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Oliveira E Silva PDD, Melo RMD, Gontijo CEDS, Oliveira ÊCD. INTRA-ABDOMINAL PRESSURE MONITORING DURING LÁZARO DA SILVA'S PROCEDURE FOR VENTRAL HERNIA REPAIR: A CROSS-SECTIONAL STUDY. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2024; 37:e1813. [PMID: 39046030 PMCID: PMC11259399 DOI: 10.1590/0102-6720202400020e1813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 05/16/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Maintaining normal intra-abdominal pressure (IAP) levels must be one major outcome of any ventral hernia repair, avoiding hypertension or abdominal compartment syndrome. AIMS To evaluate IAP during ventral hernia repair using Lázaro da Silva's procedure. METHODS IAP measurements using intravesical pressure were performed during four crucial intraoperative moments. Twenty-eight patients submitted to incisional herniorrhaphy were analyzed. RESULTS The IAP increased by 0.5 mmHg during the procedure, regardless of the type of prior laparotomy, sex, age, obesity, or hernia width. CONCLUSIONS Despite the IAP increase observed, Lázaro da Silva's procedure did not result in intra-abdominal hypertension or abdominal compartment syndrome.
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Affiliation(s)
- Pedro Ducatti de Oliveira E Silva
- Universidade Federal de Goiás, Faculty of Medicine, Postgraduate Program in Health Sciences - Goiânia (GO), Brazil
- Hospital Geral de Goiânia Dr. Alberto Rassi - Goiânia (GO), Brazil
| | - Renato Miranda de Melo
- Hospital Geral de Goiânia Dr. Alberto Rassi - Goiânia (GO), Brazil
- Universidade Federal de Goiás, Faculty of Medicine, Department of Surgery - Goiânia (GO), Brazil
| | | | - Ênio Chaves de Oliveira
- Universidade Federal de Goiás, Faculty of Medicine, Postgraduate Program in Health Sciences - Goiânia (GO), Brazil
- Universidade Federal de Goiás, Faculty of Medicine, Department of Surgery - Goiânia (GO), Brazil
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Van Hoef S, Dries P, Allaeys M, Eker HH, Berrevoet F. Intra-abdominal hypertension and compartment syndrome after complex hernia repair. Hernia 2024; 28:701-709. [PMID: 38568348 DOI: 10.1007/s10029-024-02992-3] [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: 12/06/2023] [Accepted: 02/10/2024] [Indexed: 07/16/2024]
Abstract
PURPOSE Abdominal compartment syndrome (ACS) is a well-known concept after trauma surgery or after major abdominal surgery in critically ill patients. However, ACS as a complication after complex hernia repair is considered rare and supporting literature is scarce. As complexity in abdominal wall repair increases, with the introduction of new tools and advanced techniques, ACS incidence might rise and should be carefully considered when dealing with complex abdominal wall hernias. In this narrative review, a summary of the current literature will highlight several key features in the diagnosis and management of ACS in complex abdominal wall repair and discuss several treatment options during the different steps of complex AWR. METHODS We performed a literature search across PubMed using the search terms: "Abdominal Compartment syndrome," "Intra-abdominal pressure," "Complex abdominal hernia," and "Ventral hernia." Articles corresponding to these search terms were individually reviewed by primary author and selected on relevance. CONCLUSION Intra-abdominal hypertension (IAH) and ACS require imperative attention and should be carefully considered when dealing with complex abdominal wall hernias, even without significant loss of domain. Development of a true abdominal compartment syndrome is relatively rare, but is a devastating complication and should be prevented at all cost. Current evidence on surgical treatment of ACS after hernia repair is scarce, but conservative management might be an option in the early phase and low grades of IAH. However, life-saving treatment by relaparotomy and open abdomen management should be initiated when ACS starts setting in.
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Affiliation(s)
- S Van Hoef
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium.
| | - P Dries
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - M Allaeys
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - H H Eker
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - F Berrevoet
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
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Sagnelli C, Tartaglia E, Guerriero L, Montanaro ML, D'Alterio G, Cuccurullo D. Long-term outcomes of Madrid approach after TAR for complex abdominal wall hernias: a single-center cohort study. Hernia 2024; 28:769-777. [PMID: 37726424 DOI: 10.1007/s10029-023-02864-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/11/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE Undeniably, in the last 2 decades, surgical approaches in the field of abdominal wall repair have notably improved. However, the best approach to provide a durable repair with low morbidity rate has yet to be determined. The purpose of this study is to outline our long-term results following the Transverse Abdominis Release (TAR) approach in patients with complex ventral hernias, focusing on the incidence of recurrence and overall patient satisfaction following surgery. METHODS This is a retrospective study on 167 consecutive patients who underwent TAR between January 2015 and December 2021 for primary or recurrent complex abdominal hernias. Of these, 117 patients who underwent the open Madrid approach with the use of a double mesh (absorbable and permanent synthetic mesh) were selected and analyzed. A quality of life questionnaire (EuraHS QoL) comparing the preoperative and the postoperative status was administered. RESULTS Between January 2015 and December 2021, we successfully treated 117 patients presenting with complex ventral defects using the double mesh technique (absorbable and permanent synthetic mesh). Of these, 26 (22.2%) were recurrent cases. At a median follow-up period of 37.7 months, there had been 1 (0.8%) case of recurrence and 8 cases (6.8%) of bulging. The QoL score was significantly improved when compared to the preoperative status in terms of cosmesis, body perception, and physical discomfort. CONCLUSIONS The Madrid approach for posterior component separation is associated with both a low perioperative morbidity and recurrence rate. In accordance with other studies, we demonstrated that the TAR with reconstruction according to the Madrid approach provides excellent results in the treatment of complex abdominal wall hernias, even at long-term follow-up.
