Pub Date : 2022-01-01DOI: 10.4103/ijawhs.ijawhs_55_21
H. Niebuhr, H. Dag, Zaid Malaibari, F. Köckerling, W. Reinpold, Marius Helmedag
Large incisional hernias are a permanent problem for surgeons in a growing number of operations. For the treatment of complex hernias, there are no internationally accepted evidence-based recommendations regarding the restoration of abdominal wall integrity. In this paper, we are reviewing the development of different component separations (CS) and other techniques used in treating such conditions. A literature review was carried out to describe some important techniques to treat giant hernias. After a detailed description of the CS and its important modifications, we are describing and discussing the relatively new fascial traction technique with its modification. With these reviews of the mentioned studies, we are questioning the extent to which the CS is still indicated in treating giant hernias and point out the importance of further comparison studies evaluating different techniques.
{"title":"Is the dissection of the abdominal wall still necessary in the treatment of W3 hernias?","authors":"H. Niebuhr, H. Dag, Zaid Malaibari, F. Köckerling, W. Reinpold, Marius Helmedag","doi":"10.4103/ijawhs.ijawhs_55_21","DOIUrl":"https://doi.org/10.4103/ijawhs.ijawhs_55_21","url":null,"abstract":"Large incisional hernias are a permanent problem for surgeons in a growing number of operations. For the treatment of complex hernias, there are no internationally accepted evidence-based recommendations regarding the restoration of abdominal wall integrity. In this paper, we are reviewing the development of different component separations (CS) and other techniques used in treating such conditions. A literature review was carried out to describe some important techniques to treat giant hernias. After a detailed description of the CS and its important modifications, we are describing and discussing the relatively new fascial traction technique with its modification. With these reviews of the mentioned studies, we are questioning the extent to which the CS is still indicated in treating giant hernias and point out the importance of further comparison studies evaluating different techniques.","PeriodicalId":34200,"journal":{"name":"International Journal of Abdominal Wall and Hernia Surgery","volume":"18 1","pages":"42 - 47"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79277446","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}
Pub Date : 2022-01-01DOI: 10.4103/ijawhs.ijawhs_59_21
F. Berrevoet, M. Allaeys
Large defects in the abdominal wall have been a challenge for traditional surgical techniques. Over several decades, the development of what is now known as the anterior component separation technique (CST) has evolved to reduce tension through release of the lateral abdominal wall muscles. Initially, Albanese and later Ramirez described and popularized this technique.In this procedure, the space between the external oblique muscle and the internal oblique muscle is dissected immediately lateral to the rectus compartment, that is, at the level of the linea semilunaris. To reach this area, an extensive dissection of the subcutaneous tissue and bilateral dissection of the aponeurosis of the external oblique muscle is mandatory in an open standard approach. Unfortunately, this extensive dissection comes at the cost of higher wound morbidity rates.Herein, the surgical technique, the indications as well as the complications will be discussed and a short overview of the results of the latest systematic reviews will be presented, comparing the anterior CST with other surgical options to achieve fascial closure in large abdominal wall defects.
