Complex Abdominal Wall Hernia Repair in Contaminated Surgical Fields: Factors Affecting the Choice of Prosthesis

2017 ◽  
Vol 83 (6) ◽  
pp. 583-590 ◽  
Author(s):  
Manuel LÓPez-Cano ◽  
MarÍA Teresa Quiles ◽  
José Antonio Pereira ◽  
Manuel Armengol-Carrasco ◽  
MarÍA Antonia ArbÓ S VÍA
Keyword(s):  
Abdominal Wall ◽  
Surgical Repair ◽  
Enterocutaneous Fistula ◽  
Abdominal Wall Hernia ◽  
Surgical Site Infections ◽  
Recurrent Hernia ◽  
Factors Affecting ◽  
Elective Repair ◽  
Infected Mesh ◽  
Clean Contaminated

To compare patients with complex abdominal wall hernias undergoing surgical repair using synthetic nonabsorbable or biologic meshes in contaminated fields. Retrospective review of 62 patients with complex abdominal wall hernia with surgical repair in an elective setting and in the context of a clean-contaminated or contaminated fields (January 2009–April 2015). Two groups according to the prosthesis (synthetic nonabsorbable, n = 48 or biologic, n = 14). Mean follow-up was 24.6 (15.8) months. Clean-contaminated wounds were significantly more frequent in the synthetic group. Contaminated wounds were significantly more frequent in the biologic group. Enterocutaneous fistula, recurrent hernia, and removal of chronic infected mesh were significantly more frequently in the biologic group. Differences in postoperative complications and surgical site infections were not found. Recurrence was higher in the biologic group (35.7% vs 8.3%, P = 0.03). In the elective repair of complex hernia, the level of contamination, a recurrent hernia, an enterocutaneous fistula or removal of chronic infected mesh were the factors affecting the choice of prosthesis. In the clean-contaminated setting, the use of a synthetic nonabsorbable mesh versus a biologic mesh did not increase the rate of postoperative infections. Recurrences are significantly higher with biologic meshes.

Clinical and Biochimical Comorbidities and Complications in Abdominal Surgery Using Synthetic Prosthetic Material

2018 ◽  
Vol 69 (6) ◽  
pp. 1519-1523
Author(s):  
Vlad Dumitru Baleanu ◽  
Danut Vasile ◽  
Alexandru Marian Goganau ◽  
Paul Ioan Tomescu ◽  
Dragos Davitoiu ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Abdominal Wall ◽  
Abdominal Wall Hernia ◽  
Prosthetic Material ◽  
Hernia Surgery ◽  
Tension Free ◽  
Elective Repair ◽  
Scrotal Edema ◽  
Remarkable Recovery ◽  
Risks Assessment

Hernia can be defined as an organ disorder which protrudes the wall that contains it. Synthetic material for the repair of the abdominal wall are used frequently with good results and less complications. Our research included a number of 135 patients diagnosed with inguinal hernia hospitalized and operated in Clinical County Hospital of Craiova, between 1st January 2017-31 October 2017. The purpose of our work was to identify and analyze comorbidities and complications for inguinal hernia repaired with synthetic prosthetic material. hernia repair was performed in 135 patients, 16 were women and 119 were men. Tension free meshplasty was accomplished in 131 patients with uncomplicated inguinal hernia and herniorrhaphy was successfully performed at 4 patients with complicated inguinal hernia. From our study 107 patients had a remarkable recovery without any complication. Patients who underwent tension-free hernia surgery using prosthetic mesh,short-term complications were represented by 19 patients with urinary retention, 6 surgical local infection (superficial infections) and 2 scrotal edema. Nowadays surgeons try to find the best elective repair of inguinal hernia,to be safety for the patients despite of their age and with few complications and low mortality rate. Risks assessment include general conditions and associated comorbidities of the patients. In our study we reveal the type of comorbidities which we meet. We considered that it is significant to optimize cardiopulmonary status and the other comorbidities of the patient before to repair abdominal wall hernia in order to avoid both short and long term complication.

