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LaGuardia JS, Milek D, Lebens RS, Chen DR, Moghadam S, Loria A, Langstein HN, Fleming FJ, Leckenby JI. A Scoping Review of Quality-of-Life Assessments Employed in Abdominal Wall Reconstruction. J Surg Res 2024; 295:240-252. [PMID: 38041903 DOI: 10.1016/j.jss.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/08/2023] [Accepted: 10/27/2023] [Indexed: 12/04/2023]
Abstract
INTRODUCTION Surgeons use several quality-of-life instruments to track outcomes following abdominal wall reconstruction (AWR); however, there is no universally agreed upon instrument. We review the instruments used in AWR and report their utilization trends within the literature. METHODS This scoping review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews guidelines using the PubMed, Embase, Web of Science, ClinicalTrials.gov, and Cochrane databases. All published articles in the English language that employed a quality-of-life assessment for abdominal wall hernia repair were included. Studies which focused solely on aesthetic abdominoplasty, autologous breast reconstruction, rectus diastasis, pediatric patients, inguinal hernia, or femoral hernias were excluded. RESULTS Six hernia-specific tools and six generic health tools were identified. The Hernia-Related Quality-of-Life Survey and Carolinas Comfort Scale are the most common hernia-specific tools, while the Short-Form 36 (SF-36) is the most common generic health tool. Notably, the SF-36 is also the most widely used tool for AWR outcomes overall. Each tool captures a unique set of patient outcomes which ranges from abdominal wall functionality to mental health. CONCLUSIONS The outcomes of AWR have been widely studied with several different assessments proposed and used over the past few decades. These instruments allow for patient assessment of pain, quality of life, functional status, and mental health. Commonly used tools include the Hernia-Related Quality-of-Life Survey, Carolinas Comfort Scale, and SF-36. Due to the large heterogeneity of available instruments, future work may seek to determine or develop a standardized instrument for characterizing AWR outcomes.
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Affiliation(s)
- Jonnby S LaGuardia
- Department of Plastic and Reconstructive Surgery, University of Rochester Medical Center, Rochester, New York.
| | - David Milek
- Department of Plastic and Reconstructive Surgery, University of Rochester Medical Center, Rochester, New York
| | - Ryan S Lebens
- Department of Plastic and Reconstructive Surgery, University of Rochester Medical Center, Rochester, New York
| | - David R Chen
- Department of Plastic and Reconstructive Surgery, University of Rochester Medical Center, Rochester, New York
| | - Shahrzad Moghadam
- Department of Plastic and Reconstructive Surgery, University of Rochester Medical Center, Rochester, New York
| | - Anthony Loria
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Howard N Langstein
- Department of Plastic and Reconstructive Surgery, University of Rochester Medical Center, Rochester, New York
| | - Fergal J Fleming
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Jonathan I Leckenby
- Department of Plastic and Reconstructive Surgery, University of Rochester Medical Center, Rochester, New York
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Amaral PHF, Macret JZ, Dias ERM, Carvalho JPV, Pivetta LGA, Ribeiro HB, Franciss MY, Silva RA, Malheiros CA, Roll S. Volumetry after botulinum toxin A: the impact on abdominal wall compliance and endotracheal pressure. Hernia 2024; 28:53-61. [PMID: 37563426 DOI: 10.1007/s10029-023-02848-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/23/2023] [Indexed: 08/12/2023]
Abstract
PURPOSE Botulinum toxin type A (BTA) is an adjuvant tool used in the preoperative optimization of complex hernias before abdominal wall reconstruction (AWR). This study aims to investigate changes in the abdominal cavity and hernia sac dimensions after BTA application. METHOD A prospective study with 27 patients with a hernia defect of ≥ 10 cm and loss of domain (LOD) ≥ 20% underwent AWR. Computed tomography (CT) measurements and volumetry before and after the application of BTA were performed. Intraoperative and postoperative outcomes were evaluated. RESULTS Imaging post-BTA revealed hernia width reduction of 1.9 cm (p = 0.002), lateral abdominal wall muscle elongation of 3.1 cm (p < 0.001), hernia volume reduction (HV) from 2.9 ± 0.9L to 2.4 ± 0.8L (p < 0.001), increase in abdominal cavity volume (ACV) from 9.7 ± 2.5L to 10.3L ± 2.4L (p = 0.003), and a reduction in the HV/ACV ratio from 30.2 ± 5% to 23.4 ± 6% (p < 0.001). Fascial closure was achieved in 92.6% of cases and component separation was required in 78%. The average variation in pulmonary plateau pressure was 3.53 cmH2O, and there were no postoperative respiratory failure recorded. At the 90-day follow-up, the wound morbidity rate was 25%, unplanned readmissions were 11%, and hernia recurrence 7.4%. CONCLUSION BTA produces measurable volumetric changes in abdominal wall and appears to facilitate fascial closure. Further studies are required to determine the role of BTA in the surgical armamentarium for complex hernia repair.
