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Bahraini A, Hsu J, Cochran S, Campbell S, Overby DW, Phillips S, Prabhu A, Perez A. Evaluation of 30-day outcomes for open ventral hernia repair using self-gripping versus nonself-gripping mesh. Surg Endosc 2024:10.1007/s00464-024-10778-y. [PMID: 38609587 DOI: 10.1007/s00464-024-10778-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 03/04/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND The use of mesh is standard of care for large ventral hernias repaired on an elective basis. The most used type of mesh includes synthetic polypropylene mesh; however, there has been an increase in the usage of a new polyester self-gripping mesh, and there are limited data regarding its efficacy for ventral hernia. The purpose of the study is to determine whether there is a difference in surgical site occurrence (SSO), surgical site infection (SSI), surgical site occurrence requiring procedural intervention (SSOPI), and recurrence at 30 days after ventral hernia repair (VHR) using self-gripping (SGM) versus non-self-gripping mesh (NSGM). METHODS We performed a retrospective study from January 2014 to April 2022 using the Abdominal Core Health Quality Collaborative (ACHQC). We collected data on patients over 18 years of age who underwent elective open VHR using SGM or NSGM and whom had 30-day follow-up. Propensity matching was utilized to control for variables including hernia width, body mass index, age, ASA, and mesh location. Data were analyzed to identify differences in SSO, SSI, SSOPI, and recurrence at 30 days. RESULTS 9038 patients were identified. After propensity matching, 1766 patients were included in the study population. Patients with SGM had similar demographic and clinical characteristics compared to NSGM. The mean hernia width to mesh width ratio was 8 cm:18 cm with NSGM and 7 cm:15 cm with SGM (p = 0.63). There was no difference in 30-day rates of recurrence, SSI or SSO. The rate of SSOPI was also found to be 5.4% in the nonself-gripping group compared to 3.1% in the self-gripping mesh group (p < .005). There was no difference in patient-reported outcomes at 30 days. CONCLUSIONS In patients undergoing ventral hernia repair with mesh, self-gripping mesh is a safe type of mesh to use. Use of self-gripping mesh may be associated with lower rates of SSOPI when compared to nonself-gripping mesh.
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Affiliation(s)
- Anoosh Bahraini
- University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27514, USA
| | - Justin Hsu
- University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27514, USA
| | - Steven Cochran
- University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27514, USA
| | - Shannelle Campbell
- University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27514, USA
| | - David Wayne Overby
- University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27514, USA
| | | | | | - Arielle Perez
- University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27514, USA.
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Vierra M, Rouhani Ravari M, Soleymani Sardoo F, Shogan BD. Tailored Pre-Operative Antibiotic Prophylaxis to Prevent Post-Operative Surgical Site Infections in General Surgery. Antibiotics (Basel) 2024; 13:99. [PMID: 38275328 PMCID: PMC10812803 DOI: 10.3390/antibiotics13010099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
The average American today undergoes three inpatient and two outpatient surgical procedures during one's life, each of which carries with it a risk of post-operative infection. It has long been known that post-operative infections cause significant morbidity in the immediate peri-operative period, but recent evidence suggests that they can have long-term consequences as well, increasing a patient's risk of infectious complications in unrelated surgeries performed months or even years later. While there are several theories on the origin of this association, including bacterial colonization of a post-operative infectious wound site, antimicrobial resistance from curative courses of antibiotics, subclinical immunosuppression, or the creation of an inflammatory "pathobiome" following an infectious insult, it is ultimately still unclear why patients who experience a single post-operative infection seem to be at a significantly higher risk of experiencing subsequent ones. Regardless, this association has significant implications for the routine use of pre-operative antibiotic prophylaxis. Indeed, while the prescription of antibiotics pre-operatively has dramatically reduced the rate of post-operative infections, the chosen prophylaxis regimens are typically standardized according to national guidelines, are facing increasing antimicrobial resistance patterns, and have been unable to reduce the risk of post-operative infection to acceptably low levels for certain surgeries. As a result, some clinicians have speculated that tailoring pre-operative antibiotic prophylaxis according to a patient's prior infectious and operative history could improve efficacy and further reduce the rate of post-operative infections. The purpose of this review is to describe the evidence for the link between multiple post-operative infections and explore the efficacy of individualized pre-operative prophylaxis.
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Affiliation(s)
- Mason Vierra
- Pritzker School of Medicine, The University of Chicago, Chicago, IL 60637, USA;
| | - Mohsen Rouhani Ravari
- Department of Surgery, The University of Chicago Medicine, Chicago, IL 60637, USA; (M.R.R.); (F.S.S.)
| | - Fatemeh Soleymani Sardoo
- Department of Surgery, The University of Chicago Medicine, Chicago, IL 60637, USA; (M.R.R.); (F.S.S.)
| | - Benjamin D. Shogan
- Department of Surgery, The University of Chicago Medicine, Chicago, IL 60637, USA; (M.R.R.); (F.S.S.)
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Grantham DW, Doerhoff CR, Linn JG, Mallico EJ, Washington RG. Evaluation of Long-term Performance of the GORE SYNECOR Intraperitoneal Biomaterial in the Treatment of Inguinal Hernias. Surg Laparosc Endosc Percutan Tech 2023; 33:231-234. [PMID: 36971525 PMCID: PMC10234318 DOI: 10.1097/sle.0000000000001166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 02/14/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND The objective of this study was to analyze device safety and clinical outcomes of inguinal hernia repair with the GORE SYNECOR Intraperitoneal Biomaterial device, a hybrid composite mesh. METHODS This retrospective case review analyzed device/procedure endpoints beyond 1 year in patients treated for inguinal hernia repair with the device. Three objectives were evaluated: procedural endpoint-incidence through 30 days of surgical site infection, surgical site occurrence (SSO), ileus, readmission, reoperation, and death; device endpoint-serious device incidence of mesh erosion, infection, excision/removal, exposure, migration, shrinkage, device-related bowel obstruction and fistula, and hernia recurrence through 12 months; and patient-reported outcomes of the bulge, physical symptoms, and pain. RESULTS A total of 157 patients (mean age: 67±13 y) with 201 inguinal hernias (mean size: 5.1±5 cm 2 ) were included. Laparoscopic approach and bridging repair were performed in 99.4% of patients. All device location was preperitoneal. No procedure-related adverse events within 30 days were reported. No surgical site infection or SSO events or device-related hernia recurrence occurred through 12 months. Procedure-related serious adverse events occurred in 6 patients; 5 recurrent inguinal hernias (at 1 and 2 y) and 1 scrotal hematoma (at 6 mo). Through 24 months, no SSO events requiring procedural intervention occurred. Through 50 months, 6 (2.98%) patients had confirmed hernia recurrence and 4 (1.99%) patients had hernia reoperation. The patient-reported outcome for pain was reported by 7.9% (10/126) of patients who completed the questionnaire. CONCLUSIONS In this study, inguinal hernia repair with the hybrid composite mesh was successful in most patients and the rate of recurrence was low, further supporting the long-term safety and device performance.
