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Kwasnicki RM, Giannas E, Rizk C, Kungwengwe G, Dutta T, Dunne J, Dex E, Gokani V, Henry FP, Hunter JE, Williams G, Abela C, Warren O, Jones RP, Wood SH. Quantifying postoperative recovery using wearable activity monitors following abdominal wall surgery: The AbTech trial. J Plast Reconstr Aesthet Surg 2024; 93:281-289. [PMID: 38728901 DOI: 10.1016/j.bjps.2024.04.048] [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: 12/01/2023] [Revised: 04/08/2024] [Accepted: 04/14/2024] [Indexed: 05/12/2024]
Abstract
PURPOSE This work aimed to investigate the validity of wearable activity monitors (WAMs) as an objective tool to measure the return toward normal functional mobility following abdominal wall surgery. This was achieved by quantifying and comparing pre- and postoperative physical activity (PA). METHODS A multicenter, prospective, observational cohort study was designed. Patients undergoing abdominal wall surgery were assessed for eligibility and consent for study participation was obtained. Participants were asked to wear a WAM (AX3, Axivity) on the wrist of their dominant hand at least 48 hours pre-operatively, for up to 2 weeks postop, and again after 6 months postop for 48 hours. RESULTS A cohort of 20 patients were recruited in this validation study with a mean age of 47.3 ± 13.0 years. Postoperation, the percentage median PA (±IQR) dropped to 32.6% (20.1), whereas on day 14, PA had reached 64.6% (22.7) of the preoperative value providing construct validity. Activity levels at >6 months postop increased by 16.4% on an average when compared to baseline preoperative PA (p = 0.046). CONCLUSION This study demonstrates that WAMs are valid markers of postoperative recovery following abdominal wall surgery. This was achieved by quantifying the reduction in PA postoperation, which has not been previously shown. In addition, this study suggests that abdominal wall surgery may improve the patient's quality of life via increased functional mobility at 6 months postop. In the future, this technology could be used to identify the patient and surgical factors that are predictors of outcome following abdominal wall surgery.
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Affiliation(s)
- Richard Mark Kwasnicki
- Department of Surgery and Cancer, Imperial College London, London, UK; Department of Plastic and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London UK.
| | - Emmanuel Giannas
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Chiara Rizk
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Garikai Kungwengwe
- Department of Plastic and Reconstructive Surgery, Chelsea and Westminster NHS Trust, London, UK
| | - Tanusree Dutta
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jonathan Dunne
- Department of Plastic and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London UK
| | - Elizabeth Dex
- Department of Plastic and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London UK
| | - Vimal Gokani
- Department of Plastic and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London UK
| | - Francis P Henry
- Department of Plastic and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London UK
| | - Judith E Hunter
- Department of Plastic and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London UK
| | - Georgina Williams
- Department of Plastic and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London UK
| | - Chris Abela
- Department of Plastic and Reconstructive Surgery, Chelsea and Westminster NHS Trust, London, UK
| | - Oliver Warren
- Department of General Surgery, Chelsea and Westminster NHS Trust, London, UK
| | - Rowan Pritchard Jones
- Department of Plastic and Reconstructive Surgery, Mersey and West Lancashire Teaching Hospitals NHS Trust, London, UK
| | - Simon H Wood
- Department of Plastic and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London UK
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Xv Y, Tao Q, Cao N, Wu R, Ji Z. The causal association between body fat distribution and risk of abdominal wall hernia: a two-sample Mendelian randomization study. Hernia 2024; 28:599-606. [PMID: 38294577 DOI: 10.1007/s10029-023-02954-1] [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: 10/24/2023] [Accepted: 12/21/2023] [Indexed: 02/01/2024]
Abstract
PURPOSE Obesity and a high body mass index (BMI) are considered as risk factors for abdominal wall hernia (AWH). However, anthropometric measures of body fat distribution (BFD) seem to be better indicators in the hernia field. This Mendelian randomization analysis aimed to generate more robust evidence for the impact of waist circumstance (WC), body, trunk, arm, and leg fat percentages (BFP, TFP, AFP, LFP) on AWH. METHODS A univariable MR design was employed and the summary statistics allowing for assessment were obtained from the genome-wide association studies (GWASs). An inverse variance weighted (IVW) method was applied as the primary analysis, and the odds ratio value was used to evaluate the causal relationship between BFD and AWH. RESULTS None of the MR-Egger regression intercepts deviated from null, indicating no evidence of horizontal pleiotropy (p > 0.05). The Cochran Q test showed heterogeneity between the genetic IVs for WC (p = 0.005; p = 0.005), TFP (p < 0.001; p < 0.001), AFP-L (p = 0.016; p = 0.015), LFP-R (p = 0.012; p = 0.009), and LFP-L (p < 0.001; p < 0.001). Taking the IVW random-effects model as gold standard, each standard deviation increment in genetically determined WC, BFP, TFP, AFP-R, AFP-L, LFP-R, and LFP-L raised the risk of AWH by 70.9%, 70.7%, 56.5%, 69.7%, 78.3%, 87.7%, and 72.5%, respectively. CONCLUSIONS This study proves the causal relationship between AWH and BFD, attracting more attention from BMI to BFD. It provides evidence-based medical evidence that healthy figure management can prevent AWH.
