Hernia recurrence long term follow-up after open procedures of abdominal wall plasty – Prospective study including 142 patients

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plasty – Prospective study including 142 patients" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "376" "paginaFinal" => "383" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Mircea Mureşan, Simona Mureşan, Tivadar Bara, Radu Neagoe, Daniela Sala, Bogdan Suciu" "autores" => array:6 [ 0 => array:3 [ "nombre" => "Mircea" "apellidos" => "Mureşan" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Simona" "apellidos" => "Mureşan" "email" => array:1 [ 0 => "dr_muremir@yahoo.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "Tivadar" "apellidos" => "Bara" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Radu" "apellidos" => "Neagoe" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Daniela" "apellidos" => "Sala" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Bogdan" "apellidos" => "Suciu" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Clínica Cirugía 2, Universidad de Medicina y Farmacia, Tirgu Mures, Romania" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Disciplina Fisiología, Universidad de Medicina y Farmacia, Tirgu Mures, Romania" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Clínica Cirugía 1, Universidad de Medicina y Farmacia, Tirgu Mures, Romania" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => 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Mures, Calle Gh. Marinescu, No. 35, Código 504109, Condado Mures, Romania. Tel.: +40 7 4729 1591." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Seguimiento remoto de la recaída de hernia después de procesos abiertos de plastia de la pared abdominal–estudio prospectivo que incluye 142 pacientes" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1587 "Ancho" => 2391 "Tamanyo" => 102284 ] ] "descripcion" => array:1 [ "en" => "Diagram of the distribution of the population studied." ] ] ] "textoCompleto" => "BackgroundIncisional hernia is one of the most common complications of abdominal surgery. It is cited in the specialist literature with a frequency of between 2% and 11%, after primary laparotomy.<a class="elsevierStyleCrossRef" href="#bib0170">1</a> Most develop over the first 6 months<a class="elsevierStyleCrossRef" href="#bib0175">2</a> to 3 years after surgery.<a class="elsevierStyleCrossRef" href="#bib0180">3</a> Bearing in mind that between 8% and 29%<a class="elsevierStyleCrossRef" href="#bib0185">4</a> are asymptomatic, and therefore clinically undetectable, the true incidence of incisional hernias remains a subject of controversy. The main determining factors of the disorder are obesity, factors that increase intra-abdominal pressure (IAP), post-operative wound infection and the type of suture used for post-operative wound closure. Surgical treatment for the condition has changed greatly over the last decades with the appearance of prosthetic materials and laparoscopic surgery.<a class="elsevierStyleCrossRef" href="#bib0190">5</a> However, questions remain as to the type of mesh that should be used, where we should we place it in the layers of the abdominal wall and the sort of suture materials that should be used for fixation. These questions all require more precise, better-substantiated answers.<a class="elsevierStyleCrossRef" href="#bib0195">6</a>The purpose of this study was to analyse the rate of recurrence clinically and ultrasonically, within one year of follow-up, and the correlation of recurrence with the type of process used, variations of preoperative intra-abdominal pressure, the onset of complications, and the level of post-operative pain.Material and methodsA longitudinal, prospective cohort study, carried out between 23 March 2012 and 30 November 2013, which included 142 patients. Before starting the study, the consent was sought of the Ethics Committee of the institution where the study was to be undertaken, the Emergency Clinical Hospital of Tirgu Mures (Condado Mures, Romania), signed by the Hospital Director and the Manager of Surgical Clinic Number 2. The document was registered in the hospital file as Number 1225/2012. All the patients included in the study gave their specific informed consent prior to surgery.The patient inclusion criteria were: patients with primary or recurrent post-operative eventration associated with general (hypoproteinaemia, chronic cortico-steroid treatment, leukaemia) and abdominal comorbidities (abdominal cancer). Furthermore, cases of loss to follow-up were removed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Various individual parameters were followed, such as: age, sex, level of obesity, body mass index (BMI) and associated comorbidities. Recorded trans-bladder indirect IAP was measured twice, at the start of surgery (IAP1) and at the end of surgery, after the plasty and skin closure, maintaining myorelaxation conditions (IAP2). The measurements were taken with a dedicated kit – ABV 611 (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>The types of surgery were chosen according to the size of the parietal defect, found intraoperatively. For defects under 3cm, in young patients or in patients for whom the use of prosthetic materials was contraindicated, single plasties were performed. For defects of 5–9cm, plasties with mesh in a retromuscular position were used, using the eventration sac for protection of the viscera and, for defects of 10cm, full substitution of the parietal defect. Postoperative pain was assessed using a visual analogue scale (VAS) in 6 steps.General and local postoperative wound complications were followed up in all the patients, both on discharge and in the post-operative checks. Recurrence was evaluated 12 months after surgery, clinically and ultrasonically, recalling the patients and carrying out standard monitoring. All the patients included in the study were given antibiotics on the day of surgery and 2 days after surgery.Description of the surgical techniquesSimple plasty of the abdominal wall was performed using a single suture or superimposing the edges of the abdominal muscle wall.Supraaponeurotic positioning of polypropylene mesh was used to perform the simple plasty. After supraaponeurotic suturing of the muscle edges, with thick monofilament sutures of thickness 1 or 2, in order to close the defect, a polypropylene mesh was applied using the on-lay technique. The size varied from between 15cm and 20cm in width and from 25cm to 35cm in length. The method of fixing the anterior lamina of the right abdominal sheath was using multiple separate non-absorbable prolene 2/0 monofilament sutures. At all times the sides of the mesh covered at least a lateral 4cm of the right abdominal muscles. Inferior fixation had to include suturing of the mesh on the surface of the pubic symphysis. The on-lay technique was always followed by active supraaponeurotic suction drainage.The third procedure comprised placing the mesh on the right abdominal sheath, behind the muscles. For reconstruction of the right abdominal sheaths, through both the anterior and the posterior lamina, the hernia sac was also used in order to allow suturing without tension: this is why we avoid calling it the inlay procedure and we use the term “retromuscular plasty”. Through a minimum lateral dissection of the edges of the defect, the sheaths of the rectus abdominal muscles were opened as follows: on one side of the wound, an incision was made in the anterior lamina and the retromuscular plane entered, keeping the posterior lamina in an inferior position and a fragment of the eventration sac. On the opposite side an incision was made in the posterior lamina, leaving the other peritoneal flap of the sac joined to the anterior lamina. In both cases, the retromuscular dissection was carried out with extreme care to protect the superior and inferior epigastric vessels, and the perforating branches. Then came the repair of the posterior lamina, also using the peritoneal flap joined with a continuous non-absorbable monofilament suture (size 1). After haemostasis the retromuscular mesh was inserted and fixed at a point with fine monofilament suture (prolene 4.0). The dimensions of the mesh varied between 25–35cm in width and 35–45cm in length. The superior fixation point was the xiphoid process, and the inferior fixation point was the pubic symphysis. Laterally, the mesh was implanted at least 4cm retromuscularly. After checking haemostasis, 2 drainage tubes were placed for 48h. The anterior lamina was reconstructed in the same way; the mesh was completely inserted in a new sheath, highly vascularised, and also protected from propagation of infection (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).<elsevierMultimedia ident="fig0015"></elsevierMultimedia>Patients with full parietal defect substitution with polypropylene mesh were included in the substitution plasty group. The hernia sac was prepared to be inserted in the musculoaponeurotic edges, without being removed. Because the parietal defect was greater than 10cm, it was useless to attempt an onlay process or dissection of the right abdominal sheaths, due to excessive tension on the suture lines. The two peritoneal sac flaps were stitched again with continuous monofilament suture (size 2.0). The mesh was applied to the entire surface of the defect and fixed at several separate points to the musculoaponeurotic edges using monofilament suture (size 1). Supraaponeurotic drainage was carried out routinely (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).<elsevierMultimedia ident="fig0020"></elsevierMultimedia>Results<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> presents the main statistical procedures in terms of individual factors, mean parietal defect, levels of obesity, variations in IAP, mean VAS, clinical and ultrasound recurrence, in correlation with the surgical techniques. Distribution by gender group showed the maximum incidence of the disease in women (68.21%) and by age group, at 60–70 years of age (32.95%). A total of 18 patients presented with associated comorbidities: 8 intra-abdominal neoplasms (stomach, colon, and rectum), 6 cases of connective tissue disease which required chronic corticosteroid treatment, 2 cases of nephrotic syndrome with hypoproteinaemia, and 2 cases of chronic leukaemia. Amongst the predisposing preoperative factors, obesity showed a statistically significant association with recurrence of the hernia within one year (p=0.009). The relationship between recurrence and the association of hypoproteinaemia with chronic corticosteroid treatment did not show statistically significant differences compared with the group with no comorbidities (p=0.244). By contrast, the presence of intra-abdominal neoplasms resulted in a significant increase of recurrence (p<0.001). By analysing the variations in IAP at the beginning and at the end of the operation, it was found that the retromuscular and substitution plasty procedures, considered tension free, significantly correlated with the simple and onlay plasty procedures. Therefore, it was established that between simple plasty and onlay plasty there are no statistically significant differences in IAP variation (p=0.058), but between retromuscular and substitution plasties, on the one hand, and simple and onlay plasties, on the other, the IAP varied in a statistically significant way (p<0.0445). By contrast, between retromuscular and substation plasties, the differences were not statistically significant (p=0.257) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Furthermore, the 4 types of procedures could significantly correlate with recurrence of the hernia (p=0.01). Post-operative pain was a major predictor of postoperative tension and recurrence. Therefore, on analysing the pain of hernia recurrence, there was a statistically significant association (p<0.001) (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia>The total post-operative complications were found in a proportion of 19.01%. Of these, 6.33% were general extraabdominal complications (bronchopneumonias, cerebro-vascular accidents and pulmonary emboli, which resulted in one death) and 1.40% intra-abdominal complications (intestinal obstruction and haemoperitoneum). In general, the postoperative complications resulted in a significantly greater number of recurrences (p=0.03). Analysing wound infection separately, this significantly increased the recurrence of hernia disease (p=0.01). An important factor contributing to complications was neoplastic disease, 1 case of thromboembolism and 2 wound infections (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>DiscussionThere are many studies in the specialist literature which highlight the common factors of the onset of incisional hernia. These are general<a class="elsevierStyleCrossRef" href="#bib0200">7</a> and local. Postoperative wound infection substantially increases the incidence of the disease, and is considered the most important factor (<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>). Carrel<a class="elsevierStyleCrossRef" href="#bib0205">8</a> was the first to describe the relationship between wound infection and the onset of a hernia. Bucknall et al.