Outcomes of posterior sheath supplementation with Vicryl mesh in TAR-a single-center study.

INTRODUCTION: In the Transversus Abdominis Release (TAR) procedure, ideally, the posterior sheath is completely reapproximated to establish an interface isolating the polypropylene mesh from visceral contents. When primary closure of the posterior sheath is unachievable, Vicryl mesh is commonly used to supplement the posterior sheath closure and an uncoated polypropylene mesh is placed superficial to the Vicryl mesh. The long-term implications of utilizing Vicryl mesh as an antiadhesive barrier are poorly understood. In this study, we aimed to assess our outcomes when utilizing Vicryl mesh to supplement the posterior sheath defects when placed underneath polypropylene mesh in patients undergoing posterior component separation. METHODS: Adult patients who underwent VHR with concurrent TAR procedure with a permanent synthetic mesh and posterior sheath supplementation with Vicryl mesh in the Cleveland Clinic Center for Abdominal Core Health between January 2014 and December 2022 were queried retrospectively from a prospectively collected database in the Abdominal Core Health Quality Collaborative. We evaluated 30-day wound morbidity, perioperative complications, long-term mesh-related complications, and pragmatic hernia recurrence. RESULTS: 53 patients who underwent TAR procedure with posterior sheath supplementation using Vicryl mesh and had a minimum 12-month follow-up were identified. Of the 53 patients, 94.3% presented with recurrent hernias, 73.6% had a midline hernia, 7.5% had a flank hernia, and 18.9% had concurrent parastomal hernia. The mean hernia width was 24.9 cm (± 8.8 cm). No Vicryl mesh-related operative complications were identified in our study, with no instances of mesh erosion, fistulas, or interventions for small bowel obstruction. Skin necrosis requiring reoperations was observed in three patients (5.7%), leading to permanent mesh excision in two cases (3.8%) without intraabdominal visceral involvement. Throughout the 12-month follow-up, 23 incidences (43.4%) of surgical site occurrences (SSOs) and surgical site occurrences requiring procedural intervention (SSOPI) were documented. CONCLUSIONS: Our findings suggest that posterior sheath supplementation with Vicryl mesh is a feasible approach to achieve posterior sheath closure in challenging abdominal wall reconstruction cases. Given the absence of notable mesh-related complications and a similar hernia recurrence rate to cases without posterior sheath supplementation, Vicryl mesh can be used to safely achieve posterior sheath closure in complex reconstructions with insufficient native tissue.

Preoperative optimization in hernia surgery: are we really helping or are we just stalling?

BACKGROUND: Managing patients with abdominal wall hernias and multiple comorbidities can be challenging because these patients are at increased risk for postoperative complications. Preoperative optimization has been used to identify and intervene upon modifiable risk factors to improve hernia repair outcomes, however, waiting to achieve optimization may cause unnecessary delays. METHODS: We describe our approach to preoperative optimization in hernia and we review the current evidence for preoperative optimization. CONCLUSION: Modifying risk factors before undergoing elective hernia repair can improve the overall health of patients with multiple comorbidities. However, when considering the hernia-specific data, prolonging waiting times for patients to achieve full optimization is not justified. Surgeons should take a nuanced approach to balance achieving patient optimization without unnecessarily delaying surgical care.

Transinguinal preperitoneal (TIPP) versus Lichtenstein for inguinal hernia repair: a systematic review and meta-analysis.

