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Donadieu A, Alhammadi F, Mettoudi A, Garois A, Kianmanesh R, Tashkandi A, Renard Y. Preoperative progressive pneumoperitoneum: insights on implementation in an ambulatory care setting. How I do it? Hernia 2025; 29:82. [PMID: 39899063 DOI: 10.1007/s10029-024-03253-z] [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: 01/03/2024] [Accepted: 12/15/2024] [Indexed: 02/04/2025]
Abstract
INTRODUCTION Incisional hernias with loss of domain (IHLD) are challenging to treat. Preoperative techniques like botulinum toxin injection (BTA) and preoperative progressive pneumoperitoneum (PPP) are highly effective, potentially preventing the need for perioperative component separation in the vast majority of cases. PPP involves preoperative introduction of gas into the abdominal cavity to increase the abdominal wall volume, aiding diaphragmatic prehabilitation and hernia reintegration. This study aimed at explaining our technique in performing PPP in ambulatory setting. DESCRIPTION OF THE TECHNIQUE The first insufflation and BTA injection occur during a 3-day hospitalization. Subsequently, patients are managed on an ambulatory basis with three sessions per week for at least three weeks. Each hospital visit lasts about 1 to 2 h. Patients can remain at home or in a residential center of our hospital. No preventive anticoagulation nor prophylactic antibiotics are needed. DISCUSSION Performing PPP in outpatient care does not compromise its efficacy. Instead, it allows for longer preparation, potentially improving efficacy. Patients maintain daily activities, possibly yielding better results than traditional physiotherapy. It reduces hospital stay costs and nosocomial infection risks. Each ambulatory hospitalization offers better patient attention. CONCLUSIONS PPP is a valuable preoperative technique for IHLD repair, particularly in combination with botulinum toxin, offering potential benefits for selected patients. Performing it in outpatient care may enhance patient satisfaction and offers several advantages.
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Affiliation(s)
- Alix Donadieu
- Department of General, Digestive and Endocrine Surgery, University of Reims Champagne-Ardenne, Robert-Debré University Hospital, Reims, France
- University of Reims Champagne-Ardenne, Laboratoire d'Informatique en Calcul Intensif et Image pour la Simulation (LICIIS), Reims, France
| | - Fahad Alhammadi
- Department of General, Digestive and Endocrine Surgery, University of Reims Champagne-Ardenne, Robert-Debré University Hospital, Reims, France
- General Surgery Department, Al-Adan Hospital, Hadiya, Kuwait
| | - Alicia Mettoudi
- Department of General, Digestive and Endocrine Surgery, University of Reims Champagne-Ardenne, Robert-Debré University Hospital, Reims, France
| | - Annie Garois
- Department of General, Digestive and Endocrine Surgery, University of Reims Champagne-Ardenne, Robert-Debré University Hospital, Reims, France
| | - Reza Kianmanesh
- Department of General, Digestive and Endocrine Surgery, University of Reims Champagne-Ardenne, Robert-Debré University Hospital, Reims, France
| | - Ahmad Tashkandi
- Department of General, Digestive and Endocrine Surgery, University of Reims Champagne-Ardenne, Robert-Debré University Hospital, Reims, France
- Faculty of Medicine, Department of Surgery, University of Jeddah, Jeddah, Saudi Arabia
| | - Yohann Renard
- Department of General, Digestive and Endocrine Surgery, University of Reims Champagne-Ardenne, Robert-Debré University Hospital, Reims, France.
- University of Reims Champagne-Ardenne, Laboratoire d'Informatique en Calcul Intensif et Image pour la Simulation (LICIIS), Reims, France.
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Diaz AL, Lee WY, Oh C, Kimberly LL. The Modified Frailty 5-Factor Index Predicts Adverse Outcomes After Ventral Hernia Repair in a National Database. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2025; 13:e6411. [PMID: 39810906 PMCID: PMC11730838 DOI: 10.1097/gox.0000000000006411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Accepted: 10/29/2024] [Indexed: 01/16/2025]
Abstract
Background Ventral hernia repair (VHR) is a common procedure performed on a comorbid patient population at risk for complications, necessitating effective preoperative risk assessment. Previous research suggests that frailty better predicts adverse outcomes compared with historical risk proxies including age. We examined the association between frailty as measured by the 5-factor modified frailty index and postoperative complications following VHR as reported in the National Surgical Quality Improvement Program database. Methods A retrospective review of the National Surgical Quality Improvement Program database from 2015 to 2020 was performed for patients who underwent VHR with the component separation technique. Descriptive analyses were performed on demographics, comorbidities, American Society of Anesthesiologists class, and the modified frailty index score. Multivariable regression was conducted for frailty, age, other comorbidities, and hernia characteristics to determine the relationship to all-cause and surgical site complications, complication severity, complications with Clavien-Dindo score above 3, length of stay, readmission, and reoperation. All analyses were performed using R software. A P value less than 0.05 was considered statistically significant. Results A total of 14,575 patients were identified. Frailty was a significant predictor of all-cause complications, readmission, reoperation, and increasing length of stay. Increased age was a significant predictor for length of stay and severe systemic complications. Smoking status and American Society of Anesthesiologists class of 4 were associated with all outcomes. Body mass index predicted surgical site complications and reoperation. Conclusions Frailty can predict many postoperative complications of VHR with component separation technique and is an important element of risk prediction for potential surgical candidates.
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Affiliation(s)
- Allison L. Diaz
- From the Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York, NY
| | - Wen-Yu Lee
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, New York, NY
| | - Cheongeun Oh
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, New York, NY
| | - Laura L. Kimberly
- From the Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York, NY
- Division of Medical Ethics, Department of Population Health, NYU Grossman School of Medicine, New York, NY
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Tarasova NK, Dynkov SM, Mizgirev DV, Ivanov GA. [Differentiated approach to surgical treatment of patients with large postoperative ventral hernia]. Khirurgiia (Mosk) 2025:33-38. [PMID: 40103243 DOI: 10.17116/hirurgia202503133] [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: 03/20/2025]
Abstract
OBJECTIVE To analyze the results of large postoperative ventral hernia repair using the Rives-Stoppa technique and posterior component separation between 2018 and 2023. MATERIAL AND METHODS We retrospectively analyzed 55 case histories of patients with large postoperative ventral hernias. The Rives-Stoppa technique was used in 25 (45.5%) patients, posterior component separation - in 30 (54.5%) patients. RESULTS The classical Rives-Stoppa technique was predominantly performed in women (mean age 67.3±1.2 years). In 20 (80%) patients, hernia defect did not exceed 14 cm. Mean wound drainage time was 3.8±0.7 days, mean postoperative in-hospital stay - 12.7±2.4 days. Posterior component separation was more common in men, whose age was significantly lower (58.4±2.0 years, U=160.500, p<0.001). This technique was significantly more common for hernia > 15 cm (14 (47%) patients, c²=4.288, p=0.038). Mean wound drainage time was 9.7±0.8 days, mean postoperative in-hospital stay - 18.8±1.6 days (p<0.001). In early postoperative period, 15 (27.3%) patients had wound complications. There was no significant difference in the incidence of wound complications (p=0.808), and no deaths were recorded. CONCLUSION A differentiated approach is necessary for large hernias. Some elderly and senile patients underwent Rives-Stoppa procedure. Posterior component separation is required for anterior abdominal wall reconstruction in young and middle-aged men. Posterior component separation significantly increases the wound drainage time and hospital-stay, but does not significantly affect the incidence of wound complications.
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Affiliation(s)
- N K Tarasova
- Northern State Medical University, Arkhangelsk, Russia
- Volosevich Arkhangelsk City Hospital, Arkhangelsk, Russia
| | - S M Dynkov
- Northern State Medical University, Arkhangelsk, Russia
- Volosevich Arkhangelsk City Hospital, Arkhangelsk, Russia
| | - D V Mizgirev
- Northern State Medical University, Arkhangelsk, Russia
- Volosevich Arkhangelsk City Hospital, Arkhangelsk, Russia
| | - G A Ivanov
- Volosevich Arkhangelsk City Hospital, Arkhangelsk, Russia
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Klein A, Willms A, Güsgen C, Schwab R, Schaaf S. [Planned Ventral Hernia After Open Abdomen Therapy: Complex Incisional Hernia Repair]. Zentralbl Chir 2024; 149:516-521. [PMID: 39577460 DOI: 10.1055/a-2420-1303] [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: 11/24/2024]
Abstract
A planned ventral hernia after open abdomen therapy is a rare hernia entity because the fascial closure rate has been increased due to established concepts for open abdominal treatment. Nevertheless, fascial closure is not always successful, and a planned ventral hernia has to be treated later. Preoperative optimisation and planning are essential for such challenging abdominal wall repairs.In a single centre retrospective analysis, all incisional hernias from 2013 to 2023 (n = 632) were identified and planned hernias after a laparostomy were selected (n = 11). The data on surgical management were obtained from the patient files for the operation reports. Literature search was conducted with PubMed (Medline).In all cases a physical examination, abdominal sonography, CT abdomen and a colonoscopy were carried out preoperatively. The median size of the abdominal wall defects were horizontally 13 cm (6-35 cm) and vertically 18 cm (10-28 cm). Botulinum toxin A has been used preoperatively since 2018. Median fascial closure was successful intraoperatively in all 11 patients. The surgical techniques included sublay, IPOM, sandwich technique, intraoperative fascial traction, and component separation.Planned ventral hernias after open abdomen treatment should always be considered complex hernias for which the entire expertise in hernia surgery is required. Comprehensive preoperative optimisation with botulinum toxin A infiltration is essential to facilitate anatomically appropriate reconstruction through midline closure with mesh augmentation.
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Affiliation(s)
- Angelina Klein
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Bundeswehrzentralkrankenhaus, Koblenz, Deutschland
| | - Arnulf Willms
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Bundeswehrzentralkrankenhaus, Koblenz, Deutschland
- Arnulf Willms, Bad Breisig, Deutschland
| | - Christoph Güsgen
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Bundeswehrzentralkrankenhaus, Koblenz, Deutschland
| | - Robert Schwab
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Bundeswehrzentralkrankenhaus, Koblenz, Deutschland
| | - Sebastian Schaaf
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Bundeswehrzentralkrankenhaus, Koblenz, Deutschland
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Youngren K. Preoperative abdominal wall Botulinum A toxin in the outpatient pain clinic prior to complex abdominal wall repair: A letter to the editor. INTERVENTIONAL PAIN MEDICINE 2024; 3:100440. [PMID: 39429968 PMCID: PMC11489389 DOI: 10.1016/j.inpm.2024.100440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 09/04/2024] [Accepted: 09/08/2024] [Indexed: 10/22/2024]
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Cai X, Wang F, Zhu Y, Shen Y, Peng P, Cui Y, Di Z, Chen J. Application of bridging mesh repair in giant ventral incisional hernia. Updates Surg 2024; 76:2411-2420. [PMID: 38555536 DOI: 10.1007/s13304-024-01825-3] [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: 11/24/2023] [Accepted: 03/06/2024] [Indexed: 04/02/2024]
Abstract
Achieving ideal abdominal wall reconstruction in giant ventral incisional hernia has been a challenging for surgeons. This study aimed to verify the safety and efficacy of bridging repair by comparing it with primary fascial closure (PFC) repair in the treatment of giant ventral incisional hernia. We retrospectively analyzed the clinical data of 92 patients with giant ventral incisional hernia who underwent mesh repair at our medical institution from January 1, 2014 to December 31, 2020. Patients were divided into 2 groups: the bridging repair group with 40 patients in whom repair was completed using the bridging technique and the PFC group with 52 patients in whom primary fascial closure was achieved and all patients underwent mesh reinforcement during the operation. The main outcome measures were recurrence rate and morbidity, especially intra-abdominal hypertension (IAH). Follow-up time of both groups lasted at least 24 months after surgery. After a median of 46 months and 65 months of follow-up, respectively, in the two groups, bridging repair did not increase the long-term recurrence rate (2.56%) in the larger defect area group compared to the PFC group (1.96%). There were no significant differences in perioperative morbidity, IAH, incidence of postoperative chronic pain, and sensory impairment of the abdominal wall between both groups. The application of bridging surgery in the treatment of complex giant ventral incisional hernias is safe and effective and does not significantly increase the postoperative recurrence rate.
