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Berrevoet F. Tailoring our preoperative optimization and surgical strategy seems the key in managing the complex hernia patient. Hernia 2024:10.1007/s10029-024-03058-0. [PMID: 38703284 DOI: 10.1007/s10029-024-03058-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 04/21/2024] [Indexed: 05/06/2024]
Affiliation(s)
- F Berrevoet
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
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Dries P, Verstraete B, Allaeys M, Van Hoef S, Eker H, Berrevoet F. Anterior versus posterior component separation technique for advanced abdominal wall reconstruction: a proposed algorithm. Hernia 2024:10.1007/s10029-024-03039-3. [PMID: 38652204 DOI: 10.1007/s10029-024-03039-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 04/03/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE The precise indications for employing the anterior component separation technique (ACST) and the Transversus Abdominis Release (TAR) in abdominal wall reconstruction (AWR) remain uncertain, despite the undeniable value of both techniques. The aim of this study was to analyze the anterior fascial closure rate, postoperative wound morbidity, and hernia recurrence rate for both procedures according to the algorithm used for complex AWR. METHODS A retrospective analysis of prospectively collected data was carried out. Patients undergoing AWR for midline incisional hernias using either open or endoscopic ACST (E-ACST) or TAR between March 2013 and August 2022 were included. Patients with lateral hernia components were excluded. The surgical technique was depending on the pre- and intraoperative findings regarding hernia width and on the estimated traction to achieve anterior fascial closure (see algorithm). Initially, intermediate hernia defects ranging from approximately 10-14 cm in width were repaired using E-ACST. However, as the study advanced, TAR became the preferred method for addressing these types of defects. Open ACST was consistently employed for defects wider than 14-15 cm throughout the entire study duration. Outcomes of interest were anterior fascial closure, surgical site occurrences, and hernia recurrence rate. Follow-up was performed at 1 month, 1 year, and 2 years. RESULTS A total of 119 patients underwent AWR with CST: 63 patients (52.9%) were included in the ACST group and 56 patients (47.1%) in the TAR group. No significant differences were observed in patient and hernia characteristics. The use of botulinum toxin A (BTA) injection and preoperative progressive pneumoperitoneum (PPP) was more frequently used in the ACST group (BTA 19.0%, PPP 15.9% versus BTA 5.4%, PPP 1.8% for TAR patients). Anterior fascial closure was achieved in 95.2% of the ACST group and 98.2% of the TAR group (p = 0.369). The TAR group demonstrated a significantly lower SSO rate at one month (44.3% versus 14.3%, p < 0.001) and required fewer procedural interventions (SSO-PI) (31.1% versus 8.9%, p = 0.003). The recurrence rate at one year was low and there was no statistically significant difference between the two groups (ACST 1.8% vs TAR 4.5%, p = 0.422). CONCLUSION Following a proposed algorithm, the anterior fascial closure rate was high and similar for both techniques. As postoperative wound morbidity is significantly increased after ACST, our findings support recommending TAR for defects up to 14 cm in width, while favoring open ACST for larger defects.
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Affiliation(s)
- P Dries
- Department for General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium.
| | - B Verstraete
- Department for General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - M Allaeys
- Department for General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - S Van Hoef
- Department for General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - H Eker
- Department for General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - F Berrevoet
- Department for General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
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Vierstraete M, Molnar A, Berrevoet F. Open intraperitoneal onlay mesh repair with anterior component separation as a bail-out procedure in the management of complex hernias. Hernia 2024:10.1007/s10029-024-03033-9. [PMID: 38642316 DOI: 10.1007/s10029-024-03033-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 03/28/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE Surgical repair of complex abdominal wall hernias remains technically demanding and is widely recognized as a risk factor for unfavorable outcomes with high recurrence and morbidity rates. The objective is to assess short- and long-term complications after open intraperitoneal onlay mesh (IPOM) repair combined with bilateral anterior component separation (ACS) for large and difficult incisional hernias, alongside evaluating hernia recurrence rates. METHODS This retrospective analysis utilized data sourced from Hospital electronic health records and a prospective database at an academic tertiary referral center. Data collection was carried out from patients operated between January 2006 and December 2017. Eligible patients had complex incisional hernias measuring at least 10 cm in their transverse diameter and had an open IPOM repair with bilateral ACS. RESULTS In our study group of 45 patients, the 30-day surgical site occurrence (SSO) rate was high (37.8%), primarily consisting of superficial postoperative complications as seroma (17.8%) and wound dehiscence (6.7%). Among six patients (13.3%), wound complications escalated to chronic infected mesh-related problems, leading to complete mesh removal in four cases (8.9%) and partial mesh removal in two cases (4.4%). Regarding long-term complications, five patients (11.1%) developed enterocutaneous fistula. The recurrence rate was modest [5 out of 41 (12.2%)] over a median follow-up period of 99 months. CONCLUSIONS Despite a high SSO rate, application of the open IPOM technique with ACS could serve as a valuable rescue option for managing large and complex hernias, with acceptable hernia recurrence rates at long-term follow-up.
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Affiliation(s)
- M Vierstraete
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium.
| | - A Molnar
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - F Berrevoet
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
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Berrevoet F, van Cauteren L, Gunja N, Danker WA, Schmitz ND, Tomaszewski J, Stern L, Chandak A. Clinical outcomes of triclosan-coated barbed suture in open hernia repair: a retrospective cohort study. Hernia 2024:10.1007/s10029-024-03012-0. [PMID: 38609582 DOI: 10.1007/s10029-024-03012-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/01/2024] [Indexed: 04/14/2024]
Abstract
PURPOSE We assessed clinical outcomes of patients undergoing open hernia repair using STRATAFIX™ Symmetric, a barbed triclosan-coated suture (TCS; Ethicon), versus conventional polydioxanone suture (PDS) for abdominal wall closure. METHODS This single-center retrospective cohort study identified patients undergoing hernia repair. The site used PDS from 2013 to 2016 and switched exclusively to barbed TCS in 2017. Outcomes were assessed at 30, 60, and 90 days. Multivariate regression analyses and Cox proportional hazards models were used. RESULTS Of 821 hernia repairs, 446 used barbed TCS and 375 used conventional PDS. Surgical site infections (SSIs) were significantly less frequent with barbed TCS (60 days, 5.9% vs. 11.4%; P = 0.0083; 90 days, 5.9% vs. 11.7%; P = 0.006) and this remained consistent after multivariate adjustment (60 days, OR [95% CI]: 0.5 [0.3-0.9]; 90 days, 0.5 [0.3-0.9]). Among patients with SSI, deep SSIs were less frequent with barbed TCS (60 days, 9.1% vs. 35.7%; P = 0.022; 90 days, 9.1% vs. 34.9%; P = 0.0252). Barbed TCS significantly reduced the risk of perioperative complications (HR [95% CI]: 0.5[0.3-0.8]; P = 0.0058). Hospital length of stay was 2.5 days shorter with barbed TCS (mean [95% CI]: 5.7[4.9-6.6] vs. 8.2[7.3-9.1] days; P < 0.0001). No differences in reoperation rate over time were observed by type of suture (HR[95% CI]:1.3 [0.5-3.4]; P = 0.4793). CONCLUSIONS This study showed that patients who underwent open hernia repair appeared to recover equally well regardless of the suture type. In addition, the use of barbed TCS was associated with significantly reduced risk of perioperative complications and hospital length of stay.
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Affiliation(s)
- F Berrevoet
- University Hospital Gent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - L van Cauteren
- University Hospital Gent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - N Gunja
- Ethicon Inc., 1000 US-202, Raritan, NJ, 08869, USA
| | - W A Danker
- Ethicon Inc., 1000 US-202, Raritan, NJ, 08869, USA
| | - N-D Schmitz
- Ethicon Inc., 1000 US-202, Raritan, NJ, 08869, USA
| | | | - L Stern
- Certara, 100 Overlook Center, Suite 101, Princeton, NJ, 08540, USA
| | - A Chandak
- Certara, 100 Overlook Center, Suite 101, Princeton, NJ, 08540, USA.
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Allaeys M, Visscher L, den Hartog FPJ, Dries P, Tanis PJ, Theeuwes HP, Berrevoet F, Eker HH. Strength of small-bites abdominal wall closure using different suturing methods and materials in an experimental animal model. Hernia 2024; 28:527-535. [PMID: 38212505 DOI: 10.1007/s10029-023-02945-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/08/2023] [Indexed: 01/13/2024]
Abstract
PURPOSE Using small instead of large bites for laparotomy closure results in lower incidence of incisional hernia, but no consensus exists on which suture material to use. This study aimed to compare five different closure strategies in a standardized experimental setting. METHODS Fifty porcine abdominal walls were arranged into 5 groups: (A) running 2/0 polydioxanone; (B) interlocking 2/0 polydioxanone; (C) running size 0 barbed polydioxanone; (D) running size 0 barbed glycolic acid and trimethylene carbonate; (E) running size 0 suturable polypropylene mesh. The small-bites technique was used for linea alba closure in all. The abdominal walls were divided into a supra- and infra-umbilical half, resulting in 20 specimens per group that were pulled apart in a tensile testing machine. Maximum tensile force and types of suture failure were registered. RESULTS The highest tensile force was measured when using barbed polydioxanone (334.8 N ± 157.0), but differences did not reach statistical significance. Infra-umbilical abdominal walls endured a significantly higher maximum tensile force compared to supra-umbilical (397 N vs 271 N, p < 0.001). Barbed glycolic acid and trimethylene carbonate failed significantly more often (25% vs 0%, p = 0.008). CONCLUSION Based on tensile force, both interlocking and running suture techniques using polydioxanone, and running sutures using barbed polydioxanone or suturable mesh, seem to be suitable for abdominal wall closure. Tensile strength was significantly higher in infra-umbilical abdominal walls compared to supra-umbilical. Barbed glycolic acid and trimethylene carbonate should probably be discouraged for fascial closure, because of increased risk of suture failure.
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Affiliation(s)
- M Allaeys
- Department of General and HPB Surgery and Liver Transplantation, University Hospital Ghent, Ghent, Belgium.
| | - L Visscher
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
- Surgical SkillsLab, Department of Neuroscience and Anatomy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - F P J den Hartog
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - P Dries
- Department of General and HPB Surgery and Liver Transplantation, University Hospital Ghent, Ghent, Belgium
| | - P J Tanis
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - H P Theeuwes
- Surgical SkillsLab, Department of Neuroscience and Anatomy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Trauma Surgery, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
| | - F Berrevoet
- Department of General and HPB Surgery and Liver Transplantation, University Hospital Ghent, Ghent, Belgium
| | - H H Eker
- Department of General and HPB Surgery and Liver Transplantation, University Hospital Ghent, Ghent, Belgium
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Van den Dop LM, Van Rooijen MMJ, Tollens T, Jørgensen LN, De Vries-Reilingh TS, Piessen G, Köckerling F, Miserez M, Dean M, Berrevoet F, Dousset B, Van Westreenen HL, Gossetti F, Tetteroo GWM, Koch A, Boomsma MF, Lange JF, Jeekel J. Five-Year Follow-Up of a Slowly Resorbable Biosynthetic P4HB Mesh (Phasix) in VHWG Grade 3 Incisional Hernia Repair. Ann Surg Open 2023; 4:e366. [PMID: 38144487 PMCID: PMC10735126 DOI: 10.1097/as9.0000000000000366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/02/2023] [Indexed: 12/26/2023] Open
Abstract
Objective To assess the 5-year recurrence rate of incisional hernia repair in Ventral Hernia Working Group (VHWG) 3 hernia with a slowly resorbable mesh. Summary Background Data Incisional hernia recurs frequently after initial repair. In potentially contaminated hernia, recurrences rise to 40%. Recently, the biosynthetic Phasix mesh has been developed that is resorbed in 12-18 months. Resorbable meshes might be a solution for incisional hernia repair to decrease short- and long-term (mesh) complications. However, long-term outcomes after resorption are scarce. Methods Patients with VHWG grade 3 incisional midline hernia, who participated in the Phasix trial (Clinilcaltrials.gov: NCT02720042) were included by means of physical examination and computed tomography (CT). Primary outcome was hernia recurrence; secondary outcomes comprised of long-term mesh complications, reoperations, and abdominal wall pain [visual analogue score (VAS): 0-10]. Results In total, 61/84 (72.6%) patients were seen. Median follow-up time was 60.0 [interquartile range (IQR): 55-64] months. CT scan was made in 39 patients (68.4%). A recurrence rate of 15.9% (95% confidence interval: 6.9-24.8) was calculated after 5 years. Four new recurrences (6.6%) were found between 2 and 5 years. Two were asymptomatic. In total, 13/84 recurrences were found. No long-term mesh complications and/or interventions occurred. VAS scores were 0 (IQR: 0-2). Conclusions Hernia repair with Phasix mesh in high-risk patients (VHWG 3, body mass index >28) demonstrated a recurrence rate of 15.9%, low pain scores, no mesh-related complications or reoperations for chronic pain between the 2- and 5-year follow-up. Four new recurrences occurred, 2 were asymptomatic. The poly-4-hydroxybutyrate mesh is a safe mesh for hernia repair in VHWG 3 patients, which avoids long-term mesh complications like pain and mesh infection.
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Affiliation(s)
- L M Van den Dop
- From the Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - M M J Van Rooijen
- From the Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - T Tollens
- Department of Surgery, Imelda Hospital, Bonheiden, Belgium
| | - L N Jørgensen
- Department of Surgery, Bispebjerg Hospital, Copenhagen, Denmark
| | | | - G Piessen
- Department of Surgery, University Hospital Lille, Lille, France
| | - F Köckerling
- Department of Surgery, Vivantes Klinikum Spandau, Berlin, Germany
| | - M Miserez
- Department of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium
| | - M Dean
- Department of Surgery, University College London Hospital, London, United Kingdom
| | - F Berrevoet
- Department of Surgery, University Hospital Gent, Gent, Belgium
| | - B Dousset
- Department of Surgery, Hôpital Cochin, Paris, France
| | | | - F Gossetti
- Department of Surgery, Università di Roma Sapienza, Rome, Italy
| | - G W M Tetteroo
- Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, the Netherlands
| | - A Koch
- Department of Surgery, Chirurgische Praxis Ärztehaus, Cottbus, Germany
| | - M F Boomsma
- Department of Radiology, Isala hospital, Zwolle, the Netherlands
| | - J F Lange
- From the Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - J Jeekel
- From the Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
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Balakrishnan A, Jah A, Lesurtel M, Andersson B, Gibbs P, Harper SJF, Huguet EL, Kosmoliaptsis V, Liau SS, Praseedom RK, Ramia JM, Branes A, Lendoire J, Maithel S, Serrablo A, Achalandabaso M, Adham M, Ahmet A, Al-Sarireh B, Albiol Quer M, Alconchel F, Alejandro R, Alsammani M, Alseidi A, Anand A, Anselmo A, Antonakis P, Arabadzhieva E, de Aretxabala X, Aroori S, Ashley S, Ausania F, Banerjee A, Barabino M, Bartlett A, Bartsch F, Belli A, Beristain-Hernandez J, Berrevoet F, Bhatti A, Bhojwani R, Bjornsson B, Blaz T, Byrne M, Calvo M, Castellanos J, Castro M, Cavallucci D, Chang D, Christodoulis G, Ciacio O, Clavien P, Coker A, Conde-Rodriguez M, D'Amico F, D'Hondt M, Daams F, Dasari B, De Beillis M, de Meijer V, Dede K, Deiro G, Delgado F, Desai G, Di Gioia A, Di Martino M, Dixon M, Dorovinis P, Dumitrascu T, Ebata T, Eilard M, Erdmann J, Erkan M, Famularo S, Felli E, Fergadi M, Fernandez G, Fox A, Galodha S, Galun D, Ganandha S, Garcia R, Gemenetzis G, Giannone F, Gil L, Giorgakis E, Giovinazzo F, Giuffrida M, Giuliani T, Giuliante F, Gkekas I, Goel M, Goh B, Gomes A, Gruenberger T, Guevara O, Gulla A, Gupta A, Gupta R, Hakeem A, Hamid H, Heinrich S, Helton S, Heumann A, Higuchi R, Hughes D, Inarejos B, Ivanecz A, Iwao Y, Iype S, Jaen I, Jie M, Jones R, Kacirek K, Kalayarasan R, Kaldarov A, Kaman L, Kanhere H, Kapoor V, Karanicolas P, Karayiannakis A, Kausar A, Khan Z, Kim DS, Klose J, Knowles B, Koh P, Kolodziejczyk P, Komorowski A, Koong J, Kozyrin I, Krishna A, Kron P, Kumar N, van Laarhoven S, Lakhey P, Lanari J, Laurenzi A, Leow V, Limbu Y, Liu YB, Lob S, Lolis E, Lopez-Lopez V, Lozano R, Lundgren L, Machairas M, Magouliotis D, Mahamid A, Malde D, Malek A, Malik H, Malleo G, Marino M, Mayo S, Mazzola M, Memeo R, Menon K, Menzulin R, Mohan R, Morgul H, Moris D, Mulita F, Muttillo E, Nahm C, Nandasena M, Nashidengo P, Nickkholgh A, Nikov A, Noel C, O'Reilly D, O'Rourke T, Ohtsuka M, Omoshoro-Jones J, Pandanaboyana S, Pararas N, Patel R, Patkar S, Peng J, Perfecto A, Perinel J, Perivoliotis K, Perra T, Phan M, Piccolo G, Porcu A, Primavesi F, Primrose J, Pueyo-Periz E, Radenkovic D, Rammohan A, Rowcroft A, Sakata J, Saladino E, Schena C, Scholer A, Schwarz C, Serrano P, Silva M, Soreide K, Sparrelid E, Stattner S, Sturesson C, Sugiura T, Sumo M, Sutcliffe R, Teh C, Teo J, Tepetes K, Thapa P, Thepbunchonchai A, Torres J, Torres O, Torzili G, Tovikkai C, Troncoso A, Tsoulfas G, Tuzuher A, Tzimas G, Umar G, Urbani L, Vanagas T, Varga, Velayutham V, Vigano L, Wakai T, Yang Z, Yip V, Zacharoulis D, Zakharov E, Zimmitti G. Heterogeneity of management practices surrounding operable gallbladder cancer - results of the OMEGA-S international HPB surgical survey. HPB (Oxford) 2022; 24:2006-2012. [PMID: 35922277 DOI: 10.1016/j.hpb.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/22/2022] [Accepted: 06/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gallbladder cancer (GBC) is an aggressive, uncommon malignancy, with variation in operative approaches adopted across centres and few large-scale studies to guide practice. We aimed to identify the extent of heterogeneity in GBC internationally to better inform the need for future multicentre studies. METHODS A 34-question online survey was disseminated to members of the European-African Hepatopancreatobiliary Association (EAHPBA), American Hepatopancreatobiliary Association (AHPBA) and Asia-Pacific Hepatopancreatobiliary Association (A-PHPBA) regarding practices around diagnostic workup, operative approach, utilization of neoadjuvant and adjuvant therapies and surveillance strategies. RESULTS Two hundred and three surgeons responded from 51 countries. High liver resection volume units (>50 resections/year) organised HPB multidisciplinary team discussion of GBCs more commonly than those with low volumes (p < 0.0001). Management practices exhibited areas of heterogeneity, particularly around operative extent. Contrary to consensus guidelines, anatomical liver resections were favoured over non-anatomical resections for T3 tumours and above, lymphadenectomy extent was lower than recommended, and a minority of respondents still routinely excised the common bile duct or port sites. CONCLUSION Our findings suggest some similarities in the management of GBC internationally, but also specific areas of practice which differed from published guidelines. Transcontinental collaborative studies on GBC are necessary to establish evidence-based practice to minimise variation and optimise outcomes.
