History of surgical site infection increases the odds for a new infection after open incisional hernia repair

Leiomyomas are the most common benign gynaecological tumour and contribute to 40-60% of hysterectomies performed all over the world. Despite proven benefits of GnRH analogues in reducing the size of myoma, it is used mostly as a temporary preoperative drug, as it has not shown to be associated with complete mass regression. We present a case of an abnormal uterine bleeding in a perimenopausal woman with history of multiple caesarean sections and incisional hernia repair. The patient was diagnosed with leiomyoma and was severely symptomatic due to anaemia. She responded to GnRH analogues and the mass regressed completely after 6 months. A favourable outcome in this patient establishes the role of medical treatment in symptomatic uterine fibroids in perimenopausal woman with previous abdominal surgeries where the risks of surgical intervention may be higher.

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Laparoscopic ventral and incisional hernia repair using intraperitoneal onlay mesh with peritoneal bridging

Hernia ◽

10.1007/s10029-021-02502-9 ◽

2021 ◽

Author(s):

F. Ali ◽

G. Sandblom ◽

A. Wikner ◽

G. Wallin

Keyword(s):

Incisional Hernia ◽

Hernia Repair ◽

Ventral Hernia ◽

Ventral Hernia Repair ◽

Incisional Hernia Repair ◽

Defect Closure ◽

Site Infection ◽

Group 3 ◽

The Mean ◽

Ventral And Incisional Hernia

Abstract Purpose The aim of this study was to assess the feasibility and safety of a novel IPOM procedure with peritoneal bridging (IPOM-pb) for laparoscopic ventral hernia repair, and to compare the outcomes of this procedure with IPOM with- (IPOM-plus) and IPOM without (sIPOM) defect closure. Method A single-centre retrospective study comparing a novel IPOM technique with peritoneal bridging (IPOM-pb) with the two commonly used IPOM techniques, IPOM with defect closure (IPOM-plus) and without defect closure (sIPOM). The intraoperative and postoperative data of patients who underwent laparoscopic IPOM ventral hernia repair were reviewed. Preoperative data, recurrence, and postoperative seroma, surgical site infection, and pain, were compared. Results From January 2017 to June 2020, a total of 213 patients underwent laparoscopic ventral and incisional hernia repair with IPOM technique. The mean length and width of the ventral hernia was 4.4 ± 1.8 cm and 3.6 ± 1.4 cm, respectively, and the mean BMI was 30.1 ± 5.2 kg/m2. The mean operating time was 67 ± 28 min and was longer for IPOM-pb (71 ± 27 min), less for IPOM-plus (63 ± 28 min), and least for sIPOM (61 ± 26 min). The incidence of early postoperative seroma was least in IPOM-pb (1/98, 1%), and similar in the IPOM-plus (4/94, 4%) and sIPOM (1/21, 5%) group. Late postoperative seroma was found only in IPOM-plus (2, 2%). The incidence of early and late postoperative pain was relatively higher in sIPOM (3, 14%; 1, 5%, respectively) compared to IPOM-pb and IPOM-plus in the early (5, 5% and 6, 6%) and late (2, 2% and 1, 1%) postoperative period, respectively. Surgical site infection was higher in sIPOM group (3, 14%), compared to IPOM-pb (1, 1%), and IPOM-plus (3, 3%). Recurrence rates were similar in IPOM-pb group (3/98, 3%) and IPOM-plus (3/94, 3%), and none in sIPOM (0/21). Conclusion IPOM with peritoneal bridging is as feasible and safe as conventional IPOM with defect closure and simple non-defect closure. However, a large randomised controlled trial is required to confirm this finding.

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