Physiology in Medicine: physiological basis of diaphragmatic dysfunction with abdominal hernias–implications for therapy

2015 ◽  
Vol 118 (2) ◽  
pp. 142-147 ◽  
Author(s):  
Patrick Koo ◽  
Eric J. Gartman ◽  
Jigme M. Sethi ◽  
F. Dennis McCool
Keyword(s):  
Abdominal Surgery ◽  
Incisional Hernia ◽  
Abdominal Wall ◽  
Common Complication ◽  
Diaphragmatic Dysfunction ◽  
Physiological Basis ◽  
Diaphragm Dysfunction ◽  
Incisional Hernias ◽  
Abdominal Hernias ◽  
Diaphragm Function

An incisional hernia is a common complication after abdominal surgery. Complaints of dyspnea in this population may be attributed to cardiopulmonary dysfunction or deconditioning. Large abdominal incisional hernias, however, may cause diaphragm dysfunction and result in dyspnea, which is more pronounced when standing (platypnea). The use of an abdominal binder may alleviate platypnea in this population. We discuss the link between diaphragm dysfunction and the lack of abdominal wall integrity and how abdominal wall support partially restores diaphragm function.

scholarly journals A randomized controlled study to compare the efficacy of hughes abdominal repair with conventional abdominal closure-to reduce the incidence of incisional hernias in Indian population

2017 ◽  
Vol 4 (7) ◽  
pp. 2291
Author(s):  
Rajasekaran C. ◽  
Vijaykumar K. ◽  
Arulkumaran M. ◽  
Meera S. S.
Keyword(s):  
Randomized Controlled Trial ◽  
Incisional Hernia ◽  
Abdominal Wall ◽  
Controlled Trial ◽  
Secondary Outcome ◽  
Midline Laparotomy ◽  
Incisional Hernias ◽  
Abdominal Closure ◽  
Randomized Controlled ◽  
Abdominal Repair

Background: Incisional hernia forms the most common delayed morbidity following midline laparotomy surgeries- causing mental trauma to the patient impairing their quality of life and scars the name and fame of the surgeon. So, the need for possible attributes on surgeon’s aspect to prevent the incisional hernia is the need of the hour. We planned a randomized controlled trial to compare two different abdominal closure techniques to reduce the incidence of Incisional hernia following midline laparotomy incisions. We advocated Hughes abdominal repair which includes a series of two horizontal and two vertical mattresses within single suture whereby the tension load of suture is distributed both along and across the suture line.Methods: 1:1 Randomized controlled trial in which the patient is blinded and obviously operating surgeon is non-blinded. Evaluating examiner and radiologist are blinded.100 patients who underwent emergency and elective midline laparotomies were enrolled in the study and intra-operatively randomized into two groups in 1:1 pattern. Ethical clearance obtained from the Institutional ethical committee. The primary outcome measure is the incidence of burst abdomen at the end of 15 days by the evaluating surgeon (non-operated surgeon who is blinded). The secondary outcome is the incidence of incisional hernia at the end of one year-evaluated by detailed clinical examination with radiological proof using CT abdomen.Results: The incidence of incisional hernia is significantly low in Hughes abdominal repair than conventional abdominal closure.Conclusions: Hughes abdominal wall closure is superior to conventional closure in both emergency and elective laparotomy cases, in prevention of wound dehiscence and Incisional hernias later. Present study encourages us that Hughes abdominal wall repair is comparable to mesh repairs. This study needs to be continued further to a vast sample size to perfectly assess the statistical significance.

scholarly journals Hernia reduction following laparotomy using small stitch abdominal wall closure with and without mesh augmentation (the HULC trial): study protocol for a randomized controlled trial

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Patrick Heger ◽  
Manuel Feißt ◽  
Johannes Krisam ◽  
Christina Klose ◽  
Colette Dörr-Harim ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Abdominal Wall ◽  
Fascial Closure ◽  
Abdominal Wall Closure ◽  
Midline Laparotomy ◽  
Incisional Hernias ◽  
Randomized Controlled ◽  
Onlay Technique ◽  
Mesh Augmentation ◽  
Patient Reported