<a class="elsevierStyleCrossRef" href="#bib0210">9</a> demonstrated that 48% of patients with postoperative wound infection developed a hernia. In our study, wound infection was a major, statistically significant factor contributing to recurrence, of the 6 cases of wound infection, 5 presented hernia recurrence. In traditional surgery, the mid-line incision is the easiest, as it provides adequate exposure, irrespective of the disease, and because there is the least blood loss; therefore it is the most used.<a class="elsevierStyleCrossRef" href="#bib0215">10</a><elsevierMultimedia ident="tbl0025"></elsevierMultimedia>Other research studies have looked at repair of the linea alba. Tera and Aberg<a class="elsevierStyleCrossRef" href="#bib0220">11</a> demonstrated that sutures placed widely up to the edges of the abdominal rectus muscles were followed by a lower number of incisional hernias than sutures placed directly through the linea alba, which is a weak structure that predisposes to spontaneous hernia and diastasis. Lateral paramedian incisions were followed by lower morbidity compared to mid-line incisions, in a study by Cahalane et al.<a class="elsevierStyleCrossRef" href="#bib0225">12</a> on a total of 1203 patients. With regard to transverse or even oblique incisions, outcomes are controversial in terms of the onset of incisional hernia.<a class="elsevierStyleCrossRef" href="#bib0230">13</a> However, in the last 3 cases of patients included in the study, the greatest disadvantage was exposure of the inferior part of the peritoneal cavity and denervation, followed by weakening of the muscles.<a class="elsevierStyleCrossRef" href="#bib0235">14</a> In the patients included in the study, since mid-line incisions were performed in almost all cases, only two being subcostal and one lateral, we cannot reach statistically significant conclusions about hernia recurrence according to the type of incision.The way the abdominal wall is closed is another factor to distinguish hernia morbidity. The consequence of with continuous double loop suture is a slight increase in IAP. In a study by Niggebrügge et al.<a class="elsevierStyleCrossRef" href="#bib0240">15</a> in which they compared morbidity after closure with continuous suture with morbidity after closure with separate sutures, the continuous suture technique was followed by a greater number of early wound dehiscences, and a higher incidence of hernia. However, if the continuous method is chosen for closing the abdominal wall, it is recommended that nonabsorbable monofilament sutures are used, and if interrupted closure is preferred, absorbable sutures should be chosen.<a class="elsevierStyleCrossRef" href="#bib0245">16</a> Continuous, double loop, monofilament sutures were used on the patients in the study who underwent simple plasties.The time of onset of hernia varies, according to the authors, between several months and several years. Mudge and Hughes<a class="elsevierStyleCrossRef" href="#bib0250">17</a> demonstrated in their study that 50% of hernias appeared in the first year of follow-up and 80% in the first 3 years. Another study undertaken by Akman<a class="elsevierStyleCrossRef" href="#bib0255">18</a> reported a 52% onset of hernias in the first 6 months, 68% in the first year and 79% in the first 2 years. Langer and Christiansen,<a class="elsevierStyleCrossRef" href="#bib0260">19</a> and other authors,<a class="elsevierStyleCrossRefs" href="#bib0265">20,21</a> reached the conclusion that most recurrences occurred in the first 3 years, and the majority of these in the first year.The aim in this study was to monitor recurrence over one year's follow-up. In order to increase the reliability of the diagnosis, clinical examination was backed up with ultrasound tests, which detected 3 cases that were not diagnosed clinically.Obesity is another major risk factor in open hernia surgery; however, this risk was significantly reduced when laparoscopic techniques were introduced into medical practice. Thus, in a study by Saureland y Korenkov in 2004,<a class="elsevierStyleCrossRef" href="#bib0275">22</a> it was demonstrated that out of a total of 160 patients followed up over 2 years, the general rate of recurrence was 11%, obesity being a statistically significant predisposing factor (p=0.03). In our study, obesity significantly correlated with recurrence of the hernia. Furthermore, a good number of the patients in the study presented varying levels of obesity (69.27%).The difficulty in finding the “ideal” mesh has resulted in the development of the hole characteristics of compound meshes. These combine various materials and are based on the latest models of mesh. The main advantage of the compound meshes is that they can be used in the intraperitoneal space, and reduce the formation of adherences. Despite the wide availability of brands, they all still use one of the 3 basic materials: polypropylene, polyester and ePTFE.<a class="elsevierStyleCrossRef" href="#bib0280">23</a>In plasties using mesh, irrespective of the method, polypropylene was used fixed with separate monofilament sutures. For visceral protection, in order to avoid fistulae and sores, in retromuscular and full defect substitution plasties, the peritoneum of the hernia sac was used, or suturing the omentum to the muscle/nerve edge of the wound.Finally, a very important factor in recurrence is the type of abdominal wall plasty. In addition to technical and posttraumatic defects, the surgical techniques should include the routine use of meshes. The only exception being defects smaller than 3cm, according to Jenkins, who recommends closure using continuous suture.<a class="elsevierStyleCrossRef" href="#bib0285">24</a> Hernia recurrence after simple repair of the abdominal wall is cited in several studies in the literature, varying between 35% and 50%. In our study, simple plasty using continuous double loop monofilament suture resulted in a greater recurrence rate (40.74%), but also in high postoperative pain intensity. Postoperative supraaponeurotic complications, although present, were fewer than with the onlay plasties. The use of meshes significantly reduced the relapse rate, but complications occurred associated with the presence of the mesh and the surgical technique employed to implant it. The onlay technique comprises implanting the supraaponeurotic mesh in order to reinforce a simple plasty. A study by Venclauskas et al.<a class="elsevierStyleCrossRef" href="#bib0290">25</a> on 161 patients identified a relapse rate of 31% with simple sutures and of 11% for onlay positioning (p<0.05). However, in patients who underwent the onlay technique, the postoperative complications (seroma, wound infection) were significantly higher and resulted in a longer hospital stay. Kingsnorth et al.<a class="elsevierStyleCrossRef" href="#bib0295">26</a> found the same in their study, where recurrence was very low (3.4%), but the postoperative complications increased (>10%). The results of this study confirm the data in the specialist literature, in that postoperative complications associated with the wound involved haematoma, supraaponeurotic seroma and wound infection. Furthermore, there were high levels of postoperative pain. Recurrence registered after the onlay process was 16.07%, lower than with plasties with no mesh. In all cases, recurrence after an onlay plasty occurred on the edges of the mesh, between this and the xiphoid (one case), between the mesh and the pubis symphysis (2 cases), and the remainder on the side of the mesh. In the specialist literature, the recurrence rate depends on the process used and the material used in the plasty and varies with time and from one author to another (<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>).<a class="elsevierStyleCrossRefs" href="#bib0270">21,27–32</a><elsevierMultimedia ident="tbl0030"></elsevierMultimedia>Placement of retromuscular mesh and the use of the eventration sac to protect the viscera, proved to have better outcomes thanks to better blood supply to the area where the mesh was implanted, and therefore resulted in fewer postoperative complications.<a class="elsevierStyleCrossRef" href="#bib0280">23</a> Vries Reilingh et al.,<a class="elsevierStyleCrossRef" href="#bib0330">33</a> when they compared the 3 techniques (onlay, inlay, sublay), concluded that the sublay procedure was superior in terms of recurrence and complications. The lowest rate of relapse in our study was registered for retromuscular mesh placement and complete replacement of the parietal defect with mesh. Moreover, the postoperative complications were reduced and the intensity of postoperative pain was lower than that after simple and onlay plasties.The variations of IAP in the 4 types of plasty could correlate with the extent of tension created by the sutures. Analyzing the outcomes and correlations, we can state that variations in IAP were a true indicator of the tension-free principle, with statistically significant differences between the retromuscular procedures and the replacement procedures, against procedures performed with greater suture tension, simple and onlay plasties.The association of the comorbidities is, without doubt, a risk factor in hernia recurrence.<a class="elsevierStyleCrossRef" href="#bib0200">7</a> In our study, hypoalbuminaemia, corticosteroid treatment, leukaemia did not significantly contribute to an increased number of recurrences or postoperative complications, probably due to the help of exclusive surgical treatment with meshes (6 onlay plasties and 4 retromuscular plasties) with the appropriate adjuvant therapy of the underlying disease during follow-up. By contrast, neoplastic disease contributed to the number of relapses, mainly the association with wasting syndrome.<a class="elsevierStyleCrossRef" href="#bib0170">1</a> Relapse can also be explained by the plasties undertaken. The intraoperative septic time was the factor that dictated the choice of plasty in the cancer patients, which contraindicated the use of mesh in 5 cases. Postoperative wound complications were also associated with septic times and with the immunosuppression characteristic of all neoplasms.