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Tryliskyy Y, Kebkalo A, Tyselskyi V, Owais A, Pournaras DJ. Short-term outcomes of minimally invasive techniques in posterior component separation for ventral hernia repair: a systematic review and meta-analysis. Hernia 2024:10.1007/s10029-024-03030-y. [PMID: 38632220 DOI: 10.1007/s10029-024-03030-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 03/15/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION The objective of this study was to perform a systematic review and meta-analysis to summarize various approaches in performing minimally invasive posterior component separation (MIS PCS) and ascertain their safety and short-term outcomes. METHODS A systematic literature searches of major databases were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines to identify studies that provided perioperative characteristics and postoperative outcomes of MIS PCS. Primary outcomes for this study were: surgical site events (SSE), surgical site occurrence requiring procedural intervention (SSOPI), and overall complication rates. A random-effect meta-analysis was conducted which allows computation of 95% CIs using simple approximation and incorporates inverse variance method with logit transformation of proportions. RESULTS There were 14 studies that enrolled 850 participants that were included. The study identified rate of SSE, SSOPI, and overall rate of complications of all MIS TAR modifications to be 13.4%, 5.7%, and 19%, respectively. CONCLUSIONS Our study provides important information on safety and short-term outcomes of MIS PCS. These data can be used as reference when counseling patients, calculating sample size for prospective trials, setting up targets for prospective audit of hernia centers. Standardization of reporting of preoperative characteristics and postoperative outcomes of patients undergoing MIS PCS and strict audit of the procedure through introduction of prospective national and international registries can facilitate improvement of safety of the MIS complex abdominal wall reconstruction, and help in identifying the safest and most cost-effective modification.
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Affiliation(s)
- Y Tryliskyy
- Great Western Hospitals, NHS, Marlborough Road, Swindon, England, SN3 6BB, UK.
- The University of Edinburgh, Edinburgh, UK.
| | - A Kebkalo
- Shupyk National Healthcare University of Ukraine, Kiev, Ukraine
| | - V Tyselskyi
- Shupyk National Healthcare University of Ukraine, Kiev, Ukraine
| | - A Owais
- Great Western Hospitals, NHS, Marlborough Road, Swindon, England, SN3 6BB, UK
| | - D J Pournaras
- Southmead Hospital, North Bristol NHS Trust, Bristol, England, UK
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Garcia Ureña MÁ, López-Monclús J, Hernando LAB, Munoz-Rodriguez J, García de León LR, Avilés Oliveros A, Pedrique MM, de Luca M, Valle de Lersundi AR. [Incisional hernia: open abdominal wall reconstruction. Current state of the technique and results]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:10-19. [PMID: 38157070 DOI: 10.1007/s00104-023-02005-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 01/03/2024]
Abstract
The treatment of complex midline hernias remains a particular challenge. The currently refined knowledge of the anatomy in the cadaver laboratory and advancing clinical experience have changed our present approach. The aim of this review is to present a description of the updated surgical procedures and outcomes. We favor the retromuscular or preperitoneal layer for mesh implantation, including the Rives-Stoppa procedure (sublay mesh) and posterior component separation with the Madrid modification. We operated on 334 complex midline incisional hernias: 6.3% retromuscular preperitoneal, 15% after Rives-Stoppa, 2.4% anterior component separation and 76% posterior component separation. A bridging procedure was used in 31%. A complication occurred in 35.3%, most of which were wound healing disorders (SSO). The average length of hospital stay was 7.2 days. We recorded a very low incidence of long-term complications: 3.3% recurrence, 0.9% chronic pain (daily use of pain medication), 6% bulging, 1.8% chronic seroma and 2.6% chronic mesh infection. Despite the associated morbidity, retromuscular/preperitoneal treatment offers excellent long-term results.
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Affiliation(s)
- Miguel Ángel Garcia Ureña
- Hospital Universitario del Henares, Madrid, Spanien.
- Hospital Universitario del Henares, Grupo de Investigación de Pared Compleja, Faculty of Medicine, Universidad Francisco de Vitoria, Ctra. Pozuelo-Mahadahonda km. 1, 800, 28223, Madrid, Pozuelo de Alarcón, Spanien.
| | | | | | | | | | | | | | - Marcelo de Luca
- Università degli studi di Napoli Federico II, Napoli, Italien
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Gupta S, Attri AK, Iqbal Mir Z, Bansal I. Pre-peritoneal Fat as a Guide to Extended View Total Extraperitoneal (eTEP) Repair for Inguinal Hernia. Cureus 2024; 16:e52327. [PMID: 38361684 PMCID: PMC10868912 DOI: 10.7759/cureus.52327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
In the extra-peritoneal approach for inguinal hernias, pre-peritoneal space creation is one of the most crucial steps. In the absence of well-defined landmarks, it is difficult to identify the correct plane of dissection, and blind dissection can sometimes lead to peritoneal injury, resulting in loss of working space. In this article, we describe our technique of pre-peritoneal space creation by following the fatty tissue of the median umbilical ligament and fatty tissue along the rectus muscle. The data of all patients (total 84) who underwent surgery with this technique between January 2021 and May 2023 were retrieved and assessed for demographics, hernia type, and perioperative complications. Except for two peritoneal injuries, there were no other intraoperative complications.
