Academic literature on the topic 'Retromuscular Mesh'

Background: An incisional hernia is a common complication of abdominal surgery with an incidence rate of two to 11%. Although there are various techniques described, the mesh repair has been the gold standard in the elective management of incisional hernias. But the best method of mesh placement is still debatable. Hence a study was conducted to compare the Retromuscular prefascial mesh placement with Onlay mesh placement in the treatment of incisional hernias.Methods: A prospective study was conducted in the Department of General Surgery in a tertiary center from November 2010 to May 2012. All patients with an incisional hernia underwent either Retromuscular prefascial mesh repair or onlay mesh repair. The nature of the previous surgery, size of the defect, operative, and postoperative complications were recorded. Mann Whitney test and Fisher’s exact test was used to evaluate the significance of the difference. A ‘p’ value <0.05 was considered significant.Results: A total of 60 patients were studied with 30 patients each in the Retromuscular prefascial group and the onlay group. Forty (67%) cases of incisional hernia were secondary to lower midline incision and hysterectomy was the most common surgery [30 patients (50%)]. The Retromuscular prefascial mesh group had significantly lesser postoperative complications (2/30 vs. 12/30; p=0.002; Fischer’s exact test) and seroma formation (1/30 vs. 8/30; p=0.02; Fischer’s exact test) compared to the onlay mesh group.Conclusions: Retromuscular prefascial mesh repair was equally effective but associated with fewer complications compared to onlay mesh repair.

Parastomal hernias (PHs) cause significant morbidity in patients with permanent ostomies, and several laparoscopic and open repair techniques have been described. We report our experience with open retromuscular repair of PHs using permanent synthetic mesh. A prospectively maintained database was retrospectively reviewed to identify patients undergoing PH repair. Primary outcomes are surgical site occurrence, surgical site infection (SSI), and hernia recurrence. Variables were analyzed using Pearson's χ2 test or Fisher's exact test. Values of P < 0.05 were considered significant. Forty-six patients underwent retromuscular PH repair with permanent synthetic mesh. There were 26 patients with colostomies and 20 with ileostomies. All the patients were repaired using a keyhole retromuscular technique and direct passage of stoma through mesh. Transversus abdominis release was performed in 65.2 per cent of cases. Permanent synthetic polypropylene mesh was used in all cases. Surgical site occurrence occurred in 47.8 per cent of patients, SSI in 17.4 per cent, and hernia recurrence in 21.7 per cent. Resiting the stoma yielded the highest rate of SSI (40%) compared with leaving the stoma in situ (11.8%) or rematuring the stoma (0%; P = 0.011). Open keyhole retromuscular PH repair of PH with permanent synthetic mesh is safe, effective, and durable.

<strong>Background:&nbsp;</strong>Incisional hernia is an important source of morbidity following abdominal surgery, more commonly in the middle-aged females. It is the only hernia which is truly iatrogenic. It can be repaired using anatomical, mesh or laparoscopic methods. Despite potential advantages of Rives-Stoppa retromuscular mesh repair when compared to other commonly done hernia repairs, not many systematic studies have been done in this part of country. Hence, this study analyses the various etiological factors of Incisional hernia and complications and outcome after hernia repair using Rives-Stoppa retromuscular mesh repair.&nbsp;<strong>Materials and Methods:&nbsp;</strong>This was a hospital based prospective study conducted among 30 patients with incisional hernia, who presented to Department of Surgery at Vijayanagar Institute of Medical Sciences, Ballari, from January 2020 to September 2021. Patients were subjected to mesh repair by using Rives-Stoppa retromuscular mesh repair technique. Clearance was obtained from Institutional Ethics Committee. Written informed consent was obtained from the study participants.&nbsp;<strong>Results:&nbsp;</strong>The incidence was more common in females, who underwent gynaecological procedures by lower and midline incisions. It was found to be more common in the age group of 50 &ndash; 60 years. Predominant risk factors were midline infra-umbilical incision multi-parity, obesity, occupation with strenuous work, chronic cough and smoking. Most common presenting complaint was swelling over the previous surgical scar. Majority of hernias have occurred within 2 years of previous surgery. The postoperative complications noted were mainly seroma formation. Patients had good compliance with Rives-Stoppa retromuscular mesh repair technique, with less incidence of post-operative pain complications, good recovery, and no recurrence in our study.&nbsp;<strong>Conclusion:&nbsp;</strong>Rives-Stoppa retromuscular mesh repair for incisional hernia provides good strength to the abdominal wall. Patient had good compliance, less post-operative pain, less complications, and no recurrence. &nbsp; &nbsp; &nbsp;

