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Goldstein AL, Nevo N, Nizri E, Shimonovich M, Maman Y, Pencovich N, Lahat G, Karin E. The Use of Inlay Bridge of the Posterior Fascia as Adjuvants to a Modified Rives-Stoppa Repair for Difficult Abdominal Wall Hernias. Am Surg 2023; 89:4616-4624. [PMID: 36069008 DOI: 10.1177/00031348221114027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Major abdominal wall defects remain a highly morbid complication. Occasionally a fascial defect is encountered, that despite all surgical efforts, is unable to completely approximate at the midline. Here we describe our method and outcomes of using a bridging mesh when the posterior fascia was unable to be approximated during the repair of large postoperative ventral hernias using the modified Rives-Stoppa technique. METHODS A retrospective review was conducted looking at all the open abdominal wall hernia repairs between 2014 and 2020. The cohort of patients who had a bridge placed in addition to the traditional open modified Rives-Stoppa repair were used for this study. RESULTS Nineteen patients had a mesh inlay bridge placed in addition to a modified Rives-Stoppa repair with a sublay (retrorectus) Ultrapro mesh. For the inlay mesh 13 Symbotex composite meshes were placed and 6 Vicryl meshes used. The average surface area of the defect was 358.1 cm^2. The average length of hospitalization was 8.8 days with a range of 3-24 days. During the immediate postoperative course there were 6 minor complications. During the follow-up period there were 2 recurrences. DISCUSSION The use of inlay mesh bridge as an adjuvant to a modified Rives-Stoppa repair with a sublay ultrapro mesh is an effective technique for difficult abdominal wall repairs where the posterior fascia is unable to be approximated without tension.
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Affiliation(s)
| | - Nadav Nevo
- Department of Surgery, Tel Aviv Medical Center, Ichilov Hospital, Tel Aviv, Israel
| | - Eran Nizri
- Department of Surgery, Tel Aviv Medical Center, Ichilov Hospital, Tel Aviv, Israel
| | - Michal Shimonovich
- Department of Surgery, Tel Aviv Medical Center, Ichilov Hospital, Tel Aviv, Israel
| | - Yossi Maman
- Department of Surgery, Tel Aviv Medical Center, Ichilov Hospital, Tel Aviv, Israel
| | - Niv Pencovich
- Department of Surgery B, Tel Hashomer (Sheba) Hospital, Ramat Gan, Israel
| | - Guy Lahat
- Department of Surgery, Tel Aviv Medical Center, Ichilov Hospital, Tel Aviv, Israel
| | - Eliad Karin
- Department of Surgery, Tel Aviv Medical Center, Ichilov Hospital, Tel Aviv, Israel
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Kumar R, Prakash P, Sinha SR, Ahmad N, Baitha KS. Short-Term Outcomes and Quality-of-Life Assessment Following Rives-Stoppa and Transversus Abdominis Release Procedures of Open Ventral Hernia Repair. Cureus 2023; 15:e41637. [PMID: 37565133 PMCID: PMC10411383 DOI: 10.7759/cureus.41637] [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: 07/09/2023] [Indexed: 08/12/2023] Open
Abstract
INTRODUCTION Ventral hernia is one of the common surgical conditions that can significantly impact a patient's quality of life (QoL). Open ventral hernia repair using the Rives-Stoppa (RS) and Transversus Abdominis Release (TAR) procedures has gained recognition for its effectiveness in achieving hernia repair and reducing the risk of further recurrence. However, limited research has been performed to explore the short-term outcomes and QoL assessment following these two surgical techniques. The aim of this study was to know the result after RS and TAR methods of hernia repair in terms of short-term recurrences, pain, postoperative complications, and QoL. METHODS This was a prospective, interventional study, which included 30 patients fulfilling the inclusion criteria. The study group was subjected to posterior component separation (PCS)-TAR and RS repair as per surgical indication (RS if defect size 4-10cm; PCS-TAR if defect size >10cm and = 15cm). All post-operative patients were followed up at postoperative day (POD) seven, POD 30, and POD 90 for postoperative pain, complications, and QoL using the hernia-specific Carolina Comfort Scale (CCS). At the same time, recurrence was studied till POD 180. RESULTS Not a single recurrence was observed till POD 180 in either of the repair methods. The mean operative time for RS repair was 170.47 ± 15.08 minutes while for TAR repair was 188.8 ± 22.04 (p-value= 0.013). Surgical site infection (SSI) was reported in 14.28% of RS repair cases and 11.11% of TAR repair cases. Seroma formation was observed in 9.5% of RS repair cases. RS repair has less mean CCS score than TAR. The one-way ANOVA showed f-ratio=421.43 and p-value=0.00001 for RS repair while f-ratio= 298.05 and p-value=0 .00001 for TAR repair at POD seven, POD 30, and POD 90. Both RS and TAR repair markedly reduced mean scores in all three domains on POD 90. CONCLUSION Both RS and TAR had no recurrence in a short period of six months. The intraoperative time taken in TAR was less than in earlier studies. QoL improved postoperatively in both the repairs with RS repair having better QoL than TAR repair.