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Affiliation(s)
- Sanjay Gupta
- Surgery, Government Medical College & Hospital, Chandigarh, IND
| | - Ashok K Attri
- Surgery, Government Medical College & Hospital, Chandigarh, IND
| | - Zahid Iqbal Mir
- General Surgery, Government Medical College & Hospital, Chandigarh, IND
| | - Ishan Bansal
- General Surgery, Government Medical College & Hospital, Chandigarh, IND
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Vierstraete M, Pereira Rodriguez JA, Renard Y, Muysoms F. EIT Ambivium, Linea Semilunaris, and Fulcrum Abdominalis. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2023; 2:12217. [PMID: 38312427 PMCID: PMC10831682 DOI: 10.3389/jaws.2023.12217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/11/2023] [Indexed: 02/06/2024]
Abstract
Building upon the recent advancements in posterior component separation techniques for complex abdominal wall hernia repair, highlights the critical importance of a thorough understanding of the abdominal wall anatomy. To address anatomical concepts with a pivotal role in hernia repair, we propose two new terminologies: "EIT Ambivium" referring to the lateral border of the rectus sheath, and "Fulcrum Abdominalis" demarcating the point where the Linea Arcuata intersects with the EIT Ambivium.
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Affiliation(s)
| | | | - Yohann Renard
- General and Digestive Surgery, Université de Reims Champagne-Ardenne, Reims, France
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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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Medina Pedrique M, Robin Valle de Lersundi Á, Avilés Oliveros A, Ruiz SM, López-Monclús J, Munoz-Rodriguez J, Blázquez Hernando LA, Martinez Caballero J, García-Urena MÁ. Incisions in Hepatobiliopancreatic Surgery: Surgical Anatomy and its Influence to Open and Close the Abdomen. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2023; 2:11123. [PMID: 38312419 PMCID: PMC10831649 DOI: 10.3389/jaws.2023.11123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 02/28/2023] [Indexed: 02/06/2024]
Abstract
Incisions performed for hepato-pancreatic-biliary (HPB) surgery are diverse, and can be a challenge both to perform correctly as well as to be properly closed. The anatomy of the region overlaps muscular layers and has a rich vascular and nervous supply. These structures are fundamental for the correct functionality of the abdominal wall. When performing certain types of incisions, damage to the muscular or neurovascular component of the abdominal wall, as well as an inadequate closure technique may influence in the development of long-term complications as incisional hernias (IH) or bulging. Considering that both may impair quality of life and that are complex to repair, prevention becomes essential during these procedures. With the currently available evidence, there is no clear recommendation on which is the better incision or what is the best method of closure. Despite the lack of sufficient data, the following review aims to correlate the anatomical knowledge learned from posterior component separation with the incisions performed in hepato-pancreatic-biliary (HPB) surgery and their consequences on incisional hernia formation. Overall, there is data that suggests some key points to perform these incisions: avoid vertical components and very lateral extensions, subcostal should be incised at least 2 cm from costal margin, multilayered suturing using small bites technique and consider the use of a prophylactic mesh in high-risk patients. Nevertheless, the lack of evidence prevents from the possibility of making any strong recommendations.
