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Bahareth EM, Alquhra DO, Alzhrani BM, Alsulaihebi AS, Ali AA, Khayat MA, Almaghrabi HA, Alsairafi R. Awareness of Hernias and Their Risk Factors Among Adults in the Western Region of Saudi Arabia. Cureus 2023; 15:e46994. [PMID: 38021655 PMCID: PMC10640918 DOI: 10.7759/cureus.46994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Objective To assess the awareness of hernia and its risk factors among adults in the western region of Saudi Arabia. Our hypothesis was that the studied population was in need of education regarding this matter. Methods This cross-sectional study was conducted in the western region of Saudi Arabia from November to December 2022, using a Google form. The generated questionnaire consisting of two parts was distributed electronically through social media platforms. The targeted population included adults from the western region of Saudi Arabia. The data were obtained using Microsoft Excel and analyzed using Statistical Package for Social Sciences (SPSS) v. 26 software (IBM Corp., Armonk, NY). Results A total of 1570 adults from the western region of Saudi Arabia were included in our study. We found that 13% of the participants had good overall knowledge about hernia, 31% had poor knowledge, and 56% had moderate knowledge. Alarmingly, 55% of the participants had a poor attitude, and 27% were evaluated as having poor practice. In addition, we found a significant association between people's level of knowledge and multiple factors, including age (p-value < 0.001), marital status (p-value< 0.001), and occupation (p-value< 0.001). Conclusion Based on our research, more than half of our population had a moderate level of knowledge regarding hernias including their risk factors and complications, with alarming levels of poor attitudes toward the disease. Healthcare workers were our participants' leading source of medical information, which directs us towards fully equipping them with the knowledge to educate the public effectively.
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Haskins IN. Hernia Formation: Risk Factors and Biology. Surg Clin North Am 2023; 103:835-846. [PMID: 37709390 DOI: 10.1016/j.suc.2023.04.020] [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] [Indexed: 09/16/2023]
Abstract
The incidence of ventral hernias in the United States is in increasing. Herein, the author details the etiology of congenital and acquired ventral hernias as well as the risk factors associated with the development of each of these types of ventral hernias.
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Affiliation(s)
- Ivy N Haskins
- Department of Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE 68198-3280, USA.
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Hospital-level variation in mesh use for ventral and incisional hernia repair. Surg Endosc 2023; 37:1501-1507. [PMID: 35851814 DOI: 10.1007/s00464-022-09357-w] [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: 03/17/2022] [Accepted: 05/16/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Placement of prosthetic mesh during ventral and incisional hernia repair has been shown to reduce the incidence of postoperative hernia recurrence. Consequently, multiple consensus guidelines recommend the use of mesh for ventral hernias of any size. However, the extent to which real-world practice patterns reflect these recommendations is unclear. METHODS We performed a retrospective review of the Michigan Surgical Quality Collaborative Hernia Registry (MSQC-HR) to identify patients undergoing clean ventral or incisional hernia repair between January 1, 2020 and December 31, 2021. The primary outcome was mesh use. We used two-step hierarchical logistic regression modeling with empirical Bayes estimates to evaluate the association of hospital-level mesh use with patient, operative, and hernia characteristics. RESULTS A total of 5262 patients underwent ventral and incisional hernia repair at 65 hospitals with a mean age of 53.8 (14.5) years, 2292 (43.6%) females, and a mean hernia width of 3.2 (3.4) cm. Mean hospital volume was 81 (49) cases. Mesh was used in 4098 (77.9%) patients. At the patient level, hernia width and surgical approach were significantly associated with mesh use. Specifically, mesh use was 6.2% (95% CI 4.8-7.5%) more likely with each additional centimeter of hernia width and 28.0% (95% CI 26.1-29.8%) more likely for minimally invasive repair compared to open repair. At the hospital level, there was wide variation in mesh use, ranging from 38.0% (95% CI 31.5-44.9%) to 96.4% (95% CI 95.3-97.2%). Hospital-level mesh use was not associated with differences in hernia size (β = - 0.003, P = 0.978), surgical approach (β = - 1.109, P = 0.414), or any other patient factors. CONCLUSIONS Despite strong evidence supporting the use of mesh in ventral and incisional hernia repair, there is substantial variation in mesh use between hospitals that is not explained by differences in patient characteristics or operative approach. This suggests that opportunities exist to standardize surgical practice to better align with evidence supporting the use of mesh in the management of these hernias.