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Affiliation(s)
- P H F Amaral
- Santa Casa de Sao Paulo - Abdominal Wall Surgery Unit, Rua Cesário Mota Júnior, 112 - Vila Buarque, São Paulo, SP, Brazil.
- Hospital Alemão Oswaldo Cruz, Hernia Center, São Paulo, SP, Brazil.
| | - J Z Macret
- Santa Casa de Sao Paulo - Abdominal Wall Surgery Unit, Rua Cesário Mota Júnior, 112 - Vila Buarque, São Paulo, SP, Brazil
- Hospital Alemão Oswaldo Cruz, Hernia Center, São Paulo, SP, Brazil
| | - E R M Dias
- Santa Casa de Sao Paulo - Abdominal Wall Surgery Unit, Rua Cesário Mota Júnior, 112 - Vila Buarque, São Paulo, SP, Brazil
- Hospital Alemão Oswaldo Cruz, Hernia Center, São Paulo, SP, Brazil
| | - J P V Carvalho
- Santa Casa de Sao Paulo - Abdominal Wall Surgery Unit, Rua Cesário Mota Júnior, 112 - Vila Buarque, São Paulo, SP, Brazil
- Hospital Alemão Oswaldo Cruz, Hernia Center, São Paulo, SP, Brazil
| | - L G A Pivetta
- Santa Casa de Sao Paulo - Abdominal Wall Surgery Unit, Rua Cesário Mota Júnior, 112 - Vila Buarque, São Paulo, SP, Brazil
- Hospital Alemão Oswaldo Cruz, Hernia Center, São Paulo, SP, Brazil
| | - H B Ribeiro
- Santa Casa de Sao Paulo - Abdominal Wall Surgery Unit, Rua Cesário Mota Júnior, 112 - Vila Buarque, São Paulo, SP, Brazil
| | - M Y Franciss
- Santa Casa de Sao Paulo - Abdominal Wall Surgery Unit, Rua Cesário Mota Júnior, 112 - Vila Buarque, São Paulo, SP, Brazil
| | - R A Silva
- Santa Casa de Sao Paulo - Abdominal Wall Surgery Unit, Rua Cesário Mota Júnior, 112 - Vila Buarque, São Paulo, SP, Brazil
| | - C A Malheiros
- Santa Casa de Sao Paulo - Abdominal Wall Surgery Unit, Rua Cesário Mota Júnior, 112 - Vila Buarque, São Paulo, SP, Brazil
| | - S Roll
- Santa Casa de Sao Paulo - Abdominal Wall Surgery Unit, Rua Cesário Mota Júnior, 112 - Vila Buarque, São Paulo, SP, Brazil
- Hospital Alemão Oswaldo Cruz, Hernia Center, São Paulo, SP, Brazil
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Zolin SJ, Krpata DM, Petro CC, Prabhu AS, Rosenblatt S, Rosen S, Thompson R, Fafaj A, Thomas JD, Huang LC, Rosen MJ. Long-term Clinical and Patient-Reported Outcomes After Transversus Abdominis Release With Permanent Synthetic Mesh: A Single Center Analysis of 1203 Patients. Ann Surg 2023; 277:e900-e906. [PMID: 35793810 DOI: 10.1097/sla.0000000000005443] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We aimed to report long-term clinical and patient-reported outcomes of transversus abdominis release (TAR) with permanent synthetic mesh performed in a high-volume abdominal wall reconstruction practice. SUMMARY BACKGROUND DATA Despite increasing utilization of TAR in abdominal wall reconstruction, long-term clinical and patient-reported outcomes remain uncertain. METHODS Prospectively collected registry data from the Cleveland Clinic Center for Abdominal Core Health were analyzed retrospectively. Patients undergoing elective, open VHR with TAR and permanent synthetic mesh implantation between August 2014 and March 2020 with 30-day clinical and ≥1 year clinical or patient-reported outcome follow-up were included. Outcomes included composite hernia recurrence, characterized by patient-reported bulges and recurrent hernias noted on physical exam or imaging, as well as hernia-specific quality of life and pain. RESULTS A total of 1203 patients were included. Median age was 60 years [interquartile range (IQR): 52-67], median body mass index was 32 kg/m 2 (IQR: 28-36), median hernia width was 15 cm (IQR: 12-19), and 57% of hernias were recurrent. Fascial reapproximation was achieved in 92%. At a median follow-up of 2 years (IQR: 1-4), the overall composite hernia recurrence rate was 26%, with sensitivity analysis yielding best-case and worst-case estimates of 5% and 28%, respectively. Patients experienced improved hernia-specific quality of life and pain regardless of recurrence outcome; however, those who did not recur experienced more substantial improvement. CONCLUSIONS TAR with permanent synthetic mesh remains a valuable, versatile technique; however, surgeon and patient expectations should be tempered regarding long-term durability. Despite a high rate of recurrence, patients experience measurable improvements in quality of life.
