51
|
Honig S, Diener H, Kölbel T, Reinpold W, Zapf A, Bibiza-Freiwald E, Debus ES. Abdominal incision defect following AAA-surgery (AIDA): 2-year results of prophylactic onlay-mesh augmentation in a multicentre, double-blind, randomised controlled trial. Updates Surg 2021; 74:1105-1116. [PMID: 34287760 PMCID: PMC9213335 DOI: 10.1007/s13304-021-01125-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/25/2021] [Indexed: 11/24/2022]
Abstract
The reported incidence of incisional hernia following repair of abdominal aortic aneurysm (AAA) via midline laparotomy is up to 69%. This prospective, multicenter, double-blind, randomised controlled trial was conducted at eleven hospitals in Germany. Patients aged 18 years or older undergoing elective AAA-repair via midline incision were randomly assigned using a computer-generated randomisation sequence to one of three groups for fascial closure: with long-term absorbable suture (MonoPlus®, group I), long-term absorbable suture and onlay mesh reinforcement (group II) or extra long-term absorbable suture (MonoMax®, group III). The primary endpoint was the incidence of incisional hernia within 24 months of follow-up, analysed by intention to treat. Physicians conducting the postoperative visits and the patients were blinded. Between February 2011 and July 2013, 104 patients (69.8 ± 7.7 years) were randomised, 99 of them received a study intervention. The rate of incisional hernia within 24 months was not significantly reduced with onlay mesh augmentation compared to primary suture (p = 0.290). Furthermore, the rate of incisional hernia did not differ significantly between fascial closure with slow and extra long-term absorbable suture (p = 0.111). Serious adverse events related to study intervention occurred in five patients (5.1%) from treatment groups II and III. Wound healing disorders were more frequently seen after onlay mesh implantation on the day of discharge (p = 0.010) and three (p = 0.009) and six (p = 0.023) months postoperatively. The existing evidence on prophylactic mesh augmentation in patients undergoing AAA-repair via midline laparotomy probably needs critical review. As the implementation of new RCTs is considered difficult due to the increasing number of endovascular AAA treated, registry studies could help to collect and evaluate data in cases of open AAA-repair. Comparisons between prophylactic mesh implantation and the small bite technique are also required. Trial registration: ClinicalTrials.gov Identifier: NCT01353443. Funding Sources: Aesculap AG, Tuttlingen, Germany.
Collapse
Affiliation(s)
- S Honig
- Department for Vascular Medicine, Vascular Surgery, Endovascular Therapy and Angiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - H Diener
- Department for Vascular Medicine, Vascular Surgery, Endovascular Therapy and Angiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - T Kölbel
- Department for Vascular Medicine, Vascular Surgery, Endovascular Therapy and Angiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - W Reinpold
- Department for Surgery, Hospital Wilhelmsburg Groß-Sand, Groß-Sand 3, 21107, Hamburg, Germany
| | - A Zapf
- Institute for Medical Biometry and Epidemology, University Medical Center Hamburg Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - E Bibiza-Freiwald
- Institute for Medical Biometry and Epidemology, University Medical Center Hamburg Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - E S Debus
- Department for Vascular Medicine, Vascular Surgery, Endovascular Therapy and Angiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | | |
Collapse
|
52
|
Gignoux B, Bayon Y, Martin D, Phan R, Augusto V, Darnis B, Sarazin M. Incidence and risk factors for incisional hernia and recurrence: Retrospective analysis of the French national database. Colorectal Dis 2021; 23:1515-1523. [PMID: 33570808 DOI: 10.1111/codi.15581] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/06/2020] [Accepted: 12/15/2020] [Indexed: 12/13/2022]
Abstract
AIM The aim of this work was to determine the rate of incisional hernia (IH) repair and risk factors for IH repair after laparotomy. METHOD This population-based study used data extracted from the French Programme de Médicalisation des Systèmes d'Informations (PMSI) database. All patients who had undergone a laparotomy in 2010, their hospital visits from 2010 to 2015 and patients who underwent a first IH repair in 2013 were included. Previously identified risk factors included age, gender, high blood pressure (HBP), obesity, diabetes and chronic obstructive pulmonary disease (COPD). RESULTS Among the 431 619 patients who underwent a laparotomy in 2010, 5% underwent IH repair between 2010 and 2015. A high-risk list of the most frequent surgical procedures (>100) with a significant risk of IH repair (>10% at 5 years) was established and included 71 863 patients (17%; 65 procedures). The overall IH repair rate from this list was 17%. Gastrointestinal (GI) surgery represented 89% of procedures, with the majority of patients (72%) undergoing lower GI tract surgery. The IH repair rate was 56% at 1 year and 79% at 2 years. Risk factors for IH repair included obesity (31% vs 15% without obesity, p < 0.001), COPD (20% vs 16% without COPD), HBP (19% vs 15% without HBP) and diabetes (19% vs 16% without diabetes). Obesity was the main risk factor for recurrence after IH repair (19% vs 13%, p < 0.001). CONCLUSION From the PMSI database, the real rate of IH repair after laparotomy was 5%, increasing to 17% after digestive surgery. Obesity was the main risk factor, with an IH repair rate of 31% after digestive surgery. Because of the important medico-economic consequences, prevention of IH after laparotomy in high-risk patients should be considered.
Collapse
Affiliation(s)
| | - Yves Bayon
- Sofradim Production, a Medtronic company, Trevoux, France
| | | | - Raksmey Phan
- Ecole des Mines de Saint-Etienne, Saint-Etienne, France
| | | | | | | |
Collapse
|
53
|
Kohler A, Lavanchy JL, Gasser R, Wyss R, Nowak L, Scheiwiller A, Hämmerli P, Candinas D, Beldi G. Mesh fixation to fascia during incisional hernia repair results in increased prevalence of pain at long-term follow up: a multicenter propensity score matched prospective observational study. Surg Endosc 2021; 36:951-958. [PMID: 33620567 PMCID: PMC8758635 DOI: 10.1007/s00464-021-08355-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 02/03/2021] [Indexed: 10/29/2022]
Abstract
BACKGROUND Patient-reported outcomes such as postoperative pain are critical for the evaluation of outcomes after incisional hernia repair. The aim of this study is to determine the long-term impact of mesh fixation on postoperative pain in patients operated by open and laparoscopic technique. METHODS A multicenter prospective observational cohort study was conducted from September 2011 until March 2016 in nine hospitals across Switzerland. Patients undergoing elective incisional hernia repair were included in this study and stratified by either laparoscopic or open surgical technique. Propensity score matching was applied to balance the differences in baseline characteristics between the treatment groups. Clinical follow-up was conducted 3, 12 and 36 months postoperatively to detect hernia recurrence, postoperative pain and complications. RESULTS Three-hundred-sixty-one patients were included into the study. No significant differences in hernia recurrence and pain at 3, 12 and 36 months postoperatively were observed when comparing the laparoscopic with the open treatment group. Mesh fixation by sutures to fascia versus other mesh fixation led to significantly more pain at 36 months postoperatively (32.8% vs 15.7%, p = 0.025). CONCLUSIONS At long-term follow-up, no difference in pain was identified between open and laparoscopic incisional hernia repair. Mesh fixation by sutures to fascia was identified to be associated with increased pain 36 months after surgery. Omitting mesh fixation by sutures to the fascia may reduce long-term postoperative pain after hernia repair.
