Benign esophageal strictures refractory to the conventional balloon or bougie dilatation may be subjected to various adjunctive modes of therapy, one of them being endoscopic incisional therapy(EIT). A proper delineat...Benign esophageal strictures refractory to the conventional balloon or bougie dilatation may be subjected to various adjunctive modes of therapy, one of them being endoscopic incisional therapy(EIT). A proper delineation of the stricture anatomy is a prerequisite. A host of electrocautery and mechanical devices may be used, the most common being the use of needle knife, either standard or insulated tip. The technique entails radial incision and cutting off of the stenotic rim. Adjunctive therapies, to prevent re-stenosis, such as balloon dilatation, oral or intralesional steroids or argon plasma coagulation can be used. The common strictures where EIT has been successfully used are Schatzki's rings(SR) and anastomotic strictures(AS). Short segment strictures(< 1 cm) have been found to have the best outcome. When compared with routine balloon dilatation, EIT has equivalent results in treatment na?ve cases but better long term outcome in refractory cases. Anecdotal reports of its use in other types of strictures have been noted. Post procedure complications of EIT are mild and comparable to dilatation therapy. As of the current evidence, incisional therapy can be used for management of refractory AS and SR with relatively short stenosis(< 1 cm) with good safety profile and acceptable long term patency.展开更多
Background and Aim: The incidence of incisional hernias has been reported to be around 15%. In the present scenario, a wide array of surgical procedures are available for their better management. In this study, we int...Background and Aim: The incidence of incisional hernias has been reported to be around 15%. In the present scenario, a wide array of surgical procedures are available for their better management. In this study, we intend to share our experience with one novel technique, “Hybrid IPOM (Intraperitoneal onlay meshplasty)” as a management option for a selected cohort of patients. Methods: This prospective study was undertaken during January 2019 to July 2023 at King Abdullah medical city, Makkah. A total of 51 cases were selected for Hybrid IPOM repair as per inclusion criteria;medium sized (4 - 10 cm) hernia defects;uncomplicated hernias;age more than 18 years. The follow-up period of the patients varied from 6 months to 4 years. The operation commenced with open hernia dissection, mesh deployment into abdomen, defect closure and then conversion to laparoscopy for the posterior mesh placement. Results: A total of 51 cases were repaired successfully with this technique. 48 out of 51 cases were incisional hernias secondary to some primary procedure done either for hernias itself or some other intra-abdominal pathology. The three cases were primary hernias falling in medium to large category with unaesthetic overlying skin. The age range was 19 to 72 years. The mean (range) operative time was 135 (90 - 240) min, and the average blood loss was 70 ml. The mean (range) hospital stay was 3 (2 - 11) days. All patients returned to routine work within 2 - 3 weeks of surgery. The median follow-up was 15 (6 - 48) months. Of the 51 cases, 3 patients developed seroma (managed conservatively), 1 patient developed a large hematoma (needed evacuation), and 1 patient developed superficial wound infection (managed with antibiotics). Two patients had recurrences;one patient had previously failed multiple repairs, and the other developed a postoperative hematoma. None of our patients had an iatrogenic bowel injury. Conclusion: Hybrid IPOM technique is a safe, feasible and easily reproducible technique. It may prove easier especially 展开更多
Introduction: Incisional hernia is a common medical situation and its treatment has always been a challenge for general surgeons. If laparoscopic repair has become a gold standard elsewhere, it is increasingly done in...Introduction: Incisional hernia is a common medical situation and its treatment has always been a challenge for general surgeons. If laparoscopic repair has become a gold standard elsewhere, it is increasingly done in our milieu, but no data has been found. The aim of this study was to review this surgery done in our country so far, to describe the operative technique and to evaluate the postoperative outcomes. Patients and Methods: We conducted an observational descriptive study with retrospective collection of data from the 1<sup>st</sup> of July 2018 to 30<sup>th</sup> of June 2022, in three hospitals in Cameroon. Data on socio-demographic and clinical characteristics, surgical technique and postoperative outcomes of patients who had a laparoscopic repair of their incisional hernia were collected. Results: We reviewed 20 files. There were 14 women with an average age of 54.6 years. The average BMI was 32.8 kg/m<sup>2</sup>. Thirteen patients had a moderate size hernia and the hernia was localized at the midline in 18 cases. Only composite biface meshes were used with dimensions chosen to obtain at least 5 cm overlap. Spiral tacks were the only fixation means used. We registered 3 complications. One case of generalized peritonitis secondary to missed digestive perforation, one case of seroma and one case of postoperative ileus. We registered no death. Conclusion: Laparoscopic repair of incisional hernias is feasible in a resource-limited setting like ours. Compliance with the operative technique and recommendations is important to obtain short-term results closed to that put forward by literature.展开更多
Preoperative sleep loss can amplify post-operative mechanical hyperalgesia.However,the underlying mechanisms are still largely unknown.In the current study,rats were randomly allocated to a control group and an acute ...Preoperative sleep loss can amplify post-operative mechanical hyperalgesia.However,the underlying mechanisms are still largely unknown.In the current study,rats were randomly allocated to a control group and an acute sleep deprivation(ASD)group which experienced 6 h ASD before surgery.Then the variations in cerebral function and activity were investigated with multi-modal techniques,such as nuclear magnetic resonance,functional magnetic resonance imaging,c-Fos immunofluorescence,and electrophysiology.The results indicated that ASD induced hyperalgesia,and the metabolic kinetics were remarkably decreased in the striatum and midbrain.The functional connectivity(FC)between the nucleus accumbens(NAc,a subregion of the ventral striatum)and the ventrolateral periaqueductal gray(vLPAG)was significantly reduced,and the c-Fos expression in the NAc and the vLPAG was suppressed.Furthermore,the electrophysiological recordings demonstrated that both the neuronal activity in the NAc and the vLPAG,and the coherence of the NAc-vLPAG were suppressed in both resting and task states.This study showed that neuronal activity in the NAc and the vLPAG were weakened and the FC between the NAc and the vLPAG was also suppressed in rats with ASD-induced hyperalgesia.This study highlights the importance of preoperative sleep management for surgical patients.展开更多