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Fonseca MK, Tarso L, Gus J, Cavazzola LT. Short-term complications after onlay versus preperitoneal mesh repair of umbilical hernias: a prospective randomized double-blind trial. Langenbecks Arch Surg 2023; 408:48. [PMID: 36662265 DOI: 10.1007/s00423-023-02802-x] [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: 04/16/2022] [Accepted: 11/19/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE To compare the incidence of surgical site occurrences (SSOs) following onlay versus preperitoneal mesh placement in elective open umbilical hernia repairs. METHODS This study presents a secondary analysis of a randomized double-blind trial conducted on female patients with primary umbilical hernias admitted to a general hospital, in a residency training program setting. Fifty-six subjects were randomly assigned to either onlay (n=30) or preperitoneal (n=26) mesh repair group. Data on baseline demographics, past medical history, perioperative details, postoperative pain (visual analogue scale (VAS)), wound-related complications, and recurrence were assessed using a standardized protocol. RESULTS No statistically significant differences were observed between groups regarding patients' demographics, comorbidities, or defect size. Operative time averaged 67.5 (28-110) min for onlay and 50.5 (31-90) min for preperitoneal repairs, p=.03. The overall rate of SSOs was 21.4% (n=12), mainly in the onlay group (33% vs 7.7%; p=0.02, 95% CI 0.03-0.85) and mostly due to seromas. There were no between-group significant differences in postoperative VAS scores at all timepoints. After a maximum follow-up of 48 months, one recurrence was reported in the onlay group. By logistic regression, the onlay technique was the only independent risk factor for SSOs. CONCLUSION The presented data identified a decreased wound morbidity in preperitoneal umbilical hernia repairs, thus contributing to the limited body of evidence regarding mesh place selection in future guidelines. Further cases from this ongoing study and completion of follow-up are expected to also compare both techniques in terms of long-term outcomes. TRIAL REGISTRATION NUMBER Brazilian Registry of Clinical Trials (ReBEC) UTN code: U1111-1205-0065 (date of registration: March 27, 2018).
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Affiliation(s)
- Mariana Kumaira Fonseca
- Postgraduate Program in Surgical Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
- Hospital Municipal de Pronto Socorro de Porto Alegre (HPS), Largo Theodoro Hertlz, Porto Alegre, Porto Alegre, Rio Grande do Sul, 90040-194, Brazil.
| | - Lissandro Tarso
- Hospital Materno-Infantil Presidente Vargas (HMIPV), Porto Alegre, Brazil
| | - Jader Gus
- Hospital Materno-Infantil Presidente Vargas (HMIPV), Porto Alegre, Brazil
| | - Leandro Totti Cavazzola
- Postgraduate Program in Surgical Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
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Yuan S, Li Y, Li Q, Fan L, Zhou J. Surgery Versus Non-surgery Interventions on Rectus Abdominis Diastasis With or Without Hernias: a Systematic Review. Indian J Surg 2022. [DOI: 10.1007/s12262-021-02792-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Bernardi K, Olavarria OA, Dhanani NH, Lyons N, Holihan JL, Cherla DV, Berger DH, Ko TC, Kao LS, Liang MK. Two-year Outcomes of Prehabilitation Among Obese Patients With Ventral Hernias: A Randomized Controlled Trial (NCT02365194). Ann Surg 2022; 275:288-294. [PMID: 33201119 DOI: 10.1097/sla.0000000000004486] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine if preoperative nutritional counseling and exercise (prehabilitation) improve outcomes in obese patients seeking ventral hernia repair (VHR)? SUMMARY BACKGROUND DATA Obesity and poor fitness are associated with complications following VHR. It is unknown if preoperative prehabilitation improves outcomes of obese patients seeking VHR. METHODS This is the 2-year follow-up of a blinded randomized controlled trial from 2015 to 2017 at a safety-net academic institution. Obese patients (BMI 30-40) seeking VHR were randomized to prehabilitation versus standard counseling. Elective VHR was performed once preoperative requirements were met: 7% total body weight loss or 6 months of counseling and no weight gain. Primary outcome was percentage of hernia-free and complication-free patients at 2 years. Complications included recurrence, reoperation, and mesh complications. Primary outcome was compared using chi-square. We hypothesize that prehabilitation in obese patients with VHR results in more hernia- and complication-free patients at 2-years. RESULTS Of the 118 randomized patients, 108 (91.5%) completed a median (range) follow-up of 27.3 (6.2-37.4) months. Baseline BMI (mean±SD) was similar between groups (36.8 ± 2.6 vs 37.0 ± 2.6). More patients in the prehabilitation group underwent emergency surgery (5 vs 1) or dropped out of the program (3 vs 1) compared to standard counseling (13.6% vs 3.4%, P = 0.094). Among patients who underwent surgery, there was no difference in major complications (10.2% vs 9.1%, P = 0.438). At 2-years, there was no difference in percentage of hernia-free and complication-free patients (72.9% vs 66.1%, P = 0.424, 1.14, 0.88-1.47). CONCLUSION There is no difference in 2-year outcomes of obese patients seeking VHR who undergo prehabilitation versus standard care. Prehabilitation may not be warranted in obese patients undergoing elective VHR.Clinical Trial Registration: This trial was registered with clinicaltrials.gov (NCT02365194).
