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International Journal of Abdominal Wall and Hernia Surgery最新文献

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Is the dissection of the abdominal wall still necessary in the treatment of W3 hernias? W3疝的治疗还需要腹壁夹层吗?
Q4 SURGERY Pub Date : 2022-01-01 DOI: 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.
在越来越多的手术中,大切口疝一直是困扰外科医生的难题。对于复杂疝的治疗,目前还没有国际公认的基于证据的关于恢复腹壁完整性的建议。在本文中,我们回顾了不同成分分离(CS)和其他技术用于治疗这种情况的发展。本文对治疗巨疝的一些重要技术进行了文献综述。在详细描述CS及其重要的修改后,我们描述和讨论相对较新的筋膜牵引技术及其修改。通过对上述研究的回顾,我们质疑CS在治疗巨大疝中的应用程度,并指出进一步比较研究评估不同技术的重要性。
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引用次数: 0
The open anterior component separation technique for large ventral and incisional abdominal wall reconstruction 开放前段分离技术在大腹壁及切口腹壁重建中的应用
Q4 SURGERY Pub Date : 2022-01-01 DOI: 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.
腹壁的大缺损一直是传统手术技术的挑战。经过几十年的发展,现在被称为前成分分离技术(CST)已经发展到通过释放侧腹壁肌肉来减少紧张。最初,Albanese和后来的Ramirez描述并推广了这种技术。在这个过程中,在直肌隔室的侧面,即半月线的水平处,解剖外斜肌和内斜肌之间的间隙。为了达到这个区域,在开放的标准入路中,必须广泛剥离皮下组织和双侧剥离外斜肌的腱膜。不幸的是,这种广泛的解剖是以更高的伤口发病率为代价的。本文将讨论手术技术、适应症和并发症,并简要介绍最新系统综述的结果,比较前路CST与其他手术选择在大腹壁缺陷中实现筋膜闭合。
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引用次数: 1
Erratum: Laparoscopic round ligament preserving repair for groin hernia in women: A critical appraisal 更正:腹腔镜下保留圆形韧带修复女性腹股沟疝:一个关键的评价
Q4 SURGERY Pub Date : 2022-01-01 DOI: 10.4103/2589-8736.338067
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引用次数: 0
Erratum: Retrospective research on initiative content reduction technique for obesity patients with huge abdominal incisional hernia 更正:主动减容术治疗肥胖合并巨大腹壁切口疝的回顾性研究
Q4 SURGERY Pub Date : 2022-01-01 DOI: 10.4103/2589-8736.338068
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引用次数: 0
Chemical abdominal wall release using botulinum toxin A: A personal view 肉毒杆菌毒素化学释放腹壁A:个人观点
Q4 SURGERY Pub Date : 2022-01-01 DOI: 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。
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引用次数: 0
eCST: The endoscopic-assisted component separation technique for (complex) abdominal wall reconstruction eCST:内窥镜辅助成分分离技术用于(复杂)腹壁重建
Q4 SURGERY Pub Date : 2022-01-01 DOI: 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.
简介:1990年,Ramirez提出了基于腹壁扩大的成分分离技术(CST),用于腹壁大面积缺损的重建。CST容易出现术后伤口并发症,这导致了内镜辅助CST技术的改进。该技术的细节用插图详细描述,并报告了36例患者队列的结果。材料和方法:2014年至2018年期间,在腹壁重建专家中心,未经皮下夹层的中线疝患者接受了内窥镜辅助前组件分离技术(eCST)和后直肌补片强制实施。前瞻性数据是在住院治疗和至少2年的随访期间收集的。结果:共行36例eCST手术。8例(22%)患者术后出现外、内直肌间血肿,3例(8%)出现血肿,1例(3%)出现创面裂开。4例(11%)患者出现了与临床相关的sse,其中3例(8%)患者在血肿处穿刺,1例(3%)患者因大血肿需要输血。1例患者在90天内再次手术;然而,这是气管切开术的位置。3例患者在平均随访时间24个月后复发。结论:eCST可用于特定患者。
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引用次数: 0
Erratum: Surgery of abdominal wall hernias in Russia with special reference to new technical developments 勘误:俄罗斯腹壁疝的外科手术,特别涉及新的技术发展
Q4 SURGERY Pub Date : 2022-01-01 DOI: 10.4103/2589-8736.338064
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引用次数: 0
Erratum: Obesity as a risk factor for complications and recurrences after ventral hernia repair 勘误:肥胖是腹疝修补术后并发症和复发的危险因素
Q4 SURGERY Pub Date : 2021-10-01 DOI: 10.4103/2589-8736.334556
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引用次数: 0
An observational study of short- and long-term complications including pain after onlay mesh umbilical hernia repair 脐疝补片修补术后包括疼痛在内的短期和长期并发症的观察性研究
Q4 SURGERY Pub Date : 2021-10-01 DOI: 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.
