scholarly journals P013 HOW TO IMPROVE TREATMENT OF COMPLEX INCISIONAL HERNIAS IN OBESE PATIENTS: A SINGLE-CENTRE STUDY, AN EVALUATION OF LESS-OPEN TECHNIQUE AND FREE-FIXATION TECHNIQUE

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Petr Bystřický ◽  
Stanislav Šuhájek ◽  
Petr Pták
Keyword(s):  
Length Of Stay ◽  
Incisional Hernia ◽  
Operation Time ◽  
Component Separation ◽  
Separation Technique ◽  
Obese Patients ◽  
Open Technique ◽  
Posterior Component Separation ◽  
Incisional Hernias

Abstract Aim Surgery of a complex incisional hernia in an obese patient is a challenging procedure for hernia surgeons. The aim of a new approach is to reduce complications such as pain and wound events, without increasing the number of recurrences. Material and Methods Adults with BMI more than 35 who underwent open, elective operation of a complex incisional hernia (with horizontal diameter more than 12cm) including posterior component separation technique with TAR (transversus abdominis muscle release) and retromuscular synthetic large-pore mesh placement, were identified. Patients were divided into 2 groups: The first group was treated with standard open technique with fixation using interrupted stitches, and the second group was treated with a technique using light hook and no or reduced fixation in the upper and lower pole of the mesh. For post-operative complication evaluation, the Clavien-Dindo classification was used. We have also evaluated an average operation time, length of stay, duration of opioid need. The long-term follow-up was 6 – 48 months. Results There was no significant difference in length of stay, the need of analgetic treatment, and hernia recurrence. Shorter operation time, and lower occurrence of surgical-site infections were reported in the second group, but it was not significant. Conclusions Open posterior component separation technique with TAR using large-pore mesh and no/minimal fixation seems to be a safe and sufficient method of treatment for complex incisional hernias in obese patients. Alternative methods may reduce early complications and pain and do not increase number of recurrences. A larger group of patients and longer follow-up should be needed to improve these findings.

Incidence of Ostomy Site Incisional Hernias after Stoma Closure

2015 ◽  
Vol 81 (12) ◽  
pp. 1244-1248 ◽  
Author(s):  
Stephen P. Sharp ◽  
Jacquelyn K. Francis ◽  
Brian T. Valerian ◽  
Jonathan J. Canete ◽  
A. David Chismark ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Incisional Hernia ◽  
Body Mass ◽  
Late Complication ◽  
Significant Risk ◽  
Operation Time ◽  
Stoma Closure ◽  
Incisional Hernias ◽  
Number Of Patients

This study sought to evaluate the incidence of ostomy site incisional hernias after stoma reversal at a single institution. This is a retrospective analysis from 2001 to 2011 evaluating the following demographics: age, gender, indication for stoma, urgent versus elective operation, time to closure, total follow-up time, the incidence of and reoperation for stoma incisional hernia, diabetes, postoperative wound infection, smoking status within six months of surgery, body mass index, and any immunosuppressive medications. A total of 365 patients were evaluated. The median follow-up time was 30 months. The clinical hernia rate was 19 percent. Significant risk factors for hernia development were age, diabetes, end colostomies, loop colostomies, body mass index >30, and undergoing an urgent operation. The median time to clinical hernia detection was 32 months. Sixty-four percent of patients required surgical repair of their stoma incisional hernia. A significant number of patients undergoing stoma closure developed an incisional hernia at the prior stoma site with the majority requiring definitive repair. These hernias are a late complication after stoma closure and likely why they are under-reported in the literature.

scholarly journals Predictors of Incisional Hernia after Robotic Assisted Radical Prostatectomy

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Avinash Chennamsetty ◽  
Jason Hafron ◽  
Luke Edwards ◽  
Scott Pew ◽  
Behdod Poushanchi ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Incisional Hernia ◽  
Operative Time ◽  
Patient Counseling ◽  
Incisional Hernias ◽  
Prostate Weight ◽  
History Of ◽  
Robotic Assisted Radical Prostatectomy

Introduction.To explore the long term incidence and predictors of incisional hernia in patients that had RARP.Methods.All patients who underwent RARP between 2003 and 2012 were mailed a survey reviewing hernia type, location, and repair.Results.Of 577 patients, 48 (8.3%) had a hernia at an incisional site (35 men had umbilical), diagnosed at (median) 1.2 years after RARP (mean follow-up of 5.05 years). No statistically significant differences were found in preoperative diabetes, smoking, pathological stage, age, intraoperative/postoperative complications, operative time, blood loss, BMI, and drain type between patients with and without incisional hernias. Incisional hernia patients had larger median prostate weight (45 versus 38 grams;P=0.001) and a higher proportion had prior laparoscopic cholecystectomy (12.5% (6/48) versus 4.6% (22/480);P=0.033). Overall, 4% (23/577) of patients underwent surgical repair of 24 incisional hernias, 22 umbilical and 2 other port site hernias.Conclusion.Incisional hernia is a known complication of RARP and may be associated with a larger prostate weight and history of prior laparoscopic cholecystectomy. There is concern about the underreporting of incisional hernia after RARP, as it is a complication often requiring surgical revision and is of significance for patient counseling before surgery.