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Affiliation(s)
- Rajiv Kumar
- General Surgery, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Prem Prakash
- General Surgery, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Seema R Sinha
- Biochemistry, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Nadeem Ahmad
- General Surgery, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Kanchan S Baitha
- General Surgery, Indira Gandhi Institute of Medical Sciences, Patna, IND
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Halpern DK, Liu H, Amodu LI, Weinman K, Akerman M, Petrone P. Long term outcomes of robotic-assisted abdominal wall reconstruction: a single surgeon experience. Hernia 2023; 27:645-656. [PMID: 36977947 DOI: 10.1007/s10029-023-02774-3] [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: 12/14/2022] [Accepted: 03/01/2023] [Indexed: 03/30/2023]
Abstract
INTRODUCTION Robotic abdominal wall reconstruction (RAWR) is one of the most significant advances in the management of complex abdominal wall hernias. The objective of this study was to evaluate long term outcomes in a cohort of patients that underwent complex RAWR in a single center. METHODS This was a longitudinal retrospective review of a cohort of 56 patients who underwent complex RAWR at least 24 months prior by a single surgeon at a tertiary care institution. All patients underwent bilateral retro-rectus release (rRRR) with or without robotic transversus abdominis release (rTAR). Data collected include demographics, hernia details, operative and technical details. The prospective analysis included a post-procedure visit of at least 24 months from the index procedure with a physical examination and quality of life survey using the Carolinas Comfort Scale (CCS). Patients with reported symptoms concerning for hernia recurrence underwent radiographic imaging. Descriptive statistics (mean ± standard deviation or median) were calculated for continuous variables. Chi-square or Fisher's exact test as deemed appropriate for categorical variables, and analysis of variance or the Kruskal-Wallis test for continuous data, were performed among the separate operative groups. A total score for the CCS was calculated and analyzed in accordance with the user guidelines. RESULTS One-hundred and-forty patients met the inclusion criteria. Fifty-six patients consented to participate in the study. Mean age was 60.2 years. Mean BMI was 34.0. Ninety percent of patients had at least one comorbidity and 52% of patients were scored ASA 3 or higher. Fifty-nine percent were initial incisional hernias, 19.6% were recurrent incisional hernias and 8.9% were recurrent ventral hernias. The mean defect width was 9 cm for rTAR and 5 cm for rRRR. The mean implanted mesh size was 945.0 cm2 for rTAR and 362.5 cm2 for rRRR. The mean length of follow-up was 28.1 months. Fifty-seven percent of patients underwent post-op imaging at an average follow-up of 23.5 months. Recurrence rate was 3.6% for all groups. There were no recurrences in patients that underwent solely bilateral rRRR. Two patients (7.7%) that underwent rTAR procedures were found with recurrence. Average time to recurrence was 23 months. Quality of life survey demonstrated an overall CCS score of 6.63 ± 13.95 at 24 months with 12 (21.4%) patients reporting mesh sensation, 20 (35.7%) reporting pain, and 13 (23.2%) reporting movement limitation. CONCLUSION Our study contributes to the paucity of literature describing long term outcomes of RAWR. Robotic techniques offer durable repairs with acceptable quality of life metrics.
