Epigastric Hernia Research Articles

The experience with Mini- or Less-open Sublay operation.

The MILOS concept binds the benefit of the sublay mesh augmentation in the way of functional and morphological reconstruction of the abdominal wall without the need to use penetrating fixation elements and with the benefits of minimal surgical access. The transhernial approach is carried out at low cost with standard laparoscopic instruments. The authors carried out retrospective analysis of the years 2018-2022. Included are all patients operated by the MILOS concept. The patients have suffered of the midline hernias type M according to European Hernia society, eventually combined with rectus diastasis. Authors present their own experience of this new treatment method. The evaluation of complications was performed. In the observed time we have operated 61 patients. In the years 2018 and 2019 together 35 patients were treated, none in the year of 2020. Because of the COVID plaque was the 2020 "Year of restrictions". In the year 2021 and first quarter of 2022 we have already cured 26 patients. In this time 2 major complications and 3 minor complications were observed. Since the 2nd quarter of 2022 we have already upgraded to eMILOS. Our experience with this new hernia repair shows that this treatment possibility is feasible for general use also in small district departments without the need to use of robotic technology. This skill will be necessary for future F.E.B.S AWS (Tab. 2, Fig. 3, Ref. 15). Text in PDF www.elis.sk Keywords: incisional hernia, epigastric hernia, MILOS, Mini- or Less-open sublay operation, rectus diastasis, sublay mesh, uniport, abdominal wall surgery.

An Algorithmic Approach for the MIS Repair of Ventral Midline Hernias Associated With Diastasis of the Rectus Abdominis Muscle.

Purpose: We present our algorithmic approach for symptomatic ventral hernias with Diastasis of the Rectus Abdominis Muscle (DRAM). Methods: Retrospective analysis of patients with symptomatic ventral hernias and DRAM undergoing hernia repair and plication of DRAM from July 2018-March 2021 was conducted. Based on our algorithm, patients were selected for an Endoscopic Onlay Repair (ENDOR) or a Robotic Extended Totally Extraperitoneal Ventral Repair (R-eTEP). Results: We performed a R-eTEP in fifty-seven patients and an ENDOR in twenty-four patients. In the R-eTEP group, thirty-seven (65%) patients were female, the mean age was 54.8 (±10.6), and the mean BMI was 32 (±4.8). Fifty patients (87.7%) had multiple defects, of which 19 (38%) were recurrent hernias and 31 (62%) were incisional hernias. The mean operative time was 200 (±62.4) minutes, with two cases requiring a hybrid approach. The median length of stay was 1day (0-12), and the median follow-up was 103days. Twenty-four patients underwent an ENDOR, 19 females (79.2%), the mean age was 45.7years (±11.7) and the mean BMI was 28 (±3.6). 13 patients had isolated umbilical or epigastric hernias. The mean operative time was 146.2min (±51.1). Fibrin sealant and suture was the predominant method for mesh fixation, and most cases were performed in an ambulatory setting. Four patients developed post-operative seromas; one requiring drainage due to infection. The Median follow-up was 48.5days (10-523), with two reported hernia recurrences. Conclusion: An algorithmic approach for adequate patient selection was shown to be safe for treating ventral hernias with DRAM.

Evaluation of Treatment Differences Between Men and Women Undergoing Ventral Hernia Repair: An Analysis of the Abdominal Core Health Quality Collaborative

INTRODUCTION: Sex is emerging as an important clinical variable associated with surgical outcomes and decision-making. Its impact on baseline and treatment differences in primary and incisional ventral hernia repair remains unclear. METHODS: This retrospective cohort study uses the Abdominal Core Health Quality Collaborative (ACHQC) database to identify elective umbilical, epigastric, or incisional hernia repair. Propensity matching was performed to investigate confounder-adjusted treatment differences between men and women. Treatments of interest included surgical approach, mesh use, mesh type, mesh position, anesthesia type, myofascial release, fascial closure, and fixation use. RESULTS: A total of 8,489 umbilical, 1,801 epigastric, and 16,626 incisional hernia repairs were identified. Women undergoing primary ventral hernia repair were younger (umbilical 46.4 vs 54 years, epigastric 48.7 vs 52.7 years), with lower BMI (umbilical 30.4 vs 31.5, epigastric 29.2 vs 31.1), and less likely diabetic (umbilical 9.9% vs 11.4%, epigastric 6.8% vs 8.8%). Women undergoing incisional hernia repair were also younger (mean 57.5 vs 59.1 years), but with higher BMI (33.1 vs 31.5), and more likely diabetic (21.4% vs 19.1%). Propensity analysis included 3,644 umbilical, 1,232 epigastric, and 12,480 incisional hernias. Women with incisional hernia were less likely to undergo an open repair (60.2% vs 63.4%, p < 0.001) and have mesh used (93.8% vs 94.8%, p = 0.02). Women had a higher rate of intraperitoneal mesh placement, and men had a higher rate of preperitoneal and retromuscular mesh placement. CONCLUSION: Small but statistically significant treatment differences regarding operative approach, mesh use, and mesh position exist between men and women undergoing ventral hernia repair.