BACKGROUND Laparoscopic colorectal cancer surgery increases the risk of incisional hernia(IH)at the tumor extraction site.AIM To investigate the incidence of IH at extraction sites following laparoscopic colo-rectal c...BACKGROUND Laparoscopic colorectal cancer surgery increases the risk of incisional hernia(IH)at the tumor extraction site.AIM To investigate the incidence of IH at extraction sites following laparoscopic colo-rectal cancer surgery and identify the risk factors for IH incidence.METHODS This study retrospectively analyzed the data of 1614 patients who underwent la-paroscopic radical colorectal cancer surgery with tumor extraction through the abdominal wall at our center between January 2017 and December 2022.Diffe-rences in the incidence of postoperative IH at different extraction sites and the risk factors for IH incidence were investigated.RESULTS Among the 1614 patients who underwent laparoscopic radical colorectal cancer surgery,303(18.8%),923(57.2%),171(10.6%),and 217(13.4%)tumors were ex-tracted through supraumbilical midline,infraumbilical midline,umbilical,and off-midline incisions.Of these,52 patients developed IH in the abdominal wall,with an incidence of 3.2%.The incidence of postoperative IH was significantly higher in the off-midline incision group(8.8%)than in the middle incision groups[the supraumbilical midline(2.6%),infraumbilical midline(2.2%),and umbilical incision(2.9%)groups](χ^(2)=24.985;P<0.05).Univariate analysis showed that IH occurrence was associated with age,obesity,sex,chronic cough,incision infection,and combined diabetes,anemia,and hypopro-teinemia(P<0.05).Similarly,multivariate analysis showed that off-midline incision,age,sex(female),obesity,incision infection,combined chronic cough,and hypoproteinemia were independent risk factors for IH at the site of laparoscopic colorectal cancer surgery(P<0.05).CONCLUSION The incidence of postoperative IH differs between extraction sites for laparoscopic colorectal cancer surgery.The infraumbilical midline incision is associated with a lower hernia rate and is thus a suitable tumor extraction site.展开更多
BACKGROUND Abdominal wall deficiencies or weakness are a common complication of tem-porary ostomies,and incisional hernias frequently develop after colostomy or ileostomy takedown.The use of synthetic meshes to reinfo...BACKGROUND Abdominal wall deficiencies or weakness are a common complication of tem-porary ostomies,and incisional hernias frequently develop after colostomy or ileostomy takedown.The use of synthetic meshes to reinforce the abdominal wall has reduced hernia occurrence.Biologic meshes have also been used to enhance healing,particularly in contaminated conditions.Reinforced tissue matrices(R-TMs),which include a biologic scaffold of native extracellular matrix and a syn-thetic component for added strength/durability,are designed to take advantage of aspects of both synthetic and biologic materials.To date,RTMs have not been reported to reinforce the abdominal wall following stoma reversal.METHODS Twenty-eight patients were selected with a parastomal and/or incisional hernia who had received a temporary ileostomy or colostomy for fecal diversion after rectal cancer treatment or trauma.Following hernia repair and proximal stoma closure,RTM(OviTex®1S permanent or OviTex®LPR)was placed to reinforce the abdominal wall using a laparoscopic,robotic,or open surgical approach.Post-operative follow-up was performed at 1 month and 1 year.Hernia recurrence was determined by physical examination and,when necessary,via computed tomo-graphy scan.Secondary endpoints included length of hospital stay,time to return to work,and hospital readmissions.Evaluated complications of the wound/repair site included presence of surgical site infection,seroma,hematoma,wound dehiscence,or fistula formation.RESULTS The observational study cohort included 16 male and 12 female patients with average age of 58.5 years±16.3 years and average body mass index of 26.2 kg/m^(2)±4.1 kg/m^(2).Patients presented with a parastomal hernia(75.0%),in-cisional hernia(14.3%),or combined parastomal/incisional hernia(10.7%).Using a laparoscopic(53.6%),robotic(35.7%),or open(10.7%)technique,RTMs(OviTex®LPR:82.1%,OviTex®1S:17.9%)were placed using sublay(82.1%)or intraperitoneal onlay(IPOM;17.9%)mesh positioning.At 1-month and 1-year follow-ups,there were no he展开更多
BACKGROUND Prophylactic loop ileostomy is an effective way to reduce the clinical severity of anastomotic leakage following radical resection of rectal cancer.Incisional surgical site infection(SSI)is a common complic...BACKGROUND Prophylactic loop ileostomy is an effective way to reduce the clinical severity of anastomotic leakage following radical resection of rectal cancer.Incisional surgical site infection(SSI)is a common complication after ileostomy closure.AIM To evaluate the efficacy and safety of the micro-power negative pressure wound technique(MPNPWT)in preventing incisional SSI.METHODS This was a prospective,randomized controlled clinical trial conducted at a single center.A total of 101 consecutive patients who underwent ileostomy closure after rectal cancer surgery with a prophylactic ileostomy were enrolled from January 2019 to December 2021.Patients were randomly allocated into an MPNPWT group and a control group.The MPNPWT group underwent intermittent suturing of the surgical incision with 2-0 Prolene and was covered with a micro-power negative pressure dressing.The surgical outcomes were compared between the MPNPWT(n=50)and control(n=51)groups.Risk factors for incisional SSI were identified using logistic regression.RESULTS There were no differences in baseline characteristics between the MPNPWT(n=50)and control groups(n=51).The incisional SSI rate was significantly higher in the control group than in the MPNPWT group(15.7%vs 2.0%,P=0.031).However,MPNPWT did not affect other surgical outcomes,including intra-abdominal complications,operative time,and blood loss.Postoperative hospital stay length and hospitalization costs did not differ significantly between the two groups(P=0.069 and 0.843,respectively).None of the patients experienced adverse effects of MPNPWT,including skin allergy,dermatitis,and pain.MPNPWT also helped heal the infected incision.Our study indicated that MPNPWT was an independent protective factor[odds ratio(OR)=0.005,P=0.025)]and diabetes was a risk factor(OR=26.575,P=0.029)for incisional SSI.CONCLUSION MPNPWT is an effective and safe way to prevent incisional SSI after loop ileostomy closure.展开更多
