Risk Of Hernia Research Articles

Laparoscopic extraperitoneal colostomy has a lower risk of parastomal hernia and bowel obstruction than transperitoneal colostomy.

Several studies indicate that an extraperitoneal colostomy can prevent the development of a parastomal hernia (PSH) as compared to a transperitoneal colostomy. However, the clinical value of laparoscopic extraperitoneal colostomy, and its influence on bowel obstruction and PSH remain unclear. The present study aimed to clarify the impact of laparoscopic extraperitoneal colostomy on the development of a PSH and bowel obstruction. This study included 327 consecutive patients who underwent laparoscopic abdominoperineal resection or Hartmann's procedure between January 2013 and December 2019 after fulfilling selection criteria. The incidence of a PSH (Clavien-Dindo classification ≥ grade I) and bowel obstruction (≥ grade IIIa) in the transperitoneal and extraperitoneal route groups were analyzed using univariate and multivariate analysis. The patients were classified into transperitoneal (n = 222) and extraperitoneal (n = 105) route groups. The patient characteristics, except for body mass index and operative time, were comparable between the groups. A PSH and bowel obstruction occurred more frequently in the transperitoneal than in the extraperitoneal route group (17.1% vs. 1.9% and 15.3% vs. 6.7%, respectively; p < 0.01 and p = 0.03, respectively). The multivariate analysis showed that age ≥ 70years, body mass index ≥ 22.4kg/m2, and a transperitoneal route were independent risk factors for the development of a PSH, and a transperitoneal route was an independent risk factor for bowel obstruction. The transperitoneal route was identified as a risk factor for the development of both a PSH and bowel obstruction after laparoscopic abdominoperineal resection or Hartmann's procedure.

MO674: Risk Factors for Abdominal Wall Hernias in Peritoneal Dialysis Patients

Abstract BACKGROUND AND AIMS Abdominal hernias are relatively common non-infectious complications in peritoneal dialysis (PD) patients with reported prevalence rates ranging from 7% to 27.5%. This complication can be troublesome and is sometimes associated with PD suspension and transition to hemodialysis, that can be transiently or definitively. Several risk factors for hernia formation have been proposed and included male gender, advanced age, autosomal dominant polycystic kidney disease (ADPK) and previous hernia repair. A larger dialysate diffusion volume is associated with increased intra-abdominal pressure and has been reported to increase the risk of hernia. However, studies are in conflict regarding risk factors for hernia formation. The aim of this study was to establish the incidence and the risk factors for hernia formation in patients receiving PD at our center. METHOD We developed a single-center, retrospective, observational study. Incident PD patients from January 2010 until October 2020 were screened for inclusion. Multiple logistic regression based on variables with P-value &amp;lt;0.05 in univariate comparative test and Cox regression were applied to estimate the predictors for hernia formation. A value of P &amp;lt; 0.05 was considered statistically significant. RESULTS A total of 163 PD patients were enrolled since and followed until December 2020, with 53 hernia events and 32 hernioplasties being registered in 28 patients (52.8%). The incidence rate was 0.09 hernias/patient/year. Table 1 summarizes the general characteristics of the patient with and without hernias. The umbilical hernias were the most common hernia type encountered (64.2%), followed by inguinal and incisional hernias. Median duration on PD therapy was 24.0 months (range: 18.5–35 months) and the median time from the start of PD to the development of hernia was 12.8 months (range: 6.1–18.9 months). The majority of patients who developed hernia were on continuous ambulatory PD (CAPD) (79.2%; n = 42). In the univariate comparative test (Table 1), previous abdominal surgery (49.1% versus 11.8%, P &amp;lt; 0.001) and past history of hernia (34% versus 5.5%, P &amp;lt; 0.001) were identified as risk factors. We also observed significant differences between groups in relation to total dialysate fill-volume (P = 0.001) and PD modality (P = 0.026). There was no statistically significant difference in demographic characteristics and comorbidities. Multivariate analysis showed ADPK as the only independent risk factor for development of hernia (OR 0.2, 95% CI [0.04–1.07]). In Cox regression analysis, male gender, history of nephrectomy or other abdominal surgery, CAPD and largest total dialysate fill-volume were associated with an earlier development of hernias (P &amp;lt; 0.05), but no association was found with these variables in the adjusted models for the Cox regression analyses. Overall, 32 hernias (60.4%) were surgically repaired, nearly all were handled electively (29 of 32, 90.6%); the remaining 3 hernias required emergency surgery. Six hernias (18.8%) recurred, with a median time to recurrence of 13.1 months (range: 3.7–29.6 months). Longer PD vintage was the only factor associated with the recurrence of hernia (P = 0.005). CONCLUSION In our study, abdominal hernias are very frequent in the PD population. ADPK was an independent risk factor for their development. We found that longer PD vintage is an important factor for recurrence of hernia after surgical repair.