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Affiliation(s)
- Y Xv
- School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Q Tao
- School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China.
- Department of General Surgery, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China.
| | - N Cao
- Department of General Surgery, Lishui People's Hospital, 86 Chongwen Road, Yongyang Street, Nanjing, 211200, China
| | - R Wu
- Department of General Surgery, Pukou Hospital of Traditional Chinese Medicine, 18 Gongyuan North Road, Jiangpu Street, Nanjing, 210000, China
| | - Z Ji
- School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China.
- Department of General Surgery, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China.
- Department of General Surgery, Lishui People's Hospital, 86 Chongwen Road, Yongyang Street, Nanjing, 211200, China.
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Hajian S, Ghoreifi A, Cen SY, Varghese B, Lei X, Hwang D, Tran K, Tejura T, Whang G, Djaladat H, Duddalwar V. Sarcopenia and body fat change as risk factors for radiologic incisional hernia following robotic nephrectomy. Skeletal Radiol 2023; 52:2469-2477. [PMID: 37249596 PMCID: PMC10582134 DOI: 10.1007/s00256-023-04371-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To assess the effect of body muscle and fat metrics on the development of radiologic incisional hernia (IH) following robotic nephrectomy. MATERIALS AND METHODS We retrospectively reviewed the records of patients who underwent robotic nephrectomy for kidney tumors between 2011 and 2017. All pre- and postoperative CTs were re-reviewed by experienced radiologists for detection of radiologic IH and calculation of the following metrics using Synapse 3D software: cross-sectional psoas muscle mass at the level of L3 and L4 as well as subcutaneous and visceral fat areas. Sarcopenia was defined as psoas muscle index below the lowest quartile. Cox proportional hazard model was constructed to examine the association between muscle and fat metrics and the risk of developing radiologic IH. RESULTS A total of 236 patients with a median (IQR) age of 64 (54-70) years were included in this study. In a median (IQR) follow-up of 23 (14-38) months, 62 (26%) patients developed radiologic IH. On Cox proportional hazard model, we were unable to detect an association between sarcopenia and risk of IH development. In terms of subcutaneous fat change from pre-op, both lower and higher values were associated with IH development (HR (95% CI) 2.1 (1.2-3.4), p = 0.01 and 2.4 (1.4-4.1), p < 0.01 for < Q1 and ≥ Q3, respectively). Similar trend was found for visceral fat area changes from pre-op with a HR of 2.8 for < Q1 and 1.8 for ≥ Q3. CONCLUSION Both excessive body fat gain and loss are associated with development of radiologic IH in patients undergoing robotic nephrectomy.
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Affiliation(s)
- Simin Hajian
- Department of Radiology, University of Southern California, Los Angeles, CA, USA
| | - Alireza Ghoreifi
- Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Steven Yong Cen
- Department of Radiology, University of Southern California, Los Angeles, CA, USA
| | - Bino Varghese
- Department of Radiology, University of Southern California, Los Angeles, CA, USA
| | - Xiaomeng Lei
- Department of Radiology, University of Southern California, Los Angeles, CA, USA
| | - Darryl Hwang
- Department of Radiology, University of Southern California, Los Angeles, CA, USA
| | - Khoa Tran
- Department of Radiology, University of Southern California, Los Angeles, CA, USA
| | - Tapas Tejura
- Department of Radiology, University of Southern California, Los Angeles, CA, USA
| | - Gilbert Whang
- Department of Radiology, University of Southern California, Los Angeles, CA, USA
| | - Hooman Djaladat
- Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Vinay Duddalwar
- Department of Radiology, University of Southern California, Los Angeles, CA, USA.
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González-Abós C, Pineda C, Arrocha C, Farguell J, Gil I, Ausania F. Incisional Hernia Following Open Pancreaticoduodenectomy: Incidence and Risk Factors at a Tertiary Care Centre. Curr Oncol 2023; 30:7089-7098. [PMID: 37622995 PMCID: PMC10453869 DOI: 10.3390/curroncol30080514] [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: 06/16/2023] [Revised: 07/20/2023] [Accepted: 07/22/2023] [Indexed: 08/26/2023] Open
Abstract
(1) Background: Incisional hernia (IH) is one of the most common complications following open abdominal surgery. There is scarce evidence on its real incidence following pancreatic surgery. The purpose of this study is to evaluate the incidence and the risk factors associated with IH development in patients undergoing pancreaticoduodenectomy (PD). (2) Methods: We retrospectively reviewed all patients undergoing PD between 2014 and 2020 at our centre. Data were extracted from a prospectively held database, including perioperative and long-term factors. We performed univariate and multivariate analysis to detect those factors potentially associated with IH development. (3) Results: The incidence of IH was 8.8% (19/213 patients). Median age was 67 (33-85) years. BMI was 24.9 (14-41) and 184 patients (86.4%) underwent PD for malignant disease. Median follow-up was 23 (6-111) months. Median time to IH development was 31 (13-89) months. Six (31.5%) patients required surgical repair. Following univariate and multivariate analysis, preoperative hypoalbuminemia (OR 3.4, 95% CI 1.24-9.16, p = 0.01) and BMI ≥ 30 kg/m2 (OR 2.6, 95% CI 1.06-8.14, p = 0.049) were the only factors independently associated with the development of IH. (4) Conclusions: The incidence of IH following PD was 8.8% in a tertiary care center. Preoperative hypoalbuminemia and obesity are independently associated with IH occurrence following PD.