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Affiliation(s)
- Karla Bernardi
- Surgery Department, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
- Center for Surgical Trials and Evidence-Based Practice, University of Texas Health Science Center at Houston, Houston, TX
| | - Oscar A Olavarria
- Surgery Department, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
- Center for Surgical Trials and Evidence-Based Practice, University of Texas Health Science Center at Houston, Houston, TX
| | - Naila H Dhanani
- Surgery Department, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
- Center for Surgical Trials and Evidence-Based Practice, University of Texas Health Science Center at Houston, Houston, TX
| | - Nicole Lyons
- Surgery Department, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
| | - Julie L Holihan
- Surgery Department, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
- Center for Surgical Trials and Evidence-Based Practice, University of Texas Health Science Center at Houston, Houston, TX
| | - Deepa V Cherla
- Surgery Department, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
- Center for Surgical Trials and Evidence-Based Practice, University of Texas Health Science Center at Houston, Houston, TX
| | | | - Tien C Ko
- Surgery Department, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
| | - Lillian S Kao
- Surgery Department, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
- Center for Surgical Trials and Evidence-Based Practice, University of Texas Health Science Center at Houston, Houston, TX
| | - Mike K Liang
- Surgery Department, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
- Center for Surgical Trials and Evidence-Based Practice, University of Texas Health Science Center at Houston, Houston, TX
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Spencer Netto FAC, Mainprize M, Galant G, Szasz P. The incidence of occult paraumbilical hernias in patients undergoing primary umbilical hernia repair. Hernia 2021; 25:619-623. [PMID: 33743094 DOI: 10.1007/s10029-021-02392-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The primary goal of this study was to determine the incidence of occult paraumbilical hernias during open primary umbilical hernia repair. The secondary objective was to further characterize the clinical features of these patients and hernias. METHODS This was a retrospective chart review of patients undergoing primary umbilical hernia repair at Shouldice Hospital, from 2007 to 2017. Inclusion criteria were utilized to elucidate patients, where a concomitant occult paraumbilical hernia was found. Descriptive statistics were used throughout. RESULTS 5850 patients underwent primary umbilical hernia repair, 459 (7.85%) patients had concomitant primary umbilical and paraumbilical hernias. There was a preoperative suspicion/diagnosis of a paraumbilical hernia in 166 (2.8%) of these patients. In 293 (5.01%) patients who had open primary umbilical hernia repair, at least one associated occult paraumbilical defect was found during surgery. Most of umbilical and concomitant occult paraumbilical hernias were small and medium size defects. The great majority of the reported occult paraumbilical hernias were found in the supraumbilical position at a distance of 3 cm or less from the top of the umbilical defect. CONCLUSION The incidence of concomitant occult paraumbilical hernias in patients mildly overweight undergoing primary umbilical hernia repair is 5.01%, relevant to surgical decision-making. Since the great majority of these paraumbilical defects are superior to the umbilical defect, an adequate incision and dissection for at least 3 cm above the umbilical hernia may reduce the number of missed concomitant hernias and result in less presumed recurrences.
