1
|
Cumar B, Christopher PJ, Kumar SS, Natarajan R, Ramakrishnan P, Chinnusamy P. Laparoscopic totally extraperitoneal management of giant inguinoscrotal hernia with loss of domain. J Minim Access Surg 2024:01413045-990000000-00074. [PMID: 39096001 DOI: 10.4103/jmas.jmas_98_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 05/28/2024] [Indexed: 08/04/2024] Open
Abstract
ABSTRACT A giant inguinoscrotal hernia extends below the level of the midpoint of the thigh, in an upright position. They are usually due to the neglect of the patient and fear of surgical intervention. Patients typically present with lower urinary tract symptoms, ulcers over the scrotum caused due to dribbling of urine and rarely with obstruction or strangulation. Here, we present a similar case of an uncomplicated giant inguinoscrotal hernia with a Tanaka index of 74% who was preoperatively optimised with BOTOX (BOtulinum TOXin-A) and pre-operative progressive pneumoperitoneum and was managed laparoscopically with enhanced totally extraperitoneal repair. This signifies the importance of optimisation of the patients, especially with loss of domain help in managing such cases without any resection of bowel or omentum. Moreover, this proper pre-operative optimisation also helped us in managing such a case laparoscopically.
Collapse
Affiliation(s)
- Bharath Cumar
- Department of Upper GI Surgery, Gem Hospital and Research Institute, Coimbatore, Tamil Nadu, India
| | - Pradeep Joshua Christopher
- Department of Surgical Gastroenterology and Bariatric Surgery, Gem Hospital and Research Institute, Coimbatore, Tamil Nadu, India
| | - S Saravana Kumar
- Department of Upper GI Surgery and Bariatric Surgery, Gem Hospital and Research Institute, Coimbatore, Tamil Nadu, India
| | - Ramesh Natarajan
- Department of Upper GI Surgery, Gem Hospital and Research Institute, Coimbatore, Tamil Nadu, India
| | | | | |
Collapse
|
2
|
de Jong DLC, Wegdam JA, Van der Wolk S, Nienhuijs SW, de Vries Reilingh TS. Prevention of component separation in complex abdominal wall surgery by Botox prehabilitation: a propensity-matched study. Hernia 2024; 28:815-821. [PMID: 38172376 DOI: 10.1007/s10029-023-02929-2] [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: 08/10/2023] [Accepted: 11/05/2023] [Indexed: 01/05/2024]
Abstract
AIM To facilitate midline fascial closure in complex abdominal wall surgery, component separation techniques (CST) are usually required. However, CST is associated with an enlarged morbidity. Prehabilitation could increase the compliance of the abdominal wall and thereby decrease the necessity of myofascial release. This can be accomplished by administration of botulinum toxin type A (BTA) in the lateral abdominal wall musculature. The aim of this study was to determine the effect of BTA on the subsequent necessity to perform CST in patients with complex abdominal wall hernias. METHODS Patients with a complex abdominal wall hernia, planned to undergo CST between July 2020 and November 2022 were included. Outcome of procedures with 300U of BTA 4 (2-6) weeks prior to surgery, were retrospectively analyzed by comparison with propensity matched subjects of an historical group. Hernia width difference was assessed by CT and operative details were included. RESULTS A total of 13 patients with a median hernia width of 12 cm (IQR 9-14, range 24) were prehabilitated with BTA between July 2020 and November 2022. A CST was planned for all, however not required in 6/13 patients (46%) to accomplish midline fascial closure. A mean elongation of lateral abdominal wall musculature of 4.01 cm was seen in patients not requiring CST. Compared to the propensity score matched control group, a 27% reduction (p = 0.08) in the need for CST was observed. CONCLUSION There is a tendency for decrease of necessity for CST by preoperatively administered BTA in patients with complex abdominal wall defects. Although small, as this study used propensity matched comparison, further exploration of BTA should be encouraged.
Collapse
Affiliation(s)
| | - J A Wegdam
- Elkerliek Ziekenhuis, Helmond, The Netherlands
| | | | | | | |
Collapse
|
3
|
Parker SG, Joyner J, Thomas R, Van Dellen J, Mohamed S, Jakkalasaibaba R, Blake H, Shanmuganandan A, Albadry W, Panascia J, Gray W, Vig S. A Ventral Hernia Management Pathway; A "Getting It Right First Time" approach to Complex Abdominal Wall Reconstruction. Am Surg 2024; 90:1714-1726. [PMID: 38584505 DOI: 10.1177/00031348241241650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
INTRODUCTION Abdominal wall reconstruction (AWR) is an emerging specialty, involving complex multi-stage operations in patients with high medical and surgical risk. At our hospital, we have developed a growing interest in AWR, with a commitment to improving outcomes through a regular complex hernia MDT. An MDT approach to these patients is increasingly recognized as the path forward in management to optimize patients and improve outcomes. METHODS We conducted a literature review and combined this with our experiential knowledge of managing these cases to create a pathway for the management of our abdominal wall patients. This was done under the auspices of GIRFT (Getting It Right First Time) as a quality improvement project at our hospital. RESULTS We describe, in detail, our current AWR pathway, including the checklists and information documents we use with a stepwise evidence and experience-based approach to identifying the multiple factors associated with good outcomes. We explore the current literature and discuss our best practice pathway. CONCLUSION In this emerging specialty, there is limited guidance on the management of these patients. Our pathway, the "Complex Hernia Bundle," currently provides guidance for our abdominal wall team and may well be one that could be adopted/adapted by other centers where challenging hernia cases are undertaken.
Collapse
Affiliation(s)
- Samuel G Parker
- The Abdominal Wall Unit, Croydon University Hospital, Thornton Heath, London, UK
| | - James Joyner
- The Abdominal Wall Unit, Croydon University Hospital, Thornton Heath, London, UK
| | - Rhys Thomas
- The Abdominal Wall Unit, Croydon University Hospital, Thornton Heath, London, UK
| | - Jonathan Van Dellen
- The Abdominal Wall Unit, Croydon University Hospital, Thornton Heath, London, UK
| | - Said Mohamed
- The Abdominal Wall Unit, Croydon University Hospital, Thornton Heath, London, UK
| | | | - Helena Blake
- The Abdominal Wall Unit, Croydon University Hospital, Thornton Heath, London, UK
| | - Arun Shanmuganandan
- The Abdominal Wall Unit, Croydon University Hospital, Thornton Heath, London, UK
| | - Waleed Albadry
- Plastics Surgery Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Julia Panascia
- The Abdominal Wall Unit, Croydon University Hospital, Thornton Heath, London, UK
| | - William Gray
- The Abdominal Wall Unit, Croydon University Hospital, Thornton Heath, London, UK
| | - Stella Vig
- The Abdominal Wall Unit, Croydon University Hospital, Thornton Heath, London, UK
| |
Collapse
|
4
|
Van Hoef S, Dries P, Allaeys M, Eker HH, Berrevoet F. Intra-abdominal hypertension and compartment syndrome after complex hernia repair. Hernia 2024; 28:701-709. [PMID: 38568348 DOI: 10.1007/s10029-024-02992-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/10/2024] [Indexed: 07/16/2024]
Abstract
PURPOSE Abdominal compartment syndrome (ACS) is a well-known concept after trauma surgery or after major abdominal surgery in critically ill patients. However, ACS as a complication after complex hernia repair is considered rare and supporting literature is scarce. As complexity in abdominal wall repair increases, with the introduction of new tools and advanced techniques, ACS incidence might rise and should be carefully considered when dealing with complex abdominal wall hernias. In this narrative review, a summary of the current literature will highlight several key features in the diagnosis and management of ACS in complex abdominal wall repair and discuss several treatment options during the different steps of complex AWR. METHODS We performed a literature search across PubMed using the search terms: "Abdominal Compartment syndrome," "Intra-abdominal pressure," "Complex abdominal hernia," and "Ventral hernia." Articles corresponding to these search terms were individually reviewed by primary author and selected on relevance. CONCLUSION Intra-abdominal hypertension (IAH) and ACS require imperative attention and should be carefully considered when dealing with complex abdominal wall hernias, even without significant loss of domain. Development of a true abdominal compartment syndrome is relatively rare, but is a devastating complication and should be prevented at all cost. Current evidence on surgical treatment of ACS after hernia repair is scarce, but conservative management might be an option in the early phase and low grades of IAH. However, life-saving treatment by relaparotomy and open abdomen management should be initiated when ACS starts setting in.
Collapse
Affiliation(s)
- S Van Hoef
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium.
| | - P Dries
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - M Allaeys
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - H H Eker
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - F Berrevoet
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
5
|
Toma M, Oprea V, Grad O, Staines H, Bucuri CE, Andercou O, Gherghinescu M, Molnar C. Early outcomes of open anterior versus posterior components separation with transversus abdominis release for large median incisional hernias: a retrospective stepwise analysis. Hernia 2024; 28:803-813. [PMID: 37975991 DOI: 10.1007/s10029-023-02920-x] [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: 08/15/2023] [Accepted: 10/22/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Complex incisional hernia is still a debatable topic, with increasing incidence and an increased local and systemic postoperative morbidity and mortality. The size of the defect is a risk factor for both difficult closure and 30-day readmission due to complications. The main option for closure such defect is a mesh augmented component separation technique. The goal was to evaluate 30-day wound events and general complications including 90 days mortality. MATERIAL AND METHODS We present a retrospective study that includes patients from two different university hospitals who underwent open incisional hernia repair with anterior component or posterior component separation between January 2015 and December 2021. Only non-contaminated adult patients (over 18 years old) with postoperative primary or recurrent median abdominal wall defects larger than 6 cm and with complete fascial closure were included. Demographics (age, gender, Body Mass Index-BMI, American Society of Anesthesiologists Classification-ASA score), recurrence rank, and co-morbidities), operative details, patient outcomes complications were collected. A native abdomen/pelvis computerized tomography (CT) scan was performed preoperatively in all patients and the anatomy of the defect and volumetry (abdominal cavity volume, incisional hernia volume and peritoneal volume) were evaluated. One of the component separation technique was performed according to Carbonell's equation. RESULTS Two hundred and two patients (101 from each group) were included. The patients with posterior component separation were more comorbid and with larger defects. The procedure was longer with 80 min but overall length of hospital stay shorter (p < 0.001) for posterior component separation. Seroma, hematoma and skin necrosis were equally distributed for both group of patients and there was no direct relation to surgery (OR 0.887, 95% CI 0.370-2.125, p = 0.788; OR 1.50, 95% CI 0.677-3.33, p = 0.318 and OR 0.386, 95% CI 0.117-1.276, p = 0.119). Surgical Site Infection rate was increased for anterior component separation (p =0.004). CONCLUSION Complex incisional hernia repair is a challenge given by a large amount of wound complications. Choosing between anterior and posterior component separation is still a source of significant debate. We were not able to depict significant different rates of complications between the procedures and we couldn't find any specific factor related to complications.
Collapse
Affiliation(s)
- Mihai Toma
- Clinical Department of Surgery, "Constantin Papilian" Emergency Clinical Military Hospital, Cluj-Napoca, 22 G-ral Traian Mosoiu, Cluj-Napoca-Napoca, Romania
- "George Emil Palade" University of Medicine, Pharmacy, Science and Technology, Targu-Mures, Romania
| | - Valentin Oprea
- Clinical Department of Surgery, "Constantin Papilian" Emergency Clinical Military Hospital, Cluj-Napoca, 22 G-ral Traian Mosoiu, Cluj-Napoca-Napoca, Romania.
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca-Napoca, Romania.
| | - Ovidiu Grad
- Clinical Department of Surgery, "Constantin Papilian" Emergency Clinical Military Hospital, Cluj-Napoca, 22 G-ral Traian Mosoiu, Cluj-Napoca-Napoca, Romania
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca-Napoca, Romania
| | | | - Carmen E Bucuri
- Clinical Department of Surgery, "Constantin Papilian" Emergency Clinical Military Hospital, Cluj-Napoca, 22 G-ral Traian Mosoiu, Cluj-Napoca-Napoca, Romania
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca-Napoca, Romania
| | - Octavian Andercou
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca-Napoca, Romania
- Second Clinical Department of Surgery, Emergency Clinical County Hospital, Cluj-Napoca-Napoca, Romania
| | - Mircea Gherghinescu
- "George Emil Palade" University of Medicine, Pharmacy, Science and Technology, Targu-Mures, Romania
- First Clinical Department of Surgery, Emergency Clinical County Hospital, Targu-Mures, Romania
| | - Calin Molnar
- "George Emil Palade" University of Medicine, Pharmacy, Science and Technology, Targu-Mures, Romania
- First Clinical Department of Surgery, Emergency Clinical County Hospital, Targu-Mures, Romania
| |
Collapse
|
6
|
Barbosa CDEA, Faria MHSDE, Messias BA. Predictive factors for complexity in abdominal wall hernias: a literature scope review. Rev Col Bras Cir 2024; 51:e20243670. [PMID: 38716916 PMCID: PMC11185061 DOI: 10.1590/0100-6991e-20243670-en] [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: 10/11/2023] [Accepted: 01/26/2024] [Indexed: 06/20/2024] Open
Abstract
INTRODUCTION Abdominal wall hernias encompass both ventral and incisional hernias, often poorly classified regarding complexity in general. This study aims to conduct a review on the primary topics related to defining the complexity of ventral hernias. METHODS this is a scope review conducted following the guidelines recommended by the PRISMA-ScR directive. Searches were carried out in electronic databases including PubMed, LILACS, and EMBASE, using the descriptors: Abdominal Hernia, Hernia, Ventral Hernia, Incisional Hernia, Complex, Classification, Classify, Grade, Scale, and Definition. Combinations of these terms were employed when appropriate. Inclusion criteria encompassed articles with definitions and classifications of complex hernias, as well as those utilizing these classifications to guide treatments and patient allocation. Synonyms and related topics were also considered. Articles outside the scope or lacking the themes in their title or abstract were excluded. The database search was conducted up to July 29, 2023. RESULTS several hernia classifications were identified as useful in predicting complexity. For this study, we considered six main criteria: size and location, loss of domain, use of abdominal wall relaxation techniques, characteristics of imaging exams, status of the subcutaneous cellular tissue, and likelihood of recurrence. CONCLUSION complex abdominal wall hernias can be defined by characteristics analyzed collectively, relating to the patients previous clinical status, size and location of the hernia defect, status of subcutaneous cellular tissue, myofascial release techniques, and other complicating factors.
