ABSTRACT
Objective:To investigate the application value of transversus abdominis muscle release technique in giant ventral hernia repair.Methods:The retrospective and descriptive study was conducted. The clinical data of 72 patients with giant ventral hernia who were admitted to Beijing Chaoyang Hospital of Capital Medical University from January 2017 to January 2020 were collected. There were 47 males and 25 females, aged from 29 to 79 years, with a median age of 56 years. All patients underwent ventral hernia repair with transversus abdominis muscle release technique and preperitoneal/retro-muscular polypropylene mesh reinforcement. Observation indicators: (1) surgical situations; (2) postoperative complications; (3) hernia-related quality of life. Follow-up was conducted using outpatient examination and telephone interview to detect postoperative complications at postoperative 1, 6 and 12 months. Follow-up was up to January 2021. Measurement data with normal distribution were represented as Mean± SD, and comparison within groups was analyzed using the paired t test. Measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers. Results:(1) Surgical situations: all 72 patients underwent ventral hernia repair with transversus abdominis muscle release technique and preperitoneal/retro-muscular polypropylene mesh reinforcement successfully. The operation time, volume of intraoperative blood loss and mesh size of the 72 patients were (105±46)minutes, (55±15)mL and (680±225)cm 2, respectively. (2) Postoperative complications: 72 patients were followed up for 12 to 48 months, with a median follow-up time of 16 months. During the follow-up, 7 of the 72 patients were diagnosed with seroma by abdominal computed tomography (CT) scan at postoperative 1 week, the size of which was (460±130)mm 2. The 7 patients with seroma were followed up and results of abdominal CT scan at postoperative 6 months showed that the seroma was completely absorbed. Two of the 72 patients had postoperative intestinal obstruction, which was considered as postoperative paralytic ileus. After conservative treatment, the 2 patients were improved 2 weeks after operation. None of the 72 patients had surgical site infection, intestinal fistula or hernia recurrence. (3) Hernia-related quality of life: the score of hernia-related quality of life of 72 patients before operation and at postoperative 12 months were 40±12 and 73±17, respectively, showing a significant difference ( t=12.527, P<0.05). Conclusion:Transversus abdominis muscle release technique in the giant ventral hernia repair is safe and effective, which can improve hernia-related quality of life of patients.
ABSTRACT
Antecedentes: numerosas técnicas han sido descriptas para el tratamiento de defectos complejos de la pared abdominal. La técnica de separación de componentes con liberación del músculo transverso (TAR) permite la movilización de colgajos miofasciocutáneos y cierre de la línea media, con baja tasa de complicaciones. Objetivo: evaluar los resultados del tratamiento de eventraciones complejas con técnica TAR. Material y métodos: se incluyó una serie de pacientes en los que se realizó TAR entre marzo de 2013 y abril de 2017, con seguimiento mínimo de 6 meses. Se analizaron variables demográficas y clínicoquirúrgicas. Los resultados fueron expresados en medianas. Resultados: se realizaron 14 eventroplastias con técnica TAR. Diez (70%) correspondieron a hombres. La edad fue 60 (35-81) años y el IMC fue: 28,2 kg/m². El 70% tenía al menos dos cirugías previas. Se solicitó tomografía computarizada preoperatoria en todos los pacientes. El índice de Tanaka fue 24,5%. En 7 (50%) pacientes el riesgo quirúrgico fue ASA < III. El tamaño del defecto fue 480 (224-720) cm² y el de la malla 900 (500-1050) cm². El tiempo operatorio fue 248 (180-341) minutos, y la estadía hospitalaria, 3 (2-4) días. Dos pacientes tuvieron infección del sitio quirúrgico. El seguimiento posoperatorio fue de 20 (6-48) meses, y no se detectaron recidivas. Conclusión: la técnica TAR es un método seguro y fiable para la reparación de grandes defectos de la pared abdominal con baja morbimortalidad y recidiva, por lo que debería considerarse dentro del armamentario quirúrgico.
Background: several strategies have been described for the treatment of complex abdominal wall defects. The component separation technique with transversus abdominis muscle release (TAR) allows adequate fasciomiocutaneos flaps mobilization to close the middle line and has low morbidity. Objective: to evaluate outcomes of TAR technique for the treatment of large incisional hernias. Material and methods: in the period between March 2013 and April 2017, all consecutive patients with TAR procedures with a minimum follow-up of 6 months were included. Demographics, operative and postoperative variables were analyzed. Results were expressed in medians. Results: a total of 14 TAR procedures were performed. Ten patients were men. The age was 60 (35-81) years and BMI was 28,2 kg/m². Seventy percent of the patients had at least two previous surgeries. CT scan was performed before surgery in all patients. Tanaka index was 24,5%. Seven patients had ASA < III. The defect size was 480 (224-720) cm² and mesh size 900 (500 - 1050) cm². Operative time was 248 (180 -341) minutes and hospital stay 3 (2-4) days. Two patients had surgical site infection. Postoperative follow-up was 20 (6-44) months. There was no recurrences. Conclusion: TAR technique is safe and reliable for the repair of large abdominal wall defects with low morbidity and recurrence rates. Therefore it should be taken into account in the surgical armamentarium.
Subject(s)
Humans , Incisional Hernia , Abdominal Muscles , Abdominal WallABSTRACT
Objectives : Muscle imbalance poses a problem for adequate motor function in patients with cerebral palsy. The adductor and flexor muscles around the hip become dominant, leading to a high risk of hip dislocation. When left untreated, flexion and adduction contracture progresses, leading to various impairments ; hence, it is important to undertake preventive measures at an early stage. Selective muscle release is one form of surgical treatment that has been proven effective, but there is no consensus on the timing of the surgery. Here, we investigated the difference in outcome after muscle release surgery with respect to age. Subjects and methods : The subjects were 26 patients (52 hips) from our medical center who underwent muscle release (partial modification of Matsuo's method) around the hip and were followed up for at least 6 months. Abduction was retained postoperatively by using a cast or prosthetic device. Migration percentage (MP) was measured by simple hip radiography image, and the rates of improvement (preoperative MP . final MP during observation/preoperative MP ×100%) were compared. Results : Higher rates of improvement were observed among patients aged 5 years or less at the time of surgery than those among patients aged 6 years or more. Conclusion : We consider that surgery performed at the age of 5 years or less could lead to favorable results.