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Gueroult P, Joppin V, Chaumoitre K, Di Bisceglie M, Masson C, Bege T. Linea alba 3D morphometric variability by CT scan exploration. Hernia 2024; 28:485-494. [PMID: 38177404 DOI: 10.1007/s10029-023-02939-0] [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: 09/14/2023] [Accepted: 11/26/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE The width of the Linea alba, which is often gauged by inter-rectus distance, is a key risk factor for incisional hernia and recurrence. Previous studies provided limited descriptions with no consideration for width, location variability, or curvature. We aimed to offer a comprehensive 3D anatomical analysis of the Linea alba, emphasizing its variations across diverse demographics. METHODS Using open source software, 2D sagittal plane and 3D reconstructions were performed on 117 patients' CT scans. Linea alba length, curvature assessed by the sagitta (the longest perpendicular segment between xipho-pubic line and the Linea alba), and continuous width along the height were measured. RESULTS The Linea alba had a rhombus shape, with a maximum width at the umbilicus of 4.4 ± 1.9 cm and a larger width above the umbilicus than below. Its length was 37.5 ± 3.6 cm, which increased with body mass index (BMI) (p < 0.001), and was shorter in women (p < 0.001). The sagitta was 2.6 ± 2.2 cm, three times higher in the obese group (p < 0.001), majorated with age (p = 0.009), but was independent of gender (p = 0.212). Linea alba width increased with both age and BMI (p < 0.001-p = 0.002), being notably wider in women halfway between the umbilicus and pubis (p = 0.007). CONCLUSION This study provides an exhaustive 3D description of Linea alba's anatomical variability, presenting new considerations for curvature. This method provides a patient-specific anatomy description of the Linea alba. Further studies are needed to determine whether 3D reconstruction correlates with pathologies, such as hernias and diastasis recti.
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Affiliation(s)
- P Gueroult
- Laboratoire de Biomécanique Appliquée, Aix Marseille Univ, IFSTTAR UMR T24, Marseille, France.
- Service de chirurgie viscérale et endocrinienne, Angers University Hospital, Rue Larrey, 49933, CEDEX 9, Angers, France.
| | - V Joppin
- Laboratoire de Biomécanique Appliquée, Aix Marseille Univ, IFSTTAR UMR T24, Marseille, France
| | - K Chaumoitre
- Department of Medical Imaging, Aix Marseille Univ, North Hospital, APHM, Marseille, France
- Anthropologie Biologique UMR 7268ADES, Aix Marseille Univ, Marseille, France
| | - M Di Bisceglie
- Department of Medical Imaging, Aix Marseille Univ, North Hospital, APHM, Marseille, France
| | - C Masson
- Laboratoire de Biomécanique Appliquée, Aix Marseille Univ, IFSTTAR UMR T24, Marseille, France
| | - T Bege
- Laboratoire de Biomécanique Appliquée, Aix Marseille Univ, IFSTTAR UMR T24, Marseille, France
- Department of General Surgery, Aix Marseille Univ, North Hospital, APHM, Marseille, France
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Cabral R, Naraynsingh V. The Original Rutherford Morison Incision: A Case Report. Cureus 2024; 16:e52803. [PMID: 38389618 PMCID: PMC10883410 DOI: 10.7759/cureus.52803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
In recent years, the Rutherford Morison incision has become synonymous with renal transplant surgery. However, this incision was originally intended for access to the sigmoid colon and pelvis, particularly in the case of a midline previously scarred from operation. We present a case of a middle-aged female with a caecal tumour, requiring resection. Upon examination, this patient was found to have large concomitant diastasis of the recti. A right-sided Rutherford Morison incision was utilized in performing a right hemicolectomy. Although the advantages of a minimally invasive approach to colonic resections are well described, laparoscopy was not utilized in the case discussed. Due to the wide area of anterior abdominal wall laxity, herniation is likely to develop at both port placement and specimen delivery sites. A similar outcome would result from a midline incision. However, a paramedian is an acceptable alternative to a Rutherford Morison incision in a case like this, as it is known to have very low rates of post-operative incisional herniation. While in modern times, its use may have become repurposed, the Rutherford Morison incision is one which should be remembered and used in the surgeons' armamentarium to improve clinical outcomes when necessary.
