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Baig SJ, Kulkarni GV, Priya P, Afaque MY, Bueno-Lledo J, Chintapatla S, de Beaux A, Gandhi JA, Urena MAG, Hammond TM, Lomanto D, Liu R, Mehta A, Miserez M, Montgomery A, Morales-Conde S, Palanivelu C, Pauli EM, Rege SA, Renard Y, Rosen M, Sanders DL, Singhal VK, Slade DAJ, Warren OJ, Wijerathne S. Delphi consensus statement for understanding and managing the subcostal hernia: subcostal hernias collaborative report (scholar study). Hernia 2024:10.1007/s10029-024-02963-8. [PMID: 38366238 DOI: 10.1007/s10029-024-02963-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/05/2024] [Indexed: 02/18/2024]
Abstract
INTRODUCTION Subcostal hernias are categorized as L1 based on the European Hernia Society (EHS) classification and frequently involve M1, M2, and L2 sites. These are common after hepatopancreatic and biliary surgeries. The literature on subcostal hernias mostly comprises of retrospective reviews of small heterogenous cohorts, unsurprisingly leading to no consensus or guidelines. Given the limited literature and lack of consensus or guidelines for dealing with these hernias, we planned for a Delphi consensus to aid in decision making to repair subcostal hernias. METHODS We adopted a modified Delphi technique to establish consensus regarding the definition, characteristics, and surgical aspects of managing subcostal hernias (SCH). It was a four-phase Delphi study reflecting the widely accepted model, consisting of: 1. Creating a query. 2. Building an expert panel. 3. Executing the Delphi rounds. 4. Analysing, presenting, and reporting the Delphi results. More than 70% of agreement was defined as a consensus statement. RESULTS The 22 experts who agreed to participate in this Delphi process for Subcostal Hernias (SCH) comprised 7 UK surgeons, 6 mainland European surgeons, 4 Indians, 3 from the USA, and 2 from Southeast Asia. This Delphi study on subcostal hernias achieved consensus on the following areas-use of mesh in elective cases; the retromuscular position with strong discouragement for onlay mesh; use of macroporous medium-weight polypropylene mesh; use of the subcostal incision over midline incision if there is no previous midline incision; TAR over ACST; defect closure where MAS is used; transverse suturing over vertical suturing for closure of circular defects; and use of peritoneal flap when necessary. CONCLUSION This Delphi consensus defines subcostal hernias and gives insight into the consensus for incision, dissection plane, mesh placement, mesh type, and mesh fixation for these hernias.
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Affiliation(s)
- S J Baig
- Department of Minimal Access Surgery, Belle Vue Clinic, Digestive Surgery Clinic, Bellevue Hospital Kolkata, Kolkata, 700017, India.
| | - G V Kulkarni
- Department of Colorectal Surgery, Broomfield Hospital (Mid and South Essex NHS Trust), Essex, UK
| | - P Priya
- Department of Minimal Access Surgery, Belle Vue Clinic, Digestive Surgery Clinic, Bellevue Hospital Kolkata, Kolkata, 700017, India
| | - M Y Afaque
- Department of Surgery, J N Medical College, AMU, Aligarh, Uttar Pradesh, 202002, India
| | - J Bueno-Lledo
- Hospital Universitari I Politecnic La Fe, Universidad de Valencia, Valencia, Spain
| | - S Chintapatla
- Department of General Surgery, York Abdominal Wall Unit (YAWU), York & Scarborough Teaching Hospitals NHS Foundation Trust, Wigginton Road, York, UK
| | - A de Beaux
- Spire Murrayfield Hospital, Edinburgh, UK
| | - J A Gandhi
- Department of Surgery, King Edward Memorial Hospital, Parel, Mumbai, 400012, India
| | - M A Garcia Urena
- Department of Surgery, Hospital Universitario del Henares, 28822, Madrid, Spain
| | - T M Hammond
- Department of Colorectal Surgery, Broomfield Hospital (Mid and South Essex NHS Trust), Essex, UK
| | - D Lomanto
- Minimally Invasive Surgical Centre, National University Hospital, Singapore, 119074, Singapore
| | - R Liu
- Med Director Robotic Surgery, Alta Bates Summit Medical Center, Oakland, CA, 94609, USA
| | - A Mehta
- Department of Colorectal Surgery, St. Mark's Hospital, London, UK
| | - M Miserez
- Department of Abdominal Surgery, University Hospital Gasthuisberg, KU Leuven, Louvain, Belgium
| | - A Montgomery
- Department of Surgery, Skåne University Hospital, Malmö, Sweden
| | - S Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital Virgen del Rocio, University of Sevilla, Seville, Spain
| | - C Palanivelu
- GEM Hospital and Research Centre, Coimbatore, India
| | - E M Pauli
- Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Penn State Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA
| | - S A Rege
- Department of Surgery, King Edward Memorial Hospital, Parel, Mumbai, 400012, India
| | - Y Renard
- Reims Champagne-Ardennes, Department of General, Digestive and Endocrine Surgery, Robert Debré University Hospital, Reims, France
| | - M Rosen
- Department of Surgery, Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - D L Sanders
- Department of Abdominal Wall Surgery, Royal Devon University Foundation Trust, North Devon District Hospital, Barnstaple, UK
| | - V K Singhal
- Department of GI Surgery, Medanta Medicity Hospital, Gurugram, Haryana, India
