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Database: Ovid MEDLINE(R) <1966 to January Week 4 2004>
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abdominal hernia.mp. (212)
2
Hernia, Ventral/ (2604)
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1 or 2 (2678)
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abdominal.af. and 3 (1607)
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1 or 4 (1607)
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limit 5 to (human and english language) (825)
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*Hernia, Ventral/ and 6 (643)
8
exp sports/ or exp athletic injuries/ (55076)
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limit 16 to local holdings (75)
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abdominal.ti. and 17 (27)
19
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from 19 keep 15,26,30,40,43,54,58,61,63-64 (10)
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from 21 keep 1-54 (54)
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from 21 keep 1-54 (54)
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<1>
Unique Identifier
1831010
Authors
Taylor DC. Meyers WC. Moylan JA. Lohnes J. Bassett FH. Garrett WE Jr.
Institution
Division of Orthopaedic Surgery, Duke University Medical Center, Durham, North
Carolina 27710.
Title
Abdominal musculature abnormalities as a cause of groin pain in athletes.
Inguinal hernias and pubalgia.[see comment].
Comments
Comment in: Am J Sports Med. 1991 Jul-Aug;19(4):421; PMID: 1832820
Source
American Journal of Sports Medicine. 19(3):239-42, 1991 May-Jun.
Abstract
There has been increasing interest within the European sports medicine
community regarding the etiology and treatment of groin pain in the athlete.
Groin pain is most commonly caused by musculotendinous strains of the adductors
and other muscles crossing the hip joint, but may also be related to abdominal
wall abnormalities. Cases may be termed "pubalgia" if physical examination does
not reveal inguinal hernia and there is an absence of other etiology for groin
pain. We present nine cases of patients who underwent herniorrhaphies for groin
pain. Two patients had groin pain without evidence of a hernia preoperatively
(pubalgia). In the remaining seven patients we determined the presence of a
hernia by physical examination. At operation, eight patients were found to have
inguinal hernias. One patient had no hernia but had partial avulsion of the
internal oblique fibers from their insertion at the public tubercle. The average
interval from operation to return to full activity was 11 weeks. All patients
returned to full activity within 3 months of surgery. One patient had persistent
symptoms of mild incisional tenderness, but otherwise there were no recurrences,
complications, or persistence of symptoms. Abnormalities of the abdominal wall,
including inguinal hernias and microscopic tears or avulsions of the internal
oblique muscle, can be an overlooked source of groin pain in the athlete.
Operative treatment of this condition with herniorrhaphy can return the athlete
to his sport within 3 months.
<2>
Unique Identifier
12034404
Authors
Losanoff JE. Jones JW. Richman BW.
Title
"Separation of parts" technique: is it the only alternative for autologous
repair of challenging abdominal wall defects?[comment].
Comments
Comment on: Am J Surg. 2001 Feb;181(2):115-21; PMID: 11425050
Source
American Journal of Surgery. 183(5):601-2; author reply 602-3, 2002 May.
<3>
Unique Identifier
12885607
Authors
Safadi BY.
Institution
Department of Surgery, Stanford University, VA Palo Alto HCS, 3801 Miranda
Ave., 112G, Palo Alto, CA 94304, USA. [email protected]
Title
Postherpetic self-limited abdominal wall herniation.
Source
American Journal of Surgery. 186(2):148, 2003 Aug.
<4>
Unique Identifier
12575786
Authors
Lane CT. Cohen AJ. Cinat ME.
Institution
Department of Surgery, University of California, Irvine Medical Center,
Orange, California, USA.
Title
Management of traumatic abdominal wall hernia.
Source
American Surgeon. 69(1):73-6, 2003 Jan.
Abstract
Traumatic abdominal wall hernia (TAWH) can occur after blunt trauma and can be
classified into low- or high-energy injuries. Low energy injuries occur after
impact on a small blunt object. High-energy injuries are sustained during motor
vehicle accidents or automobile versus pedestrian accidents. We present six
cases of high-energy TAWH cases that were treated at our trauma center. All
patients presented with varying degrees of abdominal tenderness with either
abdominal skin ecchymosis or abrasions, which made physical examination
difficult. CT scan confirmed the hernia in each patient. All six patients had
associated injuries that required open repair. The abdominal wall defects were
repaired primarily. Three patients (50%) in our series developed a postoperative
wound infection or abscess. Review of the literature on low-energy TAWH shows no
associated abdominal injuries. In conclusion distinction between low- and highenergy injury is imperative in the management of TAWH. Hernias following lowenergy injuries can be repaired after local exploration through an incision
overlying the defect. TAWHs following high-energy trauma should undergo
exploratory laparotomy through a midline incision. The defect should be repaired
primarily and prosthetics avoided because of the high incidence of postoperative
infection.
<5>
Unique Identifier
12013296
Authors
Admire AA. Dolich MO. Sisley AC. Samimi KJ.
Institution
College of Medicine, University of Arizona, Tucson, USA.
Title
Massive ventral hernias: role of tissue expansion in abdominal wall
restoration following abdominal compartment syndrome.
Source
American Surgeon. 68(5):491-6, 2002 May.
Abstract
Massive ventral hernias may result from a variety of clinical situations. One
such clinical situation, a common problem in trauma patients, is abdominal
compartment syndrome. Abdominal compartment syndrome frequently results in a
massive abdominal defect when primary closure after surgical decompression is
not possible. We offer a technique for repairing these massive ventral hernias
by first expanding the lateral abdominal wall muscles, fasciae, and skin with
tissue expanders and then closing the defect with elements of the "components
separation" method. Additionally we present other clinical situations resulting
in a massive ventral hernia that were repaired using this technique.
<6>
Unique Identifier
11409807
Authors
Lee JR. Hancock SM. Martindale RG.
Institution
Department of Pathology, Veterans Affairs Medical Center, and Institute of
Molecular Medicine and Genetics, Medical College of Georgia, Augusta 30904, USA.
Title
Solitary fibrous tumors arising in abdominal wall hernia sacs.
Source
American Surgeon. 67(6):577-81, 2001 Jun.
Abstract
Solitary fibrous tumor (SFT) of the peritoneum is an unusual spindle-cell
neoplasm. SFT was originally described in the pleura; however it is now
diagnosed in multiple extrathoracic sites. Most believe that the tumor is of
mesenchymal origin and should be classified as a variant of fibroma. SFT of the
pleura and peritoneum have also been called fibrous mesothelioma, and the cell
of origin is felt to be a pluripotential submesothelial mesenchymal cell.
Primary tumors arising in hernia sacs are rare, and we report on two patients
with hernia SFT. The first is a 67-year-old man who had a diffusely thickened
distal left inguinal hernia sac. Within the sac was copious myxoid material
mimicking pseudomyxoma peritonei. Herniorrhaphy and orchiectomy were performed.
The second is a 44-year-old woman with a midepigastric mass attached to a
ventral hernia. Wide local excision was performed. Both tumors demonstrated
plump spindle cells, one with myxoid background and the other with keloidal
collagen. Calretinin immunostaining was positive in both tumors, whereas CD34
was negative. This suggests tumor origin from a submesothial pluripotential cell
that maintains potential for mesothelial differentiation. Surgical excision is
the treatment of choice with the degree of resectability being a powerful
predictor of outcome.
<7>
Unique Identifier
11450777
Authors
Best IM.
Institution
Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia 303101495, USA.
Title
Complication of the retroperitoneal approach: intercostal abdominal hernia.
Source
American Surgeon. 67(7):635-6, 2001 Jul.
Abstract
The left thoracoabdominal incision with retroperitoneal dissection offers
excellent exposure of the abdominal and thoracic aorta. Disadvantages to this
approach include inadequate access to the right ileofemoral arterial segments
and the right renal artery. Additional difficulties with this approach include
flank bulges, hernias, and neuropathy. We present a case of an incisional hernia
at the tenth interspace with subsequent herniation of the left colon through
this defect. CT defined the extent of this defect and ruled out other
significant pathology. The patient underwent an uneventful herniorrhaphy.
Abdominal-intercostal hernias have not been previously reported in association
with the retroperitoneal aortic repair.
<8>
Unique Identifier
10966026
Authors
Lin PH. Koffron AJ. Heilizer TJ. Lujan HJ.
Institution
Department of Surgery at Mount Sinai Hospital Medical Center, Finch University
of Health Sciences/The Chicago Medical School, Illinois, USA.
Title
Right lower quadrant abdominal pain due to appendicitis and an incarcerated
spigelian hernia.
Source
American Surgeon. 66(8):725-7, 2000 Aug.
Abstract
Spigelian hernias are uncommon and difficult to diagnose because of their
location in the aponeurosis in the anterior abdominal wall. When they occur on
the right side, the symptoms can include nonspecific abdominal pain mimicking
appendicitis. We present an adult with right lower quadrant abdominal pain due
to an incarcerated spigelian hernia and acute appendicitis. Early recognition
and prompt surgical treatment were important to the successful treatment of our
patient.
<9>
Unique Identifier
12567063
Authors
Amir A. Silfen R. Hauben DJ.
Institution
Department of Plastic and Reconstructive Surgery, Rabin Medical Center,
Bellinson Campus, Petah Tiqva 49100, Israel.
Title
Rotation flap of the anterior rectus abdominis sheath for hernia prevention in
TRAM breast reconstruction.
Source
Annals of Plastic Surgery. 50(2):207-11, 2003 Feb.