Background and Aims: We present an open retromuscular mesh technique for incisional hernia repair, the modified peritoneal flap hernioplasty, where the fascia is sutured to the mesh and the hernia sac utilized for anterior mesh coverage. The aim was to describe the modified peritoneal flap hernioplasty technique and to compare it to a retromuscular repair, without component separation, regarding short-term complications, patient satisfaction, abdominal wall complaints, and recurrent incisional hernia. Materials and Methods: Consecutive patients operated electively with modified peritoneal flap hernioplasty technique (December 2012–December 2015) or retromuscular technique (Jan 2011–Oct 2014) were included in a retrospective single-center cohort study. Outcomes were evaluated from the Swedish Ventral Hernia Registry, by chart review, physical examination, and an abdominal wall complaints questionnaire. Results: The modified peritoneal flap hernioplasty group ( n = 78) had larger hernias (mean width 10.4 vs 8.5 cm, p = 0.005), more advanced Centers for Disease Control classification ( p = 0.009), and more simultaneous gastrointestinal-tract surgery (23.1% vs 11.5%, p = 0.041) than the retromuscular group ( n = 96). No difference in short-term complications was seen. Incisional hernia recurrence was lower in the modified peritoneal flap hernioplasty group (1.4% vs 10.3%, p = 0.023), and patients were more satisfied (93.8% vs 81.7%, p = 0.032). Follow-up time was shorter in the modified peritoneal flap hernioplasty group (614 vs 1171 days, p &lt; 0.001). Conclusion: This retrospective study showed similar rates of short-term complications, despite more complex hernias in the modified peritoneal flap hernioplasty group. Furthermore, a lower incisional hernia recurrence rate for the modified peritoneal flap hernioplasty technique compared with the retromuscular technique used in our department was found. If this holds true with equally long follow-up remains to be proven.

Ventral hernia repair (VHR) in patients with inflammatory bowel disease (IBD) presents unique surgical challenges including impaired wound healing, concomitant intestinal operations, along with likely future abdominal surgeries. Appropriate techniques and mesh choices in these patients remain under active debate. Herein we report our experience with using a retromuscular approach for major VHR in a consecutive cohort of IBD patients. We identified all patients with IBD undergoing open VHR with retrorectus mesh placement between 2007 and 2013 in our prospectively maintained database. Main outcomes included patient and hernia characteristics, perioperative details, wound complications, and hernia recurrence. A total of 38 patients with IBD met inclusion criteria. Mean hernia defect size was 338 cm2. Synthetic mesh was used in 16 patients and biologic mesh was used in 22 of patients. A surgical site occurrence (SSO) occurred in 13 (34.2%) patients, 7 (18.4%) of which were surgical site infections (SSIs). There were no instances of postoperative intestinal complications or enterocutaneous fistulae. At the mean follow-up 37 months, there were 3 (9.4%) recurrences. Our retromuscular repairs were associated with a low rate of wound morbidity and no intestinal complications. Furthermore, we report a relatively low rate of recurrences, especially in this series of complex multiply recurrent hernias. Overall, our retromuscular approach seems to be safe and effective in hernia patients with IBD.

Introduction. Recurrent incisional hernias are difficult to treat. There are many factors involved in the recurrence, and due to extensive dissections, the planes are fused with adhesions, and we may need a new plane for dissection and placement of meshes. Case Report. We report here three cases of recurrent incisional hernias which were dealt by a relatively new method to laparoscopy: the enhanced view totally extraperitoneal repair (e-TEP) retromuscular technique. There were three patients: one after an open onlay repair of lower midline incision, another after an onlay mesh repair of a subcostal incision for open cholecystectomy followed by an intraperitoneal onlay mesh hernioplasty (IPOM) repair, and another after IPOM repair of epigastric hernia. They were treated with the abovementioned technique with satisfying short-term results. Conclusion. The e-TEP technique is a relatively new method of providing minimal access surgery to these patients utilizing the previously unaccessed retromuscular (Rives and/or preperitoneal) space for the repair of these recurrent incisional hernias.

