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Warren JA, Lucas C, Beffa LR, Petro CC, Prabhu AS, Krpata DM, Rosen MJ, Orenstein SB, Nikolian VC, Pauli EM, Horne CM, LaBelle M, Phillips S, Poulose BK, Carbonell AM. Reducing the incidence of surgical site infection after ventral hernia repair: Outcomes from the RINSE randomized control trial. Am J Surg 2024; 232:68-74. [PMID: 38199871 DOI: 10.1016/j.amjsurg.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/20/2023] [Accepted: 01/04/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND The clinical and financial impact of surgical site infection after ventral hernia repair is significant. Here we investigate the impact of dual antibiotic irrigation on SSI after VHR. METHODS This was a multicenter, prospective randomized control trial of open retromuscular VHR with mesh. Patients were randomized to gentamicin + clindamycin (G + C) (n = 125) vs saline (n = 125) irrigation at time of mesh placement. Primary outcome was 30-day SSI. RESULTS No significant difference was seen in SSI between control and antibiotic irrigation (9.91 vs 9.09 %; p = 0.836). No differences were seen in secondary outcomes: SSO (11.71 vs 13.64 %; p = 0.667); 90-day SSO (11.1 vs 13.9 %; p = 0.603); 90-day SSI (6.9 vs 3.8 %; p = 0.389); SSIPI (7.21 vs 7.27 %, p = 0.985); SSOPI (3.6 vs 3.64 %; p = 0.990); 30-day readmission (9.91 vs 6.36 %; p = 0.335); reoperation (5.41 vs 0.91 %; p = 0.056). CONCLUSION Dual antibiotic irrigation with G + C did not reduce the risk of surgical site infection during open retromuscular ventral hernia repair.
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Affiliation(s)
- Jeremy A Warren
- University of South Carolina School of Medicine Greenville and Prisma Health Upstate Department of Surgery, Greenville, SC, USA.
| | - Claiborne Lucas
- Prisma Health Upstate Department of Surgery, Greenville, SC, USA
| | | | | | | | | | | | | | | | - Eric M Pauli
- Penn State Health Milton S Hershey Medical Center Department of Surgery, Hershey, PA, USA
| | - Charlotte M Horne
- Penn State Health Milton S Hershey Medical Center Department of Surgery, Hershey, PA, USA
| | - Molly LaBelle
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | | | - Benjamin K Poulose
- The Ohio State University Wexner Department of Surgery and Center for Abdominal Core Health, Columbus, OH, USA
| | - Alfredo M Carbonell
- University of South Carolina School of Medicine Greenville and Prisma Health Upstate Department of Surgery, Greenville, SC, USA
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2
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Woo KP, Ellis RC, Maskal SM, Remulla D, Shukla P, Rosen AJ, Wetzka I, Osei-Koomson W, Phillips S, Miller BT, Beffa LR, Petro CC, Krpata DM, Prabhu AS, Menzo EL, Rosen MJ. The association of permanent versus absorbable fixation on developing chronic post-herniorrhaphy groin pain in patients undergoing laparoscopic inguinal hernia repair. Surg Endosc 2024:10.1007/s00464-024-10866-z. [PMID: 38710888 DOI: 10.1007/s00464-024-10866-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/14/2024] [Indexed: 05/08/2024]
Abstract
INTRODUCTION Fixation of mesh during minimally invasive inguinal hernia repair is thought to contribute to chronic post-herniorrhaphy groin pain (CGP). In contrast to permanent tacks, absorbable tacks are hypothesized to minimize the likelihood of CGP. This study aimed to compare the rates of CGP after laparoscopic inguinal hernia repair between absorbable versus permanent fixation at maximum follow-up. METHODS This is a post hoc analysis of a randomized controlled trial in patients undergoing laparoscopic inguinal hernia repair (NCT03835351). All patients were contacted at maximum follow-up after surgery to administer EuraHS quality of life (QoL) surveys. The pain and restriction of activity subdomains of the survey were utilized. The primary outcome was rate of CGP, as defined by a EuraHS QoL pain domain score ≥ 4 measured at ≥ 1 year postoperatively. The secondary outcomes were pain and restriction of activity domain scores and hernia recurrence at maximum follow-up. RESULTS A total of 338 patients were contacted at a mean follow-up of 28 ± 11 months. 