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Amro C, Niu EF, Deianni E, Smith L, Qiu M, Torkington J, Broach RB, Maguire LH, Damrauer SM, Itani K, Fischer JP. Genetic and biologic risk factors associated with hernia formation: A review. Am J Surg 2024; 234:41-57. [PMID: 38519402 DOI: 10.1016/j.amjsurg.2024.02.029] [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: 11/20/2023] [Revised: 01/28/2024] [Accepted: 02/15/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND This systematic review aims to identify genetic and biologic markers associated with abdominal hernia formation. METHODS Following PRIMSA-guidelines, we searched PubMed, MEDLINE, Embase, Scopus, and COCHRANE databases. RESULTS Of 5946 studies, 65 were selected, excluding parastomal hernias due to insufficient data. For inguinal hernias, five studies unveiled 92 susceptible loci across 66 genes, predominantly linked to immune responses. Eleven studies observed elevated MMP-2 levels, with seven highlighting greater MMP-2 in direct compared to indirect inguinal hernias. One incisional hernia study identified unique gene-expression profiles in 174 genes associated with inflammation and cell-adhesion. In hiatal hernias, several genetic risk loci were identified. For all hernia categories, type I/III collagen ratios diminished. CONCLUSIONS Biological markers in inguinal hernias appears consistent. Yet, the genetic predisposition in incisional hernias remains elusive. Further research to elucidate these genetic and biological intricacies can pave the way for more individualized patient care.
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Affiliation(s)
- Chris Amro
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA; Hansjörg Wyss Department of Plastic Surgery, NYU Langone, New York, NY.
| | - Ellen F Niu
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Ellie Deianni
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Laurie Smith
- Department of Colorectal Surgery, Cardiff and Vale University Health Board, Cardiff, UK
| | - Maylene Qiu
- Biomedical Library, University of Pennsylvania, Philadelphia, PA, USA
| | - Jared Torkington
- Department of Colorectal Surgery, Cardiff and Vale University Health Board, Cardiff, UK
| | - Robyn B Broach
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Lillias H Maguire
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Scott M Damrauer
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Kamal Itani
- Department of Surgery, VA Boston Health Care System, Boston, MA, USA; Department of Surgery, Boston University, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - John P Fischer
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
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Rodicio Miravalles JL, Méndez CSM, Lopez-Monclus J, Moreno Gijón M, López Quindós P, Amoza Pais S, López López A, García Bear I, Menendez de Llano Ortega R, Díez Pérez de Las Vacas MI, Garcia-Urena MA. Short-term outcomes of a multicentre prospective study using a "visible" polyvinylidene fluoride onlay mesh for the prevention of midline incisional hernia. Langenbecks Arch Surg 2024; 409:136. [PMID: 38652308 DOI: 10.1007/s00423-024-03307-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 04/03/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Prophylactic meshes in high-risk patients prevent incisional hernias, although there are still some concerns about the best layer to place them in, the type of fixation, the mesh material, the significance of the level of contamination, and surgical complications. We aimed to provide answers to these questions and information about how the implanted material behaves based on its visibility under magnetic resonance imaging (MRI). METHOD This is a prospective multicentre observational cohort study. Preliminary results from the first 3 months are presented. We included general surgical patients who had at least two risk factors for developing an incisional hernia. Multivariate logistic regression was used. A polyvinylidene fluoride (PVDF) mesh loaded with iron particles was used in an onlay position. MRIs were performed 6 weeks after treatment. RESULTS Between July 2016 and June 2022, 185 patients were enrolled in the study. Surgery was emergent in 30.3% of cases, contaminated in 10.7% and dirty in 11.8%. A total of 5.6% of cases had postoperative wound infections, with the requirement of stoma being the only significant risk factor (OR = 7.59, p = 0.03). The formation of a seroma at 6 weeks detected by MRI, was associated with body mass index (OR = 1.13, p = 0.02). CONCLUSIONS The prophylactic use of onlay PVDF mesh in midline laparotomies in high-risk patients was safe and effective in the short term, regardless of the type of surgery or the level of contamination. MRI allowed us to detect asymptomatic seromas during the early process of integration. STUDY REGISTRATION This protocol was registered at ClinicalTrials.gov (NCT03105895).
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Affiliation(s)
- José Luis Rodicio Miravalles
- Division of General Surgery, Hospital Universitario Central de Asturias (HUCA), Avda de Roma, s/n, Oviedo, Asturias, 33011, Spain.
| | - Carlos San Miguel Méndez
- Division of General Surgery, Grupo de Investigación de Pared Abdominal Compleja, Universidad Francisco de Vitoria, Hospital Universitario del Henares, Madrid, Spain
| | - Javier Lopez-Monclus
- Division of General Surgery, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - María Moreno Gijón
- Division of General Surgery, Hospital Universitario Central de Asturias (HUCA), Avda de Roma, s/n, Oviedo, Asturias, 33011, Spain
| | - Patricia López Quindós
- Division of General Surgery, Grupo de Investigación de Pared Abdominal Compleja, Universidad Francisco de Vitoria, Hospital Universitario del Henares, Madrid, Spain
| | - Sonia Amoza Pais
- Division of General Surgery, Hospital Universitario Central de Asturias (HUCA), Avda de Roma, s/n, Oviedo, Asturias, 33011, Spain
| | - Antonio López López
- Division of General Surgery, Hospital Universitario Nuestra Señora del Prado, Toledo, Spain
| | - Isabel García Bear
- Division of General Surgery, Hospital Universitario San Agustin, Avilés, Spain
| | | | | | - Miguel Angel Garcia-Urena
- Division of General Surgery, Grupo de Investigación de Pared Abdominal Compleja, Universidad Francisco de Vitoria, Hospital Universitario del Henares, Madrid, Spain
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Xv Y, Al-Magedi AAS, Wu R, Cao N, Tao Q, Ji Z. The top 100 most-cited papers in incisional hernia: a bibliometric analysis from 2003 to 2023. Hernia 2024; 28:333-342. [PMID: 37897504 DOI: 10.1007/s10029-023-02909-6] [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: 07/07/2023] [Accepted: 10/01/2023] [Indexed: 10/30/2023]
Abstract
PURPOSE Incisional hernia (IH) is one of the most common complications after abdominal surgeries and may bring great suffering to patients. This study aims to evaluate the global trends in IH research from 2003 to 2023 and visualize the frontiers using bibliometric analysis. METHODS The literature search was conducted on the Web of Science for IH studies published from 2003 to 2023 and sorted by citation frequency. The top 100 most-cited articles were analyzed by the annual publication number, prolific countries and institutions, influential author and journal, and the number of citations through descriptive statistics and visualization. RESULTS The top paper was cited 1075 times and the median number of citations was 146. All studies were published between 2003 and 2019 and the most prolific year was 2003 with 14 articles. Jeekel J and Rosen M were regarded as the most productive authors with ten articles each and acquired 2738 and 2391 citations, respectively. The top three institutions with the most productive articles were Erasmus Mc, Carolinas Med Ctr, and Univ Utah, while the top three countries were the United States, Netherlands and Germany. The most frequent keyword was "incisional hernia" with 55 occurrences, followed by "mesh repair", "randomized controlled trial", and "polypropylene". CONCLUSION The 100 most-cited papers related to IH were published predominantly by USA and European countries, with randomized controlled trial (RCT) and observational study designs, addressing topics related to risk factors, complications, mesh repair, and mesh components.
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Affiliation(s)
- Y Xv
- School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - A A S Al-Magedi
- School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - R Wu
- Department of General Surgery, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - N Cao
- Department of General Surgery, Lishui People's Hospital, 86 Chongwen Road, Yongyang Street, Nanjing, 211200, China
| | - Q Tao
- Department of General Surgery, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Z Ji
- School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China.
- Department of General Surgery, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China.
- Department of General Surgery, Lishui People's Hospital, 86 Chongwen Road, Yongyang Street, Nanjing, 211200, China.
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Golling M, Breul V, Zielska Z, Baumann P. The 6:1 short stitch SL-WL-ratio: short term closure results of transverse and midline incisions in elective and emergency operations. Hernia 2024; 28:447-456. [PMID: 38285168 PMCID: PMC10997695 DOI: 10.1007/s10029-023-02927-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/27/2023] [Indexed: 01/30/2024]
Abstract
AIM To analyze laparotomy closure quality (suture/wound length ratio; SL/WL) and short term complications (surgical site occurrence; SSO) of conventional midline and transverse abdominal incisions in elective and emergency laparotomies with a longterm, absorbent, elastic suture material. METHOD Prospective, monocentric, non-randomized, controlled cohort study on short stitches with a longterm resorbable, elastic suture (poly-4-hydroxybutyrate, [p-4OHB]) aiming at a 6:1 SL/WL-ratio in midline and transverse, primary and secondary laparotomies for elective and emergency surgeries. RESULTS We included 351 patients (♂: 208; ♀: 143) with midline (n = 194), transverse (n = 103), and a combined midline/transverse L-shaped (n = 54) incisions. There was no quality difference in short stitches between elective (n = 296) and emergency (n = 55) operations. Average SL/WL-ratio was significantly higher for midline than transverse incisions (6.62 ± 2.5 vs 4.3 ± 1.51, p < 0.001). Results in the first 150 patients showed a reduced SL/WL-ratio to the following 200 suture closures (SL/WL-ratio: 5.64 ± 2.5 vs 6.1 ± 2.3; p < 0.001). SL/WL-ratio varied insignificantly among the six surgeons participating while results were steadily improving over time. Clinically, superficial surgical site infections (SSI, CDC-A1/2) were encountered in 8%, while 4,3% were related to intraabdominal complications (CDC-A3). An abdominal wall dehiscence (AWD) occurred in 22/351 patients (6,3%)-twice as common in emergency than elective surgery (12,7 vs 5,1%)-necessitating an abdominal revision in 86,3% of cases. CONCLUSION We could show that a short stitch 6:1 SL/WL-ratio with a 2-0 single, ultra-long term, absorbent, elastic suture material can be performed in only 43% of cases (85% > 4:1 SL/WL-ratio), significantly better in midline than transverse incisions. Transverse incisions should preferably be closed in two layers to achieve a sufficient SL/WL-ratio equivalent to the median incision. CLINICAL TRIALS GOV IDENTIFIER NCT01938222.
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Affiliation(s)
- M Golling
- Diakonieklinikum Schwäbisch Hall, Schwäbisch Hall, Germany.
| | | | - Z Zielska
- Diakonieklinikum Schwäbisch Hall, Schwäbisch Hall, Germany
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Mizusawa Y, Noda H, Ichida K, Fukai S, Matsuzawa N, Tamaki S, Abe I, Endo Y, Fukui T, Takayama Y, Inoue K, Muto Y, Watanabe F, Miyakura Y, Rikiyama T. A postoperative body weight increase is a novel risk factor for incisional hernia of midline abdominal incision after elective gastroenterological surgery. Langenbecks Arch Surg 2023; 408:452. [PMID: 38032404 DOI: 10.1007/s00423-023-03193-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/26/2023] [Indexed: 12/01/2023]
Abstract
PURPOSE Midline abdominal incisions (MAIs) are widely used in both open and minimally invasive surgery. Incisional hernia (IH) accounts for most long-term postoperative wound complications. This study explored the risk factors for IH due to MAI in patients with clean-contaminated wounds after elective gastroenterological surgery. METHODS The present study targeted patients enrolled in 2 randomized controlled trials to evaluate the efficacy of intraoperative interventions for incisional SSI prevention after gastroenterological surgery for clean-contaminated wounds. The patients were reassessed, and pre- and intraoperative variables and postoperative outcomes were collected. IH was defined as any abdominal wall gap, regardless of bulge, in the area of a postoperative scar that was perceptible or palpable on clinical examination or computed tomography according to the European Hernia Society guidelines. The risk factors for IH were identified using univariate and multivariate analyses. RESULTS The study population included 1,281 patients, of whom 273 (21.3%) developed IH. Seventy-four (5.8%) patients developed incisional SSI. Multivariate logistic regression analysis revealed that female sex (odds ratio [OR], 1.39; 95% confidence interval [CI] 1.03-1.86, p = 0.031), high preoperative body mass index (OR, 1.81; 95% CI 1.19-2.77, p = 0.006), incisional SSI (OR, 2.29; 95% CI 1.34-3.93, p = 0.003), and postoperative body weight increase (OR, 1.49; 95% CI 1.09-2.04, p = 0.012) were independent risk factors for IH due to MAI in patients who underwent elective gastroenterological surgery. CONCLUSION We identified postoperative body weight increase at one year as a novel risk factor for IH in patients with MAI after elective gastroenterological surgery.
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Affiliation(s)
- Yuki Mizusawa
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Hiroshi Noda
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan.
| | - Kosuke Ichida
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Shota Fukai
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Natsumi Matsuzawa
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Sawako Tamaki
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Iku Abe
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Yuhei Endo
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Taro Fukui
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Yuji Takayama
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Koetsu Inoue
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Yuta Muto
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Fumiaki Watanabe
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Yasuyuki Miyakura
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Toshiki Rikiyama
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
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Li S, Guo Y, Zhao X, Lang D, Zhou Z. Biomechanical and tissue reaction: the effects of varying sutures size on canine abdominal wall stitching. Front Vet Sci 2023; 10:1254998. [PMID: 38026614 PMCID: PMC10667435 DOI: 10.3389/fvets.2023.1254998] [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: 07/08/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Larger diameter sutures can provide sufficient tensile strength to surgical incisions but may exacerbate the inflammatory response caused by the amount of implanted foreign material. This experiment aims to investigate the differences in biomechanical stability and tissue reactivity after suturing canine midline abdominal incisions with different suture sizes. Method Assessing the biomechanical differences between USP 2-0, 3-0, and 4-0 PGA sutures using uniaxial tensile testing on ex vivo canine midline skin and fascial muscle tissues using either a simple continuous or simple interrupted technique. mRNA and protein expression levels of inflammatory factors were measured through RT-PCR and ELISA. Tissue reactivity was evaluated using a semi-quantitative scoring system. Result For strains below 30% in skin and below 50% in muscle, there were no significant differences among groups. The results of skin biomechanical testing showed that the USP 4-0 PGA suture group demonstrated significantly lower maximum tensile strength compared to the USP 2-0 PGA or USP 3-0 PGA suture groups. However, it remained capable of providing at least 56.3 N (1.03 MPa) tensile strength for canine skin incisions, matching the tensile strength requirements of general canine abdominal wall surgical incisions. In addition, there were no statistically significant differences observed in the maximum tensile strength among different size of sutures according to the data of biomechanical testing in muscle. Larger diameter sutures led to increased levels of inflammatory factors (IL-1β, IL-6, TNF-ɑ) and tissue reactivity. Simple interrupted sutures caused higher levels of inflammatory factors in muscular tissue compared to simple continuous sutures. Conclusion USP 4-0 PGA sutures provide sufficient biomechanical stability for suturing canine abdominal skin and linea alba. Suture size significantly influences tissue reactivity after suturing, with smaller gauge sutures reducing early tissue inflammatory response. Thus, USP 4-0 PGA suture has more advantages to suturing canine abdominal surgical incisions.