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Affiliation(s)
- Robyn Cabral
- Department of General Surgery, Port of Spain General Hospital, Port of Spain, TTO
- Department of Clinical Surgical Sciences, The University of the West Indies, St. Augustine, St. Augustine, TTO
| | - Vijay Naraynsingh
- Department of Clinical Surgical Sciences, The University of the West Indies, St. Augustine, St. Augustine, TTO
- Department of Surgery, Medical Associates Hospital, St. Joseph, TTO
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Naraynsingh V, Cawich SO, Hassranah S. Alternative to mesh repair for ventral hernias: Modified rectus muscle repair. World J Surg Proced 2023; 13:14-21. [DOI: 10.5412/wjsp.v13.i3.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/18/2023] [Accepted: 12/19/2023] [Indexed: 12/26/2023] Open
Abstract
BACKGROUND Mesh utilization for ventral hernia repair is associated with potential complications such as mesh infections, adhesions, seromas, fistula formation and significant postoperative pain. The modified rectus muscle repair (RMR) is as an option to repair midline ventral hernias without mesh.
AIM To evaluate the short term outcomes when the modified RMR was used to repair ventral hernias.
METHODS This was a 5-year prospective study that examined the outcome of all consecutive patients with ventral abdominal wall hernias > 5 cm in maximal diameter who underwent repair using the modified RMR technique in a single surgeon unit. Patients were reviewed in an outpatient clinic at 3, 6 and 12 mo and evaluated for hernia recurrence on clinical examination. Each patient’s abdominal wall was also assessed with using ultrasonography at 24 mo to detect recurrences. All data were examined with SPSS ver 18.0.
RESULTS Over the 5-year study period, there were 52 patients treated for ventral hernias at this institution. Four patients were excluded and there were 48 in the final study sample, at a mean age of 56 years (range 28-80). The mean maximal diameter of the hernia defect was 7 cm (range 5-12 cm). There were 5 (10.4%) seromas and 1 recurrence (2.1%) at a mean of 36 mo follow-up.
CONCLUSION The authors recommend the modified RMR as an acceptable alternative to mesh repair of ventral hernias. The seroma rate can be further reduced with routine use of drains. The modified RMR also has the benefit of eliminating all mesh-specific complications.
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Affiliation(s)
- Vijay Naraynsingh
- Department of Surgery, Port of Spain General Hospital, Port of Spain, Trinidad and Tobago
| | - Shamir O Cawich
- Department of Surgery, University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Samara Hassranah
- Department of Surgery, Medical Associate Hospital, St. Joseph, Trinidad and Tobago
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4
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Centralizing the Umbilicus in Abdominoplasty: Eccentric versus Concentric Fascial Plication in Addition to Medializing at the Skin. Plast Reconstr Surg 2023; 151:526-531. [PMID: 36730529 DOI: 10.1097/prs.0000000000009910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The umbilicus is often not a midline structure. Centralization of the umbilicus during an abdominoplasty is routinely performed at the level of the skin; however, this is associated with a high rate of postoperative reversion. The authors propose using an eccentric fascial plication centered on the true midline to maintain postoperative centralization of the umbilicus in addition to correction at the skin level. METHODS A retrospective study was conducted of all patients between 2015 and 2019 who underwent abdominoplasty with either skin only (concentric plication) or fascial (eccentric plication) umbilical centralization. The Fisher exact test and t test were used to compare the two groups and assess differences in rates of umbilical reversion. RESULTS A total of 71 patients were included in the study; the majority of patients were women [ n = 69 (97%)] and White [ n = 50 (70%)]. There were 28 (39%) patients who underwent concentric plication, and 43 (61%) had eccentric plication. Mean body mass index in the concentric and eccentric groups was 32 kg/m 2 and 28.5 kg/m 2 , respectively. Average follow-up was 51.6 months for concentric plication and 27.8 months for eccentric plication. Of those who received concentric plication, 10 patients (36%) had their umbilicus revert to the preoperative position; none in the eccentric plication group reverted ( P < 0.0001). CONCLUSIONS Midline placement of the umbilicus during an abdominoplasty is important in providing symmetry to optimize aesthetics. Eccentric fascial plication maintains the centralization of the umbilicus when compared with concentric fascial plication with skin-only centralization. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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5
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Cocco G, Ricci V, Boccatonda A, Stellin L, De Filippis G, Soresi M, Schiavone C. Sonographic demonstration of a spontaneous rectus sheath hematoma following a sneeze: a case report and review of the literature. J Ultrasound 2021; 24:125-130. [PMID: 32621122 PMCID: PMC8137746 DOI: 10.1007/s40477-020-00493-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/09/2020] [Indexed: 12/27/2022] Open
Abstract
Spontaneous rectus sheath hematoma (SRSH) is an uncommon cause of acute abdominal pain characterized by bleeding within the rectus sheath; it is a benign condition and, in most cases, it is treated conservatively. Bleeding of the abdominal wall is an unusual condition that is quite challenging to identify promptly and can be easily overlooked during a routine physical examination. In daily practice, anticoagulant therapy is one of the main risk factors for hemorrhagic events. In this respect, we report a rare case of spontaneous hematoma of the abdominal wall (diagnosed and monitored through an ultrasound examination) that arose after sneezing in a patient receiving anticoagulant treatment.
