RESUMO
PURPOSE: Annually, over 20 million patients worldwide undergo inguinal hernia repair procedures. Surgery stands as the recommended treatment, however, a consensus on the optimal method is lacking. This study aims to conduct an updated systematic review and meta-analysis to compare the risk of chronic inguinal pain and recurrence between laparo-endoscopic mesh repair (TAPP and TEP) versus Lichtenstein repair for inguinal hernia. METHODS: Searches were conducted in Ovid MEDLINE, PubMed, EBSCO, Cochrane, and Google Scholar. Inclusion criteria encompassed randomized controlled trials (RCTs) involving adults, published in English and Spanish, comparing surgical outcomes among the Lichtenstein open technique, TAPP, and/or TEP. Adherence to the PRISMA guidelines was maintained in the methodology, and the CASP tool was employed to assess the quality of the articles. Statistical analysis involved mean [± standard deviation (SD)], Odds Ratio (OR), and Confidence Interval (CI). RESULTS: Eight RCTs encompassing 1,469 patients randomized to Lichtenstein repair (n = 755) and laparo-endoscopic repair (n = 714) were included. Laparo-endoscopic repair was associated with a lower likelihood of chronic inguinal pain compared to Lichtenstein repair (OR = 0.28, 95% CI [0.30-0.56], p = 0.0001). There were no significant differences in recurrence rates between the laparo-endoscopic and the Lichtenstein group (OR = 1.03, 95% CI [0.57-1.86], p = 0.92). CONCLUSIONS: This systematic review and meta-analysis demonstrate that laparo-endoscopic hernia surgery leads to a lower incidence of chronic inguinal pain compared to Lichtenstein repair, while maintaining similar rates of recurrence.
Assuntos
Dor Crônica , Hérnia Inguinal , Herniorrafia , Laparoscopia , Dor Pós-Operatória , Recidiva , Humanos , Hérnia Inguinal/cirurgia , Dor Crônica/etiologia , Herniorrafia/métodos , Herniorrafia/efeitos adversos , Laparoscopia/métodos , Laparoscopia/efeitos adversos , Dor Pós-Operatória/etiologia , Telas CirúrgicasRESUMO
The prehabilitation of the abdominal wall through the infiltration of botulinum toxin type A, which induces temporary chemical denervation ("chemical component separation") in the lateral abdominal musculature, is a common practice in units specialized in abdominal wall surgery. However, its use for this indication is currently off-label. The main objective of this article is to describe a consensus proposal regarding indications, contraindications, dosages employed, potential side effects, administration method, and measurement of possible outcomes. Additionally, a proposal for an informed consent document endorsed by the Abdominal Wall Section of the Spanish Association of Surgeons is attached.
Assuntos
Músculos Abdominais , Toxinas Botulínicas Tipo A , Herniorrafia , Humanos , Toxinas Botulínicas Tipo A/administração & dosagem , Toxinas Botulínicas Tipo A/uso terapêutico , Herniorrafia/métodos , Parede Abdominal/cirurgia , Fármacos Neuromusculares/administração & dosagem , Fármacos Neuromusculares/uso terapêutico , Exercício Pré-OperatórioRESUMO
In the same way that renal transcatheter arterial embolisation (TAE) has demonstrated its effectiveness and safety compared with nephrectomy of the polycystic kidney at the time of transplantation, we propose that TAE can be a minimally invasive option in the surgical preparation for incisional hernia repair in order to reduce the compressive effect of the polycystic kidney, creating space and ensuring safe hernia repair. The objective of this article is to describe the first case in which TAE is used in advance of incisional hernia secondary to renal transplantation in patients with autosomal dominant polycystic kidney disease.
