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Martis G, Laczik R, Németh N, Martis G, Damjanovich L. Bilateral rectus muscle turning-over for complicated and eventrated abdominal wall hernias: results of a novel method. Acta Cir Bras 2024; 39:e393624. [PMID: 39166553 PMCID: PMC11328894 DOI: 10.1590/acb393624] [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: 11/11/2023] [Accepted: 05/20/2024] [Indexed: 08/23/2024] Open
Abstract
PURPOSE We present a technique for covering large midline loss of abdominal wall using a novel method by autologous tissues. METHODS Twenty-two patients (body mass index = 35,6 ± 6,9 kg/m2) were involved in the prospective cohort study. Acute and elective cases were included. The gap area was 450.1 ± 54 cm2. The average width of the midline gap was 16,3 ± 3,2 cm. The rectus muscles were mobilized from its posterior sheath. Both muscles were turned by180º medially, so that the complete abdominal wall gap could be covered without considerable tension. Changes in intra-abdominal pressure, quality of life and hernia recurrency were determined. RESULTS There was no significant increase in the intra-abdominal pressure. Wound infection and seroma occurred in four cases. Bleeding occurred in one case. Pre- and post-operative quality of life index significantly improved (23 ± 13 vs. 47 ± 6; p = 0,0013). One recurrent hernia was registered. The procedure could be performed safely and yielded excellent results. The method was applied in acute cases. The intact anatomical structure of rectus muscles was essential. CONCLUSIONS The midline reconstruction with bilateral turned-over rectus muscles provided low tension abdominal wall status, and it did not require synthetic mesh implantation.
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Affiliation(s)
- Gábor Martis
- University of Debrecen – Faculty of Medicine – Department of Surgery – Debrecen – Hungary
| | - Renáta Laczik
- University of Debrecen – Faculty of Medicine – Department of Angiology – Debrecen – Hungary
| | - Norbert Németh
- University of Debrecen – Faculty of Medicine – Department of Operative Techniques and Surgical Research – Debrecen – Hungary
| | - Gabriella Martis
- University of Debrecen – Faculty of Medicine – Medical School – Debrecen – Hungary
| | - László Damjanovich
- University of Debrecen – Faculty of Medicine – Department of Surgery – Debrecen – Hungary
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McBee PJ, Larsen NK, Reilly MJ, Walters RW, Olson MA, Fitzgibbons RJ. Association of Nicotine Cessation Time on the Incidence of Recurrent Incisional Hernia Repair and Postoperative Surgical Site Occurrences. Am Surg 2023; 89:6127-6133. [PMID: 37501283 DOI: 10.1177/00031348231192042] [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] [Indexed: 07/29/2023]
Abstract
BACKGROUND Nicotine products are believed to be associated with a higher incidence of incisional hernia (IH) recurrence and postoperative complications after IH repair. METHODS A retrospective analysis of the Abdominal Core Health Quality Collaborative (ACHQC) database was performed. Outcomes included risk of IH recurrence, 30-day surgical site infection (SSI), and 30-day surgical site occurrence (SSO). RESULTS We included 14,663 patients. Nicotine users who quit within 1 year of surgery had a 26% higher risk of IH recurrence compared to patients who quit more than a year before surgery or never users. Patients who quit using nicotine within 1 year of surgery had a 54% higher odds of SSI compared to former nicotine users who quit more than a year before surgery. CONCLUSION Former nicotine users with less than 1 year of nicotine use cessation before surgery exhibited worse outcomes than those with more than a year of cessation or no prior use.
