Incisional Hernia Formation Research Articles

Prophylactic Mesh Augmentation of Midline Closure in Patients Undergoing Resection for Upper Gastrointestinal Cancer Reduces the Rate of Incisional Hernia: Results of a Case-Series Study.

Incisional hernias represent a far more common complication after midline incisions than previously estimated. Patients with upper gastrointestinal tract malignancies represent a group of patients at increased risk for incisional hernia formation after undergoing major surgery. Our prospectively designed study included 50 patients who underwent onlay synthetic mesh augmentation of their midline closure along with closure using the small bites technique. At a 12-month follow-up, no incisional hernias were documented. A significant decrease compared to historical controls was achieved, with few minor complications. Mesh augmentation of midline closure in patients with upper gastrointestinal tract malignancies can significantly reduce subsequent incisional hernia formation.

FP5.5 - Simulated Abdominal Wall - a valuable educational tool for Abdominal Wall Reconstruction and Small Bite closure techniques.

Abstract Background Incisional hernia is a common complication following laparotomy (31.8% at 2 years, HART collaborative, 2022) and this may require complicated reconstructive techniques. Studies suggest that poor closure technique contributes to incisional hernia formation. Junior trainees are often left to close the abdominal wall. European and American guidelines have suggested closing the abdomen with the "small bites technique". Simulated training has gained traction. Reduction in theatre training hours necessitates simulated training. This study aims to:generate a synthetic model that anatomically represents the layers of the abdominal wall.use this model as a simulated training tool for general surgical and plastic surgical trainees who are often left to close the abdominal wall in laparotomy cases / abdominal wall reconstruction.use this model to teach reconstructive abdominal wall repair techniques. Methods 2021: literature search and research. Theatre observation of complex abdominal wall procedures and techniques. Cadaveric lab attendance at Leeds University. 2022: prototype - first model produced from medial grade silicone. 2022: amendments - alterations to the prototype. 2023: accreditation and delivery - Small Bites Course delivered and accredited by RCS Edinburgh. Results 86% of course attendees found the abdominal wall models "as realistic as possible". Attendees felt more confident to perform small bites closure and simple abdominal wall reconstruction. Total cost saving per model compared with competitors = £1109.50. Conclusions Our simulated abdominal wall model has proved to be realistic and cost effective. It is an ethical and improved way to train junior surgeons in the small-bites technique and some elements of abdominal wall reconstruction. These models have been implemented on training courses for surgical trainees within the deanery.

Outcomes of complex abdominal wall reconstruction in patients with connective tissue disorders: a single center experience.

Individuals diagnosed with connective tissue disorders (CTD) are known to be predisposed to incisional hernia formation. However, there is a scarcity of data on outcomes for these patients undergoing hernia repair. We sought to describe our outcomes in performing abdominal wall reconstructions in these complex patients. Adult patients with CTD undergoing open, elective, posterior component separation with permanent synthetic mesh at our institution from January 2018 to October 2022 were queried from a prospectively collected database in the Abdominal Core Health Quality Collaborative. We evaluated 30-day wound morbidity, perioperative complications, long-term hernia recurrence, and patient-reported quality of life. Twelve patients were identified. Connective tissue disorders included Marfan's n = 7 (58.3%), Loeys-Dietz syndrome n = 2 (16.7%), Systemic Lupus Erythematosus n = 2 (16.7%), and Scleroderma n = 1 (8.3%). Prior incisions included three midline laparotomies and nine thoracoabdominal, mean hernia width measured 14cm, and 9 were recurrent hernias. Surgical site occurrences (SSOs) were observed in 25% of cases, and 16.7% necessitated procedural intervention. All twelve patients were available for long-term follow-up, with a mean of 34 (12-62) months. There were no instances of reoperation or mesh excision related to the TAR procedure. One patient developed a recurrence after having his mesh violated for repair of a new visceral aneurysm. Mean HerQLes scores at 1year were 70 and 89 at ≥ 2years; Mean scaled PROMIS scores were 30.7 at 1year and 36.3 at ≥ 2years. Ventral hernia repair with TAR is feasible in patients with connective tissue disorder and can be a suitable alternative in patients with large complex hernias.

Duramesh registry study: short-term outcomes using mesh suture for abdominal wall closure.