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Affiliation(s)
- Xuan Cai
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang District, Beijing, 100020, China
| | - Fan Wang
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang District, Beijing, 100020, China
| | - Yilin Zhu
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang District, Beijing, 100020, China
| | - Yingmo Shen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang District, Beijing, 100020, China
| | - Peng Peng
- Department of Hernia and Abdominal Wall Surgery, Peking University People's Hospital, No.11 Xizhimennan Str., Xicheng District, Beijing, 100044, China
| | - Yan Cui
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang District, Beijing, 100020, China
| | - Zhishan Di
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang District, Beijing, 100020, China
| | - Jie Chen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang District, Beijing, 100020, China.
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Fair L, Leeds SG, Bokhari SH, Esteva S, Mathews T, Ogola GO, Ward MA, Aladegbami B. Achieving fascial closure with preoperative botulinum toxin injections in abdominal wall reconstruction: outcomes from a high-volume center. Updates Surg 2024; 76:2421-2428. [PMID: 38507174 DOI: 10.1007/s13304-024-01802-w] [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: 05/12/2023] [Accepted: 02/24/2024] [Indexed: 03/22/2024]
Abstract
Preoperative injection of Botulinum Toxin A (Botox) has been described as an adjunctive therapy to facilitate fascial closure of large hernia defects in abdominal wall reconstruction (AWR). The purpose of this study was to evaluate the impact of Botox injections on fascial closure and overall outcomes to further validate its role in AWR. A prospectively maintained database was retrospectively reviewed to identify all patients undergoing AWR at our institution between January 2014 and March 2022. Patients who did and did not receive preoperative Botox injections were analyzed and compared. A total of 426 patients were included (Botox 76, NBotox 350). The Botox group had significantly larger hernia defects (90 cm2 vs 9 cm2, p < 0.01) and a higher rate of component separations performed (60.5% vs 14.4%, p < 0.01). Despite this large difference in hernia defect size, primary fascial closure rates were similar between the groups (p = 0.49). Notably, the Botox group had higher rates of surgical-site infections (SSIs)/surgical-site occurrences (SSOs) (p < 0.01). Following propensity score matching to control for multiple patient factors including age, sex, diabetes, chronic obstructive pulmonary disease (COPD), and hernia size, the Botox group still had a higher rate of component separations (50% vs 26.3%, p = 0.03) and higher incidence of SSIs/SSOs (39.5% vs 13.5%, p = 0.01). Multimodal therapy with Botox injections and component separations can help achieve fascial closure of large defects during AWR. However, adding these combined therapies may increase the occurrence of postoperative SSIs/SSOs.
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Affiliation(s)
- Lucas Fair
- Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA.
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA.
- Research Institute, Baylor Scott and White Health, 3535 Worth St., Suite C3.510, Dallas, TX, 75246, USA.
| | - Steven G Leeds
- Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA
- Texas A&M College of Medicine, Bryan, TX, USA
| | - Syed Harris Bokhari
- Research Institute, Baylor Scott and White Health, 3535 Worth St., Suite C3.510, Dallas, TX, 75246, USA
| | | | - Tanner Mathews
- Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA
| | - Gerald O Ogola
- Research Institute, Baylor Scott and White Health, 3535 Worth St., Suite C3.510, Dallas, TX, 75246, USA
| | - Marc A Ward
- Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA
- Texas A&M College of Medicine, Bryan, TX, USA
| | - Bola Aladegbami
- Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA
- Texas A&M College of Medicine, Bryan, TX, USA
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Gillion JF, Fromont G, Verhaeghe R, Tiry P, Binot D, Dugué T, Dabrowski A. Open IPOMs for medium/large incisional ventral hernia repairs in the French Hernia Registry: factors associated with their use and mesh-related outcomes. Hernia 2024; 28:745-759. [PMID: 37581722 DOI: 10.1007/s10029-023-02853-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/19/2023] [Indexed: 08/16/2023]
Abstract
PURPOSE The use of open intra-peritoneal onlay mesh repairs (O-IPOMs) for treating medium/large incisional ventral hernias has come into question due to the development of minimally invasive and sublay procedures. This study aimed to identify factors that are associated with the use of O-IPOMs in France. METHODS We analysed prospectively collected data from the French Hernia Registry on incisional ventral hernia repairs (IVHR) for hernias ≥ 4 cm in width. RESULTS We obtained data for 2261 IVHR (from 11/09/2011 to 30/03/2020): 733 O-IPOMs and 1,528 other techniques. We found that the O-IPOMs were performed on patients with more patient-related risk factors compared with the other techniques. Specifically, there was a higher proportion of patients with ASA III/IV (40.47% vs. 28.02%; p < 0.00001) and at least one patient-related risk factor (66.17% vs. 58.51%; p = 0.0005). Of the 733 O-IPOMs, 195 used Ventrio ST™ (VST), the most commonly used mesh for such IPOMs in our database; the other 538 O-IPOMs used other meshes (OM). The VST subgroup had a higher proportion of patients with ASA III/IV (52.58% vs. 36.07%; p < 0.0001) and on anticoagulants (26.04% vs. 18.41%; p = 0.0229) compared with the OM subgroup; they also had a lower recurrence rate after 2 years (5.83% vs. 15.41%; p = 0.008). However, large (≥ 10 cm) or lateral defects were more common in the OM subgroup, and their mesh/defect area ratio was lower. CONCLUSION O-IPOMs were performed on patients with more comorbidities and/or complex incisional hernias compared with other techniques.
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Affiliation(s)
- J-F Gillion
- Ramsay Sante, Antony Private Hospital, 1 rue Velpeau, 92160, Antony, France.
| | - G Fromont
- Bois Bernard Private Hospital, 62320, Rouvroy, France
| | - R Verhaeghe
- MCO Côte d'Opale, 62280, Saint-Martin-Boulogne, France
| | - P Tiry
- Saint-Omer Clinic, 62500, Saint-Omer, France
| | - D Binot
- MCO Côte d'Opale, 62280, Saint-Martin-Boulogne, France
| | - T Dugué
- Saint-Pierre Clinic, 66000, Perpignan, France
| | - A Dabrowski
- Saint-Omer Clinic, 62500, Saint-Omer, France
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Vierstraete M, Molnar A, Berrevoet F. Open intraperitoneal onlay mesh repair with anterior component separation as a bail-out procedure in the management of complex hernias. Hernia 2024; 28:887-893. [PMID: 38642316 DOI: 10.1007/s10029-024-03033-9] [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: 01/02/2024] [Accepted: 03/28/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE Surgical repair of complex abdominal wall hernias remains technically demanding and is widely recognized as a risk factor for unfavorable outcomes with high recurrence and morbidity rates. The objective is to assess short- and long-term complications after open intraperitoneal onlay mesh (IPOM) repair combined with bilateral anterior component separation (ACS) for large and difficult incisional hernias, alongside evaluating hernia recurrence rates. METHODS This retrospective analysis utilized data sourced from Hospital electronic health records and a prospective database at an academic tertiary referral center. Data collection was carried out from patients operated between January 2006 and December 2017. Eligible patients had complex incisional hernias measuring at least 10 cm in their transverse diameter and had an open IPOM repair with bilateral ACS. RESULTS In our study group of 45 patients, the 30-day surgical site occurrence (SSO) rate was high (37.8%), primarily consisting of superficial postoperative complications as seroma (17.8%) and wound dehiscence (6.7%). Among six patients (13.3%), wound complications escalated to chronic infected mesh-related problems, leading to complete mesh removal in four cases (8.9%) and partial mesh removal in two cases (4.4%). Regarding long-term complications, five patients (11.1%) developed enterocutaneous fistula. The recurrence rate was modest [5 out of 41 (12.2%)] over a median follow-up period of 99 months. CONCLUSIONS Despite a high SSO rate, application of the open IPOM technique with ACS could serve as a valuable rescue option for managing large and complex hernias, with acceptable hernia recurrence rates at long-term follow-up.
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Affiliation(s)
- M Vierstraete
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium.
| | - A Molnar
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - F Berrevoet
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
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Pogson-Morowitz K, Porras Fimbres D, Barrow BE, Oleck NC, Patel A. Contemporary Abdominal Wall Reconstruction: Emerging Techniques and Trends. J Clin Med 2024; 13:2876. [PMID: 38792418 PMCID: PMC11122627 DOI: 10.3390/jcm13102876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 05/02/2024] [Accepted: 05/03/2024] [Indexed: 05/26/2024] Open
Abstract
Abdominal wall reconstruction is a common and necessary surgery, two factors that drive innovation. This review article examines recent developments in ventral hernia repair including primary fascial closure, mesh selection between biologic, permanent synthetic, and biosynthetic meshes, component separation, and functional abdominal wall reconstruction from a plastic surgery perspective, exploring the full range of hernia repair's own reconstructive ladder. New materials and techniques are examined to explore the ever-increasing options available to surgeons who work within the sphere of ventral hernia repair and provide updates for evolving trends in the field.
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Affiliation(s)
- Kaylyn Pogson-Morowitz
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, Durham, NC 27710, USA (A.P.)
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Willms AG, Schaaf S, Schwab R. Analysis of surgical quality indicators after certification as a Hernia Center. Updates Surg 2024; 76:255-264. [PMID: 36811182 PMCID: PMC10805962 DOI: 10.1007/s13304-023-01449-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 02/03/2023] [Indexed: 02/24/2023]
Abstract
Certifications are an increasingly used tool of quality management in the health care system. The primary goal is to improve the quality of treatment due to implemented measures based on a defined catalog of criteria and standardization of the treatment processes. However, the extent to which this affects medical and health-economic indicators is unknown. Therefore, the study aims to examine the possible effects of the certification as a Reference Center for Hernia Surgery on the treatment quality and reimbursement dimensions. The observation and recording periods were defined as 3 years before (2013-2015) and 3 years after certification as a "Reference Center for Hernia Surgery" (2016-2018). Possible changes due to the certification were examined based on multidimensional data collection and analysis. In addition, the aspects of structure, process and result quality, and the reimbursement situation were reported. One thousand three hundred and nineteen cases before and one thousand four hundred and three cases after certification were included. After the certification, the patients were older (58.1 ± 16.1 vs. 64.0 ± 16.1 years, p < 0.01), had a higher CMI (1.01 vs. 1.06), and a higher ASA score (< III 86.9 vs. 85.5%, p < 0.01). The interventions became more complex (e.g., recurrent incisional hernias 0.5% vs. 1.9%, p < 0.01). The mean length of hospital stay was significantly reduced for incisional hernias (8.8 ± 5.8 vs. 6.7 ± 4.1 days, p < 0.001). The reoperation rate for incisional hernias also decreased significantly from 8.24 to 3.66% (p = 0.04). The postoperative complication rate for inguinal hernias was significantly reduced (3.1 vs. 1.1%, p = 0.002). The reimbursement of the hernia center increased by 27.6%. There were positive changes in process and outcome quality and reimbursement after the certification, which supports the effectivity of certifications in hernia surgery.
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Affiliation(s)
- Arnulf Gregor Willms
- Department of General, Visceral and Thoracic Surgery, Hernia Reference Center of the German Armed Forces Central Hospital Koblenz, Rübenacher Str. 170, 56072, Koblenz, Germany.
- Department of General and Visceral Surgery, German Armed Forces Hospital, Lesserstr. 180, 22049, Hamburg, Germany.
| | - Sebastian Schaaf
- Department of General, Visceral and Thoracic Surgery, Hernia Reference Center of the German Armed Forces Central Hospital Koblenz, Rübenacher Str. 170, 56072, Koblenz, Germany
| | - Robert Schwab
- Department of General, Visceral and Thoracic Surgery, Hernia Reference Center of the German Armed Forces Central Hospital Koblenz, Rübenacher Str. 170, 56072, Koblenz, Germany
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Dias ERM, Rondini GZ, Amaral PHF, Macret JZ, Carvalho JPV, Pivetta LGA, Malheiros CA, Roll S. Systematic review and meta-analysis of the pre-operative application of botulinum toxin for ventral hernia repair. Hernia 2023:10.1007/s10029-023-02816-w. [PMID: 37329437 DOI: 10.1007/s10029-023-02816-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/28/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE Surgical repair of large hernia defects requires detailed pre-operative planning, particularly in cases with loss of domain. This situation often hampers mid-line reconstruction, even after component separation, when the size of the hernia is disproportional to the volume of the abdominal area. In this case, other strategies may be needed to place the viscera back into the abdominal cavity after reducing the hernia sac. The administration of botulinum toxin prior to the surgical procedure has been indicated as an adjunct for more complex cases. This results in stretching of the lateral musculature of the abdomen, allowing midline approximation. In addition, the application of botulinum toxin alone has been investigated as a means of downstaging in the management of ventral hernias, thereby precluding component separation and enabling primary closure of the midline by placement of mesh within the retromuscular space using the Rives Stoppa technique. METHODS Systematic review of the literature for observational studies involving patients undergoing pre-operative application of botulinum toxin for ventral hernia repair was conducted according to the PRISMA guidelines. RESULTS Advance of the lateral musculature of the abdomen by an average of 4.11 cm with low heterogeneity, as well as low rates of surgical site infection (SSI), surgical site occurrences (SSO) and recurrence, was shown. CONCLUSION Pre-operative application of botulinum toxin for ventral hernia repair promoted an increase in the length of the lateral musculature of the abdomen which can help improve the outcomes of morbidity and recurrence.
