Abdominal Wall Incisional Hernia Research Articles

Abdominal wall incisional hernias: techniques to minimise the risks in open gynaecological surgery

Abdominal wall incisional hernias: techniques to minimise the risks in open gynaecological surgery

Application of the mesh bridging technique in the excision of abdominal endometriosis lesions: Case report and literature review.

Abdominal wall scar endometriosis (AWE) is a rare endometriosis that usually occurs after gynecological or obstetric surgery and for which surgical resection is the standard treatment. For large tissue defects after resection, abdominal wall reconstruction is needed. Here, we describe a mesh bridging technique using biological and polypropylene meshes for abdominal wall reconstruction. A 34-year-old woman visited the center with complaints of low abdominal wall pain during menstruation for more than 5 years. Her surgical history included undergoing a cesarean section delivery twice. A mass measuring 6 cm × 5 cm × 3 cm was found above the symphysis pubis in the lower part of the abdominal incision. Endometriosis lesion was considered based on abdominal ultrasound and magnetic resonance imaging findings. After a multidisciplinary discussion that included surgical experts and gynecologists, the decision was made to perform abdominal endometrial focus excision plus abdominal wall reconstruction. Two kinds of mesh were skillfully used in the operation of this patient. Biological mesh was used close to the peritoneal side and covered with polypropylene mesh to reduce the stimulation by the polypropylene mesh of the peritoneum, enhance the strength of the biological mesh, and reduce the incidence of abdominal wall hernia. Our case demonstrates that accurate diagnosis of AWE followed by complete resection and reconstruction of the abdominal wall using a combination of biological and polypropylene mesh bridging can achieve good therapeutic results and patient satisfaction.

A Comparative Study in Elective Repair of Large Incisional Hernias Using On-Lay Mesh vs. Sub-Lay Mesh – A Meta-Analysis

Abstract Background Ventral abdominal wall incisional hernia is defined as a defect in the musculo-fascial layers of the abdominal wall in the region of postoperative scar. There is a slight increase in the incidence of incisional hernia in the female gender. The higher percentage of incisional hernia in females might be due to laxity of abdominal wall muscles after multiple pregnancies and also increased incidence of obesity in females. Objective To assess incisional hernia repair using two different techniques: on-lay mesh and sub- lay mesh, as regards operative time, postoperative recurrence, wound infection, seroma, hematoma and flap necrosis. Patients and Methods The Pubmed, web of science and Scopus were searched on 15 March, 2022. The keywords incisional hernia, sub-lay mesh on-lay mesh, retromuscular mesh, polypropylene. Results and Conclusion According to our results, there is a statistical difference between onlay and sublay regarding intra-operative time as sublay mesh is more time consuming. Regarding post- operative complications there is no statistical difference in recurrence, seroma, hematoma, flap necrosis and infection but there is a statistical difference regarding in hospital stay as patients with sublay repair stays less than onlay.

A comparative study in elective repair of large incisional hernias using on-lay mesh vs. sub-lay mesh: a meta-analysis

Ventral abdominal wall incisional hernia is defined as a defect in the musculo-fascial layers of the abdominal wall in the region of the postoperative scar. There is a slight increase in the incidence of incisional hernia in the female gender. The higher percentage of incisional hernia in females might be due to laxity of abdominal wall muscles after multiple pregnancies and also an increased incidence of obesity in females. To assess incisional hernia repair using two different techniques: on-lay mesh and sub-lay mesh, as regards operative time, postoperative recurrence, wound infection, seroma, hematoma, and flap necrosis. Pubmed, Web of Science, and Scopus were searched on 15 March 2022. The keywords incisional hernia, sub-lay mesh on-lay mesh, retromuscular mesh, and polypropylene. According to our results, there is a statistical difference between onlay and sublay regarding intra-operative time as sublay mesh is more time-consuming. Regarding postoperative complications, there is no statistical difference in recurrence, seroma, hematoma, flap necrosis, and infection but there is a statistical difference regarding in hospital stay as patients with sub-lay repair stays less than only.

