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Calcerrada Alises E, Antón Rodríguez C, Medina Pedrique M, Berrevoet F, Cuccurullo D, López Cano M, Stabilini C, Garcia-Urena MA. Systematic review and meta-analysis of the incidence of incisional hernia in urological surgery. Langenbecks Arch Surg 2024; 409:166. [PMID: 38805110 DOI: 10.1007/s00423-024-03354-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE To evaluate the incidence of incisional hernia in patients undergoing direct access to the abdominal cavity in urological surgery. METHODS We conducted a systematic review in Pubmed, Embase, and Cochrane Central from 1980 to the present according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Eighty-four studies were selected for inclusion in this analysis, and meta-analysis and meta-regression were performed. RESULTS The total incidence in the 84 studies was 4.8% (95% CI 3.7% - 6.2%) I2 93.84%. Depending on the type of incision, it was higher in the open medial approach: 7.1% (95% CI 4.3%-11.8%) I2 92.45% and lower in laparoscopic surgery: 1.9% (95% CI 1%-3.4%) I2 71, 85% According to access, it was lower in retroperitoneal: 0.9% (95% CI 0.2%-4.8%) I2 76.96% and off-midline: 4.7% (95% CI 3.5%-6.4%) I2 91.59%. Regarding the location of the hernia, parastomal hernias were more frequent: 15.1% (95% CI 9.6% - 23%) I2 77.39%. Meta-regression shows a significant effect in reducing the proportion of hernias in open lateral, laparoscopic and hand-assisted compared to medial open access. CONCLUSION The present review finds the access through the midline and stomas as the ones with the highest incidence of incisional hernia. The use of the lateral approach or minimally invasive techniques is preferable. More prospective studies are warranted to obtain the real incidence of incisional hernias and evaluate the role of better techniques to close the abdomen.
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Affiliation(s)
- Enrique Calcerrada Alises
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario del Sureste, Madrid, Spain.
- Grupo de Investigación de Pared Abdominal Compleja, Universidad Francisco de Vitoria, Madrid, Spain.
| | - Cristina Antón Rodríguez
- Grupo de Investigación de Pared Abdominal Compleja, Universidad Francisco de Vitoria, Madrid, Spain
| | - Manuel Medina Pedrique
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario del Henares, Madrid, Spain
| | - Frederick Berrevoet
- Department of General and Hepatobiliary Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Diego Cuccurullo
- Department of Surgery, Ospedale Monaldi-Azienda Ospedaliera Dei Colli, Naples, Italy
| | - Manuel López Cano
- Abdominal Wall Surgery Unit, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
- Vall d'Hebron Research Institute General and Gastrointestinal Surgery Research Group, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Cesare Stabilini
- Department of Surgery (DiSC), University of Genoa, IRCCS Policlinico San Martino, Genoa, Italy
| | - Miguel Angel Garcia-Urena
- Grupo de Investigación de Pared Abdominal Compleja, Universidad Francisco de Vitoria, Madrid, Spain
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario del Henares, Madrid, Spain
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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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Omar I, Townsend A, Hadfield O, Zaimis T, Ismaiel M, Wilson J, Magee C. Outcomes of elective and emergency surgical repair of incisional hernia: a comparative observational study. Hernia 2024:10.1007/s10029-024-02975-4. [PMID: 38446277 DOI: 10.1007/s10029-024-02975-4] [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: 10/12/2023] [Accepted: 01/25/2024] [Indexed: 03/07/2024]
Abstract
PURPOSE Incisional hernia (IH) is a common complication following abdominal surgery. Surgical repair of IH is associated with the alleviation of symptoms and improvement of quality of life. Operative intervention can pose a significant burden to the patient and healthcare facilities. This study aims to describe and compare outcomes of elective and emergency surgical repair of IH. METHODS This study is a single-centre comparative retrospective study including patients who had repair of IH. Patients were divided into Group I (Emergency) and Group II (Elective), and a comparison was conducted between them. RESULTS Two hundred sixty-two patients were identified with a mean age of 61.8 ± 14.2 years, of which 152 (58%) were females. The mean BMI was 31.6 ± 7.2 kg/m2. More than 58% had at least one comorbidity. 169 (64.5%) patients had an elective repair, and 93 (35.5%) had an emergency repair. Patients undergoing emergency repair were significantly older and had higher BMI, p = 0.031 and p = 0.002, respectively. The significant complication rate (Clavien-Dindo III and IV) was 9.54%. 30 and 90-day mortality rates were 2.3% (n = 6) and 2.68% (n = 7), respectively. In the emergency group, the overall complications, 30-day and 90-day mortality rates were significantly higher than in the elective group, p ≤ 0.001, 0.002 and 0.001, respectively. Overall, 42 (16.1%) developed wound complications, 25 (9.6%) experienced a recurrence, and 41 (15.71%) were readmitted within 90 days, without significant differences between the two groups. CONCLUSION Patients who underwent emergency repair were significantly older and had a higher BMI than the elective cases. Emergency IH repair is associated with higher complication rates and mortality than elective repair.
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Affiliation(s)
- I Omar
- Department of General Surgery, The Hillingdon Hospitals NHS Foundation Trust, Pield Heath Road, Uxbridge Middlesex, UB8 3NN, UK.
| | - A Townsend
- Department of General Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | - O Hadfield
- Department of General Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | - T Zaimis
- Department of General Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | - M Ismaiel
- Department of General Surgery, Altnagelvin Area Hospital, Londonderry, UK
| | - J Wilson
- Department of General Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | - C Magee
- Department of General Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
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Omar I, Anany A, Ismaiel M, Townsend A, Wilson J, Magee C. Outcomes of Surgical Repair of Incisional Hernia in Patients With Severe and Morbid Obesity: A Comparative Study. Cureus 2024; 16:e55782. [PMID: 38586736 PMCID: PMC10999117 DOI: 10.7759/cureus.55782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction Incisional hernia (IH) is a common complication after open and minimal access abdominal surgery. The current practice guidelines recommend weight reduction to achieve a body mass index (BMI) < 35 kg/m2 before surgical repair of ventral hernias. However, this could be challenging to achieve, especially in emergency presentations. This study aims to assess the safety of surgical repair of IH in patients with BMI ≥35 kg/m2. Methods A retrospective comparative study has been conducted to include all patients who had surgical repair of IH on an elective and emergency basis in a UK District General Hospital. The patients were divided into two groups. Group I BMI < 35 kg/m2 and Group II with BMI ≥35 kg/m2. A comparison was made between the two groups according to demographics, comorbidities, hernia characteristics, operative data, and outcomes. Results The study included 239 patients, 181 in Group I and 58 in Group II. Morbid obesity was associated with male patients, and they were younger than Group I, p= 0.001 and 0.013, respectively. 13.8% of Group I had DM compared to 29.3% in Group II, p= 0.007. There were no significant differences in hernia characteristics or mode of surgery between the two groups. However, Group II had more overall and wound-related complications, p= <0.001 each. There were no significant differences in 30-day and 90-day mortality, recurrence rate, or 90-day readmissions. Conclusions Surgical repair of IH in patients with severe and morbid obesity is associated with more overall and wound-related complications.
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Affiliation(s)
- Islam Omar
- Department of General Surgery, The Hillingdon Hospitals National Health Service (NHS) Foundation Trust, Uxbridge, GBR
| | - Amr Anany
- Department of General Surgery, Charing Cross Hospital, Imperial College National Health Service (NHS) Trust, London, GBR
| | - Mohamed Ismaiel
- Department of General Surgery, Altnagelvin Hospital, Londonderry, GBR
| | - Abby Townsend
- Department of General Surgery, Wirral University Teaching Hospital National Health Service (NHS) Foundation Trust, Wirral, GBR
| | - Jeremy Wilson
- Department of General Surgery, Wirral University Teaching Hospital National Health Service (NHS) Foundation Trust, Wirral, GBR
| | - Conor Magee
- Department of General Surgery, Wirral University Teaching Hospital National Health Service (NHS) Foundation Trust, Wirral, GBR
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Wang X, Liu C, Li X, Shen T, Lian J, Shi J, Jiang Z, Qiu G, Wang Y, Meng E, Wei G. A novel electrospun polylactic acid silkworm fibroin mesh for abdominal wall hernia repair. Mater Today Bio 2024; 24:100915. [PMID: 38188648 PMCID: PMC10767193 DOI: 10.1016/j.mtbio.2023.100915] [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: 07/17/2023] [Revised: 12/05/2023] [Accepted: 12/12/2023] [Indexed: 01/09/2024] Open
Abstract
Objective Abdominal wall hernias are common abdominal diseases, and effective hernia repair is challenging. In clinical practice, synthetic meshes are widely applied for repairing abdominal wall hernias. However, postoperative complications, such as inflammation and adhesion, are prevalent. Although biological meshes can solve this problem to a certain extent, they face the problems of heterogeneity, rapid degradation rate, ordinary mechanical properties, and high-cost. Here, a novel electrospinning mesh composed of polylactic acid and silk fibroin (PLA-SF) for repairing abdominal wall hernias was manufactured with good physical properties, biocompatibility and low production cost. Materials and methods FTIR and EDS were used to demonstrate that the PLA-SF mesh was successfully synthesized. The physicochemical properties of PLA-SF were detected by swelling experiments and in vitro degradation experiments. The water contact angle reflected the hydrophilicity, and the stress‒strain curve reflected the mechanical properties. A rat abdominal wall hernia model was established to observe degradation, adhesion, and inflammation in vivo. In vitro cell mesh culture experiments were used to detect cytocompatibility and search for affected biochemical pathways. Results The PLA-SF mesh was successfully synthesized and did not swell or degrade over time in vitro. It had a high hydrophilicity and strength. The PLA-SF mesh significantly reduced abdominal inflammation and inhibited adhesion formation in rat models. The in vitro degradation rate of the PLA-SF mesh was slower than that of tissue remodeling. Coculture experiments suggested that the PLA-SF mesh reduced the expression of inflammatory factors secreted by fibroblasts and promoted fibroblast proliferation through the TGF-β1/Smad pathway. Conclusion The PLA-SF mesh had excellent physicochemical properties and biocompatibility, promoted hernia repair of the rat abdominal wall, and reduced postoperative inflammation and adhesion. It is a promising mesh and has potential for clinical application.
