Reparação da parede abdominal com membranas acelulares de pericárdio bovino - Parte I - Achados clínicos e radiológicos / Abdominal wall repair with acellular bovine pericardial membranes - Part I - Clinical and radiological findings

Introdução: Reduzindo os índices de recidiva de forma impactante, o emprego de biomateriais como "telas de reforço" na reparação de diferentes defeitos da parede abdominal tornou-se rotina quase obrigatória para o sucesso dessas reparações. A partir da década de 1990 houve a introdução de matrizes biológicas acelulares, iniciando-se assim uma nova era na reparação dos defeitos da parede abdominal. O objetivo é avaliar a funcionalidade do pericárdio bovino acelularizado em reparações da parede abdominal. Método: Trinta pacientes foram submetidos a reparação de defeitos da parede abdominal, com biopróteses acelulares de pericárdio bovino, perfazendo um total de 40 implantes anatomicamente individualizados. O seguimento médio foi de 31 meses, sendo os pacientes avaliados clinicamente e radiologicamente. Em três casos foram feitas biópsias das áreas implantadas permitindo análise histológica do material. Resultados: Não se observou recidiva das herniações em nenhum dos casos, tanto clinica como radiologicamente. Também não houve registro de hematomas, infecções ou qualquer fenômeno de natureza reacional local ou sistêmica. Radiologicamente, não foi possível visualizar as matrizes no local de implantação em qualquer dos períodos de pós-operatório analisados. Conclusão: As matrizes mostraram similaridade às demais membranas biológicas descritas na literatura internacional. Representando uma importante atualização e evolução conceitual, as membranas acelulares de pericárdio bovino podem ser incorporadas ao arsenal terapêutico nas reparações de parede abdominal.

Introduction: Reducing recurrence rates significantly, the use of biomaterials as "reinforcement meshes" in the repair of different abdominal wall defects has become an almost mandatory routine for the success of these repairs. From the 1990s onwards, acellular biological matrices were introduced, thus beginning a new era in the repair of abdominal wall defects. The objective is to evaluate the functionality of the acellularized bovine pericardium in abdominal wall repairs. Method: Thirty patients underwent repair of abdominal wall defects using acellular bovine pericardium bioprostheses, making a total of 40 anatomically individualized implants. The average follow-up was 31 months, with patients being evaluated clinically and radiologically. In three cases, biopsies were taken from the implanted areas, allowing histological analysis of the material. Results: No recurrence of herniations was observed in any of the cases, both clinically and radiologically. There were also no records of bruises, infections or any phenomenon of a local or systemic reaction nature. Radiologically, it was not possible to visualize the matrices at the implantation site in any of the postoperative periods analyzed. Conclusion: The matrices showed similarity to other biological membranes described in the international literature. Representing an important update and conceptual evolution, acellular bovine pericardial membranes can be incorporated into the therapeutic arsenal in abdominal wall repairs.

Hernia inguinoescrotal gigante: un caso infrecuente

Introducción: Las hernias de la pared abdominal afectan entre el 10% al 15% de la población mundial, siendo hasta el 60% de estas hernias inguinales. Las hernias inguinales gigantes son poco comunes, pero con una gran carga de enfermedad para el paciente. Caso Clínico: Se presenta el caso de un paciente de 51 años, con antecedente de diabetes mellitus tipo II, proveniente de zona rural aislada, por cuatro días de evolución consistente en quemadura escrotal por metal caliente, relacionada a una hernia inguinoescrotal derecha gigante. Es llevado a intervención quirúrgica por cirugía general y urología. Por adecuada evolución clínica se da de alta al 5° día posoperatorio. Discusión: Las hernias inguinales gigantes son raras y frecuentemente se presentan en pacientes de bajo estrato socioeconómico, procedencia rural y cierto grado de negligencia. El reto del equipo quirúrgico consiste en lidiar con los posibles efectos adversos de la reducción del contenido herniario en un abdomen con diversos grados de pérdida del dominio. Se puede requerir resección o debulking del contenido abdominal o la expansión de la cavidad abdominal mediante frenectomía, neumoperitoneo progresivo perioperatorio o la creación de hernias ventrales mediante maniobras avanzadas. La reparación con malla libre de tensión disminuye el riesgo de recurrencia. Conclusión: La hernia inguinal gigante es una patología rara. El cirujano general está llamado a conocer el abanico de opciones que existen en caso de enfrentarse a estos pacientes, lo cual ayuda a reducir la elevada morbimortalidad y altas tasas de recurrencia.

