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Afaque MY. Technical reason why TAR does not decrease tension in the anterior fascial layer, and this may be a blessing in disguise. Hernia 2024; 28:939-940. [PMID: 38197894 DOI: 10.1007/s10029-023-02958-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/25/2023] [Indexed: 01/11/2024]
Affiliation(s)
- M Y Afaque
- Department of Surgery, J N Medical College, AMU, Aligarh, UP, 202001, India.
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Amro C, Ryan IA, Elhage SA, Messa CA, Niu EF, McGraw JR, Broach RB, Fischer JP. Comparative Analysis of Ventral Hernia Repair and Transverse Abdominis Release With and Without Panniculectomy: A 4-Year Match-Pair Analysis. Ann Plast Surg 2024; 92:S80-S86. [PMID: 38556652 DOI: 10.1097/sap.0000000000003871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Amid rising obesity, concurrent ventral hernia repair and panniculectomy procedures are increasing. Long-term outcomes of transverse abdominis release (TAR) combined with panniculectomy remain understudied. This study compares clinical outcomes and quality of life (QoL) after TAR, with or without panniculectomy. METHODS A single-center retrospective review from 2016 to 2022 evaluated patients undergoing TAR with and without panniculectomy. Propensity-scored matching was based on age, body mass index, ASA, and ventral hernia working group. Patients with parastomal hernias were excluded. Patient/operative characteristics, postoperative outcomes, and QoL were analyzed. RESULTS Fifty subjects were identified (25 per group) with a median follow-up of 48.8 months (interquartile range, 43-69.7 months). The median age and body mass index were 57 years (47-64 years) and 31.8 kg/m2 (28-36 kg/m2), respectively. The average hernia defect size was 354.5 cm2 ± 188.5 cm2. There were no significant differences in hernia recurrence, emergency visits, readmissions, or reoperations between groups. However, ventral hernia repair with TAR and panniculectomy demonstrated a significant increase in delayed healing (44% vs 4%, P < 0.05) and seromas (24% vs 4%, P < 0.05). Postoperative QoL improved significantly in both groups (P < 0.005) across multiple domains, which continued throughout the 4-year follow-up period. There were no significant differences in QoL among ventral hernia working group, wound class, surgical site occurrences, or surgical site occurrences requiring intervention (P > 0.05). Patients with concurrent panniculectomy demonstrated a significantly greater percentage change in overall scores and appearance scores. CONCLUSIONS Ventral hernia repair with TAR and panniculectomy can be performed safely with low recurrence and complication rates at long-term follow-up. Despite increased short-term postoperative complications, patients have a significantly greater improvement in disease specific QoL.
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Affiliation(s)
- Chris Amro
- From the Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA
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LaGuardia JS, Milek D, Lebens RS, Chen DR, Moghadam S, Loria A, Langstein HN, Fleming FJ, Leckenby JI. A Scoping Review of Quality-of-Life Assessments Employed in Abdominal Wall Reconstruction. J Surg Res 2024; 295:240-252. [PMID: 38041903 DOI: 10.1016/j.jss.2023.10.013] [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: 05/12/2023] [Revised: 09/08/2023] [Accepted: 10/27/2023] [Indexed: 12/04/2023]
Abstract
INTRODUCTION Surgeons use several quality-of-life instruments to track outcomes following abdominal wall reconstruction (AWR); however, there is no universally agreed upon instrument. We review the instruments used in AWR and report their utilization trends within the literature. METHODS This scoping review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews guidelines using the PubMed, Embase, Web of Science, ClinicalTrials.gov, and Cochrane databases. All published articles in the English language that employed a quality-of-life assessment for abdominal wall hernia repair were included. Studies which focused solely on aesthetic abdominoplasty, autologous breast reconstruction, rectus diastasis, pediatric patients, inguinal hernia, or femoral hernias were excluded. RESULTS Six hernia-specific tools and six generic health tools were identified. The Hernia-Related Quality-of-Life Survey and Carolinas Comfort Scale are the most common hernia-specific tools, while the Short-Form 36 (SF-36) is the most common generic health tool. Notably, the SF-36 is also the most widely used tool for AWR outcomes overall. Each tool captures a unique set of patient outcomes which ranges from abdominal wall functionality to mental health. CONCLUSIONS The outcomes of AWR have been widely studied with several different assessments proposed and used over the past few decades. These instruments allow for patient assessment of pain, quality of life, functional status, and mental health. Commonly used tools include the Hernia-Related Quality-of-Life Survey, Carolinas Comfort Scale, and SF-36. Due to the large heterogeneity of available instruments, future work may seek to determine or develop a standardized instrument for characterizing AWR outcomes.
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Affiliation(s)
- Jonnby S LaGuardia
- Department of Plastic and Reconstructive Surgery, University of Rochester Medical Center, Rochester, New York.
| | - David Milek
- Department of Plastic and Reconstructive Surgery, University of Rochester Medical Center, Rochester, New York
| | - Ryan S Lebens
- Department of Plastic and Reconstructive Surgery, University of Rochester Medical Center, Rochester, New York
| | - David R Chen
- Department of Plastic and Reconstructive Surgery, University of Rochester Medical Center, Rochester, New York
| | - Shahrzad Moghadam
- Department of Plastic and Reconstructive Surgery, University of Rochester Medical Center, Rochester, New York
| | - Anthony Loria
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Howard N Langstein
- Department of Plastic and Reconstructive Surgery, University of Rochester Medical Center, Rochester, New York
| | - Fergal J Fleming
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Jonathan I Leckenby
- Department of Plastic and Reconstructive Surgery, University of Rochester Medical Center, Rochester, New York
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Ivakhov GB, Kalinina AA, Andriyashkin AV, Titkova SM, Loban KM, Glagolev NS, Sazhin AV. Comparison of open and endoscopic posterior component separation with transversus abdominis release: a propensity score-matched study. Hernia 2024:10.1007/s10029-024-02964-7. [PMID: 38367096 DOI: 10.1007/s10029-024-02964-7] [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: 10/03/2023] [Accepted: 01/06/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Posterior component separation with transversus abdominis release (TAR) is considered to be the optimal technique for large incisional ventral hernia repair. Endoscopic TAR (eTAR) that gets all the benefits of minimally invasive surgery (MIS) gives a possibility to enhance results of the treatment. The aim of our study was to make the comparison between open and endoscopic TAR procedures with an emphasis on frequency and severity of postoperative complications in comparable groups. MATERIALS AND METHODS All patients had midline incisional hernia and underwent either open (open TAR group) or endoscopic (eTAR group) Rives-Stoppa repair in combination with bilateral transversus abdominis release in Moscow City Hospital №1 from January 2018 to December 2022. A propensity score matching (PSM) was used to make groups comparable. Postoperative complications were classified according to Clavien-Dindo Classification, and Comprehensive complication index was calculated. RESULTS We performed 133 open and endoscopic TAR separation for midline incisional hernia. After PSM analysis 51 patients were matched to each group. Overall surgical morbidity in the open TAR group (56.9%) was statistically significantly higher than in the eTAR group (29.4%) (p = 0.009). There were more severe complications (Clavien IIIa-V) in the open TAR group (11.8% vs. 0%, p = 0.027). Length of hospital stay after surgery was shorter in eTAR group (p < 0.001). The Comprehensive complication index in the open TAR group was significantly higher than in eTAR group, 8.7 (0-20.9) vs. 0 (0-8.7) (p = 0.011). CONCLUSION Based on the data from our study, the entire MIS procedure including endoscopic TAR is a safe and optimal technique for surgery of midline incisional ventral hernia, requiring TAR separation in terms of reducing the rate of postoperative complications, their severity and hospital length of stay, compared to open TAR procedure.
