1
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Gómez-Dos-Santos V, López-Plaza JA, Molina-Villar JM, Blázquez-Hernando L, Diez-Nicolás V, Jiménez-Cidre M, Porrero-Guerrero B, Rodríguez-Patrón R, Arias-Fúnez F, Muriel-García A, Fernández-Cebrián JM, Burgos-Revilla FJ. Prevention of incisional hernia after kidney transplantation: study protocol for a randomized controlled trial. Trials 2023; 24:528. [PMID: 37580782 PMCID: PMC10424418 DOI: 10.1186/s13063-023-07545-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/25/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Incisional hernia is a common complication after kidney transplantation with an incidence of 1.6-18%. Concerning non-transplant patients, a recently published meta-analysis describes a reduction of the incidence of incisional hernia of up to 85% due to prophylactic mesh replacement in elective, midline laparotomy. The aim of our study is to show a reduction of the incidence of incisional hernia after kidney transplantation with minimal risk for complication. METHODS/DESIGN This is a blinded, randomized controlled trial comparing time to incisional hernia over a period of 24 months between patients undergoing kidney transplantation and standardized abdominal closure with or without prophylactic placement of ProGrip™ (Medtronic, Fridley, MN, USA) mesh in an onlay position. As we believe that the mesh intervention is superior to the standard procedure in reducing the incidence of hernia, this is a superiority trial. DISCUSSION The high risk for developing incisional hernia following kidney transplantation might be reduced by prophylactic mesh placement. ProGrip™ mesh features polylactic acid (PLA) microgrips that provide immediate, strong and uniform fixation. The use of this mesh combines the effectiveness demonstrated by the macropore propylene meshes in the treatment of incisional hernias, a high simplicity of use provided by its capacity for self-fixation that does not increase significantly surgery time, and safety. TRIAL REGISTRATION ClinicalTrials.gov NCT04794582. Registered on 08 March 2021. Protocol version 2.0. (02-18-2021).
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Affiliation(s)
- Victoria Gómez-Dos-Santos
- Urology Department, Kidney Transplant Surgery, Ramón Y Cajal Hospital, Surgical Research in Urology and Renal Transplantation, IRYCIS, Alcalá University, Alcalá de Henares, Spain
| | | | - José Manuel Molina-Villar
- General and Visceral Surgery Department, Ramón Y Cajal Hospital, Alcalá University, Alcalá de Henares, Spain
| | - Luis Blázquez-Hernando
- General and Visceral Surgery Department, Ramón Y Cajal Hospital, Alcalá University, Alcalá de Henares, Spain
| | - Víctor Diez-Nicolás
- Urology Department, Kidney Transplant Surgery, Ramón Y Cajal Hospital, Surgical Research in Urology and Renal Transplantation, IRYCIS, Alcalá University, Alcalá de Henares, Spain
| | - Miguel Jiménez-Cidre
- Urology Department, Kidney Transplant Surgery, Ramón Y Cajal Hospital, Surgical Research in Urology and Renal Transplantation, IRYCIS, Alcalá University, Alcalá de Henares, Spain
| | - Belén Porrero-Guerrero
- General and Visceral Surgery Department, Ramón Y Cajal Hospital, Alcalá University, Alcalá de Henares, Spain
| | - Rafael Rodríguez-Patrón
- Urology Department, Kidney Transplant Surgery, Ramón Y Cajal Hospital, Surgical Research in Urology and Renal Transplantation, IRYCIS, Alcalá University, Alcalá de Henares, Spain
| | - Fernando Arias-Fúnez
- Urology Department, Kidney Transplant Surgery, Ramón Y Cajal Hospital, Surgical Research in Urology and Renal Transplantation, IRYCIS, Alcalá University, Alcalá de Henares, Spain
| | - Alfonso Muriel-García
- Biostatistics Department, Ramón Y Cajal Hospital, IRYCIS, CIBERESP, Alcalá University, Alcalá de Henares, Spain
| | | | - Francisco Javier Burgos-Revilla
- Urology Department, Kidney Transplant Surgery, Ramón Y Cajal Hospital, Surgical Research in Urology and Renal Transplantation, IRYCIS, Alcalá University, Alcalá de Henares, Spain
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2
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Cassese G, Castaldi A, Al Taweel B, Le Quintrec M, Thuret R, Navarro F, Panaro F. Incisional hernia repair after kidney transplantation in a tertiary high-volume center: outcomes from a 10-year retrospective cohort study. Int Urol Nephrol 2022; 54:525-531. [PMID: 35112319 DOI: 10.1007/s11255-021-03101-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/26/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIM Incisional hernia (IH) after Kidney Transplantation (KT) is a challenging complication due to both technical reasons and patients' complexity. Data regarding outcomes of hernia repair in KT recipients are uncertain, since the biggest part of previous papers focused on risk factors for incisional hernia occurrence and not on its outcomes. Aim of the study was to focus on risk factors for incisional hernia recurrence after surgical repair in KT recipients. METHODS Data regarding all consecutive patients undergoing kidney transplantations from January 2011 until September 2020 in Montpellier University Hospital were retrospectively collected from a single institutional database. RESULTS After a median follow-up of 48 months (IQR25-75 31-59), data from 1546 consecutive KT were collected. 83 patients underwent 99 incisional hernia surgeries after KT, with 14 patients that had one recurrence (14.4%) and 2 patients that experienced two recurrences (2.4%). Total recurrence rate was 16.8%. At univariate analysis, the only factor associated with an incisional hernia recurrence was having undergone to at least one previous abdominal surgery other than KT (p value 0.002). Overall morbidity was 15% (n = 15), with most of complications classified as mild (59%). No mortality related to incisional hernia repair occurred. CONCLUSION IHs after KT represent an important condition. Its surgical management is challenging due to its anatomical complexity and patient's status. This is the largest sample size in the literature of patients treated for IH after KT and it shows that a previous surgery other than the KT is a risk factor for hernia recurrence after surgical repair, without regarding surgical technique or other comorbidity and therapeutical factors.
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Affiliation(s)
- Gianluca Cassese
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Antonio Castaldi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.,Department of HPB Surgery and Liver Transplantation, Montpellier University Hospital-School of Medicine, 34000, Montpellier, France
| | - Bader Al Taweel
- Department of HPB Surgery and Liver Transplantation, Montpellier University Hospital-School of Medicine, 34000, Montpellier, France
| | - Moglie Le Quintrec
- Department of Nephrology and Kidney Transplantation, Montpellier University Hospital, Montpellier, France
| | - Rodolphe Thuret
- Department of Urology and Kidney Transplantation, Montpellier University Hospital, Montpellier, France
| | - Francis Navarro
- Department of HPB Surgery and Liver Transplantation, Montpellier University Hospital-School of Medicine, 34000, Montpellier, France
| | - Fabrizio Panaro
- Department of HPB Surgery and Liver Transplantation, Montpellier University Hospital-School of Medicine, 34000, Montpellier, France.
