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El Boghdady M, Ewalds-Kvist BM, Laliotis A. Abdominal hernia mesh repair in patients with inflammatory bowel disease: A systematic review. Langenbecks Arch Surg 2022; 407:2637-2649. [PMID: 35947216 PMCID: PMC9640397 DOI: 10.1007/s00423-022-02638-x] [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: 01/31/2022] [Accepted: 07/30/2022] [Indexed: 11/28/2022]
Abstract
Background Postoperative hernia-repair complications are frequent in patients with inflammatory bowel disease (IBD). This fact challenges surgeons’ decision about hernia mesh management in these patients. Therefore, we systematically reviewed the hernia mesh repair in IBD patients with emphasis on risk factors for postoperative complications. Method A systematic review was done in compliance with the PRISMA guidelines. A search was carried out on PubMed and ScienceDirect databases. English language articles published from inception to October 2021 were included in this study. MERSQI scores were applied along with evidence grades in agreement with GRADE’s recommendations. The research protocol was registered with PROSPERO (CRD42021247185). Results The present systematic search resulted in 11,243 citations with a final inclusion of 10 citations. One paper reached high and 4 moderate quality. Patients with IBD exhibit about 27% recurrence after hernia repair. Risk factors for overall abdominal septic morbidity in Crohn’s disease comprised enteroprosthetic fistula, mesh withdrawals, surgery duration, malnutrition biological mesh, and gastrointestinal concomitant procedure. Conclusion Patients with IBD were subject, more so than controls to postoperative complications and hernia recurrence. The use of a diversity of mesh types, a variety of position techniques, and several surgical choices in the citations left room for less explicit and more implicit inferences as regards best surgical option for hernia repair in patients with IBD.
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Affiliation(s)
- Michael El Boghdady
- Department of General Surgery, Kingston Hospital, London, UK. .,University of Edinburgh, Scotland, UK.
| | | | - Aggelos Laliotis
- Department of General Surgery, Croydon University Hospital, London, UK
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2
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Heise D, Schram C, Eickhoff R, Bednarsch J, Helmedag M, Schmitz SM, Kroh A, Klink CD, Neumann UP, Lambertz A. Incisional hernia repair by synthetic mesh prosthesis in patients with inflammatory bowel disease: a comparative analysis. BMC Surg 2021; 21:353. [PMID: 34579686 PMCID: PMC8474889 DOI: 10.1186/s12893-021-01350-9] [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] [Received: 01/14/2021] [Accepted: 09/21/2021] [Indexed: 02/06/2023] Open
Abstract
Background Patients with inflammatory bowel disease (IBD) have a high-life time risk undergoing abdominal surgery and are prone to develop incisional hernias (IH) in the postoperative course. Therefore, we investigated the role of IBD as perioperative risk factor in open ventral hernia repair (OVHR) as well as the impact of IBD on hernia recurrence during postoperative follow-up. Methods The postoperative course of 223 patients (Non-IBD (n = 199) and IBD (n = 34)) who underwent OVHR were compared by means of extensive group comparisons and binary logistic regressions. Hernia recurrence was investigated in the IBD group according to the Kaplan–Meier method and risk factors for recurrence determined by Cox regressions. Results General complications (≥ Clavien-Dindo I) occurred in 30.9% (72/233) and major complications (≥ Clavien-Dindo IIIb) in 7.7% (18/233) of the overall cohort with IBD being the single independent risk-factor for major complications (OR = 4.2, p = 0.007). Further, IBD patients displayed a recurrence rate of 26.5% (9/34) after a median follow-up of 36 months. Multivariable analysis revealed higher rates of recurrence in patients with ulcerative colitis (UC, 8/15, HR = 11.7) compared to patients with Crohn’s disease (CD, 1/19, HR = 1.0, p = 0.021). Conclusion IBD is a significant risk factor for major postoperative morbidity after OVHR. In addition, individuals with IBD show high rates of hernia recurrence over time with UC patients being more prone to recurrence than patients with CD.