Abstract
Prevention of hernia or bulge of the abdominal wall after TRAM breast
reconstruction has been a challenge for the reconstruction surgeon. Different
techniques have been described to avoid this complication. The use of anterior
rectus abdominis sheath (ARAS) for the repair of various abdominal wall hernias
has been well described in the literature and is the basis of the authors'
technique. The authors present the use of ARAS flap in TRAM breast
reconstruction. It is a simple and safe technique using autologous tissues for
hernia or bulge prevention.
<10>
Unique Identifier
12671387
Authors
Koshima I. Nanba Y. Tutsui T. Takahashi Y. Itoh S. Kobayashi R.
Institution
Department of Plastic and Reconstructive Surgery, Okayama University Medical
School, Shikata, Okayama, Japan.
Title
Dynamic reconstruction of large abdominal defects using a free rectus femoris
musculocutaneous flap with normal motor function.
Source
Annals of Plastic Surgery. 50(4):420-4, 2003 Apr.
Abstract
Reconstruction of large abdominal wall defects with conventional
reconstruction including the component separation technique is difficult because
of strong transverse tension and loss or weakness of the rectus abdominis
muscle. To overcome this problem, dynamic reconstruction of the abdominal wall
using a free innervated rectus femoris musculocutaneous flap was performed for
large defects with separation of the bilateral rectus abdominis muscles. The
intact motor nerve of the rectus femoris muscle was transferred without
transection, and only the pedicle vessels were anastomosed to the omental
vessels. Four and one-half years after surgery, the rectus femoris muscle had
voluntary strong muscle contraction and there was no abdominal protrusion,
herniation, or donor morbidity. This new method with dynamic function can
replace conventional techniques for large abdominal defects without rectus
muscle function.
<11>
Unique Identifier
12800903
Authors
Ewart CJ. Lankford AB. Gamboa MG.
Institution
Department of Surgery, Medical College of Georgia, Augusta, GA 30912, USA.
[email protected]
Title
Successful closure of abdominal wall hernias using the components separation
technique.
Source
Annals of Plastic Surgery. 50(3):269-73; discussion 273-4, 2003 Mar.
Abstract
The "components separation" technique involves separating the layers of the
abdominal wall to allow midline advancement. The purpose of the study was to
compare the success rate of the components repair versus other methods. Repair
methods included components separation (n = 11), mesh (n = 15), primary (n =
21), TFL grafts (n = 5), TFL or latissimus flaps (n = 4), and rectus turnover (n
= 4). The results were: 16 of 60 hernias recurred, with significant risk factors
being body mass index (BMI) greater than 30 kg/m2 (p = 0.04), wound infection or
breakdown (p < 0.03), and possibly concurrent colostomy or enterocutaneous
fistula repair (p = 0.11). Only one of 11 hernias recurred using the components
methods, four of 15 recurred using mesh repairs, three of 21 recurred using
primary repairs, four of five recurred using TFL grafts, two of four recurred
using TFL/latissimus flaps, and two of four recurred using rectus turnovers.
There were 19 complications (infection or wound breakdown), with risk factors
being smoking (p = 0.002) and possibly BMI greater than 30 kg/m2 (p = 0.08). The
results suggest that the components separation method is a viable option for
repair of complex abdominal wall hernias without the use of distant flaps or
grafts.
<12>
Unique Identifier
10696040
Authors
Carlson GW. Elwood E. Losken A. Galloway JR.
Institution
Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.
Title
The role of tissue expansion in abdominal wall reconstruction.
Source
Annals of Plastic Surgery. 44(2):147-53, 2000 Feb.
Abstract
Abdominal wall reconstruction of ventral hernia defects with loss of visceral
domain and inadequate soft-tissue coverage presents a surgical challenge. Four
patients with large, skin grafted ventral hernia defects were treated by staged
abdominal wall reconstruction. During the initial stage, tissue expanders were
placed under the skin and subcutaneous tissue lateral to the defects. After
adequate interval expansion, the second stage was performed. The expanders were
removed, the visceral contents reduced easily, and the fascia reapproximated
with polypropylene mesh. The expanded skin was closed easily over the fascial
repair. All four patients were reconstructed successfully without complications.
Tissue expansion can restore abdominal domain and allow soft-tissue closure in
complicated ventral hernia defects.
<13>
Unique Identifier
12838119
Authors
Robertson JD. de la Torre JI. Gardner PM. Grant JH 3rd. Fix RJ. Vasconez
LO.
Institution
University of Alabama at Birmingham, Division of Plastic Surgery, AL 35294,
USA.
Title
Abdominoplasty repair for abdominal wall hernias.
Source
Annals of Plastic Surgery. 51(1):10-6, 2003 Jul.
Abstract
The objectives of abdominal hernial repair are to reconstruct the structural
integrity of the abdominal wall while minimizing morbidity. Current techniques
include primary closure, staged repair, and the use of prosthetic materials.
Techniques for abdominoplasty include the use of the transverse lower abdominal
incision and the resection of excess skin. By incorporating these aspects into
hernial repairs, the procedures are made safer and the results are improved. The
medical records were reviewed of 123 consecutive patients who underwent hernial
repair. Seventy-six of these patients underwent a total of 82 herniorrhaphies
using an abdominoplasty approach. This included using a transverse lower
abdominal incision with or without extending it into an inverted-T incision. The
hernial defect was then identified and isolated. Repair was obtained with
primary fascial closure and plication, primary fascial approximation and
reinforcement with absorbable Vicryl mesh, or placement of permanent mesh with
or without fascial approximation. Overall, 8 of 82 hernias recurred. Most
complications were minor and could be managed with local wound care only. Major
complications included one enterocutaneous fistula, one occurrence of skin flap
necrosis requiring operative debridement and skin grafting, and one delayed
permanent mesh extrusion 2 years after repair. The abdominoplasty approach
isolates the incision from the hernial defect and repair. This technique is safe
with a low risk of complications and a low rate of recurrence. It is
particularly helpful in obese patients, in patients with multiple hernias, and
in those patients with recurrent hernias.
<14>
Unique Identifier
14501501
Authors
Jernigan TW. Fabian TC. Croce MA. Moore N. Pritchard FE. Minard G. Bee
TK.
Institution
Department of Surgery, University of Tennessee Health Science Center, 956
Court Avenue, Suite G228, Memphis, TN 38163, USA.
Title
Staged management of giant abdominal wall defects: acute and long-term
results.
Source
Annals of Surgery. 238(3):349-55; discussion 355-7, 2003 Sep.
Abstract
INTRODUCTION: Shock resuscitation leads to visceral edema often precluding
abdominal wall closure. We have developed a staged approach encompassing acute
management through definitive abdominal wall reconstruction. The purpose of this
report is to analyze our experience with this technique applied to the treatment
of patients with open abdomen and giant abdominal wall defects. METHODS: Our
management scheme for giant abdominal wall defects consists of 3 stages: stage
I, absorbable mesh insertion for temporary closure (if edema quickly resolves
within 3-5 days, the mesh is gradually pleated, allowing delayed fascial
closure); stage II, absorbable mesh removal in patients without edema resolution
(2-3 weeks after insertion to allow for granulation and fixation of viscera) and
formation of the planned ventral hernia with either split thickness skin graft
or full thickness skin closure over the viscera; and stage III, definitive
reconstruction after 6-12 months (allowing for inflammation and dense adhesion
resolution) by using the modified components separation technique. Consecutive
patients from 1993 to 2001 at a single institution were evaluated. Outcomes were
analyzed by management stage, with emphasis on wound related morbidity and
mortality, and fistula and recurrent hernia rates. RESULTS: Two hundred seventy
four patients (35 with sepsis, 239 with hemorrhagic shock) were managed. There
were 212 males (77%), and mean age was 37 (range, 12-88). The average size of
the defects was 20 x 30 cm. In the stage I group, 108 died (92% of all deaths)
because of shock. The remaining 166 had temporary closure with polyglactin 910
woven absorbable mesh. As visceral edema resolved, bedside pleating of the
absorbable mesh allowed delayed fascial closure in 37 patients (22%). In the
stage II group, 9 died (8% of all deaths) from multiple organ failure associated
with their underlying disease process, and 96% of the remaining 120 had splitthickness skin graft placed over the viscera. No wound related mortality
occurred. There were a total of 14 fistulae (5% of total, 8% of survivors). In
the stage III group, to date, 73 of the 120 have had definitive abdominal wall
reconstruction using the modified components separation technique. There were no
deaths. Mean follow-up was 24 months, (range 2-60). Recurrent hernias developed
in 4 of these patients (5%). CONCLUSIONS: The staged management of patients with
giant abdominal wall defects without the use of permanent mesh results in a safe
and consistent approach for both initial and definitive management with low
morbidity and no technique-related mortality. Absorbable mesh provides effective
temporary abdominal wall defect coverage with a low fistula rate. Because of the
low recurrent hernia rate and avoidance of permanent mesh, the components
separation technique is the procedure of choice for definitive abdominal wall
reconstruction.
<15>
Unique Identifier
12616130
Authors
Szczerba SR. Dumanian GA.
Institution
Department of Surgery and the Division of Plastic Surgery, Emory University,
Atlanta, Georgia, USA.
Title
Definitive surgical treatment of infected or exposed ventral hernia mesh.
Source
Annals of Surgery. 237(3):437-41, 2003 Mar.
