Development Of Hernia Research Articles

Not deep enough: Modeling the effect of shallow placement of the DaVinci Xi "bariatric" long trocar on the muscular abdominal wall.

The DaVinci Xi Robotic Surgical System (Xi) long cannula (Intuitive Surgical Company, Sunnyvale, CA) provides five additional centimeters of distal length compared to the standard Xi trocar. The extra length allows the cannula to traverse prohibitively thick body wall tissue. Our aims are to quantitatively model the consequences of not preserving the rotational centerpoint of motion (RCM) at the muscular abdominal wall. This is an essential tenet in robotic surgery; it is violated with shallow placement of the long trocar. This leads to unchecked, unnoticed blunt widening of port sites by the robotic arm, increasing hernia risk. We begin with an exploration of the schematic of the Xi robotic arm as patented by Intuitive (U.S. Patent #5931832). We trigonometrically model the lateral displacement of the abdominal wall at the trocar site with respect to vertical trocar shallowness, instrument tip depth, and instrument tip lateral motion from neutral midline. The rigid parallelogram movement structure of the Xi preserves the RCM at the thick black marker printed on every Xi cannula. By limitation of design, both long and standard trocars must have this marker at the exact same distance from their proximal end. The value ranges of our model parameters (presuming a reasonable maximum orientation angle of 45° from midline) are: trocar shallowness [1cm, 7cm]; instrument tip depth [0cm, 20cm]; instrument tip lateral movement [0.0cm, 14.1cm]. Abdominal wall displacement increased proportionally as each instrument tip parameter reached its maximum deviation from the orthogonal midline as described in the plot figure. Maximal wall displacement at maximal shallowness was approximately 7.0cm. Robotic surgery revolutionizes modern operation, particularly within bariatrics. However, the current Xi arm design disallows a true long trocar to be used safely without compromising the RCM, thereby risking hernia development.

Risk Factors for the Development of Parastomal Hernia: A Narrative Review.

Parastomal hernia is one of the most common late complications after stoma formation, significantly decreasing patient's quality of life and negatively impacting body image and physical functioning. Progress has been made regarding the surgical technique of stoma creation in different categories of patients, but a better understanding of the risk factors is crucial in reducing the likeliness of parastomal hernia formation and in helping develop risk stratification strategies for pre-and post-operation management. However, currently there is limited consensus on the associated risk factors. Accordingly, for this narrative review, the authors conducted a literature review through three databases (PubMed, Web of Science, and Scopus) and categorized the identified risk factors into the following three categories: patient-, surgery-, and disease-related. Within these categories, the following 10 risk factors were identified and discussed: age, gender, waist circumference, type of ostomy, laparoscopic approach, aperture size >3 cm, stoma not passing through the middle of rectus abdominis muscle, BMI >25 kg/m2, altered collagen metabolism, and diabetes.

Sarcopenia and visceral fat in patients with incisional hernia after urgent laparotomy.

Various risk factors have been associated with the development of incisional hernia (IH). Some recent papers underlined that visceral fat could be a reliable indicator. Another risk factor which is of increasing clinical interest is sarcopenia. Recent studies have identified it as an independent predictor of poor postoperative outcomes following abdominal surgery. We aimed to investigate the role of visceral fat and skeletal muscle as emerging risk factors for IH after urgent laparotomy. Patients aged 18 years or older who underwent urgent median laparotomy and with continuous direct suturing of the laparotomy were included. They were categorized into two groups: those with a median IH and those without IH at 12-month follow-up. Demographic data were prospectively collected while CT scans were retrospectively reviewed. The data were compared among two groups. From January 2018 to May 2021, 364 patients underwent urgent surgery in our Department, of whom 222 were aged >18 years old and underwent median laparotomy. Forty-four patients had diagnosis of median IH, while 41 patients without IH were identified as the control group. Statistically significant differences emerged for BMI and for the area of visceral fat. The association with the presence/absence of sarcopenia was not significant. Even when surgery is performed in urgent settings, it could be important to identify patients at risk, especially as CT scans are generally available for all patients with urgent abdominal disease.