Introduction: Abdominal wall hernias affect between 10% to 15% of the world population and up to 60% of these are inguinal hernias. Giant inguinal hernias are rare, but have high burden of disease for the patients. Clinical Case: We present the case of a 51-year-old patient, with a history of type II diabetes mellitus, from an isolated rural area, with four days of a scrotal burn by hot metal, related to a giant right inguinoscrotal hernia. He is taken to surgical intervention by general surgery and urology. Due to adequate clinical evolution, he was discharged on the 5th postoperative day. Discussion: Giant inguinal hernias are rare and frequently occur in patients of low socioeconomic status, rural origin and a certain degree of neglect. The challenge for the surgical team consist in dealing with the potential adverse effects of reducing hernia contents in an abdomen with varying degrees of loss of normal capacity. Resection or debulking of the abdominal contents or expansion of the abdominal cavity by frenectomy, perioperative progressive pneumoperitoneum, or the creation of ventral hernias by advanced maneuvers may be required. Tension-free mesh repair decreases the risk of recurrence. Conclusion: Giant inguinal hernia is a rare pathology. The general surgeon is called to know the range of options that exist in the event of facing these patients, which helps to reduce the high morbidity and mortality and high rates of recurrence.

Experiencia del tratamiento de la hernia incisional en un hospital de tercer nivel en Colombia / Experience of the treatment of incisional hernia in a third level hospital in Colombia

Introducción. El manejo de las hernias se ha instaurado como un problema quirúrgico común, estimándose su aumento en los próximos años. El objetivo del presente trabajo fue describir el curso clínico, los aspectos del tratamiento quirúrgico y factores asociados a la presencia de complicaciones en pacientes intervenidos por hernia incisional. Métodos. Estudio descriptivo en el que se analizaron las características de una cohorte de pacientes llevados a corrección quirúrgica de hernia incisional en el Hospital Universitario Hernando Moncaleano Perdomo, un centro de alta complejidad en Neiva, Colombia, entre 2012 y 2019. Los datos fueron recolectados en programa Microsoft Excel® y analizados en SPSSTM, versión 21. Resultados. Se realizaron 133 correcciones de hernias incisionales, 69,9 % en mujeres y la mayoría ubicadas en la línea media (84,2 %). La edad media de los pacientes al momento de la intervención fue de 52 años ±14,6. Las comorbilidades más frecuentes fueron obesidad, hipertensión y diabetes. La causa más frecuente de la hernia fue traumática (61,7 %). La frecuencia de complicaciones fue superior al 50 %, en su mayoría menores; se encontró asociación con obesidad para la presencia de seroma. La mortalidad fue del 2,3 %. Conclusión.La hernia incisional es un problema de salud pública. Consideramos que la obesidad y el uso de malla pueden ser factores de riesgo asociados con la presentación de complicaciones postoperatorias, así como el aumento de los gastos relacionados con días de hospitalización

Introduction. Hernias management has become a common surgical problem, with an estimated increase in the coming years. The objective of this study was to describe the clinical course, aspects of surgical treatment and factors associated with the presence of complications in patients operated on for incisional hernia. Methods. Descriptive study, in which the characteristics of a cohort of patients taken to surgical correction of incisional hernia at the Hospital Universitario Hernando Moncaleano Perdomo, a high complexity medical center located in Neiva, Colombia, between 2012 and 2019 were analyzed, whose data were collected in Microsoft Excel® software and analyzed in SPSSTM, version 21. Results. One-hundred-thirty-three incisional hernia corrections were performed. The mean age at the intervention was 52 years ±14.6. The most frequent comorbidities were weight disorders, hypertension and diabetes. Only one laparoscopy was performed, the first etiology of the hernia was traumatic (61.7%) and midline (84.2%). The frequency of complications was greater than 50%, mostly minors. An association with obesity was found for the presence of seroma. Mortality was 2.3%. Conclusion. Incisional hernia is a public health problem. We consider that obesity and the use of mesh are a risk factor associated with the presentation of postoperative complications as well as the increase in costs related to days of hospitalization

Caracterización de un grupo de pacientes sometidos a herniorrafia lateral con malla retromuscular en un centro de tercer nivel de 2015 a 2019 / Characterization of a group of patients who underwent lateral herniorrhaphy with retromuscular mesh in a third level center from 2015 to 2019

