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   2018| July-September  | Volume 1 | Issue 2  
    Online since August 16, 2018

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Optimal management of mesh infection: Evidence and treatment options
Michael R Arnold, Angela M Kao, Korene K Gbozah, B Todd Heniford, Vedra A Augenstein
July-September 2018, 1(2):42-49
Mesh reinforcement is generally considered the standard of care in ventral hernia repair. Infection is a common complication following ventral hernia repair. Infection extending to the mesh is a complex problem. Knowledge of current treatment strategies is necessary for surgeons performing abdominal wall reconstruction. A comprehensive literature review was performed of current literature to assess risk factors and treatment options for mesh infection. Modifiable risk factors for mesh infections include active smoking, poorly controlled diabetes mellitus, abdominal skin or wound issues, and obesity. Operative factors that increase the risk of mesh infection include prior hernia repair, enterotomy and contamination of the surgical field. Of the synthetic meshes, lightweight polypropylene has the highest likelihood of salvage. Patients that are current smokers, those with other synthetic mesh types, and those infected with MRSA are rarely salvaged. Following excision of infected mesh, multi-staged abdominal wall reconstruction can be considered. Biologic or biosynthetic mesh is recommended when repairing incisional hernias following excision of infected mesh and likely represent the patient's best chance at a definitive hernia repair. Wound VAC-assisted delayed primary closure should be considered in higher-risk patients. Mesh infection is a complex complication that is commonly encountered by surgeons performing hernia repair. Prevention through patient optimization should be performed whenever appropriate. However, when patients develop a mesh infection, most will require complete mesh excision and recurrent hernia repair.
  38,142 3,613 19
Prevention of seroma formation after laparoscopic inguinoscrotal indirect hernia repair by a new surgical technique: A preliminary report
Junsheng Li, Zhenling Ji, Xiangyu Shao
July-September 2018, 1(2):55-59
BACKGROUND: Seroma formation is a frequent complication of laparoscopic inguinoscrotal hernia, and the most appropriate technique regarding the distal sac management in laparoscopic inguinoscrotal hernia is still debated. The aim of this study is to present a new technique to manage the large distal sac and to avoid the clinical significant seroma formation after laparoscopic inguinoscrotal hernia repair. MATERIALS AND METHODS: One hundred and ninety-five consecutive elective inguinal hernias were performed in our group in 1-year period and 12 of them were inguinoscrotal indirect hernias, defined as the hernia sac descending into the scrotum. In these inguinoscrotal hernia patients, the distal hernia sacs were transected and left in place without complete dissection out of scrotum and reduction. Then, the lower edge of the distal sac was fixed to the posterior abdominal wall cranial and lateral to the internal ring with barbed suture. The patients were prospectively followed with physical examination, and in five of them, ultrasound was performed on the 1st day and 7th day after the operation. The primary postoperative outcome parameter was seroma formation; the secondary parameters included groin pain, surgical complications, and early hernia recurrence. RESULTS: Only one patient developed clinical significant seroma by physical examination during the follow-up period. The patients complained no chronic groin pain, and there were no other surgical complications and early hernia recurrence in these series. CONCLUSION: Seroma formation could be effectively prevented by suspension of the lower edge of the distal sac to the posterior abdominal wall is an easy, reproducible, reliable, and cost-effective method to prevent postoperative clinical significant seroma formation after laparoscopic inguinoscrotal hernia repair. Although the early results were promising, the comparative studies and randomized controlled trials are necessary for further evaluation.
  21,026 2,375 19
Thromboembolic prophylaxis in hernia surgery
Henry Hoffmann, Ralph Fabian Staerkle, Philipp Kirchhoff
July-September 2018, 1(2):37-41
INTRODUCTION: Thromboembolic prophylaxis (TP) is an effective strategy to reduce the risk of thromboembolic events such as deep vein thrombosis and pulmonary embolism. In the absence of patient- and procedure-related risk factors, the risk of thromboembolic events is considerably low among surgical patients. Since hernia repair is thought to be a low-risk procedure, the role of TP in patients undergoing hernia surgery is a matter of debate. METHODS: A systematic search of the literature was conducted in Medline/PubMed and the Cochrane database. Forty-eight relevant publications were identified. RESULTS: Overall, there is a paucity of studies specifically investigating the impact of TP in patients undergoing hernia surgery. Available studies demonstrate that the risk of thromboembolic events with TP in inguinal hernia repair is approximately 0.1%, comparable to other low-risk procedures. Lower rates of thromboembolic events are seen in outpatient surgery. Laparoscopy and implanted mesh in the groin do not increase the risk of thromboembolic events. CONCLUSION: Due to the limited data, no recommendation for or against TP in hernia surgery can be made. Further studies are urgently needed to investigate the effect of TP on the risk of thromboembolic events in patients undergoing hernia repair.
