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Cherkaoui A, Tossi S, Gotni A, Assal A, Jalal M, Lamrissi A. OIES complex diagnosed by in utero ultrasound a case report. Int J Surg Case Rep 2024; 118:109640. [PMID: 38643654 DOI: 10.1016/j.ijscr.2024.109640] [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: 02/26/2024] [Revised: 04/02/2024] [Accepted: 04/17/2024] [Indexed: 04/23/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE OEIS complex is a rare and complex anomaly of the genitourinary and intestinal tract. It includes Omphalocele, Exstrophy of cloaca, Imperforate anus and Spinal defects. PRESENTATION OF CASE We are reporting a case of OEIS complex. CLINICAL DISCUSSION Cloacal exstrophy is considered the most severe ventral abdominal wall defect. Diagnosis is primarily antenatal based on the presenting features on ultrasonography. Management requires initial resuscitation and stabilization followed by either single staged closure or multistage procedures by multi-disciplinary surgical team. CONCLUSION The introduction of better diagnostic techniques and the detection of fetal malformations during pregnancy is it's the cornerstone of care.
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Affiliation(s)
- Amal Cherkaoui
- Maternity, Mother and Child Hospital Abderrahim HAROUCHI, University Hospital IBN ROCHD of Casablanca, Morocco.
| | - Sara Tossi
- Maternity, Mother and Child Hospital Abderrahim HAROUCHI, University Hospital IBN ROCHD of Casablanca, Morocco
| | - Aicha Gotni
- Maternity, Mother and Child Hospital Abderrahim HAROUCHI, University Hospital IBN ROCHD of Casablanca, Morocco
| | - Asmaa Assal
- Maternity, Mother and Child Hospital Abderrahim HAROUCHI, University Hospital IBN ROCHD of Casablanca, Morocco
| | - Mohamed Jalal
- Maternity, Mother and Child Hospital Abderrahim HAROUCHI, University Hospital IBN ROCHD of Casablanca, Morocco
| | - Amine Lamrissi
- Maternity, Mother and Child Hospital Abderrahim HAROUCHI, University Hospital IBN ROCHD of Casablanca, Morocco
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Alpuche HAV, Torres FR, González JPS. Early results of eTEP access surgery with preperitoneal repair of primary midline ventral hernias and diastasis recti. A 33 patient case series of "PeTEP". Surg Endosc 2024:10.1007/s00464-024-10832-9. [PMID: 38637338 DOI: 10.1007/s00464-024-10832-9] [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: 12/28/2023] [Accepted: 03/25/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND This article aims to share the initial experience of the preperitoneal eTEP approach and its potential benefits in a selected group of patients. The eTEP Rives-Stoppa is a proven minimally invasive surgical technique for the treatment of ventral midline and off-midline hernias that has shown to be a solid, durable, and reproducible repair. The preperitoneal eTEP repair is a surgical technique that brings together the extraperitoneal access surgery with a preperitoneal repair for primary midline hernias avoiding posterior rectus sheath division and preservation of the retrorectus space while being able to treat simultaneous diastasis recti. METHODS The analysis included 33 patients operated with the preperitoneal eTEP approach from September 2022 to September 2023 in patients with primary small to medium (< 4 cm) midline hernias, single or multiple defects with or without diastasis recti. Age, gender, hernia characteristics, operative time, and surgical site occurrences will be discussed, as well as fine details and landmarks in the operative technique. RESULTS 33 consecutive patients were operated, 19 female (57.5%) and 14 males (42.5%) between 32 and 63 years of age, the most common comorbidity found was obesity (BMI > 30). In 70% of the cases, operative time was 90 min ± 25 min. The average hospital stay was one day, while 12 went home the same day, and so far, no reoccurrences have been reported. CONCLUSIONS We believe the preperitoneal eTEP approach for small to medium primary midline hernias is an effective and solid repair that combines excellent features of proven surgical techniques and eliminates the need for posterior rectus sheath division while saving the retrorectus space, among other benefits that will be discussed. The reproducibility of the technique remains to be proven.
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Affiliation(s)
- Héctor Alí Valenzuela Alpuche
- General Surgeon, Staff Member at Hospital Ángeles del Carmen Guadalajara, Tarascos 3469 int. 217 condominio profesional del Carmen. colonia Frac. Monraz Guadalajara, Jalisco, CP:44670, Mexico.
| | - Francisco Regin Torres
- General Surgeon, Staff Member at Hospital Ángeles del Carmen Guadalajara, Tarascos 3469 int. 217 condominio profesional del Carmen. colonia Frac. Monraz Guadalajara, Jalisco, CP:44670, Mexico
| | - Juan Pablo Saucedo González
- General Surgeon, Staff Member at Hospital Ángeles del Carmen Guadalajara, Tarascos 3469 int. 217 condominio profesional del Carmen. colonia Frac. Monraz Guadalajara, Jalisco, CP:44670, Mexico
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Martucci C, Frediani S, Accinni A, Aloi IP, Bertocchini A, Crocoli A, Madafferi S, Pardi V, Persano G, Inserra A. Femoral hernia in pediatric population: a diagnostic and surgical challenge. Hernia 2024; 28:593-597. [PMID: 38270834 DOI: 10.1007/s10029-023-02953-2] [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: 08/09/2023] [Accepted: 12/20/2023] [Indexed: 01/26/2024]
Abstract
PURPOSE Femoral hernia (FH) is a rare and often misdiagnosed pathology in pediatric population. The aim of our study was to describe the experience of a Tertiary Center in children with FH, underlying diagnostic and surgical details that could improve its management. METHODS A retrospective study of pediatric patients who underwent FH repair from January 2010 to June 2023 at our Institution was performed. RESULTS In the analyzed period, 31 patients underwent surgical procedure for FH at our institution, of whom 16 (51.6%) were female. The mean age at time of surgery was 5.8 years (range 0.5-17.1 years). The rate of pre-operative misdiagnosis was 35.5% and open approach was adopted in all cases (16.1% with mesh application). Only two patients (6.4%) experienced surgical complications: one recurrence (repaired six months later) and one post-operative hematoma (treated successfully with conservative method). CONCLUSION Due to the high rate of misdiagnosis, the variety of surgical approaches proposed, and the potential for intraoperative complications, FH poses a challenge for pediatric surgeons and urologists, as confirmed by the literature. It is essential to underline the importance of a proper clinical examination in order to correctly diagnose FH, make the best surgical plan for the patient and prevent post-operative complications.
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Affiliation(s)
- Cristina Martucci
- Department of Surgery, General and Thoracic Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, Italy.
| | - Simone Frediani
- Department of Surgery, General and Thoracic Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, Italy
| | - Antonella Accinni
- Department of Surgery, General and Thoracic Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, Italy
| | - Ivan Pietro Aloi
- Department of Surgery, General and Thoracic Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, Italy
| | - Arianna Bertocchini
- Department of Surgery, General and Thoracic Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, Italy
| | - Alessandro Crocoli
- Department of Surgery, Surgical Oncology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Silvia Madafferi
- Department of Surgery, Surgical Oncology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Valerio Pardi
- Department of Surgery, General and Thoracic Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, Italy
| | - Giorgio Persano
- Department of Surgery, Surgical Oncology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessandro Inserra
- Department of Surgery, General and Thoracic Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, Italy
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Işık NI, Katipoğlu B, Turan ÖF, Gezer AE, Yazla M, Surel AA. The significance of initial lactate levels in emergency department presentations of abdominal wall hernia. Hernia 2024; 28:567-574. [PMID: 38358539 DOI: 10.1007/s10029-023-02950-5] [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: 10/21/2023] [Accepted: 12/16/2023] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Abdominal wall hernias are a frequent cause of abdominal pain-related emergency department visits. Our study aimed to establish the connection between lactate levels and patient outcomes in those with abdominal pain due to abdominal wall hernias. MATERIALS AND METHODS Our research followed a retrospective, observational, and descriptive approach and two center. We included patients who visited the emergency department for abdominal pain and were confirmed to have abdominal wall hernias through ultrasound. RESULTS We enrolled 493 patients meeting the criteria. Median age was 65 years, with 54% (n = 266) being male. Regarding outcomes, 40.5% (n = 200) were hospitalized, 27.7% (n = 137) underwent surgery, and 7.9% (n = 39) underwent bowel resection. Mortality rate during hernia-related hospital admission was 0.6% (n = 3). For hospitalized patients, there were significant differences in white blood cell count, neutrophil count and percentage, platelet count, lymphocyte count, and percentage (p < 0.05). Patients undergoing resection showed significant differences in neutrophil count, neutrophil percentage, lymphocyte count, and lymphocyte percentage (p < 0.05). Lactate levels were statistically significant in all patient groups requiring hospitalization, surgery, and resection (p < 0.05). Sensitivity and specificity of lactate test results indicated in patients undergoing bowel resection, lactate values ≥1.96 mmol/L had a specificity of 64%, sensitivity of 71%, and a negative predictive value of 96% (p < 0.05). CONCLUSION Low lactate levels in patients presenting to the emergency department with abdominal pain caused by abdominal wall hernias have a high negative predictive value for excluding strangulation and the need for bowel resection. Therefore, we recommend the use of lactate as an additional diagnostic tool in emergency department presentations related to abdominal wall hernias.
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Affiliation(s)
- N I Işık
- Emergency Medicine Department, Ankara Etlik City Hospital, Ankara, Turkey.
| | - B Katipoğlu
- Emergency Medicine Department, Ankara Etlik City Hospital, Ankara, Turkey
| | - Ö F Turan
- Emergency Medicine Department, Ankara Etlik City Hospital, Ankara, Turkey
| | - A E Gezer
- Emergency Medicine Department, Ankara Etlik City Hospital, Ankara, Turkey
| | - M Yazla
- Emergency Medicine Department, Ankara Etlik City Hospital, Ankara, Turkey
| | - A A Surel
- General Surgery Department, Ankara Bilkent City Hospital, Ankara, Turkey
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Silveira CAB, de Figueiredo SMP, Rasador ACD, Fernandez MG, Martin RRH, Dias YJM, Lu R. Round ligament management during minimally invasive groin hernia repair in women: a systematic review and meta-analysis. Surg Endosc 2024; 38:1731-1739. [PMID: 38418634 DOI: 10.1007/s00464-024-10721-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/28/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Female sex has been associated with worse outcomes after groin hernia repair (GHR), including a higher rate of chronic pain and recurrence. Most of the studies in GHR are performed in males, and the recommendations for females extrapolate from these studies, even though females have anatomy intricacies. The round ligament of the uterus (RLU) is associated with pelvic stabilization and plays a role in sensory function. Transection of the RLU during GHR is controversial as it can allow easier mesh placement but can favor genitourinary complications and chronic pain. As no previous meta-analysis compared preserving versus transecting the RLU during minimally invasive (MIS) GHR, we aim to perform a systematic review and meta-analysis evaluating surgical outcomes comparing the approaches. METHODS Cochrane Central, Embase, and PubMed databases were systematically searched for studies comparing transection versus preservation of the RLU in MIS groin hernia surgeries. Outcomes assessed were operative time, bleeding, surgical site events, hospital stay, chronic pain, paresthesia, recurrence rates, and genital prolapse rates. Statistical analysis was performed using RevMan 5.4.1. Heterogeneity was assessed with I2 statistics. A review protocol for this meta-analysis was registered at PROSPERO (CRD 42023467146). RESULTS 1738 studies were screened. A total of six studies, comprising 1131 women, were included, of whom 652 (57.6%) had preservation of the RLU during MIS groin hernia repair. We found no statistical difference regarding chronic pain, paresthesia, recurrence rates, and postoperative complications. We found a longer operative time for the preservation group (MD 6.84 min; 95% CI 3.0-10.68; P = 0.0005; I2 = 74%). CONCLUSION Transecting the RLU reduces the operative time during MIS GHR with no difference regarding postoperative complication rates. Although transection appears safe, further prospective randomized studies with long-term follow-up and patient-reported outcomes are necessary to define the optimal management of RLU during MIS GHR.
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Affiliation(s)
- C A B Silveira
- Bahiana School of Medicine and Public Health, Rua Dom João VI, 275, Salvador, BA, 40290-000, Brazil.
| | | | - A C D Rasador
- Bahiana School of Medicine and Public Health, Rua Dom João VI, 275, Salvador, BA, 40290-000, Brazil
| | - M G Fernandez
- Bahiana School of Medicine and Public Health, Rua Dom João VI, 275, Salvador, BA, 40290-000, Brazil
| | - R R H Martin
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Y J M Dias
- Washington University in St. Louis, St. Louis, MO, USA
| | - R Lu
- University of Texas Medical Branch, Galveston, TX, USA
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Lee KY, Lee J, Kim D, Oh ST. High ligation with posterior wall repair for inguinal hernia repair in young adults: a nationwide cohort study. Ann Surg Treat Res 2024; 106:231-236. [PMID: 38586556 PMCID: PMC10995835 DOI: 10.4174/astr.2024.106.4.231] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/26/2024] [Accepted: 02/02/2024] [Indexed: 04/09/2024] Open
Abstract
Purpose This study evaluated the difference in the recurrence of inguinal hernia in young adult patients who underwent either high ligation alone or high ligation with posterior wall repair using nationwide data. Methods This retrospective study included young adult patients (aged 16-30 years) who underwent surgery for inguinal hernia between June 1, 2013 and December 31, 2020. Data from the National Health Information Database from the Korea Health Insurance Service were used for this study. Patients were divided into 2 groups (high ligation alone and posterior wall repair). The primary outcome was the difference in recurrent inguinal hernia surgeries between the 2 groups. Results Among the 10,803 patients included in the study, 947 underwent high ligation alone, and 9,856 underwent high ligation with posterior wall repair. Recurrence was observed in 18 patients (1.9%) in the high ligation only group and 84 (0.85%) in the high ligation with posterior wall repair group. Log-rank test findings revealed that recurrence was less frequent in the high ligation with posterior wall repair group than in the high ligation only group (P = 0.003). In the multivariate analysis of factors influencing recurrence, posterior wall repair (hazard ratio, 0.241; P = 0.001) was shown to significantly lower the recurrence. Conclusion Posterior wall repair might be necessary for inguinal hernia repair in young adults.
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Affiliation(s)
- Kil-yong Lee
- Department of Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jaeim Lee
- Department of Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dongjae Kim
- Department of Biomedicine Health Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seong Taek Oh
- Department of Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Amro C, Smith L, Shulkin J, McGraw JR, Hill N, Broach RB, Torkington J, Fischer JP. The enigma of incisional hernia prediction unraveled: external validation of a prognostic model in colorectal cancer patients. Hernia 2024; 28:547-553. [PMID: 38227093 DOI: 10.1007/s10029-023-02947-0] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/12/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE Accurate prediction of hernia occurrence is vital for surgical decision-making and patient management, particularly in colorectal surgery patients. While a hernia prediction model has been developed, its performance in external populations remain to be investigated. This study aims to validate the existing model on an external dataset of patients who underwent colorectal surgery. METHODS The "Penn Hernia Calculator" model was externally validated using the Hughes Abdominal Repair Trial (HART) data, a randomized trial comparing colorectal cancer surgery closure techniques. The data encompassed demographics, comorbidities, and surgical specifics. Patients without complete follow-up were omitted. Model performance was assessed using key metrics, including area under the curve (AUC-ROC and AUC-PR) and Brier score. Reporting followed the TRIPOD consensus. RESULTS An external international dataset consisting of 802 colorectal surgery patients were identified, of which 674 patients with up to 2 years follow-up were included. Average patient age was 68 years, with 63.8% male. The average BMI was 28.1. Prevalence of diabetes, hypertension, and smoking were 15.7%, 16.3%, and 36.5%, respectively. Additionally, 7.9% of patients had a previous hernia. The most common operation types were low anterior resection (35.3%) and right hemicolectomy (34.4%). Hernia were observed in 24% of cases by 2-year follow-up. The external validation model revealed an AUC-ROC of 0.66, AUC-PR of 0.72, and a Brier score of 0.2. CONCLUSION The hernia prediction model demonstrated moderate performance in the external validation. Its potential generalizability, specifically in those undergoing colorectal surgery, may suggest utility in identifying and managing high-risk hernia candidates.