Introducción. El objetivo de este estudio fue describir las características de la población y determinar las principales complicaciones de los pacientes que son llevados a cirugía por hernia lateral en el abdomen. Métodos. Estudio observacional retrospectivo, que incluyó a los pacientes sometidos a herniorrafia lateral, entre 2015 y 2019 en un centro de tercer nivel. La información se obtuvo del registro de historias clínicas. Las variables analizadas se clasificaron según las características sociodemográficas de los pacientes, clínicas y quirúrgicas. Se hizo una caracterización de acuerdo con los resultados encontrados. Resultados. Se incluyeron 51 pacientes con hernia lateral, 29 de ellos mujeres, con un promedio de edad de 59 años y de índice de masa corporal de 28 kg/m2. El 60 % tenía comorbilidades de base, siendo la hipertensión arterial la más frecuente. La mayoría se clasificaron como ASA II. En cuanto a la localización, la L3 fue la más común (37,2 %). Se presentaron complicaciones postquirúrgicas en el 27,4 % de los pacientes, siendo las más frecuentes seromas, hematomas e infecciones de sitio operatorio. Ningún paciente requirió reintervención para el manejo de las complicaciones. Conclusión. Conocer la población y determinar cuáles son las principales complicaciones postquirúrgicas de un procedimiento permite tomar medidas para disminuir su frecuencia, pero en este caso, se necesitan estudios adicionales para determinar cuáles son los mayores factores asociados a las complicaciones

Introduction. To describe the characteristics of the population and to determine the main complications of patients who undergo surgery for lateral hernia. Methods. We performed a retrospective observational study, including patients who underwent lateral herniorrhaphy between 2015 and 2019 in a third-level medical center, obtaining information through the registration of medical records. The analyzed variables were classified according to the patients' clinical, surgical and sociodemographic characteristics, performing a characterization according to the results found. Results. Fifty-one patients due to lateral hernia were included, 29 of them were women, with a mean age of 59 years and a body mass index of 28 Kg/m2. Of those, 60% presented basic comorbidities, being arterial hypertension the most frequent. Most were classified as ASA II. Regarding the location, the L3 was the most commonly presented hernia, referring to 37.2%. Postoperative complications occurred in 27.4% of the patients, with seromas being the most frequent, followed by hematomas and surgical site infections. No patient required reintervention for the management of complications. Conclusion. By knowing the population and determining which are the main complications, measures can be taken to reduce their incidence. Additional studies are needed to determine which are the main factors associated with complications

Cierre dinámico y toxina botulínica: una alternativa novedosa para el cierre definitivo del abdomen abierto y contenido / Dynamic closure system and botulinum toxin: a novel alternative for definitive closure of open abdomen

RESUMEN Se presenta el caso de un paciente masculino de 54 años que, cursando internación por neumonía- COVID-19, intercurrió con shock séptico por diverticulitis aguda Hinchey IV, por lo que se realizó cirugía de Hartmann. Evolucionó con isquemia colónica, se realizó colectomía total y abdomen abierto y contenido (AAyC). El manejo del AAyC se realizó con sistema de vacío (VAC) durante 7 semanas, resultando un AAyC tipo IIIa (Björck) con un gap de 16 cm. Se decidió iniciar, una vez dadas las condiciones clínicas del paciente, el cierre dinámico (CD) con tracción fascial con malla de polipropileno asociado a inyección de toxina botulínica (TB). Esta estrategia permitió el cierre fascial primario (CFP) de la pared abdominal en la quinta semana de comenzado el tratamiento, evitando de esta manera la morbilidad de un cierre por segunda intención.

ABSTRACT We report the case of a 54-year-old male patient hospitalized for COVID-19 pneumonia who developed septic shock due to acute Hinchey IV diverticulitis and required Hartmann's surgery. The patient evolved with colonic ischemia and underwent total colectomy and open abdomen (OA) with temporary abdominal closure (TAC) that was managed with a vacuum-assisted wound closure (VAWC) system for 7 weeks, resulting in a Björck grade 3A OA with a 16-cm gap. As he had a favorable clinic course, dynamic closure with mesh-mediated fascial traction was decided, associated with botulinum toxin (BT) injection. This strategy allowed primary fascial closure (PFC) of the abdominal wall 5 weeks after treatment was initiated, thus avoiding the complications of healing by secondary intention.

