Anterior Abdominal Wall Hernia Repair Research Articles

EFFECT OF ADDITION OF DEXAMETHASONE TO ROPIVACAINE ON POST-OPERATIVE ANALGESIA IN ULTRASOUND-GUIDED TRANSVERSE ABDOMINIS PLANE BLOCK FOR ANTERIOR ABDOMINAL WALL HERNIA REPAIR

Objective: The objective of the present study was to evaluate the adjuvant effect of dexamethasone to Ropivacaine in ultrasound-guided transverse abdominal plan block for anterior abdominal wall hernia repair. Methods: A single-blind randomized control trial was conducted by selecting patients undergoing anterior abdominal wall hernia and dividing them into two groups with Group A: received a total of 50 mL of 0.2% Ropivacaine (48 mL) with normal saline (2 mL) and Group B received a total 50 mL of 0.2% Ropivacaine (48 mL) with 8 mg dexamethasone (2 mL). Outcome was assessed on the basis of visual analog scale (VAS), the requirement of rescue analgesia, and adverse events. Results: Twenty-seven patients were recruited in each group, Group A and Group B had an average pain-free interval of 11.85±2.82 and 8.07±2.51, respectively (p<0.001). Mean VAS was lower in Group B at the end of 2 h (p<0.05). Both the groups had similar side effects with no significant difference. Total analgesia dose required in Groups B and A was 75 and 96 mg, respectively (p<0.001). Conclusion: A combination of 0.2% Ropivacaine (48 mL) with 8 mg dexamethasone (2 mL) significantly reduces the VAS in post-operative pain along with reduced quantity and frequency of rescue analgesia.

MORPHOLOGICAL FEATURES OF THE REPARATIVE PROCESS IN THE PLASTIC SECTION OF THE MUSCLE-APONEUROTIC DEFECT IN THE EXPERIMENT USING STEM CELLS

Abstract. Anterior abdominal wall hernia repair is one of the most common procedures in general surgery. Very often, the parameters of the quality of life of operated patients with ventral hernias of the anterior abdominal wall during the fi rst year after the operation, according to a number of criteria, are signifi cantly better with alloplastic with polypropylene mesh, in contrast to the use of hernioplasty with the use of inert suture material. Hernias of the anterior abdominal wall (ventral hernias) most often occur after surgical intervention on the organs of the abdominal cavity and are considered postoperative complications arising in anatomically weak areas and under the infl uence of mechanical factors. The goal of the work. To experimentally investigate the eff ect of mesenchymal stem cells on the regeneration of muscle fi bers and their reparative properties in the area of postoperative wounds. When modeling a muscle- aponeurotic defect of the anterior abdominal wall with plasticity with own tissues and plasticity with an allograft in combination with injections of mesenchymal stem cells. The study was conducted on 38 white rats of both sexes, the initial weight of each animal was 215±12 g, the experimental animals were kept in the same conditions with full compliance with bioethical norms. All animals of groups 1 and 2 were experimentally modeled a muscle- aponeurotic defect of the anterior abdominal wall by an acute method up to 2.5 cm in diameter, followed by layer-by-layer suturing of this defect with a continuous wraparound single-row suture, «Vicryl» 3/0 with a barb was used as suture material with a needle In the 2nd group, plastic surgery was performed using the «on lay» technique with polypropylene mesh and suture material «Vicryl» 3/0 with a barbed needle, and mesenchymal stem cell injections were additionally performed. At the plastic site of the muscle- aponeurotic defect, the tissue of the anterior abdominal wall was taken in full layers for further histological examination. Histological examination of the wound tissues of animals of the control group 10 days after surgery showed that the wound defect was fi lled with granulation tissue at an early stage of maturation. After 30 days, the wound defect was fi lled with young loose connective tissue, in which there were sporadic islands of granulation tissue. In the area of the wound defect of 2 groups of experimental animals, after 10 days we detected maturing granulation tissue. Visually, the area of the lesion itself decreased. On the 30th day of the study, there was no granulation tissue, the wound defect was fi lled with fully matured newly formed and vascularized connective tissue. During the histological examination, it was found that as a result of the combined use of polypropylene mesh and stem cells, the regeneration of the wound defect is intensifi ed and its healing is accelerated.

