Abdominal Incisional Hernia Research Articles

To Compare the Short-Term Outcome of Open Repair versus Laparoscopic Repair in Abdominal Incisional Hernia Repair

Background: Incisional hernia is a common complication post abdominal surgery. Its effective management is crucial for patient outcomes and healthcare efficiency. This study aims to evaluate and compare the short-term outcomes of open and laparoscopic incisional hernia repair techniques. Objective: The study's objectives are twofold: 1) To ascertain the short-term outcomes, specifically focusing on the length of hospital stay, operative time, wound infections, and recurrence rate in patients undergoing open and laparoscopic incisional hernia repair, and 2) To compare these outcomes between open and laparoscopic repair methods. Methods: A randomized design was employed, with patients assigned to either Group A (open repair) or Group B (laparoscopic repair) using computer software. The duration of surgery, from the first incision to skin closure, was timed with a digital stopwatch. Patients were followed up for one month with specific attention to any redness, persistent pain, or fever. The key outcome parameters assessed were operative time, hospital stay duration, incidence of wound infection, and hernia recurrence. Results: Group A exhibited a 9.9% wound infection rate and 51.1% recurrence rate, with 39.0% of patients achieving satisfactory outcomes. In contrast, Group B demonstrated a 13.5% wound infection rate, a notably lower recurrence rate of 11.3%, and 75.2% of patients reported satisfactory outcomes. Conclusion: Laparoscopic repair shows superior outcomes compared to open repair regarding wound infection, recurrence rate, patient satisfaction, operative time, and length of hospital stay.

Hepatic herniation: A rare presentation of abdominal incisional hernia

Hepatic herniation: A rare presentation of abdominal incisional hernia

STRONGHOLD first-year results of biomechanically calculated abdominal wall repair: a propensity score matching

PurposeEvery year around 70,000 people in Germany suffer from an abdominal incisional hernia that requires surgical treatment. Five years after reconstruction about 25% reoccur. Incisional hernias are usually closed with mesh using various reconstruction techniques, summarized here as standard reconstruction (SR). To improve hernia repair, we established a concept for biomechanically calculated reconstructions (BCR). In the BCR, two formulas enable customized patient care through standardized biomechanical measures. This study aims to compare the clinical outcomes of SR and BCR of incisional hernias after 1 year of follow-up based on the Herniamed registry.MethodsSR includes open retromuscular mesh augmented incisional hernia repair according to clinical guidelines. BCR determines the required strength (Critical Resistance to Impacts related to Pressure = CRIP) preoperatively depending on the hernia size. It supports the surgeon in reliably determining the Gained Resistance, based on the mesh-defect-area-ratio, further mesh and suture factors, and the tissue stability. To compare SR and BCR repair outcomes in incisional hernias at 1 year, propensity score matching was performed on 15 variables. Included were 301 patients with BCR surgery and 23,220 with standard repair.ResultsBCR surgeries show a significant reduction in recurrences (1.7% vs. 5.2%, p = 0.0041), pain requiring treatment (4.1% vs. 12.0%, p = 0.001), and pain at rest (6.9% vs. 12.7%, p = 0.033) when comparing matched pairs. Complication rates, complication-related reoperations, and stress-related pain showed no systematic difference.ConclusionBiomechanically calculated repairs improve patient care. BCR shows a significant reduction in recurrence rates, pain at rest, and pain requiring treatment at 1-year follow-up compared to SR.

Onlay Repair Using Self-Gripping Mesh for Lateral Trocar Site Hernia After Laparoscopic Incisional Hernia Repair: A Case Report With Short- and Mid-Term Outcomes

Introduction Trocar site hernia (TSH) is an uncommon complication after laparoscopic surgery, but it may potentially require surgical intervention. The available data have shown the importance of prediction and prevention; the optimal surgical approach for TSH remains unclear, and its long-term outcome is scarcely available. Here, we present a case of a lateral TSH after laparoscopic incisional hernia repair, which was successfully repaired using the onlay technique with a self-gripping mesh. Case presentation A 74-year-old woman presented with an abdominal incisional hernia at the midline after an open cholecystectomy. She underwent laparoscopic surgery for incisional hernia with intraperitoneal onlay mesh repair. Fascial closure was performed for trocar sites. After 12 months, she noticed a painful bulge in the left upper quadrant suggestive of TSH. At the time of diagnosis, her body mass index was 32 kg/m2. TSH repair was performed under general anesthesia. A 3 × 3 cm defect was identified, and the hernial content was found to be the omentum. Defect closure was performed using interrupted sutures followed by placement of a self-gripping mesh (11 × 11 cm in size, obtaining a 4-cm overlap for the defect). The operative time was 80 minutes. The postoperative course was uneventful except for a spontaneously resolved seroma. Computed tomography scan at the 1-year follow-up and physical examination at the 2-year visit showed no recurrence. Conclusion Our proposed onlay repair using self-gripping mesh may be considered as the treatment of choice for cases of lateral TSH after laparoscopic incisional hernia repair.

Measurements of abdominal wall defect and hernia sac volume in the treatment of incisional hernia: Application of ultrasonic volume auto-scan in 50 cases.

Abdominal incisional hernia is one of the most common complications after surgery. The preoperative evaluation of the area of abdominal wall defect and the hernia sac volume(HCV) is very important for the selection of patch size and incisional herniorrhaphy. Meanwhile the overlap range of reinforcement repair is controversial. This study aimed to explore the value of ultrasonic volume auto-scan(UVAS) in the diagnosis, classification and treatment of incisional hernia. Both the width and the area of abdominal wall defect and HCV were measured by UVAS in 50 cases with incisional hernias. In 32 of these cases, the measurements of HCV were compared with those of CT. Classification of incisional hernia based on ultrasonic images were compared with operative diagnosis. The measurements of HCV by UVAS and CT 3D reconstruction had good consistency, of which the mean ratio was 1.0084. According to the location and width of abdominal wall defect, UVAS, which showed good accuracy rate (90%, 96%), reached a good agreement in the classification of incisional hernias with operative diagnoses (Kappa=0.85, Confidence Interval [0.718,0.996]; Kappa=0.95, Confidence Interval [0.887,0.999]). The patch area should be at least two times as large as the defect area. UVAS is an accurate alternative to measure the abdominal wall defect and HCV and classify the incisional hernia, with additional benefits of no radiation exposure and instant bedside interpretation. The use of UVAS is conducive to preoperative assessment of the risk of hernia recurrence and abdominal compartment syndrome.

A Noble Structure of the Musculoskeletal System in Various Surgeries: The Fascia Lata

Objective: The objective of this work is to list the surgeries using the fascia lata. Background: The fascia lata finds a place in decayed tissues. The indications are getting wider and wider. Method: We used the PubMed database with the following words: fascia lata, ilio-tibial band, fascia lata and surgery, ilio-tibial band and surgery, fascia lata and reconstruction, ilio-tibial band and reconstruction. Results: Fascia lata is used in the reconstruction of anatomical defects. Specifically, it is used in: Hip to supplement abduction- Shoulder in glenohumeral instability, repair of the cap- Hand and fingers to reconstruct tendons- Eyes: for palpebral ptosis and scleritis - Base of the skull to reconstruct defects- Central nervous system: cerebral dura mater and Cerebrospinal Fluid leak- Otorhinolaryngology: thyroplasty, parotid surgery, rhinoplasty, tympanoplasty- Digestive tract- Tendons: Achilles, patellar, fibular, patellar, patellar, bicipital brachial and crural tendons - Ligaments: anterior cruciate ligament reconstruction, inguinal and retinaculum patellar - Perineum and penis reconstruction - Urology: Genital prolapse, fistulas and penile reconstruction - Abdominal incisional hernias - Breast reconstruction - Eschar - Thorax - Encology. Finally, in experimentation, the fascia lata is tested on cadavers, animals and in vitro. Conclusion: Because of the particular properties of fascia lata in reconstruction, it renders an enormous service to surgery. The development of techniques in surgery would allow its use in other indications.

