scholarly journals OV09 ROBOTIC REPAIR OF SUBXIPHOID INCISIONAL HERNIA POST CABG

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Moamena El-Matbouly ◽  
Yaser Janahi ◽  
Ahmed Suliman ◽  
Hany Atalah ◽  
Ahmed Albahrani
Keyword(s):  
Incisional Hernia ◽  
Abdominal Wall ◽  
Complex Structure ◽  
Median Sternotomy ◽  
Wound Dehiscence ◽  
High Recurrence Rate ◽  
Linea Alba ◽  
Prolonged Intubation ◽  
Sternal Wound Dehiscence ◽  
Upper Abdominal

Abstract Aim A median sternotomy that extends toward the epigastric area can weaken the upper abdominal wall and result in the development of subxiphoid incisional hernia. We aim to assess the efficacy and the feasibility of repair of subxiphoid incisional hernia post CABG robotically. In this video; we will also review the surgical technique and the steps for robotic repair of subxiphoid incisional hernia Material and Methods 57-year-old female presented with subxiphoid swelling post CABG in 2019. Her surgery was complicated with sternotomy wound infection with VAC dressing application and ARDS with prolonged intubation. She had 5x7 cm hernia defect that showed on the CT thorax along with sternal wound dehiscence. She underwent robotic repair of her hernia with phasix mesh and recovered well after surgery. Results The subxiphoid hernia is known for its repair complexities and high recurrence rate because the subxiphoid area is a complex structure consisting of boney structures, the rectus abdominis muscles, linea alba, and the diaphragm. The Da Vinci platform allows for accessing hard-to reach area with enhanced precision in dissection and superior dexterity compared to laparoscopy. The Robotic platform allows for manipulation of the camera to assess and operate on the abdominal wall with ease as compared to laparoscopy. Conclusions robotic repair of subxiphoid incisional hernia with mesh is safe and effective method of repair. There are no short-term or long- term side effects of the procedure with no recurrence at 6 months follow up.

scholarly journals Evaluation of a new suture material (Duramesh™) by measuring suture tension in small and large bites techniques for laparotomy closure in a porcine model

Hernia ◽  
2020 ◽  
Vol 24 (6) ◽  
pp. 1317-1324
Author(s):  
Y. Yurtkap ◽  
F. P. J. den Hartog ◽  
W. van Weteringen ◽  
J. Jeekel ◽  
G. J. Kleinrensink ◽  
...  
Keyword(s):  
Incisional Hernia ◽  
Abdominal Wall ◽  
Suture Material ◽  
Abdominal Pressure ◽  
Postoperative Phase ◽  
Burst Abdomen ◽  
Linea Alba ◽  
Custom Made ◽  
Suture Tension ◽  
Significant Difference

Abstract Purpose After closure of laparotomies, sutures may pull through tissue due to too high intra-abdominal pressure or suture tension, resulting in burst abdomen and incisional hernia. The objective of this study was to measure the suture tension in small and large bites with a new suture material. Methods Closure of the linea alba was performed with small bites (i.e., 5 mm between two consecutive stitches and 5 mm distance from the incision) and large bites (i.e., 10 mm × 10 mm) with Duramesh™ size 0 (2 mm) and PDS II 2-0 in 24 experiments on six porcine abdominal walls. The abdominal wall was fixated on an artificial computer-controlled insufflatable abdomen, known as the ‘AbdoMan’. A custom-made suture tension sensor was placed in the middle of the incision. Results The suture tension was significantly lower with the small bites technique and Duramesh™ when compared with large bites (small bites 0.12 N (IQR 0.07–0.19) vs. large bites 0.57 N (IQR 0.23–0.92), p  < 0.025). This significant difference was also found in favour of the small bites with PDS II 2-0 (p  < 0.038). No macroscopic tissue failure was seen during or after the experiments. Conclusion Closure of the abdominal wall with the small bites technique and Duramesh™ was more efficient in dividing suture tension across the incision when compared to large bites. However, suture tension compared to a conventional suture material was not significantly different, contradicting an advantage of the new suture material in the prevention of burst abdomen and incisional hernia during the acute, postoperative phase.