P-068 RESULTS OF THE OPEN INTRAPERITONEAL ONLAY MESH TECHNIQUE WITH A PREFORMED PATCH FOR PRIMARY VENTRAL HERNIA AND INCISIONAL HERNIA

Abstract Aim Primary ventral hernias and incisional hernias are frequent, but long–term results of their repair with a preformed patch are scarce. The aim was to evaluate the surgical results of the treatment of these hernias with the open intraperitoneal onlay mesh (open IPOM) technique, and to determine the needed follow–up for recurrence. Material and methods Observational retrospective single institution study of all consecutive patients intervened for ventral or incisional hernia with diameter inferior to 4 cm, from January 2013 to June 2020. The surgical repair was performed according to the open IPOM technique with a preformed patch and the defect was left unclosed. Relapsed hernias, those with a defect ≥ 4 cm, and lateral wall hernias were excluded. Results A total of 146 patients were intervened: 61.6% with umbilical hernias, 8.2% with epigastric hernias, 26.7% with trocar incisional hernias, and 3.4% with other incisional hernias. The global recurrence rate was 7.5% (11/146). Specifically, there it was 7.8% in umbilical hernias, 0% in epigastric hernias, 7.7% in trocar incisional hernias, and 20% (1/5) in other incisional hernias. The median time for recurrence was 14 months (IQR: 4,4–18,7). The median presential follow–up was 17,4 months (IQR: 6,5–27,3), and the median telematic follow-up was 36,9 months (IQR: 27,2–49,6). Conclusions The open IPOM technique with a preformed patch offers good results for the treatment of ventral and incisional hernias. A 2-year follow-up is still needed for the recurrence diagnosis. Note The preformed patch used was the Parietex™ Composite Ventral Patch (Medtronic, Minneapolis, MN, EEUU).

P-081 LAPAROSCOPIC RIVES-STOPPA ETEP FOR UMBILICAL HERNIA WITH RECTUS ABDOMINIS DIASTASIS: DOWN-TO-UP APPROACH

Abstract Aim The association of umbilical or epigastric hernia and diastasis is not uncommon.Classically, it was insisted on the repair only of hernial pathology and not of diastasis.However, according to the latest recommendations,the simultaneous treatment of both pathologies is a valid and effective option.In addition, with the rise of minimally invasive surgery(MIS) of the abdominal wall, more cases of simultaneous MIS repair of midline hernias and diastasis are being reported. Material &amp; Methods 41-year-old female-patient with umbilical hernia of 3cm associated to diastasis with a distance of 4cm(post-pregnancy). MRI abdominal wall: umbilical hernia and diastasis, not other hernial defects. Laparoscopic management is decided by eTEP-approach . Results 4ports are used, a dissector-balloon was used to dissect the right retromuscular-space.Another 5mm-trocar is placed in LRQ, 5mm-trocar in LLQ and 12mm in suprapubic-midline.The surgery continues with the dissection of the left retromuscular-space, with the dissection of the umbilical hernial sac and reducing its contents, the section is performed at the medial level of both posterior sheaths of the rectus abdominis muscle until reaching the xiphodeal region.Later we continue with the closure of the anterior wall of the rectums by replicating the diastasis with Stratafix-0.Then the posterior sheath was closed with V-Lock 2–0.A PVDF-mesh of 16×26cm was placed.The patient presented a favorable postoperative evolution and was discharged on 1°-POD. Conclusions The laparoscopic-Rives-Stoppa-eTEP-approach for hernia-pathology of the midline associated with diastasis is a valid, efficient, effective and safe option, offering the advantages of MIS:less postoperative pain, less morbidity, early return to routine daily activities with lower healthcare-spending.