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Affiliation(s)
- Xingjie Wang
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Changjun Liu
- School of Life and Health Sciences, Hunan University of Science and Technology, Xiangtan, 411201, Hunan, China
| | - Xuqi Li
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Tianli Shen
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Jie Lian
- Department of Pathology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Jing Shi
- Department of Respiratory and Endocrinology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi, China
| | - Zhengdong Jiang
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Guanglin Qiu
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Yuanbo Wang
- Department of Nuclear Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Er Meng
- School of Life and Health Sciences, Hunan University of Science and Technology, Xiangtan, 411201, Hunan, China
| | - Guangbing Wei
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
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Omar I, Zaimis T, Townsend A, Ismaiel M, Wilson J, Magee C. Incisional Hernia: A Surgical Complication or Medical Disease? Cureus 2023; 15:e50568. [PMID: 38222215 PMCID: PMC10788045 DOI: 10.7759/cureus.50568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 01/16/2024] Open
Abstract
Incisional hernia (IH) is a frequent complication following abdominal surgery. The development of IH could be more sophisticated than a simple anatomical failure of the abdominal wall. Reported IH incidence varies among studies. This review presented an overview of definitions, molecular basis, risk factors, incidence, clinical presentation, surgical techniques, postoperative care, cost, risk prediction tools, and proposed preventative measures. A literature search of PubMed was conducted to include high-quality studies on IH. The incidence of IH depends on the primary surgical pathology, incision site and extent, associated medical comorbidities, and risk factors. The review highlighted inherent and modifiable risk factors. The disorganisation of the extracellular matrix, defective fibroblast functions, and ratio variations of different collagen types are implicated in molecular mechanisms. Elective repair of IH alleviates symptoms, prevents complications, and improves the quality of life (QOL). Recent studies introduced risk prediction tools to implement preventative measures, including suture line reinforcement or prophylactic mesh application in high-risk groups. Elective repair improves QOL and prevents sinister outcomes associated with emergency IH repair. The watchful wait strategy should be reviewed, and options should be discussed thoroughly during patients' counselling. Risk stratification tools for predicting IH would help adopt prophylactic measures.
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Affiliation(s)
- Islam Omar
- General Surgery, The Hillingdon Hospitals NHS Foundation Trust, Uxbridge, GBR
| | - Tilemachos Zaimis
- General Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, GBR
| | - Abby Townsend
- General Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, GBR
| | - Mohamed Ismaiel
- General Surgery, Altnagelvin Area Hospital, Londonderry, GBR
| | - Jeremy Wilson
- General Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, GBR
| | - Conor Magee
- General Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, GBR
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García Moriana AJ, Sánchez Arteaga A, Gil Delgado JL, Maroto Sánchez R, Feria Madueño A, Tallón Aguilar L, Padillo Ruiz J, Sañudo B. Evaluation of rectus abdominis muscle strength and width of hernia defect in patients undergoing incisional hernia surgery. Hernia 2023:10.1007/s10029-023-02834-8. [PMID: 37442870 DOI: 10.1007/s10029-023-02834-8] [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: 04/15/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND The aim of this study was to analyze the strength status of the rectus abdominis muscle in patients with incisional hernia and the relationship between the width of the hernia defect and the strength of the rectus abdominis muscle. METHODS This is a observational cohort study of patients with medial line incisional hernia (July-October 2022), classified as W2 according to the European Hernia Society (EHS). The data collected were demographic and clinical characteristics related to hernia, and measure of the rectus abdominis muscle strength using an isokinetic dynamometer and a strain gauge. We analyzed the relationship between hernia width and rectus abdominis muscle strength with correlation tests to adjustment by age, sex, BMI, and body composition. RESULTS A total of 40 patients (64% female) with a mean age of 57.62 years (SD 11) were enrolled in the study. The mean BMI was 29.18 (SD 5.06), with a mean percentage of fat mass of 37.8% (SD 8.47) and a mean percentage of muscle mass of 60.33% (SD 6.43). The maximum width of the hernia defect was 6.59 cm (SD 1.54). In the male group, the mean bending force moment (ISOK_PT) was 94.01 Nw m (SD 34.58), bending force moment relative to body weight (ISOK_PT_Weight) was 103.32 Nw m (SD 37.48), and peak force (PK_90) was 184.71 N (SD 47.01). In the female group, these values were 58.11 Nw m (SD 29.41), 66.48 Nw m (SD 32.44), and 152.50 N (SD 48.49), respectively. Statistically significant differences were observed in the relationship between the data obtained with the isokinetic dynamometer and sex (p = 0.002), as well as between the data obtained with the isokinetic dynamometer and age (p = 0.006). Patients in the 90th percentile (P90) of rectus abdominis muscle strength also had smaller hernia defect widths (p = 0.048). CONCLUSIONS In this study, age and sex were identified as the most statistically significant predictor variables for rectus abdominis muscle strength. The width of the hernia defect exhibited a trend towards statistical significance.
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Affiliation(s)
- A J García Moriana
- Department of General Surgery, Hospital Universitario Virgen del Rocío, Avda. Manuel Siurot S/N, 41013, Seville, Spain
| | - A Sánchez Arteaga
- Department of General Surgery, Hospital Universitario Virgen del Rocío, Avda. Manuel Siurot S/N, 41013, Seville, Spain.
| | - J L Gil Delgado
- Department of Physical Education and Sports, University of Seville, Seville, Spain
| | - R Maroto Sánchez
- Department of Physical Education and Sports, University of Seville, Seville, Spain
| | - A Feria Madueño
- Department of Physical Education and Sports, University of Seville, Seville, Spain
| | - L Tallón Aguilar
- Department of General Surgery, Hospital Universitario Virgen del Rocío, Avda. Manuel Siurot S/N, 41013, Seville, Spain
- Surgery Department. School of Medicine, University of Seville, Seville, Spain
| | - J Padillo Ruiz
- Department of General Surgery, Hospital Universitario Virgen del Rocío, Avda. Manuel Siurot S/N, 41013, Seville, Spain
- Surgery Department. School of Medicine, University of Seville, Seville, Spain
| | - B Sañudo
- Department of Physical Education and Sports, University of Seville, Seville, Spain
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Zhang K, Lin J, Qin L, Li L, Xia C, Li J. A novel auxiliary fixation technique of meshes in intraperitoneal onlay mesh procedures for incisional hernia repair. Front Surg 2023; 10:1201992. [PMID: 37425348 PMCID: PMC10328337 DOI: 10.3389/fsurg.2023.1201992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 05/15/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction Mesh fixation is an important step in incisional hernia repair. Weak fixation possibly results in postoperative pain, and even hernia recurrence. We innovated an auxiliary fixation approach, the magnet attraction technique (MAT), to achieve better mesh fixation. The purpose of this study was to evaluate the effect of MAT in intraperitoneal onlay mesh (IPOM) procedures for incisional hernia repair. Methods Historical patient records were analyzed according to the clinical data of 16 patients with incisional hernias. Among them, 5 patients have undergone IPOM repair procedures in combination with MAT to assist in mesh fixation. As a control, 11 patients treated with IPOM and mesh fixation via conventional suspension were included. The clinical data collected include patients' basic characteristics, intraoperative and postoperative conditions, and follow-up results in both groups. Results Compared with patients in the control group, patients in the MAT group were found to suffer from a larger hernia ring diameter and longer surgical duration, but shorter hospitalization length on average. And most importantly, no complication has been reported in the MAT group. Conclusion MAT in IPOM operation was regarded as a feasible and safe technique for patients suffering from incisional hernias.
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Affiliation(s)
- Kunjie Zhang
- Department of General Surgery, The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Jiayu Lin
- Department of Obstetrics and Gynaecology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Kong Kong S.A.R., China
- Shenzhen Key Laboratory of Fertility Regulation, Reproductive Medicine Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Lianjin Qin
- Department of Ventral Hernia Surgery, The First People’s Hospital of Huzhou, Huzhou, China
| | - Leqi Li
- Department of General Surgery, Henan Hongli Hospital, Xinxiang, China
| | - Changjun Xia
- Department of General Surgery, The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Jianfang Li
- Department of Hernia and Abdominal Wall Surgery, The First People's Hospital of Xiaoshan District in Hangzhou, Hangzhou, China
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Louis V, Diab S, Villemin A, Brigand C, Manfredelli S, Delhorme JB, Rohr S, Romain B. Do surgical drains reduce surgical site occurrence and infection after incisional hernia repair with sublay mesh? A non-randomised pilot study. Hernia 2023:10.1007/s10029-023-02768-1. [PMID: 36959525 DOI: 10.1007/s10029-023-02768-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 03/05/2023] [Indexed: 03/25/2023]
Abstract
INTRODUCTION Surgical site occurrence (SSO) and surgical site infection (SSI) are common concerns with incisional hernia repair. Intraoperative drain placement is a common practice aiming to reduce SSO and SSI rates. However, literature on the matter is very poor. The aim of this study is to investigate the role of subcutaneous and periprosthetic drain placement on postoperative outcomes and SSO and SSI rates with incisional hernia repair. METHODS A non-randomised pilot study was performed between January 2018 and December 2020 and included patients with elective midline or lateral incisional hernia repair with sublay mesh placement. Patients were prospectively included, followed for 1 month and divided into three groups: group 1 without drainage, group 2 with subcutaneous drainage, and group 3 with subcutaneous and periprosthetic drains. Drains were placed at surgeon's discretion. All patients were included in the enhanced recovery program. RESULTS One hundred and four patients were included. Twenty-four patients (23.1%) did not have drains (group 1), 60 patients (57.7%) had a subcutaneous drain (group 2) and 20 patients (19.2%) had both a subcutaneous and a periprosthetic drains (group 3). SSO rates were significantly different between the 3 groups: 20.8% in group 1, 20.7% in group 2 and 50% in group 3 (p = 0.03). There was no significant difference in deep and superficial SSI rates between the 3 groups. Subgroup analysis revealed that adding a drain in direct contact with the mesh significantly increased SSO rate but did not influence SSI rate. Length of stay was also significantly increased by the presence of a drain, 3.1 ± 1.9 days for group 1; 5.9 ± 4.8 for group 2 and 5.9 ± 2.5 days for group 3 (p < 0.005). CONCLUSION Drain placement in direct contact with the mesh might increase SSO rate. More studies are necessary to evaluate the actual benefits of drainage after incisional hernia repair.
