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Omar I, Townsend A, Hadfield O, Zaimis T, Ismaiel M, Wilson J, Magee C. Outcomes of elective and emergency surgical repair of incisional hernia: a comparative observational study. Hernia 2024; 28:1619-1628. [PMID: 38446277 DOI: 10.1007/s10029-024-02975-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/25/2024] [Indexed: 03/07/2024]
Abstract
PURPOSE Incisional hernia (IH) is a common complication following abdominal surgery. Surgical repair of IH is associated with the alleviation of symptoms and improvement of quality of life. Operative intervention can pose a significant burden to the patient and healthcare facilities. This study aims to describe and compare outcomes of elective and emergency surgical repair of IH. METHODS This study is a single-centre comparative retrospective study including patients who had repair of IH. Patients were divided into Group I (Emergency) and Group II (Elective), and a comparison was conducted between them. RESULTS Two hundred sixty-two patients were identified with a mean age of 61.8 ± 14.2 years, of which 152 (58%) were females. The mean BMI was 31.6 ± 7.2 kg/m2. More than 58% had at least one comorbidity. 169 (64.5%) patients had an elective repair, and 93 (35.5%) had an emergency repair. Patients undergoing emergency repair were significantly older and had higher BMI, p = 0.031 and p = 0.002, respectively. The significant complication rate (Clavien-Dindo III and IV) was 9.54%. 30 and 90-day mortality rates were 2.3% (n = 6) and 2.68% (n = 7), respectively. In the emergency group, the overall complications, 30-day and 90-day mortality rates were significantly higher than in the elective group, p ≤ 0.001, 0.002 and 0.001, respectively. Overall, 42 (16.1%) developed wound complications, 25 (9.6%) experienced a recurrence, and 41 (15.71%) were readmitted within 90 days, without significant differences between the two groups. CONCLUSION Patients who underwent emergency repair were significantly older and had a higher BMI than the elective cases. Emergency IH repair is associated with higher complication rates and mortality than elective repair.
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Affiliation(s)
- I Omar
- Department of General Surgery, The Hillingdon Hospitals NHS Foundation Trust, Pield Heath Road, Uxbridge Middlesex, UB8 3NN, UK.
| | - A Townsend
- Department of General Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | - O Hadfield
- Department of General Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | - T Zaimis
- Department of General Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | - M Ismaiel
- Department of General Surgery, Altnagelvin Area Hospital, Londonderry, UK
| | - J Wilson
- Department of General Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | - C Magee
- Department of General Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
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Castañeda-Vozmediano R, Areces Carrasco B, López Marsella A, Ahenke Francisco C, Munoz-Rodriguez J, Blazquez Hernando LA, Robin Valle de Lersundi A, Lopez-Monclus J, Garcia-Urena MA. Comprehensive retrospective analysis of the European hernia Society quality of life in patients undergoing abdominal wall reconstruction. Am J Surg 2024:115905. [PMID: 39179478 DOI: 10.1016/j.amjsurg.2024.115905] [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: 04/18/2024] [Revised: 07/11/2024] [Accepted: 08/15/2024] [Indexed: 08/26/2024]
Abstract
INTRODUCTION This study aimed to analyze the European Hernia Society Quality of Life (EHS-QoL) in abdominal wall reconstruction by comparing preoperative scores with those at 1 and 2 postoperative years. METHODS Data from 105 patients with complex incisional hernias were collected preoperatively and at 1 and 2 years postoperatively. Statistical analyses included three ART ANOVA models to compare scores among the three time points and within each time point's items. RESULTS The EHS score significantly decreased from preoperative (Mdn = 57) to 1 year (Mdn = 10.5) and 2 years postoperative (Mdn = 8). The most significant changes occurred between preoperative and 1-year measurements, particularly in pain levels during activities and limitations in heavy labor and activities outside the home. CONCLUSION Patients' quality of life notably improved at 1 year post-surgery, with some reaching near-maximum levels, and this improvement was generally sustained or increased at 2 years post-surgery.
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Affiliation(s)
| | | | | | | | | | | | - Alvaro Robin Valle de Lersundi
- Henares University Hospital, Av. de Marie Curie S/n, 28822, Coslada, Madrid, Spain; Grupo de Investigación de Pared Abdominal Compleja. Universidad Francisco de Vitoria, Madrid, Spain
| | | | - Miguel Angel Garcia-Urena
- Henares University Hospital, Av. de Marie Curie S/n, 28822, Coslada, Madrid, Spain; Grupo de Investigación de Pared Abdominal Compleja. Universidad Francisco de Vitoria, Madrid, Spain.
