BACKGROUND Mesh utilization for ventral hernia repair is associated with potential complications such as mesh infections,adhesions,seromas,fistula formation and significant postoperative pain.The modified rectus muscl...BACKGROUND Mesh utilization for ventral hernia repair is associated with potential complications such as mesh infections,adhesions,seromas,fistula formation and significant postoperative pain.The modified rectus muscle repair(RMR)is as an option to repair midline ventral hernias without mesh.AIM To evaluate the short term outcomes when the modified RMR was used to repair ventral hernias.METHODS This was a 5-year prospective study that examined the outcome of all consecutive patients with ventral abdominal wall hernias>5 cm in maximal diameter who underwent repair using the modified RMR technique in a single surgeon unit.Patients were reviewed in an outpatient clinic at 3,6 and 12 mo and evaluated for hernia recurrence on clinical examination.Each patient’s abdominal wall was also assessed with using ultrasonography at 24 mo to detect recurrences.All data were examined with SPSS ver 18.0.RESULTS Over the 5-year study period,there were 52 patients treated for ventral hernias at this institution.Four patients were excluded and there were 48 in the final study sample,at a mean age of 56 years(range 28-80).The mean maximal diameter of the hernia defect was 7 cm(range 5-12 cm).There were 5(10.4%)seromas and 1 recurrence(2.1%)at a mean of 36 mo follow-up.CONCLUSION The authors recommend the modified RMR as an acceptable alternative to mesh repair of ventral hernias.The seroma rate can be further reduced with routine use of drains.The modified RMR also has the benefit of eliminating all mesh-specific complications.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
AIM: To compare long term outcomes of laparoscopic and open ventral hernia mesh repair with respect to recurrence, pain and satisfaction.METHODS: We conducted a single-centre follow-up study of 194 consecutive patient...AIM: To compare long term outcomes of laparoscopic and open ventral hernia mesh repair with respect to recurrence, pain and satisfaction.METHODS: We conducted a single-centre follow-up study of 194 consecutive patients after laparoscopic and open ventral hernia mesh repair between March 2000 and June 2010. Of these, 27 patients(13.9%) died and 12(6.2%) failed to attend their follow-up appointment. One hundred and fifty-three(78.9%) patients attended for follow-up and two patients(1.0%) were interviewed by telephone. Of those who attended the follow-up appointment, 82(52.9%) patients had received laparoscopic ventral hernia mesh repair(LVHR) while 73(47.1%) patients had undergone open ventral hernia mesh repair(OVHR), including 11 conversions. The follow-up study included analyses of medical records, clinical interviews, examination of hernia recurrence and assessment of pain using a 100 mm visual analogue scale(VAS) ruler anchored by word descriptors. Overall patient satisfaction was also determined. Patients with signs of recurrence were examined by magnetic resonance imaging or computed tomography scan.RESULTS: Median time from hernia mesh repair to follow-up was 48 and 52 mo after LVHR and OVHR respectively. Overall recurrence rates were 17.1% after LVHR and 23.3% after OVHR. Recurrence after LVHR was associated with higher body mass index. Smoking was associated with recurrence after OVHR. Chronic pain(VAS > 30 mm) was reported by 23.5% in the laparoscopic cohort and by 27.8% in the open surgery cohort. Recurrence and late complications were predictors of chronic pain after LVHR. Smoking was associated with chronic pain after OVHR. Sixty point five percent were satisfied with the outcome after LVHR and 49.3% after OVHR. Predictors for satisfaction were absence of chronic pain and recurrence. Old age and short time to follow-up also predicted satisfaction after LVHR.CONCLUSION: LVHR and OVHR give similar long term results for recurrence, pain and overall satisfaction. Chronic pain is frequent and is therefore important for explaining dissatisfaction.展开更多
BACKGROUND An incisional hernia is a common complication of abdominal surgery.AIM To evaluate the outcomes and complications of hybrid application of open and laparoscopic approaches in giant ventral hernia repair.MET...BACKGROUND An incisional hernia is a common complication of abdominal surgery.AIM To evaluate the outcomes and complications of hybrid application of open and laparoscopic approaches in giant ventral hernia repair.METHODS Medical records of patients who underwent open,laparoscopic,or hybrid surgery for a giant ventral hernia from 2006 to 2013 were retrospectively reviewed.The hernia recurrence rate and intra-and postoperative complications were calculated and recorded.RESULTS Open,laparoscopic,and hybrid approaches were performed in 82,94,and 132 patients,respectively.The mean hernia diameter was 13.11±3.4 cm.The incidence of hernia recurrence in the hybrid procedure group was 1.3%,with a mean follow-up of 41 mo.This finding was significantly lower than that in the laparoscopic(12.3%)or open procedure groups(8.5%;P<0.05).The incidence of intraoperative intestinal injury was 6.1%,4.1%,and 1.5%in the open,laparoscopic,and hybrid procedures,respectively(hybrid vs open and laparoscopic procedures;P<0.05).The proportion of postoperative intestinal fistula formation in the open,laparoscopic,and hybrid approach groups was 2.4%,6.8%,and 3.3%,respectively(P>0.05).CONCLUSION A hybrid application of open and laparoscopic approaches was more effective and safer for repairing a giant ventral hernia than a single open or laparoscopic procedure.展开更多
Primary ventral hernias and ventral incisional hernias have been a challenge for surgeons throughout the ages. In the current era, incisional hernias have increased in prevalence due to the very high number of laparot...Primary ventral hernias and ventral incisional hernias have been a challenge for surgeons throughout the ages. In the current era, incisional hernias have increased in prevalence due to the very high number of laparotomies performed in the 20 th century. Even though minimally invasive surgery and hernia repair have evolved rapidly, general surgeons have yet to develop the ideal, standardized method that adequately decreases common postoperative complications, such as wound failure, hernia recurrence and pain. The evolution of laparoscopy and ventral hernia repair will be reviewed, from the rectoscopy of the 4th century to the advent of laparoscopy, from suture repair to the evolution of mesh reinforcement. The nuances of minimally invasive ventral and incisional hernia repair will be summarized, from preoperative considerations to variations in intraoperative practice. New techniques have become increasingly popular, such as primary defect closure, retrorectus mesh placement, and concomitant component separation. The advent of robotics has made some of these repairs more feasible, but only time and well-designed clinical studies will tell if this will be a durable modality for ventral and incisional hernia repair.展开更多
BACKGROUND Ventral hernia,also known as incisional hernia,is a common complication of previous surgery.The contents of ventral hernia may include omentum,preperitoneal fat,small intestine or colon.However,ventral hern...BACKGROUND Ventral hernia,also known as incisional hernia,is a common complication of previous surgery.The contents of ventral hernia may include omentum,preperitoneal fat,small intestine or colon.However,ventral hernia with protrusion of more than two parenchymal organs simultaneously is extremely rare,and its repair is very complex and difficult.Surgeons should make a comprehensive assessment based on their own experience and the individual characteristics of the hernia.In addition,psychological therapy should be emphasized in the whole treatment process.CASE SUMMARY We report a rare case of asymptomatic giant ventral hernia for 15 years in a 21-year-old female.The patient underwent umbilical hernia repair at the age of 1 year.Approximately 5 years later,ventral hernia recurred and repair with Mesh was performed,but the operation failed due to postoperative infection,and a huge mass appeared in the left abdominal wall.The mass increased gradually with the development and maturity of the body.Computerized tomography scan demonstrated that the patient's total spleen,part of the pancreas and left lobe of the liver were simultaneously herniated through the abdominal incisional hernia.As the patient was unable to endure the inconvenience of life and the potential risk of spleen or liver rupture,she underwent a ventral hernia repair with Mesh at our hospital.The operation was successful and the patient had a good recovery.During a 3-mo follow-up,the patient remained asymptomatic and the appearance of the surgical incision was greatly improved.CONCLUSION Ventral hernia is a common complication of abdominal surgery.Ventral hernia with protrusion of more than two parenchymal organs simultaneously is extremely rare.Surgeons should pay attention to the psychological treatment while restoring the abdominal physiological function in ventral hernia patients.展开更多
