scholarly journals Ventral hernia from routine repairs to abdominal wall reconstruction: our initial experience

2020 ◽  
Vol 7 (10) ◽  
pp. 3348
Author(s):  
Sheetal Ishwarappagol ◽  
Rohit Krishnappa
Keyword(s):  
Abdominal Wall ◽  
Ventral Hernia ◽  
Abdominal Wall Reconstruction ◽  
Tobacco Consumption ◽  
Transversus Abdominis ◽  
Abdominal Pressure ◽  
Postural Stabilization ◽  
History Of ◽  
And Function ◽  
Ventral Hernias

Background: Loss of continuity of abdominal wall significantly affects the functions of protection of viscera, postural stabilization, and maintenance of intra-abdominal pressure. The newer understanding of abdominal wall reconstruction (AWR) aims at restoring abdominal wall anatomy and function, instead of simply patching the defect. We want to showcase the changing trends and results in hernia repair at a Medical Institution.Methods: This is an observational retrospective study conducted in RRMCH, Bengaluru from July 2018-2019 including all patients with ventral hernia undergoing the specified hernia repairs.Results: A total of 54 patients with ventral hernias undergoing routine hernia repairs/AWR surgeries were retrospectively analysed. The overall mean age was 46.62±12.44 year. Majority subjects were females (n=37; 68.5%), and overweight (Mean BMI=28.07±3.01/m2). 14 patients (25.92%), all males, had history of tobacco consumption. There were 38 (70.37%) primary ventral hernias and 7 recurrent hernias. Overall mean defect size was 10.2±0.4 cm. Most frequently performed was open retro rectus Hernioplasty (n=18; 33.33%), followed by open Preperitoneal Hernioplasty (n=17; 31.48%), laparoscopic intraperitoneal onlay mesh (IPOM) (n=16; 29.62%) and open transversus abdominis release (TAR) (n=3; 5.5%). On statistical analysis, it was found that Open repairs had higher post-operative pain (p=0.0005), longer hospitalization (p=0.0002) and higher incidence of surgical site events (p=0.0134) when compared to Laparoscopic repairs.Conclusion: As known already, minimally invasive techniques of hernia surgeries are shown to have acceptable outcomes when compared to radical open surgeries. Newer techniques of AWR are being employed to routine cases in larger numbers, and not just for complex reconstruction, at most centres with acceptable outcomes. 

scholarly journals Initial UK experience with transversus abdominis muscle release for posterior components separation in abdominal wall reconstruction of large or complex ventral hernias: a combined approach by general and plastic surgeons

2017 ◽  
Vol 99 (4) ◽  
pp. 265-270 ◽  
Author(s):  
ND Appleton ◽  
KD Anderson ◽  
K Hancock ◽  
MH Scott ◽  
CJ Walsh
Keyword(s):  
Abdominal Wall ◽  
Ventral Hernia ◽  
Abdominal Wall Reconstruction ◽  
Transversus Abdominis ◽  
Fascial Closure ◽  
Wound Complications ◽  
Components Separation ◽  
Aesthetic Appearance ◽  
Ventral Hernias ◽  
Transversus Abdominis Muscle

Introduction Large, complicated ventral hernias are an increasingly common problem. The transversus abdominis muscle release (TAMR) is a recently described modification of posterior components separation for repair of such hernias. We describe our initial experience with TAMR and sublay mesh to facilitate abdominal wall reconstruction. Methods The study is a retrospective review of patients undergoing TAMR performed synchronously by gastrointestinal and plastic surgeons. Results Twelve consecutive patients had their ventral hernias repaired using the TAMR technique from June 2013 to June 2014. Median body mass index was 30.8kg/m2 (range 19.0–34.4kg/m2). Four had a previous ventral hernia repair. Three had previous laparostomies. Four had previous stomas and three had stomas created at the time of the abdominal wall reconstruction. Average transverse distance between the recti was 13cm (3-20cm). Median operative time was 383 minutes (150–550 minutes) and mesh size was 950cm2 (532–2400cm2). Primary midline fascial closure was possible in all cases, with no bridging. Median length of hospital stay was 7.5 days (4–17 days). Three developed minor abdominal wall wound complications. At median review of 24 months (18–37 months), there have been no significant wound problems, mesh infections or explants, and none has developed recurrence of their midline ventral hernia. Visual analogue scales revealed high patient satisfaction levels overall and with their final aesthetic appearance. Conclusions We believe that TAMR offers significant advantages over other forms of components separation in this patient group. The technique can be adopted successfully in UK practice and combined gastrointestinal and plastic surgeon operating yields good results.