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Affiliation(s)
| | | | | | | | - Zhenlei Zhou
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China
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Maki H, Kim BJ, Kawaguchi Y, Fernandez-Placencia R, Haddad A, Panettieri E, Newhook TE, Baumann DP, Santos D, Tran Cao HS, Chun YS, Tzeng CWD, Vauthey JN, Vreeland TJ. Incidence of and Risk Factors for Incisional Hernia After Hepatectomy for Colorectal Liver Metastases. J Gastrointest Surg 2023; 27:2388-2395. [PMID: 37537494 DOI: 10.1007/s11605-023-05777-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 07/01/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Incisional hernia (IH) is common after major abdominal surgery; however, the incidence after hepatectomy for cancer has not been described. We analyzed incidence of and risk factors for IH after hepatectomy for colorectal liver metastases (CLM). METHODS Patients who underwent open hepatectomy with midline or reverse-L incision for CLM at a single institution between 2010 and 2018 were retrospectively analyzed. Postoperative CT scans were reviewed to identify IH and the time from hepatectomy to hernia. Cumulative IH incidence was calculated using competing risk analysis. Risk factors were assessed using Cox proportional hazards model analysis. The relationship between IH incidence and preoperative body mass index (BMI) was estimated using a generalized additive model. RESULTS Among 470 patients (median follow-up: 16.9 months), IH rates at 12, 24, and 60 months were 41.5%, 51.0%, and 59.2%, respectively. Factors independently associated with IH were surgical site infection (HR: 1.54, 95% CI 1.16-2.06, P = 0.003) and BMI > 25 kg/m2 (HR: 1.94, 95% CI 1.45-2.61, P < 0.001). IH incidence was similar in patients undergoing midline and reverse-L incisions and patients who received and did not receive a bevacizumab-containing regimen. The 1-year IH rate increased with increasing number of risk factors (zero: 22.2%; one: 46.8%; two: 60.3%; P < 0.001). Estimated IH incidence was 10% for BMI of 15 kg/m2 and 80% for BMI of 40 kg/m2. CONCLUSION IH is common after open hepatectomy for CLM, particularly in obese patients and patients with surgical site infection. Surgeons should consider risk-mitigation strategies, including alternative fascial closure techniques.
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Affiliation(s)
- Harufumi Maki
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA
| | - Bradford J Kim
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA
| | - Yoshikuni Kawaguchi
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA
| | - Ramiro Fernandez-Placencia
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA
| | - Antony Haddad
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA
| | - Elena Panettieri
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA
| | - Timothy E Newhook
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA
| | - Donald P Baumann
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David Santos
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA
| | - Hop S Tran Cao
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA
| | - Yun Shin Chun
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA
| | - Ching-Wei D Tzeng
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA.
| | - Timothy J Vreeland
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA
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Polychronidis G, Rahbari NN, Bruckner T, Sander A, Sommer F, Usta S, Hermann J, Albers MB, Sargut M, Knebel P, Klotz R. Continuous versus interrupted abdominal wall closure after emergency midline laparotomy: CONTINT: a randomized controlled trial [NCT00544583]. World J Emerg Surg 2023; 18:51. [PMID: 37848901 PMCID: PMC10583371 DOI: 10.1186/s13017-023-00517-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/23/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND High-level evidence regarding the technique of abdominal wall closure for patients undergoing emergency midline laparotomy is sparse. Therefore, we conducted a randomized controlled trial (RCT) to evaluate the efficacy and safety of two commonly applied abdominal wall closure strategies after primary emergency midline laparotomy. METHODS/DESIGN CONTINT was a multi-center pragmatic open-label exploratory randomized controlled parallel trial. Two different abdominal wall closure strategies in patients undergoing primary midline laparotomy for an emergency surgical intervention with a suspected septic focus in the abdominal cavity were compared: the continuous, all-layer suture and the interrupted suture technique. The primary composite endpoint was burst abdomen within 30 days after surgery or incisional hernia within 12 months. As reliable data on this composite primary endpoint were not available for patients undergoing emergency surgery, it was planned to initially recruit 80 patients and conduct an interim analysis after these had completed the 12 months follow-up. RESULTS From August 31, 2009, to June 28, 2012, 124 patients were randomized of whom 119 underwent surgery and were analyzed according to the intention-to-treat (ITT) principal. The primary composite endpoint did not differ between the continuous suture (C: 27.1%) and the interrupted suture group (I: 30.0%). None of the individual components of the primary endpoint (reoperation due to burst abdomen after 30 days (C: 13.5%, I: 15.1%) and reoperation due to incisional hernia (C: 3.0%, I:11.1%)) differed between groups. Time needed for fascial closure was longer in the interrupted suture group (C: 12.8 ± 4.5 min, I: 17.4 ± 6.1 min). BMI was associated with burst abdomen during the first 30 days with an OR of 1.17 (95% CI 1.04-1.32). CONCLUSION This RCT showed no difference between continuous suture with slowly absorbable suture versus interrupted rapidly absorbable sutures after primary emergency midline laparotomy in rates of postoperative burst abdomen and incisional hernia after one year. However, the trial was stopped after the interim analysis due to futility as there was no chance to show superiority of one suture technique.
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Affiliation(s)
- Georgios Polychronidis
- Department of General, Visceral and Transplant Surgery, Heidelberg University Hospital, Heidelberg, Germany
- Study Centre of the German Surgical Society (SDGC), Heidelberg, Germany
| | - Nuh N Rahbari
- Department of Surgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry (IMBI), University of Heidelberg, Heidelberg, Germany
| | - Anja Sander
- Institute of Medical Biometry (IMBI), University of Heidelberg, Heidelberg, Germany
| | - Florian Sommer
- Department of General and Visceral Surgery, Augsburg University Medical Center, Augsburg, Germany
| | - Selami Usta
- Department for General and Visceral Surgery, St. Josefs-Hospital, Dortmund, Germany
| | - Janssen Hermann
- Department of General, Visceral, Vascular and Thoracic Surgery, Düren Hospital, Düren, Germany
| | - Max Benjamin Albers
- Department of Visceral-, Thoracic- and Vascular Surgery, Philipps-University Marburg, Marburg, Germany
| | - Mine Sargut
- Department of Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - Phillip Knebel
- Department of General, Visceral and Transplant Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Rosa Klotz
- Department of General, Visceral and Transplant Surgery, Heidelberg University Hospital, Heidelberg, Germany.
- Study Centre of the German Surgical Society (SDGC), Heidelberg, Germany.
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Frassini S, Cobianchi L, Fugazzola P, Biffl WL, Coccolini F, Damaskos D, Moore EE, Kluger Y, Ceresoli M, Coimbra R, Davies J, Kirkpatrick A, Di Carlo I, Hardcastle TC, Isik A, Chiarugi M, Gurusamy K, Maier RV, Segovia Lohse HA, Jeekel H, Boermeester MA, Abu-Zidan F, Inaba K, Weber DG, Augustin G, Bonavina L, Velmahos G, Sartelli M, Di Saverio S, Ten Broek RPG, Granieri S, Dal Mas F, Farè CN, Peverada J, Zanghì S, Viganò J, Tomasoni M, Dominioni T, Cicuttin E, Hecker A, Tebala GD, Galante JM, Wani I, Khokha V, Sugrue M, Scalea TM, Tan E, Malangoni MA, Pararas N, Podda M, De Simone B, Ivatury R, Cui Y, Kashuk J, Peitzman A, Kim F, Pikoulis E, Sganga G, Chiara O, Kelly MD, Marzi I, Picetti E, Agnoletti V, De'Angelis N, Campanelli G, de Moya M, Litvin A, Martínez-Pérez A, Sall I, Rizoli S, Tomadze G, Sakakushev B, Stahel PF, Civil I, Shelat V, Costa D, Chichom-Mefire A, Latifi R, Chirica M, Amico F, Pardhan A, Seenarain V, Boyapati N, Hatz B, Ackermann T, Abeyasundara S, Fenton L, Plani F, Sarvepalli R, Rouhbakhshfar O, Caleo P, Ho-Ching Yau V, Clement K, Christou E, Castillo AMG, Gosal PKS, Balasubramaniam S, Hsu J, Banphawatanarak K, Pisano M, Adriana T, Michele A, Cioffi SPB, Spota A, Catena F, Ansaloni L. ECLAPTE: Effective Closure of LAParoTomy in Emergency-2023 World Society of Emergency Surgery guidelines for the closure of laparotomy in emergency settings. World J Emerg Surg 2023; 18:42. [PMID: 37496068 PMCID: PMC10373269 DOI: 10.1186/s13017-023-00511-w] [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: 06/29/2023] [Accepted: 07/18/2023] [Indexed: 07/28/2023] Open
Abstract
Laparotomy incisions provide easy and rapid access to the peritoneal cavity in case of emergency surgery. Incisional hernia (IH) is a late manifestation of the failure of abdominal wall closure and represents frequent complication of any abdominal incision: IHs can cause pain and discomfort to the patients but also clinical serious sequelae like bowel obstruction, incarceration, strangulation, and necessity of reoperation. Previous guidelines and indications in the literature consider elective settings and evidence about laparotomy closure in emergency settings is lacking. This paper aims to present the World Society of Emergency Surgery (WSES) project called ECLAPTE (Effective Closure of LAParoTomy in Emergency): the final manuscript includes guidelines on the closure of emergency laparotomy.
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Affiliation(s)
- Simone Frassini
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy.
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy.
| | - Lorenzo Cobianchi
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Paola Fugazzola
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Walter L Biffl
- Department of Emergency and Trauma Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Dimitrios Damaskos
- General and Emergency Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Ernest E Moore
- Ernest E Moore Shock Trauma Center at Denver Health, Denver, CO, USA
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Marco Ceresoli
- General Surgery, Monza University Hospital, Monza, Italy
| | - Raul Coimbra
- Riverside University Health System Medical Center, Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Claremont, CA, USA
| | - Justin Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge, UK
| | - Andrew Kirkpatrick
- Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Canada
| | - Isidoro Di Carlo
- Department of Surgical Sciences and Advanced Technologies, General Surgery Unit, Cannizzaro Hospital, Catania, Italy
| | - Timothy C Hardcastle
- Department of Surgical Sciences, Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, 4001, South Africa
- Trauma and Burns Services, Inkosi Albert Luthuli Central Hospital, Mayville, 4058, South Africa
| | - Arda Isik
- Division of General Surgery, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Massimo Chiarugi
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Kurinchi Gurusamy
- Division of Surgery and Interventional Science, Hampstead Campus, University College London, London, UK
| | - Ronald V Maier
- Department of Surgery, Harborview Medical Centre, University of Washington, Seattle, USA
| | - Helmut A Segovia Lohse
- II Cátedra de Clínica Quirúrgica, Hospital de Clínicas, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Hans Jeekel
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Marja A Boermeester
- Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, 1105AZ, Amsterdam, The Netherlands
| | - Fikri Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE
| | - Kenji Inaba
- Los Angeles County + USC Medical Center, 2051 Marengo Street, Room C5L100, Los Angeles, CA, 90033, USA
| | - Dieter G Weber
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Goran Augustin
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Luigi Bonavina
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy
| | - George Velmahos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Salomone Di Saverio
- Unit of General Surgery, San Benedetto del Tronto Hospital, av5 Asur Marche, San Benedetto del Tronto, Italy
| | | | - Stefano Granieri
- General Surgery Unit, ASST Vimercate, Via Santi Cosma E Damiano, 10, 20871, Vimercate, Italy
| | - Francesca Dal Mas
- Department of Management, Università Ca' Foscari, Dorsoduro 3246, 30123, Venezia, Italy
| | - Camilla Nikita Farè
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Jacopo Peverada
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Simone Zanghì
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Jacopo Viganò
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Matteo Tomasoni
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Tommaso Dominioni
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Enrico Cicuttin
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Andreas Hecker
- Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen, Germany
| | - Giovanni D Tebala
- Department of Digestive and Emergency Surgery, S. Maria Hospital Trust, Terni, Italy
| | - Joseph M Galante
- Trauma Department, University of California, Davis, Sacramento, CA, USA
| | | | - Vladimir Khokha
- Department of Emergency Surgery, City Hospital, Mozyr, Belarus
| | - Michael Sugrue
- Donegal Clinical Research Academy Emergency Surgery Outcome Project, Letterkenny University Hospital, Donegal, Ireland
| | - Thomas M Scalea
- Cowley Shock Trauma Center at the University of Maryland, Baltimore, MD, USA
| | - Edward Tan
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mark A Malangoni
- Department of Surgery, MetroHealth Medical Center Campus, Case Western Reserve University, Cleveland, OH, 44109, USA
| | - Nikolaos Pararas
- Third Department of Surgery, Attikon University Hospital, 15772, Athens, Greece
| | - Mauro Podda
- Department of Surgical Science, Cagliari State University, Cagliari, Italy
| | - Belinda De Simone
- Department of Emergency Surgery, Centre Hospitalier Intercommunal de Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, France
| | - Rao Ivatury
- Virginia Commonwealth University, Richmond, VA, USA
| | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China
| | - Jeffry Kashuk
- Department of Surgery, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Andrew Peitzman
- Division of Trauma and General Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Fernando Kim
- Denver Health Medical Center, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Emmanouil Pikoulis
- Medical School, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Gabriele Sganga
- Fondazione Policlinico Universitario A.Gemelli IRCCS, Università Cattolica, Rome, Italy
| | - Osvaldo Chiara
- Trauma Center and Emergency Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Michael D Kelly
- Department of General Surgery, Albury Hospital, Albury, Australia
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | - Vanni Agnoletti
- Anesthesia and Intensive Care Unit, Ospedale M Bufalini, Cesena, Italy
| | - Nicola De'Angelis
- Service de Chirurgie Digestive et Hépato-Bilio-Pancréatique, Hôpital Henri Mondor, Université Paris Est, Créteil, France
| | - Giampiero Campanelli
- Division of General Surgery, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, University of Insubria, Varese, Italy
| | - Marc de Moya
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andrey Litvin
- AI Medica Hospital Center / Immanuel Kant Baltic Federal University, Kaliningrad, Russia
| | - Aleix Martínez-Pérez
- Faculty of Health Sciences, Valencian International University (VIU), Valencia, Spain
| | - Ibrahima Sall
- Department of General Surgery, Military Teaching Hospital, Hôpital Principal Dakar, Dakar, Senegal
| | | | - Gia Tomadze
- Department of Surgery, Tbilisi State Medical University, Tbilisi, Georgia
| | | | - Philip F Stahel
- Department of Orthopedic Surgery and Neurosurgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO, USA
| | - Ian Civil
- Trauma Service, Auckland City Hospital, Auckland, New Zealand
| | | | - David Costa
- Department of General y Digestive Surgery, "Dr. Balmis" Alicante General University Hospital, Alicante, Spain
| | | | - Rifat Latifi
- College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Mircea Chirica
- Service de Chirurgie Digestive, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Francesco Amico
- Department of Traumatology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | | | - Vidya Seenarain
- Acute Surgical Unit, Department of General Surgery, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Nikitha Boyapati
- Acute Surgical Unit, Department of General Surgery, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Basil Hatz
- State Major Trauma Unit, Royal Perth Hospital, Wellington Street, Perth, Australia
| | - Travis Ackermann
- General Surgery, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia
| | - Sandun Abeyasundara
- Department of Colorectal Surgery, Logan Hospital, Meadowbrook, QLD, Australia
| | - Linda Fenton
- Maitland Private Hospital, East Maitland, Newcastle, NSW, Australia
| | - Frank Plani
- Chris Hani Baragwanath Hospital, Soweto, South Africa
| | - Rohit Sarvepalli
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Omid Rouhbakhshfar
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Pamela Caleo
- Nambour Selangor Private Hospital, Sunshine Coast University Private Hospital, Birtinya, QLD, Australia
| | | | - Kristenne Clement
- Department of Surgery, Nepean Hospital, Penrith, NSW, 2751, Australia
| | - Erasmia Christou
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | | | - Preet K S Gosal
- Department of General Surgery, Nepean Hospital, Sydney, NSW, Australia
| | - Sunder Balasubramaniam
- Department of Trauma, Westmead Hospital, The University of Sydney, Sydney, NSW, Australia
| | - Jeremy Hsu
- Department of Trauma, Westmead Hospital, The University of Sydney, Sydney, NSW, Australia
| | | | - Michele Pisano
- General and Emergency Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Toro Adriana
- General Surgery, Augusta Hospital, Augusta, Italy
| | - Altomare Michele
- Trauma Center and Emergency Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Stefano P B Cioffi
- Trauma Center and Emergency Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Andrea Spota
- Trauma Center and Emergency Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Fausto Catena
- Acute Care Surgery Unit, Department of Surgery and Trauma, Maurizio Bufalini Hospital, Cesena, Italy
| | - Luca Ansaloni
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
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10
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Sarkar J, Minarich MJ, Smucker LY, Hardy AN, Schwarz RE. Low incisional hernia incidence using a large-bite, low-tension technique for celiotomy closure. Surg Open Sci 2023; 13:94-98. [PMID: 37274136 PMCID: PMC10238872 DOI: 10.1016/j.sopen.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/10/2023] [Indexed: 06/06/2023] Open
Abstract
Background Incisional herniae (IH) are reported in 5->20 % of patients undergoing open celiotomy, and can be linked to closure technique. The STITCH randomized trial favors a small bite technique for midline celiotomy closure with a 1-year IH rate of 13 % over larger bites (23 %). Methods A continuous musculofascial mass closure with absorbable looped #1 PDS suture with 2-cm bite size was used for all open celiotomies. IH frequency and associated clinicopathologic factors were retrospectively analyzed from prospective data in 336 consecutive patients undergoing visceral resections by a single surgeon. Results The study population included 192 men and 144 women, 81 % of whom had a cancer diagnosis, who underwent hepatobiliary, pancreatic, gastroesophageal, and colorectal resections, or a combination. The majority of patients (84 %) had subcostal incisions, and 10 % received a midline incision. At a median follow-up of 19.5 months, the overall IH rate was 3.3 %. Hernia rates were 2.5 % for subcostal margin, 2.9 % for midline, and 5.5 % for other incisions (p = 0.006). Median time to hernia detection was 492 days. Factors associated with IH were increased weight, abdominal depth/girth, male sex, spleen size, visceral fat, and body height (p ≤ 0.04 for all), but not type of resection, prior operations, underlying diagnosis, weight loss, adjuvant chemotherapy or radiation, incision length or suture to incision ratio. Conclusions The described technique leads to a low IH rate of <3 % in subcostal or midline incisions, and can be recommended for routine use. The observed results appear superior to those of the STITCH trial, even for the smaller midline incision cohort.