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Affiliation(s)
- C Sagnelli
- Department of Laparoscopic and Robotic General Surgery, Azienda Ospedaliera dei Colli "Monaldi Hospital", 80131, Naples, Italy
| | - E Tartaglia
- Department of Laparoscopic and Robotic General Surgery, Azienda Ospedaliera dei Colli "Monaldi Hospital", 80131, Naples, Italy.
| | - L Guerriero
- Department of Laparoscopic and Robotic General Surgery, Azienda Ospedaliera dei Colli "Monaldi Hospital", 80131, Naples, Italy
| | - M L Montanaro
- Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, Bari, BA, Italy
| | - G D'Alterio
- Ospedale Antonio Cardarelli, 86100, Campobasso, CB, Italy
| | - D Cuccurullo
- Department of Laparoscopic and Robotic General Surgery, Azienda Ospedaliera dei Colli "Monaldi Hospital", 80131, Naples, Italy
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Seybold B, Deutsch AM, Deutsch BL, Simeliunas E, Weigand MA, Fiedler-Kalenka MO, Kalenka A. Differential Effects of Intra-Abdominal Hypertension and ARDS on Respiratory Mechanics in a Porcine Model. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:843. [PMID: 38929460 PMCID: PMC11205316 DOI: 10.3390/medicina60060843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/17/2024] [Accepted: 05/18/2024] [Indexed: 06/28/2024]
Abstract
Background and Objectives: Intra-abdominal hypertension (IAH) and acute respiratory distress syndrome (ARDS) are common concerns in intensive care unit patients with acute respiratory failure (ARF). Although both conditions lead to impairment of global respiratory parameters, their underlying mechanisms differ substantially. Therefore, a separate assessment of the different respiratory compartments should reveal differences in respiratory mechanics. Materials and Methods: We prospectively investigated alterations in lung and chest wall mechanics in 18 mechanically ventilated pigs exposed to varying levels of intra-abdominal pressures (IAP) and ARDS. The animals were divided into three groups: group A (IAP 10 mmHg, no ARDS), B (IAP 20 mmHg, no ARDS), and C (IAP 10 mmHg, with ARDS). Following induction of IAP (by inflating an intra-abdominal balloon) and ARDS (by saline lung lavage and injurious ventilation), respiratory mechanics were monitored for six hours. Statistical analysis was performed using one-way ANOVA to compare the alterations within each group. Results: After six hours of ventilation, end-expiratory lung volume (EELV) decreased across all groups, while airway and thoracic pressures increased. Significant differences were noted between group (B) and (C) regarding alterations in transpulmonary pressure (TPP) (2.7 ± 0.6 vs. 11.3 ± 2.1 cmH2O, p < 0.001), elastance of the lung (EL) (8.9 ± 1.9 vs. 29.9 ± 5.9 cmH2O/mL, p = 0.003), and elastance of the chest wall (ECW) (32.8 ± 3.2 vs. 4.4 ± 1.8 cmH2O/mL, p < 0.001). However, global respiratory parameters such as EELV/kg bodyweight (-6.1 ± 1.3 vs. -11.0 ± 2.5 mL/kg), driving pressure (12.5 ± 0.9 vs. 13.2 ± 2.3 cmH2O), and compliance of the respiratory system (-21.7 ± 2.8 vs. -19.5 ± 3.4 mL/cmH2O) did not show significant differences among the groups. Conclusions: Separate measurements of lung and chest wall mechanics in pigs with IAH or ARDS reveals significant differences in TPP, EL, and ECW, whereas global respiratory parameters do not differ significantly. Therefore, assessing the compartments of the respiratory system separately could aid in identifying the underlying cause of ARF.
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Affiliation(s)
- Benjamin Seybold
- Department of Anesthesiology, Medical Faculty, Heidelberg University Hospital, University Heidelberg, 69120 Heidelberg, Germany; (A.M.D.); (B.L.D.); (E.S.); (M.A.W.); (M.O.F.-K.); (A.K.)
| | - Anna M. Deutsch
- Department of Anesthesiology, Medical Faculty, Heidelberg University Hospital, University Heidelberg, 69120 Heidelberg, Germany; (A.M.D.); (B.L.D.); (E.S.); (M.A.W.); (M.O.F.-K.); (A.K.)
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Vivantes Klinikum im Friedrichshain, 10249 Berlin, Germany
| | - Barbara Luise Deutsch
- Department of Anesthesiology, Medical Faculty, Heidelberg University Hospital, University Heidelberg, 69120 Heidelberg, Germany; (A.M.D.); (B.L.D.); (E.S.); (M.A.W.); (M.O.F.-K.); (A.K.)
- Department of Anesthesiology, Intensive Care and Emergency Medicine, Asklepios Klinik Wandsbek, 22043 Hamburg, Germany
| | - Emilis Simeliunas
- Department of Anesthesiology, Medical Faculty, Heidelberg University Hospital, University Heidelberg, 69120 Heidelberg, Germany; (A.M.D.); (B.L.D.); (E.S.); (M.A.W.); (M.O.F.-K.); (A.K.)
- Department of Anesthesiology and Intensive Care Medicine, Bürgerspital Solothurn, 4500 Solothurn, Switzerland
| | - Markus A. Weigand
- Department of Anesthesiology, Medical Faculty, Heidelberg University Hospital, University Heidelberg, 69120 Heidelberg, Germany; (A.M.D.); (B.L.D.); (E.S.); (M.A.W.); (M.O.F.-K.); (A.K.)
- German Center for Lung Research (DZL), Translational Lung Research Center Heidelberg (TLRC), 69120 Heidelberg, Germany
| | - Mascha O. Fiedler-Kalenka
- Department of Anesthesiology, Medical Faculty, Heidelberg University Hospital, University Heidelberg, 69120 Heidelberg, Germany; (A.M.D.); (B.L.D.); (E.S.); (M.A.W.); (M.O.F.-K.); (A.K.)
- German Center for Lung Research (DZL), Translational Lung Research Center Heidelberg (TLRC), 69120 Heidelberg, Germany
| | - Armin Kalenka
- Department of Anesthesiology, Medical Faculty, Heidelberg University Hospital, University Heidelberg, 69120 Heidelberg, Germany; (A.M.D.); (B.L.D.); (E.S.); (M.A.W.); (M.O.F.-K.); (A.K.)
