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Ciscar A, Sánchez-Sáez E, Vila Tura M, Ruiz de Leon P, Gomez Pallarès M, Troyano Escribano D, Abadal Prades M, Mans Muntwyler E, Pereira JA, Badia JM. Assessment of the effectiveness of a polypropylene onlay mesh in the prevention of laparoscopic trocar-site incisional hernia in high-risk patients. A randomized clinical trial. Hernia 2024:10.1007/s10029-024-03124-7. [PMID: 39207550 DOI: 10.1007/s10029-024-03124-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 07/21/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE Trocar site incisional hernia (TSIH) is a common complication of laparoscopic surgery. In the scientific literature there are few descriptions of methods or tools for its prevention. The aim of this report was to assess the effectiveness and safety of a prophylactic measure designed to lower rates of TSIH. METHODS A multicenter randomized double-blinded clinical trial was performed in high-risk patients (diabetes mellitus and/or age ≥ 70 years and/or BMI ≥ 30 kg/m2 and/or extended incision for specimen retrieval) who underwent either elective or emergency laparoscopic cholecystectomy. Patients were assigned to prophylactic onlay polypropylene mesh fixation (intervention) or to standard trocar closure (control). The main aim was to analyze the efficacy of the intervention, taking occurrence of TSIH as the primary outcome. Clinical and radiological follow up lasted at least one year after surgery. Secondary endpoints were technique-related complications (surgical site occurrences). RESULTS One hundred and forty-three patients were randomized and finally 116 were analyzed (64 in the intervention arm and 52 in the control arm). Groups were homogeneous. Mean [SD] age, 65 [18] years; 86 (60.6%) were women. The cumulative TSIH incidence was lower in the intervention group although the differences did not reach statistical significance, assessed either radiologically (16 [25.4%] vs 17 [31.5%], p = 0.538) or clinically (9 [16.1%] vs 9 [20], p = 0.613). No differences in surgical site infection, hematoma or seroma were detected. Mean follow-up was 670 days (range 223-1294). CONCLUSION Our results show that, when properly assessed, the overall TSIH incidence is extremely high. Although polypropylene onlay mesh placement is safe, it does not appear to be effective in reducing the TSIH incidence rate. Radiological evaluation may be more accurate. TRIAL REGISTRATION ClinicalTrials.org NCT03495557. Date of registration: April 12, 2018.
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Affiliation(s)
- Ana Ciscar
- Department of Surgery, UD de Medicina de la Vall d'Hebron, Universitat Autonoma de Barcelona, Edifici W, Passeig Vall d'Hebron, Barcelona, 08035, Spain.
- Hospital Universitari Vall d'Hebron, Barcelona, Spain.
| | - Emma Sánchez-Sáez
- Hospital de Sant Boi, Parc Sanitari Sant Joan de Deu, Sant Boi, Spain
| | - Marina Vila Tura
- Hospital Universitari de Bellvitge, Hospitalet del Llobregat, Spain
| | | | | | | | - Marta Abadal Prades
- Hospital de Mataró. Department of Radiology. Consorci Sanitari del Maresme, Mataró, Spain
| | - Esther Mans Muntwyler
- Hospital de Mataró. Department of Surgery. Consorci Sanitari del Maresme, Mataró, Spain
| | - José-Antonio Pereira
- Abdominal Wall Unit, Department of General Surgery, Hospital del Mar. Parc de Salut Mar, Barcelona, Spain
- Medicine and Life Sciences Department, Universitat Pompeu Fabra, Barcelona, Spain
| | - Josep M Badia
- Hospital de Granollers, Granollers, Spain
- School of Medicine, Universitat Internacional de Catalunya, Sarrià-Sant Gervasi, Barcelona, Spain
