Mechanical modelling of the human abdomen following hernia surgery

Abdominal hernia is a frequent disease and diverse problems following hernia repair could reduce the quality of patient life. This work is projected to define a computational methodology based on experimental techniques that would help surgeons in deciding which prosthesis is the most convenient depending on the type of defect and patient.

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Antibiotic Prophylaxis against Surgical Site Infection after Open Hernia Surgery: A Systematic Review and Meta-Analysis

European Surgical Research ◽

10.1159/000517404 ◽

2021 ◽

pp. 1-13

Author(s):

Lolwah Al Riyees ◽

Wedad Al Madani ◽

Nistren Firwana ◽

Hanan H. Balkhy ◽

Mazen Ferwana ◽

...

Keyword(s):

Systematic Review ◽

Hernia Repair ◽

Surgical Site Infection ◽

Antibiotic Prophylaxis ◽

Meta Analysis ◽

Prophylactic Antibiotics ◽

Site Infection ◽

Hernia Surgery ◽

Significant Difference

Objective: The role of antibiotic prophylaxis (AP) in the prevention of surgical site infection (SSI) after hernia repair is debated. We conducted this systematic review and meta-analysis to assess the evidence on the value of prophylactic antibiotics in reducing the risks of SSI after open hernia surgery. Methods: We ran an online and manual search to identify relevant randomized controlled trials that compared prophylactic antibiotics to nonantibiotic controls in patients undergoing open surgical hernia repair. Data on SSI risk were extracted and pooled as risk ratios (RRs) with 95% confidence intervals (95% CIs), using RevMan software. We further used the Cochrane risk of bias tool and GRADE assessment to evaluate the quality of generated evidence. Results: Twenty-nine studies (N = 8,616 patients) were included in the current analysis. Antibiotic prophylaxis reduced the risk of SSI in open hernia repair patients (RR = 0.65, 95% CI = 0.53, 0.79). Subgroup analysis showed a significant benefit for antibiotics in mesh repair patients (RR = 0.60, 95% CI = 0.48, 0.76) yet no significant difference in SSI risk after herniorrhaphy (RR = 0.86, 95% CI = 0.54, 1.36). In addition, AP was associated with a significant reduction in superficial SSI risk (RR = 0.56, 95% CI = 0.43, 0.72) but not deep SSI (RR = 0.70, 95% CI = 0.30, 1.62). Further analysis showed a significant reduction in SSI risk with amoxicillin/clavulanic acid and cefazolin but not with cefuroxime. Conclusion: The present meta-analysis suggests that AP is beneficial prior to open mesh hernia repair. However, the quality of evidence was low, and further well-designed trials are needed.

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Prospective Assessment of the Abdominal Hernia-Q (AHQ)—Patient Burden, Reliability, and Longitudinal Assessment of Quality of Life in Hernia Repair

Annals of Surgery ◽

10.1097/sla.0000000000004713 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Viren Patel ◽

Jessica R. Cunning ◽

Arturo J. Rios-Diaz ◽

Jaclyn T. Mauch ◽

Shelby L. Nathan ◽

...

Keyword(s):

Quality Of Life ◽

Hernia Repair ◽

Abdominal Hernia ◽

Longitudinal Assessment ◽

Prospective Assessment ◽

Patient Burden

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Excess Body Weight and Abdominal Hernia

Visceral Medicine ◽

10.1159/000516047 ◽

2021 ◽

pp. 1-8

Author(s):

Ulrich A. Dietz ◽

Omar Yusef Kudsi ◽

Fahri Gokcal ◽

Naseem Bou-Ayash ◽

Urs Pfefferkorn ◽

...

Keyword(s):