Collapse
Affiliation(s)
- Cirênio DE Almeida Barbosa
- - UFOP (Universidade Federal de Ouro Preto), Departamento de Cirurgia, Ginecologia, Obstetrícia e Propedêutica da Escola de Medicina. - Ouro Preto - MG - Brasil
| | | | | |
Collapse
|
7
|
Mirnezami AH, Drami I, Glyn T, Sutton PA, Tiernan J, Behrenbruch C, Guerra G, Waters PS, Woodward N, Applin S, Charles SJ, Rose SA, Denys A, Pape E, van Ramshorst GH, Baker D, Bignall E, Blair I, Davis P, Edwards T, Jackson K, Leendertse PG, Love-Mott E, MacKenzie L, Martens F, Meredith D, Nettleton SE, Trotman MP, van Hecke JJM, Weemaes AMJ, Abecasis N, Angenete E, Aziz O, Bacalbasa N, Barton D, Baseckas G, Beggs A, Brown K, Buchwald P, Burling D, Burns E, Caycedo-Marulanda A, Chang GJ, Coyne PE, Croner RS, Daniels IR, Denost QD, Drozdov E, Eglinton T, Espín-Basany E, Evans MD, Flatmark K, Folkesson J, Frizelle FA, Gallego MA, Gil-Moreno A, Goffredo P, Griffiths B, Gwenaël F, Harris DA, Iversen LH, Kandaswamy GV, Kazi M, Kelly ME, Kokelaar R, Kusters M, Langheinrich MC, Larach T, Lydrup ML, Lyons A, Mann C, McDermott FD, Monson JRT, Neeff H, Negoi I, Ng JL, Nicolaou M, Palmer G, Parnaby C, Pellino G, Peterson AC, Quyn A, Rogers A, Rothbarth J, Abu Saadeh F, Saklani A, Sammour T, Sayyed R, Smart NJ, Smith T, Sorrentino L, Steele SR, Stitzenberg K, Taylor C, Teras J, Thanapal MR, Thorgersen E, Vasquez-Jimenez W, Waller J, Weber K, Wolthuis A, Winter DC, Brangan G, Vimalachandran D, Aalbers AGJ, Abdul Aziz N, Abraham-Nordling M, Akiyoshi T, Alahmadi R, Alberda W, Albert M, Andric M, Angeles M, Antoniou A, Armitage J, Auer R, Austin KK, Aytac E, Baker RP, Bali M, Baransi S, Bebington B, Bedford M, Bednarski BK, Beets GL, Berg PL, Bergzoll C, Biondo S, Boyle K, Bordeianou L, Brecelj E, Bremers AB, Brunner M, Bui A, Burgess A, Burger JWA, Campain N, Carvalhal S, Castro L, Ceelen W, Chan KKL, Chew MH, Chok AK, Chong P, Christensen HK, Clouston H, Collins D, Colquhoun AJ, Constantinides J, Corr A, Coscia M, Cosimelli M, Cotsoglou C, Damjanovic L, Davies M, Davies RJ, Delaney CP, de Wilt JHW, Deutsch C, Dietz D, Domingo S, Dozois EJ, Duff M, Egger E, Enrique-Navascues JM, Espín-Basany E, Eyjólfsdóttir B, Fahy M, Fearnhead NS, Fichtner-Feigl S, Fleming F, Flor B, Foskett K, Funder J, García-Granero E, García-Sabrido JL, Gargiulo M, Gava VG, Gentilini L, George ML, George V, Georgiou P, Ghosh A, Ghouti L, Giner F, Ginther N, Glover T, Golda T, Gomez CM, Harris C, Hagemans JAW, Hanchanale V, Harji DP, Helbren C, Helewa RM, Hellawell G, Heriot AG, Hochman D, Hohenberger W, Holm T, Holmström A, Hompes R, Hornung B, Hurton S, Hyun E, Ito M, Jenkins JT, Jourand K, Kaffenberger S, Kapur S, Kanemitsu Y, Kaufman M, Kelley SR, Keller DS, Kersting S, Ketelaers SHJ, Khan MS, Khaw J, Kim H, Kim HJ, Kiran R, Koh CE, Kok NFM, Kontovounisios C, Kose F, Koutra M, Kraft M, Kristensen HØ, Kumar S, Lago V, Lakkis Z, Lampe B, Larsen SG, Larson DW, Law WL, Laurberg S, Lee PJ, Limbert M, Loria A, Lynch AC, Mackintosh M, Mantyh C, Mathis KL, Margues CFS, Martinez A, Martling A, Meijerink WJHJ, Merchea A, Merkel S, Mehta AM, McArthur DR, McCormick JJ, McGrath JS, McPhee A, Maciel J, Malde S, Manfredelli S, Mikalauskas S, Modest D, Morton JR, Mullaney TG, Navarro AS, Neto JWM, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, Nordkamp S, O’Dwyer ST, Paarnio K, Pappou E, Park J, Patsouras D, Peacock O, Pfeffer F, Piqeur F, Pinson J, Poggioli G, Proud D, Quinn M, Oliver A, Radwan RW, Rajendran N, Rao C, Rasheed S, Rasmussen PC, Rausa E, Regenbogen SE, Reims HM, Renehan A, Rintala J, Rocha R, Rochester M, Rohila J, Rottoli M, Roxburgh C, Rutten HJT, Safar B, Sagar PM, Sahai A, Schizas AMP, Schwarzkopf E, Scripcariu D, Scripcariu V, Seifert G, Selvasekar C, Shaban M, Shaikh I, Shida D, Simpson A, Skeie-Jensen T, Smart P, Smith JJ, Solbakken AM, Solomon MJ, Sørensen MM, Spasojevic M, Steffens D, Stocchi L, Stylianides NA, Swartling T, Sumrien H, Swartking T, Takala H, Tan EJ, Taylor D, Tejedor P, Tekin A, Tekkis PP, Thaysen HV, Thurairaja R, Toh EL, Tsarkov P, Tolenaar J, Tsukada Y, Tsukamoto S, Tuech JJ, Turner G, Turner WH, Tuynman JB, Valente M, van Rees J, van Zoggel D, Vásquez-Jiménez W, Verhoef C, Vierimaa M, Vizzielli G, Voogt ELK, Uehara K, Wakeman C, Warrier S, Wasmuth HH, Weiser MR, Westney OL, Wheeler JMD, Wild J, Wilson M, Yano H, Yip B, Yip J, Yoo RN, Zappa MA. The empty pelvis syndrome: a core data set from the PelvEx collaborative. Br J Surg 2024; 111:znae042. [PMID: 38456677 PMCID: PMC10921833 DOI: 10.1093/bjs/znae042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/15/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Empty pelvis syndrome (EPS) is a significant source of morbidity following pelvic exenteration (PE), but is undefined. EPS outcome reporting and descriptors of radicality of PE are inconsistent; therefore, the best approaches for prevention are unknown. To facilitate future research into EPS, the aim of this study is to define a measurable core outcome set, core descriptor set and written definition for EPS. Consensus on strategies to mitigate EPS was also explored. METHOD Three-stage consensus methodology was used: longlisting with systematic review, healthcare professional event, patient engagement, and Delphi-piloting; shortlisting with two rounds of modified Delphi; and a confirmatory stage using a modified nominal group technique. This included a selection of measurement instruments, and iterative generation of a written EPS definition. RESULTS One hundred and three and 119 participants took part in the modified Delphi and consensus meetings, respectively. This encompassed international patient and healthcare professional representation with multidisciplinary input. Seventy statements were longlisted, seven core outcomes (bowel obstruction, enteroperineal fistula, chronic perineal sinus, infected pelvic collection, bowel obstruction, morbidity from reconstruction, re-intervention, and quality of life), and four core descriptors (magnitude of surgery, radiotherapy-induced damage, methods of reconstruction, and changes in volume of pelvic dead space) reached consensus-where applicable, measurement of these outcomes and descriptors was defined. A written definition for EPS was agreed. CONCLUSIONS EPS is an area of unmet research and clinical need. This study provides an agreed definition and core data set for EPS to facilitate further research.
Collapse
|
8
|
Amaral PHF, Macret JZ, Dias ERM, Carvalho JPV, Pivetta LGA, Ribeiro HB, Franciss MY, Silva RA, Malheiros CA, Roll S. Volumetry after botulinum toxin A: the impact on abdominal wall compliance and endotracheal pressure. Hernia 2024; 28:53-61. [PMID: 37563426 DOI: 10.1007/s10029-023-02848-2] [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: 03/23/2023] [Accepted: 07/23/2023] [Indexed: 08/12/2023]
Abstract
PURPOSE Botulinum toxin type A (BTA) is an adjuvant tool used in the preoperative optimization of complex hernias before abdominal wall reconstruction (AWR). This study aims to investigate changes in the abdominal cavity and hernia sac dimensions after BTA application. METHOD A prospective study with 27 patients with a hernia defect of ≥ 10 cm and loss of domain (LOD) ≥ 20% underwent AWR. Computed tomography (CT) measurements and volumetry before and after the application of BTA were performed. Intraoperative and postoperative outcomes were evaluated. RESULTS Imaging post-BTA revealed hernia width reduction of 1.9 cm (p = 0.002), lateral abdominal wall muscle elongation of 3.1 cm (p < 0.001), hernia volume reduction (HV) from 2.9 ± 0.9L to 2.4 ± 0.8L (p < 0.001), increase in abdominal cavity volume (ACV) from 9.7 ± 2.5L to 10.3L ± 2.4L (p = 0.003), and a reduction in the HV/ACV ratio from 30.2 ± 5% to 23.4 ± 6% (p < 0.001). Fascial closure was achieved in 92.6% of cases and component separation was required in 78%. The average variation in pulmonary plateau pressure was 3.53 cmH2O, and there were no postoperative respiratory failure recorded. At the 90-day follow-up, the wound morbidity rate was 25%, unplanned readmissions were 11%, and hernia recurrence 7.4%. CONCLUSION BTA produces measurable volumetric changes in abdominal wall and appears to facilitate fascial closure. Further studies are required to determine the role of BTA in the surgical armamentarium for complex hernia repair.
Collapse
Affiliation(s)
- P H F Amaral
- Santa Casa de Sao Paulo - Abdominal Wall Surgery Unit, Rua Cesário Mota Júnior, 112 - Vila Buarque, São Paulo, SP, Brazil.
- Hospital Alemão Oswaldo Cruz, Hernia Center, São Paulo, SP, Brazil.
