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Taritsa IC, Dumanian GA. Long-term outcomes of open midline ventral hernia repair using a narrow well-fixed retrorectus polypropylene mesh. Hernia 2024:10.1007/s10029-024-03133-6. [PMID: 39214935 DOI: 10.1007/s10029-024-03133-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 08/05/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION The ultimate measure of successful abdominal wall reconstruction is a pain-free, complication-free, and durable hernia repair. Open techniques have generally lost favor, but they still have much to offer for patients with skin deficits and excess. The long-term complication rates for open hernia repairs is unknown. Electronic medical records now provide the ability to easily follow patients who have switched medical institutions. Using this tool, we followed a cohort of abdominal wall reconstruction patients who had an early high "success" rate. METHODS We performed a retrospective chart review of 101 patients who underwent open ventral hernia repair with a narrow well-fixed retrorectus uncoated polypropylene mesh by a single surgeon (GAD) between the years of 2010 and 2015. These patients were initially reported in a 2016 publication. Patients' post-operative follow-up by any medical provider assessing the abdominal region were studied up until August 2023. Patient demographics, operative reports, and postoperative course were re-reviewed. RESULTS A total of 101 patients underwent ventral hernia repair. Mean follow-up time was 7.68 years (range 1.8 - 13.0 years). There were no recurrent hernias across the studied time period and no instances of enterocutaneous fistulas. 15 patients (15%) had abdominal surgery after hernia repair unrelated to their original surgery and 5 patients (5%) reported chronic post-operative pain. 13 patients died in the follow-up period, all unrelated to the abdominal wall surgery. CONCLUSION Open well-fixed narrow retrorectus mesh hernia repairs perform well in the long-term without fistulas, extrusions, and hernia recurrence.
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Affiliation(s)
- Iulianna C Taritsa
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, 259 E Erie St., Suite 20-2060, Chicago, Illinois, 60611, USA
| | - Gregory A Dumanian
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, 259 E Erie St., Suite 20-2060, Chicago, Illinois, 60611, USA.
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2
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Bauer K, Vogel R, Heinzelmann F, Büchler P, Mück B. Robotic-assisted surgery for lateral ventral hernias - experience of robot-assisted methods for retromuscular and preperitoneal abdominal wall reconstruction. Hernia 2024:10.1007/s10029-024-03132-7. [PMID: 39177907 DOI: 10.1007/s10029-024-03132-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 08/05/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Due to the proximity to bony structures and the complex anatomy of the three-layered lateral abdominal wall, the surgical treatment of lateral ventral hernias is technically demanding. With this study we would like to demonstrate how lateral abdominal wall hernias can be treated using new robotic surgical techniques with extraperitoneal mesh placement. OBJECTIVES The purpose of this study is to demonstrate that the application of the robot in minimally invasive treatment of lateral abdominal wall hernias is safe and efficient. MATERIALS AND METHODS A retrospective analysis of all patients who underwent robotically-assisted lateral ventral hernia repair surgery from June 2019 to December 2023 was performed. RESULTS A total of 50 ventral hernias were operated robotically due to a lateral hernia in the study period. 45 patients had an incisional hernia and 5 patients a primary spighelian hernia. 27 patients had only lateral findings, whereas 23 patients had combined hernias with lateral and medial hernial defects. 18 patients were treated with a preperitoneal mesh (r-vTAPP). 31 patients required TAR to achieve complete fascial closure and sufficient mesh overlap (24 extraperitoneal approach r-eTAR/7 transperitonel approach r-TAR). One patient had to be converted intraoperatively from a planned preperitoneal mesh to an intraperitoneal mesh repair (r-IPOM). The median hernia defect area was 71 cm² (3-375 cm²). The median mesh size was 600 cm² (150-1290 cm²). The median mesh defect ratio (MDR) was 10 (2,33-133,33). Five postoperative complications were encountered (10%). Two reoperations (4%) were required. CONCLUSION The utilization of new robotic surgical techniques provides a safe minimally invasive treatment option even for complex lateral ventral hernias that previously posed difficulties in surgical management. The early postoperative results show promising outcomes.
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Affiliation(s)
- K Bauer
- Department of General and Visceral Surgery, Klinikum Kempten - Klinikverbund Allgäu, Kempten, Germany
| | - R Vogel
- Department of General and Visceral Surgery, Klinikum Kempten - Klinikverbund Allgäu, Kempten, Germany
| | - F Heinzelmann
- Department of General and Visceral Surgery, Klinikum Kempten - Klinikverbund Allgäu, Kempten, Germany
| | - P Büchler
- Department of General and Visceral Surgery, Klinikum Kempten - Klinikverbund Allgäu, Kempten, Germany
| | - Björn Mück
- Department of General and Visceral Surgery, Klinikum Kempten - Klinikverbund Allgäu, Kempten, Germany.