RESUMO
BACKGROUND: This study aimed to evaluate the results of posterior component separation (CS) and transversus abdominis muscle release (TAR) with retro-muscular mesh reinforcement in patients with primary abdominal wall dehiscence (AWD). The secondary aims were to detect the incidence of postoperative surgical site occurrence and risk factors of incisional hernia (IH) development following AWD repair with posterior CS with TAR reinforced by retromuscular mesh. METHODS: Between June 2014 and April 2018, 202 patients with grade IA primary AWD (Björck's first classification) following midline laparotomies were treated using posterior CS with TAR release reinforced by a retro-muscular mesh in a prospective multicenter cohort study. RESULTS: The mean age was 42 ± 10 years, with female predominance (59.9%). The mean time from index surgery (midline laparotomy) to primary AWD was 7 ± 3 days. The mean vertical length of primary AWD was 16 ± 2 cm. The median time from primary AWD occurrence to posterior CS + TAR surgery was 3 ± 1 days. The mean operative time of posterior CS + TAR was 95 ± 12 min. No recurrent AWD occurred. Surgical site infections (SSI), seroma, hematoma, IH, and infected mesh occurred in 7.9%, 12.4%, 2%, 8.9%, and 3%, respectively. Mortality was reported in 2.5%. Old age, male gender, smoking, albumin level < 3.5 gm%, time from AWD to posterior CS + TAR surgery, SSI, ileus, and infected mesh were significantly higher in IH. IH rate was 0.5% and 8.9% at two and three years, respectively. In multivariate logistic regression analyses, the predictors of IH were time from AWD till posterior CS + TAR surgical intervention, ileus, SSI, and infected mesh. CONCLUSION: Posterior CS with TAR reinforced by retro-muscular mesh insertion resulted in no AWD recurrence, low IH rates, and low mortality of 2.5%. Trial registration Clinical trial: NCT05278117.
Assuntos
Parede Abdominal , Hérnia Ventral , Íleus , Obstrução Intestinal , Humanos , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Músculos Abdominais , Estudos de Coortes , Estudos Prospectivos , Telas Cirúrgicas , Infecção da Ferida CirúrgicaRESUMO
BACKGROUND: Surgical mesh infection (SMI) after abdominal wall hernia repair (AWHR) is a challenging and highly debated clinical problem with no current consensus. The purpose of this review was to analyze the literature about the use of negative pressure wound therapy (NPWT) in the management of the conservative treatment of SMI and report results about infected mesh salvage. METHODS: A systematic review of EMBASE and PUBMED was performed describing the use of NPWT in patients with SMI following AWHR. Reviewed articles evaluating data about the association between clinical, demographic, analytic and surgical characteristics about SMI after AWHR were analyzed. The high heterogeneity of these studies did not allow a meta-analysis of outcomes. RESULTS: The search strategy yielded 33 studies from PubMed, and 16 studies from EMBASE. NPWT was performed in 230 patients across 9 studies being achieved the mesh salvage in 196 (85.2%). Of these 230 cases, 46% were polypropylene (PPL), 9.9% polyester (PE), 16.8% polytetrafluoroethylene (PTFE), 4% biologic and 10.2% composite mesh (PPL and PTFE). Infected mesh location was onlay (43%), retromuscular (22%), preperitoneal (19%), intraperitoneal (10%) and between the oblique muscles (5%). The better option on salvageability with the use of NPWT was the combination of macroporous PPL mesh in an extraperitoneal position (19.2% onlay, 23.3% preperitoneal, 48.8% retromuscular). CONCLUSION: NPWT is a sufficient approach to treat SMI following AWHR. In most cases, infected prostheses can be salvaged with this management. Further studies with a larger sample size are needed to confirm our analysis results.
