Early Posterior Rectus Sheath Hernia Recurrence After Open Incisional Hernia Repair with Retrorectus Mesh Placement

Lately, incisional hernia repair (IHR) with onlay polypropylene mesh has been replaced by other surgical procedures. The aim of this study was to compare the complication and recurrence rate after onlay mesh repair and other surgical procedures for IHR. A retrospective cohort study of patients who underwent IHR in a single center was conducted. The data were obtained from electronic medical records. Patients who had been lost during follow-up were contacted for a visit in the clinic. Univariate and multivariate analysis was performed with Stata 13.0 to analyze the factors associated with postoperative complications and hernia recurrence. Between June 2004 and December 2015, 1078 patients underwent IHR in a single center. Onlay mesh repair was performed in 125 patients (11.6%). Other surgical procedures included Rives procedure (29.3%), sublay mesh repair (38.6%), intrabdominal mesh repair (17.1%), and primary closure (3.4%). After a mean follow-up of 2.8 years, 73 (7%) patients developed a recurrence. A higher percentage of complications were seen after onlay mesh repair than after other surgical procedures (22.4% vs 13.1%, P = 0.005). Nevertheless, recurrence was less frequent after onlay mesh repair (4.2% vs 7.1%, P = 0.241). Logistic regression discarded an association between onlay mesh repair and hernia recurrence or postoperative complications. Incisional hernia repair with onlay polypropylene mesh repair was not associated with a higher incidence of postoperative complications or recurrence rate. So, this procedure should not be discarded in selected patients presenting with incisional hernia.

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Outcomes for Incisional Hernia Repair in Patients Undergoing Concomitant Surgical Procedures

The American Surgeon ◽

10.1177/000313481207800246 ◽

2012 ◽

Vol 78 (2) ◽

pp. 243-249 ◽

Cited By ~ 3

Author(s):

Laura K. Altom ◽

Laura A. Graham ◽

Stephen H. Gray ◽

Christopher W. Snyder ◽

Catherine C. Vick ◽

...

Keyword(s):

Incisional Hernia ◽

Hernia Repair ◽

Surgical Procedures ◽

Proportional Hazards ◽

Cox Regression ◽

Incisional Hernia Repair ◽

Cox Proportional Hazards ◽

Mesh Placement ◽

Clean Contaminated ◽

Operative Notes

The safety and efficacy of performing concomitant surgical procedures with an incisional hernia repair (IHR) is not well understood. There are conflicting reports on the outcomes for permanent mesh implantation in the setting of clean-contaminated procedures. The purpose of this study was to review the effect of concomitant surgical procedures on IHR outcomes. This is a retrospective multisite cohort of patients undergoing elective IHR at 16 Veterans Affairs hospitals from 1998 to 2002. Concomitant procedure status, hernia characteristics, and operative details were determined using physician-abstracted operative notes. Hernia outcomes of recurrence and mesh explantation were determined from the medical chart. χ2 tests, Kaplan-Meier curves, and Cox regression were used to evaluate the effects of concomitant status on hernia outcomes. Of the 1495 elective IHRs, 75 (4.8%) were same site and 56 (3.8%) different site concomitant procedures. At median follow-up of 69.3 months (range 19.1–98.3), 33.6 per cent of patients had a recurrence, mesh explantation, or both. Permanent mesh placement was less likely among concomitant procedures as compared with nonconcomitant procedures ( P < 0.0001). Adjusted Cox proportional hazards models of hernia outcomes resulted in an increased hazard for recurrence among same site clean procedures (Hazard Ratio (HR) = 1.8, P = 0.03) and an increased hazard for mesh explantation among same site clean-contaminated procedures (HR = 8.4, P = 0.002). Concomitant same site procedures are significantly associated with adverse hernia outcomes as compared with isolated IHR or IHR with other site concomitant procedures. The high failure rate of hernia repairs among same site concomitant procedures should be taken into account during the surgical decision-making process.

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A new three-step hybrid approach is a safe procedure for incisional hernia: early experiences with a single centre retrospective cohort

Hernia ◽

10.1007/s10029-020-02300-9 ◽

2020 ◽

Author(s):

L. Matthijs van den Dop ◽

Gijs H. J. de Smet ◽

Michaël P. A. Bus ◽

Johan F. Lange ◽

Sascha M. P. Koch ◽

...

Keyword(s):

Incisional Hernia ◽

Hernia Repair ◽

Intraoperative Complications ◽

Operation Time ◽

Incisional Hernia Repair ◽

Hernia Recurrence ◽

Perioperative Outcomes ◽

Safe Procedure ◽

Intraoperative Complication ◽

Hybrid Repair

Abstract Purpose In this study, a three-step novel surgical technique was developed for incisional hernia, in which a laparoscopic procedure with a mini-laparotomy is combined: so-called ‘three-step incisional hybrid repair’. The aim of this study was to reduce the risk of intestinal lacerations during adhesiolysis and recurrence rate by better symmetrical overlap placement of the mesh. Objectives To evaluate first perioperative outcomes with this technique. Methods From 2016 to 2020, 70 patients (65.7% females) with an incisional hernia of > 2 and ≤ 10 cm underwent a elective three-step incisional hybrid repair in two non-academic hospitals performed by two surgeons specialised in abdominal wall surgery. Intra- and postoperative complications, operation time, hospitalisation time and hernia recurrence were assessed. Results Mean operation time was 100 min. Mean hernia size was 4.8 cm; 45 patients (64.3%) had a hernia of 1–5 cm, 25 patients (35.7%) of 6–10 cm. Eight patients had a grade 1 complication (11.4%), five patients a grade 2 (7.1%), two patients (2.8%) a grade 4 complication and one patient (1.4%) a grade 5 complication. Five patients had an intraoperative complication (7.0%), two enterotomies, one serosa injury, one omentum bleeding and one laceration of an epigastric vessel. Mean length of stay was 3.3 days. Four patients (5.6%) developed a hernia recurrence during a mean follow-up of 19.5 weeks. Conclusion A three-step hybrid incisional hernia repair is a safe alternative for incisional hernia repair. Intraoperative complications rate was low.