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Affiliation(s)
- V Louis
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 Avenue Molière, 67200, Strasbourg, France
| | - S Diab
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 Avenue Molière, 67200, Strasbourg, France
| | - A Villemin
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 Avenue Molière, 67200, Strasbourg, France
| | - C Brigand
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 Avenue Molière, 67200, Strasbourg, France
- Streinth Lab (Stress Response and Innovative Therapies), Inserm UMR_S 1113 IRFAC (Interface Recherche Fondamental Et Appliquée À La Cancérologie), Strasbourg University, Strasbourg, France
| | - S Manfredelli
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 Avenue Molière, 67200, Strasbourg, France
| | - J-B Delhorme
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 Avenue Molière, 67200, Strasbourg, France
- Streinth Lab (Stress Response and Innovative Therapies), Inserm UMR_S 1113 IRFAC (Interface Recherche Fondamental Et Appliquée À La Cancérologie), Strasbourg University, Strasbourg, France
| | - S Rohr
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 Avenue Molière, 67200, Strasbourg, France
- Streinth Lab (Stress Response and Innovative Therapies), Inserm UMR_S 1113 IRFAC (Interface Recherche Fondamental Et Appliquée À La Cancérologie), Strasbourg University, Strasbourg, France
| | - B Romain
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 Avenue Molière, 67200, Strasbourg, France.
- Streinth Lab (Stress Response and Innovative Therapies), Inserm UMR_S 1113 IRFAC (Interface Recherche Fondamental Et Appliquée À La Cancérologie), Strasbourg University, Strasbourg, France.
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DuBray BJ, Tompson JJ, Shaffer D, Hale DA, Rega SA, Feurer ID, Forbes RC. Incisional Hernia Development after Live Donor Nephrectomy: Impact of Surgical Technique. KIDNEY360 2023; 4:78-82. [PMID: 36700907 PMCID: PMC10101573 DOI: 10.34067/kid.0005262022] [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: 08/09/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Characteristics of incisional hernia (IH) formation after live donor nephrectomy (LDN) are not well-defined. The goal of this study was to describe the incidence of IH within 3 years after LDN and identify risk factors contributing to their formation. METHODS We performed a single-center, retrospective review of all LDN between February 2013 and October 2018. Patients with and without IH were compared based on donor and operative variables. Data were analyzed using chi-square tests with column proportions. Multivariable logistic regression with backward elimination was used to evaluate the likelihood of IH on the basis of potential risk factors. RESULTS Three hundred one individuals underwent live donor nephrectomy. Twenty-eight patients (9.3%) developed an IH, with a median time to development of 7 months (range: 2-24 months). Obesity (body mass index ≥30), periumbilical hand port, and vertical infraumbilical hand port were associated with increased risk of IH development on univariate analysis. On multivariate analysis, obesity and periumbilical hand port location were persistent risk factors for IH. CONCLUSIONS The incidence of IH after LDN is prevalent and associated with obesity and operative technique. Placing the hand port infraumbilical with a transverse fascial incision may reduce the risk of IH after LDN.
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Affiliation(s)
- Bernard J. DuBray
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joshua J. Tompson
- Division of General Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David Shaffer
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Doug A. Hale
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Irene D. Feurer
- Departments of Surgery and Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rachel C. Forbes
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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11
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Wagner V, Levy BE, Castle JT, Plymale M, Roth JS, Totten C. Absorbable mesh in a contaminated field: hernia repair outcomes. Updates Surg 2022:10.1007/s13304-022-01433-z. [DOI: 10.1007/s13304-022-01433-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/17/2022] [Indexed: 12/05/2022]
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12
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Samartsev VA, Parshakov AA, Gavrilov VA, Zhilina IP. SIMULTANEOUS SURGICAL INTERVENTION IN PATIENT WITH INCISIONAL HERNIA W3 AND HIGH OPERATIONAL RISK. A CLINICAL CASE. SURGICAL PRACTICE 2022. [DOI: 10.38181/2223-2427-2022-3-70-77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The paper covers the clinical case of successful simultaneous intervention in a patient with acute calculous cholecystitis, incisional hernia M2-5W3, Obese (Class III) (BMI 42 kg/m2), IV-degree ptosis of the anterior abdominal, pulmonary embolism in the anamnesis with a cava filter installed and high operational risk. After preoperative preparation, a simultaneous surgical intervention (laparoscopic cholecystectomy, transverse abdominoplasty, separation hernioplasty) was performed. The patient was discharged from hospital on the 10th day of the postoperative period. Long-term results were evaluated after 2 months. A cardiovascular, thromboembolic and wound complications was not recorded.
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Affiliation(s)
- V. A. Samartsev
- Perm State Medical University named after academician E. A. Wagner; City Clinical Hospital No. 4
| | - A. A. Parshakov
- Perm State Medical University named after academician E. A. Wagner; City Clinical Hospital No. 4
| | - V. A. Gavrilov
- Perm State Medical University named after academician E. A. Wagner; City Clinical Hospital No. 4
| | - I. P. Zhilina
- Perm State Medical University named after academician E. A. Wagner
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13
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The effect of prophylactic mesh implantation on the development of incisional hernias in patients with elevated BMI: a systematic review and meta-analysis. Hernia 2022; 27:225-234. [PMID: 36103010 PMCID: PMC10126020 DOI: 10.1007/s10029-022-02675-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/30/2022] [Indexed: 11/04/2022]
Abstract
Abstract
Background
Incisional hernia is a common complication after midline laparotomy. In certain risk profiles incidences can reach up to 70%. Large RCTs showed a positive effect of prophylactic mesh reinforcement (PMR) in high-risk populations.
Objectives
The aim was to evaluate the effect of prophylactic mesh reinforcement on incisional hernia reduction in obese patients after midline laparotomies.
Methods
Following the PRISMA guidelines, a systematic literature search in Medline, Web of Science and CENTRAL was conducted. RCTs investigating PMR in patients with a BMI ≥ 27 reporting incisional hernia as primary outcome were included. Study quality was assessed using the Cochrane risk-of-bias tool and certainty of evidence was rated according to the GRADE Working Group grading of evidence. A random-effects model was used for the meta-analysis. Secondary outcomes included postoperative complications.
Results
Out of 2298 articles found by a systematic literature search, five RCTs with 1136 patients were included. There was no significant difference in the incidence of incisional hernia when comparing PMR with primary suture (odds ratio (OR) 0.59, 95% CI 0.34–1.01, p = 0.06, GRADE: low). Meta-analyses of seroma formation (OR 1.62, 95% CI 0.72–3.65; p = 0.24, GRADE: low) and surgical site infections (OR 1.52, 95% CI 0.72–3.22, p = 0.28, GRADE: moderate) showed no significant differences as well as subgroup analyses for BMI ≥ 40 and length of stay.
Conclusions
We did not observe a significant reduction of the incidence of incisional hernia with prophylactic mesh reinforcement used in patients with elevated BMI. These results stand in contrast to the current recommendation for hernia prevention in obese patients.
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14
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Schaaf S, Willms A, Schwab R, Güsgen C. Recommendations on postoperative strain and physical labor after abdominal and hernia surgery: an expert survey of attendants of the 41st EHS Annual International Congress of the European Hernia Society. Hernia 2022; 26:727-734. [PMID: 33629178 PMCID: PMC9200870 DOI: 10.1007/s10029-021-02377-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 01/22/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND There are no valid recommendations or reliable guidelines available to guide patients how long they should refrain from lifting weights or returning to heavy physical labor after abdominal or hernia surgery. Recent studies found that surgeons' recommendations not to be evidence-based and might be too restrictive considering data on fascial healing and incisional hernia development. It is likely that this impairs the patient's quality of life and leads to remarkable socio-economic costs. Hence, we conducted this survey to gather international expert's opinions on this topic. MATERIALS AND METHODS At the 41st Annual International Congress of the EHS, attending international experts were asked to complete a questionnaire concerning recommendations on given proposals for postoperative refrain from heavy work or lifting after abdominal surgery and also after hernia repairs. RESULTS In total, 127 experts took part in the survey. 83.9% were consultants with a mean experience since specialization of more than 11 years. Two weeks of no heavy physical strain after laparoscopic surgery were considered sufficient by more than 50% of the participants. For laparotomy, more than 50% rated 4 weeks appropriate. For mesh-augmented sublay and IPOM repair of ventral or incisional hernias, more than 50% rated 4 weeks of rest appropriate. For complex hernia repair, 37% rated 4 weeks reasonable. Two weeks after, groin hernia surgery was considered sufficient by more than 50% of the participants. CONCLUSION Following groin hernia repair (Lichtenstein/endoscopic technique) and laparoscopic operation, the majority agreed on the proposal of 2 weeks refraining from physical strain. Four weeks of no physical strain were considered appropriate by a majority after laparotomy and open incisional hernia repair. However, the results showed substantial variation in the ratings, which indicates uncertainty even in this selected cohort of hernia surgery experts and emphasizes the need for further scientific evaluation. This is particularly remarkable, because a lack of evidence that early postoperative strain leads to higher incisional hernia rates. TRIAL REGISTRATION Number DRKS00023887.