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Linn JG, Mallico EJ, Doerhoff CR, Grantham DW, Washington RG. Evaluation of long-term performance of an intraperitoneal biomaterial in the treatment of ventral hernias. Surg Endosc 2022; 37:3455-3462. [PMID: 36550313 PMCID: PMC10156806 DOI: 10.1007/s00464-022-09803-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 11/27/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND One-year device safety and clinical outcomes of ventral hernia repair with the GORE® SYNECOR Intraperitoneal Biomaterial, a hybrid composite mesh was evaluated. METHODS This retrospective, multicenter, case review analyzed device/procedure endpoints and patient-reported outcomes in patients treated for hernia repair ≥ 1 year from study enrollment. RESULTS Included were 459 patients (with 469 ventral hernias) with a mean age of 58 ± 15 years; 77.1% met Ventral Hernia Working Group 2 (VHWG2) classification. Mean hernia size was 18.9 cm2 and 57.3% of hernias were incisional. Laparoscopic or robotic approach was utilized in 95.4% of patients. Mesh location was intraperitoneal for 75.6% and bridging repair was performed in 57.3%. Procedure-related adverse events within 30-days occurred in 5.0% of patients and included surgical site infection (SSI), surgical site occurrence (SSO), ileus, readmission, and re-operation. Procedure-related SSI or SSO events were 3.8% through 12 months. SSO events requiring procedural intervention (SSOPI) were 2.6% through 24 months. Four patients (0.9%) had confirmed hernia recurrence through the study (the mean follow-up was 32-months, range 14-53 months). Subgroup comparisons were conducted for all type recurrence; only diabetes was found to be statistically significant (p = .0506). CONCLUSION In this analysis, ventral hernia repair with hybrid, composite mesh results in successful outcomes in most patients. This study represents a heterogeneous patient population undergoing repair using various approaches, mesh fixation, and mesh placement locations. These data appear to confirm long-term acceptable safety and device performance with a low rate of recurrence in a predominantly VHWG2 population.
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Affiliation(s)
- John G Linn
- NorthShore University Health System, 1000 Central St Suite 800, Evanston, IL, 60201, USA.
| | - Eric J Mallico
- Novant Health Bariatric Solutions-Salisbury, Salisbury, NC, USA
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Hopkins B, Eustache J, Ganescu O, Ciopolla J, Kaneva P, Fiore JF, Feldman LS, Lee L. At least ninety days of follow-up are required to adequately detect wound outcomes after open incisional hernia repair. Surg Endosc 2022; 36:8463-8471. [PMID: 35257211 DOI: 10.1007/s00464-022-09143-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 02/14/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Incisional hernia repair (IHR) carries a high risk of wound complications. Thirty-day outcomes are frequently used in comparative-effectiveness research, but may miss a substantial number of surgical site occurrences (SSO) including surgical site infection (SSI). The objective of this study was to determine an optimal length of follow-up to detect SSI after IHR. METHODS All adult patients undergoing open IHR at a single academic center over a 3 year period were reviewed. SSIs, non-infectious SSOs, and wound-related readmissions were recorded up to 180 days. The primary outcome was the proportion of SSIs detected at end-points of 30, 60, and 90 days of follow-up. Time-to-event analysis was performed for all outcomes at 30, 60, 90, and 180 days. Logistic regression was used estimate the relative risk of SSI for relevant risk factors. RESULTS A total of 234 patients underwent open IHR. Median follow-up time of 102 days. Overall incidence of SSI was 15.8% with median time to occurrence of 23 days. Incidence of non-infectious SSO was 33.2%, and SSO-related readmission was 12.8%. At 30, 60, and 90 days sensitivity was 81.6%, 89.5%, and 92.1 for SSI, and 46.7%, 76.7%, and 83.3% for readmission. In regression analysis, body mass index (RR 1.08, 95% CI 1.00, 1.15, p = 0.04) anterior component separation (RR 4.21, 95% CI 2.09, 6.34, p = 0.003), and emergency surgery (RR 3.25, 95% CI 1.47, 5.02, p = 0.01), were independently associated with SSI after adjusting for age, sex, contamination class, and procedure duration. CONCLUSION A considerable proportion of SSIs occurred beyond 30 days, but 90-day follow-up detected 92% of SSIs. Follow-up to 90 days captured only 83% of SSO-related readmissions. These results have implications for the design of trials evaluating wound complication after open IHR, as early endpoints may miss clinically relevant outcomes and underestimate the number needed to treat. Where possible, we recommend a minimum follow-up of 90 days to estimate wound complications following open IHR.
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Affiliation(s)
- Brent Hopkins
- Department of Surgery, McGill University Health Centre, 1001 Decarie Boulevard, DS1-3310, Montreal, QC, H3G 1A4, Canada.
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Ave, D6-136, Montreal, QC, H3G 1A4, Canada.
