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Correia de Sá T, Jácome F, Basto T, Costa M, Gonçalves Á, Teixeira N, Castro Neves L, Barros da Silva J. Transabdominal preperitoneal (TAPP) repair for emergency groin hernia: a systematic review. Hernia 2024; 28:1005-1015. [PMID: 38522045 DOI: 10.1007/s10029-024-03018-8] [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: 10/08/2023] [Accepted: 03/06/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE Laparoscopic groin hernia repair has evolved and gained popularity and laparoscopic transabdominal preperitoneal (TAPP) procedure provides an opportunity to evaluate the peritoneal cavity and both inguinal areas without the need for additional dissection. There is still a paucity of evidence to support TAPP repair in the emergency setting. In this systematic review, we aim to evaluate the feasibility and safety of TAPP repair for incarcerated and strangulated groin hernias. METHODS PRISMA guidelines were followed for literature search and established inclusion and exclusion criteria were applied. Data were extracted and analyzed for the outcomes of interest. RESULTS Overall, 8 studies were included in the review, comprising 316 patients. Patients characteristics and outcomes were limitedly reported. Only 3 cases of conversion to open approach were reported and 2 recurrences were diagnosed. Postoperative complications are inconsistently reported but mostly refer to minor complications. There were no mortality cases. Visceral resections were performed in 25 cases due to ischemia, mostly extracorporeally. CONCLUSION Laparoscopy is a game changer and TAPP approach is a feasible, safe, and effective technique for the emergent repair of groin hernias. Further studies and prospective randomized data are needed to establish its role in the emergent groin hernia management.
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Affiliation(s)
- T Correia de Sá
- General Surgery Department, Unidade Local de Saúde do Tâmega e Sousa, Penafiel, Portugal.
| | - F Jácome
- Angiology and Vascular Surgery Department, Unidade Local de Saúde de São João, Porto, Portugal
| | - T Basto
- General Surgery Department, Unidade Local de Saúde do Tâmega e Sousa, Penafiel, Portugal
| | - M Costa
- General Surgery Department, Unidade Local de Saúde do Tâmega e Sousa, Penafiel, Portugal
| | - Á Gonçalves
- General Surgery Department, Unidade Local de Saúde do Tâmega e Sousa, Penafiel, Portugal
| | - N Teixeira
- General Surgery Department, Unidade Local de Saúde do Tâmega e Sousa, Penafiel, Portugal
| | - L Castro Neves
- General Surgery Department, Unidade Local de Saúde do Tâmega e Sousa, Penafiel, Portugal
| | - J Barros da Silva
- General Surgery Department, Unidade Local de Saúde do Tâmega e Sousa, Penafiel, Portugal
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Sun R, Lei L, Ji J, Chen Y, Tian W, Yang F, Huang Q. Designing a bi-layer multifunctional hydrogel patch based on polyvinyl alcohol, quaternized chitosan and gallic acid for abdominal wall defect repair. Int J Biol Macromol 2024; 263:130291. [PMID: 38378119 DOI: 10.1016/j.ijbiomac.2024.130291] [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: 08/23/2023] [Revised: 02/02/2024] [Accepted: 02/16/2024] [Indexed: 02/22/2024]
Abstract
In abdominal wall defect repair, surgical site infection (SSI) remains the primary cause of failure, while complications like visceral adhesions present significant challenges following patch implantation. We designed a Janus multifunctional hydrogel patch (JMP) with antibacterial, anti-inflammatory, and anti-adhesive properties. The patch comprises two distinct layers: a pro-healing layer and an anti-adhesion layer. The pro-healing layer was created by a simple mixture of polyvinyl alcohol (PVA), quaternized chitosan (QCS), and gallic acid (GA), crosslinked to form PVA/QCS/GA (PQG) hydrogels through GA's self-assembly effect and hydrogen bonding. Additionally, the PVA anti-adhesive layer was constructed using a drying-assisted salting method, providing a smooth and dense physical barrier to prevent visceral adhesion while offering essential mechanical support to the abdominal wall. The hydrogel patch demonstrates widely adjustable mechanical properties, exceptional biocompatibility, and potent antimicrobial properties, along with a sustained and stable release of antioxidants. In rat models of skin and abdominal wall defects, the JMP effectively promoted tissue healing by controlling infection, inhibiting inflammation, stimulating neovascularization, and successfully preventing the formation of visceral adhesions. These compelling results highlight the JMP's potential to improve the success rate of abdominal wall defect repair and reduce surgical complications.
