Beyond Damage Control Surgery: Abdominal Wall Reconstruction and Complex Hernia Repair

AbstractReconstruction of abdominal wall defects is still a big challenge in surgery, especially where there is insufficient fascia muscular or excessive tension of the defects in emergency and life-threatening scenarios. Indeed, the concept of damage control surgery has been advanced in the management of both traumatic and nontraumatic surgical settings. The strategy requires abridged surgery and quick back to intensive care units (ICU) for aggressive resuscitation. In the damage control laparotomy, patients are left with open abdomen or provisional closure of the abdomen with a planned return to the operating room for definitive surgery. So far, various techniques have been utilized to achieve early temporary abdominal closure, but there is no clear consensus on the ideal method or material for abdominal wall reconstruction. We recently successfully created the selective germline genome-edited pig (SGGEP) and here we aimed to explore the feasibility of in vivo reconstruction of the abdominal wall in a rabbit model with SGGEP meninges grafts (SGGEP-MGs). Our result showed that the SGGEP-MGs could restore the integrity of the defect very well. After 7 weeks of engraftment, there was no sign of herniation observed, the grafts were re-vascularized, and the defects were well repaired. Histologically, the boundary between the graft and the host was very well integrated and there was no strong inflammatory response. Therefore, this kind of closure could help restore the fluid and electrolyte balance and to dampen systemic inflammatory response in damge control surgery while ADM graft failed to establish re-vascularization as the same as the SGGEP-MG. It is concluded that the meninges of SGGEP could serve as a high-quality alternative for restoring the integrity of the abdominal wall, especially for damage control surgery.

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Abdominal Wall Reconstruction and Parastomal Hernia Repair

10.1007/978-3-030-66049-9_55 ◽

2021 ◽

pp. 947-959

Author(s):

Clayton C. Petro ◽

Ajita Prabhu ◽

Michael J. Rosen

Keyword(s):

Hernia Repair ◽

Abdominal Wall ◽

Parastomal Hernia ◽

Abdominal Wall Reconstruction ◽

Parastomal Hernia Repair

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An Innovative Way to Separate Gastrointestinal and Abdominal Wall Reconstruction after Complex Abdominal Trauma

The American Surgeon ◽

10.1177/000313481708300938 ◽

2017 ◽

Vol 83 (9) ◽

pp. 1001-1006 ◽

Cited By ~ 1

Author(s):

David H. Livingston ◽

David V. Feliciano

Keyword(s):

Abdominal Wall ◽

Damage Control ◽

Abdominal Wall Reconstruction ◽

Skin Grafting ◽

Small Bowel Resection ◽

Fascial Closure ◽

Thickness Skin ◽

Split Thickness Skin Grafting ◽

Staged Approach ◽

Level I

Despite advances in trauma care, a subset of patients surviving damage control cannot achieve fascial closure and require split-thickness skin grafting (STSG) of their open abdomen. Controversy exists as to whether reconstruction of the gastrointestine (GI) should be staged or performed at the time of abdominal wall reconstruction (AWR). Many surgeons do not believe that operations through the STSG can be completed safely or without loss of graft. This series reviews the outcomes of operations for GI reconstruction performed through the elevated healed STSG. Concurrent series on all patients undergoing abdominal operation through the STSG. The technique involves elevating the STSG, lysing adhesions only as needed, avoid detaching underlying omentum or viscera to avoid devascularization, and then reattaching the elevated STSG to the abdominal wall with simple sutures. From 1995 to 2017, 27 patients underwent 40 distinct procedures during 36 separate abdominal reoperations (89% GI) through the elevated STSG approach at three Level I trauma centers at a mean interval of 11 months from application of the STSG. One STSG was lost (patient closed with skin flaps), one patient had 30 per cent loss of the STSG (regrafted), and one patient had 10 per cent loss of the STSG (allowed to granulate). One patient required a small bowel resection for intraoperative enterotomy during a difficult operative dissection. There were no GI complications, intraabdominal infections, or deaths, and all patients were deemed fit to undergo AWR after three months. Major intraabdominal reoperations can be readily and safely accomplished through the elevated STSG approach with a <4 per cent need for regrafting. This staged approach significantly simplifies and increases the safety of a second stage AWR.

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Planned Hernia Repair and Late Abdominal Wall Reconstruction

World Journal of Surgery ◽

10.1007/s00268-011-1177-5 ◽

2011 ◽

Vol 36 (3) ◽

pp. 511-515 ◽

Cited By ~ 20

Author(s):

Ari Leppäniemi ◽

Erkki Tukiainen

Keyword(s):

Hernia Repair ◽

Abdominal Wall ◽

Abdominal Wall Reconstruction

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EP.TH.108A Descriptive Case Series of Incisional Hernia Repair Using Dual Mesh Technique

British Journal of Surgery ◽

10.1093/bjs/znab309.016 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Chloe Theodorou ◽

Zia Moinuddin ◽

David Van Dellen

Keyword(s):

Incisional Hernia ◽

Hernia Repair ◽

Abdominal Wall ◽

Abdominal Wall Reconstruction ◽

Surgical Techniques ◽

Case Series ◽

Incisional Hernia Repair ◽

Fistula Formation ◽

Mesh Technique ◽

Dual Mesh

Abstract Aims Incisional hernias are a common complication after surgery that cause significant patient morbidity. Symptomatic patients are offered repair but many surgical techniques exist, with abdominal wall reconstruction becoming preferable for large complex defects. This paper describes our experience of abdominal wall reconstruction using a dual mesh technique. Method 22 patients underwent incisional hernia repair between March 2019 and September 2020. All patients received dual mesh, placed in retrorectus or transversalis fascial/retromuscular space. Absorbable BIO-A GORE mesh was used with a polypropylene mesh above. All patients were followed up to assess for complications and recurrence. Results No patients experienced fistula formation, long-term pain or obstructive symptoms. We report one true hernia recurrence (4.5%) and one case of infected mesh (4.5%), these both await further treatment. One patient had a proven wound infection which resolved with conservative treatment. 4 patients (18.2%) experienced seromas, 3 of these resolved spontaneously, one requiring image-guided drainage. Conclusion Incisional hernia repair using combination polypropylene and bio-absorbable mesh provides a safe and effective repair with low recurrence and incidence of surgical site occurrences in the short term. Longer follow up and further studies are needed to evaluate this mesh technique to support ongoing use of absorbable meshes in complex hernia repair.

