Incisional Hernia Rate Research Articles

Single incision laparoscopic cholecystectomy: for what benefit?

A single-incision laparoscopic cholecystectomy (SILC) was developed to improve outcomes as compared with the four-port classic laparoscopic cholecystectomy (CLC). Any potential benefits associated with a SILC have been suggested by previous studies reporting few patients with different surgical techniques. The aim of this study was to describe the experience with a standardized SILC as compared with CLC. From June 2010 to January 2012, 40 patients underwent a SILC [median age: 47.5 years (25-92)] and operative and peri-operative data were prospectively collected. Over the same period, 37 patients underwent a CLC. A 10-point visual analogue scale (VAS) was used for qualitative data. The costs of SILC and CLC were also compared. For those patients undergoing a SILC the median operating time was 70 min (24-110). There were no conversions. An additional trocar was necessary in 16 patients. Four patients developed post-operative complications. The median immediate post-operative pain score was 5 (0-10). The median quality of life and cosmetic satisfaction at the initial post-operative visit were 10 (6-10) and 10 (5-10), respectively (VAS). Although the surgical results of both groups were similar, post-operative complications were exclusively reported in the SILC group (two incisional hernias). Standardization of SILC is possible but associated with an important rate of additional trocar placement and a disturbing rate of incisional hernias.

Prophylactic Mesh Reinforcement Reduces Stomal Site Incisional Hernia after Ileostomy Closure

Stomal site incisional hernia is a common complication following ileostomy closure. The effectiveness of prophylactic mesh placement at the time of stomal closure is unknown because of fear of mesh infection and subsequent wound complications. The present study investigated whether prophylactic mesh placement reduces the rate of incisional hernia after ileostomy closure without increasing wound complications. The study was based on retrospective review of consecutive ileostomy closures undertaken at a tertiary referral center between January 2007 and December 2011. Hernias were identified through clinical examination and computed tomography. Eighty-three cases of ileostomy closure were reviewed; 47 patients received mesh reinforcement, and 36 underwent non-mesh closure (controls). In total, 16 (19.3 %) patients developed incisional hernia, 13 (36.1 %) of which occurred in the control group; 3 (6.4 %), in the mesh group [odds ratio (OR): 8.29; 95 % confidence interval (CI) 2.14-32.08; p = 0.001]. Incisional hernia repair was performed in 3 (23 %) patients in the control group; no hernias in the mesh group required surgery. There was no significant difference in wound infection rates between mesh (2 patients, 4.3 %) and control (1 patient, 2.8 %) groups. No mesh infection was found. Multivariate analysis demonstrated that malignancy (OR: 21.93, 95 % CI 1.58-303.95; p = 0.021) and diabetes (OR: 20.98, 95 % CI 3.23-136.31; p = 0.001) independently predicted incisional herniation, while mesh reinforcement prevented hernia development (OR: 0.06, 95 % CI 0.01-0.36; p = 0.002). Mesh placement significantly reduced the incidence of incisional hernia following ileostomy closure, but without increasing complication rates. This technique should be strongly considered in patients at high risk of hernia development.

Systematic review and meta-analysis of prophylactic mesh placement for prevention of incisional hernia following midline laparotomy

Incisional hernia is a common long-term complication after laparotomy. This study investigated whether prophylactic mesh reinforcement of laparotomy reduced the rate of incisional hernia, with emphasis on trial design and quality. A systematic review of published literature was performed for studies comparing incisional hernia presence following conventional closure or prophylactic mesh reinforcement. Studies were assessed using the Cochrane Risk of Bias Tool, the Jadad score and the Newcastle Ottawa Scale (NOS). The primary endpoint was incisional hernia, assessed by meta-analysis. Seven studies [four randomised controlled trials (RCTs) and three prospective trials] included 588 patients; 262 received mesh reinforcement. All studies included elective patients at high risk of incisional hernia. Six incorporated a polypropylene mesh and one a biologic mesh. Four studies were judged high quality by NOS and two of four RCTs were at low risk of bias, although overall outcome assessment from all studies was either poor or mediocre. Mesh significantly reduced the rate of incisional hernia [odds ratio (OR) 0.15, p < 0.001]; the same effect was seen in RCTs only (OR 0.17, p < 0.001). A borderline increase of seroma seen with a fixed effect model (OR 1.82, p = 0.050) was not seen with a random effect model (OR 1.86, p = 0.210, I (2) = 45 %). Mesh reinforcement of laparotomy significantly reduced the rate of incisional hernia in high-risk patients. However, poor assessment of secondary outcomes limits applicability; routine placement in all patients cannot yet be recommended. More evidence regarding the rates of adverse events, cost-benefits and quality of life are needed.