  15,244 946 3
Surgery of abdominal wall hernias in Russia with special reference to new technical developments
V Abolmasov Alexey, V Abolmasov Andrey, Bashankaev Badma, AM Tariverdiev
July-September 2018, 1(2):50-54
BACKGROUND: We analyzed historic date to follow up hernia surgery changes in Russia since 2002 till 2018 to find out the technical tendencies and to predict the development in the future. METHODS: Official annual statistic report data, mailing questionaries' of Russian Surgery Society, Russian Surginet community and internet survey, generated by surveymonkey.com were used to obtain information regarding inguinal and ventral hernia therapy in Russia. RESULTS: For the first 12 patients operated on in the new eTEP technique we recorded no surgical site infection and recurrence. All patients were satisfied with the procedure. The median operative time was 98 min (range: 82 – 160 min). Good cosmetics were achieved in all patients. CONCLUSIONS: Unfortunately, the principal method of umbilical and midline hernia repair in Russia is a double layer technique without paying attention to concomitant rectus diastasis. This is one of the main reasons for the high recurrence rate.
  6,329 619 1
Laparoscopic transabdominal Morgagni hernia repair
Rebekah Macfie, Sean Orenstein, David Tse
July-September 2018, 1(2):66-68
Morgagni hernias are a rare finding in the adult population and represent 1%–3% of all congenital diaphragmatic hernias. Multiple approaches to these rare hernias have been described in the literature. Here, we present a novel technique of laparoscopic transabdominal repair using a combination of the Endo-Close device (Medtronic, Minneapolis, MN, USA) and the Ti-KNOT (LSI Solutions, Victor, NY, USA). In a patient with a large left anterior diaphragmatic defect, we performed transabdominal suturing utilizing the Endo-Close to perform primary closure of the defect, using the Ti-KNOT to secure the pledged sutures along the anterior fascia. Due to the size of the defect (7 cm × 10 cm), this primary repair was buttressed with polyester mesh. In a second patient with a smaller (6 cm × 8 cm) classic right-sided anterior diaphragmatic defect, we similarly performed laparoscopic transabdominal suturing using the Endo-Close to traverse both the anterior and posterior fascia and the Ti-KNOT to secure the sutures to perform a primary repair of the hernia. Both patients presented had an uneventful postoperative course and no indication of recurrence at 4 months. Morgagni hernias present unique technical challenges. In our experience, the combined use of transabdominal suture with laparoscopic knot placement device allowed for completion of both cases laparoscopically with minimal tension on the repairs.
  5,066 379 1
Retrospective single-center experience with the transversus abdominis muscle release procedure in complex abdominal wall reconstruction
Yonggang Huang, Ping Wang, Jing Ye, Guodong Gao, Fangjie Zhang, Hao Wu
July-September 2018, 1(2):60-65
OBJECTIVE: The objective of the study was to investigate the clinical utility of the transversus abdominis muscle release (TAR) procedure in complex abdominal wall reconstruction. MATERIALS AND METHODS: Retrospective study of 32 patients with complex abdominal wall defects admitted to Hangzhou First People's Hospital between January 2016 and December 2017. Clinical materials were collected and analyzed. RESULTS: Among 32 cases of large incisional hernias, there were 19 males (59.4%) and 13 females (40.6%). Mean age was 64.41 ± 12.11 years, body mass index was 30.00 ± 5.97 kg/m2, and mean width of the abdominal defect was 11.34 ± 1.82 cm. Twenty-four cases were midline incisional hernias with one case of planned incisional hernia after severe pancreatitis, and three cases were lateral. Five cases were recurrent incisional hernias. All patients underwent retromuscular mesh repair, with abdominal wall reconstruction using the TAR procedure. The operative time was 151.59 ± 28.64 min, and estimated blood loss was 118.12 ± 83.41 cm3. Length of hospital stay was 13.66 ± 2.72 days. Two cases had a superficial surgical site infection, five had Type II seroma, and one had intestinal obstruction. All postoperative complications resolved with nonsurgical therapy. No mesh infection, fistula, recurrence, or postoperative bulging was reported during follow-up. CONCLUSION: Posterior component separation through TAR is a reliable and effective technique for complex abdominal wall reconstruction. Long-term follow-up is needed to assess potential recurrence.
  4,892 440 2