Abdominal Wall Reconstruction: Advances in the Last Decade

Abstract The incidence of abdominal wall hernia (AWH) is increasing because of the aging population, obesity, and the increasing number of abdominal surgeries performed. Over the last decade, there have been many improvements with the introduction of novel techniques in the management of AWH. The development of component separation and bioprosthetic mesh has transformed the management of complex ventral hernias. An increased number of complex ventral hernia repairs are being done using minimally invasive methods, including component separation. With the introduction of three-dimensional laparoscopic technique and robotic platform, the technique of component separation for abdominal wall reconstruction (AWR) has become more reproducible. In the past decade, the prosthetic materials have greatly improved, including bioengineered smart scaffold tissues such as hydrogel and electrospun fibers that have shown promising results even in infected environment. Apart from advances in complex abdominal wall repair, patient-centric outcomes and the cost-effectiveness of hernia surgery also have gained focus in the management of AWH. Today, the field of hernia has become a discipline in itself due to a better understanding of the biomechanics and pathophysiology of AWHs. There has been a tremendous development in diverse surgical techniques for complex abdominal wall repair with huge advancements in the development of hernia implants transforming it from a simple hernia repair to the science of AWR. This review aims to summarize recent developments in the field of AWR, incorporating a brief overview of the management of AWH.

Evaluation of the double mesh and intraperitoneal onlay mesh techniques in giant incisional hernias

<b>Background:</b> Giant incisional hernias are difficult to manage. The present study aims to comparatively evaluate the intraperitoneal onlay mesh (IPOM) technique to double-mesh repair techniques in patients with a midline abdominal wall incisional hernia larger than 15 cm (transvers width) that cannot be closed primarily.<br /> <b>Material and methods:</b> Patients who underwent repair surgery with the diagnosis of incisional hernia in our hospital between January 2017 and December 2019 were retrospectively evaluated. The repair was performed with open surgery using the IPOM technique in 19 patients and the double-mesh technique in 13 patients for 2 years to evaluate for postoperative complications, pain, and recurrence.<br /> <b>Results:</b> The mean age, gender distribution, body mass index, defect size, and American Society of Anesthesiologists scores were similar between the groups. The total rate of postoperative complications was 42.1% in Group A and 30.8% in Group B, with no significant difference between the groups (p > 0.05). Recurrence occurred in three patients (15.8%) in Group A, but it did not in Group B. Although the absence of recurrence in Group B was a remarkable finding, the difference was not statistically significant (p>0.05).<br /> <b>Discussion:</b> The IPOM and double-mesh techniques can be used safely to perform tension-free abdominal wall reconstruction in patients with complex and giant incisional hernias. However, the double-mesh technique may be preferred owing to its lower recurrence rate.

V-026 LAPAROSCOPIC TAPP REPAIR: IS IT REALLY FEASIBLE IN A RE-RECURRENT HERNIA?

Abstract Aim Describe a step by step laparoscopic transabdominal preperitoneal (TAPP) repair of a re-recurrent incisional lumbar hernia. Material & Methods This is the case of a 72-year-old man who had a previous traumatic right lumbar hernia initially approached by laparoscopic intra-peritoneal onlay mesh repair (IPOM) and its recurrence approached by open onlay mesh repair. CT-scan revealed a lumbar hernia on the right with a neck size of 40 mm. The hernia sac measured 65 mm and contained part of the right colon inside, without signs of incarceration nor dilated intestinal loops. According to the European Hernia Society classification for incisional abdominal wall hernias, the patient had a lateral hernia (L4 W2). Results Lateral incisional hernias are limited by the inguinal region inferiorly, the costal margin superiorly, the lateral margin of the rectal sheath medially and the lumbar region laterally. Due to their low incidence and the resulting lack of expertise in the treatment of this abdominal wall defect, surgical treatment poses a challenge- Conclusion The repair of a recurrent hernia is a daunting task, even more so of a re-recurrent one. By choosing to perform a TAPP repair, we were able to prove a laparoscopic re-do repair is feasible even faced with weakened tissues and distorted anatomy.

A rare case of an incarcerated incisional hernia with gravid uterus

Herniation of a gravid uterus through an abdominal wall incisional hernia with overlying skin necrosis is exceptionally rare. A 29-year-old multiparous K30 + 4/40 pregnant female presented with a 1-month history of worsening abdominal wall skin changes. Magnetic resonance imaging of the abdomen and pelvis confirmed herniation of the gravid uterus into the hernia sac. A lower uterine segment caesarean section and hernia repair were performed by the general surgical and obstetrics team in view of the potential maternofoetal complications. This case highlights the importance of early recognition and the difficulties in managing gravid uterus herniation.

