Abdominal Incisional Hernia Repair Research Articles

To Compare the Short-Term Outcome of Open Repair versus Laparoscopic Repair in Abdominal Incisional Hernia Repair

Background: Incisional hernia is a common complication post abdominal surgery. Its effective management is crucial for patient outcomes and healthcare efficiency. This study aims to evaluate and compare the short-term outcomes of open and laparoscopic incisional hernia repair techniques. Objective: The study's objectives are twofold: 1) To ascertain the short-term outcomes, specifically focusing on the length of hospital stay, operative time, wound infections, and recurrence rate in patients undergoing open and laparoscopic incisional hernia repair, and 2) To compare these outcomes between open and laparoscopic repair methods. Methods: A randomized design was employed, with patients assigned to either Group A (open repair) or Group B (laparoscopic repair) using computer software. The duration of surgery, from the first incision to skin closure, was timed with a digital stopwatch. Patients were followed up for one month with specific attention to any redness, persistent pain, or fever. The key outcome parameters assessed were operative time, hospital stay duration, incidence of wound infection, and hernia recurrence. Results: Group A exhibited a 9.9% wound infection rate and 51.1% recurrence rate, with 39.0% of patients achieving satisfactory outcomes. In contrast, Group B demonstrated a 13.5% wound infection rate, a notably lower recurrence rate of 11.3%, and 75.2% of patients reported satisfactory outcomes. Conclusion: Laparoscopic repair shows superior outcomes compared to open repair regarding wound infection, recurrence rate, patient satisfaction, operative time, and length of hospital stay.

V-020 Botulinum Toxin: not just aesthetics anymore

Abstract Introduction Surgical repair of recurrent abdominal incisional hernia can be challenging. The aim should be a tension-free, mesh reinforced midline fascial closure. Different methods have been described to achieve this primary fascial closure. Botulinum toxin (BT) is a neurotoxin that when injected into muscle tissue, causes a temporary flaccid muscle paralysis. This effect can be applied to the lateral abdominal wall muscles, thereby facilitating midline rectus muscles re-approximation and defect closure. Clinical Case We present a case of a 58 year old female, with a history of right hemicolectomy and ileostomy, that underwent subsequent stoma closure one year after. She presented with a 12 cm defect width incisional hernia and right rectus muscle atrophy. We demonstrate the preoperative injection of BT using the Zielinski technique in a consultation room with no need for patient monitoring or anesthesia. Four weeks later, the patient underwent open repair with bilateral transversus abdominis release and retromuscular mesh reinforcement. The defect was closed without tension and the postoperative period was uneventful. Patient was discharged on postoperative day 4. Conclusion Preoperative BT injection as a selective muscle chemical component paralysis is a safe, easy to perform and effective technique that aims to counteract the chronic muscle retraction observed in large ventral hernias. BT in combination with advanced ventral hernia repair techniques, may help provide the crucial extra tissue mobility required to achieve primary closure, with the added advantage of less postoperative pain, thereby contributing to early patient discharge.

A Case of Abdominal Incisional Hernia Repair with Severe Aortic Valve Stenosis under Intravenous Anesthesia using Ketamine and Local Anesthesia

A Case of Abdominal Incisional Hernia Repair with Severe Aortic Valve Stenosis under Intravenous Anesthesia using Ketamine and Local Anesthesia

Construction and properties of the silk fibroin and polypropylene composite biological mesh for abdominal incisional hernia repair