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Affiliation(s)
- E R M Dias
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Rua Dr. Cesário Motta Júnior, 61, Vila Buarque, São Paulo, SP, 01221-020, Brazil.
- Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil.
| | - G Z Rondini
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Rua Dr. Cesário Motta Júnior, 61, Vila Buarque, São Paulo, SP, 01221-020, Brazil
| | - P H F Amaral
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Rua Dr. Cesário Motta Júnior, 61, Vila Buarque, São Paulo, SP, 01221-020, Brazil
- Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil
| | - J Z Macret
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Rua Dr. Cesário Motta Júnior, 61, Vila Buarque, São Paulo, SP, 01221-020, Brazil
- Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil
| | - J P V Carvalho
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Rua Dr. Cesário Motta Júnior, 61, Vila Buarque, São Paulo, SP, 01221-020, Brazil
- Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil
| | - L G A Pivetta
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Rua Dr. Cesário Motta Júnior, 61, Vila Buarque, São Paulo, SP, 01221-020, Brazil
- Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil
| | - C A Malheiros
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Rua Dr. Cesário Motta Júnior, 61, Vila Buarque, São Paulo, SP, 01221-020, Brazil
| | - S Roll
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Rua Dr. Cesário Motta Júnior, 61, Vila Buarque, São Paulo, SP, 01221-020, Brazil
- Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil
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Ferrer Martínez A, Castillo Fe MJ, Alonso García MT, Villar Riu S, Bonachia Naranjo O, Sánchez Cabezudo C, Marcos Herrero A, Porrero Carro JL. Medial incisional ventral hernia repair with Adhesix ® autoadhesive mesh: descriptive study. Hernia 2023:10.1007/s10029-023-02766-3. [PMID: 37178428 PMCID: PMC10182549 DOI: 10.1007/s10029-023-02766-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/03/2023] [Indexed: 05/15/2023]
Abstract
Nowadays, the gold standard for the surgical treatment of abdominal wall defects is the use of a mesh. There is an extensive variety of meshes, self-adhesive ones being among the most novel technologies. The literature on the self-adhesive mesh Adhesix® (Cousin Biotech Laboratory, 59117 Wervicq South, France) in medial incisional ventral hernia is scarce. We performed a retrospective descriptive study with prospective data collection from 125 patients who underwent prosthetic repair of medial incisional ventral hernia-M1-M5 classification according to European Hernia Society (EHS)-with self-adhesive mesh Adhesix® between 2013 and 2021. Follow-up was performed 1 month and yearly after the surgery. Postoperative complications and hernia recurrences were recorded. Epidemiological results were average BMI 30.5 kg/m2 (SD 5), highlighting that overweight (41.6%) and obesity type 1 (25.6%) were the most represented groups. 34 patients (27.2%) had already undergone a previous abdominal wall surgery. The epigastric-umbilical (M2-M3 EHS classification, 22.4%) and umbilical (M3 EHS classification, 20%) hernias were the predominant groups. The elective surgery technique was Rives or Rives-Stoppa with an associated supraaponeurotic mesh if the closure of the anterior aponeurosis of the rectus sheath was not surgically closed (13 patients). The most frequent postoperative complication was seroma (26.4%). The recurrence rate was 7.2%. The average follow-up length was 2.6 years (SD 1.6 years). According to the results of this study and the literature available, we consider that the self-adhesive mesh Adhesix® is an appropriate alternative mesh option for the repair of medial incisional ventral hernias.
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Affiliation(s)
- A Ferrer Martínez
- Cirugía General y del Aparato Digestivo, Hospital Universitario de Getafe, Carretera Madrid-Toledo, Km 12,500, 28905, Getafe, Spain.
| | - M J Castillo Fe
- Cirugía General y del Aparato Digestivo, Hospital Universitario Santa Cristina, Madrid, Spain
| | - M T Alonso García
- Cirugía General y del Aparato Digestivo, Hospital Universitario Santa Cristina, Madrid, Spain
| | - S Villar Riu
- Cirugía General y del Aparato Digestivo, Hospital Universitario Santa Cristina, Madrid, Spain
| | - O Bonachia Naranjo
- Cirugía General y del Aparato Digestivo, Hospital Universitario Santa Cristina, Madrid, Spain
| | - C Sánchez Cabezudo
- Cirugía General y del Aparato Digestivo, Hospital Universitario Santa Cristina, Madrid, Spain
| | - A Marcos Herrero
- Cirugía General y del Aparato Digestivo, Hospital Universitario Santa Cristina, Madrid, Spain
| | - J L Porrero Carro
- Cirugía General y del Aparato Digestivo, Hospital Universitario Santa Cristina, Madrid, Spain
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CT-measured hernia parameters can predict component separation: a cross-sectional study from China. Hernia 2023:10.1007/s10029-023-02761-8. [PMID: 36934216 DOI: 10.1007/s10029-023-02761-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/12/2023] [Indexed: 03/19/2023]
Abstract
PURPOSE Currently, there are no reliable preoperative methods for predicting component separation (CS) during incisional hernia repair. By quantitatively measuring preoperative computed tomography (CT) imaging, we aimed to assess the value of hernia defect size, abdominal wall muscle quality, and hernia volume in predicting CS. METHODS The data of 102 patients who underwent open Rives-Stoppa retro-muscular mesh repair for midline incisional hernia between January 2019 and March 2022 were retrospectively analyzed. The patients were divided into two groups: ''CS group'' patients who required CS to attempt fascial closure, and ''non-CS'' group patients who required only Rives-Stoppa retro-muscular release to achieve fascial closure. Hernia defect width, hernia defect angle, rectus width, abdominal wall muscle area and CT attenuation, hernia volume (HV), and abdominal cavity volume (ACV) were measured on CT images. The rectus width to defect width ratio (RDR), HV/ACV, and HV/peritoneal volume (PV; i.e., HV + ACV) were calculated. Differences between the indices of the two groups were compared. Logistic regression models were applied to analyze the relationships between the above CT parameters and CS. Receiver operator characteristic (ROC) curves were generated to evaluate the potential utility of CT parameters in predicting CS. RESULTS Of the102 patients, 69 were in the non-CS group and 33 were in the CS group. Compared with the non-CS group, hernia defect width (P < 0.001), hernia defect angle (P < 0.001), and hernia volume (P < 0.001) were larger in the CS group, while RDR (P < 0.001) was smaller. The abdominal wall muscle area in the CS group was slightly greater than that in the non-CS group (P = 0.046), and there was no significant difference in the CT attenuation of the abdominal wall muscle between the two groups (P = 0.089). Multivariate logistic regression identified hernia defect width (OR 1.815, 95% CI 1.428-2.308, P < 0.001), RDR (OR 0.018, 95% CI 0.003-0.106, P < 0.001), hernia defect angle (OR 1.077, 95% CI 1.042-1.114, P < 0.001), hernia volume (OR 1.002, 95% CI 1.001-1.003, P < 0.001), and CT attenuation of abdominal wall muscle (OR 0.962, 95% CI 0.927-0.998, P = 0.037) as independent predictors of CS. Hernia defect width was the best predictor for CS, with a cut-off point of 9.2 cm and an area under the curve (AUC) of 0.890. The AUCs of RDR, hernia defect angle, hernia volume, and abdominal wall muscle CT attenuation were 0.843, 0.812, 0.747, and 0.572, respectively. CONCLUSION Quantitative CT measurements are of great value for preoperative prediction of CS. Hernia defect size, hernia volume, and the CT attenuation of abdominal wall muscle are all preoperative predictive indicators of CS.
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15
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Wang D, Zheng S, Qiu X, Fu Y. Immediate Repair With a Self-Gripping Retromuscular Mesh for Abdominal Wall Defect Following Tumor Resection. Surg Innov 2023; 30:50-55. [PMID: 35357985 DOI: 10.1177/15533506221087074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Prosthetic repair is always employed after large abdominal wall tumor resection, while chronic pain is one of the mesh-related complications after traumatic fixation. The objective of this research was to evaluate the outcomes of retromuscular repair with self-gripping mesh after abdominal wall tumor resection.Methods: The study was a monocentric retrospective analysis following STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) statements of all patients with abdominal wall tumor >5 cm in diameter undergoing tumor excision and retromuscular repair with self-gripping mesh. Demographic, operative, early postoperative, and follow-up data were noted. Visual Analog Scale, ranging from 0 (no pain) to 10 (very severe pain), was used to estimate the wound pain.Results: 24 patients were included in this study, and the defect following tumor resection was 26.9±10.0 cm2. There was no tumor recurrence or incisional hernia in median follow-up of 20 months, and the mean VAS score was 0.4. Three had foreign body feeling and no one suffered chronic pain.Conclusions: Immediate repair with a self-gripping retromuscular mesh can be considered as an effective way to treat an abdominal wall defect after resecting an abdominal wall tumor.
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Affiliation(s)
- Dianchen Wang
- Department of Hernia and Abdominal Wall Surgery, 191599The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shouhua Zheng
- Department of Thyroid Surgery, 191599The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe Road, Zhengzhou, China
| | - Xinguang Qiu
- Department of Thyroid Surgery, 191599The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe Road, Zhengzhou, China
| | - Yang Fu
- Department of Hernia and Abdominal Wall Surgery, 191599The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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16
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Muacevic A, Adler JR, Altundaş N, Kara S, Cambaztepe F, Peksöz R, Kaşali K. Comparison of Surgical Treatment Results of Large Incisional Hernias. Cureus 2022; 14:e32020. [PMID: 36600861 PMCID: PMC9799076 DOI: 10.7759/cureus.32020] [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: 11/29/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Incisional hernias are one of the most common complications after abdominal surgery. Surgical repairs of large incisional hernias have higher complications and recurrence rates compared to smaller incisional hernia repairs. For this reason, it is a more difficult and experience-requiring application for surgeons. In addition, there is no evidence-based consensus in the literature regarding the optimal surgical treatment of large incisional hernias. The aim of this study is to compare the results of the three most common surgical treatment methods used in a tertiary university hospital for the repair of large incisional hernias in terms of patients' characteristics, recurrence, and complication rates of the treatment methods. Methods Between 2014 and 2020, 366 patients with incisional hernias with facial defects larger than 10 cm in a tertiary medical faculty hospital located in eastern Turkey were analyzed. Patients were divided into three groups according to the surgical method used: open onlay prolene mesh (OPM) method, laparoscopic intraperitoneal sublay dual mesh (IPSDM) method, and open IPSDM method. Postoperative complications were divided into five groups as follows: wound complications, complications due to surgical procedures, medical complications, recurrences, and mortality. Treatment methods were compared according to the demographic characteristics of the patients and the postoperative complication rates. Results Of the patients, 141 were male and 225 were female, and the mean age was 58.0 ± 28 years. Of the patients, 81.9% were operated on with the open OPM, 10.9% with the laparoscopic IPSDM, and 7.1% with the open IPSDM. Wound complications occurred in 26.7% of patients, surgical complications in 3.2%, medical complications in 6.5%, recurrence in 9.2%, and mortality in 0.8% of patients. Total wound complications were significantly higher in the open OPM group (30%) (p = 0.009). Total surgery complications were significantly higher in the laparoscopic IPSDM group (15%) (p = 0.002). There was no significant difference between groups for medical complications (p = 0.540). Although no recurrence was observed in the open IPSDM group, no significant difference was observed between the groups (p = 0.099). There was no difference in mortality rates between the groups (p = 0.450). The overall complication rate was highest in the open OPM group (48.3%) and lowest in the open IPSDM group (27%) (p = 0.092). The operative time was found to be significantly shorter in open IPSDM (p < 0.001). The length of hospital stay was highest in the open OPM group and lowest in the open IPSDM group (p = 0.450). Conclusions Although hernia defect is greater in the open IPSDM compared to other methods, this method is more advantageous in terms of the complication rate associated with the surgical procedure, the overall complication rate, the duration of surgery, and the recurrence rate. Laparoscopic IPSDM is a more advantageous method in terms of the overall wound and medical complications.