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Affiliation(s)
- Daniel Heise
- Department of General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Charles Schram
- Department of General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Roman Eickhoff
- Department of General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Jan Bednarsch
- Department of General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Marius Helmedag
- Department of General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Sophia M Schmitz
- Department of General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Andreas Kroh
- Department of General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Christian Daniel Klink
- Department of General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Ulf Peter Neumann
- Department of General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Andreas Lambertz
- Department of General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
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Perlmutter BC, Alkhatib H, Lightner AL, Fafaj A, Zolin SJ, Petro CC, Krpata DM, Prabhu AS, Holubar SD, Rosen MJ. Short-term outcomes and healthcare resource utilization following incisional hernia repair with synthetic mesh in patients with Crohn's disease. Hernia 2021; 25:1557-1564. [PMID: 34342743 DOI: 10.1007/s10029-021-02476-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 07/16/2021] [Indexed: 01/19/2023]
Abstract
PURPOSE While the use of synthetic mesh for incisional hernia repair reduces recurrence rates, little evidence exists regarding the impact of this practice on the disease burden of a Crohn's patient. We aimed to describe the post-operative outcomes and healthcare resource utilization following incisional hernia repair with synthetic mesh in patients with Crohn's disease. METHODS A retrospective review of adult patients with Crohn's disease who underwent elective open incisional hernia repair with extra-peritoneal synthetic mesh from 2014 to 2018 at a single large academic hospital with surgeons specializing in hernia repair was conducted. Primary outcomes included 30-day post-operative complications and long-term rates of fistula formation and hernia recurrence. The secondary outcome compared healthcare resource utilization during a standardized fourteen-month period before and after hernia repair. RESULTS Among the 40 patients included, six (15%) required readmission, 4 (10%) developed a surgical site occurrence, 3 (7.5%) developed a surgical site infection, and one (2.5%) required reoperation within the first 30 days. The overall median follow-up time was 42 months (IQR = 33-56), during which time one (2.5%) patient developed an enterocutaneous fistula and eight (20%) experienced hernia recurrence. Healthcare resource utilization remained unchanged or decreased across every category following repair. CONCLUSION The use of extra-peritoneal synthetic mesh during incisional hernia repair in patients with Crohn's disease was not associated with a prohibitively high rate of post-operative complications or an increase in healthcare resource utilization to suggest worsening disease during the first 4 years after repair. Future studies exploring the long-term outcomes of this technique are needed.
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Affiliation(s)
- B C Perlmutter
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - H Alkhatib
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - A L Lightner
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - A Fafaj
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - S J Zolin
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - C C Petro
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - D M Krpata
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - A S Prabhu
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - S D Holubar
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - M J Rosen
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA.
- Department of General Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA.
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Postoperative outcomes following inguinal hernia repair in inflammatory bowel disease patients compared to matched controls. Eur J Gastroenterol Hepatol 2021; 33:522-526. [PMID: 32956182 DOI: 10.1097/meg.0000000000001936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES To assess surgical outcome in inflammatory bowel disease (IBD) patients who underwent inguinal hernia repair and to asses possible risk factors. METHODS A retrospective analysis of a prospective database including all IBD patients treated in a large tertiary center between 2008 and 2019 was conducted. IBD patients who underwent inguinal hernia surgery were matched using a propensity match scoring based on demographic and perioperative characteristics. Clinical operative data were extracted from medical records and analyzed. RESULTS Overall, out of 5467 IBD patients treated in our institute, 26 patients (0.47%) underwent inguinal hernia repair. Seventy-six matched patients with similar characteristics were compared to the IBD group. Postoperative complications were found to be more common in the IBD group (30.7% vs 11.8%; P = 0.03) compared to controls. We found no significant differences in length of stay (3.38 vs 2.83 days; P = 0.21) and hernia recurrence rate (7.6% vs 9.2%; P = 1). Within the IBD group, multivariate analysis failed to demonstrate any possible risk factor for postoperative complications, including gender [-1.53 to 2.81 95% confidence interval (CI), P = 0.52], age (-0.34 to 1.15 95% CI, P = 0.25), BMI (-0.041 to 0.019 95% CI, P = 0.43), American Society of Anesthesiologists score (-0.15 to 0.54 95% CI, P = 0.24) or medications (-0.25 to 0.28 95% CI, P = 0.88). In addition, out of various operative factors, including operation urgency, surgical approach and surgery duration, only the latter was found to be correlated with postoperative complications (0.013-0.035 95% CI, P < 0.001). CONCLUSION IBD Patients undergoing abdominal wall hernia surgery are prone to more postoperative complications.
