Gracilis Flap Reconstruction After Proctocolectomy for Malignancy and Inflammatory Bowel Disease

Background Gracilis flap reconstruction (GFR) following abdominoperineal resection (APR) or proctocolectomy (PC) can reduce pelvic wound complications but has not been adequately assessed in the setting of immunosuppression, fistulous disease, and neoadjuvant chemoradiation. Methods Patients undergoing APR/PC with GFR were retrospectively analyzed with regard to perioperative characteristics, and morbidity was assessed. Results Patients underwent GFR for rectal cancer ( n = 28), anal cancer ( n = 3), inflammatory bowel disease ( n = 13), or benign fistulizing disease ( n = 1). 22.2% were chronically immunosuppressed, and 66.7% underwent preoperative chemoradiation. Twenty (44.4%) patients had minor wound complications, all treated nonoperatively. Nine patients had major complications with 4 patients requiring reoperation. The 4 threatened flaps were unilateral, and all were salvaged. Donor site morbidity was minimal. Patients with major complications were older (56 vs. 71 years, P = .030), and less likely to have pelvic drains ( P = .018). Conclusion In high-risk perineal wounds, GFR offers durable reconstruction with acceptably low morbidity.

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Incisional hernia repair by synthetic mesh prosthesis in patients with inflammatory bowel disease: a comparative analysis

BMC Surgery ◽

10.1186/s12893-021-01350-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Daniel Heise ◽

Charles Schram ◽

Roman Eickhoff ◽

Jan Bednarsch ◽

Marius Helmedag ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Risk Factor ◽

Hernia Repair ◽

Bowel Disease ◽

Hernia Recurrence ◽

Postoperative Course ◽

Major Complications ◽

Inflammatory Bowel ◽

The Impact

Abstract Background Patients with inflammatory bowel disease (IBD) have a high-life time risk undergoing abdominal surgery and are prone to develop incisional hernias (IH) in the postoperative course. Therefore, we investigated the role of IBD as perioperative risk factor in open ventral hernia repair (OVHR) as well as the impact of IBD on hernia recurrence during postoperative follow-up. Methods The postoperative course of 223 patients (Non-IBD (n = 199) and IBD (n = 34)) who underwent OVHR were compared by means of extensive group comparisons and binary logistic regressions. Hernia recurrence was investigated in the IBD group according to the Kaplan–Meier method and risk factors for recurrence determined by Cox regressions. Results General complications (≥ Clavien-Dindo I) occurred in 30.9% (72/233) and major complications (≥ Clavien-Dindo IIIb) in 7.7% (18/233) of the overall cohort with IBD being the single independent risk-factor for major complications (OR = 4.2, p = 0.007). Further, IBD patients displayed a recurrence rate of 26.5% (9/34) after a median follow-up of 36 months. Multivariable analysis revealed higher rates of recurrence in patients with ulcerative colitis (UC, 8/15, HR = 11.7) compared to patients with Crohn’s disease (CD, 1/19, HR = 1.0, p = 0.021). Conclusion IBD is a significant risk factor for major postoperative morbidity after OVHR. In addition, individuals with IBD show high rates of hernia recurrence over time with UC patients being more prone to recurrence than patients with CD.

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P310 Is ileoanal pouch excision a destination therapy for Inflammatory Bowel Disease? Data from a quaternary pouch referral center

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab076.434 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S337-S338

Author(s):