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Affiliation(s)
- Carolina González-Abós
- Department of HBP and Transplant Surgery, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain (J.F.); (I.G.); (F.A.)
- Gene Therapy and Cancer, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Catalina Pineda
- Department of HBP and Transplant Surgery, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain (J.F.); (I.G.); (F.A.)
| | - Carlos Arrocha
- Department of HBP and Transplant Surgery, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain (J.F.); (I.G.); (F.A.)
| | - Jordi Farguell
- Department of HBP and Transplant Surgery, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain (J.F.); (I.G.); (F.A.)
| | - Ignacio Gil
- Department of HBP and Transplant Surgery, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain (J.F.); (I.G.); (F.A.)
| | - Fabio Ausania
- Department of HBP and Transplant Surgery, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain (J.F.); (I.G.); (F.A.)
- Gene Therapy and Cancer, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
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Romano L, Fiasca F, Mattei A, Tersigni L, Gianneramo C, Schietroma M, Carlei F, Giuliani A. Sarcopenia and visceral fat in patients with incisional hernia after urgent laparotomy. Langenbecks Arch Surg 2023; 408:244. [PMID: 37351682 DOI: 10.1007/s00423-023-02973-7] [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: 06/17/2022] [Accepted: 06/10/2023] [Indexed: 06/24/2023]
Abstract
PURPOSE Various risk factors have been associated with the development of incisional hernia (IH). Some recent papers underlined that visceral fat could be a reliable indicator. Another risk factor which is of increasing clinical interest is sarcopenia. Recent studies have identified it as an independent predictor of poor postoperative outcomes following abdominal surgery. We aimed to investigate the role of visceral fat and skeletal muscle as emerging risk factors for IH after urgent laparotomy. METHODS Patients aged 18 years or older who underwent urgent median laparotomy and with continuous direct suturing of the laparotomy were included. They were categorized into two groups: those with a median IH and those without IH at 12-month follow-up. Demographic data were prospectively collected while CT scans were retrospectively reviewed. The data were compared among two groups. RESULTS From January 2018 to May 2021, 364 patients underwent urgent surgery in our Department, of whom 222 were aged >18 years old and underwent median laparotomy. Forty-four patients had diagnosis of median IH, while 41 patients without IH were identified as the control group. Statistically significant differences emerged for BMI and for the area of visceral fat. The association with the presence/absence of sarcopenia was not significant. CONCLUSION Even when surgery is performed in urgent settings, it could be important to identify patients at risk, especially as CT scans are generally available for all patients with urgent abdominal disease.
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Affiliation(s)
- Lucia Romano
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
- Department of General Surgery, San Salvatore Hospital, L'Aquila, Italy.
