Abdominal Wall Expanding System Obviates the Need for Lateral Release in Giant Incisional Hernia and Laparostoma

2017 ◽  
Vol 24 (5) ◽  
pp. 455-461 ◽  
Author(s):  
Dietmar Eucker ◽  
Andreas Zerz ◽  
Daniel C. Steinemann
Keyword(s):  
Abdominal Wall ◽  
Operative Time ◽  
Abdominal Wall Reconstruction ◽  
Hernia Recurrence ◽  
Lateral Release ◽  
Promising Alternative ◽  
Hernia Defect ◽  
Incisional Hernias ◽  
Onlay Mesh ◽  
Midline Closure

Background:In large incisional hernias and after laparostoma midline closure may be impossible. A novel abdominal wall expander system (AWEX) is proposed and evaluated. Methods: In patients with large incisional hernias and laparostoma where primary midline closure was impossible, AWEX was used. Patients undergoing abdominal wall reconstruction using AWEX between May 2012 and December 2015 were included. Intraoperative the abdominal wall was stretched by attaching the midline fascia borders to a retraction system under tension for 30 minutes. Length and width of the hernia defect were measured in preoperative computed tomography. Width gain after AWEX procedure, operative time, morbidity, and presence of remaining midline gap was evaluated. Patients were followed for hernia recurrence. Results: Ten patients with incisional hernias (N = 4) and grafted laparostoma (N = 6) underwent abdominal wall reconstruction using AWEX. Median (interquartile range) length and width of the hernia defect was 18.0 (15.0-20.5) and 12.0 (11.8-13.3) cm. Width gain after AWEX was 8.5 (8.0-10.5) cm. Operative time was 270 (135-379) minutes. The major morbidity was 20%. In 4 patients a gap of 4 (4-5) cm was bridged by intraperitoneal onlay mesh. After a median follow-up of 21 (7-36) months no hernia recurrence was observed. Conclusions: Stretching of the abdominal wall that has been shown successful using progressive restressed retention sutures and progressive preoperative pneumoperitoneum is reduced from days and weeks to 30 minutes in AWEX. AWEX is a promising alternative to component separation in repair of large incisional hernias. After refinement of the system prospective evaluation is required.

Abdominal Wall Expanding System. Intraoperative Abdominal Wall Expansion as a Technique to Repair Giant Incisional Hernia and Laparostoma. New and Long-Term Results From a Three-Center Feasibility Study

2021 ◽  
pp. 155335062110414
Author(s):  
Dietmar Eucker ◽  
Nadine Rüedi ◽  
Clinton Luedtke ◽  
Oliver Stern ◽  
Henning Niebuhr ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Abdominal Wall Reconstruction ◽  
Long Term Results ◽  
Anatomical Reconstruction ◽  
Time Saving ◽  
Lateral Abdominal Wall ◽  
Hernia Size ◽  
Midline Closure

Background The abdominal wall expanding system (AWEX) was first applied in 2012 and published in 2017. This novel technique was developed to reconstruct complex incisional hernias and residual skin-grafted laparostoma after treatment of an open abdomen, when primary midline closure was impossible. The main aim was the anatomical reconstruction of the abdominal wall and the avoidance of dissecting techniques (component separation). Methods Between 2012 and 2019, 33 patients underwent AWEX hernia repair in three certified hernia centers. The retracted abdominal wall was stretched with the AWEX system intraoperatively for approximately 30 min. Hernia size was measured preoperatively, on CT, and intraoperatively. The gain in length on the lateral abdominal wall (decrease in width of the defect) after stretching and any residual midline gap were determined in the OR. Results 33 patients underwent AWEX procedures. Six cases were evaluated separately because of additional procedures (TAR, four cases) and preoperative application of botulinum toxin (two cases). The median (95% confidence interval) measured width of hernia defects was 13 (12–16) cm, the median gain in length on the lateral abdominal wall was 12 (10–15) cm. After median follow-up of 29 (12–54) months, one recurrence from the broken mesh was observed. No method-related complications occurred. Conclusion Based on the 2017 and current results, the AWEX system represents an alternative or supplemental procedure to current techniques for complex abdominal wall reconstruction. The system proved again to be time-saving, safe, effective, and easy to learn. Further studies with enhanced technology are in progress.

