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Calcerrada Alises E, Antón Rodríguez C, Medina Pedrique M, Berrevoet F, Cuccurullo D, López Cano M, Stabilini C, Garcia-Urena MA. Systematic review and meta-analysis of the incidence of incisional hernia in urological surgery. Langenbecks Arch Surg 2024; 409:166. [PMID: 38805110 DOI: 10.1007/s00423-024-03354-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE To evaluate the incidence of incisional hernia in patients undergoing direct access to the abdominal cavity in urological surgery. METHODS We conducted a systematic review in Pubmed, Embase, and Cochrane Central from 1980 to the present according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Eighty-four studies were selected for inclusion in this analysis, and meta-analysis and meta-regression were performed. RESULTS The total incidence in the 84 studies was 4.8% (95% CI 3.7% - 6.2%) I2 93.84%. Depending on the type of incision, it was higher in the open medial approach: 7.1% (95% CI 4.3%-11.8%) I2 92.45% and lower in laparoscopic surgery: 1.9% (95% CI 1%-3.4%) I2 71, 85% According to access, it was lower in retroperitoneal: 0.9% (95% CI 0.2%-4.8%) I2 76.96% and off-midline: 4.7% (95% CI 3.5%-6.4%) I2 91.59%. Regarding the location of the hernia, parastomal hernias were more frequent: 15.1% (95% CI 9.6% - 23%) I2 77.39%. Meta-regression shows a significant effect in reducing the proportion of hernias in open lateral, laparoscopic and hand-assisted compared to medial open access. CONCLUSION The present review finds the access through the midline and stomas as the ones with the highest incidence of incisional hernia. The use of the lateral approach or minimally invasive techniques is preferable. More prospective studies are warranted to obtain the real incidence of incisional hernias and evaluate the role of better techniques to close the abdomen.
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Affiliation(s)
- Enrique Calcerrada Alises
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario del Sureste, Madrid, Spain.
- Grupo de Investigación de Pared Abdominal Compleja, Universidad Francisco de Vitoria, Madrid, Spain.
| | - Cristina Antón Rodríguez
- Grupo de Investigación de Pared Abdominal Compleja, Universidad Francisco de Vitoria, Madrid, Spain
| | - Manuel Medina Pedrique
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario del Henares, Madrid, Spain
| | - Frederick Berrevoet
- Department of General and Hepatobiliary Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Diego Cuccurullo
- Department of Surgery, Ospedale Monaldi-Azienda Ospedaliera Dei Colli, Naples, Italy
| | - Manuel López Cano
- Abdominal Wall Surgery Unit, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
- Vall d'Hebron Research Institute General and Gastrointestinal Surgery Research Group, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Cesare Stabilini
- Department of Surgery (DiSC), University of Genoa, IRCCS Policlinico San Martino, Genoa, Italy
| | - Miguel Angel Garcia-Urena
- Grupo de Investigación de Pared Abdominal Compleja, Universidad Francisco de Vitoria, Madrid, Spain
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario del Henares, Madrid, Spain
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Soto E, Zoog E, Nolte MD, Fang HA, de la Torre JI. Outcomes of Ventral Hernia Repair After Orthotopic Liver Transplant Using Component Separation and Onlay Biologic Mesh. Ann Plast Surg 2023; 90:S387-S390. [PMID: 36921332 PMCID: PMC10290573 DOI: 10.1097/sap.0000000000003340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
INTRODUCTION The management of ventral hernias (VHs) after orthotopic liver transplant (OLT) can be uniquely challenging because of immunosuppression coupled with large laparotomy size that can compromise the quality of the abdominal wall. The component separation with multipoint suture onlay acellular dermis fixation technique has proven to be effective in high-risk abdominal wall reconstructions. The goal of this study was to elucidate the factors that affect safety and efficacy of VH repair in post-OLT patients. METHODS A retrospective review of 345 patients who underwent repair of VH with compartment separation and onlay acellular dermal matrix reinforcement from a single surgeon from 2012 to 2020 was conducted. Of these, 27 patients were identified with a history of OLT and were stratified based on whether the defect was a initial or recurrent hernia repair. The majority of patients had a standard chevron incision (70%). Data abstraction was performed for preoperative risk factors, hernia characteristics, surgical site complications, and postoperative course including hernia recurrence. RESULTS A majority of cases in the study period were initial hernia repairs (59%) with no significant differences in the patient demographics and size of VH defects (190 ± 112.69 cm 2 ). Comorbidities were similar between the groups with the exception of a significantly higher baseline creatinine levels and higher history of smoking in the recurrent hernia repair group ( P < 0.05). Of the 27 cases, there were no demonstrable hernia recurrences noted and an overall 11% complication rate. Univariate analysis noted a statistically significant difference in surgical site complication rate ( P = 0.017), with the initial hernia repair group having the lowest rate of surgical site complications. CONCLUSIONS In complex post-OLT patients with large VH, modified component separation with onlay acellular mesh was shown to have acceptable medium-term results. Further studies investigating the factors leading to postoperative complications are necessary to reduce recurrence in this evolving patient population.
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Laproscopic versus open ventral hernia repair. Int J Health Sci (Qassim) 2022. [DOI: 10.53730/ijhs.v6ns4.6478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Ventral hernia is second most common type of abdominal hernia after inguinal hernia. Treatment includes anatomical repair, meshplasty: onlay, sublay, preperitoneal etc. Evaluation of laparoscopic hernia repair has led to new benchmark for ventral hernia repair. This study aims to compare laparoscopic ventral hernia repair versus open repair. Methods: Total 30 patients were enrolled in this study who presented to Dhiraj hospital pipariya. Detailed history was taken and patient were randomly divided in to 2 groups. Results: There were 22 females and 8 male patients in this study. Mean age was 42.4 years. Mean operative time in laparoscopic surgery was 80.25± 2.43 minutes versus 60±3.44 minutes. Mean hospital stay in laparoscopic was 3.5 days versus 5.5 days in open hernia repair. Conclusion: Laparoscopic meshplasty is better than open repair in terms of early recovery, less pain, minimal scar, early return to work.
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Nassif AT, Nagano TA, Villela IR, Simonetti GR, Dias BF, Freitas ACTD. INCISIONAL HERNIOPLASTY TECHNIQUES: ANALYSIS AFTER OPEN BARIATRIC SURGERY. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2020; 33:e1517. [PMID: 33237161 PMCID: PMC7682152 DOI: 10.1590/0102-672020200002e1517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/30/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Rives-Stoppa retromuscular technique: A) polypropylene mesh fixed on the posterior rectus sheath; B) rectus abdominal muscle; C) anterior rectus sheath being sutured. The best technique for incisional hernioplasty has not been established yet. One of the difficulties to compare these techniques is heterogeneity in the profile of the patients evaluated. AIM To analyze the results of three techniques for incisional hernioplasty after open bariatric surgery. METHOD Patients who underwent incisional hernioplasty were divided into three groups: onlay technique, simple suture and retromuscular technique. Results and quality of life after repair using Carolina's Comfort Scale were evaluated through analysis of medical records, telephone contact and elective appointments. RESULTS 363 surgical reports were analyzed and 263 were included: onlay technique (n=89), simple suture (n=100), retromuscular technique (n=74). The epidemiological profile of patients was similar between groups. The onlay technique showed higher seroma rates (28.89%) and used a surgical drain more frequently (55.56%). The simple suture technique required longer hospital stay (2.86 days). The quality of life score was worse for the retromuscular technique (8.43) in relation to the onlay technique (4.7) and the simple suture (2.34), especially because of complaints of chronic pain. There was no difference in short-term recurrence. CONCLUSION The retromuscular technique showed a worse quality of life than the other techniques in a homogeneous group of patients. The three groups showed no difference in terms of short-term hernia recurrence.