Abstract
OBJECTIVE: To discuss the difficulties in dealing with infected or exposed
ventral hernia mesh, and to illustrate one solution using an autogenous
abdominal wall reconstruction technique. SUMMARY BACKGROUND DATA: The definitive
treatment for any infected prosthetic material in the body is removal and
substitution. When ventral hernia mesh becomes exposed or infected, its removal
requires a solution to prevent a subsequent hernia or evisceration. METHODS:
Eleven patients with ventral hernia mesh that was exposed, nonincorporated, with
chronic drainage, or associated with a spontaneous enterocutaneous fistula were
referred by their initial surgeons after failed local wound care for definitive
management. The patients were treated with radical en bloc excision of mesh and
scarred fascia followed by immediate abdominal wall reconstruction using
bilateral sliding rectus abdominis myofascial advancement flaps. RESULTS: Four
of the 11 patients treated for infected mesh additionally required a bowel
resection. Transverse defect size ranged from 8 to 18 cm (average 13 cm).
Average procedure duration was 3 hours without bowel repair and 5 hours with
bowel repair. Postoperative length of stay was 5 to 7 days without bowel repair
and 7 to 9 days with bowel repair. Complications included hernia recurrence in
one case and stitch abscesses in two cases. Follow-up ranges from 6 to 54 months
(average 24 months). CONCLUSIONS: Removal of infected mesh and autogenous flap
reconstruction is a safe, reliable, and one-step surgical solution to the
problem of infected abdominal wall mesh.
<16>
Unique Identifier
10998657
Authors
Mathes SJ. Steinwald PM. Foster RD. Hoffman WY. Anthony JP.
Institution
Division of Plastic and Reconstructive Surgery, University of California at
San Francisco, San Francisco, California, USA.
Title
Complex abdominal wall reconstruction: a comparison of flap and mesh closure.
Source
Annals of Surgery. 232(4):586-96, 2000 Oct.
Abstract
OBJECTIVE: To analyze a series of patients treated for recurrent or chronic
abdominal wall hernias and determine a treatment protocol for defect
reconstruction. SUMMARY BACKGROUND DATA: Complex or recurrent abdominal wall
defects may be the result of a failed prior attempt at closure, trauma,
infection, radiation necrosis, or tumor resection. The use of prosthetic mesh as
a fascial substitute or reinforcement has been widely reported. In wounds with
unstable soft tissue coverage, however, the use of prosthetic mesh poses an
increased risk for extrusion or infection, and vascularized autogenous tissue
may be required to achieve herniorrhaphy and stable coverage. METHODS: Patients
undergoing abdominal wall reconstruction for 106 recurrent or complex defects
(104 patients) were retrospectively analyzed. For each patient, hernia etiology,
size and location, average time present, technique of reconstruction, and
postoperative results, including recurrence and complication rates, were
reviewed. Patients were divided into two groups based on defect components: Type
I defects with intact or stable skin coverage over hernia defect, and Type II
defects with unstable or absent skin coverage over hernia defect. The defects
were also assigned to one of the following zones based on primary defect
location to assist in the selection and evaluation of their treatment: Zone 1A,
upper midline; Zone IB, lower midline; Zone 2, upper quadrant; Zone 3, lower
quadrant. RESULTS: A majority of the defects (68%) were incisional hernias. Of
50 Type I defects, 10 (20%) were repaired directly, 28 (56%) were repaired with
mesh only, and 12 (24%) required flap reconstruction. For the 56 Type II defects
reconstructed, flaps were used in the majority of patients (n = 48; 80%). The
overall complication and recurrence rates for the series were 29% and 8%,
respectively. CONCLUSIONS: For Type I hernias with stable skin coverage,
intraperitoneal placement of Prolene mesh is preferred, and has not been
associated with visceral complications or failure of hernia repair. For Type II
defects, the use of flaps is advisable, with tensor fascia lata representing the
flap of choice, particularly in the lower abdomen. Rectus advancement procedures
may be used for well-selected midline defects of either type. The concept of
tissue expansion to increase both the fascial dimensions of the flap and zones
safely reached by flap transposition is introduced. Overall failure is often is
due to primary closure under tension, extraperitoneal placement of mesh, flap
use for inappropriate zone, or technical error in flap use. With use of the
proposed algorithm based on defect analysis and location, abdominal wall
reconstruction has been achieved in 92% of patients with complex abdominal
defects.
<17>
Unique Identifier
12496540
Authors
Flum DR. Horvath K. Koepsell T.
Institution
Robert Wood Johnson Clinical Scholars Program, Seattle, Washington, USA.
[email protected]
Title
Have outcomes of incisional hernia repair improved with time? A populationbased analysis.
Source
Annals of Surgery. 237(1):129-35, 2003 Jan.
Abstract
OBJECTIVE: To determine if certain outcomes of incisional hernia repair have
improved in recent eras. SUMMARY BACKGROUND DATA: Technological developments
have been reported to improve outcomes in the repair of abdominal wall
incisional hernias. METHODS: This retrospective, population-based cohort study
was conducted using a 1987 to 1999 Washington hospital discharge database.
Subjects were all Washington state residents assigned ICD9 procedure codes for
incisional hernia repair with or without synthetic material (mesh). Main outcome
measure was the rate of reoperative incisional hernia repair, length of
hospitalization, and hospital charges based on the use of synthetic material and
the era of operative repair (before and after 1995). RESULTS: A total of 10,822
Washington state patients underwent incisional hernia repair (mean age 58.7 +/15.6, 64% female). Of patients undergoing incisional hernia repair, 12.3%
underwent at least one subsequent reoperative incisional hernia repair within
the first 5 years after initial repair (23.1% at 13 years follow-up). The 5-year
reoperative rate was 23.8% after the first reoperation, 35.3% after the second,
and 38.7% after the third. The use of synthetic mesh in incisional hernia
repairs increased from 34.2% in 1987 to 65.5% in 1999. When controlling for age,
sex, comorbidity index of the patient, year of the initial procedure, and
hospital descriptors (rural location, nonprofit and teaching status), the hazard
for recurrence was 24.1% higher if no mesh was used compared to the hazard if
mesh was used. After similar adjustment, no differences were found in the hazard
of reoperation based on the era of the operative repair. Mean length of stay for
procedures performed after 1995 was 4.9 days compared to 4.8 days in preceding
eras. CONCLUSIONS: Incisional hernia repair is associated with high cumulative
rates of reoperative repairs. The expectation that important measures of adverse
outcome have improved in recent eras is not supported by the results of this
large population-based study.
<18>
Unique Identifier
12200250
Authors
Tsushima Y. Kato K. Endo K.
Institution
Department of Radiology, Motojima General Hospital, 3-8 Nishi-Honcho, Ohta,
Gunma 373-0033, Japan.
Title
Abdominal pain and vomiting after gynaecological surgery.
Source
British Journal of Radiology. 75(897):783-4, 2002 Sep.
<19>
Unique Identifier
11972542
Authors
Cassar K. Munro A.
Institution
Department of Surgery, Raigmore Hospital, Inverness IV2 3UJ, UK.
Title
Surgical treatment of incisional hernia. [Review] [75 refs]
Source
British Journal of Surgery. 89(5):534-45, 2002 May.
Abstract
BACKGROUND: Incisional hernia is a common complication of abdominal surgery
and an important source of morbidity. It may be repaired using open suture, open
mesh or laparoscopic mesh techniques. This review examines the results of these
methods of repair.METHODS: A Medline literature search was performed to identify
articles relating to 'incisional hernia', 'ventral hernia' and 'wound failure'.
Relevant papers from the reference lists of these articles were also
sought.RESULTS: The recurrence rate after open suture repair may be as high as
31-49 per cent; for open mesh repair it is between 0 and 10 per cent.
Comparative studies show that recurrence is significantly more frequent after
open suture repair than after open mesh repair; complication rates are similar
for both procedures. Recurrence rates after laparoscopic mesh repair vary from 0
to 9 per cent. Comparative studies show that laparoscopic mesh repair is at
least as safe and effective as open mesh repair.CONCLUSION: Open suture repair
for incisional hernia carries an unacceptably high recurrence rate. The results
of open mesh and laparoscopic mesh techniques are encouraging. There is scope
for a large multicentre randomized clinical trial to compare laparoscopic and
open mesh repair. [References: 75]
<20>
Unique Identifier
12390373
Authors
van 't Riet M. Steyerberg EW. Nellensteyn J. Bonjer HJ. Jeekel J.
Institution
Department of General Surgery, Erasmus University Medical Centre Rotterdam Dijkzigt, Rotterdam, The Netherlands. [email protected]
Title
Meta-analysis of techniques for closure of midline abdominal incisions.[see
comment].
Comments
Comment in: Br J Surg. 2003 Mar;90(3):370; PMID: 12594682
Source
British Journal of Surgery. 89(11):1350-6, 2002 Nov.
Abstract
BACKGROUND: Various randomized studies have evaluated techniques of abdominal
fascia closure but controversy remains, leaving surgeons uncertain about the
optimal method of preventing incisional hernia. METHOD: Medline and Embase
databases were searched. All trials with a follow-up of at least 1 year that
randomized patients with midline laparotomies to closure of the fascia by
different suture techniques and/or suture materials were subjected to metaanalysis. Primary outcome was incisional hernia; secondary outcomes were wound
dehiscence, wound infection, wound pain and suture sinus formation. RESULTS:
Fifteen studies were identified with a total of 6566 patients. Closure by
continuous rapidly absorbable suture was followed by significantly more
incisional hernias than closure by continuous slowly absorbable suture (P <
0.009) or non-absorbable suture (P = 0.001). No difference in incisional hernia
incidence was found between slowly absorbable and non-absorbable sutures (P =
0.75), but more wound pain (P < 0.005) and more suture sinuses (P = 0.02)
occurred after the use of non-absorbable suture. Similar outcomes were observed
with continuous and interrupted sutures, but continuous sutures took less time
to insert. CONCLUSION: To reduce the incidence of incisional hernia without
increasing wound pain or suture sinus frequency, slowly absorbable continuous
sutures appear to be the optimal method of fascial closure.
