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Dias Rasador AC, da Silveira CAB, Lima DL, Nogueira R, Malcher F, Sreeramoju P, Cavazzola LT. Mesh versus suture for elective primary umbilical hernia open repair: a systematic review and meta-analysis. Hernia 2024; 28:2069-2078. [PMID: 39001938 DOI: 10.1007/s10029-024-03106-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 07/01/2024] [Indexed: 07/15/2024]
Abstract
PURPOSE Recent guidelines indicate the use of mesh in UHR for defects > 1 cm, as it reduces recurrence, with 10% recurrence rate compared to up to 54.5% with primary closure. However, Nguyen et al. shows that primary closure is still widely performed in UHR, especially for small defects (1-2 cm), for which there is no published data to determine the optimal approach. In addition, previous meta-analysis by Madsen et al. comparing mesh repair with primary closure in UHR didn't exclude emergency conditions and recurrent hernias; also, didn't report subgroup analysis on hernia defect size. Thus, we aimed to perform a systematic review and meta-analysis comparing the mesh repairs vs. primary closure of the defect in an open elective primary UHR. METHODS We searched for studies comparing mesh with suture in open UHR in PubMed, Scopus, Cochrane, Scielo, and Lilacs from inception until October 2023. Studies with patients ≤ 18 years old, with recurrent or emergency conditions were excluded. Outcomes were recurrence, seroma, hematoma, wound infection, and hospital length of stay. Subgroup analysis was performed for: (1) RCTs only, and (2) hernia defects smaller than 2 cm. We used RevMan 5.4. for statistical analysis. Heterogeneity was assessed with I² statistics, and random effect was used if I² > 25%. RESULTS 2895 studies were screened and 56 were reviewed. 12 studies, including 4 RCTs, 1 prospective cohort, and 7 retrospective cohorts were included, comprising 2926 patients in total (47.6% in mesh group and 52.4% in the suture group). Mesh repair showed lower rates of recurrence in the overall analysis (RR 0.50; 95% CI 0.31 to 0.79; P = 0.003; I2 = 24%) and for hernia defects smaller than 2 cm (RR 0.56; 95% CI 0.34 to 0.93; P = 0.03; I2 = 0%). Suture repair showed lower rates of seroma (RR 1.88; 95% CI 1.07 to 3.32; P = 0.03; I2 = 0%) and wound infection (RR 1.65; 95%CI 1.12 to 2.43; P = 0.01; I2 = 15%) in the overall analysis, with no differences after performing subgroup analysis of RCTs. No differences were seen regarding hematoma and hospital length of stay. CONCLUSION The use of mesh during UHR is associated with significantly lower incidence of recurrence in a long-term follow-up compared to the suture repair, reinforcing the previous indications of the guidelines. Additionally, despite the overall analysis showing higher risk of seroma and wound infection for the mesh repair, no differences were seen after subgroup analysis of RCTs. STUDY REGISTRATION A review protocol for this systematic review and meta-analysis was registered at PROSPERO (CRD42024476854).
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Affiliation(s)
- Ana Caroline Dias Rasador
- Bahiana School of Medicine and Public Health, Dom João VI Avenue, 275, Brotas, BA, 40290-000, Brazil
| | | | - Diego Laurentino Lima
- Department of Surgery, Montefiore Medical Center, 1825 Eastchester Rd, Bronx, NY, 10461, USA.
| | - Raquel Nogueira
- Department of Surgery, Montefiore Medical Center, 1825 Eastchester Rd, Bronx, NY, 10461, USA
| | - Flavio Malcher
- Division of General Surgery, NYU Langone, New York, NY, USA
| | - Prashanth Sreeramoju
- Bahiana School of Medicine and Public Health, Dom João VI Avenue, 275, Brotas, BA, 40290-000, Brazil
| | - Leandro T Cavazzola
- Department of Surgery, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Chin M, Kit JLW, Wijerathne S, Aw A, Ann DCK, Fatt SLK, Ragupathi T, Ng Ho Man H, Lomanto D. A comparative study between condensed polytetrafluoroethylene hernia mesh versus other composite meshes in Endo-laparoscopic ventral hernia repair. Asian J Surg 2024:S1015-9584(24)02568-5. [PMID: 39603941 DOI: 10.1016/j.asjsur.2024.10.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Accepted: 10/28/2024] [Indexed: 11/29/2024] Open
Abstract
INTRODUCTION Laparoscopic ventral hernia mesh repair (LVHR) is gaining popularity possibly due to reduced complications, reduced hospital stay, early return to work and better cosmesis. In intra-peritoneal onlay method (IPOM) a dual layer composite mesh with an absorbable barrier on the visceral surface is used for minimising bowel adhesions. Three most popular prosthetic mesh scaffolds are polypropylene (PP), polyester and expanded polytetrafluoroethylene (ePTFE). A new generation of monolayer condensed polytetrafluoroethylene (cPTFE) Omyra® mesh, which theoretically has better tissue integration with parietal tissue and possibly lesser adhesions with visceral organs is now available for use. OBJECTIVE The aim of our study is to assess the safety and efficacy of Omyra (cPTFE) mesh versus other mesh types in LVHR. METHOD We retrospectively collected data from 62 patients who underwent LVHR using cPTFE, as well as other mesh types from January 1, 2011 to December 31, 2020. Patient demographics, Hernia Characteristics, perioperative events, postoperative results and complications were documented and analysed. RESULTS Among the 62 patients studied, there were 27 (43.55 %) in the Omyra group and 35 (56.45 %) in the other synthetic meshes group. The mean age of the Omyra group was 53.19 (31-85) and 55.03 (22-81) for the other synthetic meshes group. There were no differences in terms of patient demographics and major comorbidities. At presentation, the indication was more commonly for recurrence (p = 0.043), and patients were more symptomatic (p = 0.0034) in the Omyra group than the other synthetic meshes group. There were no differences in mean operating time, post-operative recovery and complications, as well as early (<30 days) and late (>30 days) complications during follow up. CONCLUSION The use of cPTFE (Omyra™) mesh yielded comparable operative characteristic compared to other synthetic meshes for LVHR. The rate of perioperative complications and early recurrence was similar between Omyra and other synthetic meshes group.
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Affiliation(s)
- Meredeth Chin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - James Lee Wai Kit
- Division of Minimally Invasive Surgery, Department of Surgery, National University Hospital, Singapore; Department of Surgery, Alexandra Hospital, Singapore
| | - Sujith Wijerathne
- Division of Minimally Invasive Surgery, Department of Surgery, National University Hospital, Singapore; Department of Surgery, Alexandra Hospital, Singapore
| | - Avelyn Aw
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Daryl Chia Kai Ann
- Division of Minimally Invasive Surgery, Department of Surgery, National University Hospital, Singapore; Department of Surgery, National University of Singapore, Singapore
| | - Sean Lee Kien Fatt
- Division of Minimally Invasive Surgery, Department of Surgery, National University Hospital, Singapore
| | - Tharun Ragupathi
- Division of Minimally Invasive Surgery, Department of Surgery, National University Hospital, Singapore
| | - Harry Ng Ho Man
- Division of Minimally Invasive Surgery, Department of Surgery, National University Hospital, Singapore
| | - Davide Lomanto
- Division of Minimally Invasive Surgery, Department of Surgery, National University Hospital, Singapore; Department of Surgery, National University of Singapore, Singapore
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Lu C, Cassidy J, Embel V, Ouellette T, Arumugam D, Kipnis S. Utilizing T-Line Mesh for Periumbilical Hernia Repair: Evaluation of Short-term Outcomes. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e6287. [PMID: 39525888 PMCID: PMC11548904 DOI: 10.1097/gox.0000000000006287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 09/10/2024] [Indexed: 11/16/2024]
Abstract
Background Abdominal periumbilical hernias are prevalent within the adult population. When symptomatic, quality of life may be affected. This case series of 10 patients evaluates the short-term outcomes of using the T-Line mesh in periumbilical hernia repair. Methods A retrospective review of adult patients with symptomatic periumbilical abdominal hernia treated with open repair with T-Line mesh was performed at a tertiary referral center. Ten patients with an average age of 51 years were offered surgical treatment. Measures of postoperative outcomes included readmission within the 30-day postoperative period; recurrence; surgical site infection; development of seroma and hematoma; and the presence of pain, numbness, or bloating. Descriptive statistics were computed in Microsoft Excel. Results All 10 patients reported improvement in symptoms. All repairs were elective and classified as clean (100%). Hernias included 40% primary umbilical, 50% ventral, and 10% incisional. The average defect size was 10 cm2, with a range from 1 to 25 cm2. The T-Line mesh was placed in a sublay manner, with an average mesh size of 36 cm2. No patients were readmitted in the 30-day postoperative period. There were no occurrences of surgical site infection or hernia recurrence. No hospital readmissions and no follow-up visits with hernia recurrence were noted at 3 months. Conclusions We present a case series of 10 patients presenting with symptomatic periumbilical hernias who underwent repair with the T-Line hernia mesh without short-term surgical occurrences. Long-term studies are required to accurately reflect safety and efficacy.
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Affiliation(s)
- Charles Lu
- From the Department of Surgery, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, N.J
| | - Jillian Cassidy
- From the Department of Surgery, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, N.J
| | - Veysel Embel
- From the Department of Surgery, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, N.J
| | - Taylor Ouellette
- From the Department of Surgery, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, N.J
| | - Dena Arumugam
- From the Department of Surgery, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, N.J
| | - Seth Kipnis
- From the Department of Surgery, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, N.J
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Alves JR, Spengler LFM, Justino LB, Justino GB, Silva IK, Amico EC. UMBILICAL AND EPIGASTRIC HERNIA REPAIR: A SYSTEMATIC REVIEW. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2024; 37:e1807. [PMID: 38896702 PMCID: PMC11182624 DOI: 10.1590/0102-6720202400014e1807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 03/25/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Umbilical and epigastric hernias are among the most common hernias of the abdominal wall; however, there is a lack of standardization for their treatment. AIMS To clarify the controversies regarding therapeutic possibilities, indications, and surgical techniques for umbilical and epigastric hernia repair. METHODS A systematic review and qualitative analysis of randomized clinical trials published in the last 20 years, involving adults (aged 18 years and over) with umbilical and/or epigastric hernias, was performed by systematically searching the PubMed/Medline, Cochrane, SciELO, and LILACS databases. The risk of bias in individual studies was assessed using the Cochrane Risk of Bias Tool. RESULTS Initially, 492 studies were selected and, subsequently, 15 randomized controlled clinical trials were chosen that met the inclusion criteria and underwent full reading and qualitative analysis, considering possible bias. CONCLUSIONS This review concluded that it is evident the superiority of the use of meshes in the repair of epigastric/primary umbilical hernias with a defect larger than 1 cm, even in certain emergency situations. However, suture repair is a good option for patients with a defect smaller than 1 cm. In the laparoscopic approach, recent evidence points towards possible superiority in fixation with fibrin sealant, and fascial defect closure is recommended. In addition, due to a scarcity of randomized controlled trials with low risk of bias, further studies are needed on types, positioning and fixation techniques, as well as the real role of video-assisted laparoscopic surgery in the correction of hernias, especially umbilical.
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Affiliation(s)
- José Roberto Alves
- Universidade Federal de Santa Catarina, Department of Surgery - Florianópolis (SC), Brazil
| | | | - Leonardo Busch Justino
- Universidade Federal de Santa Catarina, Department of Surgery - Florianópolis (SC), Brazil
| | - Gustavo Busch Justino
- Universidade Federal de Santa Catarina, Department of Surgery - Florianópolis (SC), Brazil
| | - Iago Koerich Silva
- Universidade Federal de Santa Catarina, Department of Surgery - Florianópolis (SC), Brazil
| | - Enio Campos Amico
- Universidade Federal do Rio Grande do Norte, Department of Surgery - Natal (RN), Brazil
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Keric N, Campbell A. Meshing around: high-risk hernias and infected mesh. Trauma Surg Acute Care Open 2024; 9:e001379. [PMID: 38646030 PMCID: PMC11029232 DOI: 10.1136/tsaco-2024-001379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/25/2024] [Indexed: 04/23/2024] Open
Abstract
Open laparotomy carries a risk up to 20% for an incisional hernia, making repair one of the most common operations performed by general surgeons in the USA. Despite a multitude of mesh appliances and techniques, no size fits all, and there is continued debate on what is the best mesh type, especially in high-risk patients with contaminated hernias. Infected mesh carries a significant burden to the patient, the surgeon and overall healthcare costs with medical legal implications. A stepwise approach that involves optimization of patient comorbidities, patient selective choice of mesh and technique is imperative in mitigating outcomes and recurrence rates. This review will focus on the avoidance of mesh infection and the selection of mesh in patients with contaminated wounds.