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Affiliation(s)
- S Schaaf
- Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital Koblenz, Rübenacher Str. 170, 56072, Koblenz, Germany
| | - A Willms
- Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital Koblenz, Rübenacher Str. 170, 56072, Koblenz, Germany.
| | - R Schwab
- Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital Koblenz, Rübenacher Str. 170, 56072, Koblenz, Germany
| | - C Güsgen
- Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital Koblenz, Rübenacher Str. 170, 56072, Koblenz, Germany
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15
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DAĞCI M, ÖZTEKİN D. Yara Bakımında Kullanılan Yara Örtüsü Teknolojileri: Randomize Kontrollü Çalışmaların İncelenmesi. İSTANBUL GELIŞIM ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2022. [DOI: 10.38079/igusabder.996192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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16
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Early preoperative progressive pneumoperitoneum for a symptomatic giant abdominal incisional hernia. Int J Surg Case Rep 2022; 94:107028. [PMID: 35427889 PMCID: PMC9027338 DOI: 10.1016/j.ijscr.2022.107028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/27/2022] [Accepted: 03/31/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction and importance Early preoperative progressive pneumoperitoneum (PPP) is a technique that helps large eventrations with loss of domain to reintroduce protruded organs. However, a standardized technique has not been developed. This technique has been proved in elective patients, but the evidence is scarce in patients with a high risk of incarceration/strangulation. Clinical findings and investigations We present a 61-year-old patient with history of a thoracoabdominal aneurysm repair, developed a massive incisional hernia with loss of domain. At admission, he presented with abdominal pain and inability to reduce the hernia by himself, however it reduced after clinical examination. Aortic syndromes were excluded. Interventions and outcome After a multidisciplinary meeting, early PPP was initially performed. Later he was taken to surgery and admitted in the ICU to prevent abdominal hypertension. Medical complications resolved within 14 days. The patient did not report long-term complications. Relevance and impact PPP is a technique that pursues the prevention of abdominal hypertension syndrome in patients with large hernias with loss of domain electively. For patients with high risk of hernia complications, the evidence is limited regarding the applicability of early PPP. A multidisciplinary team can improve decision making and therefore reduce the risk of long-term complications. We show a case where PPP was performed in an acute painful, reducible hernia with a high risk of incarceration, showing that this approach can be an option for acutely ill patients. Early PPP in acutely herniated patients can be feasible for non-elective surgery. Early PPP can be used to prevent complications like abdominal hypertension. A multidisciplinary approach and experts committee are useful for decision making.
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Shima T, Nitta T, Ishii M, Iida R, Ueda Y, Senpuku S, Matsutani A, Ishibashi T. Laparoscopic cholecystectomy following extended totally extraperitoneal repair of a ventral hernia: A case report. Ann Med Surg (Lond) 2021; 72:103139. [PMID: 34925824 PMCID: PMC8649210 DOI: 10.1016/j.amsu.2021.103139] [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: 11/08/2021] [Revised: 11/23/2021] [Accepted: 11/30/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction and importance Ventral hernial repair extensively requires the use of surgical meshes to cover the abdominal wall. Patients with a history of laparoscopic ventral hernial repair are predisposed to secondary mesh infections. However, strategies to avoid these mesh infections have not yet been reported. Herein, we report the safety of laparoscopic cholecystectomy in a patient with cholecystitis following extended totally extraperitoneal repair of a ventral hernia. Case presentation A 69-year-old man presented with a five-day history of right hypochondrial pain and severe epigastric pain since the previous day. He had undergone ventral hernial repair. With a diagnosis of acute cholecystitis, laparoscopic cholecystectomy was performed. During laparoscopic cholecystectomy, we inserted the first trocar from the right lower quadrant of the abdomen. Subsequently, we completed the surgery without penetrating the mesh by the ports and observing the other ports in the abdominal cavity. The patient recovered without any complications or short-term mesh infections. Clinical discussion When performing abdominal surgery in a patient after ventral hernial repair, the presence of the mesh limits the approachability of the abdominal cavity without mesh penetration. Although it remains unclear whether mesh damage during abdominal surgery causes secondary mesh infection, avoiding any damage to the mesh may be recommended, especially in patients who are highly susceptible to intra-abdominal infection. Conclusion We concluded that if the surgery is completed without damaging the mesh site, mesh infection after abdominal contamination surgery may be avoided. Strategies to avoid mesh infections after surgery have not yet been reported. Surgery without mesh infection following extended totally extraperitoneal repair. Mesh infection after surgery may be avoided by avoiding damage to the mesh.
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Affiliation(s)
- Takafumi Shima
- Department of Surgery, Gastroenterological Center, Shunjukai Shiroyama Hospital, 2-8-1 Habikino, Habikino City, Osaka, 583-0872, Japan
| | - Toshikatsu Nitta
- Department of Surgery, Gastroenterological Center, Shunjukai Shiroyama Hospital, 2-8-1 Habikino, Habikino City, Osaka, 583-0872, Japan
| | - Masatsugu Ishii
- Department of Surgery, Gastroenterological Center, Shunjukai Shiroyama Hospital, 2-8-1 Habikino, Habikino City, Osaka, 583-0872, Japan
| | - Ryo Iida
- Department of Surgery, Gastroenterological Center, Shunjukai Shiroyama Hospital, 2-8-1 Habikino, Habikino City, Osaka, 583-0872, Japan
| | - Yasuhiko Ueda
- Department of Surgery, Gastroenterological Center, Shunjukai Shiroyama Hospital, 2-8-1 Habikino, Habikino City, Osaka, 583-0872, Japan
| | - Sadakatsu Senpuku
- Department of Surgery, Gastroenterological Center, Shunjukai Shiroyama Hospital, 2-8-1 Habikino, Habikino City, Osaka, 583-0872, Japan
| | - Ayumi Matsutani
- Department of Surgery, Gastroenterological Center, Shunjukai Shiroyama Hospital, 2-8-1 Habikino, Habikino City, Osaka, 583-0872, Japan
| | - Takashi Ishibashi
- Department of Surgery, Gastroenterological Center, Shunjukai Shiroyama Hospital, 2-8-1 Habikino, Habikino City, Osaka, 583-0872, Japan
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18
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Xu Q, Zhang G, Li L, Xiang F, Qian L, Xu X, Yan Z. Non-closure of the Free Peritoneal Flap During Laparoscopic Hernia Repair of Lower Abdominal Marginal Hernia: A Retrospective Analysis. Front Surg 2021; 8:748515. [PMID: 34917646 PMCID: PMC8669332 DOI: 10.3389/fsurg.2021.748515] [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: 07/28/2021] [Accepted: 11/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background: During lower abdominal marginal hernia repair, the peritoneal flap is routinely freed to facilitate mesh placement and closed to conclude the procedure. This procedure is generally called trans-abdominal partial extra-peritoneal (TAPE). However, the necessity of closing the free peritoneal flap is still controversial. This study aimed to investigate the safety and feasibility of leaving the free peritoneal flap in-situ. Methods: A retrospective review was conducted on 68 patients (16 male, 52 female) who underwent laparoscopic hernia repair between June 2014 and March 2021. Patients were diagnosed as the lower abdominal hernia and all required freeing the peritoneal flap during the operation. Patients were divided into 2 groups: one group was TAPE group with the closed free peritoneal flap, another group left the free peritoneal flap unclosed. Analyses were performed to compare both intraoperative parameters and postoperative complications. Results: There were no significant differences in demographic, comorbidity, hernia characteristics and ASA classification. The intra-operative bleeding volume, visceral injury, hospital stay, urinary retention, visual analog scale (VAS) score, dysuria, intestinal obstruction, surgical site infection, mesh infection, recurrence rate and hospital stay were similar among the two groups. Mean operative time of the flap closing procedure was higher than for patients with the free peritoneal flap left in-situ (p = 0.002). Comparisons of postoperative complications showed flap closure resulted in a higher incidence of seroma formation (p = 0.005). Conclusion: Providing a barrier-coated mesh is used during laparoscopic lower abdominal marginal hernia repair, it is safe to leave the free peritoneal flap in-situ and this approach may prevent the occurrence of seromas.
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Affiliation(s)
- Qian Xu
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Guangyong Zhang
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Linchuan Li
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Fengting Xiang
- Department of Neonatal Pediatrics, Weifang Yidu Central Hospital, Qingzhou, China
| | - Linhui Qian
- Department of Anorectal Surgery, Feicheng People's Hospital, Feicheng, China
| | - Xiufang Xu
- Department of Nursing, Huantai TCM Hospital, Zibo, China
| | - Zhibo Yan
- Department of Hernia and Abdominal Wall Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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Alhassan AM, Alghunaim MN, Alqarni AA, Abdullah AM, Altoyan MK, Alharbi AS, Alhusain FA. Incidence Rate of Incisional Hernia Post Liver and Kidney Transplant at a Tertiary Center in Riyadh, Saudi Arabia. Cureus 2021; 13:e20223. [PMID: 34909349 PMCID: PMC8653929 DOI: 10.7759/cureus.20223] [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] [Accepted: 12/06/2021] [Indexed: 12/07/2022] Open
Abstract
Background Incisional hernia post organ transplant increases morbidity and impacts quality of life among patients undergoing abdominal organ transplants. Objectives To estimate the incidence rate of incisional hernia and the factors associated with incisional hernia among patients who underwent liver and kidney transplants. Methods This was a retrospective cohort study in which all patients from 2015 to 2020 who underwent liver and/or kidney transplants and met inclusion criteria were involved. Results A total of 424 patients who received transplantation surgery were included. Out of them, 287 patients (67.6%) underwent kidney transplants while 132 patients (31.1%) underwent a liver transplant. Additionally, five patients (1.1%) received both liver and kidney transplantation. Fourteen patients (3.3%) experienced incisional hernia across all samples. A higher incidence rate was noticed among patients with liver transplants compared to kidney transplants (6.81% in the liver group vs 1.7% in the kidney group), which showed a statistical significance between the two groups (P-value= 0.007). In multivariate analysis, surgical site infection (SSI), donor type, acute organ rejection, mycophenolate mofetil (MMF), and diabetes were all not predictors of incisional hernia among the patients. Conclusion Incisional hernia incidence in between the groups was within the global range of incisional hernia incidence among abdominal organ transplant patients, with a higher incidence among liver transplant patients. All factors associated with incisional hernia, such as SSI, DM, and old age, didn’t show significance as predictors to incisional hernia formation among the samples.