Complicaciones de la hernioplastia inguinal laparoscópica / Complications of laparoscopic inguinal hernioplasty / Complicações da herniplastia inguinal laparoscópica

Las hernias que se ubican en la pared abdominal son consideradas una patología de alta prevalencia en la población mundial, ya que se estima que el 55 % de las personas se ve afectada en algún momento de su vida por esta enfermedad. Además, se someten anualmente más de 20 millones de pacientes a nivel mundial a reparación de hernia inguinal, como gran parte de estos pacientes presentan comorbilidades, es importante conocer las complicaciones que conlleva este procedimiento. Objetivo. Identificar estrategias para reducir la incidencia de complicaciones y mejorar los resultados a largo plazo de la hernioplastia inguinal laparoscópica. Metodología. Se realizó una revisión sistemática, de estudios observacionales, donde las principales bases de datos utilizados fueron PubMed y Google Scholar cuyos descriptores DeCS-MeSH se presentan con el siguiente algoritmo de búsqueda "Complications" AND "laparoscopic" AND "inguinal" AND "hernioplasty". Se incluyeron los trabajos relacionados con el tema de investigación, publicados en español o inglés en periodos más recientes o publicados dentro de los últimos 5 años. Conclusión. La incidencia de hernias inguinales aumenta con la edad, especialmente entre la quinta y la séptima década de la vida por lo cual conlleva a complicaciones que van desde morbilidad de la herida, recurrencia de la hernia, dolor crónico y problemas relacionados con la malla. A pesar de las complicaciones que presenta la reparación de hernia inguinal vía laparoscópica es una de las técnicas más usada actualmente y que brinda una recuperación más rápida.

Hernias located in the abdominal wall are considered a highly prevalent pathology in the world population, since it is estimated that 55% of people are affected at some point in their lives by this disease. In addition, more than 20 million patients worldwide undergo inguinal hernia repair every year. Since most of these patient's present comorbidities, it is important to know the complications that this procedure entails. Objective. To identify strategies to reduce the incidence of complications and improve long-term outcomes of laparoscopic inguinal hernioplasty. Methodology. A systematic review of observational studies was performed, where the main databases used were PubMed and Google Scholar whose DeCS-MeSH descriptors are presented with the following search algorithm "Complications" AND "laparoscopic" AND "inguinal" AND "hernioplasty". Papers related to the research topic, published in Spanish or English in more recent periods or published within the last 5 years, were included. Conclusion. The incidence of inguinal hernias increases with age, especially between the fifth and seventh decade of life, which leads to complications ranging from wound morbidity, hernia recurrence, chronic pain and mesh-related problems. In spite of the complications, laparoscopic inguinal hernia repair is one of the most widely used techniques today and provides a faster recovery.

As hérnias localizadas na parede abdominal são consideradas uma patologia altamente prevalente na população mundial, pois estima-se que 55% das pessoas sejam afetadas em algum momento de suas vidas por essa doença. Além disso, mais de 20 milhões de pacientes em todo o mundo são submetidos a reparos de hérnia inguinal todos os anos. Como muitos desses pacientes têm comorbidades, é importante estar ciente das complicações associadas a esse procedimento. Objetivo. Identificar estratégias para reduzir a incidência de complicações e melhorar os resultados de longo prazo da hernioplastia inguinal laparoscópica. Metodologia. Foi realizada uma revisão sistemática de estudos observacionais, em que os principais bancos de dados utilizados foram o PubMed e o Google Scholar, cujos descritores DeCS-MeSH são apresentados com o seguinte algoritmo de pesquisa: "Complications" AND "laparoscopic" AND "inguinal" AND "hernioplasty". Foram incluídos artigos relacionados ao tópico da pesquisa, publicados em inglês ou espanhol em períodos mais recentes ou publicados nos últimos 5 anos. Conclusão. A incidência de hérnias inguinais aumenta com a idade, especialmente entre a quinta e a sétima década de vida, levando a complicações que vão desde a morbidade da ferida, recorrência da hérnia, dor crônica e problemas relacionados à malha. Apesar das complicações, a correção laparoscópica da hérnia inguinal é uma das técnicas mais usadas atualmente e proporciona uma recuperação mais rápida.