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Affiliation(s)
- André Thá Nassif
- Digestive and Bariatric Surgery Service, Santa Casa de Misericórdia, Curitiba, PR, Brazil.,Postgraduation Program in Surgical Clinics, Federal University of Paraná, Curitiba, PR, Brazil
| | - Thais Ayumi Nagano
- Medical Degree, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | | | | | - Bruno Francisco Dias
- Medical Degree, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
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Zheng W, Zhu Z, Zhang C, Zhang H. Application of the novel enhanced transabdominal preperitoneal (ETAP) technique for laparoscopic suprapubic incisional hernia repair. Surg Today 2019; 50:525-530. [PMID: 31538257 DOI: 10.1007/s00595-019-01879-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 09/04/2019] [Indexed: 11/30/2022]
Abstract
Suprapubic incisional hernia is a special type of incisional hernia, the optimal choice of surgery for which remains controversial. Inspired by advantages of laparoscopic incisional hernia repair and inguinal hernia repair, we developed a novel laparoscopic surgery procedure for suprapubic incisional hernia repair: the enhanced transabdominal preperitoneal (ETAP) technique. To create a peritoneal flap, the peritoneum was dissected from 2 cm above the abdominal wall defect to 2 cm below the pubic arch, then the hernia defect was closed with a full-thickness transabdominal suture. Following the position of mesh to cover the defect with an 5-cm overlap on all sides, the peritoneal flap was closed with continuous suture. In this study, a total of 57 patients with suprapubic incisional hernia underwent laparoscopic ETAP. The mean hernia size was 61.5 cm2, the average mesh size was 173.6 cm2, the mean operating time was 90 min, the mean blood loss was 34 cc, and the average hospital stay was 2.6 days. In the follow-up period, which ranged from 12 to 45 months, the overall incidence of complications was 17.86%. Six patients developed seroma without herniation, six patients suffered from obvious postoperative pain, and four patients experienced urinary retention. All complications resolved without treatment. No recurrence was observed. In conclusion, the laparoscopic ETAP technique contributes to reduced rates of suprapubic incisional hernia repair and mesh-induced complications.
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Affiliation(s)
- Wei Zheng
- Department of Gastrointestinal Surgery, Henan Provincial People's Hospital, Zhengzhou, Henan Province, 450003, People's Republic of China
| | - Zhonglin Zhu
- Department of Gastrointestinal Surgery, Henan Provincial People's Hospital, Zhengzhou, Henan Province, 450003, People's Republic of China
| | - Chao Zhang
- Department of Gastrointestinal Surgery, Henan Provincial People's Hospital, Zhengzhou, Henan Province, 450003, People's Republic of China
| | - Hui Zhang
- Department of Gastrointestinal Surgery, Henan Provincial People's Hospital, Zhengzhou, Henan Province, 450003, People's Republic of China.
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Frailty predicts morbidity, complications, and mortality in patients undergoing complex abdominal wall reconstruction. Hernia 2019; 24:235-243. [DOI: 10.1007/s10029-019-02047-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 09/02/2019] [Indexed: 12/11/2022]
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Sikar HE, Çetin K, Eyvaz K, Gökçeimam M, Kaptanoglu L, Küçük HF. Evaluation of the effects of absorbable and nonabsorbable tacks on laparoscopic suprapubic hernia repair: A retrospective cohort study. Int J Surg 2019; 63:16-21. [PMID: 30708060 DOI: 10.1016/j.ijsu.2019.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 01/22/2019] [Accepted: 01/24/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The contradictory results of fixation methods concerning the pubic region are an obstacle to define a standardized procedure for laparoscopic repair of suprapubic hernia (LRSPH). This study aims to evaluate the effects of different tacks on LRSPH. MATERIALS AND METHODS Seventy-three patients (70 females, three males) with suprapubic hernia were admitted and had LRSPH. Absorbable tacks were used in 42 (57.5%) patients (AG group), whereas nonabsorbable tacks were used in 31 (42.5%) patients (NAG group). Patient characteristics and demographics, previous operations, previous hernia repairs, size of the defect, size of the mesh, type of the mesh, type of the tacks, operative time, conversion rate, complications, recurrences, follow-up time, numeric pain rating scale (NRS), prolonged use of analgesics and early termination of analgesics were evaluated as variables. RESULTS NRS results were significantly lower in the AG group regarding the postoperative day one (p < 0.001) and 10 (p:0.004), whereas there was no statistically significant difference on postoperative sixth week. Prolonged use of analgesics was significantly higher in NAG, whereas early termination of analgesics was significantly higher in AG (p < 0.001). There was no patient with complaints of pain that restricted daily activities on sixth month and the following annually visits. CONCLUSION Absorbable tacks had satisfactory results with a reduction of pain and lower rates of using analgesics. However, considering the similar results of groups on long-term follow-up, it would be inaccurate to explain this situation with the property of absorption. Although the failure of attempts to bony structures during fixation with absorbable tacks could explain the lack of deep penetration, further studies are required to verify this view.
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Affiliation(s)
- Hasan Ediz Sikar
- Dr. Lütfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey.
| | - Kenan Çetin
- Dr. Lütfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey.
| | - Kemal Eyvaz
- Dr. Lütfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey.
| | - Mehmet Gökçeimam
- Dr. Lütfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey.
| | - Levent Kaptanoglu
- Dr. Lütfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey.
| | - Hasan Fehmi Küçük
- Dr. Lütfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey.
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8
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The outcome of A. Double mesh intraperitoneal repair for complex ventral hernia: A retrospective cohort study. Int J Surg 2018; 53:129-136. [PMID: 29581046 DOI: 10.1016/j.ijsu.2018.03.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/09/2018] [Accepted: 03/15/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Complex ventral hernia is a challenging surgical entity, commonly attended with huge defect, loss of domain and possible soft tissue infection. It is difficult to repair, especially with multiple recurrences. Numerous methods of repair have been described with no evidence-based data available to prefer one method over the other. The purpose of this study is to determine the long-term outcome of the proposed new modification of intraperitoneal mesh repair procedure in complex ventral hernia. MATERIALS AND METHODS This is a single-center retrospective analysis utilizing the prospectively-maintained dataset in our institution during the study period between January 2003 and June 2017. Patients who fit the inclusion criteria of having a complex ventral hernia, whether de-novo or recurrent and were subjected to A. Double Mesh Intraperitoneal Repair (ADMIR) procedure were included in the study. Patients were followed up till recurrence or lost to follow through a period ranging from 6 to 174 months (mean: 142.96 ± SE: 11.91). RESULTS Forty-nine cases were included in this study (38 females and 11 males) with a female to male ratio of 3.5:1. The age range was from 28 to 81 years (mean 49 ± 12.4). BMI range from 25 to 42 (mean 33.6 ± 5.42). The ratio between the hernia sac volume and abdominal cavity volume was more than 20% in 12 patients (24.5%), who were subjected to preoperative progressive pneumoperitoneum (PPP) for an average period of two weeks. Hernias were recurrent in 28 cases (57%) and associated comorbidities were observed in 29 patients (63%). Postoperative complications occurred in 19 patients (38.7%), among them only 2 patients developed recurrence (4%) after a mean follow up period of 142 months. Five patients were lost to follow and were included in the Kaplan and Meier survival analysis. CONCLUSIONS ADMIR procedure is successful for the repair of complex ventral hernias as it is applicable to all sites of ventral hernias. The mesh is tension free hidden within the abdomen allowing for early mobilization and the complications rate is acceptable with low recurrence rate.
