International Journal of Abdominal Wall and Hernia Surgery

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Inguinal hernia repairs represent one of the most common general surgery operations worldwide. Advances in the understanding of groin anatomy, operative technique, and prosthetics have improved the efficacy of these repairs with overall low recurrence rates and favorable outcomes. Chronic postherniorrhaphy inguinal pain has arguably become the most important and most frequent complication of inguinal hernia repair, with significant impact on patients' quality of life. Neuropathic inguinodynia may be caused by direct nerve injury, manipulation, entrapment, scarring, and interaction with mesh. Development of chronic postinguinal hernia repair pain is independent of the method of hernia repair as all inguinal hernia repair techniques may potentially cause injury. Understanding the neuroanatomy of the inguinal canal and the potential mechanisms for injury leads to lower rates of nerve injury and chronic pain and helps to guide prevention and treatment of inguinodynia. In this article, the neuroanatomy of the anterior inguinal canal and the prevention of nerve injury are addressed.

BACKGROUND: Deep knowledge of anatomy is essential for the success of any surgical intervention. This is especially true for inguinal hernia repair, due to the complex anatomical structure of the groin. METHODS: Observation and documentation of the pathology of the groin in >15,000 laparoscopic inguinal hernia repairs and careful study of the literature describe the anatomy in cadaver preparation. RESULTS: The large variability of the course of the nerves and the utmost importance of the bilaminar structure of the transversalis fascia for a precise dissection of the pelvic floor as well as for the placement of a large flat mesh are described in detail. CONCLUSION: Competent knowledge of the anatomy of the groin facilitates the operative performance, enables a tissue-protective dissection, and may provide an uncomplicated postoperative course.

INTRODUCTION: Whether antibiotic prophylaxis can really reduce the rate of surgical site infections (SSIs) or rather tends to increase the risk of antimicrobial resistance development is being increasingly questioned even for elective surgery in a clean surgical field. Since compared with the open technique, the laparoendoscopic technique per se reduces the SSI rate, that possibility must also be considered for laparoendoscopic repair of inguinal and abdominal wall hernias despite these techniques always using a mesh as a foreign body. MATERIALS AND METHODS: A systematic search of the literature was conducted in Medline/PubMed and the Cochrane database. Thirty-two relevant publications were identified. RESULTS: Overall, there is a paucity of studies on antibiotic prophylaxis in laparoendoscopic hernia surgery. Those studies available are not able to demonstrate that the use of antibiotic prophylaxis in laparoendoscopic repair of inguinal and abdominal wall hernias has a definite effect on the SSI rate. Hence, antibiotic prophylaxis can be omitted with for patients with no risk factors. But that does not apply for patients with risk factors, such as obesity, diabetes mellitus, emergency surgery, contaminated surgical field, recurrent hernia, chronic obstructive pulmonary disease, abdominal aortic aneurysm, prior SSI, long operative time, and other factors influencing the SSI rate. CONCLUSION: Further studies are urgently needed on antibiotic prophylaxis in laparoendoscopic hernia surgery in particular in association with risk factors.

BACKGROUND: The incidence of incisional hernia following surgery is a major economical and clinical burden for healthcare. METHODS: This report reviews and consolidates pertinent literature related to hernia prevention to give surgeons a solid framework on the current perspectives and emerging topics related to incisional hernia prevention. RESULTS: Pertinent anatomy and fundamentals of laparotomy closures are reviewed. Recommended closures of laparotomy incisions include the use of monofilament, slowly absorbing suture in a running fashion with a 4:1 suture to wound length ratio using a short stitch technique. The use of prophylactic mesh reduces the rate of incisional and parastomal hernias in high-risk patients. CONCLUSION: The current fundamentals of hernia prevention including pertinent anatomy and surgical techniques for appropriate laparotomy closures should be known to surgeons operating on the abdominal wall. The use of prophylactic mesh to reduce incisional and parastomal hernias has shown promise, and further research is needed to evaluate long-term efficacy.

OBJECTIVE: The objective of this study is to assess the prophylactic and therapeutic effects of initiative content reduction on intra-abdominal hypertension in obesity patients with huge abdominal incisional hernia. MATERIALS AND METHODS: In this study, the retrospective cohort/descriptive research methods were applied. We collected the clinical data of a total of 62 obesity patients with single-onset huge abdominal incisional hernia who were admitted to Beijing Chaoyang Hospital of Capital Medical University for treatment between January 2011 and December 2015. In the operation, the initiative content reduction was performed. Following observation indexes were recorded as follows: (1) Surgical condition: surgical duration, length of resected intestinal tract, and length of stay (LOS) in hospital; (2) postoperative recovery: cardiac, pulmonary, hepatic and renal functions, and and intravesical pressure; (3) incidence of postoperative complications: infection of incision and intestinal fistula; and (4) patients' condition in follow-up. Return visits in outpatient service were required respectively at 1 week, 1 month, 3 months and 6 months after surgery, and 1 year after follow-up, the follow-up was carried out through telephone. Recurrences of hernia and late-onset infection were the question to be asked in follow-up, and June 2016 was set as the deadline of follow-up. RESULTS: (1) Surgical condition: The surgeries were successfully carried out for 62 patients, in which surgical duration was (115 ± 22) min, the length of resected intestinal tract was (207 ± 64) cm, and LOS was (14.5 ± 1.9) d. (2) Postoperative recovery: the intravesical pressure of patients was decreased in comparison with the level before operation, and after surgery, no hepatic, renal and respiratory dysfunctions were observed. (3) Incidence of postoperative complications: There were four patients with infection of incision; however, no intestinal fistula was found in any patients. (4) Follow-up: follow-up was performed for 62 patients, and the average length of follow-up was 35 months, during which three patients suffered recurrence of incisional hernia. CONCLUSION: For obesity patients with huge abdominal hernia, the application of initiative content reduction can effectively prevent the postoperative intra-abdominal hypertension, which is considered as an effective and feasible therapeutic procedure.

OBJECTIVE: The aim of this study is to investigate the curative effects of mesenchymal stem cells' (MSCs') tenogenic differentiation on Linea alba incision healing. MATERIALS AND METHODS: Autologous MSCs were isolated from rat bone marrow and cultured and induced by 10 ng/mL of bone morphogenetic protein-12 (BMP-12) for 48 h. Expression of scleraxis (SCX), collagen I, and collagen III was examined at 48 h, 5 days, and 7 days to investigate the tenogenic differentiation. Fifty Sprague-Dawley rats were randomly divided into five groups: tenogenically differentiated (group E) or native mesenchymal stem cells (group D) seeded onto collagen sponge scaffolds or only sponge scaffolds (group C) were transplanted into the linea alba incision; rats that underwent operation without implantation of anything served as the sham group (group B), and rats that did not undergo operation were used as the control group (group A). Histological analysis was performed to explore the curative effects. RESULTS: The expression of SCX increases continually even in the absence of BMP-12 for 5 days (P < 0.01). However, the expression of collagen I and III requires persistent inducing by BMP-12. Abundant numbers of cells are present in the midline incision compared to the native linea alba structure (Group A), and Group B has the most serious inflammation, with obvious inflammatory corpuscles. From the sections stained with Masson's trichrome, the tenogenic differentiation of MSCs treating the Linea alba incision demonstrates a relatively rich and well-aligned collagen fibrous matrix along the transverse (tensile) axis of the incision. CONCLUSIONS: In animal experiments, MSCs' tenogenic differentiation induced by BMP-12 can dramatically enhance linea alba incision healing.

Online since 26^th Feb, 2018