Ventral Abdominal Wall Hernias Research Articles

Comparative study of open onlay mesh repair versus laparoscopic intraperitoneal dual mesh repair for ventral hernia

Background: Ventral abdominal wall hernia surgery is a common procedure in the armamentarium of surgeons. The most common forms of these surgical procedures in adults are the repair of incisional hernias and surgery for paraumbilical hernias. Aims and Objectives: Open onlay mesh repair versus laparoscopic intraperitoneal dual mesh repair (intraperitoneal onlay mesh[IPOM]) for ventral hernia compared to the duration of surgery, post-operative pain, postoperative complications, post-operative hospital stay, return to normal activity, recurrence, and cosmesis. Materials and Methods: The prospective non-randomized study was done in the Maharani Laxmi Bai Medical College, Jhansi, between January 2021 and June 2022 including 100 patients was applied for treatment of ventral hernia repair. Fifty patients were subjected to Group A (open onlay mesh repair) and 50 patients were subjected to Group B (laparoscopic intraperitoneal dual mesh repair). Results: The mean surgery durations were significantly lower in laparoscopic repair when compared to open repair (P<0.001). Themean post-operative stay in the hospital was shorter for the laparoscopic group than for the open hernia group (10.28±2.100 vs. 8.02±1.378 days; P≤0.001). Return to activity or normal daily work is significantly lower in the laparoscopic group as compared to open repair of hernia (5.12±0.659 vs. 2.94±0.550 days; P<0.001). There were fewer post-operative complications with laparoscopy. Conclusion: Laparoscopic intraperitoneal dual mesh repair (IPOM) for ventral hernia in our experience was safe and resulted in fewer complications, shorter hospital stays, and better cosmesis results. Hence, it should be considered the better choice for ventral hernia repair.

Alternative to mesh repair for ventral hernias: Modified rectus muscle repair

BACKGROUND Mesh utilization for ventral hernia repair is associated with potential complications such as mesh infections, adhesions, seromas, fistula formation and significant postoperative pain. The modified rectus muscle repair (RMR) is as an option to repair midline ventral hernias without mesh. AIM To evaluate the short term outcomes when the modified RMR was used to repair ventral hernias. METHODS This was a 5-year prospective study that examined the outcome of all consecutive patients with ventral abdominal wall hernias > 5 cm in maximal diameter who underwent repair using the modified RMR technique in a single surgeon unit. Patients were reviewed in an outpatient clinic at 3, 6 and 12 mo and evaluated for hernia recurrence on clinical examination. Each patient’s abdominal wall was also assessed with using ultrasonography at 24 mo to detect recurrences. All data were examined with SPSS ver 18.0. RESULTS Over the 5-year study period, there were 52 patients treated for ventral hernias at this institution. Four patients were excluded and there were 48 in the final study sample, at a mean age of 56 years (range 28-80). The mean maximal diameter of the hernia defect was 7 cm (range 5-12 cm). There were 5 (10.4%) seromas and 1 recurrence (2.1%) at a mean of 36 mo follow-up. CONCLUSION The authors recommend the modified RMR as an acceptable alternative to mesh repair of ventral hernias. The seroma rate can be further reduced with routine use of drains. The modified RMR also has the benefit of eliminating all mesh-specific complications.

Laparoscopic IPOMPLUS repair-current outcomes and complications

Purpose: The study aims to assess the current outcomes and complications of laparoscopic ventral hernia repair using intraperitoneal onlay mesh with defect closure (IPOM PLUS) technique by use of dual-sided synthetic mesh. Material and methods: Retrospectively clinical data for 27 patients with umbilical, paraumbilical, incisional, ventral, and primary hernia, operated in the Department of General, Visceral and Emergency Surgery “Pirogov” from 01.06.2022 to 01.06. 2022 was analyzed. The diagnosis was based on history, physical examination(mainly), ultrasound, and CT. Of the hospitalized, women were 16 (59.26%) men 11 (40.74%). Results: Of the selected group, 13 patients had umbilical defects, 3 with an epigastric hernia, 7 with a paraumbilical hernia, and 4 with incisional defects. Adhesiolysis was needed in 18 cases, while others were performed straight with hernia closure. The operating time varied between 49 and 127 minutes (average 57.4 minutes). The hospital stay ranged from 1 day to 4 days (average 1.7 days). We had noticed complications in three of the cases (11.11%). Conclusion: IPOM PLUS repair is safe, practicable, and advantageous over a standard IPOM or open repair as reported in the literature. Accordingly, we prefer this approach with the closure of the fascial defect first while repairing ventral abdominal wall hernias.

