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Denney B, De Latorre JI. Multipoint Suture Fixation Technique for Abdominal Wall Reconstruction with Component Separation and Onlay Biological Mesh Placement. Am Surg 2017. [DOI: 10.1177/000313481708300529] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Component separation with mesh reinforcement has become the primary modality for complex abdominal wall reconstruction. However, many fundamental questions remain unanswered, such as whether underlay versus overlay mesh placement is superior, and what is the best means of suture fixation technique for mesh placement? This study presents the senior author's technique for onlay biologic mesh placement with multipoint suture fixation in combination with component separation and its subsequent low recurrence rates. This is a retrospective review of the senior author's cases of component separation with onlay biologic mesh placement during his tenure at the home institution of the University of Alabama at Birmingham. A total of 75 patients were included, all of whom underwent complex abdominal wall reconstruction from September 2002 to April 2012. Patients were excluded from the dataset if their surgery occurred less than two years before date of data collection to give a minimum 2-year follow-up. Patients were identified by Current Procedural Terminology codes for component separation and their charts reviewed by the home institution's electronic medical record. Data point entries included patient demographics and comorbidities, concomitant procedures such as bowel resection or panniculectomy, and characteristics of the reconstruction such as type of mesh used. Primary data endpoints were complications following surgery, particularly recurrence and laxity. A total of 75 patients were included in the study from September 2002 to April 2012 with a minimum 2-year follow-up period. The recurrence rate was 13 per cent and the rate of laxity 2.7 per cent. There was one death (1.35%). The most frequent complication was seromas at a rate of 17 per cent. Multipoint fixation suture technique for abdominal wall reconstruction with component separation and onlay biologic mesh is a reproducible technique with reliably low recurrence rates.
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Affiliation(s)
- Brad Denney
- Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jorge I. De Latorre
- Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
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Invited comment to: Open retromuscular large mesh reconstruction of lumbar incisional hernias including the atrophic muscular area. Y. Renard, L. de Mestier, A. Cagniet et al. Hernia 2017; 21:351-353. [PMID: 28364291 PMCID: PMC5435796 DOI: 10.1007/s10029-017-1600-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 03/22/2017] [Indexed: 11/06/2022]
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Parastomal hernia following cystectomy and ileal conduit urinary diversion: a systematic review. Hernia 2016; 21:163-175. [PMID: 28025739 DOI: 10.1007/s10029-016-1561-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 11/25/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE The natural history of development of Parastomal hernia (PH) following cystectomy and ileal conduit diversion is poorly understood. The aim of this study was to systematically review the frequency and risk factors of PH following ileal conduit diversion. METHODS A systematic review of literature was performed and the Cochrane, EMBASE and PubMed databases were searched from 1st January 1985 to 30th April 2016. All articles reporting occurrence of PH following cystectomy and ileal conduit diversion were analysed. The primary outcome measure was the frequency of development of PH. Secondary outcome measures were risk factors for PH development, complications of PH, frequency of PH repair and recurrence of PH. RESULTS Twelve articles of the 63 originally identified were analysed. Sample sizes ranged from 36 to 1057 patients with a pooled total of 3170 undergoing ileal conduit surgery. Age at the time of surgery ranged from 31 to 92 years. Of the 3170 patients who underwent ileal conduit surgery, 529 patients (17.1%) developed a PH based on either clinical examination or cross sectional imaging. Female gender, high BMI, low preoperative albumin and previous laparotomy were significantly associated with the development of PH in two studies. Repair of PH was offered to 8-75% of patients. The rate of recurrence following repair of PH was reported to range from 27 to 50%. CONCLUSION A PH is frequent following cystectomy and ileal conduit urinary diversion. The diagnosis of a PH depends upon duration of clinical follow-up and the use of cross-sectional imaging. The recurrence rates following the repair of a PH remain substantial.
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Fazekas B, Fazekas B, Hendricks J, Smart N, Arulampalam T. The incidence of incisional hernias following ileostomy reversal in colorectal cancer patients treated with anterior resection. Ann R Coll Surg Engl 2016; 99:319-324. [PMID: 27869487 DOI: 10.1308/rcsann.2016.0347] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION The aim of this study was to identify the rate of incisional hernia formation following ileostomy reversal in patients who underwent anterior resection for colorectal cancer. In addition, we aimed to ascertain risk factors for the development of reversal-site incisional hernias and to record the characteristics of the resultant hernias. MATERIALS AND METHODS Using a prospectively compiled database of colorectal cancer patients who were treated with anterior resection, we identified individuals who had undergone both ileostomy formation and subsequent reversal of their ileostomies from January 2005 to December 2014. Medical records were reviewed to record descriptive patient data about risk factors for hernia formation, operative details and any subsequent operations. Computed tomography reports were reviewed to identify the number, site and characteristics of incisional hernias. RESULTS A total of 121 patients were included in this study; 14.9% (n = 18) developed an incisional hernia at the ileostomy reversal site; 17.4% (n = 21) at a non-ileostomy site and 6.6% (n = 8) developed both. The reversal-site hernias were smaller both in width and length compared with the non-ileostomy-site hernias. Risk factors for the development of reversal-site incisional hernias were higher body mass index (BMI), lower age, open surgery, longer reversal time and a history of previous hernias. We did not detect a difference in the size of the incisional hernias that developed in patients with these specific risk factors. CONCLUSIONS Incisional hernias are a significant complication of ileostomy reversal. Further evaluation of the use of prophylactic mesh to reduce the incidence of incisional hernias may be worthwhile.
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Affiliation(s)
- Balazs Fazekas
- Colorectal Department, Colchester Hospital University NHS Foundation Trust , Colchester , UK
| | | | - J Hendricks
- Colorectal Department, Colchester Hospital University NHS Foundation Trust , Colchester , UK
| | - N Smart
- Royal Devon and Exeter Hospital , Exeter , UK
| | - T Arulampalam
- Colorectal Department, Colchester Hospital University NHS Foundation Trust , Colchester , UK
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Tandon A, Shahzad K, Pathak S, Oommen CM, Nunes QM, Smart N. Parietex™ Composite mesh versus DynaMesh ®-IPOM for laparoscopic incisional and ventral hernia repair: a retrospective cohort study. Ann R Coll Surg Engl 2016; 98:568-573. [PMID: 27659375 PMCID: PMC5392900 DOI: 10.1308/rcsann.2016.0292] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2016] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Laparoscopic incisional and ventral hernia repair (LIVHR) is widely accepted and safe but the type of mesh used is still debated. We retrospectively compared postoperative outcomes with two different meshes commonly used in LIVHR. METHODS This is a retrospective study of patients who underwent incisional hernia repair between January 2008 and December 2010. Two meshes were used: Parietex™ Composite (Covidien, New Haven, CT, USA) and the DynaMesh®-IPOM (FEG Textiltechnik mbH, Aachen, Germany). The two groups were compared with respect to recurrence rates, incidence of seroma and intestinal obstruction. RESULTS Among the 88 patients who underwent LIVHR, 75 patients (85.2%) presented with primary incisional hernia, 10 (11.4%) presented with a first recurrence and 3 (3.4%) presented with a second recurrence. Median follow-up was 53.6 months (range 40-61 months). 12.9% of patients had recurrence in the Parietex™ Composite mesh group (n=62) in comparison to 3.8% in the DynaMesh®-IPOM mesh group (n=26; P=0.20). DynaMesh®-IPOM was associated with a significantly higher incidence of intestinal obstruction secondary to adhesions (11.5% vs. 0%, P=0.006) and lower incidence of seroma and haematoma formation compared to Parietex™ composite mesh group (0% vs. 6.4% of patients; P=0.185). CONCLUSIONS LIVHR is a safe and feasible technique. Dynamesh®-IPOM is associated with a significantly higher incidence of adhesion related bowel obstruction, albeit with a lower incidence of recurrence, seroma and haematoma formation compared with Parietex™ Composite mesh. However, there is a need for further well-designed, multicentre randomised controlled studies to investigate the use of these meshes.
