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Moore M, Bax T, MacFarlane M, McNevin MS. Outcomes of the fascial component separation technique with synthetic mesh reinforcement for repair of complex ventral incisional hernias in the morbidly obese. Am J Surg 2008; 195:575-9; discussion 579. [PMID: 18374893 DOI: 10.1016/j.amjsurg.2008.01.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2007] [Revised: 01/22/2008] [Accepted: 01/30/2008] [Indexed: 10/22/2022]
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Tatum RP, Shalhub S, Oelschlager BK, Pellegrini CA. Complications of PTFE mesh at the diaphragmatic hiatus. J Gastrointest Surg 2008; 12:953-7. [PMID: 17882502 DOI: 10.1007/s11605-007-0316-7] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Accepted: 08/24/2007] [Indexed: 01/31/2023]
Abstract
Paraesophageal hernia repair has been associated with a recurrence rate of up to 42%. Thus, in the last decade, there has been increasing interest in the use of mesh reinforcement of the hiatal repair. Polytetrafluoroethylene (PTFE) is one of the materials that have been used for this purpose, as it is thought to induce minimal tissue reaction. We report two cases in which complications specific to the use of PTFE mesh in this location developed over time. In the first patient, a gastrectomy was required to remove a large PTFE mesh which had eroded into the esophagogastric junction and gastric cardia. The second patient experienced severe dysphagia resulting from a stricture caused by the implant, requiring removal of the mesh. Although such complications have only rarely been reported, the severity and consequences of these incidents, as reported in the literature and in light of our observations, suggest that an alternative to PTFE should be considered for crural reinforcement during paraesophageal hernia repair.
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Affiliation(s)
- Roger P Tatum
- Department of Surgery, University of Washington, VA Puget Sound Health Care System, 1660 South Columbian Way, s-112-gs, Seattle, WA 98108, USA.
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Moreno-Egea A, Carrillo A, Aguayo JL. Midline versus nonmidline laparoscopic incisional hernioplasty: a comparative study. Surg Endosc 2008; 22:744-9. [PMID: 17704881 DOI: 10.1007/s00464-007-9480-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Nonmidline incisional hernia is a surgical problem of major interest, but to date, little information on this problem is available. This study aimed to analyze the results of nonmidline laparoscopic incisional hernioplasty in a multidisciplinary abdominal wall unit over the past 10 years. METHODS This prospective study examined a series of 199 patients undergoing surgery for incisional hernia via the laparoscopic approach: 146 midline and 53 nonmidline. A comparative analysis compared midline and nonmidline defects, and a descriptive analysis compared four nonmidline types: 18 lumbar, 11 subcostal, 14 inguinal, and 10 lateral. Clinical and follow-up parameters were assessed during a mean follow-up period of 64 months (range, 12-120 months). RESULTS The nonmidline incisional hernias were significantly larger, involved more preoperative pain, and required a longer hospital stay than the midline incisional hernias (p < 0.001). Also, the intraoperative complications and the consumption of analgesics were more frequent in the nonmidline group (p < 0.05). The postoperative morbidity and recurrence rates were similar in the two groups. No statistical differences were noted between the four types of nonmidline incisional hernias. The most common nonmidline type was lumbar hernia (34%). Hematomas (17%) predominated in the inguinal types, and pain predominated in the lumbar types. Two early recurrences were diagnosed for poor mesh placement: one subcostal and one lumbar. CONCLUSIONS Laparoscopic incisional hernioplasty can be applied to nonmidline defects with the same rates of morbidity and recurrence as for patients with midline defects. The four types of nonmidline defects seem to have their own evolutionary characteristics.
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Affiliation(s)
- A Moreno-Egea
- Abdominal Wall Unit, Department of Surgery, J. M. Morales Meseguer Hospital, Avda. Primo de Rivera 7, 5D (Edf. Berlín), 30008, Murcia, Spain.