Among minimally invasive surgical procedures,colorectal surgery is associated with a notably higher incidence of incisional hernia(IH),ranging from 1.7% to 24.3%.This complication poses a significant burden on the hea...Among minimally invasive surgical procedures,colorectal surgery is associated with a notably higher incidence of incisional hernia(IH),ranging from 1.7% to 24.3%.This complication poses a significant burden on the healthcare system annually,necessitating urgent attention from surgeons.In a study published in the World Journal of Gastrointestinal Surgery,Fan et al compared the incidence of IH among 1614 patients who underwent laparoscopic colorectal surgery with different extraction site locations and evaluated the risk factors associated with its occurrence.This editorial analyzes the current risk factors for IH after laparoscopic colorectal surgery,emphasizing the impact of obesity,surgical site infection,and the choice of incision location on its development.Furthermore,we summarize the currently available preventive measures for IH.Given the low surgical repair rate and high recurrence rate associated with IH,prevention deserves greater research and attention compared to treatment.展开更多
Incisional hernias are a prevalent problem in abdominal surgery and occur in 11% of patients who undergo laparotomy. Primary suture clo-sure of incisional hernias results in a 31%-58% chance of recurrence. The additio...Incisional hernias are a prevalent problem in abdominal surgery and occur in 11% of patients who undergo laparotomy. Primary suture clo-sure of incisional hernias results in a 31%-58% chance of recurrence. The addition of a pros-thetic mesh implant decreases recurrence rates to 8%-10%. Popularized in Europe by Rives and Stoppa, the sublay technique has proven to be very effective, with low recurrence rates (0%-23%) and minimal complications. The pur-pose of the study was to evaluate the experi-ence of a single surgeon at a large tertiary care center performing a modified Rives-Stoppa re-pair for abdominal incisional hernias. To do this, the records of all patients undergoing a modi-fied Rives-Stoppa incisional hernia repair be-tween January 2000 and August 2003 were ret-rospectively reviewed. Outpatient clinic notes, discharge summaries, operative reports, and laboratory data were reviewed for patient demographics, surgical data and postoperative complications. Univariate analysis was per-formed in order to identify predictors for recur-rence. During the study period, 83 patients un-derwent a modified Rives-Stoppa incisional hernia repair. Nineteen patients were excluded due to incomplete medical records. No patients required postoperative exploration for an in-tra-abdominal catastrophe. Twenty-five percent (n=16) of patients had a complication as a result of the hernia repair. Only two patients (3.1%) developed recurrent incisional hernias. History of diabetes (p=0.007) and benign prostatic hy-perplasia (p=0.000) were the only significant predictors for recurrence. The results presented here confirm that the modified Rives-Stoppa retromuscular repair is an effective method for the repair of incisional hernias. The complica-tion and recurrence rates compare favorably to results for currently popular alternative tech-niques.展开更多
The so-called 'burst abdomen' has been described for many years and is a well-known clinical condition, whereas the concept of the 'open abdomen' is relatively new. In clinical practice, both nosologi... The so-called 'burst abdomen' has been described for many years and is a well-known clinical condition, whereas the concept of the 'open abdomen' is relatively new. In clinical practice, both nosological entities are characterized by a complex spectrum of symptoms apparently disconnected, which in many cases poses a great challenge for surgical repair. In order to assess the management of these disorders in a more comprehensive and integral fashion, the concept of 'acute postoperative open abdominal wall'(acute POAW) is presented, which in turn can be divided into 'intentional' or planned acute POAW and 'unintentional' or unplanned POAW. The understanding of the acute POAW as a single clinical process not only allows a better optimization of the ther-apeutic approach in the surgical repair of abdominal wallrelated disorders, but also the stratification and collection of data in different patient subsets, favoring a better knowledge of the wide spectrum of conditions involved in the surgical reconstruction of the abdominal wall.展开更多
Objectives:To explore the risk factors and nursing measures of early surgical site infection(SSI)after posterior lumbar interbody fusion(PLIF).Methods:A total of 468 patients who received PLIF in our hospital from Jan...Objectives:To explore the risk factors and nursing measures of early surgical site infection(SSI)after posterior lumbar interbody fusion(PLIF).Methods:A total of 468 patients who received PLIF in our hospital from January 2017 to June 2020 were enrolled into this study.According to the occurrence of early SSI,the patients were divided into two groups,and the general data were analyzed by univariate analysis.Multivariate logistic regression analysis was conducted with the dichotomous variable of whether early SSI occurred and other factors as independent variables to identify the risk factors of early SSI and put forward targeted prevention and nursing measures.Results:Among 468 patients with PLIF,18 patients developed early SSI(3.85%).The proportion of female,age,diabetes mellitus and urinary tract infection(UTI),operation segment,operation time,post-operative drainage volume,and drainage time were significantly higher than those in the uninfected group,with statistical significance(P<0.05),whereas the preoperative albumin and hemoglobin in the infected group were significantly lower than those in the uninfected group,with statistical significance(P<0.05).There was no significant difference between the two groups in the American Society of Anesthesiologists(ASA)grading,body mass index(BMI),complications including cardiovascular and cerebrovascular diseases or hypertension(P>0.05).Logistic regression analysis showed that preoperative diabetes mellitus(OR=2.109,P=0.012)/UTI(OR=1.526,P=0.035),prolonged drainage time(OR=1.639,P=0.029)were risk factors for early SSI.Men(OR=0.736,P=0.027)and albumin level(OR=0.526,P=0.004)were protective factors in reducing early SSI.Conclusions:Women,preoperative diabetes/UTI,hypoproteinemia,and prolonged drainage time are risk factors for early SSI after PLIF.Clinical effective preventive measures should be taken in combination with targeted nursing intervention to reduce the risk of early SSI.展开更多