| | - Jules Eustache
- Department of Surgery, McGill University Health Centre, 1001 Decarie Boulevard, DS1-3310, Montreal, QC, H3G 1A4, Canada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Ave, D6-136, Montreal, QC, H3G 1A4, Canada
| | - Olivia Ganescu
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Josie Ciopolla
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Pepa Kaneva
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Ave, D6-136, Montreal, QC, H3G 1A4, Canada
| | - Julio F Fiore
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Ave, D6-136, Montreal, QC, H3G 1A4, Canada
| | - Liane S Feldman
- Department of Surgery, McGill University Health Centre, 1001 Decarie Boulevard, DS1-3310, Montreal, QC, H3G 1A4, Canada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Ave, D6-136, Montreal, QC, H3G 1A4, Canada
| | - Lawrence Lee
- Department of Surgery, McGill University Health Centre, 1001 Decarie Boulevard, DS1-3310, Montreal, QC, H3G 1A4, Canada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Ave, D6-136, Montreal, QC, H3G 1A4, Canada
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Outcomes of open transverse abdominis release for ventral hernias: a systematic review, meta-analysis and meta-regression of factors affecting them. Hernia 2022; 27:235-244. [PMID: 35922698 DOI: 10.1007/s10029-022-02657-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/23/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The primary objectives were to evaluate Surgical Site Occurrences (SSO) and Surgical Site Occurrences requiring procedural Intervention (SSOPI) after open transversus abdominis release and to study various factors affecting it. Secondary objectives were to evaluate Surgical Site Infections (SSI), recurrence rates and overall complications after transversus abdominis release (TAR) and the factors responsible for those. METHODS We searched PUBMED, SCOPUS and Cochrane databases with keywords "transversus abdominis release" or "TAR" OR "Surgical Site Occurrences" OR "posterior component separation AND "outcomes" as per PRISMA 2020 and MOOSE guidelines. Full texts and English literature studies were included, studies mentioning outcomes for open transversus abdominis release for ventral hernia were included and studies with robotic transversus abdominis release were excluded. Percentage occurrences of SSO, SSOPI, SSI, recurrence and overall complications after TAR were evaluated. Random effect meta-analysis with restricted maximum likelihood methods was used for meta-analysis. Heterogeneity was analysed using I2 statistics. Publication bias with eager's test and funnel plots. Meta0regression analysis was done to evaluate factors affecting the heterogeneity. JASP 0.16.2 software was used for meta-analysis. RESULTS Twenty-two studies including 5284 patients who underwent TAR for ventral hernia were included in systematic review and meta-analysis. Overall pooled SSO, SSOPI, Overall Complications, SSI and recurrence rates were 21.72% [95% C.I 17.18-26.27%], 9.82% [95% C.I 7.64 -12%], 33.34% [95% C.I. 27.43-39.26%], 9.13% [95% C.I. 6.41-11.84] and 1.6% [0.78-2.44], respectively. Heterogeneity was significant in all the analysis. Age (p < 0.001), sex (p < 0.001), BMI (p < 0.001),presence of comorbidities (p < 0.001), prior recurrence, defect size (p < 0.001) and current or past history of tobacco exposure were associated with SSO in multivariate meta-regression analysis. Defect size (p = 0.04) was associated with SSOPI. Age (p = 0.011), BMI (p = 0.013), comorbidities (p < 0.01), tobacco exposure (p = 0.018), prior recurrence (p < 0.01) and sex (p < 0.01) were associated with overall complications. CONCLUSION Open transversus abdominis release is associated with high rates of SSO, SSOPI, SSI and overall complications but recurrence rates are low. Various preoperative factors mentioned may be responsible for heterogeneity across studies.
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Negative Pressure Wound Therapy Prevents Hernia Recurrence in Simultaneous Ventral Hernia Repair and Panniculectomy. Plast Reconstr Surg Glob Open 2022; 10:e4171. [PMID: 35265446 PMCID: PMC8901215 DOI: 10.1097/gox.0000000000004171] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 01/07/2022] [Indexed: 11/26/2022]
Abstract
Simultaneous ventral hernia repair with panniculectomy (VHR-PAN) is associated with a high rate of wound complications. Closed incision negative pressure wound therapy (ciNPWT) has been shown to lower complications in high-risk wounds. There is a debate in the literature as to whether ciNPWT is effective at preventing complications in VHR-PAN. The aim of our study was to evaluate if ciNPWT improves outcomes of VHR-PAN.
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Afaque MY. Why Clavien-Dindo classification should be used along with SSI, SSO, and SSOPI in hernia surgery? Hernia 2022; 26:1399-1400. [PMID: 35166961 DOI: 10.1007/s10029-022-02578-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 02/03/2022] [Indexed: 11/04/2022]
Affiliation(s)
- M Y Afaque
- Department of Surgery, J N Medical College, AMU, Aligarh, UP, 202002, India.
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Hooper MA, Renshaw SM, Poulose BK. Patient perspectives on mesh-related complications after hernia repair. Surgery 2021; 171:994-999. [PMID: 34774293 DOI: 10.1016/j.surg.2021.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/13/2021] [Accepted: 09/20/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND To explore the thoughts, feelings, and experiences of patients with mesh-related complications after hernia repair. The rate of long-term mesh-related complications requiring procedural intervention after abdominal core surgery, including hernia repair, is unknown. Determining this rate is challenging due to its anticipated low chance of occuring and historically poor systematic long-term follow-up in patients' hernia repair. The lived experience of these patients is also not well understood. METHODS Purposive sampling was used to identify patients who have experienced mesh-related complications after hernia repair, and semistructured interviews were conducted. Descriptive thematic analysis was used to identify, analyze, and report common patterns across the data set related to the patient experience of mesh-related complications. RESULTS Eight patients who had undergone a hernia repair with mesh and had at least 1 mesh-related complication after their repair requiring operation, an additional procedure, or medical treatment were included in the study and completed semistructured interviews over the phone. Five domains emerged from the interviews: indicators of mesh-related complications, knowledge of potential surgical complications, relationship/satisfcation with surgeon and/or surgical team, psychosocial impact of hernia repair and mesh-related complications, and function. CONCLUSION Despite the widespread use of mesh in abdominal wall operations, little is known regarding the patient experience of mesh-related complications. The themes identified in the present study provide insight into the patient experience of mesh-related complications and can inform the future development of a patient-reported outcome measure to determine the true incidence of mesh-related complications and the impact of these complications on quality of life.
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Affiliation(s)
| | - Savannah M Renshaw
- Center for Abdominal Core Health, Department of Surgery, Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Benjamin K Poulose
- Center for Abdominal Core Health, Department of Surgery, Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, OH.
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General Surgery: Management of Postoperative Complications Following Ventral Hernia Repair and Inguinal Hernia Repair. Surg Clin North Am 2021; 101:755-766. [PMID: 34537141 DOI: 10.1016/j.suc.2021.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Ventral and inguinal hernia repairs are some of the most commonly performed general surgery operations worldwide. This review focuses on the management of postoperative complications, which include surgical site infection, hernia recurrence, postoperative pain, and mesh-related issues. In each section, we aim to discuss classifications, risk factors, diagnostic modalities, and treatment options for common complications following hernia repair.
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Parker SG, Halligan S, Berrevoet F, de Beaux AC, East B, Eker HH, Jensen KK, Jorgensen LN, Montgomery A, Morales-Conde S, Miserez M, Renard Y, Sanders DL, Simons M, Slade D, Torkington J, Blackwell S, Dames N, Windsor ACJ, Mallett S. Reporting guideline for interventional trials of primary and incisional ventral hernia repair. Br J Surg 2021; 108:1050-1055. [PMID: 34286842 DOI: 10.1093/bjs/znab157] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 03/02/2021] [Accepted: 04/13/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Primary and incisional ventral hernia trials collect unstandardized inconsistent data, limiting data interpretation and comparison. This study aimed to create two minimum data sets for primary and incisional ventral hernia interventional trials to standardize data collection and improve trial comparison. To support these data sets, standardized patient-reported outcome measures and trial methodology criteria were created. METHODS To construct these data sets, nominal group technique methodology was employed, involving 15 internationally recognized abdominal wall surgeons and two patient representatives. Initially a maximum data set was created from previous systematic and panellist reviews. Thereafter, three stages of voting took place: stage 1, selection of the number of variables for data set inclusion; stage 2, selection of variables to be included; and stage 3, selection of variable definitions and detection methods. A steering committee interpreted and analysed the data. RESULTS The maximum data set contained 245 variables. The three stages of voting commenced in October 2019 and had been completed by July 2020. The final primary ventral hernia data set included 32 variables, the incisional ventral hernia data set included 40 variables, the patient-reported outcome measures tool contained 25 questions, and 40 methodological criteria were chosen. The best known variable definitions were selected for accurate variable description. CT was selected as the optimal preoperative descriptor of hernia morphology. Standardized follow-up at 30 days, 1 year, and 5 years was selected. CONCLUSION These minimum data sets, patient-reported outcome measures, and methodological criteria have allowed creation of a manual for investigators aiming to undertake primary ventral hernia or incisional ventral hernia interventional trials. Adopting these data sets will improve trial methods and comparisons.