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Affiliation(s)
- Ran Sun
- Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School, Nanjing University, Nanjing, China
| | - Lei Lei
- Affiliated Drum Tower Hospital, Medical School, Nanjing University, Nanjing, China
| | - Jiamin Ji
- Research Institute of General Surgery, Jinling Hospital, Southeast University, Nanjing, China
| | - Yuan Chen
- Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School, Nanjing University, Nanjing, China
| | - Weiliang Tian
- Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School, Nanjing University, Nanjing, China
| | - Fan Yang
- Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School, Nanjing University, Nanjing, China
| | - Qian Huang
- Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School, Nanjing University, Nanjing, China.
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Hassan AM, Franco CM, Shah NR, Netherton TJ, Mericli AF, Garvey PP, Schaverien MV, Chang EI, Hanasono MM, Selber JC, Butler CE. Outcomes of Complex Abdominal Wall Reconstruction After Oncologic Resection: 14-Year Experience at an NCI-Designated Cancer Center. Ann Surg Oncol 2023; 30:3712-3720. [PMID: 36662331 DOI: 10.1245/s10434-023-13098-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/29/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Outcomes studies for abdominal wall reconstruction (AWR) in the setting of previous oncologic extirpation are lacking. We sought to evaluate long-term outcomes of AWR using acellular dermal matrix (ADM) after extirpative resection, compare them to primary herniorrhaphy, and report the rates and predictors of postoperative complications. METHODS We conducted a retrospective cohort study of patients who underwent AWR after oncologic resection from March 2005 to June 2019 at a tertiary cancer center. The primary outcome was hernia recurrence (HR). Secondary outcomes included surgical site occurrences (SSOs), surgical site infection (SSIs), length of hospital stay (LOS), reoperation, and 30-day readmission. RESULTS Of 720 consecutive patients who underwent AWR during the study period, 194 (26.9%) underwent AWR following resection of abdominal wall tumors. In adjusted analyses, patients who had AWR after extirpative resection were more likely to have longer LOS (β, 2.57; 95%CI, 1.27 to 3.86, p < 0.001) than those with primary herniorrhaphy, but the risk of HR, SSO, SSI, 30-day readmission, and reoperation did not differ significantly. In the extirpative cohort, obesity (Hazard ratio, 6.48; p = 0.003), and bridged repair (Hazard ratio, 3.50; p = 0.004) were predictors of HR. Radiotherapy (OR, 2.23; p = 0.017) and diabetes mellites (OR, 3.70; p = 0.005) were predictors of SSOs. Defect width (OR, 2.30; p < 0.001) and mesh length (OR, 3.32; p = 0.046) were predictors of SSIs. Concomitant intra-abdominal surgery for active disease was not associated with worse outcomes. CONCLUSIONS AWR with ADM following extirpative resection demonstrated outcomes comparable with primary herniorrhaphy. Preoperative risk assessment and optimization are imperative for improving outcomes.
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Read P, Ng Z, Wong SL. Massive scrotal cystocoele in a patient with perforated bowel cancer. ANZ J Surg 2022; 93:1060-1061. [PMID: 36195991 DOI: 10.1111/ans.18098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 09/19/2022] [Accepted: 09/22/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Phillipa Read
- Department of General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Zi Ng
- Department of General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Sze Ling Wong
- Department of General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
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Birolini C, Tanaka EY, de Miranda JS, Murakami AH, Damous SHB, Utiyama EM. The early outcomes of complex abdominal wall reconstruction with polyvinylidene (PVDF) mesh in the setting of active infection: a prospective series. Langenbecks Arch Surg 2022; 407:3089-3099. [PMID: 35906299 DOI: 10.1007/s00423-022-02625-2] [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: 02/10/2022] [Accepted: 07/22/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE The use of synthetic mesh to repair infected abdominal wall defects remains controversial. Polyvinylidene fluoride (PVDF) mesh was introduced in 2002 as an alternative to polypropylene, with the advantages of improved biostability, lowered bending stiffness, and minimum tissue response. This study aimed to evaluate the short-term outcomes of using PVDF mesh to treat infected abdominal wall defects in the elective setting. METHODS This prospective clinical trial started in 2016 and was designed to evaluate the short- and mid-term outcomes of 38 patients submitted to abdominal wall reconstruction in the setting of active mesh infection and/or enteric fistulas (AI) when compared to a group of 38 patients submitted to clean ventral hernia repairs (CC). Patients were submitted to single-staged repairs, using onlay PVDF mesh (DynaMesh®-CICAT) reinforcement to treat their defects. RESULTS Groups had comparable demographic characteristics. The AI group had more previous abdominal operations and required a longer operative and anesthesia time. At 30 days, surgical site occurrences were observed in 16 (42.1%) AI vs. 17 (44.7%) CC, p = 0.817; surgical site infection occurred in 4 (10.5%) AI vs. 6 (15.8%) CC, p = 0.497; and a higher number of procedural interventions were required in the CC group, 15.8 AI vs. 28.9% CC, p = 0.169. Both groups did not have chronic infections at 1 year of follow-up, and one hernia recurrence was observed in the AI group. CONCLUSIONS The use of PVDF mesh in the infected setting presented favorable results with a low incidence of wound infection.