| | - Fabiana Fiasca
- Department of Life, Health & Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Antonella Mattei
- Department of Life, Health & Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Leonardo Tersigni
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- Department of General Surgery, San Salvatore Hospital, L'Aquila, Italy
| | - Camilla Gianneramo
- Department of Radiology, S. Salvatore Hospital, Via L. Natali, 1, 67100, L'Aquila, Italy
| | - Mario Schietroma
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- Department of General Surgery, San Salvatore Hospital, L'Aquila, Italy
| | - Francesco Carlei
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- Department of General Surgery, San Salvatore Hospital, L'Aquila, Italy
| | - Antonio Giuliani
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- Department of General Surgery, San Salvatore Hospital, L'Aquila, Italy
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Claessen JJM, Timmer AS, Hemke R, Atema JJ, Hompes R, Boermeester MA, Rutten MVH. A computed tomography study investigating the effects of botulinum toxin injections prior to complex abdominal wall reconstruction. Hernia 2023; 27:281-291. [PMID: 36239824 PMCID: PMC10126041 DOI: 10.1007/s10029-022-02692-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/25/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To explore how intramuscular injection of botulinum toxin A (BTA) affects the lateral abdominal wall (LAW) musculature, abdominal- and hernia dimensions, and muscle structure on computed tomography (CT) in patients scheduled for complex abdominal wall reconstruction (CAWR). METHODS Retrospective analysis of prospectively registered patients who received bilateral intramuscular BTA injections into all three muscles of the LAW. Only patients for which a CT was available before and 3-6 weeks after BTA treatment prior to surgery were analyzed. RESULTS Fifty-two patients were analyzed. Median hernia width in all patients decreased with 0.4 cm (IQR - 2.1;0.6) (p = 0.023). Median intra-abdominal transverse diameter increased with 0.9 cm (IQR - 0.2;3.3) (p = 0.001) and the intra-abdominal anterior-posterior diameter decreased with 0.5 cm (IQR - 1.3;0.5) (p = 0.017), making the abdomen more oval. Median LAW muscle length increased with 0.9 cm (IQR 0.0;2.4) per side (p < 0.001), muscle thickness decreased with 0.5 cm (IQR - 0.8;- 0.2) (- 25.0%) per side (p < 0.001), and muscle mass decreased with 3.9 cm2 (IQR - 6.4;-1.5) (- 15.8%) per side (p < 0.001). Median HU of the psoas muscles (density) increased with 4.8 HU (IQR 0.4;9.7) (10.3%) per side (p < 0.001). Effects of BTA were more pronounced in patients with a loss of domain (LoD) ≥ 20%. CONCLUSIONS The main effect of BTA injections is elongation and thinning of the LAW muscles, more than a decrease in hernia width. Concomitantly, the abdomen becomes more oval. An increase of psoas muscles density is seen, associated with offloading of the LAW muscles. Patients with large LoD have a proportionally higher effect of BTA.
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Affiliation(s)
- J J M Claessen
- Department of Surgery (Suite J1A-228), Amsterdam UMC, University of Amsterdam, Location AMC, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
| | - A S Timmer
- Department of Surgery (Suite J1A-228), Amsterdam UMC, University of Amsterdam, Location AMC, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
| | - R Hemke
- Department of Radiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - J J Atema
- Department of Surgery (Suite J1A-228), Amsterdam UMC, University of Amsterdam, Location AMC, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
| | - R Hompes
- Department of Surgery (Suite J1A-228), Amsterdam UMC, University of Amsterdam, Location AMC, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
| | - M A Boermeester
- Department of Surgery (Suite J1A-228), Amsterdam UMC, University of Amsterdam, Location AMC, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands.
- Amsterdam Gastroenterology and Metabolism, Amsterdam, The Netherlands.
| | - M V H Rutten
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Kushner BS, Hamilton J, Han BJ, Sehnert M, Holden T, Holden SE. Geriatric assessment and medical preoperative screening (GrAMPS) program for older hernia patients. Hernia 2022; 26:787-794. [PMID: 33813655 DOI: 10.1007/s10029-021-02389-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/26/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE The incidence of older adults undergoing inguinal and ventral hernia repairs is increasing. Older adults are disproportionately affected by age-related risk factors, which are often under-recognized and may adversely affect surgical outcomes. These age-related risk factors often termed "geriatric syndromes," include multimorbidity, frailty, cognitive impairment, depression, obesity, functional impairment, polypharmacy, and poor subjective health. The aim of this study was to identify the prevalence of age-related risk factors in older patients undergoing elective hernia repair. METHODS Patients aged 60 years or older with a planned elective surgical repair of a ventral or inguinal hernia were prospectively enrolled in a clinic. Subjects completed several validated screening tools for geriatric syndromes. RESULTS Seventy patients completed preoperative assessments (mean age: 68.5 years). In total, 24 (34.3%) screened positive for previously unrecognized objective cognitive impairment (Mini-Cog) and 33 (47.1%) for a subjective memory concern. Sixty patients (85.7%) met criteria for polypharmacy. Additionally, 48 (68.6%) screened positive for either pre-frailty (37, 52.9%) or frailty (11, 15.7%), and 66 (94.3%) had multimorbidity. Twenty-five (35.7%) patients self-rated their health as "poor" or "fair," and 18 (25.7%) patients endorsed some functional impairment. CONCLUSIONS There is a high prevalence of age-related risk factors in older patients undergoing elective hernia repair. Further, these factors are often unrecognized and underappreciated despite their potential to significantly impact informed consent and shared decision making. Additional study is required to define the impact of these age-related risk factors on surgical outcomes, which will inform preoperative risk assessment and optimization through modifiable risk reduction.
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Affiliation(s)
- Bradley S Kushner
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA.