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17
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Korkut E, Aksungur N, Altundaş N, Kara S, Peksöz R, Öztürk G. Giant Incisional Hernia Repair Using Open Intraperitoneal Dual Mesh. Cureus 2022; 14:e27126. [PMID: 36004021 PMCID: PMC9392680 DOI: 10.7759/cureus.27126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2022] [Indexed: 11/05/2022] Open
Abstract
Aim Giant incisional herniae are larger than 15 cm and are typically treated with an open approach. Our aim was to highlight the outcomes of treating giant incisional hernia using open intraperitoneal dual mesh. Methods Between January 2015 and December 2021, 25 patients with giant incisional hernias, where fascial defects were 15-30 cm, were evaluated retrospectively. Intraperitoneal dual mesh was used in all patients. The patients were evaluated in terms of age, gender, body mass index (BMI), previous abdominal surgeries, defect diameter, anesthesia method, length of hospital stay, drain application, complications, and recurrence. Results Eleven of the patients were male and 14 were female. The mean age was 62±13.5 years (29-82 years). The average BMI was 32 kg/m2 (20-52 kg/m2). The mean size of the fascial defect was 22±5.5 cm (15-30). The mean operation time was 90 minutes (70-130 minutes). Six patients had type I and II complications according to the Clavien-Dindo classification, specifically superficial skin infections, skin erosion, subcutaneous bleeding, and temporary ileus due to intestinal adhesion. During the average follow-up period of 36 months (6-70 months), no major complications were observed related to the recurrence and use of dual mesh. Conclusion In the treatment of giant incisional hernia, open intraperitoneal dual mesh application should be kept in mind as an effective treatment option with low complication and recurrence rates.
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18
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Yazid MM, De la Fuente Hagopian A, Farhat S, Doval AF, Echo A, Pei KY. Does Surgeon Specialty Make a Difference in Ventral Hernia Repair With the Component Separation Technique? Cureus 2022; 14:e26290. [PMID: 35898356 PMCID: PMC9308972 DOI: 10.7759/cureus.26290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2022] [Indexed: 11/05/2022] Open
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Al Sadairi AR, Durtette-Guzylack J, Renard A, Durot C, Thierry A, Kianmanesh R, Passot G, Renard Y. A simplified method to evaluate the loss of domain. Hernia 2022; 26:927-936. [PMID: 34341871 DOI: 10.1007/s10029-021-02474-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The treatment of giant incisional hernia (IH) with loss of domain (LOD, IHLD) is considerably challenging due to technical difficulties and subsequent post-operative complications. These post-operative risks may be anticipated by calculating the abdominal cavity (AC) volume (ACV) and the IH volume (IHV) on the preoperative CT-scans, using the AC and IH dimensions (Tanaka's method) or using tridimensional volumetry (Sabbagh's method). These techniques are often time-consuming and require specific softwares. The aim of the present study was to develop a simple method to rapidly obtain the LOD-ratio on the preoperative CT-Scan. METHODS The CT-scans (n = 89) of patients with IHLD were retrospectively studied. Several ratios were calculated using different parameters of the AC and the IH, including width, height and depth, the areas (axial and sagittal ellipse, as well as freehand sagittal surface areas) and these were compared with the reference methods of Sabbagh et al. and Tanaka et al. RESULTS: The LOD ratios calculated from the two reference methods gave similar results (ICC = 0.82, p < 0.0001). The new "R-ratios" (Reims-ratios) obtained from the IH and AC surface areas measured using the "freehand ROI" tool on sagittal view or roughly evaluated by an ellipse on axial view showed excellent correlation with both reference ratios (all ICC ≥ 0.71, p < 0.0001). CONCLUSION The LOD ratio may be quickly obtained by drawing two circles on the pre-operative CT scan ("R ratios") and available on the webpage https://romeo.univ-reims.fr/Rratio/ . This will certainly help surgeons to routinely anticipate the post-operative complications before IHLD repair.
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Affiliation(s)
- Abdul Rahman Al Sadairi
- Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Rue Cognac-Jay, 51092, Reims Cedex, France.
- Sultan Qaboos University, Muscat, Sultanate of Oman.
| | - Jules Durtette-Guzylack
- Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Rue Cognac-Jay, 51092, Reims Cedex, France
| | - Arnaud Renard
- Laboratory Liciis and ROMEO, University of Reims Champagne-Ardenne, Reims, France
| | - Carole Durot
- Department of Radiology, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Reims, France
| | - Aurore Thierry
- Methodological Aid To Clinical Research Unit CHU Reims, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Reims, France
| | - Reza Kianmanesh
- Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Rue Cognac-Jay, 51092, Reims Cedex, France
| | - Guillaume Passot
- Department of Digestive Surgery, Hopital Lyon Sud, Pierre Bénite, University of Lyon, Lyon, France
| | - Yohann Renard
- Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Rue Cognac-Jay, 51092, Reims Cedex, France
- Laboratory Liciis and ROMEO, University of Reims Champagne-Ardenne, Reims, France
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Yang S, Wang MG, Nie YS, Zhao XF, Liu J. Outcomes and complications of open, laparoscopic, and hybrid giant ventral hernia repair. World J Clin Cases 2022; 10:51-61. [PMID: 35071505 PMCID: PMC8727244 DOI: 10.12998/wjcc.v10.i1.51] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 07/11/2021] [Accepted: 11/28/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND An incisional hernia is a common complication of abdominal surgery.
AIM To evaluate the outcomes and complications of hybrid application of open and laparoscopic approaches in giant ventral hernia repair.
METHODS Medical records of patients who underwent open, laparoscopic, or hybrid surgery for a giant ventral hernia from 2006 to 2013 were retrospectively reviewed. The hernia recurrence rate and intra- and postoperative complications were calculated and recorded.
RESULTS Open, laparoscopic, and hybrid approaches were performed in 82, 94, and 132 patients, respectively. The mean hernia diameter was 13.11 ± 3.4 cm. The incidence of hernia recurrence in the hybrid procedure group was 1.3%, with a mean follow-up of 41 mo. This finding was significantly lower than that in the laparoscopic (12.3%) or open procedure groups (8.5%; P < 0.05). The incidence of intraoperative intestinal injury was 6.1%, 4.1%, and 1.5% in the open, laparoscopic, and hybrid procedures, respectively (hybrid vs open and laparoscopic procedures; P < 0.05). The proportion of postoperative intestinal fistula formation in the open, laparoscopic, and hybrid approach groups was 2.4%, 6.8%, and 3.3%, respectively (P > 0.05).
CONCLUSION A hybrid application of open and laparoscopic approaches was more effective and safer for repairing a giant ventral hernia than a single open or laparoscopic procedure.
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Affiliation(s)
- Shuo Yang
- Department of Hernia and Abdominal Wall, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
| | - Ming-Gang Wang
- Department of Hernia and Abdominal Wall, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
| | - Yu-Sheng Nie
- Department of Hernia and Abdominal Wall, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
| | - Xue-Fei Zhao
- Department of Hernia and Abdominal Wall, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
| | - Jing Liu
- Department of Hernia and Abdominal Wall, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
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21
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López JG, Hernández LS, Fernández SL, Garrido MF. Abdominal Wall Reconstruction Using Unique Composite Anterolateral and Fascia Lata Perforator Free Flap After Failed Attempts. Indian J Surg 2022. [DOI: 10.1007/s12262-021-03196-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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22
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Gogiya BS, Chertova AD, Alyautdinov RR. [Surgical treatment of complex incisional hernia]. Khirurgiia (Mosk) 2022:117-123. [PMID: 36469478 DOI: 10.17116/hirurgia2022121117] [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: 06/17/2023]
Abstract
There is no generally accepted incisional hernia classification. To categorize incisional hernias, the European Hernia Society (EHS) proposed their classification based on the measurement of three parameters - location, dimension of hernia gate and recurrence. Unfortunately, this classification does not consider the «loss of the domain» of 20% or more, local complications including trophic ulcer or fistula of anterior abdominal wall. Moreover, implantation of mesh after previous hernia repair, obesity and other clinical factors are also not considered. Thus, surgeons have recently allocated patients with complex incisional hernia in a separate group. There is no clear definition of this term. There are no clinical guidelines on the management of patients with these hernias, and the choice of optimal surgical treatment remains individual. The authors present a patient with complex incisional hernia. Surgical strategy is described.
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Affiliation(s)
- B Sh Gogiya
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - A D Chertova
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - R R Alyautdinov
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
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Niebuhr H, Malaibari ZO, Köckerling F, Reinpold W, Dag H, Eucker D, Aufenberg T, Fikatas P, Fortelny RH, Kukleta J, Meier H, Flamm C, Baschleben G, Helmedag M. [Intraoperative fascial traction (IFT) for treatment of large ventral hernias : A retrospective analysis of 50 cases]. Chirurg 2021; 93:292-298. [PMID: 34907456 PMCID: PMC8894171 DOI: 10.1007/s00104-021-01552-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim was to evaluate the effectiveness, clinical practicability, and complication rate of the intraoperative fascial traction (IFT) procedure for the treatment of large ventral hernias. METHOD This study evaluated 50 patients from 11 specialized centers with an intraoperatively measured fascial distance of more than 8 cm, who were treated by IFT (traction time 30-35 min) using the fasciotens® hernia traction procedure. RESULTS Fascial gaps measured preoperatively ranged from 8 cm to 44 cm, with most patients (94%) having a fascial gap above 10 cm (W3 according to the European Hernia Society classification). The mean fascial distance was reduced from 16.1 ± 0.8 cm to 5.8 ± 0.7 cm (stretch gain 10.2 ± 0.7 cm, p < 0.0001, Wilcoxon matched-pairs signed-ranks test). A reduction in fascial distance of at least 50% was achieved in three quarters of the patients and in half of the treated patients the reduction in fascial distance amounted to even more than 70%. The closure rate achieved by IFT after a mean surgical duration of 207.3 ± 11.0 min was 90% (45/50). Hernia closure was performed in all cases with a mesh augmentation in a sublay position. Postoperative complications occurred in 6 patients (12%). A reoperation was required in 3 patients (6%). CONCLUSION The described IFT method is a new procedure for abdominal wall closure in large ventral hernias. The presented results demonstrate a high effectiveness, a good clinical practicability and a low complication rate of IFT.
