A novel method of incisional hernia repair in a diabetic, smoking patient
Incisional hernia is a complication of abdominal surgery, either laparotomy or laparoscopy. Some may become so massive that they hamper a patient’s daily life, and become an embarrassment. The incidence of incisional hernia among diabetic, smoking patients is higher than in the general non-diabetic, non-smoking population. Generally, these massive hernias are repaired using a synthetic or a biological mesh, either alone or to bolster a sheath closure. In diabetics and smokers, infection of the mesh invariably occurs, resulting in removal of the prosthesis and recurrence of the hernia. In this case study, a novel repair using the patient’s own tissues to bolster a sheath closure was explored. A diabetic, smoking patient with a massive incisional hernia after surgery for a perforated peptic ulcer, with resultant sepsis and re-laparotomy 5 years prior to this presentation, had the hernia repaired without a mesh, using his residual skin to bolster the component separation closure repair technique.
The use of the patient’s autologous tissue resulted in a stable and firm hernia. In this diabetic, smoking patient, the use of autologous tissue for repair of a massive incisional hernia was found to decrease the complications, and it reduced the cost of the operation. Further study to validate the procedure is needed.
PD Motale, Department of General Surgery, 2 Military Hospital, Cape Town, South Africa
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Date published: 2019-06-05
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