Surgical Repair Of Incisional Hernias Research Articles

Outcomes of Surgical Repair of Incisional Hernia in Patients With Severe and Morbid Obesity: A Comparative Study.

Introduction Incisional hernia (IH) is a common complication after open and minimal access abdominal surgery. The current practice guidelines recommend weight reduction to achieve a body mass index (BMI) < 35 kg/m2before surgical repair of ventral hernias. However, this could be challenging to achieve, especially in emergency presentations. This study aims to assess the safety of surgical repair of IH in patients with BMI ≥35 kg/m2. Methods A retrospective comparative study has been conducted to include all patients who had surgical repair of IH on an elective and emergency basis in a UK District General Hospital. The patients were divided into two groups. Group I BMI < 35 kg/m2and Group II with BMI ≥35 kg/m2. A comparison was made between the two groups according to demographics, comorbidities, hernia characteristics, operative data, and outcomes. Results The study included 239 patients, 181 in Group I and 58 in Group II. Morbid obesity was associated with male patients, and they were younger than Group I, p= 0.001 and 0.013, respectively. 13.8% of Group I had DM compared to 29.3% in Group II, p= 0.007. There were no significant differences in hernia characteristics or mode of surgery between the two groups. However, Group II had more overall and wound-related complications, p= <0.001 each. There were no significant differences in 30-day and 90-day mortality, recurrence rate, or 90-day readmissions. Conclusions Surgical repair of IH in patients with severe and morbid obesity is associated with more overall and wound-related complications.

Outcomes of elective and emergency surgical repair of incisional hernia: a comparative observational study.

Incisional hernia (IH) is a common complication following abdominal surgery. Surgical repair of IH is associated with the alleviation of symptoms and improvement of quality of life. Operative intervention can pose a significant burden to the patient and healthcare facilities. This study aims to describe and compare outcomes of elective and emergency surgical repair of IH. This study is a single-centre comparative retrospective study including patients who had repair of IH. Patients were divided into Group I (Emergency) and Group II (Elective), and a comparison was conducted between them. Two hundred sixty-two patients were identified with a mean age of 61.8 ± 14.2 years, of which 152 (58%) were females. The mean BMI was 31.6 ± 7.2 kg/m2. More than 58% had at least one comorbidity. 169 (64.5%) patients had an elective repair, and 93 (35.5%) had an emergency repair. Patients undergoing emergency repair were significantly older and had higher BMI, p = 0.031 and p = 0.002, respectively. The significant complication rate (Clavien-Dindo III and IV) was 9.54%. 30 and 90-day mortality rates were 2.3% (n = 6) and 2.68% (n = 7), respectively. In the emergency group, the overall complications, 30-day and 90-day mortality rates were significantly higher than in the elective group, p ≤ 0.001, 0.002 and 0.001, respectively. Overall, 42 (16.1%) developed wound complications, 25 (9.6%) experienced a recurrence, and 41 (15.71%) were readmitted within 90 days, without significant differences between the two groups. Patients who underwent emergency repair were significantly older and had a higher BMI than the elective cases. Emergency IH repair is associated with higher complication rates and mortality than elective repair.

SP7.11 Outcomes of Elective and Emergency Surgical Repair of Incisional Hernia - A Comparative Observational Study

Abstract Aims Incisional hernia (IH) is a common complication after abdominal surgery. This study aims to describe and compare the outcomes of IH's elective and emergency surgical repair. Methods A single-centre comparative retrospective study including all patients who had surgical repair of IH. The patients were divided into Group I (Emergency) and Group II (Elective). A comparison was made between the two groups. Results 262 patients were identified with a mean age of 61.8 SD±14.2 years, and 152 (58%) were females. More than 58% had at least one comorbidity. 169 (64.5%) had elective, and 93 (35.5%) had emergency repair. Patients undergoing emergency repair of IH were significantly older and had higher BM, p= 0.031 and 0.002, respectively. The overall complication rate in the full cohort was 46.2%, and the significant complication rate (Clavien-Dindo III and IV) was 9.54%. The 30-day and 90-day mortality rates were 6 (2.3%) and 7 (2.68%), respectively. In the emergency group, the complications, 30-day and 90-day mortality rates were significantly higher than in the elective group, p= &amp;lt;0.001, 0.002 and 0.001, respectively. The emergency group had a significantly longer hospital stay, and more of them needed a higher level of care, p= &amp;lt;0.001 each. Overall, 42 (16.1%) developed wound complications, 25 (9.6%) patients had a recurrence, and 41 (15.71%) had 90-day readmissions without significant differences between the two groups. Conclusions IH is associated with medical comorbidity and high BMI. Emergency repair of IH is associated with higher complication rates and mortality compared to elective repair.

