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Pizza F, D'Antonio D, Lucido FS, Brusciano L, Mongardini FM, Dell'Isola C, Brillantino A, Docimo L, Gambardella C. IPOM plus versus IPOM standard in incisional hernia repair: results of a prospective multicenter trial. Hernia 2023; 27:695-704. [PMID: 37149818 DOI: 10.1007/s10029-023-02802-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/25/2023] [Indexed: 05/08/2023]
Abstract
PURPOSE Laparoscopic ventral hernia repair is a well-established technique with satisfying outcomes even at long term for the treatment of incisional and ventral hernia. However, the literature debate is still ongoing regarding the preferred surgical technique. Nowadays, two approaches are commonly adopted: the intraperitoneal onlay mesh repair (sIPOM) and the intraperitoneal onlay mesh reinforcement with defect closure before mesh placement (pIPOM). The aim of this prospective analysis is to compare the postoperative outcomes of patients treated for incisional hernia (IH) with sIPOM and pIPOM after 36 months follow-up in terms of recurrence, quality of life and wound events. METHODS Patients receiving pIPOM and sIPOM for IH were actively followed up for 36 months. At the outpatient clinic, hernia recurrence (HR), mesh bulging (MB), quality of life with the Gastrointestinal Quality of Life Index (GIQLI) and wound events were assessed. RESULTS Between January 2015 and January 2019, 98 patients underwent a pIPOM and 89 underwent an sIPOM. At 36 months, nine patients (4 in pIPOM and 5 in sIPOM) experienced an HR, while MB was recorded in four patients in pIPOM and nine in sIPOM. No statistically significant difference could be identified also in terms of final GIQLI score and wound events. CONCLUSIONS LVHR with or without fascial closure, also in our study, provides satisfactory results in terms of safety and efficacy. The discordant results in the literature are probably related to independent variables such as the type of mesh, the type of suture and closure technique. Therefore, was the funeral of sIPOM done too early? STUDY DATASET IS AVAILABLE ON CLINICALTRIALS. GOV ID NCT05712213.
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Affiliation(s)
- F Pizza
- Department of Surgery, Hospital "A. Rizzoli", LaccoAmeno Aslnapoli2nord, Naples, Italy.
| | - D D'Antonio
- Department of Surgery, Hospital "A. Rizzoli", LaccoAmeno Aslnapoli2nord, Naples, Italy
| | - F S Lucido
- Division of General, Mininvasive and Bariatric Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - L Brusciano
- Division of General, Mininvasive and Bariatric Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - F M Mongardini
- Division of General, Mininvasive and Bariatric Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - C Dell'Isola
- AORN "Dei Colli" Monaldi-Cotugno-CTO Department of Infectious Diseases - Hepatologic Address Naples, Naples, Italy
| | - A Brillantino
- AORN "A. Cardarelli" Division of General Surgery Naples, Naples, Italy
| | - L Docimo
- Division of General, Mininvasive and Bariatric Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - C Gambardella
- Division of General, Mininvasive and Bariatric Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
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Pizza F, D'Antonio D, Lucido FS, Del Rio P, Dell'Isola C, Brusciano L, Tolone S, Docimo L, Gambardella C. Is absorbable mesh useful in preventing parastomal hernia after emergency surgery? The PARTHENOPE study. Hernia 2022; 26:507-516. [PMID: 35195798 DOI: 10.1007/s10029-022-02579-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/05/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Colostomy is a frequent event in oncological or inflammatory bowel diseases. Its related morbidity includes retraction, infection and parastomal hernia (PH), which is a quite common late complication. Several surgical options are available for PH repair, the majority including mesh. However, results are often disappointing with relevant recurrence rates, up to 33%. The study aim was to assess the feasibility and effectiveness of prophylactic biosynthetic mesh (BIO-A®, polyglycolide-trimethylene carbonate copolymer) placed during colostomy fashioning, in reducing PH. A prospective randomized controlled double-blind trial was conducted from January 2014 to December 2019 to compare conventional end-colostomy with end-colostomy reinforced with BIO-A mesh in ante-rectus position in patients undergoing colon diversion in emergency surgery. METHODS Patients were clinically followed up at 3, 6, and 12 months and received a CT scan at 6 and 12 months. The postoperative morbidity and wound events were also evaluated. RESULTS 55 patients receiving conventional colostomy considered as Control Group and 55 patients receiving BIO-A mesh supported colostomy (Mesh Group) were included in the study. At 12 months, the incidence of PH was 9 (12.7%) and 24 (43.6%) in the Mesh Group and Control Group, respectively (p < 0.05). Postoperative morbidity was similar between Mesh Group and Control Group (7 [12.7%] vs 4 [7.3%], respectively; p = 0.340). The multivariable analysis showed that not using a mesh (p = 0.042), age > 70 years (p = 0.041), diabetes (p < 0.001), colon dilation > 7 cm (p < 0.0001) and COPD (p = 0.009) were all related with postoperative PH. CONCLUSIONS The prophylactic BIO-A mesh positioning during colostomy is an effective procedure reducing PH incidence at a 1 years follow-up guaranteeing low postoperative morbidity. STUDY DATASET IS AVAILABLE ON CLINICALTRIALS. GOV ID NCT04436887.
