Results of a Prospective Cohort Study on Open Rives Technique of the Midline Incisional Hernia: Midline Closure and Mesh Overlap

2021 ◽  
pp. 155335062110331
Author(s):  
Montserrat Juvany ◽  
Salvador Guillaumes ◽  
Carlos Hoyuela ◽  
Irene Bachero ◽  
Miguel Trias ◽  
...  
Keyword(s):  
Incisional Hernia ◽  
Rectus Sheath ◽  
Abdominal Wall Defects ◽  
Lateral Border ◽  
Posterior Rectus Sheath ◽  
Defect Area ◽  
Retromuscular Repair ◽  
Incisional Hernia Recurrence ◽  
Midline Closure

Background. Rives repair has been traditionally used for large abdominal wall defects with good results on terms of recurrence. However, it is limited by the lateral border of the posterior rectus sheath. The objective of our study was to evaluate recurrence rate, midline closure and mesh overlap in patients operated on elective midline incisional hernia by open Rives retromuscular repair. Methods. This is a prospective observational study of 83 patients who underwent elective open Rives technique between January 2014 and December 2018. Main inclusion criteria were adults with a midline incisional hernia. Recurrence, midline closure and mesh overlap were determined. Results. At a median postoperative follow-up of 32 (5-59) months, 8 cases of recurrence were reported. Patients with recurrence had wider hernia defects (101 ± 52 mm vs 66 ± 36 mm, P = .014) and were repaired with wider meshes (191 ± 93 mm vs 137 ± 68 mm, P = .042). However, although it was not statistically significant, midline closure was lower (38% vs 59%), as well as the overlapping relationship between mesh area and hernia defect area (2.937:1 vs 3.732:1) on patients that developed a recurrence. Conclusions. Rives technique provides good mid-term results in a midline incisional hernia (10% of recurrence at 36 months), including wider hernias in the recurrent cohort. The authors believe that other techniques which allow midline closure and placement of bigger meshes should be considered, especially in those hernias classified as W3 on EuraHS classification (more than 10 cm on width size).

scholarly journals Laparoscopic Trans-Abdominal Retromuscular (TARM) Repair for Ventral Hernia: A Novel, Low-Cost Technique for Sublay and Posterior Component Separation

2019 ◽  
Vol 44 (4) ◽  
pp. 1081-1085 ◽  
Author(s):  
Ashwin A. Masurkar
Keyword(s):  
Ventral Hernia ◽  
Low Cost ◽  
Operating Time ◽  
Rectus Sheath ◽  
Component Separation ◽  
Transversus Abdominis ◽  
Mesh Placement ◽  
Posterior Component Separation ◽  
Posterior Rectus Sheath ◽  
Midline Closure

Abstract Background The complications of intraperitoneal onlay mesh repair for ventral hernia has favored sublay mesh placement like open Rives–Stoppa repair (ORS). There was a need for low-cost laparoscopic trans-abdominal repair using a polypropylene mesh (PPM) with sublay, midline closure and addition of posterior component separation (PCS) by transversus abdominis release (TAR). Methods The techniques used three or six operating ports with triangulation. After adhesiolysis, a transverse incision was made on the peritoneum (P) and posterior rectus sheath (PRS). The retromuscular space was developed by raising a P-PRS flap. Midline closure was performed with No. 1 polydioxanone, and a PPM was placed in sublay, followed by closure of defect and P-PRS incision. For large hernias with divarication; myo-fascial medialization using PCS-TAR aided low-tension midline closure. Results Eighty-nine patients were operated from 2010 to 2019, 26 primary ventral; 63 incisional; and 22 recurrent hernias. Of the primary, 21 were umbilical, one Spigelian and four epigastric hernias. The incisional group had 57 patients with lower midline scars (C-section 25, open tubal ligation 15, abdominal hysterectomy 17), five lateral (appendicectomy), one post-laparotomy. The mean age, male/female sex ratio and BMI were 41.23 years, 1:10.1 and 29.2 kg/m2, respectively. Mean defect and mesh area were 110 cm2 and 392 cm2. Mean operating time was 192 min. Conversion to open, mesh infection and recurrence rates were 3.4%, 1.1% and 5.62%. Conclusion Laparoscopic TARM with PPM in sublay avoids mesh–bowel contact. It provides midline closure and PCS-TAR within the same port geometry with results comparable with ORS.

