Management Of Ventral Hernias Research Articles

Patient expectations and decisional regret in the management of ventral hernias.

Older adult patients have many factors to contemplate when considering elective ventral hernia repair. In this study, we aimed to understand whether our novel shared decision-making (SDM) aid helped reduce this population's decisional regret when choosing hernia management strategy. Patients ≥ 60years of age presenting for ventral hernia evaluation were randomized to two groups. The experimental group had their visit guided by our novel SDM aid. All patients took a survey prior to consultation outlining their treatment expectations. All patients were called within 6months to complete the Decision Regret Scale, which measures remorse after a healthcare decision. Seventy-two patients (36 control, 36 experimental) completed final follow-up. On initial expectations evaluation, 53 patients (74%) reported wanting surgical repair and 58 patients (81%) reported expecting surgical repair. Ultimately, 18 patients in the control group and 17 patients in the experimental group did not undergo surgery. The use of the SDM aid did not affect if patients chose observation (OR 0.44, p = 0.24) or result in a lower decision regret score (9.86 vs 9.31, p = 0.89). Surgery was associated with a lower decision regret score (3.38 vs 16.14; p = 0.001). Of those who did not undergo repair, patients initially wanting or expecting surgery had higher decision regret scores (22.83 vs 3.33, p < 0.001; 20.40 vs 5.50, p = 0.009). Nonoperative patients who chose observation had less regret than those needing medical optimization (9.50 vs 25.00, p = 0.04). There were no differences in decision regret scores based on initial wants or expectations for those who had surgical repair. Decisional regret following ventral hernia management is associated with patients' expectations prior to initial surgical consultation. The use of a decisional aid did not lower decision regret scores. These findings emphasize the need for upfront expectation setting and longitudinal programs to help patients reach their treatment goals.

A systematic review and meta-analysis of randomized controlled trials for the management of ventral hernia: biologic versus synthetic mesh.

An abdominal wall hernia near the location of a prior surgical incision is referred to as an incisional hernia. A midline incisional hernia is the most prevalent form. The management of incisional hernia includes many options, from conservative to surgical. The surgeon might consider using a synthetic or biological mesh when discussing surgical options with patients. Our aim through this study is to comprehensively compare synthetic and biological mesh in terms of complication and infection rates for managing elective incisional hernia. This systematic review was designed and conducted using PRISMA guidelines. The literature was systematically searched in January 2023 using the following databases: MEDLINE, Cochrane, and EMBASE. Among the terms used to aid the search were the following: incisional hernia, ventral hernia, ventral herniorrhaphy, biologic mesh, polypropylene mesh, absorbable mesh, permanent mesh, biomaterial mesh, biological mesh, and synthetic mesh. The review of the literature resulted in a total of 3115 publications. By applying our criteria, six articles were included in this study, with 949 participants. Our meta-analysis showed the overall complication incidence displaying a significant difference favouring the synthetic mesh group (IV = 1.25, 95% CI 1.11-1.42, P = 0.0002). The operation failure rate, defined as hernia recurrence, also significantly favoured synthetic mesh (IV = 2.42, 95% CI 1.66-3.52, P < 0.00001). In conclusion, the present study found that the synthetic mesh proved superior in overall complication rate and operation failure compared to biologic mesh. However, it had no significant differences in other complications.

ROBOT-ASSISTED EXTRAPERITONEAL VENTRAL HERNIA REPAIR—EXPERIENCE FROM THE FIRST 160 CONSECUTIVE OPERATIONS WITH LATERAL eTEP AND eTAR TECHNIQUES