Effects of an abdominal binder on the development of incisional hernia in the long term: A prospective cohort study

AbstractObjectivesThe effects of using an abdominal binder after abdominal surgery on the development of incisional hernias in the long term are far from certain. This study aims to analyse the effects of abdominal binder use on the development of incisional hernia in the long term.MethodsThe population of this prospective cohort study included 84 patients, who underwent abdominal surgery and were evaluated for the effects of abdominal binder use between September 2013 and April 2014. The study sample comprised 57 patients (30 used an abdominal binder and 27 did not use one), who took part in the first research and agreed to participate. We conducted a telephone survey with the participants in September 2017 and asked them to answer the questions on the symptoms of and the risk factors associated with incisional hernia.ResultsComparison of the two groups in terms of patient, surgical and treatment characteristics revealed no statistically significant difference (P > .05). Incisional hernia occurred in eight patients who used an abdominal binder and in five patients who did not use one. There was no statistically significant relationship between abdominal binder use and the development of incisional hernia 3 years after the abdominal surgery (P > .05).ConclusionsThis study found that abdominal binder use after abdominal surgery had no effects on the development of incisional hernia in the long term. Data on abdominal binder use were self‐reported by the patients. Better designed cohort studies on larger populations may be conducted in the future.

Opportunities and challenges for the high-quality development of hernia and abdominal wall surgery in China

Hernia and abdominal wall surgery is a relatively new subspecialty in surgery. Although it started late in China, after 25 years of rapid development, it has made remarkable achievements and has become an important part of surgery, laying a solid foundation for the further development of the discipline. At the same time, one should also be soberly aware of the present deficiencies in this field. The development of the field should be more detailed and in-depth from the following aspects: correct understanding of new concepts of hernia and abdominal wall surgery, establishment of hernia patient registration and quality control system, technological innovation and development of technical equipment, especially the expansion of robot surgical systems, materials science progression to hernia and abdominal wall surgery. Faced with this challenge, China is expected to achieve high-quality development in the field of hernia and abdominal surgery.

The Risk Factors for Parastomal Hernia Development: A 8-year Retrospective Study in Colorectal Surgery

Background: Although parastomal hernia is a common complication of ostomy surgery, the exact risk factors for its development remain unclear. The aim of this study was to determine the incidence and risk factors of parastomal hernia in ostomy patients. 
 Methods: A retrospective study was conducted. The data from a cohort of 952 ostomy patients' hospital records between 2013 and 2020 were extracted and analyzed. Patients’ ostomy-related characteristics, complication notes, and the occurrence of parastomal hernia were retrieved. 
 Results: The patients' mean age was 59.6 years (±14.4 years), and 524 (55%) of them were male. Colorectal cancer (476 patients,50%) was the most common etiology for surgery. Parastomal hernia developed in 100 (10.5%) of patients. Age >65 (OR=1.753; 95%CI=1.071-2.869), BMI >24.9 (OR=2.009; 95%CI=1.201-3.362), co-morbidity (OR=1.773; 95%CI=1.021-3.080), laparoscopic surgery (OR=5.643; 95%CI=3.113-10.230), height of ostomy (OR=1.906; 95%CI=1.122-3.236), left lower quadrant ostomy location (OR=2.252; 95%CI=1.319-3.845), prolapse (OR=7.876; 95%CI=3.571-17.372), and other ostomy-related complications (OR=2.888; 95%CI=1.179-7.074) were risk factors based on logistic regression analysis. 
 Conclusion: The incidence of parastomal hernia was nearly one in ten patients after colorectal surgery with an ostomy. Advanced age, co-morbidity, laparoscopic surgery, the height of the ostomy, the left lower quadrant ostomy location, prolapse, and other ostomy-related complications were independent risk factors.

Sarcopenia and body fat change as risk factors for radiologic incisional hernia following robotic nephrectomy

ObjectiveTo assess the effect of body muscle and fat metrics on the development of radiologic incisional hernia (IH) following robotic nephrectomy.Materials and MethodsWe retrospectively reviewed the records of patients who underwent robotic nephrectomy for kidney tumors between 2011 and 2017. All pre- and postoperative CTs were re-reviewed by experienced radiologists for detection of radiologic IH and calculation of the following metrics using Synapse 3D software: cross-sectional psoas muscle mass at the level of L3 and L4 as well as subcutaneous and visceral fat areas. Sarcopenia was defined as psoas muscle index below the lowest quartile. Cox proportional hazard model was constructed to examine the association between muscle and fat metrics and the risk of developing radiologic IH.ResultsA total of 236 patients with a median (IQR) age of 64 (54–70) years were included in this study. In a median (IQR) follow-up of 23 (14–38) months, 62 (26%) patients developed radiologic IH. On Cox proportional hazard model, we were unable to detect an association between sarcopenia and risk of IH development. In terms of subcutaneous fat change from pre-op, both lower and higher values were associated with IH development (HR (95% CI) 2.1 (1.2–3.4), p = 0.01 and 2.4 (1.4–4.1), p < 0.01 for < Q1 and ≥ Q3, respectively). Similar trend was found for visceral fat area changes from pre-op with a HR of 2.8 for < Q1 and 1.8 for ≥ Q3.ConclusionBoth excessive body fat gain and loss are associated with development of radiologic IH in patients undergoing robotic nephrectomy.