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Affiliation(s)
| | - Mohammed N Alghunaim
- General Surgery, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, SAU
| | - Ayyob A Alqarni
- General Surgery, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, SAU
| | | | - Mohammed K Altoyan
- Medicine, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, SAU
| | - Abdullah S Alharbi
- Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Faisal A Alhusain
- Emergency Medicine, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, SAU
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20
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Niebuhr H, Malaibari ZO, Köckerling F, Reinpold W, Dag H, Eucker D, Aufenberg T, Fikatas P, Fortelny RH, Kukleta J, Meier H, Flamm C, Baschleben G, Helmedag M. [Intraoperative fascial traction (IFT) for treatment of large ventral hernias : A retrospective analysis of 50 cases]. Chirurg 2021; 93:292-298. [PMID: 34907456 PMCID: PMC8894171 DOI: 10.1007/s00104-021-01552-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim was to evaluate the effectiveness, clinical practicability, and complication rate of the intraoperative fascial traction (IFT) procedure for the treatment of large ventral hernias. METHOD This study evaluated 50 patients from 11 specialized centers with an intraoperatively measured fascial distance of more than 8 cm, who were treated by IFT (traction time 30-35 min) using the fasciotens® hernia traction procedure. RESULTS Fascial gaps measured preoperatively ranged from 8 cm to 44 cm, with most patients (94%) having a fascial gap above 10 cm (W3 according to the European Hernia Society classification). The mean fascial distance was reduced from 16.1 ± 0.8 cm to 5.8 ± 0.7 cm (stretch gain 10.2 ± 0.7 cm, p < 0.0001, Wilcoxon matched-pairs signed-ranks test). A reduction in fascial distance of at least 50% was achieved in three quarters of the patients and in half of the treated patients the reduction in fascial distance amounted to even more than 70%. The closure rate achieved by IFT after a mean surgical duration of 207.3 ± 11.0 min was 90% (45/50). Hernia closure was performed in all cases with a mesh augmentation in a sublay position. Postoperative complications occurred in 6 patients (12%). A reoperation was required in 3 patients (6%). CONCLUSION The described IFT method is a new procedure for abdominal wall closure in large ventral hernias. The presented results demonstrate a high effectiveness, a good clinical practicability and a low complication rate of IFT.
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Affiliation(s)
- Henning Niebuhr
- Hamburger Hernien Centrum, Eppendorfer Baum 8, 20249, Hamburg, Deutschland.
| | - Zaid Omar Malaibari
- Hamburger Hernien Centrum, Eppendorfer Baum 8, 20249, Hamburg, Deutschland.,Faculty of Medicine, Department of Surgery, University of Tabuk, Tabuk, Saudi-Arabien
| | | | - Wolfgang Reinpold
- Hamburger Hernien Centrum, Eppendorfer Baum 8, 20249, Hamburg, Deutschland
| | - Halil Dag
- Hamburger Hernien Centrum, Eppendorfer Baum 8, 20249, Hamburg, Deutschland
| | - Dietmar Eucker
- Chirurgische Klinik Kantonsspital Baselland Bruderholz, Bruderholz, Schweiz
| | - Thomas Aufenberg
- Klinik für Chirurgie, St. Elisabeth-Krankenhaus Köln, Köln, Deutschland
| | - Panagiotis Fikatas
- Klinik für Chirurgie, Charité Campus Virchow-Klinik, Berlin, Deutschland
| | | | - Jan Kukleta
- Klinik für Chirurgie, Hirslanden Klinik, Zürich, Schweiz
| | - Hansjörg Meier
- Klinik für Allgemein- und Viszeralchirurgie, Sana Krankenhaus, Benrath, Deutschland
| | - Christian Flamm
- Klinik für Allgemein‑, Viszeral‑, Endokrine und Unfallchirurgie, RoMed Clinic, Bad Aibling, Deutschland
| | - Guido Baschleben
- Klinik für Allgemein- und Viszeral Chirurgie, St. Elisabeth Hospital, Leipzig, Deutschland
| | - Marius Helmedag
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsklinik Aachen, Aachen, Deutschland
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21
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Dietz UA, Kudsi OY, Garcia-Ureña M, Baur J, Ramser M, Maksimovic S, Keller N, Dörfer J, Eisner L, Wiegering A. Robotic hernia repair III. English version : Robotic incisional hernia repair with transversus abdominis release (r‑TAR). Video report and results of a cohort study. Chirurg 2021; 92:28-39. [PMID: 34495358 PMCID: PMC8695562 DOI: 10.1007/s00104-021-01500-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2021] [Indexed: 11/22/2022]
Abstract
The principle of targeted separation or weakening of individual components of the abdominal wall to relieve tension in the median line during major abdominal reconstruction has been known for over 30 years as anterior component separation (aCS) and is an established procedure. In search of alternatives with lower complication rates, posterior component separation (pCS) was developed; transversus abdominis release (TAR) is a nerve-sparing modification of pCS. With the ergonomic resources of robotics (e.g., angled instruments), TAR can be performed in a minimally invasive manner (r-TAR): hernia gaps of up to 14 cm can be closed and a large extraperitoneal mesh implanted. In this video article, the treatment of large incisional hernias using the r‑TAR technique is presented. Exemplary results of a cohort study in 13 consecutive patients are presented. The procedure is challenging, but our own results-as well as reports from the literature-are encouraging. The r‑TAR is becoming the pinnacle procedure for abdominal wall reconstruction.
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Affiliation(s)
- Ulrich A Dietz
- Department of Visceral, Vascular and Thoracic Surgery, Cantonal Hospital Olten (soH), Baslerstrasse 150, 4600, Olten, Switzerland.
| | - O Yusef Kudsi
- Department of Surgery, Good Samaritan Medical Center, 235 North Pearl St., 02301, Brockton, MA, USA
| | - Miguel Garcia-Ureña
- Hospital Universitario del Henares, Universidade Francisco de Vitoria, 28223, Pozuelo de Alarcón, Madrid, Spain
| | - Johannes Baur
- Department of Visceral, Vascular and Thoracic Surgery, Cantonal Hospital Olten (soH), Baslerstrasse 150, 4600, Olten, Switzerland
| | - Michaela Ramser
- Department of Visceral, Vascular and Thoracic Surgery, Cantonal Hospital Olten (soH), Baslerstrasse 150, 4600, Olten, Switzerland
| | - Sladjana Maksimovic
- Department of Visceral, Vascular and Thoracic Surgery, Cantonal Hospital Olten (soH), Baslerstrasse 150, 4600, Olten, Switzerland
| | - Nicola Keller
- Department of General, Visceral and Vascular Surgery, Cantonal Hospital Baden, Im Engel 1, 5404, Baden, Switzerland
| | - Jörg Dörfer
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital Wuerzburg, Oberduerrbacher Strasse 6, 97080, Wuerzburg, Germany
| | - Lukas Eisner
- Department of Visceral, Vascular and Thoracic Surgery, Cantonal Hospital Olten (soH), Baslerstrasse 150, 4600, Olten, Switzerland
| | - Armin Wiegering
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital Wuerzburg, Oberduerrbacher Strasse 6, 97080, Wuerzburg, Germany.
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Baur J, Ramser M, Keller N, Muysoms F, Dörfer J, Wiegering A, Eisner L, Dietz UA. Robotic hernia repair II. English version : Robotic primary ventral and incisional hernia repair (rv‑TAPP and r‑Rives or r‑TARUP). Video report and results of a series of 118 patients. Chirurg 2021; 92:15-26. [PMID: 34374823 PMCID: PMC8695563 DOI: 10.1007/s00104-021-01479-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 11/26/2022]
Abstract
Endoscopic management of umbilical and incisional hernias has adapted to the limitations of conventional laparoscopic instruments over the past 30 years. This includes the development of meshes for intraperitoneal placement (intraperitoneal onlay mesh, IPOM), with antiadhesive coatings; however, adhesions do occur in a significant proportion of these patients. Minimally invasive procedures result in fewer perioperative complications, but with a slightly higher recurrence rate. With the ergonomic resources of robotics, which offers angled instruments, it is now possible to implant meshes in a minimally invasively manner in different abdominal wall layers while achieving morphologic and functional reconstruction of the abdominal wall. This video article presents the treatment of ventral and incisional hernias with mesh implantation into the preperitoneal space (robot-assisted transabdominal preperitoneal ventral hernia repair, r‑ventral TAPP) as well as into the retrorectus space (r-Rives and robotic transabdominal retromuscular umbilical prosthetic repair, r‑TARUP, respectively). The results of a cohort study of 118 consecutive patients are presented and discussed with regard to the added value of the robotic technique in extraperitoneal mesh implantation and in the training of residents.
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Affiliation(s)
- Johannes Baur
- Department of Visceral, Vascular and Thoracic Surgery, Cantonal Hospital Olten (soH), Baslerstraße 150, 4600, Olten, Switzerland
| | - Michaela Ramser
- Department of Visceral, Vascular and Thoracic Surgery, Cantonal Hospital Olten (soH), Baslerstraße 150, 4600, Olten, Switzerland
| | - Nicola Keller
- Department of General, Visceral and Vascular Surgery, Cantonal Hospital Baden, Im Engel 1, 5404, Baden, Switzerland
| | - Filip Muysoms
- Department of Surgery, AZ Maria Middelares, Buitenring Sint-Denijs 30, 9000, Ghent, Belgium
| | - Jörg Dörfer
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital Wuerzburg, Oberduerrbacher Str. 6, 97080, Wuerzburg, Germany
| | - Armin Wiegering
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital Wuerzburg, Oberduerrbacher Str. 6, 97080, Wuerzburg, Germany.
| | - Lukas Eisner
- Department of Visceral, Vascular and Thoracic Surgery, Cantonal Hospital Olten (soH), Baslerstraße 150, 4600, Olten, Switzerland
| | - Ulrich A Dietz
- Department of Visceral, Vascular and Thoracic Surgery, Cantonal Hospital Olten (soH), Baslerstraße 150, 4600, Olten, Switzerland.