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Affiliation(s)
- Anita Balakrishnan
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom.
| | - Asif Jah
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Mickael Lesurtel
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, University of Paris Cité, 100 Bd du Général Leclerc, 92110, Clichy, France
| | - Bodil Andersson
- Department of Surgery, Lund University, Skane University Hospital, Lund, Sweden
| | - Paul Gibbs
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Simon J F Harper
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Emmanuel L Huguet
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Vasilis Kosmoliaptsis
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Siong S Liau
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Raaj K Praseedom
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Jose M Ramia
- Department of Surgery, Hospital General Universitario de Alicante, Avenida Pintor Baeza, 12 03010 Alicante, Spain
| | - Alejandro Branes
- Department of HPB Surgery, Hospital Sotero del Rio, Av. Concha y Toro 3459, Puente Alto, Región Metropolitana, Chile
| | - Javier Lendoire
- Department of Surgery, University of Buenos Aires, Hospital Dr Cosme Argerich, Buenos Aires, Argentina
| | - Shishir Maithel
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, 30322 USA
| | - Alejandro Serrablo
- Department of HPB Surgery, Miguel Servet University Hospital, Zaragoza, Spain
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Van Den Dop M, Tollens T, Jørgensen L, De Vries-Reilingh T, Piessen G, Köckerling F, Miserez M, Dean M, Berrevoet F, Dousset B, Van Westreenen G, Gosetti F, Lange J, Tetteroo G, Jeekel H. OC-053 LONG-TERM FOLLOW-UP OF A SLOWLY RESORBABLE BIOSYNTHETIC MESH IN VHWG GRADE 3 HERNIA REPAIR. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Incisional hernia recurrence occurs frequently after initial repair. In potentially contaminated hernia, these numbers can rise up to 50%. Recently, resorbable meshes have been used to prevent infection in complicated incisional hernia and prevent long term mesh complications. Present study focuses on the long term outcomes of a resorbable mesh.
Methods
Patients included in the priorly conducted Phasix trial with Ventral Hernia Working Group (VHWG) grade 3 hernia were invited for an abdominal CT scan and physical examination. Primary outcome was hernia recurrence, secondary outcomes comprised of abdominal wall configuration, mesh resorption and long term mesh complications.
Results
Of the 84 patients included in the 2-year follow-up, 56 were available for long term follow-up up to five years. Mean follow-up time was 4.2 years. CT scan was made in 36 (64.3%) of patients. Kaplan-Meier analysis showed a recurrence rate of 16.7% after five years. Four (7.1%) new recurrences were found between 2-year and 4.2 years follow-up of which three by CT scan. In 50% of CT scans, no signs of postoperative distortions of the abdominal wall were observed. No long term mesh complications were reported.
Conclusion
After long term follow-up, VHWG 3 hernia repair with biosynthetic mesh demonstrated good performance with regard to hernia recurrence. Possibly, tissue reconstruction took place in the first two years after implantation by the use it or lose it principle, which led to sufficient native abdominal wall strength to prevent recurrences after resorption of the mesh.
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Affiliation(s)
- M Van Den Dop
- Surgery, Erasmus University Medical Centre , Rotterdam , Netherlands
| | - T Tollens
- Surgery, Imelda hospital , Bonheiden , Belgium
| | - L Jørgensen
- Surgery, Bispebjerg Hospital , Copenhagen , Denmark
| | | | - G Piessen
- Surgery, University Hospital Lille , Lille , France
| | - F Köckerling
- Surgery, Vivantes Klinikum Spandau , Berlin , Germany
| | - M Miserez
- Abdominal Surgery, University Hospital Leuven , Leuven , Belgium
| | - M Dean
- Surgery, University College London Hospital , London , United Kingdom
| | - F Berrevoet
- Surgery, University Hospital Gent , Gent , Belgium
| | - B Dousset
- Digsetive, hepatobiliary and Endocrine surgery , Hôpital Cochin, Paris , France
| | | | - F Gosetti
- Surgery, Università di Roma Sapienza , Rome , Italy
| | - J Lange
- Surgery, Erasmus University Medical Centre , Rotterdam , Netherlands
| | - G Tetteroo
- Surgery, IJsselland hospital , Capelle aan den IJssel , Netherlands
| | - H Jeekel
- Surgery, Erasmus University Medical Centre , Rotterdam , Netherlands
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9
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Dewulf M, Muysoms F, Vierendeels T, Huyghe M, Miserez M, Ruppert M, Van Bergen L, Berrevoet F, Detry O. OC-057 PREVENTION OF INCISIONAL HERNIAS BY PROPHYLACTIC MESH-AUGMENTED REINFORCEMENT OF MIDLINE LAPAROTOMIES FOR ABDOMINAL AORTIC ANEURYSM TREATMENT. 5-YEAR FOLLOW-UP OF A RANDOMIZED CONTROLLED TRIAL. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
The incidence of incisional hernias (IHs) after open repair of an abdominal aortic aneurysm (AAA) is high. Several randomized controlled trials have reported favorable results with the use of prophylactic mesh to prevent IHs, without increasing complications. In this analysis we report on the results of the 60-month follow-up of the PRIMAAT trial (Ann Surg 2016; 263(4): 638–45).
Methods
In a prospective, multicenter, open label, randomized design, patients were randomized between prophylactic retrorectus mesh reinforcement (MESH group), and primary closure of their midline laparotomy after open AAA repair (NOMESH group). This article reports on the results of clinical follow-up after 60 months. If performed, ultrasonography or computed tomography were used for the diagnosis of IHs.
Results
Of the 120 randomized patients, 114 were included in the intention-to-treat analysis. Thirty-three patients in the NOMESH group (33/58–56.9%) and 34 patients in the MESH group (34/56–60.7%) were evaluated after 5 years. The cumulative incidence of IHs in the NOMESH group was 32.9% after 24 months and 49.2% after 60 months. No incisional hernias were diagnosed in the MESH group. In the NOMESH group, 21.7% (5/23) underwent reoperation within 5 years due to an IH.
Conclusion
Prophylactic retrorectus mesh reinforcement after midline laparotomy for the treatment of AAAs safely and effectively decreases the rate of IHs. The cumulative incidence of IHs after open AAA repair, when no mesh is used, continues to increase during the first 5 years after surgery, which leads to a substantial rate of hernia repairs.
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Affiliation(s)
- M Dewulf
- Surgery, MUMC+ , Maastricht , Netherlands
| | - F Muysoms
- Surgery , AZ Maria Middelares, Gent , Belgium
| | | | - M Huyghe
- Surgery , AZ Monica, Antwerpen , Belgium
| | - M Miserez
- Surgery , UZ Leuven, Leuven , Belgium
| | | | | | | | - O Detry
- Surgery , CHU, Liege , Belgium
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10
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Vandenheede M, Miserez M, Jorgensen LN, Berrevoet F. OC-033 SLOWLY RESORBABLE VERSUS PERMANENT SYNTHETIC MESH IN OPEN RETROMUSCULAR VENTRAL HERNIA REPAIR - 3 YEAR RESULTS OF A RANDOMIZED CONTROLLED TRIAL. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
Implantation of synthetic meshes provides long-term hernia repair, but may result in mesh-related complications. The longterm resorbable mesh used in this study maintains more than 50% of its strength for 6 months and is completely resorbed after 3 years.
Methods
This multi-centre, randomized controlled trial compared the use of the TIGR® Matrix Surgical Mesh (Novus Scientific, Sweden) with a large-pore polypropylene mesh (Soft®mesh, BD, UK) in primary ventral and incisional hernia repair. Retromuscular mesh repair was performed. Primary endpoint was hernia recurrence rate after a 3 year follow-up period. Secondary endpoints were hernia recurrence rate at 1 year and 2 years, as well as perioperative morbidity and longterm complications including pain.
Results
Seventy-nine patients were included, but 69 patients received study treatment. Fifty-seven patients (82.6%) completed follow-up of 3 years. One patient (2.9%) developed a seroma after hernia repair with TIGR mesh. Three patients had a reintervention for hematoma (8.6%) in the control group versus two reinterventions (5.9%) after repair with TIGR mesh (p=0.673. One patient underwent late re-operation and mesh removal after hernia repair with TIGR mesh due to chronic wound infection. During three years follow-up, seven (10.1%) patients experienced a hernia recurrence, two (5.7%) in the control group and five (14.7%) after TIGR mesh (p=0.15).
Conclusion
Although not statistically significant, this multicentric RCT showed a higher recurrence rate for longterm degradable mesh patients after 3 years of follow-up. These results call for larger studies with long-term follow-up comparing slowly resorbable mesh materials with permanent mesh products.
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Affiliation(s)
- M Vandenheede
- General and HPB Surgery and Liver Transplantation, Ghent University Hospital , Ghent , Belgium
| | - M Miserez
- Dept. of Abdominal Surgery, Catholic University Leuven , Leuven , Belgium
| | - L N Jorgensen
- Dept. of Surgery, Bispebjerg Hospital, University of Copenhagen , Copenhagen , Denmark
| | - F Berrevoet
- General and HPB Surgery and Liver Transplantation, Ghent University Hospital , Ghent , Belgium
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11
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Berrevoet F, Gunja N, Danker W, Schmitz ND, Tomaszewski J, Stern L, Chandak A, Van Cauteren L. P-142 CLINICAL AND ECONOMIC OUTCOMES OF ABSORBABLE KNOTLESS BARBED SUTURE VERSUS OTHER CONVENTIONAL SUTURES FOR ABDOMINAL MIDLINE CLOSURE IN PATIENTS UNDERGOING OPEN HERNIA REPAIRS. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
We assessed clinical and economic outcomes of patients undergoing open hernia repair using absorbable knotless barbed suture versus conventional absorbable suture for abdominal wall closure.
Methods
This retrospective cohort study identified patients undergoing hernia repair at a single center between 2013 and 2020. Fixed follow-up of 30, 60, and 90 days were used to assess outcomes (peri-operative complications, and resource utilization). Multivariate analyses for outcomes and Cox Proportional Hazards models for time to readmission and complications were conducted.
Results
Of 821 hernia repairs, 446 used absorbable knotless barbed suture and 375 used conventional absorbable suture. Baseline characteristics were largely similar between the groups. Surgical site infections (SSI) were significantly less frequent with absorbable knotless barbed suture (60-day, 5.9% vs. 11.4%; P=0.0083; 90-day, 5.9% vs. 11.7%; P=0.006) and remained consistent after multivariate adjustment (60-day, OR [95% CI]: 0.52 [0.29–0.92]; 90-day, 0.51 [0.28–0.90]). Among patients with SSI, deep SSI were less frequent with absorbable knotless barbed suture (60-day, 9.1% vs. 35.7%; P=0.022; 90-day, 9.1% vs. 34.9%; P=0.0252). Absorbable knotless barbed suture significantly reduced the risk of peri-operative complications over time (HR 0.57 [95% CI 0.36–0.92]; P=0.0203). Hospital length of stay was, on average, 2.74 days longer in conventional absorbable suture patients (mean [95% CI] 8.75 [7.83–9.78] vs. 6.01 [5.16–6.99] days; P<.0001).
Conclusions
Significant differences between sutures were seen with peri-operative infections, which occurred less frequently with absorbable knotless barbed suture and less severe. Peri-operative complications and length of stay were significantly reduced with absorbable knotless barbed suture.
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Affiliation(s)
- F Berrevoet
- General and HPB Surgery and Liver Transplantation, University Hospital Gent , Gent , Belgium
| | - N Gunja
- Health Economics and Market Access , J&J MedTech, Raritan , United States
| | - W Danker
- Health Economics and Market Access , J&J MedTech, Raritan , United States
| | - N D Schmitz
- Medical Affairs , J&J MedTech, Raritan , United States
| | - J Tomaszewski
- Medical Affairs , J&J MedTech, Raritan , United States
| | - L Stern
- Evidence and Access , Certara, New York , United States
| | - A Chandak
- Evidence and Access , Certara, New York , United States
| | - L Van Cauteren
- General and HPB Surgery and Liver Transplantation, University Hospital Gent , Gent , Belgium
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12
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Wouters D, Cavallaro G, Jensen KK, East B, Jíšová B, Jorgensen LN, López-Cano M, Rodrigues-Gonçalves V, Stabilini C, Berrevoet F. The European Hernia Society Prehabilitation Project: A Systematic Review of Intra-Operative Prevention Strategies for Surgical Site Occurrences in Ventral Hernia Surgery. Front Surg 2022; 9:847279. [PMID: 35910469 PMCID: PMC9326087 DOI: 10.3389/fsurg.2022.847279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 06/06/2022] [Indexed: 11/29/2022] Open
Abstract
Background Ventral hernia repair is one of the most commonly performed surgical procedures worldwide. To reduce the risk of complications, pre- and intra-operative strategies have received increasing focus in recent years. To assess possible preventive surgical strategies, this European Hernia Society endorsed project was launched. The aim of this review was to evaluate the current literature focusing on pre- and intra-operative strategies for surgical site occurrences (SSO) and specifically surgical site infection (SSI) in ventral hernia repair. Methods A systematic review was conducted and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Databases used were Pubmed and Web of Science. Original retrospective or prospective human adult studies describing at least one intra-operative intervention to reduce SSO after ventral hernia repair were considered eligible. Results From a total of 4775 results, a total of 18 papers were considered suitable after full text reading. Prehospital chlorhexidine gluconate (CHG) scrub appears to increase the risk of SSO in patients undergoing ventral hernia repair, while there is no association between any type of surgical hat worn and the incidence of postoperative wound events. Intraoperative measures as prophylactic negative pressure therapy, surgical drain placement and the use of quilt sutures seem beneficial for decreasing the incidence of SSO and/or SSI. No positive effect has been shown for antibiotic soaking of a synthetic mesh, nor for the use of fibrin sealants. Conclusion This review identified a limited amount of literature describing specific preventive measures and techniques during ventral hernia repair. An advantage of prophylactic negative pressure therapy in prevention of SSI was observed, but different tools to decrease SSIs and SSOs continuously further need our full attention to improve patient outcomes and to lower overall costs.
