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Hackenberger PN, Stockslager C, Selimos B, Teven C, Fracol M, Howard M. Early Experience with Mesh Suture for DIEP Flap Abdominal Site Closures. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e6095. [PMID: 39175518 PMCID: PMC11340925 DOI: 10.1097/gox.0000000000006095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 06/25/2024] [Indexed: 08/24/2024]
Abstract
Background The gold standard of microsurgical breast reconstruction is the deep inferior epigastric perforator (DIEP) free flap. As techniques have evolved, DIEP flaps have significantly reduced the morbidity previously caused by transverse rectus abdominis muscle (TRAM) and muscle-sparing TRAM flaps. However, abdominal wall complications continue to persist after DIEP flap surgery, with bulge rates reported as high as 33%. Methods The first 25 patients undergoing DIEP flap surgery with the use of Duramesh (MSI, Chicago, Ill.) by the senior author were identified. A retrospective chart review of patient and surgical details was performed. Charts were reviewed for outcomes, including surgical site infections, surgical site events, incisional hernia formation, and/or bulge. Standard descriptive summary statistics were used for patient characteristics, surgical details, and primary and secondary outcomes. Results Twenty-five patients were reviewed. Average follow-up duration was 216 ± 39 days. One patient (4%) developed a surgical site infection, and four patients (16%) developed a surgical site event. One patient developed a bulge, but no patients developed an incisional hernia. Conclusions Duramesh mesh suture provides a promising opportunity for DIEP surgeons to minimize both abdominal wall morbidity and mesh-related complications. Mesh suture can be used in a similar fashion as other sutures to perform primary closure of the anterior rectus sheath while also providing force-distribution benefits typically unique to planar mesh. This pilot study suggests that Duramesh is a safe, simple alternative to existing techniques in DIEP flap surgery and can be considered by microsurgeons to reduce fascial dehiscence, bulge, and/or hernia formation.
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Affiliation(s)
- Paige N. Hackenberger
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Caitlin Stockslager
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Brianna Selimos
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Chad Teven
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Megan Fracol
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Michael Howard
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
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Bahraini A, Hsu J, Cochran S, Campbell S, Overby DW, Phillips S, Prabhu A, Perez A. Evaluation of 30-day outcomes for open ventral hernia repair using self-gripping versus nonself-gripping mesh. Surg Endosc 2024; 38:2871-2878. [PMID: 38609587 DOI: 10.1007/s00464-024-10778-y] [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: 04/14/2023] [Accepted: 03/04/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND The use of mesh is standard of care for large ventral hernias repaired on an elective basis. The most used type of mesh includes synthetic polypropylene mesh; however, there has been an increase in the usage of a new polyester self-gripping mesh, and there are limited data regarding its efficacy for ventral hernia. The purpose of the study is to determine whether there is a difference in surgical site occurrence (SSO), surgical site infection (SSI), surgical site occurrence requiring procedural intervention (SSOPI), and recurrence at 30 days after ventral hernia repair (VHR) using self-gripping (SGM) versus non-self-gripping mesh (NSGM). METHODS We performed a retrospective study from January 2014 to April 2022 using the Abdominal Core Health Quality Collaborative (ACHQC). We collected data on patients over 18 years of age who underwent elective open VHR using SGM or NSGM and whom had 30-day follow-up. Propensity matching was utilized to control for variables including hernia width, body mass index, age, ASA, and mesh location. Data were analyzed to identify differences in SSO, SSI, SSOPI, and recurrence at 30 days. RESULTS 9038 patients were identified. After propensity matching, 1766 patients were included in the study population. Patients with SGM had similar demographic and clinical characteristics compared to NSGM. The mean hernia width to mesh width ratio was 8 cm:18 cm with NSGM and 7 cm:15 cm with SGM (p = 0.63). There was no difference in 30-day rates of recurrence, SSI or SSO. The rate of SSOPI was also found to be 5.4% in the nonself-gripping group compared to 3.1% in the self-gripping mesh group (p < .005). There was no difference in patient-reported outcomes at 30 days. CONCLUSIONS In patients undergoing ventral hernia repair with mesh, self-gripping mesh is a safe type of mesh to use. Use of self-gripping mesh may be associated with lower rates of SSOPI when compared to nonself-gripping mesh.
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Affiliation(s)
- Anoosh Bahraini
- University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27514, USA
| | - Justin Hsu
- University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27514, USA
| | - Steven Cochran
- University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27514, USA
| | - Shannelle Campbell
- University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27514, USA
| | - David Wayne Overby
- University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27514, USA
| | | | | | - Arielle Perez
- University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27514, USA.
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Naga HI, Emovon E, Kim JK, Hernandez JA, Yoo JS. T-line Hernia Mesh Repairs of Large Umbilical Hernias: Technique and Short-term Outcomes. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5668. [PMID: 38510327 PMCID: PMC10954056 DOI: 10.1097/gox.0000000000005668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/22/2024] [Indexed: 03/22/2024]
Abstract
Background The T-line hernia mesh is a synthetic, polypropylene mesh specifically designed to prevent anchor point failure by evenly distributing tension through mesh suture extensions. This case series illustrates the first clinical application of the T-line mesh for umbilical hernia repair (UHR). Methods This study is a retrospective, consecutive cases series of all adult patients presenting to a single surgeon with symptomatic umbilical hernia requiring surgical repair using the T-line hernia mesh. Patient demographics, surgical details, and 30-day postoperative complications were collected. Descriptive statistics were computed in Microsoft Excel (Redmond, Va.). Results Three patients presented for UHR. All three patients were obese with mean body mass index of 37.5 ± 6.6. Two patients were former smokers, and two had presented after hernia recurrence. The average defect size was 80.1 cm2 ± 94.0 cm2. Two patients had UHR with onlay mesh placement, whereas one had a transversus abdominus release followed by retrorectus mesh placement. The average mesh size was 192.3 cm2 ± 82.5 cm2. All three cases were classified as clean. There were no intraoperative complications. No patients experienced 30-day postoperative complications or recurrence. Conclusions We present a case series of three patients presenting with large, symptomatic umbilical hernias who underwent UHR with T-line hernia mesh reinforcement without short term complications or hernia recurrence at last follow-up.
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Affiliation(s)
- Hani I Naga
- From the Department of Surgery, Duke University Hospital, Durham, N.C
| | - Emmanuel Emovon
- From the Department of Surgery, Duke University Hospital, Durham, N.C
| | - Joshua K Kim
- From the Department of Surgery, Duke University Hospital, Durham, N.C
| | | | - Jin S Yoo
- From the Department of Surgery, Duke University Hospital, Durham, N.C
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Lozada Hernández EE, Maldonado Barrios IL, Amador Ramírez S, Rodríguez Casillas JL, Hinojosa Ugarte D, Smolinski Kurek RL, Crocco Quirós B, Cethorth Fonseca RK, Sánchez Téran A, Macias Grageda M. Surgical site occurrence after prophylactic use of mesh for prevention of incisional hernia in midline laparotomy: systematic review and meta-analysis of randomized clinical trials. Surg Endosc 2024; 38:942-956. [PMID: 37932603 DOI: 10.1007/s00464-023-10509-9] [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: 04/16/2023] [Accepted: 09/24/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND The use of mesh is the standard for the prevention of incisional hernia (IH). However, the effect of surgical site occurrence (SSO) has never been compared. The aim of this meta-analysis was to evaluate the prevalence of SSO and measure its negative effect through the calculation of the number needed to treat for net effect (NNT net). METHODS A meta-analysis was performed according to the PRISMA guidelines. The primary objective was to determine the prevalence of SSO and IH, and the secondary objective was to determine the NNT net as a metric to measure the combined benefits and harms. Only published clinical trials were included. The risk of bias was analyzed, and the random effects model was used to determine statistical significance. RESULTS A total of 15 studies comparing 2344 patients were included. The incidence of IH was significantly lower in the mesh group than in the control group, with an OR of 0.29 (95% CI 0.16-0.49, p = 0.0001). The incidence of SSO was higher in the mesh group than in the control group, with an OR of 1.21 (95% CI 0.85-1.72, p = 0.0001) but without statistical significance. Therefore, the way to compare the benefits and risks of each of the studies was done with the calculation of the NNT net, which is the average number of patients who need to be treated to see the benefit exceeding the harm by one event, and the result was 5, which is the average number of patients who need to be treated to see the benefit exceeding the harm by one event. CONCLUSION The use of mesh reduces the prevalence of IH and it does not increases the prevalence of SSO, the NNT net determined that the use of mesh continues to be beneficial for the patient.
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Affiliation(s)
- Edgard Efrén Lozada Hernández
- Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajio, Circuito Quinta los Naranjos # 145 B. Colonia Quinta los Naranjos, León, Guanajuato, Mexico.
| | | | | | | | - Diego Hinojosa Ugarte
- Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajio, Circuito Quinta los Naranjos # 145 B. Colonia Quinta los Naranjos, León, Guanajuato, Mexico
| | - Rafal Ludwik Smolinski Kurek
- Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajio, Circuito Quinta los Naranjos # 145 B. Colonia Quinta los Naranjos, León, Guanajuato, Mexico
| | - Bruno Crocco Quirós
- Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajio, Circuito Quinta los Naranjos # 145 B. Colonia Quinta los Naranjos, León, Guanajuato, Mexico
| | - Roland Kevin Cethorth Fonseca
- Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajio, Circuito Quinta los Naranjos # 145 B. Colonia Quinta los Naranjos, León, Guanajuato, Mexico
| | - Alfonso Sánchez Téran
- Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajio, Circuito Quinta los Naranjos # 145 B. Colonia Quinta los Naranjos, León, Guanajuato, Mexico
| | - Michelle Macias Grageda
- Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajio, Circuito Quinta los Naranjos # 145 B. Colonia Quinta los Naranjos, León, Guanajuato, Mexico
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Alimi Y, Deldar R, Sosin M, Lofthus A, Nijhar K, Bartholomew AJ, Fan KL, Bhanot P. Outcomes of Immediate Multistaged Abdominal Wall Reconstruction of Infected Mesh: Predictors of Surgical Site Complications and Hernia Recurrence. Ann Plast Surg 2023; 91:473-478. [PMID: 37713152 DOI: 10.1097/sap.0000000000003641] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
BACKGROUND Mesh infection is one of the most devastating complications after ventral hernia repair. To date, no clear consensus exists on the optimal timing of definitive abdominal wall reconstruction (AWR) after excision of infected mesh. We evaluated outcomes of immediate multistaged AWR in patients with mesh infection. METHODS We performed a retrospective review of patients with mesh infection who underwent immediate, multistaged AWR, which consisted of exploratory laparotomy with debridement and mesh explantation, followed by definitive AWR during the same admission. Primary outcomes included hernia recurrence and surgical site occurrences, defined as wound dehiscence, surgical site infection, hematoma, and seroma. RESULTS Forty-seven patients with infected mesh were identified. At mean follow-up of 9.5 months, 5 patients (10.6%) experienced hernia recurrence. Higher body mass index (P = 0.006), bridge repair (P = 0.035), and postoperative surgical site infection (P = 0.005) were associated with hernia recurrence. CONCLUSION Immediate multistaged AWR is an effective surgical approach in patients with infected mesh.