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Affiliation(s)
- Claudio Birolini
- General and Trauma Surgery, Abdominal Wall and Hernia Repair Unit, Hospital das Clinicas, Department of Surgery, University of São Paulo School of Medicine, Avenida Dr. Enéas Carvalho de Aguiar, 255, 05403-010, São Paulo, Brazil.
| | - Eduardo Yassushi Tanaka
- General and Trauma Surgery, Abdominal Wall and Hernia Repair Unit, Hospital das Clinicas, Department of Surgery, University of São Paulo School of Medicine, Avenida Dr. Enéas Carvalho de Aguiar, 255, 05403-010, São Paulo, Brazil
| | - Jocielle Santos de Miranda
- General and Trauma Surgery, Abdominal Wall and Hernia Repair Unit, Hospital das Clinicas, Department of Surgery, University of São Paulo School of Medicine, Avenida Dr. Enéas Carvalho de Aguiar, 255, 05403-010, São Paulo, Brazil
| | - Abel Hiroshi Murakami
- General and Trauma Surgery, Abdominal Wall and Hernia Repair Unit, Hospital das Clinicas, Department of Surgery, University of São Paulo School of Medicine, Avenida Dr. Enéas Carvalho de Aguiar, 255, 05403-010, São Paulo, Brazil
| | - Sergio Henrique Bastos Damous
- General and Trauma Surgery, Abdominal Wall and Hernia Repair Unit, Hospital das Clinicas, Department of Surgery, University of São Paulo School of Medicine, Avenida Dr. Enéas Carvalho de Aguiar, 255, 05403-010, São Paulo, Brazil
| | - Edivaldo Massazo Utiyama
- General and Trauma Surgery, Abdominal Wall and Hernia Repair Unit, Hospital das Clinicas, Department of Surgery, University of São Paulo School of Medicine, Avenida Dr. Enéas Carvalho de Aguiar, 255, 05403-010, São Paulo, Brazil
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OUP accepted manuscript. Br J Surg 2022; 109:754-762. [DOI: 10.1093/bjs/znac107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/15/2022] [Accepted: 03/17/2022] [Indexed: 11/13/2022]
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Risks and Prevention of Surgical Site Infection After Hernia Mesh Repair and the Predictive Utility of ACS-NSQIP. J Gastrointest Surg 2022; 26:950-964. [PMID: 35064459 PMCID: PMC9021144 DOI: 10.1007/s11605-022-05248-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023]
Abstract
AIM The aim of this paper was to provide a narrative review of surgical site infection after hernia surgery and the influence of perioperative preventative interventions. METHODS The review was based on current national and international guidelines and a literature search. RESULTS Mesh infection is a highly morbid complication after hernia surgery, and is associated with hospital re-admission, increased health care costs, re-operation, hernia recurrence, impaired quality of life and plaintiff litigation. The American College of Surgeons National Surgical Quality Improvement Program is a particularly useful resource for the study and evidence-based practise of abdominal wall hernia repair. DISCUSSION The three major modifiable patient comorbidities significantly associated with postoperative surgical site infection in hernia surgery are obesity, tobacco smoking and diabetes mellitus. Preoperative optimization includes weight loss, cessation of smoking, and control of diabetes. Intraoperative interventions relate, in particular, to the control of fomite mediated transmission in the operating theatre and prevention of mesh contamination with S. aureus CFUs. Risk management strategies should also target the niche ecological conditions which enable bacterial survival and subsequent biofilm formation on an implanted mesh. Outcomes of mesh infection after hernia surgery are closely related to mesh type and porosity, patient smoking status, presence of MRSA, bacterial adhesion and biofilm production. The use of suction drains and the timing of drain removal are controversial and discussed in detail. Finally, the utility of the ACS-NSQIP Surgical Risk Calculator in predicting complications and outcomes in individual patients and the importance of quality improvement initiatives in surgical units are emphasized.
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