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Affiliation(s)
- G Cocco
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, "G. d'Annunzio" University, Chieti, Italy.
| | - V Ricci
- Department of Biomedical and Neuromotor Science, Physical and Rehabilitation Medicine Unit, IRCCS Rizzoli Orthopedic Institute, Bologna, Italy
| | - A Boccatonda
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, "G. d'Annunzio" University, Chieti, Italy
| | - L Stellin
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, "G. d'Annunzio" University, Chieti, Italy
| | - G De Filippis
- Radiology Department, "M.G. Vannini Hospital", Rome, Italy
| | - M Soresi
- Internal Medicine and Medical Specialties (PROMISE), Department of Health Promotion Sciences, Maternal and Infant Care, University of Palermo, Palermo, Italy
| | - C Schiavone
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, "G. d'Annunzio" University, Chieti, Italy
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6
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Hodgkinson JD, Worley G, Warusavitarne J, Hanna GB, Vaizey CJ, Faiz OD. Evaluation of the Ventral Hernia Working Group classification for long-term outcome using English Hospital Episode Statistics: a population study. Hernia 2021; 25:977-984. [PMID: 33712933 PMCID: PMC8370963 DOI: 10.1007/s10029-021-02379-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 02/14/2021] [Indexed: 11/30/2022]
Abstract
Purpose The Ventral Hernia Working Group (VHWG) classification of ventral/incisional hernia (IH) was developed by expert consensus in 2010. Subsequently, Kanters et al. have demonstrated the validity of a modified version of the system for predicting short-term outcomes. This study aims to evaluate the modified system for predicting hernia recurrence. Methods Patients undergoing IH surgery (defined by OPCS codes) in the England Hospital Episode Statistics (HES) database, from 1997 to 2012, were identified. Baseline demographics at index hernia operation and episodes of further hernia surgery (FHS) were recorded. Risk factors for FHS were identified using cox regression and evaluated against the modified-VHWG grade using receiver-operating characteristics (ROC). Results The final analysis included 214,082 index IH operations. Of these, 52.6% were female and mean age was 56.59 (SD15.9). An admission for FHS was found in 8.3% cases (17,714 patients). Multi-variate cox regression revealed contaminated hernia (p < 0.0001), pre-existing IBD (p < 0.0001) and hernia comorbidity (p = 0.05) to be significantly related to long-term FHS. Classifying patients using these factors, according to the modified-VHWG classification, revealed that compared to Grade 1, the hazard ratio (HR) of FHS increased in Grade 2 (HR 1.19; p < 0.0001) and further increased in Grade 3 (HR 1.79; p < 0.0001). ROC analysis revealed the area under the curve to be 0.73 (95% CI 0.73–0.74). Conclusion This analysis demonstrates the broad validity of the modified-VHWG classification in discriminating risk for FHS. Inclusion of pre-existing IBD as a factor defining Grade 2 patients would be recommended. This analysis is limited by the absence of certain factors within the HES database, such as BMI.