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Affiliation(s)
| | | | - Michael Sosin
- Plastic Surgery Arts of New Jersey, New Brunswick, NJ
| | | | | | | | - Kenneth L Fan
- Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC
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Hassan AM, Asaad M, Brook DS, Shah NR, Kumar SC, Liu J, Adelman DM, Clemens MW, Selber JC, Butler CE. Outcomes of Abdominal Wall Reconstruction with a Bovine versus a Porcine Acellular Dermal Matrix: A Propensity Score-Matched Analysis. Plast Reconstr Surg 2023; 152:872-881. [PMID: 36780366 DOI: 10.1097/prs.0000000000010292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND Abdominal wall reconstruction (AWR) is one of the most commonly performed procedures, yet large comparative studies comparing outcomes of AWR using bovine acellular dermal matrix (BADM) and porcine acellular dermal matrix (PADM) are lacking. METHODS In this retrospective cohort study of patients who underwent AWR from March of 2005 to June of 2019, the primary comparative outcome measure was hernia recurrence with BADM versus PADM. The secondary outcome was the incidence of surgical-site occurrence (SSO) and surgical-site infection. A propensity score matching approach was applied to compare the clinical outcomes between the two study groups. RESULTS The authors identified 725 patients who underwent AWR using BADM (50.5%) or PADM (49.5%). Their mean ± SD age was 59.8 ± 11.5 years, mean body mass index was 31.4 ± 6.7 kg/m 2 , and mean follow-up time was 42 ± 29 months. With propensity score matching, 219 matched pairs were identified. Hernia recurrence rates in BADM (11.4%) and PADM (13.7%) groups did not differ significantly ( P = 0.793). SSO (26.5% versus 29.2%; P = 0.518) and SSI (13.2% versus 11%; P = 0.456) rates did not differ significantly in the PADM and BADM groups, respectively. Conditional logistic regression model and marginal Cox proportional hazards regression model determined that type of acellular dermal matrix was not significantly associated with SSOs (adjusted OR, 1.11; 95% CI, 0.74 to 1.70; P = 0.589) or hernia recurrence (adjusted hazard ratio, 0.85; 95% CI, 0.50 to 1.42; P = 0.52). CONCLUSIONS Both BADMs and PADMs provide durable, long-term outcomes. The hernia recurrence and postoperative surgical complication rates were not significantly different between BADM and PADM. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Abbas M Hassan
- From the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center
| | - Malke Asaad
- From the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center
| | - Derek S Brook
- From the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center
| | - Nikhil R Shah
- From the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center
| | - Saloni C Kumar
- From the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center
| | - Jun Liu
- From the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center
| | - David M Adelman
- From the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center
| | - Mark W Clemens
- From the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center
| | - Jesse C Selber
- From the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center
| | - Charles E Butler
- From the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center
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7
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Skoczek AC, Ruane PW, Fernandez DL. Modifiable comorbidities impact on ventral hernia recurrence following robotic abdominal wall reconstruction using resorbable biosynthetic mesh: 36-month follow-up. Surg Open Sci 2023; 14:60-65. [PMID: 37533880 PMCID: PMC10392596 DOI: 10.1016/j.sopen.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/28/2023] [Accepted: 07/16/2023] [Indexed: 08/04/2023] Open
Abstract
Background There is an ongoing debate on the role of comorbidities in hernia outcomes, particularly with minimally invasive approaches. This study evaluated the impact of modifiable comorbidities (MCMs) on 36-month hernia recurrence rates after robotic transversus abdominis release (TAR) with resorbable biosynthetic mesh underlay for primary ventral hernia repair. Methods A review of medical records for patients who underwent the robotic TAR procedure between January 2015 and May 2022 performed by a single surgeon was conducted. Patients were separated into three groups: those with 0, 1, and 2+ MCMs, followed by a breakdown of comorbidity types and combinations of comorbidities. MCMs included obesity, diabetes, and tobacco use. The primary outcomes included hernia recurrence at 36 months and the time between surgery and recurrence. Results 175 patients met the inclusion criteria, with a mean hernia diameter of 12.9 ± 5.4 cm and a mean BMI of 34 ± 8 kg/m2. 9.7 % of patients experienced hernia recurrence at 36-month follow-up. No significant difference in the recurrence rate and length of time between surgery and recurrence was observed between the groups (p = .265 and p = .283, respectively). No group, single comorbidity, or a combination of comorbidities was found to have significantly increased odds of recurrence at 36 months. Conclusion The presence of MCMs, either alone or in combination with another, did not significantly increase the odds of hernia recurrence at 36 months following ventral hernia repair using this approach. Future studies with larger sample sizes and multiple surgeons are needed to corroborate this data. Key message Modifiable comorbidities have previously been shown to increase the risk of hernia recurrence after ventral hernia repair. Our study found relatively low rates of hernia recurrence and no significantly increased odds of recurrence among different comorbid groups at 36-month follow-up following robotic transversus abdominis release with resorbable biosynthetic mesh underlay.
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Affiliation(s)
| | - Patrick W. Ruane
- Edward Via College of Osteopathic Medicine – Carolinas, Spartanburg, SC, United States
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8
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Hassan AM, Franco CM, Shah NR, Netherton TJ, Mericli AF, Garvey PP, Schaverien MV, Chang EI, Hanasono MM, Selber JC, Butler CE. Outcomes of Complex Abdominal Wall Reconstruction After Oncologic Resection: 14-Year Experience at an NCI-Designated Cancer Center. Ann Surg Oncol 2023; 30:3712-3720. [PMID: 36662331 DOI: 10.1245/s10434-023-13098-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/29/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Outcomes studies for abdominal wall reconstruction (AWR) in the setting of previous oncologic extirpation are lacking. We sought to evaluate long-term outcomes of AWR using acellular dermal matrix (ADM) after extirpative resection, compare them to primary herniorrhaphy, and report the rates and predictors of postoperative complications. METHODS We conducted a retrospective cohort study of patients who underwent AWR after oncologic resection from March 2005 to June 2019 at a tertiary cancer center. The primary outcome was hernia recurrence (HR). Secondary outcomes included surgical site occurrences (SSOs), surgical site infection (SSIs), length of hospital stay (LOS), reoperation, and 30-day readmission. RESULTS Of 720 consecutive patients who underwent AWR during the study period, 194 (26.9%) underwent AWR following resection of abdominal wall tumors. In adjusted analyses, patients who had AWR after extirpative resection were more likely to have longer LOS (β, 2.57; 95%CI, 1.27 to 3.86, p < 0.001) than those with primary herniorrhaphy, but the risk of HR, SSO, SSI, 30-day readmission, and reoperation did not differ significantly. In the extirpative cohort, obesity (Hazard ratio, 6.48; p = 0.003), and bridged repair (Hazard ratio, 3.50; p = 0.004) were predictors of HR. Radiotherapy (OR, 2.23; p = 0.017) and diabetes mellites (OR, 3.70; p = 0.005) were predictors of SSOs. Defect width (OR, 2.30; p < 0.001) and mesh length (OR, 3.32; p = 0.046) were predictors of SSIs. Concomitant intra-abdominal surgery for active disease was not associated with worse outcomes. CONCLUSIONS AWR with ADM following extirpative resection demonstrated outcomes comparable with primary herniorrhaphy. Preoperative risk assessment and optimization are imperative for improving outcomes.
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Railianu RI, Botezatu AA, Zvyagintsev VV, Grosul-Railianu OB. Cofactorial herniotransformation peculiarities of midline abdomen. RUDN JOURNAL OF MEDICINE 2022. [DOI: 10.22363/2313-0245-2022-26-2-157-169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Relevance. Recently, much attention has been paid to the study of the role of various risk factors in the pathogenesis of herniation along the midline of the abdomen. The question of their interrelation with another equally important predictor of herniogenesis - connective tissue insufficiency remains understudied. The aim of the present study is to investigate the severity of connective tissue dysplasia and peculiarities of its interaction with other risk factors in different variants of midline abdominal herniotransformation. Materials and Methods. The examined group included 150 (89.2%) patients with postoperative median hernias of various sizes and 18 (10.8%) patients with primary hernias of the white line of the abdomen. In 12 (8%) cases, relapses of postoperative hernial protrusions were noted. In 12 (10.5 %) cases, relapses of postoperative hernial protrusions were noted. The surveyed group included 109 (64.8 %) women and 59 (35.2 %) men. Risk factors for median herniogenesis were evaluated in the opposite sense relative to the severity of connective tissue pathology. Results and Discussion. We evaluated the risk factors of median herniogenesis in the opposite value and direction with regard to the severity of connective tissue pathology in the observation groups. It was found out that the leading role in herniotransformation of the medial abdominal line belongs to the suppuration of postoperative medial wounds, relaparotomy and heavy physical load with the role efficiency of 66.6 %, 56.2 % and 54.5 % respectively. The lowest level of connective tissue dysplasia was observed in the groups where the risk factors of median herniogenesis were the age of patients, the presence of relaparotomy in the history and heavy physical activity. Only in the observation group, where pregnancy and childbirth in the anamnesis were the predictors, the patients with white line hernias had less severe connective tissue insufficiency by 27,9 % in comparison with the patients with postoperative median hernias. In patients with recurrent midline hernias in all risk factors, the severity of connective tissue dysplasia always reached the maximum score. Conclusion. At any predictor of hernia formation or their combined effect, the severity of connective tissue dysplasia always remained severe, which confirms one of the leading roles of connective tissue pathology in the formation of medial abdominal hernias.
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Polcz ME, Pierce RA, Olson MA, Blankush J, Duke MC, Broucek J, Bradley JF. Outcomes of light and midweight synthetic mesh use in clean-contaminated and contaminated ventral incisional hernia repair: an ACHQC comparative analysis. Surg Endosc 2022:10.1007/s00464-022-09739-0. [DOI: 10.1007/s00464-022-09739-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022]
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Lysenko RB, Liakhovskyi VI, Krasnov ОH, Krasnova OI. Modern Principles of Medical Rehabilitation of Patients with Median Defects of the Abdominal Wall. ACTA BALNEOLOGICA 2022. [DOI: 10.36740/abal202205105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Aim: To analyze rehabilitation and improvement of the quality of life of patients with median abdominal wall defects (MAWD) by increasing the efficiency of alloplasty by determining the general principles of planning and performing surgical interventions.
Materials and methods: We carried out an analysis of the treatment results of 346 patients with MAWD, who underwent surgery in the 1st Poltava City Hospital for the period 2005-2019. There were 269 women (77.8%), men – 77 (22.2%). 282 (81.5%) patients underwent reconstructive surgeries, 59 (17.1%) – reconstructive and corrective alloplasty techniques, and 5 (1.4%) – corrective ones. Patients underwent surgery: onlay – in 3 patients (0.9%), sublay – in 289 (83.5%), sublay-inlay – in 38 (11.0%), inlay – in 4 (1.2%), Ramirez modification – in 10 (2.9%), open IPOM – in 2 (0.6%).
Results: Local complications were in 25 (7.2%) cases: seroma in 12 (3.5%) patients, infiltrate in 5 (1.5%), necrosis of the edges in 4 (1.2%), hematoma – in 3 (0.9%), wound suppuration – in 1 (0.3%). In the remote period, 14 (4.1%) were registered: recurrence – 7 (2.0%); long-term deep seroma- 3 (0.9%); ligature fistulas with phlegmon – 2 (0.6%); abscess formation – 1 (0.3%), hernial sac infiltration – 1 (0.3%).
Conclusions: The results of MAWD alloplasty depend on the correct solution of the planning problem and the choice of the most rational treatment tactics. Adequate abdominoplasty leads to an improvement in the quality of life of patients, medical and social rehabilitation.
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12
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Transversus abdominis release with posterior component separation in patients with previously recurrent ventral hernias: A single institution experience. Surgery 2021; 171:806-810. [PMID: 34949463 DOI: 10.1016/j.surg.2021.08.067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/09/2021] [Accepted: 08/28/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Recurrent hernias pose significant challenges due to violated anatomic planes, resultant scar, and potential prior mesh. Transversus abdominis release has been widely utilized for complex hernias. Transversus abdominis release can provide a novel plane for dissection and mesh placement for recurrent hernias. This study provides our institution's experience with transversus abdominis release in patients with recurrent ventral hernias. METHODS A retrospective chart review was conducted of patients with recurrent ventral hernias from January 2018 to September 2020 who underwent transversus abdominis release by 2 fellowship-trained abdominal wall surgeons. Combined procedures (ie, gynecological/urological), robotic totally extraperitoneal, and emergency cases were excluded. Demographics, perioperative, and postoperative outcomes were reviewed. RESULTS In total, 108 patients underwent open-transversus abdominis release and 25 had robotic-transversus abdominis release for recurrent ventral hernias. All patients received a lightweight to midweight nonabsorbable polypropylene synthetic mesh. Mean age was 59, mean body mass index was 34 kg/m2, with mean hernia defect area of 333 cm2. We noted 34 (25.6%) surgical site occurrences and 11 (8.3%) surgical site infections. Mean postoperative follow-up was 15.5 months, with 7 (5%) recurrences (6 open-transversus abdominis release, 1 robotic-transversus abdominis release). A minimum 12-month follow-up was available for 62% of patients, and minimum 6-month follow-up in 80% of patients. CONCLUSION Recurrent hernias pose significant operative challenges for surgeons due to violated tissue planes and limited repair options. Our experience suggests that transversus abdominis release may provide a durable repair for difficult recurrent ventral hernias. However, long-term postoperative follow-up over multiple years is still needed to establish extended durability of transversus abdominis release in these patients.