A male patient with amyand hernia: A case report and literature review

An Amyand hernia is a protrusion of an organ or its fascia through the wall of the abdominal cavity which contains the appendix, which has an incidence rate of 0.5–1% of the many hernia cases. This review reports the case findings of a 63-year-old male patient with an inguinal hernia containing the appendix (Amyand hernia). The patient came with complaints of abdominal pain and a lump in his testicles, with a history of frequent lumps coming and going. Physical examination from the right inguinal to the scrotal sac found a lump the size of three adult fists with the same skin color as the surroundings. The patient was diagnosed with a giant right scrotal hernia and underwent herniorrhaphy surgery and mesh placement. During the operation, the appendix and mesoappendix were visible upon opening the hernia sac, so it was decided to perform an appendectomy, return the contents of the hernia sac into the abdominal cavity, and do a mesh installation. Amyand hernia itself presents a diagnostic challenge because of its low incidence, vague clinical signs and symptoms, and lack of clear radiological diagnostic features. In addition, there are still no clear guidelines for its management.

AN EVALUATION OF CLINICAL OUTCOMES AFTER ABDOMINAL MESH RECTOPEXY & DELORME'S PROCEDURE FOR RECTAL PROLAPSE AT TERTIARY HEALTH CARE CENTER.

Background: Rectal prolapse is protrusion of rectum through anal canal, and proccidentia ~ complete prolapse is the term used when full thickness rectal wall prolapse . 30 patients presenting with Materials and methods: mass per rectum were evaluated & diagnosed clinically as having rectal prolapse were included in the study. The recurrence rate for the abdominal mesh Results: rectopexy is considered to be lower than Perineal Delorme's procedure. There was no recurrence in the rectopexy group. There was 1 recurrence (10%) in Delorme's group. .Better outcomes achieved when treatment individualized to Conclusion: each patient. Abdominal rectopexy for patients who can tolerate laparotomy & significant constipation. .Delorme's considered in young patients with short prolapse but with acceptable recurrence rate.

Wide Excision of a Desmoid Tumor of the Anterior Abdominal Wall with Subsequent Reconstruction.

Desmoid tumors are benign tumors of mesenchymal origin with a complex course of the disease, due to absence of a capsule, infiltrative growth, heterogeneous structure and shape, the true extent of which is difficult to assess before surgery. Despite its benign nature, the recurrence rate reaches 25-50% of cases, and surgical treatment is often accompanied by a number of difficulties with a decrease in the quality of life of patients. In the presented clinical case, a wide excision of desmoid tumor was performed, followed by reconstruction, which ensured a good postoperative result while preserving oncological principles.

Fibromatosis del recto anterior del abdomen. Reporte de caso / Fibromatosis of the rectus abdominis. Case report

La fibromatosis es un tumor fibroblástico benigno, poco frecuente. El músculo recto anterior del abdomen es uno de los músculos de la pared abdominal más habitualmente afectado. Es un tumor con una alta frecuencia en la invasión local y recurrencia. La marcación para ß-catenina en el inmunofenotipo certifica el diagnóstico. Los márgenes negativos microscópicos (R0) deben ser el objetivo de la resección quirúrgica. La edad joven, el gran tamaño tumoral y los márgenes positivos son parámetros asociados a la recurrencia local. Presentamos el caso clínico de una paciente joven a la cual en el contexto de una abdominoplastia se le diagnostica una tumoración en el sector medio del recto anterior del abdomen izquierdo. Se hizo una biopsia incisional que certificó que correspondía a una fibromatosis abdominal (FA). Confirmado el diagnóstico se realizó resección de la tumoración y reparación de la pared abdominal con malla de polipropileno.

Fibromatosis is a rare, benign fibroblastic tumor. The rectus abdominis muscle is one of the most commonly affected abdominal wall muscles. It is a tumor with a high frequency of local invasion and recurrence. Marking for ß-catenin in the immunophenotype certifies the diagnosis. Microscopic negative margins (R0) should be the target of surgical resection. Young age, large tumor size, and positive margins are parameters associated with local recurrence. We present the clinical case of a young patient who, in the context of an abdominoplasty, was diagnosed with a tumor in the middle sector of the left rectus abdominis. An incisional biopsy was performed, which certified that it corresponded to abdominal fibromatosis (AF). Once the diagnosis was confirmed, the tumor was resected and the abdominal wall repaired with polypropylene mesh

Research progress and future prospect of hernia and abdominal wall surgery in China / 中华消化外科杂志

In recent years, due to the increasing population of ageing and obesity, the incidence rate of hernia is increasing year by year, which has become a social problem that needs to be focused. Although starting late, the hernia and abdominal wall surgery has developed rapidly in recent years in China, and many remarkable achievements have been made. The development of hernia and abdominal wall surgery is inseparable from the progress of medical technology, the continuous innovation of materials, the improvement of perioperative management concept and the improvement of registration and follow-up system. The authors investigate the relevant research at home and abroad in recent years, and summarize and prospect the materials science, the daytime surgery and the registration and follow-up system, in order to provide reference for the future development of hernia and abdominal wall surgery.