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Affiliation(s)
- Natasha Keric
- Surgery, The University of Arizona College of Medicine Phoenix, Phoenix, Arizona, USA
- Surgery, Banner—University Medical Center Phoenix, Phoenix, Arizona, USA
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Li J, Ji Z. Comment to: "Onlay mesh repair for treatment of small umbilical hernias ≤ 2 cm in adults: a single-centre investigation". Hernia 2023; 27:1329-1330. [PMID: 37036540 DOI: 10.1007/s10029-023-02791-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 04/02/2023] [Indexed: 04/11/2023]
Affiliation(s)
- J Li
- Department of General Surgery, Affiliated Zhongda Hospital, Southeast University, Nanjing, 210009, China.
| | - Z Ji
- Department of General Surgery, Affiliated Zhongda Hospital, Southeast University, Nanjing, 210009, China
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Hager M, Edgerton C, Hope WW. Primary Uncomplicated Ventral Hernia Repair: Guidelines and Practice Patterns for Routine Hernia Repairs. Surg Clin North Am 2023; 103:901-915. [PMID: 37709395 DOI: 10.1016/j.suc.2023.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
Surgical repair of primary umbilical and epigastric hernias are among the most common abdominal operations in the world. The hernia defects range from small (<1 cm) to large and complex even in the absence of prior incision or repair. Mesh has generally been shown to decrease recurrence rates, and its use and location of placement should be individualized for each patient. Open, laparoscopic, and robotic approaches provide unique considerations for the technical aspects of primary repair with or without mesh augmentation.
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Affiliation(s)
- Matthew Hager
- Department of Surgery, Novant/New Hanover Regional Medical Center, 2131 South 17th Street, PO Box 9025, Wilmington, NC 28401, USA
| | - Colston Edgerton
- Department of Surgery, Novant/New Hanover Regional Medical Center, University of North Carolina - Chapel Hill, 2131 South 17th Street, PO Box 9025, Wilmington, NC 28401, USA
| | - William W Hope
- Department of Surgery, Novant/New Hanover Regional Medical Center, University of North Carolina - Chapel Hill, 2131 South 17th Street, PO Box 9025, Wilmington, NC 28401, USA.
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Frey S, Beauvais A, Soler M, Beck M, Dugué T, Pavis d'Escurac X, Dabrowski A, Jurczak F, Gillion JF. Suture versus open mesh repair for small umbilical hernia: Results of a propensity-matched cohort study. Surgery 2023; 174:593-601. [PMID: 37357098 DOI: 10.1016/j.surg.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 04/14/2023] [Accepted: 05/24/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND The objective was to compare the outcomes of open mesh repair versus suture repair for small (≤1 cm in diameter) umbilical hernia. The primary endpoint was the 30-day outcomes including pain, and secondary endpoints were the 2-year outcomes including recurrences and patient-reported outcomes. METHODS This propensity-matched, multicenter study was carried out on data collected prospectively in the Hernia-Club database between 2011 and 2021. A total of 590 mesh repairs and 590 suture repairs were propensity score matched (age, sex, body mass index) at a ratio of 1:1. Postoperative pain was assessed using the Verbal Rating Scale-4 and 0‒10 Numerical Rating Scale-11. RESULTS Mesh insertion was intraperitoneal in 331 patients (56.1%), extraperitoneal in 249 (42.2%), and onlay in 10 (1.7%). The rate of 30-day complications and Numerical Rating Scale-11 pain scores on postoperative days 8 and 30 were similar between the groups, including surgical site occurrences (2.2 vs 1.4% after suture repair). At 1 month, postoperative discomfort (sensation of something different from before) was significantly (P < .0001) more frequent after mesh repair, whereas the rate of relevant (moderate or severe) pain (mesh repair: 1.1% vs suture repair: 2.6%) and the distribution of Numerical Rating Scale-11 scores did not differ between the groups. At the 2-year follow-up, mesh repair patients had fewer reoperated recurrences (0.2% vs 1.7%; P = .035) and no more pain or discomfort than suture repair patients. CONCLUSION Both techniques are effective and safe. Mesh repair is likely to reduce the rate of recurrences. Concerns about postoperative pain and infection might not prevent the use of mesh in smallest umbilical hernias.
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Affiliation(s)
- Samuel Frey
- Nantes Université, CHU Nantes, Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, Nantes, France.
| | | | - Marc Soler
- Service de chirurgie viscérale et digestive, Clinique Saint-Jean, Cagnes-sur-Mer, France
| | | | - Timothée Dugué
- Service de chirurgie viscérale et digestive, Clinique Saint Pierre, Perpignan, France
| | | | - André Dabrowski
- Service de chirurgie viscérale et digestive, Clinique de Saint-Omer, Blendecques, France
| | - Florent Jurczak
- Service de chirurgie digestive et viscérale, Clinique Mutualiste de l'Estuaire, Saint-Nazaire, France
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Birhanu AM, Mohammed SH, Mohammed SM, Abebe TM, Sequr BY. Incarcerated Richter's congenital umbilical hernia in a young male: A case report. Int J Surg Case Rep 2023; 109:108576. [PMID: 37524021 PMCID: PMC10407204 DOI: 10.1016/j.ijscr.2023.108576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 08/02/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Richter's hernia is a protrusion of a portion of the circumference of anti-mesenteric side of intestine through the fascial defect. It is a rare type of hernia and typically occurs in elderly patients. Richter's hernia could result in grave complications. The objective of the study was to describe a rare case of incarcerated Richter's congenital umbilical hernia in a 20-year-old male patient. CASE PRESENTATION A 20-year-old male presented with a complaint of intermittent crampy peri-umbilical pain of three days duration associated with non-reducible umbilical bulge and vomiting. On examination, there was 4 cm by 4 cm oval, firm, tender, non-reducible mass over the umbilical area without cough impulse. He was kept nothing per os, broad spectrum antibiotic started, consent taken & operated. A loop of the ilium which was mildly ischemic found in the hernia sac. Sac and entrapped intestine were thoroughly cleaned with warm saline and reduction and herniorrhaphy done. The client discharged on the 2nd postoperative day. CLINICAL DISCUSSION There have been very few reports of Richter's congenital umbilical hernia. Richter's hernia progresses more rapidly to gangrene than other strangulated hernias however patients often have no intestinal obstruction. Raised suspicion therefore is important to take timely surgical intervention before the disease advance and complications occurred. CONCLUSION Richter's hernia has subclinical symptoms and late presentation which could result in grave complications and increased mortality. The early decision for surgery has paramount importance in reducing complication and associated mortality.
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Affiliation(s)
- Anteneh Messele Birhanu
- Department of Medicine, School of Medicine, College of Medicine and Health Sciences, Mizan - Tepi University, Mizan Teferi, Ethiopia.
| | - Suleman Hassen Mohammed
- Department of Surgery, School of Medicine, College of Medicine and Health Sciences, Mizan - Tepi University, Mizan Teferi, Ethiopia
| | - Sisay Mengistu Mohammed
- Department of Surgery, School of Medicine, College of Medicine and Health Sciences, Mizan - Tepi University, Mizan Teferi, Ethiopia
| | - Tesfahun Mengistu Abebe
- Department of Surgery, School of Medicine, College of Medicine and Health Sciences, Mizan - Tepi University, Mizan Teferi, Ethiopia.
| | - Bethelhem Yaynemsa Sequr
- Department of Medicine, School of Medicine, College of Medicine and Health Sciences, Mizan - Tepi University, Mizan Teferi, Ethiopia
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Moradian S, Klosowiak JL, Boctor MJ, Issa T, Park S, Dumanian GA. Novel Approach for Umbilical Hernia Repair Using Mesh Strips. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4947. [PMID: 37113310 PMCID: PMC10129195 DOI: 10.1097/gox.0000000000004947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/24/2023] [Indexed: 04/29/2023]
Abstract
Umbilical hernia repair is a common surgical procedure without a universally accepted means of repair. We introduce a novel surgical technique for open primary umbilical hernia repair, using strips of polypropylene mesh as sutures to achieve a repair. Methods Two-centimeter-wide strips of macroporous polypropylene mesh were passed through the abdominal wall and tied as simple interrupted sutures to achieve umbilical hernia repair. A retrospective review of all elective umbilical hernia repairs performed by a single surgeon using the mesh strip technique between 2016 and 2021 was conducted, and patient-reported outcomes were assessed via a telephonic survey. Results Thirty-three patients underwent an elective, open mesh strip repair of a primary umbilical hernia and met criteria for inclusion in the study. Of these patients, 60% responded to a patient-reported outcomes telephone survey. Ninety percent of survey responders reported a pain score of 0 of 10. Additionally, 90% reported being unable to feel or palpate the knot, and 80% reported an improvement in quality of life. Mean follow-up at 3 years revealed one recurrence in the setting of ascites, yielding a recurrence rate of 3%. Conclusion Primary mesh strip repair of umbilical hernias combines the simplicity of suture repair with the advantageous force distribution properties of mesh, and constitutes a safe, efficient, and effective method of repair with a low recurrence rate at long-term follow-up that is comparable to planar mesh repair.
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Affiliation(s)
- Simon Moradian
- From the Department of Surgery, Division of Plastic Surgery, Northwestern Feinberg School of Medicine, Chicago, Ill
| | - Julian L. Klosowiak
- From the Department of Surgery, Division of Plastic Surgery, Northwestern Feinberg School of Medicine, Chicago, Ill
| | - Michael J. Boctor
- From the Department of Surgery, Division of Plastic Surgery, Northwestern Feinberg School of Medicine, Chicago, Ill
| | - Tariq Issa
- From the Department of Surgery, Division of Plastic Surgery, Northwestern Feinberg School of Medicine, Chicago, Ill
| | - Seong Park
- From the Department of Surgery, Division of Plastic Surgery, Northwestern Feinberg School of Medicine, Chicago, Ill
| | - Gregory A. Dumanian
- From the Department of Surgery, Division of Plastic Surgery, Northwestern Feinberg School of Medicine, Chicago, Ill
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Hospital-level variation in mesh use for ventral and incisional hernia repair. Surg Endosc 2023; 37:1501-1507. [PMID: 35851814 DOI: 10.1007/s00464-022-09357-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/16/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Placement of prosthetic mesh during ventral and incisional hernia repair has been shown to reduce the incidence of postoperative hernia recurrence. Consequently, multiple consensus guidelines recommend the use of mesh for ventral hernias of any size. However, the extent to which real-world practice patterns reflect these recommendations is unclear. METHODS We performed a retrospective review of the Michigan Surgical Quality Collaborative Hernia Registry (MSQC-HR) to identify patients undergoing clean ventral or incisional hernia repair between January 1, 2020 and December 31, 2021. The primary outcome was mesh use. We used two-step hierarchical logistic regression modeling with empirical Bayes estimates to evaluate the association of hospital-level mesh use with patient, operative, and hernia characteristics. RESULTS A total of 5262 patients underwent ventral and incisional hernia repair at 65 hospitals with a mean age of 53.8 (14.5) years, 2292 (43.6%) females, and a mean hernia width of 3.2 (3.4) cm. Mean hospital volume was 81 (49) cases. Mesh was used in 4098 (77.9%) patients. At the patient level, hernia width and surgical approach were significantly associated with mesh use. Specifically, mesh use was 6.2% (95% CI 4.8-7.5%) more likely with each additional centimeter of hernia width and 28.0% (95% CI 26.1-29.8%) more likely for minimally invasive repair compared to open repair. At the hospital level, there was wide variation in mesh use, ranging from 38.0% (95% CI 31.5-44.9%) to 96.4% (95% CI 95.3-97.2%). Hospital-level mesh use was not associated with differences in hernia size (β = - 0.003, P = 0.978), surgical approach (β = - 1.109, P = 0.414), or any other patient factors. CONCLUSIONS Despite strong evidence supporting the use of mesh in ventral and incisional hernia repair, there is substantial variation in mesh use between hospitals that is not explained by differences in patient characteristics or operative approach. This suggests that opportunities exist to standardize surgical practice to better align with evidence supporting the use of mesh in the management of these hernias.
