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Pereira-Rodríguez JA, Hernández-Granados P, Olona-Casa C, López-Cano M. The evolution of incisional hernia repair in Spain. A comparative analysis of results from the EVEREG registry. Cir Esp 2024; 102:275-280. [PMID: 38307255 DOI: 10.1016/j.cireng.2023.11.021] [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: 11/07/2023] [Accepted: 11/18/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND The aim of this study was to assess the utility of the EVEREG registry in evaluating the evolution of surgical treatment for incisional hernia and its outcomes in Spain by comparing data from 2 study periods. METHODS A retrospective comparative analysis of hernia surgeries performed between 2011 and 2015 (first period) and between 2017 and 2022 (second period) was conducted using data collected from the EVEREG registry. RESULTS Statistically significant differences were observed in the second cohort, including: a decrease in minimally invasive procedures (11.7% vs 8.2%; P < .001), an increase in emergency surgeries for males (31.7% vs 41.2%; P = .017), an increase in trocar hernia repairs (16% vs 26.2%; P < .0001), a reduction in suture repairs (2.8% vs 1.5%; P < .0001), and an increase in retromuscular techniques (36.4% vs 52.4%; P < .001) in open surgery with mesh. In elective surgery, there was a decrease in the average length of stay (4.9 vs 3.8 days; P < .0001), the percentage of complications (27.9% vs 24.0%; P < .0001), reoperations (3.5% vs 1.4%; P < .0001), and mortality (0.6% vs 0.2%; P = .002). Long-term outcomes included a decrease in recurrences after 12 months (20.7% vs 14.5%; P < .0001) and in chronic pain (13.7% vs 2.5%; P < .0001) and chronic infections (9.1% vs 14.5%; P < .0001) after 6 months. CONCLUSION In recent years, there has been a significant improvement in the outcomes of incisional hernia treatment. The registry serves as a fundamental tool for assessing the evolution of hernia treatment and enables the identification of key areas for improvement and the evaluation of treatment outcomes.
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Affiliation(s)
- J A Pereira-Rodríguez
- Servicio de Cirugía General, Hospital Universitari del Mar, Barcelona, Spain; Departament de Medicina i Ciéncies de la Vida, Universitat Pompeu Fabra, Barcelona, Spain.
| | | | - C Olona-Casa
- Departamento de Cirugía General y Digestiva, Hospital Universitario de Tarragona Joan XXIII, Spain
| | - M López-Cano
- Servicio de Cirugía General, Hospital Vall d'Hebrón, Spain; Departament de Cirurgia, Universitat Autònoma de Barcelona, Spain
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Lesch C, Nessel R, Adolf D, Hukauf M, Köckerling F, Kallinowski F, Willms A, Schwab R, Zarras K. STRONGHOLD first-year results of biomechanically calculated abdominal wall repair: a propensity score matching. Hernia 2024; 28:63-73. [PMID: 37815731 PMCID: PMC10891228 DOI: 10.1007/s10029-023-02897-7] [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: 06/12/2023] [Accepted: 09/18/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE Every year around 70,000 people in Germany suffer from an abdominal incisional hernia that requires surgical treatment. Five years after reconstruction about 25% reoccur. Incisional hernias are usually closed with mesh using various reconstruction techniques, summarized here as standard reconstruction (SR). To improve hernia repair, we established a concept for biomechanically calculated reconstructions (BCR). In the BCR, two formulas enable customized patient care through standardized biomechanical measures. This study aims to compare the clinical outcomes of SR and BCR of incisional hernias after 1 year of follow-up based on the Herniamed registry. METHODS SR includes open retromuscular mesh augmented incisional hernia repair according to clinical guidelines. BCR determines the required strength (Critical Resistance to Impacts related to Pressure = CRIP) preoperatively depending on the hernia size. It supports the surgeon in reliably determining the Gained Resistance, based on the mesh-defect-area-ratio, further mesh and suture factors, and the tissue stability. To compare SR and BCR repair outcomes in incisional hernias at 1 year, propensity score matching was performed on 15 variables. Included were 301 patients with BCR surgery and 23,220 with standard repair. RESULTS BCR surgeries show a significant reduction in recurrences (1.7% vs. 5.2%, p = 0.0041), pain requiring treatment (4.1% vs. 12.0%, p = 0.001), and pain at rest (6.9% vs. 12.7%, p = 0.033) when comparing matched pairs. Complication rates, complication-related reoperations, and stress-related pain showed no systematic difference. CONCLUSION Biomechanically calculated repairs improve patient care. BCR shows a significant reduction in recurrence rates, pain at rest, and pain requiring treatment at 1-year follow-up compared to SR.