- Department of Minimally Invasive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, St. Louis, MO, 63110, USA.
| | - J Hamilton
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - B J Han
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - M Sehnert
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - T Holden
- Division of Geriatrics and Nutritional Science, Department of Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - S E Holden
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
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Barten TRM, Bökkerink RMP, Venderink W, Gevers TJG, ten Broek RPG, Drenth JPH. Abdominal wall hernia is a frequent complication of polycystic liver disease and associated with hepatomegaly. Liver Int 2022; 42:871-878. [PMID: 35129293 PMCID: PMC9307001 DOI: 10.1111/liv.15177] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND AIM Polycystic liver disease (PLD) is related to hepatomegaly which causes an increased mechanical pressure on the abdominal wall. This may lead to abdominal wall herniation (AWH). We set out to establish the prevalence of AWH in PLD and explore risk factors. METHODS In this cross-sectional cohort study, we assessed the presence of AWHs from PLD patients with at least 1 abdominal computed tomography or magnetic resonance imaging scan. AWH presence on imaging was independently evaluated by two researchers. Data on potential risk factors were extracted from clinical files. RESULTS We included 484 patients of which 40.1% (n = 194) had an AWH. We found a clear predominance of umbilical hernias (25.8%, n = 125) while multiple hernias were present in 6.2% (n = 30). Using multivariate analysis, male sex (odds ratio [OR] 2.727 p < .001), abdominal surgery (OR 2.575, p < .001) and disease severity according to the Gigot classification (Type 3 OR 2.853, p < .001) were identified as risk factors. Height-adjusted total liver volume was an independent PLD-specific risk factor in the subgroup of patients with known total liver volume (OR 1.363, p = .001). Patients with multiple hernias were older (62.1 vs. 55.1, p = .001) and more frequently male (22.0% vs. 50.0%, p = .001). CONCLUSION AWHs occur frequently in PLD with a predominance of umbilical hernias. Hepatomegaly is a clear disease-specific risk factor.
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Affiliation(s)
- Thijs R. M. Barten
- Department of Gastroenterology and HepatologyRadboud University Medical CenterNijmegenthe Netherlands
| | - Roos‐Anne M. P. Bökkerink
- Department of Gastroenterology and HepatologyRadboud University Medical CenterNijmegenthe Netherlands
| | - Wulphert Venderink
- Department of Radiology and Nuclear MedicineRadboud University Medical CenterNijmegenthe Netherlands
| | - Tom J. G. Gevers
- Department of Gastroenterology and HepatologyRadboud University Medical CenterNijmegenthe Netherlands,Department of Gastroenterology and HepatologyMaastricht University Medical CenterMaastrichtthe Netherlands
| | | | - Joost P. H. Drenth
- Department of Gastroenterology and HepatologyRadboud University Medical CenterNijmegenthe Netherlands
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Jensen TK, Nielsen YW, Gögenur I, Tolstrup MB. "Sarcopenia is associated with increased risk of burst abdomen after emergency midline laparotomy: a matched case-control study". Eur J Trauma Emerg Surg 2022; 48:4189-4196. [PMID: 35353215 DOI: 10.1007/s00068-022-01958-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 03/13/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Burst abdomen is a serious complication commonly observed after emergency midline laparotomy. Sarcopenia has been associated with increased morbidity and mortality after abdominal surgery. This single-center, retrospective, matched case-control study aimed to investigate the association between sarcopenia and burst abdomen in patients undergoing emergency midline laparotomy. METHODS Patients who had burst abdomen after emergency midline laparotomy were matched 1:4 with controls based on age and sex. Abdominal wall closure was standardized in the study period with the small bites, small stitches technique. CT assessed psoas cross-sectional area was used as a surrogate measure of sarcopenia. Sarcopenia was defined as the sex-specific lowest quartile of psoas cross-sectional area adjusted for body surface area. The primary outcome was the incidence rate of sarcopenia amongst cases and controls. Secondary outcomes were risk factors for burst abdomen and death that were identified using multivariate logistic regression analysis. RESULTS 67 cases were matched to 268 controls during May 2016-December 2019. BMI > 30 kg/m2, liver cirrhosis, smoking, high ASA score and peritonitis were more frequently observed among cases. Multivariate analysis revealed that sarcopenia (odds ratio (OR) 2.3, p = 0.01), active smoking (OR 2.3, p = 0.006) and liver cirrhosis (OR 3.7, p = 0.042) were significantly associated with burst abdomen. ASA score ≥ 3 (OR 5.5, p = 0.001) and ongoing malignant disease (OR 3.2, p = 0.001) were significantly associated with increased 90-day mortality. CONCLUSION Sarcopenia is associated with increased risk of burst abdomen after midline laparotomy. Prospective trials are needed.
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Affiliation(s)
- Thomas Korgaard Jensen
- Surgical Section, Department of Gastrointestinal- and Hepatic Diseases, Copenhagen University Hospital Herlev, 2730, Herlev, Denmark.