We present a case of a 57 years old moderately obese woman with a known 12 cmincisional hernia, who subsequently developed an incarcerated acute appendicitis. The patient underwent an uneventful orthotopic liver and r...We present a case of a 57 years old moderately obese woman with a known 12 cmincisional hernia, who subsequently developed an incarcerated acute appendicitis. The patient underwent an uneventful orthotopic liver and renal transplant five years prior, and was compliant with ongoing immunosuppression without rejection. She presented with 8 hours of acute onset right lower quadrant pain, associated with anorexia, documented fevers, and nausea. Noncontrast CT demonstrated a blind-ending tubular structure with an enhancing and thickened wall within a hernia defect of the right lower quadrant. The patient underwent emergent laparotomy and a non-perforated appendix was completely excised at its base. Discussion: There have been documented reports of an acute appendicitis associated with inguinal hernias, given the eponym Amyand’s hernia. Appendicitis may present within hernias, and there should be a low threshold for radiologic assessment of its components when there is clinical doubt about the symptoms associated with the hernia. Our recommendation prompts early use of non-contrast CT scan in transplant patients with known hernias on examination and abdominal tenderness over the renal allograft considering the high risk of perforation of acute appendicitis and strangulation.展开更多
Background: Laparoscopic hernioplasty has gained popularity with significant advances in prostheses. Omega-3 coating mesh (C-Qur) is a prosthesis that can be used in the abdominal cavity, and the coating prevents adhe...Background: Laparoscopic hernioplasty has gained popularity with significant advances in prostheses. Omega-3 coating mesh (C-Qur) is a prosthesis that can be used in the abdominal cavity, and the coating prevents adhesion of the mesh to the viscera. We planned a prospective observational study of laparoscopic hernioplasty using C-Qur. Methods: C-Qur was used in laparoscopic hernioplasty over the course of 1 year. We considered laparoscopic approaches as our primary treatment method for abdominal wall hernias. Although only a single incision was made for the majority of the laparoscopic hernioplasties, additional incisions were made when severe adhesions were encountered. For incisional or ventral hernias, a lateral lower incision was made. For inguinal hernias, an umbilical incision was made. Sex, age, diagnosis, number of incisions, additional incisions, morbidity, and follow-up period were evaluated. Results: Twenty-four patients who underwent surgery between May 2010 and April 2011 were included in this study. The median follow-up period was 14 months. The most common early complications included wound pain and edema;however, there were no persistent complications.展开更多
BACKGROUND:Lumbar hernia is a rare congenital or acquired defect of the posterior abdominal wall. The acquired type is more common and occurs mainly as an incisional defect after flank surgery. Incarceration or strang...BACKGROUND:Lumbar hernia is a rare congenital or acquired defect of the posterior abdominal wall. The acquired type is more common and occurs mainly as an incisional defect after flank surgery. Incarceration or strangulation of hernia contents is uncommon. METHOD:Segmental liver incarceration through a recurrent incisional lumbar defect was diagnosed in a 58 years old woman by magnetic resonance imaging. RESULTS:The patient underwent an open repair of the com-plicated hernia. An expanded polytetraflouoroethylene(e-PTFE) mesh was fashioned as a sublay prosthesis. She had an uncomplicated postoperative course. Follow-up examinations revealed no evidence of recurrence. CONCLUSIONS:Although lumbar hernia rarely results in incarceration or strangulation,early repair is necessary because of the risks of complications and the increasing difficulty in repairment as it enlarges. Surgical repair is often difficult and challenging.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
AIM To emphasize the effectiveness and versatility of prosthesis, and good tolerance by patients with incisional hernia(IH). METHODS From December 2001 to February 2016, 270 liver transplantations were performed at Sa...AIM To emphasize the effectiveness and versatility of prosthesis, and good tolerance by patients with incisional hernia(IH). METHODS From December 2001 to February 2016, 270 liver transplantations were performed at San Camillo Hospital. IH occurred in 78 patients(28.8%). IH usually appeared early within the first year post-orthotopic liver transplantation. In the first era, fascial defect was repaired by primary closure for defects smaller than 2.5 cm or with synthetic mesh for greater defects. Recently, we started using biological mesh(Permacol?, Covidien). We present a series of five transplanted patients submitted to surgery for abdominal wall defect correction repaired with biological mesh(Permacol?, Covidien). RESULTS In our cases, the use of biological prosthesis(Permacol?, Covidien) have proven to be effective and versatile in repairing hernia defects of different kinds; patients did not suffer infections of the prosthesis and no recurrence was observed. Furthermore, the prosthesis remains intact even in the years after surgery. CONCLUSION The cases that we presented show that the use of biological mesh(Permacol?, Covidien) in transplanted patients may be safe and effective, being careful in the management of perioperative immunosuppression andrenal and graft function, although the cost of the product itself has been the main limiting factor and there is need for prospective studies for further evaluations.展开更多
Background: The purpose of this study was to describe the etiologic factors and therapeutic modalities of incisional hernias in the department of surgery at the regional hospital of Tenkodogo, in Burkina Faso. Methods...Background: The purpose of this study was to describe the etiologic factors and therapeutic modalities of incisional hernias in the department of surgery at the regional hospital of Tenkodogo, in Burkina Faso. Methods: It is a cross sectional study covering the period from 2010 to 2012. Sampling was comprehensive, including all the patients operated for incisional hernias during this period. Results: Fifty-four patients were included. Their average age was 22.3 years. There were 35 (64.8%) males and 19 (35.2%) female patients. We counted 28 large-size incisional hernias, 14 medium-size incisional hernias and 12 incisional hernias of small size. The average time from the first surgery to the diagnosis of incisional hernias was 8 months. Generalized acute peritonitis (44.4%) and acute intestinal obstructions (22.2%) were the main indications of initial surgical interventions. Vertical midline incisions have been involved in 37 cases (68.5%). Therapeutically, two surgical techniques have been used: open suture repair and open mesh repair. Forty-two patients (77.8%) were treated by open suture repair. Twelve patients (22.2%) benefited from open mesh repair. Post-operative complications were noted in 2 patients. Nine patients (16.7%) presented a recurrence after 12 months. Conclusion: In the rural area of Burkina Faso, incisional hernias occur in young patients. Emergencies with abdominal Infections are the main operative indications. Prostheses are relatively high cost and less accessible. The recidivism rate is high.展开更多
