BACKGROUND Incisional hernia is one of the known complications of renal transplant surgery,with a reported incidence between 1.1%to 3.8%.Depending on the site and extent of incisional hernia,it may require surgery par...BACKGROUND Incisional hernia is one of the known complications of renal transplant surgery,with a reported incidence between 1.1%to 3.8%.Depending on the site and extent of incisional hernia,it may require surgery particularly if it contains the trans-planted kidney either partially or completely.The current common clinical prac-tice is to repair incisional hernias using polypropylene meshes,which have their own risks and benefits.Biological meshes,which are made from human or animal-derived connective tissue,are also in use and have a less inflammatory response.Recently,hybrid meshes have been developed.These are composed of both biological and synthetic products.One such example is OviTex 1S perma-nent,which is a sterile reinforced tissue matrix composed of ovine(sheep)derived extracellular matrix and monofilament polypropylene.In this case report,we are sharing our experience with the use of OviTex 1S in the repair of post-renal transplant incisional hernias.CASE SUMMARY We report four cases of post-renal transplant incisional hernia with a median time of 27 months post-surgery.The median size of the defect was 15 cm long.There was no post-operative complication.One patient required renal transplant biopsy after mesh repair,which was easily performed compared with polypropylene meshes repaired hernias in the past.CONCLUSION The OviTex 1S mesh provides benefits in hernial repairs pKTx,but cost is an issue,and their long-term viability is unclear.Continued use and reporting will help build a more informed picture.展开更多
BACKGROUND Incisional hernia(IH)is a common complication following liver transplantation(LT),contributing to significant morbidity and impaired quality of life.The interplay of transplant-specific factors,patient como...BACKGROUND Incisional hernia(IH)is a common complication following liver transplantation(LT),contributing to significant morbidity and impaired quality of life.The interplay of transplant-specific factors,patient comorbidities,surgical complexity,and immunosuppression presents considerable challenges in hernia repair,often accompanied by substantial risks.AIM To assess the incidence,risk factors,and outcomes of IH repair in LT recipients.METHODS A systematic literature search was conducted across MEDLINE,EMBASE,Scopus,CINAHL,the Cochrane Library,Google Scholar,and PubMed,yielding 493 results.In accordance with PRISMA guidelines,39 studies reporting on IH following LT were included in the final analysis.Studies involving paediatric populations,hernias unrelated to transplant incisions,living liver donors,non-LT,and multiorgan transplants were excluded.Meta-analysis was performed using Cochrane RevMan software.The study has been registered with PROSPERO(CRD420-24563398).RESULTS A review of 39 studies revealed incidence of post-LT IH ranging from 1.7%to upto 42.8%.Pooled analysis showed comparable demographics among groups and post-LT IH incidence was higher in older age recipients[mean difference(MD)=2.39,95%CI:1.15-3.63,P<0.001],male gender(relative risk=1.42,95%CI:1.18-1.72,P<0.001),high body mass index(BMI)(MD=1.06,95%CI:0.82-1.29,P<0.001),Mercedez-Benz incision type[odds ratio(OR)=0.45,95%CI:0.21,0.96,P=0.04],and need for re-laparotomy(OR=2.49,95%CI:1.05-5.93,P=0.04).No significant differences were found in recurrence rates or wound complications between open and laparoscopic IH repairs.CONCLUSION Older recipient age,male gender,high BMI,Mercedes-Benz incision,and re-laparotomy after LT are significant risk factors for IH.In contrast,model for end-stage liver disease score,pre-LT ascites,acute rejection,and mammalian target of rapamycin inhibitor therapy do not appear to influence IH development.While open repair remains the predominant approach post-LT,no significant differences in recurrence or wound complication rates have been observed between open and laparoscopic repairs.However,open repair is associated with a shorter operative time.展开更多
BACKGROUND Laparoscopic colorectal cancer surgery increases the risk of incisional hernia(IH)at the tumor extraction site.AIM To investigate the incidence of IH at extraction sites following laparoscopic colo-rectal c...BACKGROUND Laparoscopic colorectal cancer surgery increases the risk of incisional hernia(IH)at the tumor extraction site.AIM To investigate the incidence of IH at extraction sites following laparoscopic colo-rectal cancer surgery and identify the risk factors for IH incidence.METHODS This study retrospectively analyzed the data of 1614 patients who underwent la-paroscopic radical colorectal cancer surgery with tumor extraction through the abdominal wall at our center between January 2017 and December 2022.Diffe-rences in the incidence of postoperative IH at different extraction sites and the risk factors for IH incidence were investigated.RESULTS Among the 1614 patients who underwent laparoscopic radical colorectal cancer surgery,303(18.8%),923(57.2%),171(10.6%),and 217(13.4%)tumors were ex-tracted through supraumbilical midline,infraumbilical midline,umbilical,and off-midline incisions.Of these,52 patients developed IH in the abdominal wall,with an incidence of 3.2%.The incidence of postoperative IH was significantly higher in the off-midline incision group(8.8%)than in the middle incision groups[the supraumbilical midline(2.6%),infraumbilical midline(2.2%),and umbilical incision(2.9%)groups](χ^(2)=24.985;P<0.05).Univariate analysis showed that IH occurrence was associated with age,obesity,sex,chronic cough,incision infection,and combined diabetes,anemia,and hypopro-teinemia(P<0.05).Similarly,multivariate analysis showed that off-midline incision,age,sex(female),obesity,incision infection,combined chronic cough,and hypoproteinemia were independent risk factors for IH at the site of laparoscopic colorectal cancer surgery(P<0.05).CONCLUSION The incidence of postoperative IH differs between extraction sites for laparoscopic colorectal cancer surgery.The infraumbilical midline incision is associated with a lower hernia rate and is thus a suitable tumor extraction site.展开更多
