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Qiu Z, Li S, Tang J, Fang L, Pang Y, Chen L. Measurements of abdominal wall defect and hernia sac volume for the treatment of incisional hernia: Application of the ultrasonic volume auto-scan in 50 cases. Asian J Surg 2023; 46:3601-3606. [PMID: 37100653 DOI: 10.1016/j.asjsur.2023.04.034] [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: 12/01/2022] [Accepted: 04/12/2023] [Indexed: 04/28/2023] Open
Abstract
PURPOSE Abdominal incisional hernia is one of the most common complications after surgery. The preoperative evaluation of the area of abdominal wall defect and the hernia sac volume(HCV) is very important for the selection of patch size and incisional herniorrhaphy. Meanwhile the overlap range of reinforcement repair is controversial. This study aimed to explore the value of ultrasonic volume auto-scan(UVAS) in the diagnosis, classification and treatment of incisional hernia. METHODS Both the width and the area of abdominal wall defect and HCV were measured by UVAS in 50 cases with incisional hernias. In 32 of these cases, the measurements of HCV were compared with those of CT. Classification of incisional hernia based on ultrasonic images were compared with operative diagnosis. RESULTS The measurements of HCV by UVAS and CT 3D reconstruction had good consistency, of which the mean ratio was 1.0084. According to the location and width of abdominal wall defect, UVAS, which showed good accuracy rate (90%, 96%), reached a good agreement in the classification of incisional hernias with operative diagnoses (Kappa = 0.85, Confidence Interval [0.718,0.996]; Kappa = 0.95, Confidence Interval [0.887,0.999]). The patch area should be at least two times as large as the defect area. CONCLUSIONS UVAS is an accurate alternative to measure the abdominal wall defect and HCV and classify the incisional hernia, with additional benefits of no radiation exposure and instant bedside interpretation. The use of UVAS is conducive to preoperative assessment of the risk of hernia recurrence and abdominal compartment syndrome.
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Affiliation(s)
- Zhiying Qiu
- Department of Ultrasonic Diagnosis, Huadong Hospital Affiliated to Fudan University, 221 West Yanan Road, Shanghai, 200041, China.
| | - Shaojie Li
- Department of General Surgery, Huadong Hospital Affiliated to Fudan University, 221 West Yanan Road, Shanghai, 200041, China.
| | - JianXiong Tang
- Department of General Surgery, Huadong Hospital Affiliated to Fudan University, 221 West Yanan Road, Shanghai, 200041, China.
| | - Liang Fang
- Department of Ultrasonic Diagnosis, Huadong Hospital Affiliated to Fudan University, 221 West Yanan Road, Shanghai, 200041, China.
| | - Yun Pang
- Department of Ultrasonic Diagnosis, Huadong Hospital Affiliated to Fudan University, 221 West Yanan Road, Shanghai, 200041, China.
| | - Lin Chen
- Department of Ultrasonic Diagnosis, Huadong Hospital Affiliated to Fudan University, 221 West Yanan Road, Shanghai, 200041, China.
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Holmdahl V, Stark B, Clay L, Gunnarsson U, Strigård K. Long-term follow-up of full-thickness skin grafting in giant incisional hernia repair: a randomised controlled trial. Hernia 2021; 26:473-479. [PMID: 34905143 PMCID: PMC9012705 DOI: 10.1007/s10029-021-02544-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/25/2021] [Indexed: 11/12/2022]
Abstract
Purpose Conventional repair of a giant incisional hernia often requires implantation of a synthetic mesh (SM). However, this surgical procedure can lead to discomfort, pain, and potentially serious complications. Full-thickness skin grafting (FTSG) could offer an alternative to SM, less prone to complications related to implantation of a foreign body in the abdominal wall. The aim of this study was to compare the use of FTSG to conventional SM in the repair of giant incisional hernia. Methods Patients with a giant incisional hernia (> 10 cm width) were randomised to repair with either FTSG or SM. 3-month and 1-year follow-ups have already been reported. A clinical follow-up was performed 3 years after repair, assessing potential complications and recurrence. SF-36, EQ-5D and VHPQ questionnaires were answered at 3 years and an average of 9 years (long-term follow-up) after surgery to assess the impact of the intervention on quality-of-life (QoL). Results Fifty-two patients were included. Five recurrences in the FTSG group and three in the SM group were noted at the clinical follow-up 3 years after surgery, but the difference was not significant (p = 0.313). No new procedure-related complication had occurred since the one-year follow-up. There were no relevant differences in QoL between the groups. However, there were significant improvemnts in both physical, emotional, and mental domains of the SF-36 questionnaire in both groups. Conclusion The results of this long-term follow-up together with the results from previous follow-ups indicate that autologous FTSG as reinforcement in giant incisional hernia repair is an alternative to conventional repair with SM. Trial Registration The study was registered August 10, 2011 at ClinicalTrials.gov (ID NCT01413412), retrospectively registered.