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Affiliation(s)
- C Amro
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, PCAM South Pavilion 14t Floor, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
| | - L Smith
- Department of Colorectal Surgery, University Hospital of Wales, Cardiff, UK
- School of Medicine, Cardiff University, Cardiff, UK
| | - J Shulkin
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, PCAM South Pavilion 14t Floor, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - J R McGraw
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, PCAM South Pavilion 14t Floor, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - N Hill
- School of Medicine, Cardiff University, Cardiff, UK
| | - R B Broach
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, PCAM South Pavilion 14t Floor, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - J Torkington
- Department of Colorectal Surgery, University Hospital of Wales, Cardiff, UK
| | - J P Fischer
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, PCAM South Pavilion 14t Floor, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
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Clark CR, Kelly ML, Palamuthusingam P. Spigelian hernia: a multi-site review of operative outcomes of surgical repair in the adult population. Hernia 2024; 28:537-546. [PMID: 38261159 PMCID: PMC10997718 DOI: 10.1007/s10029-023-02946-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024]
Abstract
PURPOSE Spigelian hernias arise at the linear semilunaris and account for approximately 1-2% of abdominal hernias. The aetiology is due to a defect of the aponeurosis of the transverse abdominis and when discovered, management is surgical intervention. The aim of this study was to observe operative outcomes for open and minimally invasive repair. METHODS A retrospective chart review was conducted at two hospitals in Townsville, The Townsville University Hospital and The Mater Private Hospital over a 10-year period (2010 to 2020). A surgical database search (ORMIS & IEMR) was performed at both locations using key search terms, including "spigelian hernia", "laparoscopic", "open". Descriptive statistics were utilised to analyse patient factors and operative outcomes in the public and private setting. RESULTS 43 cases of Spigelian hernias (25 female, 18 male) were reported over the study period. The average age was 66. There were 36 elective cases and 7 emergency cases. A laparoscopic approach was the preferred method of repair, occurring in 74% of cases. Of these cases, the predominant hernial content was fat only. 65% of cases had a history of prior abdominal surgery unrelated to the "Spigelian belt" location. Complications occurred in 19% of cases. Other variables, such as ethnicity, smoking status, defect size, predisposing factors and recurrence rate, were analysed and did not yield statistical significance. CONCLUSION Although a small sample size, the data suggest there is no statistically significant difference between operative outcomes, complication rate and predisposing factors between open and minimally invasive case groups.
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Affiliation(s)
- C R Clark
- Department of General Surgery, Royal Brisbane and Women's Hospital, Brisbane, QLD, 4029, Australia.
- Department of General Surgery, Townsville University Hospital, Townsville, QLD, 4814, Australia.
- Department of General Surgery, Mater Hospital Townsville, Townsville, QLD, 4812, Australia.
- James Cook University, Townsville, QLD, Australia.
| | - M L Kelly
- Department of General Surgery, Royal Brisbane and Women's Hospital, Brisbane, QLD, 4029, Australia
| | - P Palamuthusingam
- Department of General Surgery, Royal Brisbane and Women's Hospital, Brisbane, QLD, 4029, Australia
- Department of General Surgery, Townsville University Hospital, Townsville, QLD, 4814, Australia
- Department of General Surgery, Mater Hospital Townsville, Townsville, QLD, 4812, Australia
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Edholm D, Hofgård JO, Andersson E, Stenberg E, Olbers T. Very low risk of short bowel after Roux-en-Y gastric bypass - a large nationwide Swedish cohort study. Surg Obes Relat Dis 2024; 20:362-366. [PMID: 38114384 DOI: 10.1016/j.soard.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/28/2023] [Accepted: 10/29/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is one of the most common bariatric procedures. Internal herniation may lead to small bowel ischemia requiring small bowel resection, resulting in short bowel syndrome. OBJECTIVE To determine the incidence of extensive small bowel resection in patients operated with RYGB. We also aimed to look for early clinical warning signs among patients requiring extensive small bowel resection. SETTING Cohort from national quality registers. METHODS All patients having undergone RYGB between January 2007 to June 2019 were analyzed in the Scandinavian Obesity Surgery Registry (SOReg). We identified patients with small bowel obstruction (SBO) for whom small bowel resection was necessary. Additionally, we assessed clinical signs in these patients. RESULTS The study included 57,255 patients having undergone RYGB. Closure of the mesenteric openings was performed in 78%. Surgery for SBO was required in 3659 (6%) of patients, and small bowel resection in 188 (.3%). Extensive small bowel resection, resulting in less than 1.5 meters of remaining small bowel, was required in 7 patients (.01%). All patients with extensive small bowel resection presented with abdominal pain and had confirmed internal herniation as the cause of the small bowel resection, and 2 of 7 patients died. Closure of mesenteric defects was not associated with a reduction in overall small bowel resection rates (P = .89) CONCLUSION: Surgery for SBO after RYGB was common (6%). The risk of extensive small bowel resection leading to short bowel was low (.01%). Patients with abdominal pain after RYGB should be assessed for internal hernia, as it can be devastating.
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Affiliation(s)
- David Edholm
- Department of Surgery, Linköping University, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Johan Olsson Hofgård
- Department of Surgery, Linköping University, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Ellen Andersson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Surgery and Department of Biomedical and Clinical Sciences, Linköping University, Norrköping, Sweden
| | - Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Torsten Olbers
- Department of Surgery and Department of Biomedical and Clinical Sciences, Linköping University, Norrköping, Sweden; Department of Biomedical and Clinical Sciences and Wallenberg Centre for Molecular Medicine, Department of Biomedical and Clinical sciences, Linköping University, Linköping, Sweden
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Faye PM, Ndong A, Niasse A, Thiam O, Toure AO, Cisse M. Safety and effectiveness of laparoscopic adult groin hernia repair in Africa: a systematic review and meta-analysis. Hernia 2024; 28:355-365. [PMID: 38324087 DOI: 10.1007/s10029-023-02931-8] [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: 08/27/2023] [Accepted: 11/12/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND Surgery is the recommended treatment of groin hernia, and laparoscopic approach is increasingly accepted due to lower risk of chronic pain. This systematic review aims to evaluate results of laparoscopic groin hernia repair (LGHR) in Africa. METHODS We performed a literature search of published studies using electronic databases. Included African articles reported at least one of outcomes after LGHR in adult population. Newcastle-Ottawa Scale was used for quality assessment. A quantitative meta-analysis was performed to estimate the pooled prevalence of the post-operative outcomes. RESULTS We included 19 studies from 6 countries which totalized 2329 hernia cases. Mean age was 44.5 years and male patients were predominant (sex-ratio 19.8). The mean operative time was 69.1 min. The pooled prevalence of conversion to open procedure was 2.578% (95% IC: 1.209-4.443). The pooled prevalence of surgical site infection and Hematoma/Seroma was respectively 0.626% (95%IC: 0.332-1.071) and 4.617% (95% IC: 2.990-6.577). The pooled prevalence of recurrence and chronic pain was respectively 2.410% (95% IC: 1.334-3.792) and 3.180% (95% IC: 1.435-5.580). We found that total morbidity for TAPP procedure was higher than TEP procedure (p = 0.0006; OR 1.8443). CONCLUSION These results confirm that LGHR is safe and feasible and would be recommended in our African context.
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Affiliation(s)
- P M Faye
- General Surgery Department, Dalal Jamm Hospital, Dakar, Senegal.
| | - A Ndong
- Gaston Berger University, Saint Louis, Senegal
| | - A Niasse
- General Surgery Department, Cheikhoul Khadim Hospital, Touba, Senegal
| | - O Thiam
- General Surgery Department, Dalal Jamm Hospital, Dakar, Senegal
| | - A O Toure
- General Surgery Department, Dalal Jamm Hospital, Dakar, Senegal
| | - M Cisse
- General Surgery Department, Dalal Jamm Hospital, Dakar, Senegal
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Khader R, Whitehead-Clarke T, Mudera V, Kureshi A. Assessment of mesh shrinkage using fibroblast-populated collagen matrices: a proof of concept for in vitro hernia mesh testing. Hernia 2024; 28:495-505. [PMID: 38180627 PMCID: PMC10997730 DOI: 10.1007/s10029-023-02941-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 12/07/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE This study uses free-floating contractile fibroblast-populated collagen matrices (FPCMs) to test the shrinkage of different hernia mesh products. We hope to present this model as a proof of concept for the development of in vitro hernia mesh testing-a novel technology with interesting potential. METHODS FPCMs were formed by seeding Human Dermal Fibroblasts into collagen gels. FPCMs were seeded with three different cell densities and cast at a volume of 500 μl into 24-well plates. Five different mesh products were embedded within the collagen constructs. Gels were left to float freely within culture media and contract over 5 days. Photographs were taken daily and the area of the collagen gel and mesh were measured. Media samples were taken at days 2 and 4 for the purposes of measuring MMP-9 release. After 5 days, dehydrated FPCMs were also examined under light and fluorescence microscopy to assess cell morphology. RESULTS Two mesh products-the mosquito net and large pore lightweight mesh were found to shrink notably more than others. This pattern persisted across all three cell densities. There were no appreciable differences observed in MMP-9 release between products. CONCLUSIONS This study has successfully demonstrated that commercial mesh products can be successfully integrated into free-floating contractile FPCMs. Not only this, but FPCMs are capable of applying a contractile force upon those mesh products-eliciting different levels of contraction between mesh products. Such findings demonstrate this technique as a useful proof of concept for future development of in vitro hernia mesh testing.
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Affiliation(s)
- R Khader
- Centre for 3D Models of Health and Disease, Division of Surgery & Interventional Science, University College London, London, UK
| | - T Whitehead-Clarke
- Centre for 3D Models of Health and Disease, Division of Surgery & Interventional Science, University College London, London, UK.
| | - V Mudera
- Centre for 3D Models of Health and Disease, Division of Surgery & Interventional Science, University College London, London, UK
| | - A Kureshi
- Centre for 3D Models of Health and Disease, Division of Surgery & Interventional Science, University College London, London, UK
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Arhos EK, Poulose BK, Di Stasi S, Chaudhari AMW. Individuals with a ventral hernia who report moderate to high fear have worse functional performance than those with low fear. Hernia 2024; 28:643-649. [PMID: 38407674 PMCID: PMC10997437 DOI: 10.1007/s10029-024-02979-0] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/25/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE Ventral hernia repairs (VHR) are performed to restore the integrity of the abdominal wall. Fear of movement, or kinesiophobia, may develop in patients with ventral hernia due to pain and functional impairments, however it has not yet been objectively measured in this patient population. The purpose of this study was to test the hypothesis that in patients with ventral hernia awaiting surgical repair, higher levels of kinesiophobia would be associated with poorer mobility, abdominal core function, and quality of life. METHODS Seventy-seven participants scheduled for ventral hernia repair were enrolled as part of an ongoing randomized controlled trial (NCT05142618). The Tampa Scale of Kinesiophobia (TSK-11) is an 11-item questionnaire that asks about fear of movement and physical activity restriction. Participants were split into groups based on their TSK-11 score (minimal, low, moderate to high). Primary outcome measures included the five-time sit-to-stand (5xSTS), Quiet Unstable Sitting Test (QUeST), and the Hernia-Related Quality-of-Life (HerQLeS) survey. A one-way ANOVA with a Bonferroni correction compared QUeST, 5xSTS, and HerQLes results between groups. RESULTS Groups were significantly different on 5xSTS (minimal: 11.4 ± 2.6 s, low: 13.8 ± 3.1 s, moderate to high: 17.8 ± 9.8 s; p = 0.001) and HerQLes (minimal: 58.0 ± 27.8, low: 49.4 ± 22.0, moderate to high: 30.6 ± 25.3; p = 0.003) but not QUeST (minimal: - 2.8 ± 2.5, low: - 6.8 ± 10.0, moderate to high: - 5.5 ± 5.0; p = 0.16). CONCLUSION Individuals with moderate to high kinesiophobia have worse pre-operative performance-based (5xSTS) and self-reported (HerQLes) function and quality of life than those with minimal and low kinesiophobia. Future research should examine the influence of kinesiophobia on post-operative outcomes as it may be a potent target for rehabilitation.
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Affiliation(s)
- Elanna K Arhos
- School of Health and Rehabilitation Sciences, Ohio State University, 2835 Fred Taylor Drive, Columbus, OH, 43202, USA.
- Ohio State University Wexner Medical Center, Sports Medicine Research Institute, Columbus, OH, USA.
| | - Benjamin K Poulose
- Department of Surgery, Division of General and Gastrointestinal Surgery, Center for Abdominal Core Health, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Stephanie Di Stasi
- Ohio State University Wexner Medical Center, Sports Medicine Research Institute, Columbus, OH, USA
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, Ohio State University, Columbus, OH, USA
| | - Ajit M W Chaudhari
- School of Health and Rehabilitation Sciences, Ohio State University, 2835 Fred Taylor Drive, Columbus, OH, 43202, USA
- Ohio State University Wexner Medical Center, Sports Medicine Research Institute, Columbus, OH, USA
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13
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Awad PBA, Hassan BHA, Kashwaa MFA, Abdel-Maksoud IM. A comparative study between open pre-peritoneal approach versus laparoscopic trans-abdominal pre-peritoneal approach in recurrent inguinal hernia repair: a prospective cohort study. Hernia 2024; 28:629-635. [PMID: 38300399 PMCID: PMC10997692 DOI: 10.1007/s10029-024-02967-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/11/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND The repair of recurrent inguinal hernias after prosthetic mesh repair is challenging due to the technical complexity and complications associated with it. As well as the increased risk of recurrence due to weakened tissues and distorted anatomy. The Posterior Pre-Peritoneal Approach yields significantly better results than the anterior approach due to its distance from previously scarred tissue. OBJECTIVE To compare the open pre-peritoneal approach and Laparoscopic trans-abdominal pre-peritoneal approach in the management of recurrent inguinal hernia which was previously managed through an open anterior approach regarding their intra-operative time, the postoperative outcomes in the form of hematoma, wound infection and finally the recurrence within 1-year follow-up. PATIENTS AND METHODS The current study is a prospective cohort study, a single-center trial conducted from June 2021 to June 2022 in the general surgery department in Ain Shams University Hospitals, which included 74 patients presented with recurrent inguinal hernia who had previous open anterior approach 68(91.8%) males and 6(8.1%) females including a 1-year follow-up postoperative. RESULTS There were 74 patients in our study with 37 patients in each group. Group (I) underwent an open pre-peritoneal approach and group (II) underwent a Laparoscopic trans-abdominal pre-peritoneal approach. The mean age of the group (I) is 39.51 with a standard deviation of ± 3.49. While in group (II) the mean age is 39.37 with standard deviation ± 3.44 (p = 0.881). From the included 74 patients 67(91.8%) were males and 6(8.1%) were females. As regards the co-morbidities, in group (I) 17(45.9%) patients have no co-morbidities, 11(29.7%) patients have diabetes mellitus, 6(16.2%) patients have hypertension, and 3(8.1%) patients have diabetes and hypertension. Andin group (II) 26(70.3%) patients have no co-morbidities, 6(16.2%) patients have diabetes mellitus, 3(8.1%) patients have hypertension, and 2(5.4%) patients have diabetes and hypertension (p = 0.207). Regarding intra-operative time, the mean time in minutes in the group (I) is 63.33 with a standard deviation of ± 11.95. While in group (II) the mean time in minutes is 81.21 with a standard deviation of ± 18.03 (p = 0.015). The postoperative outcomes were assessed for 1-year follow-up in the form of hematoma, wound infection, and recurrence within 1 year. Regarding the hematoma occurred in 4(10.8%) patients in group (I). While in 2(5.4%) patients in group (II) (p = 0.674). The wound infection was found in 5(13.5%) patients in group(I) and zero patients in group (II) (p = 0.021). Finally, we followed up with the patients for about 1 year to detect the recurrence. Which was found in 3(8.1%) patients in group (I) and 1(2.7%) patient in group (II) (p = 0.615). CONCLUSION The results of this study demonstrate that both the laparoscopic approach and the open posterior approach are effective for recurrent inguinal hernia following anterior approach mesh hernioplasty, with comparable results. Laparoscopy has been associated with a lower rate of recurrence and overall complications compared to open technique, however, it is difficult to draw definitive conclusions about the preferred option due to its lengthy learning curve and difficulty to perform. Furthermore, the results of this study confirm the previously reported positive results of the posterior pre-peritoneal for recurrent inguinal hernia, particularly when performed by experienced surgeons. Therefore, further prospective randomized population-based trials are necessary to better assess the decision-making for recurrent hernia management and the impact of specialization in abdominal wall surgery in terms of recurrence and complications.