{"title":"The open anterior component separation technique for large ventral and incisional abdominal wall reconstruction","authors":"F. Berrevoet, M. Allaeys","doi":"10.4103/ijawhs.ijawhs_59_21","DOIUrl":"https://doi.org/10.4103/ijawhs.ijawhs_59_21","url":null,"abstract":"Large defects in the abdominal wall have been a challenge for traditional surgical techniques. Over several decades, the development of what is now known as the anterior component separation technique (CST) has evolved to reduce tension through release of the lateral abdominal wall muscles. Initially, Albanese and later Ramirez described and popularized this technique.In this procedure, the space between the external oblique muscle and the internal oblique muscle is dissected immediately lateral to the rectus compartment, that is, at the level of the linea semilunaris. To reach this area, an extensive dissection of the subcutaneous tissue and bilateral dissection of the aponeurosis of the external oblique muscle is mandatory in an open standard approach. Unfortunately, this extensive dissection comes at the cost of higher wound morbidity rates.Herein, the surgical technique, the indications as well as the complications will be discussed and a short overview of the results of the latest systematic reviews will be presented, comparing the anterior CST with other surgical options to achieve fascial closure in large abdominal wall defects.","PeriodicalId":34200,"journal":{"name":"International Journal of Abdominal Wall and Hernia Surgery","volume":"150 1","pages":"2 - 7"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74272844","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}
Pub Date : 2022-01-01DOI: 10.4103/2589-8736.338067
{"title":"Erratum: Laparoscopic round ligament preserving repair for groin hernia in women: A critical appraisal","authors":"","doi":"10.4103/2589-8736.338067","DOIUrl":"https://doi.org/10.4103/2589-8736.338067","url":null,"abstract":"","PeriodicalId":34200,"journal":{"name":"International Journal of Abdominal Wall and Hernia Surgery","volume":"34 1","pages":"52 - 52"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86670870","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}
Pub Date : 2022-01-01DOI: 10.4103/2589-8736.338068
{"title":"Erratum: Retrospective research on initiative content reduction technique for obesity patients with huge abdominal incisional hernia","authors":"","doi":"10.4103/2589-8736.338068","DOIUrl":"https://doi.org/10.4103/2589-8736.338068","url":null,"abstract":"","PeriodicalId":34200,"journal":{"name":"International Journal of Abdominal Wall and Hernia Surgery","volume":"27 1","pages":"48 - 48"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83643045","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}
Pub Date : 2022-01-01DOI: 10.4103/ijawhs.ijawhs_46_21
H. Hoffmann, D. Nowakowski, P. Kirchhoff
Introduction: Botulinum Toxin A (BTA) has gained increasing interest in hernia surgery, especially when dealing with complex ventral hernias. The goal of using BTA is the preoperative reduction of the transverse hernia diameter achieving a higher primary fascial closure rate, avoiding a potential additional component separation. However, high evidence data are sparse and the treatment protocols of BTA and patient selection are heterogenic. In this article, we review the most recent literature; discuss indications for BTA, the ideal patient selection, and available BTA protocols. Also, we provide our own data and discuss the potential future role of BTA in treating complex ventral hernias. Materials and Methods: We reviewed the available literature and analyzed our own data from patients with complex ventral hernias undergoing preoperative BTA application retrospectively. We present our BTA protocol and measured abdominal wall muscle and hernia parameters before BTA application and before surgery using CT scans. Results: In total 22 patients with a median diameter of the incisional hernias of 11.75 cm (IQR 10.9–13.4) were included in our study. BTA administration was performed 4 weeks prior to surgery. In CT scans a significant reduction of the thickness and an elongation of the lateral abdominal wall muscle compartment were seen in all patients. Also, the transverse hernia diameter decreased in all cases from median 11.8 cm (IQR 10.9–13.4) pre-BTA to 9.1 cm (IQR 7.6–10.2) presurgery. Primary fascial closure was achieved in all cases with additional component separation in three cases. Conclusion: BTA administration in the lateral abdominal wall muscle compartment is a helpful tool to simplify surgery of complex ventral hernias. It has a visible effect on the muscle parameters in the CT scans and subsequently may increase the rate of primary fascial closure. Further multicenter studies are necessary to gain data with higher evidence.
