Surgical Treatment Of Incisional Hernia Research Articles

Roboticassisted incisional hernia surgery-Retromuscular techniques

The trend to minimally invasive surgery has also made its way into the surgical treatment of incisional hernias. Unlike other areas of visceral surgery, recent years have seen aresurgence of open sublay repair in incisional hernia procedures, primarily due to the recognition of the retromuscular layer as the optimal mesh placement site. Additionally, with the growing availability of robotic systems in visceral surgery, these procedures are increasingly being offered in the form of minimally invasive procedures. These methods can be categorized based on the access routes: robotic-assisted transperitoneal procedures (e.g., r‑Rives, r‑TARUP, r‑TAR) and total extraperitoneal hernia repair (e.g., r‑eTEP, r‑eTAR). Notably, the introduction of transversus abdominis muscle release enables the robotic-assisted treatment of larger and more complex hernia cases with complete fascial closure. With respect to the comparison with open surgery required in retromuscular hernia treatment, the currently available literature on incisional hernia repair seems to show initial advantages of robotic-assisted surgery in the perioperative course. New technologies create new possibilities. In the context of surgical training the use of surgical robot systems with double consoles opens up completely new perspectives. Furthermore, the robot enables the implementation of models of artificial intelligence and augmented reality and could therefore open up novel dimensions in surgery.

Different cellular and immunohistochemical abdominal wall cicatrization parameters evaluation in comparison with sublay, onlay, and ipom technique in an experimental rat model.

Incisional hernia (IH) occurs when there is a partial or complete solution of continuity of a fascia previously incised. Systematic reviews demonstrate that surgical treatment of IHs with the use of meshes are approximately 16%. Meta-analyses have demonstrated the superiority of mesh placement using sublay technique, but without a pathophysiological explanation. Thus, we aim to evaluate the different techniques of mesh positioning in an experimental model. Fifty rats were distributed into five groups; control; simulation (SM)-submitted to laparotomy only; onlay-the mesh was positioned in onlay fashion; retromuscular (SL)-the mesh was positioned in a sublay fashion; intraperitoneal (IPOM)-positioning of the mesh adjacent to the transversalis fascia, inside the cavity. After 60days, adhesions, tensiometry, histology, and immunohistochemistry were addressed. The IPOM group had the most adhesions, together with the SL group, with significantly relevant results. The SL group had higher values of tensiometric evaluation, while the IPOM group had the lowest mean in the tensiometry evaluation, being even lower than the SM group. Regarding histological and immunohistochemical findings, the SL group had a higher pixel number count compared to the groups, with statistical significance, in addition to higher expression of polymorphonuclear infiltrate and CD68 markers. The mesh positioning in sublay compartment is associated with the development of more pronounce minimum tensile force required for detaching the surrounding abdominal wall tissues it was incorporated. The intensity of these findings correlates to the different histological and immunohistochemical profiles observed following each repair, since SL group was characterized by a higher proportion of collagen, inflammatory, and reparative elements. Characterizing these pro-healing elements and its counterparts will allow the development of new therapeutic tools which could be added to the still far-from-ideal current therapeutic options for IH treatment.

Two-Stage Abdominal Wall Reconstruction in a Patient with a Complex Postoperative Hernia

Surgical treatment of incisional hernia is an actual problem of abdominal surgery. Despite the improvement of surgical techniques, the results of surgical treatment cannot be considered satisfactory: the recurrence rate continues to be high and is due to failures in the reconstruction of complex ventral hernia. Although there are many works devoted to various aspects of the surgical treatment of patients with complex incisional hernias, the problem is not sufficiently resolved. The treatment of this category of patients is a difficult task for both surgeons and patients due to the high risk of general and local complications. A clinical case of surgical treatment of a patient with a complex incisional hernia is presented, in which it was possible to carry out a complete reconstruction of the anterior abdominal wall in two stages without "components separation" method.