Collapse
Affiliation(s)
- Andreas Kohler
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Joël L Lavanchy
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Rahel Gasser
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roland Wyss
- Department of Visceral and Thoracic Surgery, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Lars Nowak
- Department of Surgery, Spital Grabs, Grabs, Switzerland
| | - Andreas Scheiwiller
- Department of General and Visceral Surgery, Kantonsspital Luzern, Luzern, Switzerland
| | - Peter Hämmerli
- Department of Surgery, Spital Walenstadt, Walenstadt, Switzerland
| | - Daniel Candinas
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Guido Beldi
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| |
Collapse
|
54
|
How-we-do-it: the repair of postoperative ventral hernias after a Mercedes abdominal incision. Langenbecks Arch Surg 2021; 406:2117-2123. [PMID: 33587182 DOI: 10.1007/s00423-021-02087-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/11/2021] [Indexed: 12/07/2022]
Abstract
PURPOSE To describe the abdominal wall reconstruction technique with an Ultrapro mesh and outcome for the repair of postoperative ventral hernias after the use of a Mercedes incision during the initial abdominal operation. METHOD A retrospective review of all the patients undergoing elective postoperative ventral hernia repair between 2013 and 2019. The cohort of these patients that had an initial Mercedes incision was used for this study. RESULTS Fourteen patients met the criteria for this study. Thirteen of the patients were transplant patients (10 liver transplant and 3 combined pancreas and kidney transplant), and one patient was after a hepatectomy. Fifty-seven percent of these hernias were multiple defects. All the patients underwent the same repair of a modified Rives-Stoppa, transversus abdominis release, and a bilateral transverse plication. A partially absorbable Ultrapro mesh was used for all the patients, with two of the patients needing an additional Symbotex mesh in order to bridge a portion of the posterior fascia. There were 6 minor early postoperative complications (hematoma, superficial wound infection, and seroma) that did not require reoperation. Two patients were readmitted for observation of a wound hematoma, and two patients (14.2%) had recurrence during the follow-up period. The average length of hospitalization was 5.6 days. CONCLUSION This technique, with the use of an Ultrapro mesh, was found to be safe and effective for the repair of a postoperative ventral hernia due to an initial Mercedes incision.
Collapse
|
55
|
Elhage SA, Thielen ON, Otero J, Huber AT, Grigg TM, Suddreth CE, Monjimbo GA, Prasad T, Augenstein VA, Heniford BT. Perceptions and understanding about mesh and hernia surgery: What do patients really think? Surgery 2021; 169:1400-1406. [PMID: 33461777 DOI: 10.1016/j.surg.2020.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/29/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Surgical mesh and hernia repair have come under increasing scrutiny with large amounts of press, Internet, and social media reportage regarding ongoing mesh litigation, recalls, and patient testimonials. The aim of this study was to evaluate patient perceptions of mesh in hernia surgery. METHODS A 16-question survey was given to patients presenting for hernia surgery at a tertiary hernia center by trained data analysts before surgeon interaction. RESULTS Two hundred and two patients were surveyed. Patients believed mesh caused complications (45.1%) and reported concerns about mesh (38.2%). Those who performed their own research, females, and patients with recurrent hernias were more likely to have concerns about mesh (P ≤ 0.03). Most patients (81.7%) thought they were at average risk or less for complications; patients with recurrent hernias (versus primary hernias) and incisional hernias (compared with inguinal or umbilical hernias) had more negative outlooks on complications (all P < .05). Recovery expectations varied, but the failed repair and incisional hernia groups were more likely to expect prolonged recovery (>3 months) (all P < .05). After surgeon-directed education and a mesh education handout, all but one patient agreed to and underwent a mesh repair as indicated. CONCLUSION Patients had concerns about mesh and were aware of mesh related complications. Patients performing their own research, as well as females and recurrent hernia patients, had worse perceptions of mesh. Recurrent and incisional hernia patients had greater concerns about complications, recurrence, and recovery. Preoperative education concerning mesh and mesh choice for each operation eased patient anxiety.
Collapse
Affiliation(s)
- Sharbel A Elhage
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC
| | - Otto N Thielen
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC
| | - Javier Otero
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC
| | - Andrew T Huber
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC
| | - Taylor M Grigg
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC
| | - Caleb E Suddreth
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC
| | - George A Monjimbo
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC
| | - Tanushree Prasad
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC
| | - Vedra A Augenstein
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC
| | - B Todd Heniford
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC.
| |
Collapse
|
56
|
Pereira Rodríguez JA, Amador-Gil S, Bravo-Salva A, Montcusí-Ventura B, Sancho-Insenser JJ, Pera-Román M, López-Cano M. Small bites technique for midline laparotomy closure: From theory to practice: Still a long way to go. Surgery 2021; 170:140-145. [PMID: 33455821 DOI: 10.1016/j.surg.2020.12.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/03/2020] [Accepted: 12/05/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND The closure technique of the abdominal wall is a key factor in the development of incisional hernia. Our aim was to implement a protocol for closure of median laparotomy, to evaluate the grade of implementation, as well as to assess the results and safety of the technique. METHODS A series of formative activities to implement the small bites technique for closure of median laparotomy in elective operations were designed. After 1 year, a survey was conducted on knowledge and use of the technique. Prospective compilation of data of all median laparotomy in elective operations and their follow-up was done for 1 year. The incidence of incisional hernia depending on the fulfilment of the protocol was compared. RESULTS A total of 74 surgeons participated in the activities. All the participants accomplished the technique perceiving low difficulty (1.9/10). After 1 year, 44 surgeons answered the survey; 95% stated that they knew the small bites technique and used it always or almost always, but only 52% performed the calculation of the suture length and the incision length ratio. A total of 114 median laparotomy in elective operations were analyzed; among them, 30.7% were closed with small bites presenting a lower frequency of incisional hernia and burst abdomen (small bites 3.6% vs large bites 12.1%; odds ratio 1.30; confidence interval, 0.992--1.711; P = .20). CONCLUSION The measures were effective for learning, but education alone was not enough to implement the technique in the real scenario. Small bites technique is reproducible, has no risks, and provides low incidence of incisional hernia. More incentives and actions are needed to improve laparotomy closure.
Collapse
Affiliation(s)
- José Antonio Pereira Rodríguez
- Department of General and Digestive Surgery, Hospital Universitario del Mar, Parc de Salut Mar, Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona.
| | | | - Alejandro Bravo-Salva
- Department of General and Digestive Surgery, Hospital Universitario del Mar, Parc de Salut Mar, Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona
| | - Blanca Montcusí-Ventura
- Department of General and Digestive Surgery, Hospital Universitario del Mar, Parc de Salut Mar, Barcelona, Spain
| | - J J Sancho-Insenser
- Department of General and Digestive Surgery, Hospital Universitario del Mar, Parc de Salut Mar, Barcelona, Spain; Department of Surgery, Universitat Autónoma de Barcelona
| | - Miguel Pera-Román
- Department of General and Digestive Surgery, Hospital Universitario del Mar, Parc de Salut Mar, Barcelona, Spain; Department of Surgery, Universitat Autónoma de Barcelona
| | - Manuel López-Cano
- Department of Surgery, Universitat Autónoma de Barcelona; Department of General and Digestive Surgery, Hospital Valle de Hebrón, Barcelona
| |
Collapse
|
57
|
Garcia-Urena MA. Preventing incisional ventral hernias: important for patients but ignored by surgical specialities? A critical review. Hernia 2021; 25:13-22. [PMID: 33394256 DOI: 10.1007/s10029-020-02348-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/16/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Incisional ventral hernias (IHs) are a common complication across all surgical specialities requiring access to the abdomen, pelvis, and retroperitoneum. This public health issue continues to be widely ignored, resulting in appreciable morbidity and expenses. In this critical review, the issue is explored by an interdisciplinary group. METHODS A group of European surgeons encompassing representatives from abdominal wall, vascular, urological, gynecological, colorectal and hepato-pancreatico-biliary surgery have reviewed the occurrence of His in these disciplines. RESULTS Incisional hernias are a major public health issue with appreciable morbidity and cost implications. General surgeons are commonly called upon to repair IHs following an initial operation by others. Measures that may collectively reduce the frequency of IH across specialities include better planning and preparation (e.g. a fit patient, no time pressure, an experienced operator). A minimally invasive technique should be employed where appropriate. Our main recommendations in midline incisions include using the 'small bites' suture technique with a ≥ 4:1 suture-to-wound length, and adding prophylactic mesh augmentation in patients more likely to suffer herniation. For off-midline incisions, more research of this problem is essential. CONCLUSION Meticulous closure of the incision is significant for every patient. Raising awareness of the His is necessary in all surgical disciplines that work withing the abdomen or retroperitoneum. Across all specialties, surgeons should aim for a < 10% IH rate.
