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Salvino MJ, Ayuso SA, Lorenz WR, Holland AM, Kercher KW, Augenstein VA, Heniford BT. Open repair of flank and lumbar hernias: 142 consecutive repairs at a high-volume hernia center. Am J Surg 2024; 234:136-142. [PMID: 38627142 DOI: 10.1016/j.amjsurg.2024.04.014] [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: 01/27/2024] [Accepted: 04/10/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Flank and lumbar hernias (FLH) are challenging to repair. This study aimed to establish a reproducible management strategy and analyze elective flank and lumbar repair (FLHR) outcomes from a single institution. METHODS A prospective analysis using a hernia-specific database was performed examining patients undergoing open FLHR between 2004 and 2021. Variables included patient demographics and operative characteristics. RESULTS Of 142 patients, 106 presented with flank hernias, and 36 with lumbar hernias. Patients, primarily ASA Class 2 or 3, exhibited a mean age of 57.0 ± 13.4 years and BMI of 30.2 ± 5.7 kg/m2. Repairs predominantly utilized synthetic mesh in the preperitoneal space (95.1 %). After 29.9 ± 13.1 months follow-up, wound infections occurred in 8.3 %; hernia recurrence was 3.5 %. At 6 months postoperatively, 21.2 % of patients reported chronic pain with two-thirds of these individuals having preoperative pain. CONCLUSIONS Open preperitoneal FLHR provides a durable repair with low complication and hernia recurrence rates over 2.5 years of follow-up.
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Affiliation(s)
- Matthew J Salvino
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Sullivan A Ayuso
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - William R Lorenz
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Alexis M Holland
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Kent W Kercher
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Vedra A Augenstein
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - B Todd Heniford
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA.
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2
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Calcerrada Alises E, Antón Rodríguez C, Medina Pedrique M, Berrevoet F, Cuccurullo D, López Cano M, Stabilini C, Garcia-Urena MA. Systematic review and meta-analysis of the incidence of incisional hernia in urological surgery. Langenbecks Arch Surg 2024; 409:166. [PMID: 38805110 DOI: 10.1007/s00423-024-03354-4] [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: 01/09/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE To evaluate the incidence of incisional hernia in patients undergoing direct access to the abdominal cavity in urological surgery. METHODS We conducted a systematic review in Pubmed, Embase, and Cochrane Central from 1980 to the present according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Eighty-four studies were selected for inclusion in this analysis, and meta-analysis and meta-regression were performed. RESULTS The total incidence in the 84 studies was 4.8% (95% CI 3.7% - 6.2%) I2 93.84%. Depending on the type of incision, it was higher in the open medial approach: 7.1% (95% CI 4.3%-11.8%) I2 92.45% and lower in laparoscopic surgery: 1.9% (95% CI 1%-3.4%) I2 71, 85% According to access, it was lower in retroperitoneal: 0.9% (95% CI 0.2%-4.8%) I2 76.96% and off-midline: 4.7% (95% CI 3.5%-6.4%) I2 91.59%. Regarding the location of the hernia, parastomal hernias were more frequent: 15.1% (95% CI 9.6% - 23%) I2 77.39%. Meta-regression shows a significant effect in reducing the proportion of hernias in open lateral, laparoscopic and hand-assisted compared to medial open access. CONCLUSION The present review finds the access through the midline and stomas as the ones with the highest incidence of incisional hernia. The use of the lateral approach or minimally invasive techniques is preferable. More prospective studies are warranted to obtain the real incidence of incisional hernias and evaluate the role of better techniques to close the abdomen.
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Affiliation(s)
- Enrique Calcerrada Alises
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario del Sureste, Madrid, Spain.
- Grupo de Investigación de Pared Abdominal Compleja, Universidad Francisco de Vitoria, Madrid, Spain.
| | - Cristina Antón Rodríguez
- Grupo de Investigación de Pared Abdominal Compleja, Universidad Francisco de Vitoria, Madrid, Spain
| | - Manuel Medina Pedrique
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario del Henares, Madrid, Spain
| | - Frederick Berrevoet
- Department of General and Hepatobiliary Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Diego Cuccurullo
- Department of Surgery, Ospedale Monaldi-Azienda Ospedaliera Dei Colli, Naples, Italy
| | - Manuel López Cano
- Abdominal Wall Surgery Unit, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
- Vall d'Hebron Research Institute General and Gastrointestinal Surgery Research Group, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Cesare Stabilini
- Department of Surgery (DiSC), University of Genoa, IRCCS Policlinico San Martino, Genoa, Italy
| | - Miguel Angel Garcia-Urena
- Grupo de Investigación de Pared Abdominal Compleja, Universidad Francisco de Vitoria, Madrid, Spain
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario del Henares, Madrid, Spain
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3
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Martínez-López P, Rodrigues-Gonçalves V, Verdaguer-Tremolosa M, Pereira JA, Hernández-Granados P, López-Cano M. Lateral incisional hernia. EVEREG registry analysis. Hernia 2024:10.1007/s10029-024-03073-1. [PMID: 38771440 DOI: 10.1007/s10029-024-03073-1] [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: 02/02/2024] [Accepted: 05/12/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND The aim of this study is to analyze the data collected on lateral incisional hernias (LIH) in the National Incisional Hernia Registry (EVEREG) and assess current practices and outcomes in LIH repair. METHODS A retrospective cohort study was conducted using LIH data recorded over 10 years (2012-2022). Comorbidities, hernia characteristics, short-term complications, and recurrences were studied, along with their association with the type of approach used, either open or laparoscopic, in elective surgery. RESULTS 1742 LIH cases were studied. According to the EHS classification, these included L1 409 (23.5%), L2 388 (22.3%), L3 565 (32.4%), L4 150 (8.6%) and combined 230 (13.2%). An open approach was performed in 1528 (87.7%) cases and laparoscopic in 214 (12.3%). The median age was 66 ± 12.45 years, with a majority of males, 934 (53.6%). The median body mass index was 29 ± 5.18 kg/m2. The most observed comorbidity was arterial hypertension (957 patients, 55%). A specialist was present in 638 interventions (56%). The 24-month follow-up was 17.9%, and recurrence in those cases was 27.2%, with a higher incidence when there was no specialist present during the intervention, onlay mesh position, and larger defect size. CONCLUSIONS Surgery for LIH is common, although laparoscopic approach remains infrequent. Furthermore, it is associated with a high percentage of recurrences that increases when there is no specialist in abdominal wall surgery present.
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Affiliation(s)
- P Martínez-López
- Abdominal Wall Surgery Unit, General Surgery Service, Hospital Universitari Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.
| | - V Rodrigues-Gonçalves
- Abdominal Wall Surgery Unit, General Surgery Service, Hospital Universitari Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - M Verdaguer-Tremolosa
- Abdominal Wall Surgery Unit, General Surgery Service, Hospital Universitari Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - J A Pereira
- General Surgery Service, Department of Experimental and Health Sciences, Hospital Universitari del Mar, Pompeu Fabra University, Barcelona, Spain
| | | | - M López-Cano
- Abdominal Wall Surgery Unit, General Surgery Service, Hospital Universitari Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
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Abu-Jeyyab M, Al-Jafari M, AlKhawaldeh IM, Eddin SZ, Tapanjeh SA, Ja’Awin M, Aborajooh E, Nashwan AJ. Incarcerated incisional hernia on an old orthopedics incision, a rare case report and a review of the literature. J Surg Case Rep 2024; 2024:rjae369. [PMID: 38826863 PMCID: PMC11140507 DOI: 10.1093/jscr/rjae369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 05/14/2024] [Indexed: 06/04/2024] Open
Abstract
A previous surgical incision can lead to an abdominal wall defect known as an incisional hernia. The protrusion of abdominal viscera, particularly bowel loops, through this defect can result in various complications and affect organ function. Bowel loops are frequently involved and can lead to incarceration, obstruction or even strangulation. A 38-year-old male with a history of open reduction internal fixation for the left iliac wing presented with abdominal pain, vomiting and obstipation. Abdominal examination revealed a tender, distended abdominal area with swelling on the left hip. Radiological examination revealed bowel obstruction at the previous surgery site. During surgery, an incisional hernia was confirmed, and the bowel was found viable. Incisional hernias can occur even many years after primary surgery and may remain asymptomatic until complications arise. Elective hernial repair is recommended in some cases, such as the one presented here, as complications can be fatal.