| | - J Z Macret
- Santa Casa de Sao Paulo - Abdominal Wall Surgery Unit, Rua Cesário Mota Júnior, 112 - Vila Buarque, São Paulo, SP, Brazil
- Hospital Alemão Oswaldo Cruz, Hernia Center, São Paulo, SP, Brazil
| | - E R M Dias
- Santa Casa de Sao Paulo - Abdominal Wall Surgery Unit, Rua Cesário Mota Júnior, 112 - Vila Buarque, São Paulo, SP, Brazil
- Hospital Alemão Oswaldo Cruz, Hernia Center, São Paulo, SP, Brazil
| | - J P V Carvalho
- Santa Casa de Sao Paulo - Abdominal Wall Surgery Unit, Rua Cesário Mota Júnior, 112 - Vila Buarque, São Paulo, SP, Brazil
- Hospital Alemão Oswaldo Cruz, Hernia Center, São Paulo, SP, Brazil
| | - L G A Pivetta
- Santa Casa de Sao Paulo - Abdominal Wall Surgery Unit, Rua Cesário Mota Júnior, 112 - Vila Buarque, São Paulo, SP, Brazil
- Hospital Alemão Oswaldo Cruz, Hernia Center, São Paulo, SP, Brazil
| | - H B Ribeiro
- Santa Casa de Sao Paulo - Abdominal Wall Surgery Unit, Rua Cesário Mota Júnior, 112 - Vila Buarque, São Paulo, SP, Brazil
| | - M Y Franciss
- Santa Casa de Sao Paulo - Abdominal Wall Surgery Unit, Rua Cesário Mota Júnior, 112 - Vila Buarque, São Paulo, SP, Brazil
| | - R A Silva
- Santa Casa de Sao Paulo - Abdominal Wall Surgery Unit, Rua Cesário Mota Júnior, 112 - Vila Buarque, São Paulo, SP, Brazil
| | - C A Malheiros
- Santa Casa de Sao Paulo - Abdominal Wall Surgery Unit, Rua Cesário Mota Júnior, 112 - Vila Buarque, São Paulo, SP, Brazil
| | - S Roll
- Santa Casa de Sao Paulo - Abdominal Wall Surgery Unit, Rua Cesário Mota Júnior, 112 - Vila Buarque, São Paulo, SP, Brazil
- Hospital Alemão Oswaldo Cruz, Hernia Center, São Paulo, SP, Brazil
| |
Collapse
|
9
|
Capoccia Giovannini S, Podda M, Ribas S, Montori G, Botteri E, Agresta F, Sartori A, Chàrvàtova H, Aiolfi A, Antoniou SA, Arvieux C, Berrevoet F, Boermeester MA, Campanelli G, Chintapatla S, Christoffersen MW, Dahlstrand U, De la Croix H, Dietz UA, Ferreira A, Fortenly RH, Gaarder C, Garcia Urena MA, Gok H, Hernández-Granados P, Jisova B, Laver O, Lerchuk O, Lopez-Cano M, Mega M, Mitura K, Muysoms F, Oliva A, Ortenzi M, Petersson U, Piccoli M, Radu VG, Renard Y, Rogmark P, Rosin D, Senent-Boza A, Simons M, Slade D, Smart N, Smith SR, Stabilini C, Theodorou A, Torkington J, Vironen J, Woeste G, De Beaux A, East B. What defines an incisional hernia as 'complex': results from a Delphi consensus endorsed by the European Hernia Society (EHS). Br J Surg 2024; 111:znad346. [PMID: 37897716 DOI: 10.1093/bjs/znad346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/12/2023] [Accepted: 09/21/2023] [Indexed: 10/30/2023]
Affiliation(s)
- Sara Capoccia Giovannini
- Department of Integrated Surgical and Diagnostic Sciences, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Sonia Ribas
- Department of General Surgery, Centro Hospitalar Póvoa de Varzim-Vila do Conde, Póvoa de Varzim, Portugal
| | - Giulia Montori
- General Surgery Department, Azienda ULSS2 'Trevigiana', Hospital Vittorio Veneto, Treviso, Italy
| | - Emanuele Botteri
- Department of General Surgery, ASST Spedali Civili Brescia PO, Montichiari, Brescia, Italy
| | - Ferdinando Agresta
- General Surgery Department, Azienda ULSS2 'Trevigiana', Hospital Vittorio Veneto, Treviso, Italy
| | - Alberto Sartori
- Department of General Surgery, San Valentino Hospital, Montebelluna, Treviso, Italy
| | - Hana Chàrvàtova
- Faculty of Applied Informatics, Tomas Bata University in Zlín, Zlín, Czech Republic
| | - Alberto Aiolfi
- Department of General Surgery, RCCS Ospedale Galeazzi-Sant'Ambrogio, University of Milan, Milan, Italy
| | - Stavros A Antoniou
- Department of Surgery, Papageorgiou General Hospital, Thessaloniki, Greece
| | | | - Frederik Berrevoet
- Department of General and Hepatobiliary Surgery and Liver Transplantation Service, University Hospital Medical School, Ghent, Belgium
| | - Marja A Boermeester
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
| | - Giampiero Campanelli
- Department of Abdominal Wall Surgery, University of Insubria, Ospedale Galeazzi Sant' Ambrogio, Milan, Italy
| | - Srinivas Chintapatla
- Department of Surgery, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
| | | | - Ursula Dahlstrand
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Surgery, Enköping Hospital, Enköping, Sweden
| | - Hanna De la Croix
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Ulrich A Dietz
- Department of Visceral, Vascular and Thoracic Surgery, Cantonal Hospital Olten, Olten, Switzerland
| | - Antonio Ferreira
- General Surgery Unit, Centro Hospitalar Vila Nova de Gaia/Espinho, Porto, Portugal
| | - Renè H Fortenly
- General Surgery Unit, Medical Faculty Sigmund Freud Private University, Vienna, Austria
| | - Christine Gaarder
- Department of Traumatology, University Hospital, Oslo University Hospital Ullevål, Oslo, Norway
| | - Miguel Angel Garcia Urena
- Grupo de Investigación de Pared Abdominal Compleja, Universidad Francisco de Vitoria Hospital Universitario del Henares Carretera Pozuelo-Majadahonda, Madrid, Spain
| | - Hakan Gok
- Hernia Istanbul®, Comprehensive Hernia Centre, Istanbul, Turkey
| | - Pilar Hernández-Granados
- General Surgery Unit, Hospital Universitario Fundación Alcorcón, Rey Juan Carlos University, Alcorcón, Spain
| | - Barbora Jisova
- Third Department of Surgery, First Medical Faculty of Charles University, Motol University Hospital, Prague, Czech Republic
| | - Orest Laver
- General Surgery Department, Uzhhorod City Central Clinical Hospital, Uzhhorod, National University Uzhhorod, Ukraine
| | - Orest Lerchuk
- Department of General and Endocrine Surgery, Lviv Regional Clinical Hospital, Lviv Danylo Halytsky National Medical University, Lviv, Ukraine
| | - Manuel Lopez-Cano
- Abdominal Wall Surgery Unit, University Hospital Vall d´Hebrón, Barcelona, Spain
- Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Manuel Mega
- Abdominal Wall Unit, Department of General Surgery, Local Health Unit of Castel Branco, Castel Branco, Portugal
| | - Kryspin Mitura
- University of Natural Sciences and Humanities in Siedlce, Siedlce, Masovian Voivodeship, Poland
| | - Filip Muysoms
- Department of Abdominal Wall Surgery, AZ Maria Middelares, Ghent, Belgium
| | - Andrè Oliva
- Department of General Surgery, Coimbra University Hospital, Coimbra, Portugal
| | - Monica Ortenzi
- Department of General and Emergency Surgery, Università Politecnica delle Marche, Ancona, Italy
| | - Ulf Petersson
- Department of Surgery, Skane University Hospital, Malmö, Sweden
- Department for Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Micaela Piccoli
- General Surgery Unit, Civil Hospital of Baggiovara Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Victor G Radu
- Department of General Surgery, Life Memorial Hospital-Medlife Bucharest, Romania
| | - Yohann Renard
- University of Reims Champagne Ardenne, France, Unit of Visceral Surgery, Robert Debre University Hospital, Reims, France
| | - Peder Rogmark
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Danny Rosin
- Sheba Medical Centre, University of Tel Aviv, Tel Aviv, Israel
| | - Ana Senent-Boza
- Department of General and Digestive Surgery, Virgen del Rocío University Hospital, Seville, Spain
| | - Maarten Simons
- Department of Surgery, OLVG Hospital Amsterdam, Amsterdam, the Netherlands
| | - Dominic Slade
- Department of General Surgery, Salford Royal Hospital, Salford, UK
| | - Neil Smart
- Department of Gastrointestinal Surgery, Royal Devon and Exeter Hospital, Exeter, UK
| | - Stella R Smith
- General and Colorectal Surgery, Manchester Royal Infirmary, Manchester Foundation Trust, Manchester, UK
| | - Cesare Stabilini
- Department of Integrated Surgical and Diagnostic Sciences, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alexis Theodorou
- First Surgical Unit, Hygeia Hospital, Athens, Greece
- Department of Surgery, Aretaieio University Hospital, Athens, Greece
| | - Jared Torkington
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - Jaanna Vironen
- Abdominal Centre, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Guido Woeste
- Department of General and Visceral Surgery, Agaplesion Elisabethenstift, Darmstadt, Germany
| | - Andrew De Beaux
- Department of General Surgery, Spire Murrayfield Hospital, Edinburgh, UK
| | - Barbora East
- Third Department of Surgery, First Medical Faculty of Charles University, Motol University Hospital, Prague, Czech Republic
| |
Collapse
|
10
|
Eucker D, Rosenberg R. [Loss of domain and reduction in median suture tension]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:34-41. [PMID: 38085298 DOI: 10.1007/s00104-023-01997-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Abdominal wall reconstruction in large incisional hernia/laparostoma poses a particular challenge. A loss of domain is the extreme form of intestinal volume displacement. The challenge lies in overcoming retraction of the lateral abdominal muscles. OBJECTIVE Experienced surgeons have access to a variety of techniques aimed at gaining lateral length along the abdominal wall or reducing suture tension at the midline. These techniques are intended to facilitate reconstruction even in complex cases and are outlined in this article from a practical perspective. MATERIAL AND METHODS The application of botulinum toxin A (BTA) and progressive pneumoperitoneum (PPP) are described as preoperative methods to gain abdominal wall length. Peritoneal flaps, intraoperative fascial traction (IFT) and component separation including transversus abdominis muscle release (TAR) are available for the surgical reconstruction of the abdominal wall. Bridging and the intraperitoneal onlay mesh approach are fallback techniques. All these techniques were integrated into a practical algorithm for complex abdominal wall reconstruction including preoperative and postoperative care and assessed by the authors with respect to effort, effectiveness and complexity. RESULTS AND CONCLUSION In the opinion of the authors, the status of complex abdominal wall reconstruction is currently best described by a combination of the most effective and proven techniques in terms of a "categorical algorithm". The combination of BTA, IFT and TAR presently appears to be the most effective method; however, experience and expertise are a prerequisite.
Collapse
Affiliation(s)
- D Eucker
- Klinik für Allgemein- und Viszeralchirurgie, Referenzzentrum für Hernienchirurgie, Kantonsspital Baselland, Rheinstraße 26, 4410, Liestal, Schweiz.
| | - R Rosenberg
- Klinik für Allgemein- und Viszeralchirurgie, Referenzzentrum für Hernienchirurgie, Kantonsspital Baselland, Rheinstraße 26, 4410, Liestal, Schweiz
| |
Collapse
|
11
|
Wes Love M, Davis S, Blackhurst D, Cobb W, Carbonell A, Warren J. Rectus to defect ratio for estimating the complexity of ventral hernia repair: Is it reliable for robotic surgery? Am J Surg 2023; 226:917-920. [PMID: 37940439 DOI: 10.1016/j.amjsurg.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 09/19/2023] [Accepted: 10/04/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION The rectus to defect ratio (RDR) has been previously described as a metric which enables surgeons to estimate the need to perform additional myofascial release (AMR), in addition to open Rives-Stoppa retro-muscular hernia repair. We sought to validate this measurement specifically for patients undergoing robotic totally extraperitoneal (eTEP) hernia repair. METHODS A retrospective chart review of 188 patients who underwent robotic ventral hernia repair via eTEP approach. RDR on preoperative CT was compared to the final operation rendered. The primary endpoint was the RDR's ability to predict the need for TAR to achieve fascial closure. RESULTS Of 188 patients, 154 were repaired with rectus myofascial release, while 34 also required TAR. There was a linear decrease in the need for TAR with increasing RDR. RDR 1-1.49 (n = 12) required TAR in 66.7 % of cases, RDR 1.5-1.99 (n = 25) in 43.8 %, RDR 2-2.49 (n = 31) in 29 %, and RDR >2.5 (n = 151) in just 5.8 % CONCLUSION: The RDR accurately predicts the need for TAR to achieve fascial closure during robotic eTEP ventral hernia repair. An RDR >2.5 portends fascial closure without TAR 94.2 % of cases.
Collapse
Affiliation(s)
- M Wes Love
- Division of Minimal Access and Bariatric Surgery, Department of Surgery, University of South Carolina School of Medicine Greenville, Prisma Health-Upstate, 701 Grove Rd. ST3, Greenville, SC, 29605, USA.
| | - Sarah Davis
- University of South Carolina School of Medicine Greenville, 607 Grove Road, Greenville, SC, 29605, USA
| | - Dawn Blackhurst
- Department of Surgery, Prisma Health-Upstate, 701 Grove Rd. ST3, Greenville, SC, 29605, USA
| | - Wil Cobb
- Division of Minimal Access and Bariatric Surgery, Department of Surgery, University of South Carolina School of Medicine Greenville, Prisma Health-Upstate, 701 Grove Rd. ST3, Greenville, SC, 29605, USA
| | - Alfredo Carbonell
- Division of Minimal Access and Bariatric Surgery, Department of Surgery, University of South Carolina School of Medicine Greenville, Prisma Health-Upstate, 701 Grove Rd. ST3, Greenville, SC, 29605, USA
| | - Jeremy Warren
- Division of Minimal Access and Bariatric Surgery, Department of Surgery, University of South Carolina School of Medicine Greenville, Prisma Health-Upstate, 701 Grove Rd. ST3, Greenville, SC, 29605, USA
| |
Collapse
|
12
|
Omar I, Zaimis T, Townsend A, Ismaiel M, Wilson J, Magee C. Incisional Hernia: A Surgical Complication or Medical Disease? Cureus 2023; 15:e50568. [PMID: 38222215 PMCID: PMC10788045 DOI: 10.7759/cureus.50568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 01/16/2024] Open
Abstract
Incisional hernia (IH) is a frequent complication following abdominal surgery. The development of IH could be more sophisticated than a simple anatomical failure of the abdominal wall. Reported IH incidence varies among studies. This review presented an overview of definitions, molecular basis, risk factors, incidence, clinical presentation, surgical techniques, postoperative care, cost, risk prediction tools, and proposed preventative measures. A literature search of PubMed was conducted to include high-quality studies on IH. The incidence of IH depends on the primary surgical pathology, incision site and extent, associated medical comorbidities, and risk factors. The review highlighted inherent and modifiable risk factors. The disorganisation of the extracellular matrix, defective fibroblast functions, and ratio variations of different collagen types are implicated in molecular mechanisms. Elective repair of IH alleviates symptoms, prevents complications, and improves the quality of life (QOL). Recent studies introduced risk prediction tools to implement preventative measures, including suture line reinforcement or prophylactic mesh application in high-risk groups. Elective repair improves QOL and prevents sinister outcomes associated with emergency IH repair. The watchful wait strategy should be reviewed, and options should be discussed thoroughly during patients' counselling. Risk stratification tools for predicting IH would help adopt prophylactic measures.
Collapse
Affiliation(s)
- Islam Omar
- General Surgery, The Hillingdon Hospitals NHS Foundation Trust, Uxbridge, GBR
| | - Tilemachos Zaimis
- General Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, GBR
| | - Abby Townsend
- General Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, GBR
| | - Mohamed Ismaiel
- General Surgery, Altnagelvin Area Hospital, Londonderry, GBR
| | - Jeremy Wilson
- General Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, GBR
| | - Conor Magee
- General Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, GBR
| |
Collapse
|
13
|
Claessen JJM, Timmer AS, Hemke R, Atema JJ, Hompes R, Boermeester MA, Rutten MVH. A computed tomography study investigating the effects of botulinum toxin injections prior to complex abdominal wall reconstruction. Hernia 2023; 27:281-291. [PMID: 36239824 PMCID: PMC10126041 DOI: 10.1007/s10029-022-02692-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/25/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To explore how intramuscular injection of botulinum toxin A (BTA) affects the lateral abdominal wall (LAW) musculature, abdominal- and hernia dimensions, and muscle structure on computed tomography (CT) in patients scheduled for complex abdominal wall reconstruction (CAWR). METHODS Retrospective analysis of prospectively registered patients who received bilateral intramuscular BTA injections into all three muscles of the LAW. Only patients for which a CT was available before and 3-6 weeks after BTA treatment prior to surgery were analyzed. RESULTS Fifty-two patients were analyzed. Median hernia width in all patients decreased with 0.4 cm (IQR - 2.1;0.6) (p = 0.023). Median intra-abdominal transverse diameter increased with 0.9 cm (IQR - 0.2;3.3) (p = 0.001) and the intra-abdominal anterior-posterior diameter decreased with 0.5 cm (IQR - 1.3;0.5) (p = 0.017), making the abdomen more oval. Median LAW muscle length increased with 0.9 cm (IQR 0.0;2.4) per side (p < 0.001), muscle thickness decreased with 0.5 cm (IQR - 0.8;- 0.2) (- 25.0%) per side (p < 0.001), and muscle mass decreased with 3.9 cm2 (IQR - 6.4;-1.5) (- 15.8%) per side (p < 0.001). Median HU of the psoas muscles (density) increased with 4.8 HU (IQR 0.4;9.7) (10.3%) per side (p < 0.001). Effects of BTA were more pronounced in patients with a loss of domain (LoD) ≥ 20%. CONCLUSIONS The main effect of BTA injections is elongation and thinning of the LAW muscles, more than a decrease in hernia width. Concomitantly, the abdomen becomes more oval. An increase of psoas muscles density is seen, associated with offloading of the LAW muscles. Patients with large LoD have a proportionally higher effect of BTA.
