Giant Abdominal Hernia Research Articles

A novel technique for superficial complicated stomas using the Dacron vascular prosthesis.

Despite the advances achieved in surgical techniques in recent years, an intestinal stoma is still needed in many patients undergoing colorectal surgery. However, the intestinal stoma may be associated with serious complications and the need for a second surgical procedure. In extreme cases, when it is not possible to access the abdominal cavity, the management of a complicated stoma is challenging. The purpose of this study was to describe the use of a Dacron vascular prosthesis (DVP) in patients with intestinal stoma complications. In patients with a shallow, superficial stoma or mucocutaneous separation (MCS), we sutured the prosthesis in the intestinal loop (at the edge of an intestinal fistula) to create a device to direct the fecal content to the collection bag. We included 9 patients in this series (colorectal cancer, n = 5; Crohn's disease, n = 2; giant abdominal hernia and morbid obesity, n = 2). The results obtained were promising since they showed good evolution in patients with severe intestinal complications and an impossibility of surgical correction of the stoma. Five patients presented complete healing, and two patients presented partial healing. There were two deaths caused by sepsis, which were not related to the surgical procedure. With this technique, there was a reduction in the leakage of intestinal contents into the peritoneal cavity and an increase in the healing of the peristomal dermatitis in most of the patients. The DVP could possibly represent a surgical alternative in selected patients with complicated stomas when surgical correction may not be a suitable option. The authors recommend this technique for selected complex cases of stoma complications after unsuccessful attempts to adapt collecting equipment. The placement of the DVP allowed the peristomal skin to heal and improved the contamination of the peritoneal cavity.

Neumoperitoneo preoperatorio en eventración subcostal gigante

IntroductionWhat defines an abdominal incisional hernia with loss of rights home is when more than 50% of the content of the cavity is out of it. The repair of these defects can lead to several serious pathophysiological problems, such as abdominal compartment syndrome with acute respiratory distress secondary to the sudden increase of the intra-abdominal pressure. In 1940, Goñi Moreno first published preoperative progressive pneumoperitoneum for treating large hernias. Case report78-year-old man with antecedents of cholecystectomy 3 years ago consulted for a 18-month history of giant abdominal hernia, located in Kocher's scar. Computed tomography reported incisional hernia of the anterior wall of the upper abdomen with a diameter of about 10×20cm containing bowel loops. Pneumoperitoneum according to Goñi Moreno's technique was performed followed by a subcostal hernia repair with Sub Lay mesh. DiscussionCurrently, several authors recommend preoperative pneumoperitoneum in large incisional hernias with loss of rights home because it has been shown that expand the volume of the abdominal cavity in 49% and increase the total length of the parietal muscles after implementation. ConclusionPreoperative pneumoperitoneum is helpful in large hernias with loss of rights home, because it expands the volume of the abdominal cavity and increases the length of the parietal muscles allowing to repair the defect with minimal tension.

Staged abdominal closure with intramuscular tissue expanders and modified components separation technique of a giant incisional hernia after repair of a ruptured omphalocele

In patients with omphalocele, several different techniques are performed for repair of the abdominal wall defect. We present the case of a staged abdominal closure of a giant incisional hernia after repair of a ruptured omphalocele. At birth, skin flap coverage associated with silo formation occurred, but the abdominal wall defect remained, resulting in a giant abdominal hernia. To expand the layers of the abdominal wall, tissue expanders were placed between the bilateral internal oblique and transverses abdominis muscles. Postoperatively, a modified components separation technique was performed. The abdominal wall was closed in the midline. Upon closure of the skin in the midline, bilateral relaxing incisions were performed, covering the remaining defect with artificial dermis. At the age of one year and 7 months, the patient had no recurrent incisional hernia nor any wound complications.