P-032 FASCIOTENS: FIRST CASE IN THE HOSPITAL OF MéRIDA

Abstract Aim Anterior abdominal wall incisional hernias are a problem present in approximately 11–20% of patients undergoing laparotomy. Incisional hernias with loss of right of abode are associated with many physical, physiological and psychological problems. In order to surgically repair these incisional hernias with loss of right of abode, we need to perform a prehabilitation of the incisional hernias. Effective prehabilitation is required in order to close the aponeurotic defect without tension and to return the hernial contents to the abdominal cavity. Material and methods A 59-year-old female patient with a history of open cholecystectomy and incisional hernia repaired on three occasions, presenting with multisaccular midline incisional hernia (M1-M4 W3) containing colon and greater omentum. Results After application of botulinum toxin and Fasciotens, it is possible to perform Rives-Stoppa retrorectus repair, being able to reduce the hernial content without tension and without increasing intra-abdominal pressure. Conclusions Prehabilitation in complex abdominal wall surgery is essential to repair large aponeurotic defects without tension. In addition, the application of Fasciotens after administration of botulinum toxin allows closure of the aponeurotic defect using standard abdominal wall closure techniques.

To Compare Outcome of Open Versus Laproscopic Repair for Primary Ventral Hernias

Background: Primary ventral and incisional abdominal wall hernias are frequent conditions that necessitate surgery, and both types of hernias can be treated utilizing an open or laparoscopic technique. Improvements in laparoscopy have also been linked to a decrease in pain scores. Methodology: A dual setting study was conducted from July 2017 to June 2019 at Peshawar medical college with collaboration of Lady Reading Hospital and Hayatabd Medical Complex, Peshawar and was conducted on a total of 120 patients who were diagnosed with ventral hernia. A random number table created by a computer indicated repair of an open ventral hernia technique (group 1, n = 60) or laparoscopy (group 2, n = 60). Results: Among 60 patients in the laparoscopy group, there were 37 cases of PUH, 15 cases of epigastric hernia, 8 cases of umbilical hernia, and among 60 cases of open abdominal hernia, including 31 cases of PUH, 19 cases of hernia in the abdomen. upper abdomen, and 10 cases of umbilical hernia. Wound-related complications were most commonly seen in the open procedure group of patients. Conclusion: This has led to broad acceptance of the laparoscopic surgery, and advantages particularly in order to decrease the post-operative mortality and morbidity, time of operation, bleeding and the duration of hospital stay along the ability to execute the surgery on the obese people and with abdominal scarred individuals. Keywords: Incisional hernia, Laparoscopic mesh repair, Open mesh repair, Primary ventral hernia.

Enterocutaneous Fistula Management and Clinical Nutrition in Sepsis of Abdominal Wall Incisional Hernia. Tips, Tricks and Literature Revision

Enterocutaneous Fistula Management and Clinical Nutrition in Sepsis of Abdominal Wall Incisional Hernia. Tips, Tricks and Literature Revision

Gallbladder-preserving polypectomy for gallbladder polyp by embryonic-natural orifice transumbilical endoscopic surgery with a gastric endoscopy

Background and aimsCholecystectomy is performed for most gallbladder polyps (GPs). However, cholecystectomy results concerning complications in some patients. For benign GPs, adoption of gallbladder-preserving surgery is worth to recommend. We describe our experiences performing gallbladder-preserving polypectomy for GPs by embryonic-natural orifice transumbilical endoscopic surgery (E-NOTES) with a gastric endoscopy.MethodsThis is a retrospective study of patients with GPs who underwent gallbladder-preserving polypectomy by E-NOTES with a gastric endoscopy from April 2018 to September 2019 in our hospital. The operative time, intraoperative hemorrhage, intraoperative and postoperative complications, gallbladder emptying function were obtained and analyzed.ResultsThe procedure was performed successfully in all 12 patients with 5 cases of single polyp and 7 cases of multiple polyps. The range of GPs size was 2 mm to 15 mm. The mean operation time was (95.33 ± 23.08) minutes (55–135 min). There were no adverse events including heavy bleeding, mortality and conversion to open surgery during operation. All patients were discharged in 4–5 days after surgery without postoperative complications such as delayed bleeding, fever, peritonitis, intra-abdominal abscess and abdominal wall incisional hernia. All patients were followed up at 1, 3, 6, and 12 months postoperation who had almost no visible incision on the umbilical region, no recurrent GPs. The gallbladder emptying function decreased one month after surgery, and gradually improved 3, 6 and 12 months after surgery.ConclusionE-NOTES gallbladder-preserving polypectomy is a safe and effective option for patients with GPs and is close to scar-free surgery which can be performed in routine clinical practice.

The extended-view totally extraperitoneal (eTEP) approach for incisional abdominal wall hernias: results from a single center.