PURPOSE: We aimed to perform a systematic review and meta-analysis comparing postoperative outcomes in inguinal hernia repair with TIPP versus Lichtenstein technique. METHODS: Cochrane Central, Scopus, and PubMed were systematically searched for studies comparing TIPP and Lichtenstein´s technique for inguinal hernia repair. Outcomes assessed were operative time, bleeding, surgical site events, hospital stay, the Visual Analogue Pain Score, chronic pain, paresthesia rates, and recurrence. Statistical analysis was performed using RevMan 5.4.1. Heterogeneity was assessed with I2 statistics and random-risk effect was used if I2 > 25%. RESULTS: 790 studies were screened and 44 were thoroughly reviewed. A total of nine studies, comprising 8428 patients were included, of whom 4185 (49.7%) received TIPP and 4243 (50.3%) received Lichtenstein. We found that TIPP presented less chronic pain (OR 0.43; 95% CI 0.20-0.93 P = 0.03; I2 = 84%) and paresthesia rates (OR 0.27; 95% CI 0.07-0.99; P = 0.05; I2 = 63%) than Lichtenstein group. In addition, TIPP was associated with a lower VAS pain score at 14 postoperative day (MD - 0.93; 95% CI - 1.48 to - 0.39; P = 0.0007; I2 = 99%). The data showed a lower operative time with the TIPP technique (MD - 7.18; 95% CI - 12.50, - 1.87; P = 0.008; I2 = 94%). We found no statistical difference between groups regarding the other outcomes analyzed. CONCLUSION: TIPP may be a valuable technique for inguinal hernias. It was associated with lower chronic pain, and paresthesia when compared to Lichtenstein technique. Further long-term randomized studies are necessary to confirm our findings. Study registration A review protocol for this meta-analysis was registered at PROSPERO (CRD42023434909).

Management and outcomes of obturator hernias: a systematic review and meta-analysis.

PURPOSE: Obturator Hernia (OH) is a rare type of abdominal wall hernia. It usually occurs in elderly women with late symptomatic presentation, increasing mortality rates. Surgery is the standard of care for OH, and laparotomy with simple suture closure of the defect is commonly used. Given the rarity of this disease, large studies are lacking, and data to drive management are still limited. This systematic review and meta-analysis aimed to describe current surgical options for OHs, with a focus on comparing the effectiveness and safety of mesh use with primary repair. METHODS: PubMed, EMBASE, and Cochrane were searched for studies comparing mesh and non-mesh repair for OH. Postoperative outcomes were assessed by pooled analysis and meta-analysis. Statistical analysis was performed using RevMan 5.4. RESULTS: One thousand seven hundred and sixty studies were screened and sixty-seven were thoroughly reviewed. We included 13 observational studies with 351 patients surgically treated for OH with mesh or non-mesh repair. One hundred and twenty (34.2%) patients underwent mesh repair and two hundred and thirty-one (65.81%) underwent non-mesh repair. A total of 145 (41.3%) underwent bowel resection, with the majority having a non-mesh repair performed. Hernia recurrence was significantly higher in patients who underwent hernia repair without mesh (RR 0.31; 95% CI 0.11-0.94; p = 0.04). There were no differences in mortality (RR 0.64; 95% CI 0.25-1.62; p = 0.34; I2 = 0%) or complication rates (RR 0.59; 95% CI 0.28-1.25; p = 0.17; I2 = 50%) between both groups. CONCLUSION: Mesh repair in OH was associated with lower recurrence rates without an increase in postoperative complications. While mesh in clean cases is more likely to offer benefits, an overall recommendation regarding its use in OH repair cannot be made due to potential bias across studies. Given that many OH patients are frail and present emergently, the decision to use mesh is complex and should consider the patient's clinical status, comorbidities, and degree of intraoperative contamination.

Drain placement in retromuscular ventral hernia repair: a systematic review and meta-analysis.

PURPOSE: Drain placement in retromuscular ventral hernia repair is controversial. Although it may reduce seroma formation, there is a concern regarding an increase in infectious complications. We aimed to perform a meta-analysis on retromuscular drain placement in retromuscular ventral hernia repair. METHODS: We performed a literature search of Cochrane, Scopus and PubMed databases to identify studies comparing drain placement and the absence of drain in patients undergoing retromuscular ventral hernia repair. Postoperative outcomes were assessed by pooled analysis and meta-analysis. Statistical analysis was performed using RevMan 5.4. Heterogeneity was assessed with I2 statistics. RESULTS: 3808 studies were screened and 48 were thoroughly reviewed. Four studies comprising 1724 patients were included in the analysis. We found that drain placement was significantly associated with a decrease in seroma (OR 0.34; 95% CI 0.12-0.96; P = 0.04; I2 = 78%). Moreover, no differences were noted in surgical site infection, hematoma, surgical site occurrences or surgical site occurrences requiring procedural intervention. CONCLUSIONS: Based on the analysis of short-term outcomes, retromuscular drain placement after retromuscular ventral hernia repair significantly reduces seroma and does not increase infectious complications. Further prospective randomized studies are necessary to confirm our findings, evaluate the optimal duration of drain placement, and report longer-term outcomes.

