Abdominal Incisional Hernia Research Articles

Mesh repair under the anterior lamina of the rectus sheath (MUAR) for abdominal incisional hernia.

Abdominal incisional hernia is a frequent complication of major abdominal operations. Our method of performing mesh repair under the anterior lamina of the rectus sheath (MUAR) involves placing mesh between the dorsal surface of the anterior rectus sheath and the rectus abdominis muscle. We evaluated the short-term and long-term outcomes of our MUAR method. The subjects of this retrospective study were 80 patients with abdominal incisional hernia, who underwent MUAR at our hospital between August, 2009 and September, 2018. We investigated the rate of recurrence and postoperative complications in these patients, who were followed-up postoperatively for at least 18months. Patients who completed all visits were then followed-up further with questionnaires. The recurrence rate after MUAR was 0%. Postoperative complications consisted of subcutaneous wound infections in two patients (2.5%), successfully treated with wound cleansing and antibiotics; and subcutaneous hematoma in three patients (3.8%), which was spontaneously absorbed in two patients, and removed in one. There were no other complications, such as seroma, intestinal obstruction, mesh infection and bulging, or prolonged postoperative pain. Mesh repair under the anterior lamina of the rectus sheath is simple and safe with positive short-term and long-term outcomes, suggesting that it is a good option for incisional hernia repair.

Laparoscopic Versus Open Abdominal Repair of Incisional Hernia

Background: Incisional hernia is a common health problem and its method of repair [open or laparoscopic] is still under debate. Aim of the work: To evaluate the technique and results of the laparoscopic and the open abdominal incisional hernia repair. Patients and methods: This is a retrospective study conducted on 40 patients with abdominal incisional hernia, admitted to general surgery department of Al-Azhar University Hospital [Damietta]. All records were reviewed for patient demographics, preoperative evaluation, operative and postoperative data. The complications were reviewed and compared between groups. These complications included ileus, cellulitis, flap necrosis, infection, hematoma, seroma, cyst, recurrence and other injuries. Results: The open group had a shorter operative time than the laparoscopic group [85.3±13.21 vs 110.0±10.04 minutes, respectively]. However, time to oral intake [hours] and the duration of hospital stay [days] were significantly shorter in the laparoscopic when compared to the open group [9.20±1.2, 1.92±0.69 vs 20.0±2.4 and 2.70±0.68 respectively]. Postoperative complications showed no significant difference between groups. Conclusion: Thelaparoscopic repair of incisional hernia is a safe and effective alternative to the open repair with a shorter hospital stay, early oral feeding and a lower rate of complications.

Large abdominal hernia repair with closed incision negative pressure therapy: a case series.

A major challenge of large abdominal incisional hernia repair is the high rates of wound complications. Closed incision negative pressure therapy (CINPT) can offer many treatment advantages in the management of these wounds and has been shown to reduce complications for other postoperative incisions. This study assesses the wound outcomes for hernia repair patients receiving CINPT. A six-year retrospective case series of patients who had undergone large abdominal incisional hernia repair wounds treated with CINPT was conducted. Outcomes for patients treated with CINPT were compared with patients who had not received CINPT acting as a control. A total of 23 patients were treated with CINPT after hernia repair and compared with 12 patients in the control group. A statistically significant decreased rate of return to theatre (odds ratio: 0.12) was found in this study. Non-significant reductions in wound infection, seroma and wound dehiscence were also seen. No adverse events with CINPT therapy were reported. CINPT, when used after large abdominal incisional hernia repair, may help in the prevention of wound complications.

A Study of Intraperitoneal Onlay Mesh Repair Using Barbed Sutures for Abdominal Incisional Hernia

Objective We investigated the validity of our intraperitoneal onlay mesh (IPOM) Plus technique with barbed sutures. Background Laparoscopic intraperitoneal onlay mesh repair has become a proven method for treating abdominal incisional hernias in recent years. There have been a few reports on the utility of IPOM Plus, which is IPOM + celiorrhaphy, although this method has not been widely discussed. We adopted the IPOM Plus technique with barbed sutures at our hospital and investigated the validity of this technique. Methods We included 7 patients who underwent IPOM Plus repair from 2015 to 2017 at our hospital. We excluded patients with a hernia hilum <2 cm or ≥10 cm, age < 20 years old, PS3 or more, and uncontrolled comorbidity. The hernial orifice was closed laparoscopically using barbed sutures and subsequently secured by tacking on an onlay mesh. Results The median hernial orifice size of the 7 patients was 45 mm (25 to 55 mm). Hernia onset occurred after laparotomy in all cases. In one case, an abdominal incisional hernia recurred after IPOM used to treat the condition 15 years earlier. The mean duration of surgery was 80.5 minutes (53 to 126 minutes), and the median pain scale score was 3 points (0 to 3 points), indicating little pain. None of the patients reported persistent postoperative pain. The mean duration of the postoperative hospital stay was a median of 3.5 days (2 to 5 days). Both short- and long-term outcomes indicated that no recurrence or complications, such as bulging or seroma, occurred. Conclusions IPOM Plus with intracavitary abdominal suturing using barbed suture for abdominal scar hernia repair may be a valid surgical procedure.

Strangulated Bowel Obstruction due to Internal Hernia in an Abdominal Incisional Hernia Sac Treated with Component Separation Repair—A Case Report—

Strangulated Bowel Obstruction due to Internal Hernia in an Abdominal Incisional Hernia Sac Treated with Component Separation Repair—A Case Report—

Early experience with a new integrated microwave surgical device, Acrosurg Revo®, for laparoscopic surgery: A case series of two patients

IntroductionAbdominal surgery uses various energy devices for vessel sealing, tissue dissection, and detachment. Currently, Acrosurg Revo® (Nikkiso Co., Ltd., Tokyo, Japan), a novel energy device using microwaves, has been developed for use in laparoscopic surgery. This report describes the early clinical experience of using this device in two cases of laparoscopic surgery. Presentation of caseCase 1 was of a 64-year-old woman who underwent laparoscopic abdominal incisional hernia repair. Case 2 was of a 56-year-old man with a diagnosis of ascending and sigmoid colon cancer who underwent laparoscopic right hemicolectomy and sigmoid colectomy with D3 dissection. Each surgery was completed using Acrosurg Revo® and an endoscopic electrosurgical unit. The postoperative course was uneventful, and both patients were discharged from the hospital without any complications. DiscussionWith this new and novel device, vessel sealing, hemostasis, coagulation, tissue dissection, and detachment were all possible. Notably, there was no spark or mist that hindered the surgical field of view. Furthermore, because microwave coagulation did not result in tissue carbonization, there was a considerable decrease in device tip contamination. ConclusionThe Acrosurg Revo® may be a useful energy device for laparoscopic surgery.

Delayed mesh infection and mesh penetrating the transverse colon and small intestine after abdominal incisional hernia repair

The occurrence of late-onset mesh infection and mesh invasion into the intestine after abdominal incisional hernia repair is extremely rare. Herein, we describe the first case of late-onset mesh infection and mesh penetrating the transverse colon and small intestine 5 years after incisional hernia repair using an expanded polytetrafluoroethylene mesh. The symptom was drainage from the reddish wound, and computed tomography scan revealed intestinal prolapse with local wall thickening. The mesh removal and small intestine and colon resection were conducted because the small intestine and transverse colon formed a mass containing the mesh inside. The events were caused by the lack of mesh fixation, and the dislodged mesh penetrating the intestinal tract caused the infection. For mesh infections in which conservative treatment is not effective, mesh removal and organ excision should not be delayed regardless whether there is a strong adhesion of the abdominal cavity.

Prospective study of midline abdominal incisional hernia repair by component separation technique augmented with prosthetic mesh

Background: In our tertiary care hospital, we receive a large number of acute abdomen cases. Raised intra-abdominal pressure (IAP) makes laparostomy mandatory initially and abdominal wall approximation cannot be completed due to compromised state in most cases. Large incisional hernias were seen on complete healing and this study was done to see the feasibility of component separation technique (CST) with mesh augmentation.Methods: 30 patients were subjected to CST with mesh augmentation. Preoperative defect size mapping, Pre- and post-operative monitoring of IAP were done. Pain scoring by visual analogue scale (VAS), early and late complications was noted. Patients were followed up for 60 months.Results: CST with mesh augmentation was found to be feasible with 96.77% success rate as no recurrence was noted in follow up. Preoperative average Basal metabolic index was 26.09. Size of defect varied from 17-20×9-16 cm2 (length X width). Seroma seen in 50% of patients was managed without any intervention. Skin necrosis in 6.6% and wound dehiscence in 3.33%, managed with minimal debridement & local wound care respectively. Respiratory compromise and hematoma were not seen and no patient required any active ICU care. Average length of hospital stay was 5.22 days. Close monitoring of IAP in immediate post-operative period was found to be significant.Conclusion: Physical acceptance of stable abdominal wall gives a psychological boost to patients with early recovery in form of ambulation and early return to work.

Abdominal wall incisional hernia repair improves respiratory function: results after 3\xa0years of follow-up

PurposeHernias severely impact patient quality of life (QoL), and 80% of patients require a surgical operation. Moreover, hernias are responsible for respiratory function alterations. This study aims to investigate the postoperative alterations in respiratory function after open ventral hernia repair in patients with incisional hernia.MethodsPatients operated on at the Policlinico “Paolo Giaccone” at Palermo University Hospital between January 2015 and December 2016 were identified in a prospective database. Fifty-one patients were enrolled in the study. The respiratory outcome measures used were forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC ratio, peak expiratory flow (PEF) and PEF percentage (%PEF). The timepoints at which the parameters listed were assessed were t0, 1 week before the surgical operation; t1, 12 months later; and t2, 3 years later.ResultsThe difference between mean preoperative and postoperative PEF was significant [t0 4.32 (4.03–7.92), t1 6.7 (4.27–8.24) with p = 0.012 and t2 6.5 (4.25–8.21) with p = 0.026]. The %PEF increased from 75% preoperatively to 87% at t1 (p = 0.009) and to 85% at t2 (p = 0.03). No differences were found in the comparison of pre- and postoperative FVC, FEV1 or FEV1/FVC ratio.ConclusionThe improvement in respiratory measures suggests the importance of abdominal wall restoration to recover functional activity of respiratory function.

Evaluation of the effectiveness using nanomodified polipropilene meshes at laparoscopic operations of a hernia of a stomach

In laparoscopic surgical treatment of incisional abdominal hernia (AH) of great sizes, using polypropylene mesh, buth this is accompanied by a fairly high freguency of postoperative complications from the postoperative wound.In our view, the use of a polypropylene mesh modified by carbon nanotubes and an antiseptic of polyhexamethleneguanidme chloride the results of surgical treatment of AH.Aim – to improve the results of laparoscopic surgical treatment of incisional abdominal hernias of great proportions by using in combination with nanomodified polypropylene mesh.Materials and methods. The analysis of laparoscopic surgical treatment of 240 patients with AH of great sizes has been performed. Depending on the type of mesh used during laparoscopic surgical treatment, patients were divided into 2 groups. In 120 (50%) of Group I patients, the component aloplasty with the use of a nanomodified polypropylene mesh. In the 2nd group, 120 (50%) patients used the aloplasty with the use of a classic polypropylene mesh.Results and discussion. Statistically significant results were obtained in patients of Group I compared to Group II: seroma was in 17 (7.0±1.2%) in Group II compared to 4 (1.8±0.3%) in Group I (p<0.05). Chronic pain in the abdominal wall in 6 – 8 months after surgery was observed in 13 (5.3±0.4)% patients in group II and in 0 group I (p>0.05), recurrences of hernia were found in 13 (5.3±0.4%) patients of group II, in group I – in 4 (1.8±0.6)% (p<0.05). The terms of stay of patients of group II on inpatient treatment – 5,3±2,1 days group I – 2,1±1,2 days.Conclusion. Laparoscopic operacione treatment of UH using nanomodified polypropylene mesh antiseptic the use of the classical polypropylene mesh, namely, reducing the freguency of seroma from 7.0±1.2% in the II group of patients to 1.8±0.3% in group I, chronic postoperative pain – from 5.3±0.4% to 0, recurrence of hernia–from 5.3±0.4% to 1.8±0.6%.

Postoperative ileus after laparoscopic primary and incisional abdominal hernia repair with intraperitoneal mesh (DynaMesh®-IPOM versus Parietex™ Composite): a single institution experience.

Laparoscopic primary or incisional abdominal hernia repair with intraperitoneal mesh placement is a well-accepted and safe technique. Evidence for complications however remains inconclusive, and little is known about the occurrence of postoperative ileus secondary to postoperative intra-abdominal adhesions with different types of IPOM meshes used. Therefore, we retrospectively compared the occurrence of postoperative ileus between two of the different meshes used in our center. Three hundred seventy-five patients who underwent ventral hernia repair with intraperitoneal mesh placement, either with a DynaMesh®-IPOM (FEG Textiltechnik mbH, Aachen, Nordrhein-Westfalen, Germany) or a Parietex™ Composite mesh (Medtronic, Minneapolis, MN, USA), at the Heilig-Hart Hospital in Lier (Antwerp, Belgium) between 2012 and 2017 were retrospectively compared with regard to the occurrence of postoperative ileus until 6weeks postoperatively. Baseline demographics and clinical data up to 6weeks postoperatively of the patients in the two mesh groups are provided. The DynaMesh®-IPOM mesh group was associated with a significantly higher incidence of postoperative ileus compared with the Parietex™ Composite mesh group with a cutoff limit at postoperative day 1 (n= 17, 6.8% vs. n= 0, 0.0%; P= 0.003) and postoperative day 4 (n= 13, 5.2% vs. n = 0, 0.0%, P= 0.006), even with a mesh surface area of ≤ 300cm2 and when both meshes were fixated with the same method of fixation (Securestrap™) with a cutoff limit for postoperative ileus at postoperative day 1 (n= 4, 7.7% vs. n= 0, 0.0%; P= 0.013) and postoperative day 4 (n= 3, 5.8% vs. n = 0, 0.0%, P= 0.040). Of the 17 patients with a postoperative ileus, 9 (52.9%) had a suspicion of adhesive small bowel obstruction on CT scan (P= 0.033) with definitive confirmation of small bowel adhesions with the DynaMesh®-IPOM mesh at laparoscopy in 2 patients. Our results confirm current literature available regarding postoperative ileus secondary to postoperative intra-abdominal adhesions with the DynaMesh®-IPOM mesh. However, further research with well-designed, multicenter randomized controlled studies to evaluate the use and related complications of these meshes is needed.

Mesh Infection and Abscess Caused by Intestinal Penetration 13 Years after Repair of Abdominal Incisional Hernia

Mesh Infection and Abscess Caused by Intestinal Penetration 13 Years after Repair of Abdominal Incisional Hernia

The Correlation of Intraabdominal Pressure With Renal Resistive Index

BackgroundTo evaluate the correlation between intraabdominal pressure (IAP) measured via the bladder and renal resistive index (RRI) measured by Doppler ultrasonography (USG). MethodsEighty consecutive surgical patients were included into this study. Before Doppler USG evaluation, IAP was measured by a Foley catheter via the bladder. The left and right RRI, the diameters of the inferior vena cava and portal vein were measured by colored Doppler USG. Spearman correlation analysis was used to evaluate the correlation between different measurements. Intraabdominal hypertension (IAH) was defined as of IAP ≥ 12 mmHg. Significantly different variables from the univariate analysis between patients with and without IAH were entered into backward stepwise binary logistic regression analysis of IAH as the dependent variable. P values < 0.05 were accepted as statistically significant. ResultsIn total, 80 patients were included into study. In 27 patients (34%) IAP was normal and in 53 patients (66%) IAH was diagnosed. The Spearman correlation analysis of IAP and the ultrasonographic measurements revealed a strong correlation between RRI and IAP (P < 0.001). Patients with IAH were more likely to be diabetic and had abdominal incisional hernia compared with patients with normal IAP (P < 0.05). The results of the multivariate logistic regression analysis revealed right RRI as the only independent predictor of IAH (B: 57.04, S. E.: 13.7, P < 0.001). ConclusionsThere is a strong correlation between IAP and RRI. RRI can be an alternative, noninvasive technique for the diagnosis and follow-up of IAH after further evaluations in different patient groups.