The impact of sarcobesity on incisional hernia after laparoscopic colorectal cancer surgery

Incisional hernia is a common complication after abdominal surgery, especially in obese patients. The aim of the present study was to evaluate the relationship between sarcobesity and incisional hernia development after laparoscopic colorectal cancer surgery. In total, 262 patients who underwent laparoscopic colorectal cancer surgery were included in the present study. Univariate and multivariate analyses were performed to evaluate the independent risk factors for the development of incisional hernia. We then performed subgroup analyses to assess the impact of visceral obesity according to clinical variables on the development of incisional hernia in laparoscopic surgery for colorectal cancer surgery. Forty-four patients (16.8%) developed incisional hernias after laparoscopic colorectal cancer surgery. In the univariate analysis, the development of incisional hernia was significantly associated with female sex (P = 0.046), subcutaneous obesity (P = 0.002), visceral obesity (P = 0.002), sarcobesity (P < 0.001), and wound infection (P < 0.001). In the multivariate analysis, sarcobesity (P < 0.001) and wound infection (P < 0.001) were independent predictors of incisional hernia. In subgroup analysis, the odds ratio of visceral obesity was the highest (13.1; 95% confidence interval [CI], 4.51-37.8, P < 0.001) in the subgroup of sarcopenia. Sarcobesity may be a strong predictor of the development of incisional hernia after laparoscopic surgery for colorectal cancer, suggesting the importance of body composition in the development of incisional hernia.

OC-109 ONE-YEAR FOLLOW-UP ANALYSIS OF WOUND VS SUTURE LENGTH RATIO AS A PREDICTOR OF INCISIONAL HERNIA - A COHORT STUDY (WISER)

Abstract Background The purpose of the study was to determine if the recommended wound to suture length ratios of 1:4 and 1:6 were followed during midline laparotomy closure with loop PDS and 2–0 PDS, respectively, and whether this affected the development of an incisional hernia three years following the procedure. Methods This prospective study included eighty-six patients operated by the midline incision. The closures were performed as per the surgeon's choice. The length of the incision, types and length of suture used were noted. The one-year follow-up data was analyzed. Results In thirty cases, loop PDS was used for the closure, and in 56 patients, 2-0 PDS was used. Adherence to the recommendation was better with the loop PDS (13/30,43.33%) vs 2-0 PDS (8/56,14.28%). Eighteen patients were excluded(10-death-,5-loss to follow-up,3-reoperation).46.1%(12/26) developed incisional hernia in the loop PDS group vs 7.14%(3/42) with 2-0 PDS; total 22.05%(15/68). If the recommendations were followed or not, there were 20% (2/10) hernias in the loop PDS group compared to 62.5% (10/16); and 28.57% (2/7) compared to 2.8% (1/35) in the 2-0 PDS group. The loop PDS group had more malignancies (40% vs 20%, p=0.04). Conclusion The adherence to the recommendation of wound vs suture length was low. The incidence of incisional hernia was significantly low with 2-0 PDS, at one year, however the results should be interpreted with caution considering many patients closed with loop PDS had malignancies, a risk factor for incisional hernia, and low sample size due to death and loss to follow-up.