Management of the open abdomen with the Abdominal Reapproximation Anchor dynamic fascial closure system

With the increased use of damage control surgery and open abdomens, there are growing challenges in achieving primary fascial closure. The purpose of this study was to retrospectively review our experience using the Abdominal Reapproximation Anchor (ABRA; Canica Design Inc, Almonte, Ontario, Canada), a dynamic fascial closure system, to gain fascial apposition in complex abdominal surgical patients. A retrospective review of patients who underwent placement of the ABRA device to aid in abdominal closure was undertaken. Details including age, sex, the reason for an open abdomen, the number of operations, the time to primary closure, the success rate of primary closure, and complications related to the use of the ABRA were analyzed. Between January 2006 and July 2011, 36 patient charts were identified. The average Acute Physiology and Chronic Health Evaluation II score was 21.9 ± 6.9. There was a mean of 3.1± 1.8 laparotomies before ABRA placement for each patient, and the duration of ABRA placement until removal was 10.4 ± 6.1 days. Complete fascial apposition was achieved in 83% of the patients across the entire study and in 91% of the patients in the final 2 years. Component separation was used in 17% of cases. The incisional hernia rate was 13% at 6 months and 11% at 12 months. Our use of the ABRA system resulted in an 83% fascial apposition rate, which further improved when experience was taken into account. The incisional hernia rate was acceptable in this complicated patient group. This technique is an excellent addition to a surgeon's armamentarium for complicated abdominal cases that require an open abdomen. Further prospective studies are planned to identify ideal candidates for this technique.

Prophylactic Mesh Placement in High‐Risk Patients Undergoing Elective Laparotomy: A Systematic Review

Incisional hernia is a significant complication in patients undergoing elective laparotomy. Its incidence is increased in patients with risk factors, such as obesity and chronic respiratory disease. The purpose of this pooled analysis was to evaluate the use of prophylactic mesh placement following laparotomy in high-risk patients. A systematic literature search of MEDLINE, Embase, Web of Science, and Cochrane database was conducted. Outcome measures were incidence of postoperative incisional hernia, seroma, and wound infection rates. Five randomized, controlled trials (RCTs) and four comparative studies that met the inclusion criteria were identified. In total, 464 patients who underwent laparotomy closure with mesh placement and 755 patients who underwent conventional laparotomy closure were included. A reduced incidence of incisional hernia was observed when laparotomy was combined with prophylactic mesh placement in pooled analysis of RCTs (pooled odds ratio = 0.32; 95 % confidence interval = 0.12-0.83; P = 0.02) and comparative studies (pooled odds ratio = 0.11; 95 % confidence interval = 0.04-0.33; P < 0.001) respectively. No significant differences were observed in the incidence of seroma or wound infection following prophylactic mesh placement. The results of this pooled analysis suggest a benefit to prophylactic mesh placement during laparotomy closure in high-risk patients with a significantly reduced incidence of incisional hernia without any significant differences in seroma formation and wound infection rates. Further studies must evaluate the incidence of mesh-specific complications, including foreign body sensation and chronic pain, before strong recommendations can be made.

