International Journal of Abdominal Wall and Hernia Surgery最新文献

{"title":"Endoscopic and endoscopically assisted mini or less open sublay mesh repair (EMILOS and MILOS) of abdominal wall hernias: Update and 10-year experience of a single insitution","authors":"W. Reinpold, C. Berger, R. Bittner","doi":"10.4103/ijawhs.ijawhs_61_22","DOIUrl":"https://doi.org/10.4103/ijawhs.ijawhs_61_22","url":null,"abstract":"Introduction: Abdominal wall hernia and incisional hernia repair are among the most frequent operations in general surgery. However, despite the use of mesh and other recent improvements, the open mesh techniques and laparoscopic IPOM repair have specific disadvantages and risks. Materials and Methods: To minimize complications of the existing open and laparoscopic techniques we developed the endoscopic Mini- or Less Open Sublay (EMILOS) and endoscopically assisted Mini- or Less Open Sublay (MILOS) concept. We report on our large series of minimally invasive sublay repair of and ventral incisional hernias. The operation is performed transhernially with light-holding laparoscopic instruments either under direct, or endoscopic visualization, while the abdominal wall is circumferentially elevated with retractors. An endoscopic light tube was developed to facilitate this approach (Endotorch,TM Wolf Company). Each MILOS operation can be converted to standard total extraperitoneal gas endoscopy (EMILOS repair) once an extraperitoneal space of at least 8 cm has been created. The technique allows minimal invasive repair of ventral hernias with concomitant rectus diastasis. In large eventrations E/MILOS m. transversus abdominis release (TAR) can be performed. All MILOS operations were prospectively documented in the German Hernia registry Herniamed. Technical modifications and improvements from the inception of the E/MILOS concept including variants of the EMILOS technique are addressed. Results: The total and surgical complication rates of 1745 E/MILOS incisional hernia operations were 4.6% and 3.1%, respectively. The reoperation rate was 1.7%. Haemorrhage, seroma, enterotomy, infection and bowel obstruction were detected in 1.0, 0.9, 0.2, 0.3 and 0.4 percent of the cases, respectively. The recurrence rate after one year was 1.2%. Chronic pain at rest, at activities and chronic pain requiring therapy was reported in 3.8, 7.4 and 3.6 percent, respectively. Conclusion: The MILOS technique allows minimally invasive transhernial repair of incisional hernias using large retromuscular / preperitoneal meshes with low morbidity. The technique is reproducible, cost effective, easy to standardize and combines the advantages of open sublay and the laparoscopic IPOM repair.","PeriodicalId":34200,"journal":{"name":"International Journal of Abdominal Wall and Hernia Surgery","volume":"45 1","pages":"165 - 178"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84887278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of diaphragmatic omental hernias by radiology: A prevalence study","authors":"F. Çankal, B. Demir, Ali Köksal","doi":"10.4103/ijawhs.ijawhs_44_22","DOIUrl":"https://doi.org/10.4103/ijawhs.ijawhs_44_22","url":null,"abstract":"INTRODUCTION: This study aimed to describe the radiological features of omental hernias originating from the diaphragm and their localization on the diaphragm, examine their relationship with the thoracic and abdominal organs, and present guiding data to clinicians in operational planning. MATERIALS AND METHODS: This study was obtained as a result of retrospective scanning of the images of 824 patients aged 18–65 who applied for thorax and/or upper abdomen computerized tomography (CT). The patients’ thorax and upper abdomen regions were examined in detail and divided into two groups of individuals with and without hernias. Hernia types, content, localization, and effect types of patients with hernia were recorded and analyzed separately. RESULTS: Diaphragmatic hernia was detected in 197 (23.9%) of 824 patients. While 50.8% of these patients were female, 49.2% were male. Of the patients diagnosed with diaphragmatic hernia, 49.2% (n = 97) had Morgagni hernia, 30.5% (n = 60) had Bochdalek hernia, and 17.8% had hiatal hernia. While Morgagni hernia had anterior localization in 82.5%, Bochdalek hernia was generally localized on the left side (75.8%), and hiatal hernias were sliding type with a rate of 84.2%. The highest effect was observed in Bochdalek hernias (71.1%). Omental tissue (59.4%) was observed most frequently in Morgagni hernias, while stomach content (91.9%) was found to be the highest in hiatal hernias (P < 0.05). DISCUSSION–CONCLUSION: Diaphragmatic omental hernias are rare. The rarity, as well as the uncertain and nonspecific presentations, contributes to the retard in diagnosis. Commonly, the presentation in the adult age group is that of recurrent chest infection and rarely with gastroesophageal reflux and esophagitis. Physicians caring for these patients should be aware of this, and a high index of suspicion is recommended to obviate delay in diagnosis with its associated morbidity. We think the radiological features of diaphragmatic hernias should be detailed in determining and applying the optimal treatment approach. In addition, contrary to what was