181 patients received permanent tacks and 157 patients received absorbable tacks during their repair. At maximum follow-up, the rates of CGP (27 [15%] vs 28 [18%], P = 0.47), average pain scores (1.78 ± 4.38 vs 2.32 ± 5.40, P = 0.22), restriction of activity scores (1.39 ± 4.32 vs 2.48 ± 7.45, P = 0.18), and the number of patients who reported an inguinal bulge (18 [9.9%] vs 15 [9.5%], P = 0.9) were similar between patients with permanent versus absorbable tacks. On multivariable analysis, there was no significant difference in the odds of CGP between the two groups (OR 1.23, 95% CI [0.60, 2.50]). CONCLUSION Mesh fixation with permanent tacks does not appear to increase the risk of CGP after laparoscopic inguinal hernia repair when compared to fixation with absorbable tacks. Prospective trials are needed to further evaluate this relationship.
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Affiliation(s)
- Kimberly P Woo
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
| | - Ryan C Ellis
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Sara M Maskal
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Daphne Remulla
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Priya Shukla
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Alexandra J Rosen
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Isabella Wetzka
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Wilhemina Osei-Koomson
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Sharon Phillips
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Benjamin T Miller
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Lucas R Beffa
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Clayton C Petro
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - David M Krpata
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Ajita S Prabhu
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Emanuele Lo Menzo
- Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston Hospital, Weston, FL, USA
| | - Michael J Rosen
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
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3
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Wehrle CJ, Prabhu AS, Thompson R, Petro CC, Miller BT, Krpata DM, Rosen MJ, Huang LC, Beffa LR. Mesh versus suture repair of incisional hernias 2 cm or less: Is mesh necessary? A propensity score-matched analysis of the abdominal core health quality collaborative. Surgery 2024; 175:799-805. [PMID: 37716868 DOI: 10.1016/j.surg.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/13/2023] [Accepted: 08/08/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Mesh has been the acceptable standard for incisional hernia repair regardless of hernia size. It is not clear whether there is a size of incisional hernias in whom repair would be best performed without mesh. This study aims to compare outcomes of mesh versus suture repairs for incisional hernias <2 cm in size. METHODS Incisional hernia repairs from 2012 to 2021 for hernias ≤2 cm in width were queried from the Abdominal Core Health Quality Collaborative. Those with 1-year follow up were considered. Hernia recurrence was defined using composite hernia recurrence, which combines both clinical and patient reported outcomes. Propensity score matching was performed between mesh and non-mesh using body mass index, smoking, diabetes, and drains as covariates. RESULTS A total of 352 patients met inclusion criteria. After propensity score matching, there were 132 repairs with mesh and 71 without. There was no difference in recurrence rates at 1 year between mesh and non-mesh repairs (15% vs 24%, P = .12). Mesh was associated with a higher rate of 30-day postoperative complications (11% vs 1%, P = .017). There were no differences in 1-year quality of life scores. CONCLUSION The repair of incisional hernias ≤2 cm without mesh results in similar recurrence rates, similar quality of life scores, and lower postoperative early complications compared with repairs with mesh. Our findings suggest that there may be select patients with small incisional hernias that could reasonably undergo incisional hernia repair without mesh. Longer-term follow-up is needed to confirm ideal candidates and durability of these repairs.
