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Baco S, Mitric M. Transversus Abdominis Muscle Release in Giant Incisional Hernia. Cureus 2022; 14:e28277. [PMID: 36039119 PMCID: PMC9396380 DOI: 10.7759/cureus.28277] [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] [Accepted: 08/22/2022] [Indexed: 11/28/2022] Open
Abstract
Giant incisional hernias and complex abdominal wall reconstructions are challenging in terms of primary closure with typical operating techniques. Transversus abdominis muscle release (TAR) is a new myofascial release technique that involves the creation of a retro rectal place and mesh placement. It is a modification of the posterior component separation technique (CST) and enables the primary closure of the most challenging abdominal wall reconstructions. We present a case where a favorable outcome was achieved in a contaminated environment with almost no perioperative complications and no recurrence after 17 months, with the placement of inexpensive non-absorbable ‘Paha’ mesh.
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Buell JF, Flaris AN, Raju S, Hauch A, Darden M, Parker GG. Long-Term Outcomes in Complex Abdominal Wall Reconstruction Repaired With Absorbable Biologic Polymer Scaffold (Poly-4-Hydroxybutyrate). ANNALS OF SURGERY OPEN 2021; 2:e032. [PMID: 37638247 PMCID: PMC10455061 DOI: 10.1097/as9.0000000000000032] [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: 08/19/2020] [Accepted: 12/23/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction After promising early outcomes in the use of absorbable biologic mesh for complex abdominal wall reconstruction, significant criticism has been raised over the longevity of these repairs after its 2-year resorption profile. Methods This is the long-term (5-year) follow-up analysis of our initial experience with the absorbable polymer scaffold poly-4-hydroxybutyrate (P4HB) mesh compared with a consecutive contiguous group treated with porcine cadaveric mesh for complex abdominal wall reconstructions. Our clinical analysis was performed using Stata 14.2 and Excel 16.16.23. Results After a 5-year follow-up period, the P4HB group (n = 31) experienced lower rates of reherniation (12.9% vs 38.1%; P = 0.017) compared with the porcine cadaveric mesh group (n = 42). The median interval in months to recurrent herniation was similar between groups (24.3 vs 20.8; P = 0.700). Multivariate logistic regression analysis on long-term outcomes identified smoking (P = 0.004), African American race (P = 0.004), and the use of cadaveric grafts (P = 0.003) as risks for complication while smoking (P = 0.034) and the use of cadaveric grafts (P = 0.014) were identified as risks for recurrence. The long-term cost analysis showed that P4HB had a $10,595 per case costs savings over porcine cadaveric mesh. Conclusions Our study identified the superior outcomes in clinical performance and a value-based benefit of absorbable biologic P4HB scaffold persisted after the 2-year resorption timeframe. Data analysis also confirmed the use of porcine cadaveric grafts independently contributed to the incidence of complications and recurrences.
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Affiliation(s)
- Joseph F. Buell
- From the Department of Surgery, Mission Health, HCA North Carolina, MAHEC, University of North Carolina, Asheville, NC
| | | | - Sukreet Raju
- Department of Surgery, Tulane University, New Orleans, LA
| | - Adam Hauch
- Department of Surgery, University of California, San Diego, CA
| | - Michael Darden
- Carey Business School, Johns Hopkins University, Baltimore, MD
| | - Geoff G. Parker
- Thayer School of Engineering, Dartmouth College, Hanover, NH
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Toma M, Yanai T, Yoshida S. Successful closure of a large abdominal wall defect using endoscopic component separation technique in an infant with a giant ventral hernia after staged surgery for omphalocele. Surg Case Rep 2021; 7:4. [PMID: 33409717 PMCID: PMC7788121 DOI: 10.1186/s40792-020-01087-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The management of large abdominal wall defects, such as omphalocele or gastroschisis, remains a challenge for pediatric surgeons. Though several techniques have been described to repair those conditions, there is no procedure considered to be the standard worldwide. We report an infant girl with a giant ventral hernia after staged surgery for omphalocele in whom delayed closure of a large abdominal wall defect was performed successfully using "endoscopic component separation technique (ECST)" without serious complications. CASE PRESENTATION A baby girl was admitted to our hospital because of a giant omphalocele, which had been prenatally diagnosed. The omphalocele was supraumbilical and included the entire liver. After staged surgery, a large abdominal wall defect was closed by skin, creating a giant ventral hernia. We performed endoscopic separation component technique (ECST) for the closure of her abdominal wall defect when she was 11 months of age. ECST was initiated with placement of a 5.0-mm port just above the inguinal ligament and under the external oblique muscle. The space between the external and internal oblique muscles was created by the insufflation pressure, and a second 5.0-mm port was placed at 1.0 cm below the inferior edge of the rib into the space. As the further dissection was carried, the aponeurosis of the external oblique muscle was identified as a white line, running vertically from the epigastrium to inguinal ligament. It was transected longitudinally using electrocautery over its full length. The same procedure was performed on the contralateral side and the abdominal wall was successfully closed. Postoperative course was uneventful. CONCLUSIONS The technique of ECST, described here, is simple and safe for infants, and the cosmetic result is satisfactory.
