Incisional Hernia Surgery Research Articles

The Use of Minimal Invasive Surgery versus Open Approach in Hospitalized Cases.

Backgtound: The progress in development and application of Minimal Invasive Surgery (MIS) requires clinical and managerial decisions that must be evidence based; the current available scientific evidence for the Romanian medical practice is missing. Our study aims to analyze the use of MIS and open surgery in Romania and the impact of the type of surgery on the hospitalization. Methodology: A cross-sectional study analyzed the activity of the Romanian hospitals reporting primary Diagnostic Related Group (DRG) data at the patient level in the period 2008-2018; all episodes of abdominal and thoracic surgical interventions which may be performed either by MIS or an open approach were extracted from the DRG National database (www.drg.ro). A comparative analysis in terms of the volume of activity and their impact on the hospital average length of stay (ALOS) has been performed. Results: The pattern of use for MIS and open surgery interventions was changed in 2008-2018; MIS procedures doubled while open surgery interventions did not follow the same growth rate; ALOS for the MIS procedures decreased annually at a faster rate as compared to the ALOS for the open surgery and the gap between the two gradually increased in favour of the MIS interventions. The most pronounced shortening of ALOS after MIS procedures has been found for Gallbladder Surgery (by 7.95 days), Gastric Surgery (by 5.64 days) and Incisional Hernia surgery (by 4.33 days). Meanwhile, the reimbursement level for the MIS versus open surgery interventions did not changed over the analyzed period. Conclusions: MIS is significantly reducing the ALOS in Romania with a potential positive influence on the national healthcare budget. However, the pattern of use for MIS interventions is not financial incentives based and calls for in-depth analysis on other factors belonging rather to specific pathology, technology or medical practice (experience in using MIS, endowment, safety, efficacy, surgical approach area etc.) is urgently required.

Laparoscopic Versus Open Retrorectus Mesh Repair of Incisional and Ventral Hernia: A Randomised Clinical Study

Introduction: Hernias are defects or holes in the abdominal wall with protrusion of abdominal contents and are common problems in daily surgical practice. The defects can develop following previous surgical procedure or can be primary in the absence of any past surgery. The operative repair of these hernias can be done by either open procedure or laparoscopic surgery. Aim: To compare the laparoscopic hernia repair with open surgical repair in terms of operative time, hospital stay, pain, complications, cost and recurrence. Materials and Methods: This randomised clinical study was conducted from April 2015 to December 2019. Patients undergoing elective surgery for primary ventral hernias and incisional hernias were included. There were 50 patients who underwent open mesh repair and 50 patients who had laparoscopic repair. The data was analysed using Mann-Whitney U test for continuous variables and Chi-square test for categorical variables. Results: The patients were comparable for age and sex distribution and also the type of hernia, primary ventral or incisional, size of defect and body mass index in both the groups. The patients undergoing laparoscopic mesh repair had significantly less operative time (90 vs 110 minutes, p=0.036), reduced postoperative pain (p=0.001) and decreased hospital stay (3.47 vs 6.43 days p=0.0005). The cost of the laparoscopic surgery was significantly high (p-value 0.0001) basically owing to the cost of mesh and disposable tacker. The recurrence at mean follow-up of 13 months was similar in both the groups. Conclusion: Laparoscopic hernia repair is superior to open repair in select group of patients with small and medium size defects without loss of abdominal domain if cost is not a consideration.

Incisional hernia repair surgery improves patient reported outcomes

BackgroundIncisional hernias are a frequent complication after abdominal surgeries. The aim of this study is to investigate the impact of incisional hernia repair on health related quality of life. MethodsWe prospectively recruited a sample of patients waiting for incisional hernia repairs in the Vancouver Coastal Health Authority, Canada. Study participants self-report their pain, depression and overall quality of life using patient reported outcome measures EQ-5D, PHQ-9 and PEG as they were placed on the waitlist and 6 months after surgery. ResultsThere were 87 patients who responded to both the pre and post-operative survey. The average wait for surgery was 20.3 weeks. Patients with poor baseline health pre-operatively had significant improvement in pain, depression and quality of life. ConclusionsAmong patients with poorer baseline health who underwent surgery for incisional hernias, there was a significant benefit in depression, pain and overall quality of life.