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Peritoneal hernia following abdominal hysterectomy: A case report. Case Rep Womens Health 2021; 33:e00371. [PMID: 34824987 PMCID: PMC8605049 DOI: 10.1016/j.crwh.2021.e00371] [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: 11/08/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 11/23/2022] Open
Abstract
Background Internal hernias rarely lead to bowel obstruction; they are caused by a natural or unnatural opening within the peritoneal cavity. Defects in the peritoneum are extremely rare. Patients present with features of intestinal obstruction and most cases are diagnosed during surgery. Case Presentation A 47-year-old woman with a history of multiple abdominal surgeries had a small bowel hernia through a peritoneal defect of the anterior abdominal wall. She presented with abdominal pain and distension and was taken to the operating room, where findings revealed an intact fascia and small bowel herniation through a midline peritoneal defect. Conclusion Herniation of small bowel through the peritoneum is a rare type of internal hernia that can manifest in a patient with extensive history of abdominal surgeries. This type of clinical picture warrants a high degree of suspicion for prompt and proper management. Surgery should not be delayed, to avoid increased morbidity and mortality. Internal hernias caused by peritoneal defects are very rare. Most cases are diagnosed intraoperatively. Careful closure of peritoneal and/or fascial layers is warranted. Surgery should not be delayed, to avoid increased morbidity and mortality.
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Dietz UA, Kudsi OY, Garcia-Ureña M, Baur J, Ramser M, Maksimovic S, Keller N, Dörfer J, Eisner L, Wiegering A. [Robotic hernia repair : Part III: Robotic incisional hernia repair with transversus abdominis release (r-TAR). Video report and results of a cohort study]. Chirurg 2021; 92:936-947. [PMID: 34406440 PMCID: PMC8463520 DOI: 10.1007/s00104-021-01480-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2021] [Indexed: 11/29/2022]
Abstract
The principle of targeted separation or weakening of individual components of the abdominal wall to relieve tension in the median line during major abdominal reconstruction has been known for over 30 years as anterior component separation (aKS) and is an established procedure. In search of alternatives with lower complication rates, posterior component separation (pKS) was developed; transversus abdominis release (TAR) is a nerve-sparing modification of pKS. With the ergonomic resources of robotics (e.g., angled instruments), TAR can be performed in a minimally invasive manner (r-TAR): hernia gaps of up to 14 cm can be closed and a large extraperitoneal mesh implanted. In this video article, the treatment of large incisional hernias using the r‑TAR technique is presented. Exemplary results of a cohort study in 13 consecutive patients are presented. The procedure is challenging, but our own results-as well as reports from the literature-are encouraging. The r‑TAR is becoming the pinnacle procedure for abdominal wall reconstruction.
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Affiliation(s)
- Ulrich A Dietz
- Klinik für Viszeral‑, Gefäss- und Thoraxchirurgie, Kantonsspital Olten, Baslerstrasse 150, 4600, Olten, Schweiz.
| | - O Yusef Kudsi
- Department of Surgery, Good Samaritan Medical Center, 235 North Pearl St., 02301, Brockton, MA, USA
| | - Miguel Garcia-Ureña
- Hospital Universitario del Henares, Universidade Francisco de Vitoria, 28223, Pozuelo de Alarcón, Madrid, Spanien
| | - Johannes Baur
- Klinik für Viszeral‑, Gefäss- und Thoraxchirurgie, Kantonsspital Olten, Baslerstrasse 150, 4600, Olten, Schweiz
| | - Michaela Ramser
- Klinik für Viszeral‑, Gefäss- und Thoraxchirurgie, Kantonsspital Olten, Baslerstrasse 150, 4600, Olten, Schweiz
| | - Sladjana Maksimovic
- Klinik für Viszeral‑, Gefäss- und Thoraxchirurgie, Kantonsspital Olten, Baslerstrasse 150, 4600, Olten, Schweiz
| | - Nicola Keller
- Klinik für Allgemein‑, Viszeral- und Gefässchirurgie, Kantonsspital Baden, Im Engel 1, 5404, Baden, Schweiz
| | - Jörg Dörfer
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland
| | - Lukas Eisner
- Klinik für Viszeral‑, Gefäss- und Thoraxchirurgie, Kantonsspital Olten, Baslerstrasse 150, 4600, Olten, Schweiz
| | - Armin Wiegering
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland.
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Schaaf S, Schwab R, Güsgen C, Vilz TO, Willms A. Recommendations on Postoperative Activities After Abdominal Operations and Incisional Hernia Repair-A National and International Survey. Front Surg 2021; 8:713138. [PMID: 34660675 PMCID: PMC8511488 DOI: 10.3389/fsurg.2021.713138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/30/2021] [Indexed: 11/24/2022] Open
Abstract
Background: There is no conclusive data on postoperative recommendations after abdominal and hernia surgery, and there is significant variation in the literature on that question. Thus, this study evaluates the status quo of recommendations of postoperative activity restriction after abdominal surgery. Materials and Methods: A national (German) and international survey of general surgeons on postoperative recommendations after abdominal and hernia surgery was pooled and analyzed. Results: A total of 74.6% recommended postoperative reduced activity for 2 weeks or less after laparoscopy. For midline laparotomy, 48.8% considered a reduced activity of 4 weeks or less to be sufficient. A majority from the national survey recommended more than 4 weeks instead (60.2%), whereas only 31.5% from the international survey did so (p = 0.000). In the pooled analysis, 258 of 450 (57.3%) rated 4 weeks or less suitable. However, the recommendations differed significantly between the surveys (4 weeks or less: a national survey, 47.1% vs. international survey, 64.6%; p = 0.000). Conclusion: There was substantial variation in the given recommendations. However, we found no evidence against immediate mobilization, reduced physical activity, and lifting for up to 2 weeks after laparoscopic surgery and for up to 4 weeks after open abdominal surgery and open incisional/ventral hernia repair in uncomplicated and standard cases. There might be individual and socioeconomic benefits to allow patients to return to their whole personal level of activity and work without putting them at risk of complications. Due to lack of evidence, both retrospective and prospective, controlled studies are in need to develop reliable recommendations.
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Affiliation(s)
- Sebastian Schaaf
- Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital Koblenz, Koblenz, Germany
| | - Robert Schwab
- Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital Koblenz, Koblenz, Germany
| | - Christoph Güsgen
- Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital Koblenz, Koblenz, Germany
| | - Tim O. Vilz
- Department of General, Visceral, Thoracic and Vasular Surgery, University Hospital Bonn, Bonn, Germany
| | - Arnulf Willms
- Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital Koblenz, Koblenz, Germany
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Analysis of Factors Relevant to Revenue Improvement in Ventral Hernia Repair, Their Influence on Surgical Training, and Development of Predictive Models: An Economic Evaluation. Healthcare (Basel) 2021; 9:healthcare9091226. [PMID: 34575000 PMCID: PMC8470166 DOI: 10.3390/healthcare9091226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/10/2021] [Accepted: 09/11/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Ventral hernia repairs (VHR) are frequent but loss- making. This study aims to identify epidemiological and procedure related factors in VHR and their influence on surgical training. Methods: Data from 86 consecutive patients who underwent VHR in 2019 was collected. Moreover, 66 primary ventral hernias and 20 incisional hernias were repaired in open procedures. Linear regression models were made. Results: Primary VHR procedures showed a mean deficit of −378.17 CHF per case. Incisional hernia repair procedures resulted in a deficit of −1442.50 CHF per case. The two hernia groups were heterogeneous. For the primary VHR procedures, the surgery time (β = 0.564, p < 0.001) had the greatest influence, followed by the costs of the mesh (β = −0.215, p < 0.001). The epidemiological factors gender (β = 0.143, p < 0.01) and body mass index (BMI) (β = −0.087, p = 0.074) were also influential. For incisional hernia procedures a surgeon’s experience had the most significant influence (β = 0.942, p < 0.001), and the second largest influence was the price of the mesh (β = −0.500, p < 0.001). The epidemiological factor BMI (β = −0.590, p < 0.001), gender (β = −0.113, p = 0.055) and age (β = −0.026, p < 0.050) also had a significant influence. Conclusion: Our analysis shows a way of improving financial results in the field of ventral hernia repair. Costs can be visualized and reduced to optimize revenue enhancement in surgical departments. In our analysis primary ventral hernias are an appropriate training operation, in which the experience of the surgeon has no significant impact on costs. In primary VHR procedures, revenue enhancement is limited when using an expensive mesh. However, the treatment of incisional hernias is recommended by specialists. The financial burden is significantly higher with less experience. Therefore, these operations are not suitable for surgical training. The re-operation rate decreases with increasing experience of the surgeon. This directly affects the Patient Related Outcome (PROM) and quality of treatment. Therefore, high-quality training must be enforced. Since financial pressure on hospitals is increasing further, it is crucial to investigate cost influencing factors. The majority of Swiss public hospitals will no longer be able to operate ventral hernias profitably without new concepts. In addition to purchasing management, new construction projects, and mergers, improving the results of individual departments is a key factor in maintaining the profitability of hospitals in the future regarding hernia repair without losing the scope of teaching procedures.