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De Luca M, Medina Pedrique M, Morejon Ruiz S, Munoz-Rodriguez JM, Robin Valle de Lersundi A, Lopez-Monclus J, Blázquez Hernando LA, Garcia-Urena MA. The Madrid Posterior Component Separation: An Anatomical Approach for Effective Reconstruction of Complex Midline Hernias. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2024; 3:12928. [PMID: 38915322 PMCID: PMC11194669 DOI: 10.3389/jaws.2024.12928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/17/2024] [Indexed: 06/26/2024]
Abstract
Introduction In recent years, Posterior Component Separation (PCS) with the Madrid modification (Madrid PCS) has emerged as a surgical technique. This modification is believed to enhance the dissection of anatomical structures, offering several advantages. The study aims to present a detailed description of this surgical technique and to analyse the outcomes in a large cohort of patients. Materials and Methods This study included all patients who underwent the repair of midline incisional hernias, with or without other abdominal wall defects. Data from patients at three different centres specialising in abdominal wall reconstruction was analysed. All patients underwent the Madrid PCS, and several variables, such as demographics, perioperative details, postoperative complications, and recurrences, were assessed. Results Between January 2015 and June 2023, a total of 223 patients underwent the Madrid PCS. The mean age was 63.4 years, with a mean BMI of 33.3 kg/m2 (range 23-40). According to the EHS classification, 139 patients had a midline incisional hernia, and 84 had a midline incisional hernia with a concomitant lateral incisional hernia. According to the Ventral Hernia Working Group (VHWG) classification, 177 (79.4%) patients had grade 2 and 3 hernias. In total, 201 patients (90.1%) were ASA II and III. The Carolinas Equation for Determining Associated Risks (CeDAR) was calculated preoperatively, resulting in 150 (67.3%) patients with a score between 30% and 60%. A total of 105 patients (48.4%) had previously undergone abdominal wall repair surgery. There were 93 (41.7%) surgical site occurrences (SSO), 36 (16.1%) surgical site infections (SSI), including 23 (10.3%) superficial and 7 (3.1%) deep infections, and 6 (2.7%) organ/space infections. Four (1.9%) recurrences were assessed by CT scan with an average follow-up of 23.9 months (range 6-74). Conclusion The Madrid PCS appears to be safe and effective, yielding excellent long-term results despite the complexity of abdominal wall defects. A profound understanding of the anatomy is crucial for optimal outcomes. The Madrid modification contributes to facilitating a complete retromuscular preperitoneal repair without incision of the transversus abdominis. The extensive abdominal wall retromuscular dissection obtained enables the placement of very large meshes with minimal fixation.
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Affiliation(s)
- Marcello De Luca
- UOC Chirurgia Generale Oncologica e Mininvasiva, Azienda Ospedaliera Universitaria, University of Naples Federico II, Naples, Campania, Italy
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario del Henares, Fundación Investigación e Innovación Biomédica H. Santa Sofía- H del Henares, Madrid, Spain
| | - Manuel Medina Pedrique
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario del Henares, Fundación Investigación e Innovación Biomédica H. Santa Sofía- H del Henares, Madrid, Spain
- Grupo de Investigación de Pared Abdominal Compleja, Universidad Francisco de Vitoria, Madrid, Spain
| | - Sara Morejon Ruiz
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario del Henares, Fundación Investigación e Innovación Biomédica H. Santa Sofía- H del Henares, Madrid, Spain
- Grupo de Investigación de Pared Abdominal Compleja, Universidad Francisco de Vitoria, Madrid, Spain
| | | | - Alvaro Robin Valle de Lersundi
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario del Henares, Fundación Investigación e Innovación Biomédica H. Santa Sofía- H del Henares, Madrid, Spain
- Grupo de Investigación de Pared Abdominal Compleja, Universidad Francisco de Vitoria, Madrid, Spain
| | - Javier Lopez-Monclus
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Puerta de HIerro, Madrid, Spain
| | | | - Miguel Angel Garcia-Urena
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario del Henares, Fundación Investigación e Innovación Biomédica H. Santa Sofía- H del Henares, Madrid, Spain
- Grupo de Investigación de Pared Abdominal Compleja, Universidad Francisco de Vitoria, Madrid, Spain
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Quezada N, Irarrazaval MJ, Chen DC, Grimoldi M, Pimentel F, Crovari F. Robotic transversus abdominis release using HUGO RAS system: our initial experience. Surg Endosc 2024; 38:3395-3404. [PMID: 38719985 DOI: 10.1007/s00464-024-10865-0] [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: 12/22/2023] [Accepted: 04/14/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Transversus abdominis release (TAR) is an effective technique for treating large midline and off-midline hernias. Recent studies have demonstrated that robotic TAR (rTAR) is technically feasible and associated with improved outcomes compared to open surgery. There is no published experience to date describing abdominal wall reconstruction using the novel robotic platform HUGO RAS System (Medtronic®). METHODS All consecutive patients who underwent a rTAR in our institution were included. Three of the four arm carts of the HUGO RAS System were used at any given time. Each arm configuration was defined by our team in conjunction with Medtronic® personnel. rTAR was performed as previously described. Upon completion of the TAR on one side, a redocking process with different, mirrored arms angles was performed to continue with the contralateral TAR. Operative variables and early morbidity were recorded. RESULTS Ten patients were included in this study. The median BMI was 31 (21-40.6) kg/m2. The median height was 1.6 m (1.5-1.89 m). A trend of decreased operative time, console time, and redocking time was seen in these consecutive cases. No intraoperative events nor postoperative morbidity was reported. The median length of stay was 3 (1-6) days. CONCLUSION Robotic TAR utilizing the HUGO RAS system is a feasible and safe procedure. The adoption of this procedure on this novel platform for the treatment of complex abdominal wall hernias has been successful for our team.
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Affiliation(s)
- Nicolas Quezada
- Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, 362 Diagonal Paraguay, 4th Floor, Office 410, Región Metropolitana, Santiago, Chile.