<a class="elsevierStyleCrossRef" href="#bib0265">20</a>ConclusionsHernia is a common complication of laparotomy. The individual factors which favour the onset of relapse include obesity and the association with neoplasms. Hernia recurrence was more frequent in simple plasties than in those using mesh. Amongst the procedures using mesh, plasty had a higher rate of recurrence. Postoperative complications were generated and associated with the wound, and were more common in simple and onlay plasties. Hernia recurrence correlated significantly with greater variations in IAP and increased postoperative pain. Ultrasound might increase the accuracy of hernia diagnosis.Ethical disclosuresProtection of human and animal subjectsThe authors declare that no experiments were performed on humans or animals for this study.Confidentiality of dataThe authors declare that they have followed the protocols of their work center on the publication of patient data.Right to privacy and informed consentThe authors declare that no patient data appear in this article.FundingThis article was published thanks to the Human Resources Development Operational Programme of the European Social Fund, 2007–2013, project Number POSDRU/159/1.5/S/136893.Conflict of interestsThe authors have no conflict of interests to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres750989" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec753753" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres750990" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec753754" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Background" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Description of the surgical techniques" ] ] ] 6 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusions" ] 9 => array:3 [ "identificador" => "sec0040" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0050" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0055" "titulo" => "Right to privacy and informed consent" ] ] ] 10 => array:2 [ "identificador" => "sec0060" "titulo" => "Funding" ] 11 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of interests" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-05-07" "fechaAceptado" => "2015-10-14" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec753753" "palabras" => array:5 [ 0 => "Incisional hernia" 1 => "Onlay" 2 => "Retromuscular plasty" 3 => "Recurrent hernia" 4 => "Intra-abdominal pressure" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec753754" "palabras" => array:5 [ 0 => "Hernia incisional" 1 => "Onlay" 2 => "Plastia retromuscular" 3 => "Recurrencia de la hernia" 4 => "Presión intraabdominal" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "BackgroundThe incisional hernia continues to be a frequent complication of laparotomies. The purpose of study is the analysis of hernia disease relapse after one year after different open plasties methods of the abdominal wall. Material and methodsA prospective longitudinal study was performed that included 142 patients. An analysis was performed on the individual data, the level of obesity, intra-surgical variations in intra-abdominal pressure, the intensity of post-surgical pain, the post-surgical complications, and the types of plasties of abdominal wall, simple and with polypropylene mesh. ResultsThe analysis of studied group showed a general rate of relapse of 16.9%, and within the 4 procedures, 40.74% in the case of simple plasties, of 16.07% after the only plasties, 6.97% after the retro-muscular plasties, and 6.25% after the full substitution of parietal defect. On analysing the collected, hernia relapse was statistically significantly related to the level of obesity, variations in intra-abdominal pressure, post-surgical pain, and the type of procedure performed. ConclusionsHernia is a frequent complication of laparotomies. Hernia relapse was more frequent in the case of simple plasties. Among the mesh procedures, the onlay plasty showed a higher rate of relapse and post-surgical complications. Hernia relapse was more frequent in the case of variations of intra-abdominal pressure, and with increased post-surgical pain. The use of an echography examination may increase the accuracy of the presence of hernia disease." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "AntecedentesLa hernia incisional sigue siendo una complicación común de las laparotomías. El propósito del estudio es analizar la recidiva de hernia en un año, después de varios métodos abiertos de plastia de la pared abdominal. Material y métodosEstudio longitudinal prospectivo, en el que se incluyó a 142 pacientes. Se analizaron: los datos individuales, el grado de obesidad, las variaciones intraoperatorias de la presión abdominal, la intensidad del dolor postoperatorio, las complicaciones postoperatorias y los tipos de plastias de la pared abdominal: simple y con malla de polipropileno. ResultadosEl análisis del grupo estudiado estableció una tasa general de reincidencia de 16.9% y, en los 4 procesos, del 40.74% en caso de plastias simples, del 16.07% después de plastias onlay, del 6.97% después de plastias retromusculares y del 6.25% después de la sustitución completa de la avería parietal. Mediante el análisis de los datos obtenidos, la recidiva de la hernia fue significativamente correlacionada con: el grado de obesidad, las variaciones de la presión intraabdominal, el dolor postoperatorio y el tipo de procedimiento realizado. ConclusionesLa recurrencia de la hernia fue más frecuente en las plastias simples. Entre los procesos con malla, a la plastia onlay se le asignó una mayor tasa de recaídas y complicaciones postoperatorias. La recurrencia de la hernia fue más frecuente en las variaciones de la presión intraabdominal y con el dolor postoperatorio aumentado. La realización de la ecografía puede aumentar la precisión de la presencia de la hernia." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Mureşan M, Mureşan S, Bara T, Neagoe R, Sala D, Suciu B. Seguimiento remoto de la recaída de hernia después de procesos abiertos de plastia de la pared abdominal–estudio prospectivo que incluye 142 pacientes. Cir Cir. 2016;84:376–383." ] ] "multimedia" => array:10 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1587 "Ancho" => 2391 "Tamanyo" => 102284 ] ] "descripcion" => array:1 [ "en" => "Diagram of the distribution of the population studied." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 752 "Ancho" => 990 "Tamanyo" => 90741 ] ] "descripcion" => array:1 [ "en" => "Measurement of intraabdominal pressure using the dedicated kit Abviser ABV 611." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1752 "Ancho" => 1654 "Tamanyo" => 195371 ] ] "descripcion" => array:1 [ "en" => "Diagram of retromuscular plasty. M: muscle." ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 275 "Ancho" => 990 "Tamanyo" => 91449 ] ] "descripcion" => array:1 [ "en" => "Diagram of plasty with substitution mesh." ] ] 4 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "MPD: medium parietal defect; VAS: visual analogue scale; IAP1: initial intraabdominal pressure; IAP2: end intra abdominal pressure.In bold, the total number of recurrences." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Types of plasty \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">n \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">MPD \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Obesity</th><th class="td" title="table-head " align="left" valign="top" scope="col">IAP2–IAP1 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">VASm \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Clinical recurrences (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Ultrasound-detected recurrences Total n % \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">I \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">II \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">III \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Simple plasties \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2576 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.254 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.623 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (33.34) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (40.74) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Onlay plasties \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3636 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.425 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.886 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (14.28) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (16.07) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Retromuscular plasties \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6245 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.168 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.862 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (6.97) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (6.97) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Substitution plasties \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12,470 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.187 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (6.25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (6.25) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">142 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 (14.78) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 (16.90) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1242626.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Correlations between medium parietal defect, obesity, IAP, evaluation of pain and the number of relapses in relation to the surgical technique." ] ] 5 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "IAP1: initial intraabdominal pressure; IAP2: end intraabdominal pressure.In bold, statistically significant data." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">IAP2–IAP1 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Simple plasties \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Onlay plasties \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Retromuscular plasties \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Substitution plasties \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Simple plasties \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.058 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0037 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0445 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Onlay plasties \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Retromuscular plasties \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.257 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1242628.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Statistical comparisons between the surgical procedures with IAP2–IAP1 as the variable." ] ] 6 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "VAS: visual analogue scale.In bold, statistically significant data." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">VAS \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Simple plasties \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Onlay plasties \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Retromuscular plasties \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Substitution plasties \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Simple plasties \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.026 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Onlay plasties \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Retromuscular plasties \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.254 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1242624.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Comparisons of the surgical procedures with the variable of pain assessment on the visual analogue scale." ] ] 7 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Postoperative complications \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Simple plasties \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Onlay plasties \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Retromuscular plasties \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Substitution plasties \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">General complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Intraabdominal complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Supraaponeurotic haematoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Supraaponeurotic seroma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Intraparietal haematoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Wound infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1242625.