Outcomes of the fascial component separation technique with synthetic mesh reinforcement for repair of complex ventral incisional hernias in the morbidly obese

Moore, Michael F.; Bax, Timothy; Macfarlane, Mark; McNevin, Megan

doi:10.1016/j.amjsurg.2008.01.010

Cited by 55 publications

(25 citation statements)

References 19 publications

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“…24 In intermediate-risk patients (grades 2 and 3), complication rates remain high in comparison to patients with fewer comorbidities. 23,[25][26][27] Strattice has been studied prospectively in the Repair of Infected or Contaminated Hernias (RICH) trial for high-risk patients; however, no study to date has examined the success of biologic mesh for intermediate-risk patients. 28 Therefore, the purpose of this study was to determine the efficacy of Strattice mesh in AWR for intermediate-risk patients by analyzing hernia recurrence and 30-day postoperative morbidity.…”

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confidence: 99%

Critical Analysis of Strattice Performance in Complex Abdominal Wall Reconstruction: Intermediate–Risk Patients and Early Complications

Patel

Albino

Nahabedian

et al. 2013

International Surgery

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The purpose of this study was to analyze the performance of a porcine-derived acellular dermal matrix (Strattice Reconstructive Tissue Matrix) in patients at increased risk for perioperative complications. We reviewed medical records for patients with complex abdominal wall reconstruction (AWR) and Strattice underlay from 2007 to 2010. Intermediate-risk patients were defined as having multiple comorbidities without abdominal infection. Forty-one patients met the inclusion criteria (mean age, 60 years; mean body mass index, 35.5 kg/m2). Comorbidities included coronary artery disease (63.4%), diabetes mellitus (36.6%), and chronic obstructive pulmonary disease (17.1%). Fascial closure was achieved in 40 patients (97.6%). Average hospitalization was 6.4 days (range, 1–24 days). Complications included seroma (7.3%), wound dehiscence with Strattice exposure (4.9%), cellulitis (2.4%), and hematoma (2.4%). All patients achieved abdominal wall closure with no recurrent hernias or need for Strattice removal. Patients with multiple comorbidities at intermediate risk of postoperative complications can achieve successful, safe AWR with Strattice.

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confidence: 99%

Critical Analysis of Strattice Performance in Complex Abdominal Wall Reconstruction: Intermediate–Risk Patients and Early Complications

Patel

Albino

Nahabedian

et al. 2013

International Surgery

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“…The use of prosthetic repair material in conjunction with component separation was based on evidence describing reduced hernia recurrence rates compared to unreinforced component separation. 11,18,[24][25][26][27][28] The third element of technique involved how this onlay material was applied. Traditional component separation leaves the external oblique muscle loose and permanently retracted, potentially weakening the lateral abdominal wall and predisposing the patient to lateral bulging.…”

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confidence: 99%

A Modified Approach to Component Separation Using Biologic Graft as a Load-Sharing Onlay Reinforcement for the Repair of Complex Ventral Hernia

et al. 2013

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Background. Components separation has been proposed as a means to close large ventral hernia without undue tension. We report a modification on open components separation that allows for the incorporation of onlaid noncrosslinked porcine acellular dermal matrix (Strattice, LifeCell Corp, Branchburg, NJ) as a load-sharing structure. Methods. This was a retrospective case series including all cases using Strattice from July 2008 through December 2009. Data evaluated included patient demographics, comorbidities associated with risk of recurrence, hernia grade, and postoperative complications. The primary outcomes were hernia recurrence and surgical site occurrences. Results. There were 58 patients; 60.8% presented with a recurrent incisional hernia. Average length of follow-up was 384 days. There were 4 hernia recurrences (7.9%). Complications included surgical site infection (20.7%), seroma (15.5%), and hematoma (5%) requiring intervention. Four deaths occurred in the series due to causes unrelated to the hernia repair, only 1 within 30 days of operation. Conclusions. This series demonstrates that components separation reinforced with noncrosslinked porcine acellular dermal matrix onlay is an efficacious, single-stage repair with a low rate of recurrence and surgical site occurrences.