BACKGROUND High-intensity focused ultrasound(HIFU) ablation is a minimally invasive approach in gynecology that is used to manage uterine fibroids.Although this procedure is safe and effective,adverse outcomes are bec...BACKGROUND High-intensity focused ultrasound(HIFU) ablation is a minimally invasive approach in gynecology that is used to manage uterine fibroids.Although this procedure is safe and effective,adverse outcomes are becoming a major problem.CASE SUMMARY We present a case of ventral hernia that occurred as a rare and delayed complication of HIFU ablation for uterine fibroids treatment.The patient came to the hospital with abdominal bloating that occurred 6 mo after ultrasound-guided HIFU ablation for managing uterine fibroids.The ventral hernia,which occurred due to atrophied muscle layers following the procedure,was confirmed by imaging studies and intraoperative findings.She required a hernia repair with mesh and hysterectomy for definitive treatment of uterine fibroid.CONCLUSION High-intensity ultrasound ablation should be performed only on appropriate candidates.Patients should be educated about potential complications of the procedure and the possibility of subsequent treatment.Post-procedural long-term follow-up for detecting delayed adverse effects is important.展开更多
Objective:Ventral hernia is an anterior abdominal wall hernia,with an incidence of 2%-13%.Laparoscopic ventral hernia repair is the preferred method worldwide with all the advantages of the laparoscopic technique prov...Objective:Ventral hernia is an anterior abdominal wall hernia,with an incidence of 2%-13%.Laparoscopic ventral hernia repair is the preferred method worldwide with all the advantages of the laparoscopic technique proven to be an effective treatment option.This study aims to assess the long-term outcomes of laparoscopic management of ventral hernia repair using intraperitoneal onlay mesh(IPOM)or intraperitoneal onlay mesh with defect closure(IPOM PLUS)technique with the usage of variety of synthetic meshes intraperitoneally.Methods:A retrospective study of 821 patients of a single institution for a decade was conducted.Longterm outcomes such as pain,mesh infections,enterocutaneous fistula,bowel adhesions and recurrence were assessed.Results:There were 801 primary,12 incisional,and 8 recurrent hernia cases,including 532 females and 289 males with a mean age of 45.62±9.37 years.IPOM PLUS were underwent in 674(82.10%)cases.Polypropylene,dual,titanium,composite meshes were applied in 473(57.61%),208(25.33%),82(9.99%),and 58(7.06%)cases respectively.Intraoperative bleeding occurred in 3(0.37%)cases,seroma in 8(0.97%),wound infection in 4(0.49%),stitch abscess in 2(0.24%).Recurrence was found in 8(0.97%)cases,with 5 used polypropylene mesh and 3 used dual mesh.Mesh infections were discovered in 6(2.88%)cases used dual,and foreign body sensation in 4(0.85%)cases used polypropylene.Three(0.37%)patients had suture site hernia,and 3(0.37%)had chronic sinus.Conclusion:IPOM or IPOM PLUS holds good in small or medium sized ventral hernias.The safety and efficacy of intraperitoneal polypropylene mesh is comparable to that of other synthetic meshes.A mesh overlap of minimum 5 cm beyond defect edge is must to minimise hernia recurrence.Absorbable suture can be considered as alternative to tackers.展开更多
Spigelian Hernia (SH) is an uncommon anterior abdominal wall defect, it represents 0.1%</span><span style="font-family:""> </span><span style="font-family:Verdana;">-&l...Spigelian Hernia (SH) is an uncommon anterior abdominal wall defect, it represents 0.1%</span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:Verdana;">2% of all abdominal wall hernias. SHs have been traditionally repaired by open technique, but laparoscopic approaches are becoming more common and widely described in the literature. Here we present a case report of a 69-year-old woman who presented with abdominal pain, nausea, abdominal distention and absence of bowel movements for 2 days. A computed tomography performed in an external facility revealed a right-sided and incarcerated SH containing bowel and mesentery. The patient was treated surgically and the abdominal wall defect was repaired by a laparoscopic transabdominal preperitoneal (TAPP) approach. The patient was discharged 24 hours after surgery in excellent conditions. We hold that the TAPP approach is anatomically the soundest repair, with all the added benefits of minimally invasive surgery.展开更多