OC-051 MANAGEMENT OF EPIGASTRIC, UMBILICAL, SPIGELIAN AND SMALL INCISIONAL HERNIA AS A DAY CASE PROCEDURE: RESULTS OF LONG–TERM FOLLOW–UP AFTER OPEN PREPERITONEAL FLAT MESH TECHNIQUE

Abstract Aim To investigate short and long-term outcome after the open preperitoneal flat mesh technique (OPPFMT) for umbilical, epigastric, spigelian, small incisional and “port-site” hernia performed as a day case procedure. Materials and Methods We retrospectively analyzed records of patients who underwent OPFMT for umbilical, epigastric, Spigelian, small incisional and “port-site” hernia. All patients were operated under local anesthesia in ambulatory settings. The operative technique is as follows: polypropylene flat mesh exceeding the size of the hernia defect for 2–3 cm in all directions is placed into a pre-peritoneal position above the intrabdominaly repositioned hernia sac (mesh is placed into hernia sac) and fixed by at least 8 transfascial “U” sutures. Results In the period from January 2004 to April 2022, 531 patients with ventral hernias (272 with umbilical, 155 with epigastric, 69 with small incisional, 17 with “port site” and 18 with Spigelian hernia) underwent surgery. During the median follow-up of 44 months, 8 (1,5%) hematomas, 2 (0,4%) seromas, 2 (0,4%), superfitial wound infections, 8 (1,5%) mesh infections and 24 (4,6%) recurrences occurred. Conclusion Management of epigastric, umbilical, spigelian and small incisional hernia with OPFMT under local anesthesia as a day case procedure is a safe and associated with favorable long-term outcome.

BJS-02 LONG-TERM REOPERATION RATE FOLLOWING PRIMARY VENTRAL HERNIA REPAIR: A REGISTER-BASED STUDY

Abstract Aim The aim of this study was to analyse the risk for reoperation following primary ventral hernia repair. Methods The study was based on umbilical hernia and epigastric hernia repairs registered in the population-based Swedish National Patient Register (NPR) 2010–2019. Reoperation was defined as repeat repair after primary repair. Results Altogether 30,253 umbilical hernia repairs and 7407 epigastric hernia repairs were identified. There were 624 reoperations registered following primary umbilical repair and 137 following primary epigastric repairs. In multivariable Cox proportional hazard analysis, the hazard ratio (HR) for reoperation was 0.284 (95% confidence interval (CI) 0.106–0.760) after open onlay mesh repair, 0.476 (CI 0.359–0.629) after open interstitial mesh repair, 0.368 (CI 0.230–0.590) after open sublay mesh repair, 0.446 (CI 0.167–1.194) after open intraperitoneal onlay mesh repair, 0.931 (CI 0.639–1.357) after laparoscopic repair, and 0.939 (CI 0.502–1.757) after other (unknown) techniques, when compared to open suture repair as reference method. Following umbilical hernia repair, the risk for reoperation was also significantly higher for patients aged ≤49 years (HR 1.669, CI 1.391–2.002), for women (HR 1.390, CI 1.178–1.641), and for patients with liver cirrhosis (HR 2.546, CI 1.050–6.174). For patients undergoing epigastric hernia repair, the only significant risk factor for reoperation was age ≤49 years (HR 2.079, CI 1.380–3.134). Conclusions All types of open mesh repair were associated with lower reoperation rates than open suture repair and laparoscopic repair. Female sex, young age and liver cirrhosis were risk factors for reoperation due to hernia recurrence, regardless of method.

Antepartal Spontaneous Complete Fundal Non-Scarred Uterine Rupture in Twin Pregnancy.

