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Venkatarangaiah, Ranganath M., Darshan A. Manjunath, Amarnath V. Mudda, and Veerabhadra Radhakrishna. "Retromuscular prefascial mesh placement versus onlay mesh placement in the repair of incisional hernias: a prospective study." International Surgery Journal 5, no. 1 (2017): 120. http://dx.doi.org/10.18203/2349-2902.isj20175552.
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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.
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Beffa, Lucas R., Jeremy A. Warren, William S. Cobb, Bryan Knoedler, Joseph A. Ewing, and Alfredo M. Carbonell. "Open Retromuscular Repair of Parastomal Hernias with Synthetic Mesh." American Surgeon 83, no. 8 (2017): 906–10. http://dx.doi.org/10.1177/000313481708300845.
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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.
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Rhemtulla, Irfan A., Michael G. Tecce, Robyn B. Broach, Charles A. Messa, Jaclyn T. Mauch, and John P. Fischer. "Retromuscular Mesh Repair Using Fibrin Glue." Plastic and Reconstructive Surgery - Global Open 7, no. 4 (2019): e2184. http://dx.doi.org/10.1097/gox.0000000000002184.
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Khalid, Muqueem, Sushilkumar, and Somasekhar Kasa. "A Study of Rives-Stoppa Retromuscular Mesh Repair for Incisional Hernia." International Journal of Pharmaceutical and Clinical Research 14, no. 10 (2022): 884–92. https://doi.org/10.5281/zenodo.13309179.
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<strong>Background: </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. <strong>Materials and Methods: </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. <strong>Results: </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 – 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. <strong>Conclusion: </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.
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Petersson, P., A. Montgomery, and U. Petersson. "Modified Peritoneal Flap Hernioplasty Versus Retromuscular Technique for Incisional Hernia Repair: a Retrospective Cohort Study." Scandinavian Journal of Surgery 109, no. 4 (2019): 279–88. http://dx.doi.org/10.1177/1457496919863943.
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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 < 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.
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Wang, Jeremy, Arnab Majumder, Mojtaba Fayezizadeh, Cory N. Criss, and Yuri W. Novitsky. "Outcomes of Retromuscular Approach for Abdominal Wall Reconstruction in Patients with Inflammatory Bowel Disease." American Surgeon 82, no. 6 (2016): 565–70. http://dx.doi.org/10.1177/000313481608200620.
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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.
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Shakya, Vikal Chandra, Bikram Byanjankar, Rabin Pandit, Anang Pangeni, and Anir Ram Moh Shrestha. "e-TEP Retromuscular Repair for Recurrent Incisional Hernias: Report of Three Cases." Case Reports in Surgery 2019 (July 15, 2019): 1–6. http://dx.doi.org/10.1155/2019/1609193.
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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.
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Piatnochka, Volodymyr, and Iryna Dovha. "COMPARATIVE HISTOLOGICAL CHARACTERISTICS OF CHANGES IN ANTERIOR ABDOMINAL WALL TISSUES AFTER IMPLANTATION OF «CAPROMESH» MESH IN COMBINATION WITH PRP AND «LIGHT» POLYPROPYLENE MESH IN AN EXPERIMENT." Clinical anatomy and operative surgery 22, no. 3 (2023): 48–58. http://dx.doi.org/10.24061/1727-0847.22.3.2023.29.
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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.
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Weltz, Adam S., Udai S. Sibia, H. Reza Zahiri, Alexa Schoeneborn, Adrian Park, and Igor Belyansky. "Operative Outcomes after Open Abdominal Wall Reconstruction with Retromuscular Mesh Fixation Using Fibrin Glue versus Transfascial Sutures." American Surgeon 83, no. 9 (2017): 937–42. http://dx.doi.org/10.1177/000313481708300928.
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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.
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Patel, Puraj P., Jeremy A. Warren, Roozbeh Mansour, William S. Cobb, and Alfredo M. Carbonell. "A Large Single-Center ‘Experience of Open Lateral Abdominal Wall Hernia Repairs." American Surgeon 82, no. 7 (2016): 608–12. http://dx.doi.org/10.1177/000313481608200726.
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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.
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Raigani, Siavash, Cory N. Criss, Clayton C. Petro, Ajita S. Prabhu, Yuri W. Novitsky, and Michael J. Rosen. "Single-Center Experience With Parastomal Hernia Repair Using Retromuscular Mesh Placement." Journal of Gastrointestinal Surgery 18, no. 9 (2014): 1673–77. http://dx.doi.org/10.1007/s11605-014-2575-4.
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Noditi, George, Raul Zoler, Gheorghe Noditi, and Lazar Fulger. "Synthetic Mesh for Large Ventral Hernia Repair Correlated with Evaluation of Quality-of-life A 5 years retrospective study." Revista de Chimie 69, no. 5 (2018): 1264–67. http://dx.doi.org/10.37358/rc.18.5.6304.
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Ventral hernia mesh repair is considered a standard procedure in most countries and widely accepted as superior to primary suture repair. We conducted a 5 years retrospective observational study on large and giant incizional hernia repair in our Clinics. 176 consecutive patients who had a ventral hernia repair with mesh implant in 2012-2016 were evaluated in terms of demographic characteristics, comorbidities, surgical conditions (defect size, mesh type, positioning of the mesh, length of hospital) and surgical outcomes by means of EuraHS-QoL score pre- and 30 days postoperative to assess quality of life (Qol). Alloplastic substitution with polypropylene, polyester and Dacron mesh has been used in all cases. Polypropylene mesh has been used in most of cases (91%). Most preferred mesh position was intraperitoneal (78%), then retromuscular (15%) and preperitoneal (7%). Immediate postoperative complications appeared in 41 cases (23.3%). Mean hospital length was 14,3 days. We could notice a double pre- and postoperative difference for the pain, with statistical significance (2.71�1.70; p=0.23) and the same pattern of distribution for restriction of activities and for cosmetic discomfort.
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Timerbulatov, M. V., E. E. Grishina, and R. M. Sibagatov. "Comparative analysis of the results of treatment of patients with ventral hernias using IPOM and EMILOS techniques." Hirurg (Surgeon), no. 6 (December 15, 2023): 19–24. http://dx.doi.org/10.33920/med-15-2306-03.
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The influence of the mesh arrangement method on the results of video endoscopic treatment of ventral hernias remains a debatable issue. The contact of the mesh with adipose tissue during IPOM plasty leads, on the one hand, to the formation of seroma, the development of purulent complications, which can cause relapse, and a high risk of intestinal damage, complications associated with the mesh, and postoperative pain, on the other. The technique of laparoscopic IPOM plastic surgery is also ineffective in diastases, since it does not strengthen the white line of the abdomen. The best place for mesh implantation, according to the world’s leading gerontologists,is the retromuscular space. The EMILOS technique developed by the German surgeon W. Raingold combines the advantages of subway plastic surgery and the laparoscopic IPOM method. The EMILOS operation has mainly less surgical trauma, fewer postoperative complications, low recurrence rate and high economic efficiency.
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Eltyeb, HazimA, Frederick Dowker, and Duncan Light. "Long-term results of Progrip mesh for retromuscular repair of ventral hernia." International Journal of Abdominal Wall and Hernia Surgery 4, no. 1 (2021): 20. http://dx.doi.org/10.4103/ijawhs.ijawhs_42_20.
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Frigault, J., S. Lemieux, and S. Drolet. "Comment to: Prophylactic retromuscular mesh placement for parastomal hernia prevention. Author’s reply." Hernia 26, no. 2 (2021): 673–74. http://dx.doi.org/10.1007/s10029-021-02513-6.
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Goda El-Santawy, HazemM, HatemMahmod Sultan, AhmadSabry El-Gammal, AhmedFarag El-Kased, and AlaaAbd El-Azeem El-Sisy. "Evaluation of retromuscular mesh repair technique for treatment of ventral incisional hernia." Menoufia Medical Journal 27, no. 2 (2014): 226. http://dx.doi.org/10.4103/1110-2098.141640.