Hernia is a common word that most surgeons are familiar with. A retrospective study was planned to analyse the spectrum of abdominal wall hernias in a rural population inIndia. Majority of the patients were of 40 - 70...Hernia is a common word that most surgeons are familiar with. A retrospective study was planned to analyse the spectrum of abdominal wall hernias in a rural population inIndia. Majority of the patients were of 40 - 70 yrs. Male to female ratio was 7:1. Incidence of groin hernias showed an increasing trend with advancing age. Out of total 320 cases, inguinal hernias were predominating in 77.81% cases. Ventral hernias were present in about 18% cases. However, femoral hernias were rare. We concluded that spectrum of abdominal wall hernias is almost the same all over the globe despite having differences in their socioeconomic and educational status.展开更多
Despite the technological breakthroughs and discover of abdominal meshes, ventral hernia has always been challenging in therapeutic strategies by the surgeons, with high recurrence rates. The use of botulinum toxin A ...Despite the technological breakthroughs and discover of abdominal meshes, ventral hernia has always been challenging in therapeutic strategies by the surgeons, with high recurrence rates. The use of botulinum toxin A (BTA) for the management of ventral and incisional hernia (IH) poses an increasingly interesting practice, especially for the intimidating complex one. The preoperative administration of the toxin to the lateral abdominal muscles by use of Ultra-Sound guidance causes muscle paralysis and a reduction of intraabdominal pressure. Thus, the hernia defect can be primarily closed without tension, if the length of the defect is up to 10 cm. In larger hernia, this method can be combined with component separation techniques or the use of a mesh. The mesh placement seems to be better by laparoscopy. The site of injection and the dosage of BTA are still under discussion amongst authors. The optimal administration is proposed by some authors to be at least 2 weeks before repair. There is also an analgesic effect of BTA to the patients that underwent hernia reconstruction. Ultimately, the role of BTA in the reconstruction of ventral hernia seems to be promising, but there is a necessity for several randomized clinical trials.展开更多
文摘BACKGROUND Mesh utilization for ventral hernia repair is associated with potential complications such as mesh infections,adhesions,seromas,fistula formation and significant postoperative pain.The modified rectus muscle repair(RMR)is as an option to repair midline ventral hernias without mesh.AIM To evaluate the short term outcomes when the modified RMR was used to repair ventral hernias.METHODS This was a 5-year prospective study that examined the outcome of all consecutive patients with ventral abdominal wall hernias>5 cm in maximal diameter who underwent repair using the modified RMR technique in a single surgeon unit.Patients were reviewed in an outpatient clinic at 3,6 and 12 mo and evaluated for hernia recurrence on clinical examination.Each patient’s abdominal wall was also assessed with using ultrasonography at 24 mo to detect recurrences.All data were examined with SPSS ver 18.0.RESULTS Over the 5-year study period,there were 52 patients treated for ventral hernias at this institution.Four patients were excluded and there were 48 in the final study sample,at a mean age of 56 years(range 28-80).The mean maximal diameter of the hernia defect was 7 cm(range 5-12 cm).There were 5(10.4%)seromas and 1 recurrence(2.1%)at a mean of 36 mo follow-up.CONCLUSION The authors recommend the modified RMR as an acceptable alternative to mesh repair of ventral hernias.The seroma rate can be further reduced with routine use of drains.The modified RMR also has the benefit of eliminating all mesh-specific complications.