Intraparietal Hernias are hernias occurring in the anterior abdominal wall at different anatomical planes. An interparietal hernia has a hernial sac that passes between the layers of the anterior abdominal wall. Appen...Intraparietal Hernias are hernias occurring in the anterior abdominal wall at different anatomical planes. An interparietal hernia has a hernial sac that passes between the layers of the anterior abdominal wall. Appendectomy is a very common surgical procedure, and post appendectomy incisional hernia is a very rare complication. Here we present a case of a 24-year-old male with swelling in the right hypochondrium and lumbar region with an open appendectomy scar. He was diagnosed to have an interparietal hernia in the anterior abdominal wall. After obtaining consent patient was taken up for surgery. At surgery, the patient was found to have a defect in the transverse abdominis muscle with a medial leaf far from the incision site. Open repair of the defect along with double breasting of external oblique done. Interparietal hernias are rare in post appendectomy scar and this case is of significance since it Highlights a rare interstitial type incisional hernia, as a complication of post appendectomy scar, and not many cases reports are mentioned in literature.展开更多
文摘Benign esophageal strictures refractory to the conventional balloon or bougie dilatation may be subjected to various adjunctive modes of therapy, one of them being endoscopic incisional therapy(EIT). A proper delineation of the stricture anatomy is a prerequisite. A host of electrocautery and mechanical devices may be used, the most common being the use of needle knife, either standard or insulated tip. The technique entails radial incision and cutting off of the stenotic rim. Adjunctive therapies, to prevent re-stenosis, such as balloon dilatation, oral or intralesional steroids or argon plasma coagulation can be used. The common strictures where EIT has been successfully used are Schatzki's rings(SR) and anastomotic strictures(AS). Short segment strictures(< 1 cm) have been found to have the best outcome. When compared with routine balloon dilatation, EIT has equivalent results in treatment na?ve cases but better long term outcome in refractory cases. Anecdotal reports of its use in other types of strictures have been noted. Post procedure complications of EIT are mild and comparable to dilatation therapy. As of the current evidence, incisional therapy can be used for management of refractory AS and SR with relatively short stenosis(< 1 cm) with good safety profile and acceptable long term patency.
文摘Background and Aim: The incidence of incisional hernias has been reported to be around 15%. In the present scenario, a wide array of surgical procedures are available for their better management. In this study, we intend to share our experience with one novel technique, “Hybrid IPOM (Intraperitoneal onlay meshplasty)” as a management option for a selected cohort of patients. Methods: This prospective study was undertaken during January 2019 to July 2023 at King Abdullah medical city, Makkah. A total of 51 cases were selected for Hybrid IPOM repair as per inclusion criteria;medium sized (4 - 10 cm) hernia defects;uncomplicated hernias;age more than 18 years. The follow-up period of the patients varied from 6 months to 4 years. The operation commenced with open hernia dissection, mesh deployment into abdomen, defect closure and then conversion to laparoscopy for the posterior mesh placement. Results: A total of 51 cases were repaired successfully with this technique. 48 out of 51 cases were incisional hernias secondary to some primary procedure done either for hernias itself or some other intra-abdominal pathology. The three cases were primary hernias falling in medium to large category with unaesthetic overlying skin. The age range was 19 to 72 years. The mean (range) operative time was 135 (90 - 240) min, and the average blood loss was 70 ml. The mean (range) hospital stay was 3 (2 - 11) days. All patients returned to routine work within 2 - 3 weeks of surgery. The median follow-up was 15 (6 - 48) months. Of the 51 cases, 3 patients developed seroma (managed conservatively), 1 patient developed a large hematoma (needed evacuation), and 1 patient developed superficial wound infection (managed with antibiotics). Two patients had recurrences;one patient had previously failed multiple repairs, and the other developed a postoperative hematoma. None of our patients had an iatrogenic bowel injury. Conclusion: Hybrid IPOM technique is a safe, feasible and easily reproducible technique. It may prove easier especially
文摘Introduction: Incisional hernia is a common medical situation and its treatment has always been a challenge for general surgeons. If laparoscopic repair has become a gold standard elsewhere, it is increasingly done in our milieu, but no data has been found. The aim of this study was to review this surgery done in our country so far, to describe the operative technique and to evaluate the postoperative outcomes. Patients and Methods: We conducted an observational descriptive study with retrospective collection of data from the 1<sup>st</sup> of July 2018 to 30<sup>th</sup> of June 2022, in three hospitals in Cameroon. Data on socio-demographic and clinical characteristics, surgical technique and postoperative outcomes of patients who had a laparoscopic repair of their incisional hernia were collected. Results: We reviewed 20 files. There were 14 women with an average age of 54.6 years. The average BMI was 32.8 kg/m<sup>2</sup>. Thirteen patients had a moderate size hernia and the hernia was localized at the midline in 18 cases. Only composite biface meshes were used with dimensions chosen to obtain at least 5 cm overlap. Spiral tacks were the only fixation means used. We registered 3 complications. One case of generalized peritonitis secondary to missed digestive perforation, one case of seroma and one case of postoperative ileus. We registered no death. Conclusion: Laparoscopic repair of incisional hernias is feasible in a resource-limited setting like ours. Compliance with the operative technique and recommendations is important to obtain short-term results closed to that put forward by literature.
基金This work was supported by grants from the National Natural Science Foundation of China(82071208,81870851,31771193,and 81971775)the Outstanding Talented Young Doctor Program of Hubei Province(HB20200407)+2 种基金the Translational Medicine,and interdisciplinary Research Joint Fund of Zhongnan Hospital of Wuhan University(ZNJC202012)the Medical Sci-Tech Innovation Platform of Zhongnan Hospital of Wuhan Universitythe Strategic Priority Research Program of the Chinese Academy of Sciences(XDB32030200).