Comparative Study between Onlay and Sublay Placement of Polyproline Mesh in Ventral Hernia Repair

Abstract Background Ventral hernia repair is one of the most common surgical operations performed all over the world. Onlay and sublay mesh repairs are the commonly performed techniques for the same. However, the debate still continues about the superiority of both techniques over each other. The aim of this study was to compare the outcome of the onlay versus sublay mesh repair for ventral hernia. Aim of the Work The purpose of this study is to compare between two techniques of mesh placement in uncomplicated ventral hernias, onlay (mesh on external oblique) versus sublay (mesh in the retromuscular space) regarding complications (superficial skin infection, seroma collection, operative time, hospital stay and 18 months recurrence rate. Patients and Methods The study frame is two years starting from August 2019 to August 2021 in general surgery department at Ain shams university hospital a. Total 60 adult patients who are scheduled to undergo hernioplasty for ventral abdominal wall hernias, 30 are included group A (onlay) and 30 in group B (sublay). Results Maior wound infection was 10% in the onlay group in coparison by the 3.3% of sublay group. Seroma is 33.3% in onlay group while 26.7% in sublay group. Recurrence rate is 6.7% in onlay while 3.3%in sublay group. Conclusion Our study revealed that ventral hernias are common in females more than males mainly in the fifth decade of life. Although there are many methods in repair such herniorraphy which associated with a high rate of recurrence so mesh repair is the best in such cases. We have found that sublay hernioplasty is better than onlay hernioplasty according to the post-operative complications such as recurrence, seroma formation and wound infection. However sublay hernioplsaty takes longer operative time than the onlay technique due to the disscection to get the retromuscular space, no significant statistical difference in the operative time., no significant blood loss and hospital stay between the two techniques.

Demographics and outcomes of ventral wall hernia repair at Sultan Qaboos University Hospital

Background: Ventral abdominal wall hernias are one of the most common encountered surgical cases. Currently most repairs are done using a mesh either in an onlay or sublay method. The high burden of ventral abdominal wall hernias, there is a need to determine the most common predictive factors for their occurrence and the complications associated with their repair so that the best preventive measures can be taken. Methods: A retrospective cohort study was conducted at Sultan Qaboos University Hospital during the period between 1st January 2014 to 30 June 2019. All patients underwent ventral hernia repair were included and pediatric patients were excluded. Results: The total number of included patients were 383. Previous abdominal wall surgery was the most common risk factor (218 of the patient) followed by pregnancy (132). There was a significant correlation between age of patients and duration of admission (P value 0.003) however no significant correlation between gender and duration of admission was found. The percentage of recurrence in open surgery was 4.69% and 12.50% in laparoscopic repair. There was insignificant correlation between the use of mesh and recurrence rate. It was reported that 73 patients developed post operative complication with higher rate for seroma and hematoma. Conclusions: Addressing risk factors and educate the population is an important step that should be taken to decrease the incidence hernia and its complication. As the sample size was small and majority of patient are from one region, a large multicentre study will be considered for better analysis and results.

A retrospective study of short term outcomes of ventral abdominal wall hernia patients operated by extended total extraperitoneal mesh repair at a tertiary care centre

Background: Laparoscopic repair of various abdominal wall hernias are well accepted procedure due to its low post- operative complications, recurrence and long term results. Various procedures have been described like IPOM, MILOS, E-MILOS, SCOLA, TES and E-TEP. Here we present short term outcome of ventral abdominal wall hernia patients operated by extended total extra peritoneal (E-TEP) repair at a tertiary care hospital over a period of two years.Aims and Objectives: To assess the initial outcomes of patients of ventral abdominal hernias operated by extended total extra peritoneal mesh repair (E-Tep).The study was done to find out the effectiveness of E-Tep repair in surgical treatment of ventral abdominal wall hernia patients.Methods: All the patients operated electively for uncomplicated ventral hernias from November 2020 till December 2021 were selected for the study and followed up for one year till December 2022. Results: In our study 35 patients, were operated by E-Tep for ventral hernia repair. There was no incidence of postoperative complications in terms of, haemorrhage, surgical site infection, chronic pain and recurrence. There was 10.5% incidence of seroma in postoperative period which was managed conservatively.Conclusion: In our experience, E-Tep repair is found to be effective as it allows flexibility in placement of ports for better suturing and deployment of an adequate size of polypropylene mesh in a retro muscular space.