Maximum inspiratory and expiratory pressures in the pre and postoperative periods of patients with incisional abdominal hernia corrected by Lázaro da Silva technique.

To verify the effect of longitudinal abdominal incisional herniorrhaphy on respiratory muscle pressure. The technique of incisional herniorrhaphy used was proposed by Lázaro da Silva. To measure the pressure, we used a water manometer in 20 patients, median age 48.5 years (range 24 70). We analyzed the maximum inspiratory pressure at the level of residual volume (IP-RV) and functional residual capacity (IP-FRC) and the maximum expiratory pressure of functional residual capacity (EP-FRC) and total lung capacity (EP-TLC) in the preoperative and late postoperative (40 90 days) periods, in 13 patients with large incisional hernias and in 7 patients with medium incisional hernias. There was a significant increase in IP-FRC (p = 0.027), IP-RV (p = 0.011) and EP-TLC (p = 0.003) in patients with large incisional hernias. EP-FRC increased, but not significantly. In patients with medium incisional hernias, the changes were not significant. Surgical correction of large incisional hernias improves the function of the breathing muscles; however, surgery for medium incisional hernias does not alter this function.

Implementation of laparoscopic techniques by the influence in patient’s selection for incisional hernia surgery treatment

Revista monográfica de cirugía de la pared abdominal, digital y en lengua española. Artículos originales de investigación, editoriales, imágenes clínicas, cartas al director, reseñas de publicaciones, etc.

Effects of polypropylene mesh on the component separation technique in complex incisional hernia surgery

Aim: Giant or complex hernia repair is an important risk factor for poor outcome compared with results after repair for smaller hernias. Various operation techniques have been described for this hernia types. In this study, we aimed to present our outcomes of component separation technique (CST) repair in patients with giant incisional hernia and compare the results of CST with or without mesh.Material and Methods: A comprehensive retrospective study was planned and performed on all patients who underwent the CST for complex incisional hernia between 2007 and2013 at study institution. Patients were divided into two groups according to polypropylene mesh use. Follow-up appointments were typically done at 2 weeks, 4 weeks, 2 months, 3 months, 6 months, 1 year and 2 years. Hernia recurrence was diagnosed by physical examinations and ultrasonography if needed.Results: A total of 91 patients were evaluated in this study, with 45 (49.4%) men and 46 (50.6%) women. The median age was 55(23-83) years and hernia defect size was 314 cm2 (62-940 cm2). Component separation group (CS) consisted of 13 women and 10 men with median age 56 years, whereas Component separation with mesh group (CS-M) comprised 35 women and 33 men with median age 55 years. A total of three patients (13%) had recurrence hernia in CS group vs. none of patients in CS-M group (p=0.015). Surgical site complication developed in 8 (34.7 %) patients in CS group, whereas in 28 (40.5%) patients in CS-M group (p=0.66). Statistical significant factors were associated with the development of complications including male gender (p=0.032), older than 60 years (p=0.045), and ASA score was 3 (p=0.017).Conclusion: Component separation technique could be preferred by surgeons in complex ventral hernias. Contrary to common belief, onlay polypropylene mesh placement was not increase the surgical site complications. Also, recurrence rates were lower in mesh group statistically significantly.

Failure of talc seromadesis for the treatment of subcutaneous chronic seromas after incisional hernia surgery.

