Abstract:

Surgical treatment of umbilical and small ventral hernias ranges from a simple suture repair to the placement of large intra-abdominal or retromuscular meshes. Several articles report a lower incidence of recurrence after mesh repair, whether this is positioned onlay, retromuscular, or intraperitoneally. Often, a simple suture repair fails in the longterm, whereas a laparoscopic or retromomuscular approach seems too extensive for these rather small hernias. In between those two treatment options exists a go-between repair that carries the idea of posterior repair without being so aggressive in its approach. In this study, the authors examined a new device called the Proceed™ Ventral Patch (PVP) (Ethicon, Inc., Sommerville, NJ, USA). It is a self-expanding, partially absorbable, flexible laminate mesh device that allows an easy, quick and minimal invasive, tension-free, and standarized approach to umbilical hernia treatment. No data nor publication exist on this new device. Reported herein is our early and first experience with this novel technique.

Authors:

Tim Tollens, M.D., Consultant, General Surgery, David Struyve, M.D., Registrar, General Surgery, Chris Aelvoet, M.D., Consultant, General Surgery, Jean Pierre Vanrijkel, M.D., Head of Department, General Surgery, Imelda Hospital, Bonheiden, Belgium

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Abstract:

Prosthetic material composition is implicated in the phenomenon of postoperative chronic groin pain that has undermined elective open inguinal herniorrhaphy. Reported herein are our 'all-comers' experiences with a novel dual component mesh (4DDome®). A prospective cohort (Phase II) study was performed that involved all patients undergoing elective open inguinal herniorrhaphy during a four-year period. Conventional operative technique was used except for choice of prosthesis. The 4DDome mesh comprises a molded dome-shaped composite (10% polypropylene, 90% poly-L-lactic acid) with a lightweight polypropylene mesh overlay. Short- (1 week) and intermediate-term (18 months) clinical follow-up with examination and symptom questionnaire judged outcome while surgeons rated their approval using a visual analogue scale. One hundred ninety-six patients (mean age, 65.5 years; Mean BMI, 25.5; Mean ASA, 1.8, 178 males) underwent repair of 201 inguinal hernias by six surgeons (three residents). The majority of patients had an indirect hernia (n=119) 93 being combined with a posterior wall defect [Nyhus IIIa], whereas 66 had a direct hernia [Nyhus IIIb], and 11 had a recurrent hernia.) Mean operative time was 44.6 minutes with 92 patients being operated under local anesthesia. Ten patients developed seromas and two had hematomas early postoperatively. Median intermediate-term follow-up is currently 19 (range: 3-72) months for the 147 (75%) patients still available for contact. The incidence of chronic groin pain is 8.8%, whereas there has been one hernia recurrence. Surgeon satisfaction and confidence were high. The 4DDome provides appropriate clinical results and, therefore, appears valid for use in routine practice.

Authors:

Didier Mutter, M.D., Ph.D, F.A.C.S., Clinical Professor, Gastrointestional Surgery, Cosimo Callari, M.D., Resident, General and Laparoscopic Surgery, Jacopo D'Agostino, M.D., Resident, General and Laparoscopic Surgery, Ronan A. Cahill, M.D., F.R.C.S., Consultant Surgeon, Colorectal and Laparoscopic Surgery, Antonello Forgione, M.D., Consultant Surgeon, Laparoscopic Surgery, Michel Vix, M.D., Clinical Professor, Laparoscopic Surgery, Joël Leroy, M.D., F.R.C.S., Clinical Professor, Colorectal and Laparoscopic Surgery, Jacques Marescaux, M.D., F.R.C.S., F.A.C.S., Professor and Chief of Digestive Surgery, Department of Digestive and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France

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Abstract:

Burst abdomen is a postoperative complication associated with significant morbidity and mortality. The risk factors for burst abdomen are patient- and surgery-related. The management of this complication is a relatively unexplored area within the field of surgery. Relevant surgical outcomes include recurrence, mortality, and incisional hernia. A total number of 27 studies are identified that reported on at least one surgical outcome (recurrence, mortality, or incisional hernia rate) of at least 10 patients with burst abdomen. None of the identified studies were designed prospectively, and only a minority of studies reported surgical outcomes of considerable numbers of patients with burst abdomen. Reported conservative management options included use of saline-soaked gauze dressings and negative pressure wound therapy. Operative management options included temporary closure options (open abdomen treatment), primary closure with various suture techniques, closure with application of relaxing incisions, use of synthetic (nonabsorbable and absorbable) and biological meshes, and the use of tissue flaps. The treatment of burst abdomen is associated with unsatisfactory surgical outcome. Randomized controlled clinical trials are needed to provide the surgical community with a greater level of evidence for the optimal treatment strategy for burst abdomen and the various subtypes.

Authors:

Gabriëlle H. van Ramshorst, M.D., Ph.D., Fellow, Resident in Training for Specialist, Hasan H. Eker, M.D., Ph.D. Fellow, Joris J. Harlaar, M.D., Ph.D. Fellow, Kirsten J.J. Nijens, M.D., Medical Student, Johannes Jeekel, M.D., Professor, Johan F. Lange, M.D., Professor, Erasmus University Medical Center, Department of Surgery, Rotterdam, The Netherlands

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