1
|
Marte G, Tufo A, Ferronetti A, Di Maio V, Russo R, Sordelli IF, De Stefano G, Maida P. Posterior component separation with TAR: lessons learned from our first consecutive 52 cases. Updates Surg 2022; 75:723-733. [PMID: 36355329 DOI: 10.1007/s13304-022-01418-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 11/01/2022] [Indexed: 11/12/2022]
Abstract
Patients with complex incisional hernia (IH) is a growing and challenging category that surgeons are facing in daily practice and represent indeed a technical challenge for most of them. The posterior component separation with TAR (PCS-TAR) has become the procedure of choice to repair most complex abdominal wall defects, including those with loss of domain, subxiphoid, subcostal, parastomal or after trauma and sepsis treated initially with "open abdomen" and in those scenarios in which the fascia closure was not performed to avoid an abdominal compartment syndrome. Most recent studies showed that the PCS-TAR represents a valid procedure in recurrent IH. The purpose of our study is to evaluate the reproducibility of the PCS-TAR, describing our experience, our surgical technique and the rate of postoperative complications and recurrences in a cohort of consecutive patients. 52 consecutive patients with complex IH, who underwent PCS-TAR at "Betania Hospital and Ospedale del Mare Hospital" in Naples between May 2014 and November 2019 were identified from a prospectively maintained database and reviewed retrospectively. There were 36 males (69%) and 16 females (31%) with a mean age of 57.88 (range 39-76) and Body mass index (BMI kg/m2) of 31.2 (24-45). More than half of patients (58%) were active smokers. Mean defect width was 13.6 cm (range 6-30) and mean defect area was about 267.9 cm2. Mean operative time was 228 min. Posterior fascial closure was reached in all cases, while anterior fascial closure only in 29 cases (56%). Mean hospital stay was 5.7 days. 27% of patients developed minor complications (Clavien-Dindo grade I-II) and one case (1.9%) major complication (Clavien-Dindo III). Seroma was registered in 23% of cases. SSI was reported to be 3.8% with no deep wound infection. Recurrence rate was 1.9% in a mean follow-up of 28 months. In Univariate analysis Bio-A surface > 600 cm2 and drain removal at discharge were significantly associated with major complications, while in a multivariate analysis only Bio-A surface > 600 cm2 was related. Considering univariate analysis for recurrences, number of drains, SSO, Clavien-Dindo score > 2 and defect area were significantly associated with recurrence, while in a multivariate analysis no variables were related. PCS-TAR is an indispensable tool in managing complex ventral hernias associated with a low rate of SSO and recurrence. Tobacco use, obesity and comorbidities cannot be considered absolute contraindications to PCS-TAR. Peri and postoperative management of complications and drainages have an impact on short term outcomes. Based on these outcomes, posterior component separation with transversus abdominis release has become our method of choice for the management of patients with complex ventral hernia requiring open hernia repair in selected patients.
Collapse
|
2
|
Chaves CER, Girón F, Conde D, Rodriguez L, Venegas D, Vanegas M, Pardo M, Núñez-Rocha RE, Vargas F, Navarro J, Ricaurte A. Transversus abdominis release (TAR) procedure: a retrospective analysis of an abdominal wall reconstruction group. Sci Rep 2022; 12:18325. [PMID: 36316384 PMCID: PMC9622848 DOI: 10.1038/s41598-022-22062-x] [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: 02/11/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022] Open
Abstract
Complex abdominal wall defects are important conditions with high morbidity, leading to impairment of patients' physical condition and quality of life. In the last decade, the abdominal wall reconstruction paradigm has changed due to the formation of experienced and excellence groups, improving clinical outcomes after surgery. Therefore, our study shows the perspective and outcomes of an abdominal wall reconstruction group (AWRG) in Colombia, focused on the transverse abdominis release (TAR) procedure. A retrospective review of a prospectively collected database was conducted. All the patients older than 18 years old that underwent TAR procedures between January 2014-December 2020 were included. Analysis and description of postoperative outcomes (recurrence, surgical site infection (SSI), seroma, hematoma, and re-intervention) were performed. 47 patients underwent TAR procedure. 62% of patients were male. Mean age was 55 ± 13.4 years. Mean BMI was 27.8 ± 4.5 kg/m2. Abdominal wall defects were classified with EHS ventral Hernia classification having a W3 hernia in 72% of all defects (Mean gap size of 11.49 cm ± 4.03 cm). Mean CeDAR preoperative risk score was 20.5% ± 14.5%. Preoperative use of BOTOX Therapy (OR 1.0 P 0.00 95% CI 0.3-1.1) or pneumoperitoneum (OR 0.7 P 0.04 95% CI 0.3-0.89) are slightly associated with postoperative hematoma. In terms of hernia relapse, we have 12% of cases; all of them over a year after the surgery. TAR procedure for complex abdominal wall defects under specific clinical conditions including emergency scenarios is viable. Specialized and experienced groups show better postoperative outcomes; further studies are needed to confirm our results.
