|
1
|
Xu ASY, Zhou J, Sherman BE, Peterson CY, Goldblatt MI. Risk factors and timing of incisional hernia development following ostomy reversal: a retrospective analysis. Surg Endosc 2025; 39:2147-2154. [PMID: 39966126 DOI: 10.1007/s00464-025-11578-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2024] [Accepted: 01/20/2025] [Indexed: 02/20/2025]
Abstract
INTRODUCTION Former stoma-site incisional hernia (FSH) is a common complication after ostomy reversal, with a variable reported incidence of up to 50%. Current literature suggests that FSH is underreported due to the lack of a definitive understanding of the timeline of its occurrence and recurrence, making FSH prevention a clinical dilemma. This study identifies FSH risk factors and diagnostic timeline to aid surgeons' clinical decision-making. METHODS A retrospective chart review was conducted on 340 patients who underwent ostomy reversal between January 1, 2016, and December 31, 2021. Data collected include demographics, medical history, course of ostomy treatment, and hernia diagnosis. Logistic regression and Kaplan-Meier analysis were used to identify risk factors and understand the timeline of hernia occurrence. RESULTS The total incidence of hernia, including patients who had a parastomal hernia before ostomy reversal, FSH after reversal, or both, was 38.8%. The incidence of former stoma-site hernia alone was 24.4%. Significant risk factors identified were elevated BMI, presence of parastomal hernia, hypertension, diabetes, immunosuppression, and the emergency nature of the case. Kaplan-Meier analysis showed that patients with either parastomal hernia prior to ostomy reversal or obesity had a greater than 35% likelihood of being diagnosed with FSH within the first 2 years following reversal. Other risk factors, including chemotherapy, radiation therapy, ostomy history, hernia history, smoking, and type of ostomy, lacked significance. The median time between ostomy reversal and the first FSH diagnosis was 295 days, and 84.3% of the cases were diagnosed within the first 2 years. CONCLUSION Patients with ostomy are at substantial risk of developing FSH throughout the entire span of ostomy treatment. Patients with a high BMI, a parastomal hernia before ostomy closure, diabetes, and hypertension are at even higher risk of developing FSH.
Collapse
Affiliation(s)
| | - Jessica Zhou
- Medical College of Wisconsin, Wauwatosa, WI, 53226, USA
| | - Brianne E Sherman
- Medical College of Wisconsin, Wauwatosa, WI, 53226, USA
- Division of Minimally Invasive and Gastrointestinal Surgery, Department of Surgery, Medical College of Wisconsin, 8701 W Watertown Plank Rd., Wauwatosa, WI, 53226, USA
| | - Carrie Y Peterson
- Medical College of Wisconsin, Wauwatosa, WI, 53226, USA
- Division of Minimally Invasive and Gastrointestinal Surgery, Department of Surgery, Medical College of Wisconsin, 8701 W Watertown Plank Rd., Wauwatosa, WI, 53226, USA
| | - Matthew I Goldblatt
- Medical College of Wisconsin, Wauwatosa, WI, 53226, USA.
- Division of Minimally Invasive and Gastrointestinal Surgery, Department of Surgery, Medical College of Wisconsin, 8701 W Watertown Plank Rd., Wauwatosa, WI, 53226, USA.
| |
Collapse
|
|
2
|
Ong MN, Loo GH, Muthkumaran G, Md Pauzi SH, Ritza Kosai N. Incarcerated Incisional Hernia: An Unusual Presentation of Metastatic Endometrial Carcinoma. Cureus 2024; 16:e71497. [PMID: 39544575 PMCID: PMC11561335 DOI: 10.7759/cureus.71497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2024] [Indexed: 11/17/2024] Open
Abstract
Abdominal wall hernia is a common condition seen in the clinical practice of surgery. However, malignant tumors in the hernia sac are rare and there are limited studies on this subject. We report a case of a 77-year-old female who presented with generalized abdominal pain and vomiting. She was treated for an incarcerated incisional hernia and underwent an exploratory laparotomy, which showed a multiseptated incisional hernia sac. Histopathological examination revealed a metastatic endometrial serous carcinoma (ESC). ESC is an aggressive variant associated with poor prognosis, characterized by metastasis and extrauterine spread. Its treatment mainly involves a multidisciplinary approach, including surgical treatment and chemoradiotherapy. This report highlights the importance of considering malignant tumors in the differential diagnosis of hernia sac contents. Raising awareness among healthcare professionals and the general public can aid in the prompt diagnosis, appropriate treatment, and improved outcomes for individuals with such rare presentations.