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Affiliation(s)
- G B Ivakhov
- Pirogov Russian National Research Medical University, 1, Ostrovityanov Str., Moscow, Russia, 117997.
| | - A A Kalinina
- Pirogov Russian National Research Medical University, 1, Ostrovityanov Str., Moscow, Russia, 117997
| | - A V Andriyashkin
- Pirogov Russian National Research Medical University, 1, Ostrovityanov Str., Moscow, Russia, 117997
| | - S M Titkova
- Pirogov Russian National Research Medical University, 1, Ostrovityanov Str., Moscow, Russia, 117997
| | - K M Loban
- Pirogov Russian National Research Medical University, 1, Ostrovityanov Str., Moscow, Russia, 117997
| | - N S Glagolev
- Pirogov Russian National Research Medical University, 1, Ostrovityanov Str., Moscow, Russia, 117997
| | - A V Sazhin
- Pirogov Russian National Research Medical University, 1, Ostrovityanov Str., Moscow, Russia, 117997
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Miller BT, Ellis RC, Petro CC, Krpata DM, Prabhu AS, Beffa LRA, Huang LC, Tu C, Rosen MJ. Quantitative Tension on the Abdominal Wall in Posterior Components Separation With Transversus Abdominis Release. JAMA Surg 2023; 158:1321-1326. [PMID: 37792324 PMCID: PMC10551814 DOI: 10.1001/jamasurg.2023.4847] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/16/2023] [Indexed: 10/05/2023]
Abstract
Importance Posterior components separation (PCS) is a commonly used myofascial release technique in ventral hernia repairs. The contribution of each release with anterior and posterior fascial advancement has not yet been characterized in patients with ventral hernias. Objective To quantitatively assess the changes in tension on the anterior and posterior fascial elements of the abdominal wall during PCS to inform surgeons regarding the technical contribution of each step with those changes, which may help to guide intraoperative decision-making. Design, Setting, and Participants This case series enrolled patients from December 2, 2021, to August 2, 2022, and was conducted at the Cleveland Clinic Center for Abdominal Core Health. The participants included adult patients with European Hernia Society classification M1 to M5 ventral hernias undergoing abdominal wall reconstruction with PCS. Intervention A proprietary, sterilizable tensiometer measured the force needed to bring the fascial edge of the abdominal wall to the midline after each step of a PCS (retrorectus dissection, division of the posterior lamella of the internal oblique aponeurosis, and transversus abdominis muscle release [TAR]). Main Outcome The primary study outcome was the percentage change in tension on the anterior and posterior fascia associated with each step of PCS with TAR. Results The study included 100 patients (median [IQR] age, 60 [54-68] years; 52 [52%] male). The median (IQR) hernia width was 13.0 (10.0-15.2) cm. After complete PCS, the mean (SD) percentage changes in tension on the anterior and posterior fascia were -53.27% (0.53%) and -98.47% (0.08%), respectively. Of the total change in anterior fascial tension, retrorectus dissection was associated with a mean (SD) percentage change of -82.56% (0.68%), incision of the posterior lamella of the internal oblique with a change of -17.67% (0.41%), and TAR with no change. Of the total change in posterior fascial tension, retrorectus dissection was associated with a mean (SD) percentage change of -3.04% (2.42%), incision of the posterior lamella of the internal oblique with a change of -58.78% (0.39%), and TAR with a change of -38.17% (0.39%). Conclusions and Relevance In this case series, retrorectus dissection but not TAR was associated with reduced tension on the anterior fascia, suggesting that it should be performed if anterior fascial advancement is needed. Dividing the posterior lamella of the internal oblique aponeurosis and TAR was associated with reduced tension on the posterior fascia, suggesting that it should be performed for posterior fascial advancement.
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Affiliation(s)
- Benjamin T. Miller
- Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ryan C. Ellis
- Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Clayton C. Petro
- Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, Ohio
| | - David M. Krpata
- Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ajita S. Prabhu
- Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Lucas R. A. Beffa
- Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Li-Ching Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Chao Tu
- Department of Statistics, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Michael J. Rosen
- Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, Ohio
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Petro CC, Melland-Smith M. Open Complex Abdominal Wall Reconstruction. Surg Clin North Am 2023; 103:961-976. [PMID: 37709399 DOI: 10.1016/j.suc.2023.04.006] [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
This article provides an approach to open complex abdominal wall reconstruction. Herein, the authors discuss the purpose of component separation as well as its relevant indications. The techniques and anatomical considerations of both anterior and posterior component separation are described. In addition, patient selection criteria, preoperative adjuncts that may assist with fascial or soft tissue closure, and complications of component separation will be discussed.
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Affiliation(s)
- Clayton C Petro
- Lerner College of Medicine, Cleveland Clinic Center for Abdominal Core Health, 9500 Euclid Avenue A-100, Cleveland, OH 44195, USA.
| | - Megan Melland-Smith
- Lerner College of Medicine, Cleveland Clinic Center for Abdominal Core Health, 9500 Euclid Avenue A-100, Cleveland, OH 44195, USA
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Poulose BK. Abdominal Core Health: What Is It? Surg Clin North Am 2023; 103:827-834. [PMID: 37709389 DOI: 10.1016/j.suc.2023.04.012] [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
Abdominal core health encompasses the stability and function of the abdominal core and associated quality of life. Interventions to maintain core health include surgical and non-surgical therapies that integrate the functional relatedness of the abdominal core components.
