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Niebuhr H, Malaibari ZO, Köckerling F, Reinpold W, Dag H, Eucker D, Aufenberg T, Fikatas P, Fortelny RH, Kukleta J, Meier H, Flamm C, Baschleben G, Helmedag M. [Intraoperative fascial traction (IFT) for treatment of large ventral hernias : A retrospective analysis of 50 cases]. Chirurg 2021; 93:292-298. [PMID: 34907456 PMCID: PMC8894171 DOI: 10.1007/s00104-021-01552-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim was to evaluate the effectiveness, clinical practicability, and complication rate of the intraoperative fascial traction (IFT) procedure for the treatment of large ventral hernias. METHOD This study evaluated 50 patients from 11 specialized centers with an intraoperatively measured fascial distance of more than 8 cm, who were treated by IFT (traction time 30-35 min) using the fasciotens® hernia traction procedure. RESULTS Fascial gaps measured preoperatively ranged from 8 cm to 44 cm, with most patients (94%) having a fascial gap above 10 cm (W3 according to the European Hernia Society classification). The mean fascial distance was reduced from 16.1 ± 0.8 cm to 5.8 ± 0.7 cm (stretch gain 10.2 ± 0.7 cm, p < 0.0001, Wilcoxon matched-pairs signed-ranks test). A reduction in fascial distance of at least 50% was achieved in three quarters of the patients and in half of the treated patients the reduction in fascial distance amounted to even more than 70%. The closure rate achieved by IFT after a mean surgical duration of 207.3 ± 11.0 min was 90% (45/50). Hernia closure was performed in all cases with a mesh augmentation in a sublay position. Postoperative complications occurred in 6 patients (12%). A reoperation was required in 3 patients (6%). CONCLUSION The described IFT method is a new procedure for abdominal wall closure in large ventral hernias. The presented results demonstrate a high effectiveness, a good clinical practicability and a low complication rate of IFT.
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Affiliation(s)
- Henning Niebuhr
- Hamburger Hernien Centrum, Eppendorfer Baum 8, 20249, Hamburg, Deutschland.
| | - Zaid Omar Malaibari
- Hamburger Hernien Centrum, Eppendorfer Baum 8, 20249, Hamburg, Deutschland.,Faculty of Medicine, Department of Surgery, University of Tabuk, Tabuk, Saudi-Arabien
| | | | - Wolfgang Reinpold
- Hamburger Hernien Centrum, Eppendorfer Baum 8, 20249, Hamburg, Deutschland
| | - Halil Dag
- Hamburger Hernien Centrum, Eppendorfer Baum 8, 20249, Hamburg, Deutschland
| | - Dietmar Eucker
- Chirurgische Klinik Kantonsspital Baselland Bruderholz, Bruderholz, Schweiz
| | - Thomas Aufenberg
- Klinik für Chirurgie, St. Elisabeth-Krankenhaus Köln, Köln, Deutschland
| | - Panagiotis Fikatas
- Klinik für Chirurgie, Charité Campus Virchow-Klinik, Berlin, Deutschland
| | | | - Jan Kukleta
- Klinik für Chirurgie, Hirslanden Klinik, Zürich, Schweiz
| | - Hansjörg Meier
- Klinik für Allgemein- und Viszeralchirurgie, Sana Krankenhaus, Benrath, Deutschland
| | - Christian Flamm
- Klinik für Allgemein‑, Viszeral‑, Endokrine und Unfallchirurgie, RoMed Clinic, Bad Aibling, Deutschland
| | - Guido Baschleben
- Klinik für Allgemein- und Viszeral Chirurgie, St. Elisabeth Hospital, Leipzig, Deutschland
| | - Marius Helmedag
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsklinik Aachen, Aachen, Deutschland
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Eucker D, Rüedi N, Luedtke C, Stern O, Niebuhr H, Zerz A, Rosenberg R. Abdominal Wall Expanding System. Intraoperative Abdominal Wall Expansion as a Technique to Repair Giant Incisional Hernia and Laparostoma. New and Long-Term Results From a Three-Center Feasibility Study. Surg Innov 2021; 29:169-182. [PMID: 34530655 DOI: 10.1177/15533506211041477] [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: 11/16/2022]
Abstract
BACKGROUND The abdominal wall expanding system (AWEX) was first applied in 2012 and published in 2017. This novel technique was developed to reconstruct complex incisional hernias and residual skin-grafted laparostoma after treatment of an open abdomen, when primary midline closure was impossible. The main aim was the anatomical reconstruction of the abdominal wall and the avoidance of dissecting techniques (component separation). METHODS Between 2012 and 2019, 33 patients underwent AWEX hernia repair in three certified hernia centers. The retracted abdominal wall was stretched with the AWEX system intraoperatively for approximately 30 min. Hernia size was measured preoperatively, on CT, and intraoperatively. The gain in length on the lateral abdominal wall (decrease in width of the defect) after stretching and any residual midline gap were determined in the OR. RESULTS 33 patients underwent AWEX procedures. Six cases were evaluated separately because of additional procedures (TAR, four cases) and preoperative application of botulinum toxin (two cases). The median (95% confidence interval) measured width of hernia defects was 13 (12-16) cm, the median gain in length on the lateral abdominal wall was 12 (10-15) cm. After median follow-up of 29 (12-54) months, one recurrence from the broken mesh was observed. No method-related complications occurred. CONCLUSION Based on the 2017 and current results, the AWEX system represents an alternative or supplemental procedure to current techniques for complex abdominal wall reconstruction. The system proved again to be time-saving, safe, effective, and easy to learn. Further studies with enhanced technology are in progress.