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“…Большой интерес к задней сепарационной герниопластике определяется низкой частотой осложнений со стороны послеоперационной раны [6,7,8,9,10,11]. Тем не менее, по мере распространения данной методики герниопла-стики увеличивается количество сообщений о высокой частоте хронического болевого синдрома, развитие которого в значительной степени обусловлено повреждением межре-берных нервов при отделении задних листков апоневротического влагалища от прямых мышц живота [8,9].…”

Section: Introductionunclassified

To the Question of Intercostal Nerve Injury Prevention at the Posterior Separation Hernioplasty of Umbilical Hernias

Chernyh¹,

Закурдаев²,

Zakurdaeva³

2016

Novosti Khirurgii

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К ВОПРОСУ О ПРОФИЛАКТИКЕ ТРАВМАТИЗАЦИИ МЕЖРЕБЕРНЫХ НЕРВОВ ПРИ ЗАДНЕЙ СЕПАРАЦИОННОЙ ГЕРНИОПЛАСТИКЕ ПУПОЧНЫХ ГРЫЖГБОУ ВПО «Воронежский государственный медицинский университет им. Н.Н. Бурденко», Российская ФедерацияЦель. Изучить особенности топографии межреберных нервов в чревной области передней брюш-ной стенки.Материал и методы. Исследовано 88 нефиксированных трупов лиц обоего пола без признаков па-тологии передней брюшной стенки. Среди них было 45% трупов лиц мужского пола (средний возраст -53,8±11,9 лет) и 55% -женского пола (51,9±13,2 года). На каждом трупе выполнялось топографо-анатоми-ческое препарирование межреберных нервов в чревной области передней брюшной стенки с определением уровня их проникновения в прямые мышцы живота относительно нижнего края реберной дуги и наруж-ного края прямой мышцы живота.Результаты. В данном исследовании в чревной области передней брюшной стенки было выявлено от 1 до 4 пар межреберных нервов. У лиц женского пола достоверно чаще встречалось 2 пары межреберных нервов (71%), тогда как у лиц мужского пола статистически значимых различий не установлено.Межреберные нервы проникали в прямые мышцы живота чаще всего через их наружные края (52%), несколько реже -со стороны их задней поверхности (39%). У лиц мужского пола значительно чаще на-блюдался боковой вариант проникновения межреберных нервов в прямые мышцы живота (60%), а у лиц женского пола статистически значимых различий не выявлено. Для снижения риска интраоперационной травматизации межреберных нервов определены уровни их проникновения в толщу прямых мышц живота. Установлено, что расстояние от нижнего края реберной дуги до точки проникновения межреберных нервов в прямые мышцы живота достоверно больше у лиц женского пола. Расстояние от наружного края прямой мышцы живота до точки проникновения межреберных нервов в мышечную толщу значительно больше у лиц мужского пола.Заключение. Полученные данные могут быть использованы для прогнозирования топографии меж-реберных нервов при протезирующей герниопластике пупочных грыж. Ключевые слова: пупочная грыжа, топография, прямая мышца живота, задняя сепарационная гернио-пластика, проникновение, межреберные нервы, хронический болевой синдромObjectives. To study the specific features of the topography of the intercostal nerves in the celiac area of the anterior abdominal wall.Methods. The floating corpses (n=88) of both sexes without any pathology of the anterior abdominal wall were studied. There were 45% of male corpses (mean age -53,8±11,9 years) and 55% -females (51,9±13,2 years).The topographic anatomical dissection of the intercostal nerves in the celiac area of the anterior abdominal wall with the determination of the level of their penetration into the rectus abdominis in relation to the inferior edge of the costal arch and the external edge of the rectus abdominis muscle had been performed on each corpse.Results. In this study the intercostal nerves (1-4 pairs) had been identified in the celiac area of the anterior abdominal wall. Most often 2 pairs of intercostal nerves (71%) met in...

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Outcomes of the fascial component separation technique with synthetic mesh reinforcement for repair of complex ventral incisional hernias in the morbidly obese

Cited by 55 publications

References 19 publications

Critical Analysis of Strattice Performance in Complex Abdominal Wall Reconstruction: Intermediate–Risk Patients and Early Complications

Critical Analysis of Strattice Performance in Complex Abdominal Wall Reconstruction: Intermediate–Risk Patients and Early Complications

A Modified Approach to Component Separation Using Biologic Graft as a Load-Sharing Onlay Reinforcement for the Repair of Complex Ventral Hernia

To the Question of Intercostal Nerve Injury Prevention at the Posterior Separation Hernioplasty of Umbilical Hernias

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