Collapse
Affiliation(s)
- J J M Claessen
- Department of Surgery (Suite J1A-228), Amsterdam UMC, University of Amsterdam, Location AMC, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
| | - A S Timmer
- Department of Surgery (Suite J1A-228), Amsterdam UMC, University of Amsterdam, Location AMC, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
| | - R Hemke
- Department of Radiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - J J Atema
- Department of Surgery (Suite J1A-228), Amsterdam UMC, University of Amsterdam, Location AMC, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
| | - R Hompes
- Department of Surgery (Suite J1A-228), Amsterdam UMC, University of Amsterdam, Location AMC, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
| | - M A Boermeester
- Department of Surgery (Suite J1A-228), Amsterdam UMC, University of Amsterdam, Location AMC, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands.
- Amsterdam Gastroenterology and Metabolism, Amsterdam, The Netherlands.
| | - M V H Rutten
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
14
|
CT-measured hernia parameters can predict component separation: a cross-sectional study from China. Hernia 2023:10.1007/s10029-023-02761-8. [PMID: 36934216 DOI: 10.1007/s10029-023-02761-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/12/2023] [Indexed: 03/19/2023]
Abstract
PURPOSE Currently, there are no reliable preoperative methods for predicting component separation (CS) during incisional hernia repair. By quantitatively measuring preoperative computed tomography (CT) imaging, we aimed to assess the value of hernia defect size, abdominal wall muscle quality, and hernia volume in predicting CS. METHODS The data of 102 patients who underwent open Rives-Stoppa retro-muscular mesh repair for midline incisional hernia between January 2019 and March 2022 were retrospectively analyzed. The patients were divided into two groups: ''CS group'' patients who required CS to attempt fascial closure, and ''non-CS'' group patients who required only Rives-Stoppa retro-muscular release to achieve fascial closure. Hernia defect width, hernia defect angle, rectus width, abdominal wall muscle area and CT attenuation, hernia volume (HV), and abdominal cavity volume (ACV) were measured on CT images. The rectus width to defect width ratio (RDR), HV/ACV, and HV/peritoneal volume (PV; i.e., HV + ACV) were calculated. Differences between the indices of the two groups were compared. Logistic regression models were applied to analyze the relationships between the above CT parameters and CS. Receiver operator characteristic (ROC) curves were generated to evaluate the potential utility of CT parameters in predicting CS. RESULTS Of the102 patients, 69 were in the non-CS group and 33 were in the CS group. Compared with the non-CS group, hernia defect width (P < 0.001), hernia defect angle (P < 0.001), and hernia volume (P < 0.001) were larger in the CS group, while RDR (P < 0.001) was smaller. The abdominal wall muscle area in the CS group was slightly greater than that in the non-CS group (P = 0.046), and there was no significant difference in the CT attenuation of the abdominal wall muscle between the two groups (P = 0.089). Multivariate logistic regression identified hernia defect width (OR 1.815, 95% CI 1.428-2.308, P < 0.001), RDR (OR 0.018, 95% CI 0.003-0.106, P < 0.001), hernia defect angle (OR 1.077, 95% CI 1.042-1.114, P < 0.001), hernia volume (OR 1.002, 95% CI 1.001-1.003, P < 0.001), and CT attenuation of abdominal wall muscle (OR 0.962, 95% CI 0.927-0.998, P = 0.037) as independent predictors of CS. Hernia defect width was the best predictor for CS, with a cut-off point of 9.2 cm and an area under the curve (AUC) of 0.890. The AUCs of RDR, hernia defect angle, hernia volume, and abdominal wall muscle CT attenuation were 0.843, 0.812, 0.747, and 0.572, respectively. CONCLUSION Quantitative CT measurements are of great value for preoperative prediction of CS. Hernia defect size, hernia volume, and the CT attenuation of abdominal wall muscle are all preoperative predictive indicators of CS.
Collapse
|
15
|
Malaussena Z, Pittala K, Diab ARF, Docimo S. Prediction models in hernia repair: a systematic review. Surg Endosc 2023; 37:3364-3379. [PMID: 36595065 DOI: 10.1007/s00464-022-09842-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/19/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Hernias can present with unique challenges when it comes to management and repair. Prediction models can be a useful tool for clinicians to better anticipate and understand the severity of a hernia, the type of surgical technique, or presurgical planning that may be required to treat the patient, and the risk of complications. Our goal is to evaluate and consolidate prediction models in hernia repair present in the literature for which physicians can reference to best improve patient outcomes and postoperative management. METHODS We performed a literature search in PubMed using keywords, "rectus width to defect width ratio," "predicting myofascial release," "computed tomography hernia repair prediction," "component separation radiology prediction hernia," "fat volume and hernia repair," "body morphometrics and Query hernia repair," "body morphometrics and reherniation," "computed tomography findings and risk of emergency hernia repair," "loss of domain and hernia radiology," and "volumetry and hernia repair." We searched for publications that used radiographic parameters to predict hernia severity, interventions, and outcomes. RESULTS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), we found twenty-three studies related to prediction models in hernia repair published between 2000 and 2021. We summarized studies pertaining to predicting acute care, predicting operative planning with loss of domain and component separation, predicting complications, paraesophageal hernia predictions, and predicting postoperative respiratory complications. CONCLUSION Radiographic prediction models can be an objective and efficient way for surgeons to analyze hernias and better understand a patient's situation so that they can inform patients about the best treatment options and the risk of complications.
Collapse
Affiliation(s)
- Zachary Malaussena
- University of South Florida Morsani College of Medicine, 560 Channelside Dr, Tampa, FL, 33602, USA.
| | - Karthik Pittala
- University of South Florida Morsani College of Medicine, 560 Channelside Dr, Tampa, FL, 33602, USA
| | - Abdul-Rahman F Diab
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Salvatore Docimo
- University of South Florida Morsani College of Medicine, 560 Channelside Dr, Tampa, FL, 33602, USA
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| |
Collapse
|
16
|
Boermeester MA, Lobé NHJ, Engelbrecht MRW, Timmer AS. Comparison of two-dimensional measurement with three-dimensional volume rendering for the assessment of loss of domain in incisional hernia patients. Hernia 2022; 27:379-385. [PMID: 36482228 DOI: 10.1007/s10029-022-02729-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE We aimed to compare simple two-dimensional (2D) measurement with comprehensive three-dimensional (3D) volume rendering to determine loss of domain (LOD), a clinically important decision-making feature for incisional hernia repair. METHODS In this single-center retrospective study, we analyzed the CT scans of a consecutive cohort of adult patients with a midline incisional hernia. The hernia sac- and abdominal cavity volumes were obtained by two different methods. The 2D method estimated the volumes using the corresponding height, width, and depth. The 3D method comprised of a volume rendering tool. For both methods, LOD was calculated according to the Sabbagh ratio (hernia sac volume / (hernia sac volume + abdominal cavity volume)). Taking the 3D method as the reference standard, the performance of the 2D method was expressed as positive predictive value (PPV) and negative predictive value (NPV) for LOD of more than- and less than 20%. The agreement between both methods was expressed as Cohen's kappa coefficient (kappa). RESULTS We analyzed 92 CT scans. Agreement between both methods was high (kappa = 0.854, p = 0.0001); all 67 measurements for which the 2D method assessed LOD to be less than 20% were correctly classified (NPV = 100%), and 20 of 25 measurements for which the 2D method assessed LOD to be more than 20% were correctly classified (PPV = 80%). CONCLUSIONS The 2D method can exclude patients from perioperative actions needed for a more complex hernia. Since this method is easy to use and less time-consuming, it seems useful for the routine radiological assessment of LOD in clinical practice.
Collapse
Affiliation(s)
- M A Boermeester
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands.
- Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, The Netherlands.
- Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, The Netherlands.
| | - N H J Lobé
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - M R W Engelbrecht
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - A S Timmer
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
- Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, The Netherlands
| |
Collapse
|
17
|
Timmer AS, Claessen JJM, Boermeester MA. Risk Factor-Driven Prehabilitation Prior to Abdominal Wall Reconstruction to Improve Postoperative Outcome. A Narrative Review. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2022; 1:10722. [PMID: 38314165 PMCID: PMC10831687 DOI: 10.3389/jaws.2022.10722] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/31/2022] [Indexed: 02/06/2024]
Abstract
All abdominal wall reconstructions find themselves on a scale, varying between simple to highly complex procedures. The level of complexity depends on many factors that are divided into patient comorbidities, hernia characteristics, and wound characteristics. Preoperative identification of modifiable risk factors provides the opportunity for patient optimization. Because this so called prehabilitation greatly improves postoperative outcome, reconstructive surgery should not be scheduled before all modifiable risk factors are optimized to a point where no further improvement can be expected. In this review, we discuss the importance of preoperative risk factor recognition, identify modifiable risk factors, and utilize options for patient prehabilitation, all aiming to improve postoperative outcome and therewith long-term success of the reconstruction.
Collapse
Affiliation(s)
- Allard S. Timmer
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, Netherlands
| | - Jeroen J. M. Claessen
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, Netherlands
| | - Marja A. Boermeester
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, Netherlands
| |
Collapse
|
18
|
Wegdam JA, de Jong DLC, de Vries Reilingh TS, Schipper EE, Bouvy ND, Nienhuijs SW. Assessing Textbook Outcome After Implementation of Transversus Abdominis Release in a Regional Hospital. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2022; 1:10517. [PMID: 38314160 PMCID: PMC10831686 DOI: 10.3389/jaws.2022.10517] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 06/07/2022] [Indexed: 02/06/2024]
Abstract
Background: The posterior component separation technique with transversus abdominis release (TAR) was introduced in 2012 as an alternative to the classic anterior component separation technique (Ramirez). This study describes outcome and learning curve of TAR, five years after implementation of this new technique in a regional hospital in the Netherlands. Methods: A standardized work up protocol, based on the Plan-Do-Check-Act cycle, was used to implement the TAR. The TAR technique as described by Novitsky was performed. After each 20 procedures, outcome parameters were evaluated and new quality measurements implemented. Primary outcome measure was Textbook Outcome, the rate of patients with an uneventful clinical postoperative course after TAR. Textbook Outcome is defined by a maximum of 7 days hospitalization without any complication (wound or systemic), reoperation or readmittance, within the first 90 postoperative days, and without a recurrence during follow up. The number of patients with a Textbook Outcome compared to the total number of consecutively performed TARs is depicted as the institutional learning curve. Secondary outcome measures were the details and incidences of the surgical site and systemic complications within 90 days, as well as long-term recurrences. Results: From 2016, sixty-nine consecutive patients underwent a TAR. Textbook Outcome was 35% and the institutional learning curve did not flatten after 69 procedures. Systemic complications occurred in 48%, wound complications in 41%, and recurrences in 4%. Separate analyses of three successive cohorts of each 20 TARs demonstrated that both Textbook Outcome (10%, 30% and 55%, respectively) and the rate of surgical site events (45%, 15%, and 10%) significantly (p < 0.05) improved with more experience. Conclusion: Implementation of the open transversus abdominis release demonstrated that outcome was positively correlated to an increasing number of TARs performed. TAR has a long learning curve, only partially determined by the technical aspects of the operation. Implementation of the TAR requires a solid plan. Building, and maintaining, an adequate setting for patients with complex ventral hernias is the real challenge and driving force to improve outcome.
Collapse
Affiliation(s)
| | | | | | | | - Nicole D. Bouvy
- Maastricht University Medical Centre, Maastricht, Netherlands
| | | |
Collapse
|
19
|
Sagar A, Tapuria N. An Evaluation of the Evidence Guiding Adult Midline Ventral Hernia Repair. Surg J (N Y) 2022; 8:e145-e156. [PMID: 35928547 PMCID: PMC9345681 DOI: 10.1055/s-0042-1749428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 03/01/2022] [Indexed: 11/09/2022] Open
Abstract
Purpose: Several guidelines have been published in recent years to guide the clinician in ventral hernia repair. This review distils this advice, critically assesses their evidence base, and proposes avenues for future study. Methods: A PUBMED search identified four guidelines addressing midline ventral hernia repair published by major surgical societies between 2016 and 2020. The studies used to inform the advice have been critically appraised, including 20 systematic reviews/meta-analyses, 10 randomized controlled trials, 32 cohort studies, and 14 case series. Results: Despite a lack of randomized controlled trials, case heterogeneity, and variation in outcome reporting, key themes have emerged. Preoperative computed tomography scan assesses defect size, loss of domain, and the likely need for component separation. Prehabilitation, frailty assessment, and risk stratification are beneficial in complex cases. Minimally invasive component separation techniques, Botox injection, and progressive pneumoperitoneum represent novel techniques to promote closure of large fascial defects. Rives-Stoppa sublay mesh repair has become the "gold" standard for open and minimally invasive repairs. Laparoscopic repair promotes early return to functional status. The enhanced-view totally extraperitoneal approach facilitates laparoscopic sublay mesh placement, avoiding mesh contact with viscera. Robotic techniques continue to evolve, although the evidence at present remains immature. Synthetic mesh is recommended for use in clean and clean-contaminated cases. However, optimism regarding the use of biologic and biosynthetic meshes in the contaminated setting has waned. Conclusions: Surgical techniques in ventral hernia repair have advanced in recent years. High-quality data has struggled to keep pace; rigorous clinical trials are required to support the surgical innovation.