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Affiliation(s)
- Miki Toma
- Department of Pediatric Surgery, Ibaraki Children's Hospital, 3-3-1, Futabadai, Mito, Ibaraki, 311-4145, Japan.
| | - Toshihiro Yanai
- Department of Pediatric Surgery, Ibaraki Children's Hospital, 3-3-1, Futabadai, Mito, Ibaraki, 311-4145, Japan
| | - Shiho Yoshida
- Department of Pediatric Surgery, Ibaraki Children's Hospital, 3-3-1, Futabadai, Mito, Ibaraki, 311-4145, Japan
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Bueno-Lledó J, Martinez-Hoed J, Torregrosa-Gallud A, Menéndez-Jiménez M, Pous-Serrano S. Botulinum toxin to avoid component separation in midline large hernias. Surgery 2020; 168:543-549. [DOI: 10.1016/j.surg.2020.04.050] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022]
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Song YH, Huang WJ, Xie YY, Hada G, Zhang S, Lu AQ, Wang Y, Lei WZ. Application of double circular suturing technique (DCST) in repair of giant incision hernias. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:764. [PMID: 32647689 PMCID: PMC7333136 DOI: 10.21037/atm-20-4572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Our study aims to explore the feasibility and safety of a double circular suturing technique (DCST) in the repair of giant incision hernias. Methods The clinical data of 221 patients (95 men and 126 women; the average age was 61.6 years) receiving DCST in the repair of giant incision hernia between January 2010 and December 2018 was analyzed retrospectively. One hundred and five primary and 16 recurrent patients underwent herniorrhaphy with anti-adhesion underlay mesh repair using DCST. Results All the 221 operations were performed successfully. The average preparation time before the operation and hospital stays were 3.7 days (range, 1-6 days) and 7.5 days (range, 2-16 days), respectively. The average diameter of the hernia ring defect observed intraoperatively was 16.4 cm (range, 12-22 cm). The average time of operation was 83.6 min (range, 43-195 min). There were 2 cases of intestinal fistula, 4 cases of wound infection, 2 cases of mesh infection, 7 cases of serum tumescence, 3 cases of pulmonary infection, and 2 cases of wound dehiscence occurred. One hundred and ninety-five patients were followed up for 6.7 years (range, 0.8-9.5 years) postoperatively. Of them, 9 patients recurred; 14 patients had chronic pain whose visual analog scale (VAS) was 2-4 cm (average 2.7 cm). Conclusions With limited preparation time before operations, few postoperative complications, and recurrence rate, DCST in the repair of giant incision hernia is safe and possible clinically.
