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Component separation hernia

J D Hodgkinson, C A Leo, Y Maeda, P Bassett, S M Oke, C J Vaizey, J Warusavitarne
PURPOSE: This study aims to compare the outcomes of posterior component separation and transversus abdominis release (PCSTAR) with the open anterior component separation (OACS) technique. OACS, first described by Ramirez et al. (Plast Reconstr Surg 86(3):519-526, 1990), has become an established technique for local myofascial advancement in abdominal hernia surgery. PCSTAR, described by Novitsky et al. (Am J Surg 204(5):709-716, 2012), is being used more frequently and is rapidly becoming the technique of choice in complex ventral hernia repair...
March 7, 2018: Hernia: the Journal of Hernias and Abdominal Wall Surgery
Alvaro Robin-Lersundi, Luis Blazquez Hernando, Javier López-Monclús, Arturo Cruz Cidoncha, Carlos San Miguel Méndez, Elena Jimenez Cubedo, Miguel Angel García-Ureña
BACKGROUND: Posterior component separation with transversus abdominis release technique is increasingly being used for abdominal wall reconstruction in complex abdominal wall repair. The main purpose of this study is to present a modification of the surgical technique originally described that facilitates the surgical procedure and offers additional advantages. METHODS: Based on the knowledge of the anatomy of the retromuscular space and the preperitoneal aerolar tissue distribution, we start the incision on the posterior rectus sheath from the arcuate line in a down to up direction...
March 3, 2018: Langenbeck's Archives of Surgery
Catalina Mosquera, Juan M Bermudez, Jessica L Evans, Konstantinos Spaniolas, Dougald C MacGillivary, Timothy L Fitzgerald
BACKGROUND: An association between frailty and mortality exists; we hypothesized this is secondary to failure to rescue (F2R). STUDY DESIGN: Data were obtained from the National Surgical Quality Improvement Program (2005-2012) for patients undergoing thoracoabdominal surgery. Using the modified frailty index (MFI), patients were classified as not (0 points), mildly (1 point), moderately (2 points), and severely (=/>3) frail. RESULTS: 962,913 patients were included; a majority were non-frail (52...
February 23, 2018: Journal of the American College of Surgeons
Brian Hill, Rohan Kambeyanda, Donna Fewell, Stewart Bryant, Kevin O Delaney, Fernando A Herrera
PURPOSE: In this study, we reviewed our institution's experience using component separation for repair of ventral hernias. METHODS: This was a retrospective review of all component separations for ventral hernia between July 2009 and December 2015. Recorded data included body mass index (BMI), preoperative albumin, smoking history, comorbidities, additional procedures, length of surgery, hospitalization, recurrence, and postoperative complications. RESULTS: One hundred ninety-six component separations were performed in the study period...
February 23, 2018: Annals of Plastic Surgery
Z Song, D Yang, J Yang, X Nie, J Wu, H Song, Y Gu
PURPOSE: Abdominal wall defects caused by neoplasms with large extended resection defects remain a challenging problem. Autologous flaps, meshes, and component separation techniques are effective in reconstructing these defects. We retrospectively reviewed and assessed the success of reconstruction using tensor fascia lata flap with or without meshes. METHODS: 18 patients with abdominal wall neoplasms were identified during the period from 2007 to 2016. A retrospective review of office charts and hospital records was performed...
February 7, 2018: Hernia: the Journal of Hernias and Abdominal Wall Surgery
Hugo Palma Rios, André Goulart, Pedro Leão
INTRODUCTION: Performing surgery on patients with Crohn's disease is a true challenge due to the elevated risk of complications related to the chronic proinflammatory response. Stenosis is the leading cause of intestinal resection in these patients. CASE REPORT: The authors present the case of a 50-year-old woman with inflammatory stenosis of the terminal ileum due to Crohn's disease. The patient underwent a laparoscopic ileocecal resection, which was complicated by a small anastomotic dehiscence with localized peritonitis...
January 2018: Wounds: a Compendium of Clinical Research and Practice
Jill Smolevitz, Richard Jacobson, Milot Thaqi, Samantha Millikan, Keith W Millikan
BACKGROUND: Consensus guidelines recommend against elective ventral hernia repair (VHR) in patients with BMI >30 kg/m2 without preoperative weight loss intervention. We aim to compare hernia recurrence and perioperative complications in VHR utilizing anterior component separation (CS) in patients with class III obesity (BMI >40 kg/m2). METHODS: A retrospective review of patients undergoing VHR with CS was performed. The primary endpoint was hernia recurrence; secondary endpoints were wound complications, postoperative medical complications, mortality and length of stay...