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Ciscar Belles A, Makhoukhi T, López-Cano M, Hernández Granados P, Pereira Rodríguez JA. Umbilical incisional hernias (M3): are trocar-site hernias different? Comparative analysis of the EVEREG registry⋆. Cir Esp 2022; 100:336-344. [PMID: 35618203 DOI: 10.1016/j.cireng.2022.05.023] [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: 11/12/2020] [Accepted: 01/24/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND Incisional hernia (HI), in open and laparoscopic surgery, is a very frequent complication. HI located in the umbilical region are called M3. The main aim of this study is to compare HI produced by the placement of an umbilical laparoscopic trocar (M3T) with those located in M3 in open surgery (M3O) in terms of basal characteristics, complications and recurrences; and secondarily the identification of risk factors. METHOD Cross-sectional observational study based on the national prospective registry EVEREG during the period of July 2012-June 2018. The main variables were recurrences and postoperative complications. Both groups (M3T and M3O) were compared. Multiple logistic regression was performed to identify the risk factors of the entire cohort. RESULTS 882 had a follow-up time longer than 12 months. M3O group presented superior ASA-Class, more complex HI and previous repair. It also presented a higher recurrence rate at 12 and 24 months (8.6% vs. 2.5%; P < 0,0001 and 9.3% vs. 2.9%; P < 0.0001) and higher postoperative complications rate (21.9% vs. 14.6 %; P = 0.02). Previous repair, intervention length and associated procedures requirement were identified as risk factors for postoperative complications. Absence of a specialist present during surgery, previous repair, and the absence of complications were identified as risk factors for recurrence. In the PSM analysis no differences were detected in of complications and recurrences. CONCLUSIONS HI M3O is more complex than M3T. The complexity is not related to the origin of the hernia but to its characteristics and those of the patient.
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Affiliation(s)
- Ana Ciscar Belles
- Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain; Servicio de Cirugía General, Hospital de Mataró, Barcelona, Spain
| | - Touria Makhoukhi
- Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
| | - Manuel López-Cano
- Servicio de Cirugía General, Hospital Vall d'Hebron, Barcelona, Spain; Departament de Cirurgia, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - José Antonio Pereira Rodríguez
- Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain; Servicio de Cirugía General, Hospital Universitari del Mar, Barcelona, Spain.
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Ciscar Belles A, Makhoukhi T, López-Cano M, Hernández Granados P, Pereira Rodríguez JA. Umbilical incisional hernia (M3) Are trocar hernia differents? Comparative analysis of the EVEREG Registry. Cir Esp 2021; 100:S0009-739X(21)00041-5. [PMID: 33640141 DOI: 10.1016/j.ciresp.2021.01.019] [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] [Received: 11/12/2020] [Revised: 01/21/2021] [Accepted: 01/24/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Incisional hernia (HI), in open and laparoscopic surgery, is a very frequent complication. HI located in the umbilical region are called M3. The main aim of this study is to compare HI produced by the placement of an umbilical laparoscopic trocar (M3T) with those located in M3 in open surgery (M3O) in terms of basal characteristics, complications and recurrences; and secondarily the identification of risk factors. METHOD Cross-sectional observational study based on the national prospective registry EVEREG during the period of July 2012 - June 2018. The main variables were recurrences and postoperative complications. Both groups (M3T and M3O) were compared. Multiple logistic regression was performed to identify the risk factors of the entire cohort. RESULTS 882 had a follow-up time longer than 12 months. M3O group presented superior ASA-Class, more complex HI and previous repair. It also presented a higher recurrence rate at 12 and 24 months (8.6 vs. 2.5%; p < 0,0001 and 9.3 vs. 2.9%; p < 0.0001) and higher postoperative complications rate (21.9 vs. 14.6%; p = 0.02). Previous repair, intervention length and associated procedures requirement were identified as risk factors for postoperative complications. Absence of a specialist present during surgery, previous repair, and the absence of complications were identified as risk factors for recurrence. In the PSM analysis no differences were detected in of complications and recurrences. CONCLUSIONS HI M3O is more complex than M3T. The complexity is not related to the origin of the hernia but to its characteristics and those of the patient.