Collapse
Affiliation(s)
- Mang Ning Ong
- Upper GI and Metabolic Surgery Unit, Department of Surgery, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
| | - Guo Hou Loo
- Upper GI and Metabolic Surgery Unit, Department of Surgery, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
| | - Guhan Muthkumaran
- Upper GI and Metabolic Surgery Unit, Department of Surgery, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
| | - Suria Hayati Md Pauzi
- Department of Pathology, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
| | - Nik Ritza Kosai
- Upper GI and Metabolic Surgery Unit, Department of Surgery, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
| |
Collapse
|
|
3
|
Zohar N, Gorgov E, Yeo TP, Lavu H, Bowne W, Yeo CJ, Nevler A. Incisional hernia after major pancreatic resection: long term risk assessment from two distinct sources - A large multi-institutional network and a single high-volume center. HPB (Oxford) 2024:S1365-182X(24)02282-2. [PMID: 39327220 DOI: 10.1016/j.hpb.2024.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 08/06/2024] [Accepted: 08/29/2024] [Indexed: 09/28/2024]
Abstract
BACKGROUND Post-operative incisional hernia (IH) is a common complication following abdominal surgery. Data regarding IH after major pancreatic surgery are limited. We aim to evaluate the long-term risk of IH following major pancreatic resection. METHODS A dual-approach study: a large multi-institutional research network (RN) was investigated for IH incidence and risk factors in propensity-score matched survivors after pancreaticoduodenectomy (PD) and distal pancreatectomy (DP), was complemented by a patient-reported questionnaire. RESULTS RN analysis identified 22,113 patients that underwent pancreatic surgery. 11.0% of PD patients and 8.6% of DP patients developed IH (P < 0.0001). IH rates were higher with open surgery compared with minimally invasive approaches in PD (OR = 1.56, P = 0.03) and DP (OR = 1.94, P = 0.003). BMI>35 was found to correlate with increased IH rates for PD and DP (OR = 1.87, and OR = 1.86, respectively, P < 0.0001 each), as did postoperative intraabdominal infections (P < 0.0001). Patient-based survey of 104 patients, revealed that 16 patients (15%) reported post-operative IH during the follow-up period. BMI≥30, SSI and intra-abdominal abscesses were associated with increased IH risk (P < 0.05). CONCLUSION Improved survival after pancreatic resection has led to an increased prevalence of long-term surgical sequela. In this study, we demonstrate significant rates of IH among long-term survivors and assess potential risk factors.
Collapse
Affiliation(s)
- Nitzan Zohar
- Jefferson Pancreas, Biliary and Related Cancer Centre, Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Eliyahu Gorgov
- Jefferson Pancreas, Biliary and Related Cancer Centre, Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Theresa P Yeo
- Jefferson Pancreas, Biliary and Related Cancer Centre, Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Harish Lavu
- Jefferson Pancreas, Biliary and Related Cancer Centre, Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Wilbur Bowne
- Jefferson Pancreas, Biliary and Related Cancer Centre, Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Charles J Yeo
- Jefferson Pancreas, Biliary and Related Cancer Centre, Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Avinoam Nevler
- Jefferson Pancreas, Biliary and Related Cancer Centre, Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
| |
Collapse
|
|
4
|
Ozcan C, Colak T, Turkmenoglu O, Berkesoglu M, Ertas E. Impact of small-bite (5 mm) fascial closure on the incidence of incisional hernia following open colorectal cancer surgery: randomized clinical trial. Br J Surg 2024; 111:znae189. [PMID: 39107062 DOI: 10.1093/bjs/znae189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 07/06/2024] [Accepted: 07/10/2024] [Indexed: 08/09/2024]
Abstract
BACKGROUND Incisional hernia is frequently observed after open colorectal cancer surgery, and should be considered a serious short- and long-term health issue. The present study evaluated the efficacy of small-bite abdominal closure in reducing the incidence of incisional hernia in this patient group. METHODS An RCT was conducted between June 2019 and June 2022. A total of 173 patients who underwent open colorectal cancer surgery were assigned randomly to one of two groups to undergo fascial closure with either small bites (87) or conventional bites (86). The incisional hernia rate was accepted as the primary outcome, and surgical-site infection as the secondary outcome. RESULTS The incisional hernia rates at 1 year were 7 and 27% in the small- and conventional-bite groups respectively (P < 0.001). This rate increased to 9 and 31% at the end of the second year (P < 0.001). Surgical-site infections occurred in 18% of the small-bite group and 31% of the conventional-bite group (P = 0.03). Compared with the conventional-bite group, the small-bite group had higher suture/wound length ratios (mean(s.d.) 5.18(0.84) versus 3.67(0.57); P < 0.001) and a longer fascial closure time 14.1(4.64) versus 12.9(2.39) min; P = 0.03). CONCLUSION Small-bite closure with 5-mm tissue bites placed 5 mm apart reduced the incidence of incisional hernia and surgical-site infection after open colorectal cancer surgery.