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Affiliation(s)
- A Tandon
- Department of Surgery, Aintree University Hospital , Liverpool , UK
| | - K Shahzad
- Department of Surgery, Aintree University Hospital , Liverpool , UK
| | - S Pathak
- Exeter Surgical Health Services Research Unit (HESRU), Royal Devon and Exeter NHS Foundation Trust , Exeter , UK
| | - C M Oommen
- Rotherham General Hospital , Rotherham , UK
| | - Q M Nunes
- Department of Surgery, Aintree University Hospital , Liverpool , UK
| | - N Smart
- Exeter Surgical Health Services Research Unit (HESRU), Royal Devon and Exeter NHS Foundation Trust , Exeter , UK
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Revisiting the Anterior Rectus Sheath Repair for Incisional Hernia: A 10-Year Experience. World J Surg 2016; 41:713-721. [DOI: 10.1007/s00268-016-3774-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Cornish J, Harries RL, Bosanquet D, Rees B, Ansell J, Frewer N, Dhruva Rao PK, Parry C, Ellis-Owen R, Phillips SM, Morris C, Horwood J, Davies ML, Davies MM, Hargest R, Davies Z, Hilton J, Harris D, Ben-Sassi A, Rajagopal R, Hanratty D, Islam S, Watkins A, Bashir N, Jones S, Russell IR, Torkington J. Hughes Abdominal Repair Trial (HART) - Abdominal wall closure techniques to reduce the incidence of incisional hernias: study protocol for a randomised controlled trial. Trials 2016; 17:454. [PMID: 27634489 PMCID: PMC5025615 DOI: 10.1186/s13063-016-1573-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 08/14/2016] [Indexed: 01/05/2023] Open
Abstract
Background Incisional hernias are common complications of midline closure following abdominal surgery and cause significant morbidity, impaired quality of life and increased health care costs. The ‘Hughes Repair’ combines a standard mass closure with a series of horizontal and two vertical mattress sutures within a single suture. This theoretically distributes the load along the incision length as well as across it. There is evidence to suggest that this technique is as effective as mesh repair for the operative management of incisional hernias; however, no trials have compared the Hughes Repair with standard mass closure for the prevention of incisional hernia formation following a midline incision. Methods/design This is a 1:1 randomised controlled trial comparing two suture techniques for the closure of the midline abdominal wound following surgery for colorectal cancer. Full ethical approval has been gained (Wales REC 3, MREC 12/WA/0374). Eight hundred patients will be randomised from approximately 20 general surgical units within the United Kingdom. Patients undergoing open or laparoscopic (more than a 5-cm midline incision) surgery for colorectal cancer, elective or emergency, are eligible. Patients under the age of 18 years, those having mesh inserted or undergoing musculofascial flap closure of the perineal defect in abdominoperineal wound closure, and those unable to give informed consent will be excluded. Patients will be randomised intraoperatively to either the Hughes Repair or standard mass closure. The primary outcome measure is the incidence of incisional hernias at 1 year as assessed by standardised clinical examination. The secondary outcomes include quality of life patient-reported outcome measures, cost-utility analysis, incidence of complete abdominal wound dehiscence and C-POSSUM scores. The incidence of incisional hernia at 1 year, assessed by computerised tomography, will form a tertiary outcome. Discussion A feasibility phase has been completed. The results of the study will be used to inform current and future practice and potentially reduce the risk of incisional hernia formation following midline incisions. Trial registration Trial Registration Number: ISRCTN 25616490. Registered on 1 January 2012. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1573-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- J Cornish
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - R L Harries
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - D Bosanquet
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - B Rees
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - J Ansell
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - N Frewer
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - P K Dhruva Rao
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - C Parry
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - R Ellis-Owen
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - S M Phillips
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - C Morris
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - J Horwood
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - M L Davies
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - M M Davies
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - R Hargest
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - Z Davies
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - J Hilton
- Princess of Wales Hospital, Bridgend, UK
| | | | | | | | - D Hanratty
- Royal Glamorgan Hospital, Llantrisant, UK
| | - S Islam
- Swansea Clinical Trials Unit, Swansea University, Swansea, UK
| | - A Watkins
- Swansea Clinical Trials Unit, Swansea University, Swansea, UK
| | - N Bashir
- Swansea Clinical Trials Unit, Swansea University, Swansea, UK
| | - S Jones
- Involving People, Health and Care Research Wales, Cardiff, UK
| | - I R Russell
- Swansea Clinical Trials Unit, Swansea University, Swansea, UK
| | - J Torkington
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK.
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Holihan JL, Alawadi ZM, Harris JW, Harvin J, Shah SK, Goodenough CJ, Kao LS, Liang MK, Roth JS, Walker PA, Ko TC. Ventral hernia: Patient selection, treatment, and management. Curr Probl Surg 2016; 53:307-54. [DOI: 10.1067/j.cpsurg.2016.06.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 06/14/2016] [Indexed: 12/14/2022]
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Quality of life and hernia development 5 years after open abdomen treatment with vacuum-assisted wound closure and mesh-mediated fascial traction. Hernia 2016; 20:755-64. [PMID: 27324880 DOI: 10.1007/s10029-016-1516-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 06/09/2016] [Indexed: 12/29/2022]
Abstract
PURPOSE To report incisional hernia (IH) incidence, abdominal wall (AW) discomfort and quality of life (QoL) 5 years after open abdomen treatment with vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM). METHODS Five-year follow-up of patients included in a prospective study 2006-2009. The protocol included physical examination, patient interview, chart review, questionnaires on abdominal wall and stoma complaints and the SF-36 questionnaire. RESULTS Fifty-five (12 women, 43 men; median age 70 years) of 111 included patients were alive. Follow-up rate was 91 %. Cumulative IH incidence during the whole study was 62 %. One-third of the IHs was repaired. At 5-year follow-up 59 % of IHs were clinically detectable. AW symptoms were equivalent in patients with (15/23) and without (11/21) IH (p = 0.541). SF-36 scores were lower than population mean for component scores and all subscales except bodily pain. Patients with major co-morbidity had lower physical component score [31.6 (95 %, CI 25.6-37.4)] compared to those without [48.9 (95 %, CI 46.2-51.4)]. Major co-morbidity was not associated with IH (p = 0.56), AW symptoms (p = 0.54) or stoma (p = 0.10). Patients with IH or other AW symptoms had similar SF-36 results compared to those without, whereas patients with a stoma had >5 point lower mean scores for general health, social function and physical component score compared to those without. CONCLUSIONS VAWCM treatment results in high incidence of IH. However, at five years, there was no detectable difference in abdominal wall complaints and QoL in patients with IH compared to those without. Lower QoL appeared mainly to be associated with the presence of major co-morbidity.
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Ferrarese A, Enrico S, Solej M, Surace A, Nardi MJ, Millo P, Allieta R, Feleppa C, D'Ambra L, Berti S, Gelarda E, Borghi F, Pozzo G, Marino B, Marchigiano E, Cumbo P, Bellomo MP, Filippa C, Depaolis P, Nano M, Martino V. Laparoscopic management of non-midline incisional hernia: A multicentric study. Int J Surg 2016; 33 Suppl 1:S108-13. [PMID: 27353846 DOI: 10.1016/j.ijsu.2016.06.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The laparoscopic repair of non-midline ventral hernia (LNM) has been debated. The aim of this study is to analyze our experience performing the laparoscopic approach to non-midline ventral hernias (NMVHs) in Northwest Italy for 6 years. METHODS A total of 78 patients who underwent LNM between March 2008 and March 2014 in the selected institutions were analyzed. We retrospectively analyzed the peri- and postoperative data and the recurrence rate of four subgroups of NMVHs: subcostal, suprapubic, lumbar, and epigastric. We also conducted a literature review. RESULTS No difference was found between the four subgroups in terms of demographic data, defect characteristics, admission data, and complications. Subcostal defects required a shorter operating time. Obesity was found to be a risk factor for recurrence. CONCLUSIONS In our experience, subcostal defects were easier to perform, with a lower recurrence rate, lesser chronic pain, and faster surgical performance. A more specific prospective randomized trial with a larger sample is awaited. Based on our experience, however, the laparoscopic approach is a safe treatment for NMVHs in specialized centers.
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Affiliation(s)
- Alessia Ferrarese
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Torino, Italy.
| | - Stefano Enrico
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Torino, Italy.
| | - Mario Solej
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Torino, Italy.
| | - Alessandra Surace
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Torino, Italy.
| | | | - Paolo Millo
- Hospital "Umberto Parini", Section of General Surgery, Aosta, Italy.
| | - Rosaldo Allieta
- Hospital "Umberto Parini", Section of General Surgery, Aosta, Italy.
| | - Cosimo Feleppa
- Hospital "Sant'Andrea", Section of General Surgery, La Spezia, Italy.
| | - Luigi D'Ambra
- Hospital "Sant'Andrea", Section of General Surgery, La Spezia, Italy.
| | - Stefano Berti
- Hospital "Sant'Andrea", Section of General Surgery, La Spezia, Italy.
| | - Enrico Gelarda
- Hospital "Santa Croce e Carle", Section of General Surgery, Cuneo, Italy.
| | - Felice Borghi
- Hospital "Santa Croce e Carle", Section of General Surgery, Cuneo, Italy.
| | - Gabriele Pozzo
- Hospital "Civile", Section of General Surgery, Asti, Italy.
| | | | - Emma Marchigiano
- Hospital "Santa Croce", Section of General Surgery, Moncalieri, Italy.
| | - Pietro Cumbo
- Hospital "Santa Croce", Section of General Surgery, Moncalieri, Italy.
| | | | - Claudio Filippa
- Hospital "Gradenigo", Section of General Surgery, Torino, Italy.
| | - Paolo Depaolis
- Hospital "Gradenigo", Section of General Surgery, Torino, Italy.
| | - Mario Nano
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Torino, Italy.
| | - Valter Martino
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Torino, Italy.
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Martis G, Damjanovich L. Use of double-layer autologous dermal flap in the treatment of recurrent and/or infected incisional hernias: presentation of the surgical technique and the results of 1-year follow-up—a prospective, consecutive cohort study. Hernia 2015; 20:461-70. [DOI: 10.1007/s10029-015-1442-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 11/06/2015] [Indexed: 01/08/2023]
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Hopson SB, Miller LE. Open ventral hernia repair using ProGrip self-gripping mesh. Int J Surg 2015; 23:137-40. [PMID: 26433025 DOI: 10.1016/j.ijsu.2015.09.069] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 09/16/2015] [Accepted: 09/26/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Secure mesh fixation in incisional hernia repair is mandatory to prevent mesh dislocation and possible recurrence. Traditional fixation methods have been implicated as a source of chronic postoperative pain. We report 2-year outcomes with a self-gripping mesh for open tension-free repair of large incisional hernia. METHODS This prospective case series enrolled 20 patients with large primary incisional hernia (mean defect size: 84 cm(2)). Patients were electively treated by a single surgeon using a macroporous polyester mesh with resorbable polylactic acid microgrips (ProGrip, Covidien, Mansfield, MA, USA) using open onlay technique. Main outcomes included pain severity, Carolinas Comfort Scale (CCS), complications, and hernia recurrence. Patients returned for follow-up at 1, 3, 6, 12, and 24 months. RESULTS Median mesh fixation time was 2 min. Mean operative time was 38 min and blood loss was minimal (50 cc). Most patients (75%) were discharged same day. The only perioperative complication was a minor seroma in one patient. Patient follow-up compliance through 2 years was 100%. Mean pain score was 1.8 at discharge, 0.9 at 1 month, 0.7 at 1 year, and 0 at 2 years. At 2-years, all patients were "very satisfied" with treatment and hernia-specific quality of life was excellent (mean CCS score = 0). No infection, mesh removal, or hernia recurrence occurred during follow-up. CONCLUSIONS Open repair using a self-gripping mesh is a viable treatment option in patients with large incisional hernia. Immediate mesh fixation facilitates a safe and durable tension-free repair.
