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Depuydt M, Van Egmond S, Petersen SM, Muysoms F, Henriksen N, Deerenberg E. Systematic review and meta-analysis comparing surgical site infection in abdominal surgery between triclosan-coated and uncoated sutures. Hernia 2024; 28:1017-1027. [PMID: 38713430 PMCID: PMC11297069 DOI: 10.1007/s10029-024-03045-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/13/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE Surgical site infection (SSI) is a frequent complication after abdominal surgery and impacts morbidity, mortality and medical costs. This systematic review evaluates whether the use of triclosan-coated sutures for closing the fascia during abdominal surgery reduces the rate of SSI compared to uncoated sutures. METHODS A systematic review and meta-analysis were conducted using the PRISMA guidelines. On February 17, 2024, a literature search was performed in Medline ALL, Web of Science Core Collection, Cochrane Central Register of Controlled Trials and Embase. Randomized controlled trials (RCTs) on abdominal fascial closure in human adults, comparing triclosan-coated and uncoated sutures, were included. The risk of bias was assessed using the Cochrane RoB 2 tool. Pooled meta-analysis was performed using RevMan. RESULTS Out of 1523 records, eleven RCTs were included, with a total of 10,234 patients: 5159 in the triclosan-coated group and 5075 in the uncoated group. The incidence of SSI was statistically significantly lower in the triclosan-coated group (14.8% vs. 17.3%) with an odds ratio (OR) of 0.84 (95% CI [0.75, 0.93], p = 0.001). When polydioxanone was evaluated separately (coated N = 3999, uncoated N = 3900), triclosan-coating reduced SSI; 17.5% vs. 20.1%, OR 0.86 (95% CI [0.77; 0.96], p = 0.008). When polyglactin 910 was evaluated (coated N = 1160, uncoated N = 1175), triclosan-coating reduced the incidence of SSI; 5.4% vs. 7.8%, OR 0.67 (95% CI [0.48; 0.94], p = 0.02). CONCLUSION According to the results of this meta-analysis the use of triclosan-coated sutures for fascial closure statistically significantly reduces the incidence of SSI after abdominal surgery with a risk difference of about 2%.
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Affiliation(s)
- Martijn Depuydt
- General Surgery, AZ Maria Middelares, Buitenring-Sint-Denijs 30, 9000, Ghent, Belgium.
- Department of Surgery, University of Ghent, Ghent, Belgium.
| | - Sarah Van Egmond
- Department of Surgery, Franciscus Gasthuis and Vlietland, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands.
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | | | - Filip Muysoms
- General Surgery, AZ Maria Middelares, Buitenring-Sint-Denijs 30, 9000, Ghent, Belgium
| | - Nadia Henriksen
- Hepatic and Digestive Diseases, Herlev University Hospital, Copenhagen, Denmark
| | - Eva Deerenberg
- Department of Surgery, Franciscus Gasthuis and Vlietland, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands
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Wu XW, Yang DQ, Wang MW, Jiao Y. Occurrence and prevention of incisional hernia following laparoscopic colorectal surgery. World J Gastrointest Surg 2024; 16:1973-1980. [PMID: 39087097 PMCID: PMC11287670 DOI: 10.4240/wjgs.v16.i7.1973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/23/2024] [Accepted: 05/31/2024] [Indexed: 07/22/2024] Open
Abstract
Among minimally invasive surgical procedures, colorectal surgery is associated with a notably higher incidence of incisional hernia (IH), ranging from 1.7% to 24.3%. This complication poses a significant burden on the healthcare system annually, necessitating urgent attention from surgeons. In a study published in the World Journal of Gastrointestinal Surgery, Fan et al compared the incidence of IH among 1614 patients who underwent laparoscopic colorectal surgery with different extraction site locations and evaluated the risk factors associated with its occurrence. This editorial analyzes the current risk factors for IH after laparoscopic colorectal surgery, emphasizing the impact of obesity, surgical site infection, and the choice of incision location on its development. Furthermore, we summarize the currently available preventive measures for IH. Given the low surgical repair rate and high recurrence rate associated with IH, prevention deserves greater research and attention compared to treatment.
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Affiliation(s)
- Xi-Wen Wu
- The First Operating Room, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Ding-Quan Yang
- Department of Gastrointestinal and Colorectal Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Ming-Wei Wang
- Ministry of Health Key Laboratory of Radiobiology, School of Public Health of Jilin University, Changchun 130000, Jilin Province, China
| | - Yan Jiao
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
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Padinhare Madathil J, Kumar RP, Haridas TV, Job J, Chandran P, Siby J. A Prospective Study of Sutured Versus Non-sutured Subcutaneous Fat Tissue in Laparotomy Wound Closure. Cureus 2024; 16:e62034. [PMID: 38989352 PMCID: PMC11234059 DOI: 10.7759/cureus.62034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2024] [Indexed: 07/12/2024] Open
Abstract
Background This study was conducted to determine the wound-related complications, such as wound dehiscence, delayed post-operative stay, and reinterventions in both groups, and compare the incidence of surgical site infection in elective laparotomy wounds in two groups - those with closing subcutaneous fat tissue and those without. Methods At the Government Medical College, Thrissur, 248 patients undergoing elective abdominal surgeries during the period from August 2019 to August 2020 participated in this one-year prospective cross-sectional study. The institutional ethics committee approved the study, and participants provided written informed consent. Patients were randomly assigned to the subcutaneous closure group (S) and the non-closure group (N). Post-operative events were then systematically documented. Results The group with no subcutaneous suture (N) had a considerably greater percentage of patients with seromas (12 patients, 9%), hematomas (13 patients, 10.5%), superficial surgical site infection and total wound dehiscence as compared to the subcutaneous tissue closure group (S). Groups N and S displayed comparable numbers of suture sinus developments and partial wound dehiscence. Group N and Group S had similar hospital stays, according to the overall length of stay displayed. Conclusion Subcutaneous suturing during elective laparotomy wound closure significantly reduced superficial surgical site infection, hematoma, seroma, and total wound dehiscence; in the remaining categories, subcutaneous and non-subcutaneous sutures did not differ significantly. It also did not help to reduce hospital stays.
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Affiliation(s)
| | - Revathy P Kumar
- Plastic Surgery, Government Medical College, Kozhikode, Kozhikode, IND
| | - T V Haridas
- General Surgery, Government Medical College, Thrissur, Thrissur, IND
| | - Jim Job
- Upper Gastrointestinal and Bariatric Surgery, Princess Royal University Hospital, London, GBR
| | | | - Jayas Siby
- General Surgery, Whipps Cross University Hospital, London, GBR
- General Surgery, Royal Sussex County Hospital, Brighton, GBR
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Fukai S, Mizusawa Y, Noda H, Tsujinaka S, Maeda Y, Hasebe R, Eguchi Y, Kanemitsu R, Matsuzawa N, Abe I, Endo Y, Fukui T, Takayama Y, Ichida K, Inoue K, Muto Y, Watanabe F, Futsuhara K, Miyakura Y, Rikiyama T. Superiority trial for the development of an ideal method for the closure of midline abdominal wall incisions to reduce the incidence of wound complications after elective gastroenterological surgery: study protocol for a randomized controlled trial. Trials 2024; 25:327. [PMID: 38760769 PMCID: PMC11100179 DOI: 10.1186/s13063-024-08167-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 05/09/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND The recent guidelines from the European and American Hernia Societies recommend a continuous small-bite suturing technique with slowly absorbable sutures for fascial closure of midline abdominal wall incisions to reduce the incidence of wound complications, especially for incisional hernia. However, this is based on low-certainty evidence. We could not find any recommendations for skin closure. The wound closure technique is an important determinant of the risk of wound complications, and a comprehensive approach to prevent wound complications should be developed. METHODS We propose a single-institute, prospective, randomized, blinded-endpoint trial to assess the superiority of the combination of continuous suturing of the fascia without peritoneal closure and continuous suturing of the subcuticular tissue (study group) over that of interrupted suturing of the fascia together with the peritoneum and interrupted suturing of the subcuticular tissue (control group) for reducing the incidence of midline abdominal wall incision wound complications after elective gastroenterological surgery with a clean-contaminated wound. Permuted-block randomization with an allocation ratio of 1:1 and blocking will be used. We hypothesize that the study group will show a 50% reduction in the incidence of wound complications. The target number of cases is set at 284. The primary outcome is the incidence of wound complications, including incisional surgical site infection, hemorrhage, seroma, wound dehiscence within 30 days after surgery, and incisional hernia at approximately 1 year after surgery. DISCUSSION This trial will provide initial evidence on the ideal combination of fascial and skin closure for midline abdominal wall incision to reduce the incidence of overall postoperative wound complications after gastroenterological surgery with a clean-contaminated wound. This trial is expected to generate high-quality evidence that supports the current guidelines for the closure of abdominal wall incisions from the European and American Hernia Societies and to contribute to their next updates. TRIAL REGISTRATION UMIN-CTR UMIN000048442. Registered on 1 August 2022. https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000055205.
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Affiliation(s)
- Shota Fukai
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Yuki Mizusawa
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Hiroshi Noda
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan.
| | - Shingo Tsujinaka
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Yukihisa Maeda
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Ryuji Hasebe
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Yusuke Eguchi
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Rina Kanemitsu
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Natsumi Matsuzawa
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Iku Abe
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Yuhei Endo
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Taro Fukui
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Yuji Takayama
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Kosuke Ichida
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Koetsu Inoue
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Yuta Muto
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Fumiaki Watanabe
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Kazushige Futsuhara
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Yasuyuki Miyakura
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Toshiki Rikiyama
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
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Tustumi F, Darce GFB, Lobo Filho MM, Abdalla RZ, Costa TN. STAPLED FASCIAL CLOSURE VS. CONTINUOUS HAND-SEWN SUTURE: EXPERIMENTAL STUDY OF THE ABDOMINAL WALL ON PORCINE MODEL AND HUMAN CADAVER. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2024; 37:e1800. [PMID: 38716920 PMCID: PMC11072250 DOI: 10.1590/0102-672020240007e1800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 02/15/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND One of the primary complications associated with large incisions in abdominal surgery is the increased risk of fascial closure rupture and incisional hernia development. The choice of the fascial closure method and closing with minimal tension and trauma is crucial for optimal results, emphasizing the importance of uniform pressure along the suture line to withstand intra-abdominal pressure. AIMS To evaluate the resistance to pressure and tension of stapled and sutured hand-sewn fascial closure in the abdominal wall. METHODS Nine abdominal wall flaps from human cadavers and 12 pigs were used for the experimentation. An abdominal defect was induced after the resection of the abdominal wall and the creation of a flap in the cadaveric model and after performing a midline incision in the porcine models. The models were randomized into three groups. Group 1 was treated with a one-layer hand-sewn small bite suture, Group 2 was treated with a two-layer hand-sewn small bite suture, and Group 3 was treated with a two-layer stapled closure. Tension measurements were assessed in cadaveric models, and intra-abdominal pressure was measured in porcine models. RESULTS In the human cadaveric model, the median threshold for fascial rupture was 300N (300-350) in Group 1, 400N (350-500) in Group 2, and 350N (300-380) in Group 3. Statistical comparisons revealed non-significant differences between Group 1 and Group 2 (p=0.072, p>0.05), Group 1 and Group 3 (p=0.346, p>0.05), and Group 2 and Group 3 (p=0.184, p>0.05). For porcine subjects, Group 1 showed a median pressure of 80 mmHg (85-105), Group 2 had a median of 92.5 mmHg (65-95), and Group 3 had a median of 102.5 mmHg (80-135). Statistical comparisons indicated non-significant differences between Group 1 and Group 2 (p=0.243, p>0.05), Group 1 and Group 3 (p=0.468, p>0.05), and Group 2 and Group 3 (p=0.083, p>0.05). CONCLUSIONS Stapled and conventional suturing resist similar pressure and tension thresholds.
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Affiliation(s)
- Francisco Tustumi
- Universidade de São Paulo, Department of Gastroenterology - São Paulo (SP), Brazil
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Kehl S. Obesity at term: What to consider? How to deliver? Arch Gynecol Obstet 2024; 309:1725-1733. [PMID: 38326633 DOI: 10.1007/s00404-023-07354-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 12/17/2023] [Indexed: 02/09/2024]
Abstract
Obesity presents significant challenges during pregnancy, increasing the risk of complications and adverse outcomes for both mother and baby. With the rising prevalence of obesity among pregnant women, questions arise regarding optimal management, including timing of delivery and choice of delivery mode. Labour induction in obese women may require a combination of mechanical and pharmacological methods due to increased risk of failed induction. Caesarean section in obese women presents unique challenges, requiring comprehensive perioperative planning and specialized care to optimize outcomes. However, specific guidelines tailored to obese patients undergoing caesarean sections are lacking. Postpartum care should include vigilant monitoring for complications. Addressing obesity in pregnancy necessitates a multidisciplinary approach and specialized care to ensure the best outcomes.
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Affiliation(s)
- Sven Kehl
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Universitätsstr. 21-23, 91054, Erlangen, Germany.
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Xv Y, Al-Magedi AAS, Wu R, Cao N, Tao Q, Ji Z. The top 100 most-cited papers in incisional hernia: a bibliometric analysis from 2003 to 2023. Hernia 2024; 28:333-342. [PMID: 37897504 DOI: 10.1007/s10029-023-02909-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/01/2023] [Indexed: 10/30/2023]
Abstract
PURPOSE Incisional hernia (IH) is one of the most common complications after abdominal surgeries and may bring great suffering to patients. This study aims to evaluate the global trends in IH research from 2003 to 2023 and visualize the frontiers using bibliometric analysis. METHODS The literature search was conducted on the Web of Science for IH studies published from 2003 to 2023 and sorted by citation frequency. The top 100 most-cited articles were analyzed by the annual publication number, prolific countries and institutions, influential author and journal, and the number of citations through descriptive statistics and visualization. RESULTS The top paper was cited 1075 times and the median number of citations was 146. All studies were published between 2003 and 2019 and the most prolific year was 2003 with 14 articles. Jeekel J and Rosen M were regarded as the most productive authors with ten articles each and acquired 2738 and 2391 citations, respectively. The top three institutions with the most productive articles were Erasmus Mc, Carolinas Med Ctr, and Univ Utah, while the top three countries were the United States, Netherlands and Germany. The most frequent keyword was "incisional hernia" with 55 occurrences, followed by "mesh repair", "randomized controlled trial", and "polypropylene". CONCLUSION The 100 most-cited papers related to IH were published predominantly by USA and European countries, with randomized controlled trial (RCT) and observational study designs, addressing topics related to risk factors, complications, mesh repair, and mesh components.
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Affiliation(s)
- Y Xv
- School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - A A S Al-Magedi
- School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - R Wu
- Department of General Surgery, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - N Cao
- Department of General Surgery, Lishui People's Hospital, 86 Chongwen Road, Yongyang Street, Nanjing, 211200, China
| | - Q Tao
- Department of General Surgery, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Z Ji
- School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China.