Collapse
Affiliation(s)
- M A Garcia-Urena
- Hospital Universitario del Henares, Faculty of Health Sciences. Universidad Francisco de Vitoria, 28223, Pozuelo de Alarcón, Madrid, Spain.
| | | |
Collapse
|
58
|
Shin CS, Cabrera FJ, Lee R, Kim J, Ammassam Veettil R, Zaheer M, Adumbumkulath A, Mhatre K, Ajayan PM, Curley SA, Scott BG, Acharya G. 3D-Bioprinted Inflammation Modulating Polymer Scaffolds for Soft Tissue Repair. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2021; 33:e2003778. [PMID: 33325594 DOI: 10.1002/adma.202003778] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 11/14/2020] [Indexed: 06/12/2023]
Abstract
Development of inflammation modulating polymer scaffolds for soft tissue repair with minimal postsurgical complications is a compelling clinical need. However, the current standard of care soft tissue repair meshes for hernia repair is highly inflammatory and initiates a dysregulated inflammatory process causing visceral adhesions and postsurgical complications. Herein, the development of an inflammation modulating biomaterial scaffold (bioscaffold) for soft tissue repair is presented. The bioscaffold design is based on the idea that, if the excess proinflammatory cytokines are sequestered from the site of injury by the surgical implantation of a bioscaffold, the inflammatory response can be modulated, and the visceral adhesion formations and postsurgical complications can be minimized. The bioscaffold is fabricated by 3D-bioprinting of an in situ phosphate crosslinked poly(vinyl alcohol) polymer. In vivo efficacy of the bioscaffold is evaluated in a rat ventral hernia model. In vivo proinflammatory cytokine expression analysis and histopathological analysis of the tissues have confirmed that the bioscaffold acts as an inflammation trap and captures the proinflammatory cytokines secreted at the implant site and effectively modulates the local inflammation without the need for exogenous anti-inflammatory agents. The bioscaffold is very effective in inhibiting visceral adhesions formation and minimizing postsurgical complications.
Collapse
Affiliation(s)
- Crystal S Shin
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Fernando J Cabrera
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Richard Lee
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - John Kim
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Remya Ammassam Veettil
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Mahira Zaheer
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Aparna Adumbumkulath
- Department of Materials Science and Nanoengineering, Rice University, Houston, TX, 77030, USA
| | - Kirti Mhatre
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Pulickel M Ajayan
- Department of Materials Science and Nanoengineering, Rice University, Houston, TX, 77030, USA
| | - Steven A Curley
- Oncology Institute, Christus Health Institute, 910 East Houston St., Suite 270, Tyler, TX, 75702, USA
| | - Bradford G Scott
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Ghanashyam Acharya
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| |
Collapse
|
59
|
Pierrat B, Nováček V, Avril S, Turquier F. Mechanical characterization and modeling of knitted textile implants with permanent set. J Mech Behav Biomed Mater 2020; 114:104210. [PMID: 33338783 DOI: 10.1016/j.jmbbm.2020.104210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 10/22/2022]
Abstract
Textile-based implant (mesh) treatment is considered as a standard of care for abdominal wall hernia repair. Computational models and simulations have appeared as one of the most promising approach to investigate biomechanics related to hernia repair and to improve clinical outcomes. This paper presents a novel anisotropic hypo-elastoplastic constitutive model specifically established for surgical knitted textile implants. The major mechanical characteristics of these materials such as anisotropy and permanent set have been reproduced. For the first time ever, we report an extensive mechanical characterization of one of these meshes, including cyclic uniaxial tension, planar equibiaxial tension and plunger type testing. These tests highlight the complex mechanical behavior with strong nonlinearity, anisotropy and permanent set. The novel anisotropic hypo-elasto-plastic constitutive model has been identified based on the tensile experiments and validated successfully against the data of the plunger experiment. In the future, implementation of this characterization and modeling approach to additional surgical knitted textiles should be the direction to follow in order to develop clinical decision support software for abdominal wall repair.
Collapse
Affiliation(s)
- Baptiste Pierrat
- Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U 1059 Sainbiose, Centre CIS, F - 42023, Saint-Etienne, France.
| | - Vít Nováček
- New Technologies - Research Centre, University of West Bohemia, Univerzitní 8, 301 00, Plzeň, Czech Republic
| | - Stéphane Avril
- Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U 1059 Sainbiose, Centre CIS, F - 42023, Saint-Etienne, France
| | - Frédéric Turquier
- Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U 1059 Sainbiose, Centre CIS, F - 42023, Saint-Etienne, France
| |
Collapse
|
60
|
Cos H, Ahmed O, Garcia-Aroz S, Vachharajani N, Shenoy S, Wellen JR, Doyle MM, Chapman WC, Khan AS. Incisional hernia after liver transplantation: Risk factors, management strategies and long-term outcomes of a cohort study. Int J Surg 2020; 78:149-153. [PMID: 32335240 DOI: 10.1016/j.ijsu.2020.04.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/09/2020] [Accepted: 04/19/2020] [Indexed: 12/07/2022]
Abstract
INTRODUCTION Incisional hernias (IH) develop in up to 40% of liver transplant (LT) recipients and can contribute to considerable morbidity. MATERIALS AND METHODS A single center retrospective review of a prospectively maintained LT database was conducted to identify all patients diagnosed with IH after LT during a 13-year study period (2003-2015). Analyzed data included patient demographics, LT details, incidence and timing of IH, risk factors, management strategies and long-term outcomes. RESULTS During the 13-year study period, IH was diagnosed in 16.7% (163/976) of LT recipients after a median of 19.6 months (range 6.7-49.5 months) from transplant surgery. Identified risk factors for developing IH included male gender (p < 0.001) while acute cellular rejection (ACR) was found to be negatively associated with the risk of developing IH (p = 0.014). Acute incarceration/strangulation was seen in 4 patients with IH while the remaining (n = 159) presented with non-emergent symptoms. Surgical repair was undertaken in 70/163 (43%) IH patients after medical optimization when possible (open repair 83%, mesh use 90%). IH recurrence rate was 14.3% (10/70) with comparable rates in no-mesh and with-mesh repairs (42.9% vs. 11.3%; p = 0.057) and open (15.8%) and laparoscopic (9.1%) approaches (p = 0.68). CONCLUSION IH is a late complication following LT and male gender is a consistent predictive marker. Acute presentation is infrequent and elective repair can be planned in most patients allowing for risk factor optimization to ensure promising long-term outcomes.
Collapse
Affiliation(s)
- Heidy Cos
- Division of Transplantation, Department of Surgery, Washington University in St Louis, USA
| | - Ola Ahmed
- Division of Transplantation, Department of Surgery, Washington University in St Louis, USA.
| | - Sandra Garcia-Aroz
- Division of Transplantation, Department of Surgery, Washington University in St Louis, USA
| | - Neeta Vachharajani
- Division of Transplantation, Department of Surgery, Washington University in St Louis, USA
| | - Surendra Shenoy
- Division of Transplantation, Department of Surgery, Washington University in St Louis, USA
| | - Jason R Wellen
- Division of Transplantation, Department of Surgery, Washington University in St Louis, USA
| | - Maria Mb Doyle
- Division of Transplantation, Department of Surgery, Washington University in St Louis, USA
| | - William C Chapman
- Division of Transplantation, Department of Surgery, Washington University in St Louis, USA
| | - Adeel S Khan
- Division of Transplantation, Department of Surgery, Washington University in St Louis, USA
| |
Collapse
|
61
|
Wabitsch S, Schulz P, Fröschle F, Kästner A, Fehrenbach U, Benzing C, Haber PK, Denecke T, Pratschke J, Fikatas P, Schmelzle M. Incidence of incisional hernia after laparoscopic liver resection. Surg Endosc 2020; 35:1108-1115. [PMID: 32124059 DOI: 10.1007/s00464-020-07475-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 02/19/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Minimally invasive techniques have been broadly introduced to liver surgery during the last couple of years. In this study, we aimed to report the incidence and potential risk factors for incisional hernia (IH) as well as health-related quality of life (HRQoL) after laparoscopic liver resections (LLR). METHODS All patients undergoing LLR between January 2014 and June 2017 were contacted for an outpatient hernia examination. In all eligible patients, photo documentation of the scar was performed and IH was evaluated by clinical examination and by ultrasound. Patients also completed a questionnaire to evaluate IH-specific symptoms and HRQoL. Obtained results were retrospectively analyzed with regard to patients' characteristics, perioperative outcomes and applied minimally invasive techniques, such as multi-incision laparoscopic liver surgery or hand-assisted/single-incision laparoscopic surgery (HALS/SILS). RESULTS Of 184 patients undergoing surgery, 161 (87.5%) met the inclusion criteria and 49 patients (26.6%) participated in this study. After a median time of 26 months (range 19-50 months) after surgery, we observed an overall incidence of IH of 12%. Five of 6 patients were overweight or obese (BMI ≥ 25) and 5 of 6 hernias were located at the umbilical site. Univariate analysis suggested the performance status at time of operation (ASA score ≥ 3; HR 5.616, 95% CI 1.012-31.157, p = 0.048) and the approach (HALS/SILS, HR 6.571, 95% CI 1.097-39.379, p = 0.039) as potential risk factors for IH. A higher frequency of hernia-related physical restrictions (HRR; p = 0.058) and a decreased physical functioning (p = 0.17) were noted in patients with IH; however, both being short of statistical significance. CONCLUSION Advantages of laparoscopic surgery with regard to low rates of IH can be translated to minimally invasive liver surgery. Even though there are low rates of IH, patients with poor performance status at the time of operation should be monitored closely. While patients' characteristics are hard to influence, it might be worth focusing on surgical factors such as the approach and the closure of the umbilical site to further minimize the rate of IH.