Plasty of incisional ventral hernias using a mechanical suture

1982 ◽  
Vol 63 (3) ◽  
pp. 37-40
Author(s):  
B. L. Elyashevich ◽  
F. Sh. Sharafislamov ◽  
R. M. Ramazanov
Keyword(s):  
Hernia Repair ◽  
Abdominal Wall ◽  
Ventral Hernia ◽  
Ventral Hernia Repair ◽  
Anterior Abdominal Wall ◽  
Long Term Results ◽  
Mechanical Suture ◽  
And Function ◽  
Ventral Hernias

Developed and applied in patients with hernias of the anterior abdominal wall a method of plasty with own tissues using a mechanical suture. 109 patients with postoperative and recurrent ventral hernias were operated on. This method of ventral hernia repair allows to restore the anatomy and function of the abdominal wall, standardizes and simplifies the technique of the operation, reducing the time of its implementation, and gives 95.4% positive long-term results.

Systematic review of transversus abdominis release in complex abdominal wall reconstruction

Hernia ◽  
2018 ◽  
Vol 23 (1) ◽  
pp. 5-15 ◽  
Author(s):  
J. A. Wegdam ◽  
J. M. M. Thoolen ◽  
S. W. Nienhuijs ◽  
N. de Bouvy ◽  
T. S. de Vries Reilingh
Keyword(s):  
Systematic Review ◽  
Abdominal Wall ◽  
Abdominal Wall Reconstruction ◽  
Transversus Abdominis ◽  
Transversus Abdominis Release

scholarly journals P053 COMPARISON OF CLINICAL OUTCOMES BETWEEN INTRAPERITONEAL ONLAY MESH REPAIR (IPOM PLUS) AND ENHANCED-VIEW TOTALLY EXTRAPERITONEAL REPAIR (ETEP) FOR VENTRAL HERNIAS

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Hiroshi Hirukawa
Keyword(s):  
Ventral Hernia ◽  
Mesh Repair ◽  
Transversus Abdominis ◽  
Incisional Hernias ◽  
Totally Extraperitoneal ◽  
Onlay Mesh ◽  
The Mean ◽  
Totally Extraperitoneal Repair ◽  
Hernia Size ◽  
Ventral Hernias

Abstract Aim We have been performing intraperitoneal on lay mesh repair (IPOM plus) as the standard laparoscopic procedure for ventral hernia in our department. We introduced enhanced-view totally extraperitoneal repair (eTEP) for ventral hernia repair in 2018, and have performed 31 cases so far. We compared the outcomes of IPOM Plus and eTEP at our institution. Material and Methods Ventral hernia cases who underwent surgery at our department between 2018 and 2020 were included in the study. The postoperative outcomes and complications of the IPOM Plus and eTEP groups were evaluated retrospectively. Results There were 12 cases of IPOM plus, and all were incisional hernias. There were 31 cases of eTEP, including 7 cases of primary hernias and 24 cases of incisional hernias. Transversus abdominis muscle release (TAR) was added in 24 cases. The mean hernia size was 6.6 x 7.9 cm with IPOM Plus and 8.0 x 10.1 cm with eTEP, and the average meshes size was 15.5 x 22.0 cm and 20.3 x 23.6 cm, respectively. The mean postoperative hospital stay was 7.8 days and 5 days. Postoperative complications included 1 case of mesh bulging and 1 case of recurrence in the IPOM Plus group, 1 case of seroma and 1 case of intestinal obstruction in the eTEP. Conclusions The surgical outcomes for ventral hernias up to 8 cm wide were similar for IPOM Plus and eTEP. The eTEP can insert a larger mesh and may be useful for wider hernias (>8cm).