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Affiliation(s)
- C Lesch
- General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | - R Nessel
- General, Visceral and Pediatric Surgery, Klinikum Am Gesundbrunnen, Am Gesundbrunnen 20‑26, 74078, Heilbronn, Germany
| | - D Adolf
- StatConsult, Am Fuchsberg 11, 39112, Magdeburg, Germany
| | - M Hukauf
- StatConsult, Am Fuchsberg 11, 39112, Magdeburg, Germany
| | - F Köckerling
- Vivantes Humboldt Hospital Berlin, Center for Hernia Surgery, Academic Teaching Hospital of Charité University Medicine, Am Nordgraben 2, 13509, Berlin, Germany
| | - F Kallinowski
- General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - A Willms
- General and Visceral Surgery, Bundeswehrkrankenhaus Hamburg, Lesserstrasse 180, 22049, Hamburg, Germany
| | - R Schwab
- General, Visceral and Thorax Surgery, BundeswehrZentralkrankenhaus Koblenz, Rübenacher Strasse 170, 56072, Koblenz, Germany
| | - K Zarras
- Visceral, Minimal Invasive and Oncological Surgery, Marien Hospital Düsseldorf, Schloßstraße 85, 40477, Düsseldorf, Germany
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Toma M, Oprea V, Grad O, Staines H, Bucuri CE, Andercou O, Gherghinescu M, Molnar C. Early outcomes of open anterior versus posterior components separation with transversus abdominis release for large median incisional hernias: a retrospective stepwise analysis. Hernia 2023:10.1007/s10029-023-02920-x. [PMID: 37975991 DOI: 10.1007/s10029-023-02920-x] [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: 08/15/2023] [Accepted: 10/22/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Complex incisional hernia is still a debatable topic, with increasing incidence and an increased local and systemic postoperative morbidity and mortality. The size of the defect is a risk factor for both difficult closure and 30-day readmission due to complications. The main option for closure such defect is a mesh augmented component separation technique. The goal was to evaluate 30-day wound events and general complications including 90 days mortality. MATERIAL AND METHODS We present a retrospective study that includes patients from two different university hospitals who underwent open incisional hernia repair with anterior component or posterior component separation between January 2015 and December 2021. Only non-contaminated adult patients (over 18 years old) with postoperative primary or recurrent median abdominal wall defects larger than 6 cm and with complete fascial closure were included. Demographics (age, gender, Body Mass Index-BMI, American Society of Anesthesiologists Classification-ASA score), recurrence rank, and co-morbidities), operative details, patient outcomes complications were collected. A native abdomen/pelvis computerized tomography (CT) scan was performed preoperatively in all patients and the anatomy of the defect and volumetry (abdominal cavity volume, incisional hernia volume and peritoneal volume) were evaluated. One of the component separation technique was performed according to Carbonell's equation. RESULTS Two hundred and two patients (101 from each group) were included. The patients with posterior component separation were more comorbid and with larger defects. The procedure was longer with 80 min but overall length of hospital stay shorter (p < 0.001) for posterior component separation. Seroma, hematoma and skin necrosis were equally distributed for both group of patients and there was no direct relation to surgery (OR 0.887, 95% CI 0.370-2.125, p = 0.788; OR 1.50, 95% CI 0.677-3.33, p = 0.318 and OR 0.386, 95% CI 0.117-1.276, p = 0.119). Surgical Site Infection rate was increased for anterior component separation (p =0.004). CONCLUSION Complex incisional hernia repair is a challenge given by a large amount of wound complications. Choosing between anterior and posterior component separation is still a source of significant debate. We were not able to depict significant different rates of complications between the procedures and we couldn't find any specific factor related to complications.
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Affiliation(s)
- Mihai Toma
- Clinical Department of Surgery, "Constantin Papilian" Emergency Clinical Military Hospital, Cluj-Napoca, 22 G-ral Traian Mosoiu, Cluj-Napoca-Napoca, Romania
- "George Emil Palade" University of Medicine, Pharmacy, Science and Technology, Targu-Mures, Romania
| | - Valentin Oprea
- Clinical Department of Surgery, "Constantin Papilian" Emergency Clinical Military Hospital, Cluj-Napoca, 22 G-ral Traian Mosoiu, Cluj-Napoca-Napoca, Romania.