A 31-year-old, otherwise healthy patient (G1/P0) had a history of left salpingectomy for ectopic (tubal) pregnancy followed by diagnostic laparoscopy and uterine septal incision. Because of primary infertility, she underwent assisted reproduction (in vitro fertilization/embryo transfer), which resulted in a bichorial-biamniotic twin pregnancy. The further course was uneventful until 36 weeks when she felt pain in the epigastrium, leading her to be admitted to the hospital under suspicion of epigastric hernia. On admission, cardiotocographic and ultrasound findings showed a normal state of pregnancy with a palpable mobile, painless epigastric formation, without contractions and other symptoms. Two days after admission, she developed sudden pain and acute abdomen without labor, so an urgent laparotomy for suspected uterine rupture was performed, revealing a complete (12 cm) fundal rupture ([Fig. 1]) with prolapsed amniotic sac and twin legs. Live eutrophic twins (2710 g/48 cm, Apgar 10/10; 2790 g/48 cm, Apgar 10/10) were delivered through Kerr’s transverse isthmic hysterotomy, the placenta was removed, and a primary two-layer uterine suture was performed. The postoperative course was complicated by febrile puerperium, which was resolved by antibiotic treatment with complete maternal recovery.

Evaluation of Treatment Differences Between Men and Women Undergoing Ventral Hernia Repair: An Analysis of the Abdominal Core Health Quality Collaborative.

Sex is emerging as an important clinical variable associated with surgical outcomes and decision making. However, its relevance in regard to baseline and treatment differences in primary and incisional ventral hernia repair remains unclear. This is a retrospective cohort study using the Abdominal Core Health Quality Collaborative database to identify elective umbilical, epigastric, or incisional hernia repairs. Propensity matching was performed to investigate confounder-adjusted treatment differences between men and women. Treatments of interest included surgical approach (minimally invasive or open), mesh use, mesh type, mesh position, anesthesia type, myofascial release, fascial closure, and fixation use. A total of 8,489 umbilical, 1,801 epigastric, and 16,626 incisional hernia repairs were identified. Women undergoing primary ventral hernia repair were younger (umbilical 46.4 vs 54 years, epigastric 48.7 vs 52.7 years), with lower BMI (umbilical 30.4 vs 31.5, epigastric 29.2 vs 31.1), and less likely diabetic (umbilical 9.9% vs 11.4%, epigastric 6.8% vs 8.8%). Women undergoing incisional hernia repair were also younger (mean 57.5 vs 59.1 years), but with higher BMI (33.1 vs 31.5), and more likely diabetic (21.4% vs 19.1%). Propensity-matched analysis included 3,644 umbilical, 1,232 epigastric, and 12,480 incisional hernias. Women with incisional hernia were less likely to undergo an open repair (60.2% vs 63.4%, p < 0.001) and have mesh used (93.8% vs 94.8%, p = 0.02). In umbilical and incisional hernia repairs, women had higher rates of intraperitoneal mesh placement and men had higher rates of preperitoneal and retro-muscular mesh placement. Small but statistically significant treatment differences in operative approach, mesh use, and mesh position exist between men and women undergoing ventral hernia repair. It remains unknown whether these treatment differences result in differing clinical outcomes.

Operative time tracking for umbilical hernia patients.

Army medical treatment facilities (MTFs) use a surgery scheduling system that reviews historical OR times to dictate expected procedural time when posting new cases. At a single military institution there was a noted inflation to umbilical hernia repair (UHR) times that was leading to issues with under-utilized operating rooms. This is a retrospective review determining what variables correlate with longer UHR operative time. Umbilical, ventral, epigastric, and incisional hernia repairs (both open and laparoscopic) were pulled from the local OR scheduling system at Dwight D. Eisenhower Army Medical Centerfrom January 2013 to June 2018. A total of 442 patients were included in the study with a mean age of 45.74years and 54.98% male. Patient ASA level (p 0.045), primary vs. mesh repair (p < 0.001), number of hernias repaired (p 0.05), hernia size (p < 0.001), and absence of student nurse anesthetist (SRNA) (p 0.05) all correlated with longer UHR OR times. For the aggregated open hernia repair data, almost all independent variables of interest were statistically significant including age, PGY level, history of DM, case acuity, presence of SRNA, patient ASA level, patient's BMI, hernia defect size, number of hernias, history of prior repair, and history prior abdominal surgery. Multivariate regression analysis was done on the open hernia repair variables with only age and size of hernia being significant. This data were used to create a new case request option (open UHR without mesh and open UHR with mesh) to more effectively utilize available OR time.