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Affiliation(s)
- P B A Awad
- General Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - B H A Hassan
- General Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - M F A Kashwaa
- General Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - I M Abdel-Maksoud
- General Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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14
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Chan KY, Raftery N, Abdelhafiz T, Rayis A, Johnston S. Parastomal hernia repairs: A nationwide cohort study in the Republic of Ireland. Surgeon 2024; 22:92-98. [PMID: 37838612 DOI: 10.1016/j.surge.2023.09.008] [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: 05/28/2023] [Revised: 09/18/2023] [Accepted: 09/26/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND In the context of improving colorectal cancer outcomes, post-survivorship quality of life has become an important outcome measure. Parastomal hernias and their associated morbidity remain largely under-reported and under-appreciated. Despite their burden, conservative management is common. This study aims to provide a national overview on the current trends in parastomal hernia repairs (PHRs). METHODS All PHRs performed in public hospitals across the country between 1/2017 to 7/2022 were identified retrospectively from the National Quality Assurance and Improvement System (NQAIS) database. Anonymised patient characteristics and quality indices were extracted for statistical analysis. RESULTS A total of 565 PHRs, 64.1 % elective and the remainder emergent, were identified across 27 hospitals. The 8 national colorectal units performed 67.3 % of all repairs. While 42.3 % of PHRs were standalone procedures, reversal of Hartmann's procedure was the commonest simultaneous procedure in the remainder. The median age, ASA and Charlson Co-Morbidity Index were 64 years (19), 3(1) and 3(10) respectively. Mean length of stay (LOS) was 16.25 days (SD = 29.84). Linear regression analysis associated ASA (95 % CI 0.58-16.08, p < 0.035) and emergency admissions (95 % CI 5.86-25.55, P < 0.002) with a significantly longer LOS, with the latter also associated with more frequent emergency re-admissions (95 % CI 0.18-0.82, p < 0.002). CONCLUSION Patients undergoing emergency PHR were older and significantly more comorbid. Consequently, these patients were subjected to longer hospital stays, more frequent readmissions and overall higher hospital costs. Multidisciplinary perioperative optimisation and standardised referral pathways should underpin the shift towards elective PHRs.
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Affiliation(s)
- Kin Yik Chan
- Department of Surgery, Midland Regional Hospital Tullamore, Co.Offaly, R35NY51, Ireland.
| | - Nicola Raftery
- Department of Surgery, Midland Regional Hospital Tullamore, Co.Offaly, R35NY51, Ireland
| | - Tarig Abdelhafiz
- Department of Surgery, Midland Regional Hospital Tullamore, Co.Offaly, R35NY51, Ireland
| | - Abubakr Rayis
- Department of Surgery, Midland Regional Hospital Tullamore, Co.Offaly, R35NY51, Ireland
| | - Sean Johnston
- Department of Surgery, Midland Regional Hospital Tullamore, Co.Offaly, R35NY51, Ireland
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15
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Wu Q, Yang D, Dong W, Song Z, Yang J, Gu Y. Causal relationship between cigarette smoking behaviors and the risk of hernias: a Mendelian randomization study. Hernia 2024; 28:435-446. [PMID: 38148419 DOI: 10.1007/s10029-023-02925-6] [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: 10/27/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE As the global population continues to age, there is a noticeable yearly rise in the incidence of hernias. Simultaneously, smoking, a widespread addictive behavior and a significant contributor to mortality, has evolved into a pervasive public health concern. Existing literature has already established a connection between smoking and an increased risk of postoperative recurrence and postoperative infections following hernia surgery. However, there remains a dearth of research exploring the association between smoking and hernia morbidity. In this study, our objective is to systematically evaluate the causal relationship between cigarette smoking behaviors and hernia morbidity using a Mendelian randomization (MR) approach. METHODS Hernia-related data were sourced from the FinnGen Biobank database, while cigarette smoking behavior data were gathered from the GWAS and Sequencing Consortium of Alcohol and Nicotine Use. To assess the causal relationship, we employed five methods: the weighted median, the weighted mode the inverse variance weighted (IVW), MR-Egger, and the simple mode. Sensitivity analysis was conducted, incorporating Cochran's Q test, the MR-Egger intercept test, leave-one-out analysis, and funnel plot. The presentation of the causal relationship is expressed as an odds ratio (OR) along with their corresponding 95% confidence intervals (CI). RESULTS Employing the IVW method as the reference standard, we found that smoking intensity is associated with an increased risk of diaphragmatic hernia (OR = 1.21, 95% CI 1.00-1.46, P = 0.047). These consistent findings were further corroborated by the weighted median and weighted mode methods (OR = 1.26, 95% CI 1.03-1.54, P = 0.026; OR = 1.25, 95% CI 1.02-1.52, P = 0.045). Conversely, when applying the IVW method, we identified no statistically significant causal relationship between smoking age, smoking initiation status, smoking cessation status, and the incidence of hernia. CONCLUSIONS Our MR study has uncovered genetic evidence linking smoking intensity and the occurrence of diaphragmatic hernia. The risk of developing diaphragmatic hernia rises in tandem with the intensity of smoking. This emphasizes the crucial role of regularly advising patients to cease smoking in clinical settings.
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Affiliation(s)
- Q Wu
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, 221 Yan'an West Road, Jing'an District, Shanghai, 200040, China
| | - D Yang
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, 221 Yan'an West Road, Jing'an District, Shanghai, 200040, China
| | - W Dong
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, 221 Yan'an West Road, Jing'an District, Shanghai, 200040, China
| | - Z Song
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, 221 Yan'an West Road, Jing'an District, Shanghai, 200040, China
| | - J Yang
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, 221 Yan'an West Road, Jing'an District, Shanghai, 200040, China
| | - Y Gu
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, 221 Yan'an West Road, Jing'an District, Shanghai, 200040, China.
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16
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Maskal S, Chang J, Ellis R, Messer N, Melland-Smith M, Tu C, Miller B, Petro C, Simon R, Prabhu A, Rosen M, Beffa L. Abdominal wall mass resections: single-center closure practices and outcomes following oncologic resections of abdominal wall fascia. Hernia 2024; 28:457-464. [PMID: 38062203 DOI: 10.1007/s10029-023-02928-3] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/05/2023] [Indexed: 04/06/2024]
Abstract
PURPOSE Radical resections for abdominal wall tumors are rare, thus yielding limited data on reconstruction of defects. We describe surgical management and long-term outcomes following radical tumor resection. METHODS This was a single-center retrospective review of patients between January 2010 and December 2022. Variables included operative characteristics, wound complications, hernia development, tumor recurrence, and reoperation. A multivariable analysis compared wound morbidity for suture and mesh repairs while adjusting for defect width, fascial closure, and CDC wound class. RESULTS 120 patients were identified. Mean follow-up was 3.9 ± 3.4 years. Seventy-five (62.5%) of the masses were primary; most commonly desmoid (n = 25) and endometrioma (n = 27). Forty-five masses were metastases. Mean tumor width was 6.2 ± 3.4 cm; mean defect width was 8.1 ± 4.1 cm. Sixty-one patients (50.8%) had mesh placed, with variation in technique. Postoperative CT scans were available for 88 (73.3%) patients. Forty SSOs (33.3%), 11 SSIs (9.2%), and 18 (15%) SSOPIs occurred within 30 days. On multivariable analysis, increased defect width was associated with SSOPI (OR 1.17, p = 0.041) and CDC wound class II-III was associated with SSI (OR 8.38 and 49.1, p < 0.05) and SSOPI (OR 5.77 and 17.4, p < 0.05); mesh was not associated with these outcomes. Seven patients (5.8%) underwent 30-day reoperations and 35 (20.8%) required additional operations after 30 days. Thirteen percent developed abdominal wall (n = 8) or intra-abdominal tumor recurrence (n = 8) requiring reoperation. Twenty-seven (22.5%) patients developed hernias with a mean fascial defect width of 9.8 ± 7.2 cm. CONCLUSION Abdominal wall mass resections are morbid, often contaminated cases with high postoperative complication rates. Risks and benefits of mesh implantation should be tailored on an individual basis.
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Affiliation(s)
- S Maskal
- Department of Surgery, Cleveland Clinic, 2049 E 100th St, A-100, Cleveland, OH, 44106, USA.
| | - J Chang
- Department of Surgery, Cleveland Clinic, 2049 E 100th St, A-100, Cleveland, OH, 44106, USA
| | - R Ellis
- Department of Surgery, Cleveland Clinic, 2049 E 100th St, A-100, Cleveland, OH, 44106, USA
| | - N Messer
- Department of Surgery, Cleveland Clinic, 2049 E 100th St, A-100, Cleveland, OH, 44106, USA
| | - M Melland-Smith
- Department of Surgery, Cleveland Clinic, 2049 E 100th St, A-100, Cleveland, OH, 44106, USA
| | - C Tu
- Department of Surgery, Cleveland Clinic, 2049 E 100th St, A-100, Cleveland, OH, 44106, USA
| | - B Miller
- Department of Surgery, Cleveland Clinic, 2049 E 100th St, A-100, Cleveland, OH, 44106, USA
| | - C Petro
- Department of Surgery, Cleveland Clinic, 2049 E 100th St, A-100, Cleveland, OH, 44106, USA
| | - R Simon
- Department of Surgery, Cleveland Clinic, 2049 E 100th St, A-100, Cleveland, OH, 44106, USA
| | - A Prabhu
- Department of Surgery, Cleveland Clinic, 2049 E 100th St, A-100, Cleveland, OH, 44106, USA
| | - M Rosen
- Department of Surgery, Cleveland Clinic, 2049 E 100th St, A-100, Cleveland, OH, 44106, USA
| | - L Beffa
- Department of Surgery, Cleveland Clinic, 2049 E 100th St, A-100, Cleveland, OH, 44106, USA
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17
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Hope WW. Advances in Hernia Care State of the Art. Am Surg 2024:31348241241717. [PMID: 38527961 DOI: 10.1177/00031348241241717] [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] [Indexed: 03/27/2024]
Abstract
The field of hernia surgery has seen many recent advances and continues to evolve. Care of the hernia patient begins preoperatively by ensuring adequate preparation for surgery with surgeons now having the opportunity to accurately predict risk which can aid with informed consent. Imaging studies can now help surgeons diagnose and plan hernia surgery on an individual level based on hernia characteristics as well as abdominal wall musculature. In the operating room, new technology and surgical techniques have allowed surgeons to become increasingly sophisticated with goals of reducing tension on midline closures, utilizing minimally invasive and robotic techniques, and availability of new and varied mesh prosthetics. While modest improvements in outcomes have been witnessed by these advances, there is still opportunity for improvement which will be realized by continued research, use of registries, and education and training. Hernia prevention strategies focusing on minimally invasive surgery, laparotomy closure, and the use of prophylactic mesh will also help with the burden of incisional hernias. These advances in hernia surgery have led to the new field of Abdominal Core Health which helps represent this evolving and growing new subspecialty of general surgery.
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Affiliation(s)
- William W Hope
- Department of Surgery, New Hanover Regional Medical Center, Wilmington, NC
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18
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Halabi M, Khoury K, Alomar A, Dahdah JE, Hassan O, Hayyan K, Bishara E, Moussa H. Operative efficiency: a comparative analysis of Versius and da Vinci robotic systems in abdominal surgery. J Robot Surg 2024; 18:132. [PMID: 38517557 PMCID: PMC10959786 DOI: 10.1007/s11701-023-01806-5] [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: 10/20/2023] [Accepted: 12/23/2023] [Indexed: 03/24/2024]
Abstract
Robotic-assisted surgery has gained momentum in the pursuit of improved minimally invasive procedures. The adoption of new robotic platforms, such as the Versius, raises concerns about safety, efficacy, and learning curves. This study compares the Versius to the well-established da Vinci in terms of operative time and patient population. Retrospective data collection was conducted on patient data from inguinal hernia surgery, ventral hernia surgery, and cholecystectomies performed between February 2022 and March 2023 at the American Hospital of Dubai. Only experienced cases were included, ensuring proficiency with robotic technology. Versius had longer procedure times in inguinal and ventral hernia surgeries but not in cholecystectomy. No intraoperative complications were observed in either system. This study demonstrates that Versius can provide comparable outcomes to the da Vinci in abdominal surgery, with no observed intraoperative complications.
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Affiliation(s)
- Mouhammad Halabi
- Department of Surgery, American Hospital Dubai, Dubai, United Arab Emirates
- School of Medicine, Royal College of Ireland -Bahrain, Busaiteen, Bahrain
| | - Kayanne Khoury
- School of Medicine, Royal College of Ireland -Bahrain, Busaiteen, Bahrain
| | - Abdulrahman Alomar
- School of Medicine, Royal College of Ireland -Bahrain, Busaiteen, Bahrain
| | - Joseph El Dahdah
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Obai Hassan
- School of Medicine, Royal College of Ireland -Bahrain, Busaiteen, Bahrain
| | - Khadija Hayyan
- School of Medicine, Royal College of Ireland -Bahrain, Busaiteen, Bahrain
| | - Engy Bishara
- Department of Surgery, American Hospital Dubai, Dubai, United Arab Emirates
| | - Hatem Moussa
- Department of Surgery, American Hospital Dubai, Dubai, United Arab Emirates.
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19
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Scharf VF. Laparoscopic Treatment of Peritoneal-Pericardial Diaphragmatic Hernia. Vet Clin North Am Small Anim Pract 2024:S0195-5616(24)00004-4. [PMID: 38519368 DOI: 10.1016/j.cvsm.2024.02.003] [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] [Indexed: 03/24/2024]
Abstract
Laparoscopic herniorrhaphy provides a feasible minimally invasive treatment option for dogs with peritoneal-pericardial hernias with careful case selection. This article describes the techniques, instrumentation, and challenges associated with laparoscopic peritoneal-pericardial diaphragmatic hernia repair.