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Saber AA, Elgamal MH, Rao AJ, Itawi EA, Mancl TB. A simplified laparoscopic ventral hernia repair: the scroll technique. Surg Endosc 2008; 22:2527-31. [PMID: 18322743 DOI: 10.1007/s00464-008-9791-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Revised: 10/22/2007] [Accepted: 01/19/2008] [Indexed: 11/26/2022]
Abstract
BACKGROUND Laparoscopic ventral hernia repair has steadily gained recognition as an alternative to the open approach. However, the procedure can be technically challenging. The authors present their simple scroll technique for laparoscopic ventral hernia repair. METHODS A total of 174 patients underwent laparoscopic ventral hernia repair using the scroll technique. The technique entails fixation of the rolled mesh to the anterior abdominal wall before it is unfolded. Patient characteristics, operative time, and complications were analyzed and compared with pooled data from the available literature on laparoscopic ventral hernia repair. RESULTS The mean operative time was comparable with that reported by others (mean, 102 vs. 100 min). The hospital stay was shorter (mean, 1.8 vs. 2.4 h). During a mean follow-up period of 28 months, the recurrence rate was lower than that reported by others (1.7% vs. 4.3%). There were no mortalities and no cases of inadvertent bowel injury. CONCLUSION The authors' scroll technique for laparoscopic repair is simple, feasible, and reproducible, with a short learning curve and a low recurrence rate.
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Affiliation(s)
- A A Saber
- Department of Surgery, Michigan State University/Kalamazoo Center of Medical Studies, 1000 Oakland Drive, Kalamazoo, MI 49008, USA.
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56
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Berry MF, Paisley S, Low DW, Rosato EF. Repair of large complex recurrent incisional hernias with retromuscular mesh and panniculectomy. Am J Surg 2007; 194:199-204. [PMID: 17618804 DOI: 10.1016/j.amjsurg.2006.10.031] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2006] [Revised: 10/23/2006] [Accepted: 10/23/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Recurrent incisional hernia repair is associated with high recurrence and wound complication rates. METHODS The clinical courses of patients who underwent recurrent incisional hernia repair via retromuscular mesh placement with concomitant panniculectomy at a university teaching hospital from 1999 to 2004 were reviewed retrospectively. Postoperative evaluation included a quality of life survey. RESULTS Forty-seven patients (13 male, 34 female) with an average body mass index of 34.4 kg/m2, an average midline hernia defect of 31.4 cm, and at least 1 and on average 2.5 previous repair attempts underwent hernia repair. Wound infections occurred in 4 patients (8%) and seromas requiring aspiration occurred in 1 patient (2%). Four patients (8%) had re-recurrences of their hernias. All patients rated the postoperative appearance of their abdomen as at least satisfactory. CONCLUSIONS Recurrent incisional hernia repair with a retromuscular mesh and panniculectomy has low recurrence and wound complication rates and excellent patient satisfaction.
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Affiliation(s)
- Mark F Berry
- Division of Gastrointestinal Surgery, Department of Surgery, University of Pennsylvania School of Medicine, 3400 Spruce St, Philadelphia, PA 19104, USA.
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Kurzer M, Kark A, Selouk S, Belsham P. Open Mesh Repair of Incisional Hernia Using a Sublay Technique: Long-Term Follow-up. World J Surg 2007; 32:31-6; discussion 37. [PMID: 17610110 DOI: 10.1007/s00268-007-9118-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Reported results of incisional hernia repair are poor with high recurrence rates unless prosthetic mesh is used. Mesh gives improved results, but certain techniques are associated with a high incidence of infections, fistulas, and seromas. This study reports the results of a consecutive series of incisional hernias repaired using an open sublay technique with retromuscular mesh placement. The primary endpoint was hernia recurrence. Secondary endpoints were complications and long-term discomfort. METHODS A total of 125 patients were operated on between 1991 and 2001. In 2002 they were sent a questionnaire and asked to return for examination if they thought their hernia had recurred or if they had pain. A second questionnaire was sent in 2005, and all patients were asked to return for examination. RESULTS There were no postoperative deaths and no major systemic complications. There were no early (within 30 days) wound infections; the mesh subsequently became infected in two patients and had to be removed. Seromas developed in 12 patients. In 2002, a total of 106 questionnaires were returned; 3 patients had died of unrelated causes, and 16 were untraceable despite repeated attempts. There were five (4%) recurrences. Altogether, 6 patients had abdominal wall discomfort, and 49 patients spontaneously wrote that they were pleased or very pleased with the long-term result. At a second follow-up a mean of 8 years after operation (95 months; range 46-168 months) patients were assessed by an independent observer, and there were no further recurrences. CONCLUSIONS Open repair of incisional hernias with mesh in the subfascial plane is highly effective with acceptable complication rates. Surgeon experience and a team approach are important factors in obtaining good results. Trials comparing open with laparoscopic repair are needed.