Preoperative progressive pneumoperitoneum: The answer for treating giant inguinal hernias while avoiding morbidities?

Preoperative progressive pneumoperitoneum (PPP) is mostly used for giant abdominal incisional hernias, and only a few isolated or paired cases that used PPP in the treatment of giant inguinal hernias (GIH) have been reported. The main objective of this study is to describe our technique in the use of PPP in the treatment of GIH in a series of patients who presented with this challenging condition. We retrospectively reviewed the medical records of a series of patients treated with PPP for GIH during a 6-year period (2012-2018) at a single institution. The demographics, preoperative, and surgical characteristics were analyzed. In total, 7 patients were treated for GIH with PPP. The median age was 64 (range 30-89) years. The median history time with the inguinal hernia was 8 (range 2-20) years. The median time of PPP was 22 (range 15-30) days. All patients underwent the Lichtenstein technique. The median follow-up time was 12 (range 3-84) months. Three (42.8%) of the patients had preoperative complications. Two patients developed mild dyspnea during PPP, and another patient had subcutaneous emphysema during the insertion of the catheter. Two (28.5%) patients had postoperative complications. One of them developed a right scrotal abscess, and another patient developed bilateral grade III hydrocele. With our limited experience, it is too early to tell if this should be the gold standard for the treatment of GIH. To see if there is superiority among different procedures, more studies that compare the morbidity of PPP with that of other trans operative techniques are needed. Nevertheless, the procedure we propose has provided satisfactory results.

Implantation of biologic mesh in ventral hernia repair-does it make sense?

Biological acellular porcine dermis mesh, such as Permacol™, has been used since 2009 to treat abdominal incisional hernias in a septic context. This study investigated the risk factors for incisional hernia recurrence after biological mesh augmentation. Over a period of 6years from February 2009 to February 2015, 68 patients underwent surgery. The mesh was placed intraperitoneally with closure of the anterior fascia in 27 cases (39.7%). The biological mesh was placed in the retromuscular pre-fascial plane in 1 case (1.5%) and pre-aponeurotic plane in 1 case (1.5%). Closure of the anterior fascia was not achieved in 39 cases, including 20 cases in which the mesh was placed intraperitoneally (intraperitoneal bridging group, 29.4%) and 19 cases in which the mesh was placed between the edges of the fascia (inlay bridging group, 27.9%). There were 37 cases of postoperative surgical site infections (54.4%), and Clavien-Dindo morbidity staging indicated stage I-II and III-IV complications in 19.1% and 44.1% of the cases, respectively. The recurrence rate was 61.8%, and the mortality rate was 0%. The rate of recurrence was significantly lower in the «fascia approximated» group (37%), p = 0.001). Univariate analyses of risk factors for procedural failure indicated an increased risk of recurrence in cases of postoperative surgical site infections, complications of Clavien-Dindo grade III or higher, an absent fascial closure in front of the mesh (OR = 8.69), an operating time longer than 180min, and a VHWG score higher than 2. After logistic regression, the risk factors for recurrence were postoperative infections (OR = 6.2), placement of bridged biological mesh (OR = 22.3), and postoperative morbidity grade III or higher (OR = 16.7). Patients with postoperative surgical site infections are at an increased risk for recurrence, and bridged mesh placements lack efficacy. Overall, this study challenges the purported advantage of biologics in treating incisional hernia repairs.