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Lightfoot RW, Thrash C, Thompson S, Richmond BK. A Comparison of Component Separation With Porcine Acellular Dermal Reinforcement to Bovine Acellular Dermal Matrix in the Repair of Significant Midline Ventral Hernia Defects. Am Surg 2021:31348211050844. [PMID: 34772290 DOI: 10.1177/00031348211050844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The optimal material for reinforcement of complex abdominal ventral hernia repair (VHR) remains controversial. Biologic prostheses such as porcine and bovine acellular dermal matrix (PADM/BADM) have shown favorable results, but few head-to-head comparisons between the two types exist. We sought to provide such a comparison. METHODS We performed a retrospective cohort study comparing 40 consecutive patients who underwent open component separation (CS/VHR) with PADM reinforcement to 39 consecutive patients who underwent open CS/VHR with BADM reinforcement at our institution. Patient characteristics, outcomes, complications, reoperations, and hernia recurrences were obtained by chart review. Fisher's exact and t-test analyses compared patient characteristics and outcomes between the 2 cohorts. Statistical significance was set as P < .05. RESULTS Patient groups did not differ significantly in race (P=.36), age (P=.8), BMI (P=.34), sex (P=.09), steroid usage (p-1.00), COPD (P=.43), number of previous abdominal operations (P=.66), and duration of follow-up (P=.65). There were significantly more smokers in the PADM group (37.5% vs 12.8%, P=.01). Mean defect size was significantly greater in the PADM group (372.5 cm2 vs 292. cm2 in the BADM group, P=.001) as was the number of Ventral Hernia Working Group (VHWG) grade III/IV hernias (65.0% vs 38.4%, P=.02). Recurrence rates were lower in the BADM group, (12.5% vs 5.1%, P=.26), as was recurrence or complications requiring reoperation (17.5% vs 5.1%, P=.15). Postoperative wound events were also significantly lower in the BADM group (30.0% vs 2.6%, P=.001). CONCLUSIONS In our series, CS/BADM was associated with significantly fewer wound complications. Recurrences and complications requiring reoperation were also fewer, which trended toward but did not reach statistical significance, presumably due to the small sample size. These findings indicating superiority of BADM over PADM are potentially confounded by the higher percentage of smokers, the larger mean defect size, and the higher number of VHWG III/IV patients in the PADM group. Further prospective study of these findings is warranted.
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Affiliation(s)
- Robert W Lightfoot
- Department of Surgery, 20205Charleston Area Medical Center, Charleston, WV, USA
| | - Caleb Thrash
- Department of Surgery, 20205Charleston Area Medical Center, Charleston, WV, USA
| | - Stephanie Thompson
- Charleston Area Medical Center - Health Education and Research Institute, 20205Charleston Area Medical Center, Charleston, WV, USA
| | - Bryan K Richmond
- Department of Surgery, 37297West Virginia University/Charleston Division and the CAMC Institute for Academic Medicine, Charleston, WV, USA
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Chatzimavroudis G, Kotoreni G, Kostakis I, Voloudakis N, Christoforidis E, Papaziogas B. Outcomes of posterior component separation with transversus abdominis release (TAR) in large and other complex ventral hernias: a single-surgeon experience. Hernia 2021; 26:1275-1283. [PMID: 34668108 DOI: 10.1007/s10029-021-02520-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 10/04/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Over the last years, great advances in the repair of abdominal wall hernias have dramatically improved patients' outcomes. Especially for large and other complex ventral hernias, the application of component separation techniques has been a landmark in their successful management. The aim of this study is to present our experience with the posterior component separation with transversus abdominis release (TAR) in patients with these demanding ventral hernias. METHODS A retrospective analysis of prospectively collected data of all patients who underwent elective ventral hernia repair with TAR between January 2016 and December 2019 was performed. Preoperative, intraoperative, and postoperative data were analyzed. RESULTS A total of 125 patients with large and other complex ventral hernias were included in the final analysis. More than 80% of patients had one or more comorbidities. Of all patients, 116 (92.8%) had a history of previous abdominal surgery, 27 (21.6%) had a history of SSI and nine (7.2%) had active fistulas. Postoperatively, SSOs were presented in 11 patients (8.8%), including three cases of SSI. Neither mesh infection occurred, nor mesh excision required. With a mean follow-up of 2.5 years, only one recurrence was observed. CONCLUSIONS With a wound complication rate of less than 9% and a recurrence rate of less than 1%, our results show that TAR is a reliable, safe and effective technique for the repair of massive and other complex ventral hernias. The combination of knowledge of the abdominal wall anatomy at a proficient level, proper training, and adoption of a strict prehabilitation program are considered prerequisites for the successful management of such demanding hernias.
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Affiliation(s)
- G Chatzimavroudis
- 2nd Surgical Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece. .,Complex Hernia and Abdominal Wall Reconstruction Center, European Interbalkan Medical Center, Thessaloniki, Greece.
| | - G Kotoreni
- 2nd Surgical Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece.,Complex Hernia and Abdominal Wall Reconstruction Center, European Interbalkan Medical Center, Thessaloniki, Greece
| | - I Kostakis
- 2nd Surgical Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece
| | - N Voloudakis
- 2nd Surgical Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece
| | - E Christoforidis
- 2nd Surgical Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece
| | - B Papaziogas
- 2nd Surgical Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece
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15
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Hassan AM, Asaad M, Seitz AJ, Liu J, Butler CE. Effect of Wound Contamination on Outcomes of Abdominal Wall Reconstruction Using Acellular Dermal Matrix: 14-Year Experience with More than 700 Patients. J Am Coll Surg 2021; 233:676-684. [PMID: 34530123 DOI: 10.1016/j.jamcollsurg.2021.08.679] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/13/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Patients with contaminated/dirty-infected defects are at high risk for postoperative complications after abdominal wall reconstruction (AWR). We evaluated outcomes of AWR using acellular dermal matrix (ADM) for mesh reinforcement and identified predictors of hernia recurrence (HR), surgical site occurrences (SSOs), and surgical site infections (SSIs). STUDY DESIGN We conducted a retrospective cohort study of patients who underwent AWR using ADM, from March 2005 to June 2019. Outcomes were compared between Centers for Disease Control and Prevention (CDC) wound classifications. The primary outcome measure was HR. Secondary outcomes were SSOs and SSIs. RESULTS We identified 725 AWRs using ADM that met the study criteria. Participants had a mean age of 60 ± 11.5 years, mean BMI of 31 ± 7 kg/m2, and mean follow-up time of 42 ± 29 months. Three hundred two patients (41.6%) had clean defects, 322 patients (44.4%) had clean-contaminated defects, and 101 patients (13.9%) had contaminated/dirty-infected defects. Patients with contaminated/dirty-infected defects had an HR rate of 20.8%, SSO rate of 54.5%, and SSI rate of 23.8%. Multivariate logistic regression found that contaminated/dirty-infected defects were independent predictors of SSOs (OR 2.99; 95% CI 1.72-5.18; p < 0.0001) and SSIs (OR 2.32; 95% CI 1.27-4.25; p = 0.006), but not HR (OR 1.06; 95% CI 0.57-1.98; p = 0.859). CONCLUSIONS SSIs and SSOs increase as contamination levels rise, but the risk of HR does not. AWR with ADM provides safe and durable outcomes, even with increasing levels of contamination.
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Affiliation(s)
- Abbas M Hassan
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Malke Asaad
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Allison J Seitz
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jun Liu
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Charles E Butler
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
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Kushner BS, Han B, Holden SE, Majumder A, Blatnik JA. Does immunosuppression use increase perioperative wound morbidity in patients undergoing transversus abdominis release? Surgery 2021; 171:811-817. [PMID: 34474933 DOI: 10.1016/j.surg.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/13/2021] [Accepted: 08/01/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Transversus abdominis release is an effective procedure for complex ventral hernias. As wound complications contribute to hernia recurrences, mitigating risk factors is vitally important for hernia surgeons. Although immunosuppression can impair wound healing, it has inconsistently predicted wound occurrences, and its effect on wound morbidity after a transversus abdominis release is unknown. METHODS Patients undergoing either an elective open or robotic bilateral transversus abdominis release with permanent synthetic mesh were retrospectively stratified by perioperative immunosuppression and secondarily by procedure type (open versus robotic) and immunosuppression. RESULTS A total of 321 patients were included for analysis. Overall, 63 (19.6%) patients were on chronic immunosuppression, with history of solid-organ transplant being the most common indication (43 patients). Patients stratified by perioperative immunosuppression were well-matched with similar defect size (P = .97), body mass index ≥30 (P = .32), diabetes (P = .09), history of surgical site infection (P = .53), surgical approach (P = .53), and tobacco use history (P = .33). No differences between cohorts were elicited for any wound event when stratified by immunosuppression use. Similarly, no differences were elicited when cohorts were further stratified also by procedure type. CONCLUSION Chronic immunosuppression is often viewed as a notable risk factor for wound occurrences after surgery. However, our data suggest immunosuppression may not significantly increase the risk of perioperative wound morbidity follow transversus abdominis release as previously predicted.
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Affiliation(s)
- Bradley S Kushner
- Department of Surgery, Division of Minimally Invasive Surgery, Washington University, Saint Louis, MO.
| | - Britta Han
- Department of Surgery, Division of Minimally Invasive Surgery, Washington University, Saint Louis, MO
| | - Sara E Holden
- Department of Surgery, Division of Minimally Invasive Surgery, Washington University, Saint Louis, MO
| | - Arnab Majumder
- Department of Surgery, Division of Minimally Invasive Surgery, Washington University, Saint Louis, MO
| | - Jeffrey A Blatnik
- Department of Surgery, Division of Minimally Invasive Surgery, Washington University, Saint Louis, MO
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17
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Cai XY, Chen K, Pan Y, Yang XY, Huang DY, Wang XF, Chen QL. Total endoscopic sublay mesh repair for umbilical hernias. Medicine (Baltimore) 2021; 100:e26334. [PMID: 34160398 PMCID: PMC8238308 DOI: 10.1097/md.0000000000026334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 05/27/2021] [Indexed: 01/04/2023] Open
Abstract
Umbilical hernias constitute some of the most common surgical diseases addressed by surgeons. Endoscopic techniques have become standard of care together with the conventional open techniques for the treatment of umbilical hernias. Several different approaches were described to achieve laparoscopic sublay repair.We prospectively collected and reviewed the medical records of 10 patients with umbilical hernias underwent total endoscopic sublay repair (TES) at our institution from November 2017 to November 2019. All operations were performed by a same surgical team. The demographics, intraoperative details, and postoperative complications were evaluated.All TES procedures were successfully performed without conversion to an open operation. No intraoperative morbidity was encountered. The average operative time was 109.5 minutes (range, 80-140 minutes). All the patients resumed an oral diet within 6 hours after the intervention. The mean time to ambulation was 7.5 hours (range, 4-14 hours), and mean postoperative hospital stay was 2.2 day (range, 1-4 days). One patient developed postoperative seroma. No wound complications, chronic pain, or recurrence were registered during the follow-up.Initial experiences with this technique show that the TES is a safe, and effective procedure for the treatment of umbilical hernias.
