scholarly journals Predictors of Incisional Hernia after Robotic Assisted Radical Prostatectomy

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Avinash Chennamsetty ◽  
Jason Hafron ◽  
Luke Edwards ◽  
Scott Pew ◽  
Behdod Poushanchi ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Incisional Hernia ◽  
Operative Time ◽  
Patient Counseling ◽  
Incisional Hernias ◽  
Prostate Weight ◽  
History Of ◽  
Robotic Assisted Radical Prostatectomy

Introduction.To explore the long term incidence and predictors of incisional hernia in patients that had RARP.Methods.All patients who underwent RARP between 2003 and 2012 were mailed a survey reviewing hernia type, location, and repair.Results.Of 577 patients, 48 (8.3%) had a hernia at an incisional site (35 men had umbilical), diagnosed at (median) 1.2 years after RARP (mean follow-up of 5.05 years). No statistically significant differences were found in preoperative diabetes, smoking, pathological stage, age, intraoperative/postoperative complications, operative time, blood loss, BMI, and drain type between patients with and without incisional hernias. Incisional hernia patients had larger median prostate weight (45 versus 38 grams;P=0.001) and a higher proportion had prior laparoscopic cholecystectomy (12.5% (6/48) versus 4.6% (22/480);P=0.033). Overall, 4% (23/577) of patients underwent surgical repair of 24 incisional hernias, 22 umbilical and 2 other port site hernias.Conclusion.Incisional hernia is a known complication of RARP and may be associated with a larger prostate weight and history of prior laparoscopic cholecystectomy. There is concern about the underreporting of incisional hernia after RARP, as it is a complication often requiring surgical revision and is of significance for patient counseling before surgery.

scholarly journals Modified retrorectus procedure for repair of midline incisional hernias

2020 ◽  
Vol 7 (4) ◽  
pp. 1204
Author(s):  
Javed A. Mir ◽  
Sanober M. Masoodi
Keyword(s):  
Incisional Hernia ◽  
Operative Time ◽  
Mesh Size ◽  
Long Term Results ◽  
Recurrence Rates ◽  
Incisional Hernias ◽  
Abdominal Operations ◽  
A Prospective Study

Background: Incisional hernias develop after abdominal operations. Primary closure procedures carry high recurrence rates. Prosthetic repairs with different modifications have reduced the recurrence rates and are the procedures of choice for incisional hernia repair.Methods: Our study is a prospective study conducted on 30 patients of midline incisional hernia. Hernia repair was done by modified retrorectus technique with in which the mesh is placed between the rectus abdominis muscle and the posterior rectus sheath.Results: In our study, the hernia defect ranged from 25-40 cm2.The mesh size used ranged from 15×15 to 30×20 cm. Mean duration of hospital stay was 9.9±2.3 days. Operative time ranged from 90-150 minutes. Follow up period ranged from 3-15 months. There were no post-operative complications in 73.3% cases. Seroma formation occurred in 10% cases and wound infection was seen in 10% cases. One patient developed mesh infection which required partial removal of mesh. There was no recurrence, no mortality, no bowel injury or adhesion obstruction. Wound related complications and morbidity was higher in patients with risk factors and comorbidities like diabetes, obesity, anaemia, COPD, hypoalbuminemia and patients on steroids.Conclusions: The retrorectus technique for the repair of midline incisional hernia using polypropylene mesh is a safe and durable procedure with excellent long-term results, minimal comorbidities and least recurrence rates and is an open procedure of choice for the repair of large incisional hernias.

scholarly journals Prophylactic Onlay Mesh Implantation During Definitive Fascial Closure After Open Abdomen Therapy (PROMOAT): Absorbable or Non-absorbable? Methodical Description and Results of a Feasibility Study

2020 ◽  
Vol 7 ◽  
Author(s):  
Sebastian Schaaf ◽  
Robert Schwab ◽  
Christoph Güsgen ◽  
Arnulf Willms
Keyword(s):  
Incisional Hernia ◽  
Open Abdomen ◽  
Fascial Closure ◽  
Special Focus ◽  
Term Outcome ◽  
Mesh Implantation ◽  
Incisional Hernias ◽  
Onlay Mesh