Assuntos
Hérnia Ventral , Tratamento de Ferimentos com Pressão Negativa , Humanos , Hérnia Ventral/cirurgia , Hérnia Ventral/etiologia , Herniorrafia/efeitos adversos , Herniorrafia/métodos , Tratamento de Ferimentos com Pressão Negativa/métodos , Próteses e Implantes , Telas Cirúrgicas/efeitos adversosRESUMO
BACKGROUND: Surgical site occurrences pose a threat to patient health, potentially resulting in significant increases in health care spending caused by using additional resources. The objective of this study was to reach a consensus among a group of experts in incisional negative pressure wound therapy to determine the indications for using this type of treatment prophylactically and to analyze the associated risk factors of surgical site occurrences in abdominal surgery. METHODS: A group of experts in incisional negative pressure wound therapy from Spain and Portugal was formed among general surgery specialists who frequently perform colorectal, esophagogastric, or abdominal wall surgery. The Coordinating Committee performed a bibliographic search to identify the most relevant publications and to create a summary table to serve as a decision-making protocol regarding the use of prophylactic incisional negative pressure wound therapy based on factors related to the patient and type of procedure. RESULTS: The patient risk factors associated with surgical site occurrence development such as age, immunosuppression, anticoagulation, hypoalbuminemia, smoking, American Society of Anesthesiologists classification, diabetes, obesity, and malnutrition were analyzed. For surgical procedure factors, surgical time, repeated surgeries, organ transplantation, need for blood transfusion, complex abdominal wall reconstruction, surgery at a contaminated site, open abdomen closure, emergency surgery, and hyperthermic intraperitoneal chemotherapy were analyzed. CONCLUSION: In our experience, this consensus has been achieved on a tailored set of recommendations on patient and surgical aspects that should be considered to reduce the risk of surgical site occurrences with the use of prophylactic incisional negative pressure wound therapy, particularly in areas where the evidence base is controversial or lacking.
Assuntos
Tratamento de Ferimentos com Pressão Negativa , Ferida Cirúrgica , Humanos , Tratamento de Ferimentos com Pressão Negativa/efeitos adversos , Infecção da Ferida Cirúrgica/epidemiologia , Consenso , Ferida Cirúrgica/complicações , Fatores de RiscoRESUMO
INTRODUCTION: The purpose of this study is to assess the current status and knowledge of the Spanish colorectal surgeons on the wall closure. METHODS: A single answer questionnaire of 25 closed questions was conducted using specific software for online surveys that was distributed to a cohort of colorectal surgeons. RESULTS: 53 surgeons replied to the survey. The vast majority prefer a closure of the midlaparotomy with a very slow absorbing monofilament (67.92%) continuous suture (96.23%) in a single plane (81.13%). Mass stitches, retention systems, and loop sutures continue to be used. The most commonly used suture gauge was USP 1 (United States Pharmacopeia) (58.49%). The most commonly used needle is with a cylindrical body and a trocar tip. Only 50%, routinely perform wall closure after placement of a trocar equal to or greater than 10 mm. Almost everyone knows the 4:1 rule and thinks it should be applied, but the small bites technique is not performed. 50% would never place a prophylactic prosthesis. The closure is usually performed by the same surgeon who has performed the entire procedure. One out of five confesses not knowing the rate of incisional hernias in his unit. CONCLUSION: There is a lack of consensus and basic knowledge regarding the technical aspects of closure and the prevention of the appearance of incisional hernias. The use of slow absorbing monofilament continuous suture in a single plane seems well accepted.
Assuntos
Parede Abdominal , Técnicas de Fechamento de Ferimentos Abdominais , Neoplasias Colorretais , Cirurgia Colorretal , Hérnia Incisional , Humanos , Hérnia Incisional/cirurgia , Parede Abdominal/cirurgia , Técnicas de Sutura , Laparotomia/métodos , Neoplasias Colorretais/cirurgiaRESUMO
Negative pressure wound therapy (NPWT) is widely known in surgical practice. The initial indications for NPWT were chronic wounds, especially diabetic foot, vascular and decubitus ulcers, and infected traumatic wounds. Nowadays, the use has been widely increased. Although in the field of abdominal wall surgery, it has mainly been used in the treatment of surgical wound complications after hernia repair, other indications have been added after years of experience in the management of NPWT. Therefore, the aim of this article is to analyze and review the main indications of NPWT in abdominal wall surgery, as well as the advantages obtained with its application.
Assuntos
Parede Abdominal , Tratamento de Ferimentos com Pressão Negativa , Parede Abdominal/cirurgia , Herniorrafia , HumanosRESUMO
Preoperative progressive pneumoperitoneum has represented an important advancement in achieving the reintroduction of large herniated volumes into the abdominal cavity. However, this technique is not free of complications. We present a case of a man in his 70s with an accidental peritoneal-cutaneous fistula, secondary to the excessive pressure of the pneumoperitoneum, during the preparation of a large incisional hernia with loss of domain intervention.