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Böhm G, Groll J, Heffels KH, Heussen N, Ink P, Alizai HP, Neumann UP, Schnabel R, Mirastschijski U. Influence of MMP inhibitor GM6001 loading of fibre coated polypropylene meshes on wound healing: Implications for hernia repair. J Biomater Appl 2018; 32:1343-1359. [DOI: 10.1177/0885328218759043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Polypropylene meshes are standard for hernia repair. Matrix metalloproteinases play a central role in inflammation. To reduce the inflammatory response and improve remodelling with an associated reduction of hernia recurrence, we modified polypropylene meshes by nanofibre coating and saturation with the broad-spectrum matrix metalloproteinase inhibitor GM6001. The aim was to modulate the inflammatory reaction, increase collagen deposition and improve mesh biointegration. Polypropylene meshes were surface-modified with star-configured NCO-sP(EO -stat-PO) and covered with electrospun nanofibres (polypropylene-nano) and GM6001 (polypropylene-nano-GM). In a hernia model, defects were reconstructed with one of the meshes. Inflammation, neovascularization, bio-integration, proliferation and apoptosis were assessed histologically, collagen content and gelatinases biochemically. Mesh surface modification resulted in higher inflammatory response compared to polypropylene. Pro-inflammatory matrix metalloproteinase-9 paralleled findings while GM6001 reduced matrix metalloproteinase-9 significantly. Significantly increased matrix metalloproteinase-2 beneficial for remodelling was noted with polypropylene-nano-meshes. Increased vascular endothelial growth factor, neo-vascularization and collagen content were measured in polypropylene-nano-meshes compared to polypropylene. GM6001 significantly reduced myofibroblasts. This effect ended after d14 due to engineering limitations with release of maximal GM6001 loading. Nanofibre-coating of polypropylene-meshes confers better tissue vascularization to the cost of increased inflammation. This phenomenon can be only partially compensated by GM6001. Future research will enable higher GM6001 uptake in nano-coated meshes and may alter mesh biointegration in a more pronounced way.
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Affiliation(s)
- Gabriele Böhm
- Department of General and Visceral Surgery, Klinikum Bremen-Ost, Bremen, Germany
- Department of General-, Visceral- and Transplant Surgery, University Hospital, Technical University of Aachen (RWTH), Germany
| | - Jürgen Groll
- Department of Functional Materials in Medicine and Dentistry, Julius Maximilians University, Wuerzburg, Germany
| | - Karl-Heinz Heffels
- Department of Functional Materials in Medicine and Dentistry, Julius Maximilians University, Wuerzburg, Germany
| | - Nicole Heussen
- Department of Medical Statistics, Technical University of Aachen (RWTH), Germany
- Center of Biostatistic and Epidemiology, Sigmund Freud Private University, Vienna, Austria
| | - Peter Ink
- Department of General-, Visceral- and Transplant Surgery, University Hospital, Technical University of Aachen (RWTH), Germany
| | - Hamid Patrick Alizai
- Department of General-, Visceral- and Transplant Surgery, University Hospital, Technical University of Aachen (RWTH), Germany
| | - Ulf Peter Neumann
- Department of General-, Visceral- and Transplant Surgery, University Hospital, Technical University of Aachen (RWTH), Germany
| | | | - Ursula Mirastschijski
- Department of Plastic, Reconstructive and Aesthetic Surgery, Klinikum Bremen-Mitte, Germany
- Centre for Biomolecular Interactions Bremen, University of Bremen, Bremen, Germany
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Hernández-Granados P, López-Cano M, Morales-Conde S, Muysoms F, García-Alamino J, Pereira-Rodríguez JA. Incisional hernia prevention and use of mesh. A narrative review. Cir Esp 2018; 96:76-87. [PMID: 29454636 DOI: 10.1016/j.ciresp.2018.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 12/21/2017] [Accepted: 01/08/2018] [Indexed: 12/11/2022]
Abstract
Incisional hernias are a very common problem, with an estimated incidence around 15-20% of all laparotomies. Evisceration is another important problem, with a lower rate (2.5-3%) but severe consequences for patients. Prevention of both complications is an essential objective of correct patient treatment due to the improved quality of life and cost savings. This narrative review intends to provide an update on incisional hernia and evisceration prevention. We analyze the current criteria for proper abdominal wall closure and the possibility to add prosthetic reinforcement in certain cases requiring it. Parastomal, trocar-site hernias and hernias developed after stoma closure are included in this review.
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Affiliation(s)
- Pilar Hernández-Granados
- Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España; Sección de Pared Abdominal de la Asociación Española de Cirujanos, España.
| | - Manuel López-Cano
- Sección de Pared Abdominal de la Asociación Española de Cirujanos, España; Unidad de Pared Abdominal, Hospital Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, España
| | - Salvador Morales-Conde
- Unidad de Innovación en Cirugía Mínimamente Invasiva, Hospital Universitario Virgen del Rocío, Sevilla, España; Secretaría General, European Hernia Society
| | - Filip Muysoms
- Servicio de Cirugía, Hospital Maria Middelares, Ghent, Bélgica
| | - Josep García-Alamino
- Department of Primary Care Health Sciencies, University of Oxford, Oxford, Reino Unido
| | - José Antonio Pereira-Rodríguez
- Servicio de Cirugía General y Digestiva, Parc de Salut Mar, Hospital del Mar. Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, España
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Laparoscopic repair of large suprapubic hernias. Wideochir Inne Tech Maloinwazyjne 2017; 12:245-250. [PMID: 29062444 PMCID: PMC5649499 DOI: 10.5114/wiitm.2017.68794] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 05/23/2017] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Suprapubic hernia is the term to describe ventral hernias located less than 4 cm above the pubic arch in the midline. Hernias with an upper margin above the arcuate line encounter technical difficulties, and the differences in repair methods forced us to define them as large suprapubic hernias. AIM To present our experience with laparoscopic repair of large suprapubic hernias that allows adequate mesh overlap. MATERIAL AND METHODS Nineteen patients with suprapubic incisional hernias who underwent laparoscopic repair between May 2013 and January 2015 were included in the study. Patients with laparoscopic extraperitoneal repair who had a suprapubic hernia with an upper margin below the arcuate line were excluded. RESULTS Two men and 17 women, with a mean age of 58.2, underwent laparoscopic repair. Most of the incisions were midline vertical (13/68.4%). Twelve (63.1%) of the patients had previous incisional hernia repair (PIHR group); the mean number of previous incisional hernia repair was 1.4. Mean defect size of the PIHR group was higher than in patients without previous repair - 107.3 cm2 vs. 50.9 cm2 (p < 0.05). Mean operating time of the PIHR group was higher than in patients without repair - 126 min vs. 77.9 min (p < 0.05). Although all complications occurred in the PIHR group, there was no statistically significant difference. CONCLUSIONS Laparoscopic repair of large suprapubic hernias can be considered as the first option in treatment. The low recurrence rates reported in the literature and the lack of recurrence, as observed in our study, support this view.
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Wooten KE, Ozturk CN, Ozturk C, Laub P, Aronoff N, Gurunluoglu R. Role of tissue expansion in abdominal wall reconstruction: A systematic evidence-based review. J Plast Reconstr Aesthet Surg 2017; 70:741-751. [PMID: 28356202 DOI: 10.1016/j.bjps.2017.02.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 01/23/2017] [Accepted: 02/16/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Tissue expanders (TEs) can be used to assist primary closure of complicated hernias and large abdominal wall defects. However, there is no consensus regarding the optimal technique, use, or associated risk of TE in abdominal wall reconstruction. METHODS A systematic search of PubMed and Embase databases was conducted to identify articles reporting abdominal wall reconstruction with TE techniques. English articles published between 1980 and 2016 were included on the basis of the following inclusion criteria: two-stage TE surgical technique, >3 cases, reporting of postoperative complications, hernia recurrence, and patient-based clinical data. RESULTS Fourteen studies containing 103 patients (85 adults and 18 children) were identified for analysis. Most patients presented with a skin-grafted ventral hernia (n = 86). The etiology of the hernia was from trauma or prior abdominal surgery. The remaining patients had TE placed before organ transplantation (n = 12) or for congenital abdominal wall defects (n = 5). The location for expander placement was subcutaneous (n = 74), between the internal and external obliques (n = 26), posterior to the rectus sheath (n = 2), and intra-peritoneal (n = 1). Postoperative infections and implant-related problems were the most commonly reported complications after Stage I. The most common complication after Stage II was recurrent hernia, which was observed in 12 patients (11.7%). Five patients with TE died. Complications and mortality were more prevalent in children, immunosuppressed patients, and those with chronic illnesses. CONCLUSIONS Tissue expansion for abdominal wall reconstruction can be successfully used for a variety of carefully selected patients with an acceptable complication and risk profile.