Abstract Background Incisional hernias are among the most frequent complications following abdominal surgery and cause substantial morbidity, impaired health-related quality of life and costs. Despite improvements in abdominal wall closure techniques, the risk for developing an incisional hernia is reported to be between 10 and 30% following midline laparotomies. There have been two recent innovations with promising results to reduce hernia risks, namely the small stitches technique and the placement of a prophylactic mesh. So far, these two techniques have not been evaluated in combination. Methods The HULC trial is a multicentre, randomized controlled, observer- and patient-blinded surgical effectiveness trial with two parallel study groups. A total of 812 patients scheduled for elective abdominal surgery via a midline laparotomy will be randomized in 12 centres after informed consent. Patients will be randomly assigned to the control group receiving closure of the midline incision with a slowly absorbable monofilament suture in the small stitches technique or to the intervention group, who will receive a small stitches closure followed by augmentation with a light-weight polypropylene mesh in the onlay technique. The primary endpoint will be the occurrence of incisional hernias, as defined by the European Hernia Society, within 24 months after surgery. Further perioperative parameters, as well as patient-reported outcomes, will be analysed as secondary outcomes. Discussion The HULC trial will address the yet unanswered question of whether a combination of small stitched fascial closure and onlay mesh augmentation after elective midline laparotomies reduces the risk of incisional hernias. The HULC trial marks the logical and innovative next step in the development of a safe abdominal closure technique. Trial registration German Clinical Trials Register, DRKS00017517. Registered on 24th June 2019.

scholarly journals Hernia reduction following laparotomy using small stitch abdominal wall closure with and without mesh augmentation (the HULC trial, DRKS00017517): Study protocol for a randomized controlled trial

2019 ◽  
Author(s):  
Patrick Heger ◽  
Manuel Feißt ◽  
Johannes Krisam ◽  
Christina Klose ◽  
Colette Dörr-Harim ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Abdominal Wall ◽  
Fascial Closure ◽  
Abdominal Wall Closure ◽  
Midline Laparotomy ◽  
Incisional Hernias ◽  
Randomized Controlled ◽  
Onlay Technique ◽  
Mesh Augmentation ◽  
Patient Reported

Abstract Background Incisional hernias are among the most frequent complications following abdominal surgery and cause substantial morbidity, impaired health-related quality of life and costs. Despite improvements in abdominal wall closure techniques incisional hernia rates are reported to be between 10-30% following midline laparotomies. There have been two recent innovations with promising results to reduce hernia rates, namely the small stitches technique and the placement of a prophylactic mesh. So far, these two techniques have not been evaluated in combination.Methods The HULC trial is a multicentre randomized controlled, observer and patient blinded surgical effectiveness trial with two parallel study groups. A total of 812 patients scheduled for elective abdominal surgery via a midline laparotomy will be randomized in 12 centres after informed consent. Patients will be randomly assigned to the control group receiving closure of the midline incision with a slowly absorbable monofilament suture in small stitches technique or to the intervention group that will receive a small stitches closure followed by augmentation with a light-weight polypropylen mesh in onlay technique. The primary endpoint will be the occurrence of incisional hernias as defined by the European Hernia Society within 24 months after surgery. Further perioperative parameters, as well as patient-reported outcomes, will be analysed as secondary outcomes.Discussion The HULC trial will address the yet unanswered question whether a combination of small stitched fascial closure and onlay mesh augmentation after elective midline laparotomies reduces the rate of incisional hernias. The HULC trial marks the logical and innovative next step in the development of a safe abdominal closure technique.

