[Surgical treatment of large laparoceles Trattamento chirurgico dei grandi laparoceli]

Aim. The authors report their experience in the surgical treatment of complex laparoceles and refer some observations on the use of prosthetic materials and how to apply them. Methods. Since 1992, 46 patients have been surgically treated. Seven of them underwent a Redingot suture of the abdominal wall, in the other 39 patients the polypropylene mesh has been used and inserted as follows: in 16 cases in the superficial area, in 20 cases in the preperitoneal space and in 3 cases in the intraperitoneal space. According to personal experience, the preperitoneal space seems to be the most suitable area. Results. In the postoperative period, seromas have been observed in 2 patients and in 1 case a wound and prosthetic infection required the mesh removal. Cardiologic and respiratory complications have never been observed as well as thromboembolic processes. Follow-up at 24 months did not show recurrences. In order to obtain a good surgical result, it is necessary to carry out an accurate toilette and skin disinfection prior to operating. At the same time, it is also necessary to perform a good drainage in order to reduce the risk of prosthesis infections. Conclusion. Finally, a successful operation requires a good physiokinesitherapeutic preparation, the normalization of metabolic indexes and a solid cardiological and respiratory preparation.