Search

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

Incisional hernia (IH) is a postoperative defect of the abdominal wall through which the contents of the peritoneal cavity are externalized beneath the skin in a peritoneal sac. IH differs in anatomic complexity, but also in its associated comorbidities and surgical history. As IH enlarges, complications occur and these become part of its natural history. The goal of the study is to review the impact of loss of domain upon abdominal wall before and after abdominal wall reconstruction. The absence of anatomical and functional linea alba leads to a combination of muscular disturbances, chronic respiratory and gastrointestinal conditions, and psychosocial issues. The pathophysiological changes are also due to the decrease of the intra-abdominal pressure (IAP). During repair, the sudden reintroduction of the viscera into an unprepared cavity leads to a sudden increase in cavity volume and an increase in IAP with fatal pathophysiological implications. For an optimal repair, preoperatively, the abdominal wall must be augmented by achieving the following objectives: reducing the volume of the sac contents, optimizing compliance, enlargement of the container. At the same time, for the optimal repair, the following must be taken into account: increased knowledge about this condition to manage systemic and local changes, CT scan evaluation, monitoring IAP, plateau pressure (PP), and Positive End Expiratory Pressure (PEEP). In conclusion, the goals can be achieved by systemic optimization with a multidisciplinary team, using Preoperative Progressive Pneumoperitoneum (PPP) and/or Botox (BTX), and abdominal wall reconstruction through a mesh with augmented component separation technique.

Background: Both umbilical and epigastric hernias may be associated with rectus muscle divarication. In such cases, isolated repair of combined hernia defects can have high recurrence rates and poorer cosmetic outcomes, thus the repair of both pathologies ought to be favored. The goal of the study below is to provide detailed technical aspects of the endoscopic retro-rectus mesh repair. Methods: We chose a group of 16 patients who underwent the repair of ventral hernias associated with both primary and incisional rectus diastasis, using the extended-view of a totally extraperitoneal Rives-Stoppa repair (eRives) technique. All defects were < 6 cm in width. Our outcome measures perioperative complications and early recurrences. Results: The approach used in our study has led to zero cases of perioperative complications and only one early recurrence. Conclusions: We believe that the e-Rives repair is the optimal approach for ventral hernias associated with diastasis recti. This technique additionally produces favorable cosmetic outcomes that granted our results a well-deserved recognition in the medical literature.

Background: The treatment of incisional hernias has radically changed over the last 50 years due to the introduction of mesh repair, which has been proven to be superior to tissue repairs in terms of recurrence. Severe complications such as bacterial contamination, enteral fistulas and severe visceral adhesions are the bane of mesh repair and lead to great challenges as far as treatment is concerned. Methods: From January 2009 to December 2018, we retrospectively collected operative and outcome data on reoperation following septic complications of incisional hernias (IH) mesh repair in 89 patients. For adjustment, comorbidities, mesh location, prognostic nutritional index (PNI) and operative time were included in an SPSS data analyzer. Results: in the referred interval 89 patients (29 males) met the inclusion criteria. The mean time for the onset of infections 15.04+-0.95 months and the number of previous abdominal interventions varied from 1 to 5. Wound infections were reported to be the primary factor for mesh infection. Following removal only 43% of meshes were found to be positive for bacterial infections; the most common species detected being , MRSA and, . Different techniques of mesh removal and abdominal wall closure were used. After abdominal wall closure, 54% of patients developed post-operative complications with a mortality of 12%. Conclusion: The risk of infection after abdominal wall reconstruction (AWR) appears to be higher than other clean abdominal procedures. Mesh removal is mandatory when the infection prolonged over 3 months. The procedure is associated with a high rate of morbidity and mortality and with low quality of life if the abdomen can't be closed. Prevention is the best treatment option.

Background: complex groin hernia is a well describe entity with a high risk of recurrence and postoperative complications. There is no standardized approach and no reports to confirm the efficcacy of a surgical procedure. Our goal was to compare Lichtenstein repair (LR) as "golden standard" for open anterior approach with the transinguinal preperitoneal plasty (TIPP) in the treatment of complex groin hernia repair. Material and methods: the study was a prospective one and includes all patients with complex hernias admitted in the Department of Surgery of the Military Hospital Cluj-Napoca between January 2010 and December 2014. All the patients were randomized in two groups: LR and TIPP. Baseline characteristics, intraoperative findings, pain and complications were recorded. Follow-up was at least 1 year. The main outcome after 1 year were recurrence, chronic pain and its intensity recorded on VAS scale. Results: 205 patients (101 in LR group and 104 in TIPP) were included in the study. There were no differences in baseline characteristics and operative findings. Postoperative pain was lower for TIPP group (p 0.05). Follw-up was 98% at 1 month, 74% after 6 months and 64% after 1 year. Recurrence rate was higher for LR (p=0.027). Pain was increased in LR group. Conclusion: TIPP is equal in terms of chronic pain and recurrence for complex groin inguinal hernias.

Background: complex ventral hernia repair is a frequent and challenging topic. Reconstructive techniques are numerous but most of them are unable to achieve the goals of hernioplasty. Posterior component separation with transverses abdominis muscle release (TAR) is a novel approach that offers a solution for complex ventral hernias. Method The posterior rectus sheath is incised and the retrorectus plane is developed. In a modification of the Rives-Stoppa technique, the transversus abdominis is released medial to the linea semilunaris to expose a broad plane that extends from the central tendon of the diaphragm superiorly, to the space of Retzius inferiorly, and laterally to the retro-peritoneum. This preserves the neurovascular bundles innervating the medial abdominal wall. Mesh is placed in a sublay fashion above the posterior layer. In an overwhelming majority of patients, the linea alba is reconstructed, creating a functional abdominal wall with wide mesh reinforcement. Results: Between November 2014 and July 2016 we used this procedure in 24 patients (14 males) with large median ventral incisional hernias. The recurrence in various degrees was present in 18 patients (75%). The average size of the defect was 18,3 cm. in width (12 to 28 cm.). Five patients (21%) developed various wound complications requiring reoperation. Follow-up between 2 and 18 months (11,8 months) without recurrence. Conclusion TAR seems to be the "ideal" approach for complex hernias with good immediate outcomes.