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Postoperative complications." ] ] 8 => array:8 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at5" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">General factors</th><th class="td" title="table-head " align="left" valign="top" scope="col">Local factors \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Major \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Minor \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chronic pulmonary diseases \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Obesity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Wound infection \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Steroids \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Wound haematoma \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Type 2 diabetes mellitus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Postoperative ventilation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Type of mesh \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Malnutrition \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Kidney failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Type of plasty \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Jaundice \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Connective tissue disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Radiotherapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Malignant disorders \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chemotherapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Transfusions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Oral anticoagulants \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Anaemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1242629.png" ] ] ] ] "descripcion" => array:1 [ "en" => "General and local predisposing factors of hernia recurrence." ] ] 9 => array:8 [ "identificador" => "tbl0030" "etiqueta" => "Table 6" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at6" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Study \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Year \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N. of patients \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Follow-up \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Type of plasty \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Relapse in % \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Usher VAS: visual analogue scale \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1962 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">541 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Marlex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Stoppa<a class="elsevierStyleCrossRef" href="#bib0305">28</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1989 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">751 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mesh \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Liakakos et al.<a class="elsevierStyleCrossRef" href="#bib0310">29</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1994 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">102 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7.6 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Marlex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Schumpelick et al.<a class="elsevierStyleCrossRef" href="#bib0315">30</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1996 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">272 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Preperitoneal mesh \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Leber et al.<a class="elsevierStyleCrossRef" href="#bib0320">31</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1998 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">119 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6.7 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mesh \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Langer et al.<a class="elsevierStyleCrossRef" href="#bib0270">21</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2003 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">155 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">44 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Autodermal mesh \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Basoglu et al.<a class="elsevierStyleCrossRef" href="#bib0325">32</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2004 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">264 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mesh \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1242627.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Recurrence rate reported in various studies with long-term follow-up." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:33 [ 0 => array:3 [ "identificador" => "bib0170" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence of and risk factors for incisional hernia after abdominal surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K. 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Seguimiento remoto de la recaída de hernia después de procesos abiertos de plastia de la pared abdominal–estudio prospectivo que incluye 142 pacientes

Mircea Mureşana, Simona Mureşanb,

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dr_muremir@yahoo.com

Corresponding author at: Tg. Mures, Calle Gh. Marinescu, No. 35, Código 504109, Condado Mures, Romania. Tel.: +40 7 4729 1591.

, Tivadar Baraa, Radu Neagoea, Daniela Salaa, Bogdan Suciuc

a Clínica Cirugía 2, Universidad de Medicina y Farmacia, Tirgu Mures, Romania

b Disciplina Fisiología, Universidad de Medicina y Farmacia, Tirgu Mures, Romania

c Clínica Cirugía 1, Universidad de Medicina y Farmacia, Tirgu Mures, Romania

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within one year of follow-up&#44; and the correlation of recurrence with the type of process used&#44; variations of preoperative intra-abdominal pressure&#44; the onset of complications&#44; and the level of post-operative pain&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">A longitudinal&#44; prospective cohort study&#44; carried out between 23 March 2012 and 30 November 2013&#44; which included 142 patients&#46; Before starting the study&#44; the consent was sought of the Ethics Committee of the institution where the study was to be undertaken&#44; the Emergency Clinical Hospital of Tirgu Mures &#40;Condado Mures&#44; Romania&#41;&#44; signed by the Hospital Director and the Manager of Surgical Clinic Number 2&#46; The document was registered in the hospital file as Number 1225&#47;2012&#46; All the patients included in the study gave their specific informed consent prior to surgery&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The patient inclusion criteria were&#58; patients with primary or recurrent post-operative eventration associated with general &#40;hypoproteinaemia&#44; chronic cortico-steroid treatment&#44; leukaemia&#41; and abdominal comorbidities &#40;abdominal cancer&#41;&#46; Furthermore&#44; cases of loss to follow-up were removed &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Various individual parameters were followed&#44; such as&#58; age&#44; sex&#44; level of obesity&#44; body mass index &#40;BMI&#41; and associated comorbidities&#46; Recorded trans-bladder indirect IAP was measured twice&#44; at the start of surgery &#40;IAP<span class="elsevierStyleInf">1</span>&#41; and at the end of surgery&#44; after the plasty and skin closure&#44; maintaining myorelaxation conditions &#40;IAP<span class="elsevierStyleInf">2</span>&#41;&#46; The measurements were taken with a dedicated kit &#8211; ABV 611 &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The types of surgery were chosen according to the size of the parietal defect&#44; found intraoperatively&#46; For defects under 3<span class="elsevierStyleHsp" style=""></span>cm&#44; in young patients or in patients for whom the use of prosthetic materials was contraindicated&#44; single plasties were performed&#46; For defects of 5&#8211;9<span class="elsevierStyleHsp" style=""></span>cm&#44; plasties with mesh in a retromuscular position were used&#44; using the eventration sac for protection of the viscera and&#44; for defects of 10<span class="elsevierStyleHsp" style=""></span>cm&#44; full substitution of the parietal defect&#46; Postoperative pain was assessed using a visual analogue scale &#40;VAS&#41; in 6 steps&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">General and local postoperative wound complications were followed up in all the patients&#44; both on discharge and in the post-operative checks&#46; Recurrence was evaluated 12 months after surgery&#44; clinically and ultrasonically&#44; recalling the patients and carrying out standard monitoring&#46; All the patients included in the study were given antibiotics on the day of surgery and 2 days after surgery&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Description of the surgical techniques</span><p id="par0035" class="elsevierStylePara elsevierViewall">Simple plasty of the abdominal wall was performed using a single suture or superimposing the edges of the abdominal muscle wall&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Supraaponeurotic positioning of polypropylene mesh was used to perform the simple plasty&#46; After supraaponeurotic suturing of the muscle edges&#44; with thick monofilament sutures of thickness 1 or 2&#44; in order to close the defect&#44; a polypropylene mesh was applied using the on-lay technique&#46; The size varied from between 15<span class="elsevierStyleHsp" style=""></span>cm and 20<span class="elsevierStyleHsp" style=""></span>cm in width and from 25<span class="elsevierStyleHsp" style=""></span>cm to 35<span class="elsevierStyleHsp" style=""></span>cm in length&#46; The method of fixing the anterior lamina of the right abdominal sheath was using multiple separate non-absorbable prolene 2&#47;0 monofilament sutures&#46; At all times the sides of the mesh covered at least a lateral 4<span class="elsevierStyleHsp" style=""></span>cm of the right abdominal muscles&#46; Inferior fixation had to include suturing of the mesh on the surface of the pubic symphysis&#46; The on-lay technique was always followed by active supraaponeurotic suction drainage&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The third procedure comprised placing the mesh on the right abdominal sheath&#44; behind the muscles&#46; For reconstruction of the right abdominal sheaths&#44; through both the anterior and the posterior lamina&#44; the hernia sac was also used in order to allow suturing without tension&#58; this is why we avoid calling it the inlay procedure and we use the term &#8220;retromuscular plasty&#8221;&#46; Through a minimum lateral dissection of the edges of the defect&#44; the sheaths of the rectus abdominal muscles were opened as follows&#58; on one side of the wound&#44; an incision was made in the anterior lamina and the retromuscular plane entered&#44; keeping the posterior lamina in an inferior position and a fragment of the eventration sac&#46; On the opposite side an incision was made in the posterior lamina&#44; leaving the other peritoneal flap of the sac joined to the anterior lamina&#46; In both cases&#44; the retromuscular dissection was carried