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Affiliation(s)
- Steven B Hopson
- Bon Secours TPMG Hernia Center, 860 Omni Boulevard, Suite 204, Newport News, VA 23606, USA.
| | - Larry E Miller
- Miller Scientific Consulting, Inc., 1854 Hendersonville Road, #231, Asheville, NC 28803, USA
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Bosanquet DC, Ansell J, Abdelrahman T, Cornish J, Harries R, Stimpson A, Davies L, Glasbey JCD, Frewer KA, Frewer NC, Russell D, Russell I, Torkington J. Systematic Review and Meta-Regression of Factors Affecting Midline Incisional Hernia Rates: Analysis of 14,618 Patients. PLoS One 2015; 10:e0138745. [PMID: 26389785 PMCID: PMC4577082 DOI: 10.1371/journal.pone.0138745] [Citation(s) in RCA: 220] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 09/03/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The incidence of incisional hernias (IHs) following midline abdominal incisions is difficult to estimate. Furthermore recent analyses have reported inconsistent findings on the superiority of absorbable versus non-absorbable sutures. OBJECTIVE To estimate the mean IH rate following midline laparotomy from the published literature, to identify variables that predict IH rates and to analyse whether the type of suture (absorbable versus non-absorbable) affects IH rates. METHODS We undertook a systematic review according to PRISMA guidelines. We sought randomised trials and observational studies including patients undergoing midline incisions with standard suture closure. Papers describing two or more arms suitable for inclusion had data abstracted independently for each arm. RESULTS Fifty-six papers, describing 83 separate groups comprising 14,618 patients, met the inclusion criteria. The prevalence of IHs after midline incision was 12.8% (range: 0 to 35.6%) at a weighted mean of 23.7 months. The estimated risk of undergoing IH repair after midline laparotomy was 5.2%. Two meta-regression analyses (A and B) each identified seven characteristics associated with increased IH rate: one patient variable (higher age), two surgical variables (surgery for AAA and either surgery for obesity surgery (model A) or using an upper midline incision (model B)), two inclusion criteria (including patients with previous laparotomies and those with previous IHs), and two circumstantial variables (later year of publication and specifying an exact significance level). There was no significant difference in IH rate between absorbable and non-absorbable sutures either alone or in conjunction with either regression analysis. CONCLUSIONS The IH rate estimated by pooling the published literature is 12.8% after about two years. Seven factors account for the large variation in IH rates across groups. However there is no evidence that suture type has an intrinsic effect on IH rates.
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Affiliation(s)
| | - James Ansell
- University Hospital of Wales, Cardiff, CF14 4XW, United Kingdom
| | | | - Julie Cornish
- University Hospital of Wales, Cardiff, CF14 4XW, United Kingdom
| | - Rhiannon Harries
- Morriston Hospital, Heol Maes Eglwys, Swansea, SA6 6NL, United Kingdom
| | - Amy Stimpson
- Glan Clwyd Hospital, Rhyl, LL18 5UJ, United Kingdom
| | - Llion Davies
- University Hospital of Wales, Cardiff, CF14 4XW, United Kingdom
| | | | - Kathryn A. Frewer
- Cardiff University School of Medicine, Cardiff, CF14 4XN, United Kingdom
| | - Natasha C. Frewer
- Cardiff University School of Medicine, Cardiff, CF14 4XN, United Kingdom
| | - Daphne Russell
- Swansea University College of Medicine, Swansea, SA2 8AA, United Kingdom
| | - Ian Russell
- Swansea University College of Medicine, Swansea, SA2 8AA, United Kingdom
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Petro CC, O’Rourke CP, Posielski NM, Criss CN, Raigani S, Prabhu AS, Rosen MJ. Designing a ventral hernia staging system. Hernia 2015; 20:111-7. [DOI: 10.1007/s10029-015-1418-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 08/03/2015] [Indexed: 01/31/2023]
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Ross SW, Wormer BA, Kim M, Oommen B, Bradley JF, Lincourt AE, Augenstein VA, Heniford BT. Defining surgical outcomes and quality of life in massive ventral hernia repair: an international multicenter prospective study. Am J Surg 2015; 210:801-13. [PMID: 26362202 DOI: 10.1016/j.amjsurg.2015.06.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 06/17/2015] [Accepted: 06/25/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Our goal was to set criteria for massive ventral hernia and to compare surgical outcomes and quality of life after ventral hernia repair (VHR). METHODS The International Hernia Mesh Registry was queried for patients undergoing VHR from 2007 to 2013. Defect was categorized as massive if the width or length was greater than 15 cm or area greater than 150 cm(2). Massive VHR was compared to regular VHR. RESULTS A total of 878 patients underwent VHR: 436 open, 442 laparoscopic with 13 deaths (1.5%) and 45 hernia recurrences (5.1%). Of those, 158 patients (18%) met criteria for massive VHR. Massive VHR patients had longer length of stay (LOS) and operative time and more hematomas, wound infections, wound complications, and pneumonias (P < .05). On multivariate analysis, LOS was longer, and early postoperative pain and activity limitation were greater in massive VHRs (P < .01). Massive VHR in the laparoscopic approach resulted in greater long-term mesh sensation (P < .01). CONCLUSIONS VHR in massive hernias have increased rates of complications and longer LOS.
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Affiliation(s)
- Samuel W Ross
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Carolinas Hernia Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28204, USA
| | - Blair A Wormer
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Carolinas Hernia Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28204, USA
| | - Mimi Kim
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Carolinas Hernia Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28204, USA
| | - Bindhu Oommen
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Carolinas Hernia Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28204, USA
| | - Joel F Bradley
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Carolinas Hernia Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28204, USA
| | - Amy E Lincourt
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Carolinas Hernia Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28204, USA
| | - Vedra A Augenstein
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Carolinas Hernia Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28204, USA
| | - B Todd Heniford
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Carolinas Hernia Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28204, USA.
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Luc G, David A, Couzi L, Midy D, Collet D, Dubuisson V. Lateral incisional hernia after renal transplantation: a comparative study. World J Surg 2015; 38:2791-6. [PMID: 25015726 DOI: 10.1007/s00268-014-2689-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Because of the lack of published data and the relative rarity of lateral incisional hernias (LIHs), especially after renal transplantation, mesh repair of LIH remains a challenge for surgeons. The aim of the present study was to evaluate the outcomes of LIH treated by mesh repair after renal transplantation. METHODS All consecutive patients who had undergone LIH mesh repair after renal transplantation were compared with patients who had undergone LIH mesh repair without renal transplantation. Demographic data, incisional hernia characteristics, operative data, and postoperative outcomes were prospectively recorded. Early complications and recurrence rates were evaluated. RESULTS Altogether, 112 patients were treated for LIH with mesh repair. Among these patients, 61 (54.4 %) underwent LIH after renal transplantation. The early complications were similar for the patients with and without renal transplantation (24.5 vs. 23.5 %, respectively; p = 0.896). The recurrence rates also were similar for the patients with and without renal transplantation (9.8 vs. 9.8 %, respectively; p = 1). CONCLUSIONS Mesh graft repair is feasible in patients with LIH after renal transplantation. Postoperative complications and recurrences were not more frequent in renal transplantation patients than in those without renal transplantation.
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Affiliation(s)
- Guillaume Luc
- Department of Digestive Surgery, Maison du Haut-Lévêque, University Hospital of Bordeaux, Avenue de Magellan, 33604, Pessac cedex, France,
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Azoury SC, Rodriguez-Unda N, Soares KC, Hicks CW, Baltodano PA, Poruk KE, Hu QL, Cooney CM, Cornell P, Burce K, Eckhauser FE. The effect of TISSEEL fibrin sealant on seroma formation following complex abdominal wall hernia repair: a single institutional review and derived cost analysis. Hernia 2015; 19:935-42. [DOI: 10.1007/s10029-015-1403-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 06/26/2015] [Indexed: 10/23/2022]
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Lien SC, Hu Y, Wollstein A, Franz MG, Patel SP, Kuzon WM, Urbanchek MG. Contraction of abdominal wall muscles influences size and occurrence of incisional hernia. Surgery 2015; 158:278-88. [PMID: 25817097 PMCID: PMC4472479 DOI: 10.1016/j.surg.2015.01.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 01/24/2015] [Accepted: 01/30/2015] [Indexed: 01/30/2023]
Abstract
BACKGROUND Incisional hernias are a complication in 10% of all open abdominal operations and can result in substantial morbidity. The purpose of this study was to determine whether inhibiting abdominal muscle contraction influences incisional hernia formation during the fascial healing after laparotomy. We hypothesized that decreasing the deformation of the abdominal musculature would decrease the size or occurrence of an incisional hernia. METHODS Using an established rat model for incisional hernia, a laparotomy through the linea alba was closed with 1 mid-incision, fast-absorbing suture. Three groups were compared: a sham group (sham; n = 6) received no laparotomy, and the saline hernia (SH; n = 6) and Botox hernia (BH; n = 6) groups were treated once with equal volumes of saline or botulinum toxin (Botox, Allergan) before the incomplete laparotomy closure. On postoperative day 14, the abdominal wall was examined for herniation and adhesions, and contractile forces were measured for abdominal wall muscles. RESULTS No hernias developed in the sham rats. Rostral hernias developed in all SH and BH rats. Caudal hernias developed in all SH rats, but in only 50% of the BH rats. Rostral hernias in the BH group were 35% shorter and 43% narrower compared with those in the SH group (P < .05). The BH group had weaker abdominal muscles compared with the sham and SH groups (P < .05). CONCLUSION In our rat model, partial paralysis of abdominal muscles decreases the number and size of incisional hernias. These results suggest that contractions of the abdominal wall muscle play a role in the pathophysiology of the formation of incisional hernias.