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Affiliation(s)
- Martin Kurzer
- British Hernia Centre, 87 Watford Way, Hendon, NW4 4RS, UK.
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Lucha PA, Briscoe C, Brar H, Schneider JJ, Butler RE, Jaklic B, Francis M. Bursting Strength Evaluation in an Experimental Model of Incisional Hernia. Am Surg 2007. [DOI: 10.1177/000313480707300718] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Incisional hernias occur in up to 11 per cent of patients undergoing abdominal surgery. Up to 50 per cent of these patients with hernias will require repeat operative procedures. Management of these hernias have focused primarily on tensile strength of the mesh material, have not addressed currently used materials, and have not compared the strength of these repairs with each other. Forty-nine adult Sprague–Dawley rats had an incisional hernia created by removing a portion of their abdominal wall that was then repaired primarily, using either a composite mesh, Dual mesh (Gore-Tex), or polypropylene mesh. Six weeks after the repair, the rats were euthanized. Hydrostatic distension of the abdominal cavity was performed to compare bursting strength of each repair. Wound tensile strength was assessed and compared. Tissue samples were also taken to compare repair types for incorporation of prosthetic materials. The gross weight of the animals subjected to hydrostatic distention was equivalent between groups, as was the volume required prior to failure of the repair. There was a trend toward improved tensile strength of the Prolene mesh repair, which had a lower average inflammatory and fibrosis score on histology. Overall, the type of mesh used for repair does not seem to impact significantly the strength of the repair when assessed 6 weeks postoperatively. Choice of prosthetic material to repair the hernia should be made based on economics and handling characteristics alone. Prolene mesh has satisfactory strength with the least amount of inflammation and fibrosis.
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Affiliation(s)
- Paul A. Lucha
- Division of Colon and Rectal Surgery, Investigation, Naval Medical Center, Portsmouth, Virginia
| | - Crystal Briscoe
- Department of Clinical Research and Investigation, Naval Medical Center, Portsmouth, Virginia
| | - Harpreet Brar
- Department of General Surgery, and Investigation, Naval Medical Center, Portsmouth, Virginia
| | - James J. Schneider
- Department of General Surgery, and Investigation, Naval Medical Center, Portsmouth, Virginia
| | - Ralph E. Butler
- Department of General Surgery, and Investigation, Naval Medical Center, Portsmouth, Virginia
| | - Beth Jaklic
- Division of Colon and Rectal Surgery, Investigation, Naval Medical Center, Portsmouth, Virginia
| | - Michael Francis
- Division of Colon and Rectal Surgery, Investigation, Naval Medical Center, Portsmouth, Virginia
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Moreno-Egea A, Guzmán P, Morales G, Carrillo A, Aguayo JL. Tratamiento de la eventración no medial: experiencia de una unidad de pared abdominal y revisión de la literatura. Cir Esp 2007; 81:330-4. [PMID: 17553405 DOI: 10.1016/s0009-739x(07)71332-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Lateral ventral hernia is an interesting surgical problem. However, few data are available on this entity. OBJECTIVE To review current knowledge of lateral ventral hernia and present our experience of this entity in a multidisciplinary abdominal wall unit. PATIENTS AND METHOD A. LITERATURE REVIEW a search of Spanish (Cirugía Española) and international literature was performed through MEDLINE using the key words "lateral incisional/ventral hernia". B. Clinical study: a series of 53 patients who underwent endoscopic surgery for non-midline ventral hernia were prospectively studied. Clinical parameters, postoperative complications and the recurrence rate were evaluated. The mean follow-up was 64 months (range, 12-120 months). RESULTS A. LITERATURE REVIEW we found a ratio between chapters on inguinal hernia and ventral hernia of 3.8:1 and a complete absence of chapters on lateral ventral hernia. Only two articles specifically dealt with ventral hernia. B. Clinical study: the most frequent location was lumbar (34%), followed by iliac and subcostal. A total of 37.7% of patients could be treated without admission and the remaining patients had a mean length of hospital stay of 2.7 days. Hematoma (17%) predominated in iliac ventral hernias and pain was transitory in two patients with lumbar ventral hernia. There were two early recurrences due to incorrect mesh fixation in subcostal and lumbar ventral hernias. CONCLUSIONS Non-midline ventral hernia is a little known entity. Future treatment should be individualized in each patient and should be based on common classification of the type of defect to correctly evaluate the results. The laparoscopic route provides competitive results in selected patients.