Talc poudrage has been used since many years for sclerosing chronic pleural effusion. Several reports have shown good results managing chronic seromas after breast, vascular, and incisional hernia surgeries. The purpose of this study is to determine the utility of talc seromadesis for the management of chronic seromas after incisional hernia surgery. Multicentric prospective observational study including patients diagnosed of chronic seromas after incisional hernia surgery. Under local anesthesia and ultrasonographic control, two percutaneous trocars were placed in the seroma, washing the seroma cavity with 0.9% saline solution and aspirating the remaining liquid. A sample of 4 g of talcum powder was introduced in the seroma cavity, and a 15-F drain was left in place. Patients were followed each week during at least 4 weeks after drainage removal. Between January 2013 and December 2016, a total of six patients were enrolled in the study. Talc poudrage was performed without any complications. Drains were pulled out in a mean time of 3 (range: 2-4) weeks. One case of the chronic seromas was efficiently sclerosed with talc without recurrence in time. In three cases, the seroma recurred, and the final solution was surgical decortication of the seroma. In the other two cases, seroma also recurred and were managed with instillation of ethanol and iodine povidone. In our experience, the management of chronic seromas after incisional hernia repair with talc seromadesis is ineffective and is associated with a high rate of seroma recurrence.

Incisional hernias following open gynecological surgery: a population-based study

IntroductionIncisional hernia is a common and costly complication following abdominal surgery. The incidence of incisional hernia after gynecological surgery is not as well studied as that after general surgery.Materials and methodsThe Swedish National Quality Register for Gynecological Surgery (GynOp) collects preoperative, intraoperative, and postoperative information regarding gynecological surgery. Data were extracted from 2006 to 2014. The National Patient Register (NPR) contains physicians’ data from both public and private hospitals. Univariate and multivariate Cox proportional hazard analyzes were performed on risk factors.ResultsBetween 2006 and 2014, 39,312 women undergoing open surgery were registered in GynOp. The NPR recorded 526 patients who were diagnosed with or had undergone surgery for incisional hernia. The mean follow-up was 2.8 years. Five years after surgery the cumulative incidence of incisional hernias was 2.0% (95% confidence interval 1.8–2.2%). In multivariate Cox proportional hazard analysis obesity (BMI > 30), age > 60 years, midline incision, smoking, kidney, liver, and pulmonary disease were found to predict an increased risk for incisional hernias (all p < 0.05).ConclusionsThere is much to be gained if the patient can cease smoking and lose weight before undergoing abdominal surgery. The Pfannenstiel incision results in fewer incisional hernias and should be considered whenever possible.

İnsizyonel Herni Cerrahisinde Açık ve Laparoskopik Yöntemin Karşılaştırılması: Tek Merkez Deneyimi

Amaç: Hastanemizde insizyonel herni nedeniyle açık ve laparoskopik onarım yapılan hastaların sonuçlarını literatür eşliğinde değerlendirmek.Gereç ve Yöntem: 2012-2016 yılları arasında insizyonel herni nedeniyle opere edilen 250 hastanın sonuçları incelendi. Hastalar laparaskopik yapılanlar grupI (n:122) , açık yapılan grup II (n:128) olarak ayrıldı. Demografik özellikleri, ameliyat süresi, yatış süresi, post operatif erken-geç komplikasyonları ve nüks açısından istatistiksel olarak incelendi.Bulgular:Demografik özelliklerden yaşın açık teknik uygulanan hastalarda daha yüksek olduğu gözlendi. Perioperatif özellikler ve post operatif komplikasyonlar açısından açık ve kapalı teknik arasında istatistiksel açıdan anlamlı fark bulunmadı.Sonuç: Laparoskopik insizyonel fıtık onarımı, uygun hastalarda açık teknik kadar güvenli bir şekilde uygulanabilmektedir. Tekniğin daha standardize edilebilmesi için hala geniş hasta gruplu prospektif kontrollü çalışmalara ihtiyaç olduğu kanaatindeyiz.