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Affiliation(s)
- Patrick J McBee
- Department of Surgery, Creighton University School of Medicine, Omaha, NE, USA
| | - Nicholas K Larsen
- Department of Surgery, Creighton University School of Medicine, Omaha, NE, USA
| | - Matthew J Reilly
- Department of Surgery, Creighton University School of Medicine, Omaha, NE, USA
| | - Ryan W Walters
- Department of Clinical Research, Creighton University School of Medicine, Omaha, NE, USA
| | - Molly A Olson
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
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Louis V, Diab S, Villemin A, Brigand C, Manfredelli S, Delhorme JB, Rohr S, Romain B. Do surgical drains reduce surgical site occurrence and infection after incisional hernia repair with sublay mesh? A non-randomised pilot study. Hernia 2023:10.1007/s10029-023-02768-1. [PMID: 36959525 DOI: 10.1007/s10029-023-02768-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 03/05/2023] [Indexed: 03/25/2023]
Abstract
INTRODUCTION Surgical site occurrence (SSO) and surgical site infection (SSI) are common concerns with incisional hernia repair. Intraoperative drain placement is a common practice aiming to reduce SSO and SSI rates. However, literature on the matter is very poor. The aim of this study is to investigate the role of subcutaneous and periprosthetic drain placement on postoperative outcomes and SSO and SSI rates with incisional hernia repair. METHODS A non-randomised pilot study was performed between January 2018 and December 2020 and included patients with elective midline or lateral incisional hernia repair with sublay mesh placement. Patients were prospectively included, followed for 1 month and divided into three groups: group 1 without drainage, group 2 with subcutaneous drainage, and group 3 with subcutaneous and periprosthetic drains. Drains were placed at surgeon's discretion. All patients were included in the enhanced recovery program. RESULTS One hundred and four patients were included. Twenty-four patients (23.1%) did not have drains (group 1), 60 patients (57.7%) had a subcutaneous drain (group 2) and 20 patients (19.2%) had both a subcutaneous and a periprosthetic drains (group 3). SSO rates were significantly different between the 3 groups: 20.8% in group 1, 20.7% in group 2 and 50% in group 3 (p = 0.03). There was no significant difference in deep and superficial SSI rates between the 3 groups. Subgroup analysis revealed that adding a drain in direct contact with the mesh significantly increased SSO rate but did not influence SSI rate. Length of stay was also significantly increased by the presence of a drain, 3.1 ± 1.9 days for group 1; 5.9 ± 4.8 for group 2 and 5.9 ± 2.5 days for group 3 (p < 0.005). CONCLUSION Drain placement in direct contact with the mesh might increase SSO rate. More studies are necessary to evaluate the actual benefits of drainage after incisional hernia repair.
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Affiliation(s)
- V Louis
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 Avenue Molière, 67200, Strasbourg, France
| | - S Diab
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 Avenue Molière, 67200, Strasbourg, France
| | - A Villemin
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 Avenue Molière, 67200, Strasbourg, France
| | - C Brigand
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 Avenue Molière, 67200, Strasbourg, France
- Streinth Lab (Stress Response and Innovative Therapies), Inserm UMR_S 1113 IRFAC (Interface Recherche Fondamental Et Appliquée À La Cancérologie), Strasbourg University, Strasbourg, France
| | - S Manfredelli
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 Avenue Molière, 67200, Strasbourg, France
| | - J-B Delhorme
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 Avenue Molière, 67200, Strasbourg, France
- Streinth Lab (Stress Response and Innovative Therapies), Inserm UMR_S 1113 IRFAC (Interface Recherche Fondamental Et Appliquée À La Cancérologie), Strasbourg University, Strasbourg, France
| | - S Rohr
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 Avenue Molière, 67200, Strasbourg, France
- Streinth Lab (Stress Response and Innovative Therapies), Inserm UMR_S 1113 IRFAC (Interface Recherche Fondamental Et Appliquée À La Cancérologie), Strasbourg University, Strasbourg, France
| | - B Romain
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 Avenue Molière, 67200, Strasbourg, France.
- Streinth Lab (Stress Response and Innovative Therapies), Inserm UMR_S 1113 IRFAC (Interface Recherche Fondamental Et Appliquée À La Cancérologie), Strasbourg University, Strasbourg, France.