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Affiliation(s)
- V Holmdahl
- Department of Surgical and Perioperative Sciences, Surgery, Sunderby Research Unit, Umeå University, Sjukhusvägen 10, 95442, Södra Sunderbyn, Sweden.
| | - B Stark
- Department of Plastic and Reconstructive Surgery, Karolinska University Hospital, MK1 Karolinska Institute, Stockholm, Sweden
| | - L Clay
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institute, Stockholm, Sweden.,Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - U Gunnarsson
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - K Strigård
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
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Berkvens EM, Wegdam J, Visser RA, Bouvy N, Nienhuijs S, Reilingh TSV. Preoperative exercise therapy preventing postoperative complications following complex abdominal wall reconstruction: A feasibility study. INTERNATIONAL JOURNAL OF ABDOMINAL WALL AND HERNIA SURGERY 2021. [DOI: 10.4103/ijawhs.ijawhs_33_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Allart K, Sabbagh C, Regimbeau JM. Intraperitoneal catheter introduction for pre-operative progressive pneumoperitoneum for abdominal hernia with loss of domain (Goni-Moreno technique). J Visc Surg 2020; 157:335-340. [PMID: 32741730 DOI: 10.1016/j.jviscsurg.2020.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- K Allart
- Digestive surgery department, CHU Amiens Picardie, avenue René-Laennec, 80054 Amiens cedex 01, France; University of Picardie Jules-Vernes, 1, chemin du Thil, 80000 Amiens cedex 01, France; Simplifications des soins des patients chirurgicaux complexes (SSPC), Research Clinic Unit, Amiens, France
| | - C Sabbagh
- Digestive surgery department, CHU Amiens Picardie, avenue René-Laennec, 80054 Amiens cedex 01, France; University of Picardie Jules-Vernes, 1, chemin du Thil, 80000 Amiens cedex 01, France; Simplifications des soins des patients chirurgicaux complexes (SSPC), Research Clinic Unit, Amiens, France
| | - J-M Regimbeau
- Digestive surgery department, CHU Amiens Picardie, avenue René-Laennec, 80054 Amiens cedex 01, France; University of Picardie Jules-Vernes, 1, chemin du Thil, 80000 Amiens cedex 01, France; Simplifications des soins des patients chirurgicaux complexes (SSPC), Research Clinic Unit, Amiens, France.
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Olmi S, Uccelli M, Cesana GC, Ciccarese F, Oldani A, Giorgi R, De Carli SM, Villa R, Zanoni AAG, Ismail A. Laparoscopic Ventral Hernia Repair in Bariatric Patients: the Role of Defect Size and Deferred Repair. Obes Surg 2020; 30:3905-3911. [DOI: 10.1007/s11695-020-04747-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/22/2020] [Accepted: 05/28/2020] [Indexed: 11/28/2022]
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Parker SG, Wood CPJ, Butterworth JW, Boulton RW, Plumb AAO, Mallett S, Halligan S, Windsor ACJ. A systematic methodological review of reported perioperative variables, postoperative outcomes and hernia recurrence from randomised controlled trials of elective ventral hernia repair: clear definitions and standardised datasets are needed. Hernia 2018; 22:215-226. [PMID: 29305783 DOI: 10.1007/s10029-017-1718-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 12/23/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND This systematic review assesses the perioperative variables and post-operative outcomes reported by randomised controlled trials (RCTs) of VH repair. This review focuses particularly on definitions of hernia recurrence and techniques used for detection. OBJECTIVE Our aim is to identify and quantify the inconsistencies in perioperative variable and postoperative outcome reporting, so as to justify future development of clear definitions of hernia recurrence and a standardised dataset of such variables. METHODS The PubMed database was searched for elective VH repair RCTs reported January 1995 to March 2016 inclusive. Three independent reviewers performed article screening, and two reviewers independently extracted data. Hernia recurrence, recurrence rate, timing and definitions of recurrence, and techniques used to detect recurrence were extracted. We also assessed reported post-operative complications, standardised operative outcomes, patient reported outcomes, pre-operative CT scan hernia dimensions, intra-operative variables, patient co-morbidity, and hernia morphology. RESULTS 31 RCTs (3367 patients) were identified. Only 6 (19.3%) defined hernia recurrence and methods to detect recurrence were inconsistent. Sixty-four different clinical outcomes were reported across the RCTs, with wound infection (30 trials, 96.7%), hernia recurrence (30, 96.7%), seroma (29, 93.5%), length of hospital stay (22, 71%) and haematoma (21, 67.7%) reported most frequently. Fourteen (45%), 11 (35%) and 0 trials reported CT measurements of hernia defect area, width and loss of domain, respectively. No trial graded hernias using generally accepted scales. CONCLUSION VH RCTs report peri- and post-operative variables inconsistently, and with poor definitions. A standardised minimum dataset, including definitions of recurrence, is required.
