From the Guidelines
Classical repair is a traditional surgical technique that involves directly suturing or stitching torn tissues back together to restore their original anatomy and function, and it is still a viable option in certain cases, such as small defects in contaminated fields, as recommended by the 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias 1.
Key Points
- Classical repair is a time-tested technique that has been used in various surgical fields, including general surgery, orthopedics, and gynecology.
- The procedure involves making an incision to access the damaged area, removing any damaged tissue, and then carefully reconnecting the healthy tissue edges with sutures.
- The choice of suture material, either absorbable or non-absorbable, depends on the tissue type and location.
- Recovery time varies based on the specific repair, but generally requires a period of reduced activity to allow proper healing.
- According to the WSES guidelines, primary repair is recommended when the size of the defect is small (< 3 cm) in contaminated fields, as it allows for the restoration of anatomical integrity and promotes natural healing processes 1.
Considerations
- The use of classical repair in contaminated fields is supported by studies, such as the one by Han et al., which reported a low rate of infection (1.6%) and recurrences (15.9%) in a follow-up of 43 months 1.
- However, the guidelines also recommend considering the use of biological meshes in cases where direct suture is not feasible, as they can provide a low-morbidity alternative to prosthetic mesh products in complex settings 1.
- The choice between a cross-linked and a non-cross-linked biological mesh should be evaluated depending on the defect size and degree of contamination, as recommended by the guidelines 1.
From the Research
Definition of Classical Repair
- Classical repair, also known as tissue repair or suture repair, is a traditional method of hernia repair that involves fixing the mesh in place using sutures 2, 3.
- This method has been compared to other fixation methods, such as glue fixation and self-fixating mesh, in various studies 4, 5, 3, 6.
Characteristics of Classical Repair
- Classical repair involves the use of sutures to fix the mesh in place, which can cause tissue trauma and lead to chronic pain 2, 3.
- The operating time for classical repair is generally longer compared to other fixation methods, such as glue fixation 5, 6.
- Classical repair has been associated with a higher risk of complications, such as hematoma and seroma formation, compared to other fixation methods 3, 6.
Comparison with Other Fixation Methods
- Glue fixation has been shown to reduce chronic groin pain, hematoma, and acute postoperative pain compared to classical repair 3, 6.
- Self-fixating mesh has been shown to reduce operating time compared to classical repair, but has not been shown to reduce chronic pain or recurrence rates 2, 5.
- The choice of fixation method ultimately depends on the patient's preference and the surgeon's expertise 5.