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Affiliation(s)
- S G Parker
- Abdominal Wall Unit, General Surgery, University College London Hospital, London, UK
| | - S Halligan
- Centre for Medical Imaging, University College London, London, UK
| | - F Berrevoet
- Department of General and Hepatobiliary Surgery and Liver Transplantation, University Hospital Ghent, Ghent, Belgium
| | - A C de Beaux
- Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - B East
- 3rd Department of Surgery, Motol University Hospital, 1st and 2nd Medical Faculty of Charles University, Prague, Czech Republic
| | - H H Eker
- Department of Surgery, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - K K Jensen
- General Surgery, Digestive Disease Centre, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - L N Jorgensen
- General Surgery, Digestive Disease Centre, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - A Montgomery
- Department of Surgery, Skåne University Hospital Malmö, Malmö, Sweden
| | - S Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of Surgery, University Hospital Virgen del Rocio, University of Seville, Seville, Spain
| | - M Miserez
- Department of Abdominal Surgery, University Hospitals of the Katholieke Universiteit Leuven, Leuven, Belgium
| | - Y Renard
- Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Reims, France
| | - D L Sanders
- Department of General and Upper Gastrointestinal Surgery, North Devon District Hospital, Barnstaple, UK
| | - M Simons
- Department of Surgery, Onze Lieve Vrouwe Gasthuis Hospital, Amsterdam, the Netherlands
| | - D Slade
- Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Salford, UK
| | - J Torkington
- Department of Colorectal Surgery, University Hospital of Wales, Cardiff, UK
| | | | - N Dames
- Patient Representative, Glasgow, UK
| | - A C J Windsor
- Abdominal Wall Unit, General Surgery, University College London Hospital, London, UK
| | - S Mallett
- Centre for Medical Imaging, University College London, London, UK
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Gachabayov M, Latifi R. Different etiopathogeneses in early-onset and late-onset inguinal hernia mesh infections in a prospectively evaluated cohort. Acta Chir Belg 2021; 121:164-169. [PMID: 31690215 DOI: 10.1080/00015458.2019.1689648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Inguinal hernia mesh infection (IHMI) is a rare but a significant problem. The aim of this study was to determine whether etiopathogeneses of early-onset and late-onset IHMIs differ in terms of the origin of infectious agents, and route of dissemination. PATIENTS AND METHODS This was a retrospective cohort study with prospective data collection of patients operated on from 2013 to 2015. Early-onset IHMI was defined as symptoms developed within one year after the index surgery, whereas late-onset IHMI was defined as infection developed later than a year after the index surgery. Age, gender, ASA score, BMI, time from index surgery, isolated infectious agents and possible pathogeneses were analyzed. RESULTS During the study period, 1438 patients underwent inguinal hernia repair. Sixteen patients (1.1%) had IHMI, of whom nine were early-onset and seven late-onset. The groups were comparable for age (p = .54), gender (p = 1.0), BMI (p = .79), and ASA score (p = 1.0). The most common infectious agent in early-onset IHMI was St. aureus, whereas Enterococci and Enterobacter prevailed in late-onset IHMI. The possible pathogenesis of IHMI in seven patients with early-onset IHMI was primary exogenous infection, whereas in patients with late-onset IHMI the pathogenesis might be hematogenous or contact spread. All patients with IHMI underwent mesh removal. In two patients (one from each group), partial mesh removal was performed previously and IHMI recurred. CONCLUSIONS Early-onset hernia mesh infection is mostly caused by St. aureus through exogenous contamination, whereas its late-onset counterpart might be a result of hematogenous or contact spread of intestinal flora.
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Affiliation(s)
- Mahir Gachabayov
- Westchester Medical Center, New York Medical College, Valhalla, NY, USA
- Vladimir City Clinical Hospital of Emergency Medicine, Vladimir, Russia
| | - Rifat Latifi
- Westchester Medical Center, New York Medical College, Valhalla, NY, USA
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McGuirk M, Kajmolli A, Gachabayov M, Smiley A, Samson D, Latifi R. Independent Predictors for Surgical Site Infections in Patients Undergoing Complex Abdominal Wall Reconstruction. Surg Technol Int 2021; 38:179-185. [PMID: 33823057 DOI: 10.52198/21.sti.38.hr1431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Complex abdominal wall reconstruction (CAWR) in patients with large abdominal defects have become a common procedure. The aim of this study was to identify independent predictors of surgical site infections (SSI) in patients undergoing CAWR. MATERIALS AND METHODS This was an ambidirectional cohort study of 240 patients who underwent CAWR with biologic mesh between 2012 and 2020 at an academic tertiary/quaternary care center. Prior superficial SSI, deep SSI, organ space infections, enterocutaneous fistulae, and combined abdominal infections were defined as prior abdominal infections. Univariable and multivariable logistic regression models were performed to determine independent risk factors for SSI. RESULTS There were a total of 39 wound infections, with an infection rate of 16.3%. Forty percent of patients who underwent CAWR in this study had a history of prior abdominal infections. In the multivariable regression models not weighted for length of stay (LOS), prior abdominal infection (odds ratio [OR]: 2.49, p=0.013) and higher body mass index (BMI) (OR: 1.05, p=0.023) were independent predictors of SSI. In the multivariable regression model weighted for LOS, prior abdominal infection (OR: 2.2, p=0.034), higher BMI (OR: 1.05, p=0.024), and LOS (OR: 1.04, p=0.043) were independent predictors of SSI. CONCLUSION The history of prior abdominal infections, higher BMI, and increased LOS are important independent predictor of SSI following CAWR.