- Hospital Bergstrasse, 64646 Heppenheim, Germany
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Brophy SA, Minor S, French DG. Abdominal Compartment Syndrome Following Paraesophageal and Diaphragmatic Hernia Repair. ACG Case Rep J 2024; 11:e01344. [PMID: 38682075 PMCID: PMC11049705 DOI: 10.14309/crj.0000000000001344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/19/2024] [Indexed: 05/01/2024] Open
Abstract
Abdominal compartment syndrome (ACS) is defined as a sustained intra-abdominal pressure ≥ 20 mm Hg, associated with new organ dysfunction. Postoperative ACS can occur following repair of hernias with loss-of-domain. Such loss-of-domain hernias are well described involving incisional hernias, less described involving Bochdalek congenital diaphragmatic hernias (CDHs), but not yet described involving paraesophageal hernias (PEHs) or Morgagni CDHs. We describe a case of postoperative ACS following laparoscopic repair of a PEH and Morgagni CDH. This case demonstrates that prophylactic omentectomy should be considered in select patients undergoing repair of large PEHs or CDHs, as ACS is a rare but potential complication.
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Affiliation(s)
- Shawn A. Brophy
- Division of Thoracic Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Samuel Minor
- Divisions of General Surgery and Critical Care Medicine, Dalhousie University, Queen Elizabeth II Hospital Halifax, Nova Scotia, Canada
| | - Daniel G. French
- Division of Thoracic Surgery, Department of Surgery, Dalhousie University, Queen Elizabeth II Hospital Halifax, Nova Scotia, Canada
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Cai X, Wang F, Zhu Y, Shen Y, Peng P, Cui Y, Di Z, Chen J. Application of bridging mesh repair in giant ventral incisional hernia. Updates Surg 2024:10.1007/s13304-024-01825-3. [PMID: 38555536 DOI: 10.1007/s13304-024-01825-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 03/06/2024] [Indexed: 04/02/2024]
Abstract
Achieving ideal abdominal wall reconstruction in giant ventral incisional hernia has been a challenging for surgeons. This study aimed to verify the safety and efficacy of bridging repair by comparing it with primary fascial closure (PFC) repair in the treatment of giant ventral incisional hernia. We retrospectively analyzed the clinical data of 92 patients with giant ventral incisional hernia who underwent mesh repair at our medical institution from January 1, 2014 to December 31, 2020. Patients were divided into 2 groups: the bridging repair group with 40 patients in whom repair was completed using the bridging technique and the PFC group with 52 patients in whom primary fascial closure was achieved and all patients underwent mesh reinforcement during the operation. The main outcome measures were recurrence rate and morbidity, especially intra-abdominal hypertension (IAH). Follow-up time of both groups lasted at least 24 months after surgery. After a median of 46 months and 65 months of follow-up, respectively, in the two groups, bridging repair did not increase the long-term recurrence rate (2.56%) in the larger defect area group compared to the PFC group (1.96%). There were no significant differences in perioperative morbidity, IAH, incidence of postoperative chronic pain, and sensory impairment of the abdominal wall between both groups. The application of bridging surgery in the treatment of complex giant ventral incisional hernias is safe and effective and does not significantly increase the postoperative recurrence rate.
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Affiliation(s)
- Xuan Cai
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang District, Beijing, 100020, China
| | - Fan Wang
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang District, Beijing, 100020, China
| | - Yilin Zhu
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang District, Beijing, 100020, China
| | - Yingmo Shen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang District, Beijing, 100020, China
| | - Peng Peng
- Department of Hernia and Abdominal Wall Surgery, Peking University People's Hospital, No.11 Xizhimennan Str., Xicheng District, Beijing, 100044, China
| | - Yan Cui
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang District, Beijing, 100020, China
| | - Zhishan Di
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang District, Beijing, 100020, China
| | - Jie Chen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang District, Beijing, 100020, China.
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7
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Petro CC, Melland-Smith M. Open Complex Abdominal Wall Reconstruction. Surg Clin North Am 2023; 103:961-976. [PMID: 37709399 DOI: 10.1016/j.suc.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
This article provides an approach to open complex abdominal wall reconstruction. Herein, the authors discuss the purpose of component separation as well as its relevant indications. The techniques and anatomical considerations of both anterior and posterior component separation are described. In addition, patient selection criteria, preoperative adjuncts that may assist with fascial or soft tissue closure, and complications of component separation will be discussed.
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Affiliation(s)
- Clayton C Petro
- Lerner College of Medicine, Cleveland Clinic Center for Abdominal Core Health, 9500 Euclid Avenue A-100, Cleveland, OH 44195, USA.
| | - Megan Melland-Smith
- Lerner College of Medicine, Cleveland Clinic Center for Abdominal Core Health, 9500 Euclid Avenue A-100, Cleveland, OH 44195, USA
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Marturano MN, Ayuso SA, Ku D, Raible R, Lopez R, Scarola GT, Gersin K, Colavita PD, Augenstein VA, Heniford BT. Preoperative botulinum toxin A (BTA) injection versus component separation techniques (CST) in complex abdominal wall reconstruction (AWR): A propensity-scored matched study. Surgery 2023; 173:756-764. [PMID: 36229258 DOI: 10.1016/j.surg.2022.07.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/14/2022] [Accepted: 07/05/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Complete fascial closure significantly reduces recurrence rates and wound complications in abdominal wall reconstruction. While component separation techniques have clear effectiveness in closing large abdominal wall defects, preoperative botulinum toxin A has emerged as an adjunct to aid in fascial closure. Few data exist comparing preoperative botulinum toxin A to component separation techniques, and the aim was to do so in a matched study. METHODS A prospective, single-center, hernia-specific database was queried, and a 3:1 propensity-matched study of patients undergoing open abdominal wall reconstruction from 2016 to 2021 with botulinum toxin A versus component separation techniques was performed based on body mass index, defect width, hernia volume, and Centers for Disease Control and Prevention wound classification. Demographics, operative characteristics, and outcomes were evaluated. RESULTS Matched patients included 105 component separation techniques and 35 botulinum toxin A. There was no difference in tobacco use, diabetes, or body mass index (all P > .5). Hernia defects and volume were large for both the component separation techniques and botulinum toxin A groups (mean size: component separation techniques 286.2 ± 179.9 cm2 vs botulinum toxin A 289.7 ± 162.4 cm2; P = .73) (mean volume: 1,498.3 + 2,043.4 cm3 vs 2,914.7 + 6,539.4 cm3; P = .35). Centers for Disease Control and Prevention wound classifications were equivalent (CDC3 and 4%-39.1% vs 40.0%; P = .97). Component separation techniques were more frequently performed in European Hernia Society M1 hernias (21% vs 2.9%; P = .01). The botulinum toxin A group had fewer surgical site occurrences (32.4% vs 11.4%; P = .02) and surgical site infections (11.7% vs 0%; P = .04). In multivariate analysis, botulinum toxin A was associated with lower rates of surgical site occurrences (odds ratio = 5.3; 95% confidence interval [1.4-34.4]). There was no difference in fascial closure (90.5% vs 100%; P = .11) or recurrence (12.4% vs 2.9%; P = .10) with follow-up (22.8 + 29.7 vs 9.8 + 12.7 months; P = .13). CONCLUSION In a matched study comparing patients with botulinum toxin A versus component separation techniques, there was no difference in fascial closure rates or in hernia recurrence between the 2 groups. Preoperative botulinum toxin A can achieve similar outcomes as component separation techniques, while decreasing the frequency of surgical site occurrences.
