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Pilkington JJ, Pritchett J, Fullwood C, Herring A, Wilkinson FL, Sheen AJ. TACKoMesh - A randomised controlled trial comparing absorbable versus non-absorbable tack fixation in laparoscopic IPOM + repair of primary incisional hernia using post-operative pain and quality of life - Reliatack™ versus Protack™. Hernia 2024; 28:1879-1888. [PMID: 39177909 DOI: 10.1007/s10029-024-03111-y] [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: 05/08/2024] [Accepted: 07/07/2024] [Indexed: 08/24/2024]
Abstract
There is a clinical need to better understand and improve post-operative pain for patients undergoing laparoscopic repair of incisional hernia. The aim of this single-centre, double-blind, randomised controlled trial was to compare post-operative pain between absorbable and non-absorbable tack fixation in patients undergoing IPOM + repair. Patients with primary incisional hernia (size 3-10 cm), were randomised to either Reliatack™ (n = 27), an articulating-arm device deploying absorbable polymer tacks, or Protack™ (n = 36), a straight-arm device deploying permanent titanium tacks. The primary outcome was reported pain on activity using a visual analogue scale at post-operative day 30. Clinical and patient-reported outcome measures (PROMs) were assessed pre-operatively (day 0), and at 1-, 6-, 30- and 365-days post-surgery. No significant differences in reported pain 'on activity' were found at any timepoint. Less reported pain 'at rest' was found on post-operative day-1 with absorbable tacks (p = 0.020). Significantly longer mesh-fixation time (p < 0.001) and the use of more knots for fascial closure (p = 0.006) and tacks for mesh-fixation (p = 0.001) were found for the absorbable tack group. There were no differences in other clinical and PROMs between groups. For the whole trial cohort (n = 63) several domains in the Short-Form-36 showed a reduction from baseline scores at day 30 that improved at day 365. At post-operative day 30, 75.0% of patients reported 'a lot of pain' since discharge. This study found no difference in reported pain when choosing absorbable or non-absorbable tack fixation. The utility of "early" post-operative pain assessment as a comparator following incisional hernia repair needs clarification.
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Affiliation(s)
- J James Pilkington
- Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, UK
- Department of Hernia Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - James Pritchett
- Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, UK
| | - Catherine Fullwood
- Centre for Biostatistics, Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Research and Innovation, Manchester University NHS Foundation Trust, Manchester, UK
| | - Annie Herring
- Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, UK
| | - Fiona L Wilkinson
- Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, UK
| | - Aali Jan Sheen
- Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, UK.
- Department of Hernia Surgery, Manchester University NHS Foundation Trust, Manchester, UK.
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Ozcan C, Colak T, Turkmenoglu O, Berkesoglu M, Ertas E. Impact of small-bite (5 mm) fascial closure on the incidence of incisional hernia following open colorectal cancer surgery: randomized clinical trial. Br J Surg 2024; 111:znae189. [PMID: 39107062 DOI: 10.1093/bjs/znae189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 07/06/2024] [Accepted: 07/10/2024] [Indexed: 08/09/2024]
Abstract
BACKGROUND Incisional hernia is frequently observed after open colorectal cancer surgery, and should be considered a serious short- and long-term health issue. The present study evaluated the efficacy of small-bite abdominal closure in reducing the incidence of incisional hernia in this patient group. METHODS An RCT was conducted between June 2019 and June 2022. A total of 173 patients who underwent open colorectal cancer surgery were assigned randomly to one of two groups to undergo fascial closure with either small bites (87) or conventional bites (86). The incisional hernia rate was accepted as the primary outcome, and surgical-site infection as the secondary outcome. RESULTS The incisional hernia rates at 1 year were 7 and 27% in the small- and conventional-bite groups respectively (P < 0.001). This rate increased to 9 and 31% at the end of the second year (P < 0.001). Surgical-site infections occurred in 18% of the small-bite group and 31% of the conventional-bite group (P = 0.03). Compared with the conventional-bite group, the small-bite group had higher suture/wound length ratios (mean(s.d.) 5.18(0.84) versus 3.67(0.57); P < 0.001) and a longer fascial closure time 14.1(4.64) versus 12.9(2.39) min; P = 0.03). CONCLUSION Small-bite closure with 5-mm tissue bites placed 5 mm apart reduced the incidence of incisional hernia and surgical-site infection after open colorectal cancer surgery.
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Affiliation(s)
- Cumhur Ozcan
- Department of General Surgery, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Tahsin Colak
- Department of General Surgery, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Ozgur Turkmenoglu
- Department of General Surgery, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Mustafa Berkesoglu
- Department of General Surgery, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Elif Ertas
- Department of Biostatistics, Selcuk University, Konya, Turkey
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Nevo N, Jacover A, Nizri E, Cuccurullo D, Rispoli C, Pery R, Elizur Y, Horesh N, Eshkenazy R, Nachmany I, Pencovich N. Linking factors to incisional hernia following pancreatic surgery: a 14-year retrospective analysis. Hernia 2024; 28:1397-1404. [PMID: 38735017 PMCID: PMC11297065 DOI: 10.1007/s10029-024-03067-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: 12/29/2023] [Accepted: 04/28/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Incisional hernias (IH) are a significant postoperative complication with profound implications for patient morbidity and healthcare costs. The relationship between IH and perioperative factors in pancreatic surgery, with particular attention to preoperative biliary stents and pancreatic fistulas requires further exploration. METHODS This retrospective observational study examined adult patients who underwent open pancreatic surgeries via midline incision at a high-volume tertiary hepatopancreatobiliary center from January 2008 to December 2021. The study focused on IH incidence and associated risk factors, with particular attention to preoperative biliary stents and pancreatic fistulas. RESULTS In a cohort of 620 individuals undergoing pancreatic surgery, 351 had open surgery with at least one-year follow-up. Within a median follow-up of 794 days (IQR 1694-537), the overall incidence of IH was 17.38%. The highest frequency of IH was observed among patients who had a Pancreaticoduodenectomy (PD). Significant predictors for the development of IH within the entire study population in a multivariable analysis included perioperative biliary stenting (OR 2.05; 95% CI 1.06-3.96; p = 0.03), increased age at diagnosis (OR 2.05; 95% CI 1.06-3.96; p = 0.01), and BMI (OR 1.08; 95% CI 1.01-1.15; p = 0.01). In the subset of patients who underwent Pancreaticoduodenectomy (PD), although the presence of biliary stents was associated with a heightened occurrence of SSIs, it did not demonstrate a direct correlation with an increased incidence of incisional hernias (IH). The development of pancreatic fistulas did not show a significant correlation with IH in either the Distal Pancreatectomy with Splenectomy (DPS) or the PD patient groups. CONCLUSIONS The study underscores a notable association between biliary stent placement and increased IH risk after PD, mediated by elevated SSI incidence. Pancreatic fistulas were not directly correlated with IH in the studied cohorts. Further research is necessary to validate these findings and guide clinical practice.
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Affiliation(s)
- Nadav Nevo
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel-Aviv University, Tel-Aviv, Israel.
| | - Arielle Jacover
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Eran Nizri
- General Surgery Division, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Diego Cuccurullo
- Department of Laparoscopic and Robotic General Surgery, Azienda Ospedaliera Dei Colli "Monaldi Hospital", Naples, Italy
| | - Corrado Rispoli
- Department of Laparoscopic and Robotic General Surgery, Azienda Ospedaliera Dei Colli "Monaldi Hospital", Naples, Italy
| | - Ron Pery
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Yoav Elizur
- Department of Internal Medicine B, Sheba Medical Center, Tel Hashomer, Tel-Aviv University, Tel-Aviv, Israel
| | - Nir Horesh
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Rony Eshkenazy
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Ido Nachmany
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Niv Pencovich
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel-Aviv University, Tel-Aviv, Israel
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Johnson JA, Mesiti A, Herre M, Farzaneh C, Li Y, Zambare W, Carmichael J, Pigazzi A, Jafari MD. Effect of Specimen Extraction Site on Postoperative Incisional Hernia after Minimally Invasive Right Colectomy. J Am Coll Surg 2024; 239:107-112. [PMID: 38415817 DOI: 10.1097/xcs.0000000000001060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Incisional hernia (IH) is a known complication after colorectal surgery. Despite advances in minimally invasive surgery, colorectal surgery still requires extraction sites for specimen retrieval, increasing the likelihood of postoperative IH development. The objective of this study is to determine the effect of specimen extraction site on the rate of IH after minimally invasive right-sided colectomy for patients with available imaging. STUDY DESIGN This is a retrospective multi-institutional cohort study at 2 large academic medical centers in the US. Adults who underwent right-sided minimally invasive colectomy from 2012 to 2020 with abdominal imaging available at least 1 year postoperatively were included in the analysis. The primary exposure was specimen extraction via a midline specimen extraction vs Pfannenstiel specimen extraction. The main outcome was the development of IH at least 1 year postoperatively as visualized on a CT scan. RESULTS Of the 341 patients sampled, 194 (57%) had midline specimen extraction and 147 (43%) had a Pfannenstiel specimen extraction. Midline extraction patients were older (66 ± 15 vs 58 ± 16; p < 0.001) and had a higher rate of previous abdominal operation (99, 51% vs 55, 37%, p = 0.01). The rate of IH was higher in midline extraction at 25% (48) compared with Pfannenstiel extraction (0, 0%; p < 0.001). The average length of stay was higher in the midline extraction group at 5.1 ± 2.5 compared with 3.4 ± 3.1 days in the Pfannenstiel extraction group (p < 0.001). Midline extraction was associated with IH development (odds ratio 24.6; 95% CI 1.89 to 319.44; p = 0.004). Extracorporeal anastomosis was associated with a higher IH rate (odds ratio 25.8; 95% CI 2.10 to 325.71; p = 0.002). CONCLUSIONS Patients who undergo Pfannenstiel specimen extraction have a lower risk of IH development compared with those who undergo midline specimen extraction.
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Affiliation(s)
- Josh A Johnson
- From the Department of Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY (Johnson, Mesiti, Herre, Zambare, Pigazzi, Jafari)
| | - Andrea Mesiti
- From the Department of Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY (Johnson, Mesiti, Herre, Zambare, Pigazzi, Jafari)
| | - Margo Herre
- From the Department of Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY (Johnson, Mesiti, Herre, Zambare, Pigazzi, Jafari)
| | - Cyrus Farzaneh
- Department of Surgery, University of California, Irvine Medical Center, Orange, CA (Farzaneh, Carmichael)
| | - Ying Li
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY (Li)
| | - Wini Zambare
- From the Department of Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY (Johnson, Mesiti, Herre, Zambare, Pigazzi, Jafari)
| | - Joseph Carmichael
- Department of Surgery, University of California, Irvine Medical Center, Orange, CA (Farzaneh, Carmichael)
| | - Alessio Pigazzi
- From the Department of Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY (Johnson, Mesiti, Herre, Zambare, Pigazzi, Jafari)
| | - Mehraneh D Jafari
- From the Department of Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY (Johnson, Mesiti, Herre, Zambare, Pigazzi, Jafari)
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Liu Y, Huang J, Li S, Li Z, Chen C, Qu G, Chen K, Teng Y, Ma R, Ren J, Wu X. Recent Advances in Functional Hydrogel for Repair of Abdominal Wall Defects: A Review. Biomater Res 2024; 28:0031. [PMID: 38845842 PMCID: PMC11156463 DOI: 10.34133/bmr.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/18/2024] [Indexed: 06/09/2024] Open
Abstract
The abdominal wall plays a crucial role in safeguarding the internal organs of the body, serving as an essential protective barrier. Defects in the abdominal wall are common due to surgery, infection, or trauma. Complex defects have limited self-healing capacity and require external intervention. Traditional treatments have drawbacks, and biomaterials have not fully achieved the desired outcomes. Hydrogel has emerged as a promising strategy that is extensively studied and applied in promoting tissue regeneration by filling or repairing damaged tissue due to its unique properties. This review summarizes the five prominent properties and advances in using hydrogels to enhance the healing and repair of abdominal wall defects: (a) good biocompatibility with host tissues that reduces adverse reactions and immune responses while supporting cell adhesion migration proliferation; (b) tunable mechanical properties matching those of the abdominal wall that adapt to normal movement deformations while reducing tissue stress, thereby influencing regulating cell behavior tissue regeneration; (c) drug carriers continuously delivering drugs and bioactive molecules to sites optimizing healing processes enhancing tissue regeneration; (d) promotion of cell interactions by simulating hydrated extracellular matrix environments, providing physical support, space, and cues for cell migration, adhesion, and proliferation; (e) easy manipulation and application in surgical procedures, allowing precise placement and close adhesion to the defective abdominal wall, providing mechanical support. Additionally, the advances of hydrogels for repairing defects in the abdominal wall are also mentioned. Finally, an overview is provided on the current obstacles and constraints faced by hydrogels, along with potential prospects in the repair of abdominal wall defects.
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Affiliation(s)
- Ye Liu
- School of Medicine,
Southeast University, Nanjing 210009, China
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School,
Nanjing University, Nanjing 210002, China
| | - Jinjian Huang
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School,
Nanjing University, Nanjing 210002, China
| | - Sicheng Li
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School,
Nanjing University, Nanjing 210002, China
| | - Ze Li
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School,
Nanjing University, Nanjing 210002, China
| | - Canwen Chen
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School,
Nanjing University, Nanjing 210002, China
| | - Guiwen Qu
- School of Medicine,
Southeast University, Nanjing 210009, China
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School,
Nanjing University, Nanjing 210002, China
| | - Kang Chen
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School,
Nanjing University, Nanjing 210002, China
| | - Yitian Teng
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School,
Nanjing University, Nanjing 210002, China
| | - Rui Ma
- School of Medicine,
Southeast University, Nanjing 210009, China
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School,
Nanjing University, Nanjing 210002, China
| | - Jianan Ren
- School of Medicine,
Southeast University, Nanjing 210009, China
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School,
Nanjing University, Nanjing 210002, China
| | - Xiuwen Wu
- School of Medicine,
Southeast University, Nanjing 210009, China
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School,
Nanjing University, Nanjing 210002, China
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Turmine J, Florence AM, Tardivon C, Passot G, Gillion JF, Moszkowicz D. Obesity increases the surgical complexity and risk of recurrence after midline primary ventral hernia repair: results on 2307 patients from the French Society of hernia surgery (SFCP-CH) registry database. Hernia 2024; 28:779-788. [PMID: 37702874 DOI: 10.1007/s10029-023-02875-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: 05/25/2023] [Accepted: 08/28/2023] [Indexed: 09/14/2023]
Abstract
PURPOSE Obesity is a known risk factor of recurrence after hernia surgery, but available data often concern pooled cases of primary and incisional hernia, with short follow-up. We aimed to analyze the impact of severe obesity (BMI ≥ 35 kg/m2) on the results of midline primary ventral hernia repair (mPVHR), in comparison with non-severely obese patients. METHODS Data were extracted from a multicentric registry, in which patients' data are consecutively and anonymously collected. We conducted a retrospective comparative study on patients with severe obesity (sOb) versus non-severely obese patients (non-sOb), who underwent surgery, with a minimal 2-year follow-up after their mPVHR. RESULTS Among 2307 patients, 267 sOb and 2040 non-sOb matched inclusion criteria. Compared with non-sOb, sOb group gathered all the worse conditions and risk factors: more ASA3-4 (39.3% vs. 10.2%; p < 0.001), symptomatic hernia (15.7% vs. 6.8%; p < 0.001), defect > 4 cm in diameter (24.3% vs. 8.8%; p < 0.001), emergency surgery (6.1% vs. 2.5%; p = 0.003), and Altemeir class > 1 (9.4% vs. 2.9%; p < 0.001). Laparoscopic IPOM was used more often in sOb patients (40% vs. 32%; p = 0.016), but with smaller Hauters' ratio (46 vs. 73; p < 0.001). Compared with the non-sOb, the rate of day-case surgery was lower (48% vs. 68%; p < 0.001), the surgical site occurrences were significantly more frequent (6.4 %vs. 2.5%; p < 0.001). The main outcome, 2-year recurrence, was 5.9% in the sOb vs. 2.1% (p = 0.008), and 2-year reoperations was 3% vs. 0.3% (p = 0.006). In the adjusted analysis, severe obesity was an independent risk factor for recurrence [OR = 2.82, (95%CI, 1.45; 5.22); p = 0.003]. CONCLUSION In patients with severe obesity, mPVHR is technically challenging and recurrence rate is three times higher than that of non-severely obese patients.