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.
基金Supported by Akershus University Hospital,No.2619046
文摘AIM: To compare long term outcomes of laparoscopic and open ventral hernia mesh repair with respect to recurrence, pain and satisfaction.METHODS: We conducted a single-centre follow-up study of 194 consecutive patients after laparoscopic and open ventral hernia mesh repair between March 2000 and June 2010. Of these, 27 patients(13.9%) died and 12(6.2%) failed to attend their follow-up appointment. One hundred and fifty-three(78.9%) patients attended for follow-up and two patients(1.0%) were interviewed by telephone. Of those who attended the follow-up appointment, 82(52.9%) patients had received laparoscopic ventral hernia mesh repair(LVHR) while 73(47.1%) patients had undergone open ventral hernia mesh repair(OVHR), including 11 conversions. The follow-up study included analyses of medical records, clinical interviews, examination of hernia recurrence and assessment of pain using a 100 mm visual analogue scale(VAS) ruler anchored by word descriptors. Overall patient satisfaction was also determined. Patients with signs of recurrence were examined by magnetic resonance imaging or computed tomography scan.RESULTS: Median time from hernia mesh repair to follow-up was 48 and 52 mo after LVHR and OVHR respectively. Overall recurrence rates were 17.1% after LVHR and 23.3% after OVHR. Recurrence after LVHR was associated with higher body mass index. Smoking was associated with recurrence after OVHR. Chronic pain(VAS > 30 mm) was reported by 23.5% in the laparoscopic cohort and by 27.8% in the open surgery cohort. Recurrence and late complications were predictors of chronic pain after LVHR. Smoking was associated with chronic pain after OVHR. Sixty point five percent were satisfied with the outcome after LVHR and 49.3% after OVHR. Predictors for satisfaction were absence of chronic pain and recurrence. Old age and short time to follow-up also predicted satisfaction after LVHR.CONCLUSION: LVHR and OVHR give similar long term results for recurrence, pain and overall satisfaction. Chronic pain is frequent and is therefore important for explaining dissatisfaction.
文摘BACKGROUND An incisional hernia is a common complication of abdominal surgery.AIM To evaluate the outcomes and complications of hybrid application of open and laparoscopic approaches in giant ventral hernia repair.METHODS Medical records of patients who underwent open,laparoscopic,or hybrid surgery for a giant ventral hernia from 2006 to 2013 were retrospectively reviewed.The hernia recurrence rate and intra-and postoperative complications were calculated and recorded.RESULTS Open,laparoscopic,and hybrid approaches were performed in 82,94,and 132 patients,respectively.The mean hernia diameter was 13.11±3.4 cm.The incidence of hernia recurrence in the hybrid procedure group was 1.3%,with a mean follow-up of 41 mo.This finding was significantly lower than that in the laparoscopic(12.3%)or open procedure groups(8.5%;P<0.05).The incidence of intraoperative intestinal injury was 6.1%,4.1%,and 1.5%in the open,laparoscopic,and hybrid procedures,respectively(hybrid vs open and laparoscopic procedures;P<0.05).The proportion of postoperative intestinal fistula formation in the open,laparoscopic,and hybrid approach groups was 2.4%,6.8%,and 3.3%,respectively(P>0.05).CONCLUSION A hybrid application of open and laparoscopic approaches was more effective and safer for repairing a giant ventral hernia than a single open or laparoscopic procedure.