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Affiliation(s)
- F A C Spencer Netto
- General Surgeon at Shouldice Hospital, 7750 Bayview Ave., Thornhill, ON, L3T 7N2, Canada.
| | - M Mainprize
- Research Coordinator/Associate at Shouldice Hospital, Thornhill, ON, Canada
| | - G Galant
- General Surgeon at Shouldice Hospital, 7750 Bayview Ave., Thornhill, ON, L3T 7N2, Canada
| | - P Szasz
- General Surgeon at Shouldice Hospital, 7750 Bayview Ave., Thornhill, ON, L3T 7N2, Canada
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8
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Pawlak M, Newman M, de Beaux AC, Tulloh B. The darn technique for small (< 2 cm diameter) midline hernias. Hernia 2020; 25:625-630. [PMID: 32876796 DOI: 10.1007/s10029-020-02283-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/27/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Primary midline hernias arising in the linea alba are common. While mesh repair has been shown to reduce recurrence rates even in small hernias, many surgeons still use a suture repair for defects of less than 2 cm. The recent European and Americas Hernia Societies Guidelines recommended suture repair only for hernias smaller than 1 cm. A suture repair implies edge-to-edge or overlapping fascial margins, which necessarily involves tension on the repair. A darn is a tension-free repair where, in effect, a "mesh" is hand-woven across the defect in situ. METHODS The darn repair is a modification of the darn techniques for inguinal hernia repair. Eligible patients undergoing this repair at the Royal Infirmary of Edinburgh between 1 January 2008 and 31 December 2017 were identified from a prospective computer-based medical record system and their case notes reviewed. Inclusion criteria were adult patients with a primary midline abdominal wall defect smaller than 2 cm in the widest diameter of the hernia defect measured intra-operatively. Patients were followed up by telephone in 2019. Those who reported possible recurrence or other symptoms in the region of their hernia repair were reviewed in the outpatient clinic. RESULTS 47 suture-darn repairs were undertaken over the 10-year period. Fifteen of the darn repair operations (32%) were performed under local anaesthesia. Forty-one patients were followed up with a mean of 80 ± 35 and median of 87 months after surgery. Six patients (13%) were lost to follow-up. Recurrence was found in two cases (5%) and one patient has since been diagnosed with a new epigastric hernia some 5 cm cranial to the previous repair. CONCLUSIONS The darn repair for small primary midline hernias is quick and inexpensive with promising long-term results. It can be performed under local anaesthesia. It can serve as an alternative to mesh repair for defects less than 2 cm in maximum dimension.
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Affiliation(s)
- M Pawlak
- North Devon Comperhensive Hernia Centre, North Devon District Hospital, Barnstaple, UK.
| | - M Newman
- Upper GI Surgery Department, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - A C de Beaux
- Upper GI Surgery Department, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - B Tulloh
- Upper GI Surgery Department, Royal Infirmary of Edinburgh, Edinburgh, UK
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Harpain F, Wimmer K, Dawoud C, Ogrodny P, Stift A. Short-term outcome after ventral hernia repair using self-gripping mesh in sublay technique - A retrospective cohort analysis. Int J Surg 2020; 75:47-52. [PMID: 31991243 DOI: 10.1016/j.ijsu.2020.01.124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/10/2020] [Accepted: 01/18/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Hernia repair in sublay technique is widely accepted for ventral hernias, as it appears to be advantageous in terms of complication and recurrence rates. Self-gripping meshes are increasingly used for hernia repair with retromuscular mesh positioning. However, real-life data on the safe use in that specific indication are still lacking. The purpose of this study is the evaluation of short-term postoperative outcome of self-gripping versus conventional non-self-gripping meshes in sublay hernia repair. MATERIALS AND METHODS This retrospective analysis assessed patients undergoing ventral hernia repair in sublay technique between January 2011 and July 2018 at the Department of Surgery, Medical University of Vienna. 244 consecutive patients were eligible for final analysis. Patients were grouped according to the utilized mesh. Baseline characteristics and peri-as well as postoperative outcome was assessed. RESULTS There was no significant difference in baseline characteristics between the two groups. Median follow-up was 11 months (IQR 3-30). The overall complication rate (28.3% versus 13.7%, p = 0.005) due to an increased rate of seromas (17.3% versus 6.8%, p = 0.013) and surgical site infections (12.6% versus 4.3%, p = 0.021) was significantly higher in patients with a self-gripping mesh. Significantly more patients with a self-gripping mesh needed a surgical intervention (21.3% versus 9.4%, p = 0.011). CONCLUSION In sublay ventral hernia repair, the use of self-gripping meshes is associated with a higher overall complication rate and an increased rate of complication-associated surgical interventions when compared to non-self-gripping mesh placements.