EGS P25 Innovative use of Alexis ® O System for tissue retraction in hernia and abdominal wall wound repairs

Abstract Background Hernial operations may pose significant challenges due to the relaxed, dissected subcutaneous tissues and skin which obscure the surgical field during open reconstructions of the abdominal wall. Difficulty in the operation is exacerbated, in the morbidly obese patient due to the the weight of skin and subcutaneous tissue where clear retraction is of extra benefit. The key to adequate exposure during abdominal wall surgery is symmetrical retraction, failure of such can prolong operative times and increase the work and requirement of of assistants. Presentation of the use of the Alexis ® O system retractor for skin and subcutaneous tissue retraction in hernia repairs and during abdominal wall closure between Dec 2021 and May 2022. Methods The use of Alexis ® O retractor has been used for skin and subcutaneous retraction in nine cases: four ventral abdominal wall hernia repair (with two cases needing posterior component separation), four umbilical/para-umbilical hernia and one for inguinal hernias. Results This study demonstrated that the Alexis ® O retractor is a useful adjunct to surgery in all four of the abdominal wall hernias and three of the umbilical hernia repairs. It proved initially difficult to place in the first of the umbilical and in the inguinal hernia repairs due to there being inadequate available sizes or shapes of the retractor. The paper presents a novel and efficient approach to skin and subcutaneous retraction by deployment of the Alexis ® O - a self-expanding wound protector - in hernial repairs. The Alexis ® O retractor allowed equal tension retraction at all points of the incision and dissection, enabling improvedexpose of the whole surgical field, improving the symmetrical retraction and thus facilitating planning and unopposed moving between different positions of the surgical field without the requirement of changing retractor position. Furthermore, it increased the freedom of the assistants hands which allowed them to participate in more skilful task aiding the lead surgeon and improving the efficiency of the operation as a whole. The Alexis ® O provided access to surgical field for both the operating and assisting surgeons, along with improving the field that the instruments could operate in without clashing with a fixed and sometimes bulkymetal retractors. Conclusions Conclusions: The use of an Alexis ® O retractor in hernia repairs can improve the overall skin and subcutaneous tissue retraction aiding in abdominal wall closure and hernia repairs including umbilical, para-umbilical and inguinal hernias. It provides effective symmetrical retraction of skin and subcutaneous tissue, providing increased freedom to the surgeons and assistants and helps to avoid instrumental clashes. This study demonstrates that Alexis ® O retractor could be used easily without modification to provide effective subcutaneous and skin retraction in hernia operation including complex abdominal wall reconstruction. Furthermore, more potential application for Alexis ® O retractor could be achieved if wider range and different shapes of the Alexis ® O retractor were made available.

To Compare Outcome of Open Versus Laproscopic Repair for Primary Ventral Hernias

Background: Primary ventral and incisional abdominal wall hernias are frequent conditions that necessitate surgery, and both types of hernias can be treated utilizing an open or laparoscopic technique. Improvements in laparoscopy have also been linked to a decrease in pain scores. Methodology: A dual setting study was conducted from July 2017 to June 2019 at Peshawar medical college with collaboration of Lady Reading Hospital and Hayatabd Medical Complex, Peshawar and was conducted on a total of 120 patients who were diagnosed with ventral hernia. A random number table created by a computer indicated repair of an open ventral hernia technique (group 1, n = 60) or laparoscopy (group 2, n = 60). Results: Among 60 patients in the laparoscopy group, there were 37 cases of PUH, 15 cases of epigastric hernia, 8 cases of umbilical hernia, and among 60 cases of open abdominal hernia, including 31 cases of PUH, 19 cases of hernia in the abdomen. upper abdomen, and 10 cases of umbilical hernia. Wound-related complications were most commonly seen in the open procedure group of patients. Conclusion: This has led to broad acceptance of the laparoscopic surgery, and advantages particularly in order to decrease the post-operative mortality and morbidity, time of operation, bleeding and the duration of hospital stay along the ability to execute the surgery on the obese people and with abdominal scarred individuals. Keywords: Incisional hernia, Laparoscopic mesh repair, Open mesh repair, Primary ventral hernia.