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Affiliation(s)
- J D Hodgkinson
- Department of Colorectal Surgery, St Mark's Hospital and Academic Institute, Watford Road, Harrow, London, HA1 3UJ, UK. .,Department of Surgery and Cancer, Imperial College London, London, UK.
| | - G Worley
- Department of Colorectal Surgery, St Mark's Hospital and Academic Institute, Watford Road, Harrow, London, HA1 3UJ, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - J Warusavitarne
- Department of Colorectal Surgery, St Mark's Hospital and Academic Institute, Watford Road, Harrow, London, HA1 3UJ, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - G B Hanna
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - C J Vaizey
- Department of Colorectal Surgery, St Mark's Hospital and Academic Institute, Watford Road, Harrow, London, HA1 3UJ, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - O D Faiz
- Department of Colorectal Surgery, St Mark's Hospital and Academic Institute, Watford Road, Harrow, London, HA1 3UJ, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
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Cuccomarino S, Bonomo LD, Aprà F, Toscano A, Jannaci A. Preaponeurotic endoscopic repair (REPA) of diastasis recti: a single surgeon's experience. Surg Endosc 2021; 36:1302-1309. [PMID: 33661382 DOI: 10.1007/s00464-021-08405-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 02/15/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Diastasis recti is a pathology that affects not only the abdominal wall but also the stability of lumbopelvic muscles, consequently altering urinary and digestive functionality. Preaponeurotic endoscopic repair (REPA) is an endoscopic alternative to tummy tuck for the treatment of diastasis. In this study, the outcomes of REPA application by a single surgeon are presented. METHODS A total of 172 patients underwent REPA for the treatment of diastasis recti between August 2017 and December 2019. One hundred twenty-four patients were followed for at least one year. Sixty-three patients responded to a survey on satisfaction and quality of life 12 months after surgery. RESULTS Three (2.4%) recurrences occurred, of which two occurred in the same patient. The main postoperative complications observed were 12 (9.7%) seromas, 3 (2.4%) haematomas, a single wound infection, 3 (2.4%) cases of skin fold formation, and a case of trophic skin lesion that required negative pressure therapy. Quality of life after surgery, as reported by 63 patients who responded to the survey, was satisfactory. CONCLUSIONS REPA is a safe and effective technique for diastasis recti treatment, representing a valid alternative to abdominoplasty. Since there is no need to access the peritoneal cavity and the mesh is onlay, there are no risks of bowel damage or adhesions between the intestine and prosthesis.
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Affiliation(s)
| | | | - Fabrizio Aprà
- General Surgery Unit, Chivasso Hospital, Chivasso, Italy
| | - Antonio Toscano
- Department of Anesthesia and Critical Care, Città della Salute e della Scienza, Turin, Italy
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8
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Cawich SO, Dapri G, Fa Si Oen P, Thomas D, Naraynsingh V. Single Incision Laparoscopic Surgery: Feasibility of the Direct Fascial Puncture Technique Without Working Trocars. Cureus 2020; 12:e10742. [PMID: 33145144 PMCID: PMC7599059 DOI: 10.7759/cureus.10742] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Introduction As single-incision laparoscopic surgery (SILS) became popular, many access platforms and techniques emerged. When we initially described the direct fascial puncture (DFP) technique, many suggested it was not practical for three reasons: (1) increased hernia formation, (2) inability to complete operations without instrument changes and (3) insurmountable instrument drag. This study sought to determine whether the technique was a feasible approach by evaluating the outcomes with DFP-SILS in a single surgeon unit. Methods This was a retrospective audit of all consecutive patients who had unselected SILS operations by a single surgeon. For the DFP-SILS operation, a single optical trocar was used at the umbilicus, a second was rail-roaded beside the optical trocar and a third was directly passed across the fascia at the left-lateral extent of the skin wound. We recorded the number of conversions or failed operations and examined the patients routinely after operation to evaluate for incisional herniae. Results There were 50 DFP-SILS operations performed: 37 cholecystectomies, 12 appendectomies and one jejunal resection. The operations were successful in all cases with no conversions or mortality recorded. One patient (2%) developed a superficial surgical site infection after SILS-DFP appendectomy. The therapeutic outcomes were comparable to existing series of multi-port laparoscopy. There were no incisional herniae detected. Conclusion Even in the resource-poor setting, SILS operations are feasible and safe using the DFP technique. The theoretic concerns have not been realized in clinical practice.