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Affiliation(s)
- D. Wouters
- Department for General and HPB Surgery and Liver Transplantation, University Hospital Gent, Gent, Belgium
| | - G. Cavallaro
- Department for General and HPB Surgery and Liver Transplantation, University Hospital Gent, Gent, Belgium
| | - Kristian K. Jensen
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - B. East
- 3rd Department of Surgery and 1st Medical Faculty of Charles University, Motol University Hospital, Prague, Czech Republic
| | - B. Jíšová
- 3rd Department of Surgery and 1st Medical Faculty of Charles University, Motol University Hospital, Prague, Czech Republic
| | - L. N. Jorgensen
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - M. López-Cano
- Abdominal Wall Surgery Unit, Department of General Surgery, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - V. Rodrigues-Gonçalves
- Abdominal Wall Surgery Unit, Department of General Surgery, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - C. Stabilini
- Department of Surgery, University of Genoa, Genoa, Italy
- European Hernia Society, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - F. Berrevoet
- Department for General and HPB Surgery and Liver Transplantation, University Hospital Gent, Gent, Belgium
- Correspondence: Frederik Berrevoet
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13
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Jensen KK, East B, Jisova B, Cano ML, Cavallaro G, Jørgensen LN, Rodrigues V, Stabilini C, Wouters D, Berrevoet F. The European Hernia Society Prehabilitation Project: a systematic review of patient prehabilitation prior to ventral hernia surgery. Hernia 2022; 26:715-726. [PMID: 35212807 DOI: 10.1007/s10029-022-02573-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 01/23/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND Ventral hernia repair is one of the most commonly performed surgical procedures worldwide. To reduce the risk of complications, patient prehabilitation has received increasing focus in recent years. To assess prehabilitation measures, this European Hernia Society endorsed project was launched. The aim of this systematic review was to evaluate the current literature on patient prehabilitation prior to ventral hernia repair. METHODS The strategies examined were optimization of renal disease, obesity, nutrition, physical exercise, COPD, diabetes and smoking cessation. For each topic, a separate literature search was conducted, allowing for seven different sub-reviews. RESULTS A limited amount of well-conducted research studies evaluating prehabilitation prior to ventral hernia surgery was found. The primary findings showed that smoking cessation and weight loss for obese patients led to reduced risks of complications after abdominal wall reconstruction. CONCLUSION Prehabilitation prior to ventral hernia repair may be widely used; however, the literature supporting its use is limited. Future studies evaluating the impact of prehabilitation before ventral hernia surgery are warranted.
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Affiliation(s)
- K K Jensen
- Digestive Disease Center, Bispebjerg University Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark.
| | - B East
- 3rd Department of Surgery and 1st Medical Faculty of Charles University, Motol University Hospital, Prague, Czech Republic
| | - B Jisova
- 3rd Department of Surgery and 1st Medical Faculty of Charles University, Motol University Hospital, Prague, Czech Republic
| | - M López Cano
- Abdominal Wall Surgery Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - G Cavallaro
- Department of Surgery "P. Valdoni", Sapienza University, Rome, Italy
| | - L N Jørgensen
- Digestive Disease Center, Bispebjerg University Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
| | - V Rodrigues
- Abdominal Wall Surgery Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - C Stabilini
- Department of Surgery, University of Genoa, Genoa, Italy
- Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - D Wouters
- Department for General and HPB Surgery and Liver Transplantation, University Hospital Gent, Gent, Belgium
| | - F Berrevoet
- Department for General and HPB Surgery and Liver Transplantation, University Hospital Gent, Gent, Belgium
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14
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Beckers Perletti L, Spoelders F, Berrevoet F. Association between surgical hernia repair techniques and the incidence of seroma-Authors' reply. Hernia 2022; 26:1217-1218. [PMID: 35357596 DOI: 10.1007/s10029-022-02607-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 03/19/2022] [Indexed: 11/26/2022]
Affiliation(s)
- L Beckers Perletti
- Faculty of Medicine and Medical Sciences, Ghent University, Ghent, Belgium.
| | - F Spoelders
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - F Berrevoet
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
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15
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Roeyen G, Berrevoet F, Borbath I, Geboes K, Peeters M, Topal B, Van Cutsem E, Van Laethem JL. Expert opinion on management of pancreatic exocrine insufficiency in pancreatic cancer. ESMO Open 2022; 7:100386. [PMID: 35124465 PMCID: PMC8819032 DOI: 10.1016/j.esmoop.2022.100386] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/23/2021] [Accepted: 12/23/2021] [Indexed: 12/14/2022] Open
Affiliation(s)
- G Roeyen
- Department of Hepatobiliary Transplantation and Endocrine Surgery, Antwerp University Hospital and University of Antwerp, Edegem.
| | - F Berrevoet
- Department of General and Hepatobiliary Surgery, Ghent University Hospital, Ghent
| | - I Borbath
- Hepato-Gastroenterology Unit, Cliniques Universitaires Saint-Luc, Brussels
| | - K Geboes
- Department of Gastroenterology, Division of Digestive Oncology, Ghent University Hospital, Ghent
| | - M Peeters
- Department of Oncology, Antwerp University Hospital and University of Antwerp, Edegem
| | - B Topal
- Department of Visceral Surgery, University Hospitals KU Leuven, Leuven
| | - E Van Cutsem
- Department of Gastroenterology/Digestive Oncology, University Hospital Leuven, University Hospitals Gasthuisberg Leuven and KU Leuven, Leuven
| | - J-L Van Laethem
- Department of Digestive Oncology, University Hospital Erasmus Brussels, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
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16
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Berrevoet F. Could full thickness skin grafts in an onlay position be the new gold standard for incisional hernia repair? Hernia 2022; 26:663-664. [PMID: 35099632 DOI: 10.1007/s10029-022-02575-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 01/19/2022] [Indexed: 11/26/2022]
Affiliation(s)
- F Berrevoet
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Gent, Belgium.
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17
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Stabilini C, Garcia-Urena MA, Berrevoet F, Cuccurullo D, Capoccia Giovannini S, Dajko M, Rossi L, Decaestecker K, López Cano M. An evidence map and synthesis review with meta-analysis on the risk of incisional hernia in colorectal surgery with standard closure. Hernia 2022; 26:411-436. [PMID: 35018560 DOI: 10.1007/s10029-021-02555-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/27/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE To assess the incidence of incisional hernia (IH) across various type of incisions in colorectal surgery (CS) creating a map of evidence to define research trends, gaps and areas of future interest. METHODS Systematic review of PubMed and Scopus from 2010 onwards. Studies included both open (OS) and laparoscopic (LS). The primary outcome was incidence of IH 12 months after index procedure, secondary outcomes were the study features and their influence on reported proportion of IH. Random effects models were used to calculate pooled proportions. Meta-regression models were performed to explore heterogeneity. RESULTS Ninetyone studies were included reporting 6473 IH. The pooled proportions of IH for OS were 0.35 (95% CI 0.27-0.44) I2 0% in midline laparotomies and 0.02 (95% CI 0.00-0.07), I2 52% for off-midline. In case of LS the pooled proportion of IH for midline extraction sites were 0.10 (95% CI 0.07-0.16), I2 58% and 0.04 (95% CI 0.03-0.06), I2 86% in case of off-midline. In Port-site IH was 0.02 (95% CI 0.01-0.04), I2 82%, and for single incision surgery (SILS) of 0.06-95% CI 0.02-0.15, I2 81%. In case of stoma reversal sites was 0.20 (95% CI 0.16-0.24). CONCLUSION Midline laparotomies and stoma reversal sites are at high risk for IH and should be considered in research of preventive strategies of closure. After laparoscopic approach IH happens mainly by extraction sites incisions specially midline and also represent an important area of analysis.
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Affiliation(s)
- C Stabilini
- Department of Surgery (DiSC), University of Genoa, IRCCS Policlinico San Martino, Genoa, Italy
| | - M A Garcia-Urena
- Faculty of Health Sciences, Francisco de Vitoria University, Henares University Hospital, Carretera Pozuelo-Majadahonda km 1,8, 28223, Pozuelo de Alarcón, Madrid, Spain.
| | - F Berrevoet
- Department of General and Hepatobiliary Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - D Cuccurullo
- Department of Surgery, Ospedale Monaldi-Azienda Ospedaliera dei Colli, Naples, Italy
| | - S Capoccia Giovannini
- Department of Surgery (DiSC), University of Genoa, IRCCS Policlinico San Martino, Genoa, Italy
| | - M Dajko
- Gastroenterology and Clinical Oncology Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - L Rossi
- Department of Surgery (DiSC), University of Genoa, IRCCS Policlinico San Martino, Genoa, Italy
| | - K Decaestecker
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - M López Cano
- Abdominal Wall Surgery Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Vall d'Hebron Research Institute General and Gastrointestinal Surgery Research Group, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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18
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Hernández-Granados P, Henriksen NA, Berrevoet F, Cuccurullo D, López-Cano M, Nienhuijs S, Ross D, Montgomery A. European Hernia Society guidelines on management of rectus diastasis. Br J Surg 2021; 108:1189-1191. [PMID: 34595502 PMCID: PMC10364860 DOI: 10.1093/bjs/znab128] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 03/21/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND The definition, classification and management of rectus diastasis (RD) are controversial in the literature and a variety of different surgical treatments have been described. This article reports on the European Hernia Society (EHS) Clinical Practice Guideline for RD. METHOD The Guideline group consisted of eight surgeons. The Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach and the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument were used. A systematic literature search was done in November 2018 and updated in November 2019 and October 2020. Nine Key Questions (KQs) were formulated. RESULTS Literature reporting on the definition, classification, symptoms, outcomes and treatments was limited in quality, leading to weak recommendations for the majority of the KQs. The main recommendation is to define RD as a separation between rectus muscles wider than 2 cm. A new classification system is suggested based on the width of muscle separation, postpregnancy status and whether or not there is a concomitant hernia. Impaired body image and core instability appear to be the most relevant symptoms. Physiotherapy may be considered before surgical management. It is suggested to use linea alba plication in patients without concomitant hernia and a mesh-based repair of RD with concomitant midline hernias. CONCLUSION RD should be defined as a separation of rectus muscles wider than 2 cm and a new classification system is suggested.
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Affiliation(s)
- P Hernández-Granados
- General Surgery Unit, Fundación Alcorcón University Hospital, Rey Juan Carlos University, Alcorcón, Spain
| | - N A Henriksen
- Department of Surgery, Gastro Unit, Herlev Hospital, Zealand University Hospital and University of Copenhagen, Copenhagen, Denmark
| | - F Berrevoet
- General and Hepatopancreatobiliary Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - D Cuccurullo
- Department of General, Laparoscopic and Robotic Surgery, AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - M López-Cano
- Abdominal Wall Surgery Unit, Val d'Hebrón University Hospital, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - S Nienhuijs
- Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - D Ross
- Department of Plastic Surgery, The London Clinic and St Thomas' Hospital, London, UK
| | - A Montgomery
- Surgical Department, Skåne University Hospital Malmö, Lund University, Sweden
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19
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Beel E, Berrevoet F. Surgical treatment for chronic pain after inguinal hernia repair: a systematic literature review. Langenbecks Arch Surg 2021; 407:541-548. [PMID: 34471953 DOI: 10.1007/s00423-021-02311-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/20/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Chronic postoperative inguinal pain (CPIP) is a frequent complication after inguinal surgery with a significant decrease in quality of life. There is still no clear algorithm regarding surgical treatment. The aim of this systematic review was to provide an overview on the principles and outcome of surgical interventions for CPIP based on the available literature. MATERIALS AND METHODS A literature search was performed using the databases PubMed and SCOPUS following the PRISMA statement. Used Mesh terms and keywords were "postoperative pain," "chronic pain," "inguinal hernia," and "surgical treatment." All articles were reviewed regarding surgical technique and outcome. MINORS criteria for the assessment of the methodological quality of non-randomized surgical studies were applied. RESULTS Eighteen articles, of which 17 cohort studies and one randomized controlled trial (RCT), described the surgical management of CPIP. Selective as well as triple neurectomy, often in combination with mesh removal and removal of suture material, was performed. Success rate, defined as significant or complete relief of pain, ranged from 33 until 100%, with most articles reaching success rates above 70%, showing a clear advantage of surgical therapy for chronic pain. CONCLUSIONS The use of surgical triple neurectomy seems effective and helpful in a high percentage of patients with CPIP. Surgical treatment should only be considered after adequate preoperative diagnostic evaluation of which the dermatome sensory mapping seems a useful tool for detailed neurophysiological assessment of patients with persistent post-herniorrhaphy pain undergoing remedial neurectomy.
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Affiliation(s)
- E Beel
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - F Berrevoet
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
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20
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Parker SG, Halligan S, Berrevoet F, de Beaux AC, East B, Eker HH, Jensen KK, Jorgensen LN, Montgomery A, Morales-Conde S, Miserez M, Renard Y, Sanders DL, Simons M, Slade D, Torkington J, Blackwell S, Dames N, Windsor ACJ, Mallett S. Reporting guideline for interventional trials of primary and incisional ventral hernia repair. Br J Surg 2021; 108:1050-1055. [PMID: 34286842 DOI: 10.1093/bjs/znab157] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 03/02/2021] [Accepted: 04/13/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Primary and incisional ventral hernia trials collect unstandardized inconsistent data, limiting data interpretation and comparison. This study aimed to create two minimum data sets for primary and incisional ventral hernia interventional trials to standardize data collection and improve trial comparison. To support these data sets, standardized patient-reported outcome measures and trial methodology criteria were created. METHODS To construct these data sets, nominal group technique methodology was employed, involving 15 internationally recognized abdominal wall surgeons and two patient representatives. Initially a maximum data set was created from previous systematic and panellist reviews. Thereafter, three stages of voting took place: stage 1, selection of the number of variables for data set inclusion; stage 2, selection of variables to be included; and stage 3, selection of variable definitions and detection methods. A steering committee interpreted and analysed the data. RESULTS The maximum data set contained 245 variables. The three stages of voting commenced in October 2019 and had been completed by July 2020. The final primary ventral hernia data set included 32 variables, the incisional ventral hernia data set included 40 variables, the patient-reported outcome measures tool contained 25 questions, and 40 methodological criteria were chosen. The best known variable definitions were selected for accurate variable description. CT was selected as the optimal preoperative descriptor of hernia morphology. Standardized follow-up at 30 days, 1 year, and 5 years was selected. CONCLUSION These minimum data sets, patient-reported outcome measures, and methodological criteria have allowed creation of a manual for investigators aiming to undertake primary ventral hernia or incisional ventral hernia interventional trials. Adopting these data sets will improve trial methods and comparisons.
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Affiliation(s)
- S G Parker
- Abdominal Wall Unit, General Surgery, University College London Hospital, London, UK
| | - S Halligan
- Centre for Medical Imaging, University College London, London, UK
| | - F Berrevoet
- Department of General and Hepatobiliary Surgery and Liver Transplantation, University Hospital Ghent, Ghent, Belgium
| | - A C de Beaux
- Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - B East
- 3rd Department of Surgery, Motol University Hospital, 1st and 2nd Medical Faculty of Charles University, Prague, Czech Republic
| | - H H Eker
- Department of Surgery, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - K K Jensen
- General Surgery, Digestive Disease Centre, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - L N Jorgensen
- General Surgery, Digestive Disease Centre, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - A Montgomery
- Department of Surgery, Skåne University Hospital Malmö, Malmö, Sweden
| | - S Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of Surgery, University Hospital Virgen del Rocio, University of Seville, Seville, Spain
| | - M Miserez
- Department of Abdominal Surgery, University Hospitals of the Katholieke Universiteit Leuven, Leuven, Belgium
| | - Y Renard
- Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Reims, France
| | - D L Sanders
- Department of General and Upper Gastrointestinal Surgery, North Devon District Hospital, Barnstaple, UK
| | - M Simons
- Department of Surgery, Onze Lieve Vrouwe Gasthuis Hospital, Amsterdam, the Netherlands
| | - D Slade
- Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Salford, UK
| | - J Torkington
- Department of Colorectal Surgery, University Hospital of Wales, Cardiff, UK
| | | | - N Dames
- Patient Representative, Glasgow, UK
| | - A C J Windsor
- Abdominal Wall Unit, General Surgery, University College London Hospital, London, UK
| | - S Mallett
- Centre for Medical Imaging, University College London, London, UK
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21
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Belli LS, Fondevila C, Cortesi PA, Conti S, Karam V, Adam R, Coilly A, Ericzon BG, Loinaz C, Cuervas-Mons V, Zambelli M, Llado L, Diaz-Fontenla F, Invernizzi F, Patrono D, Faitot F, Bhooori S, Pirenne J, Perricone G, Magini G, Castells L, Detry O, Cruchaga PM, Colmenero J, Berrevoet F, Rodriguez G, Ysebaert D, Radenne S, Metselaar H, Morelli C, De Carlis LG, Polak WG, Duvoux C. Protective Role of Tacrolimus, Deleterious Role of Age and Comorbidities in Liver Transplant Recipients With Covid-19: Results From the ELITA/ELTR Multi-center European Study. Gastroenterology 2021; 160:1151-1163.e3. [PMID: 33307029 PMCID: PMC7724463 DOI: 10.1053/j.gastro.2020.11.045] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Despite concerns that liver transplant (LT) recipients may be at increased risk of unfavorable outcomes from COVID-19 due the high prevalence of co-morbidities, immunosuppression and ageing, a detailed analysis of their effects in large studies is lacking. METHODS Data from adult LT recipients with laboratory confirmed SARS-CoV2 infection were collected across Europe. All consecutive patients with symptoms were included in the analysis. RESULTS Between March 1 and June 27, 2020, data from 243 adult symptomatic cases from 36 centers and 9 countries were collected. Thirty-nine (16%) were managed as outpatients while 204 (84%) required hospitalization including admission to the ICU (39 of 204, 19.1%). Forty-nine (20.2%) patients died after a median of 13.5 (10-23) days, respiratory failure was the major cause. After multivariable Cox regression analysis, age >70 (HR, 4.16; 95% CI, 1.78-9.73) had a negative effect and tacrolimus (TAC) use (HR, 0.55; 95% CI, 0.31-0.99) had a positive independent effect on survival. The role of co-morbidities was strongly influenced by the dominant effect of age where comorbidities increased with the increasing age of the recipients. In a second model excluding age, both diabetes (HR, 1.95; 95% CI, 1.06-3.58) and chronic kidney disease (HR, 1.97; 95% CI, 1.05-3.67) emerged as associated with death CONCLUSIONS: Twenty-five percent of patients requiring hospitalization for COVID-19 died, the risk being higher in patients older than 70 and with medical co-morbidities, such as impaired renal function and diabetes. Conversely, the use of TAC was associated with a better survival thus encouraging clinicians to keep TAC at the usual dose.