WE5.3 Emergency laparoscopic “hybrid” IPOM+ repair of incarcerated umbilical hernia in patient with BMI 62 and small bowel obstruction; a case study

Abstract Background Large abdominal incisions in obese patients are associated with considerable rates of systemic and wound complications. Recently published European Hernia Society guidelines recommend laparoscopic intraperitoneal on-lay mesh (IPOM) repair for large hernia defects and patients at higher risk of wound morbidity, ideally with closure of the defect and a 5 cm overlap. Case Presentation: We report on a 69-year-old, morbidly obese (BMI 62), comorbid woman who presented as an emergency with a 5-day history of vomiting and abdominal pain. A pre-operative computed tomography (CT) scan confirmed small bowel obstruction secondary to a ventral abdominal wall hernia. Operative findings confirmed an obstructed paraumbilical hernia containing small bowel and omentum. A laparoscopic “hybrid” IPOM+ repair was performed, with a generous overlap. She recovered uneventfully with no surgical complications. Discussion: Minimally-invasive surgical techniques are preferred for obese patients with evidence suggesting lower perioperative complications and recurrence rates compared with open repair. However, additional challenges must be taken into consideration including; surgeon expertise, timing of operation, surgeon ergonomics, distortion of surface anatomical landmarks, need for higher pneumoperitoneum pressures and the physiological effects of this on the patient. Conclusion With preoperative planning, our case study demonstrates that IPOM ventral hernia repair remains a viable option for severely obese patients even in emergency presentations. The closure of the defect is recommended whenever feasible. Addition of the hybrid approach (excision of the sac with a limited incision after the laparoscopic closure) reduces the risk of postoperative seromas.

STUDY OF LAPAROSCOPIC VENTRAL HERNIA REPAIR IN A SINGLE INSTITUTIONAL SETUP

Objective: Incidence of Ventral hernias or anterior abdominal wall hernias is about 2-13% worldwide. Laparoscopic ventral hernia repair (LVHR) technique has proven to be effective treatment option with reduced complications. This study aims to assess the feasibility and outcome of LVHR in a government set up. A prospective observational study of patients of a single government institution was conducted. Surgical technique,Methods: Long- term outcomes such as pain, mesh infections, bowel adhesions, recurrence and feasibility were assessed. Mean age of studyResults: patients was 44.45 years, with highest incidence (33.33%) in the age group of (31-40) years. Male: Female ratio was 1: 2.529. Obesity accounted for predominant risk factor (15 %). Around (31.67 %) patients had other co morbidities like diabetes, hypertension, obesity, COPD and pulmonary tuberculosis. Incision hernia accounted for (50 %). Remaining (50 %) include the epigastria hernia, umbilical hernia, traumatic hernia and spigelian hernia. 44(73.34%) patients had defect size between (2-5) cm, 11(18.33%) patients between (5-10) cm and 5(8.33%) patients less than 2 cm. Mean defect size was 3.51 cm. 54 patients (90 %) having defect size more than 2 cm were operated by laparoscopic Intra peritoneal on lay mesh repair. 6 (10%) patients having defect size less than 2 cm operated by Laparoscopic fascial closure by intracorporeal suturing. Mean surgical time was 55.17 minutes. (Range 40 - 110 minutes). Mean postoperative hospital stay was 2.25 days. 65% of patients got discharged after 2 days. Total 8 (13.33%) patients developed complications which were managed conservatively. 1 (1.67%) patient developed recurrence. There were no mortality and minimum morbidity observed. Although we cannot conclude regarding cost factor, we can vouch that all patients with anyConclusion: primary ventral hernia should have the repair performed by the laparoscopically if technically feasible. Laparoscopic ventral hernia repair is feasible, effective and can be performed as short stay surgery even in government set up.

Laparoscopic intraperitoneal onlay mesh repair for ventral hernia: our experience