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Affiliation(s)
- Matthew N Marturano
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC. https://twitter.com/MarturanoMd
| | - Sullivan A Ayuso
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC. https://twitter.com/SAyusoMD
| | - David Ku
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC
| | | | | | - Gregory T Scarola
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC
| | - Keith Gersin
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC
| | - Paul D Colavita
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC. https://twitter.com/PDColavita
| | - Vedra A Augenstein
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC. https://twitter.com/VedraAugenstein
| | - B Todd Heniford
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC.
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Den Hartog FPJ, Van Koten EF, Van Den Dobbelsteen JJ, Tanis PJ, Van Der Elst M, Bloemendaal ALA. Minimally Invasive Tensiometry: A New Modality for Per-Operative Measurement of Medialization and Tension During Laparoscopic Hernia Surgery. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2022; 1:10850. [PMID: 38314162 PMCID: PMC10831690 DOI: 10.3389/jaws.2022.10850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 09/13/2022] [Indexed: 02/06/2024]
Abstract
Background: Newly developed techniques for minimally invasive abdominal wall reconstruction (AWR) for complex ventral hernia are continuously evolving. In order to achieve hernia defect closure, the aponeurotic edges of the hernia defect need to be approximated. Currently, surgeons have no way to objectively measure and quantify the traction required to approximate these edges. This study presents minimally invasive tensiometry (MINT), a novel technology for measuring fascial tension, as well as initial experiences and results using it. Methods: The MINT device was designed using rapid prototyping principles. It was designed as an add-on tool for any existing laparoscopic instrument, enabling objective assessment of abdominal wall tension by the use of a manually operated linear spring. Pre-clinical measurements of medialization at 10 and 20 N of tension during AWR were performed on fresh-frozen Post-Mortem Human Specimens (PMHS). Results: Three specimens were included, and a total number of 36 measurements of medialization at three different levels of the abdominal wall were performed under structured and similar circumstances. Median total medialization with 20 Newton (N) of applied tension was 25 mm (mm) cranially, 37.5 mm at the umbilicus and 27.5 mm at the caudal level. The highest rate of medialization was seen at the umbilical level (2.25 mm/N). Conclusion: MINT is a novel non-invasive technique, which allows surgeons to intraoperatively measure fascial tension when performing AWR. The MINT device is easy to use and reproduce. The next step is to start performing clinical measurements applying MINT during AWR.
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Affiliation(s)
- F. P. J. Den Hartog
- Department of Surgery, ErasmusMC, University Medical Center, Rotterdam, Netherlands
| | - E. F. Van Koten
- Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
| | | | - P. J. Tanis
- Department of Surgery, ErasmusMC, University Medical Center, Rotterdam, Netherlands
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - M. Van Der Elst
- Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
- Department of Surgery, Reinier de Graaf Gasthuis, Delft, Netherlands
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A case of severe acute respiratory failure after elective abdominoplasty. Respir Med Case Rep 2022; 38:101683. [PMID: 35711721 PMCID: PMC9194840 DOI: 10.1016/j.rmcr.2022.101683] [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: 01/29/2022] [Revised: 05/26/2022] [Accepted: 06/01/2022] [Indexed: 11/22/2022] Open
Abstract
Surgical correction of abdominal muscle diastasis may decrease intra-abdominal volume and increase intra-abdominal pressure. The induced changes may ultimately lead to respiratory compromise. In abdominoplasty, one of the most frequently performed esthetic procedures, those changes are believed to be transient and clinically insignificant. We describe a case where acute change in respiratory physiology after abdominoplasty led to severe respiratory failure with significantly decreased pulmonary compliance in a young and otherwise healthy patient. In this case mechanical ventilation failed to improve compliance, and reversal of abdominoplasty was required to restitute pulmonary function.
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Management of a Voluminous Incisional Hernia – Case Report and Brief Review. JOURNAL OF INTERDISCIPLINARY MEDICINE 2022. [DOI: 10.2478/jim-2022-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Introduction: Massive ventral hernia repairs may lead to abdominal compartment syndrome, which is associated with increased morbidity and mortality, and is caused by an acute rise in intra-abdominal pressure, frequently leading to multi-organ failure and possibly death. This report presents a case with a voluminous incisional hernia associated with intestine obstruction and the issues surrounding emergency surgical treatment. Case report: An overweight 67-year-old patient with a medical history of diabetes and multiple cardiovascular pathologies presented to the emergency department complaining of abdominal distension, pain, nausea, vomiting, and lack of intestinal transit for 48 hours. A clinical diagnosis of bowel obstruction was established, caused by a large ventral hernia. During surgery, a tension free abdominal wall reconstruction was performed with a peritoneal flap from the hernia sac and retromuscular Prolene synthetic mesh. A Redon-type drainage of the posterior rectus compartment and subcutis was applied for 48 hours. After the operation, the patient was transferred to the intensive care unit for monitoring. During the follow-up, continuous monitoring of arterial blood pressure, oxygen saturation, renal function, daily diuresis, lactic acid values, and intraabdominal pressure was performed. On the 9th postoperative day, the patient was released in good general health, stable from a cardiorespiratory point of view, with a clean, healing surgical wound. Conclusion: The repair of large ventral hernias is technically challenging. The management of giant incisional hernias is complex, requiring thoughtful preoperative evaluation with CT imaging and volumetry calculation, which can help establish the surgical strategy.