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Ram Sohan P, Mahakalkar C, Kshirsagar S, Bikkumalla S, Reddy S, Hatewar A, Dixit S. Rives-Stoppa Repair Versus Bilateral Inguinal Hernioplasty: A Comprehensive Review of Surgical Techniques and Patient Outcomes. Cureus 2024; 16:e65439. [PMID: 39184704 PMCID: PMC11345036 DOI: 10.7759/cureus.65439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Accepted: 07/26/2024] [Indexed: 08/27/2024] Open
Abstract
Hernia repair surgery is a common procedure to address the protrusion of organs or tissues through weakened muscles or connective tissue. This review compares two prominent surgical techniques for hernia repair: the Rives-Stoppa repair and bilateral inguinal hernioplasty. The Rives-Stoppa repair involves a posterior approach with extensive mesh placement suitable for complex and recurrent hernias. In contrast, bilateral inguinal hernioplasty focuses on simultaneously repairing bilateral hernias, potentially reducing operative time and enhancing recovery. This review examines each approach's technical aspects, including incision methods, mesh placement, and closure techniques. Patient outcomes, such as postoperative pain, recovery time, recurrence rates, and quality of life, are critically analyzed based on current research and clinical data. Economic considerations are also evaluated, encompassing each technique's cost-effectiveness and economic impact. By synthesizing these findings, this review aims to provide valuable insights for surgeons, healthcare providers, and policymakers in optimizing hernia repair strategies. The evolving landscape of surgical techniques and materials underscores the importance of ongoing research to refine practices and improve outcomes for patients undergoing hernia repair surgery.
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Affiliation(s)
- Poosarla Ram Sohan
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Chandrashekhar Mahakalkar
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shivani Kshirsagar
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shruthi Bikkumalla
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Srinivasa Reddy
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Akansha Hatewar
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sparsh Dixit
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Riediger H, Holzner P, Kundel L, Gröger C, Adam U, Adolf D, Köckerling F. Laparoscopic transversus abdominis release for complex ventral hernia repair: technique and initial findings. Hernia 2024; 28:761-767. [PMID: 37639071 DOI: 10.1007/s10029-023-02860-6] [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: 03/29/2023] [Accepted: 08/07/2023] [Indexed: 08/29/2023]
Abstract
PURPOSE The open Rives-Stoppa retrorectus and transversus abdominis release (TAR) techniques are well established in open ventral and incisional hernia repair. The principles are currently being translated into minimally invasive surgery with different concepts. In this study, we investigate our initial results of transperitoneal laparoscopic TAR for ventral incisional hernia repair (laparoscopic TAR). METHODS Over a 20-month period, 23 consecutive patients with incisional hernias underwent surgery. Laparoscopic TAR was performed transperitoneally with adhesiolysis from the anterior abdominal wall, development of the retrorectus space and TAR, midline reconstruction and extraperitoneal mesh reinforcement. RESULTS There were 23 incisional hernias, of which 70% were M2-M4 and 60% were W3. Median patient age was 68 years and the median BMI was 31. Median operating time was 313 min, and hospital stay was 4 days. Morbidity was 26% (Clavien-Dindo 1: n = 4 and 2 + 3b: n = 2). CONCLUSION With the laparoscopic TAR, it was possible to treat a series of patients with ventral incisional hernias. The operating times were long. However, with a low rate of perioperative complications the hospital stay was short As feasibility is demonstrated, the clinical relevance of the method has to be further evaluated.
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Affiliation(s)
- H Riediger
- Department of Surgery, Vivantes Humboldt Hospital, Academic teaching Hospital of Charité University Medicine, Am Nordgraben 2, 13509, Berlin, Germany.
| | - P Holzner
- Department of General and Visceral Surgery, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - L Kundel
- Department of Surgery, Vivantes Humboldt Hospital, Academic teaching Hospital of Charité University Medicine, Am Nordgraben 2, 13509, Berlin, Germany
| | - C Gröger
- Department of Surgery, Vivantes Humboldt Hospital, Academic teaching Hospital of Charité University Medicine, Am Nordgraben 2, 13509, Berlin, Germany
| | - U Adam
- Department of Surgery, Vivantes Humboldt Hospital, Academic teaching Hospital of Charité University Medicine, Am Nordgraben 2, 13509, Berlin, Germany
| | - D Adolf
- StatConsult GmbH, Magdeburg, Germany
| | - F Köckerling
- Department of Surgery, Vivantes Humboldt Hospital, Academic teaching Hospital of Charité University Medicine, Am Nordgraben 2, 13509, Berlin, Germany
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Bhardwaj P, Huayllani MT, Olson MA, Janis JE. Year-Over-Year Ventral Hernia Recurrence Rates and Risk Factors. JAMA Surg 2024; 159:651-658. [PMID: 38536183 PMCID: PMC10974689 DOI: 10.1001/jamasurg.2024.0233] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/04/2023] [Indexed: 06/13/2024]
Abstract