<21>
Unique Identifier
10755344
Authors
Kilic N. Balkan E. Kiristioglu I. Guney N. Dogruyol H.
Institution
Department of Paediatric Surgery, The Medical Faculty of Uludag University,
Gorukle, Bursa, Turkey.
Title
Abdominal wall ruptured by blunt trauma in a child.
Source
European Journal of Surgery. 166(3):265-6, 2000 Mar.
<22>
Unique Identifier
12113273
Authors
Junge K. Klinge U.
Institution
Klosterhalfen B.
Rosch R.
Stumpf M.
Schumpelick V.
Department of Surgery, RWTH Aachen, Germany. [email protected]
Title
Review of wound healing with reference to an unrepairable abdominal hernia.
Source
European Journal of Surgery. 168(2):67-73, 2002.
Abstract
A 58-year-old man has been under our care with an inguinal hernia that has
recurred 8 times. This stimulated us to review the biochemistry of wound repair.
We studied the composition of his collagen and tried to find out whether it was
intrinsically faulty or whether its fault had been caused by the medication he
was taken.
<23>
Unique Identifier
12549685
Authors
Arenal JJ. Rodriguez-Vielba P. Gallo E. Tinoco C.
Institution
Department of Surgery, University Hospital Rio Hortega, Valladolid, Spain.
[email protected]
Title
Hernias of the abdominal wall in patients over the age of 70 years. [Review]
[17 refs]
Source
European Journal of Surgery. 168(8-9):460-3, 2002.
Abstract
OBJECTIVE: To find out if the patients' age affects the treatment of abdominal
hernias and the results in relation of the age increase. DESIGN: Retrospective
and prospective study. SETTING: University hospital, Spain. SUBJECTS: 664
patients aged 70 years or more operated on for abdominal hernia between 19861998. Patients were divided into three groups: 443 aged 70-79; 202 aged 80-89;
and 19 patients aged 90 years or more. MAIN OUTCOME MEASURES: Perioperative
risk, type of surgery and deaths. RESULTS: 117 women (52%) had femoral hernias,
compared with 32 men (7%) (p = 0.0001). The incidence of femoral hernia over 80
years of age was 79/221 (36%) compared with 70/443 (16%) among patients in their
seventies (p = 0.0001). 97 of the patients aged 70-79 (22%) were operated on as
emergencies, 107 of those aged 80-89 (53%), and 17 in patients 90 or older (89%,
p = 0.0001). The mortality rate was 1% in the 70-79 group (n = 6), 5% (n = 10)
in the 80-89 group, and 3/19 died in the over 90 group (p = 0.0001). No deaths
were reported after elective surgery. CONCLUSION: Emergency operations in
elderly patients with abdominal wall hernias are increasingly more common as the
patient get older. As result, there is an unacceptable increase in postoperative
mortality. [References: 17]
<24>
Unique Identifier
12090580
Authors
Losanoff JE. Richman BW. Jones JW.
Institution
Department of Surgery, Health Sciences Center, University of Columbia School
of Medicine, MO 65212, USA.
Title
Handlebar hernia: ultrasonography-aided diagnosis. [Review] [16 refs]
Source
Hernia. 6(1):36-8, 2002 Mar.
Abstract
Traumatic hernia resulting from blunt impalement of the abdominal wall, known
as "handlebar hernia," is seldom addressed in the surgical literature, with only
28 previously reported cases. We describe our experience with this rare
traumatic hernia diagnosed by physical examination and confirmed by
ultrasonography. Published reports suggest handlebar hernia's potential for
serious underlying injury and the diagnostic importance of computed tomographic
scanning. The case presented here demonstrates the value of bedside
ultrasonography in diagnosis confirmation and surgical planning for this
condition. [References: 16]
<25>
Unique Identifier
12090581
Authors
Fraser N. Milligan S. Arthur RJ. Crabbe DC.
Institution
Department of Paediatric Surgery, Leeds General Infirmary, UK.
[email protected]
Title
Handlebar hernia masquerading as an inguinal haematoma. [Review] [19 refs]
Source
Hernia. 6(1):39-41, 2002 Mar.
Abstract
We report a child who sustained a traumatic hernia of the lower abdominal wall
after being thrown forward against the handlebar of his bicycle. This is a rare
injury in children, and the clinical features mimic an inguinal haematoma.
Suspicion should be raised by the immediate appearance of a mass above the
inguinal canal following groin injury, particularly if the swelling then
disappears with the patient supine. [References: 19]
<26>
Unique Identifier
12842451
Authors
Dunne JR. Malone DL. Tracy JK. Napolitano LM.
Institution
Department of Surgery, Veterans Affairs Maryland Health Care System,
Baltimore, Maryland, USA.
Title
Abdominal wall hernias: risk factors for infection and resource utilization.
Source
Journal of Surgical Research. 111(1):78-84, 2003 May 1.
Abstract
BACKGROUND: Abdominal wall hernia repairs are common surgical procedures.
Several recent reports have studied the outcomes of elderly patients undergoing
inguinal hernia repair and documented a morbidity rate ranging from 5-57% and a
mortality rate ranging from 1.6-14%. However, there has been limited data
documenting the risk factors associated with postoperative morbidity and
mortality from abdominal wall hernia repairs in general. Therefore, we sought to
investigate the incidence of complications in patients undergoing abdominal wall
hernia repair and to evaluate the risk factors for infection and resource
utilization in these patients. METHODS: Prospective data (NSQIP) were collected
on 6301 noncardiac surgical patients at the VA Maryland Healthcare System from
1995 to 2000. From this data set, 487 (7.7%) patients underwent abdominal wall
hernia repairs and comprised the study cohort. Logistic and linear regression
analyses were performed to identify risk factors for infection and hospital
length of stay. RESULTS: The mean age of the study cohort was 60 +/- 14 and the
mean ASA class was 2.4 +/- 0.7. Descriptive data revealed 99% were male, 43%
used tobacco, 8.4% were diabetic, 7.4% used alcohol, 6.3% had chronic
obstructive pulmonary disease (COPD), 2.1% were malnourished (defined as >/= 10%
weight loss over prior 6 months), 1.6% used steroids, 1.2% had ascites, and 0.2%
had coronary artery disease (CAD). The mortality rate was low at 1% but the
morbidity rate was higher with a 4.3% incidence of wound infections and a 15.1%
incidence of recurrent hernias. The mean preoperative serum albumin level was
4.1 +/- 0.6 g/dL, and the mean hospital length of stay was 1.4 +/- 4.8 days.
Multiple logistic and linear regression analyses documented that CAD, COPD, low
preoperative serum albumin, and steroid use were independent risk factors for
increased postoperative wound infections (P < 0.05) and increased hospital
length of stay (P < 0.05). CONCLUSIONS: Abdominal wall hernia repair is
associated with significant morbidity in this predominantly elderly cohort but
mortality rates were low. COPD and low preoperative serum albumin were
independent predictors of wound infections and CAD, COPD, low preoperative serum
albumin, and steroid use were independent predictors of increased hospital
length of stay. Therefore, consideration should be given to optimizing patient's
cardiopulmonary and nutritional status before abdominal wall hernia repair.
<27>
Unique Identifier
11584967
Authors
Musella M. Milone F. Chello M. Angelini P. Jovino R.
Institution
Surgical Sciences, Orthopaedics, Trauma and Emergency Department, DUSCOTE,
General and Emergency Surgery, Federico II University Medical School, Naples,
Italy.
Title
Magnetic resonance imaging and abdominal wall hernias in aortic surgery.
Source
Journal of the American College of Surgeons. 193(4):392-5, 2001 Oct.
Abstract
BACKGROUND: The aim of this study was to evaluate the incidence of abdominal
wall hernias (AWH) in patients operated on for abdominal aortic aneurysm (AAA)
compared with patients treated for aortoiliac occlusive disease. The efficacy of
MRI in early diagnosis of AWH also was studied. STUDY DESIGN: One hundred
fourteen patients operated for either AAA (51 patients, group A) or aortoiliac
occlusive disease (63 patients, group B) constitute the study. The presence of
AWH onset was evaluated by clinical observation followed by ultrasonography.
Data acquired by ultrasonography were compared with those obtained by MRI to
determine the efficacy of this diagnostic tool in all 114 patients. The
prevalence of inguinal hernias in both groups also was determined. RESULTS: A
significant difference was found in the incidence of AWH. AWH developed in 31.7%
(16 of 51) of group A patients and 17.4% (11 of 63) of group B patients (p <
0.03). A significant prevalence ofinguinal hernias was detected in group A (p <
0.01). The Cox hazard regression analysis revealed as independent predictors of
postoperative AWH only the presence of AAA and a history of laparotomy.
CONCLUSIONS: Ours and other studies recall collagen synthesis disorders to
explain the statistical association observed among AAA, inguinal hernias, and
AWH. MRI, especially in patients at risk, appears to be an effective diagnostic
approach to early detection of AWH.