Abstract Background As in various other surgical domains, robotically assisted procedures have become integral in the management of ventral hernias in recent years. The employment of robotic technology enables the integration of minimally invasive techniques with retromuscular mesh placement. Beyond the conventional transabdominal approach, these surgical interventions can alternatively be executed in a total extraperitoneal fashion. The objective of this study is to demonstrate that robotic total extraperitoneal management of abdominal wall hernias is safe and efficient. Method A retrospective analysis encompassing all patients who underwent robotic surgery for ventral hernia repair utilizing the extraperitoneal eTEP technique with a lateral approach was conducted. The study period spanned from December 2019 to December 2023. Results Over the study period, a total of 160 patients underwent surgical intervention utilizing the lateral robotic eTEP technique. Among these cases, 43 patients required a lateral extension of retro-rectal dissection through extraperitoneal transversus abdominis release (eTAR) due to either the hernia size or lateral hernia localization. In every instance, an uncoated synthetic mesh was positioned in the retromuscular location, accompanied by complete fascial closure. The median hernia defect area was 25 cm² (2.25–375 cm²). The median mesh size was 540 cm² (225–1350 cm²). The median mesh defect ratio (MDR) was 21 (2.3–150). Two conversions (1.72%) were necessary. One intraoperative and seven postoperative complications were encountered (5%) out of which two required reoperations (1.72%). Conclusion The robotic extraperitoneal eTEP technique enables a retromuscular mesh placement in a minimally invasive approach. With the possibility of combination with a transversus abdominis release, even complex findings can be treated using this technique.

A Ventral Hernia Management Pathway; A "Getting It Right First Time" approach to Complex Abdominal Wall Reconstruction.

Abdominal wall reconstruction (AWR) is an emerging specialty, involving complex multi-stage operations in patients with high medical and surgical risk. At our hospital, we have developed a growing interest in AWR, with a commitment to improving outcomes through a regular complex hernia MDT. An MDT approach to these patients is increasingly recognized as the path forward in management to optimize patients and improve outcomes. We conducted a literature review and combined this with our experiential knowledge of managing these cases to create a pathway for the management of our abdominal wall patients. This was done under the auspices of GIRFT (Getting It Right First Time) as a quality improvement project at our hospital. We describe, in detail, our current AWR pathway, including the checklists and information documents we use with a stepwise evidence and experience-based approach to identifying the multiple factors associated with good outcomes. We explore the current literature and discuss our best practice pathway. In this emerging specialty, there is limited guidance on the management of these patients. Our pathway, the "Complex Hernia Bundle," currently provides guidance for our abdominal wall team and may well be one that could be adopted/adapted by other centers where challenging hernia cases are undertaken.

How Appropriate Are Recommendations of Online Chat-Based Artificial Intelligence (ChatGPT) to Common Questions on Ventral Hernia Repair?

ChatGPT is a conversational AI model developed by OpenAI to generate human-like text based on the input it receives. ChatGPT has become increasingly popular, and the general public may use this tool to ask questions about different medical conditions. There is a lack of data to demonstrate ChatGPT is able to provide reliable information on medical conditions. The aim of our study is to assess the accuracy and appropriateness of ChatGPT answers to questions on ventral hernia management.

ROLE OF WOUND DRAINS VS ABDOMINAL BINDER AND PERCUTANEOUS ASPIRATION AFTER OPEN REPAIR OF VENTRAL HERNIA USING POLYPROLENE MESH

