Hernia

Abdominal hernias are common issues in the clinical setting, burdening millions of patients worldwide. Associated with pain, decreased quality of life, and severe potential complications, abdominal wall hernias should be treated as soon as possible. Whether an open repair or laparoscopic surgical approach is tackled, mesh reinforcement is generally required to ensure a durable hernia repair. Over the years, numerous mesh products have been made available on the market and in clinical settings, yet each of the currently used meshes presents certain limitations that reflect on treatment outcomes...

INTRODUCTION: Worldwide, more than 20 million patients undergo groin hernia repair annually. The many different approaches, treatment indications and a significant array of techniques for groin hernia repair warrant guidelines to standardize care, minimize complications, and improve results. The main goal of these guidelines is to improve patient outcomes, specifically to decrease recurrence rates and reduce chronic pain, the most frequent problems following groin hernia repair. They have been endorsed by all five continental hernia societies, the International Endo Hernia Society and the European Association for Endoscopic Surgery...

BACKGROUD: Recently, laparoscopic percutaneous extraperitoneal closure (LPEC) has gained increased popularity for pediatric inguinal hernia repair. To improve cosmesis, we developed single incision LPEC (SILPEC). The aim of this study was to assess the safety and feasibility of SILPEC compared with traditional open repair (OR). METHODS: This was a single-center retrospective cohort study of 2028 children who underwent inguinal hernia repair between April 2005 and August 2014...

OBJECTIVE: The aim of this study was to investigate long-term groin pain and inguinal hernia recurrence rates of 2 types of mesh and to describe the evolution of postoperative groin sensory disturbances. SUMMARY OF BACKGROUND DATA: Some patients with an inguinal hernia develop chronic pain following open mesh insertion. Previous trials comparing a semi-resorbable, self-gripping Progrip mesh with a standard sutured polypropylene mesh found conflicting results regarding recurrence rates and residual groin pain...

BACKGROUND: The development of laparoscopy as a means of evaluation and treatment of inguinal hernia in children has raised the question of whether simultaneous closure of a contralateral patent processus vaginalis (CPPV) is justified. The present study aimed to determine the rate of metachronous inguinal hernia (MIH) in children with CPPV. METHODS: Children with unilateral inguinal hernia from two hospitals underwent either open or laparoscopic repair, and were followed up for MIH...

BACKGROUND: The Rives-Stoppa incisional hernia repair is the gold standard for mesh repair of complex incisional hernias. The risk of infection can be reduced if fascia is closed over the prosthetic mesh. Fascial closure in large defects may require extensive dissection and can result in devascularization of the overlying skin and denervation of the abdominal wall musculature. Laparoscopic components separation minimizes these risks while facilitating anterior fascial closure. The combined technique of Rives-Stoppa repair augmented by laparoscopic separation of abdominal wall components has not previously been reported...

BACKGROUND: The prosthetic repair of incisional hernias drastically reduced the incidence of recurrence, but increased the associated morbidity. We report a consecutive series of patients with incisional hernias operated by Rives- Stoppa procedure. The aim is to identify the early and late complications associated with the procedure. MATERIAL AND METHODS: 275 patients admitted and operated on between 2002-2006 were prospectively evaluated by direct examination and questionnaire...

BACKGROUND: Use of the Rives-Stoppa (R-S) technique has markedly diminished recurrence rate. Our aim was to assess the outcomes of Iranian patients undergoing the R-S technique and to determine factors affecting recurrence rate and time. METHODS: Over a 10-year period, 86 open abdominal wall incisional hernia repairs were performed using the R-S technique. Prolene and Mersilene meshes were used. Main outcome measures were the rate and time of recurrence and mortality...

BACKGROUND: The Rives-Stoppa (RS) repair of ventral incisional hernias (VIHR) is technically difficult. It involves the retromuscular placement of mesh anterior to the posterior fascia and the primary closure of the anterior fascia. Recurrence rates are 0-8%. We proposed that the operation could be done with equal success by placing the mesh in an intraperitoneal position and primarily closing the fascia anterior to the mesh. METHODS: 81 patients who had undergone an open RS-VIHR with intraperitoneal mesh were evaluated for hernia recurrence and factors associated with recurrence...

BACKGROUND: Repair of complex incisional hernias poses a major challenge. AIM: The aim of this study was to review the outcomes of the modified Rives-Stoppa repair of complex incisional hernias using a synthetic prosthesis. METHODS: We reviewed patients undergoing a modified Rives-Stoppa repair of complex incisional hernias from 1990 to 2003. Patients were followed through clinic visits and mailed questionnaires. Follow-up data were complete in all patients (mean 70 months, range 24-177 months), and 87% of patients completed a mailed questionnaire...