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Affiliation(s)
- Valery F Scharf
- Department of Clinical Sciences, NC State University, 1052 William Moore Drive, Raleigh, NC 27607, USA.
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20
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Tran DH, Rubarth C, Leeds SG, Fair L, McGowan T, Ramakrishnan S, Shabbir R, Ogola G, Ward MA, Aladegbami B. The use of poly-4-hydroxybutyrate (P4HB, Phasix™) mesh in ventral hernia repair: a systematic review and meta-analysis. Hernia 2024:10.1007/s10029-024-02996-z. [PMID: 38512507 DOI: 10.1007/s10029-024-02996-z] [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: 12/04/2023] [Accepted: 02/18/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE/BACKGROUND Despite the growing use of bioabsorbable mesh in ventral hernia repairs (VHR), the evidence of its impact on patient outcomes remains limited. This study aims to investigate the efficacy and safety profile of poly-4-hydroxybutyrate (P4HB) mesh for ventral hernia repair through a systematic review and meta-analysis. METHODS A literature search of five databases (PubMed, Embase, Ovid, Medline, and Google Scholar) produced a list of publications that analyzed the use of P4HB mesh in ventral hernia repair in both clean and contaminated cases. The primary postoperative outcomes of hernia recurrence, surgical site infections (SSI), and any complications were analyzed through a pooled meta-analysis. RESULTS In our systematic review, 21 studies met the inclusion criteria with a total of 1858 patients (933 males and 925 females) and an average age of 56.8 years. The median follow-up ranged from 1.6 to 62.3 months. In our meta-analysis, the use of P4HB mesh in VHR in proportion of events demonstrated a recurrence rate of 9% [6%; 15%], SSI of 10% [6%; 16%] and 35% [9%; 42%] for rate of any complications. Sub-meta-analysis restricted to studies with follow up > 18 months continues to show low rates of recurrence of 9% (95%CI, 4-17%), SSI of 9% (95%CI, 4-16%), and 31% (95%CI, 23-41%) for any complications. CONCLUSION Our study demonstrates that the use of P4HB mesh is both safe and effective in ventral hernia repairs. When further analyzed past 18 months, the time where P4HB mesh fully resorbs, the rates of hernia recurrence, SSI, and any complications remain low of upwards of 5 years and comparable to the rates seen in synthetic and biologics in similar patient populations.
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Affiliation(s)
- Daniel H Tran
- Texas A&M College of Medicine, Bryan, TX, USA
- Research Institute, Baylor Scott and White Health, Dallas, TX, USA
| | - Charles Rubarth
- Research Institute, Baylor Scott and White Health, Dallas, TX, USA
| | - Steven G Leeds
- Texas A&M College of Medicine, Bryan, TX, USA
- Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA
| | - Luke Fair
- Research Institute, Baylor Scott and White Health, Dallas, TX, USA
- Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA
| | - Titus McGowan
- Research Institute, Baylor Scott and White Health, Dallas, TX, USA
| | | | - Rehma Shabbir
- Research Institute, Baylor Scott and White Health, Dallas, TX, USA
| | - Gerald Ogola
- Research Institute, Baylor Scott and White Health, Dallas, TX, USA
| | - Marc A Ward
- Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA
| | - Bola Aladegbami
- Texas A&M College of Medicine, Bryan, TX, USA.
- Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA.
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA.
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21
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Fair L, Leeds SG, Bokhari SH, Esteva S, Mathews T, Ogola GO, Ward MA, Aladegbami B. Achieving fascial closure with preoperative botulinum toxin injections in abdominal wall reconstruction: outcomes from a high-volume center. Updates Surg 2024:10.1007/s13304-024-01802-w. [PMID: 38507174 DOI: 10.1007/s13304-024-01802-w] [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: 05/12/2023] [Accepted: 02/24/2024] [Indexed: 03/22/2024]
Abstract
Preoperative injection of Botulinum Toxin A (Botox) has been described as an adjunctive therapy to facilitate fascial closure of large hernia defects in abdominal wall reconstruction (AWR). The purpose of this study was to evaluate the impact of Botox injections on fascial closure and overall outcomes to further validate its role in AWR. A prospectively maintained database was retrospectively reviewed to identify all patients undergoing AWR at our institution between January 2014 and March 2022. Patients who did and did not receive preoperative Botox injections were analyzed and compared. A total of 426 patients were included (Botox 76, NBotox 350). The Botox group had significantly larger hernia defects (90 cm2 vs 9 cm2, p < 0.01) and a higher rate of component separations performed (60.5% vs 14.4%, p < 0.01). Despite this large difference in hernia defect size, primary fascial closure rates were similar between the groups (p = 0.49). Notably, the Botox group had higher rates of surgical-site infections (SSIs)/surgical-site occurrences (SSOs) (p < 0.01). Following propensity score matching to control for multiple patient factors including age, sex, diabetes, chronic obstructive pulmonary disease (COPD), and hernia size, the Botox group still had a higher rate of component separations (50% vs 26.3%, p = 0.03) and higher incidence of SSIs/SSOs (39.5% vs 13.5%, p = 0.01). Multimodal therapy with Botox injections and component separations can help achieve fascial closure of large defects during AWR. However, adding these combined therapies may increase the occurrence of postoperative SSIs/SSOs.
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Affiliation(s)
- Lucas Fair
- Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA.
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA.
- Research Institute, Baylor Scott and White Health, 3535 Worth St., Suite C3.510, Dallas, TX, 75246, USA.
| | - Steven G Leeds
- Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA
- Texas A&M College of Medicine, Bryan, TX, USA
| | - Syed Harris Bokhari
- Research Institute, Baylor Scott and White Health, 3535 Worth St., Suite C3.510, Dallas, TX, 75246, USA
| | | | - Tanner Mathews
- Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA
| | - Gerald O Ogola
- Research Institute, Baylor Scott and White Health, 3535 Worth St., Suite C3.510, Dallas, TX, 75246, USA
| | - Marc A Ward
- Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA
- Texas A&M College of Medicine, Bryan, TX, USA
| | - Bola Aladegbami
- Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA
- Texas A&M College of Medicine, Bryan, TX, USA
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22
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Bahl P, Shetty VS, Ali IM. Iliopsoas abscess mis-diagnosed by point of care ultrasound. Asian J Surg 2024:S1015-9584(24)00274-4. [PMID: 38448289 DOI: 10.1016/j.asjsur.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/07/2024] [Indexed: 03/08/2024] Open
Affiliation(s)
- Priyanka Bahl
- Department of General Surgery, Dr D.Y. Patil Hospital and Research Centre, Dr D.Y. Patil Vidyapeeth, Pimpri, Pune, India
| | - Varun S Shetty
- Department of General Surgery, Dr D.Y. Patil Hospital and Research Centre, Dr D.Y. Patil Vidyapeeth, Pimpri, Pune, India
| | - Iqbal M Ali
- Department of General Surgery, Dr D.Y. Patil Hospital and Research Centre, Dr D.Y. Patil Vidyapeeth, Pimpri, Pune, India.
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23
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Fisher MH, Ohmes LB, Yang JH, Le E, Colakoglu S, French M, Siddikoglu D, Um G, Winocour J, Higdon K, Perdikis G, Inchauste S, Cohen J, Chong T, Kaoutzanis C, Mathes DW. Abdominal donor-site complications following autologous breast reconstruction: A multi-institutional multisurgeon study. J Plast Reconstr Aesthet Surg 2024; 90:88-94. [PMID: 38364673 DOI: 10.1016/j.bjps.2024.01.033] [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: 10/17/2023] [Revised: 12/13/2023] [Accepted: 01/29/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND The deep inferior epigastric perforator (DIEP) free flap is the gold standard procedure for autologous breast reconstruction. Although breast-related complications have been well described, donor-site complications and contributing patient risk factors are poorly understood. METHODS We examined a multi-institutional, prospectively maintained database of patients undergoing DIEP free flap breast reconstruction between 2015 and 2020. We evaluated patient demographics, operative details, and abdominal donor-site complications. Logistic regression modeling was used to predict donor-site outcomes based on patient characteristics. RESULTS A total of 661 patients were identified who underwent DIEP free flap breast reconstruction across multiple institutions. Using logistic regression modeling, we found that body mass index (BMI) was an independent risk factor for umbilical complications (odds ratio [OR] 1.11, confidence interval [CI] 1.04-1.18, p = 0.001), seroma (OR 1.07, CI 1.01-1.13, p = 0.003), wound dehiscence (OR 1.10, CI 1.06-1.15, p = 0.001), and surgical site infection (OR 1.10, CI 1.05-1.15, p = 0.001) following DIEP free flap breast reconstruction. Further, immediate reconstruction decreases the risk of abdominal bulge formation (OR 0.22, CI 0.108-0.429, p = 0.001). Perforator selection was not associated with abdominal morbidity in our study population. CONCLUSIONS Higher BMI is associated with increased abdominal donor-site complications following DIEP free flap breast reconstruction. Efforts to lower preoperative BMI may help decrease donor-site complications.
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Affiliation(s)
- Marlie H Fisher
- Department of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Lucas B Ohmes
- Department of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Jerry H Yang
- Department of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Elliot Le
- Department of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Salih Colakoglu
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Mackenzie French
- Department of Plastic and Reconstructive Surgery, University of Washington, Seattle, WA, United States
| | - Duygu Siddikoglu
- Department of Biostatistics, Canakkale OnSekiz Mart Faculty of Medicine, Canakkale, Turkey
| | - Grace Um
- Department of Plastic and Reconstructive Surgery, University of Washington, Seattle, WA, United States
| | - Julian Winocour
- Department of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Kent Higdon
- Department of Plastic and Reconstructive Surgery, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Galen Perdikis
- Department of Plastic and Reconstructive Surgery, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Suzanne Inchauste
- Department of Plastic and Reconstructive Surgery, University of Washington, Seattle, WA, United States
| | - Justin Cohen
- Department of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Tae Chong
- Department of Plastic and Reconstructive Surgery, Virginia Commonwealth University, Richmond, VA, United States
| | - Christodoulos Kaoutzanis
- Department of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - David W Mathes
- Department of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
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24
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LaGuardia JS, Milek D, Lebens RS, Chen DR, Moghadam S, Loria A, Langstein HN, Fleming FJ, Leckenby JI. A Scoping Review of Quality-of-Life Assessments Employed in Abdominal Wall Reconstruction. J Surg Res 2024; 295:240-252. [PMID: 38041903 DOI: 10.1016/j.jss.2023.10.013] [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: 05/12/2023] [Revised: 09/08/2023] [Accepted: 10/27/2023] [Indexed: 12/04/2023]
Abstract
INTRODUCTION Surgeons use several quality-of-life instruments to track outcomes following abdominal wall reconstruction (AWR); however, there is no universally agreed upon instrument. We review the instruments used in AWR and report their utilization trends within the literature. METHODS This scoping review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews guidelines using the PubMed, Embase, Web of Science, ClinicalTrials.gov, and Cochrane databases. All published articles in the English language that employed a quality-of-life assessment for abdominal wall hernia repair were included. Studies which focused solely on aesthetic abdominoplasty, autologous breast reconstruction, rectus diastasis, pediatric patients, inguinal hernia, or femoral hernias were excluded. RESULTS Six hernia-specific tools and six generic health tools were identified. The Hernia-Related Quality-of-Life Survey and Carolinas Comfort Scale are the most common hernia-specific tools, while the Short-Form 36 (SF-36) is the most common generic health tool. Notably, the SF-36 is also the most widely used tool for AWR outcomes overall. Each tool captures a unique set of patient outcomes which ranges from abdominal wall functionality to mental health. CONCLUSIONS The outcomes of AWR have been widely studied with several different assessments proposed and used over the past few decades. These instruments allow for patient assessment of pain, quality of life, functional status, and mental health. Commonly used tools include the Hernia-Related Quality-of-Life Survey, Carolinas Comfort Scale, and SF-36. Due to the large heterogeneity of available instruments, future work may seek to determine or develop a standardized instrument for characterizing AWR outcomes.
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Affiliation(s)
- Jonnby S LaGuardia
- Department of Plastic and Reconstructive Surgery, University of Rochester Medical Center, Rochester, New York.
| | - David Milek
- Department of Plastic and Reconstructive Surgery, University of Rochester Medical Center, Rochester, New York
| | - Ryan S Lebens
- Department of Plastic and Reconstructive Surgery, University of Rochester Medical Center, Rochester, New York
| | - David R Chen
- Department of Plastic and Reconstructive Surgery, University of Rochester Medical Center, Rochester, New York
| | - Shahrzad Moghadam
- Department of Plastic and Reconstructive Surgery, University of Rochester Medical Center, Rochester, New York
| | - Anthony Loria
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Howard N Langstein
- Department of Plastic and Reconstructive Surgery, University of Rochester Medical Center, Rochester, New York
| | - Fergal J Fleming
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Jonathan I Leckenby
- Department of Plastic and Reconstructive Surgery, University of Rochester Medical Center, Rochester, New York
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25
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Greenwood Francis AK, Merchant NN, Aguirre K, Andrade A. Advancing geriatric surgical outcomes in elective ventral and incisional hernia repair surgeries: An American college of surgeons national surgical quality improvement program study. Am J Surg 2024:S0002-9610(24)00126-0. [PMID: 38443271 DOI: 10.1016/j.amjsurg.2024.02.030] [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: 10/03/2023] [Revised: 01/17/2024] [Accepted: 02/15/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION Increasing age is known to be associated with increased risk for postoperative morbidity and mortality, however, the goal of this study was to determine if an increase in age correlates to differences in surgical outcomes for elective ventral hernia repair. METHODS Retrospective cohort study using American College of Surgeons NSQIP database from 2016 to 2020. Included diagnosis codes were laparoscopic or open incisional or ventral hernia repairs, categorized into three age groups: 18-64y, 65-74y, and ≥75y. Thirty-day perioperative outcomes analyzed using bivariate χ2 test and multivariate logistic regression. RESULTS We identified 116,643 people who had elective ventral or incisional hernia repair. Compared to 18-64y and 65-74y age groups, patients ≥75y were significantly more likely to develop any post-operative complication, be re-admitted post-operatively for any reason, have an extended hospital stay, and require a reoperation. CONCLUSIONS Patients ≥75y have significantly higher rates of perioperative complications after elective hernia repair compared to younger patients.
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Affiliation(s)
| | - Natalie N Merchant
- Department of Surgery, Texas Tech University Health Science Center El Paso, TX, USA
| | - Katherine Aguirre
- Department of Surgery, Texas Tech University Health Science Center El Paso, TX, USA
| | - Alonso Andrade
- Department of Surgery, Texas Tech University Health Science Center El Paso, TX, USA.
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26
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Butnari V, Mansuri A, Jaiswal SP, Ahmed MW, Ewedah M, Osilli D, Di Nubila F, Buhain RL, Sarwary SH, Kaul S. Emergency transabdominal preperitoneal (TAPP) repair of a strangulated obturator hernia: A literature review and video vignette. J Clin Imaging Sci 2024; 14:5. [PMID: 38469174 PMCID: PMC10927043 DOI: 10.25259/jcis_2_2024] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/24/2024] [Indexed: 03/13/2024] Open
Abstract
Obturator hernia (OH), a rare and potentially life-threatening condition, presents diagnostic and therapeutic challenges. This review article comprehensively delves into the clinical features, diagnosis, and management of OH, with a particular emphasis on the pivotal role of computed tomography (CT) in timely and accurate diagnosis. Delays, particularly in contrast-enhanced CT, dramatically increase mortality due to potential bowel strangulation. To illustrate the challenges and complexities surrounding OH, we present a video vignette of a 74-year-old female patient who presented with symptoms suggestive of bowel obstruction (BO) secondary to a strangulated left-sided OH. This patient case complements the theoretical framework established in the review, serving as a practical example for healthcare professionals. Her presentation included abdominal pain, absence of flatus and bowel movements, and abdominal distension. Laboratory tests demonstrated a mildly elevated white blood cell count and C-reactive protein. CT imaging confirmed the diagnosis of a strangulated OH with an ischemic small bowel. An emergency laparoscopy was undertaken, and the hernia was repaired using the transabdominal preperitoneal approach. A portion of the ischemic small bowel was resected through a 5-cm extension of the umbilical port, and an anastomosis was performed using a modified Barcelona technique. The surgery was successfully completed without immediate or long-term complications. This case highlights the crucial role of timely CT diagnosis and minimally invasive surgical management in achieving improved outcomes in acute BO secondary to OH, particularly when facilitated by pre-operative CT planning.