out with extreme care to protect the superior and inferior epigastric vessels&#44; and the perforating branches&#46; Then came the repair of the posterior lamina&#44; also using the peritoneal flap joined with a continuous non-absorbable monofilament suture &#40;size 1&#41;&#46; After haemostasis the retromuscular mesh was inserted and fixed at a point with fine monofilament suture &#40;prolene 4&#46;0&#41;&#46; The dimensions of the mesh varied between 25&#8211;35<span class="elsevierStyleHsp" style=""></span>cm in width and 35&#8211;45<span class="elsevierStyleHsp" style=""></span>cm in length&#46; The superior fixation point was the xiphoid process&#44; and the inferior fixation point was the pubic symphysis&#46; Laterally&#44; the mesh was implanted at least 4<span class="elsevierStyleHsp" style=""></span>cm retromuscularly&#46; After checking haemostasis&#44; 2 drainage tubes were placed for 48<span class="elsevierStyleHsp" style=""></span>h&#46; The anterior lamina was reconstructed in the same way&#59; the mesh was completely inserted in a new sheath&#44; highly vascularised&#44; and also protected from propagation of infection &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Patients with full parietal defect substitution with polypropylene mesh were included in the substitution plasty group&#46; The hernia sac was prepared to be inserted in the musculoaponeurotic edges&#44; without being removed&#46; Because the parietal defect was greater than 10<span class="elsevierStyleHsp" style=""></span>cm&#44; it was useless to attempt an onlay process or dissection of the right abdominal sheaths&#44; due to excessive tension on the suture lines&#46; The two peritoneal sac flaps were stitched again with continuous monofilament suture &#40;size 2&#46;0&#41;&#46; The mesh was applied to the entire surface of the defect and fixed at several separate points to the musculoaponeurotic edges using monofilament suture &#40;size 1&#41;&#46; Supraaponeurotic drainage was carried out routinely &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> presents the main statistical procedures in terms of individual factors&#44; mean parietal defect&#44; levels of obesity&#44; variations in IAP&#44; mean VAS&#44; clinical and ultrasound recurrence&#44; in correlation with the surgical techniques&#46; Distribution by gender group showed the maximum incidence of the disease in women &#40;68&#46;21&#37;&#41; and by age group&#44; at 60&#8211;70 years of age &#40;32&#46;95&#37;&#41;&#46; A total of 18 patients presented with associated comorbidities&#58; 8 intra-abdominal neoplasms &#40;stomach&#44; colon&#44; and rectum&#41;&#44; 6 cases of connective tissue disease which required chronic corticosteroid treatment&#44; 2 cases of nephrotic syndrome with hypoproteinaemia&#44; and 2 cases of chronic leukaemia&#46; Amongst the predisposing preoperative factors&#44; obesity showed a statistically significant association with recurrence of the hernia within one year &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;009&#41;&#46; The relationship between recurrence and the association of hypoproteinaemia with chronic corticosteroid treatment did not show statistically significant differences compared with the group with no comorbidities &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;244&#41;&#46; By contrast&#44; the presence of intra-abdominal neoplasms resulted in a significant increase of recurrence &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; By analysing the variations in IAP at the beginning and at the end of the operation&#44; it was found that the retromuscular and substitution plasty procedures&#44; considered tension free&#44; significantly correlated with the simple and onlay plasty procedures&#46; Therefore&#44; it was established that between simple plasty and onlay plasty there are no statistically significant differences in IAP variation &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;058&#41;&#44; but between retromuscular and substitution plasties&#44; on the one hand&#44; and simple and onlay plasties&#44; on the other&#44; the IAP varied in a statistically significant way &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0445&#41;&#46; By contrast&#44; between retromuscular and substation plasties&#44; the differences were not statistically significant &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;257&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Furthermore&#44; the 4 types of procedures could significantly correlate with recurrence of the hernia &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46; Post-operative pain was a major predictor of postoperative tension and recurrence&#46; Therefore&#44; on analysing the pain of hernia recurrence&#44; there was a statistically significant association &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">The total post-operative complications were found in a proportion of 19&#46;01&#37;&#46; Of these&#44; 6&#46;33&#37; were general extraabdominal complications &#40;bronchopneumonias&#44; cerebro-vascular accidents and pulmonary emboli&#44; which resulted in one death&#41; and 1&#46;40&#37; intra-abdominal complications &#40;intestinal obstruction and haemoperitoneum&#41;&#46; In general&#44; the postoperative complications resulted in a significantly greater number of recurrences &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;03&#41;&#46; Analysing wound infection separately&#44; this significantly increased the recurrence of hernia disease &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46; An important factor contributing to complications was neoplastic disease&#44; 1 case of thromboembolism and 2 wound infections &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0065" class="elsevierStylePara elsevierViewall">There are many studies in the specialist literature which highlight the common factors of the onset of incisional hernia&#46; These are general<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">7</span></a> and local&#46; Postoperative wound infection substantially increases the incidence of the disease&#44; and is considered the most important factor &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#46; Carrel<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">8</span></a> was the first to describe the relationship between wound infection and the onset of a hernia&#46; Bucknall et al&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">9</span></a> demonstrated that 48&#37; of patients with postoperative wound infection developed a hernia&#46; In our study&#44; wound infection was a major&#44; statistically significant factor contributing to recurrence&#44; of the 6 cases of wound infection&#44; 5 presented hernia recurrence&#46; In traditional surgery&#44; the mid-line incision is the easiest&#44; as it provides adequate exposure&#44; irrespective of the disease&#44; and because there is the least blood loss&#59; therefore it is the most used&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">10</span></a></p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Other research studies have looked at repair of the linea alba&#46; Tera and Aberg<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">11</span></a> demonstrated that sutures placed widely up to the edges of the abdominal rectus muscles were followed by a lower number of incisional hernias than sutures placed directly through the linea alba&#44; which is a weak structure that predisposes to spontaneous hernia and diastasis&#46; Lateral paramedian incisions were followed by lower morbidity compared to mid-line incisions&#44; in a study by Cahalane et al&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">12</span></a> on a total of 1203 patients&#46; With regard to transverse or even oblique incisions&#44; outcomes are controversial in terms of the onset of incisional hernia&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">13</span></a> However&#44; in the last 3 cases of patients included in the study&#44; the greatest disadvantage was exposure of the inferior part of the peritoneal cavity and denervation&#44; followed by weakening of the muscles&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">14</span></a> In the patients included in the study&#44; since mid-line incisions were performed in almost all cases&#44; only two being subcostal and one lateral&#44; we cannot reach statistically significant conclusions about hernia recurrence according to the type of incision&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The way the abdominal wall is closed is another factor to distinguish hernia morbidity&#46; The consequence of with continuous double loop suture is a slight increase in IAP&#46; In a study by Niggebr&#252;gge et al&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">15</span></a> in which they compared morbidity after closure with continuous suture with morbidity after closure with separate sutures&#44; the continuous suture technique was followed by a greater number of early wound dehiscences&#44; and a higher incidence of hernia&#46; However&#44; if the continuous method is chosen for closing the abdominal wall&#44; it is recommended that nonabsorbable monofilament sutures are used&#44; and if interrupted closure is preferred&#44; absorbable sutures should be chosen&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">16</span></a> Continuous&#44; double loop&#44; monofilament sutures were used on the patients in the study who underwent simple plasties&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The time of onset of hernia varies&#44; according to the authors&#44; between several months and several years&#46; Mudge and Hughes<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">17</span></a> demonstrated in their study that 50&#37; of hernias appeared in the first year of follow-up and 80&#37; in the first 3 years&#46; Another study undertaken by Akman<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">18</span></a> reported a 52&#37; onset of hernias in the first 6 months&#44; 68&#37; in the first year and 79&#37; in the first 2 years&#46; Langer and Christiansen&#44;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">19</span></a> and other authors&#44;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">20&#44;21</span></a> reached the conclusion that most recurrences occurred in the first 3 years&#44; and the majority of these in the first year&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The aim in this study was to monitor recurrence over one year&#39;s follow-up&#46; In order to increase the reliability of the diagnosis&#44; clinical examination was backed up with ultrasound tests&#44; which detected 3 cases that were not diagnosed clinically&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Obesity is another major risk factor in open hernia surgery&#59; however&#44; this risk was significantly reduced when laparoscopic techniques were introduced into medical practice&#46; Thus&#44; in a study by Saureland y Korenkov in 2004&#44;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">22</span></a> it was demonstrated that out of a total of 160 patients followed up over 2 years&#44; the general rate of recurrence was 11&#37;&#44; obesity being a statistically significant predisposing factor &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;03&#41;&#46; In our study&#44; obesity significantly correlated with recurrence of the hernia&#46; Furthermore&#44; a good number of the patients in the study presented varying levels of obesity &#40;69&#46;27&#37;&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">The difficulty in finding the &#8220;ideal&#8221; mesh has resulted in the development of the hole characteristics of compound meshes&#46; These combine various materials and are based on the latest models of mesh&#46; The main advantage of the compound