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Affiliation(s)
- Joy Sarkar
- Roswell Park Cancer Institute, Department of Surgical Oncology, Buffalo, NY, USA
| | - Michael J. Minarich
- Goshen Center for Cancer Care, Department of Surgical Oncology, Goshen, IN, USA
| | - Levi Y. Smucker
- Goshen Center for Cancer Care, Department of Surgical Oncology, Goshen, IN, USA
| | - Ashley N. Hardy
- Goshen Center for Cancer Care, Department of Surgical Oncology, Goshen, IN, USA
| | - Roderich E. Schwarz
- Roswell Park Cancer Institute, Department of Surgical Oncology, Buffalo, NY, USA
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11
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Heger P, Hackert T, Diener MK, Feißt M, Klose C, Dörr-Harim C, Möhlenbrock F, Büchler MW, Mihaljevic AL. Conventional partial pancreatoduodenectomy versus an extended pancreatoduodenectomy (triangle operation) for pancreatic head cancers-study protocol for the randomised controlled TRIANGLE trial. Trials 2023; 24:363. [PMID: 37254179 DOI: 10.1186/s13063-023-07337-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/29/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Pancreatic ductal carcinoma (PDAC) is the fourth most frequent cause of cancer-related death in the Western world, and its incidence is rising. In patients that undergo curative resection, local recurrence (LR) is frequent. A recently described surgical technique of extended pancreatoduodenectomy (PD) termed the TRIANGLE operation has been proposed as a promising approach to reduce LR and improve disease-free survival in PDAC patients. METHODS The TRIANGLE trial is a multicentre confirmatory randomised controlled superiority trial with two parallel study groups. A total of 270 patients with suspected or histologically confirmed pancreatic head cancer scheduled for PD will be included in the trial and randomly assigned to the intervention group (extended PD defined as Inoue level 3 dissection along the superior mesenteric and celiac artery as well as removal of all soft tissue in the so-called triangle between the celiac artery, the SMA and the mesenterico-portal axis) or the control group (conventional PD with lymphadenectomy and removal of soft tissue according to current guidelines). The primary endpoint of the trial will be the disease-free survival of patients. Other perioperative outcomes as well as oncological parameters and patient-reported outcomes will be analysed as secondary outcomes. DISCUSSION Despite multimodal treatment, LR remains high and disease-free survival is limited following PD for PDAC. The TRIANGLE operation could address these shortcomings of conventional PD as indicated in several retrospective studies. However, this technique could be associated with more adverse events for patients including intractable diarrhoea. The TRIANGLE trial will close the evidence gap as well as offer a risk-benefit assessment of this more radical approach to PD. TRIAL REGISTRATION German Clinical Trials Register DRKS00030576 (UTN U1111-1243-4412) 19th December 2022.
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Affiliation(s)
- Patrick Heger
- Department of General and Visceral Surgery and Clinical Trial Centre of the Department of General and Visceral Surgery (ulmCARES), University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
- Medical Faculty, Ulm University, Meyerhofstraße M28, Ulm, 89081, Germany
| | - Thilo Hackert
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Markus K Diener
- Department of General and Visceral Surgery, University Hospital Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Manuel Feißt
- Institute of Medical Biometry (IMBI), University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Christina Klose
- Institute of Medical Biometry (IMBI), University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Colette Dörr-Harim
- Department of General and Visceral Surgery and Clinical Trial Centre of the Department of General and Visceral Surgery (ulmCARES), University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Friedhelm Möhlenbrock
- Arbeitskreis der Pankreatektomierten e.V, Thomas-Mann-Straße 40, 53111, Bonn, Germany
| | - Markus W Büchler
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - André L Mihaljevic
- Department of General and Visceral Surgery and Clinical Trial Centre of the Department of General and Visceral Surgery (ulmCARES), University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
- Medical Faculty, Ulm University, Meyerhofstraße M28, Ulm, 89081, Germany.
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12
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ABDELSHAHID MA, ELBALSHY MA, ABU BAKRE F, ELMALLAH AS. "Cross-over" versus mass closure techniques for elective midline laparotomies. Chirurgia (Bucur) 2023. [DOI: 10.23736/s0394-9508.22.05397-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
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13
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Isozaki H. Prevention of incisional surgical site infection by subfascial closed suction drainage after open laparotomy: a single surgeon experience in 250 consecutive patients. Patient Saf Surg 2023; 17:4. [PMID: 36803411 PMCID: PMC9942376 DOI: 10.1186/s13037-023-00354-z] [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: 01/10/2023] [Accepted: 02/13/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Open laparotomy with gastroenterological surgery is a surgical procedure results in a relatively high rate (about 10% or more) of incisional surgical site infection (SSI). To reduce incisional SSI after open laparotomy, mechanical preventors, such as subcutaneous wound drainage or negative-pressure wound therapy (NPWT), have been tried; however, conclusive results have not been obtained. This study evaluated the prevention of incisional SSI by first subfascial closed suction drainage after open laparotomy. METHODS A total of 453 consecutive patients who underwent open laparotomy with gastroenterological surgery by one surgeon in one hospital (between August 1, 2011, and August 31, 2022) was investigated. Same absorbable threads and ring drapes were used in this period. Subfascial drainage was used in consecutive 250 patients in the later period (between January 1, 2016, and August 31, 2022). The incidences of SSIs in the subfascial drainage group were compared to those of in the no subfascial drainage group. RESULTS (a) No incisional SSI (superficial and deep) occurred in the subfascial drainage group (superficial = 0% [0/250] and deep = 0% [0/250]). As a result, incidences of incisional SSI of the subfascial drainage group were significantly lower than those of the no subfascial drainage group (superficial = 8.9% [18/203]; deep = 3.4% [7/203]) (p < 0.001 and p = 0.003, respectively). (b) Four out of seven deep incisional SSI patients in the no subfascial drainage group underwent debridement and re-suture under lumbar or general anesthesia. (c) There was no significant difference in the incidences of organ/space SSI of the two groups (3.4% [7/203] in the no subfascial drainage group and 5.2% [13/250] in the subfascial drainage group) (P = 0.491). CONCLUSION Subfascial drainage was associated with no incisional SSI after open laparotomy with gastroenterological surgery.
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Affiliation(s)
- Hiroshi Isozaki
- Department of Surgery, Oomoto Hospital, 1-1-5 Oomoto, Okayama, 700-0924, Japan.
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14
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Müller S, Weyhe D, Herrle F, Horvath P, Bachmann R, von Ehrlich-Treuenstätt V, Heger P, Nasir N, Klose C, Ritz A, Sander A, Grohmann E, Dörr-Harim C, Mihaljevic AL. Prophylactic effect of retromuscular mesh placement during loop ileostomy closure on incisional hernia incidence-a multicentre randomised patient- and observer-blind trial (P.E.L.I.O.N trial). Trials 2023; 24:76. [PMID: 36726155 PMCID: PMC9890770 DOI: 10.1186/s13063-023-07089-3] [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: 11/11/2022] [Accepted: 01/10/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Incisional hernia is a frequent complication following loop ileostomy reversal. Incisional hernias are associated with morbidity, loss of health-related quality of life and costs and warrant the investigation of prophylactic measures. Prophylactic mesh implantation at the time of surgical stoma reversal has shown to be a promising and safe method to prevent incisional hernias in this setting. However, the efficacy of this method has not yet been investigated in a large multicentre randomised-controlled trial (RCT) with adequate external validity. The P.E.L.I.O.N. trial will evaluate the efficacy of prophylactic mesh reinforcement after loop ileostomy closure in decreasing the rate of incisional hernia versus standard closure alone. METHODS P.E.L.I.O.N. is a multicentre, patient- and observer-blind RCT. Patients undergoing loop ileostomy closure will undergo intraoperative 1:1 randomisation into either abdominal wall closure with a continuous slowly absorbable suture in small-stitch technique without mesh reinforcement (control group) or abdominal wall closure with an additional reinforcement with a retromuscular non-absorbable, macro-pore (pore size ≥ 1000 μm or effective porosity >0%) light-weight monofilament or mixed structure mesh. A total of 304 patients (152 per group) will need to be randomised in the study. Based on inclusion and exclusion criteria, 1,014 patients are expected to be screened for eligibility in order to recruit the necessary number of patients. The primary endpoint will be the frequency of incision hernias within 24 months according to the European Hernia Society definition. Secondary endpoints will be the frequency of surgical site occurrences (including surgical site infections, wound seromas and hematomas, and enterocutaneous fistulas), postoperative pain, the number of revision surgeries and health-related quality of life. Safety will be assessed by measuring postoperative complications ≥ grade 3 according to the Dindo-Clavien classification. DISCUSSION Depending on the results of the P.E.L.I.O.N. trial, prophylactic mesh implantation could become the new standard for loop ileostomy reversal. TRIAL REGISTRATION DRKS00027921, U1111-1273-4657.
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Affiliation(s)
- Sven Müller
- Helios Klinikum Gifhorn, Campus 6, 38518 Gifhorn, Germany
| | - Dirk Weyhe
- grid.477704.70000 0001 0275 7806Klinik für Allgemein- und Viszeralchirurgie, Universitätsmedizin Oldenburg, Pius-Hospital Oldenburg, Georgstraße 12, 26121 Oldenburg, Germany
| | - Florian Herrle
- grid.411778.c0000 0001 2162 1728Chirurgische Klinik, Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Philipp Horvath
- grid.411544.10000 0001 0196 8249Klinik für Allgemeine, Viszeral- und Transplantationschirurgie, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Robert Bachmann
- grid.411544.10000 0001 0196 8249Klinik für Allgemeine, Viszeral- und Transplantationschirurgie, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Viktor von Ehrlich-Treuenstätt
- grid.5252.00000 0004 1936 973XKlinik für Allgemein-, Viszeral- und Transplantationschirurgie, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377 München, Germany
| | - Patrick Heger
- grid.410712.10000 0004 0473 882XDepartment of General and Visceral Surgery and Clinical Trial Centre Department of Surgery (ulmCARES), University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Nadir Nasir
- grid.410712.10000 0004 0473 882XDepartment of General and Visceral Surgery and Clinical Trial Centre Department of Surgery (ulmCARES), University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Christina Klose
- grid.7700.00000 0001 2190 4373Institute of Medical Biometry (IMBI), University of Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Alexander Ritz
- grid.7700.00000 0001 2190 4373Institute of Medical Biometry (IMBI), University of Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Anja Sander
- grid.7700.00000 0001 2190 4373Institute of Medical Biometry (IMBI), University of Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Erich Grohmann
- Deutsche ILCO e. V., Nietzschestr. 11, 53177 Bonn, Germany
| | - Colette Dörr-Harim
- grid.410712.10000 0004 0473 882XDepartment of General and Visceral Surgery and Clinical Trial Centre Department of Surgery (ulmCARES), University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - André L. Mihaljevic
- grid.410712.10000 0004 0473 882XDepartment of General and Visceral Surgery and Clinical Trial Centre Department of Surgery (ulmCARES), University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
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15
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Khor SN, Cheok SHX, Sultana R, Tan EKW. Incidence of incisional hernia after major colorectal cancer surgery & analysis of associated risk factors in Asian population: Is laparoscopy any better? Asian J Surg 2023; 46:99-104. [PMID: 35165026 DOI: 10.1016/j.asjsur.2022.01.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/27/2021] [Accepted: 01/20/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Incisional hernia is one of the common morbidities after major colorectal cancer surgery. We aim to compare the incidence of incisional hernias between laparoscopic and open surgery. We also aim to identify associated risk factors of incisional hernia among Asian population who has undergone major resection for colorectal cancer. METHODS Data of patients who had undergone major colorectal cancer surgery in year 2015 from a single institution was collected. Data were extracted from electronic clinical records from our institution's database. Incisional hernias were identified by clinical examination and computed tomography (CT) scan performed during post-operative follow up as part of colorectal cancer surveillance. Follow up data of up to 3 years were extracted. Univariate and multivariable logistic regression analysis were performed to identify associated risk factors for development of incisional hernia. Propensity score matching analysis was performed for laparoscopic and open resection. RESULTS 502 patients were included in the study. With a minimum follow up of 3 years, overall incisional hernia incidence rate of 13% was identified. Incisional hernias after laparoscopic and open surgery were 12.3% and 13.8% (p = 0.688) respectively. Univariate logistic regression analysis showed that body mass index (BMI) of >23kg/m2, ASA of III/IV and post-operative anastomotic leak were associated with development of incisional hernias. On multivariable analysis, female gender (OR 2.102, 95%CI: 1.155, 3.826), BMI of ≥23 kg/m2 (OR 2.862 95%CI: 1.582, 5.181), ASA III/IV (OR 2.052, 95%CI: 1.169, 3.602), were significantly associated with development of incisional hernia. Propensity scores matched analysis showed laparoscopic surgery did not significantly reduce the incidence of incisional hernia. CONCLUSION The overall incidence of incisional hernia seems lower in Asian population. Our study demonstrated no significant difference in incisional hernia rates between patients undergoing laparoscopic versus open colorectal cancer surgery. Female gender, higher BMI, and higher ASA are associated with increased risk of developing incisional hernia after major colorectal cancer resection.
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Affiliation(s)
- Shao Nan Khor
- Department of Colorectal Surgery, Singapore General Hospital, Outram Road, S169608, Singapore.
| | - S H X Cheok
- Department of Colorectal Surgery, Singapore General Hospital, Outram Road, S169608, Singapore.
| | | | - Emile Kwong Wei Tan
- Department of Colorectal Surgery, Singapore General Hospital, Outram Road, S169608, Singapore.