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Affiliation(s)
- Benjamin K Poulose
- Center for Abdominal Core Health, Department of Surgery, The Ohio State University Wexner Medical Center, Doan Hall N729, 410 West 10th Avenue, Columbus, OH 43210, USA.
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Huang Y, Wang P, Hao J, Guo Z, Xu X. The external oblique muscle flap technique for the reconstruction of abdominal wall defects. Asian J Surg 2023; 46:730-737. [PMID: 35794039 DOI: 10.1016/j.asjsur.2022.06.142] [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: 05/19/2022] [Revised: 06/15/2022] [Accepted: 06/23/2022] [Indexed: 02/08/2023] Open
Abstract
PURPOSE Several modifications to the anterior component separation technique (ACST) have been reported to facilitate the closure of abdominal wall defects. In this study, the external oblique (EO) muscle flap for modified ACST during major abdominal wall defect reconstructions has been described. METHODS A retrospective review of consecutive patients undergoing modified ACST was conducted. The clinical data were collected and retrospectively analyzed. RESULTS Among the 36 patients admitted to our hospital from December 2014 to December 2020, 9 cases had rectus abdominis tumors, 1 case had rectus abdominis trauma, and 26 cases had incisional hernias. The average age was 61.17 ± 13.76 years, and the mean BMI was 24.25 ± 3.18 kg/m2. The average width of the defect was 14.33 ± 2.90 cm. Unilateral EO muscle flap technique was used to reconstruct the abdominal wall. 3 cases of surgical site infection (8.3%), 4 cases of grade III or IV seroma (11.1%) and 2 cases of intestinal obstruction (5.5%)were reported postoperatively. Ischemic necrosis of the abdominal EO muscle flap, incision dehiscence, intestinal fistula, or other complications were not observed. 1 case of incisional hernia recurrence (2.8%) was reported. Recurrence of tumors or abdominal wall bulging were not noted during the follow-up period of 32.53 ± 14.21 months. CONCLUTIONS The EO muscle flap technique is associated with low postoperative morbidity and recurrence rate, which approves it a reliable technique for selected groups of patients. Further research are needed to confirm the effectiveness of this technique.
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Affiliation(s)
- Yonggang Huang
- Department of Hernia and Abdominal Wall Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, PR China
| | - Ping Wang
- Department of Hernia and Abdominal Wall Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, PR China.
| | - Jingduo Hao
- Department of General Surgery, People's Hospital of Zhenhai, Ningbo, 315200, PR China
| | - Zicheng Guo
- Department of Hernia and Abdominal Wall Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, PR China
| | - Xiao Xu
- Department of Hepatobiliary Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, PR China.
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Jeong S, Kim SH, Park KN. Core stability status classification based on mediolateral head motion during rhythmic movements and functional movement tests. Digit Health 2023; 9:20552076231186217. [PMID: 37434735 PMCID: PMC10331090 DOI: 10.1177/20552076231186217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 06/08/2023] [Indexed: 07/13/2023] Open
Abstract
Objective Core stability assessment is paramount for the prevention of low back pain, with core stability being considered as the most critical factor in such pain. The objective of this study was to develop a simple model for the automated assessment of core stability status. Methods To assess core stability-defined as the ability to control trunk position relative to the pelvic position - we used an inertial measurement unit sensor embedded within a wireless earbud to estimate the mediolateral head angle during rhythmic movements (RMs) such as cycling, walking, and running. The activities of muscles around the trunk were analyzed by an experienced, highly trained individual. Functional movement tests (FMTs) were performed, including single-leg squat, lunge, and side lunge. Data was collected from 77 participants, who were then classified into good and poor core stability groups based on their Sahrmann core stability test scores. Results From the head angle data, we extrapolated the symmetry index (SI) and amplitude of mediolateral head motion (Amp). Support vector machine and neural network models were trained and validated using these features. In both models, the accuracy was similar across three feature sets for RMs, FMTs, and full, and support vector machine accuracy (∼87%) is greater than neural network (∼75%). Conclusion The use of this model, trained with head motion-related features obtained during RMs or FMTs, can help to accurately classify core stability status during activities.
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Affiliation(s)
- Siwoo Jeong
- Department of Physical Therapy, Jeonju University, Jeonju, Korea
| | - Si-Hyun Kim
- Department of Physical Therapy, Sangji University, Wonju, Korea
| | - Kyue-Nam Park
- Department of Physical Therapy, Jeonju University, Jeonju, Korea
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Morphological alterations of the abdominal wall after open incisional hernia repair with endoscopic anterior and open posterior component separation. Hernia 2022; 27:327-334. [PMID: 36243858 DOI: 10.1007/s10029-022-02694-8] [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: 05/21/2022] [Accepted: 10/09/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE Effects of component separation (CS) on abdominal wall morphology have only been investigated in smaller case series or cadavers. This study aimed to compare abdominal wall alterations following endoscopic anterior CS (EACS) or open transverse abdominis release (TAR). METHODS Computed tomography scans were evaluated in patients who had undergone open incisional hernia repair with EACS or TAR. Abdominal wall circumference, lateral abdominal wall muscle thickness, and displacement were compared with (1) preoperative images after bilateral CS and (2) the undivided side postoperatively after unilateral CS. RESULTS In total, 105 patients were included. Fifty-five (52%) and 15 (14%) underwent bilateral and unilateral EACS, respectively. Five (5%) and 14 (13%) underwent bilateral and unilateral TAR, respectively. Sixteen (15%) underwent unilateral EACS and contralateral TAR. The external oblique and transverse abdominis muscles were significantly laterally displaced with a mean of 2.74 cm (95% CI 2.29-3.19 cm, P < 0.001) and 0.82 cm (0.07-1.57 cm, P = 0.032) after EACS and TAR, respectively. The combined thickness of the lateral muscles was significantly decreased after EACS (mean decrease 10.5% (5.8-15.6%, P < 0.001)) and insignificantly decreased after TAR (mean decrease 2.6% (- 4.8 to 9.5%, P = 0.50)). The abdominal wall circumference was unchanged after bilateral (mean reduction 0.90 cm (- 0.77 to 2.58 cm), P = 0.29) and unilateral CS (mean increase 0.03 cm (- 1.01 to 1.08 cm), P = 0.95). CONCLUSION Postoperative changes in the lateral abdominal wall musculature were different following EACS and open TAR. Either technique seems not to compromise the overall integrity of the lateral abdominal wall.