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Affiliation(s)
- Luca S. Belli
- Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy,Correspondence Address correspondence to: Luca S. Belli, Department of Hepatology and Gastroenterology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Constantino Fondevila
- Department of General and Digestive Surgery, Hospital Clínic, Institut d’Investigacion Biomediques August Pi-Sunyer (IDIBAPS) Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Spain
| | - Paolo A. Cortesi
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - Sara Conti
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - Vincent Karam
- European Liver Transplant Registry, Centre Hépatobiliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paul-Brousse, Paris-Saclay University, Villejuif, France
| | - Rene Adam
- European Liver Transplant Registry, Centre Hépatobiliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paul-Brousse, Paris-Saclay University, Villejuif, France
| | - Audrey Coilly
- Centre Hepato-Biliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Paul-Brousse, Paris-Sud Saclay University, Villejuif, France
| | - Bo Goran Ericzon
- Division of Transplantation Surgery, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Carmelo Loinaz
- Chirugía General, Doce de Octubre Universidad Complutense de Madrid, Madrid, Spain
| | - Valentin Cuervas-Mons
- Departimento de Medicina, Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid, Madrid, Spain
| | - Marco Zambelli
- Department of Surgery, “Papa Giovanni XXIII” Hospital, Bergamo, Lombardia, Italy
| | - Laura Llado
- Liver Transplant Unit, Hospital Uniersitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - Fernando Diaz-Fontenla
- Unidad de Trasplante Hepático, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Federica Invernizzi
- Division of Gastroenterology and Hepatology, University of Milan, Milan, Italy
| | - Damiano Patrono
- Liver Transplantation Center, Molinette Hospital, Turin, Italy
| | - Francois Faitot
- Service de Chirurgie Hépatobiliaire et Transplantation, Hôpital de Hautepierre, Strasbourg, France
| | - Sherrie Bhooori
- Department of Surgery and Oncology, Istituto Nazionale Tumori, Milan, Italy
| | - Jacques Pirenne
- Department of Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Giovanni Perricone
- Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy
| | - Giulia Magini
- Service de Transplantation, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Lluis Castells
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d’Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Oliver Detry
- Department of Abdominal Surgery and Transplantation, Centre Hospitalier Universitaire Liege, University of Liege, Liege, Belgium
| | - Pablo Mart Cruchaga
- Cirugía General y Digestiva, Clínica Universidad de Navarra, Pamplona, Spain
| | - Jordi Colmenero
- Department of General and Digestive Surgery, Hospital Clínic, Institut d’Investigacion Biomediques August Pi-Sunyer (IDIBAPS) Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Spain
| | - Frederick Berrevoet
- Department of General and Hepatobiliary Surgery, Ghent University, Ghent, Belgium
| | - Gonzalo Rodriguez
- Department of General & Digestive Surgery, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Hospital General Universitario de Alicante, Alicante, Spain
| | - Dirk Ysebaert
- Department of Surgery, Antwerp University Hospital, Antwerp University, Edegem, Belgium
| | - Sylvie Radenne
- Service d’Hépato-Gastroentérologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Herold Metselaar
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Cristina Morelli
- Liver and Multi-organ Transplantation, Sant’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Luciano G. De Carlis
- General Surgery and Abdominal Transplantation Unit, Niguarda-Cà Granda Hospital, and School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Wojciech G. Polak
- Department of Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Christophe Duvoux
- Department of Hepatology and Medical Liver Transplant Unit, Henri Mondor Hospital Assistance Publique-Hôpitaux de Paris, Paris-Est University, Creteil, France
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22
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van den Hil LCL, Mommers EHH, Bosmans JWAM, Morales-Conde S, Gómez-Gil V, LeBlanc K, Vanlander A, Reynvoet E, Berrevoet F, Gruber-Blum S, Altinli E, Deeken CR, Fortelny RH, Greve JW, Chiers K, Kaufmann R, Lange JF, Klinge U, Miserez M, Petter-Puchner AH, Schreinemacher MHF, Bouvy ND. META Score: An International Consensus Scoring System on Mesh-Tissue Adhesions. World J Surg 2021; 44:2935-2943. [PMID: 32621037 DOI: 10.1007/s00268-020-05568-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Currently, the lack of consensus on postoperative mesh-tissue adhesion scoring leads to incomparable scientific results. The aim of this study was to develop an adhesion score recognized by experts in the field of hernia surgery. METHODS Authors of three or more previously published articles on both mesh-tissue adhesion scores and postoperative adhesions were marked as experts. They were queried on seven items using a modified Delphi method. The items concerned the utility of adhesion scoring models, the appropriateness of macroscopic and microscopic variables, the range and use of composite scores or subscores, adhesion-related complications and follow-up length. This study comprised two questionnaire-based rounds and one consensus meeting. RESULTS The first round was completed by 23 experts (82%), the second round by 18 experts (64%). Of those 18 experts, ten were able to participate in the final consensus meeting and all approved the final proposal. From a total of 158 items, consensus was reached on 90 items. The amount of mesh surface covered with adhesions, tenacity and thickness of adhesions and organ involvement was concluded to be a minimal set of variables to be communicated separately in each future study on mesh adhesions. CONCLUSION The MEsh Tissue Adhesion scoring system is the first consensus-based scoring system with a wide backing of renowned experts and can be used to assess mesh-related adhesions. By including this minimal set of variables in future research interstudy comparability and objectivity can be increased and eventually linked to clinically relevant outcomes.
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Affiliation(s)
- L C L van den Hil
- Department of General Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands. .,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
| | - E H H Mommers
- Department of General Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - J W A M Bosmans
- Department of General Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - S Morales-Conde
- Unit of Innovation and Minimally Invasive Surgery, University Hospital Virgen Del Rocío, Seville, Spain
| | - V Gómez-Gil
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, Networking Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - K LeBlanc
- Our Lady of the Lake Physician Group, Minimally Invasive Surgery Institute, Baton Rouge, LA, USA
| | - A Vanlander
- Department of General and Hepatobiliary Surgery, Ghent University Hospital, Ghent, Belgium
| | - E Reynvoet
- Department of General and Hepatobiliary Surgery, Ghent University Hospital, Ghent, Belgium
| | - F Berrevoet
- Department of General and Hepatobiliary Surgery, Ghent University Hospital, Ghent, Belgium
| | - S Gruber-Blum
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - E Altinli
- Department of General Surgery, Bilim University, Istanbul, Turkey
| | | | - R H Fortelny
- Department of General Surgery, Wilhelminenspital Der Stadt Wien, Vienna, Austria
| | - J W Greve
- Department of General Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - K Chiers
- Department of Veterinary Pathology, Faculty of Veterinary Medicine, University of Ghent, Ghent, Belgium
| | - R Kaufmann
- Department of Surgery, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J F Lange
- Department of Surgery, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - U Klinge
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - M Miserez
- Department of Abdominal Surgery, University Hospitals, KU Leuven, Leuven, Belgium
| | - A H Petter-Puchner
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Austrian Cluster for Tissue Regeneration, Vienna, Austria.,Department of General Surgery, Wilhelminenspital Der Stadt Wien, Vienna, Austria
| | - M H F Schreinemacher
- Department of General Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - N D Bouvy
- Department of General Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
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23
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Balduzzi A, van Hilst J, Korrel M, Lof S, Al-Sarireh B, Alseidi A, Berrevoet F, Björnsson B, van den Boezem P, Boggi U, Busch OR, Butturini G, Casadei R, van Dam R, Dokmak S, Edwin B, Sahakyan MA, Ercolani G, Fabre JM, Falconi M, Forgione A, Gayet B, Gomez D, Koerkamp BG, Hackert T, Keck T, Khatkov I, Krautz C, Marudanayagam R, Menon K, Pietrabissa A, Poves I, Cunha AS, Salvia R, Sánchez-Cabús S, Soonawalla Z, Hilal MA, Besselink MG. Laparoscopic versus open extended radical left pancreatectomy for pancreatic ductal adenocarcinoma: an international propensity-score matched study. Surg Endosc 2021; 35:6949-6959. [PMID: 33398565 DOI: 10.1007/s00464-020-08206-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND A radical left pancreatectomy in patients with pancreatic ductal adenocarcinoma (PDAC) may require extended, multivisceral resections. The role of a laparoscopic approach in extended radical left pancreatectomy (ERLP) is unclear since comparative studies are lacking. The aim of this study was to compare outcomes after laparoscopic vs open ERLP in patients with PDAC. METHODS An international multicenter propensity-score matched study including patients who underwent either laparoscopic or open ERLP (L-ERLP; O-ERLP) for PDAC was performed (2007-2015). The ISGPS definition for extended resection was used. Primary outcomes were overall survival, margin negative rate (R0), and lymph node retrieval. RESULTS Between 2007 and 2015, 320 patients underwent ERLP in 34 centers from 12 countries (65 L-ERLP vs. 255 O-ERLP). After propensity-score matching, 44 L-ERLP could be matched to 44 O-ERLP. In the matched cohort, the conversion rate in L-ERLP group was 35%. The L-ERLP R0 resection rate (matched cohort) was comparable to O-ERLP (67% vs 48%; P = 0.063) but the lymph node yield was lower for L-ERLP than O-ERLP (median 11 vs 19, P = 0.023). L-ERLP was associated with less delayed gastric emptying (0% vs 16%, P = 0.006) and shorter hospital stay (median 9 vs 13 days, P = 0.005), as compared to O-ERLP. Outcomes were comparable for additional organ resections, vascular resections (besides splenic vessels), Clavien-Dindo grade ≥ III complications, or 90-day mortality (2% vs 2%, P = 0.973). The median overall survival was comparable between both groups (19 vs 20 months, P = 0.571). Conversion did not worsen outcomes in L-ERLP. CONCLUSION The laparoscopic approach may be used safely in selected patients requiring ERLP for PDAC, since morbidity, mortality, and overall survival seem comparable, as compared to O-ERLP. L-ERLP is associated with a high conversion rate and reduced lymph node yield but also with less delayed gastric emptying and a shorter hospital stay, as compared to O-ERLP.
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Affiliation(s)
- A Balduzzi
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef, 91100 AZ, Amsterdam, The Netherlands. .,General and Pancreatic Surgery, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy.
| | - J van Hilst
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef, 91100 AZ, Amsterdam, The Netherlands
| | - M Korrel
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef, 91100 AZ, Amsterdam, The Netherlands
| | - S Lof
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef, 91100 AZ, Amsterdam, The Netherlands.,Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - B Al-Sarireh
- Department of Surgery, Morriston Hospital, Swansea, UK
| | - A Alseidi
- Department of Surgery, Virginia Mason Medical Center, Seattle, USA
| | - F Berrevoet
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - B Björnsson
- Department of Surgery in Linköping, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - P van den Boezem
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - U Boggi
- Department of Surgery, Universitá di Pisa, Pisa, Italy
| | - O R Busch
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef, 91100 AZ, Amsterdam, The Netherlands
| | - G Butturini
- Department of Surgery, Pederzoli Hospital, Peschiera, Italy
| | - R Casadei
- Department of Surgery, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - R van Dam
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - S Dokmak
- Department of Surgery, Hospital of Beaujon, Clichy, France
| | - B Edwin
- Department of Surgery, Oslo University Hospital and Institute for Clinical Medicine, Oslo, Norway
| | - M A Sahakyan
- Department of Surgery, Oslo University Hospital and Institute for Clinical Medicine, Oslo, Norway.,Department of Surgery N1, Yerevan State Medical University After M. Heratsi, Yerevan, Armenia
| | - G Ercolani
- Department of General Surgery and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna Forlì, Forlì, Italy.,Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - J M Fabre
- Department of Surgery, Hopital Saint Eloi, Montpellier, France
| | - M Falconi
- San Raffaele Hospital Pancreas Translational & Clinical Research Center, San Raffaele Hospital, Università Vita-Salute, Milan, Italy
| | - A Forgione
- Department of Surgery, Niguarda Ca' Granda Hospital, Milan, Italy
| | - B Gayet
- Department of Surgery, Institut Mutualiste Montsouris, Paris, France
| | - D Gomez
- Department of Surgery, Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | | | - T Hackert
- Department of Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - T Keck
- Department of Surgery, University Hospital Schleswig-Holstein UKSH Campus Lübeck, Lübeck, Germany
| | - I Khatkov
- Department of Surgery, Moscow Clinical Scientific Center, Moscow, Russian Federation
| | - C Krautz
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - R Marudanayagam
- Department of Surgery, University Hospital Birmingham, Birmingham, UK
| | - K Menon
- Department of Surgery, King's College Hospital NHS Foundation Trust, London, UK
| | - A Pietrabissa
- Department of Surgery, University Hospital Pavia, Pavia, Italy
| | - I Poves
- Department of Surgery, Hospital del Mar, Barcelona, Spain
| | - A Sa Cunha
- Department of Surgery, Hôpital Paul-Brousse, Villejuif, France
| | - R Salvia
- General and Pancreatic Surgery, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - S Sánchez-Cabús
- Department of Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Z Soonawalla
- Department of Surgery, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - M Abu Hilal
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK. .,Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy. .,HPB and Minimally Invasive Surgery, Southampton University, Southampton, UK.
| | - M G Besselink
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef, 91100 AZ, Amsterdam, The Netherlands.
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24
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Willms AG, Schwab R, von Websky MW, Berrevoet F, Tartaglia D, Sörelius K, Fortelny RH, Björck M, Monchal T, Brennfleck F, Bulian D, Beltzer C, Germer CT, Lock JF. Factors influencing the fascial closure rate after open abdomen treatment: Results from the European Hernia Society (EuraHS) Registry : Surgical technique matters. Hernia 2020; 26:61-73. [PMID: 33219419 PMCID: PMC8881440 DOI: 10.1007/s10029-020-02336-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/02/2020] [Indexed: 01/09/2023]
Abstract
Purpose Definitive fascial closure is an essential treatment objective after open abdomen treatment and mitigates morbidity and mortality. There is a paucity of evidence on factors that promote or prevent definitive fascial closure. Methods A multi-center multivariable analysis of data from the Open Abdomen Route of the European Hernia Society included all cases between 1 May 2015 and 31 December 2019. Different treatment elements, i.e. the use of a visceral protective layer, negative-pressure wound therapy and dynamic closure techniques, as well as patient characteristics were included in the multivariable analysis. The study was registered in the International Clinical Trials Registry Platform via the German Registry for Clinical Trials (DRK00021719). Results Data were included from 630 patients from eleven surgical departments in six European countries. Indications for OAT were peritonitis (46%), abdominal compartment syndrome (20.5%), burst abdomen (11.3%), abdominal trauma (9%), and other conditions (13.2%). The overall definitive fascial closure rate was 57.5% in the intention-to-treat analysis and 71% in the per-protocol analysis. The multivariable analysis showed a positive correlation of negative-pressure wound therapy (odds ratio: 2.496, p < 0.001) and dynamic closure techniques (odds ratio: 2.687, p < 0.001) with fascial closure and a negative correlation of intra-abdominal contamination (odds ratio: 0.630, p = 0.029) and the number of surgical procedures before OAT (odds ratio: 0.740, p = 0.005) with DFC. Conclusion The clinical course and prognosis of open abdomen treatment can significantly be improved by the use of treatment elements such as negative-pressure wound therapy and dynamic closure techniques, which are associated with definitive fascial closure. Electronic supplementary material The online version of this article (10.1007/s10029-020-02336-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A G Willms
- Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital of Koblenz, Rübenacher Str. 170, 56072, Koblenz, Germany
| | - R Schwab
- Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital of Koblenz, Rübenacher Str. 170, 56072, Koblenz, Germany
| | - M W von Websky
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - F Berrevoet
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - D Tartaglia
- Emergency Surgery Unit, Cisanello University Hospital, Via Paradisa 1, 56124, Pisa, Italy
| | - K Sörelius
- Department of Vascular Surgery, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
| | - R H Fortelny
- Department of General, Visceral and Oncological Surgery, Wilhelminenspital, 1160, Vienna, Austria.,Medical Faculty, Sigmund Freud University of Vienna, 1020, Vienna, Austria
| | - M Björck
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, SE 751 85, Uppsala, Sweden
| | - T Monchal
- Department of General Surgery, Sainte Anne Military Hospital, 2 Boulevard Sainte-Anne, 83000, Toulon, France
| | - F Brennfleck
- Department of Surgery, Regensburg University Hospital, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - D Bulian
- Department of Abdominal, Tumor, Transplant and Vascular Surgery, Cologne-Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - C Beltzer
- Department of General, Visceral and Thoracic Surgery, German Armed Forces Hospital of Ulm, Oberer Eselsberg, Ulm, Germany
| | - C T Germer
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - J F Lock
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
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25
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Yurtkap Y, van Rooijen MMJ, Roels S, Bosmans JML, Uyttebroek O, Lange JF, Berrevoet F. Implementing preoperative Botulinum toxin A and progressive pneumoperitoneum through the use of an algorithm in giant ventral hernia repair. Hernia 2020; 25:389-398. [PMID: 32495050 DOI: 10.1007/s10029-020-02226-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/19/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Repair of large ventral hernias with loss of domain can be facilitated by preoperative Botulinum toxin A (BTA) injections and preoperative progressive pneumoperitoneum (PPP). The aim of this study is to evaluate the outcomes of ventral hernioplasty using a standardized algorithm, including component separation techniques, preoperative BTA and PPP. METHODS All patients between June 2014 and August 2018 with giant hernias (either primary or incisional) of more than 12 cm width were treated according to a previously developed standardized algorithm. Retrospective data analysis from a prospectively collected dataset was performed. The primary outcome was closure of the anterior fascia. Secondary outcomes included complications related to the preoperative treatment, postoperative complications, and recurrences. RESULTS Twenty-three patients were included. Median age was 65 years (range 28-77) and median BMI was 31.4 (range 22.7-38.0 kg/m2). The median loss of domain was 29% (range 12-226%). For the primary and secondary endpoints, 22 patients were analyzed. Primary closure of the anterior fascia was possible in 82% of all patients. After a median follow-up of 19.5 months (range 10-60 months), 3 patients (14%) developed a hernia recurrence and 16 patients (73%) developed 23 surgical site occurrences, most of which were surgical site infections (54.5%). CONCLUSION Our algorithm using both anterior or posterior component separation, together with preoperative BTA injections and PPP, achieved an acceptable fascial closure rate. Further studies are needed to explore the individual potential of BTA injections and PPP, and to research whether these methods can prevent the need for component separation, as postoperative wound morbidity remains high in our study.