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16
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Wolf S, Arbona de Gracia L, Sommer F, Schrempf MC, Anthuber M, Vlasenko D. Continuous and interrupted abdominal-wall closure after primary emergency midline laparotomy (CONIAC-trial): study protocol for a randomised controlled single centre trial. BMJ Open 2022; 12:e059709. [PMID: 36418137 PMCID: PMC9685222 DOI: 10.1136/bmjopen-2021-059709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The optimal closure of the abdominal wall after emergency midline laparotomy is still a matter of debate due to lack of evidence. Although closure of the fascia using a continuous, all-layer suture technique with slowly absorbable monofilament material is common, complications like burst abdomen and hernia are frequent. METHODS AND ANALYSIS This randomised controlled trial with a 1:1 allocation evaluates the efficacy and safety of a continuous suture with or without additional interrupted retention sutures for closure of the abdominal fascia. Patients with an indication for a primary emergency midline laparotomy are eligible to participate in this study and will be randomised intraoperatively via block randomisation. Fascia closure in the intervention group will be done with a standard continuous suture with slowly absorbable monofilament material (MonoMax 1, B. Braun, Tuttlingen, Germany) and additional interrupted retention sutures every 2 cm of the fascia using rapidly absorbable braided material (Vicryl 2, Ethicon, Norderstedt, Germany). In the control group, the fascia is closed only with the standard continuous suture with slowly absorbable monofilament material. Sample size calculations (n=111 per study arm) are based on the available literature. The primary endpoint is the rate of dehiscence of the abdominal fascia (rate of burst abdomen within 30 days or rate of incisional hernia within 12 months). Secondary endpoints are wound infections, quality of life, length of hospital stay, morbidity and mortality. Patients as well as individuals involved in data collection, endpoint assessment, data analysis and quality of life assessment will be blinded. ETHICS AND DISSEMINATION The study protocol, the patient information and the informed consent form have been approved by the ethics committee of the Ludwig-Maximilians-University, Munich, Germany (reference number: 20-1041). Study findings will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER DRKS00024802. WHO UNIVERSAL TRIAL NUMBER U1111-1259-1956.
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Affiliation(s)
- Sebastian Wolf
- Department of General, Visceral and Transplant Surgery, University of Augsburg, Augsburg, Germany
| | - Luis Arbona de Gracia
- Department of General, Visceral and Transplant Surgery, University of Augsburg, Augsburg, Germany
| | - Florian Sommer
- Department of General, Visceral and Transplant Surgery, University of Augsburg, Augsburg, Germany
| | | | - Matthias Anthuber
- Department of General, Visceral and Transplant Surgery, University of Augsburg, Augsburg, Germany
| | - Dmytro Vlasenko
- Department of General, Visceral and Transplant Surgery, University of Augsburg, Augsburg, Germany
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17
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Abdominal subcutaneous obesity and the risk of burst abdomen: a matched case-control study. Langenbecks Arch Surg 2022; 407:3719-3726. [PMID: 36125516 DOI: 10.1007/s00423-022-02682-7] [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: 03/22/2022] [Accepted: 09/12/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE The causes of burst abdomen after midline laparotomy remain uncertain. Obesity is a suspected risk factor. The purpose of this study was to investigate the association between abdominal subcutaneous obesity (ASO) and burst abdomen in patients undergoing emergency midline laparotomy. METHODS We conducted a single-centre, retrospective, matched case-control study of patients undergoing emergency midline laparotomy from May 2016 to August 2021. Patients suffering from burst abdomen were matched 1:4 with controls based on age and sex. Abdominal wall closure was standardized in the study period with the small bites, small stitches technique. ASO was defined as the highest sex-specific quartile (≥ 75%) of subcutaneous fat layer evaluated on CT. The primary outcome was the association between ASO and burst abdomen, stratified between cases and controls. Secondary outcomes included 30- and 90-day mortality, length of stay, and suspected risk factors of burst abdomen, assessed by multivariate analysis across cases and controls. RESULTS A total of 475 patients were included in this study, with 95 cases matched to 380 controls. Liver cirrhosis, active smoking, and high alcohol consumption were more common among cases in an unadjusted analysis. Liver cirrhosis (odds ratio (OR) 3.32, p = 0.045) and active smoking (OR 1.98, p = 0.009) remained significant in a multivariate analysis and were associated with burst abdomen. One hundred twenty-four patients had ASO. ASO was not significantly associated with burst abdomen (OR 1.11, p = 0.731). CONCLUSION ASO was not found to be associated with an increased risk of burst abdomen after emergency midline laparotomy.
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18
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The effect of prophylactic mesh implantation on the development of incisional hernias in patients with elevated BMI: a systematic review and meta-analysis. Hernia 2022; 27:225-234. [PMID: 36103010 PMCID: PMC10126020 DOI: 10.1007/s10029-022-02675-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/30/2022] [Indexed: 11/04/2022]
Abstract
Abstract
Background
Incisional hernia is a common complication after midline laparotomy. In certain risk profiles incidences can reach up to 70%. Large RCTs showed a positive effect of prophylactic mesh reinforcement (PMR) in high-risk populations.
Objectives
The aim was to evaluate the effect of prophylactic mesh reinforcement on incisional hernia reduction in obese patients after midline laparotomies.
Methods
Following the PRISMA guidelines, a systematic literature search in Medline, Web of Science and CENTRAL was conducted. RCTs investigating PMR in patients with a BMI ≥ 27 reporting incisional hernia as primary outcome were included. Study quality was assessed using the Cochrane risk-of-bias tool and certainty of evidence was rated according to the GRADE Working Group grading of evidence. A random-effects model was used for the meta-analysis. Secondary outcomes included postoperative complications.
Results
Out of 2298 articles found by a systematic literature search, five RCTs with 1136 patients were included. There was no significant difference in the incidence of incisional hernia when comparing PMR with primary suture (odds ratio (OR) 0.59, 95% CI 0.34–1.01, p = 0.06, GRADE: low). Meta-analyses of seroma formation (OR 1.62, 95% CI 0.72–3.65; p = 0.24, GRADE: low) and surgical site infections (OR 1.52, 95% CI 0.72–3.22, p = 0.28, GRADE: moderate) showed no significant differences as well as subgroup analyses for BMI ≥ 40 and length of stay.
Conclusions
We did not observe a significant reduction of the incidence of incisional hernia with prophylactic mesh reinforcement used in patients with elevated BMI. These results stand in contrast to the current recommendation for hernia prevention in obese patients.
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19
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Fortelny RH, Andrade D, Schirren M, Baumann P, Riedl S, Reisensohn C, Kewer JL, Hoelderle J, Shamiyeh A, Klugsberger B, Maier TD, Schumacher G, Köckerling F, Pession U, Hofmann A, Albertsmeier M. Effects of the short stitch technique for midline abdominal closure on incisional hernia (ESTOIH): randomized clinical trial. Br J Surg 2022; 109:839-845. [PMID: 35707932 PMCID: PMC10364738 DOI: 10.1093/bjs/znac194] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/13/2022] [Accepted: 05/12/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Incisional hernia remains a frequent problem after midline laparotomy. This study compared a short stitch to standard loop closure using an ultra-long-term absorbent elastic suture material. METHODS A prospective, multicentre, parallel-group, double-blind, randomized, controlled superiority trial was designed for the elective setting. Adult patients were randomly assigned by computer-generated sequence to fascial closure using a short stitch (5 to 8 mm every 5 mm, USP 2-0, single thread HR 26 mm needle) or long stitch technique (10 mm every 10 mm, USP 1, double loop, HR 48 mm needle) with a poly-4-hydroxybutyrate-based suture material (Monomax®). Incisional hernia assessed by ultrasound 1 year after surgery was the primary outcome. RESULTS The trial randomized 425 patients to short (n = 215) or long stitch technique (n = 210) of whom 414 (97.4 per cent) completed 1 year of follow-up. In the short stitch group, the fascia was closed with more stitches (46 (12 s.d.) versus 25 (7 s.d.); P < 0.001) and higher suture-to-wound length ratio (5.3 (2.2 s.d.) versus 4.0 (1.3 s.d.); P < 0.001). At 1 year, seven of 210 (3.3 per cent) patients in the short and 13 of 204 (6.4 per cent) patients in the long stitch group developed incisional hernia (odds ratio 1.97, 95 per cent confidence interval 0.77 to 5.05; P = 0.173). CONCLUSION The 1-year incisional hernia development was relatively low with clinical but not statistical difference between short and long stitches. Registration number: NCT01965249 (http://www.clinicaltrials.gov).
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Affiliation(s)
- René H Fortelny
- Wilhelminenspital, Allgemein, Viszeral und Tumorchirurgie, Vienna, Austria
- Sigmund Freud Privat Universität, Med. Fakultät, Vienna, Austria
| | - Dorian Andrade
- Ludwig-Maximilians-Universität (LMU) Munich, LMU University Hospital, Department of General, Visceral and Transplantation Surgery, Munich, Germany
| | - Malte Schirren
- Ludwig-Maximilians-Universität (LMU) Munich, LMU University Hospital, Department of General, Visceral and Transplantation Surgery, Munich, Germany
| | - Petra Baumann
- Aesculap AG, Department of Medical Scientific Affairs, Am Aesculap Platz, Tuttlingen, Germany
| | - Stefan Riedl
- Alb Fils Klinik GmbH, Klinik am Eichert, Allgemeinchirurgie, Göppingen, Germany
| | - Claudia Reisensohn
- Alb Fils Klinik GmbH, Klinik am Eichert, Allgemeinchirurgie, Göppingen, Germany
| | - Jan Ludolf Kewer
- Klinikum Landkreis Tuttlingen, Klinik für Allgemein, Viszeral und Gefäßchirurgie, Tuttlingen, Germany
| | - Jessica Hoelderle
- Klinikum Landkreis Tuttlingen, Klinik für Allgemein, Viszeral und Gefäßchirurgie, Tuttlingen, Germany
| | - Andreas Shamiyeh
- Kepler Universitätsklinikum GmbH, Klinik für Allgemein und Viszeralchirurgie, Linz, Austria
| | - Bettina Klugsberger
- Kepler Universitätsklinikum GmbH, Klinik für Allgemein und Viszeralchirurgie, Linz, Austria
| | - Theo David Maier
- Robert-Bosch-Krankenhaus, Allgemein und Viszeralchirurgie, Stuttgart, Germany
| | - Guido Schumacher
- Städtisches Klinikum Braunschweig, Chirurgische Klinik, Braunschweig, Germany
| | | | - Ursula Pession
- Universitätsklinikum Frankfurt, Zentrum der Chirurgie, Klinik für Allgemein und Viszeralchirurgie, Frankfurt am Main, Germany
| | - Anna Hofmann
- Wilhelminenspital, Allgemein, Viszeral und Tumorchirurgie, Vienna, Austria
| | - Markus Albertsmeier
- Ludwig-Maximilians-Universität (LMU) Munich, LMU University Hospital, Department of General, Visceral and Transplantation Surgery, Munich, Germany
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20
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Miyoshi N, Fujino S, Nishimura J, Suzuki Y, Ueda M, Uemura M, Fujii M, Murata K, Doki Y, Eguchi H. Effectiveness of Triclosan-Coated Sutures Compared with Uncoated Sutures in Preventing Surgical Site Infection after Abdominal Wall Closure in Open/Laparoscopic Colorectal Surgery. J Am Coll Surg 2022; 234:1147-1159. [PMID: 35703813 DOI: 10.1097/xcs.0000000000000167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Previous randomized trials have assessed the effectiveness of triclosan-coated sutures in fascia closure after midline laparotomy in preventing surgical site infections (SSIs); however, available evidence remain inconclusive. We aimed to evaluate the effectiveness of triclosan-coated sutures in abdominal fascia closure to prevent postoperative SSIs. STUDY DESIGN This study was a multicenter prospective trial conducted within 24 Japanese secondary and tertiary care centers and a propensity score (PS)-matched analysis. Patients 20 years of age or older who underwent elective surgery for colorectal cancer (CRC) were included. Between July 2016 and July 2019, 2,207 patients were prospectively enrolled into the triclosan-coated sutures or uncoated sutures groups. The per-protocol population comprised 2,195 patients. The PS matching was performed for 1,579 patients: 926 patients in the coated group and 653 patients in the uncoated group. The abdominal fascia after midline laparotomy was closed with triclosan-coated or uncoated sutures depending on group. The primary endpoint was the incidence of an SSI. Secondary endpoints were length of hospital stay and surgical complication rates. RESULTS The recorded SSI rates were 4.2% in the triclosan-coated group and 6.74% in the uncoated suture group (p = 0.028). There were no serious adverse events in the groups. The final logistic regression model showed that several variables affected the occurrence of SSI. Our meta-analysis included six phase-III trials, and our study evaluated 4,797 patients. The results show a significant superiority of triclosan-coated sutures over uncoated suture material. CONCLUSION Triclosan-coated sutures reduce the incidence of SSI after elective CRC surgery.
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Affiliation(s)
- Norikatsu Miyoshi
- From the Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan (Miyoshi, Fujino, Uemura, Doki, Eguchi)
- Department of Innovative Oncology Research and Regenerative Medicine (Miyoshi, Fujino), Osaka International Cancer Institute, Osaka, Japan
| | - Shiki Fujino
- From the Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan (Miyoshi, Fujino, Uemura, Doki, Eguchi)
- Department of Innovative Oncology Research and Regenerative Medicine (Miyoshi, Fujino), Osaka International Cancer Institute, Osaka, Japan
| | - Junichi Nishimura
- Department of Gastroenterological Surgery (Nishimura), Osaka International Cancer Institute, Osaka, Japan
| | - Yozo Suzuki
- Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan (Suzuki)
- Department of Surgery, Osaka Police Hospital, Osaka, Japan (Suzuki)
| | - Masami Ueda
- Department of Gastroenterological Surgery, Higashiosaka City Medical Center, Osaka, Japan (Ueda)
| | - Mamoru Uemura
- From the Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan (Miyoshi, Fujino, Uemura, Doki, Eguchi)
| | - Matkoto Fujii
- Department of Mathematical Health Science, Graduate School of Medicine, Osaka University, Osaka, Japan (Fujii)
| | - Kohei Murata
- Department of Gastroenterological Surgery, Kansai Rosai Hospital, Hyogo, Japan (Murata)
| | - Yuichiro Doki
- From the Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan (Miyoshi, Fujino, Uemura, Doki, Eguchi)
| | - Hidekazu Eguchi
- From the Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan (Miyoshi, Fujino, Uemura, Doki, Eguchi)
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21
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Interrupted X-Suture Prevents Burst Abdomen: Analysis of 5 Randomised Controlled Trials from India. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03411-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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22
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Jensen TK, Nielsen YW, Gögenur I, Tolstrup MB. "Sarcopenia is associated with increased risk of burst abdomen after emergency midline laparotomy: a matched case-control study". Eur J Trauma Emerg Surg 2022; 48:4189-4196. [PMID: 35353215 DOI: 10.1007/s00068-022-01958-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 03/13/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Burst abdomen is a serious complication commonly observed after emergency midline laparotomy. Sarcopenia has been associated with increased morbidity and mortality after abdominal surgery. This single-center, retrospective, matched case-control study aimed to investigate the association between sarcopenia and burst abdomen in patients undergoing emergency midline laparotomy. METHODS Patients who had burst abdomen after emergency midline laparotomy were matched 1:4 with controls based on age and sex. Abdominal wall closure was standardized in the study period with the small bites, small stitches technique. CT assessed psoas cross-sectional area was used as a surrogate measure of sarcopenia. Sarcopenia was defined as the sex-specific lowest quartile of psoas cross-sectional area adjusted for body surface area. The primary outcome was the incidence rate of sarcopenia amongst cases and controls. Secondary outcomes were risk factors for burst abdomen and death that were identified using multivariate logistic regression analysis. RESULTS 67 cases were matched to 268 controls during May 2016-December 2019. BMI > 30 kg/m2, liver cirrhosis, smoking, high ASA score and peritonitis were more frequently observed among cases. Multivariate analysis revealed that sarcopenia (odds ratio (OR) 2.3, p = 0.01), active smoking (OR 2.3, p = 0.006) and liver cirrhosis (OR 3.7, p = 0.042) were significantly associated with burst abdomen. ASA score ≥ 3 (OR 5.5, p = 0.001) and ongoing malignant disease (OR 3.2, p = 0.001) were significantly associated with increased 90-day mortality. CONCLUSION Sarcopenia is associated with increased risk of burst abdomen after midline laparotomy. Prospective trials are needed.