НОВЫЙ МЕТОД ПЛАСТИКИ ПОСЛЕОПЕРАЦИОННЫХ ВЕНТРАЛЬНЫХ ГРЫЖ: СРАВНИТЕЛЬНОЕ ЭКСПЕРИМЕНТАЛЬНОЕ ИССЛЕДОВАНИЕ

The problem of incisional hernia has become widespread due to the increase in the amount of laparotomies in abdominal surgery. After laparotomy in 4-11% cases incisional hernias occurred, which makes the problem one of the most important in abdominal and plastic surgery. The research aim is to experimentally evaluate and compare the absolute strength, increase in strength and reaching tensile strength of abdominal wall tissues after surgical treatment of incisional hernia with two different methods: Sapezhko and modified Sapezhko, the latter involving placing the mesh in the double abdominal layer. Material and methods. At the first stage of the study, incisional hernia was modeled in 36 rats. Consequently, the animals were divided into two groups. The main group consisted of 18 rats and underwent the Sapezhko surgical treatment of incisional hernia. The control group of 18 remaining rats underwent modified Sapezhko surgical treatment. On days 10, 14 and 16 the animals were taken out of the experiment. Strength of native abdominal walls of 6 rats were examined. The strength of the parts of abdominal walls was measured on the universal testing machine. Results. The findings indicate that polypropylene mesh placed in the double layer of the abdominal wall induces tighter scar formation in comparison with scars in the double layer of abdominal wall without mesh. Conclusions. The results of experimental research show that newly developed method have statistically significant advantages on the absolute strength, increase in strength and reaching tensile of strength of abdominal wall tissues.

Study on the Need for Postoperative Analgesic Medication in Patients where Polypropylene Mesh was Used in the Surgical Treatment of Incisional Hernias

One of the most common postoperative complications that may occur in patients treated for incisional hernias is pain. The occurrence of postoperative pain refractory to drug treatment may worsen the prognosis of these patients. We have carried out a retrospective observational study in which we have introduced 122 patients operated for incisional hernia at the Surgical Clinic No. 1 in the Tirgu Mures Emergency County Clinical Hospital. The patients included in the study were divided into two groups: group A consisting of 80 patients where the polypropylene mesh was used over the aponeurosis in the surgical treatment of the incisional hernias, and the group B consisting of 42 patients where no prosthetic materials were used in the surgical treatment of the incisional hernias. All patients were administrated 1 g of sodium metamizole monohydrate for the treatment of pain. The statistical analysis of the data revealed that, on the day of surgery, on the first, second and third postoperative day there were statistically significant differences in the need for analgesic medication between the two groups, the need for the analgesic medication being lower for group A. In contrast, on the 4th postoperative day there were no statistically significant differences in the need for analgesic medication between the two groups. In conclusion, our study showed that, when using the polypropylene mesh in the surgical treatment of incisional hernias, the need for analgesic medication is lower in the immediate postoperative period compared to cases where surgical meshes are not used in the surgical treatment of these patients.

Surgical treatment of incisional hernia – own material

Surgical treatment of incisional hernia – own material

Adli Otopsi İle Saptanan Şiloperikardiyum

Bu sunumda adli otopside şiloperikardiyum saptanan 72 yaşındaki kadın olguyu medikolegal boyutuyla sunarak tartışmayı ve kısa literatür incelemesi yapmayı amaçladık. Basit bir tıbbi müdahale ile giderilebilecek nitelikte yaralanmaya maruz kaldığı darp olayından 5 gün sonra gastrointestinal sistem şikayetleri nedeniyle bir hastaneye başvurmuştur. İnsizyonel herni ve kolon divertikül perforasyonu cerrahi tedavisi sonrası hemodinamisi stabil olarak klinikte takip ve tedavileri devam ederken, hastaneye yatışının ikinci gününde ölmüştür. Otopsisinde iç muayenede, perikardın gergin ve boşluğunun beyaz renkli şilöz sıvı ile dolu olduğu görüldü. Batında cerrahi sütüre yara, ekimoz, membran ve noktasal kanama alanları ile adhesiv alanlar izlendi. Makroskobik olarak yoğun peritonit bulgusu izlenmedi. Histopatolojik incelemede; akciğerlerde ödem, kalpte myosit sitoplazmalarında genişleme, ince ve kalın bağırsaklarda serozal yüzde yoğun nötrofil lökosit infiltrasyonu, sütür materyali yanısıra nonspesifik bulgular saptandı. Kimyasal analizlerde herhangi bir toksik madde saptanmadı. Perikard boşluğundan alınan sıvının biyokimyasal analizinde; 461 mg/dL trigliserid ve 114 mg/dL kolesterol saptandı. Kişinin ölüm nedeni ‘‘insizyonel herni....