scholarly journals Prophylactic Onlay Mesh Implantation During Definitive Fascial Closure After Open Abdomen Therapy (PROMOAT): Absorbable or Non-absorbable? Methodical Description and Results of a Feasibility Study

2020 ◽  
Vol 7 ◽  
Author(s):  
Sebastian Schaaf ◽  
Robert Schwab ◽  
Christoph Güsgen ◽  
Arnulf Willms
Keyword(s):  
Incisional Hernia ◽  
Open Abdomen ◽  
Fascial Closure ◽  
Special Focus ◽  
Term Outcome ◽  
Mesh Implantation ◽  
Incisional Hernias ◽  
Onlay Mesh

Introduction: Incisional hernia development after open abdomen therapy (OAT) remains a common complication in the long run. To demonstrate the feasibility, we describe our method of prophylactic onlay mesh implantation with definitive fascial closure after open abdomen therapy (PROMOAT). To display the feasibility of this concept, we evaluated the short-term outcome after absorbable and non-absorbable synthetic mesh implantation as prophylactic onlay.Material and Methods: Ten patients were prospectively enrolled, and prophylactic onlay mesh (long-term absorbable or non-absorbable) was implanted at the definitive fascial closure operation. The cohort was followed up with a special focus on incisional hernia development and complications.Results: OAT duration was 21.0 ± 12.6 days (95% CI: 16.9–25.1). Definitive fascial closure was achieved in all cases. No incisional hernias were present during a follow-up interval of 12.4 ± 10.8 months (range 1–30 months). Two seromas and one infected hematoma occurred. The outcome did not differ between mesh types.Conclusion: The prophylactic onlay mesh implantation of alloplastic, long-term absorbable, or non-absorbable meshes in OAT showed promising results and only a few complications that were of minor concern. Incisional hernias did not occur during follow-up. To validate the feasibility and safety of prophylactic onlay mesh implantation long-term data and large-scaled prospective trials are needed to give recommendations on prophylactic onlay mesh implantation after OAT.

“Component separation” technique and panniculectomy for repair of incisional hernia

2011 ◽  
Vol 201 (6) ◽  
pp. 776-783 ◽  
Author(s):  
Marco Mazzocchi ◽  
Luca Andrea Dessy ◽  
Raul Ranno ◽  
Bruno Carlesimo ◽  
Corrado Rubino
Keyword(s):  
Incisional Hernia ◽  
Component Separation ◽  
Separation Technique ◽  
Component Separation Technique

scholarly journals Ventral incisional hernia case report: A therapeutic challenge

2020 ◽  
Vol 8 ◽  
pp. 2050313X2092762
Author(s):  
Túlio Fabiano de Oliveira Leite ◽  
Lucas Alves Sarmento Pires ◽  
Carlos Alberto Araujo Chagas
Keyword(s):  
Risk Factors ◽  
Incisional Hernia ◽  
Low Income ◽  
Low Income Countries ◽  
Abdominal Wall Defects ◽  
Obese Patients ◽  
Common Condition ◽  
Recurrence Rates ◽  
Incisional Hernias ◽  
Ventral Incisional Hernia

Incisional hernias are a very common condition and they still are considered to be a surgical challenge due to their recurrence rate. Smoking, obesity and age are risk factors for developing these abdominal wall defects. Despite recent advances in hernia repairs, the recurrence rates of hernias did not significantly diminished, even after the introduction of meshes. The aim of this article is to report a case of a ventral incisional hernia in a 37-year-old man and its successful treatment with a procedure known as the Alcino-Lázaro technique repair. This procedure has been shown to be very effective in incisional hernias, especially in obese patients. Furthermore, it is as cheap as it is reliable, since it can be performed without technological aid or expensive materials (mesh); thus, patients in low-income countries can greatly benefit from this procedure.

scholarly journals Study of outcome of a new method of darning for repair of large and recurrent hernias

2019 ◽  
Vol 6 (6) ◽  
pp. 2036
Author(s):  
Dibyendu Das ◽  
Neelam Yadav ◽  
Kamlesh Jhariya ◽  
Reena Minz
Keyword(s):  
Incisional Hernia ◽  
Randomized Study ◽  
Rectus Sheath ◽  
Recurrent Hernia ◽  
Minimum Period ◽  
Mattress Suture ◽  
Incisional Hernias ◽  
Significant Challenge ◽  
Early Postoperative Complication

