scholarly journals Hybrid laparoscopic and open repair of post-nephrectomy flank hernia

2020 ◽  
Vol 2020 (9) ◽  
Author(s):  
Siang Wei Gan ◽  
Martin Bruening ◽  
Shantanu Bhattacharjya
Keyword(s):  
Hernia Repair ◽  
Surgical Repair ◽  
Open Repair ◽  
Hybrid Approach ◽  
Hybrid Technique ◽  
Bone Anchor ◽  
Flank Hernia ◽  
Open Nephrectomy ◽  
Anchor Fixation ◽  
Sublay Mesh

Abstract Surgical repair of flank hernia is not routinely performed, due to perceived technical difficulties with the surgery and risk of recurrence, or the misconception that flank hernia is solely due to a denervation injury. Due to the rareness of flank hernia in the literature, there is no general consensus on the best method of surgical repair. We present the case of a patient with a symptomatic large flank hernia following open nephrectomy, in which a hybrid technique of open and laparoscopic flank hernia repair with sublay mesh and bone anchor fixation was successfully performed with good outcome. This case highlights the benefits of the hybrid approach, which allowed a laparoscopic assessment of the defect and adhesiolysis, followed by the open repair which enabled adequate mesh overlap, fixation to surrounding tissues and bone anchor fixation.

scholarly journals Hybrid approach to ventral wall hernia repair: a single-institution cohort study

2020 ◽  
Author(s):  
Sara Jamel ◽  
Sherif Mohamad Hakky ◽  
Karina Tukanova ◽  
Sarah Huf ◽  
Sheraz Markar ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Cohort Study ◽  
Hernia Repair ◽  
Hybrid Approach ◽  
Length Of Hospital Stay ◽  
Patient Reported Outcome Measures ◽  
Defect Size ◽  
Hybrid Technique ◽  
Patient Reported

Summary Background Ventral hernias pose a substantial challenge for surgeons. Even though minimally invasive surgery and hernia repair have evolved rapidly, there is no standardised method that has been widely accepted as standard of practice. Hybrid ventral hernia repair (HVR) is an alternative surgical approach, which has not been adopted widely to date. It combines laparoscopic mesh insertion with closure of the hernia defect. The aim of this retrospective cohort study is to evaluate short- and long-term outcomes in patients undergoing HVR. Methods Between October 2012 and June 2016, 56 HVRs were performed at St Mary’s Hospital, Imperial College London. The medical records of these patients were reviewed retrospectively for demographics, comorbidities, previous surgeries, operative technique, complications and recurrences over a 3-year follow-up. Results HVRs were performed by four surgeons. Mean age was 48 years with a mean body mass index (BMI) of 32.8 kg/m2. 71.4% had incisional hernias and 28.6% had primary hernias. The number of hernia defects ranged from 1 to 4, with average defect size 42.9 cm2 (range 8–200 cm2). Adhesiolysis was performed in 66.1% of patients. Recurrence occurred in 2 patients (3.6%), 16.1% of patients developed postoperative seroma, 0.3% had respiratory complications, 0.3% had paralytic ileus and 0.2% had urinary retention. Only 2 patients required epidural postoperatively, both had a defect size of 150.0 cm2. There were no reoperations within 90 days. Mean length of hospital stay was 2 days (1–10 days). Over the follow-up period, 2 patients (3.6%) developed chronic pain. Conclusion The hybrid technique is safe and feasible, and has important benefits including low rates of seroma formation, chronic pain and hernia recurrence. Future investigations may include randomised controlled trials to evaluate the benefits of VHR, with careful assessment of patient-reported outcome measures including quality of life and postoperative pain.