V13-12 SINGLE PORT DA VINCI ROBOTIC RADICAL ADRENALECTOMY VIA MCBURNEY INCISION

You have accessJournal of UrologyCME1 May 2022V13-12 SINGLE PORT DA VINCI ROBOTIC RADICAL ADRENALECTOMY VIA MCBURNEY INCISION Jason Elyaguov, Mubashir Billah, Michael Stifelman, and Mutahar Ahmed Jason ElyaguovJason Elyaguov More articles by this author , Mubashir BillahMubashir Billah More articles by this author , Michael StifelmanMichael Stifelman More articles by this author , and Mutahar AhmedMutahar Ahmed More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002646.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Incidental adrenal masses are often benign and biopsy is not recommended. However, malignant potential exists in 6% of lesions >4cm and as high as 25% in lesions over 6cm, as a result surgical resection is recommended for masses over 5cm. Robotic resection today is considered standard of care, and the single port approach is novel and minimally described. In this video, we aim to review da Vinci single port (SP) access for left adrenalectomy via a McBurney incision as well as describe robotic instrument and assistant port configuration via the specialized da Vinci SP globe and demonstrate surgical technique for efficient and safe adrenal gland excision. METHODS: 59 year old male initially presented with left flank pain and CT imaging showed large left renal cysts as well as an incidental heterogenous 4.8 cm x 3.9 cm left adrenal mass with mixed attenuation. Full metabolic workup was normal. Surveillance MRI showed the mass to be >5cm and therefore patient elected for surgical resection. He underwent an SP left adrenalectomy in the right lateral decubitus position via a McBurney incision employing the specialized multi-access SP globe port, allowing for optimal dissection. We highlight efficient and judicious use of bipolar cautery in ligating the adrenal vein and excising out the adrenal gland. RESULTS: The patient tolerated the procedure well with a total operative time of 78 minutes and minimal blood loss. No intra-abdominal drain was placed, while a Foley catheter was removed 12 hours post operatively. The patient was discharged within 24 hours with no residual symptoms or complications at 90-day follow-up. The small single incision healed very well. Final pathology favored adrenal adenoma with a 4.2cm tumor and positive-free margins. CONCLUSIONS: SP da Vinci robotic adrenalectomy with multi-access globe port is feasible and safe. The McBurney incision allows for efficient access to the renal hilum and avoids risk of midline hernia, while providing excellent cosmesis and minimal pain. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e1034 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jason Elyaguov More articles by this author Mubashir Billah More articles by this author Michael Stifelman More articles by this author Mutahar Ahmed More articles by this author Expand All Advertisement PDF DownloadLoading ...

Characterizing Outcomes of Medial and Lateral Perforators in Deep Inferior Epigastric Perforator Flaps.