Importance Recurrence is one of the most challenging adverse events after ventral hernia repair as it impacts quality of life, utilization of resources, and subsequent need for re-repair. Rates of recurrence range from 30% to 80% after ventral hernia repair. Objective To determine the contemporary ventral hernia recurrence rate over time in patients with previous hernia repair and to determine risk factors associated with recurrence. Design, Setting, and Participants This retrospective, population-based study used the Abdominal Core Health Quality Collaborative registry to evaluate year-over-year recurrence rates in patients with prior ventral hernia repair between January 2012 and August 2022. Patients who underwent at least 1 prior ventral hernia repair were included and categorized into 2 groups based on mesh or no-mesh use. There were 43 960 eligible patients; after exclusion criteria (patients with concurrent inguinal hernias as the primary diagnosis, nonstandard hernia procedure categories, American Society of Anesthesiologists class unassigned, or no follow-up), 29 834 patients were analyzed in the mesh group and 5599 in the no-mesh group. Main Outcomes and Measures Ventral hernia recurrence rates. Risk factors analyzed include age, body mass index, sex, race, insurance type, medical comorbidities, American Society of Anesthesiologists class, smoking, indication for surgery, concomitant procedure, hernia procedure type, myofascial release, fascial closure, fixation type, number of prior repairs, hernia width, hernia length, mesh width, mesh length, operative approach, prior mesh placement, prior mesh infection, mesh location, mesh type, postoperative surgical site occurrence, postoperative surgical site infection, postoperative seroma, use of drains, and reoperation. Results Among 29 834 patients with mesh, the mean (SD) age was 57.17 (13.36) years, and 14 331 participants (48.0%) were female. Among 5599 patients without mesh, the mean (SD) age was 51.9 (15.31) years, and 2458 participants (43.9%) were female. When comparing year-over-year hernia recurrence rates in patients with and without prior mesh repair, respectively, the Kaplan Meier analysis showed a recurrence rate of 201 cumulative events with 13 872 at risk (2.8%) vs 104 cumulative events with 1707 at risk (4.0%) at 6 months; 411 cumulative events with 4732 at risk (8.0%) vs 184 cumulative events with 427 at risk (32.6%) at 1 year; 640 cumulative events with 1518 at risk (19.7%) vs 243 cumulative events with 146 at risk (52.4%) at 2 years; 731 cumulative events with 670 at risk (29.3%) vs 258 cumulative events with 73 at risk (61.4%) at 3 years; 777 cumulative events with 337 at risk (38.5%) vs 267 cumulative events with 29 at risk (71.2%) at 4 years; and 798 cumulative events with 171 at risk (44.9%) vs 269 cumulative events with 19 at risk (73.7%) at 5 years. Higher body mass index; immunosuppressants; incisional and parastomal hernias; a robotic approach; greater hernia width; use of a biologic or resorbable synthetic mesh; and complications, such as surgical site infections and reoperation, were associated with higher odds of hernia recurrence. Conversely, greater mesh width, myofascial release, and fascial closure had lower odds of recurrence. Hernia type was the most important variable associated with recurrence. Conclusions and Relevance In this study, the 5-year recurrence rate after ventral hernia repair was greater than 40% and 70% in patients with and without mesh, respectively. Rates of ventral hernia recurrence increased over time, underscoring the importance of close, long-term follow up in this population.
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Affiliation(s)
- Priya Bhardwaj
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus
| | - Maria T. Huayllani
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus
| | - Molly A. Olson
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Jeffrey E. Janis
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus
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Berger LE, Huffman SS, Bloomfield G, Marable JK, Spoer DL, Shan HD, Deldar R, Evans KK, Bhanot P, Alimi YR. Age is just a number: The role of advanced age in predicting complications following ventral hernia repair with component separation. Am J Surg 2024; 229:162-168. [PMID: 38182459 DOI: 10.1016/j.amjsurg.2023.12.032] [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: 08/31/2023] [Revised: 12/22/2023] [Accepted: 12/31/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND While advanced age is often considered a risk factor for complications following abdominal surgery, its impact on outcomes after complex open ventral hernia repair (VHR) with component separation technique (CST) remains unclear. METHODS A single-center retrospective review of patients who VHR with CST from November 2008 to January 2022 was performed and cohorts were stratified by presence of advanced age (≥60 years). RESULTS Of 219 patients who underwent VHR with CST, 114 patients (52.1 %) were aged ≥60 years. Multivariate analysis demonstrated BMI to be an independent predictor for any complication (OR 1.1, p = 0.002) and COPD was positively associated with seroma development (OR 20.1, p = 0.012). Advanced age did not independently predict postoperative outcomes, including hernia recurrence (OR 0.8, p = 0.766). CONCLUSIONS VHR with CST is generally safe to perform in patients of advanced age. Every patient's comorbidity profile should be thoroughly assessed preoperatively for risk stratification regardless of age.
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Affiliation(s)
- Lauren E Berger
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, Washington, DC 20007, USA; Rutgers Robert Wood Johnson Medical School, 125 Paterson St, New Brunswick, NJ 08901, USA
| | - Samuel S Huffman
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, Washington, DC 20007, USA; Georgetown University School of Medicine, 3800 Reservoir Road NW, Washington, DC 20007, USA
| | - Grace Bloomfield
- Georgetown University School of Medicine, 3800 Reservoir Road NW, Washington, DC 20007, USA
| | - Julian K Marable
- Georgetown University School of Medicine, 3800 Reservoir Road NW, Washington, DC 20007, USA
| | - Daisy L Spoer
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, Washington, DC 20007, USA; Georgetown University School of Medicine, 3800 Reservoir Road NW, Washington, DC 20007, USA
| | - Holly D Shan
- Georgetown University School of Medicine, 3800 Reservoir Road NW, Washington, DC 20007, USA
| | - Romina Deldar
- Department of General Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, Washington, DC 20007, USA
| | - Karen K Evans
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, Washington, DC 20007, USA
| | - Parag Bhanot
- Georgetown University School of Medicine, 3800 Reservoir Road NW, Washington, DC 20007, USA; Department of General Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, Washington, DC 20007, USA
| | - Yewande R Alimi
- Georgetown University School of Medicine, 3800 Reservoir Road NW, Washington, DC 20007, USA; Department of General Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, Washington, DC 20007, USA.