WTP7.1 Outcomes of Surgical Repair of Incisional Hernia in The Old Patients ≥70 Years

Abstract Aims Incisional hernia (IH) is a common complication after abdominal surgery. Increasing age and frailty may be associated with poor outcomes after surgical interventions. This study aims to assess the safety of surgical repair of IH in patients ≥ 70-Year-old. Methods A retrospective study of patients who had surgical repair of IH on an elective and emergency basis in a UK District Hospital. The patients were divided into two groups, Group I &amp;lt;70 and Group II ≥70 years. A comparison was made between the two groups according to demographics, comorbidities, hernia characteristics, operative data, and outcomes. Results 262 patients were included with a mean age of 61.8 SD± 14.2 years, and 152 (58%) were females. Group I included 173, and Group II had 89 patients. Group I had more morbidly obese patients, 46 (28.8%) compared to 12 (15.2%) in Group II; p= 0.021. Group II had more patients with at least one comorbidity and COPD than Group I; p= 0.004 and 0.003, respectively. There were no significant differences in overall or wound-related complications, p= 0.587 and 0.125, respectively. The 30-day mortality rates were 3 (1.7%) and 3 (3.4%), and the 90-day mortality rates were 4 (2.3%) and 3 (3.4%) in Groups I and II, respectively, without significant differences between both groups. There were no significant differences in the recurrence rate (with a mean follow-up of 56 months) or 90-day readmissions between the two groups. Conclusions Surgical repair of IH is safe and effective in patients ≥ 70 years, with comparable outcomes in younger patients.

WTP5.11 Safety of Surgical Repair of Incisional Hernia in Patients with Morbid Obesity

Abstract Aims Incisional hernia (IH) is a common complication after open and minimal access abdominal surgery. The current practice guidelines recommend weight reduction to achieve a body mass index (BMI) &amp;lt; 35 Kg/M2 before surgical repair of ventral hernias. However, this could be challenging to achieve, especially in emergency presentations. This study aims to assess the safety of surgical repair of IH in patients with BMI ≥35 Kg/M2. Methods A retrospective comparative study has been conducted to include all patients who had surgical repair of IH on an elective and emergency basis in a UK District General Hospital. The patients were divided into two groups. Group I BMI &amp;lt; 35 Kg/M2 and Group II with BMI ≥35 Kg/M2. A comparison was made between the two groups according to demographics, comorbidities, hernia characteristics, operative data, and outcomes. Results The study included 239 patients, 181 in Group I and 58 in Group II. Severe obesity was associated with male patients, and they were younger than Group I, p= 0.001 and 0.013, respectively. 13.8% of Group I had DM compared to 29.3% in Group II, p= 0.007. There were no significant differences in hernia characteristics or mode of surgery between the two groups. However, Group II had more overall and wound-related complications, p= &amp;lt;0.001 each. There were no significant differences in 30-day and 90-day mortality, recurrence rate, or 90-day readmissions. Conclusions Surgical repair of IH in patients with morbid obesity is associated with more overall and wound-related complications.

Isokinetic strength training versus core stability training on the trunk muscle strength and quality of life after surgical repair of incisional hernia in adolescents.

Isokinetic strength training versus core stability training on the trunk muscle strength and quality of life after surgical repair of incisional hernia in adolescents.

The efficacy of isokinetic strength training versus core stability training on the trunk muscle strength and quality of life after surgical repair of incisional hernia in adolescents.