- Department of General Surgery, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China.
- Department of General Surgery, Lishui People's Hospital, 86 Chongwen Road, Yongyang Street, Nanjing, 211200, China.
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Kim KE, Jeon YR, Bae SU, Jeong WK, Baek SK. Comparison between liquid skin adhesive and wound closure strip for skin closure after subcuticular suturing in single-port laparoscopic appendectomy: a single-center retrospective study in Korea. JOURNAL OF MINIMALLY INVASIVE SURGERY 2024; 27:14-22. [PMID: 38494182 PMCID: PMC10961233 DOI: 10.7602/jmis.2024.27.1.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/06/2024] [Accepted: 03/11/2024] [Indexed: 03/19/2024]
Abstract
Purpose This study was performed to evaluate the safety and feasibility of skin adhesives and to compare postoperative and cosmetic outcomes after wound closure in single-port laparoscopic appendectomy (SPLA) between skin adhesives and steri-strips. Methods This was a single-center retrospective study. We included 22 and 47 patients in whom skin adhesive and steri-strips were used respectively, for skin closure after subcuticular suturing in SPLA between August 2014 and 2020. The patient scar assessment questionnaire (PSAQ) was completed postoperatively to assess postoperative cosmetic outcomes. Results On the postoperative day, patients in whom skin adhesive was used had significantly lower numeric rating scores than in whom steri-strips were used (2.8 ± 0.8 vs. 3.9 ± 0.8, p < 0.001). The frequency of analgesic administration within 24 hours and between 24 and 48 hours after surgery was significantly lower in the skin adhesive group compared to the wound closure strip group (1.4 ± 0.8 vs. 2.7 ± 1.2, p = 0.013 and 0.2 ± 0.4 vs. 0.7 ± 0.9, p = 0.002, respectively). In the PSAQ, "satisfaction with appearance" and "satisfaction with symptoms" subitem scores were significantly lower in patients in whom skin adhesive was used (11.3 ± 3.0 vs. 15.1 ± 4.5, p = 0.006 and 6.5 ± 1.8 vs. 9.5 ± 3.3, p = 0.003), whereas, "appearance" and "consciousness" subitems revealed no statistically significant differences between the groups. Conclusion Liquid skin adhesive closures seem to be safe and feasible and cause less postoperative pain, resulting in greater patient satisfaction with postoperative scars than wound closure strip closure after subcuticular suturing in SPLA.
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Affiliation(s)
- Kyeong Eui Kim
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Yu Ra Jeon
- Department of Surgery, School of Medicine, Keimyung University, Dongsan Medical Center, Daegu, Korea
| | - Sung Uk Bae
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Woon Kyung Jeong
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Seong Kyu Baek
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
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Xv Y, Al-Magedi AAS, Cao N, Tao Q, Wu R, Ji Z. Risk factors for incisional hernia after gastrointestinal surgeries in non-tumor patients. Hernia 2024; 28:147-154. [PMID: 38010469 DOI: 10.1007/s10029-023-02914-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/14/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE Incisional hernia (IH) is a common secondary ventral hernia after abdominal incisions and there is still little reliable evidence to predict and prevent IH. This study aimed to estimate risk factors of its incidence, especially concentrating on blood results. METHODS 96 patients received midline laparotomy for gastrointestinal benign diseases and suffered from IH were enrolled in the IH group. A control group of 192 patients were randomly selected from patients underwent midline laparotomy for gastrointestinal benign diseases without IH. RESULTS Patients in the IH group exhibited higher age (P < 0.001), BMI (P < 0.001), hernia history (P = 0.001) and laparotomy history (P < 0.001). Rate of coronary heart disease (P = 0.046), hypertension (P < 0.001), diabetes (P = 0.008), incisional infection (P = 0.004) and emergency surgery (P = 0.041) were also higher in the IH group. Patients with IH had lower levels of Hb (P = 0.002), TP (P = 0.013), ALB (P < 0.001), A/G (P = 0.019), PA (P < 0.001), HDL-C (P = 0.008) and ApoA1 (P = 0.005). Meanwhile, patients in the control group bore lower levels of LDH (P = 0.008), GLU (P = 0.007), BUN (P = 0.048), UA (P = 0.021), TG (P = 0.011), TG/HDL-C (P = 0.002), TC/HDL-C (P = 0.013), ApoB/ApoA1 (P = 0.001) and Lp(a) (P = 0.001). A multivariate logistic regression revealed that high BMI, laparotomy history, incisional infection, decreased PA, elevated levels of UA, Lp(a) and ApoB/ApoA1 were independent risk factors of IH. CONCLUSION This is the first study to reveal the relationship between IH and serum biochemical levels, and give a prediction through the nomograph model. These results will help surgeons identify high-risk patients, and take measures to prevent IH during the perioperative period.
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Affiliation(s)
- Y Xv
- School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - A A S Al-Magedi
- School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - N Cao
- Department of General Surgery, Lishui People's Hospital, 86 Chongwen Road, Yongyang Street, Nanjing, 211200, China
| | - Q Tao
- Department of General Surgery, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - R Wu
- Department of General Surgery, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China.
| | - Z Ji
- School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China.
- Department of General Surgery, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China.
- Department of General Surgery, Lishui People's Hospital, 86 Chongwen Road, Yongyang Street, Nanjing, 211200, China.
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Nagaria TD, Shinde RK, Shukla S, Acharya S, Acharya N, Dighe SP. A Rare Case of Obstructed Recurrent Incisional Hernia With Incidentalomas. Cureus 2024; 16:e53473. [PMID: 38440004 PMCID: PMC10910421 DOI: 10.7759/cureus.53473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/02/2024] [Indexed: 03/06/2024] Open
Abstract
Incisional hernias (IHs) are the most common postoperative complication of incisions during laparotomy and contribute to a significant burden. The aetiology of IHs varies depending on the surgical technique, patient's condition, and surgeon's experience. Many patients present with abdominal swelling and some degree of discomfort, and in an emergency, the presentation is usually as bowel obstruction or strangulation, necessitating immediate exploration. Hernias can be repaired by closing the defect with a nonabsorbable suture or using mesh. Amidst the use of invasive techniques and mesh, the rate of recurrence remains high for IHs, with pain and infection being the most common symptoms. The consequence of IH repair is affected by comorbid conditions such as chronic cough, constipation, urethral stricture, benign prostate hyperplasia, ascites, and obesity. We present a case of a 63-year-old male with an IH, adrenal adenoma, and adrenal cyst, which was an incidental finding.
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Affiliation(s)
- Tapesh D Nagaria
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Raju K Shinde
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Samarth Shukla
- Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sourya Acharya
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Neema Acharya
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sajika P Dighe
- General Surgery, Lokmanya Tilak Municipal Medical College, Mumbai, IND
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Hackenberger PN, Mittal M, Fronza J, Shapiro M. Duramesh registry study: short-term outcomes using mesh suture for abdominal wall closure. Front Surg 2024; 10:1321146. [PMID: 38274351 PMCID: PMC10809794 DOI: 10.3389/fsurg.2023.1321146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/14/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction Sutures are flexible linear elements that join tissue and maintain their hold with a surgeon-created knot. Tension at the suture/tissue interface can cut the very tissues that sutures are designed to hold, leading to dehiscence and incisional hernia formation. A new suture design (Duramesh, Mesh Suture Inc., Chicago, IL) was approved for marketing by the United States Food and Drug Administration in September 2022. The multiple filaments of the mesh suture are designed to diffuse tension at the suture/tissue interface thereby limiting pull-through. The macroporosity and hollow core of the mesh suture encourage fibrovascular incorporation for a durable repair. We created the first registry and clinical report of patients undergoing mesh suture implantation to assess its real-world effectiveness. Methods A patient registry was created based on institutional implant logs from January to August 2023 at an integrated health-care system. Operative reports were reviewed by the study team to verify use of "Duramesh" by dictation. Retrospective chart review was conducted to evaluate patient and surgical characteristics, follow-up, and short-term outcomes of interest. Results were analyzed using descriptive statistics and Chi-squared analysis with Microsoft Excel and GraphPad Prism. Results Three hundred seventy-nine separate implantations by 56 surgeons across 12 (sub) specialties at a university hospital and two community hospitals were performed. Mesh suture was used for treatment of the abdominal wall in 314 cases. Follow-up averaged 80.8 ± 52.4 days. The most common abdominal wall indications were ventral hernia repair (N = 97), fascial closure (N = 93), abdominal donor site closure from autologous breast reconstruction (N = 51), and umbilical hernia repair (N = 41). Mesh suture was used in all Centers for Disease Control (CDC) wound classifications, including 92 CDC class 2 or 3 abdominal operations. There were 19 surgical site infections (6.1%) and 37 surgical site events (11.8%). Conclusions Short-term registry data demonstrates the wide diversity of surgical disciplines and scenarios in which mesh suture has been used to date. The early adoption of mesh suture into practice highlights that consequences of suture pull-through influence operative decision making. As this is the first interim report of the Duramesh mesh suture registry, follow-up is too short for characterization of long-term durability of abdominal wall closures.
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Affiliation(s)
| | | | | | - Michael Shapiro
- Department of Surgery, Northwestern Feinberg School of Medicine, Chicago, IL, United States
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12
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Fortelny RH, Dietz U. [Incisional hernias: epidemiology, evidence and guidelines]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:3-9. [PMID: 38078933 PMCID: PMC10781829 DOI: 10.1007/s00104-023-01999-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND From an epidemiological point of view, one third of the population in industrialized countries will undergo abdominal surgery during their lifetime. Depending on the degree of patient-related and procedure-related risks, the occurrence of incisional hernias is associated in a range of up to 30% at 2‑year follow-up and even up to 60% at 5 years. In addition to influencing comorbidities, the type of surgical approach and closure technique are of critical importance. OBJECTIVE To present a descriptive evidence-based recommendation for abdominal wall closure and prophylactic mesh augmentation. MATERIAL AND METHODS A concise summary was prepared incorporating the current literature and existing guidelines. RESULTS According to recent studies the recognized risk for the occurrence of incisional hernias in the presence of obesity and abdominal aortic diseases also applies to patients undergoing colorectal surgery and the presence of diastasis recti abdominis. Based on high-level published data, the short stitch technique for midline laparotomy in the elective setting has a high level of evidence to be a standard procedure. Patients with an increased risk profile should receive prophylactic mesh reinforcement, either onlay or sublay, in addition to the short stitch technique. In emergency laparotomy, the individual risk of infection with respect to the closure technique used must be included. CONCLUSION The avoidance of incisional hernias is primarily achieved by the minimally invasive access for laparoscopy. For closure of the most commonly used midline approach, the short stitch technique and, in the case of existing risk factors, additionally mesh augmentation are recommended.
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Affiliation(s)
- R H Fortelny
- Lehrstuhl für Allgemeinchirurgie, Medizinische Fakultät, Sigmund Freud PrivatUniversität Wien, Freudplatz 3, 1020, Wien, Österreich.
| | - U Dietz
- Chirurgie, Kantonsspital Olten, Olten, Schweiz
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Kobayashi T, Miki H, Yamamoto N, Hori S, Hatta M, Hashimoto Y, Mukaide H, Yamasaki M, Inoue K, Sekimoto M. Retrospective study of an incisional hernia after laparoscopic colectomy for colorectal cancer. BMC Surg 2023; 23:314. [PMID: 37845691 PMCID: PMC10580507 DOI: 10.1186/s12893-023-02229-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 10/11/2023] [Indexed: 10/18/2023] Open
Abstract
PURPOSE This study aimed to examine the incidence of incisional hernia (IH) in elective laparoscopic colorectal surgery (LC) using regulated computed tomography (CT) images at intervals every 6 months. METHODS We retrospectively examined the diagnosis of IH in patients who underwent LC for colorectal cancer at Kansai Medical University Hospital from January 2014 to August 2018. The diagnosis of IH was defined as loss of continuity of the fascia in the axial CT images. RESULTS 470 patients were included in the analysis. IH was diagnosed in 47 cases at 1 year after LC. The IH size was 7.8 cm2 [1.3-55.6]. In total, 38 patients with IH underwent CT examination 6 months after LC, and 37 were already diagnosed with IH. The IH size was 4.1 cm2 [0-58.9]. The IH size increased in 17 cases between 6 months and 1 year postoperatively, and in 1 case, a new IH occurred. 47%(18/38) of them continued to grow until 1 year after LC. A multivariate analysis was performed on the risk of IH occurrence. SSI was most significantly associated with IH occurrence (OR:5.28 [2.14-13.05], p = 0.0003). CONCLUSION IH occurred in 10% and 7.9% at 1 year and 6 months after LC. By examining CT images taken for the postoperative surveillance of colorectal cancer, we were able to investigate the occurrence of IH in detail.
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Affiliation(s)
- Toshinori Kobayashi
- Department of Surgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Hisanori Miki
- Department of Surgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Nobuyuki Yamamoto
- Department of Surgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Soushi Hori
- Department of Surgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Masahiko Hatta
- Department of Surgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Yuki Hashimoto
- Department of Surgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Hiromi Mukaide
- Department of Surgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Makoto Yamasaki
- Department of Surgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Kentaro Inoue
- Department of Surgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Mitsugu Sekimoto
- Department of Surgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata, Osaka, 573-1010, Japan.
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Frassini S, Cobianchi L, Fugazzola P, Biffl WL, Coccolini F, Damaskos D, Moore EE, Kluger Y, Ceresoli M, Coimbra R, Davies J, Kirkpatrick A, Di Carlo I, Hardcastle TC, Isik A, Chiarugi M, Gurusamy K, Maier RV, Segovia Lohse HA, Jeekel H, Boermeester MA, Abu-Zidan F, Inaba K, Weber DG, Augustin G, Bonavina L, Velmahos G, Sartelli M, Di Saverio S, Ten Broek RPG, Granieri S, Dal Mas F, Farè CN, Peverada J, Zanghì S, Viganò J, Tomasoni M, Dominioni T, Cicuttin E, Hecker A, Tebala GD, Galante JM, Wani I, Khokha V, Sugrue M, Scalea TM, Tan E, Malangoni MA, Pararas N, Podda M, De Simone B, Ivatury R, Cui Y, Kashuk J, Peitzman A, Kim F, Pikoulis E, Sganga G, Chiara O, Kelly MD, Marzi I, Picetti E, Agnoletti V, De'Angelis N, Campanelli G, de Moya M, Litvin A, Martínez-Pérez A, Sall I, Rizoli S, Tomadze G, Sakakushev B, Stahel PF, Civil I, Shelat V, Costa D, Chichom-Mefire A, Latifi R, Chirica M, Amico F, Pardhan A, Seenarain V, Boyapati N, Hatz B, Ackermann T, Abeyasundara S, Fenton L, Plani F, Sarvepalli R, Rouhbakhshfar O, Caleo P, Ho-Ching Yau V, Clement K, Christou E, Castillo AMG, Gosal PKS, Balasubramaniam S, Hsu J, Banphawatanarak K, Pisano M, Adriana T, Michele A, Cioffi SPB, Spota A, Catena F, Ansaloni L. ECLAPTE: Effective Closure of LAParoTomy in Emergency-2023 World Society of Emergency Surgery guidelines for the closure of laparotomy in emergency settings. World J Emerg Surg 2023; 18:42. [PMID: 38012756 PMCID: PMC10373269 DOI: 10.1186/s13017-023-00511-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/18/2023] [Indexed: 07/28/2023] Open
Abstract
Laparotomy incisions provide easy and rapid access to the peritoneal cavity in case of emergency surgery. Incisional hernia (IH) is a late manifestation of the failure of abdominal wall closure and represents frequent complication of any abdominal incision: IHs can cause pain and discomfort to the patients but also clinical serious sequelae like bowel obstruction, incarceration, strangulation, and necessity of reoperation. Previous guidelines and indications in the literature consider elective settings and evidence about laparotomy closure in emergency settings is lacking. This paper aims to present the World Society of Emergency Surgery (WSES) project called ECLAPTE (Effective Closure of LAParoTomy in Emergency): the final manuscript includes guidelines on the closure of emergency laparotomy.