Background: In this study, a new composite biological mesh named SFP was prepared by combining silk fibroin with polypropylene mesh. The mechanism and clinical application value of the SFP composite mesh were explored. Methods: The fibrous membrane was prepared by electrospinning of silk fibroin. The silk fibrous membrane was adhered to the polypropylene mesh by fibrin hydrogel to make a new composite mesh. The characterizations were verified by structural analysis and in vitro cell experiments. A total of 40 Sprague–Dawley rats were randomly divided into two groups, and 20 rats in each group were implanted with the SFP mesh and pure polypropylene mesh, respectively. The rats were sacrificed in batches on the 3rd, 7th, 14th, and 90th days after surgery. The adhesion degree and adhesion area on the mesh surface were compared, and a histopathological examination was carried out. Results: In vitro cell function experiments confirmed that the SFP mesh had good cell viability. The control group had different degrees of adhesion on the 3rd, 7th, 14th, and 90th days after surgery. However, there was almost no intraperitoneal adhesions on the 3rd and 7th days after surgery, and some rats only had mild adhesions on the 14th and 90th days after surgery in the SFP group. There were statistically significant differences in the postoperative intraperitoneal adhesion area and adhesion degree between the two groups (p < 0.05). Histopathological examination confirmed that the mesenchymal cells were well arranged and continuous, and there were more new capillaries and adipocyte proliferation under the mesenchymal cells in the SFP group. Conclusion: The SFP mesh shows good biocompatibility and biofunction in vitro and in vivo. It can promote the growth of peritoneal mesenchymal cells. The formation of a new mesenchymal cell layer can effectively reduce the extent and scope of adhesion between the mesh and abdominal organs. The SFP mesh will have a good application prospect in the field of abdominal wall hernia repair.

Midline abdominal Incisional hernia repair by component separation technique augmented with prosthetic mesh: Prospective study

Background: Raised intra-abdominal pressure (IAP) makes laparostomy mandatory initially and abdominal wall approximation cannot be completed due to compromised state in most cases. Objectives: To determine the feasibility of component separation technique (CST) with mesh augmentation. Methods: 50 patients were subjected to CST with mesh augmentation. Preoperative defect size mapping, Pre- and post-operative monitoring of IAP were done. Pain scoring by visual analogue scale (VAS), early and late complications was noted. Patients were followed up for 60 months. Results: Out of 50 patients, 17 patients had seroma formation, 2 patients developed skin necrosis, 1 patient had wound dehiscence and none had Hematoma formation. There were 33 females and 17 males and accounts to 66% of female patients. Out of 50 patients 36 patients were operated under General anaesthesia accounting to 73% of patients whereas rest of the 14 patients got operated under Combined Spinal Epidural anaesthesia. 36 out of 50 patients had split thickness skin cover, accounting for 72% of the patients whereas rest of the 14 patients had intact skin cover.

The Effect of Adipose-Derived Stromal Vascular Fraction Cells to Abdominal Wall Fascia Defects in Rats: An Experimental Study

Objective Various synthetic and biological meshes have been developed to reduce recurrence and complications in ventral incisional hernia repairs. Adipose tissue is a rich reserve for mesenchymal stromal cells. In the present study we aimed to examine the effects of adipose-derived mesenchymal stromal cells (AD-MSCs) on abdominal incisional hernia repairs in rats. Materials and Methods The study involved 32 male Wistar-Albino rats, weighing 200–250 g, which were divided into three groups. In Group 1 (control group) only an incisional hernia model was created. In Group 2, the incisional hernia model was created and 1 ml stromal vascular fraction (SVF), obtained from inguinal lipectomy material and containing mesenchymal stromal cells, was injected into the edges of the defect in the same session. In Group 3, only the incisional hernia model was created in the first stage and after 14 days, 1 ml of SVF was injected into the edges of the defect. Skin incisions of rats in Group 1 and 2 were opened on postoperative day 28 while in group 3 were opened on day 42. Peritoneal formation in abdominal wall defect was evaluated macroscopically and histopathologically. Results Peritoneal formation was significantly superior in Groups 2 and 3 than in Group 1 (p: 0.031). In histopathological evaluation, the structural distortion and polymorphonuclear leukocyte (PMNL) levels were significantly higher in Group 1 than in Group 3 (p: 0.048 and p: 0.046, respectively). Granulation, capillary density, fibrosis and collagen organization were higher in Group 2 and 3, however this difference was not statistically significant (p > 0.05). Conclusions Adipose-derived stromal vascular fraction cells obtained from inguinal lipectomy material in rats positively affect the repair of abdominal incisional hernias by increasing peritoneal formation, and reducing structural distortion and PMNL infiltration.