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Giugliano DN, Bernier GV, Johnson EK. Other Surgeries in Patients with Inflammatory Bowel Disease. Surg Clin North Am 2019; 99:1163-1176. [PMID: 31676055 DOI: 10.1016/j.suc.2019.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Patients with inflammatory bowel disease (IBD) will often require abdominal surgical intervention for indications not directly related to their IBD. Because these patients often have a history of multiple previous abdominal operations and/or ostomies, they are at increased risk for incisional and parastomal hernias. They may also have develop symptomatic cholelithiasis, chronic pain, or desmoid disease. All of these potentially surgical issues may require special consideration in the IBD population.
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Affiliation(s)
- Danica N Giugliano
- Cooper University Hospital, Department of Surgery, 3 Cooper Plaza, Suite 411, Camden, NJ 08103, USA
| | - Greta V Bernier
- UW Medicine- Valley Medical Center, Colorectal Surgery Clinic, 4011 Talbot Road South, #420, Renton, WA 98055, USA
| | - Eric K Johnson
- Cleveland Clinic Colorectal Surgery, 6770 Mayfield Road #348, HC31, Mayfield Heights, OH 44124, USA.
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Montgomery SR, Butler PD, Wirtalla CJ, Collier KT, Hoffman RL, Aarons CB, Damrauer SM, Kelz RR. Racial disparities in surgical outcomes of patients with Inflammatory Bowel Disease. Am J Surg 2018; 215:1046-1050. [PMID: 29803499 DOI: 10.1016/j.amjsurg.2018.05.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 04/05/2018] [Accepted: 05/11/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Inflammatory Bowel Disease (IBD) has not historically been a focus of racial health disparities research. IBD has been increasing in the black community. We hypothesized that outcomes following surgery would be worse for black patients. METHODS A retrospective cohort study of death and serious morbidity (DSM) of patients undergoing surgery for IBD was performed using data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP 2011-2014). Multivariable logistic regression modeling was performed to evaluate associations between race and outcomes. RESULTS Among 14,679 IBD patients, the overall rate of DSM was 20.3% (white: 19.3%, black 27.0%, other 23.8%, p < 0.001). After adjustment, black patients remained at increased risk of DSM compared white patients (OR: 1.37; 95% CI 1.14-1.64). CONCLUSIONS Black patients are at increased risk of post-operative DSM following surgery for IBD. The elevated rates of DSM are not explained by traditional risk factors like obesity, ASA class, emergent surgery, or stoma creation.
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Affiliation(s)
- Samuel R Montgomery
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Paris D Butler
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Chris J Wirtalla
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Karole T Collier
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Rebecca L Hoffman
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Cary B Aarons
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Scott M Damrauer
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Rachel R Kelz
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, United States.