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Affiliation(s)
- Mohammad Abu-Jeyyab
- Faculty of Medicine, Mutah University, Al-Karak 61710, Jordan
- Red Crescent Hospital, Amman, Jordan
| | - Mohammad Al-Jafari
- Faculty of Medicine, Mutah University, Al-Karak 61710, Jordan
- Jameel Al-Totanji Hospital, Amman, Jordan
| | | | | | | | | | - Emad Aborajooh
- General Surgery and Anesthesia Department, Faculty of Medicine, Mutah University, Al-Karak 61710, Jordan
| | - Abdulqadir J Nashwan
- Nursing & Midwifery Research Department, Hamad Medical Corporation, Doha 3050, Qatar
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5
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Tran E, Summers Z, Parker D, Townend P. Open sandwich mesh repair of a large recurrent incisional flank hernia. BMJ Case Rep 2024; 17:e259361. [PMID: 38670564 PMCID: PMC11057313 DOI: 10.1136/bcr-2023-259361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2024] [Indexed: 04/28/2024] Open
Affiliation(s)
- Elisa Tran
- RBWH, Herston, Queensland, Australia
- Medicine and Dentistry, Griffith University School of Medicine and Dentistry, Gold Coast, Queensland, Australia
| | - Zara Summers
- General Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
| | - David Parker
- General Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Philip Townend
- General Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
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Saiding Q, Chen Y, Wang J, Pereira CL, Sarmento B, Cui W, Chen X. Abdominal wall hernia repair: from prosthetic meshes to smart materials. Mater Today Bio 2023; 21:100691. [PMID: 37455815 PMCID: PMC10339210 DOI: 10.1016/j.mtbio.2023.100691] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/15/2023] [Accepted: 06/03/2023] [Indexed: 07/18/2023] Open
Abstract
Hernia reconstruction is one of the most frequently practiced surgical procedures worldwide. Plastic surgery plays a pivotal role in reestablishing desired abdominal wall structure and function without the drawbacks traditionally associated with general surgery as excessive tension, postoperative pain, poor repair outcomes, and frequent recurrence. Surgical meshes have been the preferential choice for abdominal wall hernia repair to achieve the physical integrity and equivalent components of musculofascial layers. Despite the relevant progress in recent years, there are still unsolved challenges in surgical mesh design and complication settlement. This review provides a systemic summary of the hernia surgical mesh development deeply related to abdominal wall hernia pathology and classification. Commercial meshes, the first-generation prosthetic materials, and the most commonly used repair materials in the clinic are described in detail, addressing constrain side effects and rational strategies to establish characteristics of ideal hernia repair meshes. The engineered prosthetics are defined as a transit to the biomimetic smart hernia repair scaffolds with specific advantages and disadvantages, including hydrogel scaffolds, electrospinning membranes, and three-dimensional patches. Lastly, this review critically outlines the future research direction for successful hernia repair solutions by combing state-of-the-art techniques and materials.
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Affiliation(s)
- Qimanguli Saiding
- Shanghai Key Laboratory of Embryo Original Diseases, The International Peace Maternal and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, 910 Hengshan Road, Shanghai, 200030, PR China
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, PR China
| | - Yiyao Chen
- Shanghai Key Laboratory of Embryo Original Diseases, The International Peace Maternal and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, 910 Hengshan Road, Shanghai, 200030, PR China
| | - Juan Wang
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, PR China
| | - Catarina Leite Pereira
- I3S – Instituto de Investigação e Inovação Em Saúde and INEB – Instituto de Engenharia Biomédica, Universidade Do Porto, Rua Alfredo Allen 208, 4200-135, Porto, Portugal
| | - Bruno Sarmento
- I3S – Instituto de Investigação e Inovação Em Saúde and INEB – Instituto de Engenharia Biomédica, Universidade Do Porto, Rua Alfredo Allen 208, 4200-135, Porto, Portugal
- IUCS – Instituto Universitário de Ciências da Saúde, CESPU, Rua Central de Gandra 1317, 4585-116, Gandra, Portugal
| | - Wenguo Cui
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, PR China
| | - Xinliang Chen
- Shanghai Key Laboratory of Embryo Original Diseases, The International Peace Maternal and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, 910 Hengshan Road, Shanghai, 200030, PR China
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7
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Kelly-Schuette KA, DeVitis J, Conway R, Banks-Venegoni A. Operative Repair of a Lateral Abdominal Dehiscence After External Oblique Release for Component Separation. Am Surg 2023; 89:1191-1193. [PMID: 33377804 DOI: 10.1177/0003134820982551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kathrine A Kelly-Schuette
- Spectrum Health/Michigan State University College of Human Medicine General Surgery Residency, Grand Rapids, MI, USA
| | - Joesph DeVitis
- Spectrum Health/Michigan State University College of Human Medicine Surgical Critical Care Fellowship, Grand Rapids, MI, USA
| | - Ryan Conway
- Spectrum Health/Michigan State University College of Human Medicine General Surgery Residency, Grand Rapids, MI, USA
- Spectrum Health Medical Group, Grand Rapids, MI, USA
| | - Amy Banks-Venegoni
- Spectrum Health/Michigan State University College of Human Medicine General Surgery Residency, Grand Rapids, MI, USA
- Spectrum Health Medical Group, Grand Rapids, MI, USA
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8
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Medina Pedrique M, Robin Valle de Lersundi Á, Avilés Oliveros A, Ruiz SM, López-Monclús J, Munoz-Rodriguez J, Blázquez Hernando LA, Martinez Caballero J, García-Urena MÁ. Incisions in Hepatobiliopancreatic Surgery: Surgical Anatomy and its Influence to Open and Close the Abdomen. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2023; 2:11123. [PMID: 38312419 PMCID: PMC10831649 DOI: 10.3389/jaws.2023.11123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 02/28/2023] [Indexed: 02/06/2024]
Abstract
Incisions performed for hepato-pancreatic-biliary (HPB) surgery are diverse, and can be a challenge both to perform correctly as well as to be properly closed. The anatomy of the region overlaps muscular layers and has a rich vascular and nervous supply. These structures are fundamental for the correct functionality of the abdominal wall. When performing certain types of incisions, damage to the muscular or neurovascular component of the abdominal wall, as well as an inadequate closure technique may influence in the development of long-term complications as incisional hernias (IH) or bulging. Considering that both may impair quality of life and that are complex to repair, prevention becomes essential during these procedures. With the currently available evidence, there is no clear recommendation on which is the better incision or what is the best method of closure. Despite the lack of sufficient data, the following review aims to correlate the anatomical knowledge learned from posterior component separation with the incisions performed in hepato-pancreatic-biliary (HPB) surgery and their consequences on incisional hernia formation. Overall, there is data that suggests some key points to perform these incisions: avoid vertical components and very lateral extensions, subcostal should be incised at least 2 cm from costal margin, multilayered suturing using small bites technique and consider the use of a prophylactic mesh in high-risk patients. Nevertheless, the lack of evidence prevents from the possibility of making any strong recommendations.
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Affiliation(s)
- Manuel Medina Pedrique
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Madrid, Spain
| | - Álvaro Robin Valle de Lersundi
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Madrid, Spain
| | - Adriana Avilés Oliveros
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Madrid, Spain
| | - Sara Morejón Ruiz
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Madrid, Spain
| | - Javier López-Monclús
- General and Digestive Surgery Department, Hospital Universitario Puerta de Hierro, Autónoma University of Madrid, Madrid, Spain
| | - Joaquín Munoz-Rodriguez
- General and Digestive Surgery Department, Hospital Universitario Puerta de Hierro, Autónoma University of Madrid, Madrid, Spain
| | - Luis Alberto Blázquez Hernando
- General and Digestive Surgery Department, Hospital Universitario Ramón y Cajal, Alcalá de Henares University Madrid, Madrid, Spain
| | - Javier Martinez Caballero
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Madrid, Spain
| | - Miguel Ángel García-Urena
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Madrid, Spain
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Marte G, Tufo A, Ferronetti A, Di Maio V, Russo R, Sordelli IF, De Stefano G, Maida P. Posterior component separation with TAR: lessons learned from our first consecutive 52 cases. Updates Surg 2022; 75:723-733. [PMID: 36355329 DOI: 10.1007/s13304-022-01418-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 11/01/2022] [Indexed: 11/12/2022]
Abstract
Patients with complex incisional hernia (IH) is a growing and challenging category that surgeons are facing in daily practice and represent indeed a technical challenge for most of them. The posterior component separation with TAR (PCS-TAR) has become the procedure of choice to repair most complex abdominal wall defects, including those with loss of domain, subxiphoid, subcostal, parastomal or after trauma and sepsis treated initially with "open abdomen" and in those scenarios in which the fascia closure was not performed to avoid an abdominal compartment syndrome. Most recent studies showed that the PCS-TAR represents a valid procedure in recurrent IH. The purpose of our study is to evaluate the reproducibility of the PCS-TAR, describing our experience, our surgical technique and the rate of postoperative complications and recurrences in a cohort of consecutive patients. 52 consecutive patients with complex IH, who underwent PCS-TAR at "Betania Hospital and Ospedale del Mare Hospital" in Naples between May 2014 and November 2019 were identified from a prospectively maintained database and reviewed retrospectively. There were 36 males (69%) and 16 females (31%) with a mean age of 57.88 (range 39-76) and Body mass index (BMI kg/m2) of 31.2 (24-45). More than half of patients (58%) were active smokers. Mean defect width was 13.6 cm (range 6-30) and mean defect area was about 267.9 cm2. Mean operative time was 228 min. Posterior fascial closure was reached in all cases, while anterior fascial closure only in 29 cases (56%). Mean hospital stay was 5.7 days. 27% of patients developed minor complications (Clavien-Dindo grade I-II) and one case (1.9%) major complication (Clavien-Dindo III). Seroma was registered in 23% of cases. SSI was reported to be 3.8% with no deep wound infection. Recurrence rate was 1.9% in a mean follow-up of 28 months. In Univariate analysis Bio-A surface > 600 cm2 and drain removal at discharge were significantly associated with major complications, while in a multivariate analysis only Bio-A surface > 600 cm2 was related. Considering univariate analysis for recurrences, number of drains, SSO, Clavien-Dindo score > 2 and defect area were significantly associated with recurrence, while in a multivariate analysis no variables were related. PCS-TAR is an indispensable tool in managing complex ventral hernias associated with a low rate of SSO and recurrence. Tobacco use, obesity and comorbidities cannot be considered absolute contraindications to PCS-TAR. Peri and postoperative management of complications and drainages have an impact on short term outcomes. Based on these outcomes, posterior component separation with transversus abdominis release has become our method of choice for the management of patients with complex ventral hernia requiring open hernia repair in selected patients.