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Affiliation(s)
- Kimberly E Wooten
- Department of Head, Neck and Plastic Surgery, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, USA
| | - Cemile Nurdan Ozturk
- Department of Head, Neck and Plastic Surgery, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, USA.
| | - Can Ozturk
- Department of Head, Neck and Plastic Surgery, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, USA
| | - Peter Laub
- State University of New York at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Main Street, Buffalo, NY, USA
| | - Nell Aronoff
- University Libraries, State University of New York at Buffalo, Main Street, Buffalo, NY, USA
| | - Raffi Gurunluoglu
- Department of Plastic Surgery, Cleveland Clinic, Euclid Ave, Cleveland, OH, USA
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Abdominal Closure after TRAM Flap Breast Reconstruction with Transversus Abdominis Muscle Release and Mesh. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e1014. [PMID: 27757337 PMCID: PMC5055003 DOI: 10.1097/gox.0000000000001014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 07/05/2016] [Indexed: 11/26/2022]
Abstract
Breast reconstruction with a pedicled transverse rectus abdominis muscle (TRAM) flap can result in significant abdominal wall donor-site morbidity. Although the pedicled TRAM flap donor area reinforced with mesh results in decreased rates of postoperative abdominal bulging and hernias, the best technique to accomplish that is yet to be elucidated. We present our novel technique of posterior components separation with transversus abdominis muscle release and retromuscular mesh reinforcement for donor-area closure during pedicled TRAM flap breast reconstruction.
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Garcia DPC, Santos C, Hubner PNDV, Furtado TDA, Petroianu A, Figueiredo LOD, Alberti LR. Treatment of abdominal wall hernia with suture, or polypropylene, or collagen prosthesis. Acta Cir Bras 2016; 31:371-6. [PMID: 27355743 DOI: 10.1590/s0102-865020160060000002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 05/19/2016] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To develop an experimental model for incisional hernias and to compare morphological and functional aspects of hernia repairs by suture, polypropylene mesh and collagen mesh. METHODS A defect measuring 7cm x 2cm was created in the anterior abdominal of 28 New Zealand male rabbits, divided into four groups (n = 7): (1) control, (2) suture of the anterior sheath of the rectus abdominal muscle, (3) setting of polypropylene mesh, and (4) setting of collagen mesh. On the 90th postoperative day, the animals were examined to verify the presence of incisional hernia. Samples of abdominal wall and scar were collected for histological study. RESULTS Incisional hernia was identified in 85.7% of the control group, 57.1% of the suture group, 42.9% of the collagen mesh group, and none in the polypropylene mesh group (p = 0.015). Mesh exposure could be identified in 71.4% of the animals in group 3 and in no animal in group 4 (p = 0.021). The polypropylene mesh is effective in the treatment of abdominal wall defects, causing an intense inflammatory reaction. CONCLUSION The collagen mesh is biocompatible, producing a minimal inflammatory reaction, but fails in the treatment of abdominal wall defects.
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Affiliation(s)
- Diego Paim Carvalho Garcia
- PhD, Associate Professor, General Surgeon, Department of Surgery, Instituto de Ensino e Pesquisa da Santa Casa, Belo Horizonte-MG, Brazil. Intellectual and scientific content of the study, design the protocol, technical procedures, manuscript writing
| | - Clarissa Santos
- MD, General and Trauma Surgeon, Hospital Universitário São José, Belo Horizonte-MG, Brazil. Acquisition and interpretation of data, statistical analysis, design the protocol, technical procedures, macroscopic and histopathological examinations
| | - Pablo Nelson do Valle Hubner
- MD, General Surgeon, Hospital Felício Rocho, Belo Horizonte-MG, Brazil. Acquisition and interpretation of data, statistical analysis, design the protocol, technical procedures, macroscopic and histopathological examinations
| | - Thiago de Almeida Furtado
- MD, General Surgeon, Hospital Felício Rocho, Belo Horizonte-MG, Brazil. Acquisition and interpretation of data, statistical analysis, design the protocol, technical procedures, macroscopic and histopathological examinations
| | - Andy Petroianu
- PhD, Full Professor, Department of Surgery, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte-MG, Brazil. Intellectual and scientific content of the study, design the protocol, provided guidelines for the surgical interventions, supervised all phases of the study
| | - Luiza Ohasi de Figueiredo
- Fellow of Surgery, Hospital Felício Rocho, Belo Horizonte-MG, BrazilAcquisition and interpretation of data, statistical analysis, manuscript revision
| | - Luiz Ronaldo Alberti
- PhD, Associate Professor, General Surgeon, Department of Surgery, Faculdade de Medicina, UFMG, and Instituto de Ensino e Pesquisa da Santa Casa, Belo Horizonte-MG, Brazil. Acquisition and interpretation of data, statistical analysis, design the protocol, technical procedures
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Lara FJP, Berges AF, Valdenebro MJM, Fernández JD, Del Rey Moreno A, Muñoz HO. The repair of large ventral hernias in patients with severe cardio-respiratory disease: Volume transposition technique. Int J Surg 2016; 30:90-3. [PMID: 27134126 DOI: 10.1016/j.ijsu.2016.04.036] [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: 03/30/2016] [Revised: 04/18/2016] [Accepted: 04/21/2016] [Indexed: 10/21/2022]
Abstract
Massive hernias of the abdominal wall present a major challenge to the general surgeon. In some extreme cases of patients with severe cardio-respiratory disease, the repair of such hernias may be impracticable. In these cases, we believe the volume transposition technique is appropriate. In this approach, the hernia volume is calculated and the wall repaired with mesh to accommodate the estimated volume of the hernia sac, thus avoiding any increase in intra-abdominal pressure. We believe this technique is simple, reproducible and useful in cases that are inoperable due to cardio-respiratory problems that make any loss of lung volume unacceptable.
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Affiliation(s)
| | | | | | | | | | - H Oliva Muñoz
- Service of Surgery, Antequera Hospital, Málaga, Spain
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16
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Agodirin O, Olatoke S, Adeoti M. Spontaneous Rupture: An Uncommon Complication of Ventral Hernia. Ethiop J Health Sci 2016; 25:195-7. [PMID: 26124629 PMCID: PMC4478273 DOI: 10.4314/ejhs.v25i2.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND: Literature is scarce about spontaneous rupture of hernia because spontaneous rupture of here is uncommon (1). Reported cases are complications of incisional hernias, recurrent inguinal hernia, and umbilical hernias. It is potentially life threatening (1) because the ensuing entrapment and tension on bowel mesentery may lead to vasovagal shock or strangulation. In addition to systemic problems and increased intra-abdominal pressure that lead to the herniation, the spontaneous rupture and evisceration is usually preceded by other factors such as inflammation that weaken the hernia covering (1, 2).We a report a case of spontaneous rupture of an incisional ventral hernia referred to the University of Ilorin teaching hospital.
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Affiliation(s)
- O Agodirin
- Department of Surgery, University of Ilorin, Kwara State, Nigeria
| | - S Olatoke
- Department of Surgery, University of Ilorin, Kwara State, Nigeria
| | - M Adeoti
- Department of Surgery, Ladoke Akintola University of Technology Ogbomoso, Oyo State, Nigeria
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17
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Misiakos EP, Patapis P, Zavras N, Tzanetis P, Machairas A. Current Trends in Laparoscopic Ventral Hernia Repair. JSLS 2016; 19:JSLS.2015.00048. [PMID: 26273186 PMCID: PMC4524825 DOI: 10.4293/jsls.2015.00048] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives: The purpose of this study was to analyze the surgical technique, postoperative complications, and possible recurrence after laparoscopic ventral hernia repair (LVHR) in comparison with open ventral hernia repair (OVHR), based on the international literature. Database: A Medline search of the current English literature was performed using the terms laparoscopic ventral hernia repair and incisional hernia repair. Conclusions: LVHR is a safe alternative to the open method, with the main advantages being minimal postoperative pain, shorter recovery, and decreased wound and mesh infections. Incidental enterotomy can be avoided by using a meticulous technique and sharp dissection to avoid thermal injury.