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Affiliation(s)
- Y Yurtkap
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - M M J van Rooijen
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - S Roels
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - J M L Bosmans
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - O Uyttebroek
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - J F Lange
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Department of Surgery, IJsselland Ziekenhuis, Capelle aan den IJssel, The Netherlands
| | - F Berrevoet
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium.
- Universitair Ziekenhuis Gent, Corneel Heymanslaan 10, 9000, Gent, Belgium.
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26
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Dahlqvist G, Ciccarelli O, Van Vlierberghe H, Berrevoet F, Vanwolleghem T, Ysebaert D, Gustot T, Lucidi V, Delwaide J, Detry O, Delbouille MH, Sokal E, Nevens F, Pirenne J. Liver transplantation during the COVID-19 epidemic : recommendations from the Belgian Liver Intestine Transplant Committee (BeLIAC). Acta Gastroenterol Belg 2020; 83:340-343. [PMID: 32603060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Since January 2020, the Novel Coronavirus Disease 2019 (COVID-19) pandemic has dramatically impacted the world. In March 2020, the COVID-19 epidemic reached Belgium creating uncertainty towards all aspects of life. There has been an impressive capacity and solidarity of all healthcare professionals to acutely reconvert facilities to treat these patients. In the context of liver transplantation (LTx), concerns are raised about organ donation shortage and safety, the ethics of using limited healthcare resources for LTx, selection criteria for LTx during the epidemic and the risk of de novo COVID-19 infection on the waiting list and after LTx. BeLIAC makes several recommendations to try to mitigate the deleterious effect that this epidemic has/will have on donation and LTx, taking into account the available resources, and trying to maximize patients and healthcare professionals' safety.
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Affiliation(s)
- G Dahlqvist
- UCL Liver Transplant Program; Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - O Ciccarelli
- UCL Liver Transplant Program; Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - H Van Vlierberghe
- UZ Gent Liver Transplant Program, Universitair Ziekenhuis, Gent, Belgium
| | - F Berrevoet
- UZ Gent Liver Transplant Program, Universitair Ziekenhuis, Gent, Belgium
| | - T Vanwolleghem
- UZ Antwerpen Liver Transplant Program, Universitair Ziekenhuis, Antwerpen, Belgium
| | - D Ysebaert
- UZ Antwerpen Liver Transplant Program, Universitair Ziekenhuis, Antwerpen, Belgium
| | - T Gustot
- ULB Liver Transplant Program; Hopital Universitaire Erasme, Brussels, Belgium
| | - V Lucidi
- ULB Liver Transplant Program; Hopital Universitaire Erasme, Brussels, Belgium
| | - J Delwaide
- ULg Liver Transplant Program, Hopital Universitaire du Sart Tilman, Liège, Belgium
| | - O Detry
- ULg Liver Transplant Program, Hopital Universitaire du Sart Tilman, Liège, Belgium
| | - M H Delbouille
- BTS Section of the Transplant Coordinators, Hopital Universitaire du Sart Tilman, Liège, Belgium
| | - E Sokal
- Pediatric Liver Transplantation, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - F Nevens
- KUL Liver Transplant Program, Universitair Ziekenhuis Gasthuisberg, Leuven, Belgium
| | - J Pirenne
- KUL Liver Transplant Program, Universitair Ziekenhuis Gasthuisberg, Leuven, Belgium
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27
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Henriksen NA, Montgomery A, Kaufmann R, Berrevoet F, East B, Fischer J, Hope W, Klassen D, Lorenz R, Renard Y, Garcia Urena MA, Simons MP. Guidelines for treatment of umbilical and epigastric hernias from the European Hernia Society and Americas Hernia Society. Br J Surg 2020; 107:171-190. [PMID: 31916607 DOI: 10.1002/bjs.11489] [Citation(s) in RCA: 136] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/31/2019] [Accepted: 12/02/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Umbilical and epigastric hernia repairs are frequently performed surgical procedures with an expected low complication rate. Nevertheless, the optimal method of repair with best short- and long-term outcomes remains debatable. The aim was to develop guidelines for the treatment of umbilical and epigastric hernias. METHODS The guideline group consisted of surgeons from Europe and North America including members from the European Hernia Society and the Americas Hernia Society. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, the Scottish Intercollegiate Guidelines Network (SIGN) critical appraisal checklists, and the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument were used. A systematic literature search was done on 1 May 2018, and updated on 1 February 2019. RESULTS Literature reporting specifically on umbilical and epigastric hernias was limited in quantity and quality, resulting in a majority of the recommendations being graded as weak, based on low-quality evidence. The main recommendation was to use mesh for repair of umbilical and epigastric hernias to reduce the recurrence rate. Most umbilical and epigastric hernias may be repaired by an open approach with a preperitoneal flat mesh. A laparoscopic approach may be considered if the hernia defect is large, or if the patient has an increased risk of wound morbidity. CONCLUSION This is the first European and American guideline on the treatment of umbilical and epigastric hernias. It is recommended that symptomatic umbilical and epigastric hernias are repaired by an open approach with a preperitoneal flat mesh.
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Affiliation(s)
- N A Henriksen
- Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - A Montgomery
- Department of Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
| | - R Kaufmann
- Erasmus University Medical Centre, Rotterdam, the Netherlands.,Tergooi, Hilversum, the Netherlands
| | - F Berrevoet
- Department of General and Hepatopancreatobiliary Surgery, Ghent University Hospital, Ghent, Belgium
| | - B East
- Third Department of Surgery at Motol University Hospital, First and Second Faculty of Medicine at Charles University, Prague, Czech Republic
| | - J Fischer
- University of Pennsylvania Health System, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
| | - W Hope
- New Hanover Regional Medical Center, Wilmington, North Carolina, USA
| | - D Klassen
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - R Lorenz
- Praxis 3+ Chirurgen, Berlin, Germany
| | - Y Renard
- Department of Digestive Surgery, Robert Debré University Hospital, Reims, France
| | - M A Garcia Urena
- Henares University Hospital, Faculty of Health Sciences, Francisco de Vitoria University, Madrid, Spain
| | - M P Simons
- Department of Surgery, OLVG Hospital, Amsterdam, the Netherlands
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28
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Henriksen NA, Kaufmann R, Simons MP, Berrevoet F, East B, Fischer J, Hope W, Klassen D, Lorenz R, Renard Y, Garcia Urena MA, Montgomery A. EHS and AHS guidelines for treatment of primary ventral hernias in rare locations or special circumstances. BJS Open 2020; 4:342-353. [PMID: 32207571 PMCID: PMC7093793 DOI: 10.1002/bjs5.50252] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 11/26/2019] [Indexed: 01/11/2023] Open
Abstract
Background Rare locations of hernias, as well as primary ventral hernias under certain circumstances (cirrhosis, dialysis, rectus diastasis, subsequent pregnancy), might be technically challenging. The aim was to identify situations where the treatment strategy might deviate from routine management. Methods The guideline group consisted of surgeons from the European and Americas Hernia Societies. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used in formulating the recommendations. The Scottish Intercollegiate Guidelines Network (SIGN) critical appraisal checklists were used to evaluate the quality of full‐text papers. A systematic literature search was performed on 1 May 2018 and updated 1 February 2019. The Appraisal of Guidelines for Research and Evaluation (AGREE) instrument was followed. Results Literature was limited in quantity and quality. A majority of the recommendations were graded as weak, based on low quality of evidence. In patients with cirrhosis or on dialysis, a preperitoneal mesh repair is suggested. Subsequent pregnancy is a risk factor for recurrence. Repair should be postponed until after the last pregnancy. For patients with a concomitant rectus diastasis or those with a Spigelian or lumbar hernia, no recommendation could be made for treatment strategy owing to lack of evidence. Conclusion This is the first European and American guideline on the treatment of umbilical and epigastric hernias in patients with special conditions, including Spigelian and lumbar hernias. All recommendations were weak owing to a lack of evidence. Further studies are needed on patients with rectus diastasis, Spigelian and lumbar hernias.
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Affiliation(s)
- N A Henriksen
- Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - R Kaufmann
- Erasmus University Medical Centre, Rotterdam, the Netherlands.,Tergooi, Hilversum, the Netherlands
| | - M P Simons
- Department of Surgery, OLVG Hospital, Amsterdam, the Netherlands
| | - F Berrevoet
- Department of General and Hepato-Pancreato-Biliary Surgery, Gent University Hospital, Gent, Belgium
| | - B East
- Third Department of Surgery, Motol University Hospital, Prague, Czech Republic.,First and Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - J Fischer
- University of Pennsylvania Health System, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
| | - W Hope
- New Hanover Regional Medical Center, Wilmington, North Carolina, USA
| | - D Klassen
- Department of Surgery, Dalhousie University, Halifax, Canada
| | - R Lorenz
- Praxis 3+CHIRURGEN, Berlin, Germany
| | - Y Renard
- Department of Digestive Surgery, Robert Debré University Hospital, Reims, France
| | - M A Garcia Urena
- Henares University Hospital, Faculty of Health Sciences, Francisco de Vitoria University, Madrid, Spain
| | - A Montgomery
- Department of Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
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29
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Köckerling F, Sheen AJ, Berrevoet F, Campanelli G, Cuccurullo D, Fortelny R, Friis-Andersen H, Gillion JF, Gorjanc J, Kopelman D, Lopez-Cano M, Morales-Conde S, Österberg J, Reinpold W, Simmermacher RKJ, Smietanski M, Weyhe D, Simons MP. The reality of general surgery training and increased complexity of abdominal wall hernia surgery. Hernia 2019; 23:1081-1091. [PMID: 31754953 PMCID: PMC6938469 DOI: 10.1007/s10029-019-02062-z] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 09/27/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The Accreditation and Certification of Hernia Centers and Surgeons (ACCESS) Group of the European Hernia Society (EHS) recognizes that there is a growing need to train specialist abdominal wall surgeons. The most important and relevant argument for this proposal and statement is the growing acceptance of the increasing complexity of abdominal wall surgery due to newer techniques, more challenging cases and the required 'tailored' approach to such surgery. There is now also an increasing public awareness with social media, whereby optimal treatment results are demanded by patients. However, to date the complexity of abdominal wall surgery has not been properly or adequately defined in the current literature. METHODS A systematic search of the available literature was performed in May 2019 using Medline, PubMed, Scopus, Embase, Springer Link, and the Cochrane Library, with 75 publications identified as relevant. In addition, an analysis of data from the Herniamed Hernia Registry was performed. The percentage of patients with hernia- or patient-related characteristics which unfavorably impacted the outcome of inguinal and incisional hernia repair was also calculated. RESULTS All present guidelines for abdominal wall surgery recommend the utilization of a 'tailored' approach. This relies on the prerequisite that any surgical technique used has already been mastered, as well as the recognized learning curves for each of the several techniques that can be used for both inguinal hernia (Lichtenstein, TEP, TAPP, Shouldice) and incisional hernia repairs (laparoscopic IPOM, open sublay, open IPOM, open onlay, open or endoscopic component separation technique). Other hernia- and patient-related characteristics that have recognized complexity include emergency surgery, obesity, recurrent hernias, bilateral inguinal hernias, groin hernia in women, scrotal hernias, large defects, high ASA scores, > 80 years of age, increased medical risk factors and previous lower abdominal surgery. The proportion of patients with at least one of these characteristics in the Herniamed Hernia Registry in the case of both inguinal and incisional hernia is noted to be relatively high at around 70%. In general surgery training approximately 50-100 hernia repairs on average are performed by each trainee, with around only 25 laparo-endoscopic procedures. CONCLUSION A tailored approach is now employed and seen more so in hernia surgery and this fact is referred to and highlighted in the contemporaneous hernia guidelines published to date. In addition, with the increasing complexity of abdominal wall surgery, the number of procedures actually performed by trainees is no longer considered adequate to overcome any recognized learning curve. Therefore, to supplement general surgery training young surgeons should be offered a clinical fellowship to obtain an additional qualification as an abdominal wall surgeon and thus improve their clinical and operative experience under supervision in this field. Practicing general surgeons with a special interest in hernia surgery can undertake intensive further training in this area by participating in clinical work shadowing in hernia centers, workshops and congresses.
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Affiliation(s)
- F Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.
| | - A J Sheen
- Department of Surgery, Manchester University NHS Foundation Trust, Manchester, M13 9WL, UK
| | - F Berrevoet
- Department of General and HPB Surgery and Liver Transplantation, Universitair Ziekenhuis Gent, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - G Campanelli
- General and Day Surgery Unit, Center of Research and High Specialization for the Pathologies of Abdominal Wall and Surgical Treatment and Repair of Abdominal Hernia, Milano Hernia Center, Instituto Clinico Sant'Ambrogio, University of Insurbria, Milan, Italy
| | - D Cuccurullo
- Department of General, Laparoscopic and Robotic Surgery, Chief Week Surgery Departmental Unit, A.O. dei Colli Monaldi Hospital Naples, Naples, Italy
| | - R Fortelny
- Department of General, Visceral and Oncological Surgery, Wilhelminenspital, 1160, Vienna, Austria
- Medical Faculty of Sigmund Freud University, 1020, Vienna, Austria
| | - H Friis-Andersen
- Surgical Department, Horsens Regional Hospital, Aarhus University, Sundvey 30, 8700, Horsens, Denmark
| | - J F Gillion
- Unité de Chirurgie Viscérale, Hôpital Privé d'Antony, 1, Rue Velpeau, 92160, Antony, France
| | - J Gorjanc
- Department of Surgery, Krankenhaus der Barmherzigen Brüder, Spitalgasse 26, 9300, St. Veit an der Glan, Austria
| | - D Kopelman
- Department of Surgery Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - M Lopez-Cano
- Abdominal Wall Surgery Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - S Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, University Hospital Virgen del Rocío, Av. Manuel Siurot, s/n, 41013, Seville, Spain
| | - J Österberg
- Department of Surgery, Mora Hospital, 79285, Mora, Sweden
| | - W Reinpold
- Wilhelmsburger Krankenhaus Gross-Sand, Gross-Sand 3, 21107, Hamburg, Germany
| | - R K J Simmermacher
- Department of Surgery, University Medical Center Utrecht, Heidelbergglaan 100, Utrecht, The Netherlands
| | - M Smietanski
- Department of General Surgery and Hernia Centre, Hospital in Puck, Medical University of Gdansk, Gdansk, Poland
| | - D Weyhe
- School of Medicine and Health Sciences, University Hospital for Visceral Surgery, Pius Hospital Oldenburg, Medical Campus University of Oldenburg, Georgstr. 12, 26121, Oldenburg, Germany
| | - M P Simons
- Department of Surgery, OLVG Hospital, Amsterdam, The Netherlands
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30
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Berrevoet F, Doerhoff C, Muysoms F, Hopson S, Muzi MG, Nienhuijs S, Kullman E, Tollens T, Schwartz M, Leblanc K, Velanovich V, Jørgensen LN. Open ventral hernia repair with a composite ventral patch - final results of a multicenter prospective study. BMC Surg 2019; 19:93. [PMID: 31311545 PMCID: PMC6633695 DOI: 10.1186/s12893-019-0555-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 07/03/2019] [Indexed: 01/08/2023] Open
Abstract
Background This study assessed clinical outcomes, including safety and recurrence, from the two-year follow-up of patients who underwent open ventral primary hernia repair with the use of the Parietex™ Composite Ventral Patch (PCO-VP). Methods A prospective single-arm, multicenter study of 126 patients undergoing open ventral hernia repair for umbilical and epigastric hernias with the PCO-VP was performed. Results One hundred twenty-six subjects (110 with umbilical hernia and 16 with epigastric hernia) with a mean hernia diameter of 1.8 cm (0.4–4.0) were treated with PCO-VP. One hundred subjects completed the two-year study. Cumulative hernia recurrence was 3.0% (3/101; 95%CI: 0.0–6.3%) within 24 months. Median Numeric Rating Scale pain scores improved from 2 [0–10] at baseline to 0 [0–3] at 1 month (P < 0.001) and remained low at 24 months 0 [0–6] (P < 0.001). 99% (102/103) of the patients were satisfied with their repair at 24 months postoperative. Conclusions The use of PCO-VP to repair primary umbilical and epigastric defects yielded a low recurrence rate, low postoperative and chronic pain, and high satisfaction ratings, confirming that PCO-VP is effective for small ventral hernia repair in the two-year term after implantation. Trial registration The study was registered publically at clinicaltrials.gov (NCT01848184 registered May 7, 2013).