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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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Vogel R, Heinzelmann F, Büchler P, Mück B. [Roboticassisted incisional hernia surgery-Retromuscular techniques]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:27-33. [PMID: 38051317 DOI: 10.1007/s00104-023-01998-4] [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: 11/02/2023] [Indexed: 12/07/2023]
Abstract
The trend to minimally invasive surgery has also made its way into the surgical treatment of incisional hernias. Unlike other areas of visceral surgery, recent years have seen a resurgence of open sublay repair in incisional hernia procedures, primarily due to the recognition of the retromuscular layer as the optimal mesh placement site. Additionally, with the growing availability of robotic systems in visceral surgery, these procedures are increasingly being offered in the form of minimally invasive procedures. These methods can be categorized based on the access routes: robotic-assisted transperitoneal procedures (e.g., r‑Rives, r‑TARUP, r‑TAR) and total extraperitoneal hernia repair (e.g., r‑eTEP, r‑eTAR). Notably, the introduction of transversus abdominis muscle release enables the robotic-assisted treatment of larger and more complex hernia cases with complete fascial closure. With respect to the comparison with open surgery required in retromuscular hernia treatment, the currently available literature on incisional hernia repair seems to show initial advantages of robotic-assisted surgery in the perioperative course. New technologies create new possibilities. In the context of surgical training the use of surgical robot systems with double consoles opens up completely new perspectives. Furthermore, the robot enables the implementation of models of artificial intelligence and augmented reality and could therefore open up novel dimensions in surgery.
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Affiliation(s)
- R Vogel
- Klinik für Allgemein‑, Viszeral‑ und Kinderchirurgie, Hernienzentrum Kempten - Allgäu, Klinikverbund Allgäu gGmbH, Klinikum Kempten, Robert-Weixler-Straße 50, 87439, Kempten (Allgäu), Deutschland
| | - F Heinzelmann
- Klinik für Allgemein‑, Viszeral‑ und Kinderchirurgie, Hernienzentrum Kempten - Allgäu, Klinikverbund Allgäu gGmbH, Klinikum Kempten, Robert-Weixler-Straße 50, 87439, Kempten (Allgäu), Deutschland
| | - P Büchler
- Klinik für Allgemein‑, Viszeral‑ und Kinderchirurgie, Hernienzentrum Kempten - Allgäu, Klinikverbund Allgäu gGmbH, Klinikum Kempten, Robert-Weixler-Straße 50, 87439, Kempten (Allgäu), Deutschland
| | - Björn Mück
- Klinik für Allgemein‑, Viszeral‑ und Kinderchirurgie, Hernienzentrum Kempten - Allgäu, Klinikverbund Allgäu gGmbH, Klinikum Kempten, Robert-Weixler-Straße 50, 87439, Kempten (Allgäu), Deutschland.
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Van den Dop LM, Sneiders D, Yurtkap Y, Werba A, van Klaveren D, Pierik RE, Reim D, Timmermans L, Fortelny RH, Mihaljevic AL, Kleinrensink GJ, Tanis PJ, Lange JF, Jeekel J. Prevention of incisional hernia with prophylactic onlay and sublay mesh reinforcement vs. primary suture only in midline laparotomies (PRIMA): long-term outcomes of a multicentre, double-blind, randomised controlled trial. THE LANCET REGIONAL HEALTH. EUROPE 2024; 36:100787. [PMID: 38188275 PMCID: PMC10769887 DOI: 10.1016/j.lanepe.2023.100787] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 11/03/2023] [Accepted: 11/03/2023] [Indexed: 01/09/2024]
Abstract
Background Incisional hernia occurs approximately in 40% of high-risk patients after midline laparotomy. Prophylactic mesh placement has shown promising results, but long-term outcomes are needed. The present study aimed to assess the long-term incisional hernia rates of the previously conducted PRIMA trial with radiological follow-up. Methods In the PRIMA trial, patients with increased risk of incisional hernia formation (AAA or BMI ≥27 kg/m2) were randomised in a 1:2:2 ratio to primary suture, onlay mesh or sublay mesh closure in three different countries in eleven institutions. Incisional hernia during follow-up was diagnosed by any of: CT, ultrasound and physical examination, or during surgery. Assessors and patients were blinded until 2-year follow-up. Time-to-event analysis according to intention-to-treat principle was performed with the Kaplan-Meier method and Cox proportional hazard models. Trial registration: NCT00761475 (ClinicalTrials.gov). Findings Between 2009 and 2012, 480 patients were randomized: 107 primary suture, 188 onlay mesh and 185 sublay mesh. Five-year incisional hernia rates were 53.4% (95% CI: 40.4-64.8), 24.7% (95% CI: 12.7-38.8), 29.8% (95% CI: 17.9-42.6), respectively. Compared to primary suture, onlay mesh (HR: 0.390, 95% CI: 0.248-0.614, p < 0.001) and sublay mesh (HR: 0.485, 95% CI: 0.309-0.761, p = 0.002) were associated with a significantly lower risk of incisional hernia development. Interpretation Prophylactic mesh placement remained effective in reducing incisional hernia occurrence after midline laparotomy in high-risk patients during long-term follow-up. Hernia rates in the primary suture group were higher than previously anticipated. Funding B. Braun.