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10
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Schaaf S, Willms A, Adolf D, Schwab R, Riediger H, Köckerling F. What are the influencing factors on the outcome in lateral incisional hernia repair? A registry-based multivariable analysis. Hernia 2022; 27:311-326. [PMID: 36333478 PMCID: PMC10125930 DOI: 10.1007/s10029-022-02690-y] [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: 07/26/2022] [Accepted: 09/15/2022] [Indexed: 11/06/2022]
Abstract
Abstract
Introduction
Incisional hernias following lateral abdominal wall incisions with an incidence of 1–4% are less common than following medial incisions at 14–19%. The proportion of lateral incisional hernias in the total collective of all incisional hernias is around 17%. Compared to midline defects, lateral incisional hernias are more difficult to repair because of the more complex anatomy and localization. A recent systematic review identified only 11 publications with a total of 345 patients reporting on lateral incisional hernia repair. Therefore, further studies are urgently needed.
Methods
Multivariable analysis of the data available for 6,306 patients with primary elective lateral incisional hernia repair was performed to assess the confirmatory pre-defined potential influence factors and their association with the perioperative and one-year follow-up outcomes.
Results
In primary elective lateral incisional hernia repair, open onlay, open IPOM and suture procedures were found to have an unfavorable effect on the recurrence rate. This was also true for larger defect sizes and higher BMI. A particularly unfavorable relationship was identified between larger defect sizes and perioperative complications. Laparoscopic-IPOM presented a higher risk of intraoperative, and open sublay of postoperative, complications. The chronic pain rates were especially unfavorably influenced by the postoperative complications, preoperative pain and female gender.
Conclusion
Open-onlay, open IPOM and suture procedures, larger defect sizes, female gender, higher BMI, preoperative pain and postoperative complications are associated with unfavorable outcomes following primary elective lateral incisional hernia repair.
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Affiliation(s)
- S Schaaf
- Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital Koblenz, Rübenacher Str. 170, 56072, Koblenz, Germany
| | - A Willms
- Department of General, Visceral and Vascular Surgery, Armed Forces Hospital Hamburg, Lesserstraße 180, 22049, Hamburg, Germany.
| | - D Adolf
- StatConsult GmbH, Am Fuchsberg 11, 39112, Magdeburg, Germany
| | - R Schwab
- Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital Koblenz, Rübenacher Str. 170, 56072, Koblenz, Germany
| | - H Riediger
- Hernia Center, Vivantes Humboldt Hospital, Academic Teaching Hospital of Charité, University Medicine, Am Nordgraben 2, 13509, Berlin, Germany
| | - F Köckerling
- Hernia Center, Vivantes Humboldt Hospital, Academic Teaching Hospital of Charité, University Medicine, Am Nordgraben 2, 13509, Berlin, Germany
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Khetan M, Kalhan S, John S, Sethi D, Kannaujiya P, Ramana B. MIS retromuscular repair of lateral incisional hernia: technological deliberations and short-term outcome. Hernia 2022; 26:1325-1336. [DOI: 10.1007/s10029-022-02671-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 08/30/2022] [Indexed: 11/29/2022]
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12
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Hernández-Villafranca S, Qian-Zhang S, Silla IO, de Molina Rampérez MLS, Alises EC, Sánchez C, Pardo R, Vilarrasa MF, Villarejo-Campos P, Salido S. Extended totally extraperitoneal (eTEP) treatment for lateral primary and incisional hernias. New approach to old problems. Hernia 2022; 26:1541-1549. [PMID: 35657487 DOI: 10.1007/s10029-022-02626-6] [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: 01/30/2022] [Accepted: 04/23/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe the eTEP approach for treating lateral primary and incisional hernia and show its results in a prospective series of cases. METHODS A descriptive prospective study with patients treated surgically for lateral hernias using eTEP approach. Every patient was operated by the same surgeon from November 2018 to December 2021. Inclusion criteria were primary and incisional hernia, lateral and W1 and W2 sized using the EHS classification. Exclusion criteria were W3 hernia, loss of domain, need to remove previous mesh, dystrophic or ulcerative skin, history of previous complex surgery. Details of the surgical technique are described. RESULTS 34 patients were operated. Median age was 65 years old and BMI, 29.9 (22.1-47.1). There were several locations being the most frequent L3 in 18 patients. The median length was 41 mm (10-129) and width, 44 mm (10-97). The median of defect-mesh ratio was 5.05 (0.9-447.64). TAR was practised in 21 patients (61.8%). Only one patient suffered a clinically relevant complication, being a hematoma (Dindo-Clavien II). 50% of patients were operated in ambulatory surgery. After a median follow-up of 13.5 months, only one recurrence has been reported (2.9%). CONCLUSION eTEP to treat lateral hernias is feasible and reproducible showing good results in terms of hernia recurrence and complications. A further prospective randomized clinical trial is needed to support these results.
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Affiliation(s)
- S Hernández-Villafranca
- Department of General Surgery and Digestive System, Fundación Jiménez Díaz Hospital, Avda. Reyes Católicos 2, 28040, Madrid, Spain.
| | - S Qian-Zhang
- Department of General Surgery and Digestive System, Fundación Jiménez Díaz Hospital, Avda. Reyes Católicos 2, 28040, Madrid, Spain
| | - I O Silla
- Department of General Surgery and Digestive System, Fundación Jiménez Díaz Hospital, Avda. Reyes Católicos 2, 28040, Madrid, Spain
| | - M L S de Molina Rampérez
- Department of General Surgery and Digestive System, Fundación Jiménez Díaz Hospital, Avda. Reyes Católicos 2, 28040, Madrid, Spain
| | - E C Alises
- Department of General Surgery and Digestive System, Fundación Jiménez Díaz Hospital, Avda. Reyes Católicos 2, 28040, Madrid, Spain
| | - C Sánchez
- Department of General Surgery and Digestive System, 12 Octubre Hospital, Madrid, Spain
| | - R Pardo
- Royal Bolton NHS Foundation Trust, Bolton, UK
| | - M F Vilarrasa
- Department of General Surgery and Digestive System, Villalba General Hospital, Madrid, Spain
| | - P Villarejo-Campos
- Department of General Surgery and Digestive System, Fundación Jiménez Díaz Hospital, Avda. Reyes Católicos 2, 28040, Madrid, Spain
| | - S Salido
- Department of General Surgery and Digestive System, Fundación Jiménez Díaz Hospital, Avda. Reyes Católicos 2, 28040, Madrid, Spain
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13
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Köhler G, Kaltenböck R, Fehrer HJ, Függer R, Gangl O. [Management of lateral abdominal wall hernias]. Chirurg 2021; 93:373-380. [PMID: 34812906 DOI: 10.1007/s00104-021-01537-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2021] [Indexed: 11/29/2022]
Abstract
Lateral abdominal wall hernias are rare and inconsistently defined, which is why the use of the European Hernia Society classification makes sense, not least for the purpose of comparing the quality of surgical results. A distinction must be made between true fascial defects and denervation atrophy. Based on the available literature, there is generally a low level of evidence with no consensus on the best operative strategy. The proximity to bony structures and the complex anatomy of the three-layer abdominal wall make the technical treatment of lateral hernias difficult. The surgical variations include laparoendoscopic, robotic, minimally invasive, open or hybrid approaches with different mesh positions in relation to the layers of the abdominal wall. The extensive preperitoneal mesh reinforcement open, transabdominal peritoneal (TAPP) laparoscopic repair or total extraperitoneal (TEP) endoscopic repair has met with the greatest approval. The extent of the required medial mesh overlap is determined by the distance between the medial defect boundary and the lateral edge of the straight rectus abdominus muscles. The medially directed preperitoneal and retroperitoneal dissection can be extended into the homolateral retrorectus compartment by laterally incising the posterior rectus sheath or by crossing the midline behind the intact linea alba into the contralateral retrorectus compartment. The intraperitoneal onlay mesh (IPOM) technique is a suitable procedure only for smaller defects with possible defect closure but it is also important as an exit strategy in the case of a defective peritoneum. Individualized prehabilitative and preconditioning measures are just as important as the assessment of preoperative anamnestic and clinical findings and risks with radiographic cross-sectional imaging diagnostics.