Sonographic features of thoracoabdominal wall metastases of liver cancer after liver transplantation

ObjectiveSonographic features are not well-defined in thoracoabdominal wall metastases (TAWM) of liver cancer after liver transplantation (LT), which is one of the most important reasons affecting the long-term survival of transplant recipients. The purpose of this study was to analyze the sonographic features of TAWM from liver cancer after LT and to identify the role of ultrasound (US) in the differential diagnosis between TAWM and benign lesions of the thoracoabdominal wall after LT. MethodsThis retrospective study included 1,999 LT recipients between January 2008 and July 2021. Clinical characteristics and sonographic features of 32 patients with thoracoabdominal wall lesions were analyzed. The types of thoracoabdominal wall lesions were studied, and the US findings of benign and malignant lesions were compared. Whether TAWM from liver cancer after LT exhibited any distinctive sonographic appearance was evaluated. ResultsAll seven malignant cases were metastases from liver cancer. The benign group included 13 cases of thoracoabdominal wallencapsulated effusion/hematoma, nine of abdominal incisional hernia, and three of thoracoabdominal wall inflammatory mass. Sonographic features were significantly different between two groups. Compared with the benign group, metastases lesions were frequently located in the parietal peritoneum/pleura (4/7 vs 1/25, p = 0.009), fewer lesions were located at abdominal incisions (3/7 vs 23/25, p = 0.012), all metastatic lesions were hypoechoic (7/7 vs 5/25, p = 0.001), and most lesions had blood flow signals (4/7 vs 3/25, p = 0.026). Additionally, most metastatic cases had intrahepatic lesions (4/7 vs 1/25, p = 0.004) and multiple extrahepatic solid lesions in the abdomen (6/7 vs 0/25, p = 0.000). ConclusionsCompared with benign lesions, TAWM of liver cancer after LT exhibited unique sonographic features.

Herniation of the Left Hepatic Lobe, Unusual Presentation of an Incisional Hernia

Hepatic herniation through an abdominal incisional hernia is an extremely rare phenomenon that has been reported in the medical literature in few case reports. It is associated with complications such as hepatic encephalopathy and Budd-Chiari syndrome. Most cases can be managed conservatively through observation, but many cases require surgical intervention to preserve liver function. Our case is a 61-year-old female who presented with herniation of the left hepatic lobe through an abdominal incisional hernia which was managed surgically.

OC-030 COMPARISON OF OUTCOMES OF THE EXTENDED-VIEW TOTALLY EXTRAPERITONEAL RIVES-STOPPA (ETEP-RS) AND THE INTRAPERITONEAL ONLAY MESH WITH DEFECT CLOSURE (IPOM-PLUS) FOR W1-W2 MIDLINE INCISIONAL HERNIA REPAIR

Abstract Aim This study aimed to compare the outcomes of the eTEP-RS and IPOM-plus procedures in W1 and W2 midline incisional abdominal wall hernia (IAWH) repairs performed by the same surgeon. Material and Methods Prospectively collected data of laparoscopic abdominal wall repairs performed on 61 patients with eTEP between November 2018 and April 2022 and on 67 patients with IPOM-plus between January 2016 and April 2022 were retrospectively analyzed. A total of 74 out of 128 patients, 30 in the eTEP-RS group and 44 in the IPOM-plus group, who underwent W1-W2 midline incisional hernia repair were included in the study. The mean follow-up was 24 months in the eTEP-RS group and 45 months in the IPOM-plus group. Results There was no statistically significant difference between the groups regarding age, sex, BMI, ASA score, or active smoking. The mean mesh area (MMA) and mesh/defect (M/D) ratio were higher in the eTEP-RS group (p <0.001 and p =0.004). In the eTEP-RS group, the hospital length of stay (LOS) (1.48 days vs. 2.58 days, p <0.001) and pain on the first and 10th postoperative days were significantly lower (p <0.001), while the operative time was significantly longer (p <0.001). There was no significant difference in terms of intraoperative complications (p =0.56), seroma formation (p =0.83), or recurrence (p =0.83). Conclusions The eTEP-RS technique has advantages over the IPOM-plus approach, such as a shorter LOS and less early postoperative pain with W1-W2 midline IAWH repair. However, the eTEP technique has a longer operative time.