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Loh C, Tan L, Wijerathne S, Lee J, Wai L, Parameswaran R, Goh S, Oo AM, Lomanto D. Open versus laparoscopic intraperitoneal on-lay mesh repair: A comparison of outcomes in small ventral hernia. Asian J Surg 2023; 46:712-717. [PMID: 35842388 DOI: 10.1016/j.asjsur.2022.06.153] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 06/17/2022] [Accepted: 06/30/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The ideal surgical treatment of small ventral hernias (defect less than 4 cm) is still debatable. In our study, we sought to compare the outcomes of open versus laparoscopic intraperitoneal on-lay mesh (IPOM) repair in small ventral hernias. METHODS Patients with a single ventral hernia defect of less than 4 cm undergoing surgical mesh repair between January 2016 and September 2018 were prospectively registered for this study. The minimum follow-up duration was 12 months. Patient demographics, operative findings and regular post-operative follow-up details including recurrence rates and complications were recorded and analysed. RESULTS 41 patients underwent laparoscopic IPOM repair and 47 patients underwent open IPOM repair. The mean age for both groups is similar with no significant difference. The mean hernia defect size for the laparoscopic group is 2.8 cm (±0.8) whereas the mean hernia defect size for the open repair group is 2.1 cm (±0.4). The mean surgery duration for open IPOM repair was significantly shorter (59 min (±17) vs 74 min (±26); p = 0.001). There was no significant difference in the incidence of seroma formation and surgical site infections post-operatively. There was also no significant difference in both groups in terms of chronic pain and recurrence at 1-year follow-up. CONCLUSION Open IPOM repair for small ventral hernias may be superior to laparoscopic IPOM repair due to the shorter operative duration, single incision, and no additional risk of port-site hernias. There was no difference in chronic pain, wound infection and recurrence rate between the two groups.
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Affiliation(s)
- Clement Loh
- Department of Surgery, Alexandra Hospital, Singapore
| | - Lydia Tan
- Department of Surgery, Alexandra Hospital, Singapore.
| | - Sujith Wijerathne
- Department of Surgery, Alexandra Hospital, Singapore; Minimally Invasive Surgical Centre, National University Hospital Singapore
| | - James Lee
- Department of Surgery, Alexandra Hospital, Singapore
| | - Louis Wai
- Department of Surgery, Alexandra Hospital, Singapore
| | | | - Serene Goh
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Aung Myint Oo
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Davide Lomanto
- Department of Surgery, Alexandra Hospital, Singapore; Minimally Invasive Surgical Centre, National University Hospital Singapore
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Melkemichel M, Stjärne L, Bringman S, Widhe B. Onlay mesh repair for treatment of small umbilical hernias ≤ 2 cm in adults: a single-centre investigation. Hernia 2022; 26:1483-1489. [PMID: 34591212 PMCID: PMC9684217 DOI: 10.1007/s10029-021-02509-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/09/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Previous studies on the repair of small umbilical hernias have suggested a lower recurrence rate with mesh compared to suture repair. An important question is in what anatomical position the mesh should be placed. The purpose of this study was to investigate the outcome of using a standardized 4 × 4 cm onlay-mesh for umbilical hernias ≤ 2 cm. METHODS A retrospective study was conducted at a single centre in Sweden on all umbilical hernia repairs during 2015-2019. The follow-up time was at least four months. Patients were identified using the hospital medical database. Repairs performed with suture or a sublay, ventral patch and laparoscopic mesh positioning were excluded. The patient's demographics, comorbidities, intra-and post-operative details were considered. The primary outcome was surgical site complications within 30 days. The secondary outcome was a recurrence. RESULTS 80 patients were repaired with a small onlay-mesh for an umbilical hernia ≤ 2 cm. The median (range) follow-up time was 29.0 (4.3-50.1) months. The median age was 46 (26-76) years old. The median body mass index was 28 (19-38) kg/m2. The male to female ratio was 2:1. 4 patients were identified with a surgical site post-operative complication; three with seromas and one with a superficial wound infection. 3 of these were given antibiotics. 2 patients were treated with wound openings bedside. There were no registered cases of recurrence. CONCLUSIONS Repairing small umbilical hernias with a small onlay-mesh was safe with a low surgical site complication rate. Randomized trials are needed to assess whether mesh can reduce recurrences in umbilical hernia repairs ≤ 2 cm.
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Affiliation(s)
- M Melkemichel
- Department of Surgery, Södertälje Hospital, 152 86, Södertälje, Sweden.
- Department of Clinical Sciences, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden.
| | - L Stjärne
- Department of Surgery, Södertälje Hospital, 152 86, Södertälje, Sweden
| | - S Bringman
- Department of Surgery, Södertälje Hospital, 152 86, Södertälje, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - B Widhe
- Department of Surgery, Södertälje Hospital, 152 86, Södertälje, Sweden
- Department of Clinical Sciences, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden
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14
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Katzen MM, Sacco J, Ku D, Scarola GT, Colavita PD, Heniford BT, Augenstein VA. Hernia recurrence after primary repair of small umbilical hernia defects. Am J Surg 2022; 224:1357-1361. [PMID: 36182599 DOI: 10.1016/j.amjsurg.2022.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/13/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND An evidence-based approach to the repair of umbilical hernias (UH)<1 cm has yet to be defined. METHODS A prospectively maintained, institutional hernia database was queried for patients undergoing primary suture repair of UH ≤ 1 cm. The primary outcome was recurrence and secondary outcomes were wound complications. RESULTS Of 332 patients included (226-primary, 106-incisional), recurrence was identified in 4 (1.8%) primary versus 8 (7.5%) incisional-UH (p = 0.022), with follow-up of 4.7 ± 4.4 years. There were 10 (3.0%) wound complications: 4 (1.2%) superficial wound infections, 1 (0.3%) superficial wound dehiscence, and 5 (1.5%) seromas. On multivariable analysis of recurrence, incisional-UH had an odds ratio of 4.2 compared to primary. Suture choice, diabetes, BMI, tobacco-use history, and wound complications were not significant. CONCLUSIONS With long term follow-up, recurrence after primary suture repair of UH ≤ 1 cm occurred in 1.8% of primary and 7.5% of incisional UH. On multivariable analysis, incisional-UH increased recurrence odds by 4.2 times compared to primary.
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Affiliation(s)
- Michael M Katzen
- Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, 28204, USA
| | - Jana Sacco
- Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, 28204, USA
| | - David Ku
- Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, 28204, USA
| | - Gregory T Scarola
- Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, 28204, USA
| | - Paul D Colavita
- Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, 28204, USA
| | - B Todd Heniford
- Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, 28204, USA
| | - Vedra A Augenstein
- Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, 28204, USA.
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15
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Seppey R, Benjamin A, Lambrakis P. A novel approach to managing ruptured umbilical hernias in cirrhosis. ANZ J Surg 2022; 92:2524-2528. [DOI: 10.1111/ans.17936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/15/2022] [Accepted: 07/14/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Romain Seppey
- Trauma and Acute Care Surgery Unit Liverpool Hospital Sydney New South Wales Australia
| | - Aditya Benjamin
- Trauma and Acute Care Surgery Unit Liverpool Hospital Sydney New South Wales Australia
| | - Paul Lambrakis
- Trauma and Acute Care Surgery Unit Liverpool Hospital Sydney New South Wales Australia
- School of Medicine University of New South Wales Sydney New South Wales Australia
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16
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Malysz Oyola AM, Faulkner J, Casas B, Hooks WB, W Hope W. Are Surgeons of the Abdominal Core Health Quality Collaborative Following Guidelines in Umbilical and Epigastric Hernia Repair? Am Surg 2022; 88:2163-2169. [PMID: 35642530 DOI: 10.1177/00031348221091960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Umbilical and epigastric hernias are among the top three most common hernia surgeries performed in the USA with varied techniques. The European and Americas Hernia Societies (EAHS) recently published guidelines for repair of umbilical and epigastric hernias. We evaluated how closely the general surgeons of the Abdominal Core Health Quality Collaborative (ACHQC) follow these guidelines and to identify areas for possible improvement. METHOD Data from patients undergoing elective and emergent umbilical or epigastric hernia repair from 2013 to 2021 were extracted from the ACHQC database. The procedures performed on eligible subjects were compared to those proposed by the EAHS guidelines. Data was reported as a percentage and a cutoff of 70% was selected to determine compliance. RESULTS Based on these criteria, 11,088 patients were included and most of the recommendations, including appropriate preoperative antibiotic dosing (96.1% umbilical; 97.2% epigastric), permanent mesh selection (umbilical 97.8%; 96.1 epigastric), mesh fixation with suture (83.6% umbilical; 75.5% epigastric), use of mesh for open repair of hernias greater than 1 cm (83.6 umbilical; 85.7 epigastric), and primary defect closure during open (98.6% umbilical; 97.5% epigastric) and laparoscopic (99.6% umbilical; 100% epigastric) repair, were met. DISCUSSION Surgeons of the ACHQC adhere to most of the published guidelines on umbilical and epigastric hernia repair. Further research is needed to reinforce or modify the existing recommendations. Standardization of surgical approach will facilitate additional research needed to improve procedural efficiency, while reducing negative outcomes and cost.
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Affiliation(s)
- Anna M Malysz Oyola
- Department of General Surgery, 24520Novant Health New Hanover Regional Medical Center, Wilmington, NC, USA
| | - Justin Faulkner
- Department of General Surgery, 24520Novant Health New Hanover Regional Medical Center, Wilmington, NC, USA
| | - Brandon Casas
- 6797University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - William B Hooks
- Department of General Surgery, 24520Novant Health New Hanover Regional Medical Center, Wilmington, NC, USA
| | - William W Hope
- Department of General Surgery, 24520Novant Health New Hanover Regional Medical Center, Wilmington, NC, USA
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17
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López de Antón Bueno MB, López AM, Cabrera AG, Gómez JAG, Amaro AC, Lara CD, Sebastián AA, Gómez JLF, Ruiz LA. Topical use of hyperoxygenated fatty acids decreases surgical site infection in patients following laparoscopic cholecystectomy. A randomized controlled trial. Int J Surg 2022; 99:106253. [PMID: 35149238 DOI: 10.1016/j.ijsu.2022.106253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/30/2022] [Accepted: 02/04/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND To date, the topically effect of hyperoxygenated fatty acids (HOFA) on the control of surgical site infection (SSI) is still unclear. OBJECTIVE To assess the effect of topical application of a HOFA solution on the umbilical trocar site after laparoscopic cholecystectomy on SSI. The occurrence of trocar site incisional hernia (TSIH) was also analyzed. METHODS A prospective, double-blind, randomized trial was conducted in patients undergoing laparoscopic cholecystectomy, who also presented at least one of the following associated risk factors for SSI and TSIH such as Body Mass Index (BMI) above 30 kg/m2, Diabetes Mellitus (DM), age over 65 years and Chronic Obstructive Pulmonary Disease (COPD). Patients were randomly allocated to topical application of a HOFA solution (HOFA arm) or saline physiological solution (non-HOFA arm) during closure of the umbilical trocar site with a polypropylene mesh. SSI was the primary outcome. TSIH was also assessed as a secondary outcome. RESULTS 103 patients were included, 51 (49.5%) in the HOFA group and 52 (50.5%) in the non-HOFA group. SSI rate was significantly lower in the HOFA group in comparison with the non-HOFA group (19.6% vs. 3.8%; p = 0.028). TSIH rates were similar in both groups (3.8% vs. 2%). Multivariate analyses showed that only HOFA decreased significantly SSI rate. CONCLUSION Topical application of a HOFA solution at the umbilical trocar site after laparoscopy cholecystectomy decreased SSI rate.
