The combined application of human acellular dermal matrix and vacuum wound drainage on incarcerated abdominal wall hernias.

PURPOSE: Complex contaminated or infected abdominal wall defects present a particularly challenging problem to the surgeon. The aim of this study was to describe our experience with human acellular dermal matrix (ADM) in incarcerated abdominal wall herniorrhaphy. METHODS: We retrospectively reviewed data from 63 patients (51 males and 12 females) who underwent emergency surgery for acute incarcerated abdominal wall hernias with ADM repair, between June 2008 and October 2011 at Beijing Chaoyang Hospital, Capital Medical University. RESULTS: All hernias were repaired with an intraperitoneal underlay repair and received a high-vacuum wound drainage system after herniorrhaphy. 19 patients underwent reinforced repair with component separation. Over a median follow-up period of 32 (range 13-58) months, the recurrence rate was 4.8%. Two patients developed bulges, one developed a hematoma, one developed a seroma, and one had a superficial wound infection. No patients developed fistulae, intestinal obstruction, abdominal pain, or stiffness of the abdominal wall postoperatively. CONCLUSION: Our study suggests that the use of ADM as a biological mesh combined with high-vacuum wound drainage system in complex abdominal wall reconstruction is acceptable without major side effects.

Inguinal hernia repair with tension-free hernioplasty under local anesthesia.

OBJECTIVE: To evaluate the use of local anesthesia in tension-free hernioplasty in a local hospital. METHODS: The study took place at Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China during the period from January 2007 to May 2008. All 110 patients who had undergone inguinal hernia repair with mesh under local anesthesia were included in the study. To increase the homogeneity of the sample, we excluded umbilical hernia repairs, parastomal hernia repairs, non-elective procedures, procedures not involving mesh, and repairs performed concurrently with another surgical procedure. We performed a retrospective review of all 110 patients' data. RESULTS: The average operating time was 45 minutes (30-70 minutes), and the average hospital stay was 3-4 days. There was no postoperative mortality in this study. No surgical site infection occurred. Two patients (18%) that suffered from a moderate scrotal hematoma had recovered after extract injection therapy was applied. The duration of incisional pain was 2-3 days, and no patient required post-operative analgesia. During the follow-up, no recurrence occurred. CONCLUSION: The use of local anesthesia in inguinal hernia repair with tension-free hernioplasty is a safe and effective alternative for inpatient treatment.