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Affiliation(s)
- Valentin Butnari
- Department of Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, London, United Kingdom
| | - Ahmer Mansuri
- Department of Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, London, United Kingdom
| | - Subham Prasad Jaiswal
- Department of Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, London, United Kingdom
| | - Mohamed Wael Ahmed
- Department of Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, London, United Kingdom
| | - Moataz Ewedah
- Department of Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, London, United Kingdom
| | - Dixon Osilli
- Department of Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, London, United Kingdom
| | - Francesco Di Nubila
- Department of Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, London, United Kingdom
| | - Robert Leonides Buhain
- Department of Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, London, United Kingdom
| | - Sayed Haschmat Sarwary
- Department of Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, London, United Kingdom
| | - Sandeep Kaul
- Department of Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, London, United Kingdom
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27
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Zhou P, Jin CH, Shi Y, Ma GQ, Wu WH, Wang Y, Cai K, Fan WF, Wang TB. Omental fibroma combined with right indirect inguinal hernia masquerades as a scrotal tumor: A case report. World J Clin Cases 2024; 12:988-994. [PMID: 38414599 PMCID: PMC10895632 DOI: 10.12998/wjcc.v12.i5.988] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/11/2023] [Accepted: 01/22/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND The most common causes of scrotal enlargement in patients include primary tumor of the scrotum, inflammation, hydrocele of the tunica vaginalis, and indirect inguinal hernia; scrotal enlargement caused by external tumors of the scrotum is rare. The patient had both a greater omentum tumor and an inguinal hernia, and the tumor protruded into the scrotum through the hernia sac, which is even rarer. Moreover, omental tumors are mostly metastatic, and primary omental fibroma is rare. CASE SUMMARY Here, we report a rare case of a 25-year-old young man with scrotal enlargement and pain for 3 months. Preoperative examination and multidisciplinary discussions considered intra-abdominal tumor displacement and inguinal hernia, and intraoperative exploration confirmed that the greater omentum tumor protruded into the scrotum. Therefore, tumor resection and tension-free inguinal hernia repair were performed. The final diagnosis was benign fibroma of the greater omentum accompanied by an indirect inguinal hernia. CONCLUSION This unusual presentation of a common inguinal hernia disease illustrates the necessity of performing detailed history taking, physical examination, and imaging before surgery.
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Affiliation(s)
- Ping Zhou
- Department of Gastrointestinal Surgery, South China Hospital of Shenzhen University, Shenzhen 518000, Guangdong Province, China
| | - Chan-Hui Jin
- Department of Gastrointestinal Surgery, South China Hospital of Shenzhen University, Shenzhen 518000, Guangdong Province, China
| | - Ying Shi
- Department of Gastrointestinal Surgery, South China Hospital of Shenzhen University, Shenzhen 518000, Guangdong Province, China
| | - Guo-Qing Ma
- Department of Gastrointestinal Surgery, South China Hospital of Shenzhen University, Shenzhen 518000, Guangdong Province, China
| | - Wen-Hao Wu
- Department of Gastrointestinal Surgery, South China Hospital of Shenzhen University, Shenzhen 518000, Guangdong Province, China
| | - Yu Wang
- Department of Gastrointestinal Surgery, South China Hospital of Shenzhen University, Shenzhen 518000, Guangdong Province, China
| | - Kun Cai
- Department of Gastrointestinal Surgery, South China Hospital of Shenzhen University, Shenzhen 518000, Guangdong Province, China
| | - Wu-Feng Fan
- Department of Gastrointestinal Surgery, South China Hospital of Shenzhen University, Shenzhen 518000, Guangdong Province, China
| | - Tian-Bao Wang
- Department of Gastrointestinal Surgery, South China Hospital of Shenzhen University, Shenzhen 518000, Guangdong Province, China
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28
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Li JL, Han YB, Yang GY, Tian M, Shi CS, Tian D. Inflammation in Hernia and the epigenetic control. Semin Cell Dev Biol 2024; 154:334-339. [PMID: 37080853 DOI: 10.1016/j.semcdb.2023.04.002] [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: 02/11/2023] [Revised: 03/13/2023] [Accepted: 04/01/2023] [Indexed: 04/22/2023]
Abstract
Inflammation is much more intrinsic to hernia then is what is generally appreciated. The occurrence of hernias is associated with swelling, stress and inflammation. Surgery remains an important intervention to treat hernias and for many years, post-surgical levels of inflammatory cytokines have been evaluated to compare the different strategies for their comparative advantages. All surgical procedures elicit some sort of inflammatory response and moreover the meshes used for hernia repair are also associated with elevated inflammatory response, although some favor predominantly a pro-inflammatory response while the other meshes favor anti-inflammatory response. An estimated more than 90% of hernia repairs involve some meshes with polypropylene considered as the gold standard. Efforts are underway to modulate polypropylene meshes associated inflammation through use of alternative materials as well as modifications to polypropylene meshes themselves. In the last one decade, miRNAs have entered hernia research and the data on a role of miRNAs in different hernias is slowly emerging, providing the first evidence of epigenetics in hernia. Some reports are connecting miRNAs with inflammation in hernia. All these aspects, such as, surgery-related to mesh-related inflammation as well as miRNA-related inflammation, are discussed in this article to present an up-to-date information on the topic.
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Affiliation(s)
- Jin-Long Li
- Department of Gastrointestinal Surgery, The Second Hospital of Jilin University, Changchun, China
| | - Ying-Bo Han
- Department of Gastrointestinal Surgery, The Second Hospital of Jilin University, Changchun, China
| | - Gui-Yun Yang
- Department of Operating Room, The Second Hospital of Jilin University, Changchun, China
| | - Miao Tian
- Department of Gynecology and Obstetrics, The Second Hospital of Jilin University, Changchun, China
| | - Chang-Sai Shi
- Department of Gastrointestinal Surgery, The Second Hospital of Jilin University, Changchun, China
| | - Dan Tian
- Department of Anesthesiology, The Second Hospital of Jilin University, Changchun, China.
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29
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Zukiwskyj M, Nicol A, Heathcote P. Incisional hernias following robotic-assisted laparoscopic prostatectomy: does the extraction site matter? J Robot Surg 2024; 18:61. [PMID: 38308726 DOI: 10.1007/s11701-023-01816-3] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/28/2023] [Indexed: 02/05/2024]
Abstract
The incidence of incisional hernia (IH) following robotic-assisted laparoscopic prostatectomy (RALP) varies widely within the literature (0.4-9.7%). Whilst small hernias may go unnoticed, the potential exists for bowel strangulation and subsequent emergency surgery. We suggest that the extraction site may influence the rate of IH. A retrospective chart review of a single surgeon RALP series was undertaken. One hundred charts were sampled, of which 69 had sufficient data to be analysed. Prior to July 2017, specimen extraction had been via the supra-umbilical port site. After this time, specimens were extracted via a Pfannenstiel incision. Of the 69 patients, 24 underwent RALP prior to July 2017. Three patients developed IH at the supra-umbilical port extended for extraction site in the pre-2017 group and three patients developed IH at the supra-umbilical port (not extraction) site in the post-2017 group. The rate of IH was almost double in the pre-July 2017 group (12.5% vs. 6.7%). No patient developed an incisional hernia at the Pfannenstiel site in the post-2017 group. In our series, no patient developed a hernia at the Pfannenstiel site. This is in keeping with the reported < 1% IH rate following Pfannenstiel specimen extraction. Given that incisional hernias are a known complication of robotic surgery, thought should be given to changing the site of specimen extraction site to lower the rate of incisional hernias and the morbidity associated with such.
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Affiliation(s)
- Marianna Zukiwskyj
- Princess Alexandra Hospital, Ipswich Road, Woolloongabba, QLD, 4102, Australia.
| | - Alice Nicol
- Princess Alexandra Hospital, Ipswich Road, Woolloongabba, QLD, 4102, Australia
| | - Peter Heathcote
- Greenslopes Hospital, Newdegate Street, Greenslopes, QLD, 4121, Australia
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30
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Lombardi J, Stec E, Edwards M, Connell T, Sandor M. Comparison of mechanical properties and host tissue response to OviTex™ and Strattice™ surgical meshes: author reply. Hernia 2024; 28:281-282. [PMID: 37855939 PMCID: PMC10891220 DOI: 10.1007/s10029-023-02911-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/01/2023] [Indexed: 10/20/2023]
Affiliation(s)
- J Lombardi
- Allergan Aesthetics, an AbbVie Company, 4 Millennium Way, Branchburg, NJ, 08876, USA
| | - E Stec
- Allergan Aesthetics, an AbbVie Company, 4 Millennium Way, Branchburg, NJ, 08876, USA
| | - M Edwards
- Allergan Aesthetics, an AbbVie Company, 4 Millennium Way, Branchburg, NJ, 08876, USA
| | - T Connell
- Allergan Aesthetics, an AbbVie Company, 4 Millennium Way, Branchburg, NJ, 08876, USA
| | - M Sandor
- Allergan Aesthetics, an AbbVie Company, 4 Millennium Way, Branchburg, NJ, 08876, USA.
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31
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Jourdan A, Dhume R, Guérin E, Siegel A, Le Ruyet A, Palmer M. Numerical investigation of a finite element abdominal wall model during breathing and muscular contraction. Comput Methods Programs Biomed 2024; 244:107985. [PMID: 38185041 DOI: 10.1016/j.cmpb.2023.107985] [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] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 12/04/2023] [Accepted: 12/15/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND AND OBJECTIVE Ventral hernia repair is faced with high recurrence rates. The personalization of the diagnosis, the surgical approach and the choice of the prosthetic implant seem relevant axes to improve the current results. Numerical models have the potential to allow this patient-specific approach, yet currently existing models lack validation. This work extensively investigated a realistic finite element abdominal wall model including the implementation of muscle activation. METHODS A parametric 3D finite element model composed of bone, muscle and aponeurotic structures was introduced. Hyperelastic anisotropic materials were implemented. Two loading scenarios were simulated: passive inflation of the abdominal cavity to represent, e.g., breathing, and passive inflation followed by muscular activation to simulate other daily activities such as cough. The impact of the inter-individual variability (e.g., BMI, tissue thickness, material properties, intra-abdominal pressure (IAP) and muscle contractility) on the model outputs was studied through a sensitivity analysis. RESULTS The overall model predictions were in good agreement with the experimental data in terms of shape variation, muscles displacements, strains and midline forces. A total of 34 and 41 runs were computed for the passive and active sensitivity analysis respectively. The regression model fits rendered high R-squared in both passive (84.0 ± 6.7 %) and active conditions (82.0 ± 8.3 %). IAP and muscle thickness were the most influential factors for the selected outputs during passive (breathing) activities. Maximum isometric stress, muscle thickness and pre-activation IAP were found to drive the response of the simulations involving muscular contraction. The material properties of the connective tissue were essential contributors to the behaviour of the medial part of the abdominal wall. CONCLUSIONS This work extensively investigated a realistic abdominal wall model and evaluated its robustness using experimental data from literature. Such a model could improve patient-specific simulation for ventral hernia surgical planning, prevention, and repair or implant evaluation. Further investigations will be conducted to evaluate the impact of the surgical technique and the mechanical characteristic of prosthetic meshes on the model outputs.
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Affiliation(s)
- Arthur Jourdan
- Medtronic, Surgical Operating Unit, General Surgical Technologies, 116 Avenue du Formans, BioTex 01600, Trévoux, France.
| | - Rohit Dhume
- Medtronic, Corporate Core Technologies, MN, USA
| | - Elisabeth Guérin
- Medtronic, Surgical Operating Unit, General Surgical Technologies, 116 Avenue du Formans, BioTex 01600, Trévoux, France
| | - Alice Siegel
- Medtronic, Surgical Operating Unit, General Surgical Technologies, 116 Avenue du Formans, BioTex 01600, Trévoux, France
| | - Anicet Le Ruyet
- Medtronic, Surgical Operating Unit, General Surgical Technologies, 116 Avenue du Formans, BioTex 01600, Trévoux, France
| | - Mark Palmer
- Medtronic, Corporate Core Technologies, MN, USA
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Adiamah A, Rashid A, Crooks CJ, Hammond J, Jepsen P, West J, Humes DJ. The impact of urgency of umbilical hernia repair on adverse outcomes in patients with cirrhosis: a population-based cohort study from England. Hernia 2024; 28:109-117. [PMID: 38017324 PMCID: PMC10891219 DOI: 10.1007/s10029-023-02898-6] [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: 07/07/2023] [Accepted: 09/18/2023] [Indexed: 11/30/2023]
Abstract
INTRODUCTION Umbilical hernia is common in patients with cirrhosis; however, there is a paucity of dedicated studies on postoperative outcomes in this group of patients. This population-based cohort study aimed to determine the outcomes after emergency and elective umbilical hernia repair in patients with cirrhosis. METHODS Two linked electronic healthcare databases from England were used to identify all patients undergoing umbilical hernia repair between January 2000 and December 2017. Patients were grouped into those with and without cirrhosis and stratified by severity into compensated and decompensated cirrhosis. Length of stay, readmission, 90-day case fatality rate and the odds ratio of 90-day postoperative mortality were defined using logistic regression. RESULTS In total, 22,163 patients who underwent an umbilical hernia repair were included and 297 (1.34%) had cirrhosis. More patients without cirrhosis had an elective procedure, 86% compared with 51% of those with cirrhosis (P < 0.001). In both the elective and emergency settings, patients with cirrhosis had longer hospital length of stay (elective: 0 vs 1 day, emergency: 2 vs 4 days, P < 0.0001) and higher readmission rates (elective: 4.87% vs 11.33%, emergency:11.39% vs 29.25%, P < 0.0001) than those without cirrhosis. The 90-day case fatality rates were 2% and 0.16% in the elective setting, and 19% and 2.96% in the emergency setting in patients with and without cirrhosis respectively. CONCLUSION Emergency umbilical hernia repair in patients with cirrhosis is associated with poorer outcomes in terms of length of stay, readmissions and mortality at 90 days.