Perforators are typically found in rows in the deep inferior epigastric perforator (DIEP) flap. As methods to assess flap perfusion continue to improve, surgeons may be more likely to select perforators traditionally avoided. The purpose of this article is to describe clinical outcomes based on row and number of perforators to reevaluate flap and abdominal donor site morbidity. A retrospective analysis was performed on patients who underwent breast reconstruction with DIEP flaps by four microsurgeons from 2013 to 2020. The row and number of perforators were determined from operative reports. Chi-square and t-test or nonparametric Fisher's exact test and Wilcoxon two-sample test were used for discrete and continuous variable, respectively, as applicable. Logistic regression was used for multivariable analyses. Of 628 flaps, 305 were medial row (58.7%), 159 were lateral row (30.6%), and 55 had both rows (10.6%). Partial flap loss was higher in both rows (p = 0.003). Fat necrosis was higher with medial (p = 0.03) and both rows (p = 0.01) when compared with lateral using multivariable analysis. Hernia or bulge was higher in lateral row flaps (lateral: 8/157, 5.1%; medial, 5/299, 1.7%; both, 0/55; p = 0.05); however, mesh was more commonly used in both row flaps (p = 0.05). There was no difference in fat necrosis or abdominal morbidity between single and multiple perforators. There was no difference in fat necrosis based on the number or row of perforators. The lateral row provides adequate perfusion but may be associated with an elevated risk of hernia or bulge. Patients may benefit from mesh, especially when both rows are dissected.

Robotic-assisted compared with laparoscopic incisional hernia repair following oncologic surgery: short- and long-term outcomes of a randomized controlled trial.

Patients with abdominal site cancer are at risk for incisional hernia after open surgery. This study aimed to compare the short- and long-term outcomes of robotic-assisted (RVIHR) with the laparoscopic incisional hernia repair (LVIHR) in an oncologic institute. This is a single-blinded randomized controlled pilot trial. Patients were randomized into two groups: RVIHR and LVIHR. Groups have similar baseline characteristics (LVIHR: N = 19; RVIHR: N = 18). No difference was noted in the length of hospital stay (RVIHR: 3.67 ± 1.78days; LVIHR: 3.95 ± 2.66days) and postoperative complications (16.7 versus 10.5%; p = 0.94). The mean operating time for RVIHR was significantly longer than LVIHR (RVIHR was 355.6 versus 293.5min for LVIHR; p = 0.04). Recurrence was seen in three patients in LVIHR and two in RVIHR at 24-month follow-up, with no significant difference. (p > 0.99). Laparoscopic and robotic-assisted incisional hernia repair show similar short- and long-term outcomes for cancer patients.

Evaluating the risk of peri-umbilical hernia after sutured or sutureless gastroschisis closure

IntroductionWe evaluate the incidence, outcomes, and management of peri‑umbilical hernias after sutured or sutureless gastroschisis closure. MethodsA retrospective, longitudinal follow-up of neonates with gastroschisis who underwent closure at 11 children's hospitals from 2013 to 2016 was performed. Patient encounters were reviewed through 2019 to identify the presence of a peri‑umbilical hernia, time to spontaneous closure or repair, and associated complications. ResultsOf 397 patients, 375 had follow-up data. Sutured closure was performed in 305 (81.3%). A total of 310 (82.7%) infants had uncomplicated gastroschisis. Peri-umbilical hernia incidence after gastroschisis closure was 22.7% overall within a median follow-up of 2.5 years [IQR 1.3,3.9], and higher in those with uncomplicated gastroschisis who underwent primary vs. silo assisted closure (53.0% vs. 17.2%, p< 0.001). At follow-up, 50.0% of sutureless closures had a persistent hernia, while 16.4% of sutured closures had a postoperative hernia of the fascial defect (50.0% vs. 16.4%, p< 0.001). Spontaneous closure was observed in 38.8% of patients within a median of 17 months [9,26] and most frequently observed in those who underwent a sutureless primary closure (52.2%). Twenty-seven patients (31.8%) underwent operative repair within a median of 13 months [7,23.5]. Rate and interval of spontaneous closure or repair were similar between the sutured and sutureless closure groups, with no difference between those who underwent primary vs. silo assisted closure. ConclusionPeri-umbilical hernias after sutured or sutureless gastroschisis closure may be safely observed similar to congenital umbilical hernias as spontaneous closure occurs, with minimal complications and no additional risk with either closure approach. Levels of evidenceLevel II

Evaluation of the Effect of Closure Technique on Incidence of Incisional Hernia after Single-Port Laparoscopy in Gynecologic Oncology Surgery