A systematic review of a recently published meta-analysis shows that laparoscopic and open allogeneoplasty is a safe procedure with relatively short-term and long-term results. A new minimally invasive technique has been developed that allows the mesh to be placed in the retroperitoneal space through a small transhernial incision, avoiding signifi cant trauma to the abdominal wall and contact with the abdominal cavity. However, this type of operation does not involve fi xation of the mesh in the retromuscular space, which can lead to a number of complications. The analysis of the obtained results determines the relevance of this study.Objective. To compare the features of the ultrastructural reaction of the tissues of the muscle- aponeurotic layer of tissues to the implantation of «Capromesh» in combination with PRP and polypropylene meshes in an experiment.Material and methods. The study was conducted on 16 same-sex pigs of the Vietnamese breed weighing at least 10 kg, which were divided into 2 groups. Histological and ultrastructural changes in the tissues of the muscle- aponeurotic layer of the anterior abdominal wall after implantation in the retromuscular space of «Capromesh» in combination with PRP (plasma enriched with growth factors) and polypropylene meshes were studied in the experiment.The results. A signifi cant diff erence in tissue reactions at diff erent times of the experiment on the implanted material was proven. The conducted microscopic and electron microscopic studies after the implantation of the «Capromesh» mesh in combination with PRP established that starting from the 7th day of the experiment, the infl ammatory changes in the tissues of the muscle- aponeurotic layer are not as signifi cant as during the implantation of the polypropylene mesh. Starting from the 14th day of the experiment, the signs characterizing the reduction of the infl ammatory reaction and the more intense formation of fi brous structures around the mesh material are much better expressed. On the 21st day of the experiment, at the microscopic and electron microscopic levels, a signifi cantly smaller number of areas of leukocyte infi ltration, intensive vascularization from the formation of collagen fi bers with the participation of fi broblasts around the «Capromesh» mesh material in combination with PRP was established.Conclusions. The conducted micro- and ultrastructural studies determined the priority of using the «Capromesh» mesh in combination with PRP under the conditions of material selection when performing retromuscular allogeneoplasty.

Ideal fixation techniques have not been fully elucidated at the time of complex open abdominal wall reconstruction (AWR). We compared operative outcomes and quality of life with retromuscular mesh fixation using fibrin glue (FG) versus transfascial sutures (TS). Retrospective review identified complex hernia patients who underwent open AWR with mesh from November 2012 through April 2016. Multivariate analysis examined postoperative outcomes between groups. Quality of life was assessed using the Carolinas Comfort Scale. Seventy-five patients (18 FG vs 57 TS) with mean age (54.3 vs 53.9 years, P = 0.914), body mass index (35.8 vs 34.7 kg/m2, P = 0.623) and American Society of Anesthesiologist score (2.6 vs 2.5, P = 0.617) were reviewed. No differences in wound (P = 0.072) and nonwound (P = 0.639) related complications were noted between groups. Risk of reoperations (P = 0.275) and 30-day readmissions (P = 0.137) were also comparable. The TS group was twelve times more likely to report pain at six-month follow-up compared with FG (12.29 OR, 95 per cent confidence interval 1.26–120.35, P = 0.031). No hernia recurrences were noted in either group at a mean follow-up of 390 ± 330 days. The use of FG to secure mesh in the retromuscular space during complex open AWR may be a safe alternative to penetrating transfascial fixation with potential to reduce chronic pain.