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Affiliation(s)
- A Adiamah
- National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, E Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK.
| | - A Rashid
- National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, E Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - C J Crooks
- National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, E Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - J Hammond
- Division of Hepatobiliary and Transplant Surgery, Freeman Hospital, Freeman Rd, High Heaton, Newcastle Upon Tyne, NE7 7DN, UK
| | - P Jepsen
- Department of Hepatology and Gastroenterology and Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - J West
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham, NG5 1PB, UK
| | - D J Humes
- National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, E Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham, NG5 1PB, UK
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DeLong CG, Crowell KT, Liu AT, Deutsch MJ, Scow JS, Pauli EM, Horne CM. Staged abdominal wall reconstruction in the setting of complex gastrointestinal reconstruction. Hernia 2024; 28:97-107. [PMID: 37648895 DOI: 10.1007/s10029-023-02856-2] [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: 03/12/2023] [Accepted: 07/27/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE Literature on one- versus two-staged abdominal wall reconstruction (AWR) with complex gastrointestinal reconstruction (GIR) is limited to single-arm case series with a focus on patients who complete all planned stages. Herein, we describe our experience with both one- and two-staged approaches to AWR/GIR, with attention to those who did not complete both intended stages. METHODS A retrospective review of prospectively collected data was conducted to identify patients who underwent a one- or two-stage approach to GIR/AWR from 2013 to 2020. The one-stage approach included GIR and definitive sublay mesh herniorrhaphy. The two-stage approach included Stage 1 (S1)-GIR and non-definitive herniorrhaphy and Stage 2 (S2)-definitive sublay mesh herniorrhaphy. RESULTS Fifty-four patients underwent GIR/AWR: 20 (37.0%) underwent a planned 1-stage operation while 34 (63.0%) underwent S1 of a planned 2-stage approach. Patients assigned to the 2-stage approach were more likely to be smokers, have a history of mesh infection, have an enterocutaneous fistula, and a contaminated wound class (p<0.05). Of the 34 patients who underwent S1, 12 (35.3%) completed S2 during the mean follow-up period of 44 months while 22 (64.7%) did not complete S2. Of these, 10 (45.5%) developed hernia recurrence but did not undergo S2 secondary to elective nonoperative management (40%), pending preoperative optimization (30%), additional complex GIR (10%), hernia-related incarceration requiring emergent surgery (10%), or unrelated death (10%). No differences in outcome including SSI, SSO, readmission, and recurrence were noted between the 12 patients who completed the two-stage approach and the 20 patients who completed a one-stage approach, despite increased risk factors for complications in the 2-stage group (p>0.05). CONCLUSION Planned two-stage operations for GIR/AWR may distribute operative complexity and post-operative morbidity into separate surgical interventions. However, many patients may never undergo the intended definitive S2 herniorrhaphy. Future evaluation of 1- versus 2-stage GIR/AWR is needed to clarify indications for each approach. This work must also consider the frequent deviations from intended clinical course demonstrated in this study.
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Affiliation(s)
- C G DeLong
- Department of Surgery, Penn State University College of Medicine, 500 University Drive, Hershey, PA, 17033-0850, USA
| | - K T Crowell
- Division of Colon and Rectal Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - A T Liu
- Department of Surgery, Penn State University College of Medicine, 500 University Drive, Hershey, PA, 17033-0850, USA
| | - M J Deutsch
- Division of Colon and Rectal Surgery, Penn State University College of Medicine, Hershey, PA, USA
| | - J S Scow
- Division of Colon and Rectal Surgery, Penn State University College of Medicine, Hershey, PA, USA
| | - E M Pauli
- Division of Minimally Invasive and Bariatric Surgery, Penn State University College of Medicine, Hershey, PA, USA
| | - C M Horne
- Division of Minimally Invasive and Bariatric Surgery, Penn State University College of Medicine, Hershey, PA, USA.
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Huang LC, Liu SH, Ke CC, Wang CC. Biphasic peritoneal mesothelioma in inguinal hernia sac found through laparoscopic herniorrhaphy. Asian J Surg 2024; 47:1007-1008. [PMID: 37914647 DOI: 10.1016/j.asjsur.2023.10.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 10/20/2023] [Indexed: 11/03/2023] Open
Affiliation(s)
- Liang-Chen Huang
- Department of Urology, En Chu Kong Hospital, New Taipei City, 237, Taiwan; Department of Urology, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Shih-Hao Liu
- Department of Pathology, En Chu Kong Hospital, New Taipei City, 237, Taiwan
| | - Chih-Chun Ke
- Department of Urology, En Chu Kong Hospital, New Taipei City, 237, Taiwan; PhD Program in Nutrition & Food Science, Fu Jen Catholic University, New Taipei City, 242, Taiwan.
| | - Chung-Cheng Wang
- Department of Urology, En Chu Kong Hospital, New Taipei City, 237, Taiwan; Department of Biomedical Engineering, Chung Yuan Christian University, Taoyuan City, 320, Taiwan.
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Ramanathan N, Mikulski MF, Perez Coulter AM, Seymour NE, Orthopoulos G. Investigation of optimal hernia repair techniques in patients with inflammatory bowel disease. Surg Endosc 2024; 38:975-982. [PMID: 37968385 DOI: 10.1007/s00464-023-10537-5] [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: 04/01/2023] [Accepted: 10/12/2023] [Indexed: 11/17/2023]
Abstract
INTRODUCTION Multiple laparotomies, immunosuppressive therapy, wound infection, and malnutrition are risk factors for incisional hernia development, which places inflammatory bowel disease (IBD) patients at high risk. With advances in minimally invasive techniques, this study assesses incisional hernia repair techniques and complications in the IBD population. METHODS A single-center, retrospective review of adults with IBD who underwent incisional hernia repair from 2008 to 2022. Complications relative to operative approach and mesh placement location were assessed using descriptive and univariate statistics. RESULTS Eighty-eight IBD patients underwent incisional hernia repair. Fifty-two (59.1%) were on immunomodulators and 30 (34.1%) were repaired primarily. Thirty-five (39.7%) hernias recurred, of whom 19 (33%) had mesh placed. Three (30%) occurred in onlay repairs and 16 (33%) occurred in underlay repairs. Subdivision of underlay repairs into intraperitoneal, preperitoneal and retrorectus mesh placement revealed recurrence rates of 35.1%, 50%, and 14.3%, respectively. Patients with open repair were more likely to have intraoperative bowel injury (28.6% vs 9.7%, p = 0.041) and develop postoperative seromas/abscesses (12.5% vs 0%, p = 0.001) and wound complications (17.9% vs 0%, p = 0.012) compared to laparoscopic. Seromas/abscesses developed more frequently in onlay repairs compared to underlay (40% vs 2.13%, p = 0.001). Twelve (13.6%) patients presented with postoperative small bowel obstruction (SBO), 7 (58.3%) of whom had mesh placed, and 6 (85.7%) were underlay. All SBO after underlay repair had intraperitoneally placed mesh. When comparing surgeons, hernias were more likely to recur performed by colorectal surgeons compared to hernia surgeons (63.3% vs 21.3%, p < 0.001). CONCLUSION In IBD patients, minimally invasive approaches lead to fewer perioperative complications compared to open. Underlay mesh placement demonstrated decreased incidence of seroma/abscess formation compared to onlay. When sub-grouped, underlay placements were similar in terms of complications. Retrorectus placement, however, had fewer recurrences and no readmissions for SBO. This suggests a minimally invasive approach or placement of retrorectus mesh may provide the optimal repair in this patient population.
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Affiliation(s)
- Nikita Ramanathan
- Department of Surgery, University of Massachusetts Chan Medical School - Baystate Medical Center, 759 Chestnut St., Springfield, MA, 01199, USA.
| | - Matthew F Mikulski
- Department of Surgery, University of Massachusetts Chan Medical School - Baystate Medical Center, 759 Chestnut St., Springfield, MA, 01199, USA
| | - Aixa M Perez Coulter
- Department of Surgery, University of Massachusetts Chan Medical School - Baystate Medical Center, 759 Chestnut St., Springfield, MA, 01199, USA
| | - Neal E Seymour
- Department of Surgery, University of Massachusetts Chan Medical School - Baystate Medical Center, 759 Chestnut St., Springfield, MA, 01199, USA
| | - Georgios Orthopoulos
- Department of Surgery, Beth Israel Lahey Health -Winchester Hospital, Boston, USA
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Haskins IN, Huang LC, Phillips S, Poulose B, Perez AJ. Does a " hernia center" label provide better 30-day outcomes following elective ventral hernia repair?: An analysis of the ACHQC database. Am J Surg 2024; 228:230-236. [PMID: 37951836 DOI: 10.1016/j.amjsurg.2023.10.025] [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: 06/21/2023] [Revised: 08/10/2023] [Accepted: 10/04/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION Currently, there is no agreed upon definition of a designated hernia center (DHC) and no study has investigated the association of hernia center designation with ventral hernia repair (VHR) outcomes. We sought to investigate the current utilization of DHC and the association of hernia center designation with VHR outcomes. METHODS All patients who underwent elective, ventral hernia repair with mesh with 30-day follow-up from 2013 through 2020 were in the Americas Hernia Society Quality Collaborative (ACHQC) database. Patients were divided into two groups: those that underwent VHR at a DHC and those that underwent VHR at a non-designated hernia center site (NDHC). Using a 1:1 matched analysis, differences in the incidence of 30-day wound events, the total number of 30-day complications, one-year ventral hernia recurrence rates, and 30-day and one-year patient reported outcomes were compared between DHC and NDHC. RESULTS A total of 261 sites were included in our analysis; 78 (30%) were identified as DHC. After matching, there were 14,186 VHRs available for analysis. There was no significant difference in 30-day wound morbidity events. Patients who underwent VHR at NDHC were less likely to experience any 30-day complication or 1-year hernia recurrence while patients who underwent VHR at DHC had a statistically significant greater improvement in their HerQLes scores at one-year postoperatively. CONCLUSIONS There is currently no clear superiority to VHR at a DHC. The ACHQC may self-select for surgeons invested in hernia repair outcomes regardless of hernia center designation. More standardized criteria for a hernia center are required in order to positively influence the value of hernia care delivered in the United States.
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Affiliation(s)
- Ivy N Haskins
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Li-Ching Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sharon Phillips
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Benjamin Poulose
- Center for Abdominal Core Health, The Ohio State University Wexner Medical Center, USA
| | - Arielle J Perez
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Harrell KN, Grimes AD, Gill H, Reynolds JK, Ueland WR, Sciarretta JD, Todd SR, Trust MD, Ngoue M, Thomas BW, Ayuso SA, LaRiccia A, Spalding MC, Collins MJ, Collier BR, Karam BS, de Moya MA, Lieser MJ, Chipko JM, Haan JM, Lightwine KL, Cullinane DC, Falank CR, Phillips RC, Kemp MT, Alam HB, Udekwu PO, Sanin GD, Hildreth AN, Biffl WL, Schaffer KB, Marshall G, Muttalib O, Nahmias J, Shahi N, Moulton SL, Maxwell RA. A western trauma association multicenter comparison of mesh versus non-mesh repair of blunt traumatic abdominal wall hernias. Injury 2024; 55:111204. [PMID: 38039636 DOI: 10.1016/j.injury.2023.111204] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 11/01/2023] [Accepted: 11/12/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Blunt traumatic abdominal wall hernias (TAWH) occur in <1 % of trauma patients. Optimal repair techniques, such as mesh reinforcement, have not been studied in detail. We hypothesize that mesh use will be associated with increased surgical site infections (SSI) and not improve hernia recurrence. MATERIALS AND METHODS A secondary analysis of the Western Trauma Association blunt TAWH multicenter study was performed. Patients who underwent TAWH repair during initial hospitalization (1/2012-12/2018) were included. Mesh repair patients were compared to primary repair patients (non-mesh). A logistic regression was conducted to assess risk factors for SSI. RESULTS 157 patients underwent TAWH repair during index hospitalization with 51 (32.5 %) having mesh repair: 24 (45.3 %) synthetic and 29 (54.7 %) biologic. Mesh patients were more commonly smokers (43.1 % vs. 22.9 %, p = 0.016) and had a larger defect size (10 vs. 6 cm, p = 0.003). Mesh patients had a higher rate of SSI (25.5 % vs. 9.5 %, p = 0.016) compared to non-mesh patients, but a similar rate of recurrence (13.7 % vs. 10.5%, p = 0.742), hospital length of stay (LOS), and mortality. Mesh use (OR 3.66) and higher ISS (OR 1.06) were significant risk factors for SSI in a multivariable model. CONCLUSION Mesh was used more frequently in flank TAWH and those with a larger defect size. Mesh use was associated with a higher incidence and risk of SSI but did not reduce the risk of hernia recurrence. When repairing TAWH mesh should be employed judiciously, and prospective randomized studies are needed to identify clear indications for mesh use in TAWH.
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Affiliation(s)
- Kevin N Harrell
- University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, United States.
| | | | - Harkanwar Gill
- University of Oklahoma, Oklahoma City, OK, United States
| | | | - Walker R Ueland
- University of Kentucky School of Medicine, Lexington, KY, United States
| | | | | | - Marc D Trust
- University of Texas at Austin, Austin, TX, United States
| | - Marielle Ngoue
- University of Texas at Austin, Austin, TX, United States
| | - Bradley W Thomas
- Atrium Health Carolinas Medical Center, Charlotte, NC, United States
| | - Sullivan A Ayuso
- Atrium Health Carolinas Medical Center, Charlotte, NC, United States
| | | | | | | | | | - Basil S Karam
- Medical College of Wisconsin, Milwaukee, WI, United States
| | - Marc A de Moya
- Medical College of Wisconsin, Milwaukee, WI, United States
| | - Mark J Lieser
- Research Medical Center, Kansas City, MO, United States
| | - John M Chipko
- Research Medical Center, Kansas City, MO, United States
| | - James M Haan
- Ascension Via Christi on St. Francis Hospital, Wichita, KS, United States
| | - Kelly L Lightwine
- Ascension Via Christi on St. Francis Hospital, Wichita, KS, United States
| | | | | | | | | | - Hasan B Alam
- University of Michigan, Ann Arbor, MI, United States
| | | | - Gloria D Sanin
- Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Amy N Hildreth
- Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Walter L Biffl
- Scripps Memorial Hospital La Jolla, La Jolla, CA, United States
| | | | - Gary Marshall
- Medical City Plano Hospital, Plano, TX, United States
| | - Omaer Muttalib
- University of California, Irvine, Orange, CA, United States
| | - Jeffry Nahmias
- University of California, Irvine, Orange, CA, United States
| | - Niti Shahi
- Children's Hospital Colorado, Denver, CO, United States
| | | | - Robert A Maxwell
- University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, United States
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Alzatari R, Huang LC, Poulose BK. The impact of opioid versus non-opioid analgesics on postoperative pain level, quality of life, and outcomes in ventral hernia repair. Hernia 2024:10.1007/s10029-024-02968-3. [PMID: 38296871 DOI: 10.1007/s10029-024-02968-3] [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: 11/01/2023] [Accepted: 01/11/2024] [Indexed: 02/02/2024]
Abstract
PURPOSE Managing postoperative pain remains a significant challenge in hernia operations. With ventral hernia repair (VHR) being one of the most commonly performed procedures, this study aimed to compare the effectiveness of non-opioid analgesia to opioid-based regimens for postoperative pain management. METHODS The Abdominal Core Health Quality Collaborative was queried for elective VHR patients between 2019-2022. Subjects prescribed opioid or non-opioid analgesics at discharge were matched using a propensity score. Postoperative Hernia-Related Quality of Life Survey (HerQLes) summary scores, Patient-Reported Outcome Measurement Information System (PROMIS) 3a questionnaire, and clinical outcomes were compared between the two groups. RESULTS 1,051 patients who underwent VHR met the study criteria. The 2:1 matched demographics were opioids (n = 188) and non-opioids (n = 94) (median age 63, 48% females, 91% white, and 6.5 cm hernia length). Long-term (1-year post-operation) patients' pain levels were similar between opioids vs non-opioids (median (IQR): 31(31-40) vs. 31(31-40), p = 0.46), and HerQLes summary scores were similar (92(78-100) vs. 90(59-95), p = 0.052). Clinical short-term (30-days post-operation) outcomes between opioid vs non-opioid patients had similar length-of-stay (1(0-5) vs 2(0-6), P = 0.089), readmissions (3% vs. 1%, P = 0.28), recurrences (0% vs. 0%, P = 1), reoperations (1% vs. 0%, P = 0.55), surgical site infections (3% vs. 7%, P = 0.11), surgical site occurrences (5% vs. 6%, P = 0.57), and surgical site occurrences requiring procedural intervention (3% vs. 6%, P = 0.13). Finally, long-term recurrence rates were similar (12% vs. 12%, P = 1). CONCLUSION Non-opioid postoperative regimens for analgesia are non-inferior to opioids in VHR patients with similar outcomes. Aggressive efforts should be undertaken to reduce opioid use in this population.