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Affiliation(s)
- Manuel Medina Pedrique
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Madrid, Spain
| | - Álvaro Robin Valle de Lersundi
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Madrid, Spain
| | - Adriana Avilés Oliveros
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Madrid, Spain
| | - Sara Morejón Ruiz
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Madrid, Spain
| | - Javier López-Monclús
- General and Digestive Surgery Department, Hospital Universitario Puerta de Hierro, Autónoma University of Madrid, Madrid, Spain
| | - Joaquín Munoz-Rodriguez
- General and Digestive Surgery Department, Hospital Universitario Puerta de Hierro, Autónoma University of Madrid, Madrid, Spain
| | - Luis Alberto Blázquez Hernando
- General and Digestive Surgery Department, Hospital Universitario Ramón y Cajal, Alcalá de Henares University Madrid, Madrid, Spain
| | - Javier Martinez Caballero
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Madrid, Spain
| | - Miguel Ángel García-Urena
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Madrid, Spain
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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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8
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Munoz-Rodriguez JM, Lopez-Monclus J, Perez-Flecha M, Robin-Valle de Lersundi A, Blazquez-Hernando LA, Royuela-Vicente A, Garcia-Hernandez JP, Equisoain-Azcona A, Medina-Pedrique M, Garcia-Urena MA. Reverse TAR may be added when necessary in open preperitoneal repair of lateral incisional hernias: a retrospective multicentric cohort study. Surg Endosc 2022; 36:9072-9091. [PMID: 35764844 DOI: 10.1007/s00464-022-09375-8] [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: 03/23/2022] [Accepted: 05/28/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND The best approach for lateral incisional hernia is not known. Posterior component separation (reverse TAR) offers the possibility of using the retromuscular space for medial extension of the challenging preperitoneal plane. The aim of our multicenter study was to compare the operative and patient-reported outcomes measures (PROMs) using two open surgical techniques from the lateral approach: a totally preperitoneal vs a reverse TAR. METHODS A retrospective cohort study was performed since 2012 to 2020. Patients with lateral incisional hernia treated through a lateral approach were identified from a prospectively maintained multicenter database. Reverse TAR was added when the preperitoneal plane could not be safely dissected. The results obtained using these two lateral approaches were compared, including short- and long-term complications, as well as PROMs, using the specific tool EuraHSQoL. RESULTS A total of 61 patients were identified. Reverse TAR was performed in 33 patients and lateral retromuscular preperitoneal approach in 28 patients. Both groups were comparable in terms of sociodemographic and comorbidities variables. Surgical site occurrences occurred in 13 cases (21.3%), with 8 patients (13.1%) requiring procedural intervention. During a median follow-up of 34 months, no incisional hernia recurrence was registered. There was a case (1.6%) of symptomatic bulging that required reoperation. Also 12 patients (19.7%) presented an asymptomatic bulging. No statistically significant difference was identified in the complications and PROMs between the two procedures. CONCLUSION The open lateral retromuscular reconstruction using very large meshes that reach the midline has excellent long-term results with acceptable postoperative complications, including PROMs. A reverse TAR may be added, when necessary, without increasing complications and obtaining similar long-term results.
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Affiliation(s)
- Joaquin M Munoz-Rodriguez
- Puerta de Hierro Majadahonda University Hospital, C. Joaquín Rodrigo, 1, 28222, Majadahonda, Madrid, Spain.,Autónoma de Madrid University, Madrid, Spain
| | - Javier Lopez-Monclus
- Puerta de Hierro Majadahonda University Hospital, C. Joaquín Rodrigo, 1, 28222, Majadahonda, Madrid, Spain. .,Autónoma de Madrid University, Madrid, Spain.
| | - Marina Perez-Flecha
- Henares University Hospital, Av. de Marie Curie, 0, 28822, Coslada, Madrid, Spain.,Complex Abdominal Wall Research Group From Francisco de Vitoria University, Madrid, Spain
| | - Alvaro Robin-Valle de Lersundi
- Henares University Hospital, Av. de Marie Curie, 0, 28822, Coslada, Madrid, Spain.,Complex Abdominal Wall Research Group From Francisco de Vitoria University, Madrid, Spain
| | | | - Ana Royuela-Vicente
- Puerta de Hierro Majadahonda University Hospital, C. Joaquín Rodrigo, 1, 28222, Majadahonda, Madrid, Spain.,Autónoma de Madrid University, Madrid, Spain
| | - Juan P Garcia-Hernandez
- Alcala de Henares University, Campus Universitario-C/ 19, Av. de Madrid, Km 33,600, 28871, Alcalá de Henares, Madrid, Spain
| | - Aritz Equisoain-Azcona
- Puerta de Hierro Majadahonda University Hospital, C. Joaquín Rodrigo, 1, 28222, Majadahonda, Madrid, Spain.,Autónoma de Madrid University, Madrid, Spain
| | - Manuel Medina-Pedrique
- Henares University Hospital, Av. de Marie Curie, 0, 28822, Coslada, Madrid, Spain.,Complex Abdominal Wall Research Group From Francisco de Vitoria University, Madrid, Spain
| | - Miguel A Garcia-Urena
- Henares University Hospital, Av. de Marie Curie, 0, 28822, Coslada, Madrid, Spain.,Complex Abdominal Wall Research Group From Francisco de Vitoria University, Madrid, Spain
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