scholarly journals Cadaver as an experimental a model for the study of midline incisional hernia

2011 ◽  
Vol 26 (4) ◽  
pp. 310-313 ◽  
Author(s):  
Romar Ângelo Barbato Silveira ◽  
Fábio Xerfan Nahas ◽  
Bernardo Hochman ◽  
Felix Carlos Ocariz Bazzano ◽  
Carlos Roberto Amorim ◽  
...  
Keyword(s):  
Incisional Hernia ◽  
Abdominal Wall ◽  
Abdominal Wall Defect ◽  
Tensile Force ◽  
Rectus Abdominis ◽  
Rectus Abdominis Muscle ◽  
Wall Defect ◽  
Linea Alba ◽  
Force Application ◽  
Tensile Forces

PURPOSE: To describe a cadaver model and to compare different techniques to correct midline incisional hernia using the tension at the musculoaponeurotic layer as a parameter. METHODS: Twenty-four male cadavers were used to characterize the model. The tensile force applied to the anterior layers of the rectus abdominis muscle was measured after the linea alba was resected to create an abdominal wall defect. A dynamometer was used to measure the tensile force necessary to cause a 10-mm displacement of the tissues towards the midline. An index that allows comparison of tensile forces from different points was calculated by dividing the tensile force by the distance between the point of force application at the aponeurosis and the midline. RESULTS: Cadaver is a good model for the study of midline incisional hernia. CONCLUSION: Cadaver can be used effectively as a model to evaluate tension of the abdominal wall when tissue advancement and musculoaponeurotic flaps are performed in the repair of midline incisional hernia.

Sternal wound dehiscence after median sternotomy: An alternative closure technique

2021 ◽  
Author(s):  
Filippo Tommaso Gallina ◽  
Enrico Melis ◽  
Daniele Forcella ◽  
Francesco Facciolo
Keyword(s):  
Median Sternotomy ◽  
Wound Dehiscence ◽  
Closure Technique ◽  
Sternal Wound Dehiscence

scholarly journals Prophylactic Implantation of Biologic Mesh in Peritonitis (PROPHYBIOM): A Prospective Multicentric Randomized Controlled Trial.

2021 ◽  
Author(s):  
Federico Coccolini ◽  
Antonio Tarasconi ◽  
Gabriele Luciano Petracca ◽  
Gennaro Perrone ◽  
Mario Giuffrida ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Incisional Hernia ◽  
Abdominal Wall ◽  
Controlled Trial ◽  
Wound Dehiscence ◽  
Emergency Setting ◽  
Increased Risk ◽  
Related Quality ◽  
Dermal Collagen

Abstract Background. Patients undergoing emergency surgery for peritonitis are at increased risk of abdominal wall-related complications. In patients with peritonitis the risk of incisional hernia (IH) is extremely elevated. The evaluation of quality of life of patients with incisional hernia showed lower mean scores on physical components of health-related quality of life and body image. Furthermore, the arise of a post-operative abdominal wall complication (i.e. wound dehiscence, evisceration and IH) greatly increases morbidity and mortality rates and prolongs the hospitalization.Methods. The present study aims to evaluate the efficacy of the use of a swine dermal collagen prosthesis implanted preperitoneally as a prophylactic procedure in urgency/emergency setting against abdominal wall complications in patients operated with contaminated/infected field in peritonitis. The sample size was defined in 90 patients divided in two arms (prosthesis positioning versus normal wall abdominal closure). The follow-up will be performed at 3, 6 and 12 months after surgery. The percentage of incisional hernias, wound infections, adverse events will be investigated by physical examination and ultrasound.Discussion. The objective is to evaluate the possibility to reduce the incisional hernia rate in patients undergoing urgent/emergent laparotomy in contaminated/infected field with peritonitis by using swine dermal collagen prosthesis preperitoneal positioning as a prophylactic procedure.Trial registration. The trial has been registered on clinicaltrials.gov (ID number: NCT04681326) from 23 December 2020.

scholarly journals Experimental models of longitudinal abdominal incisional hernia in rats