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Affiliation(s)
- Thomas Korgaard Jensen
- Surgical Section, Department of Gastrointestinal- and Hepatic Diseases, Copenhagen University Hospital Herlev, 2730, Herlev, Denmark.
| | | | - Ismail Gögenur
- Department of Surgery, Center for Surgical Science, Zealand University Hospital, Copenhagen University Hospital, 4600, Koege, Denmark
| | - Mai-Britt Tolstrup
- Department of Surgery, North-Zealand University Hospital, 3400, Hilleroed, Denmark
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23
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Risk factors of incisional hernia after laparoscopic colorectal surgery with periumbilical minilaparotomy incision: a propensity score matching analysis. JOURNAL OF MINIMALLY INVASIVE SURGERY 2022; 25:24-31. [PMID: 35603344 PMCID: PMC8977500 DOI: 10.7602/jmis.2022.25.1.24] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/08/2022] [Accepted: 03/12/2022] [Indexed: 12/03/2022]
Abstract
Purpose Incisional hernia is one of the most common complications after abdominal surgery conducted through a midline incision. Considerable debate remains regarding the design, comorbidity, suture material, and method. We investigated the risk factors for incisional hernia after laparoscopic colorectal surgery in the presence of limited surgery-related factors. Methods A retrospective study was designed with 541 patients who underwent laparoscopic colorectal surgery performed by a single operator from January 2015 to December 2017. Due to open conversions, other abdominal operations, or follow-up loss, only 445 patients were included in the study. After propensity score matching, 266 patients were included. The study was based on diagnosis of incisional hernia on computed tomography at 6 and 12 months postoperatively. Results Of the 266 total patients, 133 underwent abdominal closure using PDS (Ethicon), while the remaining 133 underwent closure with Vicryl (Ethicon). Of these patients, nine were diagnosed with incisional hernia at the 12-month follow-up six (4.5%) in the Vicryl group and three (2.3%) in the PDS group (p = 0.309). The incidence of incisional hernia was significantly increased in females (odds ratio [OR], 15.233; 95% confidence interval [CI], 1.905–121.799; p = 0.010), in patients with body mass index (BMI) of >25 kg/m2 (OR, 4.740; 95% CI, 1.424–15.546; p = 0.011), and in patients with liver disease (OR, 19.899; 95% CI, 1.614–245.376; p = 0.020). Conclusion BMI of >25 kg/m2, female, and liver disease were significant risk factors for incisional hernia after elective laparoscopic colorectal surgery performed through a transumbilical minilaparotomy incision.
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24
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Niebuhr H, Malaibari ZO, Köckerling F, Reinpold W, Dag H, Eucker D, Aufenberg T, Fikatas P, Fortelny RH, Kukleta J, Meier H, Flamm C, Baschleben G, Helmedag M. [Intraoperative fascial traction (IFT) for treatment of large ventral hernias : A retrospective analysis of 50 cases]. Chirurg 2021; 93:292-298. [PMID: 34907456 PMCID: PMC8894171 DOI: 10.1007/s00104-021-01552-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim was to evaluate the effectiveness, clinical practicability, and complication rate of the intraoperative fascial traction (IFT) procedure for the treatment of large ventral hernias. METHOD This study evaluated 50 patients from 11 specialized centers with an intraoperatively measured fascial distance of more than 8 cm, who were treated by IFT (traction time 30-35 min) using the fasciotens® hernia traction procedure. RESULTS Fascial gaps measured preoperatively ranged from 8 cm to 44 cm, with most patients (94%) having a fascial gap above 10 cm (W3 according to the European Hernia Society classification). The mean fascial distance was reduced from 16.1 ± 0.8 cm to 5.8 ± 0.7 cm (stretch gain 10.2 ± 0.7 cm, p < 0.0001, Wilcoxon matched-pairs signed-ranks test). A reduction in fascial distance of at least 50% was achieved in three quarters of the patients and in half of the treated patients the reduction in fascial distance amounted to even more than 70%. The closure rate achieved by IFT after a mean surgical duration of 207.3 ± 11.0 min was 90% (45/50). Hernia closure was performed in all cases with a mesh augmentation in a sublay position. Postoperative complications occurred in 6 patients (12%). A reoperation was required in 3 patients (6%). CONCLUSION The described IFT method is a new procedure for abdominal wall closure in large ventral hernias. The presented results demonstrate a high effectiveness, a good clinical practicability and a low complication rate of IFT.
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Affiliation(s)
- Henning Niebuhr
- Hamburger Hernien Centrum, Eppendorfer Baum 8, 20249, Hamburg, Deutschland.
| | - Zaid Omar Malaibari
- Hamburger Hernien Centrum, Eppendorfer Baum 8, 20249, Hamburg, Deutschland.,Faculty of Medicine, Department of Surgery, University of Tabuk, Tabuk, Saudi-Arabien
| | | | - Wolfgang Reinpold
- Hamburger Hernien Centrum, Eppendorfer Baum 8, 20249, Hamburg, Deutschland
| | - Halil Dag
- Hamburger Hernien Centrum, Eppendorfer Baum 8, 20249, Hamburg, Deutschland
| | - Dietmar Eucker
- Chirurgische Klinik Kantonsspital Baselland Bruderholz, Bruderholz, Schweiz
| | - Thomas Aufenberg
- Klinik für Chirurgie, St. Elisabeth-Krankenhaus Köln, Köln, Deutschland
| | - Panagiotis Fikatas
- Klinik für Chirurgie, Charité Campus Virchow-Klinik, Berlin, Deutschland
| | | | - Jan Kukleta
- Klinik für Chirurgie, Hirslanden Klinik, Zürich, Schweiz
| | - Hansjörg Meier
- Klinik für Allgemein- und Viszeralchirurgie, Sana Krankenhaus, Benrath, Deutschland
| | - Christian Flamm
- Klinik für Allgemein‑, Viszeral‑, Endokrine und Unfallchirurgie, RoMed Clinic, Bad Aibling, Deutschland
| | - Guido Baschleben
- Klinik für Allgemein- und Viszeral Chirurgie, St. Elisabeth Hospital, Leipzig, Deutschland
| | - Marius Helmedag
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsklinik Aachen, Aachen, Deutschland
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High rate of incisional hernia observed after mass closure of burst abdomen. Hernia 2021; 26:1267-1274. [PMID: 34674087 DOI: 10.1007/s10029-021-02523-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/06/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study investigated the long-term development of incisional hernia after implementation of a standardized surgical treatment strategy for burst abdomen in abdominal midline incisions with a continuous mass closure technique. METHODS The study was a single-center, observational study evaluating all patients treated for burst abdomen between June 2014 and April 2019 with a long-term follow-up in October 2020. In June 2014, a standardized surgical treatment for burst abdomen involving a monofilament, slowly absorbable suture in a continuous mass-closure stitch with large bites of 3 cm and small steps of 5 mm was introduced. The occurrence of incisional hernia was investigated and defined as a radiological-, clinical-, or intraoperative finding of a hernia in the abdominal midline incision at follow-up. RESULTS Ninety-four patients suffered from burst abdomen during the study period. Eighty patients were eligible for follow-up. The index surgery prior to burst abdomen was an emergency laparotomy in 78% (62/80) of the patients. Nineteen patients died within the first 30 postoperative days and 61 patients were available for further analysis. The long-term incisional hernia rate was 33% (20/61) with a median follow-up of 17 months (min 4, max 67 months). CONCLUSION Standardized surgery for burst abdomen with a mass-closure technique using slow absorbable running suture results in high rates of long-term incisional hernias, comparable to the hernia rates reported in the literature among this group of patients.
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Iida H, Tani M, Hirokawa F, Ueno M, Noda T, Takemura S, Nomi T, Nakai T, Kaibori M, Kubo S. Risk factors for incisional hernia according to different wound sites after open hepatectomy using combinations of vertical and horizontal incisions: A multicenter cohort study. Ann Gastroenterol Surg 2021; 5:701-710. [PMID: 34586100 PMCID: PMC8452478 DOI: 10.1002/ags3.12467] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/07/2021] [Accepted: 04/13/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Although several risk factors for incisional hernia after hepatectomy have been reported, their relationship to different wound sites has not been investigated. Therefore, this study aimed to examine the risk factors for incisional hernia according to various wound sites after hepatectomy. Methods: Patients from the Osaka Liver Surgery Study Group who underwent open hepatectomy using combinations of vertical and horizontal incisions (J-shaped incision, reversed L-shaped incision, reversed T-shaped incision, Mercedes incision) between January 2012 and December 2015 were included. Incisional hernia was defined as a hernia occurring within 3 y after surgery. Abdominal incisional hernia was classified into midline incisional hernia and transverse incisional hernia. The risk factors for each posthepatectomy incisional hernia type were identified. Results: A total of 1057 patients met the inclusion criteria. The overall posthepatectomy incisional hernia incidence rate was 5.9% (62 patients). In the multivariate analysis, the presence of diabetes mellitus and albumin levels <3.5 g/dL were identified as independent risk factors. Moreover, incidence rates of midline and transverse incisional hernias were 2.4% (25 patients), and 2.3% (24 patients), respectively. In multivariate analysis, the independent risk factor for transverse incisional hernia was the occurrence of superficial or deep incisional surgical site infection, and interrupted suturing for midline incisional hernia. Conclusions: Risk factors for incisional hernia after hepatectomy depend on the wound site. To prevent incisional hernia, running suture use might be better for midline wound closure. The prevention of postoperative wound infection is important for transverse wounds, under the presumption of preoperative nutrition and normoglycemia.
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Affiliation(s)
- Hiroya Iida
- Department of SurgeryShiga University of Medical ScienceShigaJapan
| | - Masaji Tani
- Department of SurgeryShiga University of Medical ScienceShigaJapan
| | - Fumitoshi Hirokawa
- Department of General and Gastroenterological SurgeryOsaka Medical CollegeOsakaJapan
| | - Masaki Ueno
- Second Department of SurgeryWakayama Medical UniversityWakayamaJapan
| | - Takehiro Noda
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversityOsakaJapan
| | - Shigekazu Takemura
- Department of Hepato‐Biliary‐Pancreatic SurgeryOsaka City University Graduate School of MedicineOsakaJapan
| | - Takeo Nomi
- Department of SurgeryNara Medical UniversityNaraJapan
| | - Takuya Nakai
- Department of SurgeryFaculty of MedicineKinki UniversityOsakaJapan
| | - Masaki Kaibori
- Department of SurgeryKansai Medical UniversityOsakaJapan
| | - Shoji Kubo
- Department of Hepato‐Biliary‐Pancreatic SurgeryOsaka City University Graduate School of MedicineOsakaJapan
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What Is the Proper Technique for Primary Laparotomy Closure? Adv Surg 2021; 55:197-214. [PMID: 34389092 DOI: 10.1016/j.yasu.2021.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Albertsmeier M, Hofmann A, Baumann P, Riedl S, Reisensohn C, Kewer JL, Hoelderle J, Shamiyeh A, Klugsberger B, Maier TD, Schumacher G, Köckerling F, Pession U, Weniger M, Fortelny RH. Effects of the short-stitch technique for midline abdominal closure: short-term results from the randomised-controlled ESTOIH trial. Hernia 2021; 26:87-95. [PMID: 34050419 PMCID: PMC8881264 DOI: 10.1007/s10029-021-02410-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 04/08/2021] [Indexed: 11/28/2022]
Abstract
Purpose The short-stitch technique for midline laparotomy closure has been shown to reduce hernia rates, but long stitches remain the standard of care and the effect of the short-stitch technique on short-term results is not well known. The aim of this study was to compare the two techniques, using an ultra-long-term absorbable elastic suture material.
Methods Following elective midline laparotomy, 425 patients in 9 centres were randomised to receive wound closure using the short-stitch (USP 2-0 single thread, n = 215) or long-stitch (USP 1 double loop, n = 210) technique with a poly-4-hydroxybutyrate-based suture material (Monomax®). Here, we report short-term surgical outcomes.
Results At 30 (+10) days postoperatively, 3 (1.40%) of 215 patients in the short-stitch group and 10 (4.76%) of 210 patients in the long-stitch group had developed burst abdomen [OR 0.2830 (0.0768–1.0433), p = 0.0513]. Ruptured suture, seroma and hematoma and other wound healing disorders occurred in small numbers without differences between groups. In a planned Cox proportional hazard model for burst abdomen, the short-stitch group had a significantly lower risk [HR 0.1783 (0.0379–0.6617), p = 0.0115].
Conclusions Although this trial revealed no significant difference in short-term results between the short-stitch and long-stitch techniques for closure of midline laparotomy, a trend towards a lower rate of burst abdomen in the short-stitch group suggests a possible advantage of the short-stitch technique. Trial registry NCT01965249, registered October 18, 2013.
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Affiliation(s)
- M Albertsmeier
- Department of General, Visceral and Transplantation Surgery, LMU University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, 81377, Munich, Germany
| | - A Hofmann
- Allgemein-, Viszeral- und Tumorchirurgie, Wilhelminenspital, Montleartstr. 37, 1160, Vienna, Austria
| | - P Baumann
- Department of Medical Scientific Affairs, Aesculap AG, Am Aesculap Platz, 78532, Tuttlingen, Germany
| | - S Riedl
- Klinik am Eichert, Allgemeinchirurgie, Alb Fils Klinik GmbH, Eichertstr.3, 73035, Göppingen, Germany
| | - C Reisensohn
- Klinik am Eichert, Allgemeinchirurgie, Alb Fils Klinik GmbH, Eichertstr.3, 73035, Göppingen, Germany
| | - J L Kewer
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Klinikum Landkreis Tuttlingen, Zeppelinstr. 21, 78532, Tuttlingen, Germany
| | - J Hoelderle
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Klinikum Landkreis Tuttlingen, Zeppelinstr. 21, 78532, Tuttlingen, Germany
| | - A Shamiyeh
- Klinik für Allgemein- und Viszeralchirurgie, Kepler Universitätsklinikum GmbH, Krankenhausstr. 9, 4021, Linz, Austria
| | - B Klugsberger
- Klinik für Allgemein- und Viszeralchirurgie, Kepler Universitätsklinikum GmbH, Krankenhausstr. 9, 4021, Linz, Austria
| | - T D Maier
- Allgemein- und Viszeralchirurgie, Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376, Stuttgart, Germany
| | - G Schumacher
- Chirurgische Klinik, Städtisches Klinikum Braunschweig, Salzdahlumer Str. 90, 38126, Brunswick, Germany
| | - F Köckerling
- Klinik für Chirurgie, Viszeral- und Gefäßchirurgie, Vivantes Klinikum Spandau, Neue Bergstr. 6, 13585, Berlin, Germany
| | - U Pession
- Zentrum der Chirurgie, Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai, 60590, Frankfurt am Main, Germany
| | - M Weniger
- Department of General, Visceral and Transplantation Surgery, LMU University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, 81377, Munich, Germany
| | - R H Fortelny
- Allgemein-, Viszeral- und Tumorchirurgie, Wilhelminenspital, Montleartstr. 37, 1160, Vienna, Austria.
- Med. Fakultät, Sigmund Freud Privatuniversität, Freudplatz 3, 1020, Vienna, Austria.
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Urie R, McBride M, Ghosh D, Fattahi A, Nitiyanandan R, Popovich J, Heys JJ, Kilbourne J, Haydel SE, Rege K. Antimicrobial laser-activated sealants for combating surgical site infections. Biomater Sci 2021; 9:3791-3803. [PMID: 33876069 PMCID: PMC9617567 DOI: 10.1039/d0bm01438a] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Surgical-site infections (SSIs) occur in 2-5% of patients undergoing surgery in the US alone, impacting 300 000-500 000 lives each year, and presenting up to 11 times greater risk of death compared to patients without SSIs. The most common cause of SSI is Staphylococcus aureus, and methicillin-resistant S. aureus (MRSA) is the most common pathogen in community hospitals. Current clinical devices used for approximating incisions and traumatic lacerations include sutures, adhesives, tapes, or staples with or without antimicrobial incorporation. However, current closure technologies may not provide adequate protection against infection, are susceptible to wound dehiscence, and can result in delayed biomechanical recoveries. Laser-activated tissue repair is a sutureless technique in which chromophore-loaded sealants convert laser light energy to heat in order to induce rapid tissue sealing. Here, we describe the generation and evaluation of laser-activated sealant (LASE) biomaterials, in which, indocyanine green (ICG), an FDA-approved dye, was embedded in a silk fibroin matrix and cast into films as wound sealants. Silk-ICG films were subjected to different near-infrared (NIR) laser powers to identify temperatures optimal for laser sealing of soft tissues. A mathematical model was developed in order to determine the photothermal conversion efficiency of LASEs following laser irradiation. NIR laser activation of silk-ICG LASEs increased the recovery of skin biomechanical strength compared to sutured skin in full-thickness incisional wounds in immunocompetent mice, and live animal imaging indicated persistence of silk-ICG LASEs over several days. LASEs loaded with the antibiotic vancomycin demonstrated higher efficacies for combating MRSA infections in a mouse model of surgical site infection compared to antibacterial sutures. Our results demonstrate that LASEs can be loaded with antimicrobial drugs and may serve as new multifunctional biomaterials for rapid tissue sealing, repair and surgical site protection following surgery.