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Affiliation(s)
- Ramez Alzatari
- Department of Surgery, Center for Abdominal Core Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
- Ohio University Heritage College of Osteopathic Medicine-Dublin Campus, Dublin, OH, USA.
| | - Li-Ching Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Benjamin K Poulose
- Department of Surgery, Center for Abdominal Core Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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López-Cano M, Hernández-Granados P, Morales-Conde S, Ríos A, Pereira-Rodríguez JA. Abdominal wall surgery units accreditation. The Spanish model. Cir Esp 2024:S2173-5077(24)00036-X. [PMID: 38296193 DOI: 10.1016/j.cireng.2024.01.005] [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: 01/08/2024] [Accepted: 01/14/2024] [Indexed: 02/10/2024]
Abstract
The Spanish Association of Surgeons (AEC) deems it essential to define and regulate the acquisition of high-specialization competencies within General Surgery and Gastrointestinal Surgery and proposes the Regulation for the accreditation of specialized surgical units. The AEC aims to define specialized surgical units as those functional elements of the health system that meet the defined requirements regarding their provision, solvency, and specialization in care, teaching, and research. In this paper we present the proposed accreditation model for Abdominal Wall Surgery Units, as well as the results of a survey conducted to assess the status of such units in our country. The model presented represents one of the pioneering initiatives worldwide concerning the accreditation of Abdominal Wall Surgery Units.
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Affiliation(s)
- Manuel López-Cano
- Unidad de Cirugía de Pared Abdominal Hospital Universitario Vall d´Hebrón, Barcelona Universidad Autónoma de Barcelona, Spain.
| | - Pilar Hernández-Granados
- Unidad de Pared Abdominal Hospital Universitario Fundación Alcorcón. Universidad Rey Juan Carlos, Spain
| | - Salvador Morales-Conde
- Serviciode Cirugía General y del Aparato Digestivo Hospital Universitario Virgen Macarena. Sevilla Facultad de Medicina, Universidad de Sevilla, Spain
| | - Antonio Ríos
- Unidad de Pared Abdominal Hospital Clínico Universitario Virgen de la Arrixaca Universidad de Murcia, Spain
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Hansen ML, Jensen TB, Kristensen CS, Larsen I, Pedersen KS. Umbilical outpouchings in Danish piglets and weaners: prevalence and clinical characteristics-a cross-sectional study at herd level. Porcine Health Manag 2024; 10:3. [PMID: 38218966 PMCID: PMC10788040 DOI: 10.1186/s40813-023-00352-8] [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: 08/23/2023] [Accepted: 12/20/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Umbilical outpouchings (UO) in pigs present a welfare concern because of ulceration risk and complications. Danish legislation requires pigs with larger UOs to be housed in sick pens with soft bedding, and some UO pigs might not be suited for transport. Because of this, many UO pigs are euthanized, adding to the costs of pig production. The true prevalence of UO is unknown as no scientific reports with randomly sampled herds exist. This study aimed to estimate the prevalence of UO in Danish piglets and weaners and describe their clinical characteristics: size, texture, reducibility, and occurrence of ulcers. Lastly, risk factors for the occurrence of ulcers on UOs were investigated. RESULTS A cross-sectional study was conducted in 30 Danish conventional herds, with at least 800 weaned pigs and 200 sows. The herds were selected randomly from the Danish Husbandry Register and visited once between September 2020 and May 2021. Piglets were examined during their last week in the farrowing unit, and weaners were examined between weeks three and eight after weaning. The abdominal area was palpated on all pigs, and all irregularities were recorded; the results presented are umbilical outpouchings measuring at least 2 × 2 cm. The within-herd prevalence of piglets with UO averaged 4.2% with a range from 0.8 to 13.6% between herds. The within-herd prevalence of weaners with UO averaged 2.9%, ranging from 1.0 to 5.3% between herds. Approximately 80% of the UOs were classified as small or medium (< 7 cm piglets/ < 11cm weaners). Large outpouchings had significantly higher odds of ulcer occurrence (OR = 9.9, p < 0.001). CONCLUSION UOs are common in Denmark, with a prevalence of 2.9% in weaners and an estimated annual production of 32 million Danish pigs almost a million pigs are affected yearly. Most of these pigs will have a small or medium UO. If the pigs have large UOs the odds of ulcer occurrence increase significantly. Numerous of these pigs are wasted, challenging sustainability and economy. UOs might also affect the welfare of the pigs. More research is therefore needed, especially in the prevention of UOs.
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Affiliation(s)
- Marie-Louise Hansen
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Grønnegårdsvej 2, 1870, Frederiksberg C, Denmark.
| | | | | | - Inge Larsen
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Grønnegårdsvej 2, 1870, Frederiksberg C, Denmark
| | - Ken Steen Pedersen
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Grønnegårdsvej 2, 1870, Frederiksberg C, Denmark
- Ø-Vet A/S, Køberupvej 33, 4700, Næstved, Denmark
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Zhu L, Chen F, Xiong J, Xu W, Zhang H, Huang X, Liu T, Lv Z. Effectiveness of preoperative ultrasonography in predicting metachronous contralateral inguinal hernia in children: a single-arm prospective study using a historical control for comparison. Pediatr Surg Int 2024; 40:33. [PMID: 38206388 DOI: 10.1007/s00383-023-05612-w] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE To analyze the value of ultrasonography in predicting metachronous contralateral inguinal hernia (MCIH) and diagnosing contralateral persistent processus vaginalis (CPPV) in children with unilateral inguinal hernia, a prospective study was conducted. METHODS All participants underwent a preoperative ultrasound on the contralateral groin. Patients in group A1 received operating procedure according to ultrasound results (patients with negative contralateral US results received hernia repair on the affected side), and patients in group A2 received operation according to laparoscopic results (patients received hernia repair and CPPV ligation). All patients were followed up 2 years and compared to a historical control (group B) who underwent open hernia repair only on the affected side regardless of contralateral US results. RESULTS In groups A1 and A2, laparoscopic exploration revealed the presence of a CPPV in 490 cases. Ultrasound was found to be accurate in 104 out of the 490 cases with four false-positive and 386 false-negative results. This yielded an accuracy of 59.3%, a sensitivity of 21.2%, and a specificity of 99.2%. 10 patients in group A1, and 74 patients in group B developed MCIH. The accuracy, sensitivity, and specificity of the value of ultrasonography in predicting MCIH were 89.3%, 52.4%, and 92.5%, respectively. CONCLUSIONS Preoperative ultrasonography of the contralateral groin is currently unable to accurately detect CPPV, but it appears to be a promising method in predicting MCIH by using rigorous diagnosing criteria.
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Affiliation(s)
- Linlin Zhu
- Department of General Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 355, Luding Road, Shanghai, China
| | - Feng Chen
- Department of General Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 355, Luding Road, Shanghai, China
| | - Jing Xiong
- Department of General Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 355, Luding Road, Shanghai, China
| | - Weijue Xu
- Department of General Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 355, Luding Road, Shanghai, China
| | - Haorong Zhang
- Department of Ultrasound, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiong Huang
- Department of General Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 355, Luding Road, Shanghai, China
| | - Tao Liu
- Department of General Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 355, Luding Road, Shanghai, China
| | - Zhibao Lv
- Department of General Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 355, Luding Road, Shanghai, China.
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Jaro VZ, Marc K, Bart W, Klaas VDH. Five years of robot-assisted ventral hernia repair: initial experience and surgical outcome. Acta Chir Belg 2024:1-8. [PMID: 38197175 DOI: 10.1080/00015458.2024.2304386] [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: 05/30/2023] [Accepted: 01/06/2024] [Indexed: 01/11/2024]
Abstract
OBJECTIVE Robot-assisted ventral hernia repair (RVHR) has become a feasible alternative for open ventral hernia repair showing fewer postoperative complications and satisfying short-term results. However, long-term results are scarce in current literature. METHODS All consecutive patients who underwent robot-assisted surgery for ventral hernias from June 2018 until February 2023 were included. Patient records were retrospectively reviewed for indication, need for conversion, length of stay (LOS), postoperative complications, and postoperative pain.In addition, long-term (>24 months) results (recurrence, chronic pain, and esthetic satisfaction) were assessed by phone questionnaire. RESULTS In total, 177 patients underwent a robot-assisted ventral hernia repair. Indication for surgery was incisional hernia (N = 109) and primary hernia (N = 68), including 124 cases with abdominal rectus diastasis. A TransAbdominal Retromuscular Umbilical Prosthesis (TARUP) was performed in 138 patients. Robotic Transversus Abdominis Release (TAR) and Extended Totally Extraperitoneal Repair (eTEP) were performed in 20 (11%) and 9 (5%) cases, respectively.Median LOS was 2 days for TARUP and 3.5 days for TAR. Minor complications occurred in 22 patients (16 TARUP, 5 TAR, 1 eTEP). The average pain score on the first postoperative day was 1.8/10. No risk factors for morbidity could be identified by uni- and multivariable analysis.Hernia recurrence developed in four (2%) patients. Chronic pain was reported in two (1%) cases. Seven (4%) patients had esthetic complaints. CONCLUSION Robot-assisted ventral hernia repair is a safe procedure with low postoperative pain and short LOS. Long-term results including recurrence and chronic pain are satisfying.
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Affiliation(s)
- Van Zande Jaro
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst-Asse-Ninove, Aalst, Belgium
| | - Krick Marc
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst-Asse-Ninove, Aalst, Belgium
| | - Willaert Bart
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst-Asse-Ninove, Aalst, Belgium
| | - Van Den Heede Klaas
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst-Asse-Ninove, Aalst, Belgium
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de Jong DLC, Wegdam JA, Van der Wolk S, Nienhuijs SW, de Vries Reilingh TS. Prevention of component separation in complex abdominal wall surgery by Botox prehabilitation: a propensity-matched study. Hernia 2024:10.1007/s10029-023-02929-2. [PMID: 38172376 DOI: 10.1007/s10029-023-02929-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/05/2023] [Indexed: 01/05/2024]
Abstract
AIM To facilitate midline fascial closure in complex abdominal wall surgery, component separation techniques (CST) are usually required. However, CST is associated with an enlarged morbidity. Prehabilitation could increase the compliance of the abdominal wall and thereby decrease the necessity of myofascial release. This can be accomplished by administration of botulinum toxin type A (BTA) in the lateral abdominal wall musculature. The aim of this study was to determine the effect of BTA on the subsequent necessity to perform CST in patients with complex abdominal wall hernias. METHODS Patients with a complex abdominal wall hernia, planned to undergo CST between July 2020 and November 2022 were included. Outcome of procedures with 300U of BTA 4 (2-6) weeks prior to surgery, were retrospectively analyzed by comparison with propensity matched subjects of an historical group. Hernia width difference was assessed by CT and operative details were included. RESULTS A total of 13 patients with a median hernia width of 12 cm (IQR 9-14, range 24) were prehabilitated with BTA between July 2020 and November 2022. A CST was planned for all, however not required in 6/13 patients (46%) to accomplish midline fascial closure. A mean elongation of lateral abdominal wall musculature of 4.01 cm was seen in patients not requiring CST. Compared to the propensity score matched control group, a 27% reduction (p = 0.08) in the need for CST was observed. CONCLUSION There is a tendency for decrease of necessity for CST by preoperatively administered BTA in patients with complex abdominal wall defects. Although small, as this study used propensity matched comparison, further exploration of BTA should be encouraged.
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Affiliation(s)
| | - J A Wegdam
- Elkerliek Ziekenhuis, Helmond, The Netherlands
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Frommer ML, Faderani R, Kanapathy M, Pérusseau-Lambert A, Shankar A, Malhotra A, Khosh Zaban M, Floyd D, Butler PEM, Ghali S. Preoperative CT imaging as a tool to predict incisional hernia outcomes following abdominal wall reconstruction: A retrospective cohort analysis. J Plast Reconstr Aesthet Surg 2024; 88:369-377. [PMID: 38061260 DOI: 10.1016/j.bjps.2023.11.007] [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: 07/19/2023] [Revised: 10/11/2023] [Accepted: 11/08/2023] [Indexed: 01/02/2024]
Abstract
INTRODUCTION Ventral wall hernia often causes significant morbidity and requires complex abdominal wall reconstruction (AWR). This study aims to determine whether subcutaneous abdominal fat thickness (AFT) measured with preoperative CT scans could predict postoperative outcomes in patients undergoing AWR. METHODS A retrospective cohort study was conducted on all patients who underwent AWR at our institution between 2009 and 2021, with a minimum follow-up of 12 months. Using preoperative CT scans, AFT was measured at the xiphoid process, umbilicus, and pubic tubercle, as well as the hernia dimensions. Demographic, operative, and surgical outcome data were also collected and analyzed using statistical tests. RESULTS The results showed that 9 of 101 patients (8.9%) experienced hernia recurrence. Smoking was associated with an increased risk of hernia recurrence (p < 0.001) with a predictive odds ratio (OR) of 18.27 (p = 0.041). Increased AFT at the xiphoid (p = 0.005), umbilicus (p < 0.001), and pubic tubercle (p < 0.001) were also associated with hernia recurrence and risk of infection. Only AFT at the pubic tubercle reached significance in the regression model predicting recurrence (OR=1.10; p = 0.030) and infection (OR=1.04; p = 0.021). A cut-off value of 67 mm was associated with a positive predictive value of 42.14% (sensitivity of 67% and specificity of 91%). Hernia defect area was not associated with risk of recurrence or infection. CONCLUSIONS Smoking and increased AFT at the pubic tubercle are significant predictive factors for recurrence and infection in patients undergoing AWR, and preoperative optimization should focus on reducing these factors.