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Online information for incisional hernia repair: What are patients reading? Surgeon 2022:S1479-666X(22)00137-8. [PMID: 36588086 DOI: 10.1016/j.surge.2022.12.002] [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: 10/04/2022] [Revised: 12/04/2022] [Accepted: 12/05/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE Patients increasingly access online materials for health-related information. Using validated assessment tools, we aim to assess the quality and readability of online information for patients considering incisional hernia (IH) repair. METHODS The top three online search engines (Google, Bing, Yahoo) were searched in July 2022 for "Incisional hernia repair" and "Surgical hernia repair". Included websites were classified as academic, hospital-affiliated, commercial, and unspecified. The quality of information was assessed using the Journal of the American Medical Association (JAMA) benchmark criteria (0-4), DISCERN instrument (16-80), and the presence of Health On the Net code (HONcode) certification. Readability was assessed using the Flesch Reading Ease (FRE) and Flesch-Kincaid Grade Level (FKGL) tests. RESULTS 25 unique websites were included. The average JAMA and DISCERN scores of all websites were 0.68 ± 1.02 and 36.50 ± 10.91, respectively. Commercial sites showed a significantly higher DISCERN mean score than academic sites (p = 0.034), while no significant difference was demonstrated between other website categories. 3 (12%) websites reported HONcode certification and had significantly higher JAMA (p = 0.016) and DISCERN (p = 0.045) mean scores than sites without certification. Average FRE and FKGL scores were 39.84 ± 13.11 and 10.62 ± 1.76, respectively, corresponding to college- and high school-level comprehensibility. CONCLUSIONS Our findings suggest online patient resources on IH repair are of poor overall quality and may not be comprehensible to the public. Patients accessing internet resources for additional information on IH repair should be made aware of these inadequacies and directed to sites bearing HONcode certification.
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Initial results of an indigenous absorbable tacker for mesh fixation in laparoscopic ventral hernia repair: a retrospective analysis of 158 cases. Hernia 2022; 26:1583-1589. [DOI: 10.1007/s10029-022-02670-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 08/25/2022] [Indexed: 11/04/2022]
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Fehér D, Ferencz A, Szabó G, Juhos K, Csukás D, Voniatis C, Reininger L, Molnár K, Jedlovszky-Hajdú A, Wéber G. Early and late effects of absorbable poly(vinyl alcohol) hernia mesh to tissue reconstruction. IET Nanobiotechnol 2021; 15:565-574. [PMID: 34694741 PMCID: PMC8675808 DOI: 10.1049/nbt2.12015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/15/2020] [Accepted: 12/26/2020] [Indexed: 11/19/2022] Open
Abstract
Hernia is a defect of the abdominal wall. Treatment is principally surgical mesh implantation. Non-degradable surgical meshes produce numerous complications and side-effects such as inflammatory response, mesh migration and chronic pain. In contrast, the biodegradable, poly (vinyl alcohol) (PVA) based polymers have excellent chemical, mechanical and biological properties and after their degradation no chronic pain can be expected. The toxicology of PVA solution and fibers was investigated with Human dermal fibroblast- Adult cell line. Implantation tests were observed on long-term contact (rat) and large animal (swine) models. To measure the adhesion formation, Diamond and Vandendael score were used. Macroscopical and histological responses were graded from the samples. In vitro examination showed that PVA solution and fibers are biocompatible for the cells. According to the implantation tests, all samples were integrated into the surrounding tissue, and there was no foreign body reaction. The average number of adhesions was found on the non-absorbable suture line. The biocompatibility of the PVA nanofiber mesh was demonstrated. It has a non-adhesive, non-toxic and good quality structure which has the potential to be an alternative solution for the part of the hernia mesh.