The study aimed to compare the impact of isokinetic strength training (IST) with core stability training (CST) in terms of trunk muscle strength and quality of life (QoL) after surgical repair of incisional hernia in adolescents. The prospective, randomized, comparative study was conducted at the College of Applied Medical Sciences, Department of Health and Rehabilitation Sciences between August 2019 and June 2020. Thirty patients (16 males, 14 females; mean age: 17.1±0.6 years; range, 12 to 18 years) who had undergone primary incisional hernia repair surgery were included in the study. The patients were randomly divided into two groups: the IST group of 15 patients who underwent the isokinetic exercise program for trunk muscles and the CST group of 15 patients who practiced the core exercise program. Each group exercised three times per week for six weeks. All patients were assessed pre-and post-treatment by an isokinetic dynamometer for trunk flexors and extensors at 60 and 90°/s angular velocities and the European Registry for Abdominal Wall Hernias (EuraHS)-QoL questionnaire. The trunk flexor and extensor Peak torque/body weight ratio at 60 and 90o/s angular velocities and QoL were significantly improved in both IST and CST groups (p<0.05). The post-treatment values of both groups revealed marked but not statistically significant differences in all measured variables (p>0.05). Both IST and CST are effective training programs that can improve the strength of trunk flexors and extensors as well as QoL after surgical repair of incisional hernia in adolescents.

P026 PREOPERATIVE ABDOMINAL WALL RELAXATION WITH BOLULINUM TOXIN A INJECTION CAN FACILITATE SURGICAL REPAIR OF INCISIONAL HERNIAS: LONG-TERM SINGLE CENTER FOLLOW-UP OF 12 PATIENTS

Abstract Aim It was investigated how preoperative botox injection in the abdominal musculature both facilitates the surgical repair of incisional hernias and reduce the rate of hernia recurrence. Material and Methods Botulinum toxin A injections was given to 12 patients (7 female and 5 male) suffering from complex incisional wall hernia, 4 to 6 weeks preoperatively. Mean age was 54 years. 9 patients were treated by anterior and/or posterior component separation repair and 3 by Rives-Stoppa repair. By all patients the mesh could be placed in the retromuscular position. No bridging was necessary. Results After a follow-up of 3 to 4 years we examined the patients clinically and by sonography. The rate of incisional hernia recurrence was low as well as the rate of side effects like chronic pain, persisting paresthesia and mobility disorders of the abdomen. Conclusions Preoperative injection of botulinum toxin A can help to reduce the risk of further hernia recurrence after surgical repair of complex incisional hernias of the abdominal wall.

Enhanced recovery after surgical repair of incisional hernias.

Enhanced recovery programmes (ERPs) were developed to improve the patient's post-operative comfort and reduce post-operative morbidity after several types of major surgery including the incisional hernia repair. The aim of this review was to describe the features of ERPs in the setting for incisional hernia repair. The literature review was conducted until March 2019, but retrieved very few papers (n = 4) on this topic. All studies were retrospective. Setting and comorbidities of incisional hernia patients are of such importance in many cases that prehabilitation (including tobacco use cessation, management of obesity, diabetes or malnutrition) should play a greater role compared with other specialties. The other peri-operative measures are similar to other specialties but their implementation was very heterogeneous in the published studies. Like in other surgeries, ERPs were feasible and probably efficient to improve the post-operative course of incisional hernia patients. But the level of evidence remains low.

Predictive Factors for Intraabdominal Hypertension after Incisional Hernia Repair.

The purpose of our research is to synthesize the risk factors quoted in the literature which predispose to intra-abdominal hypertension occurrence following surgical repair of incisional hernias. We used for our research the Web of Science, Scopus and PubMed research platforms and we used the following search formula: (Intra-abdominal hypertension OR intra-abdominal pressure OR abdominal compartment syndrome) AND risk factors AND incisional hernia. The results were filtered according to the following criteria: language (English), publish year ( 2000) and access (in extenso). In this context, we chose to classify the risk factors for IAP increase in the following categories: (1) those related body habitus and anthropometry; (2) those associated with the presence of comorbidities; (3) those related to the defect of the abdominal wall; (4) those associated with the surgical management. Among the most important risk factors we mention: elevated BMI, chronic obstructive pulmonary disease, large incisional hernias with loss of domain, surgical technique used, prolonged surgeries and repeated attempts to close the defect.