Collapse
Affiliation(s)
- S Wabitsch
- Department of Surgery,, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte
- Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - P Schulz
- Department of Surgery,, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte
- Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - F Fröschle
- Department of Surgery,, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte
- Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - A Kästner
- Department of Surgery,, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte
- Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - U Fehrenbach
- Department of Radiology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - C Benzing
- Department of Surgery,, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte
- Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - P K Haber
- Department of Surgery,, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte
- Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - T Denecke
- Department of Radiology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - J Pratschke
- Department of Surgery,, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte
- Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - P Fikatas
- Department of Surgery,, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte
- Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - M Schmelzle
- Department of Surgery,, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte
- Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
| |
Collapse
|
62
|
Jairam AP, López-Cano M, Garcia-Alamino JM, Pereira JA, Timmermans L, Jeekel J, Lange J, Muysoms F. Prevention of incisional hernia after midline laparotomy with prophylactic mesh reinforcement: a meta-analysis and trial sequential analysis. BJS Open 2020; 4:357-368. [PMID: 32057193 PMCID: PMC7260413 DOI: 10.1002/bjs5.50261] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 12/17/2019] [Indexed: 02/04/2023] Open
Abstract
Background Incisional hernia is a frequent complication after abdominal surgery. The aim of this study was to assess the efficacy of prophylactic mesh reinforcement (PMR) after midline laparotomy in reducing the incidence of incisional hernia. Methods A meta‐analysis was conducted following PRISMA guidelines. The primary outcome was the incidence of incisional hernia after follow‐up of at least 12 months. Secondary outcomes were postoperative complications. Only RCTs were included. A random‐effects model was used for the meta‐analysis, and trial sequential analysis was conducted. Results Twelve RCTs were included, comprising 1815 patients. The incidence of incisional hernia was significantly lower after PMR compared with sutured closure (risk ratio (RR) 0·35, 95 per cent c.i. 0·21 to 0·57; P < 0·001). Both onlay (RR 0·26, 0·11 to 0·67; P = 0·005) and retromuscular (RR 0·28, 0·10 to 0·82; P = 0·02) PMR led to a significant reduction in the rate of incisional hernia. The occurrence of seroma was higher in patients who had onlay PMR (RR 2·23, 1·10 to 4·52; P = 0·03). PMR did not result in an increased rate of surgical‐site infection. Conclusion PMR of a midline laparotomy using an onlay or retromuscular technique leads to a significant reduction in the rate of incisional hernia in high‐risk patients. Individual risk factors should be taken into account to select patients who will benefit most. [Correction added on 19 February 2020, after first online publication: J. García Alamino has been amended to J. M. Garcia‐Alamino]
Collapse
Affiliation(s)
- A P Jairam
- Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, Netherlands
| | - M López-Cano
- Department of General and Digestive Surgery, Hospital Vall d'Hebrón, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - J M Garcia-Alamino
- Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
| | - J A Pereira
- Department of General and Digestive Surgery, Hospital Del Mar, Barcelona, Spain
| | - L Timmermans
- Department of Surgery, Maasstad Ziekenhuis Rotterdam, Rotterdam, Netherlands
| | - J Jeekel
- Department of General Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - J Lange
- Department of General Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - F Muysoms
- Department of Surgery, Maria Middelares Hospital, Ghent, Belgium
| |
Collapse
|
63
|
Rios-Diaz AJ, Fischer JP. Stoma closure reinforcement with biological mesh and incisional hernia. Lancet 2020; 395:393-395. [PMID: 32035534 DOI: 10.1016/s0140-6736(19)32958-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 11/26/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Arturo J Rios-Diaz
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - John P Fischer
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA.
| |
Collapse
|
64
|
Varathan N, Rotigliano N, Nocera F, Tampakis A, Füglistaler I, von Flüe M, Steinemann DC, Posabella A. Left lower transverse incision versus Pfannenstiel-Kerr incision for specimen extraction in laparoscopic sigmoidectomy: a match pair analysis. Int J Colorectal Dis 2020; 35:233-238. [PMID: 31823052 DOI: 10.1007/s00384-019-03444-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The ideal location of specimen extraction in laparoscopic-assisted colorectal surgery is still debatable. The aim of this study was to compare the incidence of incisional hernias and surgical site infections in patients undergoing elective laparoscopic resection for recurrent sigmoid diverticulitis by performing specimen extraction through left lower transverse incision or Pfannenstiel-Kerr incision. METHODS A total of 269 patients operated between January 2014 and December 2017 were retrospectively screened for inclusion in the study. Patients with specimen extraction through left lower transverse incision (LLT) and patients with specimen extraction through Pfannenstiel-K incision (P-K) were matched in 1:1 proportion regarding age, sex, comorbidities, and previous abdominal surgery. The incidence of incisional hernias and surgical site infections were compared by using Fisher's exact test. RESULTS After matching 77 patients in the LLT group and 77 patients in the P-K group, they were found to be homogenous regarding the above mentioned descriptive characteristics. No patients in the P-K group developed an incisional hernia compared with 10 patients (13%) in the LLT group (p = 0.001). All these patients required hernia repair with mesh augmentation. The rate of surgical site infections was 1/77 in the P-K group and 0/77 in the LLT group (p = 1.0). In the P-K group, a wound protector was used in 86% of patients whereas in the LLT group, 39% of the wounds were protected during specimen extraction (p < 0.0001). CONCLUSION The Pfannenstiel-Kerr incision may be the preferred extraction site compared with the left lower transverse incision given the significant reduction of the risk of incisional hernias.
Collapse
Affiliation(s)
- N Varathan
- University Center for Gastrointestinal and Liver Diseases, St Clara Hospital and University Hospital of Basel, Spitalstrasse 21, 4002, Basel, Switzerland
| | - N Rotigliano
- University Center for Gastrointestinal and Liver Diseases, St Clara Hospital and University Hospital of Basel, Spitalstrasse 21, 4002, Basel, Switzerland
| | - F Nocera
- University Center for Gastrointestinal and Liver Diseases, St Clara Hospital and University Hospital of Basel, Spitalstrasse 21, 4002, Basel, Switzerland
| | - A Tampakis
- University Center for Gastrointestinal and Liver Diseases, St Clara Hospital and University Hospital of Basel, Spitalstrasse 21, 4002, Basel, Switzerland
| | - I Füglistaler
- University Center for Gastrointestinal and Liver Diseases, St Clara Hospital and University Hospital of Basel, Spitalstrasse 21, 4002, Basel, Switzerland
| | - M von Flüe
- University Center for Gastrointestinal and Liver Diseases, St Clara Hospital and University Hospital of Basel, Spitalstrasse 21, 4002, Basel, Switzerland
| | - D C Steinemann
- University Center for Gastrointestinal and Liver Diseases, St Clara Hospital and University Hospital of Basel, Spitalstrasse 21, 4002, Basel, Switzerland
| | - A Posabella
- University Center for Gastrointestinal and Liver Diseases, St Clara Hospital and University Hospital of Basel, Spitalstrasse 21, 4002, Basel, Switzerland.