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Affiliation(s)
- Ying-Han Song
- Department of Day Surgery Center, West China Hospital of Sichuan University, Chengdu, China
| | - Wei-Jia Huang
- West China School of Medicine, Sichuan University, West China Hospital of Sichuan University, Chengdu, China
| | - Yan-Yan Xie
- Hernia Center of Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Gonish Hada
- Hernia Center of Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Sen Zhang
- Hernia Center of Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - An-Qing Lu
- Hernia Center of Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Yong Wang
- Hernia Center of Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Wen-Zhang Lei
- Hernia Center of Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu, China
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Bara T, Gurzu S, Borz C, Muresan M, Jung I, Fulop Z, Bara T. Retromuscular mesh and hernial sac technique in the reconstruction of 139 cases of large median incisional hernias: one institution's experience. Hernia 2020; 24:99-105. [PMID: 30806887 DOI: 10.1007/s10029-019-01915-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 02/19/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE Incisional hernia is the most common complication of laparotomy. Postoperative parietal defects tend to relapse, even after the most optimal surgical methods. The aim of this study was to present the effectiveness of an adapted retromuscular technique with prolene mesh and a hernial sac, in patients with large incisional median hernias. The reported results were obtained by our team after more than 15 years of experience. METHODS This retrospective study included 139 consecutive cases of large median incisional hernias operated on using a retromuscular mesh and hernial sac technique. The cross-sectional diameter of incisional hernias was larger than 10 cm, being classified in the W3 group, according to the European Hernia Society classification. RESULTS The study included 83 females (59.71%) and 56 males (40.29%) with a median age of 62.4 ± 16.6 years and an average body mass index of 32.4 ± 7.6 kg. The hernia was supraumbilically located in 54 cases, subumbilically in 61 cases, and supra- and subumbilically in 24 cases. Postoperative complications were recorded in eight cases (5.75%): one case with a hematoma in the right abdominal muscle sheath; five cases with supra-aponeurotic seromas; two cases with skin necrosis and one with a mesh infection. Recurrence occurred in seven cases (5.03%): four cases in the first 2 years postoperatively and three cases in the third year after surgery. CONCLUSIONS The retromuscular technique with prolene mesh and a hernial sac is an effective method of restoring the integrity of the abdominal wall in large median incisional hernias with low rates of morbidity and recurrence.
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Affiliation(s)
- T Bara
- Department of Surgery, University of Medicine, Pharmacy, Sciences and Technology, Tirgu Mures, Romania
| | - S Gurzu
- Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology, 38 Gheorghe Marinescu Street, 540139, Tîrgu Mureş, Romania.
- Advanced Medical and Pharmaceutical Research Center (CCAMF), University of Medicine, Pharmacy, Sciences and Technology, Tirgu Mures, Romania.
| | - C Borz
- Department of Surgery, University of Medicine, Pharmacy, Sciences and Technology, Tirgu Mures, Romania
| | - M Muresan
- Department of Surgery, University of Medicine, Pharmacy, Sciences and Technology, Tirgu Mures, Romania
| | - I Jung
- Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology, 38 Gheorghe Marinescu Street, 540139, Tîrgu Mureş, Romania
| | - Z Fulop
- Department of Surgery, University of Medicine, Pharmacy, Sciences and Technology, Tirgu Mures, Romania
- Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology, 38 Gheorghe Marinescu Street, 540139, Tîrgu Mureş, Romania
| | - T Bara
- Department of Surgery, University of Medicine, Pharmacy, Sciences and Technology, Tirgu Mures, Romania
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Afaque M, Rizvi A. Comparison between transversus abdominis release and anterior component separation technique in complex ventral hernia. INTERNATIONAL JOURNAL OF ABDOMINAL WALL AND HERNIA SURGERY 2020. [DOI: 10.4103/ijawhs.ijawhs_55_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Recurrent intestinal fistulation after porcine acellular dermal matrix reinforcement in enteric fistula takedown and simultaneous abdominal wall reconstruction. Hernia 2019; 24:537-543. [DOI: 10.1007/s10029-019-02097-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 11/17/2019] [Indexed: 10/25/2022]
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Pre-operative CT scan measurements for predicting complications in patients undergoing complex ventral hernia repair using the component separation technique. Hernia 2019; 23:347-354. [PMID: 30847719 PMCID: PMC6456480 DOI: 10.1007/s10029-019-01899-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 01/22/2019] [Indexed: 11/04/2022]
Abstract
Background The component separation technique (CST) is considered an excellent technique for complex ventral hernia repair. However, postoperative infectious complications and reherniation rates are significant. Risk factor analysis for postoperative complication and reherniation has focused mostly on patient history and co-morbidity and shows equivocal results. The use of abdominal morphometrics derived from CT scans to assist in risk assessment seems promising. The aim of this study is to determine the predictability of reherniation and surgical site infections (SSI) using pre-operative CT measurements. Methods Electronic patient records were searched for patients who underwent CST between 2000 and 2013 and had a pre-operative CT scan available. Visceral fat volume (VFV), subcutaneous fat volume (SFV), loss of domain (LOD), rectus thickness and width (RT, RW), abdominal volume, hernia sac volume, total fat volume (TFV), sagittal distance (SD) and waist circumference (WC) were measured or calculated. Relevant variables were entered in multivariate regression analysis to determine their effect on reherniation and SSI as separate outcomes. Results Sixty-five patients were included. VFV (p = 0.025, OR = 1.65) was a significant predictor regarding reherniation. Hernia sac volume (p = 0.020, OR = 2.10) and SFV per 1000 cm3 (p = 0.034, OR = 0.26) were significant predictors of SSI. Conclusion Visceral fat volume, subcutaneous fat volume and hernia sac volume derived from CT scan measurements may be used to predict reherniation and SSI in patients undergoing complex ventral hernia repair using CST. These findings may aid in optimizing patient-tailored preoperative risk assessment.