Introduction: Incisional hernia is a common medical situation and its treatment has always been a challenge for general surgeons. If laparoscopic repair has become a gold standard elsewhere, it is increasingly done in...Introduction: Incisional hernia is a common medical situation and its treatment has always been a challenge for general surgeons. If laparoscopic repair has become a gold standard elsewhere, it is increasingly done in our milieu, but no data has been found. The aim of this study was to review this surgery done in our country so far, to describe the operative technique and to evaluate the postoperative outcomes. Patients and Methods: We conducted an observational descriptive study with retrospective collection of data from the 1<sup>st</sup> of July 2018 to 30<sup>th</sup> of June 2022, in three hospitals in Cameroon. Data on socio-demographic and clinical characteristics, surgical technique and postoperative outcomes of patients who had a laparoscopic repair of their incisional hernia were collected. Results: We reviewed 20 files. There were 14 women with an average age of 54.6 years. The average BMI was 32.8 kg/m<sup>2</sup>. Thirteen patients had a moderate size hernia and the hernia was localized at the midline in 18 cases. Only composite biface meshes were used with dimensions chosen to obtain at least 5 cm overlap. Spiral tacks were the only fixation means used. We registered 3 complications. One case of generalized peritonitis secondary to missed digestive perforation, one case of seroma and one case of postoperative ileus. We registered no death. Conclusion: Laparoscopic repair of incisional hernias is feasible in a resource-limited setting like ours. Compliance with the operative technique and recommendations is important to obtain short-term results closed to that put forward by literature.展开更多
Purpose： Metalloproteinases are a key component of the pathogenesis of abdominal hernias. Obesity is considered a risk factor in herniogenesis and hernia recurrence. The aim of this study was to evaluate the serum co...Purpose： Metalloproteinases are a key component of the pathogenesis of abdominal hernias. Obesity is considered a risk factor in herniogenesis and hernia recurrence. The aim of this study was to evaluate the serum concentrations of metalloproteinase-2（MMP-2）, MMP-9, MMP-13, and adiponectin in morbidly obese and nonoverweight controls. Materials and methods： The participants were recruited from among patients undergoing bariatric and non-bariatric surgery and divided into two groups： I（body mass index（BMI）≥35 kg/m^2, n=40） and II（BMI〈25 kg/m^2, n=30）. Serum concentrations of MMP-2, MMP-9, MMP-13, and adiponectin were measured using enzyme-linked immunosorbent assay（ELISA）. Results： A statistically significant difference between groups was observed for MMP-2 concentration. The median MMP-9 concentration was higher in the obese group, but the difference was not statistically significant. Median MMP-13 concentrations did not differ between groups. Serum adiponectin concentration was insignificantly higher in the non-obese group. Conclusions： The elevated serum MMP-2 and MMP-9 concentrations in obese individuals may be related to the higher incidence of incisional hernias in this population.展开更多
BACKGROUND Abdominal wall deficiencies or weakness are a common complication of tem-porary ostomies,and incisional hernias frequently develop after colostomy or ileostomy takedown.The use of synthetic meshes to reinfo...BACKGROUND Abdominal wall deficiencies or weakness are a common complication of tem-porary ostomies,and incisional hernias frequently develop after colostomy or ileostomy takedown.The use of synthetic meshes to reinforce the abdominal wall has reduced hernia occurrence.Biologic meshes have also been used to enhance healing,particularly in contaminated conditions.Reinforced tissue matrices(R-TMs),which include a biologic scaffold of native extracellular matrix and a syn-thetic component for added strength/durability,are designed to take advantage of aspects of both synthetic and biologic materials.To date,RTMs have not been reported to reinforce the abdominal wall following stoma reversal.METHODS Twenty-eight patients were selected with a parastomal and/or incisional hernia who had received a temporary ileostomy or colostomy for fecal diversion after rectal cancer treatment or trauma.Following hernia repair and proximal stoma closure,RTM(OviTex®1S permanent or OviTex®LPR)was placed to reinforce the abdominal wall using a laparoscopic,robotic,or open surgical approach.Post-operative follow-up was performed at 1 month and 1 year.Hernia recurrence was determined by physical examination and,when necessary,via computed tomo-graphy scan.Secondary endpoints included length of hospital stay,time to return to work,and hospital readmissions.Evaluated complications of the wound/repair site included presence of surgical site infection,seroma,hematoma,wound dehiscence,or fistula formation.RESULTS The observational study cohort included 16 male and 12 female patients with average age of 58.5 years±16.3 years and average body mass index of 26.2 kg/m^(2)±4.1 kg/m^(2).Patients presented with a parastomal hernia(75.0%),in-cisional hernia(14.3%),or combined parastomal/incisional hernia(10.7%).Using a laparoscopic(53.6%),robotic(35.7%),or open(10.7%)technique,RTMs(OviTex®LPR:82.1%,OviTex®1S:17.9%)were placed using sublay(82.1%)or intraperitoneal onlay(IPOM;17.9%)mesh positioning.At 1-month and 1-year follow-ups,there were no hernia recurrences(0%).Average hospital stays were 2.1 d±1.2 d and return to work occurred at 8.3 post-operative days±3.0 post-operative days.Three patients(10.7%)were readmitted before the 1-month follow up due to mesh infection and/or gastrointestinal issues.Fistula and mesh infection were observed in two patients each(7.1%),leading to partial mesh removal in one patient(3.6%).There were no complications between 1 month and 1 year(0%).CONCLUSION RTMs were used successfully to treat parastomal and incisional hernias at ileostomy reversal,with no hernia recurrences and favorable outcomes after 1-month and 1-year.展开更多
Among minimally invasive surgical procedures,colorectal surgery is associated with a notably higher incidence of incisional hernia(IH),ranging from 1.7% to 24.3%.This complication poses a significant burden on the hea...Among minimally invasive surgical procedures,colorectal surgery is associated with a notably higher incidence of incisional hernia(IH),ranging from 1.7% to 24.3%.This complication poses a significant burden on the healthcare system annually,necessitating urgent attention from surgeons.In a study published in the World Journal of Gastrointestinal Surgery,Fan et al compared the incidence of IH among 1614 patients who underwent laparoscopic colorectal surgery with different extraction site locations and evaluated the risk factors associated with its occurrence.This editorial analyzes the current risk factors for IH after laparoscopic colorectal surgery,emphasizing the impact of obesity,surgical site infection,and the choice of incision location on its development.Furthermore,we summarize the currently available preventive measures for IH.Given the low surgical repair rate and high recurrence rate associated with IH,prevention deserves greater research and attention compared to treatment.展开更多