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S041-Trends and short-term outcomes of three approaches to minimally invasive repair of small ventral hernias. An ACHQC analysis. Surg Endosc 2022:10.1007/s00464-022-09629-5. [PMID: 36163562 DOI: 10.1007/s00464-022-09629-5] [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: 03/19/2022] [Accepted: 09/11/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Different approaches and mesh positions are used for minimally invasive ventral hernia repair (MIS-VHR). Our aim was to evaluate the trends and short-term outcomes of intraperitoneal onlay mesh (IPOM), preperitoneal, and retromuscular repairs for small ventral hernias. METHODS We conducted a retrospective cohort study using the Abdominal Core Health Quality Collaborative (ACHQC). We included elective MIS-VHR in adults with hernia defect width < = 6 cm from 2012 to 2021. We compared patient/hernia characteristics, trends, and short-term outcomes between IPOM, preperitoneal, and retromuscular repairs. Inverse probability of treatment weighting (IPTW) was used to balance baseline characteristics. RESULTS A total of 7261 patients were included (IPOM = 4484, preperitoneal = 1829, retromuscular = 948). Preperitoneal repair was associated with lower rates of incisional (preperitoneal = 37%, IPOM = 63%, retromuscular = 73%) and recurrent hernias (preperitoneal = 11%, IPOM = 21%, retromuscular = 22%) compared to IPOM and retromuscular. Median defect width was 3.0, 2.0, and 4.0 cm for IPOM, preperitoneal, and retromuscular, respectively. There has been a progressive increase in the proportion of preperitoneal and retromuscular repairs over time (10% in 2013-53% in 2021 of all MIS-VHR). Robotic approach was more frequently utilized in preperitoneal and retromuscular (both > 85%) compared to IPOM (47%). Transversus abdominis release was performed in 14% of retromuscular repairs. After IPTW, no clinically significant differences were noted in the short-term outcomes between IPOM versus preperitoneal. Retromuscular repairs were associated with higher risk of 30-day reoperation (OR = 3.54, 95%CI [1.67, 7.5] and OR = 5.29, 95%CI [1.23, 22.74]) compared to IPOM and preperitoneal repairs, respectively, and higher risk of 30-day readmission compared to preperitoneal repairs (OR = 2.6, 95%CI [2.6, 6.4]). CONCLUSION Based on ACHQC data, preperitoneal and retromuscular approaches for MIS-VHR of small hernias have increased over time and are primarily performed robotically. Transversus abdominis release was performed in 14% of retromuscular repairs of these small hernias. Retromuscular repairs were associated with higher 30-day readmission and reoperation rates compared to the other approaches.
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Quezada N, Grimoldi M, Jacubovsky I, Besser N, Riveros S, Achurra P, Crovari F. Midterm Results of the Open and Minimally Invasive Transversus Abdominis Release Technique for the Treatment of Abdominal Wall Hernias in an Academic Center. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2022; 1:10407. [PMID: 38314163 PMCID: PMC10831654 DOI: 10.3389/jaws.2022.10407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 05/16/2022] [Indexed: 02/06/2024]
Abstract
Introduction: Large hernia defects are a challenge for general and specialized hernia surgeons. The transversus abdominis release (TAR) technique has revolutionized the treatment of complex hernias since it allows the closure of large midline hernias, as well as hernias in different locations. This study aims to report the experience with the TAR technique and mid-term results in the first 101 patients. Methods: Non-concurrent cohort review of our prospectively collected electronic database. All patients submitted to a TAR (open or minimally invasive eTEP-TAR) from 2017 to 2020 were included. Demographic data, comorbidities, hernia characteristics, preoperative optimization, intraoperative variables, and clinical outcomes were gathered. The main outcomes of this study are hernia recurrences and surgical morbidity. Results: A total of 101 patients were identified. The median follow-up was 26 months. Mean age and body mass index was 63 years and 31.4 Kg/m2, respectively. Diabetes was present in 22% of patients and 43% had at least one previous hernia repair. Nineteen patients had significant loss of domain. Mean hernia size and area were 13 cm and 247 cm2, respectively. Ninety-six percent of cases were clean or clean-contaminated. The mean operative time was 164 min and all patients received a synthetic mesh. We diagnosed two hernia recurrences and the overall (medical and surgical) complication rate was 32%. The hernia-specific complication rate was 17%, with seven surgical site infections and seven surgical site occurrences requiring procedural interventions. Notably, weight loss was associated with a lower risk of SSOPI and reoperations. Conclusion: We show an encouraging 2% of recurrences in the mid-term follow-up in the setting of clinically complex hernia repair. However, we observed a high frequency of overall and hernia-specific complications pointing to the complexity of the type of surgery itself and the patients we operated on.
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Affiliation(s)
- Nicolás Quezada
- Department of Digestive Surgery, Surgery Division, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Milenko Grimoldi
- General Surgery Service, Hospital Dr. Sótero Del Río, Santiago, Chile
| | - Ioram Jacubovsky
- General Surgery Service, Hospital Dr. Sótero Del Río, Santiago, Chile
| | - Nicolás Besser
- Surgery Division, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sergio Riveros
- Surgery Division, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Achurra
- Department of Digestive Surgery, Surgery Division, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Fernando Crovari
- Department of Digestive Surgery, Surgery Division, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Chaudhari AMW, Renshaw SM, Breslin LM, Curtis TL, Himes MD, Collins CE, Di Stasi S, Poulose BK. A Quiet Unstable Sitting Test to quantify core stability in clinical settings: Application to adults with ventral hernia. Clin Biomech (Bristol, Avon) 2022; 93:105594. [PMID: 35183879 DOI: 10.1016/j.clinbiomech.2022.105594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 02/04/2022] [Accepted: 02/08/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND The abdominal core is comprised of the diaphragm, abdominal wall, and pelvic floor, and serves several important functions for balance, movement, and strength. Injury to this area, such as hernia, can have substantial impact. The Quiet Unstable Sitting Test involves individuals seated on the rounded surface of a BOSU® balance trainer placed on top of a force plate and situated on a flat, elevated surface. METHODS An ordinal Quiet Unstable Sitting Test core stability score was calculated from center of pressure measurements, with 0 representing "normal" and < 0 indicating worsening stability. Hernia-Related Quality of Life survey summary scores were assessed (higher scores indicating better quality). FINDINGS A developmental cohort of 32 was used to establish reliability and normative values for the Quiet Unstable Sitting Test. A control group of 32 participants (43.7 ± 16.2 yrs., BMI 29.0 ± 4.9, 66% Female) was then compared to 21 patients with hernia (56.2 ± 12.5 yrs., BMI 29.2 ± 6.3, 24% Female). Hernia patients had median composite score of -2 and median quality of life score of 66, versus median Quiet Unstable Sitting Test of -0.5 and median quality of life of 93 for controls (p ≤ 0.01). Quality of life and Quiet Unstable Sitting Test scores were not correlated (p > 0.05). INTERPRETATION Hernia patients demonstrated significantly worse core stability and quality of life. These assessments were independent of one another across the entire population, indicating each measure's unique constructs of patient function. Core stability can be reliably measured in a clinical setting and may help with patient activation and rehabilitation.