Laparoscopic Versus Open Abdominal Repair of Incisional Hernia

Background: Incisional hernia is a common health problem and its method of repair [open or laparoscopic] is still under debate. Aim of the work: To evaluate the technique and results of the laparoscopic and the open abdominal incisional hernia repair. Patients and methods: This is a retrospective study conducted on 40 patients with abdominal incisional hernia, admitted to general surgery department of Al-Azhar University Hospital [Damietta]. All records were reviewed for patient demographics, preoperative evaluation, operative and postoperative data. The complications were reviewed and compared between groups. These complications included ileus, cellulitis, flap necrosis, infection, hematoma, seroma, cyst, recurrence and other injuries. Results: The open group had a shorter operative time than the laparoscopic group [85.3±13.21 vs 110.0±10.04 minutes, respectively]. However, time to oral intake [hours] and the duration of hospital stay [days] were significantly shorter in the laparoscopic when compared to the open group [9.20±1.2, 1.92±0.69 vs 20.0±2.4 and 2.70±0.68 respectively]. Postoperative complications showed no significant difference between groups. Conclusion: Thelaparoscopic repair of incisional hernia is a safe and effective alternative to the open repair with a shorter hospital stay, early oral feeding and a lower rate of complications.

Large abdominal hernia repair with closed incision negative pressure therapy: a case series.

A major challenge of large abdominal incisional hernia repair is the high rates of wound complications. Closed incision negative pressure therapy (CINPT) can offer many treatment advantages in the management of these wounds and has been shown to reduce complications for other postoperative incisions. This study assesses the wound outcomes for hernia repair patients receiving CINPT. A six-year retrospective case series of patients who had undergone large abdominal incisional hernia repair wounds treated with CINPT was conducted. Outcomes for patients treated with CINPT were compared with patients who had not received CINPT acting as a control. A total of 23 patients were treated with CINPT after hernia repair and compared with 12 patients in the control group. A statistically significant decreased rate of return to theatre (odds ratio: 0.12) was found in this study. Non-significant reductions in wound infection, seroma and wound dehiscence were also seen. No adverse events with CINPT therapy were reported. CINPT, when used after large abdominal incisional hernia repair, may help in the prevention of wound complications.

Early experience with a new integrated microwave surgical device, Acrosurg Revo®, for laparoscopic surgery: A case series of two patients

IntroductionAbdominal surgery uses various energy devices for vessel sealing, tissue dissection, and detachment. Currently, Acrosurg Revo® (Nikkiso Co., Ltd., Tokyo, Japan), a novel energy device using microwaves, has been developed for use in laparoscopic surgery. This report describes the early clinical experience of using this device in two cases of laparoscopic surgery. Presentation of caseCase 1 was of a 64-year-old woman who underwent laparoscopic abdominal incisional hernia repair. Case 2 was of a 56-year-old man with a diagnosis of ascending and sigmoid colon cancer who underwent laparoscopic right hemicolectomy and sigmoid colectomy with D3 dissection. Each surgery was completed using Acrosurg Revo® and an endoscopic electrosurgical unit. The postoperative course was uneventful, and both patients were discharged from the hospital without any complications. DiscussionWith this new and novel device, vessel sealing, hemostasis, coagulation, tissue dissection, and detachment were all possible. Notably, there was no spark or mist that hindered the surgical field of view. Furthermore, because microwave coagulation did not result in tissue carbonization, there was a considerable decrease in device tip contamination. ConclusionThe Acrosurg Revo® may be a useful energy device for laparoscopic surgery.

Delayed mesh infection and mesh penetrating the transverse colon and small intestine after abdominal incisional hernia repair

The occurrence of late-onset mesh infection and mesh invasion into the intestine after abdominal incisional hernia repair is extremely rare. Herein, we describe the first case of late-onset mesh infection and mesh penetrating the transverse colon and small intestine 5 years after incisional hernia repair using an expanded polytetrafluoroethylene mesh. The symptom was drainage from the reddish wound, and computed tomography scan revealed intestinal prolapse with local wall thickening. The mesh removal and small intestine and colon resection were conducted because the small intestine and transverse colon formed a mass containing the mesh inside. The events were caused by the lack of mesh fixation, and the dislodged mesh penetrating the intestinal tract caused the infection. For mesh infections in which conservative treatment is not effective, mesh removal and organ excision should not be delayed regardless whether there is a strong adhesion of the abdominal cavity.