scholarly journals Evaluation of Double Mesh Modification of Chevrel’s Technique in Management of Midline Incisional Hernia

2021 ◽  
Vol 18 (1) ◽  
pp. 18-22
Author(s):  
Hazem Nour ◽  
Hany Mohamed ◽  
Mohamed Farid
Keyword(s):  
Incisional Hernia ◽  
Subcutaneous Tissue ◽  
Rectus Sheath ◽  
Incisional Hernia Repair ◽  
Bare Area ◽  
Anterior Rectus Sheath ◽  
Prolene Mesh ◽  
Posterior Rectus Sheath ◽  
Superficial Wound ◽  
Mesh Technique

Background: Chevrel’s technique provides tensionfree repair of midline incisional hernia, but wide skin and subcutaneous dissection increases rate of complications. Here, we evaluate the double mesh modification of Chevrel’s technique in midline incisional hernia repair. Methods: 22 patients with midline incisional hernia underwent double mesh modification of Chevrel’s technique. After excision of hernial sac with minimal dissection of the skin and subcutaneous tissue, the anterior rectus sheath is incised on both sides to create medial flaps that are sutured toeach other. Both recti abdominis muscles were dissected off the posterior rectus sheath, opening the retrorectus space. Prolene mesh was fixed in the retrorectus space with prolene sutures, and tailored to cover the bare area of anterior surface of both recti muscles and fixed to the lateral flaps of the anterior rectus sheath with interrupted prolene sutures. Results: We observed no recurrences, no skin necrosis, two cases of seroma, one case of superficial wound infection and one case of temporarychronic pain. Conclusion: Double mesh modification of Chevrel technique is an efficient method for treatment of midline incisional hernia, with minimal surgical site occurrences. Keywords: Chevrel technique, Double mesh technique, Midline incisional hernia

scholarly journals Incidence of incisional hernia with respect to different sites and causes

2020 ◽  
Vol 7 (8) ◽  
pp. 2539
Author(s):  
Shahaji G. Chavan ◽  
Saladi Naga Nithin ◽  
Karan Jaiswal ◽  
Manasa Rambatla
Keyword(s):  
Incisional Hernia ◽  
Rectus Sheath ◽  
P Value ◽  
Inclusion Criteria ◽  
Previous Surgery ◽  
Incisional Hernias ◽  
Medical College ◽  
Primary Surgery ◽  
Posterior Rectus Sheath ◽  
A Prospective Study

Background: Of all hernias encountered, incisional hernias can be the most frustrating and difficult to treat. The aim of this study is to find out the incidence of incisional hernia at different sites and to find out their possible causes.Methods: This was a prospective study of 50 cases of Incisional hernias admitted during the period between July 2017 to July 2019. Collected data is analysed over a period of 3 months. Patients with Incisional hernia satisfying the inclusion criteria, attending surgery OPD at Dr. D. Y. Patil Medical College, Pimpri, Pune were included in study group.Results: Mean age at presentation was 45 (32/50) were female 18 patients were male. Majority of the patients were obese. Infra-umbilical variety of incisional hernia is most common 42%. The most common primary surgery is tubal ligation was 14 (28%). Significant association noted between diabetes mellitus and SSI, p value <0.05. There is a significant association between addictions (tobacco, smoking and alcohol) and hernias in umbilical region and above p value <0.005.Conclusions: The incidence of incisional hernia is more in multiparous females. Infra-umbilical midline was the most common site for herniation in 42% of cases. Lower midline incisions are more prone for herniation as the posterior rectus sheath is deficient below arcuate line. The most common previous surgery was tubectomy 14. Diabetes and SSI played important role in causing incisional hernia in our study.

scholarly journals Study of outcome of a new method of darning for repair of large and recurrent hernias