thought, we found that the prevalence of diaphragmatic hernia in our population is higher than that reported in the literature.","PeriodicalId":34200,"journal":{"name":"International Journal of Abdominal Wall and Hernia Surgery","volume":"6 1","pages":"192 - 199"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75145607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current status of inguinal hernia management: A review","authors":"Patrick J. McBee, R. Walters, R. Fitzgibbons","doi":"10.4103/ijawhs.ijawhs_36_22","DOIUrl":"https://doi.org/10.4103/ijawhs.ijawhs_36_22","url":null,"abstract":"Groin hernias are the most common reason for primary care physicians to refer patients for surgical management. Patients often present with a bulge in the groin that is associated with pain in two-thirds of cases. Diagnosis is usually clinical, with physical exam and history being sufficient enough to confirm diagnosis without imaging. Groin hernias may be associated with morbidity and can become complicated by incarceration or strangulation, requiring emergent surgical repair. However, the risk of strangulation is sufficiently low in asymptomatic or minimally symptomatic patients with inguinal hernias that an initial approach of watchful waiting is safe and appropriate. Chronic pain and hernia recurrence are other potential complications that support a watchful waiting approach in asymptomatic patients. Patients with symptomatic hernias should be offered surgical repair. The objective of this paper is to review the current status of the clinical diagnosis and management of patients with inguinal hernias.","PeriodicalId":34200,"journal":{"name":"International Journal of Abdominal Wall and Hernia Surgery","volume":"23 1","pages":"159 - 164"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81879267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility of robotic repair of parastomal hernias","authors":"Kyle Schmitt, Vance L. Albaugh, K. LeBlanc","doi":"10.4103/ijawhs.ijawhs_87_21","DOIUrl":"https://doi.org/10.4103/ijawhs.ijawhs_87_21","url":null,"abstract":"BACKGROUND: Parastomal hernias present a common complex surgical problem that has a severe clinical impact on quality of life. Several techniques for repair have been described with open or minimally invasive techniques, although recurrence and reoperation continue to be common problems. In the following, a case series utilizing a technique for a minimally invasive repair using the Di Vinci robotic platform for a mesh-reinforced, modified Sugarbaker repair is described. STUDY DESIGN: This study is a retrospective review of 24 cases of robotic-assisted parastomal hernia repairs performed by a single surgeon from 2014 to 2020. Primary endpoints of interest were operative times and length of stay, as well as postoperative complications. RESULTS: Twenty-four patients were included in the study. The average operative time was 194.8 min (range: 95–378 min) and the average console time was 149.5 min (range: 72–319 min). The average length of stay was 3.9 days. No patients required conversion to either a laparoscopic or an open procedure, although two complications required reoperation. Twelve patients developed minor complications, including four who developed a postoperative seroma, but none of them required surgical intervention. CONCLUSIONS: This is the first and largest series describing a technique for a robotic-assisted parastomal hernia repair. This shows that this procedure can be reliably undertaken with the robotic platform with consistent and reproducible results and few complications. Further long-term research will be needed as new robotic techniques evolve and patients will need follow-up regarding recurrence rates and any late complications evaluated.","PeriodicalId":34200,"journal":{"name":"International Journal of Abdominal Wall and Hernia Surgery","volume":"3 1","pages":"116 - 121"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81667222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing safety in ventral patch repair for umbilical hernia by utilizing a hybrid technique","authors":"R. Jhaveri, Vishakha Kalikar, R. Modi, R. Patankar","doi":"10.4103/ijawhs.ijawhs_26_22","DOIUrl":"https://doi.org/10.4103/ijawhs.ijawhs_26_22","url":null,"abstract":"BACKGROUND: Both suture and mesh repairs are used for smaller (1-3 cm) umbilical hernias. But primary repair has a higher recurrence rate in literature. The use of mesh repairs has become the way to go for small and medium sized ventral hernias. Ventral patch placement is a simple and effective procedure for the repair of umbilical hernias of 1–3 cm size. We demonstrate the safety and efficacy of the ventral patch for the same with our modification of the technique in 100 consecutive patients. We would initially insert the patch as described by the company, but had one patient presenting with intestinal obstruction, who on diagnostic laparoscopy had a small bowel loop entrapped between the patch and the anterior abdominal wall. This brought about a change in the original technique at our institute, which we adopted for all patients thereafter. MATERIALS AND METHODS: A single centre retrospective analysis of prospectively collected data was done. Our modified technique was done