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Affiliation(s)
- Simone Frassini
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy.
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy.
| | - Lorenzo Cobianchi
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Paola Fugazzola
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Walter L Biffl
- Department of Emergency and Trauma Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Dimitrios Damaskos
- General and Emergency Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Ernest E Moore
- Ernest E Moore Shock Trauma Center at Denver Health, Denver, CO, USA
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Marco Ceresoli
- General Surgery, Monza University Hospital, Monza, Italy
| | - Raul Coimbra
- Riverside University Health System Medical Center, Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Claremont, CA, USA
| | - Justin Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge, UK
| | - Andrew Kirkpatrick
- Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Canada
| | - Isidoro Di Carlo
- Department of Surgical Sciences and Advanced Technologies, General Surgery Unit, Cannizzaro Hospital, Catania, Italy
| | - Timothy C Hardcastle
- Department of Surgical Sciences, Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, 4001, South Africa
- Trauma and Burns Services, Inkosi Albert Luthuli Central Hospital, Mayville, 4058, South Africa
| | - Arda Isik
- Division of General Surgery, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Massimo Chiarugi
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Kurinchi Gurusamy
- Division of Surgery and Interventional Science, Hampstead Campus, University College London, London, UK
| | - Ronald V Maier
- Department of Surgery, Harborview Medical Centre, University of Washington, Seattle, USA
| | - Helmut A Segovia Lohse
- II Cátedra de Clínica Quirúrgica, Hospital de Clínicas, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Hans Jeekel
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Marja A Boermeester
- Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, 1105AZ, Amsterdam, The Netherlands
| | - Fikri Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE
| | - Kenji Inaba
- Los Angeles County + USC Medical Center, 2051 Marengo Street, Room C5L100, Los Angeles, CA, 90033, USA
| | - Dieter G Weber
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Goran Augustin
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Luigi Bonavina
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy
| | - George Velmahos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Salomone Di Saverio
- Unit of General Surgery, San Benedetto del Tronto Hospital, av5 Asur Marche, San Benedetto del Tronto, Italy
| | | | - Stefano Granieri
- General Surgery Unit, ASST Vimercate, Via Santi Cosma E Damiano, 10, 20871, Vimercate, Italy
| | - Francesca Dal Mas
- Department of Management, Università Ca' Foscari, Dorsoduro 3246, 30123, Venezia, Italy
| | - Camilla Nikita Farè
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Jacopo Peverada
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Simone Zanghì
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Jacopo Viganò
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Matteo Tomasoni
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Tommaso Dominioni
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Enrico Cicuttin
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Andreas Hecker
- Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen, Germany
| | - Giovanni D Tebala
- Department of Digestive and Emergency Surgery, S. Maria Hospital Trust, Terni, Italy
| | - Joseph M Galante
- Trauma Department, University of California, Davis, Sacramento, CA, USA
| | | | - Vladimir Khokha
- Department of Emergency Surgery, City Hospital, Mozyr, Belarus
| | - Michael Sugrue
- Donegal Clinical Research Academy Emergency Surgery Outcome Project, Letterkenny University Hospital, Donegal, Ireland
| | - Thomas M Scalea
- Cowley Shock Trauma Center at the University of Maryland, Baltimore, MD, USA
| | - Edward Tan
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mark A Malangoni
- Department of Surgery, MetroHealth Medical Center Campus, Case Western Reserve University, Cleveland, OH, 44109, USA
| | - Nikolaos Pararas
- Third Department of Surgery, Attikon University Hospital, 15772, Athens, Greece
| | - Mauro Podda
- Department of Surgical Science, Cagliari State University, Cagliari, Italy
| | - Belinda De Simone
- Department of Emergency Surgery, Centre Hospitalier Intercommunal de Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, France
| | - Rao Ivatury
- Virginia Commonwealth University, Richmond, VA, USA
| | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China
| | - Jeffry Kashuk
- Department of Surgery, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Andrew Peitzman
- Division of Trauma and General Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Fernando Kim
- Denver Health Medical Center, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Emmanouil Pikoulis
- Medical School, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Gabriele Sganga
- Fondazione Policlinico Universitario A.Gemelli IRCCS, Università Cattolica, Rome, Italy
| | - Osvaldo Chiara
- Trauma Center and Emergency Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Michael D Kelly
- Department of General Surgery, Albury Hospital, Albury, Australia
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | - Vanni Agnoletti
- Anesthesia and Intensive Care Unit, Ospedale M Bufalini, Cesena, Italy
| | - Nicola De'Angelis
- Service de Chirurgie Digestive et Hépato-Bilio-Pancréatique, Hôpital Henri Mondor, Université Paris Est, Créteil, France
| | - Giampiero Campanelli
- Division of General Surgery, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, University of Insubria, Varese, Italy
| | - Marc de Moya
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andrey Litvin
- AI Medica Hospital Center / Immanuel Kant Baltic Federal University, Kaliningrad, Russia
| | - Aleix Martínez-Pérez
- Faculty of Health Sciences, Valencian International University (VIU), Valencia, Spain
| | - Ibrahima Sall
- Department of General Surgery, Military Teaching Hospital, Hôpital Principal Dakar, Dakar, Senegal
| | | | - Gia Tomadze
- Department of Surgery, Tbilisi State Medical University, Tbilisi, Georgia
| | | | - Philip F Stahel
- Department of Orthopedic Surgery and Neurosurgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO, USA
| | - Ian Civil
- Trauma Service, Auckland City Hospital, Auckland, New Zealand
| | | | - David Costa
- Department of General y Digestive Surgery, "Dr. Balmis" Alicante General University Hospital, Alicante, Spain
| | | | - Rifat Latifi
- College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Mircea Chirica
- Service de Chirurgie Digestive, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Francesco Amico
- Department of Traumatology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | | | - Vidya Seenarain
- Acute Surgical Unit, Department of General Surgery, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Nikitha Boyapati
- Acute Surgical Unit, Department of General Surgery, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Basil Hatz
- State Major Trauma Unit, Royal Perth Hospital, Wellington Street, Perth, Australia
| | - Travis Ackermann
- General Surgery, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia
| | - Sandun Abeyasundara
- Department of Colorectal Surgery, Logan Hospital, Meadowbrook, QLD, Australia
| | - Linda Fenton
- Maitland Private Hospital, East Maitland, Newcastle, NSW, Australia
| | - Frank Plani
- Chris Hani Baragwanath Hospital, Soweto, South Africa
| | - Rohit Sarvepalli
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Omid Rouhbakhshfar
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Pamela Caleo
- Nambour Selangor Private Hospital, Sunshine Coast University Private Hospital, Birtinya, QLD, Australia
| | | | - Kristenne Clement
- Department of Surgery, Nepean Hospital, Penrith, NSW, 2751, Australia
| | - Erasmia Christou
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | | | - Preet K S Gosal
- Department of General Surgery, Nepean Hospital, Sydney, NSW, Australia
| | - Sunder Balasubramaniam
- Department of Trauma, Westmead Hospital, The University of Sydney, Sydney, NSW, Australia
| | - Jeremy Hsu
- Department of Trauma, Westmead Hospital, The University of Sydney, Sydney, NSW, Australia
| | | | - Michele Pisano
- General and Emergency Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Toro Adriana
- General Surgery, Augusta Hospital, Augusta, Italy
| | - Altomare Michele
- Trauma Center and Emergency Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Stefano P B Cioffi
- Trauma Center and Emergency Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Andrea Spota
- Trauma Center and Emergency Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Fausto Catena
- Acute Care Surgery Unit, Department of Surgery and Trauma, Maurizio Bufalini Hospital, Cesena, Italy
| | - Luca Ansaloni
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
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15
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Li LT, Hebballi NB, Nguyen T, Morice C, Lally KP. Complication rates in very low and extremely low birth weight infants following laparotomy: a prospective study. Pediatr Surg Int 2023; 39:237. [PMID: 37477761 DOI: 10.1007/s00383-023-05520-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 07/22/2023]
Abstract
INTRODUCTION Surgical site occurrences (SSO), including surgical site infection, dehiscence, and incisional hernia, are complications following laparotomy. SSO rates in premature neonates are poorly understood. We hypothesize that SSO rates are higher among extremely low birth weight (ELBW) infants compared to very low birth weight (VLBW) infants and strive to determine the optimal abdominal closure method for these infants. METHODS We conducted a prospective observational study of infants < 1.5 kg (kg) undergoing laparotomy at two institutions from 1/1/2020 to 5/1/2022. Patients were grouped by weight and closure; SSO rates were computed and the association tested using Fisher's exact test. RESULTS We identified 59 patients and 104 total operations. At initial surgery, 37 patients weighed < 1 kg (ELBW); 22 patients weighed 1-1.5 kg (VLBW). Complication rate for ELBW was 6(16%) vs. 2(9%) in VLBW, but not significant (p = 0.45). More complications followed a single-layer compared to a two-layer closure (18 vs. 2), but not significant (p = 0.30). CONCLUSIONS SSO rates are higher for ELBW infants undergoing laparotomy, and fewer complications follow two-layer closure. However, these findings did not reach statistical significance. Further studies are needed to identify modifiable factors to reduce postoperative complications in these infants.
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Affiliation(s)
- Linda T Li
- Department of Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Nutan B Hebballi
- Department of Pediatric Surgery, McGovern Medical School at UTHealth Houston, 6431 Fannin St., Houston, TX, 77030, USA
| | - Thian Nguyen
- Department of Pediatric Surgery, McGovern Medical School at UTHealth Houston, 6431 Fannin St., Houston, TX, 77030, USA
| | - Christina Morice
- Department of Pediatric Surgery, McGovern Medical School at UTHealth Houston, 6431 Fannin St., Houston, TX, 77030, USA
| | - Kevin P Lally
- Department of Pediatric Surgery, McGovern Medical School at UTHealth Houston, 6431 Fannin St., Houston, TX, 77030, USA
- Children's Memorial Hermann Hospital, 6411 Fannin St., Houston, TX, 77030, USA
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Romano L, Fiasca F, Mattei A, Tersigni L, Gianneramo C, Schietroma M, Carlei F, Giuliani A. Sarcopenia and visceral fat in patients with incisional hernia after urgent laparotomy. Langenbecks Arch Surg 2023; 408:244. [PMID: 37351682 DOI: 10.1007/s00423-023-02973-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 06/10/2023] [Indexed: 06/24/2023]
Abstract
PURPOSE Various risk factors have been associated with the development of incisional hernia (IH). Some recent papers underlined that visceral fat could be a reliable indicator. Another risk factor which is of increasing clinical interest is sarcopenia. Recent studies have identified it as an independent predictor of poor postoperative outcomes following abdominal surgery. We aimed to investigate the role of visceral fat and skeletal muscle as emerging risk factors for IH after urgent laparotomy. METHODS Patients aged 18 years or older who underwent urgent median laparotomy and with continuous direct suturing of the laparotomy were included. They were categorized into two groups: those with a median IH and those without IH at 12-month follow-up. Demographic data were prospectively collected while CT scans were retrospectively reviewed. The data were compared among two groups. RESULTS From January 2018 to May 2021, 364 patients underwent urgent surgery in our Department, of whom 222 were aged >18 years old and underwent median laparotomy. Forty-four patients had diagnosis of median IH, while 41 patients without IH were identified as the control group. Statistically significant differences emerged for BMI and for the area of visceral fat. The association with the presence/absence of sarcopenia was not significant. CONCLUSION Even when surgery is performed in urgent settings, it could be important to identify patients at risk, especially as CT scans are generally available for all patients with urgent abdominal disease.
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Affiliation(s)
- Lucia Romano
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
- Department of General Surgery, San Salvatore Hospital, L'Aquila, Italy.
| | - Fabiana Fiasca
- Department of Life, Health & Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Antonella Mattei
- Department of Life, Health & Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Leonardo Tersigni
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- Department of General Surgery, San Salvatore Hospital, L'Aquila, Italy
| | - Camilla Gianneramo
- Department of Radiology, S. Salvatore Hospital, Via L. Natali, 1, 67100, L'Aquila, Italy
| | - Mario Schietroma
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- Department of General Surgery, San Salvatore Hospital, L'Aquila, Italy
| | - Francesco Carlei
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- Department of General Surgery, San Salvatore Hospital, L'Aquila, Italy
| | - Antonio Giuliani
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- Department of General Surgery, San Salvatore Hospital, L'Aquila, Italy
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17
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Dias ERM, Rondini GZ, Amaral PHF, Macret JZ, Carvalho JPV, Pivetta LGA, Malheiros CA, Roll S. Systematic review and meta-analysis of the pre-operative application of botulinum toxin for ventral hernia repair. Hernia 2023:10.1007/s10029-023-02816-w. [PMID: 37329437 DOI: 10.1007/s10029-023-02816-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/28/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE Surgical repair of large hernia defects requires detailed pre-operative planning, particularly in cases with loss of domain. This situation often hampers mid-line reconstruction, even after component separation, when the size of the hernia is disproportional to the volume of the abdominal area. In this case, other strategies may be needed to place the viscera back into the abdominal cavity after reducing the hernia sac. The administration of botulinum toxin prior to the surgical procedure has been indicated as an adjunct for more complex cases. This results in stretching of the lateral musculature of the abdomen, allowing midline approximation. In addition, the application of botulinum toxin alone has been investigated as a means of downstaging in the management of ventral hernias, thereby precluding component separation and enabling primary closure of the midline by placement of mesh within the retromuscular space using the Rives Stoppa technique. METHODS Systematic review of the literature for observational studies involving patients undergoing pre-operative application of botulinum toxin for ventral hernia repair was conducted according to the PRISMA guidelines. RESULTS Advance of the lateral musculature of the abdomen by an average of 4.11 cm with low heterogeneity, as well as low rates of surgical site infection (SSI), surgical site occurrences (SSO) and recurrence, was shown. CONCLUSION Pre-operative application of botulinum toxin for ventral hernia repair promoted an increase in the length of the lateral musculature of the abdomen which can help improve the outcomes of morbidity and recurrence.