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18
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Miyagi D, Nakahara O, Ohya Y, Kuramoto K, Tsuji A, Hayashida S, Inoue M, Iizaka M, Sasaki M, Inomata Y. Percutaneous surgical repair for a patient with adult pararectal hernia caused by intractable ascites associated with liver cirrhosis. Drug Discov Ther 2022; 16:251-253. [DOI: 10.5582/ddt.2022.01060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Daichi Miyagi
- Department of Surgery, Kumamoto Rosai Hospital, Kumamoto, Japan
| | - Osamu Nakahara
- Department of Surgery, Kumamoto Rosai Hospital, Kumamoto, Japan
| | - Yuki Ohya
- Department of Surgery, Kumamoto Rosai Hospital, Kumamoto, Japan
| | | | - Akira Tsuji
- Department of Surgery, Kumamoto Rosai Hospital, Kumamoto, Japan
| | | | - Mitsuhiro Inoue
- Department of Surgery, Kumamoto Rosai Hospital, Kumamoto, Japan
| | | | - Masato Sasaki
- Department of Gastroenterology and Hepatology, Kumamoto Rosai Hospital, Kumamoto, Japan
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19
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Loss L, Meier J, Phung T, Ordonez J, Huerta S. Feasibility of Umbilical Hernia Repair Under Local Anesthesia and Monitored Anesthesia Care at a Veteran Affairs Hospital. Am Surg 2021; 88:167-173. [PMID: 34846213 DOI: 10.1177/0003134820951452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Local anesthesia (LA) for open umbilical hernia tissue repair (OUHTR) is not widely utilized in academic centers in the United States. We hypothesize that LA for OUHTR is feasible in a veteran patient population. METHODS From 2015 to 2019, 449 umbilical hernias were repaired at our institution utilizing a standardized technique in veteran patients. OUHTR was included in this analysis (n = 283). Since 2017, 18.7% (n = 53) UH were repaired under LA. We compared outcomes and operative times between general anesthesia and LA in patients undergoing OUHTR. Univariable and multivariable analyses were performed to determine significance. RESULTS The entire cohort was composed of older (56.3 ± 12.1 years), White (75.5%), obese (body mass index [BMI] = 32.3 ± 4.6 kg/m2) men (98.0%). The average hernia size for the entire cohort was 2.42 ± 1.2 cm. The groups were similar in age and BMI. Patients with higher American Society of Anesthesiologists (ASA) (Odds ratio [OR] 3.1; 95% CI 1.5-6.8) and cardiovascular disease (OR 2.7; 95% CI 1.0-7.2) were more likely to receive LA. Recurrence (0.0% vs 6.0%; P = .9) and 30-day complications (6.0% vs 13%; P = .9) were similar between LA and GA after correcting for hernia size. Operating room times were reduced in the LA group (17.7 minutes; P < .05). None of the patients with LA required postanesthesia care unit for recovery. The patients who received LA reported being comfortable (78.9% of patients), with the worst reported pain being 2.4 ± 2.4 (out of a scale of 10), and 94.7% would elect to receive LA if they had another hernia repair. CONCLUSION Patients who received LA had more cardiac disease and a higher ASA. Complications were similar between both groups. LA reduced operating room times. Patients were satisfied with LA.
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Affiliation(s)
- Lindsey Loss
- Department of Surgery, University of Toledo, Toledo, OH, USA
| | - Jennie Meier
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tri Phung
- 7067 Department of Anesthesiology, VA North Texas Health Care System, TX, USA
| | - Javier Ordonez
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sergio Huerta
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.,7067 Department of Surgery, VA North Texas Health Care System, TX, USA
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Beckers Perletti L, Spoelders F, Berrevoet F. Association between surgical hernia repair techniques and the incidence of seroma: a systematic review and meta-analysis of randomized controlled trials. Hernia 2021; 26:3-15. [PMID: 34773524 DOI: 10.1007/s10029-021-02531-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 10/22/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Ventral hernia repair (VHR) includes the surgical reconstruction of the abdominal wall (AW) using different surgical techniques. Although such procedures are usually devoid of complications, the formation of seroma may frequently occur. We performed a systematic review to assess the evidence from randomized controlled trials (RCTs) comparing VHR techniques and their impact on seroma formation. METHODS We included RCTs having seroma formation as primary endpoint. We included patients of both sexes (age > 18). For data synthesis we applied a random-effects model and calculated risk ratios (RR) with 95% confidence intervals (CI) using the Mantel-Haenszel method. Risk of bias (ROB) and publication bias were evaluated following Cochrane recommendations. RESULTS After database search and article screening, 21 records were included in this review. Ten RCTs compared onlay vs. sublay mesh placement techniques. Pooled analysis showed a significantly higher risk ratio for seroma in the onlay cohort (RR = 2.61, 95% CI 1.86-3.66, I2 = 0, GRADE quality of evidence, moderate). Five RCTs compared laparoscopic intraperitoneal onlay mesh repair vs. open mesh placement. Pooled analysis showed that seroma formation did not differ significantly between groups (RR = 1.91, 95% CI 0.69-5.28, I2 = 66%, GRADE quality of evidence, poor). High ROB was found in all studies and significant publication bias was detected in both meta-analyses. CONCLUSION Compared to sublay ventral hernia repair, the onlay procedure is associated with a significantly higher risk of seroma. No significant differences were observed when laparoscopic VHR was compared with the open surgical procedure. Due to the diversity of surgical techniques reported in included RCTs, it is currently not possible to draw conclusive clinical recommendations. Future studies should be standardized to provide detailed data allowing thorough evaluation of the impact of the evidence on clinical practice.
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Affiliation(s)
- L Beckers Perletti
- Faculty of Medicine and Medical Sciences, Ghent University, Ghent, Belgium
| | - F Spoelders
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Frederik Berrevoet
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium.
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21
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Corset Autodermis External Obliqueplasty Reinforcement of Rectus Diastasis and Umbilical Hernia Repairs during Abdominoplasty. Plast Reconstr Surg 2021; 147:860-863. [PMID: 33710174 DOI: 10.1097/prs.0000000000007768] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY Abdominoplasty is among the most commonly performed aesthetic operations and is frequently combined with rectus abdominis musculoaponeurotic plication of rectus diastasis and repair of umbilical and ventral hernias. The authors present a spare parts technique to assist in reinforcement of both rectus diastasis plication and hernia repair during abdominoplasty operations using an autodermis onlay reinforcement graft. The graft is harvested from the excess abdominal pannus normally discarded during abdominoplasty and is inset on tension between the bilateral semilunar lines and plicated along a concave "corset" contour. This reduces distracting forces on the hernia and diastasis repairs and further augments abdominal contour. This technique has been performed for 8 years on 82 low-surgical-risk patients, without any noted increase in complications. The corset autodermis external obliqueplasty is a spare parts technique that may reduce recurrence of rectus diastasis and abdominal hernias repaired at the time of abdominoplasty and is an alternative strategy to mesh placement in this risk-averse aesthetic surgery population.
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22
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Management of epigastric, umbilical, spigelian and small incisional hernia as a day case procedure: results of long-term follow-up after open preperitoneal flat mesh technique. Hernia 2021; 25:1095-1101. [PMID: 34165648 DOI: 10.1007/s10029-021-02446-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/09/2021] [Indexed: 01/19/2023]
Abstract
PURPOSE To investigate short and long-term outcome after the open preperitoneal flat mesh technique (OPFMT) for umbilical, epigastric, spigelian, small incisional and "port-site" hernia performed as a day case procedure. METHODS We retrospectively analyzed records of patients who underwent OPFMT for umbilical, epigastric, Spigelian, small incisional and "port-site" hernia in ambulatory settings between 2004 and 2020 at Clinical Center of Serbia. Demographic and clinical characteristics, operative data and postoperative complications were compared between the groups. Univariate and multivariate analyses were performed to identify predictive factors for mesh infection and recurrence. RESULTS Overall, 476 patients were divided according to the type of hernia. Early postoperative complications were similar in all study groups. Mesh infection, chronic pain and recurrence were different between groups (p = 0.013, p = 0.019 and p = 0.011, respectively). Overall recurrence rate after OPFMT was 2.5%. Hernia defect, hematoma and length of postoperative stay at the Day Surgery Unit were identified as potential predictors of mesh infection (Odds ratio 6.449, 22.143 and 1.546, respectively; p = 0.027, p = 0.011 and p = 0.038, respectively) while mesh infection was the only potential predictor of recurrence in univariate analysis. Hematoma was an independent predictor of recurrence (Odds ratio 27.068; 95% Confidence interval 2.355-311.073; p = 0.008). CONCLUSION The OPFMT performed under local anesthesia as a day case procedure is a safe technique associated with favorable long-term outcome. Hematoma is an independent predictor of mesh infection occurrence.
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23
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Melkemichel M, Bringman S, Granåsen G, Widhe B. SUMMER Trial: mesh versus suture repair in small umbilical hernias in adults-a study protocol for a prospective randomized double-blind multicenter clinical trial. Trials 2021; 22:411. [PMID: 34158088 PMCID: PMC8218273 DOI: 10.1186/s13063-021-05366-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/10/2021] [Indexed: 11/16/2022] Open
Abstract
Background Small umbilical hernia repair is one of the most common surgical performances in general surgery. Yet, a gold standard procedure for the repair is still lacking today. There is an increasing evidence that mesh could be advantageous compared to suture repair in lowering recurrence rates. An additional important question remains with regard to the optimal anatomical positioning of the mesh. We hypothesize that the use of an onlay mesh in small umbilical hernia defects can reduce recurrence rates without increasing the complications compared to a simple suture repair. Methods A prospective, national, multicenter, randomized, double-blind clinical trial comparing a standardized 4 × 4 cm onlay mesh to a conventional suture repair will be conducted. A total of 288 patients with a primary elective umbilical hernia ≤ 2 cm from 7 participating Swedish surgical centers will be enrolled. Intraoperative randomization will take place using a centralized web-based system resulting in total allocation concealment. Stratification will be done by surgical site and by defect size. Trial participants and follow-up clinical surgeons will be blinded to the assigned allocation. The primary outcome assessed will be postoperative recurrence at 1 and 3 years. Secondary outcomes assessed will be postoperative complications at 30 days and pain 1 year after surgery. Discussion Currently, there has been no randomized clinical trial comparing the recurrence rates between an onlay mesh repair and a simple suture repair for small umbilical hernia defects. How to best repair a small umbilical hernia continues to be debated. This trial design should allow for a good assessment of the differences in recurrence rate due to the large sample size and the adequate follow-up. Surgeons’ concerns surrounding optimal anatomical positioning and fear for larger required dissections are understandable. A small onlay mesh may become an easy and safe method of choice to reduce recurrence rates. Guidelines for small umbilical hernia repairs have stressed the need for reliable data to improve treatment recommendations. We can expect that this trial will have a direct implication on small umbilical hernia repair standards. Trial registration ClinicalTrials.gov NCT04231071. Registered on 31 January 2020. SUMMER Trial underwent external peer review as part of the funding process.