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3
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Incisional Hernia Repaired Using Thigh Muscle Fascia After Kidney Transplantation: A Case Report. Transplant Proc 2022; 54:533-536. [PMID: 35033368 DOI: 10.1016/j.transproceed.2021.09.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 09/28/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although monofilament mesh-based repair is a safe and effective procedure for incisional hernia (IH) in organ transplant patients, there is no definite evidence of IH treatment for patients with graft rejection and enhanced immunosuppressive therapy. We report a successful case of large IH repair using an autologous thigh muscle fascia sheet in a kidney transplant patient. CASE PRESENTATION A 69-year-old man had IH from the incision of kidney transplantation, which was performed 6 years ago. He had a large right lower abdominal distension hanging down to the inguinal portion. A computed tomography scan revealed a large IH with a maximum abdominal defect diameter of 15 cm. The hernia sac contained the intestine, colon, and transplanted kidney, which had pulled out along with the retroperitoneum and protruded into the abdominal wall. He had chronic active acute antibody-mediated rejection, which required frequent steroid pulse therapy and additional or adjusted immunosuppressive drugs. After total circumferential exposure of the hernia sac and abdominal fascia, the abdominal wall defect was closed using a horizontal mattress suture. The sutured line was covered with a thigh muscle fascia sheet harvested from the patient's right femur and attached to the closed fascia. He was discharged on postoperative day 13 without any complications, and no IH recurrence was observed 10 months after surgery. CONCLUSIONS Hernia repair using autologous tissue could be a treatment option for post-transplant IH with a higher risk of infection.
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4
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Pérez-Köhler B, Benito-Martínez S, Gómez-Gil V, Rodríguez M, Pascual G, Bellón JM. New Insights into the Application of 3D-Printing Technology in Hernia Repair. MATERIALS 2021; 14:ma14227092. [PMID: 34832493 PMCID: PMC8623842 DOI: 10.3390/ma14227092] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 12/29/2022]
Abstract
Abdominal hernia repair using prosthetic materials is among the surgical interventions most widely performed worldwide. These materials, or meshes, are implanted to close the hernial defect, reinforcing the abdominal muscles and reestablishing mechanical functionality of the wall. Meshes for hernia repair are made of synthetic or biological materials exhibiting multiple shapes and configurations. Despite the myriad of devices currently marketed, the search for the ideal mesh continues as, thus far, no device offers optimal tissue repair and restored mechanical performance while minimizing postoperative complications. Additive manufacturing, or 3D-printing, has great potential for biomedical applications. Over the years, different biomaterials with advanced features have been successfully manufactured via 3D-printing for the repair of hard and soft tissues. This technological improvement is of high clinical relevance and paves the way to produce next-generation devices tailored to suit each individual patient. This review focuses on the state of the art and applications of 3D-printing technology for the manufacture of synthetic meshes. We highlight the latest approaches aimed at developing improved bioactive materials (e.g., optimizing antibacterial performance, drug release, or device opacity for contrast imaging). Challenges, limitations, and future perspectives are discussed, offering a comprehensive scenario for the applicability of 3D-printing in hernia repair.
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Affiliation(s)
- Bárbara Pérez-Köhler
- Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, 28805 Alcalá de Henares, Spain; (B.P.-K.); (S.B.-M.)
- Biomedical Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, Spain; (V.G.-G.); (M.R.); (J.M.B.)
- Ramón y Cajal Health Research Institute (IRYCIS), 28034 Madrid, Spain
| | - Selma Benito-Martínez
- Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, 28805 Alcalá de Henares, Spain; (B.P.-K.); (S.B.-M.)
- Biomedical Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, Spain; (V.G.-G.); (M.R.); (J.M.B.)
- Ramón y Cajal Health Research Institute (IRYCIS), 28034 Madrid, Spain
| | - Verónica Gómez-Gil
- Biomedical Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, Spain; (V.G.-G.); (M.R.); (J.M.B.)
- Departamento de Cirugía, Ciencias Médicas y Sociales, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, 28805 Alcalá de Henares, Spain
- Departamento de Ciencias Biomédicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, 28805 Alcalá de Henares, Spain
| | - Marta Rodríguez
- Biomedical Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, Spain; (V.G.-G.); (M.R.); (J.M.B.)
- Ramón y Cajal Health Research Institute (IRYCIS), 28034 Madrid, Spain
- Departamento de Cirugía, Ciencias Médicas y Sociales, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, 28805 Alcalá de Henares, Spain
| | - Gemma Pascual
- Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, 28805 Alcalá de Henares, Spain; (B.P.-K.); (S.B.-M.)
- Biomedical Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, Spain; (V.G.-G.); (M.R.); (J.M.B.)
- Ramón y Cajal Health Research Institute (IRYCIS), 28034 Madrid, Spain
- Correspondence:
| | - Juan Manuel Bellón
- Biomedical Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, Spain; (V.G.-G.); (M.R.); (J.M.B.)
- Ramón y Cajal Health Research Institute (IRYCIS), 28034 Madrid, Spain
- Departamento de Cirugía, Ciencias Médicas y Sociales, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, 28805 Alcalá de Henares, Spain
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Gioco R, Sanfilippo C, Veroux P, Corona D, Privitera F, Brolese A, Ciarleglio F, Volpicelli A, Veroux M. Abdominal wall complications after kidney transplantation: A clinical review. Clin Transplant 2021; 35:e14506. [PMID: 34634148 PMCID: PMC9285099 DOI: 10.1111/ctr.14506] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/06/2021] [Accepted: 10/06/2021] [Indexed: 12/16/2022]
Abstract
Introduction Abdominal wall complications are common after kidney transplantation, and although they have a minor impact on patient and graft survival, they increase the patient's morbidity and may have an impact on quality of life. Abdominal wall complications have an overall incidence of 7.7–21%. Methods This review will explore the natural history of abdominal wall complications in the kidney transplant setting, with a special focus on wound dehiscence and incisional herni, with a particular emphasis on risk factors, clinical characteristics, and treatment. Results Many patient‐related risk factors have been suggested, including older age, obesity, and smoking, but kidney transplant recipients have an additional risk related to the use of immunosuppression. Wound dehiscence usually does not require surgical intervention. However, for deep dehiscence involving the fascial layer with concomitant infection, surgical treatment and/or negative pressure wound therapy may be required. Conclusions Incisional hernia (IH) may affect 1.1–18% of kidney transplant recipients. Most patients require surgical treatment, either open or laparoscopic. Mesh repair is considered the gold standard for the treatment of IH, since it is associated with a low rate of postoperative complications and an acceptable rate of recurrence. Biologic mesh could be an attractive alternative in patients with graft exposition or infection.