Collapse
Affiliation(s)
- Carlos Eduardo Rey Chaves
- grid.41312.350000 0001 1033 6040School of Medicine, Pontificia Universidad Javeriana, Calle 6A #51a - 48, 111711 Bogotá D.C., Colombia
| | - Felipe Girón
- grid.412191.e0000 0001 2205 5940School of Medicine, Universidad del Rosario, Bogotá, Colombia ,grid.7247.60000000419370714School of Medicine, Universidad de los Andes, Bogotá, Colombia
| | - Danny Conde
- Department of Surgery, Hospital Universitario Méderi, Bogotá, Colombia ,grid.412191.e0000 0001 2205 5940School of Medicine, Universidad del Rosario, Bogotá, Colombia
| | - Lina Rodriguez
- grid.7247.60000000419370714School of Medicine, Universidad de los Andes, Bogotá, Colombia
| | - David Venegas
- grid.412191.e0000 0001 2205 5940School of Medicine, Universidad del Rosario, Bogotá, Colombia
| | - Marco Vanegas
- grid.412191.e0000 0001 2205 5940School of Medicine, Universidad del Rosario, Bogotá, Colombia
| | - Manuel Pardo
- grid.412191.e0000 0001 2205 5940School of Medicine, Universidad del Rosario, Bogotá, Colombia
| | - Ricardo E. Núñez-Rocha
- grid.7247.60000000419370714School of Medicine, Universidad de los Andes, Bogotá, Colombia
| | - Felipe Vargas
- Department of Surgery, Hospital Universitario Méderi, Bogotá, Colombia ,grid.412191.e0000 0001 2205 5940School of Medicine, Universidad del Rosario, Bogotá, Colombia
| | - Jorge Navarro
- grid.41312.350000 0001 1033 6040School of Medicine, Pontificia Universidad Javeriana, Calle 6A #51a - 48, 111711 Bogotá D.C., Colombia ,Department of Surgery, Hospital Universitario Méderi, Bogotá, Colombia
| | - Alberto Ricaurte
- Department of Surgery, Hospital Universitario Méderi, Bogotá, Colombia
| |
Collapse
|
3
|
Component separation and large incisional hernia: predictive factors of recurrence. Hernia 2021; 25:1593-1600. [PMID: 34424440 DOI: 10.1007/s10029-021-02489-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To clarify the factors related to recurrence after component separation technique (CST). MATERIALS AND METHODS A retrospective study was conducted of 381 patients who underwent CST between May 2006 and May 2017 at a tertiary center. All patients had a transverse hernia defect grade W3 in EHS classification. Recurrence rate was determined by clinical examination plus confirmation by abdominal CT scan. RESULTS At a median of 61.6 months of postoperative follow-up, we reported 34 cases of hernia recurrence (8.9%). On multivariate analysis, BMI > 30 (OR 2.20; CI 1.10-3.91, p = 0.031), immunosuppressive drug use (OR 1.06 CI 1.48-2.75, p = 0.003) and development of surgical site infection (OR 2.7; CI 1.53-4.01, p = 0.002) were factors of recurrence after CST. There was no difference in recurrence rate among repairs of primary and recurrent hernias, urgent repair, operative time, type of prosthesis, or concomitant procedures, even planned or unplanned enterotomies. CONCLUSION Obesity (BMI > 30), immunosuppressive drug use, and postoperative wound infections were predictors of recurrence after CST.
Collapse
|
4
|
Harris H, Young C, Lyo V. Fasical defect size predicts recurrence following incisional hernia repair: A 7-year, single-surgeon experience. INTERNATIONAL JOURNAL OF ABDOMINAL WALL AND HERNIA SURGERY 2020. [DOI: 10.4103/ijawhs.ijawhs_50_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
5
|
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.