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Affiliation(s)
- Ana Ciscar Belles
- Departament de Ciències Experimentals i de la Salut. Universitat Pompeu Fabra, Barcelona, España; Servicio de Cirugía General. Hospital de Mataró, Barcelona, España
| | - Touria Makhoukhi
- Departament de Ciències Experimentals i de la Salut. Universitat Pompeu Fabra, Barcelona, España
| | - Manuel López-Cano
- Servicio de Cirugía General. Hospital Vall d'Hebron, Barcelona, España; Departament de Cirurgia. Universitat Autònoma de Barcelona, Barcelona, España
| | | | - José Antonio Pereira Rodríguez
- Departament de Ciències Experimentals i de la Salut. Universitat Pompeu Fabra, Barcelona, España; Servicio de Cirugía General. Hospital Universitari del Mar, Barcelona, España.
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Incidence and risk factors for trocar-site incisional hernia detected by clinical and ultrasound examination: a prospective observational study. BMC Surg 2020; 20:330. [PMID: 33317503 PMCID: PMC7737369 DOI: 10.1186/s12893-020-01000-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 12/03/2020] [Indexed: 01/12/2023] Open
Abstract
Background Trocar site incisional hernia (TSIH) is the most frequent complication associated with laparoscopic surgery. Few studies currently describe its incidence or risk factors. The aim of this report is to determine the real incidence of TSIH and to identify risk factors. Methods A cross-sectional prospective study was performed including consecutive patients who underwent a laparoscopic procedure during a 4 months period. All the patients were assessed both clinically (TSIHc) and by an ultrasonographic examination (TSIHu). The main variable studied was the incidence of TSIH. A multivariate analysis was performed to identify risk factors. Results 76 patients were included. 27.6% of patients were clinically diagnosed as having TSIH (TSIHc) but only 23.7% of those cases were radiologically confirmed (TSIHu). In the logistic regression analysis, age > 70 years (OR 3.462 CI 1.14–10.515, p = 0.028) and body mass index (BMI) ≥ 30 kg/m2 (OR 3.313 CI 1.037–10.588, p = 0.043) were identified as risk factors for TSIH. The size of the trocar also showed statistically significant differences (p < 0.001). Mean follow-up time was 34 months. Conclusions TSIH is under-diagnosed due to the lack of related symptomatology and the inadequacy of the postoperative follow-up period. We detected discrepancies between the clinical and ultrasonographic examinations. TSIHu should be considered as the gold standard for the diagnosis of TSIH. Risk factors such as age, BMI and size of the trocar were confirmed. Patients should be followed-up for a minimum of 2 years. Trial registration The study has been retrospectively registered in Clinicaltrials.gov on June 4, 2020 under registration number: NCT04410744
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Ghoreifi A, Whang G, Tran K, Tejura T, Liu B, Cai J, Lei X, Cen S, Aslzare M, Burg M, Desai M, Aron M, Gill I, Duddalwar V, Djaladat H. Natural History of Radiologic Incisional Hernia Following Robotic Nephrectomy. J Endourol 2020; 34:974-980. [DOI: 10.1089/end.2020.0055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Alireza Ghoreifi
- Institute of Urology, University of Southern California, Los Angeles, California, USA
| | - Gilbert Whang
- Department of Radiology, University of Southern California, Los Angeles, California, USA
| | - Khoa Tran
- Department of Radiology, University of Southern California, Los Angeles, California, USA
| | - Tapas Tejura
- Department of Radiology, University of Southern California, Los Angeles, California, USA
| | - Benjamin Liu
- Institute of Urology, University of Southern California, Los Angeles, California, USA
| | - Jie Cai
- Institute of Urology, University of Southern California, Los Angeles, California, USA
| | - Xiaomeng Lei
- Department of Radiology, University of Southern California, Los Angeles, California, USA
| | - Steven Cen
- Department of Radiology, University of Southern California, Los Angeles, California, USA
| | - Mohammad Aslzare
- Department of Urology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Madeleine Burg