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Affiliation(s)
- Felix Harpain
- Department of Surgery, Division of General Surgery, Medical University Vienna, Austria
| | - Kerstin Wimmer
- Department of Surgery, Division of General Surgery, Medical University Vienna, Austria
| | - Christopher Dawoud
- Department of Surgery, Division of General Surgery, Medical University Vienna, Austria
| | - Philipp Ogrodny
- Department of Surgery, Division of General Surgery, Medical University Vienna, Austria
| | - Anton Stift
- Department of Surgery, Division of General Surgery, Medical University Vienna, Austria.
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Louie M, Strassle PD, Moulder JK, Overby W. Risk factors for repeat hernia repair in women of childbearing age. Hernia 2019; 24:577-585. [PMID: 31773551 DOI: 10.1007/s10029-019-02077-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 11/03/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE Herniorrhaphy is a source of substantial cost and morbidity. Although women are a substantial proportion of patients seeking repair, gender-specific data, including the influence of childbirth on hernia recurrence, are lacking. Our objective was to estimate the rate and identify risk factors for repeat herniorrhaphy in reproductive-aged women. METHODS Retrospective cohort study of women who underwent herniorrhaphy during June 2000-December 2014 in the United States. Women aged 18-50 who underwent umbilical, incisional/ventral, or inguinal/femoral herniorrhaphy in the Truven Health Analytics MarketScan® Commercial Claims and Encounters database were included. Women without a hernia diagnosis or multiple/concurrent index herniorrhaphy types were excluded. Primary outcome of interest was second herniorrhaphy. RESULTS Of 123,674 women, 13% had a second herniorrhaphy within 10 years; increasing age, comorbidities, childbirth, smoking, obesity, and inpatient procedure were independently associated with increased risk. Cesarean delivery before umbilical herniorrhaphy (HR 1.61, 95% CI 1.34, 1.92) and both vaginal (HR 2.57, 95% CI 1.98, 3.34) and cesarean delivery (HR 2.95, 95% CI 2.25, 3.87) after umbilical herniorrhaphy were associated with increased risk of second herniorrhaphy. Both vaginal (HR 1.66, 95% CI 1.13, 2.43) and cesarean delivery (HR 2.72, 95% CI 2.09, 3.53) after incisional/ventral herniorrhaphy and vaginal delivery after inguinal/femoral herniorrhaphy (HR 1.75, 95% CI 1.22, 2.51) were associated with increased risk of second herniorrhaphy. CONCLUSIONS Among reproductive-aged women, childbirth, increasing age, comorbidities, smoking, and obesity increase risk of subsequent herniorrhaphy. Risk of second herniorrhaphy is higher with cesarean delivery compared to vaginal delivery, and higher for delivery occurring after initial hernia repair compared to before.
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Affiliation(s)
- M Louie
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, 4010 Old Clinic Building, Campus Box 7570, Chapel Hill, NC, 27599-7570, USA.
| | - P D Strassle
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - J K Moulder
- Department of Obstetrics and Gynecology, Wake Forest University, Wake Forest, NC, USA
| | - W Overby
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Donovan K, Denham M, Kuchta K, Denham W, Linn JG, Haggerty SP, Carbray J, Ujiki M. Predictors for recurrence after open umbilical hernia repair in 979 patients. Surgery 2019; 166:615-622. [DOI: 10.1016/j.surg.2019.04.040] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 04/08/2019] [Accepted: 04/16/2019] [Indexed: 12/19/2022]
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Lora-Aguirre A, Vega-Peña NV, Barrios-Parra AJ, Ruiz-Pineda JP. Hernia umbilical: un problema no resuelto. IATREIA 2019. [DOI: 10.17533/udea.iatreia.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
La cirugía de la hernia umbilical ha sido considerada tradicionalmente como sencilla y de fácil ejecución. El cambio conceptual de la hernia umbilical y los avances en su tratamiento han modificado su abordaje, estableciéndose escenarios de complejidad variable (obesidad, embarazo, cirróticos, distasis de los rectos, etc.) que demandan un conocimiento más profundo del tema por parte de la comunidad médica. El impacto económico en el sistema de salud, debido a su alta prevalencia como patología quirúrgica, implica un uso racional de recursos, así como la necesidad de una nueva categorización dentro de la cirugía de la pared abdominal. Es necesario establecer modificaciones en los procesos diagnósticos y terapéuticos en una entidad que ha sido relegada a los niveles básicos del ejercicio quirúrgico habitual.