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Affiliation(s)
- Daniella Fehér
- Department of Surgical Research and Techniques, Semmelweis University, Budapest, Hungary
| | - Andrea Ferencz
- Department of Surgical Research and Techniques, Semmelweis University, Budapest, Hungary
| | - Györgyi Szabó
- Department of Surgical Research and Techniques, Semmelweis University, Budapest, Hungary
| | - Krisztina Juhos
- Department of Surgical Research and Techniques, Semmelweis University, Budapest, Hungary
| | - Domokos Csukás
- Department of Surgical Research and Techniques, Semmelweis University, Budapest, Hungary
| | - Constantinos Voniatis
- Department of Surgical Research and Techniques, Semmelweis University, Budapest, Hungary.,Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Lilla Reininger
- Laboratory of Nanochemistry, Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary
| | - Kristóf Molnár
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Angéla Jedlovszky-Hajdú
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - György Wéber
- Department of Surgical Research and Techniques, Semmelweis University, Budapest, Hungary
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Skolimowska-Rzewuska M, Mitura K. Essential anatomical landmarks in placement of an adequate size mesh for a successful ventral hernia repair. POLISH JOURNAL OF SURGERY 2021; 93:1-5. [PMID: 34552025 DOI: 10.5604/01.3001.0014.9349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Safe and effective hernia repair requires a surgeon to have the appropriate knowledge necessary to learn details of the surgical technique. Long-term results of treatment, even with the use of synthetic implants, have shown that recurrences were still a significant clinical problem concerning up to every fourth patient. Therefore, it was pointed out that the mere presence of synthetic material is not a solitary circumstance sufficient for a successful repair. A key finding in recurrence prevention has been to focus surgeons' attention on the relationship between the size of the hernia orifice and the mesh surface. An optimal ratio of these values has not been established yet, however, it is considered that the mesh surface area should be at least sixteen times larger than the area of the abdominal wall defect. In cases of medium and large hernias, in order to place an extensive mesh sheet in the appropriate anatomical space of the abdominal wall, an extensive dissection needs to be performed, including several different compartments. Therefore, a surgeon undertaking a hernia repair needs to know perfectly the anatomy and function of all the myofascial structures involved. Performing an incorrect dissection of a mistaken structure may lead to catastrophic abdominal deformities. Depriving the patient of the natural support of the abdominal wall provided by the muscles may lead to total or partial destabilization of the trunk and lead to disability. In this paper a detailed description of anatomical structures and its practical use has been presented.
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Affiliation(s)
| | - Kryspin Mitura
- Faculty of Medical Sciences and Health Sciences, Siedlce University of Natural Sciences and Humanities, Poland
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Oprea V, Mardale S, Buia F, Gheorghescu D, Nica R, Zdroba S, Grad O. The influence of Transversus Abdominis Muscle Release (TAR) for complex incisional hernia repair on the intraabdominal pressure and pulmonary function. Hernia 2021; 25:1601-1609. [PMID: 33751278 PMCID: PMC7983096 DOI: 10.1007/s10029-021-02395-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/08/2021] [Indexed: 11/25/2022]
Abstract
Introduction Among many other techniques for Abdominal Wall Reconstruction (AWR), posterior component separation with Transversus Abdominis Release (TAR), continues to gain popularity and it is increasingly used with promising long-term results. Our goal was to evaluate the influence of TAR with mesh retromuscular reinforcement on the intra-abdominal pressure (IAP) and respiratory function in a series of patients with complex incisional hernias (IH). Methods Since November 2014 through February 2019, patients with TAR were identified in the Clinical Department of Surgery database and were retrospectively reviewed. Outcome measures include: demographics, pre- and perioperative details, preoperative and postoperative IAP and plateau pressure (PP). Results One-hundred-and-one consecutive TAR procedures (19.7% from all incisional hernia repairs) were analyzed. Mean age was 63 years with a mean Body Mass Index (BMI) of 31.85 kg/m2 (25–51). Diabetes and Chronic Obstructive Pulmonary Disease (COPD) were the main major comorbidities. Mean hernia defect area was 247 cm2 (104–528 cm2). Conclusion TAR is a safe and sound procedure with acceptable modifications of the IAP morbidity and recurrence rate when correctly performed on the right patient.