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Affiliation(s)
- Chase J Wehrle
- Cleveland Clinic Foundation Center for Abdominal Core Health, Cleveland, OH.
| | - Ajita S Prabhu
- Cleveland Clinic Foundation Center for Abdominal Core Health, Cleveland, OH
| | - Reid Thompson
- Cleveland Clinic Foundation Center for Abdominal Core Health, Cleveland, OH
| | - Clayton C Petro
- Cleveland Clinic Foundation Center for Abdominal Core Health, Cleveland, OH
| | - Benjamin T Miller
- Cleveland Clinic Foundation Center for Abdominal Core Health, Cleveland, OH
| | - David M Krpata
- Cleveland Clinic Foundation Center for Abdominal Core Health, Cleveland, OH
| | - Michael J Rosen
- Cleveland Clinic Foundation Center for Abdominal Core Health, Cleveland, OH
| | - Li-Ching Huang
- Vanderbilt University Medical Center, Department of Biostatistics, Nashville, TN
| | - Lucas R Beffa
- Cleveland Clinic Foundation Center for Abdominal Core Health, Cleveland, OH. https://twitter.com/BeffaLukeMD
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Petro CC, Maskal SM, Renton DB, Yunis JP, Meara MP, Diaz K, Wilber M, McKenzie K, Tu C, Phillips SE, Miller BT, Beffa LR, Rosen MJ, Prabhu AS. Robotic Enhanced-View Totally Extraperitoneal vs Intraperitoneal Onlay Mesh Evaluation: 1-Year Exploratory Outcomes of the REVEAL Randomized Clinical Trial. J Am Coll Surg 2023; 237:614-620. [PMID: 37310015 DOI: 10.1097/xcs.0000000000000784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Patients with small- to medium-sized ventral hernias randomized to robotic enhanced-view totally extraperitoneal (eTEP) or robotic intraperitoneal onlay mesh (rIPOM) previously demonstrated comparable 30-day patient-reported outcomes. Here we report 1-year exploratory outcomes for this multi-center, patient-blinded randomized clinical trial. STUDY DESIGN Patients with midline ventral hernias 7 cm wide or less undergoing mesh repair were randomized to robotic eTEP or rIPOM. Planned exploratory outcomes at 1 year include pain intensity (using the Patient-Reported Outcomes Measurement Information System [PROMIS 3a]), Hernia-Related Quality of Life Survey (HerQLes) scores, pragmatic hernia recurrence, and reoperation. RESULTS One hundred randomized patients (51 eTEP, 49 rIPOM) reached a median 12-month follow-up (interquartile range 11 to 13) with 7% lost. After regression analysis adjusting for baseline scores, there was no difference in postoperative pain intensity at 1-year for eTEP compared with rIPOM (odds ratio [OR] 2.1 [95% CI 0.85 to 5.1]; p = 0.11). HerQLes scores were 15 points lower on average (ie less improved) at 1 year after eTEP repairs compared with rIPOM, a difference maintained after regression analysis (OR 0.31 [95% CI 0.15 to 0.67]; p = 0.003). Pragmatic hernia recurrence was 12.2% (6 of 49) for eTEP and 15.9% (7 of 44) for rIPOM (p = 0.834). In the first year, 2 eTEP and 1 rIPOM patients required reoperations related to their index repair (p = 0.82). CONCLUSIONS Exploratory analyses showed similar outcomes at 1 year in regard to pain, hernia recurrence, and reoperation. Abdominal wall quality of life at 1 year appears to favor rIPOM, and the possibility that an eTEP dissection is less advantageous in that regard should be the subject of future investigation.