Collapse
Affiliation(s)
- Cumhur Ozcan
- Department of General Surgery, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Tahsin Colak
- Department of General Surgery, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Ozgur Turkmenoglu
- Department of General Surgery, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Mustafa Berkesoglu
- Department of General Surgery, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Elif Ertas
- Department of Biostatistics, Selcuk University, Konya, Turkey
| |
Collapse
|
|
5
|
Johnson JA, Mesiti A, Herre M, Farzaneh C, Li Y, Zambare W, Carmichael J, Pigazzi A, Jafari MD. Effect of Specimen Extraction Site on Postoperative Incisional Hernia after Minimally Invasive Right Colectomy. J Am Coll Surg 2024; 239:107-112. [PMID: 38415817 DOI: 10.1097/xcs.0000000000001060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Incisional hernia (IH) is a known complication after colorectal surgery. Despite advances in minimally invasive surgery, colorectal surgery still requires extraction sites for specimen retrieval, increasing the likelihood of postoperative IH development. The objective of this study is to determine the effect of specimen extraction site on the rate of IH after minimally invasive right-sided colectomy for patients with available imaging. STUDY DESIGN This is a retrospective multi-institutional cohort study at 2 large academic medical centers in the US. Adults who underwent right-sided minimally invasive colectomy from 2012 to 2020 with abdominal imaging available at least 1 year postoperatively were included in the analysis. The primary exposure was specimen extraction via a midline specimen extraction vs Pfannenstiel specimen extraction. The main outcome was the development of IH at least 1 year postoperatively as visualized on a CT scan. RESULTS Of the 341 patients sampled, 194 (57%) had midline specimen extraction and 147 (43%) had a Pfannenstiel specimen extraction. Midline extraction patients were older (66 ± 15 vs 58 ± 16; p < 0.001) and had a higher rate of previous abdominal operation (99, 51% vs 55, 37%, p = 0.01). The rate of IH was higher in midline extraction at 25% (48) compared with Pfannenstiel extraction (0, 0%; p < 0.001). The average length of stay was higher in the midline extraction group at 5.1 ± 2.5 compared with 3.4 ± 3.1 days in the Pfannenstiel extraction group (p < 0.001). Midline extraction was associated with IH development (odds ratio 24.6; 95% CI 1.89 to 319.44; p = 0.004). Extracorporeal anastomosis was associated with a higher IH rate (odds ratio 25.8; 95% CI 2.10 to 325.71; p = 0.002). CONCLUSIONS Patients who undergo Pfannenstiel specimen extraction have a lower risk of IH development compared with those who undergo midline specimen extraction.
Collapse
Affiliation(s)
- Josh A Johnson
- From the Department of Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY (Johnson, Mesiti, Herre, Zambare, Pigazzi, Jafari)
| | - Andrea Mesiti
- From the Department of Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY (Johnson, Mesiti, Herre, Zambare, Pigazzi, Jafari)
| | - Margo Herre
- From the Department of Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY (Johnson, Mesiti, Herre, Zambare, Pigazzi, Jafari)
| | - Cyrus Farzaneh
- Department of Surgery, University of California, Irvine Medical Center, Orange, CA (Farzaneh, Carmichael)
| | - Ying Li
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY (Li)
| | - Wini Zambare
- From the Department of Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY (Johnson, Mesiti, Herre, Zambare, Pigazzi, Jafari)
| | - Joseph Carmichael
- Department of Surgery, University of California, Irvine Medical Center, Orange, CA (Farzaneh, Carmichael)
| | - Alessio Pigazzi
- From the Department of Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY (Johnson, Mesiti, Herre, Zambare, Pigazzi, Jafari)
| | - Mehraneh D Jafari
- From the Department of Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY (Johnson, Mesiti, Herre, Zambare, Pigazzi, Jafari)
| |
Collapse
|
|
6
|
Wu XW, Yang DQ, Wang MW, Jiao Y. Occurrence and prevention of incisional hernia following laparoscopic colorectal surgery. World J Gastrointest Surg 2024; 16:1973-1980. [PMID: 39087097 PMCID: PMC11287670 DOI: 10.4240/wjgs.v16.i7.1973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/23/2024] [Accepted: 05/31/2024] [Indexed: 07/22/2024] Open
Abstract
Among minimally invasive surgical procedures, colorectal surgery is associated with a notably higher incidence of incisional hernia (IH), ranging from 1.7% to 24.3%. This complication poses a significant burden on the healthcare system annually, necessitating urgent attention from surgeons. In a study published in the World Journal of Gastrointestinal Surgery, Fan et al compared the incidence of IH among 1614 patients who underwent laparoscopic colorectal surgery with different extraction site locations and evaluated the risk factors associated with its occurrence. This editorial analyzes the current risk factors for IH after laparoscopic colorectal surgery, emphasizing the impact of obesity, surgical site infection, and the choice of incision location on its development. Furthermore, we summarize the currently available preventive measures for IH. Given the low surgical repair rate and high recurrence rate associated with IH, prevention deserves greater research and attention compared to treatment.
Collapse
Affiliation(s)
- Xi-Wen Wu
- The First Operating Room, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Ding-Quan Yang
- Department of Gastrointestinal and Colorectal Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Ming-Wei Wang
- Ministry of Health Key Laboratory of Radiobiology, School of Public Health of Jilin University, Changchun 130000, Jilin Province, China
| | - Yan Jiao
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| |
Collapse
|
|
7
|
Calcerrada Alises E, Antón Rodríguez C, Medina Pedrique M, Berrevoet F, Cuccurullo D, López Cano M, Stabilini C, Garcia-Urena MA. Systematic review and meta-analysis of the incidence of incisional hernia in urological surgery. Langenbecks Arch Surg 2024; 409:166. [PMID: 38805110 DOI: 10.1007/s00423-024-03354-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE To evaluate the incidence of incisional hernia in patients undergoing direct access to the abdominal cavity in urological surgery. METHODS We conducted a systematic review in Pubmed, Embase, and Cochrane Central from 1980 to the present according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Eighty-four studies were selected for inclusion in this analysis, and meta-analysis and meta-regression were performed. RESULTS The total incidence in the 84 studies was 4.8% (95% CI 3.7% - 6.2%) I2 93.84%. Depending on the type of incision, it was higher in the open medial approach: 7.1% (95% CI 4.3%-11.8%) I2 92.45% and lower in laparoscopic surgery: 1.9% (95% CI 1%-3.4%) I2 71, 85% According to access, it was lower in retroperitoneal: 0.9% (95% CI 0.2%-4.8%) I2 76.96% and off-midline: 4.7% (95% CI 3.5%-6.4%) I2 91.59%. Regarding the location of the hernia, parastomal hernias were more frequent: 15.1% (95% CI 9.6% - 23%) I2 77.39%. Meta-regression shows a significant effect in reducing the proportion of hernias in open lateral, laparoscopic and hand-assisted compared to medial open access. CONCLUSION The present review finds the access through the midline and stomas as the ones with the highest incidence of incisional hernia. The use of the lateral approach or minimally invasive techniques is preferable. More prospective studies are warranted to obtain the real incidence of incisional hernias and evaluate the role of better techniques to close the abdomen.