Bariatric Surgery ◽

Body Weight ◽

Hernia Repair ◽

Perioperative Complications ◽

Total Body Weight ◽

Abdominal Hernia ◽

Excess Body Weight ◽

Obese Patients ◽

Hernia Surgery ◽

Interdisciplinary Approaches

Background: Obese patients have an increased incidence of ventral hernias; in over 50% of these cases, patients are symptomatic. At the same time, morbid obesity is a disease of epidemic proportions. The combination of symptomatic hernia and obesity is a challenge for the treating surgeon, because the risk of perioperative complications and recurrence increases with increasing BMI. Summary: This review outlines this problem and discusses interdisciplinary approaches to the management of affected patients. In emergency cases, the hernia is treated according to the surgeon’s expertise. In elective cases, an individual decision must be made whether bariatric surgery is indicated before hernia repair or whether both should be performed simultaneously. After bariatric surgery a weight reduction of 25–30% of total body weight in the first year can be achieved and it is often advantageous to perform a bariatric operation prior to hernia repair. Technically, the risk of complications is lower with minimally invasive procedures than with open ones, but laparoscopy is challenging in obese patients, and meshes can only be implanted in intraperitoneal position. This mesh position has to be questioned because of adhesions, recurrence rate, and risk of contamination during re-interventions in patients who are often still relatively young. Key Messages: Obese patients with hernia need to be approached in an interdisciplinary manner, in some patients a weight loss procedure may be advantageous before hernia repair. Recent data show the benefits of robotic hernia surgery in obese patients, as not only haptic advantages result, but especially the mesh can be implanted in a variety of extraperitoneal positions in the abdominal wall with low morbidity.

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P089 THE IMPACT OF VENTRAL HERNIA REPAIR ON PATIENT-REPORTED QUALITY OF LIFE: IDENTIFYING FACTORS ASSOCIATED WITH IMPROVEMENT

British Journal of Surgery ◽

10.1093/bjs/znab395.083 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Martin Morris ◽

Viren Patel ◽

Adrienne Christopher ◽

Robyn Broach ◽

John Fischer

Keyword(s):

Quality Of Life ◽

Hernia Repair ◽

Ventral Hernia ◽

Ventral Hernia Repair ◽

Abdominal Hernia ◽

Factors Associated ◽

Patient Reported ◽

The Impact

Abstract Aim Assessing pre- and postoperative quality of life (QoL) is essential to quantify the magnitude of improvement in disease burden after ventral hernia repair (VHR). Here, we identify patient and operative factors associated with QoL improvement after VHR. Material and Methods Patients that underwent VHR by a single surgeon were retrospectively identified and included if they had minimum 1 year of follow-up, and completed pre- and postoperative Abdominal Hernia-Q (AHQ) questionnaires. Patients were divided into quintiles based on absolute pre- to postoperative improvement in AHQ score. Chi-squared and fisher’s exact tests were used for categorical data, and Student’s t-test for continuous data, as appropriate. Results Compared to the lowest quintile (n = 27, follow-up 32.6 months, mean improvement 3.24 [SD 10.4]), patients in the highest quintile (n = 26, follow up 23.9 months, mean improvement 66.3 [SD 12.1]) were female (76.9% vs 37.0%, p = 0.005) with a greater number of previous hernia repairs (mean 2.12 vs. 0.78, p < 0.005) and previous abdominal surgeries (mean 4.0 vs 2.0, p < 0.001). Patients with greater improvement also had higher incidences of delayed healing (42.3% vs 7.41%), required more office visits (5.54 vs 3.89), and had higher inpatient costs ($30,084 USD vs. $16,886, all p < 0.05). No significant differences were seen in terms of race, ethnicity, body mass index, age, length of stay, Clavien-Dindo scores, hernia recurrence, or other postoperative complications. Conclusions Despite increased preoperative risk and healthcare burden, some of the most significant QoL improvement after VHR is demonstrated in patients with complex repairs and recoveries. This indicates the global utility of VHR regardless of patient demographics and complicating perioperative factors.

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P088 SURGEON AS A RISK FACTOR OF REDUCED EURAHS QOL SCORE AFTER HERNIA REPAIR

British Journal of Surgery ◽

10.1093/bjs/znab395.082 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Jakub Woleský ◽

Barbora Jíšová ◽

Barbora East

Keyword(s):

Incisional Hernia ◽

Hernia Repair ◽

Internal Audit ◽

Major Complication ◽

Incisional Hernia Repair ◽

Hernia Surgery ◽

Post Surgery ◽

Before And After

Abstract Aim Our aim was to analyze patient’s reported EuraHS QoL (quality of life) scores before and after hernia surgery. And find whether the result is surgeon dependent or not, because hernia repair often serves as a training surgery for young surgeons or is performed by surgeons with no hernia interest. However, even a simple groin hernia repair can lead to life-long pain or reduced QoL and the risk of complications following incisional hernia repair is much higher. Material and Methods We have utilized the EuraHS database and its QoL questionnaire and prospectively entered all patients undergoing any hernia repair at our department since Jan. 2019. Results 519 patients have been included. Many patients in the incisional hernia cohort have reported no or very little symptoms before the operation. Only 251 have completed their 1 month follow-up with the QoL questionnaire. 63 patients have been contacted and questioned 1 year post-surgery to this date. In 6 cases the QoL scores are lower than pre-repair. 45 patients had a record of major complication or reoccurrence requiring surgery so far. Unfortunately 31 of those did not fill up the QoL questionnaire. 37 were operated on by resident with a supervision of a surgeon without a hernia interest. Conclusions Results of hernia repair are surgeon dependent and an internal audit of current practices is needed at many general surgery departments.