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Fayezizadeh, Mojtaba, Arnab Majumder, Igor Belyansky, and Yuri W. Novitsky. "Outcomes of Retromuscular Porcine Biologic Mesh Repairs Using Transversus Abdominis Release Reconstruction." Journal of the American College of Surgeons 223, no. 3 (2016): 461–68. http://dx.doi.org/10.1016/j.jamcollsurg.2016.06.008.
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Berry, Mark F., Sonya Paisley, David W. Low, and Ernest F. Rosato. "Repair of large complex recurrent incisional hernias with retromuscular mesh and panniculectomy." American Journal of Surgery 194, no. 2 (2007): 199–204. http://dx.doi.org/10.1016/j.amjsurg.2006.10.031.
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Mohamed, Mundhir Said, and Ramadhani Omari Abdalla. "Spontaneous Lumbar Hernia: A Case Report." Annals of African Surgery 20, no. 3 (2023): 99–102. http://dx.doi.org/10.4314/aas.v20i3.5.
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Lumbar hernias are rare, and the diagnosis can be easily missed. Acquired lumbar hernias can occur spontaneously; however, they are increasingly being reported due to trauma or flank surgery. A good history and examination can aid in diagnosis with imaging confirming the condition. Hernia repair can be laparoscopic or through open surgical approaches. We report a case of primary spontaneous lumbar hernia which was managed by an open approach to close the defect with retromuscular mesh placement.
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Sridhar, J., E. M. J. Karthikeyan, Arla Sai Varsha, K. Naresh, and R. Joycey. "Comparative study of retromuscular prefascial placement of mesh versus onlay mesh placement in repair of incisional hernias." MedPulse International Journal of Surgery 12, no. 2 (2019): 52–55. http://dx.doi.org/10.26611/1061221.
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Como, John J., Oliver L. Gunter, Jose J. Diaz, Vanessa P. Ho, and Preston R. Miller. "Use of posterior component separation and transversus abdominis release in trauma and emergency general surgery patients: a case report and review of the literature." Trauma Surgery & Acute Care Open 4, no. 1 (2019): e000268. http://dx.doi.org/10.1136/tsaco-2018-000268.
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Posterior component separation with transversus abdominis release and implantation of synthetic mesh in the retromuscular space is a durable type of repair for many large incisional hernias with recurrence rates consistently less than 10%. The purported advantage of biologic prostheses in contaminated fields has recently been challenged, and the concern for placing synthetic mesh in contaminated fields may be overstated. There are almost no data specifically addressing the use of this type of repair for chronic incisional hernias in trauma and emergency general surgery patients, so research is needed on this patient population. In this review, a case of a trauma patient receiving posterior component separation with transversus abdominis release and implantation of synthetic mesh for a chronic incisional hernia resulting from a gunshot wound to the abdomen is presented, the technique is explained, and relevant literature is reviewed.
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Jinka, Sanjay K. A., and Jeffrey E. Janis. "Clinically Applied Biomechanics of Mesh-reinforced Ventral Hernia Repair: A Practical Review." Plastic and Reconstructive Surgery - Global Open 12, no. 11 (2024): e6294. http://dx.doi.org/10.1097/gox.0000000000006294.
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Background: Ventral hernia repair is inherently prone to recurrence. This article is a practical review that summarizes the literature on the biomechanics of ventral hernia repairs to provide clinically applicable, evidence-based recommendations to reduce hernia recurrence. Methods: A practical review of all relevant literature in PubMed concerning the mechanics of ventral hernia repairs and the forces involved was conducted in August 2023. Results: Of the 598 full-text publications retrieved, 29 satisfied inclusion criteria. Among these, 5 articles included enough numeric data for a quantitative analysis of the ultimate tensile strength of the layers of the abdominal wall. Conclusions: The utilization of mesh in ventral hernia repairs is recommended to strengthen weakened abdominal wall tissue. It is essential to primarily close the anterior sheath with a robust mesh–tissue overlap to promote “load-sharing” between the mesh and the abdominal wall. This approach reduces mesh deformity and stress on fixation points, leading to lower hernia recurrence rates. Minimizing mesh fixation (when placed in the retromuscular plane) can reduce postoperative pain and hospital stay without significantly affecting hernia recurrence. Orienting mesh according to abdominal anisotropy is crucial for reducing mesh stiffness, improving healing, and preventing recurrence. Future studies with advanced computer modeling will continue to provide further insights into mesh biomechanics and abdominal wall healing.
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V. I. Pyatnochka, I. Ya. Dzyubanovsʹkyy, and K. S. Volkov. "MORPHOLOGICAL CHARACTERISTICS OF THE ANTERIOR ABDOMINAL WALL TIS-SUES IN CASES OF IMPLANTATION OF POLYPROPYLENE MESH WITH PRF MEMBRANE." Clinical anatomy and operative surgery 17, no. 3 (2018): 16–23. http://dx.doi.org/10.24061/1727-0847.17.3.2018.3.
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According to the experimental study on Vietnamese pigs after implantation of a polypropylene mesh with PRF membrane into retromuscular space, the results of ultrastructural changes in the cells of muscular aponeurotic layer of abdominal wall were presented. It was proved that on the 14th day of the experiment, inflammatory changes in tissues were expressed significantly less than in cases of the isolated implantation of the polypropylene mesh without PRF membrane. Activation of fibroblasts and signs of fiber structures development around the mesh material increased. In the late experimental period (28 days), at the microscopic and electron-microscopic levels the minor manifestations of inflammatory reaction, improved microcirculation in the area of implantation of the mesh with PRF membrane were found that in turn contributed to the increased activity of fibroblasts and development of collagen fibers around the mesh material. The use of PRF plasma membranes stimulated an active development of new capillaries, improved blood flow, accelerated metabolic processes in tissues, and suddenly increased development of collagen, hyaluronic acid that in turn created favourable environment for a complete integration of the polypropylene mesh into the muscular aponeurotic layer of anterior abdominal wall tissue.
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Ruano-Campos, A., A. E. Pérez-Jiménez, M. E. Ossola Revilla, et al. "P-047 REDUCING THE RISK OF MESH EROSION IN A MODIFIED RETROMUSCULAR SUGARBAKER TECHNIQUE FOR PARASTOMAL HERNIA REPAIR." British Journal of Surgery 110, Supplement_2 (2023). http://dx.doi.org/10.1093/bjs/znad080.183.
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Abstract Aim Modified retromuscular Sugarbaker procedure (SP) is a promising approach for parastomal hernia repair. However, its potential complications, including the risk of mesh erosion, encourages us to develop other techniques of mesh placement. We propose an addition to this parastomal retromuscular mesh reinforcement. Materials and Methods We present the case of a 53 year old-woman, with a history of proctocolectomy with end ileostomy due to anal adenocarcinoma, undergoing emergency surgery due to parastomal hernia incarceration. Sugarbaker repair was performed placing inlay composite mesh fixed with reabsorbable tackers. Subsequently, the patient was admitted for recurrent parastomal hernia and midline ventral hernia surgery. Results We performed a modified retromuscular SP as described by Pauli in 2016. After midline laparotomy, hernia content was reduced and extensive retromuscular dissection with transversus abdominis release (TAR) performed, placing a wide retromuscular polypropylene mesh prior to closing parastomal fascial defect. Stoma was parietalized from lateral to medial in an S-shaped configuration. We placed a segment of bioabsorbable mesh covering the parietalized stoma to avoid direct contact with the polypropylene mesh. No recurrence was detected 3 months after surgery, pending reassessment at 6 months. Conclusions This repair provides the benefits of an open posterior component separation with TAR, maintaining the biomechanics of a functional abdominal wall, whilst offering the advantages of mesh reinforcement in a modified Sugarbaker configuration. Our experience with this novel technique seems promising. Rate of mesh erosion is yet to be defined and requires long-term studies before widespread adoption, with special concern on mesh placement.
