173 Long Term Analysis of The Evolution of Practice and Results of Abdominal Wall Reconstruction by A Single Surgeon

Abstract Background It is estimated that at least 12-15% of abdominal operations lead to incisional hernias, and Worldwide, evidence shows high rates of recurrence after surgical repair ranging from 12.7% in the Danish hernia registry to 23% in the Swedish registry. Method This is a retrospective analysis of the practice of a single surgeon at a tertiary centre. An electronic database provided all hernia surgeries done by the surgeon. A total of 185 patients with complete data were included who had open hernia repair. Electronic patient records were analysed to collect the data. Results 185 patients, with a median age of 57 years (IQR 68 – 49), and BMI of 31.14 (IQR 36.02 – 27.52), had a hernia recurrence rate of 15.6% (29/185). More than 80% of the cases were complex hernias with a European Hernia classification of M3 and/ or W3, with dense intestinal adhesions and multiple previous repairs. Variability in techniques and mesh evolved over this period, from anterior component separation to transversus abdominis release to achieve closure of the abdomen. Polypropylene meshes were used for non-contaminated or less complex cases. The use of biologics in the early years has been superseded by biosynthetic. Conclusions The creation of the abdominal wall unit and subsequent MDT at this centre resulted in a rise of total procedures, complexity of cases and patients with significant co-morbidities. Specialised abdominal wall surgeons are associated with better results when performing complex abdominal wall reconstructions.

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Long-Term Clinical Outcomes of an Antibiotic-Coated Non–Cross-linked Porcine Acellular Dermal Graft for Abdominal Wall Reconstruction for High-Risk and Contaminated Wounds

The American Surgeon ◽

10.1177/00031348211023392 ◽

2021 ◽

pp. 000313482110233

Author(s):

Jordan Robinson ◽

Jesse K. Sulzer ◽

Benjamin Motz ◽

Erin H. Baker ◽

John B. Martinie ◽

...

Keyword(s):

High Risk ◽

Abdominal Wall ◽

Clinical Outcomes ◽

Open Abdomen ◽

Abdominal Wall Reconstruction ◽

Dermal Graft ◽

Elective Repair ◽

Acellular Dermal

Background Abdominal wall reconstruction in high-risk and contaminated cases remains a challenging surgical dilemma. We report long-term clinical outcomes for a rifampin-/minocycline-coated acellular dermal graft (XenMatrix™ AB) in complex abdominal wall reconstruction for patients with a prior open abdomen or contaminated wounds. Methods Patients undergoing abdominal wall reconstruction at our institution at high risk for surgical site occurrence and reconstructed with XenMatrix™ AB with intent-to-treat between 2014 and 2017 were included. Demographics, operative characteristics, and outcomes were collected. The primary outcome was hernia recurrence. The secondary outcomes included length of stay, surgical site occurrence, readmission, morbidity, and mortality. Results Twenty-two patients underwent abdominal wall reconstruction using XenMatrix™ AB during the study period. Two patients died while inpatient from progression of their comorbid diseases and were excluded. Sixty percent of patients had an open abdomen at the time of repair. All patients were from modified Ventral Hernia Working Group class 2 or 3. There were a total of four 30-day infectious complications including superficial cellulitis/fat necrosis (15%) and one intraperitoneal abscess (5%). No patients required reoperation or graft excision. Median clinical follow-up was 38.2 months with a mean of 35.2 +/− 18.5 months. Two asymptomatic recurrences and one symptomatic recurrence were noted during this period with one planning for elective repair of an eventration. Follow-up was extended by phone interview which identified no additional recurrences at a median of 45.5 and mean of 50.5 +/−12.7 months. Conclusion We present long-term outcomes for patients with high-risk and contaminated wounds who underwent abdominal wall reconstruction reinforced with XenMatrix™ AB to achieve early, permanent abdominal closure. Acceptable outcomes were noted.

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Abdominal Wall Expanding System. Intraoperative Abdominal Wall Expansion as a Technique to Repair Giant Incisional Hernia and Laparostoma. New and Long-Term Results From a Three-Center Feasibility Study

Surgical Innovation ◽

10.1177/15533506211041477 ◽

2021 ◽

pp. 155335062110414

Author(s):

Dietmar Eucker ◽

Nadine Rüedi ◽

Clinton Luedtke ◽

Oliver Stern ◽

Henning Niebuhr ◽

...