Development of the Acellular Dermal Matrix and Experimental Substantiation of Its Use in the Anterior Abdominal Wall hernia Repair

Objective: To develop a biological implant that is an acellular dermal matrix (ADM), evaluate its use as a support material in tensionfree hernioplasty for ventral hernia, and compare it to that of the commercially available implant PermacolTM. Materials and methods: ADM was derived from the porcine dermis (Landrace breed) decellularized using detergents and enzymes. The quality of devitalization was assessed in vitro. We performed sublay hernioplasty in 4-month-old Landrace pigs using ADM (experimental group) and PermacolTM (control group). The specimens were explanted on day 120 of the experiment for histological and immunohistochemical examination. Results: All cellular elements were removed by the detergent-enzymatic treatment of the dermis; the native architecture of the dermis was slightly disrupted. The specimens of the commercially available chemically cross-linked biomaterial PermacolTM had better mechanical properties than ADM specimens; however, there were no significant differences in terms of cytotoxicity. The state of the tissues after the explantation (number of fibroblasts and endothelial cells) showed no differences in the result of using ADM and PermacolTM. In 120 days, the materials integrated into the tissues without the formation of adhesions or inflammation. Conclusions: Our findings show that ADM does not have cytotoxic properties, has adequate biomechanical parameters to effectively reinforce supporting soft tissues, does not cause an inflammatory response during implantation, and integrates fully into tissues. Our study demonstrates the effectiveness and utility of the developed ADM in surgical treatment of anterior abdominal wall defects.

Comparison of Absorbable versus Non Absorbable Tackers for Fixation of Mesh in Laparoscopic Midline Anterior Abdominal Wall Hernia Repair: A Randomised Clinical Study

Introduction: Tackers are divided in two broad categories namely, absorbable and non absorbable. Absorbable tackers are believed to achieve sufficient tensile strength compared to conventional non absorbable tackers. It is a matter of debate that which type of tacker has an upper hand over the other especially in terms of postoperative pain and recurrences even after few years of clinical experience with these tackers and available clinical studies. Aim: To compare various aspects of absorbable versus non absorbable tackers for fixation of mesh in Laparoscopic Midline Anterior Abdominal Wall Hernia Repair for short period of follow-up. Materials and Methods: In this prospective randomised clinical study from November 2016 till March 2018 at ABVIMS and Dr. RML Hospital, India. Eighty patients of age ≥18 years with midline anterior abdominal wall hernia were included and randomised into two groups (40 patients each). Group 1: Absorbable Tackers; and Group 2: Non Absorbable Tackers. Outcomes evaluated were postoperative pain, seroma formation, paralytic ileus, early recurrence (3 months follow-up) and duration of hospital stay.The data acquired was analysed using Statistical Package for Social Sciences (SPSS) version 22.0. Comparison of ordinal paired data was done using Wilcoxon signed rank sum test. The nominal categorical data was compared using chi-squared or Fisher’sexact test as appropriate. A p-value of <0.05 was considered statistically significant. Results: Out of 80 patients included in this study with a range of 21 to 60 years, the median age was 30 years. There was no statistically significant association noted in terms of postoperative pain (p-value >0.05), seroma formation (p-value=1), paralytic ileus (p-value >0.05), length of hospital stay (p-value=0.801) and early recurrence (3 months). Conclusion: This study has shown that both non absorbable and absorbable tackers are associated with minimal postoperative complications and have similar postoperative morbidity. Both absorbable and non absorbable tackers are comparable for fixation of mesh in laparoscopic midline anterior abdominal wall hernia with respect to the above mentioned outcomes.

Efficacy of single dose versus multiple dose antibiotic prophylaxis in anterior abdominal wall hernia repair at a tertiary hospital

Introduction: Our study is aimed to compare the impact of single vs. multiple dose of antibiotic in terms of post-operative infection related complications. In Anterior Abdominal Wall Hernia Repair at a Tertiary Hospital. Materials and Methods: The present study was prospective and longitudinal. Protocol of the procedure was formed along with Performa, Patient Information Sheet and Informed Consent Form. This study was carried out from October 2017 to September 2018 in surgery department of SSMC, Tumkur, in association with. Total 100 patients who were admitted for elective surgery were included in our study. The patients were randomly divided in two equal groups: single dose (SD) group and multiple dose (MD) group, comprising of 50 patients in each group. SD group was given Amoxycillin-Clavulanic acid (2 gm) intravenously at the time of induction of anaesthesia. Whereas, MD group was given Amoxycillin-Clavulanic acid (2 gm) intravenously at the time of induction of anaesthesia followed by Amoxycillin-Clavulanic acid (1 gm) intravenously twice a day for two days post-operatively. Results: In single dose antibiotic group, total post-operative infection rate was 8% and that in multiple dose groups was found to be 0%. Data was analyzed with Chi- square test and the difference in the rate of SSI in both the groups was found statistically insignificant. Conclusion: The rate of post-operative SSI after single dose antibiotic intravenously at induction of anaesthesia is comparable with that of multiple dose antibiotics. So single dose antibiotic regimen can be safely practiced in this surgery.