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Affiliation(s)
| | - Giovanni Dapri
- Surgery, International School of Reduced Scar Laparoscopy, Brussels, BEL
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9
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Draghi F, Cocco G, Richelmi FM, Schiavone C. Abdominal wall sonography: a pictorial review. J Ultrasound 2020; 23:265-278. [PMID: 32125676 DOI: 10.1007/s40477-020-00435-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 02/13/2020] [Indexed: 02/07/2023] Open
Abstract
The anterior abdominal wall, which is composed of three layers (skin and adipose tissues; the myofascial layer; and the deep layer, consisting of the transversalis fascia, preperitoneal fat, and the parietal peritoneum), has many functions: containment, support and protection for the intraperitoneal contents, and involvement in movement and breathing. While hernias are often encountered and well reviewed in the literature, the other abdominal wall pathologies are less commonly described. In this pictorial review, we briefly discuss the normal anatomy of the anterior abdominal wall, describe the normal ultrasonographic anatomy, and present a wide range of pathologic abnormalities beyond hernias. Sonography emerges as the diagnostic imaging of first choice for assessing abdominal wall disorders, thus representing a valuable tool for ensuring appropriate management and limiting functional impairment.
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Affiliation(s)
- Ferdinando Draghi
- Radiology Institute, IRCCS Policlinico San Matteo Foundation, University of Pavia, Viale Camillo Golgi 19, 27100, Pavia, Italy
| | - Giulio Cocco
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Aging Sciences, University of Chieti G d'Annunzio, Via dei Vestini 31, 66100, Chieti, Italy.
| | - Filippo Maria Richelmi
- Radiology Institute, IRCCS Policlinico San Matteo Foundation, University of Pavia, Viale Camillo Golgi 19, 27100, Pavia, Italy
| | - Cosima Schiavone
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Aging Sciences, University of Chieti G d'Annunzio, Via dei Vestini 31, 66100, Chieti, Italy
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10
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Hodgkinson JD, Oke SM, Warusavitarne J, Hanna GB, Gabe SM, Vaizey CJ. Incisional hernia and enterocutaneous fistula in patients with chronic intestinal failure: prevalence and risk factors in a cohort of patients referred to a tertiary centre. Colorectal Dis 2019; 21:1288-1295. [PMID: 31218774 DOI: 10.1111/codi.14735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 04/08/2019] [Indexed: 12/14/2022]
Abstract
AIM This study aims to determine the prevalence of incisional hernia (IH) and enterocutaneous fistula (ECF) in patients with intestinal failure (IF) referred to a tertiary centre and to identify factors associated with their development. METHOD A retrospective case note review was undertaken of a prospectively maintained database of all patients on home parenteral nutrition between 2011 and 2016 at a UK tertiary referral centre for IF. Risk factors were identified using binary logistic regression. RESULTS The database search identified 447 patients, of whom 349 (78.1%) had surgery prior to developing IF. Eighty-one (23.2%) patients had an IH and 123 (35.2%) had an ECF at the time of referral. Of these, 51 (14.6%) had both IH and ECF. IH was associated with a high body mass index (P = 0.05), a history of a major surgical complication resulting in IF (P = 0.01), previous emergency surgery (P = 0.04), increasing number of operations (P = 0.02) and surgical site infection (SSI; P = 0.01). ECF was associated with complications relating to earlier surgery. (P ≤ .001), previous treatment with an open abdomen (P = 0.03), SSI (P = 0.001), intra-abdominal collection (P ≤ 0.001) and anastomotic leak (P = 0.02). CONCLUSION In this series, patients with IF had a prevalence of IH which was more than double that expected following elective laparotomy (about 10%) and one in three had an ECF. Risk factors for IH and ECF are discussed.
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Affiliation(s)
- J D Hodgkinson
- St Mark's Hospital and Academic Institute, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - S M Oke
- St Mark's Hospital and Academic Institute, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - J Warusavitarne
- St Mark's Hospital and Academic Institute, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - G B Hanna
- Department of Surgery and Cancer, Imperial College, London, UK
| | - S M Gabe
- St Mark's Hospital and Academic Institute, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - C J Vaizey
- St Mark's Hospital and Academic Institute, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
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11
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Lora-Aguirre A, Vega-Peña NV, Barrios-Parra AJ, Ruiz-Pineda JP. Hernia umbilical: un problema no resuelto. IATREIA 2019. [DOI: 10.17533/udea.iatreia.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
La cirugía de la hernia umbilical ha sido considerada tradicionalmente como sencilla y de fácil ejecución. El cambio conceptual de la hernia umbilical y los avances en su tratamiento han modificado su abordaje, estableciéndose escenarios de complejidad variable (obesidad, embarazo, cirróticos, distasis de los rectos, etc.) que demandan un conocimiento más profundo del tema por parte de la comunidad médica. El impacto económico en el sistema de salud, debido a su alta prevalencia como patología quirúrgica, implica un uso racional de recursos, así como la necesidad de una nueva categorización dentro de la cirugía de la pared abdominal. Es necesario establecer modificaciones en los procesos diagnósticos y terapéuticos en una entidad que ha sido relegada a los niveles básicos del ejercicio quirúrgico habitual.
