scholarly journals Failure of talc seromadesis for the treatment of subcutaneous chronic seromas after incisional hernia surgery

2019 ◽  
pp. 145749691989159 ◽  
Author(s):  
J. Lopez-Monclus ◽  
M. Artes ◽  
J. Gonzalez ◽  
L. A. Blazquez ◽  
J. L. Lucena ◽  
...  
Keyword(s):  
Incisional Hernia ◽  
Prospective Observational Study ◽  
Saline Solution ◽  
Incisional Hernia Repair ◽  
High Rate ◽  
Final Solution ◽  
Hernia Surgery ◽  
Talcum Powder ◽  
Talc Poudrage ◽  
Mean Time

Background and Aim: Talc poudrage has been used since many years for sclerosing chronic pleural effusion. Several reports have shown good results managing chronic seromas after breast, vascular, and incisional hernia surgeries. The purpose of this study is to determine the utility of talc seromadesis for the management of chronic seromas after incisional hernia surgery Materials and Methods: Multicentric prospective observational study including patients diagnosed of chronic seromas after incisional hernia surgery. Under local anesthesia and ultrasonographic control, two percutaneous trocars were placed in the seroma, washing the seroma cavity with 0.9% saline solution and aspirating the remaining liquid. A sample of 4 g of talcum powder was introduced in the seroma cavity, and a 15-F drain was left in place. Patients were followed each week during at least 4 weeks after drainage removal. Results: Between January 2013 and December 2016, a total of six patients were enrolled in the study. Talc poudrage was performed without any complications. Drains were pulled out in a mean time of 3 (range: 2–4) weeks. One case of the chronic seromas was efficiently sclerosed with talc without recurrence in time. In three cases, the seroma recurred, and the final solution was surgical decortication of the seroma. In the other two cases, seroma also recurred and were managed with instillation of ethanol and iodine povidone. Conclusion: In our experience, the management of chronic seromas after incisional hernia repair with talc seromadesis is ineffective and is associated with a high rate of seroma recurrence.

scholarly journals OV10 LAPAROSCOPIC-GUIDED TRANSVERSUS ABDOMINIS PLANE (TAP) BLOCK IN HERNIA SURGERY - HOW WE DO IT

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Mário Rui Gonçalves ◽  
Conceição Antunes ◽  
Mariana Capinha ◽  
Ana Rita Arantes ◽  
Paulo Almeida ◽  
...  
Keyword(s):  
Incisional Hernia ◽  
Hernia Repair ◽  
Ventral Hernia ◽  
Incisional Hernia Repair ◽  
Transversus Abdominis ◽  
Direct Visualization ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Hernia Surgery ◽  
Surgical Department

Abstract Aim “COVID has been a great challenge for Hospitals around the world. At our surgical department a new protocol of TAP block was designed and implemented in our laparoscopic incisional ventral hernia repairs, to allow these patients to be operated in ambulatory regime, without compromising pain control and the outcomes. In this video we aim to present the technique for the Laparoscopic-guided TAP Block during a Laparoscopic IPOM Plus ventral hernia repair.” Material and Methods “We implemented this protocol in July 2020 and since then, we performed 18 TAP block in laparoscopic incisional hernia repairs, laparoscopic guided by the Surgeon or ultrasound-guided by the Anesthesiologist. In this case, the video reports to a Laparoscopic IPOM Plus incisional hernia repair performed on a 54-year-old patient, male, with obesity, arterial hypertension and dyslipidemia. He had a 6 centimeter incisional hernia post-colorectal surgery in 2013.” Results “As detailed in the video, we show all the steps to perform a TAP block under laparoscopic direct visualization” Conclusions “TAP block can be performed by the Surgeon, with direct visualization at the beginning of the laparoscopic procedure.”