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Affiliation(s)
- J Turmine
- Department of General Surgery and Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - A-M Florence
- Department of Epidemiology Biostatistics and Clinical Research, AP-HP Nord, Hôpital Bichat, Paris, France
- Université Paris Cité, INSERM, IAME, UMR 1137, Paris, France
| | - C Tardivon
- Department of Epidemiology Biostatistics and Clinical Research, AP-HP Nord, Hôpital Bichat, Paris, France
- Centre d'Investigations Cliniques-Epidémiologie Clinique 1425, INSERM, Hôpital Bichat, 75018, Paris, France
| | - G Passot
- Department of General Surgery and Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Hospices Civils de Lyon, University of Lyon I, Lyon, France
- CICLY EMR 3738 Lyon Sud Charles Mérieux Faculty, Claude Bernard University Lyon 1, Oullins, France
| | - J-F Gillion
- Unité de Chirurgie Viscérale et Digestive, Ramsay Santé, Hôpital Privé d'Antony, Antony, France
| | - D Moszkowicz
- Université Paris Cité, Gastrointestinal and Metabolic Dysfunctions in Nutritional Pathologies Centre de Recherche sur l'Inflammation Paris Montmartre INSERM UMRS 1149, 75890, Paris, France.
- Service de Chirurgie Générale et Digestive, AP-HP, Hôpital Louis Mourier, DMU ESPRIT-GHU AP-HP, Nord-Université Paris Cité, 178 rue des Renouillers, 92700, Colombes, France.
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Tang F, Miao D, Huang R, Zheng B, Yu Y, Ma P, Peng B, Li Y, Wang H, Wu D. Double-Layer Asymmetric Porous Mesh with Dynamic Mechanical Support Properties Enables Efficient Single-Stage Repair of Contaminated Abdominal Wall Defect. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024; 36:e2307845. [PMID: 38408735 DOI: 10.1002/adma.202307845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 02/08/2024] [Indexed: 02/28/2024]
Abstract
Contamination tolerance and long-term mechanical support are the two critical properties of meshes for contaminated abdominal wall defect repair. However, biological meshes with excellent pollution tolerance fail to provide bio-adaptive long-term mechanical support due to their rapid degradation. Here, a novel double-layer asymmetric porous mesh (SIS/PVA-EXO) is designed by simple and efficient in situ freeze-thaw of sticky polyvinyl alcohol (PVA) solution on the loosely porous surface of small intestinal submucosal decellularized matrix (SIS), which can successfully repair the contaminated abdominal wall defect with bio-adaptive dynamic mechanical support through only single-stage surgery. The exosome-loaded degradable loosely porous SIS layer accelerates the tissue healing; meanwhile, the exosome-loaded densely porous PVA layer can maintain long-term mechanical support without any abdominal adhesion. In addition, the tensile strength and strain at break of SIS/PVA-EXO mesh change gradually from 0.37 MPa and 210% to 0.10 MPa and 385% with the degradation of SIS layer. This unique performance can dynamically adapt to the variable mechanical demands during different periods of contaminated abdominal wall reconstruction. As a result, this SIS/PVA-EXO mesh shows an attractive prospect in the treatment of contaminated abdominal wall defect without recurrence by integrating local immune regulation, tissue remodeling, and dynamic mechanical supporting.
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Affiliation(s)
- Fuxin Tang
- Department of General Surgery (Colorectal Surgery), Guangdong Institute of Gastroenterology, Biomedical Innovation Center, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, P. R. China
| | - Dongtian Miao
- PCFM Lab, School of Chemistry, Sun Yat-sen University, Guangzhou, 510006, P. R. China
| | - Rongkang Huang
- Department of General Surgery (Colorectal Surgery), Guangdong Institute of Gastroenterology, Biomedical Innovation Center, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, P. R. China
| | - Bingna Zheng
- The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518000, P.R. China
| | - Yang Yu
- Department of General Surgery (Colorectal Surgery), Guangdong Institute of Gastroenterology, Biomedical Innovation Center, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, P. R. China
| | - Pengwei Ma
- PCFM Lab, School of Chemistry, Sun Yat-sen University, Guangzhou, 510006, P. R. China
| | - Binying Peng
- Department of General Surgery (Colorectal Surgery), Guangdong Institute of Gastroenterology, Biomedical Innovation Center, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, P. R. China
| | - Yong Li
- Department of General Surgery (Gastrointestinal Surgery), Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, P. R. China
| | - Hui Wang
- Department of General Surgery (Colorectal Surgery), Guangdong Institute of Gastroenterology, Biomedical Innovation Center, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, P. R. China
| | - Dingcai Wu
- PCFM Lab, School of Chemistry, Sun Yat-sen University, Guangzhou, 510006, P. R. China
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8
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Sánchez Arteaga A, Gil Delgado JL, Feria Madueño A, Tallón Aguilar L, Sañudo B, Padillo Ruiz J. Impact of incisional hernia on abdominal wall strength. BJS Open 2024; 8:zrae045. [PMID: 38818958 PMCID: PMC11140820 DOI: 10.1093/bjsopen/zrae045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/22/2024] [Accepted: 04/01/2024] [Indexed: 06/01/2024] Open
Affiliation(s)
- Alejandro Sánchez Arteaga
- Department of General Surgery, Hospital Universitario Virgen del Rocío, Seville, Spain
- Surgery Department, School of Medicine, University of Seville, Seville, Spain
| | | | - Adrián Feria Madueño
- Department of Physical Education and Sports, University of Seville, Seville, Spain
| | - Luis Tallón Aguilar
- Department of General Surgery, Hospital Universitario Virgen del Rocío, Seville, Spain
- Surgery Department, School of Medicine, University of Seville, Seville, Spain
| | - Borja Sañudo
- Department of Physical Education and Sports, University of Seville, Seville, Spain
| | - Javier Padillo Ruiz
- Department of General Surgery, Hospital Universitario Virgen del Rocío, Seville, Spain
- Surgery Department, School of Medicine, University of Seville, Seville, Spain
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9
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Rodicio Miravalles JL, Méndez CSM, Lopez-Monclus J, Moreno Gijón M, López Quindós P, Amoza Pais S, López López A, García Bear I, Menendez de Llano Ortega R, Díez Pérez de Las Vacas MI, Garcia-Urena MA. Short-term outcomes of a multicentre prospective study using a "visible" polyvinylidene fluoride onlay mesh for the prevention of midline incisional hernia. Langenbecks Arch Surg 2024; 409:136. [PMID: 38652308 DOI: 10.1007/s00423-024-03307-x] [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: 01/21/2024] [Accepted: 04/03/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Prophylactic meshes in high-risk patients prevent incisional hernias, although there are still some concerns about the best layer to place them in, the type of fixation, the mesh material, the significance of the level of contamination, and surgical complications. We aimed to provide answers to these questions and information about how the implanted material behaves based on its visibility under magnetic resonance imaging (MRI). METHOD This is a prospective multicentre observational cohort study. Preliminary results from the first 3 months are presented. We included general surgical patients who had at least two risk factors for developing an incisional hernia. Multivariate logistic regression was used. A polyvinylidene fluoride (PVDF) mesh loaded with iron particles was used in an onlay position. MRIs were performed 6 weeks after treatment. RESULTS Between July 2016 and June 2022, 185 patients were enrolled in the study. Surgery was emergent in 30.3% of cases, contaminated in 10.7% and dirty in 11.8%. A total of 5.6% of cases had postoperative wound infections, with the requirement of stoma being the only significant risk factor (OR = 7.59, p = 0.03). The formation of a seroma at 6 weeks detected by MRI, was associated with body mass index (OR = 1.13, p = 0.02). CONCLUSIONS The prophylactic use of onlay PVDF mesh in midline laparotomies in high-risk patients was safe and effective in the short term, regardless of the type of surgery or the level of contamination. MRI allowed us to detect asymptomatic seromas during the early process of integration. STUDY REGISTRATION This protocol was registered at ClinicalTrials.gov (NCT03105895).
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Affiliation(s)
- José Luis Rodicio Miravalles
- Division of General Surgery, Hospital Universitario Central de Asturias (HUCA), Avda de Roma, s/n, Oviedo, Asturias, 33011, Spain.
| | - Carlos San Miguel Méndez
- Division of General Surgery, Grupo de Investigación de Pared Abdominal Compleja, Universidad Francisco de Vitoria, Hospital Universitario del Henares, Madrid, Spain
| | - Javier Lopez-Monclus
- Division of General Surgery, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - María Moreno Gijón
- Division of General Surgery, Hospital Universitario Central de Asturias (HUCA), Avda de Roma, s/n, Oviedo, Asturias, 33011, Spain
| | - Patricia López Quindós
- Division of General Surgery, Grupo de Investigación de Pared Abdominal Compleja, Universidad Francisco de Vitoria, Hospital Universitario del Henares, Madrid, Spain
| | - Sonia Amoza Pais
- Division of General Surgery, Hospital Universitario Central de Asturias (HUCA), Avda de Roma, s/n, Oviedo, Asturias, 33011, Spain
| | - Antonio López López
- Division of General Surgery, Hospital Universitario Nuestra Señora del Prado, Toledo, Spain
| | - Isabel García Bear
- Division of General Surgery, Hospital Universitario San Agustin, Avilés, Spain
| | | | | | - Miguel Angel Garcia-Urena
- Division of General Surgery, Grupo de Investigación de Pared Abdominal Compleja, Universidad Francisco de Vitoria, Hospital Universitario del Henares, Madrid, Spain
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10
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van den Berg R, den Hartog FPJ, Bali C, Matsagkas M, Bevis PM, Earnshaw JJ, Debus ES, Honig S, Berrevoet F, Detry O, Stabilini C, Muysoms F, Tanis PJ. Protocol for an independent patient data meta-analysis of prophylactic mesh placement for incisional hernia prevention after abdominal aortic aneurysm surgery: a collaborative European Hernia Society project (I-PREVENT-AAA). BMJ Open 2024; 14:e081046. [PMID: 38626979 PMCID: PMC11029178 DOI: 10.1136/bmjopen-2023-081046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/05/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Incisional hernia (IH) is a prevalent and potentially dangerous complication of abdominal surgery, especially in high-risk groups. Mesh reinforcement of the abdominal wall has been studied as a potential intervention to prevent IHs. Randomised controlled trials (RCTs) have demonstrated that prophylactic mesh reinforcement after abdominal surgery, in general, is effective and safe. In patients with abdominal aortic aneurysm (AAA), prophylactic mesh reinforcement after open repair has not yet been recommended in official guidelines, because of relatively small sample sizes in individual trials. Furthermore, the identification of subgroups that benefit most from prophylactic mesh placement requires larger patient numbers. Our primary aim is to evaluate the efficacy and effectiveness of the use of a prophylactic mesh after open AAA surgery to prevent IH by performing an individual patient data meta-analysis (IPDMA). Secondary aims include the evaluation of postoperative complications, pain and quality of life, and the identification of potential subgroups that benefit most from prophylactic mesh reinforcement. METHODS AND ANALYSIS We will conduct a systematic review to identify RCTs that study prophylactic mesh placement after open AAA surgery. Cochrane Central Register of Controlled Trials, MEDLINE Ovid, Embase, Web of Science Core Collection and Google Scholar will be searched from the date of inception onwards. RCTs must directly compare primary sutured closure with mesh closure in adult patients who undergo open AAA surgery. Lead authors of eligible studies will be asked to share individual participant data (IPD). The risk of bias (ROB) for each included study will be assessed using the Cochrane ROB tool. An IPDMA will be performed to evaluate the efficacy, with the IH rate as the primary outcome. Any signs of heterogeneity will be evaluated by Forest plots. Time-to-event analyses are performed using Cox regression analysis to evaluate risk factors. ETHICS AND DISSEMINATION No new data will be collected in this study. We will adhere to institutional, national and international regulations regarding the secure and confidential sharing of IPD, addressing ethics as indicated. We will disseminate findings via international conferences, open-source publications in peer-reviewed journals and summaries posted online. PROSPERO REGISTRATION NUMBER CRD42022347881.
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Affiliation(s)
- Rudolf van den Berg
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Medicine, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Floris P J den Hartog
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Christina Bali
- Department of Surgery, University Hospital of Ioannina, Ioannina, Greece
| | | | - Paul M Bevis
- Department of Vascular Surgery, North Bristol NHS Trust, Westbury on Trym, UK
| | - Jonothan J Earnshaw
- Department of Vascular Surgery, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Eike S Debus
- Department of Vascular Medicine, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Eppendorf, Hamburg, Germany
| | - Susanne Honig
- Department of Vascular Surgery, Hospital Robert Schuman Kirchberg Hospital, Luxembourg City, Luxembourg
| | - Frederik Berrevoet
- Department of General and Hepatobiliary Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Olivier Detry
- Department of Abdominal Surgery and Transplantation, Division of Abdominal Wall Surgery, CHU Liege, University of Liege, Liege, Belgium
| | - Cesare Stabilini
- Department of Surgical Sciences, University of Genoa, Genoa, Italy
| | - Filip Muysoms
- Department of Surgery, AZ Maria Middelares Hospital, Ghent, Belgium
| | - Pieter J Tanis
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
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11
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Odogwu SO, Magsi AM, Spurring E, Malik M, Kadir B, Cutler K, Abdelrahman S, Prescornita C, Li E. Component separation repair of incisional hernia: evolution of practice and review of long-term outcomes in a single center. Hernia 2024; 28:465-474. [PMID: 38214787 DOI: 10.1007/s10029-023-02932-7] [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: 05/14/2023] [Accepted: 11/12/2023] [Indexed: 01/13/2024]
Abstract
PURPOSE To review the long-term outcomes of complex abdominal wall reconstruction using anterior and posterior component separation (CS) techniques in our center. METHODS This was a descriptive analytical study. Analysis of data from a prospectively collected database of patients who had undergone Component Separation (CS) repair of incisional hernias was performed. Two techniques were used. Anterior component separation (ACS) and posterior component separation with transversus abdominis release (PCS/TAR). Follow-up was clinical review at 6 weeks, 6 months, and 12 months with direct access telephone review thereafter. Long-term outcome data was obtained from electronic records and based on either clinical or CT assessment. Minimum physical follow-up was 6 months for all patients. RESULTS 89 patients with large incisional hernias underwent CS repair. 29 patients had ACS while 60 underwent PCS/TAR. Mean follow-up was 60 months (range 6-140 months) in the ACS group and 20 months (range 6-72 months) in the PCS group. Twenty-five patients (28%) had simultaneous major procedures including 21 intestinal anastomoses. Twenty-six (29%) of patients had associated stomas. Twenty-seven (30.3%) of the patients had undergone previous hernia repairs. Seromas occurred in 24 (26.97%) patients. Wound infections were more common after ACS. There have been 10 (11.2%) recurrences to date. CONCLUSION Component separation repair techniques result in good long-term outcomes with acceptable complication rates. They can be performed simultaneously with gastrointestinal procedures with low morbidity. Appropriate patient selection and use of appropriate mesh are important.