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Kumar S, Rao N, Parker S, Plumb A, Windsor A, Mallett S, Halligan S. Are preoperative CT variables associated with the success or failure of subsequent ventral hernia repair: nested case-control study. Eur Radiol 2022; 32:6348-6354. [PMID: 35348860 PMCID: PMC9381620 DOI: 10.1007/s00330-022-08701-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Systematic review of CT measurements to predict the success or failure of subsequent ventral hernia repair has found limited data available in the indexed literature. To rectify this, we investigated multiple preoperative CT metrics to identify if any were associated with postoperative reherniation. METHODS Following ethical permission, we identified patients who had undergone ventral hernia repair and had preoperative CT scanning available. Two radiologists made multiple measurements of the hernia and abdominal musculature from these scans, including loss of domain. Patients were divided subsequently into two groups, defined by hernia recurrence at 1-year subsequent to surgery. Hypothesis testing investigated any differences between CT measurements from each group. RESULTS One hundred eighty-eight patients (95 male) were identified, 34 (18%) whose hernia had recurred by 1-year. Only three of 34 CT measurements were significantly different when patients whose hernia had recurred were compared to those who had not; these significant findings were assumed contingent on multiple testing. In particular, preoperative hernia volume (recurrence 155.3 cc [IQR 355.65] vs. no recurrence 78.2 [IQR 303.52], p = 0.26) nor loss of domain, whether calculated using the Tanaka (recurrence 0.02 [0.04] vs. no recurrence 0.009 [0.04], p = 0.33) or Sabbagh (recurrence 0.019 [0.05] vs. no recurrence 0.009 [0.04], p = 0.25) methods, differed between significantly between groups. CONCLUSIONS Preoperative CT measurements of ventral hernia morphology, including loss of domain, appear unrelated to postoperative recurrence. It is likely that the importance of such measurements to predict recurrence is outweighed by other patient factors and surgical reconstruction technique. KEY POINTS • Preoperative CT scanning is often performed for ventral hernia but systematic review revealed little data regarding whether CT variables predict postoperative reherniation. • We found that the large majority of CT measurements, including loss of domain, did not differ significantly between patients whose hernia did and did not recur. • It is likely that the importance of CT measurements to predict recurrence is outweighed by other patient factors and surgical reconstruction technique.
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Affiliation(s)
- Shankar Kumar
- UCL Centre for Medical Imaging, University College London UCL, Charles Bell House, 43-45 Foley Street, London, W1W 7TS UK
| | - Nikhil Rao
- Radiology Department, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX UK
| | - Sam Parker
- Addominal Wall Reconstruction Unit, University College London Hospital, 235 Euston Road, London, NW1 2BU UK
| | - Andrew Plumb
- UCL Centre for Medical Imaging, University College London UCL, Charles Bell House, 43-45 Foley Street, London, W1W 7TS UK
| | - Alastair Windsor
- Addominal Wall Reconstruction Unit, University College London Hospital, 235 Euston Road, London, NW1 2BU UK
| | - Sue Mallett
- UCL Centre for Medical Imaging, University College London UCL, Charles Bell House, 43-45 Foley Street, London, W1W 7TS UK
| | - Steve Halligan
- UCL Centre for Medical Imaging, University College London UCL, Charles Bell House, 43-45 Foley Street, London, W1W 7TS UK
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Chatzimavroudis G, Kotoreni G, Kostakis I, Voloudakis N, Christoforidis E, Papaziogas B. Outcomes of posterior component separation with transversus abdominis release (TAR) in large and other complex ventral hernias: a single-surgeon experience. Hernia 2021; 26:1275-1283. [PMID: 34668108 DOI: 10.1007/s10029-021-02520-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 10/04/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Over the last years, great advances in the repair of abdominal wall hernias have dramatically improved patients' outcomes. Especially for large and other complex ventral hernias, the application of component separation techniques has been a landmark in their successful management. The aim of this study is to present our experience with the posterior component separation with transversus abdominis release (TAR) in patients with these demanding ventral hernias. METHODS A retrospective analysis of prospectively collected data of all patients who underwent elective ventral hernia repair with TAR between January 2016 and December 2019 was performed. Preoperative, intraoperative, and postoperative data were analyzed. RESULTS A total of 125 patients with large and other complex ventral hernias were included in the final analysis. More than 80% of patients had one or more comorbidities. Of all patients, 116 (92.8%) had a history of previous abdominal surgery, 27 (21.6%) had a history of SSI and nine (7.2%) had active fistulas. Postoperatively, SSOs were presented in 11 patients (8.8%), including three cases of SSI. Neither mesh infection occurred, nor mesh excision required. With a mean follow-up of 2.5 years, only one recurrence was observed. CONCLUSIONS With a wound complication rate of less than 9% and a recurrence rate of less than 1%, our results show that TAR is a reliable, safe and effective technique for the repair of massive and other complex ventral hernias. The combination of knowledge of the abdominal wall anatomy at a proficient level, proper training, and adoption of a strict prehabilitation program are considered prerequisites for the successful management of such demanding hernias.
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Affiliation(s)
- G Chatzimavroudis
- 2nd Surgical Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece. .,Complex Hernia and Abdominal Wall Reconstruction Center, European Interbalkan Medical Center, Thessaloniki, Greece.