Collapse
Affiliation(s)
- Alex Sagar
- General Surgery Department, Milton Keynes University Hospital, United Kingdom
| | - Niteen Tapuria
- General Surgery Department, Milton Keynes University Hospital, United Kingdom
| |
Collapse
|
20
|
Al Sadairi AR, Durtette-Guzylack J, Renard A, Durot C, Thierry A, Kianmanesh R, Passot G, Renard Y. A simplified method to evaluate the loss of domain. Hernia 2022; 26:927-936. [PMID: 34341871 DOI: 10.1007/s10029-021-02474-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The treatment of giant incisional hernia (IH) with loss of domain (LOD, IHLD) is considerably challenging due to technical difficulties and subsequent post-operative complications. These post-operative risks may be anticipated by calculating the abdominal cavity (AC) volume (ACV) and the IH volume (IHV) on the preoperative CT-scans, using the AC and IH dimensions (Tanaka's method) or using tridimensional volumetry (Sabbagh's method). These techniques are often time-consuming and require specific softwares. The aim of the present study was to develop a simple method to rapidly obtain the LOD-ratio on the preoperative CT-Scan. METHODS The CT-scans (n = 89) of patients with IHLD were retrospectively studied. Several ratios were calculated using different parameters of the AC and the IH, including width, height and depth, the areas (axial and sagittal ellipse, as well as freehand sagittal surface areas) and these were compared with the reference methods of Sabbagh et al. and Tanaka et al. RESULTS: The LOD ratios calculated from the two reference methods gave similar results (ICC = 0.82, p < 0.0001). The new "R-ratios" (Reims-ratios) obtained from the IH and AC surface areas measured using the "freehand ROI" tool on sagittal view or roughly evaluated by an ellipse on axial view showed excellent correlation with both reference ratios (all ICC ≥ 0.71, p < 0.0001). CONCLUSION The LOD ratio may be quickly obtained by drawing two circles on the pre-operative CT scan ("R ratios") and available on the webpage https://romeo.univ-reims.fr/Rratio/ . This will certainly help surgeons to routinely anticipate the post-operative complications before IHLD repair.
Collapse
Affiliation(s)
- Abdul Rahman Al Sadairi
- Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Rue Cognac-Jay, 51092, Reims Cedex, France.
- Sultan Qaboos University, Muscat, Sultanate of Oman.
| | - Jules Durtette-Guzylack
- Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Rue Cognac-Jay, 51092, Reims Cedex, France
| | - Arnaud Renard
- Laboratory Liciis and ROMEO, University of Reims Champagne-Ardenne, Reims, France
| | - Carole Durot
- Department of Radiology, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Reims, France
| | - Aurore Thierry
- Methodological Aid To Clinical Research Unit CHU Reims, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Reims, France
| | - Reza Kianmanesh
- Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Rue Cognac-Jay, 51092, Reims Cedex, France
| | - Guillaume Passot
- Department of Digestive Surgery, Hopital Lyon Sud, Pierre Bénite, University of Lyon, Lyon, France
| | - Yohann Renard
- Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Rue Cognac-Jay, 51092, Reims Cedex, France
- Laboratory Liciis and ROMEO, University of Reims Champagne-Ardenne, Reims, France
| |
Collapse
|
21
|
Van Orden K, Santos J, Stanfield B, Frost LS, Ruditsky A, Foster A, Brahmbhatt TS, Burke PA, Fernandez-Moure J, Haines K, Agarwal S, Kasotakis G. Bovine versus porcine acellular dermal matrix for abdominal wall herniorrhaphy or bridging. Eur J Trauma Emerg Surg 2022; 48:1993-2001. [PMID: 33712893 DOI: 10.1007/s00068-021-01641-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 03/03/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The management of complicated ventral hernias (CVH), namely ventral hernias in actively or recently infected/contaminated operative fields, and open abdomens in which the native fascia cannot be primarily reapproximated, pose a surgical challenge. Fetal Bovine and Porcine Acellular Dermal Matrix (BADM and PADM) biologic meshes are being increasingly used in these scenarios. A comparison, however, of clinically relevant outcomes between the two is lacking. With this investigation, we aim to review and compare clinically relevant outcomes in patients that underwent abdominal wall herniorrhaphy with either BADM or PADM at a tertiary urban academic institution over a 5-year period. METHODS Patients who had a BADM or PADM implanted during CVH over a 5-year period at a tertiary urban academic hospital were identified. Baseline clinical and hernia characteristics, as well as postoperative outcomes were compared after a retrospective chart review. Phone interviews were also conducted to assess for recurrence, followed by in-person visits as indicated. Cox Proportional Hazard regression was fitted to identify risk factors for recurrence. RESULTS Of the 140 patients who underwent biologic mesh implantation for CVH, 109 were for ventral hernia repair and 31 for open abdomen bridging. Mean age was 52.7 ± 14.2 and males constituted 57.9% of our sample, while 25.1% had undergone > 5 prior abdominal operations. Thirty percent were active smokers, and another 30% required emergency surgery. Only immunosuppression was a risk factor for recurrence [HR 13.3 (1.04-169.2), p = 0.047] on Cox Proportional Hazard regression, while mesh selection had no effect. CONCLUSIONS Both BADM and PADM meshes perform well in CVH, with satisfactory recurrence rates, only slightly higher compared to traditional synthetic mesh repairs.
Collapse
Affiliation(s)
- Kathryn Van Orden
- Division of Trauma, Acute Care Surgery and Surgical Critical Care, Boston Medical Center, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Jeffrey Santos
- Division of Trauma, Acute Care Surgery and Surgical Critical Care, Boston Medical Center, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Brent Stanfield
- Department of Surgery, Division of Trauma, Acute Care Surgery and Surgical Critical Care, Duke University Medical Center, Duke University School of Medicine, 40 Duke Medicine Circle, Duke South, #1557A, Durham, NC, 27710, USA
| | | | - Alexander Ruditsky
- Division of Trauma, Acute Care Surgery and Surgical Critical Care, Boston Medical Center, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Andrea Foster
- Division of Trauma, Acute Care Surgery and Surgical Critical Care, Boston Medical Center, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Tejal S Brahmbhatt
- Division of Trauma, Acute Care Surgery and Surgical Critical Care, Boston Medical Center, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Peter A Burke
- Division of Trauma, Acute Care Surgery and Surgical Critical Care, Boston Medical Center, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Joseph Fernandez-Moure
- Department of Surgery, Division of Trauma, Acute Care Surgery and Surgical Critical Care, Duke University Medical Center, Duke University School of Medicine, 40 Duke Medicine Circle, Duke South, #1557A, Durham, NC, 27710, USA
| | - Krista Haines
- Department of Surgery, Division of Trauma, Acute Care Surgery and Surgical Critical Care, Duke University Medical Center, Duke University School of Medicine, 40 Duke Medicine Circle, Duke South, #1557A, Durham, NC, 27710, USA
| | - Suresh Agarwal
- Department of Surgery, Division of Trauma, Acute Care Surgery and Surgical Critical Care, Duke University Medical Center, Duke University School of Medicine, 40 Duke Medicine Circle, Duke South, #1557A, Durham, NC, 27710, USA
| | - George Kasotakis
- Department of Surgery, Division of Trauma, Acute Care Surgery and Surgical Critical Care, Duke University Medical Center, Duke University School of Medicine, 40 Duke Medicine Circle, Duke South, #1557A, Durham, NC, 27710, USA.
| |
Collapse
|
22
|
Management of a Voluminous Incisional Hernia – Case Report and Brief Review. JOURNAL OF INTERDISCIPLINARY MEDICINE 2022. [DOI: 10.2478/jim-2022-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Introduction: Massive ventral hernia repairs may lead to abdominal compartment syndrome, which is associated with increased morbidity and mortality, and is caused by an acute rise in intra-abdominal pressure, frequently leading to multi-organ failure and possibly death. This report presents a case with a voluminous incisional hernia associated with intestine obstruction and the issues surrounding emergency surgical treatment. Case report: An overweight 67-year-old patient with a medical history of diabetes and multiple cardiovascular pathologies presented to the emergency department complaining of abdominal distension, pain, nausea, vomiting, and lack of intestinal transit for 48 hours. A clinical diagnosis of bowel obstruction was established, caused by a large ventral hernia. During surgery, a tension free abdominal wall reconstruction was performed with a peritoneal flap from the hernia sac and retromuscular Prolene synthetic mesh. A Redon-type drainage of the posterior rectus compartment and subcutis was applied for 48 hours. After the operation, the patient was transferred to the intensive care unit for monitoring. During the follow-up, continuous monitoring of arterial blood pressure, oxygen saturation, renal function, daily diuresis, lactic acid values, and intraabdominal pressure was performed. On the 9th postoperative day, the patient was released in good general health, stable from a cardiorespiratory point of view, with a clean, healing surgical wound. Conclusion: The repair of large ventral hernias is technically challenging. The management of giant incisional hernias is complex, requiring thoughtful preoperative evaluation with CT imaging and volumetry calculation, which can help establish the surgical strategy.
Collapse
|
23
|
Guerrero-Antolino P, Pous-Serrano S, Bueno-Lledo J, Torregrosa-Gallud A. Accidental peritoneum-cutaneous fistula after insufflation of preoperative progressive pneumoperitoneum in a large incisional hernia with loss of domain. BMJ Case Rep 2022; 15:e248984. [PMID: 35589262 PMCID: PMC9121406 DOI: 10.1136/bcr-2022-248984] [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] [Accepted: 05/02/2022] [Indexed: 11/04/2022] Open
Abstract
Preoperative progressive pneumoperitoneum has represented an important advancement in achieving the reintroduction of large herniated volumes into the abdominal cavity. However, this technique is not free of complications. We present a case of a man in his 70s with an accidental peritoneal-cutaneous fistula, secondary to the excessive pressure of the pneumoperitoneum, during the preparation of a large incisional hernia with loss of domain intervention.
Collapse
Affiliation(s)
| | | | - Jose Bueno-Lledo
- General Surgery, Hospital La Fe, Valencia, Comunidad Valenciana, Spain
| | | |
Collapse
|
24
|
Timmer AS, Claessen JJM, Brouwer de Koning IM, Haenen SM, Belt EJT, Bastiaansen AJNM, Verdaasdonk EGG, Wolffenbuttel CP, Schreurs WH, Draaisma WA, Boermeester MA. Clinical outcomes of open abdominal wall reconstruction with the use of a polypropylene reinforced tissue matrix: a multicenter retrospective study. Hernia 2022; 26:1241-1250. [PMID: 35441284 PMCID: PMC9525385 DOI: 10.1007/s10029-022-02604-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/14/2022] [Indexed: 02/06/2023]
Abstract
Objective To assess mesh behaviour and clinical outcomes of open complex abdominal wall reconstruction (CAWR) with the use of a polypropylene reinforced tissue matrix. Methods A multicenter retrospective study of adult patients who underwent open CAWR with the use of a permanent polypropylene reinforced tissue matrix (OviTex®) between June 2019 and January 2021. Results Fifty-five consecutive patients from four hospitals in the Netherlands were analysed; 46 patients with a ventral hernia and 9 patients with an open abdomen. Most patients with a ventral hernia had one or more complicating comorbidities (91.3%) and one or more complicating hernia characteristics (95.7%). Most procedures were performed in a (clean) contaminated surgical field (69.6% CDC 2–4; 41.3% CDC 3–4). All nine patients with an open abdomen underwent semi-emergent surgery. Twelve out of 46 patients with a ventral hernia (26.1%) and 4 of 9 patients with an open abdomen (44.4%) developed a postoperative surgical site infection that made direct contact with the mesh as confirmed on computed tomography (CT), suspicious of mesh infection. No patient needed mesh explantation for persistent infection of the mesh. During a median follow-up of 13 months, 4 of 46 ventral hernia patients (8.7%) developed a CT confirmed hernia recurrence. Conclusion Polypropylene reinforced tissue matrix can withstand infectious complications and provides acceptable mid-term recurrence rates in this retrospective study on open complex abdominal wall reconstructions. Longer follow-up data from prospective studies are required to determine further risk of hernia recurrence. Supplementary Information The online version contains supplementary material available at 10.1007/s10029-022-02604-y.
Collapse
Affiliation(s)
- Allard S Timmer
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam Infection and Immunity, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands
| | - Jeroen J M Claessen
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam Infection and Immunity, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands
| | | | - Suzanne M Haenen
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam Infection and Immunity, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands
| | - Eric J T Belt
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | | | | | | | | | - Werner A Draaisma
- Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Marja A Boermeester
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam Infection and Immunity, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands.
| |
Collapse
|
25
|
Truncal function after abdominal wall reconstruction via transversus abdominis muscle release (TAR) for large incisional hernias: a prospective case-control study. Hernia 2022; 26:1285-1292. [PMID: 35018559 DOI: 10.1007/s10029-022-02563-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 12/30/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Data about abdominal wall function in patients with incisional hernias (IH) are limited. Abdominal Wall Reconstruction (AWR) could be beneficial for the improvement of this function. The goal of the study was to evaluate if the abdominal wall function was restored after transversus abdominis muscle release (TAR). METHODS We performed a prospective case-control study of 59 patients with IH equal or larger than 10 cm in their width undergoing AWR via TAR with mesh reinforcement and complete linea alba restoration. With two simple physical tests-Trunk Raising (TR) and Double Leg Lowering (DLL), we clinically assessed, preoperatively, 1 month and 1 year postoperatively the functionality of the abdominal wall (flexion). Patients were compared with a control group (n = 57) with an intact abdominal wall undergoing visceral surgery through a midline laparotomy. RESULTS There were no differences between the groups in terms of sex and mean age. In the study group, TR demonstrated an increase from 1.93 preoperatively to 2.44 at 1 month and 4.27, respectively, at 1 year postoperatively (p < 0.001). DLL was improved from 2.067 to 4.37 at 1 year postoperatively (p = 0.016). In the control group, surgery resulted in a decrease of truncal flexion. At 1 year postoperatively, the abdominal wall function for study group patients was almost identical with that the functionality of the control group featuring an intact abdominal wall (TR 4.26 vs 4.33 p = 0.532; DLL 4.42 vs 4.21 p = 0.193). CONCLUSION AWR via TAR for large IH specifically improved long-term abdominal wall muscular function.
