scholarly journals Parastomal hernia repair with onlay mesh remains a safe and effective approach

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Marie Shella De Robles ◽  
Christopher J. Young
Keyword(s):  
Mesh Repair ◽  
Parastomal Hernia ◽  
Loop Ileostomy ◽  
Wound Complication ◽  
Loop Colostomy ◽  
Wound Complications ◽  
Parastomal Hernia Repair ◽  
Significant Difference ◽  
Onlay Mesh ◽  
Midline Approach

Abstract Background Parastomal hernia (PSH) management poses difficulties due to significant rates of recurrence and morbidity after repair. This study aims to describe a practical approach for PSH, particularly with onlay mesh repair using a lateral peristomal incision. Methods This is a retrospective review of consecutive patients who underwent PSH repair between 2001 and 2018. Results Seventy-six consecutive PSH with a mean follow-up of 93.1 months were reviewed. Repair was carried out for end colostomy (40%), end ileostomy (25%), ileal conduit (21%), loop colostomy (6.5%) end-loop colostomy (5%) and loop ileostomy (2.5%). The repair was performed either with a lateral peristomal incision (59%) or a midline incision (41%). Polypropylene mesh (86%), biologic mesh (8%) and composite mesh (6%) were used. Stoma relocation was done in 9 patients (12%). Eight patients (11%) developed postoperative wound complications. Recurrence occurred in 16 patients (21%) with a mean time to recurrence at 29.4 months. No significant difference in wound complication and recurrence was observed based on the type of stoma, incision used, type of mesh used, and whether or not the stoma was repaired on the same site or relocated. Conclusion Onlay mesh repair of PSH remains a practical and safe approach and could be an advantageous technique for high-risk patients. It can be performed using a lateral peristomal incision with low morbidity and an acceptable recurrence rate. However, for patients with significant adhesions and very large PSH, a midline approach with stoma relocation may also be considered.

Primary or Redo Posterior Sagittal Anorectoplasty without a Stoma: To Feed or Not to Feed?

2017 ◽  
Vol 29 (02) ◽  
pp. 150-152 ◽  
Author(s):  
Clare Skerrit ◽  
Alexander Dingemans ◽  
Victoria Lane ◽  
Alejandra Sanchez ◽  
Laura Weaver ◽  
...  
Keyword(s):  
Breast Milk ◽  
Wound Dehiscence ◽  
Anorectal Malformations ◽  
Wound Complication ◽  
Wound Complications ◽  
Age At Surgery ◽  
Significant Difference ◽  
Male Patients ◽  
The Mean ◽  
Picc Line

Introduction Repair of anorectal malformations (ARMs), primarily or with a reoperation, may be performed in certain circumstances without a diverting stoma. Postoperatively, the passage of bulky stool can cause wound dehiscence and anastomotic disruption. To avoid this, some surgeons keep patients NPO (nothing by mouth) for a prolonged period. Here, we report the results of a change to our routine from NPO for 7 days to clear fluids or breast milk. Materials and Methods After primary or redo ARM surgery, patients given clear liquids were compared to those who were kept strictly NPO. Age, indication for surgery, incision type, use of a peripherally inserted central catheter (PICC) line, and wound complications were recorded. Results There were 52 patients, including 15 primary and 37 redo cases. Group 1 comprised 11 female and 15 male patients. The mean age at surgery was 4.9 years (standard deviation [SD]: 2.3). There were 8 primary cases and 18 redo cases. Twelve (46.6%) received a PICC line. The average start of clear liquids was on day 5.3 (SD: 2.2) after examination of the wound, and the diet advanced as tolerated. The first stool passage was recorded on average on day 2.3 (SD: 1.3). Four minor wound complications and no major wound complications occurred.Group 2 comprised 14 females and 12 male patients. The mean age at surgery was 3.5 (SD: 2.4) years. There were 7 primary and 19 redo cases. One (3.8%) patient required a PICC line. A clear liquid diet was started within 24 hours after surgery. A regular diet was started on average on day 5.8 (SD: 1.3). The first stool passage was recorded on an average of day 1.6 (SD: 0.9). Three minor wound complications occurred; however, there was no significant difference between the two groups (SD: 0.71). One major wound complication occurred. However, there was no significant difference in major wound complications between the groups (SD: 0.33). Conclusion No increase in wound problems was noted in children receiving clear liquids or breast milk compared with the strict NPO group, and PICC line use was reduced. We believe this change in practice simplifies postoperative care without increasing the risk of wound complications.

scholarly journals Analysis of Outcomes in Adolescents and Young Adults With Pilonidal Disease

