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Valera-Montiel AE, López-Sánchez J, Diaz-Maag CR. Septic Shock After Endoscopic Sleeve Gastroplasty: A Post-procedural Complication? Obes Surg 2024; 34:1990-1992. [PMID: 38564175 DOI: 10.1007/s11695-024-07198-1] [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: 01/23/2024] [Revised: 03/20/2024] [Accepted: 03/20/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND ESG is a safe and effective technique in the obesity management, usually indicated in class I and II obesity. It is also an acceptable treatment in patients with class III obesity who have high surgical risk or refuse surgery. This procedure results in a significant weight loss and important improvement in metabolic comorbidities. Nevertheless, there are several procedure-related complications. Few cases of gastric perforation following ESG have been reported. We present a case of septic shock after ESG with preoperative diagnostic uncertainties. METHODS We present the case of a 54-year-old male with a BMI of 43.6 kg/m2 who underwent ESG 7 days before in an external center. The patient came to the emergency department presenting abdominal pain, nausea, and vomiting since the day after the procedure. Physical examination revealed hemodynamic instability, altered level of consciousness, diffuse abdominal pain, and a painful umbilical lump due to a complicated umbilical hernia. Emergent surgery was decided after preoperative assessment. RESULTS Intraoperative gastroscopy was performed, viewing a gastric ischemic ulcer covered with fibrin and a mucosal defect and suspecting a covered gastric perforation. Firstly, we performed an open approach to the complicated umbilical hernia. Subsequently, an exploratory laparoscopy was performed through the hernial ring, where a fibrin-covered area was evidenced in the anterior face of the gastric body, adhered to the round ligament by a transmural suture of the ESG. Additionally, multiple transmural sutures were observed adhered to the greater omentum and lesser sac and an intramural hematoma in the greater gastric curvature. No intra-abdominal free fluid was evidenced. A laparoscopic barbed suture of the area covered with fibrin was performed, after its release from the round ligament. The adhesions of the sutures and metallic material from the ESG were released. Finally, two abdominal drains were placed in the anterior and posterior gastric face. The patient presented superficial incisional surgical site infection and was discharged 6 days after laparoscopic surgery. CONCLUSIONS ESG is a novel procedure, which has proven to be an effective alternative in the treatment of obesity. However, this technique may have major complications that can require urgent surgery.
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Affiliation(s)
- Andrés E Valera-Montiel
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Salamanca - Paseo de la transición española, 37007, Salamanca, Spain.
| | - Jaime López-Sánchez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Salamanca - Paseo de la transición española, 37007, Salamanca, Spain
| | - Carlos R Diaz-Maag
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Salamanca - Paseo de la transición española, 37007, Salamanca, Spain
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Hadj-Youssef S, Rondeau F, Golo KT, Ghali N, Laberge M, Li P, Beltempo M, Lacroix G, Wissanji H. Provincial Review of Adherence to Age-specific Guidelines for Umbilical Hernia Repair and Trends in Management. J Pediatr Surg 2024; 59:791-799. [PMID: 38418272 DOI: 10.1016/j.jpedsurg.2024.01.035] [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: 01/10/2024] [Accepted: 01/22/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND Umbilical hernia (UH) is a common pediatric condition, for which delaying surgical repair for asymptomatic UH until after age 3 is recommended due to a high incidence of spontaneous closure. We aimed to determine the adherence to guidelines, rate of urgent surgical repair, outcomes, cost, and interinstitutional referral patterns of UH repair in the province of Quebec (Canada). METHODS This was a population-based retrospective cohort study of children 28 days to 17 years old who underwent UH repair between 2010 and 2020 using health administrative databases. Children who had multiple procedures, or prolonged peri-operative stays were excluded. Early repair was defined as elective surgery at or under age 3. RESULTS Of the 3215 children, 1744 (54.2%) were female, and 1872 (58.2%) were treated in a tertiary children's hospital. Guidelines were respected for 2853 out of 3215 children (89.7%). Patients living over 75 km from their treating hospitals (OR 2.36, 95% CI 1.33-4.16, P < 0.01), with pre-existing comorbidities (OR, 2.82; 95% CI, 1.96-4.05; P < 0.001), or being treated in a tertiary center (OR 2.10, 95% CI 1.45-3.03, P < 0.001) had a higher risk of early repair. Repair at or under age 3 and urgent surgery were associated with significant cost increases of 411$ (P < 0.001) and 558$ (P < 0.001), respectively. CONCLUSION Quebec has a high rate of adherence to age-specific guidelines for UH repair. Future research should explore factors that explain transfers into tertiary centers, and the extent to which these reflect efficient use of resources. LEVEL OF EVIDENCE level III. TYPE OF STUDY Retrospective comparative study.
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Affiliation(s)
- Shadi Hadj-Youssef
- School of Medicine, Faculty of Medicine and Health Sciences, McGill University, 3605 Rue de la Montagne, Montréal, QC, Canada
| | - Félix Rondeau
- Department of Economics, Université Laval, Pavillon Charles-De Koninck, 1030 Av. des Sciences Humaines, Québec, QC, Canada
| | - Kossi Thomas Golo
- Ministère de la santé et des services sociaux (MSSS), 1075, chemin Sainte-Foy, Québec City, QC, Canada
| | - Nizar Ghali
- Ministère de la santé et des services sociaux (MSSS), 1075, chemin Sainte-Foy, Québec City, QC, Canada
| | - Maude Laberge
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Ferdinand Vandry Pavillon, 1050 Av. de la Médecine, Québec City, QC, Canada; Vitam, Centre de recherche en santé durable-Université Laval, Québec, QC, Canada; Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Patricia Li
- Division of General Pediatrics, Department of Pediatrics, McGill University Health Centre - Montreal Children's Hospital, 1001 Decarie Blvd, Montreal, QC, Canada
| | - Marc Beltempo
- Division of Neonatology, Department of Pediatrics, McGill University Health Centre - Montreal Children's Hospital, 1001 Decarie Blvd, Montreal, Quebec, Canada
| | - Guy Lacroix
- Department of Economics, Université Laval, Pavillon Charles-De Koninck, 1030 Av. des Sciences Humaines, Québec, QC, Canada
| | - Hussein Wissanji
- Harvey E. Beardmore Division of Pediatric Surgery, Department of Pediatric Surgery, McGill University Health Center, Montreal Children's Hospital, Canada.
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Jalalian A, Gallagher S, Mathur M, Cohen D. Umbilical Wall Hernia Rupture: A Torrential Case of Flood Syndrome. Am J Med 2024; 137:e83-e84. [PMID: 38395295 DOI: 10.1016/j.amjmed.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024]
Affiliation(s)
- Aria Jalalian
- Department of Internal Medicine, Lankenau Medical Center, Wynnewood, Pa.
| | | | - Malini Mathur
- Department of Gastroenterology, Lankenau Medical Center, Wynnewood, Pa
| | - David Cohen
- Department of Internal Medicine, Lankenau Medical Center, Wynnewood, Pa
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Grappolini N, Zanchetta M, Inversini D, Ietto G. Spontaneous bowel evisceration through umbilical hernia in an adult non-cirrhotic patient. BMJ Case Rep 2024; 17:e258602. [PMID: 38589238 PMCID: PMC11015293 DOI: 10.1136/bcr-2023-258602] [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] [Accepted: 03/16/2024] [Indexed: 04/10/2024] Open
Abstract
Few cases of spontaneous bowel evisceration (SBE) through umbilical hernias (UHs) in adult patients have been reported in the literature. Interestingly, the spontaneous rupture of the hernia sac is a rare complication usually seen in adult cirrhotic patients with persistent ascites or in patients with congenital wall defects. A man in his early 50s was admitted to our emergency department with SBE through a long-standing acquired UH. He was not clinically cirrhotic, although being HCV positive. Surgeons performed an urgent laparotomy with ileal resection, latero-lateral ileal anastomosis and direct hernioplasty without mesh. Given the rarity of this presentation, we reported it and reviewed the available literature on this subject. Elective hernioplasty is currently suggested to lower the risk of complications. Mesh placement should be preferred, but only if comorbidities and infectious risks do not contraindicate its use. In emergency situations, a direct hernia repair is preferred.
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Affiliation(s)
- Niccolo Grappolini
- General, Emergency and Transplant Surgery Department, University of Insubria, Varese, Italy
| | - Matteo Zanchetta
- General, Emergency and Transplant Surgery Department, University of Insubria, Varese, Italy
| | - Davide Inversini
- General, Emergency and Transplant Surgery Department, University of Insubria, Varese, Italy
- Department of Medicine and Innovation Technology, University of Insubria, Varese, Italy
| | - Giuseppe Ietto
- General, Emergency and Transplant Surgery Department, University of Insubria, Varese, Italy
- Department of Medicine and Innovation Technology, University of Insubria, Varese, Italy
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Puntigam L, Imdahl A. [Umbilical hernias - early indication for surgery]. MMW Fortschr Med 2024; 166:50-51. [PMID: 38637393 DOI: 10.1007/s15006-024-3738-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Affiliation(s)
- Lisa Puntigam
- Klinik für Viszeral-, Thorax- und Gefäßchirurgie, Klinikum Heidenheim, Klinikum Heidenheim, Schloßhaustraße 100, 89522, Heidenheim an der Brenz, Deutschland
| | - Andreas Imdahl
- Klinik für Viszeral- Thorax- und Gefäßchirurgie, Klinikum Heidenheim, Schloßhausstr. 100, 89520, Heidenheim, Deutschland
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Gil LA, Asti L, Nishimura L, Banks AR, Woodard J, Islam S, Forrest CB, Acker SN, Berman L, Allukian M, Rymeski B, Greenberg S, Kelleher K, Minneci PC. Assessing Alternative Approaches for Wound Closure in a National Pediatric Learning Health System. J Surg Res 2024; 295:783-790. [PMID: 38157730 DOI: 10.1016/j.jss.2023.11.068] [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: 05/17/2023] [Revised: 08/17/2023] [Accepted: 11/12/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Our objective was to perform a feasibility study using real-world data from a learning health system (LHS) to describe current practice patterns of wound closure and explore differences in outcomes associated with the use of tissue adhesives and other methods of wound closure in the pediatric surgical population to inform a potentially large study. METHODS A multi-institutional cross-sectional study was performed of a random sample of patients <18 y-old who underwent laparoscopic appendectomy, open or laparoscopic inguinal hernia repair, umbilical hernia repair, or repair of traumatic laceration from January 1, 2019, to December 31, 2019. Sociodemographic and operative characteristics were obtained from 6 PEDSnet (a national pediatric LHS) children's hospitals and OneFlorida Clinical Research Consortium (a PCORnet collaboration across 14 academic health systems). Additional clinical data elements were collected via chart review. RESULTS Of the 692 patients included, 182 (26.3%) had appendectomies, 155 (22.4%) inguinal hernia repairs, 163 (23.6%) umbilical hernia repairs, and 192 (27.8%) traumatic lacerations. Of the 500 surgical incisions, sutures with tissue adhesives were the most frequently used (n = 211, 42.2%), followed by sutures with adhesive strips (n = 176, 35.2%), and sutures only (n = 72, 14.4%). Most traumatic lacerations were repaired with sutures only (n = 127, 64.5%). The overall wound-related complication rate was 3.0% and resumption of normal activities was recommended at a median of 14 d (interquartile ranges 14-14). CONCLUSIONS The LHS represents an efficient tool to identify cohorts of pediatric surgical patients to perform comparative effectiveness research using real-world data to support medical and surgical products/devices in children.
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Affiliation(s)
- Lindsay A Gil
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Lindsey Asti
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio
| | - Leah Nishimura
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio
| | - Ashley R Banks
- Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio
| | - Jennifer Woodard
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Saleem Islam
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida
| | - Christopher B Forrest
- Center for Applied Clinical Research, Research Institute at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Shannon N Acker
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Loren Berman
- Division of Pediatric Surgery, Department of Surgery Nemours Children's Health, Wilmington, Delaware; Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Myron Allukian
- Division of Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Beth Rymeski
- Division of Pediatric Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Sarah Greenberg
- Division of Pediatric General and Thoracic Surgery, Department of Surgery, University of Washington, Seattle, Washington
| | - Kelly Kelleher
- Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio
| | - Peter C Minneci
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio; Division of Pediatric Surgery, Department of Surgery Nemours Children's Health, Wilmington, Delaware; Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.
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7
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Shrestha BB, Lamichhane A, Pokhrel RC, Parajuli P, Goyal P. Incarcerated Littre's Umbilical Hernia: A Case Report. JNMA J Nepal Med Assoc 2024; 62:139-141. [PMID: 38409995 PMCID: PMC10924516 DOI: 10.31729/jnma.8443] [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: 01/24/2024] [Indexed: 02/28/2024] Open
Abstract
Littre's hernia is an extremely rare type of hernia which has Meckel's diverticulum as its content. A 63-year-old male, presented to the emergency department with chief complaints of swelling and pain around the umbilicus. The patient was diagnosed with an incarcerated umbilical hernia. Following the emergency laparotomy, the intraoperative finding depicted an umbilical Littre's hernia. The patient underwent open Meckel's diverticulectomy with mesh repair. Preoperative diagnosis of Littre's hernia is unlikely due to its low incidence and lack of specific radiological and clinical findings, but the role of computed tomography scan and ultrasound are important in differentiating between strangulated or incarcerated bowel and omentum and in guiding the urgency of operative management. Keywords case reports; hernia; Meckel diverticulum.