Assuntos
Fístula Cutânea , Hérnia Ventral , Hérnia Incisional , Insuflação , Pneumoperitônio , Fístula Cutânea/etiologia , Fístula Cutânea/cirurgia , Hérnia Ventral/cirurgia , Herniorrafia/métodos , Humanos , Hérnia Incisional/etiologia , Hérnia Incisional/cirurgia , Masculino , Recidiva Local de Neoplasia/cirurgia , Peritônio/cirurgia , Pneumoperitônio/diagnóstico por imagem , Pneumoperitônio/etiologia , Pneumoperitônio/cirurgia , Pneumoperitônio Artificial/efeitos adversos , Pneumoperitônio Artificial/métodos , Cuidados Pré-Operatórios/métodosRESUMO
INTRODUCTION: The surgical procedure to repair a subxiphoid incisional hernia is a complex technique due to the anatomical area that it appears. The objective of our study is the analysis of the results obtained with the different surgical techniques performed in our center for 9 years, especially postoperative complications and the recurrence rate. METHODS: It is an observational, retrospective study from January 2011 to January 2019 of patients operated of subxiphoid incisional hernia in our Unit. We analysed the comorbidities, surgical techniques (preperitoneal hernia repair or TP, and adjusted double mesh technique) and postoperative variable, especially the hernia recurrence. The postoperative complications were summarized flowing the Clavien-Dindo classification. RESULTS: 42 patients were operated: 22 (52,4%) TP and 20 (47,6%) adjusted double mesh technique. All the complications registered were minor (grade I) and it appeared mostly in TP group (P = .053). The average follow up was 25.8 ± 15.1 months; there were no statistically significant differences in hernia recurrence comparing two treatment groups (P = .288). CONCLUSIONS: According to our results, TP is the ideal technique to repair a subxiphoid incisional hernia. Adjusted double mesh technique may represent an effective approach with a low complication rate, although globally analyzing the recurrence rate, aponeurosis closure over the preperitoneal mesh entails less impact on it.
Assuntos
Hérnia Ventral , Hérnia Incisional , Hérnia Ventral/cirurgia , Humanos , Hérnia Incisional/cirurgia , Recidiva Local de Neoplasia , Estudos Retrospectivos , Telas CirúrgicasRESUMO
OBJECTIVE: A randomized controlled trial (RCT) was undertaken to evaluate whether the prophylactic application of a specific single-use negative pressure (sNPWT) dressing on closed surgical incisions after incisional hernia (IH) repair decreases the risk of surgical site occurrences (SSOs) and the length of stay. BACKGROUND: The sNPWT dressings have been associated to several advantages like cost savings and prevention of SSOs like seroma, hematoma, dehiscence, or wound infection (SSI) in closed surgical incisions. But this beneficious effect has not been previously studied in cases of close wounds after abdominal wall hernia repairs. METHODS: An RCT was undertaken between May 2017 and January 2020 (ClinicalTrials.gov registration number NCT03576222). Participating patients, with IH type W2 or W3 according to European Hernia Society classification, were randomly assigned to receive intraoperatively either the sNPWT (PICO)(72 patients) or a conventional dressing at the end of the hernia repair (74 patients). The primary endpoint was the development of SSOs during the first 30 days after hernia repair. The secondary endpoint included length of hospital stay. Statistical analysis was performed using IBM SPSS Statistics Version 23.0. RESULTS: At 30 days postoperatively, there was significatively higher incidence of SSOs in the control group compared to the treatment group (29.8% vs 16.6%, P < 0.042). There was no SSI in the treatment group and 6 cases in the control group (0% vs 8%, P < 0.002). No significant differences regarding seroma, hematoma, wound dehiscence, and length of stay were observed between the groups. CONCLUSION: The use of prophylactic sNPWT PICO dressing for closed surgical incisions following IH repair reduces significatively the overall incidence of SSOs and the SSI at 30 days postoperatively.
