A Fafaj, L Tastaldi, H Alkhatib, S J Zolin, S Rosenblatt, L-C Huang, S Phillips, D M Krpata, A S Prabhu, C C Petro, M J Rosen
BACKGROUND: An enterocutaneous fistula (ECF) with an associated large hernia defect poses a significant challenge for the reconstructive surgeon. We aim to describe operative details and 30-day outcomes of elective hernia repair with an ECF when performed by surgeons participating in the Abdominal Core Health Quality Collaborative (ACHQC). STUDY DESIGN: Patients undergoing concomitant hernia and ECF elective repair were identified within the ACHQC. Outcomes of interest were operative details and 30-day rates of surgical site infections (SSI), surgical site occurrences requiring procedural intervention (SSOPI), medical complications, and mortality...
January 2, 2021: Hernia: the Journal of Hernias and Abdominal Wall Surgery
Lindsey L Wolf, Kristin A Sonderman, Nicollette K Kwon, Lindsey B Armstrong, Brent R Weil, Tracey P Koehlmoos, Elena Losina, Robert L Ricca, Christopher B Weldon, Adil H Haider, Samuel E Rice-Townsend
PURPOSE: We sought to estimate the prevalence, incidence, and timing of surgery for elective and non-elective hernia repairs. METHODS: We performed a retrospective cohort study, abstracting data on children < 18 years from the 2005-2014 DoD Military Health System Data Repository, which includes > 3 million dependents of U.S. Armed Services members. Our primary outcome was initial hernia repair (inguinal, umbilical, ventral, or femoral), stratified by elective versus non-elective repair and by age...
January 1, 2021: Pediatric Surgery International
Ali P Mourad, Marie Shella De Robles, Robert D Winn
Background: Complex ventral hernias following laparotomy present a unique challenge in that repair is hindered by the lateral tension of the abdominal wall. A novel approach to overcome this is the "chemical component separation" technique. Here, botulinum toxin A (BTA) is instilled into the muscles of the abdominal wall. This induces flaccid paralysis and effectively reduces tension in the wall, allowing the muscles to be successfully joined in the midline during surgery. We describe a method where a large incisional hernia was repaired using this technique and review the variations in methodology...
December 28, 2020: Medicina
John Scott Roth, Gary J Anthone, Don J Selzer, Benjamin K Poulose, Richard A Pierce, James G Bittner, William W Hope, Raymond M Dunn, Robert G Martindale, Matthew I Goldblatt, David B Earle, John R Romanelli, Gregory J Mancini, Jacob A Greenberg, John G Linn, Eduardo Parra-Davila, Bryan J Sandler, Corey R Deeken, Jasenka Verbarg, Jennifer L Salluzzo, Guy R Voeller
Background: This study represents a prospective, multicenter, open-label study to assess the safety, performance, and outcomes of poly-4-hydroxybutyrate (P4HB, Phasix™) mesh for primary ventral, primary incisional, or multiply-recurrent hernia in subjects at risk for complications. This study reports 3-year clinical outcomes. Materials and methods: P4HB mesh was implanted in 121 patients via retrorectus or onlay technique. Physical exam and/or quality of life surveys were completed at 1, 3, 6,12, 18, 24, and 36 months, with 5-year (60-month) follow-up ongoing...
January 2021: Annals of Medicine and Surgery
Eva Barbara Deerenberg, Sharbel Adib Elhage, Jenny Meng Shao, Robert Lopez, Robert Joseph Raible, Kent Williams Kercher, Paul Dominick Colavita, Vedra Abdomerovic Augenstein, B Todd Heniford
BACKGROUND: Fascial closure significantly reduces postoperative complications and hernia recurrence after abdominal wall reconstruction (AWR), but can be challenging in massive ventral hernias. METHODS: A prospective single-institution cohort study was performed to examine the effects of preoperative injection of botulinum toxin A (BTA) in patients undergoing AWR for midline or flank hernias. RESULTS: A total of 108 patients underwent BTA injection with average 243 units, mean 32...
December 23, 2020: Journal of Surgical Research
Xiaodong Phoenix Chen, Amalia Cochran, Alan E Harzman, E Christopher Ellison
INTRODUCTION: We evaluated the effect of an operative coaching (OC) model on general surgery chief residents' operative efficiency (OE) measured by operative times. We hypothesized that higher levels of entrustment surgeons intend to offer resident in future similar cases are associated with improved OE. MATERIALS AND METHODS: From July 2018 to June 2019, we used a validated instrument to score prospective resident entrustment in 228 evaluations of 6 chief residents during 12 OC sessions each (3 lap colectomy, 3 lap cholecystectomy, 3 ventral hernia, 3 inguinal hernia)...