文摘Preoperative sleep loss can amplify post-operative mechanical hyperalgesia.However,the underlying mechanisms are still largely unknown.In the current study,rats were randomly allocated to a control group and an acute sleep deprivation(ASD)group which experienced 6 h ASD before surgery.Then the variations in cerebral function and activity were investigated with multi-modal techniques,such as nuclear magnetic resonance,functional magnetic resonance imaging,c-Fos immunofluorescence,and electrophysiology.The results indicated that ASD induced hyperalgesia,and the metabolic kinetics were remarkably decreased in the striatum and midbrain.The functional connectivity(FC)between the nucleus accumbens(NAc,a subregion of the ventral striatum)and the ventrolateral periaqueductal gray(vLPAG)was significantly reduced,and the c-Fos expression in the NAc and the vLPAG was suppressed.Furthermore,the electrophysiological recordings demonstrated that both the neuronal activity in the NAc and the vLPAG,and the coherence of the NAc-vLPAG were suppressed in both resting and task states.This study showed that neuronal activity in the NAc and the vLPAG were weakened and the FC between the NAc and the vLPAG was also suppressed in rats with ASD-induced hyperalgesia.This study highlights the importance of preoperative sleep management for surgical patients.
基金This study was reviewed and approved by the Ethics Committee of Shenzhen People's Hospital.
文摘BACKGROUND Laparoscopic colorectal cancer surgery increases the risk of incisional hernia(IH)at the tumor extraction site.AIM To investigate the incidence of IH at extraction sites following laparoscopic colo-rectal cancer surgery and identify the risk factors for IH incidence.METHODS This study retrospectively analyzed the data of 1614 patients who underwent la-paroscopic radical colorectal cancer surgery with tumor extraction through the abdominal wall at our center between January 2017 and December 2022.Diffe-rences in the incidence of postoperative IH at different extraction sites and the risk factors for IH incidence were investigated.RESULTS Among the 1614 patients who underwent laparoscopic radical colorectal cancer surgery,303(18.8%),923(57.2%),171(10.6%),and 217(13.4%)tumors were ex-tracted through supraumbilical midline,infraumbilical midline,umbilical,and off-midline incisions.Of these,52 patients developed IH in the abdominal wall,with an incidence of 3.2%.The incidence of postoperative IH was significantly higher in the off-midline incision group(8.8%)than in the middle incision groups[the supraumbilical midline(2.6%),infraumbilical midline(2.2%),and umbilical incision(2.9%)groups](χ^(2)=24.985;P<0.05).Univariate analysis showed that IH occurrence was associated with age,obesity,sex,chronic cough,incision infection,and combined diabetes,anemia,and hypopro-teinemia(P<0.05).Similarly,multivariate analysis showed that off-midline incision,age,sex(female),obesity,incision infection,combined chronic cough,and hypoproteinemia were independent risk factors for IH at the site of laparoscopic colorectal cancer surgery(P<0.05).CONCLUSION The incidence of postoperative IH differs between extraction sites for laparoscopic colorectal cancer surgery.The infraumbilical midline incision is associated with a lower hernia rate and is thus a suitable tumor extraction site.
基金This study was reviewed and approved by the UT Health Houston Institutional Review Board(approval No.HSC-MS-23-0471).
文摘BACKGROUND Abdominal wall deficiencies or weakness are a common complication of tem-porary ostomies,and incisional hernias frequently develop after colostomy or ileostomy takedown.The use of synthetic meshes to reinforce the abdominal wall has reduced hernia occurrence.Biologic meshes have also been used to enhance healing,particularly in contaminated conditions.Reinforced tissue matrices(R-TMs),which include a biologic scaffold of native extracellular matrix and a syn-thetic component for added strength/durability,are designed to take advantage of aspects of both synthetic and biologic materials.To date,RTMs have not been reported to reinforce the abdominal wall following stoma reversal.METHODS Twenty-eight patients were selected with a parastomal and/or incisional hernia who had received a temporary ileostomy or colostomy for fecal diversion after rectal cancer treatment or trauma.Following hernia repair and proximal stoma closure,RTM(OviTex®1S permanent or OviTex®LPR)was placed to reinforce the abdominal wall using a laparoscopic,robotic,or open surgical approach.Post-operative follow-up was performed at 1 month and 1 year.Hernia recurrence was determined by physical examination and,when necessary,via computed tomo-graphy scan.Secondary endpoints included length of hospital stay,time to return to work,and hospital readmissions.Evaluated complications of the wound/repair site included presence of surgical site infection,seroma,hematoma,wound dehiscence,or fistula formation.RESULTS The observational study cohort included 16 male and 12 female patients with average age of 58.5 years±16.3 years and average body mass index of 26.2 kg/m^(2)±4.1 kg/m^(2).Patients presented with a parastomal hernia(75.0%),in-cisional hernia(14.3%),or combined parastomal/incisional hernia(10.7%).Using a laparoscopic(53.6%),robotic(35.7%),or open(10.7%)technique,RTMs(OviTex®LPR:82.1%,OviTex®1S:17.9%)were placed using sublay(82.1%)or intraperitoneal onlay(IPOM;17.9%)mesh positioning.At 1-month and 1-year follow-ups,there were no he
基金Supported by the Zhejiang Provincial Natural Science Foundation of China,No.LQ20H260002.
文摘BACKGROUND Prophylactic loop ileostomy is an effective way to reduce the clinical severity of anastomotic leakage following radical resection of rectal cancer.Incisional surgical site infection(SSI)is a common complication after ileostomy closure.AIM To evaluate the efficacy and safety of the micro-power negative pressure wound technique(MPNPWT)in preventing incisional SSI.METHODS This was a prospective,randomized controlled clinical trial conducted at a single center.A total of 101 consecutive patients who underwent ileostomy closure after rectal cancer surgery with a prophylactic ileostomy were enrolled from January 2019 to December 2021.Patients were randomly allocated into an MPNPWT group and a control group.The MPNPWT group underwent intermittent suturing of the surgical incision with 2-0 Prolene and was covered with a micro-power negative pressure dressing.The surgical outcomes were compared between the MPNPWT(n=50)and control(n=51)groups.Risk factors for incisional SSI were identified using logistic regression.RESULTS There were no differences in baseline characteristics between the MPNPWT(n=50)and control groups(n=51).The incisional SSI rate was significantly higher in the control group than in the MPNPWT group(15.7%vs 2.0%,P=0.031).However,MPNPWT did not affect other surgical outcomes,including intra-abdominal complications,operative time,and blood loss.Postoperative hospital stay length and hospitalization costs did not differ significantly between the two groups(P=0.069 and 0.843,respectively).None of the patients experienced adverse effects of MPNPWT,including skin allergy,dermatitis,and pain.MPNPWT also helped heal the infected incision.Our study indicated that MPNPWT was an independent protective factor[odds ratio(OR)=0.005,P=0.025)]and diabetes was a risk factor(OR=26.575,P=0.029)for incisional SSI.CONCLUSION MPNPWT is an effective and safe way to prevent incisional SSI after loop ileostomy closure.