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Affiliation(s)
- D K Halpern
- Department of Surgery, NYU Langone Hospital-Long Island, NYU Long Island School of Medicine, 222 Station Plaza North, Suite 300, Mineola, NY, 11501, USA.
| | - H Liu
- Department of Surgery, NYU Langone Hospital-Long Island, NYU Long Island School of Medicine, 222 Station Plaza North, Suite 300, Mineola, NY, 11501, USA
| | - L I Amodu
- Department of Surgery, NYU Langone Hospital-Long Island, NYU Long Island School of Medicine, 222 Station Plaza North, Suite 300, Mineola, NY, 11501, USA
| | - K Weinman
- Department of Surgery, NYU Langone Hospital-Long Island, NYU Long Island School of Medicine, 222 Station Plaza North, Suite 300, Mineola, NY, 11501, USA
| | - M Akerman
- Biostatistics Core, Division of Health Services Research, Department of Foundations of Medicine, NYU Long Island School of Medicine, Mineola, NY, 11501, USA
| | - P Petrone
- Department of Surgery, NYU Langone Hospital-Long Island, NYU Long Island School of Medicine, 222 Station Plaza North, Suite 300, Mineola, NY, 11501, USA
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Favourable outcomes after Retro-Rectus (Rives-Stoppa) Mesh Repair as Treatment for Non-Complex Ventral Abdominal Wall Hernia, a Systematic Review and Meta-Analysis. Ann Surg 2022; 276:55-65. [PMID: 35185120 DOI: 10.1097/sla.0000000000005422] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess prevalence of hernia recurrence, surgical site infection (SSI), seroma, serious complications, and mortality after retro-rectus repair. SUMMARY BACKGROUND DATA Ventral abdominal wall hernia is a common problem, tied to increasing frailty and obesity of patients undergoing surgery. For non-complex ventral hernia, retro-rectus (Rives-Stoppa) repair is considered the gold standard treatment. Level-1 evidence confirming this presumed superiority is lacking. METHODS Five databases were searched for studies reporting on retro-rectus repair. Single-armed and comparative randomized and non-randomized studies were included. Outcomes were pooled with mixed-effects, inverse variance or random-effects models. RESULTS Ninety-three studies representing 12440 patients undergoing retro-rectus repair were included. Pooled hernia recurrence was estimated at 3.2% (95%CI: 2.2-4.2%, n = 11049) after minimally 12 months and 4.1%, (95%CI: 2.9-5.5%, n = 3830) after minimally 24 months. Incidences of SSI and seroma were estimated at respectively 5.2% (95%CI: 4.2-6.4%, n = 4891) and 5.5% (95%CI: 4.4-6.8%, n = 3650). Retro-rectus repair was associated with lower recurrence rates compared to onlay repair (OR: 0.27, 95%CI: 0.15-0.51, p < 0.001) and equal recurrence rates compared to intraperitoneal onlay (IPOM) repair (OR: 0.92, 95%CI: 0.75-1.12, p = 0.400). Retro-rectus repair was associated with more SSI than IPOM repair (OR: 1.8, 95%CI: 1.03-3.14, p = 0.038). Minimally invasive retro-rectus repair displayed low rates of recurrence (1.3%, 95%CI: 0.7-2.3%, n = 849) and SSI (1.5%, 95%CI: 0.8-2.8%, n = 982), albeit based on non-randomized studies. CONCLUSIONS Retro-rectus (Rives-Stoppa) repair results in excellent outcomes, superior or similar to other techniques for all outcomes except surgical site infection. The latter rarely occurred, yet less frequently after IPOM repair, which is usually performed by laparoscopy.
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Juvany M, Guillaumes S, Hoyuela C, Bachero I, Trias M, Ardid J, Martrat A. Results of a Prospective Cohort Study on Open Rives Technique of the Midline Incisional Hernia: Midline Closure and Mesh Overlap. Surg Innov 2021; 29:321-328. [PMID: 34275369 DOI: 10.1177/15533506211033137] [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
Background. Rives repair has been traditionally used for large abdominal wall defects with good results on terms of recurrence. However, it is limited by the lateral border of the posterior rectus sheath. The objective of our study was to evaluate recurrence rate, midline closure and mesh overlap in patients operated on elective midline incisional hernia by open Rives retromuscular repair. Methods. This is a prospective observational study of 83 patients who underwent elective open Rives technique between January 2014 and December 2018. Main inclusion criteria were adults with a midline incisional hernia. Recurrence, midline closure and mesh overlap were determined. Results. At a median postoperative follow-up of 32 (5-59) months, 8 cases of recurrence were reported. Patients with recurrence had wider hernia defects (101 ± 52 mm vs 66 ± 36 mm, P = .014) and were repaired with wider meshes (191 ± 93 mm vs 137 ± 68 mm, P = .042). However, although it was not statistically significant, midline closure was lower (38% vs 59%), as well as the overlapping relationship between mesh area and hernia defect area (2.937:1 vs 3.732:1) on patients that developed a recurrence. Conclusions. Rives technique provides good mid-term results in a midline incisional hernia (10% of recurrence at 36 months), including wider hernias in the recurrent cohort. The authors believe that other techniques which allow midline closure and placement of bigger meshes should be considered, especially in those hernias classified as W3 on EuraHS classification (more than 10 cm on width size).