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Affiliation(s)
- Evangelos P Misiakos
- Third Department of Surgery, University of Athens School of Medicine, Attikon University Hospital, Rimini 1, Chaidari, Athens, Greece
| | - Paul Patapis
- Third Department of Surgery, University of Athens School of Medicine, Attikon University Hospital, Rimini 1, Chaidari, Athens, Greece
| | - Nick Zavras
- Third Department of Surgery, University of Athens School of Medicine, Attikon University Hospital, Rimini 1, Chaidari, Athens, Greece
| | - Panagiotis Tzanetis
- Third Department of Surgery, University of Athens School of Medicine, Attikon University Hospital, Rimini 1, Chaidari, Athens, Greece
| | - Anastasios Machairas
- Third Department of Surgery, University of Athens School of Medicine, Attikon University Hospital, Rimini 1, Chaidari, Athens, Greece
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Hegab B, Abdelfattah MR, Azzam A, Al Sebayel M. The usefulness of laparoscopic hernia repair in the management of incisional hernia following liver transplantation. J Minim Access Surg 2016; 12:58-62. [PMID: 26917921 PMCID: PMC4746977 DOI: 10.4103/0972-9941.152102] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION The reported incidence of incisional hernia following orthotopic liver transplantation (OLT) varies from 4% to 23%. Postoperative wound complications are less frequent after laparoscopic repair while maintaining low recurrence rates. We present our experience in managing this complication. MATERIALS AND METHODS Retrospectively, collected data of all patients who underwent liver transplant and developed incisional hernias were analyzed. Patients' demographic data, anthropometric data, transplantation-related data, and repair-related operative and postoperative data were collected. Risk factors for post-transplant incisional hernia were appraised in our patients. Patients were divided into two groups: Group A included patients who had their incisional hernia repaired through the laparoscopic approach, and Group B included patients who had their incisional hernia repaired through open conventional approach. RESULTS A total of 488 liver transplantations were performed at our institution between May 2001 and end of December 2012. Thirty-three patients developed incisional hernias after primary direct closure of the abdominal wall with an overall incidence of 6.9%. Hernia repair was done in 25 patients. Follow-up ranged from 6.4 to 106.1 months with a mean of 48.3 ± 28.3 months. All patients were living at the end of the follow up except four patients (16%). Group A included 13 patients, and Group B included 12 patients. The size of defects and operative time did not differ significantly between both the groups. On the other hand, hospital stay was significantly shorter in laparoscopic group. Complication rate following laparoscopic repair was insignificantly different for open repair. CONCLUSION In experienced hands, laparoscopic incisional hernia repair in post-liver transplant setting proved to be a safe and feasible alternative to open approach and showed superior outcome expressed in shorter hospital stay, with low recurrence and complication rate.
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Affiliation(s)
- Bassem Hegab
- Department of Liver Transplant and Hepatobiliary Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, National Liver Institute, University of Menoufiya, Menoufiya, Egypt
| | - Mohamed Rabei Abdelfattah
- Department of Liver Transplant and Hepatobiliary Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Department of General Surgery, University Of Alexandria, Faculty of Medicine, Menoufiya, Egypt
- Address for Correspondence: Dr. Mohamed R. Abdelfattah, Department of Liver Transplantation and Hepatobiliary Surgery, MBC 72, King Faisal Specialist Hospital and Research Center, Riyadh - 11211, P.O box 3354. Kingdom of Saudi Arabia. E-mail:
| | - Ayman Azzam
- Department of Liver Transplant and Hepatobiliary Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Department of General Surgery, University Of Alexandria, Faculty of Medicine, Menoufiya, Egypt
| | - Mohamed Al Sebayel
- Department of Liver Transplant and Hepatobiliary Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Johnson KC, Miller MT, Plymale MA, Levy S, Davenport DL, Roth JS. Abdominal Wall Reconstruction: A Comparison of Totally Extraperitoneal and Transabdominal Preperitoneal Approaches. J Am Coll Surg 2015; 222:159-65. [PMID: 26705900 DOI: 10.1016/j.jamcollsurg.2015.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 10/30/2015] [Accepted: 11/09/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Abdominal wall reconstruction for complex ventral and incisional hernias is associated with significant complications. Commonly, the peritoneal cavity is opened and adhesiolysis is performed with the potential for enterotomy. A totally extraperitoneal (TE) approach to abdominal wall reconstruction is feasible in many ventral hernia repairs and can reduce visceral injuries without impacting other outcomes. This study compares outcomes after retro-rectus ventral hernia repairs with TE and transabdominal (TA) preperitoneal approaches. STUDY DESIGN An IRB-approved review of a prospective hernia database was performed for all ventral hernia repairs between 2009 and 2013. Preoperative patient characteristics, including demographics and comorbidities; operative variables, including surgical technique, operative duration, type/size/location of mesh, concomitant procedures, and incidence of inadvertent injury; and patient outcomes in terms of length of stay, wound and nonwound complications, and readmissions or returns to the operating room were obtained. Groups were compared using t-tests, Mann-Whitney U tests, chi-square tests, and Fisher's exact tests as appropriate. Significance was set at p < .05. RESULTS One hundred and seventy-five complex abdominal wall reconstructions were performed between 2009 and 2013. Of those, 85 patients underwent hernia repair for CDC grade 1 hernias with retro-rectus mesh placement performed (n = 45 TA, n = 40 TE). Groups did not differ in age, BMI, sex, smoking status, hernia defect size, history of COPD, asthma, hypertension, cancer, or renal failure. More TA patients had diabetes (36% vs. 13%; p = 0.02) and previous hernia repair (73% vs. 45%; p = 0.01) than TE patients. Mesh size was larger in the TE group (625 ± 234 cm(2) vs. 424 ± 214 cm(2); p < .001). There was no difference in enterotomy between TA and TE groups (0% vs. 2%; p = 1.0). However, there was a reduced operative time with TE (170 ± 49 minutes vs. 212 ± 49 minutes; p < .001). CONCLUSIONS Abdominal wall reconstruction can be performed safely in a TE fashion. The extraperitoneal approach results in shorter operative duration, but had similar complications when compared with TA preperitoneal approach.
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Affiliation(s)
- Kai C Johnson
- Division of General Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, KY
| | - Michael T Miller
- Division of General Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, KY
| | - Margaret A Plymale
- Division of General Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, KY
| | - Salomon Levy
- Division of General Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, KY
| | - Daniel L Davenport
- Division of General Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, KY
| | - J Scott Roth
- Division of General Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, KY.
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20
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Laparoscopic ventral hernia repair with primary fascial closure versus bridged repair: a risk-adjusted comparative study. Surg Endosc 2015; 30:3231-8. [DOI: 10.1007/s00464-015-4644-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 10/24/2015] [Indexed: 10/22/2022]
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21
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Punjani R, Shaikh I, Soni V. Component Separation Technique: an Effective Way of Treating Large Ventral Hernia. Indian J Surg 2015; 77:1476-9. [PMID: 27011605 DOI: 10.1007/s12262-015-1265-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 03/23/2015] [Indexed: 11/28/2022] Open
Abstract
Repair of large ventral hernia is a challenge for even experienced surgeons, as there are large defects with large contents, often with loss of domain. The large defects were bridged by various plastic surgical procedures like myofascial flaps or free flaps with high recurrences and complications. More often, the bridging was done with artificial prosthesis, leaving the defects open. This was accomplished by either open surgery (onlay, inlay, sublay or underlay) or laparoscopic intraperitoneal onlay meshes (IPOMs). However, non-closure of the midline had adverse effects on postural maintenance, respiration, micturition, defecation and biomechanical properties, which have a profound impact on the patients' overall physical capacity and quality of life. Component separation technique (CST) is a novel answer to the closure of midline with live, active tissues with or without the use of additional prosthesis. Though this technique was originally described in 1990, it has undergone lots of modifications like perforator preserving CST, endoscopic technique and posterior component separation. So, we present a series of 22 patients with large ventral hernia repaired using various options of component separation technique in the last 3 years.