Background: Abdominal wall hernias are among the most common of all surgical problems. Ventral hernia repair (VHR) is a commonly performed operation so hernia defect size affects operative time and surgical technique for repair of a ventral hernia. Incisional hernia is the most frequent postoperative complication following general surgery. Complications of ventral hernia repair include seroma, hematoma, wound infection, bowel injury, bowel obstruction, recurrence whether earlyorlate,the mostcommoncomplicationisseroma formation.New advances in the management of ventral hernias including different methodsofrepaireitheropenor laparoscopic and differentmesh types: non-absorbable partially absorbable and absorbable. Objectives: This study was done to review and assess thedifference between insertion of wound drain and the use of abdominal binder and percutaneousaspirationafteropenrepairofventralherniasanditseffect on postoperative outcome. Patients and Methods: A total of 100 patients with non-complicated abdominal wall (ventral) hernia were enrolled to review andassess the difference between insertion of wound drain and the use of abdominal binder and percutaneous aspiration after open repair of ventral hernias and its effect on postoperative outcome. Patients were divided into two groups: Group (A) includes 50 patients with insertion of wound drain. Group (B) includes 50 patients with application of abdominal binder immediately postoperatively for 2 weeks. Results: This study showed distribution of patients according to age, ranging from 27 years to 70 years with mean age of 49.2 years (±11.6 years).25% of patients below 39, 50 % of patients below 50 and 75% ofpatientsbelow59.75.Inourstudy,60%ofoperationswerecarriedout under spinal anesthesia and 40% of operations were carried out under general anesthesia. Out of 100 patients of our study, in 28 % of cases, the hernial content was intestine and in 72 of cases the hernial content wasomentum.Outof100patientsofourstudy,therewasdevelopingof significant seroma in (30%) of patients as follow: (17%) at group A (with drain)&amp; (13%) at group B (without drain). Significant seroma was not seen in (70%) of patients. Wound infection was developed in (18%)ofpatientsasfollow(12%)forgroupA(withdrain)and(6%)for groupB(withoutdrain).Woundinfectionnotseenin(82%)ofpatients. Out of 100 patients of our study, (2%)oftotalcountonlyshowing earlyrecurrencethatpresentat group B. (9%) of total count only complained of persistent postoperativepainasfollows, 6 cases fromgroup (A) and 3 casesfrom group (B). Mean hospital stay was 1.46 days for group (A) and 1.26 daysforgroup(B).Meanperiodbeforereturningto normalactivitywas 3.7weeksforgroup(A)and2.9weeksforgroup(B). Conclusion: Combined abdominal binder and percutaneous aspiration for selected caseswere superior to insertionof wound drains asregards seroma formation, wound infection and postoperativereturn to normal activity with no significant difference as regards hematoma, postoperative pain, hospital stay andpatientsatisfaction.

Surgical management of ventral hernia in a calf by hernioplasty using non-absorbable Polypropylene mesh

Surgical management of ventral hernia in a calf by hernioplasty using non-absorbable Polypropylene mesh

Systematic review and meta-analysis of the pre-operative application of botulinum toxin for ventral hernia repair.

Surgical repair of large hernia defects requires detailed pre-operative planning, particularly in cases with loss of domain. This situation often hampers mid-line reconstruction, even after component separation, when the size of the hernia is disproportional to the volume of the abdominal area. In this case, other strategies may be needed to place the viscera back into the abdominal cavity after reducing the hernia sac. The administration of botulinum toxin prior to the surgical procedure has been indicated as an adjunct for more complex cases. This results in stretching of the lateral musculature of the abdomen, allowing midline approximation. In addition, the application of botulinum toxin alone has been investigated as a means of downstaging in the management of ventral hernias, thereby precluding component separation and enabling primary closure of the midline by placement of mesh within the retromuscular space using the Rives Stoppa technique. Systematic review of the literature for observational studies involving patients undergoing pre-operative application of botulinum toxin for ventral hernia repair was conducted according to the PRISMA guidelines. Advance of the lateral musculature of the abdomen by an average of 4.11cm with low heterogeneity, as well as low rates of surgical site infection (SSI), surgical site occurrences (SSO) and recurrence, was shown. Pre-operative application of botulinum toxin for ventral hernia repair promoted an increase in the length of the lateral musculature of the abdomen which can help improve the outcomes of morbidity and recurrence.

Comparative study of onlay versus sublay mesh repair in the management of ventral hernias.