Collapse
|
6
|
Predictors of hernia recurrence after Rives-Stoppa repair in the treatment of incisional hernias: a retrospective cohort. Surg Endosc 2018; 33:2934-2940. [DOI: 10.1007/s00464-018-6597-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 11/13/2018] [Indexed: 11/25/2022]
|
7
|
Warren JA, McGrath SP, Hale AL, Ewing JA, Carbonell AM, Cobb WS. Patterns of Recurrence and Mechanisms of Failure after Open Ventral Hernia Repair with Mesh. Am Surg 2017. [DOI: 10.1177/000313481708301131] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Recurrence after ventral hernia repair (VHR) remains a significant complication. We sought to identify the technical aspects of VHR associated with recurrence. Patients who underwent open midline VHR between 2006 and 2013 (n = 261) were retrospectively evaluated. Patients with recurrence (Group 1, n = 48) were compared with those without recurrence (Group 2, n = 213). Smoking, diabetes, and body mass index were not different between groups. More patients in Group 1 underwent clean-contaminated, contaminated, or dirty procedures (43.8 vs 27.7%; P = 0.021). Group 1 had a higher incidence of surgical site occurrence (52.1 vs 32.9%; P = 0.020) and surgical site infection (43.8 vs 15.5%; P < 0.001). Recurrences were due to central mesh failure (CMF) (39.6%), midline recurrence after biologic or bioabsorbable mesh repair (18.8%), superior midline (16.7%), lateral (16.7%), and after mesh explantation (12.5%). Most CMF (78.9%) occurred with light-weight polypropylene (LWPP). Recurrence was higher if the midline fascia was unable to be closed. Recurrence with midweight polypropylene (MWPP) was lower than biologic (P < 0.001), bioabsorbable (P = 0.006), and light-weight polypropylene (P = 0.046) mesh. Fixation, component separation technique, and mesh position were not different between groups. Wound complications are associated with subsequent recurrence, whereas midweight polypropylene is associated with a lower overall risk of recurrence and, specifically, CMF.
Collapse
Affiliation(s)
- Jeremy A. Warren
- Department of Surgery, Division of Minimally Invasive Surgery, Greenville Health System, Greenville, South Carolina
| | - Sean P. McGrath
- Department of Surgery, Division of Minimally Invasive Surgery, Greenville Health System, Greenville, South Carolina
| | - Allyson L. Hale
- Department of Surgery, Division of Minimally Invasive Surgery, Greenville Health System, Greenville, South Carolina
| | - Joseph A. Ewing
- Department of Surgery, Division of Minimally Invasive Surgery, Greenville Health System, Greenville, South Carolina
| | - Alfredo M. Carbonell
- Department of Surgery, Division of Minimally Invasive Surgery, Greenville Health System, Greenville, South Carolina
| | - William S. Cobb
- Department of Surgery, Division of Minimally Invasive Surgery, Greenville Health System, Greenville, South Carolina
| |
Collapse
|
8
|
|
9
|
Jensen KK, Brondum TL, Harling H, Kehlet H, Jorgensen LN. Enhanced recovery after giant ventral hernia repair. Hernia 2016; 20:249-56. [PMID: 26910800 DOI: 10.1007/s10029-016-1471-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 02/05/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Giant ventral hernia repair is associated with a high risk of postoperative morbidity and prolonged length of stay (LOS). Enhanced recovery (ERAS) measures have proved to lead to decreased morbidity and LOS after various surgical procedures, but never after giant hernia repair. The current study prospectively examined the results of implementation of an ERAS pathway including high-dose preoperative glucocorticoid, and compared the outcome with patients previously treated according to standard care (SC). METHODS Consecutive patients who underwent giant ventral hernia repair were included. Pain, nausea and fatigue were registered prospectively in all patients treated according to ERAS, as well as continuous measurement of transcutaneous capillary oxygen saturation. Postoperative morbidity and LOS were compared between patients treated according to ERAS and a historic group treated with SC. RESULTS A total of 32 patients were included. Postoperative LOS was decreased after the introduction of the ERAS pathway compared with SC (median 3.0 vs. 5.5 days, P = 0.003). Scores of pain, nausea and fatigue were low, while mean oxygen saturation during the first three postoperative days was 0.92. There were no differences when comparing readmission (5 vs. 2, P = 0.394), postoperative complications (7 vs. 4, P = 0. 458), or reoperation (5 vs. 1, P = 0.172) in ERAS versus controls. CONCLUSIONS The current study suggests that an ERAS pathway including preoperative high-dose glucocorticoid may lead to low scores of pain, fatigue and nausea after giant ventral hernia repair with reduced LOS compared with patients treated according to SC.
Collapse
Affiliation(s)
- K K Jensen
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark.
| | - T L Brondum
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark
| | - H Harling
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark
| | - H Kehlet
- Section of Surgical Pathophysiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - L N Jorgensen
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark
| |
Collapse
|