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Affiliation(s)
- Montserrat Juvany
- Department of General and Digestive Surgery, 221694Hospital Plató, Barcelona, Catalunya, Spain
| | - Salvador Guillaumes
- Department of General and Digestive Surgery, 221694Hospital Plató, Barcelona, Catalunya, Spain
| | - Carlos Hoyuela
- Department of General and Digestive Surgery, 221694Hospital Plató, Barcelona, Catalunya, Spain
| | - Irene Bachero
- Department of General and Digestive Surgery, 221694Hospital Plató, Barcelona, Catalunya, Spain
| | - Miguel Trias
- Department of General and Digestive Surgery, 221694Hospital Plató, Barcelona, Catalunya, Spain
| | - Jordi Ardid
- Department of General and Digestive Surgery, 221694Hospital Plató, Barcelona, Catalunya, Spain
| | - Antoni Martrat
- Department of General and Digestive Surgery, 221694Hospital Plató, Barcelona, Catalunya, Spain
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Bueno-Lledó J, Martinez-Hoed J, Torregrosa-Gallud A, Menéndez-Jiménez M, Pous-Serrano S. Botulinum toxin to avoid component separation in midline large hernias. Surgery 2020; 168:543-549. [DOI: 10.1016/j.surg.2020.04.050] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022]
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Jolissaint JS, Dieffenbach BV, Tsai TC, Pernar LI, Shoji BT, Ashley SW, Tavakkoli A. Surgical site occurrences, not body mass index, increase the long-term risk of ventral hernia recurrence. Surgery 2020; 167:765-771. [PMID: 32063341 DOI: 10.1016/j.surg.2020.01.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 12/30/2019] [Accepted: 01/02/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Recurrence rates after ventral hernia repair vary widely and evidence about risk factors for recurrence are conflicting. There is little evidence for risk factors for long-term recurrence. METHODS Patients who underwent ventral hernia repair at our institution and were captured in the American College of Surgeons-National Surgical Quality Improvement Program database between 2002 and 2015 were included. We reviewed all demographic, procedural, and hernia-specific data. RESULTS Six hundred and thirty patients were included for analysis with a median follow-up of 4.9 years (inter-quartile range, 2-7.3 years). By univariate analysis, index hernia repairs were more likely to recur if defect size was ≥4 cm (P = .019), no mesh was used (P = .026), or if the repair was for a recurrent hernia (P = .001). Five-year cumulative incidence of recurrence and reoperation was 24.3% and 16.0%, respectively. Patients with a perioperative surgical site occurrence, which included superficial, deep-incisional, and organ space surgical site infections as well as wound disruption, had a 5-year cumulative incidence of recurrence of 54.9% compared with 22.6% for those without surgical site occurrence. By multivariable analysis, non-primary hernia repair (hazard ratio 1.7, 95% confidence interval 1.2-2.4, P = .005) and any postoperative surgical site occurrence (hazard ratio 1.9, 95% confidence interval 1.1-3.6, P = .02) were the only risk factors predictive of recurrence. Patient body mass index had no independent effect on recurrence. CONCLUSION 1 in 4 patients undergoing an open ventral hernia repair will have a recurrence after 5 years, and this risk is doubled among patients who experience any perioperative surgical site occurrence. After controlling for patient comorbidities, including body mass index, hernia size, and mesh position, the most significant risk factor for recurrence after ventral hernia repair was a non-primary hernia and surgical site occurrence.
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Affiliation(s)
- Joshua S Jolissaint
- Department of Surgery, Brigham and Women's Hospital, Boston, MA; Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
| | | | - Thomas C Tsai
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | | | - Brent T Shoji
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Stanley W Ashley
- Department of Surgery, Brigham and Women's Hospital, Boston, MA; Laboratory for Metabolic and Surgical Research, Brigham and Women's Hospital, Boston, MA
| | - Ali Tavakkoli
- Department of Surgery, Brigham and Women's Hospital, Boston, MA; Laboratory for Metabolic and Surgical Research, Brigham and Women's Hospital, Boston, MA
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