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Affiliation(s)
- Matthew McGuirk
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York
| | - Agon Kajmolli
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York
| | - Mahir Gachabayov
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York
| | - Abbas Smiley
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York
| | - David Samson
- Department of Surgery Clinical Research Unit, Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York
| | - Rifat Latifi
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York
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Emile SH, Elfallal AH, Elbaz SA, Elmetwally AM. Development and validation of risk prediction score for incisional surgical site infection after appendectomy. Updates Surg 2021; 73:2189-2197. [PMID: 33394358 DOI: 10.1007/s13304-020-00944-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
Surgical site infection (SSI) is a challenging and resource-consuming healthcare problem. Predicting the onset of SSI beforehand can help prevent or minimize its incidence. The present study aimed to determine the independent predictors of incisional SSI after open appendectomy using a multivariate analysis and to establish a predictive risk score of SSI after appendectomy. Records of eligible patients who underwent open appendectomy were reviewed. The characteristics and treatment outcomes of patients were collected and analyzed. Significant association between different variables and SSI after appendectomy was examined by univariate analysis. Then, variables with a significant association with SSI were entered into a multivariate binary logistic regression analysis to determine the significant independent predictors of SSI. The study included 343 patients (51.3% female). Incisional SSI was recorded in 44 (12.8%) patients. Univariate analysis revealed five parameters with a significant association with SSI, including BMI > 30 kg/m2 (p < 0.0001), diabetes mellitus (DM) (p = 0.0001), total leukocyte count (p = 0.04), free intraperitoneal fluid (p < 0.0001), and perforated/gangrenous appendicitis (p < 0.0001). After identifying four significant independent predictors of incisional SSI by binary logistic regression analysis, a predictive risk score was developed. The independent predictors of SSI were DM (OR = 6.05, p = 0.005), free intraperitoneal fluid (OR = 6.94, p = 0.0001), obesity (OR = 8.94, p = 0.0001), and perforated/gangrenous appendicitis (OR = 24.64, p = 0.0001). Four independent predictors of incisional SSI after open appendectomy were found after multivariate analysis. A predictive risk score of SSI was developed and included obesity, DM, free intraperitoneal fluid, and perforated/gangrenous appendicitis as predictors of SSI.
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Affiliation(s)
- Sameh Hany Emile
- Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt.
| | - Ahmed Hossam Elfallal
- Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
| | - Samy Abbas Elbaz
- Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
| | - Ahmed Magdy Elmetwally
- Vascular Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
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Emile SH, Elfallal AH, Abdel-Razik MA, El-Said M, Elshobaky A. A randomized controlled trial on irrigation of open appendectomy wound with gentamicin- saline solution versus saline solution for prevention of surgical site infection. Int J Surg 2020; 81:140-146. [PMID: 32798761 DOI: 10.1016/j.ijsu.2020.07.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/03/2020] [Accepted: 07/21/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Surgical site infection (SSI) is one of the most common complications after abdominal surgery. The present trial examined the efficacy of saline irrigation of open appendectomy wound with or without topical antibiotics in prevention of SSI. METHODS This was a double-blind randomized trial on patients with acute appendicitis who underwent open appendectomy. Patients were randomly allocated to one of three equal groups; group I had layer-by-layer wound irrigation with gentamicin-saline solution, group II had wound irrigation with saline solution, and group III received no irrigation (Control group). The main outcome measures were the incidence of incisional SSI, surgical site occurrence (SSO), other complications, operation time, postoperative pain, and patients' satisfaction. RESULTS 205 patients (113 female) of a mean age of 27.9 years were included. The average hospital stay and pain scores were similar in the three groups. Groups I and II had significantly lower rates of incisional SSI (4.3% Vs 2.9%; Vs 17.4%, p = 0.005) and SSO (24.6% Vs 13.4% Vs 43.5%; p = 0.0003) as compared to group III. Groups I and II had comparable rates of SSI and SSO. The three groups had similar rates of wound seroma, hematoma, and dehiscence. Groups I and II had significantly higher satisfaction with the procedure than group III. CONCLUSIONS Layer-by-layer irrigation of open appendectomy wound decreased the rates of incisional SSI and SSO significantly compared to the no-irrigation group. Adding gentamicin to saline solution was useless to improve the outcome and did not decrease rates of SSI or other complications.
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Affiliation(s)
- Sameh Hany Emile
- General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura City, Egypt.
| | - Ahmed Hossam Elfallal
- General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura City, Egypt.
| | - Mohamed Anwar Abdel-Razik
- General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura City, Egypt.
| | - Mohamed El-Said
- General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura City, Egypt.
| | - Ayman Elshobaky
- General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura City, Egypt.
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16
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Schlosser KA, Maloney SR, Horton JM, Prasad T, Colavita PD, Heniford BT, Augenstein VA. The association of penicillin allergy with outcomes after open ventral hernia repair. Surg Endosc 2020; 34:4148-4156. [PMID: 32016513 DOI: 10.1007/s00464-019-07183-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 09/30/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Up to 11% of patients report a penicillin allergy (PA), with 1-2% demonstrating a true IgE mediated allergy upon testing. PA patients often receive non-beta-lactam antibiotic surgical prophylaxis (non-BLP). This study evaluates the relationship of PA to outcomes after open ventral hernia repair (OVHR). METHODS A prospective institutional database was queried for patients undergoing OVHR. Demographics, operative characteristics, and outcomes were evaluated by the reported PA and the administration of beta-lactam prophylaxis (BLP). RESULTS Allergy histories were reviewed in 1178 patients. PA was reported in 21.6% of patients, with 55.5% reporting rash or hives, 15.0% airway compromise or anaphylaxis, and 29.5% no specific reaction. BLP was administered to 76.3% of patients, including 22.1% of PA patients and 89.9% of patients without PA. PA patients were more often female (64.6% PA patients vs. 56% non-PA, p = 0.01), with higher rates of chronic steroids, MRSA, anxiety, asthma, COPD, chronic pain, and sleep apnea (p < 0.03 all values). PA patients had higher rates of contaminated cases, including mesh infection and fistula. Of the 683 clean cases, 82.1% received BLP. Of the 117 clean contaminated cases (CDC wound class 2), 82.9% received BLP, which was associated with reduced long-term readmission for hernia complications (21.5 vs. 55%, p = 0.002, OR 0.27, CI 0.09-0.83). In the 120 CDC wound class 3 and 4 patients, 65.8% received BLP. In multivariate analysis, BLP was associated with lower rates of reoperation (OR 0.31, CI 0.12-0.76) and recurrence (OR 0.32, CI 0.11-0.86). BLP was given to 22.1% of the PA patients with no adverse reactions noted. CONCLUSION PA patients had more comorbidities and complex ventral hernias. When controlling for contamination and MRSA history, BLP is associated with improved outcomes particularly in contaminated cases. PA may be a risk factor for patient complexity, and further studies are warranted to determine if allergy testing can be warranted in known or anticipated contaminated cases.
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Affiliation(s)
- Kathryn A Schlosser
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, 28204, USA
| | - Sean R Maloney
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, 28204, USA
| | - James M Horton
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, 28204, USA
| | - Tanushree Prasad
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, 28204, USA
| | - Paul D Colavita
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, 28204, USA
| | - B Todd Heniford
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, 28204, USA
| | - Vedra A Augenstein
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, 28204, USA. .,Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC, 28204, USA.