Sutures are flexible linear elements that join tissue and maintain their hold with a surgeon-created knot. Tension at the suture/tissue interface can cut the very tissues that sutures are designed to hold, leading to dehiscence and incisional hernia formation. A new suture design (Duramesh, Mesh Suture Inc., Chicago, IL) was approved for marketing by the United States Food and Drug Administration in September 2022. The multiple filaments of the mesh suture are designed to diffuse tension at the suture/tissue interface thereby limiting pull-through. The macroporosity and hollow core of the mesh suture encourage fibrovascular incorporation for a durable repair. We created the first registry and clinical report of patients undergoing mesh suture implantation to assess its real-world effectiveness. A patient registry was created based on institutional implant logs from January to August 2023 at an integrated health-care system. Operative reports were reviewed by the study team to verify use of "Duramesh" by dictation. Retrospective chart review was conducted to evaluate patient and surgical characteristics, follow-up, and short-term outcomes of interest. Results were analyzed using descriptive statistics and Chi-squared analysis with Microsoft Excel and GraphPad Prism. Three hundred seventy-nine separate implantations by 56 surgeons across 12 (sub) specialties at a university hospital and two community hospitals were performed. Mesh suture was used for treatment of the abdominal wall in 314 cases. Follow-up averaged 80.8 ± 52.4 days. The most common abdominal wall indications were ventral hernia repair (N = 97), fascial closure (N = 93), abdominal donor site closure from autologous breast reconstruction (N = 51), and umbilical hernia repair (N = 41). Mesh suture was used in all Centers for Disease Control (CDC) wound classifications, including 92 CDC class 2 or 3 abdominal operations. There were 19 surgical site infections (6.1%) and 37 surgical site events (11.8%). Short-term registry data demonstrates the wide diversity of surgical disciplines and scenarios in which mesh suture has been used to date. The early adoption of mesh suture into practice highlights that consequences of suture pull-through influence operative decision making. As this is the first interim report of the Duramesh mesh suture registry, follow-up is too short for characterization of long-term durability of abdominal wall closures.

Is the mercedes incision still fit for purpose in liver transplants? A systematic review and meta-analysis of incisional hernia formation

Is the mercedes incision still fit for purpose in liver transplants? A systematic review and meta-analysis of incisional hernia formation

Educating Residents in Abdominal Wall Closure: An Overview.

Background and Aims: Incisional hernia prevention has become an important concept for surgeons operating on the abdominal wall. Several techniques have been proposed to help decrease incisional hernia formation with suture closure of the abdominal wall being one of the cornerstones. Technical details that have been reported to decrease incisional hernia rates include achieving a 4:1 Suture to Wound length ratio and the use of a small bites technique. Despite evidence to support many of these techniques there appears to be a gap in practice patterns amongst practicing surgeons. Introducing and promoting these principles in surgical residency may help to close this gap. This paper reviews our experience with surgical training for abdominal wall closures at our institution. Materials and Methods: Programs and projects related to abdominal wall closure were reviewed from our institution from 2010-Present. Type of project, intervention, and impact on education was evaluated and summarized. Results: Seven projects were identified relating to surgical training and abdominal wall closure. Three projects dealt with skills training using an abdominal wall simulation model and related to suturing techniques. Two projects were clinical studies focused on suture to wound length ratios and improving outcomes with this variable in a residency training program. Two projects dealt with models relating to abdominal wall closure and education. Conclusion: Implementation of educational programs in surgical residency programs can lead to improvements in technique and knowledge around abdominal wall closure and help in research endeavors.

Prevention of incisional hernia with prophylactic onlay and sublay mesh reinforcement vs. primary suture only in midline laparotomies (PRIMA): long-term outcomes of a multicentre, double-blind, randomised controlled trial