| |
Collapse
|
65
|
Heger P, Feißt M, Krisam J, Klose C, Dörr-Harim C, Tenckhoff S, Büchler MW, Diener MK, Mihaljevic AL. Hernia reduction following laparotomy using small stitch abdominal wall closure with and without mesh augmentation (the HULC trial): study protocol for a randomized controlled trial. Trials 2019; 20:738. [PMID: 31842966 PMCID: PMC6915967 DOI: 10.1186/s13063-019-3921-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 11/19/2019] [Indexed: 12/28/2022] Open
Abstract
Background Incisional hernias are among the most frequent complications following abdominal surgery and cause substantial morbidity, impaired health-related quality of life and costs. Despite improvements in abdominal wall closure techniques, the risk for developing an incisional hernia is reported to be between 10 and 30% following midline laparotomies. There have been two recent innovations with promising results to reduce hernia risks, namely the small stitches technique and the placement of a prophylactic mesh. So far, these two techniques have not been evaluated in combination. Methods The HULC trial is a multicentre, randomized controlled, observer- and patient-blinded surgical effectiveness trial with two parallel study groups. A total of 812 patients scheduled for elective abdominal surgery via a midline laparotomy will be randomized in 12 centres after informed consent. Patients will be randomly assigned to the control group receiving closure of the midline incision with a slowly absorbable monofilament suture in the small stitches technique or to the intervention group, who will receive a small stitches closure followed by augmentation with a light-weight polypropylene mesh in the onlay technique. The primary endpoint will be the occurrence of incisional hernias, as defined by the European Hernia Society, within 24 months after surgery. Further perioperative parameters, as well as patient-reported outcomes, will be analysed as secondary outcomes. Discussion The HULC trial will address the yet unanswered question of whether a combination of small stitched fascial closure and onlay mesh augmentation after elective midline laparotomies reduces the risk of incisional hernias. The HULC trial marks the logical and innovative next step in the development of a safe abdominal closure technique. Trial registration German Clinical Trials Register, DRKS00017517. Registered on 24th June 2019.
Collapse
Affiliation(s)
- Patrick Heger
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,The Study Center of the German Surgical Society (SDGC), University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Manuel Feißt
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Johannes Krisam
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Christina Klose
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Colette Dörr-Harim
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,The Study Center of the German Surgical Society (SDGC), University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Solveig Tenckhoff
- The Study Center of the German Surgical Society (SDGC), University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Markus W Büchler
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Markus K Diener
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,The Study Center of the German Surgical Society (SDGC), University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - André L Mihaljevic
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. .,The Study Center of the German Surgical Society (SDGC), University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
| |
Collapse
|
66
|
Laparotomy closure techniques: Do surgeons follow the latest guidelines? Results of a questionnaire. Int J Surg 2019; 71:110-116. [DOI: 10.1016/j.ijsu.2019.09.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/25/2019] [Accepted: 09/19/2019] [Indexed: 02/07/2023]
|
67
|
Frailty predicts morbidity, complications, and mortality in patients undergoing complex abdominal wall reconstruction. Hernia 2019; 24:235-243. [DOI: 10.1007/s10029-019-02047-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 09/02/2019] [Indexed: 12/11/2022]
|
68
|
Safety and efficacy of prophylactic resorbable biosynthetic mesh following midline laparotomy in clean/contemned field: preliminary results of a randomized double blind prospective trial. Hernia 2019; 24:85-92. [DOI: 10.1007/s10029-019-02025-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/04/2019] [Indexed: 01/09/2023]
|
69
|
Parker SG, Halligan S, Erotocritou M, Wood CPJ, Boulton RW, Plumb AAO, Windsor ACJ, Mallett S. A systematic methodological review of non-randomised interventional studies of elective ventral hernia repair: clear definitions and a standardised minimum dataset are needed. Hernia 2019; 23:859-872. [PMID: 31152271 PMCID: PMC6838456 DOI: 10.1007/s10029-019-01979-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/15/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Ventral hernias (VHs) often recur after surgical repair and subsequent attempts at repair are especially challenging. Rigorous research to reduce recurrence is required but such studies must be well-designed and report representative and comprehensive outcomes. OBJECTIVE We aimed to assesses methodological quality of non-randomised interventional studies of VH repair by systematic review. METHODS We searched the indexed literature for non-randomised studies of interventions for VH repair, January 1995 to December 2017 inclusive. Each prospective study was coupled with a corresponding retrospective study using pre-specified criteria to provide matched, comparable groups. We applied a bespoke methodological tool for hernia trials by combining relevant items from existing published tools. Study introduction and rationale, design, participant inclusion criteria, reported outcomes, and statistical methods were assessed. RESULTS Fifty studies (17,608 patients) were identified: 25 prospective and 25 retrospective. Overall, prospective studies scored marginally higher than retrospective studies for methodological quality, median score 17 (IQR: 14-18) versus 15 (IQR 12-18), respectively. For the sub-categories investigated, prospective studies achieved higher median scores for their, 'introduction', 'study design' and 'participants'. Surprisingly, no study stated that a protocol had been written in advance. Only 18 (36%) studies defined a primary outcome, and only 2 studies (4%) described a power calculation. No study referenced a standardised definition for VH recurrence and detection methods for recurrence varied widely. Methodological quality did not improve with publication year or increasing journal impact factor. CONCLUSION Currently, non-randomised interventional studies of VH repair are methodologically poor. Clear outcome definitions and a standardised minimum dataset are needed.
Collapse
Affiliation(s)
- S G Parker
- The Abdominal Wall Unit UCLH, GI Services Department, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK.
| | - S Halligan
- UCL Centre for Medical Imaging, 2nd Floor Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK
| | - M Erotocritou
- The Abdominal Wall Unit UCLH, GI Services Department, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - C P J Wood
- The Abdominal Wall Unit UCLH, GI Services Department, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - R W Boulton
- The Abdominal Wall Unit UCLH, GI Services Department, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - A A O Plumb
- UCL Centre for Medical Imaging, 2nd Floor Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK
| | - A C J Windsor
- The Abdominal Wall Unit UCLH, GI Services Department, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - S Mallett
- The Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| |
Collapse
|
70
|
Gillion JF, Lepere M, Barrat C, Cas O, Dabrowski A, Jurczak F, Khalil H, Zaranis C. Two-year patient-related outcome measures (PROM) of primary ventral and incisional hernia repair using a novel three-dimensional composite polyester monofilament mesh: the SymCHro registry study. Hernia 2019; 23:767-781. [PMID: 30887379 PMCID: PMC6661060 DOI: 10.1007/s10029-019-01924-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 03/02/2019] [Indexed: 01/05/2023]
Abstract
Purpose This study examined patient-related outcome measures (PROMs) after repair of ventral primary or incisional hernias using Symbotex™ composite mesh (SCM), a novel three-dimensional collagen-coated monofilament polyester textile. Methods Pre-operative, peri-operative, and post-operative data were obtained from the French “Club Hernie” registry with 12- and 24-month follow-up. Results One-hundred consecutive patients (mean age 62.0 ± 13.7; 51% female) underwent repair of 105 hernias: primary (39/105, 37.1%, defect area 5.2 ± 5.6 cm2) and incisional (66/105, 62.9%, 31.9 ± 38.7.8 cm2). The mean BMI was 29.7 (± 5.6 kg/m2). American Society of Anesthesiologists classifications were I 39.4%, II 37.4% and III 23.2%. 75% had risk factors for healing and/or dissection. Of 38 primary repairs, 37 were completed laparoscopically (combined approach n = 1), and of 62 incisional hernia repairs, 40 were completed laparoscopically, and 20 by open repair (combined approach n = 2). Laparoscopic was quicker than open repair (36.2 ± 23.5 min vs. 67.4 ± 25.8, p < 0001). Before surgery, 86.3% of hernias were reported to cause discomfort/pain or dysesthesia. At 24 months (93 of 100 patients), 91 (97.8%) reported no lump and 81 (87.1%) no pain or discomfort. Of 91 patients, 86 (94.5%) rated their repair “good” or “excellent.” There were nine non-serious, surgeon-detected adverse events (ileus, n = 3; seroma, n = 6) and one hernia recurrence (6–12 months). Conclusions Compared to baseline, open and laparoscopic surgery improved PROMs 24 months after primary and incisional hernia repair. Minimal complications and recurrence support the long-term efficacy of SCM.