Collapse
|
26
|
Adams ST, Slade D, Shuttleworth P, West C, Scott M, Benson A, Tokala A, Walsh CJ. Reading a preoperative CT scan to guide complex abdominal wall reconstructive surgery. Hernia 2022; 27:265-272. [PMID: 34988686 DOI: 10.1007/s10029-021-02548-9] [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: 09/21/2021] [Accepted: 12/19/2021] [Indexed: 11/30/2022]
Abstract
Computed tomography (CT) scanning is the imaging modality of choice when planning the overall management and operative approach to complex abdominal wall hernias. Despite its availability and well-recognised benefits there are no guidelines or recommendations regarding how best to read or report such scans for this application. In this paper we aim to outline an approach to interpreting preoperative CT scans in abdominal wall reconstruction (AWR). This approach breaks up the interpretive process into 4 steps-concentrating on the hernia or hernias, any complicating features of the hernia(s), the surrounding soft tissues and the abdominopelvic cavity as a whole-and was developed as a distillation of the authors' collective experience. We describe the key features that should be looked for at each of the four steps and the rationale for their inclusion.
Collapse
Affiliation(s)
- S T Adams
- Department of Plastic Surgery, St Helen's and Knowsley Teaching Hospitals NHS Trust, Prescot, Merseyside, UK. .,Department of General Surgery, Wirral University Teaching Hospitals NHS Foundation Trust, Arrowe Park Hospital, Arrowe Park Rd, Upton, Wirral, CH49 5PE, UK. .,Department of General Surgery, St Helen's and Knowsley Teaching Hospitals NHS Trust, Prescot, Merseyside, UK.
| | - D Slade
- Department of Surgery, Salford Royal NHS Foundation Trust, Salford, Lancashire, UK
| | - P Shuttleworth
- Department of General Surgery, Wirral University Teaching Hospitals NHS Foundation Trust, Arrowe Park Hospital, Arrowe Park Rd, Upton, Wirral, CH49 5PE, UK
| | - C West
- Department of Plastic Surgery, St Helen's and Knowsley Teaching Hospitals NHS Trust, Prescot, Merseyside, UK
| | - M Scott
- Department of General Surgery, St Helen's and Knowsley Teaching Hospitals NHS Trust, Prescot, Merseyside, UK
| | - A Benson
- Department of Plastic Surgery, St Helen's and Knowsley Teaching Hospitals NHS Trust, Prescot, Merseyside, UK
| | - A Tokala
- Department of Radiology, Salford Royal NHS Foundation Trust, Salford, Lancashire, UK
| | - C J Walsh
- Department of General Surgery, Wirral University Teaching Hospitals NHS Foundation Trust, Arrowe Park Hospital, Arrowe Park Rd, Upton, Wirral, CH49 5PE, UK
| |
Collapse
|
27
|
Kumar S, Rao N, Parker S, Plumb A, Windsor A, Mallett S, Halligan S. Are preoperative CT variables associated with the success or failure of subsequent ventral hernia repair: nested case-control study. Eur Radiol 2022; 32:6348-6354. [PMID: 35348860 PMCID: PMC9381620 DOI: 10.1007/s00330-022-08701-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Systematic review of CT measurements to predict the success or failure of subsequent ventral hernia repair has found limited data available in the indexed literature. To rectify this, we investigated multiple preoperative CT metrics to identify if any were associated with postoperative reherniation. METHODS Following ethical permission, we identified patients who had undergone ventral hernia repair and had preoperative CT scanning available. Two radiologists made multiple measurements of the hernia and abdominal musculature from these scans, including loss of domain. Patients were divided subsequently into two groups, defined by hernia recurrence at 1-year subsequent to surgery. Hypothesis testing investigated any differences between CT measurements from each group. RESULTS One hundred eighty-eight patients (95 male) were identified, 34 (18%) whose hernia had recurred by 1-year. Only three of 34 CT measurements were significantly different when patients whose hernia had recurred were compared to those who had not; these significant findings were assumed contingent on multiple testing. In particular, preoperative hernia volume (recurrence 155.3 cc [IQR 355.65] vs. no recurrence 78.2 [IQR 303.52], p = 0.26) nor loss of domain, whether calculated using the Tanaka (recurrence 0.02 [0.04] vs. no recurrence 0.009 [0.04], p = 0.33) or Sabbagh (recurrence 0.019 [0.05] vs. no recurrence 0.009 [0.04], p = 0.25) methods, differed between significantly between groups. CONCLUSIONS Preoperative CT measurements of ventral hernia morphology, including loss of domain, appear unrelated to postoperative recurrence. It is likely that the importance of such measurements to predict recurrence is outweighed by other patient factors and surgical reconstruction technique. KEY POINTS • Preoperative CT scanning is often performed for ventral hernia but systematic review revealed little data regarding whether CT variables predict postoperative reherniation. • We found that the large majority of CT measurements, including loss of domain, did not differ significantly between patients whose hernia did and did not recur. • It is likely that the importance of CT measurements to predict recurrence is outweighed by other patient factors and surgical reconstruction technique.
Collapse
Affiliation(s)
- Shankar Kumar
- UCL Centre for Medical Imaging, University College London UCL, Charles Bell House, 43-45 Foley Street, London, W1W 7TS UK
| | - Nikhil Rao
- Radiology Department, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX UK
| | - Sam Parker
- Addominal Wall Reconstruction Unit, University College London Hospital, 235 Euston Road, London, NW1 2BU UK
| | - Andrew Plumb
- UCL Centre for Medical Imaging, University College London UCL, Charles Bell House, 43-45 Foley Street, London, W1W 7TS UK
| | - Alastair Windsor
- Addominal Wall Reconstruction Unit, University College London Hospital, 235 Euston Road, London, NW1 2BU UK
| | - Sue Mallett
- UCL Centre for Medical Imaging, University College London UCL, Charles Bell House, 43-45 Foley Street, London, W1W 7TS UK
| | - Steve Halligan
- UCL Centre for Medical Imaging, University College London UCL, Charles Bell House, 43-45 Foley Street, London, W1W 7TS UK
| |
Collapse
|
28
|
Elstner KE, Moollan Y, Chen E, Jacombs ASW, Rodriguez-Acevedo O, Ibrahim N, Ho-Shon K, Magnussen J, Read JW. Preoperative Progressive Pneumoperitoneum Revisited. Front Surg 2021; 8:754543. [PMID: 34733881 PMCID: PMC8559773 DOI: 10.3389/fsurg.2021.754543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/17/2021] [Indexed: 12/05/2022] Open
Abstract
Incisional hernia represents a common and potentially serious complication of open abdominal surgery, with up to 20% of all patients undergoing laparotomy subsequently developing an incisional hernia. This incidence increases to as much as 35% for laparotomies performed in high-risk patients and emergency procedures. A rarely used technique for enabling closure of large ventral hernias with loss of domain is preoperative progressive pneumoperitoneum (PPP), which uses intermittent insufflation to gradually stretch the contracted abdominal wall muscles, increasing the capacity of the abdominal cavity and allowing viscera to re-establish right of domain. This assists in tension-free closure of giant hernias which may otherwise be considered inoperable. This technique may be used on its own, or in conjunction with preoperative Botulinum Toxin A to confer paralysis to the lateral oblique muscles. These two complementary techniques, are changing the way complex hernias are managed.
Collapse
Affiliation(s)
- Kristen E Elstner
- Department of Surgery, Macquarie University Hospital, Macquarie University, Sydney, NSW, Australia.,Hernia Institute Australia, Edgecliff, NSW, Australia
| | - Yusuf Moollan
- Department of Surgery, Macquarie University Hospital, Macquarie University, Sydney, NSW, Australia.,Hernia Institute Australia, Edgecliff, NSW, Australia
| | - Emily Chen
- Department of Surgery, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Anita S W Jacombs
- Department of Surgery, Macquarie University Hospital, Macquarie University, Sydney, NSW, Australia.,Hernia Institute Australia, Edgecliff, NSW, Australia
| | | | - Nabeel Ibrahim
- Department of Surgery, Macquarie University Hospital, Macquarie University, Sydney, NSW, Australia.,Hernia Institute Australia, Edgecliff, NSW, Australia
| | - Kevin Ho-Shon
- Macquarie Medical Imaging, Macquarie University Hospital, Macquarie University, Sydney, NSW, Australia
| | - John Magnussen
- Macquarie Medical Imaging, Macquarie University Hospital, Macquarie University, Sydney, NSW, Australia
| | - John W Read
- Macquarie Medical Imaging, Macquarie University Hospital, Macquarie University, Sydney, NSW, Australia
| |
Collapse
|
29
|
Seretis F, Chrysikos D, Samolis A, Troupis T. Botulinum Toxin in the Surgical Treatment of Complex Abdominal Hernias: A Surgical Anatomy Approach, Current Evidence and Outcomes. In Vivo 2021; 35:1913-1920. [PMID: 34182463 DOI: 10.21873/invivo.12457] [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] [Received: 03/30/2021] [Revised: 04/18/2021] [Accepted: 04/22/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Abdominal wall hernias represent a common problem in surgical practice. A significant proportion of them entails large defects, often difficult to primarily close without advanced techniques. Injection of botulinum toxin preoperatively at specific points targeting lateral abdominal wall musculature has been recently introduced as an adjunct in achieving primary fascia closure rates. MATERIALS AND METHODS A literature search was conducted investigating the role of botulinum toxin in abdominal wall reconstruction focusing on anatomic repair of hernia defects. RESULTS Injecting botulinum toxin preoperatively achieved chemical short-term paralysis of the lateral abdominal wall muscles, enabling a tension-free closure of the midline, which according to anatomic and clinical studies should be the goal of hernia repair. No significant complications from botulinum injections for complex hernias were reported. CONCLUSION Botulinum is a significant adjunct to complex abdominal wall reconstruction. Further studies are needed to standardize protocols and create more evidence.
Collapse
Affiliation(s)
- Fotios Seretis
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimosthenis Chrysikos
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandros Samolis
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodore Troupis
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
30
|
Jain N, Upadhyay Y, Bhojwani R. Emerging Concepts in the Minimal Access Repair of Abdominal Wall Hernia—a Narrative Review. Indian J Surg 2021. [DOI: 10.1007/s12262-021-03018-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
31
|
Outcomes of mid-term and long-term degradable biosynthetic meshes in single-stage open complex abdominal wall reconstruction. Hernia 2021; 25:1647-1657. [PMID: 34097187 PMCID: PMC8182350 DOI: 10.1007/s10029-021-02415-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/12/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess clinical outcomes in patients that underwent open single-stage complex abdominal wall reconstruction (CAWR) with biosynthetic mesh. METHODS Retrospective observational study of two prospectively registered series of consecutive patients undergoing CAWR with either long-term degradable (LTD) Phasix™ or mid-term degradable (MTD) BIO-A® biosynthetic mesh in a single institution between June 2016 and December 2019. RESULTS From 169 patients with CAWR, 70 consecutive patients were identified who underwent CAWR with either LTD or MTD biosynthetic mesh. More than 85% of patients had an incisional hernia that could be classified as moderately complex to major complex due to a previous wound infection (67%), one or more complicating comorbidities (87.1%), one or more complicating hernia characteristics (75.7%) or contaminated or dirty defects (37.1%). Concomitant component separation was performed in 43 of 70 patients (61.4%). Overall surgical site infection (SSI) rate in these CAWR patients was 45.7%. Seventeen of 70 patients (24.3%) had computed tomography (CT) - and culture-confirmed SSI in direct contact of mesh, suspicious of mesh infection. Mesh removal for persistent local infection occurred in 10% (7 of 70) after a median of 229 days since surgery. Salvage rate of mesh after direct contact with infection was 58.8%. All removed meshes were in the LTD group. Seven patients (10%) had a recurrence; four patients in the LTD group (10%) had a recurrence at a median follow-up of 35 months and three patients in the MTD group (10%) at a median follow-up of 11 months. Three of the seven recurrences occurred in patients with SSI in persistent and direct contact with mesh. CONCLUSIONS Comorbid patients undergoing open complex abdominal wall reconstruction are at high risk of postoperative wound complications regardless of which type of biosynthetic mesh is used. When in persistent and direct contact with infection, long-term biodegradable biosynthetic meshes may need to be removed, whereas mid-term biodegradable biosynthetic meshes can be salvaged.
Collapse
|
32
|
Al-Mansour MR, Wu J, Gagnon G, Knee A, Romanelli J, Seymour NE. Validation of a simple technique of volumetric analysis of complex incisional hernias without 3D CT scan reconstruction. Surg Endosc 2021; 36:1936-1942. [PMID: 33860351 DOI: 10.1007/s00464-021-08476-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/28/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE Volumetric analysis is being increasingly utilized in the preoperative evaluation of complex incisional hernias. Three-dimensional (3D) reconstruction of abdominal computed tomography (CT) scan has been used to obtain surface area (SA) and volume (Vol.) measurements, while others have used simple mathematical formulas to obtain SA and Vol. estimates without 3D reconstruction. Our objective was to assess the correlation of SA and Vol. measurements and estimates of complex incisional hernias. METHODS We conducted a retrospective agreement study of adults who underwent abdominal wall reconstruction from 2007 to 2018. Demographics, hernia characteristics, and operative data were collected from the medical record. SA and Vol. measurements were obtained after 3D CT reconstruction. Linear CT variables were obtained independently by two surgeons and SA and Vol. estimates were calculated. Because both surgeons reported similar results, only lead author values are reported in the abstract. We used Pearson's correlation coefficient (r) to assess inter-rater agreement and the agreement between SA and Vol. measurements and estimates. RESULTS A total of 108 patients were eligible for analysis. The mean age was 57 ± 11 years and 53 (49%) were female. 42 (39%) hernias were recurrent, 10 (9%) patients had a stoma, and 9 (8%) had a history of open abdomen. The mean defect width was 11 ± 4 cm and mean defect surface area (DSA) was 150 ± 95 cm2. Inter-rater agreement of SA and Vol. estimates was high (r ≥ 0.80). There was high correlation between SA and Vol. measurements and estimates for DSA, hernia sac volume (HSV), abdominal cavity volume (ACV), and HSV/ACV ratio (r = 0.81, 0.89, 0.94 and 0.91, respectively). CONCLUSION SA and Vol. estimates demonstrated high level of agreement with SA and Vol. measurements using 3D reconstruction. SA and Vol. estimates can be obtained using simple mathematical formulas using easily obtained linear variables negating the need for the time and effort consuming 3D reconstruction.
