Repair Of Ventral Abdominal Hernias Research Articles

Semiresorbable biologic hybrid meshes for ventral abdominal hernia repair in potentially contaminated settings: lower risk of recurrence

In case of potential contamination, implantation of synthetic meshes in hernia and abdominal wall surgery is problematic due to a higher risk of mesh infection. As an alternative, a variety of different biologic meshes have been used. However, relevant data comparing outcome after implantation of these meshes are lacking. Between January 2012 and October 2021, biologic meshes were used for reconstruction of the abdominal wall in 71 patients with preoperative or intraoperative abdominal contamination. In this retrospective study, semiresorbable biologic hybrid meshes (BHM) and completely resorbable meshes (CRM) were compared and analyzed using a Castor EDC database. In 28 patients, semiresorbable biologic hybrid meshes were used; in 43 patients, completely resorbable meshes were used. Both groups showed no difference in age, gender, BMI, operation duration, hernia size and Charlson comorbidity index. The risk degree of surgical-site occurrences was graded according to the Ventral Hernia Working Group (VHWG) classification, and the median value was 3 (range 2–4) in the BHM group and 3 (range 2–4) in the CRM group. Hernia recurrence within 24 months after hernia repair was significantly lower in the BHM group (3.6% vs. 28.9%; p = 0.03), while postoperative complication rate, with respect to seromas in need of therapy (61.4% vs. 55.5%, p = 0.43) and operative revision (28.6% vs. 16.3%, p = 0.22) was not different in either group. Biologic hybrid meshes can be used safely in case of possible contamination. BHM seems to reduce the risk of hernia recurrence compared to completely resorbable biologic meshes, but this has to be investigated further.

Efficacy of general anesthesia as compared to spinal anesthesia for patients undergoing ventral abdominal hernia repair, a randomized controlled trial.

Objective: To compare the use of general anesthesia with spinal anesthesia in patients undergoing ventral hernia repair. Study Design: Randomized Controlled Trial. Setting: Department of Anesthesia CMC Hospital @ SMBBMU Larkana. Period: January 2018 to December 2019. Material & Methods: We included patients above the age of 18 years, who presented with initial complaint of a ventral hernia, requiring surgical intervention. The exclusion criterion was all the patients with co-morbidities like malignancy, having a BMI score of greater than 35, having known allergies to anesthetic agents, and neurologic or neuromuscular diseases. A total of n=120 patients were included in the study and randomly divided into two groups. All the data including clinical parameters, drugs administered, and relevant side effects and complications were recorded in a pre-designed proforma. Results: The study population was n= 120 patients, the mean age was 45.5 +/- 15.5 years, there were n= 42 (35%) males and n= 78 (65%) females. There were no statistically significant differences among the two groups in terms of patient’s age, gender, blood pressures and heart rate. N= 54 (90%) of the patients belonging to the spinal anesthesia group had adequate anesthesia, the rest required administration of supplemental analgesic. None of the cases in the cohort had failure of the anesthetic technique. The postoperative visual analog scale scores at various time intervals (0, 2, 4 and 8 hours post procedure) were higher in the general anesthesia group versus spinal anesthesia group (p value of <0.05). Conclusion: Patients receiving spinal anesthesia had less incidence of post-operative nausea and required less analgesics, while patients receiving general anesthesia had more stable blood pressure profiles.

Abstract No. 523 Pre-operative Botox injection for ventral hernia repair: early experience at a single institution

Ventral wall hernias are a common pathology occurring in 10% of open abdominal operations. Surgical management of hernias can be complex due to chronic muscle contraction resulting in recurrence and significant morbidity. Botulism Toxin A (BTA) has been described as a preoperative therapy utilized to reduce muscle contraction and increase intrabdominal volume. Interventional radiologists may increase procedural accuracy while reducing complications by utilizing ultrasound (US) guidance; however, corresponding literature and data are sparse. The present study describes the efficacy and safety of pre-operative US-guided BTA injection in patients undergoing ventral abdominal wall hernia repair at a single institution. Eight patients underwent BTA injection from 2018 to 2020. Injections were performed via ultrasound guidance targeting the external oblique, internal oblique, and transversus abdominis muscles at three locations along the right and left lateral abdominal wall. Retrospective chart review was performed documenting date of birth, sex, preoperative hernia size by computed tomography (CT) evaluation, postoperative hernia size by CT evaluation, post-operative clinical assessment of hernia repair, number of injections, units of Botox, complications, use of mesh, date of repair, and technical success. Technical success was considered to be the ability to inject the BTA in the target muscles. The cohort consisted of 25% (2/8) women and 75% (6/8) men with an average age of 43.3 ± 8.1 years. The maximal pretreatment diameter of the hernia defect prior to surgery was 14.7 ± 4.6 cm. The technical success was 100% (8/8). The patients each had a total of 18 injections and 7/8 (87.5%) had 300 units of BTA while 1/8 (12.5%) had 240 units of BTA injected. None of the patients suffered complications from the injections. The patients underwent hernia repair at an average of 34.7 ± 4 days following BTA injection. Twenty percent (1/5) of patients did not require mesh insertion. Pre-operative US-guided BTA injection is a safe procedure that can aid in ventral abdominal hernia repair via induction of flaccid paralysis.

A novel laparoscopic approach: (e-TEP) technique in ventral abdominal hernia-our experience

Background: Enhanced view totally extra peritoneal (eTEP) repair is the novel method for inguinal hernia management. Igor Belyansky extended the principle of eTEP to ventral and incisional hernia. The eTEP technique is based on the principle that the extra peritoneal space can be created from almost anywhere in the anterior abdominal wall. The classical Totally Extra peritoneal (TEP) technique is considered closest to an ideal hernia repair, but this technique has several drawbacks such as restricted port placement, limited space for dissection and mesh placement, a low tolerance of accidental pneumoperitoneum, and difficulty in teaching and learning the technique. We present our experience with eTEP technique, which overcomes several of these drawbacks.Methods: We conducted a short term 6 months retrospective analysis of 24 patients in our hospital who underwent eTEP procedure for umbilical hernia and inguinal hernia, with a minimum of 3 months follow-up. Their data were analyzed for operative details, intra‑operative and post‑operative complications.Results: Judging from our short term results, for 24 patients we have not come across any post-operative complications like seroma, SSI, recurrence, with a minimum of 3 months follow-up.Conclusion: Our evaluation of eTEP technique in umbilical and inguinal hernias has found the approach not only novel one but also very feasible and highly effective. This technique provides flexible port set-up optimal for laparoscopic closure of defects, along with placement of wide mesh in the retro-muscular space with no transfascial fixation while restoring abdominal wall dynamics. We suggest that the eTEP technique is the most ideal option for ventral abdominal hernia repair and can be adapted in hospitals with advanced laparoscopic setup.

Use of Prolonged Prophylactic Antibiotics with Closed Suction Drains in Ventral Abdominal Hernia Repair

Closed suction drains (CSD) are commonly used in ventral hernia repair (VHR), with or without prolonged postoperative prophylactic antibiotics (PPA) for the duration of their use. We examine the evidence that PPA with CSD reduce surgical site infection (SSI) in patients undergoing VHR. We also examine the evidence assessing the association between SSI and CSD in VHR. A systematic review of PubMed, CIHNL, and Cochrane databases was performed to identify studies analyzing rates of SSI with CSD in patients undergoing abdominal VHR and related procedures with or without the concomitant use of PPA. The primary outcome was the rate of SSI. Five studies totaling 772 patients were identified, 525 patients were confirmed to have CSD, and 434 patients received prolonged antibiotics while drains were in place. PPA had no significant effect on SSI in two studies and were associated with decreased SSI in one study (Odds ratio 0.235, 95% confidence interval 0.090-0.617, P = 0.003). Two studies documented a higher rate of SSI in patients with CSD (79% vs 49% and 19% vs 10%) on univariate analysis. One study demonstrated a very low risk of SSI despite CSD (4.2%) and another demonstrated no increased risk with or without CSD. The use of drains is not clearly associated with an increased risk of SSI in VHR, and there is limited evidence to support antibiotic use while the drains are in place to decrease the potential risk. Prospective randomized studies are needed to more clearly assess these associations.