Collapse
Affiliation(s)
- J F Gillion
- Hôpital Privé d'Antony, 1 rue Velpeau, 92160, Antony, France.
| | - M Lepere
- Clinique Saint Augustin, Nantes, France
| | - C Barrat
- Hôpital J Verdier, Bondy, France
| | - O Cas
- Centre Médico-Chirurgical, Fondation Wallerstein, Arès, France
| | | | - F Jurczak
- Clinique mutualiste de l'estuaire, Saint-Nazaire, France
| | - H Khalil
- Chu-Hôpitaux De Rouen, Rouen, France
| | - C Zaranis
- Clinique du Mail, La Rochelle, France
| | | |
Collapse
|
71
|
Long-term results of a prospective randomized trial of midline laparotomy closure with onlay mesh. Hernia 2019; 23:335-340. [DOI: 10.1007/s10029-019-01891-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 01/14/2019] [Indexed: 01/21/2023]
|
72
|
Cost-Utility Analysis of Biologic and Biosynthetic Mesh in Ventral Hernia Repair: When Are They Worth It? J Am Coll Surg 2019; 228:66-71. [DOI: 10.1016/j.jamcollsurg.2018.10.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/08/2018] [Accepted: 10/09/2018] [Indexed: 11/22/2022]
|
73
|
Incidence of incisional hernias following single-incision versus traditional laparoscopic surgery: a meta-analysis. Hernia 2018; 23:91-100. [DOI: 10.1007/s10029-018-1853-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 11/08/2018] [Indexed: 12/14/2022]
|
74
|
Budget Impact Analysis of a Biosynthetic Mesh for Incisional Hernia Repair. Clin Ther 2018; 40:1830-1844.e4. [DOI: 10.1016/j.clinthera.2018.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/08/2018] [Accepted: 09/05/2018] [Indexed: 01/14/2023]
|
75
|
Henriksen NA, Deerenberg EB, Venclauskas L, Fortelny RH, Miserez M, Muysoms FE. Meta-analysis on Materials and Techniques for Laparotomy Closure: The MATCH Review. World J Surg 2018; 42:1666-1678. [PMID: 29322212 DOI: 10.1007/s00268-017-4393-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND The aim of this systematic review and meta-analysis was to evaluate closure materials and suture techniques for emergency and elective laparotomies. The primary outcome was incisional hernia after 12 months, and the secondary outcomes were burst abdomen and surgical site infection. METHODS A systematic literature search was conducted until September 2017. The quality of the RCTs was evaluated by at least 3 assessors using critical appraisal checklists. Meta-analyses were performed. RESULTS A total of 23 RCTs were included in the meta-analysis. There was no evidence from RCTs using the same suture technique in both study arms that any suture material (fast-absorbable/slowly absorbable/non-absorbable) is superior in reducing incisional hernias. There is no evidence that continuous suturing is superior in reducing incisional hernias compared to interrupted suturing. When using a slowly absorbable suture for continuous suturing in elective midline closure, the small bites technique results in significantly less incisional hernias than a large bites technique (OR 0.41; 95% CI 0.19, 0.86). CONCLUSIONS There is no high-quality evidence available concerning the best suture material or technique to reduce incisional hernia rate when closing a laparotomy. When using a slowly absorbable suture and a continuous suturing technique with small tissue bites, the incisional hernia rate is significantly reduced compared with a large bites technique.
Collapse
Affiliation(s)
- N A Henriksen
- Department of Surgery, Zealand University Hospital, Koege, Denmark.
| | - E B Deerenberg
- Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - L Venclauskas
- Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - R H Fortelny
- Department of General, Visceral and Oncological Surgery, Medical Faculty, Wilhelminenspital & Sigmund Freud University, Vienna, Austria
| | - M Miserez
- University Hospitals, KU Leuven, Louvain, Belgium
| | | |
Collapse
|
76
|
Prophylactic Intraperitoneal Onlay Mesh Reinforcement Reduces the Risk of Incisional Hernia, Two-Year Results of a Randomized Clinical Trial. World J Surg 2018; 42:1687-1694. [PMID: 29159603 DOI: 10.1007/s00268-017-4363-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Incisional hernias still are a major concern after laparotomy and are causing substantial morbidity. This study examines the feasibility, safety and incisional hernia rate of the use of a prophylactic intraperitoneal onlay mesh stripe (IPOM) to prevent incisional hernia following midline laparotomy. METHODS This prospective, randomized controlled trial randomly allocated patients undergoing median laparotomy either to mass closure of the abdominal wall with a PDS-loop running suture reinforced by an intraperitoneal composite mesh stripe (Group A) or to the same procedure without the additional mesh stripe (Group B). Primary endpoint was the incidence of incisional hernias at 2 years following midline laparotomy. Secondary endpoints are were the feasibility, the safety of the mesh stripe implantation including postoperative pain, and the incidence of incisional hernias at 5 years. RESULTS A total of 267 patients were included in this study. Follow-up data 2 years after surgery was available from 210 patients (Group A = 107; Group B = 103). An incisional hernia was diagnosed in 18/107 (17%) patients in Group A and in 40/103 (39%) patients in Group B (p < 0.001). A surgical operation due to an incisional hernia was conducted for 12/107 (11%) patients in Group A and for 24/103 (23%) patients in Group B (p = 0.039). In both groups, minor and major complications as well as postoperative pain are reported with no statistically significant difference between the groups, even in contaminated situations. CONCLUSIONS This first randomized clinical trial indicates that the placement of a non-absorbable IPOM-stripe with prophylactic intention may significantly reduce the risk for a midline incisional hernia. TRIAL REGISTRATION Ref. NCT01003067 (clinicaltrials.gov).
Collapse
|
77
|
Long-term outcomes after prophylactic use of onlay mesh in midline laparotomy. Hernia 2018; 22:1113-1122. [DOI: 10.1007/s10029-018-1833-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 09/24/2018] [Indexed: 10/28/2022]
|
78
|
Law-Ki C, Robineau C, Garnier N, Guenfoudi MP, Lazzarotti A, Cheynel N, Cailliod R, Ortega-Deballon P. Cost of complex abdominal wall reconstruction with biological prostheses in a French public hospital. J Visc Surg 2018; 155:349-353. [DOI: 10.1016/j.jviscsurg.2018.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
79
|
Squid Ring Teeth-coated Mesh Improves Abdominal Wall Repair. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1881. [PMID: 30254828 PMCID: PMC6143318 DOI: 10.1097/gox.0000000000001881] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/08/2018] [Indexed: 01/24/2023]
Abstract
Background Hernia repair is a common surgical procedure with polypropylene (PP) mesh being the standard material for correction because of its durability. However, complications such as seroma and pain are common, and repair failures still approach 15% secondary to poor tissue integration. In an effort to enhance mesh integration, we evaluated the applicability of a squid ring teeth (SRT) protein coating for soft-tissue repair in an abdominal wall defect model. SRT is a biologically derived high-strength protein with strong mechanical properties. We assessed tissue integration, strength, and biocompatibility of a SRT-coated PP mesh in a first-time pilot animal study. Methods PP mesh was coated with SRT (SRT-PP) and tested for mechanical strength against uncoated PP mesh. Cell proliferation and adhesion studies were performed in vitro using a 3T3 cell line. Rats underwent either PP (n = 3) or SRT-PP (n = 6) bridge mesh implantation in an anterior abdominal wall defect model. Repair was assessed clinically and radiographically, with integration evaluated by histology and mechanical testing at 60 days. Results Cell proliferation was enhanced on SRT-PP mesh. This was corroborated in vivo by abdominal wall histology, dramatically diminished craniocaudal mesh contraction, improved strength testing, and higher tissue failure strain. There was no increase in seroma or visceral adhesion formation. No foreign body reactions were noted on liver histology. Conclusions SRT applied as a coating appears to augment mesh-tissue integration and improve abdominal wall stability following bridged repair. Further studies in larger animals will determine its applicability for hernia repair in patients.