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Affiliation(s)
- Rossella Gioco
- General Surgery Unit, University Hospital of Catania, Catania, Italy
| | | | | | - Daniela Corona
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | | | | | | | | | - Massimiliano Veroux
- General Surgery Unit, University Hospital of Catania, Catania, Italy.,Organ Transplant Unit, University Hospital of Catania, Catania, Italy
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6
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Mei T, Noguchi H, Otsu K, Shimada Y, Sato Y, Hisadome Y, Kaku K, Okabe Y, Nakamura M. Risk Factors and Optimal Methods for Incisional Hernias After Kidney Transplantation: A Single-Center Experience From Asia. Transplant Proc 2021; 53:1048-1054. [PMID: 33726941 DOI: 10.1016/j.transproceed.2021.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/08/2021] [Accepted: 02/10/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND For kidney transplant patients, incisional hernia (IH) is a major complication resulting from prolonged pretransplant dialysis, immunosuppressive drugs, and the high prevalence of diabetes. However, there have been relatively few studies of IH after kidney transplantation (KT) in Japan and in the greater Asian population. Additionally, operative methods for IH repair have not been established. METHODS We retrospectively analyzed 465 consecutive patients who underwent KT at our hospital from April 2013 to March 2019. Patients who underwent incisional hernia repair were included in this study, and the follow-up time was extended to September 2020. We defined severe IH as an IH requiring surgical repair. We examine the risk factors for severe IH among KT patients and also discuss the operative methods of IH repair. RESULTS During the study period, 7 patients developed severe IH after KT. The cumulative occurrence rate for severe IH was 1.1% 1 year postoperatively. Multivariate logistic regression analyses showed that age at KT and dialysis duration (hazard ratio = 1.112, P = .016; hazard ratio = 1.106, respectively; P = .038) were independent risk factors for severe IH. We used polypropylene mesh for IH repair in all cases, with onlay repair performed in 5 of 7 cases. There was no recurrence or infection after mesh repair during follow-up. CONCLUSIONS In this study, age at KT and dialysis duration were independent risk factors for severe IH in the Japanese population. Onlay repair with a polypropylene mesh appeared to be a safe and acceptable operation for IH repair after KT.
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Affiliation(s)
- Takanori Mei
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroshi Noguchi
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kanae Otsu
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuki Shimada
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yu Sato
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yu Hisadome
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keizo Kaku
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuhiro Okabe
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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7
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Lee LD, Stroux A, Nickisch D, Wröbel L, Aschenbrenner K, Weixler B, Kreis ME, Lauscher JC. Operative outcome of hernia repair with synthetic mesh in immunocompromised patients. ANZ J Surg 2020; 90:2248-2253. [DOI: 10.1111/ans.16212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 07/14/2020] [Accepted: 07/19/2020] [Indexed: 01/29/2023]
Affiliation(s)
- Lucas D. Lee
- Department of General, Visceral and Vascular Surgery Charité University Medicine Berlin, Campus Benjamin Franklin Berlin Germany
| | - Andrea Stroux
- Institute for Biometrics and Epidemiology Charité University Medicine Berlin, Campus Benjamin Franklin Berlin Germany
| | - Daniela Nickisch
- Practice of Gynecology and Obstetrics Practice Kadgien/Stuttmann Berlin Germany
| | - Lea Wröbel
- Department of General, Visceral and Vascular Surgery Charité University Medicine Berlin, Campus Benjamin Franklin Berlin Germany
| | - Katja Aschenbrenner
- Department of General, Visceral and Vascular Surgery Charité University Medicine Berlin, Campus Benjamin Franklin Berlin Germany
| | - Benjamin Weixler
- Department of General, Visceral and Vascular Surgery Charité University Medicine Berlin, Campus Benjamin Franklin Berlin Germany
| | - Martin E. Kreis
- Department of General, Visceral and Vascular Surgery Charité University Medicine Berlin, Campus Benjamin Franklin Berlin Germany
| | - Johannes C. Lauscher
- Department of General, Visceral and Vascular Surgery Charité University Medicine Berlin, Campus Benjamin Franklin Berlin Germany
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8
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Martínez-Hoed J, Bonafe Diana S, Torregrosa-Gallud A, García Pastor P, Abelló Audi D, Menéndez-Jiménez de Zavada Y Lissón M, Carbonell Tatay F, Bueno-Lledó J. Incisional hernia repair outcome after renal transplantation in a reference center. Our experience of 7 years. Cir Esp 2019; 98:350-356. [PMID: 31785777 DOI: 10.1016/j.ciresp.2019.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/01/2019] [Accepted: 10/10/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Incisional hernias secondary to renal transplantation (IHRT) are considered complex hernias because they are lateral to the sheath of the rectus abdominis muscle. The presence of the graft in the iliac fossa and the proximity to the inguinal area, costal margin and iliac bones, as zones with difficult fixation for prostheses, increases repair complexity. In addition, these patients have specific characteristics, such as treatment with immunosuppressive medication, that could alter postoperative evolution. The objective of this study was to analyze the results obtained in IHRT repair at a tertiary hospital, and to compare these data with the international literature. METHODS Retrospective observational study of patients treated surgically for IHRT in our unit from January 1, 2011 to January 31, 2018. Preoperative conditions, intraoperative factors and postoperative complications during follow-up were analyzed. RESULTS Twenty-five patients underwent hernia repair, finding a 4% hernia recurrence rate during a median follow-up of 27.5 months (20-39). The most frequently used technique was the posterior transversus abdominis release component separation technique in 42%, followed by preperitoneal repair in 27% and interoblique repair in 12%. The overall postoperative morbidity was 23%, which was frequently related to the surgical site (12%). CONCLUSIONS IHRT repair is a safe procedure at our medical center, with an acceptable rate of hernia recurrence, but it is not without complications.
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Affiliation(s)
- Jesús Martínez-Hoed
- Unidad de Cirugía de Pared Abdominal y Corta Estancia, Hospital Politécnico y Universitario La Fe, Valencia, España.
| | - Santiago Bonafe Diana
- Unidad de Cirugía de Pared Abdominal y Corta Estancia, Hospital Politécnico y Universitario La Fe, Valencia, España
| | - Antonio Torregrosa-Gallud
- Unidad de Cirugía de Pared Abdominal y Corta Estancia, Hospital Politécnico y Universitario La Fe, Valencia, España
| | - Providencia García Pastor
- Unidad de Cirugía de Pared Abdominal y Corta Estancia, Hospital Politécnico y Universitario La Fe, Valencia, España
| | - David Abelló Audi
- Unidad de Cirugía de Pared Abdominal y Corta Estancia, Hospital Politécnico y Universitario La Fe, Valencia, España
| | | | | | - José Bueno-Lledó
- Unidad de Cirugía de Pared Abdominal y Corta Estancia, Hospital Politécnico y Universitario La Fe, Valencia, España
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Damiano G, Palumbo VD, Fazzotta S, Buscemi S, Ficarella S, Maffongelli A, Buscemi G, Lo Monte AI. Laparoscopic Repair of Boundary Incisional Hernia in a Kidney Transplant Patient: A Safe Tacks-Fibrin Glue Combined Mesh Fixation Technique. Transplant Proc 2019; 51:215-219. [PMID: 30655152 DOI: 10.1016/j.transproceed.2018.04.084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 04/13/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Incisional hernia in renal transplant patients is a complication that negatively affects the global outcome of transplant and quality of life. The repair of this condition was classically made by open repair with mesh. Increasing evidence suggests that laparoscopic repair could be advocated as the technique of choice in these patients with optimal results. However, the fixation of mesh should be performed by a mixed combination of fibrin sealant (lateral margin of wall defect) and tacks (medial margin). The tacks fixation of the mesh along the lateral margin of the wall defect, close to the graft, is generally difficult for the small size of the remaining aponeurotic plane and dangerous for the underlying presence of the graft. MATERIALS AND METHODS A case of incisional hernia in a kidney transplant recipient was repaired by laparoscopic mesh technique. The polypropylene-polyglycolic acid composite mesh was fastened with a mixed technique of absorbable tacks for medial margin of the defect and fibrin sealant for the lateral side in contiguity with graft surface. RESULTS The patient was discharged after 4 days. The 6-month follow-up did not show mesh displacement or recurrence of hernia. CONCLUSIONS The laparoscopic mesh repair may become the criterion standard for kidney transplant patients affected by incisional hernia. The difficulties of mesh fixation close to the graft can be overcome by the combination of fibrin sealant glue and absorbable tacks at different margins of the wall defect. This technique may offer advantages for this population of patients.