Background and Aim: The incidence of incisional hernias has been reported to be around 15%. In the present scenario, a wide array of surgical procedures are available for their better management. In this study, we int...Background and Aim: The incidence of incisional hernias has been reported to be around 15%. In the present scenario, a wide array of surgical procedures are available for their better management. In this study, we intend to share our experience with one novel technique, “Hybrid IPOM (Intraperitoneal onlay meshplasty)” as a management option for a selected cohort of patients. Methods: This prospective study was undertaken during January 2019 to July 2023 at King Abdullah medical city, Makkah. A total of 51 cases were selected for Hybrid IPOM repair as per inclusion criteria;medium sized (4 - 10 cm) hernia defects;uncomplicated hernias;age more than 18 years. The follow-up period of the patients varied from 6 months to 4 years. The operation commenced with open hernia dissection, mesh deployment into abdomen, defect closure and then conversion to laparoscopy for the posterior mesh placement. Results: A total of 51 cases were repaired successfully with this technique. 48 out of 51 cases were incisional hernias secondary to some primary procedure done either for hernias itself or some other intra-abdominal pathology. The three cases were primary hernias falling in medium to large category with unaesthetic overlying skin. The age range was 19 to 72 years. The mean (range) operative time was 135 (90 - 240) min, and the average blood loss was 70 ml. The mean (range) hospital stay was 3 (2 - 11) days. All patients returned to routine work within 2 - 3 weeks of surgery. The median follow-up was 15 (6 - 48) months. Of the 51 cases, 3 patients developed seroma (managed conservatively), 1 patient developed a large hematoma (needed evacuation), and 1 patient developed superficial wound infection (managed with antibiotics). Two patients had recurrences;one patient had previously failed multiple repairs, and the other developed a postoperative hematoma. None of our patients had an iatrogenic bowel injury. Conclusion: Hybrid IPOM technique is a safe, feasible and easily reproducible technique. It may prove easier especially for beginners in laparoscopy, as it achieves faster and easy adhesiolysis thereby reducing operative time and easier establishment of the pneumoperitoneum. Besides, it gives the chance to excise ugly scars and improve the cosmesis.展开更多
Intraparietal Hernias are hernias occurring in the anterior abdominal wall at different anatomical planes. An interparietal hernia has a hernial sac that passes between the layers of the anterior abdominal wall. Appen...Intraparietal Hernias are hernias occurring in the anterior abdominal wall at different anatomical planes. An interparietal hernia has a hernial sac that passes between the layers of the anterior abdominal wall. Appendectomy is a very common surgical procedure, and post appendectomy incisional hernia is a very rare complication. Here we present a case of a 24-year-old male with swelling in the right hypochondrium and lumbar region with an open appendectomy scar. He was diagnosed to have an interparietal hernia in the anterior abdominal wall. After obtaining consent patient was taken up for surgery. At surgery, the patient was found to have a defect in the transverse abdominis muscle with a medial leaf far from the incision site. Open repair of the defect along with double breasting of external oblique done. Interparietal hernias are rare in post appendectomy scar and this case is of significance since it Highlights a rare interstitial type incisional hernia, as a complication of post appendectomy scar, and not many cases reports are mentioned in literature.展开更多
Objective:Transversus abdominus release(TAR)is often required to achieve apposition of the rectus muscles and achieve wide mesh reinforcement of the abdominal wall.Traditionally,TAR has been done with an open techniqu...Objective:Transversus abdominus release(TAR)is often required to achieve apposition of the rectus muscles and achieve wide mesh reinforcement of the abdominal wall.Traditionally,TAR has been done with an open technique(oTAR),and the benefits of the newer robotic approach(rTAR)has not been well established in the Australian setting.The aim of this study was to compare the results of oTAR with rTAR to demonstrate its safety and efficacy.Methods:A retrospective review of patients who underwent rTAR and oTAR at two tertiary hospitals was conducted between January 2018 and January 2020 in New South Wales,Australia.Patient demographics,perioperative and postoperative outcomes were compared in both groups.Results:There were 26 patients identified to have undergone TAR(13 rTAR,13 oTAR).Both groups were comparable in regards to age,sex and defect size.oTAR was associated with a higher American Society of Anaesthesiologist score.rTAR was associated with significantly longer average operative time(260.0±78.9 min vs.185.7±64.5 min,p=0.017)but found to have a significantly shorter length of stay(3.6±2.1 d vs.6.9±3.6 d,p=0.007)with a comparable complication rate.Conclusions:rTAR is associated with shorter length of hospital stay with comparable postoperative outcomes when compared to oTAR.We are seeing increasing evidence supporting the safety and benefits of robotics,however larger scale studies are required to fully understand this approach.展开更多
Background and Objectives: The aim of this study is to evaluate the usefulness of Magnetic Resonance Imaging (MRI) for planning surgery and postoperative control of complex cases of abdominal wall hernia. Methods: Inc...Background and Objectives: The aim of this study is to evaluate the usefulness of Magnetic Resonance Imaging (MRI) for planning surgery and postoperative control of complex cases of abdominal wall hernia. Methods: Included in a prospective data base with more than 350 patients treated in two centers, a prospective study over ten patients with complex incisional hernias was designed. In all cases, preoperative diagnosis study and postoperative imaging control by MR Imaging were established. In the early and late follow-up controls, local and general complications were specifically noted and studied by MRI in each case. Results: The preoperative MRI was effective method for an adequate understanding of the defects and hernia sack content. In the postoperative control, the MRI was useful in the follow-up of the mesh integration, detection of complications and diagnosis of the relapsing. Conclusion: In our experience the MRI test is specially recommended in the preoperative workup of complex cases of incisional hernia.展开更多
Objective Abdominal wall hernias,particularly midline primary and incisional types,represent a common and challenging surgical condition.The extended-view totally extraperitoneal(e-TEP)technique has recently been adap...Objective Abdominal wall hernias,particularly midline primary and incisional types,represent a common and challenging surgical condition.The extended-view totally extraperitoneal(e-TEP)technique has recently been adapted for ventral hernia repair,offering potential advantages over other approaches.This study aimed to evaluate the initial outcomes and institutional experience of the e-TEP technique for midline primary and incisional ventral hernia repair at a tertiary center in Vietnam.Methods This prospective descriptive study was conducted on 65 patients with midline primary or incisional ventral hernias who underwent e-TEP repair between June 2022 and August 2024.All procedures were performed by two experienced surgeons at the Department of General Surgery,Can Tho General Hospital,Vietnam.Follow-up continued until February 2025.Data were collected and analyzed on demographics,clinical characteristics,surgical details,postoperative outcomes,and recurrence.Results A total of 65 