A briefly discussion of the progress and development direction of incisional hernia surgery in China

Since large-scale popularization of the surgical treatment of hernia in the 1990s, China has made great process in the field of hernia and abdominal wall surgery. In the treatment of incisional hernia of abdominal wall, a relatively complete system has been established in China, for instance, the formulation of guidelines, the purpose of incisional hernia treatment, the principle of surgical treatment, the choice of surgical methods, the improvement of material application, standardized treatment process, optimized management system. Common procedures of incisional hernia are open operations, including direct repair suture, bridging repair, and separation techniques of tissue construction. Meanwhile, the laparoscopic repair develops quickly in China as well. Compared with Western countries however, we still have a long way in overall level, for instance, treatment innovation, data integrity accumulation, quality control, technical innovation, new materials research, and monitoring of side-effects of implant materials. What we should consider and pay attention to is how to further develop hernia surgery and make it sustainable. Based on surgical experiences of incisional hernia in China, this paper intends to share the modern knowledge of incisional hernia and abdominal wall surgery.

Immunosuppression is not a risk factor for 30-day wound events or additional 30-day morbidity or mortality after open ventral hernia repair: An analysis of the Americas Hernia Society Quality Collaborative

Some form of immunosuppression is relatively common in patients undergoing ventral hernia repair. Nevertheless, the association of immunosuppression with 30-day wound events and additional outcomes of morbidity and mortality remains unknown. The purpose of our study was to investigate the association of immunosuppression with 30-day wound events and additional morbidity and mortality after ventral hernia repair by evaluating the database of the Americas Hernia Society Quality Collaborative. All patients undergoing open, elective, incisional ventral hernia surgery from July 2013 through April 2017 were identified within the database of the Americas Hernia Society Quality Collaborative. Patients on immunosuppression within the 3 months before operative intervention were compared with patients not on immunosuppression with respect to the incidence of 30-day wound events, using a 1:5 propensity matched analysis. A total of 3,537 patients met inclusion criteria; 200 (5.7%) patients were on some form of immunosuppression at the time of ventral hernia repair. After propensity matching, 1,200 patients remained for analysis; 200 (16.7%) patients were in the immunosuppression group. There were no statistically significant differences between the 2 groups with respect to the incidence of 30-day surgical site infection, surgical site occurrence requiring procedural intervention, or additional 30-day morbidity or mortality outcomes. Patients in the immunosuppression group had a greater rate of surgical site occurrences, the majority of which were seromas (P = .03). Immunosuppression is associated with an increased risk of 30-day surgical site occurrence but not surgical site infection, surgical site occurrence requiring procedural intervention, or additional 30-day morbidity or mortality. Additional studies are needed to determine the clinical importance of these surgical site occurrences with respect to long-term durability of the hernia repair.

Balancing mesh-related complications and benefits in primary ventral and incisional hernia surgery. A meta-analysis and trial sequential analysis.

BackgroundPrimary ventral hernia (PVH) and incisional hernia (IH) repair using a mesh appears to reduce hernia recurrence. However, are the benefits of mesh offset in part by mesh-related complications? The aim of this study was to compare placement of a mesh versus simple suture for recurrence and postoperative complications in the repair of PVH or IH.MethodsFive databases were searched for randomized controlled trials (RCTs). The study population was patients with a PVH or IH undergoing hernia repair. Intervention was placement of a nonabsorbable synthetic mesh, regardless of mesh location, surgical technique, hernia characteristics or surgical setting compared to primary suture. Primary outcome was the incidence of hernia recurrence. Secondary outcomes were wound infection, hematoma, seroma, postsurgical pain, duration of operation, and quality of life. A random-effects meta-analysis with trial sequential analysis (TSA) was used.Results10 RCTs with a total of 1270 patients were included. A significant reduction of the incidence of PVH or IH recurrence using a mesh for repair (risk ratio [RR] 0.39, 95% CI 0.27–0.55; P < 0.00001; I2 = 20%) was observed. TSA for recurrence, the accrued information size (1270) was 312% of the estimated required information size (RIS). Subgroup analysis for PVH and IH confirms reduction of recurrence after using a mesh in both groups. Overall postoperative complications did not show statistically significant differences between the mesh and surgical suture groups (RR 1.31, 95% CI 0.94–1.84; P = 0.12; I2 = 27%) but the accrued information size was only 22.4% of RIS and by subgroups complications were only related with IH repair.ConclusionsEvidence for the efficacy of repair of PVH or IH using a nonabsorbable synthetic mesh in terms of recurrence was found to be robust. Evidence for complications remains inconclusive.