Incisional hernia occurs approximately in 40% of high-risk patients after midline laparotomy. Prophylactic mesh placement has shown promising results, but long-term outcomes are needed. The present study aimed to assess the long-term incisional hernia rates of the previously conducted PRIMA trial with radiological follow-up. In the PRIMA trial, patients with increased risk of incisional hernia formation (AAA or BMI ≥27kg/m2) were randomised in a 1:2:2 ratio to primary suture, onlay mesh or sublay mesh closure in three different countries in eleven institutions. Incisional hernia during follow-up was diagnosed by any of: CT, ultrasound and physical examination, or during surgery. Assessors and patients were blinded until 2-year follow-up. Time-to-event analysis according to intention-to-treat principle was performed with the Kaplan-Meier method and Cox proportional hazard models. Trial registration: NCT00761475 (ClinicalTrials.gov). Between 2009 and 2012, 480 patients were randomized: 107 primary suture, 188 onlay mesh and 185 sublay mesh. Five-year incisional hernia rates were 53.4% (95% CI: 40.4-64.8), 24.7% (95% CI: 12.7-38.8), 29.8% (95% CI: 17.9-42.6), respectively. Compared to primary suture, onlay mesh (HR: 0.390, 95% CI: 0.248-0.614, p<0.001) and sublay mesh (HR: 0.485, 95% CI: 0.309-0.761, p=0.002) were associated with a significantly lower risk of incisional hernia development. Prophylactic mesh placement remained effective in reducing incisional hernia occurrence after midline laparotomy in high-risk patients during long-term follow-up. Hernia rates in the primary suture group were higher than previously anticipated. B. Braun.

A Clinical Comparative Study of Rectus Sheath Closure Techniques in Emergency Exploratory Laparotomy: Evaluating "Far-Near-Near-Far" vs. Conventional Closure Approach.

Midline exploratory laparotomy is essential in emergency surgery, and effective closure of the abdominal wall is crucial for optimal healing and reduced complications. The far-near-near-far technique for rectus sheath closure has gained attention due to potential advantages over conventional closure due to the fact that even if one suture gives way it does not affect the nearby suture and the rectus sheath is still held in place. This study aims to compare these techniques in emergency exploratory laparotomy. This single-center prospective observational study included all patients undergoing emergency exploratory laparotomy at a tertiary care hospital. Patients were categorized into two groups based on the closure technique used: conventional closure or far-near-near-far technique. Sociodemographic data and comorbidities were collected. Operative time, closure time, and postoperative complications were assessed. Statistical analysis was performed using IBM SPSS Statistics 22.0(IBM Corp., Armonk, NY). The study included patients with a mean age of 42.14 years. Operative and closure times did not significantly differ between the groups. There was no significant difference in comorbidities between the two techniques. The incidence of wound infection, dehiscence, burst abdomen, incisional hernia, and sinus formation did not significantly differ between the groups. Late complications were also similar. The far-near-near-far technique for rectus sheath closure in emergency exploratory laparotomy showed comparable outcomes to conventional closure methods. No significant differences were found in operative time, closure time, or postoperative complications. This study contributes to the understanding of different closure techniques, allowing surgeons to make informed decisions.

Optimal computed tomography-based biomarkers for prediction of incisional hernia formation.

Unstructured data are an untapped source for surgical prediction. Modern image analysis and machine learning (ML) can harness unstructured data in medical imaging. Incisional hernia (IH) is a pervasive surgical disease, well-suited for prediction using image analysis. Our objective was to identify optimal biomarkers (OBMs) from preoperative abdominopelvic computed tomography (CT) imaging which are most predictive of IH development. Two hundred and twelve rigorously matched colorectal surgery patients at our institution were included. Preoperative abdominopelvic CT scans were segmented to derive linear, volumetric, intensity-based, and textural features. These features were analyzed to find a small subset of OBMs, which are maximally predictive of IH. Three ML classifiers (Ensemble Boosting, Random Forest, SVM) trained on these OBMs were used for prediction of IH. Altogether, 279 features were extracted from each CT scan. The most predictive OBMs found were: (1) abdominopelvic visceral adipose tissue (VAT) volume, normalized for height; (2) abdominopelvic skeletal muscle tissue volume, normalized for height; and (3) pelvic VAT volume to pelvic outer aspect of body wall skeletal musculature (OAM) volume ratio. Among ML prediction models, Ensemble Boosting produced the best performance with an AUC of 0.85, accuracy of 0.83, sensitivity of 0.86, and specificity of 0.81. These OBMs suggest increased intra-abdominopelvic volume/pressure as the salient pathophysiologic driver and likely mechanism for IH formation. ML models using these OBMs are highly predictive for IH development. The next generation of surgical prediction will maximize the utility of unstructured data using advanced image analysis and ML.