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Affiliation(s)
- S O Odogwu
- Walsall Healthcare NHS Trust, West Midlands, Walsall, WS2 9PS, England, UK.
| | - A M Magsi
- Brighton and Sussex University Hospitals NHS Trust, Brighton, BN2 5BE, East Sussex, England, UK
| | - E Spurring
- Walsall Healthcare NHS Trust, West Midlands, Walsall, WS2 9PS, England, UK
| | - M Malik
- Walsall Healthcare NHS Trust, West Midlands, Walsall, WS2 9PS, England, UK
| | - B Kadir
- University Hospitals Birmingham, Mindelsohn Way, Birmingham, B15 2GW, England, UK
| | - K Cutler
- Walsall Healthcare NHS Trust, West Midlands, Walsall, WS2 9PS, England, UK
| | - S Abdelrahman
- Walsall Healthcare NHS Trust, West Midlands, Walsall, WS2 9PS, England, UK
| | - C Prescornita
- Walsall Healthcare NHS Trust, West Midlands, Walsall, WS2 9PS, England, UK
| | - E Li
- University Hospitals Birmingham, Mindelsohn Way, Birmingham, B15 2GW, England, UK
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12
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Allaeys M, Visscher L, den Hartog FPJ, Dries P, Tanis PJ, Theeuwes HP, Berrevoet F, Eker HH. Strength of small-bites abdominal wall closure using different suturing methods and materials in an experimental animal model. Hernia 2024; 28:527-535. [PMID: 38212505 DOI: 10.1007/s10029-023-02945-2] [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: 09/12/2023] [Accepted: 12/08/2023] [Indexed: 01/13/2024]
Abstract
PURPOSE Using small instead of large bites for laparotomy closure results in lower incidence of incisional hernia, but no consensus exists on which suture material to use. This study aimed to compare five different closure strategies in a standardized experimental setting. METHODS Fifty porcine abdominal walls were arranged into 5 groups: (A) running 2/0 polydioxanone; (B) interlocking 2/0 polydioxanone; (C) running size 0 barbed polydioxanone; (D) running size 0 barbed glycolic acid and trimethylene carbonate; (E) running size 0 suturable polypropylene mesh. The small-bites technique was used for linea alba closure in all. The abdominal walls were divided into a supra- and infra-umbilical half, resulting in 20 specimens per group that were pulled apart in a tensile testing machine. Maximum tensile force and types of suture failure were registered. RESULTS The highest tensile force was measured when using barbed polydioxanone (334.8 N ± 157.0), but differences did not reach statistical significance. Infra-umbilical abdominal walls endured a significantly higher maximum tensile force compared to supra-umbilical (397 N vs 271 N, p < 0.001). Barbed glycolic acid and trimethylene carbonate failed significantly more often (25% vs 0%, p = 0.008). CONCLUSION Based on tensile force, both interlocking and running suture techniques using polydioxanone, and running sutures using barbed polydioxanone or suturable mesh, seem to be suitable for abdominal wall closure. Tensile strength was significantly higher in infra-umbilical abdominal walls compared to supra-umbilical. Barbed glycolic acid and trimethylene carbonate should probably be discouraged for fascial closure, because of increased risk of suture failure.
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Affiliation(s)
- M Allaeys
- Department of General and HPB Surgery and Liver Transplantation, University Hospital Ghent, Ghent, Belgium.
| | - L Visscher
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
- Surgical SkillsLab, Department of Neuroscience and Anatomy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - F P J den Hartog
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - P Dries
- Department of General and HPB Surgery and Liver Transplantation, University Hospital Ghent, Ghent, Belgium
| | - P J Tanis
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - H P Theeuwes
- Surgical SkillsLab, Department of Neuroscience and Anatomy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Trauma Surgery, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
| | - F Berrevoet
- Department of General and HPB Surgery and Liver Transplantation, University Hospital Ghent, Ghent, Belgium
| | - H H Eker
- Department of General and HPB Surgery and Liver Transplantation, University Hospital Ghent, Ghent, Belgium
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13
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Amro C, Smith L, Shulkin J, McGraw JR, Hill N, Broach RB, Torkington J, Fischer JP. The enigma of incisional hernia prediction unraveled: external validation of a prognostic model in colorectal cancer patients. Hernia 2024; 28:547-553. [PMID: 38227093 DOI: 10.1007/s10029-023-02947-0] [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: 09/27/2023] [Accepted: 12/12/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE Accurate prediction of hernia occurrence is vital for surgical decision-making and patient management, particularly in colorectal surgery patients. While a hernia prediction model has been developed, its performance in external populations remain to be investigated. This study aims to validate the existing model on an external dataset of patients who underwent colorectal surgery. METHODS The "Penn Hernia Calculator" model was externally validated using the Hughes Abdominal Repair Trial (HART) data, a randomized trial comparing colorectal cancer surgery closure techniques. The data encompassed demographics, comorbidities, and surgical specifics. Patients without complete follow-up were omitted. Model performance was assessed using key metrics, including area under the curve (AUC-ROC and AUC-PR) and Brier score. Reporting followed the TRIPOD consensus. RESULTS An external international dataset consisting of 802 colorectal surgery patients were identified, of which 674 patients with up to 2 years follow-up were included. Average patient age was 68 years, with 63.8% male. The average BMI was 28.1. Prevalence of diabetes, hypertension, and smoking were 15.7%, 16.3%, and 36.5%, respectively. Additionally, 7.9% of patients had a previous hernia. The most common operation types were low anterior resection (35.3%) and right hemicolectomy (34.4%). Hernia were observed in 24% of cases by 2-year follow-up. The external validation model revealed an AUC-ROC of 0.66, AUC-PR of 0.72, and a Brier score of 0.2. CONCLUSION The hernia prediction model demonstrated moderate performance in the external validation. Its potential generalizability, specifically in those undergoing colorectal surgery, may suggest utility in identifying and managing high-risk hernia candidates.
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Affiliation(s)
- C Amro
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, PCAM South Pavilion 14t Floor, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
| | - L Smith
- Department of Colorectal Surgery, University Hospital of Wales, Cardiff, UK
- School of Medicine, Cardiff University, Cardiff, UK
| | - J Shulkin
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, PCAM South Pavilion 14t Floor, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - J R McGraw
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, PCAM South Pavilion 14t Floor, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - N Hill
- School of Medicine, Cardiff University, Cardiff, UK
| | - R B Broach
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, PCAM South Pavilion 14t Floor, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - J Torkington
- Department of Colorectal Surgery, University Hospital of Wales, Cardiff, UK
| | - J P Fischer
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, PCAM South Pavilion 14t Floor, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
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14
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Tansawet A, Numthavaj P, Teza H, Pattanateepapon A, Piebpien P, Poprom N, Techapongsatorn S, McKay G, Attia J, Sumritpradit P, Thakkinstian A. External validation and revision of Penn incisional hernia prediction model: A large-scale retrospective cohort of abdominal operations. Surgeon 2024; 22:e34-e40. [PMID: 37558540 DOI: 10.1016/j.surge.2023.07.008] [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: 05/20/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Incisional hernia (IH) manifests in 10%-15% of abdominal surgeries and patients at elevated risk of this complication should be identified for prophylactic intervention. This study aimed to externally validate the Penn hernia risk calculator. METHODS The Ramathibodi abdominal surgery cohort was constructed by linking relevant hospital databases from 2010 to 2021. Penn hernia risk scores were calculated according to the original model which was externally validated using a seven-step approach. An updated model which included four additional predictor variables (i.e., age, immunosuppressive medication, ostomy reversal, and transfusion) added to those of the three original predictors (i.e., body mass index, chronic liver disease, and open surgery) was also evaluated. The area under the receiver operating characteristic curve (AUC) was estimated, and calibration performance was compared using the Hosmer-Lemeshow goodness-of-fit method for the observed/expected (O/E) ratio. RESULTS A total of 12,155 abdominal operations were assessed. The original Penn model yielded fair discrimination with an AUC (95% confidence interval (CI)) of 0.645 (0.607, 0.683). The updated model that included the additional predictor variables achieved an acceptable AUC (95% CI) of 0.733 (0.698, 0.768) with the O/E ratio of 0.968 (0.848, 1.088). CONCLUSION The updated model achieved improved discrimination and calibration performance, and should be considered for the identification of high-risk patients for further hernia prevention strategy.
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Affiliation(s)
- Amarit Tansawet
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Pawin Numthavaj
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Htun Teza
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Anuchate Pattanateepapon
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pongsathorn Piebpien
- Information Technology Department, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Napaphat Poprom
- Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suphakarn Techapongsatorn
- Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Gareth McKay
- Centre for Public Health, School of Medicine, Dentistry, and Biomedical Sciences, Queen's University Belfast, Northern Ireland, UK
| | - John Attia
- Centre for Clinical Epidemiology and Biostatistics, Hunter Medical Research Institute, School of Medicine and Public Health, The University of Newcastle, New Lambton, New South Wales, Australia
| | - Preeda Sumritpradit
- Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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15
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Prabha Shankar A, Mathew S, Tippana VSSN, B R K, Naik S, Pandita RK, L B, Kumar An N, Narasimha Rao V V, Kumar Bhat B, Moharana AK, Ts D. A Prospective Randomized Controlled Trial Comparing Clinical Equivalence of PD Synth and PDS Polydioxanone Sutures. Cureus 2023; 15:e50293. [PMID: 38205458 PMCID: PMC10776896 DOI: 10.7759/cureus.50293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2023] [Indexed: 01/12/2024] Open
Abstract
Introduction Incisional hernia is a common complication of midline laparotomy that may develop even after several years of surgery. Abdominal fascia closure with ideal suture material reduces the incidence of incisional hernia. This study compared the clinical equivalence of PD Synth (Healthium Medtech Limited) and PDS (Ethicon, Johnson & Johnson) slowly absorbed polydioxanone suture with respect to the occurrence of incisional hernia, following elective/emergency midline laparotomy. Methods Eighty-eight subjects undergoing elective/emergency midline laparotomy were randomized to PD Synth (n=45) and PDS (n=43) groups of this prospective, multicenter, randomized (1:1), single-blind, two-arm, parallel-group study (December 2020-May 2023). Primary endpoint was incidence of incisional hernia, occurring within six and 12 months of surgery. Secondary endpoints included incidence of fascial dehiscence, surgical site infection (SSI), suture sinus, seroma, hematoma, scar tenderness, and re-suturing, and evaluation of operative data, hospital stay, intra-operative suture handling, pain, time to return to normal day-to-day activities and work, overall patient satisfaction score, and adverse events. Results One subject in both PD Synth and PDS groups (p>0.05) developed incisional hernia at umbilicus 12 months post-laparotomy. In PDS group, one subject each had incidences of SSI on day 2, day 7, and one month, two subjects developed seroma on day seven, and one subject had readmission on one month; two subjects in PD Synth group developed superficial SSI (one month). Findings of other secondary endpoints were comparable between the groups. Conclusion Primary and secondary outcomes manifested that PD Synth and PDS slowly absorbed polydioxanone sutures are clinically equivalent, and can be used for abdominal fascial closure following midline laparotomy.
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Affiliation(s)
- Amritha Prabha Shankar
- Department of Surgical Oncology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, IND
| | - Stanley Mathew
- Department of General Surgery, Kasturba Medical College and Kasturba Hospital, Manipal, IND
| | - V S S Nagababu Tippana
- Department of General Surgery, King George Hospital/Andhra Medical College, Visakhapatnam, IND
| | - Keerthi B R
- Department of Surgical Oncology, Vydehi Institute of Medical Sciences & Research Centre, Bengaluru, IND
| | - Saleem Naik
- Department of General Surgery, Batra Hospital and Medical Research Center, New Delhi, IND
| | - Ravinder K Pandita
- Department of General Surgery, Batra Hospital and Medical Research Center, New Delhi, IND
| | - Badareesh L
- Department of General Surgery, Kasturba Medical College and Kasturba Hospital, Manipal, IND
| | - Naveen Kumar An
- Department of Surgical Oncology, Kasturba Medical College, Manipal, IND
| | - Venkata Narasimha Rao V
- Department of Surgical Oncology, Kasturba Medical College and Kasturba Hospital, Manipal, IND
| | - Bharath Kumar Bhat
- Department of Gastrosurgery, Kasturba Medical College and Kasturba Hospital, Manipal, IND
| | - Ashok K Moharana
- Department of Clinical Affairs, Healthium Medtech Limited, Bengaluru, IND
| | - Deepak Ts
- Department of Clinical Affairs, Healthium Medtech Limited, Bengaluru, IND
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16
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Omar I, Zaimis T, Townsend A, Ismaiel M, Wilson J, Magee C. Incisional Hernia: A Surgical Complication or Medical Disease? Cureus 2023; 15:e50568. [PMID: 38222215 PMCID: PMC10788045 DOI: 10.7759/cureus.50568] [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: 12/15/2023] [Indexed: 01/16/2024] Open
Abstract
Incisional hernia (IH) is a frequent complication following abdominal surgery. The development of IH could be more sophisticated than a simple anatomical failure of the abdominal wall. Reported IH incidence varies among studies. This review presented an overview of definitions, molecular basis, risk factors, incidence, clinical presentation, surgical techniques, postoperative care, cost, risk prediction tools, and proposed preventative measures. A literature search of PubMed was conducted to include high-quality studies on IH. The incidence of IH depends on the primary surgical pathology, incision site and extent, associated medical comorbidities, and risk factors. The review highlighted inherent and modifiable risk factors. The disorganisation of the extracellular matrix, defective fibroblast functions, and ratio variations of different collagen types are implicated in molecular mechanisms. Elective repair of IH alleviates symptoms, prevents complications, and improves the quality of life (QOL). Recent studies introduced risk prediction tools to implement preventative measures, including suture line reinforcement or prophylactic mesh application in high-risk groups. Elective repair improves QOL and prevents sinister outcomes associated with emergency IH repair. The watchful wait strategy should be reviewed, and options should be discussed thoroughly during patients' counselling. Risk stratification tools for predicting IH would help adopt prophylactic measures.
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Affiliation(s)
- Islam Omar
- General Surgery, The Hillingdon Hospitals NHS Foundation Trust, Uxbridge, GBR
| | - Tilemachos Zaimis
- General Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, GBR
| | - Abby Townsend
- General Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, GBR
| | - Mohamed Ismaiel
- General Surgery, Altnagelvin Area Hospital, Londonderry, GBR
| | - Jeremy Wilson
- General Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, GBR
| | - Conor Magee
- General Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, GBR
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17
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Yu Q, Sun H, Zhang L, Jiang L, Liang L, Yu C, Dong X, Guo B, Qiu Y, Li J, Zhang H, Yao F, Zhu D, Li J. A Zwitterionic Hydrogel with Anti-Oxidative and Anti-Inflammatory Properties for the Prevention of Peritoneal Adhesion by Inhibiting Mesothelial-Mesenchymal Transition. Adv Healthc Mater 2023; 12:e2301696. [PMID: 37669499 DOI: 10.1002/adhm.202301696] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/04/2023] [Indexed: 09/07/2023]
Abstract
Postoperative peritoneal adhesion is a serious clinical complication. Various hydrogel barriers have been developed to prevent peritoneal adhesion. However, it remains a challenge to design a hydrogel with desirable physicochemical properties and bioactivities. In this study, a zwitterionic polysaccharide-based multifunctional hydrogel is developed using epigallocatechin-3-gallate (EGCG) to prevent postoperative abdominal adhesion. This hydrogel is simple to use and has desirable properties, such as excellent injectability, self-healing, and non-swelling properties. The hydrogel also has ultralow fouling capabilities, such as superior bactericidal performance, cell and protein adhesion, and low immunogenicity resistance. Moreover, the hydrogel exhibits good antioxidant activity, which is attributed to the integration of EGCG. Furthermore, the detailed mechanism from in vivo and in vitro experimental studies illustrates that hydrogel compositions can synergistically prevent adhesion formation through multiple pathways, including anti-inflammatory and antioxidant capabilities and inhibition effects on the mesothelial-mesenchymal transition (MMT) process induced by transforming growth factor (TGF-β). In summary, this zwitterionic multifunctional hydrogel has great potential to prevent postoperative adhesion formation in the clinical setting.