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Affiliation(s)
- Samuel G Parker
- The Abdominal Wall Unit, University College London Hospital, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London, NW1 2BU, UK.
| | - C P J Wood
- The Abdominal Wall Unit, University College London Hospital, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London, NW1 2BU, UK
| | - J W Butterworth
- Upper Gastrointestinal Surgery Department, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London, W2 1NY, UK
| | - R W Boulton
- The Abdominal Wall Unit, University College London Hospital, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London, NW1 2BU, UK
| | - A A O Plumb
- Centre for Medical Imaging, University College London, 3rd Floor East 250 Euston Road, London, NW1 2PG, UK
| | - S Mallett
- Institute of Applied Health Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - S Halligan
- Centre for Medical Imaging, University College London, 3rd Floor East 250 Euston Road, London, NW1 2PG, UK
| | - A C J Windsor
- The Abdominal Wall Unit, University College London Hospital, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London, NW1 2BU, UK
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Complex hernias with loss of domain in morbidly obese patients: role of laparoscopic sleeve gastrectomy in a multi-step approach. Surg Obes Relat Dis 2017; 13:768-773. [DOI: 10.1016/j.soard.2017.01.035] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 01/01/2017] [Accepted: 01/20/2017] [Indexed: 11/17/2022]
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8
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Polypropylene-based composite mesh versus standard polypropylene mesh in the reconstruction of complicated large abdominal wall hernias: a prospective randomized study. Hernia 2016; 20:691-700. [PMID: 27507403 DOI: 10.1007/s10029-016-1526-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 07/29/2016] [Indexed: 12/18/2022]
Abstract
PURPOSE To compare polypropylene mesh positioned onlay supported by omentum and/or peritoneum versus inlay implantation of polypropylene-based composite mesh in patients with complicated wide-defect ventral hernias. METHODS This was a prospective randomized study carried out on 60 patients presenting with complicated large ventral hernia in the period from January 2012 to January 2016 in the department of Gastrointestinal Surgery unit and Surgical Emergency of the Main Alexandria University Hospital, Egypt. Large hernia had an abdominal wall defect that could not be closed. Patients were divided into two groups of 30 patients according to the type of mesh used to deal with the large abdominal wall defect. RESULTS The study included 38 women (63.3 %) and 22 men (37.7 %); their mean age was 46.5 years (range, 25-70). Complicated incisional hernia was the commonest presentation (56.7 %).The operative and mesh fixation times were longer in the polypropylene group. Seven wound infections and two recurrences were encountered in the propylene group. Mean follow-up was 28.7 months (2-48 months). CONCLUSIONS Composite mesh provided, in one session, satisfactory results in patients with complicated large ventral hernia. The procedure is safe and effective in lowering operative time with a trend of low wound complication and recurrence rates.
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Nieuwenhuizen J, Halm JA, Jeekel J, Lange JF. Natural Course of Incisional Hernia and Indications for Repair. Scand J Surg 2016; 96:293-6. [DOI: 10.1177/145749690709600406] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Incisional hernias and incisional hernia repair can be a significant challenge for both surgeon and patient. Despite the growing amount of literature describing various methods of surgical techniques, little has been published the natural course of an incisional hernia and regarding indications for incisional hernia repair. Methods: An internet database search was performed to identify articles describing symptoms presented by patients and indications for incisional hernia repair. Results: Various symptoms and indications regarding incisional hernia repair and the natural course of an incisional hernia are mentioned in the literature. Nevertheless, published data accurately describing these symptoms and indications are rare. Conclusion: A prospective trial monitoring incisional hernias as well as comparing conservative treatment with repair should be performed.
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Affiliation(s)
- J. Nieuwenhuizen
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J. A. Halm
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J. Jeekel
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J. F. Lange
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
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10
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Lara FJP, Berges AF, Valdenebro MJM, Fernández JD, Del Rey Moreno A, Muñoz HO. The repair of large ventral hernias in patients with severe cardio-respiratory disease: Volume transposition technique. Int J Surg 2016; 30:90-3. [PMID: 27134126 DOI: 10.1016/j.ijsu.2016.04.036] [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: 03/30/2016] [Revised: 04/18/2016] [Accepted: 04/21/2016] [Indexed: 10/21/2022]
Abstract
Massive hernias of the abdominal wall present a major challenge to the general surgeon. In some extreme cases of patients with severe cardio-respiratory disease, the repair of such hernias may be impracticable. In these cases, we believe the volume transposition technique is appropriate. In this approach, the hernia volume is calculated and the wall repaired with mesh to accommodate the estimated volume of the hernia sac, thus avoiding any increase in intra-abdominal pressure. We believe this technique is simple, reproducible and useful in cases that are inoperable due to cardio-respiratory problems that make any loss of lung volume unacceptable.