OC-052 Study of incisional hernia as a result of patients with open abdomen management in a tertiary hospital

Abstract Aim Open abdomen (OA) is a useful resource in critical situations, such as damage control surgery, abdominal sepsis, or compartment syndrome. However, it is not an innocuous technique with repercussions on the abdominal wall, for this reason, we have reviewed the results in our center. Material and Methods Retrospective descriptive study was carried out in a tertiary hospital between 2015–2022, all patients who required OA therapy were included. Results 92 patients (68 men, 24 women) were operated, with a mean age of 65 years, 65.3% were ASA 3–4. The most frequently system used was negative pressure therapy (NPT) (81 patients). 45 patients were closed without need replacement and 14 died before being performed. In the rest, the first TPN change was performed in 48–72 h, requiring a mean of 3.5 changes. Of the 78 patients underwent closure, 30 received primary fascial closure, 43 associated prophylactic mesh and other 5 only skin closure due to poor short-term prognosis. 24 patients died before discharge. 5 of the 30 patients with primary fascial closure had an incisional hernia. There were no hernias in the patients treated with prophylactic mesh but there was one case of chronic rejection. Conclusions OA is a useful resource; however, it is not exempt from short and long-term complications. At the time of definitive closure, it must be taken into account that these patients present multiple risk factors for the development of incisional hernias. For this reason, the use of prophylactic meshes in a protocolized manner is justified.

OC-023 INCIDENCE OF TRUE CONTRALATERAL METACHRONOUS INGUINAL HERNIA ON LONG TERM FOLLOW-UP AFTER UNILATERAL INGUINAL HERNIA REPAIR: A SYSTEMATIC REVIEW

Abstract Aim The repair of inguinal hernias is one of the most common surgical procedures with few complications. Some patients will need a second operation because of the development of a metachronous contralateral inguinal hernia (MCIH). The suggestion has been made to strengthen the contralateral side at the same time as primary surgery. In this study we aim to determine how many patients, with a unilateral inguinal hernia will develop a MCIH. Methods We performed a literature review following the PRISMA guidelines. As outcome measure, the number of patients diagnosed with a MCIH were registered. A meta-analysis was performed to obtain a summary estimate of the percentage of patients with MCIH. Results A total of 19 articles with a combined total of 277.288 patients who underwent elective unilateral inguinal hernia repair were included. The combined estimate for MCIH equaled 8.3% (95%CI: 7.1%-9.5%). A random-effects meta-regression was performed to obtain the percentage of MCIH as a function of the median follow-up time. The percentage of MCIH at 3, 5 and 10 years was estimated as 5.2%, 8% and 17.1%, respectively. Conclusion We believe there is not enough clinical evidence to support the idea of prophylactic contralateral repair. We suggest a patient-specific approach in the decision to perform prophylactic repair, taking into account potential risk factors, type of surgical approach, and general risk factors for chronic postoperative inguinal pain. More long term prospective data are needed to guide the decision for prophylactic contralateral mesh placement in a clinical healthy groin.

V-003 Parastomal &amp; ileal conduit hernia: Top docking robotic eTEP approach

Abstract Aim Parastomal hernias are frequent in patients with end colostomy. Recently, the robotic approach for the treatment of this pathology had spread abroad. On the other hand, patients with an ileal conduit urinary diversion after a radical cystoprostatectomy have a high risk of incisional hernia development. The combination of both parastomal hernia and ileal conduit hernia is rare. The aim of this video is to describe a top docking robotic eTEP approach combining a modified retromuscular Sugarbaker technique (Pauli) with a retromuscular keyhole for the parastomal and ileal conduit hernias respectively. Material and Methods The case is a 71 years old man patient with a BMI of 36 who presented a progressive 2-year discomfort bulging around the end colostomy that turned in an intermittent constipation. Additionally, a progressive bulging started the last 6 months on the ileal conduit. An abdominal CT scan was made showing a bilateral ostomal defect with small bowel parastomal content and fat tissue in the ileal conduit. Once the patient was assessed, a top docking robotic eTEP approach was planned with a Xi Da Vinci robotic platform. The patient was in a hyperextended supine position. Result The patient was discharged 3 days after the operation with a mild pain controlled by oral medication. Conclusion The Pauli technique and retromuscular keyhole for combined parastomal and ileal conduit hernia performed by a top docking robotic approach is feasible, but a long follow-up is needed to demonstrate its effectiveness.