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Affiliation(s)
- G Damiano
- Department of Surgical, Oncological and Oral Sciences, Università degli Studi di Palermo, Palermo, Italy.
| | - V D Palumbo
- Department of Surgical, Oncological and Oral Sciences, Università degli Studi di Palermo, Palermo, Italy
| | - S Fazzotta
- Department of Surgical, Oncological and Oral Sciences, Università degli Studi di Palermo, Palermo, Italy
| | - S Buscemi
- Department of Surgical, Oncological and Oral Sciences, Università degli Studi di Palermo, Palermo, Italy
| | - S Ficarella
- Department of Surgical, Oncological and Oral Sciences, Università degli Studi di Palermo, Palermo, Italy
| | - A Maffongelli
- Department of Surgical, Oncological and Oral Sciences, Università degli Studi di Palermo, Palermo, Italy
| | - G Buscemi
- Department of Surgical, Oncological and Oral Sciences, Università degli Studi di Palermo, Palermo, Italy
| | - A I Lo Monte
- Department of Surgical, Oncological and Oral Sciences, Università degli Studi di Palermo, Palermo, Italy
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10
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Optimal surgical management in kidney and pancreas transplantation to minimise wound complications: A systematic review and meta-analysis. Ann Med Surg (Lond) 2018; 33:24-31. [PMID: 30167299 PMCID: PMC6108074 DOI: 10.1016/j.amsu.2018.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 08/13/2018] [Indexed: 01/18/2023] Open
Abstract
Background Immunosuppression in transplant patients increases the risk of wound complications. However, an optimal surgical approach to kidney and pancreas transplantation can minimise this risk. Materials and methods We performed a systematic review and meta-analysis to examine factors contributing to incisional hernia formation in kidney and pancreas transplant recipients. Bias appraisal of studies was conducted via the Newcastle-Ottawa scale. We considered recipient factors, surgical methods, and complications of repair. Results The rate of incisional hernia formation in recipients of kidney and pancreas transplants was 4.4% (CI 95% 2.6-7.3, p < 0.001). Age above or below 50 years did not predict hernia formation (Q (1) = 0.09, p = 0.77). Body mass index (BMI) above 25 (10.8%, CI 95% 3.2-30.9, p < 0.001) increased the risk of an incisional hernia. Mycophenolate mofetil (MMF) use significantly reduced the risk of incisional hernia from 11.9% (CI 95% 4.3-28.7, p < 0.001) to 3.8% (CI 95% 2.5-5.7, p < 0.001), Q (1) = 4.25, p = 0.04. Sirolimus significantly increased the rate of incisional hernia formation from 3.7% (CI 95% 1.7-7.1, p < 0.001) to 18.1% (CI 95% 11.7-27, p < 0.001), Q (1) = 13.97, p < 0.001. While paramedian (4.1% CI 95% 1.7-9.4, p < 0.001) and Rutherford-Morrison incisions (5.6% CI 95% 2.5-11.7, p < 0.001) were associated with a lower rate of hernia compared to hockey-stick incisions (8.5% CI 95% 3.1-21.2, p < 0.001) these differences were not statistically significant (Q (1) = 1.38, p = 0.71). Single layered closure (8.1% CI 95% 4.9-12.8, p < 0.001) compared to fascial closure (6.1% CI 95% 3.4-10.6, p < 0.001) did not determine the rate of hernia formation [Q (1) = 0.55, p = 0.46]. Conclusions Weight reduction and careful immunosuppression selection can reduce the risk of a hernia. Rutherford-Morrison incisions along with single-layered closure represent a safe and effective technique reducing operating time and costs.
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Simson N, Samuel P, Stonier T, Halligan S, Windsor A. Incisional Hernia in Renal Transplant Recipients: A Systematic Review. Am Surg 2018. [DOI: 10.1177/000313481808400644] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Incisional hernia follows midline laparotomy in 8 to 20 per cent of cases, but the rate following lateral incision is not well documented. This systematic review summarizes incisional hernia rate after open renal transplant. We searched EMBASE, MEDLINE, and the Cochrane Library databases from January 2000 to November 2016 inclusive. The outcomes included in our analysis were the posttransplant incisional hernia rate, significant patient risk factors for incisional hernia, the definition of incisional hernia used, the method used to detect incisional hernia, and the incision used for transplantation. Eight retrospective case series were identified, three describing renal transplant recipients and five describing incisional hernia repairs postrenal transplant. All reported the incisional hernia rate postrenal transplant at the host institution. The hernia rate ranged from 1.1 to 7.0 per cent, with a mean of 3.2 per cent. Factors associated with incisional hernia were body mass index >30, age >50, cadaveric graft, and reoperation through the same incision. Despite the significant comorbidity of renal transplant recipients, the incisional hernia rate postrenal transplant is significantly lower than that of post-midline laparotomy. The reasons for this are discussed. This demonstrates the importance of operative technique, local tissue quality and biomechanical factors in the formation of incisional hernia.
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Affiliation(s)
- Nick Simson
- Department of Urology, Princess Alexandra Hospital NHS Trust, Harlow, Essex, United Kingdom and
| | - Parker Samuel
- University College London Hospital, London, United Kingdom
| | - Thomas Stonier
- Department of Urology, Princess Alexandra Hospital NHS Trust, Harlow, Essex, United Kingdom and
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El-Kader AA, Ali H. The outcome of using a prosthetic mesh in the repair of emergent abdominal midline incisional hernias: a prospective comparative study. THE EGYPTIAN JOURNAL OF SURGERY 2018; 37:147. [DOI: 10.4103/ejs.ejs_96_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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13
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LÓPez-Cano M, Teresa Quiles M, Antonio Pereira J, Armengol-Carrasco M, ArbÓ S VÍA MA. Complex Abdominal Wall Hernia Repair in Contaminated Surgical Fields: Factors Affecting the Choice of Prosthesis. Am Surg 2017. [DOI: 10.1177/000313481708300622] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To compare patients with complex abdominal wall hernias undergoing surgical repair using synthetic nonabsorbable or biologic meshes in contaminated fields. Retrospective review of 62 patients with complex abdominal wall hernia with surgical repair in an elective setting and in the context of a clean-contaminated or contaminated fields (January 2009–April 2015). Two groups according to the prosthesis (synthetic nonabsorbable, n = 48 or biologic, n = 14). Mean follow-up was 24.6 (15.8) months. Clean-contaminated wounds were significantly more frequent in the synthetic group. Contaminated wounds were significantly more frequent in the biologic group. Enterocutaneous fistula, recurrent hernia, and removal of chronic infected mesh were significantly more frequently in the biologic group. Differences in postoperative complications and surgical site infections were not found. Recurrence was higher in the biologic group (35.7% vs 8.3%, P = 0.03). In the elective repair of complex hernia, the level of contamination, a recurrent hernia, an enterocutaneous fistula or removal of chronic infected mesh were the factors affecting the choice of prosthesis. In the clean-contaminated setting, the use of a synthetic nonabsorbable mesh versus a biologic mesh did not increase the rate of postoperative infections. Recurrences are significantly higher with biologic meshes.
