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AbstractAbstractObjective. The objective of this study is to evaluate the outcomes of tension-free mesh and sutured repairs in incisional hernia surgery.Patients & methods: Between September 2004 and December 2007, a randomized controlled study had been conducted in two main hospitals in Hadhramout-Yemen in which 415 patients with primary incisional hernias were randomly allocated to either suture or mesh repair. The primary outcome measure was hernia recurrence. The secondary outcome measures were operative time, patients’ comfort, analgesic requirement, hospital stay, rehabilitation, and complications. The patients were followed up for 3 years.Result: The recurrence rate was 4.3% in the mesh group and 27.5 % in the sutured group. The patients in the mesh group have prolonged operative time (61.16 minutes vs 59.13 minutes), but shorter hospital stay (2.8 days comparable with 3.1days), and earlier return to normal activities (23.8 days vs 26.6 days). Suturedrepair showed greater levels of pain (p<0.001,and more consumption of parenteral (93.7% vs 65.4%) and oral analgesics (63.8% versus 38%). The post-operative complications were comparable in both groups except, in the sutured group more patients, presented with chronic pain, (13.0% versus 4.3%). Conclusion: Tension-free repair of incisional hernia is safe and effective. It is associated with lower recurrence rate, lesser postoperative pain, lesser consumption of analgesic drugs, and earlier rehabilitation, than suturedrepair.
1- Luijendijk RW, Lemmen MHM, Hop WCJ, et al.
Incisional hernia following vest-over-pants, or
Mayo repair of primary hernias of the midline. J
Surg 1997; 21:62 – 66.
2- Korenkov M, Sauerland S, Amdt M, et al.
“Randomized clinical trial of suture repair,
polypropylene mesh or autodermal hernioplasty
for incisional hernia”. Br J Surg 2002; 89:50-56.
3- Luijendijk RW, Hop WC, VandenTol MP, et al. A
comparison of suture repair with mesh repair for
incisional hernias. N Engl J Med 2000; 343: 292-
Bin Tayair SA1, Yahia Al-Tayeb Al-Arabi2
4- Burger JW, Luijendijk RW, Hope WC, et al. Longterm follw-up of a randomized controlled trial of
suture versus mesh repair of incisional hernia.
Ann Surg 2004; 240:578 – 83.
5- Toniato A, Pagetta C, Bernante P, et al.
Incisional hernia recurrence with progressive
pneumoperitoneum and retromuscular prosthetic
hernioplasty. Langenbecks Arch Surg 2002; 387:
246 – 48.
6- Kurzer M., Kark A., Selouk S., and Belsham P.,
Open mesh repair of incisional hernia using a
sub-lay technique: long-term follow-up . World
J. Surg. 2008 Jun.; 32:31-36.
7- Tayair S., & Yahia Arabi. Comparison of tension
free versus sutured repair in inguinal hernias.
Presented at the 36th international meeting of the
Sudanese Association of Surgeons. Khartoum,
8- Chiasson PM, Pace D E, Sclachata CM., et al A
survey of general surgeons on Ontario Can. J.
9- Hesselink V. J., Luijendijl R. W., de Wilt J. H. W.
et al. An evaluation of factors in the incisional
hernia recurrence. Surg. Gynecol. Obstet. 1993
Mar.; 176: 228-234
10- Sauerland S., Schmedt C. G., Leins. et al.
Primary incisional hernia repair with or without
polypropylene mesh: a report on 384 patients
with 5-year follow-up. Langenbecks Arch. Surg.,
2005 September; 390: 408-12
11- Loh A., Rajhumar J. S., & South L. M., Anatomical
repair of large incisional hernias. Ann. R. Coll.
Surg. Engl., 1992; 74:100-105
12- Liakakos T., Karannikas I., & Panagoitidis H., Use
of marlex mesh in repair of recurrent incisional
hernia. Br. J. Surg. , 1994; 81:248 - 49
13- Tercero F.M., Awad Z. T., & Filipi C. J., Ventral
hernia recurrence: A literature Review. J.
Abdominal Surg., 2000.
14- Hamilton Le, & Jeffrey S. Retrofascial mesh
repair of ventral incisional hernias. Presented at
the 47th Annual meeting of the Midwest. Surgical
Association. Mackinac Island Michigan. 2004
15- O’ Dwyer PJ, Courtney CA. Factors involved
in the abdominal wall closure and subsequent
incisional hernia. Surg J R Coll Surg Edinb Ired
2003 1 February; 17-22
16- Kelly RF, Catherine CV, Catarina LK, et al.
Predictors of wound infection in ventral hernia
repair. Am J Surg 2005; 190: 676 – 681.
17- Anthony T, Bergen PC, keim LT, et al. Factors
affecting recurrence following incisional
herniorrhaphy. World J Surg 2000; 24:95 – 101.
18- Medina M, Sillero M, Martinez Gallego G, et
al. Risk factors of surgical wound infection in
patients undergoing herniorrhaphy. Eur J Surg
1997; 163: 191-98.
19- Manninen MJ, Lavonius M, Perhoniemi VJ.
Results of incisional hernia repair Eur J Surg
1991:157; 29 -31.
20- Sugerman HJ, Kellum JM Jr, Reins HD, et al.
New some obese than steroid dependent patients
and low recurrence with prefascial polypropylene
mesh. Am J Surg 1996; 171: 80 – 84.
21- Lichtenstein IL, Amid K, Shulman AG. Returning
to work after herniorrhaphy. Br J Surg 1994;309: