Abdominal Wall Spaces for Mesh Placement: Onlay, Sublay, Underlay

2016 ◽  
pp. 79-87 ◽  
Author(s):  
Gina L. Adrales
Keyword(s):  
Abdominal Wall ◽  
Mesh Placement

scholarly journals Traumatic Abdominal Wall Hernia-A Rare Case Managed with Preperitoneal Mesh Placement Using Stoppa Technique

2016 ◽  
Vol 04 (01) ◽  
Author(s):  
Satpal Hans ◽  
Manjit Singh Khalsa ◽  
NIrmal Singh ◽  
Anoop Handa ◽  
Amiy Arnav
Keyword(s):  
Abdominal Wall ◽  
Rare Case ◽  
Abdominal Wall Hernia ◽  
Traumatic Abdominal Wall Hernia ◽  
Mesh Placement

scholarly journals P138 PREPERITONEAL ENDOSCOPIC GROIN HERNIA SURGERY - REASSESSMENT OF TOPOGRAPHIC ANATOMY AS A BASIS FOR STANDARDIZED DESCRIPTION OF SURGICAL STEPS

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Marvin Heimke ◽  
Tilmann Heinze ◽  
Andreas Kuthe ◽  
Thilo Wedel ◽  
Christoph W Strey
Keyword(s):  
Abdominal Wall ◽  
Groin Hernia ◽  
Histological Study ◽  
Learning Curves ◽  
Surgical Approaches ◽  
Anatomical Landmarks ◽  
Hernia Surgery ◽  
Mesh Placement ◽  
Topographic Anatomy ◽  
Total Extraperitoneal

Abstract Aim Fascial groin anatomy remains a conundrum. In particular, a clear anatomical allocation of the correct extraperitoneal dissection planes and spaces in total extraperitoneal endoscopic hernia surgery (TEP) has not yet agreed upon. The differing anatomical concepts are reflected by the variability of surgical approaches, the considerably long learning curves and subsequent complications. Thus, the aim of this study was to reassess the topographic anatomy of the groin region providing a basis to standardize the surgical steps of TEP according to clearly defined anatomical landmarks. Material and Methods Video analysis of intraoperative surgical anatomy of groin hernia patients was correlated with the findings retrieved by macroscopic anatomical studies. The groin region of formalin fixed body donors was subjected to a stepwise dissection exposing the fascial system of the abdominal wall layer-by-layer and via different angles. Selected areas of interest were processed for histological study. Surgically relevant anatomical landmarks were defined and termed according to the most appropriate anatomical nomenclature. Results The essential surgical dissection steps during TEP could be related to specific anatomical landmarks extending within the extraperitoneal space of the ventral and dorsolateral abdominal wall. The definition of fascial structures and interfaces and the identification of structures at risk allowed the identification of correct dissection planes for mesh placement. Conclusions Our study helps to clarify the definition and nomenclature of anatomical key structures required for a standardized description of TEP in a simplified model. The data may contribute to reduce complications and improve surgical teaching and training.

scholarly journals P049 SAFETY AND EFFICACY OF ABSORBABLE AND NON-ABSORBABLE FIXATION SYSTEMS FOR INTRAPERITONEAL MESH FIXATION: AN EXPERIMENTAL STUDY IN SWINE

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Spyridon Kapoulas ◽  
Apostolos Papalois ◽  
Georgios Papadakis ◽  
Georgios Tsoulfas ◽  
Emmanouil Christoforidis ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Mesh Fixation ◽  
Peel Strength ◽  
Swine Model ◽  
Abdominal Wall Defects ◽  
Hernia Surgery ◽  
Safety And Efficacy ◽  
Mesh Placement ◽  
Intraperitoneal Mesh ◽  
Mesh Shrinkage

Abstract Aim Choice of the best fixation system in terms of safety and effectiveness for intraperitoneal mesh placement in hernia surgery remains controversial. The aim of this study was to compare the performance of four fixation systems in a swine model of intraperitoneal mesh fixation. Material and Methods Fourteen Landrace swine were utilized and the experiment included two stages. Initially, four pieces of polypropylene mesh with hydrogel barrier coating1 were fixed intraperitoneally to reinforce 4 small full thickness abdominal wall defects created with diathermy. Each mesh was anchored with a different tack device between titanium2, steel3 or absorbable (4,5) fasteners. The second stage took place after 60 days and included euthanasia, laparoscopy, and laparotomy. The primary endpoint was to compare the peel strength of the compound tack/mesh from the abdominal wall. Secondary parameters were the extent and quality of visceral adhesions to the mesh, the degree of mesh shrinkage and the histological response around the tacks. Results Thirteen out of 14 animals survived the experiment and 10 were included in the final analysis. Steel tacks had higher peel strength when compared to titanium and absorbable fasteners. No significant differences were noted regarding the secondary endpoints. Conclusions Steel fasteners provided higher peel strength that the other devices in this swine model of intraperitoneal mesh fixation. Our findings generate the hypothesis that this type of fixation may be superior in a clinical setting. Clinical trials with long-term follow-up are required to assess the safety and efficacy of mesh fixation systems in hernia surgery.

scholarly journals The optical analysis of the abdominal wall using the biospeckle after implants of polypropylene mesh in rats

2009 ◽  
Vol 24 (6) ◽  
pp. 442-448
Author(s):  
Tâmara Maria Nieri ◽  
Marco Antonio de Oliveira Peres ◽  
Emerson Rodrigo da Silva ◽  
Inácio Maria Dal Fabbro ◽  
Mikiya Muramatsu ◽  
...  
Keyword(s):  
Animal Model ◽  
Abdominal Wall ◽  
Polypropylene Mesh ◽  
Male Rats ◽  
Mesh Placement ◽  
Group 4 ◽  
Mesh Prosthesis ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

PURPOSE: To evaluate an experimental animal model to study the abdominal tissue activity considering its interaction with a polypropylene mesh, through the use of one of the optical phenomena of light Laser, the biospeckle. METHODS: Fifty Wistar male rats were divided into four groups: Group 1: ten animals not submitted to surgery; Group 2: ten animals submitted to surgery without polypropylene mesh; Group 3: 20 animals submitted to surgery followed by the mesh placement; Group 4: (sham) with ten animals. None of the animals presented post surgical complications being submitted to the optical tests at the 20th postoperative day. RESULTS: The analysis from the biospeckle tests, comparing the medians and standard deviations with T Student test, indicated that no significative difference was observed on the abdominal wall tissue activity in the four groups considered, with and without polypropylene mesh prosthesis implantation. CONCLUSION: The animal model is viable and the biospeckle open ways for a great number of experiments to be developed in evaluating tissue activity.

scholarly journals Repair Methods in Parastomal Hernia Surgery

2020 ◽  
Vol 2 (4) ◽  
Author(s):  
Salih Tosun ◽  
Oktay Yener ◽  
Ihsan Metin Leblebici ◽  
Özgür Ekinci
Keyword(s):  
Abdominal Wall ◽  
Recurrence Rate ◽  
Mesh Repair ◽  
Laparoscopic Approach ◽  
Operation Time ◽  
High Recurrence Rate ◽  
Suture Repair ◽  
Hernia Surgery ◽  
Promising Alternative ◽  
Mesh Placement

Background-Aim: Parastomal hernias (PSH) are incisional hernias that must be classified separately from the other abdominal wall hernias. The high recurrence rate of PSH is the most important problem after suture repair or relocation of the stoma; whereas open or laparoscopic mesh repair results in much lower recurrence rates. The aim of this study is to investigate PSH predisposing factors, surgical repair methods, postoperative complications and recurrence in surgery practice. Methods: Patient demographics, operation time before the first surgery, operation method, and the recurrence rate seen in patients who underwent PSH surgery in a 10-year time/ period (2008-2018) were investigated  from the patient records. Except for emergency cases, 2 years of disease-free time was set for PSH surgery in malignant cases to be sure that no malignancy was present in the time of operation.  Results: 14 PSHs were treated surgically using mesh repair in all cases.  There were 6 male and 8 female patients with a mean age of 71.7 years (range:45-84;median:78). Open sublay polypropylene mesh placement technique was performed in 12 patients and intraperitoneal composite mesh (using either keyhole or Sugarbaker techniques) was placed laparoscopically in 2 patients. Superficial wound infections were developed in 4 patients (28.5 %) and 2 patients developed recurrence (14.2%). Conclusion: There is no effective method defined for the surgery of PSH but the laparoscopic approach has been proposed as a promising alternative to open technique as it causes less abdominal wall trauma. Whether performed open or laparoscopic; mesh repair is the optimal standard for PSH surgery.

scholarly journals Recurrent petit traumatic hernia plasty: case report

2019 ◽  
Vol 6 (2) ◽  
pp. 593
Author(s):  
Gamaliel Vázquez Estudillo ◽  
Edwin Y. Ochoa Viveros ◽  
Amado Q. Nicasio Delgado ◽  
David Trejo Cervantes ◽  
Gerardo Rodarte Cajica ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Surgical Procedure ◽  
Humeral Fracture ◽  
Lumbar Hernia ◽  
Abdominal Wall Defects ◽  
Large Hospital ◽  
Mesh Placement ◽  
First Case ◽  
One Year ◽  
Lower Lumbar