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Affiliation(s)
- Clayton C Petro
- From the Department of Surgery, Center for Abdominal Core Health (Petro, Maskal, Miller, Beffa, Rosen, Prabhu), Cleveland Clinic Foundation, Cleveland, OH
| | - Sara M Maskal
- From the Department of Surgery, Center for Abdominal Core Health (Petro, Maskal, Miller, Beffa, Rosen, Prabhu), Cleveland Clinic Foundation, Cleveland, OH
| | - David B Renton
- Department of Surgery, Center for Abdominal Core Health, The Ohio State University Wexner Medical Center, Columbus, OH (Renton, Meara, Diaz)
| | - Jonathan P Yunis
- Center for Hernia Repair, Sarasota Memorial Hospital, Sarasota, FL (Yunis, Wilber, McKenzie)
| | - Michael P Meara
- Department of Surgery, Center for Abdominal Core Health, The Ohio State University Wexner Medical Center, Columbus, OH (Renton, Meara, Diaz)
| | - Kayla Diaz
- Department of Surgery, Center for Abdominal Core Health, The Ohio State University Wexner Medical Center, Columbus, OH (Renton, Meara, Diaz)
| | - Melanie Wilber
- Center for Hernia Repair, Sarasota Memorial Hospital, Sarasota, FL (Yunis, Wilber, McKenzie)
| | - Kristen McKenzie
- Center for Hernia Repair, Sarasota Memorial Hospital, Sarasota, FL (Yunis, Wilber, McKenzie)
| | - Chao Tu
- Department of Statistics (Tu), Cleveland Clinic Foundation, Cleveland, OH
| | - Sharon E Phillips
- the Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN (Phillips)
| | - Benjamin T Miller
- From the Department of Surgery, Center for Abdominal Core Health (Petro, Maskal, Miller, Beffa, Rosen, Prabhu), Cleveland Clinic Foundation, Cleveland, OH
| | - Lucas R Beffa
- From the Department of Surgery, Center for Abdominal Core Health (Petro, Maskal, Miller, Beffa, Rosen, Prabhu), Cleveland Clinic Foundation, Cleveland, OH
| | - Michael J Rosen
- From the Department of Surgery, Center for Abdominal Core Health (Petro, Maskal, Miller, Beffa, Rosen, Prabhu), Cleveland Clinic Foundation, Cleveland, OH
| | - Ajita S Prabhu
- From the Department of Surgery, Center for Abdominal Core Health (Petro, Maskal, Miller, Beffa, Rosen, Prabhu), Cleveland Clinic Foundation, Cleveland, OH
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5
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Blake KE, Zolin SJ, Tu C, Baier KF, Beffa LR, Alaedeen D, Krpata DM, Prabhu AS, Rosen MJ, Petro CC. Comparing anterior gastropexy to no anterior gastropexy for paraesophageal hernia repair: a study protocol for a randomized control trial. Trials 2022; 23:616. [PMID: 35907909 PMCID: PMC9338471 DOI: 10.1186/s13063-022-06571-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 07/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND More than half of patients undergoing paraesophageal hernia repair (PEHR) will have radiographic hernia recurrence at 5 years after surgery. Gastropexy is a relatively low-risk intervention that may decrease recurrence rates, but it has not been studied in a prospective manner. Our study aims to evaluate the effect of anterior gastropexy on recurrence rates after PEHR, compared to no anterior gastropexy. METHODS This is a two-armed, single-blinded, registry-based, randomized controlled trial comparing anterior gastropexy to no anterior gastropexy in PEHR. Adult patients (≥18 years) with a symptomatic paraesophageal hernia measuring at least 5 cm in height on computed tomography, upper gastrointestinal series, or endoscopy undergoing elective minimally invasive repair are eligible for recruitment. Patients will be blinded to their arm of the trial. All patients will undergo laparoscopic or robotic PEHR, where some operative techniques (crural closure techniques and fundoplication use or avoidance) are left to the discretion of the operating surgeon. During the operation, after closure of the diaphragmatic crura, participants are randomized to receive either no anterior gastropexy (control arm) or anterior gastropexy (treatment arm). Two hundred forty participants will be recruited and followed for 1 year after surgery. The primary outcome is radiographic PEH recurrence at 1 year. Secondary outcomes are symptoms of gastroesophageal reflux disease, dysphagia, odynophagia, gas bloat, regurgitation, chest pain, abdominal pain, nausea, vomiting, postprandial pain, cardiovascular, and pulmonary symptoms as well as patient satisfaction in the immediate postoperative period and at 1-year follow-up. Outcome assessors will be blinded to the patients' intervention. DISCUSSION This randomized controlled trial will examine the effect of anterior gastropexy on radiographic PEH recurrence and patient-reported outcomes. Anterior gastropexy has a theoretical benefit of decreasing PEH recurrence; however, this has not been proven beyond a suggestion of effectiveness in retrospective series. If anterior gastropexy reduces recurrence rates, it would likely become a routine component of surgical PEH management. If it does not reduce PEH recurrence, it will likely be abandoned. TRIAL REGISTRATION ClinicalTrials.gov NCT04007952 . Registered on July 5, 2019.
