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Hiekkaranta JM, Ahonen M, Mäkäräinen E, Ohtonen P, Saarnio J, Rautio T. Ventralex™ ST Hernia Patch Repair for Small Umbilical Hernia is Safe and Effective: A Retrospective Cohort Study. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2023; 2:11499. [PMID: 38312418 PMCID: PMC10831647 DOI: 10.3389/jaws.2023.11499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 05/24/2023] [Indexed: 02/06/2024]
Abstract
Background: Hernia patches for umbilical hernia repair have gained popularity due to their short operation time and ease of use. However, up to 10% re-operation and 8% recurrence rates at 2-year follow-up have been published. This retrospective cohort study presents the long-term results of the hernia patch technique for umbilical hernia repair. Methods: All adult patients who underwent a primary umbilical hernia repair at Oulu University Hospital hernia surgery units during 2014-2018 were included in the study. The primary outcome measure was recurrence rate. Secondary outcomes were complications and re-operation rate. Results: A total of 619 elective primary umbilical hernia repairs were performed during 2014-2018. The major technique used was Ventralex™ ST hernia patch repair (79.0%, 488/619) for small hernias with a mean width of 1.8 (SD 0.79) cm. Most of the patches (84.7%, 414/488) were placed in the preperitoneal space. Hernia recurrence rate of patient operated on using Ventralex™ ST hernia patch was 2.5% (12/488) during a mean follow-up time of 68 (SD 16, 43-98) months. Re-operation rate for another reason than recurrence was 1.6% (8/488). Clavien-Dindo complications ≥3 occurred in 4.1% (20/488) of cases and surgical site infection rate was 3.3% (16/488). Conclusion: Umbilical hernia repair using a Ventralex™ ST hernia patch placed in preperitoneal space have acceptable results in terms of recurrence and re-operations in this cohort study.
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Affiliation(s)
- Juha M. Hiekkaranta
- Department of Surgery, Oulu University Hospital, Medical Research Center, University of Oulu, Oulu, Finland
| | - Mirella Ahonen
- Department of Surgery, Oulu University Hospital, Medical Research Center, University of Oulu, Oulu, Finland
| | - Elisa Mäkäräinen
- Department of Surgery, Oulu University Hospital, Medical Research Center, University of Oulu, Oulu, Finland
| | - Pasi Ohtonen
- Research Service Unit, Oulu University Hospital, The Research Unit of Surgery, Anesthesia and Intensive Care, University of Oulu, Oulu, Finland
| | - Juha Saarnio
- Department of Surgery, Oulu University Hospital, Medical Research Center, University of Oulu, Oulu, Finland
| | - Tero Rautio
- Department of Surgery, Oulu University Hospital, Medical Research Center, University of Oulu, Oulu, Finland
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Gallagher KC, Pinzon-Guzman C, Pierce RA, Tan MCB. Small Bowel Obstruction Caused by Bezoar Formation Around Intraluminal Hernia Mesh. Am Surg 2022; 88:1904-1906. [PMID: 35451332 DOI: 10.1177/00031348221086788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We present a case report wherein a 55-year-old female presented to our clinic with chronic nausea, vomiting, and dehydration in the setting of a complex past surgical history, including laparoscopic incisional hernia repair in 2007 with intraperitoneal TiMeshTM. She then developed chronic nausea and vomiting and was hospitalized numerous times for dehydration. Due to her ongoing symptoms, she was taken to the operating room for exploration. A large, firm, mobile mass was identified within a loop of small bowel and was found to be a large bezoar firmly attached to a piece of intraluminal mesh. She progressed well postoperatively and, on outpatient follow-up, her pre-operative abdominal symptoms had completely resolved. To our knowledge, this is the first reported case of gallstone-like bezoar formation around an intraluminal hernia mesh causing small bowel obstruction and chronic abdominal pain.