<28>
Unique Identifier
11245371
Authors
Munegato G. Brandolese R.
Institution
First Surgical Department, General Hospital, Padova, Italy.
Title
Respiratory physiopathology in surgical repair for large incisional hernias of
the abdominal wall.
Source
Journal of the American College of Surgeons. 192(3):298-304, 2001 Mar.
Abstract
BACKGROUND: The computerized noninvasive measurement of respiratory mechanics
enables new prospects in the study of respiratory physiopathology in surgical
repair of large incisional hernias. STUDY DESIGN: We studied 10 patients with
COPD ventilated with a Servo Ventilator 900C. We measured inspiratory flow by
means ofa pneumotacograph, the volume by integrating the flow signal, and
esophageal and airway opening pressure by means of two differential pressure
transducers (an esophageal balloon measures, separately, chest wall and lung
mechanical properties). The signals were sent by an analogic-digital converter
to a personal portable computer to be analyzed. We calculated compliance of
total respiratory system (Crs), chest wall (Ccw), and lung (CI); maximum
resistance of the total respiratory system (Rmax, Rs), chest wall (Rmax, w), and
lung (Rmax, L); and work of breathing (Wob). Statistics were performed using
one-way analysis of variance and p = 0.05 was considered significant. RESULTS:
At the closure of the peritoneum a reduction of Crs and Wob was recorded in
seven patients in whom a PTFE prosthesis widening the abdominal cavity was used
to restore the baseline value. Variations in respiratory compliance are from
variations in Ccw with unaffected CI (Ccw varied from 0.180 to 0.130 L/cmH2O at
peritoneal closure and from 0.130 to 0.170 L/cmH2O by prosthetic peritoneal
widening). Respiratory resistances remained unchanged (11.3 cmH2O/ L/s) at any
time of measurement. CONCLUSIONS: The intraoperative assessment of respiratory
mechanics is useful to evaluate and eventually to decrease the mechanical
workload (prosthesis widening peritoneum or fascia incisions). The passive
mechanical work performed by the ventilator needs to be kept constant or no
higher than 10% basic data: if these conditions are maintained, mostly in
patients with COPD, there is no risk of respiratory muscular fatigue during the
postoperative period.
<29>
Unique Identifier
11030241
Authors
Birolini C. Utiyama EM. Rodrigues AJ Jr. Birolini D.
Institution
Department of Surgery, Hospital das Clinicas da Faculdade de Medicina da
Universidade de Sao Paulo, Brazil.
Title
Elective colonic operation and prosthetic repair of incisional hernia: does
contamination contraindicate abdominal wall prosthesis use?.
Source
Journal of the American College of Surgeons. 191(4):366-72, 2000 Oct.
Abstract
BACKGROUND: Wound infection and sepsis leading to incisional hernia
development are common after emergency colonic operations. Later on, while being
operated on to correct an incisional hernia, most of these patients will need
colonic resection or bowel continuity reestablishment. Simultaneous treatment of
incisional hernias in patients with colostomy or colonic disease remains a
difficult challenge, considering the reluctance of most surgeons to treat both
conditions at the same time, especially when prosthetic repair is needed. STUDY
DESIGN: The aim of this study was to analyze the short-term results of patients
undergoing colonic resection or bowel continuity reestablishment and
simultaneous incisional hernia repair with an onlay polypropylene mesh
technique. Over a period of 6 years, 20 patients were operated on for colonic
problems associated with incisional hernias, including 8 Hartmanns' colostomies,
6 colostomies or ileostomies with colonic mucous fistulas, 3 postoperative
colocutaneous fistulas, a paracolostomic hernia, a Chagas' megacolon, and a
pseudotumoral diverticulitis. A "rule of three" statistical analysis was used to
estimate the maximum risk of adverse effects, concerning mesh-related morbidity,
after 1- and 2-year followup. RESULTS: A major complication occurred in a
patient who developed an anastomotic leakage and secondary wound infection; the
patient was treated with parenteral nutrition and antibiotics. Other
complications included a minor wound infection, a seroma, and a chronic sinus.
One patient died from postoperative problems unrelated to the surgical
technique. The occurrence of postoperative wound infection did not prevent mesh
incorporation. Followup ranging from 1 to 7 years detected no hernia
recurrences; 13 patients were followed for 2 years or more. Our results suggest
that risk of mesh-related morbidity does not exceed 15.8% (3 of 19) within the
first year and 23.1% (3 of 13) for 2 years followup, with 95% confidence.
CONCLUSIONS: We concluded that prosthetic repair of incisional hernias
associated with simultaneous colonic operations was possible, allowing abdominal
wall anatomy reestablishment. There is no reason to believe that abdominal wall
prostheses must be avoided in contaminated operations when an adequate surgical
technique is used.
<30>
Unique Identifier
12168980
Authors
Losanoff JE. Richman BW. Jones JW.
Title
Endoscopically assisted "component separation" method for abdominal wall
reconstruction.
Source
Journal of the American College of Surgeons. 195(2):288; author reply 288-9,
2002 Aug.
<31>
Unique Identifier
12517546
Authors
de Vries Reilingh TS. van Goor H. Rosman C. Bemelmans MH. de Jong D. van
Nieuwenhoven EJ. van Engeland MI. Bleichrodt RP.
Institution
Department of Surgery, University Medical Center, Nijmegen, Heerlen, The
Netherlands.
Title
"Components separation technique" for the repair of large abdominal wall
hernias.[see comment].
Comments
Comment in: J Am Coll Surg. 2003 May;196(5):825-6; PMID: 12742222
Source
Journal of the American College of Surgeons. 196(1):32-7, 2003 Jan.
Abstract
BACKGROUND: The "components separation technique" is a method for abdominal
wall reconstruction in patients with large midline hernias that cannot be closed
primarily. The early and late results of this technique were evaluated in 43
patients. METHODS: Records of 43 patients, 11 women and 32 men, with a mean age
of 49.7 (range 22 to 78), were reviewed for body length and weight, size and
cause of the hernia, intra- and postoperative mortality and morbidity, with
special attention given to wound and pulmonary complications. Patients were
invited to attend the outpatient clinic afterward for at least 12 months for
physical examination of the abdominal wall. RESULTS: The defect resulted after
elective surgery in 19 patients and after acute surgery in 24 patients. In 11
patients, the defect was a result of open treatment of generalized peritonitis,
and 13 patients had a recurrent incisional hernia. One patient died on the sixth
postoperative day from mesenteric thrombosis. The postoperative course was
complicated in 17 patients: fascial dehiscence in one, hematoma in five, seroma
in two, wound infection in six, skin necrosis in one, and respiratory
insufficiency in two. Thirty-eight patients were seen for followup. After a mean
followup of 15.6 months (range 12 to 30 months), a recurrent hernia was found in
12 of the 38 patients (32%). The remaining four patients had no recurrent hernia
after 1, 1, 3, and 4 months, respectively. CONCLUSIONS: The "components
separation technique" is useful for the reconstruction of large abdominal wall
hernias, especially under contaminated conditions in which the use of prosthetic
material is contraindicated. Further research is needed to reduce the relatively
high reherniation rate. Copyright 2003 by the American College of Surgeons
<32>
Unique Identifier
14644296
Authors
Fergestad J. Noonan KJ. Mack E.
Institution
Department of Surgery, The University of Wisconsin, Madison, WI 53792, USA.
Title
An innovative approach for repair of complex inguinal and abdominal wall
hernias.
Source
Journal of the American College of Surgeons. 197(6):1050-2, 2003 Dec.
<33>
Unique Identifier
9783640
Authors
Iuchtman M.
Title
Rarity of traumatic abdominal wall hernias.[comment].
Comments
Comment on: J Trauma. 1998 Mar;44(3):568; PMID: 9529196
Source
Journal of Trauma-Injury Infection & Critical Care. 45(4):853, 1998 Oct.
<34>
Unique Identifier
9529196
Authors
Perez VM. McDonald AD. Ghani A. Bleacher JH.
Institution
Department of Surgery, Western Reserve Care System, Youngstown, Ohio, USA.
Title
Handlebar hernia: a rare traumatic abdominal wall hernia.[see comment].
Comments
Comment in: J Trauma. 1998 Oct;45(4):853; PMID: 9783640
Source
Journal of Trauma-Injury Infection & Critical Care. 44(3):568, 1998 Mar.
<35>
Unique Identifier
12634550
Authors
Borens O. Bettschart V. Fischer JF. Mouhsine E.
Institution
Department of Orthopaedic Surgery and Traumatology, Centre Hospitalier
Universitaire Vaudois, Lausanne, Switzerland. [email protected]
Title
Missed traumatic hernia of the abdominal wall after contralateral pelvic and
acetabular fracture.
Source
Journal of Trauma-Injury Infection & Critical Care. 54(3):626, 2003 Mar.
<36>
Unique Identifier
11977234
Authors
Devendra K. Mahajan JK. Rao KL.
Institution
Department of Pediatric Surgery, Postgraduate Institute of Medical Education
and Research, Chandigarh, India.
Title
Herniation of transverse colon into parietal wall after blunt trauma.
Source
Journal of Trauma-Injury Infection & Critical Care. 52(4):810, 2002 Apr.
<37>
Unique Identifier
12813326
Authors
Sriussadaporn S. Pak-Art R. Bunjongsat S.
