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Scripta Scientifica Medica

The Chevrel Technique in the Treatment of Midline Giant Incisional Hernia

D. Mladenovikj, I. Lozev, A. Devaja, S.Tahir undefined, A. Nikolovski

Abstract


Introduction: Giant incisional hernia (GIH) is a serious pathological entity which is characterized with a massive loss of muscle and fascial tissue and a total impairment of the anatomical and physiological function of the anterior abdominal wall, which also leads to severe respiratory and visceral malfunction. Reconstruction is accompanied with a high rate of relapses, complications and even mortality.Materials and Methods: During a 15-year period (2000-2015), 319 patients in total have been operated on for midline GIH. Using the Chevrel classification, it is classified as an M4-W4R type of incissional hernia. The patients have been electively operated on under general endotracheal anesthesia. Standard reconstruction by Chevrel`s techniqe was used with the creation of a new linea alba. The defect on the anterior rectus sheath was covered with polypropylene mesh. Female to male ratio was 209/110 with a median age of 48 (31-72). The median BMI was 32.1. Concomitant cholecystectomies were done in 11 patients and dermolypectomies were performed on 31 at the same time.Results: There were no cases of intraoperative complications and mortality. Postoperative mortality, as a result of a perforated peptic ulcer was seen in one patient. The operative time after the improvement of the technique varied between 60-70 min. The average time of hospitalization was 8.8 days (range 7-21). SSI were noted in 56 (17%) patients. Seroma was a leading complication in our series. Partial necrosis of the skin was seen in 12 patients (4%). Hernia recurrence was observed in 7 patients (2.1%) during the follow-up period (6-48 months) in the controlled 284 patients.Conclusion: The original Chevrel technique consists of tissue reconstruction on the linea alba and approximation of rectus muscle, strengthened with a mesh lining. It represents an acceptable method with very good results. The low recurrence and complication rate, as well as the functional results, influence the acceptance of this method by highly specialized institutions that deal with the treatment of GIH.

Keywords

Keywords: Chevrel, incisional hernia




DOI: http://dx.doi.org/10.14748/ssm.v48i0.2266

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About The Authors

D. Mladenovikj

I. Lozev

A. Devaja

S.Tahir undefined

A. Nikolovski

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