Prophylactic Preperitoneal Mesh Placement in Open Bariatric Surgery: a Guard Against Incisional Hernia Development

Abstract Caecal volvulus represents 25–40% of all colonic volvulus. Symptoms include abdominal distension, constipation, nausea and vomiting where it may be intermittent. Abdominal X-rays and computed tomography (CTs) may help with diagnosis and recommended treatment is resection of mobile caecum. A 70-year old comorbid woman with previous open bariatric surgery and known incisional hernia presented with symptoms of bowel obstruction. CT showed caecal volvulus contained within the ventral hernia confirmed intra-operatively. Patient recovered well and was discharged on Day 6 of admission. This is the second case described in literature of a caecal volvulus occurring in an incisional hernia. The altered normal anatomy may have contributed to caecal mobility. Diagnosis of caecal volvulus can be challenging, more so in the presence of a more clinically apparent pathology. We present a second known case of caecal volvulus in a giant incisional hernia, where there were unique challenges to management.

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Endovascular Bariatric Surgery as Novel Minimally Invasive Technique for Weight Management in the Morbidly Obese: Review of the Literature

Nutrients ◽

10.3390/nu13082541 ◽

2021 ◽

Vol 13 (8) ◽

pp. 2541

Author(s):

Giuseppe Massimo Sangiorgi ◽

Alberto Cereda ◽

Nicola Porchetta ◽

Daniela Benedetto ◽

Andrea Matteucci ◽

...

Keyword(s):

Bariatric Surgery ◽

Minimally Invasive ◽

Weight Management ◽

World Health ◽

Invasive Technique ◽

Morbidly Obese ◽

World Population ◽

Obese Patients ◽

The World ◽

Open Bariatric Surgery

Nowadays, obesity represents one of the most unresolved global pandemics, posing a critical health issue in developed countries. According to the World Health Organization, its prevalence has tripled since 1975, reaching a prevalence of 13% of the world population in 2016. Indeed, as obesity increases worldwide, novel strategies to fight this condition are of the utmost importance to reduce obese-related morbidity and overall mortality related to its complications. Early experimental and initial clinical data have suggested that endovascular bariatric surgery (EBS) may be a promising technique to reduce weight and hormonal imbalance in the obese population. Compared to open bariatric surgery and minimally invasive surgery (MIS), EBS is much less invasive, well tolerated, with a shorter recovery time, and is probably cost-saving. However, there are still several technical aspects to investigate before EBS can be routinely offered to all obese patients. Further prospective studies and eventually a randomized trial comparing open bariatric surgery vs. EBS are needed, powered for clinically relevant outcomes, and with adequate follow-up. Yet, EBS may already appear as an appealing alternative treatment for weight management and cardiovascular prevention in morbidly obese patients at high surgical risk.

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Prevention of incisional hernia at the site of stoma closure with different reinforcing mesh types: a systematic review and meta-analysis

Hernia ◽

10.1007/s10029-021-02393-w ◽

2021 ◽

Author(s):

Roberto Peltrini ◽

Nicola Imperatore ◽

Gaia Altieri ◽

Simone Castiglioni ◽

Maria Michela Di Nuzzo ◽

...

Keyword(s):

Incisional Hernia ◽

Operative Time ◽

Meta Analysis ◽

Short Term ◽

Mesh Group ◽

Closure Technique ◽

Mesh Placement ◽

Mesh Reinforcement ◽

Significant Difference ◽

Significant Superiority

Abstract Purpose To evaluate safety and efficacy of a mesh reinforcement following stoma reversal to prevent stoma site incisional hernia (SSIH) and differences across the prostheses used. Methods A systematic search of PubMed/MEDLINE, EMBASE, SCOPUS and Cochrane databases was conducted to identify comparative studies until September 2020. A meta-analysis of postoperative outcomes and a network meta-analysis for a multiple comparison of the prostheses with each other were performed. Results Seven studies were included in the analysis (78.4% ileostomy and 21.6% colostomy) with a total of 1716 patients with (n = 684) or without (n = 1032) mesh. Mesh placement was associated with lower risk of SSIH (7.8%vs18.1%, OR0.266,95% CI 0.123–0.577, p < 0.001) than no mesh procedures but also with a longer operative time (SMD 0.941, 95% CI 0.462–1.421, p < 0.001). There was no statistically significant difference in terms of Surgical Site infection (11.5% vs 11.1%, OR 1.074, 95% CI 0.78–1.48, p = 0.66), seroma formation (4.4% vs 7.1%, OR 1.052, 95% CI 0.64–1.73, p = 0.84), anastomotic leakage (3.7% vs 2.7%, OR 1.598, 95% CI 0.846–3.019, p = 0.149) and length of stay (SMD − 0.579,95% CI − 1.261 to 0.102, p = 0.096) between mesh and no mesh groups. Use of prosthesis was associated with a significant lower need for a reoperation than no mesh group (8.1% vs 12.1%, OR 0.332, 95% CI 0.119–0.930, p = 0.036). Incidence of seroma is lower with biologic than polypropylene meshes but they showed a trend towards poor results compared with polypropylene or biosynthetic meshes. Conclusion Despite longer operative time, mesh prophylactic reinforcement at the site of stoma seems a safe and effective procedure with lower incidence of SSIH, need for reoperation and comparable short-term outcomes than standard closure technique. A significant superiority of a specific mesh type was not identified.