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Affiliation(s)
- M Melkemichel
- Department of Surgery, Södertälje Hospital, Södertälje, Sweden. .,Department of Clinical Sciences, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden.
| | - S Bringman
- Department of Surgery, Södertälje Hospital, Södertälje, Sweden.,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - G Granåsen
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - B Widhe
- Department of Surgery, Södertälje Hospital, Södertälje, Sweden.,Department of Clinical Sciences, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden
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24
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Mesh in Elective Hernia Repair: 10-Year Experience with over 6,000 Patients. J Am Coll Surg 2021; 233:51-62. [PMID: 33746110 DOI: 10.1016/j.jamcollsurg.2021.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/19/2021] [Accepted: 03/01/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND The use of mesh in hernia repair has faced intense scrutiny, leading patients to become fearful of its use, despite its benefits in reducing hernia recurrence. We report a single institutional experience in performing hernia repair with mesh in terms of hernia-specific outcomes, mesh-related complications, and patient-reported quality of life. STUDY DESIGN Patients who underwent abdominal wall hernia repair with mesh at a single institution were identified from a prospectively maintained quality database. Demographic, perioperative, and postoperative outcomes data were analyzed. Surgical Outcomes Measurements System (SOMS) and Carolinas Comfort Scale (CCS) surveys were administered pre- and postoperatively at 3 weeks, 6 months, 1, 2, and 5 years. RESULTS Between 2010 and 2020, a total of 6,387 patients underwent abdominal hernia repair with mesh. Inguinal hernia repairs made up the majority (65%) of the operations. Rates of mesh infection varied by hernia type, with lower rates after umbilical (0.0%) and inguinal (0.4%) repair, and highest after incisional repair (1.3%). Similarly, mesh explantation rates were low after umbilical and inguinal repair (0.0% and 0.4%, respectively) and highest after incisional repair (3.0%). Scores on all SOMS domains were significantly improved from baseline (all p < 0.05). On CCS, 2.9%, 3.3%, and 4.4% of patients reported severe or disabling symptoms postoperatively at 1, 2, and 5 years, respectively. CONCLUSIONS Rates of mesh-related complications vary by hernia type. A majority of patients report excellent long-term quality of life, although a relatively large percentage of patients experience severe or disabling symptoms at long-term follow-up.
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Guo C, Liu Q, Wang Y, Li J. Umbilical Hernia Repair in Cirrhotic Patients With Ascites: A Systemic Review of Literature. Surg Laparosc Endosc Percutan Tech 2020; 31:356-362. [PMID: 33347087 DOI: 10.1097/sle.0000000000000891] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 10/05/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Umbilical hernia is a common abdominal complication in cirrhotic patients. The incidence of umbilical hernias can be up to 20% in the presence of ascites. However, there is no consensus regarding the optimal management of umbilical hernias in cirrhotic patients. The purpose of this study is to review the management of umbilical hernias in cirrhotic patients with ascites. METHODS A search of the available literature in English since 1980 was performed using PubMed, the Cochrane Library, and a search of relevant journals and reference lists. The search terms included "umbilical hernia," "ascites," "cirrhosis," and any derivatives of these terms, and the literature search identified all the relevant publications. RESULTS Thirty-three relevant articles published in the language of English were identified. Fourteen studies involved the management of refractory ascites in cirrhotic patients. Twenty-four studies included cirrhotic patients receiving elective or emergency surgery. Because of much lower morbidity and mortality in elective surgery than in emergency surgery, many authors advocated early elective repair of uncomplicated umbilical hernias in cirrhotic patients. Of these, 2 studies described laparoscopic umbilical hernioplasty, with a significant lower morbidity and hernia recurrence than open repair. Fifteen studies described the use of prosthetic mesh umbilical hernia repair in cirrhotic patients, which was associated with minimal wound-related morbidity and markedly lower recurrences. CONCLUSIONS Our results indicate that early elective repair of uncomplicated umbilical hernias is recommended in cirrhotic patients with tolerable hepatic functional reserve or when the expected time for liver transplantation is >3 months. Umbilical hernias are supposed to be corrected in the process of liver transplantation, provided that patients could have a better prospect to be transplanted within 3 months. Control of ascites is a crucial part to successful outcomes of umbilical hernia repair. Large volume paracentesis, concomitant peritoneovenous shunting with herniorrhaphy and transjugular intrahepatic portosystemic shunting can be applied to control refractory ascites. Emergency repair of umbilical hernias is indicated in cirrhotic patients with ascites when complications develop.
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Affiliation(s)
| | | | - Yong Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Junsheng Li
- Department of General Surgery, Affiliated Zhongda Hospital, Southeast University, Nanjing
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Tao Z, Ordonez J, Huerta S. Hernia Size and Mesh Placement in Primary Umbilical Hernia Repair. Am Surg 2020; 87:1005-1013. [PMID: 33295197 DOI: 10.1177/0003134820971624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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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Affiliation(s)
- Zoe Tao
- Department of Surgery and VA North Texas Health Care System, Southwestern Medical Center, 25989University of Texas, Dallas, TX, USA
| | - Javier Ordonez
- Department of Surgery and VA North Texas Health Care System, Southwestern Medical Center, 25989University of Texas, Dallas, TX, USA
| | - Sergio Huerta
- Department of Surgery and VA North Texas Health Care System, Southwestern Medical Center, 25989University of Texas, Dallas, TX, USA
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Gu Y, Wang P, Li H, Tian W, Tang J. Chinese expert consensus on adult ventral abdominal wall defect repair and reconstruction. Am J Surg 2020; 222:86-98. [PMID: 33239177 DOI: 10.1016/j.amjsurg.2020.11.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Surgical management of patients with ventral abdominal wall defects, especially complex abdominal wall defects, remains a challenging problem for abdominal wall reconstructive surgeons. Effective surgical treatment requires appropriate preoperative assessment, surgical planning, and correct operative procedure in order to improve postoperative clinical outcomes and minimize complications. Although substantial advances have been made in surgical techniques and prosthetic technologies, there is still insufficient high-level evidence favoring a specific technique. Broad variability in existing practice patterns, including clinical pre-operative evaluation, surgical techniques and surgical procedure selection, are still common. DATA SOURCES With the purpose of providing a best practice algorithm, a comprehensive search was conducted in Medline and PubMed. Sixty-four surgeons considered as experts on abdominal wall defect repair and reconstruction in China were solicited to develop a Chinese consensus and give recommendations to help surgeons standardize their techniques and improve clinical results. CONCLUSIONS This consensus serves as a starting point to provide recommendations for adult ventral abdominal wall repair and reconstruction in China and may help build opportunities for international cooperation to refine AWR practice.
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Affiliation(s)
- Yan Gu
- Hernia and Abdominal Wall Disease Center, Shanghai Jiao Tong University, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
| | - Ping Wang
- Department of Hernia Surgery, Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - Hangyu Li
- Department of General Surgery, Fourth Hospital of China Medical University, Shenyang, 110000, China
| | - Wen Tian
- Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, 100853, China.
| | - Jianxiong Tang
- Department of General Surgery, Huadong Hospital, Fudan University, Shanghai, 200040, China.
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Ferguson DH, Smith CG, Olufajo OA, Zeineddin A, Williams M. Risk Factors Associated With Adverse Outcomes After Ventral Hernia Repair With Component Separation. J Surg Res 2020; 258:299-306. [PMID: 33039639 DOI: 10.1016/j.jss.2020.08.063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 08/05/2020] [Accepted: 08/25/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Over 350,000 surgeries are performed for ventral hernias (VHs) annually. Abdominal wall component separation has been more frequently used for the management of VHs. The goal of this study is to better understand factors associated with component separation complication rates. METHODS The National Inpatient Sample (2005-2014) was used to identify all patients with an International Classification of Diseases ninth Revision diagnosis of VHs who underwent open VH repair with a pedicleor graft advancement flap. All cases included in this study were elective and not associated with additional procedures. Demographic, clinical, and hospital characteristics were extracted. Independent predictors of complications and outcomes were determined by multivariable regression analysis. RESULTS Component separation was performed in 4346 patients. Mean age was 56; majority were female (55%) and white (80%). Most patients (73%) underwent surgery in an urban teaching hospital; mesh was used in 80% of cases and 11% were smokers. Hypertension was the most common comorbidity (50%), followed by obesity (26%), diabetes mellitus (DM) (23%), coronary artery disease (11%), and chronic obstructive pulmonary disease (COPD) (8%). Half of the patients (50%) had private insurance, and 35% had Medicare. Patients were distributed equally over household income quartiles. The mortality rate was 0.5%; median length of stay was 5 d. Overall complication rate was 25% (wound 11%, intraoperative 5%, infectious 11%, and pulmonary 8%). Mesh was associated with a lower rate of wound complications (10% versus 15%, P = 0.001). On multivariable analysis, patients with COPD (odds ratio: 2.02; 95% confidence interval: 1.58-2.59), obesity (1.37; 1.16-1.63), DM (1.3; 1.09-1.55), and those in the lowest income quartile (1.44; 1.06-1.96) had higher overall complication rates. CONCLUSIONS Consistent with other studies, patients with COPD, Obesity, DM, and lower income status were associated with increased complications after component separation.
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Affiliation(s)
- Deangelo H Ferguson
- Department of Surgery, Howard University College of Medicine, Washington, DC.
| | - Ciara G Smith
- Howard University College of Medicine, Washington, DC
| | - Olubode A Olufajo
- Department of Surgery, Howard University College of Medicine, Washington, DC
| | - Ahmad Zeineddin
- Department of Surgery, Howard University College of Medicine, Washington, DC
| | - Mallory Williams
- Department of Surgery, Howard University College of Medicine, Washington, DC
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Holzheimer RG, Gaschütz N. Trocar umbilical hernia repair by open suture repair and open suture-mesh repair in an ambulatory setting in comparison to recurrent and primary umbilical hernia repair. J Surg Case Rep 2020; 2020:rjaa270. [PMID: 32905093 PMCID: PMC7464594 DOI: 10.1093/jscr/rjaa270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/22/2020] [Accepted: 06/29/2020] [Indexed: 11/14/2022] Open
Abstract
Reports on the ambulatory open repair of umbilical trocal hernias are missing. Patients with trocar, primary and recurrent umbilical hernia open suture and open suture–mesh repair with prospective follow-up were retrospectively evaluated. Patients received perioperative antibiotic prophylaxis, preemptive analgesia and modified anesthesia. In total, 171 patients with umbilical hernia (51 years, female 14%; male 86%) were treated with open suture (n = 29; 17%) and suture–mesh (n = 142; 83%) repair. In total, 10% of patients were treated for trocar hernia (late onset), 5% for recurrent hernia and 85% for a primary umbilical hernia. In total, 29% of trocar hernia repairs had minor complications associated with obesity (40%) and comorbidity (80%). Age, suture and suture–mesh repair were not associated with complications. According to guidelines for umbilical hernia repair open flat mesh may be useful in the treatment of trocar hernia.
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Affiliation(s)
- René G Holzheimer
- Clinic for Day Surgery, Sauerlach/LMU München, Sauerlach/München Süd, Germany
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Shao JM, Elhage SA, Prasad T, Colavita PD, Augenstein VA, Heniford BT. Outcomes of Laparoscopic-Assisted, Open Umbilical Hernia Repair. Am Surg 2020; 86:1001-1004. [PMID: 32853047 DOI: 10.1177/0003134820942162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Umbilical hernia repair (UHR) is one of the most commonly performed hernia operations with reported recurrence rate from 1% to 54%. Our aim was to describe an open, laparoscopic-assisted (OLA) technique and its outcome in an institutional review board-approved prospective study at a tertiary hernia center from 2008 to 2019. All patients underwent a standard periumbilical incision, open dissection of the hernia, and closure of the fascial defect with laparoscopic intraperitoneal onlay mesh (IPOM) fixation with permanent tacks. A total of 186 patients were identified who underwent an OLA UHR repair. Patient characteristics are as follows: average age 52.8 ± 12.5 years, male gender 79.6%, body mass index 31.4 ± 8.0 kg/m2, and average hernia defect size of 2.8 ± 4.8 cm2. Forty-one (22.0%) patients had previous failed repair. Sixty-nine (37.1%) patients had another procedure performed at the time of the UHR, most commonly a laparoscopic transabdominal inguinal hernia repair (58%). The mean operative time was 87.3 ± 51.2 minutes, but only 63.9 ± 31.9 minutes for patients undergoing an OLA repair. There were no recurrences (0%) on abdominal physical or radiographic examination with an average follow-up of 16.5 ± 17.7 months. Postoperative complications included wound erythema (2.7%), hematomas (1.1%), seromas (2.7%), and 4.3% received postoperative oral antibiotics. One person was readmitted for seroma drainage, and another required reoperation for small bowel obstruction unrelated to the hernia repair. One patient had chronic pain requiring tack removal. With moderate follow-up, an OLA UHR with mesh appears to be a durable repair with favorable results, including those patients with recurrent hernias.