Incisional hernia rate after open abdomen treatment with negative pressure and delayed primary fascia closure

Various techniques for delayed primary fascia closure have been published in patients treated with open abdomen (OA) and application of negative pressure, but to date, no data are available on incisional hernia (IH) rate. The aim of this retrospective analysis was to investigate the long-term outcome of this patient population with special interest in IH development. Two hundred and nine consecutive patients, 90(43 %) female, were treated at our institution for various abdominal emergencies involving OA from June 2006 to June 2011. Mean age was 63(16-92) years. The indication was abdominal sepsis in 155(74 %) patients, ischemia in 24(12 %) and other reasons in 30(14 %). Hospital mortality was 21 %(n = 44); and planned ventral hernia was 7 %(n = 15); and mortality until follow-up was 16 %(n = 25), and 9 %(n = 13) patients were lost to follow-up, leaving 112 patients for evaluation of IH development. The rate of IH for patients with OA and delayed primary fascia closure was overall 35 % at a median (range) follow-up time of 26(12-81) months. Mean time for development of a ventral hernia was 11 months; 21(57 %) patients underwent surgery for symptomatic hernia (2 emergency operations for incarceration). Kaplan-Meier estimate for 5 years gave a 66 % IH rate. BMI, small bowel as source of infection and rapid adsorbable interrupted suture were identified risk factors. The rate of IH after open abdomen treatment with delayed primary fascia closure is high with a running suture with slow absorbable suture material showing the best results.

Extraction site location and incisional hernias after laparoscopic colorectal surgery: should we be avoiding the midline?

Laparoscopic colorectal procedures require specimen extraction. It is unclear whether extraction site affects the incidence of incisional hernia (IH). Patients undergoing laparoscopic colectomy over a 6-year period were identified. Outcomes were compared between patients to evaluate the incidence of hernia. Among 480 laparoscopic colorectal procedures, extraction sites were midline (n = 305), muscle splitting (n = 128), Pfannenstiel (n = 26), and ostomy (n = 21). Average follow-up was 3.5years. Age, gender, diagnosis, extraction incision length, and hospital stay were similar. The mean body mass index for all patients was 28 kg/m(2) and for those with IHs was 31 kg/m(2) (P = .008). The overall IH rate was 7%. Midline IHs accounted for 84% of all hernias, occurring in 8.9% of midline extractions (P < .05 vs nonmidline extractions). Hernia rates for muscle-splitting, Pfannenstiel, and ostomy site extractions were 2.3%, 3.8%, and 4.8%, respectively. Although midline hernia rates were lower than traditionally reported with open surgery, midline extraction sites have a higher chance of IH than nonmidline sites.

Incidence of Incisional Hernia After Open and Laparoscopic Colorectal Cancer Resection

Abstract Objectives To determine the incidence of incisional hernia in patients subjected to colorectal cancer surgery. To analyse the individual risk factors and to determine which patients would benefit more from the use of prophylactic measures. Patients and methods A retrospective study was performed on the demographic and surgical data, as well as the complications, risk factors and outcomes of all patients subjected to colorectal cancer surgery in the period between January 2006 and September 2008. The diagnosis of incisional hernia was made by means of physical examination or by a review of the follow up CT scan. Results A total of 338 patients were reviewed (249 laparotomy and 89 laparoscopy). After a median follow-up of 19.7 months, 87 patients (25.7%) were diagnosed with incisional hernia by a physical examination. The CT scan enabled 48 hernias (14.2%) not detected clinically. The incisional hernia rate was 39.9% (135 patients). There were no significant differences between patients subjected to laparotomy (40.9%) or laparoscopy (37.1%). The incisional hernia rate in overweight patients (BMI≥25 kg/m2) was 51.3% compared to 31.1% in patients with normal weight (P=.02). Post-surgical complications (P=.007), surgical wound infections (P=.04), and further surgery during the post-operative period (P Conclusion The prevalence of incisional hernia after colorectal cancer resection is higher than expected (41%). Patients with a BMI greater than 25 kg/m2, and those who require further surgery are candidates to receive a prophylactic mesh.

New-Fangled Slowly-Absorbable versus Non-Absorbable Sutures for Abdominal Fascial Closure. Have the Goals towards an Advantageous Suture Been Met?