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Affiliation(s)
| | | | | | | | | | - H Oliva Muñoz
- Service of Surgery, Antequera Hospital, Málaga, Spain
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11
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Petro CC, Posielski NM, Raigani S, Criss CN, Orenstein SB, Novitsky YW. Risk factors for wound morbidity after open retromuscular (sublay) hernia repair. Surgery 2015; 158:1658-68. [DOI: 10.1016/j.surg.2015.05.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 04/20/2015] [Accepted: 05/12/2015] [Indexed: 01/01/2023]
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12
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Ross SW, Wormer BA, Kim M, Oommen B, Bradley JF, Lincourt AE, Augenstein VA, Heniford BT. Defining surgical outcomes and quality of life in massive ventral hernia repair: an international multicenter prospective study. Am J Surg 2015; 210:801-13. [PMID: 26362202 DOI: 10.1016/j.amjsurg.2015.06.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 06/17/2015] [Accepted: 06/25/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Our goal was to set criteria for massive ventral hernia and to compare surgical outcomes and quality of life after ventral hernia repair (VHR). METHODS The International Hernia Mesh Registry was queried for patients undergoing VHR from 2007 to 2013. Defect was categorized as massive if the width or length was greater than 15 cm or area greater than 150 cm(2). Massive VHR was compared to regular VHR. RESULTS A total of 878 patients underwent VHR: 436 open, 442 laparoscopic with 13 deaths (1.5%) and 45 hernia recurrences (5.1%). Of those, 158 patients (18%) met criteria for massive VHR. Massive VHR patients had longer length of stay (LOS) and operative time and more hematomas, wound infections, wound complications, and pneumonias (P < .05). On multivariate analysis, LOS was longer, and early postoperative pain and activity limitation were greater in massive VHRs (P < .01). Massive VHR in the laparoscopic approach resulted in greater long-term mesh sensation (P < .01). CONCLUSIONS VHR in massive hernias have increased rates of complications and longer LOS.
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Affiliation(s)
- Samuel W Ross
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Carolinas Hernia Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28204, USA
| | - Blair A Wormer
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Carolinas Hernia Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28204, USA
| | - Mimi Kim
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Carolinas Hernia Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28204, USA
| | - Bindhu Oommen
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Carolinas Hernia Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28204, USA
| | - Joel F Bradley
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Carolinas Hernia Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28204, USA
| | - Amy E Lincourt
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Carolinas Hernia Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28204, USA
| | - Vedra A Augenstein
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Carolinas Hernia Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28204, USA
| | - B Todd Heniford
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Carolinas Hernia Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28204, USA.
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Is There an Association between Component Separation and Venous Thromboembolism? Analysis of the NSQIP. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e429. [PMID: 26180730 PMCID: PMC4494499 DOI: 10.1097/gox.0000000000000167] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 06/27/2014] [Indexed: 11/26/2022]
Abstract
Background: Patients undergoing incisional/ventral hernia repair are at risk of developing several postoperative complications particularly venous thromboembolism (VTE), which is a major cause of morbidity and mortality. The aim of this study was to assess 30-day postoperative morbidity and mortality of patients undergoing incisional/ventral hernia repair and to determine the association between component separation and VTE. Methods: We reviewed the 2005–2011 American College of Surgeons National Surgical Quality Improvement Program databases to identify patients undergoing incisional/ventral hernia repair. Preoperative variables and postoperative outcomes were compared between a component separation group and a non–component separation group. The χ2 tests and Fisher’s exact test were used for categorical variables and t tests for continuous variables. Logistic regression analysis was performed to determine preoperative predictors for complications in both groups. Results: Thirty-four thousand five hundred forty-one patients were included in our study; 501 patients underwent a component separation procedure. A higher rate of wound complications, minor/major morbidity, mortality, and return to the operating room occurred in the component separation group. However, there was no statistically significant difference in deep vein thrombosis/thrombophlebitis and pulmonary embolism rates between the 2 groups (P = 0.780 and P = 0.591, respectively). Several risk factors were significantly associated with postoperative complications in both groups. Conclusions: Component separation is used for large and complex incisional/ventral hernia repairs to achieve tension-free midline closure. Although component separation hernia repair is associated with higher incidence of wound complication, morbidity, and mortality, perhaps because of the complexity of the defects, it does not seem to be associated with increased VTE rates.