Ventral hernias with large defects (≥ 2cm) are managed with tension free mesh repair. The growing consensus that sublay (retrorectus) mesh repair is superior to onlay mesh repair due to fewer complications is based on literature dominated by retrospective studies from high and upper-middle income countries. There is thus a need of more prospective studies from various countries to resolve the controversy. The objective of this study was to compare the outcomes of onlay versus sublay mesh repair in the management of ventral hernias. Our single centre, prospective comparative study set in a low-middle income country comprised of 60 patients with a ventral hernia undergoing open surgical repair using either onlay technique (n = 30) or sublay technique (n = 30). Surgical site infections, seroma formation, recurrence were found in 3.33%, 6.67%, 0% patients in sublay repair group and in 16.67%, 20%, 6.67% patients in onlay repair group respectively. Mean duration of surgery, mean Visual Analogue Scale (VAS) score for chronic pain, mean duration of hospital stay were 46min, 4.5, 8days in onlay repair group and 61min, 4.2, 6days in sublay repair group respectively. Onlay repair group was associated with shorter duration of surgery. However, sublay repair was associated with lesser rates of surgical site infections, chronic pain and recurrence than onlay repair. Sublay mesh repair had better outcomes than onlay mesh repair for the management of ventral hernias, however superiority of any one technique could not be established.

A PROSPECTIVE COMPARATIVE STUDY BETWEEN ONLAY AND RETRO-RECTUS MESH REPAIR IN VENTRAL HERNIA CASES IN A TERTIARY CARE CENTER

Ventral hernia, a commonly dealt surgical problem in clinical practice, is dened as an abnormal protrusion of a viscus or a part of the viscus through a defect or weakness in the anterior abdominal wall. Various risk factors such as old age, history of previous surgery, obesity, COPD, diabetes mellitus, smoking &amp; alcoholism lead to the formation of ventral hernias. Mesh hernioplasty has become the gold standard in the management of ventral hernias. There are various procedures in the management of ventral hernias based on the placement of mesh. In this study, we compare the traditional onlay and retro-rectus mesh repair in ventral hernias in terms of postoperative complications, hospital stay &amp; feasibility

Laparoscopic Intra Peritoneal Onlay Mesh Plus (IPOM Plus) repair of Ventral Hernias – Experience in a Tertiary Hospital

Introduction: Laparoscopic Ventral Hernia Repair (LVHR) was first described by Karl Leblanc in 1992 and has increasingly been gaining popularity in this present era of minimal access surgery. Laparoscopic Intraperitoneal Onlay Mesh (IPOM) repair with its modification intraoperative Onlay Mesh Plus (IPOM Plus) repair is now being well-accepted option for the treatment of ventral hernias. Objective: To assess the safety and efficacy of the laparoscopic IPOM plus modality in the management of ventral hernias. Methods: This is a descriptive observational study, carried out on 22 patients who underwent Laparoscopic ventral hernia repair by IPOM Plus technique between January 2017 to December 2018 at CMH Dhaka. Patients who had ventral hernia with a defect size&gt; 2 cm but &lt; 10 cm were included in this study. Primary subcutaneous transfascial suture closure of all ventral hernias with defect size &gt;2 cm were done using prolene 1-0.Optimized composite mesh (ParietexTM) and Polymesh composite partially absorbable mesh were used as prosthesis anchored with four corner sutures and fixed with non absorbable tacking device. Follow up period was one year. Results: A total of 22 patients underwent Laparoscopic IPOM Plus repair of ventral hernias. Intraoperative and postoperative complications were negligible. No seroma, bulging of mesh, intestinal obstruction, mesh infection and recurrence observed in one year follow up time. But one patient developed de novo spigelian hernia on the right side outside the mesh system after one year. One patient (4.5%) developed post operative persisting pain requiring analgesic at 2 months. Conclusion:: Laparoscopic IPOM plus repair of ventral hernia is a safe, effective and well accepted modality. J Bangladesh Coll Phys Surg 2023; 41: 150-155

The ANZ hernia repair practices study: low consensus on inguinal and small ventral hernia management and infrequent long-term follow-up.

The ANZ hernia repair practices study: low consensus on inguinal and small ventral hernia management and infrequent long-term follow-up.

Outcomes of Ventral Hernia Repair After Orthotopic Liver Transplant Using Component Separation and Onlay Biologic Mesh.