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17
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Improving Shared Decision-making and Treatment Planning Through Predictive Modeling: Clinical Insights on Ventral Hernia Repair. Comput Inform Nurs 2020; 38:227-231. [PMID: 31929356 DOI: 10.1097/cin.0000000000000590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Abdominal wall hernia repair, including ventral hernia repair, is one of the most common general surgical procedures. Nationally, at least 350 000 ventral hernia repairs are performed annually, and of those, 150 000 cases were identified as incisional hernias. Outcomes are reported to be poor, resulting in additional surgical repair rates of 12.3% at 5 years and as high as 23% at 10 years. Healthcare costs associated with ventral hernia repair are estimated to exceed $3 billion each year. Additionally, ventral hernia repair is often complex and unpredictable when there is a current infection or a history of infection and significant comorbidities. Accordingly, a predictive model was developed using a retrospectively collected dataset to associate the pre- and intra-operative characteristics of patients to their outcomes, with the primary goal of identifying patients at risk of developing complications a priori in the future. The benefits and implications of such a predictive model, however, extend beyond this primary goal. This predictive model can serve as an important tool for clinicians who may use it to support their clinical intuition and clarify patient need for lifestyle modification prior to abdominal wall reconstruction. This predictive model can also support shared decision-making so that a personalized plan of care may be developed. The outcomes associated with use of the predictive model may include surgical repair but may suggest lifestyle modification coupled with less invasive interventions.
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Tastaldi L, Petro CC, Krpata DM, Alkhatib H, Fafaj A, Tu C, Rosenblatt S, Prabhu AS, Poulose BK, Rosen MJ. History of surgical site infection increases the odds for a new infection after open incisional hernia repair. Surgery 2019; 166:88-93. [DOI: 10.1016/j.surg.2019.01.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/12/2019] [Accepted: 01/25/2019] [Indexed: 01/03/2023]
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Petro CC, Tastaldi L, Rosen MJ, Prabhu AS. Response to: Active smoking really matters before ventral hernia repair. Surgery 2019; 165:853-858. [PMID: 30739751 DOI: 10.1016/j.surg.2018.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/15/2018] [Accepted: 12/18/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Clayton C Petro
- Cleveland Clinic, Department of General Surgery, Cleveland Clinic Comprehensive Hernia Center, Cleveland, OH.
| | - Luciano Tastaldi
- Cleveland Clinic, Department of General Surgery, Cleveland Clinic Comprehensive Hernia Center, Cleveland, OH
| | - Michael J Rosen
- Cleveland Clinic, Department of General Surgery, Cleveland Clinic Comprehensive Hernia Center, Cleveland, OH
| | - Ajita S Prabhu
- Cleveland Clinic, Department of General Surgery, Cleveland Clinic Comprehensive Hernia Center, Cleveland, OH
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20
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Long-term follow-up of a randomized controlled trial of Lichtenstein repair vs the Valenti technique for inguinal hernia. Hernia 2019; 23:547-554. [PMID: 30659397 PMCID: PMC6586697 DOI: 10.1007/s10029-019-01879-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 01/01/2019] [Indexed: 01/15/2023]
Abstract
Purpose The aim of the study was to offer a prospective comparative assessment of long-term outcomes for inguinal hernia repair using Valenti and Lichtenstein techniques. Materials and methods 568 surgical procedures for unilateral inguinal hernia repair using the Valenti (group V) or the Lichtenstein technique (group L) were performed. After the mean follow-up time of 9 years (8–12), 185 patients (70.1%) treated using Valenti method and 186 patients (71.3%) treated using Lichtenstein method were clinically assessed. All clinical data were registered in National Hernia Registry. The rate of recurrence was assessed as primary outcome. The secondary outcome involved chronic pain (VAS). Results 9-year recurrence rate was 2.2% in both groups. No significant difference in recurrence rate was demonstrated in analysis adjusted for surgeon’s education, type of hernia, hernia size, hernia duration, or BMI between two groups (OR 1.0; 95% CI 0.69–1.67; p = 1.0). In follow-up the majority of patients reported no pain (71.9% in V; 73.7% in L). A constant pain was reported by four patients in each group. Severe pain was reported by 1.6% in V and 2.1% in L (p = 0.192). Conclusions Inguinal hernia repairs using Valenti and Lichtenstein methods show high, long-term effectiveness and do not significantly differ in the recurrence rate. Both methods ensure a low rate of chronic pain. The use of a single mesh size with a precisely defined shape and of a uniform mesh fixation method ensures the standardization of surgical technique. The Valenti method is an uncomplicated, technically reproducible procedure with a low learning curve.
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21
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Tubre DJ, Schroeder AD, Estes J, Eisenga J, Fitzgibbons RJ. Surgical site infection: the "Achilles Heel" of all types of abdominal wall hernia reconstruction. Hernia 2018; 22:1003-1013. [PMID: 30276561 DOI: 10.1007/s10029-018-1826-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 09/14/2018] [Indexed: 01/12/2023]
Abstract
PURPOSE Surgical site infection is the most common hospital-acquired infection in surgical patients. Recently, public health organizations have updated prevention guidelines. This review discusses surgical site infections as a complication of abdominal wall reconstruction. METHODS The authors reviewed guidelines on prevention of surgical site infections from the Center for Disease Control and Prevention, World Health Organization, and National Institute for Health and Care Excellence and put them into context with the relevant abdominal wall reconstruction literature. This was the subject of the Nyhus-Wantz lecture given at The International Hernia Congress on March 14, 2018 in Miami, FL and is summarized here. RESULTS Routine use of preoperative antibiotics in prosthetic groin hernia repair is not supported by the available literature. High-quality data on antibiotic prophylaxis in ventral (both primary and incisional) hernia repair is lacking, but it is widely utilized and may reduce SSIs. Recommended preventative strategies discussed in this manuscript include: treatment of remote site infections, perioperative normothermia and normoglycemia, avoidance of hypoxemia, antiseptic preparation of surgical team hands and patient skin, treatment of obesity, smoking cessation, correction of malnutrition, and physical conditioning. CONCLUSION Surgical site infections lead to significant morbidity and mortality, hernia recurrences, prolonged hospital stay, and increased hospital costs. This makes surgical site infections the "Achilles Heel" of abdominal wall reconstruction. Strict adherence to standardized guidelines and preoperative optimization of patients' risk profiles are crucial to decrease the incidence of surgical site infections.