SURGICAL OUTCOME OF MODIFIED LAPAROSCOPIC RETRORECTUS APPROACH FOR UPPER MIDLINE VENTRAL AND UMBILICAL HERNIAS

Background: The incidence of ventral hernias such as umbilical, epigastric and midline incisional hernias has increased over the years. Many surgical modalities of treatment have been evolved for better management and outcome of hernia repair. Igor Belyansky performed the rst successful endoscopic Rives Stoppa procedure (eTEP). The current Laparoscopic retrorectus repair needs more than three ports, and it also requires USG marking of the retrorectus space. Crossing over to the opposite retrorectus space will be difcult for beginners. This study standardises the easy and ergonomically better Laparoscopic Retrorectus approach for umbilical and upper midline hernias using three ports in the suprapubic area. Aim And Objectives: To study the feasibility and effectiveness of the Modied Laparoscopic Retrorectus approach. Material And Methods: This prospective study involved 18 patients admitted to tertiary health center, with umbilical hernia, epigastic hernia and upper midline ventral hernia. We performed the analysis after taking institutional ethical committee approval and informed consent from patients. A qualied surgeon performed laparoscopic retrorectus hernioplasty (e -TEP) with modication in port placement. An observational analysis was done on the feasibility and outcome of the modied approach. SPSS version 20. was used to perform the statistical analysis. Unpaired t-test, Pearson's correlation coefcient was applied. Results: A total of 18 patients were included in the study, with a mean age of 48.78 years. The hernia was predominantly seen in the female gender, overweight or obese patients. The mean duration of the procedure with the modied approach was 160minutes. The patients' numeric rating scale of pain on postoperative day 1 and day 2 was mild in 66.6% of patients. We noted seroma formation in two patients, which was signicantly associated with the duration of surgery (p =0.0069). Most of the patients were discharged on postoperative day 5. Follow up of patients up to 1 year had no history of recurrence or chronic pain. Conclusion: The standard of care for ventral hernia repair is the laparoscopic e – TEP approach. This study's modication of port placement showed better cosmetic results with reduced risk of chronic pain and low recurrence rate. The prolene mesh used during this procedure is very economical, making laparoscopic hernia surgery affordable for low socio–economic populations in developing countries.

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.

Management of cholecystocolonic fistula: a rare case report

Cholecystocolonic fistula is a rare condition usually found intraoperatively if not managed may lead to serious consequences. In this case report we described a case of a 52-year-old female who was following in outpatient department (OPD) for epigastric hernia found to have cholecystocolonic fistula which was managed operatively with cholecystectomy with excision of fistula with primary repair of colon. The patient had an uneventful recovery.

A Prospective Observational Study of Ventral Hernia.

BackgroundVentral hernias are commonly encountered problems in the field of general surgery. Incisional hernia is a common complication following abdominal surgery that requires reoperation. This study was conducted to understand the incidence of various types of ventral hernia in both sexes and various age groups, predisposing factors, clinical features, and complications.MethodsThis prospective observational study was conducted in the Department of Surgery, Dr. Hedgewar Hospital, Aurangabad, Maharashtra, India, on a total of 100 patients diagnosed with anterior abdominal wall hernia between September 2020 to February 2021. Data collection included thorough history taking and clinical examination along with relevant investigations. The data collected was entered in a proforma, tabulated, and analyzed with the IBM SPSS Statistics for Windows, Version 24.0 (Released 2016; IBM Corp., Armonk, New York, United States).ResultsIncisional hernia (43%) was the most common of all ventral hernias. Females were much more affected than males. Out of these types studied, epigastric hernia showed more incidence among males. The average age of presentation was 52 years. Obesity was the most common predisposing factor (34%) with female preponderance. Obese patients were also associated with a higher rate of postoperative complications like wound infection and seroma. In the cases of incisional hernia, 32.6% of the patients gave a history of previous surgery complicated by a wound infection. Incisional hernias were more common in lower midline incisions (34.9%) and after gynecological surgery (55.81%) like total abdominal hysterectomy, cesarean section, or tubal ligation. In the majority of the patients (62.8%), the incisional hernia occurred within three years of the previous surgery. Wound infection following ventral hernia repair occurred in 11% of the cases, wound dehiscence in 3%, and seroma in 2 % of the cases.ConclusionsThe most common ventral hernias in decreasing order of their frequency are incisional hernia, umbilical hernia, para-umbilical hernia, and epigastric hernia. Epigastric and umbilical hernias are more common in males whereas incisional hernia is more common in females. Obesity and constipation were found to be the major predisposing risk factors. Incisional hernia is more common in females after gynecological and obstetrics surgery. The lower midline segment is the most common site for developing an incisional hernia.