Microstructure and mechanical properties of hernia mesh / 国际生物医学工程杂志

Objective:The microstructure, tensile strength, and bursting strength of different brands of hernia meshes were compared and analyzed through experiments to evaluate the performance of different meshes.Methods:The balance and microscope were used to test the weight and microstructure of 15 common meshes and the tensile testing machine and burst testing machine were used to test the tensile and bursting properties of the mesh, and the mechanical properties of the mesh were analyzed.Results:The woven structures of the mesh are diamond, polygon and circle. The average weight of inguinal meshes is 0.08 mg/mm 2, and the average weight of abdominal wall hernia meshes is 0.18 mg/mm 2. The wire diameters of G3 - G6 meshes are larger, while the mesh opening ratio of G12 is lower. In the tensile performance test, it is known that G15 has the highest tensile strength, G12 and G14 have lower tensile strengths in lightweight meshes, and G1, G2, and G7 have lower tensile strengths in lightweight meshes. In the burst performance test, it is known that G3, G9, and G15 have the highest burst strength, while G12, G13, and G14 have the lowest burst strength in lightweight meshes. G1, G2, and G4 have the lowest burst strength in lightweight meshes. Conclusions:The mesh with a polygonal mesh and a large mesh opening ratio has better mechanical properties. The results of this study provide experimental evidence for optimizing hernia meshes, which is expected to provide better support for related research and applications.

Analysis of recurrent factors and therapeutic effect after laparoscopic inguinal hernia repair / 中华外科杂志

Objective: To analyze the recurrence factors and reoperation effect of laparoscopic inguinal hernia repair. Methods: A total of 41 patients with recurrence after laparoscopic repair of the inguinal hernia admitted to the Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University from January 2017 to December 2021 were retrospectively analyzed. All patients were males, aging (62±7) years (range: 51 to 75 years). The recurrence intervals were 3 days to 7 years postoperatively. The surgical methods, causes of recurrence, and treatment outcomes of the patients were analyzed. Fisher exact probability method is used to compare the rates. Results: Among all cases, the primary surgical procedures included transabdominal preperitoneal herniorrhaphy (TAPP) in 31 cases and total extraperitoneal herniorrhaphy in 10 cases. The reoperative procedures included the TAPP of 11 cases and the Lichtenstein procedure of 30 cases. The factors of recurrent cases in all patients could be divided into 4 categories, including insufficient mesh coverage in 23 cases, mesh curling in 9 cases, mesh contractuture in 7 cases, and improper mesh fixation in 2 cases. Recurrence, infection, chronic pain, foreign body sensation didn't occur in the followed period of(M(IQR)) 18(24) months(range: 12 to 50 months). There was no statistical difference in the incidence of postoperative seroma between the TAPP and Lichtenstein procedure (3/11 vs. 20.0% (6/30), P=0.68). Conclusions: Postoperative recurrence of laparoscopic inguinal hernia is mostly caused by the lack of mesh coverage. Due to the emphasis on standardized surgical operation, a good outcome could be achieved through reoperation by the TAPP or Lichtenstein procedure.

Summary of experience with patterning cropped and shaped mesh repair for perineal hernia after abdominoperineal excision in rectal cancer / 中华外科杂志