Lumbar hernias are very infrequent posterior abdominal wall defects. They are usually located in the upper lumbar triangle and represent approximately 1.5-2% of all hernias of the abdominal wall. In fact, there are few cases described in the literature and most of the large hospital centers have published only 2 or 3 cases. This is a 34 year-old female, who suffered a car accident, in which bilateral femoral fracture and left humeral fracture, after recovery of said fractures has asymmetry of flanks with the appearance of volume increase in the left abdominal flank, computed tomography was performed evidencing left lower lumbar hernia (Petit's Hernia) so, it was protocolized for open lumbar hernia repair with placement of mesh by anterior approach, later one year later, it presented recurrent left lumbar hernia, therefore, a protocol and surgical procedure of open lumbar plasty was performed again with mesh placement by lumbotomy approach in 2016. After a year of the surgical procedure, a pelvic abdominal control CT scan was requested, where a proper prosthesis placement was observed without protruding tissues. This was the first case of recurrent post-traumatic Pettit hernia in this institution. There are few cases reported in the universal literature, the treatment was surgical when performing the diagnosis, either laparoscopically or openly with decision and according to the experience of the surgeon.

Management of Complex Abdominal Wall Defects Using Acellular Porcine Dermal Collagen

2010 ◽  
Vol 76 (1) ◽  
pp. 96-100 ◽  
Author(s):  
Luis Felipe Chavarriaga ◽  
Edward Lin ◽  
Albert Losken ◽  
Michael W. Cook ◽  
Louis O. Jeansonne ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Primary Repair ◽  
Abdominal Wall Reconstruction ◽  
Long Term Results ◽  
Wound Complications ◽  
Abdominal Wall Defects ◽  
Mesh Placement ◽  
Postoperative Wound ◽  
Porcine Dermal Collagen ◽  
Dermal Collagen

Multiple techniques have been used for the repair of complex abdominal wall defects after recurrent incisional hernias with varying rates of success. Primary repair has been associated with high recurrence rates, and prosthetic mesh placement is contraindicated in contaminated surgical fields. The development of biologic prostheses has changed the approach to these difficult problems. This study evaluates the management of complex abdominal wall defects using acellular porcine dermal collagen. Between August 2006 and May 2007, 18 patients underwent abdominal wall reconstruction for complex defects with acellular porcine dermal collagen (CollaMend™; Bard Inc., Warwick, RI). Patient demographics, preoperative risk factors, previous herniorrhaphy attempts, postoperative complications, recurrences, and long-term results were retrospectively reviewed. Records were reviewed at a mean follow up of 7.3 months; the recurrence rate was 44.4 per cent. A total of 38.9 per cent (seven of 18) developed a postoperative wound complications, including infection in 22.2 per cent (four of 18). All of the patients with infection required prosthesis removal as a result of encapsulation rather than incorporation of the biologic prosthesis. Acellular porcine dermal collagen has the potential for reconstruction of abdominal wall defects with postoperative wound occurrences comparable with other biologic materials. Encapsulation of the material was a major problem in cases with wound infection that required graft removal rather than local wound measures. Hernia recurrence and dehiscence of the graft were problems in noncompromised surgical fields.

scholarly journals Prophylactic mesh placement of permanent stomas at index operation for colorectal cancer

2012 ◽  
Vol 94 (8) ◽  
pp. 569-573 ◽  
Author(s):  
NT Ventham ◽  
RR Brady ◽  
RG Stewart ◽  
BM Ward ◽  
C Graham ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Abdominal Wall ◽  
Parastomal Hernia ◽  
Abdominal Wall Defect ◽  
Prophylactic Mesh ◽  
Permanent Colostomy ◽  
Wall Defect ◽  
Mesh Placement ◽  
Clinical Endpoints ◽  
Index Operation

INTRODUCTION Parastomal herniation occurs in 30–50% of colostomy formations. The aim of this study was to radiologically evaluate the mechanical defects at stoma sites in patients who had previously undergone a permanent colostomy with or without mesh at the index operation for colorectal cancer. METHODS A study was performed of all colorectal cancer patients (n=41) having an end colostomy between 2002 and 2010, with or without Prolene® mesh plication, with blinded evaluation of the annual follow-up staging computed tomography (CT) for stomal characteristics. The presence of parastomal hernias, volume, dimensions, grade of the parastomal hernia and abdominal wall defect size were measured by two independent radiologists, and compared with demographic and operative variables. RESULTS In those patients with radiological evidence of a parastomal hernia, Prolene® mesh plication significantly reduced the incidence of bowel containing parastomal hernias at one year following the procedure (p<0.05) and also reduced the diameter of the abdominal wall defect (p=0.006). CONCLUSIONS Prophylactic mesh placement at the time of the index procedure reduces the diameter of abdominal wall aperture and the incidence of parastomal hernias containing bowel. Future studies should use both objective radiological as well as clinical endpoints when assessing parastomal hernia development with and without prophylactic mesh.