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Affiliation(s)
- Samuel C Lien
- Section of Plastic Surgery, University of Washington Medical Center, Seattle, WA
| | - Yaxi Hu
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Adi Wollstein
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Michael G Franz
- Section of General Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Shaun P Patel
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - William M Kuzon
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI; Ann Arbor Veterans Administration Medical Center, Ann Arbor, MI
| | - Melanie G Urbanchek
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI.
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69
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Wu J, Wang Y, Yu J, Chen Y, Pang Y, Diao X, Qiu Z. Identification of implanted mesh after incisional hernia repair using an automated breast volume scanner. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:1071-1081. [PMID: 26014327 DOI: 10.7863/ultra.34.6.1071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES This study aimed to evaluate the utility of an automated breast volume scanner (ABVS) versus handheld ultrasound (US) for identifying implanted mesh after incisional hernia repair. METHODS In vitro, the appearances of 3 samples of different flat mesh and a mesh plug on both ABVS and handheld US examinations were evaluated. In vivo, 97 patients received both ABVS and handheld US examinations in the incisional region. The frequency used for handheld US was 11 MHz. The presence of the previously implanted mesh in the incisional region was evaluated and compared between the US modalities. The identified results were confirmed by surgical findings. RESULTS In the in vitro study, the ABVS had more visualized and efficient imaging results for implanted mesh than handheld US. In the in vivo study, among 97 cases, 39 and 32 were identified as regions with mesh by the ABVS and handheld US, respectively. The ABVS had better identification performance than handheld US in terms of accuracy (94.8% versus 83.5%), sensitivity (90.5% versus 69.0%), and specificity (98.2% versus 94.5%). The κ values showed that handheld US had substantial agreement with surgical findings (κ = 0.78; 95% confidence interval, 0.66-0.90), whereas the ABVS had almost perfect agreement with surgical findings (κ = 0.93; 95% confidence interval, 0.86-1.00). More importantly, the ABVS could display the texture of lightweight mesh in the coronal plane. The specificity and sensitivity for mesh texture were 100.0% (55 of 55) and 94.4% (17 of 18), respectively. CONCLUSIONS The use of an ABVS may help identify the presence of implanted mesh after incisional hernia repair in some cases in which the implant is difficult to appreciate on handheld US imaging with an 11-MHz transducer.
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Affiliation(s)
- Jun Wu
- Department of Electronic Engineering, Fudan University, Shanghai, China (J.W., Y.W., J.Y.); Department of Electronic Engineering, Yunnan University, Kunming, China (J.W.); Key Laboratory of Medical Imaging Computing and Computer-Assisted Intervention of Shanghai, Shanghai, China (Y.W.); and Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China (Y.C., Y.P., X.D., Z.Q.)
| | - Yuanyuan Wang
- Department of Electronic Engineering, Fudan University, Shanghai, China (J.W., Y.W., J.Y.); Department of Electronic Engineering, Yunnan University, Kunming, China (J.W.); Key Laboratory of Medical Imaging Computing and Computer-Assisted Intervention of Shanghai, Shanghai, China (Y.W.); and Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China (Y.C., Y.P., X.D., Z.Q.).
| | - Jinhua Yu
- Department of Electronic Engineering, Fudan University, Shanghai, China (J.W., Y.W., J.Y.); Department of Electronic Engineering, Yunnan University, Kunming, China (J.W.); Key Laboratory of Medical Imaging Computing and Computer-Assisted Intervention of Shanghai, Shanghai, China (Y.W.); and Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China (Y.C., Y.P., X.D., Z.Q.)
| | - Yue Chen
- Department of Electronic Engineering, Fudan University, Shanghai, China (J.W., Y.W., J.Y.); Department of Electronic Engineering, Yunnan University, Kunming, China (J.W.); Key Laboratory of Medical Imaging Computing and Computer-Assisted Intervention of Shanghai, Shanghai, China (Y.W.); and Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China (Y.C., Y.P., X.D., Z.Q.)
| | - Yun Pang
- Department of Electronic Engineering, Fudan University, Shanghai, China (J.W., Y.W., J.Y.); Department of Electronic Engineering, Yunnan University, Kunming, China (J.W.); Key Laboratory of Medical Imaging Computing and Computer-Assisted Intervention of Shanghai, Shanghai, China (Y.W.); and Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China (Y.C., Y.P., X.D., Z.Q.)
| | - Xuehong Diao
- Department of Electronic Engineering, Fudan University, Shanghai, China (J.W., Y.W., J.Y.); Department of Electronic Engineering, Yunnan University, Kunming, China (J.W.); Key Laboratory of Medical Imaging Computing and Computer-Assisted Intervention of Shanghai, Shanghai, China (Y.W.); and Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China (Y.C., Y.P., X.D., Z.Q.)
| | - Zhiying Qiu
- Department of Electronic Engineering, Fudan University, Shanghai, China (J.W., Y.W., J.Y.); Department of Electronic Engineering, Yunnan University, Kunming, China (J.W.); Key Laboratory of Medical Imaging Computing and Computer-Assisted Intervention of Shanghai, Shanghai, China (Y.W.); and Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China (Y.C., Y.P., X.D., Z.Q.)
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Deerenberg EB, Timmermans L, Hogerzeil DP, Slieker JC, Eilers PHC, Jeekel J, Lange JF. A systematic review of the surgical treatment of large incisional hernia. Hernia 2014; 19:89-101. [PMID: 25380560 DOI: 10.1007/s10029-014-1321-x] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 10/26/2014] [Indexed: 01/12/2023]
Abstract
PURPOSE Incisional hernia (IH) is one of the most frequent postoperative complications. Of all patients undergoing IH repair, a vast amount have a hernia which can be defined as a large incisional hernia (LIH). The aim of this study is to identify the preferred technique for LIH repair. METHODS A systematic review of the literature was performed and studies describing patients with IH with a diameter of 10 cm or a surface of 100 cm2 or more were included. Recurrence hazards per year were calculated for all techniques using a generalized linear model. RESULTS Fifty-five articles were included, containing 3,945 LIH repairs. Mesh reinforced techniques displayed better recurrence rates and hazards than techniques without mesh reinforcement. Of all the mesh techniques, sublay repair, sandwich technique with sublay mesh and aponeuroplasty with intraperitoneal mesh displayed the best results (recurrence rates of <3.6%, recurrence hazard <0.5% per year). Wound complications were frequent and most often seen after complex LIH repair. CONCLUSIONS The use of mesh during LIH repair displayed the best recurrence rates and hazards. If possible mesh in sublay position should be used in cases of LIH repair.
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Affiliation(s)
- E B Deerenberg
- Department of Surgery, Erasmus University Medical Center Rotterdam, ErasmusMC, Room Ee-173, Postbus 2400, 3000 CA, Rotterdam, The Netherlands,
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71
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Lamoshi AY, Hobbs GR, Khan FJ. Factors affecting hernia recurrence after Strattice mesh repair: A retrospective study. SURGICAL PRACTICE 2014. [DOI: 10.1111/1744-1633.12087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Abdulraouf Y. Lamoshi
- Department of General Surgery; West Virginia University; Morgantown West Virginia USA
| | - Gerry R. Hobbs
- Department of General Surgery; West Virginia University; Morgantown West Virginia USA
| | - Fawad J. Khan
- Department of General Surgery; West Virginia University; Morgantown West Virginia USA
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72
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Positive outcomes with negative pressure therapy over primarily closed large abdominal wall reconstruction reduces surgical site infection rates. Hernia 2014; 19:273-8. [DOI: 10.1007/s10029-014-1312-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 09/12/2014] [Indexed: 11/25/2022]
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73
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Podwojewski F, Otténio M, Beillas P, Guérin G, Turquier F, Mitton D. Mechanical response of human abdominal walls ex vivo: Effect of an incisional hernia and a mesh repair. J Mech Behav Biomed Mater 2014; 38:126-33. [DOI: 10.1016/j.jmbbm.2014.07.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 06/26/2014] [Accepted: 07/01/2014] [Indexed: 11/15/2022]
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Fang L, Chen L, Wang WP, Chen Y, Pang Y, Qiu ZY, Tang JX. Diagnostic value of automated 3D ultrasound for incisional hernia. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:1966-1972. [PMID: 24857417 DOI: 10.1016/j.ultrasmedbio.2014.02.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 02/13/2014] [Accepted: 02/15/2014] [Indexed: 06/03/2023]
Abstract
The automated volume scanning system (AVSS) has been applied in breast diseases, but its use in incisional hernias has not been reported. In this study, conventional handheld B-mode ultrasound (HHUS) and AVSS examined a total of 122 hernia defects in 78 patients. The results from two modalities were then compared with surgical findings for the purpose of assessing the diagnostic value of AVSS. Statistics showed that surgeries identified 38 small, 23 medium and 17 large incisional hernias. The results of AVSS completely agreed with surgical findings; however, HHUS misidentified nine large hernias as medium and seven medium hernias as large. AVSS proved to be more accurate than HHUS in measuring the length and width of the hernia. It also outperformed HHUS in both detecting the incisional hernias (91.8% vs. 78.7%, p = 0.00) and determining hernia contents (89.3% vs. 68.0%, p = 0.00). Moreover, the coronal images AVSS obtained clearly displayed the shapes of the hernias, with 46 being regular and 32 irregular. Overall, AVSS can be used as a promising diagnostic modality for incisional hernias.