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van Rooijen MMJ, Jairam AP, Tollens T, Jørgensen LN, de Vries Reilingh TS, Piessen G, Köckerling F, Miserez M, Windsor ACJ, Berrevoet F, Fortelny RH, Dousset B, Woeste G, van Westreenen HL, Gossetti F, Lange JF, Tetteroo GWM, Koch A, Kroese LF, Jeekel J. A post-market, prospective, multi-center, single-arm clinical investigation of Phasix™ mesh for VHWG grade 3 midline incisional hernia repair: a research protocol. BMC Surg 2018; 18:104. [PMID: 30458747 PMCID: PMC6247668 DOI: 10.1186/s12893-018-0439-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 11/07/2018] [Indexed: 02/05/2023] Open
Abstract
Background Incisional heia is a frequent complication of midline laparotomy. The use of mesh in hernia repair has been reported to lead to fewer recurrences compared to primary repair. However, in Ventral Hernia Working Group (VHWG) Grade 3 hernia patients, whose hernia is potentially contaminated, synthetic mesh is prone to infection. There is a strong preference for resorbable biological mesh in contaminated fields, since it is more able to resist infection, and because it is fully resorbed, the chance of a foreign body reaction is reduced. However, when not crosslinked, biological resorbable mesh products tend to degrade too quickly to facilitate native cellular ingrowth. Phasix™ Mesh is a biosynthetic mesh with both the biocompatibility and resorbability of a biological mesh and the mechanical strength of a synthetic mesh. This multi-center single-arm study aims to collect data on safety and performance of Phasix™ Mesh in Grade 3 hernia patients. Methods A total of 85 VHWG Grade 3 hernia patients will be treated with Phasix™ Mesh in 15 sites across Europe. The primary outcome is Surgical Site Occurrence (SSO) including hematoma, seroma, infection, dehiscence and fistula formation (requiring intervention) through 3 months. Secondary outcomes include recurrence, infection and quality of life related outcomes after 24 months. Follow-up visits will be at drain removal (if drains were not placed, then on discharge or staple removal instead) and in the 1st, 3rd, 6th, 12th, 18th and 24th month after surgery. Conclusion Based on evidence from this clinical study Depending on the results this clinical study will yield, Phasix™ Mesh may become a preferred treatment option in VHWG Grade 3 patients. Trial registration The trial was registered on March 25, 2016 on clinicaltrials.gov: NCT02720042.
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Affiliation(s)
- M M J van Rooijen
- Erasmus University Medical Centre Rotterdam, Department of Surgery, Rotterdam, The Netherlands.