meshes is that they can be used in the intraperitoneal space&#44; and reduce the formation of adherences&#46; Despite the wide availability of brands&#44; they all still use one of the 3 basic materials&#58; polypropylene&#44; polyester and ePTFE&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">23</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">In plasties using mesh&#44; irrespective of the method&#44; polypropylene was used fixed with separate monofilament sutures&#46; For visceral protection&#44; in order to avoid fistulae and sores&#44; in retromuscular and full defect substitution plasties&#44; the peritoneum of the hernia sac was used&#44; or suturing the omentum to the muscle&#47;nerve edge of the wound&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Finally&#44; a very important factor in recurrence is the type of abdominal wall plasty&#46; In addition to technical and posttraumatic defects&#44; the surgical techniques should include the routine use of meshes&#46; The only exception being defects smaller than 3<span class="elsevierStyleHsp" style=""></span>cm&#44; according to Jenkins&#44; who recommends closure using continuous suture&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">24</span></a> Hernia recurrence after simple repair of the abdominal wall is cited in several studies in the literature&#44; varying between 35&#37; and 50&#37;&#46; In our study&#44; simple plasty using continuous double loop monofilament suture resulted in a greater recurrence rate &#40;40&#46;74&#37;&#41;&#44; but also in high postoperative pain intensity&#46; Postoperative supraaponeurotic complications&#44; although present&#44; were fewer than with the onlay plasties&#46; The use of meshes significantly reduced the relapse rate&#44; but complications occurred associated with the presence of the mesh and the surgical technique employed to implant it&#46; The onlay technique comprises implanting the supraaponeurotic mesh in order to reinforce a simple plasty&#46; A study by Venclauskas et al&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">25</span></a> on 161 patients identified a relapse rate of 31&#37; with simple sutures and of 11&#37; for onlay positioning &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; However&#44; in patients who underwent the onlay technique&#44; the postoperative complications &#40;seroma&#44; wound infection&#41; were significantly higher and resulted in a longer hospital stay&#46; Kingsnorth et al&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">26</span></a> found the same in their study&#44; where recurrence was very low &#40;3&#46;4&#37;&#41;&#44; but the postoperative complications increased &#40;&#62;10&#37;&#41;&#46; The results of this study confirm the data in the specialist literature&#44; in that postoperative complications associated with the wound involved haematoma&#44; supraaponeurotic seroma and wound infection&#46; Furthermore&#44; there were high levels of postoperative pain&#46; Recurrence registered after the onlay process was 16&#46;07&#37;&#44; lower than with plasties with no mesh&#46; In all cases&#44; recurrence after an onlay plasty occurred on the edges of the mesh&#44; between this and the xiphoid &#40;one case&#41;&#44; between the mesh and the pubis symphysis &#40;2 cases&#41;&#44; and the remainder on the side of the mesh&#46; In the specialist literature&#44; the recurrence rate depends on the process used and the material used in the plasty and varies with time and from one author to another &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">21&#44;27&#8211;32</span></a></p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Placement of retromuscular mesh and the use of the eventration sac to protect the viscera&#44; proved to have better outcomes thanks to better blood supply to the area where the mesh was implanted&#44; and therefore resulted in fewer postoperative complications&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">23</span></a> Vries Reilingh et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">33</span></a> when they compared the 3 techniques &#40;onlay&#44; inlay&#44; sublay&#41;&#44; concluded that the sublay procedure was superior in terms of recurrence and complications&#46; The lowest rate of relapse in our study was registered for retromuscular mesh placement and complete replacement of the parietal defect with mesh&#46; Moreover&#44; the postoperative complications were reduced and the intensity of postoperative pain was lower than that after simple and onlay plasties&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The variations of IAP in the 4 types of plasty could correlate with the extent of tension created by the sutures&#46; Analyzing the outcomes and correlations&#44; we can state that variations in IAP were a true indicator of the tension-free principle&#44; with statistically significant differences between the retromuscular procedures and the replacement procedures&#44; against procedures performed with greater suture tension&#44; simple and onlay plasties&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">The association of the comorbidities is&#44; without doubt&#44; a risk factor in hernia recurrence&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">7</span></a> In our study&#44; hypoalbuminaemia&#44; corticosteroid treatment&#44; leukaemia did not significantly contribute to an increased number of recurrences or postoperative complications&#44; probably due to the help of exclusive surgical treatment with meshes &#40;6 onlay plasties and 4 retromuscular plasties&#41; with the appropriate adjuvant therapy of the underlying disease during follow-up&#46; By contrast&#44; neoplastic disease contributed to the number of relapses&#44; mainly the association with wasting syndrome&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">1</span></a> Relapse can also be explained by the plasties undertaken&#46; The intraoperative septic time was the factor that dictated the choice of plasty in the cancer patients&#44; which contraindicated the use of mesh in 5 cases&#46; Postoperative wound complications were also associated with septic times and with the immunosuppression characteristic of all neoplasms&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">20</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusions</span><p id="par0125" class="elsevierStylePara elsevierViewall">Hernia is a common complication of laparotomy&#46; The individual factors which favour the onset of relapse include obesity and the association with neoplasms&#46; Hernia recurrence was more frequent in simple plasties than in those using mesh&#46; Amongst the procedures using mesh&#44; plasty had a higher rate of recurrence&#46; Postoperative complications were generated and associated with the wound&#44; and were more common in simple and onlay plasties&#46; Hernia recurrence correlated significantly with greater variations in IAP and increased postoperative pain&#46; Ultrasound might increase the accuracy of hernia diagnosis&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Ethical disclosures</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Protection of human and animal subjects</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Confidentiality of data</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Right to privacy and informed consent</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Funding</span><p id="par0150" class="elsevierStylePara elsevierViewall">This article was published thanks to the <span class="elsevierStyleGrantSponsor" id="gs1">Human Resources Development Operational Programme of the European Social Fund</span>&#44; 2007&#8211;2013&#44; project Number <span class="elsevierStyleGrantNumber" refid="gs1">POSDRU&#47;159&#47;1&#46;5&#47;S&#47;136893</span>&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflict of interests</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
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              "identificador" => "abst0030"
              "titulo" => "Material y m&#233;todos"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
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            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusiones"
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        3 => array:2 [
          "identificador" => "xpalclavsec753754"
          "titulo" => "Palabras clave"
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        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Background"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Material and methods"
          "secciones" => array:1 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Description of the surgical techniques"
            ]
          ]
        ]
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          "identificador" => "sec0020"
          "titulo" => "Results"
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        7 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Conclusions"
        ]
        9 => array:3 [
          "identificador" => "sec0040"
          "titulo" => "Ethical disclosures"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Protection of human and animal subjects"
            ]
            1 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Confidentiality of data"
            ]
            2 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        10 => array:2 [
          "identificador" => "sec0060"
          "titulo" => "Funding"
        ]
        11 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Conflict of interests"
        ]
        12 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2015-05-07"
    "fechaAceptado" => "2015-10-14"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec753753"
          "palabras" => array:5 [
            0 => "Incisional hernia"
            1 => "Onlay"
            2 => "Retromuscular plasty"
            3 => "Recurrent hernia"
            4 => "Intra-abdominal pressure"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec753754"
          "palabras" => array:5 [
            0 => "Hernia incisional"
            1 => "<span class="elsevierStyleItalic">Onlay</span>"
            2 => "Plastia retromuscular"
            3 => "Recurrencia de la hernia"