| | - G Kotoreni
- 2nd Surgical Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece.,Complex Hernia and Abdominal Wall Reconstruction Center, European Interbalkan Medical Center, Thessaloniki, Greece
| | - I Kostakis
- 2nd Surgical Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece
| | - N Voloudakis
- 2nd Surgical Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece
| | - E Christoforidis
- 2nd Surgical Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece
| | - B Papaziogas
- 2nd Surgical Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece
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Tang H, Liu D, Guo Y, Zhang H, Li Y, Peng X, Wang Y, Jiang D, Zhang L, Wang Z. A New Device for Measuring Abdominal Wall Tension and Its Value in Screening Abdominal Infection. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2021; 14:119-131. [PMID: 33911903 PMCID: PMC8075309 DOI: 10.2147/mder.s291407] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/19/2021] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE This study is the largest clinical study of noninvasive Abdominal wall tension (AWT) measurement with a tensiometer to date. It also initially applies a polynomial regression equation to analyze the correlation between AWT measurement and intravesical pressure (IVP) measurement and remarkably finds interesting changes between different IVP intervals and AWT. METHODS Critically ill patients who were treated in the intensive care unit (ICU) of Daping Hospital, Army Medical University, from August 30, 2018, to June 30, 2020, and met the inclusion criteria were prospectively included in this study. The patients were divided into an intra-abdominal hypertension group and a non-intra-abdominal hypertension group and an abdominal infection group and no abdominal infection group. AWT and IVP were measured at 9 points on the abdominal wall on the first day after admission to the ICU. The correlations between AWTs and IVP were analyzed, and the role of AWT in the diagnosis of complications of abdominal infection and the prediction of adverse prognosis were analyzed. RESULTS A total of 127 patients were included. The average AWT and IVP were 2.77±0.38 N/mm and 12.31±7.01 mmHg, respectively, on the first day of admission. There was a positive correlation between AWT and IVP (correlation coefficient r = 0.706, p < 0.05). The polynomial regression model was AWT= -1.616×10-3 IVP2 +8.323×10-2 IVP+2.094. The cutoff value of the sensitivity and specificity of AWT for the diagnosis of abdominal infection was 2.57 N/mm. Furthermore, AWT = 2.57 N/mm had the best diagnostic efficiency, which was better than that of IAH and lactate. CONCLUSION There was a correlation between AWT and IVP. AWT measurement was helpful in the diagnosis of IAH and abdominal infection complications and can therefore serve as a new method for the clinical diagnosis of IVP and abdominal infection.
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Affiliation(s)
- Hao Tang
- Wound Trauma Medical Center, State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, People’s Republic of China
| | - Dong Liu
- Wound Trauma Medical Center, State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, People’s Republic of China
| | - Yong Guo
- Wound Trauma Medical Center, State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, People’s Republic of China
| | - Huayu Zhang
- Wound Trauma Medical Center, State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, People’s Republic of China
| | - Yang Li
- Wound Trauma Medical Center, State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, People’s Republic of China
| | - Xiaoyu Peng
- Wound Trauma Medical Center, State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, People’s Republic of China
| | - Yaoli Wang
- Wound Trauma Medical Center, State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, People’s Republic of China
| | - Dongpo Jiang
- Wound Trauma Medical Center, State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, People’s Republic of China
| | - Lianyang Zhang
- Wound Trauma Medical Center, State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, People’s Republic of China
| | - Zhengguo Wang
- Wound Trauma Medical Center, State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, People’s Republic of China
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Badawy A, Bessa SS. Massive ventral hernia with small bowel obstruction in a cirrhotic patient. ANZ J Surg 2021; 91:E714-E716. [PMID: 33734537 DOI: 10.1111/ans.16755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/07/2021] [Accepted: 03/09/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Amr Badawy
- General Surgery Department, Alexandria University, Alexandria, Egypt
| | - Samer Saad Bessa
- General Surgery Department, Alexandria University, Alexandria, Egypt
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Quintela C, Freire L, Marrana F, Barbosa E, Guerreiro E, Ferreira F. Quaternary abdominal compartment syndrome in complex ventral hernias. INTERNATIONAL JOURNAL OF ABDOMINAL WALL AND HERNIA SURGERY 2021. [DOI: 10.4103/ijawhs.ijawhs_43_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Song YH, Huang WJ, Xie YY, Hada G, Zhang S, Lu AQ, Wang Y, Lei WZ. Application of double circular suturing technique (DCST) in repair of giant incision hernias. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:764. [PMID: 32647689 PMCID: PMC7333136 DOI: 10.21037/atm-20-4572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Our study aims to explore the feasibility and safety of a double circular suturing technique (DCST) in the repair of giant incision hernias. Methods The clinical data of 221 patients (95 men and 126 women; the average age was 61.6 years) receiving DCST in the repair of giant incision hernia between January 2010 and December 2018 was analyzed retrospectively. One hundred and five primary and 16 recurrent patients underwent herniorrhaphy with anti-adhesion underlay mesh repair using DCST. Results All the 221 operations were performed successfully. The average preparation time before the operation and hospital stays were 3.7 days (range, 1-6 days) and 7.5 days (range, 2-16 days), respectively. The average diameter of the hernia ring defect observed intraoperatively was 16.4 cm (range, 12-22 cm). The average time of operation was 83.6 min (range, 43-195 min). There were 2 cases of intestinal fistula, 4 cases of wound infection, 2 cases of mesh infection, 7 cases of serum tumescence, 3 cases of pulmonary infection, and 2 cases of wound dehiscence occurred. One hundred and ninety-five patients were followed up for 6.7 years (range, 0.8-9.5 years) postoperatively. Of them, 9 patients recurred; 14 patients had chronic pain whose visual analog scale (VAS) was 2-4 cm (average 2.7 cm). Conclusions With limited preparation time before operations, few postoperative complications, and recurrence rate, DCST in the repair of giant incision hernia is safe and possible clinically.