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Affiliation(s)
- Binod Bade Shrestha
- Department of Surgery, Manipal College of Medical Sciences, Pokhara, Kaski, Nepal
| | | | | | | | - Prince Goyal
- Manipal College of Medical Sciences, Pokhara, Kaski, Nepal
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8
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Wang Y, Li M, Wang Z, Liu W. Use of Bilateral Rectus Sheath Blocks in Open Umbilical Hernia Repair. Pain Physician 2024; 27:E239-E244. [PMID: 38324789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND In recent years, the rectus sheath block (RSB) has become increasingly prevalent in laparoscopic surgery. However, there is currently no definitive research on its use in the open repair of umbilical hernias with cirrhotic ascites. OBJECTIVE In this study, we assessed the safety and clinical efficacy of ultrasound-guided (US-guided) bilateral RSBs in open umbilical hernia repair for patients diagnosed with cirrhotic ascites. STUDY DESIGN Seventy-two patients diagnosed with umbilical hernias that presented with cirrhotic ascites and who were admitted to our hospital were randomly divided into 2 groups. These categories were labeled the RSB group (Group R) and the local infiltration group (Group L); we used US-guided RSBs in Group R and local infiltration in Group L. SETTING The clinical outcomes of the patients in each group were compared to one another. Heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were recorded at various time points in both groups. METHODS Measurements of the patients' outcomes were taken before anesthesia (T0), at the beginning of surgery (T1), at the time of the separation of the hernia sac (T2), at the end of surgery (T3), 6 hours postoperatively (T4), and 24 hours postoperatively (T5). On the Visual Analog Scale (VAS), pain scores at rest (T1-T3) and during activity (T4-T5) were recorded, as were the incidence of perioperative remedial analgesia and adverse effects. RESULTS Compared to T0, both groups' HR was significantly higher at T1-T3 (P < 0.05). The SBP and DBP were also significantly higher (P < 0.05). At T1-T3, the HR of Group R was significantly slower than that of Group L (P < 0.05), and at T4-T5, the VAS score for activity in Group R was significantly lower than that of Group L (P < 0.05). Group R had a significantly lower incidence of intraoperative remedial analgesia and postoperative nausea and vomiting than did Group L (P < 0.05). Neither group required postoperative remedial analgesia, and no patient experienced adverse reactions during the perioperative period. LIMITATIONS This study has limitations in its sample size, lack of blood ammonia levels, and absence of data on patient satisfaction, necessitating future studies to address these issues. CONCLUSION US-guided RSBs are an efficient method of anesthesia for open umbilical hernia repair in patients diagnosed with cirrhosis. This technique not only provides precise anesthesia and appropriate analgesia but also results in a low incidence of postoperative nausea and vomiting.
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Affiliation(s)
- Yuanyuan Wang
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China
| | - Mingying Li
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China
| | - Zhenyuan Wang
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China
| | - Wei Liu
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China
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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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Liang C, Zheng R, Liu X, Ma Q, Chen J, Shen Y. Predictive value of hematological parameters in cirrhotic patients with open umbilical hernia repair. Hernia 2024; 28:119-126. [PMID: 37848581 DOI: 10.1007/s10029-023-02908-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/01/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE Patients with liver cirrhosis sometimes suffer from high recurrence rates and postoperative complications. We previously reported that platelet-related hematological parameters are associated with the outcomes after incisional herniorrhaphy, and aim to evaluate the predictive value of these criteria in cirrhotic patients undergoing open umbilical herniorrhaphy. METHODS This is a retrospective study. The data of 95 cirrhotic patients undergoing open umbilical herniorrhaphy were analyzed. Patients were grouped based on the recurrence and defined hematological values. Platelet-multiple-lymphocyte index (PLM), neutrophil-leukocyte ratio, lymphocyte-monocyte ratio, platelet-neutrophil ratio, systemic immune-inflammation index, and aspartate aminotransferase-leukocyte ratio values were calculated based on preoperative blood analyses. The outcomes were obtained from hospital records and follow-up calls to patients. RESULTS Using cutoff values acquired by the Youden Index, we found a PLM value < 27.9, and the history of inguinal herniorrhaphy were revealed to be statistically significant in the recurrence based on univariant and multivariant analyses (p < 0.05). We further divided patients into two groups based on the cutoff value of PLM and found that a PLM value < 27.9 was significantly associated with the recurrence of incisional hernias (p = 0.018) and the occurrence of postoperative foreign sensation (p = 0.044), and tended to result in other postoperative complications such as cardiopathy, respiratory infection, hypoproteinemia, and hepatic diseases (p = 0.089). CONCLUSION The preoperative hematological values, especially PLM, may indicate the outcomes in cirrhotic patients after open umbilical herniorrhaphy. Accurate identification of risks may alert the intraoperative and postoperative care for patients.
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Affiliation(s)
- C Liang
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, No. 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - R Zheng
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, No. 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - X Liu
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, No. 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Q Ma
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, No. 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - J Chen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, No. 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
- Department of Hernia and Abdominal Wall Surgery, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Y Shen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, No. 5 JingYuan Road, Shijingshan District, Beijing, 100043, China.
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Marckmann M, Krarup PM, Henriksen NA, Christoffersen MW, Jensen KK. Enhanced recovery after robotic ventral hernia repair: factors associated with overnight stay in hospital. Hernia 2024; 28:223-231. [PMID: 37668820 PMCID: PMC10891254 DOI: 10.1007/s10029-023-02871-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/19/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE Enhanced recovery after surgery (ERAS) protocols lead to reduced post-operative stay and improved outcomes after most types of abdominal surgery. Little is known about the optimal post-operative protocol after robotic ventral hernia repair (RVHR), including the potential limits of outpatient surgery. We report the results of an ERAS protocol after RVHR aiming to identify factors associated with overnight stay in hospital, as well as patient-reported pain levels in the immediate post-operative period. METHODS This was a prospective cohort study of consecutive patients undergoing RVHR. Patients were included in a prospective database, registering patient characteristics, operative details, pain and fatigue during the first 3 post-operative days and pre- and 30-day post-operative hernia-related quality of life, using the EuraHS questionnaire. RESULTS A total of 109 patients were included, of which 66 (61%) underwent incisional hernia repair. The most performed procedure was TARUP (robotic transabdominal retromuscular umbilical prosthetic hernia repair) (60.6%) followed by bilateral roboTAR (robotic transversus abdominis release) (19.3%). The mean horizontal fascial defect was 4.8 cm, and the mean duration of surgery was 141 min. In total, 78 (71.6%) patients were discharged on the day of surgery, and factors associated with overnight stay were increasing fascial defect area, longer duration of surgery, and transverse abdominis release. There was no association between post-operative pain and overnight hospital stay. The mean EuraHS score decreased significantly from 38.4 to 6.4 (P < 0.001). CONCLUSION An ERAS protocol after RVHR was associated with a high rate of outpatient procedures with low patient-reported pain levels.
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Affiliation(s)
- M Marckmann
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark.
| | - P-M Krarup
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark
| | - N A Henriksen
- Department of hepatic and gastrointestinal diseases, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - M W Christoffersen
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark
| | - K K Jensen
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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12
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Pini R, Mongelli F, Iaquinandi F, Gaffuri P, Previsdomini M, Cianfarani A, La Regina D. Switching from robotic-assisted extended transabdominal preperitoneal (eTAPP) to totally extraperitoneal (eTEP) hernia repair for umbilical and epigastric hernias. Sci Rep 2024; 14:1800. [PMID: 38245577 PMCID: PMC10799892 DOI: 10.1038/s41598-024-52165-6] [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: 05/24/2023] [Accepted: 01/15/2024] [Indexed: 01/22/2024] Open
Abstract
Our study aimed to assess the safety and effectiveness of the robotic-assisted extended totally extraperitoneal (eTEP) repair compared to transabdominal preperitoneal (eTAPP) repair with a suprapubic trocar insertion to treat umbilical and epigastric hernias. On a prospectively maintained database, we identified patients who underwent either eTEP or eTAPP for treating umbilical and epigastric hernias. During the study period, 53 patients were included, 32 in the eTEP group and 21 in the eTAPP group. The mean age was 59.0 ± 13.9 years, 45 patients (84.9%) were male, and the mean BMI was 28.0 ± 5.9 kg/m2. Most hernias were umbilical (81.1%) and primary (83.0%). The operative time for eTEP was slightly shorter than for eTAPP (106 ± 43 min vs. 126 ± 74 min, p = 0.232). Postoperatively, only one case of bleeding and one seroma were recorded. No complication occurred during a mean follow-up of 11.3 ± 6.4 months in the eTEP group and 20.5 ± 9.7 months in the eTAPP group. In conclusion, our study showed that the eTEP with suprapubic approach was safe and feasible in the treatment of epigastric and umbilical hernias. According to our experience, shorter operative time, integrity of the posterior layers and increased overlap size are the main surgical reasons of switching from eTAPP to eTEP.
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Affiliation(s)
- Ramon Pini
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Via Gallino 12, 6500, Bellinzona, Switzerland
| | - Francesco Mongelli
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Via Gallino 12, 6500, Bellinzona, Switzerland.
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, 6500, Lugano, Switzerland.
| | - Fabiano Iaquinandi
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Via Gallino 12, 6500, Bellinzona, Switzerland
| | - Paolo Gaffuri
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Via Gallino 12, 6500, Bellinzona, Switzerland
| | - Marco Previsdomini
- Intensive Care Unit, Bellinzona e Valli Regional Hospital, EOC, 6500, Bellinzona, Switzerland
| | - Agnese Cianfarani
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Via Gallino 12, 6500, Bellinzona, Switzerland
| | - Davide La Regina
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Via Gallino 12, 6500, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, 6500, Lugano, Switzerland
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13
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Medeiros GA, Gualberto IJN, da Silva CHND, Diniz AMB, de Santana JBF, Volpe FP, Gadde R, Mazzo A, de Oliveira RC, Sbragia L. Development of a low-cost congenital abdominal wall defect simulator (wall-go) for undergraduate medical education: a validation study. BMC Med Educ 2023; 23:966. [PMID: 38102605 PMCID: PMC10724958 DOI: 10.1186/s12909-023-04929-3] [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] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Congenital Anomalies were responsible for 303,000 deaths in the neonatal period, according to the WHO, they are among the world's top 20 causes of morbidity and mortality. Expensive simulators demonstrate several diseases, but few are related to congenital anomalies. This study aims to develop, validate, and evaluate low-cost simulator models (WALL-GO) of the most common abdominal wall defects, gastroschisis, and omphalocele, to enable diagnosis through an accessible tool with study value and amenable to replication. METHODS Market research was conducted to find materials to build low-cost models. The researchers built the model and underwent validation assessment of the selected experts who scored five or more in the adapted Fehring criteria. The experts were assessed through a 5-point Likert scale to 7 statements (S1-7). Statements were assigned values according to relevance in face and transfer validities. Concomitantly, the model was also evaluated by students from 1st to 5th year with the same instruments. Content Validity Indexes (CVIs) were considered validated between groups with concordance greater than 90%. Text feedback was also collected. Each statement was subjected to Fisher's Exact Test. RESULTS Gastroschisis and omphalocele model costs were US $15 and US $27, respectively. In total, there were 105 simulator evaluators. 15 experts were selected. Of the 90 students, there were 16 (1st year), 22 (2nd), 16 (3rd), 22 (4th), and 14 (5th). Students and experts obtained CVI = 96.4% and 94.6%, respectively. The CVIs of each statement were not significantly different between groups (p < 0,05). CONCLUSIONS The WALL-GO models are suitable for use and replicable at a manufacturable low cost. Mannequins with abdominal wall defects are helpful in learning to diagnose and can be applied in teaching and training health professionals in developing and low-income countries.
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Affiliation(s)
- Gabriel Araújo Medeiros
- Bauru Medical School, Department of Pediatric Dentistry, Orthodontics, and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru, Sao Paulo, Brazil
| | - Igor José Nogueira Gualberto
- Bauru Medical School, Department of Pediatric Dentistry, Orthodontics, and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru, Sao Paulo, Brazil
| | | | - Ana Maria Bicudo Diniz
- Division of Pediatric Surgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Av Bandeirantes 3900, 10th floor, Ribeirão Preto, São Paulo, SP, Brazil
| | | | - Fábio Perecin Volpe
- Division of Pediatric Surgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Av Bandeirantes 3900, 10th floor, Ribeirão Preto, São Paulo, SP, Brazil
| | - Rahul Gadde
- Division of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Alessandra Mazzo
- Bauru Medical School, Department of Pediatric Dentistry, Orthodontics, and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru, Sao Paulo, Brazil
| | - Rodrigo Cardoso de Oliveira
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Sao Paulo, Brazil
| | - Lourenço Sbragia
- Division of Pediatric Surgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Av Bandeirantes 3900, 10th floor, Ribeirão Preto, São Paulo, SP, Brazil.