Institution
Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok,
Thailand. [email protected]
Title
Immediate closure of the open abdomen with bilateral bipedicle anterior
abdominal skin flaps and subsequent retrorectus prosthetic mesh repair of the
late giant ventral hernias.
Source
Journal of Trauma-Injury Infection & Critical Care. 54(6):1083-9, 2003 Jun.
Abstract
BACKGROUND: Management of the open abdomen in trauma and nontrauma patients is
difficult, and some areas of controversy remain. Gastrointestinal fistulas are
serious complications that are associated with significant mortality. We present
our method for management of patients with open abdomen and also present a
logical technique of subsequent repair of the late giant ventral hernias that
uniformly occur in these patients. METHODS: From January 1992 to December 2001,
nine patients with open abdomen underwent successful immediate closure with
bilateral bipedicle anterior abdominal skin flaps. The major points of this
technique of abdominal closure are coverage of abdominal viscera with absorbable
mesh and mobilization of the skin and subcutaneous tissue on both sides of the
abdominal wound to cover the absorbable mesh. All patients had uneventful
recovery and also had subsequent late giant ventral hernias. Repair of the late
giant ventral hernias was performed several months later by inserting a large
sheet of nonabsorbable mesh under the rectus abdominis muscles that form the
neck of the ventral hernia bilaterally. This technique of ventral hernia repair
is also called retrorectus prosthetic mesh repair. RESULTS: Five men and four
women were entered into the study. The age ranged from 22 to 53 years (median,
35 years). Seven patients suffered from blunt and penetrating trauma and two
patients suffered from nontrauma causes. All patients with immediate closure of
the open abdomen had uneventful recovery. Late giant ventral hernias (diameter,
> 10 cm) occurred in all patients. The time from closure of the open abdomen to
subsequent repair of the giant ventral hernias ranged from 7 to 48 months
(median, 14 months). Follow-up after hernia repair ranged from 1 to 72 months
(median, 9 months), and we have seen no evidence of recurrence. CONCLUSION:
Immediate closure of the open abdomen with bilateral bipedicle anterior
abdominal skin flaps is an effective technique for dealing with such potentially
complicated problems. Management of late giant ventral hernias with retrorectus
prosthetic mesh repair is theoretically reasonable and, so far, no recurrence
has been observed in our patients.
<38>
Unique Identifier
11535916
Authors
Grover SB. Ratan SK.
Institution
Department of Radiology, Safdarjung Hospital, New Delhi 10019, India.
[email protected]
Title
Simultaneous dual posttraumatic diaphragmatic and abdominal wall hernias.
Source
Journal of Trauma-Injury Infection & Critical Care. 51(3):583-6, 2001 Sep.
<39>
Unique Identifier
12441940
Authors
Petersen S. Schuster F. Steinbach F. Henke G. Hellmich G. Ludwig K.
Institution
Department of General and Abdominal Surgery, General Hospital DresdenFriedrichstadt, Germany.
Title
Sublay prosthetic repair for incisional hernia of the flank.
Source
Journal of Urology. 168(6):2461-3, 2002 Dec.
Abstract
PURPOSE: A large hernia after flank incision for nephrectomy is a challenging
problem in hernia surgery. In recent decades preperitoneal prosthetic
herniorrhaphy became a widely accepted procedure for hernias of the abdominal
wall. To evaluate the outcome of mesh hernia repair of the flank we reviewed our
data on all patients who underwent preperitoneal mesh repair. MATERIALS AND
METHODS: We identified 4 patients who underwent prosthesis repair after
incisional hernia of the flank within the last 6 years. The primary reason for
surgery was nephrectomy in 2 cases, pyeloplasty in 1 and complicated kidney cyst
resection in 1. Mean followup time was 33 months. RESULTS: In a mean operative
time +/- SD of 208 +/- 55 minutes the patients underwent incisional hernia
repair with prosthesis implantation in the sublay position. In 3 patients an
expanded polytetrafluoroethylene patch was used and in 1 polypropylene mesh was
implanted. Mean prosthesis size was 25 x 38 cm. (950 +/- 300 cm. ). There were
no postoperative complications. Patients were discharged from the hospital after
a mean of 15 +/- 2 days. Followup revealed that none of the 4 patients with
flank incision had recurrent hernia. Pain persisted in 3 patients after flank
incision. However, no regular analgesic drug prescription was necessary.
CONCLUSIONS: Mesh repair for incisional flank hernia provides reinforcement of
the hernia. However, the flank remains paralyzed with a muscle bulge and some
patients have persistent discomfort.
<40>
Unique Identifier
12764257
Authors
Raffetto JD. Cheung Y.
Menzoian JO.
Fisher JB.
Cantelmo NL.
Watkins MT.
Lamorte WW.
Institution
Department of Surgery, Section of Vascular Surgery D506, One Boston Medical
Center Place, Boston, MA 02118-2393, USA. [email protected]
Title
Incision and abdominal wall hernias in patients with aneurysm or occlusive
aortic disease.
Source
Journal of Vascular Surgery. 37(6):1150-4, 2003 Jun.
Abstract
INTRODUCTION: Patients undergoing midline incision for abdominal aortic
reconstruction appear to be at greater risk for postoperative incision hernia
compared with patients undergoing celiotomy for general surgical procedures.
Controversy exists as to whether incidence of abdominal wall hernia and
increased risk for incision hernia is higher in patients with abdominal aortic
aneurysm (AAA) than in patients operated on because of aortoiliac occlusive
disease (AOD). We conducted a prospective multi-institutional study to assess
frequency of incision hernia after aortic surgery through a midline laparotomy
and of previous abdominal wall hernia. METHODS: Patients with AAA (n = 177) or
AOD (n = 82) from three major institutions were prospectively enrolled in the
study and examined. Data collected included demographic data, cardiopulmonary
risk factors, smoking status, history of previous or current abdominal wall
hernia (incision, inguinal, umbilical, femoral), previous midline incision,
suture type, and postoperative complications. At a minimum of 6 months after
laparotomy, patients were evaluated clinically for a new incision hernia.
Differences were tested with the unpaired t test, X(2) test, or Fisher exact
test, and multiple logistic regression was used to control for confounding
variables. RESULTS: Mean follow-up of the cohort was 32.8 +/- 2.3 months. Rate
of abdominal wall hernia and inguinal hernia in patients with AAA versus AOD was
38.4% versus 11% (P =.001) and 23.7% versus 6.1% (P =.003), respectively. Rate
of postoperative incision hernia in patients with AAA was 28.2%, and in patients
with AOD was 11.0% (P =.002). Adjusting for age, smoking, chronic obstructive
pulmonary disease, body mass index, diabetes, bowel obstruction, and suture
type, patients with AAA had almost a ninefold risk for postoperative incision
hernia formation (odds ratio [OR], 8.8; P =.0049). CONCLUSION: Compared with
patients with AOD, patients with AAA have a higher frequency of abdominal wall
hernia and inguinal hernia, and are at significant increased risk for
development of incision hernia postoperatively. The higher frequency of hernia
formation in patients with AAA suggests the presence of a structural defect
within the fascia. Further studies are needed to delineate the molecular changes
of the aorta and its relation to the abdominal wall fascia.
<41>
Unique Identifier
11304595
Authors
Levine JP. Karp NS.
Institution
Institute of Reconstructive Plastic Surgery, New York University Medical
Center, New York, NY, USA.
Title
Restoration of abdominal wall integrity as a salvage procedure in difficult
recurrent abdominal wall hernias using a method of wide myofascial release.
Source
Plastic & Reconstructive Surgery. 107(3):707-16; discussion 717-8, 2001 Mar.
Abstract
The management of primary and recurrent giant incisional hernias remains a
complex and frustrating challenge even with multiple alloplastic and autogenous
closure options. The purpose of this study was to develop a reconstructive
technique of restoring abdominal wall integrity to a subcategory of patients,
who have failed initial hernia therapy, by performing superior and lateral
myofascial release. Over a 1.5-year period, 10 patients with previously
unsuccessful treatment of abdominal wall hernias, using either primary repair or
placement of synthetic material, were studied. The patients had either
recurrence of the hernia or complications such as infections requiring removal
of synthetic material. The hernias were not able to be treated with standard
primary closure techniques or synthetic material. The average defect size was 19
x 9 cm. Each patient underwent wide lysis of bowel adhesions releasing the
posterior abdominal wall fascia to the posterior axillary line, subcutaneous
release of the anterior abdominal wall fascia to a similar level, and complete
removal of any synthetic material (if present). The abdominal domain was
reestablished by releasing the laterally retracted abdominal wall. The amount of
available abdominal wall tissue was increased by wide release of the cephalic
abdominal wall fascia overlying the costal margin and the external oblique
fascia and muscle laterally. If needed, partial thickness of the internal
oblique muscle and its anterior fascia were also released laterally to perform a
tension-free primary closure of the defect. All repairs were closed with
satisfactory functional and aesthetic results. All alloplastic material was
removed. Fascial release was limited so as to close only the hernia defect
without tension. No significant release of the rectus sheath and muscle was
needed. Good, dynamic muscle function was noted postoperatively. All repairs
have remained intact, and no further abdominal wall hernias have been noted on
follow-up.
<42>
Unique Identifier
11176601
Authors
Shestak KC. Fedele GM. Restifo RJ.
Institution
Magee-Womens Hospital and Department of Surgery, University of Pittsburgh
School of Medicine, PA 15213, USA. [email protected]
Title
Treatment of difficult TRAM flap hernias using intraperitoneal synthetic mesh
application.