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Affiliation(s)
| | | | - Yagmur Yurtkap
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Alexander Werba
- Department of Surgery, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - David van Klaveren
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | | | - Daniel Reim
- Department of Surgery, Technische Universität München, München, Germany
| | - Lucas Timmermans
- Department of Surgery, Radboud University Hospital, Nijmegen, the Netherlands
| | | | - André L. Mihaljevic
- Department of General and Visceral Surgery, University Hospital Ulm, Ulm, Germany
| | - Gert-Jan Kleinrensink
- Department of Neuroscience, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Pieter J. Tanis
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Johan F. Lange
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Johannes Jeekel
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
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10
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Petro CC, Melland-Smith M. Open Complex Abdominal Wall Reconstruction. Surg Clin North Am 2023; 103:961-976. [PMID: 37709399 DOI: 10.1016/j.suc.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
This article provides an approach to open complex abdominal wall reconstruction. Herein, the authors discuss the purpose of component separation as well as its relevant indications. The techniques and anatomical considerations of both anterior and posterior component separation are described. In addition, patient selection criteria, preoperative adjuncts that may assist with fascial or soft tissue closure, and complications of component separation will be discussed.
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Affiliation(s)
- Clayton C Petro
- Lerner College of Medicine, Cleveland Clinic Center for Abdominal Core Health, 9500 Euclid Avenue A-100, Cleveland, OH 44195, USA.
| | - Megan Melland-Smith
- Lerner College of Medicine, Cleveland Clinic Center for Abdominal Core Health, 9500 Euclid Avenue A-100, Cleveland, OH 44195, USA
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11
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Goullieux M, Abo-Alhassan F, Vieira-Da-Silva R, Lauranne P, Guiraud A, Ortega-Deballon P. Primary Ventral Hernia Repair and the Risk of Postoperative Small Bowel Obstruction: Intra Versus Extraperitoneal Mesh. J Clin Med 2023; 12:5341. [PMID: 37629383 PMCID: PMC10455485 DOI: 10.3390/jcm12165341] [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: 06/13/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
OBJECTIVE The aim of this study was to compare the likelihood of bowel obstruction according to the placement of the mesh (either intraperitoneal or extraperitoneal) in ventral hernia repairs. MATERIALS AND METHODS Patients were divided into two groups, an intraperitoneal (IP) group (mesh placed by laparoscopy or with an open approach) and an extraperitoneal (EP) group, all operated on in the Digestive Surgery Department at the Dijon University Hospital. The primary outcome was the occurrence of an episode of bowel obstruction requiring hospitalization and confirmed by abdominal CT scan. RESULTS Between March 2008 and July 2021, 318 patients were included, with 99 patients in the EP group (71 meshes placed preperitoneally and 28 placed retromuscularly) and 219 patients in the IP group (175 patients operated on laparoscopically versus 44 patients by direct approach). Three patients presented an episode of acute intestinal obstruction, with no difference between the two groups (p = 0.245), although all bowel obstructions occurred in the IP group and with the laparoscopic approach (1.7% of patients operated on by laparoscopy). The occlusive events occurred at 1 month, 2 years, and 3 years. There was no difference in terms of recurrence or postoperative chronic pain. There were more seroma and mesh infections in the EP group (p < 0.05). Two patients operated on by laparoscopy had undetected bowel injuries, prompting emergent surgery for peritonitis. CONCLUSIONS No statistically significant difference was found in terms of bowel obstruction between the intraperitoneal and the extraperitoneal position, but all cases of obstruction happened in the intraperitoneal mesh group. Visceral lesions remain a major complication of the laparoscopic approach that should not be neglected.
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Affiliation(s)
| | - Fawaz Abo-Alhassan
- Department of Digestive Surgery, University Hospital of Dijon, 14 Rue Paul Gaffarel, 21000 Dijon, France
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López-Cano M, Verdaguer Tremolosa M, Hernández Granados P, Pereira JA. Open vs. minimally invasive sublay incisional hernia repair. Is there a risk of overtreatment? EVEREG registry analysis. Cir Esp 2023; 101 Suppl 1:S46-S53. [PMID: 37951467 DOI: 10.1016/j.cireng.2023.02.013] [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: 12/19/2022] [Accepted: 02/21/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION Incisional hernia (IH) is a very common surgical procedure. Registries provide real world data. The objective is to analyze the open and minimally invasive (MIS) sublay technique (with or without associated components separation [CS]) in IH cases from the EVEREG registry and to evaluate the evolution over time of the techniques. METHODS All patients in EVEREG from July 2012 to December 2021 were included. The characteristics of the patients, IH, surgical technique, complications and mortality in the first 30 days were collected. We analyzed Group 1 (open sublay vs MIS sublay, without CS), Group 2 (open sublay vs MIS sublay, with CS) and Group 3 where the evolution of open and MIS techniques was evaluated over time. RESULTS 4867 IH were repaired using a sublay technique. Group 1: 3739 (77%) open surgery, mostly midline hernias combined (P = .016) and 55 (1%) MIS, mostly lateral hernias (LH) (P = .000). Group 2: 1049 (21.5%) open surgery and 24 (0.5%) MIS. A meaningful difference (P = .006) was observed in terms of transverse diameters (5.9 (SD 2.1) cm for the MIS technique and 10.11 (SD 4.8) for the open technique). The LH MIS associated more CS (P = .002). There was an increase in the use of the sublay technique over time (with or without CS). CONCLUSION Increased use of the sublay technique (open and MIS) over time. For some type of hernia (LH) the MIS sublay technique with associated CS may have represented an overtreatment.