Tuberculosis determined by Mycobacterium bovis in captive waterbucks (Kobus ellipsiprymnus) in São Paulo, Brazil

Two waterbucks from São Paulo Zoo Foundation exhibited respiratory symptoms in July 2004. After euthanasia, granulommas in lungs and mediastinic lymph nodes were observed. Acid-fast bacilli isolated were identified as Mycobacterium bovis spoligotype SB0121 by PRA and spoligotyping. They were born and kept in the same enclosure with the same group, without any contact to other species housed in the zoo. This is the first detailed description of M. bovis infection in Kobus ellipsiprymnus.

Brucelose bovina no estado da Paraíba: estudo retrospectivo / Bovine brucelosis in the state of Paraíba: a retrospective survey

O objetivo do presente trabalho foi determinar a frequência de propriedades positivas (focos) e de animais soropositivos para a brucelose bovina no Estado da Paraíba. Foram utilizados dados da Agência de Defesa Agropecuária do Estado, coletados de suas 23 microrregiões, durante o período de janeiro de 2008 a julho de 2009. Durante esse período, foram examinadas 11.149 propriedades, e 55.691 soros de bovinos foram submetidos ao diagnóstico de brucelose. Para o diagnóstico sorológico, foi utilizado o teste do antígeno acidificado tamponado (AAT). Uma propriedade foi considerada foco quando apresentou pelo menos um animal soropositivo. Das propriedades investigadas, 104 (0,93%) apresentaram pelo menos um animal soropositivo e, dos animais analisados, 199 (0,36%) foram soropositivos. Houve diferença significativa (p < 0,001) na proporção de fêmeas (0,47%) e machos (0,04%) soropositivos.

The aim of this study was to determine the frequency of positive herds (foci) and seropositive animals for bovine brucellosis in the state of Paraíba, Northeast region of Brazil. Data from the Agency of Agricultural Protection in the state, collected from its 23 microregions, during the period from January 2008 to July 2009, were used. During this period, 11,149 herds were examined, and 55,691 cattle sera were submitted to the diagnosis of brucellosis. For serological diagnosis the rose bengal test was used. A herd was considered a focus when it presented at least one seropositive animal. Of the herds investigated, 104 (0.93%) had at least one seropositive animal, and of the animals examined, 199 (0.36%) were seropositive. There was a significant difference (p < 0.001) in the proportion of seropositivity for females (0.47%) and males (0.04%).

Tuberculosis determined by Mycobacterium bovis in captive waterbucks (Kobus ellipsiprymnus) in SÃo paulo, Brazil.

Two waterbucks from São Paulo Zoo Foundation exhibited respiratory symptoms in July 2004. After euthanasia, granulommas in lungs and mediastinic lymph nodes were observed. Acid-fast bacilli isolated were identified as Mycobacterium bovis spoligotype SB0121 by PRA and spoligotyping. They were born and kept in the same enclosure with the same group, without any contact to other species housed in the zoo. This is the first detailed description of M. bovis infection in Kobus ellipsiprymnus.

Frequência de leptospirose em ovinos abatidos no município de Patos, Paraíba / Frequency of leptospirosis in ovine slaughtered in Patos, Paraíba, Brazil

Foram colhidas amostras de placenta, ampola do ducto deferente e glândulas vesiculares de 80 ovinos abatidos no matadouro público de Patos, Estado da Paraíba, região Nordeste do Brasil para isolamento de Leptospira spp., bem como amostras de sangue para a pesquisa de anticorpos anti-Leptospira spp. O meio de Ellinghausen-McCullough-Johnson-Harris (EMJH) modificado com a adição de 10% de soro de coelho foi usado para o isolamento do agente e a técnica de soroaglutinação microscópica para a pesquisa sorológica. Os cultivos foram observados semanalmente por microscopia de campo escuro durante 16 semanas. Seis animais (7,5%) foram soropositivos na SAM, sendo o sorovar Autumnalis o mais frequente, com cinco soros reagentes, seguido pelo sorovar Icterohaemorragiae, com um soro reagente. Foi isolado micro-organismo morfologicamente similar a Leptospira spp. de uma amostra de ampola do ducto deferente e outra de placenta.