Impact of Surgical Site Infections on Elective Incisional Hernia Surgery: A Prospective Study.

Although incisional hernia repair is classified as a clean surgery, it still has a high incidence of surgical site infection (SSI) (0.7%-26.6%). The presence of an SSI could increase early recurrence rates after incisional hernia repair. Patients undergoing elective incisional hernia repair with no bowel contamination between January and December 2015 were assessed prospectively. Demographic and surgical data, local post-operative complications, and one-year recurrence rates in patients with and without SSI were compared. The management of SSI was determined. Patients with SSI (16/101) showed more prolonged surgical procedures (91 ± 39 vs. 63 ± 30 min, p = 0.012), more post-operative sero-hematomas (38% vs. 8%, p = 0.001), and a higher one-year recurrence rate (19% vs. 4%, p = 0.047). Multivariable analysis revealed the only identified risk factor for SSI to be post-operative sero-hematomas (p = 0.042; odds ratio [OR] = 4.17 [1.05-16.54]). Patients who developed an SSI required antibiotic agents and daily treatment from one to five months. One of these required the removal of the mesh. Surgical site infection rates are high for incisional hernia surgery (16%), and associated with local complications. Surgical site infection requires long-term treatments and leads to a higher one-year recurrence rate.

Long-term follow-up (at 5years) of midline incisional hernia repairs using a primary closure and prosthetic onlay technique: recurrence and quality of life.

The recurrence rate of incisional hernia (IH) repair is usually underestimated due to a lack of long-term follow-up. The objective of this study was to evaluate recurrence rate for patients operated on midline IH surgery, using a primary closure and prosthetic onlay technique, 5years after the procedure. From January 2009 to January 2011, all 92 patients operated on elective midline IH repair by primary closure and prosthetic onlay technique in a General Surgery Department were retrospectively included in the study. Exclusion criteria were absence of follow-up or death. Recurrence rate and quality of life were assessed. Demographic, surgical data and quality of life in patients with and without 5-year recurrence were compared. Mean follow-up was 64months. Ultimately, 76 patients were included in the study, representing 82% of the selected patients during the study period (76/92), of whom 24 presented a recurrence (32%). Half (12) were diagnosed for recurrence more than 3years after the surgery. Patients who developed a recurrence had more percentage of obesity (64 vs. 29%, p=0.016), which denoted an odds ratio (OR) for recurrence of 4.4 (1.2-15.7; p=0.01) and they punctuated lower in quality of life (6.0±2.9 vs. 7.6±2.6, p=0.006). Recurrence rate on midline IH repair is still a concern (32% at 5years). It is advisable to look for other strategies and more efficient surgical techniques for IH surgery, especially in obese patients.

External Validation of the European Hernia Society Classification for Postoperative Complications after Incisional Hernia Repair: A Cohort Study of 2,191 Patients

Incisional hernia is a frequent complication after midline laparotomy. Surgical hernia repair is associated with complications, but no clear predictive risk factors have been identified. The European Hernia Society (EHS) classification offers a structured framework to describe hernias and to analyze postoperative complications. Because of its structured nature, it might prove to be useful for preoperative patient or treatment classification. The objective of this study was to investigate the EHS classification as a predictor for postoperative complications after incisional hernia surgery. An analysis was performed using a registry-based, large-scale, prospective cohort study, including all patients undergoing incisional hernia surgery between September 1, 2011 and February 29, 2016. Univariate analyses and multivariable logistic regression analysis were performed to identify risk factors for postoperative complications. A total of 2,191 patients were included, of whom 323 (15%) had 1 or more complications. Factors associated with complications in univariate analyses (p < 0.20) and clinically relevant factors were included in the multivariable analysis. In the multivariable analysis, EHS width class, incarceration, open surgery, duration of surgery, Altemeier wound class, and therapeutic antibiotic treatment were independent risk factors for postoperative complications. Third recurrence and emergency surgery were associated with fewer complications. Incisional hernia repair is associated with a 15% complication rate. The EHS width classification is associated with postoperative complications. To identify patients at risk for complications, the EHS classification is useful.

