Intraperitoneal Tension-free Repair of a Small Midline Ventral Abdominal Wall Hernia: Randomized Study with a Mean Follow-up of 3 Years

2014 ◽  
Vol 80 (1) ◽  
pp. 57-65 ◽  
Author(s):  
Hocine Bensaadi ◽  
Luca Paolino ◽  
Antonio Valenti ◽  
Claude Polliand ◽  
Christophe Barrat ◽  
...  
Keyword(s):  
Hernia Repair ◽  
Abdominal Wall ◽  
Randomized Study ◽  
Abdominal Wall Hernia ◽  
Late Complications ◽  
Abdominal Wall Defects ◽  
Complication Rates ◽  
Surgeon Experience

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.

MO701COMBINED PROCEDURE OF PRE- EXISTING ABDOMINAL WALL HERNIA REPAIR AND PERITONEAL CATHETER INSERTION. LONG TERM FOLLOW- UP IN PERITONEAL DIALYSIS TREATMENT

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Tatiana Tanasiychuk ◽  
Daniel Kushnir ◽  
Oleg Sura ◽  
Husein Darawsha ◽  
Ariel Chami ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Hernia Repair ◽  
Abdominal Wall ◽  
Abdominal Wall Hernia ◽  
Catheter Insertion ◽  
Diabetic Patients ◽  
Hernia Formation ◽  
Catheter Implantation

Abstract Background and Aims Successful peritoneal dialysis (PD) program requires a combination of optimal peritoneal access and low incidence of complications. Between pitfalls of this modality are early mechanical complications such as leak, malfunction, and new abdominal wall hernia formation in the long term of PD treatment. Pre-existing abdominal wall hernia is a relative contraindication for PD. Hernias are also a known and not uncommon complication over the course of PD and one of the causes of technique failure. In our center, a physical examination and an ultrasound for hernias detection are routine procedures before the start of PD. If a hernia is discovered, combined hernia repair and catheter implantation are performed. The aim of this study was to assess to long- term results of this approach. Method The current study presents the retrospective analysis of 10 years' experience of our PD program (1.01.2009 – 31.12. 2018) including all incident PD patients who underwent their first peritoneal catheter placement procedure during the study period. The primary endpoints of the study were the rate of hernia formation in the course of PD treatment, type of hernias, identification risk factors for hernia formation and rate of hernia recurrence after previous repair. The secondary endpoint was the rate of procedure-related complications: infectious, leaks and primary catheter malfunction in patients who underwent surgical catheter insertion compared to percutaneous technique. Patients were followed until the end of PD treatment or until 31.10.2019. Results A total of 211 patients were included in the analysis. Of these, 24.5% underwent surgical procedures and 75.5% percutaneous insertion. Mean follow-up was 23.3 ± 25 months (2 to 96 months). About half (53.1%) of the patients were diabetic, aged 64.2±13 years. In 32 patients (15%) a preventive hernia repair with a simultaneous catheter implantation were performed. Patients who underwent a preventive hernia repair were significantly older than other patients (69.4±11.1 years versus 63.2±13.1 years, P=0.013). During the study period, 203 of 211 patients were treated by PD. Thirty three (16.1%) have developed 38 new hernias. Patients suffering from a new hernia during PD were predominantly male, with longer dialysis vintage than patients without new hernia formation (35.3±22.8 months versus 23±22.9, respectively. P=0.001). Five of 33 patients suffered multiple hernias, including recurrent hernias at the same site. Most common types were inguinal and umbilical (44.7% each other), while only few were incisional or ventral. None of our patients suffered from a pericatheter one. The overall rate of new hernias development was 0.09/patient/years. Neither age, comorbidities, obesity nor polycystic kidney disease did not increase the rate of hernia formation during the course of PD treatment. There was no significant association between type of catheter insertion procedure (surgical/percutaneous) and infections, leakages or catheter function. Leak incidence in diabetic patients was significantly higher in comparison with nondiabetic patients (8% versus 1%, P=0.021). Infectious complications were not different between diabetic and not diabetics patients (5.4% among diabetic patients versus 2% nondiabetic, P=0.29). Conclusion Our findings show that male gender and prolonged peritoneal dialysis duration are the main risk factors for the appearance of hernias in the course of PD therapy. Our data also confirm previous observations that the placement of PD catheter using a paramedian incision approach significantly reduces the incidences of exit site and incision hernias. We suggest that early diagnosis of latent asymptomatic hernias and hernia repair prior to starting PD can improve technique survival.

