Impact of Surgihoney Reactive Oxygen on surgical site infection (SSI) after complex abdominal wall reconstruction (AWR) of grade 3 and 4 ventral Hernias: A single arm pilot study

The aim of our study was to determine whether patients with neutropenia (absolute neutrophil count (ANC) ≤1,500 cells/µL) had higher rates of surgical site infection after elective abdominal wall reconstruction. This was a case series from a prospective complex abdominal wall reconstruction cohort describing the surgical outcomes of 4 neutropenic patients (ANC ≤1,500 cells/µL) within 48 hours of index operation. Median age was 55 years, 3 patients were female. All patients had liver cirrhosis as a comorbidity: 2 patients as a result of alcohol abuse and 2 patients secondary to cryptogenic and nonalcoholic fatty liver disease, respectively. All patients underwent a posterior component separation with transversus abdominis release and retro-rectus biologic mesh. None of the 4 patients developed a surgical site infection 90 days postoperatively. Complex abdominal wall reconstruction in neutropenic patients could be safe.

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The Impact of Mesh Reinforcement with Components Separation for Abdominal Wall Reconstruction

The American Surgeon ◽

10.1177/000313481808400648 ◽

2018 ◽

Vol 84 (6) ◽

pp. 959-962 ◽

Cited By ~ 3

Author(s):

Seyed Amirhossein Razavi ◽

Karan A. Desai ◽

Alexandra M. Hart ◽

Peter W. Thompson ◽

Albert Losken

Keyword(s):

Postoperative Complications ◽

Surgical Site Infection ◽

Abdominal Wall ◽

Recurrence Rate ◽

Abdominal Wall Reconstruction ◽

Abdominal Hernia ◽

Fascial Closure ◽

Site Infection ◽

Components Separation ◽

The Impact

The goal in abdominal wall reconstruction (AWR) is to minimize morbidity and prevent hernia recurrence. Components separation and mesh reconstruction are two options, however, with advantages and disadvantages. The purpose of this review was to investigate outcomes in patients with abdominal wall hernia undergoing primary closure with component separation (CS) versus CS with acellular dermal matrix (ADM) reinforcement (CS + mesh). Medical records of consecutive patients who underwent abdominal wall reconstruction using CS with or without ADM reinforcement were retrospectively reviewed. Primary fascial closure was achieved in all patients. ADM reinforcement when used was performed using the underlay technique. Reconstructive technique and postoperative complications including delayed healing, skin necrosis, fistula, seroma, hematoma and surgical site infection, recurrence, and reoperation were recorded. Comparisons between the two groups were assessed. One hundred and seven patients were included (mean age, 55.7; 51.4% male; median follow-up 297 days). Twenty-six patients (24%) underwent CS alone; whereas 81 patients (76%) CS + mesh placement. Patient comorbidities, including smoking (26%), diabetes (20%), and hypertension (46%); body mass index (mean 32.3 ± 7.6); and albumin level on the day of surgery (mean 3.4 ± 0.5 mg/dL) were not significantly different between groups. Surgical site infection was significantly higher among CS + mesh patients (22.2%) versus CS only patients (3.9%) (P = 0.02). The recurrence rate of abdominal hernia was significantly lower in CS + mesh patients compared with CS only (14.8% vs 34.6%; P = 0.02). No significant differences in other postoperative complications were identified between the two groups. ADM reinforcement at the time of components separation is often selected in more complex, higher risk patients. Although the incidence of infection was higher in these patients, it was usually treated without mesh removal and recurrence rate was significantly lower when compared to CS alone.

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Positive outcomes with negative pressure therapy over primarily closed large abdominal wall reconstruction reduces surgical site infection rates

Hernia ◽

10.1007/s10029-014-1312-y ◽

2014 ◽

Vol 19 (2) ◽

pp. 273-278 ◽

Cited By ~ 28

Author(s):

A. Gassman ◽

A. Mehta ◽

E. Bucholdz ◽

A. Abthani ◽

O. Guerra ◽

...

Keyword(s):

Surgical Site Infection ◽

Abdominal Wall ◽

Negative Pressure ◽

Abdominal Wall Reconstruction ◽

Positive Outcomes ◽

Site Infection ◽

Infection Rates ◽

Negative Pressure Therapy ◽

Pressure Therapy

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Increased Incidence of Surgical Site Infection with a Body Mass Index ≥35 kg/m 2 after Abdominal Wall Reconstruction

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2017.07.579 ◽

2017 ◽

Vol 225 (4) ◽

pp. e21-e22

Author(s):

Salvatore Docimo ◽

Konstantinos Spaniolas ◽

Andrew Bates ◽

Samer Sbayi ◽

Jessica Schnur ◽

...

Keyword(s):

Body Mass Index ◽

Surgical Site Infection ◽

Abdominal Wall ◽

Body Mass ◽

Abdominal Wall Reconstruction ◽

Site Infection

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Transversus Abdominis Release (TAR) Procedure: Experience of An Abdominal Wall Reconstruction Group.