Bone Anchor Fixation in Abdominal Wall Reconstruction: A Useful Adjunct in Suprapubic and Para-iliac Hernia Repair

2015 ◽  
Vol 81 (7) ◽  
pp. 693-697 ◽  
Author(s):  
Laurel J. Blair ◽  
Tiffany C. Cox ◽  
Ciara R. Huntington ◽  
Samuel W. Ross ◽  
Jeffrey S. Kneisl ◽  
...  
Keyword(s):  
Hernia Repair ◽  
Ventral Hernia ◽  
Mesh Fixation ◽  
Abdominal Wall Reconstruction ◽  
Pelvic Bone ◽  
Prosthetic Material ◽  
Suture Fixation ◽  
Bone Anchor ◽  
Recurrence Rates ◽  
Anchor Fixation

Suprapubic hernias, parailiac or flank hernias, and lumbar hernias are difficult to repair and are associated with high-recurrence rates owing to difficulty in obtaining substantive overlap and especially mesh fixation due to bone being a margin of the hernia. Orthopedic suture anchors used for ligament reconstruction have been used to attach prosthetic material to bony surfaces and can be used in the repair of these hernias where suture fixation was impossible. A prospective, single institution study of ventral hernia repairs involving bone anchor mesh fixation was performed. Demographics, operative details, and outcomes data were collected. Twenty patients were identified, with a mean age 53 (range: 35–70 years) and mean body mass index 28.4 kg/m2 (range 21–38). Ten lumbar, seven suprapubic, and three parailiac hernias were studied. The majority were recurrent hernias (n = 13), with one to seven previously failed repairs. The mean hernia defect size was very large (270 cm2; range: 56–832 cm2) with average mesh size of 1090 cm2 (range 224–3640 cm2). Both Mitek GII (Depuy, Raynham, MA) and JuggerKnot 2.9-mm (Biomet, Biomedical Instruments, Warsaw, IN) anchors were used, with an average of four anchors/case (range: 1–16). Mean operative time was 218 minutes (120–495). There were three minor complications, no operative mortality, and no recurrences during an average follow-up of 24 months. Pelvic bone anchors permit mesh fixation in high-recurrence areas not amenable to traditional suture fixation. The ability to safely and effectively use bone anchor fixation is an essential tool in complex open ventral hernia repair.

A novel technique of lumbar hernia repair using bone anchor fixation

Hernia ◽  
2004 ◽  
Vol 9 (1) ◽  
pp. 22-25 ◽  
Author(s):  
A. M. Carbonell ◽  
K. W. Kercher ◽  
L. Sigmon ◽  
B. D. Matthews ◽  
R. F. Sing ◽  
...  
Keyword(s):  
Hernia Repair ◽  
Lumbar Hernia ◽  
Bone Anchor ◽  
Novel Technique ◽  
Anchor Fixation

scholarly journals Laparoscopic lumbar hernia repair with bone anchor fixation

2010 ◽  
Vol 25 (5) ◽  
pp. 1665-1665 ◽  
Author(s):  
Vanessa P. Ho ◽  
Gregory F. Dakin
Keyword(s):  
Hernia Repair ◽  
Lumbar Hernia ◽  
Bone Anchor ◽  
Anchor Fixation

scholarly journals Polypropylene “in vivo” Implantation in Inguinal Hernia Repair - Adverse Reactions

2020 ◽  
Vol 70 (12) ◽  
pp. 4507-4513
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Polypropylene Mesh ◽  
Hybrid Approach ◽  
Definitive Treatment ◽  
Hybrid Technique ◽  
Open Approach ◽  
Mesh Infection

Polypropylene mesh is the preferred biomaterial used in iguinal hernia repair due to its flexibility, strength, rapid integration by surrounding tissues and resistance to infection. Despite being rare, adverse reaction to polypropylene mesh “in vivo” implantation are still a reality in clinical practice. Infections of an implanted mesh are extremely rare, with an incidence lower than 0,1% in laparoscopic inguinal hernia repair, respectively 1,5% in the open approach. However, when this complication occurs, managing it can be extremely difficult. This paper presents the case study of a 41-year-old male patient operated for right inguinal hernia, using a polypropylene mesh implanted laparososcopically. As a delayed postoperative complication, he developed mesh infection, which could not be treated with conservative measures. Definitive treatment consisted in surgical excision of the mesh and one titanium clip, using a hybrid technique, which combined the laparoscopic approach and open surgery. The postoperative course was favourable, with resolution of the symptoms. No recurrent abscess or hernia were noted during 18 months follow-up. In conclusion, removal of the mesh using the hybrid approach, can be a solution for polypropylene mesh infection. Keywords: polypropylene mesh infection, hernia repair, mesh excision, hybrid approach.