scholarly journals Perioperative Tablet-Based Telemonitoring After Abdominal Wall Hernia Surgery: Pilot Prospective Observational Cohort Study (Preprint)

2019 ◽  
Author(s):  
Alexander Gräfitsch ◽  
Philipp Kirchhoff ◽  
Henry Hoffmann ◽  
Ralph F Staerkle ◽  
Savas D Soysal ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Surgical Repair ◽  
Abdominal Wall Hernia ◽  
Activity Levels ◽  
Hernia Surgery ◽  
Entire Study ◽  
Median Proportion ◽  
Activity Measurements ◽  
Outpatient Settings

BACKGROUND Hernia repairs account for millions of general surgical procedures performed each year worldwide, with a notable shift to outpatient settings over the last decades. As technical possibilities such as smartphones, tablets, and different kinds of probes are becoming more and more available, such systems have been evaluated for applications in various clinical settings. However, there have been few studies conducted in the surgical field, especially in general surgery. OBJECTIVE We aimed to assess the feasibility of a tablet-based follow up to monitor activity levels after repair of abdominal wall hernias and to evaluate a possible reduction of adverse events by their earlier recognition. METHODS Patients scheduled for elective surgical repair of minor abdominal wall hernias (eg, inguinal, umbilical, or trocar hernias) were equipped with a telemonitoring system, including a tablet, pulse oximeter, and actimeter, for a monitoring phase of 7 days before and 30 days after surgery. Descriptive statistical analyses were performed. RESULTS We enrolled 16 patients with a mean overall age of 48.75 (SD 16.27) years. Preoperative activity levels were reached on postoperative day 12 with a median of 2242 (IQR 0-4578) steps after plunging on the day of surgery. The median proportion of available activity measurements over the entire study period of 38 days was 69% (IQR 56%-81%). We observed a gradual decrease in the proportion of available data for all parameters during the postoperative course. Six out of ten patients (60%) regained preoperative activity levels within 3 weeks after surgery. Overall, patients rated the usability of the system as relatively easy. CONCLUSIONS Tablet-based follow up is feasible after surgical repair of minor abdominal wall hernias, with good adherence rates during the first couple of weeks after surgery. Thus, such a system could be a useful tool to supplement or even replace traditional outpatient follow up in selected general surgical patients.

scholarly journals Elective Repair of Adult Abdominal Wall Hernia: A Nigerian Tertiary Hospital Experience

2021 ◽  
Vol 3 (1) ◽  
pp. 68-72
Author(s):  
Emeka Ray-Offor ◽  
Chidi Joshua Okeke
Keyword(s):  
Hernia Repair ◽  
Abdominal Wall ◽  
Operating Time ◽  
Abdominal Wall Hernia ◽  
Tertiary Hospital ◽  
Laparoscopic Technique ◽  
Suture Repair ◽  
True Incidence ◽  
Repair Technique ◽  
Elective Repair

Background: Hernia repair is one of the most common procedures performed by general surgeons, mostly in an elective setting. The true incidence/prevalence of hernias in Nigeria is unknown, however, suture (tissue) repair is predominantly reported. Aims: To study the distribution of adult abdominal wall hernia and the surgical and anaesthetic techniques for elective repair in a Nigerian tertiary hospital. Methods: A retrospective cross-sectional study of surgical patients undergoing elective abdominal wall hernia repair in University of Port Harcourt Teaching Hospital Nigeria from January 2009 to December 2014. Data extracted from the theatre records were patients’ demographic, type of hernia, repair technique, anaesthesia, operating time, and cadre of performing surgeon. Statistical analysis was performed using SPSS version 20. Results: A total of 400 adult patients had elective repair of abdominal wall hernias during study period. The age range was from 17- 85 years (mean 39.3 ± 6.0) and M: F ratio of 1.9:1. There were 287(70.9%) inguinal, 43(10.6%) incisional and 36(8.9%) epigastric hernias. Mesh repair was recorded in 11(2.7%) cases with laparoscopic technique in 2 cases. Subarachnoid block was the choice anaesthesia in 365(85.4%) cases. The least mean operating time (38.6 mins) recorded was in repair of femoral hernia and longest (105.3mins) with incisional hernia repair. Conclusions: Suture repair is the predominant repair technique. Routine hernioplasty and laparoscopic hernia repair need to be encouraged.