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Patient reported outcomes after incisional hernia repair—establishing the ventral hernia recurrence inventory

The American Journal of Surgery ◽

10.1016/j.amjsurg.2015.06.007 ◽

2016 ◽

Vol 212 (1) ◽

pp. 81-88 ◽

Cited By ~ 60

Author(s):

Rebeccah B. Baucom ◽

Jenny Ousley ◽

Irene D. Feurer ◽

Gloria B. Beveridge ◽

Richard A. Pierce ◽

...

Keyword(s):

Incisional Hernia ◽

Hernia Repair ◽

Ventral Hernia ◽

Patient Reported Outcomes ◽

Incisional Hernia Repair ◽

Hernia Recurrence ◽

Patient Reported

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

Annals of African Surgery ◽

10.4314/aas.v18i1.4 ◽

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

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Laparoscopic ventral and incisional hernia repair: a simplified method of mesh placement

Journal of the American College of Surgeons ◽

10.1016/s1072-7515(01)01135-8 ◽

2002 ◽

Vol 194 (1) ◽

pp. 93-95 ◽

Cited By ~ 3

Author(s):

Mark A Liberman ◽

Raul J Rosenthal ◽

Edward H Phillips

Keyword(s):

Incisional Hernia ◽

Hernia Repair ◽

Incisional Hernia Repair ◽

Mesh Placement ◽

Simplified Method ◽

Ventral And Incisional Hernia

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509 Surgeon and Facility Volume Play Significant Role in Hernia Recurrence and Reoperation After Open Incisional Hernia Repair

Gastroenterology ◽

10.1016/s0016-5085(14)63698-2 ◽

2014 ◽

Vol 146 (5) ◽

pp. S-1016-S-1017 ◽

Cited By ~ 1

Author(s):

Christopher T. Aquina ◽

Fergal Fleming ◽

Kristin N. Kelly ◽

Christian P. Probst ◽

Katia Noyes ◽

...

Keyword(s):

Incisional Hernia ◽

Hernia Repair ◽

Significant Role ◽

Incisional Hernia Repair ◽

Hernia Recurrence

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A comparative study of onlay and retrorectus mesh placement in incisional hernia repair

Medical Journal of Dr D Y Patil University ◽

10.4103/0975-2870.114650 ◽

2013 ◽

Vol 6 (3) ◽

pp. 258

Author(s):

Kundan Kharde ◽

Sunil Panchabhai ◽

KaranV. S. Rana ◽

Srihari Sridharan ◽

BharatBhushan Dogra ◽

...

Keyword(s):

Incisional Hernia ◽

Hernia Repair ◽

Comparative Study ◽

Incisional Hernia Repair ◽

Mesh Placement

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Increased risk of postoperative complications with retromuscular mesh placement in emergency incisional hernia repair: A nationwide register-based cohort study

Scandinavian Journal of Surgery ◽

10.1177/1457496920966237 ◽

2020 ◽

pp. 145749692096623

Author(s):

N. Juul ◽

N. A. Henriksen ◽

K. K. Jensen

Keyword(s):

Postoperative Complications ◽

Incisional Hernia ◽

Hernia Repair ◽

Incisional Hernia Repair ◽

Secondary Outcome ◽

Emergency Setting ◽

Mesh Placement ◽

Increased Risk ◽

Elective Repair ◽

Onlay Mesh

Introduction: Incisional hernia is common after abdominal surgery. Watchful waiting carries the risk of incarceration and a need for emergency intervention. The aim of this study was to examine the risk of postoperative complications after emergency versus elective incisional hernia repair. Methods: Patients above 18 years of age undergoing open incisional hernia repair in Denmark in 2017–2018 were identified in the Danish Ventral Hernia Database. Patients were grouped according to elective or emergency hernia repair. The primary outcome was postoperative complications requiring operative intervention within 90 days, and the secondary outcome was postoperative length of stay. Results: We included 1050 patients, of whom 882 were admitted for elective and 168 for emergency operation. Patients undergoing emergency repair were older (64.7 years vs 59.2 years, p < 0.001), more often smokers (25.8% vs 13.6%, p = 0.003), and more often had a Charlson comorbidity score ⩾2 (26.8% vs 19.2%, p = 0.005) compared to patients undergoing elective repair. In a multivariate regression analysis, emergency compared to elective operation (OR = 2.71, 95% CI = 1.4–5.25, p = 0.003) and retromuscular compared to onlay mesh placement (OR = 2.14, 95% CI = 1.08–4.24, p = 0.013) were factors significantly associated with increased risk of postoperative complications. In a subgroup analysis including only emergency repairs, risk of complications after retromuscular mesh placement was even higher (OR = 10.12, 95% CI = 1.81–56.68, p = 0.008). Conclusion: Emergency incisional hernia repair was associated with increased risk of postoperative complications and this risk was accentuated with retromuscular mesh placement. The use of retromuscular mesh in the emergency setting should be avoided, and the abdominal wall could either be closed by sutures or additional onlay mesh.

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