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Affiliation(s)
- Kathleen C Gallagher
- Section of Surgical Sciences, 5718Vanderbilt University Medical Center, Nashville, TN, USA
| | - Carolina Pinzon-Guzman
- Section of Surgical Sciences, 5718Vanderbilt University Medical Center, Nashville, TN, USA
| | - Richard A Pierce
- Section of Surgical Sciences, 5718Vanderbilt University Medical Center, Nashville, TN, USA
| | - Marcus C B Tan
- Section of Surgical Sciences, 5718Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Ingram Cancer Center, 12328Vanderbilt University Medical Center, Nashville, TN, USA
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Behbehani M, AlAtwan AA, AlHaddad A. Colon diverticulosis adherent to mesh plug migration after laparoscopic hernia repair: A case study and review of literature. Int J Surg Case Rep 2021; 87:106403. [PMID: 34537527 PMCID: PMC8449232 DOI: 10.1016/j.ijscr.2021.106403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/10/2021] [Accepted: 09/10/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Inguinal hernia repair has evolved from open suture methods to mesh repair which is preformed either open or laparoscopically. Mesh hernia repair has improved the outcome in regards to patient care and recurrence rate but it is also associated with a number of complications. The complications of mesh hernia repair such as deep seated infections, mesh erosion and mesh perforation into nearby viscera has been scarcely reported in literature. Case presentation We report a 43 years old male case of diverticulosis adherent to a migrated mesh plug from previous laparoscopic inguinal hernia repair procedure. Discussion The choice of mesh material, appropriate suture placement and closure of the peritoneum after mesh repair is very crucial to avoid long term mesh complications. Conclusion The aim of this case report is to present a rare complication of mesh erosion with colovesical fistula and abscess formation. Inguinal hernia repair is one of the most common procedures performed in surgical practice. Mesh hernia repair has improved patient outcomes; regardless it is associated with some complications. Mesh migration as a complication should be thought of in patients presenting with acute abdomen.
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Leach JR, Manoukian B, Stewart L. Mesh on the move: a case report of total transmural surgical mesh migration causing bowel obstruction. Clin J Gastroenterol 2020; 14:136-140. [PMID: 33241525 DOI: 10.1007/s12328-020-01291-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 10/28/2020] [Indexed: 08/30/2023]
Abstract
We present the case of a 60-year-old man with a complex medical history, presenting to the hospital with generalized weakness and found to be markedly hyperglycemic. Early in the patient's hospital course, he developed abdominal pain and was found to have a small bowel obstruction secondary to intraluminal migrated surgical mesh entrapped in the terminal ileum. The bowel obstruction was relieved surgically with uncomplicated mesh removal and ileocecectomy. Surgical mesh migration is a relatively rare complication of hernia repair and abdominal wall reconstruction, and intraluminal mesh migration is an even more rare variant. Our case demonstrates key clinical and imaging features and serves as an important example of how such cases may present.
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Affiliation(s)
- Joseph Ryan Leach
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA. .,Department of Radiology, San Francisco Veterans Affairs Medical Center, 4150 Clement St, Building 200, Room 2D-008, San Francisco, CA, 94121, USA.
| | - Bryan Manoukian
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Lygia Stewart
- Department of Surgery, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
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Lee Y, Bae BN. Transmural Mesh Migration From the Abdominal Wall to the Rectum After Hernia Repair Using a Prolene Mesh: A Case Report. Ann Coloproctol 2020; 37:S28-S33. [PMID: 32674553 PMCID: PMC8359694 DOI: 10.3393/ac.2020.04.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 04/19/2020] [Indexed: 12/29/2022] Open
Abstract
Mesh erosion or migration is a rare and late complication after hernia repair. Its incidence is increasing as the utilization of prosthetic mesh gains popularity for abdominal hernia repair. However, mesh migration is exceedingly rare and its clinical presentation is atypical and diverse. Therefore, the management of mesh migration should be individualized to each patient. This research reports the case of a 94-year-old man with transmural migration of Prolene mesh (Ethicon) from the abdominal wall to the rectum 14 years after incisional hernia repair. He presented with only chronic abdominal pain and constipation. Migration of the mesh and a fistula between the right abdominal wall and transverse colon was observed on computed tomography. The mesh was evacuated manually from the anus without any sequelae. These findings made this case atypical, since complete transluminal migration of mesh is exceedingly rare and mesh erosion or migration requires surgical treatment in many cases.
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Affiliation(s)
- Yujin Lee
- Department of General Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Byung-Noe Bae
- Department of General Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Re-do surgery after prosthetic abdominal wall repair: intraoperative findings of mesh-related complications. Hernia 2020; 25:435-440. [PMID: 32495044 DOI: 10.1007/s10029-020-02225-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 05/20/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Mesh repair is one of the most popular technique for the treatment of abdominal wall hernias, resulting in lower recurrence rates. However, it is associated with a high risk of mesh-related complications. The aim of the present study is to assess the impact of biomaterials on the intra-abdominal organs, in terms of adhesions and visceral complications, in a series of patients undergoing re-do surgery at our abdominal wall unit. MATERIALS AND METHODS We reviewed the clinical records of 301 patients who undergone laparotomy between June 2008 and May 2018, selecting 67 patients with one or more previous prosthetic abdominal wall repair (AWR). RESULTS The average number of previous repairs was 1.6 with a mean time interval of 66 months from the last repair. Clinical presentation included hernia recurrence (69%), mesh infection (26%), infection and recurrence (10%), and fistula (1%). Adhesions were intraoperatively observed in all patients, except for eight cases. Mesh was completely removed in 43 patients, partially in four. Postoperative complications were observed in 39% of cases, including wound dehiscence, hematoma, seroma, and mesh infection. CONCLUSIONS Long-term implant results in abdominal wall repair and are not completely known, and literature is still lacking on this topic. Re-do surgery for subsequent pathological events may represent a way to increase our knowledge.