Factors Predicting Increased Length of Stay in Abdominal Wall Reconstruction

2021 ◽  
pp. 000313482110475
Author(s):  
Sharbel A. Elhage ◽  
Sullivan A. Ayuso ◽  
Eva B. Deerenberg ◽  
Jenny M. Shao ◽  
Tanushree Prasad ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Length Of Stay ◽  
Abdominal Wall ◽  
Operative Time ◽  
Enhanced Recovery ◽  
Abdominal Wall Reconstruction ◽  
Mesh Infection ◽  
Inclusion Criteria ◽  
Increased Risk ◽  
Eras Protocol

Background Enhanced recovery after surgery (ERAS) programs have become increasingly popular in general surgery, yet no guidelines exist for an abdominal wall reconstruction (AWR)–specific program. We aimed to evaluate predictors of increased length of stay (LOS) in the AWR population to aid in creating an AWR-specific ERAS protocol. Methods A prospective, single institution hernia center database was queried for all patients undergoing open AWR (1999-2019). Standard statistical methods and linear and logistic regression were used to evaluate for predictors of increased LOS. Groups were compared based on LOS below or above the median LOS of 6 days (IQR = 4-8). Results Inclusion criteria were met by 2,505 patients. On average, the high LOS group was older, with higher rates of CAD, COPD, diabetes, obesity, and pre-operative narcotic use (all P < .05). Longer LOS patients had more complex hernias with larger defects, higher rates of mesh infection/fistula, and more often required a component separation (all P < .05). Multivariate analysis identified age (β0.04,SE0.02), BMI (β0.06,SE0.03), hernia defect size (β0.003,SE0.001), active mesh infection or mesh fistula (β1.8,SE0.72), operative time (β0.02,SE0.002), and ASA score >4 (β3.6,SE1.7) as independently associated factors for increased LOS (all P < .05). Logistic regression showed that an increased length of stay trended toward an increased risk of hernia recurrence ( P = .06). Conclusions Multiple patient and hernia characteristics are shown to significantly affect LOS, which, in turn, increases the odds of AWR failure. Weight loss, peri-operative geriatric optimization, prehabilitation of comorbidities, and operating room efficiency can enhance recovery and shorten LOS following AWR.

scholarly journals A pragmatic, evidence-based approach to coding for abdominal wall reconstruction

Hernia ◽  
2021 ◽  
Author(s):  
◽  
B. K. Poulose ◽  
L.-C. Huang ◽  
S. Phillips ◽  
J. Greenberg ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Operative Time ◽  
Abdominal Wall Reconstruction ◽  
Rectus Sheath ◽  
Primary Outcome Measure ◽  
Transversus Abdominis ◽  
Secondary Outcome ◽  
Evidence Based ◽  
Myofascial Release ◽  
Posterior Rectus Sheath

Abstract Purpose Ambiguity exists defining abdominal wall reconstruction (AWR) and associated Current Procedural Terminology code usage in the context of ventral hernia repair (VHR), especially with recent adoption of laparoscopic and robotic-assisted AWR techniques. Current guidelines have not accounted for the spectrum of repair complexity and have relied on expert opinion. This study aimed to develop an evidence-based definition and coding algorithm for AWR based on myofascial releases performed. Methods Three vignettes and associated outcomes were evaluated in adult patients who underwent elecive VHR with mesh between 2013 and 2020 in the Abdominal Core Health Quality Collaborative including: (1) no myofascial release (NR), (2) posterior rectus sheath myofascial release (PRS), and (3) PRS with transversus abdominis release or external oblique release (PRS-TA/EO). The primary outcome measure was operative time based on the following categories (min): 0–59, 60–119, 120–179, 180–239, and 240 + ; secondary outcomes included disease severity measures and 30-day postoperative outcomes. Results 15,246 patients were included: 7287(NR), 2425(PRS), and 5534(PRS-TA/EO). Operative time increased based on myofascial releases performed: 180–239 min (p < 0.05): NR(5%), PRS(23%), PRS-TA/EO(28%) and greater than 240 min (p < 0.05): NR (4%), PRS (17%), PRS-TA/EO(44%). A dose–response effect was observed for all secondary outcome measures indicative of three distinct levels of patient complexity and outcomes for each of the three vignettes. Conclusion AWR is defined as VHR including myofascial release. Coding for AWR should reflect the actual effort used to manage these patients. We propose an evidence-based approach to AWR coding that focuses on myofascial release and is inclusive of minimally invasive techniques.