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P085 CLINICAL AND LONGITUDINAL PATIENT REPORTED OUTCOMES AFTER TRANSVERSUS ABDOMINIS RELEASE: A SINGLE SURGEON EXPERIENCE

British Journal of Surgery ◽

10.1093/bjs/znab395.079 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Adrienne Christopher ◽

Martin Morris ◽

Louis-Xavier Barrette ◽

Robyn Broach ◽

John Fischer

Keyword(s):

Hernia Repair ◽

Patient Reported Outcomes ◽

Transversus Abdominis ◽

Abdominal Hernia ◽

Transversus Abdominis Release ◽

Surgeon Experience ◽

Patient Reported ◽

Related Quality

Abstract Aim Posterior component separation with transversus abdominis release (TAR) is a novel complex abdominal wall repair technique that maximizes medial myofascial flap advancement in a vascularized, pre-peritoneal plane. Here, we add to a growing body of literature on this technique by assessing longitudinal clinical and patient reported outcomes (PROs) after ventral hernia repair (VHR) with TAR. Material and Methods Adult patients undergoing VHR with TAR between 10/1/2015 and 01/15/2020 by a single surgeon were retrospectively identified. Patients with parastomal hernias and <12 months of follow-up were excluded. Clinical outcomes and PROs using the Abdominal Hernia Questionnaire (AQH) and Hernia Related Quality of Life Survey (HerQLes) were assessed. Results 57 patients were included with a median age and body mass index of 60 and 30.6 kg/m2, respectively. The average hernia defect was 384 cm2 [IQR 205-471], and all patients had retro-muscular mesh placed. The most common complications were delayed healing (19.3%) and seroma (14.0%). One patient required return to the OR for management of a complication and there were no cases of mesh infection or explantation. Previous hernia repair and concurrent panniculectomy were risk factors for developing any complication (p < 0.05). One patient (1.8%) recurred at a median follow-up of 25.7 months [IQR 18.2-42.1]. Significant improvement in disease-specific PROs was observed and maintained throughout the follow-up period (pre to post p < 0.05). Conclusions Longitudinal clinical and patient-reported outcomes after VHR with TAR are limited. We conclude that TAR is a safe and efficacious adjunct in the repair of complex hernia defects.

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Elective Inguinal Hernia Repair: A Unified Informed Consent, or who Wants to Know What?

The American Surgeon ◽

10.1177/000313480907500406 ◽

2009 ◽

Vol 75 (4) ◽

pp. 296-300 ◽

Cited By ~ 2

Author(s):

Julian E. Losanoff ◽

Kathleen M. Litwinczuk ◽

Michael J. Ranella ◽

Marc D. Basson

Keyword(s):

Inguinal Hernia ◽

Informed Consent ◽

Hernia Repair ◽

Invasive Procedure ◽

Postoperative Recovery ◽

Hernia Surgery ◽

Common Procedure ◽

Types Of Information ◽

Surgical Hernia Repair

Informed consent is increasingly being standardized. We sought to evaluate variability in the amount and quality of information desired by patients in choosing whether to undergo elective surgical hernia repair, a prototypical low- to moderate-risk common procedure. Consecutive stable outpatients were asked to assume that they were considering hernia repair and interviewed with a standard questionnaire that asked them to rate their interest in learning about the natural history, pathology, and management of inguinal hernia as well as herniorrhaphy complications and postoperative recovery. Ninety-eight consecutive patients exhibited substantial interpersonal variability in their level of interest in receiving information. Although interest in some types of information tended to correlate with interest in other types of information, patients’ degree of interest in receiving information about anesthesia during the procedure was independent of other variables. Education and previous exposure to individuals with hernias also affected interest in receiving potentially important information before deciding whether to consent to hernia surgery. Patients may vary with regard to the information they want to receive when deciding whether to consent to an invasive procedure. It may be preferable to individualize the consent process to patients’ preferences rather than adhering to standardized content.

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