Background: Ventral hernia is one of the most common pathologic conditions encountered with an estimated prevalence of one-fourth of individuals being born with it, developing, or acquiring a ventral hernia in their lifetime. Ventral hernias include both primary abdominal wall hernia and incisional hernia. Numerous studies indicate that the laparoscopic approach is safe and effective, and may be superior to open repair with regard to lower rates of recurrence and wound infection, greater patient acceptance, shorter hospital stay and early return to work. Aim of the study was to analyse the outcome, complications, postoperative pain and patient compliance in laparoscopic ventral hernia repair by intraperitoneal onlay mesh (IPOM) technique, using composite mesh.Methods: This was a prospective study conducted in the department of general surgery, MVJ medical college, Bangalore from December 2020 to August 2021. There were 100 cases operated by experienced surgeons. All patients posted electively for laparoscopic repair of ventral hernia on an intention to treat basis were included in the study. The immediate complications of pain, perioperative bleeding and major visceral injury were noted in all cases. We then followed up each patient prospectively in the postoperative period at 1 month, 3 months and 6 months to assess the incidence of port-site hernia and recurrence.Results: Of the 100 patients, 63 had an umbilical hernia, 33 had incisional hernias and 4 had an epigastric hernia. The mean age of the patients was 44.7 years. Female to male ratio of 2.25:1. The average defect width was 1.3 cm for umbilical hernias and 2.4 cm for incisional hernias. The mean operating time was 38 min for umbilical hernias and 61 min for incisional hernias. The mean postoperative hospital stay was 4.7 days. The mean duration of return to normal daily activity was 6.4 days. The average duration for which postoperative pain lasted was 4.6 days. No conversion to open laparotomy was required in any of the cases. The only short complication reported was postoperative pain. No case of postoperative ileus/seroma/port site infection/mesh displacement/infection or port site hernia and recurrence was reported over one year of follow up.Conclusions: IPOM technique is safe, feasible and effective technique for treatment of ventral abdominal wall hernias.

Favorable Outcomes After Retro-Rectus (Rives-Stoppa) Mesh Repair as Treatment for Noncomplex Ventral Abdominal Wall Hernia, a Systematic Review and Meta-analysis.

To assess prevalence of hernia recurrence, surgical site infection (SSI), seroma, serious complications, and mortality after retro-rectus repair. Ventral abdominal wall hernia is a common problem, tied to increasing frailty and obesity of patients undergoing surgery. For noncomplex ventral hernia, retro-rectus (Rives-Stoppa) repair is considered the gold standard treatment. Level-1 evidence confirming this presumed superiority is lacking. Five databases were searched for studies reporting on retro-rectus repair. Single-armed and comparative randomized and non-randomized studies were included. Outcomes were pooled with mixed-effects, inverse variance or random-effects models. Ninety-three studies representing 12,440 patients undergoing retro-rectus repair were included. Pooled hernia recurrence was estimated at 3.2% [95% confidence interval (CI): 2.2%-4.2%, n = 11,049] after minimally 12months and 4.1%, (95%CI: 2.9%-5.5%, n = 3830) after minimally 24 months. Incidences of SSI and seroma were estimated at respectively 5.2% (95%CI: 4.2%-6.4%, n = 4891) and 5.5% (95%CI: 4.4%-6.8%, n = 3650). Retro-rectus repair was associated with lower recurrence rates compared to onlay repair [odds ratios (OR): 0.27, 95%CI: 0.15-0.51, P < 0.001] and equal recurrence rates compared to intraperitoneal onlay mesh (IPOM) repair (OR: 0.92, 95%CI: 0.75-1.12, P = 0.400). Retro-rectus repair was associated with more SSI than IPOM repair (OR: 1.8, 95%CI: 1.03 -3.14, P = 0.038). Minimally invasive retro-rectus repair displayed low rates of recurrence (1.3%, 95%CI: 0.7%-2.3%, n = 849) and SSI (1.5%, 95%CI: 0.8%-2.8%, n = 982), albeit based on non-randomized studies. Retro-rectus (Rives-Stoppa) repair results in excellent outcomes, superior or similar to other techniques for all outcomes except SSI. The latter rarely occurred, yet less frequently after IPOM repair, which is usually performed by laparoscopy.

The lumbar hernia

Lumbar hernias are rarely encountered as compared to other ventral abdominal wall hernias and are often misdiagnosed and overlooked. They account for less than 1.5% of all abdominal hernias. Fewer than 300 cases have been reported over the past 300 years. A lumbar hernia is defined as a protrusion of intra-abdominal contents through a weakness or rupture in the posterior abdominal wall. It must be distinguished from a lipoma, cold (tuberculous) abscess or a pseudo-hernia due to local muscular paralysis. Presenting a case of 65-year-old female who came to surgery OPD with complaint of a swelling in the right lumbar area since 5 years. On examination, a smooth and non-tender swelling measuring approximately 4 x 3 cm was evident in right lumbar region. We proceeded with a lumbar ultrasound which confirmed the presence of the hernia in posterior abdominal wall. Later, the patient was admitted for surgery under spinal anaesthesia. An open approach was performed and intraoperative findings revealed retroperitoneal fat, intermuscular lipoma and a small hernia sac as contents of swelling. It is very unusual to find lumbar hernias presenting with a lipoma, as in our case, the clinical findings alone can be very confusing and increase the chances of incorrect diagnosis and subsequent treatment. Inability of clinical examination and ultrasonography alone in making an adequate diagnosis of lumbar hernia in preoperative setting mandates a routine CT/MRI for all such patients, to ensure surgeons have a correct diagnosis before proceeding for surgery. Ideal management is just like other hernias, i.e., with mesh hernioplasty either laparoscopically or through an open approach.