Collapse
Affiliation(s)
- Enrique Calcerrada Alises
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario del Sureste, Madrid, Spain.
- Grupo de Investigación de Pared Abdominal Compleja, Universidad Francisco de Vitoria, Madrid, Spain.
| | - Cristina Antón Rodríguez
- Grupo de Investigación de Pared Abdominal Compleja, Universidad Francisco de Vitoria, Madrid, Spain
| | - Manuel Medina Pedrique
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario del Henares, Madrid, Spain
| | - Frederick Berrevoet
- Department of General and Hepatobiliary Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Diego Cuccurullo
- Department of Surgery, Ospedale Monaldi-Azienda Ospedaliera Dei Colli, Naples, Italy
| | - Manuel López Cano
- Abdominal Wall Surgery Unit, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
- Vall d'Hebron Research Institute General and Gastrointestinal Surgery Research Group, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Cesare Stabilini
- Department of Surgery (DiSC), University of Genoa, IRCCS Policlinico San Martino, Genoa, Italy
| | - Miguel Angel Garcia-Urena
- Grupo de Investigación de Pared Abdominal Compleja, Universidad Francisco de Vitoria, Madrid, Spain
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario del Henares, Madrid, Spain
| |
Collapse
|
|
8
|
López-Cano M, Hernández-Granados P, Morales-Conde S, Ríos A, Pereira-Rodríguez JA. Abdominal wall surgery units accreditation. The Spanish model. Cir Esp 2024; 102:283-290. [PMID: 38296193 DOI: 10.1016/j.cireng.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/14/2024] [Indexed: 02/10/2024]
Abstract
The Spanish Association of Surgeons (AEC) deems it essential to define and regulate the acquisition of high-specialization competencies within General Surgery and Gastrointestinal Surgery and proposes the Regulation for the accreditation of specialized surgical units. The AEC aims to define specialized surgical units as those functional elements of the health system that meet the defined requirements regarding their provision, solvency, and specialization in care, teaching, and research. In this paper we present the proposed accreditation model for Abdominal Wall Surgery Units, as well as the results of a survey conducted to assess the status of such units in our country. The model presented represents one of the pioneering initiatives worldwide concerning the accreditation of Abdominal Wall Surgery Units.
Collapse
Affiliation(s)
- Manuel López-Cano
- Unidad de Cirugía de Pared Abdominal Hospital Universitario Vall d´Hebrón, Barcelona Universidad Autónoma de Barcelona, Spain.
| | - Pilar Hernández-Granados
- Unidad de Pared Abdominal Hospital Universitario Fundación Alcorcón. Universidad Rey Juan Carlos, Spain
| | - Salvador Morales-Conde
- Serviciode Cirugía General y del Aparato Digestivo Hospital Universitario Virgen Macarena. Sevilla Facultad de Medicina, Universidad de Sevilla, Spain
| | - Antonio Ríos
- Unidad de Pared Abdominal Hospital Clínico Universitario Virgen de la Arrixaca Universidad de Murcia, Spain
| | | |
Collapse
|
|
9
|
Slim K, Tilmans G, Occéan BV, Dziri C, Pereira B, Canis M. Meta-analysis of randomized clinical trials comparing robotic versus laparoscopic surgery for mid-low rectal cancers. J Visc Surg 2024; 161:76-89. [PMID: 38355331 DOI: 10.1016/j.jviscsurg.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Robotic surgery (RS) is experiencing major development, particularly in the context of rectal cancer. The aim of this meta-analysis was to summarize data from the literature, focusing specifically on the safety and effectiveness of robotic surgery in mid-low rectal cancers, based on the hypothesis that that robotic surgery can find its most rational indication in this anatomical location. METHOD The meta-analysis was conducted according to the PRISMA 2000 recommendations, including all randomized trials that compared robotic surgery versus laparoscopic surgery (LS) that were found in the Medline-PICO, Cochrane Database, Scopus and Google databases. Data were extracted independently by two reviewers. The risk of bias was analyzed according to the Cochrane Handbook method and the certainty of the evidence according to the GRADE method. The analysis was carried out with R software Version 4.2-3 using the Package for Meta-Analysis "meta" version 6.5-0. RESULTS Eight randomized trials were included (with a total of 2342 patients), including four that focused specifically on mid-low rectal cancer (n=1,734 patients). No statistically significant difference was found for overall morbidity, intra-operative morbidity, anastomotic leakage, post-operative mortality, quality of mesorectal specimen, and resection margins. The main differences identified were a lower conversion rate for RS (RR=0.48 [0.24-0.95], p=0.04, I2=0%), and a longer operative time for RS (mean difference=39.11min [9.39-68.83], p<0.01, I2=96%). The other differences had no real clinical relevance, i.e., resumption of flatus passage (5hours earlier after RS), and lymph node dissection (one more lymph node for LS). CONCLUSION This meta-analysis does not confirm the initial hypothesis and does not show a statistically significant or clinically relevant benefit of RS compared to LS for mid-low rectal cancer.
