Medialization after combined anterior and posterior component separation in giant incisional hernia surgery, an anatomical study

Sneiders, Dimitri; Smet, Gijs H J de; Hartog, Floris den; Verstoep, Laura; Menon, Anand; Muysoms, Filip; Kleinrensink, Gert-Jan; Lange, Johan F.

doi:10.1016/j.surg.2021.06.018

Cited by 9 publications

(4 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It should be noted that complex ventral hernia repair (contaminated environment or giant hernias) may benefit from using different techniques, allowing for a technically less demanding laparoscopic approach or including additional component separation. From a technical perspective, retro-rectus repair will provide medialization of the rectus sheath, and may be extended with either anterior or posterior component separation when tension free closure is not possible 134,135 . Therefore, open ventral hernia repair should preferably be performed with retro-rectus mesh (Rives-Stoppa) repair, whereas other techniques may be reserved as salvage techniques in case of recurrence or in case retro-rectus repair is not possible due to anatomical or patient related concerns.…”

Section: Discussionmentioning

confidence: 99%

“…From a technical perspective, retro-rectus repair will provide medialization of the rectus sheath, and may be extended with either anterior or posterior component separation when tension free closure is not possible. 134,135 Therefore, open ventral hernia repair should preferably be performed with retrorectus mesh (Rives-Stoppa) repair, whereas other techniques may be reserved as salvage techniques in case of recurrence or in case retrorectus repair is not possible due to anatomical or patient related concerns.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Favorable Outcomes After Retro-Rectus (Rives-Stoppa) Mesh Repair as Treatment for Noncomplex Ventral Abdominal Wall Hernia, a Systematic Review and Meta-analysis

et al. 2022

Self Cite

View full text Add to dashboard Cite

Objective: To assess prevalence of hernia recurrence, surgical site infection (SSI), seroma, serious complications, and mortality after retro-rectus repair. Summary Background Data: Ventral abdominal wall hernia is a common problem, tied to increasing frailty and obesity of patients undergoing surgery. For noncomplex ventral hernia, retro-rectus (Rives-Stoppa) repair is considered the gold standard treatment. Level-1 evidence confirming this presumed superiority is lacking. Methods: Five databases were searched for studies reporting on retro-rectus repair. Single-armed and comparative randomized and non-randomized studies were included. Outcomes were pooled with mixed-effects, inverse variance or random-effects models. Results: Ninety-three studies representing 12,440 patients undergoing retrorectus repair were included. Pooled hernia recurrence was estimated at 3.2% [95% confidence interval (CI): 2.2%-4.2%, n ¼ 11,049] after minimally 12months and 4.1%, (95%CI: 2.9%-5.5%, n ¼ 3830) after minimally 24 months. Incidences of SSI and seroma were estimated at respectively 5.2% (95%CI: 4.2%-6.4%, n ¼ 4891) and 5.5% (95%CI: 4.4%-6.8%, n ¼ 3650). Retro-rectus repair was associated with lower recurrence rates compared to onlay repair [odds ratios (OR): 0.27, 95%CI: 0.15-0.51, P < 0.001] and equal recurrence rates compared to intraperitoneal onlay mesh (IPOM) repair (OR: 0.92, 95%CI: 0.75-1.12, P ¼ 0.400). Retro-rectus repair was associated with more SSI than IPOM repair (OR: 1.8, 95%CI: 1.03 -3.14, P ¼ 0.038). Minimally invasive retro-rectus repair displayed low rates of recurrence (1.3%, 95%CI: 0.7%-2.3%, n ¼ 849) and SSI (1.5%, 95%CI: 0.8%-2.8%, n ¼ 982), albeit based on non-randomized studies.Conclusions: Retro-rectus (Rives-Stoppa) repair results in excellent outcomes, superior or similar to other techniques for all outcomes except SSI. The latter rarely occurred, yet less frequently after IPOM repair, which is usually performed by laparoscopy.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Favorable Outcomes After Retro-Rectus (Rives-Stoppa) Mesh Repair as Treatment for Noncomplex Ventral Abdominal Wall Hernia, a Systematic Review and Meta-analysis

et al. 2022

Self Cite

View full text Add to dashboard Cite

show abstract

“…TAR has a low recurrence rate and does not negatively impact trunk function, improving overall quality of life [23]. We can even combine TAR with ACST in large hernia with a loss of domain if sufficient expertise exists, although it is quite challenging [24,25]. TAR can also be combined with peritoneal flap hernioplasty, PPP, or Botox therapy and achieve optimal results [26,27].…”

Section: Discussionmentioning

confidence: 99%

Surgical Anatomy of Transversus Abdominis Muscle for Transversus Abdominis Release: A CT‐Based Study in Three Patient Groups

Afaque,

Qaseem,

Shah

et al. 2023

World j. surg.