To evaluate incidence and risk factors for incisional hernia in women undergoing single-port laparoscopy (SPL) for gynecologic oncology indications with a standardized fascia closure (SC) technique vs historical controls (HC). Retrospective cohort study. Single academic institution. Women who underwent SPL from June 1, 2017, to December 31, 2019, for gynecologic oncology indications with SC were compared with HC who underwent SPL from January 1, 2009, to December 31, 2015. Data were collected for patient demographics, postoperative outcomes, and incisional hernia development. Univariate analysis and multivariable regression models were built for predictors of incisional hernia. Of 1163 patients, 242 (20.8%) patients had SC, and 921 (79.2%) patients were HC. SC cohort had lower rates of diabetes vs HC (10.3% vs 15.3%; p=.049) but no differences in hypertension (36.8% vs 43.0% p=.081) and obesity (42.6% vs 36.9%, p=.11). A total of 1123 (96.6%) patients did not undergo conversion to multiport laparoscopy or laparotomy, of whom 7.2% (n=81) of patients developed an incisional hernia; there was no difference in incisional hernia development for SC with SPL (n=237) vHC with SPL (n=886) (9.7% vs 6.5%, p=.095). On multivariable analysis, increased body mass index (odds ratio [OR] 1.06; 95% confidence interval [CI] 1.03-1.09, p < .001) and diabetes (OR 2.41; CI 1.34-4.32, p=.003) were associated with incisional hernia, but age (OR 1.00; CI .98-1.02, p=.92), length of surgery (OR 1.00; CI 1.00-1.01, p=.62), and hypertension (OR .89; CI .52-1.53, p=.68) were not. Patients with prior abdominal surgeries (OR 1.92; CI 1.14-3.26, p=.015) and hand-assist surgery (OR 3.17; CI 1.48-6.80, p=.003) were significantly associated with incisional hernia. Implementation of an SC protocol did not decrease the rate of incisional hernia vs HC during SPL. Risk of incisional hernia must be considered for SPL planning in patients with complex medical comorbidities and prior abdominal surgery.

Systematic variable reduction for simplification of incisional hernia risk prediction instruments

BackgroundIncisional hernia (IH) is a complex, costly and difficult to manage surgical complication. We aim to create an accurate and parsimonious model to assess IH risk, pared down for practicality and translation in the clinical environment. MethodsInstitutional abdominal surgical patients from 2002 to 2019 were identified (N = 102,281); primary outcome of IH, demographic factors, and comorbidities were extracted. A 32-variable Cox proportional hazards model was generated. Reduced-variable models were created by systematic removal of variables 1–4 and 23–25 at a time. ResultsThe c-statistic of the full 32-variable model was 0.7232. Four comorbidities decreased accuracy of the model: COPD, paralysis, cancer and combined autoimmune/hereditary collagenopathy or AAA diagnosis. The model with those 4 comorbidities removed had the highest c-statistic (0.7291). The most reduced model included 7 variables and had a c-statistic of 0.7127. ConclusionAccuracy of an IH predictive model is only marginally affected by a vast reduction in end-user inputs.

PROPHYlactic Implantation of BIOlogic Mesh in peritonitis (PROPHYBIOM): a prospective multicentric randomized controlled trial

BackgroundPatients undergoing emergency surgery for peritonitis are at increased risk of abdominal wall-related complications. In patients with peritonitis, the risk of incisional hernia (IH) is extremely elevated. The evaluation of quality of life of patients with incisional hernia showed lower mean scores on physical components of health-related quality of life and body image. Furthermore, the arise of a post-operative abdominal wall complication (i.e., wound dehiscence, evisceration and IH) greatly increases morbidity and mortality rates and prolongs the hospitalization.MethodsThe present study aims to evaluate the efficacy of the use of a swine dermal collagen prosthesis implanted preperitoneally as a prophylactic procedure in urgency/emergency setting against abdominal wall complications in patients operated with contaminated/infected field in peritonitis. The sample size was defined in 90 patients divided in two arms (prosthesis positioning versus normal wall abdominal closure). The follow-up will be performed at 3, 6, and 12 months after surgery. The percentage of incisional hernias, wound infections, and adverse events will be investigated by physical examination and ultrasound.DiscussionThe objective is to evaluate the possibility to reduce the incisional hernia rate in patients undergoing urgent/emergent laparotomy in contaminated/infected field with peritonitis by using swine dermal collagen prosthesis preperitoneal positioning as a prophylactic procedure.Trial registrationClinicalTrials.gov NCT04681326. Registered (retrospectively after first patient recruited) on 23 December 2020.