in 100 consecutive patients with umbilical hernia defect size ranging from 1 cm to 2.5 cm, from January 2017 to January 2021. Demographics, post-operative pain, duration of hospital stay, surgical site occurrences (early and late), post-operative complications and recurrences were noted. RESULTS: A total of 100 patients were included in the study. Two patients had superficial surgical site infection which was managed conservatively. We did not record any other major complications or recurrence. Visual analogue scale for pain was recorded at 24 hours. Majority (95%) of the patients had none to mild pain and were discharged at 24 hours. Five patients experienced moderate pain and were discharged at 36–48 hours. No patient experienced chronic pain at follow up. CONCLUSION: The hybrid technique of the ventral patch placement is a safe way for optimum visualization for the correct mesh placement and may improve results, decrease complications and recurrences.","PeriodicalId":34200,"journal":{"name":"International Journal of Abdominal Wall and Hernia Surgery","volume":"5 1","pages":"129 - 134"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81535159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When hernia mesh erodes into the bowel: A “bezoar” case","authors":"I. Nair, Kellee Slater","doi":"10.4103/ijawhs.ijawhs_88_21","DOIUrl":"https://doi.org/10.4103/ijawhs.ijawhs_88_21","url":null,"abstract":"Incisional hernia repair surgery is commonly performed by using a synthetic mesh; due to its low complication rate. This article describes the management of a patient with mesh erosion into the small bowel, a rare complication of mesh-based ventral hernia repair. Fatigue secondary to iron-deficiency anemia and disfigurement from his hernia were his only symptoms. The patient was conservatively managed for several years due to the risks associated with restorative surgery. Eventually, due to deterioration of his health as well as advances in the techniques of abdominal wall reconstruction, the patient underwent surgery. The patient made excellent recovery. The complications associated with the synthetic mesh are likely to be very underreported. This article discusses the factors leading to mesh erosion, including mesh type, fixation methods, mesh migration, and mesh position, and it emphasizes the importance of reporting and following up hernia patients to advance the science behind mesh technology and surgical techniques surrounding ventral hernia repair.","PeriodicalId":34200,"journal":{"name":"International Journal of Abdominal Wall and Hernia Surgery","volume":"40 1","pages":"150 - 153"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76273414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"To compare the outcome of inguinal hernia repair under local and spinal anesthesia","authors":"N. Maurya, Shadab Asif, Saleem Tahir, Kumar Aishwarya, Swarnlata Shiromani","doi":"10.4103/ijawhs.ijawhs_7_22","DOIUrl":"https://doi.org/10.4103/ijawhs.ijawhs_7_22","url":null,"abstract":"INTRODUCTION: The most frequent form of hernia is inguinal hernia, affecting around 15% of adult males. The optimal surgical anesthetic method for ambulatory inguinal hernia repair is unknown at the moment, and there is no consensus on the procedure. The goal of this study was to examine the outcome of inguinal hernia repair under local anesthesia compared with spinal anesthesia. MATERIALS AND METHODS: In this prospective observational study, 80 patients were randomly assigned into two groups by the SNOSE method with a different mode of anesthesia: group SA (n = 40) and group LA (n = 40). Lichtenstein tension-free hernioplasty was done in all patients. Pre- and post-OP clinical examinations (3rd day) were looked for complications. RESULTS: There were no significant demographic differences between the two groups. When compared with the SA group, the LA group experienced much less post-operative pain. With local anesthesia, post-operative ambulation was substantially faster. The use of a local anesthetic allowed for a shorter stay in the hospital and a speedy return to regular activity. In general, local anesthesia was linked to less post-operative complications in the early aftermath. CONCLUSION: Local anesthesia is a preferable choice to spinal anesthesia for short stay or daycare surgery, particularly for patients who are unable to tolerate spinal anesthesia. As a result, Lichtenstein’s hernioplasty performed under local anesthesia is attracting considerable interests in the field of groin hernia repair.","PeriodicalId":34200,"journal":{"name":"International Journal of Abdominal Wall and Hernia Surgery","volume":"6 1","pages":"122 - 128"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84409438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is there a link between mesh implantation and systematic autoimmune disease?","authors":"Junsheng Li, X. Shao, T. Cheng, Z. Ji","doi":"10.4103/ijawhs.ijawhs_1_22","DOIUrl":"https://doi.org/10.4103/ijawhs.ijawhs_1_22","url":null,"abstract":"Autoimmune/autoinflammatory syndrome induced by adjuvants (ASIA)/“Shoenfeld’s syndrome” corresponds to a spectrum of immune-mediated diseases triggered by exposure to various materials. Polypropylene (PP) mesh has become the standard