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Jensen, K. K., F. Helgstrand, and N. A. Henriksen. "OC-012 NATIONWIDE ANALYSIS OF SHORT-TERM OUTCOMES AFTER LAPAROSCOPIC IPOM VS. ROBOT-ASSISTED RETROMUSCULAR REPAIR OF SMALL TO MEDIUM VENTRAL HERNIA." British Journal of Surgery 110, Supplement_2 (2023). http://dx.doi.org/10.1093/bjs/znad080.019.
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Abstract Aim With the introduction of a robot-assisted approach, retromuscular mesh placement is technically more feasible compared to laparoscopic IPOM, with potential gains for the patient, including avoidance of painful mesh fixation and intraperitoneal mesh placement. We aimed to examine the short-term outcomes after laparoscopic intraperitoneal onlay mesh (IPOM) compared to robot-assisted retromuscular repair of small to medium sized ventral hernia. Material & Methods This was a nationwide cohort study of all patients undergoing either laparoscopic IPOM or robot-assisted retromuscular repair of a ventral hernia with a horizontal fascial defect &lt;7 cm in the period 2017 to 2022. Outcomes included postoperative hospital length of stay, 90-day readmission, and 90-day operative reintervention, and multivariable logistic regression analysis was performed to adjust for the relevant confounder. Results A total of 2,453 patients were included for analysis, of which 389 patients underwent robot-assisted retromuscular hernia repair and 2,064 laparoscopic IPOM repair. The rate of IPOM repaired patients hospitalized more than 2 days was 4 times higher than after robotic retromuscular repair (18.2% vs. 4.5%, P &lt; 0.001). The incidence of readmission within 90 days postoperatively was significantly higher after laparoscopic IPOM repair (10.9% vs. 6.7%, P = 0.016). There was no difference in the incidence of patients undergoing operative intervention within the first 90 days postoperatively (laparoscopic IPOM 1.8% vs. robot-assisted retromuscular 1.3%, P = 0.579). Conclusions Robot-assisted retromuscular ventral hernia repair was associated with a significantly reduced incidence of prolonged length of postoperative hospital stay and risk of 90-day compared to laparoscopic IPOM.
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Drs, A., J. Frank, and J. Fronek. "UNILATERAL TRANSVERSUS ABDOMINIS MUSCLE RELEASE WITH RETROMUSCULAR MESH REPAIR AS A SOLUTION FOR A SECOND RECURRENCE OF LARGE MULTILOCULAR INCISIONAL HERNIA AFTER LIVER TRANSPLANTATION." British Journal of Surgery 111, Supplement_5 (2024). http://dx.doi.org/10.1093/bjs/znae122.284.
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Abstract Background Transversus abdominis muscle release was published by Novitsky et al. in 2012. It is a posterior component separation technique allowing the closure of large abdominal wall defects and the insertion of very large retromuscular meshes without damaging the vessels and intercostal nerves. Method We would like to present a case of a second recurrence of a large multilocular incisional hernia after liver transplantation and its solution. Results We present a patient after liver transplantation in January 2021. In April 2022 retromuscular sublay mesh repair was performed for subcostal incisional hernia. In December 2022 onlay mesh repair was performed for medial recurrence of the previous incisional hernia. Four months later, unfortunately, the second recurrence appeared. At the beginning, we proceeded conservatively, but because of an increasing size of the hernia, we decided to perform a retromuscular mesh plastic. Because of the size of the defect (fascial gap 10 × 20 cm), with the transversus abdominis muscle release. Due to the violated tissue planes after previous plastics, we performed only unilateral (left) release. It was sufficient to close the posterior rectus sheath without any tension. Large retromuscular mesh was placed and covered by closure of the anterior rectus sheaths. The patient was discharged on the third postoperative day without any complications. Conclusion Transversus abdominis muscle release with retromuscular mesh placement provides a great solution for difficult recurrent ventral hernias.
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Maskal, Sara M., Ryan C. Ellis, Aldo Fafaj, et al. "Open Retromuscular Sugarbaker vs Keyhole Mesh Placement for Parastomal Hernia Repair." JAMA Surgery, June 12, 2024. http://dx.doi.org/10.1001/jamasurg.2024.1686.
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ImportanceDurable parastomal hernia repair remains elusive. There is limited evidence comparing the durability of the open retromuscular Sugarbaker and keyhole mesh configurations.ObjectiveTo determine if the open retromuscular Sugarbaker mesh placement technique would lower parastomal hernia recurrence rates.Design, Setting, and ParticipantsIn this single-center, randomized clinical trial, 150 patients with a permanent stoma and associated parastomal hernia who were candidates for open retromuscular parastomal hernia repair were enrolled and randomized from April 2019 to April 2022 and followed up for 2 years.InterventionsFollowing intraoperative assessment to determine the feasibility of either technique, enrolled patients were randomized to receive either retromuscular Sugarbaker or keyhole synthetic mesh placement.Main Outcomes and MeasuresThe primary outcome was parastomal hernia recurrence at 2 years. Secondary outcomes included mesh-related complications, wound complications, reoperations, as well as patient-reported pain, abdominal wall–specific quality of life, stoma-specific quality of life, and decision regret at 1 year and 2 years.ResultsA total of 150 patients were randomized, and with 91% follow-up at 2 years, there were 13 (17%) parastomal hernia recurrences in the retromuscular Sugarbaker arm and 18 (24%) in the keyhole arm (adjusted risk difference, −0.029; 95% CI, −0.17 to 0.153, and adjusted risk ratio, 0.87; 95% CI, 0.42 to 1.69). There were no statistically significant differences between the Sugarbaker and keyhole groups regarding reoperations for recurrence (2 vs 7, respectively), nonhernia intra-abdominal pathology (4 vs 10, respectively), stoma necrosis (1 vs 0, respectively), mesh-related complications (4 vs 1, respectively), patient-reported pain, abdominal wall–specific quality of life, stoma-specific quality of life, and decision regret at any time point.Conclusions and RelevanceIn the setting of open parastomal hernia repair, a retromuscular Sugarbaker mesh placement technique was not superior to a keyhole configuration 2 years after repair. Further innovation is necessary to improve parastomal hernia repair outcomes.Trial RegistrationClinicalTrials.gov Identifier: NCT03972553
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Maskal, S. M., R. C. Ellis, and B. T. Miller. "Parastomal hernia repair, trying to optimize the impossible reconstruction." Hernia, April 28, 2024. http://dx.doi.org/10.1007/s10029-024-03041-9.
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Abstract Purpose Parastomal hernias are a common and challenging problem with high rates of wound complications and hernia recurrence after repair. We present our approach to optimizing parastomal hernia repair through preoperative preparation, surgical approach, and postoperative management. Methods Patients are carefully evaluated and optimized prior to surgery. Our typical surgical approach involves a generous midline laparotomy and retrorectus dissection followed by a posterior component separation with transversus abdominis release. We typically utilize a Sugarbaker technique for retromuscular mesh placement but also use the retromuscular keyhole or cruciate technique if there is insufficient bowel length. Results Previously published results from our institution include wound complication rates of up to 16% after open retromuscular parastomal hernia repair. Stoma-specific complications, such as mesh erosion in the bowel, may be attributed to the mesh placement techniques. Hernia recurrence rates range from 11 to 30% up to 2 years postoperatively. Conclusion We prefer an open retromuscular approach with a Sugarbaker mesh configuration to treat complex parastomal hernias. However, wound morbidity and repair failure rates remain high, and additional research is needed to optimize surgical outcomes.
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Miller, Benjamin T., Jonah D. Thomas, Chao Tu, et al. "Comparing Sugarbaker versus keyhole mesh technique for open retromuscular parastomal hernia repair: study protocol for a registry-based randomized controlled trial." Trials 23, no. 1 (2022). http://dx.doi.org/10.1186/s13063-022-06207-x.