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Affiliation(s)
| | - Nadine Rüedi
- 367307Kantonsspital Baselland, Liestal, Switzerland
| | | | | | | | - Andreas Zerz
- 273720Clinic Stephanshorn, St Gallen, Switzerland
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Niebuhr H, Aufenberg T, Dag H, Reinpold W, Peiper C, Schardey HM, Renter MA, Aly M, Eucker D, Köckerling F, Eichelter J. Intraoperative Fascia Tension as an Alternative to Component Separation. A Prospective Observational Study. Front Surg 2021; 7:616669. [PMID: 33708790 PMCID: PMC7940755 DOI: 10.3389/fsurg.2020.616669] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/14/2020] [Indexed: 11/13/2022] Open
Abstract
Incisional hernias are common late complications of abdominal surgery, with a 1-year post-laparotomy incidence of about 20%. A giant hernia is often preceded by severe peritonitis of various causes. The Fasciotens® Abdomen device is used to stretch the fascia in a measurably controlled manner during surgery to achieve primary tension-free abdominal closure. This prospective observational study aims to clarify the extent to which this traction method can function as an alternative to component separation (CS) methods. Methods: We included data of 21 patients treated with intraoperative fascia stretching in seven specialized hernia centers between November 2019 and August 2020. Results: Intraoperatively-measured fascial distance averaged 17.3 cm (range 8.5-44 cm). After application of diagonal-anterior traction >10 kg for an average duration of 32.3 min (range 30-40 min), the fascial distance decreased by 9.8 cm (1-26 cm) to an average 7.5 cm (range 2-19 cm), which is a large effect (r = 0.62). The fascial length increase (average 9.8 cm) after applied traction was highly significant. All hernias were closed under moderate tension after the traction phase. In 19 patients, this closure was reinforced with mesh using a sublay technique. Conclusion: This method allows primary closure of complex (LOD) hernias and is potentially less prone to complications than component separation (CS) methods.
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Affiliation(s)
| | | | - Halil Dag
- Hanse Hernia Centre, Hamburg, Germany
| | | | - Christian Peiper
- Clinic for General, Visceral and Thoracic Surgery, Protestant Hospital, Hamm, Germany
| | - Hans Martin Schardey
- Clinic for General, Visceral, Vascular and Endocrine Surgery, Agatharied Hospital, Hausham, Germany
| | | | - Mohamed Aly
- Clinic for General, Visceral and Thoracic Surgery, Landshut-Achdorf Hospital, Landshut, Germany
| | - Dietmar Eucker
- Clinic for General, Visceral, Thoracic and Vascular Surgery, Canton Hospital Basel-Land, Liestal, Switzerland
| | - Ferdinand Köckerling
- Clinic for General, Visceral and Vascular Surgery, Vivantes Klinikum Spandau, Berlin, Germany
| | - Jakob Eichelter
- Department of Surgery, Division of General Surgery, Medical University of Vienna, Vienna, Austria
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Hutan M, Bartko C, Majesky I, Prochotsky A, Sekac J, Skultety J. Reconstruction option of abdominal wounds with large tissue defects. BMC Surg 2014; 14:50. [PMID: 25103782 PMCID: PMC4127081 DOI: 10.1186/1471-2482-14-50] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 07/30/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Abdominal wall defects result from trauma, abdominal wall tumors, necrotizing infections or complications of previous abdominal surgeries. Apart from cosmetics, abdominal wall defects have strong negative functional impact on the patients.Many different techniques exist for abdominal wall repair. Most problematic and troublesome are defects, where major part of abdominal wall had to be resected and tissue for transfer or reconstruction is absent. CASE PRESENTATION Authors of the article present operative technique, in which reconstruction of abdominal wall was managed by composite polypropylene mesh with absorbable collagen film, creation of granulation tissue with use of NPWT (negative pressure wound therapy), and subsequent split skin grafting.Three patients with massive abdominal wall defect were successfully managed and abdominal wall reconstruction was performed by mentioned technique. Functional and cosmetic effect is acceptable and patients have good postoperative quality of life. CONCLUSIONS Patients with giant abdominal defects can benefit from described technique. It serves as the only option, with which abdominal wall is fully reconstructed without need for the secondary intervention.