Assuntos
Herniorrafia/métodos , Hérnia Incisional/cirurgia , Tratamento de Ferimentos com Pressão Negativa , Complicações Pós-Operatórias/prevenção & controle , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
BACKGROUND: The goal of this article was to report the results about the efficacy of treatment of chronic mesh infection (CMI) after abdominal wall hernia repair (AWHR) in one-stage management, with complete mesh explantation of infected prosthesis and simultaneous reinforcement with a biosynthetic poly-4-hydroxybutyrate absorbable (P4HB) mesh. METHODS: This is a retrospective analysis of all patients that needed mesh removal for CMI between September 2016 and January 2019 at a tertiary center. Epidemiological data, hernia characteristics, surgical, and postoperative variables (Clavien-Dindo classification) of these patients were analyzed. RESULTS: Of the 32 patients who required mesh explantation, 30 received one-stage management of CMI. In 60% of the patients, abdominal wall reconstruction was necessary after the infected mesh removal: 8 cases (26.6%) were treated with Rives-Stoppa repair, 4 (13.3%) with a fascial plication, 1 (3.3%) with anterior component separation, and 1 (3.3%) with transversus abdominis release to repair hernia defects. Three Lichtenstein (10%) and 1 Nyhus repairs (3.3%) were performed in patients with groin hernias. The most frequent postoperative complications were surgical site occurrences: seroma in 5 (20%) patients, hematoma in 2 (6.6%) patients, and wound infection in 1 (3.3%) patient. During the mean follow-up of 34.5 months (range 23-46 months), the overall recurrence rate was 3.3%. Persistent, recurrent, or new CMIs were not observed. CONCLUSIONS: In our experience, single-stage management of CMI with complete removal of infected prosthesis and replacement with a P4HB mesh is feasible with acceptable results in terms of mesh reinfection and hernia recurrence.
Assuntos
Implantes Absorvíveis , Hérnia Abdominal/cirurgia , Herniorrafia/efeitos adversos , Infecções Relacionadas à Prótese/cirurgia , Telas Cirúrgicas/efeitos adversos , Parede Abdominal/cirurgia , Adulto , Idoso , Doença Crônica , Remoção de Dispositivo , Feminino , Hérnia Ventral/cirurgia , Herniorrafia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Polímeros , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/microbiologia , Recidiva , Estudos Retrospectivos , Telas Cirúrgicas/microbiologia , Resultado do TratamentoRESUMO
INTRODUCTION: The surgical procedure to repair a subxiphoid incisional hernia is a complex technique due to the anatomical area that it appears. The objective of our study is the analysis of the results obtained with the different surgical techniques performed in our center for 9 years, especially postoperative complications and the recurrence rate. METHODS: It is an observational, retrospective study from January 2011 to January 2019 of patients operated of subxiphoid incisional hernia in our Unit. We analysed the comorbidities, surgical techniques (preperitoneal hernia repair or TP, and adjusted double mesh technique) and postoperative variable, especially the hernia recurrence. The postoperative complications were summarized flowing the Clavien-Dindo classification. RESULTS: 42 patients were operated: 22 (52,4%) TP and 20 (47,6%) adjusted double mesh technique. All the complications registered were minor (grade I) and it appeared mostly in TP group (P=.053). The average follow up was 25.8±15.1 months; there were no statistically significant differences in hernia recurrence comparing two treatment groups (P=.288). CONCLUSIONS: According to our results, TP is the ideal technique to repair a subxiphoid incisional hernia. Adjusted double mesh technique may represent an effective approach with a low complication rate, although globally analyzing the recurrence rate, aponeurosis closure over the preperitoneal mesh entails less impact on it.