A Large Single-Center ‘Experience of Open Lateral Abdominal Wall Hernia Repairs

2016 ◽  
Vol 82 (7) ◽  
pp. 608-612 ◽  
Author(s):  
Puraj P. Patel ◽  
Jeremy A. Warren ◽  
Roozbeh Mansour ◽  
William S. Cobb ◽  
Alfredo M. Carbonell
Keyword(s):  
Abdominal Wall ◽  
Abdominal Wall Hernia ◽  
Lateral Wall ◽  
Synthetic Mesh ◽  
Mesh Placement ◽  
Lateral Abdominal Wall ◽  
Single Center Experience ◽  
European Hernia Society ◽  
Open Mesh Repair ◽  
Mesh Reconstruction

Lateral abdominal wall hernias may occur after a variety of procedures, including anterior spine exposure, urologic procedures, ostomy closures, or after trauma. Anatomically, these hernias are challenging and require a complete understanding of abdominal wall, interparietal and retroperitoneal, anatomy for successful repair. Mesh placement requires extensive dissection of often unfamiliar planes, and its fixation is difficult. We report our experience with open mesh repair of lateral abdominal wall hernias. A retrospective review of a prospectively maintained database was performed to identify patients with a classification of lateral abdominal wall hernia who underwent an open repair. A total of 61 patients underwent open lateral hernia repairs. Mean patient age was 58 years (range 25–78), with a mean body mass index of 32 kg/m2 (range 19.0–59.1). According to the European Hernia Society classification, defects were located subcostal (L1, 14 patients), flank (L2, 33 patients), iliac (L3, 11 patients), and lumber (L4, 3 patients). Mean defect size was 78.6 cm2, with a mean greatest single dimension of 9.2 cm (range 2–25 cm). Retromuscular or interparietal repair was performed in 50.8 per cent, preperitoneal in 41.0 per cent, intraperitoneal in 6.6 per cent, and onlay in 1.6 per cent. The rate of surgical site occurrence was 49.2 per cent, primarily seroma and surgical site infection rate was 13.1 per cent. With a mean follow-up of 15.4 months, seven patients (11.5%) have documented recurrence. Synthetic mesh reconstruction of lateral wall hernias is challenging. Our experience demonstrates the safety and success of repair using synthetic mesh primarily in the retromuscular, interparietal, or preperitoneal planes.

scholarly journals EP.TU.933Late enterocutaneous fistula formation after evisceration repair using intraperitoneal mesh

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Jose Rodicio ◽  
Sandra Sanz ◽  
Tamara Vico ◽  
Sonia Amoza ◽  
Maria Moreno ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Potential Risk ◽  
Postoperative Period ◽  
Glycosylated Hemoglobin ◽  
Abdominal Wall Reconstruction ◽  
Transversus Abdominis ◽  
Fascial Closure ◽  
Fistula Formation ◽  
Mesh Placement ◽  
Intraperitoneal Mesh

Abstract Introduction Intraperitoneal meshes pose a potential risk of complications, either due to the material itself or the method of fixation. Enteric fistulas are a rare but serious complication following the repair of an abdominal wall reconstruction using an intraperitoneal prosthesis. Case report We present a 59-year-old male patient, who underwent surgery 5 years previously for urothelial carcinoma with radical cystoprostatectomy and a Bricker-type urinary diversion, without subsequent radiotherapy. He presented an evisceration in the postoperative period treated with an inlay placement of an intraperitoneal mesh, without fascial closure. During these five years the wound did not present any complications, and spontaneous intestinal drainage began through the laparotomy. The physical exploration showed a 2cm hole in the abdominal infraumbilical midline, a wall defect of 20x20cm contained by mesh, no parastomal hernia, BMI 31.2 kg/m2. Thoraco-abdominal CT studies were completed that ruled out other pathologies, nasal culture and optimization were performed with parenteral nutrition and glycosylated hemoglobin control to achieve values below 6. The reconstruction of the abdominal wall was done with posterior component separation with transversus abdominis release, double mesh placement a BioA and PVDF mesh, with a final bridge measuring 8x5cm. The postoperative period was prolonged by an ileus, with an admission period of two weeks. Discussion Intraperitoneal meshes, some of which are no longer commercially available, represent a potential risk of complication. As long as we can optimize the patient for surgery, we will improve the results. Retromuscular repair with large mesh and PVDF material gives us good results.

Sign in / Sign up

Export Citation Format

Share Document