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Affiliation(s)
- Manuel López-Cano
- Unidad de Cirugía de la Pared Abdominal, Hospital Universitario Vall d´Hebrón, Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - Mireia Verdaguer Tremolosa
- Unidad de Cirugía de la Pared Abdominal, Hospital Universitario Vall d´Hebrón, Universidad Autónoma de Barcelona, Barcelona, Spain
| | | | - José Antonio Pereira
- Servicio de Cirugía General, Hospital Universitari del Mar, Barcelona, Spain; Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
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Zaman J, Teixeira L, Patel PB, Ridler G, Ata A, Singh TP. From transabdominal to totally extra-peritoneal robotic ventral hernia repair: observations and outcomes. Hernia 2023; 27:635-643. [PMID: 36973467 PMCID: PMC10042403 DOI: 10.1007/s10029-023-02767-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 03/02/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE While robotic-assisted hernia repair has increased the popularity of minimally invasive hernia surgery, selecting between the types of approaches is a challenge for both experts and novices alike. In this study, we compared a single surgeon's early experience transitioning from transabdominal hernia repair with sublay mesh in either the pre-peritoneal or retrorectus space (TA-SM) and enhanced-view totally extra-peritoneal (eTEP) ventral hernia repair in the peri-operative and long-term post-operative time periods. METHODS We conducted a retrospective review of 50 eTEP and 108 TA-SM procedures to collect demographics, intraoperative details, and 30-day and 1-year post-operative outcomes. Statistical analysis was performed utilizing Chi-square analysis, Fisher's test, and two sample t-tests with equal variances. RESULTS There were no significant differences in patient demographics or comorbidities. eTEP patients had larger defects (109.1 cm2 vs. 31.8 cm2, p = 0.043) and mesh used (432.8 cm2 vs. 137.9 cm2, p = 0.001). Operative times were equivalent (158.3 ± 90.6 min eTEP and 155.8 ± 65.2 min TA-SM, p = 0.84), but conversion to alternate procedure type was higher for the transabdominal approach (4% eTEP vs. 22% TA-SM, p < 0.05). Hospital stay was less in the eTEP cohort (1.3 days vs. 2.2 days, p < 0.05). Within 30 days, there were no significant differences in emergency visits or hospital readmissions. There was a greater propensity for eTEP patients to develop seromas (12.0% vs. 1.9%, p < 0.05). At 1 year, there was no statistically significant difference in recurrence rate (4.56% eTEP vs. 12.2% TA-SM, p = 0.28) respective to average time to recurrence (9.17 months eTEP vs. 11.05 months TA-SM). CONCLUSION The eTEP approach can be adopted safely and efficiently, and may have superior peri-operative outcomes including fewer conversions and reduced hospital stay.
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Affiliation(s)
- J Zaman
- Department of Surgery, Albany Medical College, 50 New Scotland Avenue, Albany, NY, 12208, USA.
| | - L Teixeira
- Department of Surgery, Albany Medical College, 50 New Scotland Avenue, Albany, NY, 12208, USA
| | - P B Patel
- Department of Surgery, Albany Medical College, 50 New Scotland Avenue, Albany, NY, 12208, USA
| | - G Ridler
- Department of Surgery, Albany Medical College, 50 New Scotland Avenue, Albany, NY, 12208, USA
| | - A Ata
- Department of Surgery, Albany Medical College, 50 New Scotland Avenue, Albany, NY, 12208, USA
| | - T P Singh
- Department of Surgery, Albany Medical College, 50 New Scotland Avenue, Albany, NY, 12208, USA
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López-Cano M, Verdaguer Tremolosa M, Hernández Granados P, Pereira JA. Técnica sublay abierta vs. mínimamente invasiva en el tratamiento de la hernia incisional. ¿Hay riesgo de sobretratamiento? Análisis del registro EVEREG. Cir Esp 2023. [DOI: 10.1016/j.ciresp.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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15
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Vierstraete M, Beckers R, Vangeel L, Foriers B, Pletinckx P, Muysoms F. Prospective cohort study on mesh shrinkage measured with MRI after robot-assisted minimal invasive retrorectus ventral hernia repair using an iron-oxide-loaded polyvinylidene fluoride mesh. Surg Endosc 2023:10.1007/s00464-023-09938-3. [PMID: 36854798 DOI: 10.1007/s00464-023-09938-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 02/05/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Mesh-reinforced ventral hernia repair is considered the gold standard treatment for all but the smallest of hernias. Human data on mesh shrinkage in the retrorectus mesh position is lacking. A prospective observational cohort study was performed to measure mesh shrinkage in robot-assisted minimal invasive retrorectus repair of ventral hernias. METHODS A cohort of 20 patients underwent a robot-assisted minimal invasive retrorectus repair of their ventral hernia. Magnetic resonance imaging (MRI) imaging was performed one month and thirteen months after implantation of an iron-oxide-impregnated polyvinylidene fluoride (PVDF) mesh to assess the decrease in mesh surface area. Inter-rater reliability among three radiologists regarding measurement of the mesh dimensions was analyzed. Quality of Life scoring was evaluated. RESULTS The inter-rater reliability between the radiologists reported as the intra-class correlations proved to be excellent for mesh width (ICC 0.95), length (ICC 0.98) and surface area (ICC 0.99). Between MRI measurements at one month and thirteen months postoperatively, there was a significant increase in mesh surface area (+ 12.0 cm2, p = 0.0013) and mesh width (+ 0.8 cm, p < 0.001), while the length of the mesh remained unchanged (-0.1 cm, p = 0.754). Quality of Life Scoring showed a significant improvement in Quality of Life after one month and a further improvement at thirteen months (p < 0.001). CONCLUSION There was an excellent inter-rater reliability between three radiologists when measuring width, length, and surface area of an iron-oxide-impregnated PVDF mesh using MRI visualization. Mesh shrinkage was not observed, instead the effective mesh surface area and width of the mesh increased.