The extended-view totally extraperitoneal (eTEP) approach is a promising technique for abdominal wall hernias and has increased in popularity among hernia surgeons in recent years. This study aims to present the results of applying the laparoscopic eTEP approach for incisional abdominal wall hernias (IAWHs). This study is a retrospective analysis of a prospectively collected dataset of 30 patients who underwent laparoscopic eTEP for IAWHs between October 2018 and March 2021 (median follow-up of 15months). Thirty patients (8 male, 22 female) with a mean age, mean body mass index, and median ASA score of 53.5, 30.8, and 2, respectively, underwent the eTEP procedure for incisional abdominal wall hernias. In total, 11 (36.7%) patients had a recurrent IAWH. Seventeen (56.7%) patients were treated with eTEP RivesStoppa (eTEP-RS), whereas 10 (33.3%) patients needed the eTEP transversus abdominis release (eTEP-TAR) procedure. In three patients, conversions to other procedures (laparoscopic intraperitoneal onlay mesh-plus (IPOM-Plus) and open RivesStoppa) were needed due to intraoperative complications: iatrogenic perforation to the intestine and large peritoneal tear causing loss of the working space. The mean operative time and mean length of stay (LOS) were 203.5min and 1.5days for eTEP-RS and 291.5min and 1.6days for eTEP-TAR, respectively. Two patients developed asymptomatic seromas, and one patient developed an asymptomatic hematoma; all were treated conservatively. Only one recurrence was observed over the course of the follow-up period. The eTEP approach is a safe and feasible option for IAWH repair and a valuable addition to the armamentarium of hernia surgeons.

Open posterior component separation with transversus abdominis release (TAR) for large incisional abdominal wall hernias: Results from a single center

Transversus abdominis release (TAR) is the newest approach that allows effective myofascial mobilization, creating a large retromuscular space and wide mesh overlap to repair complex and large incisional ventral hernias. This article narrates the technical details and results of the TAR technique performed in a single center. The present study is a retrospective analysis of a prospective dataset from 25 patients who underwent posterior component separation (PCS) with TAR procedure for large incisional ventral hernias between October 2017 and July 2021. The minimum follow-up period was ten months. Twenty-five patients (five male, 20 female) with a mean age of 61.2 years, a mean BMI of 32.2 kg/m2, and a median ASA score of 2.0 underwent the TAR procedure. Fifteen (60%) patients had a history of incisional hernia surgery. The mean surgical time was 248 minutes. The mean total defect and mesh areas were 187.4 (90-500) cm2 and 1141.8 (750-2250) cm2, respectively. The mean visual analog scale (VAS) pain score on the first postoperative day was 4.5 and the median hospital length of stay (LOS) was 5 days. There were three (12%) surgical site infections (SSIs), two of which were deep infections that needed debridement. During the follow-up period (median of 26 months), two (8%) recurrences were recorded. The TAR technique represents an effective and safe repair modality of large and complex incisional hernias. TAR is an essential addition to the repertoire of the surgical community.

Abdominal aortic aneurysms and abdominal wall hernias - a systematic review and meta-analysis.

Background: Abdominal wall hernias (AWHs) share common epidemiological characteristics with abdominal aortic aneurysms (AAAs), typically presenting in male population and older ages. Prior reports have associated those two disease entities. Our objective was to perform a systematic review and meta-analysis and examine whether AAA rates are higher among patients with AWH vs controls and whether the incidence of AWH was higher among patients with AAA vs patients without AAA. Methods: We performed a systematic review and meta-analysis according to the PRISMA guidelines. The Medline database was searched up to July 31, 2020. A random effects meta-analysis was performed. Results: In total, 17 articles and 738,972 participants were included in the systematic review, while 107,578 patients were eligible for the meta-analysis. Among four studies investigating the incidence of AAA in patients with hernias, AAA was more common in patients with hernias, compared to patients without hernias. [OR: 2.53, 95% CI: 1.24-5.16, I2=81.6%]. Among thirteen studies that compared patients with known AAA vs no AAA, the incidence of hernias was higher in patients with AAA, compared with patients without AAA [OR: 2.27, 95% CI: 1.66-3.09, I2=84.6%]. Conclusions: Our study findings indicate that a strong association between AWH and AAA exists. AWHs could therefore be used as an additional selection criterion for screening patients for AAA, apart from age, gender, family history and smoking.