Comparing clinical outcomes between patients receiving non-absorbable and delayed absorbable sutures for abdominal wound closure after laparotomy

Background: There is a lot of debate about the best suture for repairing the abdominal fascia post-laparotomy. This research compared the clinical results of patients who received non-absorbable versus delayed absorbable sutures for abdominal wound closure after laparotomy. Methods: We conducted a prospective non-randomized clinical trial in the Department of General Surgery, Janaki Medical College and Teaching Hospital, Janakpur, Nepal. We included patients aged more than 18 years who underwent an elective laparotomy surgery with midline vertical incision for any indication between April 2020 till March 2022 in our department. Two study groups were formed: non-absorbable suture (polypropylene suture) and delayed absorbable suture (polydiaxanone suture). Results: The two study groups were similar with respect to indication of surgery (p value = 0.52). Bowel was opened in 81% in non-absorbable group and in 85% in delayed absorbable suture group. Mean duration of surgery was found to be significantly lower in the delayed absorbable suture group as compared to non-absorbable suture group (185±21.8 vs. 232±27.3 minutes, p value &lt; 0.05). Post-operative complications included surgical site infection, burst abdomen, incisional hernia and sinus formation. It was observed that surgical site infection rate was significantly higher among non-absorbable suture group patients as compared to delayed absorbable suture group (25% vs. 13%, p value &lt;0.05). Conclusions: Comparing early and late post-operative complications, there was no statistically significant difference between non-absorbable suture group and delayed absorbable suture group.

P-084 INDEPENDENT PATIENT DATA META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS ON PROPHYLACTIC MESH PLACEMENT FOR INCISIONAL HERNIA PREVENTION: STUDY PROTOCOL

Abstract Aim In high risk groups such as patients undergoing open abdominal aortic aneurysm (AAA) surgery, the risk of incisional hernia (IH) formation is up to 69%. IH can be prevented through prophylactic mesh augmentation (PMA). Several randomized controlled trials (RCT) have shown a significant decrease in IH formation after PMA. However, due to study design and sample size issues, implementation of PMA into daily practice is lacking. Methods International collaboration will be initiated under the guidance of the European Hernia Society. RCTs studying PMA after open AAA surgery will be identified through a literature search. Corresponding authors of the selected studies will be approached for participation by e-mail, telephone or other means. Where independent patient data (IPD) are available, a suitable data delivery agreement (DDA) will be drafted and signed upon agreement. Pseudonymised or anonymised data sets will be securely transferred and stored, and relevant study parameters will be harmonized. A 1-stage IPD meta-analysis (IPDMA) will be performed, stratified per centre, assessing PMA effectivity according to the intention-to-treat principle. If a 1-stage IPDMA is not feasible, a 2-step IPDMA will be performed, analysing each RCT separately and pooling outcomes. Results will be published in internationally recognized, peer-reviewed journals. This study protocol was registered under PROSPERO number CRD42022347881. Conclusions Gathering IPD across relevant RCTs and performing an IPDMA on the combined data will help to better establish effectiveness of PMA in preventing IH after open AAA surgery. Secondarily, subgroup analyses will allow identification of patients who will benefit from PMA most.

OC-022 Quality and Quantity Matter - Incidence of Incisional Hernia Following Common Abdominal Surgeries by Abdominal Surgical History: A United States Population-based Analysis of 945,262 Patients