scholarly journals Factors Affecting Morbidity and Mortality in Patients Who Underwent Emergency Operation for Incarcerated Abdominal Wall Hernia

2013 ◽  
Vol 97 (4) ◽  
pp. 305-309 ◽  
Author(s):  
Mesut Gul ◽  
Ibrahim Aliosmanoglu ◽  
Murat Kapan ◽  
Akin Onder ◽  
Fatih Taskesen ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Abdominal Wall ◽  
Intestinal Resection ◽  
Abdominal Wall Hernia ◽  
Emergency Operation ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
Concomitant Disease ◽  
Factors Affecting ◽  
Emergency Care Units

Abstract Patients with incarcerated abdominal wall hernias (AWHs) are often encountered in emergency care units. Despite advances in anesthesia, antisepsis, antibiotic therapy, and fluid therapy, the morbidity and mortality rates for these patients remain high. Between 2006 and 2011, we retrospectively analyzed the cases of 131 patients who underwent emergency surgery for incarcerated abdominal wall hernias. Of these, there were 70 women (53.4%) and 61 men (46.6%) with an average age of 63.3 ± 17.4 years (range, 17–91 years). Morbidity was observed in 28 patients (21.4%), and the mortality rate was 2.3%. Intestinal resection, presence of concomitant disease, and general anesthesia were the independent variants that affected morbidity of patients with incarcerated abdominal wall hernias.

scholarly journals Hernia rationing: an assessment of commissioning guidelines

2021 ◽  
Vol 103 (4) ◽  
pp. 192-195
Author(s):  
W Gewanter ◽  
T Hubbard ◽  
D Ferguson
Keyword(s):  
Hernia Repair ◽  
Abdominal Wall ◽  
Surgical Repair ◽  
Abdominal Wall Hernia ◽  
Emergency Repair ◽  
Number Of Patients ◽  
Almost All ◽  
Surgical Hernia Repair ◽  
The Impact

Introduction Hernias are a common surgical condition. Most guidelines recommend repair in almost all cases. NHS Devon clinical commissioning group (CCG) guidelines restrict the commissioning of hernia repair. The aim of this study was to follow up a cohort of patients referred for hernia repair to assess the impact of commissioning guidelines on clinical outcomes. Methods All patients referred to a single UK surgeon with an abdominal wall hernia over a 12-month period were followed up to determine whether CCG criteria were initially met. If they were not, time to any subsequent surgical intervention was recorded. Results After exclusions, 106 patients referred for abdominal wall hernia repair were followed up. Of these, 53 (49%) fulfilled commissioning guidelines for surgical repair. Thirty-one patients (23%) who had an indication for surgical repair did not fulfil commissioning criteria. This group was followed up for a median of 1,112 days (range: 962–1,287 days). Twelve patients (39%) required an operation within 900 days with one of these (3%) requiring emergency repair. These 12 patients waited a mean of 232 days before being accepted for surgery. Conclusions A large number of patients who did not initially meet NHS Devon CCG’s criteria ultimately required surgery. Three per cent of this ‘watch and wait’ group required emergency repair. NHS Devon CCG guidelines do not effectively identify patients who can be managed safely without surgical hernia repair. The incidence of emergency repair in this group should inform the prioritisation of hernia repairs when restarting elective services that have been halted because of the COVID-19 pandemic.

scholarly journals Perioperative Tablet-Based Telemonitoring After Abdominal Wall Hernia Surgery: Pilot Prospective Observational Cohort Study