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Affiliation(s)
- F Pizza
- Department of Surgery, Aslnapoli2nord - Hospital "A. Rizzoli", Naples, Italy.
| | - D D'Antonio
- Department of Surgery, Aslnapoli2nord - Hospital "A. Rizzoli", Naples, Italy
| | - F S Lucido
- Division of General, Mininvasive and Bariatric Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - P Del Rio
- Istituto Nazionale dei Tumori IRCS "Fondazione Pascale", Naples, Italy
| | - C Dell'Isola
- AORN "dei Colli" Monaldi-Cotugno-CTO Department of Infectious Diseases-Hepatologic Address, Rome, Italy
| | - L Brusciano
- Division of General, Mininvasive and Bariatric Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - S Tolone
- Division of General, Mininvasive and Bariatric Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - L Docimo
- Division of General, Mininvasive and Bariatric Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - C Gambardella
- Division of General, Mininvasive and Bariatric Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
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Pizza F, Lucido FS, D'Antonio D, Gambardella C. Author response to: Prophylactic sublay non-absorbable mesh positioning following midline laparotomy in a clean-contaminated field: randomized clinical trial (PROMETHEUS). Br J Surg 2021; 108:e356. [PMID: 34459869 DOI: 10.1093/bjs/znab242] [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] [Received: 06/01/2021] [Accepted: 06/05/2021] [Indexed: 11/13/2022]
Affiliation(s)
- F Pizza
- Department of Surgery, Hospital 'A. Rizzoli', LaccoAmeno, Naples, Italy
| | - F S Lucido
- Division of General, Mininvasive and Bariatric Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - D D'Antonio
- Department of Surgery, Hospital 'A. Rizzoli', LaccoAmeno, Naples, Italy
| | - C Gambardella
- Division of General, Mininvasive and Bariatric Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
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Pizza F, Lucido FS, D'Antonio D, Gambardella C. Author response to: Prophylactic sublay non-absorbable mesh positioning following midline laparotomy in a clean-contaminated field: randomized clinical trial (PROMETHEUS). Br J Surg 2021; 108:e352. [PMID: 34453511 DOI: 10.1093/bjs/znab239] [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] [Received: 06/04/2021] [Accepted: 06/05/2021] [Indexed: 11/13/2022]
Affiliation(s)
- F Pizza
- Department of Surgery, Hospital 'A. Rizzoli', LaccoAmeno, Naples, Italy
| | - F S Lucido
- Division of General, Mininvasive and Bariatric Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - D D'Antonio
- Department of Surgery, Hospital 'A. Rizzoli', LaccoAmeno, Naples, Italy
| | - C Gambardella
- Division of General, Mininvasive and Bariatric Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
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Pizza F, Lucido FS, D'Antonio D, Gambardella C. Prophylactic sub-lay non absorbable mesh positioning following midline laparotomy in clean/contaminated field: the randomized PROMETHEUS trialCompeting interests. Br J Surg 2021; 108:e348. [PMID: 34160011 DOI: 10.1093/bjs/znab219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/13/2021] [Indexed: 11/12/2022]
Affiliation(s)
- F Pizza
- Department of Surgery, Hospital 'A. Rizzoli', LaccoAmeno, Naples, Italy
| | - F S Lucido
- Division of General, Mininvasive and Bariatric Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - D D'Antonio
- Department of Surgery, Hospital 'A. Rizzoli', LaccoAmeno, Naples, Italy
| | - C Gambardella
- Division of General, Mininvasive and Bariatric Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
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Pizza F, D'Antonio D, Ronchi A, Lucido FS, Brusciano L, Marvaso A, Dell'Isola C, Gambardella C. Prophylactic sublay non-absorbable mesh positioning following midline laparotomy in a clean-contaminated field: randomized clinical trial (PROMETHEUS). Br J Surg 2021; 108:638-643. [PMID: 33907800 DOI: 10.1093/bjs/znab068] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/11/2020] [Accepted: 01/31/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Incisional hernia is a frequent postoperative complication after midline laparotomy. Prophylactic mesh augmentation in abdominal wall closure after elective surgery is recommended, but its role in emergency surgery is less well defined. METHODS This prospective randomized trial evaluated the incidence of incisional hernia in patients undergoing urgent midline laparotomy for clean-contaminated surgery. Closure using a slowly absorbable running suture was compared with closure using an additional sublay mesh (Parietex ProGrip™). Patients were randomized just before abdominal wall closure using computer-generated permuted blocks. Patients, care providers, staff collecting data, and those assessing the endpoints were all blinded to the group allocation. Patients were followed