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Affiliation(s)
- Ramesh Punjani
- Fortis Hospital, Mulund Goregaon Link Road, Mumbai, 400080 India
| | - Imran Shaikh
- Fortis Hospital, Mulund Goregaon Link Road, Mumbai, 400080 India
| | - Vinne Soni
- Fortis Hospital, Mulund Goregaon Link Road, Mumbai, 400080 India
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22
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Negative-pressure therapy in the postoperative treatment of incisional hernioplasty wounds: a pilot study. Adv Skin Wound Care 2015; 27:77-80. [PMID: 24440865 DOI: 10.1097/01.asw.0000442873.48590.b5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Negative pressure therapy has proven useful in the treatment of the complex complications of surgical wounds. In this pilot study, the authors found that the negative pressure system can be used safely in the postoperative period of incisional hernia surgery and reduces the number of days of drainage.
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23
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Özkaya Mutlu Ö, Egemen O, Akan A, Akan M, Karahangil M, Filinte G, Bozdağ E, Sünbüloğlu E, Kurtul H. The use of dermal automesh for incidental hernia repair in abdominoplasty: Clinical, biochemical, and radiological results. J Plast Surg Hand Surg 2014; 49:172-6. [DOI: 10.3109/2000656x.2014.976571] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
A laparoscopic approach to ventral hernia repair using Proceed mesh was associated with low conversion rate and no major complications in this study of single surgeon's experience. Background and Objectives: Laparoscopic technique to repair ventral hernia offers advantages over conventional open surgery such as shorter recovery time, decreased pain, and lower recurrence rates. There are a myriad of meshes available for laparoscopic repair of ventral hernias. This study evaluated the outcomes of laparoscopic repair of ventral hernias with Proceed mesh (Ethicon, Somerville, NJ, USA) in a single academic institution. Methods: An institutional review board–approved retrospective review was performed for 100 consecutive patients with ventral hernia who underwent a laparoscopic approach at our institution from August 2006 to February 2009. All patients were operated on by a single surgeon using a standard technique with transabdominal suture fixation and tacks. Results: The study included 100 consecutive patients (57 female and 43 male patients). The mean age was 55 years (range, 16–78 years), and the mean body mass index was 33.3 kg/m2 (range, 19.6–68.9 kg/m2). Of the repairs, 27% were performed for a recurrent hernia. The mean and median size of the defect were 128 cm2 and 119.5 cm2 (range, 4–500 cm2), respectively. To ensure appropriate mesh overlap, the mean size of mesh was 253 cm2 (range, 36–700 cm2). There were 4 conversions. The mean operative time was 117 minutes (range, 35–286 minutes). The mean length of stay was 1.9 days. There were no major abdominal complications. With a mean follow-up period of 50 months (range, 38–68 months), we have not recorded any recurrences. No mesh-related complications have been documented. Conclusions: The laparoscopic approach to ventral hernia repairs using Proceed mesh is associated with a low conversion rate and no major complications. At 50 months of follow-up, the recurrence rate is 0%. There were no mesh-related complications.
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Affiliation(s)
- Parag Bhanot
- Department of Surgery, Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007, USA.
| | - Brenton R Franklin
- Department of Plastic Surgery, Georgetown University Hospital, Washington, DC, USA
| | - Ketan M Patel
- Department of Plastic Surgery, Georgetown University Hospital, Washington, DC, USA
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Sosin M, Patel KM, Nahabedian MY, Bhanot P. Patient-centered outcomes following laparoscopic ventral hernia repair: a systematic review of the current literature. Am J Surg 2014; 208:677-84. [PMID: 25241956 DOI: 10.1016/j.amjsurg.2014.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 12/17/2013] [Accepted: 01/05/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND The purpose of this study was to systematically review patients who underwent laparoscopic ventral hernia repair (LVHR) and assess quality of life, pain, functionality, and patient satisfaction. DATA SOURCES MEDLINE, PubMed, and Cochrane database search identified 880 relevant articles. After the limits were applied, 14 articles were accepted for review. The analysis included health-related quality of life (HRQoL) measures including quality of life, pain, function, satisfaction, and mental and emotional well-being. CONCLUSIONS Fourteen studies were reviewed. Mean study size was 92.6 subjects (24 to 306) and mean defect size was 71.7 cm(2). LVHR improved the overall HRQoL in 6 of the 8 studies. Thirteen studies assessing pain demonstrated improved pain scores relative to preoperative levels and long-term follow up. LVHR was not associated with long-term pain. Functionality improved in 12 studies. Return to work ranged from 6 to 18 days postoperatively in 50% of studies and physical function scores improved in the remaining 50% of the studies. Patient satisfaction improved after LVHR in all studies assessing patient satisfaction. Fixation methods did not influence HRQoL. Laparoscopic repair was associated with improving mental and emotional well-being in 6 of the 7 studies.
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Affiliation(s)
- Michael Sosin
- Department of Surgery, Georgetown University Hospital, 3800 Reservoir Road, NW, Washington, DC 20007, USA.
| | - Ketan M Patel
- Department of Plastic Surgery, Georgetown University Hospital, 3800 Reservoir Road, NW, Washington, DC 20007, USA
| | - Maurice Y Nahabedian
- Department of Plastic Surgery, Georgetown University Hospital, 3800 Reservoir Road, NW, Washington, DC 20007, USA
| | - Parag Bhanot
- Department of Surgery, Georgetown University Hospital, 3800 Reservoir Road, NW, Washington, DC 20007, USA
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de ARAÚJO LMG, SERIGIOLLE LC, GOMES HMP, RODRIGUES DAB, LOPES CM, LEME PLS. Volume calculation of rats' organs and its application in the validation of the volume relation between the abdominal cavity and the hernial sac in incisional hernias with "loss of abdominal domain". ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2014; 27:177-81. [PMID: 25184766 PMCID: PMC4676367 DOI: 10.1590/s0102-67202014000300004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 03/20/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND The calculation of the volume ratio between the hernia sac and the abdominal cavity of incisional hernias is based on tomographic sections as well as the mathematical formula of the volume of the ellipsoid, which allows determining whether this is a giant hernia or there is a "loss of domain". As the images used are not exact geometric figures, the study of the volume of two solid organs of Wistar rats was performed to validate these calculations. AIM To correlate two methods for determining the volume of the kidney and spleen of rats, comparing a direct method of observation of the volume with the mathematical calculation of this value. METHODS The volume of left kidney, geometrically more regular, and spleen, with its peculiar shape, of ten animals was established in cubic centimeters after complete immersion in water with the aid of a beaker graduated in millimeters. These values were compared with those obtained by calculating the same volume with a specific mathematical formula: V = 4/3 × π × (r1 x r2 x r3). Data were compared and statistically analyzed by Student's t test. RESULTS Although the average volume obtained was higher through the direct method (1.13 cm3 for the left kidney and 0.71 cm3 for the spleen) than the values calculated with the mathematical formula (0.81 cm3 and 0.54 cm3), there were no statistically significant differences between the values found for the two organs (p>0.05). CONCLUSION There was adequate correlation between the direct calculation of the volume of the kidney and spleen with the result of mathematical calculation of these values in the animals' studies.