Keyword(s):

Abdominal Wall ◽

Abdominal Wall Reconstruction ◽

Long Term Results ◽

Anatomical Reconstruction ◽

Time Saving ◽

Lateral Abdominal Wall ◽

Hernia Size ◽

Midline Closure

Background The abdominal wall expanding system (AWEX) was first applied in 2012 and published in 2017. This novel technique was developed to reconstruct complex incisional hernias and residual skin-grafted laparostoma after treatment of an open abdomen, when primary midline closure was impossible. The main aim was the anatomical reconstruction of the abdominal wall and the avoidance of dissecting techniques (component separation). Methods Between 2012 and 2019, 33 patients underwent AWEX hernia repair in three certified hernia centers. The retracted abdominal wall was stretched with the AWEX system intraoperatively for approximately 30 min. Hernia size was measured preoperatively, on CT, and intraoperatively. The gain in length on the lateral abdominal wall (decrease in width of the defect) after stretching and any residual midline gap were determined in the OR. Results 33 patients underwent AWEX procedures. Six cases were evaluated separately because of additional procedures (TAR, four cases) and preoperative application of botulinum toxin (two cases). The median (95% confidence interval) measured width of hernia defects was 13 (12–16) cm, the median gain in length on the lateral abdominal wall was 12 (10–15) cm. After median follow-up of 29 (12–54) months, one recurrence from the broken mesh was observed. No method-related complications occurred. Conclusion Based on the 2017 and current results, the AWEX system represents an alternative or supplemental procedure to current techniques for complex abdominal wall reconstruction. The system proved again to be time-saving, safe, effective, and easy to learn. Further studies with enhanced technology are in progress.

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Systematic review of transversus abdominis release in complex abdominal wall reconstruction

Hernia ◽

10.1007/s10029-018-1870-5 ◽

2018 ◽

Vol 23 (1) ◽

pp. 5-15 ◽

Cited By ~ 12

Author(s):

J. A. Wegdam ◽

J. M. M. Thoolen ◽

S. W. Nienhuijs ◽

N. de Bouvy ◽

T. S. de Vries Reilingh

Keyword(s):

Systematic Review ◽

Abdominal Wall ◽

Abdominal Wall Reconstruction ◽

Transversus Abdominis ◽

Transversus Abdominis Release

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P011 THE EARLY OUTCOMES OF ABDOMINAL WALL RECONSTRUCTION WITH POLYVINYLIDENE (PVDF) MESH IN THE INFECTED SETTING: A CASE-CONTROL SERIES

British Journal of Surgery ◽

10.1093/bjs/znab395.010 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Claudio Birolini ◽

Eduardo Tanaka ◽

Jocielle Miranda ◽

Abel Murakami ◽

Edivaldo Utiyama

Keyword(s):

Abdominal Wall ◽

Abdominal Wall Reconstruction ◽

Synthetic Mesh ◽

Tissue Response ◽

Abdominal Wall Defects ◽

Chronic Infections ◽

Control Series ◽

Elective Setting ◽

Abdominal Operations ◽

Low Incidence

Abstract Aim The use of synthetic mesh to repair infected defects of the abdominal wall remains controversial. PVDF mesh was introduced in 2002 as an alternative to polypropylene, with the advantages of improved biostability, lowered bending stiffness, and minimum tissue response. This study aimed to evaluate the short-term outcomes of using PVDF mesh to treat infected abdominal wall defects in the elective setting. Material and Methods A prospective clinical trial started in 2016 and designed to evaluate the short and mid-term outcomes of 38 patients submitted to abdominal wall reconstruction in the setting of active mesh infection and/or enteric fistulas (AI) when compared to a group of 38 patients submitted to clean ventral hernia repairs (CC). Patients were submitted to single-staged repairs, using onlay PVDF mesh reinforcement to treat their defects. Results Groups had comparable demographic characteristics. The AI group had more previous abdominal operations and a longer operative and anesthesia time. At 30-days, surgical site occurrences were observed in 18 (47.4%) AI vs. 17 (44.7%) CC; surgical site infection occurred in 4 (10.4%) AI vs. 6 (15.8%) CC, and a higher number of procedural interventions were required in the CC group, 15.8% AI vs. 28.9% CC. At 6-months follow-up, no chronic infections or hernia recurrences were observed in both groups. Conclusions The use of PVDF mesh in the infected setting presented very favorable results with a low incidence of wound infection.

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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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Retrospective single-center experience with the transversus abdominis muscle release procedure in complex abdominal wall reconstruction

International Journal of Abdominal Wall and Hernia Surgery ◽

10.4103/ijawhs.ijawhs_11_18 ◽

2018 ◽

Vol 1 (2) ◽

pp. 60

Author(s):

Ping Wang ◽

Yonggang Huang ◽

Jing Ye ◽

Guodong Gao ◽

Fangjie Zhang ◽

...