- Institute of Urology, University of Southern California, Los Angeles, California, USA
| | - Mihir Desai
- Institute of Urology, University of Southern California, Los Angeles, California, USA
| | - Monish Aron
- Institute of Urology, University of Southern California, Los Angeles, California, USA
| | - Inderbir Gill
- Institute of Urology, University of Southern California, Los Angeles, California, USA
| | - Vinay Duddalwar
- Department of Radiology, University of Southern California, Los Angeles, California, USA
| | - Hooman Djaladat
- Institute of Urology, University of Southern California, Los Angeles, California, USA
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Todros S, de Cesare N, Concheri G, Natali AN, Pavan PG. Numerical modelling of abdominal wall mechanics: The role of muscular contraction and intra-abdominal pressure. J Mech Behav Biomed Mater 2020; 103:103578. [DOI: 10.1016/j.jmbbm.2019.103578] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/30/2019] [Accepted: 11/29/2019] [Indexed: 01/27/2023]
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Characteristics of Trocar Site Hernia after Laparoscopic Cholecystectomy. Sci Rep 2020; 10:2868. [PMID: 32071382 PMCID: PMC7029008 DOI: 10.1038/s41598-020-59721-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/03/2020] [Indexed: 12/19/2022] Open
Abstract
Trocar site hernia (TSH) is an incisional hernia occurring at the trocar insertion sites after different types of laparoscopic surgeries. The aim of this study is to present characteristics of patient and surgery series with trocar site hernia after laparoscopic cholecystectomy. A 2930 consecutive patients underwent laparoscopic cholecystectomy in two major university- affiliated hospitals from April 2014 to March 2018 and the patient followed up for variable periods of time. Retrospective medical chart review to study trocar site hernia including patient, operation, instruments, and pathologic characteristics described. Six patients had trocar site hernia (incidence 0.20%), the hernias occurred mostly at the umbilical port site after using 10 mm trocar. Risk factors included mainly obesity, female gender and use of 10 mm trocars at midline sites. TSH is more described. It occurs mostly at the umbilical port site. Major risk factors include obesity, diabetes mellitus, lengthy procedure, extension of entry site, and wound infection. Closure of fascial defect is supposed to reduce the incidence despite weak evidence.
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Abstract
Background and Objectives Laparoendoscopic single site surgery (LESS), a minimally invasive procedure, is performed in many hospitals. Although its cosmetic superiority is widely touted, some authors have disputed this view. Here, we compare the surgical and long-term cosmetic outcomes of and patient satisfaction with postoperative wounds for LESS and over 2-port laparoscopy (OTPL), including 2-port laparoscopy (TPL) and standard laparoscopy (SL), after a 6-mo follow-up period. Methods A total of 125 patients who underwent adnexal surgery performed by the same surgeon at the same institution between March 2005 and May 2017 were included. The patients were divided into 2 groups: the LESS group and the OTPL group. The patients completed an evaluation using the Patient Scar Assessment Scale (PSAS, used to evaluate linear scars) and the Ultimate Question (UQ, used to determine overall patient satisfaction). We evaluated surgical scars using the Observer Scar Assessment Scale, which includes the Umbilical Scar Overall Shape Assessment Scale (USOSAS) and the Vancouver Scar Scale (VSS). Results There were no significant differences in the PSAS, UQ, USOSAS, and VSS results between the study groups. The USOSAS score was consistently correlated with VSS scores of 2, 3, and 4 and the total VSS score, indicating that the USOSAS score may be as effective as the VSS score. Conclusions Because the long-term patient satisfaction with and cosmetic wound outcomes of LESS were not significantly different from those achieved by OTPL, surgeons should consider performing LESS after weighing the pros and cons with regard to the patient's condition.