Collapse
Affiliation(s)
- Mazen R Al-Mansour
- Department of Surgery, University of Massachusetts Medical School-Baystate, Springfield, MA, USA.
- Department of Surgery, University of Florida, 1600 SW Archer Rd, Gainesville, FL, 32610, USA.
| | - Jacqueline Wu
- Department of Surgery, University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - Greg Gagnon
- Department of Clinical Engineering, Baystate Medical Center, Springfield, MA, USA
| | - Alexander Knee
- Department of Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - John Romanelli
- Department of Surgery, University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - Neal E Seymour
- Department of Surgery, University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| |
Collapse
|
33
|
Fafaj A, Thomas J, Zolin SJ, Poli de Figueiredo SM, Tastaldi L, Liu PS, Petro CC, Krpata DM, Prabhu AS, Rosen MJ. Can Hernia Sac to Abdominal Cavity Volume Ratio Predict Fascial Closure Rate for Large Ventral Hernia? Reliability of the Tanaka Score. J Am Coll Surg 2021; 232:948-953. [PMID: 33831538 DOI: 10.1016/j.jamcollsurg.2021.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The hernia sac to abdominal cavity volume ratio (VR) on abdominal CT was described previously as a way to predict which hernias would be less likely to achieve fascial closure. The aim of this study was to test the reliability of the previously described cutoff ratio in predicting fascial closure in a cohort of patients with large ventral hernias. METHODS Patients who underwent elective, open incisional hernia repair of 18 cm or larger width at a single center were identified. The primary end point of interest was fascial closure for all patients. Secondary outcomes included operative details and abdominal wall-specific quality-of-life metrics. We used VR as a comparison variable and calculated the test characteristics (ie, sensitivity, specificity, and positive and negative predictive values). RESULTS A total of 438 patients were included, of which 337 (77%) had complete fascial closure and 101 (23%) had incomplete fascial closure. The VR cutoff of 25% had a sensitivity of 76% (95% CI, 71% to 80%), specificity of 64% (95% CI, 54% to 74%), positive predictive value of 88% (95% CI, 83% to 91%), and negative predictive value of 45% (95% CI, 36% to 53%). The incomplete fascial closure group had significantly lower quality of life scores at 1 year (83.3 vs 52.5; p = 0.001), 2 years (85 vs 33.3; p = 0.003), and 3 years (86.7 vs 63.3; p = 0.049). CONCLUSIONS In our study, the VR cutoff of 25% was sensitive for predicting complete fascial closure for patients with ratios below this threshold. Although there is a higher likelihood of incomplete fascial closure when VR is ≥ 25%, this end point cannot be predicted reliably. Additional studies should be done to study this ratio in conjunction with other hernia-related variables to better predict this important surgical end point.
Collapse
Affiliation(s)
- Aldo Fafaj
- Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH.
| | - Jonah Thomas
- Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Samuel J Zolin
- Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
| | | | - Luciano Tastaldi
- Department of General Surgery, University of Texas Medical Branch, University Boulevard, Galveston, TX
| | - Peter S Liu
- Department of Diagnostic Radiology, Imaging Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Clayton C Petro
- Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - David M Krpata
- Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Ajita S Prabhu
- Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Michael J Rosen
- Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
| |
Collapse
|
34
|
Afaque MY. Hernia sac volume is important in predicting difficulty in ventral hernia surgery. Hernia 2021; 25:1731-1732. [PMID: 33687573 DOI: 10.1007/s10029-021-02390-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 02/26/2021] [Indexed: 11/30/2022]
Affiliation(s)
- M Y Afaque
- Department of Surgery, J N Medical College, AMU, Aligarh (UP), India.
| |
Collapse
|
35
|
Adjunct botox to preoperative progressive pneumoperitoneum for incisional hernia with loss of domain: no additional effect but may improve outcomes. Hernia 2021; 25:1507-1517. [PMID: 33686553 DOI: 10.1007/s10029-021-02387-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 02/26/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Incisional hernia with loss of domain (IHLD) remains a surgical challenge. Its management requires complex approaches including specific preoperative and intra-operative techniques. This study focuses on the interest of adding preoperative botulinum toxin A (BTA) injection to preoperative progressive pneumoperitoneum (PPP), compared to PPP alone. MATERIAL Patients between January 2015 and March 2020 with IHLD who underwent pre-operative preparation were included. Their baseline characteristics were retrospectively analyzed, along with the characteristics of their incisional hernia before and after preparation including CT-scan volumetry. Intra-operative data, early post-operative outcomes, surgical site occurrences (SSOs) including surgical site infection (SSI) were recorded. RESULTS Four hundred and fifty (450) patients with incisional hernia were operated, including 41 patients (9.1%) with IHLD, 13 of which had both BTA and PPP, while 28 had PPP only. Both groups were comparable in term of patients and IHLD characteristics. Median increase in the volume of the abdominal cavity (VAbC) was + 55% for the entire population (+ 58.3% for the BTA-PPP group, p < 0.0001 and + 52.8% for the PPP-alone group, p < 0.0001) although the increase in volume was not different between the two groups (p = 0.99). Complete fascial closure was achieved in all patients. SSOs were more frequent in the PPP-alone group than in the BTA-PPP group (17 (60.7%) versus 3 (23.1%) patients, respectively, p = 0.043). CONCLUSION BTA and PPP are both useful in pre-operative preparation for IHLD. Combining both significantly increases the volume of abdominal cavity but associating BTA to PPP does not add any volumetric benefit but may decrease the post-operative SSO rate.
Collapse
|
36
|
Parker SG, Halligan S, Liang MK, Muysoms FE, Adrales GL, Boutall A, de Beaux AC, Dietz UA, Divino CM, Hawn MT, Heniford TB, Hong JP, Ibrahim N, Itani KMF, Jorgensen LN, Montgomery A, Morales-Conde S, Renard Y, Sanders DL, Smart NJ, Torkington JJ, Windsor ACJ. Definitions for Loss of Domain: An International Delphi Consensus of Expert Surgeons. World J Surg 2021; 44:1070-1078. [PMID: 31848677 DOI: 10.1007/s00268-019-05317-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND No standardized written or volumetric definition exists for 'loss of domain' (LOD). This limits the utility of LOD as a morphological descriptor and as a predictor of peri- and postoperative outcomes. Consequently, our aim was to establish definitions for LOD via consensus of expert abdominal wall surgeons. METHODS A Delphi study involving 20 internationally recognized abdominal wall reconstruction (AWR) surgeons was performed. Four written and two volumetric definitions of LOD were identified via systematic review. Panelists completed a questionnaire that suggested these definitions as standardized definitions of LOD. Consensus on a preferred term was pre-defined as achieved when selected by ≥80% of panelists. Terms scoring <20% were removed. RESULTS Voting commenced August 2018 and was completed in January 2019. Written definition: During Round 1, two definitions were removed and seven new definitions were suggested, leaving nine definitions for consideration. For Round 2, panelists were asked to select all appealing definitions. Thereafter, common concepts were identified during analysis, from which the facilitators advanced a new written definition. This received 100% agreement in Round 3. Volumetric definition: Initially, panelists were evenly split, but consensus for the Sabbagh method was achieved. Panelists could not reach consensus regarding a threshold LOD value that would preclude surgery. CONCLUSIONS Consensus for written and volumetric definitions of LOD was achieved from 20 internationally recognized AWR surgeons. Adoption of these definitions will help standardize the use of LOD for both clinical and academic activities.
Collapse
Affiliation(s)
- Samuel G Parker
- The Abdominal Wall Unit, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK.
| | - Steve Halligan
- UCL Centre for Medical Imaging, 2nd floor Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK
| | - Mike K Liang
- Department of Surgery, McGovern Medical Center, University of Texas Health Science Center, 5656 Kelley Street, Houston, TX, 77026, USA
| | - Filip E Muysoms
- Department of Surgery, Maria Middelares Hospital, Buitenring-Sint-Denijs 30, 9000, Ghent, Belgium
| | - Gina L Adrales
- Division of Minimally Invasive Surgery, The John Hopkins Hospital, 600 North Wolfe Street Blalock 618, Baltimore, MD, 21287, USA
| | - Adam Boutall
- The Colorectal Unit, Groote Schuur Hospital, Main Road, Observatory, Cape Town, 7925, South Africa
| | - Andrew C de Beaux
- Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK
| | - Ulrich A Dietz
- Department of Visceral, Vascular and Thoracic Surgery, Kantonal Hospital of Olten, Baselstrasse 150, Olten, 4600, Switzerland
| | - Celia M Divino
- Department of General Surgery, Department of Surgery, Mount Sinai School of Medicine, New York, NY, 10029, USA
| | - Mary T Hawn
- Department of Surgery, Stanford University Medical Center, 300 Pasteur Drive, Palo Alto, CA, 94304, USA
| | - Todd B Heniford
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1000 Blythe Boulevard, Charlotte, NC, 28203, USA
| | - Joon P Hong
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan, 88 Oympicro, 43gil Songpagu, Seoul, 05505, South Korea
| | - Nabeel Ibrahim
- Department of General Surgery, Macquarie University Hospital, 3 Technology Pl, Macquarie University, Sydney, NSW, 2109, Australia
| | - Kamal M F Itani
- Department of General Surgery, Veterans Affairs Boston Health Care System, Boston and Harvard Universities, 1400 VFW Parkway, West Roxbury, MA, 02132, USA
| | - Lars N Jorgensen
- Digestive Disease Center, Bispebjerg University Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
| | - Agneta Montgomery
- Department of Surgery, Skane University Hospital Malmo, 202 05, Malmo, Sweden
| | - Salvador Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital ''Virgen del Rocio'', Betis-65, 1, 41010, Seville, Spain
| | - Yohann Renard
- Department of General, Digestive and Endocrine Surgery, Robert-Debre´ University Hospital, University of Reims Champagne-Ardenne, Rue Cognacq-Jay, 51092, Reims Cedex, France
| | - David L Sanders
- Department of General and Upper GI Surgery, North Devon, District Hospital, Raleigh Park, Barnstaple, Devon, EX31 4JB, UK
| | - Neil J Smart
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon, EX2 5DW, England, UK
| | - Jared J Torkington
- Department of Colorectal Surgery, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - Alastair C J Windsor
- The Abdominal Wall Unit, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| |
Collapse
|
37
|
Right Colectomy with Absorbable Mesh Repair as a Salvage Solution for the Management of Giant Incisional Hernia with Loss of Domain: Results of a Bicentric Study. World J Surg 2021; 44:1762-1770. [PMID: 32016544 DOI: 10.1007/s00268-020-05395-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Incisional hernia (IH) may occur in 20% of patients after laparotomy. The hernia sac volume may be of significance, with reintegration of visceral contents potentially leading to repair failure or abdominal compartment syndrome. The present study aimed to evaluate a two-step surgical strategy comprising right colectomy for hernia reduction with synchronous absorbable mesh repair followed by definitive non-absorbable mesh repair in recurrence. METHODS Patients operated between 2012 and 2017 at two university centers were retrospectively included. Volumetric evaluation of the IH was performed by CT imaging. RESULTS Eleven patients were included. The mean BMI was 43 kg/m2 (23-52 kg/m2). Progressive preoperative pneumoperitoneum was performed in 82% of patients, with complications in 22%. The mean volumetric ratio of the volume of the hernia to the volume of the abdominal cavity was 70% (48-100%). The first parietal repair was performed using an synthetic absorbable mesh (36%), a biologic mesh (27%), or a slowly absorbable mesh (36%). No patients died as a result of the procedure. Seven (64%) patients developed grade III-IV complications, including one case of an anastomotic fistula. Recurrence occurred in eight (73%) patients after the first repair. Of these, four (50%) patients were reoperated using a non-absorbable mesh, leading to solid repair in 75% of cases. After 27 ± 18 months of follow-up, the residual IH rate was 46%. CONCLUSIONS Right colectomy for volume reduction in IH with loss of domain potentially represents an appropriate salvage option, supporting bowel reintegration and temporary hernia repair with absorbable material.
Collapse
|
38
|
Parker SG, Halligan S, Erotocritou M, Plumb AAO, Warren OJ, Windsor ACJ. What exactly is meant by 'loss of domain' for ventral hernia? A survey of 100 surgeons. ANZ J Surg 2021; 90:205-207. [PMID: 32147915 DOI: 10.1111/ans.15602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/10/2019] [Accepted: 11/11/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Samuel G Parker
- The Abdominal Wall Unit UCLH, GI Services Department, University College London Hospital, London, UK
| | - Steve Halligan
- Division of Medicine, Centre for Medical Imaging, University College London, London, UK
| | - Marios Erotocritou
- The Abdominal Wall Unit UCLH, GI Services Department, University College London Hospital, London, UK
| | - Andrew A O Plumb
- Division of Medicine, Centre for Medical Imaging, University College London, London, UK
| | - Oliver J Warren
- The Abdominal Wall Reconstruction and Hernia Unit, Chelsea and Westminster Hospital, London, UK
| | - Alastair C J Windsor
- The Abdominal Wall Unit UCLH, GI Services Department, University College London Hospital, London, UK
| |
Collapse
|
39
|
Al-Mansour MR, Wu J, Gagnon G, Knee A, Romanelli JR, Seymour NE. Linear versus volumetric CT analysis in predicting tension-free fascial closure in abdominal wall reconstruction. Hernia 2021; 25:91-98. [PMID: 33389214 DOI: 10.1007/s10029-020-02349-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/16/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Improved outcomes of abdominal wall reconstruction (AWR) have been shown when tension-free fascial closure (TFFC) is achieved. Our objective was to determine the clinical and radiologic predictors of TFFC in patients undergoing AWR. STUDY DESIGN We conducted a single institution retrospective cohort study of adults who underwent AWR between 2007 and 2018. Demographics, hernia characteristics and operative data were collected. Linear and volumetric variables were obtained from preoperative abdominal CT scans, the latter following 3D reconstruction. Logistic regression was used to evaluate predictors of TFFC. Area under the curve (AUC) ≥ 0.70 was considered to have acceptable discrimination. RESULTS A total of 108 patients were eligible for analysis. The mean age was 57 ± 11 years and 53 (49%) were female. 42 (39%) hernias were recurrent, 10 (9%) patients had a stoma and 9 (8%) had a history of open abdomen. The mean defect width was 11 ± 4 cm and mean defect surface area was 150 ± 95 cm2. The most common AWR technique was endoscopic component separation 75 (69%). TFFC was achieved in 90 (83%) patients. No demographics or 3D volumetric measures were predictive of TFFC (all AUC < 0.7). European hernia society (EHS) class M1 was predictive of failure of TFFC [AUC = 0.70; odds ratio 7.0 (referent M3); 95% confidence interval, 2.1-23.8]. Linear variables of rectus muscle separation were the most predictive of TFFC (AUC 0.73-0.77). CONCLUSION In contrast to clinical characteristics, radiologic characteristics of large incisional hernias requiring AWR are predictive of TFFC. In particular, EHS class M1 and linear variables of rectus muscle separation appear to be better predictors of TFFC than volumetric measurements.