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Kulacoglu H, Köckerling F. Hernia and Cancer: The Points Where the Roads Intersect. Front Surg 2019; 6:19. [PMID: 31024927 PMCID: PMC6460227 DOI: 10.3389/fsurg.2019.00019] [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: 01/11/2019] [Accepted: 03/18/2019] [Indexed: 12/24/2022] Open
Abstract
Introduction: This review aimed to present common points, intersections, and potential interactions or mutual effects for hernia and cancer. Besides direct relationships, indirect connections, and possible involvements were searched. Materials and Methods: A literature search of PubMed database was performed in July 2018 as well as a search of relevant journals and reference lists. The total number of screened articles was 1,422. Some articles were found in multiple different searches. A last PubMed search was performed during manuscript writing in December 2018 to update the knowledge. Eventually 427 articles with full text were evaluated, and 264 included, in this review. Results: There is no real evidence for a possible common etiology for abdominal wall hernias and any cancer type. The two different diseases had been found to have some common points in the studies on genes, integrins, and biomarkers, however, to date no meaningful relationship has been identified between these points. There is also some, albeit rather conflicting, evidence for inguinal hernia being a possible risk factor for testicular cancer. Neoadjuvant or adjuvant therapeutic modalities like chemotherapy and radiotherapy may cause postoperative herniation with their adverse effects on tissue repair. Certain specific substances like bevacizumab may cause more serious complications and interfere with hernia repair. There are only two articles in PubMed directly related to the topic of "hernia and cancer." In one of these the authors claimed that there was no association between cancer development and hernia repair with mesh. The other article reported two cases of squamous-cell carcinoma developed secondary to longstanding mesh infections. Conclusion: As expected, the relationship between abdominal wall hernias and cancer is weak. Hernia repair with mesh does not cause cancer, there is only one case report on cancer development following a longstanding prosthetic material infections. However, there are some intersection points between these two disease groups which are worthy of research in the future.
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Affiliation(s)
| | - Ferdinand Köckerling
- Department of Surgery, Centre for Minimally Invasive Surgery, Vivantes Klinikum, Berlin, Germany
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14
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van Schalkwyk CP, Dusseldorp JR, Liang DG, Keshava A, Gilmore AJ, Merten S. Concomitant Abdominoplasty and Laparoscopic Umbilical Hernia Repair. Aesthet Surg J 2018; 38:NP196-NP204. [PMID: 29897393 DOI: 10.1093/asj/sjy100] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Umbilical hernia is a common finding in patients undergoing abdominoplasty, especially those who are postpartum with rectus divarication. Concurrent surgical treatment of the umbilical hernia at abdominoplasty presents a "vascular challenge" due to the disruption of dermal blood supply to the umbilicus, leaving the stalk as the sole axis of perfusion. To date, there have been no surgical techniques described to adequately address large umbilical herniae during abdominoplasty. OBJECTIVES To present an effective and safe technique that can address large umbilical herniae during abdominoplasty. METHODS A prospective series of 10 consecutive patients, undergoing concurrent abdominoplasty and laparoscopic umbilical hernia repair between 2014 and 2017 were included in the study. All procedures were performed by the same general surgeon and plastic surgeon at the Macquarie University Hospital in North Ryde, NSW, Australia. Data were collected with approval of our ethics committee. RESULTS At 12-month follow up there were no instances of umbilical necrosis, wound complications, seroma, or recurrent hernia. The mean body mass index was 23.8 kg/m2 (range, 16.1-30.1 kg/m2). Rectus divarication ranged from 35 to 80 mm (mean, 53.5 mm). Umbilical hernia repair took a mean of 25.9 minutes to complete (range, 18-35 minutes). CONCLUSIONS We present a technique that avoids incision of the rectus fascia minimizes dissection of the umbilical stalk and is able to provide a gold standard hernia repair with mesh. This procedure is particularly suited to postpartum patients with large herniae (>3-4 cm diameter) and wide rectus divarication, where mesh repair with adequate overlap is the recommended treatment. LEVEL OF EVIDENCE 4
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Affiliation(s)
- Constant P van Schalkwyk