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Affiliation(s)
- Gernot Köhler
- Abteilung für Allgemein und Viszeralchirurgie, Klinikum Rohrbach, Krankenhausstraße 1, 4150, Rohrbach, Österreich. .,Universitätsklinik für Chirurgie, Paracelsus Medizinische Universität Salzburg, Salzburg, Österreich.
| | - Richard Kaltenböck
- Abteilung für Allgemein, Viszeral, Gefäß, Thorax und Transplantationschirurgie, Ordensklinikum Linz, Linz, Österreich
| | - Hans-Jörg Fehrer
- Abteilung für Allgemein, Viszeral, Gefäß, Thorax und Transplantationschirurgie, Ordensklinikum Linz, Linz, Österreich.,Abteilung für Allgemein und Viszeralchirurgie, Kepler Universitätsklinikum Linz, Linz, Österreich
| | - Reinhold Függer
- Abteilung für Allgemein, Viszeral, Gefäß, Thorax und Transplantationschirurgie, Ordensklinikum Linz, Linz, Österreich.,Abteilung für Allgemein und Viszeralchirurgie, Kepler Universitätsklinikum Linz, Linz, Österreich
| | - Odo Gangl
- Abteilung für Allgemein, Viszeral, Gefäß, Thorax und Transplantationschirurgie, Ordensklinikum Linz, Linz, Österreich
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14
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Hermann M, Gustafsson O, Sundqvist P, Sandblom G. Rate of incisional hernia after minimally invasive and open surgery for renal cell carcinoma: a nationwide population-based study. Scand J Urol 2021; 55:372-376. [PMID: 34286660 DOI: 10.1080/21681805.2021.1953579] [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] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To determine the rate of incisional hernia after surgery for renal cell carcinoma, to compare the rate after open vs minimally invasive surgery and radical nephrectomy vs partial nephrectomy and to identify risk factors for incisional hernia. MATERIALS AND METHODS From the Renal Cell Cancer Database Sweden we identified all patients (n = 9,638) diagnosed with renal cell carcinoma in Sweden between January 2005 and November 2015. Of these, 6,417 were included in the analyses to determine comorbidity and subsequent diagnosis of or surgery for incisional hernia. RESULTS In all, 6,417 patients underwent surgery for renal cell carcinoma between January 2005 and November 2015, of these 5,216 (81%) underwent open surgery and 1,201 (19%) underwent minimally invasive surgery. Altogether 140 patients were diagnosed with incisional hernia. The cumulative rate of incisional hernia after 5 years was 5.2% (95% confidence interval [CI] = 4.0-6.4%) after open surgery and 2.4% (95% CI = 1.0-3.4%) after minimally invasive surgery (p < 0.05). In Cox proportional hazard analysis, age and left-sided surgery were associated with incisional hernia in the open surgery group (both p < 0.05), whereas in the minimally invasive group, no statistically significant risk factors for incisional hernia were found. CONCLUSIONS Open surgery for renal cell carcinoma is associated with a significantly higher risk for developing incisional hernia. If open surgery is the only option, care should be taken when choosing the approach and closing the wound. More studies are needed to find strategies to reduce the risk of abdominal wall complications following open kidney surgery.
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Affiliation(s)
- Maria Hermann
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institute, Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Ove Gustafsson
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institute, Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Pernilla Sundqvist
- Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Gabriel Sandblom
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institute, Stockholm, Department of Surgery, Södersjukhuset, Stockholm, Sweden
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15
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Kranz J, Grundl S, Wußow F, Steffens J, Anheuser P, Schneidewind L. Permanent Flank Bulge after Flank Incision: Patient- and Physician-Reported Outcome. Urol Int 2021; 106:387-396. [PMID: 34284406 DOI: 10.1159/000517288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/29/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of this study was to determine the incidence and risk factors for postoperative flank bulging and associated physiologic/psychologic consequences as well as to establish a clinical flank bulge classification system after open retroperitoneal surgery. METHODS In this retrospective study, a postal patient survey was sent to 240 patients who underwent open retroperitoneal surgery between 2007 and 2017. Patients, who reported a flank bulge, were invited for further evaluation, which included a clinical examination and standardized photo documentation. RESULTS Forty-three of 120 patients (35.8%) reported a flank bulging after retroperitoneal surgery. During clinical examination, a flank bulge could be confirmed in 25 patients, whereas in 18 patients, no bulging could be detected, leading to a corrected rate of flank bulge-positive patients of 20.8%. The corresponding relaxation values ranged from 1 to 1.44 and correlated with the clinical degree of bulging. A body mass index of ≥25 was identified as a risk factor. No correlation was found regarding age, gender, surgery side, access to the retroperitoneum, surgical procedure, and pathology. Thirty-seven patients complained about chronic pain or suffered from the cosmetic impact of bulging. Thirteen of those patients had shown a flank bulge during clinical examination, resulting in a symptomatic bulge rate of 10.8% (13/120 patients). CONCLUSION Chronic pain and postoperative flank bulging are 2 of the most common long-term complications after open retroperitoneal access. If an open retroperitoneal approach is required, particularly obese patients should be thoroughly informed about the risk of flank bulging and chronic pain.
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Affiliation(s)
- Jennifer Kranz
- Department of Urology and Paediatric Urology, St.-Antonius Hospital gGmbH, Eschweiler, Germany.,Department of Urology and Kidney Transplantation, Martin-Luther-University, Halle, Germany
| | - Sebastian Grundl
- Department of Urology and Paediatric Urology, St.-Antonius Hospital gGmbH, Eschweiler, Germany
| | - Friederike Wußow
- Department of Obstetrics, Bethlehem Health Center gGmbH, Stolberg, Germany
| | - Joachim Steffens
- Department of Urology and Paediatric Urology, St.-Antonius Hospital gGmbH, Eschweiler, Germany
| | - Petra Anheuser
- Department of Urology, Asklepios Clinic Wandsbek, Hamburg, Germany
| | - Laila Schneidewind
- Department of Urology, University Medical Center Rostock, Rostock, Germany
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16
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San Miguel-Méndez C, López-Monclús J, Munoz-Rodriguez J, de Lersundi ÁRV, Artes-Caselles M, Blázquez Hernando LA, García-Hernandez JP, Minaya-Bravo AM, Garcia-Urena MÁ. Stepwise transversus abdominis muscle release for the treatment of complex bilateral subcostal incisional hernias. Surgery 2021; 170:1112-1119. [PMID: 34020792 DOI: 10.1016/j.surg.2021.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/14/2021] [Accepted: 04/08/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Management of subcostal incisional hernias is particularly complicated due to their proximity to the costochondral limits in addition to the lack of aponeurosis on the lateral side of the abdomen. We present our results of posterior component separation through the same previous incision as a safe and reproducible technique for these complex cases. METHODS We presented a multicenter and prospective cohort of patients diagnosed with bilateral subcostal incisional hernias on either clinical examination or imaging based on computed tomography from 2014 to 2020. The aim of this investigation was to assess the outcomes of abdominal wall reconstruction for subcostal incisional hernias through a new approach. The outcomes reported were short- and long-term complications, including recurrence, pain, and bulging. Quality of life was assessed with the European Registry for Abdominal Wall Hernias Quality of Life score. RESULTS A total of 46 patients were identified. All patients underwent posterior component separation. Surgical site occurrences occurred in 10 patients (22%), with only 7 patients (15%) requiring procedural intervention. During a mean follow-up of 18 months (range, 6-62 months), 1 (2%) case of clinical recurrence was registered. Also, there were 8 (17%) patients with asymptomatic but visible bulging. The European Registry for Abdominal Wall Hernias Quality of Life score showed a statistically significant decrease in the 3 domains (pain, restriction, and cosmetic) of the postoperative scores compared with the preoperative score. CONCLUSION Posterior component separation technique for the repair of subcostal incisional hernias through the same incision is a safe procedure that avoids injury to the linea alba. It is associated with acceptable morbidity, low recurrence rate, and improvement in patients' reported outcomes.