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Affiliation(s)
- E R M Dias
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Rua Dr. Cesário Motta Júnior, 61, Vila Buarque, São Paulo, SP, 01221-020, Brazil.
- Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil.
| | - G Z Rondini
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Rua Dr. Cesário Motta Júnior, 61, Vila Buarque, São Paulo, SP, 01221-020, Brazil
| | - P H F Amaral
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Rua Dr. Cesário Motta Júnior, 61, Vila Buarque, São Paulo, SP, 01221-020, Brazil
- Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil
| | - J Z Macret
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Rua Dr. Cesário Motta Júnior, 61, Vila Buarque, São Paulo, SP, 01221-020, Brazil
- Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil
| | - J P V Carvalho
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Rua Dr. Cesário Motta Júnior, 61, Vila Buarque, São Paulo, SP, 01221-020, Brazil
- Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil
| | - L G A Pivetta
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Rua Dr. Cesário Motta Júnior, 61, Vila Buarque, São Paulo, SP, 01221-020, Brazil
- Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil
| | - C A Malheiros
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Rua Dr. Cesário Motta Júnior, 61, Vila Buarque, São Paulo, SP, 01221-020, Brazil
| | - S Roll
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Rua Dr. Cesário Motta Júnior, 61, Vila Buarque, São Paulo, SP, 01221-020, Brazil
- Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil
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18
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Sarkar J, Minarich MJ, Smucker LY, Hardy AN, Schwarz RE. Low incisional hernia incidence using a large-bite, low-tension technique for celiotomy closure. Surg Open Sci 2023; 13:94-98. [PMID: 37274136 PMCID: PMC10238872 DOI: 10.1016/j.sopen.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/10/2023] [Indexed: 06/06/2023] Open
Abstract
Background Incisional herniae (IH) are reported in 5->20 % of patients undergoing open celiotomy, and can be linked to closure technique. The STITCH randomized trial favors a small bite technique for midline celiotomy closure with a 1-year IH rate of 13 % over larger bites (23 %). Methods A continuous musculofascial mass closure with absorbable looped #1 PDS suture with 2-cm bite size was used for all open celiotomies. IH frequency and associated clinicopathologic factors were retrospectively analyzed from prospective data in 336 consecutive patients undergoing visceral resections by a single surgeon. Results The study population included 192 men and 144 women, 81 % of whom had a cancer diagnosis, who underwent hepatobiliary, pancreatic, gastroesophageal, and colorectal resections, or a combination. The majority of patients (84 %) had subcostal incisions, and 10 % received a midline incision. At a median follow-up of 19.5 months, the overall IH rate was 3.3 %. Hernia rates were 2.5 % for subcostal margin, 2.9 % for midline, and 5.5 % for other incisions (p = 0.006). Median time to hernia detection was 492 days. Factors associated with IH were increased weight, abdominal depth/girth, male sex, spleen size, visceral fat, and body height (p ≤ 0.04 for all), but not type of resection, prior operations, underlying diagnosis, weight loss, adjuvant chemotherapy or radiation, incision length or suture to incision ratio. Conclusions The described technique leads to a low IH rate of <3 % in subcostal or midline incisions, and can be recommended for routine use. The observed results appear superior to those of the STITCH trial, even for the smaller midline incision cohort.
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Affiliation(s)
- Joy Sarkar
- Roswell Park Cancer Institute, Department of Surgical Oncology, Buffalo, NY, USA
| | - Michael J. Minarich
- Goshen Center for Cancer Care, Department of Surgical Oncology, Goshen, IN, USA
| | - Levi Y. Smucker
- Goshen Center for Cancer Care, Department of Surgical Oncology, Goshen, IN, USA
| | - Ashley N. Hardy
- Goshen Center for Cancer Care, Department of Surgical Oncology, Goshen, IN, USA
| | - Roderich E. Schwarz
- Roswell Park Cancer Institute, Department of Surgical Oncology, Buffalo, NY, USA
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Mubashir M, Tang B, DeBernardo RL, Feng X. Surgical management of spontaneous bowel perforation and fascial dehiscence in a patient on bevacizumab and pembrolizumab in the setting of active Clostridium difficile infection. BMJ Case Rep 2023; 16:e253815. [PMID: 37137546 PMCID: PMC10163437 DOI: 10.1136/bcr-2022-253815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
Immunotherapy such as bevacizumab and pembrolizumab is used to treat an increasing number of malignancies. These medications have been associated with poor wound healing and several gastrointestinal complications, including intestinal perforations in rare cases. We present a unique case of a patient with metastatic cervical cancer on pembrolizumab and recent bevacizumab therapy, presenting with a colonic perforation requiring urgent exploratory laparotomy, in the setting of active Clostridium difficile infection. She required a second laparotomy shortly after due to fascial dehiscence, where a synthetic absorbable mesh was used for fascial approximation. We review the factors that led to these events and describe the surgical technique used for safe abdominal closure.
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Affiliation(s)
| | - Brian Tang
- General Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Robert L DeBernardo
- Obstetrics and Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Xiaoxi Feng
- General Surgery, Cleveland Clinic, Cleveland, Ohio, USA
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20
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Pous-Serrano S, García-Pastor P, Bueno-Lledó J. National survey of colorectal surgery units on abdominal wall closure. Cir Esp 2023; 101:258-264. [PMID: 36108954 DOI: 10.1016/j.cireng.2022.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 02/08/2022] [Indexed: 04/21/2023]
Abstract
INTRODUCTION The purpose of this study is to assess the current status and knowledge of the Spanish colorectal surgeons on the wall closure. METHODS A single answer questionnaire of 25 closed questions was conducted using specific software for online surveys that was distributed to a cohort of colorectal surgeons. RESULTS 53 surgeons replied to the survey. The vast majority prefer a closure of the midlaparotomy with a very slow absorbing monofilament (67.92%) continuous suture (96.23%) in a single plane (81.13%). Mass stitches, retention systems, and loop sutures continue to be used. The most commonly used suture gauge was USP 1 (United States Pharmacopeia) (58.49%). The most commonly used needle is with a cylindrical body and a trocar tip. Only 50%, routinely perform wall closure after placement of a trocar equal to or greater than 10 mm. Almost everyone knows the 4:1 rule and thinks it should be applied, but the small bites technique is not performed. 50% would never place a prophylactic prosthesis. The closure is usually performed by the same surgeon who has performed the entire procedure. One out of five confesses not knowing the rate of incisional hernias in his unit. CONCLUSION There is a lack of consensus and basic knowledge regarding the technical aspects of closure and the prevention of the appearance of incisional hernias. The use of slow absorbing monofilament continuous suture in a single plane seems well accepted.
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Affiliation(s)
- Salvador Pous-Serrano
- Unidad de Cirugía de Pared, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
| | - Providencia García-Pastor
- Unidad de Cirugía de Pared, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - José Bueno-Lledó
- Unidad de Cirugía de Pared, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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21
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Gonzalez M, Ruffa T, Scaravonati R, Ardiles V, Brandi C, Bertone S. Fascial dehiscence: predictable complication? Development and validation of a risk model: a retrospective cohort study. Langenbecks Arch Surg 2023; 408:50. [PMID: 36662279 DOI: 10.1007/s00423-023-02782-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 12/12/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE Fascial dehiscence is still an important cause of morbidity and mortality in the postoperative period of abdominal surgery. Different authors have sought to identify risk factors for this entity. Two risk scores have been developed, but they include postoperative variables, which hinder preventive decision-making during the early surgical period. Our aim is to identify preoperative and intraoperative risk factors for fascial dehiscence and to develop and validate a risk prediction score that allows taking preventive behaviors. METHODS All adult patients, with no prior history of abdominal surgery, who underwent midline laparotomy by a general surgery division between January 2009 and December 2019 were included. Recognized preoperative risk factors for fascial dehiscence were evaluated in a univariate analysis and subsequently entered in a multivariate stepwise logistic regression model. A prognostic risk model was developed and posteriorly validated by bootstrapping. This study was conducted following the STROBE statement. RESULTS A total of 594 patients were included. Fascial dehiscence was detected in 41 patients (6.9%). On multivariate analysis, eight factors were identified: chronic obstructive pulmonary disease (COPD), immunosuppression, smoking, prostatic hyperplasia, anticoagulation use, sepsis, and overweight. The resulting score ranges from 1 to 8. Scores above 3 are predictive of 18% risk of dehiscence with a sensitivity of 70% and specificity of 80% (ROC 0.88). CONCLUSIONS We present a new preoperative prognostic score to identify patients with a high risk of fascial dehiscence. It can be a guide for decision-making that allows taking intraoperative preventive measures. External validation is still required.
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Affiliation(s)
- Marcos Gonzalez
- Section of Colorectal Surgery, Department of General Surgery, Hospital Italiano de Buenos Aires, Rivadavia 2134 (1034) CABA, Buenos Aires, Argentina.
| | - Tatiana Ruffa
- Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Rodolfo Scaravonati
- Section of Abdominal Wall Surgery, Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Victoria Ardiles
- Section of Hepatopancreatobiliary Surgery, Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Claudio Brandi
- Section of Abdominal Wall Surgery, Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Santiago Bertone
- Section of Abdominal Wall Surgery, Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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22
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McDaniel LF, White MN, Obi EN, Kohinke RM, Lockhart ERS, Chipriano DJ, Chen Y, Everson NA. Clinical and Economic Outcomes After Implementation of a Fidaxomicin Treatment Optimization and Access Pathway at a US Hospital System. Infect Dis Ther 2023; 12:95-107. [PMID: 35854204 PMCID: PMC9868207 DOI: 10.1007/s40121-022-00665-1] [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: 04/19/2022] [Accepted: 06/07/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION This study aimed to evaluate the clinical and economic outcomes of implementing a Clostridiodes difficile infection (CDI) Treatment Optimization and Access Pathway (treatment pathway) directing first-line use of fidaxomicin for CDI. METHODS This was a retrospective, quasi-experimental study of adult patients with CDI using Electronic Health Record data from a single center. The primary intervention was implementation of a treatment pathway directing first-line use of fidaxomicin for patients with first/second CDI episode and at high risk of recurrence. The primary clinical outcome was CDI recurrence within 30 days of completing therapy in patients achieving clinical cure. Secondary clinical outcomes included clinical cure and sustained response evaluated at 90 days after completion of CDI treatment. Economic outcomes included costs associated with hospital stay at index admission and 30- and 90-day readmission. Differences between the pre- and post-implementation cohorts were assessed for baseline characteristics, CDI treatment utilization, clinical outcomes, and economic outcomes. The budget impact was calculated for the pre- vs. post-implementation cohorts, each normalized to 100 patients. RESULTS Post- vs. pre-implementation, 30-day recurrence (6.4% vs. 18.0%., p = 0.001), 90-day recurrence (14.9% vs. 27.1%, p = 0.009), and 30-day (4.6% vs. 12.7%, p = 0.007) and 90-day CDI-related readmissions (8.5% vs. 18.9%, p = 0.007) were lower. The clinical cure (94.1% vs. 84.4%, p = 0.002) and 90-day sustained response rates were higher (73.3% vs. 55.9%, p < 0.001). Median total costs were also lower in the post- vs. pre-implementation cohorts at index admission ($11,934.64 vs. $14,523.27, p = 0.048), and 30-day ($7685.82 vs. $12,424.44, p = 0.102) and 90-day CDI-related readmission episodes ($8246.69 vs. $12,729.57, p = 0.042). The budget impact analyses of 100 patients post- vs. pre-implementation found saving of $222,895 overall and $9432 per CDI-readmission avoided. CONCLUSIONS Implementation of the CDI treatment pathway was associated with better clinical outcomes and hospital cost savings. The findings help validate real-world value of fidaxomicin for CDI disease management.
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Affiliation(s)
- Lauren F. McDaniel
- grid.413420.00000 0004 0459 1303Carilion Clinic, 1906 Belleview Ave, Roanoke, VA 24014 USA
| | - Melissa N. White
- grid.413420.00000 0004 0459 1303Carilion Clinic, 1906 Belleview Ave, Roanoke, VA 24014 USA
| | - Engels N. Obi
- grid.417993.10000 0001 2260 0793Merck & Co., Inc., Rahway, NJ USA
| | - Rose M. Kohinke
- grid.413420.00000 0004 0459 1303Carilion Clinic, 1906 Belleview Ave, Roanoke, VA 24014 USA
| | | | - Damian J. Chipriano
- grid.413420.00000 0004 0459 1303Carilion Clinic, 1906 Belleview Ave, Roanoke, VA 24014 USA
| | - Yiyun Chen
- grid.417993.10000 0001 2260 0793Merck & Co., Inc., Rahway, NJ USA
| | - Nathan A. Everson
- grid.413420.00000 0004 0459 1303Carilion Clinic, 1906 Belleview Ave, Roanoke, VA 24014 USA
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Fortelny RH. The Best Closure Technique Without Mesh in Elective Midline Laparotomy Closure. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2022; 1:10962. [PMID: 38314158 PMCID: PMC10831662 DOI: 10.3389/jaws.2022.10962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 11/18/2022] [Indexed: 02/06/2024]
Abstract
Introduction: The risk of developing an incisional hernia after primary elective median laparotomy is reported in the literature as being between 5 and 20 percent. The basic of an optimal outcome after midline incision is the appropriate closure technique with or without a prophylactic mesh. The objective of this paper is to critically examine the various closure techniques and, in particular, to present a detailed comparison of the long stitch and short stitch techniques. Method: Based on the available literature, the characteristics of the different closure techniques are described in detail, advantages and disadvantages are compared, and the current status of a practicable recommendation is discussed. Special attention is paid to the criteria of the short stitch technique, such as the suture to incision length ratio, number of stitches and distances, as well as suture material. Results: For elective midline closures, the use of a continuous closure using a slowly absorbable suture material in the small-bites technique with suture to wound ratio of at least 5:1 result in significantly lower risk of complications such as bursting abdomen and less incisional hernia rates compared to the large-bites technique. Conclusion: Based on the present evidence in midline closure after elective laparotomy the small bites technique can be recommended to significantly reduce the rate of incisional hernia.