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14
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Huerta S. Letter re: Elective Hernia Repair in Obese Patients. Am Surg 2023; 89:6438-6439. [PMID: 34823404 DOI: 10.1177/00031348211058638] [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] [Indexed: 11/16/2022]
Abstract
NA this is a Letter to the Editor.
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Affiliation(s)
- Sergio Huerta
- Department of Surgery, VA North Texas Health Care System, University of Texas Southwestern Medical Center, Dallas, TX, USA
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15
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Brindle ME. Influences on the timing of pediatric umbilical hernia repair in the era of choosing wisely. Surgery 2023; 174:1290-1291. [PMID: 37696724 DOI: 10.1016/j.surg.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 08/08/2023] [Indexed: 09/13/2023]
Affiliation(s)
- Mary E Brindle
- Cumming School of Medicine University of Calgary, Pediatric General Surgeon, Alberta Children's Hospital, Calgary, Alberta, Canada; Director of Safe Surgery Systems at Ariadne Labs, Brigham and Women's Hospital, Harvard TH Chan School of Public Health, Boston, MA.
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16
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Torabi J, Florman S, Divino C. Leaking Umbilical Hernias in Cirrhotic Patients, Repair or Observe? Am Surg 2023; 89:5365-5371. [PMID: 36571828 DOI: 10.1177/00031348221148362] [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] [Indexed: 12/22/2023]
Abstract
BACKGROUND Umbilical hernias (UHs) in cirrhotic patients are common, can be quite complicated and are associated with significant morbidity and mortality. Leakage of ascites is a challenging entity and poses significant risks. METHODS This is a retrospective study of patients with cirrhosis and UHs with ascitic leakage. Patients were divided into two groups: patients managed operatively during index admission (Group 1) and those managed non-surgically during index admission (Group 2). Group 2 was further divided into those that subsequently underwent repair of UH and those managed medically. RESULTS Of 47 cirrhotic patients with leaking UHs, 19 patients were managed surgically during index admission (Group 1). In Group 2, 15 patients were managed non-surgically and 13 subsequently underwent surgery. The groups had comparable demographics, MELD-Na and Child-Pugh class. Group 2 had a higher rate of emergency surgery (92% vs 58%, P = .04) and higher rate of recurrence (31 vs. 0%, P = .02). The non-surgical patients in Group 2 had higher 1-year mortality (67%) compared to Group 1 (21%) and surgical patients in Group 2 (31%, P = .007). Multi-variable logistic regression for 1-year mortality demonstrated MELD-Na as the most significant risk factor (OR = 1.2, P = .05) and undergoing UH repair as the most significant protective factor (OR = .16, P = .02). CONCLUSIONS Cirrhotic patients with leaking UHs should undergo urgent repair. Non-operative management confers high risk of continued or increased ascitic leakage necessitating more emergent surgery. Despite high rate of post-operative complications related to cirrhosis, there is a clear mortality benefit to the repair of leaking UHs in cirrhotic patients.
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Affiliation(s)
- Julia Torabi
- Division of General Surgery, Mount Sinai Hospital, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sander Florman
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Hospital, Recanati/Miller Transplantation Institute, New York, NY, USA
| | - Celia Divino
- Division of General Surgery, Mount Sinai Hospital, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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17
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Benítez TM, Kim YJ, Kong L, Wang L, Chung KC. Impact of consensus guideline publication on the timing of elective pediatric umbilical hernia repair. Surgery 2023; 174:1281-1289. [PMID: 37586892 DOI: 10.1016/j.surg.2023.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/10/2023] [Accepted: 07/18/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND The American Academy of Pediatrics published consensus guidelines advising observation of asymptomatic umbilical hernias until age 4 or 5, given unnecessary risks of early intervention and substantial practice variation. Yet, the impact of guidelines on early repair (age <4) or if certain groups remain at risk for avoidable intervention is unclear. METHODS This retrospective study used data from children's hospitals participating in the Pediatric Health Information System database. Children aged 17 years and younger who underwent umbilical hernia repair from July 2017 to August 2022 were eligible for inclusion. Children with recurrent hernias, an emergency, or urgent presentation were excluded. An interrupted time series using segmented multivariable logistic regression estimated the association of guideline publication in November 2019 with the odds of guideline-adherent repair (age ≥4) after adjusting for sociodemographic characteristics and hospital-level random effects. RESULTS 16,544 children underwent repair, of which 3,115 (18.8%) were children <4 years old. After adjustment, guideline publication was associated with an immediate increase in guideline-adherent repairs (odds ratio = 1.25 95% confidence interval = 1.05-1.49). The interrupted time series found that each month after publication was associated with a 2% increase in the odds of guideline-adherent repair (odds ratio = 1.02, 95% confidence interval = 1.01-1.03). Children with public insurance were nearly 20% less likely to receive guideline-adherent repair than privately insured children (odds ratio = 0.82, 95% confidence interval = 0.74-0.91). Children in the Midwest had lower odds of guideline-adherent repair (Midwest versus Northeast: odds ratio = 0.45. 95% confidence interval = 0.24-0.84). CONCLUSION Guideline publication was associated with greater odds of guideline-adherent repair, yet public insurance coverage and Midwest location remain significant predictors of early repair against recommendations.
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Affiliation(s)
- Trista M Benítez
- University of Michigan Medical School, Ann Arbor, MI; Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI. https://www.twitter.com/benitez_trista
| | - You J Kim
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI; Rush University Medical College, Chicago, IL. https://www.twitter.com/kim_youj
| | - Lingxuan Kong
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI
| | - Lu Wang
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI
| | - Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI.
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18
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Takahashi T, Saiki H, Sato A, Nakano S, Sato Y, Koizumi J, Akasaka M. Abnormal inferior vena cava course mimicking inferior vena cava interruption with azygos continuation in the postoperative patient with omphalocele. J Echocardiogr 2023; 21:179-180. [PMID: 36129632 DOI: 10.1007/s12574-022-00589-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 08/24/2022] [Accepted: 09/13/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Takuya Takahashi
- Department of Pediatrics, Iwate Medical University, 1-1-1 Idaidori, Yahaba, Shiwa, Iwate, 028-3694, Japan
| | - Hirofumi Saiki
- Department of Pediatrics, Iwate Medical University, 1-1-1 Idaidori, Yahaba, Shiwa, Iwate, 028-3694, Japan.
| | - Akira Sato
- Department of Pediatrics, Iwate Medical University, 1-1-1 Idaidori, Yahaba, Shiwa, Iwate, 028-3694, Japan
| | - Satoshi Nakano
- Department of Pediatrics, Iwate Medical University, 1-1-1 Idaidori, Yahaba, Shiwa, Iwate, 028-3694, Japan
| | - Yumi Sato
- Department of Pediatrics, Iwate Medical University, 1-1-1 Idaidori, Yahaba, Shiwa, Iwate, 028-3694, Japan
| | - Junichi Koizumi
- Department of Cardiovascular Surgery, Iwate Medical University, 1-1-1 Idaidori, Yahaba, Shiwa, Iwate, 028-3694, Japan
| | - Manami Akasaka
- Department of Pediatrics, Iwate Medical University, 1-1-1 Idaidori, Yahaba, Shiwa, Iwate, 028-3694, Japan
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Rombaldi MC, Barreto CG, Feldens L, Holanda F, Takamatu EE, Schopf L, Peterson CAH, Costa EC, Cavazzola LT, Isolan P, Fraga JC. Giant omphalocele: A novel approach for primary repair in the neonatal period using botulinum toxin. Rev Col Bras Cir 2023; 50:e20233582. [PMID: 37991062 PMCID: PMC10644868 DOI: 10.1590/0100-6991e-20233582-en] [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: 05/02/2023] [Accepted: 08/02/2023] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION Giant omphalocele (GO) is a complex condition for which many surgical treatments have been developed; however, no consensus on its treatment has been reached. The benefits and efficacy of botulinum toxin A (BTA) in the repair of large abdominal wall defects in adults has been proven, and its reported use in children has recently grown. The goal of this study is to describe a novel technique for primary repair of GO using BTA during the neonatal period and report our initial experience. METHODS patients were followed from August 2020 to July 2022. BTA was applied to the lateral abdominal wall in the first days of life followed by surgical repair of the abdominal defect. RESULTS while awaiting surgery, patients had minimal manipulation, without requiring mechanical ventilation, were on full enteral feeding, and in contact with their parents. The midline was approximated without tension and without the need for additional techniques or the use of a prosthesis. Patients were discharged with repaired defects. CONCLUSION this approach represents a middle ground between staged and the nonoperative delayed repairs. It does not require aggressive interventions early in life, allowing maintenance of mother-child bonding and discharge of the patient with a repaired defect without the need for additional techniques or the use of a prosthesis. We believe that this technique should be considered as a new possible asset when managing this complex condition.
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Affiliation(s)
- Marcelo Costamilan Rombaldi
- - Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Medicina: Ciências Cirúrgicas - Porto Alegre - RS - Brasil
- - Hospital de Clínicas de Porto Alegre, Departamento de Cirurgia Pediátrica - Porto Alegre - RS - Brasil
| | - Caroline Gargioni Barreto
- - Hospital de Clínicas de Porto Alegre, Departamento de Cirurgia Pediátrica - Porto Alegre - RS - Brasil
| | - Letícia Feldens
- - Hospital de Clínicas de Porto Alegre, Departamento de Cirurgia Pediátrica - Porto Alegre - RS - Brasil
| | - Felipe Holanda
- - Hospital de Clínicas de Porto Alegre, Departamento de Cirurgia Pediátrica - Porto Alegre - RS - Brasil
| | - Eliziane Emy Takamatu
- - Hospital de Clínicas de Porto Alegre, Departamento de Cirurgia Pediátrica - Porto Alegre - RS - Brasil
| | - Luciano Schopf
- - Hospital de Clínicas de Porto Alegre, Departamento de Cirurgia Pediátrica - Porto Alegre - RS - Brasil
| | | | - Eduardo Corrêa Costa
- - Hospital de Clínicas de Porto Alegre, Departamento de Cirurgia Pediátrica - Porto Alegre - RS - Brasil
| | - Leandro Totti Cavazzola
- - Hospital de Clínicas de Porto Alegre, Departamento de Cirurgia Geral - Porto Alegre - RS - Brasil
- - Universidade Federal do Rio Grande do Sul, Departamento de Cirurgia - Porto Alegre - RS - Brasil
| | - Paola Isolan
- - Hospital de Clínicas de Porto Alegre, Departamento de Cirurgia Pediátrica - Porto Alegre - RS - Brasil
- - Universidade Federal do Rio Grande do Sul, Departamento de Cirurgia - Porto Alegre - RS - Brasil
| | - José Carlos Fraga
- - Hospital de Clínicas de Porto Alegre, Departamento de Cirurgia Pediátrica - Porto Alegre - RS - Brasil
- - Universidade Federal do Rio Grande do Sul, Departamento de Cirurgia - Porto Alegre - RS - Brasil
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Broomfield M, Agabani Z, Guadagno E, Poenaru D, Baird R. The evidence mismatch in pediatric surgical practice. Pediatr Surg Int 2023; 39:295. [PMID: 37978994 DOI: 10.1007/s00383-023-05569-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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/15/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE Outpatient pediatric surgical practice often involves conditions of limited morbidity but significant parental concern. We explore existing evidence-based management recommendations and the mismatch with practice patterns for four common outpatient pediatric surgical conditions. METHODS Using the Cochrane Rapid Review Group recommendations and librarian oversight, we conducted a rapid review of four outpatient surgical conditions: dermoid cysts, epigastric hernias, hydroceles, and umbilical hernias. We extracted patient demographics, intervention details, outcome measures and evaluated justifications presented for chosen management options. A metric of evidence volume (patient/publication ratio) was generated and compared between diagnoses. RESULTS Out of 831 articles published since 1990, we identified 49 cohort studies (10-dermoid cyst, 6-epigastric hernia, 25-hydrocele, and 8-umbilical hernia). The 49 publications included 34,172 patients treated across 18 countries. The evidence volume for each outpatient condition demonstrates < 1 cohort/condition/year. The evidence mismatch rate varied between 33 and 75%; many existing recommendations are not evidence-based, sometimes conflicting and frequently misrepresentative of clinical practice. CONCLUSIONS Published literature concerning common outpatient pediatric surgical conditions is sparse and demonstrates wide variations in practice. All individual practice choices were justified using either risk of complications or patient preference. Most early intervention practices were based on weak or outdated studies and "common wisdom" rather than genuine evidence. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Marina Broomfield
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Zena Agabani
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada
- University of Toronto, Toronto, ON, Canada
| | - Elena Guadagno
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada
| | - Dan Poenaru
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Robert Baird
- Division of Pediatric Surgery, BC Children's Hospital, 4480 Oak Street, Vancouver, Canada.
