ABSTRACT
PURPOSE: The main objective was to assess the prevalence of hernia recurrence, wound complications (surgical site infections [SSI], seroma and hematoma) and mortality after anterior component separation (ACS) and posterior component separation via transversus abdominis muscle release (PCSTAR) in patients with complex incisional hernias. The so-called complex IH is a serious medical and societal challenge due to its direct and indirect costs; it is also hampered by the use of different surgical techniques, different type of meshes, and different results heterogeneously reported and interpreted. According to actual data, the best approach seems to be a mesh reinforcement component separation procedure augmented or not with an adjuvant technique (preoperative progressive pneumoperitoneum and/or Botulin toxin type A infiltration). METHODS: A systematic search of four databases (MEDLINE, PubMed, Web of Science, and Google Scholars) was conducted to identify studies reporting on outcomes of component separation techniques and which were published before December 2021. A systematic review and a meta-analysis of postoperative outcomes were performed. RESULTS: Nineteen studies including 3412 patients (1709 with ACS and 1703 with PCSTAR) were selected. Pooled hernia recurrence rate after a minimum 1-year follow-up was evaluated at 5.15% (odds ratio [OR] 0.68; 95% confidence interval [CI] 0.5-0.9; p = 0.0175). Pooled surgical site infection rate was 10.6% (OR 1.32; 95% CI 1.06-1.65; p = 0.0119). Seroma and hematoma were estimated at 9.75% (OR 1.93; 95% CI 1.52-2.44; p = 0.0001) and 3.83% (OR 1.81; 95% CI 1.26-2.61; p = 0.0012), respectively. ACS was associated with increased wound morbidity, seroma and hematoma. PCSTAR displayed higher recurrence rate (4.27% vs 6.11%). CONCLUSIONS: PCSTAR was superior to ACS in terms of wound morbidity, surgical site infections, seroma and hematoma incidence. The procedure should be further evaluated in comparative head-to-head randomized controlled trials.
Subject(s)
Hernia, Ventral , Incisional Hernia , Humans , Abdominal Muscles/surgery , Incisional Hernia/etiology , Incisional Hernia/surgery , Hernia, Ventral/surgery , Hernia, Ventral/complications , Surgical Wound Infection/etiology , Surgical Wound Infection/complications , Seroma/epidemiology , Seroma/etiology , Herniorrhaphy/adverse effects , Herniorrhaphy/methods , Hematoma , Surgical Mesh/adverse effects , RecurrenceABSTRACT
Neoplasms of the body and tail of the pancreas are rarer in comparison to those occurring in the head of the pancreas, representing only 10% of the total number of pancreatic malignancies. They poses even in present one of the greatest therapeutic challenge for the surgeon as their diagnosis and treatment are difficult to be done mainly due to specific anatomic position of the pancreas as well as due to the absence of any specific symptomatology belonging to the tumors of the body and tail of the pancreas having smaller dimensions. Here we are presenting two cases of neoplasms of the body and tail of the pancreas from the archives of 3rd Surgical Clinic, Cluj Napoca, hereby illustrating the experience of this clinic in the domain of high class pancreatic surgery. The two patients, having 55 and 43 years of age respectively, were diagnosed with neoplasm of the body and tail of the pancreas for which they had undergone the procedure of distal pancreatectomy along with the resection of the spleen. Out of those two cases, the first case had an invasive process of the tumor in the region of the superior mesenteric vein for what it was performed a segmental resection of the superior mesenteric vein with a termino-terminal anastomosis of the remaining two proximal and distal ends, while the second case inspite of its large dimension of the tumor (approximately 10 c.m in diameter) did not have any loco-regional invasion or any kind of distal metastasis which rendered it possible for a radical intervention. The aim of this case presentation as well as the reviews of the literatures belonging to this specialised domain is to sustain the idea that pancreatic surgery should be performed in those specialised surgical centres having profound knowledge as well as all the existing information about the diagnostic procedures, therapeutic attitude and prognostic factors of this specific pathology.