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Affiliation(s)
- K E Blake
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A10-133, Cleveland, OH, 44195, USA.
| | - S J Zolin
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A10-133, Cleveland, OH, 44195, USA
| | - C Tu
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - K F Baier
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A10-133, Cleveland, OH, 44195, USA
| | - L R Beffa
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A10-133, Cleveland, OH, 44195, USA
| | - D Alaedeen
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A10-133, Cleveland, OH, 44195, USA
| | - D M Krpata
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A10-133, Cleveland, OH, 44195, USA
| | - A S Prabhu
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A10-133, Cleveland, OH, 44195, USA
| | - M J Rosen
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A10-133, Cleveland, OH, 44195, USA
| | - C C Petro
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A10-133, Cleveland, OH, 44195, USA
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6
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Warren JA, Love M, Cobb WS, Beffa LR, Couto FJ, Hancock B, Morrow D, Ewing JA, Carbonell AM. Factors affecting salvage rate of infected prosthetic mesh. Am J Surg 2020; 220:751-756. [DOI: 10.1016/j.amjsurg.2020.01.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 01/16/2020] [Accepted: 01/18/2020] [Indexed: 02/06/2023]
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Abstract
Flank and lumbar hernias are challenging because of their rarity and anatomic location. Several challenges exist when approaching these specific abdominal wall defects, including location, innervation of the lateral abdominal wall musculature, and their proximity to bony landmarks. These hernias are confined by the costal margin, spine, and pelvic brim, which makes closure of the defect, including mesh placement, difficult. This article discusses the anatomy of lumbar and flank hernias, the various etiologies for these hernias, and the procedural steps for open and robotic preperitoneal approaches. The available clinical evidence regarding outcomes for various repair techniques is also reviewed.
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Affiliation(s)
- Lucas R Beffa
- Division of Minimal Access and Bariatric Surgery, Greenville Health System, University of South Carolina School of Medicine - Greenville, Greenville, SC, USA
| | - Alyssa L Margiotta
- Division of Minimal Access and Bariatric Surgery, Greenville Health System, University of South Carolina School of Medicine - Greenville, Greenville, SC, USA
| | - Alfredo M Carbonell
- Division of Minimal Access and Bariatric Surgery, Greenville Health System, University of South Carolina School of Medicine - Greenville, Greenville, SC, USA.