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Affiliation(s)
- Liang Fang
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China; Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lin Chen
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Yue Chen
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China.
| | - Yun Pang
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| | - Zhi-Ying Qiu
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| | - Jian-Xiong Tang
- Department of General Surgery, Huadong Hospital, Fudan University, Shanghai, China
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Jerabek J, Novotny T, Vesely K, Cagas J, Jedlicka V, Vlcek P, Capov I. Evaluation of three purely polypropylene meshes of different pore sizes in an onlay position in a New Zealand white rabbit model. Hernia 2014; 18:855-64. [PMID: 25033941 DOI: 10.1007/s10029-014-1278-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Accepted: 06/27/2014] [Indexed: 01/05/2023]
Abstract
BACKGROUND The aim of the study was to evaluate the influence of the pore size of a polypropylene mesh on the shrinkage and elasticity of the mesh-tissue complex and the inflammatory reaction to the implant in an open onlay hernia repair. MATERIALS AND METHODS Twenty-one 10 × 10 cm samples of polypropylene meshes of a different pore size (3.0 × 2.8 mm-PP3, 1.0 × 0.8 mm-PP1 and 0.6 × 0.5 mm-PP.5) were implanted in an onlay position in 21 New Zealand white rabbits. After 90 days of implantation the shrinkage, elasticity and foreign body reaction (FBR) were assessed. RESULTS The shrinkage of PP3 was 30.6 ± 4.3 %, PP1 49.3 ± 2.9 % and PP.5 49.5 ± 2.6 %. The shrinkage of PP3 was significantly lower (PP3 × PP1 p = 0.007, PP3 × PP.5 p = 0.005), PP1 and PP.5 were similar. The elasticity was similar. The strength of FBR in mesh pores was similar. The width of foreign body granuloma layers at the mesh-tissue interface was significantly reduced with increasing pore size (inner: PP3 10.1 ± 1.2; PP1 12.5 ± 2.9; PP.5 17.4 ± 5.2 and outer: PP3 21.2 ± 2.5; PP1 30.6 ± 6.3; PP.5 60.4 ± 14.9). All differences between the widths of granuloma layers were statistically significant (p < 0.010). One animal (PP1) was excluded because of a mesh infection. CONCLUSIONS Implantation of polypropylene mesh of a pore size of 3 mm in an onlay position is associated with a significant reduction of shrinkage in comparison to a 1 mm pore lightweight and 0.5 mm pore heavyweight mesh. A pore size increase to 3 mm is not sufficient for an improvement of mesh-tissue complex elasticity in comparison to a 1 mm pore lightweight and 0.5 mm heavyweight mesh. Polypropylene mesh with enlarged pores to 3 mm is associated with a similar strength of FBR in mesh pores and a reduced foreign body granuloma in comparison to a 1 mm pore lightweight and 0.5 mm pore heavyweight mesh.
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Affiliation(s)
- J Jerabek
- 1st Department of Surgery, St. Anne's University Hospital, Faculty of Medicine, Masaryk University, Pekarska 53, 656 91, Brno, Czech Republic,
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Petersson P, Montgomery A, Petersson U. Wound dehiscence: outcome comparison for sutured and mesh reconstructed patients. Hernia 2014; 18:681-9. [PMID: 24916421 DOI: 10.1007/s10029-014-1268-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 05/23/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Treatment guidelines for abdominal wound dehiscence (WD) are lacking. The primary aim of the study was to compare suture to mesh repair in WD patients concerning incisional hernia incidence. Secondary aims were to compare recurrent WD, morbidity, mortality and long-term abdominal wall complaints. METHODS A retrospective chart review of 46 consecutive patients operated for WD between January 2010 and August 2012 was conducted. Physical examination and a questionnaire enquiry were performed in January 2013. RESULTS Six patients were treated by vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) before definitive closure. Three patients died early resulting in 23 patients closed by suture and 20 by mesh repair. Five sutured, but no mesh repair patients had recurrent WD (p = 0.051) with a mortality of 60 %. Finally, 18 sutured and 21 mesh repair patients were eligible for follow-up. The incidence of incisional hernia was higher for the sutured patients (53 vs. 5 %, p = 0.002), while mesh repair patients had a higher short-term morbidity rate (76 vs. 28 %, p = 0.004). Abdominal wall complaints were rare in both groups. CONCLUSIONS Suture of WD was afflicted with a high incidence of recurrent WD and incisional hernia formation. Mesh repair overcomes these problems at the cost of more wound complications. VAWCM seems to be an alternative for treating contaminated patients until definitive closure is possible. Long-term abdominal wall complaints are uncommon after WD treatment.
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Affiliation(s)
- P Petersson
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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77
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Meta-analysis of sublay versus onlay mesh repair in incisional hernia surgery. Am J Surg 2014; 207:980-8. [DOI: 10.1016/j.amjsurg.2013.08.030] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 06/25/2013] [Accepted: 08/10/2013] [Indexed: 01/30/2023]
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78
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A comparative study of sutured versus bovine pericardium mesh abdominal closure after open abdominal aortic aneurysm repair. Hernia 2014; 19:267-71. [DOI: 10.1007/s10029-014-1262-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 04/28/2014] [Indexed: 11/26/2022]
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79
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Bjarnason T, Montgomery A, Ekberg O, Acosta S, Svensson M, Wanhainen A, Björck M, Petersson U. One-year follow-up after open abdomen therapy with vacuum-assisted wound closure and mesh-mediated fascial traction. World J Surg 2014; 37:2031-8. [PMID: 23703638 DOI: 10.1007/s00268-013-2082-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Open abdomen (OA) therapy frequently results in a giant planned ventral hernia. Vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) enables delayed primary fascial closure in most patients, even after prolonged OA treatment. Our aim was to study the incidence of hernia and abdominal wall discomfort 1 year after abdominal closure. METHODS A prospective multicenter cohort study of 111 patients undergoing OA/VAWCM was performed during 2006-2009. Surviving patients underwent clinical examination, computed tomography (CT), and chart review at 1 year. Incisional and parastomal hernias and abdominal wall symptoms were noted. RESULTS The median age for the 70 surviving patients was 68 years, 77 % of whom were male. Indications for OA were visceral pathology (n = 40), vascular pathology (n = 22), or trauma (n = 8). Median length of OA therapy was 14 days. Among 64 survivors who had delayed primary fascial closure, 23 (36 %) had a clinically detectable hernia and another 19 (30 %) had hernias that were detected on CT (n = 18) or at laparotomy (n = 1). Symptomatic hernias were found in 14 (22 %), 7 of them underwent repair. The median hernia widths in symptomatic and asymptomatic patients were 7.3 and 4.8 cm, respectively (p = 0.031) with median areas of 81.0 and 42.9 cm(2), respectively (p = 0.025). Of 31 patients with a stoma, 18 (58 %) had a parastomal hernia. Parastomal hernia (odds ratio 8.9; 95 % confidence interval 1.2-68.8) was the only independent factor associated with an incisional hernia. CONCLUSIONS Incisional hernia incidence 1 year after OA therapy with VAWCM was high. Most hernias were small and asymptomatic, unlike the giant planned ventral hernias of the past.
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80
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Laparoscopic incisional hernia repair in an ambulatory surgery-extended recovery centre: a review of 259 consecutive cases. Hernia 2014; 19:487-92. [PMID: 24609586 DOI: 10.1007/s10029-014-1229-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 02/15/2014] [Indexed: 01/30/2023]
Abstract
PURPOSE The high prevalence of incisional hernias and an average stay of 3-10 days for open procedures have made this pathology both a health problem and an economic issue. A protocol was developed for performing this procedure in an Ambulatory Surgery Center (ASC) with extended recovery. METHODS From January 2000 to December 2011, data about all laparoscopic incisional hernia repairs were gathered prospectively. The patients' clinical features, hernia type, intraoperative and postoperative complications and reasons for hospital admission are studied. RESULTS A total of 259 patients have been operated for incisional hernia (185) or recurrent hernioplasty (74) in our ASC. Laparoscopic repair was successful in 254 patients (98.07 %). Conversion to open surgery was necessary in five patients (1.93 %). A total of 50 patients (19.69 %) in whom surgery was completed laparoscopically were discharged the same day of surgery, 179 (70.47 %) at 24 h and 25 (9.84 %) required a stay of over 24 h. Postoperative pain was severe in 10 % of patients, moderate in 40 %, and mild in 50 %. Complications, mostly minor and self-limiting, were observed in 25 patients (9.84 %) during hospital stay. Five major complications that occured were: bile peritonitis, an acute peritonitis, due to an inadvertent intestinal perforation, and one intestinal obstruction by partial detachment of the mesh, an intra-abdominal hematoma and a colo-cutaneous fistula. There were no deaths in the series. The mean follow-up of patients was 29.35 months (range 12-129 months). The recurrence rate was 7.03 % (n = 18). Four trocar-site hernias were detected. CONCLUSIONS It is essential to create a protocol with selection criteria that take into account the patient, his entourage, the anesthetic-surgical procedure, and a team dedicated to surgical laparoscopic surgery in an ASC with extended recovery to achieve good results in terms of morbidity and patient safety.