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Affiliation(s)
- Ying-Han Song
- Department of Day Surgery Center, West China Hospital of Sichuan University, Chengdu, China
| | - Wei-Jia Huang
- West China School of Medicine, Sichuan University, West China Hospital of Sichuan University, Chengdu, China
| | - Yan-Yan Xie
- Hernia Center of Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Gonish Hada
- Hernia Center of Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Sen Zhang
- Hernia Center of Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - An-Qing Lu
- Hernia Center of Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Yong Wang
- Hernia Center of Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Wen-Zhang Lei
- Hernia Center of Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu, China
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Candan Y, Akinci M, Eraslan O, Yilmaz KB, Karabacak H, Dural HI, Tatar IG, Kaya IO. The Correlation of Intraabdominal Pressure With Renal Resistive Index. J Surg Res 2020; 252:240-246. [PMID: 32304930 DOI: 10.1016/j.jss.2020.03.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/01/2020] [Accepted: 03/09/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND To evaluate the correlation between intraabdominal pressure (IAP) measured via the bladder and renal resistive index (RRI) measured by Doppler ultrasonography (USG). METHODS Eighty consecutive surgical patients were included into this study. Before Doppler USG evaluation, IAP was measured by a Foley catheter via the bladder. The left and right RRI, the diameters of the inferior vena cava and portal vein were measured by colored Doppler USG. Spearman correlation analysis was used to evaluate the correlation between different measurements. Intraabdominal hypertension (IAH) was defined as of IAP ≥ 12 mmHg. Significantly different variables from the univariate analysis between patients with and without IAH were entered into backward stepwise binary logistic regression analysis of IAH as the dependent variable. P values < 0.05 were accepted as statistically significant. RESULTS In total, 80 patients were included into study. In 27 patients (34%) IAP was normal and in 53 patients (66%) IAH was diagnosed. The Spearman correlation analysis of IAP and the ultrasonographic measurements revealed a strong correlation between RRI and IAP (P < 0.001). Patients with IAH were more likely to be diabetic and had abdominal incisional hernia compared with patients with normal IAP (P < 0.05). The results of the multivariate logistic regression analysis revealed right RRI as the only independent predictor of IAH (B: 57.04, S. E.: 13.7, P < 0.001). CONCLUSIONS There is a strong correlation between IAP and RRI. RRI can be an alternative, noninvasive technique for the diagnosis and follow-up of IAH after further evaluations in different patient groups.
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Affiliation(s)
- Yeliz Candan
- Department of Surgery, University of Health Sciences, Ankara Diskapi Teaching and Research Hospital, Ankara, Turkey
| | - Melih Akinci
- Department of Surgery, University of Health Sciences, Gulhane Teaching and Research Hospital, Ankara, Turkey.
| | - Onder Eraslan
- Department of Radiology, Tokat Erbaa Ministry of Health State Hospital, Tokat, Turkey
| | - Kerim Bora Yilmaz
- Department of Surgery, University of Health Sciences, Gulhane Teaching and Research Hospital, Ankara, Turkey
| | - Harun Karabacak
- Department of Surgery, University of Health Sciences, Ankara Diskapi Teaching and Research Hospital, Ankara, Turkey
| | - Halil Ibrahim Dural
- Department of Surgery, University of Health Sciences, Ankara Diskapi Teaching and Research Hospital, Ankara, Turkey
| | - Idil Gunes Tatar
- Department of Radiology, University of Health Sciences, Ankara Diskapi Teaching and Research Hospital, Ankara, Turkey
| | - Ismail Oskay Kaya
- Department of Surgery, University of Health Sciences, Ankara Diskapi Teaching and Research Hospital, Ankara, Turkey
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Schlosser KA, Maloney SR, Prasad T, Colavita PD, Augenstein VA, Heniford BT. Too big to breathe: predictors of respiratory failure and insufficiency after open ventral hernia repair. Surg Endosc 2019; 34:4131-4139. [PMID: 31637601 DOI: 10.1007/s00464-019-07181-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 09/30/2019] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Increased intra-abdominal pressure in open ventral hernia repair (OVHR) is hypothesized to contribute to postoperative respiratory insufficiency (RI) or failure (RF). This study examines the impact of abdominal volumes on postoperative RI in OVHR. METHODS OVHR patients with preoperative CT scans were identified. 3D volumetric software measured hernia volume (HV), subcutaneous volume (SQV), and intra-abdominal volume (IAV). The ratio of hernia to intra-abdominal volume (HV:IAV) was calculated. A principal component analysis was performed to create new component variables for collinear volume and hernia variables. RESULTS There were 1178 OVHR patients with preoperative CT scans. Demographics included a mean BMI of 34.2 ± 7.7 kg/m2, age of 58.5 ± 12.4 years, and 57.8% were female. RI occurred in 8.3% of patients, including 4.0% requiring > 24 h respiratory support with ezPAP, CPAP, or biPAP (RI), and 4.3% requiring intubation (RF). Patients who developed RI had a higher BMI (33.8 ± 7.5 vs. 38.2 ± 9.1 kg/m2, p < 0.0001), older age (58.1 ± 12.5 vs. 62.8 ± 10.4 years, p = 0.0001), larger defects (140.9 ± 128.4 vs. 254.0 ± 173.9 cm2, p < 0.0001), HV (865.8 ± 1200.0 vs. 2005.6 ± 1791.7 cm3, p < 0.0001), and HV:IAV (0.26 ± 0.45 vs. 0.53 ± 0.58, p < 0.0001). Three PC variables accounted for 85% of variance: hernia volume PC consists primarily of HV (61.8%), ratio HV:IAV (57.7%), and defect size (50.1%) and accounts for 38.3% variance. Extra-abdominal volume PC consists primarily of SQV (63.7%) and BMI (60.8%) and accounts for 32.5% variance. Intra-abdominal volume PC is primarily IAV (75.8%) and accounts for 14.9% variance. In multivariate analysis, predictors of RI included asthma and COPD (OR 4.04, CI 1.82-8.96), hernia PC (OR 1.47, CI 1.48-1.98), EAV PC (OR 1.24, CI 1.04-1.48), increased age (OR 1.04, CI 1.01-1.06), and diabetes (OR 1.8, CI 1.11-2.91). Component separation, fascial closure, contamination, and panniculectomy were not associated with RI. CONCLUSION The impact of defect size, BMI, HV, SQV, IAV, and HV:IAV on respiratory insufficiency after OVHR is collinear. Patients with large defects and a large ratio of HV:IAV (greater than 0.5) are also at significantly increased risk of RI after OVHR. While BMI impacts these parameters, it is not directly predictive of postoperative RI.
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Affiliation(s)
- Kathryn A Schlosser
- Department of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, 28204, USA
| | - Sean R Maloney
- Department of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, 28204, USA
| | - Tanushree Prasad
- Department of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, 28204, USA
| | - Paul D Colavita
- Department of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, 28204, USA
| | - Vedra A Augenstein
- Department of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, 28204, USA
| | - B Todd Heniford
- Department of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, 28204, USA. .,Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC, 28204, USA.