Prospective study of midline abdominal incisional hernia repair by component separation technique augmented with prosthetic mesh

Background: In our tertiary care hospital, we receive a large number of acute abdomen cases. Raised intra-abdominal pressure (IAP) makes laparostomy mandatory initially and abdominal wall approximation cannot be completed due to compromised state in most cases. Large incisional hernias were seen on complete healing and this study was done to see the feasibility of component separation technique (CST) with mesh augmentation.Methods: 30 patients were subjected to CST with mesh augmentation. Preoperative defect size mapping, Pre- and post-operative monitoring of IAP were done. Pain scoring by visual analogue scale (VAS), early and late complications was noted. Patients were followed up for 60 months.Results: CST with mesh augmentation was found to be feasible with 96.77% success rate as no recurrence was noted in follow up. Preoperative average Basal metabolic index was 26.09. Size of defect varied from 17-20×9-16 cm2 (length X width). Seroma seen in 50% of patients was managed without any intervention. Skin necrosis in 6.6% and wound dehiscence in 3.33%, managed with minimal debridement &amp; local wound care respectively. Respiratory compromise and hematoma were not seen and no patient required any active ICU care. Average length of hospital stay was 5.22 days. Close monitoring of IAP in immediate post-operative period was found to be significant.Conclusion: Physical acceptance of stable abdominal wall gives a psychological boost to patients with early recovery in form of ambulation and early return to work.

Abdominal wall incisional hernia repair improves respiratory function: results after 3\xa0years of follow-up

PurposeHernias severely impact patient quality of life (QoL), and 80% of patients require a surgical operation. Moreover, hernias are responsible for respiratory function alterations. This study aims to investigate the postoperative alterations in respiratory function after open ventral hernia repair in patients with incisional hernia.MethodsPatients operated on at the Policlinico “Paolo Giaccone” at Palermo University Hospital between January 2015 and December 2016 were identified in a prospective database. Fifty-one patients were enrolled in the study. The respiratory outcome measures used were forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC ratio, peak expiratory flow (PEF) and PEF percentage (%PEF). The timepoints at which the parameters listed were assessed were t0, 1 week before the surgical operation; t1, 12 months later; and t2, 3 years later.ResultsThe difference between mean preoperative and postoperative PEF was significant [t0 4.32 (4.03–7.92), t1 6.7 (4.27–8.24) with p = 0.012 and t2 6.5 (4.25–8.21) with p = 0.026]. The %PEF increased from 75% preoperatively to 87% at t1 (p = 0.009) and to 85% at t2 (p = 0.03). No differences were found in the comparison of pre- and postoperative FVC, FEV1 or FEV1/FVC ratio.ConclusionThe improvement in respiratory measures suggests the importance of abdominal wall restoration to recover functional activity of respiratory function.

Mesh Infection and Abscess Caused by Intestinal Penetration 13 Years after Repair of Abdominal Incisional Hernia

Mesh Infection and Abscess Caused by Intestinal Penetration 13 Years after Repair of Abdominal Incisional Hernia

Non-healing wounds: Can it take different diagnosis?

Wound healing is a complex cellular and biochemical process and can be affected by several systemic and local factors. In this study, we aimed to discuss the aetiologic factors of non-healing wounds and the management of this complicated process with current information. The medical data of the patients who were admitted to our clinic due to non-healing or chronic wounds were analysed retrospectively. A total of 27 patients were evaluated retrospectively during the 14 months of the study. The data of 6 patients who were followed up for chronic wound that developed after abdominal incisional hernia repair and pilonidal sinus surgery were not included in the study as their data could not be reached. A total of 21 patients were included in the study. Malignancy was diagnosed in two patients and granulomatous disease was found in four patients. The aetiology of the other cases included foreign body reaction, infection, and mechanical causes. Non-healing wounds are a serious social and economic problem for patients. Further studies on the pathophysiology of various aetiologies in non-healing wounds in both clinical settings and experimental animal models would be a useful step in treatment.