Collapse
Affiliation(s)
- Karem Slim
- Department of gynecology and pelvic surgery, CHU de Clermont-Ferrand, Clermont-Ferrand, France.
| | - Gilles Tilmans
- Digestive surgery department, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Chadly Dziri
- Honoris Center for Medical Simulation, Tunis, Tunisia
| | - Bruno Pereira
- Department of Clinical Research and Innovation, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Michel Canis
- Department of gynecology and pelvic surgery, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| |
Collapse
|
|
10
|
Fortelny RH, Dietz U. [Incisional hernias: epidemiology, evidence and guidelines]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:3-9. [PMID: 38078933 PMCID: PMC10781829 DOI: 10.1007/s00104-023-01999-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND From an epidemiological point of view, one third of the population in industrialized countries will undergo abdominal surgery during their lifetime. Depending on the degree of patient-related and procedure-related risks, the occurrence of incisional hernias is associated in a range of up to 30% at 2‑year follow-up and even up to 60% at 5 years. In addition to influencing comorbidities, the type of surgical approach and closure technique are of critical importance. OBJECTIVE To present a descriptive evidence-based recommendation for abdominal wall closure and prophylactic mesh augmentation. MATERIAL AND METHODS A concise summary was prepared incorporating the current literature and existing guidelines. RESULTS According to recent studies the recognized risk for the occurrence of incisional hernias in the presence of obesity and abdominal aortic diseases also applies to patients undergoing colorectal surgery and the presence of diastasis recti abdominis. Based on high-level published data, the short stitch technique for midline laparotomy in the elective setting has a high level of evidence to be a standard procedure. Patients with an increased risk profile should receive prophylactic mesh reinforcement, either onlay or sublay, in addition to the short stitch technique. In emergency laparotomy, the individual risk of infection with respect to the closure technique used must be included. CONCLUSION The avoidance of incisional hernias is primarily achieved by the minimally invasive access for laparoscopy. For closure of the most commonly used midline approach, the short stitch technique and, in the case of existing risk factors, additionally mesh augmentation are recommended.
Collapse
Affiliation(s)
- R H Fortelny
- Lehrstuhl für Allgemeinchirurgie, Medizinische Fakultät, Sigmund Freud PrivatUniversität Wien, Freudplatz 3, 1020, Wien, Österreich.
| | - U Dietz
- Chirurgie, Kantonsspital Olten, Olten, Schweiz
| |
Collapse
|
|
11
|
Ramírez-Giraldo C, Van-Londoño I, Monroy DC, Navarro-Alean J, Hernández-Ferreira J, Hernández-Álvarez D, Rojas-López S, Avendaño-Morales V. Risk factors associated to incisional hernia in stoma site after stoma closure: A systematic review and meta-analysis. Int J Colorectal Dis 2023; 38:267. [PMID: 37975888 DOI: 10.1007/s00384-023-04560-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND This study aims to identify which risk factors are associated with the appearance of an incisional hernia in a stoma site after its closure. This in the sake of identifying which patients would benefit from a preventative intervention and thus start implementing a cost-effective protocol for prophylactic mesh placement in high-risk patients. METHODS A systematic review of PubMed, Cochrane library, and ScienceDirect was performed according to PRISMA guidelines. Studies reporting incidence, risk factors, and follow-up time for appearance of incisional hernia after stoma site closure were included. A fixed-effects and random effects models were used to calculate odds ratios' estimates and standardized mean values with their respective grouped 95% confidence interval. This to evaluate the association between possible risk factors and the appearance of incisional hernia after stoma site closure. RESULTS Seventeen studies totaling 2899 patients were included. Incidence proportion between included studies was of 16.76% (CI95% 12.82; 21.62). Out of the evaluated factors higher BMI (p = 0.0001), presence of parastomal hernia (p = 0.0023), colostomy (p = 0,001), and end stoma (p = 0.0405) were associated with the appearance of incisional hernia in stoma site after stoma closure, while malignant disease (p = 0.0084) and rectum anterior resection (p = 0.0011) were found to be protective factors. CONCLUSIONS Prophylactic mesh placement should be considered as an effective preventative intervention in high-risk patients (obese patients, patients with parastomal hernia, colostomy, and end stoma patients) with the goal of reducing incisional hernia rates in stoma site after closure while remaining cost-effective.
Collapse
Affiliation(s)
- Camilo Ramírez-Giraldo
- Hospital Universitario Mayor-Méderi, Bogotá, Colombia.