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Affiliation(s)
- Ajit M W Chaudhari
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, Ohio State University, 453 W 10(th) Ave, Columbus, Franklin County, OH 43210, United States of America; Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 3200 Fred Taylor Drive, Columbus, Franklin County, OH 43202, United States of America.
| | - Savannah M Renshaw
- Center for Abdominal Core Health, Division of General and Gastrointestinal Surgery, Department of Surgery, Ohio State University Wexner Medical Center, 410 W 10(th) Ave, Columbus, Franklin County, OH 43210, United States of America
| | - Lindsay M Breslin
- Center for Abdominal Core Health, Division of General and Gastrointestinal Surgery, Department of Surgery, Ohio State University Wexner Medical Center, 410 W 10(th) Ave, Columbus, Franklin County, OH 43210, United States of America
| | - Torri L Curtis
- Center for Abdominal Core Health, Division of General and Gastrointestinal Surgery, Department of Surgery, Ohio State University Wexner Medical Center, 410 W 10(th) Ave, Columbus, Franklin County, OH 43210, United States of America
| | - Melissa D Himes
- Center for Abdominal Core Health, Division of General and Gastrointestinal Surgery, Department of Surgery, Ohio State University Wexner Medical Center, 410 W 10(th) Ave, Columbus, Franklin County, OH 43210, United States of America
| | - Courtney E Collins
- Center for Abdominal Core Health, Division of General and Gastrointestinal Surgery, Department of Surgery, Ohio State University Wexner Medical Center, 410 W 10(th) Ave, Columbus, Franklin County, OH 43210, United States of America
| | - Stephanie Di Stasi
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, Ohio State University, 453 W 10(th) Ave, Columbus, Franklin County, OH 43210, United States of America; Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 3200 Fred Taylor Drive, Columbus, Franklin County, OH 43202, United States of America
| | - Benjamin K Poulose
- Center for Abdominal Core Health, Division of General and Gastrointestinal Surgery, Department of Surgery, Ohio State University Wexner Medical Center, 410 W 10(th) Ave, Columbus, Franklin County, OH 43210, United States of America
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Haisley KR, Vadlamudi C, Gupta A, Collins CE, Renshaw SM, Poulose BK. Greatest Quality of Life Improvement in Patients With Large Ventral Hernias: An Individual Assessment of Items in the HerQLes Survey. J Surg Res 2021; 268:337-346. [PMID: 34399356 DOI: 10.1016/j.jss.2021.06.075] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/20/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Ventral hernia repair (VHR) has been shown to improve overall quality of life (QOL) by the validated 12-question Hernia-Related Quality-of-Life survey (HerQLes). However, which specific aspects of quality of life are most affected by VHR have not been formally investigated. METHODS Through retrospective analysis of the Abdominal Core Health Quality Collaborative national database, we measured the change in each individual component of the HerQLes questionnaire from a pre-operative baseline assessment to one-year postoperatively in VHR patients. RESULTS In total, 1,875 VHR patients had completed both pre- and post-operative questionnaires from 2014-2018. They were predominately Caucasian (92.3%), 57.9 ± 12.4 Y old, and evenly gender split (50.5% male, 49.5% female, P = 0.31). Most operations were performed open (80.5%) with fewer laparoscopic (7.5%) or robotic cases (12.1%). For each of the 12 individual categories, improvement in QOL from baseline to 1-Y was found to be statistically significant (P < 0.0001). This held true with subgroup analysis of small (<2 cm), medium (2-6 cm), and large (>6 cm) hernias (P < 0.0001), though a larger improvement was seen in 8 of 12 components in hernias >6 cm (P < 0.001). Operative approach did not carry a significant effect except in medium hernias (2-6 cm), where an open approach saw a greater improvement in the "accomplish less at work" item (P = 0.02). CONCLUSIONS VHR is associated with improvement in each of the 12 components of QOL measured in the HerQLes questionnaire, regardless of the size of their hernia. The amount of improvement, however, may be dependent on hernia size and approach.
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Affiliation(s)
- Kelly R Haisley
- Division of GI and General Surgery, The Ohio State University, Columbus, Ohio; Center for Minimally Invasive Surgery, Columbus, Ohio.
| | | | - Anand Gupta
- Division of GI and General Surgery, The Ohio State University, Columbus, Ohio; Center for Surgical Health Assessment Research and Policy (SHARP), Columbus, Ohio
| | - Courtney E Collins
- Division of GI and General Surgery, The Ohio State University, Columbus, Ohio; Center for Surgical Health Assessment Research and Policy (SHARP), Columbus, Ohio
| | - Savanah M Renshaw
- Division of GI and General Surgery, The Ohio State University, Columbus, Ohio; Center for Surgical Health Assessment Research and Policy (SHARP), Columbus, Ohio
| | - Benjamin K Poulose
- Division of GI and General Surgery, The Ohio State University, Columbus, Ohio; Center for Minimally Invasive Surgery, Columbus, Ohio
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15
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Preoperative exercise and outcomes after ventral hernia repair: Making the case for prehabilitation in ventral hernia patients. Surgery 2021; 170:516-524. [PMID: 33888317 DOI: 10.1016/j.surg.2021.03.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/25/2021] [Accepted: 03/03/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND An increasing body of information suggests that preoperative physical activity level can impact postoperative outcomes. We sought to investigate this relationship in patients undergoing ventral hernia repair (VHR). METHODS The Abdominal Core Health Quality Collaborative registry was used to identify patients undergoing a VHR between 2013 and 2019. Patient-reported preoperative exercise level was used to stratify the study population into 4 groups: none (no reported exercise), sporadic (once a month), moderate (once per week), and intense (more than once per week). Multi-variate logistic regression analyses were used to assess the impact of preoperative exercise frequency on postoperative outcomes, including complications, hospital readmissions and length of stay. Changes in quality of life and pain from baseline to 30-days postoperatively were assessed using the Hernia-Related Quality of Life Survey and National Institutes of Health Patient-Reported Outcomes Measurement Information System 3A Pain Scale. RESULTS A total of 2,994 patients were included in the study, out of which 1,519 (50.7%) patients reported no preoperative exercise, 662 (22.1%) sporadic exercise, 467 (15.6%) moderate exercise, and 346 (11.6%) intense exercise. A total of 1,253 patients (19.2%) experienced a postoperative complication, out of which 249 (3.8%) had a surgical site infection. After multi-variable analysis and adjusting for demographics, comorbidities, and hernia characteristics, increasing exercise frequency (versus no reported exercise) was associated with significantly lower odds of experiencing any postoperative complication (sporadic: odds ratio 0.70; P = .008; moderate: odds ratio 0.62, P = .006; intense: odds ratio 0.67, P = .04), as well as lower odds of readmission (sporadic: odds ratio 0.04; moderate: odds ratio 0.40; intense: odds ratio 0.03; P = .01). Exercise level was not associated with length of stay (sporadic: P = .36; moderate: P = .19; intense: P = .95). No significant differences were found in changes in quality of life or pain from baseline to 30-days after surgery (Hernia-Related Quality of Life Survey, P = .24; National Institutes of Health Patient-Reported Outcomes Measurement Information System 3A P = .14). CONCLUSION Patients reporting greater exercise frequency before surgery demonstrated decreased risk of complications and readmission after undergoing ventral hernia repair. Increasing preoperative exercise participation through targeted prehabilitation programs may be a viable way for patients to reduce complications associated with VHR and improve their postoperative recovery.