| | | | - Ismail Gögenur
- Department of Surgery, Center for Surgical Science, Zealand University Hospital, Copenhagen University Hospital, 4600, Koege, Denmark
| | - Mai-Britt Tolstrup
- Department of Surgery, North-Zealand University Hospital, 3400, Hilleroed, Denmark
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10
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Fabulas F, Paisant P, Dinomais M, Mucci S, Casa C, Le Naoures P, Hamel JF, Perrot J, Venara A. Pre-habilitation before colorectal cancer surgery could improve postoperative gastrointestinal function recovery: a case-matched study. Langenbecks Arch Surg 2022; 407:1595-1603. [PMID: 35260942 DOI: 10.1007/s00423-022-02487-8] [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: 05/12/2021] [Accepted: 03/02/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE While its effect is controverted, multimodal pre-habilitation could be used to improve the postoperative course following colorectal cancer surgery. However, by increasing lean body mass, pre-habilitation could reduce the time needed to recover gastrointestinal (GI) functions. The aim was to assess the impact of pre-habilitation before colorectal cancer surgery on postoperative GI motility recovery. METHODS This is a matched retrospective study based on a prospective database including patients undergoing colorectal surgery without pre-habilitation (NPH) (2016-2018) and with pre-habilitation (PH group) (2018-2019). The main outcome measure was the time to GI-3 recovery (tolerance to solid food and flatus and/or stools). RESULTS One hundred thirteen patients were included, 37 underwent pre-habilitation (32.7%). The patient's age, the surgical procedure, the surgical access, the rate of synchronous metastasis, the rate of preoperative chemoradiotherapy, and the rate of stoma were more important in the PH group. Conversely, the rate of patients with an ASA score of > 2 was higher in the NPH group. By matching patients according to age, gender and surgical procedure, 84 patients were compared (61 in the NPH group and 23 in the PH group). The mean of GI-3 recovery was significantly lower in the PH group. The other endpoints were not significantly different but time to GI function recovery and medical morbidity tended to be higher in the NPH group. Compliance with the enhanced recovery program was significantly higher in the PH group. CONCLUSION Pre-habilitation before colorectal cancer surgery reduced time to GI function recovery and may increase compliance with the enhanced recovery program.
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Affiliation(s)
- F Fabulas
- Department of Visceral Surgery, CHU Angers, 4 rue Larrey, 49933 ANGERS Cedex 9, Angers, France.,Department of Medicine, Faculty of Health of Angers, Angers, France
| | | | - M Dinomais
- Department of Medicine, Faculty of Health of Angers, Angers, France.,CRRRF, Angers, France
| | - S Mucci
- Department of Visceral Surgery, CHU Angers, 4 rue Larrey, 49933 ANGERS Cedex 9, Angers, France
| | - C Casa
- Department of Visceral Surgery, CHU Angers, 4 rue Larrey, 49933 ANGERS Cedex 9, Angers, France
| | - P Le Naoures
- Department of Visceral Surgery, CHU Angers, 4 rue Larrey, 49933 ANGERS Cedex 9, Angers, France
| | - J F Hamel
- Department of Medicine, Faculty of Health of Angers, Angers, France.,Department of Biostatistics, CHU Angers, La Maison de la Recherche4 rue Larrey, 49933 ANGERS Cedex 9, Angers, France
| | - J Perrot
- Department of Medicine, Faculty of Health of Angers, Angers, France.,Department of Biostatistics, CHU Angers, La Maison de la Recherche4 rue Larrey, 49933 ANGERS Cedex 9, Angers, France
| | - Aurélien Venara
- Department of Visceral Surgery, CHU Angers, 4 rue Larrey, 49933 ANGERS Cedex 9, Angers, France. .,Department of Medicine, Faculty of Health of Angers, Angers, France. .,HIFIH, UPRES, Angers, France.
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11
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Cannataro R, Carbone L, Petro JL, Cione E, Vargas S, Angulo H, Forero DA, Odriozola-Martínez A, Kreider RB, Bonilla DA. Sarcopenia: Etiology, Nutritional Approaches, and miRNAs. Int J Mol Sci 2021; 22:9724. [PMID: 34575884 PMCID: PMC8466275 DOI: 10.3390/ijms22189724] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/03/2021] [Accepted: 09/06/2021] [Indexed: 02/06/2023] Open
Abstract
Sarcopenia, an age-related decline in skeletal muscle mass and function, dramatically affects the quality of life. Although there is a consensus that sarcopenia is a multifactorial syndrome, the etiology and underlying mechanisms are not yet delineated. Moreover, research about nutritional interventions to prevent the development of sarcopenia is mainly focused on the amount and quality of protein intake. The impact of several nutrition strategies that consider timing of food intake, anti-inflammatory nutrients, metabolic control, and the role of mitochondrial function on the progression of sarcopenia is not fully understood. This narrative review summarizes the metabolic background of this phenomenon and proposes an integral nutritional approach (including dietary supplements such as creatine monohydrate) to target potential molecular pathways that may affect reduce or ameliorate the adverse effects of sarcopenia. Lastly, miRNAs, in particular those produced by skeletal muscle (MyomiR), might represent a valid tool to evaluate sarcopenia progression as a potential rapid and early biomarker for diagnosis and characterization.