肉毒杆菌毒素A (BTA)在疝手术中越来越受到关注,特别是在处理复杂的腹疝时。使用BTA的目的是术前减少横疝直径,获得更高的初级筋膜闭合率,避免潜在的额外成分分离。然而,高证据的数据是稀疏的,BTA的治疗方案和患者选择是异质的。在这篇文章中,我们回顾了最新的文献;讨论BTA的适应症,理想的患者选择,以及可用的BTA方案。此外,我们提供了我们自己的数据,并讨论了BTA在治疗复杂腹疝中的潜在作用。材料和方法:我们回顾了现有的文献,并回顾性分析了我们自己的数据,这些数据来自于术前应用BTA的复杂腹疝患者。我们提出了BTA方案,并在BTA应用前和手术前使用CT扫描测量了腹壁肌肉和疝气参数。结果:共纳入22例切口疝中位直径11.75 cm (IQR 10.9-13.4)的患者。术前4周给予BTA。在CT扫描中,所有患者均可见腹壁外壁肌室的厚度明显减少和延伸。此外,所有病例的横疝直径从bta前的中位11.8 cm (IQR 10.9-13.4)下降到手术前的9.1 cm (IQR 7.6-10.2)。所有病例均完成了初级筋膜闭合,其中3例进行了额外的成分分离。结论:BTA外侧腹壁肌室给药是简化复杂腹疝手术的有效工具。它对CT扫描中的肌肉参数有明显的影响,随后可能增加初级筋膜闭合率。需要进一步的多中心研究以获得更有证据的数据。
{"title":"Chemical abdominal wall release using botulinum toxin A: A personal view","authors":"H. Hoffmann, D. Nowakowski, P. Kirchhoff","doi":"10.4103/ijawhs.ijawhs_46_21","DOIUrl":"https://doi.org/10.4103/ijawhs.ijawhs_46_21","url":null,"abstract":"Introduction: Botulinum Toxin A (BTA) has gained increasing interest in hernia surgery, especially when dealing with complex ventral hernias. The goal of using BTA is the preoperative reduction of the transverse hernia diameter achieving a higher primary fascial closure rate, avoiding a potential additional component separation. However, high evidence data are sparse and the treatment protocols of BTA and patient selection are heterogenic. In this article, we review the most recent literature; discuss indications for BTA, the ideal patient selection, and available BTA protocols. Also, we provide our own data and discuss the potential future role of BTA in treating complex ventral hernias. Materials and Methods: We reviewed the available literature and analyzed our own data from patients with complex ventral hernias undergoing preoperative BTA application retrospectively. We present our BTA protocol and measured abdominal wall muscle and hernia parameters before BTA application and before surgery using CT scans. Results: In total 22 patients with a median diameter of the incisional hernias of 11.75 cm (IQR 10.9–13.4) were included in our study. BTA administration was performed 4 weeks prior to surgery. In CT scans a significant reduction of the thickness and an elongation of the lateral abdominal wall muscle compartment were seen in all patients. Also, the transverse hernia diameter decreased in all cases from median 11.8 cm (IQR 10.9–13.4) pre-BTA to 9.1 cm (IQR 7.6–10.2) presurgery. Primary fascial closure was achieved in all cases with additional component separation in three cases. Conclusion: BTA administration in the lateral abdominal wall muscle compartment is a helpful tool to simplify surgery of complex ventral hernias. It has a visible effect on the muscle parameters in the CT scans and subsequently may increase the rate of primary fascial closure. Further multicenter studies are necessary to gain data with higher evidence.","PeriodicalId":34200,"journal":{"name":"International Journal of Abdominal Wall and Hernia Surgery","volume":"1 1","pages":"30 - 35"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83152418","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}
Pub Date : 2022-01-01DOI: 10.4103/ijawhs.ijawhs_41_21
T. S. de Vries Reilingh, S. Nienhuijs, D. D. de Jong, E. Mommers, J. Wegdam
INTRODUCTION: In 1990, Ramirez introduced his component separation technique (CST) based on enlargement of the abdominal wall for reconstruction of large abdominal wall defects. CST is prone to postoperative wound complications which lead to modification of the technique to an endoscopic assisted CST. The details of the technique are described in detail with illustrations and report the results of a 36 patient cohort. MATERIALS AND METHODS: Between 2014 and 2018, patients with midline hernias without previous subcutaneous dissection underwent endoscopic-assisted anterior components separation technique (eCST) with retro-rectus mesh enforcement in an expert center for abdominal wall reconstructions. Prospective data were gathered during inpatient care and at least 2 years of follow-up. RESULTS: A total of 36 eCST procedures were performed. Eight patients (22%) had postoperative seroma in the dissection plan between external and internal rectus muscle, 3 (8%) had a hematoma, 1 (3%) had wound dehiscence. Clinical relevant SSEs were present in 4 patients (11%) and consisted of 3 (8%) puncture in seroma, 1 (3%) patient needed a blood transfusion due to large hematoma. One patient was re-operated within 90 days; however, this was the placement of a surgical tracheostomy. Three patients had a recurrence in a mean follow-up length of 24 months. CONCLUSION: eCST can be useful in selected patients.