| | | | - David C Chen
- Lichtenstein Amid Hernia Institute at University of California, Los Angeles, USA
| | - Milenko Grimoldi
- Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Fernando Pimentel
- Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, 362 Diagonal Paraguay, 4th Floor, Office 410, Región Metropolitana, Santiago, Chile
| | - Fernando Crovari
- Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, 362 Diagonal Paraguay, 4th Floor, Office 410, Región Metropolitana, Santiago, Chile
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Sagnelli C, Tartaglia E, Guerriero L, Montanaro ML, D'Alterio G, Cuccurullo D. Long-term outcomes of Madrid approach after TAR for complex abdominal wall hernias: a single-center cohort study. Hernia 2024; 28:769-777. [PMID: 37726424 DOI: 10.1007/s10029-023-02864-2] [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: 05/01/2023] [Accepted: 08/11/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE Undeniably, in the last 2 decades, surgical approaches in the field of abdominal wall repair have notably improved. However, the best approach to provide a durable repair with low morbidity rate has yet to be determined. The purpose of this study is to outline our long-term results following the Transverse Abdominis Release (TAR) approach in patients with complex ventral hernias, focusing on the incidence of recurrence and overall patient satisfaction following surgery. METHODS This is a retrospective study on 167 consecutive patients who underwent TAR between January 2015 and December 2021 for primary or recurrent complex abdominal hernias. Of these, 117 patients who underwent the open Madrid approach with the use of a double mesh (absorbable and permanent synthetic mesh) were selected and analyzed. A quality of life questionnaire (EuraHS QoL) comparing the preoperative and the postoperative status was administered. RESULTS Between January 2015 and December 2021, we successfully treated 117 patients presenting with complex ventral defects using the double mesh technique (absorbable and permanent synthetic mesh). Of these, 26 (22.2%) were recurrent cases. At a median follow-up period of 37.7 months, there had been 1 (0.8%) case of recurrence and 8 cases (6.8%) of bulging. The QoL score was significantly improved when compared to the preoperative status in terms of cosmesis, body perception, and physical discomfort. CONCLUSIONS The Madrid approach for posterior component separation is associated with both a low perioperative morbidity and recurrence rate. In accordance with other studies, we demonstrated that the TAR with reconstruction according to the Madrid approach provides excellent results in the treatment of complex abdominal wall hernias, even at long-term follow-up.
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Affiliation(s)
- C Sagnelli
- Department of Laparoscopic and Robotic General Surgery, Azienda Ospedaliera dei Colli "Monaldi Hospital", 80131, Naples, Italy
| | - E Tartaglia
- Department of Laparoscopic and Robotic General Surgery, Azienda Ospedaliera dei Colli "Monaldi Hospital", 80131, Naples, Italy.
| | - L Guerriero
- Department of Laparoscopic and Robotic General Surgery, Azienda Ospedaliera dei Colli "Monaldi Hospital", 80131, Naples, Italy
| | - M L Montanaro
- Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, Bari, BA, Italy
| | - G D'Alterio
- Ospedale Antonio Cardarelli, 86100, Campobasso, CB, Italy
| | - D Cuccurullo
- Department of Laparoscopic and Robotic General Surgery, Azienda Ospedaliera dei Colli "Monaldi Hospital", 80131, Naples, Italy
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Giuffrida M, Biolchini F, Capelli P, Banchini F, Perrone G. Botulinum Toxin and Progressive Pneumoperitoneum in Loss of Domain Ventral Hernias: A Systematic Review. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2024; 3:12650. [PMID: 38572390 PMCID: PMC10990139 DOI: 10.3389/jaws.2024.12650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 03/06/2024] [Indexed: 04/05/2024]
Abstract
Introduction: Preoperative progressive pneumoperitoneum (PPP) and botulinum toxin A (BTX) have been used together in the preoperative preparation of patients with loss of domain hernias. This study aims to evaluate the efficacy and safety of the combined use of PPP and BTX. Methods: A systematic electronic search was performed according to the PRISMA criteria. A literature search of scientific articles was conducted up to December 2023. Articles were chosen based on the reference to BTX and PPP in loss of domain ventral hernias with a defect width greater than 10 cm before surgery. The GRADE methodology and the modified Newcastle-Ottawa scale were used to assess the quality of the studies. Results: The research yielded seven articles, with 217 patients analysed in total. BTX was performed 29.5 ± 1.7 days before surgery and PPP was inflated 14.8 ± 5.8 days before surgery. PPP complications were reported in 25.6% of patients, The average reduction of the volume of hernia (VH)/volume of the abdominal cavity (VAC) ratio was 7.6% (range 0.9%-15%). Only 40 patients (18.4%) required a PCS or TAR to repair the loss of domain hernias. The SSI and SSO rates were 17.5% and 26.2%, respectively. No differences in SSI and SSO rates were found between the different repair techniques. The recurrence rate was 5.9% (13/217). Recurrence was significantly higher in patients who underwent IPOM repair than other techniques (p < 0.001). Conclusion: BTX and PPP may be useful tools for the management of loss of domain hernias presenting lower SSI and SSO. The combination of BTX and PPP reduces the use of more invasive repair techniques.
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Affiliation(s)
- Mario Giuffrida
- Department of General Surgery, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Federico Biolchini
- General Surgery Unit, Department of Surgery, Azienda USL—IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Patrizio Capelli
- Department of General Surgery, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Filippo Banchini
- Department of General Surgery, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Gennaro Perrone
- Department of Emergency Surgery, Parma University Hospital, Parma, Italy
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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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Garcia Ureña MÁ, López-Monclús J, Hernando LAB, Munoz-Rodriguez J, García de León LR, Avilés Oliveros A, Pedrique MM, de Luca M, Valle de Lersundi AR. [Incisional hernia: open abdominal wall reconstruction. Current state of the technique and results]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:10-19. [PMID: 38157070 DOI: 10.1007/s00104-023-02005-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 01/03/2024]
Abstract
The treatment of complex midline hernias remains a particular challenge. The currently refined knowledge of the anatomy in the cadaver laboratory and advancing clinical experience have changed our present approach. The aim of this review is to present a description of the updated surgical procedures and outcomes. We favor the retromuscular or preperitoneal layer for mesh implantation, including the Rives-Stoppa procedure (sublay mesh) and posterior component separation with the Madrid modification. We operated on 334 complex midline incisional hernias: 6.3% retromuscular preperitoneal, 15% after Rives-Stoppa, 2.4% anterior component separation and 76% posterior component separation. A bridging procedure was used in 31%. A complication occurred in 35.3%, most of which were wound healing disorders (SSO). The average length of hospital stay was 7.2 days. We recorded a very low incidence of long-term complications: 3.3% recurrence, 0.9% chronic pain (daily use of pain medication), 6% bulging, 1.8% chronic seroma and 2.6% chronic mesh infection. Despite the associated morbidity, retromuscular/preperitoneal treatment offers excellent long-term results.