Retrorectus sublay mesh repair using polypropylene mesh: Cost-effective approach for laparoscopic treatment of ventral abdominal wall hernias.

Introduction:Laparoscopic repair of ventral abdominal hernias has become a standard of care. The surgery involves placement of a composite mesh with 3–5 cm overlap at the edges of the defect. The disadvantage of this repair is one, the composite mesh used for intraperitoneal placement is quite costly and two, it leaves a foreign body inside the peritoneal cavity, with the potential to cause problems in the future. To circumvent both these issues, we have developed a new approach, called the retrorectus sublay Mesh (RRSM) repair, which allows placement of a plain polypropylene mesh in an extraperitoneal plane.Patients and Methods:Patients with paraumbilical hernia and lower midline incisional hernias were included in this pilot study performed at a single centre by the same surgeon. The steps of the technique are described in detail.Results:Since 2016, a total of 52 patients were operated by this technique, including both male and female patients. It included patients with para-umbilical hernias as well as incisional hernias. The RRSM repair could be successfully carried out in all the patients. In six of the patients, transversus abdominis release was added as the defect size was large to allow closure of the defect. The results were satisfactory with a low morbidity and no mortality.Conclusion:In our opinion, the RRSM technique is an important tool in the armamentarium of the laparoscopic surgeon dealing with ventral abdominal hernias, allowing placement of polypropylene mesh in an extraperitoneal space. It allows significant cost savings as compared to the prevalent intraperitoneal onlay mesh repair.

Retrorectal onlay mesh repair using polypropylene mesh: Cost-effective approach for laparoscopic treatment of ventral abdominal wall hernias.

Introduction: Laparoscopic repair of ventral abdominal hernias has become a standard of care. The surgery involves placement of a composite mesh with 3–5 cm overlap at the edges of the defect. The disadvantage of this repair is one, the composite mesh used for intraperitoneal placement is quite costly and two, it leaves a foreign body inside the peritoneal cavity, with the potential to cause problems in the future. To circumvent both these issues, we have developed a new approach, called the retrorectus sublay Mesh (RRSM) repair, which allows placement of a plain polypropylene mesh in an extraperitoneal plane. Patients and Methods: Patients with paraumbilical hernia and lower midline incisional hernias were included in this pilot study performed at a single centre by the same surgeon. The steps of the technique are described in detail. Results: Since 2016, a total of 52 patients were operated by this technique, including both male and female patients. It included patients with para-umbilical hernias as well as incisional hernias. The RRSM repair could be successfully carried out in all the patients. In six of the patients, transversus abdominis release was added as the defect size was large to allow closure of the defect. The results were satisfactory with a low morbidity and no mortality. Conclusion: In our opinion, the RRSM technique is an important tool in the armamentarium of the laparoscopic surgeon dealing with ventral abdominal hernias, allowing placement of polypropylene mesh in an extraperitoneal space. It allows significant cost savings as compared to the prevalent intraperitoneal onlay mesh repair.

Use of a Rat Model to Study Ventral Abdominal Hernia Repair

Use of a Rat Model to Study Ventral Abdominal Hernia Repair

Use of a Rat Model to Study Ventral Abdominal Hernia Repair.

Ventral abdominal hernia is a relatively common clinical condition that sometimes requires herniorraphy (surgical repair). The repair of ventral abdominal hernia typically requires implantation of a material to serve as a mechanical bridge across the defect in the abdominal wall. Biomaterials, such as porcine small intestinal submucosa (SIS), also serve as a lattice for cell growth into the implant and can naturally incorporate into the host tissue. Development of such repair materials benefits from use of animal models in which experimental abdominal wall defects are easily created and are amenable to repair in a reproducible fashion. The method offered here describes surgical creation and repair of ventral abdominal hernia in a rat model. When SIS is used to repair an experimental ventral abdominal hernia in this model, it is rapidly incorporated into host tissue within 28 days of implantation. Histologically, incorporation of their implanted material into host tissue is characterized by a robust fibrovascular response. Future refinements and applications of the rat abdominal hernia model may likely involve diabetic and/or obese animals as a means to more closely mimic common co-morbidities of man.