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8
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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: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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9
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Warren JA, Beffa LR, Couto FJ, Hancock BH, Morrow D, Ewing J, Cobb WS, Carbonell AM. Factors Affecting Salvage Rate of Infected Prosthetic Mesh. J Am Coll Surg 2017. [DOI: 10.1016/j.jamcollsurg.2017.07.577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Erwin PA, Beffa LR, Jones WB, Hale AL, Scott JD. Metallic Surgical Clip Causing Cholangitis after Cholecystectomy. Am Surg 2017; 83:e403-e405. [PMID: 30454369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Philip A Erwin
- Department of Surgery, Greenville Health System, Greenville, South Carolina, USA
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11
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Erwin PA, Beffa LR, Jones WB, Hale AL, Scott JD. Metallic Surgical Clip Causing Cholangitis after Cholecystectomy. Am Surg 2017. [DOI: 10.1177/000313481708300924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Philip A. Erwin
- Department of Surgery Greenville Health System Greenville, South Carolina
| | - Lucas R. Beffa
- Department of Surgery Greenville Health System Greenville, South Carolina
| | - Wesley B. Jones
- Department of Surgery Greenville Health System Greenville, South Carolina
| | - Allyson L. Hale
- Department of Surgery Greenville Health System Greenville, South Carolina
| | - John D. Scott
- Department of Surgery Greenville Health System Greenville, South Carolina
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12
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Beffa LR, Warren JA, Cobb WS, Knoedler B, Ewing JA, Carbonell AM. Open Retromuscular Repair of Parastomal Hernias with Synthetic Mesh. Am Surg 2017; 83:906-910. [PMID: 28822400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Parastomal hernias (PHs) cause significant morbidity in patients with permanent ostomies, and several laparoscopic and open repair techniques have been described. We report our experience with open retromuscular repair of PHs using permanent synthetic mesh. A prospectively maintained database was retrospectively reviewed to identify patients undergoing PH repair. Primary outcomes are surgical site occurrence, surgical site infection (SSI), and hernia recurrence. Variables were analyzed using Pearson's χ2 test or Fisher's exact test. Values of P < 0.05 were considered significant. Forty-six patients underwent retromuscular PH repair with permanent synthetic mesh. There were 26 patients with colostomies and 20 with ileostomies. All the patients were repaired using a keyhole retromuscular technique and direct passage of stoma through mesh. Transversus abdominis release was performed in 65.2 per cent of cases. Permanent synthetic polypropylene mesh was used in all cases. Surgical site occurrence occurred in 47.8 per cent of patients, SSI in 17.4 per cent, and hernia recurrence in 21.7 per cent. Resiting the stoma yielded the highest rate of SSI (40%) compared with leaving the stoma in situ (11.8%) or rematuring the stoma (0%; P = 0.011). Open keyhole retromuscular PH repair of PH with permanent synthetic mesh is safe, effective, and durable.
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Abstract
Parastomal hernias (PHs) cause significant morbidity in patients with permanent ostomies, and several laparoscopic and open repair techniques have been described. We report our experience with open retromuscular repair of PHs using permanent synthetic mesh. A prospectively maintained database was retrospectively reviewed to identify patients undergoing PH repair. Primary outcomes are surgical site occurrence, surgical site infection (SSI), and hernia recurrence. Variables were analyzed using Pearson's χ2 test or Fisher's exact test. Values of P < 0.05 were considered significant. Forty-six patients underwent retromuscular PH repair with permanent synthetic mesh. There were 26 patients with colostomies and 20 with ileostomies. All the patients were repaired using a keyhole retromuscular technique and direct passage of stoma through mesh. Transversus abdominis release was performed in 65.2 per cent of cases. Permanent synthetic polypropylene mesh was used in all cases. Surgical site occurrence occurred in 47.8 per cent of patients, SSI in 17.4 per cent, and hernia recurrence in 21.7 per cent. Resiting the stoma yielded the highest rate of SSI (40%) compared with leaving the stoma in situ (11.8%) or rematuring the stoma (0%; P = 0.011). Open keyhole retromuscular PH repair of PH with permanent synthetic mesh is safe, effective, and durable.