November 11, 2017: American Journal of Surgery
F Köckerling, N N Alam, S A Antoniou, I R Daniels, F Famiglietti, R H Fortelny, M M Heiss, F Kallinowski, I Kyle-Leinhase, F Mayer, M Miserez, A Montgomery, S Morales-Conde, F Muysoms, S K Narang, A Petter-Puchner, W Reinpold, H Scheuerlein, M Smietanski, B Stechemesser, C Strey, G Woeste, N J Smart
INTRODUCTION: Although many surgeons have adopted the use of biologic and biosynthetic meshes in complex abdominal wall hernia repair, others have questioned the use of these products. Criticism is addressed in several review articles on the poor standard of studies reporting on the use of biologic meshes for different abdominal wall repairs. The aim of this consensus review is to conduct an evidence-based analysis of the efficacy of biologic and biosynthetic meshes in predefined clinical situations...
January 31, 2018: Hernia: the Journal of Hernias and Abdominal Wall Surgery
J S Winder, A Majumder, M Fayezizadeh, Y W Novitsky, E M Pauli
BACKGROUND: A minority of patients undergoing posterior component separation (PCS) have abdominal wall defects that preclude complete reconstruction of the visceral sac with native tissue. The use of absorbable mesh bridges (AMB) to span such defects has not been established. We hypothesized that AMB use during posterior sheath closure of PCS is safe and provides favorable outcomes. METHODS: We performed a retrospective review of consecutive patients undergoing PCS with AMB at two hernia centers...
January 18, 2018: Hernia: the Journal of Hernias and Abdominal Wall Surgery
Julio Gómez-Menchero, Juan Francisco Guadalajara Jurado, Juan Manuel Suárez Grau, Juan Antonio Bellido Luque, Joaquin Luis García Moreno, Isaías Alarcón Del Agua, Salvador Morales-Conde
BACKGROUND: Closing the defect (CD) during laparoscopic ventral hernia repair began to be performed in order to decrease seroma, to improve the functionality of the abdominal wall, and to decrease the bulging effect. However, tension at the incision after CD in large defects is related to an increased rate of pain and recurrence. We present the preliminary results of a new technique for medium midline hernias as an alternative to conventional CD. METHODS: A prospective controlled study was conducted from January 2015 to January 2017 to evaluate an elective new procedure (LIRA) performed on patients with midline ventral hernias (4-10 cm width)...
January 17, 2018: Surgical Endoscopy
Julia Isabelle Staubitz, Peter Gassmann, Daniel Wilhelm Kauff, Hauke Lang
BACKGROUND: An inguinoscrotal hernia is defined as "giant" if descending below the midpoint of the inner thigh of a patient in upright position. In developed countries this is a rare entity. In the literature different surgical techniques have been reported so far to achieve a successful treatment. CASE PRESENTATION: We present the case of a 63 year-old man suffering from a giant inguinoscrotal hernia, whom we treated using a combined open transabdominal and inguinal approach following an unsuccessful laparoscopic attempt...
December 19, 2017: BMC Surgery
P Praveen Raj, Siddhartha Bhattacharya, S Saravana Kumar, R Parthasarathi, C Palanivelu
Bariatric surgery can be safely combined with laparoscopic intraperitoneal onlay mesh (IPOM) repair. In case of large ventral hernias, laparoendoscopic component separation can also be combined to achieve tension-free closure of the defect. Concomitant bariatric surgery and hernia repair also offer the additional benefit of reduction in recurrence of hernias as obesity, one of the risk factors, is treated in the process. We present a case of 60-year-old man with a body mass index of 45.3 kg/m2 with a large recurrent ventral hernia...
December 11, 2017: Journal of Minimal Access Surgery
Kerry L Thomas, Ricardo J Gonzalez, Evita Henderson-Jackson, Jamie T Caracciolo
A man with left scrotal swelling felt to represent inguinal hernia underwent computed tomography scan for reported bleeding after prostate biopsy. Computed tomography scan revealed a 15-cm extratesticular left scrotal mass containing both fat and soft tissue components, raising concern for dedifferentiated liposarcoma. At surgery and pathology, the mass was separate from the left testis, epididymis, and spermatic cord. Histopathologic findings were consistent with paratesticular dedifferentiated liposarcoma...
December 1, 2017: Urology
Jeremy A Warren, Sean P McGrath, Allyson L Hale, Joseph A Ewing, Alfredo M Carbonell, William S Cobb
Recurrence after ventral hernia repair (VHR) remains a significant complication. We sought to identify the technical aspects of VHR associated with recurrence. Patients who underwent open midline VHR between 2006 and 2013 (n = 261) were retrospectively evaluated. Patients with recurrence (Group 1, n = 48) were compared with those without recurrence (Group 2, n = 213). Smoking, diabetes, and body mass index were not different between groups. More patients in Group 1 underwent clean-contaminated, contaminated, or dirty procedures (43...
