eTep-retromuscular Repair for Ventral Hernia; a Technique Closest to Ideal

Introduction. Ventral hernia represents a problem for the surgeon and patients alike. eTEP repair is a technique that is minimally invasive, provides lower overall complication rates, decreased wound complications and the recurrence rates and shortens the length of stay in the hospital. Case. We present a case of a 48 year old patient who was admitted to our hospital for elective treatment of recurrent umbilical hernia. The patient had umbilical hernia repair 4 years ago, suture repair without mesh placement was performed according to the information given by the patient. On inspection there is visible supraumbillical scar, 12 cm in length with hernia bulging under the scar which is partially reducible on pressure. Discussion. The eTEP technique is closest to ideal because the abdominal cavity is not penetrated, is lessening the risk of visceral lesions and trocar site hernias, allows local or regional anesthesia, gives unsurpassed views of inguinal region and hernias and reproduces the technique of Rives-Stoppa. In favor to overcome the limitations deriving from the limited surgical field and restricted port set up, this technique has been modified based on the normal anatomy of the abdominal wall naming it dependently of the extension of the dissection and the location of the hernia. Conclusion. The extended-TEP (e-TEP) technique is based on the anatomical principle that the extraperitoneal space can be reached from almost anywhere in the anterior abdominal wall. It provides the most of the benefits for the patients but also requires great surgical skill and understanding of the anatomy of the anterior abdominal wall.

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The risk of anterior abdominal wall adhesions in patients with previous umbilical hernia repair

The Journal of the American Association of Gynecologic Laparoscopists ◽

10.1016/s1074-3804(05)80877-1 ◽

1994 ◽

Vol 1 (4) ◽

pp. S4

Author(s):

EJ Bieber ◽

S Levrant

Keyword(s):

Hernia Repair ◽

Abdominal Wall ◽

Umbilical Hernia ◽

Anterior Abdominal Wall ◽

Umbilical Hernia Repair

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A comparative study of laparoscopic trans abdominal pre peritoneal ventral hernia repair versus open pre peritoneal ventral hernia repair

International Surgery Journal ◽

10.18203/2349-2902.isj20195984 ◽

2019 ◽

Vol 7 (1) ◽

pp. 274

Author(s):

Pravin N. Shingade ◽

Anshu Rawat ◽

Rizhin Sooraj

Keyword(s):

Hernia Repair ◽

Abdominal Wall ◽

Ventral Hernia ◽

Umbilical Hernia ◽

Ventral Hernia Repair ◽

Open Repair ◽

Hernia Surgery ◽

Mesh Placement ◽

Medical College ◽

A Prospective Study

Background: Ventral hernias are defined as a protrusion of abdominal contents through the abdominal wall muscle. It can be categorised as spontaneous or acquired or by their location on the abdominal wall like epigastric hernia, umbilical hernia, para umbilical hernia etc. This original article reveals that laparoscopic trans abdominal pre peritoneal (TAPP) mesh placement for ventral hernia usually follows the current principle of hernia surgery and give better results from open pre peritoneal ventral hernia repair.Methods: A prospective study conducted in Dr. D. Y. Patil Medical College and Hospital, Pune for the period of 2017-2019 comparing laparoscopic TAPP vs. open preperitoneal ventral hernia repair. Total of 25 patients for laparoscopic TAPP repair and 25 patients for open preperitoneal repair were compared.Results: Total 50 cases were studies in which 25 for laparoscopic and 25 for open repair. Majority of patients were female than males. Incidence of para umbilical (56%) was found to be more. Intra operative, post-operative complications were found to be more in open repair than laparoscopic TAPP repair.Conclusions: Laparoscopic TAPP ventral hernia repair is safe with fewer complications. Therefore, offers successful treatment for ventral hernia repair with added benefits of laparoscopy such as better visualization and magnification of the hernia defects which are not clinically apparent and less chances of injury which is not possible by open technique. Laparoscopic TAPP ventral hernia repair gives equal results in terms of recurrence and less complications than open ventral hernia repair.

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Diagnosis and treatment of anterior abdominal wall ligature fistulas

Kazan medical journal ◽

10.17750/kmj2016-204 ◽

2016 ◽

Vol 97 (2) ◽

pp. 204-207 ◽

Cited By ~ 1

Author(s):

A G Izmaylov ◽

S V Dobrokvashin ◽

D E Volkov ◽

V A Pyrkov ◽

R F Zakirov ◽

...