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Abstract
Ventral and incisional hernias in obese patients are particularly challenging. Suboptimal outcomes are reported for elective repair in this population. Preoperative weight loss is ideal but is not achievable in all patients for a variety of reasons, including access to bariatric surgery, poor quality of life, and risk of incarceration. Surgeons must carefully weigh the risk of complications from ventral hernia repair with patient symptoms, the ability to achieve adequate weight loss, and the risks of emergency hernia repair in obese patients.
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17
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Long-term outcomes and quality of life assessment after posterior component separation with transversus abdominis muscle release (TAR). Surg Endosc 2021; 36:1278-1283. [PMID: 33661379 DOI: 10.1007/s00464-021-08402-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 02/15/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although transversus abdominis release (TAR) to treat large incisional hernias has shown favorable postoperative outcomes, devastating complications may occur when it is used in suboptimal conditions. We aimed to evaluate postoperative outcomes and long-term follow-up after TAR for large incisional hernias. METHODS A consecutive series of patients undergoing TAR for complex incisional hernias between 2014 and 2019 with a minimum of 6 month follow-up was included. Demographics, operative and postoperative variables were analyzed. Postoperative imaging (CT-scan) was also evaluated to detect occult recurrences. The HerQLes survey for quality of life (QoL) assessment was performed preoperatively and 6 months after the surgery. RESULTS A total of 50 TAR repairs were performed. Mean age was 65 (35-83) years, BMI was 28.5 ± 3.4 kg/m2, and 8 (16%) patients had diabetes. Mean Tanaka index was 14.2 ± 8.5. Mean defect area was 420 (100-720) cm2, average defect width was 19 ± 6.2 cm, and mesh area was 900 (500-1050) cm2; 78% were clean procedures, and in 60% a panniculectomy was associated. Operative time was 252 (162-438) minutes, and hospital stay was 4.5 (2-16) days. Thirty-day morbidity was 24% (12 patients), and 16% (8 patients) had surgical site infections. Overall recurrence rate was 4% (2 patients) after 28.2 ± 20.1 months of follow-up. QoL showed a significant improvement after surgery (p = 0.001). CONCLUSIONS The TAR technique is an effective treatment modality for large incisional hernias, showing an acceptable postoperative morbidity, a significant improvement in QoL, and low recurrence rates at long-term follow-up.
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18
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Niebuhr H, Aufenberg T, Dag H, Reinpold W, Peiper C, Schardey HM, Renter MA, Aly M, Eucker D, Köckerling F, Eichelter J. Intraoperative Fascia Tension as an Alternative to Component Separation. A Prospective Observational Study. Front Surg 2021; 7:616669. [PMID: 33708790 PMCID: PMC7940755 DOI: 10.3389/fsurg.2020.616669] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/14/2020] [Indexed: 11/13/2022] Open
Abstract
Incisional hernias are common late complications of abdominal surgery, with a 1-year post-laparotomy incidence of about 20%. A giant hernia is often preceded by severe peritonitis of various causes. The Fasciotens® Abdomen device is used to stretch the fascia in a measurably controlled manner during surgery to achieve primary tension-free abdominal closure. This prospective observational study aims to clarify the extent to which this traction method can function as an alternative to component separation (CS) methods. Methods: We included data of 21 patients treated with intraoperative fascia stretching in seven specialized hernia centers between November 2019 and August 2020. Results: Intraoperatively-measured fascial distance averaged 17.3 cm (range 8.5-44 cm). After application of diagonal-anterior traction >10 kg for an average duration of 32.3 min (range 30-40 min), the fascial distance decreased by 9.8 cm (1-26 cm) to an average 7.5 cm (range 2-19 cm), which is a large effect (r = 0.62). The fascial length increase (average 9.8 cm) after applied traction was highly significant. All hernias were closed under moderate tension after the traction phase. In 19 patients, this closure was reinforced with mesh using a sublay technique. Conclusion: This method allows primary closure of complex (LOD) hernias and is potentially less prone to complications than component separation (CS) methods.