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Affiliation(s)
- René H. Fortelny
- Department of General, Viszeral and Oncologic Surgery, Wilhelminenspital, Vienna, Austria
- Faculty of Medicine, Sigmund Freud Private University Vienna, Vienna, Austria
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24
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Tramontin DF, da Costa LVP, de Araújo NP, dos Santos DR, Lemos RS, Teixeira RKC, Yasojima EY. Incisional hernia repair in rats: description of the sublay technique under videomagnification system. Acta Cir Bras 2022; 37:e370802. [PMID: 36327396 PMCID: PMC9633014 DOI: 10.1590/acb370802] [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: 04/03/2022] [Accepted: 07/02/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To describe the technique of sublay correction of incisional hernia in Wistar rats under videomagnification system. METHODS Five male rats of the species Rattus norvegicus, of the Wistar lineage, with body weight between 250-350 g and 60 days old were used. Incisional hernia was inducted in all animals. After that, the incisional hernia was immediately corrected by the sublay method. RESULTS There were no cases of recurrence of the incisional hernia after placement of the polypropylene mesh using the sublay technique. No postoperative complications were observed. CONCLUSIONS The technique is suitable for execution in Wistar rats.
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Affiliation(s)
- Daniela Ferreira Tramontin
- Graduate student. Universidade do Estado do Pará – School of Medicine – Belém (PA), Brazil.,Corresponding author:
- (55 91) 98857-1936
| | | | | | - Deivid Ramos dos Santos
- MD, MS. Universidade do Estado do Pará – School of Medicine – Department of Experimental Surgery – Belém (PA), Brazil
| | - Rafael Silva Lemos
- Graduate student. Universidade do Estado do Pará – School of Medicine – Belém (PA), Brazil
| | - Renan Kleber Costa Teixeira
- MD, MS. Universidade do Estado do Pará – School of Medicine – Department of Experimental Surgery – Belém (PA), Brazil
| | - Edson Yuzur Yasojima
- PhD, Associate Professor. Universidade do Estado do Pará – School of Medicine – Department of Experimental Surgery – Belém (PA), Brazil
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Azimirad M, Noori M, Azimirad F, Gholami F, Naseri K, Yadegar A, Asadzadeh Aghdaei H, Zali MR. Curcumin and capsaicin regulate apoptosis and alleviate intestinal inflammation induced by Clostridioides difficile in vitro. Ann Clin Microbiol Antimicrob 2022; 21:41. [PMID: 36155114 PMCID: PMC9511736 DOI: 10.1186/s12941-022-00533-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 09/01/2022] [Indexed: 11/21/2022] Open
Abstract
Background The dramatic upsurge of Clostridioides difficile infection (CDI) by hypervirulent isolates along with the paucity of effective conventional treatment call for the development of new alternative medicines against CDI. The inhibitory effects of curcumin (CCM) and capsaicin (CAP) were investigated on the activity of toxigenic cell-free supernatants (Tox-S) of C. difficile RT 001, RT 126 and RT 084, and culture-filtrate of C. difficile ATCC 700057. Methods Cell viability of HT-29 cells exposed to varying concentrations of CCM, CAP, C. difficile Tox-S and culture-filtrate was assessed by MTT assay. Anti-inflammatory and anti-apoptotic effects of CCM and CAP were examined by treatment of HT-29 cells with C. difficile Tox-S and culture-filtrate. Expression of BCL-2, SMAD3, NF-κB, TGF-β and TNF-α genes in stimulated HT-29 cells was measured using RT-qPCR. Results C. difficile Tox-S significantly (P < 0.05) reduced the cell viability of HT-29 cells in comparison with untreated cells. Both CAP and CCM significantly (P < 0.05) downregulated the gene expression level of BCL-2, SMAD3, NF-κB and TNF-α in Tox-S treated HT-29 cells. Moreover, the gene expression of TGF-β decreased in Tox-S stimulated HT-29 cells by both CAP and CCM, although these reductions were not significantly different (P > 0.05). Conclusion The results of the present study highlighted that CCM and CAP can modulate the inflammatory response and apoptotic effects induced by Tox-S from different clinical C. difficile strains in vitro. Further studies are required to accurately explore the anti-toxin activity of natural components, and their probable adverse risks in clinical practice.
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Affiliation(s)
- Masoumeh Azimirad
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Noori
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Azimirad
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Gholami
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kaveh Naseri
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Yadegar
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Hamid Asadzadeh Aghdaei
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Zali
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Andraos Y. Safety and Efficacy of Trocar Port-Site Closure Using a Biological Plug Closure in Laparoscopic Bariatric Surgery: a Prospective Study. Obes Surg 2022; 32:3796-3806. [PMID: 36071329 DOI: 10.1007/s11695-022-06238-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/29/2022] [Accepted: 08/04/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Port-site trocar closure is a challenging procedure in laparoscopic surgeries, especially in morbidly obese patients, and complications (herniation, bleeding, pain, and nerve trapping) have potentially severe consequences. This paper provides an overview of existing techniques of suturing and closure in intra-abdominal laparoscopic surgery, outlines the complications associated with port-site closure, and presents a novel technique designed to address those problems by using a sterile absorbable gelatin sponge with strong hemostatic properties (Cutanplast® Plug). MATERIALS AND METHODS In this prospective study, 83 successive obese patients undergoing laparoscopic bariatric surgery (sleeve gastrectomy, sleeve plication, gastric bypass), using a standardized skin incision for trocar insertion, had port-site closure using the Cutanplast plug procedure (n = 42) or conventional suturing techniques (n = 41). RESULTS The incidence of early complications was lower in the Cutanplast group; no patients had infections compared with 9.8% of Controls (p = 0.055) and no bleeding, ecchymosis, erythema, or redness occurred. Late complications during 2 years of follow-up were significantly lower in the Cutanplast group (0 vs. 7 hernias, p = 0.005). Most patients in the Cutanplast group required only 1-2 procedures (78.6% vs. 58.5%, p = 0.049), whereas 41.5% of controls required 3 procedures. In total, 82 trocars were used in the Cutanplast group versus 99 in controls. The single-step Cutanplast plug technique reduced operating times compared with two-step suturing techniques. CONCLUSION Closure of port-site trocar incisions using Cutanplast plug is fast, efficient, with potential to reduce operating times and decrease bleeding and herniation from port-site trocars insertion, particularly in obese patients.
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Affiliation(s)
- Youssef Andraos
- Department of General and Bariatric Surgery, Abou Jaoude Hospital, P.O. Box 60144, BeirutJaleldib, 1241 2020, Lebanon.
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O'Connell S, Islam S, Sewell B, Farr A, Knight L, Bashir N, Harries R, Jones S, Cleves A, Fegan G, Watkins A, Torkington J. Hughes abdominal closure versus standard mass closure to reduce incisional hernias following surgery for colorectal cancer: the HART RCT. Health Technol Assess 2022; 26:1-100. [PMID: 35938554 DOI: 10.3310/cmwc8368] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Incisional hernias can cause chronic pain and complications and affect quality of life. Surgical repair requires health-care resources and has a significant associated failure rate. A prospective, multicentre, single-blinded randomised controlled trial was conducted to investigate the clinical effectiveness and cost-effectiveness of the Hughes abdominal closure method compared with standard mass closure following surgery for colorectal cancer. The study randomised, in a 1 : 1 ratio, 802 adult patients (aged ≥ 18 years) undergoing surgical resection for colorectal cancer from 28 surgical departments in UK centres. INTERVENTION Hughes abdominal closure or standard mass closure. MAIN OUTCOME MEASURES The primary outcome was the incidence of incisional hernias at 1 year, as assessed by clinical examination. Within-trial cost-effectiveness and cost-utility analyses over 1 year were conducted from an NHS and a social care perspective. A key secondary outcome was quality of life, and other outcomes included the incidence of incisional hernias as detected by computed tomography scanning. RESULTS The incidence of incisional hernia at 1-year clinical examination was 50 (14.8%) in the Hughes abdominal closure arm compared with 57 (17.1%) in the standard mass closure arm (odds ratio 0.84, 95% confidence interval 0.55 to 1.27; p = 0.4). In year 2, the incidence of incisional hernia was 78 (28.7%) in the Hughes abdominal closure arm compared with 84 (31.8%) in the standard mass closure arm (odds ratio 0.86, 95% confidence interval 0.59 to 1.25; p = 0.43). Computed tomography scanning identified a total of 301 incisional hernias across both arms, compared with 100 identified by clinical examination at the 1-year follow-up. Computed tomography scanning missed 16 incisional hernias that were picked up by clinical examination. Hughes abdominal closure was found to be less cost-effective than standard mass closure. The mean incremental cost for patients undergoing Hughes abdominal closure was £616.45 (95% confidence interval -£699.56 to £1932.47; p = 0.3580). Quality of life did not differ significantly between the study arms at any time point. LIMITATIONS As this was a pragmatic trial, the control arm allowed surgeon discretion in the approach to standard mass closure, introducing variability in the techniques and equipment used. Intraoperative randomisation may result in a loss of equipoise for some surgeons. Follow-up was limited to 2 years, which may not have been enough time to see a difference in the primary outcome. CONCLUSIONS Hughes abdominal closure did not significantly reduce the incidence of incisional hernias detected by clinical examination and was less cost-effective at 1 year than standard mass closure in colorectal cancer patients. Computed tomography scanning may be more effective at identifying incisional hernias than clinical examination, but the clinical benefit of this needs further research. FUTURE WORK An extended follow-up using routinely collected NHS data sets aims to report on incisional hernia rates at 2-5 years post surgery to investigate any potential mortality benefit of the closure methods. Furthermore, the proportion of incisional hernias identified by a computed tomography scan (at 1 and 2 years post surgery), but not during clinical examination (occult hernias), proceeding to surgical repair within 3-5 years after the initial operation will be explored. TRIAL REGISTRATION This trial is registered as ISRCTN25616490. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 34. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Susan O'Connell
- Cedar Healthcare Technology Research Centre, Cardiff and Vale University Health Board, Cardiff, UK
| | - Saiful Islam
- Swansea Trials Unit, Swansea University, Swansea, UK
| | - Bernadette Sewell
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - Angela Farr
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - Laura Knight
- Cedar Healthcare Technology Research Centre, Cardiff and Vale University Health Board, Cardiff, UK
| | - Nadim Bashir
- Swansea Trials Unit, Swansea University, Swansea, UK
| | - Rhiannon Harries
- Department of Colorectal Surgery, Swansea Bay University Health Board, Swansea, UK
| | | | - Andrew Cleves
- Cedar Healthcare Technology Research Centre, Cardiff and Vale University Health Board, Cardiff, UK
| | - Greg Fegan
- Swansea Trials Unit, Swansea University, Swansea, UK
| | - Alan Watkins
- Swansea Trials Unit, Swansea University, Swansea, UK
| | - Jared Torkington
- Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff, UK
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Al Sadairi AR, Durtette-Guzylack J, Renard A, Durot C, Thierry A, Kianmanesh R, Passot G, Renard Y. A simplified method to evaluate the loss of domain. Hernia 2022; 26:927-936. [PMID: 34341871 DOI: 10.1007/s10029-021-02474-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The treatment of giant incisional hernia (IH) with loss of domain (LOD, IHLD) is considerably challenging due to technical difficulties and subsequent post-operative complications. These post-operative risks may be anticipated by calculating the abdominal cavity (AC) volume (ACV) and the IH volume (IHV) on the preoperative CT-scans, using the AC and IH dimensions (Tanaka's method) or using tridimensional volumetry (Sabbagh's method). These techniques are often time-consuming and require specific softwares. The aim of the present study was to develop a simple method to rapidly obtain the LOD-ratio on the preoperative CT-Scan. METHODS The CT-scans (n = 89) of patients with IHLD were retrospectively studied. Several ratios were calculated using different parameters of the AC and the IH, including width, height and depth, the areas (axial and sagittal ellipse, as well as freehand sagittal surface areas) and these were compared with the reference methods of Sabbagh et al. and Tanaka et al. RESULTS: The LOD ratios calculated from the two reference methods gave similar results (ICC = 0.82, p < 0.0001). The new "R-ratios" (Reims-ratios) obtained from the IH and AC surface areas measured using the "freehand ROI" tool on sagittal view or roughly evaluated by an ellipse on axial view showed excellent correlation with both reference ratios (all ICC ≥ 0.71, p < 0.0001). CONCLUSION The LOD ratio may be quickly obtained by drawing two circles on the pre-operative CT scan ("R ratios") and available on the webpage https://romeo.univ-reims.fr/Rratio/ . This will certainly help surgeons to routinely anticipate the post-operative complications before IHLD repair.
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Affiliation(s)
- Abdul Rahman Al Sadairi
- Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Rue Cognac-Jay, 51092, Reims Cedex, France.
- Sultan Qaboos University, Muscat, Sultanate of Oman.
| | - Jules Durtette-Guzylack
- Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Rue Cognac-Jay, 51092, Reims Cedex, France
| | - Arnaud Renard
- Laboratory Liciis and ROMEO, University of Reims Champagne-Ardenne, Reims, France
| | - Carole Durot
- Department of Radiology, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Reims, France
| | - Aurore Thierry
- Methodological Aid To Clinical Research Unit CHU Reims, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Reims, France
| | - Reza Kianmanesh
- Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Rue Cognac-Jay, 51092, Reims Cedex, France
| | - Guillaume Passot
- Department of Digestive Surgery, Hopital Lyon Sud, Pierre Bénite, University of Lyon, Lyon, France
| | - Yohann Renard
- Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Rue Cognac-Jay, 51092, Reims Cedex, France
- Laboratory Liciis and ROMEO, University of Reims Champagne-Ardenne, Reims, France
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Turcotte JJ, Allen RS, Klune JR, Feather CB. Open and Closed Approaches to Skin Closure After Nonelective Open Colorectal Operations. Am Surg 2022:31348221101578. [PMID: 35580356 DOI: 10.1177/00031348221101578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Optimal wound management strategies to reduce surgical site infections (SSIs) in nonelective open colorectal surgery (NOCS) remain controversial and variable. Our aim is to describe SSI and other 30-day outcome measures among patients with varying wound management techniques undergoing NOCS. METHODS All NOCS patients were extracted from the 2016 to 2018 ACS-NSQIP database. Outcomes of patients managed with all layers closed (ALC) were compared to patients managed with skin open (SO), using propensity score matching (PSM) to control for significant confounding risk factors for SSI. RESULTS A total of 40,820 patients were included; 4622 patients managed with SO and 36,198 managed with ALC. Patients in the SO group were more likely to have a history of hypertension, renal failure, chronic obstructive pulmonary disease, smoking, obesity, and sepsis on presentation (P < .001). After PSM, no differences in risk factors remained; 4622 and 4344 patients were included in the SO and ALC cohorts, respectively. While ALC patients experienced a higher rate of superficial SSI (1.4% vs 7.3%, P < .001) and any wound complications (6.8% vs 10.8%, P < .001), the SO group had higher wound dehiscence (4.4% vs 2.8%, P < .001). There were no significant differences in deep wound infection. The SO group had longer average length of stay (14.7 vs 13.1 days, P < .001), higher non-wound-related complications, discharge to SNF, and in-hospital mortality. DISCUSSION Significant differences in SSI rates among NOCS patients with differing wound management techniques were observed. More notably, other important quality measures, such as length of stay, disposition, mortality, and non-wound-related complications were also significantly impacted by wound management strategy.