patients,with a mean age of 57.9±12.6 years,a mean BMI of 25.0±3.3 kg/m^(2),and 47(72.3%)female,were included.The types of hernias included primary hernias in 63.1%(41 patients)and incisional hernias in 36.9%(24 patients).Among the incisional hernias,3 cases were recurrences.The median defect area was 9 cm^(2)(range,1–50 cm2).A 15 cm×15 cm mesh was used in nearly all cases(98.5%).The mean operating time was 131.9±51.8 min,with no conversions to open repair or other procedures,and no intraoperative complications were observed.Nine patients(13%)experienced postoperative complications,with seroma being the most common(5 cases).Two patients sustained intestinal injuries that required reoperation,one developed a wound infection and one reported postoperative skin paresthesia.The mean visual analogue scale pain scores at postoperative 24 hours,48 hours,and at discharge were 4.3±1.3,3.0±1.5,and 1.0±0.4,respectively.The mean postoperative hospital stay was 4.52±2.24 d.Only one case of recurrence(1.5%)was observed,and no patient reported chronic pain during the mean follow-up period of 14.5±7.6 m.Conclusion The e-TEP technique for midline primary and incisional ventral hernia repair is a feasible and safe option when performed by experienced surgeons.It offers a low rate of complications,short hospital stay,and minimal recurrence rates.This technique can be considered a viable alternative for the management of midline ventral hernias,with promising short-term outcomes.展开更多
Aim:The utilization and outcomes of abdominal wall reconstruction(AWR)using advanced techniques such as component separation for incisional hernia(IH)repair following laparotomy in trauma populations has not been desc...Aim:The utilization and outcomes of abdominal wall reconstruction(AWR)using advanced techniques such as component separation for incisional hernia(IH)repair following laparotomy in trauma populations has not been described.The objective was to describe AWR with component separation(AWR-CS)utilization in this setting and to assess postoperative complications and readmissions.Methods:We identified adult patients admitted for IH repair(IHR)with a history of and admission for traumatic injuries with concurrent laparotomy in six geographically diverse statewide inpatient databases(2006-2015).AWR-CS was defined by ICD-9 codes corresponding to myocutaneous flap.Risk-adjusted logistic regression and generalized linear models were used to compare postoperative complications,30-day readmissions and cumulative costs associated with AWR-CS.Results:Of 952 patients with a history of trauma laparotomy who were admitted electively for IHR,6.8%underwent AWR-CS.Patients who underwent AWR-CS experienced increased complications[adjusted odds ratio 2.6(95%CI:1.48-4.57);P<0.001],cumulative costs(median$20,805 vs.$15,529;P<0.001)and longer length-of-stay(median days 6 vs.5;P=0.002).These differences were driven by postoperative complication,which were independently associated with increased length of stay[predicted mean difference 6.53 days(95%CI:4.66-8.41);P<0.001],costs[$14,550(95%CI:$9,258-19,841);P<0.001]and 30-day cumulative costs[$20,176(95%CI:$12,621-27,731);P<0.001]within risk-adjusted analyses.Conclusion:AWR-CS is part of the armamentarium needed to manage trauma laparotomy survivors who develop complex IH defects requiring surgical repair.It can result in increased complications that amplify postoperative healthcare utilization.Leverage of tools for the identification of high-risk patients,prehabilitation and enhanced surgical techniques is warranted to minimize postoperative complications in these patients.展开更多
BACKGROUND Internal hernia is a rare complication following abdominal surgery,primarily resulting from structural defects caused by anastomosis.We report a unique case of a late abdominal wall internal hernia highly s...BACKGROUND Internal hernia is a rare complication following abdominal surgery,primarily resulting from structural defects caused by anastomosis.We report a unique case of a late abdominal wall internal hernia highly suspected as resulting from insu-fficient peritoneal closure.CASE SUMMARY A 72-year-old woman presented with symptoms of intestinal obstruction 40 years after undergoing an abdominal hysterectomy.Abdominal computed tomography revealed a suspicious closed loop of intestine;then,a laparotomy was performed for suspected internal hernia.During the procedure,herniation of intestine into the preperitoneal space through a parietal peritoneal defect between rectus abdominis and sigmoid colon was identified.Intestinal reduction,resection of the ischemic segment and closure of the peritoneal defect were performed.The patient recovered well.CONCLUSION Non-closure of peritoneum might lead to late internal hernias.Meticulous peritoneal closure should be considered to prevent this potentially lethal complication.展开更多
BACKGROUND Severe intraabdominal adhesions and ventral hernias pose significant technical challenges in bariatric surgery,especially in patients with a history of complex abdominal procedures.CASE SUMMARY This report ...BACKGROUND Severe intraabdominal adhesions and ventral hernias pose significant technical challenges in bariatric surgery,especially in patients with a history of complex abdominal procedures.CASE SUMMARY This report describes a case involving a 30-year-old morbidly obese man who previously underwent a right lobe hepatectomy for living donor liver transplan-tation.The patient presented with a body mass index of 40.7 kg/m2 and a giant incisional hernia,compounded by extensive intraabdominal adhesions from mul-tiple previous surgeries.A laparoscopic sleeve gastrectomy was performed as the initial step of a staged surgical plan.Adhesiolysis was conducted carefully to address the dense intraabdominal adhesions,and the procedure was completed successfully using standard stapling techniques.Postoperative recovery was smooth,with significant weight loss achieved within the first month.CONCLUSION This case highlights the need for personalized surgical planning and precise techniques in bariatric surgery for patients with past abdominal operations.展开更多
