Sunday, May 6, 2012
Sometimes, in the face of an intraabdominal disaster and/or loss of the abdominal wall, a temporary closure of the abdomen is needed. Synthetic absorbable mesh has been used extensively in this situation. Polyglactin (Vicryl) and polyglycolic acid (Dexon) have been in the surgical armamentarium for approximately 25 years. This type of prosthetic mesh implant has been used in the repair of traumatic liver, splenic, and renal injuries and in pelvic floor repair in the setting of abdominal peroneal resection of the rectum. Although early burst strength (at 8 wk) is comparable to that of permanent mesh, as the mesh is absorbed (at 10-12 wk), hernias inevitably develop in most patients.
As described by Bender et al, the mesh is applied loosely over the abdominal contents and then covered with fine mesh gauze packing, maintaining the bowel below the absorbable mesh and within the abdominal contents. This may decrease bowel wall distention, thinning, and subsequent desiccation, which may decrease the incidence of enterocutaneous fistula.
An example of the use of Vicryl Mesh can be seen at this link.
Saturday, May 5, 2012
The patient illustrated here came with a recurrent left inguinal hernia. During the previous surgery, the cord was extensively skeletonized. The recurrence came through a defect of the floor and the sac contained momentum. The sac was pushed back into the peritoneum without excision. A plug was then placed in the defect. Following, a piece of mesh was used to patch the floor using a running 0 prolene.
|Recurrent defect of the inguinal floor|
|Mesh plug placed in defect|
|Mesh patch to inguinal floor|