Intracorporeal anastomosis versus extracorporeal anastomosis after laparoscopic right hemicolectomy for colon cancer: morbidity comparison at long-term follow-up.

Minimally invasive right hemicolectomy is nowadays considered the gold standard for treatment of malignant right colon disease. What is still debated is instead the choice between intracorporeal or extracorporeal anastomosis. The aim of this study was to compare morbidity and the long-term results between these two techniques. This retrospective, double-center cohort study was performed between January 2013 and December 2014. A total of 197 patients were enrolled after laparoscopic right hemicolectomy for malignant disease. The extracorporeal anastomosis group (ECA) included 95 patients, while the intracorporeal anastomosis group (ICA) included 102 patients. All patients were followed up for 5 years after surgery. Data analysis was performed in February 2021. The ICA group showed a reduced rate of non-surgical complications Clavien-Dindo grade I-II (10% vs. 31%; P=0.001) as well as a lower rate of wound infections (2% vs. 12%; P=0.01). Most importantly, a decreased risk of incisional hernias in a five-year follow-up period (1% vs. 8%; P=0.01) has been underlined. Intracorporeal anastomosis technique after totally laparoscopic right hemicolectomy showed better outcomes as it significantly reduces the risk for short and long-term complications, namely, incisional hernias.

266 Improving Management of Women Presenting with Groin Hernias at Royal Devon and Exeter Hospital (RD&amp;E)

Abstract Aim Determine the percentage of women with groin hernia undergoing laparoscopic repair at RD&amp;E hospital and if it was offered during clinic visit. Background The lifetime risk of groin hernia in women is 3–5.8%. The incidence of missed femoral hernia at re-operation after open repair in women is 41%. The HerniaSurge group has recommended laparoscopic repair of all groin hernias in women as it offers opportunity to identify all types of groin hernias and reduces post-operative pain and recurrence. Method All female patients undergoing groin hernia surgery at RD&amp;E hospital from 1 Feb 2018–31 Jan 2020 were identified. Patients undergoing surgery after this period were not included as the surgical practice was changing due to COVID-19 pandemic. Electronic patient records including clinic letters, operative notes, radiology reports and follow up letters were reviewed. Results 117 female patients undergoing groin hernia repair were identified. During clinic visit, rationale for laparoscopic surgery was documented only in 29/117 while discussion regarding material risks of surgery was documented in 51/117. Only 41/117 (35%) patients underwent laparoscopic hernia repair. Conclusion and second cycle The current practice at RD&amp;E requires improvements in terms of documentation of material risks associated with groin hernia repair and offering laparoscopic repair for women with groin hernias. For the next cycle, we aim to present at the local audit meeting and then collect further data to evaluate improvements in practice. We also aim to create a standardised electronic clinic letter and operative note format to bring uniformity of care.

Congenital collagenopathies increased the risk of inguinal hernia developing and repair: analysis from a nationwide population-based cohort study

Herein, we aimed to explore whether male patients with congenital collagen diseases had a higher risk of inguinal herniation than patients without these diseases. Data were retrospectively collected from the National Health Insurance Research Database of Taiwan. The study cohort included 1,801 male patients diagnosed with congenital collagen diseases based on the ICD-9 CM diagnostic codes; after propensity score matching, the control group comprised 6,493 men without congenital collagen diseases. The primary endpoint was inguinal hernia repair during the observation period. During a median follow-up period of 133.9 months, the risk of inguinal herniation in the collagen group was significantly higher than that in the control group (HR = 2.237, 95% CI 1.646–3.291, p < 0.001). This phenomenon was observed in patients younger than 18 years (HR: 3.040, 95% CI 1.819–5.083, p < 0.001) and in those aged 18–80 years (HR: 1.909, 95% CI 1.186–3.073, p < 0.001). Asian men with congenital collagen diseases are at a high risk of developing inguinal hernias, regardless of age. Detailed physical examination and patient education should be performed for these patients to prevent inguinal herniation.