- Universidad del Rosario, Bogotá, Colombia.
| | | | - Danny Conde Monroy
- Hospital Universitario Mayor-Méderi, Bogotá, Colombia
- Universidad del Rosario, Bogotá, Colombia
| | - Jorge Navarro-Alean
- Hospital Universitario Mayor-Méderi, Bogotá, Colombia
- Universidad del Rosario, Bogotá, Colombia
| | | | | | - Susana Rojas-López
- Hospital Universitario Mayor-Méderi, Bogotá, Colombia
- Universidad del Rosario, Bogotá, Colombia
| | | |
Collapse
|
|
12
|
Mao Y, Xi L, Lu C, Miao J, Li Q, Shen X, Yu C. Incidence, risk factors, and predictive modeling of stoma site incisional hernia after enterostomy closure: a multicenter retrospective cohort study. BMC Gastroenterol 2023; 23:201. [PMID: 37296427 DOI: 10.1186/s12876-023-02805-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 05/09/2023] [Indexed: 06/12/2023] Open
Abstract
PURPOSE Stoma site incisional hernia (SSIH) is a common complication, but its incidence and risk factors are not well known. The objective of this study is to explore the incidence and risk factors of SSIH and build a predictive model. METHODS We performed a multicenter retrospective analysis on the patients who underwent enterostomy closure from January 2018 to August 2020. Patient's general condition, perioperative, intraoperative, and follow-up information was collected. The patients were divided into control group (no occurrence) and observation group (occurrence) according to whether SSIH occurred. Univariate and multivariate analysis were used to evaluate the risk factors of SSIH, following which we constructed a nomogram for SSIH prediction. RESULTS One hundred fifty-six patients were enrolled in the study. The incidence of SSIH was 24.4% (38 cases), of which 14 were treated with hernia mesh repair, and the others were treated with conservative treatment. Univariate and multivariate analysis showed that age ≥ 68 years (OR 1.045, 95% CI 1.002 ~ 1.089, P = 0.038), colostomy (OR 2.913, 95% CI 1.035 ~ 8.202, P = 0.043), BMI ≥ 25 kg/m2 (OR 1.181, 95% CI 1.010 ~ 1.382, P = 0.037), malignant tumor (OR 4.838, 95% CI 1.508 ~ 15.517, P = 0.008) and emergency surgery (OR 5.327, 95% CI 1.996 ~ 14.434, P = 0.001) are the independent risk factors for SSIH. CONCLUSIONS Based on the results, a predictive model for the occurrence of SSIH was constructed to screen high-risk groups of SSIH. For patients at high risk for SSIH, how to deal with the follow-up and prevent the occurrence of SSIH is worth further exploration.
Collapse
Affiliation(s)
- Yonghuan Mao
- Department of General Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
- Department of General Surgery, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ling Xi
- Department of Gerontology, Geriatric Hospital of Nanjing Medical University, Nanjing, China
| | - Chen Lu
- Department of General Surgery, Sir Run Run Hospital of Nanjing Medical University, Nanjing, China
| | - Ji Miao
- Department of General Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Qiang Li
- Department of General Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.
| | - Xiaofei Shen
- Department of General Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.
| | - Chunzhao Yu
- Department of General Surgery, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China.
- Department of General Surgery, Sir Run Run Hospital of Nanjing Medical University, Nanjing, China.
| |
Collapse
|
|
13
|
Medina Pedrique M, Robin Valle de Lersundi Á, Avilés Oliveros A, Ruiz SM, López-Monclús J, Munoz-Rodriguez J, Blázquez Hernando LA, Martinez Caballero J, García-Urena MÁ. Incisions in Hepatobiliopancreatic Surgery: Surgical Anatomy and its Influence to Open and Close the Abdomen. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2023; 2:11123. [PMID: 38312419 PMCID: PMC10831649 DOI: 10.3389/jaws.2023.11123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 02/28/2023] [Indexed: 02/06/2024]
Abstract
Incisions performed for hepato-pancreatic-biliary (HPB) surgery are diverse, and can be a challenge both to perform correctly as well as to be properly closed. The anatomy of the region overlaps muscular layers and has a rich vascular and nervous supply. These structures are fundamental for the correct functionality of the abdominal wall. When performing certain types of incisions, damage to the muscular or neurovascular component of the abdominal wall, as well as an inadequate closure technique may influence in the development of long-term complications as incisional hernias (IH) or bulging. Considering that both may impair quality of life and that are complex to repair, prevention becomes essential during these procedures. With the currently available evidence, there is no clear recommendation on which is the better incision or what is the best method of closure. Despite the lack of sufficient data, the following review aims to correlate the anatomical knowledge learned from posterior component separation with the incisions performed in hepato-pancreatic-biliary (HPB) surgery and their consequences on incisional hernia formation. Overall, there is data that suggests some key points to perform these incisions: avoid vertical components and very lateral extensions, subcostal should be incised at least 2 cm from costal margin, multilayered suturing using small bites technique and consider the use of a prophylactic mesh in high-risk patients. Nevertheless, the lack of evidence prevents from the possibility of making any strong recommendations.