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Affiliation(s)
- Sang Wook Yi
- Division of Minimally Invasive Surgery and Gynecological Laparoendoscopy, Department of Obstetrics and Gynecology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Korea
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Rodríguez de Guzmán CA, Morandeira Rivas AJ, Herrero Bogajo ML, Moreno Sanz C. Hernia del orificio del trocar, ¿un problema más frecuente de lo que creemos? Cir Esp 2019; 97:410-411. [DOI: 10.1016/j.ciresp.2018.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 10/19/2018] [Indexed: 01/16/2023]
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Chorti A, AbuFarha S, Michalopoulos A, Papavramidis TS. Richter's hernia in a 5-mm trocar site. SAGE Open Med Case Rep 2019; 7:2050313X18823413. [PMID: 30719305 PMCID: PMC6349989 DOI: 10.1177/2050313x18823413] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 12/13/2018] [Indexed: 11/15/2022] Open
Abstract
We present an unusual case of a trocar site incision hernia at a 5-mm trocar port occurring approximately 2 weeks post-operatively after a laparoscopic cholecystectomy. The patient, in her mid-60s, reported diffuse abdominal pain, constipation, nausea and vomiting. An abdominal X-ray demonstrated dilated small bowel loops with gas-fluid levels. Abdominal computed tomography revealed the small bowel herniation through the 5-mm port site. Laparotomy confirmed a Richter’s hernia of the small bowel in the fascia defect. This case highlights the necessity to examine and investigate any complaint post-operatively and deliberate its possible significance. Furthermore, it demonstrates that, even during a normal recovery period for a patient without any underlying disease or risk factors, a rare complication could still develop in a delayed fashion multiple days post-operatively from a laparoscopic procedure. High clinical suspicion is essential in order to avoid further deterioration of the patient condition and optimal treatment.
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Affiliation(s)
- Angeliki Chorti
- 1st Propedeutic Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Samer AbuFarha
- 1st Propedeutic Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Michalopoulos
- 1st Propedeutic Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodosios S Papavramidis
- 1st Propedeutic Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Li M, Cao B, Gong R, Sun D, Zhang P, Jiang X, Sheng Y. Randomized trial of umbilical incisional hernia in high-risk patients: extraction of gallbladder through subxiphoid port vs. umbilical port after laparoscopic cholecystectomy. Wideochir Inne Tech Maloinwazyjne 2018; 13:342-349. [PMID: 30302147 PMCID: PMC6174159 DOI: 10.5114/wiitm.2018.76001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 03/27/2018] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Trocar site incisional hernia (TSIH) is one of the most common complications of laparoscopic surgery. Using the umbilical port as a common hole for removing the gallbladder in laparoscopic cholecystectomy is more likely to lead to TSIH than other ports. Thus, extracting the gallbladder through other ports may reduce the incidence of TSIH. AIM To ascertain whether extraction of the gallbladder through the subxiphoid port is more beneficial for reducing umbilical incisional hernia than the umbilical port. MATERIAL AND METHODS From April 2014 to March 2017, a randomized clinical trial was conducted among patients with high risk of incisional hernia and accepted for three-port laparoscopic cholecystectomy (TLC) in our department. 182 patients with indications of cholecystectomy were allocated randomly to group A (subxiphoid port) and group B (umbilical port). Data collection was carried out on operative time, postoperative pain, hospital stay, wound infection and TSIH in the early postoperative course, and at 1, 10, and 24 months after surgery. RESULTS The incidence of TSIH in group A was lower than that in group B (4.9% vs. 14.6%; odds ratio = 8.02; 95% CI: 2.15-47.6; p < 0.001). The mean operative time of group A was significantly shorter than that of group B (35 ±15.16 min vs. 42 ±14.58 min, p < 0.01). There was no significant difference in wound infection rate between group A and group B (p = 0.068). The data of hospital stay (p = 0.428) and postoperative pain (p = 0.349) of all analyzed patients were similar in the two groups. CONCLUSIONS Extraction of the gallbladder through the subxiphoid port can reduce umbilical incisional hernia in high-risk patients effectively.