1997 ◽  
Vol 12 (4) ◽  
pp. 235-239
Author(s):  
Danilo N. S. Paulo ◽  
Fausto E. L. Pereira ◽  
Ricardo F. da Mata ◽  
Fabyano R. Dauad ◽  
Isabel C. A. L. Paulo
Keyword(s):  
Incisional Hernia ◽  
Abdominal Wall ◽  
Subcutaneous Tissue ◽  
Skin Incision ◽  
Abdominal Muscle ◽  
Experimental Models ◽  
Abdominal Muscles ◽  
Median Line ◽  
Large Defect ◽  
Linea Alba

Abdominal incisional hernias in rats has been produced after resection of a segment of abdominal muscle. In a attempt to create a model of incisional hernia in rats, without resection of abdominal muscle, the following surgical procedures were performed: (a) Rats anesthetized with ether were submitted to a 4 cm long median incision, supra and infraumbilical, followed by dissection of the subcutaneous tissue 1.5 cm laterally to the median line in each side; after, one incision was performed in the linea alba and peritoneum, with the same extension of the skin incision; the skin incision was sutured. (b) Rats were submited to a suprapubic transversal incision and a scissors introduced through this incision and used to dissect the subcutaneous tissue at least 1.5 cm for each side of median line; after, the linea alba and peritoneoum were incised and the transversal skin incision sutured. (c) For control, rats were submitted to a resection of a 2.5 x 4 cm of the abdominal muscles, creating a large defect in the abdominal wall. All the animal, submitted to the three different procedures, developed similar well constituted hernias. We concluded that abdominal incisonal hernias are easily induced in rats after an incision of the abdominal wall, without partial resection of abdominal muscle, since the subcutaneous have been dissected at least 1.5 cm laterally to the median line.

scholarly journals P054 REDUCTION OF FAILURE RATES AFTER INCISIONAL HERNIA REPAIR BY ADDING A PROPHYLACTIC MESH

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Carolin Lesch ◽  
Friedrich Kallinowski ◽  
Katharina Uhr ◽  
Matthias Vollmer ◽  
Christian Gerhard ◽  
...  
Keyword(s):  
Incisional Hernia ◽  
Abdominal Wall ◽  
Mesh Size ◽  
Incisional Hernia Repair ◽  
Bench Test ◽  
Failure Rates ◽  
Defect Closure ◽  
Prophylactic Mesh ◽  
Linea Alba ◽  
Class A

Abstract Aim “Can a mesh reduce failure rates after closure of a hernia defect?” Material and Methods “Porcine abdominal walls and bovine flanks were used as model tissues. After preparation, a 15 cm long incision was placed in the linea alba of the porcine abdominal wall. An additional round 5 cm defect was punched in the middle of the incision. The bovine flank was prepared in a similar manner. The incisions with the defects were closed with running sutures in a small stitch, small bite technique. Monomax® 2-0 sutures were used with suture to wound lengths above 4:1. Dynamesh® CiCAT meshes of three different sizes were placed in the sublay position. The mesh-tissue compounds were investigated on our self-built hydraulic bench test simulating coughs. Dynamic intermitted strain (DIS) was repeatedly delivered with impacts around 210 mmHg. Each of ten preparation was loaded 425 times by the pressure peaks.” Results “Small stitch, small bite sutures using 2-0 Monomax® with a suture-incision-ratio of 4.5:1 can provide a durable defect closure. Under other conditions, suture lines can reopen. A mesh reduces the recurrence of incisional hernia depending on the mesh size.” Conclusions “An additional DIS-class A mesh in sublay position can provide sufficient support for a suture closing the defect of the abdominal wall. It can prevent a tear-out of the suture from the tissue. On average, a mesh-augmented defect closure reduces the recurrence rate of incisional hernia.”