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Abstract Background Parastomal hernia, common after stoma creation, negatively impacts patient quality of life. For patients with a permanent stoma, durable parastomal hernia repair remains a challenge, with few high-quality studies for guidance. An alternative to open retromuscular parastomal hernia repair with retromuscular “keyhole” mesh is the recent Sugarbaker modification. We aim to compare these two techniques in a head-to-head prospective study. Methods This is a registry-based randomized controlled trial designed to investigate whether the retromuscular Sugarbaker technique is superior to the retromuscular keyhole technique for parastomal hernia repair. The primary study endpoint is parastomal hernia recurrence at 2 years. Secondary endpoints include hospital length-of-stay, readmission, wound morbidity, mesh-related complications, re-operation, all 30-day morbidity, and patient-reported outcomes, including hernia-related quality of life, stoma-specific quality of life, pain, and decision regret. Discussion Based on the post hoc analysis of a recent randomized controlled trial, we hypothesize that the retromuscular Sugarbaker technique will reduce parastomal hernia recurrence by 20% at 2 years compared to the retromuscular keyhole mesh technique. The results of this study may provide evidence-based guidance for surgeons repairing parastomal hernias. Trial registration ClinicalTrials.gov NCT03972553. Registered on 3 June 2019
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Mück, Björn, Frank Heinzelamann, Robert Vogel, and Peter Büchler. "P135 ESTABLISHMENT OF MINIMALLY INVASIVE VENTRAL HERNIA REPAIR WITH EXTRAPERITONEAL MESH PLACEMENT AS A STANDARD APPROACH OF VENTRAL HERNIA REPAIR USING THE ROBOTIC PLATFORM." British Journal of Surgery 108, Supplement_8 (2021). http://dx.doi.org/10.1093/bjs/znab395.128.
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Abstract Aim Several meta-analyses indicated, that extraperitoneal mesh placement in the retromuscular or preperitoneal space shows advantages over intraperitoneal mesh placement. Previous surgical interventions which included extraperitoneal mesh placement were usually performed using open surgery. For several years now, our hospital has pursued to treat ventral hernias using a minimally invasive approach with extraperitoneal mesh placement. A Da Vinci X system has been available since the beginning of 2019. The aim of this analysis is to show the process of changing the operative procedure in ventral hernia repair over the period from 2016 to 2020. Material and Methods All hernia operations from 2016-2020 were evaluated using our hospitals information system. Every surgical intervention which included ventral hernia repair with the indication for mesh implantation was taken into the analysis. Results In 2016, the proportion of minimally invasive procedures was 36.67%. In all of these cases an intraperitoneal mesh was implanted in the abdominal cavity (laparoscopic IPOM operation). Open surgery was performed in 63.33%, out of which we implanted an intraperitoneal mesh in 23.68%, a retromuscular mesh in 73.68% and an onlay mesh in 2.63% of the cases. In 2020, the proportion of minimally invasive operations was already 87.5%, of which 83.33% were performed robotically assisted and 16.67% laparoscopically. In 94.29% of the minimally invasive operated patients an extraperitoneal mesh implantation was carried out, among which 75.76% were placed in the retromuscular and 24.24% in the preperitoneal position. Conclusions The majority of elective operations on ventral hernias can be performed in a minimally invasive technique with retromuscular mesh placement, using the robot.
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Gröger, Christian, Lena Kundel, Ulrich Adam, and Hartwig Riediger. "P083 PARASTOMAL HERNIA REPAIR - EXPERIENCES WITH THE MODIFIED RETROMUSCULAR SUGARBAKER TECHNIQUE." British Journal of Surgery 108, Supplement_8 (2021). http://dx.doi.org/10.1093/bjs/znab395.077.
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Abstract Aim Parastomal hernias are complex findings with a high recurrence rate. Various methods were described for surgical repair. A new method for the treatment of parastomal hernias with extraperitoneal mesh placement was published in 2016 (Pauli et al.). Recently, open retromuscular repair has been shown to be safe, effective and durable (Beffa et al. 2017). Still, there are concerns regarding mesh related complications (Tastaldi et al. 2017). Material and Methods All patients who underwent an open or laparoscopic modified retromuscular Sugarbaker parastomal hernia repair at our institution were identified. We describe the patient characteristics, operative details, perioperative results and the follow-up. Results Between January 2018 to May 2021 14 patients received surgical repair for parastomal hernia at our institution. Eight of these patients received retromuscular extraperitoneal mesh placement (4 open, 4 laparoscopic) in the aforementioned technique. The median age was 72 years (65 – 85) and the median BMI was 31 kg/m² (26 – 34). Six patients had a urostomy and two had a colostomy. One patient had a recurrent parastomal hernia after previous intraabdominal mesh repair. The median operating time was 223 minutes (144 – 425). Median Mesh size was 300 cm² (225 – 750). Two minor complications (Clavien-Dindo Classification Grade II) demanding pharmacological treatment. The median hospital stay was 8 days (4 – 17). Median follow up was 17 month (range 1 – 26). Recurrence rate was 25 %. Conclusions The modified retromuscular sugerbaker technique seems to be safe and feasible as shown by our data. Due to the extraperitoneal mesh position, we see fundamental methodological advantages. Further studies are necessary for long-term results.
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Rodríguez González, D., B. Guil-Ortiz, C. Tuñón-Féquant, R. Casanova-Ramos, A. Montes-Montero, and I. J. Arteaga-González. "V-004 ROBOTIC PARASTOMAL HERNIA REPAIR WITH RETROMUSCULAR MESH (PAULI TECHNIQUE)." British Journal of Surgery 110, Supplement_2 (2023). http://dx.doi.org/10.1093/bjs/znad080.237.
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Abstract Aim Parastomal hernia is a common complication of ostomy formation. We present a case of robotic parastomal hernia repair with retromuscular mesh (Pauli technique). Material and Methods Patient was 58 years-old man and had history of anterior resection of the rectum, terminal colostomy and onlay mesh parastomal hernia repair. After 2 months of parastomal hernia repair, the patient developed a recurrence (type III, European Hernia Society Classification). Results Robotic parastomal hernia repair was performed with transabdominal approach. Firstly, a small adhesiolysis of the colon to the stoma orifice was made. Then, the peritoneum and posterior sheath of the left rectus muscle was incised. The retrorectal space was dissected. The hernia sac was incised circumferentially. TAR dissection was launched lateral to the stoma. After the development of the landing zone for the mesh, the posterior retromuscular fascia was incised lateral to the stoma. The inner orifice of stoma was repositioned. A large-pore polypropylene mesh (20×28 cm) was placed in the retromuscular space and fixed it, lateral to the ostomy orifice. Finally, the retromuscular pocket was closed by suturing the posterior fascia to the linea alba. The patient was discharged on postoperative day 4 and had no complications. After 4 months of follow-up, no hernia recurrence had been recorded. Conclusions Robotic Pauli is a technique to repair parastomal hernias that provides wide coverage of the defect and avoids leaving mesh intraperitoneally. They could provide a secure repair and prevent postoperative complications (pain or intestinal ileus). It is technically challenging but feasible.
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"E-TEP in Ventral and Incisional Hernia Repair – Our Experiences." South-East Europe Endo-Surgery Journal, April 1, 2022. http://dx.doi.org/10.55791/2831-0098.1.1.99.