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Affiliation(s)
- Russell Urie
- Chemical Engineering Program, School for Engineering of Matter, Transport, and Energy, Arizona State University, Tempe, AZ 85287, USA.
| | - Michelle McBride
- Biodesign Institute Center for Bioelectronics and Biosensors, Arizona State University, Tempe, AZ 85287, USA.
| | - Deepanjan Ghosh
- Biological Design Graduate Program, Arizona State University, Tempe, AZ 85287, USA
| | - Ali Fattahi
- Chemical Engineering Program, School for Engineering of Matter, Transport, and Energy, Arizona State University, Tempe, AZ 85287, USA.
| | | | - John Popovich
- Biodesign Institute Center for Bioelectronics and Biosensors, Arizona State University, Tempe, AZ 85287, USA.
| | - Jeffrey J Heys
- Chemical and Biological Engineering Department, Montana State University, Bozeman, MT 59717, USA
| | - Jacquelyn Kilbourne
- Department of Animal Care and Technologies, Arizona State University, Tempe, AZ 85287, USA
| | - Shelley E Haydel
- Biodesign Institute Center for Bioelectronics and Biosensors, Arizona State University, Tempe, AZ 85287, USA. and School of Life Sciences, Arizona State University, Tempe, AZ 85287, USA
| | - Kaushal Rege
- Chemical Engineering Program, School for Engineering of Matter, Transport, and Energy, Arizona State University, Tempe, AZ 85287, USA. and Biological Design Graduate Program, Arizona State University, Tempe, AZ 85287, USA
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Weyhe D, Salzmann D, Gloy K. [Prophylaxis of parastomal, perineal and incisional hernias in colorectal surgery]. Chirurg 2021; 92:621-629. [PMID: 33913011 DOI: 10.1007/s00104-021-01415-8] [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] [Accepted: 03/26/2021] [Indexed: 11/26/2022]
Abstract
This article gives an overview of the relevant evidence from the literature on the topic of prophylactic use of meshes to prevent incisional and parastomal hernias in colorectal surgery. In addition, based on a structured literature search the incidence of hernias in colorectal surgery over the past 5 years was analyzed. A slight majority (54%) of articles recommended the use of prophylactic mesh implantation in colorectal surgery. The prophylactic use of meshes appears to reduce the risk of hernias in colorectal surgery but is associated with a slightly increased perioperative wound infection rate. Parastomal hernias are associated with higher incidence rates compared with incisional hernias and also appear to benefit more from prophylactic mesh implantation. The evidence in the literature is still unclear regarding the use of synthetic or biological implants due to the lack of randomized controlled trials. Perineal hernias were excluded from the analysis due to the incomparability of the mainly casuistic literature. An overview is given in the discussion. The analysis of the literature and also in reflection of our own experience comes to the conclusion that the disrupted integrity of the abdominal wall due to the operation should be prophylactically reinforced with a mesh after colorectal surgery. An evidence-based recommendation is not possible based on the current state of research on implantation techniques, e.g. onlay, sublay intraperitoneal onlay mesh (IPOM) and selection of the implant.
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Affiliation(s)
- Dirk Weyhe
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinik für Viszeralchirurgie, Pius Hospital Oldenburg, Medizinischer Campus Universität Oldenburg, Georgstraße 12, 26121, Oldenburg, Deutschland.
| | - Daniela Salzmann
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinik für Viszeralchirurgie, Pius Hospital Oldenburg, Medizinischer Campus Universität Oldenburg, Georgstraße 12, 26121, Oldenburg, Deutschland
| | - Kilian Gloy
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinik für Viszeralchirurgie, Pius Hospital Oldenburg, Medizinischer Campus Universität Oldenburg, Georgstraße 12, 26121, Oldenburg, Deutschland
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Mehdorn M, Groos L, Kassahun W, Jansen-Winkeln B, Gockel I, Moulla Y. Interrupted sutures prevent recurrent abdominal fascial dehiscence: a comparative retrospective single center cohort analysis of risk factors of burst abdomen and its recurrence as well as surgical repair techniques. BMC Surg 2021; 21:208. [PMID: 33902549 PMCID: PMC8074409 DOI: 10.1186/s12893-021-01219-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 04/20/2021] [Indexed: 11/25/2022] Open
Abstract
Background Burst abdomen (BA) is a severe complication after abdominal surgery, which often requires urgent repair. However, evidence on surgical techniques to prevent burst abdomen recurrence (BAR) is scarce. Methods We conducted a retrospective analysis of patients with BA comparing them to patients with superficial surgical site infections from the years 2015 to 2018. The data was retrieved from the institutional wound register. We analyzed risk factors for BA occurrence as well as its recurrence after BA repair and surgical closure techniques that would best prevent BAR. Results We included 504 patients in the analysis, 111 of those suffered from BA. We found intestinal resection (OR 172.510; 22.195–1340.796, p < 0.001), liver cirrhosis (OR 4.788; 2.034–11.269, p < 0.001) and emergency surgery (OR 1.658; 1.050–2.617; p = 0.03) as well as postoperative delirium (OR 5.058; 1.349–18.965, p = 0.016) as the main predictor for developing BA. The main reason for BA was superficial surgical site infection (40.7%). 110 patients received operative revision of the abdominal fascial dehiscence and 108 were eligible for BAR analysis with 14 cases of BAR. Again, post-operative delirium was the patient-related predictor for BAR (OR 13.73; 95% CI 1.812–104-023, p = 0.011). The surgical technique of using interrupted sutures opposed to continuous sutures showed a preventive effect on BAR (OR 0.143, 95% CI 0.026–0,784, p = 0.025). The implantation of an absorbable IPOM mesh did not reduce BAR, but it did reduce the necessity of BAR revision significantly. Conclusion The use of interrupted sutures together with the implantation of an intraabdominal mesh in burst abdomen repair helps to reduce BAR and the need for additional revision surgeries.
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Affiliation(s)
- Matthias Mehdorn
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
| | - Linda Groos
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Woubet Kassahun
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Boris Jansen-Winkeln
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Yusef Moulla
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
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Synchronous Hartmann reversal and incisional hernia repair is associated with higher complication rate compared to a staged procedure. Sci Rep 2021; 11:1390. [PMID: 33446852 PMCID: PMC7809028 DOI: 10.1038/s41598-021-81064-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 12/29/2020] [Indexed: 11/09/2022] Open
Abstract
Post operative ventral hernias are common following Hartmann's procedure. There is a debate whether hernia repair is safe when performed concomitantly with colostomy closure. In this study we aimed to evaluate the outcomes of synchronous Hartmann reversal (HR) with a hernia repair, compared to a staged procedure. A retrospective multi-center study was conducted, including all patients who underwent Hartmann's procedure from January 2004 to July 2017 in 5 medical centers. Patient data included demographics, surgical data and post-operative outcome. Two hundred and seventy-four patients underwent colostomy reversal following Hartmann's procedure. In 107 patients (39%) a concomitant ventral hernia was reported during the Hartmann's reversal. Out of this cohort, 62 patients (58%) underwent hernia repair during follow-up. Thirty two patients (52%) underwent a synchronous hernia repair and 30 patients (48%) underwent hernia repair as a separate procedure. Post operative complication rate was significantly higher in the colostomy reversal with synchronous hernia repair group when compared to HR alone group (53% vs. 20%; p < 0.01; OR 4.5). In addition, severe complication rate (Clavien-Dindo score ≥ 3) was higher in the synchronous hernia repair group (25% vs. 7%). A tendency for higher hernia recurrence rate was noted in the synchronous group (56% vs. 40%). Median follow up time was 2.53 years (range 1-13.3 years). Synchronous colostomy closure and ventral hernia repair following Hartmann's procedure carries a significant risk for post operative complications, indicating that a staged procedure might be preferable.
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Standard of Care and Outcomes of Primary Laparotomy Versus Laparotomy in Patients with Prior Open Abdominal Surgery (ReLap Study; DRKS00013001). J Gastrointest Surg 2021; 25:2600-2609. [PMID: 33511544 PMCID: PMC8523469 DOI: 10.1007/s11605-020-04904-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/22/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients undergoing relaparotomy are generally underrepresented in trials, despite how common the procedure is in clinical practice. The aim of this trial was to determine standard of care and gain evidence of intra- and postoperative outcomes for patients undergoing relaparotomy compared to primary laparotomy. METHODS In this single-center controlled clinical trial, adult patients scheduled for elective abdominal surgery via relaparotomy or primary laparotomy were consecutively screened for eligibility. The perioperative course was monitored prospectively in five study visits during hospital stay and one study visit 1 year after surgery. Intraoperative standards, short and long-term outcomes were statistically explored at a level of significance of 5%. RESULTS A total of 131 patients with relaparotomy and 50 patients with primary laparotomy were analyzed. In the relaparotomy group, the access to the abdomen took longer (23.5 min vs. 8.8 min; p = < 0.001) and the peritoneal adhesion index was higher (10.8 vs. 0.4; p = < 0.001). Inadvertent enterotomies were more frequent in the relaparotomy group (relaparotomy 0.3 versus primary laparotomy: 0.0; p = 0.002). The overall comprehensive complication index and rates of surgical site infection and wound dehiscence with evisceration were not different between the two groups. At long-term follow-up, rates of incisional hernia did not differ (relaparotomy: n = 12/104 (11.5%); primary laparotomy: n = 7/35 (20.0%); p = 0.208). DISCUSSION In this first prospective comparison of relaparotomy with primary laparotomy, inadvertent enterotomies were more frequent in the relaparotomy group. However, contrary to previous retrospective studies, the risk of complications and incisional hernias was not increased compared to primary laparotomy. TRIAL REGISTRATION Deutsches Register Klinischer Studien ( www.germanctr.de ): DRKS00013001.
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Ohge H, Mayumi T, Haji S, Kitagawa Y, Kobayashi M, Kobayashi M, Mizuguchi T, Mohri Y, Sakamoto F, Shimizu J, Suzuki K, Uchino M, Yamashita C, Yoshida M, Hirata K, Sumiyama Y, Kusachi S. The Japan Society for Surgical Infection: guidelines for the prevention, detection, and management of gastroenterological surgical site infection, 2018. Surg Today 2021; 51:1-31. [PMID: 33320283 PMCID: PMC7788056 DOI: 10.1007/s00595-020-02181-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND The guidelines for the prevention, detection, and management of gastroenterological surgical site infections (SSIs) were published in Japanese by the Japan Society for Surgical Infection in 2018. This is a summary of these guidelines for medical professionals worldwide. METHODS We conducted a systematic review and comprehensive evaluation of the evidence for diagnosis and treatment of gastroenterological SSIs, based on the concepts of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The strength of recommendations was graded and voted using the Delphi method and the nominal group technique. Modifications were made to the guidelines in response to feedback from the general public and relevant medical societies. RESULTS There were 44 questions prepared in seven subject areas, for which 51 recommendations were made. The seven subject areas were: definition and etiology, diagnosis, preoperative management, prophylactic antibiotics, intraoperative management, perioperative management, and wound management. According to the GRADE system, we evaluated the body of evidence for each clinical question. Based on the results of the meta-analysis, recommendations were graded using the Delphi method to generate useful information. The final version of the recommendations was published in 2018, in Japanese. CONCLUSIONS The Japanese Guidelines for the prevention, detection, and management of gastroenterological SSI were published in 2018 to provide useful information for clinicians and improve the clinical outcome of patients.
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Affiliation(s)
- Hiroki Ohge
- Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan.
| | - Toshihiko Mayumi
- Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Seiji Haji
- Department of Surgery, Soseikai General Hospital, Kyoto, Japan
| | - Yuichi Kitagawa
- Department of Infection Control, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Masahiro Kobayashi
- Laboratory of Clinical Pharmacokinetics, School of Pharmacy, Kitasato University, Tokyo, Japan
| | - Motomu Kobayashi
- Perioperative Management Center, Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan
| | - Toru Mizuguchi
- Division of Surgical Science, Department of Nursing, Sapporo Medical University, Sapporo, Japan
| | - Yasuhiko Mohri
- Department of Surgery, Mie Prefectural General Medical Center, Mie, Japan
| | - Fumie Sakamoto
- Infection Control Division, Quality Improvement Center, St. Luke's International Hospital, Tokyo, Japan
| | - Junzo Shimizu
- Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan
| | - Katsunori Suzuki
- Division of Infection Control and Prevention, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Motoi Uchino
- Division of Inflammatory Bowel Disease Surgery, Department of Gastroenterological Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Chizuru Yamashita
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Aichi, Japan
| | - Masahiro Yoshida
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare, School of Medicine, Chiba, Japan
| | | | | | - Shinya Kusachi
- Department of Surgery, Tohokamagaya Hospital, Chiba, Japan
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Guilbaud T, Feretti C, Holowko W, Garbarino GM, Marchese U, Sarran A, Beaussier M, Gayet B, Fuks D. Laparoscopic Major Hepatectomy: Do Not Underestimate the Impact of Specimen Extraction Site. World J Surg 2020; 44:1223-1230. [PMID: 31748884 DOI: 10.1007/s00268-019-05285-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND In laparoscopic major hepatectomy, analysis of outcomes according to specimen extraction site remains poorly described. The aim was to compare postoperative outcomes according to specimen extraction site. METHODS From 2000 to 2017, all laparoscopic major hepatectomies were reviewed and postoperative outcomes were analyzed according to specimen extraction site: subcostal (Group 1), midline (Group 2), or suprapubic (Group 3) incision. RESULTS Among 163 patients, 15 (9.2%) belonged to Group 1, 49 (30.1%) in Group 2, and 99 (60.7%) in Group 3. The proportion of right-sided, left-sided, or central hepatectomies, mortality, and overall and severe complications were comparable between groups. Group 1 had larger tumors (61 vs. 38 vs. 47 mm; P = 0.014), higher operative time (338 vs. 282 vs. 260 min; P < 0.008), higher adjacent organ resection rate (46.6 vs. 16.3 vs. 7.1%; P < 0.001), and tended to increase pulmonary complications (40.0 vs. 12.2 vs. 18.2%; P = 0.064). In Group 2, a previous midline incision scar was more frequently used for specimen extraction site (65.3 vs. 26.6 and 30.3%, Group 1 and 3; P < 0.001). Postoperative incisional hernia was observed in 16.4% (n = 23) and was more frequent in Group 2 (26.6 vs. 6.6% and 10.1%, Group 1 and Group 3; P = 0.030). Finally, Group 2 (HR 2.63, 95% CI 1.41-3.53; P = 0.032) was the only independent predictive factor of postoperative incisional hernia. CONCLUSIONS While using a previous incision makes sense, the increased risk of postoperative incisional hernia after midline incision promotes the suprapubic incision.