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Affiliation(s)
- Henning Niebuhr
- Hamburger Hernien Centrum, Eppendorfer Baum 8, 20249, Hamburg, Deutschland.
| | - Zaid Omar Malaibari
- Hamburger Hernien Centrum, Eppendorfer Baum 8, 20249, Hamburg, Deutschland.,Faculty of Medicine, Department of Surgery, University of Tabuk, Tabuk, Saudi-Arabien
| | | | - Wolfgang Reinpold
- Hamburger Hernien Centrum, Eppendorfer Baum 8, 20249, Hamburg, Deutschland
| | - Halil Dag
- Hamburger Hernien Centrum, Eppendorfer Baum 8, 20249, Hamburg, Deutschland
| | - Dietmar Eucker
- Chirurgische Klinik Kantonsspital Baselland Bruderholz, Bruderholz, Schweiz
| | - Thomas Aufenberg
- Klinik für Chirurgie, St. Elisabeth-Krankenhaus Köln, Köln, Deutschland
| | - Panagiotis Fikatas
- Klinik für Chirurgie, Charité Campus Virchow-Klinik, Berlin, Deutschland
| | | | - Jan Kukleta
- Klinik für Chirurgie, Hirslanden Klinik, Zürich, Schweiz
| | - Hansjörg Meier
- Klinik für Allgemein- und Viszeralchirurgie, Sana Krankenhaus, Benrath, Deutschland
| | - Christian Flamm
- Klinik für Allgemein‑, Viszeral‑, Endokrine und Unfallchirurgie, RoMed Clinic, Bad Aibling, Deutschland
| | - Guido Baschleben
- Klinik für Allgemein- und Viszeral Chirurgie, St. Elisabeth Hospital, Leipzig, Deutschland
| | - Marius Helmedag
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsklinik Aachen, Aachen, Deutschland
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Sebastián-Tomás JC, Díez-Ares JÁ, Peris-Tomás N, Navarro-Martínez S, Periañez-Gómez D, Pérez-Rubio Á, Martínez-Mas E, Trullenque-Juan R. Simultaneous Complex Incisional Hernia Repair and Bariatric Surgery for Obese Patients: a Case Series of a Single-Center Early Experience. JOURNAL OF METABOLIC AND BARIATRIC SURGERY 2021; 10:55-65. [PMID: 36683670 PMCID: PMC9847639 DOI: 10.17476/jmbs.2021.10.2.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 09/16/2021] [Accepted: 09/16/2021] [Indexed: 01/25/2023]
Abstract
Purpose Obesity is associated with recurrence of complex incisional hernia repair (CIHR). Bariatric procedure during CIHR can improve recurrence rates without increasing morbidity. This study aimed to describe our results after CIHR in patients with obesity, in which a simultaneous bariatric procedure was performed. Materials and Methods We performed a retrospective observational study including patients who underwent surgery between January 2014 and December 2018, with a complex incisional hernia (CIH) according to the Slater classification and body mass index (BMI) ≥35. CIHR was the main indication for surgery. We collected demographic data, comorbidities, CIH classification according to the European Hernia Society, type of bariatric procedure, postoperative morbidity using the Dindo-Clavien classification, and short-term results. Computed tomography (CT) is performed preoperatively. Results Ten patients were included in the study (7 women). The mean BMI was 43.63±4.91 kg/m2. The size of the abdominal wall defect on CT was 8.86±3.93 cm. According to the European Hernia Society classification, all CIHs were W2 or higher. Prosthetic repair of the CIH was selected. Onlay, sublay, preperitoneal, and inlay mesh placement were performed twice each, as well as one modified component separation technique and one transversus abdominis release. Gastric leak after sleeve gastrectomy was the only major complication. Short-term outcomes included one recurrence, and % total weight loss was 24.04±8.03 after 1-year follow-up. Conclusion The association of bariatric procedures during CIHR seems to be feasible, safe, and could be an option for surgical treatment in selected patients.
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Affiliation(s)
| | - José Ángel Díez-Ares
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Nuria Peris-Tomás
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Sergio Navarro-Martínez
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Dolores Periañez-Gómez
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Álvaro Pérez-Rubio
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Ezequiel Martínez-Mas
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Ramón Trullenque-Juan
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
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25
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Kurumety S, Walker A, Samet J, Grant T, Dumanian GA, Deshmukh S. Ultrasound-Guided Lateral Abdominal Wall Botulinum Toxin Injection Before Ventral Hernia Repair: A Review for Radiologists. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:2019-2030. [PMID: 33320354 DOI: 10.1002/jum.15591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/05/2020] [Accepted: 11/17/2020] [Indexed: 06/12/2023]
Abstract
Preoperative ultrasound-guided lateral abdominal wall botulinum toxin injection is a promising method for improving patient outcomes and reducing recurrence rates after ventral hernia repair. A review of the literature demonstrates variability in the procedural technique, without current standardization of protocols. As radiologists may be increasingly asked to perform ultrasound-guided botulinum toxin injections of the lateral abdominal wall, familiarity with the procedure and current literature is necessary.
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Affiliation(s)
- Sasha Kurumety
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Austin Walker
- Department of Otolaryngology, University of Iowa, Iowa City, Iowa, USA
| | - Jonathan Samet
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Thomas Grant
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Gregory A Dumanian
- Division of Plastic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Swati Deshmukh
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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A novel approach for the treatment of Morgagni hernias: robotic transabdominal preperitoneal diaphragmatic hernia repair. Hernia 2021; 26:355-361. [PMID: 34494141 DOI: 10.1007/s10029-021-02472-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE We introduce a novel approach to the surgical repair of Morgagni hernias (MHs) utilizing the robotic transabdominal preperitoneal repair (rTAPP) approach. Borrowed from our previous and robust experience with rTAPP repairs for hernias of the anterior abdominal wall, this technique boasts the benefits of hernia sac reduction, the use of an uncoated mesh in an extraperitoneal plane, and minimal fixation leading to lower postoperative pain relative to other approaches. METHODS To evaluate the effectiveness of this novel approach, five consecutive symptomatic Morgagni hernias (MHs) were repaired with the rTAPP approach. The size of the defect, mesh size, length of stay, follow-up imaging, and follow-up complications were documented for comparison. RESULTS The size of the MH defects ranged from 4 × 6 cm to 5 × 10 cm. LOS was an average of 1.2 days. Two out of the five patients underwent concomitant repair of a lower abdominal hernias (one Spigelian hernia, and one indirect inguinal hernia). Outpatient follow-up from surgery ranged anywhere from 6 months to 4 years, with most patients receiving follow-up after 1 year. Four out of the five patients received follow-up CT scans to confirm the absence of hernia recurrence. One patient experienced an incisional hernia from the midline 12-mm port site which was repaired 1 year after. CONCLUSION We propose a new technique for a minimally invasive strategy to treat these complex hernias utilizing an rTAPP technique resulting in minimal length of stay and a durable result in long-term follow-up. The benefits of repair, which include minimal postoperative pain, minimal length of stay, and cost-effective prosthetic mesh hidden from the visceral contents, are consistent with the author's experience for rTAPP repairs for hernias of the anterior abdominal wall.
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27
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Faustino LD, Ferreira LM, Ramirez OM, Nahas FX. Components separation technique of the abdominal wall: Which muscle release produces the greatest reduction in tension on the mideline? J Plast Reconstr Aesthet Surg 2021; 74:3361-3370. [PMID: 34229956 DOI: 10.1016/j.bjps.2021.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 03/24/2021] [Accepted: 05/24/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The components separation technique (CS) is used for the reconstruction of complex abdominal wall defects. Release and undermining of the rectus abdominis muscle (RAM) and external oblique muscle (EOM) decrease tension on the abdominal midline, reducing recurrence of ventral hernia, but causes major changes in the physiology of abdominal wall. The purpose of the study was to determine which muscle release and undermining produces the lowest tension on the midline. METHODS Twenty fresh cadavers were dissected and the anterior and posterior layers of the rectus sheath were isolated in the midline. The forces necessary to advance the layers of the rectus sheath to the mid abdomen were measured bilaterally at two points located 3 cm above and 2 cm below the umbilicus, and at 3 different stages: before any muscle release; after release and undermining of the right RAM and left EOM; and after release and undermining of the left RAM and right EOM. Comparisons of tensile forces were conducted separately for the different muscles involved, layers of the rectus sheath, measurement points, and stages of separation. RESULTS Tension on the abdominal midline after the release and undermining of both the RAM and EOM was reduced by 56% (p <0.05), 42% after the release and undermining of the EOM alone (p <0.05), and 35% after release and undermining of the RAM alone (p <0.05). CONCLUSION Release and undermining of the EOM by CS led to lower tension on the abdominal midline compared to that associated with the release of the RAM alone.
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Affiliation(s)
- Leandro Dario Faustino
- Division of Plastic Surgery, Department of Surgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Lydia Masako Ferreira
- Division of Plastic Surgery, Department of Surgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Oscar M Ramirez
- Division of Plastic Surgery, Cleveland Clinic, Fort Lauderdale, FL, United States
| | - Fábio Xerfan Nahas
- Division of Plastic Surgery, Department of Surgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
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28
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Lindsey JT, Boyd CJ, Davis C, Wilson J, Kurapati S, de la Torre JI. The Case for Onlay Biologic Mesh in Abdominal Wall Reconstruction Using Progressive Tension Suture Fixation. Ann Plast Surg 2021; 86:S498-S502. [PMID: 34100806 DOI: 10.1097/sap.0000000000002911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND After many years of debate, underlay and sublay placement of mesh slowly emerged as the standard of care in abdominal wall reconstruction because of lower hernia recurrence rates. However, onlay has the advantages of being faster, less invasive, and technically easier compared with underlay and sublay. Therefore, if a similar recurrence could be achieved, then onlay should be a consideration. In this study, we present a new onlay method using multipoint progressive tension suture fixation. METHODS This was a retrospective chart review of patients who underwent abdominal wall reconstruction from 2012 to 2019. Inclusion criteria included onlay mesh placement and at least 1 year of follow-up. The core principles of the surgical technique are establishing myofascial continuity by component separation and reinforcing the repair with onlay mesh that is fixated with multipoint progressive tension sutures. RESULTS The number of patients after exclusions was 59, and the average body mass index was 32.52 ± 6.44 kg/m2. More than half (62.7%) of patients had a history of hypertension, 95% had at least 1 prior abdominal/pelvic surgery, and 61% had at least 1 prior hernia repair. Postoperative complications included 20.3% of patients requiring drainage of a fluid collection in the clinic setting, and 29.3% of patients requiring return to the operating room for any reason (including superficial wound debridement). The average defect size was 231.88 ± 195.86 cm2, the mean follow-up was 3.11 ± 1.83 years, and the recurrence rate was 5.1%. CONCLUSIONS We report a hernia recurrence rate of 5.1% in a high-risk population with complex defects at a mean of 3.1 years of follow-up using onlay mesh fixated with multipoint progressive tension sutures. This recurrence rate is similar to that reported for both underlay and sublay techniques. However, the onlay approach is technically easier, faster, and less invasive compared with underlay and sublay techniques, which may translate into wider reproducibility, lower costs, and improved patient safety.
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Affiliation(s)
- John T Lindsey
- From the Division of Plastic Surgery, University of Alabama at Birmingham School of Medicine
| | - Carter J Boyd
- From the Division of Plastic Surgery, University of Alabama at Birmingham School of Medicine
| | - Claire Davis
- From the Division of Plastic Surgery, University of Alabama at Birmingham School of Medicine
| | - John Wilson
- From the Division of Plastic Surgery, University of Alabama at Birmingham School of Medicine
| | - Srikanth Kurapati
- From the Division of Plastic Surgery, University of Alabama at Birmingham School of Medicine
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Should Negative Pressure Therapy Replace Any Other Temporary Abdominal Closure Device in Open-Abdomen Management of Secondary Peritonitis? Surg Technol Int 2021. [PMID: 33844240 DOI: 10.52198/21.sti.38.gs1386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM To clarify the advantages of negative pressure therapy (NPT) compared to other methods of temporary abdominal closure (TAC) in the management of secondary peritonitis. METHODS We retraced the history of known methods of TAC, and analyzed their advantages and disadvantages. We evaluated as the NPT mechanisms, both from the macroscopic that bio-molecular point of view, well suits to manage this difficult condition. RESULTS The ideal TAC technique should be quick to apply, easy to change, protect and contain the abdominal viscera, decrease bowel edema, prevent loss of domain and abdominal compartment syndrome, limit contamination, allow egress of peritoneal fluid (and its estimation) and not result in adhesions. It should also be cost-effective, minimize the number of dressing changes and the number of surgical revisions, and ensure a high rate of early closure with a low rate of complications (especially entero-atmospheric fistula). For NPT, the reported fistula rate is 7%, primary fascial closure ranges from 33 to 100% (average 60%) and the mortality rate is about 20%. With the use of NPT as TAC, it may be possible to extend the window of time to achieve primary fascial closure (for up to 20-40 days). CONCLUSION NPT has several potential advantages in open-abdomen (OA) management of secondary peritonitis and may make it possible to achieve all the goals suggested above for an ideal TAC system. Only trained staff should use NPT, following the manufacturer's instructions when commercial products are used. Even if there was a significant evolution in OA management, we believe that further research into the role of NPT for secondary peritonitis is necessary.