Background-Aim: The technique of abdominal closure along with the material to be used is constantly evolving. The aim of the present study is to evaluate differences in midline laparotomy closure with a standard closure technique and new-fangled slow-absorbable versus non-absorbable sutures. Material and Methods: A prospective, comparative study of patients undergoing laparotomy closure with either STARDIOX (Polydioxanone) or STARLENE (Polypropylene) sutures during a 9 month period was performed. Patients were evaluated and compared in terms of surgical site infection, incisional hernia, burst abdomen, and suture sinus formation. Results: A total of 284 patients were included [141 in the STARDIOX (Polydioxanone) group and 143 in the STARLENE (Polypropylene) group]. Sinus formation was not noticed and no palpable knots were reported in both groups. Moreover burst abdomen was never encountered. Incisional hernia rates were similar for both suture materials: n = 6 (4.3%) for the STARDIOX (Polydioxanone) group and n = 5 (3.5%) for the STARLENE (Polypropylene) group. There was not statistically significant relationship between the type of suture that was used and wound infection: n = 5 (3.5%) in the STARDIOX (Polydioxanone) group and n = 6 (4.2%) in the STARLENE (Polypropylene) group. Complications did not occur in 96.1% of all patients. Conclusions: Our study suggests that there are no significant differences between these two new-fangled sutures. It seems that progress of suture materials has led to a step towards the goals of a beneficial suture and from then on complications of surgical wound closure should be merely a matter of operative technique.

Closing midline abdominal incisions

The most important wound complications are surgical site infection, wound dehiscence and incisional hernia. Experimental and clinical evidences support that the development of wound complications is closely related to the surgical technique at wound closure. The suture technique monitored through the suture length-to-wound length ratio is of major importance for the development of wound complications. The risk of wound dehiscence is low with a high ratio. The ratio must be higher than 4; otherwise, the risk of developing an incisional hernia is increased four times. With a ratio higher than 4, both the rate of wound infection and incisional hernia are significantly lower if closure is done with small stitches placed 5 to 8mm from the wound edge than with larger stitches placed more than 10mm from the wound edge. Midline incisions should be closed in one layer by a continuous suture technique. A monofilament suture material should be used and be tied with self-locking knots. Excessive tension should not be placed on the suture. Wounds must always be closed with a suture length-to-wound length ratio higher than 4. The only way to ascertain this is to measure, calculate and document the ratio at every wound closure. A high ratio should be accomplished with many small stitches placed 5 to 8mm from the wound edge at very short intervals.

Commentary on “Incisional Hernia Rate May Increase After Single-Port Cholecystectomy”

Journal of Laparoendoscopic & Advanced Surgical TechniquesVol. 22, No. 8 Full ReportsCommentary on “Incisional Hernia Rate May Increase After Single-Port Cholecystectomy”L. Michael BruntL. Michael BruntSearch for more papers by this authorPublished Online:5 Oct 2012https://doi.org/10.1089/lap.2012.9991AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Commentary on “Incisional Hernia Rate May Increase After Single-Port Cholecystectomy”." , 22(8), pp. 738–739FiguresReferencesRelatedDetails Volume 22Issue 8Oct 2012 InformationCopyright 2012, Mary Ann Liebert, Inc.To cite this article:L. Michael Brunt.Commentary on “Incisional Hernia Rate May Increase After Single-Port Cholecystectomy”.Journal of Laparoendoscopic & Advanced Surgical Techniques.Oct 2012.738-739.http://doi.org/10.1089/lap.2012.9991Published in Volume: 22 Issue 8: October 5, 2012PDF download