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Affiliation(s)
- F Berrevoet
- Department of General and Hepatopancreatobiliary Surgery, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - C Doerhoff
- Surgicare of Missouri, Jefferson City, MO, USA
| | - F Muysoms
- Department of Surgery AZ Maria Middelares, Ghent, Belgium
| | - S Hopson
- Bon Secours Hernia Center, Mary Immaculate Hospital, Newport News, VA, USA
| | - M G Muzi
- University Hospital Tor Vergata, Rome, Italy
| | - S Nienhuijs
- Department of Surgery, Catharina Hospital, Eindhoven, Netherlands
| | - E Kullman
- HELSA Specialist Center, Linköping, Sweden
| | - T Tollens
- Imelda Hospital -General Surgery Imelda Hospital, Bonheiden, Belgium
| | - M Schwartz
- Monmouth Medical Center, Long Branch, NJ, USA
| | - K Leblanc
- Our Lady of Lakes Regional Medical Center, Baton Rouge, LA, USA
| | - V Velanovich
- Division of General Surgery, University of South Florida, Tampa General Hospital, Tampa, FL, USA
| | - L N Jørgensen
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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31
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Laurent S, Verhelst X, Geerts A, Geboes K, De Man M, Troisi R, Vanlander A, Rogiers X, Berrevoet F, Van Vlierberghe H. Update on liver transplantation for cholangiocarcinoma : a review of the recent literature. Acta Gastroenterol Belg 2019; 82:417-420. [PMID: 31566330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Cholangiocarcinoma (CC) represent 3% of all gastrointestinal tumours and can be classified anatomically in 3 types: intrahepatic (ICC), perihilar (PCC) and distal (DCC) cholangiocarcinomas. Resection is the treatment of choice but is only achieved in a few cases (<20%) because of invasion of the biliary tract and/or vascular structures. The outcome of advanced CC is poor with an overall survival (OS) of maximum 15 months with chemotherapy. In the 1990s, CC was regarded as a contraindication for liver transplantation (LT). LT has recently been proposed as potentially curative option for ICC and PCC. Careful patient selection has changed OS. This article provides an update on current status of LT for patients with unresectable CC.
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Affiliation(s)
- S Laurent
- Digestive Oncology, Ghent University Hospital Ghent, Belgium
| | - X Verhelst
- Hepatology, Ghent University Hospital Ghent, Belgium
| | - A Geerts
- Hepatology, Ghent University Hospital Ghent, Belgium
| | - K Geboes
- Digestive Oncology, Ghent University Hospital Ghent, Belgium
| | - M De Man
- Digestive Oncology, Ghent University Hospital Ghent, Belgium
| | - R Troisi
- Hepatobiliary Surgery, Ghent University Hospital Ghent, Belgium
| | - A Vanlander
- Hepatobiliary Surgery, Ghent University Hospital Ghent, Belgium
| | - X Rogiers
- Hepatobiliary Surgery, Ghent University Hospital Ghent, Belgium
| | - F Berrevoet
- Hepatobiliary Surgery, Ghent University Hospital Ghent, Belgium
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Bittner R, Bain K, Bansal VK, Berrevoet F, Bingener-Casey J, Chen D, Chen J, Chowbey P, Dietz UA, de Beaux A, Ferzli G, Fortelny R, Hoffmann H, Iskander M, Ji Z, Jorgensen LN, Khullar R, Kirchhoff P, Köckerling F, Kukleta J, LeBlanc K, Li J, Lomanto D, Mayer F, Meytes V, Misra M, Morales-Conde S, Niebuhr H, Radvinsky D, Ramshaw B, Ranev D, Reinpold W, Sharma A, Schrittwieser R, Stechemesser B, Sutedja B, Tang J, Warren J, Weyhe D, Wiegering A, Woeste G, Yao Q. Update of Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS))-Part A. Surg Endosc 2019; 33:3069-3139. [PMID: 31250243 PMCID: PMC6722153 DOI: 10.1007/s00464-019-06907-7] [Citation(s) in RCA: 149] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 06/07/2019] [Indexed: 02/08/2023]
Abstract
Abstract In 2014, the International Endohernia Society (IEHS) published the first international “Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias.” Guidelines reflect the currently best available evidence in diagnostics and therapy and give recommendations to help surgeons to standardize their techniques and to improve their results. However, science is a dynamic field which is continuously developing. Therefore, guidelines require regular updates to keep pace with the evolving literature. Methods For the development of the original guidelines, all relevant literature published up to year 2012 was analyzed using the ranking of the Oxford Centre for Evidence-Based Medicine. For the present update, all of the previous authors were asked to evaluate the literature published during the recent years from 2012 to 2017 and revise their statements and recommendations given in the initial guidelines accordingly. In two Consensus Conferences (October 2017 Beijing, March 2018 Cologne), the updates were presented, discussed, and confirmed. To avoid redundancy, only new statements or recommendations are included in this paper. Therefore, for full understanding both of the guidelines, the original and the current, must be read. In addition, the new developments in repair of abdominal wall hernias like surgical techniques within the abdominal wall, release operations (transversus muscle release, component separation), Botox application, and robot-assisted repair methods were included. Results Due to an increase of the number of patients and further development of surgical techniques, repair of primary and secondary abdominal wall hernias attracts increasing interests of many surgeons. Whereas up to three decades ago hernia-related publications did not exceed 20 per year, currently this number is about 10-fold higher. Recent years are characterized by the advent of new techniques—minimal invasive techniques using robotics and laparoscopy, totally extraperitoneal repairs, novel myofascial release techniques for optimal closure of large defects, and Botox for relaxing the abdominal wall. Furthermore, a concomitant rectus diastasis was recognized as a significant risk factor for recurrence. Despite insufficient evidence with respect to these new techniques, it seemed to us necessary to include them in the update to stimulate surgeons to do research in these fields. Conclusion Guidelines are recommendations based on best available evidence intended to help the surgeon to improve the quality of his daily work. However, science is a continuously evolving process, and as such guidelines should be updated about every 3 years. For a comprehensive reference, however, it is suggested to read both the initial guidelines published in 2014 together with the update. Moreover, the presented update includes also techniques which were not known 3 years before.
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Affiliation(s)
- R Bittner
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Trubetskaya str., 8, b. 2, 119992, Moscow, Russia. .,Emeritus Director Marienhospital Stuttgart, Supperstr. 19, 70565, Stuttgart, Germany.
| | - K Bain
- Department of Surgery, New York University, New York, USA
| | - V K Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5026A, 5th Floor, Teaching Block, Ansari Nagar, New Delhi, 110029, India
| | - F Berrevoet
- Universitair Ziekenhuis Gent, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - J Bingener-Casey
- Division of Breast, Endocrine, Metabolic & Gastrointestinal Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - D Chen
- Lichtenstein Amid Hernia Clinic at UCLA, Section of Minimally Invasive Surgery, UCLA Division of General Surgery, Los Angeles, USA
| | - J Chen
- Department of Hernia and Abdominal Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Fengtai, China
| | - P Chowbey
- Max Super Speciality Hospital, 2 Press Enclave Road, Saket, New Delhi, 110017, India
| | - U A Dietz
- Klinik für Viszeral-, Gefäss- und Thoraxchirurgie, Kantonsspital Olten, Baslerstrasse 150, 4600, Olten, Switzerland
| | - A de Beaux
- Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK
| | - G Ferzli
- Department of Surgery, New York University, New York, USA
| | - R Fortelny
- Allgemein-, Viszeral- und Tumorchirurgie, Wilhelminenspital, 1160, Vienna, Austria
| | - H Hoffmann
- ZweiChirurgen GmbH, Zentrum für Hernienchirurgie und Proktologie, St. Johanns-Vorstadt 44, 4056, Basel, Switzerland
| | - M Iskander
- Department of Surgery, Mount Sinai Hospital, 1010 5th Avenue, New York, NY, 10028, USA
| | - Z Ji
- Department of Surgery, Southeast University School of Medicine, Main Add. 87 Ding Jia Qiao, Nanjing, 210009, Jiangsu, China
| | - L N Jorgensen
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, 2400, Copenhagen NV, Denmark
| | - R Khullar
- Max Super Speciality Hospital, 2 Press Enclave Road, Saket, New Delhi, 110017, India
| | - P Kirchhoff
- ZweiChirurgen GmbH, Zentrum für Hernienchirurgie und Proktologie, St. Johanns-Vorstadt 44, 4056, Basel, Switzerland
| | - F Köckerling
- Visceral- und Gefäßchirurgie, Zentrum für Minimal Invasive Chirurgie, Vivantes Klinikum Spandau, Neue Bergstraße 6, 13585, Berlin, Germany
| | - J Kukleta
- Klinik im Park, Grossmuensterplatz 9, 8001, Zurich, Switzerland
| | - K LeBlanc
- Our Lady of the Lake Physician Group, 7777 Hennessy Blvd., Suite 612, Baton Rouge, LA, 70808, USA
| | - J Li
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - D Lomanto
- Department of Surgery, YLL School of Medicine, National University Hospital, Level 2, Kent Ridge Wing 2, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - F Mayer
- Paracelsus Medizinische Universität Salzburg (PMU), Universitätsklinik für Chirurgie, Salzburg, Austria
| | - V Meytes
- Department of Surgery, New York University, New York, USA
| | - M Misra
- Mahatma Gandhi University of Medical Sciences & Technology, RIICO Institutional Area, Tonk Road, Sitapura, Jaipur, Rajasthan, 302 022, India
| | - S Morales-Conde
- Centro de Cirugía Mayor Ambulatoria Ave María, Avda. de la Palmera, 53, 41013, Seville, Spain
| | - H Niebuhr
- HANSECHIRURGIE, Niebuhr Marleschki & Partner, Alte Holstenstr. 16, 21031, Hamburg, Germany
| | - D Radvinsky
- SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA
| | - B Ramshaw
- Department of Surgery, University Surgeons Associates, 1930 Alcoa Highway, Bldg A, Ste 285, Knoxville, TN, 37920, USA
| | - D Ranev
- Lenox Hill Hospital-Northwell Health, New York, USA
| | - W Reinpold
- Abteilung für Chirurgie, Wilhelmsburger Krankenhaus, Groß-Sand 3, 21107, Hamburg, Germany
| | - A Sharma
- Max Super Speciality Hospital, 2 Press Enclave Road, Saket, New Delhi, 110017, India
| | - R Schrittwieser
- Abteilung für Chirurgie, LKH Hochsteiermark, Standort Bruck an der Mur Tragösser Str. 1, 8600, Bruck an der Mur, Austria
| | - B Stechemesser
- Hernienzentrum Köln, Zeppelinstraße 1, 50667, Cologne, Germany
| | - B Sutedja
- Gading Pluit Hospital, Jl. Boulevard Timur Raya Kelapa Gading, Jakarta, 14250, Indonesia
| | - J Tang
- Department of General Surgery, Huadong Hospital, Fudan University, Shanghai, China
| | - J Warren
- Minimally Invasive Surgery, Greenville Health System, Department of Surgery, University of South Carolina School of Medicine, Greenville, USA
| | - D Weyhe
- Pius-Hospital Oldenburg, Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinik für Viszeralchirurgie, Georgstraße 12, 26121, Oldenburg, Germany
| | - A Wiegering
- Department of General, Visceral, Vascular and Paediatric Surgery, University Hospital of Wuerzburg, Oberduerrbacher Strasse 6, 97080, Würzburg, Germany
| | - G Woeste
- AGAPLESION ELISABETHENSTIFT gemeinnützige GmbH, Akademisches Lehrkrankenhaus, Landgraf-Georg-Strasse 100, 64287, Darmstadt, Germany
| | - Q Yao
- Department of Hernia and Abdominal Surgery, Huashan Hospital, Fudan University, Shanghai, China
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Köckerling F, Sheen AJ, Berrevoet F, Campanelli G, Cuccurullo D, Fortelny R, Friis-Andersen H, Gillion JF, Gorjanc J, Kopelman D, Lopez-Cano M, Morales-Conde S, Österberg J, Reinpold W, Simmermacher RKJ, Smietanski M, Weyhe D, Simons MP. Accreditation and certification requirements for hernia centers and surgeons: the ACCESS project. Hernia 2019; 23:185-203. [PMID: 30671899 PMCID: PMC6456484 DOI: 10.1007/s10029-018-1873-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 12/11/2018] [Indexed: 12/15/2022]
Abstract
INTRODUCTION There is a need for hernia centers and specialist hernia surgeons because of the increasing complexity of hernia surgery procedures due to new techniques, more difficult cases and a tailored approach with an increasing public awareness demanding optimal treatment results. Therefore, the requirements for accredited/certified hernia centers and specialist hernia surgeons should be formulated by the international and national hernia societies, while taking account of the respective health care systems. METHODS The European Hernia Society (EHS) has appointed a working group composed of 18 hernia experts from all regions of Europe (ACCESS Group-Hernia Accreditation and Certification of Centers and Surgeons-Working Group) to formulate scientifically based requirements for hernia centers and specialist hernia surgeons while taking into consideration different health care systems. A consensus was reached on the key questions by means of a meeting, a telephone conference and the exchange of contributions. The requirements formulated below were deemed implementable by all participating hernia experts in their respective countries. RESULTS The ACCESS Group suggests for an adequately equipped hernia center the following requirements: (a) to be accredited/certified by a national or international hernia society, (b) to perform a higher case volume in all types of hernia surgery compared to an average general surgery department in their country, (c) to be staffed by experienced hernia surgeons who are beyond the learning curve for all types of hernia surgery recommended in the guidelines and are responsible for education and training of hernia surgery in their department, (d) to treat hernia patients according to the current guidelines and scientific recommendations, (e) to document each case prospectively in a registry or quality assurance database (f) to perform follow-up for comparison of their own results with benchmark data for continuous improvement of their treatment results and ensuring contribution to research in hernia treatment. To become a specialist hernia surgeon, the ACCESS Group suggests a general surgeon to master the learning curve of all open and laparo-endoscopic hernia procedures recommended in the guidelines, perform a high caseload and additionally to implement and fulfill the other requirements for a hernia center. CONCLUSION Based on the above requirements formulated by the European Hernia Society for accredited/certified hernia centers and hernia specialist surgeons, the national and international hernia societies can now develop their own programs, while taking account of their specific health care systems.