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30
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San Miguel-Méndez C, López-Monclús J, Munoz-Rodriguez J, de Lersundi ÁRV, Artes-Caselles M, Blázquez Hernando LA, García-Hernandez JP, Minaya-Bravo AM, Garcia-Urena MÁ. Stepwise transversus abdominis muscle release for the treatment of complex bilateral subcostal incisional hernias. Surgery 2021; 170:1112-1119. [PMID: 34020792 DOI: 10.1016/j.surg.2021.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/14/2021] [Accepted: 04/08/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Management of subcostal incisional hernias is particularly complicated due to their proximity to the costochondral limits in addition to the lack of aponeurosis on the lateral side of the abdomen. We present our results of posterior component separation through the same previous incision as a safe and reproducible technique for these complex cases. METHODS We presented a multicenter and prospective cohort of patients diagnosed with bilateral subcostal incisional hernias on either clinical examination or imaging based on computed tomography from 2014 to 2020. The aim of this investigation was to assess the outcomes of abdominal wall reconstruction for subcostal incisional hernias through a new approach. The outcomes reported were short- and long-term complications, including recurrence, pain, and bulging. Quality of life was assessed with the European Registry for Abdominal Wall Hernias Quality of Life score. RESULTS A total of 46 patients were identified. All patients underwent posterior component separation. Surgical site occurrences occurred in 10 patients (22%), with only 7 patients (15%) requiring procedural intervention. During a mean follow-up of 18 months (range, 6-62 months), 1 (2%) case of clinical recurrence was registered. Also, there were 8 (17%) patients with asymptomatic but visible bulging. The European Registry for Abdominal Wall Hernias Quality of Life score showed a statistically significant decrease in the 3 domains (pain, restriction, and cosmetic) of the postoperative scores compared with the preoperative score. CONCLUSION Posterior component separation technique for the repair of subcostal incisional hernias through the same incision is a safe procedure that avoids injury to the linea alba. It is associated with acceptable morbidity, low recurrence rate, and improvement in patients' reported outcomes.
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Affiliation(s)
- Carlos San Miguel-Méndez
- General and Digestive Surgery Department, Hospital Universitario del Henares, Francisco de Vitoria University, Madrid, Spain
| | - Javier López-Monclús
- General and Digestive Surgery Department, Hospital Universitario Puerta de Hierro, Autónoma University of Madrid, Spain.
| | - Joaquín Munoz-Rodriguez
- General and Digestive Surgery Department, Hospital Universitario Puerta de Hierro, Autónoma University of Madrid, Spain
| | - Álvaro Robin Valle de Lersundi
- General and Digestive Surgery Department, Hospital Universitario del Henares, Francisco de Vitoria University, Madrid, Spain
| | - Mariano Artes-Caselles
- General and Digestive Surgery Department, Hospital Universitario Puerta de Hierro, Autónoma University of Madrid, Spain
| | - Luis Alberto Blázquez Hernando
- General and Digestive Surgery Department, Hospital Universitario Ramón y Cajal, Alcalá de Henares University Madrid, Spain
| | | | - Ana María Minaya-Bravo
- General and Digestive Surgery Department, Hospital Universitario del Henares, Francisco de Vitoria University, Madrid, Spain
| | - Miguel Ángel Garcia-Urena
- General and Digestive Surgery Department, Hospital Universitario del Henares, Francisco de Vitoria University, Madrid, Spain
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Adjunct botox to preoperative progressive pneumoperitoneum for incisional hernia with loss of domain: no additional effect but may improve outcomes. Hernia 2021; 25:1507-1517. [PMID: 33686553 DOI: 10.1007/s10029-021-02387-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 02/26/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Incisional hernia with loss of domain (IHLD) remains a surgical challenge. Its management requires complex approaches including specific preoperative and intra-operative techniques. This study focuses on the interest of adding preoperative botulinum toxin A (BTA) injection to preoperative progressive pneumoperitoneum (PPP), compared to PPP alone. MATERIAL Patients between January 2015 and March 2020 with IHLD who underwent pre-operative preparation were included. Their baseline characteristics were retrospectively analyzed, along with the characteristics of their incisional hernia before and after preparation including CT-scan volumetry. Intra-operative data, early post-operative outcomes, surgical site occurrences (SSOs) including surgical site infection (SSI) were recorded. RESULTS Four hundred and fifty (450) patients with incisional hernia were operated, including 41 patients (9.1%) with IHLD, 13 of which had both BTA and PPP, while 28 had PPP only. Both groups were comparable in term of patients and IHLD characteristics. Median increase in the volume of the abdominal cavity (VAbC) was + 55% for the entire population (+ 58.3% for the BTA-PPP group, p < 0.0001 and + 52.8% for the PPP-alone group, p < 0.0001) although the increase in volume was not different between the two groups (p = 0.99). Complete fascial closure was achieved in all patients. SSOs were more frequent in the PPP-alone group than in the BTA-PPP group (17 (60.7%) versus 3 (23.1%) patients, respectively, p = 0.043). CONCLUSION BTA and PPP are both useful in pre-operative preparation for IHLD. Combining both significantly increases the volume of abdominal cavity but associating BTA to PPP does not add any volumetric benefit but may decrease the post-operative SSO rate.
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Köckerling F, Lammers B, Weyhe D, Reinpold W, Zarras K, Adolf D, Riediger H, Krüger CM. What is the outcome of the open IPOM versus sublay technique in the treatment of larger incisional hernias?: A propensity score-matched comparison of 9091 patients from the Herniamed Registry. Hernia 2021; 25:23-31. [PMID: 32100213 PMCID: PMC7867529 DOI: 10.1007/s10029-020-02143-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 02/11/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION In an Expert Consensus guided by systematic review, the panel agreed that for open elective incisional hernia repair, sublay mesh location is preferred, but open intraperitoneal onlay mesh (IPOM) may be useful in certain settings. This analysis of data from the Herniamed Registry aimed to compare the outcomes of open IPOM and sublay technique. METHODS Propensity score matching of 9091 patients with elective incisional hernia repair and with defect width ≥ 4 cm was performed. The following matching variables were selected: age, gender, risk factors, ASA score, preoperative pain, defect size, and defect localization. RESULTS For the 1977 patients with open IPOM repair and 7114 patients with sublay repair, n = 1938 (98%) pairs were formed. No differences were seen between the two groups with regard to the intraoperative, postoperative and general complications, complication-related reoperations and recurrences. But significant disadvantages were identified for the open IPOM repair in respect of pain on exertion (17.1% vs. 13.7%; p = 0.007), pain at rest (10.4% vs. 8.3%; p = 0.040) and chronic pain requiring treatment (8.8% vs. 5.8%; p < 0.001), in addition to rates of 3.8%, 1.1% and 1.1%, respectively, occurring in both matched patients. No relationship with tacker mesh fixation was identified. There are only very few reports in the literature with comparable findings. CONCLUSION Compared with sublay repair, open IPOM repair appears to pose a higher risk of chronic pain. This finding concords with the Expert Consensus recommending that incisional hernia should preferably be repaired using the sublay technique.
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Affiliation(s)
- F Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.
| | - B Lammers
- Department of Surgery I - Section Coloproctology and Hernia Surgery, Lukas Hospital, Preussenstr. 84, 41464, Neuss, Germany
| | - D Weyhe
- University Clinic for Visceral Surgery, Pius Hospital Oldenburg, Georgstraße 12, 26121, Oldenburg, Germany
| | - W Reinpold
- Wilhelmsburger Hospital Groß-Sand, Groß-Sand 3, 21107, Hamburg, Germany
| | - K Zarras
- Marien Hospital Düsseldorf, Rochusstraße 2, 40479, Düsseldorf, Germany
| | - D Adolf
- StatConsult GmbH, Halberstädter Strasse 40 a, 39112, Magdeburg, Germany
| | - H Riediger
- Vivantes Humboldt Hospital, Am Nordgraben 2, 13509, Berlin, Germany
| | - C M Krüger
- Immanuel Hospital Rüdersdorf, Seebad 82/83, 155562, Rüdersdorf, Germany
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Nassif AT, Nagano TA, Villela IR, Simonetti GR, Dias BF, Freitas ACTD. INCISIONAL HERNIOPLASTY TECHNIQUES: ANALYSIS AFTER OPEN BARIATRIC SURGERY. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2020; 33:e1517. [PMID: 33237161 PMCID: PMC7682152 DOI: 10.1590/0102-672020200002e1517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/30/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Rives-Stoppa retromuscular technique: A) polypropylene mesh fixed on the posterior rectus sheath; B) rectus abdominal muscle; C) anterior rectus sheath being sutured. The best technique for incisional hernioplasty has not been established yet. One of the difficulties to compare these techniques is heterogeneity in the profile of the patients evaluated. AIM To analyze the results of three techniques for incisional hernioplasty after open bariatric surgery. METHOD Patients who underwent incisional hernioplasty were divided into three groups: onlay technique, simple suture and retromuscular technique. Results and quality of life after repair using Carolina's Comfort Scale were evaluated through analysis of medical records, telephone contact and elective appointments. RESULTS 363 surgical reports were analyzed and 263 were included: onlay technique (n=89), simple suture (n=100), retromuscular technique (n=74). The epidemiological profile of patients was similar between groups. The onlay technique showed higher seroma rates (28.89%) and used a surgical drain more frequently (55.56%). The simple suture technique required longer hospital stay (2.86 days). The quality of life score was worse for the retromuscular technique (8.43) in relation to the onlay technique (4.7) and the simple suture (2.34), especially because of complaints of chronic pain. There was no difference in short-term recurrence. CONCLUSION The retromuscular technique showed a worse quality of life than the other techniques in a homogeneous group of patients. The three groups showed no difference in terms of short-term hernia recurrence.
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Affiliation(s)
- André Thá Nassif
- Digestive and Bariatric Surgery Service, Santa Casa de Misericórdia, Curitiba, PR, Brazil.,Postgraduation Program in Surgical Clinics, Federal University of Paraná, Curitiba, PR, Brazil
| | - Thais Ayumi Nagano
- Medical Degree, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | | | | | - Bruno Francisco Dias
- Medical Degree, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
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Willms AG, Schwab R, von Websky MW, Berrevoet F, Tartaglia D, Sörelius K, Fortelny RH, Björck M, Monchal T, Brennfleck F, Bulian D, Beltzer C, Germer CT, Lock JF. Factors influencing the fascial closure rate after open abdomen treatment: Results from the European Hernia Society (EuraHS) Registry : Surgical technique matters. Hernia 2020; 26:61-73. [PMID: 33219419 PMCID: PMC8881440 DOI: 10.1007/s10029-020-02336-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/02/2020] [Indexed: 01/09/2023]
Abstract
Purpose Definitive fascial closure is an essential treatment objective after open abdomen treatment and mitigates morbidity and mortality. There is a paucity of evidence on factors that promote or prevent definitive fascial closure. Methods A multi-center multivariable analysis of data from the Open Abdomen Route of the European Hernia Society included all cases between 1 May 2015 and 31 December 2019. Different treatment elements, i.e. the use of a visceral protective layer, negative-pressure wound therapy and dynamic closure techniques, as well as patient characteristics were included in the multivariable analysis. The study was registered in the International Clinical Trials Registry Platform via the German Registry for Clinical Trials (DRK00021719). Results Data were included from 630 patients from eleven surgical departments in six European countries. Indications for OAT were peritonitis (46%), abdominal compartment syndrome (20.5%), burst abdomen (11.3%), abdominal trauma (9%), and other conditions (13.2%). The overall definitive fascial closure rate was 57.5% in the intention-to-treat analysis and 71% in the per-protocol analysis. The multivariable analysis showed a positive correlation of negative-pressure wound therapy (odds ratio: 2.496, p < 0.001) and dynamic closure techniques (odds ratio: 2.687, p < 0.001) with fascial closure and a negative correlation of intra-abdominal contamination (odds ratio: 0.630, p = 0.029) and the number of surgical procedures before OAT (odds ratio: 0.740, p = 0.005) with DFC. Conclusion The clinical course and prognosis of open abdomen treatment can significantly be improved by the use of treatment elements such as negative-pressure wound therapy and dynamic closure techniques, which are associated with definitive fascial closure. Electronic supplementary material The online version of this article (10.1007/s10029-020-02336-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A G Willms
- Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital of Koblenz, Rübenacher Str. 170, 56072, Koblenz, Germany
| | - R Schwab
- Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital of Koblenz, Rübenacher Str. 170, 56072, Koblenz, Germany
| | - M W von Websky
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - F Berrevoet
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - D Tartaglia
- Emergency Surgery Unit, Cisanello University Hospital, Via Paradisa 1, 56124, Pisa, Italy
| | - K Sörelius
- Department of Vascular Surgery, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
| | - R H Fortelny
- Department of General, Visceral and Oncological Surgery, Wilhelminenspital, 1160, Vienna, Austria.,Medical Faculty, Sigmund Freud University of Vienna, 1020, Vienna, Austria
| | - M Björck
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, SE 751 85, Uppsala, Sweden
| | - T Monchal
- Department of General Surgery, Sainte Anne Military Hospital, 2 Boulevard Sainte-Anne, 83000, Toulon, France
| | - F Brennfleck
- Department of Surgery, Regensburg University Hospital, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - D Bulian
- Department of Abdominal, Tumor, Transplant and Vascular Surgery, Cologne-Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - C Beltzer
- Department of General, Visceral and Thoracic Surgery, German Armed Forces Hospital of Ulm, Oberer Eselsberg, Ulm, Germany
| | - C T Germer
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - J F Lock
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
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Gu Y, Wang P, Li H, Tian W, Tang J. Chinese expert consensus on adult ventral abdominal wall defect repair and reconstruction. Am J Surg 2020; 222:86-98. [PMID: 33239177 DOI: 10.1016/j.amjsurg.2020.11.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Surgical management of patients with ventral abdominal wall defects, especially complex abdominal wall defects, remains a challenging problem for abdominal wall reconstructive surgeons. Effective surgical treatment requires appropriate preoperative assessment, surgical planning, and correct operative procedure in order to improve postoperative clinical outcomes and minimize complications. Although substantial advances have been made in surgical techniques and prosthetic technologies, there is still insufficient high-level evidence favoring a specific technique. Broad variability in existing practice patterns, including clinical pre-operative evaluation, surgical techniques and surgical procedure selection, are still common. DATA SOURCES With the purpose of providing a best practice algorithm, a comprehensive search was conducted in Medline and PubMed. Sixty-four surgeons considered as experts on abdominal wall defect repair and reconstruction in China were solicited to develop a Chinese consensus and give recommendations to help surgeons standardize their techniques and improve clinical results. CONCLUSIONS This consensus serves as a starting point to provide recommendations for adult ventral abdominal wall repair and reconstruction in China and may help build opportunities for international cooperation to refine AWR practice.