2019 ◽  
Vol 6 (6) ◽  
pp. 2036
Author(s):  
Dibyendu Das ◽  
Neelam Yadav ◽  
Kamlesh Jhariya ◽  
Reena Minz
Keyword(s):  
Incisional Hernia ◽  
Randomized Study ◽  
Rectus Sheath ◽  
Recurrent Hernia ◽  
Minimum Period ◽  
Mattress Suture ◽  
Incisional Hernias ◽  
Significant Challenge ◽  
Early Postoperative Complication

Background: Incisional hernia is the result of a failure of fascial tissues to heal and close following laparotomy. Laparoscopic Meshplasty is a standard method of repair but not usually done in large incisional and recurrent hernias.  Recurrence after repair is common in incisional hernia and poses a significant challenge for the plastic surgeons. We describe here a technique of anatomical repair of the large incisional, and recurrent hernia by darning without using mesh, which is effective in midline, paramedian as well as transverse incisional hernias. Aims and objectives to study the outcome and efficacy of our technique of Darning in cases of large and recurrent incisional hernias without using mesh.Methods: It is a prospective non randomized study of 5 year duration in which we have studied 20 cases of either large or recurrent incisional hernia admitted in our hospital. We operated these cases by darning of the rectus sheath without tension by mattress suture by prolene no.1.Results: 20 patients underwent this repair with few minor complications and there was no recurrence for minimum period of follow of 2 years.  Approximation of inner margin and separately mattress pattern darning of outer rectus sheath by prolene no.1 strengthens the repair, but do not cause complication associated with meshplasty like infection, adhesion and fistula formatioṇ.Conclusions: Our technique of darning is an extraperitoneal method of hernia repair which do not incorporate mesh and is an effective method of hernioplasty with manageable early postoperative complication. We have not seen any recurrences in follow up period.

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 A new minimally invasive technique for the repair of diastasis recti: a pilot study

2021 ◽  
Author(s):  
Gabriele Manetti ◽  
Maria Giulia Lolli ◽  
Elena Belloni ◽  
Giuseppe Nigri
Keyword(s):  
Open Access ◽  
Minimally Invasive ◽  
Abdominal Wall Defect ◽  
Rectus Sheath ◽  
Rectus Muscle ◽  
Laparoscopic Technique ◽  
Invasive Technique ◽  
Diastasis Recti ◽  
Posterior Rectus Sheath

Abstract Background Diastasis recti is an abdominal wall defect that occurs frequently in women during pregnancy. Patients with diastasis can experience lower back pain, uro-gynecological symptoms, and discomfort at the level of the defect. Diastasis recti is diagnosed when the inter-rectus distance is > 2 cm. Several techniques, including both minimally invasive and open access surgical treatment, are available. Abdominoplasty with plication of the anterior rectus sheath is the most commonly used, with the major limitation of requiring a wide skin incision. The new technique we propose is a modification of Costa’s technique that combines Rives–Stoppa principles and minimally invasive access using a surgical stapler to plicate the posterior sheaths of the recti abdominis. Methods It is a fully laparoscopic technique. The pneumoperitoneum is induced from a sovrapubic trocar, placed using an open access technique. The posterior rectus sheath is dissected from the rectus muscle using a blunt dissector to create a virtual cavity. The posterior sheets of the recti muscles are plicated using an endo-stapler. A mesh is then placed in the retromuscular space on top of the posterior sheet without any fixation. Using a clinical questionnaire, we analyzed the outcomes in 74 patients who underwent minimally invasive repair for diastasis of the rectus abdominis sheath. Results Seventy-four patients (9 men and 65 women) were treated using this technique. Follow-up was started two months after surgery. All procedures were conducted successfully. There were no major complications or readmissions. No postoperative infections were reported. There were two recurrences after six months. There was a significant reduction in symptoms. Conclusions This new method is feasible and has achieved promising results, even though a longer follow-up is needed to objectively assess this technique.

scholarly journals Modified Peritoneal Flap Hernioplasty Versus Retromuscular Technique for Incisional Hernia Repair: a Retrospective Cohort Study

2019 ◽  
Vol 109 (4) ◽  
pp. 279-288 ◽  
Author(s):  
P. Petersson ◽  
A. Montgomery ◽  
U. Petersson
Keyword(s):  
Cohort Study ◽  
Incisional Hernia ◽  
Hernia Repair ◽  
Abdominal Wall ◽  
Incisional Hernia Repair ◽  
Hernia Recurrence ◽  
Short Term ◽  
Peritoneal Flap ◽  
Incisional Hernia Recurrence