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 P101 BIOSYNTHETIC MESH LIMITS ADHESION FORMATION FOLLOWING INCISIONAL HERNIA REPAIR

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Gillian Manchip ◽  
Alex Shaw ◽  
Sarah Herrick
Keyword(s):  
Animal Models ◽  
Incisional Hernia ◽  
Hernia Repair ◽  
Experimental Animal ◽  
Adhesion Formation ◽  
Incisional Hernia Repair ◽  
Biological Mesh ◽  
High Rate ◽  
Experimental Animal Models ◽  
Surgical Meshes

Abstract Aim Adhesions are fibrous bands of scar tissue that form following peritoneal injury, commonly intra-abdominal surgery, and are associated with serious morbidity such as small bowel obstruction and pain. Surgical meshes used for incisional hernia repair are associated with increased incidence and severity of adhesions. There is limited consensus on which mesh may induce the least adhesions following incisional hernia repair, and most previous data has come from experimental animal models. We aimed to evaluate existing primary research to investigate whether biological mesh limits adhesion formation compared to synthetic or biosynthetic mesh when used in patients for incisional hernia repair and also to assess whether there is correlation with existing animal model data. Material and Methods A systematic search was conducted on PubMed and EMBASE. The number of mesh-related adhesions, character of adhesions and adhesion-related complications were documented. Results were compared to previously published results from animal models. Results Thirty-two studies were included, 11 of which did not document whether the adhesions were mesh related. A total of 14,161 participants underwent incisional hernia repair, 8,526 of whom were included in follow-up analysis. Overall, 9.7% developed adhesions. Biological mesh induced a high rate of dense adhesions, whereas biosynthetic mesh induced loose, filmy adhesions suggested to cause fewer complications. These findings were similar to findings from experimental animal models. Conclusions Bio-synthetic mesh was superior in causing fewer and less dense adhesions. Further analysis of mesh-induced adhesion formation on a larger scale is required to fully understand the consequences of different mesh types.

scholarly journals P045 MEDIALIZATION AFTER COMBINED ANTERIOR AND POSTERIOR COMPONENT SEPARATION IN GIANT INCISIONAL HERNIA SURGERY, AN ANATOMICAL STUDY

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Dimitri Sneiders ◽  
Gijs de Smet ◽  
Floris den Hartog ◽  
Laura Verstoep ◽  
Anand Menon ◽  
...  
Keyword(s):  
Incisional Hernia ◽  
Rectus Sheath ◽  
Incisional Hernia Repair ◽  
Anatomical Study ◽  
Reference Points ◽  
Component Separation ◽  
Hernia Surgery ◽  
Anterior Rectus Sheath ◽  
Posterior Component Separation ◽  
Posterior Rectus Sheath

Abstract Aim To obtain tension-free closure for giant incisional hernia repair, anterior or posterior component separation (ACS, PCS) is often performed. In extreme patients, ACS and PCS may be combined. The aim of this study was to assess the additional medialization after simultaneous ACS and PCS. Material and Methods Fresh-frozen post mortem human specimens were used. Both sides of the abdominal wall were subjected to retro-rectus dissection (Rives-Stoppa), ACS and PCS, the order in which the component separation techniques (CST) were performed was reversed for the contralateral side. Medialization was measured at three reference points. Results ACS provided most medialization for the anterior rectus sheath, PCS provided most medialization for the posterior rectus sheath. After combined CST total median medialization ranged between 5.8 and 9.2 cm for the anterior rectus sheath, and between 10.1 and 14.2 cm for the posterior rectus sheath (depending on the level on the abdomen). For the anterior rectus sheath, additional PCS after ACS provided 15% to 16%, and additional ACS after PCS provided 32% to 38% of the total medialization after combined CST. For the posterior rectus sheath, additional PCS after ACS provided 50% to 59%, and additional ACS after PCS provided 11% to 17% of the total medialization after combined CST. Retro-rectus dissection alone contributed up to 41% of maximum obtainable medialization. Conclusions ACS provided most medialization of the anterior rectus sheath and PCS provided most medialization of the posterior rectus sheath. Combined CST provides marginal additional medialization, clinical use of this technique should be carefully balanced against additional risks.