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Affiliation(s)
- Yan Gu
- Hernia and Abdominal Wall Disease Center, Shanghai Jiao Tong University, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
| | - Ping Wang
- Department of Hernia Surgery, Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - Hangyu Li
- Department of General Surgery, Fourth Hospital of China Medical University, Shenyang, 110000, China
| | - Wen Tian
- Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, 100853, China.
| | - Jianxiong Tang
- Department of General Surgery, Huadong Hospital, Fudan University, Shanghai, 200040, China.
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Velmahos GC, Demetriades D, Mahoney E, Burke P, Davis K, Larentzakis A, Fikry K, El Moheb M, Kovach S, Schreiber M, Hassan M, Albrecht R, Dennis A. The worst-case scenario: Bridging repair with a biologic mesh in high-risk patients with very large abdominal wall hernias-a prospective multicenter study. Surgery 2020; 169:318-324. [PMID: 33066982 DOI: 10.1016/j.surg.2020.08.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/25/2020] [Accepted: 08/31/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND While modern techniques allow midline fascial closure for most abdominal hernias, a bridge repair with mesh may be the only alternative in very large defects. When the risk of infection is high, the use of prosthetic mesh is controversial. We aim to examine outcomes after bridge repair of very large abdominal hernias at high risk for postoperative infection with a second-generation biologic mesh. METHODS Prospective, multicenter, single-arm study of patients with very large abdominal hernias who received bridge repair with a neonatal bovine dermis mesh. Primary outcome was hernia recurrence, as identified on computed tomography 1 year after the operation. Secondary outcomes included mesh laxity, surgical site occurrences, and any other mesh-related complications. Independent risk factors of the outcomes were determined by univariate and multivariable analyses. RESULTS A total of 117 bridge repair patients were enrolled with a mean defect size of 442.5 ± 254.2 cm2. The patients were predominantly obese (mean body mass index 36.5 ± 10.5) and with multiple comorbidities (Charlson comorbidity index 3 ± 2.5). Hernia recurrence was identified in 24 (20.5%) patients. An infected mesh at the index operation was an independent predictor of hernia recurrence, whereas obesity was an independent predictor of the pooled endpoint of recurrence and mesh laxity. Surgical site occurrences were recorded in 36.8% of the patients, and no independent risk factors were identified. CONCLUSION In patients with very large abdominal hernias and at high risk for postoperative infection, who cannot undergo midline fascial closure, a bridge repair with neonatal bovine dermis mesh offers an acceptable profile in terms of hernia recurrence and wound occurrences.
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Affiliation(s)
| | - Demetrios Demetriades
- Los Angeles County and University of Southern California Medical Center, Keck School of Medicine, Los Angeles, CA
| | - Eric Mahoney
- Boston Medical Center, Boston University School of Medicine, MA
| | - Peter Burke
- Boston Medical Center, Boston University School of Medicine, MA
| | - Kimberly Davis
- Yale University Hospital, Yale University School of Medicine, New Haven, CT
| | | | - Karim Fikry
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Mohamad El Moheb
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Stephen Kovach
- Hospital of the University of Pennsylvania, Philadelphia, PA
| | | | - Moustafa Hassan
- State University of New York Upstate Medical Center, Syracuse, NY
| | - Roxie Albrecht
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
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Song YH, Huang WJ, Xie YY, Hada G, Zhang S, Lu AQ, Wang Y, Lei WZ. Application of double circular suturing technique (DCST) in repair of giant incision hernias. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:764. [PMID: 32647689 PMCID: PMC7333136 DOI: 10.21037/atm-20-4572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Our study aims to explore the feasibility and safety of a double circular suturing technique (DCST) in the repair of giant incision hernias. Methods The clinical data of 221 patients (95 men and 126 women; the average age was 61.6 years) receiving DCST in the repair of giant incision hernia between January 2010 and December 2018 was analyzed retrospectively. One hundred and five primary and 16 recurrent patients underwent herniorrhaphy with anti-adhesion underlay mesh repair using DCST. Results All the 221 operations were performed successfully. The average preparation time before the operation and hospital stays were 3.7 days (range, 1-6 days) and 7.5 days (range, 2-16 days), respectively. The average diameter of the hernia ring defect observed intraoperatively was 16.4 cm (range, 12-22 cm). The average time of operation was 83.6 min (range, 43-195 min). There were 2 cases of intestinal fistula, 4 cases of wound infection, 2 cases of mesh infection, 7 cases of serum tumescence, 3 cases of pulmonary infection, and 2 cases of wound dehiscence occurred. One hundred and ninety-five patients were followed up for 6.7 years (range, 0.8-9.5 years) postoperatively. Of them, 9 patients recurred; 14 patients had chronic pain whose visual analog scale (VAS) was 2-4 cm (average 2.7 cm). Conclusions With limited preparation time before operations, few postoperative complications, and recurrence rate, DCST in the repair of giant incision hernia is safe and possible clinically.
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Affiliation(s)
- Ying-Han Song
- Department of Day Surgery Center, West China Hospital of Sichuan University, Chengdu, China
| | - Wei-Jia Huang
- West China School of Medicine, Sichuan University, West China Hospital of Sichuan University, Chengdu, China
| | - Yan-Yan Xie
- Hernia Center of Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Gonish Hada
- Hernia Center of Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Sen Zhang
- Hernia Center of Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - An-Qing Lu
- Hernia Center of Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Yong Wang
- Hernia Center of Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Wen-Zhang Lei
- Hernia Center of Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu, China
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Abstract
Open abdominal surgery continues to be most commonly complicated by postoperative herniation at the incision line. In 2012, Novitsky et al described a novel hernia repair technique that utilized a transversus abdominis release coupled with a posterior (retrorectus) component separation (TAR-PCS) of the ventral abdominal wall. Early reports attest to the versatility and low recurrence rate of this technique, particularly when repairing large and complex defects. We present a rare case of herniation below the linea arcuate (LAH) following repair via TAR-PCS. Given its novelty compared with more widely utilized techniques, literature review revealed less discussion regarding potential pitfalls associated with this type of reconstruction, in particular the potential for LAH. To date, only 9 cases of symptomatic LAH have been described, although 2 previously described "suprapubic" herniations following TAR-PCS may represent previously mischaracterized cases of this type of complication. Nonetheless, none of these reports were in the setting of ventral hernia repair.
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Ibrahim MM, Green JL, Everitt J, Ruppert D, Glisson R, Leopardi F, Risoli T, Kuchibhatla M, Reynolds R, Levinson H. Soft Tissue Anchoring Performance, Biomechanical Properties, and Tissue Reaction of a New Hernia Mesh Engineered to Address Hernia Occurrence and Recurrence. J Med Device 2019; 13:0450021-450029. [PMID: 32280408 PMCID: PMC7104760 DOI: 10.1115/1.4043740] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 04/24/2019] [Indexed: 01/22/2023] Open
Abstract
One opportunity to reduce hernia occurrence and recurrence rates (currently estimated to be 30% at 10 years postoperatively) is by enhancing the ability of hernia meshes to anchor into tissue to prevent mesh migration, mesh contraction, and mesh tearing away from tissue. To address this, we developed a novel moderate-weight, macroporous, polypropylene mesh (termed the T-line mesh) with mesh extensions to optimize anchoring. We examined the physical properties, biomechanical performance, and biocompatibility of this novel mesh versus a predicate mesh anchored with #0-suture. The physical properties of the T-line mesh and predicate mesh were measured using American Society for Testing and Materials (ASTM) standards. Meshes were implanted into a swine hernia model and harvested after one day to determine anchoring strength of the meshes in the perioperative period. A separate group was implanted into a swine hernia model and harvested at 30 days and 90 days for semiquantitative histological analysis of biocompatibility. T-line mesh physical properties were similar to commonly used moderate-weight meshes in thickness and areal density. The T-line mesh outperformed the predicate mesh in all mechanical testing (P < 0.05). In the perioperative period, the T-line mesh was ∼275% stronger (P < 0.001) than the standard of care. Histological analysis of biocompatibility demonstrated no significant difference between the T-line mesh and predicate mesh (P > 0.05). The T-line mesh is a novel hernia mesh that outperforms a predicate mesh in mechanical and biomechanical performance testing while exhibiting similar biocompatibility. The T-line mesh has the potential to reduce hernia occurrence and recurrence caused by mechanical failure.
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Affiliation(s)
- Mohamad M. Ibrahim
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of
Surgery, Duke University Medical Center, DUMC
3181, Durham, NC 27710
| | - Jason L. Green
- Duke University School of Medicine,
487 Medical Science Research Building 1, 203 Research Drive, Durham,
NC 27710
| | - Jeffrey Everitt
- Department of Pathology, Duke University Medical
Center, Durham, NC 27710
| | - David Ruppert
- Division of Plastic and Reconstructive Surgery, Department of Surgery,
Duke University Medical Center, Durham, NC
27710
| | - Richard Glisson
- Department of Orthopaedic Surgery, Duke University Medical
Center, Durham, NC 27710
| | - Frank Leopardi
- Department of Surgery, Duke University Medical
Center, Durham, NC 27710
| | - Thomas Risoli
- Department of Biostatistics and Bioinformatics, Duke
University Medical Center, Durham, NC
27710
| | - Maragatha Kuchibhatla
- Department of Biostatistics and Bioinformatics, Duke
University Medical Center, Durham, NC
27710
| | - Randall Reynolds
- Division of Lab Animal Resources (DLAR), Duke University
School of Medicine, Durham, NC 27710
| | - Howard Levinson
- Division of Plastic and Reconstructive Surgery, Department of Surgery,
Duke University Medical Center, Durham, NC
27710
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Nisiewicz M, Hughes T, Plymale MA, Davenport DL, Roth JS. Abdominal wall reconstruction with large polypropylene mesh: is bigger better? Hernia 2019; 23:1003-1008. [DOI: 10.1007/s10029-019-02026-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/04/2019] [Indexed: 10/26/2022]
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Kraft CT, Eiferman D, Jordan S, Skoracki RJ. Complications after vascularized jejunal mesenteric lymph node transfer: A 3-year experience. Microsurgery 2019; 39:497-501. [PMID: 31283856 DOI: 10.1002/micr.30491] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 05/25/2019] [Accepted: 06/10/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND Vascularized lymph node transfer (VLNT) is a well-established method for the surgical management of refractory extremity lymphedema. Generally, donor lymph nodes are harvested from the axilla, groin, or supraclavicular area. However, these sites offer their own disadvantages and introduce risk for inducing lymphedema at the surgical donor site. In our experience, the jejunal mesentery can be an excellent source of lymph nodes without the risk of donor site lymphedema. Long term complications are unknown for this procedure; we report our experience, complication rates, and lessons learned. METHODS A retrospective review was performed for all patients at our institution undergoing surgical treatment of lymphedema using jejunal mesenteric VLNT from February 2015 to February 2018. Demographic data, length of follow up, and surgical complications were reviewed. RESULTS Twenty-nine patients have undergone jejunal VLNT at our institution during the three-year study period, with a total of 30 transfers. Five patients had a concurrent omental lymph node transfer. Average length of follow up was 17.6 months (range 1.0-36.8 months). There was one flap loss in this time frame (3.3%). Four patients developed hernias post-operatively (13.8%), and three had nonoperative small bowel obstructions (10.3%). One patient had a postoperative wound infection at the abdominal incision (3.4%). CONCLUSIONS Jejunal VLNT can be an effective option for surgical treatment of lymphedema, without the risk of postoperative donor site lymphedema. Patients and surgeons should be aware of the risks of hernia and small bowel obstruction with this method compared to other lymph node sources.