Abstract Objective Patients with prior abdominal surgery (prior-AS) may have increased risk of developing incisional hernia (IH) at the time of subsequent abdominal surgery (AS). We hypothesized that prior-AS history is associated with increased incisional hernia (IH) formation and that the risk is higher for prior IH repair (prior-IHR). Methods Patients undergoing common AS operations (bariatric, cholecystectomy, small/large bowel resection, prostatectomy, and gynecologic) were identified and followed-up for 1-year using Statewide Inpatient/Ambulatory Databases (2009–2016; FL, IA, NE, NY, UT). Prior-AS history was ascertained within 3-year period preceding the index operation. Risk-adjusted Cox regression examined the association of surgical history with IH. Results Of 945,262 patients, 8.55% had prior-AS. Median age was 49 years, most patients were female (68.95%), undergoing open (80.5%) elective (74.5%) AS. Risk-adjusted revealed increased IH risk by surgical history: prior-AS (HR 1.36 [95%CI 1.25–1.48]), multiple prior-AS (2.0 [1.67–2.46]), prior-IHR (3.4 [2.99–3.66]), and multiple prior-IHR (3.56 [2.5–4.28]; Figure). For every additional prior-AS and prior-IHR there was an increase in IH by 9.7% (95%CI 1%-18.6%) and 22.5% (15.6%-29.9%), respectively. Conclusion Both the type and number of previous AS are associated with increased risk for IH, particularly in patients with prior-IHR, and multiple prior operations. These findings demonstrate that reoperation through a previously-disrupted abdominal wall poses technical challenges that impact long-term morbidity, and underscore the need to consider preventive measures at the time of subsequent AS.

46. Optimal Computed Tomography-based Biomarkers for Prediction of Incisional Hernia Formation

PURPOSE: Incisional hernia (IH) is a pervasive surgical disease. Computer vision and machine learning (ML) were used to derive computed tomography (CT)-based features predictive of IH. METHODS: Patients who underwent colorectal surgery between 2005-2017 were identified (n=14,345). Patients who developed IH were matched with those who did not (n=212). Preoperative abdominopelvic CT scans were segmented to derive linear, volumetric, intensity-based, and textural measurements. Optimal biomarkers (OBMs) were derived and used to test ML classifiers (SVMs, Random Forests, Ensemble Boosting) for IH prediction. RESULTS: 279 features were extracted from preoperative CTs. The most predictive combination of OBMs was: 1) abdominopelvic visceral adipose tissue volume (VAT); 2) abdominopelvic intra-abdominal musculature volume; and 3) pelvic VAT to outer abdominal musculature volume (OAM) ratio. ML models using these OBMs were tested, Ensemble Boosting outperformed other models across all metrics. CONCLUSION: These OBMs suggest intra-abdominal volume/pressure is the most salient pathophysiologic mechanism for IH formation. ML models using OBMs are highly predictive of IH. Image analysis is a powerful tool in surgical risk prediction.

Incisions in Hepatobiliopancreatic Surgery: Surgical Anatomy and its Influence to Open and Close the Abdomen.

Incisions performed for hepato-pancreatic-biliary (HPB) surgery are diverse, and can be a challenge both to perform correctly as well as to be properly closed. The anatomy of the region overlaps muscular layers and has a rich vascular and nervous supply. These structures are fundamental for the correct functionality of the abdominal wall. When performing certain types of incisions, damage to the muscular or neurovascular component of the abdominal wall, as well as an inadequate closure technique may influence in the development of long-term complications as incisional hernias (IH) or bulging. Considering that both may impair quality of life and that are complex to repair, prevention becomes essential during these procedures. With the currently available evidence, there is no clear recommendation on which is the better incision or what is the best method of closure. Despite the lack of sufficient data, the following review aims to correlate the anatomical knowledge learned from posterior component separation with the incisions performed in hepato-pancreatic-biliary (HPB) surgery and their consequences on incisional hernia formation. Overall, there is data that suggests some key points to perform these incisions: avoid vertical components and very lateral extensions, subcostal should be incised at least 2cm from costal margin, multilayered suturing using small bites technique and consider the use of a prophylactic mesh in high-risk patients. Nevertheless, the lack of evidence prevents from the possibility of making any strong recommendations.

Comparison of Midline and Off-midline specimen extraction following laparoscopic left-sided colorectal resections: A systematic review and meta-analysis.