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Affiliation(s)
- Jenny M Shao
- Department of Minimally Invasive and Gastrointestinal Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Sharbel A Elhage
- Department of Minimally Invasive and Gastrointestinal Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Tanu Prasad
- Department of Minimally Invasive and Gastrointestinal Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Paul D Colavita
- Department of Minimally Invasive and Gastrointestinal Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Vedra A Augenstein
- Department of Minimally Invasive and Gastrointestinal Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - B Todd Heniford
- Department of Minimally Invasive and Gastrointestinal Surgery, Carolinas Medical Center, Charlotte, NC, USA
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Bensaadi H, Paolino L, Valenti A, Polliand C, Barrat C, Champault G. Intraperitoneal Tension-free Repair of a Small Midline Ventral Abdominal Wall Hernia: Randomized Study with a Mean Follow-up of 3 Years. Am Surg 2020. [DOI: 10.1177/000313481408000125] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Funding received from Cousin Biotech, Wervicq Sud, France, and CR Bard Inc., Cranston, RI. The aim of this prospective randomized study was to determine the long-term recurrence and complication rates after small abdominal wall hernia repair with two different bilayer prostheses. Hernia repair using prosthetic mesh material has become the preferred method of repair, because the recurrence rates are much lower than with conventional repair techniques. The use of a hernia bilayer patch, composite expanded polytetrafluoroethylene (ePTFE)-polypropylene, with intraperitoneal placement behind the hernia defect, through a small incision, may be efficient, safe, and cost-effective. This study is a randomized, single-institution trial, including 83 selected consecutive patients with primary (umbilical, epigastric) or incisional anterior abdominal wall defects from 2 to 5 cm. Hernia repair was performed by direct local access in ambulatory surgery; the prosthesis used was a circular bilayer with an inner face in ePTFE to avoid bowel adhesion. One group was treated with a Ventralex® Hernia Patch (Bard USA). The second group was treated with a Cabs'Air® Composite (Cousin Biotech France), which was delivered with two to four fixation sutures and a balloon to properly deploy the mesh intraperitoneally. Patients’ characteristics and operative and postoperative data were prospectively collected. The primary outcome was late recurrence. Secondary outcomes included, pain, discomfort and quality of life before and after (3 months) surgery using the SF-12 questionnaire, patient-surgeon satisfaction, and early and late complications. Among 98 patients, 83 were included in the study protocol between January 2007 and August 2011. The two groups were comparable according to pre- and intraoperative data. According to surgeon experience, placement of the Cabs'Air® device was significantly faster ( P = 0.01) and easier. At 3 months, there was significantly less pain and less discomfort for the Cabs'Air® group and patient satisfaction rate was higher. This was confirmed by all components of the SF-12 questionnaire. Long-term follow-up was available for 77 patients. The mean follow-up was similar for the two groups (42 months; range, 14 to 70 months). At this point, for the Ventralex® group, there were four recurrences (11.7%); one mesh infection; one small bowel obstruction; and six cases (15.7%) of severe pain resulting from a mass syndrome (shrinkage) with a sense of the presence of a foreign body. Six reoperations (15.6%) were required with explant of the prosthesis. There were no recurrences or late complications in the comparative group. The Ventralex® Hernia Patch is associated with inconsistent deployment, spreading, or shrinkage, which account for late complications and decreases the overlap, which contributes to the recurrence rate. The Cabs'Air®-associated balloon facilitates superior deployment of the prosthesis allowing for good fixation with four sutures.
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Affiliation(s)
- Hocine Bensaadi
- Paris XIII University-Hopitaux Universitaires de Paris Seine Saint Denis, Hôpital Jean Verdier, Paris, France
| | - Luca Paolino
- Paris XIII University-Hopitaux Universitaires de Paris Seine Saint Denis, Hôpital Jean Verdier, Paris, France
| | - Antonio Valenti
- Paris XIII University-Hopitaux Universitaires de Paris Seine Saint Denis, Hôpital Jean Verdier, Paris, France
| | - Claude Polliand
- Paris XIII University-Hopitaux Universitaires de Paris Seine Saint Denis, Hôpital Jean Verdier, Paris, France
| | | | - Gerard Champault
- Paris XIII University-Hopitaux Universitaires de Paris Seine Saint Denis, Hôpital Jean Verdier, Paris, France
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Abstract
There are conflicting views regarding techniques for repair of small umbilical hernias (UHs). Here, we compare the recurrence rate in primary repair with that reported for mesh repair by examining a single surgeon's practice at a large medical center with a comprehensive electronic medical record. A six-year retrospective review of primary UH repairs between January 2012 and December 2017 at Kaiser Permanente Los Angeles Medical Center was undertaken. Patients were identified through a database search of the electronic medical record. The primary endpoint of UH recurrence was examined; median follow-up was 3.4 years. Primary, elective UH repair was performed in 244 patients; 71 per cent of hernias were small (<2 cm). The total number of recurrences was seven (3%). The t test analysis showed significant differences in the average size of hernia defects between those with recurrences (2 cm) and those without (1.4 cm), P < 0.05. Primary repair affords low infection and recurrence rates, comparable to those reported for mesh repair. Our single-surgeon/large-volume study contributes to the evidence that primary UH repair is a safe and durable method, with low risk of recurrence. The use of absorbable monofilament suture, and selection for lower BMI and smaller hernia sizes proved to be effective.
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Dissanayake B, Burstow MJ, Yuide PJ, Gundara JS, Chua TC. Early outcomes of emergency ventral hernia repair in a cohort of poorly optimized patients. ANZ J Surg 2020; 90:1447-1453. [PMID: 32510828 DOI: 10.1111/ans.16020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 04/20/2020] [Accepted: 05/10/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Strangulated and obstructed ventral hernias require emergent repair to mitigate the risk of life-threatening complications. Emergency ventral hernia repairs are associated with a higher rate of surgical complications and recurrence compared to elective repairs. The purpose of this study was to explore the impact of patient factors, hernia and operative characteristics on post-operative outcomes in patients requiring emergency ventral hernia repairs. METHODS Data were collected from a prospectively held database on 86 consecutive patients undergoing emergency ventral hernia repairs between January 2016 and January 2019 at Logan Hospital. Patient, hernia and operative characteristics were collected for reporting and analysis. RESULTS Of the 86 patients, 29 (34%) developed a surgical complication, of which 17 patients (59%) had surgical site infections. We identified obesity (P = 0.017), history of smoking (P = 0.008), American Society of Anesthesiologists class of III-IV (P = 0.008), hernia defect size ≥3 cm (P = 0.048) and concomitant small bowel resection (P = 0.028) to be associated with post-operative surgical complication. Multivariate analysis identified smoking (P = 0.005) and concomitant small bowel resection (P = 0.026) as independent predictors for developing surgical complications. Seven patients (8%) recurred at a median of 221 days. Incisional hernias (P = 0.001), recurrent hernias (P < 0.001), greater than one defect (P < 0.001) and bowel involvement (P = 0.049) were associated with higher rates of hernia recurrence. CONCLUSION Patient factors significantly influence outcomes in the emergency setting. Given that this is not modifiable at the time of surgery, greater emphasis needs to be placed on optimizing the physical and behavioural factors of patients with early symptomatic hernias for an elective repair.
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Affiliation(s)
- Bhanuka Dissanayake
- Department of Surgery, Logan Hospital, Logan City, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Matthew J Burstow
- Department of Surgery, Logan Hospital, Logan City, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Peter J Yuide
- Department of Surgery, Logan Hospital, Logan City, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Justin S Gundara
- Department of Surgery, Logan Hospital, Logan City, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Terence C Chua
- Department of Surgery, Logan Hospital, Logan City, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Yanari S, Suto T, Fujiwara H, Ariyoshi Y, Umemura A, Sasaki A. Intraperitoneal onlay mesh repair (IPOM) plus technique using a hybrid procedure of open laparotomy and laparoscopic approach (hybrid IPOM plus) for incarceration of umbilical hernia in a severely obese patient: a case report. Surg Case Rep 2020; 6:83. [PMID: 32337655 PMCID: PMC7183571 DOI: 10.1186/s40792-020-00845-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/15/2020] [Indexed: 12/03/2022] Open
Abstract
Background A standard procedure for the treatment of incarcerated umbilical hernia among severely obese patients has yet to be established. We used the hybrid intraperitoneal onlay mesh repair (IPOM) plus method, which combines open and laparoscopic surgery to treat incarcerated umbilical hernia in a severely obese patient. Case presentation A 46-year-old man presented in our department with a chief complaint of a painful mass in the umbilical region. Incarcerated umbilical hernia was diagnosed on the basis of abdominal computed tomography, and the decision was made to perform emergency surgery. The patient was severely obese (body mass index, 53.8 kg/m2), and the incarcerated portion of the hernia was therefore first addressed by open surgery. As bowel resection was unnecessary, the risk of infection was considered low, and after direct closure of the hernia orifice, IPOM was performed laparoscopically using the hybrid IPOM plus method. Conclusion Among severely obese patients, first trocar insertion is difficult and the wound site tends to come under strain, meaning that simple closure of the hernia orifice results in a high recurrence rate. The hybrid IPOM plus method used in this case combines open surgery and laparoscopy and appears useful for treating uninfected incarcerated umbilical hernia in severely obese patients safely and with an anticipated low rate of postoperative recurrence.
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Affiliation(s)
- Shingo Yanari
- Department of Surgery, Morioka Municipal Hospital, 5-15-1 Motomiya, Morioka, Iwate, 020-0866, Japan
| | - Takayuki Suto
- Department of Surgery, Morioka Municipal Hospital, 5-15-1 Motomiya, Morioka, Iwate, 020-0866, Japan.
| | - Hisataka Fujiwara
- Department of Surgery, Morioka Municipal Hospital, 5-15-1 Motomiya, Morioka, Iwate, 020-0866, Japan
| | - Yu Ariyoshi
- Department of Surgery, Morioka Municipal Hospital, 5-15-1 Motomiya, Morioka, Iwate, 020-0866, Japan
| | - Akira Umemura
- Department of Surgery, Iwate Medical University School of Medicine, 1-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
| | - Akira Sasaki
- Department of Surgery, Iwate Medical University School of Medicine, 1-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
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Kaufmann R, Halm JA, Lange JF. Comparing apples and oranges will not guide treatment the right way in umbilical hernia repair: use either level-1 evidence or guidelines. Hernia 2020; 25:821-822. [PMID: 32323038 DOI: 10.1007/s10029-020-02193-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 04/09/2020] [Indexed: 11/30/2022]
Affiliation(s)
- R Kaufmann
- Department of Radiology, Haga Teaching Hospital, Els Borst-Eilersplein 275, 2545 AA, The Hague, The Netherlands. .,Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - J A Halm
- Department of Traumasurgery, Amsterdam University Medical Centres, Location AMC, Amsterdam, The Netherlands
| | - J F Lange
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
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Madsen LJ, Oma E, Jorgensen LN, Jensen KK. Mesh versus suture in elective repair of umbilical hernia: systematic review and meta-analysis. BJS Open 2020; 4:369-379. [PMID: 32250556 PMCID: PMC7260408 DOI: 10.1002/bjs5.50276] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 02/10/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Mesh repair of umbilical hernia has been associated with a reduced recurrence rate compared with suture closure, but potentially at the expense of increased postoperative complications and chronic pain. The objective of this systematic review and meta-analysis was to examine the outcomes after elective open mesh and suture repair for umbilical hernia in adults. METHODS A literature search was conducted to identify studies presenting original data on elective open mesh and suture repair of umbilical hernia. The primary outcome was hernia recurrence. Secondary outcomes included surgical-site infection (SSI), seroma, haematoma and chronic pain. Meta-analyses were undertaken. RESULTS The search resulted in 5353 hits and led to 14 studies being included (6 RCTs and 8 observational studies) describing a total of 2361 patients. Compared with suture, mesh repair was associated with a lower risk of recurrence (risk ratio (RR) 0·48, 95 per cent c.i. 0·30 to 0·77), with number needed to treat 19 (95 per cent c.i. 14 to 31). Mesh repair was associated with a higher risk of seroma (RR 2·37, 1·45 to 3·87), with number needed to harm 30 (17 to 86). There was no significant difference in the risk of SSI, haematoma or chronic pain. CONCLUSION The use of mesh in elective repair of umbilical hernia reduced the risk of recurrence compared with suture closure without altering the risk of chronic pain.