scholarly journals P016 A COMPARATIVE STUDY BETWEEN ROBOTIC AND LAPAROSCOPIC VENTRAL AND INCISIONAL HERNIA REPAIR WITH THE ETEP - TAR TECHNIQUE

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Fotis Archontovasilis ◽  
Ioannis Tselios
Keyword(s):  
Incisional Hernia ◽  
Hernia Repair ◽  
Comparative Study ◽  
Operative Time ◽  
Case Series ◽  
Incisional Hernia Repair ◽  
Perioperative Outcomes ◽  
Hernia Surgery ◽  
Advantages And Disadvantages ◽  
Ventral And Incisional Hernia

Abstract Aim The aim of this study is to present a single centre’s experience in Robotic and Laparoscopic eTEP TAR technique in ventral and incisional hernia repair. Additionally, the purpose of this study is to compare these Robotic and Laparoscopic techniques in terms of feasibility, efficacy, safety, advantages and disadvantages. Material and Methods This is a case-series comparative study of patients with M1-M5 / W3 ventral and incisional hernia that underwent Robotic or Laparoscopic eTEP-TAR repair in a single institution. Patients’ characteristics were reviewed and perioperative outcomes were extracted. All patients were followed-up at the outpatient surgical unit. Intraoperative and postoperative parameters were analyzed. Results 35 patients (19 males) with a mean age of 57 years underwent Robotic eTEP-TAR (21 patients) and Laparoscopic eTEP-TAR (14 patients) repair of M1-M3/W3 ventral (12 patients) and M2-M5/W3 incisional hernia. There were 3 conversions to open repair in the Robotic group (Rg) and 1 for the Laparoscopic group (Lg). The mean operative time in Rg was 345 minutes, while in Lg was 320 min. All patients were discharged between the first and fifth postoperative day. No major complications or recurrences were revealed during a mean postoperative follow-up time of 26 months. Conclusions Both techniques are feasible, reproducible, and safe, with no major differences in operative time, recurrence and complications rate. Nevertheless, these techniques are highly demanding procedures that should be performed by experienced hernia surgeons, in well-organized centers of excellence in hernia surgery.

scholarly journals P088 SURGEON AS A RISK FACTOR OF REDUCED EURAHS QOL SCORE AFTER HERNIA REPAIR

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Jakub Woleský ◽  
Barbora Jíšová ◽  
Barbora East
Keyword(s):  
Incisional Hernia ◽  
Hernia Repair ◽  
Internal Audit ◽  
Major Complication ◽  
Incisional Hernia Repair ◽  
Hernia Surgery ◽  
Post Surgery ◽  
Before And After

Abstract Aim Our aim was to analyze patient’s reported EuraHS QoL (quality of life) scores before and after hernia surgery. And find whether the result is surgeon dependent or not, because hernia repair often serves as a training surgery for young surgeons or is performed by surgeons with no hernia interest. However, even a simple groin hernia repair can lead to life-long pain or reduced QoL and the risk of complications following incisional hernia repair is much higher. Material and Methods We have utilized the EuraHS database and its QoL questionnaire and prospectively entered all patients undergoing any hernia repair at our department since Jan. 2019. Results 519 patients have been included. Many patients in the incisional hernia cohort have reported no or very little symptoms before the operation. Only 251 have completed their 1 month follow-up with the QoL questionnaire. 63 patients have been contacted and questioned 1 year post-surgery to this date. In 6 cases the QoL scores are lower than pre-repair. 45 patients had a record of major complication or reoccurrence requiring surgery so far. Unfortunately 31 of those did not fill up the QoL questionnaire. 37 were operated on by resident with a supervision of a surgeon without a hernia interest. Conclusions Results of hernia repair are surgeon dependent and an internal audit of current practices is needed at many general surgery departments.