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Affiliation(s)
- Justin J Turcotte
- Department of Surgery, 1267Luminis Health Anne Arundel Medical Center, Annapolis, MD, USA
| | - Rebecca S Allen
- Department of Surgery, 1267Luminis Health Anne Arundel Medical Center, Annapolis, MD, USA
| | - J Robert Klune
- Department of Surgery, 1267Luminis Health Anne Arundel Medical Center, Annapolis, MD, USA
| | - Cristina B Feather
- Department of Surgery, 1267Luminis Health Anne Arundel Medical Center, Annapolis, MD, USA
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Manning-Geist BL, Cowan RA, Schlappe B, Braxton K, Sonoda Y, Long Roche K, Leitao Jr MM, Chi DS, Zivanovic O, Abu-Rustum NR, Mueller JJ. Assessment of wound perfusion with near-infrared angiography: A prospective feasibility study. Gynecol Oncol Rep 2022; 40:100940. [PMID: 35169608 PMCID: PMC8829563 DOI: 10.1016/j.gore.2022.100940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/25/2022] [Accepted: 01/30/2022] [Indexed: 11/29/2022] Open
Abstract
There are no validated technologies for skin perfusion assessment at time of laparotomy closure. This prospective non-randomized study failed to demonstrate feasibility of skin perfusion measurement using NIR angiography. Successful subjective perfusion assessment with NIR angiography suggests an ongoing role for investigation of this technology.
Objective To assess the feasibility of quantitatively measuring skin perfusion before and after suture or staple skin closure of vertical laparotomies using indocyanine green (ICG) uptake with near-infrared angiography. Methods This was a prospective, non-randomized feasibility study of patients undergoing surgery with a gynecologic oncology service from 2/2018–8/2019. Feasibility was defined as the ability to quantitatively measure ICG uptake adjacent to the wound at the time of skin closure in ≥ 80% of patients. Patients were assigned suture or staple skin closure in a sequential, non-randomized fashion. Skin perfusion was recorded using a near-infrared imaging system after ICG injection and measured by video analysis at predefined points before and after skin closure. Clinicodemographic, pre- and intraoperative details, and surgical secondary events were recorded. Results Of 20 participants, 10 were assigned staple closure and 10 suture closure. Two patients (10%) achieved objective quantification of ICG fluorescence before and after laparotomy closure, failing the predefined feasibility threshold of ≥ 80%. Reasons for failed quantification included overexposure (12), insufficient ICG signal uptake (6), and insufficient video quality (2). Near-infrared angiography wound perfusion was subjectively appreciated intraoperatively in 85% (17/20) of patients before and after wound closure. Conclusions Objective assessment of laparotomy skin closure with near-infrared angiography–measured perfusion did not meet the pre-specified feasibility threshold. Adjustments to the protocol to minimize overexposure may be warranted. The ability to subjectively appreciate ICG perfusion with near-infrared angiography suggests a possible role for near-infrared angiography in the real-time intraoperative assessment of wound perfusion, particularly in high-risk patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Jennifer J. Mueller
- Corresponding author at: Gynecology Service, Department of Surgerym, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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31
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Antic A, Kmezic S, Nikolic V, Radenkovic D, Markovic V, Pejovic I, Aleksic L, Loncar Z, Antic S, Kovac J, Markovic-Denic L. Quality of life following two different techniques of an open ventral hernia repair for large hernias: a prospective randomized study. BMC Surg 2022; 22:99. [PMID: 35300651 PMCID: PMC8932116 DOI: 10.1186/s12893-022-01551-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 02/21/2022] [Indexed: 11/10/2022] Open
Abstract
Background We compare the health-related quality of life (QoL) of patients with incision hernias before and after surgery with two different techniques. Methods In this prospective randomized study, the study population consisted of all patients who underwent the first surgical incisional hernias repair during the 1-year study period. Patients who met the criteria for inclusion in the study were randomized into two groups: the first group consisted of patients operated by an open Rives sublay technique, and the second group included patients operated by a segregation component technique. The change in the quality of life before and 6 months after surgery was assessed using two general (Short form of SF-36 questionnaires and European Quality of Life Questionnaire—EQ-5D-3L), and three specific hernia questionnaires (Hernia Related Quality of Life Survey-HerQles, Eura HS Quality of Life Scale—EuraHS QoL, and Carolinas Comfort Scale—CCS). Results A total of 93 patients were included in the study. Patients operated on by the Rives technique had a better role physical score before surgery, according to the SF-36 tool, although this was not found after surgery. The postoperative QoL measured with each scale of all questionnaires was significantly better after surgery. Comparing two groups of patients after surgery, only the pain domain of the EuraHS Qol questionnaire was worse in patients operated by a segregation component technique. Conclusion Both techniques improve the quality of life after surgery. Generic QoL questionnaires showed no difference in the quality of life compared to repair technique but specific hernia-related questionnaires showed differences.
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Affiliation(s)
- Andrija Antic
- Clinical Center of Serbia, Clinic of Digestive Surgery, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Stefan Kmezic
- Clinical Center of Serbia, Clinic of Digestive Surgery, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Dejan Radenkovic
- Clinical Center of Serbia, Clinic of Digestive Surgery, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Velimir Markovic
- Clinical Center of Serbia, Clinic of Digestive Surgery, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ilija Pejovic
- Clinical Center of Serbia, Clinic of Digestive Surgery, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Lidija Aleksic
- Clinical Center of Serbia, Clinic of Digestive Surgery, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Zlatibor Loncar
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinical Center of Serbia, Emergency Center, Belgrade, Serbia
| | | | - Jelena Kovac
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinical Center of Serbia, Institute of Radiology, Belgrade, Serbia
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Risk factors of incisional hernia after laparoscopic colorectal surgery with periumbilical minilaparotomy incision: a propensity score matching analysis. JOURNAL OF MINIMALLY INVASIVE SURGERY 2022; 25:24-31. [PMID: 35603344 PMCID: PMC8977500 DOI: 10.7602/jmis.2022.25.1.24] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/08/2022] [Accepted: 03/12/2022] [Indexed: 12/03/2022]
Abstract
Purpose Incisional hernia is one of the most common complications after abdominal surgery conducted through a midline incision. Considerable debate remains regarding the design, comorbidity, suture material, and method. We investigated the risk factors for incisional hernia after laparoscopic colorectal surgery in the presence of limited surgery-related factors. Methods A retrospective study was designed with 541 patients who underwent laparoscopic colorectal surgery performed by a single operator from January 2015 to December 2017. Due to open conversions, other abdominal operations, or follow-up loss, only 445 patients were included in the study. After propensity score matching, 266 patients were included. The study was based on diagnosis of incisional hernia on computed tomography at 6 and 12 months postoperatively. Results Of the 266 total patients, 133 underwent abdominal closure using PDS (Ethicon), while the remaining 133 underwent closure with Vicryl (Ethicon). Of these patients, nine were diagnosed with incisional hernia at the 12-month follow-up six (4.5%) in the Vicryl group and three (2.3%) in the PDS group (p = 0.309). The incidence of incisional hernia was significantly increased in females (odds ratio [OR], 15.233; 95% confidence interval [CI], 1.905–121.799; p = 0.010), in patients with body mass index (BMI) of >25 kg/m2 (OR, 4.740; 95% CI, 1.424–15.546; p = 0.011), and in patients with liver disease (OR, 19.899; 95% CI, 1.614–245.376; p = 0.020). Conclusion BMI of >25 kg/m2, female, and liver disease were significant risk factors for incisional hernia after elective laparoscopic colorectal surgery performed through a transumbilical minilaparotomy incision.
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Ahmed O, Afzal Y, Beg MSA, Siddiqui AS, Iqbal FM. Comparison of the Interrupted and Continuous Suture Techniques for the Closure of Oral and Nasal Mucosal Layers in Cleft Palate Surgery. Cureus 2021; 13:e20779. [PMID: 35111463 PMCID: PMC8793892 DOI: 10.7759/cureus.20779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2021] [Indexed: 11/05/2022] Open
Abstract
Background Cleft lip and palate are common congenital craniofacial anomalies, treated conventionally by surgery at the ages of six to 18 months. Mostly, the interrupted suture technique is used to close the nasal and oral layers of the palate. In some studies, the interrupted suture technique was compared with continuous suture techniques for the closure of oral and nasal layers and found that there was less utilization of time and suture materials in the continuous technique. This study was designed to see the outcomes of interrupted versus continuous suture techniques. Materials & methods A total of 36 patients were included in the study and were divided into two groups according to the type of suturing technique. The time utilized for the repair of the oral and nasal layers of the cleft palate, the number of suture packs utilized, and the incidence of fistula formation were noted and compared between the two groups. Out of 36 patients, 17 were included in group A (operated by interrupted techniques), and 19 were included in group B (operated by the continuous technique). Results The mean time taken to close nasal layer in Group A was 18.12 ± 1.16 minutes and in Group B was 8.37 ± 0.89 minutes (p-value < 0.001), whereas for oral layer closure, it was 14.00 ± 1.17 minutes in group A and 6.00 ± 0.57 minutes in group B (p-value < 0.001). The average usage was 2.26 ± 0.45 suture packs for repair with the continuous technique and 4.00 ± 0.35 suture packs when repaired via interrupted stitches. There was no difference noted in postoperative outcomes in both groups in terms of postoperative fistula and wound dehiscence. Conclusion A continuous suture technique for closing the oral and nasal layers in patients with cleft palate is recommended, as it is more beneficial in terms of time, cost-effectiveness, and utilization of suture material.
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Memba R, Morató O, Estalella L, Pavel MC, Llàcer-Millán E, Achalandabaso M, Julià E, Padilla E, Olona C, O'Connor D, Jorba R. Prevention of Incisional Hernia after Open Hepato-Pancreato-Biliary Surgery: A Systematic Review. Dig Surg 2021; 39:6-16. [PMID: 34875657 DOI: 10.1159/000521169] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/21/2021] [Indexed: 12/10/2022]
Abstract
INTRODUCTION Most hepato-pancreato-biliary (HPB) procedures are still performed through open approach. Incisional hernia (IH) is one of the most common complications after open surgery. To date, published data on IH after HPB surgery are scarce; therefore, the aim of this study was to assess the current evidence regarding incidence, risk factors, and prevention. METHODS Medline/PubMed (1946-2020), EMBASE (1947-2020), and the Cochrane library (1995-2020) were searched for studies on IH in open HPB surgery. Animal studies, editorials, letters, reviews, comments, short case series and liver transplant, laparoscopic, or robotic procedures were excluded. The protocol was registered with PROSPERO (CRD42020163296). RESULTS A total of 5,079 articles were retrieved. Eight studies were finally included for the analysis. The incidence of IH after HPB surgery ranges from 7.7% to 38.8%. The identified risk factors were body mass index, surgical site infection, ascites, Mercedes or reversed T incisions, and previous IH. Prophylactic mesh might be safe and effective. CONCLUSIONS IH after open HPB surgery is still an important matter. Some of the risk factors are specific for the HPB operations and the incision type should be carefully considered. Randomized controlled trials are required to confirm the role of prophylactic mesh after HPB operations.
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Affiliation(s)
- Robert Memba
- Hepato-Pancreato-Biliary Unit, General Surgery Department, University Hospital of Tarragona Joan XXIII, Tarragona, Spain.,School of Medicine, Rovira i Virgili University, Reus, Spain
| | - Olga Morató
- Hepato-Pancreato-Biliary Unit, General Surgery Department, University Hospital of Tarragona Joan XXIII, Tarragona, Spain
| | - Laia Estalella
- Hepato-Pancreato-Biliary Unit, General Surgery Department, University Hospital of Tarragona Joan XXIII, Tarragona, Spain.,School of Medicine, Rovira i Virgili University, Reus, Spain
| | - Mihai C Pavel
- Hepato-Pancreato-Biliary Unit, General Surgery Department, University Hospital of Tarragona Joan XXIII, Tarragona, Spain.,School of Medicine, Rovira i Virgili University, Reus, Spain
| | - Erik Llàcer-Millán
- Hepato-Pancreato-Biliary Unit, General Surgery Department, University Hospital of Tarragona Joan XXIII, Tarragona, Spain.,School of Medicine, Rovira i Virgili University, Reus, Spain
| | - Mar Achalandabaso
- Hepato-Pancreato-Biliary Unit, General Surgery Department, University Hospital of Tarragona Joan XXIII, Tarragona, Spain.,School of Medicine, Rovira i Virgili University, Reus, Spain
| | - Elisabet Julià
- Hepato-Pancreato-Biliary Unit, General Surgery Department, University Hospital of Tarragona Joan XXIII, Tarragona, Spain
| | - Erlinda Padilla
- Abdominal Wall Surgery Unit, General Surgery Department, University Hospital of Tarragona Joan XXIII, Tarragona, Spain
| | - Carles Olona
- School of Medicine, Rovira i Virgili University, Reus, Spain.,Abdominal Wall Surgery Unit, General Surgery Department, University Hospital of Tarragona Joan XXIII, Tarragona, Spain
| | - Donal O'Connor
- Department of Surgery, School of Medicine, Trinity College Dublin, College Green, Dublin, Ireland
| | - Rosa Jorba
- Hepato-Pancreato-Biliary Unit, General Surgery Department, University Hospital of Tarragona Joan XXIII, Tarragona, Spain.,School of Medicine, Rovira i Virgili University, Reus, Spain
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Iida H, Tani M, Hirokawa F, Ueno M, Noda T, Takemura S, Nomi T, Nakai T, Kaibori M, Kubo S. Risk factors for incisional hernia according to different wound sites after open hepatectomy using combinations of vertical and horizontal incisions: A multicenter cohort study. Ann Gastroenterol Surg 2021; 5:701-710. [PMID: 34586100 PMCID: PMC8452478 DOI: 10.1002/ags3.12467] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/07/2021] [Accepted: 04/13/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Although several risk factors for incisional hernia after hepatectomy have been reported, their relationship to different wound sites has not been investigated. Therefore, this study aimed to examine the risk factors for incisional hernia according to various wound sites after hepatectomy. Methods: Patients from the Osaka Liver Surgery Study Group who underwent open hepatectomy using combinations of vertical and horizontal incisions (J-shaped incision, reversed L-shaped incision, reversed T-shaped incision, Mercedes incision) between January 2012 and December 2015 were included. Incisional hernia was defined as a hernia occurring within 3 y after surgery. Abdominal incisional hernia was classified into midline incisional hernia and transverse incisional hernia. The risk factors for each posthepatectomy incisional hernia type were identified. Results: A total of 1057 patients met the inclusion criteria. The overall posthepatectomy incisional hernia incidence rate was 5.9% (62 patients). In the multivariate analysis, the presence of diabetes mellitus and albumin levels <3.5 g/dL were identified as independent risk factors. Moreover, incidence rates of midline and transverse incisional hernias were 2.4% (25 patients), and 2.3% (24 patients), respectively. In multivariate analysis, the independent risk factor for transverse incisional hernia was the occurrence of superficial or deep incisional surgical site infection, and interrupted suturing for midline incisional hernia. Conclusions: Risk factors for incisional hernia after hepatectomy depend on the wound site. To prevent incisional hernia, running suture use might be better for midline wound closure. The prevention of postoperative wound infection is important for transverse wounds, under the presumption of preoperative nutrition and normoglycemia.