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Menchaca AD, Style CC, Chawla M, Kenney BD, Diefenbach KA, Olutoye OO. Giant Omphaloceles-Morbidity, Mortality, and Financial Impact of Early Versus Delayed Repair. J Surg Res 2023; 291:342-351. [PMID: 37506434 DOI: 10.1016/j.jss.2023.06.022] [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: 11/10/2022] [Revised: 05/31/2023] [Accepted: 06/20/2023] [Indexed: 07/30/2023]
Abstract
INTRODUCTION We compared strategy outcomes and financial impact over the first two years of life (F2YOL) for patients with giant omphaloceles undergoing early repair (ER) (primary or staged) versus delayed repair (DR). METHODS A retrospective review of giant omphaloceles (fascial defect > 5 cm/> 50% liver herniation) at a tertiary children's hospital between 1/1/2010 and 12/31/2019 was performed. Survival, length of stay, age at repair, ventilation days (VD), time to full enteral feeds, readmissions during the F2YOL, incidence of major associated anomalies, and total hospitalization charges during the F2YOL were compared. A subanalysis removing potential confounders and only including patients who underwent fascial closure within the F2YOL was also conducted. RESULTS Thirty four giant omphaloceles (23DR and 11ER) were identified. The median age (days) at repair was 289 [148, 399] DR versus 10 [5, 21] ER, P < 0.001. Total cohort two-year survival was significantly higher in the DR group (95.7% versus 63.6%, P = 0.03). Including patients with a tracheostomy there was no significant difference in VD during the index hospitalization. Excluding tracheostomy patients, the DR group had significantly fewer VD during the index hospitalization, 15 [0, 15] versus 18 [10, 54], P = 0.02 and over the F2YOL 6.5 [ 0, 21] versus 18 [14, 43], P = 0.03. There were no significant differences in the incidence/type of major associated anomalies, time to full enteral feeds, index length of stay, total hospital days, total admissions, or associated hospital charges. On subanalysis, there was no significant difference in VD or survival at any time. CONCLUSIONS Delayed and early repair strategies for giant omphaloceles have equivalent outcomes in the index hospitalization and over the course of the first two years of life. These findings are useful for family counseling and expectation setting.
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Affiliation(s)
- Alicia D Menchaca
- Center for Regenerative Medicine, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; Department of General Surgery, Indiana University, Indianapolis, Indiana
| | - Candace C Style
- Center for Regenerative Medicine, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio
| | - Mehak Chawla
- Center for Regenerative Medicine, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; The Ohio State University College of Medicine, Columbus, Ohio
| | - Brian D Kenney
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio; Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio
| | - Karen A Diefenbach
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio; Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio
| | - Oluyinka O Olutoye
- Center for Regenerative Medicine, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio; Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio.
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22
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Men G, Wang L, Lu X. Surgery cannot change the outcomes of all infants with omphalocele. Asian J Surg 2023; 46:5267. [PMID: 37474380 DOI: 10.1016/j.asjsur.2023.07.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 07/09/2023] [Indexed: 07/22/2023] Open
Affiliation(s)
- Guangguo Men
- Department of Neonatology, Ningbo Women and Children's Hospital, Ningbo, Zhejiang, China.
| | - Lili Wang
- Department of Neonatology, Traditional Chinese Medicine Hospital of Dong'e, Shandong, 252201, China
| | - Xudan Lu
- Department of Neonatology, Ningbo Women and Children's Hospital, Ningbo, Zhejiang, China
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23
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Li XT, Lin MZ, Chen HD, Chen M. Incarcerated umbilical hernia in a patient with cirrhotic ascites in combination with chronic lymphocytic leukemia: a case report. J Int Med Res 2023; 51:3000605231208574. [PMID: 37933975 PMCID: PMC10631368 DOI: 10.1177/03000605231208574] [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: 03/21/2023] [Accepted: 10/02/2023] [Indexed: 11/08/2023] Open
Abstract
Umbilical hernia is a common type of extra-abdominal hernia in adults. However, chronic granulocytic leukemia in combination with cirrhotic ascites and renal insufficiency is less common. The patient reported here had both indications and contraindications for emergency surgery; therefore, the treatment options were subject to debate. We report the case of a man in his 60s who had a strangulated umbilical hernia, with overlying purple-colored infected and necrotic skin. The area was painful, but his bowel movements were normal. Patients underwent comprehensive conservative management, and remote follow-ups via telephone and video conferencing for a period of 60 days, during which the incarcerated contents of the hernia eventually retracted and his pain was relieved, such that there were no longer indications for emergency surgery. In addition, his skin infection disappeared and his quality of life improved, and therefore the treatment outcomes were good. Thus, we provide evidence that not all incarcerated umbilical hernias require emergency surgery, but may respond well to conservative treatment when the contents do not include intestinal loops or other critical organs.
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Affiliation(s)
- Xiao-Tian Li
- Department of Hepatobiliary Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Man-Zhou Lin
- Department of Hepatobiliary Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
- Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Huan-De Chen
- Department of Hepatobiliary Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Ming Chen
- Department of Hepatobiliary Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
- Guangdong Medical University, Zhanjiang, Guangdong, China
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24
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Bernhardt GA. Hernia Repair in Cirrhotic Patients with Ascites: How Can We Improve? World J Surg 2023; 47:2741-2742. [PMID: 37624420 DOI: 10.1007/s00268-023-07109-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 08/26/2023]
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25
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Li J, Ji Z. Comment to: "Onlay mesh repair for treatment of small umbilical hernias ≤ 2 cm in adults: a single-centre investigation". Hernia 2023; 27:1329-1330. [PMID: 37036540 DOI: 10.1007/s10029-023-02791-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 04/02/2023] [Indexed: 04/11/2023]
Affiliation(s)
- J Li
- Department of General Surgery, Affiliated Zhongda Hospital, Southeast University, Nanjing, 210009, China.
| | - Z Ji
- Department of General Surgery, Affiliated Zhongda Hospital, Southeast University, Nanjing, 210009, China
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26
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Frey S, Beauvais A, Soler M, Beck M, Dugué T, Pavis d'Escurac X, Dabrowski A, Jurczak F, Gillion JF. Suture versus open mesh repair for small umbilical hernia: Results of a propensity-matched cohort study. Surgery 2023; 174:593-601. [PMID: 37357098 DOI: 10.1016/j.surg.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 04/14/2023] [Accepted: 05/24/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND The objective was to compare the outcomes of open mesh repair versus suture repair for small (≤1 cm in diameter) umbilical hernia. The primary endpoint was the 30-day outcomes including pain, and secondary endpoints were the 2-year outcomes including recurrences and patient-reported outcomes. METHODS This propensity-matched, multicenter study was carried out on data collected prospectively in the Hernia-Club database between 2011 and 2021. A total of 590 mesh repairs and 590 suture repairs were propensity score matched (age, sex, body mass index) at a ratio of 1:1. Postoperative pain was assessed using the Verbal Rating Scale-4 and 0‒10 Numerical Rating Scale-11. RESULTS Mesh insertion was intraperitoneal in 331 patients (56.1%), extraperitoneal in 249 (42.2%), and onlay in 10 (1.7%). The rate of 30-day complications and Numerical Rating Scale-11 pain scores on postoperative days 8 and 30 were similar between the groups, including surgical site occurrences (2.2 vs 1.4% after suture repair). At 1 month, postoperative discomfort (sensation of something different from before) was significantly (P < .0001) more frequent after mesh repair, whereas the rate of relevant (moderate or severe) pain (mesh repair: 1.1% vs suture repair: 2.6%) and the distribution of Numerical Rating Scale-11 scores did not differ between the groups. At the 2-year follow-up, mesh repair patients had fewer reoperated recurrences (0.2% vs 1.7%; P = .035) and no more pain or discomfort than suture repair patients. CONCLUSION Both techniques are effective and safe. Mesh repair is likely to reduce the rate of recurrences. Concerns about postoperative pain and infection might not prevent the use of mesh in smallest umbilical hernias.
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Affiliation(s)
- Samuel Frey
- Nantes Université, CHU Nantes, Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, Nantes, France.
| | | | - Marc Soler
- Service de chirurgie viscérale et digestive, Clinique Saint-Jean, Cagnes-sur-Mer, France
| | | | - Timothée Dugué
- Service de chirurgie viscérale et digestive, Clinique Saint Pierre, Perpignan, France
| | | | - André Dabrowski
- Service de chirurgie viscérale et digestive, Clinique de Saint-Omer, Blendecques, France
| | - Florent Jurczak
- Service de chirurgie digestive et viscérale, Clinique Mutualiste de l'Estuaire, Saint-Nazaire, France
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27
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McCarty JC, Lorenzi-Mendez R, Fruge S, Hamaguchi R, Colwell AS. Does Concomitant Umbilical Hernia Repair Increase the Risk of Complications in Abdominoplasty? A Propensity Score Matched Analysis. Aesthet Surg J 2023; 43:986-993. [PMID: 37265092 DOI: 10.1093/asj/sjad174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/14/2023] [Accepted: 05/31/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Patients seeking cosmetic abdominoplasty often have umbilical hernias. Optimal management and safety of concomitant umbilical hernia repair with abdominoplasty is not well described. OBJECTIVES The goal of this study was to compare complication rates following abdominoplasty with or without umbilical hernia repair. METHODS A retrospective propensity score matched cohort study of patients who underwent an abdominoplasty at Massachusetts General Hospital was performed. Direct umbilical hernia repair was performed by making a fascial slit inferior or superior to the umbilical stalk. The fascial edges were approximated with up to three 0-Ethibond sutures (Ethicon, Raritan, NJ) from the preperitoneal or peritoneal space. Propensity score matching was used to adjust for confounding variables. RESULTS The authors identified 231 patients with a mean [standard deviation] age of 46.7 [9.7] years and a mean BMI of 25.9 [4.4] kg/m2. Nine (3.9%) had diabetes, 8 (3.5%) were active smokers, and the median number of previous pregnancies was 2. In total, 223 (96%) had a traditional abdominoplasty, whereas 8 (3.5%) underwent a fleur-de-lys approach. Liposuction was performed on 90%, and 45.4% underwent simultaneous breast or body contouring surgery. The overall complication rate was 6.9%. Propensity scores matched 61 pairs in each group (n = 122) with closely aligned covariates. There was no significant difference in total complication rates between abdominoplasty alone vs abdominoplasty with hernia repair. There were no cases of skin necrosis or umbilical necrosis in either group. CONCLUSIONS Performing umbilical hernia repair with abdominoplasty is safe when utilizing the technique reported in this series. LEVEL OF EVIDENCE: 3
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Penalver-Calero P, Vásquez-Caicedo ML, González-Nieto J, Astrain JEA, Montero JVM. Flood Syndrome: Endovascular management of spontaneous rupture of an umbilical hernia due to long-standing ascites - A case report. J Radiol Case Rep 2023; 17:29-37. [PMID: 38090640 PMCID: PMC10713232 DOI: 10.3941/jrcr.v17i8.4884] [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] [Indexed: 12/18/2023] Open
Abstract
Umbilical hernias are common in patients with cirrhosis of the liver and ascites; however, spontaneous rupture of the hernia is a rare complication. Flood Syndrome occurs very rarely in cirrhotic patients with massive ascites and refers to the spontaneous rupture of an umbilical hernia followed by leakage of ascites fluid. A literature search shows that patients have been managed both operatively and nonoperatively for this condition. We report a case of a 56-year-old man with a history of alcohol-related liver cirrhosis and massive ascites refractory to medical therapy with sudden and spontaneous perforation of his hernia leading to drainage of ascitic fluid from the abdomen. We performed a transjugular intrahepatic portosystematic shunt to relieve portal pressure and subsequent intraabdominal pressure. The patient had resolution of symptoms and the ascitic fluid outflow was resolved.
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29
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Barranquero AG, Villalobos Mori R, Maestre González Y, Protti GP, López Soler G, Villarreal León F, González Alfaro IJ, Olsina Kissler JJ. Parietex™ Composite Ventral Patch for primary and incisional hernia repair. ANZ J Surg 2023; 93:1799-1805. [PMID: 37231992 DOI: 10.1111/ans.18524] [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: 01/06/2023] [Revised: 04/24/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUNDS Ventral hernia repair with a preformed device is a frequent intervention, but few reports exist with Parietex™ Composite Ventral Patch. The aim was to evaluate the results of this mesh with the open intraperitoneal onlay mesh (open IPOM) technique. METHODS Observational retrospective single institution study of all consecutive patients intervened for ventral or incisional hernia with a diameter inferior to 4 cm, from January 2013 to June 2020. The surgical repair was performed according to the open IPOM technique with Parietex™ Composite Ventral Patch. RESULTS A total of 146 patients were intervened: 61.6% with umbilical hernias, 8.2% with epigastric hernias, 26.7% with trocar incisional hernias, and 3.4% with other incisional hernias. The global recurrence rate was 7.5% (11/146). Specifically, it was 7.8% in umbilical hernias, 0% in epigastric hernias, 7.7% in trocar incisional hernias and 20% (1/5) in other incisional hernias. The median time for recurrence was 14 months (IQR: 4.4-18.7). The median indirect follow-up was 36.9 months (IQR: 27.2-49.6), and the median presential follow-up was 17.4 months (IQR: 6.5-27.3). CONCLUSION The open IPOM technique with a preformed patch offered satisfactory results for the treatment of ventral and incisional hernias.