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Affiliation(s)
- Martin Hutan
- II.nd Surgical Clinic of Medical faculty Comenius University, University Hospital Bratislava, Hospital of st. Cyril and Methodius, Antolska 11, Bratislava 85107, Slovakia
| | - Christian Bartko
- II.nd Surgical Clinic of Medical faculty Comenius University, University Hospital Bratislava, Hospital of st. Cyril and Methodius, Antolska 11, Bratislava 85107, Slovakia
| | - Ivan Majesky
- II.nd Surgical Clinic of Medical faculty Comenius University, University Hospital Bratislava, Hospital of st. Cyril and Methodius, Antolska 11, Bratislava 85107, Slovakia
| | - Augustin Prochotsky
- II.nd Surgical Clinic of Medical faculty Comenius University, University Hospital Bratislava, Hospital of st. Cyril and Methodius, Antolska 11, Bratislava 85107, Slovakia
| | - Jaroslav Sekac
- II.nd Surgical Clinic of Medical faculty Comenius University, University Hospital Bratislava, Hospital of st. Cyril and Methodius, Antolska 11, Bratislava 85107, Slovakia
| | - Jan Skultety
- II.nd Surgical Clinic of Medical faculty Comenius University, University Hospital Bratislava, Hospital of st. Cyril and Methodius, Antolska 11, Bratislava 85107, Slovakia
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Köhler G. [Median incisional hernias and coexisting parastomal hernias : new surgical strategies and an algorithm for simultaneous repair]. Chirurg 2014; 85:697-704. [PMID: 24823998 DOI: 10.1007/s00104-014-2746-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The co-occurrence of incisional and parastomal hernias (PSH) remains a surgical challenge. Standardized treatment guidelines are missing, and the patients concerned require an individualized surgical approach. The laparoscopic techniques can be performed with incised and/or stoma-lateralizing flat meshes with intraperitoneal onlay placement. The purely laparoscopic and laparoscopic-assisted approaches with 3-D meshes offer advantages regarding the complete coverage of the edges of the stomal areas and the option of equilateral or contralateral stoma relocation in cases of PSH, which are difficult to handle due to scarring, adhesions, and large fascial defects > 5 cm with intestinal hernia sac contents. A relevant stoma prolapse can be relocated by tunnel-like preformed 3-D meshes and shortening the stoma bowel. The positive effect on prolapse prevention arises from the dome of the 3-D mesh, which is directed toward the abdominal cavity and tightly fits to the bowel. In cases of large incisional hernias (> 8-10 cm in width) or young patients with higher physical demands, an open abdominal wall reconstruction in sublay technique is required. Component separation techniques that enable tension-free ventral fascial closure should be preferred to mesh-supported defect bridging methods. The modified posterior component separation with transversus abdominis release (TAR) and the minimally invasive anterior component separation are superior to the original Ramirez technique with respect to wound morbidity. By using 3-D textile implants, which were specially designed for parastomal hernia prevention, the stoma can be brought out through the lateral abdominal wall without increased risk of parastomal hernia or prolapse development. An algorithm for surgical treatment, in consideration of the complexity of combined hernias, is introduced for the first time.
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Affiliation(s)
- G Köhler
- Abteilung für Allgemein- und Viszeralchirurgie, Krankenhaus der Barmherzigen Schwestern, Seilerstätte 4, 4010, Linz, Österreich,
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López-Cano M, Pereira JA, Armengol-Carrasco M. “Acute postoperative open abdominal wall”: Nosological concept and treatment implications. World J Gastrointest Surg 2013; 5:314-320. [PMID: 24392182 PMCID: PMC3879415 DOI: 10.4240/wjgs.v5.i12.314] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 08/02/2013] [Accepted: 10/16/2013] [Indexed: 02/06/2023] Open
Abstract
The so-called “burst abdomen” has been described for many years and is a well-known clinical condition, whereas the concept of the “open abdomen” is relatively new. In clinical practice, both nosological entities are characterized by a complex spectrum of symptoms apparently disconnected, which in many cases poses a great challenge for surgical repair. In order to assess the management of these disorders in a more comprehensive and integral fashion, the concept of “acute postoperative open abdominal wall” (acute POAW) is presented, which in turn can be divided into “intentional” or planned acute POAW and “unintentional” or unplanned POAW. The understanding of the acute POAW as a single clinical process not only allows a better optimization of the therapeutic approach in the surgical repair of abdominal wall-related disorders, but also the stratification and collection of data in different patient subsets, favoring a better knowledge of the wide spectrum of conditions involved in the surgical reconstruction of the abdominal wall.
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