Hernia最新文献

Purpose: Incisional hernias (IH) after kidney transplantation (KTx) can cause significant morbidity in kidney transplant recipients (KTR). We aimed to report the outcomes of surgical repair of IH in KTR from our centre.

Methods: We retrospectively analysed all the IH repairs in KTR from May 2018 to May 2023. We documented pre-transplant baseline characteristics, peri- and post-KTx events and outcomes and post-IH repair complications. We also documented length of stay, survival, and hernia recurrence post-IH repair.

Results: We performed 35 incisional hernia repairs in 34 KTR from May 2018 to May 2023 with an overall incidence of 1.63% symptomatic IH. Mean patient age was 56.7 ± 10.1 years and mean body mass index (BMI) 29.7 ± 6.49 kg/m². A history of previous hernia operation and open abdominal operations was present in 11.4% and 22.9% of the population, respectively. The types of repairs performed were primary (5.7%), onlay (62.9%), inlay (2.9%) and retromuscular sublay (28.6%). Mean hernia neck size was 8.9 ± 5.6 cm. After IH repair, there was no perioperative mortality with an average 5.5 ± 3.9 days of length of stay. There were seven episodes (20%) of IH recurrence. There was a 6% of superficial wound dehiscence rate and a 3% of surgical site infection. Pearson's correlation test revealed that post-operative hernia recurrence was not related with neck size, post-transplant complications or pre- and post-transplant characteristics, as well as post-transplant outcome.

Conclusions: The recurrence rate in our cohort was 20%. Known risk factors for IH in KTR as well as post-KTx events were not correlated with hernia recurrence or other post-hernia repair complications.

Background: Repair of large incisional hernias is challenging, and the risks of postoperative complications have been associated with obesity, smoking, and diabetes. The present study was conducted to determine the impact of these risk factors on short and long-term outcomes following the repair with the peritoneal flap hernioplasty (PFH).

Methods: Three hundred twenty-seven patients undergoing PFH for incisional hernia repair were identified. Patient demographics and clinical data were recorded. Patients presenting signs of complications were assessed during a visit to the outpatient clinic. A multivariable regression analysis was performed to evaluate the association between BMI, smoking and diabetes, and postoperative complications.

Results: The study included 157 males (48.0%) and 170 females (52.0%). Median BMI was 30.9 kg/m². Diabetes was present in 13.8% of patients. 23.2% were active smokers. The recurrence rate was 2.4%. The odds ratios for postoperative complications were increased by 9% per BMI unit (P < 0.01), due predominantly to a rise in superficial wound infections (P < 0.01) and seroma production (P = 0.07). The adjusted odds ratio increased fourfold in patients with BMI > 40 kg/m² (P = 0.06).

Conclusion: Incisional hernia repair with the PFH technique is associated with a low risk of short and long-term complications. The risk is associated with obesity and significantly increased in patients with a BMI exceeding 40 kg/m², where a fourfold increase was observed predominantly due to seroma and superficial wound infections. The recurrence rate was 2.4% and was unaltered across BMI categories. No association was established between smoking, diabetes, and the risk of all-cause complications.

Introduction: The ultimate measure of successful abdominal wall reconstruction is a pain-free, complication-free, and durable hernia repair. Open techniques have generally lost favor, but they still have much to offer for patients with skin deficits and excess. The long-term complication rates for open hernia repairs is unknown. Electronic medical records now provide the ability to easily follow patients who have switched medical institutions. Using this tool, we followed a cohort of abdominal wall reconstruction patients who had an early high "success" rate.

Methods: We performed a retrospective chart review of 101 patients who underwent open ventral hernia repair with a narrow well-fixed retrorectus uncoated polypropylene mesh by a single surgeon (GAD) between the years of 2010 and 2015. These patients were initially reported in a 2016 publication. Patients' post-operative follow-up by any medical provider assessing the abdominal region were studied up until August 2023. Patient demographics, operative reports, and postoperative course were re-reviewed.