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Affiliation(s)
- Maaike Vierstraete
- Department of Surgery, Maria Middelares Hospital, Buitenring Sint-Denijs 30, 9000, Ghent, Belgium.
| | - Roel Beckers
- Department of Radiology, Maria Middelares Hospital, Buitenring Sint-Denijs 30, 9000, Ghent, Belgium
| | - Lorenz Vangeel
- Department of Radiology, Maria Middelares Hospital, Buitenring Sint-Denijs 30, 9000, Ghent, Belgium
| | - Brend Foriers
- Department of Radiology, Maria Middelares Hospital, Buitenring Sint-Denijs 30, 9000, Ghent, Belgium
| | - Pieter Pletinckx
- Department of Surgery, Maria Middelares Hospital, Buitenring Sint-Denijs 30, 9000, Ghent, Belgium
| | - Filip Muysoms
- Department of Surgery, Maria Middelares Hospital, Buitenring Sint-Denijs 30, 9000, Ghent, Belgium
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Amiki M, Ishiyama Y, Mochizuki I, Narita K, Goto M, Sekikawa K. Ventral hernia repair with enhanced-view totally extraperitoneal technique after a massive weight loss by laparoscopic sleeve gastrectomy. Surg Case Rep 2023; 9:27. [PMID: 36807016 PMCID: PMC9939563 DOI: 10.1186/s40792-023-01610-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/12/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Ventral hernia repair (VHR) for obese patients is often associated with an increased risk of postoperative complications and hernia recurrences. Achieving preoperative weight loss is ideal before VHR; however, it is difficult to attain with medical treatment. Metabolic and bariatric surgery (MBS) offers the most effective and durable treatment for obesity. Therefore, massive weight loss occurring after MBS will improve the outcome of VHR. CASE PRESENTATION A 49-year-old man (122.9 kg, BMI 39.1 kg/m2) presented to our hospital wishing to undergo laparoscopic sleeve gastrectomy and VHR. Physical examination revealed a tennis ball-sized lower midline defect. Computed tomography (CT) scans revealed a hernia orifice 5 cm in width and 10 cm in height. As the hernia orifice was large, mesh reinforcement was essential. We planned for him to undergo VHR after massive weight loss was achieved by MBS. VHR was performed using the enhanced-view totally extraperitoneal (eTEP) technique after weight loss of 38 kg was achieved 9 months following laparoscopic sleeve gastrectomy. His postoperative course was uneventful, and neither recurrence nor seroma was observed at 1 year follow-up. CONCLUSIONS eTEP repair of a ventral hernia after massive weight loss following MBS would appear to be the best combination treatment for obese patients with ventral hernias. However, long-term follow-up is necessary to establish its safety and efficacy.
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Affiliation(s)
- Manabu Amiki
- Kawasaki Saiwai Hospital, 31-27 Omiya-Cho, Saiwai-Ku, Kawasaki City, Kanagawa, 212-0014, Japan.
| | - Yasuhiro Ishiyama
- Kawasaki Saiwai Hospital, 31-27 Omiya-Cho, Saiwai-Ku, Kawasaki City, Kanagawa 212-0014 Japan
| | - Ichitaro Mochizuki
- Kawasaki Saiwai Hospital, 31-27 Omiya-Cho, Saiwai-Ku, Kawasaki City, Kanagawa 212-0014 Japan
| | - Kazuhiro Narita
- Kawasaki Saiwai Hospital, 31-27 Omiya-Cho, Saiwai-Ku, Kawasaki City, Kanagawa 212-0014 Japan
| | - Manabu Goto
- Kawasaki Saiwai Hospital, 31-27 Omiya-Cho, Saiwai-Ku, Kawasaki City, Kanagawa 212-0014 Japan
| | - Koji Sekikawa
- Kawasaki Saiwai Hospital, 31-27 Omiya-Cho, Saiwai-Ku, Kawasaki City, Kanagawa 212-0014 Japan
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Bauer K, Heinzelmann F, Büchler P, Mück B. [Robot-assisted extraperitoneal ventral hernia repair-Experience from the first 61 consecutive operations with eTEP and eTAR techniques]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:147-154. [PMID: 36280627 DOI: 10.1007/s00104-022-01737-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/14/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND As in many other fields of surgery, robotically assisted surgical procedures have been established in the treatment of ventral hernias in recent years. The use of the robot can combine the demands of a minimally invasive approach and retromuscular mesh placement. In addition to a transabdominal approach, these procedures can also be performed using an extraperitoneal approach. OBJECTIVES The purpose of this study is to demonstrate that robotic total extraperitoneal management of abdominal wall hernias is safe and efficient. MATERIALS AND METHODS A retrospective analysis of all robotically operated patients on ventral hernia using extraperitoneal eTEP technique from September 2019 to May 2022 was performed. RESULTS A total of 61 ventral hernias were operated on using the robotic eTEP technique during the study period. In 14 patients retro-rectal dissection was extended laterally by an extraperitoneal transversus abdominis release (eTAR) because of the hernia size or a lateral hernia localization. In all cases, an uncoated synthetic mesh was placed in the retromuscular position with complete closure of the hernia defects. The median hernia defect area was 30 cm² (4-308 cm²). The median mesh size was 540 cm² (300-1350 cm²). The median mesh defect ratio (MDR) was 17.78 (3.06-145). One intraoperative and three postoperative complications were encountered. Neither conversion nor reoperation were required. CONCLUSION The robotic extraperitoneal eTEP technique enables the required retromuscular mesh placement in a minimally invasive approach. With the possibility of a combination with a transversus abdominis release, even complex findings can be treated using this technique.