The quest to improve outcomes for abdominal wall incisional hernia repair in Pietermaritzburg: between Scylla and Charybdis

ABSTRACT BACKGROUND: The repair and outcomes of incisional abdominal wall hernias have not yet been benchmarked to allow comparison with recommended best practice in a South African context. This study aimed to address this deficit METHOD: Patients who underwent an incisional hernia repair between December 2012 and December 2018 were analysed in respect to the following variables: demographics, comorbidities, indication for surgery, site, size, surgical approach, mesh usage, operating times, complications and 30-day mortality RESULTS: Of the cohort of 224 patients, 185 underwent elective repair. There were 152 open and 72 laparoscopic procedures, and 17 patients (8%) required a repeat operation with an overall in-hospital mortality rate of 6% (13). Eight patients developed an enteric leak. There were nine cardiovascular complications, 24 respiratory complications, 22 surgical site infections and 13 patients developed an acute kidney injury (AKI). There were 39 emergency operations. The emergency cohort were older than the elective with a higher rate of cardiovascular or surgical (CVS) complications and AKI. Eight patients developed an enteric leak. Mortality rates of were significantly higher in the emergency operation cohort compared to the elective group (18% vs 3%). The 13 in-hospital deaths were older, more likely to have undergone an emergency operation, to be diabetic (46% vs 10%), hypertensive (92% vs 33%), have a bowel anastomosis (39% vs 9%), experience an enteric leak (46% vs 1%) and require repeat operation than the patients who survived CONCLUSION: Incisional abdominal wall hernias are difficult to manage as the patients often have several comorbidities which when coupled with an emergency operation leads to poor outcomes. Improving outcomes requires strategies that address comorbidities and shift the focus to elective rather than emergency repair Keywords: incisional, hernia

CONCOMITANT VENTER PENDULUM, DYSTROPHY AND HERNIA OF THE ABDOMINAL WALL SURGERY – OUR EXPERIENCE

Weakness and incisional hernias of the anterior abdominal wall are a consequence of severe weight loss and complications after abdominal surgery. The presence of excess skin of the anterior abdominal wall necessitates the need for concomitant surgery of the excess skin and the weakness of the muscles of the anterior abdominal wall. The aim of this paper was to present our experience with concomitant surgery of the weakness of the anterior abdominal wall and excess skin when these two conditions were present at the same time. This retrospective consecutive study included 9 patients, in whom dermolipectomy was performed and strengthening of the anterior abdominal wall by placing individual sutures supra- and infraumbilically, in two layers. Due to the presence of incisional hernia, a polypropylene mesh was placed in three patients. In all patients, two drains were placed pubically. Postoperatively, patients wore a compression bandage. A total number of 9 patients, the ratio of women to men 8 : 1, were included in the study. Polypropylene mesh was placed in three patients due to the presence of an infraumbilical incisional hernia. The average number of days for drainage was 7 in 45% of patients. Early postoperative complication with seroma occurred in 23%, and late postoperative complication also with seroma formation occurred in 11% of cases. Concomitant surgery to strengthen the anterior abdominal wall and remove excess skin is a safe and effective method, which saves time and money. Keywords: concomitant, dermolipectomy, hernioplasty

METHODS FOR ASSESSING THE RISKS OF COMPLICATIONS IN PATIENTS WITH HERNIAS OF THE ANTERIOR ABDOMINAL WALL. REVIEW

The work is based on the analysis of literature data devoted to the problem of assessing postoperative complications in patients with primary and incisional hernias of the anterior abdominal wall. The main purpose of this review is identifying existing methods for assessing local, general perioperative complications and determining of the most reliable prognostic scales and methods for assessing risk factors among the existing ones.The first part of the article is devoted to the assessment of the general condition of patients with hernias of the anterior abdominal wall. The existing scales for assessing modifiable risk factors (MFR), methods of preventing complications, including abdominal bandage, are considered. The main risk factors were determined: CDC wound class, patient age, hernia size, smoking, diabetes, risk 3 and higher according to ASA.In the second part, the assessment of risk factors for complications from the surgical site is considered. The problem of terminology standardization, the difference between surgical site infection (SSI), adverse surgical events (SSO) and surgical site occurrences requiring procedural interventions (SSOPI) is described. Scales for assessing the risks of perioperative complications are presented. The evolution of SSO assessment methods from a four level to a three level scale is described. The Russian experience in assessing the combination of MFR is presented.The third part describes the importance of evaluating post traumatic stress disorder in patients as a risk factor for an unfavorable course of the postoperative period. The European EuraHS QoL Questionnaire, recommended for use in the European Hernia Registry, is presented. The section also highlights the relevance of the selection of patients with hernias in outpatient surgery and one day hospitals.The main idea of developing modern methods for assessing complications after hernioplasty is a comprehensive assessment of the patient's individual profile before operations for primary and incisional hernias in different risk groups. Priority should be given to tailored specific electronic questionnaires.

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.

Diagnostic Aspects and Results of Surgical Treatment of Post-Operative Incisional Abdominal Wall Hernias at The University Hospital Center of Libreville (Gabon)

Diagnostic Aspects and Results of Surgical Treatment of Post-Operative Incisional Abdominal Wall Hernias at The University Hospital Center of Libreville (Gabon)