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Affiliation(s)
- Carlos San Miguel-Méndez
- General and Digestive Surgery Department, Hospital Universitario del Henares, Francisco de Vitoria University, Madrid, Spain
| | - Javier López-Monclús
- General and Digestive Surgery Department, Hospital Universitario Puerta de Hierro, Autónoma University of Madrid, Spain.
| | - Joaquín Munoz-Rodriguez
- General and Digestive Surgery Department, Hospital Universitario Puerta de Hierro, Autónoma University of Madrid, Spain
| | - Álvaro Robin Valle de Lersundi
- General and Digestive Surgery Department, Hospital Universitario del Henares, Francisco de Vitoria University, Madrid, Spain
| | - Mariano Artes-Caselles
- General and Digestive Surgery Department, Hospital Universitario Puerta de Hierro, Autónoma University of Madrid, Spain
| | - Luis Alberto Blázquez Hernando
- General and Digestive Surgery Department, Hospital Universitario Ramón y Cajal, Alcalá de Henares University Madrid, Spain
| | | | - Ana María Minaya-Bravo
- General and Digestive Surgery Department, Hospital Universitario del Henares, Francisco de Vitoria University, Madrid, Spain
| | - Miguel Ángel Garcia-Urena
- General and Digestive Surgery Department, Hospital Universitario del Henares, Francisco de Vitoria University, Madrid, Spain
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17
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Inkiläinen A, Blomqvist L, Ljungberg B, Strigård K. Patient-reported outcome measures of abdominal wall morbidity after flank incision for open partial nephrectomy. BJU Int 2021; 128:497-503. [PMID: 33825298 DOI: 10.1111/bju.15420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare patient-reported outcome measures in patients with and without abdominal wall complications after open partial nephrectomy (OPN) via flank incision. PATIENTS AND METHODS Patient-reported outcome measures were collected in 2017 from all patients operated on with OPN via flank incision between 2004 and 2016 in Västerbotten County, Sweden. Patients were mailed the ventral hernia pain questionnaire (VHPQ) and an abdominal wall asymmetry (AWA) questionnaire to evaluate postoperative AWA, attributed to bulge or incisional hernia. Demographic and follow-up data were retrieved from patient records. RESULTS A total of 198 patients were eligible for the study, and 146 questionnaires were returned (74%). Forty-five patients (31%) reported postoperative AWA and 27 (18%) reported ongoing pain. Three patients who reported AWA had a known incisional hernia. Pain and abdominal wall stiffness were more common in patients with AWA than in those without (P < 0.01 and P < 0.01, respectively). Of the 45 patients with AWA, 25 (56%) reported this as being negative cosmetically and 16 (36%) as negative regarding activities. Patients that reported AWA were younger and had a higher body mass index at surgery (P = 0.03 and 0.04, respectively). CONCLUSION Abdominal wall asymmetry is a common sequel of flank incision for OPN and is associated with a higher incidence of chronic pain and abdominal stiffness compared to absence of postoperative AWA. Some patients reported that the effect on daily activities and the cosmetic effect caused by AWA had a negative impact on their quality of life.
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Affiliation(s)
- Aapo Inkiläinen
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Lennart Blomqvist
- Department of Molecular Medicine and Surgery (MMK), Karolinska Institutet, Stockholm, Sweden.,Department of Imaging and Physiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Radiation Sciences, Diagnostic Radiology, Umeå University, Umeå, Sweden
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Karin Strigård
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
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18
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Li B, Qin C, Yu J, Gong D, Nie X, Li G, Bittner R. Totally endoscopic sublay (TES) repair for lateral abdominal wall hernias: technique and first results. Hernia 2021; 25:523-533. [PMID: 33599899 DOI: 10.1007/s10029-021-02374-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/22/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The optimal surgical treatment for lateral hernias of the abdominal wall remains unclear. The presented prospective study assesses for the first time in detail the clinical value of a totally endoscopic sublay (TES) technique for the repair of these hernias. METHODS Twenty-four consecutive patients with a lateral abdominal wall hernia underwent TES repair. This technique is naturally combined with a transversus abdominis release maneuver to create a sufficient retromuscular/preperitoneal space that can accommodate, if necessary, a giant prosthetic mesh. RESULTS The operations were successful in all but one patient who required open conversion because of dense intestinal adhesion. The mean defect width was 6.7 ± 3.9 cm. The mean defect area was 78.0 ± 102.4 cm2 (range 4-500 cm2). The mean mesh size used was 330.2 ± 165.4 cm2 (range 108-900 cm2). The mean operative time was 170.2 ± 73.8 min (range, 60-360 min). The mean visual analog scale score for pain at rest on the first day was 2.5 (range 1-4). The average postoperative stay was 3.4 days (range 2-7 days). No serious complications (Dindo-Clavien Grade 2-4) were seen within a mean follow-up period of 13.3 months. CONCLUSIONS A totally endoscopic technique (TES) for the treatment of lateral hernias is described. The technique revealed to be reliable, safe and cost-effective. The first results are promising, but larger studies with longer follow-up periods are recommended to determine the real clinical value.
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Affiliation(s)
- B Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - C Qin
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, China
| | - J Yu
- Department of General Surgery, School of Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, 201999, China
| | - D Gong
- Department of General Surgery, The First School of Clinical Medicine of Southern Medical University, Guangzhou, 511400, China
| | - X Nie
- Department of General Surgery, The First School of Clinical Medicine of Southern Medical University, Guangzhou, 511400, China
| | - G Li
- Department of General Surgery, The First School of Clinical Medicine of Southern Medical University, Guangzhou, 511400, China.
| | - R Bittner
- Emeritus Director Marienhospital Stuttgart, Supperstr. 19, 70565, Stuttgart, Germany.
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19
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Garcia-Urena MA. Preventing incisional ventral hernias: important for patients but ignored by surgical specialities? A critical review. Hernia 2021; 25:13-22. [PMID: 33394256 DOI: 10.1007/s10029-020-02348-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/16/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Incisional ventral hernias (IHs) are a common complication across all surgical specialities requiring access to the abdomen, pelvis, and retroperitoneum. This public health issue continues to be widely ignored, resulting in appreciable morbidity and expenses. In this critical review, the issue is explored by an interdisciplinary group. METHODS A group of European surgeons encompassing representatives from abdominal wall, vascular, urological, gynecological, colorectal and hepato-pancreatico-biliary surgery have reviewed the occurrence of His in these disciplines. RESULTS Incisional hernias are a major public health issue with appreciable morbidity and cost implications. General surgeons are commonly called upon to repair IHs following an initial operation by others. Measures that may collectively reduce the frequency of IH across specialities include better planning and preparation (e.g. a fit patient, no time pressure, an experienced operator). A minimally invasive technique should be employed where appropriate. Our main recommendations in midline incisions include using the 'small bites' suture technique with a ≥ 4:1 suture-to-wound length, and adding prophylactic mesh augmentation in patients more likely to suffer herniation. For off-midline incisions, more research of this problem is essential. CONCLUSION Meticulous closure of the incision is significant for every patient. Raising awareness of the His is necessary in all surgical disciplines that work withing the abdomen or retroperitoneum. Across all specialties, surgeons should aim for a < 10% IH rate.
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Affiliation(s)
- M A Garcia-Urena
- Hospital Universitario del Henares, Faculty of Health Sciences. Universidad Francisco de Vitoria, 28223, Pozuelo de Alarcón, Madrid, Spain.
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20
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Hipolito Canario DA, Isaacson AJ, Martissa JA, Stewart JK. Ultrasound-Guided Chemical Component Separation with Botulinum Toxin A prior to Surgical Hernia Repair. J Vasc Interv Radiol 2020; 32:256-261. [PMID: 33303339 DOI: 10.1016/j.jvir.2020.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 10/22/2022] Open
Abstract
US-guided chemical component separation (CCS) of the abdominal musculature using botulinum toxin A can facilitate the surgical repair of large or complex hernias. Eight patients (2 women and 6 men with median age of 54 years [range, 34-78 years]) underwent preoperative US-guided CCS with hydrodissection before planned surgical repair of large or complex ventral (n = 4), inguinal (n = 2), and flank (n = 2) hernias by 2 interventional radiologists. Technical success rate of US-guided CCS procedures was 100%, and all patients achieved surgical closure a mean 34.1 days (range, 14-48 days) after US-guided CCS.