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca-Napoca, Romania.
| | - Ovidiu Grad
- Clinical Department of Surgery, "Constantin Papilian" Emergency Clinical Military Hospital, Cluj-Napoca, 22 G-ral Traian Mosoiu, Cluj-Napoca-Napoca, Romania
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca-Napoca, Romania
| | | | - Carmen E Bucuri
- Clinical Department of Surgery, "Constantin Papilian" Emergency Clinical Military Hospital, Cluj-Napoca, 22 G-ral Traian Mosoiu, Cluj-Napoca-Napoca, Romania
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca-Napoca, Romania
| | - Octavian Andercou
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca-Napoca, Romania
- Second Clinical Department of Surgery, Emergency Clinical County Hospital, Cluj-Napoca-Napoca, Romania
| | - Mircea Gherghinescu
- "George Emil Palade" University of Medicine, Pharmacy, Science and Technology, Targu-Mures, Romania
- First Clinical Department of Surgery, Emergency Clinical County Hospital, Targu-Mures, Romania
| | - Calin Molnar
- "George Emil Palade" University of Medicine, Pharmacy, Science and Technology, Targu-Mures, Romania
- First Clinical Department of Surgery, Emergency Clinical County Hospital, Targu-Mures, Romania
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Valle de Lersundi AR, López-Monclús J, Blázquez Hernando LA, Muñoz Rodriguez J, Medina Pedrique M, Avilés Oliveros A, Morejón Ruiz S, García-Ureña MA. Recurrence after retromuscular repair or posterior components separation: How to address them. A retrospective multicentre cohort study. Cir Esp 2023; 101 Suppl 1:S40-S45. [PMID: 38042592 DOI: 10.1016/j.cireng.2023.01.014] [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: 12/27/2022] [Accepted: 01/14/2023] [Indexed: 12/04/2023]
Abstract
Abdominal wall hernias are common entities that represent important issues. Retromuscular repair and component separation for complex abdominal wall defects are considered useful treatments according to both short and long-term outcomes. However, failure of surgical techniques may occur. The aim of this study is to analyze results of surgical treatment for hernia recurrence after prior retromuscular or posterior components separation. We have retrospectively reviewed patient charts from a prospectively maintained database. This study was conducted in three different hospitals of the Madrid region with surgical units dedicated to abdominal wall reconstruction. We have included in the database 520 patients between December 2014 and December 2021. Fifty-one patients complied with the criteria to be included in this study. We should consider offering surgical treatment for hernia recurrence after retromuscular repair or posterior components separation. However, the results might be associated to increased peri-operative complications.
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Affiliation(s)
| | - Javier López-Monclús
- Servicio de Cirugía General, Hospital Universitario Puerta de Hierro, C. Joaquín Rodrigo, 1, 28222 Majadahonda, Madrid, Spain
| | - Luis Alberto Blázquez Hernando
- Servicio de Cirugía General, Hospital Universitario Ramón y Cajal, Ctra. de Colmenar Viejo km. 9,100, 28034 Madrid, Spain
| | - Joaquin Muñoz Rodriguez
- Servicio de Cirugía General, Hospital Universitario Puerta de Hierro, C. Joaquín Rodrigo, 1, 28222 Majadahonda, Madrid, Spain
| | - Manuel Medina Pedrique
- Servicio de Cirugía General, Hospital Universitario del Henares, Av. de Marie Curie, 0, 28822 Coslada, Madrid, Spain
| | - Adriana Avilés Oliveros
- Servicio de Cirugía General, Hospital Universitario del Henares, Av. de Marie Curie, 0, 28822 Coslada, Madrid, Spain
| | - Sara Morejón Ruiz
- Servicio de Cirugía General, Hospital Universitario del Henares, Av. de Marie Curie, 0, 28822 Coslada, Madrid, Spain
| | - Miguel-Angel García-Ureña
- Servicio de Cirugía General, Hospital Universitario del Henares, Av. de Marie Curie, 0, 28822 Coslada, Madrid, Spain
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López-Cano M, Verdaguer Tremolosa M, Hernández Granados P, Pereira JA. Open vs. minimally invasive sublay incisional hernia repair. Is there a risk of overtreatment? EVEREG registry analysis. Cir Esp 2023; 101 Suppl 1:S46-S53. [PMID: 37951467 DOI: 10.1016/j.cireng.2023.02.013] [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: 12/19/2022] [Accepted: 02/21/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION Incisional hernia (IH) is a very common surgical procedure. Registries provide real world data. The objective is to analyze the open and minimally invasive (MIS) sublay technique (with or without associated components separation [CS]) in IH cases from the EVEREG registry and to evaluate the evolution