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12
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Effect of transversus abdominis release on core stability: Short-term results from a single institution. Surgery 2019; 165:412-416. [DOI: 10.1016/j.surg.2018.08.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 07/24/2018] [Accepted: 08/09/2018] [Indexed: 11/20/2022]
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13
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Abstract
Hernia formation after surgical procedures continues to be an important cause of surgical morbidity. Incisional reinforcement at the time of the initial operation has been used in some patient populations to reduce the risk of subsequent hernia formation. In this article, reinforcement techniques in different surgical wounds are examined to identify situations in which hernia formation may be prevented. Mesh use for midline closure, pelvic floor reconstruction, and stoma site reinforcement is discussed. Additionally, the use of retention sutures, closure of the open abdomen, and reinforcement after component separation are examined using current literature. Although existing studies do not support the routine use of mesh reinforcement for all surgical incisions, certain patient populations appear to benefit from reinforcement with lower rates of subsequent hernia formation. The identification and characterization of these groups will guide the future use of mesh reinforcement in surgical incisions.
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Affiliation(s)
- Timothy F Feldmann
- Department of Surgery, University of California Irvine, Orange County, California
| | - Monica T Young
- Department of Surgery, University of California Irvine, Orange County, California
| | - Alessio Pigazzi
- Department of Surgery, University of California Irvine, Orange County, California
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14
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O'Halloran EB, Barwegen CJ, Dombrowski JM, Vandevender DK, Luchette FA. Can't have one without the other: component separation plus mesh for repairing difficult incisional hernias. Surgery 2014; 156:894-9. [PMID: 25239341 DOI: 10.1016/j.surg.2014.06.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 06/20/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Incisional hernia recurrence after repair continues to be a persistent complication. The purpose of this study was to investigate the association between patient-specific factors, surgeon-specific factors, and hernia recurrence in patients undergoing repair of an incisional hernia in whom the component separation technique was used. METHODS All patients undergoing incisional herniorrhaphy with component separation from October 2006 to May 2013 were reviewed. Data collected included demographics, comorbidities, postoperative complications, and factors related to mesh implantation. Computed tomography images were used to evaluate the size of the hernia and dimensions of the linea alba. RESULTS The 85 patients were followed for a mean of 14.4 months, and 12 (14.1%) recurrent hernias were diagnosed. More than 91% of the herniorrhaphies were performed after a previous repair failed. The recurrence rate decreased to 11.1% when, in addition to the component separation, a mesh was used to reinforce the repair. There were no differences between the group who developed a recurrence and those who did not in terms of sex, age, race, body mass index, preoperative comorbidities, or type of mesh used. CONCLUSION In this case series of complex abdominal wall herniorrhaphies using component separation, the recurrence rate was 14.1% overall and 11.1% when a mesh was used to reinforce the repair. Recurrent hernia was not associated with patient demographics, comorbidities, thickness or width of the linea alba, presence of a contaminated wound, or postoperative surgical-site occurrences.
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Affiliation(s)
| | - Corbin J Barwegen
- Stritch School of Medicine, Loyola University of Chicago, Chicago, IL
| | | | | | - Fred A Luchette
- Division of General Surgery, Loyola University of Chicago, Chicago, IL
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15
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Preventive midline laparotomy closure with a new bioabsorbable mesh: An experimental study. J Surg Res 2013; 181:160-9. [DOI: 10.1016/j.jss.2012.05.041] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 05/03/2012] [Accepted: 05/10/2012] [Indexed: 12/11/2022]
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16
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Hernández-Gascón B, Mena A, Peña E, Pascual G, Bellón JM, Calvo B. Understanding the Passive Mechanical Behavior of the Human Abdominal Wall. Ann Biomed Eng 2012; 41:433-44. [DOI: 10.1007/s10439-012-0672-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 09/29/2012] [Indexed: 02/05/2023]
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