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Affiliation(s)
- Diego A Hipolito Canario
- Division of Vascular and Interventional Radiology, Department of Radiology, University of North Carolina School of Medicine, 2017 Old Clinic Building CB #7510, Chapel Hill, NC 27599-7510
| | - Ari J Isaacson
- Division of Vascular and Interventional Radiology, Department of Radiology, University of North Carolina School of Medicine, 2017 Old Clinic Building CB #7510, Chapel Hill, NC 27599-7510
| | - Jessica A Martissa
- Division of Vascular and Interventional Radiology, Department of Radiology, University of North Carolina School of Medicine, 2017 Old Clinic Building CB #7510, Chapel Hill, NC 27599-7510
| | - Jessica K Stewart
- Division of Vascular and Interventional Radiology, Department of Radiology, University of North Carolina School of Medicine, 2017 Old Clinic Building CB #7510, Chapel Hill, NC 27599-7510.
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21
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Gan SW, Bruening M, Bhattacharjya S. Hybrid laparoscopic and open repair of post-nephrectomy flank hernia. J Surg Case Rep 2020; 2020:rjaa299. [PMID: 32963758 PMCID: PMC7490209 DOI: 10.1093/jscr/rjaa299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 07/15/2020] [Indexed: 11/14/2022] Open
Abstract
Surgical repair of flank hernia is not routinely performed, due to perceived technical difficulties with the surgery and risk of recurrence, or the misconception that flank hernia is solely due to a denervation injury. Due to the rareness of flank hernia in the literature, there is no general consensus on the best method of surgical repair. We present the case of a patient with a symptomatic large flank hernia following open nephrectomy, in which a hybrid technique of open and laparoscopic flank hernia repair with sublay mesh and bone anchor fixation was successfully performed with good outcome. This case highlights the benefits of the hybrid approach, which allowed a laparoscopic assessment of the defect and adhesiolysis, followed by the open repair which enabled adequate mesh overlap, fixation to surrounding tissues and bone anchor fixation.
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Affiliation(s)
- Siang Wei Gan
- Discipline of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Martin Bruening
- Discipline of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Shantanu Bhattacharjya
- Discipline of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, Adelaide, Australia
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22
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Kriegmair MC, Younsi N, Hiller K, Leitsmann C, Kowalewski KF, Siegel F, Rothamel M, Ritter M, Bolenz C, Kriegmair M, Trojan L, Michel MS. Single- vs multiple-layer wound closure for flank incisions: results of a prospective, randomised, double-blinded multicentre study. BJU Int 2020; 127:64-70. [PMID: 32564459 DOI: 10.1111/bju.15148] [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: 05/08/2020] [Revised: 06/11/2020] [Accepted: 06/13/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To compare the incidence of postoperative flank bulges between patients with multiple-layer closure and single superficial-layer closure after retroperitoneal surgery via open flank incision in the SIngle versus MUltiple-LAyer wound Closure for flank incision (SIMULAC) trial. PATIENTS AND METHODS The study was a randomised controlled, patient- and assessor-blinded, multicentre trial. Between May 2015 and February 2017, 225 patients undergoing flank incisions were randomised 1:1 to a multiple-layer closure (SIMULAC-I) or a single superficial-layer closure (SIMULAC-II) group. The primary outcome was the occurrence of a flank bulge 6 months after surgery. RESULTS Overall, 177 patients (90 in SIMULAC-I, 87 in SIMULAC-II) were eligible for final assessment. The cumulative incidence of a flank bulge was significantly higher in the SIMULAC-II group (51.7%) compared to the SIMULAC-I group [34.4%; odds ratio (OR) 2.04, 95% confidence interval (CI) 1.11-3.73; P = 0.02]. Rate of severe postoperative complications (4.4% SIMULAC-I vs 10.3% SIMULAC-II; P = 0.21) or hernia (6.7% SIMULAC-I vs 10.3% SIMULAC-II; P = 0.59) was similar between the groups. There was no difference in pain (visual analogue scale) and the requirement for pain medication at 6 months postoperatively. Quality of life assessed with the European Quality of Life 5 Dimensions Questionnaire was higher in the SIMULAC-I group compared to the SIMULAC-II group at 6 months postoperatively, with a (median range) score of 80 (30-100) vs 75 (5-100) (P = 0.012). CONCLUSION The overall risk of a flank bulge after flank incision is high. Multiple-layer closure after flank incision should be performed as a standard procedure.
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Affiliation(s)
| | - Nina Younsi
- Department of Urology and Urosurgery, University Hospital Manheim, Mannheim, Germany
| | - Kiriaki Hiller
- Department of Urology and Urosurgery, University Hospital Manheim, Mannheim, Germany
| | - Conrad Leitsmann
- Department of Urology, University Hospital Göttingen, Göttingen, Germany
| | - Karl F Kowalewski
- Department of Urology and Urosurgery, University Hospital Manheim, Mannheim, Germany
| | - Fabian Siegel
- Department of Urology and Urosurgery, University Hospital Manheim, Mannheim, Germany
| | | | - Manuel Ritter
- Department of Urology, University of Bonn, Bonn, Germany
| | | | | | - Lutz Trojan
- Department of Urology, University Hospital Göttingen, Göttingen, Germany
| | - Maurice S Michel
- Department of Urology and Urosurgery, University Hospital Manheim, Mannheim, Germany
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23
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Di Giuseppe M, Mongelli F, Marcantonio M, La Regina D, Pini R. Robotic assisted treatment of flank hernias: case series. BMC Surg 2020; 20:184. [PMID: 32787817 PMCID: PMC7430830 DOI: 10.1186/s12893-020-00843-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 08/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Flank hernias are uncommon, surgical treatment is challenging and the minimally-invasive approach not always feasible. The aim of this study was to report the safety and feasibility of the robotic-assisted repair. METHODS The study was approved by the local ethic committee (2019-01132 CE3495). A retrospective search on a prospectively collected dataset including demographic and clinical records on robotic surgery at our institution was performed to identify patients treated for a flank hernia. Patients were followed-up 6 months. RESULTS From January 2018 to December 2019, out of 190 patients who underwent robotic-assisted hernia surgery, seven with incisional flank hernia were included. Median age was 69.0 years (IQR 63.2-78.0), BMI was 27.3 kg/m2 (IQR 25.8-32.3) and two patients were male (29%). All patients were referred to surgery because of pain, whereas one of them described recurrent episodes of small bowel obstruction. The median hernia defect measured 25 mm ((IQR 21-40), median mesh diameter was 10 cm (IQR 10-12.5) and median operative time was 137 min (IQR 133-174). No intraoperative complication occurred. Postoperatively, one patient developed a pneumonia, which required antibiotics. Length of hospital stay was 4.0 days (IQR 3.0-7.7). Six months after surgery, neither recurrence nor chronic pain were recorded. CONCLUSIONS Robotics in abdominal wall hernia surgery remains a matter of debate, despite a growing interest from the surgical community. In our reported experience with flank hernias, we found the robotic-assisted approach to be safe and feasible for the treatment of this uncommon clinical entity.
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Affiliation(s)
- Matteo Di Giuseppe
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, via Ospedale 12, 6500, Bellinzona, Switzerland
| | - Francesco Mongelli
- Department of Surgery, Ospedale Regionale di Lugano, via Tesserete 46, 6900, Lugano, Switzerland.
| | - Maria Marcantonio
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, via Ospedale 12, 6500, Bellinzona, Switzerland
| | - Davide La Regina
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, via Ospedale 12, 6500, Bellinzona, Switzerland
| | - Ramon Pini
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, via Ospedale 12, 6500, Bellinzona, Switzerland
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24
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An extraperitoneal approach for complex flank, iliac, and lumbar hernia. Hernia 2020; 25:535-544. [PMID: 32451790 DOI: 10.1007/s10029-020-02214-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 05/06/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of this paper is to propose our four-step technique, an open extraperitoneal approach for complex flank, lumbar, and iliac hernias. METHODS A big polypropylene mesh is placed, covering and reinforcing all the lateral abdominal wall in an extraperitoneal space. Its borders are retroxiphoid fatty triangle and the costal arch cranially and the retropubic space caudally, psoas muscle, and paravertebral region posteriorly and contralateral rectus muscle medially. Mesh dimensions do not depend from the defect size, but prosthesis has to cover all the lateral abdominal wall. RESULTS No major complications have been reported. The mean length of stay is 4.8 days (range 3-11). Mean follow-up is 44.8 months (range 5-92). One recurrence (4.5%) has been reported at the 1-year clinical evaluation. CONCLUSION In conclusion, we believe that regardless size and location of the defect, every complex lateral hernia requires the same extensive repair because of the critical anatomy of the region with a big medium-heavyweight polypropylene mesh placed in an extraperitoneal plane, the only one that allows adequate covering of the visceral sac. Our technique is a safe, feasible, and reproducible treatment for this challenging surgical problem.