December 22, 2020: Journal of Surgical Education
Joseph G Brungardt, Quinn A Nix, Kurt P Schropp
BACKGROUND: Congenital diaphragmatic hernia (CDH) is a pathology most often affecting the pediatric population, although adults can also be affected. Few studies exist of adults undergoing repair of this defect. Using a national database, we sought to determine demographics and outcomes of this population. METHODS: An analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database (2015-2018) was performed, capturing patients with postoperative diagnosis of CDH, distinct from ventral hernia...
December 19, 2020: American Surgeon
Marc Miserez, Rolf Lefering, Federico Famiglietti, Tim Mathes, Dörthe Seidel, Stefan Sauerland, Dragan Korolija, Markus Heiss, Gyorgy Weber, Ferdinando Agresta, Willem-Hans Steup, Maciej Śmietański, Rui Ribeiro, Diego Cuccurullo, Fausto Catena, Claudia Rudroff, Georg Rosanelli, Fabian Schön, Bart Smet, Frank Wenger, Stefano Saad, Lars Naver, Edmund Neugebauer
OBJECTIVE: The aim of this study was to investigate the approach (open or laparoscopic) and mesh type (synthetic or biological) in ventral hernias in a clean setting.Summary of Background Data: The level of evidence on the optimal surgical approach and type of mesh in ventral hernia repair is still low. METHODS: Patients with a ventral abdominal hernia (diameter 4-10 cm) were included in this double-blind randomized controlled trial across 17 hospitals in 10 European countries...
January 1, 2021: Annals of Surgery
Crystal S Shin, Fernando J Cabrera, Richard Lee, John Kim, Remya Ammassam Veettil, Mahira Zaheer, Aparna Adumbumkulath, Kirti Mhatre, Pulickel M Ajayan, Steven A Curley, Bradford G Scott, Ghanashyam Acharya
Development of inflammation modulating polymer scaffolds for soft tissue repair with minimal postsurgical complications is a compelling clinical need. However, the current standard of care soft tissue repair meshes for hernia repair is highly inflammatory and initiates a dysregulated inflammatory process causing visceral adhesions and postsurgical complications. Herein, the development of an inflammation modulating biomaterial scaffold (bioscaffold) for soft tissue repair is presented. The bioscaffold design is based on the idea that, if the excess proinflammatory cytokines are sequestered from the site of injury by the surgical implantation of a bioscaffold, the inflammatory response can be modulated, and the visceral adhesion formations and postsurgical complications can be minimized...
December 16, 2020: Advanced Materials
Ryan Howard, Emily Johnson, Nicholas L Berlin, Zhaohui Fan, Michael Englesbe, Justin B Dimick, Dana A Telem
BACKGROUND: Ventral hernia repair is an extremely common operation, however the variability in patient outcomes between individual hospitals and surgeons is unclear. We analyzed variability in 30-day complication rates and identified specific complications that contributed to this variability. METHODS: Retrospective, cross-sectional analysis of 30-day complication rates following ventral hernia repair across 73 hospital and 978 surgeons between January 1, 2014 and December 31, 2018...
December 11, 2020: American Journal of Surgery
Sasha Kurumety, Austin Walker, Jonathan Samet, Thomas Grant, Gregory A Dumanian, Swati Deshmukh
Preoperative ultrasound-guided lateral abdominal wall botulinum toxin injection is a promising method for improving patient outcomes and reducing recurrence rates after ventral hernia repair. A review of the literature demonstrates variability in the procedural technique, without current standardization of protocols. As radiologists may be increasingly asked to perform ultrasound-guided botulinum toxin injections of the lateral abdominal wall, familiarity with the procedure and current literature is necessary...
December 15, 2020: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
Hailie Ciomperlik, Naila H Dhanani, Nicolas Cassata, Cassandra Mohr, Karla Bernardi, Julie L Holihan, Nicole Lyons, Oscar Olavarria, Tien C Ko, Mike K Liang
BACKGROUND: Recurrence is often reported as the primary outcome among studies of patients with hernias; however, there is growing interest in patient quality of life. The relationship between quality of life and recurrence is poorly understood. This study evaluates this relationship. METHODS: A secondary analysis of 3 prospective clinical trials was performed. The modified Activities Assessment Scale, a validated, abdominal wall-specific quality of life tool was used (1 = poor quality of life and 100 = perfect quality of life)...
December 11, 2020: Surgery
Kryspin Mitura, Anna Rzewuska, Marzena Skolimowska-Rzewuska, Michał Romańczuk, Krystian Kisielewski, Dorota Wyrzykowska
Introduction: Incisional hernias can complicate up to one in four laparotomy procedures, and successful repair remains a significant clinical challenge for surgeons. Recently, the surgical technique of ventral hernia repair (eTEP-RS) has been introduced. Aim: To present early results in treating patients with ventral hernia using the eTEP-RS technique and to discuss key technical aspects affecting the safety and efficiency of repair. Material and methods: A prospective study of early outcomes was conducted for all ventral hernia patients (hernia orifice between 4 and 8 cm) who underwent eTEP-RS between March 2019 and July 2020...