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Affiliation(s)
- K Bauer
- Abteilung für Allgemein-, Viszeral- und Kinderchirurgie, Klinikum Kempten, Klinikverbund Allgäu, Robert-Weixler-Str. 50, 87439, Kempten, Deutschland
| | - F Heinzelmann
- Abteilung für Allgemein-, Viszeral- und Kinderchirurgie, Klinikum Kempten, Klinikverbund Allgäu, Robert-Weixler-Str. 50, 87439, Kempten, Deutschland
| | - P Büchler
- Abteilung für Allgemein-, Viszeral- und Kinderchirurgie, Klinikum Kempten, Klinikverbund Allgäu, Robert-Weixler-Str. 50, 87439, Kempten, Deutschland
| | - B Mück
- Abteilung für Allgemein-, Viszeral- und Kinderchirurgie, Klinikum Kempten, Klinikverbund Allgäu, Robert-Weixler-Str. 50, 87439, Kempten, Deutschland.
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den Hartog FPJ, van Egmond S, Poelman MM, Menon AG, Kleinrensink GJ, Lange JF, Tanis PJ, Deerenberg EB. The incidence of extraction site incisional hernia after minimally invasive colorectal surgery: a systematic review and meta-analysis. Colorectal Dis 2022; 25:586-599. [PMID: 36545836 DOI: 10.1111/codi.16455] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/09/2022] [Accepted: 11/22/2022] [Indexed: 01/06/2023]
Abstract
AIM Minimally invasive colorectal surgery reduces surgical trauma with better preservation of abdominal wall integrity, but the extraction site is still at risk of incisional hernia (IH). The aim of this study was to determine pooled incidence of IH for each type of extraction site and to compare rates of IH after midline, nonmidline and Pfannenstiel extraction. METHOD A systematic review and meta-analysis was conducted using the PRISMA guidelines. Single-armed and multiple-armed cohort studies and randomized controlled trials regarding minimally invasive colorectal surgery were searched from five databases. Outcomes were pooled and compared with random-effects, inverse-variance models. Risk of bias within the studies was assessed using the Cochrane ROBINS-I and RoB 2 tool. RESULTS Thirty six studies were included, with a total 11,788 patients. The pooled extraction site IH rate was 16.0% for midline (n = 4081), 9.3% for umbilical (n = 2425), 5.2% for transverse (n = 3213), 9.4% for paramedian (n = 134) and 2.1% for Pfannenstiel (n = 1449). Nonmidline extraction (transverse and paramedian) showed significantly lower odds ratios (ORs) for IH when compared with midline extraction (including umbilical). Pfannenstiel extraction resulted in a significantly lower OR for IH compared with midline [OR 0.12 (0.50-0.30)], transverse [OR 0.25 (0.13-0.50)] and umbilical (OR 0.072 [0.033-0.16]) extraction sites. The risks of surgical site infection, seroma/haematoma or wound dehiscence were not significantly different in any of the analyses. CONCLUSION Pfannenstiel extraction is the preferred method in minimally invasive colorectal surgery. In cases where Pfannenstiel extraction is not possible, surgeons should avoid specimen extraction in the midline.
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Affiliation(s)
- Floris P J den Hartog
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Sarah van Egmond
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Marijn M Poelman
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Anand G Menon
- Department of Surgery, IJsselland Ziekenhuis, Capelle aan den IJssel, The Netherlands
| | - Gert-Jan Kleinrensink
- Department of Neuroscience, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Johan F Lange
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Pieter J Tanis
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Eva B Deerenberg
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
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Berner-Hansen V, Oma E, Willaume M, Jensen KK. Prophylactic negative pressure wound therapy after open ventral hernia repair: a systematic review and meta-analysis. Author's reply. Hernia 2022; 26:1221-1222. [PMID: 35482169 DOI: 10.1007/s10029-022-02620-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 04/09/2022] [Indexed: 11/04/2022]
Affiliation(s)
- V Berner-Hansen
- Digestive Disease Center, Bispebjerg Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark.
| | - E Oma
- Digestive Disease Center, Bispebjerg Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
| | - M Willaume
- Digestive Disease Center, Bispebjerg Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
| | - K K Jensen
- Digestive Disease Center, Bispebjerg Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
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