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Affiliation(s)
| | | | - Halil Dag
- Hanse Hernia Centre, Hamburg, Germany
| | | | - Christian Peiper
- Clinic for General, Visceral and Thoracic Surgery, Protestant Hospital, Hamm, Germany
| | - Hans Martin Schardey
- Clinic for General, Visceral, Vascular and Endocrine Surgery, Agatharied Hospital, Hausham, Germany
| | | | - Mohamed Aly
- Clinic for General, Visceral and Thoracic Surgery, Landshut-Achdorf Hospital, Landshut, Germany
| | - Dietmar Eucker
- Clinic for General, Visceral, Thoracic and Vascular Surgery, Canton Hospital Basel-Land, Liestal, Switzerland
| | - Ferdinand Köckerling
- Clinic for General, Visceral and Vascular Surgery, Vivantes Klinikum Spandau, Berlin, Germany
| | - Jakob Eichelter
- Department of Surgery, Division of General Surgery, Medical University of Vienna, Vienna, Austria
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Perez JE, Schmidt MA, Narvaez A, Welsh LK, Diaz R, Castro M, Ansari K, Cason RW, Bilezikian JA, Hope W, Guerron AD, Yoo J, Levinson H. Evolving concepts in ventral hernia repair and physical therapy: prehabilitation, rehabilitation, and analogies to tendon reconstruction. Hernia 2020; 25:1-13. [PMID: 32959176 DOI: 10.1007/s10029-020-02304-5] [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: 04/27/2020] [Accepted: 09/02/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE The abdominal wall and musculoskeletal tendons share many anatomic, physiologic, and functional characteristics. This review aims to highlight these similar characteristics and to present a rationale why the treatment principles of successful musculoskeletal tendon reconstruction, including principles of surgical technique and physical therapy, can be used in the treatment of complex abdominal wall reconstruction or ventral hernia repair. METHODS The MEDLINE/PubMed database was used to identify published literature relevant to the purpose of this review. CONCLUSIONS There are several anatomical and functional similarities between the linea alba and musculoskeletal tendons. Because of this reason, many of the surgical principles for musculoskeletal tendon repair and ventral hernia repair overlap. Distribution of tension is the main driving principle for both procedures. Suture material and configuration are chosen to maximize tension distribution among the tissue edges, as seen in the standard of care multistrand repairs for musculoskeletal tendons, as well as in the small bites for laparotomy technique described in the STITCH trial. Physical therapy is also one of the mainstays of tendon repair, but surprisingly, is not routine in ventral hernia repair. The evidence surrounding physical therapy prehabilitation and rehabilitation protocols in other disciplines is significant. This review challenges the fact that these protocols are not routinely implemented for ventral hernia repair, and presents the rationale and feasibility for the routine practice of physical therapy in ventral hernia repair.
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Affiliation(s)
- J E Perez
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, NC, 27704, US
| | - M A Schmidt
- Department of Physical Therapy and Occupational Therapy, Duke University, Durham, NC, 27710, US
| | - A Narvaez
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, NC, 27704, US
| | - L K Welsh
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, NC, 27704, US
| | - R Diaz
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, NC, 27704, US
| | - M Castro
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, NC, 27704, US
| | - K Ansari
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, 27710, US
| | - R W Cason
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, 27710, US
| | - J A Bilezikian
- Department of General Surgery, New Hanover Regional Medical Center, Wilmington, NC, 28403, US
| | - W Hope
- General Surgery Specialists, New Hanover Regional Medical Center, Wilmington, NC, 28403, US
| | - A D Guerron
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, NC, 27704, US
| | - J Yoo
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, NC, 27704, US
| | - H Levinson
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, 27710, US. .,Director of Innovation and Entrepreneurship, Associate Professor of Plastic and Reconstructive Surgery, Pathology, Dermatology and Surgical Sciences, Departments of Dermatology, Pathology, and Surgery, Duke University Medical Center, DUMC 3181, Durham, NC, 27710, US.
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20
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Bigolin AV, Jost RT, Franceschi R, Wermann R, FalcÃo R, DO-Pinho AS, Plentz RDM, Cavazzola LT. What is the best method to assess the abdominal wall? Restoring strength does not mean functional recovery. ACTA ACUST UNITED AC 2020; 33:e1487. [PMID: 32609254 PMCID: PMC7325695 DOI: 10.1590/0102-672020190001e1487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/07/2020] [Indexed: 12/16/2022]
Abstract
Background: Restoring the contractile function to the abdominal wall is a major goal in
hernia repair. However, the core understanding is required when choosing the
method for outcome assessment. Aim: To assess the role of the anterolateral abdominal muscles on abdominal wall
function in patients undergoing hernia repair by analysis of correlation
between the surface electromyography activation signal of these muscles and
torque produced during validated strength tests. Methods: Activation of the rectus abdominis, external oblique, and internal
oblique/transverse abdominis muscles was evaluated by surface
electromyography during two validated tests: Step: 1-A, isometric
contraction in dorsal decubitus; 1-B, isometric contraction in lateral
decubitus; 2-A, isokinetic Biodex testing; and 2-B, isometric Biodex
testing. Results: Twenty healthy volunteers were evaluated. The linear correlation coefficient
between root mean square/peak data obtained from surface electromyography
signal analysis for each muscle and the peak torque variable was always
<0.2 and statistically non-significant (p<0.05). The
agonist/antagonist ratio showed a positive, significant, weak-to-moderate
correlation in the external oblique (Peak, p=0.027; root mean square,
0.564). Surface electromyography results correlated positively among
different abdominal contraction protocols, as well as with a daily physical
activity questionnaire. Conclusions: There was no correlation between surface electromyography examination of the
anterolateral abdominal wall muscles and torque measured by a validated
instrument, except in a variable that does not directly represent torque
generation.
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Affiliation(s)
- André Vicente Bigolin
- Cirurgia do Aparelho Digestivo, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Renan Trevisan Jost
- Cirurgia do Aparelho Digestivo, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Rafaela Franceschi
- Cirurgia do Aparelho Digestivo, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Rodolfo Wermann
- Cirurgia do Aparelho Digestivo, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Rodrigo FalcÃo
- Cirurgia do Aparelho Digestivo, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | | | - Rodrigo Della Mea Plentz
- Fisioterapia, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil
| | - Leandro Totti Cavazzola
- Cirurgia do Aparelho Digestivo, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
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21
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Priya P, Kantharia N, Agrawal JB, Agrawal A, Agrawal L, Afaque MY, Rizvi ASA, Baig SJ. Short- to Midterm Results After Posterior Component Separation with Transversus Abdominis Release: Initial Experience from India. World J Surg 2020; 44:3341-3348. [PMID: 32566977 DOI: 10.1007/s00268-020-05644-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Posterior component separation with transversus abdominis release is a new procedure and is quickly gaining popularity. It has shown promising results in terms of low recurrence rates for large and complex hernias. However, there are very little Indian data available on this to date. The purpose of this study was to assess the outcomes of the technique at three centers in India. METHODS This was a retrospective analysis of the prospectively collected data. Patients with a minimum follow-up of 3 months who underwent open or minimal access posterior component separation were included. RESULTS A total of 72 patients (open = 44, minimal access = 25, and hybrid = 3) were included in the analysis. At a follow-up ranging from 3 months to 35 months, there were two recurrences (2.78%). Surgical site occurrences were seen in 23/72 (31.9%), and surgical site infection was seen in 7/72 (9.7%). Surgical site occurrence requiring procedural intervention was 3/72 (4.2%). There were two (2.78%) mortalities in the open group due to myocardial infarction. CONCLUSION Posterior component separation with transversus abdominis release may have advantages in terms of low recurrence in large hernias in the Indian population and can be used in carefully selected patients.