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Affiliation(s)
- Roberto Cannataro
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Italy;
- Galascreen Laboratories, University of Calabria, 87036 Rende, Italy
- Research Division, Dynamical Business & Science Society, DBSS International SAS, Bogotá 110311, Colombia; (J.L.P.); (S.V.); (D.A.B.)
| | - Leandro Carbone
- Research Division, Dynamical Business & Science Society, DBSS International SAS, Bogotá 110311, Colombia; (J.L.P.); (S.V.); (D.A.B.)
- Faculty of Medicine, University of Salvador, Buenos Aires 1020, Argentina
| | - Jorge L. Petro
- Research Division, Dynamical Business & Science Society, DBSS International SAS, Bogotá 110311, Colombia; (J.L.P.); (S.V.); (D.A.B.)
- Research Group in Physical Activity, Sports and Health Sciences (GICAFS), Universidad de Córdoba, Montería 230002, Colombia
| | - Erika Cione
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Italy;
- Galascreen Laboratories, University of Calabria, 87036 Rende, Italy
| | - Salvador Vargas
- Research Division, Dynamical Business & Science Society, DBSS International SAS, Bogotá 110311, Colombia; (J.L.P.); (S.V.); (D.A.B.)
- Faculty of Sport Sciences, EADE-University of Wales Trinity Saint David, 29018 Málaga, Spain
| | - Heidy Angulo
- Grupo de Investigación Programa de Medicina (GINUMED), Corporación Universitaria Rafael Núñez, Cartagena 130001, Colombia;
| | - Diego A. Forero
- Health and Sport Sciences Research Group, School of Health and Sport Sciences, Fundación Universitaria del Área Andina, Bogotá 111221, Colombia;
| | - Adrián Odriozola-Martínez
- Sport Genomics Research Group, Department of Genetics, Physical Anthropology and Animal Physiology, University of the Basque Country UPV/EHU, 48940 Leioa, Spain;
- kDNA Genomics, Joxe Mari Korta Research Center, University of the Basque Country UPV/EHU, 20018 Donostia-San Sebastián, Spain
| | - Richard B. Kreider
- Exercise & Sport Nutrition Lab, Human Clinical Research Facility, Texas A&M University, College Station, TX 77843, USA;
| | - Diego A. Bonilla
- Research Division, Dynamical Business & Science Society, DBSS International SAS, Bogotá 110311, Colombia; (J.L.P.); (S.V.); (D.A.B.)
- Research Group in Physical Activity, Sports and Health Sciences (GICAFS), Universidad de Córdoba, Montería 230002, Colombia
- kDNA Genomics, Joxe Mari Korta Research Center, University of the Basque Country UPV/EHU, 20018 Donostia-San Sebastián, Spain
- Research Group in Biochemistry and Molecular Biology, Universidad Distrital Francisco José de Caldas, Bogotá 110311, Colombia
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12
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Grove TN, Kontovounisios C, Montgomery A, Heniford BT, Windsor ACJ, Warren OJ. Perioperative optimization in complex abdominal wall hernias: Delphi consensus statement. BJS Open 2021; 5:6375607. [PMID: 34568888 PMCID: PMC8473840 DOI: 10.1093/bjsopen/zrab082] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 08/03/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The incidence of incisional hernia after major abdominal surgery via a midline laparotomy is 20-41 per cent with short-term follow-up, and over 50 per cent in those surviving an abdominal catastrophe. Abdominal wall reconstruction (AWR) requires complex operations, often involving mesh resection, management of scarred skin, fistula takedown, component separation or flap reconstruction. Patients tend to have more complex conditions, with multiple co-morbidities predisposing them to a vicious cycle of complications and, subsequently, hernia recurrence. Currently there appears to be variance in perioperative practice and minimal guidance globally. The aim of this Delphi consensus was to provide a clear benchmark of care for the preoperative assessment and perioperative optimization of patients undergoing AWR. METHODS The Delphi method was used to achieve consensus from invited experts in the field of AWR. Thirty-two hernia surgeons from recognized hernia societies globally took part. The process included two rounds of anonymous web-based voting with response analysis and formal feedback, concluding with a live round of voting followed by discussion at an international conference. Consensus for a strong recommendation was achieved with 80 per cent agreement, and a weak recommendation with 75 per cent agreement. RESULTS Consensus was obtained on 52 statements including surgical assessment, preoperative assessment, perioperative optimization, multidisciplinary team and decision-making, and quality-of-life assessment. Forty-six achieved over 80 per cent agreement; 14 statements achieved over 95 per cent agreement. CONCLUSION Clear consensus recommendations from a global group of experts in the AWR field are presented in this study. These should be used as a baseline for surgeons and centres managing abdominal wall hernias and performing complex AWR.