| | - A P Jairam
- Erasmus University Medical Centre Rotterdam, Department of Surgery, Rotterdam, The Netherlands
| | - T Tollens
- Imelda Hospital, Department of General Surgery, Bonheiden, Belgium
| | - L N Jørgensen
- University of Copenhagen, Bispebjerg Hospital, Department of Surgery, Copenhagen, Denmark
| | | | - G Piessen
- Department of Surgery, University Hospital Lille, Lille, France
| | - F Köckerling
- Vivantes Klinikum Spandau, Department of Surgery, Berlin, Germany
| | - M Miserez
- Department of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium
| | - A C J Windsor
- Department of Colorectal Surgery, University College London Hospital, London, UK
| | - F Berrevoet
- Department of General and Hepatobiliary Surgery, University Hospital Ghent, Ghent, Belgium
| | - R H Fortelny
- Wilhelminenhospital, Department of General, Visceral and Oncologic Surgery, Vienna, Austria
| | - B Dousset
- Hôpital Cochin, Department of Digestive, Hepatobiliary and Endocrine Surgery, Paris, France
| | - G Woeste
- Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main, Germany
| | | | - F Gossetti
- Università di Roma Sapienza, Rome, Italy
| | - J F Lange
- Erasmus University Medical Centre Rotterdam, Department of Surgery, Rotterdam, The Netherlands
| | - G W M Tetteroo
- IJsselland Ziekenhuis, Department of Surgery, Capelle aan den Ijssel, The Netherlands
| | - A Koch
- Chirurgische Praxis Cottbus, Cottbus Area, Germany
| | - L F Kroese
- Erasmus University Medical Centre Rotterdam, Department of Surgery, Rotterdam, The Netherlands
| | - J Jeekel
- Erasmus University Medical Centre Rotterdam, Department of Surgery, Rotterdam, The Netherlands
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Scheuerlein H, Thiessen A, Schug-Pass C, Köckerling F. What Do We Know About Component Separation Techniques for Abdominal Wall Hernia Repair? Front Surg 2018; 5:24. [PMID: 29637073 PMCID: PMC5881422 DOI: 10.3389/fsurg.2018.00024] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 03/05/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction The component separation technique (CST) was introduced to abdominal wall reconstruction to treat large, complex hernias. It is very difficult to compare the published findings because of the vast number of technical modifications to CST as well as the heterogeneity of the patient population operated on with this technique. Material and Methods The main focus of the literature search conducted up to August 2017 in Medline and PubMed was on publications reporting comparative findings as well as on systematic reviews in order to formulate statements regarding the various CSTs. Results CST without mesh should no longer be performed because of too high recurrence rates. Open anterior CST has too high a surgical site occurrence rate and henceforth should only be conducted as endoscopic and perforator sparing anterior CST. Open posterior CST and posterior CST with transversus abdominis release (TAR) produce better results than open anterior CST. To date, no significant differences have been found between endoscopic anterior, perforator sparing anterior CST and posterior CST with transversus abdominis release. Robot-assisted posterior CST with TAR is the latest, very promising alternative. The systematic use of biologic meshes cannot be recommended for CST. Conclusion CST should always be performed with mesh as endoscopic or perforator sparing anterior or posterior CST. Robot-assisted posterior CST with TAR is the latest development.
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Affiliation(s)
- Hubert Scheuerlein
- Department for General and Visceral Surgery, Vincenz Hospital, Paderborn, Germany
| | - Andreas Thiessen
- Department for General and Visceral Surgery, Vincenz Hospital, Paderborn, Germany
| | - Christine Schug-Pass
- Department of Surgery and Center for Minimally Invasive Surgery, Vivantes Hospital, Academic Teaching Hospital of Charité Medical School, Berlin, Germany
| | - Ferdinand Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Vivantes Hospital, Academic Teaching Hospital of Charité Medical School, Berlin, Germany
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Birindelli A, Sartelli M, Di Saverio S, Coccolini F, Ansaloni L, van Ramshorst GH, Campanelli G, Khokha V, Moore EE, Peitzman A, Velmahos G, Moore FA, Leppaniemi A, Burlew CC, Biffl WL, Koike K, Kluger Y, Fraga GP, Ordonez CA, Novello M, Agresta F, Sakakushev B, Gerych I, Wani I, Kelly MD, Gomes CA, Faro MP, Tarasconi A, Demetrashvili Z, Lee JG, Vettoretto N, Guercioni G, Persiani R, Tranà C, Cui Y, Kok KYY, Ghnnam WM, Abbas AES, Sato N, Marwah S, Rangarajan M, Ben-Ishay O, Adesunkanmi ARK, Lohse HAS, Kenig J, Mandalà S, Coimbra R, Bhangu A, Suggett N, Biondi A, Portolani N, Baiocchi G, Kirkpatrick AW, Scibé R, Sugrue M, Chiara O, Catena F. 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias. World J Emerg Surg 2017; 12:37. [PMID: 28804507 PMCID: PMC5545868 DOI: 10.1186/s13017-017-0149-y] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 07/31/2017] [Indexed: 02/08/2023] Open
Abstract
Emergency repair of complicated abdominal wall hernias may be associated with worsen outcome and a significant rate of postoperative complications. There is no consensus on management of complicated abdominal hernias. The main matter of debate is about the use of mesh in case of intestinal resection and the type of mesh to be used. Wound infection is the most common complication encountered and represents an immense burden especially in the presence of a mesh. The recurrence rate is an important topic that influences the final outcome. A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bergamo in July 2013 with the aim to define recommendations for emergency repair of abdominal wall hernias in adults. This document represents the executive summary of the consensus conference approved by a WSES expert panel. In 2016, the guidelines have been revised and updated according to the most recent available literature.
