Dr.Tarek Said's Scientific Publications

Repair of large Abdominal Wall Hernias Using Expanded Abdominal Wall Musculature

Tarek Ahmed Said, M.D

The Department of Surgery, Faculty of Medicine, Cairo University

Egypt. J. Plast. Reconstr. Surg., Vol (24), No (1),2000: 71-77

A new technique to deal with huge midline anterior abdominal wall hernias is described using expanded anterolateral abdominal wall muscles and fascia by two tissue expanders placed laterally in the bloodless plane between the external and internal oblique muscles through small subcostal incisions lateral to the rectus abdominis muscle. 10 cases of huge midline hernias with a mean defect diameter of 13.5 cms were operated upon using two 800 cc expanders. Expansion of abdominal wall musculature was done for a mean period of 50 days and using a mean volume of 760 cc in each expander. Complications were in the form of bilateral seroma development in one case (10%) and unilateral infection in another (5% of expanders) (10% of cases). Both were treated and expansion was completed. Easy closure of abdominal wall defect was accomplished in all cases with no significant postoperative respiratory distress. No synthetic mesh was needed in any case and there were no recurrences on 6 months follow-ups. This technique provides an excellent choice for huge ventral midline abdominal wall hernia closure that avoids the use of synthetic mesh with its inherent hazards of resistant infection that can in some instances necessitate mesh removal. It avoids the limitations and disadvantages of using extra-abdominal flaps and moreover can be used as a remedy for complications of other methods of hernia repair especially infections and recurrence accompanying mesh hernioplasty. Expansion of abdominal muscles also serves to enlarge the capacity of abdominal cavity in face of returning hernial contents.

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