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Affiliation(s)
- Qingyu Yu
- Key Laboratory of Systems Bioengineering (Ministry of Education), Department of Polymer Science, School of Chemical Engineering and Technology, Tianjin University, Tianjin, 300072, China
- Tianjin Key Laboratory of Biomedical Materials, Key Laboratory of Biomaterials and Nanotechnology for Cancer Immunotherapy, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300192, China
| | - Hong Sun
- School of Basic Medical Sciences, North China University of Science and Technology, Tangshan, 063210, China
| | - Linhua Zhang
- Tianjin Key Laboratory of Biomedical Materials, Key Laboratory of Biomaterials and Nanotechnology for Cancer Immunotherapy, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300192, China
| | - Lijie Jiang
- School of Basic Medical Sciences, North China University of Science and Technology, Tangshan, 063210, China
| | - Lei Liang
- Key Laboratory of Systems Bioengineering (Ministry of Education), Department of Polymer Science, School of Chemical Engineering and Technology, Tianjin University, Tianjin, 300072, China
| | - Chaojie Yu
- Key Laboratory of Systems Bioengineering (Ministry of Education), Department of Polymer Science, School of Chemical Engineering and Technology, Tianjin University, Tianjin, 300072, China
| | - Xiaoru Dong
- Key Laboratory of Systems Bioengineering (Ministry of Education), Department of Polymer Science, School of Chemical Engineering and Technology, Tianjin University, Tianjin, 300072, China
| | - Bingyan Guo
- Key Laboratory of Systems Bioengineering (Ministry of Education), Department of Polymer Science, School of Chemical Engineering and Technology, Tianjin University, Tianjin, 300072, China
| | - Yuwei Qiu
- Key Laboratory of Systems Bioengineering (Ministry of Education), Department of Polymer Science, School of Chemical Engineering and Technology, Tianjin University, Tianjin, 300072, China
| | - Jingwu Li
- Surgical Oncology, Tangshan People' Hospital, Tangshan, 063001, China
| | - Hong Zhang
- Key Laboratory of Systems Bioengineering (Ministry of Education), Department of Polymer Science, School of Chemical Engineering and Technology, Tianjin University, Tianjin, 300072, China
| | - Fanglian Yao
- Key Laboratory of Systems Bioengineering (Ministry of Education), Department of Polymer Science, School of Chemical Engineering and Technology, Tianjin University, Tianjin, 300072, China
| | - Dunwan Zhu
- Tianjin Key Laboratory of Biomedical Materials, Key Laboratory of Biomaterials and Nanotechnology for Cancer Immunotherapy, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300192, China
| | - Junjie Li
- Key Laboratory of Systems Bioengineering (Ministry of Education), Department of Polymer Science, School of Chemical Engineering and Technology, Tianjin University, Tianjin, 300072, China
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18
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van Steensel S, Deerenberg EB, Poelman MM. Abdominal wall closure. Br J Surg 2023; 110:1597-1600. [PMID: 37713648 DOI: 10.1093/bjs/znad294] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 08/27/2023] [Indexed: 09/17/2023]
Affiliation(s)
| | - Eva B Deerenberg
- Department of General Surgery, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
| | - Marijn M Poelman
- Department of General Surgery, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
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19
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Zhang N, Huang Y, Wei P, Sun L, Jing W, Xue Y, Zhang Y, Zhao B, Yang Z. Killing two birds with one stone: A therapeutic copper-loaded bio-patch promoted abdominal wall repair via VEGF pathway. Mater Today Bio 2023; 22:100785. [PMID: 37680583 PMCID: PMC10480776 DOI: 10.1016/j.mtbio.2023.100785] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/09/2023] Open
Abstract
Hernia and life-threatening intestinal obstruction often result from abdominal wall injuries, and the regeneration of abdominal wall defects is limited due to the lack of biocompatible, antibacterial and angiogenic scaffolding materials for treating injured tissues. Taking inspiration from the facile preparation of dopamine polymerization and its surface modification technology, in this study, multi-therapeutic copper element was introduced into porcine small intestinal submucosa (SIS) bio-patches through polydopamine (PDA) deposition, in order to regenerate abdominal wall injury. In both in vitro antibacterial assays, cytocompatibility assays and in vivo abdominal wall repair experiments, the SIS/PDA/Cu bio-patches exhibited robust antibacterial efficiency (>99%), excellent biocompatibility to cells (>90%), and enhanced neovascularization and improved collagen maturity compared to other commercially available patches (3.0-fold higher than the PP mesh), due to their activation of VEGF pathway. These findings indicated the bio-patch was a promising application for preventing visceral adhesion, bacterial infection, and promoting soft tissue regeneration.
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Affiliation(s)
- Nan Zhang
- Department of General Surgery, Tianjin Nankai Hospital, Tianjin, 300100, China
| | - Yiqian Huang
- Beijing Biosis Healing Biological Technology Co., Ltd, Beijing, 102600, China
| | - Pengfei Wei
- Beijing Biosis Healing Biological Technology Co., Ltd, Beijing, 102600, China
- Foshan (Southern China) Institute for New Materials, Foshan, 528220, China
| | - Liya Sun
- Beijing Biosis Healing Biological Technology Co., Ltd, Beijing, 102600, China
| | - Wei Jing
- Beijing Biosis Healing Biological Technology Co., Ltd, Beijing, 102600, China
- Foshan (Southern China) Institute for New Materials, Foshan, 528220, China
| | - Yunxia Xue
- Beijing Biosis Healing Biological Technology Co., Ltd, Beijing, 102600, China
| | - Yan Zhang
- Beijing Biosis Healing Biological Technology Co., Ltd, Beijing, 102600, China
| | - Bo Zhao
- Beijing Biosis Healing Biological Technology Co., Ltd, Beijing, 102600, China
| | - Ziang Yang
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
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20
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Saiding Q, Chen Y, Wang J, Pereira CL, Sarmento B, Cui W, Chen X. Abdominal wall hernia repair: from prosthetic meshes to smart materials. Mater Today Bio 2023; 21:100691. [PMID: 37455815 PMCID: PMC10339210 DOI: 10.1016/j.mtbio.2023.100691] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/15/2023] [Accepted: 06/03/2023] [Indexed: 07/18/2023] Open
Abstract
Hernia reconstruction is one of the most frequently practiced surgical procedures worldwide. Plastic surgery plays a pivotal role in reestablishing desired abdominal wall structure and function without the drawbacks traditionally associated with general surgery as excessive tension, postoperative pain, poor repair outcomes, and frequent recurrence. Surgical meshes have been the preferential choice for abdominal wall hernia repair to achieve the physical integrity and equivalent components of musculofascial layers. Despite the relevant progress in recent years, there are still unsolved challenges in surgical mesh design and complication settlement. This review provides a systemic summary of the hernia surgical mesh development deeply related to abdominal wall hernia pathology and classification. Commercial meshes, the first-generation prosthetic materials, and the most commonly used repair materials in the clinic are described in detail, addressing constrain side effects and rational strategies to establish characteristics of ideal hernia repair meshes. The engineered prosthetics are defined as a transit to the biomimetic smart hernia repair scaffolds with specific advantages and disadvantages, including hydrogel scaffolds, electrospinning membranes, and three-dimensional patches. Lastly, this review critically outlines the future research direction for successful hernia repair solutions by combing state-of-the-art techniques and materials.
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Affiliation(s)
- Qimanguli Saiding
- Shanghai Key Laboratory of Embryo Original Diseases, The International Peace Maternal and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, 910 Hengshan Road, Shanghai, 200030, PR China
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, PR China
| | - Yiyao Chen
- Shanghai Key Laboratory of Embryo Original Diseases, The International Peace Maternal and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, 910 Hengshan Road, Shanghai, 200030, PR China
| | - Juan Wang
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, PR China
| | - Catarina Leite Pereira
- I3S – Instituto de Investigação e Inovação Em Saúde and INEB – Instituto de Engenharia Biomédica, Universidade Do Porto, Rua Alfredo Allen 208, 4200-135, Porto, Portugal
| | - Bruno Sarmento
- I3S – Instituto de Investigação e Inovação Em Saúde and INEB – Instituto de Engenharia Biomédica, Universidade Do Porto, Rua Alfredo Allen 208, 4200-135, Porto, Portugal
- IUCS – Instituto Universitário de Ciências da Saúde, CESPU, Rua Central de Gandra 1317, 4585-116, Gandra, Portugal
| | - Wenguo Cui
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, PR China
| | - Xinliang Chen
- Shanghai Key Laboratory of Embryo Original Diseases, The International Peace Maternal and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, 910 Hengshan Road, Shanghai, 200030, PR China
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21
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Kaushik K, Srivastava V, Datta Sai Subramanyam A, Kishore R, Pratap A, Ansari MA. A Comparative Study on Outcomes and Quality of Life Changes Following Ventral Transabdominal Preperitoneal (Ventral-TAPP) and Laparoscopic Intraperitoneal Onlay Mesh (IPOM)-Plus Repair for Ventral Hernia. Cureus 2023; 15:e42222. [PMID: 37605677 PMCID: PMC10439842 DOI: 10.7759/cureus.42222] [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: 07/20/2023] [Indexed: 08/23/2023] Open
Abstract
Background Ventral transabdominal preperitoneal (ventral-TAPP) repair and intraperitoneal onlay mesh (IPOM) plus repair are two options among the available techniques of laparoscopic ventral hernia repair (LVHR). We conducted a comparative study to evaluate the clinical and quality of life (QoL)-related outcomes between ventral-TAPP and IPOM-plus repair. It was hypothesized that both procedures offered similar outcomes and QoL. Materials and methods The study included 32 consecutive patients undergoing LVHR, divided equally between ventral-TAPP and IPOM-plus groups. In the ventral-TAPP procedure, a peritoneal flap was created around the defect, followed by defect approximation and polypropylene mesh placement in the pre-peritoneal pocket. For the IPOM-plus procedure, the defect was closed and a composite (dual-side) mesh was placed around the defect. The minimum overlap beyond the original defect margin in both groups was 5 cm. Data regarding pre-operative parameters and postoperative outcomes, including pain and QoL at one week, one month, and three months, were recorded. A p-value of less than or equal to 0.05 was considered to be statistically significant. Results While the mean duration of surgery was longer, the cost of treatment was lower in group 1 (ventral-TAPP) with a p-value of <0.05 for both parameters. The length of hospital stay was significantly shorter in group 1 (ventral-TAPP), while the return to normal activity was similar in both groups. The visual analog scale (VAS) score for overall pain perception and the European registry for abdominal wall hernias (EuraHS; hernia-related QoL) score for 'Pain at Site' and 'Restriction of Activity' domains were significantly higher in group 2 (IPOM-plus) at one week. Conclusion Although the ventral-TAPP procedure requires more time and expertise to perform, the EuraHS QoL assessment at one week was better in group 1 (ventral-TAPP). Ventral-TAPP group scored better in terms of length of hospital stay and cost-effectiveness as well.
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Affiliation(s)
- Kumar Kaushik
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Vivek Srivastava
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | | | - Ritwik Kishore
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Arvind Pratap
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Mumtaz A Ansari
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
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22
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Ortega-Deballon P, Renard Y, de Launay J, Lafon T, Roset Q, Passot G. Incidence, risk factors, and burden of incisional hernia repair after abdominal surgery in France: a nationwide study. Hernia 2023:10.1007/s10029-023-02825-9. [PMID: 37368183 PMCID: PMC10374769 DOI: 10.1007/s10029-023-02825-9] [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: 01/23/2023] [Accepted: 06/10/2023] [Indexed: 06/28/2023]
Abstract
PURPOSE Incisional hernias are common after laparotomies. The aims of this study were to assess the rate of incisional hernia repair after abdominal surgery, recurrence rate, hospital costs, and risk factors, in France. METHODS This national, retrospective, longitudinal, observational study was based on the exhaustive hospital discharge database (PMSI). All adult patients (≥ 18 years old) hospitalised for an abdominal surgical procedure between 01-01-2013 and 31-12-2014 and hospitalised for incisional hernia repair within five years were included. Descriptive analyses and cost analyses from the National Health Insurance (NHI) viewpoint (hospital care for the hernia repair) were performed. To identify risk factors for hernia repair a multivariable Cox model and a machine learning analysis were performed. RESULTS In 2013-2014, 710074 patients underwent abdominal surgery, of which 32633 (4.6%) and 5117 (0.7%) had ≥ 1 and ≥ 2 incisional hernia repair(s) within five years, respectively. Mean hospital costs amounted to €4153/hernia repair, representing nearly €67.7 million/year. Some surgical sites exposed patients at high risk of incisional hernia repair: colon and rectum (hazard ratio [HR] 1.2), and other sites on the small bowel and the peritoneum (HR 1.4). Laparotomy procedure and being ≥ 40 years old put patients at high risk of incisional hernia repair even when operated on low-risk sites such as stomach, duodenum, and hepatobiliary. CONCLUSION The burden of incisional hernia repair is high and most patients are at risk either due to age ≥ 40 or the surgery site. New approaches to prevent the onset of incisional hernia are warranted.
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Affiliation(s)
- P Ortega-Deballon
- Service de Chirurgie Générale, Digestive, Cancérologique et Urgences, CHU de Dijon - CR INSERM 1231 - CIC 1432, Module Épidémiologie Clinique - Université de Bourgogne, 14, rue Paul Gaffarel, 21079, Dijon Cedex, France.
| | - Y Renard
- Service de Chirurgie Générale, Digestive et Endocrinienne, CHU de Reims, Reims, France
| | - J de Launay
- Department of Medical Affairs, Becton, Dickinson and Company, 11 Rue Aristide Berges, 38800, Le Pont-de-Claix, France
| | - T Lafon
- Heva, 186 avenue thiers, 69600, Lyon, France
| | - Q Roset
- Heva, 186 avenue thiers, 69600, Lyon, France
| | - G Passot
- Service de Chirurgie Digestive et Oncologique, Hôpital Lyon Sud, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69310, Pierre-Bénite, France
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23
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Aiolfi A, Bona D, Gambero F, Sozzi A, Bonitta G, Rausa E, Bruni PG, Cavalli M, Campanelli G. What is the ideal mesh location for incisional hernia prevention during elective laparotomy? A network meta-analysis of randomized trials. Int J Surg 2023; 109:1373-1381. [PMID: 37026844 PMCID: PMC10389496 DOI: 10.1097/js9.0000000000000250] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 01/26/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Incisional hernia (IH) represents an important complication after surgery. Prophylactic mesh reinforcement (PMR) with different mesh locations [onlay (OL), retromuscular (RM), preperitoneal (PP), and intraperitoneal (IP)] has been described to possibly reduce the risk of postoperative IH. However, data reporting the 'ideal' mesh location are sparse. The aim of this study was to evaluate the optimal mesh location for IH prevention during elective laparotomy. METHODS Systematic review and network meta-analysis of randomized controlled trials (RCTs). OL, RM, PP, IP, and no mesh (NM) were compared. The primary aim was postoperative IH. Risk ratio (RR) and weighted mean difference (WMD) were used as pooled effect size measures, whereas 95% credible intervals (CrI) were used to assess relative inference. RESULTS Fourteen RCTs (2332 patients) were included. Overall, 1052 (45.1%) had no mesh (NM) while 1280 (54.9%) underwent PMR stratified in IP ( n =344 pts), PP ( n =52 pts), RM ( n =463 pts), and OL ( n =421 pts) placement. Follow-up ranged from 12 months to 67 months. RM (RR=0.34; 95% CrI: 0.10-0.81) and OL (RR=0.15; 95% CrI: 0.044-0.35) were associated with significantly reduced IH RR compared to NM. A tendency toward reduced IH RR was noticed for PP versus NM (RR=0.16; 95% CrI: 0.018-1.01), while no differences were found for IP versus NM (RR=0.59; 95% CrI: 0.19-1.81). Seroma, hematoma, surgical site infection, 90-day mortality, operative time and hospital length of stay were comparable among treatments. CONCLUSIONS RM or OL mesh placement seems associated with reduced IH RR compared to NM. PP location appears promising; however, future studies are warranted to corroborate this preliminary indication.
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Affiliation(s)
- Alberto Aiolfi
- Division of General Surgery, Department of Biomedical Science for Health, University of Milan
| | - Davide Bona
- Division of General Surgery, Department of Biomedical Science for Health, University of Milan
| | - Fabio Gambero
- Division of General Surgery, Department of Biomedical Science for Health, University of Milan
| | - Andrea Sozzi
- Division of General Surgery, Department of Biomedical Science for Health, University of Milan
| | - Gianluca Bonitta
- Division of General Surgery, Department of Biomedical Science for Health, University of Milan
| | - Emanuele Rausa
- General Surgery 1, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Piero G. Bruni
- Department of Surgery, University of Insubria, Istituto Clinico Sant’Ambrogio, Milan
| | - Marta Cavalli
- Department of Surgery, University of Insubria, Istituto Clinico Sant’Ambrogio, Milan
| | - Giampiero Campanelli
- Department of Surgery, University of Insubria, Istituto Clinico Sant’Ambrogio, Milan
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24
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Xiang L, Liang J, Wang Z, Lin F, Zhuang Y, Saiding Q, Wang F, Deng L, Cui W. Motion lubrication suppressed mechanical activation via hydrated fibrous gene patch for tendon healing. SCIENCE ADVANCES 2023; 9:eadc9375. [PMID: 36763658 PMCID: PMC9917012 DOI: 10.1126/sciadv.adc9375] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 01/06/2023] [Indexed: 06/18/2023]
Abstract
Mechanical activation of fibroblasts, caused by friction and transforming growth factor-β1 recognition, is one of the main causes of tissue adhesions. In this study, we developed a lubricated gene-hydrogel patch, which provides both a motion lubrication microenvironment and gene therapy. The patch's outer layer is composed of polyethylene glycol polyester hydrogel. The hydrogel forms hydrogen bonds with water molecules to create the motion lubrication layer, and it also serves as a gene delivery library for long-term gene silencing. Under the motion lubricated microenvironment, extracellular signal-regulated kinase-small interfering RNA can silence fibroblasts and enhance the blocking effect against fibroblast activation. In vitro, the proposed patch effectively inhibits fibroblast activation and reduces the coefficient of friction. In vivo, this patch reduces the expression of vimentin and α-smooth muscle actin in fibroblasts. Therefore, the lubricated gene-hydrogel patch can inhibit the mechanical activation of fibroblasts to promote tendon healing.