10.21203/rs.3.rs-766601/v1 ◽

2021 ◽

Author(s):

Alberto Ricaurte ◽

Carlos Rey ◽

Felipe Giron ◽

Danny Conde ◽

Lina Rodriguez ◽

...

Keyword(s):

Surgical Site Infection ◽

Abdominal Wall ◽

Abdominal Wall Reconstruction ◽

Transversus Abdominis ◽

High Morbidity ◽

Abdominal Wall Defects ◽

Site Infection ◽

Emergency Scenarios ◽

Clinical Conditions ◽

Reconstruction Group

Abstract BackgroundComplex abdominal wall defects are important conditions with a high morbidity, leading to impairment of patients physical condition and quality of life. In the last decade, the abdominal wall reconstruction paradigm has changed due to formation of experienced and excellence groups, improving clinical outcomes after surgery. Therefore, our study shows the perspective and outcomes of an abdominal wall reconstruction group (AWRG) in Colombia, focused on transverse abdominis release (TAR) procedure.MethodsA retrospective review of a prospectively collected database was conducted. All the patients older than 18 years old that underwent TAR procedure between January 2014 – December 2020 were included. Analysis and description of postoperative outcomes (recurrence, surgical site infection (SSI), seroma, hematoma, and re-intervention) was performed.Results50 patients underwent TAR procedure. 62% of patients were male. Mean age was 55 ± 13.4 years. Mean BMI was 27.8 ± 4.5 Kg/m2. Abdominal wall defects were classified with EHS ventral Hernia classification having a W3 hernia in 72% of all defects (Mean gap size of 11.49 cm ± 4.03 cm). Mean CeDAR preoperative risk score was 20.5 % ± 14.5%. Protective association was established for SSI if the procedure was performed by the AWRG OR 0.7 (IC 95% 0.05-0.93 ). Higher risk of SSI was found in cases not performed by the abdominal wall reconstruction group OR 13.6 (CI 95% 9.12 - 15.5 ). ConclusionsTAR procedure for complex abdominal wall defects under specific clinical conditions including emergency scenarios is viable. Specialized and experienced groups lessen surgical site infection.

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PWE-410 Initial UK experience with transversus abdominus muscle release for posterior components separation in abdominal wall reconstruction of large or complex ventral hernias. a combined approach by general and plastic surgeons

Gut ◽

10.1136/gutjnl-2015-309861.856 ◽

2015 ◽

Vol 64 (Suppl 1) ◽

pp. A390.1-A390 ◽

Cited By ~ 1

Author(s):

N Appleton ◽

K Anderson ◽

K Hancock ◽

M Scott ◽

C Walsh

Keyword(s):

Abdominal Wall ◽

Abdominal Wall Reconstruction ◽

Combined Approach ◽

Components Separation ◽

Ventral Hernias

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Ventral hernia from routine repairs to abdominal wall reconstruction: our initial experience

International Surgery Journal ◽

10.18203/2349-2902.isj20204135 ◽

2020 ◽

Vol 7 (10) ◽

pp. 3348

Author(s):

Sheetal Ishwarappagol ◽

Rohit Krishnappa

Keyword(s):

Abdominal Wall ◽

Ventral Hernia ◽

Abdominal Wall Reconstruction ◽

Tobacco Consumption ◽

Transversus Abdominis ◽

Abdominal Pressure ◽

Postural Stabilization ◽

History Of ◽

And Function ◽

Ventral Hernias

Background: Loss of continuity of abdominal wall significantly affects the functions of protection of viscera, postural stabilization, and maintenance of intra-abdominal pressure. The newer understanding of abdominal wall reconstruction (AWR) aims at restoring abdominal wall anatomy and function, instead of simply patching the defect. We want to showcase the changing trends and results in hernia repair at a Medical Institution.Methods: This is an observational retrospective study conducted in RRMCH, Bengaluru from July 2018-2019 including all patients with ventral hernia undergoing the specified hernia repairs.Results: A total of 54 patients with ventral hernias undergoing routine hernia repairs/AWR surgeries were retrospectively analysed. The overall mean age was 46.62±12.44 year. Majority subjects were females (n=37; 68.5%), and overweight (Mean BMI=28.07±3.01/m2). 14 patients (25.92%), all males, had history of tobacco consumption. There were 38 (70.37%) primary ventral hernias and 7 recurrent hernias. Overall mean defect size was 10.2±0.4 cm. Most frequently performed was open retro rectus Hernioplasty (n=18; 33.33%), followed by open Preperitoneal Hernioplasty (n=17; 31.48%), laparoscopic intraperitoneal onlay mesh (IPOM) (n=16; 29.62%) and open transversus abdominis release (TAR) (n=3; 5.5%). On statistical analysis, it was found that Open repairs had higher post-operative pain (p=0.0005), longer hospitalization (p=0.0002) and higher incidence of surgical site events (p=0.0134) when compared to Laparoscopic repairs.Conclusion: As known already, minimally invasive techniques of hernia surgeries are shown to have acceptable outcomes when compared to radical open surgeries. Newer techniques of AWR are being employed to routine cases in larger numbers, and not just for complex reconstruction, at most centres with acceptable outcomes.

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