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McGuirk M, Kajmolli A, Gachabayov M, Smiley A, Samson D, Latifi R. Independent Predictors for Surgical Site Infections in Patients Undergoing Complex Abdominal Wall Reconstruction. Surg Technol Int 2021; 38:179-185. [PMID: 33823057 DOI: 10.52198/21.sti.38.hr1431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Complex abdominal wall reconstruction (CAWR) in patients with large abdominal defects have become a common procedure. The aim of this study was to identify independent predictors of surgical site infections (SSI) in patients undergoing CAWR. MATERIALS AND METHODS This was an ambidirectional cohort study of 240 patients who underwent CAWR with biologic mesh between 2012 and 2020 at an academic tertiary/quaternary care center. Prior superficial SSI, deep SSI, organ space infections, enterocutaneous fistulae, and combined abdominal infections were defined as prior abdominal infections. Univariable and multivariable logistic regression models were performed to determine independent risk factors for SSI. RESULTS There were a total of 39 wound infections, with an infection rate of 16.3%. Forty percent of patients who underwent CAWR in this study had a history of prior abdominal infections. In the multivariable regression models not weighted for length of stay (LOS), prior abdominal infection (odds ratio [OR]: 2.49, p=0.013) and higher body mass index (BMI) (OR: 1.05, p=0.023) were independent predictors of SSI. In the multivariable regression model weighted for LOS, prior abdominal infection (OR: 2.2, p=0.034), higher BMI (OR: 1.05, p=0.024), and LOS (OR: 1.04, p=0.043) were independent predictors of SSI. CONCLUSION The history of prior abdominal infections, higher BMI, and increased LOS are important independent predictor of SSI following CAWR.
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Affiliation(s)
- Matthew McGuirk
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York
| | - Agon Kajmolli
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York
| | - Mahir Gachabayov
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York
| | - Abbas Smiley
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York
| | - David Samson
- Department of Surgery Clinical Research Unit, Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York
| | - Rifat Latifi
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York
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Pérez-Köhler B, Benito-Martínez S, García-Moreno F, Rodríguez M, Pascual G, Bellón JM. Antibacterial polypropylene mesh fixation with a cyanoacrylate adhesive improves its response to infection. Surgery 2021; 170:507-515. [PMID: 33612292 DOI: 10.1016/j.surg.2021.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/31/2020] [Accepted: 01/11/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Antibacterial meshes for hernia repair seek to avoid infection in the patient. As these biomaterials are especially prone to bacteria settling at their sutured borders, this study examines whether the use of a cyanoacrylate tissue adhesive could improve mesh behavior at the fixation zones. METHODS First, antibacterial polypropylene meshes were prepared by soaking in 0.05% chlorhexidine, and the response of n-hexyl cyanoacrylate to contamination with Staphylococcus aureus ATCC25923 was assessed in vitro. Then, in a preclinical model, partial defects (5 x 3 cm) were created in the abdominal wall of 18 New Zealand White rabbits and repaired with mesh to establish the following 3 study groups: (1) mesh without chlorhexidine fixed with cyanoacrylate, (2) antibacterial mesh fixed with sutures, and (3) antibacterial mesh fixed with cyanoacrylate (n = 6 each). The implants were inoculated with 106 CFU/mL of S aureus. At 14 days after surgery, bacterial adhesion to the implant and its integration within host tissue were determined through microbiological, histological and immunohistochemical procedures. RESULTS As observed in vitro, the cyanoacrylate gave rise to a 1.5-cm bacteria-free margin around the prosthetic mesh. In vivo, the tissue adhesive prevented bacterial adhesion to the fixation zones, reducing infection of chlorhexidine-free meshes and optimizing the efficacy of the antibacterial meshes compared with those fixed with sutures. CONCLUSION These findings indicated that cyanoacrylate fixation does not affect mesh integration into the host tissue. Likewise, the antibacterial behavior and tissue response of a chlorhexidine-treated polypropylene mesh is improved when cyanoacrylate is used for its fixation.
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Affiliation(s)
- Bárbara Pérez-Köhler
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Madrid, Spain; Biomedical Networking Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain; Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
| | - Selma Benito-Martínez
- Biomedical Networking Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain; Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain; Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Madrid, Spain
| | - Francisca García-Moreno
- Biomedical Networking Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain; Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain; Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Madrid, Spain
| | - Marta Rodríguez
- Biomedical Networking Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain; Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain; Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Madrid, Spain
| | - Gemma Pascual
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Madrid, Spain; Biomedical Networking Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain; Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain.
| | - Juan Manuel Bellón
- Biomedical Networking Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain; Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain; Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Madrid, Spain
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20
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Abstract
Morbid Obesity is increasing worldwide at fast pace with associated co-morbidities also on the rise. Considering that Obesity is one of the main risk factors for developing a Ventral Hernia this will results that in the future we will experience a rise in those hernia in patients undergoing any abdominal surgery. There is no clarity on the best timing and choice for procedures. We are well aware also on the difficulties in hernia repair surgery and the relative outcome so adding obesity as co-factors amplify the challenges. In fact, today both general surgeons with expertise in abdominal wall repair and bariatric surgeons are faced with a new dilemma: the obese patient with an abdominal wall hernia. This article will briefly review the impact of obesity on the natural history of hernia, its associated complication, management strategies and outcome.
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Affiliation(s)
- Davide Lomanto
- Department of Surgery, Minimal Invasive Surgery Center (MISC), NUHS Hernia Center, Center for Obesity and Metabolic Surgery (COMS), National University Hospital, Singapore, Singapore - .,Yong Loo Lin School of Medicine, National University Hospital, Singapore, Singapore -
| | - Asim Shabbir
- Department of Surgery, Minimal Invasive Surgery Center (MISC), NUHS Hernia Center, Center for Obesity and Metabolic Surgery (COMS), National University Hospital, Singapore, Singapore
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21
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Ferguson DH, Smith CG, Olufajo OA, Zeineddin A, Williams M. Risk Factors Associated With Adverse Outcomes After Ventral Hernia Repair With Component Separation. J Surg Res 2020; 258:299-306. [PMID: 33039639 DOI: 10.1016/j.jss.2020.08.063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 08/05/2020] [Accepted: 08/25/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Over 350,000 surgeries are performed for ventral hernias (VHs) annually. Abdominal wall component separation has been more frequently used for the management of VHs. The goal of this study is to better understand factors associated with component separation complication rates. METHODS The National Inpatient Sample (2005-2014) was used to identify all patients with an International Classification of Diseases ninth Revision diagnosis of VHs who underwent open VH repair with a pedicleor graft advancement flap. All cases included in this study were elective and not associated with additional procedures. Demographic, clinical, and hospital characteristics were extracted. Independent predictors of complications and outcomes were determined by multivariable regression analysis. RESULTS Component separation was performed in 4346 patients. Mean age was 56; majority were female (55%) and white (80%). Most patients (73%) underwent surgery in an urban teaching hospital; mesh was used in 80% of cases and 11% were smokers. Hypertension was the most common comorbidity (50%), followed by obesity (26%), diabetes mellitus (DM) (23%), coronary artery disease (11%), and chronic obstructive pulmonary disease (COPD) (8%). Half of the patients (50%) had private insurance, and 35% had Medicare. Patients were distributed equally over household income quartiles. The mortality rate was 0.5%; median length of stay was 5 d. Overall complication rate was 25% (wound 11%, intraoperative 5%, infectious 11%, and pulmonary 8%). Mesh was associated with a lower rate of wound complications (10% versus 15%, P = 0.001). On multivariable analysis, patients with COPD (odds ratio: 2.02; 95% confidence interval: 1.58-2.59), obesity (1.37; 1.16-1.63), DM (1.3; 1.09-1.55), and those in the lowest income quartile (1.44; 1.06-1.96) had higher overall complication rates. CONCLUSIONS Consistent with other studies, patients with COPD, Obesity, DM, and lower income status were associated with increased complications after component separation.
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Affiliation(s)
- Deangelo H Ferguson
- Department of Surgery, Howard University College of Medicine, Washington, DC.
| | - Ciara G Smith
- Howard University College of Medicine, Washington, DC
| | - Olubode A Olufajo
- Department of Surgery, Howard University College of Medicine, Washington, DC
| | - Ahmad Zeineddin
- Department of Surgery, Howard University College of Medicine, Washington, DC
| | - Mallory Williams
- Department of Surgery, Howard University College of Medicine, Washington, DC
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22
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Biosynthetic Resorbable Prosthesis is Useful in Single-Stage Management of Chronic Mesh Infection After Abdominal Wall Hernia Repair. World J Surg 2020; 45:443-450. [PMID: 33025154 DOI: 10.1007/s00268-020-05808-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The goal of this article was to report the results about the efficacy of treatment of chronic mesh infection (CMI) after abdominal wall hernia repair (AWHR) in one-stage management, with complete mesh explantation of infected prosthesis and simultaneous reinforcement with a biosynthetic poly-4-hydroxybutyrate absorbable (P4HB) mesh. METHODS This is a retrospective analysis of all patients that needed mesh removal for CMI between September 2016 and January 2019 at a tertiary center. Epidemiological data, hernia characteristics, surgical, and postoperative variables (Clavien-Dindo classification) of these patients were analyzed. RESULTS Of the 32 patients who required mesh explantation, 30 received one-stage management of CMI. In 60% of the patients, abdominal wall reconstruction was necessary after the infected mesh removal: 8 cases (26.6%) were treated with Rives-Stoppa repair, 4 (13.3%) with a fascial plication, 1 (3.3%) with anterior component separation, and 1 (3.3%) with transversus abdominis release to repair hernia defects. Three Lichtenstein (10%) and 1 Nyhus repairs (3.3%) were performed in patients with groin hernias. The most frequent postoperative complications were surgical site occurrences: seroma in 5 (20%) patients, hematoma in 2 (6.6%) patients, and wound infection in 1 (3.3%) patient. During the mean follow-up of 34.5 months (range 23-46 months), the overall recurrence rate was 3.3%. Persistent, recurrent, or new CMIs were not observed. CONCLUSIONS In our experience, single-stage management of CMI with complete removal of infected prosthesis and replacement with a P4HB mesh is feasible with acceptable results in terms of mesh reinfection and hernia recurrence.
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23
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Martinez M, Dove J, Blansfield J, Widom K, Semian J, Alaparthi M, Factor M. Outcomes of Open Retro-Rectus Hernia Repair With Mesh in Obesity Class III. Am Surg 2020; 86:1163-1168. [PMID: 32972209 DOI: 10.1177/0003134820945246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Abdominal wall hernias continue to be one of the most common general surgery pathologies. Patients with an elevated body mass index (BMI) are routinely counseled about weight loss before elective repair. However, a definitive BMI "cutoff" has not been established. Here, we report our experience with open retro-rectus hernia repair (ORRHR) with mesh in patients with a BMI over 40 kg/m2, and we attempt to determine if a BMI "cutoff" can be established. METHODS Data from patients undergoing ORRHR with mesh at Geisinger Medical Center from January 1, 2014, to December 31, 2018, were collected and retrospectively analyzed. RESULTS Cohorts were composed of 2 groups, BMI ≥ 40 kg/m2 (n = 117) and BMI < 40 kg/m2 (n = 90). All patients underwent an elective ORRHR with mesh. Operative time increased significantly as the patient's BMI increased (P ≤ .01). Patients in the higher BMI group had a significantly higher rate of surgical site infections (SSIs) (8.55% vs. 1.1%, P = .018). Higher BMI did not translate to a higher recurrence rate. CONCLUSIONS Patients undergoing ORRHR with mesh who had a BMI over 40 kg/m2 had an increased risk of SSI and longer operative time, possibly suggesting a potential association other than SSI and BMI. More studies are needed to determine if BMI is indeed correlated with hernia recurrence and if BMI should influence the decision to undergo repair.