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Affiliation(s)
- Casey T Kraft
- Department of Plastic Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Daniel Eiferman
- Department of General Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Sumanas Jordan
- Department of Plastic Surgery, Northwestern University, Chicago, Illinois
| | - Roman J Skoracki
- Department of Plastic Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
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New, simple and reliable volumetric calculation technique in incisional hernias with loss of domain. Hernia 2019; 24:403-409. [PMID: 31218439 DOI: 10.1007/s10029-019-01990-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 06/02/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The management of hernias with loss of domain is a challenging problem. It has been shown that the volume of the incisional hernia/peritoneal volume ratio < 20% was a predictive factor for tension-free fascia closure, after pre-operative pneumoperitoneum preparation (Goni Moreno technique). In this study, we propose an easy, reliable and fast technique to perform volumetric calculation, by the surgeon alone. MATERIALS AND METHODS 3D slicer software (free open-source software) was used to calculate with precision the intra-peritoneal and intra-hernia volumes, and to create a 3D reconstruction of both volumes. The measurement technique is described step by step using detailed figures and videos. RESULTS The method was used to calculate the volumes for five consecutive patients, managed between January 2018 and March 2019. All the five patients had a ratio greater than 20% and, therefore, received a PPP program. The effectiveness of the procedure is objectified by the increase of the intraabdominal volume and the reduction of the incisional hernia/peritoneal volume ratio. The feasibility of a tension-free fascia closure was confirmed for the five patients. CONCLUSION In addition to a standardized definition of "loss of domain", a standardized volumetric technique, easy to reproduce, needs to be adopted. Our method can be done by any surgeon with basic computer skills and radiological knowledge in an autonomous and a fast manner, thus helping to select the right technique for the right patient.
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Evaluation of decellularization protocols for production of porcine small intestine submucosa for use in abdominal wall reconstruction. Hernia 2019; 24:1221-1231. [PMID: 31041557 DOI: 10.1007/s10029-019-01954-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 04/16/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Porcine-derived acellular biologic grafts are increasingly used in abdominal wall reconstruction and other soft tissue repairs. In a previous work, we have shown porcine small intestine submucosa (PSIS) exhibits clear advantages over porcine pericardium (PPC) and porcine acellular dermal matrix (PADM) in repairing full-thickness abdominal wall defects. In the present study, we aim to determine, quantify, and compare the effects of two most commonly used decellularization protocols on biomechanical and biocompatible properties of PSIS. MATERIALS AND METHODS After mechanical preparation, PSIS was treated with either alkaline and acid (AA) protocol or sodium dodecyl sulfate (SDS) protocol. Cellular content removal, preservation of matrix components, micro- and ultra- structures, and mechanical properties were compared. The host responses were evaluated using PSIS for repairing rat abdominal wall defects. RESULTS AND CONCLUSION With regard to the absence of cellular contents, neatly arranged collagen fiber structures, better retention of growth factors, better mechanical strength, lower degrees of local and systemic inflammatory responses, higher degree of vascularization and tissue ingrowth, alkaline and acid protocol exhibits clear advantages over SDS protocol for the preparation of PSIS extracellular matrix.
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Kallinowski F, Gutjahr D, Vollmer M, Harder F, Nessel R. Increasing hernia size requires higher GRIP values for a biomechanically stable ventral hernia repair. Ann Med Surg (Lond) 2019; 42:1-6. [PMID: 31061707 PMCID: PMC6488564 DOI: 10.1016/j.amsu.2019.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 04/14/2019] [Indexed: 10/27/2022] Open
Abstract
Background Increasing hernia sizes lead to higher recurrence rates after ventral hernia repair. A better grip might reduce the failure rates. Material and methods A biomechanical model delivering dynamic intermittent strain (DIS) was used to assess grip values at various hernia orifices. The model consists of a water-filled aluminium cylinder covered with tissues derived from pig bellies which are punched with a central defect varying in diameter. DIS was applied mimicking coughs lasting for up to 2 s with peak pressures between 180 and 220 mmHg and a plateau phase of 0.1 s. Ventral hernia repair was simulated with hernia meshes in the sublay position secured by tacks, glue or sutures as needed to achieve certain grip values. Grip was calculated taking into account the mesh: defect area ratio and the fixation strength. Data were assessed using non-parametric statistics. Results Using a mesh classified as highly stable upon DIS testing (DIS class A) a reduced overlap without fixation led to early slippage (p < 0.001). With the application of 16 fixation points, transmural sutures were better than tacks with Securestrap® being better than Absorbatack® (p < 0.001). Plotting the likelihood of a durable repair as a function of the calculated grip higher grip values were needed with increasing hernia diameter to achieve biomechanical stability. This is important for clinical work since the calculated grip values both from a registry and from published data tend to drop as hernia sizes increase indicating biomechanical instability. Conclusion The experimental work reported here demonstrates for the first time that higher grip values should be reached when repairing larger ventral hernias.
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Affiliation(s)
- F Kallinowski
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Chirurgische Universitätsklinik Heidelberg, Im Neuenheimer Feld 110, D-69120, Heidelberg, Germany
| | - D Gutjahr
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Chirurgische Universitätsklinik Heidelberg, Im Neuenheimer Feld 110, D-69120, Heidelberg, Germany
| | - M Vollmer
- Technische Universität Hamburg-Harburg, Institut für Biomechanik, Eissendorferstrasse 38, D-21075, Hamburg, Germany
| | - F Harder
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Marchioninistraße 15, 81377, München, Germany
| | - R Nessel
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Chirurgische Universitätsklinik Heidelberg, Im Neuenheimer Feld 110, D-69120, Heidelberg, Germany
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Hijji T, AlShammari A, AlHammad A, AlKhalefah G, Hashem F, Almomen S, Aburahmah M. Incisional hernia repair with plication and utilization of Botox injections: First case report from Saudi Arabia for a 19-year-old female. Clin Case Rep 2019; 7:311-315. [PMID: 30847196 PMCID: PMC6389482 DOI: 10.1002/ccr3.1984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 12/02/2018] [Indexed: 11/24/2022] Open
Abstract
This article reports on the use of Botox preoperatively for the treatment of a complex ventral hernia which would have typically been treated with component separation technique. The case demonstrates that using the recently developed technique can aid in performing a tension-free hernia repair with potentially lower complication and recurrence rates.
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Affiliation(s)
- Talal Hijji
- College of MedicineAlfaisal UniversityRiyadhSaudi Arabia
| | - Abdullah AlShammari
- College of MedicineAlfaisal UniversityRiyadhSaudi Arabia
- King Faisal Specialist Hospital and Research Center (KFSH&RC)RiyadhSaudi Arabia
| | - Alanoud AlHammad
- King Faisal Specialist Hospital and Research Center (KFSH&RC)RiyadhSaudi Arabia
| | - Ghadah AlKhalefah
- King Faisal Specialist Hospital and Research Center (KFSH&RC)RiyadhSaudi Arabia
| | - Fuad Hashem
- King Faisal Specialist Hospital and Research Center (KFSH&RC)RiyadhSaudi Arabia
| | - Salha Almomen
- King Faisal Specialist Hospital and Research Center (KFSH&RC)RiyadhSaudi Arabia
| | - Mohammad Aburahmah
- College of MedicineAlfaisal UniversityRiyadhSaudi Arabia
- King Faisal Specialist Hospital and Research Center (KFSH&RC)RiyadhSaudi Arabia
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Lindmark M, Strigård K, Löwenmark T, Dahlstrand U, Gunnarsson U. Risk Factors for Surgical Complications in Ventral Hernia Repair. World J Surg 2018; 42:3528-3536. [PMID: 29700567 PMCID: PMC6182761 DOI: 10.1007/s00268-018-4642-6] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim of this study was to identify risk factors for an adverse event, i.e. early surgical complication, need for ICU care and readmission, following ventral hernia repair. Our hypothesis was that there is an association between an increased complication rate following ventral hernia repair and specific factors, including hernia size, BMI > 35, concomitant bowel surgery, ASA-class, age, gender and method of hernia repair. METHODS Data from a hernia database with prospectively entered data on 408 patients operated for ventral hernia between 2007 and 2014 at two Swedish university hospitals were analysed. A 3-month follow-up of complications, need for intensive care and readmission, was performed by reviewing the medical records. RESULTS Eighty-one of 408 patients (20%) had a registered complication. Fifty-eight (14%) of these were classed as Clavien I-IIIa, and in 19 cases a Clavien IIIb-IV complication was reported. Large hernia size was associated with increased risk for early complication. A Kendall Tau test analysis revealed a proportional relationship between hernia size and modified Clavien outcome class (p < 0.001). Morbid obesity, ASA-class, method, hernia recurrence, age and concomitant bowel surgery were not statistically significant predictors of adverse events. CONCLUSIONS Assessment of hernia aperture size is of great importance in the preoperative evaluation of ventral hernia patients to consider risk for post-operative complications. These results suggest a careful attitude when applying watchful waiting concepts and when postponing hernia surgery to achieve weight loss. A delaying attitude may result in increased risk of complications caused by increasing hernia size.
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Affiliation(s)
- Mikael Lindmark
- Department of Surgical and Perioperative Sciences, Umeå University, 901 87, Umeå, Sweden
| | - Karin Strigård
- Department of Surgical and Perioperative Sciences, Umeå University, 901 87, Umeå, Sweden.
| | - Thyra Löwenmark
- Department of Surgical and Perioperative Sciences, Umeå University, 901 87, Umeå, Sweden
| | - Ursula Dahlstrand
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 141 86, Stockholm, Sweden
- Centre for Digestive Diseases, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Ulf Gunnarsson
- Department of Surgical and Perioperative Sciences, Umeå University, 901 87, Umeå, Sweden
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Suwa K, Okamoto T, Yanaga K. Is fascial defect closure with intraperitoneal onlay mesh superior to standard intraperitoneal onlay mesh for laparoscopic repair of large incisional hernia? Asian J Endosc Surg 2018; 11:378-384. [PMID: 29573191 DOI: 10.1111/ases.12471] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 01/16/2018] [Accepted: 01/17/2018] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The ideal surgical technique for large incisional hernia repair has not yet been identified. The aim of this study was to evaluate surgical outcomes of standard intraperitoneal onlay mesh (sIPOM) versus fascial defect closure with intraperitoneal onlay mesh (IPOM-Plus) for large incisional hernia repair. METHODS Of 49 patients who underwent laparoscopic incisional hernia repair between November 2005 and December 2016, 26 cases with large incisional hernia (transverse diameter ≥10 cm) were examined to compare surgical outcomes between sIPOM (n = 12) and IPOM-Plus (n = 14). Statistical analysis was performed using the Mann-Whitney U-test and Fisher's exact test. P < 0.05 was considered to be statistically significant. RESULTS We compared sIPOM with IPOM-Plus for similar hernia types during median follow-up periods of 53 and 21 months, respectively. The operation time was 150 min for sIPOM and 148 min for IPOM-Plus (P = 0.6220). Early postoperative complications including seroma formation were observed in four sIPOM patients (33%) and three IPOM-Plus patients (21%) (P = 0.6652). Significantly more mesh bulged with sIPOM than with IPOM-Plus (50% vs 0%; P = 0.0082). Chronic pain lasting 3 months after the operation was found in two cases of IPOM-Plus (14%), but this was not statistically significant. Postoperative hospital stay was longer for sIPOM patients than for IPOM-Plus patients. Only one recurrence was observed in the sIPOM group (8%), but this was not statistically significant. CONCLUSION For large incisional hernia repair, IPOM-Plus seems to be more effective than sIPOM in terms of reducing mesh bulging.
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Affiliation(s)
- Katsuhito Suwa
- Department of Surgery, The Jikei University Daisan Hospital, Tokyo, Japan
| | - Tomoyoshi Okamoto
- Department of Surgery, The Jikei University Daisan Hospital, Tokyo, Japan
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