            4 => "Presi&#243;n intraabdominal"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The incisional hernia continues to be a frequent complication of laparotomies&#46; The purpose of study is the analysis of hernia disease relapse after one year after different open plasties methods of the abdominal wall&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A prospective longitudinal study was performed that included 142 patients&#46; An analysis was performed on the individual data&#44; the level of obesity&#44; intra-surgical variations in intra-abdominal pressure&#44; the intensity of post-surgical pain&#44; the post-surgical complications&#44; and the types of plasties of abdominal wall&#44; simple and with polypropylene mesh&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The analysis of studied group showed a general rate of relapse of 16&#46;9&#37;&#44; and within the 4 procedures&#44; 40&#46;74&#37; in the case of simple plasties&#44; of 16&#46;07&#37; after the only plasties&#44; 6&#46;97&#37; after the retro-muscular plasties&#44; and 6&#46;25&#37; after the full substitution of parietal defect&#46; On analysing the collected&#44; hernia relapse was statistically significantly related to the level of obesity&#44; variations in intra-abdominal pressure&#44; post-surgical pain&#44; and the type of procedure performed&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Hernia is a frequent complication of laparotomies&#46; Hernia relapse was more frequent in the case of simple plasties&#46; Among the mesh procedures&#44; the onlay plasty showed a higher rate of relapse and post-surgical complications&#46; Hernia relapse was more frequent in the case of variations of intra-abdominal pressure&#44; and with increased post-surgical pain&#46; The use of an echography examination may increase the accuracy of the presence of hernia disease&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La hernia incisional sigue siendo una complicaci&#243;n com&#250;n de las laparotom&#237;as&#46; El prop&#243;sito del estudio es analizar la recidiva de hernia en un a&#241;o&#44; despu&#233;s de varios m&#233;todos abiertos de plastia de la pared abdominal&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio longitudinal prospectivo&#44; en el que se incluy&#243; a 142 pacientes&#46; Se analizaron&#58; los datos individuales&#44; el grado de obesidad&#44; las variaciones intraoperatorias de la presi&#243;n abdominal&#44; la intensidad del dolor postoperatorio&#44; las complicaciones postoperatorias y los tipos de plastias de la pared abdominal&#58; simple y con malla de polipropileno&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El an&#225;lisis del grupo estudiado estableci&#243; una tasa general de reincidencia de 16&#46;9&#37; y&#44; en los 4 procesos&#44; del 40&#46;74&#37; en caso de plastias simples&#44; del 16&#46;07&#37; despu&#233;s de plastias <span class="elsevierStyleItalic">onlay</span>&#44; del 6&#46;97&#37; despu&#233;s de plastias retromusculares y del 6&#46;25&#37; despu&#233;s de la sustituci&#243;n completa de la aver&#237;a parietal&#46; Mediante el an&#225;lisis de los datos obtenidos&#44; la recidiva de la hernia fue significativamente correlacionada con&#58; el grado de obesidad&#44; las variaciones de la presi&#243;n intraabdominal&#44; el dolor postoperatorio y el tipo de procedimiento realizado&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La recurrencia de la hernia fue m&#225;s frecuente en las plastias simples&#46; Entre los procesos con malla&#44; a la plastia <span class="elsevierStyleItalic">onlay</span> se le asign&#243; una mayor tasa de reca&#237;das y complicaciones postoperatorias&#46; La recurrencia de la hernia fue m&#225;s frecuente en las variaciones de la presi&#243;n intraabdominal y con el dolor postoperatorio aumentado&#46; La realizaci&#243;n de la ecograf&#237;a puede aumentar la precisi&#243;n de la presencia de la hernia&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Antecedentes"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Material y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Mure&#351;an M&#44; Mure&#351;an S&#44; Bara T&#44; Neagoe R&#44; Sala D&#44; Suciu B&#46; Seguimiento remoto de la reca&#237;da de hernia despu&#233;s de procesos abiertos de plastia de la pared abdominal&#8211;estudio prospectivo que incluye 142 pacientes&#46; Cir Cir&#46; 2016&#59;84&#58;376&#8211;383&#46;</p>"
      ]
    ]
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      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
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        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Diagram of the distribution of the population studied&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 752
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Measurement of intraabdominal pressure using the dedicated kit Abviser ABV 611&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1752
            "Ancho" => 1654
            "Tamanyo" => 195371
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Diagram of retromuscular plasty&#46; M&#58; muscle&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 275
            "Ancho" => 990
            "Tamanyo" => 91449
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Diagram of plasty with substitution mesh&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">MPD&#58; medium parietal defect&#59; VAS&#58; visual analogue scale&#59; IAP<span class="elsevierStyleInf">1</span>&#58; initial intraabdominal pressure&#59; IAP<span class="elsevierStyleInf">2</span>&#58; end intra abdominal pressure&#46;</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">In bold&#44; the total number of recurrences&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Types of plasty&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">MPD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Obesity</th><th class="td" title="table-head  " align="left" valign="top" scope="col">IAP<span class="elsevierStyleInf">2</span>&#8211;IAP<span class="elsevierStyleInf">1</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">VAS<span class="elsevierStyleInf">m</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Clinical recurrences &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Ultrasound-detected recurrences<br>Total <span class="elsevierStyleItalic">n</span> &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Simple plasties&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2576&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;254&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;623&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;33&#46;34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">11 &#40;40&#46;74&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Onlay plasties&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3636&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;425&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;886&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;14&#46;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">9 &#40;16&#46;07&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Retromuscular plasties&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6245&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;168&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;862&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;6&#46;97&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">3 &#40;6&#46;97&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Substitution plasties&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#44;470&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;187&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;6&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">1 &#40;6&#46;25&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">142&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#40;14&#46;78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">24 &#40;16&#46;90&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1242626.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Correlations between medium parietal defect&#44; obesity&#44; IAP&#44; evaluation of pain and the number of relapses in relation to the surgical technique&#46;</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">IAP<span class="elsevierStyleInf">1</span>&#58; initial intraabdominal pressure&#59; IAP<span class="elsevierStyleInf">2</span>&#58; end intraabdominal pressure&#46;</p><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">In bold&#44; statistically significant data&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">IAP<span class="elsevierStyleInf">2</span>&#8211;IAP<span class="elsevierStyleInf">1</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Simple plasties&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Onlay plasties&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Retromuscular plasties&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Substitution plasties&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Simple plasties&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;058&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">0&#46;0037</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">0&#46;0445</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Onlay plasties&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Retromuscular plasties&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;257&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab1242628.png"
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            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Statistical comparisons between the surgical procedures with IAP<span class="elsevierStyleInf">2</span>&#8211;IAP<span class="elsevierStyleInf">1</span> as the variable&#46;</p>"
        ]
      ]
      6 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
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        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Table "
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">VAS&#58; visual analogue scale&#46;</p><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">In bold&#44; statistically significant data&#46;</p>"
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">VAS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Simple plasties&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Onlay plasties&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Retromuscular plasties&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Substitution plasties&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Simple plasties&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">0&#46;026</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Onlay plasties&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Retromuscular plasties&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;254&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1242624.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Comparisons of the surgical procedures with the variable of pain assessment on the visual analogue scale&#46;</p>"
        ]
      ]
      7 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at4"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Postoperative complications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Simple plasties&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Onlay plasties&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Retromuscular plasties&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Substitution plasties&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">General complications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Intraabdominal complications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Supraaponeurotic haematoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Supraaponeurotic seroma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Intraparietal haematoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Wound infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1242625.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Postoperative complications&#46;</p>"
        ]
      ]
      8 => array:8 [
        "identificador" => "tbl0025"
        "etiqueta" => "Table 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at5"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">General factors</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Local factors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Major&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Minor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chronic pulmonary diseases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Obesity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Wound infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Steroids&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Male sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Wound haematoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Type 2 diabetes mellitus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Postoperative ventilation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Type of mesh&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Malnutrition&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Kidney failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Type of plasty&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Jaundice&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Connective tissue disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Radiotherapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Malignant disorders&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chemotherapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Transfusions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Oral anticoagulants&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Anaemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">General and local predisposing factors of hernia recurrence&#46;</p>"