KARIN ÖN DUVARI FITIKLARININ TAMİRİNDE AÇIK VE LAPAROSKOPİK YÖNTEMLERİN SONUÇLARININ KARŞILAŞTIRILMASI

Objective: In this study, we compared the results of patients who underwent laparoscopic and open ventral and incisional hernia repair in our clinic during last four years. Materials and Methods: The data of 76 patients who underwent surgery for ventral and incisional hernia between January 2012 and January 2016 in our clinic were analyzed retrospectively. The patients who underwent surgery for other types of abdominal wall hernias (such as inguinal, femoral, Spiegelian etc.) and patients who underwent primary repair without use of mesh were excluded. Forty-three patients (n: 43, 56,5%) whose operation was completed laparoscopically were defined as group1 and 33 patients (n:33, %43,5) who were operated using mesh with onlay technique were defined as group2. The cases were evaluated in terms of demographic data, body mass index (BMI), repair procedures, operation time, duration of hospital stay and postoperative complications. Results: In 44 patients, operation was initiated laparoscopically and in 43 were completed laparoscopically, whereas 33 patients were operated by open surgical technique. There was no significant difference in demographic data between these two groups. In the laparoscopic group, the operation time was significantly higher than the open group. However, the duration of hospital stay was significantly shorter. When the general complication rates during and after the surgery were compared, it was found that group 2 had significantly more complications. When the factors affecting recurrence&nbsp;were compared, it was found that there was no difference between laparoscopic and open techniques, but the history of a previous hernia operation was an important risk factor for recurrence. Conclusion: In our opinion laparoscopy can be safely performed with high patient satisfaction except in cases with very large ventral hernias (≥15 cm).

Incidence of incisional hernia after minimally invasive and open radical prostatectomy: a population-based nationwide study

Objective: Minimally invasive techniques (laparoscopic or robot-assisted laparoscopic) are gradually becoming the methods of choice for surgical treatment of prostate cancer. However, the impact of these techniques on the risk of developing incisional hernia has yet to be fully evaluated. The aim of this study was to compare the risk of incisional hernia after open radical prostatectomy (ORP) and minimally invasive radical prostatectomy (MIRP).Materials and methods: From the National Prostate Cancer Register of Sweden, all men who underwent radical prostatectomy for prostate cancer between 2004 and 2013 were identified. These data were linked with the National Patient Register to determine comorbidity and subsequent diagnosis of incisional hernia or surgery for incisional hernia. The endpoint was diagnosis of or surgery for incisional hernia. Multivariate proportional Cox hazard regression analyses were performed to analyze risk factors.Results: In total, 19,743 men underwent radical prostatectomy during the study period. The cumulative incidence of incisional hernia was 1.4% [95% confidence interval (CI) 1.2–1.7%] and 2.3% (CI 1.9–2.7%) 5 years after ORP and MIRP, respectively (p < .05). For men undergoing ORP, age above the median was associated with increased risk of incisional hernia (p < .001). For men undergoing MIRP, age above the median, prostate volume above the median and lymph-node dissection were associated with increased risk of incisional hernia (p < .05).Conclusion: MIRP is associated with a significantly higher risk of developing an incisional hernia compared to ORP. Awareness of appropriate surgical technique may reduce this risk.