OC-096 Short-Term Results of Transversus Abdominis Release in Patients under Immunosuppression

Abstract Aim Immunosuppressive medication might increase the likelihood of wound morbidity, with possible higher rate of surgical site infections (SSIs). We aim to identify short-term outcomes and hospital stay after incisional hernia repair with transversus abdominis release (TAR) in patients with versus without immunosuppression. Material & Methods All patients undergoing open incisional abdominal wall hernia repair with uni-or bilateral TAR from January 2021 through November 2022 were identified using a prospectively maintained database. Minimum follow-up was 30 days. Outcomes included 30-day SSIs, seroma rate, hospital stay, and early recurrence. Results Twenty-seven patients with immunosuppressive medication were identified and 75 without (mean age 59.0 ± 13.9 vs. 65.1 ± 11.4, 74.1% vs. 46.7% male, respectively). Median hernia width was 7.7 ± 5.1 cm vs. 7.9 ± 4.3 cm respectively. At 30 days follow-up, SSI rate was 1/27 (3.7%) in the group under immunosuppression and 5/75 (6.7%) in the group without (p = 0.575). Seroma rate was 3/27 (11.1%) vs. 12/75 (16.0%), respectively (p = 0.539). Mean hospital stay was 6.0 ± 3.6 days in the immunosuppression group vs 8.1 ± 6.7 days in the group without (p = 0.052). No early recurrences were detected in either group. Conclusion Immunosuppression does not significantly increase the risk of short-term complications in incisional hernia repair with transversus abdominis release. There is a trend towards a shorter hospital stay in patients under immunosuppression, possibly related to a reduced inflammatory response.

V-020 Botulinum Toxin: not just aesthetics anymore

Abstract Introduction Surgical repair of recurrent abdominal incisional hernia can be challenging. The aim should be a tension-free, mesh reinforced midline fascial closure. Different methods have been described to achieve this primary fascial closure. Botulinum toxin (BT) is a neurotoxin that when injected into muscle tissue, causes a temporary flaccid muscle paralysis. This effect can be applied to the lateral abdominal wall muscles, thereby facilitating midline rectus muscles re-approximation and defect closure. Clinical Case We present a case of a 58 year old female, with a history of right hemicolectomy and ileostomy, that underwent subsequent stoma closure one year after. She presented with a 12 cm defect width incisional hernia and right rectus muscle atrophy. We demonstrate the preoperative injection of BT using the Zielinski technique in a consultation room with no need for patient monitoring or anesthesia. Four weeks later, the patient underwent open repair with bilateral transversus abdominis release and retromuscular mesh reinforcement. The defect was closed without tension and the postoperative period was uneventful. Patient was discharged on postoperative day 4. Conclusion Preoperative BT injection as a selective muscle chemical component paralysis is a safe, easy to perform and effective technique that aims to counteract the chronic muscle retraction observed in large ventral hernias. BT in combination with advanced ventral hernia repair techniques, may help provide the crucial extra tissue mobility required to achieve primary closure, with the added advantage of less postoperative pain, thereby contributing to early patient discharge.

