Introduction Among many other techniques for Abdominal Wall Reconstruction (AWR), posterior component separation with Transversus Abdominis Release (TAR), continues to gain popularity and it is increasingly used with promising longterm results. Our goal was to evaluate the influence of TAR with mesh retromuscular reinforcement on the intra-abdominal pressure (IAP) and respiratory function in a series of patients with complex incisional hernias (IH). Methods Since November 2014 through February 2019, patients with TAR were identified in the Clinical Department of Surgery database and were retrospectively reviewed. Outcome measures include: demographics, pre-and perioperative details, preoperative and postoperative IAP and plateau pressure (PP). Results One-hundred-and-one consecutive TAR procedures (19.7% from all incisional hernia repairs) were analyzed. Mean age was 63 years with a mean Body Mass Index (BMI) of 31.85 kg/m 2 (25-51). Diabetes and Chronic Obstructive Pulmonary Disease (COPD) were the main major comorbidities. Mean hernia defect area was 247 cm 2 (104-528 cm 2 ). Conclusion TAR is a safe and sound procedure with acceptable modifications of the IAP morbidity and recurrence rate when correctly performed on the right patient.
Introducere: hernia inghinală complexă este o entitate bine descrisă cu un risc ridicat de recidivă şi complicaţii postoperatorii. Nu există o abordare standardizată şi nu există rapoarte care să confirme eficacitatea unei proceduri chirurgicale. Scopul nostru a fost de a compara operaţia Lichtenstein (LR), considerată "standard de aur" pentru abordarea anterioară deschisă cu plastia preperitoneală transinginală (TIPP) în tratamentul herniei inghinale complexe. Material şi Metode: studiul a fost prospectiv şi include toţi pacienţii cu hernie complexă internaţi în Departamentul de Chirurgie al Spitalului Militar Cluj-Napoca între ianuarie 2010 şi decembrie 2014. Toţi pacienţii au fost randomizaţi în două loturi: LR şi TIPP. Caracteristicile de bază, constatările intraoperatorii, durerea şi complicaţiile postoperatorii au fost înregistrate. Urmărirea a fost de cel puţin 1 an. Principalele obiective urmărite după 1 an postoperator au fost recidiva, durerea cronică şi intensitatea sa înregistrată pe scara VAS. Rezultate: 205 de pacienţi (101 în grupul LR şi 104 în TIPP) au fost incluşi în studiu. Nu au existat diferenţe între caracteristicile iniţiale şi rezultatele operatorii. Durerea postoperatorie a fost mai mică pentru grupul TIPP (p<0,05). Urmărirea a fost de 98% la 1
Objective
the aim of this study was to determine the long-term recurrence and complication rates following Rives-Stoppa repair of midline incisional hernias with different types of synthetic materials.
Patients and Methods
medical files of 1628 patients with midline incisional hernias who underwent abdominal wall reconstruction using Rives-Stoppa repair between January 1999 and December 2019 were reviewed. All patients followed up after 1 month, 6 months, and 1year later and after that yearly.
Results
until 2007, 674 patients were operated on with available meshes for that time (mosquito net – 135, polyester mesh – 322, and polypropylene mesh – 217). After 2007, polypropylene meshes were used in 1054 patients (heavyweight in 428 patients and lightweight meshes in 626). The global recurrence rate after a mean follow-up of 96.5 months in the first group of patients was 13.3% and in the second group was 7.13% (mean follow-up of 108.4 months). The infection rate was 16.8% versus 9.2% with an increased incidence at 30 days (84 vs 62 patients). The hematoma rate was equally distributed. Seroma formation was almost 2.5-fold increased in the first group of patients (21.3% vs 8.7%). Increased rate of seroma formation were associated with mosquito net (OR = 1.7; 95% CI = 0.5–1.3; p=o.o2), heavyweight type type (OR = 0.9; 95 CI = 0.07–0.4; p=o.o31). Infection was associated with the usage of mosquito net, heavyweight type, and polyester mesh.
Conclusions
the lightweight mesh offers a safe method for abdominal wall reconstruction.
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