Anterior abdominal wall hernia repair with e-TEP technique: A single-center experience with short term results

Anterior abdominal wall hernia repair with e-TEP technique: A single-center experience with short term results

Efficacy of intraoperative local administration of 0.5% bupivacaine on postoperative pain control following anterior abdominal wall hernia repair-A prospective case-control study

Introduction: With current technological advancement and availability of synthetic materials used in inguinal hernia repair, a recurrence after first intervention is not a common and important adverse event [1, 2]. On the other hand, however, some patients complain about chronic pain of the operated site after surgeries using a polypropylene mesh [3]. Many patients are constrained to a prolonged use of analgesics and increased frequency of control visits, which may even­tually result in loss of trust in the operator [3]. Every surgical intervention is associated with the risk of immediate or delayed complications [4, 5]. Genitofemoral neuralgia is associated with dysfunction of peripheral nerves passing through the inguinal canal or the surround­ing tissue and it is a chronic, troublesome and undesired complication of an inguinal hernia repair [5]. The possibility of minimizing chronic inguinal pain by proper management during herniorrhaphy should be considered in all cas­es of an inguinal canal reconstruction [6]. Objectives: To assess the efficacy of intraoperative injection of 0.5% bupivacaine (analgesic) into the operated site on the postoperative pain over operated site, assessed on the day of operation as well as the 1st and 2nd postoper­ative day after anterior abdominal wall hernia repair. Materials and methods: A prospective analysis of patient data compiled by assessment of Post-Operative pain at operated site documented and patient follow up recorded over the period from March 2018 and December 2018 at RL Jalappa hospital and research centre, Tamaka, Kolar. Results: All complications of the surgical wound significantly increased pain level on postoperative day 2. The NRS score for complicated surgical wound was 2.1 on av­erage. In the case of uncomplicated wounds, it was 0.72 (2.1 vs. 0.72 on day 2). Presence of blood in the surgical wound manifesting itself by ecchymosis and hematoma increased pain level assessed on postoperative day 2 (NRS score 2.0 vs. 0.79 in day 2). Duration of procedure did not influence pain sensation on post­operative day 0, 1, 2. In the group with inguinal hernias, postoperative complications of the wound occurred in 8.3% (n=3). Skin and subcutaneous tissue oedema of the wound was found in 10% (n=5) of patients.

Diagnosis and treatment of seroma after anterior abdominal wall hernia repair by using of mesh implant

Diagnosis and treatment of seroma after anterior abdominal wall hernia repair by using of mesh implant

Efficacy of Multiple Doses of Antibiotics in Anterior Abdominal Wall Hernia Repair at a Tertiary Rural Hospital

Efficacy of Multiple Doses of Antibiotics in Anterior Abdominal Wall Hernia Repair at a Tertiary Rural Hospital

Cost–Benefit Analysis Comparing Laparoscopic and Open Ventral Hernia Repair

ObjectiveLaparoscopic surgery is a successful treatment option offering significant advantages to patients compared with open ventral hernia repair. A cost–benefit analysis was performed to compare the clinical results and economic costs of the open and laparoscopic techniques for anterior abdominal wall hernia repair, in order to determine the more efficient procedure. Materials and methodsWe performed a prospective study of 140 patients with primary and incisional hernia, and analyzed clinical data, morbidity, costs of surgery and hospital stay costs. ResultsThe cost of disposable surgical supplies was higher with laparoscopic repair but reduced the average length of stay (P<.001) and patient morbidity (P<.001). The total cost of the laparoscopic procedure was, therefore, less than initially estimated, yielding a savings of 1260€ per patient (2865€ vs 4125€). ConclusionsLaparoscopic ventral hernia repair is associated with a reduced complication rate, a lower average length of stay and with lower total costs. Laparoscopic repair can save 1260€ for each patient, and so this procedure should be considered a cost-effective approach.

