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giant ventral hernia and component separation

A Torregrosa-Gallud, J Sancho Muriel, J Bueno-Lledó, P García Pastor, J Iserte-Hernandez, S Bonafé-Diana, O Carreño-Sáenz, F Carbonell-Tatay
BACKGROUND: An increasing number of patients have large or complex abdominal wall defects. Component separation technique (CST) is a very effective method for reconstructing complex midline abdominal wall defects in a manner that restores innervated muscle function without excessive tension. Our goal is to show our results by a modified CST for treating large ventral hernias. MATERIALS AND METHODS: A total of 351 patients with complex ventral hernias have been treated over a 10-year period...
August 2017: Hernia: the Journal of Hernias and Abdominal Wall Surgery
J Škach, R Harcubová, V Petráková, L Brzulová, M Krejbichová, K Kocmanová
INTRODUCTION: The authors introduce a unique programme in the Czech Republic focused on extreme herniology. Patients with giant complex ventral hernias (monster hernias) have been concentrated in a high-volume hernia center with the most advanced perioperative intensive care since 2012. The authors present their single centre experience with the support of literature. RESULTS: Between 20122015 we operated on 36 patients with a giant complex hernia. Minimal inclusion criteria for enrolment in the very heterogeneous group included: a defect over 15 cm wide, loss of domain of 20% and higher, and the mean surface area of at least 225 cm²...
December 0: Rozhledy V Chirurgii: Měsíčník Československé Chirurgické Společnosti
Erin A Miller, Adam Goldin, Geoffrey N Tse, Raymond Tse
Abdominal wall reconstruction ideally involves maintenance of domain by restoration of competent fascia and innervated muscle. Component separation allows closure of ventral hernias, but the technique is limited for high abdominal defects in the epigastric region. We describe an extended component separation that facilitated mobilization of the rectus abdominis muscle along its costal insertion to close an upper midline defect in a child with giant omphalocele, who had already undergone previous traditional component separation...
September 2015: Plastic and Reconstructive Surgery. Global Open
N M Posielski, S T Yee, A Majumder, S B Orenstein, A S Prabhu, Y W Novitsky
INTRODUCTION: Prosthetic reinforcement is a critical component of hernia repair. For massive defects, mesh overlap is often limited by the dimensions of commercially available implants. In scenarios where larger mesh prosthetics are required for adequate reinforcement, it may be necessary to join several pieces of mesh together using non-absorbable suture. Here, we report our outcomes for abdominal wall reconstructions in which "quilted" mesh was utilized for fascial reinforcement. METHODS: Patients undergoing open incisional hernia repair utilizing posterior component separation and transversus abdominis muscle release, with use of quilted synthetic mesh placed in the retromuscular position, were reviewed...
June 2015: Hernia: the Journal of Hernias and Abdominal Wall Surgery
R Kumar, A K Shrestha, S Basu
AIMS: Giant midline abdominal wall incisional herniae require repair/reconstruction to restore the structural and functional continuity of the anterior abdominal wall. We describe here our approach to these demanding cases through a combined retro-rectus mesh placement and components separation and their overall functional outcome. METHODS: A retrospective analysis of a prospectively collected data was carried out and 28 patients who underwent giant (≥15 cm) midline incisional hernia reconstruction were identified in a large district general hospital between 2007 and 2013 with a median follow-up of 34 (6-76) months...
October 2014: Hernia: the Journal of Hernias and Abdominal Wall Surgery
Jai Bikhchandani, Robert Joseph Fitzgibbons
Repair of huge ventral hernias is technically challenging for the surgeon and a major operation for the patient and should be performed by experienced surgeons in centers that are used to caring for patients who are commonly massively obese with significant comorbidities. Preoperative medical optimization of patients is an important part in the overall management of these large hernias. Conventional component separation with retromuscular mesh repair is the workhorse operation, which successfully deals with many giant ventral hernias, but multiple alternative strategies must be available to address situations in which myofascial elements are completely deficient or there is significant loss of domain The complexity of this surgery is reflected by recurrence rates ranging from 10% to 30% and wound complication rates as high as 40% to 50% in experienced centers...
2013: Advances in Surgery
Joaquín Picazo-Yeste, Antonio Morandeira-Rivas, Carlos Moreno-Sanz
BACKGROUND: The components separation technique has been proposed as the best solution when facing large abdominal wall defects. In counterpart, this sometimes comes at the price of high rates of wound complications and recurrence. Moreover, the components separation method alone seems insufficient for huge defects, in which it is impossible to reapproximate the rectus muscles without tension. For these cases, we illustrate a novel operation using a modified components separation technique...
September 2013: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
F Berrevoet, T Martens, K Van Landuyt, B de Hemptinne
In the management of giant incisional hernias with loss of domain several surgical obstacles have to be addressed. Adequate coverage of the defect using mesh, sufficient local tissue advancement and prevention of wound and mesh infections are prerequisites for success. We present a case of a complicated giant incisional hernia repair after oncologic surgery, in which we chose for an intraabdominal mesh repair using a composite mesh. The patient developed a wound dehiscence and mesh infection, successfully treated with negative pressure therapy followed by a free ALT perforator flap...
May 2010: Acta Chirurgica Belgica
Jennifer M DiCocco, Louis J Magnotti, Katrina P Emmett, Ben L Zarzaur, Martin A Croce, John P Sharpe, C Patrick Shahan, Haiqiao Jiao, Steven P Goldberg, Timothy C Fabian
BACKGROUND: Although damage control strategies and the open abdomen have improved survival, they present their own unique set of challenges in caring for the multiply injured trauma patient. We previously reported the technique of staged abdominal wall closure for the management of the open abdomen. The purpose of this study was to evaluate the efficacy of various techniques of abdominal wall reconstruction (final stage of management) on long-term outcomes after planned ventral hernia, and to better define risk factors for recurrence...
May 2010: Journal of the American College of Surgeons
Bohdan Pomahac, Pejman Aflaki
BACKGROUND: Reconstruction of complex abdominal wall defects is challenging. The use of prosthetic mesh can be associated with surgical site infection, fistula formation, and adhesions. This study presents our experience using a non-cross-linked porcine dermal scaffold (NCPDS) in abdominal wall reconstruction. METHODS: Patients undergoing abdominal wall reconstruction with NCPDS between May 2006 and January 2008 underwent a retrospective chart review. Demographics, indications for NCPDS placement, surgical technique, complications, and follow-up data were evaluated...
January 2010: American Journal of Surgery
T Wright Jernigan, Timothy C Fabian, Martin A Croce, Natalie Moore, F Elizabeth Pritchard, Gayle Minard, Tiffany K Bee
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...
September 2003: Annals of Surgery
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