over time of the techniques. METHODS All patients in EVEREG from July 2012 to December 2021 were included. The characteristics of the patients, IH, surgical technique, complications and mortality in the first 30 days were collected. We analyzed Group 1 (open sublay vs MIS sublay, without CS), Group 2 (open sublay vs MIS sublay, with CS) and Group 3 where the evolution of open and MIS techniques was evaluated over time. RESULTS 4867 IH were repaired using a sublay technique. Group 1: 3739 (77%) open surgery, mostly midline hernias combined (P = .016) and 55 (1%) MIS, mostly lateral hernias (LH) (P = .000). Group 2: 1049 (21.5%) open surgery and 24 (0.5%) MIS. A meaningful difference (P = .006) was observed in terms of transverse diameters (5.9 (SD 2.1) cm for the MIS technique and 10.11 (SD 4.8) for the open technique). The LH MIS associated more CS (P = .002). There was an increase in the use of the sublay technique over time (with or without CS). CONCLUSION Increased use of the sublay technique (open and MIS) over time. For some type of hernia (LH) the MIS sublay technique with associated CS may have represented an overtreatment.
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Affiliation(s)
- Manuel López-Cano
- Unidad de Cirugía de la Pared Abdominal, Hospital Universitario Vall d´Hebrón, Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - Mireia Verdaguer Tremolosa
- Unidad de Cirugía de la Pared Abdominal, Hospital Universitario Vall d´Hebrón, Universidad Autónoma de Barcelona, Barcelona, Spain
| | | | - José Antonio Pereira
- Servicio de Cirugía General, Hospital Universitari del Mar, Barcelona, Spain; Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
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6
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López-Cano M, Verdaguer Tremolosa M, Hernández Granados P, Pereira JA. Técnica sublay abierta vs. mínimamente invasiva en el tratamiento de la hernia incisional. ¿Hay riesgo de sobretratamiento? Análisis del registro EVEREG. Cir Esp 2023. [DOI: 10.1016/j.ciresp.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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7
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Oprea V, Toma M, Grad O, Bucuri C, Pavel P, Chiorescu S, Moga D. The outcomes of open anterior component separation versus posterior component separation with transversus abdominis release for complex incisional hernias: a systematic review and meta-analysis. HERNIA : THE JOURNAL OF HERNIAS AND ABDOMINAL WALL SURGERY 2023; 27:503-517. [PMID: 36729336 DOI: 10.1007/s10029-023-02745-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 01/15/2023] [Indexed: 02/03/2023]
Abstract
PURPOSE The main objective was to assess the prevalence of hernia recurrence, wound complications (surgical site infections [SSI], seroma and hematoma) and mortality after anterior component separation (ACS) and posterior component separation via transversus abdominis muscle release (PCSTAR) in patients with complex incisional hernias. The so-called complex IH is a serious medical and societal challenge due to its direct and indirect costs; it is also hampered by the use of different surgical techniques, different type of meshes, and different results heterogeneously reported and interpreted. According to actual data, the best approach seems to be a mesh reinforcement component separation procedure augmented or not with an adjuvant technique (preoperative progressive pneumoperitoneum and/or Botulin toxin type A infiltration). METHODS A systematic search of four databases (MEDLINE, PubMed, Web of Science, and Google Scholars) was conducted to identify studies reporting on outcomes of component separation techniques and which were published before December 2021. A systematic review and a meta-analysis of postoperative outcomes were performed. RESULTS Nineteen studies including 3412 patients (1709 with ACS and 1703 with PCSTAR) were selected. Pooled hernia recurrence rate after a minimum 1-year follow-up was evaluated at 5.15% (odds ratio [OR] 0.68; 95% confidence interval [CI] 0.5-0.9; p = 0.0175). Pooled surgical site infection rate was 10.6% (OR 1.32; 95% CI 1.06-1.65; p = 0.0119). Seroma and hematoma were estimated at 9.75% (OR 1.93; 95% CI 1.52-2.44; p = 0.0001) and 3.83% (OR 1.81; 95% CI 1.26-2.61; p = 0.0012), respectively. ACS was associated with increased wound morbidity, seroma and hematoma. PCSTAR displayed higher recurrence rate (4.27% vs 6.11%). CONCLUSIONS PCSTAR was superior to ACS in terms of wound morbidity, surgical site infections, seroma and hematoma incidence. The procedure should be further evaluated in comparative head-to-head randomized controlled trials.