scholarly journals Intracameral Bevacizumab Versus Sub-Tenon’s Mitomycin C as Adjuncts to Trabeculectomy: 3-Year Results of a Prospective Randomized Study

2021 ◽  
Vol 10 (10) ◽  
pp. 2054
Author(s):  
Gerasimos Kopsinis ◽  
Dimitrios Tsoukanas ◽  
Dimitra Kopsini ◽  
Theodoros Filippopoulos
Keyword(s):  
Mitomycin C ◽  
Primary Outcome ◽  
Randomized Study ◽  
Primary Outcome Measure ◽  
Complication Rates ◽  
Filtration Surgery ◽  
Significant Difference ◽  
Exfoliative Glaucoma

Conjunctival wound healing determines success after filtration surgery and the quest for better antifibrotic agents remains active. This study compares intracameral bevacizumab to sub-Tenon’s mitomycin C (MMC) in trabeculectomy. Primary open-angle or exfoliative glaucoma patients were randomized to either bevacizumab (n = 50 eyes) or MMC (n = 50 eyes). The primary outcome measure was complete success, defined as Intraocular Pressure (IOP) > 5 mmHg and ≤ 21 mmHg with a minimum 20% reduction from baseline without medications. Average IOP and glaucoma medications decreased significantly in both groups at all follow-up points compared to baseline (p < 0.001), without significant difference between groups at 3 years (IOP: bevacizumab group from 29 ± 9.4 to 15 ± 3.4 mmHg, MMC group from 28.3 ± 8.7 to 15.4 ± 3.8 mmHg, p = 0.60; Medications: bevacizumab group from 3.5 ± 0.9 to 0.5 ± 1, MMC group from 3.6 ± 0.7 to 0.6 ± 1.1, p = 0.70). Complete success, although similar between groups at 3 years (66% vs. 64%), was significantly higher for bevacizumab at months 6 and 12 (96% vs. 82%, p = 0.03; 88% vs. 72%, p = 0.04, respectively) with fewer patients requiring medications at months 6, 9 and 12 (4% vs. 18%, p = 0.03; 6% vs. 20%, p = 0.04; 8% vs. 24%, p = 0.03, respectively). Complication rates were similar between groups. In conclusion, intracameral bevacizumab appears to provide similar long-term efficacy and safety results as sub-Tenon’s MMC after trabeculectomy.

Outcome of Abdominal Wall Hernia Repair with Biologic Mesh: Permacol™ versus Strattice™

2014 ◽  
Vol 80 (10) ◽  
pp. 999-1002 ◽  
Author(s):  
Amy W. Cheng ◽  
Maher A. Abbas ◽  
Talar Tejirian
Keyword(s):  
Hernia Repair ◽  
Abdominal Wall ◽  
Abdominal Wall Hernia ◽  
Hernia Recurrence ◽  
Biologic Mesh ◽  
Abdominal Hernia ◽  
Complication Rates ◽  
Short Term ◽  
Porcine Dermis ◽  
Abdominal Wall Hernia Repair

The use of biologic mesh in abdominal wall operations has gained popularity despite a paucity of outcome data. Numerous biologic products are available with virtually no clinical comparison studies. A retrospective study was conducted to compare patients who underwent abdominal wall hernia repair with Permacol™ (crosslinked porcine dermis) and Strattice™ (noncrosslinked porcine dermis). Of 270 reviewed patients, 195 were implanted with Permacol™ and 75 with Strattice™. Ventral hernia repairs comprised the majority (85% for Permacol, 97% for Strattice™). Postoperative infection rate was lower in the Strattice™ group (5 vs 21%, P < 0.01). In the Permacol™ group only, the overall complication rates were significantly higher in patients with infected versus clean wounds (55 vs 35%, P < 0.05) and in obese patients (body mass index 40 kg/m2 or greater [57 vs 34%], P < 0.01). Short-term complication and recurrence rates were higher when mesh was used as a fascial bridge: 51 versus 28 per cent for Permacol™, 58 versus 20 per cent for Strattice™. The hernia recurrence was similar in both groups. In this review of patients undergoing abdominal hernia repair with biologic mesh, Strattice™ mesh was associated with a lower short-term complication rate compared with Permacol™, but the hernia recurrence rate was similar.