The management of ventral hernias (VHs) after orthotopic liver transplant (OLT) can be uniquely challenging because of immunosuppression coupled with large laparotomy size that can compromise the quality of the abdominal wall. The component separation with multipoint suture onlay acellular dermis fixation technique has proven to be effective in high-risk abdominal wall reconstructions. The goal of this study was to elucidate the factors that affect safety and efficacy of VH repair in post-OLT patients. A retrospective review of 345 patients who underwent repair of VH with compartment separation and onlay acellular dermal matrix reinforcement from a single surgeon from 2012 to 2020 was conducted. Of these, 27 patients were identified with a history of OLT and were stratified based on whether the defect was a initial or recurrent hernia repair. The majority of patients had a standard chevron incision (70%). Data abstraction was performed for preoperative risk factors, hernia characteristics, surgical site complications, and postoperative course including hernia recurrence. A majority of cases in the study period were initial hernia repairs (59%) with no significant differences in the patient demographics and size of VH defects (190 ± 112.69 cm 2 ). Comorbidities were similar between the groups with the exception of a significantly higher baseline creatinine levels and higher history of smoking in the recurrent hernia repair group ( P < 0.05). Of the 27 cases, there were no demonstrable hernia recurrences noted and an overall 11% complication rate. Univariate analysis noted a statistically significant difference in surgical site complication rate ( P = 0.017), with the initial hernia repair group having the lowest rate of surgical site complications. In complex post-OLT patients with large VH, modified component separation with onlay acellular mesh was shown to have acceptable medium-term results. Further studies investigating the factors leading to postoperative complications are necessary to reduce recurrence in this evolving patient population.

Computed tomography for ventral hernia: Need for a standardised reporting format.

Computed tomography for ventral hernia: Need for a standardised reporting format.

Ventral hernia repair surgery after abdominal gunshot wound

Gunshot wounds to the abdomen frequently result in significant damage to the abdominal organs, which is accompanied by peritonitis and the further development of different complications (anastomotic leakage, formation of abscesses, repeated bleeding, etc.), which require repeated surgical interventions that contribute to the formation of postoperative ventral hernias. The surgical management of ventral hernias is challenging due to severe adhesion in the abdominal cavity (irrespective of the time period since the injury and the last surgical interventions), the difficulties in closing massive defects of the muscle‑aponeurotic component of the anterior abdominal wall, contracture of the anterior abdominal wall, and the development of the abdominal compartment syndrome in the postoperative period. As a result, there is still some debate over the best surgical treatment for postoperative ventral hernias. Objective — to carry out a comparative analysis of open and video‑assisted laparoscopic operations for the selection of the most optimal surgical strategy for the management of ventral hernias after gunshot wounds to the abdomen. Materials and methods. We analyzed the surgical treatment of 45 wounded patients with postoperative ventral hernias that developed after operations for abdominal gunshot wounds. The patients were treated at the Military Medical Clinical Center of the Southern Region (Odesa) from 2014 to 2021; 32 of them had penetrating gunshot wounds, and 13 patients had a closed gunshot wound to the abdomen with injuries to the abdominal organs. 66.7 % of those injured had one operation on their abdominal organs, 22.2 % had two operations, 6.7 % had three operations, and 4.4 % had five operations. The size of the hernia orifices and severity of recurrence risk were determined according to the SWE classification: W1 (width of the hernia orifices up to 4 cm) — 28.9 %, W2 (from 4 to 10 cm) — 44.4 %, and W3 (over 10 cm) — 26.7 % of patients. The patients who had laparoscopic hernia repair (LHR) (IPOM‑Plus method — 17 patients, sIPOM — 2 patients) belonged to the LHR group (n = 19). The patients who had open hernia repair (OHR) (IPOM‑Plus method — 7 patients, sublay technique — 11 patients, onlay technique — 8 patients) were added to the OHR group (n = 26). The patients of both groups did not statistically differ by age, nature of a gunshot injury, number of operations before hernia repair, or hernia parameters (all p &gt; 0.05). Results. Postoperative hernias after gunshot wounds are associated with pronounced adhesions in the abdominal cavity. The mean value of the peritoneal adhesion index averaged 11.7 ± 0.7 points (from 5 to 23 points) and did not statistically differ between groups: in the OHR group — 12.4 ± 0.9 points, in the LHR group — 10.8 ± 0.9 points (p = 0.339). Laparoscopic and open hernia repair in injured patients did not differ in the frequency of intraoperative complications — 19.2 % and 15.8 %, respectively (p = 0.766). There were fewer postoperative complications (10.5 % vs. 38.5 %, p = 0.036), a shorter operation duration — 79.5 ± 6.8 min vs. 105.9 ± 4.7 min, p = 0.002, a shorter bed‑day — 8.6 ± 0.4 days vs. 10.8 ± 0.5 days, p = 0.004, and fewer patients required narcotic analgesics within the first two days after surgery (p &lt; 0.05). During the one‑year follow‑up, no hernia recurrence or adhesion signs were detected in the groups. Conclusions. In the structure of postoperative ventral hernias after gunshot wounds to the abdomen, patients with open gunshot injuries predominate and amount to 71.1 % (р = 0.007). Among them, patients with combined and multiple wounds make up 65.6 %, while those with isolated wounds make up 34.4 % (р = 0.112); 33.3 % of patients require more than one operation before hernia repair. The laparoscopic IPOM‑Plus technique should be considered the operation of choice in the treatment of hernias after gunshot wounds to the abdomen. At the same time, for extensive cosmetic defects of the anterior abdominal wall, open operations are preferable, especially the IPOM‑Plus technique. If this is technically impossible, a sublay or onlay hernia repair using the tension‑free allohernioplasty technique should be performed.