Protein-losing enteropathy resolved after ventral abdominal hernia repair

Protein-losing enteropathy resolved after ventral abdominal hernia repair

Minimally invasive component separation techniques in complex ventral abdominal hernia repair: a systematic review of the literature.

Open component separation (CS) has traditionally been a popular method for management of complex abdominal wall hernias. However, it has been associated with significant wound complications. The aim of this systematic review was to examine the evidence in the literature on modern CS techniques (endoscopic and minimally invasive) for the management of such hernias. A systematic literature search was performed (2000 to 2013) using major electronic databases (PUBMED, EMBASE). The outcomes of interest were hernia recurrence rate and wound morbidity. A total of 33 publications were retrieved. Thirteen studies involving in total 220 patients were included in this analysis. No randomised controlled trials were identified. The overall hernia recurrence and wound complication rates appear similar and in some studies superior to the results of open CS. The initial results of the 2 more recent component separation techniques appear encouraging. However, better quality studies with longer follow-up are needed.

Outcomes of Complex Abdominal Herniorrhaphy

Reconstruction of abdominal wall defects is a challenging problem. Often, the surgeon is presented with a patient having multiple comorbidities, who has already endured numerous unsuccessful operations, leaving skin and fascia that are attenuated and unreliable. Our study investigated preoperative, intraoperative, and postoperative factors and techniques during abdominal wall reconstruction to determine which variables were associated with poor outcomes. Data were collected on all patients who underwent ventral abdominal hernia repair by 3 senior-level surgeons at our institution during an 8-year period. In all cases, placement of either a synthetic or a biologic mesh was used to provide additional reinforcement of the repair. A total of 106 patients were included. Seventy-nine patients (75%) had preoperative comorbid conditions. Sixty-seven patients developed a postoperative complication (63%). Skin necrosis was the most common complication (n = 21, 19.8%). Other complications included seroma (n = 19, 17.9%), cellulitis (n = 19, 17.9%), abscess (n = 14 13.2%), pulmonary embolus/deep vein thrombosis (n = 3, 2.8%), small bowel obstruction (n = 2, 1.9%), and fistula (n = 8, 7.5%). Factors that significantly contributed to postoperative complications (P < 0.05) included obesity, diabetes, hypertension, fistula at the time of the operation, a history of >2 prior hernia repairs, a history of >3 prior abdominal operations, hospital stay for >14 days, defect size > 300 square cm, and the use of human-derived mesh allograft. Factors that significantly increased the likelihood of a hernia recurrence (P < 0.05) included a history of >2 prior hernia repairs, the use of human-derived allograft, using an overlay-only mesh placement, and the presence of a postoperative complication, particularly infection. Hernia recurrences were significantly reduced (P < 0.05) by using a "sandwich" repair with both a mesh overlay and underlay and by using component separation. A history of multiple abdominal operations is a major predictor of complications and recurrences. If needed, component separation should be used to achieve primary tension-free closure, which helps to reduce the likelihood of hernia recurrences. Our data suggest that mesh reinforcement used concomitantly in a "sandwich" repair with component separation release may lead to reduced recurrence rates and may provide the optimal repair in complex hernia defects.

The acquisition of antibiotic resistant coagulase-negative staphylococci by aortic graft recipients

The staphylococcal flora of the groin and perianal area was studied in 12 patients undergoing aortic grafts and 3 patients having repair of ventral abdominal hernias. A total of 892 isolates of coagulase-negative staphylococci (CNS) were identified and their antibiotic resistance determined. The species most frequently isolated were S. epidermidis and S. haemolyticus with the latter showing the highest incidence of antibiotic resistance. Five of 15 patients had CNS resistant to methicillin and gentamicin on admission. The effect of pre-operative bathing with chlorhexidine was studied in 6 patients and appeared to reduce the acquisition of multi-resistant CNS in the week after operation.