Estudio de coste-beneficio comparando la reparación de la hernia ventral abierta y laparoscópica

ObjectiveLaparoscopic surgery is a successful treatment option offering significant advantages to patients compared with open ventral hernia repair. A cost-benefit analysis was performed to compare the clinical results and economic costs of the open and laparoscopic techniques for anterior abdominal wall hernia repair, in order to determine the more efficient procedure. Material and methodsWe performed a prospective study of 140 patients with primary and incisional hernia, and analyzed clinical data, morbidity, costs of surgery and hospital stay costs. ResultsThe cost of disposable surgical supplies was higher with laparoscopic repair but reduced the average length of stay (P<.001) and patient morbidity (P<.001). The total cost of the laparoscopic procedure was, therefore, less than initially estimated, yielding a savings of 1,260€ per patient (2,865€ vs. 4,125€). ConclusionsLaparoscopic ventral hernia repair is associated with a reduced complication rate, a lower average length of stay and with lower total costs. Laparoscopic repair can save 1.260€ for each patient, and so this procedure should be considered a cost-effective approach.

Single-incision laparoscopic intraperitoneal onlay mesh hernioplasty for anterior abdominal wall hernia: A safe and feasible approach.

BACKGROUND:Single-incision laparoscopic surgery is being increasingly performed in experienced laparoscopic centres. The primary aim is at improving the cosmetic outcome of surgery without compromising the safety of the operation. The challenge of this surgery lies in limited range of movement of the instruments due to proximity of working ports and limited triangulation.METHODS:We describe our first four consecutive cases of single-incision laparoscopic intraperitoneal onlay mesh hernioplasty for anterior abdominal wall hernia repair during a period of June to July 2009. Operative time, hospital stay and postoperative pain were assessed, and follow up was done for 3 months.RESULTS:Three patients were discharged on first postoperative day and one on second postoperative day without any complications.CONCLUSIONS:Based on our experience, we believe that the procedure is feasible without additional risk. Cosmetic benefit is clear; however, beyond that the actual outcome with respect to patient recovery, postoperative pain and long-term complications needs to be evaluated and compared to standard laparoscopic intraperitoneal onlay mesh hernioplasty.

Concurrent Gastric Bypass and Repair of Anterior Abdominal Wall Hernias

Many patients seeking surgical treatment for morbid obesity present with anterior abdominal wall hernias. Although principles of hernia repair involve a tension-free repair with the use of prosthetic mesh, there is concern about the use of mesh in gastric bypass surgery due to potential contamination with the contents of the gastrointestinal tract and resultant mesh infection. We report our series of patients undergoing Roux-en-Y gastric bypass (RYGBP) and simultaneous anterior abdominal wall hernia repair. All patients who underwent simultaneous RYGBP surgery and anterior abdominal wall hernia repair were reviewed. 12 patients underwent concurrent RYGBP and anterior wall hernia repair. There were 5 women and 7 men with average age 54.9 +/- 8.5 years (range 35 to 64) and average body mass index (BMI) 50.4 +/- 10.3 kg/m(2) (range 38 to 70). Two open and 10 laparoscopic RYGBP operations were performed. Nine patients (75%) underwent incisional hernia repairs and 3 patients (25%) underwent umbilical hernia repair concurrent with gastric bypass. Average size of defect was 14.7 +/- 13.4 cm(2). One patient had primary repair and 11 patients had prosthetic mesh repair: polypropylene in 3 patients (25%) and polyester in 8 patients (67%). With a 14.1 +/- 9.3 month follow-up, there have been no mesh infections and 2 recurrences, one in the patient who underwent primary repair and one in a patient repaired with polyester mesh but with two previous failed incisional hernia repairs. Concurrent RYGBP and repair of anterior abdominal wall hernias is safe and feasible. In order to optimize success, tension-free principles of hernia repair with the use of prosthetic mesh should be followed since no mesh infections occurred in our series.

A novel laparoscopic technique for the repair of pediatric umbilical and epigastric hernias

Background/Purpose The aim of this study was to determine whether a novel laparoscopic technique for pediatric umibilical and epigastric hernia repair is safe, quick, effective, durable, and cosmetically acceptable. Methods Forty-one consecutive umbilical and 13 epigastric hernias were repaired laparoscopically. Six patients had concomitant epigastric and umbilical hernias repaired during one procedure. Two 3-mm ports were used via a lateral approach. Mean age was 4.2 years for those with an umbilical hernia and 2.0 years for those with an epigastric hernia. Results All procedures were completed laparoscopically. The mean operative time was 27 minutes for umbilical hernia repair and 16 minutes for epigastric hernia repair. There were no intraoperative or postoperative complications. Follow-up was 100% and ranged from 6 to 35 months. There have been no recurrent hernias, and patient/parent satisfaction was subjectively excellent. Conclusion This case series demonstrated that this novel technique of laparoscopic anterior abdominal wall hernia repair is safe, quick, effective, durable, and cosmetically acceptable. It requires few instruments and minimal advanced laparoscopic techniques.