Collapse
Affiliation(s)
- Manuel Medina Pedrique
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Madrid, Spain
| | - Álvaro Robin Valle de Lersundi
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Madrid, Spain
| | - Adriana Avilés Oliveros
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Madrid, Spain
| | - Sara Morejón Ruiz
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Madrid, Spain
| | - Javier López-Monclús
- General and Digestive Surgery Department, Hospital Universitario Puerta de Hierro, Autónoma University of Madrid, Madrid, Spain
| | - Joaquín Munoz-Rodriguez
- General and Digestive Surgery Department, Hospital Universitario Puerta de Hierro, Autónoma University of Madrid, Madrid, Spain
| | - Luis Alberto Blázquez Hernando
- General and Digestive Surgery Department, Hospital Universitario Ramón y Cajal, Alcalá de Henares University Madrid, Madrid, Spain
| | - Javier Martinez Caballero
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Madrid, Spain
| | - Miguel Ángel García-Urena
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Madrid, Spain
| |
Collapse
|
|
14
|
den Hartog FPJ, van Egmond S, Poelman MM, Menon AG, Kleinrensink GJ, Lange JF, Tanis PJ, Deerenberg EB. The incidence of extraction site incisional hernia after minimally invasive colorectal surgery: a systematic review and meta-analysis. Colorectal Dis 2022; 25:586-599. [PMID: 36545836 DOI: 10.1111/codi.16455] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/09/2022] [Accepted: 11/22/2022] [Indexed: 01/06/2023]
Abstract
AIM Minimally invasive colorectal surgery reduces surgical trauma with better preservation of abdominal wall integrity, but the extraction site is still at risk of incisional hernia (IH). The aim of this study was to determine pooled incidence of IH for each type of extraction site and to compare rates of IH after midline, nonmidline and Pfannenstiel extraction. METHOD A systematic review and meta-analysis was conducted using the PRISMA guidelines. Single-armed and multiple-armed cohort studies and randomized controlled trials regarding minimally invasive colorectal surgery were searched from five databases. Outcomes were pooled and compared with random-effects, inverse-variance models. Risk of bias within the studies was assessed using the Cochrane ROBINS-I and RoB 2 tool. RESULTS Thirty six studies were included, with a total 11,788 patients. The pooled extraction site IH rate was 16.0% for midline (n = 4081), 9.3% for umbilical (n = 2425), 5.2% for transverse (n = 3213), 9.4% for paramedian (n = 134) and 2.1% for Pfannenstiel (n = 1449). Nonmidline extraction (transverse and paramedian) showed significantly lower odds ratios (ORs) for IH when compared with midline extraction (including umbilical). Pfannenstiel extraction resulted in a significantly lower OR for IH compared with midline [OR 0.12 (0.50-0.30)], transverse [OR 0.25 (0.13-0.50)] and umbilical (OR 0.072 [0.033-0.16]) extraction sites. The risks of surgical site infection, seroma/haematoma or wound dehiscence were not significantly different in any of the analyses. CONCLUSION Pfannenstiel extraction is the preferred method in minimally invasive colorectal surgery. In cases where Pfannenstiel extraction is not possible, surgeons should avoid specimen extraction in the midline.
Collapse
Affiliation(s)
- Floris P J den Hartog
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Sarah van Egmond
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Marijn M Poelman
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Anand G Menon
- Department of Surgery, IJsselland Ziekenhuis, Capelle aan den IJssel, The Netherlands
| | - Gert-Jan Kleinrensink
- Department of Neuroscience, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Johan F Lange
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Pieter J Tanis
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Eva B Deerenberg
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| |
Collapse
|
|
15
|
Boermeester MA, Lobé NHJ, Engelbrecht MRW, Timmer AS. Comparison of two-dimensional measurement with three-dimensional volume rendering for the assessment of loss of domain in incisional hernia patients. Hernia 2022; 27:379-385. [PMID: 36482228 DOI: 10.1007/s10029-022-02729-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE We aimed to compare simple two-dimensional (2D) measurement with comprehensive three-dimensional (3D) volume rendering to determine loss of domain (LOD), a clinically important decision-making feature for incisional hernia repair. METHODS In this single-center retrospective study, we analyzed the CT scans of a consecutive cohort of adult patients with a midline incisional hernia. The hernia sac- and abdominal cavity volumes were obtained by two different methods. The 2D method estimated the volumes using the corresponding height, width, and depth. The 3D method comprised of a volume rendering tool. For both methods, LOD was calculated according to the Sabbagh ratio (hernia sac volume / (hernia sac volume + abdominal cavity volume)). Taking the 3D method as the reference standard, the performance of the 2D method was expressed as positive predictive value (PPV) and negative predictive value (NPV) for LOD of more than- and less than 20%. The agreement between both methods was expressed as Cohen's kappa coefficient (kappa). RESULTS We analyzed 92 CT scans. Agreement between both methods was high (kappa = 0.854, p = 0.0001); all 67 measurements for which the 2D method assessed LOD to be less than 20% were correctly classified (NPV = 100%), and 20 of 25 measurements for which the 2D method assessed LOD to be more than 20% were correctly classified (PPV = 80%). CONCLUSIONS The 2D method can exclude patients from perioperative actions needed for a more complex hernia. Since this method is easy to use and less time-consuming, it seems useful for the routine radiological assessment of LOD in clinical practice.