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Background: Rives-Stoppa repair has become the standard for repairing ventral and incisional hernias. The endoscopic retromuscular approach has the same benefits and offers the advantages of minimal invasive surgery. Method: The technique is based on the retromuscular approach to the linea semilunaris (longitudinal technique) or the linea semicircularis (transverse technique). The incision is made on the anterior rectus sheath, and the trocar is placed below the muscle. A retromuscular space is created and the neck of the hernia sac can be reached. Upon release of the hernia, the sheath of the opposite rectus muscle opens up entirely up to the semilunar line, allowing the creation of enough space for placing the mesh. The mesh can be fixed using transcutaneous sutures, glue or be non-fixed. It is not always necessary to close the defect. Results: Between 2003 and 2017 we performed 108 operations. We had 35 umbilical, 17 epigastric, one Spigelian and 55 incisional hernias. There were no intraoperative complications with ventral hernias, and one bowel injury in the incisional hernia group. There were five conversions and four recurrences. All of them were caused by a small mesh, after insufficient dissection. There were no infections. Conclusion: Unlike LVRH, e-TEP will probably achieve the results and benefits of the retromuscular open technique.
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Wang, Dianchen, Shouhua Zheng, Xinguang Qiu, and Yang Fu. "Immediate Repair With a Self-Gripping Retromuscular Mesh for Abdominal Wall Defect Following Tumor Resection." Surgical Innovation, March 31, 2022, 155335062210870. http://dx.doi.org/10.1177/15533506221087074.
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Background: Prosthetic repair is always employed after large abdominal wall tumor resection, while chronic pain is one of the mesh-related complications after traumatic fixation. The objective of this research was to evaluate the outcomes of retromuscular repair with self-gripping mesh after abdominal wall tumor resection. Methods: The study was a monocentric retrospective analysis following STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) statements of all patients with abdominal wall tumor >5 cm in diameter undergoing tumor excision and retromuscular repair with self-gripping mesh. Demographic, operative, early postoperative, and follow-up data were noted. Visual Analog Scale, ranging from 0 (no pain) to 10 (very severe pain), was used to estimate the wound pain. Results: 24 patients were included in this study, and the defect following tumor resection was 26.9±10.0 cm2. There was no tumor recurrence or incisional hernia in median follow-up of 20 months, and the mean VAS score was 0.4. Three had foreign body feeling and no one suffered chronic pain. Conclusions: Immediate repair with a self-gripping retromuscular mesh can be considered as an effective way to treat an abdominal wall defect after resecting an abdominal wall tumor.
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Juul, N., N. A. Henriksen, and K. K. Jensen. "Increased risk of postoperative complications with retromuscular mesh placement in emergency incisional hernia repair: A nationwide register-based cohort study." Scandinavian Journal of Surgery, October 22, 2020, 145749692096623. http://dx.doi.org/10.1177/1457496920966237.
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Introduction: Incisional hernia is common after abdominal surgery. Watchful waiting carries the risk of incarceration and a need for emergency intervention. The aim of this study was to examine the risk of postoperative complications after emergency versus elective incisional hernia repair. Methods: Patients above 18 years of age undergoing open incisional hernia repair in Denmark in 2017–2018 were identified in the Danish Ventral Hernia Database. Patients were grouped according to elective or emergency hernia repair. The primary outcome was postoperative complications requiring operative intervention within 90 days, and the secondary outcome was postoperative length of stay. Results: We included 1050 patients, of whom 882 were admitted for elective and 168 for emergency operation. Patients undergoing emergency repair were older (64.7 years vs 59.2 years, p < 0.001), more often smokers (25.8% vs 13.6%, p = 0.003), and more often had a Charlson comorbidity score ⩾2 (26.8% vs 19.2%, p = 0.005) compared to patients undergoing elective repair. In a multivariate regression analysis, emergency compared to elective operation (OR = 2.71, 95% CI = 1.4–5.25, p = 0.003) and retromuscular compared to onlay mesh placement (OR = 2.14, 95% CI = 1.08–4.24, p = 0.013) were factors significantly associated with increased risk of postoperative complications. In a subgroup analysis including only emergency repairs, risk of complications after retromuscular mesh placement was even higher (OR = 10.12, 95% CI = 1.81–56.68, p = 0.008). Conclusion: Emergency incisional hernia repair was associated with increased risk of postoperative complications and this risk was accentuated with retromuscular mesh placement. The use of retromuscular mesh in the emergency setting should be avoided, and the abdominal wall could either be closed by sutures or additional onlay mesh.
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Gallardo, A., J. L. Garcia, P. Talavera, et al. "PARASTOMAL HERNIA REPAIR IN BRICKER TYPE URINARY DIVERSION USING THE MODIFIED PAULI TECHNIQUE: A CASE REPORT." British Journal of Surgery 111, Supplement_5 (2024). http://dx.doi.org/10.1093/bjs/znae122.307.
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Abstract Introduction The incidence of parastomal hernia (PH) associated with Bricker ileal urinary diversion is approximately 20%. Surgery becomes necessary in the presence of symptoms or development of complications. Clinical case A 77-year-old woman with a Bricker urinary diversion following radical cystectomy presented to the emergency department with 72 hours of evolving obstructive symptoms, coupled with a large PH featuring incarcerated bowel. A CT scan confirmed complete intestinal obstruction. Urgent surgery was conducted, revealing ileum incarceration without perforations. Reduction of the intestinal content was performed, restoring viability. Transversus abdominis release (TAR) around the stoma was executed, followed by the placement of a retromuscular progrip mesh using the Pauli technique. The patient was discharged after 8 days without complications. Discussion The surgical treatment of PH remains controversial, lacking a consensus as the most effective technique. We opted for modified Pauli technique, involving retromuscular dissection, subsequent components separation via TAR and mesh repair according to the Keyhole technique. This combination leverages the advantages of each of procedures to reduce the recurrence risk: retromuscular mesh placement physiologically pushing the wall, utilization of wider prostheses reinforcing a larger surface area, complete mesh contact with the wall facilitating integration around the defect, and direct stoma exit without the need for repositioning. Conclusions The modified Pauli technique with Keyhole mesh placement, while demanding, can provide advantages in emergency surgery without causing significant postoperative complications.
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Barranquero, A. G., R. Villalobos Mori, Y. Maestre González, E. Gutiérrez, and J. Olsina Kissler. "V-008 ROBOTIC TOTALLY EXTRAPERITONEAL RETROMUSCULAR REPAIR OF A TYPE III PARASTOMAL HERNIA." British Journal of Surgery 109, Supplement_7 (2022). http://dx.doi.org/10.1093/bjs/znac308.260.
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Abstract Aim The retromuscular repair described by Pauli et al. (2016) dissects the retromuscular space, releases the transversus muscle, and lateralizes the stoma to place a retromuscular mesh. The aim was to show the results of the robotic approach for this intervention. Material & Methods Video description of a case report. The patient was a 71-year-old woman that underwent an abdominoperineal resection for rectal cancer in 2017 and presented with a 5.8 cm parastomal hernia without midline defects (type III of the EHS classification). Results Three robotic trocars were placed in the lateral of the right rectus sheath, and posteriorly a 12 mm assistance port was inserted in the left hypochondrium. The dissection began in the inferior preperitoneal space, until finding the left transversus muscle. Then, the rectus sheath was dissected superiorly and laterally. A posterior rectus sheath release was performed in a down–to–up direction, initially avoiding the parastomal hernia, which was later reduced. Posteriorly, the peritoneum was incised and then sutured to lateralize the stoma. The parastomal hernia defect and the posterior rectus sheath were equally sutured. Finally, a polyvinylidene difluoride (PVDF) mesh was placed in the retromuscular space, which was fixed with transfascial sutures to the sides of the stoma. Conclusions The robotic totally extraperitoneal retromuscular approach for parastomal hernias is safe and feasible, with the advantage of avoiding the intraperitoneal space.
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Pokorny, H., P. S. Koo, M. Hofmann, M. Schlögl, and K. Reznicek. "OC-029 E- MILOS EXTRAPERITONEAL MESH REPAIR OF UMBILICAL HERNIAS WITH COMBINED RECTUSDIASTASIS." British Journal of Surgery 110, Supplement_2 (2023). http://dx.doi.org/10.1093/bjs/znad080.036.