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Affiliation(s)
- Théophile Guilbaud
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France. .,Université Paris Descartes, 15 rue de l'école de médecine, 75005, Paris, France. .,Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris Descartes, 42 Boulevard Jourdan, 75014, Paris, France.
| | - Carlotta Feretti
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France.,Université Paris Descartes, 15 rue de l'école de médecine, 75005, Paris, France
| | - Waclaw Holowko
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France.,Université Paris Descartes, 15 rue de l'école de médecine, 75005, Paris, France
| | - Giovanni Maria Garbarino
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France.,Université Paris Descartes, 15 rue de l'école de médecine, 75005, Paris, France
| | - Ugo Marchese
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France.,Université Paris Descartes, 15 rue de l'école de médecine, 75005, Paris, France
| | - Anthony Sarran
- Department of Radiology and Medical Imaging, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France
| | - Marc Beaussier
- Department of Anesthesiology, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France
| | - Brice Gayet
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France.,Université Paris Descartes, 15 rue de l'école de médecine, 75005, Paris, France
| | - David Fuks
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France.,Université Paris Descartes, 15 rue de l'école de médecine, 75005, Paris, France
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Al Dhaheri M, Nada MA, El Ansari W, Kurer M, Ahmed AA. Left iliac fossa mini-incision sigmoidectomy for treatment of sigmoid volvulus. Case series of six patients from Qatar. Int J Surg Case Rep 2020; 75:534-538. [PMID: 32950438 PMCID: PMC7567052 DOI: 10.1016/j.ijscr.2020.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/03/2020] [Accepted: 09/03/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Midline laparotomy is the definitive treatment for sigmoid volvulus after initial colonoscopic detorsion. We successfully adopted another technique at our center on 6 patients, treating sigmoid volvulus by left iliac fossa mini-incision. PRESENTATION OF CASES We report our experience of six non-consecutive cases of sigmoid volvulus treated by left iliac fossa mini-incision. The cases were a 33 year old Egyptian female, a 21 year old Bangladeshi male, a 58 year old Qatari male, a 30 year old Ethiopian male, a 36 year old Ugandan male, and a 58 year old Indian male. The six cases are unique in the surgical technique employed in their management. This is possibly the second case series of left iliac fossa mini-incision for sigmoid volvulus in the Middle East and North Africa Region. DISCUSSION All patients underwent initial colonoscopic detorsion followed by sigmoidectomy and anastomosis. The procedure was successful in treating the volvulus in five patients with no complication or recurrence over a mean follow up of 8 months (range: 1-36 months). One patient required further laparotomy and resection with anastomosis due to incompletely removed sigmoid colon. CONCLUSIONS Left iliac fossa mini-incision for sigmoid volvulus is safe, feasible, cosmetically appealing and with low morbidity.
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Affiliation(s)
- Mahmood Al Dhaheri
- Department of Colorectal Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Abu Nada
- Department of Colorectal Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Walid El Ansari
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar; College of Medicine, Qatar University, Doha, Qatar; School of Health and Education, University of Skovde, Skovde, Sweden.
| | - Mohamed Kurer
- Department of Colorectal Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ayman Abdelhafiz Ahmed
- Department of Colorectal Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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van Rooijen MM, Jairam AP, Tollens T, Jørgensen LN, de Vries Reilingh TS, Piessen G, Köckerling F, Miserez M, Windsor AC, Berrevoet F, Fortelny RH, Dousset B, Woeste G, van Westreenen HL, Gossetti F, Lange JF, Tetteroo GW, Koch A, Kroese LF, Jeekel J. Outcomes of a new slowly resorbable biosynthetic mesh (Phasix™) in potentially contaminated incisional hernias: A prospective, multi-center, single-arm trial. Int J Surg 2020; 83:31-36. [PMID: 32931978 DOI: 10.1016/j.ijsu.2020.08.053] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 08/21/2020] [Accepted: 08/26/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Resorbable biomaterials have been developed to reduce the amount of foreign material remaining in the body after hernia repair over the long-term. However, on the short-term, these resorbable materials should render acceptable results with regard to complications, infections, and reoperations to be considered for repair. Additionally, the rate of resorption should not be any faster than collagen deposition and maturation; leading to early hernia recurrence. Therefore, the objective of this study was to collect data on the short-term performance of a new resorbable biosynthetic mesh (Phasix™) in patients requiring Ventral Hernia Working Group (VHWG) Grade 3 midline incisional hernia repair. MATERIALS AND METHODS A prospective, multi-center, single-arm trial was conducted at surgical departments in 15 hospitals across Europe. Patients aged ≥18, scheduled to undergo elective Ventral Hernia Working Group Grade 3 hernia repair of a hernia larger than 10 cm2 were included. Hernia repair was performed with Phasix™ Mesh in sublay position when achievable. The primary outcome was the rate of surgical site occurrence (SSO), including infections, that required intervention until 3 months after repair. RESULTS In total, 84 patients were treated with Phasix™ Mesh. Twenty-two patients (26.2%) developed 32 surgical site occurrences. These included 11 surgical site infections, 9 wound dehiscences, 7 seromas, 2 hematomas, 2 skin necroses, and 1 fistula. No significant differences in surgical site occurrence development were found between groups repaired with or without component separation technique, and between clean-contaminated or contaminated wound sites. At three months, there were no hernia recurrences. CONCLUSION Phasix™ Mesh demonstrated acceptable postoperative surgical site occurrence rates in patients with a Ventral Hernia Working Group Grade 3 hernia. Longer follow-up is needed to evaluate the recurrence rate and the effects on quality of life. This study is ongoing through 24 months of follow-up.
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Affiliation(s)
- Mathilde Mj van Rooijen
- Erasmus University Medical Centre Rotterdam, Department of Surgery, Rotterdam, The Netherlands.
| | - An P Jairam
- Erasmus University Medical Centre Rotterdam, Department of Surgery, Rotterdam, The Netherlands
| | - Tim Tollens
- Imelda Hospital, Department of General Surgery, Bonheiden, Belgium
| | - Lars N Jørgensen
- University of Copenhagen, Bispebjerg Hospital, Department of Surgery, Copenhagen, Denmark
| | | | | | | | - Marc Miserez
- University Hospital Leuven, Department of Abdominal Surgery, Leuven, Belgium
| | - Alastair Cj Windsor
- University College London Hospital, Department of Colorectal Surgery, London, United Kingdom
| | - Frederik Berrevoet
- University Hospital Ghent, Department of General and Hepatobiliary Surgery, Ghent, Belgium
| | - René H Fortelny
- Wilhelminenhospital, Department of General, Visceral and Oncologic Surgery, Vienna, Austria
| | - Bertrand Dousset
- Hôpital Cochin, Department of Digestive, Hepatobiliary and Endocrine Surgery, Paris, France
| | - Guido Woeste
- Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt Am Main, Germany
| | | | | | - Johan F Lange
- Erasmus University Medical Centre Rotterdam, Department of Surgery, Rotterdam, The Netherlands; IJsselland Ziekenhuis, Department of Surgery, Capelle Aan Den Ijssel, The Netherlands
| | - Geert Wm Tetteroo
- IJsselland Ziekenhuis, Department of Surgery, Capelle Aan Den Ijssel, The Netherlands
| | - Andreas Koch
- Chirurgische Praxis Cottbus, Cottbus Area, Germany
| | - Leonard F Kroese
- Erasmus University Medical Centre Rotterdam, Department of Surgery, Rotterdam, The Netherlands
| | - Johannes Jeekel
- Erasmus University Medical Centre Rotterdam, Department of Surgery, Rotterdam, The Netherlands
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Denys A, Monbailliu T, Allaeys M, Berrevoet F, van Ramshorst GH. Management of abdominal wound dehiscence: update of the literature and meta-analysis. Hernia 2020; 25:449-462. [PMID: 32897452 DOI: 10.1007/s10029-020-02294-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 08/27/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Abdominal wound dehiscence (AWD) is associated with significant morbidity and mortality. We aimed to provide a contemporary overview of management strategies for AWD. METHODS PubMed, EMBASE, the Cochrane library and a clinical trials registry were searched from 2009 onwards using the key words "abdominal wound dehiscence", "fascial dehiscence" and "burst abdomen". Study outcomes included surgical site infection (SSI), recurrence, incisional hernia and 30-day mortality. Studies reported by the EHS clinical guidelines on AWD were included and compared with. OpenMetaAnalyst was used for meta-analysis to calculate statistical significance and odds ratios (OR). RESULTS Nineteen studies were included reporting on a total of 632 patients: 16 retrospective studies, one early terminated randomized controlled trial, one review and the European Hernia Society guidelines. Nine studies reported use of synthetic mesh (n = 241), two of which used vacuum-assisted mesh-mediated fascial traction (VAWCM) (n = 19), six without VAWCM (n = 198) and one used synthetic mesh with both VAWCM (n = 6) and without VAWCM (n = 18); two used biological mesh (n = 19). Seven studies reported primary suture closure (n = 299). Three studies reported on an alternative method (n = 91). Follow-up ranged between 1 and 96 months. Meta-analysis was performed to compare the primary suture group with the synthetic mesh group. Heterogeneity was low to moderate depending on outcome. The overall SSI rate in the primary suture group was 27.6% versus 27.9% in the synthetic mesh group, resulting in mesh explantation in five patients; OR 0.65 (95% CI 0.23-1.81). Incisional hernia rates were 11.1% in the synthetic mesh group (19/171) and 30.7% in the primary suture group (67/218); OR 4.01 (95% CI 1.70-9.46). Recurrence rate did not show a statistically significant difference at 2.7% in the synthetic mesh group (3/112), compared to 10.2% in the primary suture group (21/206); OR 1.81 (95% CI 0.18-17.80). Mortality rates varied between 11.2% and 16.7% for primary suture group versus synthetic mesh; OR 1.85 (95% CI 0.91-3.76). CONCLUSION Included studies were of low to very low quality. The use of synthetic mesh results in a significantly lower rate of incisional hernia, whereas SSI rate was comparable to primary suture repair.
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Affiliation(s)
- Andreas Denys
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - Thomas Monbailliu
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Mathias Allaeys
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Frederik Berrevoet
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
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Davey S, Rajaretnem N, Harji D, Rees J, Messenger D, Smart NJ, Pathak S. Incisional hernia formation in hepatobiliary surgery using transverse and hybrid incisions: a systematic review and meta-analysis. Ann R Coll Surg Engl 2020; 102:663-671. [PMID: 32808799 DOI: 10.1308/rcsann.2020.0163] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Evidence suggests that midline incisions should be closed with the small-bite technique to reduce IH formation. No recommendations exist for the closure of transverse incisions used in hepatobiliary surgery. This work systematically summarises rates of IH formation and associated technical factors for these transverse incisions. METHODS A systematic search was undertaken. Studies describing the incidence of IH were included. Incisions were classified as transverse (two incision types) or hybrid (transverse with midline extension, comprising five incision types). The primary outcome measure was the pooled proportion of IH. Subgroup analysis based on minimum follow-up of two years and a priori definition of IH with clinical and radiological diagnosis was undertaken. FINDINGS Thirteen studies were identified and included 5,427 patients; 1,427 patients (26.3%) underwent surgery for benign conditions, 3,465 (63.8%) for malignancy and 535 (9.9%) for conditions that were not stated or classified as 'other'. The pooled incidence of IH was 6.0% (2.0-10.0%) at a weighted mean follow-up of 17.5 months in the transverse group, compared with 15.0% (11.0-19.0%) at a weighted mean follow-up of 42.0 months in the hybrid group (p = 0.045). Subgroup analysis did not demonstrate a statistical difference in IH formation between the hybrid versus transverse groups. CONCLUSION Owing to the limitations in study design and heterogeneity, there is limited evidence to guide incision choice and methods of closure in hepatopancreatobiliary surgery. There is an urgent need for a high-quality prospective cohort study to understand the techniques used and their outcomes, to inform future research.
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Affiliation(s)
- S Davey
- North Bristol NHS Trust, Bristol, UK
| | - N Rajaretnem
- University Hospitals Plymouth, Crownhill, Plymouth, UK
| | - D Harji
- Institute of Health and Society, Newcastle University, UK
| | - J Rees
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - D Messenger
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - N J Smart
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - S Pathak
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK.,Bristol Centre for Surgical Research, Bristol Medical School, Bristol, UK
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Guerra O. Noncrosslinked Porcine-derived Acellular Dermal Matrix for Single-stage Complex Abdominal Wall Herniorrhaphy after Removal of Infected Synthetic Mesh: A Retrospective Review. Am Surg 2020. [DOI: 10.1177/000313481408000521] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This retrospective case review details the use of noncrosslinked intact porcine-derived acellular dermal matrix (PADM) for incisional herniorrhaphy in patients with infected synthetic mesh. A consecutive series of adult patients underwent single-stage ventral herniorrhaphy involving removal of infected synthetic mesh and repair with PADM by a single surgeon (2009 to 2011). Comorbidities, repair procedures, postoperative complications, and hernia recurrence were noted. Of the 13 patients (mean age, 60 years; female, n = 8), seven (54%) were obese and six (46%) had chronic obstructive pulmonary disease/emphysema. Most synthetic mesh infections were polymicrobial (n = 7, 46%) or associated with Staphylococcus aureus (n = 4 [31%]). Six patients had undergone two or more previous repairs. With single-stage herniorrhaphy using PADM, primary fascial closure was achieved in 11 patients; bridged closure was required in two patients. Mean (median) duration of hospital stay was 12 (7) days and follow-up was 23 (22) months. There was one wound infection (drained surgically, PADM remained in place) and one seroma (resolved without intervention) observed during follow-up. There were two hernia recurrences, both in patients who received PADM as bridged repair. PADM yielded favorable outcomes when used for single-stage repair of complex ventral hernias in high-risk patients with infected synthetic mesh.
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Affiliation(s)
- Omar Guerra
- From Suburban Surgical Associates, St. Louis, Missouri
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Probst P, Tran DTA, Hüttner FJ, Harnoss JC, Heger P, Ritter AS, Doerr-Harim C, Mihaljevic AL, Knebel P, Schneider M, Büchler MW, Diener MK. Randomised-controlled feasibility trial on abdominal wall closure techniques in patients undergoing relaparotomy (ReLap study; DRKS00013001). Langenbecks Arch Surg 2020; 405:427-434. [PMID: 32504207 PMCID: PMC7359135 DOI: 10.1007/s00423-020-01903-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 05/25/2020] [Indexed: 10/29/2022]
Abstract
BACKGROUND Patients undergoing relaparotomy are generally underrepresented in clinical trials, despite how common the procedure is in clinical practice. Specifically, techniques for re-do abdominal wall closure have never been evaluated in a randomised-controlled trial. The aim of this trial was to identify the optimal abdominal wall closure technique in patients undergoing relaparotomy. METHODS In this monocentric, randomised feasibility trial, patients scheduled for elective relaparotomy were randomised to abdominal wall closure with either the small stitches technique, using Monomax® 2-0, or the large stitches technique, using PDS II® 1 loop. Patients' postoperative courses were followed for 1 year after the index operation. Effectiveness and safety outcomes were compared at a level of significance of 5% between the two techniques. RESULTS A total of 100 out of 131 patients (76.3%) were evenly randomised to the small stitches and large stitches groups. The time for abdominal wall closure did not differ between the two techniques (small stitches 27.5 ± 9.5 min versus large stitches 25.3 ± 12.4 min; p = 0.334). The overall comprehensive complication index was 14.4 ± 15.5 in the small stitches group and 19.9 ± 23.4 in the large stitches group (p = 0.168). Specifically, rates of surgical site infection (small stitches 30.0% versus large stitches 36.0%; p = 0.524) and burst abdomen (small stitches 4.0% versus large stitches 0.0%; p = 0.495) did not differ. After 1 year, incisional hernia rate was 7.5% in the small stitches group and 10.0% in the large stitches group (p > 0.999). DISCUSSION Both abdominal wall closure techniques investigated in this trial were feasible in relaparotomy patients. This exploratory trial revealed no noticeable difference in the effectiveness or safety of the small stitches technique with Monomax® 2-0 versus the large stitches technique with PDS II® 1 loop. Therefore, surgeons should stay with their preferred suture technique in relaparotomy patients. TRIAL REGISTRATION Deutsches Register Klinischer Studien ( www.germanctr.de ): DRKS00013001.