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Heimann TM, Swaminathan S, Greenstein AJ, Greenstein AJ, Steinhagen RM. Outcome of incisional hernia repair in patients with Inflammatory Bowel Disease. Am J Surg 2017; 214:468-473. [DOI: 10.1016/j.amjsurg.2017.05.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Revised: 05/07/2017] [Accepted: 05/29/2017] [Indexed: 11/26/2022]
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Beffa LR, Warren JA, Cobb WS, Knoedler B, Ewing JA, Carbonell AM. Open Retromuscular Repair of Parastomal Hernias with Synthetic Mesh. Am Surg 2017. [DOI: 10.1177/000313481708300845] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Parastomal hernias (PHs) cause significant morbidity in patients with permanent ostomies, and several laparoscopic and open repair techniques have been described. We report our experience with open retromuscular repair of PHs using permanent synthetic mesh. A prospectively maintained database was retrospectively reviewed to identify patients undergoing PH repair. Primary outcomes are surgical site occurrence, surgical site infection (SSI), and hernia recurrence. Variables were analyzed using Pearson's χ2 test or Fisher's exact test. Values of P < 0.05 were considered significant. Forty-six patients underwent retromuscular PH repair with permanent synthetic mesh. There were 26 patients with colostomies and 20 with ileostomies. All the patients were repaired using a keyhole retromuscular technique and direct passage of stoma through mesh. Transversus abdominis release was performed in 65.2 per cent of cases. Permanent synthetic polypropylene mesh was used in all cases. Surgical site occurrence occurred in 47.8 per cent of patients, SSI in 17.4 per cent, and hernia recurrence in 21.7 per cent. Resiting the stoma yielded the highest rate of SSI (40%) compared with leaving the stoma in situ (11.8%) or rematuring the stoma (0%; P = 0.011). Open keyhole retromuscular PH repair of PH with permanent synthetic mesh is safe, effective, and durable.
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Affiliation(s)
- Lucas R. Beffa
- Greenville Health System, Division of Minimal Access Surgery, Greenville, South Carolina
| | - Jeremy A. Warren
- Greenville Health System, Division of Minimal Access Surgery, Greenville, South Carolina
| | - William S. Cobb
- Greenville Health System, Division of Minimal Access Surgery, Greenville, South Carolina
| | - Bryan Knoedler
- University of South Carolina School of Medicine, Greenville, South Carolina
| | - Joseph A. Ewing
- Greenville Health System, Division of Minimal Access Surgery, Greenville, South Carolina
| | - Alfredo M. Carbonell
- Greenville Health System, Division of Minimal Access Surgery, Greenville, South Carolina
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Comparative analysis of perioperative outcomes of robotic versus open transversus abdominis release. Surg Endosc 2017; 32:840-845. [PMID: 28733746 DOI: 10.1007/s00464-017-5752-1] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 07/14/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Transversus abdominis release (TAR) has evolved as an effective approach to complex abdominal wall reconstructions. Although the role of robotics in hernia surgery is rapidly expanding, the benefits of a robotic approach for abdominal wall reconstruction have not been established well. We aimed to compare the impact of the application of robotics to the TAR procedure on the perioperative outcomes when compared to the open TAR repairs. METHODS Case-matched comparison of patients undergoing robotic TAR (R-TAR) at two specialized hernia centers to a matched historic cohort of open TAR (O-TAR) patients was performed. Outcome measures included patient demographics, operative details, postoperative complications, and length of hospitalization. RESULTS 38 consecutive patients undergoing R-TAR were compared to 76 matched O-TAR. Patient demographics were similar between the groups, but ASA III status was more prevalent in the O-TAR group. The average operative time was significantly longer in the R-TAR group (299 ± 95 vs.. 211 ± 63 min, p < 0.001) and blood loss was significantly lower for the R-TAR group (49 ± 60 vs. 139 ± 149 mL, p < 0.001). Wound morbidity was minimal in the R-TAR, but the rate of surgical site events and surgical site infection was not different between groups. Systemic complications were significantly less frequent in the R-TAR group (0 vs. 17.1%, p = 0.026). The length of hospitalization was significantly reduced in the R-TAR group (1.3 ± 1.3 vs. 6.0 ± 3.4 days, p < 0.001). CONCLUSIONS In our early experience, robotic TAR was associated with longer operative times. However, we found that the use of robotics was associated with decreased intraoperative blood loss, fewer systemic complications, shorter hospitalizations, and eliminated readmissions. While long-term outcomes and patient selection criteria for robotic TAR repair are under investigations, we advocate selective use of robotics for TAR reconstructions in patients undergoing AWR.
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