BACKGROUND Incisional hernias are a common complication of previous surgeries and remain a persistent issue in clinical practice,posing a significant burden on healthcare systems despite advances in education and tech...BACKGROUND Incisional hernias are a common complication of previous surgeries and remain a persistent issue in clinical practice,posing a significant burden on healthcare systems despite advances in education and technology.Surgical techniques,primarily involving the use of mesh to cover the abdominal wall gap,are widely used as a standard intervention strategy.AIM To examine the regeneration of the aponeurosis defect in the anterior abdominal wall in rats using regenerative mimetic factors of the extracellular matrix[ReGeneraTing Agent(RGTA)],adipose tissue micrografts(ATM),and platelet rich plasma(PRP)as regenerative agents.METHODS Regenerative agents such as RGTA,ATM,and PRP are gaining popularity.ATM involves autologous adipose tissue cells with mesenchymal stem cell markers and a high percentage of stromal vascular fraction cells.RGTAs are heparan sulfate(HS)mimetics that replace degraded HSs in damaged tissue,enhancing the quality and speed of repair.PRP is a concentrated plasma preparation containing seven fundamental proteins responsible for tissue production.An acellular dermal matrix is a biological implant free of cellular or antigenic components,making it an excellent material for reconstructive surgery.Polyglactin is a synthetic,absorbable mesh that loses 50%of its strength after fourteen days,providing initial support for new tissue regeneration before being completely absorbed.RESULTS Rats will undergo a laparotomy with a precise 2 cm by 2 cm excision of the anterior abdominal wall fascia below the umbilicus.They will be divided into sixteen groups,each receiving different combinations of regenerative factor injections into the denervated area in both non-contaminated and contaminated environments.A collagenelastin matrix will be used to join the aponeurosis edges,with an absorbable polyglactin mesh anchored over it.Samples will be taken for macroscopic,histological,and immunohistochemical evaluation of tissue regeneration.CONCLUSION Our study aims to demonstrate how these factors promote cell proliferation and healing of the denervated anterior abdominal wall,potentially reducing the frequency and complications of incisional hernias.This approach could offer a more economical and efficient treatment option compared to current costly methods.展开更多
文摘BACKGROUND Incisional hernia is one of the known complications of renal transplant surgery,with a reported incidence between 1.1%to 3.8%.Depending on the site and extent of incisional hernia,it may require surgery particularly if it contains the trans-planted kidney either partially or completely.The current common clinical prac-tice is to repair incisional hernias using polypropylene meshes,which have their own risks and benefits.Biological meshes,which are made from human or animal-derived connective tissue,are also in use and have a less inflammatory response.Recently,hybrid meshes have been developed.These are composed of both biological and synthetic products.One such example is OviTex 1S perma-nent,which is a sterile reinforced tissue matrix composed of ovine(sheep)derived extracellular matrix and monofilament polypropylene.In this case report,we are sharing our experience with the use of OviTex 1S in the repair of post-renal transplant incisional hernias.CASE SUMMARY We report four cases of post-renal transplant incisional hernia with a median time of 27 months post-surgery.The median size of the defect was 15 cm long.There was no post-operative complication.One patient required renal transplant biopsy after mesh repair,which was easily performed compared with polypropylene meshes repaired hernias in the past.CONCLUSION The OviTex 1S mesh provides benefits in hernial repairs pKTx,but cost is an issue,and their long-term viability is unclear.Continued use and reporting will help build a more informed picture.
文摘BACKGROUND Incisional hernia(IH)is a common complication following liver transplantation(LT),contributing to significant morbidity and impaired quality of life.The interplay of transplant-specific factors,patient comorbidities,surgical complexity,and immunosuppression presents considerable challenges in hernia repair,often accompanied by substantial risks.AIM To assess the incidence,risk factors,and outcomes of IH repair in LT recipients.METHODS A systematic literature search was conducted across MEDLINE,EMBASE,Scopus,CINAHL,the Cochrane Library,Google Scholar,and PubMed,yielding 493 results.In accordance with PRISMA guidelines,39 studies reporting on IH following LT were included in the final analysis.Studies involving paediatric populations,hernias unrelated to transplant incisions,living liver donors,non-LT,and multiorgan transplants were excluded.Meta-analysis was performed using Cochrane RevMan software.The study has been registered with PROSPERO(CRD420-24563398).RESULTS A review of 39 studies revealed incidence of post-LT IH ranging from 1.7%to upto 42.8%.Pooled analysis showed comparable demographics among groups and post-LT IH incidence was higher in older age recipients[mean difference(MD)=2.39,95%CI:1.15-3.63,P<0.001],male gender(relative risk=1.42,95%CI:1.18-1.72,P<0.001),high body mass index(BMI)(MD=1.06,95%CI:0.82-1.29,P<0.001),Mercedez-Benz incision type[odds ratio(OR)=0.45,95%CI:0.21,0.96,P=0.04],and need for re-laparotomy(OR=2.49,95%CI:1.05-5.93,P=0.04).No significant differences were found in recurrence rates or wound complications between open and laparoscopic IH repairs.CONCLUSION Older recipient age,male gender,high BMI,Mercedes-Benz incision,and re-laparotomy after LT are significant risk factors for IH.In contrast,model for end-stage liver disease score,pre-LT ascites,acute rejection,and mammalian target of rapamycin inhibitor therapy do not appear to influence IH development.While open repair remains the predominant approach post-LT,no significant differences in recurrence or wound complication rates have been observed between open and laparoscopic repairs.However,open repair is associated with a shorter operative time.
基金This study was reviewed and approved by the Ethics Committee of Shenzhen People's Hospital.
文摘BACKGROUND Laparoscopic colorectal cancer surgery increases the risk of incisional hernia(IH)at the tumor extraction site.AIM To investigate the incidence of IH at extraction sites following laparoscopic colo-rectal cancer surgery and identify the risk factors for IH incidence.METHODS This study retrospectively analyzed the data of 1614 patients who underwent la-paroscopic radical colorectal cancer surgery with tumor extraction through the abdominal wall at our center between January 2017 and December 2022.Diffe-rences in the incidence of postoperative IH at different extraction sites and the risk factors for IH incidence were investigated.RESULTS Among the 1614 patients who underwent laparoscopic radical colorectal cancer surgery,303(18.8%),923(57.2%),171(10.6%),and 217(13.4%)tumors were ex-tracted through supraumbilical midline,infraumbilical midline,umbilical,and off-midline incisions.Of these,52 patients developed IH in the abdominal wall,with an incidence of 3.2%.The incidence of postoperative IH was significantly higher in the off-midline incision group(8.8%)than in the middle incision groups[the supraumbilical midline(2.6%),infraumbilical midline(2.2%),and umbilical incision(2.9%)groups](χ^(2)=24.985;P<0.05).Univariate analysis showed that IH occurrence was associated with age,obesity,sex,chronic cough,incision infection,and combined diabetes,anemia,and hypopro-teinemia(P<0.05).Similarly,multivariate analysis showed that off-midline incision,age,sex(female),obesity,incision infection,combined chronic cough,and hypoproteinemia were independent risk factors for IH at the site of laparoscopic colorectal cancer surgery(P<0.05).CONCLUSION The incidence of postoperative IH differs between extraction sites for laparoscopic colorectal cancer surgery.The infraumbilical midline incision is associated with a lower hernia rate and is thus a suitable tumor extraction site.