Incisional Hernia Rate May Increase After Single-Port Cholecystectomy

The major concerns of single-port cholecystectomy are port-site hernia and cost. Essentially, a larger transumbilical incision is more likely to increase the incidence of incisional hernia. The effect of single-port cholecystectomy on hospital cost is controversial. This study evaluated single-port cholecystectomy and traditional four-port cholecystectomy with respect to perioperative outcomes, hospital cost, and postoperative complications. Between January 2010 and March 2011, 52 patients underwent single-port cholecystectomy, and 111 patients underwent traditional laparoscopic cholecystectomy. We used equal instruments in patients undergoing operation with the same surgical technique. Demographics, diagnosis, operative data, complications, length of hospital stay, and cost were compared between the two groups. The patients undergoing laparoscopic cholecystectomy were significantly older than patients undergoing single-port cholecystectomy (55.8±13.8 years versus 48.7±12.7 years, P=.002). The trocar site hernia rate was 1.8% in laparoscopic cholecystectomy, and the port-site hernia rate was 5.8% in single-port cholecystectomy. This is the highest rate reported in the literature for port-site hernia following single-port cholecystectomy. Surgical techniques were not different in terms of conversion to open surgery, postoperative hospital stay, and operative time. The relative cost of single-port cholecystectomy versus laparoscopic cholecystectomy was 1.54. Although single-port cholecystectomy seems to be a feasible surgical technique, it is not superior over the traditional laparoscopic cholecystectomy. Single-port cholecystectomy is equal to laparoscopic cholecystectomy with respect to conversion to open surgery, postoperative hospital stay, and operative time, but it is associated with high hospital cost and high port-site hernia rate.

Atypical incisional hernia following Pfannenstiel incision

Herniation following Pfannenstiel incision is rare. Closure of the incision in four layers including the rectii abdominis, is done uncommonly. The authors report five cases of interstitial herniae between the rectus muscles and the anterior rectus sheath, incarcerating omentum and bowel. Four patients underwent repair, two as an emergency. One patient was managed conservatively. Subsequently all consultant and specialist registrars in obstetrics and gynaecology in the Wessex region were sent questionnaires on their methods of closure of Pfannenstiel incisions and rates of associated herniae. Fifty-three of 74 surgeons responded and only three (5.6 %) routinely closed the abdominal recti. The surveyed surgeons felt post-Pfannenstiel incisional hernia rates were low (0-1 %) though the rate was unknown to 33 % of surgeons. Complex incisional interstitial herniae of this type have not previously been described. Closure of the rectii abdominis (as originally described by Pfannenstiel in 1900) could minimise the incidence of incisional herniae.

Incisional Hernia Risk after Hand-Assisted Laparoscopic Surgery

Hand-assisted laparoscopic surgery (HALS) bridges traditional open surgery and pure laparoscopy. The HALS technique provides the necessary site for organ retrieval, reduces operative time, and realizes the postoperative benefits of laparoscopic techniques. Although the reported rates of incisional hernia should be theoretically low, we sought to determine our incidence of hernia after HALS procedures. A retrospective review of all HALS procedures was performed from July 2006 to June 2011. All patients who developed postoperative incisional hernias at the hand port site were confirmed by imaging or examination findings. Patient factors were reviewed to determine any predictors of hernia formation. Over the 5 years, 405 patients undergoing HALS procedures were evaluated: colectomy (264), nephrectomy (107), splenectomy/pancreatectomy (18), and ostomy reversal (10). The overall incidence of incisional hernia was 10.6 per cent. There were three perioperative wound dehiscences. The mean body mass index was significantly higher in the hernia group versus the no hernia cohort (32.1 vs 29.2 kg/m(2); P = 0.001). The hernia group also had a higher incidence of renal disease (18.6 vs 7.2%; P = 0.018). Mean time to hernia formation was 11.4 months (range, 1 to 57 months). Follow-up was greater than 12 months in 188 (46%) of patients, in which the rate of incisional hernia was 17 per cent. The rate of incisional hernia formation after hand-assisted laparoscopic procedures is higher than the reported literature. Because the mean time to hernia development is approximately 1 year, it is important to follow these patients to this end point to determine the true incidence of incisional hernia after hand-assisted laparoscopy.

Rectus Abdominus Fascial Sheath Usage for Crural Reinforcement During Surgical Management of GERD

Many materials are currently being used to reinforce the crural repair. Perforation, intensive fibrosis, and price are limiting the usage of these materials. Our purpose was to seek an alternative, cheap, always available, and inert material to use for cruroplasty reinforcement. Twenty-four patients participated and were randomly divided into 2 groups (graft+laparoscopic Nissen fundoplication and laparoscopic Nissen fundoplication alone) with 12 patients in each group. Total operation time, postoperative dysphagia rate, dysphagia improvement time, postoperative pain, recurrence, and incisional hernia rate were compared. There was no difference in terms of study parameters between both groups except for the mean operation time. Autograft hiatoplasty seems to be a good alternative for crural reinforcement. It provides safe reinforcement, has the same dysphagia rates as meshless hiatoplasty, and avoids potential complications of redo surgery by minimizing extensive fibrosis. Furthermore, the rectus abdominus sheath is always available and inexpensive.