文摘Among minimally invasive surgical procedures,colorectal surgery is associated with a notably higher incidence of incisional hernia(IH),ranging from 1.7% to 24.3%.This complication poses a significant burden on the healthcare system annually,necessitating urgent attention from surgeons.In a study published in the World Journal of Gastrointestinal Surgery,Fan et al compared the incidence of IH among 1614 patients who underwent laparoscopic colorectal surgery with different extraction site locations and evaluated the risk factors associated with its occurrence.This editorial analyzes the current risk factors for IH after laparoscopic colorectal surgery,emphasizing the impact of obesity,surgical site infection,and the choice of incision location on its development.Furthermore,we summarize the currently available preventive measures for IH.Given the low surgical repair rate and high recurrence rate associated with IH,prevention deserves greater research and attention compared to treatment.
文摘Incisional hernias are a prevalent problem in abdominal surgery and occur in 11% of patients who undergo laparotomy. Primary suture clo-sure of incisional hernias results in a 31%-58% chance of recurrence. The addition of a pros-thetic mesh implant decreases recurrence rates to 8%-10%. Popularized in Europe by Rives and Stoppa, the sublay technique has proven to be very effective, with low recurrence rates (0%-23%) and minimal complications. The pur-pose of the study was to evaluate the experi-ence of a single surgeon at a large tertiary care center performing a modified Rives-Stoppa re-pair for abdominal incisional hernias. To do this, the records of all patients undergoing a modi-fied Rives-Stoppa incisional hernia repair be-tween January 2000 and August 2003 were ret-rospectively reviewed. Outpatient clinic notes, discharge summaries, operative reports, and laboratory data were reviewed for patient demographics, surgical data and postoperative complications. Univariate analysis was per-formed in order to identify predictors for recur-rence. During the study period, 83 patients un-derwent a modified Rives-Stoppa incisional hernia repair. Nineteen patients were excluded due to incomplete medical records. No patients required postoperative exploration for an in-tra-abdominal catastrophe. Twenty-five percent (n=16) of patients had a complication as a result of the hernia repair. Only two patients (3.1%) developed recurrent incisional hernias. History of diabetes (p=0.007) and benign prostatic hy-perplasia (p=0.000) were the only significant predictors for recurrence. The results presented here confirm that the modified Rives-Stoppa retromuscular repair is an effective method for the repair of incisional hernias. The complica-tion and recurrence rates compare favorably to results for currently popular alternative tech-niques.
文摘 The so-called 'burst abdomen' has been described for many years and is a well-known clinical condition, whereas the concept of the 'open abdomen' is relatively new. In clinical practice, both nosological entities are characterized by a complex spectrum of symptoms apparently disconnected, which in many cases poses a great challenge for surgical repair. In order to assess the management of these disorders in a more comprehensive and integral fashion, the concept of 'acute postoperative open abdominal wall'(acute POAW) is presented, which in turn can be divided into 'intentional' or planned acute POAW and 'unintentional' or unplanned POAW. The understanding of the acute POAW as a single clinical process not only allows a better optimization of the ther-apeutic approach in the surgical repair of abdominal wallrelated disorders, but also the stratification and collection of data in different patient subsets, favoring a better knowledge of the wide spectrum of conditions involved in the surgical reconstruction of the abdominal wall.
文摘Objectives:To explore the risk factors and nursing measures of early surgical site infection(SSI)after posterior lumbar interbody fusion(PLIF).Methods:A total of 468 patients who received PLIF in our hospital from January 2017 to June 2020 were enrolled into this study.According to the occurrence of early SSI,the patients were divided into two groups,and the general data were analyzed by univariate analysis.Multivariate logistic regression analysis was conducted with the dichotomous variable of whether early SSI occurred and other factors as independent variables to identify the risk factors of early SSI and put forward targeted prevention and nursing measures.Results:Among 468 patients with PLIF,18 patients developed early SSI(3.85%).The proportion of female,age,diabetes mellitus and urinary tract infection(UTI),operation segment,operation time,post-operative drainage volume,and drainage time were significantly higher than those in the uninfected group,with statistical significance(P<0.05),whereas the preoperative albumin and hemoglobin in the infected group were significantly lower than those in the uninfected group,with statistical significance(P<0.05).There was no significant difference between the two groups in the American Society of Anesthesiologists(ASA)grading,body mass index(BMI),complications including cardiovascular and cerebrovascular diseases or hypertension(P>0.05).Logistic regression analysis showed that preoperative diabetes mellitus(OR=2.109,P=0.012)/UTI(OR=1.526,P=0.035),prolonged drainage time(OR=1.639,P=0.029)were risk factors for early SSI.Men(OR=0.736,P=0.027)and albumin level(OR=0.526,P=0.004)were protective factors in reducing early SSI.Conclusions:Women,preoperative diabetes/UTI,hypoproteinemia,and prolonged drainage time are risk factors for early SSI after PLIF.Clinical effective preventive measures should be taken in combination with targeted nursing intervention to reduce the risk of early SSI.
