How-we-do-it: the repair of postoperative ventral hernias after a Mercedes abdominal incision

Nevo, Nadav; Goldstein, Adam; Yakubovsky, O.; Biesse, R.; Nizri, Eran; Lahat, Guy; Karin, Eliad

doi:10.1007/s00423-021-02087-y

Cited by 5 publications

(3 citation statements)

References 27 publications

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“…29,30 The traditional chevron and Mercedes-Benz incisions are a combination of midline, subcostal, and flank components that can lead to disruption of the myofascial domain of the abdomen and weakening of the rectus abdominis. 10,[31][32][33] These approaches can lead to higher rates of recurrences compared with traditional laparotomy incision at the midline. 7,34 We hypothesize that the senior author's technique 18 is uniquely suited to address large defects of the post-OLT population.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Ventral Hernia Repair After Orthotopic Liver Transplant Using Component Separation and Onlay Biologic Mesh

Soto¹,

Zoog²,

Nolte³

et al. 2023

Ann Plast Surg

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IntroductionThe management of ventral hernias (VHs) after orthotopic liver transplant (OLT) can be uniquely challenging because of immunosuppression coupled with large laparotomy size that can compromise the quality of the abdominal wall. The component separation with multipoint suture onlay acellular dermis fixation technique has proven to be effective in high-risk abdominal wall reconstructions. The goal of this study was to elucidate the factors that affect safety and efficacy of VH repair in post-OLT patients.MethodsA retrospective review of 345 patients who underwent repair of VH with compartment separation and onlay acellular dermal matrix reinforcement from a single surgeon from 2012 to 2020 was conducted. Of these, 27 patients were identified with a history of OLT and were stratified based on whether the defect was a initial or recurrent hernia repair. The majority of patients had a standard chevron incision (70%). Data abstraction was performed for preoperative risk factors, hernia characteristics, surgical site complications, and postoperative course including hernia recurrence.ResultsA majority of cases in the study period were initial hernia repairs (59%) with no significant differences in the patient demographics and size of VH defects (190 ± 112.69 cm2). Comorbidities were similar between the groups with the exception of a significantly higher baseline creatinine levels and higher history of smoking in the recurrent hernia repair group (P < 0.05). Of the 27 cases, there were no demonstrable hernia recurrences noted and an overall 11% complication rate. Univariate analysis noted a statistically significant difference in surgical site complication rate (P = 0.017), with the initial hernia repair group having the lowest rate of surgical site complications.ConclusionsIn complex post-OLT patients with large VH, modified component separation with onlay acellular mesh was shown to have acceptable medium-term results. Further studies investigating the factors leading to postoperative complications are necessary to reduce recurrence in this evolving patient population.

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Section: Discussionmentioning

confidence: 99%

Outcomes of Ventral Hernia Repair After Orthotopic Liver Transplant Using Component Separation and Onlay Biologic Mesh

Soto¹,

Zoog²,

Nolte³

et al. 2023

Ann Plast Surg

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“…Preoperative antibiotics (first generation cephalosporin) and venous thromboembolism prophylaxis are given. These basic principles of a modified Rives-Stoppa technique [11][12][13] were incorporated in all of the surgeries: The initial incision most always incorporates the previous scar either excising it or going through it, and extensions as needed to the xyphoid and pubis bone. The hernia sac is excised, usually together with the scar.…”

Section: Surgical Techniquementioning

confidence: 99%

The Use of Inlay Bridge of the Posterior Fascia as Adjuvants to a Modified Rives-Stoppa Repair for Difficult Abdominal Wall Hernias