Collapse
Affiliation(s)
- M A Boermeester
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands.
- Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, The Netherlands.
- Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, The Netherlands.
| | - N H J Lobé
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - M R W Engelbrecht
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - A S Timmer
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
- Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, The Netherlands
| |
Collapse
|
|
16
|
Diastasis recti is associated with incisional hernia after midline abdominal surgery. Hernia 2022; 27:363-371. [PMID: 36136228 DOI: 10.1007/s10029-022-02676-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/30/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE Incisional hernia occurs in up to 20% of patients after abdominal surgery and is most common after vertical midline incisions. Diastasis recti may contribute to incisional hernia but has not been explored as a risk factor or included in hernia risk models. We examined the association between diastasis recti and incisional hernia after midline incisions. METHODS In this single-center study, all patients undergoing elective gastrointestinal surgery with a midline open incision or extraction site in a prospective surgical quality collaborative database between 2016 and 2020 were included. Eligible patients had axial imaging within 6 months prior to surgery and no less than 6 months after surgery to determine the presence of diastasis recti and incisional hernia, respectively. Radiographic hernia-free survival was assessed with log-rank tests and multivariable Cox regression, comparing patients with and without diastasis width > 25 mm. RESULTS Of 156 patients, forty-four (28.2%) developed radiographic hernia > 1 cm. 36 of 85 patients (42.4%) with DR width > 25 mm developed IH, compared to 9 of 71 (12.7%) without DR (p < 0.001). Hernia-free survival differed by DR width on bivariate and multivariable Cox regression, adjusted hazard ratio: 3.87, 95% confidence interval: 1.84-8.14. CONCLUSION Diastasis recti is a significant risk factor for incisional hernia after midline abdominal surgery. When present, surgeons can include these data when discussing surgical risks and should consider a lower risk, off-midline approach when feasible. Incorporating diastasis into larger studies may improve comprehensive models of incisional hernia risk.
Collapse
|
|
17
|
Wilson MZ. We Asked the Experts: Repair Techniques as Prevention: Ostomy Closure is an Incisional Hernia Repair. World J Surg 2022; 46:1896-1897. [PMID: 35391559 DOI: 10.1007/s00268-022-06540-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Matthew Z Wilson
- Department of Surgery, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, USA.
| |
Collapse
|
|
18
|
Comment to: An evidence map and synthesis review with meta-analysis on the risk of incisional hernia in colorectal surgery with standard closure. Hernia 2022; 27:471-472. [PMID: 35666401 DOI: 10.1007/s10029-022-02639-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/22/2022] [Indexed: 11/04/2022]
|
|
19
|
Timmer AS, Claessen JJM, Brouwer de Koning IM, Haenen SM, Belt EJT, Bastiaansen AJNM, Verdaasdonk EGG, Wolffenbuttel CP, Schreurs WH, Draaisma WA, Boermeester MA. Clinical outcomes of open abdominal wall reconstruction with the use of a polypropylene reinforced tissue matrix: a multicenter retrospective study. Hernia 2022; 26:1241-1250. [PMID: 35441284 PMCID: PMC9525385 DOI: 10.1007/s10029-022-02604-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/14/2022] [Indexed: 02/06/2023]
Abstract
Objective To assess mesh behaviour and clinical outcomes of open complex abdominal wall reconstruction (CAWR) with the use of a polypropylene reinforced tissue matrix. Methods A multicenter retrospective study of adult patients who underwent open CAWR with the use of a permanent polypropylene reinforced tissue matrix (OviTex®) between June 2019 and January 2021. Results Fifty-five consecutive patients from four hospitals in the Netherlands were analysed; 46 patients with a ventral hernia and 9 patients with an open abdomen. Most patients with a ventral hernia had one or more complicating comorbidities (91.3%) and one or more complicating hernia characteristics (95.7%). Most procedures were performed in a (clean) contaminated surgical field (69.6% CDC 2–4; 41.3% CDC 3–4). All nine patients with an open abdomen underwent semi-emergent surgery. Twelve out of 46 patients with a ventral hernia (26.1%) and 4 of 9 patients with an open abdomen (44.4%) developed a postoperative surgical site infection that made direct contact with the mesh as confirmed on computed tomography (CT), suspicious of mesh infection. No patient needed mesh explantation for persistent infection of the mesh. During a median follow-up of 13 months, 4 of 46 ventral hernia patients (8.7%) developed a CT confirmed hernia recurrence. Conclusion Polypropylene reinforced tissue matrix can withstand infectious complications and provides acceptable mid-term recurrence rates in this retrospective study on open complex abdominal wall reconstructions. Longer follow-up data from prospective studies are required to determine further risk of hernia recurrence. Supplementary Information The online version contains supplementary material available at 10.1007/s10029-022-02604-y.
Collapse
Affiliation(s)
- Allard S Timmer
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam Infection and Immunity, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands
| | - Jeroen J M Claessen
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam Infection and Immunity, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands
| | | | - Suzanne M Haenen
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam Infection and Immunity, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands
| | - Eric J T Belt
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | | | | | | | | | - Werner A Draaisma
- Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Marja A Boermeester
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam Infection and Immunity, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands.
| |
Collapse
|