up for 24 months by means of clinical and ultrasonographic evaluations. RESULTS From January 2015 to June 2018, 200 patients were randomized: 100 to primary closure (control group) and 100 to Parietex ProGrip™ mesh-supported closure (mesh group). Eight patients in the control group and six in the mesh group were lost to follow-up. By 24 months after surgery, 21 patients in the control group and six in the mesh group had developed incisional hernia (P = 0.002). There was no difference between groups in the incidence of haematoma (2 versus 5; P = 0.248) and superficial wound infection (4 versus 5; P = 0.733). Multivariable analysis confirmed the role of mesh in preventing incisional hernia (odds ratio 0.11, 95 per cent c.i. 0.03 to 0.37; P < 0.001). One patient in the mesh group required mesh removal because of deep infection. CONCLUSION Prophylactic mesh-augmented abdominal wall closure after urgent laparotomy in clean-contaminated wounds is safe and effective in reducing the incidence of incisional hernia. Registration number: NCT04436887 (http://www.clinicaltrials.gov). GRAPHICAL ABSTRACT An RCT was conducted to compare the widely recommended midline laparotomy closure using a slowly absorbable running suture with closure using a sublay mesh (Parietex ProGrip™), in patients undergoing urgent midline laparotomy for clean-contaminated surgery. Patients were followed up for 24 months with clinical and ultrasonographic evaluation during outpatient visits. Prophylactic reinforcement of the midline abdominal wall, using a ProGrip™ Parietex mesh in the retromuscular position, at the time of urgent laparotomy in clean-contaminated wounds was safe and effective in reducing the incidence of incisional hernia, although larger studies with longer follow-up are required.
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Affiliation(s)
- F Pizza
- Department of Surgery, Hospital 'Rizzoli', Naples, Italy
| | - D D'Antonio
- Department of Surgery, Hospital 'Rizzoli', Naples, Italy
| | - A Ronchi
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Naples University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - F S Lucido
- Division of General, Mininvasive and Bariatric Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - L Brusciano
- Division of General, Mininvasive and Bariatric Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - A Marvaso
- Department of Surgery, Hospital 'Rizzoli', Naples, Italy
| | - C Dell'Isola
- Department of Infectious Diseases, AORN 'dei Colli' Monaldi-Cotugno - CTO, Naples, Italy
| | - C Gambardella
- Division of General, Mininvasive and Bariatric Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
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Del Genio G, Merlino F, Tolone S, Brusciano L, Lucido FS, Docimo L, Gambardella C. Surgery at the time of COVID-19 pandemic: initial evidence of safe practice. Br J Surg 2020; 107:e266. [PMID: 32488860 PMCID: PMC7300976 DOI: 10.1002/bjs.11732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/04/2020] [Indexed: 11/11/2022]
Affiliation(s)
- G Del Genio
- University of Campania 'Luigi Vanvitelli' and Ruesch Clinic, Naples, Italy
| | - F Merlino
- University of Campania 'Luigi Vanvitelli' and Ruesch Clinic, Naples, Italy
| | - S Tolone
- University of Campania 'Luigi Vanvitelli' and Ruesch Clinic, Naples, Italy
| | - L Brusciano
- University of Campania 'Luigi Vanvitelli' and Ruesch Clinic, Naples, Italy
| | - F S Lucido
- University of Campania 'Luigi Vanvitelli' and Ruesch Clinic, Naples, Italy
| | - L Docimo
- University of Campania 'Luigi Vanvitelli' and Ruesch Clinic, Naples, Italy
| | - C Gambardella
- University of Campania 'Luigi Vanvitelli' and Ruesch Clinic, Naples, Italy
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Gualtieri G, Brusciano L, Gambardella C, Tolone S, Lucido FS, Del Genio G, Terracciano G, Docimo L. Sars-cov-2 hurricane impacting proctology outpatient clinics and proctologic emergencies. On the verge of phase 2, learning from phase 1. correspondence. Int J Surg 2020; 79:86-87. [PMID: 32442687 PMCID: PMC7235580 DOI: 10.1016/j.ijsu.2020.05.049] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 11/17/2022]
Affiliation(s)
- G Gualtieri
- Division of General, Mini-invasive and Obesity Surgery, Master of Coloproctology and Master of Pelvi-Perineal Rehabilitation, University of Study of Campania "Luigi Vanvitelli", Naples, Italy
| | - L Brusciano
- Division of General, Mini-invasive and Obesity Surgery, Master of Coloproctology and Master of Pelvi-Perineal Rehabilitation, University of Study of Campania "Luigi Vanvitelli", Naples, Italy
| | - C Gambardella
- Division of General, Mini-invasive and Obesity Surgery, Master of Coloproctology and Master of Pelvi-Perineal Rehabilitation, University of Study of Campania "Luigi Vanvitelli", Naples, Italy; Department of Cardiothoracic Sciences, University of Campania "Luigi Vanvitelli", School of Medicine, Naples, Italy.