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Affiliation(s)
- Miguel Ángel Garcia Ureña
- Hospital Universitario del Henares, Madrid, Spanien.
- Hospital Universitario del Henares, Grupo de Investigación de Pared Compleja, Faculty of Medicine, Universidad Francisco de Vitoria, Ctra. Pozuelo-Mahadahonda km. 1, 800, 28223, Madrid, Pozuelo de Alarcón, Spanien.
| | | | | | | | | | | | | | - Marcelo de Luca
- Università degli studi di Napoli Federico II, Napoli, Italien
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Medina Pedrique M, Robin Valle de Lersundi Á, Avilés Oliveros A, Ruiz SM, López-Monclús J, Munoz-Rodriguez J, Blázquez Hernando LA, Martinez Caballero J, García-Urena MÁ. Incisions in Hepatobiliopancreatic Surgery: Surgical Anatomy and its Influence to Open and Close the Abdomen. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2023; 2:11123. [PMID: 38312419 PMCID: PMC10831649 DOI: 10.3389/jaws.2023.11123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 02/28/2023] [Indexed: 02/06/2024]
Abstract
Incisions performed for hepato-pancreatic-biliary (HPB) surgery are diverse, and can be a challenge both to perform correctly as well as to be properly closed. The anatomy of the region overlaps muscular layers and has a rich vascular and nervous supply. These structures are fundamental for the correct functionality of the abdominal wall. When performing certain types of incisions, damage to the muscular or neurovascular component of the abdominal wall, as well as an inadequate closure technique may influence in the development of long-term complications as incisional hernias (IH) or bulging. Considering that both may impair quality of life and that are complex to repair, prevention becomes essential during these procedures. With the currently available evidence, there is no clear recommendation on which is the better incision or what is the best method of closure. Despite the lack of sufficient data, the following review aims to correlate the anatomical knowledge learned from posterior component separation with the incisions performed in hepato-pancreatic-biliary (HPB) surgery and their consequences on incisional hernia formation. Overall, there is data that suggests some key points to perform these incisions: avoid vertical components and very lateral extensions, subcostal should be incised at least 2 cm from costal margin, multilayered suturing using small bites technique and consider the use of a prophylactic mesh in high-risk patients. Nevertheless, the lack of evidence prevents from the possibility of making any strong recommendations.
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Affiliation(s)
- Manuel Medina Pedrique
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Madrid, Spain
| | - Álvaro Robin Valle de Lersundi
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Madrid, Spain
| | - Adriana Avilés Oliveros
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Madrid, Spain
| | - Sara Morejón Ruiz
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Madrid, Spain
| | - Javier López-Monclús
- General and Digestive Surgery Department, Hospital Universitario Puerta de Hierro, Autónoma University of Madrid, Madrid, Spain
| | - Joaquín Munoz-Rodriguez
- General and Digestive Surgery Department, Hospital Universitario Puerta de Hierro, Autónoma University of Madrid, Madrid, Spain
| | - Luis Alberto Blázquez Hernando
- General and Digestive Surgery Department, Hospital Universitario Ramón y Cajal, Alcalá de Henares University Madrid, Madrid, Spain
| | - Javier Martinez Caballero
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Madrid, Spain
| | - Miguel Ángel García-Urena
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Madrid, Spain
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10
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Marte G, Tufo A, Ferronetti A, Di Maio V, Russo R, Sordelli IF, De Stefano G, Maida P. Posterior component separation with TAR: lessons learned from our first consecutive 52 cases. Updates Surg 2022; 75:723-733. [PMID: 36355329 DOI: 10.1007/s13304-022-01418-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 11/01/2022] [Indexed: 11/12/2022]
Abstract
Patients with complex incisional hernia (IH) is a growing and challenging category that surgeons are facing in daily practice and represent indeed a technical challenge for most of them. The posterior component separation with TAR (PCS-TAR) has become the procedure of choice to repair most complex abdominal wall defects, including those with loss of domain, subxiphoid, subcostal, parastomal or after trauma and sepsis treated initially with "open abdomen" and in those scenarios in which the fascia closure was not performed to avoid an abdominal compartment syndrome. Most recent studies showed that the PCS-TAR represents a valid procedure in recurrent IH. The purpose of our study is to evaluate the reproducibility of the PCS-TAR, describing our experience, our surgical technique and the rate of postoperative complications and recurrences in a cohort of consecutive patients. 52 consecutive patients with complex IH, who underwent PCS-TAR at "Betania Hospital and Ospedale del Mare Hospital" in Naples between May 2014 and November 2019 were identified from a prospectively maintained database and reviewed retrospectively. There were 36 males (69%) and 16 females (31%) with a mean age of 57.88 (range 39-76) and Body mass index (BMI kg/m2) of 31.2 (24-45). More than half of patients (58%) were active smokers. Mean defect width was 13.6 cm (range 6-30) and mean defect area was about 267.9 cm2. Mean operative time was 228 min. Posterior fascial closure was reached in all cases, while anterior fascial closure only in 29 cases (56%). Mean hospital stay was 5.7 days. 27% of patients developed minor complications (Clavien-Dindo grade I-II) and one case (1.9%) major complication (Clavien-Dindo III). Seroma was registered in 23% of cases. SSI was reported to be 3.8% with no deep wound infection. Recurrence rate was 1.9% in a mean follow-up of 28 months. In Univariate analysis Bio-A surface > 600 cm2 and drain removal at discharge were significantly associated with major complications, while in a multivariate analysis only Bio-A surface > 600 cm2 was related. Considering univariate analysis for recurrences, number of drains, SSO, Clavien-Dindo score > 2 and defect area were significantly associated with recurrence, while in a multivariate analysis no variables were related. PCS-TAR is an indispensable tool in managing complex ventral hernias associated with a low rate of SSO and recurrence. Tobacco use, obesity and comorbidities cannot be considered absolute contraindications to PCS-TAR. Peri and postoperative management of complications and drainages have an impact on short term outcomes. Based on these outcomes, posterior component separation with transversus abdominis release has become our method of choice for the management of patients with complex ventral hernia requiring open hernia repair in selected patients.