This study aims to evaluate comparative outcomes following midline versus off-midline specimen extractions following laparoscopic left-sided colorectal resections. A systematic search of electronic information sources was conducted. Studies comparing 'midline' versus 'off midline' specimen extraction following laparoscopic left-sided colorectal resections performed for malignancies were included. The rate of incisional hernia formation, surgical site infection (SSI), total operative time and blood loss, anastomotic leak (AL) and length of hospital stay (LOS) was the evaluated outcome parameters. Five comparative observational studies reporting a total of 1187 patients comparing midline (n = 701) and off-midline (n = 486) approaches for specimen extraction were identified. Specimen extraction performed through an off-midline incision was not associated with a significantly reduced rate of SSI (odds ratio [OR]: 0.71; P = 0.68), the occurrence of AL (OR: 0.76; P = 0.66) and future development of incisional hernias (OR: 0.65; P = 0.64) compared to the conventional midline approach. No statistically significant difference was observed in total operative time (mean difference [MD]: 0.13; P = 0.99), intraoperative blood loss (MD: 2.31; P = 0.91) and LOS (MD: 0.78; P = 0.18) between the two groups. Off-midline specimen extraction following minimally invasive left-sided colorectal cancer surgery is associated with similar rates of SSI and incisional hernia formation compared to the vertical midline incision. Furthermore, there were no statistically significant differences observed between the two groups for evaluated outcomes such as total operative time, intra-operative blood loss, AL rate and LOS. As such, we did not find any advantage of one approach over the other. Future high-quality well-designed trials are required to make robust conclusions.

Herniation and incarceration of the gallbladder through the abdominal drain site

A rare case of herniation and incarceration of the gallbladder through the abdominal drain site in an 86-year-old woman with degenerative aortic valve disease, a severe aortic stenosis, and an aortic insufficiency grade 2 hospitalized for transcatheter aortic valve implantation is described. An incarcerated incisional hernia through the abdominal drain site was confirmed by contrast-enhanced multislice computed tomography (MSCT) scan of the abdomen. Given the short duration of incarceration and the absence of MSCT findings of the gallbladder wall necrosis, the patient was dynamically monitored. There were no indications for emergency surgery. The presented case recalls the possibility of the formation of incisional hernias containing the gallbladder through the abdominal drain site. Literature data indicate that the diagnostic errors when they are incarcerated can lead to fatal consequences.

PREEMPTIVE DEEP TENSION SUTURING IN PREVENTION OF BURST ABDOMEN

Background :Burst abdomen is a major complication associated with contaminated or dirty surgeries, including emergency midline laparotomy. Possible causative factors involve wound sepsis, patients’ overall pressure inside the abdomen, and many system problems. Conventional oncosurgical approaches could prove inadequate, leading to evaluation of preventive methods, such as DTS, of minimizing such adverse outcomes. Objectives :To evaluate the level of success of deep tension suturing done before the primary closure of the abdomen against formation of burst abdomen, wound infection, and incisional hernia than mass closure techniques. Study design: A Cross sectional study. Place and duration of study. This Cross Sectional study was carried out at Setting: Done at Ziauddin Hospital, Civil Hospital- ward 06, and PAF Hospital, Karachi from Change the dates in duration of study as follows: January 2019 to Jan 2022 Methods: A Cross Sectional study which involved 100 adults who were posted for emergency midline laparotomy due to generalized peritonitis. Patients were divided into two groups: Group A: conventional mass closure Group B: closure with DTS. Both groups received simple polypropylene sutures for wound closure as in the standard mesh repair technique but not in group B they also received four deep tension sutures using the rubber tubing to distribute tension over wider areas of the tissue. Patients with diabetes, immunosuppression, or use of corticosteroids were excluded as a result. Results The age in years of the participants was 31.61 ± 9.31 years; the maximum age was 61 years, the minimum was 18 years. The observation was made that the incidence of burst abdomen in Group B was 4 and that of Group A was 18 (p&lt;0.05). Bacteremia was noticed in 10 Pt’s in Group B and 17 Pt’s in Group A(p&lt;0.05). Postoperative incisional hernia was identified in seven patients in Group A and none in Group B with p&lt;0.05. These outcomes show decreases in all of the primary complications when implementing DTS on the approaches as there were statistically significant improvements for all of them. Conclusion :The pro-active use of deep tension sutures in emergency midline laparotomy dramatically decreases the rate of burst abdomen, wound infection, and incisional hernia. As tension on the wound edges is reduced by DTS, the study shows that postoperative complications are preventable in high-risk surgeries, patient benefits maximized, and reoperations minimized.

Incisional Hernia Development after Live Donor Nephrectomy: Impact of Surgical Technique.