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Affiliation(s)
- Lucas R. Beffa
- Greenville Health System, Division of Minimal Access Surgery, Greenville, South Carolina
| | - Jeremy A. Warren
- Greenville Health System, Division of Minimal Access Surgery, Greenville, South Carolina
| | - William S. Cobb
- Greenville Health System, Division of Minimal Access Surgery, Greenville, South Carolina
| | - Bryan Knoedler
- University of South Carolina School of Medicine, Greenville, South Carolina
| | - Joseph A. Ewing
- Greenville Health System, Division of Minimal Access Surgery, Greenville, South Carolina
| | - Alfredo M. Carbonell
- Greenville Health System, Division of Minimal Access Surgery, Greenville, South Carolina
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14
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Beffa LR, Petroski GF, Kruse RL, Vogel TR. Functional status of nursing home residents before and after abdominal aortic aneurysm repair. J Vasc Nurs 2017; 33:106-11. [PMID: 26298614 DOI: 10.1016/j.jvn.2015.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 02/06/2015] [Accepted: 02/06/2015] [Indexed: 11/16/2022]
Abstract
Although many trials have evaluated abdominal aortic aneurysm (AAA) repair, the impact of these procedures on the functional status of frail elderly patients is not well-described. The effects of elective open AAA repair (OAR) and endovascular AAA repair (EVAR) and comorbidities were evaluated for their impact on functional trajectories after discharge. Medicare inpatient claims were linked with nursing home assessment data to identify elective admissions for OAR and EVAR. A functional score (range, 0-28; higher scores indicate greater impairment) was calculated before and after interventions. Logistic regression was used to develop a propensity score for receiving EVAR because residents were not randomized. Hierarchical linear modeling determined the effect of surgery on residents' function, controlling for prehospital function, hospital length of stay (LOS), stroke, and the propensity score.Fifty-two residents underwent OAR and 161 underwent EVAR. Most (65.3%) were men and 62.0% were from 76 to 85 years old. Mean LOS was 8.3 days for OAR and 5.1 days for EVAR. Of the residents, 47.4% had good prehospital function (activities of daily living [ADL] score of 0-10), and 48.4% were moderately impaired (ADL score of 11-20). Higher baseline ADL score, increased LOS, and stroke were associated with worse trajectories. Procedure type was not significantly related to postoperative function or the subsequent rate of improvement. OAR and EVAR were associated with similar initial declines and comparable postoperative trajectories, suggesting that less invasive EVAR was not associated with improved functional preservation compared with OAR. LOS was found to be higher than expected in the frail elderly after EVAR; longer stays were associated with poorer functional trajectories. Higher baseline ADL scores were significantly associated with inferior functional status after both procedures. Evaluation of preoperative function may assist physicians in predicting outcomes in this high-risk population.
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Affiliation(s)
- Lucas R Beffa
- Division of Vascular Surgery, University of Missouri, School of Medicine, Columbia, Missouri, USA
| | - Gregory F Petroski
- Department of Health Management and Informatics, University of Missouri, School of Medicine, Columbia, Missouri, USA
| | - Robin L Kruse
- Department of Family and Community Medicine, University of Missouri, School of Medicine, Columbia, Missouri, USA
| | - Todd R Vogel
- Division of Vascular Surgery, University of Missouri, School of Medicine, Columbia, Missouri, USA.
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15
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Berg Z, Beffa LR, Cook DP, Cornelison DDW. Muscle satellite cells from GRMD dystrophic dogs are not phenotypically distinguishable from wild type satellite cells in ex vivo culture. Neuromuscul Disord 2011; 21:282-90. [PMID: 21277207 DOI: 10.1016/j.nmd.2010.12.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Revised: 12/20/2010] [Accepted: 12/21/2010] [Indexed: 12/26/2022]
Abstract
Duchenne muscular dystrophy is a neuromuscular degenerative disorder caused by the absence of dystrophin protein. It is characterized by progressive muscle weakness and cycles of degeneration/regeneration accompanying chronic muscle damage and repair. Canine models of muscular dystrophy, including the dystrophin-deficient golden retriever muscular dystrophy (GRMD), are the most promising animal models for evaluation of potential therapies, however canine-specific molecular tools are limited. In particular, few immune reagents for extracellular epitopes marking canine satellite cells (muscle stem cells) are available. We generated an antibody to the satellite cell marker syndecan-4 that identifies canine satellite cells. We then characterized isolated satellite cells from GRMD muscle and wildtype muscle by several in vitro metrics, and surprisingly found no significant differences between the two populations. We discuss whether accumulated adverse changes in the muscle environment rather than cell-intrinsic defects may be implicated in the eventual failure of satellite cell efficacy in vivo.
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Affiliation(s)
- Zachary Berg
- Division of Biological Sciences and Christopher S. Bond Life Sciences Center, University of Missouri, Columbia, MO 65211, USA
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