The outcomes of open anterior component separation versus posterior component separation with transversus abdominis release for complex incisional hernias: a systematic review and meta-analysis.

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.

Truncal function after abdominal wall reconstruction via transversus abdominis muscle release (TAR) for large incisional hernias: a prospective case-control study.

BACKGROUND: Data about abdominal wall function in patients with incisional hernias (IH) are limited. Abdominal Wall Reconstruction (AWR) could be beneficial for the improvement of this function. The goal of the study was to evaluate if the abdominal wall function was restored after transversus abdominis muscle release (TAR). METHODS: We performed a prospective case-control study of 59 patients with IH equal or larger than 10 cm in their width undergoing AWR via TAR with mesh reinforcement and complete linea alba restoration. With two simple physical tests-Trunk Raising (TR) and Double Leg Lowering (DLL), we clinically assessed, preoperatively, 1 month and 1 year postoperatively the functionality of the abdominal wall (flexion). Patients were compared with a control group (n = 57) with an intact abdominal wall undergoing visceral surgery through a midline laparotomy. RESULTS: There were no differences between the groups in terms of sex and mean age. In the study group, TR demonstrated an increase from 1.93 preoperatively to 2.44 at 1 month and 4.27, respectively, at 1 year postoperatively (p < 0.001). DLL was improved from 2.067 to 4.37 at 1 year postoperatively (p = 0.016). In the control group, surgery resulted in a decrease of truncal flexion. At 1 year postoperatively, the abdominal wall function for study group patients was almost identical with that the functionality of the control group featuring an intact abdominal wall (TR 4.26 vs 4.33 p = 0.532; DLL 4.42 vs 4.21 p = 0.193). CONCLUSION: AWR via TAR for large IH specifically improved long-term abdominal wall muscular function.

The influence of Transversus Abdominis Muscle Release (TAR) for complex incisional hernia repair on the intraabdominal pressure and pulmonary function.

INTRODUCTION: Among many other techniques for Abdominal Wall Reconstruction (AWR), posterior component separation with Transversus Abdominis Release (TAR), continues to gain popularity and it is increasingly used with promising long-term results. Our goal was to evaluate the influence of TAR with mesh retromuscular reinforcement on the intra-abdominal pressure (IAP) and respiratory function in a series of patients with complex incisional hernias (IH). METHODS: Since November 2014 through February 2019, patients with TAR were identified in the Clinical Department of Surgery database and were retrospectively reviewed. Outcome measures include: demographics, pre- and perioperative details, preoperative and postoperative IAP and plateau pressure (PP). RESULTS: One-hundred-and-one consecutive TAR procedures (19.7% from all incisional hernia repairs) were analyzed. Mean age was 63 years with a mean Body Mass Index (BMI) of 31.85 kg/m2 (25-51). Diabetes and Chronic Obstructive Pulmonary Disease (COPD) were the main major comorbidities. Mean hernia defect area was 247 cm2 (104-528 cm2). CONCLUSION: TAR is a safe and sound procedure with acceptable modifications of the IAP morbidity and recurrence rate when correctly performed on the right patient.

Rural teleradiology: a snapshot.

A national survey was conducted among rural hospitals active in teleradiology and their affiliated health care providers to delineate the current status of rural telemedicine. 109 telemedicine programs were identified that use teleradiology as well as other telemedicine applications, and 340 programs were identified that use only teleradiology. Programs that use only teleradiology have been in operation longer than programs that combine teleradiology with other telemedicine services. Most teleradiology facilities are adjacent to small metropolitan areas or in more rural counties with a population of at least 2500. Only 22% of the teleradiology-only facilities spend more than $60,000 on initial equipment, and annual transmission costs average less than $4,000 for most facilities. Ordinary copper telephone lines are the transmission medium most commonly used for transfer of radiology images. Radiographs and CT scans are the types of studies most commonly transmitted, followed by MRI and nuclear medicine studies.

Suicide of a patient: gender differences in bereavement reactions of therapists.