Introduction: Incisional hernia development after open abdomen therapy (OAT) remains a common complication in the long run. To demonstrate the feasibility, we describe our method of prophylactic onlay mesh implantation with definitive fascial closure after open abdomen therapy (PROMOAT). To display the feasibility of this concept, we evaluated the short-term outcome after absorbable and non-absorbable synthetic mesh implantation as prophylactic onlay.Material and Methods: Ten patients were prospectively enrolled, and prophylactic onlay mesh (long-term absorbable or non-absorbable) was implanted at the definitive fascial closure operation. The cohort was followed up with a special focus on incisional hernia development and complications.Results: OAT duration was 21.0 ± 12.6 days (95% CI: 16.9–25.1). Definitive fascial closure was achieved in all cases. No incisional hernias were present during a follow-up interval of 12.4 ± 10.8 months (range 1–30 months). Two seromas and one infected hematoma occurred. The outcome did not differ between mesh types.Conclusion: The prophylactic onlay mesh implantation of alloplastic, long-term absorbable, or non-absorbable meshes in OAT showed promising results and only a few complications that were of minor concern. Incisional hernias did not occur during follow-up. To validate the feasibility and safety of prophylactic onlay mesh implantation long-term data and large-scaled prospective trials are needed to give recommendations on prophylactic onlay mesh implantation after OAT.

scholarly journals Long-term Follow-Up of Prophylactic Mesh Reinforcement After Emergency Laparotomy. Cohorts Study.

2020 ◽  
Author(s):  
Alejandro Bravo-Salva ◽  
Nuria Argudo-Aguirre ◽  
Ana María González-Castillo ◽  
Estela Membrilla-Fernandez ◽  
Joan Sancho-Insenser ◽  
...  
Keyword(s):  
Risk Factors ◽  
Incisional Hernia ◽  
Long Term Results ◽  
Emergency Laparotomy ◽  
Prophylactic Mesh ◽  
Midline Laparotomy ◽  
Incisional Hernias ◽  
Mesh Reinforcement

Abstract BackgroundPrevention of incisional hernias with a prophylactic mesh in emergency surgery is controversial. The present study aimed to analyze the long-term results of prophylactic mesh used for preventing incisional hernia after emergency midline laparotomies. MethodsThis study was a registered (NCT04578561) retrospective analysis of patients who underwent an emergency midline laparotomy between January 2009 and July 2010 with a follow-up period of longer than 2 years. Long-term outcomes and risk factors for the development of incisional hernias between patients who received a prophylactic reinforcement mesh (Group M) and suture (Group S) were compared. ResultsFrom an initial 266 emergency midline laparotomies, 187 patients were included. The median follow-up time was 64.4 months (SD 35). Both groups had similar characteristics, except for a higher rate of previous operations (62% vs. 43.2%; P=0.01) and operation due to a revision laparotomy (32.5% vs. 13%; P=0.02) in the M group. During follow-up, 29.9% of patients developed an incisional hernia (Group S 36.6% vs. Group M 14.3%; P=0.002). Chronic mesh infections were diagnosed in 2 patients, but no mesh explants were needed, and no patient in the M group developed chronic pain. Long-term risk factors for incisional hernia were as follows: smoking (HR=2.47; 95% CI 1.318–4.624; P=0.05), contaminated surgery (HR=2.98; 95% CI 1.142–7.8; P=0.02), surgical site infection (SSI; HR=3.83; 95% CI 1.86–7.86; P=0.001), and no use of prophylactic mesh (HR=5.09; 95% CI 2.1–12.2; P=0.001). ConclusionIncidence of incisional hernias after emergency midline laparotomies is high and increases with time. High-risk patients, contaminated surgery, and SSI benefit from mesh reinforcement. Prophylactic mesh use is safe and feasible in emergencies with a low long-term complication rate.