Collapse
|
80
|
Primus FE, Young DM, Grenert JP, Harris HW. Silver microparticles plus fibrin tissue sealant prevents incisional hernias in rats. J Surg Res 2018; 227:130-136. [DOI: 10.1016/j.jss.2018.02.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 01/14/2018] [Accepted: 02/14/2018] [Indexed: 10/17/2022]
|
81
|
Harries RL, Torkington J. Stomal Closure: Strategies to Prevent Incisional Hernia. Front Surg 2018; 5:28. [PMID: 29670882 PMCID: PMC5893847 DOI: 10.3389/fsurg.2018.00028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 03/13/2018] [Indexed: 12/18/2022] Open
Abstract
Incisional hernias following ostomy reversal occur frequently. Incisional hernias at the site of a previous stoma closure can cause significant morbidity, impaired quality of life, lead to life-threatening hernia incarceration or strangulation and result in a significant financial burden on health care systems Despite this, the evidence base on the subject is limited. Many recognised risk factors for the development of incisional hernia following ostomy reversal are related to patient factors such as age, malignancy, diabetes, COPD, hypertension and obesity, and are not easily correctable. There is a limited amount of evidence to suggest that prophylactic mesh reinforcement may be of benefit to reduce the post stoma closure incisional hernia rate but a further large scale randomised controlled trial is due to report in the near future. There appears to be weak evidence to suggest that surgeons should favour circular, or "purse-string" closure of the skin following stoma closure in order to reduce the risk of SSI, which in turn may reduce incisional hernia formation. There remains the need for further evidence in relation to suture technique, skin closure techniques, mechanical bowel preparation and oral antibiotic prescription focusing on incisional hernia development as an outcome measure. Within this review, we discuss in detail the evidence base for the risk factors for the development of, and the strategies to prevent ostomy reversal site incisional hernias.
Collapse
Affiliation(s)
- Rhiannon L Harries
- Department of Colorectal Surgery, University Hospital of Wales, Cardiff, United Kingdom
| | - Jared Torkington
- Department of Colorectal Surgery, University Hospital of Wales, Cardiff, United Kingdom
| |
Collapse
|
82
|
Abstract
BACKGROUND There is a high incidence of incisional hernias in specific high-risk patient populations. For these patients, the prophylactic placement of mesh during closure of the abdominal wall incision has been investigated in several prospective studies. OBJECTIVE This article aims to summarize and synthetize the currently available evidence on prophylactic meshes in a narrative review. MATERIALS AND METHODS Systematic reviews were performed on the use of prophylactic meshes in different indications: midline laparotomies, stoma reversal wounds, and permanent stoma. RESULTS High-quality data from randomized trials shows that prophylactic synthetic non-absorbable mesh implantation is safe and effective, both in prevention of incisional hernias after midline laparotomies and during construction of an elective end colostomy. It should be considered in patients with a high risk for incisional hernia development, such as those receiving open abdominal aortic aneurysm, obesity, or colorectal cancer surgery. It is strongly recommended for construction of an elective permanent end colostomy. For midline laparotomies, both the retromuscular and onlay positions of a prophylactic mesh seem equally effective and safe. For parastomal hernia prevention, only the retromuscular prophylactic mesh and its use for end colostomies has been proven to be effective and safe. No data support the choice of a biological mesh or a synthetic absorbable mesh over a non-absorbable synthetic mesh, even in clean-contaminated surgical procedures. No data yet support the standard use of prophylactic mesh when closing the wound during closure of a temporary stoma. CONCLUSION Prophylactic mesh implantation should be standard of care during construction of an elective end colostomy and will become standard of care for midline laparotomies in patients at a high risk of incisional hernias.
Collapse
Affiliation(s)
- F E Muysoms
- Department for General, Thoracic and Cardiovascular Surgery, AZ Maria Middelares Dienst Algemene Heelkunde, Buitenring Sint-Denijs 30, 9000, Ghent, Belgium.
| | - U A Dietz
- Klinik und Poliklinik für Allgemein-, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany
| |
Collapse
|
83
|
Juvany M, Hoyuela C, Carvajal F, Trias M, Martrat A, Ardid J. Long-term follow-up (at 5 years) of midline incisional hernia repairs using a primary closure and prosthetic onlay technique: recurrence and quality of life. Hernia 2018; 22:319-324. [DOI: 10.1007/s10029-018-1730-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 01/04/2018] [Indexed: 12/21/2022]
|
84
|
Hoyuela C, Juvany M, Trias M, Ardid J, Martrat A. Incisional hernia prevention using a cyanoacrilate-fixed retrofascial mesh. Cir Esp 2017; 96:35-40. [PMID: 29249278 DOI: 10.1016/j.ciresp.2017.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 10/24/2017] [Accepted: 10/28/2017] [Indexed: 01/15/2023]
Abstract
INTRODUCTION The rate of incisional hernia in high-risk patients (obesity, cancer, etc.) is high, even in laparoscopic surgery. The aim of this study is to evaluate the safety of the use of cyanoacrylate fixed prophylactic meshes in the assistance incision in overweight or obese patients undergoing laparoscopic colorectal surgery. METHODS A prospective, non-randomized cohort study of patients undergoing elective laparoscopic resection for colorectal cancer between January 2013 and March 2016 was performed. Those with a body mass index greater than 25kg / m2 were evaluated to implant a prophylactic meshes fixed with cyanoacrylate (Histoacryl®) as reinforcement of the assistance incision. RESULTS 52 patients were analyzed (mean body mass index: 28.4±2kg / m 2). Prophylactic meshes was implanted in 15 patients. The time to put the mesh in place was always less than 5minutes. There was no significant difference in wound infection rate (12% vs. 10%). No mesh had to be explanted. Although the mean follow-up was shorter (14.1±4 vs. 22.3±9 months), there were no incisional hernia in the mesh group. On the other hand, in the non-mesh group, 1 acute evisceration (2.7%) and 4 incisional hernia of the assistance incision were observed (10.8%). There were no significant differences between groups regarding trocar incisional hernia (6.6 vs. 5.4%). CONCLUSIONS The implantation of a reinforcement prophylactic mesh in overweight or obese patients undergoing laparoscopic colorectal surgery is safe and seems to reduce the short-term rate of incisional hernia. Fixation with cyanoacrylate is a rapid method that facilitates the procedure without additional complications.
Collapse
Affiliation(s)
- Carlos Hoyuela
- Servicio de Cirugía Digestiva, Hospital Platón Barcelona, Universitat Autònoma de Barcelona, Barcelona, España.
| | - Montserrat Juvany
- Servicio de Cirugía Digestiva, Hospital Platón Barcelona, Universitat Autònoma de Barcelona, Barcelona, España
| | - Miquel Trias
- Servicio de Cirugía Digestiva, Hospital Platón Barcelona, Universitat Autònoma de Barcelona, Barcelona, España
| | - Jordi Ardid
- Servicio de Cirugía Digestiva, Hospital Platón Barcelona, Universitat Autònoma de Barcelona, Barcelona, España
| | - Antoni Martrat
- Servicio de Cirugía Digestiva, Hospital Platón Barcelona, Universitat Autònoma de Barcelona, Barcelona, España
| |
Collapse
|
85
|
Sutton N, MacDonald MH, Lombard J, Ilie B, Hinoul P, Granger DA. Preclinical evaluation of the effect of the combined use of the Ethicon Securestrap ® Open Absorbable Strap Fixation Device and Ethicon Physiomesh™ Open Flexible Composite Mesh Device on surgeon stress during ventral hernia repair. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2017; 11:1-9. [PMID: 29296101 PMCID: PMC5739108 DOI: 10.2147/mder.s146761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Aim To evaluate whether performing ventral hernia repairs using the Ethicon Physiomesh™ Open Flexible Composite Mesh Device in conjunction with the Ethicon Securestrap® Open Absorbable Strap Fixation Device reduces surgical time and surgeon stress levels, compared with traditional surgical repair methods. Methods To repair a simulated ventral incisional hernia, two surgeries were performed by eight experienced surgeons using a live porcine model. One procedure involved traditional suture methods and a flat mesh, and the other procedure involved a mechanical fixation device and a skirted flexible composite mesh. A Surgery Task Load Index questionnaire was administered before and after the procedure to establish the surgeons’ perceived stress levels, and saliva samples were collected before, during, and after the surgical procedures to assess the biologically expressed stress (cortisol and salivary alpha amylase) levels. Results For mechanical fixation using the Ethicon Physiomesh Open Flexible Composite Mesh Device in conjunction with the Ethicon Securestrap Open Absorbable Strap Fixation Device, surgeons reported a 46.2% reduction in perceived workload stress. There was also a lower physiological reactivity to the intraoperative experience and the total surgical procedure time was reduced by 60.3%. Conclusions This study provides preliminary findings suggesting that the combined use of a mechanical fixation device and a skirted flexible composite mesh in an open intraperitoneal onlay mesh repair has the potential to reduce surgeon stress. Additional studies are needed to determine whether a reduction in stress is observed in a clinical setting and, if so, confirm that this results in improved clinical outcomes.