Background and Aims: We present an open retromuscular mesh technique for incisional hernia repair, the modified peritoneal flap hernioplasty, where the fascia is sutured to the mesh and the hernia sac utilized for anterior mesh coverage. The aim was to describe the modified peritoneal flap hernioplasty technique and to compare it to a retromuscular repair, without component separation, regarding short-term complications, patient satisfaction, abdominal wall complaints, and recurrent incisional hernia. Materials and Methods: Consecutive patients operated electively with modified peritoneal flap hernioplasty technique (December 2012–December 2015) or retromuscular technique (Jan 2011–Oct 2014) were included in a retrospective single-center cohort study. Outcomes were evaluated from the Swedish Ventral Hernia Registry, by chart review, physical examination, and an abdominal wall complaints questionnaire. Results: The modified peritoneal flap hernioplasty group ( n = 78) had larger hernias (mean width 10.4 vs 8.5 cm, p = 0.005), more advanced Centers for Disease Control classification ( p = 0.009), and more simultaneous gastrointestinal-tract surgery (23.1% vs 11.5%, p = 0.041) than the retromuscular group ( n = 96). No difference in short-term complications was seen. Incisional hernia recurrence was lower in the modified peritoneal flap hernioplasty group (1.4% vs 10.3%, p = 0.023), and patients were more satisfied (93.8% vs 81.7%, p = 0.032). Follow-up time was shorter in the modified peritoneal flap hernioplasty group (614 vs 1171 days, p < 0.001). Conclusion: This retrospective study showed similar rates of short-term complications, despite more complex hernias in the modified peritoneal flap hernioplasty group. Furthermore, a lower incisional hernia recurrence rate for the modified peritoneal flap hernioplasty technique compared with the retromuscular technique used in our department was found. If this holds true with equally long follow-up remains to be proven.

scholarly journals P012 RISK FACTORS FOR INCISIONAL HERNIA AND ITS RECURRENCE: OBSERVATIONAL, AMBISPECTIVE STUDY

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Lia Jimenez ◽  
Alexei Rojas ◽  
Angela Merchan ◽  
Braulio Velasquez ◽  
Daniel Fernandez ◽  
...  
Keyword(s):  
Risk Factors ◽  
Incisional Hernia ◽  
Incomplete Data ◽  
Hernia Recurrence ◽  
Urgent Surgery ◽  
History Of ◽  
Incisional Hernia Recurrence ◽  
Level Hospital ◽  
Hospital Group

Abstract Aims In patients with herniorrhaphy treated in a 3rd level hospital in the Southwestern of Colombia from January 2014 to March 2020, determine the frequency of incisional hernia recurrence and the risk factors related to. Materials and methods Observational, ambispective study that included patients older than 15 years with a history of incisional hernia that agreed to participate and signed a consent form. Patients with incomplete data or who underwent surgery in another institution were excluded. Follow-up appointments every 3 months were made to evaluate the incidence of hernia recurrence. Results 112 patients were included, 64.3% female with a mean age of 58.6-year-old. The frequency of recurrence was 38.4% with a mean of appearance of 22.9 months; 44.2% were repaired with only one technique and 39.5% with non-mesh. Non-use of mesh increased the risk for recurrence (RR 2.02; CI95%: 1.17-3.48). Other risk factors were urgent surgery (RR 1.82; CI95%: 1.14-2.91), defect closure with multifilament suture (RR 1.61; CI95%: 1.15-2.25), not do adhesiolysis (RR 3.17; CI 95%; 0.85 – 11.76) and the no use of postoperative antibiotics (RR 1.67M CI95%: 0.97-2.89). Conclusions Incisional hernia recurrences increase with time. Therefore, a follow-up of at least for 3 years should be guaranteed to avoid undiagnosed cases. Risk factors identified like absorbable multifilament sutures and non-use of the mesh must be removed from the surgery plans. Furthermore, a specialized in-hospital group of the abdominal wall and an institutional protocol would help to diminish this complication.

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