Components Separation: A Solution to Complex Abdominal Wall Defects

2008 ◽  
Vol 74 (10) ◽  
pp. 912-916
Author(s):  
Hooman Shabatian ◽  
Dong-Joon Lee ◽  
Maher A. Abbas
Keyword(s):  
Abdominal Wall ◽  
Hospital Readmission ◽  
Recurrent Hernia ◽  
Abdominal Wall Defects ◽  
Viable Option ◽  
Components Separation ◽  
Mean Size ◽  
Abdominal Operations

Complex abdominal wall hernias can be challenging to treat. The purpose of this study was to retrospectively review the results of components separation. Seventeen patients underwent components separation between 2000 and 2007. Mean size of the hernia defect was 318 cm2. Mean number of prior abdominal operations/patient was 3.2. Nine patients (53%) had prior failed repair. At time of components separation, five patients (29%) had concurrent gastrointestinal operations and two (12%) had panniculectomy. Mean hospitalization stay was 3.8 days with a readmission rate of 41 per cent. The most common postoperative complications were wound related and occurred in 35 per cent of patients. During a mean follow-up of 21 months, only one patient had recurrent hernia (6%). Five patients (29%) required additional operations. Components separation is a viable option for patients with complex abdominal wall defects. Long-term recurrence is rare but wound related complications, operative reinterventions, and hospital readmission are common.

scholarly journals Hernia rationing: an assessment of commissioning guidelines

2021 ◽  
Vol 103 (4) ◽  
pp. 192-195
Author(s):  
W Gewanter ◽  
T Hubbard ◽  
D Ferguson
Keyword(s):  
Hernia Repair ◽  
Abdominal Wall ◽  
Surgical Repair ◽  
Abdominal Wall Hernia ◽  
Emergency Repair ◽  
Number Of Patients ◽  
Almost All ◽  
Surgical Hernia Repair ◽  
The Impact

Introduction Hernias are a common surgical condition. Most guidelines recommend repair in almost all cases. NHS Devon clinical commissioning group (CCG) guidelines restrict the commissioning of hernia repair. The aim of this study was to follow up a cohort of patients referred for hernia repair to assess the impact of commissioning guidelines on clinical outcomes. Methods All patients referred to a single UK surgeon with an abdominal wall hernia over a 12-month period were followed up to determine whether CCG criteria were initially met. If they were not, time to any subsequent surgical intervention was recorded. Results After exclusions, 106 patients referred for abdominal wall hernia repair were followed up. Of these, 53 (49%) fulfilled commissioning guidelines for surgical repair. Thirty-one patients (23%) who had an indication for surgical repair did not fulfil commissioning criteria. This group was followed up for a median of 1,112 days (range: 962–1,287 days). Twelve patients (39%) required an operation within 900 days with one of these (3%) requiring emergency repair. These 12 patients waited a mean of 232 days before being accepted for surgery. Conclusions A large number of patients who did not initially meet NHS Devon CCG’s criteria ultimately required surgery. Three per cent of this ‘watch and wait’ group required emergency repair. NHS Devon CCG guidelines do not effectively identify patients who can be managed safely without surgical hernia repair. The incidence of emergency repair in this group should inform the prioritisation of hernia repairs when restarting elective services that have been halted because of the COVID-19 pandemic.