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Affiliation(s)
- Manuel Martinez
- 195466 Department of General Surgery, Geisinger Medical Center, Danville, PA, USA
| | - James Dove
- 195466 Department of General Surgery, Geisinger Medical Center, Danville, PA, USA
| | - Joseph Blansfield
- 195466 Department of General Surgery, Geisinger Medical Center, Danville, PA, USA
| | - Kenneth Widom
- 195466 Department of General Surgery, Geisinger Medical Center, Danville, PA, USA
| | - John Semian
- 195466 Department of General Surgery, Geisinger Medical Center, Danville, PA, USA
| | - Mohanbabu Alaparthi
- 195466 Department of General Surgery, Geisinger Medical Center, Danville, PA, USA
| | - Matthew Factor
- 195466 Department of General Surgery, Geisinger Medical Center, Danville, PA, USA
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24
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Lee LD, Stroux A, Nickisch D, Wröbel L, Aschenbrenner K, Weixler B, Kreis ME, Lauscher JC. Operative outcome of hernia repair with synthetic mesh in immunocompromised patients. ANZ J Surg 2020; 90:2248-2253. [DOI: 10.1111/ans.16212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 07/14/2020] [Accepted: 07/19/2020] [Indexed: 01/29/2023]
Affiliation(s)
- Lucas D. Lee
- Department of General, Visceral and Vascular Surgery Charité University Medicine Berlin, Campus Benjamin Franklin Berlin Germany
| | - Andrea Stroux
- Institute for Biometrics and Epidemiology Charité University Medicine Berlin, Campus Benjamin Franklin Berlin Germany
| | - Daniela Nickisch
- Practice of Gynecology and Obstetrics Practice Kadgien/Stuttmann Berlin Germany
| | - Lea Wröbel
- Department of General, Visceral and Vascular Surgery Charité University Medicine Berlin, Campus Benjamin Franklin Berlin Germany
| | - Katja Aschenbrenner
- Department of General, Visceral and Vascular Surgery Charité University Medicine Berlin, Campus Benjamin Franklin Berlin Germany
| | - Benjamin Weixler
- Department of General, Visceral and Vascular Surgery Charité University Medicine Berlin, Campus Benjamin Franklin Berlin Germany
| | - Martin E. Kreis
- Department of General, Visceral and Vascular Surgery Charité University Medicine Berlin, Campus Benjamin Franklin Berlin Germany
| | - Johannes C. Lauscher
- Department of General, Visceral and Vascular Surgery Charité University Medicine Berlin, Campus Benjamin Franklin Berlin Germany
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One-Year Health Care Utilization and Recurrence After Incisional Hernia Repair in the United States: A Population-Based Study Using the Nationwide Readmission Database. J Surg Res 2020; 255:267-276. [PMID: 32570130 DOI: 10.1016/j.jss.2020.03.070] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/15/2020] [Accepted: 03/27/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Most data on health care utilization after incisional hernia (IH) repair are limited to 30-days and are not nationally representative. We sought to describe nationwide 1-year readmission burden after IH repair (IHR). METHODS Patients undergoing elective IHR discharged alive were identified using the 2010-2014 Nationwide Readmission Database. Transfers and incomplete follow-up were excluded. Descriptive statistics were used to describe rates of 1-year readmission, IH recurrence, and bowel obstruction. Cox regression allowed identification of factors associated with 1-year readmissions. Generalized linear models were used to estimate predicted mean difference in cumulative costs/year, which allowed estimation of IHR readmission costs/year nationwide. RESULTS Of 15,935 identified patients, 19.35% were readmitted within 1 y. Patients who were readmitted differed by insurance, Charlson index, illness severity, smoking status, disposition, and surgical approach compared with those who were not (P < 0.05). Of readmitted patients, 39.3% returned within 30 d; 50.9% and 25.6% were due to any and infectious complications, respectively; 25.6% presented to a different hospital; 35.4% required reoperation; 5.4% experienced bowel obstruction; and 5% had IHR revision. Factors associated with readmissions included Medicare (hazard ratio [HR] 1.46 [95% confidence interval 1.19-1.8]; P < 0.01) or Medicaid (HR 1.42 [1.12-1.8], P < 0.01); chronic pulmonary disease (1.38 [1.17-1.64], P < 0.01), and anemia (1.36, [1.05-1.75], P = 0.02). Readmitted patients had higher 1-year cumulative costs (predicted mean difference $12,190 [95% CI: 10,941-13,438]; P < 0.01). Nationwide cost related to readmissions totaled $90,196,248/y. CONCLUSIONS One-year readmissions after IHR are prevalent and most commonly due to postoperative complications, especially infections. One-third of readmitted patients require a subsequent operation, and 5% experience IH recurrence, intensifying the burden to patients and on the health care system.
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Richmond B, Ubert A, Judhan R, King J, Harrah T, Dyer B, Thompson S. Component Separation with Porcine Acellular Dermal Reinforcement is Superior to Traditional Bridged Mesh Repairs in the Open Repair of Significant Midline Ventral Hernia Defects. Am Surg 2020. [DOI: 10.1177/000313481408000818] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The optimal technique for complex ventral hernia repair (VHR) remains controversial. Component separation (CS) reinforced with porcine acellular dermal matrix (PADM) has shown favorable results compared with series of conventional bridged VHR, but few comparative studies exist. We conducted a retrospective cohort study comparing 40 randomly selected patients who underwent CS/PADM reinforcement against an identical number of patients who underwent conventional open VHR with mesh at our institution. Patient characteristics, operative findings, outcomes, complications, reoperations, and recurrences were obtained by chart review. Fisher's exact/ t test compared outcomes between the two cohorts. Statistical significance was set as P < 0.05. Mean follow-up was 33.1 months. Patient groups did not differ significantly in race ( P = 1.00), age ( P = 0.82), body mass index ( P = 0.14), or comorbid conditions (smoking, chronic obstructive pulmonary disease, obesity, steroid use; P values 0.60, 0.29, 0.08, and 0.56, respectively). Defect size was greater in the CS/PADM group (mean, 372.5 vs 283.7 cm2, P = 0.01) as was the percentage Ventral Hernia Working Group Grade III/IV hernias (65.0 vs 30.0%, P = 0.03). Recurrences were lower in the CS/PADM group (13.2 vs 37.5%, P = 0.02). Mesh infection was lower in the CS/PADM group (0 vs 23% in the bridged group, P = 0.002), all of which occurred with synthetic mesh. Indications for reoperation (recurrence or complications requiring reoperation) were also lower in the CS/PADM group (17.5 vs 52.5%, P = 0.002). Superior results are achieved with CS/PADM reinforcement over traditional bridged VHR. This is evidenced by lower recurrence rates and overall complications requiring reoperation, particularly mesh infection. This is despite the greater use of CS in larger defects and contaminated hernias (VHWG Grade III and IV). CS/PADM reinforcement should be strongly considered for the repair of significant midline ventral hernia defects.
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Affiliation(s)
- Bryan Richmond
- Department of Surgery, West Virginia University, Charleston, West Virginia
| | - Adam Ubert
- Department of Surgery, West Virginia University, Charleston, West Virginia
| | - Rudy Judhan
- Department of Surgery, West Virginia University, Charleston, West Virginia
| | - Jonathan King
- Department of Surgery, West Virginia University, Charleston, West Virginia
| | - Tanner Harrah
- Charleston Area Medical Center Health Education and Research Institute, Charleston, West Virginia
| | - Benjamin Dyer
- Department of Surgery, West Virginia University, Charleston, West Virginia
| | - Stephanie Thompson
- Charleston Area Medical Center Health Education and Research Institute, Charleston, West Virginia
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Re-do surgery after prosthetic abdominal wall repair: intraoperative findings of mesh-related complications. Hernia 2020; 25:435-440. [PMID: 32495044 DOI: 10.1007/s10029-020-02225-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 05/20/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Mesh repair is one of the most popular technique for the treatment of abdominal wall hernias, resulting in lower recurrence rates. However, it is associated with a high risk of mesh-related complications. The aim of the present study is to assess the impact of biomaterials on the intra-abdominal organs, in terms of adhesions and visceral complications, in a series of patients undergoing re-do surgery at our abdominal wall unit. MATERIALS AND METHODS We reviewed the clinical records of 301 patients who undergone laparotomy between June 2008 and May 2018, selecting 67 patients with one or more previous prosthetic abdominal wall repair (AWR). RESULTS The average number of previous repairs was 1.6 with a mean time interval of 66 months from the last repair. Clinical presentation included hernia recurrence (69%), mesh infection (26%), infection and recurrence (10%), and fistula (1%). Adhesions were intraoperatively observed in all patients, except for eight cases. Mesh was completely removed in 43 patients, partially in four. Postoperative complications were observed in 39% of cases, including wound dehiscence, hematoma, seroma, and mesh infection. CONCLUSIONS Long-term implant results in abdominal wall repair and are not completely known, and literature is still lacking on this topic. Re-do surgery for subsequent pathological events may represent a way to increase our knowledge.
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Levy AS, Bernstein JL, Premaratne ID, Rohde CH, Otterburn DM, Morrison KA, Lieberman M, Pomp A, Spector JA. Poly-4-hydroxybutyrate (Phasix™) mesh onlay in complex abdominal wall repair. Surg Endosc 2020; 35:2049-2058. [PMID: 32385706 DOI: 10.1007/s00464-020-07601-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/24/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Poly-4-hydroxybutyric acid (P4HB, Phasix™) is a biosynthetic polymer that degrades by hydrolysis that can be woven into a mesh for use in soft tissue reinforcement. Herein, we describe our initial experience performing complex abdominal wall repair (CAWR) utilizing component separation and P4HB mesh as onlay reinforcement. METHODS All patients undergoing CAWR between June 2014 and May 2017 were followed prospectively for postoperative outcomes. Only those patients who underwent components separation with primary repair of the fascial edges followed by onlay of P4HB mesh were included in this study. RESULTS 105 patients (52 male, 53 female; mean age 59.2 years, range 22-84) met inclusion criteria. Mean BMI was 29.1 (range 16-48); 52% patients had prior attempted hernia repair, most with multiple medical comorbidities (71% of patients with ASA 3 or greater). 30% of cases were not clean at the time of repair (CDC class 2 or greater). Median follow-up was 36 months (range 9-63). Eighteen patients (17%) developed a hernia recurrence ranging from 2 to 36 months postoperatively. Five (5%) patients developed a localized superficial infection treated with antibiotics, three (2.8%) required re-operation for non-healing wounds, and six (6%) patients developed seroma. CONCLUSIONS These data demonstrate a relatively low rate of hernia recurrence, seroma, and other common complications of CAWR in a highly morbid patient population. Importantly, the rate of mesh infection was low and no patients required complete mesh removal, even when placed into a contaminated or infected surgical field.
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Affiliation(s)
- Adam S Levy
- Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Jaime L Bernstein
- Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Ishani D Premaratne
- Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Christine H Rohde
- Division of Plastic and Reconstructive Surgery, Columbia University Medical Center, New York, NY, USA
| | - David M Otterburn
- Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Kerry A Morrison
- Hansjorg Wyss Department of Plastic Surgery, NYU Langone Medical Center, New York, NY, USA
| | - Michael Lieberman
- Division of General Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Alfons Pomp
- Division of General Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Jason A Spector
- Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, NY, USA.
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Koebe S, Greenberg J, Huang LC, Phillips S, Lidor A, Funk L, Shada A. Current practice patterns for initial umbilical hernia repair in the United States. Hernia 2020; 25:563-570. [PMID: 32162111 DOI: 10.1007/s10029-020-02164-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/26/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE The approach to repairing an initial umbilical hernia (IUH) varies substantially, and this likely depends on hernia size, patient age, sex, BMI, comorbidities including diabetes mellitus, and surgeon preference. Of these, only hernia size has been widely studied. This cross-sectional study aims to look at the practice pattern of umbilical hernia repair in the United States. METHODS A retrospective study was performed using data from the America Hernia Society Quality Collaborative. Patient characteristics included age, sex, hernia width, BMI, smoking status, and diabetes. Outcomes were use of mesh for repair, as well as surgical approach (open vs minimally invasive). Multivariate logistic regression was performed to assess the independent effect of age, sex, hernia width, BMI, smoking status, and diabetes on use of mesh and approach to repair. RESULTS 3475 patients were included. 74% were men. Mesh use was more common in men (67% vs 60%, P < 0.001). Mesh was used in 33% of repairs ≤ 1 cm, and 82% of repairs > 1 cm (P < 0.001). Younger patients were less likely to receive a mesh repair (54% if age ≤ 35 vs 67% for age > 35, P < 0.001). However, on multivariate analysis, mesh use was associated with increasing hernia width (OR 5.474, 95% CI 4.7-6.3) as well as BMI (OR 1.8, 95% CI 1.5-2.1) but not with age or sex. CONCLUSION The majority of IUH are performed open. Patient BMI and hernia defect size contribute to choice of surgical technique including use of mesh. The use of mesh in 33% of hernias below 1 cm demonstrates a gap between evidence and practice. Patient factors including patient age and sex had no impact on operative approach or use of mesh.