10.2196/15672 ◽  
2020 ◽  
Vol 3 (2) ◽  
pp. e15672
Author(s):  
Alexander Gräfitsch ◽  
Philipp Kirchhoff ◽  
Henry Hoffmann ◽  
Ralph F Staerkle ◽  
Savas D Soysal ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Surgical Repair ◽  
Abdominal Wall Hernia ◽  
Activity Levels ◽  
Hernia Surgery ◽  
Entire Study ◽  
Median Proportion ◽  
Activity Measurements ◽  
Outpatient Settings

Background Hernia repairs account for millions of general surgical procedures performed each year worldwide, with a notable shift to outpatient settings over the last decades. As technical possibilities such as smartphones, tablets, and different kinds of probes are becoming more and more available, such systems have been evaluated for applications in various clinical settings. However, there have been few studies conducted in the surgical field, especially in general surgery. Objective We aimed to assess the feasibility of a tablet-based follow up to monitor activity levels after repair of abdominal wall hernias and to evaluate a possible reduction of adverse events by their earlier recognition. Methods Patients scheduled for elective surgical repair of minor abdominal wall hernias (eg, inguinal, umbilical, or trocar hernias) were equipped with a telemonitoring system, including a tablet, pulse oximeter, and actimeter, for a monitoring phase of 7 days before and 30 days after surgery. Descriptive statistical analyses were performed. Results We enrolled 16 patients with a mean overall age of 48.75 (SD 16.27) years. Preoperative activity levels were reached on postoperative day 12 with a median of 2242 (IQR 0-4578) steps after plunging on the day of surgery. The median proportion of available activity measurements over the entire study period of 38 days was 69% (IQR 56%-81%). We observed a gradual decrease in the proportion of available data for all parameters during the postoperative course. Six out of ten patients (60%) regained preoperative activity levels within 3 weeks after surgery. Overall, patients rated the usability of the system as relatively easy. Conclusions Tablet-based follow up is feasible after surgical repair of minor abdominal wall hernias, with good adherence rates during the first couple of weeks after surgery. Thus, such a system could be a useful tool to supplement or even replace traditional outpatient follow up in selected general surgical patients.

Survey on Ventral Hernias: Surgeon Indications, Contraindications, and Management of Large Ventral Hernias

2012 ◽  
Vol 78 (4) ◽  
pp. 388-397 ◽  
Author(s):  
Karen Kim Evans ◽  
Harvey Chim ◽  
Ketan M. Patel ◽  
Christopher J. Salgado ◽  
Samir Mardini
Keyword(s):  
Patient Satisfaction ◽  
Abdominal Wall ◽  
Enterocutaneous Fistula ◽  
Class Iii ◽  
Hernia Surgery ◽  
Subjective Impression ◽  
Asymptomatic Patients ◽  
Elective Repair ◽  
American Society ◽  
Ventral Hernias

Repair of ventral hernias constitutes one of the most common surgical procedures. Although an abundance of data exists on objective outcome measures, very little information exists on subjective measures of surgeon preference and patient satisfaction in surgical management of ventral hernias. Moreover, there are minimal data on indications for elective repair of ventral hernias. Two questionnaires were sent to a population of general and plastic surgeons active in hernia surgery. The first of these aimed at gathering information from surgeons about their indications and contraindications for repair of ventral hernias. The second survey was aimed at determining surgeons’ perception of patient satisfaction with repair of large ventral hernias (greater than 15 cm width). Five hundred sixty-eight surgeons responded to the first survey and 336 responded to the second survey. The most common indications for elective repair of abdominal wall hernias were generalized pain (68.7%) and cosmesis (54.6%), whereas the most common contraindications were morbid obesity (43.3%), American Society of Anesthesiologists Class III or IV (35.4%), and enterocutaneous fistula (33.1%). The majority of surgeons do not routinely repair large abdominal wall hernias in asymptomatic patients, but 31.6 per cent do repair asymptomatic large hernias. Most surgeons reported that the majority of patients had resolution of pain and subjective impression of improved cosmesis after surgery. This study demonstrates uniform indications and contraindications for surgical repair of ventral hernias among surgeons as well as surgeons’ perception of improvements in satisfaction of most patients after surgery. Future studies will focus on comparing surgeon and patient satisfaction.