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Affiliation(s)
- Alberto G Barranquero
- Abdominal Wall Surgery Division, General and Digestive Surgery Department, Hospital Universitari, Arnau de Vilanova, Lleida, Spain
| | - Rafael Villalobos Mori
- Abdominal Wall Surgery Division, General and Digestive Surgery Department, Hospital Universitari, Arnau de Vilanova, Lleida, Spain
| | - Yolanda Maestre González
- Abdominal Wall Surgery Division, General and Digestive Surgery Department, Hospital Universitari, Arnau de Vilanova, Lleida, Spain
| | - Gian Pier Protti
- General and Digestive Surgery Department, Hospital Universitari, Germans Trias i Pujol, Badalona, Spain
| | - Guillermo López Soler
- General and Digestive Surgery Department, Hospital Universitari, Arnau de Vilanova, Lleida, Spain
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30
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Shahait A, Mesquita-Neto JWB, Weaver D, Mostafa G. Outcomes of umbilical hernia repair in cirrhotic veterans: a VASQIP study. Langenbecks Arch Surg 2023; 408:246. [PMID: 37358646 DOI: 10.1007/s00423-023-02984-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/14/2023] [Indexed: 06/27/2023]
Abstract
PURPOSE Umbilical hernia repair (UHR) in cirrhotics with ascites is a challenging problem associated with increased morbidity and mortality. This study examines the outcomes of UHR in veterans, comparing those undergoing elective versus emergent repair. METHODS VASQIP was queried for all UHRs during the period 2008-2015. Data collection included demographics, operative details, Model for End-stage Liver Disease (MELD) score, and postoperative outcomes. Univariate and multivariate regression analyses were performed, and a p value of ≤ 0.05 was considered significant. RESULTS A total of 383 patients were included in the analysis. Overall, mean age was 58.9, 99.0% were males, mean body mass index (BMI) was 26.7 kg/m2, 98.2% had American Society of Anesthesiologists (ASA) classification ≥ III, and 87.7% had independent functional status. More than 1/3 the patients underwent emergent UHR (37.6%). Compared with the elective UHR group, who underwent emergent repair were older, more likely to be functionally dependent, higher MELD score. Hypoalbuminemia, emergency repair and MELD score were found to be independent predictors of poor outcomes. CONCLUSION UHR in cirrhotic veterans has worse outcomes when performed emergently. Diagnosis should be followed by medical optimization and elective repair, rather than waiting for an emergent indication in > 1/3 of patients.
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Affiliation(s)
- Awni Shahait
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Medical Center, 6C, University Health Center, 4201 St. Antoine, Detroit, MI, 48201, USA.
- Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, MI, USA.
| | - Jose Wilson B Mesquita-Neto
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Medical Center, 6C, University Health Center, 4201 St. Antoine, Detroit, MI, 48201, USA
- Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, MI, USA
| | - Donald Weaver
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Medical Center, 6C, University Health Center, 4201 St. Antoine, Detroit, MI, 48201, USA
- Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, MI, USA
| | - Gamal Mostafa
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Medical Center, 6C, University Health Center, 4201 St. Antoine, Detroit, MI, 48201, USA
- Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, MI, USA
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31
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Zingaretti N, Intini SG, Albanese R, De Francesco F, Riccio M, Parodi PC. Umbilicus Necrosis During Mesh Repair of Rectus Diastasis for Abdominoplasty: Practical Tips for Prevention and Treatment. Aesthetic Plast Surg 2023; 47:28-31. [PMID: 35428917 DOI: 10.1007/s00266-022-02879-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 03/19/2022] [Indexed: 11/29/2022]
Abstract
Rectus muscles widened by pregnancy are handled in dramatically different ways in standard abdominoplasty and mesh abdominoplasty. Patients with significant abdominal wall laxity and/or umbilical hernia repair are treated with the use of retrorectus mesh placement. In these conditions the risk of damaging the blood supply to the umbilicus might be greater. Despite the fact that it is of no functional significance in adults, the umbilicus is a key esthetic landmark of the anterior abdominal wall. For both patients and surgeons alike, its absence, distortion, or misplacement after surgery can be distressing and can be a source of frequent patient complaint. Umbilical stalk necrosis represents an underreported yet important complication for patients following mesh abdominoplasty. We advance some recommendations for patients undergoing abdominoplasty with mesh repair of rectus diastasis and/or concomitant umbilical hernia mesh repair via the open approach. This information should help influence intraoperative decision-making to prevent the development of this undesirable complication.Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Nicola Zingaretti
- Clinic of Plastic and Reconstructive Surgery, Department of Medical Area (DAME), Academic Hospital of Udine, University of Udine, Udine, Italy.
- Research and Training Center in Regenerative Surgery, Accademia del Lipofilling, Jesi, Ancona, Italy.
- Department of Neuroscience, Biomedicine and Movement, Human Anatomy and Histology Section, University of Verona, 37135, Verona, Italy.
| | - Sergio Giuseppe Intini
- Department of General Surgery, Department of Medical Area (DAME), Academic Hospital of Udine, University of Udine, Udine, Italy
| | - Roberta Albanese
- Clinic of Plastic and Reconstructive Surgery, Department of Medical Area (DAME), Academic Hospital of Udine, University of Udine, Udine, Italy
| | - Francesco De Francesco
- Research and Training Center in Regenerative Surgery, Accademia del Lipofilling, Jesi, Ancona, Italy
- Department of Reconstructive Surgery and Hand Surgery, AOU Ospedali Riuniti, Ancona, Italy
| | - Michele Riccio
- Research and Training Center in Regenerative Surgery, Accademia del Lipofilling, Jesi, Ancona, Italy
- Department of Reconstructive Surgery and Hand Surgery, AOU Ospedali Riuniti, Ancona, Italy
| | - Pier Camillo Parodi
- Clinic of Plastic and Reconstructive Surgery, Department of Medical Area (DAME), Academic Hospital of Udine, University of Udine, Udine, Italy
- Research and Training Center in Regenerative Surgery, Accademia del Lipofilling, Jesi, Ancona, Italy
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Christophersen C, Fonnes S, Andresen K, Rosenberg J. Risk of Reoperation for Recurrence After Elective Primary Groin and Ventral Hernia Repair by Supervised Residents. JAMA Surg 2023; 158:359-367. [PMID: 36723916 PMCID: PMC10099066 DOI: 10.1001/jamasurg.2022.7502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/28/2022] [Indexed: 02/02/2023]
Abstract
Importance Surgical training involves letting residents operate under supervision. Since hernia repair is a common procedure worldwide, it is a frequent part of the surgical curriculum. Objective To assess the risk of reoperation for recurrence after elective primary groin and ventral hernia repair performed by supervised residents compared with that by specialists. Design, Setting, and Participants This nationwide register-based cohort study included data from January 2016 to September 2021. Patients were followed up until reoperation, emigration, death, or the end of the study period. The study used data from the Danish Inguinal and Ventral Hernia Databases linked with data from the Danish Patient Safety Authority's Online Register via surgeons' unique authorization ID. The cohort included patients aged 18 years or older who underwent primary elective hernia repairs performed by supervised residents or specialists for inguinal, femoral, epigastric, or umbilical hernias. Hernia repairs were divided into the following 4 groups: Lichtenstein groin, laparoscopic transabdominal preperitoneal (TAPP) groin, open ventral, and laparoscopic ventral. Exposures Hernia repairs performed by supervised residents vs specialists. Main Outcomes and Measures Reoperation for recurrence, analyzed separately for all 4 groups. Results A total of 868 specialists and residents who performed 31 683 primary groin and 7777 primary ventral hernia repairs were included in this study. The median age of patients who underwent hernia repair was 60 years (IQR, 48-70 years), and 33 424 patients (84.7%) were male. There was no significant difference in the adjusted risk of reoperation after Lichtenstein groin hernia repair (hazard ratio [HR], 1.26; 95% CI, 0.99-1.59), laparoscopic groin hernia repair (HR, 1.01; 95% CI, 0.73-1.40), open ventral hernia repair (HR, 0.89; 95% CI, 0.61-1.29), and laparoscopic ventral hernia repair (HR, 2.96; 95% CI, 0.99-8.84) performed by supervised residents compared with those by specialists. There was, however, a slightly increased unadjusted, cumulative reoperation rate after Lichtenstein repairs performed by supervised residents compared with those by specialists (4.8% vs 4.2%; P = .048). Conclusions and Relevance The findings of this study suggest that neither open nor laparoscopic repair of groin and ventral hernias performed by supervised residents appeared to be associated with a higher risk of reoperation for recurrence compared with the operations performed by specialists. This indicates that residents may safely perform elective hernia repair when supervised as part of their training curriculum.
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Affiliation(s)
- Camilla Christophersen
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Siv Fonnes
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kristoffer Andresen
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Rosenberg
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
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Park JY, Chung JH. Using acellular porcine dermal matrix (XCM Biologic® Tissue Matrix) to repair a giant omphalocele: A case report. Medicine (Baltimore) 2023; 102:e33016. [PMID: 36800589 PMCID: PMC9936033 DOI: 10.1097/md.0000000000033016] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 01/30/2023] [Indexed: 02/19/2023] Open
Abstract
RATIONALE An omphalocele is an abdominal wall birth defect, and a giant omphalocele (GO) is defined as an omphalocele having a diameter >5 cm or containing a herniated liver. GOs are usually treated in stages and in this case, during the silo reduction, dehiscence occurred at the suture site of the axis ring and skin edge, which was repaired using synthetic absorbable mesh. PATIENT CONCERNS A girl infant was born at 36 weeks with a GO of 8 cm diameter, and herniated multiple organs such as the small bowel, cecum, appendix, and the entire liver. Even after the staged repair technique for the GO silo, wound dehiscence between the ring of the silo and the edge of the skin occurred and gradual reduction failed. DIAGNOSIS A GO of 8 cm diameter, which was found during prenatal ultrasonography. INTERVENTIONS Revision was performed to repair the defect. The small bowel and liver were still prolapsed, and there were severe adhesions. After adhesiolysis, the muscle layer of the abdominal wall was repaired using the tissue matrix, but the skin could not be repaired. After the second operation, the defect wound was dressed as sterilely as possible. OUTCOMES The abdominal wall defect was repaired completely; there were no residual complications. LESSONS Repair of GOs using an acellular porcine dermal matrix can be considered a viable treatment option.
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Affiliation(s)
- Joo Yeon Park
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Hee Chung
- Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Fonseca MK, Tarso L, Gus J, Cavazzola LT. Short-term complications after onlay versus preperitoneal mesh repair of umbilical hernias: a prospective randomized double-blind trial. Langenbecks Arch Surg 2023; 408:48. [PMID: 36662265 DOI: 10.1007/s00423-023-02802-x] [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: 04/16/2022] [Accepted: 11/19/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE To compare the incidence of surgical site occurrences (SSOs) following onlay versus preperitoneal mesh placement in elective open umbilical hernia repairs. METHODS This study presents a secondary analysis of a randomized double-blind trial conducted on female patients with primary umbilical hernias admitted to a general hospital, in a residency training program setting. Fifty-six subjects were randomly assigned to either onlay (n=30) or preperitoneal (n=26) mesh repair group. Data on baseline demographics, past medical history, perioperative details, postoperative pain (visual analogue scale (VAS)), wound-related complications, and recurrence were assessed using a standardized protocol. RESULTS No statistically significant differences were observed between groups regarding patients' demographics, comorbidities, or defect size. Operative time averaged 67.5 (28-110) min for onlay and 50.5 (31-90) min for preperitoneal repairs, p=.03. The overall rate of SSOs was 21.4% (n=12), mainly in the onlay group (33% vs 7.7%; p=0.02, 95% CI 0.03-0.85) and mostly due to seromas. There were no between-group significant differences in postoperative VAS scores at all timepoints. After a maximum follow-up of 48 months, one recurrence was reported in the onlay group. By logistic regression, the onlay technique was the only independent risk factor for SSOs. CONCLUSION The presented data identified a decreased wound morbidity in preperitoneal umbilical hernia repairs, thus contributing to the limited body of evidence regarding mesh place selection in future guidelines. Further cases from this ongoing study and completion of follow-up are expected to also compare both techniques in terms of long-term outcomes. TRIAL REGISTRATION NUMBER Brazilian Registry of Clinical Trials (ReBEC) UTN code: U1111-1205-0065 (date of registration: March 27, 2018).