The long-term outcomes of modified Harrington procedure using antegrade pins for periacetabular metastasis and haematological diseases

2019 ◽  
Vol 101-B (12) ◽  
pp. 1557-1562
Author(s):  
Roger Tillman ◽  
Yusuke Tsuda ◽  
Manoj Puthiya Veettil ◽  
Peter S. Young ◽  
Deepak Sree ◽  
...  
Keyword(s):  
Large Diameter ◽  
Survival Rates ◽  
Late Complications ◽  
Complication Rates ◽  
Implant Survival ◽  
Long Term Outcomes ◽  
Perioperative Mortality ◽  
Acetabular Loosening

Aims The aim of this study was to present the long-term surgical outcomes, complications, implant survival, and causes of implant failure in patients treated with the modified Harrington procedure using antegrade large diameter pins. Patients and Methods A cohort of 50 consecutive patients who underwent the modified Harrington procedure for periacetabular metastasis or haematological malignancy between January 1996 and April 2018 were studied. The median follow-up time for all survivors was 3.2 years (interquartile range 0.9 to 7.6 years). Results The five-year overall survival rate was 33% for all the patients. However, implant survival rates were 100% and 46% at five and ten years, respectively. Eight patients survived beyond five years. There was no immediate perioperative mortality or complications. A total of 15 late complications occurred in 11 patients (22%). Five patients (10%) required further surgery to treat complications. The most frequent complication was pin breakage without evidence of acetabular loosening (6%). Two patients (4%) underwent revision for aseptic loosening at 6.5 and 8.9 years after surgery. Ambulatory status and pain level were improved in 83% and 89%, respectively. Conclusion The modified Harrington procedure for acetabular destruction has low complication rates, good functional outcome, and improved pain relief in selected patients Cite this article: Bone Joint J 2019;101-B:1557–1562

scholarly journals Long term results of open complex abdominal wall hernia repair with self-gripping mesh: A retrospective cohort study

2017 ◽  
Vol 44 ◽  
pp. 255-259 ◽  
Author(s):  
Leonard F. Kroese ◽  
Lien H.A. van Eeghem ◽  
Joost Verhelst ◽  
Johannes Jeekel ◽  
Gert-Jan Kleinrensink ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hernia Repair ◽  
Abdominal Wall ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Abdominal Wall Hernia ◽  
Long Term Results ◽  
Abdominal Wall Hernia Repair

scholarly journals Predictive factors of surgical site infections in abdominal wall hernias

2018 ◽  
Vol 5 (3) ◽  
pp. 971
Author(s):  
Siddharth Keswani ◽  
Murtaza Akhtar ◽  
Divish Saxena ◽  
Gayatri Deshpande
Keyword(s):  
Hernia Repair ◽  
Abdominal Wall ◽  
Predictive Factors ◽  
Laparoscopic Hernia Repair ◽  
Abdominal Wall Hernia ◽  
Surgical Site Infections ◽  
Related Factors ◽  
Common Procedure ◽  
Increased Risk ◽  
Surgeon Experience

Background: Surgical site infections (SSI) are infections presents in any location along the surgical tract after a surgical procedure. Knowledge of predictive factors associated with SSI is important for planning remedial measures. Abdominal wall hernia repair is a common procedure in general surgery practice and knowing the predictors of SSI in these clean surgeries requiring placement of mesh is the aim of the present study.Methods: In a hospital based longitudinal study the subjects were diagnosed cases of anterior abdominal wall hernias undergoing planned or emergency surgeries. Patients of either gender and age group of 18 to 80 years were included in the study. Patients undergoing laparoscopic hernia repair were excluded. The study factors were patient and the surgeon related factors like laboratory parameters, surgeon experience etc. The outcome was SSI assessed with up to 30 days post-operative follow up.Results: Total 198 patients were enrolled with a mean age of 42.49±15.72 years and male preponderance. Overall SSI rate was 9.09% and in planned cases it was 7.07% and 50% in emergency cases. Pre-operative hospital stays of >5 days was the only patient factor associated with increased risk of SSI (p=0.0004) and operating surgeon’s experience was associated with increased risk if SSI i.e. cases operated by junior surgeons had a higher risk of SSI (p=0.013).Conclusions: The only modifiable factor associated with SSI was pre-operative hospital stay of >5 days while high incidence of SSI with junior surgeons cannot be modified in a teaching institute.

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