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Beyond the Hernia Repair: A Review of the Insurance Coverage of Critical Adjuncts in Abdominal Wall Reconstruction

Plastic & Reconstructive Surgery Global Open ◽

10.1097/gox.0000000000003309 ◽

2020 ◽

Vol 8 (12) ◽

pp. e3309

Author(s):

Hani I. Naga ◽

Joseph A. Mellia ◽

Fortunay Diatta ◽

Sammy Othman ◽

Viren Patel ◽

...

Keyword(s):

Hernia Repair ◽

Abdominal Wall ◽

Insurance Coverage ◽

Abdominal Wall Reconstruction

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Laparoscopic intracorporeal rectus aponeuroplasty (LIRA technique): a step forward in minimally invasive abdominal wall reconstruction for ventral hernia repair (LVHR)

Surgical Endoscopy ◽

10.1007/s00464-018-6070-y ◽

2018 ◽

Vol 32 (8) ◽

pp. 3502-3508 ◽

Cited By ~ 8

Author(s):

Julio Gómez-Menchero ◽

Juan Francisco Guadalajara Jurado ◽

Juan Manuel Suárez Grau ◽

Juan Antonio Bellido Luque ◽

Joaquin Luis García Moreno ◽

...

Keyword(s):

Minimally Invasive ◽

Hernia Repair ◽

Abdominal Wall ◽

Ventral Hernia ◽

Ventral Hernia Repair ◽

Abdominal Wall Reconstruction

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Discussion on the Key Factors for the Treatment of Extremely High-risk Abdominal Trauma Patients With Partial Full-thickness Abdominal Wall Defects

10.21203/rs.3.rs-1078551/v1 ◽

2021 ◽

Author(s):

JiaQing Gong ◽

MingHui Pang ◽

Wei Li ◽

GuoDe Luo ◽

ZhiBing Yuan ◽

...

Keyword(s):

High Risk ◽

Abdominal Wall ◽

Abdominal Trauma ◽

Successful Treatment ◽

Damage Control ◽

Damage Control Surgery ◽

Abdominal Wall Defects ◽

Trauma Patients ◽

Full Thickness ◽

Key Factors

Abstract BackgroundPatients with extremely high-risk abdominal trauma and full-thickness necrosis and defects of the partial abdominal wall are clinically rare, and the treatments for these patients are very difficult and complex . In this study, we will explore the key factors for successful treatment of these patients . MethodsThree patients with extremely high-risk abdominal trauma and partial full-thickness abdominal wall defects were involved in this retrospective study, and one representative case was emphatically reviewed. According to the theory of damage control surgery,the consultation and coordinated treatment of multidisciplinary team(MDT) were involved firstly, then, stepped multiple operations,such as partial perforated small bowel resection, full-thickness abdominal wall defects repair, vacuum sealing drainage (VSD), and wounds skin grafts, were performed, meanwhile, systemic life resuscitation was strengthened. ResultsTwo patients were cured and discharged after 3 and 9 operations respectively. One patient suffered 2 operations and eventually died of lung infection and respiratory failure. ConclusionThe determination and responsibility of surgeons, rational use of damage control theory and multidisciplinary cooperation should be the keys for successful treatment.

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Early Fascial Closure of the Damage Control Abdomen in Children

The American Surgeon ◽

10.1177/000313481007600517 ◽

2010 ◽

Vol 76 (5) ◽

pp. 497-501 ◽

Cited By ~ 2

Author(s):

Myrick C. Shinall ◽

Kaushik Mukherjee ◽

Harold N. Lovvorn

Keyword(s):

Abdominal Wall ◽

Ventral Hernia ◽

Damage Control ◽

Necrotizing Pancreatitis ◽

Abdominal Wall Reconstruction ◽

Acellular Dermal Matrix ◽

Fascial Closure ◽

Time Range ◽

Dermal Matrix ◽

Abdominal Closure

Traditional staged closure of the damage control abdomen frequently results in a ventral hernia, need for delayed abdominal wall reconstruction, and risk of multiple complications. We examined the potential benefits in children of early fascial closure of the damage control abdomen using human acellular dermal matrix (HADM). We reviewed our experience with five consecutive children sustaining intra-abdominal catastrophe and managed with damage control celiotomy. To accomplish early definitive abdominal closure, HADM was sewn in place as a fascial substitute; the skin and subcutaneous layers were approximated over silicone drains. The five patients ranged in age from 1 month to 19 years at the time of presentation. Intra-abdominal catastrophes included complex bowel injuries after blunt trauma in two children, necrotizing pancreatitis and gastric perforation in one teenager, necrotizing enterocolitis in one premature infant, and perforated typhlitis in one adolescent. All damage control wounds were dirty. Time range from initial celiotomy to definitive abdominal closure was 6 to 9 days. After definitive closure, one child developed a superficial wound infection. No patient developed a ventral hernia. After damage control celiotomy in children, early abdominal wall closure using HADM may minimize complications associated with delayed closure techniques and the need for additional procedures.

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