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Abstract Aim Umbilical hernias with combined rectusdiastasis have a higher risk für recurrence after single repair of the umbilical hernia. The E- MILOS concept enables the minimal invasive sublay mesh repair realizing the benefits of minimally invasive surgery and placing the mesh in the retromuscular position. Materials & Methods All E- MILOS operations were documented prospectively. For 1 year follow-up all patients received a questionnaire. Results From January 2019 to December 2022, 89 patients (24 female/65 male) with umbilical hernia and a coexisting rectus diastasis (median hernia size 2 cm/diastasis recti 5,5 cm) and median age of 61 yrs were operated by 3 experienced surgeons. In all cases a polypropylene mesh (median size 40×12 cm) was implanted in the retromuscular space without any fixation and continuous suture (V-Loc 2–0) of the anterior and posterior rectus sheet was achieved for reconstructing the midline. The average skin incision was 4,5 cm; median operation time was 125 min. The median hospital stay was 5 days, the postoperative median pain score (VAS) was 2. Two patients needed reoperation due to a retromuscular haematoma. Chronic pain was reported by 13 patients, no postoperative infection and 4 recurrences were observed. Not satisfied with the cosmetic result (subcutaneous bulging) were 4 female patients. Conclusions The E- MILOS technique allows minimally invasive transhernial repair of umbilical hernias with combined rectusdiastasis using large retromuscular meshes with low morbidity. The technique is reliable and easy to standardize and shows mostly good cosmetic results.
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Trujillo Díaz, J., C. Jezieniecki Fernández, J. R. Gomez Lopez, et al. "V-004 REDO ETEP APPROACH FOR SMALL BOWEL INCARCERATION DUE TO POSTERIOR SHEATH SEPARATION: AN UNUSUAL COMPLICATION." British Journal of Surgery 109, Supplement_7 (2022). http://dx.doi.org/10.1093/bjs/znac308.256.
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Abstract Aims The retromuscular-preperitoneal approach of primary or incisional hernias is a technique that is being performed more frequently due to the more anatomical position of the mesh, the lower rates of complications and recurrences in the short and long term.However, this technique is not without complications, the most frequent being retromuscular seromas or hematomas, the rarest being incarcerated hernias secondary to dehiscence of the posterior sheath closure,hence the importance of presenting this case. Methods Video-case presentation. Results 40-year-old man with surgical histories:open appendectomy 20years-ago, and endoscopic repair(eTEP-Rives) of umbilical hernia and diastasis of the rectus abdominis. He went to the emergency room 4days after surgery(eTEP) due to sudden, intense abdominal pain, located in the mesogastrium.Abdominal-CT:hernial defect at the umbilical level (posterior-sheath-dehiscence) with incarcerated and dilated small-bowel inside. We decided to perform urgent surgical intervention.An iterative eTEP-retromuscular-laparoscopic-approach was performed,observing hernial defect due to dehiscence of the posterior-sheath suture at the umbilical level with incarcerated small bowel loops within the retromuscular space.Hernia content revision and reduction is performed, previous mesh is removed and since tension is visualized for the closure of the hernial defect, right Hemi-TAR is performed, after which a tension-free closure of the the posterior sheath, and PVDF-mesh is placed.The patient presented a satisfactory evolution. Conclusions The enhanced view totally-extraperitoneal-approach(eTEP) is a valid, effective and safe option in cases of acute complications,such as the one presented,through which more complex separation techniques(TAR) can be associated to achieve a correct and tension-free closure of the abdominal wall, presenting the advantages of MIS.
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Vogel, R., F. Heinzelmann, P. Büchler, and B. Mück. "ROBOT-ASSISTED EXTRAPERITONEAL VENTRAL HERNIA REPAIR—EXPERIENCE FROM THE FIRST 160 CONSECUTIVE OPERATIONS WITH LATERAL eTEP AND eTAR TECHNIQUES." British Journal of Surgery 111, Supplement_5 (2024). http://dx.doi.org/10.1093/bjs/znae122.104.
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Abstract Background As in various other surgical domains, robotically assisted procedures have become integral in the management of ventral hernias in recent years. The employment of robotic technology enables the integration of minimally invasive techniques with retromuscular mesh placement. Beyond the conventional transabdominal approach, these surgical interventions can alternatively be executed in a total extraperitoneal fashion. The objective of this study is to demonstrate that robotic total extraperitoneal management of abdominal wall hernias is safe and efficient. Method A retrospective analysis encompassing all patients who underwent robotic surgery for ventral hernia repair utilizing the extraperitoneal eTEP technique with a lateral approach was conducted. The study period spanned from December 2019 to December 2023. Results Over the study period, a total of 160 patients underwent surgical intervention utilizing the lateral robotic eTEP technique. Among these cases, 43 patients required a lateral extension of retro-rectal dissection through extraperitoneal transversus abdominis release (eTAR) due to either the hernia size or lateral hernia localization. In every instance, an uncoated synthetic mesh was positioned in the retromuscular location, accompanied by complete fascial closure. The median hernia defect area was 25 cm² (2.25–375 cm²). The median mesh size was 540 cm² (225–1350 cm²). The median mesh defect ratio (MDR) was 21 (2.3–150). Two conversions (1.72%) were necessary. One intraoperative and seven postoperative complications were encountered (5%) out of which two required reoperations (1.72%). Conclusion The robotic extraperitoneal eTEP technique enables a retromuscular mesh placement in a minimally invasive approach. With the possibility of combination with a transversus abdominis release, even complex findings can be treated using this technique.
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Ahmed, Usamah, Jacob Rosenberg, and Jason Joe Baker. "Chronic pain and foreign body sensation based on mesh placement in primary ventral hernia repair: a systematic review highlighting the evidence gap and a call to action." Langenbeck's Archives of Surgery 410, no. 1 (2025). https://doi.org/10.1007/s00423-025-03671-2.
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Abstract Purpose This systematic review aimed to investigate differences in chronic pain and foreign body sensation based on mesh placement, with recurrence as a secondary outcome. Methods The review was registered in PROSPERO (ID: CRD42024592114), and searches were conducted in MEDLINE (PubMed), Embase Ovid, and Cochrane CENTRAL on October 3rd, 2024. Studies were included if they compared mesh placements, categorized as onlay, retromuscular, preperitoneal, or intraperitoneal onlay mesh (IPOM), in primary ventral hernia repairs in adults. Chronic pain (≥ 6 months post-surgery) and foreign body sensation were the primary outcomes. Randomized controlled trials (RCTs) and cohort studies were included, while incisional hernias alone and animal studies were excluded. Risk of bias was assessed using the Newcastle-Ottawa Scale for observational studies and Cochrane Risk of Bias 2 (RoB2) tool for RCTs. Due to significant heterogeneity, a meta-analysis was not feasible, and a narrative synthesis was provided. Results A total of 6,562 records were screened, of which nine cohort studies and one RCT were included. Studies were heterogeneous and many did not aim to assess chronic pain as the primary outcome. Two studies reported significantly lower chronic pain rates with retromuscular mesh placement, but data pooling was not possible. Foreign body sensation could not be assessed because the only study reporting on this did not have extractable data. Conclusion Currently, there is insufficient evidence to favor one mesh placement over another for chronic pain or foreign body sensation. While crude rates suggest that retromuscular and preperitoneal placements may result in less chronic pain than onlay and IPOM, the evidence remains very uncertain due to significant clinical and methodological heterogeneity. Further research is warranted.
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García Ureña, M. Á., M. Medina, A. Avilés, et al. "V-018 PAULI REPAIR FOR THE COMBINATION OF MIDLINE INCISIONAL AND PARASTOMAL HERNIAS." British Journal of Surgery 110, Supplement_2 (2023). http://dx.doi.org/10.1093/bjs/znad080.251.