D126. A DIEP Dive into Patient Risk Factors for Hernia and Bulge Development: A Meta-regression

PURPOSE: This meta-analysis aims to investigate risk factors for abdominal hernia and bulge in patients undergoing DIEP flaps and the effect of prophylactic mesh placement on postoperative complications. METHODS: A systematic search was conducted in July, 2022 in alignment with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. 87 studies published between 2000 and 2022 met the inclusion criteria. 64 studies were included in the analysis for bulge and 72 studies were included in the analysis for hernia. Meta-regressions were run on the proportion of patients experiencing hernia or bulge to assess for patient risk factors and the role of prophylactic mesh placement. Proportions were transformed using the Freeman-Tukey double arcsine method. RESULTS: Increased age (β = 0.0058, p = 0.0145) and pregnancy history (β=-0.0015, p=0.0001) were significantly associated with hernia. Percentage of active smokers (β=0.003, p=0.0361) and pregnancy history (β= 0.0018, p<0.0001) were significantly associated with bulge. Having both medial and lateral perforators harvested during the procedure was significantly associated with a decreased incidence of bulge (β=-0.0039, p=0.0472). Prophylactic mesh placement did not seem to have any effect on hernia or bulge rates. CONCLUSION: Understanding the morbidities associated with DIEP flap breast reconstruction, such as advanced age, pregnancy history, and smoking status, allows surgeons to proactively identify high-risk patients for abdominal hernia or bulge and prepare for a potential repair. Future studies may further explore whether patients may benefit from prophylactic mesh placement.

How do young surgeons understand and grasp the new concepts, new techniques, and recent progress of hernia and abdominal wall surgery?

With the development of modern surgery, the field of hernia and abdominal wall surgery is undergoing a transformative change, and new techniques, new concepts, and recent progress are being updated, which have motivated the high-quality development of the discipline. In the past two decades, the development of hernia and abdominal wall surgery in China has been recognized by international peers. Many young surgeons have gradually become the main force in the treatment of hernia and leaders in surgical technique. The innovation and development of discipline will never terminate; young surgeons as the main force should seriously think about how to improve their professional qualities. Young surgeons are interested in the innovation of surgical techniques and need to push for a traditional operation on the one hand and an innovative operation on the other. Updates to concepts and acquisition of new materials are more important, which can provide a solid foundation for technological innovation. Young surgeons should start with the basics and classics. Understanding the history and development of new techniques, new concepts and recent progress, and grasping indications of clinical application, is the important part of growing up for young surgeons, which can make surgical treatment more standardized, benefit patients, and promote the progress of Chinese specialized medical education.

Issues and challenges in the surgical treatment of anterior abdominal wall hernias. Review

The literature review discusses contentious issues and challenges that arise in the surgical treatment of anterior abdominal wall hernias. The author identified the causes of hernia formation and examined the dynamics of change in the pattern of hernia incidence. An analysis of the factors that contribute to the development of incisional ventral hernias was given special consideration. The causes of hernia recurrence were also studied. The entire spectrum of existing classifications of primary and incisional ventral hernias was reviewed, along with their advantages and disadvantages. Evaluation of current recommendations regarding the use of additional imaging methods for the examination of patients with ventral hernias was carried out. In the study, considerable attention was paid to surgical methods for hernia treatment. The advantages and disadvantages of “open” and minimally invasive laparoscopic hernioplasty techniques were critically evaluated. The difficulties in selecting an intervention method for certain types of hernias, including large ones, were highlighted, as was the importance of preventing hernia recurrence.&#x0D; It has been established that there are still many unsolved problems in the surgical treatment of anterior abdominal wall hernias. The author justified the need for a standardized approach to determining the characteristics of anterior abdominal wall hernias and their further classification. It is necessary to study the effectiveness of using imaging methods (ultrasound, computed tomography) for ventral hernias, depending on their size and location. There is a need for wider implementation of laparoscopic hernioplasty techniques, and the degree of the hernial defect should be taken into account when determining the indications for surgical intervention. The possibility of using laparoscopic hernioplasty for large hernias, as well as for hernias associated with rectus abdominis diastasis, requires further investigation. Improving management strategies for patients with anterior abdominal wall hernias is critical in order to reduce the risk of hernia recurrence and complications.

Patient-specific computational simulations of wound healing following midline laparotomy closure.