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Affiliation(s)
| | | | | | - Federico Coccolini
- Department of General Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Luca Ansaloni
- Department of General Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Gabrielle H van Ramshorst
- Department of Surgery, Red Cross Hospital Beverwijk, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Vladimir Khokha
- Department of General Surgery, Mozyr City Hospital, Mazyr, Belarus
| | | | - Andrew Peitzman
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - George Velmahos
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | | | - Ari Leppaniemi
- Department of Abdominal Surgery, University Hospital Meilahti, Helsinki, Finland
| | | | - Walter L Biffl
- Department of Surgery, University of Hawaii, Honolulu, HI USA
| | - Kaoru Koike
- Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Gustavo P Fraga
- Division of Trauma Surgery, Hospital de Clinicas, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Carlos A Ordonez
- Department of Surgery, Universidad del Valle, Fundacion Valle del Lili, Cali, Colombia
| | - Matteo Novello
- Department of Surgery, University of Bologna, Bologna, Italy
| | | | - Boris Sakakushev
- General Surgery Clinic, University Hospital St. George/Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Igor Gerych
- Department of Surgery 1, Lviv Regional Hospital, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Imtiaz Wani
- Department of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | | | - Carlos Augusto Gomes
- Federal University of Juiz de Fora (UFJF), Juiz de Fora, MG Brazil.,Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (SUPREMA), Juiz de Fora, MG Brazil
| | - Mario Paulo Faro
- Department of General Surgery, Trauma and Emergency Surgery Division, ABC Medical School, Santo André, SP Brazil
| | - Antonio Tarasconi
- Department of Emergency Surgery, Maggiore Parma Hospital, Parma, Italy
| | - Zaza Demetrashvili
- Department of Surgery, Tbilisi State Medical University, Tbilisi, Georgia
| | - Jae Gil Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Nereo Vettoretto
- Department of Surgery, Montichiari Hospital, ASST Spedali Civili Brescia, Brescia, Italy
| | | | | | - Cristian Tranà
- Department of Surgery, Macerata Hospital, Macerata, Italy
| | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China
| | - Kenneth Y Y Kok
- Department of Surgery, RIPAS Hospital, Bandar Seri Begawan, Brunei
| | - Wagih M Ghnnam
- Department of Surgery Mansoura, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ashraf El-Sayed Abbas
- Department of Surgery Mansoura, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Norio Sato
- Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Sanjay Marwah
- Department of Surgery, Pt. BDS Post Graduate Institute of Medical Sciences, Rohtak, India
| | - Muthukumaran Rangarajan
- Department of Laparoscopic and Bariatric Surgery, Health City Cayman Islands, Grand Cayman, Cayman Islands
| | - Offir Ben-Ishay
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Abdul Rashid K Adesunkanmi
- Department of Surgery, College of Health Sciences, Obafemi Awolowo University Hospital, Ile-Ife, Nigeria
| | - Helmut Alfredo Segovia Lohse
- II Cátedra de Clínica Quirúrgica, Hospital de Clínicas, Facultad de Ciencias Médicas, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Jakub Kenig
- 3rd Department of General Surgery, Jagiellonian University Collegium Medium, Krakow, Poland
| | - Stefano Mandalà
- Department of Surgery, G. Giglio Hospital Cefalù, Palermo, Italy
| | - Raul Coimbra
- Department of Surgery, Division of Trauma, Surgical Care, Burns and Acute Care Surgery, UC San Diego Medical Center, San Diego, CA USA
| | - Aneel Bhangu
- Academic Department of Surgery, University Hospitals Birmingham NHS Foundation Trust, Edgabaston, Birmingham, UK
| | - Nigel Suggett
- Department of Colorectal Surgery, New Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK
| | | | | | | | - Andrew W Kirkpatrick
- Departments of Critical Care Medicine and Surgery, Foothills Medical Centre, Calgary, AB Canada
| | - Rodolfo Scibé
- Department of Surgery, Macerata Hospital, Macerata, Italy
| | | | | | - Fausto Catena
- Department of Emergency Surgery, Maggiore Parma Hospital, Parma, Italy