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Affiliation(s)
- Min Li
- Department of General Surgery, Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Baoqiang Cao
- Department of General Surgery, Anhui Armed Police General Hospital, Hefei, China
| | - Renhua Gong
- Department of General Surgery, Anhui Armed Police General Hospital, Hefei, China
| | - Dengqun Sun
- Department of General Surgery, Anhui Armed Police General Hospital, Hefei, China
| | - Peisong Zhang
- Department of General Surgery, Anhui Armed Police General Hospital, Hefei, China
| | - Xudong Jiang
- Department of General Surgery, Anhui Armed Police General Hospital, Hefei, China
| | - Yanfei Sheng
- Department of Emergency Department, Anhui Armed Police General Hospital, Hefei, China
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Lyons M, Winter DC, Simms CK. Mechanical characterisation of porcine rectus sheath under uniaxial and biaxial tension. J Biomech 2014; 47:1876-84. [DOI: 10.1016/j.jbiomech.2014.03.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 02/12/2014] [Accepted: 03/01/2014] [Indexed: 12/11/2022]
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High incidence of trocar site hernia after laparoscopic or robotic Roux-en-Y gastric bypass. Surg Endosc 2014; 28:2890-8. [DOI: 10.1007/s00464-014-3543-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 04/08/2014] [Indexed: 01/10/2023]
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Armañanzas L, Ruiz-Tovar J, Arroyo A, García-Peche P, Armañanzas E, Diez M, Galindo I, Calpena R. Prophylactic mesh vs suture in the closure of the umbilical trocar site after laparoscopic cholecystectomy in high-risk patients for incisional hernia. A randomized clinical trial. J Am Coll Surg 2014; 218:960-8. [PMID: 24680572 DOI: 10.1016/j.jamcollsurg.2014.01.049] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 12/23/2013] [Accepted: 01/13/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Prosthetic repair has become the standard method for hernia repair. Mesh placement for the prevention of trocar site incisional hernia (TSIH) is still a controversial issue. We tested the hypothesis that closure with an intraperitoneal prophylactic mesh of the umbilical trocar after a laparoscopic cholecystectomy can reduce the incidence of a TSIH in high-risk patients. STUDY DESIGN A randomized clinical trial was conducted among patients undergoing elective laparoscopic cholecystectomy who presented the following high-risk factors for incisional hernia, according to the literature: age 65 years and older, diabetes mellitus, chronic pulmonary disease, and obesity (ie, body mass index ≥30 kg/m(2)). Patients were assigned to have closure of the umbilical trocar site with either nonabsorbable sutures (group A) or intraperitoneal polypropylene omega-3 mesh (group B). Trocar site incisional hernia, pain, and surgical complications were evaluated at the early postoperative course and at 1, 6, and 12 months after surgery. RESULTS A total of 106 patients were randomized into the study and 92 patients were finally analyzed, including 47 in group A and 45 in group B. The TSIH rate was higher in group A (31.9%) than in group B (4.4%) (odds ratio = 10.1; 95% CI, 2.15-47.6; p < 0.001)). The wound infection rate was 4.3%; 8.5% in group A and 0% in group B (odds ratio = 2.04; 95% CI, 1.7-2.5; p = 0.045). Median postoperative pain evaluated by a visual analogue scale was 3 in group A and 2 in group B (p = 0.05). No differences were observed in complication rate, operative time, or hospital stay between the groups. CONCLUSIONS Prosthetic closure of the umbilical trocar site after laparoscopic surgery could become the standard method for preventing TSIH in high-risk patients.
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Affiliation(s)
- Laura Armañanzas
- Department of Surgery, General University Hospital Elche, Elche, Spain.
| | - Jaime Ruiz-Tovar
- Department of Surgery, General University Hospital Elche, Elche, Spain; Department of Pathology and Surgery, School of Medicine, Miguel Hernandez University, Elche, Spain
| | - Antonio Arroyo
- Department of Surgery, General University Hospital Elche, Elche, Spain; Department of Pathology and Surgery, School of Medicine, Miguel Hernandez University, Elche, Spain
| | | | | | - María Diez
- Department of Surgery, General University Hospital Elche, Elche, Spain
| | - Isabel Galindo
- Department of Surgery, General University Hospital Elche, Elche, Spain
| | - Rafael Calpena
- Department of Surgery, General University Hospital Elche, Elche, Spain; Department of Pathology and Surgery, School of Medicine, Miguel Hernandez University, Elche, Spain
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Abstract
A modified Aptos needle appeared to allow an easy, simple, safe method for fascial closure of trocar sites. Background and Objectives: Trocar-site incisional hernias are the most common complications in laparoscopic surgery. Fascial closure of port sites represents a challenging issue in laparoscopic surgery. Methods: We describe a simple easy technique for fascial closure of port sites using a double-tip needle (Lasheen needle). This study included 100 patients who underwent laparoscopic surgery from January 2009 through August 2011 in the General Surgery Department, Zagazig University Hospital, Zagazig, Egypt. The mean follow-up period was 2 years for any wound complications at these trocar sites. Results: The mean age of the patients was 39.5 years, and the mean time for placement of one suture was 2 minutes. No trocar-site herniation occurred with our technique during the period of follow-up. Infection developed at the trocar site in 3 patients. Conclusion: This technique is easy, simple, safe, fast, inexpensive, and effective for fascial closure of trocar sites.