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Affiliation(s)
- Manuel LÓPez-Cano
- Abdominal Wall Surgery Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- General and Digestive Surgery Research Group, Institut de Reserca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - MarÍA Teresa Quiles
- General and Digestive Surgery Research Group, Institut de Reserca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Antonio Pereira
- Departament de Ciències Experimentals i de la Salut, Servei de Cirurgia General, Hospital del Mar, Parc de Salut Mar, Universitat Pompeu Fabra, Barcelona, Spain
| | - Manuel Armengol-Carrasco
- Abdominal Wall Surgery Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- General and Digestive Surgery Research Group, Institut de Reserca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - MarÍA Antonia ArbÓ S VÍA
- General and Digestive Surgery Research Group, Institut de Reserca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Complications chirurgicales de la transplantation rénale. Prog Urol 2016; 26:1066-1082. [DOI: 10.1016/j.purol.2016.09.052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 08/29/2016] [Accepted: 09/01/2016] [Indexed: 12/13/2022]
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Polypropylene-based composite mesh versus standard polypropylene mesh in the reconstruction of complicated large abdominal wall hernias: a prospective randomized study. Hernia 2016; 20:691-700. [PMID: 27507403 DOI: 10.1007/s10029-016-1526-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 07/29/2016] [Indexed: 12/18/2022]
Abstract
PURPOSE To compare polypropylene mesh positioned onlay supported by omentum and/or peritoneum versus inlay implantation of polypropylene-based composite mesh in patients with complicated wide-defect ventral hernias. METHODS This was a prospective randomized study carried out on 60 patients presenting with complicated large ventral hernia in the period from January 2012 to January 2016 in the department of Gastrointestinal Surgery unit and Surgical Emergency of the Main Alexandria University Hospital, Egypt. Large hernia had an abdominal wall defect that could not be closed. Patients were divided into two groups of 30 patients according to the type of mesh used to deal with the large abdominal wall defect. RESULTS The study included 38 women (63.3 %) and 22 men (37.7 %); their mean age was 46.5 years (range, 25-70). Complicated incisional hernia was the commonest presentation (56.7 %).The operative and mesh fixation times were longer in the polypropylene group. Seven wound infections and two recurrences were encountered in the propylene group. Mean follow-up was 28.7 months (2-48 months). CONCLUSIONS Composite mesh provided, in one session, satisfactory results in patients with complicated large ventral hernia. The procedure is safe and effective in lowering operative time with a trend of low wound complication and recurrence rates.
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Use of Mesh During Ventral Hernia Repair in Clean-contaminated and Contaminated Cases: Outcomes of 33,832 Cases. Ann Surg 2016; 263:e47. [PMID: 25371119 DOI: 10.1097/sla.0000000000001022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Petro CC, Orenstein SB, Criss CN, Sanchez EQ, Rosen MJ, Woodside KJ, Novitsky YW. Transversus abdominis muscle release for repair of complex incisional hernias in kidney transplant recipients. Am J Surg 2015; 210:334-9. [DOI: 10.1016/j.amjsurg.2014.08.043] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Revised: 08/24/2014] [Accepted: 08/28/2014] [Indexed: 10/24/2022]
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Luc G, David A, Couzi L, Midy D, Collet D, Dubuisson V. Lateral incisional hernia after renal transplantation: a comparative study. World J Surg 2015; 38:2791-6. [PMID: 25015726 DOI: 10.1007/s00268-014-2689-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Because of the lack of published data and the relative rarity of lateral incisional hernias (LIHs), especially after renal transplantation, mesh repair of LIH remains a challenge for surgeons. The aim of the present study was to evaluate the outcomes of LIH treated by mesh repair after renal transplantation. METHODS All consecutive patients who had undergone LIH mesh repair after renal transplantation were compared with patients who had undergone LIH mesh repair without renal transplantation. Demographic data, incisional hernia characteristics, operative data, and postoperative outcomes were prospectively recorded. Early complications and recurrence rates were evaluated. RESULTS Altogether, 112 patients were treated for LIH with mesh repair. Among these patients, 61 (54.4 %) underwent LIH after renal transplantation. The early complications were similar for the patients with and without renal transplantation (24.5 vs. 23.5 %, respectively; p = 0.896). The recurrence rates also were similar for the patients with and without renal transplantation (9.8 vs. 9.8 %, respectively; p = 1). CONCLUSIONS Mesh graft repair is feasible in patients with LIH after renal transplantation. Postoperative complications and recurrences were not more frequent in renal transplantation patients than in those without renal transplantation.
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Affiliation(s)
- Guillaume Luc
- Department of Digestive Surgery, Maison du Haut-Lévêque, University Hospital of Bordeaux, Avenue de Magellan, 33604, Pessac cedex, France,
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López-Cano M, Pereira JA, Villanueva B, Vallribera F, Espin E, Armengol Carrasco M, Arbós Vía MA, Feliu X, Morales-Conde S. Abdominal wall closure after a stomal reversal procedure. Cir Esp 2014; 92:387-92. [PMID: 24581880 DOI: 10.1016/j.ciresp.2014.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 12/06/2013] [Accepted: 01/09/2014] [Indexed: 12/17/2022]
Abstract
The closure of a temporary stoma involves 2 different surgical procedures: the stoma reversal procedure and the abdominal wall reconstruction of the stoma site. The management of the abdominal wall has different areas that should be analyzed such us how to avoid surgical site infection (SSI), the technique to be used in case of a concomitant hernia at the stoma site or to prevent an incisional hernia in the future, how to deal with the incision when the stoma reversal procedure is performed by laparoscopy and how to close the skin at the stoma site. The aim of this paper is to analyze these aspects in relation to abdominal wall reconstruction during a stoma reversal procedure.