Biological prosthesis, platelet enriched plasma and bone marrow stem cells in complicated incisional hernia reconstruction in emergency surgery: a prospective case control study

Numerous innovations have been aided by abdominal wall surgical repair. Abdominal wall surgery was drastically altered by synthetic materials. Tissue engineering was unquestionably first applied to biomaterials. The purpose of the present study is to compare different repeating approaches with rising tissue engineering complexity in repairing complex incisional hernia in emergency setting. Patients with complicated incisional hernia were prospectively included in the study and divided into 4 groups: DR (Direct Repair) group underwent direct reconstruction of the abdominal wall, BR (Biological mesh Repair) group underwent reconstruction of the abdominal wall with biological mesh (retro-muscular), BPR [Biological mesh and Platelet Enriched Plasma (PEP), gel] group underwent reconstruction of the abdominal wall with Biological mesh (retro-muscular) and PEP, BPSR (biological mesh, PEP gel and Bone Marrow Stem Cells) group underwent reconstruction of the abdominal wall with biological mesh (retromuscular), PEP and Bone Marrow Stem cells (BMSc). Forty patients were enrolled. Patients in the DR group experienced a higher rate of severe complication (p<0.05). Recurrence rates were 60% for DR patients, 20% for BM patients and 10% for the BM+PEP group (p<0.05). Median follow-up period was 64.6, 55.7 and 55.8 months (p<0.05). 7- and 30-days abdominal wall thickness is progressively increased by different techniques: BP, BP+PEP and BP+PEP+BMSc (p<0.05). No mortality was registered. Tissue engineering techniques in abdominal wall reconstruction showed promising results. They seem to reduce the recurrence rate without increasing complication one in complicated incisional abdominal wall hernia. Although many aspects are yet to be determined and standardized, it seems extremely important to continue research and experimentation in this field.

Comparison of outcomes of the extended-view totally extraperitoneal rives-stoppa (eTEP-RS) and the intraperitoneal onlay mesh with defect closure (IPOM-plus) for W1-W2 midline incisional hernia repair-a single-center experience.

The eTEP technique is a new approach that has recently gained popularity in abdominal wall hernia surgery. This study aimed to compare the outcomes of the eTEP-RS and IPOM-plus procedures in W1 and W2 midline incisional abdominal wall hernia (IAWH) repairs performed by the same surgeon. Prospectively collected data of laparoscopic abdominal wall repairs performed on 61 patients with eTEP between November 2018 and April 2022 and on 67 patients with IPOM-plus between January 2016 and April 2022 were retrospectively analyzed. A total of 74 out of 128 patients, 30 in the eTEP-RS group and 44 in the IPOM-plus group, who underwent W1-W2 midline incisional hernia repair were included in the study. The mean follow-up was 24months in the eTEP-RS group and 45months in the IPOM-plus group. There was no statistically significant difference between the groups regarding age, sex, BMI, ASA score, or active smoking. No difference was seen between the two groups in terms of the mean defect area (MDA, 28.17cm2 vs. 27.41cm2, p = 0.84), but the mean mesh area (MMA) and mesh/defect (M/D) ratio were higher in the eTEP-RS group (404.11cm2 vs. 267.85cm2, p < 0.001 and 20.96 vs. 12.36, p = 0.004). In the eTEP-RS group, the hospital length of stay (LOS) (1.48days vs. 2.58days, p < 0.001) and pain on the first and 10th postoperative days were significantly lower (p < 0.001), while the operative time was significantly longer (204.07min vs. 88.33min, p < 0.001). There was no significant difference in terms of intraoperative complications (p = 0.56), seroma formation (p = 0.83), or recurrence (p = 0.83). The eTEP-RS technique has advantages over the IPOM-plus approach, such as a shorter LOS and less early postoperative pain with W1-W2 midline IAWH repair. However, the eTEP technique has a longer operative time.