Characteristics of incisional hernia (IH) formation after live donor nephrectomy (LDN) are not well-defined. The goal of this study was to describe the incidence of IH within 3 years after LDN and identify risk factors contributing to their formation. We performed a single-center, retrospective review of all LDN between February 2013 and October 2018. Patients with and without IH were compared based on donor and operative variables. Data were analyzed using chi-square tests with column proportions. Multivariable logistic regression with backward elimination was used to evaluate the likelihood of IH on the basis of potential risk factors. Three hundred one individuals underwent live donor nephrectomy. Twenty-eight patients (9.3%) developed an IH, with a median time to development of 7 months (range: 2-24 months). Obesity (body mass index ≥30), periumbilical hand port, and vertical infraumbilical hand port were associated with increased risk of IH development on univariate analysis. On multivariate analysis, obesity and periumbilical hand port location were persistent risk factors for IH. The incidence of IH after LDN is prevalent and associated with obesity and operative technique. Placing the hand port infraumbilical with a transverse fascial incision may reduce the risk of IH after LDN.

Suture-TOOL: A suturing device for swift and standardized abdominal aponeurosis closure

Surgeons can reduce incisional hernia formation by adhering to standardized techniques for incisional wound closure. This is often neglected by the time a long operation is to be ended and can lead to the risk of developing an incisional hernia or a wound rupture. To address this issue, a suturing machine (Suture-TOOL) was developed for swift and standardized abdominal closure. The aim was to compare the user safety, speed, and suturing quality between Suture-TOOL and manual Needle-Driver suturing. Fifteen surgeons who were specialists in surgery, urology, and gynaecology as well as surgical trainees were invited. The Suture-TOOL was presented to the surgeons who read the instructions for use before starting the test. Each surgeon closed nine 15-cm-long incisions in a human body model; six with Suture-TOOL and three with the Needle-Driver technique. Gloves were examined for puncture damage. Endpoints were suture-length/wound-length (SL/WL)-ratio, closure time, number of stitches, learning curve, and glove puncture rate. A VAS-evaluation concerning different Suture-Tool user impressions was completed. A SL/WL-ratio ≥4 was 98% for Suture-TOOL versus 69% for Needle-Driver (p<0.001). Suture time was shorter for Suture-TOOL (p<0.001). Wound stitch count was higher for Needle-Driver (p<0.013). The median SL/WL-ratio was similar between groups. The learning curve plateaued after three closures using Suture-TOOL. Two glove punctures were detected—all in the Needle-Driver group. Suture-TOOL received high VAS scores for all measured functionalities. Suture-TOOL is a promising device for clinical use. It is safe, easy, and fast resulting in a high-quality suture lines with a short learning curve and a high functionality ranking.

A study on clinical profile and risk factors in incisional hernia patients

Incisional hernias of the abdominal wall are a frequently encountered complication in cases of open abdominal surgeries like midline laparotomies, caesarian sections etc. Wound infections, obesity, poor healing due to malnutrition etc., were thought to be the important causative factors in the development of incisional hernia.To study the clinical profile of incisional hernia patients with respect to various etiological factors, distribution of cases in relation to age and sex, details of previous surgical procedures undergone.52 patients admitted in Department of General Surgery were included in the study. Study was conducted during the period from August 2018 to August 2020 including all patient with incisional hernia. Pediatric cases were excluded from the study. Data of all the patients were collected from the hospital records and were compiled in a predesignated proforma which included patient details, clinical examination, investigations, and previous surgical history. Informed consent was obtained from each patient. Retrospective observational study. There were 32 females (61.54%) and 20 males (38.46%) with female to male ratio was found to be 1.6:1. Majority of the patients presented with abdominal swelling (n=30, 58%) followed by both abdominal swelling and pain (n=20, 38%). Among the females now presented with incisional hernias the mean parity was 2.69. Majority of the cases developed hernias within 1 year (n=29, 55.77%) and about 26.93% of the patients developed hernia in 1 to 3 years. Most of cases of incisional hernia in our study occurred over midline (n=22, 42.3%) at the site of incisions made for midline laparotomy (n=20.38.5%) Risk factors favouring incisional hernia formation were post-operative wound infection (n=45, 84.9%) and obesity (n=21, 40.38%). Incisional hernia is more common in females who undergo emergency midline laparotomy and emergency caesarean section. Majority of the cases presented within 1 year of surgery. Post-operative wound infection, obesity and anemia were the crucial factors for the development of incisional hernias.