Lateral abdominal wall hernias may occur after a variety of procedures, including anterior spine exposure, urologic procedures, ostomy closures, or after trauma. Anatomically, these hernias are challenging and require a complete understanding of abdominal wall, interparietal and retroperitoneal, anatomy for successful repair. Mesh placement requires extensive dissection of often unfamiliar planes, and its fixation is difficult. We report our experience with open mesh repair of lateral abdominal wall hernias. A retrospective review of a prospectively maintained database was performed to identify patients with a classification of lateral abdominal wall hernia who underwent an open repair. A total of 61 patients underwent open lateral hernia repairs. Mean patient age was 58 years (range 25–78), with a mean body mass index of 32 kg/m2 (range 19.0–59.1). According to the European Hernia Society classification, defects were located subcostal (L1, 14 patients), flank (L2, 33 patients), iliac (L3, 11 patients), and lumber (L4, 3 patients). Mean defect size was 78.6 cm2, with a mean greatest single dimension of 9.2 cm (range 2–25 cm). Retromuscular or interparietal repair was performed in 50.8 per cent, preperitoneal in 41.0 per cent, intraperitoneal in 6.6 per cent, and onlay in 1.6 per cent. The rate of surgical site occurrence was 49.2 per cent, primarily seroma and surgical site infection rate was 13.1 per cent. With a mean follow-up of 15.4 months, seven patients (11.5%) have documented recurrence. Synthetic mesh reconstruction of lateral wall hernias is challenging. Our experience demonstrates the safety and success of repair using synthetic mesh primarily in the retromuscular, interparietal, or preperitoneal planes.

Abstract“Bridged-IPOM” of Leblanc has been introduced in the 1990s [1]. IPOM is still the mainstay of the repair of ventral hernia, but it has not been without limitation. Adhesive bowel obstruction, mesh erosion, enterocutaneous fistula, and chronic pain are due to tight mesh fixations [2]. Extraperitoneal mesh placement offer advantages: the retromuscular positioning of the mesh permits the integration of both sides, providing the repair with superior tensile strength and costly coated mesh is unnecessary. Nevertheless, the laparoscopic extraperitoneal approach continues to pose limitation in available degree of freedom and significant ergonomic challenge to the operating surgeons.

Hernias comprise a growing problem in surgical science. The most recent classification scheme for hernias emphasizes on the size of defect as well as on whether it is an incisional hernia. The latter group includes complex hernias, namely hernias that can not be managed with simple surgical techniques. This can be accomplished with retromuscular repairs or the more complex anterior and posterior component separation techniques. An anatomic repair is usually reinforced with interposition of mesh. Newest techniques, such as the use of botulinum toxin to induce temporary paralysis of the lateral abdominal wall musculature, referred to as chemical component separation, now present new tools in the restoration of anatomy-based repairs. The chapter entitled “Anatomical and surgical principles of ventral hernia repairs” aims to describe the anatomical and surgical principles of current practice regarding the repair of ventral -primary and incisional-hernias.