Absorbable Barbed Continuous versus Nonabsorbable Nonbarbed Interrupted Suturing Methods for Donor-site Closure of the Rectus Abdominis Myocutaneous Flap.

This study included 145 patients who underwent free RAMC flap reconstruction after head and neck cancer surgery at Kobe University Hospital between January 2012 and March 2020. The nAnBI method was selected between January 2012 and August 2016, and the ABC method was selected between September 2016 and March 2020. The incidence of abdominal incisional hernia and the average time required for donor-site closure were compared between the two groups. Of the 145 patients surveyed, 116 (57 and 59 in the nAnBI and ABC groups, respectively) were followed-up for at least 90 days after the surgery. The incidence rates of abdominal incisional hernia were 0% and 5.1% (n = 3) in the nAnBI and ABC groups, respectively, with no significant differences (p = 0.244). The average donor-site closure times were 127.6 and 111.3 minutes in the nAnBI and ABC groups, respectively, with no significant differences (p = 0.122). No significant differences in the incidence of abdominal incisional hernia and donor-site closure time were observed between the nAnBI and ABC groups. However, there was a tendency for increased hernia occurrence and shorter wound closure time in the ABC group. A randomized prospective multicenter study is warranted to validate our findings of the ABC method.

Abdominal incisional hernia in vascular surgery

Abdominal incisional hernia in vascular surgery

Preparation of antiadhesion polypropylene mesh using bacterial cellulose combined with chitosan hydrogel application in rat abdominal incisional hernia

Preparation of antiadhesion polypropylene mesh using bacterial cellulose combined with chitosan hydrogel application in rat abdominal incisional hernia

Comparison of the Efficacy of IPOM-Plus and Sublay in the Treatment of Small and Medium-Sized Abdominal Incisional Hernia

Comparison of the Efficacy of IPOM-Plus and Sublay in the Treatment of Small and Medium-Sized Abdominal Incisional Hernia

“工字型”双层补片治疗腹壁切口疝的临床分析

“工字型”双层补片治疗腹壁切口疝的临床分析

A Case of Abdominal Incisional Hernia Repair with Severe Aortic Valve Stenosis under Intravenous Anesthesia using Ketamine and Local Anesthesia

A Case of Abdominal Incisional Hernia Repair with Severe Aortic Valve Stenosis under Intravenous Anesthesia using Ketamine and Local Anesthesia

Postoperative adverse events and re-treatment among patients who have undergone laparoscopic and robotic sacrocolpopexy for pelvic organ prolapse in Japan.

To describe and compare the postoperative adverse events and re-treatment for recurrence after laparoscopic and robotic-assisted sacrocolpopexy in Japanese patients with pelvic organ prolapse (POP). This was a retrospective cohort study using the DeSC database, which contains claims and medical check-up data provided by DeSC Healthcare Inc., Tokyo, Japan. We identified all patients who had undergone either laparoscopic or robotic-assisted sacrocolpopexy from April 2014 to May 2021. Patient backgrounds and postoperative outcomes were compared between the laparoscopic and robotic-assisted sacrocolpopexy groups. Moreover, the composite adverse event comprising vaginal erosion, postoperative urinary incontinence, postoperative dysuria, urinary tract injury, and abdominal incisional hernia was evaluated. Re-treatment for POP recurrence included pessary use and surgery for POP was also evaluated. Among 28 748 patients diagnosed with POP, 409 (1.4%) had undergone laparoscopic sacrocolpopexy and 52 (0.2%) had undergone robotic-assisted sacrocolpopexy. The prevalence of postoperative adverse events was 20.8% and 13.5% in the laparoscopic and robotic-assisted sacrocolpopexy groups, respectively (P= 0.270). One patient (1.9%) underwent surgery after robotic-assisted sacrocolpopexy, and none of the patients was administered pessaries postoperatively in both groups. In Japan, postoperative outcomes after laparoscopic and robotic-assisted sacrocolpopexy are similar and comparable to those reported in western countries.