Variation of ventral and incisional hernia repairs in kidney transplant recipients.

As survivorship following kidney transplant continues to improve, so does the probability of intervening on common surgical conditions, such as ventral or incisional hernia, in this population. Ventral hernia management is known to vary across institutions and this variation has an impact on patient outcomes. We sought to evaluate hospital level variation of ventral or incisional hernia repair (VIHR) in the kidney transplant population. We performed a retrospective review of 100% inpatient Medicare claims to identify patients who underwent kidney transplant between 2007 and 2018. The primary outcome was 1- and 3-year ventral or incisional risk- and reliability-adjusted VIHR rates. Patient and hospital characteristics were evaluated across risk- and reliability-adjusted VIHR rate tertiles. Models were adjusted for age, sex, race, and Elixhauser comorbidities. Overall, 139,741 patients underwent kidney transplant during the study period with a mean age (SD) of 51.6 (13.7) years. 84,717 (60.6%) were male, and 72,657 (52.0%) were white. Median follow up time was 5.4years. 2098 (1.50%) patients underwent VIHR. the 1year risk- and reliability-adjusted hernia repair rates were 0.49% (95% Conf idence Interval (CI) 0.48-0.51, range 0.31-0.59) in tertile 1, 0.63% (95% CI 0.62-0.63, range 0.59-0.68) in tertile 2, and 0.98 (95% CI 0.91-1.05, range 0.68-2.94) in tertile 3. Accordingly, compared to hospitals in tertile 1, the odds of post-transplant hernia repair tertile 2 hospitals were 1.78 (95% CI 1.37-2.31) and at tertile 3 hospitals 3.53 (95% CI 2.87-4.33). In a large cohort of Medicare patients undergoing kidney transplant, the overall cumulative incidence of hernia repair varied substantially across hospital tertiles. Patient and hospital characteristics varied across tertile, most notably in diabetes and obesity. Future research is needed to understand if program and surgeon level factors are contributing to the observed variation in treatment of this common disease.

The Omental Plug: A Novel Management Approach of Concomitant Ventral Hernias During Bariatric Surgery.

