腹壁瘢痕ヘルニアの症例検討

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  • ANALYSIS OF THE CASES FOR REPAIRING INCISIONAL HERNIAS

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Since incisional hernia is one of the major factors in morbidity after abdominal surgery, its incidence is of concern to abdominal surgeons. In 1972-1981, 31 patients were operated on for incisional hernias following abdominal surgery in the Yachiyo Hospital.<br> The mean age of the patients was 60 years. There were 26 females and five males. The location of hernia was as follows: upper midline in five, lower midline in 13, right lower quadrant in 10, and other locations in five cases. Ten cases developed incisional hernias within one year of operation, while 13 cases developed hernia more than 10 years after opration. It seems that a difference in possible causal factors might have existed between the two groups. Computed tomography was useful for preoperative evaluation of contents in the hernia sac.<br> These patients were divided into five groups: 21 patients in whom vertical abdominoplasties were used and 10 who underwent transverse abdominoplasty. Fascial graft was applied in four cases.<br> The technique for repairing incisional hernia should be selected according to the contents in the hernia sac, its size, its form, and the duration of the asymptomatic period after past laparotomy. The main technical points are as follows: 1. if possivle, avoidance of resecting the peritoneal sac, like the keel operation; 2. transverse abdominoplasty where applicable; 3. reinforcement with fascial autogtaft, if necessary. Satisfactory results were observed in this series.

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