Collapse
Affiliation(s)
- M R Al-Mansour
- Department of Surgery, University of Massachusetts Medical School-Baystate, Springfield, MA, USA.
- Department of Surgery, University of Florida, 1600 SW Archer Rd, Gainesville, FL, 32610, USA.
| | - J Wu
- Department of Surgery, University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - G Gagnon
- Department of Clinical Engineering, Baystate Medical Center, Springfield, MA, USA
| | - A Knee
- Department of Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - J R Romanelli
- Department of Surgery, University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - N E Seymour
- Department of Surgery, University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| |
Collapse
|
40
|
Quintela C, Freire L, Marrana F, Barbosa E, Guerreiro E, Ferreira F. Quaternary abdominal compartment syndrome in complex ventral hernias. INTERNATIONAL JOURNAL OF ABDOMINAL WALL AND HERNIA SURGERY 2021. [DOI: 10.4103/ijawhs.ijawhs_43_20] [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
|
41
|
Computed Tomography Image Analysis in Abdominal Wall Reconstruction: A Systematic Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3307. [PMID: 33425615 PMCID: PMC7787336 DOI: 10.1097/gox.0000000000003307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 09/01/2020] [Indexed: 12/24/2022]
Abstract
Ventral hernias are a complex and costly burden to the health care system. Although preoperative radiologic imaging is commonly performed, the plethora of anatomic features present and available in routine imaging are seldomly quantified and integrated into patient selection, preoperative risk stratification, and perioperative planning. We herein aimed to critically examine the current state of computed tomography feature application in predicting surgical outcomes. Methods A systematic review was conducted in accordance with the Preferred Reporting Items for a Systematic Review and Meta-Analysis (PRISMA) checklist. PubMed, MEDLINE, and Embase databases were reviewed under search syntax "computed tomography imaging" and "abdominal hernia" for papers published between 2000 and 2020. Results Of the initial 1922 studies, 12 papers met inclusion and exclusion criteria. The most frequently used radiologic features were hernia volume (n = 9), subcutaneous fat volume (n = 5), and defect size (n = 8). Outcomes included both complications and need for surgical intervention. Median area under the curve (AUC) and odds ratio were 0.68 (±0.16) and 1.12 (±0.39), respectively. The best predictive feature was hernia neck ratio > 2.5 (AUC 0.903). Conclusions Computed tomography feature selection offers hernia surgeons an opportunity to identify, quantify, and integrate routinely available morphologic tissue features into preoperative decision-making. Despite being in its early stages, future surgeons and researchers will soon be able to integrate 3D volumetric analysis and complex machine learning and neural network models to improvement patient care.
Collapse
|
42
|
Gu Y, Wang P, Li H, Tian W, Tang J. Chinese expert consensus on adult ventral abdominal wall defect repair and reconstruction. Am J Surg 2020; 222:86-98. [PMID: 33239177 DOI: 10.1016/j.amjsurg.2020.11.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Surgical management of patients with ventral abdominal wall defects, especially complex abdominal wall defects, remains a challenging problem for abdominal wall reconstructive surgeons. Effective surgical treatment requires appropriate preoperative assessment, surgical planning, and correct operative procedure in order to improve postoperative clinical outcomes and minimize complications. Although substantial advances have been made in surgical techniques and prosthetic technologies, there is still insufficient high-level evidence favoring a specific technique. Broad variability in existing practice patterns, including clinical pre-operative evaluation, surgical techniques and surgical procedure selection, are still common. DATA SOURCES With the purpose of providing a best practice algorithm, a comprehensive search was conducted in Medline and PubMed. Sixty-four surgeons considered as experts on abdominal wall defect repair and reconstruction in China were solicited to develop a Chinese consensus and give recommendations to help surgeons standardize their techniques and improve clinical results. CONCLUSIONS This consensus serves as a starting point to provide recommendations for adult ventral abdominal wall repair and reconstruction in China and may help build opportunities for international cooperation to refine AWR practice.
Collapse
Affiliation(s)
- Yan Gu
- Hernia and Abdominal Wall Disease Center, Shanghai Jiao Tong University, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
| | - Ping Wang
- Department of Hernia Surgery, Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - Hangyu Li
- Department of General Surgery, Fourth Hospital of China Medical University, Shenyang, 110000, China
| | - Wen Tian
- Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, 100853, China.
| | - Jianxiong Tang
- Department of General Surgery, Huadong Hospital, Fudan University, Shanghai, 200040, China.
| |
Collapse
|
43
|
Management of complex hernias with loss of domain using daily and fractioned preoperative progressive pneumoperitoneum: a retrospective single-center cohort study. Hernia 2020; 25:1499-1505. [PMID: 32926260 DOI: 10.1007/s10029-020-02298-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/02/2020] [Indexed: 01/12/2023]
Abstract
PURPOSE The incidence of complex hernias with loss of domain (CHLD) has been increasing and the treatment of these cases may require auxiliary techniques in addition to surgery. This study aims to refine the progressive preoperative pneumoperitonium (PPP) in patients with CHLD, to achieve an increased in wall dimensions. METHODS Patients presented with a CHLD undergoing PPP protocol were analyzed between May 2017 and May 2019. Our PPP protocol was to use two daily insufflations of 1000 ml of ambient air during a period of 14 days. We compared the abdominal cavity volume (ACV), the hernial sac volume (HSV) and the volume ratio (VR), before and after our refined PPP. RESULTS During our evaluation period, the protocol was performed on 16 patients. The mean age was 55.73 (± 12.87), and the mean BMI was 31.35 (± 7.33). The median of HSV was 2104.53 ml; Mean ACV was 6722.36 ml, and median of VR was 29.97% (27.46-34.38 IIQ). The averages were: daily volume of gas ± 1526.66 ml, total volume ± 17,350 ml, and the PPP period of ± 10.7 days. The increase in post-PPP ACV was 52.13% (p < 0.0001), and the VR decreased to 26.9% (p < 0.609). All patients' symptoms and complications were mild (according Clavien-Dindo grades I and II), and there were no loop injuries, no catheter complications, or any surgical re-interventions. CONCLUSION The study suggests that the use of this method results in a significant increase in ACV, and reduction of the herniated content in a safe and efficient manner, with mild complications.
Collapse
|
44
|
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]
|
45
|
Afaque MY. Assessing the complexity of ventral hernia by methods of Tanaka, Sabbagh, Carbonell, and Love. Hernia 2020; 25:557-558. [PMID: 32696149 DOI: 10.1007/s10029-020-02267-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/14/2020] [Indexed: 11/26/2022]
Affiliation(s)
- M Y Afaque
- Department of Surgery, J N Medical College, AMU, Aligarh, UP, 202002, India.
| |
Collapse
|
46
|
Park JW, Lee H, Jeon BJ, Pyon JK, Mun GH. Assessment of the risk of bulge/hernia formation after abdomen-based microsurgical breast reconstruction with the aid of preoperative computed tomographic angiography-derived morphometric measurements. J Plast Reconstr Aesthet Surg 2020; 73:1665-1674. [PMID: 32522519 DOI: 10.1016/j.bjps.2020.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 09/28/2019] [Accepted: 05/09/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND No preoperative risk assessment tool is available to predict postoperative bulge formation after abdomen-based breast reconstruction. The authors evaluated the association between clinical variables and morphometric measurements on preoperative computed tomographic (CT) angiography and postoperative abdominal wall morbidity. METHODS The authors evaluated all cases of postoperative bulge/hernia and normal controls in patients who underwent preoperative CT angiography and abdomen-based microsurgical breast reconstruction between July 2009 and January 2018. CT-based abdominal wall profiles, including abdominal wall protrusion, abdominopelvic cavity cross-sectional area (CSA), and abdominopelvic cavity-to-total body CSA ratio, were obtained and analyzed. A novel risk stratification scoring system to stratify the risk of bulge/hernia was developed. RESULTS Among 463 patients who underwent abdomen-based breast reconstruction, 23 were diagnosed as having a bulge/hernia. Age (OR 2.912; 95% CI 1.157-7.333), lateral row perforator (OR 5.065; 95% CI 1.834-13.986), and abdominal wall protrusion (OR 3.687; 95% CI 1.494-9.100) were significant risk factors associated with postoperative bulge/hernia in the multivariate analysis. Using the risk stratification scoring system, the incidence rates of postoperative bulge/hernia were 1.7%, 4.8%, and 19.0% for low-, intermediate-, and high-risk patients, respectively (p<0.001). CONCLUSIONS Age, lateral row perforator, and abdominal wall protrusion were significantly associated with postoperative bulge/hernia formation after abdomen-based microsurgical breast reconstruction. The authors' risk score based on the three variables may help predict and minimize donor-site morbidity.
Collapse
Affiliation(s)
- Jin-Woo Park
- Department of Plastic Surgery, Ewha Womans University Mokdong Hospital, College of Medicine, Ewha Womans University, 1071, Anyangcheon-ro, Yangcheon-gu, Seoul 07985, Republic of Korea
| | - Hojune Lee
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Byung-Joon Jeon
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Jai-Kyong Pyon
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Goo-Hyun Mun
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea.
| |
Collapse
|
47
|
Love MW, Warren JA, Davis S, Ewing JA, Hall AM, Cobb WS, Carbonell AM. Computed tomography imaging in ventral hernia repair: can we predict the need for myofascial release? Hernia 2020; 25:471-477. [PMID: 32277369 DOI: 10.1007/s10029-020-02181-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 03/25/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Currently, the need for additional myofascial release (AMR) in addition to retromuscular dissection during open Rives-Stoppa hernia repair is determined intraoperatively based on the discretion of the surgeon. We developed a novel method to objectively predict the need for AMR preoperatively using computed tomography (CT)-measured rectus width to hernia width ratio (RDR). METHODS A retrospective chart review of all patients who underwent open retro-muscular mesh repair of midline ventral hernia between August 1, 2007 and February 1, 2018, who had a preoperative CT scan within 1 year prior to their operation. The primary endpoint was the ability of the defect ratio to predict the need for AMR in pursuit of fascial closure. The secondary endpoint was the ability of Component Separation Index (CSI) to predict the need for AMR to obtain fascial closure. RESULTS Of 342 patients, 208 repaired with rectus abdominis release alone (RM group), while 134 required AMR (RM + group). An RDR of > 1.34 on area under the curve analysis predicted the need for AMR with 77.6% accuracy. There was a linear decrease in the need for AMR with increasing RDR: RDR < 1 required AMR in 78.8% of cases, RDR 1.1-1.49 in 52%, RDR 1.5-1.99 in 32.1%, and RDR > 2 in just 10.8%. Similarly, CSI > 0.146 predicted the need for AMR with 76.3% accuracy on area under the curve analysis. CONCLUSION The RDR is a practical and reliable tool to predict the ability to close the defect during open Rives-Stoppa ventral hernia repair without AMR. An RDR of > 2 portends fascial closure with rectus abdominis myofascial release alone in 90% of cases.
Collapse
Affiliation(s)
- M W Love
- Division of Minimal Access and Bariatric Surgery, Department of Surgery, Prisma Health-Upstate, Greenville, SC, USA
| | - J A Warren
- Division of Minimal Access and Bariatric Surgery, Department of Surgery, University of South Carolina School of Medicine Greenville, Prisma Health-Upstate, 701 Grove Rd. ST3, Greenville, SC, 29605, USA.
| | - S Davis
- Division of Minimal Access and Bariatric Surgery, Department of Surgery, Prisma Health-Upstate, Greenville, SC, USA
| | - J A Ewing
- Health Sciences Center, Prisma Health-Upstate, Greenville, SC, USA
| | - A M Hall
- Division of Minimal Access and Bariatric Surgery, Department of Surgery, Prisma Health-Upstate, Greenville, SC, USA
| | - W S Cobb
- Division of Minimal Access and Bariatric Surgery, Department of Surgery, University of South Carolina School of Medicine Greenville, Prisma Health-Upstate, 701 Grove Rd. ST3, Greenville, SC, 29605, USA
| | - A M Carbonell
- Division of Minimal Access and Bariatric Surgery, Department of Surgery, University of South Carolina School of Medicine Greenville, Prisma Health-Upstate, 701 Grove Rd. ST3, Greenville, SC, 29605, USA
| |
Collapse
|
48
|
Preoperative Progressive Pneumoperitoneum Enables Defect Closure and Laparoscopic Repair of Large Parastomal Hernias. Surg Laparosc Endosc Percutan Tech 2020; 30:123-128. [DOI: 10.1097/sle.0000000000000759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
49
|
Mancini A, Mougin N, Venchiarutti V, Shen Z, Risse O, Abba J, Arvieux C. Goni Moreno progressive preoperative pneumoperitoneum for giant hernias: a monocentric retrospective study of 162 patients. Hernia 2020; 24:545-550. [DOI: 10.1007/s10029-019-02113-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 12/23/2019] [Indexed: 11/24/2022]
|
50
|
Oprea V, Rosian M, Mardale S, Grad O. Is transversus abdominis muscle release sustainable for the reconstruction of peritoneal volumes? A retrospective computed tomography study. INTERNATIONAL JOURNAL OF ABDOMINAL WALL AND HERNIA SURGERY 2020. [DOI: 10.4103/ijawhs.ijawhs_49_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|