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Affiliation(s)
- T N Grove
- Department of Surgery, Chelsea and Westminster Hospital, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - C Kontovounisios
- Department of Surgery, Chelsea and Westminster Hospital, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK.,Department of General Surgery, Royal Marsden Hospital, London, UK
| | - A Montgomery
- Department of Surgery, Skåne University Hospital SUS, Malmö, Sweden
| | - B T Heniford
- Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA
| | | | - O J Warren
- Department of Surgery, Chelsea and Westminster Hospital, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
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13
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Hamilton J, Kushner B, Holden S, Holden T. Age-Related Risk Factors in Ventral Hernia Repairs: A Review and Call to Action. J Surg Res 2021; 266:180-191. [PMID: 34015515 DOI: 10.1016/j.jss.2021.04.004] [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] [Received: 01/09/2021] [Revised: 03/29/2021] [Accepted: 04/02/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND As the population ages, the incidence of ventral hernias in older adults is increasing. Ventral hernia repairs (VHR) should not be considered low risk operations, particularly in older adults who are disproportionately affected by multiple age-related factors that can complicate surgery and adversely affect outcomes. Although age-related risk factors have been well established in other surgical fields, there is currently little data describing their impact on VHR. METHODS We performed a systematic review of the literature to identify studies that examine the effects of age-related risk factors on VHR outcomes. This was conducted using Cochrane Library, Embase, PubMed (Medline), and Google Scholar databases, all updated through June 2020. We selected relevant studies using the keywords, multimorbidity, comorbidities, polypharmacy, functional dependence, functional status, frailty, cognitive impairment, dementia, sarcopenia, and malnutrition. Primary outcomes include mortality and overall complications following VHR. RESULTS We summarize the evidence basis for the significance of age-related risk factors in elective surgery and discuss how these factors increase the risk of adverse outcomes following VHR. In particular, we explore the impact of the following risk factors: multimorbidity, polypharmacy, functional dependence, frailty, cognitive impairment, sarcopenia, and malnutrition. As opposed to chronological age itself, age-related risk factors are more clinically relevant in determining VHR outcomes. CONCLUSIONS Given the increasing complexity of VHR, addressing age-related risk factors pre-operatively has the potential to improve surgical outcomes in older adults. Preoperative risk assessment and individualized prehabilitation programs aimed at improving patient-centered outcomes may be particularly useful in this population.
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Affiliation(s)
- Julia Hamilton
- Department of Surgery, Washington University School of Medicine. St. Louis, Missouri.
| | - Bradley Kushner
- Department of Surgery, Washington University School of Medicine. St. Louis, Missouri
| | - Sara Holden
- Department of Surgery, Washington University School of Medicine. St. Louis, Missouri
| | - Timothy Holden
- Department of Medicine, Division of Geriatrics and Nutritional Science, Washington University School of Medicine, St. Louis, Missouri
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14
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Smith O, MacLeod T, Lim P, Chitsabesan P, Chintapatla S. A structured pathway for developing your complex abdominal hernia service: our York pathway. Hernia 2021; 25:267-275. [PMID: 33599900 PMCID: PMC7890783 DOI: 10.1007/s10029-020-02354-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 12/04/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Clinical pathways are widely prevalent in health care and may be associated with increased clinical efficacy, improved patient care, streamlining of services, while providing clarity on patient management. Such pathways are well established in several branches of healthcare services but, to the authors' knowledge, not in complex abdominal wall reconstruction (CAWR). A stepwise, structured and comprehensive approach to managing complex abdominal wall hernia (CAWH) patients, which has been successfully implemented in our practice, is presented. METHODS A literature search of common databases including Embase® and MEDLINE® for CAWH pathways identified no comprehensive pathway. We therefore undertook a reiterative process to develop the York Abdominal Wall Unit (YAWU) through examination of current evidence and logic to produce a pragmatic redesign of our own pathway. Having introduced our pathway, we then performed a retrospective analysis of the complexity and number of abdominal wall cases performed in our trust over time. RESULTS We describe our pathway and demonstrate that the percentage of cases and their complexity, as defined by the VHWG classification, have increased over time in York Abdominal Wall Unit. CONCLUSION A structured pathway for complex abdominal wall hernia service is one way to improve patient experience and streamline services. The relevance of pathways for the hernia surgeon is discussed alongside this pathway. This may provide a useful guide to those wishing to establish similar personalised pathways within their own units and allow them to expand their service.
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Affiliation(s)
- O Smith
- York Abdominal Wall Unit, Department of General Surgery, York Teaching Hospital NHS Foundation Trust, Wigginton Road, York, YO31 8HE, UK
| | - T MacLeod
- Department of Plastic Surgery, York Teaching Hospital NHS Foundation Trust, Wigginton Road, York, YO31 8HE, UK
| | - P Lim
- Department of Plastic Surgery, York Teaching Hospital NHS Foundation Trust, Wigginton Road, York, YO31 8HE, UK
| | - P Chitsabesan
- York Abdominal Wall Unit, Department of General Surgery, York Teaching Hospital NHS Foundation Trust, Wigginton Road, York, YO31 8HE, UK
| | - S Chintapatla
- York Abdominal Wall Unit, Department of General Surgery, York Teaching Hospital NHS Foundation Trust, Wigginton Road, York, YO31 8HE, UK.
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