Parastomal hernias and information retention: how and when to educate ostomates on risk minimisation

Background: Parastomal herniation is a common complication of stoma formation, caused by protrusion of the bowel through the abdominal wall, with a major negative impact on quality of life. Stoma care nurses should educate ostomates on how to minimise the risk of a parastomal hernia. However, new ostomates must absorb so much pre- and postoperative information that some of it may be missed, misunderstood or forgotten. Aims: A survey was conducted to determine how much information about parastomal hernias and risk minimisation patients remember, as well as the best way and time to deliver this information, including how often it should be repeated. Method: The survey comprised 13 multiple-choice questions and was distributed to adults with any type of stoma through medical equipment supplier SecuriCare Medical's postal mailing list and social media pages. These results were compared with findings from the literature. Findings: Of 544 participants, most were over 70 years old (55.2%) and had had a stoma for more than 10 years (59.1%). Of these, 70.6% had heard of parastomal hernias and 29.4% had not. Most of those who had heard of parastomal herniation heard of it when they were diagnosed with the complication (37.3%). Only 9.8% first heard of it from a stoma care nurse. Of those who had discussed herniation with a nurse, the largest group (26.4%) had done so at a postoperative home visit or clinic appointment. Conclusion: Those who have had their stoma for a long time are particularly likely to have never been educated on parastomal herniation or forgotten what they had learned, so are a priority for patient education. This education should be tailored to a patient's age, learning style and ability to process information in a short period, as well as anxiety level. Stoma care nurses should be careful to limit their use of jargon, abbreviations and the passive voice, as well as the amount and type of information being delivered. Such education should be delivered early and then repeated at regular intervals.

A problem at any age: a case report of congenital malrotation with bowel ischemia in an 84-year-old

BackgroundMalrotation with bowel ischemia is classically thought of as a disease of infants. However, the true prevalence of malrotation in both the pediatric and adult population is unknown due to the unclear number of asymptomatic patients.Case presentationA previously healthy 84-year-old man with no prior abdominal surgeries presented with an acute abdomen and was found on CT to have small bowel located in the right hemiabdomen and an abnormal SMA-SMV relationship suggestive of intestinal malrotation, as well as pneumatosis intestinalis. He underwent an exploratory laparotomy, where he was found to have a paraduodenal space which did not contain any bowel but was the likely source of an internal hernia. His duodenojejunal flexure was located to the right of the spinal column, the cecum in the left lower quadrant, a thick congenital band at the proximal jejunum, and multiple Ladd’s bands at the level of the duodenum. The bowel appeared viable and a Ladd’s procedure was performed. The patient had an uneventful post-operative course.ConclusionsThere is a lack of guidelines regarding screening for and management of asymptomatic malrotation in older children and adults. However, the traditional thinking is that asymptomatic malrotation diagnosed after two years of age poses minimal risk. This case illustrates the potential risk of an internal hernia in the setting of malrotation at any time during one’s lifetime.

An Analysis of the Risk Factors for the Development of Parastomal Hernia: A Single Institutional Experience.

Objectives: To study the frequency of risk factors affecting the development of parastomal hernias in patients undergoing stoma formation.Study Design: A retrospective descriptive cross-sectional study.Duration of Study: This study was conducted at the Department of General Surgery between January 2017 to December 2020.Methodology: A total of 163 patients aged between 20 and 100 years and who required a stoma formation were included in the study. The patients with incomplete data and those lacking post-operative imaging were excluded. According to this selection criteria, 80 patients were excluded. The data was collected for all patients from the hospital database. This included patient’s demographic information, co-morbidities, pre-surgery patient characteristics, an indication of stoma formation, the location of stoma exit, type of surgery, associated comorbidities, subcutaneous fat thickness, and type of stoma formed. Data were analyzed using IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp.Results: The mean age was 68.46 ± 16.50 years, with males in the majority: 48 (57.8%). Most of the patients, 53 (63.8%), had malignant disease. Post-stoma formation, a total of 38 (45.9%) patients developed parastomal hernias, mostly involving the sigmoid colon (n=62, 74.7%). However, there was a statistically significant relationship between paroxysmal sympathetic hyperactivity (PSH) incidence with non-trans-rectus stomas (trans-oblique n=07, junctional n=28) (OR 3.04, CI 1.23-7.5, p=0.014). Furthermore, malignancy was also not an independent predictor of PSH (OR 0.408, CI 0.15-1.2, p=0.056). All other risk factors included in this study were nonsignificant.Conclusion: Our study shows that the incidence of parastomal hernias is rising with a high rate demonstrated in our patients. There was no statistically significant association between patient-related preoperative and operative factors with increased risk of parastomal hernias in our population except for a non-trans-rectus stoma, which was identified as an independent risk factor for parastomal hernias. Based on our findings, we would recommend a trans-rectus stoma over all other stoma sites. However, a much larger study is needed to validate this finding further.