Collapse
Affiliation(s)
- Nadia Sutton
- Global Health Economics and Market Access, Johnson & Johnson Medical Devices, New Brunswick, NJ, USA
| | - Melinda H MacDonald
- Preclinical Center of Excellence, Johnson & Johnson Medical Devices Companies, Somerville, NJ, USA
| | - John Lombard
- Global Health Economics and Market Access, Johnson & Johnson Medical Devices, New Brunswick, NJ, USA
| | | | - Piet Hinoul
- Medical Affairs, Ethicon, Somerville, NJ, USA
| | - Douglas A Granger
- Institute for Interdisciplinary Salivary Bioscience Research (IISBR), University of California at Irvine, Irvine, CA, USA.,Johns Hopkins University School of Nursing, Bloomberg School of Public Health, and School of Medicine, Baltimore, MD, USA
| |
Collapse
|
86
|
Penny-Dimri JC, Warrier S, Coventry C, Wale R, Nelson RL, Perry LA, Ramson D. Mesh prophylaxis for hernia in abdominal incisions. Hippokratia 2017. [DOI: 10.1002/14651858.cd012795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Satish Warrier
- Alfred Health; Colorectal Department; 55 Commercial Road Melbourne Victoria Australia 3004
| | - Charles Coventry
- Central Adelaide Health Network; Department of Surgery; Royal Adelaide Hosital, North Terrace Adelaide South Australia Australia
| | - Roger Wale
- Alfred Health; Colorectal Unit; Commercial Rd Melbourne Victoria Australia
| | - Richard L Nelson
- University of Illinois School of Public Health; Epidemiology/Biometry Division; 1603 West Taylor Room 956 Chicago Illinois USA 60612
| | - Luke A Perry
- Monash University; 246 Clayton Rd Melbourne Victoria Australia
| | - Dhruvesh Ramson
- Monash University; 246 Clayton Rd Melbourne Victoria Australia
| |
Collapse
|
87
|
Botulinum Toxin A as an Adjunct to Abdominal Wall Reconstruction for Incisional Hernia. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1358. [PMID: 28740773 PMCID: PMC5505834 DOI: 10.1097/gox.0000000000001358] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 04/17/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND Repair of large incisional hernias remains a surgical and costly challenge. Temporary paralysis of the lateral abdominal wall muscles with topical administration of botulinum toxin A (BTA) is a new therapeutic concept, which may obviate the need for component separation technique (CST) for repair of large incisional hernias. Current literature on the administration of BTA as adjunct to surgical repair of abdominal incisional hernias was investigated. METHODS The electronic databases PubMed and Embase were searched for eligible studies. Two independent investigators evaluated the literature. Data were sought regarding primary fascial closure with and without CST, safety, hernia recurrence, method of application, and preoperative radiological imaging. RESULTS Six cohort studies including a total of 133 patients receiving BTA were identified. No randomized or case-control studies were found. In total, 83.5% of the patients achieved primary fascial closure. Supplemental CST was necessary in 24.1% of the patients. Two patients developed hernia recurrence during follow-up. No postoperative complications or adverse events were considered related to the administration of BTA, except for impairment of postoperative coughing and sneezing. Additionally, radiological imaging showed that BTA increased the length of lateral abdominal muscles before surgery. CONCLUSIONS Preoperative administration of BTA increases muscle length and may facilitate primary fascial closure. Optimal administration is at least 2 weeks before repair, whereas the optimal dose of BTA remains to be defined. Carefully designed randomized controlled trials are warranted to identify patients who would benefit from BTA and to eliminate the confounding effect of CST.
Collapse
|
88
|
Cost analysis of incisional hernia repair with synthetic mesh and biological mesh: an Italian study. Updates Surg 2017; 69:375-381. [PMID: 28444543 DOI: 10.1007/s13304-017-0453-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 04/15/2017] [Indexed: 10/19/2022]
Abstract
Repair of an incisional hernia (IH) generates costs on several levels and domains of society. The aim of this study was to make a complete cost analysis of incisional hernia repair (IHR) with synthetic and biological mesh and to compare it with financial reimbursement. Patients were grouped into three levels to determine the complexity of their care, and hence, the costs involved. Group 1 included patients without comorbidities, who underwent a "standard" incisional hernia repair (SIHR), with synthetic mesh. Group 2 included patients with comorbidities, who underwent the same surgical procedure. Group 3 included all patients who underwent a "complex" IHR (CIHR) with biological mesh. Total costs were divided into direct (including preoperative and operative phases) and indirect costs (medications and working days loss). Reimbursement was calculated according to Diagnosis-Related Group (DRG). From 2012 to 2014, 76 patients underwent prosthetic IHR: group 1 (35 pts); group 2 (30 pts); and group 3 (11 pts). The direct costs of preoperative and operative phases for groups 1 and 2 were €5544.25 and €5020.65, respectively, and €16,397.17 in group 3. The total reimbursement in the three groups was €68,292.37 for group 1, €80,014.14 for group 2, and €72,173.79 for group 3, with a total loss of €124,658.43, €69,675.36, and €100,620.04, respectively. All DRGs underestimate the costs related to IHR and CIHR, thus resulting in an important economic loss for the hospital. The cost analysis shows that patient-related risk factors do not alter the overall costs. To provide a correct "cost-based" reimbursement, different DRGs should be created for different types of hernias and prostheses.
Collapse
|
89
|
Robotic versus laparoscopic rectal resection for sphincter-saving surgery: pathological and short-term outcomes in a single-center analysis of 130 consecutive patients. Surg Endosc 2017; 31:4085-4091. [PMID: 28271268 DOI: 10.1007/s00464-017-5455-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 02/03/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Minimally invasive sphincter-saving rectal resection represents a challenging procedure. Robotic surgery for rectal cancer has several advantages over conventional surgery in performing precise dissection and was proved to be safe and effective in previous studies. However, comparison between laparoscopic and robotic rectal resection has drawn contradictory results. The aim of the present study was to compare robotic and laparoscopic sphincter-saving rectal resections for short-term and pathological outcomes. METHODS Between January 2013 and May 2016, we performed a total of 258 robotic surgeries, including 146 colorectal resections (56%). For this study, we included the first 65 sphincter-saving robotic resections and compared them to the last 65 consecutive laparoscopic resections. The laparoscopic group was constituted by the last 65 consecutively operated patients who matched the inclusion criteria. RESULTS Patients' baseline characteristics were similar in both the groups. Conversion rate was greater in the laparoscopic group (17 vs. 5%, p=0.044). Reoperation rate, overall and severe morbidity, and median hospital stay were similar in both the groups. Quality of mesorectal excision specimen was considered complete or near complete in 97 and 96% in the laparoscopic and robotic groups, respectively. There was no difference in the rates of negative circumferential radial margin, distal margin, and surgical success measured by composite criteria. CONCLUSION The main finding of this study was that robotic proctectomy for sphincter-saving procedures offers similar quality of TME with a statistically significant lower rate of conversion when compared to laparoscopic proctectomy.
Collapse
|
90
|
Wang XC, Zhang D, Yang ZX, Gan JX, Yin LN. Mesh reinforcement for the prevention of incisional hernia formation: a systematic review and meta-analysis of randomized controlled trials. J Surg Res 2017; 209:17-29. [DOI: 10.1016/j.jss.2016.09.055] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 09/04/2016] [Accepted: 09/27/2016] [Indexed: 02/07/2023]
|
91
|
|