Comparative Study on the Use of Polypropylene Mesh in the Surgical Treatment of Patients with Strangulated or Uncomplicated Incisional Hernias

Incisional hernias affects approximately 10-20% of patients with history of abdominal surgery. The purpose of this study was to examine the tissue integration of the polypropylene mesh in patients operated for strangulated incisional hernias to those operated for uncomplicated incisional hernias. For this purpose, we introduced 218 patients with surgical treatment of the incisional hernia with polypropylene mesh. The total number of patients studied was divided into 2 lots: group A consisting of 189 patients with uncomplicated incisional hernia and group B of 29 patients with strangulated incisional hernia. We studied separately the local postoperative complications in the two groups (hematomas, seromas, abdominal wall infections). Although the number of local postoperative complications was higher for group B, the differences were statistically significant only for the incidence of abdominal wall infections. Although the use of the polypropylene mesh in the surgical treatment of strangulated incisional hernias predisposes to a higher risk of local postoperative complications compared to its use in the surgical treatment of the uncomplicated incisional hernias, its use in the surgical treatment of the strangulated incisional hernias is beneficial.

Comparative Study on the Efficiency of 2 Different Types of Meshes (Polypropylene and ProGripTM ) in the Surgical Treatment of Incisional Hernias

Postoperative eventration is a quite common condition in patients with clinical records of abdominal surgery. The purpose of this study was to investigate the efficacy of use of 2 different types of meshes (Polypropylene mesh and ProGripTM mesh-self-gripping mesh) in the surgical treatment of incisional hernias. In this respect, we conducted a study in which we introduced 128 patients operated for incisional hernias. Patients were divided into 2 lots: group A (102 patients with polypropylene mesh) and group B (26 patients with ProGripTM mesh). From the analysis of the data studied, we noticed that the average duration of surgery and hospitalization for patients with ProGripTM mesh is lower compared to patients with polypropylene mesh. Also, the rate of local postoperative complications was lower when using the ProGripTM mesh (15.38%) than in the case of polypropylene mesh. In conclusion, we can state that the use of the ProGripTM heterologous mesh is beneficial in the surgical treatment of patients with incisional hernias. The major advantage of using this type of mesh is given by a shorter hospitalization period for these patients, as well as by a lower rate of local postoperative complications in these patients.

Серомы как осложнение хирургического лечения послеоперационных грыж передней брюшной стенки с использованием сетчатых имплантов: современное состояние проблемы

Серомы как осложнение хирургического лечения послеоперационных грыж передней брюшной стенки с использованием сетчатых имплантов: современное состояние проблемы

Fixation-free incisional hernia repair in the elderly: our experience with a tentacle-shaped implant.

Incisional hernia in aged patients represents a challenge even for experienced surgeons. Besides increased risk of complications due to comorbidities, mesh fixation and assuring a sufficient mesh overlap of the defect are the main issues in carrying out the repair. In order to assure broader coverage of the abdominal wall and a tension- and fixation-free repair, a specifically designed prosthesis was developed for the surgical treatment of incisional hernias. The results of a fixation-free incisional hernia repair carried out in elderly patients using a tentacle-shaped implant are reported herewith. A tentacle-shaped flat mesh with a large central body and integrated arms was used to repair incisional hernia in 23 elderly patients. The mesh was placed fixation-free and secured in place through the friction exerted by the tentacles. All tentacle straps were positioned with a special passer needle. Implant placement was preperitoneal in 18 patients and retromuscular sublay in five. In a follow-up of 18 to 59months (mean 36months), four seromas occurred. Postoperative fast track helped avoid the typical complications affecting this patient subset. No infection, hematoma, chronic pain, mesh dislocation or recurrence have been reported to date. The tentacle strap system allowed for reduced skin incision thus minimizing surgical trauma and ensuring easier and faster implant placement. The tentacle arms of the implant ensured mesh stability and broad defect overlap. Besides a very low complication rate, none of the typical postoperative complications of aged patients occurred.