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Abstract
Repair of huge ventral hernias is technically challenging for the surgeon and a major operation for the patient and should be performed by experienced surgeons in centers that are used to caring for patients who are commonly massively obese with significant comorbidities. Preoperative medical optimization of patients is an important part in the overall management of these large hernias. Conventional component separation with retromuscular mesh repair is the workhorse operation, which successfully deals with many giant ventral hernias, but multiple alternative strategies must be available to address situations in which myofascial elements are completely deficient or there is significant loss of domain The complexity of this surgery is reflected by recurrence rates ranging from 10% to 30% and wound complication rates as high as 40% to 50% in experienced centers.
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Affiliation(s)
- Jai Bikhchandani
- Department of General Surgery, Creighton University Medical Center, 601 N 30th Street, Omaha, NE 68131, USA.
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82
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Timmermans L, Deerenberg EB, Lamme B, Jeekel J, Lange JF. Parastomal hernia is an independent risk factor for incisional hernia in patients with end colostomy. Surgery 2014; 155:178-83. [DOI: 10.1016/j.surg.2013.06.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 06/21/2013] [Indexed: 01/22/2023]
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83
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King J, Hayes JD, Richmond B. Repair of giant subcostal hernia using porcine acellular dermal matrix (Strattice™) with bone anchors and pedicled omental flap coverage: a case report. J Med Case Rep 2013; 7:258. [PMID: 24215723 PMCID: PMC3826842 DOI: 10.1186/1752-1947-7-258] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 09/14/2013] [Indexed: 11/17/2022] Open
Abstract
Introduction Giant abdominal wall hernias represent a major challenge to the hernia surgeon in practice today. Of the common abdominal wall hernias, those located in the subcostal region are among the most difficult to repair, and have historically been plagued by higher recurrence rates than other locations, such as the midline. No technique has been identified as the clearly superior choice for hernias of this type. Case presentation We report a successful repair of a giant, multiply recurrent subcostal hernia with loss of domain in a 45-year-old obese Caucasian man. This was accomplished in a novel fashion, using a porcine acellular dermal matrix (Strattice™) as the floor of the repair, which was fixed to the costal margin using orthopedic bone anchors (Mitek™), then covered with a pedicled omental flap to eliminate dead space and facilitate a more rapid revascularization of the porcine acellular dermal matrix implant. Conclusions This case emphasizes the need for a thorough understanding of the challenges of the specific type of hernia defect encountered, as well as knowledge of any available techniques that may be adjunctively employed to enhance the chances of achieving a successful result.
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Affiliation(s)
| | | | - Bryan Richmond
- Department of Surgery, West Virginia University/Charleston Division, 3110 MacCorkle Avenue SE, Charleston, WV 25304, USA.
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84
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Stoikes N, Webb D, Powell B, Voeller G. Preliminary Report of a Sutureless Onlay Technique for Incisional Hernia Repair Using Fibrin Glue Alone for Mesh Fixation. Am Surg 2013. [DOI: 10.1177/000313481307901121] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Rives repair for ventral/incisional (V/I) hernias involves sublay mesh placement requiring retrorectus dissection and transfascial stitches. Chevrel described a repair by onlaying mesh after a unique primary fascial closure. Although Chevrel fixated mesh to the anterior fascia with sutures, he used fibrin glue for fascial closure reinforcement. We describe an onlay technique with mesh fixated to the anterior fascia solely with fibrin glue without suture fixation. From January 2010 to January 2012, 50 patients underwent a V/I hernia onlay technique with fibrin glue mesh fixation. Records were reviewed for technical details, demographics, mesh characteristics, and postoperative outcomes. Primary fascial closure with interrupted permanent suture was done with or without myofascial advancement flaps. Onlay polypropylene mesh was placed providing 8 cm of overlap. Fibrin glue was applied over the prosthesis and subcutaneous drains were placed. Mean age was 62.4 years. Mean body mass index was 30.1 kg/m2. Average mesh size was 14.5 cm 3 19.1 cm. Mean operative time was 144.4 minutes (range, 38 to 316 minutes). Mean discharge was postoperative Day 2.9 (range, 0 to 15 days). Morbidity included eight seromas, one hematoma, and three wound infections. Seventeen patients required components separation. Mean follow-up was 19.5 months with no recurrences. This is the first series describing fibrin glue alone for mesh fixation for V/I hernia repair. It allows for immediate prosthesis fixation to the anterior fascia. Early results are promising. Potential advantages include less operative time, less technical difficulty, and less long-term pain. A prospective trial is needed to evaluate this approach.
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Affiliation(s)
- Nathaniel Stoikes
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - David Webb
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Ben Powell
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Guy Voeller
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
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85
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Slater NJ, Montgomery A, Berrevoet F, Carbonell AM, Chang A, Franklin M, Kercher KW, Lammers BJ, Parra-Davilla E, Roll S, Towfigh S, van Geffen E, Conze J, van Goor H. Criteria for definition of a complex abdominal wall hernia. Hernia 2013; 18:7-17. [PMID: 24150721 DOI: 10.1007/s10029-013-1168-6] [Citation(s) in RCA: 164] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Accepted: 10/03/2013] [Indexed: 12/24/2022]
Abstract
PURPOSE A clear definition of "complex (abdominal wall) hernia" is missing, though the term is often used. Practically all "complex hernia" literature is retrospective and lacks proper description of the population. There is need for clarification and classification to improve patient care and allow comparison of different surgical approaches. The aim of this study was to reach consensus on criteria used to define a patient with "complex" hernia. METHODS Three consensus meetings were convened by surgeons with expertise in complex abdominal wall hernias, aimed at laying down criteria that can be used to define "complex hernia" patients, and to divide patients in severity classes. To aid discussion, literature review was performed to identify hernia classification systems, and to find evidence for patient and hernia variables that influence treatment and/or prognosis. RESULTS Consensus was reached on 22 patient and hernia variables for "complex" hernia criteria inclusion which were grouped under four categories: "Size and location", "Contamination/soft tissue condition", "Patient history/risk factors", and "Clinical scenario". These variables were further divided in three patient severity classes ('Minor', 'Moderate', and 'Major') to provide guidance for peri-operative planning and measures, the risk of a complicated post-operative course, and the extent of financial costs associated with treatment of these hernia patients. CONCLUSION Common criteria that can be used in defining and describing "complex" (abdominal wall) hernia patients have been identified and divided under four categories and three severity classes. Next step would be to create and validate treatment algorithms to guide the choice of surgical technique including mesh type for the various complex hernias.
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Affiliation(s)
- N J Slater
- Department of Surgery, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands,
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Singh DP, Zahiri HR, Gastman B, Holton LH, Stromberg JA, Chopra K, Wang HD, Condé Green A, Silverman RP. A modified approach to component separation using biologic graft as a load-sharing onlay reinforcement for the repair of complex ventral hernia. Surg Innov 2013; 21:137-46. [PMID: 23804996 DOI: 10.1177/1553350613492585] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Components separation has been proposed as a means to close large ventral hernia without undue tension. We report a modification on open components separation that allows for the incorporation of onlaid noncrosslinked porcine acellular dermal matrix (Strattice, LifeCell Corp, Branchburg, NJ) as a load-sharing structure. METHODS This was a retrospective case series including all cases using Strattice from July 2008 through December 2009. Data evaluated included patient demographics, comorbidities associated with risk of recurrence, hernia grade, and postoperative complications. The primary outcomes were hernia recurrence and surgical site occurrences. RESULTS There were 58 patients; 60.8% presented with a recurrent incisional hernia. Average length of follow-up was 384 days. There were 4 hernia recurrences (7.9%). Complications included surgical site infection (20.7%), seroma (15.5%), and hematoma (5%) requiring intervention. Four deaths occurred in the series due to causes unrelated to the hernia repair, only 1 within 30 days of operation. CONCLUSIONS This series demonstrates that components separation reinforced with noncrosslinked porcine acellular dermal matrix onlay is an efficacious, single-stage repair with a low rate of recurrence and surgical site occurrences.
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87
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Parameswaran R, Hornby ST, Kingsnorth AN. Medical talc increases the incidence of seroma formation following onlay repair of major abdominal wall hernias. Hernia 2013; 17:459-63. [PMID: 23644773 DOI: 10.1007/s10029-013-1097-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 04/26/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Seroma is a well established complication of the repair of major abdominal wall hernias, occasionally requiring aspiration and reoperation. Medical talc seromadesis (MTS) has been described in the literature. The aim of this study was to determine the effect of MTS on seroma formation after onlay repair of incisional hernia. METHODS A retrospective review of a prospective database was conducted for 5 months from April 2011, when 21 consecutive patients received MTS. Outcomes were compared with a published and validated series from the same unit. RESULTS There were no differences in basic demographics and co-morbidities between the two groups. The mean BMI was 34 for the MTS group. The incidence of recurrent incisional hernia prior to surgery was greater in MTS (9/21 vs. 36/116, p = 0.39). The mean area of fascial defect measured intra-operatively and mesh used to cover the incisional hernia defect was 170 and 309 cm(2) for the MTS group. The mean operating time was 152 min and a mean of 10 g of medical talc was used for seromadesis. The seroma rate increased from 11/116 (9.5 %) to 16/21 (76 %) (p = 0.001) as did the rate of superficial wound infection 10/116 (8.6 %) to 9/21 (43 %) (p = 0.03) in the MTS group. There was no difference in the length of in-hospital stay between the two groups. CONCLUSIONS The application of medical talc increased the rate of seroma formation and superficial wound infection in patients undergoing open 'onlay' repair of major abdominal wall hernia.