A Case of Bladder Necrosis in Incisional Abdominal Hernia

症例は86歳，女性．腹痛および嘔吐を主訴に当院を受診した．子宮筋腫摘出術の既往があり下腹部正中に手術創瘢痕を認め，同部位に一致して腹部腫瘤を認めた．腹部造影CTで下腹部正中に2cm大の腹壁瘢痕ヘルニアを認め，ヘルニア内には小腸と膀胱が脱出していた．小腸・膀胱ともに造影効果に乏しく，特に膀胱は壁在ガスを認め，虚血・壊死を強く疑う所見であった．腹壁瘢痕ヘルニアの小腸・膀胱嵌頓に対して，緊急手術を施行した．膀胱は破裂までは至っていなかったものの，壊死に陥っており，壊死部の切除および縫合閉鎖を施行した．小腸も同様の所見で，小腸部分切除術を施行した．腹壁瘢痕ヘルニアへの膀胱嵌頓および壊死は稀な疾患だが，本症例は術前診断が可能であった．下腹部の腹壁瘢痕ヘルニアへの臓器脱出を有する場合には，膀胱嵌頓壊死も鑑別診断に入れた上で患者の状態に応じた術式を選択する必要があると考えられた．

INCISIONAL HERNIA IN PREGNANCY A SILENT BUT POTENTIAL FATALITY – CASE REPORT

Rupture of incisional hernia, with consequent emergency laparotomy and repair, is an uncommon complication of pregnancy. The risk to the mother and baby is enormous. We present an un-booked 29 year old G4P2+1 (1- alive) with one previous caesarean section at 29 weeks of gestation. She had a huge anterior abdominal wall incisional hernia with gravid uterus as content. She was admitted on conservative management on account of abdominal pain and preterm contractions, but subsequently developed spontaneous rupture from an ulcer with bowel evisceration. She had emergency laparotomy and repair but unfortunately had unavoidable bowels injury as they were morbidly adherent to the anterior abdominal wall with injury necessitating resection and re-anastomosis with caesarean section. The neonate suffered early neonatal death. The presence of ulceration may be a predictor of adverse maternal and foetal outcome

Maximum inspiratory and expiratory pressures in the pre and postoperative periods of patients with incisional abdominal hernia corrected by Lázaro da Silva technique.

To verify the effect of longitudinal abdominal incisional herniorrhaphy on respiratory muscle pressure. The technique of incisional herniorrhaphy used was proposed by Lázaro da Silva. To measure the pressure, we used a water manometer in 20 patients, median age 48.5 years (range 24 70). We analyzed the maximum inspiratory pressure at the level of residual volume (IP-RV) and functional residual capacity (IP-FRC) and the maximum expiratory pressure of functional residual capacity (EP-FRC) and total lung capacity (EP-TLC) in the preoperative and late postoperative (40 90 days) periods, in 13 patients with large incisional hernias and in 7 patients with medium incisional hernias. There was a significant increase in IP-FRC (p = 0.027), IP-RV (p = 0.011) and EP-TLC (p = 0.003) in patients with large incisional hernias. EP-FRC increased, but not significantly. In patients with medium incisional hernias, the changes were not significant. Surgical correction of large incisional hernias improves the function of the breathing muscles; however, surgery for medium incisional hernias does not alter this function.

A Case of Abdominal Incisional Hernia Complicated by an Abdominal Wall Abscess due to Ileal Diverticulum Penetration

A Case of Abdominal Incisional Hernia Complicated by an Abdominal Wall Abscess due to Ileal Diverticulum Penetration

Non-healing wounds: Can it take different diagnosis?

Wound healing is a complex cellular and biochemical process and can be affected by several systemic and local factors. In this study, we aimed to discuss the aetiologic factors of non-healing wounds and the management of this complicated process with current information. The medical data of the patients who were admitted to our clinic due to non-healing or chronic wounds were analysed retrospectively. A total of 27 patients were evaluated retrospectively during the 14 months of the study. The data of 6 patients who were followed up for chronic wound that developed after abdominal incisional hernia repair and pilonidal sinus surgery were not included in the study as their data could not be reached. A total of 21 patients were included in the study. Malignancy was diagnosed in two patients and granulomatous disease was found in four patients. The aetiology of the other cases included foreign body reaction, infection, and mechanical causes. Non-healing wounds are a serious social and economic problem for patients. Further studies on the pathophysiology of various aetiologies in non-healing wounds in both clinical settings and experimental animal models would be a useful step in treatment.