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Affiliation(s)
- Manuel López-Cano
- Cirugía de la Pared Abdominal, Servicio de Cirugía General y Digestiva, Hospital Universitario Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, España; Grupo de Investigación de Cirugía General y Digestiva, Pared Abdominal, Biomateriales, Institut de Recerca Vall d'Hebrón (IRVH), Edificio Collserola; Lab 211A, Barcelona, España.
| | - José Antonio Pereira
- Departament de Ciéncies Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, España
| | - Borja Villanueva
- Cirugía de la Pared Abdominal, Servicio de Cirugía General y Digestiva, Hospital Universitario Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, España
| | - Francesc Vallribera
- Cirugía Colorrectal, Servicio de Cirugía General y Digestiva, Hospital Universitario Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, España
| | - Eloy Espin
- Cirugía Colorrectal, Servicio de Cirugía General y Digestiva, Hospital Universitario Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, España
| | - Manuel Armengol Carrasco
- Cirugía de la Pared Abdominal, Servicio de Cirugía General y Digestiva, Hospital Universitario Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, España; Grupo de Investigación de Cirugía General y Digestiva, Pared Abdominal, Biomateriales, Institut de Recerca Vall d'Hebrón (IRVH), Edificio Collserola; Lab 211A, Barcelona, España
| | - María Antonia Arbós Vía
- Grupo de Investigación de Cirugía General y Digestiva, Pared Abdominal, Biomateriales, Institut de Recerca Vall d'Hebrón (IRVH), Edificio Collserola; Lab 211A, Barcelona, España
| | - Xavier Feliu
- Servicio de Cirugía General, Hospital General d'Igualada, Igualada, Barcelona, España
| | - Salvador Morales-Conde
- Unidad de Innovación en Cirugía Mínimamente Invasiva, Hospital Universitario Virgen del Rocío, Sevilla, España
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López-Cano M, Pereira JA, Armengol-Carrasco M. “Acute postoperative open abdominal wall”: Nosological concept and treatment implications. World J Gastrointest Surg 2013; 5:314-320. [PMID: 24392182 PMCID: PMC3879415 DOI: 10.4240/wjgs.v5.i12.314] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 08/02/2013] [Accepted: 10/16/2013] [Indexed: 02/06/2023] Open
Abstract
The so-called “burst abdomen” has been described for many years and is a well-known clinical condition, whereas the concept of the “open abdomen” is relatively new. In clinical practice, both nosological entities are characterized by a complex spectrum of symptoms apparently disconnected, which in many cases poses a great challenge for surgical repair. In order to assess the management of these disorders in a more comprehensive and integral fashion, the concept of “acute postoperative open abdominal wall” (acute POAW) is presented, which in turn can be divided into “intentional” or planned acute POAW and “unintentional” or unplanned POAW. The understanding of the acute POAW as a single clinical process not only allows a better optimization of the therapeutic approach in the surgical repair of abdominal wall-related disorders, but also the stratification and collection of data in different patient subsets, favoring a better knowledge of the wide spectrum of conditions involved in the surgical reconstruction of the abdominal wall.
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Carbonell AM, Cobb WS. Safety of Prosthetic Mesh Hernia Repair in Contaminated Fields. Surg Clin North Am 2013; 93:1227-39. [DOI: 10.1016/j.suc.2013.06.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Abstract
BACKGROUND Biologic grafts hold promise of a durable repair for ventral hernias with the potential for fewer complications than synthetic mesh. This systematic review was performed to evaluate the effectiveness and safety of biologic grafts for ventral hernia repair. METHODS MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched for studies on biologic grafts for the repair of ventral hernias. Outcomes are presented as weighted pooled proportions. RESULTS Twenty-five retrospective studies were included. Recurrence depended on wound class, with an overall rate of 13.8% (95% confidence interval [CI], 7.6-21.3). The recurrence rate in contaminated/dirty repairs was 23.1% (95% CI, 11.3-37.6). Abdominal wall laxity occurred in 10.5% (95% CI, 3.7-20.3) of patients. The surgical morbidity rate was 46.3% (95% CI, 33.3-59.6). Infection occurred in 15.9% (95% CI, 9.8-23.2) of patients but only led to graft removal in 4.9% of cases. CONCLUSIONS No randomized trials are available to properly evaluate biologic grafts for ventral hernia repair. The current evidence suggests that biologic grafts perform similarly to other surgical options. Biologic grafts are associated with a high salvage rate when faced with infection.
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Abd Ellatif ME, Negm A, Elmorsy G, Al-Katary M, Yousef AEAM, Ellaithy R. Feasibility of mesh repair for strangulated abdominal wall hernias. Int J Surg 2012; 10:153-6. [PMID: 22343572 DOI: 10.1016/j.ijsu.2012.02.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 01/23/2012] [Accepted: 02/02/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND Prosthetic mesh reduces the risk of hernia recurrence. The use of mesh in patients with strangulated hernias requiring bowel resection is controversial. PATIENTS AND METHODS Patients with acutely incarcerated hernias (with small intestine contents) who underwent polypropylene mesh hernioplasty were included in this prospective study from June 2005 to Jan. 2011. RESULTS 163 patients were included; 48 required intestinal resection and anastomosis (Group I) and 115 did not (Group II). Operative times and hospital stay were longer in Group I (P = 0.001). No significant difference was noted between both groups in terms of postoperative morbidities (16.6% vs 13% P = 0.5), wound infection (6% vs 4% P = 0.6), and recurrence rate (2% vs 2.8% P = 0.8), All cases of wound infection were successfully managed with drainage and local wound care and no mesh had to be removed. One patient in Group I and five patients in Group II died of concomitant diseases in the follow-up period (P = 0.5). CONCLUSION Mesh hernioplasty is crucial to prevent recurrence, and it is safe to utilize it in repair of acutely incarcerated hernias even if associated with intestinal resection.
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Affiliation(s)
- Mohamed E Abd Ellatif
- General Surgical Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
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Lopes RI. Laparoscopic elective colonic operation and concomitant abdominall wall hernia prosthetic repair: safe and feasible? J Surg Tech Case Rep 2011; 3:5-6. [PMID: 22022643 PMCID: PMC3192524 DOI: 10.4103/2006-8808.78460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Roberto Iglesias Lopes
- Department of Surgery and Urology, University of São Paulo Medical School, São Paulo, Brazil E-mail:
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Yannam GR, Gutti TL, High R, Stevens RB, Thompson JS, Morris MC. Experience of laparoscopic incisional hernia repair in kidney and/or pancreas transplant recipients. Am J Transplant 2011; 11:279-86. [PMID: 21272235 DOI: 10.1111/j.1600-6143.2010.03351.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Despite the wide popularity of laparoscopic incisional hernia repair (LIHR) in the nontransplant population, there are very few reports of LIHR available in abdominal organ transplant patients and none exclusively on kidney and/or pancreas (KP) transplant patients. We retrospectively reviewed a consecutive series of LIHR in KP transplant recipients performed over a period of 4 years and compared the results with LIHR in non-transplant patients during the same period. A total of 36 transplant patients were compared with 62 nontransplant patients. There were five patients converted to the open procedure in the transplant and four in nontransplant patients (p-NS). There were three seromas and one patient had a bowel perforation in the transplant group versus eight seromas, one bowel perforation and one small bowel obstruction noted in the nontransplant group. One patient in each group had a mesh infection requiring explant. Patients were followed up for a mean period of 2.2 years in the transplant group and 3 years in the nontransplant group. Overall there were five recurrences in the transplant group and four in the nontransplant group (p = NS). These results suggest that that LIHR is a safe and effective alternative to open repair.