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Predicting abdominal closure after component separation for complex ventral hernias: maximizing the use of preoperative computed tomography. Ann Plast Surg 2014; 71:261-5. [PMID: 23945530 DOI: 10.1097/sap.0b013e3182773915] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Component separation techniques (CSTs) have allowed for midline fascial reapproximation in large midline ventral hernias. In certain cases, however, fascial apposition is not feasible, resulting in a bridged repair that is suboptimal. Previous estimates on myofascial advancement are based on hernia location and do not take into account variability between patients. Examination of preoperative computed tomography (CT) may provide insight into these variabilities and may allow for prediction of abdominal closure with CST. STUDY DESIGN A retrospective review was conducted of patients who underwent abdominal wall reconstruction from 2007 to 2012 with CST. Preoperative CT was obtained, and specific parameters were analyzed using image analysis software. Logistic regression was used to predict ideal operative closure. Multivariate analyses were adjusted for age and sex. An a priori value was set at P < 0.05. RESULTS Fifty-four patients met the criteria and had preoperative CT available for analysis. Forty-eight patients had fascial reapproximation achieved, whereas 6 patients had a bridged repair. Age, sex, weight, and body mass index were similar between groups (P > 0.05). Significant differences were seen between groups in 3 variables: transverse defect size (19.8 vs 10 cm, P < 0.05), defect area (420 vs 184.2 cm, P < 0.05), and percent abdominal wall defect (18.9% vs 10.6%, P < 0.05). CONCLUSIONS Preoperative determination of abdominal wall defect ratios and hernia defect areas may represent a more accurate method to predict abdominal wall closure after CST. Predicting midline approximation after CST is critical because outcomes after bridged repair can result in higher recurrence rates.
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Giant midline abdominal incisional herniae repair through combined retro-rectus mesh placement and components separation: experience from a single centre. Hernia 2014; 18:631-6. [PMID: 24676536 DOI: 10.1007/s10029-014-1239-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 03/10/2014] [Indexed: 10/25/2022]
Abstract
AIMS Giant midline abdominal wall incisional herniae require repair/reconstruction to restore the structural and functional continuity of the anterior abdominal wall. We describe here our approach to these demanding cases through a combined retro-rectus mesh placement and components separation and their overall functional outcome. METHODS A retrospective analysis of a prospectively collected data was carried out and 28 patients who underwent giant (≥15 cm) midline incisional hernia reconstruction were identified in a large district general hospital between 2007 and 2013 with a median follow-up of 34 (6-76) months. RESULTS Demographic data of our series include age of 60 (median) (30-87) years with a M:F ratio of 12:16, length of symptomatic hernia 18 (median) (12-36) months, more than two previous laparotomies (15), bowel obstructive symptoms (7) and recurrent herniation (7). BMI recorded was 32 (median) (24-46) and ASA of II (median) (I-III). Co-morbidities included cardiac disease (6), diabetes (6), respiratory disease (4) and systemic immunocompromise (2). Operative and technical details showed operative duration to be 180 (median) min, cranio-caudal rectus sheath defect 21 (median) cm, transverse rectus sheath defect 15 (median) cm, cross-sectional area of fascial defect 300 (median) cm(2) and size of mesh 690 (median) cm(2). Seven (25 %) developed short-term post operative complications: grade I seromata all resolving spontaneously (5); grade II superficial wound infections (2). Twenty-five (89 %) were completely asymptomatic at 34 (median) months' follow-up; 2 (7 %) reported mild pain, but not limiting any activity; 1 (4 %) described pain occasionally limiting activity. There was no clinical recurrence with one patient developing global bulging. CONCLUSIONS Our series is comparable to the literature in patient cohort demographics, co-morbidity and risk factor profile; however, we demonstrate an excellent intermediate term outcome with no clinical recurrence and an improvement in quality of life, through their ability to perform normal day to day activities.
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Laparoscopic incisional hernia repair in an ambulatory surgery-extended recovery centre: a review of 259 consecutive cases. Hernia 2014; 19:487-92. [PMID: 24609586 DOI: 10.1007/s10029-014-1229-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 02/15/2014] [Indexed: 01/30/2023]
Abstract
PURPOSE The high prevalence of incisional hernias and an average stay of 3-10 days for open procedures have made this pathology both a health problem and an economic issue. A protocol was developed for performing this procedure in an Ambulatory Surgery Center (ASC) with extended recovery. METHODS From January 2000 to December 2011, data about all laparoscopic incisional hernia repairs were gathered prospectively. The patients' clinical features, hernia type, intraoperative and postoperative complications and reasons for hospital admission are studied. RESULTS A total of 259 patients have been operated for incisional hernia (185) or recurrent hernioplasty (74) in our ASC. Laparoscopic repair was successful in 254 patients (98.07 %). Conversion to open surgery was necessary in five patients (1.93 %). A total of 50 patients (19.69 %) in whom surgery was completed laparoscopically were discharged the same day of surgery, 179 (70.47 %) at 24 h and 25 (9.84 %) required a stay of over 24 h. Postoperative pain was severe in 10 % of patients, moderate in 40 %, and mild in 50 %. Complications, mostly minor and self-limiting, were observed in 25 patients (9.84 %) during hospital stay. Five major complications that occured were: bile peritonitis, an acute peritonitis, due to an inadvertent intestinal perforation, and one intestinal obstruction by partial detachment of the mesh, an intra-abdominal hematoma and a colo-cutaneous fistula. There were no deaths in the series. The mean follow-up of patients was 29.35 months (range 12-129 months). The recurrence rate was 7.03 % (n = 18). Four trocar-site hernias were detected. CONCLUSIONS It is essential to create a protocol with selection criteria that take into account the patient, his entourage, the anesthetic-surgical procedure, and a team dedicated to surgical laparoscopic surgery in an ASC with extended recovery to achieve good results in terms of morbidity and patient safety.
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Abstract
Hernia emergencies are commonly encountered by the acute care surgeon. Although the location and contents may vary, the basic principles are constant: address the life-threatening problem first, then perform the safest and most durable hernia repair possible. Mesh reinforcement provides the most durable long-term results. Underlay positioning is associated with the best outcomes. Components separation is a useful technique to achieve tension-free primary fascial reapproximation. The choice of mesh is dictated by the degree of contamination. Internal herniation is rare, and preoperative diagnosis remains difficult. In all hernia emergencies, morbidity is high, and postoperative wound complications should be anticipated.
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Affiliation(s)
- D Dante Yeh
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA 02114, USA.
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Abstract
Stomas are created for a wide range of indications such as temporary protection of a high-risk anastomosis, diversion of sepsis, or permanent relief of obstructed defecation or incontinence. Yet this seemingly benign procedure is associated with an overall complication rate of up to 70%. Therefore, surgeons caring for patients with gastrointestinal diseases must be proficient not only with stoma creation but also with managing postoperative stoma-related complications. This article reviews the common complications associated with ostomy creation and strategies for their management.
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Affiliation(s)
- Andrea C Bafford
- Division of General and Oncologic Surgery, Department of Surgery, University of Maryland Medical Center, University of Maryland School of Medicine, Baltimore, MD 21230, USA
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Combined prosthetic incisional hernioplasty and panniculectomy—a 5-year single-centre experience. EUROPEAN JOURNAL OF PLASTIC SURGERY 2012. [DOI: 10.1007/s00238-012-0720-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Figel NA, Ellis CN. Prosthetics for Parastomal Hernia Repair. SEMINARS IN COLON AND RECTAL SURGERY 2012. [DOI: 10.1053/j.scrs.2011.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Gupta V, Nirkhiwale S, Gupta P, Phatak S. Achromobacter xylosoxidans mesh related infection: a case of delayed diagnosis and management. J Infect 2011; 64:e1-5. [PMID: 21959012 DOI: 10.1016/j.jinf.2011.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 09/14/2011] [Accepted: 09/15/2011] [Indexed: 11/30/2022]
Abstract
We present the first case of mesh related infection caused by Achromobacter xylosoxidans after ventral hernia repair. After repair of a small paraumbilical hernia, the postoperative course was complicated by persistent discharging sinuses despite the removal of underlying polypropylene mesh. Removal of an intrabdominal omental inflammatory mass containing pus that showed growth of A. xylosoxidans led to the resolution of all the symptoms.