Elevada incidencia de hernia incisional tras resección abierta y laparoscópica por cáncer colorrectal

Determinar la tasa de hernia incisional en pacientes intervenidos por neoplasia de colon y recto. Analizar los factores de riesgo individuales y determinar aquellos pacientes en los que pudiera ser adecuado el uso de medidas profilácticas. Estudio retrospectivo de los datos demográficos, quirúrgicos, complicaciones, factores de riesgo y evolución de todos los pacientes intervenidos por cáncer colorrectal en el período enero de 2006 y septiembre de 2008. El diagnóstico de hernia incisional se hizo mediante exploración física o mediante revisión de la TAC de seguimiento. Se revisó a un total de 338 pacientes (249 laparotomía y 89 laparoscopia). Tras una mediana de seguimiento de 19,7 meses, 87 pacientes (25,7%) fueron diagnosticados por exploración física de hernia incisional. La TAC permitió diagnosticar 48 hernias (14,2%) no detectadas clínicamente. La tasa de hernia incisional fue del 39,9% (135 pacientes). No hubo diferencias significativas entre los pacientes intervenidos por laparotomía (40,9%) y laparoscopia (37,1%). En pacientes con sobrepeso (IMC ≥ 25 kg/m2), la tasa de hernia incisional fue del 51,3% frente a un 31,1% en los pacientes con peso normal (p = 0.02). La aparición de complicaciones postoperatorias (p = 0,007), infección de herida quirúrgica (p = 0,04) y reintervención durante el periodo postoperatorio (p < 0,0001) también se asoció a mayor tasa de hernia incisional. La prevalencia de hernia incisional tras resección por cáncer colorrectal es superior a la esperada (39,9%). Los pacientes con un IMC superior a 25 kg/m2 y los que precisan reintervención son candidatos a recibir una malla profiláctica. To determine the incidence of incisional hernia in patients subjected to colorectal cancer surgery. To analyse the individual risk factors and to determine which patients would benefit more from the use of prophylactic measures. A retrospective study was performed on the demographic and surgical data, as well as the complications, risk factors and outcomes of all patients subjected to colorectal cancer surgery in the period between January 2006 and September 2008. The diagnosis of incisional hernia was made by means of physical examination or by a review of the follow up CT scan. A total of 338 patients were reviewed (249 laparotomy and 89 laparoscopy). After a median follow-up of 19.7 months, 87 patients (25.7%) were diagnosed with incisional hernia by a physical examination. The CT scan enabled 48 hernias (14.2%) not detected clinically. The incisional hernia rate was 39.9% (135 patients). There were no significant differences between patients subjected to laparotomy (40.9%) or laparoscopy (37.1%). The incisional hernia rate in overweight patients (BMI ≥ 25 Kg/m2), was 51.3% compared to 31.1% in patients with normal weight (P = .02). Post-surgical complications (P = .007), surgical wound infections (P = .04), and further surgery during the post-operative period (P < .0001), was also associated with a higher incidence of incisional hernia. The prevalence of incisional hernia after colorectal cancer resection is higher than expected (39,9%). Patients with a BMI greater than 25 kg/m2, and those who require further surgery are candidates to receive a prophylactic mesh.

