Comparison of open and endoscopic posterior component separation with transversus abdominis release: a propensity score-matched study.

BACKGROUND: Posterior component separation with transversus abdominis release (TAR) is considered to be the optimal technique for large incisional ventral hernia repair. Endoscopic TAR (eTAR) that gets all the benefits of minimally invasive surgery (MIS) gives a possibility to enhance results of the treatment. The aim of our study was to make the comparison between open and endoscopic TAR procedures with an emphasis on frequency and severity of postoperative complications in comparable groups. MATERIALS AND METHODS: All patients had midline incisional hernia and underwent either open (open TAR group) or endoscopic (eTAR group) Rives-Stoppa repair in combination with bilateral transversus abdominis release in Moscow City Hospital №1 from January 2018 to December 2022. A propensity score matching (PSM) was used to make groups comparable. Postoperative complications were classified according to Clavien-Dindo Classification, and Comprehensive complication index was calculated. RESULTS: We performed 133 open and endoscopic TAR separation for midline incisional hernia. After PSM analysis 51 patients were matched to each group. Overall surgical morbidity in the open TAR group (56.9%) was statistically significantly higher than in the eTAR group (29.4%) (p = 0.009). There were more severe complications (Clavien IIIa-V) in the open TAR group (11.8% vs. 0%, p = 0.027). Length of hospital stay after surgery was shorter in eTAR group (p < 0.001). The Comprehensive complication index in the open TAR group was significantly higher than in eTAR group, 8.7 (0-20.9) vs. 0 (0-8.7) (p = 0.011). CONCLUSION: Based on the data from our study, the entire MIS procedure including endoscopic TAR is a safe and optimal technique for surgery of midline incisional ventral hernia, requiring TAR separation in terms of reducing the rate of postoperative complications, their severity and hospital length of stay, compared to open TAR procedure.

Risk factors of venous thromboembolism after incisional ventral hernia repair.

BACKGROUND: The problem of venous thromboembolic events (VTE) after incisional hernia repair remains relevant. According to the literature the frequency of VTE ranges from 0.2 to 4.2%. The data on risk factors of VTE in this cohort of patients are scarce. Aim of our study is to find frequency and risk factors for VTE development in patients who underwent surgery for incisional ventral hernia. MATERIALS AND METHODS: There were 240 patients enrolled in our retrospective study. We included patients, who were operated for incisional hernia in Saveljev University Surgery Clinic from January 2018 to December 2019. Compression duplex ultrasound of lower extremity veins was performed within median 3 days (min 1 day, max 7 days) after surgery for all participants. The primary endpoint was the occurrence of the VTE event, including deep venous thrombosis (DVT) and pulmonary embolism (PE). RESULTS: VTE was detected in 19 patients, which accounted for 7.9% in analyzed cohort. All patients received standard pharmacological prophylaxis. There were 3 (1.3%) proximal, 16 (6.7%) distal DVT, in one patient (0.4%) distal thrombosis was complicated by symptomatic pulmonary embolism. In multivariate Cox proportional hazard model was found that component separation (HR 3.99, 95% CI 1.14-14.0, p = 0.03), duration of operation in hours (HR 1.67. 95% CI 1.13-2.5, p = 0.011) and body mass index (HR 1.13, 95% CI 1.02-1.2, p = 0.02) were statistically significant risk factors. CONCLUSION: The incidence of postoperative VTE in patients after incisional hernia repair is high with a predominant distal DVT as a thrombotic event. Component separation, duration of operation and body mass index are statistically significant factors of VTE in patients undergoing surgery for incisional hernia.

[Endoscopic retro-muscular alloplasty for primary and postoperative ventral hernias: our initial experience]. / Éndoskopicheskaia retromuskuliarnaia alloplastika pri pervichnykh i posleoperatsionnykh ventral'nykh gryzhakh: nash pervyi opyt.

AIM: To define optimal surgical approach for middle primary and postoperative ventral hernias. MATERIAL AND METHODS: We have presented the first results of endoscopic retro-muscular alloplasty in 8 patients with umbilical hernia and postoperative ventral hernia combined with rectus abdominis muscles diastase. RESULTS: One patient had seroma above mesh implant that was evacuated under ultrasonic control. Absent hernial protrusion and reduced diastase were noted in all patients. There were no symptoms of recurrence, purulent-septic complications and venous thromboembolic complications. Mortality was absent. CONCLUSION: Further experience and analysis of long-term results are necessary to determine the role of this technique in anterior abdominal wall hernias management.

[Incidence of abdominal wall hernias: the results of population study]. / Rasprostranennost' gryzh perednei bryushnoi stenki: rezul'taty populyatsionnogo issledovaniya.

AIM: to define the incidence of abdominal wall hernias among ethnically homogeneous population older than 10 years within single locality. MATERIAL AND METHODS: One-stage investigation of abdominal wall hernias incidence was performed in June-July 2015 in the Kryukovskoye rural settlement of the Borisovskiy district of the Belgorod region. Citizens were examined in FAPs or at home. Specially designed questionnaire was used for every person. Presence of hernia was confirmed by clinical signs or anamnestic data about previous abdominal wall repair. RESULTS AND DISCUSSION: 783 (86.6%) persons were surveyed. There were 298 (38%) men and 485 (62%) women among them aged 10-90 years. Clinical signs or anamnestic data were revealed in 164 (20.9%) persons. Inguinal (n=80, 10.2%) and umbilical (n=65, 8.3%) hernias were predominant. Postoperative ventral hernia was diagnosed in 19 (2.4%) humans. CONCLUSION: Incidence of abdominal wall hernias was 20.9% in our study.