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Affiliation(s)
- S Koebe
- University of Wisconsin School of Medicine and Public Health, 750 Highland Ave, Madison, WI, 53726, USA
| | - J Greenberg
- Department of Surgery, University of Wisconsin, 600 Highland Ave, Madison, WI, 53736, USA
| | - L-C Huang
- America Hernia Society Quality Collaborative, Vanderbilt University Medical Center, Nashville, TN, USA
| | - S Phillips
- America Hernia Society Quality Collaborative, Vanderbilt University Medical Center, Nashville, TN, USA
| | - A Lidor
- Department of Surgery, University of Wisconsin, 600 Highland Ave, Madison, WI, 53736, USA
| | - L Funk
- Department of Surgery, University of Wisconsin, 600 Highland Ave, Madison, WI, 53736, USA
| | - A Shada
- Department of Surgery, University of Wisconsin, 600 Highland Ave, Madison, WI, 53736, USA.
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, 4602 Eastpark Blvd Suite 3525, Madison, WI, 53718, USA.
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Yurtkap Y, Jairam AP, Kaufmann R, Kroese LF, Clahsen-van Groningen MC, Mouton JW, Menon AG, Kleinrensink GJ, Jeekel J, Lange JF, Belt EJ. Zinc-Impregnated Mesh for Abdominal Wall Repair Reduces Infection in a Rat Model of Peritonitis. J Surg Res 2020; 246:560-567. [DOI: 10.1016/j.jss.2019.09.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/03/2019] [Accepted: 09/19/2019] [Indexed: 01/24/2023]
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Harpain F, Wimmer K, Dawoud C, Ogrodny P, Stift A. Short-term outcome after ventral hernia repair using self-gripping mesh in sublay technique - A retrospective cohort analysis. Int J Surg 2020; 75:47-52. [PMID: 31991243 DOI: 10.1016/j.ijsu.2020.01.124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/10/2020] [Accepted: 01/18/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Hernia repair in sublay technique is widely accepted for ventral hernias, as it appears to be advantageous in terms of complication and recurrence rates. Self-gripping meshes are increasingly used for hernia repair with retromuscular mesh positioning. However, real-life data on the safe use in that specific indication are still lacking. The purpose of this study is the evaluation of short-term postoperative outcome of self-gripping versus conventional non-self-gripping meshes in sublay hernia repair. MATERIALS AND METHODS This retrospective analysis assessed patients undergoing ventral hernia repair in sublay technique between January 2011 and July 2018 at the Department of Surgery, Medical University of Vienna. 244 consecutive patients were eligible for final analysis. Patients were grouped according to the utilized mesh. Baseline characteristics and peri-as well as postoperative outcome was assessed. RESULTS There was no significant difference in baseline characteristics between the two groups. Median follow-up was 11 months (IQR 3-30). The overall complication rate (28.3% versus 13.7%, p = 0.005) due to an increased rate of seromas (17.3% versus 6.8%, p = 0.013) and surgical site infections (12.6% versus 4.3%, p = 0.021) was significantly higher in patients with a self-gripping mesh. Significantly more patients with a self-gripping mesh needed a surgical intervention (21.3% versus 9.4%, p = 0.011). CONCLUSION In sublay ventral hernia repair, the use of self-gripping meshes is associated with a higher overall complication rate and an increased rate of complication-associated surgical interventions when compared to non-self-gripping mesh placements.
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Affiliation(s)
- Felix Harpain
- Department of Surgery, Division of General Surgery, Medical University Vienna, Austria
| | - Kerstin Wimmer
- Department of Surgery, Division of General Surgery, Medical University Vienna, Austria
| | - Christopher Dawoud
- Department of Surgery, Division of General Surgery, Medical University Vienna, Austria
| | - Philipp Ogrodny
- Department of Surgery, Division of General Surgery, Medical University Vienna, Austria
| | - Anton Stift
- Department of Surgery, Division of General Surgery, Medical University Vienna, Austria.
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Harris H, Young C, Lyo V. Fasical defect size predicts recurrence following incisional hernia repair: A 7-year, single-surgeon experience. INTERNATIONAL JOURNAL OF ABDOMINAL WALL AND HERNIA SURGERY 2020. [DOI: 10.4103/ijawhs.ijawhs_50_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Köckerling F, Sheen AJ, Berrevoet F, Campanelli G, Cuccurullo D, Fortelny R, Friis-Andersen H, Gillion JF, Gorjanc J, Kopelman D, Lopez-Cano M, Morales-Conde S, Österberg J, Reinpold W, Simmermacher RKJ, Smietanski M, Weyhe D, Simons MP. The reality of general surgery training and increased complexity of abdominal wall hernia surgery. Hernia 2019; 23:1081-1091. [PMID: 31754953 PMCID: PMC6938469 DOI: 10.1007/s10029-019-02062-z] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 09/27/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The Accreditation and Certification of Hernia Centers and Surgeons (ACCESS) Group of the European Hernia Society (EHS) recognizes that there is a growing need to train specialist abdominal wall surgeons. The most important and relevant argument for this proposal and statement is the growing acceptance of the increasing complexity of abdominal wall surgery due to newer techniques, more challenging cases and the required 'tailored' approach to such surgery. There is now also an increasing public awareness with social media, whereby optimal treatment results are demanded by patients. However, to date the complexity of abdominal wall surgery has not been properly or adequately defined in the current literature. METHODS A systematic search of the available literature was performed in May 2019 using Medline, PubMed, Scopus, Embase, Springer Link, and the Cochrane Library, with 75 publications identified as relevant. In addition, an analysis of data from the Herniamed Hernia Registry was performed. The percentage of patients with hernia- or patient-related characteristics which unfavorably impacted the outcome of inguinal and incisional hernia repair was also calculated. RESULTS All present guidelines for abdominal wall surgery recommend the utilization of a 'tailored' approach. This relies on the prerequisite that any surgical technique used has already been mastered, as well as the recognized learning curves for each of the several techniques that can be used for both inguinal hernia (Lichtenstein, TEP, TAPP, Shouldice) and incisional hernia repairs (laparoscopic IPOM, open sublay, open IPOM, open onlay, open or endoscopic component separation technique). Other hernia- and patient-related characteristics that have recognized complexity include emergency surgery, obesity, recurrent hernias, bilateral inguinal hernias, groin hernia in women, scrotal hernias, large defects, high ASA scores, > 80 years of age, increased medical risk factors and previous lower abdominal surgery. The proportion of patients with at least one of these characteristics in the Herniamed Hernia Registry in the case of both inguinal and incisional hernia is noted to be relatively high at around 70%. In general surgery training approximately 50-100 hernia repairs on average are performed by each trainee, with around only 25 laparo-endoscopic procedures. CONCLUSION A tailored approach is now employed and seen more so in hernia surgery and this fact is referred to and highlighted in the contemporaneous hernia guidelines published to date. In addition, with the increasing complexity of abdominal wall surgery, the number of procedures actually performed by trainees is no longer considered adequate to overcome any recognized learning curve. Therefore, to supplement general surgery training young surgeons should be offered a clinical fellowship to obtain an additional qualification as an abdominal wall surgeon and thus improve their clinical and operative experience under supervision in this field. Practicing general surgeons with a special interest in hernia surgery can undertake intensive further training in this area by participating in clinical work shadowing in hernia centers, workshops and congresses.
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Affiliation(s)
- F Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.
| | - A J Sheen
- Department of Surgery, Manchester University NHS Foundation Trust, Manchester, M13 9WL, UK
| | - F Berrevoet
- Department of General and HPB Surgery and Liver Transplantation, Universitair Ziekenhuis Gent, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - G Campanelli
- General and Day Surgery Unit, Center of Research and High Specialization for the Pathologies of Abdominal Wall and Surgical Treatment and Repair of Abdominal Hernia, Milano Hernia Center, Instituto Clinico Sant'Ambrogio, University of Insurbria, Milan, Italy
| | - D Cuccurullo
- Department of General, Laparoscopic and Robotic Surgery, Chief Week Surgery Departmental Unit, A.O. dei Colli Monaldi Hospital Naples, Naples, Italy
| | - R Fortelny
- Department of General, Visceral and Oncological Surgery, Wilhelminenspital, 1160, Vienna, Austria
- Medical Faculty of Sigmund Freud University, 1020, Vienna, Austria
| | - H Friis-Andersen
- Surgical Department, Horsens Regional Hospital, Aarhus University, Sundvey 30, 8700, Horsens, Denmark
| | - J F Gillion
- Unité de Chirurgie Viscérale, Hôpital Privé d'Antony, 1, Rue Velpeau, 92160, Antony, France
| | - J Gorjanc
- Department of Surgery, Krankenhaus der Barmherzigen Brüder, Spitalgasse 26, 9300, St. Veit an der Glan, Austria
| | - D Kopelman
- Department of Surgery Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - M Lopez-Cano
- Abdominal Wall Surgery Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - S Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, University Hospital Virgen del Rocío, Av. Manuel Siurot, s/n, 41013, Seville, Spain
| | - J Österberg
- Department of Surgery, Mora Hospital, 79285, Mora, Sweden
| | - W Reinpold
- Wilhelmsburger Krankenhaus Gross-Sand, Gross-Sand 3, 21107, Hamburg, Germany
| | - R K J Simmermacher
- Department of Surgery, University Medical Center Utrecht, Heidelbergglaan 100, Utrecht, The Netherlands
| | - M Smietanski
- Department of General Surgery and Hernia Centre, Hospital in Puck, Medical University of Gdansk, Gdansk, Poland
| | - D Weyhe
- School of Medicine and Health Sciences, University Hospital for Visceral Surgery, Pius Hospital Oldenburg, Medical Campus University of Oldenburg, Georgstr. 12, 26121, Oldenburg, Germany
| | - M P Simons
- Department of Surgery, OLVG Hospital, Amsterdam, The Netherlands
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Baltodano PA, Chattha A, Johnson PK, Kittredge J, Ricci JA, Patel A. Postoperative Prophylactic Antibiotics Reduce Surgical Site Infection Rates after Ventral Hernia Repair: A Systematic Review. Am Surg 2019. [DOI: 10.1177/000313481908501128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
SSIs after ventral hernia repair (VHR) represent a significant complication. The impact of postoperative prophylactic antibiotics on the SSI rates after VHRs is unclear. A systematic review of PubMed and Web of Science databases from inception through March 2016 investigating the effect of postoperative prophylactic antibiotics after VHRs was performed. Strict inclusion and exclusion criteria were implemented, and the methodological quality of the included studies was assessed. After systematic independent assessment of 216 citations, four studies, involving 344 patients, met the inclusion criteria. Among the included studies, 164 patients received >24 hours of postoperative prophylactic antibiotics, whereas 180 patients were controls. The overall incidence of SSI among patients receiving postoperative antibiotics was 14.6 per cent (95% confidence interval [CI], 9.9 to 20.9) which compares favorably with the control group: 35.5 per cent (95% CI, 28.9 to 42.7) (odds ratio: 0.3, 95% CI: 0.2 to 0.5, P < 0.01). Among patient's receiving postoperative antibiotics, the pooled average duration of postoperative antibiotic treatment was 6.2 ± 0.4 days. Based on the available evidence, the use of postoperative prophylactic antibiotics seems to be associated with lower SSI rates after VHRs. Future prospective randomized controlled trials should be conducted to further confirm the efficacy of this prophylactic intervention.