Arterial Stiffness Assessed by Cardio-Ankle Vascular Index in Patients With Abdominal Aortic Aneurysm and Its Alterations After Treatment

2021 ◽  
pp. 153857442110232
Author(s):  
Spyridon N. Mylonas ◽  
Konstantinos G. Moulakakis ◽  
Nikolaos Kadoglou ◽  
Constantinos Antonopoulos ◽  
Thomas E. Kotsis ◽  
...  
Keyword(s):  
Arterial Stiffness ◽  
Surgical Repair ◽  
Open Repair ◽  
Abdominal Aortic ◽  
Gender And Age ◽  
Baseline Values ◽  
The Difference ◽  
The Impact ◽  
Repair Group

Purpose: The aim of the present study was to investigate a potential difference on the arterial stiffness among aneurysm patients and non-aneurysm controls, as well as to explore potential changes between patients treated either with endovascular or open repair. Materials and Methods: A 110 patients with an infrarenal AAA were prospectively enrolled in this study. Fifty-six patients received an EVAR, whereas 54 patients received an open surgical repair. Moreover, 103 gender and age-matched subjects without AAA served as controls. The cardio-ankle vascular index (CAVI) was applied for measurement of the arterial stiffness. Results: CAVI values were statistically higher in the AAA patients when compared with control subjects. Although at 48 hours postoperatively the CAVI values were increased in both groups when compared to baseline values, the difference in CAVI had a tendency to be higher in the open group compared to the endovascular group. At 6 months of follow up the CAVI values returned to the baseline for the patients of the open repair group. However, in the endovascular group CAVI values remained higher when compared with the baseline values. Conclusion: Patients with AAAs demonstrated a higher value of CAVI compared to healthy controls. A significant increase of arterial stiffness in both groups during the immediate postoperative period was documented. The increase in arterial stiffness remained significant at 6 months in EVAR patients. Further studies are needed to elucidate the impact of a decreased aortic compliance after stentgraft implantation on the cardiac function of patients with AAA.

scholarly journals Hybrid technique of virtual-assisted lung mapping and systemic indocyanine green injection for extended segmentectomy

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Masahiro Yanagiya ◽  
Noriko Hiyama ◽  
Jun Matsumoto
Keyword(s):  
Indocyanine Green ◽  
Hybrid Approach ◽  
Lung Nodule ◽  
Adenocarcinoma In Situ ◽  
Hybrid Technique ◽  
Medical Checkup ◽  
Resection Line ◽  
Intersegmental Plane ◽  
Computed Tomography Image ◽  
Dye Marking

Abstract Background Various approaches have been used to assist and facilitate segmentectomy with favorable oncological outcomes. We describe a hybrid approach comprising virtual-assisted lung mapping (VAL-MAP), which is a preoperative bronchoscopic dye-marking technique, combined with systemic indocyanine green (ICG) injection. Clinical presentation An asymptomatic 64-year-old man was referred to our department because of a lung nodule detected during his annual medical checkup. The chest computed-tomography image revealed a 16-mm, partly solid, ground-glass nodule in the left segment 4. Because the nodule was hardly palpable and deeply located between the left upper division segment and the left lingular segment, we performed VAL-MAP to facilitate extended left lingulectomy. Five dye markings were undertaken preoperatively. Surgery to remove the nodule was then conducted via complete three-port video-assisted thoracic surgery. The VAL-MAP markings were easily identified intraoperatively and helped locate the nodule. The intersegmental plane was identified by the ICG injection. The resection line was determined based on the intersegmental plane identified by the ICG injection and the site of the nodule suggested by the VAL-MAP markings. Following the resection line, we thoracoscopically achieved extended lingulectomy with sufficient surgical margins. The patient was discharged with no complications. The pathological diagnosis was adenocarcinoma in situ. Conclusion The hybrid technique of VAL-MAP and systemic ICG injection can be useful for accomplishing successful extended segmentectomy.

scholarly journals Trans-hiatal herniation following esophagectomy or gastrectomy: retrospective single-center experiences with a potential surgical emergency

