scholarly journals Timing of repair and mesh use in traumatic abdominal wall defects: a systematic review and meta-analysis of current literature

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Steffi Karhof ◽  
Rianne Boot ◽  
Rogier K. J. Simmermacher ◽  
Karlijn J. P. van Wessem ◽  
Luke P. H. Leenen ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Current Literature ◽  
Mesh Repair ◽  
Surgical Repair ◽  
Pooled Analysis ◽  
Hernia Recurrence ◽  
Cochrane Library ◽  
Abdominal Wall Defects ◽  
Delayed Repair ◽  
Mesh Augmentation

Abstract Background Traumatic abdominal wall hernias or defects (TAWDs) after blunt trauma are rare and comprehensive literature on this topic is scarce. Altogether, there is no consensus about optimal methods and timing of repair, resulting in a surgeon’s dilemma. The aim of this study was to analyze current literature, comparing (1) acute versus delayed repair and (2) mesh versus no mesh repair. Methods A broad and systematic search was conducted in PubMed, EMBASE, and the Cochrane Library. The selected articles were assessed on methodological quality using a modified version of the CONSORT 2010 Checklist and the Newcastle-Ottawa scale. Primary endpoint was hernia recurrence, diagnosed by clinical examination or CT. Random effects meta-analyses on hernia recurrence rates after acute versus delayed repair, and mesh versus no mesh repair, were conducted separately. Results In total, 19 studies were evaluated, of which 6 were used in our analysis. These studies reported a total of 229 patients who developed a TAWD, of whom a little more than half underwent surgical repair. Twenty-three of 172 patients (13%) who had their TAWD surgically repaired developed a recurrence. In these studies, nearly 70% of the patients who developed a recurrence had their TAWD repaired primarily without a mesh augmentation and mostly during the initial hospitalization. Pooled analysis did not show any statistically significant favor for either use of mesh augmentation or the timing of surgical repair. Conclusion Although 70% of the recurrences occurred in patients without mesh augmentation, pooled analysis did not show significant differences in either mesh versus no mesh repair, nor acute versus delayed repair for the management of traumatic abdominal wall defects. Therefore, a patient’s condition (e.g., concomitant injuries) should determine the timing of repair, preferably with the use of a mesh augmentation.

scholarly journals Treatment of Ruptured Giant Omphalocele and Gastroschisis with Liver Herniation using a Wound Retractor as a Novel Approach

2020 ◽  
Vol 08 (01) ◽  
pp. e112-e116
Author(s):  
Jana Nelson ◽  
Robin Wachowiak ◽  
Manuela Siekmeyer ◽  
Matthias Knuepfer ◽  
Ulrich Thome ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Surgical Repair ◽  
Abdominal Cavity ◽  
Abdominal Wall Defects ◽  
Lethal Outcome ◽  
Total Liver ◽  
Novel Approach ◽  
Wound Retractor ◽  
Liver Herniation ◽  
Secondary Closure

AbstractRuptured giant omphaloceles (GO) and gastroschisis with total liver herniation are rare cases of exceptionally large abdominal wall defects. Many of these children have lethal outcome. The surgical and postsurgical management are complex. We report on two cases treated with staged surgical repair using a wound retractor as a silo. With this technique, the liver and intestines could be reduced into the abdomen with secondary closure of the abdominal cavity within the first 1 to 2 weeks of life.

Result of delayed repair of quadriceps muscle following a sharp cut injury

2021 ◽  
Vol 14 (3) ◽  
pp. e239863
Author(s):  
Hira Lal Nag ◽  
Gunjar Jain ◽  
Mayur Nayak ◽  
Archit Goyal
Keyword(s):  
Polypropylene Mesh ◽  
Surgical Repair ◽  
Functional Limitations ◽  
Quadriceps Muscle ◽  
Knee Extension ◽  
Middle Term ◽  
Delayed Repair ◽  
Mesh Augmentation ◽  
Muscle Tear

We herewith report a case of a 22-year-old man who suffered from a transverse laceration of the quadriceps muscle. The patient presented to us after 3 months of the injury with an inability to extend the knee. We undertook a surgical repair of the muscle tear using the modified Mason-Allen technique and a polypropylene mesh augmentation. To the best of our knowledge, the use of polypropylene mesh for repair augmentation of mid-substance tear of quadriceps muscle has never been described in the literature. The patient had achieved a full active knee extension at 9 months following the surgery. At 3 years of follow-up, the patient has maintained the movements and strength of the knee. He has no functional limitations and is satisfied with the outcome. Thus, the middle term results are good and the treatment is promising.