Preoperative progressive pneumoperitoneum for giant inguinal hernias

Reduction of giant hernia contents into the abdominal cavity may cause intraoperative and postoperative problems such as abdominal compartment syndrome. Preoperative progressive pneumoperitoneum expands the abdominal cavity, increases the patient’s tolerability to operation, and can diminish intraoperative and postoperative complications. Preoperative progressive pneumoperitoneum is recommended for giant ventral hernias, but rarely for giant inguinal hernias. We present two giant inguinal hernia patients who were prepared for hernia repair with preoperative progressive pneumoperitoneum and then treated successfully by graft hernioplasty. We observed that abdominal expansion correlated with the inflated volume and pressure during the first four days of pneumperitoneum. Although insufflated gas volume can be different among patients, we observed that the duration of insufflation may be the same for similar patients.

Herniated gravid uterus through an incisional hernia treated with the component separation technique

Herniation of a gravid uterus through an incisional hernia of the anterior abdominal wall is a rare but serious condition due to the potentially severe maternal and foetal risks. Because of the rarity of the condition, no consensus exists regarding the optimal treatment. The component separation technique (CST) has proven to be effective for the treatment of those giant abdominal hernias in which prosthetic material utilisation is not indicated. We report the case of a woman who presented at 38 weeks of gestation with non-reducible herniation of the pregnant uterus through an anterior abdominal wall incisional hernia treated with CST immediately after caesarean section. Review of the existing literature is performed to further underline the efficacy of CST and the need for the practising surgeons to be familiar with this technique and the scenarios when it may become extremely valuable.

Repair of giant abdominal wall hernias with full-thickness skin transplants in high-risk patients

The repair of giant abdominal hernias in high-risk obese patients remains a great challenge. There is no single simple surgical procedure to provide correction for this condition, and the risk for recurrence of hernia is high. Moreover, the insertion of a foreign material, i.e., synthetic mesh, adds an increased risk of infection, particularly in the presence of concomitant immunosuppressant therapy or diabetes. Eight patients, classified ASA 3–4, with giant abdominal wall hernias had 3 months pre-treatment with a custom-made compressive garment before abdominal wall repair. Four patients had a stoma at the time of surgery. Abdominal wall reconstruction was undertaken by realignment of the rectus muscles and fascia under tension. The fascia repair was stabilized with a full-thickness skin overlay graft. Early complications included two wound infections and one seroma. Two patients had pulmonary insufficiencies and required intensive care management. One complete recurrence of hernia was noted at follow-up. Full-thickness skin overlay grafts can be recommended in high-risk patients with abdominal wall hernias when the use of foreign material such as synthetic mesh is contraindicated.

Giant Post-Inflammatory Pancreatic Cyst Associated with Giant Abdominal Hernia - a Case Report

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Stellenwert des Pneumoperitoneums beim chirurgischen Management einer monströsen Skrotalhernie

Surgical treatment of giant abdominal hernias includes reduction of the hernia content and tension-free closure of the abdominal wall. Initial laparoscopy simulates the postoperative abdominal wall tension. Recognizing the need for a preoperative pneumoperitoneum in cases of chronic eventration may help to avoid "abdominal catastrophes" including bowel resection, abdominal compartment, and extended abdominal wall reconstruction. We report a 66-year-old man with an asymptomatic long-standing giant scrotal hernia who was admitted with sepsis and uremia caused by intestinal obstruction.

Component separation technique to repair large midline hernias

In patients with omphalocele, several different techniques are performed for repair of the abdominal wall defect. We present the case of a staged abdominal closure of a giant incisional hernia after repair of a ruptured omphalocele. At birth, skin flap coverage associated with silo formation occurred, but the abdominal wall defect remained, resulting in a giant abdominal hernia. To expand the layers of the abdominal wall, tissue expanders were placed between the bilateral internal oblique and transverses abdominis muscles. Postoperatively, a modified components separation technique was performed. The abdominal wall was closed in the midline. Upon closure of the skin in the midline, bilateral relaxing incisions were performed, covering the remaining defect with artificial dermis. At the age of one year and 7 months, the patient had no recurrent incisional hernia nor any wound complications.