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Affiliation(s)
- D J Tubre
- Department of Surgery, Creighton University Medical Center, Bergan Mercy, 7710 Mercy Road, Suite 501, Omaha, NE, 68124, USA
| | - A D Schroeder
- Department of Surgery, Creighton University Medical Center, Bergan Mercy, 7710 Mercy Road, Suite 501, Omaha, NE, 68124, USA
| | - J Estes
- Creighton University School of Medicine, 2500 California Plaza, Omaha, NE, 68178, USA
| | - J Eisenga
- Creighton University School of Medicine, 2500 California Plaza, Omaha, NE, 68178, USA
| | - R J Fitzgibbons
- Department of Surgery, Creighton University Medical Center, Bergan Mercy, 7710 Mercy Road, Suite 501, Omaha, NE, 68124, USA.
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22
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DeBord J, Novitsky Y, Fitzgibbons R, Miserez M, Montgomery A. SSI, SSO, SSE, SSOPI: the elusive language of complications in hernia surgery. Hernia 2018; 22:737-738. [PMID: 30203373 DOI: 10.1007/s10029-018-1813-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 08/19/2018] [Indexed: 11/29/2022]
Affiliation(s)
- J DeBord
- University of Illinois College of Medicine at Peoria, Peoria, USA.
| | | | | | - M Miserez
- University Hospital Leuven, Leuven, Belgium
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Haskins IN, Krpata DM, Prabhu AS, Tastaldi L, Perez AJ, Tu C, Rosenblatt S, Poulose BK, Rosen MJ. Immunosuppression is not a risk factor for 30-day wound events or additional 30-day morbidity or mortality after open ventral hernia repair: An analysis of the Americas Hernia Society Quality Collaborative. Surgery 2018; 164:594-600. [PMID: 30029991 DOI: 10.1016/j.surg.2018.05.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/13/2018] [Accepted: 05/18/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Some form of immunosuppression is relatively common in patients undergoing ventral hernia repair. Nevertheless, the association of immunosuppression with 30-day wound events and additional outcomes of morbidity and mortality remains unknown. The purpose of our study was to investigate the association of immunosuppression with 30-day wound events and additional morbidity and mortality after ventral hernia repair by evaluating the database of the Americas Hernia Society Quality Collaborative. METHODS All patients undergoing open, elective, incisional ventral hernia surgery from July 2013 through April 2017 were identified within the database of the Americas Hernia Society Quality Collaborative. Patients on immunosuppression within the 3 months before operative intervention were compared with patients not on immunosuppression with respect to the incidence of 30-day wound events, using a 1:5 propensity matched analysis. RESULTS A total of 3,537 patients met inclusion criteria; 200 (5.7%) patients were on some form of immunosuppression at the time of ventral hernia repair. After propensity matching, 1,200 patients remained for analysis; 200 (16.7%) patients were in the immunosuppression group. There were no statistically significant differences between the 2 groups with respect to the incidence of 30-day surgical site infection, surgical site occurrence requiring procedural intervention, or additional 30-day morbidity or mortality outcomes. Patients in the immunosuppression group had a greater rate of surgical site occurrences, the majority of which were seromas (P = .03). CONCLUSION Immunosuppression is associated with an increased risk of 30-day surgical site occurrence but not surgical site infection, surgical site occurrence requiring procedural intervention, or additional 30-day morbidity or mortality. Additional studies are needed to determine the clinical importance of these surgical site occurrences with respect to long-term durability of the hernia repair.
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Affiliation(s)
- Ivy N Haskins
- Comprehensive Hernia Center, Department of General Surgery, The Cleveland Clinic Foundation, Cleveland, OH
| | - David M Krpata
- Comprehensive Hernia Center, Department of General Surgery, The Cleveland Clinic Foundation, Cleveland, OH
| | - Ajita S Prabhu
- Comprehensive Hernia Center, Department of General Surgery, The Cleveland Clinic Foundation, Cleveland, OH
| | - Luciano Tastaldi
- Comprehensive Hernia Center, Department of General Surgery, The Cleveland Clinic Foundation, Cleveland, OH
| | - Arielle J Perez
- Comprehensive Hernia Center, Department of General Surgery, The Cleveland Clinic Foundation, Cleveland, OH
| | - Chao Tu
- Department of Quantitative Health Sciences, Lerner Research Institute, The Cleveland Clinic Foundation, Cleveland, OH
| | - Steven Rosenblatt
- Comprehensive Hernia Center, Department of General Surgery, The Cleveland Clinic Foundation, Cleveland, OH
| | - Benjamin K Poulose
- The Vanderbilt Hernia Center, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Michael J Rosen
- Comprehensive Hernia Center, Department of Surgery, Cleveland Clinic, Cleveland, OH.
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Abstract
This article reviews the literature that supports routine expectations for smoking cessation; weight loss; diabetic, nutritional, or metabolic optimization; and decolonization techniques before ventral hernia repair. These methods diminish postoperative complications. In an era of value-centric care, an upfront investment in patient optimization can improve the quality of the repair by reducing wound morbidity and hernia recurrence, naturally translating to a reduction in cost. The adoption of these practices and further study aimed at identifying other effective optimization techniques are encouraged.
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Affiliation(s)
- Clayton C Petro
- Department of Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Ajita S Prabhu
- Department of Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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25
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Haskins IN, Horne CM, Krpata DM, Prabhu AS, Tastaldi L, Perez AJ, Rosenblatt S, Poulose BK, Rosen MJ. A call for standardization of wound events reporting following ventral hernia repair. Hernia 2018; 22:729-736. [PMID: 29429064 DOI: 10.1007/s10029-018-1748-6] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 01/25/2018] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Postoperative wound events following ventral hernia repair are an important outcome measure. While efforts have been made by hernia surgeons to identify and address risk factors for postoperative wound events following VHR, the definition of these events lacks standardization. Therefore, the purpose of our study was to detail the variability of wound event definitions in recent ventral hernia literature and to propose standardized definitions for postoperative wound events following VHR. METHODS The top 50 cited ventral hernia, peer-reviewed publications from 1995 through 2015 were identified using the search engine Google Scholar. The definition of wound event used and the incidence of postoperative wound events was recorded for each article. The number of articles that used a standardized definition for surgical site infection (SSI), surgical site occurrence (SSO), or surgical site occurrence requiring procedural intervention (SSOPI) was also identified. RESULTS Of the 50 papers evaluated, only nine (18%) used a standardized definition for SSI, SSO, or SSOPI. The papers that used standardized definitions had a smaller variability in the incidence of wound events when compared to one another and their reported rates were more consistent with recently published ventral hernia repair literature. CONCLUSION Postoperative wound events following VHR are intimately associated with patient quality of life and long-term hernia repair durability. Standardization of the definition of postoperative wound events to include SSI, SSO, and SSOPI following VHR will improve the ability of hernia surgeons to make evidence-based decisions regarding the management of ventral hernias.