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Nasirov MI, Dzhamalova TP, Dzhamalov FG, Akhundov IT, Guseĭnov SG, Sharifov ÉI. [Analysis of remote results of simultaneous hernioalloplasty and abdominoplasty in patients with postoperative ventral hernias and obesity]. Khirurgiia (Mosk) 2015:70-74. [PMID: 26031823 DOI: 10.17116/hirurgia2015270-74] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
It was performed a comparative research of remote results including local status and life quality of simultaneous surgical treatment in 64 patients with postoperative ventral hernias (W1-W4) and obesity (1-3 degrees). It was compared advanced hernioalloplasty with new synthetic materials including Prolene-Monocryl-composite mesh and absorbable adhesion barrier INTERCEED (TC7) in combination with abdominoplasty and hernioalloplasty with the same materials. It was concluded that simultaneous hernioalloplasty and abdominoplasty contributed statistically significant (p < 0.01) decreasing of number of recurrent hernias in 2 times, body mass index and body mass on 24% in comparison with single alloplasty.
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Affiliation(s)
- M Ia Nasirov
- Kafedra khirurgicheskikh bolezneĭ Azerbaĭdzhanskogo meditsinskogo universiteta, Baku
| | - T P Dzhamalova
- Kafedra khirurgicheskikh bolezneĭ Azerbaĭdzhanskogo meditsinskogo universiteta, Baku
| | - F G Dzhamalov
- Kafedra khirurgicheskikh bolezneĭ Azerbaĭdzhanskogo meditsinskogo universiteta, Baku
| | - I T Akhundov
- Kafedra khirurgicheskikh bolezneĭ Azerbaĭdzhanskogo meditsinskogo universiteta, Baku
| | - Sh G Guseĭnov
- Kafedra khirurgicheskikh bolezneĭ Azerbaĭdzhanskogo meditsinskogo universiteta, Baku
| | - É Ia Sharifov
- Kafedra khirurgicheskikh bolezneĭ Azerbaĭdzhanskogo meditsinskogo universiteta, Baku
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Chávez-Tostado KV, Cárdenas-Lailson LE, Pérez-Trigos H. Resultado de la aplicación preoperatoria de toxina botulínica A en el tratamiento de hernias incisionales gigantes. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.rehah.2014.06.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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17
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Sorour MA. Interposition of the omentum and/or the peritoneum in the emergency repair of large ventral hernias with polypropylene mesh. Int J Surg 2014; 12:578-86. [DOI: 10.1016/j.ijsu.2014.04.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 04/12/2014] [Accepted: 04/27/2014] [Indexed: 11/30/2022]
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18
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Nelson JA, Fischer JP, Cleveland EC, Wink JD, Serletti JM, Kovach SJ. Abdominal wall reconstruction in the obese: an assessment of complications from the National Surgical Quality Improvement Program datasets. Am J Surg 2014; 207:467-75. [PMID: 24507860 DOI: 10.1016/j.amjsurg.2013.08.047] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 07/26/2013] [Accepted: 08/01/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study utilizes the American College of Surgeons National Surgical Quality Improvement Program database to better understand the impact of obesity on perioperative surgical morbidity in abdominal wall reconstruction (AWR). METHODS We reviewed the 2005 to 2010 American College of Surgeons National Surgical Quality Improvement Program databases, identifying cases of AWR and examining early complications in the context of obesity (body mass index > 30, World Health Organization classes 1 to 3). RESULTS Of 1,695 patients undergoing AWR, 1,078 (63.2%) patients were obese (mean body mass index = 37.6 kg/m(2)). Major surgical complications (15.3% vs 10.1%, P = .003), wound complications (12.5% vs 8.1%, P = .006), medical complications (16.2% vs 11.2%, P = .005) and return to the operating room (9.1% vs 5.4%, P = .006) were significantly increased, while renal complications (1.9% vs .8%, P = .09) neared significance. On logistic regression, obesity only directly led to a significantly increased odds of having a renal complication (odds ratio = 4.4, P = .04). Complications were still noted to increase with World Health Organization classification, including a concerning incidence of venous thromboembolism. CONCLUSIONS Although the incidence of complications increased with obesity, obesity itself does not appear to increase the odds of perioperative morbidity. Specific care should be given to VTE prophylaxis and to preventing renal complications.
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Affiliation(s)
- Jonas A Nelson
- Division of Plastic Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
| | - John P Fischer
- Division of Plastic Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Emily C Cleveland
- Division of Plastic Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Jason D Wink
- Division of Plastic Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Joseph M Serletti
- Division of Plastic Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Stephen J Kovach
- Division of Plastic Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
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Eastern Association for the Surgery of Trauma: management of the open abdomen, part III-review of abdominal wall reconstruction. J Trauma Acute Care Surg 2013; 75:376-86. [PMID: 23928736 DOI: 10.1097/ta.0b013e318294bee3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Hasbahceci M, Basak F. Interposition of the hernia sac as a protective layer in repair of giant incisional hernia with polypropylene mesh. Surg Today 2013; 44:227-32. [DOI: 10.1007/s00595-013-0595-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 11/04/2012] [Indexed: 11/29/2022]
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22
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Predicting Severe Postoperative Respiratory Complications following Abdominal Wall Reconstruction. Plast Reconstr Surg 2012; 130:836-841. [DOI: 10.1097/prs.0b013e318262f160] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hillenbrand A, Henne-Bruns D, Wolf AM. Panniculus, giant hernias and surgical problems in patients with morbid obesity. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2012; 1:Doc05. [PMID: 26504689 PMCID: PMC4582477 DOI: 10.3205/iprs000005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Prevalence of morbid obesity is rising. Along with it, the adipose associated co-morbidities increase - included panniculus morbidus, the end stage of obesity of the abdominal wall. In the course of time panniculus often develop a herniation of bowel. An incarcerated hernia and acute exacerbation of a chronic inflammation of the panniculus must be treated immediately and presents a surgical challenge. The resection of such massive abdominal panniculus presents several technical problems to the surgeon. Preparation of long standing or fixed hernias may require demanding adhesiolysis. The wound created is huge and difficult to manage, and accompanied by considerable complications at the outset. We provide a comprehensive overview of a possible approach for panniculectomy and hernia repair and overlook of the existing literature.