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11
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Zuvela M, Galun D, Bogdanovic A, Loncar Z, Zivanovic M, Zuvela M, Zuvela M. The combination of the three modifications of the component separation technique in the management of complex subcostal abdominal wall hernia. Hernia 2022; 26:1369-1379. [PMID: 35575863 DOI: 10.1007/s10029-022-02622-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 04/21/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE The purpose of this study is to present a concept combining three modifications of the component separation technique (CST) in one procedure as an original solution for the management of complex subcostal abdominal wall hernia. METHODS Between January 2010 and January 2020, seven patients presenting at the high-volume academic center with complex subcostal hernia underwent surgery in which three modifications of CST were combined into one procedure. Major complex subcostal hernia was defined by either width or length of the defect being greater than 10 cm. The following were the stages of the operative technique: (a) the "method of wide myofascial release" at the side of the hernia defect; (b) "open-book variation" of the component separation technique at the opposite side of the hernia defect; (c) a modified component separation technique for closure of midline abdominal wall hernias in the presence of enterostomies; (d) suturing of the myofascial flaps to each other to cover the defect; and (e) repair augmentation with an absorbable mesh in the onlay position. RESULTS The median length and width of the complex subcostal hernias were 15 cm (10-19) and 15 cm (8-24), respectively. The overall morbidity rate was 57.1% (wound infection occurred in three patients, seroma in two patients, and skin necrosis in one patient). There was no hernia recurrence during the median follow-up period of 19 months. CONCLUSION The operative technique integrating three modifications of CST in one procedure with onlay absorbable mesh reinforcement is a feasible solution for the management of complex subcostal abdominal wall hernia.
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Affiliation(s)
- M Zuvela
- Clinic for Digestive Surgery, University Clinical Center of Serbia, Koste Todorovica 6, 11 000, Belgrade, Serbia
- School of Medicine, University of Belgrade, 11 000, Belgrade, Serbia
| | - D Galun
- Clinic for Digestive Surgery, University Clinical Center of Serbia, Koste Todorovica 6, 11 000, Belgrade, Serbia
- School of Medicine, University of Belgrade, 11 000, Belgrade, Serbia
| | - A Bogdanovic
- Clinic for Digestive Surgery, University Clinical Center of Serbia, Koste Todorovica 6, 11 000, Belgrade, Serbia.
- School of Medicine, University of Belgrade, 11 000, Belgrade, Serbia.
| | - Z Loncar
- Emergency Center, University Clinical Center of Serbia, 11 000, Belgrade, Serbia
- School of Medicine, University of Belgrade, 11 000, Belgrade, Serbia
| | - M Zivanovic
- Clinic for Digestive Surgery, University Clinical Center of Serbia, Koste Todorovica 6, 11 000, Belgrade, Serbia
| | - M Zuvela
- Clinic for Digestive Surgery, University Clinical Center of Serbia, Koste Todorovica 6, 11 000, Belgrade, Serbia
| | - M Zuvela
- Clinic for Digestive Surgery, University Clinical Center of Serbia, Koste Todorovica 6, 11 000, Belgrade, Serbia
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Garcia-Urena MÁ, Lopez-Monclus J, de Robin Valle de Lersundi A, Blazquez Hernando LA, Medina Pedrique M, Rial Justo X, Cruz Cidoncha A, Nogueira Sixto M, Munoz-Rodriguez J. Pathways of the preperitoneal plane: from the “fatty triangle” in Rives to the “fatty trident" in extended retromuscular abdominal wall reconstruction. A tribute to Prof. Schumpelick. Hernia 2022; 27:395-407. [PMID: 35426573 DOI: 10.1007/s10029-022-02602-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/08/2022] [Indexed: 12/21/2022]
Abstract
PURPOSE Extended retromuscular dissection performed for abdominal wall reconstruction in complex abdominal wall repair has progressively exposed the anatomy between the peritoneal layer and abdominal wall muscles. This study aimed to assess the morphology and distribution of preperitoneal fat in a cadaveric model and its influence in retromuscular preperitoneal dissections. METHODS Thirty frozen cadaver torsos were dissected by posterior component separation. The shape of the preperitoneal fat was identified, and the dimensions and more significant distances were calculated. RESULTS The results showed that the preperitoneal fat resembles a trident, exists along the midline under the linea alba, and expands in the epigastric area into a rhomboid shape. The fatty triangle was found to be a part of this rhomboid. Caudally, the midline preperitoneal fat widened under the arcuate line to reach the Retzius space. Laterally, the Bogros space communicated the root of the trident with the paracolic gutters, Toldt's fascia, and pararenal fats, forming the lateral prong of the trident. The peritoneum not covered by the preperitoneal fatty trident was easy to break. Three pathways could be tracked following the distribution of this fat that facilitated the dissection of the preperitoneal space to prepare the landing zone of the meshes in hernia repair. CONCLUSION The concept of preperitoneal fatty trident may be of practical assistance to perform various hernia procedures, from the simple ventral hernia repair to the more complex preperitoneal ventral repair or posterior component separation techniques. The consistency of this layer allows us to follow three specific pathways to find our plane between the peritoneum and muscle layers to extend the preperitoneal dissection.