Results: A total of 101 patients underwent ventral hernia repair. Mean follow-up time was 7.68 years (range 1.8 - 13.0 years). There were no recurrent hernias across the studied time period and no instances of enterocutaneous fistulas. 15 patients (15%) had abdominal surgery after hernia repair unrelated to their original surgery and 5 patients (5%) reported chronic post-operative pain. 13 patients died in the follow-up period, all unrelated to the abdominal wall surgery.

Conclusion: Open well-fixed narrow retrorectus mesh hernia repairs perform well in the long-term without fistulas, extrusions, and hernia recurrence.

Background: Sarcopenia is defined as the loss of skeletal muscle mass and is associated with an increased risk or morbidity and mortality in complex surgical patient populations. Its role in complex abdominal wall surgery (AWS) is yet to be determined. The aim of this study is to establish if sarcopenia has an impact on postoperative complications, mortality and hernia recurrence.

Methods: Retrospective study of patients undergoing elective surgery for complex incisional hernias > 10 cm (W3 of European Hernia Society classification) between 2014-2023. Sarcopenia was stablished as the skeletal muscle index (SMI), measured at L3 transversal section of a preoperative CT-scan. Previously defined literature-based SMI cutoff values were used: men ≤ 52.4 cm²/m², women ≤ 38.5 cm²/m².

Results: 135 patients undergoing complex AWS were included. Of them, 38 were sarcopenic (28.1%). The median follow-up time was 13 months (IQR 12-25). In total, 11 patients died (8.1%). We found that sarcopenia was associated with a higher risk of mortality [HR 7.494 (95% CI 1.985-28.289); p 0.003]. There were no statistically significant differences in postoperative complications or hernia recurrence between both groups.

Conclusion: Although sarcopenia does not seem to have an influence on hernia recurrence or the development of postoperative complications, whether local or systemic, in our study sarcopenia is associated with a higher risk of mortality after complex abdominal wall surgery. Nonetheless, with the results obtained in our study, we think that prehabilitation programs before complex AWS is advisable.

Background: The incidence of incisional hernia (IH) after an open abdominal aortic aneurysm (AAA) repair can reach up to 35%, contributing to long-term morbidity. Individual studies have been limited in identifying modifiable risk factors for IH after an open AAA repair. This meta-analysis aims to review all the risk factors for IH after an open AAA repair.

Methods: We searched Cochrane Central, Embase, PubMed, MEDLINE, and Web of Science databases for original studies. Risk factors assessed were age, sex, comorbidities, surgical incision, blood loss, and surgical site infection (SSI). Data analysis was done using RStudio 4.1.2. We computed Relative Risk (RR) for dichotomous outcomes and Mean differences (MD) with 95% Confidence Interval (CI) for continuous outcomes. P-values less than 0.05 were considered statistically significant.

Results: Ten studies met the inclusion criteria among 1,795 screened articles. Among those ten studies, there were a total of 1,806 patients of which 341 patients developed IH. Older age (Mean 69.6-70.7 years, MD 1.39 years, CI [1.12-1.66], P < 0.01), midline vertical incision (RR 1.55, CI [1.06-2.25], P = 0.02) and increased intraoperative blood loss (MD 429.8 ml, CI [234.8- 624.8], P < 0.01) were associated with an increased incidence of IH. Surgical site infection (SSI) was noted as a risk factor for IH after open AAA repair (RR 2.36, CI [1.31-4.24], P = 0.004). No statistically significant association was found between the incidence of IH and sex (RR 1.0, CI [0.8-1.14], P = 0.98), smoking (RR 1.01, CI [0.93-1.09], P = 0.88), diabetes (RR 1.38, CI [0.85-2.25], P = 0.19), and chronic kidney disease (RR 1.55, CI [0.47-5.09], P = 0.46).

Conclusion: This meta-analysis shows that age, midline vertical incision, intraoperative blood loss, and SSI are risk factors for IH after open AAA repair.

Purpose: Numerous clinical practice guidelines and consensus statements have been published in hernia surgery, however, there is still a need for high-quality evidence to address remaining unanswered questions. The aim of this study was to conduct research priority setting through a modified Delphi process to identify a list of top research priorities in hernia surgery.