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Affiliation(s)
- Hiroya Iida
- Department of SurgeryShiga University of Medical ScienceShigaJapan
| | - Masaji Tani
- Department of SurgeryShiga University of Medical ScienceShigaJapan
| | - Fumitoshi Hirokawa
- Department of General and Gastroenterological SurgeryOsaka Medical CollegeOsakaJapan
| | - Masaki Ueno
- Second Department of SurgeryWakayama Medical UniversityWakayamaJapan
| | - Takehiro Noda
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversityOsakaJapan
| | - Shigekazu Takemura
- Department of Hepato‐Biliary‐Pancreatic SurgeryOsaka City University Graduate School of MedicineOsakaJapan
| | - Takeo Nomi
- Department of SurgeryNara Medical UniversityNaraJapan
| | - Takuya Nakai
- Department of SurgeryFaculty of MedicineKinki UniversityOsakaJapan
| | - Masaki Kaibori
- Department of SurgeryKansai Medical UniversityOsakaJapan
| | - Shoji Kubo
- Department of Hepato‐Biliary‐Pancreatic SurgeryOsaka City University Graduate School of MedicineOsakaJapan
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Outcomes of redo-transversus abdominis release for abdominal wall reconstruction. Hernia 2021; 25:1581-1592. [PMID: 34287726 DOI: 10.1007/s10029-021-02457-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Transversus abdominis release (TAR) is increasingly used to address complex ventral hernias; consequently, associated complications are seen more frequently. Our hernia center has a growing experience with redo-transversus abdominis release (redo-TAR) to address large, complex hernia recurrences after failed TAR. Here, we describe our outcomes after abdominal wall reconstruction with redo-TAR. STUDY DESIGN Adults undergoing elective open, redo-TAR at our institution from January 2015 to February 2021 were queried from a prospectively collected database in the Abdominal Core Health Quality Collaborative. The primary outcome was 30-day wound morbidity. Secondary outcomes were long-term composite hernia recurrence and patient-reported quality of life. RESULTS Sixty-five patients underwent redo-TAR. Median age was 60 years, 50.8% were female, and median BMI 31.8 kg/m2. Median recurrent hernias were 16 cm wide by 25 cm long. Frequent mechanisms of recurrence included linea semilunaris injury (27.7%), mesh fracture (18.5%), infection (16.9%), and posterior sheath disruption (15.4%). Wound complications occurred in 33.8% and 16.9% required procedural intervention. With median clinical and PRO follow-up of 12 and 19 months, respectively, the composite hernia recurrence rate was 22.5% and patients reported significantly improved quality of life (HerQLes: median + 36.7, PROMIS: median - 9.5). CONCLUSION Redo-TAR may be performed as a salvage procedure to reconstruct complex defects after failed TAR, however, in our center, it is associated with increased wound morbidity and fairly high composite recurrence rates. Despite this, patients report improvements in quality of life and pain. Tracking outcomes after TAR will facilitate understanding how to manage its failures.
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Albertsmeier M, Hofmann A, Baumann P, Riedl S, Reisensohn C, Kewer JL, Hoelderle J, Shamiyeh A, Klugsberger B, Maier TD, Schumacher G, Köckerling F, Pession U, Weniger M, Fortelny RH. Effects of the short-stitch technique for midline abdominal closure: short-term results from the randomised-controlled ESTOIH trial. Hernia 2021; 26:87-95. [PMID: 34050419 PMCID: PMC8881264 DOI: 10.1007/s10029-021-02410-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 04/08/2021] [Indexed: 11/28/2022]
Abstract
Purpose The short-stitch technique for midline laparotomy closure has been shown to reduce hernia rates, but long stitches remain the standard of care and the effect of the short-stitch technique on short-term results is not well known. The aim of this study was to compare the two techniques, using an ultra-long-term absorbable elastic suture material.
Methods Following elective midline laparotomy, 425 patients in 9 centres were randomised to receive wound closure using the short-stitch (USP 2-0 single thread, n = 215) or long-stitch (USP 1 double loop, n = 210) technique with a poly-4-hydroxybutyrate-based suture material (Monomax®). Here, we report short-term surgical outcomes.
Results At 30 (+10) days postoperatively, 3 (1.40%) of 215 patients in the short-stitch group and 10 (4.76%) of 210 patients in the long-stitch group had developed burst abdomen [OR 0.2830 (0.0768–1.0433), p = 0.0513]. Ruptured suture, seroma and hematoma and other wound healing disorders occurred in small numbers without differences between groups. In a planned Cox proportional hazard model for burst abdomen, the short-stitch group had a significantly lower risk [HR 0.1783 (0.0379–0.6617), p = 0.0115].
Conclusions Although this trial revealed no significant difference in short-term results between the short-stitch and long-stitch techniques for closure of midline laparotomy, a trend towards a lower rate of burst abdomen in the short-stitch group suggests a possible advantage of the short-stitch technique. Trial registry NCT01965249, registered October 18, 2013.
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Affiliation(s)
- M Albertsmeier
- Department of General, Visceral and Transplantation Surgery, LMU University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, 81377, Munich, Germany
| | - A Hofmann
- Allgemein-, Viszeral- und Tumorchirurgie, Wilhelminenspital, Montleartstr. 37, 1160, Vienna, Austria
| | - P Baumann
- Department of Medical Scientific Affairs, Aesculap AG, Am Aesculap Platz, 78532, Tuttlingen, Germany
| | - S Riedl
- Klinik am Eichert, Allgemeinchirurgie, Alb Fils Klinik GmbH, Eichertstr.3, 73035, Göppingen, Germany
| | - C Reisensohn
- Klinik am Eichert, Allgemeinchirurgie, Alb Fils Klinik GmbH, Eichertstr.3, 73035, Göppingen, Germany
| | - J L Kewer
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Klinikum Landkreis Tuttlingen, Zeppelinstr. 21, 78532, Tuttlingen, Germany
| | - J Hoelderle
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Klinikum Landkreis Tuttlingen, Zeppelinstr. 21, 78532, Tuttlingen, Germany
| | - A Shamiyeh
- Klinik für Allgemein- und Viszeralchirurgie, Kepler Universitätsklinikum GmbH, Krankenhausstr. 9, 4021, Linz, Austria
| | - B Klugsberger
- Klinik für Allgemein- und Viszeralchirurgie, Kepler Universitätsklinikum GmbH, Krankenhausstr. 9, 4021, Linz, Austria
| | - T D Maier
- Allgemein- und Viszeralchirurgie, Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376, Stuttgart, Germany
| | - G Schumacher
- Chirurgische Klinik, Städtisches Klinikum Braunschweig, Salzdahlumer Str. 90, 38126, Brunswick, Germany
| | - F Köckerling
- Klinik für Chirurgie, Viszeral- und Gefäßchirurgie, Vivantes Klinikum Spandau, Neue Bergstr. 6, 13585, Berlin, Germany
| | - U Pession
- Zentrum der Chirurgie, Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai, 60590, Frankfurt am Main, Germany
| | - M Weniger
- Department of General, Visceral and Transplantation Surgery, LMU University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, 81377, Munich, Germany
| | - R H Fortelny
- Allgemein-, Viszeral- und Tumorchirurgie, Wilhelminenspital, Montleartstr. 37, 1160, Vienna, Austria.
- Med. Fakultät, Sigmund Freud Privatuniversität, Freudplatz 3, 1020, Vienna, Austria.
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Are the collagen types and density in the wound healed after midline and transverse laparotomy different? An experimental study in mice. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.840890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mc Geehan G, Edelduok IM, Bucholc M, Watson A, Bodnar Z, Johnston A, Sugrue M. Systematic Review and Meta-Analysis of Wound Bundles in Emergency Midline Laparotomy Identifies That It Is Time for Improvement. Life (Basel) 2021; 11:life11020138. [PMID: 33670186 PMCID: PMC7916918 DOI: 10.3390/life11020138] [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: 12/31/2020] [Revised: 01/20/2021] [Accepted: 02/07/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Emergency midline laparotomy is the cornerstone of survival in patients with peritonitis. While bundling of care elements has been shown to optimize outcomes, this has focused on elective rather than emergency abdominal surgery. The aim of this study was to undertake a systematic review and meta-analysis of factors affecting the development of surgical site infection (SSI) in patients undergoing midline emergency laparotomy. METHODS An ethically approved, PROSPERO registered (ID: CRD42020193246) meta-analysis and systematic review, searching PubMed, Scopus, Web of Science and Cochrane Library electronic databases from January 2015 to June 2020 and adhering to PRISMA guidelines was undertaken. Search headings included "emergency surgery", "laparotomy", "surgical site infection", "midline incision" and "wound bundle". Suitable publications were graded using Methodological Index for Non-Randomised Studies (MINORS); papers scoring ≥16/24 were included for data analysis. The primary outcome in this study was SSI rates following the use of wound bundles. Secondary outcomes consisted of the effect of the individual interventions included in the bundles and the SSI rates for superficial and deep infections. Five studies focusing on closure techniques were grouped to assess their effect on SSI. RESULTS This study identified 1875 articles. A total of 58 were potentially suitable, and 11 were included after applying MINORS score. The final cohort included 2,856 patients from eight countries. Three papers came from the USA, two papers from Japan and the remainder from Denmark, England, Iran, Netherlands, Spain and Turkey. There was a 32% non-significant SSI reduction after the implementation of wound bundles (RR = 0.68; CI, 0.39-1.17; p = 0.16). In bundles used for technical closure the reduction in SSI of 15% was non-significant (RR = 0.85; CI, 0.57-1.26; p = 0.41). Analysis of an effective wound bundle was limited due to insufficient data. CONCLUSIONS This study identified a significant deficit in the world literature relating to emergency laparotomy and wound outcome optimisation. Given the global burden of emergency general surgery urgent action is needed to assess bundle's ability to potentially improve outcome after emergency laparotomy.
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Affiliation(s)
- Gearóid Mc Geehan
- Donegal Clinical Research Academy, Letterkenny University Hospital, F92AE81 County Donegal, Ireland
- School of Medicine, University of Limerick, V94T9PX Limerick, Ireland
| | - Itoro M Edelduok
- Department of Surgery, Letterkenny University Hospital, F92AE81 County Donegal, Ireland
| | - Magda Bucholc
- Intelligent Systems Research Centre, School of Computing, Engineering and Intelligent Systems, Ulster University (Magee Campus), Northern Ireland BT48 7JL, UK
| | - Angus Watson
- Raigmore Hospital, NHS-Highland, Inverness IV2 3DZ, UK
| | - Zsolt Bodnar
- Department of Surgery, Letterkenny University Hospital, F92AE81 County Donegal, Ireland
| | - Alison Johnston
- Donegal Clinical Research Academy, Letterkenny University Hospital, F92AE81 County Donegal, Ireland
- Emergency Surgery Outcome Advancement Project, Letterkenny University Hospital, F92AE81 County Donegal, Ireland
| | - Michael Sugrue
- Donegal Clinical Research Academy, Letterkenny University Hospital, F92AE81 County Donegal, Ireland
- Department of Surgery, Letterkenny University Hospital, F92AE81 County Donegal, Ireland
- Emergency Surgery Outcome Advancement Project, Letterkenny University Hospital, F92AE81 County Donegal, Ireland
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Liedberg F, Hagberg O, Aljabery F, Gårdmark T, Jahnson S, Jerlström T, Montgomery A, Sherif A, Ströck V, Häggström C, Holmberg L. Cumulative incidence of midline incisional hernia and its surgical treatment after radical cystectomy and urinary diversion for bladder cancer: A nation-wide population-based study. PLoS One 2021; 16:e0246703. [PMID: 33539475 PMCID: PMC7861544 DOI: 10.1371/journal.pone.0246703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/25/2021] [Indexed: 12/02/2022] Open
Abstract
Background and objective To study the cumulative incidence and surgical treatment of midline incisional hernia (MIH) after cystectomy for bladder cancer. Methods In the nationwide Bladder Cancer Data Base Sweden (BladderBaSe), cystectomy was performed in 5646 individuals. Cumulative incidence MIH and surgery for MIH were investigated in relation to age, gender, comorbidity, previous laparotomy and/or inguinal hernia repair, operative technique, primary/secondary cystectomy, postoperative wound dehiscence, year of surgery, and period-specific mean annual hospital cystectomy volume (PSMAV). Results Three years after cystectomy the cumulative incidence of MIH and surgery for MIH was 8% and 4%, respectively. The cumulative incidence MIH was 12%, 9% and 7% in patients having urinary diversion with continent cutaneous pouch, orthotopic neobladder and ileal conduit. Patients with postoperative wound dehiscence had a higher three-year cumulative incidence MIH (20%) compared to 8% without. The corresponding cumulative incidence surgery for MIH three years after cystectomy was 9%, 6%, and 4% for continent cutaneous, neobladder, and conduit diversion, respectively, and 11% for individuals with postoperative wound dehiscence (vs 4% without). Using multivariable Cox regression, secondary cystectomy (HR 1.3 (1.0–1.7)), continent cutaneous diversion (HR 1.9 (1.1–2.4)), robot-assisted cystectomy (HR 1.8 (1–3.2)), wound dehiscence (HR 3.0 (2.0–4.7)), cystectomy in hospitals with PSMAV 10–25 (HR 1.4 (1.0–1.9)), as well as cystectomy during later years (HRs 2.5–3.1) were all independently associated with increased risk of MIH. Conclusions The cumulative incidence of MIH was 8% three years postoperatively, and increase over time. Avoiding postoperative wound dehiscence after midline closure is important to decrease the risk of MIH.