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Baur J, Ramser M, Keller N, Muysoms F, Dörfer J, Wiegering A, Eisner L, Dietz UA. [Robotic hernia repair : Part II: Robotic primary ventral and incisional hernia repair (rv-TAPP and r-Rives or r-TARUP). Video report and results of a series of 118 patients]. Chirurg 2021; 92:809-821. [PMID: 34255114 PMCID: PMC8384833 DOI: 10.1007/s00104-021-01450-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 02/01/2023]
Abstract
Endoscopic management of umbilical and incisional hernias has adapted to the limitations of conventional laparoscopic instruments over the past 30 years. This includes the development of meshes for intraperitoneal placement (intraperitoneal onlay mesh, IPOM), with antiadhesive coatings; however, adhesions do occur in a significant proportion of these patients. Minimally invasive procedures result in fewer perioperative complications, but with a slightly higher recurrence rate. With the ergonomic resources of robotics, which offers angled instruments, it is now possible to implant meshes in a minimally invasively manner in different abdominal wall layers while achieving morphologic and functional reconstruction of the abdominal wall. This video article presents the treatment of ventral and incisional hernias with mesh implantation into the preperitoneal space (robot-assisted transabdominal preperitoneal ventral hernia repair, r‑ventral TAPP) as well as into the retrorectus space (r-Rives and robotic transabdominal retromuscular umbilical prosthetic repair, r‑TARUP, respectively). The results of a cohort study of 118 consecutive patients are presented and discussed with regard to the added value of the robotic technique in extraperitoneal mesh implantation and in the training of residents.
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Affiliation(s)
- Johannes Baur
- Klinik für Viszeral‑, Gefäss- und Thoraxchirurgie, Kantonsspital Olten, Baslerstrasse 150, 4600, Olten, Schweiz
| | - Michaela Ramser
- Klinik für Viszeral‑, Gefäss- und Thoraxchirurgie, Kantonsspital Olten, Baslerstrasse 150, 4600, Olten, Schweiz
| | - Nicola Keller
- Klinik für Allgemein‑, Viszeral- und Gefässchirurgie, Kantonsspital Baden, Im Engel 1, 5404, Baden, Schweiz
| | - Filip Muysoms
- Department of Surgery, AZ Maria Middelares, Buitenring Sint-Denijs 30, 9000, Gent, Belgien
| | - Jörg Dörfer
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland
| | - Armin Wiegering
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland.
| | - Lukas Eisner
- Klinik für Viszeral‑, Gefäss- und Thoraxchirurgie, Kantonsspital Olten, Baslerstrasse 150, 4600, Olten, Schweiz
| | - Ulrich A Dietz
- Klinik für Viszeral‑, Gefäss- und Thoraxchirurgie, Kantonsspital Olten, Baslerstrasse 150, 4600, Olten, Schweiz.
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Kallinowski F, Gutjahr D, Harder F, Sabagh M, Ludwig Y, Lozanovski VJ, Löffler T, Rinn J, Görich J, Grimm A, Vollmer M, Nessel R. The Grip Concept of Incisional Hernia Repair-Dynamic Bench Test, CT Abdomen With Valsalva and 1-Year Clinical Results. Front Surg 2021; 8:602181. [PMID: 33937312 PMCID: PMC8080034 DOI: 10.3389/fsurg.2021.602181] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 02/24/2021] [Indexed: 02/03/2023] Open
Abstract
Incisional hernia is a frequent consequence of major surgery. Most repairs augment the abdominal wall with artificial meshes fixed to the tissues with sutures, tacks, or glue. Pain and recurrences plague at least 10-20% of the patients after repair of the abdominal defect. How should a repair of incisional hernias be constructed to achieve durability? Incisional hernia repair can be regarded as a compound technique. The biomechanical properties of a compound made of tissue, textile, and linking materials vary to a large extent. Tissues differ in age, exercise levels, and comorbidities. Textiles are currently optimized for tensile strength, but frequently fail to provide tackiness, dynamic stiction, and strain resistance to pulse impacts. Linking strength with and without fixation devices depends on the retention forces between surfaces to sustain stiction under dynamic load. Impacts such a coughing or sharp bending can easily overburden clinically applied composite structures and can lead to a breakdown of incisional hernia repair. Our group developed a bench test with tissues, fixation, and textiles using dynamic intermittent strain (DIS), which resembles coughing. Tissue elasticity, the size of the hernia under pressure, and the area of instability of the abdominal wall of the individual patient was assessed with low-dose computed tomography of the abdomen preoperatively. A surgical concept was developed based on biomechanical considerations. Observations in a clinical registry based on consecutive patients from four hospitals demonstrate low failure rates and low pain levels after 1 year. Here, results from the bench test, the application of CT abdomen with Valsalva's maneuver, considerations of the surgical concept, and the clinical application of our approach are outlined.
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Affiliation(s)
- Friedrich Kallinowski
- General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Dominik Gutjahr
- General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Felix Harder
- General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Mohammad Sabagh
- General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Yannique Ludwig
- General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Vladimir J. Lozanovski
- General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
- General and Visceral Surgery, Gesundheitszentren Rhein-Neckar (GRN) Hospital Eberbach, Eberbach, Germany
| | - Thorsten Löffler
- General and Visceral Surgery, Gesundheitszentren Rhein-Neckar (GRN) Hospital Eberbach, Eberbach, Germany
| | - Johannes Rinn
- General and Visceral Surgery, Kreiskrankenhaus Bergstrasse (KKB) Hospital Bergstrasse, Heppenheim, Germany
| | | | | | - Matthias Vollmer
- Institute of Biomechanics, Hamburg University of Technology, Hamburg, Germany
| | - Regine Nessel
- General, Visceral and Pediatric Surgery, Klinikum Am Gesundbrunnen, Heilbronn, Germany
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Güsgen C, Willms A, Schaaf S, Prior M, Weber C, Schwab R. Lack of Standardized Advice on Physical Strain Following Abdominal Surgery. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 117:737-744. [PMID: 33439823 DOI: 10.3238/arztebl.2020.0737] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 11/26/2019] [Accepted: 06/02/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND In Germany as elsewhere, standardized recommendations are lacking on the avoidance of physical exertion to protect the abdom - inal wall in patients who have recently undergone abdominal surgery. It is unclear how much stress the abdominal wall can withstand and how long the patient should be exempted from work. The goal of this review is to determine whether there are any standardized, evidence-based recommendations for postoperative care from which valid recommendations for Germany can be derived. METHODS We systematically searched the literature for evidence-based recommendations on exertion avoidance after abdominal surgery, as well as for information on the extent to which postoperative abdominal wall stress contributes to incisional hernia formation. We then created a questionnaire on recommendation practices and sent it to all of the chiefs of general and visceral surgery services that were listed in the German hospital registry (1078 chiefs of service as of June 2016). RESULTS All 16 of the included studies on postoperative exertion avoidance contained low-level evidence that could only be used to formulate weak recommendations ("can," rather than "should" or "must"). Some 50 000 incisional hernia repair procedures are performed in Germany each year, with a reported incidence of 12.8% in the first two years after surgery. The scientifically documented risk factors for incisional herniation are related to techniques of wound closure, the suture materials used, wound infections, and the patient risk profile. From the biological point of view, the abdominal wall regains full, normal resistance to exertional stress 30 days after a laparotomy with uncomplicated healing. Most incisional hernias (>50%) arise 18 months or more after surgery; they are more common in patients who have avoided exertion for longer periods of time (more than 8 weeks). Our questionnaire was returned by 386 surgical clinics. The responses showed that 78% of recommendations were based on personal experience only. The recommendations varied widely; exertion avoidance was recommended for as long as 6 months. CONCLUSION The dilemma of a deficient evidence base for postoperative exertion avoidance to protect the abdominal wall should be resolved with the much higher-quality evidence available from hernia research, which concerns the patient population with the biologically least favorable starting conditions. Based on our analysis of the available literature in light of the biomechanical principles of abdominal wall healing, we propose a new set of recommendations on postoperative exertion avoidance after abdominal surgery, with the goal of eliminating excessively protracted exertion avoidance and enabling a timely return to work.
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Affiliation(s)
- Christoph Güsgen
- Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital, German Society for General and Visceral Surgery (DGAV), Koblenz, Germany
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Incisional hernia after surgical correction of abdominal congenital anomalies in infants: a systematic review with meta-analysis. Sci Rep 2020; 10:21170. [PMID: 33273483 PMCID: PMC7713071 DOI: 10.1038/s41598-020-77976-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 11/04/2020] [Indexed: 12/17/2022] Open
Abstract
Incisional hernia (IH) in children could result in life-threatening complications, including incarceration and bowel strangulation. The incidence and risk factors of IH in infants are scarcely reported. Since IH-correction may require extensive surgery and a long recovery program, identifying infants and birth defects at risk, may lead to a different approach during the primary surgery. Therefore, the aim of this review is to systematically review the available data on the incidence of IH following surgery for congenital anomalies in infants. All studies describing IH were considered eligible. PubMed and Embase were searched and risk of bias was assessed. Primary outcome was the incidence of IH, secondary outcomes were difference in IH occurrence between disease severity (complex vs simple) and closure method (SILO vs primary closure) in gastroschisis patients. A meta-analysis was performed to pool the reported incidences in total and per congenital anomaly separately. Subgroup analysis within gastroschisis articles was performed. The 50 included studies represent 3140 patients. The pooled proportion of IH was 0.03 (95% CI 0.02–0.05; I2 = 79%, p ≤ 0.01) all anomalies combined. Gastroschisis (GS) reported highest pooled proportion 0.10 (95% CI 0.06–0.17; n = 142/1273; I2 = 86%; p ≤ 0.01). SILO closure (OR 3.09) and simple gastroschisis, i.e. without additional anomalies, (OR 0.18) were of significant influence. This review reports the incidence of IH in infants with different congenital abdominal anomalies, of which gastroschisis reported the highest risk. In GS patients, complex GS and SILO closure are risk factors for IH development.