Keyword(s):

Abdominal Wall ◽

Comparison Group ◽

Anterior Abdominal Wall ◽

Abdominal Cavity ◽

Main Group ◽

Wound Complications ◽

Control Group ◽

Absorbable Suture ◽

Wound Debridement ◽

Complications Rate

AIM. To improve treatment results of patients with ligature fistulas of the anterior abdominal wall by the development of pyo-inflammatory wound complications diagnosis and prevention methods.METHODS. During the period from the beginning of 2001 to June, 2015, 34 patients with a ligature fistulas of the anterior abdominal wall were admitted to the Department of Surgery of Hospital for War Veterans, Kazan. Terms of ligature fistula occurrence ranged from 3 months to 5.5 years after surgery. 7 (20.6%) patients previously underwent herniotomy, 20 (58.8%) - laparotomy for various acute surgical diseases of the abdominal cavity, 2 (5.9%) - appendectomy, 5 (14.7%) - pelvic organs surgery. The patients mean age was 59±4.5 years. Patients were divided into two groups: the first - the comparison group, 23 (67.6%) patients. In this group suturing was performed with polypropylene or absorbable suture filaments, wound debridement was performed by the conventional technique using different antiseptics types: 0.5% chlorhexidine (chlorhexidine bigluconate) and 3% hydrogen peroxide solutions. The second group - the main one, included 11 (32.4%) patients. In this group polyglycolide-co-lactide (purple), USP 2/0 (3 Matric) 75 cm with the atraumatic tip suture materials were used and the wound debridement was performed with 10% aqueous hydroxyethyldimethyldihydropyrimidin (xymedon) solution using a device developed by us.RESULTS. The postoperative pyo-inflammatory complications rate in the control group was 17.4% (4 cases), in the main group - 9.1% (1 case); thereby infiltrates were registered in 3 patients of comparison group and in 1 patient of main group, seroma - in 1 patient of comparison group. Monoculture was isolated in microbiological assay of material from the surgical wounds in 86% of patients. Staphylococci, enterobacteria and non-fermentative Gram-negative bacteria were detected most often. Our results of microbiological assays point to the need for perioperative antibiotic prophylaxis.CONCLUSION. The infectious wound complications rate when using conventional methods of anterior abdominal wall ligature fistulas prevention and treatment is 17.4%, which makes it relevant to search for new methods of treatment and wound surface debridement; the author’s technique offered by us allowed to significantly reduce the wound complications rate.

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Umbilical hernia: Factors indicative of recurrence

Medicina ◽

10.3390/medicina44110108 ◽

2008 ◽

Vol 44 (11) ◽

pp. 855 ◽

Cited By ~ 31

Author(s):

Linas Venclauskas ◽

Jolita Šilanskaitė ◽

Mindaugas Kiudelis

Keyword(s):