Objective: To examine the patterning cropped and shaped mesh repair for perineal hernia after abdominoperineal excision (APE) in rectal cancer. Methods: The clinical data of 8 patients with perineal hernia after APE who accepted surgical treatment in the Department of Hepatopancreatobiliary and Hernia Surgery, the First Affiliated Hospital of Fujian Medical University from March 2017 to December 2022 were retrospectively reviewed. There were 3 males and 5 females, aged (67.6±7.2) years (range: 56 to 76 years). Eight patients developed a perineal mass at (11.3±2.9) months (range: 5 to 13 months) after APE. After surgical separation of adhesion and exposing the pelvic floor defect, a 15 cm×20 cm anti-adhesion mesh was fashioned as a three-dimensional pocket shape to fit the pelvic defect, then fixed to the promontory or sacrum and sutured to the pelvic sidewalls and the anterior peritoneum, while two side slender slings were tailored in front of the mesh and fixed on the pectineal ligament. Results: The repair of their perineal hernias went well, with an operating time of (240.6±48.8) minutes (range: 155 to 300 minutes). Five patients underwent laparotomy, 3 patients tried laparoscopic surgery first and then transferred to laparotomy combined with the perineal approach. Intraoperative bowel injury was observed in 3 patients. All patients did not have an intestinal fistula, bleeding occurred. No reoperation was performed and their preoperative symptoms improved significantly. The postoperative hospital stay was (13.5±2.9) days (range: 7 to 17 days) and two patients had postoperative ileus, which improved after conservative treatment. Two patients had a postoperative perineal hernia sac effusion, one of them underwent placement of a tube to puncture the hernia sac effusion due to infection, and continued irrigation and drainage. The postoperative follow-up was (34.8±14.0) months (range: 13 to 48 months), and 1 patient developed recurrence in the seventh postoperative month, no further surgery was performed. Conclusions: Surgical repair of the perineal hernia after APE can be preferred transabdominal approach, routine application of laparoscopy is not recommended, combined abdominoperineal approach can be considered if necessary. The perineal hernia after APE can be repaired safely and effectively using the described technique of patterning cropped and shaped mesh repair.

Clinical analysis of laparoscopic treatment of chronic traumatic diaphragmatic hernia in 29 cases / 中华外科杂志

Objective: To examine the safety and effectiveness of laparoscopic individualized surgical treatment for chronic traumatic diaphragmatic hernia (CTDH). Methods: The clinical data and follow-up data of 29 CTDH cases admitted to the Qilu Hospital of Shandong University or the First Affiliated Hospital of Shandong First Medical University from June 2015 to January 2023 were retrospectively analyzed. There were 21 males and 8 females, aged (49.4±17.8) years (range: 19 to 79 years). The main clinical manifestations were symptoms of the digestive system and respiratory system, and only 4 cases were asymptomatic. All patients received laparoscopic treatment (conversion to open surgery was not excluded). Intraoperative exploration (location of the hernia, contents of the hernia, diameter of the hernia ring), surgical conditions (surgical repair plan, operation time, blood loss, postoperative complications) and postoperative follow-up were analyzed and discussed. Results: Laparoscopic repair was successfully completed in 27 cases, including simple suture in 6 cases, suture and patch repair in 17 cases, the anterior abdominal wall muscle flap reversal suture and patch repair of in 3 cases, and patch bridge repair in 1 case. The operation time was (112.8±44.7) minutes (range: 60 to 200 minutes). The amount of bleeding (M(IQR)) was 35 (58) ml (range: 10 to 300 ml). The other 2 patients were converted to laparotomy. Except for one patient with transverse colon strangulation necrosis who died of aggravated pulmonary infection after surgery, the remaining 28 patients were discharged successfully. The follow-up time was 36 (24) months (range: 1 to 60 months). During the follow-up period, only two patients had occasional left upper abdominal discomfort. Twenty-seven patients with left diaphragmatic hernia had no recurrence, and the symptoms of 1 patient with right diaphragmatic hernia were relieved. Conclusion: Customized laparoscopic surgical repair for CTDH according to the location and size of the diaphragmatic defect can achieve good surgical results.

How do young surgeons understand and grasp the new concepts, new techniques, and recent progress of hernia and abdominal wall surgery? / 中华外科杂志

With the development of modern surgery, the field of hernia and abdominal wall surgery is undergoing a transformative change, and new techniques, new concepts, and recent progress are being updated, which have motivated the high-quality development of the discipline. In the past two decades, the development of hernia and abdominal wall surgery in China has been recognized by international peers. Many young surgeons have gradually become the main force in the treatment of hernia and leaders in surgical technique. The innovation and development of discipline will never terminate; young surgeons as the main force should seriously think about how to improve their professional qualities. Young surgeons are interested in the innovation of surgical techniques and need to push for a traditional operation on the one hand and an innovative operation on the other. Updates to concepts and acquisition of new materials are more important, which can provide a solid foundation for technological innovation. Young surgeons should start with the basics and classics. Understanding the history and development of new techniques, new concepts and recent progress, and grasping indications of clinical application, is the important part of growing up for young surgeons, which can make surgical treatment more standardized, benefit patients, and promote the progress of Chinese specialized medical education.