SP7.2.4 Evaluation of Non-crosslinked Acellular Porcine Dermal Mesh – A Single Centre Experience

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Rama Karri ◽  
Amaar Aamery ◽  
Deepak Singh-Ranger
Keyword(s):  
Chronic Pain ◽  
Incisional Hernia ◽  
Abdominal Wall ◽  
Parastomal Hernia ◽  
Abdominal Wall Reconstruction ◽  
Hernia Recurrence ◽  
Biological Mesh ◽  
Ease Of Use ◽  
Secondary Outcome ◽  
Retrospective Case

Abstract Aims We report our experience with a cellular porcine dermal non-crosslinked biological mesh (EGIS®). We conducted a review of indications and outcomes of patients requiring the mesh for incisional hernia/complex abdominal wall reconstruction with component separation, parastomal hernia repairs and ELAPE. Patients were followed for a minimum of 6 and assessed for recurrence, seroma formation and chronic pain. Secondary outcome was the assessment of ease of use by the Surgeon – suturing and pliability. Method A retrospective case notes review of patients requiring biological mesh (EGIS®) from 2016 to present. A qualitative survey about ease of use of EGIS® for operations studied was sent to all Consultant Surgeons. Results EGIS® mesh was used in 38 patients: 23 Hernia repairs – 13 Incisional, 8 Parastomal, 2 Paraumbilical; 12 Pelvic floor repairs after ELAPE; and 3 abdominal wall reconstructions. Hernia recurrence occurred in 12 (32%), seroma 7 (18%) and chronic pain 7 (18%). The highest complications occurred in the incisional and parastomal hernia groups. Incisional hernia: recurrence in 5 (38%), seroma in 5 (38%) and chronic pain in 3 (23%). Parastomal hernia: recurrence in 3 (38%), chronic pain 2 (25%), seroma 1 (13%). Consultants scored the mesh 4.3 to 4.5 out of 10 for pliability, ease of use and suturing. Conclusion Biological mesh is used to reinforce hernia repairs in contaminated or potentially contaminated fields. Non-crosslinked meshes are preferred for their greater cellular infiltration from host tissue with improved integration. Our experience with this mesh shows a high complication rate and requires re-evaluation.

scholarly journals Performance of biological mesh materials in abdominal wall reconstruction: study protocol for a randomised controlled trial

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e024091 ◽  
Author(s):  
David A Carver ◽  
Andrew W Kirkpatrick ◽  
Tammy L Eberle ◽  
Chad G Ball
Keyword(s):  
Informed Consent ◽  
Randomised Controlled Trial ◽  
Abdominal Wall ◽  
Controlled Trial ◽  
Abdominal Wall Reconstruction ◽  
Hernia Recurrence ◽  
Biological Mesh ◽  
Common Source ◽  
Porcine Dermis ◽  
Randomised Controlled

IntroductionAbdominal wall hernias are a common source of morbidity and mortality. The use of biological mesh has become an important adjunct in successful abdominal wall reconstruction. There are a variety of biological mesh products available; however, there is limited evidence supporting the use of one type over another. This study aims to compare the performance (eg, the rate of hernia recurrence) of either a crosslinked biological mesh product or a non-crosslinked product in patients undergoing abdominal wall reconstruction.Methods and analysisThis is a single-centre, dual arm randomised controlled trial. Patients requiring abdominal wall reconstruction will be assessed for eligibility. Eligible patients will then undergo an informed consent process following by randomisation to either (1) crosslinked porcine dermis mesh (Permacol); or (2) non-crosslinked porcine dermis mesh (Strattice). These groups will be compared for the rate of hernia recurrence at 1 and 2 years as well as the rate of postoperative complications (eg, surgical site infections).Ethics and disseminationThis study has been approved by the institution’s research ethics board and registered with clinicaltrials.gov. All eligible participants will provide informed consent prior to randomization. The results of this study may help guide the choice of biologic mesh for this population. The results of this study will be published in peer-reviewed journals as well as national and international conferences.Trial registration numberNCT02703662.