Placenta, ampulla of the deferent duct, and seminal vesicle samples were collected from 80 sheep slaughtered in the public slaughterhouse of Patos, Paraíba state, Northeastern region of Brazil, for isolation of Leptospira spp., and blood samples were taken from the same animals to check for the presence of anti-Leptospira spp. antibodies. Ellinghausen-McCullough-Johnson-Harris (EMJH) medium modified with the addition of 10% rabbit serum was used for the leptospira isolation, while the microscopic agglutination test (MAT) was used to check for the presence of antibodies. The cultures were observed weekly by dark field microscopy for 16 weeks. Six animals (7.5%) were seropositive by MAT, the serovar Autumnalis being the most frequent, with 5 reactant sera, followed by the serovar Icterohaemorragiae, with 1 reactant serum. A microorganism morphologically similar to Leptospira spp. was isolated from 1 ampulla of the deferent duct sample and 1 placenta sample.

Tuberculose bovina no estado da Paraíba: estudo retrospectivo / Bovine tuberculosis in the state of Paraíba: retrospective survey

O objetivo do presente trabalho foi determinar a frequência de propriedades positivas (focos) e de animais positivos para a tuberculose bovina no Estado da Paraíba. Foram utilizados dados da Agência de Defesa Agropecuária do Estado, coletados de suas 23 microrregiões, durante o período de janeiro de 2008 a julho de 2009. Durante esse período, foram examinadas 10.963 propriedades e 54.472 bovinos foram submetidos ao teste de tuberculinização. Para o diagnóstico foi utilizada, como prova de triagem, a tuberculinização cervical simples para gado de leite e a tuberculinização na prega caudal para gado de corte; como prova confirmatória foi utilizada a tuberculinização cervical comparativa. Uma propriedade foi considerada foco quando apresentou pelo menos um animal soropositivo. Das propriedades investigadas, 62 (0,57 por cento) apresentaram pelo menos um animal positivo e dos animais analisados, 136 (0,25 por cento) foram positivos. Houve diferença significativa (p<0,001) na proporção de fêmeas (0,32 por cento) e machos (0,04 por cento) positivos. A despeito da baixa frequência de focos de brucelose e de animais soropositivos, é necessária a condução de medidas que incluem a conscientização dos produtores, fiscalização nas barreiras sanitárias e levantamentos periódicos da situação epidemiológica desta doença, principalmente nas microrregiões com maior frequência da infecção, com o objetivo de evitar, ou pelo menos minimizar, a disseminação do agente.

The aim of this study was to determine the frequency of positive herds (foci) and positive animals for bovine tuberculosis in the state of Paraíba, Northeast region of Brazil. Data from the Agency of Agricultural Protection in the state, collected from its 23 microregions, during the January 2008 to July 2009 period, were used. During this period, 10,963 herds were examined and 54,472 cattle were submitted to the tuberculin test. For diagnosis the cervical and caudal-fold tuberculin tests were used as screening tests in dairy and beef cattle, respectively; as confirmatory test, comparative cervical test was used. A herd was considered focus when presented at least one positive animal. Of the herds investigated, 62 (0.57 percent) had at least one positive animal, and of the animals examined, 136 (0.25 percent) were positive. There was significant difference (p<0.001) in the proportion of positivity for females (0.32 percent) and males (0.04 percent). Despite low frequency of foci of brucellosis and seropositive animals, it is necessary to conduct measures including awareness of producers, surveillance in sanitary barriers and periodic surveys of epidemiological situation of this disease especially in the regions with highest frequency of infection, aiming to avoid, or at least minimize, the spread of the agent.