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Affiliation(s)
- Pablo A. Baltodano
- Division of Plastic Surgery, Department of Surgery, Albany Medical Center, Albany, New York
| | - Anmol Chattha
- Division of Plastic Surgery, Department of Surgery, Albany Medical Center, Albany, New York
| | - Philip K. Johnson
- Division of Plastic Surgery, Department of Surgery, Albany Medical Center, Albany, New York
| | - Justin Kittredge
- Division of Plastic Surgery, Department of Surgery, Albany Medical Center, Albany, New York
| | - Joseph A. Ricci
- Division of Plastic Surgery, Department of Surgery, Albany Medical Center, Albany, New York
| | - Ashit Patel
- Division of Plastic Surgery, Department of Surgery, Albany Medical Center, Albany, New York
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Mayfield CK, Gould DJ, Wong A, Patel KM, Carey J. Value Improvement and Resource Utilization in Complex Abdominal Wall Reconstruction. Am Surg 2019. [DOI: 10.1177/000313481908501008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although recommendations help guide surgeons’ mesh choice in abdominal wall reconstruction (AWR), financial and institutional pressures may play a bigger role. Standardization of an AWR algorithm may help reduce costs and change mesh preferences. We performed a retrospective review of high- and low-risk patients who underwent inpatient AWR between 2014 and 2016. High risk was defined as immunosuppression and/or history of infection/contamination. Patients were stratified by the type of mesh as biologic/biosynthetic or synthetic. These cohorts were analyzed for outcome, complications, and cost. One hundred twelve patients underwent complex AWR. The recurrence rate at two years was not statistically different between high- and low-risk cohorts. No significant difference was found in the recurrence rate between biologic and synthetic meshes when comparing both high- and low-risk cohorts. The average cost of biologic mesh was $9,414.80 versus $524.60 for synthetic. The estimated cost saved when using synthetic mesh for low-risk patients was $295,391.20. In conclusion, recurrence rates for complex AWR seem to be unrelated to mesh selection. There seems to be an excess use of biologic mesh in low-risk patients, adding significant cost. Implementing a critical process to evaluate indications for biologic mesh use could decrease costs without impacting the quality of care, thus improving the overall value of AWR.
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Affiliation(s)
- Cory K. Mayfield
- Keck School of Medicine of the University of Southern California, Los Angeles, California and
| | - Daniel J. Gould
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California
| | - Alex Wong
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California
| | - Ketan M. Patel
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California
| | - Joseph Carey
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California
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Tran BNN, Johnson AR, Shen C, Lee BT, Lee ES. Closed-Incision Negative-Pressure Therapy Efficacy in Abdominal Wall Reconstruction in High-Risk Patients: A Meta-analysis. J Surg Res 2019; 241:63-71. [DOI: 10.1016/j.jss.2019.03.033] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 02/14/2019] [Accepted: 03/22/2019] [Indexed: 12/26/2022]
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Alkhatib H, Tastaldi L, Krpata DM, Petro CC, Huang LC, Phillips S, Fafaj A, Rosenblatt S, Rosen MJ, Prabhu AS. Impact of modifiable comorbidities on 30-day wound morbidity after open incisional hernia repair. Surgery 2019; 166:94-101. [DOI: 10.1016/j.surg.2019.03.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 03/01/2019] [Accepted: 03/11/2019] [Indexed: 01/15/2023]
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Retromuscular Mesh Repair Using Fibrin Glue: Early Outcomes and Cost-effectiveness of an Evolving Technique. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2184. [PMID: 31321182 PMCID: PMC6554171 DOI: 10.1097/gox.0000000000002184] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 01/15/2019] [Indexed: 12/18/2022]
Abstract
Background Retromuscular hernia repairs (RHRs) decrease hernia recurrence and surgical site infections but can cause significant pain. We aimed to determine if pain and postoperative outcomes differed when comparing suture fixation (SF) of mesh to fibrin glue fixation (FGF). Methods Patients undergoing RHR (n = 87) between December 1, 2015 and December 31, 2017 were retrospectively identified. Patients received SF of mesh (n = 59, 67.8%) before the senior author changing his technique to FGF (n = 28, 32.2%). These 2 cohorts were matched (age, body mass index, number of prior repairs, mesh type, defect size, and wound class). Outcomes were analyzed using a matched pairs design with multivariable linear regression. Results Two matched groups (21 FGF and 21 SF) were analyzed (45.2% female, average age 56 years, average body mass index 34.7 kg/m2, and average defect size 330 cm2). Statistical significance was observed for FGF compared with SF: length of stay (3.7 versus 7.1 days, P = 0.032), time with a drain (17.2 versus 27.5 days, P = 0.012), 30-day postoperative visits (2 versus 3, P = 0.003), pain scores (5.2 versus 3.1, P = 0.019) and activity within the first 24 hours (walking versus sitting, P = 0.002). Operative time decreased by 23.1 minutes (P = 0.352) and postoperative narcotic represcription (3 versus. 8 patients, p=0.147) also decreased. Average cost for patients receiving SF was $36,152 compared to $21,782 for FGF (P = 0.035). Conclusions Sutureless RHR using FGF may result in decreased pain when compared with a matched cohort receiving SF, translating to enhanced recovery time, shortened hospital stay, and decreased costs.
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Budget Impact Analysis of a Biosynthetic Mesh for Incisional Hernia Repair. Clin Ther 2018; 40:1830-1844.e4. [DOI: 10.1016/j.clinthera.2018.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/08/2018] [Accepted: 09/05/2018] [Indexed: 01/14/2023]
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American Society for Metabolic and Bariatric Surgery and American Hernia Society consensus guideline on bariatric surgery and hernia surgery. Surg Obes Relat Dis 2018; 14:1221-1232. [DOI: 10.1016/j.soard.2018.07.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 07/05/2018] [Indexed: 02/02/2023]
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Abstract
Rives and Stoppa described the sublay technique of hernia repair more than half a century ago, but it took almost three decades to become truly appreciated and even longer for its full clinical potential and benefits to be realized. Modifications to the original operation have significantly improved surgical approaches, postsurgical outcomes, and quality of life. The retromuscular approach requires technical expertise and a firm grasp of the anatomy. With constant substitution of the terms sublay, retrorectus, retromuscular, preperitoneal, and Rives-Stoppa throughout the literature, the nuances need to be distinguished to appreciate the surgical planes encountered during the operation. This article explains the origin of the nomenclature while clarifying these terms, describing the technique, highlighting outcomes, and discussing future considerations.
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Affiliation(s)
- Irfan A. Rhemtulla
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John P. Fischer
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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Haskins IN, Krpata DM, Prabhu AS, Tastaldi L, Perez AJ, Tu C, Rosenblatt S, Poulose BK, Rosen MJ. Immunosuppression is not a risk factor for 30-day wound events or additional 30-day morbidity or mortality after open ventral hernia repair: An analysis of the Americas Hernia Society Quality Collaborative. Surgery 2018; 164:594-600. [PMID: 30029991 DOI: 10.1016/j.surg.2018.05.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/13/2018] [Accepted: 05/18/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Some form of immunosuppression is relatively common in patients undergoing ventral hernia repair. Nevertheless, the association of immunosuppression with 30-day wound events and additional outcomes of morbidity and mortality remains unknown. The purpose of our study was to investigate the association of immunosuppression with 30-day wound events and additional morbidity and mortality after ventral hernia repair by evaluating the database of the Americas Hernia Society Quality Collaborative. METHODS All patients undergoing open, elective, incisional ventral hernia surgery from July 2013 through April 2017 were identified within the database of the Americas Hernia Society Quality Collaborative. Patients on immunosuppression within the 3 months before operative intervention were compared with patients not on immunosuppression with respect to the incidence of 30-day wound events, using a 1:5 propensity matched analysis. RESULTS A total of 3,537 patients met inclusion criteria; 200 (5.7%) patients were on some form of immunosuppression at the time of ventral hernia repair. After propensity matching, 1,200 patients remained for analysis; 200 (16.7%) patients were in the immunosuppression group. There were no statistically significant differences between the 2 groups with respect to the incidence of 30-day surgical site infection, surgical site occurrence requiring procedural intervention, or additional 30-day morbidity or mortality outcomes. Patients in the immunosuppression group had a greater rate of surgical site occurrences, the majority of which were seromas (P = .03). CONCLUSION Immunosuppression is associated with an increased risk of 30-day surgical site occurrence but not surgical site infection, surgical site occurrence requiring procedural intervention, or additional 30-day morbidity or mortality. Additional studies are needed to determine the clinical importance of these surgical site occurrences with respect to long-term durability of the hernia repair.
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Affiliation(s)
- Ivy N Haskins
- Comprehensive Hernia Center, Department of General Surgery, The Cleveland Clinic Foundation, Cleveland, OH
| | - David M Krpata
- Comprehensive Hernia Center, Department of General Surgery, The Cleveland Clinic Foundation, Cleveland, OH
| | - Ajita S Prabhu
- Comprehensive Hernia Center, Department of General Surgery, The Cleveland Clinic Foundation, Cleveland, OH
| | - Luciano Tastaldi
- Comprehensive Hernia Center, Department of General Surgery, The Cleveland Clinic Foundation, Cleveland, OH
| | - Arielle J Perez
- Comprehensive Hernia Center, Department of General Surgery, The Cleveland Clinic Foundation, Cleveland, OH
| | - Chao Tu
- Department of Quantitative Health Sciences, Lerner Research Institute, The Cleveland Clinic Foundation, Cleveland, OH
| | - Steven Rosenblatt
- Comprehensive Hernia Center, Department of General Surgery, The Cleveland Clinic Foundation, Cleveland, OH
| | - Benjamin K Poulose
- The Vanderbilt Hernia Center, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Michael J Rosen
- Comprehensive Hernia Center, Department of Surgery, Cleveland Clinic, Cleveland, OH.
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Haskins IN, Horne CM, Krpata DM, Prabhu AS, Tastaldi L, Perez AJ, Rosenblatt S, Poulose BK, Rosen MJ. A call for standardization of wound events reporting following ventral hernia repair. Hernia 2018; 22:729-736. [PMID: 29429064 DOI: 10.1007/s10029-018-1748-6] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 01/25/2018] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Postoperative wound events following ventral hernia repair are an important outcome measure. While efforts have been made by hernia surgeons to identify and address risk factors for postoperative wound events following VHR, the definition of these events lacks standardization. Therefore, the purpose of our study was to detail the variability of wound event definitions in recent ventral hernia literature and to propose standardized definitions for postoperative wound events following VHR. METHODS The top 50 cited ventral hernia, peer-reviewed publications from 1995 through 2015 were identified using the search engine Google Scholar. The definition of wound event used and the incidence of postoperative wound events was recorded for each article. The number of articles that used a standardized definition for surgical site infection (SSI), surgical site occurrence (SSO), or surgical site occurrence requiring procedural intervention (SSOPI) was also identified. RESULTS Of the 50 papers evaluated, only nine (18%) used a standardized definition for SSI, SSO, or SSOPI. The papers that used standardized definitions had a smaller variability in the incidence of wound events when compared to one another and their reported rates were more consistent with recently published ventral hernia repair literature. CONCLUSION Postoperative wound events following VHR are intimately associated with patient quality of life and long-term hernia repair durability. Standardization of the definition of postoperative wound events to include SSI, SSO, and SSOPI following VHR will improve the ability of hernia surgeons to make evidence-based decisions regarding the management of ventral hernias.