Correção de hérnia abdominal com tela envolta por tecido fibroso: estudo em ratos Wistar

To assess the efficacy and complications of surgical repair of incisional hernias by grafting of polypropylene mesh surrounded by fibrous tissue, compared to polypropylene mesh. twenty-five male and female Wistar rats were divided into two groups: control and experimental. The 15 animals of the experimental group underwent implantation of the mesh in the subcutaneous tissue. After 21 days, the screen was removed and served to correct an induced abdominal hernia. The animals were euthanized after 21 days and submitted to macroscopic, microscopic and tension analises. The control group had undergone usual abdominal hernia repair with polypropylene mesh. There was a significant difference in macroscopic adhesions. The control group had a higher degree of adhesions when compared to the experiment ones (p = 0.003). We could not determine whether there were significant differences in tensile strength and microscopy. The polypropylene mesh surrounded by fibrous tissue was effective in the correction of induced abdominal hernias, with a lower degree of macroscopic adhesions when compared to polypropylene mesh.

Mechanical characterization and constitutive modelling of the damage process in rectus sheath

The aim of this study is to characterize and model the damage process in the anterior rectus abdominal aponeurosis (anterior rectus sheath) undergoing finite deformations. The resistance of the anterolateral abdominal aponeuroses is important when planning the surgical repair of incisional hernias, among other medical procedures. Previous experiments in prolapsed vaginal tissue revealed that a softening process occurs before tissue rupture. This nonlinear damage behaviour requires a continuum damage theory commonly used to describe the softening behaviour of soft tissues under large deformations. The structural model presented here was built within the framework of non-linear continuum mechanics. Tissue damage was simulated considering different damage behaviours for the matrix and the collagen fibres. The model parameters were fit to the experimental data obtained from anterior rectus sheath samples undergoing finite deformations in uniaxial tension tests. The tests were carried out with samples cut along the direction of the collagen fibres, and transversal to the fibres. Longitudinal and transverse mechanical properties of human anterior rectus sheath are significantly different.The damage model was able to predict the stress–strain behaviour and the damage process accurately. The error estimations pointed to an excellent agreement between experimental results and model fittings. For all the fitted data, the normalized RMS error ε presented very low values and the coefficient of determination R2 was close to 1. The present work constitutes the first attempt (as far as the authors know) to present a damage model for the human rectus sheath.

The comparison of heavyweight mesh and lightweight mesh in an incisional animal model

An incisional hernia may occur through the incision area following a surgical operation, through the trocar opening and even through drainage exit points. Various synthetic surgical meshes have recently been used for the surgical repair of incisional hernias. In this study, we analysed the burst strength forces of heavyweight mesh and lightweight mesh in an incisional animal model. Following experimental formation of incisional hernias in 32 Wistar albino rats, they were divided into four groups. Polypropylene suture was used for closure of the abdominal incision in Group 1. In Groups 2, 3 and 4, polyester, polypropylene + polyglactin and polypropylene meshes, respectively, were fixed on the surface of the fascia after closing the defects in the rats. Polypropylene and polyester meshes are classified as heavy mesh. Light mesh is composed of a non-absorbable part (polypropylene) and an absorbable part (polyglactin), which will disappear 80 days after implantation. The rats were sacrificed at the end of the experiment. The pullout force of the fascia and meshes were recorded by use of a digital tension meter. The mean pullout forces for Groups 1, 2, 3 and 4 were found to be 123.4 +/- 13.3, 292.33 +/- 17.4, 281.66 +/- 16.3 and 310.60 +/- 26.1 N, respectively. At the end of the experiment, the polypropylene (25 g/cm(2)) present in the lightweight mesh was found to lose only a small percentage of the burst strength compared to the polypropylene (85 g/cm(2)) present in the heavyweight mesh.