In the current study, we developed a new computational methodology to simulate wound healing in soft tissues. We assumed that the injured tissue recovers partially its mechanical strength and stiffness by gradually increasing the volume fraction of collagen fibers. Following the principles of the constrained mixture theory, we assumed that new collagen fibers are deposited at homeostatic tension while the already existing tissue undergoes a permanent deformation due to the effects of remodeling. The model was implemented in the finite-element software Abaqus® through a VUMAT subroutine and applied to a complex and realistic case: simulating wound healing following midline laparotomy closure. The incidence of incisional hernia is still quite significant clinically, and our goal was to investigate different conditions hampering the success of these procedures. We simulated wound healing over periods of 6months on a patient-specific geometry. One of the outcomes of the finite-element simulations was the width of the wound tissue, which was found to be clinically correlated with the development of incisional hernia after midline laparotomy closure. We studied the impact of different suturing modalities and the effects of situations inducing increased intra-abdominal pressure or its intermittent variations such as coughing. Eventually, the results showed that the main risks of developing an incisional hernia mostly depend on the elastic strains reached in the wound tissue after degradation of the suturing wires. Despite the need for clinical validation, these results are promising for establishing a digital twin of wound healing in midline laparotomy incision.

Early experience with robotic central pancreatectomy with patient-reported outcomes and comparison with open central pancreatectomy.

Robotic central pancreatectomy (CP) has emerged in recent years as a noninferior approach to open CP and may offer improved patient-reported outcomes and reduction in incisional hernias. All patients who underwent open and robotic CP between (2013 and 2022) were selected, and perioperative outcomes were analyzed. Patients who underwent robotic CP were interviewed over the phone to assess patient-reported postoperative outcomes. A total of 18 CP operations (56%-open vs. 44%-robotic) were identified. The overall median age was 67 years (interquartile range: 60-72), and 50% (n = 9) of patients were female. Median length of surgery was statistically longer for robotic CP(411 vs. 138 min,p = 0.002); all other intraoperative variables were similar. Postoperatively, a similar number of patients in the open and robotic cohorts developed clinically significant postoperative pancreatic fistulas (37.5% vs. 30%,p = 1) and major complications (37.5% vs. 20%,p = 0.60), respectively. No patients in the robotic cohort developed an incisional hernia, compared to 40% (n = 4) in open (p = 0.08). All patients returned to a baseline level of activity and reported a high quality of life. With the exception of longer operative times, robotic CP is a noninferior, definitive resection technique for select lesions of the middle pancreas. Additionally, the robotic approach may result in a reduction in incisional hernia development.

V06-12 PROPHYLACTIC MESH STRIPS: AN EFFECTIVE WAY TO REDUCE HERNIA DURING RADICAL CYSTECTOMY

You have accessJournal of UrologyCME1 Apr 2023V06-12 PROPHYLACTIC MESH STRIPS: AN EFFECTIVE WAY TO REDUCE HERNIA DURING RADICAL CYSTECTOMY Noah Frydenlund, Eric Li, Clayton Neill, Gergory Dumanian, and Joshua J. Meeks Noah FrydenlundNoah Frydenlund More articles by this author , Eric LiEric Li More articles by this author , Clayton NeillClayton Neill More articles by this author , Gergory DumanianGergory Dumanian More articles by this author , and Joshua J. MeeksJoshua J. Meeks More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003274.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Postoperative hernia development, especially parastomal hernia (PSH), remains a challenging problem after radical cystectomy (RC). The incidence of incisional hernia (IH) has been reported to range from 5-15%, while PSHs occur between 15-65%. The use of prophylactic mesh sheets during RC has been shown to reduce the incidence of PSH in a recent randomized trial. We present our technique for the prophylactic use of soft polypropylene mesh strips as sutures at the time of RC as a potential alternative to mesh sheets and review our early experience. METHODS: A retrospective review of a single surgeon's experience with RC from January 2017 to July 2022 was performed. The inclusion criteria were the use of prophylactic parastomal and/or ventral mesh strips. Patients that required intra-operative assistance from plastic surgery for complex abdominal closure were excluded. Radiographic hernias were identified by radiology reports. Hernias that were noticeable on physical exam, symptomatic, or required operative repair were classified as clinical hernias. RESULTS: A total of 72 patients with prophylactic mesh strip placement during radical cystectomy were included. The average age was 73.5 years (Range 41-88 years), with an average follow of 10.8 months (range 1.1 – 63 months) and an average BMI of 27.9 (range 16.0 – 39.13). Sixty-one patients underwent RC with ileal conduit (IC), while 11 underwent RC with neobladder (NB) creation. 93% of the cases were performed robotically with extracorporeal diversion, and the remainder were open. In the RC with IC cohort, 54 patients had ventral and stomal mesh strips placed while 4 had ventral only and 3 had stomal only strips. Radiographic IH was reported in 6/69 (8.7%) patients with ventral mesh strips. Clinical IH was reported in 2/69 (2.9%) patients. For the RC/IC cohort, radiographic PSH was identified in 11/57 (19.3%) patients, and clinical PSH occurred in 6/57 (10.5%) patients. 2/57 (3.5%) patients underwent parastomal hernia repair, 2/57 (3.5%) developed stomal stenosis, and one patient underwent incisional hernia repair. No mesh-related complications were identified. CONCLUSIONS: The prophylactic use of mesh strips as sutures during RC may provide a safe and effective method to reduce postoperative hernia. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e512 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Noah Frydenlund More articles by this author Eric Li More articles by this author Clayton Neill More articles by this author Gergory Dumanian More articles by this author Joshua J. Meeks More articles by this author Expand All Advertisement PDF downloadLoading ...