O avanço das plataformas robóticas trouxe consigo uma série de implicações abrangentes, envolvendo aspectos éticos, econômicos, educacionais e aplicação clínica. Isso nos leva a fazer uma retrospectiva até o início dos anos 1990, quando a laparoscopia começou a se disseminar como uma tecnologia inovadora com o potencial de transformar a cirurgia. No Brasil, sua adoção inicial, em 1990, enfrentou resistência em várias esferas, inclusive no seio da comunidade médica. Argumentava-se que essa técnica era dispendiosa, complexa, de acesso limitado e com aplicações clínicas restritas. No entanto, em um curto período, a laparoscopia solidificou sua posição como o padrão de excelência para o tratamento de uma ampla gama de doenças em diversas especialidades cirúrgicas e sistemas orgânicos. Na cirurgia videolaparoscópica, os movimentos são orientados com base em uma imagem ampliada vinte vezes de uma área cirúrgica indireta. A interface de vídeo usada presume a avaliação da profundidade com base em apenas duas dimensões, em contraste com as três dimensões convencionais. Dentre os diversos dispositivos robóticos disponíveis para procedimentos cirúrgicos urológicos, destacam-se os sistemas telemanipuladores sinérgicos. Vários desses sistemas obtiveram aprovação clínica e licenciamento para uso em pacientes, incluindo renomados exemplos como o sistema da Vinci, Avatera, Hinotori, Revo-i, Senhance, Versius e Surgenius. Destaca-se ainda, o fato de que os dispositivos sinérgicos portáteis e de fácil utilização desempenham um papel relevante em cirurgias urológicas, abrangendo abordagens minimamente invasivas e endoscópicas. As tendências futuras na inovação robótica nesta área incluem a exploração de sistemas hápticos mais avançados, que fornecem feedback tátil e cinestésico mais preciso, bem como a miniaturização e o desenvolvimento de microrrobôs. Outros focos incluem melhorias no feedback visual, com ampliação aprimorada e detalhes mais nítidos, juntamente com o desenvolvimento de robôs autônomos para aprimorar a eficácia das intervenções cirúrgicas. Os cistos de colédoco representam anomalias raras de dilatação cística nos ductos biliares que surgem desde o nascimento, com cerca de 80% dos casos ocorrendo em crianças (4). Quando o diagnóstico é confirmado por meio de exames de imagem, a intervenção cirúrgica é indicada, visando sempre à ressecção completa do cisto, sempre que possível. O procedimento específico depende do tipo de cisto e normalmente envolve a remoção completa do cisto e a restauração do fluxo biliar para o intestino, seja por meio de duodenostomia ou hepaticojejunostomia em Y-de-Roux. Em alguns casos, a videolaparoscopia, uma técnica minimamente invasiva, pode ser uma alternativa viável para a ressecção do cisto de colédoco, sendo considerada segura mesmo em situações de reoperação, desde que realizada por cirurgiões experientes. Ao tanger o tratamento cirúrgico das hérnias ventrais, ainda persiste um debate em torno da abordagem ideal. O fechamento da abertura e o uso de telas para reforçar a parede abdominal são elementos fundamentais nesse tratamento, podendo ser realizados tanto por meio de cirurgia aberta quanto por técnicas minimamente invasivas. A cirurgia aberta tende a apresentar maiores taxas de infecção no local da incisão, enquanto o reparo laparoscópico IPOM (intraperitoneal onlay mesh) traz riscos adicionais, como lesões intestinais, aderências e obstruções intestinais, além de exigir o uso de telas de dupla face e dispositivos de fixação que encarecem o procedimento e podem causar desconforto pós-operatório. A técnica eTEP (extended/enhanced view totalmente extraperitoneal) tem emergido como uma alternativa promissora. Ao longo das últimas duas décadas, têm sido empreendidos esforços significativos na tentativa de estabelecer procedimentos cirúrgicos robóticos como parte integrante da prática médica. No entanto, apesar dos avanços e das evidências que demonstram a eficiência das cirurgias robóticas minimamente invasivas, ainda não testemunhamos uma adoção generalizada dessas técnicas na área médica. Destaca-se a eficácia das cirurgias robóticas minimamente invasivas, o que as posicionou como um padrão de excelência em procedimentos cirúrgicos. Entretanto, ele também identifica um desafio persistente: a baixa adesão a essas técnicas devido às considerações financeiras. O custo envolvido em procedimentos videolaparoscópicos e minimamente invasivos continua a ser uma barreira substancial. É importante notar que essa limitação não é uniforme em todas as regiões do país, sendo influenciada pela realidade do sistema de saúde em cada local. Ao compararmos a técnica E/MILOS com as abordagens tradicionais, como cirurgias abertas com colocação de tela no espaço retromuscular ou técnicas laparoscópicas (IPOM e eTEP), observamos que a E/MILOS apresenta resultados igualmente eficazes. Além disso, ela se destaca por reduzir de maneira significativa as complicações pós-operatórias, reoperações e reinternações não planejadas. A acessibilidade dessa técnica em hospitais da rede pública de saúde também é uma realidade, ressaltando sua viabilidade e facilidade de replicação. Em síntese, as cirurgias minimamente invasivas, incluindo as robóticas e videolaparoscópicas, oferecem inegáveis vantagens, como recuperação rápida, menor incidência de contaminação e infecção, bem como precisão aprimorada em procedimentos de alta complexidade. No entanto, não podemos ignorar as desvantagens associadas, tais como os custos envolvidos na aquisição de equipamentos e materiais, a necessidade de treinamento especializado para os profissionais e os requisitos de manutenção desses sistemas. O equilíbrio entre esses fatores é essencial para garantir a eficácia e a acessibilidade dessas técnicas, priorizando sempre o bem-estar do paciente e a eficiência do sistema de saúde.