scholarly journals 425 The Impact Of COVID-19 On Hernia Surgery in The Lothian Region Of Scotland

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Ewing ◽  
K Hodge ◽  
R McFadyen ◽  
C Grossart ◽  
B East ◽  
...  
Keyword(s):  
Incisional Hernia ◽  
Hernia Repair ◽  
Emergency Surgery ◽  
Elective Surgery ◽  
Incisional Hernia Repair ◽  
Emergency Operation ◽  
Hernia Surgery ◽  
Time Period ◽  
Surgical Audit ◽  
The Impact

Abstract Aim The COVID-19 pandemic resulted in a lockdown in South East Scotland on the 23 March 2020. This had an impact on the volume of benign elective surgery able to be undertaken. The degree to which this reduced hernia surgery was unknown. The aim of this study was to review the hernia surgery workload in the Lothian region of Scotland and assess the impact of COVID-19 on hernia surgery. Method The Lothian Surgical Audit database was used to identify all elective and emergency hernia operations over a six-month period from 23 March 2020, and for the same time period in 2019. Data was collected on age, gender, location of the hernia, type of hernia repair and whether elective or emergency operation. Results The number of hernia repairs reduced dramatically between 2019 and 2020 (570 versus 149). The majority of this can be explained by a reduction in elective operating (488 versus 87). There was, however, also a reduction in the numbers of hernias repaired as an emergency over the same study periods (82 to 62). Lockdown in 2020 had the biggest effect on elective incisional hernia repair (74 versus 2). Conclusions The COVID-19 pandemic has reduced both the number of elective and emergency hernia operations in 2020 compared to 2019. While the reduction in elective surgery has not resulted in an associated increase in emergency surgery over the study period, it is possible that if continuing reduced availability to elective hernia surgery continues in Lothian, the emergency hernia workload may increase.

scholarly journals Biocellulose for Incisional Hernia Repair—An Experimental Pilot Study

Nanomaterials ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. 236 ◽  
Author(s):  
Falk Rauchfuß ◽  
Julian Helble ◽  
Johanna Bruns ◽  
Olaf Dirsch ◽  
Uta Dahmen ◽  
...  
Keyword(s):  
Incisional Hernia ◽  
Abdominal Wall ◽  
Incisional Hernia Repair ◽  
Common Disease ◽  
Hernia Surgery ◽  
Minimal Loss ◽  
Sublay Technique ◽  
Disease Pattern ◽  
Clinical Problems ◽  
Observation Period

Ventral or incisional hernia are a common disease pattern in general surgery. Mostcommonly, a mesh repair is used for reconstruction, whereby the mesh itself might causecomplications, like infections or adhesions. Biological materials, like biocellulose, might reducethese clinical problems substantially. In this prospective rodent study, a biocellulose mesh(produced by Gluconacetobacter xylinus) was implanted either by a sublay technique or assupplementation of the abdominal wall. After an observation period of 90 days, animals weresacrificed. The adhesions after the reconstruction of the abdominal wall were moderate. Thehistologic investigations revealed that the biocellulose itself was inert, with a minimal regenerativeresponse surrounding the mesh. The explanted mesh showed a minimal shrinkage (around 15%) aswell as a minimal loss of tear-out force, which might be without clinical relevance. This is the firstin vivo study describing biocellulose as a suitable mesh for the repair of ventral hernia in twodifferent hernia models. The material seems to be a promising option for solving actual problems inmodern hernia surgery.

scholarly journals C-reactive protein is a predictive factor for complications after incisional hernia repair using a biological mesh

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Julien Janet ◽  
Sophiane Derbal ◽  
Sylvaine Durand Fontanier ◽  
Stephane Bouvier ◽  
Niki Christou ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Incisional Hernia ◽  
Hernia Repair ◽  
Incisional Hernia Repair ◽  
Biological Mesh ◽  
C Reactive Protein ◽  
Hernia Surgery ◽  
Reactive Protein ◽  
Wbc Count ◽  
Complications And Mortality