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Affiliation(s)
| | | | - Zhen Wang
- Department of Orthopedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai 200025, P.R. China
| | - Feng Lin
- Department of Orthopedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai 200025, P.R. China
| | - Yaping Zhuang
- Department of Orthopedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai 200025, P.R. China
| | - Qimanguli Saiding
- Department of Orthopedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai 200025, P.R. China
| | - Fei Wang
- Department of Orthopedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai 200025, P.R. China
| | - Lianfu Deng
- Department of Orthopedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai 200025, P.R. China
| | - Wenguo Cui
- Department of Orthopedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai 200025, P.R. China
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25
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Pereira-Rodríguez JA, Bravo-Salva A, Argudo-Aguirre N, Amador-Gil S, Pera-Román M. Defining High-Risk Patients Suitable for Incisional Hernia Prevention. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2023; 2:10899. [PMID: 38312422 PMCID: PMC10831640 DOI: 10.3389/jaws.2023.10899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 01/19/2023] [Indexed: 02/06/2024]
Affiliation(s)
- Jose Antonio Pereira-Rodríguez
- General and Digestive Surgery Department, Parc de Salut Mar, Hospital del Mar, Barcelona, Spain
- Department of Medicine and Life Sciences, Pompeu Fabra University, Barcelona, Spain
| | - Alejandro Bravo-Salva
- General and Digestive Surgery Department, Parc de Salut Mar, Hospital del Mar, Barcelona, Spain
- Department of Medicine and Life Sciences, Pompeu Fabra University, Barcelona, Spain
| | - Núria Argudo-Aguirre
- General and Digestive Surgery Department, Parc de Salut Mar, Hospital del Mar, Barcelona, Spain
- Department of Medicine and Life Sciences, Pompeu Fabra University, Barcelona, Spain
| | - Sara Amador-Gil
- General and Digestive Surgery Department, Hospital de Granollers, Granollers, Spain
| | - Miguel Pera-Román
- General and Digestive Surgery Department, Parc de Salut Mar, Hospital del Mar, Barcelona, Spain
- Department of Medicine and Life Sciences, Pompeu Fabra University, Barcelona, Spain
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26
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Müller S, Weyhe D, Herrle F, Horvath P, Bachmann R, von Ehrlich-Treuenstätt V, Heger P, Nasir N, Klose C, Ritz A, Sander A, Grohmann E, Dörr-Harim C, Mihaljevic AL. Prophylactic effect of retromuscular mesh placement during loop ileostomy closure on incisional hernia incidence-a multicentre randomised patient- and observer-blind trial (P.E.L.I.O.N trial). Trials 2023; 24:76. [PMID: 36726155 PMCID: PMC9890770 DOI: 10.1186/s13063-023-07089-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/10/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Incisional hernia is a frequent complication following loop ileostomy reversal. Incisional hernias are associated with morbidity, loss of health-related quality of life and costs and warrant the investigation of prophylactic measures. Prophylactic mesh implantation at the time of surgical stoma reversal has shown to be a promising and safe method to prevent incisional hernias in this setting. However, the efficacy of this method has not yet been investigated in a large multicentre randomised-controlled trial (RCT) with adequate external validity. The P.E.L.I.O.N. trial will evaluate the efficacy of prophylactic mesh reinforcement after loop ileostomy closure in decreasing the rate of incisional hernia versus standard closure alone. METHODS P.E.L.I.O.N. is a multicentre, patient- and observer-blind RCT. Patients undergoing loop ileostomy closure will undergo intraoperative 1:1 randomisation into either abdominal wall closure with a continuous slowly absorbable suture in small-stitch technique without mesh reinforcement (control group) or abdominal wall closure with an additional reinforcement with a retromuscular non-absorbable, macro-pore (pore size ≥ 1000 μm or effective porosity >0%) light-weight monofilament or mixed structure mesh. A total of 304 patients (152 per group) will need to be randomised in the study. Based on inclusion and exclusion criteria, 1,014 patients are expected to be screened for eligibility in order to recruit the necessary number of patients. The primary endpoint will be the frequency of incision hernias within 24 months according to the European Hernia Society definition. Secondary endpoints will be the frequency of surgical site occurrences (including surgical site infections, wound seromas and hematomas, and enterocutaneous fistulas), postoperative pain, the number of revision surgeries and health-related quality of life. Safety will be assessed by measuring postoperative complications ≥ grade 3 according to the Dindo-Clavien classification. DISCUSSION Depending on the results of the P.E.L.I.O.N. trial, prophylactic mesh implantation could become the new standard for loop ileostomy reversal. TRIAL REGISTRATION DRKS00027921, U1111-1273-4657.
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Affiliation(s)
- Sven Müller
- Helios Klinikum Gifhorn, Campus 6, 38518 Gifhorn, Germany
| | - Dirk Weyhe
- grid.477704.70000 0001 0275 7806Klinik für Allgemein- und Viszeralchirurgie, Universitätsmedizin Oldenburg, Pius-Hospital Oldenburg, Georgstraße 12, 26121 Oldenburg, Germany
| | - Florian Herrle
- grid.411778.c0000 0001 2162 1728Chirurgische Klinik, Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Philipp Horvath
- grid.411544.10000 0001 0196 8249Klinik für Allgemeine, Viszeral- und Transplantationschirurgie, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Robert Bachmann
- grid.411544.10000 0001 0196 8249Klinik für Allgemeine, Viszeral- und Transplantationschirurgie, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Viktor von Ehrlich-Treuenstätt
- grid.5252.00000 0004 1936 973XKlinik für Allgemein-, Viszeral- und Transplantationschirurgie, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377 München, Germany
| | - Patrick Heger
- grid.410712.10000 0004 0473 882XDepartment of General and Visceral Surgery and Clinical Trial Centre Department of Surgery (ulmCARES), University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Nadir Nasir
- grid.410712.10000 0004 0473 882XDepartment of General and Visceral Surgery and Clinical Trial Centre Department of Surgery (ulmCARES), University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Christina Klose
- grid.7700.00000 0001 2190 4373Institute of Medical Biometry (IMBI), University of Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Alexander Ritz
- grid.7700.00000 0001 2190 4373Institute of Medical Biometry (IMBI), University of Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Anja Sander
- grid.7700.00000 0001 2190 4373Institute of Medical Biometry (IMBI), University of Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Erich Grohmann
- Deutsche ILCO e. V., Nietzschestr. 11, 53177 Bonn, Germany
| | - Colette Dörr-Harim
- grid.410712.10000 0004 0473 882XDepartment of General and Visceral Surgery and Clinical Trial Centre Department of Surgery (ulmCARES), University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - André L. Mihaljevic
- grid.410712.10000 0004 0473 882XDepartment of General and Visceral Surgery and Clinical Trial Centre Department of Surgery (ulmCARES), University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
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Durbin B, Spencer A, Briese A, Edgerton C, Hope WW. If Evidence is in Favor of Incisional Hernia Prevention With Mesh, why is it not Implemented? JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2023; 2:11000. [PMID: 38312399 PMCID: PMC10831655 DOI: 10.3389/jaws.2023.11000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/16/2023] [Indexed: 02/06/2024]
Affiliation(s)
| | | | | | | | - William W. Hope
- Department of Surgery, Novant/New Hanover Medical Center, Wilmington, NC, United States
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Smith L, Meggy A, Watts T, Knight L, Torkington J, Cornish J. Incisional hernia prevention: risk-benefit from a patient perspective (INVITE) - protocol for a single-centre, mixed-methods, cross-sectional study aiming to determine if using prophylactic mesh in incisional hernia prevention is acceptable to patients. BMJ Open 2022; 12:e069568. [PMID: 36585153 PMCID: PMC9809247 DOI: 10.1136/bmjopen-2022-069568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Incisional hernia (IH) is a common complication of abdominal surgery affecting between 10% and 20% of patients and is associated with significant morbidity along with cost to the National Health Service. With high recurrence rates following repair, focus must be on prevention of IH rather than cure. There is an increasing evidence that patients at high risk of developing IH may benefit from prophylactic mesh placement during their index operation. With recent controversy surrounding the use of mesh in the UK, however, there is little understanding of whether this intervention would be acceptable to patients. METHODS AND ANALYSIS INVITE is a mixed-methods, cross-sectional study to explore patient perceptions of the use of mesh as prophylaxis to prevent IH. Patients with and without IH who have undergone colorectal surgery between 2017 and 2020 in a single UK health-board will be approached to participate. 120 participants will be asked to complete a questionnaire and a subgroup of 24 participants will be invited to semistructured interviews. The primary outcome is to assess the acceptability of prophylactic mesh to patients. Secondary outcomes include understanding patients' knowledge of IH, and factors that may influence or alter the acceptability of mesh. Questionnaires have been developed using a 5-point Likert scale to allow quantitative analysis. Qualitative analysis of interviews will be conducted using NVivo software and thematic analysis. Data will be presented using the Journal Article Reporting Standards for mixed-methods research. ETHICS AND DISSEMINATION Ethical approval has been granted by REC Wales (22/PR/0678), and the study is currently in setup. All participants will be required to provide informed consent prior to their participation in the study. We plan to report the results of the study in peer-reviewed scientific and medical journals and via presentations at scientific meetings. Results from this study will aid the design of interventional trials using prophylactic mesh. TRIAL REGISTRATION NUMBER NCT05384600.
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Affiliation(s)
- Laurie Smith
- Department of Colorectal Surgery, Cardiff and Vale University Health Board, Cardiff, UK
- Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Alun Meggy
- Research and Development, Cardiff and Vale University Health Board, Cardiff, UK
| | - Tessa Watts
- School of Healthcare Science, Cardiff University, Cardiff, UK
| | - Laura Knight
- CEDAR Health Technology Research Centre, Cardiff, UK
| | - Jared Torkington
- Department of Colorectal Surgery, Cardiff and Vale University Health Board, Cardiff, UK
| | - Julie Cornish
- Department of Colorectal Surgery, Cardiff and Vale University Health Board, Cardiff, UK
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Theodorou A, Banysch M, Gök H, Deerenberg EB, Kalff JC, von Websky MW. Don't fear the (small) bite: A narrative review of the rationale and misconceptions surrounding closure of abdominal wall incisions. Front Surg 2022; 9:1002558. [PMID: 36504582 PMCID: PMC9727106 DOI: 10.3389/fsurg.2022.1002558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/11/2022] [Indexed: 11/24/2022] Open
Abstract
Background The most common complications related to the closure of abdominal wall incisions are surgical site infections, wound dehiscence and the development of an incisional hernia. Several factors relating to the surgical technique and the materials used have been identified and analysed over the years, as mirrored in the current recommendations of the European Hernia Society, but some misconceptions still remain that hinder wide implementation. Method A literature search was performed in the PubMed and GoogleScholar databases on 15 July 2021 and additionally on 30 March 2022 to include recent updates. The goal was to describe the scientific background behind the optimal strategies for reducing incisional hernia risk after closure of abdominal wall incisions in a narrative style review. Results An aponeurosis alone, small bites/small steps continuous suture technique should be used, using a slowly resorbable USP 2/0 or alternatively USP 0 suture loaded in a small ½ circle needle. The fascial edges should be properly visualised and tension should be moderate. Conclusion Despite the reproducibility, low risk and effectiveness in reducing wound complications following abdominal wall incisions, utilisation of the recommendation of the guidelines of the European Hernia Society remain relatively limited. More work is needed to clear misconceptions and disseminate the established knowledge and technique especially to younger surgeons.
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Affiliation(s)
- Alexis Theodorou
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Bonn, Germany,Correspondence: Alexis Theodorou
| | - Mark Banysch
- Department of Surgery, St. Bernhard Hospital Kamp-Lintfort, Kamp-Lintfort, Germany
| | - Hakan Gök
- Hernia Istanbul, Hernia Istanbul®, Hernia Surgery Center, Istanbul, Turkey
| | - Eva B. Deerenberg
- Department of Surgery, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
| | - Joerg C. Kalff
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Bonn, Germany
| | - Martin W. von Websky
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Bonn, Germany
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30
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Deerenberg EB, Henriksen NA, Antoniou GA, Antoniou SA, Bramer WM, Fischer JP, Fortelny RH, Gök H, Harris HW, Hope W, Horne CM, Jensen TK, Köckerling F, Kretschmer A, López-Cano M, Malcher F, Shao JM, Slieker JC, de Smet GHJ, Stabilini C, Torkington J, Muysoms FE. Updated guideline for closure of abdominal wall incisions from the European and American Hernia Societies. Br J Surg 2022; 109:1239-1250. [PMID: 36026550 PMCID: PMC10364727 DOI: 10.1093/bjs/znac302] [Citation(s) in RCA: 74] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/28/2022] [Accepted: 08/05/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Incisional hernia is a frequent complication of abdominal wall incision. Surgical technique is an important risk factor for the development of incisional hernia. The aim of these updated guidelines was to provide recommendations to decrease the incidence of incisional hernia. METHODS A systematic literature search of MEDLINE, Embase, and Cochrane CENTRAL was performed on 22 January 2022. The Scottish Intercollegiate Guidelines Network instrument was used to evaluate systematic reviews and meta-analyses, RCTs, and cohort studies. The GRADE approach (Grading of Recommendations, Assessment, Development and Evaluation) was used to appraise the certainty of the evidence. The guidelines group consisted of surgical specialists, a biomedical information specialist, certified guideline methodologist, and patient representative. RESULTS Thirty-nine papers were included covering seven key questions, and weak recommendations were made for all of these. Laparoscopic surgery and non-midline incisions are suggested to be preferred when safe and feasible. In laparoscopic surgery, suturing the fascial defect of trocar sites of 10 mm and larger is advised, especially after single-incision laparoscopic surgery and at the umbilicus. For closure of an elective midline laparotomy, a continuous small-bites suturing technique with a slowly absorbable suture is suggested. Prophylactic mesh augmentation after elective midline laparotomy can be considered to reduce the risk of incisional hernia; a permanent synthetic mesh in either the onlay or retromuscular position is advised. CONCLUSION These updated guidelines may help surgeons in selecting the optimal approach and location of abdominal wall incisions.