S Choi ◽

A Lightner ◽

J Lipman ◽

T Hull ◽

S Steele ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Perineal Wound ◽

Ileoanal Pouch ◽

Late Complications ◽

Wound Complications ◽

Destination Therapy ◽

Pouch Excision ◽

Perineal Wound Complications ◽

Inflammatory Bowel

Abstract Background Although ileal pouch-anal anastomosis (IPAA) is the surgical procedure of choice of many patients with ulcerative colitis and other conditions, some patients may require pouch excision (PEx). We aimed to describe our experience with pouch excisions and associated outcomes with an emphasis on late medical, endoscopic, and surgical interventions for inflammatory bowel disease (IBD). Methods We performed a retrospective review of a prospective colorectal surgery database. All pouch excisions performed at our quaternary pouch center from 2006 – 2019 were included; pelvic exenteration, PEx with neo-IPAA or Kock-pouch were excluded. Early complications occurred <30 days, late complications >30 days. Medications taken prior to PEx were included if taken within 12 weeks of pouch excision. Data are reported in frequency (proportion) or median (interquartile range). Results A total of 197 cases met inclusion criteria, and were performed by 23 surgeons, median 6 excision (IQR 2 - 14) cases over a 14-year period: of these, 105 had their index pouch created at our quaternary pouch referral center (overall PE rate 2.7%). Indications for PEx are shown in Table 1. Median time to PEx was 7 years and 94 (48%) patients had re-diversion prior to PEx. Medications prior to PEx: 34 (17%) steroids, 27 (14%) biologics, and 22 (11%) immune-modulators. The median duration of surgery was 4 hours (3.2-5). The median estimated blood loss was 263 ml (150-500) with 24 patients (12%) requiring at least one unit of packed red blood cells intra-operatively. Most pouch excisions were done through laparotomy; 2 cases (1%) were started robotically and 11 cases (10%) laparoscopically with a 26% conversion rate. Intersphincteric dissection was used in 172 cases (87%) while 26 cases (13%) required abdomino-perineal resection, of which 58% had a neoplastic indication. Intra-operative, early and late complications are shown in Table 2; 40 patients (20%) had perineal wound complications in less than 30 days, while 26 patients (13%) had long-term perineal wound complications, of which 15 patients required return to the operating room. After PEx, 23 patients out of 167 patients (14%) required continuation of IBD medications, 6 patients (3.6%) required surgery, and 4 patients (2.4%) required endoscopic intervention for their IBD. Conclusion In this large series of ileoanal pouch excisions, we found that perineal wound complications are common, but infrequently require operative intervention. For most IBD patients in this series, pouch excision did appear to be a destination therapy for IBD with a small minority requiring ongoing medical therapy for IBD.

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Outcomes of Retromuscular Approach for Abdominal Wall Reconstruction in Patients with Inflammatory Bowel Disease

The American Surgeon ◽

10.1177/000313481608200620 ◽

2016 ◽

Vol 82 (6) ◽

pp. 565-570 ◽

Cited By ~ 5

Author(s):

Jeremy Wang ◽

Arnab Majumder ◽

Mojtaba Fayezizadeh ◽

Cory N. Criss ◽

Yuri W. Novitsky

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Abdominal Wall Reconstruction ◽

Surgical Site Infections ◽

Synthetic Mesh ◽

Wound Complications ◽

Impaired Wound Healing ◽

Mesh Placement ◽

Inflammatory Bowel ◽

Low Rate

Ventral hernia repair (VHR) in patients with inflammatory bowel disease (IBD) presents unique surgical challenges including impaired wound healing, concomitant intestinal operations, along with likely future abdominal surgeries. Appropriate techniques and mesh choices in these patients remain under active debate. Herein we report our experience with using a retromuscular approach for major VHR in a consecutive cohort of IBD patients. We identified all patients with IBD undergoing open VHR with retrorectus mesh placement between 2007 and 2013 in our prospectively maintained database. Main outcomes included patient and hernia characteristics, perioperative details, wound complications, and hernia recurrence. A total of 38 patients with IBD met inclusion criteria. Mean hernia defect size was 338 cm2. Synthetic mesh was used in 16 patients and biologic mesh was used in 22 of patients. A surgical site occurrence (SSO) occurred in 13 (34.2%) patients, 7 (18.4%) of which were surgical site infections (SSIs). There were no instances of postoperative intestinal complications or enterocutaneous fistulae. At the mean follow-up 37 months, there were 3 (9.4%) recurrences. Our retromuscular repairs were associated with a low rate of wound morbidity and no intestinal complications. Furthermore, we report a relatively low rate of recurrences, especially in this series of complex multiply recurrent hernias. Overall, our retromuscular approach seems to be safe and effective in hernia patients with IBD.

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