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Abstract Introduction Parastomal hernias (PH) can be a complex surgical problem. When there is a combination of midline and parastomal hernias, an option could be using both posterior component separation technique and an intraparietal Sugarbaker as described by Pauli. We present a case with the combination of midline and parastomal hernias. The aim of this video is to offer the most relevant steps that should be followed for a Pauli repair. Methods This is a 75 years-old man,, that underwent abdominoperineal resection for rectal cancer T3N2 in 2018. He developed a very symptomatic incisional hernia + parastomal and repaired was offered. After adhesiolysis, a retromuscular Rives dissection and a left posterior component separation were made. A Pauli was planned lateralizing the bowel in the retromuscular plane (like an intraparietal Sugarbaker repair) and a biosynthetic mesh was used in the retromuscular preperitoneal plane, making an inner stoma site with the mesh and bringing the colon trough the previous stoma site. Finally, anterior abdominal wall was closed Results The patient was discharged uneventfully on the 6th postoperative day. Discussion Pauli described 3 patients in similar circumstances but leaving the new posterior ostomy site lateral to the mesh. This technique that we describe in this video could be particularly useful in patients in whom a simpler Sugarbaker laparoscopic repair is not adequate and in those cases with PH with concomitant midline defects.
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Bloemendaal, A. L. A. "Robotic Retromuscular (Recurrent) Parastomal Hernia Repair (r-Pauli-Repair) With Synthetically Reinforced Biological Mesh; Technique, Early Experience, and Short-Term Follow-Up." Journal of Abdominal Wall Surgery 2 (December 13, 2023). http://dx.doi.org/10.3389/jaws.2023.12059.
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Introduction: Parastomal hernia repair remains a challenge. We describe a robotic retromuscular non-keyhole mesh repair using a synthetically reinforced biological mesh (Ovitex) for the repair of complex and/or recurrent parastomal hernia and technical modifications we made along the way to improve our technique.Methods: All patients underwent the described retromuscular parastomal hernia repair. Data was collected in a database and a retrospective analysis was performed on direct postoperative results and early follow-up.Results: Eleven patients underwent the operation. Median follow-up was 12 months. Median LOS was 6 days. Two recurrences occurred. One patient suffered postoperative hematoma and skin necrosis, which healed completely, but did lead to a recurrence. One patient had a significant seroma, which subsided without intervention. Both recurrences were reoperated, and a local repair was performed.Conclusion: This paper is the first to describe a modified robotic Pauli repair for complex and recurrent parastomal hernia, using a synthetically reinforced biological mesh. Results are satisfying so far, especially considering the complexity of the cases.
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Eklöv, Karolina, Sven Bringman, Jenny Löfgren, Jonas Nygren, and Åsa H. Everhov. "PHaLIR: prevent hernia after loop ileostomy reversal—a study protocol for a randomized controlled multicenter study." Trials 24, no. 1 (2023). http://dx.doi.org/10.1186/s13063-023-07430-w.
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Abstract Background Rectal cancer is a common cancer worldwide. Surgery for rectal cancer with low anterior resection often includes the formation of a temporary protective loop ileostomy. The temporary ostomy is later reversed in a separate operation. One complication following stoma closure is the development of a hernia at the former stoma site, and this has been reported in 7–15% of patients. The best method to avoid hernia after stoma closure is unclear. The most common closure is by suturing only, but different forms of mesh have been tried. Biological mesh has in a randomized trial halved hernia incidence after stoma reversal. Biosynthetic mesh and retromuscular mesh are currently being evaluated in ongoing studies. Methods The present multicenter, double-blinded, randomized, controlled study will compare standard suture closure of the abdominal wall in loop ileostomy reversal with retromuscular synthetic mesh at the stoma site. The study has been approved by the Regional Ethical Review board in Stockholm. Patients aged 18–90 years, operated on with low anterior resection and a protective loop ileostomy for rectal cancer and planned for ileostomy reversal, will be considered for inclusion in the study. Randomization will be 1:1 on the operation day with concealed envelopes. The estimated sample size is intended to evaluate the superiority of the experimental arm and to detect a reduction of hernia occurrence from 12 to 3%. The operation method is blinded to the patients and in the chart and for the observer at the 30-day follow-up. The main outcome is hernia occurrence at the stoma site within 3 years postoperatively, diagnosed through CT with strain. Secondary outcomes are operation time, length of hospital stay, pain, and 30-day complications. Discussion This double-blinded randomized controlled superiority study will compare retromuscular synthetic mesh during the closure of loop ileostomy to standard care. If this study can show a lower frequency of hernia with the use of prophylactic mesh, it may lead to new surgical guidelines during stoma closure. Trial registration ClinicalTrials.gov NCT03720262. Registered on October 25, 2018.
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Musilova, Z., and V. Handl. "CASE REPORT: OUR MISTAKES IN THE eMILOS TECHNIQUE LEADING TO THE NEED FOR REOPERATION." British Journal of Surgery 111, Supplement_5 (2024). http://dx.doi.org/10.1093/bjs/znae122.399.
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Abstract The Endoscopic MILOS (Mini- or Less-Open Sublay) technique has demonstrably fewer complications, favorable healing, a better cosmetic effect. Adherence to the precise procedure is necessary for a successful operation and patient satisfaction. This case report presents our mistakes that led to the reoperation and could have been avoided. The patient underwent eMILOS hernioplasty in 2019 for an umbilical hernia with a symptomatic wide diastasis extending to the xiphoid. Mesh was implanted retromusculary with fixation to the xiphoid. The wound healed primarily, however, on the 13th postoperative day, patient felt a burst beneath the xiphoid without any complications. In 2023, the patient presented with year-lasting subxiphoidal pain. A palpable resistance was found in the abdominal wall in the epigastric region. A CT scan revealed a hyperdense infiltrate at the site of the mesh. During the reoperation, a retromuscular calcified hematoma (14 × 6 cm) was found wrapped in a folded mesh. The hematoma with a portion of the mesh was removed. The likely cause of the formation of the calcified hematoma was a torn fixation suture of the mesh to the xiphoid. The resulting hematoma leaked into the folds of the mesh, did not absorb, and calcified. The mesh was likely extremely wide, leading to its wrinkling. In conclusion, we would like to emphasize that fixation of the mesh is not necessary in eMILOS, and the accurate size of the implanted mesh is crucial. The patient could have avoided painful laparotomy, and the cosmetic effect would have been more favourable.
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Blázquez, Luis Alberto, Diego Oto, Belén Porrero, José Manuel Molina, Paula Pastor, and María del Rocío Nieto. "P029 HOW DOES THE MADRID APPROACH WORK." British Journal of Surgery 108, Supplement_8 (2021). http://dx.doi.org/10.1093/bjs/znab395.027.
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Abstract Aim The Madrid APPROACH is the combination of an absorbable mesh and a permanent retromuscular mesh for the treatment of the complex abdominal wall problems. It has been controversial because of the need of two different meshes. We present a clinic case to show the utility of this technique and how it allows rebuilding the inguinal ligament. Material and Methods 78 years old woman who underwent a right ilioinguinal and obturatriz lymphadenectomy due to a melanoma. Incisional hernia fixed in 2018 with a retromuscular polyester mesh. New incisional iliac hernia (L3) over the right iliac vessels, with an absence of inguinal ligament, right rectus atrophy, and the previous mesh being part of the sac. Surgery: incision over the previous scar. Wide dissection of the preperitoneal space, Retzius space and lateral to the cuadratus lumborum, retrodiafragmatic dissection, lateral transverse abdominus release, and cross-over to the retrorectal left space. Preperitoneal BioA mesh and an upper 40x40cm medium weight polipropilene mesh set to both Cooper ligaments. Results After two and a half months, a PET-TC showed the BioA mesh perfectly adapted to the abdominal wall and rebuilt a new inguinal ligament. Also intense FDG capitation of the mesh due to the high cellular metabolism. Two years later the patient has a continent abdominal wall, the follow up TC shows the disappearance of the absorbable mesh and the perfect abdominal wall rebuilt. Conclusions The BioA mesh acts like a tissue scaffold for new conjunctive tissue as we see the intense FDG captation. The Madrid APPROACH allows giving response to very complex abdominal wall problems.