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Affiliation(s)
- G R Yannam
- Transplant Surgery Division Department of Pharmacology Department of Public Health and Statistics Department of General Surgery, University of Nebraska Medical Center, Omaha, NE, USA
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Nieuwenhuizen J, van Ramshorst GH, ten Brinke JG, de Wit T, van der Harst E, Hop WCJ, Jeekel J, Lange JF. The use of mesh in acute hernia: frequency and outcome in 99 cases. Hernia 2011; 15:297-300. [PMID: 21259032 PMCID: PMC3114066 DOI: 10.1007/s10029-010-0779-4] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 12/31/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Incarceration of inguinal, umbilical and cicatricial hernias is a frequent problem. However, little is known about the relationship between the use of mesh and outcome after surgery. The goal of this study was to describe the relationship between the use of mesh in incarcerated hernia and the clinical outcome. PATIENTS AND METHODS Correspondence, operation reports and patient files between January 1995 and December 2005 of patients presented at one academic and one teaching hospital in Rotterdam were searched for the following keywords: incarceration, strangulation and hernia. The patient characteristics, clinical presentation, pre-operative findings and clinical course were scored and analysed. RESULTS A total of 203 patients could be identified: 76 inguinal, 52 umbilical, 39 incisional, 14 epigastric, 14 femoral, five trocar and three spigelian hernias. In the statistical analysis, epigastric, femoral, trocar and spigelian hernias were pooled, due to their small group sizes. One patient was excluded from the analysis because the hernia was not corrected during operation. In total, 99 hernias were repaired using mesh versus 103 primary suture repairs. Twenty-five wound infections were registered (12.3%). One mesh was removed during a reintervention for anastomotic leakage, although no signs of wound infection were present. Nine patients died, none of them due to wound-related problems [one cardiovascular, one ruptured aneurysm, two anastomotic leakage, two sepsis e causa incognita (e.c.i.), three pulmonary complications]. Univariate analysis showed that female patients (P = 0.007), adipose patients (P = 0.016), patients with an umbilical hernia (P = 0.01) and patients who underwent a bowel resection (P = 0.015) had a significantly higher rate of wound infections. The type of repair (e.g. primary suture or mesh), use of antibiotic prophylaxis, gender, ASA class and age showed no significant relation with post-operative wound infection. After logistic regression analysis, only bowel resection (P = 0.020) showed a significant relation with post-operative wound infection. CONCLUSIONS Wound infection rates are high after the correction of acute hernia, but clinical consequences are relatively low. Mesh correction of an acute hernia seems to be safe and should be considered in every incarcerated hernia.
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Affiliation(s)
- J Nieuwenhuizen
- Department of Surgery, 10M, Erasmus MC, University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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Rice RD, Ayubi FS, Shaub ZJ, Parker DM, Armstrong PJ, Tsai JW. Comparison of Surgisis, AlloDerm, and Vicryl Woven Mesh grafts for abdominal wall defect repair in an animal model. Aesthetic Plast Surg 2010; 34:290-6. [PMID: 19967358 DOI: 10.1007/s00266-009-9449-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Accepted: 11/05/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND Surgisis and AlloDerm, two biosynthetic materials, have been previously used with success in abdominal wall repairs in the setting of contaminated fields. Historically, Vicryl Woven Mesh, a synthetic material, has also been used in such settings as a temporary bridge for abdominal wall reconstruction. This study compares Surgisis and AlloDerm with Vicryl Woven Mesh with respect to tensile strength, collagen remodeling, and neovascularization using a rat hernia model. METHODS A prospective randomized trial of 54 Sprague-Dawley rats were assigned to the Surgisis, AlloDerm, or Vicryl Woven Mesh group with baseline, 30-day, and 60-day end points. A 1.5-cm x 5.0-cm defect was created in the right abdominis rectus muscle and repaired with an underlay bridge graft using the different treatment materials. Tensile strength was measured using an Instron tensiometer. Histologic specimens were evaluated for neovascularization, collagen deposition, and collagen organization at the 30- and 60-day time points. RESULTS Surgisis had significantly greater tensile strength compared to Vicryl Woven Mesh at the baseline time point (0.142 vs. 0.091 MPa, p < 0.05). There were no differences between groups tensile strength at 30 or 60 days postoperatively. The Vicryl Woven Mesh and AlloDerm groups showed increases in tensile strength at 30 days postoperatively versus baseline (p < 0.05). Vicryl Woven Mesh, Surgisis, and AlloDerm all showed increases in tensile strength at 60 days postoperatively compared to 30 days postoperatively and at baseline (p < 0.05). Surgisis and AlloDerm had significantly greater (p < 0.05) amounts of collagen deposition and organization at 30 and 60 days compared to Vicryl Woven Mesh. There was no significant difference between AlloDerm and Surgisis with respect to collagen deposition and organization. Surgisis and AlloDerm showed a significantly greater amount (p < 0.05) of neovascularization than Vicryl Woven Mesh at both time points. In addition, Surgisis had a significantly greater amount (p < 0.05) of neovascularization than AlloDerm at both 30 and 60 days. CONCLUSION Surgisis has increased baseline tensile strength compared to Vicryl Woven Mesh. Tensile strength in Vicryl Woven Mesh is equal to biosynthetic grafts after tissue incorporation. Biosynthetic grafts showed superior collagen deposition and organization. Surgisis mesh showed increased neovascularization over both AlloDerm and Vicryl Woven Mesh.
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Affiliation(s)
- Robert D Rice
- Department of General Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA 30905, USA.
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Lo Monte AI, Damiano G, Maione C, Gioviale MC, Lombardo C, Buscemi G, Romano M. Use of intraperitoneal ePTFE Gore dual-mesh plus in a giant incisional hernia after kidney transplantation: a case report. Transplant Proc 2009; 41:1398-401. [PMID: 19460570 DOI: 10.1016/j.transproceed.2009.02.060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
We evaluated the incidence of and predisposing factors for an incisional hernia after kidney transplantation. Numerous techniques have been used to repair postoperative fascial dehiscences or simple incisional hernias, but no clear treatment exists for giant hernias. Our aim was to obtain (1) a safe procedure to repair a large abdominal defect and reinforce the surrounding, fragile zones and (2) a simple, rapid technique to reduce the operative time. Herein we have described the surgical repair of a giant incisional hernia using intraperitoneal Gore ePTFE dual-mesh plus (Gore-Tex; W. L. Gore, Flagstaff, Ariz, USA) in a 55-year-old man status-post renal transplantation. Total necrosis of distal graft ureter had caused a giant urinoma. The patient was reexplored on day 2 posttransplantation with a primary fascial approximation. Thirty days after transplantation we discovered a large incisional hernia and performed a repair. No drain was used. The patient continued immunosuppressive therapy (cyclosporine, mycophenolate mofetil, prednisolone) and was discharged on postoperative day 4 with no complications. An ultrasonographic follow-up at 1 year revealed the prosthesis to be correctly positioned. Incisional hernia is not rare after renal transplantation but the real incidence is unknown. Immunosuppressive therapy, prolonged pretransplantation dialysis, obesity, and diabetes are probably the major causes of incisional hernias in these patients. Surgical complications of renal transplantation surgery, such as wound hematoma, urinoma, and lymphocele, are the most important predisposing factors for an incisional hernia. The use of intraperitoneal ePTFE dual-mesh is feasible, safe, and easy to repair a large incisional hernia in a kidney transplant patient.