Management of large incisional hernias with loss of domain: A prospective series of patients prepared by progressive preoperative pneumoperitoneum

The surgical treatment of giant incisional hernias with loss of domain is challenging due to the possibility of intra-abdominal hypertension after the herniated content is returned to the peritoneal cavity. Progressive preoperative pneumoperitoneum has been described before repair of the hernia, although its efficacy has not been demonstrated clearly. Our aim was to evaluate the efficacy of preoperative progressive pneumoperitoneum in expanding the volume of the peritoneal cavity and the outcomes after surgical treatment of incisional hernias with loss of domain. All consecutive patients with incisional hernias with loss of domain undergoing preoperative progressive pneumoperitoneum and operative repair were included in a prospective observational study. All patients had pre- and postoperative progressive pneumoperitoneum computed tomography of the abdomen. Open incisional hernias with loss of domain repair consisted of anatomic reconstruction of the abdominal wall by complete closure of the defect and reinforcement with a sublay synthetic mesh, whenever possible. The cohort was composed of 45 patients (mean age, 60.5years). Before the preoperative progressive pneumoperitoneum, the mean volume of the herniated content was 38% of the total peritoneal volume. The mean abdominal volume increased by 53% after the preoperative progressive pneumoperitoneum. One patient died during preoperative progressive pneumoperitoneum, but the postoperative mortality was zero, giving a mortality rate of 2% to the treatment using preoperative progressive pneumoperitoneum. Complete reduction of the herniated content intraperitoneally with primary closure of the fascia was achieved in 42 out of 45 patients (94%). Reinforcement by a synthetic mesh was possible in 37 patients (84%). Overall, surgical complications related directly to the operative procedure occured in 48% of cases. The rates of overall and severe morbidity were 75 and 34%, respectively. At a mean follow-up of 18.6months, the recurrence rate was 8% (3 out of 37 patients) with non-absorbable meshes and 57% (4 out of 7 patients) with absorbable mesh. Preoperative progressive pneumoperitoneum increased the volume of the abdominal cavity in patients with incisional hernias with loss of domain, allowing complete reduction of the herniated content and primary fascial closure in 94% of patients, with acceptable overall morbidity.

Incisional hernia in the elderly: Risk factors and clinical considerations

Objective: Ventral incisional hernia is a common complication of abdominal surgery. The marked improvements in medical technology and healthcare, lead to an increasing number of elderly patients to take advantage of even complex surgical procedures. The objective of this literature review was to analyze the risk factors for ventral incisional hernia in elderly patients and to identify measures that might decrease the incidence of this complication. Materials and methods: An analysis of the surgical literature was performed using the search engines EMBASE, Cochrane Library, and PubMed with particular reference to elderly patients using the keywords: abdominal hernia, wound dehiscence, incisional hernia, incidence, trocar site hernia, and hernia prevention. Results: In our opinion the risk factors for incisional hernia should be separately considered. First those related to the patients and to the abdominal surgery and, in addition, those related to the surgery of the abdominal wall defects. Conclusions: Reparative surgery of the abdominal wall, to date uniquely characterized by the use of the mesh, should be considered an additional risk factor for the occurrence of incisional hernia. However, the low incarceration risk, the risk of recurrence, the relevant rate of postoperative pain and discomfort and complications associated with mesh repair, as small bowel obstruction, mesh infection, and entero-cutaneous fistula, suggest that the general indication for surgical treatment of incisional hernias, in a symptomatic or oligosymptomatic elderly patients, should be critically reconsidered in order to avoid unnecessary surgery.

Outcome of tension free repair of incisional hernia

Background: The surgical treatment ofincisional hernia has changed rapidly during the last decade with the increasing use of mesh technique and the introduction oflaparoscopy. However, many questions concerning mesh type, mesh positioning, fixation method and operation type still remain unanswered. Methods: The study includes 100 cases of anterior abdominal wall hernias, including incisional hernia (cicatricial or paralytic types). The idea of the tension free repair of anterior abdominal wall hernia depends on repair of the defect by double layer onlay polypropylene mesh the deeper mesh is fixed to the free edge of the defect by polypropylene (No.1). The mean operative time was 2 hours (ranging between 1.5- 4 hours). Follow up of the patients was performed every 3 month with maximum follow up of two years and a minimum of six months. Results: The early postoperative course was uneventful in 96 patients (96%). Four patients presented with wound infection, two patients presented with superficial infection, the other two patients presented with deep infection and exposed mesh. The follow up revealed 8 cases of recurrent hernia (8%), two ofthese cases were associated with obesity, and one case was associated with bronchial asthma. Conclusion: In our study we modified the onlay technique for incisional hernia repair by using double layer onlay polypropylene mesh the deeper mesh is fixed to the free edge of the external oblique muscle, this modification insured a tension free repair of the hernia, the technique is universal and can be applied in both scar and paralytic insicional hernia.