2021 ◽  
Vol 8 ◽  
Author(s):  
Mackenzie N. Abraham ◽  
Steven L. Raymond ◽  
Russell B. Hawkins ◽  
Atif Iqbal ◽  
Shawn D. Larson ◽  
...  
Keyword(s):  
Young Adults ◽  
Older Patients ◽  
Pilonidal Disease ◽  
Wound Complication ◽  
Wound Complications ◽  
Complication Rates ◽  
Recurrence Rates ◽  
Significant Difference ◽  
Secondary Healing ◽  
Age And Sex

Purpose: Numerous definitive surgical techniques exist for the treatment of pilonidal disease with varied recurrence rates and wound complications. Due to the wide array of techniques and lack of consensus on the best approach, we proposed to study our experience treating pilonidal disease in adolescents and young adults.Methods: A retrospective analysis was conducted of patients 10–24 years old treated at a tertiary medical center from 2011 to 2016. Data including demographics, management, and outcomes were collected and analyzed. Primary outcome was recurrence of disease.Results: One hundred and thirty three patients with pilonidal disease underwent operative management. Fifty one percent underwent primary closure and 49% healed by secondary intention with no significant difference in recurrence rates (primary 18%, secondary 11%; p = 0.3245). Secondary healing patients had significantly lower wound complication rates (primary 51%, secondary 23%; p = 0.0012). After accounting for sex, race, weight, and operative technique, age was predictive of disease recurrence with an adjusted odds ratio (OR) of 0.706 (0.560–0.888; p = 0.003). Age and sex were both predictive of wound complications. Older patients had decreased risk of wound complication (adjusted OR 0.806, 95% CI 0.684–0.951; p = 0.0105), and male patients had increased risk of wound complication (adjusted OR 2.902, 95% CI 1.001–8.409; p = 0.0497).Conclusion: In summary, there is no significant difference in the recurrence rates between operative techniques for pilonidal disease. Older patients have decreased risk of recurrence following intervention. Wound complication rates are lower in patients undergoing secondary healing, though this may be better explained by differences in age and sex. Additional research investigating newer, minimally-invasive techniques needs to be pursued.

scholarly journals Does Concurrent Distal Tibiofibular Joint Arthrodesis Affect the Nonunion and Complication Rates of Tibiotalar Arthrodesis?

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0036
Author(s):  
Julie Neumann ◽  
Maxwell Weinberg ◽  
Chong Zhang ◽  
Charles Saltzman ◽  
Alexej Barg
Keyword(s):  
Wound Complication ◽  
Ankle Arthrodesis ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Wound Complications ◽  
Complication Rates ◽  
Vein Thrombosis ◽  
Significant Difference ◽  
Tibiotalar Arthrodesis ◽  
End Stage

Category: Ankle Introduction/Purpose: Tibiotalar arthrodesis is generally a successful treatment option for patients with end stage ankle arthritis. However, there is a 9% risk of nonunion in patients undergoing primary tibiotalar arthrodesis. To date, it is unclear whether concurrent distal tibio-fibular joint arthrodesis affects this nonunion rate as there have been no studies directly comparing patients with and without arthrodesis of the distal tibio-fibular joint. The purpose of this clinical study is to compare the rate of nonunion in patients with a distal tibio-fibular fusion to those without a distal tibio-fibular fusion in the setting of a primary, open ankle arthrodesis. The hypothesis of this study was that the addition of a distal tibio-fibular fusion would decrease the nonunion rate in patients undergoing open ankle arthrodesis. Methods: This is a retrospective review of 521 consecutive patients from October 2002 to April 2016. 366 ankles from 354 unique patients met inclusion criteria. All patients underwent primary, open tibiotalar arthrodesis. 250 patients underwent open tibiotalar arthrodesis with a distal tibio-fibular fusion and 116 patients underwent open tibiotalar arthrodesis without a distal tibio-fibular fusion. Age, gender, body mass index, smoking, and preoperative radiographic deformity were controlled. The primary outcome measure was nonunion rate of tibiotalar arthrodesis. Secondary outcome measures were time to union, rate of wound complications, and rate of development of post-operative deep vein thrombosis (DVT)/Pulmonary embolism (PE). Results: Average age of the patients was 56.2 +/- 14.2 years. Mean follow-up time was 33.8 months. Unions were assessed on routine post-operative radiographs and by clinical examination. If there was a concern for nonunion, computerized tomography scan was utilized for further assessment. Nonunion rate of patients who had the distal tibio-fibular joint included was 19/250 (8%) and nonunion rate of those who did not have the distal tibio-fibular joint fused was 14/116 (12%) (p=0.16). There was no significant difference between those who had the distal tibio-fibular joint included versus who did not in wound complication rate (27% vs 31%, p=0.40), time to union (4.9 weeks versus 5 weeks, p =0.54), and DVT/PE rate (5% vs 3%, p=0.41), respectively [Table 1]. There were no major complications. Conclusion: To our knowledge, this is the first study directly comparing nonunion rates and complication rates in patients who underwent primary, open ankle arthrodesis with and without distal tibio-fibular joint arthrodesis. In this study, inclusion of the distal tibio-fibular joint in tibiotalar arthrodesis does not affect nonunion rate in patients undergoing primary, open ankle arthrodesis. Additionally, inclusion of the distal tibio-fibular joint does not affect rate of wound complication, time to union, and DVT/PE rate.