Carbimazole-Related Gastroschisis

2003 ◽  
Vol 37 (6) ◽  
pp. 829-831 ◽  
Author(s):  
Anne-Maëlle Guignon ◽  
Michel P Mallaret ◽  
Pierre Simon Jouk
Keyword(s):  
Abdominal Wall ◽  
White Woman ◽  
Surgical Repair ◽  
Causality Assessment ◽  
In Utero ◽  
Abdominal Wall Defects ◽  
Rare Occurrence ◽  
Case Summary ◽  
The Relationship ◽  
Malformative Syndrome

OBJECTIVE: To report a case of gastroschisis in a newborn secondary to carbimazole exposure in utero. CASE SUMMARY: A 25-year-old white woman was treated for Graves disease with carbimazole throughout pregnancy. A boy was born prematurely by vaginal delivery, with a gastroschisis without associated malformative syndrome. Death occurred in the 25th hour of life after surgical repair. DISCUSSION: Carbimazole is completely metabolized to methimazole after absorption. Carbimazole or methimazole intake during pregnancy has been associated with an increased incidence of scalp aplasia. Abdominal wall defects secondary to carbimazole or methimazole exposure in utero seem to be a rare occurrence. However, other cases of abdominal wall defects have been reported in 4 newborns, 2 of them associated with scalp aplasia. An objective causality assessment revealed that the relationship between the gastroschisis and the exposure to carbimazole in utero was possible. CONCLUSIONS: It is important to emphasize the possible risk of abdominal wall defects in newborns to pregnant women taking carbimazole or methimazole.

scholarly journals Flap Surgical Techniques For Incisional Hernias Reccurences. A Swine Experimental Model

2017 ◽  
Vol 90 (2) ◽  
pp. 203-211
Author(s):  
Florina Popa ◽  
Filip Ardelean ◽  
Cosmin Pestean ◽  
Robert Purdoiu ◽  
Oana Rosca ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Mesh Repair ◽  
Surgical Techniques ◽  
Careful Examination ◽  
Large Animal ◽  
Abdominal Wall Defects ◽  
Flap Surgery ◽  
Abdominal Wall Repair ◽  
Large Animal Models ◽  
The University

Background and aims. In the age of synthetic prostheses most of hernia studies include a careful examination of the various types of prosthesis, their characteristics and their repair indications. Biological prostheses are also beginning to draw attention. But in terms of recurrence especially for poor or developing countries, the discussion is different, due to their high cost which makes them difficult to afford. In this article we present new flap reconstruction techniques for the reconstruction of the abdominal wall versus mesh repair, applied on swine models, outline the results of each technique, and specify the indications for their use.Methods. An experimental protocol using four swine models (PIC-FII-337 hybrid breed pigs), five months old, was conducted. All animal care and operative procedures were studied following the protocol approved by the Ethics Committee of the University of Medicine and Pharmacy resolution no. 281/2014 of the Department of Surgery of the University of Agricultural Sciences and Veterinary Medicine); the study was carried out between November 2015 and February 2016. The primary objective was to compare the effect of surgical strategies in the treatment of the abdominal wall defect using variable flaps versus mesh repair in a large-animal models. Physical examination and ultrasound imaging of the abdominal wall repair were done on determined periods, during one month. The complications occurring after the abdominal wall repair were edema, collections, superficial dehiscence an recurrences.Results. No recurrences were reported at one month results, all seromas reported were solved over time by natural drainage. Superficial necrosis appeared in two swine models and superficial dehiscence occurred in one model, the perforator ”plus” flap. Mesh infection was detected in the “onlay” swine model.Conclusions. In terms of recurrences, contaminated abdominal wall defects or other contraindications to the use of prosthetic materials, biological mesh repair or flap surgery are the only surgical options. Based on our findings and considering the high cost reported by the biological meshes use, flap surgery becomes the suitable treatment for such cases, allowing a good reconstruction of the abdominal wall.

scholarly journals The results of expanded-polytetrafluoroethylene mesh repair in difficult abdominal wall defects

2019 ◽  
Vol 42 (1) ◽  
pp. 131-143 ◽  
Author(s):  
Tarkan Ünek ◽  
Selman Sökmen ◽  
Tufan Egeli ◽  
Vildan Avkan Oğuz ◽  
Hülya Ellidokuz ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Mesh Repair ◽  
Abdominal Wall Defects ◽  
Expanded Polytetrafluoroethylene

Surgical Management of Congenital Abdominal Wall Defects in Germany: A Population-Based Study and Comparison with Literature Reports

2017 ◽  
Vol 27 (06) ◽  
pp. 516-525 ◽  
Author(s):  
Janine Dietrich ◽  
Jan Zeidler ◽  
Jochen Blaser ◽  
Jan Gosemann ◽  
Martin Lacher ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Surgical Management ◽  
Current Literature ◽  
Surgical Approach ◽  
German Population ◽  
Abdominal Wall Defects ◽  
Secondary Closure ◽  
First Time ◽  
Duration Of Ventilation ◽  
Congenital Abdominal Wall Defects

