very late-onset deep infection after prosthetic inguinal hernia repair. Chirurgia (Bucur). 2010, 105 (4): 555-7.Google Scholar
- Huang M, Musa F, Castillo C, Holcomb K: Postoperative bowel herniation in a 5-mm nonbladed trocar site. JSLS. 2010, 14 (2): 289-91. 10.4293/108680810X12785289144845.PubMed CentralView ArticlePubMedGoogle Scholar
- Malik AM, Khan A, Talpur KA, Laghari AA: Factors influencing morbidity and mortality in elderly population undergoing inguinal hernia surgery. J Pak Med Assoc. 2010, 60 (1): 4-Google Scholar
This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.