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        "identificador" => "tbl0030"
        "etiqueta" => "Table 6"
        "tipo" => "MULTIMEDIATABLA"
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          0 => array:3 [
            "identificador" => "at6"
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        ]
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          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N&#46; of patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Follow-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Type of plasty&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Relapse in &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Usher VAS&#58; visual analogue scale&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1962&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">541&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Marlex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Stoppa<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">28</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1989&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">751&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mesh&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Liakakos et al&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">29</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1994&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">102&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;6 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Marlex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Schumpelick et al&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">30</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1996&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">272&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Preperitoneal mesh&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Leber et al&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">31</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1998&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">119&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#46;7 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mesh&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Langer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">21</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">155&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Autodermal mesh&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Basoglu et al&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">32</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">264&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mesh&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">Recurrence rate reported in various studies with long-term follow-up&#46;</p>"
        ]
      ]
    ]
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      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:33 [
            0 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence of and risk factors for incisional hernia after abdominal surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46; Itatsu"
                            1 => "Y&#46; Yokoyama"
                            2 => "G&#46; Sugawara"
                            3 => "H&#46; Kubota"
                            4 => "Y&#46; Tojima"
                            5 => "Y&#46; Kurumiya"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/bjs.9600"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Surg"
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                        "volumen" => "101"
                        "paginaInicial" => "1439"
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                        "link" => array:1 [
                          0 => array:2 [
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                            "web" => "Medline"
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            1 => array:3 [
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                      "titulo" => "Prospective clinical trial of factors predicting the early development of incisional hernia after midline laparotomy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46; Veljkovic"
                            1 => "M&#46; Protic"
                            2 => "A&#46; Gluhovic"
                            3 => "Z&#46; Potic"
                            4 => "Z&#46; Milosevici"
                            5 => "A&#46; Stojadinovic"
                          ]
                        ]
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jamcollsurg.2009.10.013"
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Natural course of incisional hernia and indications for repair"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46; Nieuwenhuizen"
                            1 => "J&#46;A&#46; Halm"
                            2 => "J&#46; Jeekel"
                            3 => "J&#46;F&#46; Lange"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
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                      "Revista" => array:6 [
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                  ]
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              ]
            ]
            3 => array:3 [
              "identificador" => "bib0185"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patient awareness and symptoms from an incisional hernia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "E&#46;Y&#46; Ah-Kee"
                            1 => "T&#46; Kallachil"
                            2 => "P&#46;J&#46; O&#8217;Dwyer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.9738/INTSURG-D-14-00039.1"
                      "Revista" => array:6 [
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                        "paginaInicial" => "241"
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                        ]
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                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Milestones in the history of hernia surgery&#58; prosthetic repair"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46;C&#46; Read"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10029-003-0169-2"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hernia"
                        "fecha" => "2004"
                        "volumen" => "8"
                        "paginaInicial" => "8"
                        "paginaFinal" => "14"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14586774"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incisional ventral hernias&#58; review of the literature and recommendations regarding the grading and technique of repair"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Ventral Hernia Working Group"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46; Breuing"
                            1 => "C&#46;E&#46; Butler"
                            2 => "S&#46; Ferzoco"
                            3 => "M&#46; Franz"
                            4 => "C&#46;S&#46; Hultman"
                            5 => "J&#46;F&#46; Kilbridge"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.surg.2010.01.008"
                      "Revista" => array:6 [
                        "tituloSerie" => "Surgery"
                        "fecha" => "2010"
                        "volumen" => "148"
                        "paginaInicial" => "544"
                        "paginaFinal" => "558"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20304452"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
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                ]
              ]
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              "identificador" => "bib0200"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incisional hernias&#46; Related risk factors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "E&#46; Yahchouchy-Chouillard"
                            1 => "T&#46; Aura"
                            2 => "O&#46; Picone"
                            3 => "J&#46;C&#46; Etienne"
                            4 => "A&#46; Fingerhut"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "68850"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dig Surg"
                        "fecha" => "2003"
                        "volumen" => "20"
                        "paginaInicial" => "3"
                        "paginaFinal" => "9"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12637797"
                            "web" => "Medline"
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                      ]
                    ]
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                ]
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            ]
            7 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effet d&#8217;un abc&#232;s distance sur la cicatrisation d&#8217;une plaie aseptique"
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Article information

ISSN: 24440507
Original language: English

DOI:10.1016/j.circen.2016.08.007

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 October	16	2	18
2024 September	60	15	75
2024 August	46	11	57
2024 July	47	6	53
2024 June	25	2	27
2024 May	34	8	42
2024 April	93	9	102
2024 March	50	8	58
2024 February	34	3	37
2024 January	116	3	119
2023 December	42	4	46
2023 November	58	8	66
2023 October	67	11	78
2023 September	37	12	49
2023 August	41	5	46
2023 July	36	6	42
2023 June	68	3	71
2023 May	58	5	63
2023 April	43	3	46
2023 March	62	4	66
2023 February	50	13	63
2023 January	45	6	51
2022 December	42	4	46
2022 November	42	5	47
2022 October	32	11	43
2022 September	54	19	73
2022 August	48	16	64
2022 July	32	10	42
2022 June	29	9	38
2022 May	24	7	31
2022 April	20	10	30
2022 March	53	7	60
2022 February	44	6	50
2022 January	68	14	82
2021 December	46	13	59
2021 November	25	4	29
2021 October	39	10	49
2021 September	25	11	36
2021 August	28	5	33
2021 July	11	10	21
2021 June	21	10	31
2021 May	17	11	28
2021 April	24	15	39
2021 March	13	9	22
2021 February	10	12	22
2021 January	14	13	27
2020 December	8	3	11
2020 November	15	5	20
2020 October	3	8	11
2020 September	9	9	18
2020 August	23	7	30
2020 July	18	7	25
2020 June	13	3	16
2020 May	21	9	30
2020 April	20	3	23
2020 March	12	4	16
2020 February	8	5	13
2020 January	17	10	27
2019 December	15	10	25
2019 November	16	6	22
2019 October	26	4	30
2019 September	21	9	30
2019 August	7	5	12
2019 July	14	12	26
2019 June	44	19	63
2019 May	120	22	142
2019 April	46	10	56
2019 March	12	2	14
2019 February	18	2	20
2019 January	12	1	13
2018 December	11	1	12
2018 November	11	4	15
2018 October	33	9	42
2018 September	15	2	17
2018 August	5	12	17
2018 July	3	1	4
2018 June	8	4	12
2018 May	5	4	9
2018 April	8	8	16
2018 March	5	0	5
2018 February	8	1	9
2018 January	2	0	2
2017 December	2	2	4
2017 November	6	0	6
2017 October	23	1	24
2017 September	1	18	19
2017 August	9	4	13
2017 July	13	3	16
2017 June	25	14	39
2017 May	18	10	28
2017 April	19	8	27
2017 March	6	103	109
2017 February	5	3	8
2017 January	18	3	21
2016 December	21	4	25
2016 November	34	13	47
2016 October	7	7	14
2016 September	6	14	20
2016 August	0	2	2

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