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25
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Munoz-Rodriguez JM, Lopez-Monclus J, San Miguel Mendez C, Perez-Flecha Gonzalez M, Robin-Valle de Lersundi A, Blázquez Hernando LA, Cuccurullo D, Garcia-Hernandez E, Sanchez-Turrión V, Garcia-Urena MA. Outcomes of abdominal wall reconstruction in patients with the combination of complex midline and lateral incisional hernias. Surgery 2020; 168:532-542. [PMID: 32527646 DOI: 10.1016/j.surg.2020.04.045] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/04/2020] [Accepted: 04/18/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The best treatment for the combined defects of midline and lateral incisional hernia is not known. The aim of our multicenter study was to evaluate the operative and patient-reported outcomes using a modified posterior component separation in patients who present with the combination of midline and lateral incisional hernia. METHODS We identified patients from a prospective, multicenter database who underwent operative repairs of a midline and lateral incisional hernia at 4 centers with minimum 2-year follow-up. Hernias were divided into a main hernia based on the larger size and associated abdominal wall hernias. Outcomes reported were short- and long-term complications, including recurrence, pain, and bulging. Quality of life was assessed with the European Registry for Abdominal Wall Hernias Quality of Life score. RESULTS Fifty-eight patients were identified. Almost 70% of patients presented with a midline defect as the main incisional hernia. The operative technique was a transversus abdominis release in 26 patients (45%), a modification of transversus abdominis release 27 (47%), a reverse transversus abdominis release in 3 (5%), and a primary, lateral retromuscular preperitoneal approach in 2 (3%). Surgical site occurrences occurred in 22 patients (38%), with only 8 patients (14%) requiring procedural intervention. During a mean follow-up of 30.1 ± 14.4 months, 2 (3%) cases of recurrence were diagnosed and required reoperation. There were also 4 (7%) patients with asymptomatic but visible bulging. The European Registry for Abdominal Wall Hernias Quality of Life score showed a statistically significant decrease in the 3 domains (pain, restriction, and cosmetic) in the postoperative score compared with the preoperative score. CONCLUSION The different techniques of posterior component separation in the treatment of combined midline and lateral incisional hernia show acceptable results, despite the associated high complexity. Patient-reported outcomes after measurement of the European Registry for Abdominal Wall Hernias Quality of Life score demonstrated a clinically important improvement in quality of life and pain.
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Affiliation(s)
| | | | - Carlos San Miguel Mendez
- Faculty of Health Sciences, Francisco de Vitoria University, Henares University Hospital, Madrid, Spain
| | | | | | | | - Diego Cuccurullo
- Department of Surgery, Ospedale Monaldi-Azienda Ospedaliera dei Colli, Naples, Italy
| | | | | | - Miguel Angel Garcia-Urena
- Faculty of Health Sciences, Francisco de Vitoria University, Henares University Hospital, Madrid, Spain
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26
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Robotic repair of lateral incisional hernias using intraperitoneal onlay, preperitoneal, and retromuscular mesh placement: a comparison of mid-term results and surgical technique. Eur Surg 2020. [DOI: 10.1007/s10353-020-00634-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Katkhouda N, Alicuben ET, Pham V, Sandhu K, Samakar K, Bildzukewicz N, Houghton C, Dunn CP, Hawley L, Lipham J. Management of lateral abdominal hernias. Hernia 2020; 24:353-358. [PMID: 32052297 DOI: 10.1007/s10029-020-02126-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/08/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Lateral abdominal wall hernias are rare defects but, due to their location, repair is difficult, and recurrence is common. Few studies exist to support a standard protocol for repair of these lateral hernias. We hypothesized that anchoring our repair to fixed bony structures would reduce recurrence rates. METHODS A retrospective review of all patients who underwent lateral hernia repair at our institution was performed. RESULTS Eight cases (seven flank and one thoracoabdominal) were reviewed. The median defect size was 105 cm2 (range 36-625 cm2). The median operative time was 185 min (range 133-282 min). There were no major complications. One patient who was repaired without mesh attachment to bony landmarks developed a recurrence at ten months and subsequently underwent reoperation. Patients with mesh secured to bony landmarks were recurrence free at a median follow-up of 171 days. CONCLUSIONS Lateral hernias present a greater challenge due to their anatomic location. An open technique with mesh fixation to bony structures is a promising solution to this complex problem.
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Affiliation(s)
- N Katkhouda
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of University of Southern California, 1510 San Pablo Street, HCC I, Suite 527, Los Angeles, CA, 90033-4612, USA.
| | - E T Alicuben
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of University of Southern California, 1510 San Pablo Street, HCC I, Suite 527, Los Angeles, CA, 90033-4612, USA
| | - V Pham
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of University of Southern California, 1510 San Pablo Street, HCC I, Suite 527, Los Angeles, CA, 90033-4612, USA
| | - K Sandhu
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of University of Southern California, 1510 San Pablo Street, HCC I, Suite 527, Los Angeles, CA, 90033-4612, USA
| | - K Samakar
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of University of Southern California, 1510 San Pablo Street, HCC I, Suite 527, Los Angeles, CA, 90033-4612, USA
| | - N Bildzukewicz
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of University of Southern California, 1510 San Pablo Street, HCC I, Suite 527, Los Angeles, CA, 90033-4612, USA
| | - C Houghton
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of University of Southern California, 1510 San Pablo Street, HCC I, Suite 527, Los Angeles, CA, 90033-4612, USA
| | - C P Dunn
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of University of Southern California, 1510 San Pablo Street, HCC I, Suite 527, Los Angeles, CA, 90033-4612, USA
| | - L Hawley
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of University of Southern California, 1510 San Pablo Street, HCC I, Suite 527, Los Angeles, CA, 90033-4612, USA
| | - J Lipham
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of University of Southern California, 1510 San Pablo Street, HCC I, Suite 527, Los Angeles, CA, 90033-4612, USA
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28
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Chan DL, Ravindran P, Fan HS, Elstner KE, Jacombs ASW, Ibrahim N, Talbot ML. Minimally invasive Venetian blinds ventral hernia repair with botulinum toxin chemical component separation. ANZ J Surg 2019; 90:67-71. [PMID: 31566297 DOI: 10.1111/ans.15438] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 07/02/2019] [Accepted: 08/16/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Laparoscopic ventral repair is safe, with lower wound infection rates compared with open repair. 'Venetian blinds' technique of plication in combination with mesh reinforcement, is totally intra-corporeal, with hernia defect and sac plication to reduce seroma formation. While laparoscopic suturing of the abdominal wall can represent a technical challenge, pre-operative botulinum toxin A (BTA) injections as an adjunct can assist. This study aims to demonstrate feasibility and efficacy of this technique in abdominal wall hernia repair, with BTA adjunct in midline hernias. METHODS A single-centre case series was conducted using minimally invasive 'Venetian blinds' technique for repair of complex ventral abdominal hernias. Twelve patients (seven midline, five non-midline) underwent repair (11 laparoscopic; one robotic). Midline hernias received BTA (200-300 units Botox) 4-6 weeks prior to surgery. Repairs were mesh-reinforced following fascial closure. RESULTS Twelve (10 female, two male) patients, with a median age 72 years (range 31-83) and body mass index of 27.3 kg/m2 (range 22.8-61.7) were included. The median length of operation was 133 min (range 45-290) and length of hospital stay 3 days (range 1-28). To date there has been no recurrence of hernia. A single symptomatic seroma was treated with antibiotics and did not require mesh removal. One patient developed hospital-acquired pneumonia and pseudomembranous colitis. CONCLUSION Minimally invasive 'Venetian blinds' technique has promising early results with both midline and non-midline ventral hernias. The addition of BTA is a novel and feasible combination for repair of midline ventral hernias.