RESUMO
BACKGROUND: The goal of our study was to compare results in patients with large midline incisional hernia using modified anterior component separation versus preoperative botulinum toxin and following Rives repair, with a focus on surgical site occurrences, possibility of fascial closure, duration of hospital stay, and hernia recurrence rate. METHODS: From to March 2016 to June 2019, a prospective comparative study was performed in 80 consecutive patients with large midline incisional hernias and hernia transverse diameters between 11 and 17 cm under elective hernia repair at our tertiary center. Two groups were analyzed prospectively: 40 patients with preoperative botulinum toxin administration and following open Rives repair (botulinum toxin group) were compared with 40 patients who underwent open component separation during that period (component separation group). RESULTS: All large midline incisional hernias were classified W3, with mean transverse and longitudinal defect diameters of 14.9 cm (11.8-16.5) and 24 cm (11-28), respectively. Complete fascial closure was possible in all patients in the preoperative botulinum toxin group. No complications occurred during the administration of preoperative botulinum toxin, but surgical site complications were most frequent in the component separation group, especially skin necrosis (12.5%, P = .020). At a median of 19.6 months (range, 11-35) of postoperative follow-up, 2 cases of hernia recurrence (8.9%) were reported, all of them in the component separation group. CONCLUSION: Botulinum toxin allows getting a successful downstaging from surgical repair to Rives technique in patients with large midline incisional hernia, especially with hernia transverse diameters between 11 and 17 cm. These results contribute to minimize disadvantages associated to the anterior component separation.
Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Hérnia Ventral/terapia , Herniorrafia/métodos , Hérnia Incisional/terapia , Cuidados Pré-Operatórios/métodos , Músculos Abdominais/diagnóstico por imagem , Músculos Abdominais/cirurgia , Parede Abdominal/diagnóstico por imagem , Parede Abdominal/cirurgia , Adulto , Idoso , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Hérnia Ventral/diagnóstico , Humanos , Hérnia Incisional/diagnóstico , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tomografia Computadorizada por Raios XRESUMO
Objectives: Preoperative botulinum toxin type A (BT) and progressive pneumoperitoneum (PPP) are useful tools in the preparation of patients with loss of domain hernias (LODH). The purpose of our retrospective study is to report our experience in the treatment of 100 consecutive patients with LODH, with the combined use of these techniques. Methods: Of the 753 patients operated on for ventral incisional hernia between June 2010 and December 2018 in our hospital, 100 patients with LODH were analyzed retrospectively. Diameters of abdominal cavity and hernia sac, and volumes of incisional hernia (VIH) and abdominal cavity (VAC) were calculated from CT scan, based on the index of Tanaka. Results: The median insufflated volume of air for PPP was 8,600 ± 4,200 cc (4,500-15,250). BT administration time was 38.2 days (33-48). A significant average reduction of 15% of the VIH/VAC ratio was observed on CT scan after the combination of PPP and BT (p = 0.001). Anterior component separation (CST) and transversus abdominis release (TAR) were the most frequent repair techniques. Complete fascial closure was possible in 97%, and mesh bridging was needed in three cases. In postoperative follow-up of 34.5 months (11-62), we reported eight cases of hernia recurrence (8%). Conclusion: PPP and BT are useful tools in the treatment of LODH. These techniques significantly reduce the VIH/VAC ratio, allowing the reduction of the hernia content into the abdominal cavity, which represents a key factor in the management of these hernias.
RESUMO
INTRODUCTION: Incisional hernias secondary to renal transplantation (IHRT) are considered complex hernias because they are lateral to the sheath of the rectus abdominis muscle. The presence of the graft in the iliac fossa and the proximity to the inguinal area, costal margin and iliac bones, as zones with difficult fixation for prostheses, increases repair complexity. In addition, these patients have specific characteristics, such as treatment with immunosuppressive medication, that could alter postoperative evolution. The objective of this study was to analyze the results obtained in IHRT repair at a tertiary hospital, and to compare these data with the international literature. METHODS: Retrospective observational study of patients treated surgically for IHRT in our unit from January 1, 2011 to January 31, 2018. Preoperative conditions, intraoperative factors and postoperative complications during follow-up were analyzed. RESULTS: Twenty-five patients underwent hernia repair, finding a 4% hernia recurrence rate during a median follow-up of 27.5 months (20-39). The most frequently used technique was the posterior transversus abdominis release component separation technique in 42%, followed by preperitoneal repair in 27% and interoblique repair in 12%. The overall postoperative morbidity was 23%, which was frequently related to the surgical site (12%). CONCLUSIONS: IHRT repair is a safe procedure at our medical center, with an acceptable rate of hernia recurrence, but it is not without complications.