scholarly journals COMPARISON BETWEEN INCIDENCE OF INCISIONAL HERNIA IN LAPAROSCOPIC CHOLECYSTECTOMY AND BY SINGLE PORT

2018 ◽  
Vol 31 (1) ◽  
Author(s):  
Fernando Athayde MADUREIRA ◽  
Cristiane Luzia Teixeira GOMEZ ◽  
Eduardo Monteiro ALMEIDA
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Incisional Hernia ◽  
Single Port ◽  
Conventional Technique ◽  
Single Port Access ◽  
Conventional Laparoscopic Cholecystectomy ◽  
Incisional Hernias ◽  
Conventional Laparoscopic ◽  
Port Access

ABSTRACT Background: Surgeries with single port access have been gaining ground among surgeons who seek minimally invasive procedures. Although this technique uses only one access, the incision is larger when compared to laparoscopic cholecystectomy and this fact can lead to a higher incidence of incisional hernias. Aim: To compare the incidence of incisional hernia after laparoscopic cholecystectomy and by single port. Methods: A total of 57 patients were randomly divided into two groups and submitted to conventional laparoscopic cholecystectomy (n=29) and laparoscopic cholecystectomy by single access (n=28). The patients were followed up and reviewed in a 40.4 month follow-up for identification of incisional hernias. Results: Follow-up showed 21,4% of incisional hernia in single port group and 3.57% in conventional technique. Conclusions: There was a higher incidence of late incisional hernia in patients submitted to single port access cholecystectomy compared to conventional laparoscopic cholecystectomy.

scholarly journals Long-term follow-up of prophylactic mesh reinforcement after emergency laparotomy. A retrospective controlled study

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
A. Bravo-Salva ◽  
N. Argudo-Aguirre ◽  
A. M. González-Castillo ◽  
E. Membrilla-Fernandez ◽  
J. J. Sancho-Insenser ◽  
...  
Keyword(s):  
Risk Factors ◽  
Incisional Hernia ◽  
Surgical Site Infection ◽  
Long Term Results ◽  
Site Infection ◽  
Prophylactic Mesh ◽  
Incisional Hernias ◽  
Mesh Reinforcement

Abstract Background Prevention of incisional hernias with a prophylactic mesh in emergency surgery is controversial. The present study aimed to analyze the long-term results of prophylactic mesh used for preventing incisional hernia after emergency midline laparotomies. Methods This study was a registered (NCT04578561) retrospective analysis of patients who underwent an emergency midline laparotomy between January 2009 and July 2010 with a follow-up period of longer than 2 years. Long-term outcomes and risk factors for the development of incisional hernias between patients who received a prophylactic reinforcement mesh (Group M) and suture (Group S) were compared. Results From an initial 266 emergency midline laparotomies, 187 patients were included. The median follow-up time was 64.4 months (SD 35). Both groups had similar characteristics, except for a higher rate of previous operations (62 vs. 43.2%; P = 0.01) and operation due to a revision laparotomy (32.5 vs.13%; P = 0.02) in the M group. During follow-up, 29.9% of patients developed an incisional hernia (Group S 36.6% vs. Group M 14.3%; P = 0.002). Chronic mesh infections were diagnosed in 2 patients, but no mesh explants were needed, and no patient in the M group developed chronic pain. Long-term risk factors for incisional hernia were as follows: smoking (HR = 2.47; 95% CI 1.318–4.624; P = 0.05), contaminated surgery (HR = 2.98; 95% CI 1.142–7.8; P = 0.02), surgical site infection (SSI; HR = 3.83; 95% CI 1.86–7.86; P = 0.001), and no use of prophylactic mesh (HR = 5.09; 95% CI 2.1–12.2; P = 0.001). Conclusion Incidence of incisional hernias after emergency midline laparotomies is high and increases with time. High-risk patients, contaminated surgery, and surgical site infection (SSI) benefit from mesh reinforcement. Prophylactic mesh use is safe and feasible in emergencies with a low long-term complication rate. Trial registration: NCT04578561. www.clinicaltrials.gov

scholarly journals P111 HIGH RATE OF INCISIONAL HERNIA AFTER MASS CLOSURE OF BURST ABDOMEN