Parastomal hernia repair with a 3-D mesh device and additional flat mesh repair of the abdominal wall

Hernia ◽  
2014 ◽  
Vol 18 (5) ◽  
pp. 653-661 ◽  
Author(s):  
G. Köhler ◽  
O. O. Koch ◽  
S. A. Antoniou ◽  
M. Lechner ◽  
F. Mayer ◽  
...  
Keyword(s):  
Hernia Repair ◽  
Abdominal Wall ◽  
Mesh Repair ◽  
Parastomal Hernia ◽  
Parastomal Hernia Repair

Effect of Simple Interrupted Suture Spacing on Aesthetic and Functional Outcomes of Skin Closures

2019 ◽  
Vol 23 (6) ◽  
pp. 580-585 ◽  
Author(s):  
Allison Stoecker ◽  
Collin M Blattner ◽  
Stephanie Howerter ◽  
Whitney Fancher ◽  
John Young ◽  
...  
Keyword(s):  
Wound Repair ◽  
Healing Process ◽  
Wound Complication ◽  
Wound Complications ◽  
Low Density ◽  
Tissue Ischemia ◽  
Wound Closure Techniques ◽  
Interrupted Suture ◽  
Scar Assessment ◽  
Significant Difference

Background Dermatologic surgeons are trained in fundamental wound closure techniques that minimize wound tension and tissue ischemia to optimize healing and create discrete scars. These include orienting excisions along resting skin tension lines, handling tissue edges with care, and avoiding strangulation while tying suture. Another variable that may affect wound healing and cosmetic outcomes is the spacing between sutures. Objective This prospective, single-centre, randomized, split-scar comparison trial was designed to explore how suture spacing distance affects wound complication rate and scar cosmesis. Methods Elliptical surgical wounds of the trunk and extremities were repaired with simple interrupted sutures with varying suture spacing. One half of each wound was repaired with high-density suture spacing (approximately 5 mm apart) and the other with low-density suture spacing (approximately 10 mm apart). Wounds were evaluated at 2-week suture removal for complications, and then reevaluated at 3 and 6 months for cosmesis using the Patient and Observer Scar Assessment Scale score. Results Results revealed no significant difference in minor wound complications during the early healing process between high- and low-density suture spacing. At 3 months postoperatively, physicians and patients alike preferred the aesthetics of the low-density suture placement. By 6 months postoperatively, this preference disappeared. Conclusions These results suggest that suture spacing may affect early scar formation. Additionally, placing sutures farther apart results in fewer total puncture wounds, decreases tissue trauma, and saves surgical time while conserving suture material. Therefore, dermatologic surgeons should consider placing fewer percutaneous sutures during wound repair.

scholarly journals First Report of the Stapled Mesh Stoma Reinforcement Technique in a Urologic Context

2014 ◽  
Vol 2014 ◽  
pp. 1-3
Author(s):  
Dwayne Tun Soong Chang ◽  
Isaac Andrew Thyer ◽  
John Oliver Larkin ◽  
Marina Helen Wallace ◽  
Dickon Hayne
Keyword(s):  
Hernia Repair ◽  
Mesh Repair ◽  
Parastomal Hernia ◽  
Ileal Conduit ◽  
Perioperative Complications ◽  
Common Complication ◽  
First Case ◽  
Parastomal Hernia Repair ◽  
Novel Method ◽  
Term Data

Parastomal hernia is a common complication of ileal conduit formation. Mesh repair of parastomal hernia has lower rate of recurrence than nonmesh techniques but can be time-consuming to perform. The stapled mesh stoma reinforcement technique (SMART) is a novel method of rapidly constructing a reinforced stapled stoma. We report the first case utilising this technique in a urologic context. The procedure was performed on a middle-aged female with recurrent parastomal hernia of her ileal conduit. There were no perioperative complications. The resited stoma remained healthy and functioned normally. Longer term data is clearly desirable though this technique deserves consideration in the treatment of urologic parastomal hernias. This case demonstrates that SMART is an easy and convenient procedure for parastomal hernia repair.

