Ventral Hernia Defects Research Articles

Minimally Invasive Components Separation—An Updated Method for Closure of Abdominal Wall Defects

We describe a new minimally invasive percutaneous/laparoscopic-assisted technique based on the principles of the original open components separation described by Ramirez et al. The technique of minimally invasive components separation (MICS) is described in detail as a stepwise approach. The main advantages of MICS are compared with its traditional open counterpart and previously described endoscopic/laparoscopic modifications. Open components separation is associated with increased wound problems due to extensive dissection. The MICS technique minimizes the need for large myocutaneous flap dissection, which in turn decreases postoperative wound complications. We have successfully corrected abdominal defects as large as 12 cm in diameter (113 cm(2)) with our MICS technique in a high-risk group of patients with minimal morbidity. The objectives of abdominal wall reconstruction, which includes restoring structural support, providing stable soft-tissue coverage, and optimizing aesthetic appearance, were all obtained with this newly described MICS technique. We believe that MICS is a safe, practical choice for repair of ventral hernia defects, because it minimizes postoperative morbidity and restores abdominal wall physiology.

Maximizing the Aesthetic Result in Panniculectomy after Massive Weight Loss

Plastic surgical consultation for abdominal contouring following massive weight loss is becoming increasingly prevalent, especially with the popularity of surgical weight loss procedures. The authors reviewed their experience with a novel panniculectomy technique that generally combines horizontal and vertical tissue excision to generate the best contour possible while providing effective relief of symptoms related to a dependent abdominal panniculus. A retrospective chart review was conducted of 100 consecutive patients who underwent panniculectomy using the authors' technique over a 5-year period. Demographic and procedural data were collected, and outcome measures were analyzed. Eighty-seven women and 13 men with an average weight loss of 133 lb underwent abdominal panniculectomy. A total of 37 ventral hernias were repaired concomitantly. Mean clinical follow-up was 16 months. Hospital length of stay averaged 4 days, and the most common complications were blood transfusion requirement (n = 39), fluid collections (n = 32), tissue necrosis requiring debridement (n = 18), and contour irregularities requiring revision (n = 15). Overall, 56 patients had a completely uncomplicated recovery. Greater amounts of tissue resection were associated with higher rates of transfusion (p < 0.01). The panniculectomy technique described can be performed safely and reproducibly. It yields an excellent abdominal contour and is effective in alleviating many symptoms of the dependent abdominal panniculus. It also provides exposure for improved evaluation and repair of concomitant ventral hernia defects.

Occult ventral hernia defects: a common finding during laparoscopic ventral hernia repair

Background In many incidences, laparoscopic exploration reveals occult ventral hernia defects that were not detected on physical examination. The objective of this study was to describe the frequency of occult ventral hernia defects detected during laparoscopy. Methods Prospectively collected data on 146 consecutive patients who underwent laparoscopic ventral hernia repair were reviewed. The numbers of ventral defects found on preoperative physical examination were compared with those found during the laparoscopic procedure. Results Out of 146 laparoscopic ventral hernia repair patients, 70 patients (48%) were found to have occult defects that were not detected on preoperative abdominal examination. Among all the possible variables, only the type of hernia was found to have a significant difference. Conclusion Almost half of the patients with a ventral hernia have clinically occult hernia defects that can be recognized laparoscopically. This indicates the importance of careful inspection of the anterior abdominal wall during the surgical procedure.

Abdominal Wall Hernia Repair: A Comparison of Sepramesh and Parietex Composite Mesh in a Rabbit Hernia Model

This study compared Parietex composite mesh (PCM) with Sepramesh (SM) in terms of strength of tissue incorporation, adhesion formation, and mesh shrinkage, using an animal model. A two-phase, prospective, randomized study using 44 New Zealand white rabbits. Each animal underwent creation of a standardized ventral hernia defect, followed by repair using either SM or PCM. Half of each group was sacrificed and examined at 1 month, and the remainder at 5 months. Outcomes measurements were strength of incorporation (SOI), type and area of adhesions (AA), and mesh shrinkage. SOI for PCM was much greater than for SM, both at 1 month (60.8 N versus 42.6 N) and 5 months (70.9 N versus 31.5 N). The incidence of bowel adhesions was lower with PCM than SM, both at 1 month (1 versus 6) and at 5 months (0 versus 4). At 5 months, PCM demonstrated lower AA, both as a percentage of the mesh (5.6% versus 12.8%) and in terms of absolute area involved (321 mm(2) versus 840 mm(2)). PCM underwent considerably more shrinkage than SM, at both 1 month (38.2% versus 18.1%) and 5 months (17.4% versus 6.1%). PCM demonstrated a substantially stronger SOI, which improved over time, and SOI of SM decreased. PCM was also superior in terms of adhesion prevention, but underwent considerably more shrinkage in this experimental model.