Goldstein

Nevo

Nizri

et al. 2022

The American Surgeon™

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Background Major abdominal wall defects remain a highly morbid complication. Occasionally a fascial defect is encountered, that despite all surgical efforts, is unable to completely approximate at the midline. Here we describe our method and outcomes of using a bridging mesh when the posterior fascia was unable to be approximated during the repair of large postoperative ventral hernias using the modified Rives-Stoppa technique. Methods A retrospective review was conducted looking at all the open abdominal wall hernia repairs between 2014 and 2020. The cohort of patients who had a bridge placed in addition to the traditional open modified Rives-Stoppa repair were used for this study. Results Nineteen patients had a mesh inlay bridge placed in addition to a modified Rives-Stoppa repair with a sublay (retrorectus) Ultrapro mesh. For the inlay mesh 13 Symbotex composite meshes were placed and 6 Vicryl meshes used. The average surface area of the defect was 358.1 cm^2. The average length of hospitalization was 8.8 days with a range of 3-24 days. During the immediate postoperative course there were 6 minor complications. During the follow-up period there were 2 recurrences. Discussion The use of inlay mesh bridge as an adjuvant to a modified Rives-Stoppa repair with a sublay ultrapro mesh is an effective technique for difficult abdominal wall repairs where the posterior fascia is unable to be approximated without tension.

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“…Laparotomy is performed by many types of surgeons [2], including liver and kidney transplant surgeons, urologists, gynecologists [2], vascular-, esophageal-, colorectal-, liver-, pancreatic-, cancer-, AW-, bariatric-, thoracic-and neurosurgeons. They may carry out several different types of laparotomy, which can be median laparotomy with xiphoidpubic incision, the Mercedes Benz-type incision [3], minimedian-type, sub-costal unilateral [4,5]/bilateral sub-costal laparotomy [6], the pararectus abdominis approach [7], the in the same patient, more than one incisional hernia may develop at the laparotomy sites [3], appearing as widelyspaced. Sometimes a spaced primary ventral hernia (VH), e.g.…”

Section: Introductionmentioning

confidence: 99%

The "Slim-Mesh": Single Operation with Multiple Slim-Meshes for Multiple Widely-Spaced Ventral Hernias in the Same Patient

Silvio Alen

2023

Ann Minim Invasive Surg

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Purpose: Test the technical feasibility of the "Slim-Mesh" technique using multiple "Slim-Meshes" during an operation for multiple widely-spaced ventral hernias in the same patient; verify the results of a 12-year followup.Methods: From September 2009 to December 2019, 8 patients with the above hernias were treated exclusively with the "Slim-Mesh" technique at our Department. This was a prospective (63%)-retrospective study.Results: This study comprised 6 males and 2 females. Mean age was 57 years. Three of the 8 cases had a triple spaced ventral hernia (Group 1): 2 of the 3 were treated with 2 "Slim-Meshes" each, and the remaining patient with 3. The remaining 5 cases had one double spaced ventral hernia each (Group 2); each case was operated on with 2 "Slim-Meshes". During operation, the author also found and repaired associated diastasis recti in 38% of cases, doing so without using additional "Slim-Meshes". Mean operation time for all 8 cases, Group 1 and Group 2 was 153, 220 and 112 minutes respectively. Composite mesh, non-composite mesh, titanium tacks and absorbable straps for mesh fixations were used in 87.5%, 12.5%, 25% and 75% of cases respectively. Mean length of hospital stay was 3 days. Mean follow-up time was 6 years. No early or long-term postoperative complications occurred. Conclusion:This study revealed the existence of a new patient-type, namely one with multiple widely-spaced ventral hernias (7%). My technique facilitates intra-abdominal introduction and fixation of successive multiple meshes during the same operation, proving to be safe, fast and economical.

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How-we-do-it: the repair of postoperative ventral hernias after a Mercedes abdominal incision

Cited by 5 publications

References 27 publications

Outcomes of Ventral Hernia Repair After Orthotopic Liver Transplant Using Component Separation and Onlay Biologic Mesh

Outcomes of Ventral Hernia Repair After Orthotopic Liver Transplant Using Component Separation and Onlay Biologic Mesh

The Use of Inlay Bridge of the Posterior Fascia as Adjuvants to a Modified Rives-Stoppa Repair for Difficult Abdominal Wall Hernias

The "Slim-Mesh": Single Operation with Multiple Slim-Meshes for Multiple Widely-Spaced Ventral Hernias in the Same Patient

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