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Affiliation(s)
- M L Frommer
- Charles Wolfson Centre for Reconstructive Surgery, Royal Free Hospital, London NW3 2QG, United Kingdom; Division of Surgery & Interventional Science, University College London, London NW3 2QG, United Kingdom; Department of Plastic Surgery, Royal Free Hospital, London NW3 2QG, United Kingdom.
| | - R Faderani
- Department of Plastic Surgery, Royal Free Hospital, London NW3 2QG, United Kingdom
| | - M Kanapathy
- Division of Surgery & Interventional Science, University College London, London NW3 2QG, United Kingdom; Department of Plastic Surgery, Royal Free Hospital, London NW3 2QG, United Kingdom
| | - A Pérusseau-Lambert
- Division of Surgery & Interventional Science, University College London, London NW3 2QG, United Kingdom
| | - A Shankar
- The Lister Hospital, London, London SW1W 8RH, United Kingdom
| | - A Malhotra
- Department of Radiology, Royal Free Hospital, London NW3 2QG, United Kingdom
| | - M Khosh Zaban
- Department of Radiology, Royal Free Hospital, London NW3 2QG, United Kingdom
| | - D Floyd
- Division of Surgery & Interventional Science, University College London, London NW3 2QG, United Kingdom; Department of Plastic Surgery, Royal Free Hospital, London NW3 2QG, United Kingdom
| | - P E M Butler
- Charles Wolfson Centre for Reconstructive Surgery, Royal Free Hospital, London NW3 2QG, United Kingdom; Division of Surgery & Interventional Science, University College London, London NW3 2QG, United Kingdom; Department of Plastic Surgery, Royal Free Hospital, London NW3 2QG, United Kingdom
| | - S Ghali
- Division of Surgery & Interventional Science, University College London, London NW3 2QG, United Kingdom; Department of Plastic Surgery, Royal Free Hospital, London NW3 2QG, United Kingdom
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45
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O'Herlihy F, Dempsey PJ, Gorman D, McDermott E, Kavanagh EC. Ureteroinguinal herniation complicated by obstructive uropathy and pyelonephritis. Radiol Case Rep 2024; 19:111-113. [PMID: 37941986 PMCID: PMC10628784 DOI: 10.1016/j.radcr.2023.09.089] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 11/10/2023] Open
Abstract
Herniation of the ureters into the inguinal canal is a rare but recognized phenomenon. It may be noted incidentally on cross-sectional imaging, or when it presents with complications such as obstruction or infection. It is important to highlight the finding when present, as surgical intervention will be required in the majority of cases. We present a case of a 91-year-old man who developed obstructive uropathy and pyelonephritis due to inguinal herniation of the ureter.
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Affiliation(s)
- Fergus O'Herlihy
- Mater Misericordiae University Hospital, Eccles St, Dublin, Ireland
| | - Philip J Dempsey
- Mater Misericordiae University Hospital, Eccles St, Dublin, Ireland
| | - Dora Gorman
- Mater Misericordiae University Hospital, Eccles St, Dublin, Ireland
| | - Edward McDermott
- Mater Misericordiae University Hospital, Eccles St, Dublin, Ireland
| | - Eoin C Kavanagh
- Mater Misericordiae University Hospital, Eccles St, Dublin, Ireland
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Naraynsingh V, Cawich SO, Hassranah S. Alternative to mesh repair for ventral hernias: Modified rectus muscle repair. World J Surg Proced 2023; 13:14-21. [DOI: 10.5412/wjsp.v13.i3.14] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/18/2023] [Accepted: 12/19/2023] [Indexed: 12/26/2023] Open
Abstract
BACKGROUND Mesh utilization for ventral hernia repair is associated with potential complications such as mesh infections, adhesions, seromas, fistula formation and significant postoperative pain. The modified rectus muscle repair (RMR) is as an option to repair midline ventral hernias without mesh.
AIM To evaluate the short term outcomes when the modified RMR was used to repair ventral hernias.
METHODS This was a 5-year prospective study that examined the outcome of all consecutive patients with ventral abdominal wall hernias > 5 cm in maximal diameter who underwent repair using the modified RMR technique in a single surgeon unit. Patients were reviewed in an outpatient clinic at 3, 6 and 12 mo and evaluated for hernia recurrence on clinical examination. Each patient’s abdominal wall was also assessed with using ultrasonography at 24 mo to detect recurrences. All data were examined with SPSS ver 18.0.
RESULTS Over the 5-year study period, there were 52 patients treated for ventral hernias at this institution. Four patients were excluded and there were 48 in the final study sample, at a mean age of 56 years (range 28-80). The mean maximal diameter of the hernia defect was 7 cm (range 5-12 cm). There were 5 (10.4%) seromas and 1 recurrence (2.1%) at a mean of 36 mo follow-up.
CONCLUSION The authors recommend the modified RMR as an acceptable alternative to mesh repair of ventral hernias. The seroma rate can be further reduced with routine use of drains. The modified RMR also has the benefit of eliminating all mesh-specific complications.
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Affiliation(s)
- Vijay Naraynsingh
- Department of Surgery, Port of Spain General Hospital, Port of Spain, Trinidad and Tobago
| | - Shamir O Cawich
- Department of Surgery, University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Samara Hassranah
- Department of Surgery, Medical Associate Hospital, St. Joseph, Trinidad and Tobago
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Goffioul L, Zjukovitsj D, Moise M, Waltregny D, Detry O. Repair of parastomal hernia after Bricker procedure: retrospective consecutive experience of a tertiary center. Hernia 2023:10.1007/s10029-023-02940-7. [PMID: 38150078 DOI: 10.1007/s10029-023-02940-7] [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: 07/18/2023] [Accepted: 11/26/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Ileal conduit parastomal hernias (ICPHs) are frequent after radical cystectomy with ileal conduit urinary diversion, but their management is debated. This study aimed to review the results of ICPH repair according to Sugarbaker or Sandwich techniques, with special interest in ICPH recurrence and urological complications. METHODS The authors reviewed a consecutive series of patients undergoing ICPH repair between January 2014 and December 2020. Primary endpoints were ICPH recurrences at clinical exam and cross-sectional abdominal computed tomography (CT) scans. Secondary endpoints were any other complications possibly related to the ICPH repair. RESULTS Twenty-three patients underwent ICPH repair surgery (16 Sugarbaker and 7 Sandwich techniques) during the study period. Sixteen patients underwent a primary laparoscopic approach. All but one patient underwent at least one abdominal CT during the follow-up. Median clinical and CT scan follow-up times were 57 and 50.5 months, respectively. Clinical and CT ICPH recurrence rates were 4.5% and 13% at 5 years, respectively. Eighteen patients (78%) suffered no urological complications during the follow-up period, but three patients (13%) needed redo surgery on the urinary ileal conduit. CONCLUSION The modified Sugarbaker or Sandwich techniques might be considered as promising techniques for ICPH repair with a low rate of recurrence. The urological complications, and particularly the ileal conduit-related issues, need to be evaluated in further studies. Controlled and prospective data are required to compare the Sugarbaker and Sandwich techniques to the Keyhole approach for ICPH repairs.
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Affiliation(s)
- L Goffioul
- Department of Abdominal Surgery and Transplantation, Division of Abdominal Wall Surgery, CHU Liege, University of Liege, Sart Tilman B35, B4000, Liege, Belgium
- Department of Abdominal Surgery, CHR Citadelle, Liege, Belgium
| | - D Zjukovitsj
- Department of Abdominal Surgery and Transplantation, Division of Abdominal Wall Surgery, CHU Liege, University of Liege, Sart Tilman B35, B4000, Liege, Belgium
| | - M Moise
- Department of Radiology, CHU Liege, University of Liege, Liege, Belgium
| | - D Waltregny
- Department of Urology, CHU Liege, University of Liege, Liege, Belgium
| | - O Detry
- Department of Abdominal Surgery and Transplantation, Division of Abdominal Wall Surgery, CHU Liege, University of Liege, Sart Tilman B35, B4000, Liege, Belgium.
- Centre de Recherche et d'Enseignement du Département de Chirurgie (CREDEC), University of Liege, Liege, Belgium.
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Park SH, Kim JY, Seol KH, Roh JH, Lee HN, Kim SH, Jeong J, Namgoong JM, Lee BS, Jung E. Pulmonary Artery Measurements as Postnatal Prognostic Tool in Right Congenital Diaphragmatic Hernia. J Pediatr Surg 2023:S0022-3468(23)00755-8. [PMID: 38168548 DOI: 10.1016/j.jpedsurg.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/07/2023] [Accepted: 12/12/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Right-sided congenital diaphragmatic hernia (RCDH) is a rare and often fatal congenital anomaly, primarily attributed to lung hypoplasia, which is associated with small branch pulmonary artery (PA). This study investigated whether postnatal PA measurements obtained through echocardiography are associated with mortality or the extracorporeal membrane oxygenation (ECMO) requirement in neonates with RCDH. METHODS A retrospective study was conducted on neonates with RCDH born between 2008 and 2022. Echocardiography was performed on the day of birth. The diameter of the main PA (MPA) was measured at the maximal dimension, and the diameters of the left PA (LPA) and right PA (RPA) were measured at the bifurcation. The primary outcome was mortality or ECMO requirement. Parameters, including the LPA:MPA ratio, RPA:MPA ratio, Nakata index, McGoon ratio, and ejection fraction (EF), were analyzed and compared with the observed-to-expected lung-to-head ratio (o/e LHR), initial blood gas, and defect size as predictive values. RESULTS Among 39 neonates with RCDH, 25 (64.1 %) survived without ECMO. The non-survivor or ECMO group exhibited lower o/e LHR, reduced EF, smaller LPA and RPA diameters, and larger MPA diameter than survivors. Lower LPA:MPA ratio, Nakata index, McGoon ratio, and higher initial PaCO2 were associated with adverse outcomes. Notably, the LPA:MPA ratio showed the highest predictive capability (area under the curve, 0.983; p < 0.001). CONCLUSION The LPA:MPA ratio is a promising postnatal predictor of mortality or ECMO requirement in neonates with RCDH. Additionally, Nakata index, McGoon ratio, and initial PaCO2 are significantly correlated with outcomes. LEVEL OF EVIDENCE This is a level III. TYPE OF STUDY Prognostic study.
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Affiliation(s)
- Sung Hyeon Park
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji Yoo Kim
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Keon Hee Seol
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Joo Hyung Roh
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ha Na Lee
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soo Hyun Kim
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jiyoon Jeong
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jung-Man Namgoong
- Department of Pediatric Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Byong Sop Lee
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Euiseok Jung
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Howard R, Ehlers A, O'Neill S, Shao J, Englesbe M, Dimick JB, Telem D, Huynh D. Mesh overlap for ventral hernia repair in current practice. Surg Endosc 2023; 37:9476-9482. [PMID: 37697114 DOI: 10.1007/s00464-023-10348-8] [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: 03/29/2023] [Accepted: 07/30/2023] [Indexed: 09/13/2023]
Abstract
INTRODUCTION Sufficient overlap of mesh beyond the borders of a ventral hernia helps prevent hernia recurrence. Guidelines from the European Hernia Society and American Hernia Society recommend ≥ 2 cm overlap for open repair of < 1-cm hernias, ≥ 3-cm overlap for open repair of 1-4-cm hernias, ≥ 5-cm overlap for open repair of > 4-cm hernias, and ≥ 5-cm overlap for all laparoscopic ventral hernia repairs. We evaluated whether current practice reflects this guidance. METHODS We used the Michigan Surgical Quality Collaborative Hernia Registry to evaluate patients who underwent elective ventral and umbilical hernia repair between 2020 and 2022. Mesh overlap was calculated as [(width of mesh - width of hernia)/2]. The main outcome was "sufficient overlap," defined based on published EHS and AHS guidelines. Explanatory variables included patient, operative, and hernia characteristics. The main analysis was a multivariable logistic regression to evaluate the association between explanatory variables and sufficient mesh overlap. RESULTS 4178 patients underwent ventral hernia repair with a mean age of 55.2 (13.9) years, 1739 (41.6%) females, mean body mass index (BMI) of 33.1 (7.2) kg/m2, and mean hernia width of 3.7 (3.4) cm. Mean mesh overlap was 3.7 (2.5) cm and ranged from - 5.5 to 21.4 cm. Only 1074 (25.7%) ventral hernia repairs had sufficient mesh overlap according to published guidelines. Operative factors associated with increased odds of sufficient overlap included myofascial release (adjusted odds ratio [aOR] 5.35 [95% CI 4.07-7.03]), minimally invasive approach (aOR 1.86 [95% CI 1.60-2.17]), and onlay mesh location (aOR 1.31 [95% CI 1.07-1.59]). Patient factors associated with increased odds of sufficient overlap included prior hernia repair (aOR 1.59 [95% CI 1.32-1.92]). CONCLUSION Although sufficient mesh overlap is recommended to prevent ventral hernia recurrence, only a quarter of ventral hernia repairs in a state-wide cohort of patients had sufficient overlap according to evidence-based guidelines. Factors strongly associated with sufficient overlap included myofascial release, mesh type, and laparoscopic repair.
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Affiliation(s)
- Ryan Howard
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Anne Ehlers
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
- Division of Minimally Invasive Surgery, Department of Surgery, Michigan Medicine, 2926 Taubman Center, 1500 E Medical Center Dr, SPC 5331, Ann Arbor, MI, 48109-5331, USA
| | - Sean O'Neill
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
- Division of Minimally Invasive Surgery, Department of Surgery, Michigan Medicine, 2926 Taubman Center, 1500 E Medical Center Dr, SPC 5331, Ann Arbor, MI, 48109-5331, USA
| | - Jenny Shao
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
- Division of Minimally Invasive Surgery, Department of Surgery, Michigan Medicine, 2926 Taubman Center, 1500 E Medical Center Dr, SPC 5331, Ann Arbor, MI, 48109-5331, USA
| | - Michael Englesbe
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Justin B Dimick
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
- Division of Minimally Invasive Surgery, Department of Surgery, Michigan Medicine, 2926 Taubman Center, 1500 E Medical Center Dr, SPC 5331, Ann Arbor, MI, 48109-5331, USA
| | - Dana Telem
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA.
- Division of Minimally Invasive Surgery, Department of Surgery, Michigan Medicine, 2926 Taubman Center, 1500 E Medical Center Dr, SPC 5331, Ann Arbor, MI, 48109-5331, USA.
| | - Desmond Huynh
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
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Jacob MO, Karatassas A, Hewett P, Guirgis M, Hensman C, Catterwell R. The use of a porcine model to teach advanced abdominal wall dissection techniques. Surg Endosc 2023; 37:9684-9689. [PMID: 37957301 DOI: 10.1007/s00464-023-10547-3] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/13/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND In the era of minimally invasive surgery, it is clear that a robust simulation model is required for the training of surgeons in advanced abdominal wall reconstruction. The purpose of this experimentation was to evaluate whether a porcine model could be used to teach advanced minimally invasive abdominal wall dissection techniques to novice surgeons. Secondary objectives included: time to completion, identification of various anatomical landmarks, to note the difference in porcine and human models and finally, the ability to dock a Da Vinci Xi robotic platform on the porcine model. METHODOLOGY Two post-fellowship surgeons were given the task of performing an extended total extraperitoneal dissection (ETEP) on one female Landrace pig under the supervision of a surgeon experienced in robotic-assisted ventral hernia repair. This included insertion of ports, developing a retro-rectus plane, crossover from left to right rectus, bilateral transverse abdominus release, and sub-diaphragmatic dissection. A 5-mm vessel sealer was used to facilitate the dissection. The steps of the surgery were given to the trainees, and an experienced hernia surgeon guided the steps of dissection. The emphasis of the tasks was to develop the planes of extraperitoneal dissection to demonstrate that the porcine model could be considered for a viable and realistic model for training. RESULTS The candidates were able to successfully complete the task and dock a Da Vinci Xi with the porcine model providing a realistic platform for training. CONCLUSION The porcine model can be a considerable tool in the education of surgeons embarking on learning the art of minimally invasive abdominal wall reconstruction techniques. The advantage of live tissue dissection, similarity in anatomy and the relatively inexpensive availability of porcine models, makes it an unparalleled form of simulation-based training. We believe that this will have transitional capabilities to robotic ETEP education for complex hernia repair.
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Affiliation(s)
- Mathew Ollapallil Jacob
- Lyell McEwin Hospital, Elizabeth Vale, SA, Australia.
- University of Adelaide, Adelaide, Australia.
| | - Alex Karatassas
- University of Adelaide, Adelaide, Australia
- Queen Elizabeth Hospital, Woodville South, SA, Australia
| | - Peter Hewett
- University of Adelaide, Adelaide, Australia
- Queen Elizabeth Hospital, Woodville South, SA, Australia
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