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Affiliation(s)
- Mariana Kumaira Fonseca
- Postgraduate Program in Surgical Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
- Hospital Municipal de Pronto Socorro de Porto Alegre (HPS), Largo Theodoro Hertlz, Porto Alegre, Porto Alegre, Rio Grande do Sul, 90040-194, Brazil.
| | - Lissandro Tarso
- Hospital Materno-Infantil Presidente Vargas (HMIPV), Porto Alegre, Brazil
| | - Jader Gus
- Hospital Materno-Infantil Presidente Vargas (HMIPV), Porto Alegre, Brazil
| | - Leandro Totti Cavazzola
- Postgraduate Program in Surgical Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
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Sangiorgio G, Falzone U, Sapienza E, Lombardo FM, Saguto D, Tomasello G, Zanghì M, Zanghì G. Flat patch mesh versus three-dimensional mesh (plug) for open umbilical or epigastric hernia repair. A retrospective study. Ann Ital Chir 2023; 94:512-517. [PMID: 38051502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
INTRODUCTION Hernia repair using prosthetic mesh materials has become the preferred method of repair, as the recurrence rates are much lower than with conventional repair techniques. The aim of this retrospective study was to compare open small- and medium-sized abdominal wall hernia repair with flat patch mesh versus three-dimensional mesh (plug) in terms of recurrence and complication rates. METHODS The medical records of 300 patients who underwent abdominal wall hernia repair using flat patch mesh versus three-dimensional mesh between January 2010 to December 2015 were reviewed. All patients were followed up after 1 month, 3 month and 1 year. The rate of recurrence, and short-term postoperative complications such as incidence of Surgical Site Infections (SSIs), hematoma and seroma were evaluated. RESULTS Short-term follow-up data were available for all patients. The first group was composed of 150 patients that were treated with a flat polypropylene mesh (68% presened umbilical hernia and 32% presented epigastric hernia). The second group was composed of 150 patients that were treated with a three-dimensional polypropylene mesh (60% presented umbilical hernia and 40% presented epigastric hernia). The majority of postoperative (1-month) complications were wound related, representing superficial SSI or seroma. Our results showed a statistically significant reduction of SSIs [3 (2%) vs 13 (8.6%); p = 0.038] and seroma [2 (1.3%) vs 12 (8%); p = 0.030] in the group of patients treated with plugs compared to flat-mesh group. There was no statistically significant difference in hernia recurrences. DISCUSSION Usage three-dimensional mesh for open small- and medium-sized umbilical or epigastric hernia repair represents a feasible and safe technique that significantly lowers the incidence of complications such as SSIs and seroma. Furthermore, compared to flat patch mesh, plugs displayed non-inferiority in terms recurrence. Further, well-designed clinical trials could be realized to investigate possible applications of plugs in treatment of small- and medium-sized umbilical and epigastric hernias. KEY WORDS Mesh, Umbilical Hernia.
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Melkemichel M, Stjärne L, Bringman S, Widhe B. Onlay mesh repair for treatment of small umbilical hernias ≤ 2 cm in adults: a single-centre investigation. Hernia 2022; 26:1483-1489. [PMID: 34591212 PMCID: PMC9684217 DOI: 10.1007/s10029-021-02509-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/09/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Previous studies on the repair of small umbilical hernias have suggested a lower recurrence rate with mesh compared to suture repair. An important question is in what anatomical position the mesh should be placed. The purpose of this study was to investigate the outcome of using a standardized 4 × 4 cm onlay-mesh for umbilical hernias ≤ 2 cm. METHODS A retrospective study was conducted at a single centre in Sweden on all umbilical hernia repairs during 2015-2019. The follow-up time was at least four months. Patients were identified using the hospital medical database. Repairs performed with suture or a sublay, ventral patch and laparoscopic mesh positioning were excluded. The patient's demographics, comorbidities, intra-and post-operative details were considered. The primary outcome was surgical site complications within 30 days. The secondary outcome was a recurrence. RESULTS 80 patients were repaired with a small onlay-mesh for an umbilical hernia ≤ 2 cm. The median (range) follow-up time was 29.0 (4.3-50.1) months. The median age was 46 (26-76) years old. The median body mass index was 28 (19-38) kg/m2. The male to female ratio was 2:1. 4 patients were identified with a surgical site post-operative complication; three with seromas and one with a superficial wound infection. 3 of these were given antibiotics. 2 patients were treated with wound openings bedside. There were no registered cases of recurrence. CONCLUSIONS Repairing small umbilical hernias with a small onlay-mesh was safe with a low surgical site complication rate. Randomized trials are needed to assess whether mesh can reduce recurrences in umbilical hernia repairs ≤ 2 cm.
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Affiliation(s)
- M Melkemichel
- Department of Surgery, Södertälje Hospital, 152 86, Södertälje, Sweden.
- Department of Clinical Sciences, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden.
| | - L Stjärne
- Department of Surgery, Södertälje Hospital, 152 86, Södertälje, Sweden
| | - S Bringman
- Department of Surgery, Södertälje Hospital, 152 86, Södertälje, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - B Widhe
- Department of Surgery, Södertälje Hospital, 152 86, Södertälje, Sweden
- Department of Clinical Sciences, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden
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Mowrer AR, DeUgarte DA, Wagner AJ. Abdominal Wall Defects: A Review of Current Practice Guidelines. Clin Perinatol 2022; 49:943-953. [PMID: 36328609 DOI: 10.1016/j.clp.2022.07.004] [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] [Indexed: 01/27/2023]
Abstract
The 2 most common congenital abdominal wall defects are gastroschisis and omphalocele. Gastroschisis is a defect in the abdominal wall with exposed abdominal contents. Mortality rates are low but lengths of stay are often prolonged by bowel dysmotility and other intestinal abnormalities in complicated cases. Omphalocele is a defect through the umbilical cord with herniated abdominal contents covered by a sac. It is associated with other genetic abnormalities and other anomalies that can lead to significant morbidity and mortality. Prenatal diagnosis in both conditions allows for improved prenatal consultation and coordinated perinatal care to improve clinical outcomes.
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Affiliation(s)
- Alyssa R Mowrer
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Children's Wisconsin, Administration Office, 999 North 92nd Street Suite 320, Milwaukee, WI 53226, USA.
| | - Daniel A DeUgarte
- UCLA Division of Pediatric Surgery, Westwood Clinic Location, 200 UCLA Medical Plaza, Suite 265, Los Angeles, CA 90095, USA
| | - Amy J Wagner
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Children's Wisconsin, Administration Office, 999 North 92nd Street Suite 320, Milwaukee, WI 53226, USA
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James TJ, Wu J, Won P, Hawley L, Putnam LR, Nguyen JD, Dobrowolsky A, Samakar K. Hernia-to-neck ratio is associated with emergent ventral hernia repair. Surg Endosc 2022; 36:9374-9378. [PMID: 35411455 DOI: 10.1007/s00464-022-09213-x] [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: 09/07/2021] [Accepted: 01/17/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND The ratio of hernia size to fascial defect size, termed the hernia-to-neck ratio (HNR), has been proposed as a novel predictive factor for umbilical hernia complications. HNR ≥ 2.5 has been suggested to warrant surgery due to association with bowel strangulation, incarceration, and necrosis. The aim of this study was to evaluate the association between HNR and emergent ventral hernia repair at our institution. METHODS A retrospective cohort study was performed of consecutive patients with ventral hernias evaluated at a large safety-net hospital from 2017 to 2019. Patients who required emergent ventral hernia repair were compared to patients who did not require repair at latest follow-up. HNR was calculated using a previously described method: maximal hernia sac size and maximal fascial defect size (termed "hernia neck size") were measured in the sagittal plane on CT scan. Data are described as mean ± standard deviation and median (interquartile range). RESULTS A total of 166 patients were included: 84 (51%) required emergent hernia repair and 82 (49%) did not undergo repair. Median follow-up was 19 (8-27) months. Patient groups were similar except the emergent repair group had more males (50% vs. 34%, p = 0.03), umbilical hernias (93% vs. 56%, p < 0.01), recurrent hernias (31% vs. 15%, p < 0.01), and lower mean BMI (34.3 ± 9.9 vs. 39.1 ± 6.5, p < 0.01). Hernia sac size did not differ between groups (5.8 [3.8-8.4] cm vs. 6.1 [3.5-11.8] cm, p = 0.45). Hernia neck size was significantly smaller in the emergent repair group (1.5 [2.3-3.5] cm vs. 3.4 [1.8-6.2] cm, p < 0.01). Hernia-to-neck ratio was significantly higher in the emergent repair group (2.4 [1.8-3.1] vs. 1.7 [1.1-2.9], p < 0.01). CONCLUSION This study demonstrated an association between higher HNR and increased risk of emergent ventral hernia repair. Future studies will evaluate the use of HNR to risk-stratify patients with ventral hernias in a safety-net hospital.
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Affiliation(s)
- Tayler J James
- Los Angeles County + University of Southern California Medical Center, University of Southern California, 1510 San Pablo Street, HCC I, Suite 514, Los Angeles, CA, 90033, USA.
| | - Jessica Wu
- Los Angeles County + University of Southern California Medical Center, University of Southern California, 1510 San Pablo Street, HCC I, Suite 514, Los Angeles, CA, 90033, USA
| | - Paul Won
- Los Angeles County + University of Southern California Medical Center, University of Southern California, 1510 San Pablo Street, HCC I, Suite 514, Los Angeles, CA, 90033, USA
| | - Lauren Hawley
- Los Angeles County + University of Southern California Medical Center, University of Southern California, 1510 San Pablo Street, HCC I, Suite 514, Los Angeles, CA, 90033, USA
| | - Luke R Putnam
- Los Angeles County + University of Southern California Medical Center, University of Southern California, 1510 San Pablo Street, HCC I, Suite 514, Los Angeles, CA, 90033, USA
| | - James D Nguyen
- Los Angeles County + University of Southern California Medical Center, University of Southern California, 1510 San Pablo Street, HCC I, Suite 514, Los Angeles, CA, 90033, USA
| | - Adrian Dobrowolsky
- Los Angeles County + University of Southern California Medical Center, University of Southern California, 1510 San Pablo Street, HCC I, Suite 514, Los Angeles, CA, 90033, USA
| | - Kamran Samakar
- Los Angeles County + University of Southern California Medical Center, University of Southern California, 1510 San Pablo Street, HCC I, Suite 514, Los Angeles, CA, 90033, USA
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Dai X, Zhang Y, Wang F, Luo Y, Gong Y. Effects of Umbilical Preparation Before Trans-umbilical Laparo-endoscopic Single-site Surgery on Umbilical Wounds Healing: a Randomized Controlled Trial. Surg Laparosc Endosc Percutan Tech 2022; 32:632-636. [PMID: 36314980 DOI: 10.1097/sle.0000000000001115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The umbilicus is the only anatomic entrance and incision site for trans-umbilical laparoendoscopic single-site surgery (TU-LESS). Data on incisional surgical site infections (ISSI) and incision healing in TU-LESS are lacking. Therefore, we aimed to observe umbilical incision healing and possible hernia after TU-LESS and explore the efficacy of preoperative umbilicus preparation on ISSI. SUBJECTS AND METHODS Consecutive patients aged 18 to 65 years, who were scheduled to undergo TU-LESS at a teaching hospital between March 2020 and November 2021, were enrolled in this prospective study. All patients were randomized to the study group with preoperative umbilicus preparation 30 minutes before patients were sent to the operating room and to the control group without preparation. The umbilical dimple was disinfected twice using povidone-iodine in both groups before the skin incision. The primary outcome was ISSI within 30 days of surgery. Umbilical hernia at 3 months after surgery and perioperative data such as operation time, complications, and incision healing were recorded and compared. RESULTS A total of 400 patients were recruited for this study. TU-LESS was performed in all patients without major complications. ISSI occurred in 5 patients in the study group (2.5%) and 3 patients in the control group (1.5%), with no significant differences between both groups ( P =0.479). No umbilical hernia occurred in any patient during the 3 months follow-up. Six patients in the study group (3.1%) and 1 in the control group (0.5%) experienced excessive scarring, a relatively high incidence in the study group, though the difference was not statistically significant ( P =0.067). CONCLUSIONS TU-LESS-related umbilical hernias are rare with existing suturing methods. Umbilicus preparation before TU-LESS could not decrease ISSI; however, it increased the nursing workload, which should be avoided.
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Affiliation(s)
- Xuelin Dai
- First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Pipek LZ, Cortez VS, Taba JV, Suzuki MO, do Nascimento FS, de Mattos VC, Moraes WA, Iuamoto LR, Hsing WT, Carneiro-D’Albuquerque LA, Meyer A, Andraus W. Cirrhosis and hernia repair in a cohort of 6352 patients in a tertiary hospital: Risk assessment and survival analysis. Medicine (Baltimore) 2022; 101:e31506. [PMID: 36397364 PMCID: PMC9666189 DOI: 10.1097/md.0000000000031506] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The prevalence of hernias in patient with cirrhosis can reach up to 40%. The pathophysiology of cirrhosis is closely linked to that of the umbilical hernia, but other types are also common in this population. The aim of this study is to evaluate factors that influence in the prognosis after hernia repair in patients with cirrhosis. A historical cohort of 6419 patients submitted to hernia repair was gathered. Clinical, epidemiological data and hernia characteristics were obtained. For patient with cirrhosis, data from exams, surgery and follow-up outcomes were also analyzed. Survival curves were constructed to assess the impact of clinical and surgical variables on survival. 342 of the 6352 herniated patients were cirrhotic. Patient with cirrhosis had a higher prevalence of umbilical hernia (67.5% × 24.2%, P < .001) and a lower prevalence of epigastric (1.8% × 9.0%, P < .001) and lumbar (0% × 0.18%, P = .022). There were no significant differences in relation to inguinal hernia (P = .609). Ascites was present in 70.1% of patient with cirrhosis and its prevalence was different in relation to the type of hernia (P < .001). The survival curve showed higher mortality for emergency surgery, MELD > 14 and ascites (HR 12.6 [3.79-41.65], 4.5 [2.00-10.34], and 6.1 [1.15-20.70], respectively, P < .05). Hernia correction surgery in patient with cirrhosis has a high mortality, especially when performed under urgent conditions associated with more severe clinical conditions of patients, such as the presence of ascites and elevated MELD.