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Affiliation(s)
- Eva B Deerenberg
- Department of Surgery, Franciscus Gasthuis en Vlietland, Rotterdam, the Netherlands
| | - Nadia A Henriksen
- Department of Hepatic and Digestive diseases, Herlev University Hospital, Copenhagen, Denmark
| | - George A Antoniou
- Department of Vascular Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - Stavros A Antoniou
- Mediterranean Hospital of Cyprus, Limassol, Cyprus.,Medical School, European University Cyprus, Nicosia, Cyprus
| | - Wichor M Bramer
- Medical Library, Erasmus MC, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - John P Fischer
- Department of Plastic Surgery, University of Pennsylvania Health System, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
| | - Rene H Fortelny
- Certified Hernia Center, Wilhelminenspital, Veinna, Austria.,Paracelsus Medical, University Salzburg, Salzburg, Austria
| | - Hakan Gök
- Hernia Istanbul®, Hernia Surgery Centre, Istanbul, Turkey
| | - Hobart W Harris
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - William Hope
- Department of Surgery, Novant/New Hanover Regional Medical Center, Wilmington, North Carolina, USA
| | - Charlotte M Horne
- Department of Surgery, Penn State Health Department, Hershey, Pennsylvania, USA
| | - Thomas K Jensen
- Department of Hepatic and Digestive diseases, Herlev University Hospital, Copenhagen, Denmark
| | - Ferdinand Köckerling
- Hernia Center, Vivantes Humboldt-Hospital, Academic Teaching Hospital of Charité University Medicine, Berlin, Germany
| | - Alexander Kretschmer
- Klinikum der Ludwig-Maximillians-Universität München, Munchen, Germany.,Janssen Oncology, Los Angeles, CA, USA
| | - Manuel López-Cano
- Abdominal Wall Surgery Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Unviversitat Autònoma de Barcelona, Barcelona, Spain
| | - Flavio Malcher
- Department of Surgery, NYU Langone Health/NYU Grossman School of Medicine, New York, New York, USA
| | - Jenny M Shao
- Division of Gastrointestinal Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Gijs H J de Smet
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Cesare Stabilini
- Department of Surgery, Policlinico San Martino IRCCS and Department of Surgical Sciences, University of Genoa, Genoa, Italy
| | - Jared Torkington
- Department of Surgery, University Hospital of Wales, Cardiff, UK
| | - Filip E Muysoms
- Department of Surgery, Maria Middelares Hospital, Ghent, Belgium
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31
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Dewulf M, Muysoms F, Vierendeels T, Huyghe M, Miserez M, Ruppert M, Tollens T, van Bergen L, Berrevoet F, Detry O. Prevention of Incisional Hernias by Prophylactic Mesh-augmented Reinforcement of Midline Laparotomies for Abdominal Aortic Aneurysm Treatment: Five-year Follow-up of a Randomized Controlled Trial. Ann Surg 2022; 276:e217-e222. [PMID: 35762612 DOI: 10.1097/sla.0000000000005545] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The incidence of incisional hernias (IHs) after open repair of an abdominal aortic aneurysm (AAA) is high. Several randomized controlled trials have reported favorable results with the use of prophylactic mesh to prevent IHs, without increasing complications. In this analysis, we report on the results of the 60-month follow-up of the PRIMAAT trial. METHODS In a prospective, multicenter, open-label, randomized design, patients were randomized between prophylactic retrorectus mesh reinforcement (mesh group), and primary closure of their midline laparotomy after open AAA repair (no-mesh group). This article reports on the results of clinical follow-up after 60 months. If performed, ultrasonography or computed tomography were used for the diagnosis of IHs. RESULTS Of the 120 randomized patients, 114 were included in the intention-to-treat analysis. Thirty-three patients in the no-mesh group (33/58-56.9%) and 34 patients in the mesh group (34/56-60.7%) were evaluated after 5 years. In each treatment arm, 10 patients died between the 24-month and 60-month follow-up. The cumulative incidence of IHs in the no-mesh group was 32.9% after 24 months and 49.2% after 60 months. No IHs were diagnosed in the mesh group. In the no-mesh group, 21.7% (5/23) underwent reoperation within 5 years due to an IH. CONCLUSIONS Prophylactic retrorectus mesh reinforcement after midline laparotomy for the treatment of AAAs safely and effectively decreases the rate of IHs. The cumulative incidence of IHs after open AAA repair, when no mesh is used, continues to increase during the first 5 years after surgery, which leads to a substantial rate of hernia repairs.
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Affiliation(s)
- Maxime Dewulf
- Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Filip Muysoms
- Department of Surgery, Maria Middelares Hospital Ghent, Ghent, Belgium
| | | | - Marc Huyghe
- Department of Surgery, Sint-Augustinus Hospital, Antwerp, Belgium
| | - Marc Miserez
- Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven, Belgium
| | - Martin Ruppert
- Department of Surgery, University Hospital Antwerp, Edegem, Belgium
| | - Tim Tollens
- Department of Surgery, Imelda Hospital Bonheiden, Bonheiden, Belgium
| | | | - Frederik Berrevoet
- Department of General and HPB Surgery, Ghent University Hospital, Ghent, Belgium
| | - Olivier Detry
- Department of Abdominal Surgery and Transplantation, CHU Liege, Liege, Belgium
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32
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Torkington J, Harries R, O'Connell S, Knight L, Islam S, Bashir N, Watkins A, Fegan G, Cornish J, Rees B, Cole H, Jarvis H, Jones S, Russell I, Bosanquet D, Cleves A, Sewell B, Farr A, Zbrzyzna N, Fiera N, Ellis-Owen R, Hilton Z, Parry C, Bradbury A, Wall P, Hill J, Winter D, Cocks K, Harris D, Hilton J, Vakis S, Hanratty D, Rajagopal R, Akbar F, Ben-Sassi A, Francis N, Jones L, Williamson M, Lindsey I, West R, Smart C, Ziprin P, Agarwal T, Faulkner G, Pinkney T, Vimalachandran D, Lawes D, Faiz O, Nisar P, Smart N, Wilson T, Myers A, Lund J, Smolarek S, Acheson A, Horwood J, Ansell J, Phillips S, Davies M, Davies L, Bird S, Palmer N, Williams M, Galanopoulos G, Rao PD, Jones D, Barnett R, Tate S, Wheat J, Patel N, Rahmani S, Toynton E, Smith L, Reeves N, Kealaher E, Williams G, Sekaran C, Evans M, Beynon J, Egan R, Qasem E, Khot U, Ather S, Mummigati P, Taylor G, Williamson J, Lim J, Powell A, Nageswaran H, Williams A, Padmanabhan J, Phillips K, Ford T, Edwards J, Varney N, Hicks L, Greenway C, Chesters K, Jones H, Blake P, Brown C, Roche L, Jones D, Feeney M, Shah P, Rutter C, McGrath C, Curtis N, Pippard L, Perry J, Allison J, Ockrim J, Dalton R, Allison A, Rendell J, Howard L, Beesley K, Dennison G, Burton J, Bowen G, Duberley S, Richards L, Giles J, Katebe J, Dalton S, Wood J, Courtney E, Hompes R, Poole A, Ward S, Wilkinson L, Hardstaff L, Bogden M, Al-Rashedy M, Fensom C, Lunt N, McCurrie M, Peacock R, Malik K, Burns H, Townley B, Hill P, Sadat M, Khan U, Wignall C, Murati D, Dhanaratne M, Quaid S, Gurram S, Smith D, Harris P, Pollard J, DiBenedetto G, Chadwick J, Hull R, Bach S, Morton D, Hollier K, Hardy V, Ghods M, Tyrrell D, Ashraf S, Glasbey J, Ashraf M, Garner S, Whitehouse A, Yeung D, Mohamed SN, Wilkin R, Suggett N, Lee C, Bagul A, McNeill C, Eardley N, Mahapatra R, Gabriel C, Datt P, Mahmud S, Daniels I, McDermott F, Nodolsk M, Park L, Scott H, Trickett J, Bearn P, Trivedi P, Frost V, Gray C, Croft M, Beral D, Osborne J, Pugh R, Herdman G, George R, Howell AM, Al-Shahaby S, Narendrakumar B, Mohsen Y, Ijaz S, Nasseri M, Herrod P, Brear T, Reilly JJ, Sohal A, Otieno C, Lai W, Coleman M, Platt E, Patrick A, Pitman C, Balasubramanya S, Dickson E, Warman R, Newton C, Tani S, Simpson J, Banerjee A, Siddika A, Campion D, Humes D, Randhawa N, Saunders J, Bharathan B, Hay O. Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART). Br J Surg 2022; 109:943-950. [PMID: 35979802 PMCID: PMC10364691 DOI: 10.1093/bjs/znac198] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Incisional hernias cause morbidity and may require further surgery. HART (Hughes Abdominal Repair Trial) assessed the effect of an alternative suture method on the incidence of incisional hernia following colorectal cancer surgery. METHODS A pragmatic multicentre single-blind RCT allocated patients undergoing midline incision for colorectal cancer to either Hughes closure (double far-near-near-far sutures of 1 nylon suture at 2-cm intervals along the fascia combined with conventional mass closure) or the surgeon's standard closure. The primary outcome was the incidence of incisional hernia at 1 year assessed by clinical examination. An intention-to-treat analysis was performed. RESULTS Between August 2014 and February 2018, 802 patients were randomized to either Hughes closure (401) or the standard mass closure group (401). At 1 year after surgery, 672 patients (83.7 per cent) were included in the primary outcome analysis; 50 of 339 patients (14.8 per cent) in the Hughes group and 57 of 333 (17.1 per cent) in the standard closure group had incisional hernia (OR 0.84, 95 per cent c.i. 0.55 to 1.27; P = 0.402). At 2 years, 78 patients (28.7 per cent) in the Hughes repair group and 84 (31.8 per cent) in the standard closure group had incisional hernia (OR 0.86, 0.59 to 1.25; P = 0.429). Adverse events were similar in the two groups, apart from the rate of surgical-site infection, which was higher in the Hughes group (13.2 versus 7.7 per cent; OR 1.82, 1.14 to 2.91; P = 0.011). CONCLUSION The incidence of incisional hernia after colorectal cancer surgery is high. There was no statistical difference in incidence between Hughes closure and mass closure at 1 or 2 years. REGISTRATION NUMBER ISRCTN25616490 (http://www.controlled-trials.com).
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Aiolfi A, Cavalli M, Gambero F, Mini E, Lombardo F, Gordini L, Bonitta G, Bruni PG, Bona D, Campanelli G. Prophylactic mesh reinforcement for midline incisional hernia prevention: systematic review and updated meta-analysis of randomized controlled trials. Hernia 2022; 27:213-224. [PMID: 35920944 DOI: 10.1007/s10029-022-02660-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 07/20/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Incisional hernia (IH) is a common complication after abdominal surgery. Prevention of IH is matter of intense research. Prophylactic mesh reinforcement (PMR) has been shown to be promising in the minimization of IH risk after elective midline laparotomy. METHODS Systematic review and meta-analysis of randomized controlled trials (RCTs) comparing PMR vs. primary suture closure (PSC). Risk ratio (RR) and standardized mean difference (MD) were used as pooled effect size measures whereas 95% confidence intervals (95%CI) were used to assess relative inference. RESULTS Fourteen RCTs (2332 patients) were included. Overall, 1280 (54.9%) underwent PMR while 1052 (45.1%) PSC. Postoperative follow-up ranged from 12 to 67 months. The incidence of IH was reduced for PMR vs. PSC (13.4% vs. 27.5%). The estimated pooled IH RR for PMR vs. PSC is 0.38 (95% CI 0.24-0.58; p < 0.001). Stratified subgroup analysis according to mesh location shows a risk reduction for intraperitoneal (RR = 0.65; 95% CI 0.48-0.89), preperitoneal (RR = 0.18; 95% CI 0.04-0.81), retromuscular (RR = 0.47; 95% CI 0.24-0.92) and onlay (RR = 0.24; 95% CI 0.12-0.51) compared to PSC. The seroma RR was higher for PMR (RR = 2.05; p = 0.0008). No differences were found for hematoma (RR = 1.49; p = 0.34), surgical site infection (SSI) (RR = 1.17; p = 0.38), operative time (OT) (MD = 0.27; p = 0.413), and hospital length of stay (HLOS) (MD = -0.03; p = 0.237). CONCLUSIONS PMR seems effective in reducing the risk of IH after elective midline laparotomy compared to PSC in the medium-term follow-up. While the risk of postoperative seroma appears higher for PMR, hematoma, SSI, HLOS and OT seems comparable.
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Affiliation(s)
- A Aiolfi
- Department of Biomedical Science for Health, Division of General Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, n.16, 20149, Milan, Italy.
| | - M Cavalli
- Department of Surgery, Istituto Clinico Sant'Ambrogio, University of Insubria, Milan, Italy
| | - F Gambero
- Department of Surgery, Istituto Clinico Sant'Ambrogio, University of Insubria, Milan, Italy
| | - E Mini
- Department of Biomedical Science for Health, Division of General Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, n.16, 20149, Milan, Italy
| | - F Lombardo
- Department of Biomedical Science for Health, Division of General Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, n.16, 20149, Milan, Italy
| | - L Gordini
- Department of Biomedical Science for Health, Division of General Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, n.16, 20149, Milan, Italy
| | - G Bonitta
- Department of Biomedical Science for Health, Division of General Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, n.16, 20149, Milan, Italy
| | - P G Bruni
- Department of Surgery, Istituto Clinico Sant'Ambrogio, University of Insubria, Milan, Italy
| | - D Bona
- Department of Biomedical Science for Health, Division of General Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, n.16, 20149, Milan, Italy
| | - G Campanelli
- Department of Surgery, Istituto Clinico Sant'Ambrogio, University of Insubria, Milan, Italy
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34
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O'Connell S, Islam S, Sewell B, Farr A, Knight L, Bashir N, Harries R, Jones S, Cleves A, Fegan G, Watkins A, Torkington J. Hughes abdominal closure versus standard mass closure to reduce incisional hernias following surgery for colorectal cancer: the HART RCT. Health Technol Assess 2022; 26:1-100. [PMID: 35938554 DOI: 10.3310/cmwc8368] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Incisional hernias can cause chronic pain and complications and affect quality of life. Surgical repair requires health-care resources and has a significant associated failure rate. A prospective, multicentre, single-blinded randomised controlled trial was conducted to investigate the clinical effectiveness and cost-effectiveness of the Hughes abdominal closure method compared with standard mass closure following surgery for colorectal cancer. The study randomised, in a 1 : 1 ratio, 802 adult patients (aged ≥ 18 years) undergoing surgical resection for colorectal cancer from 28 surgical departments in UK centres. INTERVENTION Hughes abdominal closure or standard mass closure. MAIN OUTCOME MEASURES The primary outcome was the incidence of incisional hernias at 1 year, as assessed by clinical examination. Within-trial cost-effectiveness and cost-utility analyses over 1 year were conducted from an NHS and a social care perspective. A key secondary outcome was quality of life, and other outcomes included the incidence of incisional hernias as detected by computed tomography scanning. RESULTS The incidence of incisional hernia at 1-year clinical examination was 50 (14.8%) in the Hughes abdominal closure arm compared with 57 (17.1%) in the standard mass closure arm (odds ratio 0.84, 95% confidence interval 0.55 to 1.27; p = 0.4). In year 2, the incidence of incisional hernia was 78 (28.7%) in the Hughes abdominal closure arm compared with 84 (31.8%) in the standard mass closure arm (odds ratio 0.86, 95% confidence interval 0.59 to 1.25; p = 0.43). Computed tomography scanning identified a total of 301 incisional hernias across both arms, compared with 100 identified by clinical examination at the 1-year follow-up. Computed tomography scanning missed 16 incisional hernias that were picked up by clinical examination. Hughes abdominal closure was found to be less cost-effective than standard mass closure. The mean incremental cost for patients undergoing Hughes abdominal closure was £616.45 (95% confidence interval -£699.56 to £1932.47; p = 0.3580). Quality of life did not differ significantly between the study arms at any time point. LIMITATIONS As this was a pragmatic trial, the control arm allowed surgeon discretion in the approach to standard mass closure, introducing variability in the techniques and equipment used. Intraoperative randomisation may result in a loss of equipoise for some surgeons. Follow-up was limited to 2 years, which may not have been enough time to see a difference in the primary outcome. CONCLUSIONS Hughes abdominal closure did not significantly reduce the incidence of incisional hernias detected by clinical examination and was less cost-effective at 1 year than standard mass closure in colorectal cancer patients. Computed tomography scanning may be more effective at identifying incisional hernias than clinical examination, but the clinical benefit of this needs further research. FUTURE WORK An extended follow-up using routinely collected NHS data sets aims to report on incisional hernia rates at 2-5 years post surgery to investigate any potential mortality benefit of the closure methods. Furthermore, the proportion of incisional hernias identified by a computed tomography scan (at 1 and 2 years post surgery), but not during clinical examination (occult hernias), proceeding to surgical repair within 3-5 years after the initial operation will be explored. TRIAL REGISTRATION This trial is registered as ISRCTN25616490. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 34. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Susan O'Connell
- Cedar Healthcare Technology Research Centre, Cardiff and Vale University Health Board, Cardiff, UK
| | - Saiful Islam
- Swansea Trials Unit, Swansea University, Swansea, UK
| | - Bernadette Sewell
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - Angela Farr
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - Laura Knight
- Cedar Healthcare Technology Research Centre, Cardiff and Vale University Health Board, Cardiff, UK
| | - Nadim Bashir
- Swansea Trials Unit, Swansea University, Swansea, UK
| | - Rhiannon Harries
- Department of Colorectal Surgery, Swansea Bay University Health Board, Swansea, UK
| | | | - Andrew Cleves
- Cedar Healthcare Technology Research Centre, Cardiff and Vale University Health Board, Cardiff, UK
| | - Greg Fegan
- Swansea Trials Unit, Swansea University, Swansea, UK
| | - Alan Watkins
- Swansea Trials Unit, Swansea University, Swansea, UK
| | - Jared Torkington
- Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff, UK
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Kasetsermwiriya W, Laopeamthong I, Sukhvibul P, Techapongsatorn S, Tansawet A. Onlay and retrorectus synthetic nonabsorbable mesh-augmented fascia closure during midline laparotomy: A systematic review and updated meta-analysis using trial sequential analysis. INTERNATIONAL JOURNAL OF SURGERY OPEN 2022. [DOI: 10.1016/j.ijso.2022.100501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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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: 2.5] [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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Lozada-Martinez ID, Covaleda-Vargas JE, Gallo-Tafur YA, Mejía-Osorio DA, González-Pinilla AM, Florez-Fajardo MA, Benavides-Trucco FE, Santodomingo-Rojas JC, Julieth Bueno-Prato NK, Narvaez-Rojas AR. Pre-operative factors associated with short- and long-term outcomes in the patient with inguinal hernia: What does the current evidence say? Ann Med Surg (Lond) 2022; 78:103953. [PMID: 35734704 PMCID: PMC9207143 DOI: 10.1016/j.amsu.2022.103953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/02/2022] [Accepted: 06/03/2022] [Indexed: 11/24/2022] Open
Abstract
Hernia repair is one of the most frequent interventions in surgery worldwide. The approach to abdominal wall and inguinal hernias remains a challenge due to emerging evidence on aspects such as timely diagnosis, use of innovative techniques or post-surgical care. However, pre-operative preparation is also a factor that substantially affects the absolute success rate of this type of condition. Time management between diagnosis and intervention, control of diseases that increase intra-abdominal pressure, weight and nutritional status, are some of the many elements to be considered in this type of patients before surgery. Considering that this condition carries high health care costs, especially in case of recurrence, has a risk of complications and affects the individual's functional capacity, the objective of this review is to synthesize evidence on the role of these factors on the short- and long-term outcome of inguinal hernia management, and to make suggestions on the general approach to this type of patients.