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Affiliation(s)
- A I Lo Monte
- Department of General Surgery, University of Palermo, School of Medicine, Palermo, Italy.
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Implicaciones de los nuevos diseños protésicos de baja densidad en la mejora de la reparación de defectos herniarios. Cir Esp 2009; 85:268-73. [DOI: 10.1016/j.ciresp.2009.01.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Accepted: 01/22/2009] [Indexed: 11/21/2022]
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Mekeel K, Mulligan D, Reddy KS, Moss A, Harold K. Laparoscopic incisional hernia repair after liver transplantation. Liver Transpl 2007; 13:1576-81. [PMID: 17969189 DOI: 10.1002/lt.21290] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Incisional hernias occur in up to 17% of patients after liver transplantation. Laparoscopic ventral hernia repair is associated with fewer wound complications and a decreased incidence of recurrence when compared to open hernia repair in nontransplant patients. This is a retrospective review of 13 patients who underwent laparoscopic incisional hernia repair (LAP group) after liver transplantation compared to 14 patients who had open repairs (OP group; all but one with mesh). Primary immunosuppression in both groups at the time of transplantation was tacrolimus, but more patients in the LAP group were on sirolimus at the time of hernia, while more patients in the OP group were on prednisone at the time of hernia repair. All operations were completed with a laparoscopic approach; there were no conversions to open. Length of stay differed significantly between the 2 groups, with a mean of 5.4 days for the LAP group compared to 2.7 days in the OP group (0.0059). Complications occurred in 2 (15%) of the patients in the LAP group and 5 (36%) in the OP group. One patient in the LAP group required mesh removal to exclude causes of recurrent ascites, and 1 in the OP group for mesh infection. One (7.6%) of the patients in the LAP group developed a recurrence, compared to 29% (4) of the OP group (P =0.3259). In conclusion, laparoscopic incisional hernia repair is safe in patients after liver transplantation, with a low risk of infection or recurrence.
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Affiliation(s)
- Kristin Mekeel
- Division of Transplant Surgery and General Surgery, Mayo Clinic Hospital, Phoenix, AZ 85254, USA.
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Mehrabi A, Fonouni H, Wente M, Sadeghi M, Eisenbach C, Encke J, Schmied BM, Libicher M, Zeier M, Weitz J, Büchler MW, Schmidt J. Wound complications following kidney and liver transplantation. Clin Transplant 2007; 20 Suppl 17:97-110. [PMID: 17100709 DOI: 10.1111/j.1399-0012.2006.00608.x] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Advances in surgical techniques and immunosuppression (IS) have led to an appreciable reduction in postoperative complications following transplantation. However, wound complications as probably the most common type of post-transplantation surgical complication can still limit these improved outcomes and result in prolonged hospitalization, hospital readmission, and reoperation, consequently increasing overall transplant cost. Our aim was to review the literature to delineate the evidence-based risk factors for wound complications following kidney and liver transplantation (KTx, LTx), and to present the preventive and therapeutic modalities for this bothersome morbidity. Generally, wound complications are categorized as superficial and deep wound dehiscences, perigraft fluid collections and seroma, superficial and deep wound infections, cellulitis, lymphocele and wound drainage. The results of several studies showed that the most important risk factors for wound complications are IS and obesity. Additionally, there are surgical and/or technical factors, including type of incision, reoperation, and surgeon's expertise, as well as comorbidities such as advanced age, diabetes mellitus, malnutrition, and uremia. Preventive management of wound complications necessitates defining their etiological factors so that their detrimental effects on healing processes can be addressed and reduced. IS modalities and agents, especially sirolimus (SRL), and steroids (ST) should be adjusted according to the patient's co-existing risk factors. SRL should be administered three months after transplantation and ST should be tapered as soon as possible. A body mass index (BMI) lower than 30 kg/m2 is advisable for inclusion in a transplantation program, but higher BMIs do not exclude recipients. Surgical risk factors can be prevented by applying precise surgical techniques. Therapeutic modalities must focus on the most efficient and cost-effective medications and/or interventions to facilitate and improve wound healing.
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Affiliation(s)
- A Mehrabi
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
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Whiting J. Perioperative concerns for transplant recipients undergoing nontransplant surgery. Surg Clin North Am 2006; 86:1185-94, vi-vii. [PMID: 16962408 DOI: 10.1016/j.suc.2006.06.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
At some time in a general surgeon's career it is likely that they will be asked to care for a surgical problem in a transplant recipient. In many instances, the treating surgeon may opt for transferring the patient to a transplant center more familiar with organ transplant recipients, but at other times transfer may not be the optimal option for the patient. This article is intended to touch on some of the more common situations that a general surgeon in community practice might encounter in dealing with organ transplant recipients, and highlight perioperative and in a few cases, intraoperative, concerns.
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Affiliation(s)
- James Whiting
- Division of Organ Transplantation, Maine Medical Center, 887 Congress Street, Suite 400, Portland, ME 04102, USA.
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Vardanian AJ, Farmer DG, Ghobrial RM, Busuttil RW, Hiatt JR. Incisional hernia after liver transplantation. J Am Coll Surg 2006; 203:421-5. [PMID: 17000384 DOI: 10.1016/j.jamcollsurg.2006.06.017] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2006] [Revised: 06/20/2006] [Accepted: 06/20/2006] [Indexed: 11/21/2022]
Abstract
BACKGROUND Incisional hernia is a potential complication of orthotopic liver transplantation (OLT), with various options for repair. STUDY DESIGN We conducted a retrospective review of a series of adult patients with incisional hernias after OLT to identify risk factors and to compare methods of repair. RESULTS Incisional hernia repair was performed in 44 of 959 patients (4.6%) who underwent OLT from 1999 to 2005. Mean age at time of OLT was 53 years, and 73% were men. One or more complications of OLT occurred in 33 patients (75%) and included reoperation for bile leak or hemoperitoneum (34%), pulmonary problems (27%), early acute rejection (7%), and severe ascites and retransplantation (5% each). Incisional hernia was diagnosed at 419 days (range 62 to 1,524 days) and repaired at 471 days (range 109 to 1,581 days) after OLT. Presentation included pain or discomfort (78%) and incarceration or strangulation (5%); 17% were asymptomatic. Herniorrhaphy techniques included fascial repair with onlay polypropylene mesh reinforcement (n=25, 57%); fascial repair only (n=15, 34%); or inlay mesh sewn to fascial edges (n=4, 9%). Complications of repair included recurrence in seven patients (16%) and wound infection and seroma in one patient each. Recurrence occurred in five patients with primary repair and two with mesh techniques (33% versus 6%, p=0.04). CONCLUSIONS Incisional hernia is a late complication of OLT for which male gender and early post-OLT complications are risk factors. Repair is safe when undertaken after acute problems have resolved and is best accomplished using mesh reinforcement of autologous tissue.
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Affiliation(s)
- Andrew J Vardanian
- Division of Liver and Pancreas Transplantation, Department of Surgery, Dumont-UCLA Transplant Center, David Geffen School of Medicine at UCLA, 650 C.E. Young Drive South, Los Angeles, CA 90095, USA
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