- Department of Plastic and Reconstructive Surgery, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Joseph R Dusseldorp
- Department of Plastic and Reconstructive Surgery, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Derek G Liang
- Department of Plastic and Reconstructive Surgery, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Anil Keshava
- Department of General Surgery, Macquarie University Hospital, North Ryde, NSW, Australia
- Concord Repatriation General Hospital, Concords, NSW, Australia
- Concord Clinical School, The University of Sydney, NSW, Australia
| | - Andrew J Gilmore
- Macquarie University Hospital, North Ryde, NSW, Australia
- Liverpool Hospital, Liverpool, NSW, Australia
- Liverpool Hospital, Liverpool, NSW, Australia
| | - Steve Merten
- Department of Plastic and Reconstructive Surgery, Concord Repatriation General Hospital, Concord, NSW, Australia
- The Australian School of Advanced Medicine, Macquarie University Hospital, North Ryde, NSW, Australia
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15
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Umbilical hernia repair with composite prosthesis: a single-centre experience. Hernia 2018; 23:143-147. [DOI: 10.1007/s10029-018-1843-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 10/29/2018] [Indexed: 10/27/2022]
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16
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Liang MK, Bernardi K, Holihan JL, Cherla DV, Escamilla R, Lew DF, Berger DH, Ko TC, Kao LS. Modifying Risks in Ventral Hernia Patients With Prehabilitation. Ann Surg 2018; 268:674-680. [DOI: 10.1097/sla.0000000000002961] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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17
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Importance of mesh overlap on hernia recurrence after open umbilical hernia repair with bilayer prosthesis. Am J Surg 2018; 216:919-922. [PMID: 29429547 DOI: 10.1016/j.amjsurg.2018.01.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 01/07/2018] [Accepted: 01/13/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND importance of mesh overlap on recurrence after open umbilical hernia repair has been poorly studied. METHODS a retrospective cohort study was performed with patients who underwent open umbilical hernia repair with bilayer prosthesis between 2004 and 2015. RESULTS 1538 patients were included. Fifty patients (3.3%) had a mesh overlap lower than 1 cm. After a mean follow-up of 4.1 years 53 patients (3.5%) developed a recurrence. Recurrence was associated with a mesh overlap smaller than 1 cm (10.2% vs. 3.3%, p = 0.010, OR = 3.3). In the logistic regression model an overlap smaller than 1 cm was not statistically associated with recurrence (OR = 2.5, p = 0.123). Female gender, postoperative complications and prosthesis size were associated with hernia recurrence. CONCLUSIONS mesh overlap seems to be an important factor for hernia recurrence. A mesh overlap of at least 1 cm should be used until more studies are performed about this issue.
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18
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Shipkov HD, Mojallal A, Braye F. Simultaneous Abdominoplasty and Umbilical Hernia Repair via Laparoscopy: a Preliminary Report. Folia Med (Plovdiv) 2017; 59:222-227. [DOI: 10.1515/folmed-2017-0026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 11/16/2016] [Indexed: 12/23/2022] Open
Abstract
AbstractBackground:Umbilical hernias (UH) are common in postpartum patients seeking abdominal contouring surgery and the question of simultaneous abdominoplasty and UH repair is raised. This presents, however, a risk to the umbilicus vascularisation with possible umbilical necrosis. To minimize this risk we associated abdominoplasty with laparoscopic UH repair. The aim of this study was to present the technique of simultaneous abdominoplasty and UH repair and the first results.Materials and methods:Simultaneous abdominoplasty and laparoscopic mesh UH repair was analysed in the first 10 cases. The intervention was performed by a plastic surgeon and a general surgeon. It begins as a standard abdominoplasty with flap elevation, umbilicus detachment and diastasis repair, if indicated. The second stage is the UH repair via laparoscopy using an intraperitoneal mesh. The third stage consists of umbilical transposition and closure of the abdominoplasty incision.Results:We had no complications at the umbilicus or the hernia mesh. In all cases, umbilical vascularisation was preserved and no hernia recurrence was noted.Conclusions:Our first results suggest that the simultaneous UH repair with abdominoplasty is safe, minimizing the risk to the umbilicus blood supply. These first results encourage us to recommend this approach and perform a more detailed analysis of the whole series since our first case.