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Affiliation(s)
- V Oprea
- Clinical Department of Surgery, "Constantin Papilian" Emergency Clinical Military Hospital, No 22 Gral Traian Mosoiu Street, Cluj-Napoca, Cluj County, Romania. .,Second Department of Surgery, Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - M Toma
- Clinical Department of Surgery, "Constantin Papilian" Emergency Clinical Military Hospital, No 22 Gral Traian Mosoiu Street, Cluj-Napoca, Cluj County, Romania
| | - O Grad
- Clinical Department of Surgery, "Constantin Papilian" Emergency Clinical Military Hospital, No 22 Gral Traian Mosoiu Street, Cluj-Napoca, Cluj County, Romania.,Second Department of Surgery, Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - C Bucuri
- Clinical Department of Surgery, "Constantin Papilian" Emergency Clinical Military Hospital, No 22 Gral Traian Mosoiu Street, Cluj-Napoca, Cluj County, Romania.,Second Department of Surgery, Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - P Pavel
- Clinical Department of Surgery, "Constantin Papilian" Emergency Clinical Military Hospital, No 22 Gral Traian Mosoiu Street, Cluj-Napoca, Cluj County, Romania
| | - S Chiorescu
- Second Department of Surgery, Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - D Moga
- Department of Surgery, "Alexandru Augustin" Emergency Military Hospital, Sibiu, Romania.,Medicine and Pharmacy Faculty, "Lucian Blaga" University, Sibiu, Romania
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8
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Recurrence after retromuscular repair or posterior components separation: How to address them. A retrospective multicentre cohort study. Cir Esp 2023. [DOI: 10.1016/j.ciresp.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Marte G, Tufo A, Ferronetti A, Di Maio V, Russo R, Sordelli IF, De Stefano G, Maida P. Posterior component separation with TAR: lessons learned from our first consecutive 52 cases. Updates Surg 2022; 75:723-733. [PMID: 36355329 DOI: 10.1007/s13304-022-01418-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 11/01/2022] [Indexed: 11/12/2022]
Abstract
Patients with complex incisional hernia (IH) is a growing and challenging category that surgeons are facing in daily practice and represent indeed a technical challenge for most of them. The posterior component separation with TAR (PCS-TAR) has become the procedure of choice to repair most complex abdominal wall defects, including those with loss of domain, subxiphoid, subcostal, parastomal or after trauma and sepsis treated initially with "open abdomen" and in those scenarios in which the fascia closure was not performed to avoid an abdominal compartment syndrome. Most recent studies showed that the PCS-TAR represents a valid procedure in recurrent IH. The purpose of our study is to evaluate the reproducibility of the PCS-TAR, describing our experience, our surgical technique and the rate of postoperative complications and recurrences in a cohort of consecutive patients. 52 consecutive patients with complex IH, who underwent PCS-TAR at "Betania Hospital and Ospedale del Mare Hospital" in Naples between May 2014 and November 2019 were identified from a prospectively maintained database and reviewed retrospectively. There were 36 males (69%) and 16 females (31%) with a mean age of 57.88 (range 39-76) and Body mass index (BMI kg/m2) of 31.2 (24-45). More than half of patients (58%) were active smokers. Mean defect width was 13.6 cm (range 6-30) and mean defect area was about 267.9 cm2. Mean operative time was 228 min. Posterior fascial closure was reached in all cases, while anterior fascial closure only in 29 cases (56%). Mean hospital stay was 5.7 days. 27% of patients developed minor complications (Clavien-Dindo grade I-II) and one case (1.9%) major complication (Clavien-Dindo III). Seroma was registered in 23% of cases. SSI was reported to be 3.8% with no deep wound infection. Recurrence rate was 1.9% in a mean follow-up of 28 months. In Univariate analysis Bio-A surface > 600 cm2 and drain removal at discharge were significantly associated with major complications, while in a multivariate analysis only Bio-A surface > 600 cm2 was related. Considering univariate analysis for recurrences, number of drains, SSO, Clavien-Dindo score > 2 and defect area were significantly associated with recurrence, while in a multivariate analysis no variables were related. PCS-TAR is an indispensable tool in managing complex ventral hernias associated with a low rate of SSO and recurrence. Tobacco use, obesity and comorbidities cannot be considered absolute contraindications to PCS-TAR. Peri and postoperative management of complications and drainages have an impact on short term outcomes. Based on these outcomes, posterior component separation with transversus abdominis release has become our method of choice for the management of patients with complex ventral hernia requiring open hernia repair in selected patients.