| | - S Tolone
- Division of General, Mini-invasive and Obesity Surgery, Master of Coloproctology and Master of Pelvi-Perineal Rehabilitation, University of Study of Campania "Luigi Vanvitelli", Naples, Italy
| | - F S Lucido
- Division of General, Mini-invasive and Obesity Surgery, Master of Coloproctology and Master of Pelvi-Perineal Rehabilitation, University of Study of Campania "Luigi Vanvitelli", Naples, Italy
| | - G Del Genio
- Division of General, Mini-invasive and Obesity Surgery, Master of Coloproctology and Master of Pelvi-Perineal Rehabilitation, University of Study of Campania "Luigi Vanvitelli", Naples, Italy
| | - G Terracciano
- Division of General, Mini-invasive and Obesity Surgery, Master of Coloproctology and Master of Pelvi-Perineal Rehabilitation, University of Study of Campania "Luigi Vanvitelli", Naples, Italy
| | - L Docimo
- Division of General, Mini-invasive and Obesity Surgery, Master of Coloproctology and Master of Pelvi-Perineal Rehabilitation, University of Study of Campania "Luigi Vanvitelli", Naples, Italy
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Brusciano L, Gualtieri G, Gambardella C, Tolone S, Lucido FS, Del Genio G, Pellino G, Docimo L. When preserving life becomes imperative, quality of life is eclipsed! COVID-19 outbreak impacting patients with pelvic floor disorders undergoing pelvic floor rehabilitation. Br J Surg 2020; 107:e242. [PMID: 32406933 PMCID: PMC7272943 DOI: 10.1002/bjs.11675] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 11/07/2022]
Affiliation(s)
- L Brusciano
- Division of General, Mini-Invasive and Obesity Surgery, Naples, Italy
| | - G Gualtieri
- Division of General, Mini-Invasive and Obesity Surgery, Naples, Italy
| | - C Gambardella
- Division of General, Mini-Invasive and Obesity Surgery, Naples, Italy.,Department of Cardiothoracic Sciences, Naples, Italy
| | - S Tolone
- Division of General, Mini-Invasive and Obesity Surgery, Naples, Italy
| | - F S Lucido
- Division of General, Mini-Invasive and Obesity Surgery, Naples, Italy
| | - G Del Genio
- Division of General, Mini-Invasive and Obesity Surgery, Naples, Italy
| | - G Pellino
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy.,Colorectal Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - L Docimo
- Division of General, Mini-Invasive and Obesity Surgery, Naples, Italy
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Brusciano L, Gualtieri G, Gambardella C, Terracciano G, Tolone S, Del Genio G, Lucido FS, Docimo L. Pelvic floor dyssynergia: the new iceberg syndrome. Tech Coloproctol 2020; 24:393-394. [PMID: 32112246 DOI: 10.1007/s10151-020-02164-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/06/2020] [Indexed: 11/29/2022]
Affiliation(s)
- L Brusciano
- U.O.C General and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli" Naples, Naples, Italy.
| | - G Gualtieri
- U.O.C General and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli" Naples, Naples, Italy
| | - C Gambardella
- U.O.C General and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli" Naples, Naples, Italy.,Department of Cardiothoracic Sciences, School of Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - G Terracciano
- U.O.C General and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli" Naples, Naples, Italy
| | - S Tolone
- U.O.C General and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli" Naples, Naples, Italy
| | - G Del Genio
- U.O.C General and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli" Naples, Naples, Italy
| | - F S Lucido
- U.O.C General and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli" Naples, Naples, Italy
| | - L Docimo
- U.O.C General and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli" Naples, Naples, Italy
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