Hernia ◽  
2021 ◽  
Author(s):  
P. U. Oppelt ◽  
I. Askevold ◽  
R. Hörbelt ◽  
F. C. Roller ◽  
W. Padberg ◽  
...  
Keyword(s):  
Hernia Repair ◽  
Hiatal Hernia ◽  
Surgical Repair ◽  
Clinical Symptoms ◽  
Gastrointestinal Symptoms ◽  
Case Series ◽  
Gastric Surgery ◽  
Hiatal Hernia Repair ◽  
Single Center ◽  
Asymptomatic Patients

Abstract Purpose Trans-hiatal herniation after esophago-gastric surgery is a potentially severe complication due to the risk of bowel incarceration and cardiac or respiratory complaints. However, measures for prevention and treatment options are based on a single surgeon´s experiences and small case series in the literature. Methods Retrospective single-center analysis on patients who underwent surgical repair of trans-hiatal hernia following gastrectomy or esophagectomy from 01/2003 to 07/2020 regarding clinical symptoms, hernia characteristics, pre-operative imaging, hernia repair technique and perioperative outcome. Results Trans-hiatal hernia repair was performed in 9 patients following abdomino-thoracic esophagectomy (40.9%), in 8 patients following trans-hiatal esophagectomy (36.4%) and in 5 patients following conventional gastrectomy (22.7%). Gastrointestinal symptoms with bowel obstruction and pain were mostly prevalent (63.6 and 59.1%, respectively), two patients were asymptomatic. Transverse colon (54.5%) and small intestine (77.3%) most frequently prolapsed into the left chest after esophagectomy (88.2%) and into the dorsal mediastinum after gastrectomy (60.0%). Half of the patients had signs of incarceration in pre-operative imaging, 10 patients underwent emergency surgery. However, bowel resection was only necessary in one patient. Hernia repair was performed by suture cruroplasty without (n = 12) or with mesh reinforcement (n = 5) or tension-free mesh interposition (n = 5). Postoperative pleural complications were most frequently observed, especially in patients who underwent any kind of mesh repair. Three patients developed recurrency, of whom two underwent again surgical repair. Conclusion Trans-hiatal herniation after esophago-gastric surgery is rare but relevant. The role of surgical repair in asymptomatic patients is disputed. However, early hernia repair prevents patients from severe complications. Measures for prevention and adequate closure techniques are not yet defined.

scholarly journals Lifting restrictions on coherence loss when characterizing non-transparent hypersonic phononic crystals

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Konrad Rolle ◽  
Dmytro Yaremkevich ◽  
Alexey V. Scherbakov ◽  
Manfred Bayer ◽  
George Fytas
Keyword(s):  
Frequency Domain ◽  
Hybrid Approach ◽  
Three Dimensional ◽  
Phononic Crystals ◽  
Hybrid Technique ◽  
Detection Mechanism ◽  
Pump Probe ◽  
Fabry Perot ◽  
Multilayer Stacks ◽  
Deposition Techniques

AbstractHypersonic phononic bandgap structures confine acoustic vibrations whose wavelength is commensurate with that of light, and have been studied using either time- or frequency-domain optical spectroscopy. Pulsed pump-probe lasers are the preferred instruments for characterizing periodic multilayer stacks from common vacuum deposition techniques, but the detection mechanism requires the injected sound wave to maintain coherence during propagation. Beyond acoustic Bragg mirrors, frequency-domain studies using a tandem Fabry–Perot interferometer (TFPI) find dispersions of two- and three-dimensional phononic crystals (PnCs) even for highly disordered samples, but with the caveat that PnCs must be transparent. Here, we demonstrate a hybrid technique for overcoming the limitations that time- and frequency-domain approaches exhibit separately. Accordingly, we inject coherent phonons into a non-transparent PnC using a pulsed laser and acquire the acoustic transmission spectrum on a TFPI, where pumped appear alongside spontaneously excited (i.e. incoherent) phonons. Choosing a metallic Bragg mirror for illustration, we determine the bandgap and compare with conventional time-domain spectroscopy, finding resolution of the hybrid approach to match that of a state-of-the-art asynchronous optical sampling setup. Thus, the hybrid pump–probe technique retains key performance features of the established one and going forward will likely be preferred for disordered samples.

Sign in / Sign up

Export Citation Format

Share Document