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Incisional Hernia Repair in Contaminated Surgical fields (I.H.R.C.S.) study using biological prostheses in emergency surgery setting with contaminated hernias: a multicenter prospective observational study

Journal of Peritoneum (and other serosal surfaces) ◽

10.4081/joper.2016.26 ◽

2016 ◽

Cited By ~ 2

Author(s):

Belinda De Simone ◽

Fausto Catena ◽

Antonio Biondi ◽

Gianluca Baiocchi ◽

Fabio Campanile ◽

...

Keyword(s):

Observational Study ◽

Incisional Hernia ◽

Prospective Observational Study ◽

Wound Complication ◽

Hernia Recurrence ◽

Mesh Placement ◽

Asa Score ◽

Surgical Field ◽

The Mean ◽

Biological Prostheses

There are still difficulties to find appropriate indication for prosthetic implant in hernia surgery in contaminated surgical fields. Biologic prosthetic materials have been developed and proposed for the clinical use in contaminated surgical fields with interesting outcomes. The aim of this study is to analyze data from nine Italian Emergency Surgery Units concerning patients consecutively admitted with diagnosis of strangulated incisional hernia (IH), submitted to surgery in emergency and treated with biological prostheses. This is a prospective observational study. Subjects submitted to singlestaged IH repair in a contaminated surgical field, with the use of biologic mesh, were prospectively studied over a 1-year time period. All patients enrolled in this study were submitted to bowel/intestinal resection at the same operative time for perforation. Primary end points of our study were wound complication and hernia recurrence. Seventy-one patients were enrolled (F=21, M=50); the mean age was 69.2±11.1 standard deviation (SD) years and the mean American Society of Anesthesiologist (ASA) score was 3.1±0.8 SD. Twenty-one patients (29.57%) had a wound complication, associated with high ASA score, diabetes, smoking, chronic immunosuppression, number of previous hernia repairs, dirty surgical field, sublay extra peritoneal mesh placement and no anterior fascia closure. After a mean follow up time of 27.2 months, hernia recurrence occurred in 19 patients (26.76%). Predictors of hernia recurrence included wound complications, high ASA score, diabetes, chronic immunosuppression, dirty surgical field and sublay extra peritoneal mesh placement. Use of biological prostheses in contaminated fields is safe with favorable medium term recurrence rate (26.76% in our experience). Surgical technique performed is important to decrease hernia recurrence rate.

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Incidence and risk factors for incisional hernia after temporary loop ileostomy closure: choosing candidates for prophylactic mesh placement

Hernia ◽

10.1007/s10029-019-02042-3 ◽

2019 ◽

Vol 24 (1) ◽

pp. 93-98 ◽

Cited By ~ 1

Author(s):

A. G. Barranquero ◽

E. Tobaruela ◽

M. Bajawi ◽

P. Muñoz ◽

J. Die Trill ◽

...

Keyword(s):

Risk Factors ◽

Incisional Hernia ◽

Loop Ileostomy ◽

Ileostomy Closure ◽

Prophylactic Mesh ◽

Mesh Placement

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Outcomes for Incisional Hernia Repair in Patients Undergoing Concomitant Surgical Procedures

The American Surgeon ◽

10.1177/000313481207800246 ◽

2012 ◽

Vol 78 (2) ◽

pp. 243-249 ◽

Cited By ~ 3

Author(s):

Laura K. Altom ◽

Laura A. Graham ◽

Stephen H. Gray ◽

Christopher W. Snyder ◽

Catherine C. Vick ◽

...

Keyword(s):

Incisional Hernia ◽

Hernia Repair ◽

Surgical Procedures ◽

Proportional Hazards ◽

Cox Regression ◽

Incisional Hernia Repair ◽

Cox Proportional Hazards ◽

Mesh Placement ◽

Clean Contaminated ◽

Operative Notes

The safety and efficacy of performing concomitant surgical procedures with an incisional hernia repair (IHR) is not well understood. There are conflicting reports on the outcomes for permanent mesh implantation in the setting of clean-contaminated procedures. The purpose of this study was to review the effect of concomitant surgical procedures on IHR outcomes. This is a retrospective multisite cohort of patients undergoing elective IHR at 16 Veterans Affairs hospitals from 1998 to 2002. Concomitant procedure status, hernia characteristics, and operative details were determined using physician-abstracted operative notes. Hernia outcomes of recurrence and mesh explantation were determined from the medical chart. χ2 tests, Kaplan-Meier curves, and Cox regression were used to evaluate the effects of concomitant status on hernia outcomes. Of the 1495 elective IHRs, 75 (4.8%) were same site and 56 (3.8%) different site concomitant procedures. At median follow-up of 69.3 months (range 19.1–98.3), 33.6 per cent of patients had a recurrence, mesh explantation, or both. Permanent mesh placement was less likely among concomitant procedures as compared with nonconcomitant procedures ( P < 0.0001). Adjusted Cox proportional hazards models of hernia outcomes resulted in an increased hazard for recurrence among same site clean procedures (Hazard Ratio (HR) = 1.8, P = 0.03) and an increased hazard for mesh explantation among same site clean-contaminated procedures (HR = 8.4, P = 0.002). Concomitant same site procedures are significantly associated with adverse hernia outcomes as compared with isolated IHR or IHR with other site concomitant procedures. The high failure rate of hernia repairs among same site concomitant procedures should be taken into account during the surgical decision-making process.

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