{"title":"eCST: The endoscopic-assisted component separation technique for (complex) abdominal wall reconstruction","authors":"T. S. de Vries Reilingh, S. Nienhuijs, D. D. de Jong, E. Mommers, J. Wegdam","doi":"10.4103/ijawhs.ijawhs_41_21","DOIUrl":"https://doi.org/10.4103/ijawhs.ijawhs_41_21","url":null,"abstract":"INTRODUCTION: In 1990, Ramirez introduced his component separation technique (CST) based on enlargement of the abdominal wall for reconstruction of large abdominal wall defects. CST is prone to postoperative wound complications which lead to modification of the technique to an endoscopic assisted CST. The details of the technique are described in detail with illustrations and report the results of a 36 patient cohort. MATERIALS AND METHODS: Between 2014 and 2018, patients with midline hernias without previous subcutaneous dissection underwent endoscopic-assisted anterior components separation technique (eCST) with retro-rectus mesh enforcement in an expert center for abdominal wall reconstructions. Prospective data were gathered during inpatient care and at least 2 years of follow-up. RESULTS: A total of 36 eCST procedures were performed. Eight patients (22%) had postoperative seroma in the dissection plan between external and internal rectus muscle, 3 (8%) had a hematoma, 1 (3%) had wound dehiscence. Clinical relevant SSEs were present in 4 patients (11%) and consisted of 3 (8%) puncture in seroma, 1 (3%) patient needed a blood transfusion due to large hematoma. One patient was re-operated within 90 days; however, this was the placement of a surgical tracheostomy. Three patients had a recurrence in a mean follow-up length of 24 months. CONCLUSION: eCST can be useful in selected patients.","PeriodicalId":34200,"journal":{"name":"International Journal of Abdominal Wall and Hernia Surgery","volume":"28 1","pages":"13 - 20"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73232966","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}
Pub Date : 2022-01-01DOI: 10.4103/2589-8736.338064
{"title":"Erratum: Surgery of abdominal wall hernias in Russia with special reference to new technical developments","authors":"","doi":"10.4103/2589-8736.338064","DOIUrl":"https://doi.org/10.4103/2589-8736.338064","url":null,"abstract":"","PeriodicalId":34200,"journal":{"name":"International Journal of Abdominal Wall and Hernia Surgery","volume":"30 1","pages":"49 - 49"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85070429","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}
Pub Date : 2021-10-01DOI: 10.4103/2589-8736.334556
{"title":"Erratum: Obesity as a risk factor for complications and recurrences after ventral hernia repair","authors":"","doi":"10.4103/2589-8736.334556","DOIUrl":"https://doi.org/10.4103/2589-8736.334556","url":null,"abstract":"","PeriodicalId":34200,"journal":{"name":"International Journal of Abdominal Wall and Hernia Surgery","volume":"26 1","pages":"236 - 236"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82899636","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}
Pub Date : 2021-10-01DOI: 10.4103/ijawhs.ijawhs_9_21
A. McCombie, D. Osborn, R. Roberts
BACKGROUND: Information about outcomes for patients who undergo onlay mesh placement for umbilical hernia repair is scarce and the factors that influence adverse outcomes, such as long-term pain, are not well understood. A study of patients undergoing open umbilical hernia repair was undertaken. MATERIALS AND METHODS: Patients who underwent open umbilical hernia repair through a private surgical practice over a 13-year period using either an onlay mesh or suture alone repair were given a questionnaire following surgery to document the incidence of long-term pain or other complications. Data were then analyzed to understand any potential contributors to a poor outcome. RESULTS: The information on 346 patients was available for study. Mesh was used for repair in 327 (94.5%) patients, whereas 