[Method for the correction of ventral hernia using a parietal prosthesis held by a metal stapler. Apropos of seventy cases]

Abstract

The authors propose a technique of fixation of the parietal prosthesis by metallic staples in order to reduce the operation time which is often long. The operation was performed according to J Rive's principles, using a Dacron patch (n = 65) or a polyglactin patch (n = 5). A mechanical stapler for aponeurotic suture was used for fixation of the patch. The bent shape of the stapler made it possible to very easily insert the lateral edge of the patch, previously hemmed, to slip it under the rectus abdominis muscle and to clamp it onto the lateral linea alba. We placed the patch under tension very easily with circular clamping. Seventy ruptures were treated by this technique. In 80% of cases, the rupture was frontal and in 20% of cases, it was fronto-lateral. The mean diameter of the parietal defect was 15 cm (E = 10-35 cm). The time for fixation of prosthesis was less than 5 min; the usual duration of the operation was therefore considerably reduced. In every case, we obtained optimal tension of the suture, without any folds, and this very easily. There was no mortality. Two postoperative hematomas, one consecutive to an injury of the epigastric artery required a second operation. We only had one case of superficial parietal sepsis. None of these complications required removal of the parietal prosthesis. The functional results were always satisfactory for the patients who suffered no pain induration over the metallic staples. A radiological follow-up of the position of the prosthesis encircled by the metallic staples was systematically performed after every operation. Only one relapse, due to a technical error, was observed. If we consider that the follow-up of these results is about two years (3 months-5 years), they suggest that the use of a stapler allows strong fixation, without any fold and with a regular tension, of the prosthetic patch used in the treatment of large incisional hernia. If we compare this technique with the usual techniques of fixation, we can say that this technique significantly reduces the duration of the operation which is often long. These technical advantages help to reduce the long operating time and the risk of sepsis, which is always serious, also minimizing recurrences of the rupture.