Methods: A structured literature review of clinical practice guidelines was performed by the steering committee. Topics considered clinically significant, practical to study and lacking strong evidence were extracted and refined into a comprehensive list, then entered into a two-round Delphi survey for prioritization at the Abdominal Core Health Quality Collaborative (ACHQC) Quality Improvement Summit. In round 1, participants were instructed to select any topic that should be prioritized for future research. Topics were ranked according to the proportion of votes and the 25 highest-ranking topics were included in the second round. In round 2, participants were instructed to select only the top 10 topics for research prioritization.

Results: Eleven clinical practice guidelines were reviewed. Eighty-seven topics were extracted by the steering committee and submitted for prioritization. After the first round, 25 of the highest-ranking topics were determined and included in the second round. A final list of 11 research questions was identified. The hernia types with the most research interest were inguinal and epigastric/umbilical hernias. Other topics of high interest were the management of diastasis recti, primary versus mesh repairs and expectant management versus surgical repair.

Conclusion: Our study provides a research agenda generated through expert consensus that may be used in the prioritization of the design and funding of clinical trials in hernia surgery.

Purpose: Trocar site incisional hernia (TSIH) is a common complication of laparoscopic surgery. In the scientific literature there are few descriptions of methods or tools for its prevention. The aim of this report was to assess the effectiveness and safety of a prophylactic measure designed to lower rates of TSIH.

Methods: A multicenter randomized double-blinded clinical trial was performed in high-risk patients (diabetes mellitus and/or age ≥ 70 years and/or BMI ≥ 30 kg/m² and/or extended incision for specimen retrieval) who underwent either elective or emergency laparoscopic cholecystectomy. Patients were assigned to prophylactic onlay polypropylene mesh fixation (intervention) or to standard trocar closure (control). The main aim was to analyze the efficacy of the intervention, taking occurrence of TSIH as the primary outcome. Clinical and radiological follow up lasted at least one year after surgery. Secondary endpoints were technique-related complications (surgical site occurrences).

Results: One hundred and forty-three patients were randomized and finally 116 were analyzed (64 in the intervention arm and 52 in the control arm). Groups were homogeneous. Mean [SD] age, 65 [18] years; 86 (60.6%) were women. The cumulative TSIH incidence was lower in the intervention group although the differences did not reach statistical significance, assessed either radiologically (16 [25.4%] vs 17 [31.5%], p = 0.538) or clinically (9 [16.1%] vs 9 [20], p = 0.613). No differences in surgical site infection, hematoma or seroma were detected. Mean follow-up was 670 days (range 223-1294).

Conclusion: Our results show that, when properly assessed, the overall TSIH incidence is extremely high. Although polypropylene onlay mesh placement is safe, it does not appear to be effective in reducing the TSIH incidence rate. Radiological evaluation may be more accurate.

Trial registration: ClinicalTrials.org NCT03495557. Date of registration: April 12, 2018.

Purpose: In laparoscopic inguinal hernia repair, it is thought that the mesh can be displaced more in the enhanced-view totally extraperitoneal (eTEP) technique. The aim of this study was to compare eTEP and totally extraperitoneal (TEP) techniques without mesh fixation in terms of mesh displacement and hernia recurrence.

Methods: Between December 2022 and April 2023, 60 consecutive patients with unilateral inguinal hernia were randomized into two groups; eTEP group (n = 30) and TEP group (n = 30). There was without mesh fixation in both groups. Study was registered at http://Clinicaltrials.gov (NCT06070142). The mesh was marked with three radiopaque clips. Pelvic radiographs were performed to evaluate the displacement of the mesh. The primary outcome of this study was mesh displacement. In addition, this is the first study in the literature to compare eTEP and TEP techniques in terms of mesh displacement without fixation in laparoscopic inguinal hernia.

Results: There was no significant difference between the groups in terms of mesh displacement, recurrence, postoperative VAS scores, length of hospital stay, hematoma, and seroma formation. The operation time was higher in the eTEP group and was statistically significant.

Conclusion: Without mesh fixation, the eTEP technique does not increase the risk of mesh displacement and recurrence. The eTEP technique can be safely applied without mesh fixation in laparoscopic inguinal hernia repairs.

Trial registration: ClinicalTrials number: NCT06070142.