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Affiliation(s)
- Ahmed Lasheen
- General Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Lyons M, Winter DC, Simms CK. Extrusion properties of porcine intestines and surrogate materials for ventral hernia modelling. J Mech Behav Biomed Mater 2013; 18:57-66. [DOI: 10.1016/j.jmbbm.2012.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 10/08/2012] [Accepted: 10/09/2012] [Indexed: 10/27/2022]
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NOTES transvaginal hybrid cholecystectomy: the United States human experience. Surg Endosc 2012; 27:514-7. [PMID: 22806528 DOI: 10.1007/s00464-012-2470-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 06/18/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND "Pure" NOTES and "hybrid" NOTES procedures have gained popularity during the past few years. However, most of these published series have been documented outside the United States. METHODS This is a prospective, nonrandomized series of patients. Female subjects who presented to the University of California at San Diego surgery clinic for elective cholecystectomy were offered participation in this study. Patients met the following criteria: aged 18-75 years; diagnosis of gallbladder disease that required cholecystectomy and American Society of Anesthesiology (ASA) class 1. Hybrid NOTES transvaginal technique was used for cholecystectomy. RESULTS A total of 27 women underwent hybrid transvaginal NOTES cholecystectomy during a 43-month period. The median age was 40.1 (range 23-63) years. The mean body mass index was 25.2 (range 16.4-34.1). All patients had an ASA I-II classification. The mean operative time was 92 (range 38-165) min. There was no conversion to an open operation. The mean hospital stay was 1.07 (range 1-2) days. Patients were followed for a mean of 3.32 (range 0.06-12.2) months. There were no postoperative complications. No scars were visible on the abdominal wall. CONCLUSIONS This study is the largest series of hybrid transvaginal cholecystectomy published in the United States. With our experience, we demonstrate that this technique is safe and clinically viable.
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Moreno-Sanz C, Morandeira-Rivas A, Morales-Conde S, Targarona Soler EM, Salvador-Sanchís JL. [Single incision laparoscopic surgery: analysis of the national register]. Cir Esp 2012; 90:298-309. [PMID: 22503147 DOI: 10.1016/j.ciresp.2012.02.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2012] [Accepted: 02/06/2012] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Laparoscopic surgery through a single incision is an innovative concept which is a challenge for surgeons to implement and develop. The interest aroused by these techniques in Spain led to the Endoscopy Section of the Spanish Association of Surgeons (AEC) to start a National Register for Single-Incision Surgery (RNCIU). The aim of this study was to collect the primary clinical data, techniques, and the possible complications of these techniques in Spain. MATERIAL AND METHODS Data were gathered using a form available on the AEC website. The forms included in this study correspond to those received between June 2010 and June 2011. RESULTS A total of 35 centers had taken part during the study period, with 1,198 forms being collected. The surgeries performed included 62.2% cholecystectomies, 22% appendectomies, and 7.8% colectomies. Procedures on solid organs (3.4%), bariatric surgery (2.7%), and various hernia repairs (1.9%), were also registered. The overall incidence of complications was 0.8%. The mortality rate in the series was 0.1%. CONCLUSIONS Single incision laparoscopic surgery is a novel concept that is not beyond our scientific community. The results of the Register demonstrate the feasibility of numerous effective and safe procedures. Finally, the RNCIU is an important data source to be able to study sub-groups of diseases in detail, with the aim of advancing the knowledge of these techniques and generating scientific evidence.
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Affiliation(s)
- Carlos Moreno-Sanz
- Servicio de Cirugía, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España.
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