Introduction We aimed to analyze for the first time the characteristics, treatment modalities, and outcomes in infants with congenital abdominal wall defects (CAWDs) in Germany and to compare the results with current literature reports. Patients and Methods Data of a health insurance covering approximately 10% of the German population were analyzed. Patients who had undergone CAWD closure during a period of nearly 6 years were included. Surgical approach was categorized into primary versus secondary closure. Complications were defined as any reintervention within 1 year after initial treatment. Results Patients with gastroschisis were treated in 24 centers, newborns with omphalocele in 34 centers. There was no mortality, and the type of surgical approach had no significant impact on the incidence of complications in both gastroschisis and omphalocele. Out of 39 patients with gastroschisis, 72% had undergone primary closure being associated with a shorter duration of ventilation (p = 0.003) and hospitalization (p < 0.001). Out of 54 patients with omphalocele, 54% had undergone secondary closure, whereas modality of management did not affect duration of ventilation and hospitalization. Although heterogeneous, data of the current literature were comparable to those of this study. Conclusion Unbiased data demonstrate for the first time that the quality of the current surgical management of newborns with CAWD across Germany is excellent. There was no correlation of complications with the method of closure in gastroschisis and omphalocele.

scholarly journals Umbilical hernia repair and recurrence: need for a clinical trial?

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jennifer Mannion ◽  
Mohamed Khalid Hamed ◽  
Ritu Negi ◽  
Alison Johnston ◽  
Magda Bucholc ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hernia Repair ◽  
Mesh Repair ◽  
Umbilical Hernia ◽  
Hernia Recurrence ◽  
Cochrane Library ◽  
Large Defect ◽  
Linea Alba ◽  
Multiple Defects ◽  
Umbilical Hernia Repair

Abstract Introduction Umbilical hernia repair, despite its perceived simplicity, is associated with recurrence between 2.7 and 27%, in mesh repair and non mesh repair respectively. Many factors are recognized contributors to recurrence however multiple defects in the linea alba, known to occur in up to 30% of patients, appear to have been overlooked by surgeons. Aims This systematic review assessed reporting of second or multiple linea alba defects in patients undergoing umbilical hernia repair to establish if these anatomical variations could contribute to recurrence along with other potential factors. Methods A systematic review of all published English language articles was undertaken using databases PubMed, Embase, Web of Science and Cochrane Library from January 2014 to 2019. The search terms ‘Umbilical hernia’ AND ‘repair’ AND ‘recurrence’ were used across all databases. Analysis was specified in advance to avoid selection bias, was registered with PROSPERO (154173) and adhered to PRISMA statement. Results Six hundred and forty-six initial papers were refined to 10 following article review and grading. The presence of multiple linea alba defects as a contributor to recurrence was not reported in the literature. One paper mentioned the exclusion of six participants from their study due multiple defects. In all 11 factors were significantly associated with umbilical hernia recurrence. These included: large defect, primary closure without mesh, high BMI in 5/10 publications; smoking, diabetes mellitus, surgical site Infection (SSI) and concurrent hernia in 3/10. In addition, the type of mesh, advanced age, liver disease and non-closure of the defect were identified in individual papers. Conclusion This study identified many factors already known to contribute to umbilical hernia recurrence in adults, but the existence of multiple defects in the linea, despite it prevalence, has evaded investigators. Surgeons need to be consider documentation of this potential confounder which may contribute to recurrence.

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.

scholarly journals Lateral Abdominal Wall Reconstruction

2018 ◽  
Vol 32 (03) ◽  
pp. 141-146 ◽  
Author(s):  
Sahil Kapur ◽  
Charles Butler
Keyword(s):  
Abdominal Wall ◽  
Iliac Crest ◽  
Surgical Repair ◽  
Abdominal Wall Reconstruction ◽  
Abdominal Wall Defects ◽  
Costal Margin ◽  
Challenging Problem ◽  
Muscle Denervation ◽  
Careful Planning ◽  
Lateral Abdominal Wall

AbstractLateral abdominal wall defects, while rare, present a more challenging problem than commonly encountered ventral defects due to the complexity of the anatomy, physiologic forces, and impact of muscle denervation. The lateral abdominal wall encompasses a large surface area ranging from the costal margin superiorly to the iliac crest inferiorly and from the linea semilunaris anteriorly to the paraspinous musculature posteriorly. The ratio of muscle to fascia/aponeurosis is much higher, which makes repair through muscle tissue versus fascia less secure. Furthermore, these defects are subject to asymmetric forces caused by the independent contraction of anterior and posterior muscle units, which lead to unbalanced strain and hernia progression. These features necessitate the use of wide underlay mesh load bearing repairs supported by the static pillars of the abdominal wall. Management can be further complicated when defects extend beyond the defined boundaries, requiring surgical repair to be adapted based on the border structures involved. Primary fascial coaptation may not be as easily accomplished, and therefore careful planning is important to ensure stable coverage of exposed mesh.

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