文摘Introduction: Incisional hernia is a common medical situation and its treatment has always been a challenge for general surgeons. If laparoscopic repair has become a gold standard elsewhere, it is increasingly done in our milieu, but no data has been found. The aim of this study was to review this surgery done in our country so far, to describe the operative technique and to evaluate the postoperative outcomes. Patients and Methods: We conducted an observational descriptive study with retrospective collection of data from the 1<sup>st</sup> of July 2018 to 30<sup>th</sup> of June 2022, in three hospitals in Cameroon. Data on socio-demographic and clinical characteristics, surgical technique and postoperative outcomes of patients who had a laparoscopic repair of their incisional hernia were collected. Results: We reviewed 20 files. There were 14 women with an average age of 54.6 years. The average BMI was 32.8 kg/m<sup>2</sup>. Thirteen patients had a moderate size hernia and the hernia was localized at the midline in 18 cases. Only composite biface meshes were used with dimensions chosen to obtain at least 5 cm overlap. Spiral tacks were the only fixation means used. We registered 3 complications. One case of generalized peritonitis secondary to missed digestive perforation, one case of seroma and one case of postoperative ileus. We registered no death. Conclusion: Laparoscopic repair of incisional hernias is feasible in a resource-limited setting like ours. Compliance with the operative technique and recommendations is important to obtain short-term results closed to that put forward by literature.
文摘Purpose： Metalloproteinases are a key component of the pathogenesis of abdominal hernias. Obesity is considered a risk factor in herniogenesis and hernia recurrence. The aim of this study was to evaluate the serum concentrations of metalloproteinase-2（MMP-2）, MMP-9, MMP-13, and adiponectin in morbidly obese and nonoverweight controls. Materials and methods： The participants were recruited from among patients undergoing bariatric and non-bariatric surgery and divided into two groups： I（body mass index（BMI）≥35 kg/m^2, n=40） and II（BMI〈25 kg/m^2, n=30）. Serum concentrations of MMP-2, MMP-9, MMP-13, and adiponectin were measured using enzyme-linked immunosorbent assay（ELISA）. Results： A statistically significant difference between groups was observed for MMP-2 concentration. The median MMP-9 concentration was higher in the obese group, but the difference was not statistically significant. Median MMP-13 concentrations did not differ between groups. Serum adiponectin concentration was insignificantly higher in the non-obese group. Conclusions： The elevated serum MMP-2 and MMP-9 concentrations in obese individuals may be related to the higher incidence of incisional hernias in this population.
基金This study was reviewed and approved by the UT Health Houston Institutional Review Board(approval No.HSC-MS-23-0471).
文摘BACKGROUND Abdominal wall deficiencies or weakness are a common complication of tem-porary ostomies,and incisional hernias frequently develop after colostomy or ileostomy takedown.The use of synthetic meshes to reinforce the abdominal wall has reduced hernia occurrence.Biologic meshes have also been used to enhance healing,particularly in contaminated conditions.Reinforced tissue matrices(R-TMs),which include a biologic scaffold of native extracellular matrix and a syn-thetic component for added strength/durability,are designed to take advantage of aspects of both synthetic and biologic materials.To date,RTMs have not been reported to reinforce the abdominal wall following stoma reversal.METHODS Twenty-eight patients were selected with a parastomal and/or incisional hernia who had received a temporary ileostomy or colostomy for fecal diversion after rectal cancer treatment or trauma.Following hernia repair and proximal stoma closure,RTM(OviTex®1S permanent or OviTex®LPR)was placed to reinforce the abdominal wall using a laparoscopic,robotic,or open surgical approach.Post-operative follow-up was performed at 1 month and 1 year.Hernia recurrence was determined by physical examination and,when necessary,via computed tomo-graphy scan.Secondary endpoints included length of hospital stay,time to return to work,and hospital readmissions.Evaluated complications of the wound/repair site included presence of surgical site infection,seroma,hematoma,wound dehiscence,or fistula formation.RESULTS The observational study cohort included 16 male and 12 female patients with average age of 58.5 years±16.3 years and average body mass index of 26.2 kg/m^(2)±4.1 kg/m^(2).Patients presented with a parastomal hernia(75.0%),in-cisional hernia(14.3%),or combined parastomal/incisional hernia(10.7%).Using a laparoscopic(53.6%),robotic(35.7%),or open(10.7%)technique,RTMs(OviTex®LPR:82.1%,OviTex®1S:17.9%)were placed using sublay(82.1%)or intraperitoneal onlay(IPOM;17.9%)mesh positioning.At 1-month and 1-year follow-ups,there were no hernia recurrences(0%).Average hospital stays were 2.1 d±1.2 d and return to work occurred at 8.3 post-operative days±3.0 post-operative days.Three patients(10.7%)were readmitted before the 1-month follow up due to mesh infection and/or gastrointestinal issues.Fistula and mesh infection were observed in two patients each(7.1%),leading to partial mesh removal in one patient(3.6%).There were no complications between 1 month and 1 year(0%).CONCLUSION RTMs were used successfully to treat parastomal and incisional hernias at ileostomy reversal,with no hernia recurrences and favorable outcomes after 1-month and 1-year.
文摘Among minimally invasive surgical procedures,colorectal surgery is associated with a notably higher incidence of incisional hernia(IH),ranging from 1.7% to 24.3%.This complication poses a significant burden on the healthcare system annually,necessitating urgent attention from surgeons.In a study published in the World Journal of Gastrointestinal Surgery,Fan et al compared the incidence of IH among 1614 patients who underwent laparoscopic colorectal surgery with different extraction site locations and evaluated the risk factors associated with its occurrence.This editorial analyzes the current risk factors for IH after laparoscopic colorectal surgery,emphasizing the impact of obesity,surgical site infection,and the choice of incision location on its development.Furthermore,we summarize the currently available preventive measures for IH.Given the low surgical repair rate and high recurrence rate associated with IH,prevention deserves greater research and attention compared to treatment.