文摘Primary ventral hernias and ventral incisional hernias have been a challenge for surgeons throughout the ages. In the current era, incisional hernias have increased in prevalence due to the very high number of laparotomies performed in the 20 th century. Even though minimally invasive surgery and hernia repair have evolved rapidly, general surgeons have yet to develop the ideal, standardized method that adequately decreases common postoperative complications, such as wound failure, hernia recurrence and pain. The evolution of laparoscopy and ventral hernia repair will be reviewed, from the rectoscopy of the 4th century to the advent of laparoscopy, from suture repair to the evolution of mesh reinforcement. The nuances of minimally invasive ventral and incisional hernia repair will be summarized, from preoperative considerations to variations in intraoperative practice. New techniques have become increasingly popular, such as primary defect closure, retrorectus mesh placement, and concomitant component separation. The advent of robotics has made some of these repairs more feasible, but only time and well-designed clinical studies will tell if this will be a durable modality for ventral and incisional hernia repair.
基金Supported by the National Natural Science Foundation of China,No.81172269 and No.30972910Jiangsu Provincial Commission of Health and Family Planning,No.Z201603+1 种基金Youth talent support program of Nanjing City during the 13th Five-Year Plan Period,No.QRX17107Natural Science Fund of Nanjing Medical University,No.2017NJMU041.
文摘BACKGROUND Ventral hernia,also known as incisional hernia,is a common complication of previous surgery.The contents of ventral hernia may include omentum,preperitoneal fat,small intestine or colon.However,ventral hernia with protrusion of more than two parenchymal organs simultaneously is extremely rare,and its repair is very complex and difficult.Surgeons should make a comprehensive assessment based on their own experience and the individual characteristics of the hernia.In addition,psychological therapy should be emphasized in the whole treatment process.CASE SUMMARY We report a rare case of asymptomatic giant ventral hernia for 15 years in a 21-year-old female.The patient underwent umbilical hernia repair at the age of 1 year.Approximately 5 years later,ventral hernia recurred and repair with Mesh was performed,but the operation failed due to postoperative infection,and a huge mass appeared in the left abdominal wall.The mass increased gradually with the development and maturity of the body.Computerized tomography scan demonstrated that the patient's total spleen,part of the pancreas and left lobe of the liver were simultaneously herniated through the abdominal incisional hernia.As the patient was unable to endure the inconvenience of life and the potential risk of spleen or liver rupture,she underwent a ventral hernia repair with Mesh at our hospital.The operation was successful and the patient had a good recovery.During a 3-mo follow-up,the patient remained asymptomatic and the appearance of the surgical incision was greatly improved.CONCLUSION Ventral hernia is a common complication of abdominal surgery.Ventral hernia with protrusion of more than two parenchymal organs simultaneously is extremely rare.Surgeons should pay attention to the psychological treatment while restoring the abdominal physiological function in ventral hernia patients.
文摘BACKGROUND High-intensity focused ultrasound(HIFU) ablation is a minimally invasive approach in gynecology that is used to manage uterine fibroids.Although this procedure is safe and effective,adverse outcomes are becoming a major problem.CASE SUMMARY We present a case of ventral hernia that occurred as a rare and delayed complication of HIFU ablation for uterine fibroids treatment.The patient came to the hospital with abdominal bloating that occurred 6 mo after ultrasound-guided HIFU ablation for managing uterine fibroids.The ventral hernia,which occurred due to atrophied muscle layers following the procedure,was confirmed by imaging studies and intraoperative findings.She required a hernia repair with mesh and hysterectomy for definitive treatment of uterine fibroid.CONCLUSION High-intensity ultrasound ablation should be performed only on appropriate candidates.Patients should be educated about potential complications of the procedure and the possibility of subsequent treatment.Post-procedural long-term follow-up for detecting delayed adverse effects is important.