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Ngo P, Cossa JP, Largenton C, Johanet H, Gueroult S, Pélissier E. Ventral hernia repair by totally extraperitoneal approach (VTEP): technique description and feasibility study. Surg Endosc 2020; 35:1370-1377. [PMID: 32240382 DOI: 10.1007/s00464-020-07519-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 03/26/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The repair of ventral hernias by intra-peritoneal patch (IPOM) involves a risk of pain due to stapling as well as intestinal adhesions. Extraperitoneal placement of the patch without fixation can prevent these drawbacks. Techniques of endoscopic preperitoneal repair were previously described by others. The aim of this article is to describe our technique and to evaluate the feasibility and short-term results. METHODS The totally endoscopic technique consists of dividing the median aponeurotic structures, while preserving the proper linea alba, to create a unique retro-muscular space, in which the patch is deployed without any fixation. Hundred twelve consecutive patients were operated on for ventral hernias (82 umbilical, 20 epigastric, 10 combined). Perioperative data including duration of operation, technical problems, conversions and complications, as well as postoperative pain, time to resume daily activities and time off work were prospectively assessed. RESULTS 98 (87.5%) patients were operated in ambulatory surgery, and 14 (12.5%) in overnight stay. The mean sizes of the hernia and the patch were 9 (1-50) cm2 and 225 (50-500) cm2, respectively. The mean operation duration was 75 (30-270) min. The peritoneum was opened in 43 (38.4%) cases and closed by suture in 41 instances. There were 5 (4.5%) conversions to IPOM and 4 (3.6%) complications (1 seroma, 1 urine retention, 1 transitory ileus, and 1 intestinal obstruction) which were reoperated. The mean VAS value of postoperative pain was 2.45 (0-8), pain was scored 0 by 17 (15%) patients. The mean times to resume daily activity and work were 4 (1-15) days and 11.5 (1-30) days, respectively. CONCLUSION Our results suggest that VTEP is safely feasible by surgeons skilled in laparoscopy, and might contribute to minimize pain, though this must be established by comparative studies.
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Affiliation(s)
- Philippe Ngo
- Institut de La Hernie, 15 Rue du Cirque, 75008, Paris, France
| | | | - Claude Largenton
- Polyclinique de La Manche, 45 Boulevard Général Koenig, 50000, Saint-Lô, France
| | - Hubert Johanet
- Institut de La Hernie, 15 Rue du Cirque, 75008, Paris, France
| | - Sylvie Gueroult
- Institut de La Hernie, 15 Rue du Cirque, 75008, Paris, France
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Mesh-related visceral complications following inguinal hernia repair: an emerging topic. Hernia 2019; 23:699-708. [PMID: 30796629 DOI: 10.1007/s10029-019-01905-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/30/2019] [Indexed: 01/26/2023]
Abstract
The use of meshes in inguinal hernia repair (IHR) has gained popularity but new complications have been observed. Mesh-related visceral complications (MRVCs) are generally considered rare and hence are not studied in depth. We carried out a thorough literature search and collected 101 clinical reports published from 1992 to 2018. The reported complications seem to have tripled in the last decade. Ninety-seven cases met the inclusion criteria and they were subdivided into four groups (group A-onlay IHR, group B-3-D IHR, group C-preperitoneal IHR, group D-laparoscopic IHR) to be analyzed, according to the herniorraphy technique. Every prosthetic IHR can be followed by MRVCs but, according to the present review, the highest incidence is related to laparoscopic repairs, the lowest to Lichtenstein technique. Time-to-event was shorter in case of preperitoneal position of the prosthesis than when the mesh was implanted over the transversalis fascia. Urinary bladder involvement predominantly occurred after laparosopic IHR. A pathogenic correlation between the most frequently complained clinical signs and the previous mesh herniorraphy was rarely reported. The diagnosis was generally made at laparotomy, which was usually performed as an emergency. Removing the infected mesh and resecting or suture repairing the involved viscera was the challenging surgical treatment. Prevention of MRVCs after inguinal hernia repair appears to be an important significant issue. It is important to pay attention to the choice of a proper implantation site, avoiding direct contact between the mesh and viscera, and to select a proper device.
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