Comparative Study between Intraperitoneal Onlay Mesh Repair (IPOM) vs Intraperitoneal Onlay Mesh Repair with Closure of Fascial Defect (IPOM PLUS) for Ventral Hernias

Introduction: In the recent times, minimal access surgery for ventral hernias is becoming popular. However several issues like postoperative pain, recurrence, seroma formation arising due to the procedure are yet to be resolved. To find a solution to the above mentioned issues, closing the defect in the fascia laparoscopically along with reinforcement by mesh has been tried. About The Study: It was a prospective randomized study done at KEMPEGOWDA INSTITUTE OF MEDICAL SCIENCES BENGALURU from October 2018 to March 2020. Aims and Objectives: To compare between intra peritoneal onlay mesh repair (IPOM) V/S intra peritoneal onlay mesh repair with closure of fascial defect (IPOM PLUS) for ventral abdominal wall hernias. To study: 1) Postoperative bulge (pseudo hernia). 2) Seroma formation. 3) Pain in the postoperative period. 4) Recurrence. 5) Early return to normal activity especially forward bending. Materials and Methods: The study was conducted on 40 patients. All of them underwent surgery on an elective basis...A pneumoperitoneum of 12-15mmhg was built up by inflating through veress needle at the palmer’s point. A camera port and two working ports were inserted .The sac of the hernia was excised after cutting the adhesions. The defect was closed from within with self sustaining continuous /interrupted non absorbable sutures. A composite mesh was oriented with transfascial sutures. Additional tackers applied if required. Patients are divided into two groups of 20 each namely the closure and the non closure groups respectively. Each patient was assessed for pain, seroma, forward bending and pseudo bulge on postop day 1,3 and day of discharge. Patient is called for follow up after, 1 month and 6 months. Conclusion: Patients who underwent IPOM PLUS had a decreased incidence of seroma formation, recurrence, postoperative bulge and a early return to normal activity when compared to those who underwent IPOM.

Waist Circumference is not Superior to Body Mass Index in Predicting Groin Hernia Repair in Either Men or Women

Background and aimsA high body mass index (BMI) is considered a risk factor for ventral abdominal wall hernias but protective for the development of groin hernias. The reason for this is unclear. The surrounding abdominal fat in obesity might “protect” and limit the passage through the inguinal canal. The aim was to compare two different methods used for obesity registration in groin hernia patients and to investigate the hypothesis of high BMI/low groin hernia risk phenomenon.MethodsThis was a population-based observational study comparing BMI to waist circumference (WC) as well as their correlations to the quantity of groin hernia repair performed in either sex. Two national registers were crosslinked to a large regional register including information on WC.ResultsA larger WC and a higher BMI were associated with a lower risk of having groin hernia repair in both sexes. There was no difference using either WC or BMI as a risk factor for groin hernia repair in either sex. There was no advantage to using body composition based on WC rather than BMI for surgery indication.ConclusionsOverweight patients, both men and women, have a lower risk of undergoing groin hernia repair regardless of fat distribution. BMI is a well-established method for obesity registration and is recommended in the evaluation of hernia patients.

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.

Comparison of abdominal binder use versus no abdominal binder use after ventral abdominal wall hernia repair . A randomized controlled trial