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Affiliation(s)
- M Á Garcia-Urena
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Universidad Francisco de Vitoria, Carretera Pozuelo-Majadahonda km. 1.8, 28223, Pozuelo de Alarcón, Spain
| | - J Lopez-Monclus
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Puerta de Hierro-Majadahonda, Calle Joaquín Rodrigo 2, 28220, Majadahonda, Spain.
| | - A de Robin Valle de Lersundi
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Universidad Francisco de Vitoria, Carretera Pozuelo-Majadahonda km. 1.8, 28223, Pozuelo de Alarcón, Spain
| | - L A Blazquez Hernando
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Ramón y Cajal, M-607, 9,100, 28034, Madrid, Spain
| | - M Medina Pedrique
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Universidad Francisco de Vitoria, Carretera Pozuelo-Majadahonda km. 1.8, 28223, Pozuelo de Alarcón, Spain
| | - X Rial Justo
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Universidad Francisco de Vitoria, Carretera Pozuelo-Majadahonda km. 1.8, 28223, Pozuelo de Alarcón, Spain
| | - A Cruz Cidoncha
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Universidad Francisco de Vitoria, Carretera Pozuelo-Majadahonda km. 1.8, 28223, Pozuelo de Alarcón, Spain
| | - M Nogueira Sixto
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Alvaro Cunqueiro, Estrada de Clara Campoamor 341, 36213, Vigo, Spain
| | - J Munoz-Rodriguez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Puerta de Hierro-Majadahonda, Calle Joaquín Rodrigo 2, 28220, Majadahonda, Spain
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13
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Robin Valle de Lersundi A, Rupealta N, San Miguel Mendez C, Muñoz Rodriguez J, Pérez Flecha M, López Monclús J, Blazquez Hernando L, García Ureña MA. High recurrence rate after posterior component separation and keyhole mesh reconstruction for complex parastomal hernia: A case series study. Colorectal Dis 2021; 23:2137-2145. [PMID: 34075675 DOI: 10.1111/codi.15729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/17/2021] [Accepted: 05/04/2021] [Indexed: 01/06/2023]
Abstract
AIM This study aimed to describe the results of complex parastomal hernia repair after posterior component separation and keyhole reconstruction. METHOD We conducted a retrospective review of a prospectively sustained database in one single complex abdominal wall referral centre. We analysed the data of patients who underwent the posterior component separation technique using modified transversus abdominis release for complex parastomal hernia and retromuscular keyhole mesh repair from February 2014 to January 2017. Demographic data, hernia characteristics, operative details and outcomes were analysed. The primary outcome measured was the recurrence rate during the follow-up. RESULTS Twenty patients were included in this study. Among the patients who underwent surgery for parastomal hernia, 17 patients had a colostomy (85%) and three patients had a ureteroileostomy after the Bricker procedure (15%). The mean body mass index was 33.2 kg/m2 (range 25-47). Twelve patients had an expected associated risk according to the Carolinas equation for determining associated risk classification of >60%. Sixty per cent of our patients had contaminated or dirty/infected wounds. The overall complication rate was 60%. Surgical site infection was observed in 25% of the cases. The mortality rate in our study group was 5% (n = 1). We found clinical or radiological evidence of parastomal hernia recurrence in nine out of 20 (45%) patients during follow-up. No hernia recurrence was detected in the concomitant incisional hernias. CONCLUSIONS Although posterior component separation in the form of modified transversus abdominis muscle release allows abdominal wall reconstruction, keyhole mesh configuration at the stoma site does not offer satisfactory results in terms of long-term recurrence rate at the parastomal defect.
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Affiliation(s)
| | - Niccolo Rupealta
- Department of General Surgery, Hospital Universitario del Henares, Coslada, Spain
| | | | | | - Marina Pérez Flecha
- Department of General Surgery, Hospital Universitario del Henares, Coslada, Spain
| | - Javier López Monclús
- Department of General Surgery, Hospital Universitario Puerta del Hierro Majadahonda, Majadahonda, Spain
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Outcomes of mid-term and long-term degradable biosynthetic meshes in single-stage open complex abdominal wall reconstruction. Hernia 2021; 25:1647-1657. [PMID: 34097187 PMCID: PMC8182350 DOI: 10.1007/s10029-021-02415-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/12/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess clinical outcomes in patients that underwent open single-stage complex abdominal wall reconstruction (CAWR) with biosynthetic mesh. METHODS Retrospective observational study of two prospectively registered series of consecutive patients undergoing CAWR with either long-term degradable (LTD) Phasix™ or mid-term degradable (MTD) BIO-A® biosynthetic mesh in a single institution between June 2016 and December 2019. RESULTS From 169 patients with CAWR, 70 consecutive patients were identified who underwent CAWR with either LTD or MTD biosynthetic mesh. More than 85% of patients had an incisional hernia that could be classified as moderately complex to major complex due to a previous wound infection (67%), one or more complicating comorbidities (87.1%), one or more complicating hernia characteristics (75.7%) or contaminated or dirty defects (37.1%). Concomitant component separation was performed in 43 of 70 patients (61.4%). Overall surgical site infection (SSI) rate in these CAWR patients was 45.7%. Seventeen of 70 patients (24.3%) had computed tomography (CT) - and culture-confirmed SSI in direct contact of mesh, suspicious of mesh infection. Mesh removal for persistent local infection occurred in 10% (7 of 70) after a median of 229 days since surgery. Salvage rate of mesh after direct contact with infection was 58.8%. All removed meshes were in the LTD group. Seven patients (10%) had a recurrence; four patients in the LTD group (10%) had a recurrence at a median follow-up of 35 months and three patients in the MTD group (10%) at a median follow-up of 11 months. Three of the seven recurrences occurred in patients with SSI in persistent and direct contact with mesh. CONCLUSIONS Comorbid patients undergoing open complex abdominal wall reconstruction are at high risk of postoperative wound complications regardless of which type of biosynthetic mesh is used. When in persistent and direct contact with infection, long-term biodegradable biosynthetic meshes may need to be removed, whereas mid-term biodegradable biosynthetic meshes can be salvaged.