Source
Plastic & Reconstructive Surgery. 107(1):55-62; discussion 63-6, 2001 Jan.
Abstract
The authors report the successful repair of large lower abdominal hernia
defects after transverse rectus abdominis muscle (TRAM) flap breast
reconstruction in 11 patients using a technique of intraperitoneal application
of synthetic polypropylene (Prolene) mesh anchored to the peritoneal surface of
the abdominal wall tissues. Five of these patients had previously failed hernia
repairs after a unipedicle TRAM flap breast reconstruction employing the onlay
mesh technique, with two of the patients having undergone three previous hernia
repairs. The other six patients had developed large hernias after bipedicle TRAM
flap reconstruction without previous mesh supplementation of the abdominal wall
repair. After their successful hernia repairs, all of the patients healed
without difficulty and demonstrated no sign of recurrence in an 8 to 36-month
follow-up. Each patient returned to her activity level before breast
reconstruction.
<43>
Unique Identifier
11129180
Authors
Girotto JA. Malaisrie SC. Bulkely G. Manson PN.
Institution
Division of Plastic and Reconstructive Surgery, The Johns Hopkins School of
Medicine, Baltimore, MD, USA. [email protected]
Title
Recurrent ventral herniation in Ehlers-Danlos syndrome.
Source
Plastic & Reconstructive Surgery. 106(7):1520-6, 2000 Dec.
Abstract
Ehlers-Danlos syndrome is an inherited collagen disorder characterized by skin
hyperextensibility, joint laxity, and tissue friability. In this study, it was
hypothesized that Ehlers-Danlos syndrome is frequently undiagnosed in patients
who present for repair of ventral abdominal wall hernias. A retrospective chart
review was conducted, and patients who had presented for elective repair of
recurrent abdominal wall herniation were identified. In all patients, one or
more prior attempts at repair with either mesh or autologous tissues had failed.
Patients in whom abdominal wall components were lost secondary to extirpation or
trauma, patients who had required acute closure, and patients with less than 2
months of follow-up were excluded. Twenty patients met these criteria. Twenty
cases of recurrent ventral hernia repairs were reviewed, with special attention
to identification of the preoperative diagnosis of Ehlers-Danlos syndrome.
Patients ranged in age from 29 to 75 years, with a mean age of 54 years. Five
patients were male (25 percent), and 15 were female (75 percent). The majority
(95 percent) were Caucasian. The most common initial procedures were gynecologic
in origin (35 percent). A precise closure technique that minimizes recurrence
after ventral hernia repairs was used. With use of this technique, there was
only one recurrence over a follow-up period that ranged from 2 to 60 months
(mean follow-up duration, 25.7 months). Two patients with Ehlers-Danlos syndrome
were identified, and their cases are presented in this article. The "components
separation" technique with primary component approximation and mesh overlay was
used for defect closure in the two cases presented. The identification of these
two patients suggests the possibility of underdiagnosis of Ehlers-Danlos
syndrome among patients who undergo repeated ventral hernia repair and who have
had previous adverse postoperative outcomes. There are no previous reports in
the literature that address recurrent ventral abdominal herniation in patients
with Ehlers-Danlos syndrome.
<44>
Unique Identifier
12045549
Authors
Saulis AS. Dumanian GA.
Institution
Division of Plastic and Reconstructive Surgery, Northwestern University
Medical Center, 675 N. St. Clair Street, Chicago, IL 60611, USA.
Title
Periumbilical rectus abdominis perforator preservation significantly reduces
superficial wound complications in "separation of parts" hernia repairs.
Source
Plastic & Reconstructive Surgery. 109(7):2275-80; discussion 2281-2, 2002
Jun.
Abstract
Midline ventral hernia repair with bilateral sliding myofascial rectus
abdominis flaps, or the "separation of parts" technique, has low hernia
recurrence rates. However, this technique, as originally described, creates
massively undermined skin and subcutaneous tissue flaps. These undermined skin
flaps can suffer marginal skin loss, fat necrosis, and delayed wound healing.
The authors propose that preserving the periumbilical rectus abdominis
perforators to the abdominal skin flaps will decrease the prevalence of
postoperative superficial wound complications. A retrospective review of 66
consecutive, large, midline hernia repairs using a separation of parts technique
was undertaken to identify any correlation between the preservation of
periumbilical rectus abdominis perforators to the skin flaps and the prevalence
of postoperative wound complications. In 25 cases, the standard separation of
parts technique was performed with wide undermining of the skin and subcutaneous
tissues. In 41 cases, the modified separation of parts technique was performed
with maintenance of the periumbilical rectus abdominis perforators to the
abdominal skin flaps.Comparison of these two groups revealed no difference in
age; sex; body mass index; initial hernia size on physical examination;
prevalence of smoking, diabetes, or steroid use; or prevalence of a simultaneous
intraabdominal procedure. A statistically significant difference was noted in
postoperative wound complications between the two groups (p < 0.05). Of patients
who underwent the standard separation of parts technique, five of 25 patients
(20 percent) had wound complications as compared with one of 41 patients (2
percent) who underwent the modified separation of parts technique with
perforator preservation. The postoperative hernia recurrence (7 percent and 8
percent, respectively) and hematoma (4 percent and 2 percent, respectively)
rates were similar in both groups. A trend of increased wound complications was
noted when separation of parts was combined with an intraabdominal procedure (18
percent versus 3 percent, p = 0.08). Interestingly, within this group, the
modified separation of parts technique with preservation of the periumbilical
rectus abdominis perforators demonstrated a trend of fewer wound complications
as compared with the standard separation of parts technique (7 percent versus 31
percent, p = 0.15). The authors conclude that preservation of the periumbilical
rectus abdominis perforators significantly reduces the prevalence of major
postoperative superficial wound complications in separation of parts hernia
repairs. Simultaneous intraabdominal procedures with separation of parts hernia
repairs seem to increase the prevalence of wound complications. This increased
prevalence of wound complications seems to be minimized when the modified
separation of parts technique is performed.
<45>
Unique Identifier
12900605
Authors
Lindsey JT.
Title
Abdominal wall partitioning (the accordion effect) for reconstruction of major
defects: a retrospective review of 10 patients.
Source
Plastic & Reconstructive Surgery. 112(2):477-85, 2003 Aug.
Abstract
Ten patients underwent abdominal wall reconstruction using the technique of
abdominal wall partitioning. All defects were closed in the midline by
approximating fascia to fascia with the assistance of a general surgeon. One
patient had skin grafted small bowel. Five patients had chronically infected
mesh and previous failed attempts at repair. Four patients had large ventral
hernias following gastric reduction operations and massive weight loss. No
defect in any dimension was less than 20 cm. All patients had secure abdominal
wall repair by reconstruction of a midline anchor for the abdominal wall
musculature. One patient was lost to follow-up after 3 weeks. The average
follow-up time for the remaining nine patients was 18.6 months (range, 6 months
to 4.7 years). One patient required readmission to the hospital for management
of a limited area of skin necrosis. Two patients had minor wound infections, and
three patients had subcutaneous seromas, all of which were managed on an
outpatient basis. One patient developed a 2 x 2-cm subxiphoid hernia recurrence.
Technical details include subcutaneous undermining of the abdominal skin to the
anterior axillary lines bilaterally, mobilization of the viscera to expose the
white lines of Toldt bilaterally, and parallel, parasagittal, staggered releases
of the transversalis fascia, transversalis muscle, external oblique fascia,
external oblique muscle, and rectus fascia. These multiple releases allow
expansion and translation of the abdominal wall by an accordion-like effect.
This accordion-like effect allows closure of abdominal wall defects that are
substantially larger than what can be closed with current techniques.
<46>
Unique Identifier
12832883
Authors
Girotto JA. Chiaramonte M. Menon NG. Singh N. Silverman R. Tufaro AP.
Nahabedian M. Goldberg NH. Manson PN.
Institution
Division of Plastic, Reconstructive, and Maxillofacial Surgery, Department of
Surgery, The Johns Hopkins School of Medicine, Baltimore, Md, USA.
Title
Recalcitrant abdominal wall hernias: long-term superiority of autologous
tissue repair.
Source
Plastic & Reconstructive Surgery. 112(1):106-14, 2003 Jul.