Concurrent hysterectomy and umbilical hernia repair via transvaginal notes among morbidly obese patients

Background: Umbilical hernias are especially common along with overweight, multiparous women. Laparoscopic hernia repair is preferred due to many advantages. On the other hand, the risk of trocar site hernia is disadvantageous. Trocars do not go through the abdominal wall via transvaginal natural orifice transluminal endoscopic surgery (V-NOTES). We investigate the V-NOTES hysterectomy and concomitant umbilical hernia repairment feasibility and outcomes. Methods: Six morbidly obese patients underwent V-NOTES hysterectomy and concurrent umbilical hernia repair between April 2020 and January 2021. Demographic features of patients, operating time, hernia size, complications, hospitalization time, recurrence of the hernia, visual analog scale (VAS) at 6th, 12th, and 24th hours, first, fourth, 12th weeks, and sixth months were recorded. Results: The average age of patients was 47.667 ± 2.422 (45–52). Mean body mass index (BMI), hernia and operating time size were 44.367 ± 3.217 kg/m2 (40.3–48.5), 6.167 ± 1.722 cm (4–9) and 88 ± 12.791 minutes (75–110), respectively. Intraoperative complications did not occur. Seroma was detected in one patient(16.6%). In six month follow-up period, we did not establish a diagnosis of hernia recurrence and postoperative chronic pain. Conclusion: Our study offers a novel perspective on V-NOTES umbilical hernia repair and hysterectomy in morbidly obese patients. According to our study, performing V-NOTES umbilical hernia repairment in a risky patient population is feasible and has promising outcomes.

Validation of ventral hernia risk score in predicting surgical site infections.

Ventral hernia risk score (VHRS) is a risk assessment tool for predicting the development of surgical site infection (SSI) developed in the Veterans Affairs population by Berger et al. The score was externally validated by the same study group in a diverse population in another study. It was also shown to be better than the existing Centre for Diseases (CDC) wound class and Ventral Hernia Working Group (VHWG) models. Our study aims to test the performance of the score in an Asian-Indian population. A prospective database of ventral hernia repairs done in a tertiary care centre between February 2019 and December 2020 was utilized for the study. All patients with a minimum follow-up of 1-month period were included in the study. The CDC definition of SSI was used. The VHRS, VHWG, and CDC class of each of the patients was determined. Receiver-Operating curves (ROC) of the scores and area under the curves (AUC) were used to compare the three scores. A total of 120 patients were included. During the course of our study, a total of 33 patients developed SSI (27.5%). Important factors which seemed to predict SSI were median operating time, CDC incision class, concomitant hernia repair, and creating skin flaps. The AUC of the VHRS score was 0.76 which was higher than those of VHWG (0.61) and CDC (0.58). Our study externally validates the novel VHRS which outperforms both CDC incision class and VHWG in predicting SSI following open ventral hernia repair, especially in a group with lower BMI compared to the previous reports. Trial registration No CTRI/2020/07/026289 registered on 01/07/2020.

