Aim Large or complex incisional hernias require more than just mesh placement.There are techniques such as component separation, retromuscular techniques (Rives-Stoppa, transversus abdominis muscle release-TAR), which help to repair the hernia and physiologically rebuild the abdominal wall.However, this type of technique can present a higher incidence rate of complications, such as hematomas, seromas, SSI, skin necrosis.We present our initial experience in complex abdominal wall reconstruction using the retromuscular sublay technique (RST). Methods Retrospective study analyzing our database of patients with complex incisional hernia undergoing abdominal wall surgery using the RST, during November-2018 to October-2020.In addition, we conducted a comparative analysis with patients undergoing hernia repair using the onlay-technique. Results 44 patients underwent RST (male:56.8%, age:66(IQR: 52–73years)). Hospital stay:4(IQR: 2–6days).Pathological history: diabetes mellitus (4.5%), arterial hypertension(20.5%), dyslipidemia(36.4%), smoking(34.1%), alcohol consumption(27.3%), cardiovascular disease(9.1%).ASA-classification:I(9.1%), II(59.1%), III(31.8%). BMI: 29.3±2kg/m2. Hernia location: midline(95.5%), others(4.5%). Preoperative botulinum toxin (PBT): 20.45%. Preoperative progressive pneumoperitoneum (PPP): 9.1%. Type of surgery performed: Rives-Stoppa(68.2%), TAR(31.8%). Postoperative complications: global(13.6%), Clavien-Dindo≥III:0%, clinical seroma(13.6%) and ultrasound-seroma(22.7%), SSI(0%). Hernia recurrence:0%. In the bivariate analysis of patients undergoing hernia repair using the RST compared to patients undergoing onlay repair, we observed that the RST presented lower incidence of global complications, both clinical and ultrasound seromas, surgical site infections and recurrences (13.6% vs 39.1% p=0.004; 13.6% vs 33.3% p=0.019; 22.7% vs 39.1% p=0.07; 0% vs 14.5% p=0.008; 0% vs 5.8% p=0.1; respectively). Conclusions In our enviroment, the management of complex incisional hernias using RST and the use of PBT and PPP is effective and safe, with a lower incidence of complications and recurrences.
Aim To demonstrate that the use of cyanoacrylate (Glubran®) can decrease the incidence of postoperative surgical site occurrences (SSO) in incisional hernia (IH) surgery. Methods Retrospective cohort analysis of SSO after elective IH repairs (November 2018 to October 2020). Group 1: mesh fixation by interrupted stitches associating cyanoacrylate (as well as spreading it in subcutaneous tissue). Group 2: without cyanoacrylate. Results 113 patients were analyzed included (females: 50.4%, age: 70 (IQR: 59–75years)). Length of stay: 3 (IQR: 2–6days). Comorbidities: diabetes (7.1%), hypertension(29.2%), dyslipidemia(41%), smoking(38.1%), alcohol consumption(22.1%), cardiovascular disease(15.9%). ASA: I(5.3%), II(62.8%), III(31.9%). BMI: 29.14±3.63kg/m2. Hernia location: midline (89.4%), others (10.6%). Cyanoacrylate group:54.9%. Surgical technique: onlay (61.1%), sublay (38.9%). Postoperative complications: global (29.2%), clinical seroma (25.7%), ultrasound seroma (32.7%). Surgical site infection-SSI (8.8%). Recurrence: 3.5%. Patients with cyanoacrylate had lower overall complications, clinical and ultrasound seroma and SSI rates (17.7% vs 43.1% p=0.003; 16.1% vs 37.3% p=0.011; 27.4% vs 39.2% p=0.1; 3.2% vs 15.7% p=0.02 respectively). These findings are even more statistically significant after selecting onlay procedures (23.3% vs 51.3% p=0.018; 16.7% vs 46.2% p=0.01; 30% vs 46.2% p=0.1; 6.7% vs 20.5% p=0.04 respectively). These differences were maintained in the multivariate analysis (p <0.05). Conclusion The cyanoacrylate (Glubran®) is a good tool in preventing postoperative seromas in patients with IH (particularly in onlay procedures), without increasing the incidence of other complications.
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