Prophylactic retention sutures in midline laparotomy in high-risk patients for wound dehiscence: A randomized controlled trial

Abdominal wound dehiscence (WD) is a postoperative complication with high mortality and morbidity rates. Retention sutures are often used in surgical take-back for dehiscence. The aim of this study was to assess the reduced rate of dehiscence in midline laparotomy using prophylactic retention sutures in high-risk patients. Three hundred high-risk patients with at least two risk factors for dehiscence who underwent midline laparotomy between 2008 and 2010 were randomly divided into two groups. In the control group, the fascia was continuously repaired using a running looped #1 nylon suture. For the intervention group, we added retention sutures that included the skin, subcutaneous tissue, rectus muscle, and abdominal fascia. We compared the rates of WD, evisceration, wound infection, postoperative pain, postdehiscence mortality, and late incisional hernia for these two groups. After accounting for early mortalities, 147 patients were followed in the intervention group and 148 patients in the control group. WD occurred in 6 patients (4%) in the intervention group and 20 control patients (13.3%) (P = 0.007). Abdominal evisceration after surgery occurred in 1 patient (0.7%) with retention sutures and 4 control patients (2.7%) (P=0.371). There was no significant difference in wound infection and incisional hernia between the two groups. Postoperative pain scores between the two groups did not differ significantly during the first 3 d, but did differ on the fourth day. Prophylactic retention sutures reduce the occurrence of WD following midline laparotomy in high-risk patients with multiple risk factors for impaired wound healing without imposing remarkable postoperative complications.

Intraperitoneal Mesh Implantation for Fascial Dehiscence and Open Abdomen

Postoperative fascial dehiscence and open abdomen are severe postoperative complications and are associated with surgical site infections, fistula, and hernia formation at long-term follow-up. This study was designed to investigate whether intraperitoneal implantation of a composite prosthetic mesh is feasible and safe. A total of 114 patients with postoperative fascial dehiscence and open abdomen who had undergone surgery between 2001 and 2009 were analyzed retrospectively. Contaminated (wound class 3) or dirty wounds (wound class 4) were present in all patients. A polypropylene-based composite mesh was implanted intraperitoneally in 51 patients, and in 63 patients the abdominal wall was closed without mesh implantation. The primary endpoint was incidence of incisional hernia, and the incidence of enterocutaneous fistula was a secondary endpoint. The incidence of enterocutaneous fistulas after wound closure post-fascial dehiscence (13% vs. 6% without and with mesh, respectively) or post-open abdomen (22% vs. 28% without and with mesh, respectively) was not significantly different. The incidence of incisional hernia was significantly lower with mesh implantation compared with no-mesh implantation in both contaminated (4% vs. 28%; p = 0.025) and dirty abdominal cavities (5% vs. 34%; p = 0.01). Intra-abdominal contamination is not a contraindication for intra-abdominal mesh implantation. The incidence of enterocutaneous fistula is not elevated despite the presence of contamination. The rate of incisional hernias is significantly reduced after intraperitoneal mesh implantation for postoperative fascial dehiscence or open abdomen.

Minimally Invasive Suprapubic Laparoscopic Donor Nephrectomy

Abstract Introduction: There is an increasing discrepancy between the number of patients awaiting transplantation and the number of available transplantable organs. To increase the donor pool, live...

A clinical and radiological assessment of incisional hernias following closure of temporary stomas

The rate of incisional hernia at stoma closure sites is unclear. This study aimed to describe this rate in patients with closed stomas who had definitive post-operative imaging of their abdominal wall. A retrospective review of patients who had undergone stoma reversal and had a CT or MRI scan of the abdomen ≥2 months following reversal was performed. A radiologist, blinded to the original radiological report and clinical results, reviewed all scans for abdominal wall herniation. This was correlated to documented clinical findings. Fifty-nine patients were included: 49 loop ileostomy and 10 end colostomy reversals. CT scans were performed for 57 patients and MRI for two. The median time from closure to imaging was 10 months (range 3-32 months). The combined clinical and radiological hernia rate was 34% (20/59). Imaging alone produced a rate of 31% (18/59). The clinical rate of hernia detection was 14% (8/59). Using the rate of clinical herniation as the detection standard, imaging had a low positive predictive value (33%, 6/18) but a high negative predictive value (95%, 39/41). Four patients required surgical repair of their stoma site hernia (20%, 4/20). One in three patients undergoing stoma closure developed an incisional hernia. One in five of those with a hernia underwent surgical repair. Definitive imaging may provide an early surrogate marker for late clinically relevant hernias. Consideration of methods to prevent stoma closure site hernias should be considered.