December 2020: Videosurgery and Other Miniinvasive Techniques
Aldo Fafaj, David M Krpata, Clayton C Petro, Ajita S Prabhu, Steven Rosenblatt, Luciano Tastaldi, Hemasat Alkhatib, Chao Tu, Samuel J Zolin, Jonah D Thomas, Adele M Costanzo, Michael J Rosen
OBJECTIVE: To study the efficacy of liposomal bupivacaine on postoperative opioid requirement and pain following abdominal wall reconstruction. SUMMARY BACKGROUND DATA: Despite the widespread use of liposomal bupivacaine in transversus abdominis plane block, there is inadequate evidence demonstrating its efficacy in open abdominal wall reconstruction. We hypothesized that liposomal bupivacaine plane block would result in decreased opioid requirements compared to placebo in the first 72 hours after surgery...
December 2, 2020: Annals of Surgery
Oscar A Olavarria, Karla Bernardi, Naila H Dhanani, Nicole B Lyons, John A Harvin, Stefanos G Millas, Tien C Ko, Lillian S Kao, Mike K Liang
Background: Many surgeons utilize biologic mesh for elective complex ventral hernia repair (VHR; large hernias, contaminated fields, or patients with comorbid conditions). However, no randomized controlled trials (RCTs) have compared biologic and synthetic mesh. We hypothesize biologic mesh would result in fewer major complications at one-year post-operative compared with synthetic mesh. Patients and Methods: We performed a single-center, pilot RCT. All eligible patients undergoing complex, open VHR were randomly assigned to receive biologic or synthetic mesh placed in the retromuscular position...
December 1, 2020: Surgical Infections
Alejandro Martín-Mattar, Rigoberto Isarraraz-Flores, Juan P Ávila
Background: Spiegel hernia is a rare type of ventral hernia that occurs when there is a defect in the semilunar line (Spiegel line) through which there is protrusion of preperitoneal fat or a peritoneal sac with or without an intra-abdominal viscus. Clinical case: A 52-year-old female patient admitted for abdominal pain and tumor in the lower right quadrant of 15 cm. In the operating room, wall plasty was performed and when hernia sac was opened, necrotic appendicitis was identified...
2020: Cirugia y Cirujanos
Patrik Petersson, Ulf Petersson
Introduction: Several different temporary abdominal closure techniques are described in the context of open abdomen treatment. Techniques based on dynamic fascial closure combined with negative pressure therapy have gained popularity and seem to result in the highest fascial closure rates without increased complications and are highlighted in recent guidelines and recommendations. One dynamic closure technique is the vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) technique, first described in 2007...
2020: Frontiers in Surgery
Jenny M Shao, Eva B Deerenberg, Sharbel A Elhage, Tanu Prasad, Bradley R Davis, Kent W Kercher, Paul D Colavita, Vedra A Augenstein, B Todd Heniford
BACKGROUND: Recurrent ventral hernia repairs are reported to have higher recurrence and complication rates than initial ventral hernia repairs. This is the largest analysis of outcomes for initial versus recurrent open ventral hernia repairs reported in the literature. METHODS: A prospective, institutional database at a tertiary hernia center was queried for patients undergoing open ventral hernia repairs with complete fascial closure and synthetic mesh placement...
November 25, 2020: Surgery
Amina I Abuabakar, Elijah N Miner
Ventral hernia is a common complication of abdominal surgeries, with the incidence of up to 20% in some series. Giant ventral hernia is that with a neck more than 10 cm wide. The loss of abdominal domain due to the shift of viscera into the hernia sac could lead to the complication after surgery. A 54-year-old female presented with a giant pedunculated ventral hernia. She had low tension mesh repair through a transverse suprapubic incision. The surgical repair of giant hernia with mesh has led to reduced complications...
October 2020: Annals of African Medicine
Shiva M Rangwani, Casey T Kraft, Steven J Schneeberger, Ibrahim Khansa, Jeffrey E Janis
Ventral hernias have numerous etiologies ranging from sequelae of surgical procedures to congenital deformities. Patients suffering from these hernias experience a reduced quality of life through pain, associated complications, and physical disfigurement. Therefore, it is important to provide these patients with a steadfast repair that restores functionality and native anatomy. In order to do this, techniques and materials for abdominal wall reconstruction have advanced throughout the decades leading to durable surgical repairs...
November 2, 2020: Plastic and Reconstructive Surgery
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