Use of biological meshes in abdominal wall reconstruction. Results of a survey in Germany

Surgical treatment of incisional hernia includes implantation of a mesh. The use of synthetic grafts in contaminated fields results in an increased risk of infection. In these cases a potential advantage is described for biological repair material. Evidence for this problem is lacking; therefore, we initiated a survey among surgeons in Germany concerning this question. A survey concerning indications, experience and techniques of using synthetic and biological meshes was sent to 60 surgical departments. The emphasis of the survey was on the differentiation of clean and contaminated fields. The survey was answered by 42 %. The use of biological repair material was preferred in clean-contaminated, contaminated and soiled fields. Synthetic meshes were preferred in clean, rarely in clean-contaminated and not in contaminated or soiled situations. Primary suture repair was chosen in clean fields and barely in contaminated fields. For closure of giant hernias a component separation technique (CST) was favored by the majority of respondents. A single stage repair was preferred by most of the surgeons even in cases with simultaneous stoma takedown. A total of 72 % of the respondents were satisfied with the use of biological repair material, but the reimbursement was considered to be inappropriate. Although the response rate was low, this survey gives an idea of the attitude towards the use of synthetic and biological meshes. Biological repair material is favored for hernia repair in contaminated or soiled fields. The advantage of this choice is a one stage repair despite the contamination. As the results of this survey are not able to provide arguments for the use of different meshes this question should be further investigated with a randomized controlled trial.

Mesh-Reinforced Ventral Hernia Repair

Long-term (5-year) recurrence rates are comparable between onlay vs retrorectus mesh-reinforced ventral hernia repairs. Retrospective study of prospective data collection. University and Veterans Affairs hospitals. One hundred twenty-five patients treated between February 1988 and September 2001. Ninety-four patients were male. The mean patient age was 56 years (age range, 29-80 years). Fifty percent of patients were smokers, and 32.0% were obese; comorbidities were similar in the 2 cohorts studied. Open surgical extraperitoneal prosthetic mesh reinforcement of the incisional closure among 75 patients (onlay repair [cohort OR]) or in the retrorectus position among 50 patients (retrorectus repair [cohort RR]). Recurrent hernia, wound infection, and intestinal fistulas. Nine patients in cohort OR and 2 patients in cohort RR (8.8%) had wound infections; no fistulas occurred. Complications were similar in the 2 cohorts. One mortality occurred. All hernias recurred at the cranial or caudal edge of the mesh. The median recurrence rates were 20.0% at 15 months in the OR cohort and 4.0% at 9 months in cohort RR (P < .02). Follow-up periods averaged 64 months. Three other patients in cohort OR developed subsequent hernia adjacent to their mesh reinforcement at 72, 73, and 86 months. Extraperitoneal mesh reinforcement avoids intestinal complications and subsequent operations to remove mesh. Recurrence is more frequent after onlay mesh reinforcement and usually occurs at the cranial or caudal edge of the mesh within the first 2 years after hernia repair. Retrorectus repair is the preferred open surgical treatment of incisional hernia, but it has not been universally applicable. Hernias developing 6 to 7 years after surgery are not the result of failed earlier repairs.