Keyword(s):

Abdominal Wall ◽

Abdominal Wall Reconstruction ◽

Transversus Abdominis ◽

Single Center ◽

Single Center Experience ◽

Transversus Abdominis Muscle

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Acute kidney injury e-alerts in pregnancy: rates, recognition and recovery

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa217 ◽

2020 ◽

Cited By ~ 1

Author(s):

Rouvick M Gama ◽

Katherine Clark ◽

Mahua Bhaduri ◽

Amanda Clery ◽

Kelly Wright ◽

...

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

Postpartum Women ◽

Electronic Patient Records ◽

Repeat Testing ◽

Tertiary Centre ◽

Delivery Date ◽

Maternal Morbidity And Mortality ◽

In Pregnancy

Abstract Background Acute kidney injury (AKI) in pregnancy (Pr-AKI) is associated with substantial maternal morbidity and mortality. E-alerts are routinely used for detection of AKI in non-pregnant patients but their role in maternity care has not been explored. Methods All pregnant or postpartum women with AKI e-alerts for AKI Stages 1–3 (Kidney Disease Improving Global Outcomes (KDIGO) criteria) were identified at a tertiary centre >2 years. Two women matched by delivery date for each case were selected as controls. AKI stage, recognition of AKI, pregnancy outcomes, renal recovery, AKI aetiology and risk factors were extracted from electronic patient records. Results 288 of 11 922 (2.4%) women had AKI e-alerts, of which only 118 (41%) were recognized by the obstetric team. Common Pr-AKI causes included infection (48%), pre-eclampsia (26%) and haemorrhage (25%), but no cause was identified in 15% of women. Renal function recovered in 213 (74%) women, but in 47 (17%) repeat testing was not undertaken and 28 (10%) did not recover function. Hypertensive disorders of pregnancy and Caesarean section were associated with increased incidence of Pr-AKI compared with controls. Conclusions Pr-AKI e-alerts were identified in ∼1 in 40 pregnancies. However, a cause for Pr-AKI was not identified in many cases and e-alerts may have been triggered by gestational change in serum creatinine. Pregnancy-specific e-alert algorithms may be required. However, 1 in 10 women with Pr-AKI had not recovered kidney function on repeat testing. Better understanding of long-term impacts of Pr-AKI on pregnancy and renal outcomes is needed to inform relevant Pr-AKI e-alert thresholds.

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Perioperative Outcomes of Minimally Invasive vs Open Transversus Abdominis Release in Patients Undergoing Abdominal Wall Reconstruction

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2019.08.243 ◽

2019 ◽

Vol 229 (4) ◽

pp. S108

Author(s):

Alex J. Addo ◽

Allison Estep ◽

Andrew Broda ◽

Richard Lu ◽

H Reza Zahiri ◽

...

Keyword(s):

Minimally Invasive ◽

Abdominal Wall ◽

Abdominal Wall Reconstruction ◽

Transversus Abdominis ◽

Perioperative Outcomes ◽

Transversus Abdominis Release

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Concomitant Anterior and Posterior Component Separations: Absolutely Contraindicated?

Surgical Innovation ◽

10.1177/1553350620914195 ◽

2020 ◽

pp. 155335062091419

Author(s):

Jorge Daes ◽

Joshua S. Winder ◽

Eric M. Pauli

Keyword(s):

Abdominal Wall ◽

Lateral Displacement ◽

Abdominal Wall Reconstruction ◽

Component Separation ◽

Transversus Abdominis ◽

Lateral Abdominal Wall ◽

Computed Tomography Images ◽

Fresh Cadaver ◽

Semilunar Line ◽

Internal Oblique

Many experts in abdominal wall reconstruction believe that the combination of simultaneous ipsilateral anterior component separation (ACS) and posterior component separation (PCS) is contraindicated. We performed ipsilateral endoscopic ACS and either endoscopic or open PCS-transversus abdominis release (TAR) in 5 fresh cadaver models. The full length of the semilunar line and the lateral abdominal wall remained well reinforced by 2 complete layers, comprising the internal oblique (IO) and TA muscles and their investing fasciae. Myofascial releases occurred 4 cm (median) apart. Additionally, we reviewed computed tomography images at 1 month and 1 year after PCS-TAR in 17 patients (30 PCS-TARs). Lateral displacement of the TA relative to the rectus abdominis (RA) was significant only at the superior mesenteric artery level, where it was <1 cm (median). Muscle mass changed minimally over time. Several studies showed that abdominal wall reconstruction after PCS-TAR results in compensatory muscular hypertrophy of the RA, external oblique (EO), and IO muscles and provides better quality of life and improved core physiology. These changes did not occur when the midline was not restored. Theoretically, endoscopic ACS-EO may be added to PCS-TAR to avoid partially bridged mesh repair in patients in whom complete midline restoration is impossible via PCS-TAR alone. Nevertheless, we advise most surgeons to perform a small-bridged repair instead of risking increased morbidity by attempting a highly complicated procedure.

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