Mesh sutured repairs of contaminated incisional hernias.

BACKGROUND: We sought to evaluate the results of a new mesh sutured repair technique for closure of contaminated incisional hernias. METHODS: 48 patients with contaminated hernias 5 cm wide or greater by CT scan were closed with mesh sutures. Surgical site occurrence, infections, and hernia recurrence were compared to similar patient series reported in the literature. RESULTS: Of the 48 patients, 20 had clean-contaminated wounds, 16 had contaminated wounds, and 12 were infected. 69% of the patients underwent an anterior perforator sparing components release for hernias that averaged 10.5 cm transversely (range 5 cm-25 cm). SSO occurred in 27% of patients while SSI was 19%. There were no fistulas or delayed suture sinuses. With a mean follow-up of almost 12 months, 3 midline hernias recurred (6%). In these same patients, three parastomal hernias repaired with mesh sutures failed out of 4 attempted for a total failure rate of 13%. CONCLUSION: Mesh sutured closure represents a simplified and effective surgical strategy for contaminated midline incisional hernia repair.

Percutaneous endovascular repair of ruptured abdominal aortic aneurysms.

HYPOTHESIS: Percutaneous endovascular repair of ruptured abdominal aortic aneurysms (RAAAs) has better outcomes than traditional open surgical repair. DESIGN: Single-center retrospective review. SETTING: University hospital tertiary referral center. PATIENTS: Thirty-seven RAAAs treated using endovascular repair (n = 15) or open surgery (n = 22). INTERVENTIONS: From January 1, 2000, through December 31, 2005, 15 RAAAs were treated with endovascular stent graft exclusion using commercially available systems. Twenty-two other patients undergoing standard open surgical repair during the same interval comprised a control group for comparison. MAIN OUTCOME MEASURES: Early outcomes of percutaneous endovascular repair of RAAAs. RESULTS: Among the endovascular group, the mean +/- SD age was 73 +/- 9.8 years, 86.6% were men (n = 13), and 20.0% had a preoperative systolic blood pressure of 80 mm Hg or lower (n = 3). An entirely percutaneous procedure was performed in the final 11 patients using arterial closure systems. Technical success of attempted endovascular exclusion was 100.0%. The mean +/- SD procedure time (107 +/- 30 minutes), transfusion requirements (6.6 +/- 4.7 U), and length of stay (3.0 +/- 6.8 days) were statistically significantly reduced compared with open surgery. The 30-day mortality was 6.7% (1 of 15) compared with an open surgery 30-day mortality of 13.6% (3 of 22). No late complications (pseudoaneurysm, infection, lymphocele, or neuropathy) occurred after a completely percutaneous technique during a mean follow-up of 12 months. CONCLUSION: Percutaneous endovascular repair of RAAAs is a more expedient and less morbid alternative than open surgical repair.

Percutaneous drainage and explanation of an infected aortic endoluminal stent graft.

Endoluminal repair of abdominal aortic aneurysms (AAAs) has undergone explosive growth in the last decade. Although immediate benefits are attractive to both the patient and the treating physician, concerns regarding long-term success have dampened sustained enthusiasm for this technique. A rare but catastrophic complication is stent graft infection. This case report describes an early infection of an endoluminal aortic stent graft treated initially with percutaneous drainage and ultimately with staged extraanatomic bypass and graft explantation.