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Affiliation(s)
- Alfredo Moreno-Egea
- Unidad de Pared Abdominal, Departamento de Cirugía, Hospital J.M. Morales Meseguer, Murcia, España.
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Muysoms FE, Cathenis KKJ, Claeys DAB. "Suture hernia": identification of a new type of hernia presenting as a recurrence after laparoscopic ventral hernia repair. Hernia 2006; 11:199-201. [PMID: 17119854 DOI: 10.1007/s10029-006-0170-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2006] [Accepted: 10/19/2006] [Indexed: 11/29/2022]
Abstract
After laparoscopic repair of ventral or incisional hernias, the recurrence rates reported are around 4%. Different mechanisms for the recurrences have been identified. We report two cases in which the patients were operated on laparoscopically for recurrence after laparoscopic ventral hernia repair. In both cases, the site of the recurrent hernia was situated at the transfascial fixation sutures. Patients were treated by laparoscopy with a larger intraperitoneal mesh covering the new hernia and the old mesh.
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Affiliation(s)
- F E Muysoms
- Department of Surgery, AZ Maria Middelares, Kortrijksesteenweg 1026, Gent, Belgium.
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Moreno-Egea A, Torralba JA, Morales G, Aguayo JL. Reformulación conceptual de la técnica de reparación doble: una solución sencilla para defectos muy complejos de la pared abdominal. Cir Esp 2006; 80:101-4. [PMID: 16945308 DOI: 10.1016/s0009-739x(06)70931-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Repair of complex abdominal wall defects remains a challenge for the general surgeon. The aim of the present study was to validate the double mesh repair technique in complex hernias. MATERIAL AND METHOD We performed a prospective study of 15 patients with complex abdominal wall defects who underwent surgery in a university hospital. All patients were evaluated in a multidisciplinary unit. Indications consisted of incisional hernias with multiple recurrences (> 3 times), prior mesh complicated by fistula and chronic infection, giant diffuse lumbar hernia, and ventral hernia (associated with parastomal hernia or occurring after bariatric surgery with associated dermolipectomy). The surgical technique used was double intra-abdominal and supra-aponeurotic mesh repair without associated plasty techniques. Clinical, surgical and follow-up data were analyzed. RESULTS Nine defects were lateral, three were lumbar, one was parapubic, and two were located in the mid-line (one associated with giant parastomal hernia and one occurring after bariatric surgery). Eight showed significant tissue loss, five showed trophic skin lesions, and two showed chronic suppurative infection. The mean size of the defects was 17.5 cm. Seroma occurred in three patients and limited cutaneous necrosis occurred in one patient. The mean length of hospital stay was 4.3 days (range 2-7 days). No complications, recurrences or mortality were detected during follow-up. CONCLUSION Complex abdominal wall defects can be corrected through double repair using mesh only. This technique is simple to learn and perform and can be applied in many anatomical sites and types of defect, as well as in the presence of tissue destruction.
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Affiliation(s)
- Alfredo Moreno-Egea
- Unidad de Pared Abdominal, Servicio de Cirugía General, Hospital Universitario J.M. Morales Meseguer, Murcia, España.
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