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Affiliation(s)
- F Köckerling
- Department of Surgery, Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.
| | - A J Sheen
- Associate Clinical Head of Division (Surgery), Manchester University NHS Foundation Trust, Manchester, UK
| | - F Berrevoet
- General and HPB Surgery and Liver Transplantations, Pancreas and Abdominal Wall Specialist, Universitair Ziekenhuis Gent, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - G Campanelli
- General and Day Surgery Unit, Center of Research and High Specialization for the Pathologies of Abdominal Wall and Surgical Treatment and Repair of Abdominal Hernia, Milano Hernia Center, Instituto Clinico Sant'Ambrogio, University of Insurbria, Milan, Italy
| | - D Cuccurullo
- Chief Week Surgery Departmental Unit, Department of General, Laparoscopic and Robotic Surgery, A.O. Dei Colli Monaldi Hospital Naples, Naples, Italy
| | - R Fortelny
- Department of General, Visceral and Oncological Surgery, Wilhelminenspital, 1160, Vienna, Austria
| | - H Friis-Andersen
- Surgical Department, Horsens Regional Hospital, Horsens, Denmark
| | - J F Gillion
- Unité de Chirurgie Viscérale, Hôpital Privé d'Antony, 1, Rue Velpeau, 92160, Antony, France
| | - J Gorjanc
- Department of Surgery, Krankenhaus der Barmherzigen Brüder, Spitalgasse 26, 9300, St. Veit an der Glan, Austria
| | - D Kopelman
- Department of Surgery Emek Medical Center, Afula and the Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - M Lopez-Cano
- Abdominal Wall Surgery Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - S Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, University Hospital Virgen del Rocío, Av. Manuel Siurot, s/n, 41013, Seville, Spain
| | - J Österberg
- Department of Surgery, Mora Hospital, 79285, Mora, Sweden
| | - W Reinpold
- Wilhelmsburger Krankenhaus Gross-Sand, Gross-Sand 3, 21107, Hamburg, Germany
| | - R K J Simmermacher
- Department of Surgery, University Medical Center Utrecht, Heidelbergglaan 100, Utrecht, The Netherlands
| | - M Smietanski
- Department of General Surgery and Hernia Centre, Hospital in Puck, Medical University of Gdansk, Gdańsk, Poland
| | - D Weyhe
- School of Medicine and Health Sciences, University Hospital for Visceral Surgery, Pius-Hospital Oldenburg, Medical Campus University of Oldenburg, Georgstrasse 12, 26121, Oldenburg, Germany
| | - M P Simons
- Department of Surgery, OLVG Hospital, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands
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van Rooijen MMJ, Jairam AP, Tollens T, Jørgensen LN, de Vries Reilingh TS, Piessen G, Köckerling F, Miserez M, Windsor ACJ, Berrevoet F, Fortelny RH, Dousset B, Woeste G, van Westreenen HL, Gossetti F, Lange JF, Tetteroo GWM, Koch A, Kroese LF, Jeekel J. A post-market, prospective, multi-center, single-arm clinical investigation of Phasix™ mesh for VHWG grade 3 midline incisional hernia repair: a research protocol. BMC Surg 2018; 18:104. [PMID: 30458747 PMCID: PMC6247668 DOI: 10.1186/s12893-018-0439-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 11/07/2018] [Indexed: 02/05/2023] Open
Abstract
Background Incisional heia is a frequent complication of midline laparotomy. The use of mesh in hernia repair has been reported to lead to fewer recurrences compared to primary repair. However, in Ventral Hernia Working Group (VHWG) Grade 3 hernia patients, whose hernia is potentially contaminated, synthetic mesh is prone to infection. There is a strong preference for resorbable biological mesh in contaminated fields, since it is more able to resist infection, and because it is fully resorbed, the chance of a foreign body reaction is reduced. However, when not crosslinked, biological resorbable mesh products tend to degrade too quickly to facilitate native cellular ingrowth. Phasix™ Mesh is a biosynthetic mesh with both the biocompatibility and resorbability of a biological mesh and the mechanical strength of a synthetic mesh. This multi-center single-arm study aims to collect data on safety and performance of Phasix™ Mesh in Grade 3 hernia patients. Methods A total of 85 VHWG Grade 3 hernia patients will be treated with Phasix™ Mesh in 15 sites across Europe. The primary outcome is Surgical Site Occurrence (SSO) including hematoma, seroma, infection, dehiscence and fistula formation (requiring intervention) through 3 months. Secondary outcomes include recurrence, infection and quality of life related outcomes after 24 months. Follow-up visits will be at drain removal (if drains were not placed, then on discharge or staple removal instead) and in the 1st, 3rd, 6th, 12th, 18th and 24th month after surgery. Conclusion Based on evidence from this clinical study Depending on the results this clinical study will yield, Phasix™ Mesh may become a preferred treatment option in VHWG Grade 3 patients. Trial registration The trial was registered on March 25, 2016 on clinicaltrials.gov: NCT02720042.
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Affiliation(s)
- M M J van Rooijen
- Erasmus University Medical Centre Rotterdam, Department of Surgery, Rotterdam, The Netherlands.
| | - A P Jairam
- Erasmus University Medical Centre Rotterdam, Department of Surgery, Rotterdam, The Netherlands
| | - T Tollens
- Imelda Hospital, Department of General Surgery, Bonheiden, Belgium
| | - L N Jørgensen
- University of Copenhagen, Bispebjerg Hospital, Department of Surgery, Copenhagen, Denmark
| | | | - G Piessen
- Department of Surgery, University Hospital Lille, Lille, France
| | - F Köckerling
- Vivantes Klinikum Spandau, Department of Surgery, Berlin, Germany
| | - M Miserez
- Department of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium
| | - A C J Windsor
- Department of Colorectal Surgery, University College London Hospital, London, UK
| | - F Berrevoet
- Department of General and Hepatobiliary Surgery, University Hospital Ghent, Ghent, Belgium
| | - R H Fortelny
- Wilhelminenhospital, Department of General, Visceral and Oncologic Surgery, Vienna, Austria
| | - B Dousset
- Hôpital Cochin, Department of Digestive, Hepatobiliary and Endocrine Surgery, Paris, France
| | - G Woeste
- Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main, Germany
| | | | - F Gossetti
- Università di Roma Sapienza, Rome, Italy
| | - J F Lange
- Erasmus University Medical Centre Rotterdam, Department of Surgery, Rotterdam, The Netherlands
| | - G W M Tetteroo
- IJsselland Ziekenhuis, Department of Surgery, Capelle aan den Ijssel, The Netherlands
| | - A Koch
- Chirurgische Praxis Cottbus, Cottbus Area, Germany
| | - L F Kroese
- Erasmus University Medical Centre Rotterdam, Department of Surgery, Rotterdam, The Netherlands
| | - J Jeekel
- Erasmus University Medical Centre Rotterdam, Department of Surgery, Rotterdam, The Netherlands
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López-Cano M, García-Alamino JM, Antoniou SA, Bennet D, Dietz UA, Ferreira F, Fortelny RH, Hernandez-Granados P, Miserez M, Montgomery A, Morales-Conde S, Muysoms F, Pereira JA, Schwab R, Slater N, Vanlander A, Van Ramshorst GH, Berrevoet F. EHS clinical guidelines on the management of the abdominal wall in the context of the open or burst abdomen. Hernia 2018; 22:921-939. [DOI: 10.1007/s10029-018-1818-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 08/21/2018] [Indexed: 12/22/2022]
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Kroese LF, Mommers EH, Robbens C, Bouvy ND, Lange JF, Berrevoet F. Complications and recurrence rates of patients with Ehlers-Danlos syndrome undergoing ventral hernioplasty: a case series. Hernia 2018; 22:611-616. [PMID: 29388078 PMCID: PMC6061067 DOI: 10.1007/s10029-018-1739-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 01/19/2018] [Indexed: 12/02/2022]
Abstract
Purpose Ventral hernia repair is one of the most frequently performed surgical procedures, though recurrences are common. Recurrence can be caused by impaired collagen formation or maturation; hence, patients with Ehlers-Danlos syndrome (EDS) are potentially at increased risk for hernia recurrence. EDS causes altered collagen metabolism, though little is known about the influence of EDS on ventral hernioplasty outcomes. This study aims to analyze these patients to report complication rates, recurrence rates, and, if possible, to give recommendations for surgical intervention. Methods A retrospective analysis between January 2000 and January 2017 was performed in a university hospital Belgium (UZ Ghent). Data on baseline characteristics, primary surgery, and hernias were extracted from patients’ medical charts. Noted endpoints were postoperative complications and recurrences. Results Fourteen patients (50% males) were included. Ten (71%) had an incisional hernia and four (29%) had a primary ventral hernia. Median age was 45 years (IQR 37.75–52.75), median BMI was 24.82 (IQR 22.43–26.87). Four patients (29%) smoked, one patient (7.1%) had diabetes mellitus, and five patients (36%) had an aneurysm of the abdominal aorta. All patients underwent elective open hernioplasty with mesh reinforcement. Three patients (21%) had a postoperative complication (two infections, one seroma). Recurrence rate was 7.1% (one patient). Conclusions This series describes 14 patients with a median follow-up of 50 months and a recurrence rate of 7.1%. The low recurrence rate could be explained by the use of large meshes that reinforce the entire midline to compensate for the reduced collagen strength in EDS patients.
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Affiliation(s)
- L F Kroese
- Department of Surgery, Erasmus MC, University Medical Center, Room Ee-173, PO BOX 2040, 3000 CA, Rotterdam, The Netherlands.
| | - E H Mommers
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - C Robbens
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - N D Bouvy
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - J F Lange
- Department of Surgery, Erasmus MC, University Medical Center, Room Ee-173, PO BOX 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Surgery, Havenziekenhuis Rotterdam, Rotterdam, The Netherlands
| | - F Berrevoet
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
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Antoniou SA, Agresta F, Garcia Alamino JM, Berger D, Berrevoet F, Brandsma HT, Bury K, Conze J, Cuccurullo D, Dietz UA, Fortelny RH, Frei-Lanter C, Hansson B, Helgstrand F, Hotouras A, Jänes A, Kroese LF, Lambrecht JR, Kyle-Leinhase I, López-Cano M, Maggiori L, Mandalà V, Miserez M, Montgomery A, Morales-Conde S, Prudhomme M, Rautio T, Smart N, Śmietański M, Szczepkowski M, Stabilini C, Muysoms FE. European Hernia Society guidelines on prevention and treatment of parastomal hernias. Hernia 2017; 22:183-198. [PMID: 29134456 DOI: 10.1007/s10029-017-1697-5] [Citation(s) in RCA: 190] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 08/19/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND International guidelines on the prevention and treatment of parastomal hernias are lacking. The European Hernia Society therefore implemented a Clinical Practice Guideline development project. METHODS The guidelines development group consisted of general, hernia and colorectal surgeons, a biostatistician and a biologist, from 14 European countries. These guidelines conformed to the AGREE II standards and the GRADE methodology. The databases of MEDLINE, CINAHL, CENTRAL and the gray literature through OpenGrey were searched. Quality assessment was performed using Scottish Intercollegiate Guidelines Network checklists. The guidelines were presented at the 38th European Hernia Society Congress and each key question was evaluated in a consensus voting of congress participants. RESULTS End colostomy is associated with a higher incidence of parastomal hernia, compared to other types of stomas. Clinical examination is necessary for the diagnosis of parastomal hernia, whereas computed tomography scan or ultrasonography may be performed in cases of diagnostic uncertainty. Currently available classifications are not validated; however, we suggest the use of the European Hernia Society classification for uniform research reporting. There is insufficient evidence on the policy of watchful waiting, the route and location of stoma construction, and the size of the aperture. The use of a prophylactic synthetic non-absorbable mesh upon construction of an end colostomy is strongly recommended. No such recommendation can be made for other types of stomas at present. It is strongly recommended to avoid performing a suture repair for elective parastomal hernia. So far, there is no sufficient comparative evidence on specific techniques, open or laparoscopic surgery and specific mesh types. However, a mesh without a hole is suggested in preference to a keyhole mesh when laparoscopic repair is performed. CONCLUSION An evidence-based approach to the diagnosis and management of parastomal hernias reveals the lack of evidence on several topics, which need to be addressed by multicenter trials. Parastomal hernia prevention using a prophylactic mesh for end colostomies reduces parastomal herniation. Clinical outcomes should be audited and adverse events must be reported.
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Affiliation(s)
- S A Antoniou
- Department of General Surgery, University Hospital of Herakion, Crete, Greece.
| | - F Agresta
- Department of General Surgery, ULSS19 del Veneto, Adria, RO, Italy
| | - J M Garcia Alamino
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - D Berger
- Clinic of Abdominal, Thoracic and Pediatric Surgery, Klinikum Mittelbaden/Balg, Baden-Baden, Germany
| | - F Berrevoet
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - H-T Brandsma
- Department of Colorectal Surgery, Western General Hospital, Edinburgh, UK
| | - K Bury
- Department Cardiac and Vascular Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - J Conze
- Herniacenter Dr. Muschaweck/Dr. Conze, Munich, Germany
- Herniacenter Dr. Muschaweck/Dr. Conze, London, UK
- Department of General, Visceral and Transplant Surgery, University Hospital, RWTH Aachen University, Aachen, Germany
| | - D Cuccurullo
- Department of General, Laparoscopic, and Robotic Surgery, Ospedale Monaldi, Azienda Ospedaliera dei Colli, Naples, Italy
| | - U A Dietz
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - R H Fortelny
- Certified Hernia Center, Department of General, Visceral and Oncological Surgery, Wilhelminenspital, Vienna, Austria
| | - C Frei-Lanter
- Department of Surgery, Kantonsspital Winterthur, Winterthur, Switzerland
| | - B Hansson
- Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - F Helgstrand
- Department of Surgery, Zealand University Hospital, Køge, Denmark
| | - A Hotouras
- National Bowel Research Centre, The Royal London Hospital, London, United Kingdom
| | - A Jänes
- Department of Surgery, Sundsvall Hospital, Sundsvall, Sweden
| | - L F Kroese
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - J R Lambrecht
- Surgical Department, Innlandet Hospital Trust, Gjøvik, Norway
| | - I Kyle-Leinhase
- Department of Surgery, Maria Middelares Hospital, Ghent, Belgium
| | - M López-Cano
- Abdominal Wall Surgery Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - L Maggiori
- Department of Colorectal Surgery, Beaujon Hospital, Assistance publique-Hôpitaux de Paris, Université Paris VII, Clichy, France
| | - V Mandalà
- Department of General Surgery, Buccheri La Ferla Hospital, Palermo, Italy
| | - M Miserez
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - A Montgomery
- Department of Surgery, Skåne University Hospital, Malmö, Sweden
| | | | - M Prudhomme
- Digestive Surgery Department, CHU Nîmes, Nîmes, France
| | - T Rautio
- Department of Surgery, Division of Gastroenterology, Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - N Smart
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital, Exeter, UK
| | - M Śmietański
- 2nd Department of Radiology, Medical University of Gdansk, Gdańsk, Poland
- Department of General Surgery and Hernia Centre, District Hospital in Puck, Puck, Poland
| | - M Szczepkowski
- Department of Rehabilitation, Józef Piłsudski University of Physical Education in Warsaw, Warsaw, Poland
- Clinical Department of General and Colorectal Surgery, Bielanski Hospital, Warsaw, Poland
| | - C Stabilini
- Department of Surgery, University of Genoa, Genoa, Italy
| | - F E Muysoms
- Department of Surgery, Maria Middelares Hospital, Ghent, Belgium
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Fernandez M, Arvanitakis M, Musala C, Devière J, Van Steenbergen W, Putzeys V, Ausloos F, Bastens B, Gast P, Roeyen G, Berrevoet F, Scheers I, Delhaye M, Deprez PH. The Belgian national registry on chronic pancreatitis: A prospective multi-centre study covering more than 800 patients in one year. Pancreatology 2017; 17:572-579. [PMID: 28600220 DOI: 10.1016/j.pan.2017.05.387] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 05/12/2017] [Accepted: 05/24/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES The epidemiology, natural history, complications, and therapeutic management of chronic pancreatitis (CP) are not well described at the national level. This multi-centre prospective observational study involving eight Belgian hospitals aimed to improve the understanding of these aspects of CP in Belgium. METHODS All patients with a diagnosis of CP based on imaging were eligible for this study. Data were gathered regarding epidemiology, etiology, CP complications, and treatment modalities. RESULTS A total of 809 patients were included between 1/9/2014 and 31/8/2015. Most patients (794) were adults ≥16-years old, 74% were male, the median age at symptom onset was 47 (38-57) years, the median disease duration was 7 (3-13) years, and the median Izbicki pain score (IPS) was 96 (0-195). The main etiological risk factors according to the TIGAR-O classification were alcohol and tobacco (67%). Current drinkers had lower body mass index (BMI) (21.4 kg/m2 vs 24.1 kg/m2), higher IPS (110 vs 56), and longer inability to work than non-drinkers. Current smokers had lower BMI (21.5 kg/m2 vs 25 kg/m2) and higher IPS (120 vs 30) than non-smokers. Endocrine insufficiency and/or clinical steatorrhea was recorded in 41% and 36% of patients, respectively. The highest IPS was reported in patients with ongoing endotherapy (166 vs 50 for patients who completed endoscopy). CONCLUSION This multicentric study on CP patients showed that current alcohol drinking and smoking are associated with pain and malnutrition. Pain scores were higher in patients with ongoing endotherapy, independently of surgery.