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Affiliation(s)
- R Parameswaran
- Department of Upper GI Surgery, The Maidstone and Tunbridge Wells Hospital, Hermitage Lane, Maidstone, ME16 9QQ, UK.
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88
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Brandl A, Laimer E, Perathoner A, Zitt M, Pratschke J, Kafka-Ritsch R. Incisional hernia rate after open abdomen treatment with negative pressure and delayed primary fascia closure. Hernia 2013; 18:105-11. [PMID: 23456149 DOI: 10.1007/s10029-013-1064-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 02/17/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE Various techniques for delayed primary fascia closure have been published in patients treated with open abdomen (OA) and application of negative pressure, but to date, no data are available on incisional hernia (IH) rate. The aim of this retrospective analysis was to investigate the long-term outcome of this patient population with special interest in IH development. METHODS Two hundred and nine consecutive patients, 90(43 %) female, were treated at our institution for various abdominal emergencies involving OA from June 2006 to June 2011. Mean age was 63(16-92) years. The indication was abdominal sepsis in 155(74 %) patients, ischemia in 24(12 %) and other reasons in 30(14 %). Hospital mortality was 21 %(n = 44); and planned ventral hernia was 7 %(n = 15); and mortality until follow-up was 16 %(n = 25), and 9 %(n = 13) patients were lost to follow-up, leaving 112 patients for evaluation of IH development. RESULTS The rate of IH for patients with OA and delayed primary fascia closure was overall 35 % at a median (range) follow-up time of 26(12-81) months. Mean time for development of a ventral hernia was 11 months; 21(57 %) patients underwent surgery for symptomatic hernia (2 emergency operations for incarceration). Kaplan-Meier estimate for 5 years gave a 66 % IH rate. BMI, small bowel as source of infection and rapid adsorbable interrupted suture were identified risk factors. CONCLUSION The rate of IH after open abdomen treatment with delayed primary fascia closure is high with a running suture with slow absorbable suture material showing the best results.
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Affiliation(s)
- A Brandl
- Department of Visceral, Thorax and Transplant Surgery, University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
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89
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Abstract
Mesh materials have undergone a considerable evolution over the last several decades. There has been enhancement of biomechanical properties, improvement in manufacturing processes, and development of antiadhesive laminate synthetic meshes. The evolution of bioprosthetic mesh materials has markedly changed our indications and methods for complex abdominal wall reconstruction. The authors review the optimal properties of bioprosthetic mesh materials, their evolution over time, and their indications for use. The techniques to optimize outcomes are described using bioprosthetic mesh for complex abdominal wall reconstruction. Bioprosthetic mesh materials clearly have certain advantages over other implantable mesh materials in select indications. Appropriate patient selection and surgical technique are critical to the successful use of bioprosthetic materials for abdominal wall repair.
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Affiliation(s)
- Donald P Baumann
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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90
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Ahn BK. Risk factors for incisional hernia and parastomal hernia after colorectal surgery. JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2013; 28:280-1. [PMID: 23346503 PMCID: PMC3548139 DOI: 10.3393/jksc.2012.28.6.280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Byung-Kwon Ahn
- Department of Surgery, Kosin University College of Medicine, Busan, Korea
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91
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Repair of large and giant incisional hernia with onlay mesh: perspective of a tertiary care hospital of a developing country. Int J Surg 2012. [PMID: 23178155 DOI: 10.1016/j.ijsu.2012.11.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Ventral incisional hernias, especially large and giant, carry significant post repair complications. This retrospective review is undertaken to determine the outcomes of large and giant incisional hernia repair as well as the risk factors of recurrence and surgical site infection at a tertiary care hospital in developing country. METHOD This case series included adult patients, operated between January 2001 and June 2009 for incisional hernia of size ≥ 10 cm (vertical or horizontal dimension) at our institute with follow up of at least one year. The charts of selected patients were reviewed by a general surgery fellow for hernia recurrence, complications, mortality and the predictive factors. RESULTS Sixty out of 391 patients operated for incisional hernia were found eligible; of them 29 (48.3%) had large (defect of 10-15 cm) and 31 (51.7%) had giant hernia (defect size >15 cm). Mean age of patients was 43.8 ± 11.8 with female preponderance (male: female; 1:1.6). Fourteen (23.33%) patients developed complications and there was no mortality. Surgical Site Infection (SSI) was observed in 13 (21.67%) patients and significant predisposing factors for SSI (with or without mesh infection) were diabetes mellitus, emergency surgery, contaminated surgery and recurrent incisional hernia. With a mean follow up of 20.05 ± 8.8 months (range: 12-48 months), four (6.67%) patients had recurrence of hernia. CONCLUSIONS Repair of large and giant incisional hernia using prosthetic non-absorbable mesh, mainly onlay, carry acceptable rates of complications.
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Importance of recurrence rating, morphology, hernial gap size, and risk factors in ventral and incisional hernia classification. Hernia 2012; 18:19-30. [PMID: 23070583 DOI: 10.1007/s10029-012-0999-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Accepted: 09/30/2012] [Indexed: 02/05/2023]
Abstract
BACKGROUND There is limited evidence on the natural course of ventral and incisional hernias and the results of hernia repair, what might partially be explained by the lack of an accepted classification system. The aim of the present study is to investigate the association of the criteria included in the Wuerzburg classification system of ventral and incisional hernias with postoperative complications and long-term recurrence. METHODS In a retrospective cohort study, the data on 330 consecutive patients who underwent surgery to repair ventral and incisional hernias were analyzed. The following four classification criteria were applied: (a) recurrence rating (ventral, incisional or incisional recurrent); (b) morphology (location); (c) size of the hernial gap; and (d) risk factors. The primary endpoint was the occurrence of a recurrence during follow-up. Secondary endpoints were incidence of postoperative complications. Independent association between classification criteria, type of surgical procedures and postoperative complications was calculated by multivariate logistic regression analysis and between classification criteria, type of surgical procedures and risk of long-term recurrence by Cox regression analysis. RESULTS Follow-up lasted a mean 47.7 ± 23.53 months (median 45 months) or 3.9 ± 1.96 years. The criterion "recurrence rating" was found as predictive factor for postoperative complications in the multivariate analysis (OR 2.04; 95 % CI 1.09-3.84; incisional vs. ventral hernia). The criterion "morphology" had influence neither on the incidence of the critical event "recurrence during follow-up" nor on the incidence of postoperative complications. Hernial gap "width" predicted postoperative complications in the multivariate analysis (OR 1.98; 95 % CI 1.19-3.29; ≤5 vs. >5 cm). Length of the hernial gap was found to be an independent prognostic factor for the critical event "recurrence during follow-up" (HR 2.05; 95 % CI 1.25-3.37; ≤5 vs. >5 cm). The presence of 3 or more risk factors was a consistent predictor for "recurrence during follow-up" (HR 2.25; 95 % CI 1.28-9.92). Mesh repair was an independent protective factor for "recurrence during follow-up" compared to suture (HR 0.53; 95 % CI 0.32-0.86). CONCLUSIONS The ventral and incisional hernia classification of Dietz et al. employs a clinically proven terminology and has an open classification structure. Hernial gap size and the number of risk factors are independent predictors for "recurrence during follow-up", whereas recurrence rating and hernial gap size correlated significantly with the incidence of postoperative complications. We propose the application of these criteria for future clinical research, as larger patient numbers will be needed to refine the results.
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93
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Abdalla RZ, Garcia RB, Costa RIDD, Luca CRPD, Abdalla BMZ. Procedimento de Rives/Stoppa modificado robô-assistido para correção de hernias ventrais da linha média. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2012; 25:129-32. [DOI: 10.1590/s0102-67202012000200014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Accepted: 02/09/2012] [Indexed: 11/22/2022]
Abstract
RACIONAL: Os defeitos da linha média podem ser congênitos ou adquiridos. Os procedimentos convencionais para correção desse defeito geralmente envolvem grandes incisões, com grandes descolamentos de pele e tecido celular subcutâneo. O uso da videocirurgia para a correção desses defeitos, ainda é controverso. OBJETIVOS: Realizar descrição inédita na literatura, mostrando a experiência inicial do uso da robótica nas reconstruções de linha média, associando a cirurgia minimamente invasiva à técnicas consagradas como Rives/Stoppa e separação de componentes. MÉTODOS: Foram operados cinco pacientes no mesmo hospital, pela mesma equipe, usando o sistema robótico da Vinci S. RESULTADOS: Foram três mulheres e dois homens, sem mortalidade na amostra. Duas pacientes foram reoperadas com hérnia pelo tunel entre os músculos retos do abdomen e aponeurose posterior, com fechamento dos mesmos na reoperação. CONCLUSÕES: O procedimento robótico para reconstrução da linha média mostrou-se factível e esteticamente aceitável. Tem a vantagem de seguir os princípios tradicionais aventados para a parede abdominal através de via minimamente invasiva.