November 1, 2017: American Surgeon
Reiko Wiessner, Thomas Vorwerk, Claudia Tolla-Jensen, Alexander Gehring
Despite extensive experience and significant reduction of complications in recent years, laparoscopic treatment of complex abdominal hernias is a challenge even for the experienced endoscopic surgeon. Patients with severe incisional hernias or symptomatic rectus diastasis benefit from the closure of the linea alba as a morphological and physiological reconstruction of the abdominal wall followed by mesh implantation. Occasionally, an additional component separation is necessary. In open surgery, this is associated with very large wound areas, postoperative seromas, poor wound healing and, in the worst case, mesh infections...
2017: Frontiers in Surgery
Imran R A Punekar, Joseph S Khouri, Michael Catanzaro, Aizaz L Shaikh, Howard N Langstein
BACKGROUND: The abdominal wall is frequently manipulated in a variety of reconstructive procedures, and its anatomy is well described. The authors' clinical observations, however, contradict the standard depiction of the components of the abdominal wall at various levels-particularly regarding the course of the transversus abdominis muscle. Therefore, the authors sought to characterize the components of the rectus sheath at various surgical landmarks to define anatomic points important to abdominal wall repair...
February 2018: Plastic and Reconstructive Surgery
Takintope Akinbiyi, Sanjeev Kaul
Introduction: Heterotopic ossification involves the formation of trabecular bone outside of its usual anatomic location. While it is a well-known entity in orthopedic and spinal injury literature, it has also been observed after midline laparotomy and severe burns. Methods/Case Report: We present a case of a 69-year-old man who presented for ventral hernia repair after a prolonged postoperative course following colectomy involving an open abdomen with eventual closure with skin grafting. Results: Two large calcified objects were encountered during the excision of the skin graft from the small intestine and during the component separation...
2017: Eplasty
Lucas Torres Oliveira, Felipe Futema Essu, Gustavo Heluani Antunes de Mesquita, Yuri Justi Jardim, Leandro Ryuchi Iuamoto, Fábio Yuji Suguita, Diego Ramos Martines, Fernanda Nii, Daniel Reis Waisberg, Alberto Meyer, Wellington Andraus, Luiz Augusto Carneiro D'Albuquerque
PURPOSE: Transplantation patients have a series of associated risk factors that make appearance of incisional hernia (IH) more likely. A number of aspects of the closure of large defects remain controversial. In this manuscript, we present the repair of a large IH following liver transplantation through the technique of posterior components separation combined with the anterior, together with the intraoperative use of botulinum toxin A and the placement of mesh. As a secondary objective, we analyze the incidence of IH following liver transplantation in our service...
2017: International Journal of Surgery Case Reports
Gernot Köhler, Ines Fischer, Richard Kaltenböck, Michael Lechner, Bernhard Dauser, Lars Nannestad Jorgensen
INTRODUCTION: Endoscopic anterior component separation (ECS) techniques facilitate tension-free midline closure of wide ventral hernia defects. We describe a novel approach with a precostal incision and a new cylindrical ballon trocar. MATERIALS AND METHODS: A single-center analysis of 19 patients undergoing ECS between January 1, 2014 and August 2, 2017 was performed with regard to improvement of technique. We currently start with a lateral precostal incision. This access in a low-fat and stable area allows for easy identification of the external oblique muscle with the ribs functioning as dorsal abutment for entering the correct plane between external and internal oblique muscles...
October 20, 2017: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
Vashisht Madabhushi, Margaret A Plymale, John Scott Roth, Sara Johnson, Alex Wade, Daniel L Davenport
BACKGROUND: Open ventral hernia repair (VHR) is often performed in conjunction with other abdominal procedures. Clinical outcomes and financial implications of VHR are becoming better understood; however, financial implications of concomitant VHR during other abdominal procedures are unknown. This study aimed to evaluate the financial implications of adding VHR to open abdominal procedures. METHODS: This IRB-approved study retrospectively reviewed hospital costs to 180-day post-discharge of standalone VHRs, isolated open abdominal surgeries (bowel resection or stoma closure, removal of infected mesh, hysterectomy or oophorectomy, panniculectomy or abdominoplasty, open appendectomy or cholecystectomy), performed at our institution from October 1, 2011 to September 30, 2014...
October 19, 2017: Surgical Endoscopy
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