文摘Background and Aim: The incidence of incisional hernias has been reported to be around 15%. In the present scenario, a wide array of surgical procedures are available for their better management. In this study, we intend to share our experience with one novel technique, “Hybrid IPOM (Intraperitoneal onlay meshplasty)” as a management option for a selected cohort of patients. Methods: This prospective study was undertaken during January 2019 to July 2023 at King Abdullah medical city, Makkah. A total of 51 cases were selected for Hybrid IPOM repair as per inclusion criteria;medium sized (4 - 10 cm) hernia defects;uncomplicated hernias;age more than 18 years. The follow-up period of the patients varied from 6 months to 4 years. The operation commenced with open hernia dissection, mesh deployment into abdomen, defect closure and then conversion to laparoscopy for the posterior mesh placement. Results: A total of 51 cases were repaired successfully with this technique. 48 out of 51 cases were incisional hernias secondary to some primary procedure done either for hernias itself or some other intra-abdominal pathology. The three cases were primary hernias falling in medium to large category with unaesthetic overlying skin. The age range was 19 to 72 years. The mean (range) operative time was 135 (90 - 240) min, and the average blood loss was 70 ml. The mean (range) hospital stay was 3 (2 - 11) days. All patients returned to routine work within 2 - 3 weeks of surgery. The median follow-up was 15 (6 - 48) months. Of the 51 cases, 3 patients developed seroma (managed conservatively), 1 patient developed a large hematoma (needed evacuation), and 1 patient developed superficial wound infection (managed with antibiotics). Two patients had recurrences;one patient had previously failed multiple repairs, and the other developed a postoperative hematoma. None of our patients had an iatrogenic bowel injury. Conclusion: Hybrid IPOM technique is a safe, feasible and easily reproducible technique. It may prove easier especially for beginners in laparoscopy, as it achieves faster and easy adhesiolysis thereby reducing operative time and easier establishment of the pneumoperitoneum. Besides, it gives the chance to excise ugly scars and improve the cosmesis.
文摘Intraparietal Hernias are hernias occurring in the anterior abdominal wall at different anatomical planes. An interparietal hernia has a hernial sac that passes between the layers of the anterior abdominal wall. Appendectomy is a very common surgical procedure, and post appendectomy incisional hernia is a very rare complication. Here we present a case of a 24-year-old male with swelling in the right hypochondrium and lumbar region with an open appendectomy scar. He was diagnosed to have an interparietal hernia in the anterior abdominal wall. After obtaining consent patient was taken up for surgery. At surgery, the patient was found to have a defect in the transverse abdominis muscle with a medial leaf far from the incision site. Open repair of the defect along with double breasting of external oblique done. Interparietal hernias are rare in post appendectomy scar and this case is of significance since it Highlights a rare interstitial type incisional hernia, as a complication of post appendectomy scar, and not many cases reports are mentioned in literature.
文摘Objective:Transversus abdominus release(TAR)is often required to achieve apposition of the rectus muscles and achieve wide mesh reinforcement of the abdominal wall.Traditionally,TAR has been done with an open technique(oTAR),and the benefits of the newer robotic approach(rTAR)has not been well established in the Australian setting.The aim of this study was to compare the results of oTAR with rTAR to demonstrate its safety and efficacy.Methods:A retrospective review of patients who underwent rTAR and oTAR at two tertiary hospitals was conducted between January 2018 and January 2020 in New South Wales,Australia.Patient demographics,perioperative and postoperative outcomes were compared in both groups.Results:There were 26 patients identified to have undergone TAR(13 rTAR,13 oTAR).Both groups were comparable in regards to age,sex and defect size.oTAR was associated with a higher American Society of Anaesthesiologist score.rTAR was associated with significantly longer average operative time(260.0±78.9 min vs.185.7±64.5 min,p=0.017)but found to have a significantly shorter length of stay(3.6±2.1 d vs.6.9±3.6 d,p=0.007)with a comparable complication rate.Conclusions:rTAR is associated with shorter length of hospital stay with comparable postoperative outcomes when compared to oTAR.We are seeing increasing evidence supporting the safety and benefits of robotics,however larger scale studies are required to fully understand this approach.
文摘Background and Objectives: The aim of this study is to evaluate the usefulness of Magnetic Resonance Imaging (MRI) for planning surgery and postoperative control of complex cases of abdominal wall hernia. Methods: Included in a prospective data base with more than 350 patients treated in two centers, a prospective study over ten patients with complex incisional hernias was designed. In all cases, preoperative diagnosis study and postoperative imaging control by MR Imaging were established. In the early and late follow-up controls, local and general complications were specifically noted and studied by MRI in each case. Results: The preoperative MRI was effective method for an adequate understanding of the defects and hernia sack content. In the postoperative control, the MRI was useful in the follow-up of the mesh integration, detection of complications and diagnosis of the relapsing. Conclusion: In our experience the MRI test is specially recommended in the preoperative workup of complex cases of incisional hernia.
文摘Objective Abdominal wall hernias,particularly midline primary and incisional types,represent a common and challenging surgical condition.The extended-view totally extraperitoneal(e-TEP)technique has recently been adapted for ventral hernia repair,offering potential advantages over other approaches.This study aimed to evaluate the initial outcomes and institutional experience of the e-TEP technique for midline primary and incisional ventral hernia repair at a tertiary center in Vietnam.Methods This prospective descriptive study was conducted on 65 patients with midline primary or incisional ventral hernias who underwent e-TEP repair between June 2022 and August 2024.All procedures were performed by two experienced surgeons at the Department of General Surgery,Can Tho General Hospital,Vietnam.Follow-up continued until February 2025.Data were collected and analyzed on demographics,clinical characteristics,surgical details,postoperative outcomes,and recurrence.Results A total of 65 patients,with a mean age of 57.9±12.6 years,a mean BMI of 25.0±3.3 kg/m^(2),and 47(72.3%)female,were included.The types of hernias included primary hernias in 63.1%(41 patients)and incisional hernias in 36.9%(24 patients).Among the incisional hernias,3 cases were recurrences.The median defect area was 9 cm^(2)(range,1–50 cm2).A 15 cm×15 cm mesh was used in nearly all cases(98.5%).The mean operating time was 131.9±51.8 min,with no conversions to open repair or other procedures,and no intraoperative complications were observed.Nine patients(13%)experienced postoperative complications,with seroma being the most common(5 cases).Two patients sustained intestinal injuries that required reoperation,one developed a wound infection and one reported postoperative skin paresthesia.The mean visual analogue scale pain scores at postoperative 24 hours,48 hours,and at discharge were 4.3±1.3,3.0±1.5,and 1.0±0.4,respectively.The mean postoperative hospital stay was 4.52±2.24 d.Only one case of recurrence(1.5%)was observed,and no patient reported chronic pain during the mean follow-up period of 14.5±7.6 m.Conclusion The e-TEP technique for midline primary and incisional ventral hernia repair is a feasible and safe option when performed by experienced surgeons.It offers a low rate of complications,short hospital stay,and minimal recurrence rates.This technique can be considered a viable alternative for the management of midline ventral hernias,with promising short-term outcomes.