Ancestry- and sex-specific effects underlying inguinal hernia susceptibility identified in a multiethnic genome-wide association study meta-analysis

Inguinal hernias are some of the most frequently diagnosed conditions in clinical practice and inguinal hernia repair is the most common procedure performed by general surgeons. Studies of inguinal hernias in non-European populations are lacking, though it is expected that such studies could identify novel loci. Further, the cumulative lifetime incidence of inguinal hernia is nine times greater in men than women, however, it is not clear why this difference exists. We conducted a genome-wide association meta-analysis of inguinal hernia risk across 513 120 individuals (35 774 cases and 477 346 controls) of Hispanic/Latino, African, Asian and European descent, with replication in 728 418 participants (33 491 cases and 694 927 controls) from the 23andMe, Inc dataset. We identified 63 genome-wide significant loci (P < 5 × 10−8), including 41 novel. Ancestry-specific analyses identified two loci (LYPLAL1-AS1/SLC30A10 and STXBP6-NOVA1) in African ancestry individuals. Sex-stratified analyses identified two loci (MYO1D and ZBTB7C) that are specific to women, and four (EBF2, EMX2/RAB11FIP2, VCL and FAM9A/FAM9B) that are specific to men. Functional experiments demonstrated that several of the associated regions (EFEMP1 and LYPLAL1-SLC30A10) function as enhancers and show differential activity between risk and reference alleles. Our study highlights the importance of large-scale genomic studies in ancestrally diverse populations for identifying ancestry-specific inguinal hernia susceptibility loci and provides novel biological insights into inguinal hernia etiology.

An evidence map and synthesis review with meta-analysis on the risk of incisional hernia in colorectal surgery with standard closure.

To assess the incidence of incisional hernia (IH) across various type of incisions in colorectal surgery (CS) creating a map of evidence to define research trends, gaps and areas of future interest. Systematic review of PubMed and Scopus from 2010 onwards. Studies included both open (OS) and laparoscopic (LS). The primary outcome was incidence of IH 12months after index procedure, secondary outcomes were the study features and their influence on reported proportion of IH. Random effects models were used to calculate pooled proportions. Meta-regression models were performed to explore heterogeneity. Ninetyone studies were included reporting 6473 IH. The pooled proportions of IH for OS were 0.35 (95% CI 0.27-0.44) I2 0% in midline laparotomies and 0.02 (95% CI 0.00-0.07), I2 52% for off-midline. In case of LS the pooled proportion of IH for midline extraction sites were 0.10 (95% CI 0.07-0.16), I2 58% and 0.04 (95% CI 0.03-0.06), I2 86% in case of off-midline. In Port-site IH was 0.02 (95% CI 0.01-0.04), I2 82%, and for single incision surgery (SILS) of 0.06-95% CI 0.02-0.15, I2 81%. In case of stoma reversal sites was 0.20 (95% CI 0.16-0.24). Midline laparotomies and stoma reversal sites are at high risk for IH and should be considered in research of preventive strategies of closure. After laparoscopic approach IH happens mainly by extraction sites incisions specially midline and also represent an important area of analysis.

Laparoscopic repair of giant diaphragmatic hernia after minimal invasive esophagectomy: a case report and review of the literature

: The incidence of esophageal cancer (EC) is rapidly increasing, as well as the overall survival of patients affected by it, given the improvement in its multimodal treatment. Minimally invasive esophagectomy (MIE) is the cornerstone to reach this goal, but the alteration of the anatomy that comes along with the surgery leads to an increased risk of diaphragmatic hernia (DH). This latter is a rare but highly morbid complication of MIE, which is expected to become more and more relevant. A 61-year-old man undergone to MIE for cancer, with uneventful immediate post-operative course, presented to our observation, 8 years after the procedure, with unspecific abdominal pain and vomiting. The CT scan showed a giant DH involving the small bowel and the transverse colon, which ascended in the thoracic cavity through a large defect of the left hemi diaphragm. A laparoscopic transabdominal repair, with direct suture of the diaphragm pillars, was performed. We did not record any immediate or long term post-operative complications, but a recurrence at 2 years CT scan follow-up. We treated the recurrent DH with an open repair employing a dual mesh placed on the left hemi diaphragm. No post-operative complications or further recurrences have been recorded. DH may be a life threatening early or long term post-esophagectomy complication. Nowadays, still little is known on its risk factors, and it has a nuanced clinical presentation, which frequently brings to a delayed diagnosis. Moreover, to the best of our knowledge a general consensus is lacking on the most appropriate attitude or technique to adopt in front of this uncommon disease. Our personal experience shows the efficacity and safety of a surgical approach, with direct suture, in a symptomatic post-MIE.