scholarly journals Posterior Components Separation With Transversus Abdominis Release (TAR) Versus Alternative Techniques of Components Separation: Systematic Review

2018 ◽  
Vol 103 (7-8) ◽  
pp. 355-365
Author(s):  
Aseel Sleiwah ◽  
Sandra McAllister
Keyword(s):  
Abdominal Wall ◽  
Primary Repair ◽  
Abdominal Wall Reconstruction ◽  
Hernia Recurrence ◽  
Transversus Abdominis ◽  
Wound Complications ◽  
Cochrane Central Register ◽  
Components Separation ◽  
Abdominal Hernias ◽  
Wall Components

The aim of this study is to assess the clinical effectiveness of posterior abdominal wall components separation with transversus abdominis muscle release (PCS-TAR) in the management of ventral abdominal hernias. Ventral abdominal hernias complicate up to 11% of laparotomy wounds. Surgical management includes primary repair, hernioplasty, flaps, and components separation. A technique has been described to close large abdominal defects by releasing bilateral myofascial flaps of rectus abdominis from external oblique and advancing these flaps to the midline. Minimally invasive and endoscopic techniques were subsequently developed to reduce complications. A recently described method is PCS-TAR. The hypothesis is that PCS-TAR for abdominal wall reconstruction is associated with lower rates of wound complications and hernia recurrence than other components separation techniques. A comprehensive search of databases including Medline, Embase, Cochrane Central Register of Controlled Trials, and Scopus was conducted in accordance with PRISMA guidelines, looking for the primary outcomes of hernia recurrence and wound complications following different techniques of components separation. Inclusion and exclusion criteria were defined. The quality of studies was examined independently by 2 assessors. A total of 363 studies were identified. Three retrospective comparative studies met the inclusion criteria. No randomized control trial comparing different techniques of abdominal wall components separation was identified. No technique could be identified as superior to others, due to a paucity of the literature. However, based on a few retrospective cohort studies, PCS-TAR emerges as a well-tolerated new technique, with a low incidence of wound complications and hernia recurrence.

scholarly journals Outcomes of abdominal wall reconstruction in patients with the combination of complex midline and lateral incisional hernias

Surgery ◽  
2020 ◽  
Vol 168 (3) ◽  
pp. 532-542 ◽  
Author(s):  
Joaquin Manuel Munoz-Rodriguez ◽  
Javier Lopez-Monclus ◽  
Carlos San Miguel Mendez ◽  
Marina Perez-Flecha Gonzalez ◽  
Alvaro Robin-Valle de Lersundi ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Abdominal Wall Reconstruction ◽  
Incisional Hernias

scholarly journals P026 PREOPERATIVE ABDOMINAL WALL RELAXATION WITH BOLULINUM TOXIN A INJECTION CAN FACILITATE SURGICAL REPAIR OF INCISIONAL HERNIAS: LONG-TERM SINGLE CENTER FOLLOW-UP OF 12 PATIENTS

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Felix Hönes ◽  
Marios Konstantinos Kokkalis
Keyword(s):  
Botulinum Toxin ◽  
Abdominal Wall ◽  
Surgical Repair ◽  
Botulinum Toxin A ◽  
Hernia Recurrence ◽  
Toxin A ◽  
Incisional Hernias ◽  
Incisional Hernia Recurrence

Abstract Aim It was investigated how preoperative botox injection in the abdominal musculature both facilitates the surgical repair of incisional hernias and reduce the rate of hernia recurrence. Material and Methods Botulinum toxin A injections was given to 12 patients (7 female and 5 male) suffering from complex incisional wall hernia, 4 to 6 weeks preoperatively. Mean age was 54 years. 9 patients were treated by anterior and/or posterior component separation repair and 3 by Rives-Stoppa repair. By all patients the mesh could be placed in the retromuscular position. No bridging was necessary. Results After a follow-up of 3 to 4 years we examined the patients clinically and by sonography. The rate of incisional hernia recurrence was low as well as the rate of side effects like chronic pain, persisting paresthesia and mobility disorders of the abdomen. Conclusions Preoperative injection of botulinum toxin A can help to reduce the risk of further hernia recurrence after surgical repair of complex incisional hernias of the abdominal wall.

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