Repair of Abdominal Wall Hernias with Restoration of Abdominal Wall Function

Rosen, Michael J.; Fatima, Javairiah; Sarr, Michael G.

doi:10.1007/s11605-009-0981-9

Cited by 35 publications

(11 citation statements)

References 11 publications

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“…12 In brief, when utilizing a biologic graft for the repair of abdominal wall defects, we prefer to utilize the graft as a sublay to an intact fascial reconstruction. 12 In brief, when utilizing a biologic graft for the repair of abdominal wall defects, we prefer to utilize the graft as a sublay to an intact fascial reconstruction.…”

Section: Methodsmentioning

confidence: 99%

A 5-Year Clinical Experience With Single-Staged Repairs of Infected and Contaminated Abdominal Wall Defects Utilizing Biologic Mesh

et al. 2013

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Section: Methodsmentioning

confidence: 99%

A 5-Year Clinical Experience With Single-Staged Repairs of Infected and Contaminated Abdominal Wall Defects Utilizing Biologic Mesh

et al. 2013

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“…Our preferred surgical approach to VHR is retrorectus mesh reinforcement with midline reapproximation of the fascia with restoration of linea alba. 7 In all cases, a midline laparotomy is initially performed to access the peritoneal cavity with subsequent adhesiolysis of all adhesions of bowel to the anterior abdominal. The retrorectus space is then created by incising the posterior rectus sheath and developing a retromuscular plane toward linea semilunaris.…”

Section: Surgical Techniquementioning

confidence: 99%

Outcomes of Retromuscular Approach for Abdominal Wall Reconstruction in Patients with Inflammatory Bowel Disease

Wang

Majumder

Fayezizadeh

et al. 2016

The American Surgeon™

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Ventral hernia repair (VHR) in patients with inflammatory bowel disease (IBD) presents unique surgical challenges including impaired wound healing, concomitant intestinal operations, along with likely future abdominal surgeries. Appropriate techniques and mesh choices in these patients remain under active debate. Herein we report our experience with using a retromuscular approach for major VHR in a consecutive cohort of IBD patients. We identified all patients with IBD undergoing open VHR with retrorectus mesh placement between 2007 and 2013 in our prospectively maintained database. Main outcomes included patient and hernia characteristics, perioperative details, wound complications, and hernia recurrence. A total of 38 patients with IBD met inclusion criteria. Mean hernia defect size was 338 cm2. Synthetic mesh was used in 16 patients and biologic mesh was used in 22 of patients. A surgical site occurrence (SSO) occurred in 13 (34.2%) patients, 7 (18.4%) of which were surgical site infections (SSIs). There were no instances of postoperative intestinal complications or enterocutaneous fistulae. At the mean follow-up 37 months, there were 3 (9.4%) recurrences. Our retromuscular repairs were associated with a low rate of wound morbidity and no intestinal complications. Furthermore, we report a relatively low rate of recurrences, especially in this series of complex multiply recurrent hernias. Overall, our retromuscular approach seems to be safe and effective in hernia patients with IBD.

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“…Emphasis on the patient as the cause of operative failure has been taken so far as to suggest highly restrictive criteria: “With a BMI > 35 (or even 30), the primary discussion with the patient should not be directed at the hernia but rather at their obesity; strong consideration should be given to obligating substantive weight loss or a bariatric operation before any definitive repair of the abdominal wall hernia” (italics from original manuscript). 16 The introduction of preoperative risk assessment tools like those evaluated in this study follows this trend.…”

Section: Discussionmentioning

confidence: 94%

Current Risk Stratification Systems Are Not Generalizable across Surgical Technique in Midline Ventral Hernia Repair

Fligor

Lanier

Dumanian

2017

Plastic and Reconstructive Surgery - Global Open

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Background:Current ventral hernia repair risk estimation tools focus on patient comorbidities with the goal of improving clinical outcomes through improved patient selection. However, their predictive value remains unproven.Methods:Outcomes of patients who underwent midline ventral hernia repair with retrorectus placement of mid-weight soft polypropylene mesh between 2010 and 2015 were retrospectively reviewed and compared with predicted wound-related complication risk from 3 tools in the literature: Carolinas Equation for Determining Associated Risk, the Ventral Hernia Working Group (VHWG) grade, and a modified VHWG grade.Results:A total of 101 patients underwent hernia repair. Mean age was 56 years and mean body mass index was 29 m/kg2 (range, 18–51 m/kg2). We found no significant relationship between the risk estimated by Carolinas Equation for Determining Associated Risk (B = 1.45, P = 0.61) and actual wound-related complications. VHWG grades >1 were not statistically different with regard to rate of wound complication compared with VHWG grade 1 (grade 2: B = 0.05, P = 0.95; grade 3: B = −0.21, P = 0.86; grade 4: B = 2.57, P = 0.10). Modified VHWG grades >1 were not statistically different with regard to rate of wound complication compared with modified VHWG grade 1 (grade 2: B = 0.20, P = 0.80; grade 3: B = 1.03, P = 0.41).Conclusions:Current risk stratification tools overemphasize patient factors, ignoring the importance of technique in minimizing complications and recurrence. We attribute our low complication rate to retrorectus placement of a narrow, macroporous polypropylene mesh with up to 45 suture fixation points for force distribution in contrast to current strategies that employ wide meshes with minimal fixation.

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Repair of Abdominal Wall Hernias with Restoration of Abdominal Wall Function

Cited by 35 publications

References 11 publications

A 5-Year Clinical Experience With Single-Staged Repairs of Infected and Contaminated Abdominal Wall Defects Utilizing Biologic Mesh

A 5-Year Clinical Experience With Single-Staged Repairs of Infected and Contaminated Abdominal Wall Defects Utilizing Biologic Mesh

Outcomes of Retromuscular Approach for Abdominal Wall Reconstruction in Patients with Inflammatory Bowel Disease

Current Risk Stratification Systems Are Not Generalizable across Surgical Technique in Midline Ventral Hernia Repair

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