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Fafaj, Aldo, Lucas R. A. Beffa, Clayton C. Petro, et al. "Comparing Short-Term Outcomes of Ventral Hernia Repair Using Heavyweight Non-Woven Polypropylene Mesh With Heavyweight Knitted Polypropylene Mesh." Journal of Abdominal Wall Surgery 4 (April 4, 2025). https://doi.org/10.3389/jaws.2025.14316.
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IntroductionThe mesh choice for the majority of our retromuscular repairs is heavyweight knitted polypropylene (KP) mesh. However, supply chain issues necessitated a change to a newer non-woven polypropylene mesh (NWP). We aimed to evaluate our initial experience with using NWP mesh in retromuscular abdominal wall reconstruction.MethodsWe performed a retrospective review of all patients at our institution who underwent elective, open incisional hernia repair with NWP or KP mesh from January 2014 until December 2023. The analyzed variables included patient demographics, comorbidities, operative techniques, mesh type, position, and postoperative outcomes. A propensity score model and matching algorithms were implemented to address potential treatment-choice bias. Patients receiving NWP mesh were matched with patients receiving KP mesh in a 1:2 ratio.ResultsA total of 771 patients were included in the study, 63 (8.2%) patients had their hernia repaired with NWP and 708 (91.2%) patients with KP mesh. After propensity score matching, 63 patients in the NWP group and 126 in the KP were analyzed. At 30-day follow-up, there were significantly more deep SSIs in the NWP group, however, there were no differences in readmission, reoperation, hernia recurrence, and overall SSI, SSO, and SSOPI.ConclusionRetromuscular hernia repaired with non-woven polypropylene mesh showed no difference in readmission, reoperation, hernia recurrence, and overall SSI, SSO, and SSOPI when compared with knitted polypropylene. There were significantly more deep SSIs in the NWP group; however, in all cases, the mesh was salvaged with local wound care, and all patients made a complete recovery. In the short term, the use of NWP mesh appears to be safe, with outcomes comparable to KP mesh.
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Lopez-Monclus, J., J. Muñoz Rodriguez, L. Roman García De Leon, et al. "P-136 MANAGEMENT OF DIRTY ABDOMINAL WALL SITUATIONS WITH AN OVINE RUMEN BIOLOGIC MESH WITH POLYPROPYLENE REINFORCEMENT." British Journal of Surgery 109, Supplement_7 (2022). http://dx.doi.org/10.1093/bjs/znac308.233.
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Abstract Aim To present our initial results of abdominal wall surgery in dirty situations with an ovine rumen (OR) biologic mesh reinforced with polypropylene. Patients and Methods Five patients with elective abdominal wall surgery in a dirty setting were included. Two cases were previous PTFE mesh infections after IPOM repairs, one case of enteroatmospheric fistula through a previous posterior component separation repair, one deep tissue infection after a MILOS retromuscular repair and one definitive closure after a 8 weeks open abdomen in a liver transplantation patient. In the five cases cultures showed polymicrobian infections. Both PTFE meshes were removed and substituted by the OR biologic mesh. In the enteroatmospheric fistula patient the exposed mesh was resected together with the fistula take down, and a re-Rives was performed. In the case of the MILOS deep tissue infection after two weeks with an open abdomen and a temporary abdominal closure the definitive closure was performed with the biologic mesh in the retromuscular space. In the definitive closure of the liver transplantation patient the mesh was placed intraperitoneally as prophylaxis. Results In four cases there weren´t any surgical sites ocurrences. In the case of the enteroatmospheric fistula the patient presented a partial fascial dehiscence with mesh exposure, managed with a VAC system. With less than a year follow up no hernia recurrence has taken place. Conclusión The use of an OR biologic mesh with polypropylene reinforcement seems to be safe in abdominal wall repair in dirty settings, with good results during early follow up.
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López-Cano, M., M. Adell-Trapé, M. Verdaguer-Tremolosa, V. Rodrigues-Gonçalves, J. Badia-Closa, and X. Serra-Aracil. "Parastomal hernia prevention with permanent mesh in end colostomy: failure with late follow-up of cohorts in three randomized trials." Hernia, March 25, 2023. http://dx.doi.org/10.1007/s10029-023-02781-4.
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Abstract Purpose Short-term results have been reported regarding parastomal hernia (PH) prevention with a permanent mesh. Long-term results are scarce. The objective was to assess the long-term PH occurrence after a prophylactic synthetic non-absorbable mesh. Methods Long-term data of three randomized controlled trials (RCTs) were collected. The primary outcome was the detection of PH based exclusively on a radiological diagnosis by computed tomography (CT) performed during the long-term follow-up. The Kaplan–Meier method was used for the comparison of time to diagnosis of PH according to the presence of mesh vs. no-mesh and the technique of mesh insertion: open retromuscular, laparoscopic keyhole, and laparoscopic modified Sugarbaker. Results We studied 121 patients (87 men, median age 70 years), 82 (67.8%) of which developed a PH. The median overall length of follow-up was 48.5 months [interquartile range (IQR) 14.4–104.9], with a median time until PH diagnosis of 17.7 months (IQR 9.3–49.0). The survival analysis did not show significant differences in the time to development of a PH according to the presence or absence of a prophylactic mesh neither in the overall study population (log-rank, P = 0.094) nor in the groups of each technique of mesh insertion, although according to the surgical technique, a higher reduction in the appearance of PH for the open retromuscular technique was found (log-rank, P = 0.001). Conclusion In the long-term follow-up placement of a non-absorbable synthetic prophylactic mesh in the context of an elective end colostomy does not seem effective for preventing PH.
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Kroh, Andreas, Markus Zufacher, Roman Eickhoff, et al. "No difference in outcomes between large- and small-pore meshes in a prospective, randomized, multicenter trial investigating open retromuscular meshplasty for incisional hernia repair." Langenbeck's Archives of Surgery 408, no. 1 (2023). http://dx.doi.org/10.1007/s00423-022-02751-x.
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Abstract Study design A randomized, controlled, prospective multicenter clinical trial with a parallel group design was initiated in eight surgical centers to compare a large-pore polypropylene mesh (Ultrapro®) to a small-pore polypropylene mesh (Premilene®) within a standardized retromuscular meshplasty for incisional hernia repair. Methods Between 2004 and 2006, patients with a fascial defect with a minimum diameter of 4 cm after vertical midline laparotomy were recruited for the trial. Patients underwent retromuscular meshplasty with either a large-pore or a small-pore mesh to identify the superiority of the large-pore mesh. Follow-up visits were scheduled at 5 and 21 days and 4, 12, and 24 months after surgery. A clinical examination, a modified short form 36 (SF-36®), a daily activity questionnaire, and an ultrasound investigation of the abdominal wall were completed at every follow-up visit. The primary outcome criterion was foreign body sensation at the 12-month visit, and the secondary endpoint criteria were the occurrence of hematoma, seroma, and chronic pain within 24 months postoperatively. Results In 8 centers, 181 patients were included in the study. Neither foreign body sensation within the first year after surgery (27.5% Ultrapro®, 32.2% Premilene®) nor the time until the first occurrence of foreign body sensation within the first year was significantly different between the groups. Regarding the secondary endpoints, no significant differences could be observed. At the 2-year follow-up, recurrences occurred in 5 Ultrapro® patients (5.5%) and 4 Premilene® patients (4.4%). Conclusion Despite considerable differences in theoretical and experimental works, we have not been able to identify differences in surgical or patient-reported outcomes between the use of large- and small-pore meshes for retromuscular incisional hernia repair. Trial registration Clinical Trials NCT04961346 (16.06.2021) retrospectively registered.