scholarly journals Predictive factors of surgical site infections in abdominal wall hernias

2018 ◽  
Vol 5 (3) ◽  
pp. 971
Author(s):  
Siddharth Keswani ◽  
Murtaza Akhtar ◽  
Divish Saxena ◽  
Gayatri Deshpande
Keyword(s):  
Hernia Repair ◽  
Abdominal Wall ◽  
Predictive Factors ◽  
Laparoscopic Hernia Repair ◽  
Abdominal Wall Hernia ◽  
Surgical Site Infections ◽  
Related Factors ◽  
Common Procedure ◽  
Increased Risk ◽  
Surgeon Experience

Background: Surgical site infections (SSI) are infections presents in any location along the surgical tract after a surgical procedure. Knowledge of predictive factors associated with SSI is important for planning remedial measures. Abdominal wall hernia repair is a common procedure in general surgery practice and knowing the predictors of SSI in these clean surgeries requiring placement of mesh is the aim of the present study.Methods: In a hospital based longitudinal study the subjects were diagnosed cases of anterior abdominal wall hernias undergoing planned or emergency surgeries. Patients of either gender and age group of 18 to 80 years were included in the study. Patients undergoing laparoscopic hernia repair were excluded. The study factors were patient and the surgeon related factors like laboratory parameters, surgeon experience etc. The outcome was SSI assessed with up to 30 days post-operative follow up.Results: Total 198 patients were enrolled with a mean age of 42.49±15.72 years and male preponderance. Overall SSI rate was 9.09% and in planned cases it was 7.07% and 50% in emergency cases. Pre-operative hospital stays of >5 days was the only patient factor associated with increased risk of SSI (p=0.0004) and operating surgeon’s experience was associated with increased risk if SSI i.e. cases operated by junior surgeons had a higher risk of SSI (p=0.013).Conclusions: The only modifiable factor associated with SSI was pre-operative hospital stay of >5 days while high incidence of SSI with junior surgeons cannot be modified in a teaching institute.

scholarly journals Enterocutaneous Fistula and Abscess Diagnosed with Point-of-care Ultrasound

2021 ◽  
Vol 5 (4) ◽  
pp. 470-472
Author(s):  
Sarah McCuskee ◽  
Kenton Anderson
Keyword(s):  
Hernia Repair ◽  
Abdominal Wall ◽  
Point Of Care ◽  
Enterocutaneous Fistula ◽  
Fluid Collection ◽  
Source Control ◽  
Point Of Care Ultrasound ◽  
Mesh Infection ◽  
Umbilical Hernia Repair ◽  
Infected Mesh

Case Presentation: A 64-year-old female with history of umbilical hernia repair with mesh 18 years prior, cystocele, and diabetes mellitus presented with 10 days of abdominal and flank pain. The patient was tachycardic, normotensive, afebrile, and had an erythematous, tender, protuberant abdominal wall mass. Point-of-care ultrasound (POCUS) revealed an irregular, heterogeneous extraperitoneal fluid collection with intraperitoneal communication; these findings were consistent with an abscess and infected mesh with evidence for intraperitoneal extension. The diagnosis of enterocutaneous fistula (ECF) with infected mesh and abdominal wall abscess was confirmed with computed tomography and the patient was admitted for antibiotics and source control. Discussion: A rare complication of hernia repair with mesh, ECF typically occurs later than more common complications including cellulitis, hernia recurrence, and bowel obstruction. In the emergency department, POCUS is commonly used to evaluate for abscess; in other settings, comprehensive ultrasound is used to evaluate for complications after hernia repair with mesh. However, to date there is no literature reporting POCUS diagnosis of ECF or mesh infection. This case suggests that distant surgery should not preclude consideration of mesh infection and ECF, and that POCUS may be useful in evaluating for these complications.

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