文摘Objective:Ventral hernia is an anterior abdominal wall hernia,with an incidence of 2%-13%.Laparoscopic ventral hernia repair is the preferred method worldwide with all the advantages of the laparoscopic technique proven to be an effective treatment option.This study aims to assess the long-term outcomes of laparoscopic management of ventral hernia repair using intraperitoneal onlay mesh(IPOM)or intraperitoneal onlay mesh with defect closure(IPOM PLUS)technique with the usage of variety of synthetic meshes intraperitoneally.Methods:A retrospective study of 821 patients of a single institution for a decade was conducted.Longterm outcomes such as pain,mesh infections,enterocutaneous fistula,bowel adhesions and recurrence were assessed.Results:There were 801 primary,12 incisional,and 8 recurrent hernia cases,including 532 females and 289 males with a mean age of 45.62±9.37 years.IPOM PLUS were underwent in 674(82.10%)cases.Polypropylene,dual,titanium,composite meshes were applied in 473(57.61%),208(25.33%),82(9.99%),and 58(7.06%)cases respectively.Intraoperative bleeding occurred in 3(0.37%)cases,seroma in 8(0.97%),wound infection in 4(0.49%),stitch abscess in 2(0.24%).Recurrence was found in 8(0.97%)cases,with 5 used polypropylene mesh and 3 used dual mesh.Mesh infections were discovered in 6(2.88%)cases used dual,and foreign body sensation in 4(0.85%)cases used polypropylene.Three(0.37%)patients had suture site hernia,and 3(0.37%)had chronic sinus.Conclusion:IPOM or IPOM PLUS holds good in small or medium sized ventral hernias.The safety and efficacy of intraperitoneal polypropylene mesh is comparable to that of other synthetic meshes.A mesh overlap of minimum 5 cm beyond defect edge is must to minimise hernia recurrence.Absorbable suture can be considered as alternative to tackers.
文摘Spigelian Hernia (SH) is an uncommon anterior abdominal wall defect, it represents 0.1%</span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:Verdana;">2% of all abdominal wall hernias. SHs have been traditionally repaired by open technique, but laparoscopic approaches are becoming more common and widely described in the literature. Here we present a case report of a 69-year-old woman who presented with abdominal pain, nausea, abdominal distention and absence of bowel movements for 2 days. A computed tomography performed in an external facility revealed a right-sided and incarcerated SH containing bowel and mesentery. The patient was treated surgically and the abdominal wall defect was repaired by a laparoscopic transabdominal preperitoneal (TAPP) approach. The patient was discharged 24 hours after surgery in excellent conditions. We hold that the TAPP approach is anatomically the soundest repair, with all the added benefits of minimally invasive surgery.
文摘Hernia is a common word that most surgeons are familiar with. A retrospective study was planned to analyse the spectrum of abdominal wall hernias in a rural population inIndia. Majority of the patients were of 40 - 70 yrs. Male to female ratio was 7:1. Incidence of groin hernias showed an increasing trend with advancing age. Out of total 320 cases, inguinal hernias were predominating in 77.81% cases. Ventral hernias were present in about 18% cases. However, femoral hernias were rare. We concluded that spectrum of abdominal wall hernias is almost the same all over the globe despite having differences in their socioeconomic and educational status.
文摘Despite the technological breakthroughs and discover of abdominal meshes, ventral hernia has always been challenging in therapeutic strategies by the surgeons, with high recurrence rates. The use of botulinum toxin A (BTA) for the management of ventral and incisional hernia (IH) poses an increasingly interesting practice, especially for the intimidating complex one. The preoperative administration of the toxin to the lateral abdominal muscles by use of Ultra-Sound guidance causes muscle paralysis and a reduction of intraabdominal pressure. Thus, the hernia defect can be primarily closed without tension, if the length of the defect is up to 10 cm. In larger hernia, this method can be combined with component separation techniques or the use of a mesh. The mesh placement seems to be better by laparoscopy. The site of injection and the dosage of BTA are still under discussion amongst authors. The optimal administration is proposed by some authors to be at least 2 weeks before repair. There is also an analgesic effect of BTA to the patients that underwent hernia reconstruction. Ultimately, the role of BTA in the reconstruction of ventral hernia seems to be promising, but there is a necessity for several randomized clinical trials.