Re-discussion on the comprehensive treatment strategy of complex ventral hernia from the perspective of intraperitoneal pressure / 中华外科杂志

Complex ventral hernia refers to a large hernia that is complicated by a series of concurrent conditions. Change in intra-abdominal pressure is one of the main pathways through which various factors exert an impact on perioperative risk and postoperative recurrence. Taking abdominal pressure reconstruction as the core, the treatment strategy for complex abdominal hernia can be formulated from three aspects: improving patients' tolerance, expanding abdominal cavity volume, and reducing the volume of abdominal contents. Improving patients' tolerance includes abdominal wall compliance training and progressive preoperative pneumoperitoneum. To expand the volume of the abdominal cavity, implanting hernia repair materials, component separation technique, autologous tissue transplantation, component expend technique, and chemical component separation can be used. Initiative content reduction surgery and temporary abdominal closure may be performed to reduce the volume of abdominal contents. For different cases of complex ventral hernia, personalized treatment measures can be safely and feasibly adopted depending on the condition of the patients and the intra-abdominal pressure situation.

Clinical value of mesh prophylaxis for parastomal hernia based on evidence-based medicine / 中华外科杂志

The incidence of parastomal hernia is substantially high, significantly affecting the quality of life of patients with stoma. How to effectively solve the problem of parastomal hernia is a long-term focus of hernia and abdominal wall surgery and colorectal surgery. The European Hernia Society guidelines on prevention and treatment of parastomal hernia published in 2018 has recommended the use of a prophylactic mesh to prevent parastomal hernia for the first time. In the following 5 years, more randomized controlled trials of multi-center, large-sample, double-blind, long-term follow-up have been published, and no significant effect of mesh prophylaxis has been observed on the incidence of parastomal hernia. However, whether mesh could decrease surgical intervention by limiting the symptoms of parastomal hernias would become a potential value of prophylaxis, which requires further research to elucidate.

Opportunities and challenges for the high-quality development of hernia and abdominal wall surgery in China / 中华外科杂志

Hernia and abdominal wall surgery is a relatively new subspecialty in surgery. Although it started late in China, after 25 years of rapid development, it has made remarkable achievements and has become an important part of surgery, laying a solid foundation for the further development of the discipline. At the same time, one should also be soberly aware of the present deficiencies in this field. The development of the field should be more detailed and in-depth from the following aspects: correct understanding of new concepts of hernia and abdominal wall surgery, establishment of hernia patient registration and quality control system, technological innovation and development of technical equipment, especially the expansion of robot surgical systems, materials science progression to hernia and abdominal wall surgery. Faced with this challenge, China is expected to achieve high-quality development in the field of hernia and abdominal surgery.

Elective incisional hernia repair: lower risk of postoperative wound infection with laparoscopic versus open repair

INTRODUCTION@#The superiority of laparoscopic repair over open repair of incisional hernias (IHs) in the elective setting is still controversial. Our study aimed to compare the postoperative outcomes of laparoscopic and open elective IH repair in an Asian population.@*METHODS@#This retrospective study was conducted in an acute general hospital in Singapore between 2010 and 2015. Inclusion criteria were IH repair in an elective setting, IHs with diameter of 3-15 cm, and location at the ventral abdominal wall. We excluded patients who underwent emergency repair, had recurrent hernias or had loss of abdominal wall domain (i.e. hernia sac containing more than 30% of abdominal contents or any solid organs). Postoperative outcomes within a year such as recurrence, pain, infection, haematoma and seroma formation were compared between the two groups.@*RESULTS@#There were 174 eligible patients. The majority were elderly Chinese women who were overweight. Open repair was performed in 49.4% of patients, while 50.6% underwent laparoscopic repair. The mean operation time for open repair was 116 minutes (116 ± 60.6 minutes) and 139 minutes (136 ± 64.1 minutes) for laparoscopic repair (P = 0.079). Within a year after open repair, postoperative wound infection occurred in 15.1% of the patients in the open repair group compared to 1.1% in the laparoscopic group (P = 0.0007). Postoperative pain, recurrence and haematoma/seroma formation were comparable.@*CONCLUSION@#Elective laparoscopic IH repair has comparable outcomes with open repair and may offer the advantage of reduced postoperative wound infection rates.