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Affiliation(s)
- Ivan David Lozada-Martinez
- Medical and Surgical Research Center, Future Surgeons Chapter, Colombian Surgery Association, Bogotá, Colombia
- Grupo Prometheus y Biomedicina Aplicada a Las Ciencias Clínicas, School of Medicine, Universidad de Cartagena, Cartagena, Colombia
| | | | | | | | | | | | | | | | | | - Alexis Rafael Narvaez-Rojas
- Department of Surgery, Hospital Carlos Roberto Huembes, Universidad Nacional Autonoma de, Nicaragua, Managua, Nicaragua
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Comparative Effectiveness Analysis of Resorbable Synthetic Onlay and Biologic Intraperitoneal Mesh for Abdominal Wall Reconstruction: A 2-Year Match-Paired Analysis. Plast Reconstr Surg 2022; 149:1204-1213. [PMID: 35311754 DOI: 10.1097/prs.0000000000009021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Abdominal wall reconstruction persists as a challenging surgical issue with a multitude of management strategies available. The aim of this study was to examine the efficacy of resorbable synthetic mesh onlay plane against biologic mesh in the intraperitoneal plane. METHODS A single-center, two-surgeon, 5-year retrospective review (2014 to 2019) was performed examining subjects who underwent abdominal wall reconstruction in the onlay plane with resorbable synthetic mesh or in the intraperitoneal plane with biologic mesh. A matched paired analysis was conducted. Data examining demographic characteristics, intraoperative variables, postoperative outcomes, and costs were analyzed. RESULTS Eighty-eight subjects (44 per group) were identified (median follow-up, 24.5 months). The mean age was 57.7 years, with a mean body mass index of 30.4 kg/m2. The average defect size was 292 ± 237 cm2, with most wounds being clean-contaminated (48.9 percent) and 55 percent having failed prior repair. Resorbable synthetic mesh onlay subjects were significantly less likely (4.5 percent) to experience recurrence compared to biologic intraperitoneal mesh subjects (22.7 percent; p < 0.026). In addition, mesh onlay suffered fewer postoperative surgical-site occurrences (18.2 percent versus 40.9 percent; p < 0.019) and required fewer procedural interventions (11.4 percent versus 36.4 percent; p < 0.011), and was also associated with significantly lower total costs ($16,658 ± $14,930) compared to biologic intraperitoneal mesh ($27,645 ± $16,864; p < 0.001). CONCLUSIONS Abdominal wall reconstruction remains an evolving field, with various techniques available for treatment. When faced with hernia repair, resorbable synthetic mesh in the onlay plane may be preferable to biologic mesh placed in the intraperitoneal plane because of lower long-term recurrence rates, surgical-site complications, and costs. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Liang W, He W, Huang R, Tang Y, Li S, Zheng B, Lin Y, Lu Y, Wang H, Wu D. Peritoneum-Inspired Janus Porous Hydrogel with Anti-Deformation, Anti-Adhesion, and Pro-Healing Characteristics for Abdominal Wall Defect Treatment. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2022; 34:e2108992. [PMID: 34981867 DOI: 10.1002/adma.202108992] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/10/2021] [Indexed: 06/14/2023]
Abstract
Implantable meshes used in tension-free repair operations facilitate treatment of internal soft-tissue defects. However, clinical meshes fail to achieve anti-deformation, anti-adhesion, and pro-healing properties simultaneously, leading to undesirable surgery outcomes. Herein, inspired by the peritoneum, a novel biocompatible Janus porous poly(vinyl alcohol) hydrogel (JPVA hydrogel) is developed to achieve efficient repair of internal soft-tissue defects by a facile yet efficient strategy based on top-down solvent exchange. The densely porous and smooth bottom-surface of JPVA hydrogel minimizes adhesion of fibroblasts and does not trigger any visceral adhesion, and its loose extracellular-matrix-like porous and rough top-surface can significantly improve fibroblast adhesion and tissue growth, leading to superior abdominal wall defect treatment to commercially available PP and PCO meshes. With unique anti-swelling property (maximum swelling ratio: 6.4%), JPVA hydrogel has long-lasting anti-deformation performance and maintains high mechanical strength after immersion in phosphate-buffered saline (PBS) for 14 days, enabling tolerance to the maximum abdominal pressure in an internal wet environment. By integrating visceral anti-adhesion and defect pro-healing with anti-deformation, the JPVA hydrogel patch shows great prospects for efficient internal soft-tissue defect repair.
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Affiliation(s)
- Weiwen Liang
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, P. R. China
| | - Wenyi He
- PCFM Lab, School of Chemistry, Sun Yat-sen University, Guangzhou, 510006, P. R. China
| | - Rongkang Huang
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, P. R. China
| | - Youchen Tang
- Center of Accurate Diagnosis, Treatment and Transformation of Bone and Joint Diseases, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518000, P. R. China
| | - Shimei Li
- PCFM Lab, School of Chemistry, Sun Yat-sen University, Guangzhou, 510006, P. R. China
| | - Bingna Zheng
- PCFM Lab, School of Chemistry, Sun Yat-sen University, Guangzhou, 510006, P. R. China
- Center of Accurate Diagnosis, Treatment and Transformation of Bone and Joint Diseases, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518000, P. R. China
| | - Yayu Lin
- PCFM Lab, School of Chemistry, Sun Yat-sen University, Guangzhou, 510006, P. R. China
| | - Yuheng Lu
- PCFM Lab, School of Chemistry, Sun Yat-sen University, Guangzhou, 510006, P. R. China
| | - Hui Wang
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, P. R. China
| | - Dingcai Wu
- PCFM Lab, School of Chemistry, Sun Yat-sen University, Guangzhou, 510006, P. R. China
- Center of Accurate Diagnosis, Treatment and Transformation of Bone and Joint Diseases, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518000, P. R. China
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Mäkäräinen E, Tolonen M, Sallinen V, Mentula P, Leppäniemi A, Ahonen-Siirtola M, Saarnio J, Ohtonen P, Muysoms F, Rautio T. OUP accepted manuscript. BJS Open 2022; 6:6526454. [PMID: 35143628 PMCID: PMC8830749 DOI: 10.1093/bjsopen/zrab142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Despite the fact that emergency midline laparotomy is a risk factor for an incisional hernia, active research on hernia prevention in emergency settings is lacking. Different kinds of meshes and mesh positions have been studied in elective abdominal surgery, but no randomized controlled trials in emergency settings have been published thus far. Method The PREEMER trial (registration number NCT04311788) is a multicentre, patient- and assessor-blinded, randomized controlled trial to be conducted in six hospitals in Finland. A total of 244 patients will be randomized at a 1 : 1 ratio to either the retrorectus mesh group, featuring a self-gripping prophylactic mesh, or to the no mesh (control) group, both closed by small-stitch 4 : 1 closure with continuous slowly absorbable monofilament suturing. The primary outcome of the PREEMER trial is the incidence of incisional hernia 2 years after surgery, which will be detected clinically and/or radiologically. Secondary outcomes are the Comprehensive Complication Index score, incidence of surgical-site infections and fascial dehiscence within 30 days of surgery; the incisional hernia repair rate and mesh- or hernia-related reoperations within the 2- and 5-year follow-ups; the incidence of incisional hernia within the 5-year follow-up; and quality of life measured by RAND-36, the Activities Assessment Scale and the PROMIS questionnaire within 30 days and 2 and 5 years from surgery. Additionally, health–economic explorative measures will be explored. Conclusion The PREEMER trial will provide level 1 evidence on incisional hernia prevention in an emergency setting. Registration number NCT04311788 (http://www.clinicaltrials.gov). Registered 7 March 2020.
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Affiliation(s)
- Elisa Mäkäräinen
- Correspondence to: Elisa Mäkäräinen, Oulu University Hospital, PL 29, 90029 OYS, Oulu, Finland (e-mail: )
| | - Matti Tolonen
- Department of Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Ville Sallinen
- Department of Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Panu Mentula
- Department of Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Ari Leppäniemi
- Department of Surgery, Helsinki University Hospital, Helsinki, Finland
| | | | - Juha Saarnio
- Department of Surgery, Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Pasi Ohtonen
- Department of Surgery, Medical Research Center, Oulu University Hospital, Oulu, Finland
| | | | - Tero Rautio
- Department of Surgery, Medical Research Center, Oulu University Hospital, Oulu, Finland
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Tansawet A, Numthavaj P, Techapongsatorn T, Techapongsatorn S, Attia J, McKay G, Thakkinstian A. Fascial Dehiscence and Incisional Hernia Prediction Models: A Systematic Review and Meta-analysis. World J Surg 2022; 46:2984-2995. [PMID: 36102959 PMCID: PMC9636101 DOI: 10.1007/s00268-022-06715-6] [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: 08/07/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Fascial dehiscence (FD) and incisional hernia (IH) pose considerable risks to patients who undergo abdominal surgery, and many preventive strategies have been applied to reduce this risk. An accurate predictive model could aid identification of high-risk patients, who could be targeted for particular care. This study aims to systematically review existing FD and IH prediction models. METHODS Prediction models were identified using pre-specified search terms on SCOPUS, PubMed, and Web of Science. Eligible studies included those conducted in adult patients who underwent any kind of abdominal surgery, and reported model performance. Data from the eligible studies were extracted, and the risk of bias (RoB) was assessed using the PROBAST tool. Pooling of C-statistics was performed using a random-effect meta-analysis. [Registration: PROSPERO (CRD42021282463)]. RESULTS Twelve studies were eligible for review; five were FD prediction model studies. Most included studies had high RoB, especially in the analysis domain. The C-statistics of the FD and IH prediction models ranged from 0.69 to 0.92, but most have yet to be externally validated. Pooled C-statistics (95% CI) were 0.80 (0.74, 0.86) and 0.81 (0.75, 0.86) for the FD (external-validation) and IH prediction model, respectively. Some predictive factors such as body mass index, smoking, emergency operation, and surgical site infection were associated with FD or IH occurrence and were included in multiple models. CONCLUSIONS Several models have been developed as an aid for FD and IH prediction, mostly with modest performance and lacking independent validation. New models for specific patient groups may offer clinical utility.
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Affiliation(s)
- Amarit Tansawet
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Rama VI Road, Bangkok, Ratchathewi, 10400 Thailand ,Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Pawin Numthavaj
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Rama VI Road, Bangkok, Ratchathewi, 10400 Thailand
| | - Thawin Techapongsatorn
- Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Suphakarn Techapongsatorn
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Rama VI Road, Bangkok, Ratchathewi, 10400 Thailand ,Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - John Attia
- Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, New Lambton, NSW Australia
| | - Gareth McKay
- Centre for Public Health, School of Medicine, Dentistry, and Biomedical Sciences, Queen’s University Belfast, Belfast, Northern Ireland, UK
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Rama VI Road, Bangkok, Ratchathewi, 10400 Thailand
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Meyer J, Delaune V, Abbassi Z, Douissard J, Toso C, Ris F, Buchs N. PROphylactic MESH (PROMESH) for stoma closure: does it reduce the incidence of incisional hernia? Protocol for a triple-blinded randomised controlled trial. BMJ Open 2021; 11:e053751. [PMID: 34907065 PMCID: PMC8671978 DOI: 10.1136/bmjopen-2021-053751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Application of a prophylactic mesh during stoma closure was shown to reduce the incidence of incisional hernia at the site of stoma closure. Our objective is to provide high quality evidence to validate this finding. METHODS AND ANALYSIS The study will be a randomised controlled triple-blinded superiority parallel monocentric trial. Patients undergoing elective ileostomy or colostomy closure after surgery for digestive cancer will be eligible for inclusion. Patients allergic to the mesh, immunosuppressed or refusing to participate will be excluded. Randomisation will be performed based on a 1:1 allocation ratio between stoma closure with application of a non-absorbable mesh in the sublay position (intervention) and stoma closure without a mesh (control). The primary outcome will be the 1-year incidence of incisional hernia at the site of stoma closure, determined clinically and by CT. Secondary outcomes will be the 31-day incidence of surgical site infection and the modified Carolinas Comfort Scale. Patients, radiologists and investigators performing the assessment at 1 year will be blinded for the allocated study group. Analysis will be performed in intention-to-treat. The trial will include 68 patients (34 with mesh, 34 without mesh). ETHICS AND DISSEMINATION The present randomised controlled trial was registered into clinicaltrials.gov (NCT04510558) and was accepted by the local ethic committee (Geneva, Switzerland: CCER 2021-00053). The results will be presented at national and international congresses in the fields of colorectal surgery and general surgery, and published in a peer-reviewed journal.
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Affiliation(s)
- Jeremy Meyer
- Medical School, University of Geneva, Geneva, Switzerland
- Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Vaihere Delaune
- Medical School, University of Geneva, Geneva, Switzerland
- Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Ziad Abbassi
- Medical School, University of Geneva, Geneva, Switzerland
- Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Jonathan Douissard
- Medical School, University of Geneva, Geneva, Switzerland
- Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Christian Toso
- Medical School, University of Geneva, Geneva, Switzerland
- Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Frédéric Ris
- Medical School, University of Geneva, Geneva, Switzerland
- Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Nicolas Buchs
- Medical School, University of Geneva, Geneva, Switzerland
- Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland
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Liu H, Cao J, Balluff B, Jongen AC, Gijbels MJ, Melenhorst J, Heeren RM, Bouvy ND. Examination of lipid profiles in abdominal fascial healing using MALDI-TOF to identify potential therapeutic targets. J Mass Spectrom Adv Clin Lab 2021; 20:35-41. [PMID: 34820669 PMCID: PMC8600998 DOI: 10.1016/j.jmsacl.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 11/20/2022] Open
Abstract
Lipids change overtime in normal fascial healing in the early post-surgery period. Specific lipid species are correlated with the changes of inflammation cells and fibroblasts. Lipid species in the present study are considered as predictive markers for the formation of incisional hernia.
