Pathologies Associated with Incisional Hernia: Timing of Intervention
UPDATES IN SURGERY(2008)
摘要
The treatment of concomitant endo-abdominal pathologies at the same time as incisional hernia repair remains a subject of
controversy in surgical practice. In recent years, treatment of incisional hernias, especially very large ones, has consisted
exclusively of prosthetic mesh repair. While initially mesh repair was used only in selected cases, it has since become the
gold standard in treating this pathology, due to technological innovations and the increased experience of surgeons carrying
out this procedure [1]. Since the early 1980s, the work of French, American and Italian surgeons has demonstrated the efficiency and feasibility
of prosthetic mesh repair [2–4]. New, increasingly sophisticated prostheses are being introduced almost on a daily basis; however, rejection and infection
of the mesh remain the most threatening complication that surgeons must consider. For this reason, the well-respected schools
of abdominal-wall surgery of Stoppa and Rives have always issued vigorous precautions regarding the uses of prosthetic meshes
for specific indications [5]. In this context, until the 1980s, the treatment of concomitant pathologies was absolutely contraindicated, as it was considered
to interfere with incisional hernia repair. Nevertheless, Stoppa and Rives have allowed that certain concomitant procedures
and pathologies can be managed during mesh repair without a high risk of mesh infection [6].
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