Risk Factors ◽

Recurrence Rate ◽

Umbilical Hernia ◽

Hernia Recurrence ◽

Suture Repair ◽

Repair Technique ◽

Umbilical Hernia Repair ◽

Open Mesh Repair ◽

Onlay Technique ◽

Hernia Size

Umbilical hernia has gained little attention from surgeons in comparison with other types of abdominal wall hernias (inguinal, postoperative); however, the primary suture for umbilical hernia is associated with a recurrence rate of 19–54%. The aim of this study was to analyze the results of the umbilical hernia repair and to assess the independent risk factors influencing umbilical hernia recurrence. Materials and methods. A retrospective analysis of patients who underwent surgery for umbilical hernia in the Hospital of Kaunas University of Medicine in 2001–2006 was performed. Age, sex, hospital stay, hernia size, patient’s body mass index, and postoperative complications were analyzed. Postoperative evaluation included pain and discomfort in the abdomen and hernia recurrence rate. The questionnaire, which involved all these previously mentioned topics, was sent to all patients by mail. Hernia recurrence was diagnosed during the patients’ visit to a surgeon. Two surgical methods were used to repair umbilical hernia: open suture repair technique (keel technique) and open mesh repair technique (onlay technique). Every operation was chosen individually by a surgeon. Results. Ninety-seven patients (31 males and 66 females) with umbilical hernia were examined. The mean age of the patients was 57.1±15.4 years, hernia anamnesis – 7.6±8.6 years, hospital stay – 5.38±3.8 days. Ninety-two patients (94.8%) were operated on using open suture repair technique and 5 (5.2%) patients – open mesh repair technique. Only 7% of patients whose BMI was >30 kg/m2 and hernia size >2 cm and 4.3% of patients whose BMI was <30 kg/m2 and hernia size <2 cm were operated on using onlay technique (P>0.05). The rate of postoperative complications was 5.2%. Sixty-seven patients (69%) answered the questionnaire. The complete patient’s recovery time after surgery was 2.4±3.4 months. Fourteen patients (20.9%) complained of pain or discomfort in the abdomen, and 7 patients (10.4%) had ligature fistula after the surgery. Forty-five patients (67.2%) did not have any complaints after surgery. The recurrence rate after umbilical hernia repair was 8.9%. The recurrence rate was higher when hernia size was >2 cm (9% for <2 cm vs 10.5% for >2 cm) and patient’s BMI was >30 kg/m2 (8.6% for < 30 vs 10.7% for >30). There were 5 recurrence cases after open suture repair and one case after onlay technique. Fifty-six patients (83.6%) assessed their general condition after surgery as good, 9 patients (13.4%) as satisfactory, and only 2 patients (3%) as poor. Conclusions. We did not find any significant independent risk factors for umbilical hernia recurrence. However, based on reviewed literature, higher patient’s body mass index and hernia size of >2 cm could be the risk factors for umbilical hernia recurrence.

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Efficacy evaluation of case-specific approach for surgical treatment of incisional ventral hernia

Polish Journal of Surgery ◽

10.5604/01.3001.0014.9756 ◽

2021 ◽

Vol 93 (5) ◽

pp. 1-5

Author(s):

Svetlana Sokolova ◽

Andrey Sherbatykh ◽

Konstantin Tolkachev ◽

Vladimir Beloborodov ◽

Vadim Dulskiy ◽

...

Keyword(s):

Surgical Treatment ◽

Abdominal Wall ◽

Ventral Hernia ◽

Anterior Abdominal Wall ◽

Abdominal Wall Defect ◽

Long Term Results ◽

Treatment Results ◽

Specific Approach ◽

Incisional Ventral Hernia

The Aim of research is to improve the results of surgical treatment of incisional ventral hernia by applying a case-specific approach and a new method of plastic repair of anterior abdominal wall. The prospective controlled dynamic study is based on incisional ventral hernia treatment results with the use of meshed endoprostheses among 219 patients. On-lay alloplasty was used in patients younger than 60 years of age, without severe concomitant pathology, with small and medium hernias and anterior abdominal wall defect of up to 10 cm (W1 - W2). The article shows a selection algorithm for anterior abdominal wall plastic repair method. It goes through advantages of the author’s proprietary technique. The article displays frequency and patterns of complications, life quality of the patients after various prosthetic plastic repairs. In the main group, positive treatment results were observed in 65.0%, long-term results of the operation were observed in 88.4%, complications occurred in 13.6%, relapse in 4.5%. «On lay» treatment tactics showed positive results in 59.4%, long-term results of the operation were observed in 74.7%, complications occurred in 40%, relapse in 3.1%. After «sub lay» intervention, excellent results were observed in 40.0% of patients, long-term results of the operation were observed in 81.9%, complications occurred in 12%, and relapse in 1.4%.

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Anterior abdominal wall necrotizing fasciitis due to strangulated umbilical hernia: a diagnostic dilemma

Grand Rounds ◽

10.1102/1470-5206.2013.0013 ◽

2013 ◽

Vol 13 (1) ◽

pp. 69-73 ◽

Cited By ~ 1

Author(s):

Michael Bartholomew Mwandri ◽

Julius Chacha Mwita ◽

Negussie Alula Bekele ◽

Ibrahim Mohamed Ali ◽

Michael Stephen Walsh

Keyword(s):

Necrotizing Fasciitis ◽

Abdominal Wall ◽

Umbilical Hernia ◽

Anterior Abdominal Wall ◽

Diagnostic Dilemma

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Hernia Size and Mesh Placement in Primary Umbilical Hernia Repair