Background Failure of fascial healing in the abdominal wall can result in incisional hernia, which is one of the most common complications after laparotomy. Understanding the molecular healing process of abdominal fascia may provide lipid markers of incisional hernia or therapeutic targets that allow prevention or treatment of incisional hernias. Purpose This study aims to investigate temporal and in situ changes of lipids during the normal healing process of abdominal fascia in the first postoperative week. Methods Open hemicolectomy was performed in a total of 35 Wistar rats. The midline fascia was closed identically for all rats using a single continuous suturing technique. These animals were sacrificed with equal numbers (n = 5) at each of 7-time points (6, 12, 24, 48, 72, 120, and 168 h. The local and temporal changes of lipids were examined with mass spectrometry imaging and correlated to histologically scored changes during healing using hematoxylin and eosin staining. Results Two phosphatidylcholine lipid species (PC O-38:5 and PC 38:4) and one phosphatidylethanolamine lipid (PE O-16:1_20:4) were found to significantly correlate with temporal changes of inflammation. A phosphatidylcholine (PC 32:0) and a monosialodihexosylganglioside (GM3 34:1;2) were found to correlate with fibroblast cell growth. Conclusion Glycerophospholipids and gangliosides are strongly involved in the normal healing process of abdominal fascia and their locally fluctuating concentrations are considered as potential lipid markers and therapeutic targets of fascial healing.
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Key Words
- AA, Arachidonic acid
- CL, Cardiolipin
- CerPE, Ceramide phosphorylethanolamine
- Fascia
- GM3, Monosialodihexosylganglioside
- Incisional hernia
- LPA, Lysophosphatidic acid
- LPC, Lysophosphatidylcholine
- Lipids
- MMPE, Monomethyl-phosphatidylethanolamine
- Mass spectrometry imaging
- PA, Phosphatidic acid
- PC, Phosphatidylcholine
- PE, Phosphatidylethanolamine
- PI, Phosphatidylinositol
- SM, Sphingomyelin
- Wound healing
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Affiliation(s)
- Hong Liu
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Corresponding author at: Department of General Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
| | - Jianhua Cao
- Maastricht MultiModal Molecular Imaging Institute (M4I), Maastricht University, Maastricht, The Netherlands
| | - Benjamin Balluff
- Maastricht MultiModal Molecular Imaging Institute (M4I), Maastricht University, Maastricht, The Netherlands
| | - Audrey C.H.M. Jongen
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Marion J. Gijbels
- Department of Medical Biochemistry, Experimental Vascular Biology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Pathology CARIM, Cardiovascular Research Institute Maastricht, GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Jarno Melenhorst
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Ron M.A. Heeren
- Maastricht MultiModal Molecular Imaging Institute (M4I), Maastricht University, Maastricht, The Netherlands
| | - Nicole D. Bouvy
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
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When to use a prophylactic mesh after stoma closure: a case-control study. Hernia 2021; 26:467-472. [PMID: 34767104 PMCID: PMC9012710 DOI: 10.1007/s10029-021-02508-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/08/2021] [Indexed: 12/14/2022]
Abstract
Purpose The closure of a stoma is frequently associated with an acceptable morbidity and mortality. One of the most frequent complications is incisional hernia at the stoma site, which occurs in 20%–40% of cases, higher than incisions in other parts of the abdomen. The objective of this study was to identify the risk factors associated with the presentation of incisional hernia after stoma closure, this in order to select patients who are candidates for prophylactic mesh placement during closure. Methods An unpaired case–control study was conducted. This study involved 164 patients who underwent a stoma closure between January 2014 and December 2019. Associated factors for the development of incisional hernia at the site of the stoma after closure were identified, for which it was performed a logistic regression analysis. Results 41 cases and 123 controls were analyzed, with a mean follow-up of 35.21 ± 18.42 months, the mean age for performing the stoma closure was 65.28 ± 14.07 years, the most frequent cause for performing the stoma was malignant disease (65.85%). Risk factor for the development of incisional hernia at the stoma site after its closure was identified as a history of parastomal hernia (OR 5.90, CI95% 1.97–17.68). Conclusions The use of prophylactic mesh at stoma closure should be considered in patients with a history of parastomal hernia since these patients present a significantly higher risk of developing a hernia.
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van der Oest MJW, Teunissen JS, Poelstra R, Feitz R, Burdorf A, Selles RW. Factors affecting return to work after surgical treatment of trapeziometacarpal joint osteoarthritis. J Hand Surg Eur Vol 2021; 46:979-984. [PMID: 33287620 PMCID: PMC8559178 DOI: 10.1177/1753193420978631] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study aimed to identify factors contributing to the timing of return to work after surgical treatment of trapeziometacarpal joint osteoarthritis and to calculate the costs of lost productivity. We included 627 patients with paid employment who underwent trapeziectomy and ligament reconstruction with tendon interposition. Time to return to work was measured through filling online questionnaires and analysed using survival analysis at 6 weeks and 3, 6 and 12 months after the surgery. Patients also filled in the Michigan Hand Outcomes Questionnaire. Costs of lost productivity were calculated using the human capital method. After 1 year, 78% of the patients returned to work. The median time to return to work was 12 weeks. Factors that significantly affected the time to return to work were occupational intensity (light, moderate or heavy physical labour), whether the dominant hand was treated and the Michigan Hand Outcomes Questionnaire work score and hand function score of the unoperated side at baseline. The costs of lost productivity were estimated at €11,000 on the patient level, resulting in €16.8 million on the Dutch population level per year.Level of evidence: II.
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Affiliation(s)
- Mark J. W. van der Oest
- Department of Plastic, Reconstructive and Hand
Surgery, Erasmus MC, Rotterdam, The Netherlands,Department of Rehabilitation Medicine, Erasmus
MC, Rotterdam, The Netherlands,Hand and Wrist Center, Xpert Clinic, The
Netherlands
| | - Joris S. Teunissen
- Department of Plastic, Reconstructive and Hand
Surgery, Erasmus MC, Rotterdam, The Netherlands,Department of Rehabilitation Medicine, Erasmus
MC, Rotterdam, The Netherlands,Plastic Surgery, Radboud University Medical
Centre, Nijmegen, The Netherlands,Joris S. Teunissen, Department of Plastic,
Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, Doctor Molewaterplein 40, 3015 GD
Rotterdam, The Netherlands.
| | - Ralph Poelstra
- Department of Plastic, Reconstructive and Hand
Surgery, Erasmus MC, Rotterdam, The Netherlands,Department of Rehabilitation Medicine, Erasmus
MC, Rotterdam, The Netherlands,Hand and Wrist Center, Xpert Clinic, The
Netherlands
| | - Reinier Feitz
- Hand and Wrist Center, Xpert Clinic, The
Netherlands
| | - Alex Burdorf
- Department of Public Health, Erasmus MC,
Rotterdam, The Netherlands
| | - Ruud W Selles
- Department of Plastic, Reconstructive and Hand
Surgery, Erasmus MC, Rotterdam, The Netherlands,Department of Rehabilitation Medicine, Erasmus
MC, Rotterdam, The Netherlands
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46
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High rate of incisional hernia observed after mass closure of burst abdomen. Hernia 2021; 26:1267-1274. [PMID: 34674087 DOI: 10.1007/s10029-021-02523-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/06/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study investigated the long-term development of incisional hernia after implementation of a standardized surgical treatment strategy for burst abdomen in abdominal midline incisions with a continuous mass closure technique. METHODS The study was a single-center, observational study evaluating all patients treated for burst abdomen between June 2014 and April 2019 with a long-term follow-up in October 2020. In June 2014, a standardized surgical treatment for burst abdomen involving a monofilament, slowly absorbable suture in a continuous mass-closure stitch with large bites of 3 cm and small steps of 5 mm was introduced. The occurrence of incisional hernia was investigated and defined as a radiological-, clinical-, or intraoperative finding of a hernia in the abdominal midline incision at follow-up. RESULTS Ninety-four patients suffered from burst abdomen during the study period. Eighty patients were eligible for follow-up. The index surgery prior to burst abdomen was an emergency laparotomy in 78% (62/80) of the patients. Nineteen patients died within the first 30 postoperative days and 61 patients were available for further analysis. The long-term incisional hernia rate was 33% (20/61) with a median follow-up of 17 months (min 4, max 67 months). CONCLUSION Standardized surgery for burst abdomen with a mass-closure technique using slow absorbable running suture results in high rates of long-term incisional hernias, comparable to the hernia rates reported in the literature among this group of patients.
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47
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Zemzemi C, Catheline S, Turquier F. Shear wave elastography biases in abdominal wall layers characterization. Phys Med Biol 2021; 66. [PMID: 34560674 DOI: 10.1088/1361-6560/ac29cd] [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: 12/10/2020] [Accepted: 09/24/2021] [Indexed: 11/12/2022]
Abstract
Ventral incisional hernia repair is one of the most common surgical procedures. The characterization of the abdominal wall layer mechanical properties is the first step towards personalized treatment. This study investigates the capability of elastography to assess these properties using anin vivoandin vitromodel of abdominal wall layers. Two experiment approaches are considered: shear wave elastography imaging and guided wave dispersion characterization, where the latter is used as a reference. Results show measurement biases in the shear wave elastography approach in such a layer structure configuration. Methods to overcome these biases are suggested to improve and to correct the elastography approach for abdominal wall layers and similar anatomical structures.
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Affiliation(s)
- C Zemzemi
- LabTAU, INSERM, Centre Léon Bérard, Université Lyon 1, Univ-Lyon, F-69003, Lyon, France
| | - S Catheline
- LabTAU, INSERM, Centre Léon Bérard, Université Lyon 1, Univ-Lyon, F-69003, Lyon, France
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48
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Meyer J, Simillis C, Joshi H, Xanthis A, Ashcroft J, Buchs N, Ris F, Davies RJ. Does the Choice of Extraction Site During Minimally Invasive Colorectal Surgery Change the Incidence of Incisional Hernia? Protocol for a Systematic Review and Network Meta-Analysis. Int J Surg Protoc 2021; 25:216-219. [PMID: 34616959 PMCID: PMC8462477 DOI: 10.29337/ijsp.164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 09/06/2021] [Indexed: 11/24/2022] Open
Abstract
Background Various sites are used for specimen extraction in oncological minimally invasive colorectal surgery. The objective is to determine if the choice of extraction site modulates the incidence of incisional hernia (IH). Methods/design A systematic review will be performed in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. MEDLINE, Embase and CENTRAL will be searched to look for original studies reporting the incidence of IH after minimally invasive colorectal surgery. Studies will be excluded from the analysis if: 1) they do not report original data, 2) the outcome of interest (incidence of incisional hernia) is not clearly reported and does not allow to extrapolate and/or calculate the required data for network meta-analysis, 3) they include pediatric patients, 4) they include a patients' population with a conversion rate to laparotomy >10%, 5) they do not compare at least two different extraction sites for the operative specimen, 6) they report patients who underwent pure (and not hybrid) natural orifice transluminal endoscopic surgery (NOTES). Network meta-analysis will be performed to determine the incidence of IH per extraction site. Discussion By determining which specimen extraction site leads to reduced rate of IH, this systematic review and network meta-analysis will help colorectal surgeons to choose their extraction site and reduce the morbidity and costs associated with IH. Registration The systematic review and meta-analysis protocol is registered in the International Prospective Register of Ongoing Systematic Reviews (PROSPERO) with number CRD42021272226. Highlights Various sites are used for specimen extraction in oncological minimally invasive colorectal surgery, and the choice of the site may probably modulate the incidence of incisional hernia.The present protocol aims to design a systematic review which will identify original studies comparing two extraction sites during minimally invasive colorectal surgery in terms of incidence of incisional hernia.Network meta-analysis will be performed to determine the incidence of IH per extraction site.
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Affiliation(s)
- Jeremy Meyer
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, GB.,Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Genève 14, CH.,Medical School, University of Geneva, Rue Michel-Servet 1, 1205 Genève, CH
| | - Constantinos Simillis
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, GB
| | - Heman Joshi
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, GB
| | - Athanasios Xanthis
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, GB
| | - James Ashcroft
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, GB
| | - Nicolas Buchs
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Genève 14, CH.,Medical School, University of Geneva, Rue Michel-Servet 1, 1205 Genève, CH
| | - Frédéric Ris
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Genève 14, CH.,Medical School, University of Geneva, Rue Michel-Servet 1, 1205 Genève, CH
| | - R Justin Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, GB
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Tansawet A, Numthavaj P, Sumritpradit P, Techapongsatorn S, McKay G, Attia J, Thakkinstian A. Midline incisional hernia prophylaxis using synthetic mesh in an emergency or urgent gastrointestinal tract surgery: a protocol for multicentre randomised clinical trial. BMJ Open 2021; 11:e045541. [PMID: 34479930 PMCID: PMC8420735 DOI: 10.1136/bmjopen-2020-045541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 08/13/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Between 5% and 30% of abdominal incisions eventually result in incisional hernias (IHs) that can lead to severe complications and impaired quality of life. Unfortunately, IH repair is often unsuccessful; therefore, hernia prophylaxis is an important issue. The efficacy of mesh augmentation has been proven for hernia prophylaxis in high-risk patients, but no randomised clinical trial has evaluated prophylactic mesh placement in emergency/urgent gastrointestinal operations. METHODS AND ANALYSIS A multicentre, prospective randomised, open and patient-assessor blinded endpoint design will be conducted. A total of 470 patients will be enrolled and randomly allocated to retrorectus mesh augmentation with lightweight polypropylene mesh or primary suture closure. The primary outcome is IH occurrence within 24 months of follow-up, while other clinical outcomes are secondary endpoints. A cost-effectiveness analysis will be conducted from the societal and provider perspectives. ETHICS AND DISSEMINATION Ethics approval was obtained from Ramathibodi Hospital (MURA2020/1478) and Vajira Hospital (COA164/2563). The protocol is on the process of submission to the local ethics committee of the other study sites. Results will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER TCTR20200924002.
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Affiliation(s)
- Amarit Tansawet
- Surgery, Navamindradhiraj University, Bangkok, Thailand
- Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pawin Numthavaj
- Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Preeda Sumritpradit
- Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Gareth McKay
- Centre for Public Health, Faculty of Medicine Health and Life Sciences, Queen's University Belfast, Belfast, UK
| | - John Attia
- Centre for Clinical Epidemiology and Biostatistics, Hunter Medical Research Institute, School of Medicine and Public Health, The University of Newcastle, New Lambton, New South Wales, Australia
| | - Ammarin Thakkinstian
- Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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50
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Tansawet A, Numthavaj P, Techapongsatorn S, McKay G, Attia J, Pattanaprateep O, Thakkinstian A. Risk-benefit assessment of onlay and retrorectus mesh augmentation for incisional hernia prophylaxis: A secondary analysis from network meta-analysis. Int J Surg 2021; 92:106053. [PMID: 34375768 DOI: 10.1016/j.ijsu.2021.106053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/29/2021] [Accepted: 08/06/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Mesh augmentation has proved efficacious for the prevention of incisional hernia (IH). A recent network meta-analysis (NMA) identified onlay and retrorectus mesh (OM and RM) as the most effective therapeutic options, but the risk of surgical site infection (SSI) and other complications require additional consideration. METHODS The NMA generated pooled risk differences (RD) for the benefits of reducing IH and the risk of SSI and composite seroma/hematoma (CSH) for use in Monte-Carlo data simulations with 1000 replications. Mean incremental risk-benefit ratios (IRBR), i.e., the ratio of incremental risk (or RD) and incremental benefit, and 95% confidence intervals (95% CI) were estimated with a probability of risk-benefits (PRB) across risk-benefit acceptability thresholds from the acceptability curves generated. RESULTS The RDs of IH were 0.237 and 0.201 lower in OM and RM than primary suture closure, compared to 0.027 and -0.001 for SSI. IRBRs (95% CI) for SSI risk were -0.118 (-0.124, -0.112) and 0.006 (-0.002, 0.013) for OM and RM, respectively. PRBs were much higher in RM than OM, especially at low acceptability thresholds of 0.05 and 0.1. IRBRs (95% CI) for CSH were -0.388 (-0.395, -0.381) and -0.105 (-0.111, -0.100) for OM and RM, respectively. RM yielded a PRB of 0.87 at an acceptability threshold of 0.2, in contrast to OM, which did not. CONCLUSION Overall, RM offered improved benefit in IH prophylaxis over the risk of complications relative to OM and appeared to be the preferred treatment option for this indication.
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Affiliation(s)
- Amarit Tansawet
- Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand; Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pawin Numthavaj
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Suphakarn Techapongsatorn
- Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Gareth McKay
- Centre for Public Health, School of Medicine, Dentistry, and Biomedical Sciences, Queen's University Belfast, Northern Ireland, UK
| | - John Attia
- Centre for Clinical Epidemiology and Biostatistics, Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle, New Lambton, NSW, Australia
| | - Oraluck Pattanaprateep
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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