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San Miguel-Méndez C, López-Monclús J, Munoz-Rodriguez J, de Lersundi ÁRV, Artes-Caselles M, Blázquez Hernando LA, García-Hernandez JP, Minaya-Bravo AM, Garcia-Urena MÁ. Stepwise transversus abdominis muscle release for the treatment of complex bilateral subcostal incisional hernias. Surgery 2021; 170:1112-1119. [PMID: 34020792 DOI: 10.1016/j.surg.2021.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/14/2021] [Accepted: 04/08/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Management of subcostal incisional hernias is particularly complicated due to their proximity to the costochondral limits in addition to the lack of aponeurosis on the lateral side of the abdomen. We present our results of posterior component separation through the same previous incision as a safe and reproducible technique for these complex cases. METHODS We presented a multicenter and prospective cohort of patients diagnosed with bilateral subcostal incisional hernias on either clinical examination or imaging based on computed tomography from 2014 to 2020. The aim of this investigation was to assess the outcomes of abdominal wall reconstruction for subcostal incisional hernias through a new approach. The outcomes reported were short- and long-term complications, including recurrence, pain, and bulging. Quality of life was assessed with the European Registry for Abdominal Wall Hernias Quality of Life score. RESULTS A total of 46 patients were identified. All patients underwent posterior component separation. Surgical site occurrences occurred in 10 patients (22%), with only 7 patients (15%) requiring procedural intervention. During a mean follow-up of 18 months (range, 6-62 months), 1 (2%) case of clinical recurrence was registered. Also, there were 8 (17%) patients with asymptomatic but visible bulging. The European Registry for Abdominal Wall Hernias Quality of Life score showed a statistically significant decrease in the 3 domains (pain, restriction, and cosmetic) of the postoperative scores compared with the preoperative score. CONCLUSION Posterior component separation technique for the repair of subcostal incisional hernias through the same incision is a safe procedure that avoids injury to the linea alba. It is associated with acceptable morbidity, low recurrence rate, and improvement in patients' reported outcomes.
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Affiliation(s)
- Carlos San Miguel-Méndez
- General and Digestive Surgery Department, Hospital Universitario del Henares, Francisco de Vitoria University, Madrid, Spain
| | - Javier López-Monclús
- General and Digestive Surgery Department, Hospital Universitario Puerta de Hierro, Autónoma University of Madrid, Spain.
| | - Joaquín Munoz-Rodriguez
- General and Digestive Surgery Department, Hospital Universitario Puerta de Hierro, Autónoma University of Madrid, Spain
| | - Álvaro Robin Valle de Lersundi
- General and Digestive Surgery Department, Hospital Universitario del Henares, Francisco de Vitoria University, Madrid, Spain
| | - Mariano Artes-Caselles
- General and Digestive Surgery Department, Hospital Universitario Puerta de Hierro, Autónoma University of Madrid, Spain
| | - Luis Alberto Blázquez Hernando
- General and Digestive Surgery Department, Hospital Universitario Ramón y Cajal, Alcalá de Henares University Madrid, Spain
| | | | - Ana María Minaya-Bravo
- General and Digestive Surgery Department, Hospital Universitario del Henares, Francisco de Vitoria University, Madrid, Spain
| | - Miguel Ángel Garcia-Urena
- General and Digestive Surgery Department, Hospital Universitario del Henares, Francisco de Vitoria University, Madrid, Spain
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Li B, Qin C, Yu J, Gong D, Nie X, Li G, Bittner R. Totally endoscopic sublay (TES) repair for lateral abdominal wall hernias: technique and first results. Hernia 2021; 25:523-533. [PMID: 33599899 DOI: 10.1007/s10029-021-02374-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/22/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The optimal surgical treatment for lateral hernias of the abdominal wall remains unclear. The presented prospective study assesses for the first time in detail the clinical value of a totally endoscopic sublay (TES) technique for the repair of these hernias. METHODS Twenty-four consecutive patients with a lateral abdominal wall hernia underwent TES repair. This technique is naturally combined with a transversus abdominis release maneuver to create a sufficient retromuscular/preperitoneal space that can accommodate, if necessary, a giant prosthetic mesh. RESULTS The operations were successful in all but one patient who required open conversion because of dense intestinal adhesion. The mean defect width was 6.7 ± 3.9 cm. The mean defect area was 78.0 ± 102.4 cm2 (range 4-500 cm2). The mean mesh size used was 330.2 ± 165.4 cm2 (range 108-900 cm2). The mean operative time was 170.2 ± 73.8 min (range, 60-360 min). The mean visual analog scale score for pain at rest on the first day was 2.5 (range 1-4). The average postoperative stay was 3.4 days (range 2-7 days). No serious complications (Dindo-Clavien Grade 2-4) were seen within a mean follow-up period of 13.3 months. CONCLUSIONS A totally endoscopic technique (TES) for the treatment of lateral hernias is described. The technique revealed to be reliable, safe and cost-effective. The first results are promising, but larger studies with longer follow-up periods are recommended to determine the real clinical value.