Abstract
Secondary repair of recurrent ventral hernia is difficult, and success depends
on re-establishing the functional integrity of the abdominal wall. Current
techniques used for closure of these defects have documented recurrence rates as
high as 54 percent. The authors' 8-year experience utilizing variations of the
components separation technique for autologous tissue repair of recalcitrant
hernias emphasizes that recurrent or recalcitrant hernias benefit from the
creation of a dynamic abdominal wall. A total of 389 patients were
retrospectively identified as having abdominal wall defects, and 284 of these
patients met the selection criteria. Study patients were grouped according to
the type of surgical repair used. The recurrence rate was 20.7 percent over all
study groups and was directly related to the extent of repair required. Group 1
patients (wide tissue undermining) had a recurrence rate of only 15 percent,
while in group 2 (complete components separation), the recurrence rate was 22
percent. Group 3 patients (interpositional fascia lata graft) had a 29 percent
recurrence rate. Time to recurrence was also significantly different across
treatment groups, with study group 3 experiencing earlier hernia recurrence. The
most frequent postoperative complication was wound infection, which was directly
related to the repair performed. The relative odds of recurrence versus the risk
factors of age, sex, perioperative steroid use, wound infection, defect size,
and the presence of enterocutaneous fistula were studied with a logistic
regression analysis. These factors did not possess statistical significance for
predicting hernia recurrence. The preoperative presence of mesh was
independently significant for hernia recurrence, increasing the relative odds
2.2 times (p = 0.01). Similarly, when other risk factors were controlled for,
increasing the complexity of the treatment group, from study group 1 (wide
tissue undermining) to study group 3 (interpositional fascia lata graft), also
increased the odds of hernia recurrence 1.5-fold per group (p = 0.04). Average
inpatient cost was $24,488. The length of inpatient stay ranged from 2 to 172
days (average, 12.8 days). The length of inpatient stay and costs were directly
related to the extent of repair required. Using the analysis of variance test
for multiple factors, the presence of an enterocutaneous fistula (p = 0.0014) or
a postoperative wound infection (p = 0.008) independently increased the length
of inpatient stay and hospital costs. A total of 108 successfully repaired
patients were contacted by telephone and agreed to participate in a selfreported satisfaction survey. The patients noticed improvements in the
appearance of their abdomen, in their postoperative emotional state, and in
their ability to lift objects, arise from a chair or a bed, and exercise. These
results suggest that recalcitrant hernia defects should be solved, when
possible, by reconstructing a dynamic abdominal wall.
<47>
Unique Identifier
12973257
Authors
de Vooght A. Feruzi G. Detry R. Lerut J. Vanwijck R.
Title
Vacuum-assisted closure for abdominal wound dehiscence with prosthesis
exposure in hernia surgery.
Source
Plastic & Reconstructive Surgery. 112(4):1188-9, 2003 Sep 15.
<48>
Unique Identifier
12560709
Authors
Sensoz O. Unlu RE. Ortak T. Baran C.
Institution
Department of Plastic and Reconstructive Surgery, Ankara Numune Hospital,
Turkey. [email protected]
Title
The overlap flap: a method of repairing recurrent large abdominal hernias.
Source
Plastic & Reconstructive Surgery. 111(2):831-6, 2003 Feb.
<49>
Unique Identifier
10697186
Authors
Lowe JB. Garza JR. Bowman JL. Rohrich RJ. Strodel WE.
Institution
Department of Surgery, The University of Texas Health Science Center, San
Antonio, USA.
Title
Endoscopically assisted "components separation" for closure of abdominal wall
defects.
Source
Plastic & Reconstructive Surgery. 105(2):720-9; quiz 730, 2000 Feb.
Abstract
The repair of ventral hernia defects of the abdominal wall challenges both
general and plastic surgeons. Ventral herniation is a postoperative complication
in 10 percent of abdominal surgeries; the repair of such defects has a
recurrence rate as high as 50 percent. The "components separation" technique has
successfully decreased the recurrence rates of ventral abdominal hernias.
However, this technique has been associated with midline dehiscence and a
prolonged postoperative stay at the authors' institutions. The purpose of this
study was to determine whether endoscopically assisted components separation
could minimize operative damage to the vasculature of the abdominal wall and
decrease postoperative wound dehiscence. The study group consisted of seven
patients who underwent endoscopically assisted components separation; the
control group consisted of 30 patients who underwent open components separation.
The two groups were similar regarding demographic data and defect size. The
endoscopic group had a higher initial success rate than the open group (100
versus 77 percent). Recurrence rates were not significantly different between
the two groups. However, the endoscopically assisted components separation
patients had fewer postoperative and long-term complications. In the authors'
experience, endoscopically assisted components separation has proved to be a
safe and effective method for the repair of complicated and recurrent midline
ventral hernias.
<50>
Unique Identifier
11996228
Authors
Toms AP. Cash CC. Fernando B. Freeman AH.
Institution
Department of Radiology, Addenbrookes's Hospital, Cambridge, UK.
[email protected]
Title
Abdominal wall hernias: a cross-sectional pictorial review. [Review] [92 refs]
Source
Seminars in Ultrasound, CT & MR. 23(2):143-55, 2002 Apr.
Abstract
The classification of abdominal wall hernias is often made difficult by
confusing eponymous and anatomic nomenclature. In this article, we review the
anatomy that defines the various types of hernias. The specific cross-sectional
radiologic features required to correctly identify each type are then
emphasized. The appropriate clinical context and the merits of the various
imaging techniques available for the investigation of abdominal wall hernias are
also discussed. [References: 92]
<51>
Unique Identifier
10987039
Authors
Larson GM.
Institution
Department of Surgery, University of Louisville School of Medicine, Kentucky,
USA.
Title
Ventral hernia repair by the laparoscopic approach. [Review] [18 refs]
Source
Surgical Clinics of North America. 80(4):1329-40, 2000 Aug.
Abstract
An analysis of these results indicates that laparoscopic hernia repair can be
performed safely by experienced laparoscopic surgeons, and with lower
perioperative complication rates than for open hernia repair. Although the
follow-up period for the laparoscopic repair is only 2 or 3 years, the
recurrence rate is likely lower than with open repair. Most patients with
ventral hernias are candidates for this laparoscopic repair if safe access and
trocar placement can be obtained. The choice of mesh often provokes a debate
among surgeons, but little practical difference in the results seems to exist
between the two types of mesh available. Although the ePTFE mesh has a good
theoretic basis for promoting tissue ingrowth on the parietal side of the mesh
and minimizing adhesions to the bowel side of the mesh, data indicate that no
difference in outcome exists related to adhesions or fistula formation (Tables 1
and 2), so surgeon preference and cost of the prosthesis should be the deciding
variables. Fistulas are of concern because of the experience with mesh in the
trauma patient and in the treatment of severe abdominal wall infections, when
abdominal wall reconstruction often is performed in contaminated wounds in the
acute phases and leaves the mesh exposed without soft tissue coverage. These
conditions do not apply for most cases of elective hernia repair. Laparoscopic
ventral hernia repair offers advantages over the conventional open mesh repair
and may decrease the hernia recurrence rate to 10% to 15%. When properly
performed, the laparoscopic approach does not and should not compromise the
principles for successful mesh repair of ventral hernias. [References: 18]
<52>
Unique Identifier
14533913
Authors
Montes IS. Deysine M.
Institution
Department of Surgery, Hospital Los Venados, Mexican Institute of Social
Security, Mexico City, Mexico.
Title
Spigelian and other uncommon hernia repairs. [Review] [41 refs]
Source
Surgical Clinics of North America. 83(5):1235-53, viii, 2003 Oct.
Abstract
This article offers an overview of abdominal wall hernias, which are uncommon
because of the unusual contents of their sacs. These include: Meckel's
diverticulum, segments of the intestinal wall antimesenteric border, the
vermiform appendix, the bladder; plus the penetration by the sac within the
different muscle layers of the abdominal wall. These hernias present diagnostic
difficulties and some are associated with high morbidity, but modern technology
may help their prognosis. This article describes their histories and their
unique presenting signs and symptoms and suggests up-to-date methods of imaging,
as well as surgical tactics and technique. [References: 41]
<53>
Unique Identifier
14533912
Authors
Millikan KW.
Institution
Department of General Surgery, Rush-Presbyterian-St. Luke's Medical Center,
1650 West Harrison Street, Chicago, IL 60612-3800, USA. [email protected]
Title
Incisional hernia repair. [Review] [67 refs]
Source
Surgical Clinics of North America. 83(5):1223-34, 2003 Oct.
Abstract
Incisional ventral hernias are a common problem encountered by surgeons, with
over 100,000 repairs being performed annually in the United States. Although
many predisposing factors for incisional ventral hernia are patient-related,
some factors such as type of primary closure and materials used may reduce the
overall incidence of incisional ventral hernia. With the advent of prosthetic
meshes being used for incisional ventral hernia repair, the recurrence rate has
dropped to approximately 10%. More recently, with the development of prosthetic
mesh that is now safe to place intraperitoneally, the recurrence rate has
dropped to under 5%. The current controversies that exist for incisional ventral
hernia repair are which approach to use (open versus laparoscopic) and what type
of fixation (partial- versus full-thickness abdominal muscular/fascial wall) is
necessary to stabilize the position of the mesh while tissue ingrowth occurs.
During the next decade the answers to these controversies should be available in
the surgical literature. [References: 67]
<54>
Unique Identifier
12163959
Authors
Thoman DS. Phillips EH.
Institution
Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Boulevard,
Los Angeles, CA 90048, USA.
Title
Current status of laparoscopic ventral hernia repair. [Review] [24 refs]
Source
Surgical Endoscopy. 16(6):939-42, 2002 Jun.
Abstract
Ventral abdominal wall hernias are a common problem for the general surgeon.
Historically, the best results have been obtained with the open Rives-Stoppa
approach. This is done by fixing a large piece of prosthetic mesh behind the
rectus muscle. Extensive dissection is required and can lead to postoperative
pain and wound complications. A laparoscopic approach allows similar mesh
placement with minimal dissection. Several small comparative studies have found
laparoscopic ventral hernia repair to have fewer complications, a shorter length
of stay, and possibly a lower recurrence rate when compared to open mesh repair.
Large prospective studies have now confirmed these findings, with recurrence
rates below 4%. This is significantly lower than the best reported rates of open
mesh repair. Additionally, the morbidity appears to be significantly less. This
technique is easily mastered by anyone with basic laparoscopic skills and is
briefly presented. [References: 24]