The American Surgeon ◽

10.1177/0003134820971624 ◽

2020 ◽

pp. 000313482097162

Author(s):

Zoe Tao ◽

Javier Ordonez ◽

Sergio Huerta

Keyword(s):

Systematic Review ◽

Hernia Repair ◽

Tissue Repair ◽

Umbilical Hernia ◽

Multivariable Analysis ◽

Review Of The Literature ◽

Mesh Placement ◽

Institutional Review ◽

Umbilical Hernia Repair ◽

Hernia Size

Introduction Umbilical hernia repair (UHR) using mesh has been demonstrated to significantly reduce recurrence. However, many surgical centers still perform tissue repair for UH. In the present study, we assessed a cohort of veteran patients undergoing a standard open tissue repair for primary UH to determine at which size recurrence may preclude tissue repair. A systematic review of the literature on hernia size recommendations to guide mesh placement was performed. Methods A single-institution single-surgeon retrospective review of all patients undergoing open tissue repair of primary UH (n = 344) was undertaken at the VA North Texas Health Care System between 2005 and 2019. Guidelines for the preferred reporting items for systematic reviews and meta-analysis were undertaken for systematic review. Results A literature review yielded inconsistent guidance for a specific hernia size to proceed with tissue vs. mesh repair. Our institutional review yielded 17 (4.9%) recurrences. Univariable analysis demonstrated recurrence to be associated with hernia size (2.8 vs. 2.3 cm; P = .04). However, on multivariable analysis, hernia size was demonstrated as not an independent predictor of recurrence [OR 1.47 (95% CI; .97-2.21; P = .07)]. Conclusion A review of the literature suggests mesh placement most commonly when the hernia size is > 2.0 cm; however, sources of evidence are heterogeneous in study design, patient population, and hernia types studied. Our institutional review demonstrated that primary UHs < 2.3 cm can successfully be treated via tissue repair. Larger, recurrent, incisional, and primary epigastric hernias may benefit from mesh placement.

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Surgical Anatomy of the Retroperitoneal Spaces Part II: The Architecture of the Retroperitoneal Space

The American Surgeon ◽

10.1177/000313481007600108 ◽

2010 ◽

Vol 76 (1) ◽

pp. 33-42 ◽

Cited By ~ 16

Author(s):

Petros Mirilas ◽

John E. Skandalakis

Keyword(s):

Urinary Bladder ◽

Abdominal Wall ◽

Anterior Abdominal Wall ◽

Anterior Part ◽

Abdominal Cavity ◽

Surgical Anatomy ◽

Preperitoneal Space ◽

Renal Fascia ◽

Pelvic Wall ◽

Prevesical Space

The extraperitoneal space extends between peritoneum and investing fascia of muscles of anterior, lateral and posterior abdominal and pelvic walls, and circumferentially surrounds the abdominal cavity. The retroperitoneum, which is confined to the posterior and lateral abdominal and pelvic wall, may be divided into three surgicoanatomic zones: centromedial, lateral (right and left), and pelvic. The preperitoneal space is confined to the anterior abdominal wall and the subperitoneal extraperitoneal space to the pelvis. In the extraperitoneal tissue, condensation fascias delineate peri- and parasplanchnic spaces. The former are between organs and condensation fasciae, the latter between this fascia and investing fascia of neighboring muscles of the wall. Thus, perirenal space is encircled by renal fascia, and pararenal is exterior to renal fascia. Similarly for the urinary bladder, paravesical space is between the umbilical prevesical fascia and fascia of the pelvic wall muscles—the prevesical space is its anterior part, between transversalis and umbilical prevesical fascia. For the rectum, the “mesorectum” describes the extraperitoneal tissue bound by the mesorectal condensation fascia, and the pararectal space is between the latter and the muscles of the pelvic wall. Perisplanchnic spaces are closed, except for neurovascular pedicles. Prevesical and pararectal (presacral) and posterior pararenal spaces are in the same anatomical level and communicate. Anterior to the anterior layer of the renal fascia, the anterior interfascial plane (superimposed and fused mesenteries of pancreas, duodenum, and colon) permits communication across the midline. Thus parasplanchnic extraperitoneal spaces of abdomen and pelvis communicate with each other and across the midline.

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