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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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Anipchenko AN, Allakhverdyan AS, Levchuk AL, Panin SI, Fedorov AV. [Koblenz algorithm for open abdomen management]. Khirurgiia (Mosk) 2021:65-70. [PMID: 34270196 DOI: 10.17116/hirurgia202107165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The issue of laparostomy treatment is still controversial, since there are insufficient evidence-based data. German military surgeons have developed and implemented the «Koblenz algorithm» of laparostomy treatment into everyday practice. The algorithm was developed at the Bundeswehr Central Hospital in Koblenz (Germany). Today, approximately 50% of German civilian hospitals use the «Koblenz algorithm». The database for laparostomy treatment was created on the basis of international platform European Registry of Abdominal wall Hernias (EuraHS) in May 2015. These data will be valuable for further multipla-center studies. This manuscript is devoted to analysis of clinical effectiveness of the «Koblenz algorithm» in the treatment of patients with laparostomy. Searching of Russian, English and German studies devoted to «Koblenz algorithm» in the treatment of patients with laparostomy was carried out in the eLIBRARY, Elektronische Zeitschriftenbibliothek, the Cochrane Library and the PubMed databases. The authors comprehensively described «Koblenz algorithm». Mortality in the group of VAC - therapy was 57% (31/54), in case of «Koblenz algorithm» - 33% (33/100). Between-group differences were significant (OR 0.36, 95% CI 0.18-0.72, p=0.003). However, an efficacy of «Koblenz algorithm» should be confirmed in further multiple-center studies including national evidence-based trials.
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Affiliation(s)
- A N Anipchenko
- Moscow Regional Research Clinical Institute, Moscow, Russia
| | | | - A L Levchuk
- Pirogov National Medical Surgical Center, Moscow, Russia
| | - S I Panin
- Volgograd State Medical University, Volgograd, Russia
| | - A V Fedorov
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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Mann CD, Luther A, Hart C, Finch JG. Laparoscopic incisional and ventral hernia repair in a district general hospital. Ann R Coll Surg Engl 2015; 97:22-6. [PMID: 25519261 DOI: 10.1308/003588414x14055925058913] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The laparoscopic approach to repairing ventral and incisional hernias has gained increasing popularity worldwide. We reviewed the experience of laparoscopic ventral hernia repair at a district general hospital in the UK with particular reference to patients with massive defects (diameter ≥15cm) and the morbidly obese. METHODS A total of 144 patients underwent laparoscopic ventral (incisional or umbilical/paraumbilical) hernia repair between April 2007 and September 2012. RESULTS The prevalence of conversion to open surgery was 2.8%. The prevalence of postoperative complications was 3.5%. Median postoperative follow-up was 30.2 months. A total of 5.6% cases suffered late complications and 2.8% developed recurrence. Thirty-four patients underwent repair of defects ≥10cm in diameter with a prevalence of recurrence of 5.6%. Sixteen patients underwent repair of 'massive' incisional hernia (diameter ≥15cm) with a prevalence of recurrence of 12.5%. Sixteen patients with a body mass index (BMI) ≥40kg/m(2) (range, 40-61kg/m(2)) underwent laparoscopic repair with a prevalence of recurrence of 6.3% (p>0.05 vs BMI <40kg/m(2)). CONCLUSIONS Laparoscopic ventral hernia repair can be carried out safely with a low prevalence of recurrence. It may have advantages in morbidly obese patients in whom open repair would represent a significant undertaking. Laparoscopic ventral hernia repair may be used in cases of large and massive hernias, in which the risk of recurrence increases but is comparable with open repair and associated with low morbidity.
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Affiliation(s)
- C D Mann
- Northampton General Hospital, UK
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Willms A, Güsgen C, Schaaf S, Bieler D, von Websky M, Schwab R. Management of the open abdomen using vacuum-assisted wound closure and mesh-mediated fascial traction. Langenbecks Arch Surg 2014; 400:91-9. [PMID: 25128414 DOI: 10.1007/s00423-014-1240-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 08/08/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND The open abdomen has become an accepted treatment option of critically ill patients with severe intra-abdominal conditions. Fascial closure is a particular challenge in patients with peritonitis. This study investigates whether fascial closure rates can be increased in peritonitis patients by using an algorithm that combines vacuum-assisted wound closure and mesh-mediated fascial traction. Moreover, fascial closure rates for patients with peritonitis, trauma or abdominal compartment system (ACS) are compared. METHODS Data were collected prospectively from all patients who underwent open abdomen management at our institution from 2006 to 2012. All patients were treated under a standardised algorithm that combines vacuum-assisted closure and mesh placement at the fascial level. RESULTS During the study period, 53 patients (mean age 53 years) underwent open abdomen management for a mean duration of 15 days. Indications for leaving the abdomen open were peritonitis (51 %), trauma (26 %), and ACS or abdominal wall dehiscence (23 %). The fascial closure rate was 79 % in an intention-to-treat analysis and 89 % in a per-protocol analysis. Mortality was 13 %. No patient developed an enteroatmospheric fistula or abdominal wall dehiscence after closure. The mean duration of treatment was significantly longer in peritonitis patients (20 days) than in patients without peritonitis (10 days) (p = 0.03). There were no significant differences in fascial closure rates between patients with peritonitis (87 %), trauma (85 %), and ACS or abdominal wall dehiscence (100 %) (p = 0.647). CONCLUSIONS Regardless of the underlying pathology, high fascial closure rates can be achieved using a combination of vacuum-assisted closure and mesh-mediated fascial traction.
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Affiliation(s)
- A Willms
- Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital of Koblenz, Ruebenacher Strasse 170, 56072, Koblenz, Germany,
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