Observational study of comparison between laparoscopic retro-rectal vs open pre-peritoneal Ventral hernia repair

Background: Hernias are one of the most common anatomical derangements in men and women and have left an indelible mark throughout most of recorded history. For hundreds of years various surgical and non-surgical treatments were offered to patients suffering from chronic pain, obstruction and strangulation related to their hernias. Materials &amp; Methods: The study was undertaken in tertiary health centre in prospective manner from July 2017 to July 2019 on Laparoscopic retro-rectal versus Open pre-peritoneal ventral hernia repair. Results: In present study, mean age of patients in Laparoscopy group was 45.26 years &amp; in Open group was 48.92 years. 25 patients were males and 15 patients were females in the study. 10 patients were of Umbilical hernia, 3 patients were of Paraumbilical hernia and 2 patients were of Epigastric hernia in Laparoscopy group. While for Open group there were 14, 7 &amp; 4 patients respectively. Swelling in abdomen which disappears on lying down was the main complaint of patients, followed by pain in abdomen. Average BMI of patients in Laparoscopy group was 25 Kg/m2 while in Open group it was 25.33 Kg/m2.

Pentalogy of Cantrell.

Pentalogy of Cantrell.

Laparoscopic Versus Open Ventral Hernia Repair: Experience at a Tertiary Care Center in Western Rajasthan.

BackgroundVentral hernias are the second most common type of hernias accounting for 21-35% of all hernia types. Ventral hernia includes incisional, umbilical, epigastric, and Spigelian hernias, among others. Currently, patients and surgeons prefer laparoscopic repair of ventral hernias. This study aimed to compare laparoscopic with open hernia repair in terms of various operative and patient parameters.MethodologyThis was a prospective observational study conducted in the Department of General Surgery, Dr. Sampurnanand Medical College, Jodhpur. All patients admitted with a diagnosis of ventral hernia for mesh repair (open as well as laparoscopic) were included. Laparoscopic and open hernia repair were compared in terms of operative time, postoperative hospital stay, time to resume routine activity, postoperative complications, and recurrence.ResultsAmong the 50 patients included in the study (25 patients each in the laparoscopic and open groups), the mean operative time was 57.52 ± 5.80 minutes in the laparoscopic group and 59.8 ± 11.15 minutes in the open group. The mean hospital stay in the laparoscopy and open groups was 7.4 ± 1.58 days and 9.88 ± 2.96 days, respectively (p-value = 0.0006; significant). Postoperative pain (using the visual analog scale score) was less in patients who underwent laparoscopic surgery (p-value = 0.001; significant). Seroma and surgical site infections were the most common complications which were observed more in the open hernia repair group. Recurrence was seen in one case operated by the open technique.ConclusionsLaparoscopic ventral hernia repair is technically safer, effective, and feasible with better clinical outcomes in patients seeking treatment in a government hospital.

Etiology of Acute Intestinal Obstruction and its Association with Socio-demographic among Patients at Tertiary Care Institute of North India