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Affiliation(s)
- Andreas Hillenbrand
- Universitätsklinikum Ulm, Klinik für Allgemein-, Viszeral- u. Transplantationschirurgie, Ulm, Germany,*To whom correspondence should be addressed: Andreas Hillenbrand, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Ulm, Steinhövelstr. 9, 89073 Ulm, Germany, E-mail:
| | - Doris Henne-Bruns
- Universitätsklinikum Ulm, Klinik für Allgemein-, Viszeral- u. Transplantationschirurgie, Ulm, Germany
| | - Anna M. Wolf
- Universitätsklinikum Ulm, Klinik für Allgemein-, Viszeral- u. Transplantationschirurgie, Ulm, Germany
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Sabbagh C, Dumont F, Fuks D, Yzet T, Verhaeghe P, Regimbeau JM. Progressive preoperative pneumoperitoneum preparation (the Goni Moreno protocol) prior to large incisional hernia surgery: volumetric, respiratory and clinical impacts. A prospective study. Hernia 2011; 16:33-40. [PMID: 21773758 DOI: 10.1007/s10029-011-0849-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Accepted: 06/24/2011] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Progressive preoperative pneumoperitoneum (PPP) is used to prepare incisional hernias with loss of domain (IHLD) operations. The aim of the present study was to analyze the effect of PPP on peritoneal volume [measured using a new computed tomography (CT)-based method] and respiratory function. METHODS From July 2004 to July 2008, 19 patients were included in a prospective, observational study. The volumes of the incisional hernia (VIH), the abdominal cavity (VAC), the total peritoneal content (VP) and the VIH/VP ratio were measured before and after PPP using abdominal CT scan data. Spirometric parameters were measured before and after PPP, and postoperative clinical data were evaluated. RESULTS Before and after PPP, the mean VIH was 1,420 cc and 2,110 cc (P < 0.01), and the mean VAC was 9,083 cc and 11,104 cc (P < 0.01). The VAC increased by 2,021 cc (P < 0.01) and was greater than the mean VIH before PPP. After PPP, the spirometric measurements revealed a restrictive syndrome. The overall postoperative morbidity rate was 37%. CONCLUSIONS PPP increased the hernia and abdominal volumes. PPP induced a progressive, restrictive syndrome.
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Affiliation(s)
- C Sabbagh
- Department of Digestive Surgery, Amiens University Medical Center, Place Victor Pauchet, 80054 Amiens Cedex 01, France
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Peritoneal volume is predictive of tension-free fascia closure of large incisional hernias with loss of domain: a prospective study. Hernia 2011; 15:559-65. [PMID: 21584816 DOI: 10.1007/s10029-011-0832-y] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 04/29/2011] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The surgical treatment of large incisional hernias with loss of domain (LIHLD) carries the risk of fascia closure under tension and, thus, abdominal compartment syndrome. We investigated volume measurements as a predictive factor for tension-free fascia closure. PATIENTS AND METHODS From September 2004 to July 2008, we prospectively included 17 patients with LIHLD. The operation was prepared by a progressive preoperative pneumoperitoneum (PPP) technique known as the Goni Moreno procedure. The patient's age and body mass index (BMI), the incisional hernia's width, length and surface area, and the incisional hernia volume (IHV)/peritoneal volume (PV) ratio <20% were evaluated as predictive factors for tension-free fascia closure. A tension-free closure was defined as a closure in which the use of a surgical device for avoiding postoperative compartment syndrome was not required. RESULTS The mean PPP volume introduced was 12.7 ± 4.4 l (range 4.5-19.2) over a period of 11 ± 6 days (range 4-24). The mean width, height and surface area of the incisional hernia after PPP were 11.3 ± 4.7 cm (range 4.5-19), 13.4 ± 7.8 cm (range 4.4-30) and 165 ± 101 cm(2) (range 19-304), respectively. The mean IHV after PPP was 2,374 ± 1,356 cc (range 517-4,802) and the mean abdominal cavity volume was 9,558 ± 4,106 cc (range 4,785-21,782). The mean IHV/PV ratio was 16.3 ± 10.4% (range 4.4-34). In a univariate analysis, the BMI and the IHV/PV ratio were predictive of tension-free fascia closure. In a multivariate analysis, only an IHV/PV ratio <20% was a significant predictive factor. CONCLUSIONS The IHV/PV ratio is predictive of tension-free fascia closure for hernias or incisional hernias with loss of domain. Simplification of the volumetry method is necessary.