Background: Incisional hernia is the result of a failure of fascial tissues to heal and close following laparotomy. Laparoscopic Meshplasty is a standard method of repair but not usually done in large incisional and recurrent hernias.  Recurrence after repair is common in incisional hernia and poses a significant challenge for the plastic surgeons. We describe here a technique of anatomical repair of the large incisional, and recurrent hernia by darning without using mesh, which is effective in midline, paramedian as well as transverse incisional hernias. Aims and objectives to study the outcome and efficacy of our technique of Darning in cases of large and recurrent incisional hernias without using mesh.Methods: It is a prospective non randomized study of 5 year duration in which we have studied 20 cases of either large or recurrent incisional hernia admitted in our hospital. We operated these cases by darning of the rectus sheath without tension by mattress suture by prolene no.1.Results: 20 patients underwent this repair with few minor complications and there was no recurrence for minimum period of follow of 2 years.  Approximation of inner margin and separately mattress pattern darning of outer rectus sheath by prolene no.1 strengthens the repair, but do not cause complication associated with meshplasty like infection, adhesion and fistula formatioṇ.Conclusions: Our technique of darning is an extraperitoneal method of hernia repair which do not incorporate mesh and is an effective method of hernioplasty with manageable early postoperative complication. We have not seen any recurrences in follow up period.

Using Prophylactic Prolene Mesh to Reduce the Incidence of Incisional Hernia at the Site of Stoma Closure

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Hassan Sayed Tantawy ◽  
Mohamed Mahfouz Mohamed ◽  
Ahmed Yasser Abdel Halim ◽  
Mostafa Mohamed Abdel Aziz
Keyword(s):  
Incisional Hernia ◽  
Prospective Study ◽  
Clinical Examination ◽  
Stoma Closure ◽  
Prolene Mesh ◽  
Incisional Hernias ◽  
Stoma Site ◽  
A Prospective Study ◽  
Over Time

Abstract Background Incisional hernias at stoma sites are not an infrequent problem, occurring in up to 30% of cases and it also varied in a range of studies from 0-48%. Objectives This is a prospective study to detect the feasibility of application of prolene mesh at the site of stoma closure in reducing the rate of post stomal incisional. INTRODUCTION Abdominal wall hernias are common and are a significant cause of morbidity. Stomas are commonly constructed following colorectal surgery to protect distal anastomosis or when sepsis prevents primary anastomosis. There is a risk of a wide range of morbidity following both stoma formation and stoma reversal (Chow et al., 2009). Incisional hernias at stoma sites are not an infrequent problem, occurring in up to 30% of cases and it also varied in a range of studies from 0-48% (Tilney et al., 2008). They occur over time and are generally under-reported, which may be due to the elderly nature of the population, the significant co-morbidities or early discharge from follow-up (Cingi et al., 2006). One in three patients may develop a hernia after stoma closure, and around half of hernias that are detected require repair.Risk of hernia is greater after colostomy closure than after ileostomy closure(Bhangu et al., 2012). A meta-analysis published in 2012 investigated the incidence of incisional hernia following closure of stoma, The overall mean incisional hernia rate following stoma closures was 7.4%. The authors reported a lower risk of hernia following reversal of ileostomy when compared to respectively (Bhangu et al., 2012). A further systematic review found a similar incidence for stoma site incisional hernias to be 8.3% (0–33.9%) (Nguyen et al., 2014). Two factors should be noted with regard to the incidence of stoma site hernia. Firstly, that the long-term risk is not known and secondly, that clinical examination alone is shown to have a lower detection rate of incisional hernia post stoma closure when compared to clinical imaging (Bhangu et al., 2012; Cingi et al., 2006). Therefore, studies focusing on only clinical examination may be underestimating the prevalence, as radiological detected herniae may become symptomatic over time and may be missed in studies with a short follow-up period. AIM OF THE WORK This is a prospective study to detect the feasibility of application of prolene mesh at the site of stoma closure in reducing the rate of post stomal incisional.

scholarly journals COMPARISON BETWEEN INCIDENCE OF INCISIONAL HERNIA IN LAPAROSCOPIC CHOLECYSTECTOMY AND BY SINGLE PORT

2018 ◽  
Vol 31 (1) ◽  
Author(s):  
Fernando Athayde MADUREIRA ◽  
Cristiane Luzia Teixeira GOMEZ ◽  
Eduardo Monteiro ALMEIDA
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Incisional Hernia ◽  
Single Port ◽  
Conventional Technique ◽  
Single Port Access ◽  
Conventional Laparoscopic Cholecystectomy ◽  
Incisional Hernias ◽  
Conventional Laparoscopic ◽  
Port Access

ABSTRACT Background: Surgeries with single port access have been gaining ground among surgeons who seek minimally invasive procedures. Although this technique uses only one access, the incision is larger when compared to laparoscopic cholecystectomy and this fact can lead to a higher incidence of incisional hernias. Aim: To compare the incidence of incisional hernia after laparoscopic cholecystectomy and by single port. Methods: A total of 57 patients were randomly divided into two groups and submitted to conventional laparoscopic cholecystectomy (n=29) and laparoscopic cholecystectomy by single access (n=28). The patients were followed up and reviewed in a 40.4 month follow-up for identification of incisional hernias. Results: Follow-up showed 21,4% of incisional hernia in single port group and 3.57% in conventional technique. Conclusions: There was a higher incidence of late incisional hernia in patients submitted to single port access cholecystectomy compared to conventional laparoscopic cholecystectomy.

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