Abdominal Wall Thickness is a Predictor for Surgical Site Infections in Patients Undergoing Colorectal Operations

2020 ◽  
pp. 000313482095693
Author(s):  
Yu-Wei W. Chang ◽  
Kyle Murphy ◽  
Daniel Yackzan ◽  
Sarah Thomas ◽  
Danielle Kay ◽  
...  
Keyword(s):  
Risk Factor ◽  
Abdominal Wall ◽  
Wall Thickness ◽  
Surgical Site Infections ◽  
Wound Dehiscence ◽  
Abdominal Circumference ◽  
Fat Percentage ◽  
University Of Kentucky ◽  
Improvement Project ◽  
Acs Nsqip Database

Background Surgical site infections (SSIs) are an established complication following colorectal operations, with rates up to 30% reported in the literature. Obesity is a known risk factor for SSI; however, body mass index (BMI), body fat percentage, waist-hip ratio, or abdominal circumference are imperfect measures. The purpose of our study was to determine whether abdominal wall thickness (AWT) is predictive of SSI. Methods We queried our American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database for patients (age ≥18 years) undergoing a colectomy at the University of Kentucky (UK) from January 1, 2013 to December 31, 2018. The exclusion criteria included patients with open abdomens or the lack of preoperative computed tomography (CT) within 3 months of their operation. AWT was measured at the level of the anterior superior iliac spine (ASIS) on abdominal CT. SSI was defined by superficial SSI, deep SSI, and wound dehiscence. Results Of 1261 patients enrolled, 52.2% were female, with an average age of 57.4 years. More patients had laparoscopic operations (51%), and the median length of stay was 7 days. Our study demonstrated an SSI rate of 9.4% and a 30-day readmission rate of 11%. The overall mean AWT was 2.6 cm (range .1-13.1), and patients with the highest AWT quintile were more likely to develop an SSI than the lowest quintile (12% vs. 5%). After controlling for risk factors and confounders, the odds of an SSI were 3.6 times higher for patients with the highest AWT than patients with the lowest AWT. Conclusions Among colorectal surgery patients, AWT is an independent risk factor predictive for SSI.

Chemotherapy and Abdominal Wall Closure Technique Increase the Probability of Postoperative Ventral Incisional Hernia in Patients With Colon Cancer

2021 ◽  
pp. 000313482110111
Author(s):  
David A. Santos ◽  
Liangliang Zhang ◽  
Kim-Anh Do ◽  
Brian K. Bednarski ◽  
Celia Robinson Ledet ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Incisional Hernia ◽  
Abdominal Wall ◽  
Suture Technique ◽  
Abdominal Wall Closure ◽  
Clinical Predictors ◽  
Closure Technique ◽  
Ventral Incisional Hernia

Background Chemotherapy is associated with postoperative ventral incisional hernia (PVIH) after right hemicolectomy (RHC) for colon cancer, and abdominal wall closure technique may affect PVIH. We sought to identify clinical predictors of PVIH. Methods We retrospectively analyzed patients who underwent RHC for colon cancer from 2008-2018 and later developed PVIH. Time to PVIH was analyzed with Kaplan-Meier analysis, clinical predictors were identified with multivariable Cox proportional hazards modeling, and the probability of PVIH given chemotherapy and the suture technique was estimated with Bayesian analysis. Results We identified 399 patients (209 no adjuvant chemotherapy and 190 adjuvant chemotherapy), with an overall PVIH rate of 38%. The 5-year PVIH rate was 55% for adjuvant chemotherapy, compared with 38% for none (log-rank P < .05). Adjuvant chemotherapy (hazard ratio [HR] 1.65, 95% confidence interval [CI] 1.18-2.31, P < .01), age (HR .99, 95% CI .97-1.00, P < .01), body mass index (HR 1.02, 95% CI 1.00-1.04, P < .01), and neoadjuvant chemotherapy (HR 1.92, 95% CI 1.21-3.00, P < .01) were independently associated with PVIH. Postoperative ventral incisional hernia was more common overall in patients who received adjuvant chemotherapy (46% compared with 30%, P < .01). In patients who received adjuvant chemotherapy, the probability of PVIH for incision closure with #1 running looped polydioxanone was 42%, compared with 59% for incision closure with #0 single interrupted polyglactin 910. Discussion Exposure to chemotherapy increases the probability of PVIH after RHC, and non–short stitch incision closure further increases this probability, more so than age or body mass index. The suture technique deserves further study as a modifiable factor in this high-risk population.

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