scholarly journals P018 COLLABORATIVE APPROACH FOR SIMULTANEOUS REPAIR OF COMPLEX INCISIONAL HERNIA AND STOMA REVERSAL

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Carles Olona ◽  
Aleidis Caro ◽  
Raquel Casanova ◽  
Beatriz Espina ◽  
Jordi Vadillo ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Incisional Hernia ◽  
Abdominal Wall ◽  
Surgical Techniques ◽  
Incisional Hernia Repair ◽  
Clinical Results ◽  
Intestinal Transit ◽  
Simultaneous Treatment ◽  
Incisional Hernias ◽  
The Mean

Abstract Aim The simultaneous repair of incisional hernias (IH) and the reconstruction of the intestinal transit may pose a challenge for many surgeons. Collaboration between units specialized in abdominal wall and colorectal surgery can favor simultaneous treatment. We present our experience in the collaboration between specialized units for the simultaneous treatment of complex incisional hernias and ostomy closure. Material and Methods Descriptive study of patients undergoing simultaneous surgery of complex IH repair and intestinal transit reconstruction in the period 2018.2021. All interventions were performed electively and with the collaboration of surgeons experts in abdominal wall and colorectal surgery. Demographic variables, hernias characteristics, surgical techniques, postoperative evolution, morbidity and mortality are recorded Results 16 patients are included. 8 with ileostomy, 3 lateral colostomies and 5 end colostomies . All the patients presented IH of the middle laparotomy and 12 had stomal hernias associated. The mean diameters of the IH were 16.2cm longitudinal and 11cm transverse. Intestinal transit was reconstructed in 15 cases (94%) and incisional hernia repair in 100%. Component separation was required in 75% of cases (8 posterior and 4 anterior). Morbidity in the first postoperative month was 18%, requiring 2 reoperations (12%). At the end of the mean follow-up of 10.8 months, 81% of the cases did not present complications. Conclusions The collaboration between specialist allows the use of advanced techniques in the simultaneous reconstruction of the abdominal wall and intestinal transit, with good clinical results and patient quality of life.

scholarly journals Patient-reported outcomes after incisional hernia repair

Hernia ◽  
2021 ◽  
Author(s):  
N. van Veenendaal ◽  
M. M. Poelman ◽  
B. van den Heuvel ◽  
B. J. Dwars ◽  
W. H. Schreurs ◽  
...  
Keyword(s):  
Incisional Hernia ◽  
Hernia Repair ◽  
Abdominal Wall ◽  
Patient Reported Outcomes ◽  
Incisional Hernia Repair ◽  
Hernia Surgery ◽  
Incisional Hernias ◽  
Patient Reported ◽  
Postoperative Symptoms

Abstract Purpose Patient-reported outcomes (PROs) are pivotal to evaluate the efficacy of surgical management. Debate persists on the optimal surgical technique to repair incisional hernias. Assessment of PROs can guide the selection of the best management of patients with incisional hernias. The objective of this cohort study was to present the PROs after incisional hernia repair at long term follow-up. Methods Patients with a history of incisional hernia repair were seen at the out-patient clinic to collect PROs. Patients were asked about the preoperative indication for repair and postoperative symptoms, such as pain, feelings of discomfort, and bulging of the abdominal wall. Additionally, degree of satisfaction was asked and Carolina Comfort Scales were completed. Results Two hundred and ten patients after incisional hernia repair were included with a median follow-up of 3.2 years. The main indication for incisional hernia repair was the presence of a bulge (60%). Other main reasons for repair were pain (19%) or discomfort (5%). One hundred and thirty-two patients (63%) reported that the overall status of their abdominal wall had improved after the operation. Postoperative symptoms were reported by 133 patients (63%), such as feelings of discomfort, pain and bulging. Twenty percent of patients reported that the overall status of their abdominal wall was the same, and 17% reported a worse status, compared to before the operation. Ten percent of the patients would not opt for operation in hindsight. Conclusion This study showed that a majority of the patients after incisional hernia repair still report pain or symptoms such as feelings of discomfort, pain, and bulging of the abdominal wall 3 years after surgery. Embedding patients’ expectations and PROs in the preoperative counseling discussion is needed to improve decision-making in incisional hernia surgery.

scholarly journals Incisional abdominal hernias, some consideration about it.