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Thomas Korgaard Jensen ◽  
Ismail Gögenur ◽  
Mai-Britt Tolstrup
Keyword(s):  
Incisional Hernia ◽  
High Rate ◽  
Fascial Closure ◽  
Closure Technique ◽  
Burst Abdomen ◽  
Incisional Hernias ◽  
Mass Closure ◽  
Long Term Effect

Abstract Aim This study investigated the long-term effect of a standardized strategy of fascial closure with a mass closure technique, using a slowly absorbable running stitch for burst abdomen and evaluated the incidence of incisional hernia in these patients. Material and Methods A single-center, retrospective study including all patients that underwent surgery for burst abdomen between June 2014 and April 2019 was followed up in October 2020 to report the rate of incisional hernias. Results 94 patients underwent surgery for burst abdomen. 80 patients was enrolled for follow up. Index surgery was acute in 78%. Incisional hernia rate was 33%. 30-day mortality rate was 24%. Conclusions Standardized surgery for burst abdomen with a standardized mass-closure technique still results in high rates of incisional hernias.

The natural history of pituitary apoplexy: long term follow-up study

2019 ◽  
Author(s):  
Ayesha Shaikh ◽  
Natasha Shrikrishnapalasuriyar ◽  
Giselle Sharaf ◽  
David Price ◽  
Maneesh Udiawar ◽  
...  
Keyword(s):  
Natural History ◽  
Pituitary Apoplexy ◽  
Follow Up Study ◽  
Long Term Follow Up ◽  
History Of

Long-term systolic blood pressure and all-cause mortality in heart failure with preserved ejection fraction: an analysis of the TOPCAT trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Huang ◽  
C Liu
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Ejection Fraction ◽  
Funding Source ◽  
Preserved Ejection Fraction ◽  
Risk Of Mortality ◽  
All Cause Mortality ◽  
History Of

Abstract Background Lower systolic blood pressure (SBP) at admission or discharge was associated with poor outcomes in patients with heart failure and preserved ejection fraction (HFpEF). However, the optimal long-term SBP for HFpEF was less clear. Purpose To examine the association of long-term SBP and all-cause mortality among patients with HFpEF. Methods We analyzed participants from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) study. Participants had at least two SBP measurements of different times during the follow-up were included. Long-term SBP was defined as the average of all SBP measurements during the follow-up. We stratified participants into four groups according to long-term SBP: <120mmHg, ≥120mmHg and <130mmHg, ≥130mmHg and <140mmHg, ≥140mmHg. Multivariable adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for all-cause mortality associated with SBP level. To assess for nonlinearity, we fitted restricted cubic spline models of long-term SBP. Sensitivity analyses were conducted by confining participants with history of hypertension or those with left ventricular ejection fraction≥50%. Results The 3338 participants had a mean (SD) age of 68.5 (9.6) years; 51.4% were women, and 89.3% were White. The median long-term SBP was 127.3 mmHg (IQR 121–134.2, range 77–180.7). Patients in the SBP of <120mmHg group were older age, less often female, less often current smoker, had higher estimated glomerular filtration rate, less often had history of hypertension, and more often had chronic obstructive pulmonary disease and atrial fibrillation. After multivariable adjustment, long-term SBP of 120–130mmHg and 130–140mmHg was associated with a lower risk of mortality during a mean follow-up of 3.3 years (HR 0.65, 95% CI: 0.49–0.85, P=0.001; HR 0.66, 95% CI 0.50–0.88, P=0.004, respectively); long-term SBP of <120mmHg had similar risk of mortality (HR 1.03, 95% CI: 0.78–1.36, P=0.836), compared with long-term SBP of ≥140mmHg. Findings from restricted cubic spline analysis demonstrate that there was J-shaped association between long-term SBP and all-cause mortality (P=0.02). These association was essentially unchanged in sensitivity analysis. Conclusions Among patients with HFpEF, long-term SBP showed a J-shaped pattern with all-cause mortality and a range of 120–140 mmHg was significantly associated with better outcomes. Future randomized controlled trials need to evaluate optimal long-term SBP goal in patients with HFpEF. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): China Postdoctoral Science Foundation Grant (2019M660229 and 2019TQ0380)

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