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Affiliation(s)
- Pascal Probst
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. .,The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| | - Dinh Thien-An Tran
- The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Felix J Hüttner
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Julian C Harnoss
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Patrick Heger
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Alina S Ritter
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Colette Doerr-Harim
- The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - André L Mihaljevic
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Phillip Knebel
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Martin Schneider
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Markus W Büchler
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Markus K Diener
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
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Suturable mesh better resists early laparotomy failure in a cyclic ball-burst model. Hernia 2020; 24:559-565. [DOI: 10.1007/s10029-020-02133-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 01/27/2020] [Indexed: 12/30/2022]
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Heger P, Feißt M, Krisam J, Klose C, Dörr-Harim C, Tenckhoff S, Büchler MW, Diener MK, Mihaljevic AL. Hernia reduction following laparotomy using small stitch abdominal wall closure with and without mesh augmentation (the HULC trial): study protocol for a randomized controlled trial. Trials 2019; 20:738. [PMID: 31842966 PMCID: PMC6915967 DOI: 10.1186/s13063-019-3921-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 11/19/2019] [Indexed: 12/28/2022] Open
Abstract
Background Incisional hernias are among the most frequent complications following abdominal surgery and cause substantial morbidity, impaired health-related quality of life and costs. Despite improvements in abdominal wall closure techniques, the risk for developing an incisional hernia is reported to be between 10 and 30% following midline laparotomies. There have been two recent innovations with promising results to reduce hernia risks, namely the small stitches technique and the placement of a prophylactic mesh. So far, these two techniques have not been evaluated in combination. Methods The HULC trial is a multicentre, randomized controlled, observer- and patient-blinded surgical effectiveness trial with two parallel study groups. A total of 812 patients scheduled for elective abdominal surgery via a midline laparotomy will be randomized in 12 centres after informed consent. Patients will be randomly assigned to the control group receiving closure of the midline incision with a slowly absorbable monofilament suture in the small stitches technique or to the intervention group, who will receive a small stitches closure followed by augmentation with a light-weight polypropylene mesh in the onlay technique. The primary endpoint will be the occurrence of incisional hernias, as defined by the European Hernia Society, within 24 months after surgery. Further perioperative parameters, as well as patient-reported outcomes, will be analysed as secondary outcomes. Discussion The HULC trial will address the yet unanswered question of whether a combination of small stitched fascial closure and onlay mesh augmentation after elective midline laparotomies reduces the risk of incisional hernias. The HULC trial marks the logical and innovative next step in the development of a safe abdominal closure technique. Trial registration German Clinical Trials Register, DRKS00017517. Registered on 24th June 2019.
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Affiliation(s)
- Patrick Heger
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,The Study Center of the German Surgical Society (SDGC), University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Manuel Feißt
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Johannes Krisam
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Christina Klose
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Colette Dörr-Harim
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,The Study Center of the German Surgical Society (SDGC), University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Solveig Tenckhoff
- The Study Center of the German Surgical Society (SDGC), University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Markus W Büchler
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Markus K Diener
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,The Study Center of the German Surgical Society (SDGC), University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - André L Mihaljevic
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. .,The Study Center of the German Surgical Society (SDGC), University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
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van Veenendaal N, Poelman MM, van den Heuvel B, Dwars BJ, Schreurs WH, Stoot JHMB, Bonjer HJ. The PINCH-Phone: a new screenings method for recurrent incisional hernias. Surg Endosc 2019; 33:2794-2801. [PMID: 30430246 PMCID: PMC6684537 DOI: 10.1007/s00464-018-6567-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 10/26/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Debate persists on the optimal management of incisional hernias due to paucity of accurate recurrence rates. Reoperation rates implicate a severe underestimation of the risk of a recurrence. Therefore, long-term postoperative clinic visits allowing physical examination of the abdomen are deemed necessary. However, these are time and costs consuming. Aim of this study was to develop and evaluate a new screenings method for recurrent hernias, the 'PINCH-Phone' (Post-INCisional-Hernia repair-Phone). METHODS The PINCH-Phone is a telephone questionnaire. In this multicenter prospective study, the PINCH-Phone was answered by patients after incisional hernia repair. Afterwards the patients were seen at the clinic and physical examination was done to detect any recurrences. RESULTS The PINCH-Phone questions were answered by 210 patients with a median postoperative follow-up of 36 months. Fifty-six patients were seen after multiple incisional hernia repairs. In 137 patients who had replied positively to one or more questions, 28 recurrent incisional hernias were detected at physical examination. Six recurrences were noted in 73 patients who had replied negatively to all questions. The overall sensitivity and specificity of the PINCH-Phone were 82% and 38%, respectively. CONCLUSION The PINCH-Phone appears a simple and valuable screenings method for recurrences after incisional hernia repair and, hence, is recommended for implementation.
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Affiliation(s)
- Nadine van Veenendaal
- Department of Surgery, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Marijn M Poelman
- Department of Surgery, Sint Franciscus Gasthuis, Rotterdam, The Netherlands
| | | | - Boudewijn J Dwars
- Department of Surgery, Slotervaart Medical Center, Amsterdam, The Netherlands
| | - W Hermien Schreurs
- Department of Surgery, NoordWest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Jan H M B Stoot
- Department of Surgery, Zuyderland Medical Center, Sittard/Heerlen, The Netherlands
| | - H Jaap Bonjer
- Department of Surgery, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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Kraft CT, Eiferman D, Jordan S, Skoracki RJ. Complications after vascularized jejunal mesenteric lymph node transfer: A 3-year experience. Microsurgery 2019; 39:497-501. [PMID: 31283856 DOI: 10.1002/micr.30491] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 05/25/2019] [Accepted: 06/10/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND Vascularized lymph node transfer (VLNT) is a well-established method for the surgical management of refractory extremity lymphedema. Generally, donor lymph nodes are harvested from the axilla, groin, or supraclavicular area. However, these sites offer their own disadvantages and introduce risk for inducing lymphedema at the surgical donor site. In our experience, the jejunal mesentery can be an excellent source of lymph nodes without the risk of donor site lymphedema. Long term complications are unknown for this procedure; we report our experience, complication rates, and lessons learned. METHODS A retrospective review was performed for all patients at our institution undergoing surgical treatment of lymphedema using jejunal mesenteric VLNT from February 2015 to February 2018. Demographic data, length of follow up, and surgical complications were reviewed. RESULTS Twenty-nine patients have undergone jejunal VLNT at our institution during the three-year study period, with a total of 30 transfers. Five patients had a concurrent omental lymph node transfer. Average length of follow up was 17.6 months (range 1.0-36.8 months). There was one flap loss in this time frame (3.3%). Four patients developed hernias post-operatively (13.8%), and three had nonoperative small bowel obstructions (10.3%). One patient had a postoperative wound infection at the abdominal incision (3.4%). CONCLUSIONS Jejunal VLNT can be an effective option for surgical treatment of lymphedema, without the risk of postoperative donor site lymphedema. Patients and surgeons should be aware of the risks of hernia and small bowel obstruction with this method compared to other lymph node sources.
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Affiliation(s)
- Casey T Kraft
- Department of Plastic Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Daniel Eiferman
- Department of General Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Sumanas Jordan
- Department of Plastic Surgery, Northwestern University, Chicago, Illinois
| | - Roman J Skoracki
- Department of Plastic Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
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Interrupted versus continuous fascial closure in patients undergoing emergent laparotomy: A randomized controlled trial. J Trauma Acute Care Surg 2019; 85:459-465. [PMID: 29787547 DOI: 10.1097/ta.0000000000001970] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The optimal method of fascial closure, interrupted fascial closure (IFC) versus continuous fascial closure (CFC) has never been studied exclusively in the setting of emergency surgery. We hypothesized that IFC decreases postoperative incisional hernia development following emergent laparotomies. METHODS Between August 2008 and September 2015, patients undergoing emergent laparotomies were consented and randomly assigned to either IFC or CFC. Patients were followed up postoperatively for at least 3 months and assessed for incisional hernia, dehiscence, or wound infection. We excluded those with trauma, elective surgery, mesh in place, primary ventral hernia, previous abdominal surgery within 30 days, or those not expected to survive for more than 48 hours. Our primary endpoint was the incidence of postoperative incisional hernias. RESULTS One hundred thirty-six patients were randomly assigned to IFC (n = 67) or CFC (n = 69). Baseline characteristics were similar between the groups. No difference was noted in the length of the abdominal incision, or the peak inspiratory pressure after the closure. The median time needed for closure was significantly longer in the IFC group (22 minutes vs. 13 minutes, p < 0.001). Thirty-seven (55.2%) IFC and 41 (59.4%) CFC patients completed their follow-up visits. There was no statistically significant difference in baseline and intraoperative characteristics between those who completed follow-ups and those who did not. The median time from the day of surgery to the day of the last follow-up was similar between IFC and CFC (233 days vs. 216 days, p = 0.67), as were the rates of incisional hernia (13.5% versus 22.0%, p = 0.25), dehiscence (2.7% vs. 2.4%, p = 1.0), and surgical site infection (16.2% vs. 12.2%, p = 0.75). CONCLUSION There was no statistically detectable difference in postoperative hernia development between those undergoing IFC versus CFC after emergent laparotomies. However, this may be due to the relatively low sample size. LEVEL OF EVIDENCE Therapeutic/Care Management Study, level III.
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Chida K, Watanabe J, Suwa Y, Suwa H, Momiyama M, Ishibe A, Ota M, Kunisaki C, Endo I. Risk factors for incisional surgical site infection after elective laparoscopic colorectal surgery. Ann Gastroenterol Surg 2019; 3:202-208. [PMID: 30923790 PMCID: PMC6422835 DOI: 10.1002/ags3.12229] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 12/12/2018] [Accepted: 12/18/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Surgical site infection (SSI) is a common morbidity in patients undergoing colorectal surgery, and the focus of previous studies has primarily been on incisional SSI. Most reports thus far have focused on open surgery rather than on laparoscopic colorectal surgery (Lap CR). Therefore, the aim of the present study was to identify the risk factors for incisional SSI in patients undergoing elective Lap CR. METHODS This retrospective study was conducted to evaluate the occurrence and risk factors of incisional SSI for elective Lap CR. From January 2008 to June 2018, 1825 consecutive patients with a preoperative diagnosis of colorectal cancer who underwent Lap CR were analyzed at a single institution. RESULTS Incidence of incisional SSI was 3.3%. Postoperative hospital stay (days) was significantly longer in the incisional SSI group than in the non-incisional SSI group (8 [6-12] vs 10 [8-19], P < 0.001). Incisional SSI were significantly associated with five operative factors: blood loss (g) (P < 0.014), midline wound length (mm) (P = 0.038), suture materials (P = 0.014), suture technique (interrupted vs continuous mass closure, P = 0.003), and organ/space SSI (P = 0.041). Multivariate analysis showed that continuous mass closure (odds ratio 0.290; 95% confidence interval 0.101-0.831, P = 0.021) was the only factor independently associated with the incidence of incisional SSI. CONCLUSIONS Incidence of incisional SSI was comparable to that in previous reports. Continuous mass closure decreased the risk of incisional SSI in elective Lap CR.
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Affiliation(s)
- Keigo Chida
- Department of SurgeryGastroenterological CenterYokohama City University Medical CenterYokohamaJapan
| | - Jun Watanabe
- Department of SurgeryGastroenterological CenterYokohama City University Medical CenterYokohamaJapan
| | - Yusuke Suwa
- Department of SurgeryGastroenterological CenterYokohama City University Medical CenterYokohamaJapan
| | - Hirokazu Suwa
- Department of SurgeryYokosuka Kyosai HospitalYokosukaJapan
| | | | - Atsushi Ishibe
- Department of Gastroenterological SurgeryGraduate School of MedicineYokohama City UniversityYokohamaJapan
| | - Mitsuyoshi Ota
- Department of SurgeryGastroenterological CenterYokohama City University Medical CenterYokohamaJapan
| | - Chikara Kunisaki
- Department of SurgeryGastroenterological CenterYokohama City University Medical CenterYokohamaJapan
| | - Itaru Endo
- Department of Gastroenterological SurgeryGraduate School of MedicineYokohama City UniversityYokohamaJapan
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Henriksen NA, Deerenberg EB, Venclauskas L, Fortelny RH, Miserez M, Muysoms FE. Meta-analysis on Materials and Techniques for Laparotomy Closure: The MATCH Review. World J Surg 2018; 42:1666-1678. [PMID: 29322212 DOI: 10.1007/s00268-017-4393-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND The aim of this systematic review and meta-analysis was to evaluate closure materials and suture techniques for emergency and elective laparotomies. The primary outcome was incisional hernia after 12 months, and the secondary outcomes were burst abdomen and surgical site infection. METHODS A systematic literature search was conducted until September 2017. The quality of the RCTs was evaluated by at least 3 assessors using critical appraisal checklists. Meta-analyses were performed. RESULTS A total of 23 RCTs were included in the meta-analysis. There was no evidence from RCTs using the same suture technique in both study arms that any suture material (fast-absorbable/slowly absorbable/non-absorbable) is superior in reducing incisional hernias. There is no evidence that continuous suturing is superior in reducing incisional hernias compared to interrupted suturing. When using a slowly absorbable suture for continuous suturing in elective midline closure, the small bites technique results in significantly less incisional hernias than a large bites technique (OR 0.41; 95% CI 0.19, 0.86). CONCLUSIONS There is no high-quality evidence available concerning the best suture material or technique to reduce incisional hernia rate when closing a laparotomy. When using a slowly absorbable suture and a continuous suturing technique with small tissue bites, the incisional hernia rate is significantly reduced compared with a large bites technique.
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Affiliation(s)
- N A Henriksen
- Department of Surgery, Zealand University Hospital, Koege, Denmark.
| | - E B Deerenberg
- Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - L Venclauskas
- Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - R H Fortelny
- Department of General, Visceral and Oncological Surgery, Medical Faculty, Wilhelminenspital & Sigmund Freud University, Vienna, Austria
| | - M Miserez
- University Hospitals, KU Leuven, Louvain, Belgium
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Zucker BE, Simillis C, Tekkis P, Kontovounisios C. Suture choice to reduce occurrence of surgical site infection, hernia, wound dehiscence and sinus/fistula: a network meta-analysis. Ann R Coll Surg Engl 2018; 101:150-161. [PMID: 30286645 DOI: 10.1308/rcsann.2018.0170] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND There are many options and little guiding evidence when choosing suture types with which to close the abdominal wall fascia. This network meta-analysis investigated the effect of suture materials on surgical site infection, hernia, wound dehiscence and sinus/fistula occurrence after abdominal surgery. The aim was to provide clarity on whether previous recommendations on suture choice could be followed with confidence. METHODS AND METHODS In February 2017, the Cochrane Central Register of Controlled Trials, Medline, EMBASE and Science Citation Index Expanded were searched for randomised controlled trials investigating the effect of suture choice on these four complications in closing the abdomen. A reference search of identified trials was performed. Prisma guidelines and the Cochrane risk of bias tool were followed in the data extraction and synthesis. Two review authors screened titles and abstracts of trials identified. A random effect model was used for the surgical site infection network based on the deviance information criterion statistics. RESULTS Thirty-one trials were included (11,533 participants). No suture material reached the predetermined 90% probability threshold for determination of 'best treatment' for any outcome. Pairwise comparisons largely showed no differences between suture types for all outcomes measured. However, nylon demonstrated a reduction in the occurrence of incisional hernias with respect to two commonly used absorbable sutures: polyglycolic acid (odds ratio, OR 1.91; 95% confidence interval, CI, 1.01-3.63) and polyglyconate (OR 2.18; 95% CI 1.17-4.07). CONCLUSIONS No suture type can be considered the 'best treatment' for the prevention of surgical site infection, hernia, wound dehiscence and sinus/fistula occurrence.
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Affiliation(s)
- B E Zucker
- Department of Colorectal Surgery, Chelsea and Westminster Hospital , London , UK
| | - C Simillis
- Department of Colorectal Surgery, Chelsea and Westminster Hospital , London , UK
| | - P Tekkis
- Department of Colorectal Surgery, Chelsea and Westminster Hospital , London , UK.,Department of Colorectal Surgery, Royal Marsden Hospital , London , UK.,Department of Surgery and Cancer, Imperial College , London , UK
| | - C Kontovounisios
- Department of Colorectal Surgery, Chelsea and Westminster Hospital , London , UK.,Department of Colorectal Surgery, Royal Marsden Hospital , London , UK.,Department of Surgery and Cancer, Imperial College , London , UK
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