for nearly all kinds of hernia repair. There are conflicting reports on the link between ASIA and PP mesh implantation for hernia repair. We reported a typical ASIA/“Shoenfeld’s syndrome” after inguinal hernia repair with PP mesh, and the patient′s systematic syndrome was completely alleviated after mesh removal. The present case highlights that there is a link between ASIA/“Shoenfeld’s syndrome” and hernia repair with PP mesh, although not frequently. Both surgeons and patients should bear in mind this disease, and patients should be fully informed before surgery, and registry is an important and possible tool to evaluate and determine the frequency of ASIA after hernia repairs with PP meshes.","PeriodicalId":34200,"journal":{"name":"International Journal of Abdominal Wall and Hernia Surgery","volume":"43 1","pages":"154 - 158"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80852489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic transversus abdominis release for ventral hernia repairs","authors":"Tiffany Nguyen, K. Kunes, Christine Crigler, C. Ballecer","doi":"10.4103/ijawhs.ijawhs_62_21","DOIUrl":"https://doi.org/10.4103/ijawhs.ijawhs_62_21","url":null,"abstract":"Background: Robotic transversus abdominis release (roboTAR) is a minimally invasive surgical approach for ventral hernia repairs that builds on the concepts developed by Rives and Stoppa. The Rives–Stoppa procedure incorporates Rives’ retromuscular repair and Stoppa’s concept of giant prosthetic reinforcement of the visceral sac (GPRVS).[1] In an effort to mitigate the limitations of the Rives–Stoppa procedure, Novitsky et al. developed the open transversus abdominis release (TAR). The TAR approach is favorable when repairing large ventral hernia defects, as it provides myofascial advancement to reconstitute linea alba, preserves the neurovascular bundles of the medial abdominal wall, and creates a large extraperitoneal space to allow for mesh reinforcement. Methods: The three main technical components of the roboTAR include the following: bottom-up, Novitsky method, and top-down approach. An understanding of the anatomy and technique involved in the three techniques is critical for performing roboTAR. Results: Within the authors’ practice, the average hernia defect size is 115 cm2. With a n = 200, approximately 1% of our patients has had a surgical site complication. Recurrences are rare and occur in very large complex hernias. The average operative time is approximately 400 min with an average length of stay being 1.2 days. This is consistent with others. Conclusion: Utilizing a minimally invasive approach, as seen in roboTAR, provides additional advantages, including shorter length of hospital stay, reduced wound morbidity, reduced postoperative pain, and expedited return to work and activities of daily living. This article is a comprehensive review of the pertinent anatomy, preoperative evaluation, operative technique, and the postoperative course of roboTAR.","PeriodicalId":34200,"journal":{"name":"International Journal of Abdominal Wall and Hernia Surgery","volume":"41 1","pages":"103 - 109"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83586874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic transabdominal preperitoneal morgagni hernia repair technique: A case report","authors":"C. Janowski, N. Sioda, Siwen Liu, A. Sabatino, C. Ballecer","doi":"10.4103/ijawhs.ijawhs_71_21","DOIUrl":"https://doi.org/10.4103/ijawhs.ijawhs_71_21","url":null,"abstract":"Robotic transabdominal preperitoneal Morgagni hernia repair: A step-wise approach. Morgagni hernia (MH) is an atypical and rare type of diaphragmatic hernia that presents surgical challenges given its location and proximity to vital structures. Classically, these hernias have been repaired either open or laparoscopically with the use of an intraperitoneal onlay mesh without defect closure. Borrowing from the groups’ excellent experience in robotic transabdominal preperitoneal hernia repair (rTAPP) ventral and atypically located hernias, this approach has shown promise in repairing MHs in albeit a small cohort of patients. The rTAPP technique in our opinion overcomes many of the challenges and pitfalls associated with atypical hernias, including those of the diaphragm, providing excellent visualization and facilitating wide preperitoneal dissection with a complete reduction of the hernia sac located in the anterior mediastinum. The wide preperitoneal exposure allows for directed diaphragmatic closure, minimizing the risk of injury to mediastinal structures, placement of a large uncoated mesh sandwiched in between layers of the abdominal wall, and safely targeted fixation at cardinal points. Preperitoneal mesh allows for the use of a more cost-effective uncoated mesh that is not exposed to the viscera. It also allows for minimal and targeted fixation without the use of tacks, leading to decreased postoperative pain and complications. In this article, we are detailing the rTAPP approach in managing MHs.","PeriodicalId":34200,"journal":{"name":"International Journal of Abdominal Wall and Hernia Surgery","volume":"70 1","pages":"135 - 139"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86272890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}