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Affiliation(s)
- I N Haskins
- Department of General Surgery, Comprehensive Hernia Center, The Cleveland Clinic Foundation, Cleveland, OH, USA. .,Department of General Surgery, Cleveland Clinic Comprehensive Hernia Center, The Cleveland Clinic, 9500 Euclid Avenue, A100, Cleveland, OH, 44195, USA.
| | - C M Horne
- Department of General Surgery, Comprehensive Hernia Center, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - D M Krpata
- Department of General Surgery, Comprehensive Hernia Center, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - A S Prabhu
- Department of General Surgery, Comprehensive Hernia Center, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - L Tastaldi
- Department of General Surgery, Comprehensive Hernia Center, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Arielle J Perez
- Department of General Surgery, Comprehensive Hernia Center, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - S Rosenblatt
- Department of General Surgery, Comprehensive Hernia Center, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - B K Poulose
- Department of Surgery, The Vanderbilt Hernia Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - M J Rosen
- Department of General Surgery, Comprehensive Hernia Center, The Cleveland Clinic Foundation, Cleveland, OH, USA
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Delineating the burden of chronic post-operative pain in patients undergoing open repair of complex ventral hernias. Am J Surg 2018; 215:610-617. [PMID: 29402389 DOI: 10.1016/j.amjsurg.2018.01.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 12/19/2017] [Accepted: 01/03/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND After open complex ventral hernia repair (cVHR), chronic pain has a significant impact on quality of life and processes of care. METHODS Records of 177 patients undergoing cVHR were reviewed in order to characterize the burden of managing postoperative pain in the first post-operative year following open cVHR. RESULTS In this cohort, 91 patients initiated at least one unsolicited complaint of pain, though phone call (37), unscheduled clinic visit (45) or evaluation in the emergency room (9); among these an actionable diagnosis was found in 38 (41.8%). Among 41 patients who initiated additional unsolicited complaints of pain, an actionable diagnosis was found in only 3 patients. Risk factors for such complaints included pre-operative pain and the use of synthetic mesh. CONCLUSIONS Even in the absence of an actionable diagnosis, significant resources are utilized in evaluation and management of unsolicited complaints of pain in the first year after cVHR.
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Warren JA, Beffa LR, Carbonell AM, Cull J, Sinopoli B, Ewing JA, McFadden C, Crockett J, Cobb WS. Prophylactic placement of permanent synthetic mesh at the time of ostomy closure prevents formation of incisional hernias. Surgery 2017; 163:839-846. [PMID: 29224706 DOI: 10.1016/j.surg.2017.09.041] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 08/22/2017] [Accepted: 09/13/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Reversal of an enterostomy results in a high rate of incisional hernia at the ostomy site. Prophylactic mesh reinforcement of the fascial defect is typically not considered due to the contaminated nature of the case. We present the outcomes of a series of prophylactic mesh reinforcements with retromuscular, large-pore polypropylene at the time of enterostomy reversal. METHODS Retrospective review of all ostomy reversals was performed. All cases with placement of synthetic mesh reinforcement were identified from a prospectively maintained, hernia database. Primary end points were surgical site occurrence, surgical site infection, and hernia occurrence. RESULTS Ostomy reversal was performed in 359 patients; 91 were reinforced with mesh and 268 without mesh. Colostomy reversal was performed in 56.5% and ileostomy in 43.5%. The mesh group had a greater body mass index and a greater incidence of chronic obstructive pulmonary disease, but groups were otherwise similar. A midline incisional hernia was present in 45% of the mesh group vs 4.5% in the controls. Incidence of surgical site occurrence and surgical site infection were similar for mesh and control groups (21 vs 22.8%; P = .82 and 20 vs 19.8%; P = 1.000, respectively). Superficial surgical site infection was less with mesh (8 vs 16.4%; P = .039). Incidence of a hernia developing at the stoma site was decreased markedly with mesh (1% vs 17.2%; P < .001), as was the occurrence of a midline hernia (6% vs 19%; P = .004). Mesh was placed across the midline prophylactically in 29.7% of cases, which decreased midline hernia formation from 24.1% to 4% (P = .019). CONCLUSION Retromuscular placement of permanent synthetic mesh at the time of enterostomy reversal is effective in preventing development of incisional hernia without increased risk of surgical site occurrence or surgical site infection.
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Affiliation(s)
- Jeremy A Warren
- Department of Surgery, Division of Minimally Invasive and Bariatric Surgery, Greenville Health System, University of South Carolina School of Medicine Greenville, Greenville, SC.
| | - Lucas R Beffa
- Department of Surgery, Division of Minimally Invasive and Bariatric Surgery, Greenville Health System, University of South Carolina School of Medicine Greenville, Greenville, SC
| | - Alfredo M Carbonell
- Department of Surgery, Division of Minimally Invasive and Bariatric Surgery, Greenville Health System, University of South Carolina School of Medicine Greenville, Greenville, SC
| | - Jennifer Cull
- University of South Carolina School of Medicine Greenville, Greenville, SC
| | - Brent Sinopoli
- Department of Surgery, Division of Minimally Invasive and Bariatric Surgery, Greenville Health System, University of South Carolina School of Medicine Greenville, Greenville, SC
| | - Joseph A Ewing
- Greenville Health System, Department of Quality Management, Greenville, SC
| | - Cedrek McFadden
- Department of Surgery, Division of Colorectal Surgery, Greenville Health System, Greenville, SC
| | - Jay Crockett
- Department of Surgery, Division of Colorectal Surgery, Greenville Health System, Greenville, SC
| | - William S Cobb
- Department of Surgery, Division of Minimally Invasive and Bariatric Surgery, Greenville Health System, University of South Carolina School of Medicine Greenville, Greenville, SC
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Zigman JS, Yazdany J, Trinidad J, Yazdany T. Scleroderma and Pelvic Organ Prolapse: A Multidisciplinary Approach to Patient Care and Surgical Planning. J Gynecol Surg 2017. [DOI: 10.1089/gyn.2017.0014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jessica S. Zigman
- Department of Obstetrics and Gynecology, Division of Urogynecology, Los Angeles County Harbor University of California– Los Angeles Medical Center, Torrance, CA
| | - Jinoos Yazdany
- Department of Medicine, Division of Rheumatology, University of California–San Francisco, San Franciso, CA
| | - John Trinidad
- Department of Dermatology, Los Angeles County Harbor University of California–Los Angeles Medical Center, Torrance, CA
| | - Tajnoos Yazdany
- Department of Obstetrics and Gynecology, Division of Urogynecology, Los Angeles County Harbor University of California– Los Angeles Medical Center, Torrance, CA
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Comparison of Synthetic and Biologic Mesh in Ventral Hernia Repair Using Components Separation Technique. Ann Plast Surg 2017; 76:674-9. [PMID: 25003419 DOI: 10.1097/sap.0000000000000253] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Ventral hernia repair (VHR) for large abdominal wall defects is challenging. Prior research established that the use of mesh is superior to suture closure alone and that component separation is an effective technique to combat loss of abdominal domain. Studies comparing component separation technique (CST) outcomes utilizing synthetic versus biologic mesh are limited. A retrospective review was conducted of 72 consecutive patients who underwent VHR with CST between 2006 and 2010 at our institution. Surgeon preference and the presence of contamination guided whether synthetic mesh (27 patients) or biologic mesh (45 patients) was used. Mean follow-up interval for all comers was 13.9 months and similar in both groups (P > 0.05). Degree of contamination and severity of premorbid medical conditions were significantly higher in the biologic mesh group, as reflected in the higher Ventral Hernia Working Group (VHWG) score (2.04 versus 2.86). Clinical outcomes, as measured by both minor and major complication rates and recurrence rates, were not significantly different. Minor complication rates were 26% in the synthetic group and 37% in the biologic group and major complication rates 15% in the synthetic group and 22% in the biologic group. There was 1 recurrence (4%) in the synthetic mesh group versus 5 (11%) in the biologic mesh group. Multivariable analysis for major complications revealed no significant difference for either synthetic or biologic mesh while controlling for other variables. Subset analysis of uncontaminated cases revealed recurrence rates of 4% in the synthetic mesh group and 6% in the biologic mesh group. VHR using CST and either synthetic mesh or biologic mesh resulted in low recurrence rates with similar overall complication profiles, despite the higher average VHWG grading score in the biologic mesh group. Our results support the VHWG recommendation for biologic mesh utilization in higher VHWG grade patients. In VHWG grade 2 patients, our clinical outcomes were similar, supporting the use of either type of mesh.
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Kroese LF, van Eeghem LHA, Verhelst J, Jeekel J, Kleinrensink GJ, Lange JF. Long term results of open complex abdominal wall hernia repair with self-gripping mesh: A retrospective cohort study. Int J Surg 2017; 44:255-259. [PMID: 28689863 DOI: 10.1016/j.ijsu.2017.07.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 07/03/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND In case of complex ventral hernias, Rives-Stoppa and component separation technique are considered as favourable treatment techniques. However, mesh-related complications like recurrence, infection and chronic pain are still a common problem after mesh repair. Previous studies have reported promising results of the use of a self-gripping mesh (ProGrip™) in incisional hernia repair. This study aimed to evaluate the long term results of this mesh for complex ventral hernia treatment. MATERIALS AND METHODS Patients with complex ventral hernia undergoing repair between June 2012 and June 2015, using the ProGrip™-mesh in retromuscular position, were included. All patients visited the outpatient clinic to evaluate short term complications and recurrence. After at least one year, telephone interviews were conducted to evaluate long term results. RESULTS A total of 46 patients (median age 59 years) were included. 40 patients (87%) were diagnosed with incisional hernia. Seven patients (18%) had incisional hernia combined with another hernia. Four patients (8.7%) had an umbilical hernia, one patient (2.2%) had an epigastric hernia and one patient (2.2%) had rectus diastasis. 39 patients completed follow-up. Median follow-up was 25 months (IQR: 19-35 months). 28 patients (72%) did not report any complaints. Nine patients reported pain (average VAS of 1.7). Two patients developed a recurrence requiring reoperation. One patient developed mesh infection requiring reoperation. CONCLUSION Long term results of the use of a self-gripping mesh for complex abdominal wall hernias show a low recurrence rate, even in complex hernia cases. This makes the mesh a good choice in this difficult patient group.
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Affiliation(s)
- Leonard F Kroese
- Erasmus University Medical Center Rotterdam, Department of Surgery, The Netherlands.
| | | | - Joost Verhelst
- Erasmus University Medical Center Rotterdam, Department of Surgery, The Netherlands
| | - Johannes Jeekel
- Erasmus University Medical Center Rotterdam, Department of Neuroscience, The Netherlands
| | - Gert-Jan Kleinrensink
- Erasmus University Medical Center Rotterdam, Department of Neuroscience, The Netherlands
| | - Johan F Lange
- Erasmus University Medical Center Rotterdam, Department of Surgery, The Netherlands; Havenziekenhuis Rotterdam, Department of Surgery, The Netherlands
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Moores N, Rosenblatt S, Prabhu A, Rosen M. Do Iodine-Impregnated Adhesive Surgical Drapes Reduce Surgical Site Infections during Open Ventral Hernia Repair? A Comparative Analysis. Am Surg 2017. [DOI: 10.1177/000313481708300627] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study evaluated the role of iodine-impregnated adhesive drapes to reduce surgical site infections and occurrences in open ventral hernia repairs. All patients undergoing open ventral hernia repair of clean wounds with a retromuscular repair using synthetic mesh by a single surgeon were prospectively evaluated from the American Hernia Society Quality Collaborative. Patients were divided into those that had an Ioban drape and those that did not. The primary endpoints of this study were postoperative surgical site occurrence and infections. One hundred and four patients met inclusion criteria and were analyzed. There were 56 patients that received a 3M™ Ioban™ drape and 48 patients did not. The two groups were similar based on baseline demographics, risk factors, and operative details. There were four (7%) surgical site occurrences in the Ioban group (one wound cellulitis, one superficial surgical site infection, one allergic reaction to the Ioban, and one sterile seroma). There was one (2%) surgical site occurrence in the non-Ioban group (one superficial wound dehiscence). For patients undergoing clean ventral hernia repair with synthetic mesh placed in the retrorectus plane, the use of an iodine-impregnated drape does not result in a reduction in surgical site occurrences or superficial surgical site infections.
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Affiliation(s)
- Neal Moores
- Cleveland Clinic Comprehensive Hernia Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Steven Rosenblatt
- Cleveland Clinic Comprehensive Hernia Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ajita Prabhu
- University Hospitals of Cleveland, Cleveland, Ohio
| | - Michael Rosen
- Cleveland Clinic Comprehensive Hernia Center, Cleveland Clinic Foundation, Cleveland, Ohio
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