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Affiliation(s)
- M Fernandez
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
| | - M Arvanitakis
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - C Musala
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - J Devière
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - W Van Steenbergen
- Department of Gastroenterology and Hepatology, University of Leuven, Leuven, Belgium
| | - V Putzeys
- Department of Gastroenterology, Centre Hospitalier Régional de la Citadelle, Liège, Belgium
| | - F Ausloos
- Department of Gastroenterology, Centre Hospitalier Chrétien de Liège, Liège, Belgium
| | - B Bastens
- Department of Gastroenterology, Centre Hospitalier Chrétien de Liège, Liège, Belgium
| | - P Gast
- Department of Gastroenterology, Centre Hospitalier Universitaire du Sart-Tilman, Université de Liège, Liège, Belgium
| | - G Roeyen
- Department of Hepatobiliary, Endocrine, and Transplantation Surgery, Universitair Ziekenhuis Antwerpen, Universiteit Antwerpen, Antwerp, Belgium
| | - F Berrevoet
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - I Scheers
- Pediatric Gastroenterology, Hepatology, and Nutrition Unit, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - M Delhaye
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - P H Deprez
- Department of Hepato-gastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
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Koning GG, Vriens PWHE, Berrevoet F. Comment to: Recurrence mechanisms after inguinal hernia repair by the Onstep technique: a case series. Hernia 2017; 21:661-662. [PMID: 28124307 DOI: 10.1007/s10029-017-1578-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 01/06/2017] [Indexed: 10/20/2022]
Affiliation(s)
- G G Koning
- Department of Surgery, Medical Center Leeuwarden, Henri Dunantweg 2, 8901 BR, Leeuwarden, The Netherlands.
| | - P W H E Vriens
- Department of Surgery, Elisabeth TweeSteden Hospital, Tilburg, The Netherlands
| | - F Berrevoet
- Department of General and HBP Surgery, Ghent University Hospital and Medical School, Ghent, Belgium
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Berrevoet F, Tollens T, Berwouts L, Bertrand C, Muysoms F, Gols JD, Meir E, Backer AD. A Belgian Multicenter Prospective Observational Cohort Study Shows Safe and Efficient Use of a Composite Mesh with Incorporated Oxidized Regenerated Cellulose in Laparoscopic Ventral Hernia Repair. Acta Chir Belg 2016. [DOI: 10.1080/00015458.2014.11681018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - T. Tollens
- Imelda Hospital Bonheiden, Brussels, Belgium
| | - L. Berwouts
- Sint Vincentius Hospital Deinze, Brussels, Belgium
| | - C. Bertrand
- Hospital de Jolimont La Louvriere, Brussels, Belgium
| | - F. Muysoms
- Maria Middelares Hospital Ghent, Brussels, Belgium
| | | | - E. Meir
- St Jozef Hospital Mortsel, Brussels, Belgium
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Reynvoet E, Van Cleven S, Van Overbeke I, Chiers K, De Baets P, Troisi R, Berrevoet F. The use of cyanoacrylate sealant as simple mesh fixation in laparoscopic ventral hernia repair: a large animal evaluation. Hernia 2015; 19:661-70. [DOI: 10.1007/s10029-015-1347-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 01/17/2015] [Indexed: 11/24/2022]
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Croo A, De Wolf E, Boterbergh K, Vanlander A, Peeters H, Troisi RI, Berrevoet F. Laparoscopic cholecystectomy in acute cholecystitis: support for an early interval surgery. Acta Gastroenterol Belg 2014; 77:306-311. [PMID: 25509201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND AND STUDY AIMS Although laparoscopic cholecystectomy is advocated for acute cholecystitis, debate still exists about its optimal timing. This retrospective study compares the outcome of laparoscopic cholecystectomy within versus later than 5 days of onset of symptoms in patients with acute cholecystitis. PATIENTS AND METHODS One hundred thirty six patients with acute cholecystitis grade I or II were included in the study and divided in two groups. Group 1 received surgery within 5 days of symptoms and group 2 received conservative therapy and delayed surgery after 6 weeks. RESULTS Group 1 and 2 consisted of 100 and 36 patients respec- tively. Because of failure of conservative therapy 5 patients of group 2 had surgery before 6 weeks. The remaining 31 patients underwent surgery after 6 weeks. Preoperative ERCP was indicated in 2 and 11 patients in groups 1 and 2 respectively (p < 0.001). The median total hospital stay was 3.0 days for group 1 and 11.0 days for group 2 (p < 0.001). In terms of operation time, conversion rates, intraoperative cholangiography, postoperative ERCP, morbidity or mortality both groups were comparable (p > 0.05). CONCLUSION Laparoscopic cholecystectomy can be performed safely within 5 days after the onset of symptoms in patients with acute cholecystitis. Because of shortened total hospital stay and risk of failure of conservative therapy, early laparoscopic cholecystectomy should be favored.
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43
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Berrevoet F, Tollens T, Berwouts L, Bertrand C, Muysoms F, De Gols J, Meir E, De Backer A. A belgian multicenter prospective observational cohort study shows safe and efficient use of a composite mesh with incorporated oxidized regenerated cellulose in laparoscopic ventral hernia repair. Acta Chir Belg 2014; 114:233-238. [PMID: 26021417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND A variety of anti-adhesive composite mesh products have become available to use inside the peritoneal cavity. However, reimbursement of these meshes by the Belgian Governemental Health Agency (RIZIV/INAMI) can only be obtained after conducting a prospective study with at least one year of clinical follow-up. This -Belgian multicentric cohort study evaluated the experience with the use of Proceed®-mesh in laparoscopic ventral hernia repair. METHODS During a 25 month period 210 adult patients underwent a laparoscopic primary or incisional hernia repair using an intra-abdominal placement of Proceed®-mesh. According to RIZIV/INAMI criteria recurrence rate after 1 year was the primary objective, while postoperative morbidity, including seroma formation, wound and mesh infections, quality of life and recurrences after 2 years were evaluated as secondary endpoints (NCT00572962). RESULTS In total 97 primary ventral and 103 incisional hernias were repaired, of which 28 (13%) were recurrent. There were no conversions to open repair, no enterotomies, no mesh infections and no mortality. One year cumulative follow-up showed 10 recurrences (n = 192, 5.2%) and chronic discomfort or pain in 4.7% of the patients. Quality of life could not be analyzed due to incomplete data set. CONCLUSIONS More than 5 years after introduction of this mesh to the market, this prospective multicentric study documents a favorable experience with the Proceed mesh in laparoscopic ventral hernia repair. However, it remains to be discussed whether reimbursement of these meshes in Belgium should be limited to the current strict criteria and therefore can only be obtained after at least 3-4 years of clinical data gathering and necessary follow-up.
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Slater NJ, Montgomery A, Berrevoet F, Carbonell AM, Chang A, Franklin M, Kercher KW, Lammers BJ, Parra-Davilla E, Roll S, Towfigh S, van Geffen E, Conze J, van Goor H. Criteria for definition of a complex abdominal wall hernia. Hernia 2013; 18:7-17. [PMID: 24150721 DOI: 10.1007/s10029-013-1168-6] [Citation(s) in RCA: 158] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Accepted: 10/03/2013] [Indexed: 12/24/2022]
Abstract
PURPOSE A clear definition of "complex (abdominal wall) hernia" is missing, though the term is often used. Practically all "complex hernia" literature is retrospective and lacks proper description of the population. There is need for clarification and classification to improve patient care and allow comparison of different surgical approaches. The aim of this study was to reach consensus on criteria used to define a patient with "complex" hernia. METHODS Three consensus meetings were convened by surgeons with expertise in complex abdominal wall hernias, aimed at laying down criteria that can be used to define "complex hernia" patients, and to divide patients in severity classes. To aid discussion, literature review was performed to identify hernia classification systems, and to find evidence for patient and hernia variables that influence treatment and/or prognosis. RESULTS Consensus was reached on 22 patient and hernia variables for "complex" hernia criteria inclusion which were grouped under four categories: "Size and location", "Contamination/soft tissue condition", "Patient history/risk factors", and "Clinical scenario". These variables were further divided in three patient severity classes ('Minor', 'Moderate', and 'Major') to provide guidance for peri-operative planning and measures, the risk of a complicated post-operative course, and the extent of financial costs associated with treatment of these hernia patients. CONCLUSION Common criteria that can be used in defining and describing "complex" (abdominal wall) hernia patients have been identified and divided under four categories and three severity classes. Next step would be to create and validate treatment algorithms to guide the choice of surgical technique including mesh type for the various complex hernias.
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Affiliation(s)
- N J Slater
- Department of Surgery, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands,
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45
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Troisi RI, Wojcicki M, Tomassini F, Houtmeyers P, Vanlander A, Berrevoet F, Smeets P, Van Vlierberghe H, Rogiers X. Pure laparoscopic full-left living donor hepatectomy for calculated small-for-size LDLT in adults: proof of concept. Am J Transplant 2013; 13:2472-8. [PMID: 23914734 DOI: 10.1111/ajt.12362] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Revised: 03/07/2013] [Accepted: 04/02/2013] [Indexed: 01/25/2023]
Abstract
Adult-to-adult living donor liver transplantation (A2ALDLT) is an accepted mode of treatment for end-stage liver disease. Right-lobe grafts have usually been preferred in view of the higher graft volume, which lowers the risk of a small-for-size syndrome. However, donor left hepatectomy is associated with less morbidity than when it is compared to right hepatectomy. Laparoscopic donor hepatectomy (LDH) has been considered almost exclusively in pediatric transplantation. The results of laparoscopic left-liver graft procurement for calculated small-for-size A2ALDLT in four donors are presented. The graft-to-recipient body weight ratio was <0.8 in all recipients. The mean portal vein flow and the pressure and hepatic artery flows were measured at 190 ± 56 mL/min/100 g, 13 ± 1.4 mm/Hg and 109 ± 19 mL/min, respectively. No early postoperative donor complications were recorded. One graft was lost due to intrahepatic abscesses. Asymptomatic stenosis of a right posterior duct was treated with a Roux-en-Y loop 4 months later in one donor. We show that LDH of the full-left lobe is feasible. LDH is a very demanding operation, potentially decreasing donor morbidity. Standardization of this procedure, making it accessible to the growing number of experienced laparoscopic liver surgeons, could help renewing the interest for A2ALDLT in the Western world.
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Affiliation(s)
- R I Troisi
- Department of General and Hepatobiliary Surgery, Liver Transplantation Service, Ghent University Hospital and Medical School, Ghent, Belgium
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46
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Colle I, Verhelst X, Vanlander A, Geerts A, Vlierberghe HV, Berrevoet F, Rogiers X, Troisi RI. Pathophysiology and management of post resection liver failure. Acta Chir Belg 2013; 113:155-61. [PMID: 24941709 DOI: 10.1080/00015458.2013.11680904] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Post resection liver failure (PRLF) is defined by the occurrence of jaundice, coagulopathy and encephalopathy after liver resection. When PRLF is present, it has a high morbidity and mortality. The incidence of PRLF ranges between 0-30%. For having a healthy regeneration of the liver remnant an adequate number of hepatocytes and nonparenchymal cells, a normal functional and regenerative capacity and also a good accommodation of haemodynamic changes without congestion are needed. To avoid the presence of PRLF ongoing parenchymal damage after the liver resection should be avoided. So, ischemia reperfusion injury should be minimalized, infection and sepsis should be treated immediately and small for size syndrome should be avoided.
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Affiliation(s)
- I. Colle
- Department of Hepatology and Gastroenterology,Ghent University Hospital, Ghent, Belgium
| | - X. Verhelst
- Department of Hepatology and Gastroenterology,Ghent University Hospital, Ghent, Belgium
| | - A. Vanlander
- Department of General and Hepatobiliary Surgery and Liver Transplantation Service,Ghent University Hospital, Ghent, Belgium
| | - A. Geerts
- Department of Hepatology and Gastroenterology,Ghent University Hospital, Ghent, Belgium
| | - H. Van Vlierberghe
- Department of Hepatology and Gastroenterology,Ghent University Hospital, Ghent, Belgium
| | - F. Berrevoet
- Department of General and Hepatobiliary Surgery and Liver Transplantation Service,Ghent University Hospital, Ghent, Belgium
| | - X. Rogiers
- Department of General and Hepatobiliary Surgery and Liver Transplantation Service,Ghent University Hospital, Ghent, Belgium
| | - R. I. Troisi
- Department of General and Hepatobiliary Surgery and Liver Transplantation Service,Ghent University Hospital, Ghent, Belgium
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Berrevoet F, Vanlander A, Sainz-Barriga M, Rogiers X, Troisi R. Infected large pore meshes may be salvaged by topical negative pressure therapy. Hernia 2012; 17:67-73. [PMID: 22836918 DOI: 10.1007/s10029-012-0969-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 07/12/2012] [Indexed: 01/10/2023]
Abstract
PURPOSE To evaluate the efficacy of negative pressure therapy for superficial and deep mesh infections after ventral and incisional hernia repair by a prospective monocentric observational study. METHODS During a 6-year period, 724 consecutive open ventral and incisional hernia repairs were performed. Pre- and intraoperative data as well as postoperative complications were prospectively recorded. In case of wound infection, negative pressure therapy (NPT) was our primary treatment. RESULTS Sixty-three patients (8.7 %) were treated using negative pressure therapy after primary ventral and incisional hernia repair. Infectious complications needing NPT occurred in 54 patients in the retromuscular group (54/523; 10.3 %), none when laparoscopically treated and in 9 patients (9/143; 6.3 %) treated by an open intraperitoneal mesh technique. Considering outcome, all meshes were completely salvaged in the retromuscular mesh group after a median of 5 dressing changes (range, 2-9), while in the intraperitoneal mesh, group 3 meshes needed complete (n = 2) or partial (n = 1) excision. Mean duration to complete wound closure was 44 days (range, 26-63 days). CONCLUSION NPT is a useful adjunct for salvage of deep infected meshes, particularly when large pore monofilament mesh is used.
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Affiliation(s)
- F Berrevoet
- Department of General and Hepatobiliary Surgery and Liver Transplantation Service, Ghent University Hospital and Medical School, De Pintelaan 185 2K12 IC, 9000, Ghent, Belgium.
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48
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Scarinci A, Sainz-Barriga M, Berrevoet F, van den Bossche B, Colle I, Geerts A, Rogiers X, van Vlierberghe H, de Hemptinne B, Troisi R. Early arterial revascularization after hepatic artery thrombosis may avoid graft loss and improve outcomes in adult liver transplantation. Transplant Proc 2011; 42:4403-8. [PMID: 21168708 DOI: 10.1016/j.transproceed.2010.07.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Hepatic artery thrombosis (HAT) represents a devastating complication after liver transplantation (LT), occurring in 1.6%-9.2% of adult recipients. Treatments of HAT include thrombectomy and thrombolysis (with or without redo of the arterial anastomosis), percutaneous thrombolysis through an angiogram, liver retransplantation, and clinical observation. METHODS We retrospectively analyzed data from 739 adult LTs between January 1992 and September 2009. HAT was classified as early (E-HAT), when occurring within the first 30 days after LT, or late HAT (L-HAT), when diagnosed from the 2nd month onward. HAT suspected clinically was confirmed by Doppler ultrasound and angiography in all cases. Attempted revascularization was defined as early (ER) if performed within the first 2 weeks after LT and late (LR) if performed between 15 and 30 days. RESULTS After a median follow-up (FU) of 62 months (range, 1-227 months), HAT occurred in 31/739 grafts (4.3%). E-HAT was recorded in 25/31 cases (3.4%) and L-HAT in 11/31 cases (0.8%). ER was performed in 20/31 patients (65%) leading to 62% graft salvage; it was 81% when the revascularization was performed within the first week after LT (P = ns). LR was unsuccessful in all cases (P = .08). The overall incidence of BC among rescued grafts was 54% without graft loss during FU. Graft survival was 79% versus 71%; and 50% versus 50% at 1 and 3 years for E-HAT and L-HAT, respectively (P = ns). CONCLUSIONS Urgent revascularization in cases of early HAT may decrease graft loss, especially when performed within the first week after LT, with improved overall outcomes.
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Affiliation(s)
- A Scarinci
- Department of General and Hepatobiliary Surgery, Liver Transplantation Service, Ghent University Hospital and Medical School, Ghent, Belgium
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Berrevoet F, Martens T, Van Landuyt K, de Hemptinne B. The anterolateral thigh flap for complicated abdominal wall reconstruction after giant incisional hernia repair. Acta Chir Belg 2010; 110:376-82. [PMID: 20690529 DOI: 10.1080/00015458.2010.11680639] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In the management of giant incisional hernias with loss of domain several surgical obstacles have to be addressed. Adequate coverage of the defect using mesh, sufficient local tissue advancement and prevention of wound and mesh infections are prerequisites for success. We present a case of a complicated giant incisional hernia repair after oncologic surgery, in which we chose for an intraabdominal mesh repair using a composite mesh. The patient developed a wound dehiscence and mesh infection, successfully treated with negative pressure therapy followed by a free ALT perforator flap. Several surgical techniques are discussed to manage these complicated hernias, such as progressive pneumoperitoneum, the component separation technique and the importance of soft tissue coverage (e.g. anterolateral thigh flap). In cases of wound complications, negative pressure therapy and new soft tissue coverage are discussed.
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Affiliation(s)
- F. Berrevoet
- Department of General and Hepatobiliary Surgery and Liver Transplantation,Ghent University Hospital and Medical School, Ghent, Belgium
| | - T. Martens
- Department of General and Hepatobiliary Surgery and Liver Transplantation,Ghent University Hospital and Medical School, Ghent, Belgium
| | - K. Van Landuyt
- Department of Plastic and Reconstructive Surgery,Ghent University Hospital and Medical School, Ghent, Belgium
| | - B. de Hemptinne
- Department of General and Hepatobiliary Surgery and Liver Transplantation,Ghent University Hospital and Medical School, Ghent, Belgium
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Bertrand C, Squifflet J, Gys T, Berrevoet F, Jehaes C, Lerut T, Malaise J, Topal B. The Society for Internet-based Scientific Studies: a new platform to promote multicentric studies in the Royal Belgian Society for Surgery. Acta Chir Belg 2010; 110:3-5. [PMID: 20306901 DOI: 10.1080/00015458.2010.11680554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- C.L. Bertrand
- (Past)-members of the Scientific Committee of the Royal Belgian Society for Surgery-Past Scientific Secretaries
- Unit of Digestive and Endocrine Surgery, Hôpital de Jolimont, Haine Saint-Paul,
| | - J.P. Squifflet
- Department of Abdominal Surgery and Transplantation, CHU Sart Tilman, LIEGE-ARSMB/KVBMG,
| | - T. Gys
- (Past)-members of the Scientific Committee of the Royal Belgian Society for Surgery-Past Scientific Secretaries
- AZ St Dimpna Hospital, Geel,
| | | | - C. Jehaes
- Department of surgery, Les cliniques Saint-Joseph, Liège ,
| | - T. Lerut
- Department of Surgery, UZ Leuven,
| | | | - B. Topal
- Department of Surgery, UZ Leuven,
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