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Affiliation(s)
- L J Madsen
- Digestive Disease Centre, Research Department, Bispebjerg and Frederiksberg Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Nielsine Nielsens Vej 11, Entrance 8, Ground Floor, DK-2400, Copenhagen, NV, Denmark
| | - E Oma
- Digestive Disease Centre, Research Department, Bispebjerg and Frederiksberg Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Nielsine Nielsens Vej 11, Entrance 8, Ground Floor, DK-2400, Copenhagen, NV, Denmark
| | - L N Jorgensen
- Digestive Disease Centre, Research Department, Bispebjerg and Frederiksberg Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Nielsine Nielsens Vej 11, Entrance 8, Ground Floor, DK-2400, Copenhagen, NV, Denmark
| | - K K Jensen
- Digestive Disease Centre, Research Department, Bispebjerg and Frederiksberg Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Nielsine Nielsens Vej 11, Entrance 8, Ground Floor, DK-2400, Copenhagen, NV, Denmark
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37
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Preperitoneal Versus Retromuscular Mesh Repair for Ventral Abdominal Hernias: A Propensity Matched Analysis. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02153-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Is mesh always necessary in every small umbilical hernia repair? Comparison of standardized primary sutured versus patch repair: retrospective cohort study. Hernia 2020; 25:571-577. [PMID: 32189143 PMCID: PMC8197705 DOI: 10.1007/s10029-020-02170-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 03/06/2020] [Indexed: 12/13/2022]
Abstract
Purpose A retrospective analysis was carried out to compare the results of patch repair using ready-made, synthetic mesh (PR) and sutured repair (SR) based on standard protocols. The accumulated recurrence rate was accepted as the primary outcome. Pain at rest and during exercise, cosmetic effect and treatment satisfaction were chosen as the secondary endpoints. Methods Adult patients after elective, open surgical repair of a single, primary umbilical hernia < 2 cm in diameter were included. Patients with incarceration or strangulation, after previous umbilical hernia repair or other abdominal surgical interventions were excluded. In the SR group, single-layer sutures were placed using the short-stitch technique. In PR group, a 6.3-mm ready-made Parietene Ventral Patch (Medtronic) was used. Results 161 patients (104 in PR and 57 in SR groups) were included in the study (22 months follow-up). Nine recurrences were observed [six in PR (5.8%) and three in SR group (5.2%)]. In PR group, three patients (2.9%) reported complaints at rest and none in SR group, while 18 patients (17.3%) in PR group reported pain during exercises and 7 (12.3%) in SR group. Conclusion For the smallest umbilical hernias, the use of dense fascia suturing (short-stitch technique) may be an effective alternative to patch repair techniques in patients with no additional risk factors for recurrence. The mesh patch repair method is associated with a significantly higher risk of postsurgical pain. Diastasis recti is a factor favoring umbilical hernia recurrence after both pure tissue repair and patch repair.
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Aiolfi A, Cavalli M, Micheletto G, Bruni PG, Lombardo F, Morlacchi A, Bonitta G, Campanelli G, Bona D. Open mesh vs. suture umbilical hernia repair: systematic review and updated trial sequential meta-analysis of randomized controlled trials. Hernia 2020; 24:707-715. [DOI: 10.1007/s10029-020-02146-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 02/11/2020] [Indexed: 02/07/2023]
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Harpain F, Wimmer K, Dawoud C, Ogrodny P, Stift A. Short-term outcome after ventral hernia repair using self-gripping mesh in sublay technique - A retrospective cohort analysis. Int J Surg 2020; 75:47-52. [PMID: 31991243 DOI: 10.1016/j.ijsu.2020.01.124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/10/2020] [Accepted: 01/18/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Hernia repair in sublay technique is widely accepted for ventral hernias, as it appears to be advantageous in terms of complication and recurrence rates. Self-gripping meshes are increasingly used for hernia repair with retromuscular mesh positioning. However, real-life data on the safe use in that specific indication are still lacking. The purpose of this study is the evaluation of short-term postoperative outcome of self-gripping versus conventional non-self-gripping meshes in sublay hernia repair. MATERIALS AND METHODS This retrospective analysis assessed patients undergoing ventral hernia repair in sublay technique between January 2011 and July 2018 at the Department of Surgery, Medical University of Vienna. 244 consecutive patients were eligible for final analysis. Patients were grouped according to the utilized mesh. Baseline characteristics and peri-as well as postoperative outcome was assessed. RESULTS There was no significant difference in baseline characteristics between the two groups. Median follow-up was 11 months (IQR 3-30). The overall complication rate (28.3% versus 13.7%, p = 0.005) due to an increased rate of seromas (17.3% versus 6.8%, p = 0.013) and surgical site infections (12.6% versus 4.3%, p = 0.021) was significantly higher in patients with a self-gripping mesh. Significantly more patients with a self-gripping mesh needed a surgical intervention (21.3% versus 9.4%, p = 0.011). CONCLUSION In sublay ventral hernia repair, the use of self-gripping meshes is associated with a higher overall complication rate and an increased rate of complication-associated surgical interventions when compared to non-self-gripping mesh placements.
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Affiliation(s)
- Felix Harpain
- Department of Surgery, Division of General Surgery, Medical University Vienna, Austria
| | - Kerstin Wimmer
- Department of Surgery, Division of General Surgery, Medical University Vienna, Austria
| | - Christopher Dawoud
- Department of Surgery, Division of General Surgery, Medical University Vienna, Austria
| | - Philipp Ogrodny
- Department of Surgery, Division of General Surgery, Medical University Vienna, Austria
| | - Anton Stift
- Department of Surgery, Division of General Surgery, Medical University Vienna, Austria.
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Henriksen NA, Montgomery A, Kaufmann R, Berrevoet F, East B, Fischer J, Hope W, Klassen D, Lorenz R, Renard Y, Garcia Urena MA, Simons MP. Guidelines for treatment of umbilical and epigastric hernias from the European Hernia Society and Americas Hernia Society. Br J Surg 2020; 107:171-190. [PMID: 31916607 DOI: 10.1002/bjs.11489] [Citation(s) in RCA: 164] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/31/2019] [Accepted: 12/02/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Umbilical and epigastric hernia repairs are frequently performed surgical procedures with an expected low complication rate. Nevertheless, the optimal method of repair with best short- and long-term outcomes remains debatable. The aim was to develop guidelines for the treatment of umbilical and epigastric hernias. METHODS The guideline group consisted of surgeons from Europe and North America including members from the European Hernia Society and the Americas Hernia Society. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, the Scottish Intercollegiate Guidelines Network (SIGN) critical appraisal checklists, and the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument were used. A systematic literature search was done on 1 May 2018, and updated on 1 February 2019. RESULTS Literature reporting specifically on umbilical and epigastric hernias was limited in quantity and quality, resulting in a majority of the recommendations being graded as weak, based on low-quality evidence. The main recommendation was to use mesh for repair of umbilical and epigastric hernias to reduce the recurrence rate. Most umbilical and epigastric hernias may be repaired by an open approach with a preperitoneal flat mesh. A laparoscopic approach may be considered if the hernia defect is large, or if the patient has an increased risk of wound morbidity. CONCLUSION This is the first European and American guideline on the treatment of umbilical and epigastric hernias. It is recommended that symptomatic umbilical and epigastric hernias are repaired by an open approach with a preperitoneal flat mesh.
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Affiliation(s)
- N A Henriksen
- Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - A Montgomery
- Department of Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
| | - R Kaufmann
- Erasmus University Medical Centre, Rotterdam, the Netherlands.,Tergooi, Hilversum, the Netherlands
| | - F Berrevoet
- Department of General and Hepatopancreatobiliary Surgery, Ghent University Hospital, Ghent, Belgium
| | - B East
- Third Department of Surgery at Motol University Hospital, First and Second Faculty of Medicine at Charles University, Prague, Czech Republic
| | - J Fischer
- University of Pennsylvania Health System, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
| | - W Hope
- New Hanover Regional Medical Center, Wilmington, North Carolina, USA
| | - D Klassen
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - R Lorenz
- Praxis 3+ Chirurgen, Berlin, Germany
| | - Y Renard
- Department of Digestive Surgery, Robert Debré University Hospital, Reims, France
| | - M A Garcia Urena
- Henares University Hospital, Faculty of Health Sciences, Francisco de Vitoria University, Madrid, Spain
| | - M P Simons
- Department of Surgery, OLVG Hospital, Amsterdam, the Netherlands
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Primary uncomplicated midline ventral hernias: factors that influence and guide the surgical approach. Hernia 2019; 23:873-883. [DOI: 10.1007/s10029-019-02051-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/09/2019] [Indexed: 12/24/2022]
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Primary non-complicated midline ventral hernia: overview of approaches and controversies. Hernia 2019; 23:885-890. [PMID: 31493055 DOI: 10.1007/s10029-019-02037-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 08/18/2019] [Indexed: 10/26/2022]
Abstract
Umbilical hernias and epigastric hernias are some of the most common hernias in the world. Umbilical and epigastric hernia defects can range from small (<1 cm) to very large/complex hernias, and treatment options should be tailored to the clinical situation. Repair techniques include open, laparoscopic, and robotics options, each with advantages and disadvantages. A mesh-based repair is indicated in most cases due to having fewer associated recurrences. Overall outcomes are favorable following umbilical and epigastric hernia repairs; however, some patients have chronic complaints mostly related to recurrences. This report is an overview of available techniques for repair of umbilical and epigastric hernias. It also discusses ongoing controversies related to umbilical and epigastric hernia repairs, the limitations of available literature, and the need for future research.
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Berrevoet F, Doerhoff C, Muysoms F, Hopson S, Muzi MG, Nienhuijs S, Kullman E, Tollens T, Schwartz M, Leblanc K, Velanovich V, Jørgensen LN. Open ventral hernia repair with a composite ventral patch - final results of a multicenter prospective study. BMC Surg 2019; 19:93. [PMID: 31311545 PMCID: PMC6633695 DOI: 10.1186/s12893-019-0555-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 07/03/2019] [Indexed: 01/08/2023] Open
Abstract
Background This study assessed clinical outcomes, including safety and recurrence, from the two-year follow-up of patients who underwent open ventral primary hernia repair with the use of the Parietex™ Composite Ventral Patch (PCO-VP). Methods A prospective single-arm, multicenter study of 126 patients undergoing open ventral hernia repair for umbilical and epigastric hernias with the PCO-VP was performed. Results One hundred twenty-six subjects (110 with umbilical hernia and 16 with epigastric hernia) with a mean hernia diameter of 1.8 cm (0.4–4.0) were treated with PCO-VP. One hundred subjects completed the two-year study. Cumulative hernia recurrence was 3.0% (3/101; 95%CI: 0.0–6.3%) within 24 months. Median Numeric Rating Scale pain scores improved from 2 [0–10] at baseline to 0 [0–3] at 1 month (P < 0.001) and remained low at 24 months 0 [0–6] (P < 0.001). 99% (102/103) of the patients were satisfied with their repair at 24 months postoperative. Conclusions The use of PCO-VP to repair primary umbilical and epigastric defects yielded a low recurrence rate, low postoperative and chronic pain, and high satisfaction ratings, confirming that PCO-VP is effective for small ventral hernia repair in the two-year term after implantation. Trial registration The study was registered publically at clinicaltrials.gov (NCT01848184 registered May 7, 2013).