19 (5.5%) had suture alone repair. Early (≤30 days) complications were experienced by 73 patients (21.1%). The most common complications were seroma formation (27 patients), wound infection (13 patients), and hematoma (11 patients). Four patients developed a combination of hematoma, infection, and seroma formation. Late (>30 days) complications (other than persistent pain) were recorded for nine patients and were all wound-related problems. Long-term pain was significantly more common in those patients reporting wound complications (odds ratio: 7.01, 95% confidence interval 1.82–26.99). Recurrent umbilical herniation developed in three patients (0.9%). CONCLUSION: Onlay mesh repair for umbilical hernia repair can be performed with low rates of chronic pain and low recurrence rates; however, surgical site occurrences remain common albeit easily treatable.
{"title":"An observational study of short- and long-term complications including pain after onlay mesh umbilical hernia repair","authors":"A. McCombie, D. Osborn, R. Roberts","doi":"10.4103/ijawhs.ijawhs_9_21","DOIUrl":"https://doi.org/10.4103/ijawhs.ijawhs_9_21","url":null,"abstract":"BACKGROUND: Information about outcomes for patients who undergo onlay mesh placement for umbilical hernia repair is scarce and the factors that influence adverse outcomes, such as long-term pain, are not well understood. A study of patients undergoing open umbilical hernia repair was undertaken. MATERIALS AND METHODS: Patients who underwent open umbilical hernia repair through a private surgical practice over a 13-year period using either an onlay mesh or suture alone repair were given a questionnaire following surgery to document the incidence of long-term pain or other complications. Data were then analyzed to understand any potential contributors to a poor outcome. RESULTS: The information on 346 patients was available for study. Mesh was used for repair in 327 (94.5%) patients, whereas 19 (5.5%) had suture alone repair. Early (≤30 days) complications were experienced by 73 patients (21.1%). The most common complications were seroma formation (27 patients), wound infection (13 patients), and hematoma (11 patients). Four patients developed a combination of hematoma, infection, and seroma formation. Late (>30 days) complications (other than persistent pain) were recorded for nine patients and were all wound-related problems. Long-term pain was significantly more common in those patients reporting wound complications (odds ratio: 7.01, 95% confidence interval 1.82–26.99). Recurrent umbilical herniation developed in three patients (0.9%). CONCLUSION: Onlay mesh repair for umbilical hernia repair can be performed with low rates of chronic pain and low recurrence rates; however, surgical site occurrences remain common albeit easily treatable.","PeriodicalId":34200,"journal":{"name":"International Journal of Abdominal Wall and Hernia Surgery","volume":"409 1","pages":"174 - 180"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74364073","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}
Pub Date : 2021-10-01DOI: 10.4103/ijawhs.ijawhs_60_21
S. Mazzola Poli de Figueiredo, L. Tastaldi, R. Mao, R. Lu, D. Tyler, Alexander Perez
BACKGROUND: Obturator hernia (OH) usually presents as a surgical emergency, with open primary repair most commonly performed. Given the morbidity and high recurrence of this approach, we present a case and review the literature to evaluate the influence of the operative approach on OH repair. METHODS: A literature search via PubMed was performed. Inclusion criteria were studies that: (1) were written in English and published within 10 years; (2) included as keywords “obturator hernia” and/or “incarcerated” and/or “strangulated”; (3) reported the operative approach; and (4) reported postoperative outcomes. RESULTS: Overall, 225 studies were identified, and 53 met the inclusion criteria. Data from 425 patients were