scholarly journals Modified Laparoscopic Sugarbaker Repair of Parastomal Hernia With a Totally Extraperitoneal Technique

2021 ◽  
Vol 8 ◽  
Author(s):  
Huiyong Jiang ◽  
Dil Momin Thapa ◽  
Xiangjun Cai ◽  
Chun Ma ◽  
Mofei Wang
Keyword(s):  
Parastomal Hernia ◽  
Special Treatment ◽  
Wound Complications ◽  
Stoma Creation ◽  
Totally Extraperitoneal ◽  
Stoma Formation ◽  
Parastomal Hernia Repair ◽  
The Mean ◽  
Laparoscopic Tep

Purpose: Many patients develop a parastomal hernia within the first 2 years of stoma formation, and even surgical repair is associated with high recurrence rates. An intraperitoneal approach is typically used for the laparoscopic repair of parastomal hernia; it is unknown whether a totally extraperitoneal technique (TEP) is feasible. Here we describe a laparoscopic TEP approach using a modified Sugarbaker method for the repair of parastomal hernia.Methods: Seven patients underwent parastomal hernia repair. The retrograde puncture technique was used to create the extrapneumoperitoneum, and the peritoneum was separated with a laparoscopic TEP approach; the mesh was placed using a modified Sugarbaker technique.Results: All patients had an oncologic etiology for stoma creation. The mean (±SD) size of the hernia defect was 3.1 ± 2.7 cm and the mesh size was 303.4 ± 96.8 cm2. The mean operative time was 195.5 ± 20.7 min and average length of hospital stay after surgery was 4.8 ± 2.1 days. One patient had intraoperative subcutaneous emphysema. The average follow-up time was 8.5 ± 2.7 months; mild pain occurred in 2 patients, 3 experienced seroma formation (with no special treatment required), and 1 had early intestinal obstruction (which was treated with conservative care). There was no hernia recurrence, wound complications, or infections of the surgical site or mesh during follow-up.Conclusion: A laparoscopic TEP technique is technically challenging but feasible. Modified laparoscopic Sugarbaker repair of a parastomal hernia with the TEP technique is safe and effective, although the recurrence rate and late complications require confirmation in more cases with long-term follow-up.

scholarly journals Low Risk of Wound Complications with Sinus Tarsi Approach for Treatment of Calcaneus Fractures

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0048
Author(s):  
S. Blake Wallace ◽  
David O’Neill ◽  
Anish Narayanan ◽  
George T. Liu ◽  
Avneesh Chhabra ◽  
...  
Keyword(s):  
Smoking Status ◽  
Case Series ◽  
Wound Complication ◽  
Wound Complications ◽  
Complication Rates ◽  
Sinus Tarsi ◽  
Radiographic Measurements ◽  
Sinus Tarsi Approach ◽  
Significant Difference ◽  
Calcaneus Fractures

Category: Trauma; Hindfoot Introduction/Purpose: Fractures of the calcaneus are life-changing events with a major socioeconomic impact from lost productivity. Traditional operative treatment with the extensile lateral approach has shown relatively high rates of wound complications. Less invasive approaches can improve fracture alignment and decrease wound healing complications. The purpose of this study is to report our experience with the sinus tarsi approach in treating calcaneus fractures. Methods: We retrospectively identified patients at our institution treated with a limited sinus tarsi approach for calcaneus fractures from 2009-2018. Demographic and radiographic data were collected including: age, sex, mechanism of injury, occupation, presence of diabetes, smoking status, Sanders classification, Bohler and Gissane angles. Postoperatively, we recorded the presence of complications, return-to-work time, and radiographic measurements. Results: Our analysis included 105 fractures in 100 patients: 86% males, 42% smokers, 4% diabetics, with an average body mass index of 26.5. The fractures were: Sanders type 2 (32%), type 3 (48%), type 4 (18%), and 2% were a tongue-type variant. Preoperatively 38% of fractures displayed a negative angle, 50% had an angle 0-20 degrees, and 12% over 20 degrees; postoperatively 13% had an angle 0-20 degrees, and 87% had an angle over 20 degrees. Of patients working prior to the injury, 72% had returned to work by 6 months, and 89% by 12 months. The wound complication rate was 12% (12/100), with only 2% (2/100) requiring additional procedures. There was no significant difference in wound complication rates in smokers versus nonsmokers (11.9% vs 12.2%, p=0.55). Conclusion: The limited sinus tarsi approach for depressed calcaneus fractures allows radiographic restoration of calcaneal height with a low rate of wound complications, even amongst active smokers. To the authors’ best knowledge, this is the largest published case series of calcaneus fractures treated with the sinus tarsi approach. Further follow up is needed to determine the success of this approach in mitigating long term complications.