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Prospective Measurements of Intra-Abdominal Volume and Pulmonary Function After Repair of Massive Ventral Hernias With the Components Separation Technique. Ann Surg 2010; 251:981-8. [DOI: 10.1097/sla.0b013e3181d7707b] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Massive paraumbilical hernia: not all is as it seems. Hernia 2010; 15:333-7. [DOI: 10.1007/s10029-010-0645-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Accepted: 02/15/2010] [Indexed: 11/26/2022]
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Repair of complex incisional hernias using double prosthetic repair: single-surgeon experience with 50 cases. Surgery 2010; 148:140-4. [PMID: 20138324 DOI: 10.1016/j.surg.2009.12.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2009] [Accepted: 12/24/2009] [Indexed: 11/23/2022]
Abstract
BACKGROUND The treatment of complex incisional hernias is still difficult and controversial. With technologic developments we can modify and update the operative techniques described for treating complex abdominal wall hernias. METHODS This is a prospective study of 50 patients with complex incisional hernias undergoing complex abdominal wall herniorrhaphy at a university hospital. All patients were evaluated in a multidisciplinary clinic dedicated to abdominal wall reconstruction. All patients underwent pre-operative computed tomography. Complex incisional hernias were regarded as those with multiple recurrences (>3 times), a previous mesh complicated by fistula and chronic infection, giant diffuse lumbar hernias, an associated parastomal hernia, or hernias developing after bariatric surgery. The operative technique was a double reconstruction prosthetic mesh. The type of repair as well as clinical, operative, and follow-up data were analyzed. RESULTS Eight patients had considerable loss of tissue, 5 had trophic skin lesions, and 2 had chronic suppurative infection. The mean size of the defects was 18.2 cm. Morbidity included 5 cases of seroma, 2 neuralgias, and 2 cutaneous necroses. The mean duration of hospital stay was 5 days (range, 2-9). Complete follow-up (mean, 48 months; range, 12-108) showed no recurrent hernias. CONCLUSION While awaiting a longer follow-up to confirm the results, we conclude that complex incisional hernias can be repaired safely and with a low morbidity and recurrence rate by means of a double prosthetic repair technique.
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Ammar SA. Management of giant ventral hernia by polypropylene mesh and host tissue barrier: trial of simplification. J Clin Med Res 2009; 1:226-9. [PMID: 22461873 PMCID: PMC3299185 DOI: 10.4021/jocmr2009.10.1268] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2009] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Surgical management of giant ventral hernias is a surgical challenge due to limited abdominal cavity. This study evaluates management of giant ventral hernias using polypropylene mesh and host tissue barrier after suitable preoperative preparation. METHODS In the period from January 2005 and January 2007, 35 patients with giant ventral hernias underwent hernia repair. After careful preoperative preparation, repair was done using polypropylene mesh. The mesh was separated from the viscera by a small part of the hernia sac and the greater omentum. RESULTS The average age of the patients was 52. Twenty patients had post-operative incisional and 15 had para-umbilical hernias. The mean hernia defect size was 16.8 cm. Mean body mass index was 33. Follow up ranged from 18-36 months. No patient required ventilation after operation. Recurrent seroma, which responded to repeated aspiration, was experienced in 4 patients. Minor wound infection was observed in 5 patients. Small hernia recurrence occurred in one patient. CONCLUSION The use of polypropylene and host tissue barrier after suitable preoperative preparation is relatively simple, safe, and reliable surgical solution to the problem of giant ventral hernia. KEYWORDS Hernia repair; Giant ventral hernia; Polypropylene mesh.
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Affiliation(s)
- Samir A Ammar
- Surgery Department, Assiut University Hospitals, El Gamma Street, Assiut, Egypt.