Background: Hernia repair is most common surgical procedure in a surgical setting.Ventral hernias are defined as non-inguinal, no hiatal defect in abdominal wall fascia.Abdominal binders are usually recommended in routine after repair of ventral hernias.Abdominal binder is a belt which is wide enough to surrounds the abdominal region and supports the wound. Findings reported in previous studies are better with binders.&#x0D; Objective: To compare the outcome of binder use versus no abdominal binder use after ventral abdominal wall hernia repair&#x0D; Material &amp; methods: This Randomized Controlled Trial was done at Department of Surgery, Central Park Teaching Hospital Lahore for 6 months. Sixty patients were included and underwent ventral hernia repair under general anesthesia. Then patients were randomly divided in two groups. Group A for Abdominal Binder and Group B for without Abdominal Binder by using lottery method. During 6 weeks, patients were followed-up in OPD fortnightly. Patient were evaluated for pain, Pulmonary Function Assessment on spirometer, Physical Function Assessment by 6 minutes’ walk test, Seroma formation assessment, wound infection, wound dehiscence and patients satisfaction.Data was analyzed in SPSS version 20.&#x0D; Results: In this study, the mean age of patients was 42.36±8.52years in binder group while 45.11±10.22years in non-binder group. There were 12 males and 18 females in binder group while 16 males and 14 females in non-binder group. At the end of study, the mean pain score was 0.0±0.0 in binder group while 0.7±0.1 in non-binder group (p&lt;0.05), the mean FEV1 was 90.21±6.39 in binder group while 89.91±12.30 in non-binder group (p&gt;0.05) and the mean 6MWT was 559.49±52.10m in binder group while 514.79±42.39m in non-binder group (p&lt;0.05). Seroma formation occur in 2 (6.7%) cases in binder group while in 8 (26.7%) in non-binder group (p&lt;0.05). Wound infection occurred in 1 (3.3%) in binder group while in 6 (20%) cases of non-binder group (p&lt;0.05) While wound dehiscence was not observed in any case in binder group (0%) but in 2 (6.7%) cases in non-binder group (p&gt;0.05).&#x0D; Conclusion: Thus results of this study showed that abdominal binder can help to improve the physical condition as well as can well manage wound.

Utility of CT in the diagnosis of an incarcerated Spigelian hernia without palpable abdominal mass

Introduction: Spigelian hernia is a rare type of ventral abdominal wall hernia. We report the case of an incarcerated Spigelian hernia without palpable abdominal mass diagnosed by computed tomography (CT) scan. Case Report: We report a case of a 63-year-old obese male patient with no particular pathological or surgical history received for bowel obstruction. The abdominal CT concluded to an incarcerated Spigelian hernia whereas this diagnosis was not considered at the clinical examination in the absence of visible or palpable mass on the anterolateral abdominal wall. Conclusion: This case report illustrates the key place of CT scan in this form of clinical presentation of Spigelian hernia.

Post-operative pain after laparoscopic ventral hernia repair, the impact of mesh soakage with bupivacaine solution versus normal saline solution: A randomised controlled trial (HAPPIEST Trial).

Background and Aims:Early postoperative pain after laparoscopic ventral hernia repair remains a concern for patients. Local application of anaesthetic agent in the surgical dissection area can potentially overcome this problem. The objective of this study was to evaluate the impact of soaking mesh in 0.5% bupivacaine solution as compared to normal saline solution on the post-operative pain.Methodology:We conducted a parallel-design double-blind randomised controlled trial. Adult patients with uncomplicated ventral abdominal wall hernias were included in the trial. Mesh was soaked in 0.5% solution of bupivacaine before application in patients in the intervention arm, whereas it was soaked in normal saline solution for patients in the control arm. Post-operative pain was assessed by trained staff at 6 h and 24 h from surgery. It was graded on visual analogue scale (VAS) from 0 to 10.Results:Trial was conducted from 16 November, 2015, to 15 September, 2017. During the study period, a total of 114 patients were randomised. Nine patients were excluded after randomisation. A total of 55 patients were analysed in the intervention arm and 50 patients were analysed in the control arm. Mean pain score at VAS at 6 h after laparoscopic ventral hernia repair in the intervention arm was 5.05 ± 1.2, whereas in the control arm, it was 5.54 ± 1.1 and the difference was statistically significant (P = 0.03-independent sample t-test). Mean pain score at VAS at 24 h after laparoscopic ventral hernia repair in the intervention arm was 3.16 ± 1.2, whereas in the control arm, it was 3.58 ± 1.4 and the difference was not statistically significant (P = 0.11-independent sample t-test).Conclusion:Soakage of mesh in 0.5% bupivacaine solution before application in laparoscopic ventral hernia repair significantly reduces early post-operative pain.Trial Registration: Trial was registered with clinicaltrials. gov (NCT03035617)URL: https://clinicaltrials. gov

Correction to: Update of Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS))—Part A

This article was updated to include the middle initial of author L. N. Jorgensen's name.