pooled. Open repair without mesh was performed in 239 (56.2%) patients, 121 (28.5%) had open repair with mesh, 44 (10.4%) had laparoscopic repair with mesh, and 21 (4.9%) had laparoscopic repair without mesh. Open repair had a mean hospital length of stay (LOS) of 13.4 days, 40.3% postoperative complications, and 9.7% 30-day mortality rate whereas laparoscopic repair had a mean LOS of 7.9 days, 3.1% postoperative complications, and no deaths. Small bowel resection (SBR) was performed in 44.7% of open and 15.4% of laparoscopic repairs. Patients with SBR demonstrated higher morbidity and mortality compared with patients without SBR. In patients without SBR, laparoscopy had advantages over open surgery in LOS, complications, and mortality rate. The overall recurrence rate was 7.7%, with a mean follow-up of 20.4 months. One (0.7%) recurrence was reported in mesh repair, whereas 28 (12.1%) recurrences were reported with tissue repair. CONCLUSION: OHs are the most common open repair without mesh. Our literature review showed that laparoscopic OH repair is associated with enhanced postoperative recovery and the use of mesh was associated with less recurrence. Further studies are still necessary to determine the optimal approach for OH repair, but laparoscopic repair with mesh should be performed when possible.
{"title":"A case report and a contemporary review of incarcerated and strangulated obturator hernia repair","authors":"S. Mazzola Poli de Figueiredo, L. Tastaldi, R. Mao, R. Lu, D. Tyler, Alexander Perez","doi":"10.4103/ijawhs.ijawhs_60_21","DOIUrl":"https://doi.org/10.4103/ijawhs.ijawhs_60_21","url":null,"abstract":"BACKGROUND: Obturator hernia (OH) usually presents as a surgical emergency, with open primary repair most commonly performed. Given the morbidity and high recurrence of this approach, we present a case and review the literature to evaluate the influence of the operative approach on OH repair. METHODS: A literature search via PubMed was performed. Inclusion criteria were studies that: (1) were written in English and published within 10 years; (2) included as keywords “obturator hernia” and/or “incarcerated” and/or “strangulated”; (3) reported the operative approach; and (4) reported postoperative outcomes. RESULTS: Overall, 225 studies were identified, and 53 met the inclusion criteria. Data from 425 patients were pooled. Open repair without mesh was performed in 239 (56.2%) patients, 121 (28.5%) had open repair with mesh, 44 (10.4%) had laparoscopic repair with mesh, and 21 (4.9%) had laparoscopic repair without mesh. Open repair had a mean hospital length of stay (LOS) of 13.4 days, 40.3% postoperative complications, and 9.7% 30-day mortality rate whereas laparoscopic repair had a mean LOS of 7.9 days, 3.1% postoperative complications, and no deaths. Small bowel resection (SBR) was performed in 44.7% of open and 15.4% of laparoscopic repairs. Patients with SBR demonstrated higher morbidity and mortality compared with patients without SBR. In patients without SBR, laparoscopy had advantages over open surgery in LOS, complications, and mortality rate. The overall recurrence rate was 7.7%, with a mean follow-up of 20.4 months. One (0.7%) recurrence was reported in mesh repair, whereas 28 (12.1%) recurrences were reported with tissue repair. CONCLUSION: OHs are the most common open repair without mesh. Our literature review showed that laparoscopic OH repair is associated with enhanced postoperative recovery and the use of mesh was associated with less recurrence. Further studies are still necessary to determine the optimal approach for OH repair, but laparoscopic repair with mesh should be performed when possible.","PeriodicalId":34200,"journal":{"name":"International Journal of Abdominal Wall and Hernia Surgery","volume":"1 1","pages":"166 - 173"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89476060","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}