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94
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Validation of a questionnaire for the assessment of pain following ventral hernia repair--the VHPQ. Langenbecks Arch Surg 2012; 397:1219-24. [PMID: 22446989 DOI: 10.1007/s00423-012-0932-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2011] [Accepted: 02/14/2012] [Indexed: 02/01/2023]
Abstract
PURPOSE The aim of this study was to create and evaluate the validity and reliability of a novel ventral hernia pain questionnaire (VHPQ) to assess pain following surgery for ventral hernia. METHODS The questionnaire was constructed using focus groups and patient interviews. Validity was tested on 51 patients who responded to the VHPQ and brief pain inventory (BPI) 1 and 4 weeks following surgery. Reliability and internal consistency was tested on 74 patients who had surgery 3 years earlier and received the VHPQ and BPI on two separate occasions. Pain not related to surgery was examined on one occasion using the VHPQ on 100 non-operated people. RESULTS For pain intensity items, a significant decrease was seen from week 1 to week 4 postoperative (p < 0.05). Spearman rank correlations were significant between the pain intensity items of the VHPQ and the BPI, tested 1 week postoperative (p < 0.05). Kappa levels for test-retest of items for interference with daily activities were higher than 0.5 for all items except one. Intra-class correlation was significant for pain intensity items (p < 0.05) in the test-retest group. Three years after surgery, the operated group stated more pain in the pain intensity items (p < 0.05) and more interference with daily activities (p < 0.05) than a non-operated group from the general population. CONCLUSION The validity and reliability of the VHPQ make it a useful tool in assessing postoperative pain and patient satisfaction.
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95
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Smart NJ, Marshall M, Daniels IR. Biological meshes: a review of their use in abdominal wall hernia repairs. Surgeon 2012; 10:159-71. [PMID: 22436406 DOI: 10.1016/j.surge.2012.02.006] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 02/23/2012] [Accepted: 02/23/2012] [Indexed: 12/13/2022]
Abstract
PURPOSE Biological meshes are mostly used in infected fields within complex abdominal wall hernia repairs. There is no consensus, however, on the most appropriate material to be used in a given situation. METHODS A literature review of published articles reporting the utilization of biological meshes in ventral/incisional hernia repair was conducted. Data were analyzed to compare the recurrence rates obtained with biological meshes. MAIN FINDINGS Only a few prospective comparative studies were identified. Most publications relate to AlloDerm®, Permacol™ and Surgisis™ with data from other meshes insufficient to draw conclusions. AlloDerm has a 0-100% recurrence rate among studies. It compares poorly with Surgisis and results in an unfavorable outcome when used as a 'bridge prosthesis'. Permacol has consistent recurrence rates of 0-15%, whatever the patients' profiles or the context of infected fields, when considering the most relevant studies. The Surgisis results are more conflicting: the mesh exhibits low recurrence rates in clean fields, but in infected fields the recurrence rate is up to 39%. CONCLUSION Taken together, these studies suggest that the cross-linked mesh, Permacol has the lowest failure rate and the longest time to failure, particularly in contaminated or infected fields. However, this data should be confirmed by large prospective randomized studies.
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Affiliation(s)
- Neil J Smart
- Exeter Surgical Health Sciences Research Unit (HESRU), Royal Devon & Exeter Hospital, Barrack Road, Exeter, Devon, EX2 5DW, UK.
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96
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Pre-operative progressive pneumoperitoneum for repair of a large incisional hernia. Updates Surg 2012; 65:165-8. [PMID: 22392573 DOI: 10.1007/s13304-012-0134-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 01/30/2012] [Indexed: 10/28/2022]
Abstract
Large incisional hernias are difficult to treat surgically because of the post-operative respiratory complications and abdominal compartment syndrome. Pre-operative progressive pneumoperitoneum is a technique which has been used in such cases. We describe a case of a large incisional hernia, where this technique was employed by objectively calculating abdominal and hernial sac volumes on the basis of computerized tomography scan of abdomen with a satisfactory outcome. A review of literature and issues involved in pre-operative progressive pneumoperitoneum have been discussed.
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97
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Evaluation of a knitted polytetrafluoroethylene mesh placed intraperitoneally in a New Zealand white rabbit model. Surg Endosc 2012; 26:1884-91. [PMID: 22219009 DOI: 10.1007/s00464-011-2120-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 12/05/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND The intraperitoneal application of surgical mesh remains a controversial issue because of possible complications, especially adhesion and fistula formation. This study aimed to assess the potential of a knitted polytetrafluoroethylene (PTFE) mesh for intraabdominal implantation. METHODS Twenty-eight 5 × 5 cm samples of knitted macroporous PTFE mesh and light-weight polypropylene mesh (LW-PP) were implanted intraperitoneally in 14 New Zealand white rabbits in a randomized manner and fixed using eight polypropylene stitches. After 90 days, the adhesion formation, adhesion score, shrinkage, strength of fixation to the abdominal wall, and histologic biocompatibility were assessed. RESULTS No intraoperative or anesthesia-related complications or mesh infection were recorded. The average area covered by adhesions was 4.7 ± 7.2% for the PTFE and 36.4 ± 36.1% for the LW-PP. The median adhesion score was 0 for the PTFE and 8 for the LW-PP. Shrinkage was 36.9 ± 12.9% for the PTFE mesh and 12.6 ± 8.72% for the LW-PP. The mesh-to-abdominal wall fixation strength was almost the same for both materials (PTFE 3.6 ± 1.9 vs. LW-PP 3.6 ± 2.9). The inflammatory cell count was almost the same for the two groups, with no statistically significant difference. The width of the inner granuloma was equal (PTFE 10.5 ± 0.9 vs. LW-PP 11.1 ± 0.9). The outer granuloma was reduced significantly in the PTFE group (PTFE 23.0 ± 2.1 vs. LW-PP 33.6 ± 7.9). One of the animals in the PTFE group died on postoperative day 12 because of ileus. The reason was an adhesion of the small intestine to the polypropylene fixation stitch, which caused small intestine strangulation. CONCLUSIONS The knitted PTFE mesh induces fewer intraperitoneal adhesions of lower density than the light-weight polypropylene mesh. The strength of the knitted PTFE mesh fixation to the abdominal wall is comparable with that of the light-weight polypropylene mesh, but the shrinkage is greater. The biocompatibility of the knitted PTFE mesh is comparable with that of the light-weight polypropylene implant.
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98
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Moreno-Egea A, Carrillo-Alcaraz A. Management of non-midline incisional hernia by the laparoscopic approach: results of a long-term follow-up prospective study. Surg Endosc 2011; 26:1069-78. [PMID: 22042591 DOI: 10.1007/s00464-011-2001-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Accepted: 10/10/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND The role of the laparoscopic approach in the repair of non-midline incisional hernias is controversial due to the absence of adequate scientific studies. This study aimed to determine the safety and efficacy of laparoscopic repair for non-midline incisional hernias. METHODS This prospective clinical study was conducted in an abdominal wall unit of a teaching hospital. Patients underwent surgery for non-midline incisional hernias using the laparoscopic approach (n = 73) and were classified into three groups: subcostal, iliac, and lumbar. The primary end point was recurrence. The secondary end points were intraoperative parameters, comorbidity, and patient outcomes. The median follow-up period was 62 months (range, 36-170 months). RESULTS No hospital stay was needed for 34% of the patients. The remaining patients needed an average hospital stay of 2.7 days. The most frequent morbidity was hematoma. The overall recurrence rate was 8.2% and was higher for the subcostal hernias (25%). The three groups differed in size, local morbidity, and recurrence (P < 0.05). The independent risk factors for recurrence were size (hazard ratio [HR], 2.16; 95% confidence interval [CI], 1.08-4.33) and local morbidity (HR 30.62; 95% CI 1.22-768-82). The best predictor of recurrence was a hernia diameter greater than 15 cm. The only predictive factor of local morbidity was obesity (P < 0.007). CONCLUSIONS The laparoscopic approach is a safe and effective treatment for non-midline incisional hernias. Caution should be taken with subcostal hernias, obese patients, and a defect size greater than 15 cm. An algorithm is suggested to guide the "rational" treatment of non-midline incisional hernias.
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Affiliation(s)
- Alfredo Moreno-Egea
- Abdominal Wall Unit, Department of Surgery, J. M. Morales Meseguer Hospital, Avenida Primo de Rivera 7, 5º D, Edif, 30008, Murcia, Berlin, Spain.
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Comparison of ultrasonography and physical examination in the diagnosis of incisional hernia in a prospective study. Hernia 2011; 16:53-7. [DOI: 10.1007/s10029-011-0865-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Accepted: 07/14/2011] [Indexed: 10/17/2022]
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Sabbagh C, Dumont F, Fuks D, Yzet T, Verhaeghe P, Regimbeau JM. Progressive preoperative pneumoperitoneum preparation (the Goni Moreno protocol) prior to large incisional hernia surgery: volumetric, respiratory and clinical impacts. A prospective study. Hernia 2011; 16:33-40. [PMID: 21773758 DOI: 10.1007/s10029-011-0849-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Accepted: 06/24/2011] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Progressive preoperative pneumoperitoneum (PPP) is used to prepare incisional hernias with loss of domain (IHLD) operations. The aim of the present study was to analyze the effect of PPP on peritoneal volume [measured using a new computed tomography (CT)-based method] and respiratory function. METHODS From July 2004 to July 2008, 19 patients were included in a prospective, observational study. The volumes of the incisional hernia (VIH), the abdominal cavity (VAC), the total peritoneal content (VP) and the VIH/VP ratio were measured before and after PPP using abdominal CT scan data. Spirometric parameters were measured before and after PPP, and postoperative clinical data were evaluated. RESULTS Before and after PPP, the mean VIH was 1,420 cc and 2,110 cc (P < 0.01), and the mean VAC was 9,083 cc and 11,104 cc (P < 0.01). The VAC increased by 2,021 cc (P < 0.01) and was greater than the mean VIH before PPP. After PPP, the spirometric measurements revealed a restrictive syndrome. The overall postoperative morbidity rate was 37%. CONCLUSIONS PPP increased the hernia and abdominal volumes. PPP induced a progressive, restrictive syndrome.
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Affiliation(s)
- C Sabbagh
- Department of Digestive Surgery, Amiens University Medical Center, Place Victor Pauchet, 80054 Amiens Cedex 01, France
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