Mesh removal and reconstruction with posterior components separation technique for delayed mesh infection developed 10 years after abdominal incisional hernia repair: a rare case report

BackgroundVery few literatures can be found reporting cases and treatment strategies of late-onset mesh infection after abdominal incisional hernia reconstruction. Here, we report a rare case of delayed mesh infection developed 10 years after abdominal incisional hernia repair, which was successfully treated by mesh removal and reconstruction with posterior components separation technique.Case presentationA 66-year-old man, who underwent reconstruction of abdominal incisional hernia by retroperitoneal Composix mesh application 10 years prior, developed 12 × 6.0 × 2.5 cm subcutaneous abscess followed by methicillin-resistant Staphylococcus aureus (MRSA)-related mesh infection. The operation was performed excising the abscess wall without damaging peritoneum, and huge intermuscular defect was successfully reconstructed by posterior components separation technique application.ConclusionsAn early decision of excising contaminated mesh would be preferable to extensive conservative treatments when mesh infection is suspected. Components separation technique application can be of great help when designing reconstruction of huge intramuscular defect after removal of infected mesh.

The abdominal wall incisional hernia repair in cirrhotic patients.

The incidence of abdominal wall hernia in cirrhotic patients with ascites is between 20 and 40%. Controversies regarding the treatment modality and surgical timing of abdominal wall incisional hernia repair in cirrhotic patients remain. The study proposed wants to analyze the abdominal incisional hernia repair in cirrhotic patients with ascites performed in a single center to determine post-operative morbidity, mortality and complication rate. Cirrhotic patients with abdominal incisional hernia that underwent surgical operation for abdominal wall hernia repair at the "Policlinico Paolo Giaccone" at Palermo University Hospital between January 2015 and December 2016 were identified and the data collected were retrospectively reviewed; patients' medical and surgical records were collected from charts and the surgical and ICU registries. The degree of hepatic dysfunction was classified using Child-Pugh classification. Post-operative mortality was considered up to 30-days after surgery. A follow-up period of 6 months at least was performed to evaluate hernia recurrence and complications. Mortality rate is of 18.5% (p 0.002). Recurrence rate (p 0.004) and seroma formation rate (p 0.001) are most frequent in urgency group. The elevated ASA score and the prediction of a complicated post-operative course is higher in urgency group (p 0.004) as higher is the in-hospital stay (p 0.001) and the ICU stay (p 0.001). Elective surgery for abdominal wall hernia repair in cirrhotic patients seems to be successful and associated with lower mortality/morbidity rate and recurrence rate than urgency.

Application value of the preoperative multi-slice spiral computed tomography for the repair of huge abdominal incisional hernia

Objective To explore the application value of the preoperative multi-slice spiral computed tomography (MSCT) for the repair of huge abdominal incisional hernia. Methods The retrospective cross-sectional study was conducted. The clinical data of 61 patients with huge abdominal incisional hernia who were admitted to the Xinjiang Uygur Autonomous Region People′s Hospital from January 2012 to February 2016 were collected. All patients underwent preoperative MSCT and three-dimensional reconstruction to measure the percentage of volumes of the hernia sac and abdominal cavity and then selected the individualized surgical methods according to the percentage, and length of small intestine resected was calculated in patients undergoing initiative volume reduction combined with onlay repair. Observation indicators: (1) pre- and post-operative situations: percentage of volumes of the hernia sac and abdominal cavity, duration of preoperative hospital stay, surgical procedure, length of small intestine resected in patients undergoing initiative volume reduction combined with onlay repair, operation time and volume of intraoperative blood loss; (2) postoperative recovery situation: intra-abdominal pressure at postoperative 48 hours, recovery time of postoperative gastrointestinal function, removal time of postoperative abdominal drainage-tube, postoperative complications and duration of postoperative hospital stay; (3) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect the postoperative hernia recurrence and long-term complications up to March 2017. Measurement data with normal distribution were represented as ±s and measurement data with skewed distribution were described as M (range). Results (1) Pre- and post-operative situations: percentage of volumes of the hernia sac and abdominal cavity in 61 patients was 19%±4%, and duration of preoperative hospital stay was (7±5)days. All the 61 patients underwent successful operation, including 48 receiving onlay repair and 13 receiving initiative volume reduction combined with onlay repair, without conversion to other surgery. Length of small intestine resected in 13 patients undergoing initiative volume reduction combined with onlay repair was (48±8)cm. Operation time and volume of intraoperative blood loss in 61 patients were (2.6±0.8)hours and (82±50)mL. (2) Postoperative recovery situation: intra-abdominal pressure at postoperative 48 hours, recovery time of postoperative gastrointestinal function and removal time of postoperative abdominal drainage-tube in 61 patients were (9.6±2.9)mmHg (1 mmHg=0.133kPa), (2.1±0.9)days and (3.5±1.1)days, respectively. Twelve patients had postoperative complications, and grade Ⅰ intra-abdominal hypertension, grade Ⅱ intra-abdominal hypertension, incisional effusion, incisional infection, incisional sinus, mesh infection and urinary retention were respectively detected in 4, 2, 4, 2, 1, 1, 1 in patients undergoing the onlay repair and 2, 1, 1, 0, 0, 0, 0 in patients undergoing initiative volume reduction combined with onlay repair. Some patients had 2 or more of complications. There was no occurrence of abdominal compartment syndrome and perioperative death. Patients with complications were cured or improved by symptomatic treatment. Duration of postoperative hospital stay in 61 patients was (8±4)days. (3) Follow-up: all the patients were followed up for 6-36 months, with a median time of 19 months. During follow-up, 2 patients with recurrence of huge abdominal incisional hernia received tentative follow-up, and were suggested to treat risk factors of recurrence firstly and then undergo reoperations. Other patients didn′t have long-term complications. Conclusion MSCT can provide the accurate data of percentage of volumes of the hernia sac and abdominal cavity before repair of huge abdominal incisional hernia, it also has the important clinical value of choosing the individualized surgical method, preserving the maximum out of normal organs in initiative volume reduction combined with onlay repair and increasing surgical outcomes. Key words: Abdominal incisional hernia, huge; Hernia repair; Multiplanar reconstruction; Tomography