Open retromuscular mesh repair versus onlay technique of incisional hernia: A randomized controlled trial

IntroductionThe aim of this prospective randomized clinical study was to compare and analyze the results of two methods of treatment of incisional hernia: open retromuscular mesh repair and onlay technique. Methods180 patients who underwent open elective surgery for middle primary incisional hernia were randomized into two groups. The retomuscular mesh repair was used in the first group and the onlay technique – in the second group. Several preoperative and intraoperative factors, also wound complications (wound infection, hematoma, seroma) and hernia recurrence rate were determined and compared between the groups. ResultsThe operative time was significantly longer in the retromuscular group compared with the onlay group (P < 0.001). In the retromuscular group 17 (22.1%) wound complications were observed, in the onlay group–39 (50.0%) wound complications. The difference was statistically significance (P < 0.001). Seroma was the most frequent postoperative wound complication, ranging from 16.9% to 41.0% among the groups, respectively (P = 0.0013). No significantly difference has been found between groups by wound infection and hematoma. 2 (2.6%) case of hernia recurrence was marked in retromuscular group and 4 (5.1%) case of hernia recurrence – in onlay group. But there was no statistically significantly difference between the two groups. ConclusionOur research shows no significant difference in frequency of hernia recurrence between retromuscular mesh repair and onlay technique for treatment of incisional hernia. The usage of the retromuscular mesh repair is associated with significantly less wound complications than onlay technique. That can be considered as an advantage of retromuscular method, which makes it more preferential than onlay method.

Risk factors of severe incisional hernia after renal transplantation: a retrospective multicentric case-control study on 225 patients.

The aim of this study was to analyze the incidence of severe incisional hernias and find their specific risk factors in renal transplant patients. This retrospective multicentric case-control study focused on 225 kidney transplant patients among 4348 patients transplanted during this period within two French university hospitals (Saint-Louis/Lariboisière in Paris and Tours, Loire Valley) from 2000 to 2014 and from 1995 to 2014, respectively. Forty-five patients developed a severe incisional hernia after renal transplantation. The primary outcome measure was the development of a severe incisional hernia after surgery. Statistical analysis included an univariate analysis and a multivariate analysis using a logistic regression according to the Cox model. Forty-five patients (1.03%) had a severe incisional hernia surgery after renal transplantation. The median follow-up was 55.5months. In univariate analysis, smoking, the occurrence of a lymphocele and parietal closure in a single musculo-fascial layer was significantly associated with the occurrence of incisional hernia after renal transplantation. Former or active smoking (OR 2.32, p=0.0370), lymphocele (OR 4.3903, p=0.0018) and parietal musculo-fascial closure in one single layer (OR 3.37, p=0.0088) significantly increased the risk of incisional hernia after kidney transplant in multivariate analysis. We report in this study one of the largest series of patients who had incisional hernia after renal transplantation. Former or active smoking, lymphocele and parietal closure in one single musculo-fascial layer were independent risk factors for incisional hernia following kidney transplant.

Evidence for Replacement of an Infected Synthetic by a Biological Mesh in Abdominal Wall Hernia Repair.

The incidence of deep infection using a synthetic mesh in inguinal hernia repair is low and reported to be well below 1%. This is in contrast to incisional hernia surgery where the reported incidence is 3% respective 13% comparing laparoscopic to open mesh repair reported in a Cochrane review. Main risk factors were long operation time, surgical site contamination, and early wound complications. An infected mesh can be preserved using conservative treatment were negative pressure wound therapy (VAC(®)) could play an important role. If strategy fails, the mesh needs to be removed. This review aims to look at evidence for situations were a biological mesh would work as a replacement of a removed infected synthetic mesh. A literature search of the Medline database was performed using the PubMed search engine. Twenty publications were found relevant for this review. For studies reviewed three options are presented: removal of the infected synthetic mesh alone, replacement with either a new synthetic or a new biological mesh. Operations were all performed at specialist centers. Removal of the mesh alone was an option limited to inguinal hernias. In ventral/incisional hernias, the use of a biological mesh for replacement resulted in a very high recurrence rate, if bridging was required. Either a synthetic or a biological mesh seems to work as a replacement when fascial closure can be achieved. Evidence is though very low. When required, either a synthetic or a biological mesh seems to work as a replacement for an infected synthetic mesh if the defect can be closed. It is, however, not recommended to use a biological mesh for bridging. Mesh replacement surgery is demanding and is recommended to be performed in a specialist center.