Open Surgical Management of Incisional Hernia

Objective: To study the effect of different surgical techniques and the outcome of treatment in a group of 68 patients with incisional hernias and different predisposing factors (age, sex and BMI). Materials and Methods: Sixty-eight patients admitted to King Khalid Hospital, Al Kharj, Saudi Arabia over a period of 5 years (from January 2000 to December 2004) were included in this retrospective study. The predisposing factors, the surgical techniques and the outcome of treatment were determined by review of the medical records. Results: Type of previous surgery and obesity were the predominant predisposing factors and recurrence was more common in the obese patients, especially those with post-operative wound infection. Conclusion: Repair of incisional hernias still remains a challenge for the general surgeon and the surgical management has to be tailored to the individual patient. INTRODUCTION Incisional hernias represent one of the most frequent complications of abdominal surgery. Development of incisional hernias after abdominal surgery has been reported in 3.8-11.5% 1,2 , ninety percent of them within three years of operation. The incidence depends on a number of factors including old age, male sex, obesity, bowel surgery, suture type, chest infection, wound infection and co-morbidities like chronic bronchitis and asthma. Various methods have been described for the open surgical repair of incisional hernias, for example 5,6,7,8,9,10 Primary repair in one or two layers 1. Mayo-type overlap darning repair 2. Shoelace repair and 3. The use of a synthetic mesh. 4. Recurrence is a common complication after repair of large abdominal incisional hernias. Recurrence rates of up to 33% after first repair and 44% after second repair have been reported. 3 Hence repair of such hernias needs the use of techniques suitable and tailored to individual patients. We operated upon 68 patients during the five-year period from January 2000 to December 2004 and the details are presented in this article. MATERIALS AND METHODS Sixty-eight patients were included in the study; 38 males and 30 females; of an age between 20 and 80 years. History of previous operations including that of wound infections, comorbidities like diabetes mellitus, hypertension, bronchial asthma, chronic bronchitis and other risk factors like obesity and smoking habits were documented. Forty-three out of 68 patients were obese with BMI >30; the remaining 25 were overweight with BMI between 25 and 30. Twenty-five male patients were smokers. Out of the total of 68 patients, 3 patients had chronic bronchitis and 5 gave history of bronchial asthma in the past but none had an acute episode during admission. Sixteen were diabetics but well controlled; so were the 10 hypertensive patients (6 of them diabetic also). Routine investigations were completed as outpatient and patients were admitted only the day prior to surgery after ensuring fitness for surgery; prophylactic heparin therapy was given for all. All operations were performed by open method under general anesthesia. The techniques used were Primary fascial repair 1. Open Surgical Management of Incisional Hernia 2 of 5 Tension free repair with synthetic mesh prostheses 2.

Review of technique for combined closed incisional hernia repair and panniculectomy status post–open bariatric surgery

Background After open bariatric surgery, many patients develop incisional hernia. Patients who were once morbidly obese provide a unique challenge to hernia repair, given the larger nature of their fascial defects and the concomitant problem of extreme amounts of abdominal wall laxity. We reviewed a technique for surgical repair of incisional hernias combined with panniculectomy. Methods A retrospective review of 50 consecutive patients status post–open bariatric surgery who underwent incisional hernia repair with overlay mesh and combined panniculectomy between 2000 and 2003. Results Hernia repair and panniculectomy were performed 18 months after open bariatric surgery. The patients had an average weight loss of 58.6 kg. Mean follow-up after hernia repair and panniculectomy was 18 months. Patients underwent prefascial hernia repair with plication of the fascial edges followed by midline anchoring of overlay mesh. The averave amount of excess tissue excised via panniculectomy was 3001 g. The average hospital stay was 4 days. Minor wound problems (eg, suture abscess, seroma) occurred in 20 patients. Seromas were treated with serial aspiration in the office. There were no intra-abdominal complications or recurrences of the incisional hernias. Conclusion Closed hernia repair with prefascial plication and overlay mesh is a safe, effective alternative to traditional incisional hernia repair. It provides adequate hernia repair without recurrence and eliminates intra-abdominal complications. It is our belief that combining the hernia repair and panniculectomy minimizes the risk of hernia recurrence through alleviation of stress on the repair by removing excess abdominal wall tissue.