文摘We present a case of a 57 years old moderately obese woman with a known 12 cmincisional hernia, who subsequently developed an incarcerated acute appendicitis. The patient underwent an uneventful orthotopic liver and renal transplant five years prior, and was compliant with ongoing immunosuppression without rejection. She presented with 8 hours of acute onset right lower quadrant pain, associated with anorexia, documented fevers, and nausea. Noncontrast CT demonstrated a blind-ending tubular structure with an enhancing and thickened wall within a hernia defect of the right lower quadrant. The patient underwent emergent laparotomy and a non-perforated appendix was completely excised at its base. Discussion: There have been documented reports of an acute appendicitis associated with inguinal hernias, given the eponym Amyand’s hernia. Appendicitis may present within hernias, and there should be a low threshold for radiologic assessment of its components when there is clinical doubt about the symptoms associated with the hernia. Our recommendation prompts early use of non-contrast CT scan in transplant patients with known hernias on examination and abdominal tenderness over the renal allograft considering the high risk of perforation of acute appendicitis and strangulation.
文摘Background: Laparoscopic hernioplasty has gained popularity with significant advances in prostheses. Omega-3 coating mesh (C-Qur) is a prosthesis that can be used in the abdominal cavity, and the coating prevents adhesion of the mesh to the viscera. We planned a prospective observational study of laparoscopic hernioplasty using C-Qur. Methods: C-Qur was used in laparoscopic hernioplasty over the course of 1 year. We considered laparoscopic approaches as our primary treatment method for abdominal wall hernias. Although only a single incision was made for the majority of the laparoscopic hernioplasties, additional incisions were made when severe adhesions were encountered. For incisional or ventral hernias, a lateral lower incision was made. For inguinal hernias, an umbilical incision was made. Sex, age, diagnosis, number of incisions, additional incisions, morbidity, and follow-up period were evaluated. Results: Twenty-four patients who underwent surgery between May 2010 and April 2011 were included in this study. The median follow-up period was 14 months. The most common early complications included wound pain and edema;however, there were no persistent complications.
文摘BACKGROUND:Lumbar hernia is a rare congenital or acquired defect of the posterior abdominal wall. The acquired type is more common and occurs mainly as an incisional defect after flank surgery. Incarceration or strangulation of hernia contents is uncommon. METHOD:Segmental liver incarceration through a recurrent incisional lumbar defect was diagnosed in a 58 years old woman by magnetic resonance imaging. RESULTS:The patient underwent an open repair of the com-plicated hernia. An expanded polytetraflouoroethylene(e-PTFE) mesh was fashioned as a sublay prosthesis. She had an uncomplicated postoperative course. Follow-up examinations revealed no evidence of recurrence. CONCLUSIONS:Although lumbar hernia rarely results in incarceration or strangulation,early repair is necessary because of the risks of complications and the increasing difficulty in repairment as it enlarges. Surgical repair is often difficult and challenging.
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.
文摘AIM To emphasize the effectiveness and versatility of prosthesis, and good tolerance by patients with incisional hernia(IH). METHODS From December 2001 to February 2016, 270 liver transplantations were performed at San Camillo Hospital. IH occurred in 78 patients(28.8%). IH usually appeared early within the first year post-orthotopic liver transplantation. In the first era, fascial defect was repaired by primary closure for defects smaller than 2.5 cm or with synthetic mesh for greater defects. Recently, we started using biological mesh(Permacol?, Covidien). We present a series of five transplanted patients submitted to surgery for abdominal wall defect correction repaired with biological mesh(Permacol?, Covidien). RESULTS In our cases, the use of biological prosthesis(Permacol?, Covidien) have proven to be effective and versatile in repairing hernia defects of different kinds; patients did not suffer infections of the prosthesis and no recurrence was observed. Furthermore, the prosthesis remains intact even in the years after surgery. CONCLUSION The cases that we presented show that the use of biological mesh(Permacol?, Covidien) in transplanted patients may be safe and effective, being careful in the management of perioperative immunosuppression andrenal and graft function, although the cost of the product itself has been the main limiting factor and there is need for prospective studies for further evaluations.
文摘Background: The purpose of this study was to describe the etiologic factors and therapeutic modalities of incisional hernias in the department of surgery at the regional hospital of Tenkodogo, in Burkina Faso. Methods: It is a cross sectional study covering the period from 2010 to 2012. Sampling was comprehensive, including all the patients operated for incisional hernias during this period. Results: Fifty-four patients were included. Their average age was 22.3 years. There were 35 (64.8%) males and 19 (35.2%) female patients. We counted 28 large-size incisional hernias, 14 medium-size incisional hernias and 12 incisional hernias of small size. The average time from the first surgery to the diagnosis of incisional hernias was 8 months. Generalized acute peritonitis (44.4%) and acute intestinal obstructions (22.2%) were the main indications of initial surgical interventions. Vertical midline incisions have been involved in 37 cases (68.5%). Therapeutically, two surgical techniques have been used: open suture repair and open mesh repair. Forty-two patients (77.8%) were treated by open suture repair. Twelve patients (22.2%) benefited from open mesh repair. Post-operative complications were noted in 2 patients. Nine patients (16.7%) presented a recurrence after 12 months. Conclusion: In the rural area of Burkina Faso, incisional hernias occur in young patients. Emergencies with abdominal Infections are the main operative indications. Prostheses are relatively high cost and less accessible. The recidivism rate is high.
文摘Intraparietal Hernias are hernias occurring in the anterior abdominal wall at different anatomical planes. An interparietal hernia has a hernial sac that passes between the layers of the anterior abdominal wall. Appendectomy is a very common surgical procedure, and post appendectomy incisional hernia is a very rare complication. Here we present a case of a 24-year-old male with swelling in the right hypochondrium and lumbar region with an open appendectomy scar. He was diagnosed to have an interparietal hernia in the anterior abdominal wall. After obtaining consent patient was taken up for surgery. At surgery, the patient was found to have a defect in the transverse abdominis muscle with a medial leaf far from the incision site. Open repair of the defect along with double breasting of external oblique done. Interparietal hernias are rare in post appendectomy scar and this case is of significance since it Highlights a rare interstitial type incisional hernia, as a complication of post appendectomy scar, and not many cases reports are mentioned in literature.