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Affiliation(s)
- I N Haskins
- Department of General Surgery, Comprehensive Hernia Center, The Cleveland Clinic Foundation, Cleveland, OH, USA. .,Department of General Surgery, Cleveland Clinic Comprehensive Hernia Center, The Cleveland Clinic, 9500 Euclid Avenue, A100, Cleveland, OH, 44195, USA.
| | - C M Horne
- Department of General Surgery, Comprehensive Hernia Center, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - D M Krpata
- Department of General Surgery, Comprehensive Hernia Center, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - A S Prabhu
- Department of General Surgery, Comprehensive Hernia Center, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - L Tastaldi
- Department of General Surgery, Comprehensive Hernia Center, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Arielle J Perez
- Department of General Surgery, Comprehensive Hernia Center, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - S Rosenblatt
- Department of General Surgery, Comprehensive Hernia Center, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - B K Poulose
- Department of Surgery, The Vanderbilt Hernia Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - M J Rosen
- Department of General Surgery, Comprehensive Hernia Center, The Cleveland Clinic Foundation, Cleveland, OH, USA
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Emile SH, Elgendy H, Sakr A, Gado WA, Abdelmawla AA, Abdelnaby M, Magdy A. Outcomes following repair of incarcerated and strangulated ventral hernias with or without synthetic mesh. World J Emerg Surg 2017; 12:31. [PMID: 28729881 PMCID: PMC5516310 DOI: 10.1186/s13017-017-0143-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 07/10/2017] [Indexed: 12/21/2022] Open
Abstract
Background The use of synthetic mesh for ventral hernia repair under contaminated conditions is a controversial issue due to the considerable risk of surgical site infection (SSI). This study aimed to review the outcomes of repair of incarcerated and strangulated ventral hernias with or without synthetic mesh in compliance with established clinical guidelines regarding the incidence of SSI and hernia recurrence. Methods The records of patients with complicated ventral hernias who were treated with or without synthetic mesh repair were reviewed. Variables collected included the characteristics of patients and of ventral hernias, type of repair, and incidence of SSI and recurrence. Results One hundred twenty-two patients (56 males) of a mean age of 56 years were included. Fifty-two (42.6%) and 70 (57.4%) patients presented with incarcerated and strangulated ventral hernias, respectively. Sixty-six (54%) patients were treated with on-lay mesh repair, and 56 (46%) were managed with suture repair. Twenty-one patients required bowel resection. SSI was detected in eight (6.5%) patients. There was no significant difference between both groups regarding the incidence of SSI (7.5% for mesh group vs 5.3% for suture group). Recurrence occurred in seven patients. Median follow-up period was 24 months. The suture repair group had a significantly higher incidence of recurrence than the mesh group. Diabetes mellitus, previous recurrence, and intestinal resection were significant predictors for SSI. Conclusion Following established guidelines, synthetic mesh repair of incarcerated and strangulated ventral hernias attained lower recurrence rate, comparable incidence of SSI, and higher rate of seroma formation than suture repair. Trial registration Research Registry, researchregistry1891
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Affiliation(s)
- Sameh Hany Emile
- General surgery department, faculty of Medicine, Mansoura University Hospitals, Elgomhuoria Street, Mansoura city, Egypt
| | - Hesham Elgendy
- General surgery department, faculty of Medicine, Mansoura University Hospitals, Elgomhuoria Street, Mansoura city, Egypt
| | - Ahmad Sakr
- General surgery department, faculty of Medicine, Mansoura University Hospitals, Elgomhuoria Street, Mansoura city, Egypt
| | - Waleed Ahmed Gado
- General surgery department, faculty of Medicine, Mansoura University Hospitals, Elgomhuoria Street, Mansoura city, Egypt
| | - Ahmed Aly Abdelmawla
- General surgery department, faculty of Medicine, Mansoura University Hospitals, Elgomhuoria Street, Mansoura city, Egypt
| | - Mahmoud Abdelnaby
- General surgery department, faculty of Medicine, Mansoura University Hospitals, Elgomhuoria Street, Mansoura city, Egypt
| | - Alaa Magdy
- General surgery department, faculty of Medicine, Mansoura University Hospitals, Elgomhuoria Street, Mansoura city, Egypt
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Papageorge CM, Funk LM, Poulose BK, Phillips S, Rosen MJ, Greenberg JA. Primary fascial closure during laparoscopic ventral hernia repair does not reduce 30-day wound complications. Surg Endosc 2017; 31:4551-4557. [PMID: 28378079 DOI: 10.1007/s00464-017-5515-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 03/14/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Laparoscopic ventral hernia repair (LVHR) is associated with decreased wound morbidity compared to open repair. It remains unclear whether primary fascial closure (PFC) offers any benefit in reducing postoperative seroma compared to bridged repair. We hypothesized that PFC would have no effect on seroma formation following LVHR. METHODS A retrospective cohort study was performed using data from the prospectively maintained Americas Hernia Society Quality Collaborative. All patients undergoing LVHR from 2013 to 2016 were included. The primary outcome was seroma formation, diagnosed either clinically or radiographically. Secondary outcomes included surgical site infections (SSI), surgical site occurrences (SSO), and SSO requiring intervention. Patient characteristics and outcomes were compared between groups with univariate analysis using Pearson's chi-squared or Wilcoxon tests. Multivariable logistic regression controlling for patient and hernia characteristics was then performed to investigate the independent effect of PFC on seroma formation. RESULTS 1280 patients were included in the study. 69% (n = 887) underwent PFC. Patients undergoing bridged repairs had slightly larger defects and were more likely to have a recurrent hernia. The overall rate of seroma formation was 10.4% (n = 133). There was no association on univariate analysis between PFC and wound complications. Similarly, on multivariable analysis, PFC had no significant effect on the risk of seroma formation (OR 0.87, 95% CI 0.58-1.31). CONCLUSIONS PFC does not decrease the risk of short-term wound complications. Given that prior studies have also suggested no difference in hernia recurrence, PFC does not appear to improve postoperative outcomes for patients undergoing LVHR.
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Affiliation(s)
- Christina M Papageorge
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, BX 7375 Clinical Science Center - H4, Madison, WI, 53792, USA.
| | - Luke M Funk
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, BX 7375 Clinical Science Center - H4, Madison, WI, 53792, USA
- William S. Middleton VA, Madison, WI, USA
| | - Benjamin K Poulose
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sharon Phillips
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael J Rosen
- Department of Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Jacob A Greenberg
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, BX 7375 Clinical Science Center - H4, Madison, WI, 53792, USA
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28
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Kummerow Broman K, Huang LC, Faqih A, Phillips SE, Baucom RB, Pierce RA, Holzman MD, Sharp KW, Poulose BK. Hidden Morbidity of Ventral Hernia Repair with Mesh: As Concerning as Common Bile Duct Injury? J Am Coll Surg 2017; 224:35-42. [DOI: 10.1016/j.jamcollsurg.2016.09.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 09/20/2016] [Accepted: 09/21/2016] [Indexed: 02/04/2023]
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