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Affiliation(s)
| | | | - João Victor Taba
- Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
| | | | | | | | | | - Leandro Ryuchi Iuamoto
- Center of Acupuncture, Department of Orthopaedics and Traumatology, University of Sao Paulo School of Medicine, São Paulo, Brazil
| | - Wu Tu Hsing
- Center of Acupuncture, Department of Orthopaedics and Traumatology, University of Sao Paulo School of Medicine, São Paulo, Brazil
| | | | - Alberto Meyer
- Department of Gastroenterology, Hospital das Clínicas, HCFMUSP, São Paulo, Brazil
- *Correspondence: Alberto Meyer, Avenida Doutor Arnaldo, 455, São Paulo 05403-000, Brazil (e-mail: )
| | - Wellington Andraus
- Department of Gastroenterology, Hospital das Clínicas, HCFMUSP, São Paulo, Brazil
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Ali MS, Chowdhury LH, Baten MA, Islam S, Khan N, Islam MA, Saha BK, Mamun MA, Mushtabshirah L, Mokarabin M. Comparative Study between Acacia Nilotica versus Povidone Iodine in Topical Treatment of Omphalocele Major. Mymensingh Med J 2022; 31:925-930. [PMID: 36189534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Well established and common practice in conservative management of omphalocele major is escharotics therapy with different topical agents. Among them mercurochrome, alcohol, silver salts, povidone iodine, acacia nilotca paste are commonly used. It is a comparative study between application of acacia nilotica paste and povidone iodine solution as a primary non surgical treatment of omphalocele major regarding efficacy and safety of these two topical agents. A double blind randomized controlled study was conducted at the department of Paediatric Surgery, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from July 2016 to June 2019. In this study 20 cases of omphalocele major and randomly divided into two equal groups. Group A and Group B treated with acacia nilotica paste and povidone iodine solution respectively. Gastroschisis, ruptured-omphalocele major or omphalocele minor excluded in this study. The size of the fascial defect in cm, time required for full oral feeding tolerance and duration of hospital stay were evaluating parameters. Patients with Group A tolerated full oral feeding earlier, shorter total hospital stay duration and low mortality rate than those from Group B. Application of acacia nilotica is a safe and effective treatment of omphalocele major regarding rapid full oral feeding tolerance, shorter hospital stay and low mortality rate.
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Affiliation(s)
- M S Ali
- Dr Mohammad Showkot Ali, Assistant Professor, Department of Paediatric Surgery, Mymensingh Medical College (MMC), Mymensingh, Bangladesh;
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Zhen LH, Wang HB, Zhou Y. Comparison of rectus sheath block and local anesthetic for analgesia in pediatric umbilical hernia repair: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e30391. [PMID: 36086758 PMCID: PMC10980434 DOI: 10.1097/md.0000000000030391] [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: 01/09/2022] [Accepted: 07/25/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Pediatric umbilical hernia repair could cause considerable postoperative discomfort. This study aimed to compare the analgesia between rectus sheath block and local anesthetic infiltration in child pediatric umbilical hernia repair. METHODS The relevant randomized controlled trials were searched from PubMed, Embase, Web of Science, EBSCO, and Cochrane library databases from its inception to October 2020. The random-effects model was used for meta-analysis. RESULTS Four randomized controlled trials were included in the meta-analysis. The 4 studies were published between 2006 and 2017, with sample sizes ranging from 13 to 52 and a total of 143 individuals across the 4 studies. The Jadad scores of the 4 included studies ranged from 4 to 5, and all 4 studies were considered high quality based on quality assessment. There was no difference in analgesic effect at 10 minutes (standardized mean difference [SMD] = -0.19; 95% confidence interval [CI] = -1.52 to 1.16; P = .78), 30 minutes (SMD = -0.37; 95% CI = -1.53 to 0.78; P = .52), 1 hour (SMD = -0.73; 95% CI = -2.00 to 0.53; P = .26) after surgery. Besides, there was no significant difference in postoperative nausea (risk ratio = 0.95; 95% CI = 0.18 to 5.02; P = .95) and postoperative morphine use in morphine equivalents (mean difference = -0.95; 95% CI = -0.06 to 0.01; P = .12). CONCLUSION Rectus sheath block and local anesthetic are effective methods for analgesia in pediatric umbilical hernia repair.
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Affiliation(s)
- Lun-Hui Zhen
- Department of Cardiothoracic Surgery and Abdominal Hernia Surgery, The People’s Hospital of Kai Zhou District, Chongqing, and
| | - Hong-Bing Wang
- Department of Gastrointestinal Surgery and Breast Surgery, The People’s Hospital of Kai Zhou District, Chongqing
| | - Yun Zhou
- Department of Cardiothoracic Surgery and Abdominal Hernia Surgery, The People’s Hospital of Kai Zhou District, Chongqing, and
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He K, Hills-Dunlap JL, Kashtan MA, Riley H, Henry OS, Graham DA, Wynne N, Cramm SL, Rangel SJ. Frequency of Potentially Avoidable Surgical Referrals for Asymptomatic Umbilical Hernias in Children. J Surg Res 2022; 277:290-295. [PMID: 35525211 PMCID: PMC9446374 DOI: 10.1016/j.jss.2022.04.022] [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: 02/04/2022] [Revised: 03/10/2022] [Accepted: 04/08/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The American Association of Pediatrics released guidelines in 2019 recommending delay of surgical referral in children with asymptomatic umbilical hernias until 4-5 y of age. The purpose of this study was to assess contemporary rates of potentially avoidable referrals in this cohort of children, and to assess whether rates have decreased following guideline release. METHODS Retrospective analysis of umbilical hernias referrals evaluated at a single pediatric surgery clinic from October 2014 to August 2021. Potentially avoidable referrals (PAR) were defined as asymptomatic, non-enlarging umbilical hernia referrals in a child 3 y of age or younger without a history of incarceration. Referral indication, disposition following clinic visit, and rates of PAR were compared before and after guideline release. RESULTS A total of 803 umbilical hernia referrals were evaluated, of which 48% were in children 3 y of age or younger at time of evaluation ("early" referrals). 33% of all referrals and 68% of early referrals were categorized as a PAR, and rates were similar before and after guideline release (all referrals: 32% versus 33%, P = 0.94; early referrals: 68% versus 67%, P = 0.94). Of the 333 early referrals who were managed expectantly per guideline recommendations, 2 (0.6%) developed incarceration which was managed with successful reduction and interval repair. CONCLUSIONS One-third of all referrals for umbilical hernia evaluation are potentially avoidable, and this rate did not change following release of American Academy of Pediatrics guidelines. Aligning expectations between surgeons and referring providers through improved education and guideline dissemination may reduce avoidable visits, lost caregiver productivity, and exposure to potentially avoidable surgery.
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Affiliation(s)
- Katherine He
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts
| | | | - Mark A Kashtan
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Heather Riley
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Owen S Henry
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Dionne A Graham
- Boston Children's Hospital, Center for Applied Pediatric Quality Analytics, Boston, Massachusetts
| | - Nicole Wynne
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Shannon L Cramm
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Shawn J Rangel
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts.
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Odion-Obomhense HK, Awunor NS, Onyeaso S. A Method of Conservative Management of Giant Omphalocele Useful in Preventing Rupture of Sac. West Afr J Med 2022; 39:816-822. [PMID: 36057973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Omphalocele consists of congenital malformation of anterior abdominal wall defects occurring at the midline with herniation of the viscera through this defect. Giant omphaloceles constitute a challenging situation as such conservative management has been advocated as an effective method of treatment. This study aimed to compare the conventional method of dressing the omphalocele sac using gauze, an escharotic agent, and a crepe bandage to our improvised method of the usage of a sterilization wrap over the escharotic agent with a crepe bandage. METHODS This was a retrospective comparative review of 7 babies with giant omphalocele that was treated with topical honey and the non-adherent sterilization wrap covering (group B) and compared with 6 babies that had honey, sofratulle ,and dry gauze covering (group A) that was initially done in our center. RESULTS All of the babies who were in group B had an uneventful epithelization of the sac with no rupture; also, no death occurred in this group. However, three in group A had sacs that ruptured before epithelization. Two of these died from complications of sepsis following rupture of the sac, one had a small point on the sac which was ruptured and it healed with a dressing left in place for a week. CONCLUSION The use of Kimberley-Clark sterilization wrap prevents rupture of the sac while using the escharotic agent, thereby reducing mortality. We advocate that gauze should not make any contact with the omphalocele sac.
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Affiliation(s)
| | - N S Awunor
- Department of Community Medicine, Delta State University, Abraka, Nigeria
| | - S Onyeaso
- Department of Pediatrics, Delta State University, Abraka, Nigeria
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Patel S, Smiley A, Feingold C, Khandehroo B, Kajmolli A, Latifi R. Chances of Mortality Are 3.5-Times Greater in Elderly Patients with Umbilical Hernia Than in Adult Patients: An Analysis of 21,242 Patients. Int J Environ Res Public Health 2022; 19:10402. [PMID: 36012037 PMCID: PMC9408293 DOI: 10.3390/ijerph191610402] [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: 06/30/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
The goal of this study was to identify risk factors that are associated with mortality in adult and elderly patients who were hospitalized for umbilical hernia. A total of 14,752 adult patients (ages 18−64 years) and 6490 elderly patients (ages 65+), who were admitted emergently for umbilical hernia, were included in this retrospective cohort study. The data were gathered from the National Inpatient Sample (NIS) 2005−2014 database. Predictors of mortality were identified via a multivariable logistic regression, in patients who underwent surgery and those who did not for adult and elderly age groups. The mean (SD) ages for adult males and females were 48.95 (9.61) and 46.59 (11.35) years, respectively. The mean (SD) ages for elderly males and females were 73.62 (6.83) and 77.31 (7.98) years, respectively. The overall mortality was low (113 or 0.8%) in the adult group and in the elderly group (179 or 2.8%). In adult patients who underwent operation, age (OR = 1.066, 95% CI: 1.040−1.093, p < 0.001) and gangrene (OR = 5.635, 95% CI: 2.288−13.874, p < 0.001) were the main risk factors associated with mortality. Within the same population, female sex was found to be a protective factor (OR = 0.547, 95% CI: 0.351−0.854, p = 0.008). Of the total adult sample, 43% used private insurance, while only 18% of patients in the deceased population used private insurance. Conversely, within the entire adult population, only about 48% of patients used Medicare, Medicaid, or self-pay, while these patients made up 75% of the deceased group. In the elderly surgical group, the main risk factors significantly associated with mortality were frailty (OR = 1.284, 95% CI: 1.105−1.491, p = 0.001), gangrene (OR = 13.914, 95% CI: 5.074−38.154, p < 0.001), and age (OR = 1.034, 95% CI: 1.011−1.057, p = 0.003). In the adult non-operation group, hospital length of stay (HLOS) was a significant risk factor associated with mortality (OR = 1.077, 95% CI: 1.004−1.155, p = 0.038). In the elderly non-operation group, obstruction was the main risk factor (OR = 4.534, 95% CI: 1.387−14.819, p = 0.012). Elderly patients experienced a 3.5-fold higher mortality than adult patients who were emergently admitted with umbilical hernia. Increasing age was a significant risk factor of mortality within all patient populations. In the adult surgical group, gangrene, Medicare, Medicaid, and self-pay were significant risk factors of mortality and female sex was a significant protective factor. In the adult non-surgical group, HLOS was the main risk factor of mortality. In the elderly population, frailty and gangrene were the main risk factors of mortality within the surgical group, and obstruction was the main risk factor for the non-surgical group.
