Incisional hernia is a frequent complication of midline laparotomy and enterostomal creation and is associated with high morbidity, decreased quality of life, and high costs. The International Symposium on Incisional Hernia Prevention was held October 19-20, 2017, at the InterContinental Hotel in San Francisco, CA, hosted by the Department of Surgery, University of California, San Francisco. One hundred and three attendees included general and plastic surgeons from 9 countries, including principal participants for several of the seminal studies in the field. Over the course of the 2-day meeting, there were 38 oral presentations, 3 keynote lectures, and 2 panel discussions. The Symposium was a combination of new information but also a comprehensive review of the existing data so as to assess the current state of the field and to set the stage for future research. Further, the Symposium sought to increase awareness and thus emphasize the importance of preventing the formation of incisional and enterostomal hernias.
Conclusion:This discriminatory biomarker panel shows potential for BE diagnosis using an inexpensive, minimally invasive sampling technique and thus merits further study in case-control sponge studies. Due to our systematic and rigid method of selecting these markers, these genes are expected to be extremely important for the diagnosis of BE.
No robust data support laparoscopic mesh repair in strangulated groin hernias. This is a retrospective review over 6 years of a single surgeon's experience treating strangulated groin hernias using the laparoscopic trans-abdominal preperitoneal mesh repair with concomitant bowel resection through a periumbilical incision. Nine patients presented with incarceration of 2 inguinal and 7 femoral hernias. The median age was 83 years (IQR 68, 85). One patient was male, all were Caucasian, and 5 were ASA 3-4. The median hospital length of stay was 6 days (IQR 4, 7). There were no known hernia recurrences or mesh infections at 30 days. Laparoscopic repair necessitates mesh placement, and doing so in a clean-contaminated setting is acceptably low risk. Laparoscopy permits better assessment of bowel viability compared to open repair and enables mesh coverage of both the inguinal and femoral spaces.
Introduction- Hiatal hernia repair is associated with substantial recurrence of both hiatal hernia and symptoms of gastroesophageal reflux (GER). While small randomized controlled trials demonstrate limited differences in outcomes with use of mesh or fundoplication type, uncertainty remains.
Methods- A multicenter, retrospective review of patients undergoing surgical treatment of hiatal hernias between 2015-2020 was performed. Patients with mesh and with suture only repair were compared, and partial versus complete fundoplication was compared. Primary outcomes were hernia recurrence and occurrence of post-operative GER symptoms and dysphagia. Multivariable regression was performed to assess the effect of each intervention on clinical outcomes.
Results- A total of 453 patients from four sites were followed for a median (IQR) of 17 (13) months. On multivariate analysis, mesh had no impact on hernia recurrence (odds ratio 0.993, 95% CI 0.53-1.87, p=0.982), and fundoplication type did not impact recurrence of post-operative GER symptoms (complete: odds ratio 0.607, 95% CI 0.33-1.12, p=0.112) or dysphagia (complete: odds ratio 1.17, 95% CI 0.56-2.43, p=0.677).
Conclusion- During hiatal hernia repair, mesh and fundoplication type do not appear to have substantial impact on GER symptoms, dysphagia, or hernia recurrence. This multicenter study provides real-world evidence to support the findings of small RCTs.
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