Severe obesity leads to a higher incidence of ventral hernias, thus complicating up to 8% of bariatric procedures. The optimal management of these hernias continues to be a controversial topic. We present our novel approach of utilizing an omental plug for concomitant ventral hernia management during metabolic surgery. To prevent early bowel incarceration and obstruction during bariatric surgery, we sutured the omentum circumferentially to the edges of the hernia defect and to the hernia sac itself with absorbable suture. Four patients were managed with this novel omental plug technique. All patients were female. The mean age was 53 years (range 39 to 68 y), the mean body-mass index was 54.75 kg/m 2 (range 49 to 59 kg/m 2 ), and the mean follow-up was 4.6 months (range 1.5 to 6.5 mo). There were no hernia-related complications through the follow-up period. The omental plug technique is a feasible, inexpensive, and safe alternative for ventral hernias with the potential prevention of bowel incarceration during bariatric surgery. This approach allows deferring the definitive hernia repair for a later stage.

Epidemiology and management of ventral hernia in a tertiary health care centre- a prospective observational study

Background: Ventral hernias are a common problem confronting surgeons. Data about standards of their surgical management have failed to keep pace with rapid advances in surgical techniques, and materials. Older techniques have often been discarded simply because of availability of newer ones without due consideration to availability, feasibility, training, local conditions and constraints. Therefore, a balanced, practical and pragmatic opinion regarding surgical management at individual, institutional and regional levels is needed. We studied clinical aspects and best treatment modalities of ventral hernias in our set-up.Methods: This is a prospective observational study of various types of ventral hernias, surgically managed at a tertiary care hospital between January 2018 and September 2019.Results: Mean age of presentation among 71 patients (27 males, 44 females) was 48.11±5.71 years. Incisional hernias (30.98%) were the commonest type. Painless swelling (49.29%) was the most common clinical presentation. Obesity (40.84%) and multiparity (30.98%) were the most common associated risk factors. Incisional hernias are probably better managed by open approach.Conclusions: Ventral hernias are more prevalent in the elderly and females. Incisional, umbilical, epigastric hernias are the more common types. Laparoscopy is being preferred over open procedure due to some advantages that it offers, but incisional hernias can often be better managed by open approach depending upon local set up. In addition, laparoscopic approach is not universally applicable and also has certain drawbacks.

Transversus Abdominis Muscle Release (TAR) for Posterior Component Separation during Major Abdominal Wall Reconstruction

Abstract Background Ventral hernia repair is one of the most common operations performed today, yet when complex and huge it presents a true challenge for the surgical team. Aim of the Work To assess the feasibility, safety and efficacy of Transversus Abdominis release technique in management of ventral hernia with large defects. Patients and Methods This study is a prospective interventional study conducted at Ain Shams University Hospitals on 40 patients diagnosed as having ventral hernia with a defect equal to or more than 10cm in width and operated upon between October 2018 and October 2019 with minimal follow up of 6 months postoperatively. Results 40 ventral hernia patients were enrolled in the study. Mean operative time (in minutes) in TAR patient is 268.5min (4hr 28min) with SD ± 47.4. Postoperative pain evaluation using the visual analogue scale (VAS) score, the postoperative pain was assessed 48hrs postoperatively, the mean VAS score for TAR patient being (6.77 ± 1.70). Early Postoperative wound complications 10 (25.0%). Conclusion After this TAR technique are effective and reliable method in experienced hands.

Novel Approach to Open Onlay Meshplasty for Ventral Hernia Rep

Background and Objectives: Hernia is defined as abnormal protrusion of viscus through a normal or abnormal weakness in the wall of its containing cavity. Ventral Hernias are second most common type of hernias accounting for 21 to 35% of all verities of hernias. Reported incidence of Incisional hernias is 2 to 11%. It is the most common complication after laparotomy by a 2:1 ratio over bowel obstruction and is most common indication for reoperation by 3:1 ratio over adhesive small bowel obstruction. This study was under taken to study the various clinical presentation and management of ventral hernias. Materials and Methods: 300 cases of ventral hernias admitted to department of surgery Guru Gobind Singh hospital Jamnagar between periods of October 2010 to March 2021 were chosen for study. Data was collected including detailed history, clinical examination and investigation. Data was tabulated, analyzed and results interpreted.