AbstractThe introduction of biological or absorbable synthetic meshes has provided an alternative to conventional repair for incisional hernia. The ability to predict the development of complications after hernia surgery is important, as it guides surgical planning and patient management. This retrospective study assessed whether the postoperative C-reactive protein (CRP) level can predict complications after incisional hernia repair using biological mesh reinforcement. Patients who underwent incisional hernia repair surgery using biological meshes between February 2009 and February 2015 were screened for study inclusion. Patients included in the study were divided into two groups: those with and without postoperative complications. The two groups were analysed based on sex, surgical operation, length of intensive care unit stay (ICU), complications and mortality. Laboratory values, including white blood cell (WBC) count and CRP levels, were determined preoperatively and up to postoperative day (POD) 10. Postoperative complications requiring further management occurred in 32 of the 60 patients (53.3%). Among 47 patients, the mean CRP and WBC levels were 6.6 mg/L and 9.073 G/L in the group without complications vs. 141.0 mg/L, 16.704 G/L in the group with complications (p < 0.001). Patients with complications also had a longer ICU stay (10.1 vs. 0.6 days, p < 0.0001). A cut-off was 101 mg/L and offered 80.00% sensitivity (IC 61.43% to 92.29) and 95.24% specificity (76.18% to 99.88%) for postoperative complication. The rate of postoperative complications before POD10 was 95% in the group with CRP > 100 mg/L vs. 46% in the group with CRP < 100 mg/L (p = 0.000372). A high postoperative CRP level (> 100 mg/L) up to POD10 may serve as a predictor of postoperative complications in patients undergoing incisional hernia using biological meshes.

scholarly journals External and internal oblique abdominis muscle release (eimr) for complex incisional hernia repair: Modification of partition surgical technique

2021 ◽  
pp. 69-76
Keyword(s):  
Incisional Hernia ◽  
Demographic Data ◽  
Incisional Hernia Repair ◽  
Intravesical Pressure ◽  
Hernia Surgery ◽  
Incisional Hernias ◽  
The Mean ◽  
And Gender ◽  
Relaxation Incision ◽  
Hernia Size

Incisional hernia is the name given to hernias that form in the incision site after abdominal operations. The only treatment option for incisional hernias is surgery and the repair of incisional hernias is still a serious issue for surgeons. The aim of this study is to present an alternative surgical treatment procedure for the treatment of incisional hernias. The study included patients who were diagnosed with complex incisional hernia and underwent surgery between November 2016 and December 2017. In addition to demographic data such as age and gender, the operative and postoperative morbidity and mortality rates were documented. The patients who underwent additional surgical procedure other than herniography were excluded from the study. The study included 16 patients who met the inclusion criteria. Of 16 patients, nine (56.25%) were male and seven (43.75%) were female. The mean age of the patients was 51.25 years and the mean body mass index was 25.3 kg/m2. The hernia size measured in the computed tomography was 11.01 cm on average in men and 11.56 cm on average in women. The intravesical pressure measured intraoperatively before the surgery was 3.4 mmHg on average. While the mean intravesical pressure was found as 12.25 mmHg after the abdomen was closed, the mean intravesical pressure was measured as 6.43 mmHg after the relaxation incision and graft installment. The duration of the surgery was 48 minutes on average. In the postoperative period, paralytic ileus responsive to treatment was observed in two patients and skin necrosis was observed in one patient. No pulmonary embolism, respiratory problems and compartment syndrome that may cause mortality developed in patients. No recurrence was observed in patients in the control one year after the surgery. The golden standard surgical method for the incisional hernia surgery has yet to be determined. There is still a need for prospective randomized studies. We believe that our technique can be an alternative to other techniques in the incisional hernia surgery due to its easy applicability and low rate of complications.

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