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Affiliation(s)
- Saral Patel
- Westchester Medical Center, School of Medicine, New York Medical College, Valhalla, NY 10595, USA
| | - Abbas Smiley
- Westchester Medical Center, School of Medicine, New York Medical College, Valhalla, NY 10595, USA
| | - Cailan Feingold
- Westchester Medical Center, School of Medicine, New York Medical College, Valhalla, NY 10595, USA
| | - Bardia Khandehroo
- Westchester Medical Center, School of Medicine, New York Medical College, Valhalla, NY 10595, USA
| | - Agon Kajmolli
- Westchester Medical Center, School of Medicine, New York Medical College, Valhalla, NY 10595, USA
| | - Rifat Latifi
- Minister of Health, Republic of Kosova, Adjunct Professor of Surgery, University of Arizona, Tucson, AZ 10000, USA
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Nevo N, Goldstein AL, Staierman M, Eran N, Carmeli I, Rayman S, Mnouskin Y. eTEP inferior access with tailored retromuscular dissection for small to mid-sized umbilical hernia repair with or without inguinal hernia: early experience. Hernia 2022; 26:1491-1499. [PMID: 35962875 DOI: 10.1007/s10029-022-02649-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/21/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The minimally invasive surgical repair of combined inguinal and ventral hernias often requires shifting from one approach or plane to another. The traditional enhanced-view totally extraperitoneal Rives-Stoppa repair consists of a large retro muscular dissection that is unjustified for small ventral hernias. Here we describe a modification to the minimally invasive Rives-Stoppa repair using a limited retro muscular dissection based on the ventral defect size for small/medium-sized hernias, with or without combined inguinal hernias. METHODS From a single surgical team, a retrospective study was performed over a 1-year period. Demographics, hernia characteristics, surgical techniques, intraoperative/postoperative complications, and outcomes were all analyzed and reported. We also included detailed surgical steps, landmarks, pitfalls, and personal tips for this technique. RESULTS Twenty-four patients underwent a laparoscopic limited retromuscular dissection ventral hernia repair utilizing the eTEP access technique. Eighteen were primary umbilical hernias and six postoperative incisional hernias, and nine were combined ventral and inguinal hernia repairs. Eight of the primary umbilical hernias were EHS classified as medium size, 11 small, and for the incisional hernias, three were classified as M3W1 and two as M3W2. One procedure was converted to TAPP. There were no intraoperative complications. The mean length of stay was 1.25 days (range 1-3). There was one postoperative retromuscular hematoma and no recurrence during the follow-up period. CONCLUSION eTEP with limited dissection offers a good and safe solution for small to medium size hernias; it provides an efficient solution when an inguinal hernia is to be addressed as well.
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Affiliation(s)
- N Nevo
- Department of General Surgery, Assuta Ashdod Public Hospital (Affiliated to the Faculty of Health and Science, Ben-Gurion University, Beer-Sheba, Israel), Ashdod, Israel.
| | - A L Goldstein
- Trauma Surgery Unit, Wolfson Medical Center Holon, Holon, Israel
| | - M Staierman
- Department of General Surgery, Assuta Ashdod Public Hospital (Affiliated to the Faculty of Health and Science, Ben-Gurion University, Beer-Sheba, Israel), Ashdod, Israel
| | - N Eran
- General Surgery Division, The Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - I Carmeli
- Department of General Surgery, Assuta Ashdod Public Hospital (Affiliated to the Faculty of Health and Science, Ben-Gurion University, Beer-Sheba, Israel), Ashdod, Israel
| | - S Rayman
- Department of General Surgery, Assuta Ashdod Public Hospital (Affiliated to the Faculty of Health and Science, Ben-Gurion University, Beer-Sheba, Israel), Ashdod, Israel
| | - Y Mnouskin
- Department of General Surgery, Assuta Ashdod Public Hospital (Affiliated to the Faculty of Health and Science, Ben-Gurion University, Beer-Sheba, Israel), Ashdod, Israel
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Howard R, Ehlers A, Delaney L, Solano Q, Shen M, Englesbe M, Dimick J, Telem D. Sex disparities in the treatment and outcomes of ventral and incisional hernia repair. Surg Endosc 2022; 37:3061-3068. [PMID: 35920905 DOI: 10.1007/s00464-022-09475-5] [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: 03/20/2022] [Accepted: 07/13/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite females accounting for nearly half of ventral and incisional hernia repairs performed each year in the United States, shockingly little attention has been paid to sex disparities in hernia treatment and outcomes. We explored sex-based differences in operative approach and outcomes using a population-level hernia registry. METHODS We performed a retrospective review of the Michigan Surgical Quality Collaborative Hernia Registry (MSQC-HR) to identify patients undergoing clean ventral or incisional hernia repair between January 1, 2020 to December 31, 2021. The primary outcomes were risk-adjusted rates of laparoscopic/robotic approach, mesh use, and composite 30-day adverse events stratified by sex. Risk adjustment between sex was performed using all patient, clinical, and hernia characteristics. RESULTS 5269 patients underwent ventral and incisional hernia repair of whom 2295 (43.6%) patients were female. Mean age was 53.9 (14.5) years. Females had slightly larger hernias (3.5 cm vs. 3.0 cm, P < 0.001), fewer umbilical hernias (50.9% vs. 73.0%, P < 0.001), and a higher prevalence of prior hernia repair (17.9% vs. 13.4%, P < 0.001). In a multivariable logistic regression adjusting for differences between males and females, female sex was associated with lower odds of mesh use [aOR 0.62 (95% CI 0.52-0.74)] and higher odds of laparoscopic/robotic repair [aOR 1.26 (95% CI 1.10-1.44)]. In a similar multivariable model, female sex was also associated with significantly higher odds of composite 30-day adverse events [aOR 1.64 (95% CI 1.32-2.02)]. This equates to predicted probabilities of 11.7% (95% CI 10.3-13.0%) vs. 7.6% (95% CI 6.6-8.6%) for adverse events in females compared to males. CONCLUSIONS Despite being younger and having fewer comorbidities, women were more likely to experience adverse events after surgery. Moreover, women were less likely to have mesh placed. Additional work is needed to understand the factors that drive these gender disparities in ventral hernia treatment and outcomes.
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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
| | - Lia Delaney
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Quintin Solano
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Mary Shen
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Michael Englesbe
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
- Michigan Surgical Quality Collaborative, Ann Arbor, MI, USA
| | - Justin Dimick
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
- Division of Minimally Invasive 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.
- Division of Minimally Invasive Surgery, Michigan Medicine, 2926 Taubman Center, 1500 E Medical Center Dr, SPC 5331, Ann Arbor, MI, 48109-5331, USA.
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Grape S, Kirkham KR, Albrecht E. The analgesic efficacy of transversus abdominis plane block vs. wound infiltration after inguinal and infra-umbilical hernia repairs: A systematic review and meta-analysis with trial sequential analysis. Eur J Anaesthesiol 2022; 39:611-618. [PMID: 35131973 PMCID: PMC10317296 DOI: 10.1097/eja.0000000000001668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Both transversus abdominis plane (TAP) block and wound infiltration with local anaesthetic have been used to relieve pain after inguinal or infra-umbilical hernia repair. OBJECTIVES To determine whether TAP block or local anaesthetic infiltration is the best analgesic option after inguinal or infra-umbilical hernia repair. DESIGN Systematic review and meta-analysis with trial sequential analysis. DATA SOURCES MEDLINE, Embase, Cochrane Central Register of Controlled Clinical Trials, Web of Science, up to June, 2020. ELIGIBILITY CRITERIA We retrieved randomised controlled trials comparing TAP block with wound infiltration after inguinal or infra-umbilical hernia repair. Primary outcome was rest pain score (analogue scale 0 to 10) at 2 postoperative hours. Secondary pain-related outcomes included rest pain score at 12 and 24 h, and intravenous morphine consumption at 2, 12 and 24 h. Other secondary outcomes sought were block-related complications such as rates of postoperative infection, haematoma, visceral injury and systemic toxicity of local anaesthetic. RESULTS Seven trials including 420 patients were identified. There was a significant difference in rest pain score at 2 postoperative hours in favour of TAP block compared with wound infiltration, with a mean (95% confidence interval) difference of -0.8 (-1.3 to -0.2); I2 = 85%; P = 0.01. Most secondary pain-related outcomes were also significantly improved following TAP block. No complication was reported. The overall quality of evidence was moderate. CONCLUSION There is moderate level evidence that TAP block provides superior analgesia compared with wound infiltration following inguinal or infra-umbilical hernia repair. TRIAL REGISTRY NUMBER PROSPERO CRD42020208053.
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Affiliation(s)
- Sina Grape
- From the Department of Anaesthesia, Valais Hospital, Sion (SG), University of Lausanne, Lausanne, Switzerland (SG, EA), Department of Anaesthesia, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada (KRK) and Department of Anaesthesia, University Hospital of Lausanne, Lausanne, Switzerland (EA)
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Higgins RM, Petro CC, Warren J, Perez AJ, Dews T, Phillips S, Reinhorn M. The opioid reduction task force: using the ACHQC Data Registry to combat an epidemic in hernia patients. Hernia 2022; 26:855-864. [PMID: 35039950 DOI: 10.1007/s10029-021-02556-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/27/2021] [Indexed: 11/04/2022]
Abstract
PURPOSE Post-operative opioid prescriptions contribute to prolonged opioid misuse and abuse. Using a national hernia registry, we aimed to evaluate the effectiveness of a data-driven educational intervention on surgeon prescribing behavior. METHODS After collecting opioid prescribing and patient consumption data from March 2019-December 2019 in inguinal and umbilical hernia repair, the Abdominal Core Health Quality Collaborative (ACHQC) Opioid Reduction Task Force presented data at a Quality Improvement (QI) Summit to educate surgeons on strategies to minimize opioid prescribing. Surgeons were asked to implement a multimodal pain management approach and were supported with educational tools created by the task force. Prescribing and consumption data after the summit, December 2019-March 2021, were then collected to assess the effectiveness of the QI effort. RESULTS Registry participation before and after the QI summit increased from 52 to 91 surgeons, with an increase of 353-830 umbilical hernia patients and 976-2447 inguinal hernia patients. After the summit, high (> 10 tablets) surgeon prescribers shifted toward low (≤ 10 tablets) prescribing. Yet, patients consumed less than what was prescribed, with a significant increase in patients consuming ≤ 10 tablets before and after the summit: 79-88% in umbilical hernia (p = 0.01) and 85-94% in inguinal hernia (p < 0.001). CONCLUSIONS Following an educational QI summit by the ACHQC Opioid Reduction Task Force, high opioid prescribing has shifted toward low. However, patients consume less than prescribed, highlighting the importance of continuing this effort to reduce opioid prescribing.
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Affiliation(s)
- R M Higgins
- Division of Minimally Invasive Gastrointestinal Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
| | - C C Petro
- Center for Abdominal Core Health, Cleveland Clinic, Cleveland, OH, USA
| | - J Warren
- The University of South Carolina School of Medicine Greenville, Greenville, SC, USA
| | - A J Perez
- Division of General, Acute Care and Trauma Surgery, The University of North Carolina, Chapel Hill, NC, USA
| | - T Dews
- Pain Management Department, Cleveland Clinic Euclid Hospital, Cleveland, OH, USA
| | - S Phillips
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - M Reinhorn
- Mass General Brigham-Newton Wellesley Hospital, Boston Hernia and Pilonidal Center, Newton, MA, USA
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Ciscar Belles A, Makhoukhi T, López-Cano M, Hernández Granados P, Pereira Rodríguez JA. Umbilical incisional hernias (M3): are trocar-site hernias different? Comparative analysis of the EVEREG registry⋆. Cir Esp 2022; 100:336-344. [PMID: 35618203 DOI: 10.1016/j.cireng.2022.05.023] [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: 11/12/2020] [Accepted: 01/24/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND Incisional hernia (HI), in open and laparoscopic surgery, is a very frequent complication. HI located in the umbilical region are called M3. The main aim of this study is to compare HI produced by the placement of an umbilical laparoscopic trocar (M3T) with those located in M3 in open surgery (M3O) in terms of basal characteristics, complications and recurrences; and secondarily the identification of risk factors. METHOD Cross-sectional observational study based on the national prospective registry EVEREG during the period of July 2012-June 2018. The main variables were recurrences and postoperative complications. Both groups (M3T and M3O) were compared. Multiple logistic regression was performed to identify the risk factors of the entire cohort. RESULTS 882 had a follow-up time longer than 12 months. M3O group presented superior ASA-Class, more complex HI and previous repair. It also presented a higher recurrence rate at 12 and 24 months (8.6% vs. 2.5%; P < 0,0001 and 9.3% vs. 2.9%; P < 0.0001) and higher postoperative complications rate (21.9% vs. 14.6 %; P = 0.02). Previous repair, intervention length and associated procedures requirement were identified as risk factors for postoperative complications. Absence of a specialist present during surgery, previous repair, and the absence of complications were identified as risk factors for recurrence. In the PSM analysis no differences were detected in of complications and recurrences. CONCLUSIONS HI M3O is more complex than M3T. The complexity is not related to the origin of the hernia but to its characteristics and those of the patient.
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Affiliation(s)
- Ana Ciscar Belles
- Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain; Servicio de Cirugía General, Hospital de Mataró, Barcelona, Spain
| | - Touria Makhoukhi
- Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
| | - Manuel López-Cano
- Servicio de Cirugía General, Hospital Vall d'Hebron, Barcelona, Spain; Departament de Cirurgia, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - José Antonio Pereira Rodríguez
- Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain; Servicio de Cirugía General, Hospital Universitari del Mar, Barcelona, Spain.
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