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Affiliation(s)
- Pallawi Priya
- Belle Vue Clinic, 9 and 10, Loudon Street, Kolkata, 700046, India.
| | | | | | | | | | - Md Yusuf Afaque
- J N Medical College, Aligarh Muslim University, Aligarh, India
| | | | - Sarfaraz J Baig
- Belle Vue Clinic, 9 and 10, Loudon Street, Kolkata, 700046, India
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22
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Daes J, Winder JS, Pauli EM. Concomitant Anterior and Posterior Component Separations: Absolutely Contraindicated? Surg Innov 2020; 27:328-332. [PMID: 32204655 DOI: 10.1177/1553350620914195] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Many experts in abdominal wall reconstruction believe that the combination of simultaneous ipsilateral anterior component separation (ACS) and posterior component separation (PCS) is contraindicated. We performed ipsilateral endoscopic ACS and either endoscopic or open PCS-transversus abdominis release (TAR) in 5 fresh cadaver models. The full length of the semilunar line and the lateral abdominal wall remained well reinforced by 2 complete layers, comprising the internal oblique (IO) and TA muscles and their investing fasciae. Myofascial releases occurred 4 cm (median) apart. Additionally, we reviewed computed tomography images at 1 month and 1 year after PCS-TAR in 17 patients (30 PCS-TARs). Lateral displacement of the TA relative to the rectus abdominis (RA) was significant only at the superior mesenteric artery level, where it was <1 cm (median). Muscle mass changed minimally over time. Several studies showed that abdominal wall reconstruction after PCS-TAR results in compensatory muscular hypertrophy of the RA, external oblique (EO), and IO muscles and provides better quality of life and improved core physiology. These changes did not occur when the midline was not restored. Theoretically, endoscopic ACS-EO may be added to PCS-TAR to avoid partially bridged mesh repair in patients in whom complete midline restoration is impossible via PCS-TAR alone. Nevertheless, we advise most surgeons to perform a small-bridged repair instead of risking increased morbidity by attempting a highly complicated procedure.
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Affiliation(s)
- Jorge Daes
- Clinica Portoazul, Barranquilla, Colombia
| | | | - Eric M Pauli
- Penn State Hershey Medical Center, Hershey, PA, USA
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23
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Sandø A, Rosen MJ, Heniford BT, Bisgaard T. Long-term patient-reported outcomes and quality of the evidence in ventral hernia mesh repair: a systematic review. Hernia 2020; 24:695-705. [DOI: 10.1007/s10029-020-02154-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 02/19/2020] [Indexed: 12/30/2022]
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Zolin SJ, Fafaj A, Krpata DM. Transversus abdominis release (TAR): what are the real indications and where is the limit? Hernia 2020; 24:333-340. [PMID: 32152808 DOI: 10.1007/s10029-020-02150-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 02/19/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE To review literature surrounding transversus abdominis release (TAR) for incisional hernia repair, with the aim of describing key preoperative and technical considerations for this procedure. METHODS Existing literature on TAR was reviewed and synthesized with the clinical experience and approach to TAR from a high-volume hernia center. RESULTS Recommendations regarding patient selection, optimization and technique for TAR are presented. CONCLUSIONS While published outcomes of TAR from expert centers are favorable, potentially devastating complications may result when TAR is performed incorrectly or in suboptimal clinical situations. Appropriate patient selection, optimization, and surgeon expertise are necessary if TAR is to be performed.
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Affiliation(s)
- S J Zolin
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A100-133, Cleveland, OH, 44195, USA.
| | - A Fafaj
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A100-133, Cleveland, OH, 44195, USA
| | - D M Krpata
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A100-133, Cleveland, OH, 44195, USA
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25
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Afaque M, Rizvi A. Comparison between transversus abdominis release and anterior component separation technique in complex ventral hernia. INTERNATIONAL JOURNAL OF ABDOMINAL WALL AND HERNIA SURGERY 2020. [DOI: 10.4103/ijawhs.ijawhs_55_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Wegdam JA, Thoolen JMM, Nienhuijs SW, de Bouvy N, de Vries Reilingh TS. Systematic review of transversus abdominis release in complex abdominal wall reconstruction. Hernia 2018; 23:5-15. [PMID: 30539311 DOI: 10.1007/s10029-018-1870-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Transversus abdominis release (TAR), as a type of posterior component separation, is a new myofascial release technique in complex ventral hernia repair. TAR preserves rectus muscle innervation, creates an immense retromuscular plane and allows bilaminar ingrowth of the mesh. The place of the TAR within the range of established anterior component separation techniques (CST) is unclear. Aim of this systematic literature review is to estimate the position of the TAR in the scope of ventral hernia repair techniques. METHODS MEDLINE, Embase, Pubmed and the Cochrane controlled trials register and Science citation index were searched using the following terms: 'posterior component separation', 'transversus abdominis release', 'ventral hernia repair', 'complex abdominal wall reconstruction'. To prevent duplication bias, only studies with a unique cohort of patients who underwent transversus abdominis release for complex abdominal wall reconstruction were eligible. Postoperative complications and recurrences had to be registered adequately. The rate of surgical site occurrences and recurrences of the TAR were compared with those after anterior CST, published earlier in two meta-analyses. RESULTS Five articles met our strict inclusion criteria, describing 646 TAR patients. Methodological quality per study was good. Mean hernia surface was 509 cm2 and 88% of the hernias were located in the midline. Preoperative risk stratification was distributed in low risk (10%), co-morbid (55%), potentially contaminated (32%) and infected (3%). Pooled calculations demonstrated a mean SSO rate of 15% after TAR (20-35% after anterior CST) and a mean 2-year hernia recurrence rate of 4% (13% after anterior CST). Mean hernia surface was 300 cm2 in anterior component separation studies. CONCLUSION This review demonstrates that the transversus abdominis release is a good alternative for anterior CST in terms of SSO and recurrence, especially in very large midline ventral hernias.
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Affiliation(s)
- J A Wegdam
- Department of Surgery, Elkerliek Hospital, Helmond, The Netherlands
| | - J M M Thoolen
- Department of Surgery, Elkerliek Hospital, Helmond, The Netherlands.
| | - S W Nienhuijs
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - N de Bouvy
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
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