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Affiliation(s)
- Samuel J Zolin
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease & Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - David M Krpata
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease & Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Clayton C Petro
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease & Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Ajita S Prabhu
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease & Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Steven Rosenblatt
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease & Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Samantha Rosen
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease & Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Reid Thompson
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease & Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Aldo Fafaj
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease & Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Jonah D Thomas
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Li-Ching Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Michael J Rosen
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease & Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
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Kumar S, Rao N, Parker S, Plumb A, Windsor A, Mallett S, Halligan S. Are preoperative CT variables associated with the success or failure of subsequent ventral hernia repair: nested case-control study. Eur Radiol 2022; 32:6348-6354. [PMID: 35348860 PMCID: PMC9381620 DOI: 10.1007/s00330-022-08701-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Systematic review of CT measurements to predict the success or failure of subsequent ventral hernia repair has found limited data available in the indexed literature. To rectify this, we investigated multiple preoperative CT metrics to identify if any were associated with postoperative reherniation. METHODS Following ethical permission, we identified patients who had undergone ventral hernia repair and had preoperative CT scanning available. Two radiologists made multiple measurements of the hernia and abdominal musculature from these scans, including loss of domain. Patients were divided subsequently into two groups, defined by hernia recurrence at 1-year subsequent to surgery. Hypothesis testing investigated any differences between CT measurements from each group. RESULTS One hundred eighty-eight patients (95 male) were identified, 34 (18%) whose hernia had recurred by 1-year. Only three of 34 CT measurements were significantly different when patients whose hernia had recurred were compared to those who had not; these significant findings were assumed contingent on multiple testing. In particular, preoperative hernia volume (recurrence 155.3 cc [IQR 355.65] vs. no recurrence 78.2 [IQR 303.52], p = 0.26) nor loss of domain, whether calculated using the Tanaka (recurrence 0.02 [0.04] vs. no recurrence 0.009 [0.04], p = 0.33) or Sabbagh (recurrence 0.019 [0.05] vs. no recurrence 0.009 [0.04], p = 0.25) methods, differed between significantly between groups. CONCLUSIONS Preoperative CT measurements of ventral hernia morphology, including loss of domain, appear unrelated to postoperative recurrence. It is likely that the importance of such measurements to predict recurrence is outweighed by other patient factors and surgical reconstruction technique. KEY POINTS • Preoperative CT scanning is often performed for ventral hernia but systematic review revealed little data regarding whether CT variables predict postoperative reherniation. • We found that the large majority of CT measurements, including loss of domain, did not differ significantly between patients whose hernia did and did not recur. • It is likely that the importance of CT measurements to predict recurrence is outweighed by other patient factors and surgical reconstruction technique.
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Affiliation(s)
- Shankar Kumar
- UCL Centre for Medical Imaging, University College London UCL, Charles Bell House, 43-45 Foley Street, London, W1W 7TS UK
| | - Nikhil Rao
- Radiology Department, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX UK
| | - Sam Parker
- Addominal Wall Reconstruction Unit, University College London Hospital, 235 Euston Road, London, NW1 2BU UK
| | - Andrew Plumb
- UCL Centre for Medical Imaging, University College London UCL, Charles Bell House, 43-45 Foley Street, London, W1W 7TS UK
| | - Alastair Windsor
- Addominal Wall Reconstruction Unit, University College London Hospital, 235 Euston Road, London, NW1 2BU UK
| | - Sue Mallett
- UCL Centre for Medical Imaging, University College London UCL, Charles Bell House, 43-45 Foley Street, London, W1W 7TS UK
| | - Steve Halligan
- UCL Centre for Medical Imaging, University College London UCL, Charles Bell House, 43-45 Foley Street, London, W1W 7TS UK
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