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Modified components separation technique: experience treating large, complex ventral hernias at a University Hospital. Hernia 2017; 21:601-608. [DOI: 10.1007/s10029-017-1619-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 05/01/2017] [Indexed: 11/26/2022]
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Abstract
With advances in abdominal surgery and the management of major trauma, complex abdominal wall defects have become the new surgical disease, and the need for abdominal wall reconstruction has increased dramatically. Subsequently, how to reconstruct these large defects has become a new surgical question. While most surgeons use native abdominal wall whenever possible, evidence suggests that synthetic or biologic mesh needs to be added to large ventral hernia repairs. One particular group of patients who exemplify "complex" are those with contaminated wounds, enterocutaneous fistulas, enteroatmospheric fistulas, and/or stoma(s), where synthetic mesh is to be avoided if at all possible. Most recently, biologic mesh has become the new standard in high-risk patients with contaminated and dirty-infected wounds. While biologic mesh is the most common tissue engineered used in this field of surgery, level I evidence is needed on its indication and long-term outcomes. Various techniques for reconstructing the abdominal wall have been described, however the long-term outcomes for most of these studies, are rarely reported. In this article, I outline current practical approaches to perioperative management and definitive abdominal reconstruction in patients with complex abdominal wall defects, with or without fistulas, as well as those who have lost abdominal domain.
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Madani A, Niculiseanu P, Marini W, Kaneva PA, Mappin-Kasirer B, Vassiliou MC, Khwaja K, Fata P, Fried GM, Feldman LS. Biologic mesh for repair of ventral hernias in contaminated fields: long-term clinical and patient-reported outcomes. Surg Endosc 2016; 31:861-871. [PMID: 27334966 DOI: 10.1007/s00464-016-5044-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 06/11/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Guidelines recommend biologic prosthetics for ventral hernia repair (VHR) in contaminated fields, yet long-term and patient-reported data are limited. We aimed to determine the long-term rate of hernia recurrence, and other clinical and patient-reported outcomes following the use of porcine small intestine submucosa (PSIS) for VHR in a contaminated field. METHODS Consecutive patients undergoing open VHR with PSIS mesh in a contaminated field from 2004 to 2014 were prospectively evaluated for hernia recurrence and other post-operative complications. Multivariate logistic and Cox regression analyses identified predictors of hernia recurrence and surgical site infection. Patient-reported outcomes were evaluated using SF-36, Hernia-Related Quality-of-Life Survey (HerQLes) and Body Image Questionnaire instruments. RESULTS Forty-six hernias were repaired in clean-contaminated [16 (35 %)], contaminated [11 (24 %)] and dirty [19 (41 %)] fields. Median follow-up was 47 months [interquartile range: 31-79] and all patients had greater than 12-month follow-up. Sixteen patients (35 %) were not re-examined. Incidence of surgical site events and surgical site infection were 43 % (n = 20) and 56 % (n = 25), respectively. American Society of Anesthesiologists score 3 or greater was an independent predictor of surgical site infection (odds ratio 5.34 [95 % confidence interval 1.01-41.80], p = 0.04). Hernia recurrence occurred in 61 % (n = 28) with a median time to diagnosis of 16 months [interquartile range 8-26]. After bridged repair, 16 of 18 patients (89 %) recurred, compared to 12 of 28 (43 %) when fascia was approximated (p < 0.01). Bridged repair was an independent predictor of recurrence (odds ratio 10.67 [95 % confidence interval 2.42-76.08], p < 0.01). Patients with recurrences had significantly worse scores on the SF-36 mental health component and self-perceived body image, whereas HerQLes scores were similar. CONCLUSIONS Hernia recurrences and wound infections are high with the use of biologic PSIS mesh in contaminated surgical fields. Careful consideration is warranted using this approach.
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Affiliation(s)
- Amin Madani
- Department of Surgery, McGill University Health Centre, 1650 Cedar Avenue, Rm D6-257, Montreal, QC, H3G 1A4, Canada.