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Affiliation(s)
- F Berrevoet
- Department of General and Hepatopancreatobiliary Surgery, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - C Doerhoff
- Surgicare of Missouri, Jefferson City, MO, USA
| | - F Muysoms
- Department of Surgery AZ Maria Middelares, Ghent, Belgium
| | - S Hopson
- Bon Secours Hernia Center, Mary Immaculate Hospital, Newport News, VA, USA
| | - M G Muzi
- University Hospital Tor Vergata, Rome, Italy
| | - S Nienhuijs
- Department of Surgery, Catharina Hospital, Eindhoven, Netherlands
| | - E Kullman
- HELSA Specialist Center, Linköping, Sweden
| | - T Tollens
- Imelda Hospital -General Surgery Imelda Hospital, Bonheiden, Belgium
| | - M Schwartz
- Monmouth Medical Center, Long Branch, NJ, USA
| | - K Leblanc
- Our Lady of Lakes Regional Medical Center, Baton Rouge, LA, USA
| | - V Velanovich
- Division of General Surgery, University of South Florida, Tampa General Hospital, Tampa, FL, USA
| | - L N Jørgensen
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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Komaei I, La Malfa G, Damiano C, Sarra F, Cassaro G, Barbera A, Bartolotta M, Currò G, Navarra G. Voluminous paraumbilical hernia containing the pancreas - An unusual cause of acute pancreatitis: A case report. Ann Med Surg (Lond) 2019; 45:6-10. [PMID: 31360452 PMCID: PMC6637250 DOI: 10.1016/j.amsu.2019.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 06/25/2019] [Accepted: 07/07/2019] [Indexed: 02/07/2023] Open
Abstract
Introduction The paraumbilical hernia sac often contains the omentum, the small bowel, and less commonly the colon. The herniation of the pancreas through a paraumbilical hernia is extremely rare and has been reported only by two cases in the literature; moreover, acute pancreatitis secondary to this condition is a particularly unusual event. Case report We present a very unusual case of a 67-year-old female patient with a voluminous paraumbilical hernia containing the pancreas, complicated by acute pancreatitis. Laboratory data revealed an elevation of the pancreatic enzymes. An intravenous contrast-enhanced computed tomography (CT) scan of the abdomen demonstrated a large hernia sac containing multiple viscera, including the pancreas. The patient underwent emergency laparotomy with a diagnosis of intestinal obstruction. Conclusion The clinicians should consider this rare condition in the differential diagnosis of patients presenting with large paraumbilical hernias associated with classical symptoms of acute pancreatitis, particularly in the absence of typical risk factors for pancreatitis. An intravenous contrast-enhanced abdominal CT scan should be performed immediately in these patients. We recommend the patients and the surgeons to consider prompt surgical repair for paraumbilical hernias to avoid further complications and the higher incidence of morbidity and mortality associated with emergency surgeries.
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Affiliation(s)
- Iman Komaei
- Department of Human Pathology of Adult and Evolutive Age, General Surgery Unit, Surgical Oncology Division, University Hospital of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Giuseppe La Malfa
- Department of Human Pathology of Adult and Evolutive Age, General Surgery Unit, Surgical Oncology Division, University Hospital of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Cristina Damiano
- Department of Human Pathology of Adult and Evolutive Age, General Surgery Unit, Surgical Oncology Division, University Hospital of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Federica Sarra
- Department of Human Pathology of Adult and Evolutive Age, General Surgery Unit, Surgical Oncology Division, University Hospital of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Gabriele Cassaro
- Department of Human Pathology of Adult and Evolutive Age, General Surgery Unit, Surgical Oncology Division, University Hospital of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Adalberto Barbera
- Department of Human Pathology of Adult and Evolutive Age, General Surgery Unit, Surgical Oncology Division, University Hospital of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Marcello Bartolotta
- Department of Human Pathology of Adult and Evolutive Age, General Surgery Unit, Surgical Oncology Division, University Hospital of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Giuseppe Currò
- Department of Human Pathology of Adult and Evolutive Age, General Surgery Unit, Surgical Oncology Division, University Hospital of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Giuseppe Navarra
- Department of Human Pathology of Adult and Evolutive Age, General Surgery Unit, Surgical Oncology Division, University Hospital of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
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Chung I, Cheung BH, Law TT, Ng KK, Ng L, Wong KY. Laparoscopic versus open repair for small paraumbilical hernia: A retrospective review. Asian J Endosc Surg 2019; 12:306-310. [PMID: 30168291 DOI: 10.1111/ases.12644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/22/2018] [Accepted: 07/31/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The advantages of laparoscopic surgery for ventral hernia repairs are well documented, but its application for small paraumbilical hernias has been less studied. There is no consensus regarding the best technique. METHODS All patients who had open (suture or mesh) and laparoscopic repair of primary paraumbilical hernia between September 2007 and September 2017 in a single center were identified. Hernial defects of 2 cm or less were included; recurrent hernias were excluded. Primary outcomes included operative time, length of hospital stay, and surgical complications. RESULTS Seventy-seven patients were recruited: 54 (70.1%) had open repair and 23 (29.9%) had laparoscopic repair. Forty-six patients (85%) in the open group had primary suture repair. The mean operative time was significantly shorter in the open group than in the laparoscopic group (27.2 vs 56.1 min, P < 0.05). The length of hospital stay in the open group was significantly shorter than in the laparoscopic group (0.8 vs 1.4 days, P = 0.00). Early complications rates were similar, with wound complications in 5.6% (3/54) of open repair patients and 4.3% (1/23) of laparoscopic repair patients (P = 1.0). Among open repair patients, 19 patients (35.2%) were successfully discharged within 12 h after operation. Two patients (3.7%) in the open simple suture group developed recurrence, but no recurrence was identified in the laparoscopic group; this was not statistically significant (P = 1.0). CONCLUSION The laparoscopic approach is comparable to the open approach in the repair of small paraumbilical hernias. For small paraumbilical hernias, we recommend that laparoscopic repair be reserved for obese patients or those with suspected multiple hernial defects.
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Affiliation(s)
- Iris Chung
- Department of Surgery, Queen Mary Hospital, Hong Kong
| | | | - Tsz Ting Law
- Department of Surgery, Tung Wah Hospital, Hong Kong
| | - Ka Kin Ng
- Department of Surgery, Tung Wah Hospital, Hong Kong
| | - Lily Ng
- Department of Surgery, Tung Wah Hospital, Hong Kong
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Prevalence and risk factors for abdominal wall hernia in the general Russian population. Hernia 2019; 23:1237-1242. [PMID: 31089836 DOI: 10.1007/s10029-019-01971-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 05/04/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To find out the prevalence and risk factors for abdominal wall hernias in the general Russian population. METHODS 783 residents of Kryukovo rural community (Central Russia) of 10 > years were enrolled. Medical history was taken and clinical examination was performed documenting hernia presence. Ultrasound examination was performed in inconclusive situations. We considered residents with hernias at the time of examination, as well as those who had previously undergone hernia repair, to be hernia positive. RESULTS There were 298 (38%) men and 485 (62%) women (mean age 49.3). Abdominal wall hernias have been found in 20.9% of population. 31.2% of men and 14.6% of women were affected (p < 0.0001). Umbilical hernias was found in 10.2%, groin hernias in 8.3%, incisional in 2.4% of residents. 72% of individuals with hernia reported local pain. 70% had never asked for medical advice before, 30% had undergone hernia repair before. Male gender, age, family history were confirmed as risk factors for any hernia with OR 3.9, 1.03 and 2.7, respectively (p < 0.01). For groin hernias male gender, age, family history and rough labour were confirmed with ORs 9.2, 1.03, 2.9 (p < 0.01) and 2.1 (p < 0.05). Risk factors for umbilical hernias were male gender with OR 2.2 (p < 0.01), age, family history and BMI with ORs 1.02, 1.8 and 1.08 (p < 0.05). CONCLUSIONS This study is the first to demonstrate prevalence of abdominal wall hernias and its risk factors in Russia. The results confirm that hernias are common in a general population pointing the need for improvement of surgical activity.
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Amato G, Romano G, Agrusa A, Canu GL, Gulotta E, Erdas E, Calò PG. Tentacle-shaped mesh for fixation-free repair of umbilical hernias. Hernia 2019; 23:801-807. [PMID: 30980199 PMCID: PMC6661022 DOI: 10.1007/s10029-019-01950-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 04/07/2019] [Indexed: 12/01/2022]
Abstract
Purpose Mesh fixation and broad overlap represent an open issue in umbilical hernia repair. A proprietary-designed implant with tentacle straps at its boundary has been developed to ensure a suture-free repair and a broader coverage of the abdominal wall. The study describes the results of umbilical hernia procedures carried out with the tentacle-shaped implant and the related surgical technique. Methods A proprietary tentacle-shaped flat mesh having a central body with integrated radiating arms at its edge was used to repair large umbilical hernias in 62 patients. The implant was placed in preperitoneal sublay. The friction of the straps, crossing the abdominal wall thanks to a special needle passer, was intended to assure adequate grip to hold the implant in place assuring a fixation-free procedure and broad overlap of the hernia defect. Results In a mean follow-up of 48 months (range 10–62 months), 4 seromas and 2 ischemia of the navel skin occurred. No infections, hematomas, chronic pain, mesh dislocation, or recurrence has been reported. Conclusions The tentacle strap system of the prosthesis effectively ensured an easier implant placement avoiding the need for suturing the mesh. The arms of the implant ensured a proper orientation and stabilization of the mesh in association with a broad defect overlap. The specifically developed surgical procedure showed a quick postoperative recovery, a very low complication rate, and no recurrences even in the long term.
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Affiliation(s)
- G Amato
- Postgraduate School of General Surgery, University of Cagliari, Cittadella Universitaria di Monserrato, 09042, Monserrato - Cagliari, Italy.
| | - G Romano
- Department of General Surgery and Urgency, University of Palermo, Palermo, Italy
| | - A Agrusa
- Department of General Surgery and Urgency, University of Palermo, Palermo, Italy
| | - G L Canu
- Department of General Surgery, University of Cagliari, Cagliari, Italy
| | - E Gulotta
- Department of General Surgery and Urgency, University of Palermo, Palermo, Italy
| | - E Erdas
- Department of General Surgery, University of Cagliari, Cagliari, Italy
| | - P G Calò
- Department of General Surgery, University of Cagliari, Cagliari, Italy
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Shrestha D, Shrestha A, Shrestha B. Open mesh versus suture repair of umbilical hernia: Meta-analysis of randomized controlled trials. Int J Surg 2019; 62:62-66. [PMID: 30682412 DOI: 10.1016/j.ijsu.2018.12.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 11/11/2018] [Accepted: 12/31/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND The optimal methodology of surgical treatment of umbilical hernia in adults remains controversial. Previously published randomized controlled trials (RCTs) and cohort studies have demonstrated advantage for open mesh over suture repair. Two published meta-analyses, including RCTs and retrospective cohort studies, have compared the outcomes of open mesh versus suture repair of umbilical hernia in adult, which were flawed since they included both elective and emergency repairs of umbilical hernias. The aim of this meta-analysis is to include RCTs to examine whether open mesh repair of umbilical hernia produces a better outcome than suture repair in adult patients. METHODS A literature search using Medline, Embase and Cochrane Database was performed, and meta-analysis was performed using RevMan 5.3.5 software. Outcomes evaluated incidence of hernia recurrence, wound infection, haematoma, seroma and patient death. RESULTS Of the 620 records identified, 4 RCTs, including 620 patients, were included in the meta-analysis. In the RCTS, when open mesh repair was compared with suture repair, open mesh repair was associated with significantly low incidence of recurrence (odds ratio (OR) 0.22, 95% confidence interval (CI) 0.10-0.48; P = 0.0001). The incidence of wound infection (OR 0.89, 95% CI 0.35-2.31; P = 0.82), haematoma (OR 0.83, 95% CI 0.28-2.41; P = 0.73), and seroma (OR 2.01, 95% CI 0.82-4.91; P = 0.13), were similar between the two groups. CONCLUSIONS Open mesh repair was associated with significant reduction in the recurrence rate in comparison to suture repair of umbilical hernia.
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Affiliation(s)
- Donna Shrestha
- North Manchester General Hospital, Manchester, United Kingdom
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