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Affiliation(s)
- Daniel L Chan
- Department of Surgery, St George Hospital, Sydney, New South Wales, Australia.,Department of Surgery, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia.,Faculty of Medicine, Western Sydney University, Sydney, New South Wales, Australia.,Department of Surgery, Macquarie University Hospital, Sydney, New South Wales, Australia
| | - Praveen Ravindran
- Department of Surgery, St George Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Howard S Fan
- Department of Surgery, St George Hospital, Sydney, New South Wales, Australia
| | - Kristen E Elstner
- Department of Surgery, Macquarie University Hospital, Sydney, New South Wales, Australia
| | - Anita S W Jacombs
- Department of Surgery, Macquarie University Hospital, Sydney, New South Wales, Australia
| | - Nabeel Ibrahim
- Department of Surgery, Macquarie University Hospital, Sydney, New South Wales, Australia
| | - Michael L Talbot
- Department of Surgery, St George Hospital, Sydney, New South Wales, Australia.,Department of Surgery, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia.,Department of Surgery, Macquarie University Hospital, Sydney, New South Wales, Australia
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29
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Incarcerated Lumbar Hernia Complicated by Retroperitoneal Pseudoaneurysm 50 Years after Resection and Radiation Therapy of a Sarcoma. Case Rep Surg 2019; 2019:1072821. [PMID: 31183241 PMCID: PMC6512066 DOI: 10.1155/2019/1072821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 01/06/2019] [Accepted: 01/30/2019] [Indexed: 11/18/2022] Open
Abstract
Background Lumbar hernias are rare abdominal hernias. Surgery is the only treatment option but remains challenging. Posterior incisional hernias are even rarer especially with incarceration of intra-abdominal contents. Case Presentation A 68-year old female presented with a 3-day history of worsening acute abdominal pain and distension, with multiple episodes of emesis. A CT scan indicated a large incarcerated posterolateral abdominal hernia. The patient had a history of resection of a sarcoma on her back as a child and also received chemotherapy and radiation. During emergency laparoscopy, a hemorrhagic small bowel segment incarcerated in the hernia was reduced and resected, and the distended small bowel was decompressed. An elective hernia repair was scheduled. After temporary clinical improvement, the patient again developed abdominal pain, distention, and emesis. During emergency laparotomy, a large hematoma in the right flank was found and partially evacuated. The right colon was mobilized out of the hernia and the duodenum was kocherized. A 20 × 20 cm BIO-A mesh was placed on top of the Gerota fascia and cranially tucked under liver segment VI. Anteriorly, the mesh was fixated with absorbable tacks. The duodenum and colon were placed into the mesh pocket. A postoperative CT scan identified a 2 cm pseudoaneurysm of a side branch of a lumbar artery, and the bleeding source was embolized. The postoperative course was complicated by Clostridium difficile-associated colitis, but ultimately, the patient recovered fully. At 6-month follow-up, there was no evidence for a recurrent hernia. Discussion There is a paucity of literature concerning lumbar incisional hernias. Repair with bioabsorbable mesh seems feasible, but longer follow-up is necessary as the mesh was placed in an unusual fashion due to the retroperitoneal hematoma. The exact cause of the hemorrhage is unclear and may have been caused during the initial incarceration, during surgery, or may be a late complication of her previous radiation.
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30
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Kapur SK, Liu J, Baumann DP, Butler CE. Surgical Outcomes in Lateral Abdominal Wall Reconstruction: A Comparative Analysis of Surgical Techniques. J Am Coll Surg 2019; 229:267-276. [PMID: 30998975 DOI: 10.1016/j.jamcollsurg.2019.03.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/25/2019] [Accepted: 03/28/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Lateral abdominal wall (LAW) myofascial defects are a challenging reconstructive problem, and no consensus exists on their surgical management. We hypothesized that mesh repairs anchored to the nonyielding LAW boundaries (pillar-anchored repairs [PARs]) would provide more durable reconstructions, with lower hernia recurrence and bulge occurrence rates, compared with mesh repairs anchored to the surrounding oblique muscle complexes (direct repairs [DRs]). STUDY DESIGN We retrospectively reviewed LAW reconstructions at a single center from 2004 to 2010. Patients were divided into 2 groups based on whether they had received a PAR or a DR. The primary outcome measure was hernia recurrence. The secondary outcome measures were surgical site occurrences (SSOs), surgical site infections (SSIs), and reoperations for complications. RESULTS We analyzed 106 consecutive patients with LAW reconstructions (PAR, 59 DR, 47). The median follow-up time was 28.1 months (PAR, 24.5 months; DR, 34.5 months). The baseline demographics were similar in the groups. Nineteen hernia recurrences were observed (PAR, 5 [8.5%]; DR, 14 [29.8%]; p = 0.033, log-rank test). The "closure type" (bridged vs reinforced repair), "mesh type" or "defect area" were not associated with hernia recurrence or bulge occurrence. The groups did not differ significantly regarding SSOs, SSIs, or reoperations for complications. In the multivariable Cox proportional regression model, PAR provided a 3.5 times lower risk of hernia recurrence than DR (adjusted hazard ratio, 0.28; 95% CI 0.09 to 0.88; p = 0.03). CONCLUSIONS The PAR technique is superior to DR for reconstructing LAW defects in order to achieve the lowest hernia recurrence rates in this complex patient population.
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Affiliation(s)
- Sahil K Kapur
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Jun Liu
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Donald P Baumann
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Charles E Butler
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
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31
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Amaral PHF, Tastaldi L, Barros PHF, Abreu Neto IP, Hernani BL, Brasil H, Mendes CJL, Franciss MY, Pacheco AM, Altenfelder Silva R, Roll S. Combined open and laparoscopic approach for repair of flank hernias: technique description and medium-term outcomes of a single surgeon. Hernia 2019; 23:157-165. [PMID: 30697653 DOI: 10.1007/s10029-019-01880-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 01/02/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE A residual bulge in the lateral abdominal wall is a reason for patient dissatisfaction after flank hernia repair (FHR). We hypothesized that combining a laparoscopically-placed intraperitoneal mesh (IPOM) with onlay hernia repair performed through a small open incision would increase repair durability and decrease such residual bulges. We aim to report our medium-term outcomes with this technique. METHODS Patients who have undergone FHR using the technique described above from March 2013 through June 2017 were identified in a prospectively maintained database. Outcomes of interest included surgical site infections (SSI), surgical site occurrences (SSO), surgical site occurrences requiring procedural intervention (SSOPI) and hernia recurrence. RESULTS Sixteen patients were identified (62% females; mean age 59 ± 8 years, mean body mass index 29.5 kg/m2). Mean hernia width was. 6.4 ± 3 cm and 31% were recurrent hernias previously repaired through an onlay approach. Mean operative time was 159 ± 40 min, fascial closure was achieved in all cases, and there were no intraoperative complications. Median length of stay was 3 days (IQR 3-4), and there were no unplanned readmissions or reoperations. At a median 37-month follow-up (IQR 21-55), wound morbidity rate was 12.5% (2 seromas). There were no SSI/SSOPI and one hernia recurrence (6%) was detected at 12 months postoperatively. CONCLUSION Combining laparoscopic IPOM with open onlay hernia repair resulted in low recurrence and acceptable wound morbidity rates, with no residual bulges noted at medium-term follow-up. Further studies with larger number of patients and other surgeon's experiences are necessary to determine the role of such technique in the surgical armamentarium for flank hernia repair.
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Affiliation(s)
- P H F Amaral
- Hernia Center, Hospital Alemão Oswaldo Cruz, R. Treze de Maio, 1815, 01327-001, São Paulo, SP, Brazil. .,Abdominal Wall Surgery Group, Department of Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, R. Dr. Cesário Mota Júnior, 112., 01221-020, São Paulo, SP, Brazil.
| | - L Tastaldi
- Comprehensive Hernia Center, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue A10-133, Cleveland, OH, 44195, USA
| | - P H F Barros
- Hernia Center, Hospital Alemão Oswaldo Cruz, R. Treze de Maio, 1815, 01327-001, São Paulo, SP, Brazil.,Abdominal Wall Surgery Group, Department of Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, R. Dr. Cesário Mota Júnior, 112., 01221-020, São Paulo, SP, Brazil
| | - I P Abreu Neto
- Hernia Center, Hospital Alemão Oswaldo Cruz, R. Treze de Maio, 1815, 01327-001, São Paulo, SP, Brazil.,Abdominal Wall Surgery Group, Department of Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, R. Dr. Cesário Mota Júnior, 112., 01221-020, São Paulo, SP, Brazil
| | - B L Hernani
- Hernia Center, Hospital Alemão Oswaldo Cruz, R. Treze de Maio, 1815, 01327-001, São Paulo, SP, Brazil.,Abdominal Wall Surgery Group, Department of Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, R. Dr. Cesário Mota Júnior, 112., 01221-020, São Paulo, SP, Brazil
| | - H Brasil
- Abdominal Wall Surgery Group, Department of Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, R. Dr. Cesário Mota Júnior, 112., 01221-020, São Paulo, SP, Brazil
| | - C J L Mendes
- Abdominal Wall Surgery Group, Department of Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, R. Dr. Cesário Mota Júnior, 112., 01221-020, São Paulo, SP, Brazil
| | - M Y Franciss
- Abdominal Wall Surgery Group, Department of Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, R. Dr. Cesário Mota Júnior, 112., 01221-020, São Paulo, SP, Brazil
| | - A M Pacheco
- Abdominal Wall Surgery Group, Department of Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, R. Dr. Cesário Mota Júnior, 112., 01221-020, São Paulo, SP, Brazil
| | - R Altenfelder Silva
- Abdominal Wall Surgery Group, Department of Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, R. Dr. Cesário Mota Júnior, 112., 01221-020, São Paulo, SP, Brazil
| | - S Roll
- Hernia Center, Hospital Alemão Oswaldo Cruz, R. Treze de Maio, 1815, 01327-001, São Paulo, SP, Brazil.,Abdominal Wall Surgery Group, Department of Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, R. Dr. Cesário Mota Júnior, 112., 01221-020, São Paulo, SP, Brazil
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