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Affiliation(s)
- Fredrik Liedberg
- Department of Urology Skåne University Hospital, Malmö, Sweden
- Institution of Translational Medicine, Lund University, Malmö, Sweden
- * E-mail:
| | - Oskar Hagberg
- Institution of Translational Medicine, Lund University, Malmö, Sweden
- Regional Cancer Centre South, Region Skåne, Lund, Sweden
| | - Firas Aljabery
- Division of Urology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Truls Gårdmark
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Staffan Jahnson
- Division of Urology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Tomas Jerlström
- Department of Urology, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Agneta Montgomery
- Institution of Clinical Sciences Malmö, Surgical Research Unit, Lund University, Lund, Sweden
| | - Amir Sherif
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Viveka Ströck
- Department of Urology, Sahlgrenska University Hospital and Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christel Häggström
- Department of Biobank Research, Umeå University, Umeå, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Lars Holmberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom
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Iwaya A, Yamazaki T, Kameyama H, Uehara H, Hirai M, Komatsu M, Kubota A, Katada T, Kobayashi K, Sato D, Yokoyama N, Kuwabara S. Influence of Suture Materials on Incisional Hernia Rate after Laparoscopic Colorectal Cancer Surgery: A Propensity Score Analysis. JOURNAL OF THE ANUS RECTUM AND COLON 2021; 5:46-51. [PMID: 33537500 PMCID: PMC7843141 DOI: 10.23922/jarc.2020-066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 10/25/2020] [Indexed: 11/30/2022]
Abstract
Objectives Incisional hernia is a common problem after colorectal surgery, and a laparoscopic approach does not reduce the incisional hernia rate. Previous reports have described the risk factors for incisional hernia; however, the impact of suture materials remains unclear. As such, this study compared the incisional hernia rate using different suture materials for abdominal wall closure after laparoscopic colorectal cancer surgery. Methods Patients undergoing laparoscopic colorectal cancer surgery between January 2014 and December 2016 were included in this study. We separated patients into the following two groups based on the suture materials used for abdominal wall closure: (1.) fast-absorbable group and (2.) non-absorbable group. The primary outcome was incisional hernia rate that was diagnosed using computed tomography. We compared outcomes between these two groups using propensity score matching. Results Before matching, 394 patients were included (168 in the fast-absorbable group and 226 in the non-absorbable group). After one-to-one matching, patients were stratified into the fast-absorbable group (n = 158) and the non-absorbable group (n = 158). The incisional hernia rate was higher in the fast-absorbable group than in the non-absorbable group (13.9% vs. 6.3%; P = 0.04). The median time to develop an incisional hernia was significantly shorter in the fast-absorbable group (6.7 months vs. 12.3 months; P < 0.01). The incidence of surgical site infection was not different between the two groups, but the incidence of suture sinus was lower in the fast-absorbable group (0% vs. 5.1%; P < 0.01). Conclusions The use of fast-absorbable sutures may increase the risk of incisional hernia after laparoscopic colorectal cancer surgery.
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Affiliation(s)
- Akira Iwaya
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Toshiyuki Yamazaki
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Hitoshi Kameyama
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Hiroaki Uehara
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Motoharu Hirai
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Masaru Komatsu
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Akira Kubota
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Tomohiro Katada
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Kazuaki Kobayashi
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Daisuke Sato
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Naoyuki Yokoyama
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Shirou Kuwabara
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
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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.
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Affiliation(s)
- M A Garcia-Urena
- Hospital Universitario del Henares, Faculty of Health Sciences. Universidad Francisco de Vitoria, 28223, Pozuelo de Alarcón, Madrid, Spain.
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Perez JE, Schmidt MA, Narvaez A, Welsh LK, Diaz R, Castro M, Ansari K, Cason RW, Bilezikian JA, Hope W, Guerron AD, Yoo J, Levinson H. Evolving concepts in ventral hernia repair and physical therapy: prehabilitation, rehabilitation, and analogies to tendon reconstruction. Hernia 2020; 25:1-13. [PMID: 32959176 DOI: 10.1007/s10029-020-02304-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/02/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE The abdominal wall and musculoskeletal tendons share many anatomic, physiologic, and functional characteristics. This review aims to highlight these similar characteristics and to present a rationale why the treatment principles of successful musculoskeletal tendon reconstruction, including principles of surgical technique and physical therapy, can be used in the treatment of complex abdominal wall reconstruction or ventral hernia repair. METHODS The MEDLINE/PubMed database was used to identify published literature relevant to the purpose of this review. CONCLUSIONS There are several anatomical and functional similarities between the linea alba and musculoskeletal tendons. Because of this reason, many of the surgical principles for musculoskeletal tendon repair and ventral hernia repair overlap. Distribution of tension is the main driving principle for both procedures. Suture material and configuration are chosen to maximize tension distribution among the tissue edges, as seen in the standard of care multistrand repairs for musculoskeletal tendons, as well as in the small bites for laparotomy technique described in the STITCH trial. Physical therapy is also one of the mainstays of tendon repair, but surprisingly, is not routine in ventral hernia repair. The evidence surrounding physical therapy prehabilitation and rehabilitation protocols in other disciplines is significant. This review challenges the fact that these protocols are not routinely implemented for ventral hernia repair, and presents the rationale and feasibility for the routine practice of physical therapy in ventral hernia repair.
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Affiliation(s)
- J E Perez
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, NC, 27704, US
| | - M A Schmidt
- Department of Physical Therapy and Occupational Therapy, Duke University, Durham, NC, 27710, US
| | - A Narvaez
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, NC, 27704, US
| | - L K Welsh
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, NC, 27704, US
| | - R Diaz
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, NC, 27704, US
| | - M Castro
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, NC, 27704, US
| | - K Ansari
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, 27710, US
| | - R W Cason
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, 27710, US
| | - J A Bilezikian
- Department of General Surgery, New Hanover Regional Medical Center, Wilmington, NC, 28403, US
| | - W Hope
- General Surgery Specialists, New Hanover Regional Medical Center, Wilmington, NC, 28403, US
| | - A D Guerron
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, NC, 27704, US
| | - J Yoo
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, NC, 27704, US
| | - H Levinson
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, 27710, US. .,Director of Innovation and Entrepreneurship, Associate Professor of Plastic and Reconstructive Surgery, Pathology, Dermatology and Surgical Sciences, Departments of Dermatology, Pathology, and Surgery, Duke University Medical Center, DUMC 3181, Durham, NC, 27710, US.
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Predictors of hernia after loop ileostomy closure: a single-center retrospective review. Int J Colorectal Dis 2020; 35:1695-1702. [PMID: 32451647 DOI: 10.1007/s00384-020-03637-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Our aims were to determine the rate of incisional hernia after closure of a loop ileostomy (LI) and to identify any perioperative risk factors that may be associated with hernia development. METHODS We performed an IRB-approved retrospective review that included consecutive patients who underwent LI closure from January 1, 2012, to December 31, 2014. The primary outcome was identification of hernia on physical exam or by abdominal imaging. A stepwise logistic regression analysis was used to determine predictors of ileostomy site hernia. RESULTS A total of 243 consecutive patients had LI closure during the study timeframe. The overall rate of hernia formation was 11.9% (29/243). The median time to discovery of the hernia was 16.4 (range, 2.2-55.9) months with a median follow-up time of 49 months. Although LI performed in conjunction with sigmoidectomy for diverticulitis consisted of only 19% of ileostomy cases, 62% of hernias were (18/29) identified in this cohort. Rates of hernia formation increased with respect to body mass index (underweight 0%; normal 4.6%; overweight 13.8%; obese 21%). The multivariable model identified increased BMI (underweight/normal weight versus overweight: OR 4.13, 95% CI 1.06-16.04; underweight/normal weight versus obese: OR 8.74, 95% CI 2.17-35.23) and surgical indication (reference variable: diverticulitis; rectal cancer: OR 0.21, 95% CI 0.06-0.76; Crohn's/ulcerative colitis: OR 0.06, 95% CI 0.01-0.53; other: OR 0.15, 95% CI 0.04-0.64) as significant predictors of ileostomy site hernia. CONCLUSION The development of a hernia at the site of LI closure was influenced mostly by BMI, surgical indication, and operative time.
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Kubyshkin VA, Galliamov EA, Agapov MA, Kakotkin VV, Davlyatov MR. SIGNIFICANCE OF THE STRUCTURE AND METABOLISM OF THE EXTRACELLULAR MATRIX IN THE PATHOGENESIS OF ABDOMINAL HERNIAS. REVIEW. SURGICAL PRACTICE 2020. [DOI: 10.38181/2223-2427-2020-1-24-32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- V. A. Kubyshkin
- Federal State Budget Educational Institution of Higher Education M.V. Lomonosov Moscow State University
| | - E. A. Galliamov
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - M. A. Agapov
- Federal State Budget Educational Institution of Higher Education M.V. Lomonosov Moscow State University
| | - V. V. Kakotkin
- Federal State Budget Educational Institution of Higher Education M.V. Lomonosov Moscow State University
| | - M. R. Davlyatov
- Federal State Budget Educational Institution of Higher Education M.V. Lomonosov Moscow State University
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Subcutaneous fat area as a risk factor for extraction site incisional hernia following gastrectomy for gastric cancer. Surg Today 2020; 50:1418-1426. [PMID: 32488478 DOI: 10.1007/s00595-020-02039-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 04/26/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To identify the incidence of extraction site incisional hernia following gastrectomy for gastric cancer and its significant risk factors, including the subcutaneous fat area. METHODS We reviewed data gathered prospectively on patients with gastric cancer, who underwent gastrectomy between 2008 and 2012 at Kyushu University Hospital, Fukuoka, Japan. The subcutaneous fat area (SFA) and visceral fat area (VFA) were measured using axial computed tomography at the level of the L4 and L3 transverse processes, and the L2-L3 intervertebral disc. The primary endpoint of the rate of extraction site incisional hernia was based on the computed tomography and clinical data including hospital follow-up reports. RESULTS After applying the inclusion and exclusion criteria, 320 patients were included in this retrospective analysis: 3.1% (10/320) had extraction site incisional hernias after a mean follow-up of 11 months. Multivariate analysis revealed that age and the SFA were independent risk factors (age ≥ 70.5 years: P = .013, odds ratio: 9.116, 95% confidence interval 1.581-52.553; L4 SFA ≥ 124 cm2: P = .004, odds ratio: 13.752, 95% confidence interval 2.290-82.582). CONCLUSION Age and the SFA were independent risk factors for extraction site incisional hernia in patients undergoing gastrectomy for gastric cancer.
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Kubyshkin VA, Agapov MA, Davlyatov MR, Kakotkin VV. [Ventral hernias and extracellular matrix of connective tissue]. Khirurgiia (Mosk) 2020:62-67. [PMID: 32105257 DOI: 10.17116/hirurgia202002162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Ventral hernia is still one of the most common reason for scheduled and emergency surgery. The review is designed to reveal relationships between metabolism in extracellular matrix of connective tissue and pathogenesis of ventral hernias. These data will be valuable to develop a personalized approach to the treatment of these patients.
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Affiliation(s)
| | - M A Agapov
- Lomonosov Moscow State University, Moscow, Russia
| | | | - V V Kakotkin
- Lomonosov Moscow State University, Moscow, Russia
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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.
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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.
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Battarbee AN, Pfister A, Manuck TA. Suture thickness and transvaginal cervical cerclage outcomes. Am J Obstet Gynecol MFM 2019; 1:100056. [PMID: 33179009 DOI: 10.1016/j.ajogmf.2019.100056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Cervical cerclage placement has been shown to benefit women who have cervical insufficiency, however, the best type of suture to use for transvaginal cerclage placement is unknown. Objective To evaluate the association between transvaginal cerclage suture thickness and pregnancy outcomes. Study Design Retrospective cohort study of women with a singleton, non-anomalous gestation who underwent history-, ultrasound- or physical exam-indicated transvaginal cerclage at a single tertiary care center (2013-2016). The primary outcome was gestational age at delivery. Secondary outcomes included preterm birth less than 34 weeks, chorioamnionitis, neonatal intensive care unit admission and composite neonatal morbidity. Baseline characteristics and outcomes were compared by thickness of suture material: thick 5mm braided polyester fiber (Mersilene® tape) versus thin polyester braided thread (Ethibond®) or polypropylene non-braided monofilament (Prolene®) with selection of suture type at the discretion of the provider. The association between thick suture and gestational age at delivery was estimated using Cox proportional hazard regression. Multivariable logistic regression was used to estimate the association between thick suture and the secondary outcomes. Effect modification of cerclage indication was also assessed. Results A total of 203 women met inclusion criteria: 120 (59%) with thick suture and 83 (41%) with thin suture. Of these, 130 women had history-indicated, 35 had ultrasound-indicated, and 38 had exam-indicated cerclages. Compared to women who had thin suture, women with thick suture were more likely to have had a history- or ultrasound-indicated cerclage, rather than exam-indicated cerclage, and more likely to have had a Shirodkar or cervico-isthmic approach, rather than McDonald. Women with thick suture were also more likely to have received progesterone and had placement at earlier gestational age, but there were no differences in cervical exam at placement. After adjusting for confounding factors, thick suture was associated with longer pregnancy duration among women with ultrasound-indicated cerclage (aHR 0.61, 95%CI 0.41-0.91) and exam-indicated cerclage (aHR 0.30, 95%CI 0.15-0.58), but not with history-indicated cerclage (aHR 1.27, 95%CI 0.83-1.94). Thick suture was also associated with lower odds of preterm birth < 34 weeks, chorioamnionitis and neonatal intensive care unit admission, compared to thin suture. Conclusion Thick, compared to thin suture, for transvaginal cervical cerclage was associated with longer duration of pregnancy among women with ultrasound- and exam-indicated cerclages and lower odds of chorioamnionitis and neonatal intensive care unit admission among all women regardless of cerclage indication.
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Affiliation(s)
- Ashley N Battarbee
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of North Carolina School of Medicine and University of North Carolina Health Care, Chapel Hill, NC
| | - Abbey Pfister
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of North Carolina School of Medicine and University of North Carolina Health Care, Chapel Hill, NC
| | - Tracy A Manuck
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of North Carolina School of Medicine and University of North Carolina Health Care, Chapel Hill, NC.,Institute for Environmental Health Solutions, Gillings School of Global Public Health, University of North Carolina- Chapel Hill, Chapel Hill, NC
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Abstract
INTRODUCTION A laparotomy is commonly required to gain abdominal access. A safe standardized access and closure technique is warranted to minimize abdominal wall complications like wound infections, burst abdomen and incisional hernias. Stitches are recommended to be small and placed tightly, obtaining a suture length-to-incision length (SL/WL) ratio of ≥ 4:1. This can be time-consuming and difficult to achieve especially following long trying surgical procedures. The aim was to develop and evaluate a new mechanical suture device for standardized wound closure. METHODS A mechanical suture device (Suture-tool) was developed in collaboration between a medical technology engineer team with the aim to achieve a standardized suture line of high quality that could be performed speedy and safe. Ten surgeons closed an incision in an animal tissue model after a standardized introduction of the instrument comparing the device to conventional needle driver suturing (NDS) using the 4:1 technique. Outcome measures were SL/WL ratio, number of stitches and suture time. RESULTS In total, 80 suture lines were evaluated. SL/WL ratio of ≥ 4 was achieved in 95% using the Suture-tool and 30% using NDS (p < 0,001). Number of stitches was similar. Suture time was 30% shorter using the Suture-tool compared to NDS (2 min 54 s vs. 4 min 5 s; p < 0.001). CONCLUSIONS The mechanical needle driver seems to be a promising device to perform a speedy standardized high-quality suture line for fascial closure.
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