Background: The etiology of acute intestinal obstruction, which is one of the commonest surgical emergencies, varies between countries and has also changed over the decades. Present study was done to evaluate the etiology of acute intestinal obstruction and its association with Socio-demographic among patients at IGMC Shimla. Material and Methodology: This cross sectional study was done among total of 50 patients admitted with features of acute intestinal obstruction in the general surgery department of Indira Gandhi Medical College Shimla, randomly selected during the period from 15 June 2019 to 15 June 2020. Data regarding etiology of acute intestinal obstruction and Socio-demographic Characteristics was extracted and analysed using Epi Info Software v7. Results: The study showed the peak incidence of Intestinal obstruction in the age group 51-60 (11) and 61-70(10) years .Mean age in our current study was 53 years and male to female ratio was 3:1. Most common etiology was Adhesive intestinal obstruction (40%), followed by tuberculosis (28%), Malignancy (16%), Obstructed hernia (6%),Volvulus (6%) and Perforated appendix (4%). 76% of small bowel and 24% of large bowel accounts to intestinal obstruction.In the present study Adhesions due to previous surgeries, Obstructed hernia, Malignancy and Volvulus occurred mostly in patients above 50 years of age while there were equal number of Koch abdomen and Perforated appendix among below 50 years and above 50 years patients .Adhesions due to previous surgeries nearly equally affected male and female but obstructed hernia affected males only. Interestingly, Tuberculosis affected females more than males in this study mainly because of low socioeconomic status. Obstructed umbilical and epigastric hernia affected 8.1% males. Colonic and rectosigmoid malignancies affected 21.6% males. Conclusion: Our study concluded that most of cases were of small bowel obstruction. Adhesions due to previous abdominal surgeries and tuberculosis were the commonest cause of intestinal obstruction and occurred mostly in patients above 50 years of age and in males.

Long-term reoperation rate following primary ventral hernia repair: a register-based study

BackgroundThe aim of this study was to analyse the risk for reoperation following primary ventral hernia repair.MethodsThe study was based on umbilical hernia and epigastric hernia repairs registered in the population-based Swedish National Patient Register (NPR) 2010–2019. Reoperation was defined as repeat repair after primary repair.ResultsAltogether 29,360 umbilical hernia repairs and 6514 epigastric hernia repairs were identified. There were 624 reoperations registered following primary umbilical repair and 137 following primary epigastric repairs. In multivariable Cox proportional hazard analysis, the hazard ratio (HR) for reoperation was 0.292 (95% confidence interval (CI) 0.109–0.782) after open onlay mesh repair, 0.484 (CI 0.366–0.641) after open interstitial mesh repair, 0.382 (CI 0.238–0.613) after open sublay mesh repair, 0.453 (CI 0.169–1.212) after open intraperitoneal onlay mesh repair, 1.004 (CI 0.688–1.464) after laparoscopic repair, and 0.940 (CI 0.502–1.759) after other techniques, when compared to open suture repair as reference method. Following umbilical hernia repair, the risk for reoperation was also significantly higher for patients aged < 50 years (HR 1.669, CI 1.389–2.005), for women (HR 1.401, CI 1.186–1.655), and for patients with liver cirrhosis (HR 2.544, CI 1.049–6.170). For patients undergoing epigastric hernia repair, the only significant risk factor for reoperation was age < 50 years (HR 2.046, CI 1.337–3.130).ConclusionsAll types of open mesh repair were associated with lower reoperation rates than open suture repair and laparoscopic repair. Female sex, young age and liver cirrhosis were risk factors for reoperation due to hernia recurrence, regardless of method.

DIASTASIS RECTI ABDOMINIS: PROBLEMS OF DIAGNOSIS AND TREATMENT OF FALSE HERNIA

Diastasis recti abdominis (DRA) is a pathological state characterized by thinning and stretching of the aponeurotic plate of the white line. In the neglected cases, the entire muscular-aponeurotic skeleton of the anterior abdominal wall, up to the Spigelian line, sticks out and bulges. DRA is an urgent problem of modern surgery. Its management and treatment takes much time and effort.&#x0D; The literature review analyzes the main causes and risk factors of DRA, and describes its pathogenesis in detail. Particular attention is paid to diagnostic methods. A number of classifications are considered depending on diastasis etiology, localization and degree. It is shown that diastasis diagnosis is based on a thorough history, patient’s complaints, and clinical examinations. Ultrasonography, computed tomography, and magnetic resonance imaging should be performed when a concomitant umbilical or epigastric hernia or other reason for the patient’s symptoms cannot be ruled out. The authors describe practical methods for DRA surgical management. They evaluate the efficacy of various treatment modalities and the results of treating patients with DRA. It is noted that optimal surgical management for DRA correction has not been found yet. However, there is no treatment modality, which suggests an operation without general anesthesia. Any surgical intervention for DRA management implies the use of combined endotracheal anesthesia. Choosing a surgery for DRA management, the surgeon should take into account the patient’s opinion on the method of surgical assistance, minimize the period of hospital treatment if possible, use reliable techniques, ensure a patient’s quick recovery with a maximum cosmetic effect and minimum complications.