2021 ◽  
Vol 8 (10) ◽  
pp. 5683-5686
Author(s):  
Dritan Çobani ◽  
Agron Dogjani ◽  
Arben Gjata ◽  
Kastriot Haxhirexha ◽  
Etmont Çeliku ◽  
...  
Keyword(s):  
Risk Factors ◽  
Abdominal Surgery ◽  
Abdominal Wall ◽  
Abdominal Wall Hernia ◽  
Suture Technique ◽  
University Hospital ◽  
Abdominal Wall Defects ◽  
Abdominal Incision ◽  
Abdominal Hernias ◽  
Number Of Patients

Background: Abdominal incision hernia is a common complication of abdominal surgery. Despite significant improvements in medical technology and healthcare, an increasing number of patients are also benefiting from complex surgical procedures. The objective of this study was to analyze the risk factors for incisional abdominal hernias and to identify measures that could reduce the incidence of this complication. Material and methods: All patients included in the study are from the University Hospital of Trauma for a period of 3 years, from January 1, 2015, to December 31, 2017. Eighty-seven adult patients who underwent surgical repair of incisional abdominal wall hernia were enrolled. Variables that are compared in this study include the type of suture material, type of suture technique and concomitant diseases .etc. Results: According to our study the risk factors for incisional hernia are related to patients and the abdominal surgery used, the size of the abdominal wall defects. Conclusions: Risk factors such as the size of the defect, wound infection, obesity, use of steroids and chronic constipation have great importance and have to be strictly evaluated as they have more chances to lead to a possible recurrence…

scholarly journals A comprehensive study on the incidence and management of incisional hernia

2017 ◽  
Vol 4 (7) ◽  
pp. 2303
Author(s):  
Ajay Malviya ◽  
Arvind Patel ◽  
Girish Bhardwaj ◽  
Hitesh P. Bulchandani ◽  
Vivek Saini
Keyword(s):  
Abdominal Surgery ◽  
Incisional Hernia ◽  
Wound Infection ◽  
Mesh Repair ◽  
Predisposing Factor ◽  
Incisional Hernias ◽  
Medical College ◽  
Vertical Incision ◽  
Obesity Hypertension ◽  
Comprehensive Study

Background: Incisional hernia is a frequent complication of abdominal surgery. The reported incidence of incisional hernia following abdominal surgery ranges from 2-20%. It may be caused by flawed operative techniques, by postoperative complications such as wound infection, by increased abdominal wall tension or by a metabolic connective tissue disorder.Methods: The present study was conducted on patients of incisional hernias admitted in various surgical wards of the department of surgery, associated group of hospitals attached to Dr. Sampurnanand Medical College, Jodhpur over a period of 10 years extending from 2005 to 2015. Detailed history and clinical examination of all patients were obtained from the case sheets. Other risk factors like obesity, hypertension, diabetes mellitus and malignant disease were recorded. Routine investigations were also documented. Patients were closely monitored in pre, intra and post-operative periods. The data collected were systemically recorded and statistically analysed.Results: Maximum incidence (67.21%) of incisional hernia seen in 31-60years of age and mean age was 48.54years with twice common in female sex. Abdominal swelling was the commonest (90.57%) presenting symptom. 80% of patients present within 1 year. Of previous surgery, 50% of them were gynaecological. Midline vertical incision (70%) was most notorious to develop in incisional hernia. Wound infection (50%) was major risk factor. Mesh repair (laproscopic 3.68% & open 92%) was the procedure of choice.Conclusions: Incisional hernia is twice common in women than in men with gynaecological procedures mainly caesarean section contributing for half of the cases of incisional hernias. It more frequently develops in vertical midline incision and post-operative wound infection is the most important predisposing factor. Incisional hernia usually appears within 1 year of previous operation. Mesh repair of incisional hernia has of late become popular amongst surgeons.