Colosigmoid Junction: A Study of Its Functional Activity With Identification of a Physiologic Sphincter and Involvement in Reflex Actions

The colosigmoid junction (CSJ) marks the termination of the descending colon (DC) and the beginning of the sigmoid colon (SC); it is a fixed area in the retroperitoneum. At this site where two functionally different areas meet, we hypothesized the presence at the CSJ of a physiologic sphincter that regulates the passage of gut contents from the DC to the SC. This hypothesis was investigated for this communication. Eight subjects (mean age 36.6 &#45 4.7 SD years, 6 women) were studied during surgical repair of incisional hernia or laparotomy. The pressure responses of the CSJ to individual distension of the DC and SC were recorded. A balloon-ended tube was introduced per anum to lie in the DC or SC, and the pressure in the DC, CSJ, and SC was measured by saline-perfused catheters. To study whether the CSJ response to individual DC or SC distension was a direct or reflex action, the test was repeated in six of eight patients after separate anesthetization of the DC, CSJ, and SC. The CSJ had a higher pressure than that of the DC or SC; the high-pressure zone measured a mean of 2.1 &#45 0.9 cm. High-volume DC distension effected a significant DC pressure rise ( p < .001) and a CSJ pressure decline ( p < .05), which lasted a mean of 7.2 &#45 1.2 s. In contrast, the CSJ responded to big volume SC distension by significant pressure elevation ( p < .001) which was also momentary. Small volume distension of the DC or SC effected no significant CSJ pressure response ( p > .05). The CSJ pressure did not respond to distension of the anesthetized DC or SC. Likewise, the anesthetized CSJ did not react to DC or SC distension. When the test was repeated using saline instead of xylocaine, the CSJ pressure response was similar to that without saline injection. The CSJ is a high pressure zone with a measurable length. It reacts to DC or SC balloon distension by dilatation or narrowing, respectively. These findings presumably denote the existence of a "physiologic sphincter" at the CSJ, which appears to regulate the passage of colonic contents to the SC. We postulate that the CSJ pressure response to DC or SC distension is reflex and mediated through the "colosigmoid reflexes." The role of the colosigmoid sphincter and reflexes in colonic motility disorders remains to be investigated.

Colosigmoid Junction: A Study of Its Functional Activity With Identification of a Physiologic Sphincter and Involvement in Reflex Actions

The colosigmoid junction (CSJ) marks the termination of the descending colon (DC) and the beginning of the sigmoid colon (SC); it is a fixed area in the retroperitoneum. At this site where two functionally different areas meet, we hypothesized the presence at the CSJ of a physiologic sphincter that regulates the passage of gut contents from the DC to the SC. This hypothesis was investigated for this communication. Eight subjects (mean age 36.6 - 4.7 SD years, 6 women) were studied during surgical repair of incisional hernia or laparotomy. The pressure responses of the CSJ to individual distension of the DC and SC were recorded. A balloon-ended tube was introduced per anum to lie in the DC or SC, and the pressure in the DC, CSJ, and SC was measured by saline-perfused catheters. To study whether the CSJ response to individual DC or SC distension was a direct or reflex action, the test was repeated in six of eight patients after separate anesthetization of the DC, CSJ, and SC. The CSJ had a higher pressure than that of the DC or SC; the high-pressure zone measured a mean of 2.1 - 0.9 cm. High-volume DC distension effected a significant DC pressure rise ( p < .001) and a CSJ pressure decline ( p < .05), which lasted a mean of 7.2 - 1.2 s. In contrast, the CSJ responded to big volume SC distension by significant pressure elevation ( p < .001) which was also momentary. Small volume distension of the DC or SC effected no significant CSJ pressure response ( p > .05). The CSJ pressure did not respond to distension of the anesthetized DC or SC. Likewise, the anesthetized CSJ did not react to DC or SC distension. When the test was repeated using saline instead of xylocaine, the CSJ pressure response was similar to that without saline injection. The CSJ is a high pressure zone with a measurable length. It reacts to DC or SC balloon distension by dilatation or narrowing, respectively. These findings presumably denote the existence of a "physiologic sphincter" at the CSJ, which appears to regulate the passage of colonic contents to the SC. We postulate that the CSJ pressure response to DC or SC distension is reflex and mediated through the "colosigmoid reflexes." The role of the colosigmoid sphincter and reflexes in colonic motility disorders remains to be investigated.