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Wegdam JA, de Jong DLC, de Vries Reilingh TS, Schipper EE, Bouvy ND, Nienhuijs SW. Assessing Textbook Outcome After Implementation of Transversus Abdominis Release in a Regional Hospital. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2022; 1:10517. [PMID: 38314160 PMCID: PMC10831686 DOI: 10.3389/jaws.2022.10517] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 06/07/2022] [Indexed: 02/06/2024]
Abstract
Background: The posterior component separation technique with transversus abdominis release (TAR) was introduced in 2012 as an alternative to the classic anterior component separation technique (Ramirez). This study describes outcome and learning curve of TAR, five years after implementation of this new technique in a regional hospital in the Netherlands. Methods: A standardized work up protocol, based on the Plan-Do-Check-Act cycle, was used to implement the TAR. The TAR technique as described by Novitsky was performed. After each 20 procedures, outcome parameters were evaluated and new quality measurements implemented. Primary outcome measure was Textbook Outcome, the rate of patients with an uneventful clinical postoperative course after TAR. Textbook Outcome is defined by a maximum of 7 days hospitalization without any complication (wound or systemic), reoperation or readmittance, within the first 90 postoperative days, and without a recurrence during follow up. The number of patients with a Textbook Outcome compared to the total number of consecutively performed TARs is depicted as the institutional learning curve. Secondary outcome measures were the details and incidences of the surgical site and systemic complications within 90 days, as well as long-term recurrences. Results: From 2016, sixty-nine consecutive patients underwent a TAR. Textbook Outcome was 35% and the institutional learning curve did not flatten after 69 procedures. Systemic complications occurred in 48%, wound complications in 41%, and recurrences in 4%. Separate analyses of three successive cohorts of each 20 TARs demonstrated that both Textbook Outcome (10%, 30% and 55%, respectively) and the rate of surgical site events (45%, 15%, and 10%) significantly (p < 0.05) improved with more experience. Conclusion: Implementation of the open transversus abdominis release demonstrated that outcome was positively correlated to an increasing number of TARs performed. TAR has a long learning curve, only partially determined by the technical aspects of the operation. Implementation of the TAR requires a solid plan. Building, and maintaining, an adequate setting for patients with complex ventral hernias is the real challenge and driving force to improve outcome.
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Affiliation(s)
| | | | | | | | - Nicole D. Bouvy
- Maastricht University Medical Centre, Maastricht, Netherlands
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11
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Pereira-Rodriguez JA, Bravo-Salva A, Montcusí-Ventura B, Hernández-Granados P, Rodrigues-Gonçalves V, López-Cano M. Comment to: Early outcomes of component separation techniques: an analysis of the Spanish registry of incisional hernia (EVEREG)-Author's reply. Hernia 2021; 26:661-662. [PMID: 34751839 DOI: 10.1007/s10029-021-02515-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 10/19/2022]
Affiliation(s)
- J A Pereira-Rodriguez
- Department of Surgery, Hospital del Mar-Parc de Salut Mar, Passeig Maritim 25-29, 08003, Barcelona, Spain. .,Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain.
| | - A Bravo-Salva
- Department of Surgery, Hospital del Mar-Parc de Salut Mar, Passeig Maritim 25-29, 08003, Barcelona, Spain.,Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - B Montcusí-Ventura
- Department of Surgery, Hospital del Mar-Parc de Salut Mar, Passeig Maritim 25-29, 08003, Barcelona, Spain
| | | | | | - M López-Cano
- Abdominal Wall Surgery Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain
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12
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Comment to: "Early outcomes of component separation techniques: an analysis of the Spanish registry of incisional Hernia (EVEREG)". Hernia 2021; 26:657-660. [PMID: 34487280 DOI: 10.1007/s10029-021-02490-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
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