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Affiliation(s)
- V Oprea
- Clinical Department of Surgery, "Constantin Papilian" Emergency Military Clinical Hospital, No. 22 General Traian Mosoiu Street, Cluj-Napoca, Cluj County, Romania.
| | - S Mardale
- Department of Radiology, "Constantin Papilian" Emergency Military Clinical Hospital, Cluj-Napoca, Romania
| | - F Buia
- Clinical Department of Surgery, "Constantin Papilian" Emergency Military Clinical Hospital, No. 22 General Traian Mosoiu Street, Cluj-Napoca, Cluj County, Romania
| | - D Gheorghescu
- Clinical Department of Surgery, "Constantin Papilian" Emergency Military Clinical Hospital, No. 22 General Traian Mosoiu Street, Cluj-Napoca, Cluj County, Romania
| | - R Nica
- Intensive Care Unit, "Constantin Papilian" Emergency Military Clinical Hospital, Cluj-Napoca, Romania
| | - S Zdroba
- Intensive Care Unit, "Constantin Papilian" Emergency Military Clinical Hospital, Cluj-Napoca, Romania
| | - O Grad
- Clinical Department of Surgery, "Constantin Papilian" Emergency Military Clinical Hospital, No. 22 General Traian Mosoiu Street, Cluj-Napoca, Cluj County, Romania.,2nd Department of Surgery, Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Right Colectomy with Absorbable Mesh Repair as a Salvage Solution for the Management of Giant Incisional Hernia with Loss of Domain: Results of a Bicentric Study. World J Surg 2021; 44:1762-1770. [PMID: 32016544 DOI: 10.1007/s00268-020-05395-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Incisional hernia (IH) may occur in 20% of patients after laparotomy. The hernia sac volume may be of significance, with reintegration of visceral contents potentially leading to repair failure or abdominal compartment syndrome. The present study aimed to evaluate a two-step surgical strategy comprising right colectomy for hernia reduction with synchronous absorbable mesh repair followed by definitive non-absorbable mesh repair in recurrence. METHODS Patients operated between 2012 and 2017 at two university centers were retrospectively included. Volumetric evaluation of the IH was performed by CT imaging. RESULTS Eleven patients were included. The mean BMI was 43 kg/m2 (23-52 kg/m2). Progressive preoperative pneumoperitoneum was performed in 82% of patients, with complications in 22%. The mean volumetric ratio of the volume of the hernia to the volume of the abdominal cavity was 70% (48-100%). The first parietal repair was performed using an synthetic absorbable mesh (36%), a biologic mesh (27%), or a slowly absorbable mesh (36%). No patients died as a result of the procedure. Seven (64%) patients developed grade III-IV complications, including one case of an anastomotic fistula. Recurrence occurred in eight (73%) patients after the first repair. Of these, four (50%) patients were reoperated using a non-absorbable mesh, leading to solid repair in 75% of cases. After 27 ± 18 months of follow-up, the residual IH rate was 46%. CONCLUSIONS Right colectomy for volume reduction in IH with loss of domain potentially represents an appropriate salvage option, supporting bowel reintegration and temporary hernia repair with absorbable material.
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Laparoscopic enhanced-view totally extraperitoneal Rives-Stoppa repair (eTEP-RS) for ventral and incisional hernias - early operative outcomes and technical remarks on a novel retromuscular approach. Wideochir Inne Tech Maloinwazyjne 2020; 15:533-545. [PMID: 33294067 PMCID: PMC7687670 DOI: 10.5114/wiitm.2020.99371] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 09/12/2020] [Indexed: 02/06/2023] Open
Abstract
Introduction Incisional hernias can complicate up to one in four laparotomy procedures, and successful repair remains a significant clinical challenge for surgeons. Recently, the surgical technique of ventral hernia repair (eTEP-RS) has been introduced. Aim To present early results in treating patients with ventral hernia using the eTEP-RS technique and to discuss key technical aspects affecting the safety and efficiency of repair. Material and methods A prospective study of early outcomes was conducted for all ventral hernia patients (hernia orifice between 4 and 8 cm) who underwent eTEP-RS between March 2019 and July 2020. Results As of July 2020, we performed a total of 11 eTEP-RS procedures. The mean duration of the surgery was 204 min (158 to 295). The average size of the treated defect in the transverse dimension was 5.8 cm, and the defect area was 38.5 cm2. The average size of the mesh used was 486 cm2 (280 to 590). After an average follow-up of 7 months (1–17) there was no recurrence or major complication. Based on our initial experiences we present a detailed description of the main aspects of the surgical technique itself, as well as the essential nuances, to enable evaluation of the technique and future popularization. Conclusions The eTEP-RS technique is a safe alternative to open ventral hernia repair and allows for the placement of a large piece of mesh in accordance with current recommendations. Excellent knowledge of the detailed anatomy of the abdominal wall is essential for safe and effective hernia repair.