PURPOSE: The purpose of this study is to evaluate the tension at the aponeurotic edges after the undermining of the anterior rectus sheath associated with the classic components separation in cadavers. METHODS: Twenty fresh adult cadavers were placed supine and an incision in the anterior rectus sheath was done, thus exposing the posterior sheath. The two levels to be studied were marked 3 cm above and 2 cm below the umbilicus. An analogical dynamometer was used to measure the traction values, consecutively during four stages as follows: initial stage, no aponeurotic undermining; Stage 1, separation of the anterior rectus sheaths; Stage 2, after Stage 1 the external oblique aponeurosis were incised along the semilunaris and the external oblique muscles were undermined; Stage 3, after Stage 2 rectus muscles were completely separated from their posterior sheaths...

Repairing large incisional hernia with abdominal wall reconstruction is a technically challenging problem for surgeons. We report our experience of large midline incisional hernia which was repaired successfully with components separation technique. A patient with incisional hernia, 35 × 20 cm in size, underwent operation following standard components separation technique. The aponeurosis of the external abdominal oblique muscle was longitudinally transected from the rectus sheath, and the external abdominal oblique muscle was separated from the internal abdominal oblique muscle...

Component separation is established for complex hernia repairs. This case presents early component separation and release of the anterior and posterior sheath to facilitate closure of the abdominal wall following emergency laparotomy, reinforcing the repair with a biological mesh. On Day 11 following an emergency laparotomy for penetrating trauma, this patient underwent component separation and release of the anterior and posterior sheath. An intra-abdominal biological mesh was secured, and the fascia and skin closed successfully...

Repair of large ventral hernia is a challenge for even experienced surgeons, as there are large defects with large contents, often with loss of domain. The large defects were bridged by various plastic surgical procedures like myofascial flaps or free flaps with high recurrences and complications. More often, the bridging was done with artificial prosthesis, leaving the defects open. This was accomplished by either open surgery (onlay, inlay, sublay or underlay) or laparoscopic intraperitoneal onlay meshes (IPOMs)...

In this article, the authors describe their current operative technique for open ventral hernia repair using component separation. Although methods of anterior component separation are described, in their current practice, the authors primarily use posterior component separation with transversus abdominis release to permit dissection beyond the retrorectus space. This method adheres to the literature-supported principles of a tension-free midline fascial closure with wide mesh overlap of mesh positioned in a sublay position...

BACKGROUND: Anterior components separation (ACS) creates large lipocutaneous flaps to release the external oblique fascia often leading to major wound complications. Posterior components separation (PCS) involves the release of the posterior rectus sheath and transversus abdominis muscles. We hypothesized that PCS provides effective fascial advancement while reducing wound morbidity during abdominal wall reconstructions. METHODS: A retrospective review of consecutive components separation performed by a single surgeon over 5 years...

UNLABELLED: Large complex ventral hernias act as tissue expanders for skin and subcutaneous fat. The purpose of this study is to evaluate outcomes of total abdominal wall reconstruction with component separation, posterior reinforcement, and vertical abdominoplasty in patients with large complex ventral hernias. Between 2010 and 2014, 58 patients underwent total abdominal wall reconstruction with component separation, intra-abdominal reinforcement, and vertical abdominoplasty. Between 2010 and 2012, patients underwent the conventional technique of component separation, while a perforator-preserving technique was performed during 2013 and 2014...

No abstract text is available yet for this article.

BACKGROUND: Several modifications of the classic retromuscular Stoppa technique to facilitate dissection beyond the lateral border of the rectus sheath recently were reported. We describe a novel technique of transversus abdominis muscle release (TAR) for posterior component separation during major abdominal wall reconstructions. METHODS: Retrospective review of consecutive patients undergoing TAR. Briefly, the retromuscular space is developed laterally to the edge of the rectus sheath...

PURPOSE: Anterior component separation (ACS) with external oblique release for ventral hernia repair has a recurrence rate up to 32%. Hernia recurrence after prior ACS represents a complex surgical challenge. In this context, we report our experience utilizing posterior component separation with transversus abdominis muscle release (PCS/TAR) and retromuscular mesh reinforcement. METHODS: Patients with a history of recurrent hernia following ACS repaired with PCS/TAR were retrospectively identified from prospective databases collected at two large academic institutions...