背景:关于在脐带疝修补术中接受补片放置的患者的结果的信息很少,影响不良结果的因素,如长期疼痛,也不是很清楚。一项研究的患者接受开放式脐疝修补进行。材料和方法:通过私人外科诊所接受开放脐疝修补术的患者,在13年的时间里,使用衬垫补片或单独缝合修复,并在手术后进行问卷调查,以记录长期疼痛或其他并发症的发生率。然后对数据进行分析,以了解导致不良结果的任何潜在因素。结果:346例患者的信息可用于研究。补片修复327例(94.5%),单纯缝合修复19例(5.5%)。早期(≤30天)出现并发症73例(21.1%)。最常见的并发症是血肿形成(27例)、伤口感染(13例)和血肿(11例)。4例患者并发血肿、感染和血肿形成。9例患者记录了晚期(>30天)并发症(持续疼痛除外),均为伤口相关问题。长期疼痛在报告伤口并发症的患者中更为常见(优势比:7.01,95%可信区间1.82-26.99)。3例(0.9%)出现复发性脐疝。结论:采用补片修复脐疝,慢性疼痛率低,复发率低;然而,手术部位的发生仍然很常见,尽管很容易治疗。
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引用次数: 1
A case report and a contemporary review of incarcerated and strangulated obturator hernia repair 嵌顿和绞窄闭孔疝修补术一例报告及当代回顾
Q4 SURGERY Pub Date : 2021-10-01 DOI: 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.
背景:闭孔疝(OH)通常表现为外科急诊,最常进行开放式一期修复。鉴于该入路的发病率和高复发率,我们报告一个病例并回顾文献,以评估手术入路对OH修复的影响。方法:通过PubMed进行文献检索。纳入标准为:(1)用英文撰写并在10年内发表的研究;(2)以关键词包含“闭孔疝”和/或“嵌顿”和/或“绞窄”;(3)报告手术入路;(4)报道术后结果。结果:共纳入225项研究,其中53项符合纳入标准。来自425名患者的数据被汇总。239例(56.2%)患者行开放修补,121例(28.5%)患者行开放修补,44例(10.4%)患者行腹腔镜修补,21例(4.9%)患者行腹腔镜修补。开放式修复的平均住院时间(LOS)为13.4天,术后并发症为40.3%,30天死亡率为9.7%,而腹腔镜修复的平均住院时间为7.9天,术后并发症为3.1%,无死亡。小肠切除术(SBR)占开放手术的44.7%,腹腔镜手术的15.4%。与没有SBR的患者相比,SBR患者的发病率和死亡率更高。在没有SBR的患者中,腹腔镜手术在LOS、并发症和死亡率方面优于开放手术。总复发率为7.7%,平均随访20.4个月。补片修复有1例(0.7%)复发,而组织修复有28例(12.1%)复发。结论:OHs是最常见的无补片开放式修复。我们的文献综述显示,腹腔镜氢氧根修复与增强术后恢复有关,使用补片与减少复发有关。需要进一步的研究来确定OH修复的最佳方法,但在可能的情况下应进行腹腔镜补片修复。
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引用次数: 1
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International Journal of Abdominal Wall and Hernia Surgery
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