Emotional reactions of therapists who experienced the death by suicide of one or more of their patients were investigated. Data were collected by a questionnaire containing both objective and open-ended items from 27 men and 36 women, psychiatrists and psychologists, working in psychiatric hospitals in Slovenia. The most frequently reported reactions by the therapists were of increased caution in the treatment of their patients and an increase in conferring with colleagues, partners, and supervisors. About two thirds reported experiencing strong guilt feelings along with other commonly reported survivor feelings of grief, depression, and loss. Gender differences were apparent (women more often felt shame and guilt, sought consolation, or doubted their professional knowledge). No significant differences appeared between disciplines and years of work experience. Agreement was general that support was important both professionally and personally. Suggestions are offered to help the therapist work through the trauma of a patient's suicide.

Psychosocial impact of bereavement after suicide and fatal traffic accident: a comparative two-country study.

This study examines the psychosocial problems of spouses bereaved as a consequence of unnatural causes of death (suicide and traffic fatality) in two countries, Slovenia (n = 53) and The Netherlands (n = 32). Structured interviews consisted of standardized measures for depression, substance use, social reactions, and acceptance and attribution of the loss. Although marked differences in sociodemographic background exist, bereaved subjects from both countries show more similarities than differences. Depressed symptomatology is slightly higher in the Slovene bereaved, but symptom patterns are almost identical. Core indicators of clinical depression, as well as reported substance use, are equally low in both countries, and gender and mode of death do not differ significantly. Social acceptance is more problematic in suicide bereaved, particularly in Slovenia. Methodological considerations of cross-cultural bereavement studies are discussed.

Aggression as a natural part of suicide bereavement.

This article analyzes anger as a phase in the process of bereavement after suicide. Anger is generally very difficult for the survivors to recognize, accept, and express. At the beginning of the survivors' group meetings, anger is repressed and denied. After the group has become more structured and more cohesive, the aggression is first expressed indirectly (through dreams) and directed at different objects (the environment, the survivor him- or herself). In the final group sessions, when the members support each other emotionally, both the group atmosphere and the therapist help them to recognize their anger and to vent their aggression toward their relative who committed suicide. If the survivors do not go through this phase, the bereavement process should not be considered completed.

A cross-cultural comparison of ideal and undesirable qualities of crisis line workers.

Telephone crisis line workers in two different crisis centers (Los Angeles, USA, and Ljubljana, Yugoslavia; LA and LJ) self-assessed the most important ideal and undesirable personality traits for their work. Both LA and LJ counselors rated the most important traits as: motivated for the work and being a good listener. LA counselors rated themselves as possessing the majority of the required positive traits, while the LJ counselors thought themselves lacking in several significant qualities. In their listing of undesirable traits, the LJ workers again tended to be more critical of themselves than the LA workers but with fewer differences than on the desirable traits. The source of the differences may lie between the use of volunteers in LA and professional and semi-professional counselors in LJ. The ratings of a sample of US crisis center directors on both desirable and undesirable traits tended to parallel those of the LJ counselors more closely than those of the LA workers. Center directors were also critical of their own counselors on a number of the listed traits.

Synaptic vesicles containing substance P purified by chromatography on controlled pore glass.

Subsynaptosomal particles containing the peptide, substance P, detected by radioimmunoassay were prepared by osmotic lysis of rat brainstem synaptosomes and chromatographed on a calibrated column of controlled pore glass beads of nominal pore size 300 nm. Immunoreactive substance P migrated on this column with particles of apparent mean diameter 117 nm. This particulate, immunoreactive substance P was indistinguishable from synthetic substance P by gel filtration and reverse-phase high pressure liquid chromatography. The specific activity of substance P with respect to protein in peak fractions was 140 pmoles/mg protein, 75-fold higher than in the crude homogenate. Particulate substance P was resistant to attack by endogenous proteases in a crude preparation. Depolarization of synaptosomes with 75 muM veratridine prior to vesicle purification decreased the recovery of particulate substance P 37%. This depletion was dependent on external calcium ions and was blocked by 1 muM tetrodotoxin. The foregoing properties of particulate substance P are consistent with its identification with the large, intraterminal substance P-positive vesicles seen by immunocytochemistry and suggest that these vesicles are involved in the release of substance P.