Revising Recommendations and Outcome Measurements after Complex Open Abdominal Wall Reconstruction

2015 ◽  
Vol 81 (10) ◽  
pp. 955-960 ◽  
Author(s):  
Shawn Diamond ◽  
H. Gill Cryer
Keyword(s):  
Abdominal Wall ◽  
Abdominal Wall Reconstruction ◽  
Clinical History ◽  
Long Term Results ◽  
Functional Domain ◽  
Grading Systems ◽  
History Of ◽  
Grade Ii ◽  
Restricted Use

Grading systems developed by the Ventral Hernia Working Group (VHWG) for complex open abdominal wall reconstruction rely on limited outcomes: surgical site occurrence (SSO) and hernia recurrence. This does not account for the longitudinal restoration of a functional abdominal wall and the ability to correct complications. We performed a single-site, retrospective review of consecutive complex open abdominal wall reconstruction interventions with 24-month minimum follow-up to establish reoperation rates and compare long-term results to the VHWG. About 125 midline hernia repairs (>200 cm2) were studied. All had loss of functional domain and 47-month average follow-up. Demographics included: mean age 57 years, 47 per cent male, 63 per cent obese, and 34 per cent with contamination. Rates of SSO per VHWG grade were 9 per cent grade I, 45 per cent grade II, and 55 per cent grade III. Forty-three of 59 patients who developed complications were eventually successful after reoperation leading to an 87 per cent restoration rate. Select factors independently associated with reoperation included biological mesh and clinical history of infection. Although rates of SSO were higher than the VHWG published, we experienced high salvage rates except in patients who underwent biologic repair. We recommend restricted use of biologic mesh in contaminated and clean fields as well as modifications to the VHWG grading and recommendations.

Concomitant Anterior and Posterior Component Separations: Absolutely Contraindicated?

2020 ◽  
pp. 155335062091419
Author(s):  
Jorge Daes ◽  
Joshua S. Winder ◽  
Eric M. Pauli
Keyword(s):  
Abdominal Wall ◽  
Lateral Displacement ◽  
Abdominal Wall Reconstruction ◽  
Component Separation ◽  
Transversus Abdominis ◽  
Lateral Abdominal Wall ◽  
Computed Tomography Images ◽  
Fresh Cadaver ◽  
Semilunar Line ◽  
Internal Oblique

Many experts in abdominal wall reconstruction believe that the combination of simultaneous ipsilateral anterior component separation (ACS) and posterior component separation (PCS) is contraindicated. We performed ipsilateral endoscopic ACS and either endoscopic or open PCS-transversus abdominis release (TAR) in 5 fresh cadaver models. The full length of the semilunar line and the lateral abdominal wall remained well reinforced by 2 complete layers, comprising the internal oblique (IO) and TA muscles and their investing fasciae. Myofascial releases occurred 4 cm (median) apart. Additionally, we reviewed computed tomography images at 1 month and 1 year after PCS-TAR in 17 patients (30 PCS-TARs). Lateral displacement of the TA relative to the rectus abdominis (RA) was significant only at the superior mesenteric artery level, where it was <1 cm (median). Muscle mass changed minimally over time. Several studies showed that abdominal wall reconstruction after PCS-TAR results in compensatory muscular hypertrophy of the RA, external oblique (EO), and IO muscles and provides better quality of life and improved core physiology. These changes did not occur when the midline was not restored. Theoretically, endoscopic ACS-EO may be added to PCS-TAR to avoid partially bridged mesh repair in patients in whom complete midline restoration is impossible via PCS-TAR alone. Nevertheless, we advise most surgeons to perform a small-bridged repair instead of risking increased morbidity by attempting a highly complicated procedure.

Sign in / Sign up

Export Citation Format

Share Document