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van Silfhout L, Leenders LAM, Heisterkamp J, Ibelings MS. Recurrent incisional hernia repair: surgical outcomes in correlation with body-mass index. Hernia 2020; 25:77-83. [PMID: 33200326 DOI: 10.1007/s10029-020-02320-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/07/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hernia recurrence rates after incisional hernia repair vary between 8.7 and 32%, depending on multiple factors such as patient characteristics, the use of meshes, surgical technique and the degree of experience of the treating surgeon. Recurrent hernias are considered complex wall hernias, and 20% of all incisional hernia repairs involve a recurrent hernia. The aim of this study was to investigate the outcomes after recurrent incisional hernia repair, in association with surgical technique and body-mass index (BMI). METHODS All patients who had incisional hernia repair between 2013 and 2018 were included. Primary outcome was rate of recurrent incisional hernia after initial hernia repair. Secondary outcomes were complication rate and recurrence rate in association with BMI. RESULTS A number of 269 patients were included, of which 75 patients (27.9%) with a recurrent incisional hernia. Recurrent hernia repair was performed in 49 patients, 83.7% underwent open repair. Complication rate for recurrent hernia repair was higher than for the initial incisional hernia repair. Of the 49 patients with recurrent hernia repair, patients with a BMI above 30 had higher complication and recurrence rates compared to patients with BMI below 30. Especially infectious complications were more common in patients with a higher BMI: 23.1% vs. 0% wound infections. CONCLUSION The results from this study show that complication and recurrence rates are increased after recurrent incisional hernia repair, which are further increased by obesity. Only a limited amount of literature is available on this topic, further larger multicenter studies are necessary, until then a patient-specific surgical approach based on the surgeon's expertise is recommended.
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Affiliation(s)
| | | | - J Heisterkamp
- Department of Surgery, ETZ, Tilburg, The Netherlands
| | - M S Ibelings
- Department of Surgery, ETZ, Tilburg, The Netherlands
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Abdominal Wall Reconstruction (AWR): Initial Experience from an Indian Centre. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02123-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Katkhouda N, Alicuben ET, Pham V, Sandhu K, Samakar K, Bildzukewicz N, Houghton C, Dunn CP, Hawley L, Lipham J. Management of lateral abdominal hernias. Hernia 2020; 24:353-358. [PMID: 32052297 DOI: 10.1007/s10029-020-02126-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/08/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Lateral abdominal wall hernias are rare defects but, due to their location, repair is difficult, and recurrence is common. Few studies exist to support a standard protocol for repair of these lateral hernias. We hypothesized that anchoring our repair to fixed bony structures would reduce recurrence rates. METHODS A retrospective review of all patients who underwent lateral hernia repair at our institution was performed. RESULTS Eight cases (seven flank and one thoracoabdominal) were reviewed. The median defect size was 105 cm2 (range 36-625 cm2). The median operative time was 185 min (range 133-282 min). There were no major complications. One patient who was repaired without mesh attachment to bony landmarks developed a recurrence at ten months and subsequently underwent reoperation. Patients with mesh secured to bony landmarks were recurrence free at a median follow-up of 171 days. CONCLUSIONS Lateral hernias present a greater challenge due to their anatomic location. An open technique with mesh fixation to bony structures is a promising solution to this complex problem.
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Affiliation(s)
- N Katkhouda
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of University of Southern California, 1510 San Pablo Street, HCC I, Suite 527, Los Angeles, CA, 90033-4612, USA.
| | - E T Alicuben
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of University of Southern California, 1510 San Pablo Street, HCC I, Suite 527, Los Angeles, CA, 90033-4612, USA
| | - V Pham
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of University of Southern California, 1510 San Pablo Street, HCC I, Suite 527, Los Angeles, CA, 90033-4612, USA
| | - K Sandhu
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of University of Southern California, 1510 San Pablo Street, HCC I, Suite 527, Los Angeles, CA, 90033-4612, USA
| | - K Samakar
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of University of Southern California, 1510 San Pablo Street, HCC I, Suite 527, Los Angeles, CA, 90033-4612, USA
| | - N Bildzukewicz
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of University of Southern California, 1510 San Pablo Street, HCC I, Suite 527, Los Angeles, CA, 90033-4612, USA
| | - C Houghton
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of University of Southern California, 1510 San Pablo Street, HCC I, Suite 527, Los Angeles, CA, 90033-4612, USA
| | - C P Dunn
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of University of Southern California, 1510 San Pablo Street, HCC I, Suite 527, Los Angeles, CA, 90033-4612, USA
| | - L Hawley
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of University of Southern California, 1510 San Pablo Street, HCC I, Suite 527, Los Angeles, CA, 90033-4612, USA
| | - J Lipham
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of University of Southern California, 1510 San Pablo Street, HCC I, Suite 527, Los Angeles, CA, 90033-4612, USA
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Zipper CT, Friedrich U, Backhaus J, König S, Mavroveli S, Wiegering A, Olbrecht S, Puppe F, Günster SA, Dietz UA. Incisional hernia repair in a high-fidelity silicone model for open retro-muscular mesh implantation with preparation of the fatty triangle: validation and educational impact study. Hernia 2019; 24:1307-1315. [PMID: 31792801 DOI: 10.1007/s10029-019-02094-5] [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] [Received: 07/19/2019] [Accepted: 11/17/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Incisional hernia repair requires detailed anatomic knowledge. Regarding median subxiphoidal hernias, the proper preparation of the fatty triangle is challenging. To foster proficiency-based training, a cost-efficient model for open median retromuscular mesh repair resembling the human body was developed, including the main anatomical structures related to the procedure. The aim is to create and validate a high-fidelity model on open retromuscular mesh repair suitable for "training before doing". MATERIALS AND METHODS Different types of fabrics for imitation of connective tissue and 2-component silicones were used to construct the incisional hernia model. Sample size for validation of the model was determined by a triangular testing approach. Operations from six beginners and six experts were assessed by three blinded-raters. Reliability and construct-validity were evaluated on a behaviorally anchored rating scale (highest score: 4) for the criteria: "instrument use", "tissue handling", "near misses and errors", and "end-product quality". RESULTS The model authentically mimicked an open median retromuscular mesh repair. Participants considered the procedure realistic. Reliability was excellent, ranging from 0.811 to 0.974 for "end-product quality", and "tissue handling" respectively. Construct-validity was confirmed with experts significantly outperforming beginners in the "use of instruments" (Mbeg. = 2.33, Mexp. = 3.94, p < 0.001), "tissue handling" (Mbeg. = 2.11, Mexp. = 3.72, p < 0.001), "near misses and errors" (Mbeg. = 2.67, Mexp. = 3.67, p < 0.001), and "end-product quality" (Mbeg. = 2.78, Mexp. = 3.72, p < 0.001). Criterion-validity revealed a paradox effect: beginners performed significantly better than experts (p < 0.05) when preparing the fatty triangle. CONCLUSIONS The model covers all relevant aspects involved in median-open retromuscular incisional hernia mesh repair. Performance differences between beginners and experts confirm construct-validity and thereby realism of the model. It enables to efficiently improve and practice technical skills of the demanding surgery.
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Affiliation(s)
- C T Zipper
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital Wuerzburg, Oberduerrbacher Strasse 6, 97080, Wuerzburg, Germany
| | - U Friedrich
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital Wuerzburg, Oberduerrbacher Strasse 6, 97080, Wuerzburg, Germany
| | - J Backhaus
- Institute of Medical Teaching and Medical Education Research, University of Wuerzburg, Josef-Schneider Strasse 2, 97080, Wuerzburg, Germany
| | - S König
- Institute of Medical Teaching and Medical Education Research, University of Wuerzburg, Josef-Schneider Strasse 2, 97080, Wuerzburg, Germany
| | - S Mavroveli
- London General Surgical Skills Programme, Imperial College London, South Wharf Road, Paddington, London, W2 1BL, UK
| | - A Wiegering
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital Wuerzburg, Oberduerrbacher Strasse 6, 97080, Wuerzburg, Germany.,Department of Biochemistry and Molecular Biology, University of Wuerzburg, Am Hubland, 97074, Wuerzburg, Germany
| | - S Olbrecht
- Institute for Artificial Intelligence and Applied Informatics (VI), University of Wuerzburg, Am Hubland, 97074, Wuerzburg, Germany
| | - F Puppe
- Institute for Artificial Intelligence and Applied Informatics (VI), University of Wuerzburg, Am Hubland, 97074, Wuerzburg, Germany
| | - S A Günster
- Institut für Allgemeinmedizin, Friedrich-Alexander-Universitaet Erlangen-Nuernberg, Universitaetsstrasse 29, 91054, Erlangen, Germany
| | - U A Dietz
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital Wuerzburg, Oberduerrbacher Strasse 6, 97080, Wuerzburg, Germany. .,Department of General, Visceral, Vascular and Thoracic Surgery, Kantonsspital Olten (soH), Baselstrasse 150, 4600, Olten, Switzerland.
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Köckerling F, Schug-Pass C, Scheuerlein H. What Is the Current Knowledge About Sublay/Retro-Rectus Repair of Incisional Hernias? Front Surg 2018; 5:47. [PMID: 30151365 PMCID: PMC6099094 DOI: 10.3389/fsurg.2018.00047] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/05/2018] [Indexed: 12/17/2022] Open
Abstract
Introduction: There continues to be very little agreement among experts on the precise treatment strategy for incisional hernias. That is the conclusion drawn from the very limited scientific evidence available on the repair of incisional hernias. The present review now aims to critically assess the data available on the sublay/retro-rectus technique for repair of incisional hernia. Materials and Methods: A systematic search of the literature was performed in May 2018 using Medline, PubMed, and the Cochrane Library. This article is based on 77 publications. Results: The number of available RCTs that permit evaluation of the role of the sublay/retro-rectus technique in the repair of only incisional hernia is very small. The existing data suggest that the sublay/retro-rectus technique has disadvantages compared with the laparoscopic IPOM technique for repair of incisional hernia, but in that respect has advantages over all other open techniques. However, the few existing studies provide only a limited level of evidence for assessment purposes. Conclusion: Further RCTs based on a standardized technique are urgently needed for evaluation of the role of the sublay/retro-rectus incisional hernia repair technique.
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Affiliation(s)
- Ferdinand Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Berlin, Germany
| | - Christine Schug-Pass
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Berlin, Germany
| | - Hubert Scheuerlein
- Department of General and Visceral Surgery, St. Vinzenz Hospital, Paderborn, Germany
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