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Köhler G. Präoperative Konditionierung und operative Strategien zur Therapie komplexer Bauchwandhernien. Chirurg 2019; 91:134-142. [DOI: 10.1007/s00104-019-01027-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Abstract
Large ventral hernias are a significant surgical challenge. "Loss of domain" (LOD) expresses the relationship between hernia and abdominal volume, and is used to predict operative difficulty and success. This systematic review assessed whether different definitions of LOD are used in the literature. The PubMed database was searched for articles reporting large hernia repairs that explicitly described LOD. Two reviewers screened citations and extracted data from selected articles, focusing on the definitions used for LOD, study demographics, study design, and reporting surgical specialty. One hundred and seven articles were identified, 93 full-texts examined, and 77 were included in the systematic review. Sixty-seven articles were from the primary literature, and 10 articles were from the secondary literature. Twenty-eight articles (36%) gave a written definition for loss of domain. These varied and divided into six broad groupings; four described the loss of the right of domain, six described abdominal strap muscle contraction, five described the "second abdomen", five describing large irreducible hernias. Six gave miscellaneous definitions. Two articles gave multiple definitions. Twenty articles (26%) gave volumetric definitions; eight used the Tanaka method [hernia sac volume (HSV)/abdominal cavity volume] and five used the Sabbagh method [(HSV)/total peritoneal volume]. The definitions used for loss of domain were not dependent on the reporting specialty. Our systematic review revealed that multiple definitions of loss of domain are being used. These vary and are not interchangeable. Expert consensus on this matter is necessary to standardise this important concept for hernia surgeons.
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Reconstruction of the Abdominal Wall after Oncologic Resection: Defect Classification and Management Strategies. Plast Reconstr Surg 2019; 142:187S-196S. [PMID: 30138289 DOI: 10.1097/prs.0000000000004877] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Compared with conventional ventral hernia repair, there are several additional considerations germane to the oncologic abdominal wall reconstruction, including the management of radiation soft-tissue injury, the management of bacterial contamination, and the location and extent of the defect. Herein, we review some of the unique challenges associated with oncologic abdominal wall reconstruction and introduce a new classification schema to assist the reconstructive surgeon in performing these complex cases.
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Sanford Z, Weltz AS, Singh D, Hanley R, Todd D, Belyansky I. Minimally Invasive Multidisciplinary Approach to Chronic Giant Inguinoscrotal Hernias. Surg Innov 2019; 26:427-431. [PMID: 30734667 DOI: 10.1177/1553350619828888] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Giant inguinoscrotal hernias (GIH) are defined as groin hernias extending below the mid-thigh when standing, often significantly encumbering activities of daily living. To date, there are no reports utilizing the combination of progressive pneumoperitoneum (PPP), botulinum toxin A injection (BTI), and enhanced view-totally extraperitoneal (eTEP) technique for GIH repair. In this report, we present 2 such cases of this unique minimally invasive multidisciplinary approach to address GIH. Series Presentation. Two individuals with lifelong complaints of GIH presented for elective hernia repair, each with significant morbidity relating to their pathology and profound loss of abdominal domain. Four weeks prior to surgery, BTI was administered to the lateral abdominal compartment muscles to facilitate regional paralysis, followed by PPP to develop larger intraabdominal domain. Utilizing the eTEP access technique and transversus abdominis release, a wide retromuscular dissection was performed to aid in the increase of intraabdominal domain and to develop a large space for mesh placement. Reconstruction including partial scrotectomy and scrotoplasty using adjacent tissue transfer technique was completed. Both patients tolerated the procedures well without recurrence in the first postoperative year. Conclusion. In this article, we present the first series of GIH patients undergoing combined PPP, BTI, and eTEP access approach to retromuscular dissection. This multidisciplinary approach to patient care has proven both safe and effective.
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Affiliation(s)
| | - Adam S Weltz
- 1 Anne Arundel Medical Center, Annapolis, MD, USA
| | | | | | - David Todd
- 1 Anne Arundel Medical Center, Annapolis, MD, USA
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Comment on: preoperative progressive pneumoperitoneum in obese patients with loss of domain hernias. Surg Obes Relat Dis 2017; 14:142-143. [PMID: 29198752 DOI: 10.1016/j.soard.2017.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 11/03/2017] [Accepted: 11/03/2017] [Indexed: 11/22/2022]
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Intraabdominal Hypertension, Abdominal Compartment Syndrome, and the Open Abdomen. Chest 2017; 153:238-250. [PMID: 28780148 DOI: 10.1016/j.chest.2017.07.023] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 06/27/2017] [Accepted: 07/18/2017] [Indexed: 12/11/2022] Open
Abstract
Abdominal compartment syndrome (ACS) is the end point of a process whereby massive interstitial swelling in the abdomen or rapid development of a space-filling lesion in the abdomen (such as ascites or a hematoma) leads to pathologically increased pressure. This results in so-called intraabdominal hypertension (IAH), causing decreased perfusion of the kidneys and abdominal viscera and possible difficulties with ventilation and maintenance of cardiac output. These effects contribute to a cascade of ischemia and multiple organ dysfunction with high mortality. A few primary disease processes traditionally requiring large-volume crystalloid resuscitation account for most cases of IAH and ACS. Once IAH is recognized, nonsurgical steps to decrease intraabdominal pressure (IAP) can be undertaken (diuresis/dialysis, evacuation of intraluminal bowel contents, and sedation), although the clinical benefit of such therapies remains largely conjectural. Surgical decompression with midline laparotomy is the standard ultimate treatment once ACS with organ dysfunction is established. There is minimal primary literature on the pathophysiological underpinnings of IAH and ACS and few prospective randomized trials evaluating their treatment or prevention; this concise review therefore provides only brief summaries of these topics. Many modern studies nominally dealing with IAH or ACS are simply epidemiologic surveys on their incidence, so this paper summarizes the incidence of IAH and ACS in a variety of disease states. Especially emphasized is the fact that modern critical care paradigms emphasize rational limitations to fluid resuscitation, which may have contributed to an apparent decrease in ACS among critically ill patients.
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Complex hernias with loss of domain in morbidly obese patients: role of laparoscopic sleeve gastrectomy in a multi-step approach. Surg Obes Relat Dis 2017; 13:768-773. [DOI: 10.1016/j.soard.2017.01.035] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 01/01/2017] [Accepted: 01/20/2017] [Indexed: 11/17/2022]
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