Wound Complications With Posterior Midline and Posterior Medial Leg Incisions

2011 ◽  
Vol 4 (6) ◽  
pp. 361-369 ◽  
Author(s):  
Peter Highlander ◽  
Robert M. Greenhagen
Keyword(s):  
Wound Healing ◽  
Wound Complication ◽  
Wound Complications ◽  
Complication Rates ◽  
Inclusion Criteria ◽  
Level Of Evidence ◽  
Patient Demographics ◽  
Group 2 ◽  
Midline Approach ◽  
Group 1

There is no consensus on the optimal incisional approach at the posterior leg to avoid wound healing complications. The purpose of this systematic review is to report and compare complication rates associated with two common incisions used to approach the Achilles tendon in order to provide additional recommendations for optimal incision placement. Materials and Methods. Four electronic databases were searched using keywords for procedures using posterior leg incisions. A total of 8724 studies were analyzed and subjected to inclusion and exclusion criteria. Once inclusion criteria were met, each article was placed in 1 of 2 groups based on incision placement: midline (group 1) or posterior medial (group 2). Study format, patient demographics, surgical indication and other details, and wound complications were recorded. The data obtained was reviewed for trends between the two groups. Results. 38 articles met the inclusion criteria. Seven articles used the midline approach (group 1) whereas 31 articles used the posterior medial incision (group 2). The 38 articles included 1287 patients, of whom 25.6% were female with an average age of 43.9 years. Group 1 included 142 patients and group 2 had 1145 patients. The total wound complication rate among all reports was determined to be 8.2%, with 7.0% and 8.3% between groups 1 and 2, respectively. Discussion. Although incision placement may influence wound healing complications, it appears that additional factors such as advanced age, delay in surgical intervention, gender, comorbid conditions, prior surgery, and postoperative protocols also play a role. This report suggests that a midline approach is no less precarious in avoidance of wound complications regardless of patient demographics or other surgical details in comparison with a posterior medial incision. Level of Evidence: Therapeutic, Level IV

scholarly journals Meta-analysis of elective surgical complications related to defunctioning loop ileostomy compared with loop colostomy after low anterior resection for rectal carcinoma

2015 ◽  
Vol 97 (7) ◽  
pp. 494-501 ◽  
Author(s):  
Hong Zhi Geng ◽  
Dilidan Nasier ◽  
Bing Liu ◽  
Hua Gao ◽  
Yi Ke Xu
Keyword(s):  
Rectal Carcinoma ◽  
Anterior Resection ◽  
Surgical Complications ◽  
Low Anterior Resection ◽  
Meta Analysis ◽  
Loop Ileostomy ◽  
Loop Colostomy ◽  
Lower Prevalence ◽  
Randomized Controlled ◽  
Significant Difference

Introduction Defunctioning loop ileostomy (LI) and loop colostomy (LC) are used widely to protect/treat anastomotic leakage after colorectal surgery. However, it is not known which surgical approach has a lower prevalence of surgical complications after low anterior resection for rectal carcinoma (LARRC). Methods We conducted a literature search of PubMed, MEDLINE, Ovid, Embase and Cochrane databases to identify studies published between 1966 and 2013 focusing on elective surgical complications related to defunctioning LI and LC undertaken to protect a distal rectal anastomosis after LARRC. Results Five studies (two randomized controlled trials, one prospective non-randomized trial, and two retrospective trials) satisfied the inclusion criteria. Outcomes of 1,025 patients (652 LI and 373 LC) were analyzed. After the construction of a LI or LC, there was a significantly lower prevalence of sepsis (p=0.04), prolapse (p=0.03), and parastomal hernia (p=0.02) in LI patients than in LC patients. Also, the prevalence of overall complications was significantly lower in those who received LIs compared with those who received LCs (p<0.0001). After closure of defunctioning loops, there were significantly fewer wound infections (p=0.006) and incisional hernias (p=0.007) in LI patients than in LC patients, but there was no significant difference between the two groups in terms of overall complications. Conclusions The results of this meta-analysis show that a defunctioning LI may be superior to LC with respect to a lower prevalence of surgical complications after LARRC.

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