Incidence, predisposing factors, and results of surgical treatment of incisional hernia after orthotopic liver transplantation

The literature provides little data about incisional herniae (IH) developing after orthotopic liver transplantation (OLTx). We evaluated the incidence, predisposing factors, and results of surgical treatment of this pathological condition. We reviewed the records of 718 consecutive OLTx performed in 623 patients between April 1986 and May 2002. Patients whose IH developed after transplantation were included in the study. We identified 31 patients (incidence, 4.9%) whose IH developed from 2 to 140 months after the transplantation. This complication was significantly more frequent in men. Important predisposing factors included: virus-correlated cirrhosis, body mass index >25, severe ascites, incision type for OLTx (bilateral subcostal extended upper midline to xiphoid), and post-OLTx complications. In 17 patients, repair of hernia was performed using direct fascial approximation, in 20 patients, it required a prosthesis. After hernia treatment, we observed no deaths but a morbidity rate of 6.4%, a mean postoperative hospital stay of 8 days and a recurrence rate of 6.4%. IH post-OLTx need surgical treatment.

Surgical treatment of incisional hernia.

Incisional hernia is a common complication of abdominal surgery and an important source of morbidity. It may be repaired using open suture, open mesh or laparoscopic mesh techniques. This review examines the results of these methods of repair. A Medline literature search was performed to identify articles relating to 'incisional hernia', 'ventral hernia' and 'wound failure'. Relevant papers from the reference lists of these articles were also sought. The recurrence rate after open suture repair may be as high as 31-49 per cent; for open mesh repair it is between 0 and 10 per cent. Comparative studies show that recurrence is significantly more frequent after open suture repair than after open mesh repair; complication rates are similar for both procedures. Recurrence rates after laparoscopic mesh repair vary from 0 to 9 per cent. Comparative studies show that laparoscopic mesh repair is at least as safe and effective as open mesh repair. Open suture repair for incisional hernia carries an unacceptably high recurrence rate. The results of open mesh and laparoscopic mesh techniques are encouraging. There is scope for a large multicentre randomized clinical trial to compare laparoscopic and open mesh repair.

Classification and surgical treatment of incisional hernia. Results of an experts' meeting.

The treatment of incisional hernia (IH) is a current problem in modern surgery. Many important aspects of incisional hernia surgery are yet to be answered, especially the choice of surgical technique and its adaptation to the individual patient. The aim of this experts' meeting was to resolve some current questions in incisional hernia surgery and to organise an international hernia register. An international panel of ten experts met under the auspices of the European Hernia Society (GREPA) to investigate the classification and therapeutic alternatives for incisional hernia. Prior to the conference, all experts were asked to submit their arguments in the form of published results. All papers received were weighted according to their scientific quality and relevance. The information from this correspondence was used as a basis for panel discussion. The personal experiences of the participants and other aspects of individualised therapy were also considered. The expert panel suggested a new classification of incisional hernia based on localisation, size, recurrences and symptoms. All experts agreed that the fascia duplication and the fascia adaptation should only be used for small incisional hernias. Fascia duplication is of value only in the horizontal direction. The technical details and the pros and cons of each procedure were discussed for prosthetic implantation using onlay and sublay techniques and the technique of autodermal hernioplasty. The management of incisional hernia is currently not standardised. In order to answer relevant questions of incisional hernia surgery, an international hernia register should be established.

Surgical treatment of incisional hernias with marked loss of substance

The surgical approach for the treatment of abdominal incisional hernias is a difficult problem. Only the use of prosthetic materials can provide a solution, yet their use in case of abundant loss of peritoneum can involve complications due to direct contact between the mesh and the intestine. The use of prosthetic materials in reconstruction of the abdominal wall highlights two closely connected problems: the kind of mesh to be used and the best implant site The prosthesis should be positioned only in the pre-peritoneal space or in the retromuscular prefascial plane. We report our experience with a surgical technique in which the peritoneum is integrated with an absorbable prosthesis and the nonabsorbable prosthesis is positioned in the neo-preperitoneal plane. From January 1992 to January 2000 65 patients underwent surgery for large incisional hernias. The follow-up period ranged from 6 to 60 months. There were 15 (23.1%) early complications (seromas, hematomas and infections) and 2 (3.1%) late complications: a fistula between the skin and the prosthesis and a subacute infection of the abdominal wall. No recurrence was noted. In patients with abundant loss of substance there is no real pre-peritoneal space; therefore a new one must be created to restore the mechanical and functional structure of the peritoneum. The prosthetic Vicryl® mesh permits good tissue repair with almost no involvement of the intestinal loop. Follow-up studies confirm the efficacy of this method.