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Affiliation(s)
- B Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - C Qin
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, China
| | - J Yu
- Department of General Surgery, School of Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, 201999, China
| | - D Gong
- Department of General Surgery, The First School of Clinical Medicine of Southern Medical University, Guangzhou, 511400, China
| | - X Nie
- Department of General Surgery, The First School of Clinical Medicine of Southern Medical University, Guangzhou, 511400, China
| | - G Li
- Department of General Surgery, The First School of Clinical Medicine of Southern Medical University, Guangzhou, 511400, China.
| | - R Bittner
- Emeritus Director Marienhospital Stuttgart, Supperstr. 19, 70565, Stuttgart, Germany.
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Robin Valle de Lersundi A, Munoz-Rodriguez J, Lopez-Monclus J, Blazquez Hernando LA, San Miguel C, Minaya A, Perez-Flecha M, Garcia-Urena MA. Second Look After Retromuscular Repair With the Combination of Absorbable and Permanent Meshes. Front Surg 2021; 7:611308. [PMID: 33490101 PMCID: PMC7821836 DOI: 10.3389/fsurg.2020.611308] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 12/09/2020] [Indexed: 12/12/2022] Open
Abstract
Objective: The aim of this study is to describe the macroscopic features and histologic details observed after retromuscular abdominal wall reconstruction with the combination of an absorbable mesh and a permanent mesh. Methods: We have considered all patients that underwent abdominal wall reconstruction (AWR) with the combination of two meshes that required to be reoperated for any reason. Data was extracted from a prospective multicenter study from 2012 to 2019. Macroscopic evaluation of parietal adhesions and histological analysis were carried out in this group of patients. Results: Among 466 patients with AWR, we identified 26 patients that underwent a reoperation after abdominal wall reconstruction using absorbable and permanent mesh. In eight patients, the reoperation was related to abdominal wall issues: four patients were reoperated due to recurrence, three patients required an operation for chronic mesh infection and one patient for symptomatic bulging. A miscellanea of pathologies was the cause for reoperation in 18 patients. During the second surgical procedures made after a minimum of 3 months follow-up, a fibrous tissue between the permanent mesh covering and protecting the peritoneum was identified. This fibrous tissue facilitated blunt dissection between the permanent material and the peritoneum. Samples of this tissue were obtained for histological examination. No case of severe adhesions to the abdominal wall was seen. In four cases, the reoperation could be carried out laparoscopically with minimal adhesions from the previous procedure. Conclusions: The reoperations performed after the combination of absorbable and permanent meshes have shown that the absorbable mesh acts as a protective barrier and is replaced by a fibrous layer rich in collagen. In the cases requiring new hernia repair, the layer between peritoneum and permanent mesh could be dissected without special difficulty. Few intraperitoneal adhesions to the abdominal wall were observed, mainly filmy, easy to detach, facilitating reoperations.
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Affiliation(s)
| | - Joaquín Munoz-Rodriguez
- Hospital Universitario del Henares, Madrid, Spain.,Universidad Francisco de Vitoria, Madrid, Spain
| | | | | | - Carlos San Miguel
- Hospital Universitario del Henares, Madrid, Spain.,Universidad Francisco de Vitoria, Madrid, Spain
| | - Ana Minaya
- Hospital Universitario del Henares, Madrid, Spain.,Universidad Francisco de Vitoria, Madrid, Spain
| | - Marina Perez-Flecha
- Hospital Universitario del Henares, Madrid, Spain.,Universidad Francisco de Vitoria, Madrid, Spain
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Laparoscopic enhanced-view totally extraperitoneal Rives-Stoppa repair (eTEP-RS) for ventral and incisional hernias - early operative outcomes and technical remarks on a novel retromuscular approach. Wideochir Inne Tech Maloinwazyjne 2020; 15:533-545. [PMID: 33294067 PMCID: PMC7687670 DOI: 10.5114/wiitm.2020.99371] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 09/12/2020] [Indexed: 02/06/2023] Open
Abstract
Introduction Incisional hernias can complicate up to one in four laparotomy procedures, and successful repair remains a significant clinical challenge for surgeons. Recently, the surgical technique of ventral hernia repair (eTEP-RS) has been introduced. Aim To present early results in treating patients with ventral hernia using the eTEP-RS technique and to discuss key technical aspects affecting the safety and efficiency of repair. Material and methods A prospective study of early outcomes was conducted for all ventral hernia patients (hernia orifice between 4 and 8 cm) who underwent eTEP-RS between March 2019 and July 2020. Results As of July 2020, we performed a total of 11 eTEP-RS procedures. The mean duration of the surgery was 204 min (158 to 295). The average size of the treated defect in the transverse dimension was 5.8 cm, and the defect area was 38.5 cm2. The average size of the mesh used was 486 cm2 (280 to 590). After an average follow-up of 7 months (1–17) there was no recurrence or major complication. Based on our initial experiences we present a detailed description of the main aspects of the surgical technique itself, as well as the essential nuances, to enable evaluation of the technique and future popularization. Conclusions The eTEP-RS technique is a safe alternative to open ventral hernia repair and allows for the placement of a large piece of mesh in accordance with current recommendations. Excellent knowledge of the detailed anatomy of the abdominal wall is essential for safe and effective hernia repair.
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