Preoperative Optimization Before Ventral Hernia Repair: A Systematic Review and Meta-analysis.

Obesity is associated with an increased risk of ventral hernia development and recurrence rates after ventral hernia repair (VHR). The metabolic derangements caused by obesity can also lead to many postoperative complications. Therefore, it is a common practice to attempt weight loss before VHR. However, there is still no consensus on optimal preoperative management for obese patients with a ventral hernia. This study aims to perform a meta-analysis to evaluate the effect of preoperative weight optimization on VHR outcomes. We performed a literature search of PubMed, Scopus, and Cochrane Library databases to identify studies comparing obese patients who underwent surgical or non-surgical weight loss interventions before undergoing hernia repair surgery to obese patients who underwent hernia repair surgery without prehabilitation. Postoperative outcomes were assessed by means of pooled analysis and meta-analysis. Statistical analysis was performed using RevMan 5.4. Heterogeneity was assessed with I2 statistics. One thousand six hundred nine studies were screened and 13 were thoroughly reviewed. Five studies comprising 465 patients undergoing hernia repair surgery were included. No differences in hernia recurrence [odds ratio (OR) 0.66; 95% CI 0.23-1.89; P=0.44; I2=20%], seroma (OR 0.70; 95% CI 0.25-1.95; P=0.50; I2=5%), hematoma (OR 2.00; 95% CI 0.5-7.94; P=0.45; I2=0%), surgical site infection (OR 1.96; 95% CI 0.52-7.40; P=0.32; I2=0%), and overall complication (OR 0.80; 95% CI 0.37-1.74; P=0.58; I2=40%) rates were noted when comparing patients who underwent a preoperative weight loss intervention (prehabilitation or bariatric surgery) versus those who did not. In the subgroup analysis of patients who underwent bariatric surgery, we found no difference in hernia recurrence (OR 0.64; 95% CI 0.12-3.33; P= 0.59; I2=41%) or overall complications (OR 1.14; 95% CI 0.36-3.64; P=0.82; I2=64%). In the subgroup analysis of patients who lost weight versus patients who did not, there was no significant difference in overall complication rates (OR 0.86; 95% CI 0.34-2.21; P=0.76; I2=55%). We found similar hernia recurrence, seroma, hematoma, and surgical site infection rates in patients who underwent preoperative optimization. These findings underline the need for prospective studies to define the optimal role of preoperative optimization and weight loss in obese patients undergoing ventral hernia repair.

Smoking History and the Development of Incisional Umbilical Hernia After Laparoscopic and Laparoendoscopic Single-Site Cholecystectomy.

The aim of this study was to analyze umbilical hernia occurrences in patients who underwent laparoscopic or laparoendoscopic single-sight (LESS) cholecystectomy. Patients who underwent cholecystectomy by a single surgeon between 2015 and 2020 were surveyed. Data are presented as median (mean +/- standard deviation). Two hundred and fifty-three patients were sent the survey and 130 (51%) patients responded. The overall age was 57 (31 +/- 18) and the overall BMI was 30 (31 +/- 7). Twelve (9%) patients developed an umbilical hernia. Seventeen patients were active smokers and four (24%) developed an umbilical hernia. One hundred and thirteen patients were inactive smokers and eight (7%) developed an umbilical hernia. There was a statistical significance between umbilical hernia occurrence and smoking history (P < .05). Active smokers have a higher risk of developing an umbilical hernia following a minimally invasive cholecystectomy, regardless of operative approach. Elective cholecystectomy should be reconsidered for current smokers.