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Affiliation(s)
- Vishal Gupta
- Department of Surgical Gastroenterology, Chhatrapati Shahuji Maharaj Medical University,(Erstwhile King George Medical College), Lucknow 226003, Uttar Pradesh, India.
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Changes in Quality of Life and Functional Status following Abdominal Contouring in the Massive Weight Loss Population. Plast Reconstr Surg 2011; 128:520-526. [DOI: 10.1097/prs.0b013e31821b62f0] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Snyder CW, Graham LA, Gray SH, Vick CC, Hawn MT. Effect of mesh type and position on subsequent abdominal operations after incisional hernia repair. J Am Coll Surg 2011; 212:496-502; discussion 502-4. [PMID: 21463777 DOI: 10.1016/j.jamcollsurg.2010.12.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 12/08/2010] [Indexed: 11/15/2022]
Abstract
BACKGROUND The frequency of subsequent abdominal operations (SAO) and complications attributable to earlier ventral incisional hernia repair (VIHR) are unknown. We examined the effect of repair type and technique on the difficulty and complications of subsequent surgery. STUDY DESIGN A cohort of VIHRs at 16 Veterans Affairs hospitals between 1998 and 2002 was examined for postrepair abdominal operation by chart review. The primary independent variable was type and technique of the index VIHR: suture or mesh repair stratified by mesh type and position in relation to abdominal wall musculature. Subsequent surgery characteristics including operative time, inadvertent enterotomy, mesh removal, and length of postoperative stay were determined by chart review. Regression modeling was used to adjust for potential confounding variables. RESULTS At a median of 80 months after VIHR in 1,444 patients, 366 (25.3%) experienced SAO. Nearly two-thirds of these involved rerepair of the VIHR with or without a concomitant procedure. Mesh removal was significantly more likely in expanded polytetrafluoroethylene repairs as compared with polypropylene repairs, regardless of technique (odds ratio = 3.6; p = 0.01). On multivariable regression modeling, polypropylene underlay (p = 0.03) and inlay (p = 0.001) and absorbable/biologic mesh (p = 0.05) significantly increased operative time for SAO. Repair type, mesh type, or position had no significant effect on risk of inadvertent enterotomy during the SAO (p≥0.27). CONCLUSIONS Subsequent abdominal operations after VIHR are common. Underlay or inlay polypropylene mesh increases SAO operative time, but there was no increased risk of intestinal injury. Earlier repair with expanded polytetrafluoroethylene did not increase operative time, but there was equivalent risk for intestinal injury and increased risk for mesh removal.
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Affiliation(s)
- Christopher W Snyder
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35294-0016, USA
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Llaguna OH, Avgerinos DV, Nagda P, Elfant D, Leitman IM, Goodman E. Does Prophylactic Biologic Mesh Placement Protect Against the Development of Incisional Hernia in High-risk Patients? World J Surg 2011; 35:1651-5. [DOI: 10.1007/s00268-011-1131-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Byrnes MC, Irwin E, Carlson D, Campeau A, Gipson JC, Beal A, Croston JK. Repair of High-Risk Incisional Hernias and Traumatic Abdominal Wall Defects with Porcine Mesh. Am Surg 2011. [DOI: 10.1177/000313481107700210] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Complex ventral hernias represent a significant challenge to surgeons. We hypothesized that a wide underlay technique in combination with a novel biologic mesh would result in repair with a low recurrence rate. Medical records of patients undergoing ventral herniorrhaphy with Xen-Matrix biologic mesh were evaluated. All patients were evaluated for hernia recurrence both immediately and after 2 to 3 years. There were 57 patients included in the study. The overall recurrence rate was 7.2 per cent; however, all recurrences were early and were likely technical failures. The average duration of follow-up was 30.6 months with no further recurrences after the early technical failures. The average number of previous recurrences was 1.5. Fascial closure was obtained over the mesh in 84 per cent of patients, with component separation being necessary in 36 per cent of patients. Lack of fascial reapproximation over the mesh was associated with early recurrence (0 vs 55%, P < 0.0001). Complex ventral hernias can be repaired with a low recurrence rate. Our technique in combination with the XenMatrix biologic mesh provides for durable repair. Whenever possible, the fascia should be closed above the underlay mesh, because this technique provides a more durable repair than using the mesh as a “fascial bridge.”
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Affiliation(s)
- Matthew C. Byrnes
- Department of Trauma, North Memorial Medical Center, Robbinsdale, Minnesota
- Division of Critical Care and Acute Care Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Eric Irwin
- Department of Trauma, North Memorial Medical Center, Robbinsdale, Minnesota
| | - Dana Carlson
- Department of Trauma, North Memorial Medical Center, Robbinsdale, Minnesota
| | - Amy Campeau
- Department of Trauma, North Memorial Medical Center, Robbinsdale, Minnesota
| | - Jonathon C. Gipson
- Department of Trauma, North Memorial Medical Center, Robbinsdale, Minnesota
| | - Alan Beal
- Department of Trauma, North Memorial Medical Center, Robbinsdale, Minnesota
| | - J. Kevin Croston
- Department of Trauma, North Memorial Medical Center, Robbinsdale, Minnesota
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Sharma A, Dey A, Khullar R, Soni V, Baijal M, Chowbey PK. Laparoscopic repair of suprapubic hernias: transabdominal partial extraperitoneal (TAPE) technique. Surg Endosc 2010; 25:2147-52. [PMID: 21184109 DOI: 10.1007/s00464-010-1513-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Accepted: 10/17/2010] [Indexed: 12/20/2022]
Abstract
BACKGROUND Suprapubic hernias are considered difficult to repair laparoscopically due to deficient posterior rectus sheath and proximity to important neurovascular structures and the urinary bladder. METHODS We retrospectively reviewed 72 patients (18 males, 54 females) who, between 1998 and 2008, had undergone laparoscopic repair for suprapubic hernial defects located less than 5 cm from the pubic arch. Five patients (6.9%) had recurrent hernias. A peritoneal flap was dissected distally to facilitate a mesh overlap of at least 5 cm from the hernial defect. The lower margin of the mesh was fixed under direct vision to Cooper's ligaments bilaterally. The raised peritoneal flap was reattached to the anterior abdominal wall thereby partially extraperitonealizing the mesh. RESULTS Mean diameter of the hernial defect was 5.2 cm (range=3.1-7.3 cm) as measured intraperitoneally. Mean size of the mesh used was 328.8 cm2 (range=225-506 cm2). Mean operating time was 116 min (range=64-170 min). Overall complication rate was 27.8%. There were no conversions. No recurrences were observed at a mean follow-up of 4.8 years (range=1.2-6.9 years) and a follow-up rate of 84.7% CONCLUSION A mesh overlap of at least 5 cm and fixation of the lower margin of the mesh under direct vision to Cooper's ligaments appears to confer increased strength and durability and contribute to low hernia recurrence rates in patients with suprapubic hernias.
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Affiliation(s)
- Anil Sharma
- Max Institute of Minimal Access, Metabolic and Bariatric Surgery, Max Super Speciality Hospital-East Block, 2, Press Enclave Road, Saket, New Delhi, 110 017, India.
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Snyder CW, Graham LA, Vick CC, Gray SH, Finan KR, Hawn MT. Patient satisfaction, chronic pain, and quality of life after elective incisional hernia repair: effects of recurrence and repair technique. Hernia 2010; 15:123-9. [DOI: 10.1007/s10029-010-0750-4] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Accepted: 10/22/2010] [Indexed: 11/24/2022]
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Llaguna OH, Avgerinos DV, Lugo JZ, Matatov T, Abbadessa B, Martz JE, Leitman IM. Incidence and risk factors for the development of incisional hernia following elective laparoscopic versus open colon resections. Am J Surg 2010; 200:265-9. [DOI: 10.1016/j.amjsurg.2009.08.044] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2009] [Revised: 08/26/2009] [Accepted: 08/26/2009] [Indexed: 10/19/2022]
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