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Challenges of giant ventral hernia repair in children in an African tertiary care center with limited resources. Hernia 2008; 13:143-7. [PMID: 18853227 DOI: 10.1007/s10029-008-0439-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2008] [Accepted: 09/19/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The objective of this study is to report the challenges and outcome of giant ventral abdominal hernia repair in infants/children in a tertiary care center in Africa. DESIGN A retrospective analysis of infants/children who had a repair of giant ventral abdominal hernia between January 1998 and December 2007 at the University of Benin Teaching Hospital (UBTH), Benin City, Nigeria, was carried out. RESULTS A total of 41 children aged between 9 months and 12 years (mean 2.6 +/- 1.8 years) comprising 25 males and 16 females with a male:female ratio of 1.6:1 had a repair of giant ventral abdominal hernias which were due to healed omphalocele in 37 (90.3%), incisional hernia in three (7.3%), and following initial skin closure of gastroschisis in one (2.4%). They had an average hernia defect of size 7.1 x 8.3 cm, which contained both solid and hollow viscera in all of the patients, along with 11 (29.7%) syndromic omphalocele. The major challenge was inadequate intraabdominal volume needed to accommodate the herniated viscera in nine children, which was compounded by the nonavailability of silastic materials, a pediatric ventilator, facilities required for intraabdominal pressure monitoring during closure, as well as undiagnosed associated cardiac anomaly. Overall, 39 (95.1%) children survived, while two (4.9%) mortalities were recorded due to postoperative aspiration in one child and cardiopulmonary failure in the other. Of those who survived, 29 (74.4%) had a smooth postoperative course, while ten (25.6%) had morbidity, with a mean hospitalization duration of 10 +/- 2.5 days. There was no recurrence recorded on follow-up for 5 years at the surgical outpatient clinic. CONCLUSION Despite the challenges, better results were achieved with repairs in infants/children compared to repairs performed in neonates.
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Staged repair of massive incisional hernias with loss of abdominal domain: a novel approach. Am J Surg 2008; 195:84-8. [DOI: 10.1016/j.amjsurg.2007.02.017] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2006] [Revised: 02/08/2007] [Accepted: 02/08/2007] [Indexed: 11/19/2022]
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Han JG, Ma SZ, Song JK, Wang ZJ. Operative treatment of ventral hernia using prosthetic materials. Hernia 2007; 11:419-23. [PMID: 17576519 DOI: 10.1007/s10029-007-0248-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2007] [Accepted: 05/07/2007] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to summarize the clinical experiences in repairing abdominal incisional hernia with prosthetic materials. METHODS Eighty-three patients with ventral hernia were analyzed retrospectively. RESULTS Two patients developed pulmonary infection, one developed adhesive ileus, and five developed wound infection. All wounds healed completely during follow-up. Seventy-three (88%) patients were free of pain, and ten patients (12%) felt pain in the operated area within the last month; only one patient required pain-relieving drugs. Twenty-nine patients (35%) felt discomfort, such as stiffness. Four cases experienced postoperative recurrence. CONCLUSIONS Incisional herniorrhaphy with prosthetic materials is safe and effective but has a high discomfort rate. Open giant incisional hernia or recurrent incisional hernia should be performed by trained surgeons. Placing mesh in a suitable position and using a patch with minimal reaction and enough tensile strength may improve the prognosis. Further studies are necessary utilizing light polypropylene mesh.
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Affiliation(s)
- J G Han
- Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Baijiazhuang Lu, Chaoyang District, Beijing 100020, China.
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Ohana G, Bramnik Z, Miller A, Seror D, Ariche A, Bachar Gil N, Belavsky R, Dreznik Z. Treatment of large incisional abdominal wall hernias, using a modified preperitoneal prosthetic mesh repair. Hernia 2006; 10:232-5. [PMID: 16453073 DOI: 10.1007/s10029-006-0070-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2005] [Accepted: 01/04/2006] [Indexed: 10/25/2022]
Abstract
Very large and complex incisional hernias, especially those with loss of abdominal wall, can be a very interesting and perplexing problem, which present a particular challenge to the surgeon. The reported technique was developed and refined by one of our surgeons, between 1998 and 1999 for the repair of incisional hernias in a selected group of patients with large defects, often with a major loss of abdominal wall, overweight and previous attempts for incisional hernia repair. The technique involves a modified preperitoneal approach and was used on 43 eligible patients between 1999 and 2002. There were 30 females and 13 males at a mean age of 61 years. The median ASA score of the group was 2, with a mean BMI of 30.4 and a mean hernia surface area of 162 cm(2). One-third of the patients had one or more previous incisional hernia repair. Mean operating time was 190 min with an average hospital stay of 5.7 days. Postoperative complications occurred in 28% of the patients, most of which were minor and did not necessitate admission to the intensive care unit. None of the patients died. Wound infections occurred in 9.3%, was associated with an increased risk for cutaneous sinus formation, but not for mesh removal or hernia recurrence. A recurrence rate of 12.5% was found after a mean follow-up period of 46 months. We advocate this procedure for the repair of large, complex incisional hernias with loss of abdominal domain in patients with significant risk factors for recurrence.
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Affiliation(s)
- G Ohana
- Division of Surgery, Hasharon Hospital, Rabin Medical Center, Petach Tikva and Sackler Faculty of Medicine Tel-Aviv University, 7 Keren Kayemet Str., Petach Tikva, Israel.
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