Repair of Giant Abdominal Hernias: Does the Type of Prosthesis Matter?

Closure of the abdominal wall after trauma or major surgery may be difficult due to visceral edema or fascial weakness; thus, the risk of developing a ventral hernia (VH) is high. Commonly, these hernias are repaired using a prosthetic mesh. Complications following mesh repair can develop. We hypothesize that the type of prosthetic material affects outcome. This is a retrospective chart review of patients admitted from 1996 to 2002 undergoing VH (> or = 20 x 10 cm) repair with prosthetic mesh. Data collected included age, sex, and race. Patients were stratified by prosthetic material as follows: Gore-Tex (GR), Marlex + Gore-Tex (MG), Marlex (MR), and Marlex + Vicryl (MV). For the purpose of clinical analysis, the groups were collapsed into subgroups: Gore-Tex exposure (GT) or non-Gore-Tex exposure (NG). Outcome measures were hernia recurrence (HR), wound infection (WI), and fistula formation (FF). Statistical analysis utilized chi2 test and Fisher's exact test. There were 55 VH repairs in 37 patients. The mean age was 43.9 (+/- 16.3), males out-numbered females 22 (59.5%) to 15 (40.5%). The majority of the patients were Caucasian (29; 78.4%). There were 30 trauma patients (81.1%), and 7 general surgery patients (18.9%). The HR for the study (n = 55) was 20 (36.4%), the WI was 17 (30.9%), and the FF was 3 (5.5%). GR group (6; 66.7%) had a significant higher wound IF rate than MR group (8; 26.7%) (Chi P = 0.02, Fisher P = 0.047). All other group comparisons (HR, WI, and FF) were N.S. The Gore-Tex versus non-Gore-Tex subgroup comparison results were as follows: GT (n = 18) had a WI 8 (44.4%), HR 6 (33.3%), and FF 0 (0%). NG (n = 37) had a WI 9 (24.3%), HR 14 (37.8%), and a FF 3 (8.1%). There was a trend toward a higher wound infection in the GT versus NG, but it did not reach statistical significance. We conclude that 1) the wound infection rate was higher in the Gore-Tex versus the Marlex group (Chi P = 0.02, Fisher P = 0.047). Wound infection in the presence of Gore-Tex usually mandates the removal of the mesh resulting in a hernia recurrence. 2) There was a trend toward a higher wound infection in the GT (44.4%) versus NG (24.3%), but it did not reach statistical significance.

The Use of Pneumoperitoneum in the Repair of Giant Hernias.

Preoperative pneumoperitoneum is used to re-establish the right of domain for abdominal viscera before repair of otherwise inoperable giant abdominal hernias. The aim of this study was to evaluate the use and safety of preoperative pneumoperitoneum in the repair of giant hernias in relation to surgical treatment of obesity. The medical records of patients who underwent preoperative pneumoperitoneum in the treatment of giant hernias between 1953-1993 were reviewed. There were 27 patients (11 males, 16 females; mean age: 56 years) whose mean preoperative weight was 99 kg (range: 69-183). Hernias were predominantly in the midline (17). Other locations were right lower quadrant (5), right upper quadrant (3) and groin (2). The mean duration of preoperative pneumoperitoneum was 28 days (3-100). Subcutaneous emphysema developed in three patients with no sequelae. Primary repair of the giant hernia without Marlex mesh was possible in 19 patients (70%). Marlex mesh was used in seven (26%). One patient had a fascia late graft. Operative complications were one pulmonary embolus and one hematoma. There were no deaths. We conclude that preoperative pneumoperitoneum is a useful adjunct to giant hernia repair. Severe obesity should be corrected before preoperative pneumoperitoneum and hernia repair. Some patients may need mesh to replace insufficient abdominal wall or to reinforce repair.

Progressive pneumoperitoneum in the treatment of giant abdominal hernias. (Polish)

Progressive pneumoperitoneum in the treatment of giant abdominal hernias. (Polish)