文摘Aim:The utilization and outcomes of abdominal wall reconstruction(AWR)using advanced techniques such as component separation for incisional hernia(IH)repair following laparotomy in trauma populations has not been described.The objective was to describe AWR with component separation(AWR-CS)utilization in this setting and to assess postoperative complications and readmissions.Methods:We identified adult patients admitted for IH repair(IHR)with a history of and admission for traumatic injuries with concurrent laparotomy in six geographically diverse statewide inpatient databases(2006-2015).AWR-CS was defined by ICD-9 codes corresponding to myocutaneous flap.Risk-adjusted logistic regression and generalized linear models were used to compare postoperative complications,30-day readmissions and cumulative costs associated with AWR-CS.Results:Of 952 patients with a history of trauma laparotomy who were admitted electively for IHR,6.8%underwent AWR-CS.Patients who underwent AWR-CS experienced increased complications[adjusted odds ratio 2.6(95%CI:1.48-4.57);P<0.001],cumulative costs(median$20,805 vs.$15,529;P<0.001)and longer length-of-stay(median days 6 vs.5;P=0.002).These differences were driven by postoperative complication,which were independently associated with increased length of stay[predicted mean difference 6.53 days(95%CI:4.66-8.41);P<0.001],costs[$14,550(95%CI:$9,258-19,841);P<0.001]and 30-day cumulative costs[$20,176(95%CI:$12,621-27,731);P<0.001]within risk-adjusted analyses.Conclusion:AWR-CS is part of the armamentarium needed to manage trauma laparotomy survivors who develop complex IH defects requiring surgical repair.It can result in increased complications that amplify postoperative healthcare utilization.Leverage of tools for the identification of high-risk patients,prehabilitation and enhanced surgical techniques is warranted to minimize postoperative complications in these patients.
文摘BACKGROUND Internal hernia is a rare complication following abdominal surgery,primarily resulting from structural defects caused by anastomosis.We report a unique case of a late abdominal wall internal hernia highly suspected as resulting from insu-fficient peritoneal closure.CASE SUMMARY A 72-year-old woman presented with symptoms of intestinal obstruction 40 years after undergoing an abdominal hysterectomy.Abdominal computed tomography revealed a suspicious closed loop of intestine;then,a laparotomy was performed for suspected internal hernia.During the procedure,herniation of intestine into the preperitoneal space through a parietal peritoneal defect between rectus abdominis and sigmoid colon was identified.Intestinal reduction,resection of the ischemic segment and closure of the peritoneal defect were performed.The patient recovered well.CONCLUSION Non-closure of peritoneum might lead to late internal hernias.Meticulous peritoneal closure should be considered to prevent this potentially lethal complication.
文摘BACKGROUND Severe intraabdominal adhesions and ventral hernias pose significant technical challenges in bariatric surgery,especially in patients with a history of complex abdominal procedures.CASE SUMMARY This report describes a case involving a 30-year-old morbidly obese man who previously underwent a right lobe hepatectomy for living donor liver transplan-tation.The patient presented with a body mass index of 40.7 kg/m2 and a giant incisional hernia,compounded by extensive intraabdominal adhesions from mul-tiple previous surgeries.A laparoscopic sleeve gastrectomy was performed as the initial step of a staged surgical plan.Adhesiolysis was conducted carefully to address the dense intraabdominal adhesions,and the procedure was completed successfully using standard stapling techniques.Postoperative recovery was smooth,with significant weight loss achieved within the first month.CONCLUSION This case highlights the need for personalized surgical planning and precise techniques in bariatric surgery for patients with past abdominal operations.
文摘BACKGROUND Incisional hernias are a common complication of previous surgeries and remain a persistent issue in clinical practice,posing a significant burden on healthcare systems despite advances in education and technology.Surgical techniques,primarily involving the use of mesh to cover the abdominal wall gap,are widely used as a standard intervention strategy.AIM To examine the regeneration of the aponeurosis defect in the anterior abdominal wall in rats using regenerative mimetic factors of the extracellular matrix[ReGeneraTing Agent(RGTA)],adipose tissue micrografts(ATM),and platelet rich plasma(PRP)as regenerative agents.METHODS Regenerative agents such as RGTA,ATM,and PRP are gaining popularity.ATM involves autologous adipose tissue cells with mesenchymal stem cell markers and a high percentage of stromal vascular fraction cells.RGTAs are heparan sulfate(HS)mimetics that replace degraded HSs in damaged tissue,enhancing the quality and speed of repair.PRP is a concentrated plasma preparation containing seven fundamental proteins responsible for tissue production.An acellular dermal matrix is a biological implant free of cellular or antigenic components,making it an excellent material for reconstructive surgery.Polyglactin is a synthetic,absorbable mesh that loses 50%of its strength after fourteen days,providing initial support for new tissue regeneration before being completely absorbed.RESULTS Rats will undergo a laparotomy with a precise 2 cm by 2 cm excision of the anterior abdominal wall fascia below the umbilicus.They will be divided into sixteen groups,each receiving different combinations of regenerative factor injections into the denervated area in both non-contaminated and contaminated environments.A collagenelastin matrix will be used to join the aponeurosis edges,with an absorbable polyglactin mesh anchored over it.Samples will be taken for macroscopic,histological,and immunohistochemical evaluation of tissue regeneration.CONCLUSION Our study aims to demonstrate how these factors promote cell proliferation and healing of the denervated anterior abdominal wall,potentially reducing the frequency and complications of incisional hernias.This approach could offer a more economical and efficient treatment option compared to current costly methods.