Botulinum Toxin A as an Adjunct to Abdominal Wall Reconstruction for Incisional Hernia.

Background:Repair of large incisional hernias remains a surgical and costly challenge. Temporary paralysis of the lateral abdominal wall muscles with topical administration of botulinum toxin A (BTA) is a new therapeutic concept, which may obviate the need for component separation technique (CST) for repair of large incisional hernias. Current literature on the administration of BTA as adjunct to surgical repair of abdominal incisional hernias was investigated.Methods:The electronic databases PubMed and Embase were searched for eligible studies. Two independent investigators evaluated the literature. Data were sought regarding primary fascial closure with and without CST, safety, hernia recurrence, method of application, and preoperative radiological imaging.Results:Six cohort studies including a total of 133 patients receiving BTA were identified. No randomized or case–control studies were found. In total, 83.5% of the patients achieved primary fascial closure. Supplemental CST was necessary in 24.1% of the patients. Two patients developed hernia recurrence during follow-up. No postoperative complications or adverse events were considered related to the administration of BTA, except for impairment of postoperative coughing and sneezing. Additionally, radiological imaging showed that BTA increased the length of lateral abdominal muscles before surgery.Conclusions:Preoperative administration of BTA increases muscle length and may facilitate primary fascial closure. Optimal administration is at least 2 weeks before repair, whereas the optimal dose of BTA remains to be defined. Carefully designed randomized controlled trials are warranted to identify patients who would benefit from BTA and to eliminate the confounding effect of CST.

腹壁瘢痕ヘルニア修復術後の遅発性メッシュ感染の1例

Composix Kugel Patch®（CKP）による腹壁瘢痕ヘルニア修復術後の遅発性メッシュ感染の1例を経験したので報告する．症例は70歳の男性で，2005年，腹壁瘢痕ヘルニアに対しCKPによる修復術を施行した．2016年，遅発性メッシュ感染から腸管皮膚瘻を形成し手術を施行した．Expanded polytetrafluoroethyleneシートが腹腔側に折れ返り，polypropyleneメッシュが腹腔内に露出し，小腸瘻を形成していた．CKPと腸管皮膚瘻を切除し，component separation technique （CST）で腹壁再建した．CSTはメッシュを必要とせず，感染手術にも対応可能である．筋膜欠損が大きく，感染を伴う腹壁再建の選択肢の一つとして検討すべき有用な術式であると考えられた．

Mesh vs. Suture Closure of Incisional Hernias

Patients often seek referrals from their primary care clinicians for repair of an abdominal wall incisional hernia and sometimes seek counsel about the