The suturing concept for laparoscopic mesh fixation in ventral and incisional hernia repair: Mid-term analysis of 400 cases

The authors describe a minimally invasive treatment of moderate to large incisional and ventral hernia defects using Parietex composite mesh. All defects are closed laparoscopically or through a minilaparotomy using sutures, and the composite mesh is fixed intraperitonally using transabdominal fixation with nonabsorbable sutures to avoid the use of staple or tack fixation, which has been associated with various complications, including major loop adhesion and mesh migration. The midterm results for 400 patients are presented in terms of efficacy and safety. During a mean follow-up period of 28 months for 80% of the patients, the median operating time was 74 min and the median hospital stay was 3 days. There were eight seromas (2%), all on large defects. Transient pain was experienced by 10 patients (2.5%), and resolved over time with analgesic treatment. There was one early case of sepsis (0.25%), attributable to secondary breakdown of the bowel wall in a case of recurrent incisional hernia, which led to removal of the mesh. Residual chronic parietal pain was reported for 10 patients (2.5%), 2 of whom were released after excision of neuroma; 3 trocar-site herniations (0.75%); and lipoma formation on the site of the hernia sac in 6 cases (1.5%). Laparoscopic ventral hernia treatment using Parietex composite mesh is an effective and safe procedure. Morbidity and recurrence rates are low, and the 2-year outcomes are promising, with no prosthesis migration or complication related to intraperitoneal positioning of the mesh.

Open Reconstruction of Sizeable Ventral Hernias in the Laparoscopic Era

The purpose of this study was to review our 15 years of experience in the repair of sizeable ventral hernias with a standardized open surgery technique, to evaluate the clinical outcome, and to assess the decreasing role of traditional surgical techniques in the laparoscopic era. A retrospective study has been conducted, including 200 patients operated for ventral hernia defects with a standardized underlay mesh implantation technique between 1990 and 2004. Their mean age was 62.6 (range 21-88) years and their mean BMI (body mass index) was 33.4 (range 22-69). Out of them, 56 per cent presented one to four major risk factors and 31.5 per cent had previously undergone ventral hernia repair surgery. The mean size of hernial defect was 135.2 (range 24-684) cm2. The mean follow-up was 43 (range 3-174) months. The overall major complication rate was 3.8 per cent and overall recurrence rate was 9.6 per cent. Our retrospective study confirms the safety and efficacy of open reconstruction in complex hernias. Prospective randomized homogenous trials with long-term follow-up are needed to provide us a better evidence-based approach. Minimal invasive surgery is favored but open reconstruction should still be considered as an alternative for sizeable ventral hernias management. A careful selection among patients for selecting the optimal technique is necessary.

Components Separation Technique and Laparoscopic Approach: A Review of Two Evolving Strategies for Ventral Hernia Repair

When faced with large ventral hernias, surgeons frequently must choose between higher incidence of recurrence after primary repair and higher incidence of wound complications after repair with mesh. The aim of this study is to compare early outcomes between laparoscopic repair (LR) and components separation technique (CST), two evolving strategies for the management of large ventral hernias. We reviewed 42 consecutive patients who underwent CST and 45 consecutive patients who underwent LR of ventral hernia defects of at least 12 cm2. Demographics, hernia characteristics, and short-term outcomes were compared between groups. Patients in the LR group were younger (53 +/- 2 vs 68 +/- 2 years, P < 0.0001), had greater body mass index (34 +/- 2 vs 29 +/- 1 kg/m2, P = 0.02), and had larger hernia defects (318 +/- 49 vs 101 +/- 16 cm2, P < 0.0001) than patients in the CST group. The LR resulted in shorter length of hospital stay (4.9 +/- 0.9 vs 9.6 +/- 1.8 days, P < 0.0001), lower incidence of ileus (7% vs 48%, P < 0.0001), and lower incidence of wound complications (2% vs 33%, P < 0.001) than the CST. Both techniques resulted in similar operative times, transfusion requirements, and mortality. Recurrences occurred in 7 per cent of patients at mean follow-up of 16 months in the CST group and 0 per cent at mean follow-up of 9 months after LR. The LR may have a short-term advantage over the CST in terms of incidence of ileus, wound complications, and hospital stay. Because of their unique advantage over traditional hernia repairs, both techniques may play a significant role in the future treatment of large ventral hernias. Adequate training will be essential for the safe and effective implementation of these techniques within the surgical community.

Abdominal Wall Hernia Repair: A Long-Term Comparison of Sepramesh and Dualmesh in a Rabbit Hernia Model

Surgeons are faced with a wide variety of mesh products, which they can use to perform tension-free abdominal wall hernia repair. The purpose of this study is to compare Sepramesh (SM) and Dualmesh (DM) in terms of strength of tissue incorporation, mesh shrinkage, and adhesiogenesis. We conducted a prospective, randomized trial using 24 New Zealand White rabbits. Each animal underwent creation of a standardized ventral hernia defect and was randomized to receive either SM or DM repair. There were 12 animals in each study arm. Five months postoperatively, the animals were sacrificed and the hernia repairs were analyzed. Specimens were evaluated for strength of incorporation (SOI), mesh shrinkage, as well as the type and amount of adhesions. SOI for DM was not statistically different from SM (37.2N vs 40.8N). DM underwent significantly more shrinkage than did SM (50.8% vs 32.6%, P < 0.0001). Adhesions were predominantly omental in nature. DM demonstrated a greater amount of adhesed area as a percentage of the mesh (30.7% vs 25.2%), but fewer adhesions in terms of absolute area involved (636 mm2 vs 717 mm2). This difference was not statistically significant. Previous studies, terminated at 30 days, demonstrated an increased SOI for SM as compared to DM. This study shows that SOI for DM continues to increase over time such that it is equivalent to DM at 5 months. Though there is increased mesh shrinkage for DM, adhesions to the two materials are equivalent.