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Canada.
| | - Petru Niculiseanu
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Canada
| | - Wanda Marini
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Canada
| | - Pepa A Kaneva
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Canada
| | - Benjamin Mappin-Kasirer
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Canada
| | - Melina C Vassiliou
- Department of Surgery, McGill University Health Centre, 1650 Cedar Avenue, Rm D6-257, Montreal, QC, H3G 1A4, Canada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Canada
| | - Kosar Khwaja
- Department of Surgery, McGill University Health Centre, 1650 Cedar Avenue, Rm D6-257, Montreal, QC, H3G 1A4, Canada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Canada
| | - Paola Fata
- Department of Surgery, McGill University Health Centre, 1650 Cedar Avenue, Rm D6-257, Montreal, QC, H3G 1A4, Canada
| | - Gerald M Fried
- Department of Surgery, McGill University Health Centre, 1650 Cedar Avenue, Rm D6-257, Montreal, QC, H3G 1A4, Canada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Canada
| | - Liane S Feldman
- Department of Surgery, McGill University Health Centre, 1650 Cedar Avenue, Rm D6-257, Montreal, QC, H3G 1A4, Canada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Canada
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17
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How to perform the endoscopically assisted components separation technique (ECST) for large ventral hernia repair. Hernia 2016; 20:441-7. [DOI: 10.1007/s10029-016-1485-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 03/19/2016] [Indexed: 10/22/2022]
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Abstract
Many publications are available on the best surgical techniques and treatment of incisional hernias with reports of experiences and randomized clinical studies at the two extremes of the evidence scale. The ultimate proof of the best operative technique has, however, not yet been achieved. In practically no other field of surgery are the variability and the resulting potential aims of surgery so great. The aim of surgery is to provide patients with the optimal recommendation out of a catalogue of possibilities from a holistic perspective. This article describes the surgical techniques using meshes for strengthening (in combination with an anatomical reconstruction) and for replacement of the abdominal wall (with bridging of the defect).
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Modified triple-layer peritoneal-aponeurotic transposition: A new strategy to close the "open abdomen". J Trauma Acute Care Surg 2015; 79:694-7. [PMID: 26402547 DOI: 10.1097/ta.0000000000000817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Holihan JL, Alawadi Z, Martindale RG, Roth JS, Wray CJ, Ko TC, Kao LS, Liang MK. Adverse Events after Ventral Hernia Repair: The Vicious Cycle of Complications. J Am Coll Surg 2015. [DOI: 10.1016/j.jamcollsurg.2015.04.026] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Transitional mesh repair for large incisional hernia in the elderly. Int J Surg Case Rep 2015; 7C:70-4. [PMID: 25594736 PMCID: PMC4336395 DOI: 10.1016/j.ijscr.2014.12.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 12/13/2014] [Accepted: 12/15/2014] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Large incisional hernias are difficult to repair, especially in elderly patients with thin abdominal walls. Although most such incisional hernias are simply observed, they do not spontaneously resolve. Previously reported procedures are inadequate for repair of all incisional hernias. We herein propose an innovative technique for repair of ventral incisional hernias. PRESENTATION OF CASE A 88-year-old woman had a large incisional hernia with bilateral inguinal hernias. Incisional hernioplasty was successfully performed for extraperitoneal reinforcement by combining underlay and onlay methods using one prosthesis with transitional sutures. Bilateral inguinal hernioplasty was performed simultaneously. Twelve months postoperatively, the patient is well, without hernia recurrence. DISCUSSION Elderly patients often have thin, attenuated abdominal walls, and large incisional hernia reinforcement may require a prosthesis. In such cases, a retrorectal prosthesis position is recommended. However, the prosthesis cannot be placed on the cranial side in the presence of a destroyed or adhered abdominal wall is present. In this case, one prosthesis was placed using an underlay method on the caudal side and using an onlay method on the cranial side. The abdominal layers were shifted and each transition point was covered by the other layers to secure the overlapping margins between the abdominal wall and prosthesis. CONCLUSION This transitional mesh repair was successfully performed for a large incisional hernia in an elderly patient. The procedure is a useful strategy for incisional hernia repair in patients with thin, destroyed abdominal walls. However, further studies are required for a more thorough evaluation of this technique.
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