Preventing Incisional Hernias: Closure of Abdominal Wall, Follow-Up in Abdominal Surgery

2019 ◽  
pp. 71-83
Author(s):  
Cesare Stabilini ◽  
Linda D’Amore ◽  
Elena Annesi ◽  
Lucia Bambi ◽  
Paolo Negro ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Abdominal Wall ◽  
Incisional Hernias

scholarly journals Partial Liver Herniation Through the Incisional Defect on Anteriot Abdominal Wall

2016 ◽  
Vol 70 (1) ◽  
pp. 47-51
Author(s):  
Antonio Gligorievski ◽  
Ana Lazarova
Keyword(s):  
Abdominal Surgery ◽  
Abdominal Wall ◽  
Rare Case ◽  
Sagittal Plane ◽  
Anterior Abdominal Wall ◽  
Open Cholecystectomy ◽  
Liver Lobe ◽  
Incisional Hernias ◽  
Liver Herniation ◽  
The Right

Abstract Introduction. Ventral hernias are quite common, but liver herniation is an extremely rare case. This type of abdominal protrusion of part of the liver usually occurs through incisional weak spots on the abdominal wall. Incisional herniation of the liver usually occurs 2 to 3 years after an abdominal operation consequently leading to focal weakness of the abdominal wall. Case report. We present an extremely rare case of incisional herniation of part of the left and smaller part of the right liver lobe in a woman aged 64 years, as a consequence of a previous open cholecystectomy, creating a focal abdominal wall weakness. Abdominal CT scan was performed. Analysis of the CT scans, as well as of the reconstruction made in the coronal and sagittal plane was performed. Herniation of the left and the smaller part of the right liver lobe through an incisive focal weakness of the right upper quadrant of the abdominal wall was detected. Discussion. Incisional hernias are delayed complications of abdominal surgery. They can occur anywhere on the abdominal wall and are more frequently encountered in a vertical than in a transverse incision. Typically, incisional hernias occur during the first months following surgery, but later occurrence has been reported as well. Herniation of the liver through the anterior abdominal wall is an extremely rare condition and usually related to previous surgery on the upper abdomen. Due to its rarity it is both a diagnostic and therapeutic challenge. Conclusion. We can conclude that there is a connection between liver herniation through the upper abdominal wall and a previously performed open abdominal surgery. CT is the method of choice for diagnosis of liver herniation through the anterior abdominal wall.

scholarly journals Comparative Study on the Use of Polypropylene Mesh in the Surgical Treatment of Patients with Strangulated or Uncomplicated Incisional Hernias

2018 ◽  
Vol 55 (2) ◽  
pp. 207-210
Author(s):  
Ioana Halmaciu ◽  
Bogdan Andrei Suciu ◽  
Decebal Fodor ◽  
Dumitru Godja ◽  
Cristian Trambitas ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Incisional Hernia ◽  
Abdominal Wall ◽  
Polypropylene Mesh ◽  
Incisional Hernias ◽  
Tissue Integration ◽  
Number Of Patients ◽  
History Of ◽  
Group B

Incisional hernias affects approximately 10-20% of patients with history of abdominal surgery. The purpose of this study was to examine the tissue integration of the polypropylene mesh in patients operated for strangulated incisional hernias to those operated for uncomplicated incisional hernias. For this purpose, we introduced 218 patients with surgical treatment of the incisional hernia with polypropylene mesh. The total number of patients studied was divided into 2 lots: group A consisting of 189 patients with uncomplicated incisional hernia and group B of 29 patients with strangulated incisional hernia. We studied separately the local postoperative complications in the two groups (hematomas, seromas, abdominal wall infections). Although the number of local postoperative complications was higher for group B, the differences were statistically significant only for the incidence of abdominal wall infections. Although the use of the polypropylene mesh in the surgical treatment of strangulated incisional hernias predisposes to a higher risk of local postoperative complications compared to its use in the surgical treatment of the uncomplicated incisional hernias, its use in the surgical treatment of the strangulated incisional hernias is beneficial.

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