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Chen W, Liu L, Huang H, Jiang M, Zhang T. A case report of spontaneous umbilical enterocutaneous fistula resulting from an incarcerated Richter's hernia, with a brief literature review. BMC Surg 2017; 17:15. [PMID: 28193213 PMCID: PMC5307766 DOI: 10.1186/s12893-017-0216-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 02/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Richter's hernia is a high-risk ischaemic gastrointestinal disorder that is typically diagnosed in a delayed manner due to a lack of obvious symptoms. Spontaneous umbilical enterocutaneous fistula (ECF) resulting from an incarcerated Richter's hernia is extremely rare. CASE PRESENTATION A 62-year-old female presented with a chief complaint of recurrent umbilical region infection for the preceding 20 months with no symptoms of ileus. Preoperative CT and fistulography revealed an incarcerated Richter's hernia complicated by an ECF. Exploratory laparotomy revealed a loop of the distal ileum adherent to the umbilical region that was retrieved back into the abdominal cavity. Side-to-side ileo-ileal anastomosis was performed using a 75 mm linear stapler to remove the affected ileum segment. The internal hernia ring was closed using plication sutures instead of via mesh repair due to the patient's small defect and infection risk. CONCLUSION Richter's hernia can be observed at any age but is particularly common in frail, elderly patients. This nonspecific clinical and laboratory findings of this condition are associated with a high misdiagnosis rate, resulting inrelatively high mortality. Abdominal CT and gastrointestinal imaging are recommended if Richter's hernia is suspected. Timely surgical intervention is crucial for reducing mortality and improving prognosis.
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Affiliation(s)
- Wei Chen
- Key Laboratory for Molecular Diagnosis of Hubei Province, The Central Hospital of the Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, People's Republic of China.
- Department of Gastrointestinal Surgery, The Central Hospital of the Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, People's Republic of China.
| | - Lei Liu
- Department of Gastrointestinal Surgery, The Central Hospital of the Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, People's Republic of China
| | - Hui Huang
- Department of Gastrointestinal Surgery, The Central Hospital of the Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, People's Republic of China
| | - Mianxu Jiang
- Department of Gastrointestinal Surgery, The Central Hospital of the Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, People's Republic of China
| | - Tao Zhang
- Department of Gastrointestinal Surgery, The Central Hospital of the Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, People's Republic of China
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20
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Ha W, Song SY, Yoon CS, Kim KN. Severe Irreversible Diastasis Recti Abdominis and Abdominal Hernia in Postpartum Women: Rare Case Report. Int Surg 2016; 105:10-13. [PMID: 27104868 DOI: 10.9738/intsurg-d-15-00204.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Diastasis recti abdominis is a condition defined as the separation between the rectus abdominis and the linea alba, which leads to weakness in the abdominal muscles. Diastasis may be slight or severe, sometimes resulting in herniation of the abdominal viscera. Following childbirth, most women develop some extent of muscle separation in the postpartum period. However, if the diastasis recti abdominis in the postpartum period remain severe, it should be corrected to prevent concurrent abdominal hernia, strangulation or incarceration. We herein present two Korean cases of postpartum women with severe diastasis recti abdominis with abdominal hernia; it is the first report of its kind from Korea. Two women were referred to our clinic with severe abdominal bulge. Computerized tomography scan showed widening of the linea alba with abdominal hernia. The standard abdominoplasty with multiple wide longitudinal plications of the abdominal wall was performed in each patient under general anesthesia. There was no recurrence of diastasis recti abdominis or abdominal hernia during follow-up periods. The application of abdominoplasty in postpartum women with severe diastasis recti abdominis with abdominal hernia is thus considered to be an efficient management option. We hope these cases can provide a reference for the treatment of similar situations.
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Affiliation(s)
- Won Ha
- 1 Department of Plastic and Reconstructive Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sin Young Song
- 2 Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chi Sun Yoon
- 1 Department of Plastic and Reconstructive Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Kyu Nam Kim
- 3 Department of Plastic and Reconstructive Surgery, Konyang University Hospital, Daejeon, Korea
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García-Moreno F, Pérez-López P, Sotomayor S, Pérez-Köhler B, Bayon Y, Pascual G, Bellón JM. Comparing the host tissue response and peritoneal behavior of composite meshes used for ventral hernia repair. J Surg Res 2015; 193:470-82. [DOI: 10.1016/j.jss.2014.07.049] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Revised: 06/03/2014] [Accepted: 07/14/2014] [Indexed: 12/30/2022]
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