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Fafaj A, Petro CC, Tastaldi L, Alkhatib H, AlMarzooqi R, Olson MA, Stewart TG, Prabhu A, Krpata D, Rosen MJ. Intraperitonealversusretromuscular mesh placement for open incisional hernias: an analysis of the Americas Hernia Society Quality Collaborative. Br J Surg 2020; 107:1123-1129. [DOI: 10.1002/bjs.11560] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/23/2020] [Accepted: 01/27/2020] [Indexed: 01/20/2023]
Abstract
AbstractBackgroundIncisional hernia repair with mesh improves long-term outcomes, but the ideal mesh position remains unclear. This study compared intraperitoneal versus retromuscular or preperitoneal sublay (RPS) mesh positions for open incisional hernia repairs.MethodsAll patients who had elective open incisional hernia repairs were identified retrospectively in the Americas Hernia Society Quality Collaborative database. The primary outcome was the rate of 30-day surgical-site infection (SSI). Other outcomes of interest included 30-day surgical-site occurrences requiring procedural intervention (SSOPI), hernia-related quality-of-life survey (HerQLes) scores and long-term recurrence. A logistic model was used to generate propensity scores for mesh position using several clinically relevant co-variables. Regression models adjusting for propensity score and baseline characteristics were developed to assess the effect of mesh placement.ResultsA total of 4211 patients were included in the study population: 587 had intraperitoneal mesh and 3624 had RPS mesh. Analysis with propensity score adjustment provided no evidence for differences in SSOPI (odds ratio (OR) 0·79, 95 per cent c.i. 0·49 to 1·26) and SSI (OR 0·91, 0·50 to 1·67) rates or HerQLes scores at 30 days (OR 1·20, 0·79 to 1·82), or recurrence rates (hazard ratio 1·28, 0·90 to 1·82).ConclusionMesh position had no effect on short- or long-term outcomes, including SSOPI and SSI rates, HerQLes scores and long-term recurrence rates.
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Affiliation(s)
- A Fafaj
- Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - C C Petro
- Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - L Tastaldi
- Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - H Alkhatib
- Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - R AlMarzooqi
- Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - M A Olson
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, Tennessee, USA
| | - T G Stewart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - A Prabhu
- Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - D Krpata
- Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - M J Rosen
- Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Improving Shared Decision-making and Treatment Planning Through Predictive Modeling: Clinical Insights on Ventral Hernia Repair. Comput Inform Nurs 2020; 38:227-231. [PMID: 31929356 DOI: 10.1097/cin.0000000000000590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Abdominal wall hernia repair, including ventral hernia repair, is one of the most common general surgical procedures. Nationally, at least 350 000 ventral hernia repairs are performed annually, and of those, 150 000 cases were identified as incisional hernias. Outcomes are reported to be poor, resulting in additional surgical repair rates of 12.3% at 5 years and as high as 23% at 10 years. Healthcare costs associated with ventral hernia repair are estimated to exceed $3 billion each year. Additionally, ventral hernia repair is often complex and unpredictable when there is a current infection or a history of infection and significant comorbidities. Accordingly, a predictive model was developed using a retrospectively collected dataset to associate the pre- and intra-operative characteristics of patients to their outcomes, with the primary goal of identifying patients at risk of developing complications a priori in the future. The benefits and implications of such a predictive model, however, extend beyond this primary goal. This predictive model can serve as an important tool for clinicians who may use it to support their clinical intuition and clarify patient need for lifestyle modification prior to abdominal wall reconstruction. This predictive model can also support shared decision-making so that a personalized plan of care may be developed. The outcomes associated with use of the predictive model may include surgical repair but may suggest lifestyle modification coupled with less invasive interventions.
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