| | - D A J Slade
- Department of Colorectal Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - O J Warren
- Department of Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - S Wijerathne
- Department of General Surgery, Alexandra Hospital, National University Health System), Singapore, Singapore
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Baig SJ, Priya P. Management of ventral hernia in patients with BMI > 30 Kg/m 2: outcomes based on an institutional algorithm. Hernia 2020; 25:689-699. [PMID: 33044608 DOI: 10.1007/s10029-020-02318-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: 06/25/2020] [Accepted: 09/28/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Management of ventral hernia in obese is a complex problem. The methods of weight loss, alternatives if the patient cannot undergo bariatric surgery, timing, and type of hernia surgery lacks clarity and are dependent on resources and expertise. There is a need for algorithms based on local population and expertise. In this paper, we present the outcomes of our institutional algorithm. METHODS It was a retrospective analysis of prospectively collected data. Patients with body mass index (BMI) > 30Kg/m2 were included to undergo surgery as per algorithm taking into account (a) presentation (symptomatic vs asymptomatic), (b) hernia characteristics (defect width, site, reducibility), and (c) obesity characteristics (BMI, subcutaneous fat, android vs gynecoid). Data on age, BMI, comorbidities, tobacco consumption, hernia width, location, contents, previous surgery, intraoperative parameters (the type of surgery, mesh, drain, fixation), and outcomes (seroma, hematoma, infection, recurrence) were collected. RESULTS A total of 50 patients underwent treatment as per the algorithm. Mean BMI was 36.6 ± 7.3 kg/m2. The mean follow-up was 17.6 ± 7.2 months. The mean defect width was 4.8 ± 2.9 cm. There were two (4%) recurrences in patients who underwent an anatomical repair under emergency conditions. None of the patients who underwent an elective repair had a recurrence. Total surgical site occurrence was 12% and surgical site occurrence requiring procedural intervention was 8%. There was one (2%) mortality on postoperative day 7 due to myocardial infarction. CONCLUSION The algorithm has shown encouraging results in the short-to-medium term. Long-term evaluation with a higher number of patients is needed to confirm its usefulness.
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Affiliation(s)
- S J Baig
- Belle Vue Clinic, 9 and 10, Loudon street, Kolkata, India
| | - P Priya
- Belle Vue Clinic, 9 and 10, Loudon street, Kolkata, India.
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Baig SJ, Biswas S, Das S, Basu K, Chattopadhyay G. Histopathological changes in gallbladder mucosa in cholelithiasis: correlation with chemical composition of gallstones. Trop Gastroenterol 2002; 23:25-7. [PMID: 12170916] [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] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND Cholelithiasis produces diverse histopathological changes in gallbladder mucosa namely acute inflammation, chronic inflammation, glandular hyperplasia, granulomatous inflammation, cholesterosis, dysplasia, and carcinoma. Gallstones have different chemical composition. They may be cholesterol, pigment or mixed stones. The aim of this prospective study was to see if any correlation existed between the chemistry of gallstones and any particular histopathologic picture. METHODS Between May 1997 and December 1997 we diagnosed and operated on 40 patients with cholelithiasis. Diagnosis was established by ultrasound. After operation gallstones were sent for chemical analysis to detect presence of calcium bilirubinate and cholesterol. Serial sections of gallbladder from fundus to neck were stained by haematoxylin and eosin, and studied. RESULTS Out of 40 patients (n = 40) 29 were females and 11 were males. The mean age of our patients was 38 +/- 21 years with a median of 40 years. Median age of males was 48 years compared to 38 years for females. Twenty-eight patients had mixed stones, 8 had pigment stones and 4 had cholesterol stones. Out of 28 patients with mixed stones 14 had histological picture of chronic cholecystitis, 8 had granulomatous cholecystitis, 4 had adenomatous hyperplasia, 1 had dysplasia and 1 had carcinoma. All 8 patients having pigment gallstones had chronic cholecystitis. Out of 4 patients with cholesterol gallstones, 2 had chronic cholecystitis, 1 had adenomatous hyperplasia and 1 had cholesterosis. Gallbladder having pigment stones were devoid of Rokitansky-Aschoff sinuses. CONCLUSION Adenomatous hyperplasia and Rokitansky-Aschoff sinuses were not seen in gallbladder containing pigment stones but seen in gallbladders containing mixed and cholesterol stones in our study. Cholesterol may be a more potent stimulus for glandular hyperplasia or glandular hyperplasia may responsible for formation of cholesterol rich stones.
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Affiliation(s)
- S J Baig
- Medical College Hospital, Calcutta 700 073, India
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