View full text Add to dashboard Cite

Background The anatomy of the transversus abdominis muscle and its aponeurosis is important in transversus abdominis release surgery. We studied the CT anatomy of the transversus abdominis muscle medial to the linea semilunaris at different levels in the abdomen and measured the thickness of this muscle. Methods In this retrospective study, we analysed 150 abdominal computed tomography at L1, L3, and L5 vertebral levels corresponding to subxiphoid, umbilical, and suprapubic regions, respectively. The patients were divided into three groups based on age and sex: women aged 15-20 years (nulliparous), women aged 30-60 years (multiparous), and men aged 15-60 years, with each group having 50 patients. We compared the thickness of the TA muscle at the L1 level between men and women and between nulliparous and multiparous women. Results Transversus abdominis muscle was consistently present medial to the linea semilunaris at L1 vertebral level in the subxiphoid region (150/150). At the L3 vertebral level in the mid-abdomen, only eight patients had the transversus abdominis muscle there (8/150, 5%). At the L5 vertebral level in the suprapubic region, no patient had the transversus abdominis muscle medial to the linea semilunaris. The mean thickness of the transversus abdominis muscle at the L1 level was 3.4 mm, and at the L3 level, it was 1.6 mm. There was no statistically significant difference in the transversus abdominis muscle thickness between the men and women; however, a significant difference was found between the nulliparous and multiparous women, with thinner TA muscle in later. Conclusion There is good transversus abdominis muscle bulk medial to the linea semilunaris for doing transversus abdominis muscle division in the upper abdomen. However, as we move towards the mid-abdomen, we have TA aponeurosis or rarely TA muscle of little bulk.

show abstract

“…This space lies between the rectus abdominis muscle and the posterior rectus sheath, which comprises the posterior leaf of the internal oblique aponeurosis and the transversus abdominis aponeurosis. In a large complex hernia repair, a posterior component separation procedure is sometimes needed 22 . In this manoeuvre, the posterior rectus www.nature.com/scientificreports/ sheath and transversus abdominis aponeurosis muscle are incised in order to reduce tension and the mesh is placed in the space between the rectus abdominis and internal and external oblique anteriorly and the posterior rectus sheath and peritoneal sac posteriorly.…”

Section: Incisional Herniamentioning

confidence: 99%

Biomechanical stability of hernia-damaged abdominal walls

Karrech

Ahmad

Hamdorf

2023

Sci Rep

View full text Add to dashboard Cite

Hernia occurs when the peritoneum and/or internal organs penetrate through a defect in the abdominal wall. Implanting mesh fabrics is a common way to reinforce the repair of hernia-damaged tissues, despite the risks of infection and failure associated with them. However, there is neither consensus on the optimum mesh placement within the abdominal muscles complex nor on the minimum size of hernia defect that requires surgical correction. Here we show that the optimum position of the mesh depends on the hernia location; placing the mesh on the transversus abdominis muscles reduces the equivalent stresses in the damaged zone and represents the optimum reinforcement solution for incisional hernia. However, retrorectus reinforcement of the linea alba is more effective than preperitoneal, anterectus, and onlay implantations in the case of paraumbilical hernia. Using the principles of fracture mechanics, we found that the critical size of a hernia damage zone becomes severe at 4.1 cm in the rectus abdominis and at larger sizes (5.2–8.2 cm) in other anterior abdominal muscles. Furthermore, we found that the hernia defect size must reach 7.8 mm in the rectus abdominis before it influences the failure stress. In other anterior abdominal muscles, hernia starts to influence the failure stress at sizes ranging from 1.5 to 3.4 mm. Our results provide objective criteria to decide when a hernia damage zone becomes severe and requires repair. They demonstrate where mesh should be implanted for a mechanically stable reinforcement, depending on the type of hernia. We anticipate our contribution to be a starting point for sophisticated models of damage and fracture biomechanics. For example, the apparent fracture toughness is an important physical property that should be determined for patients living with different obesity levels. Furthermore, relevant mechanical properties of abdominal muscles at various ages and health conditions would be significant to generate patient specific results.

show abstract

Medialization after combined anterior and posterior component separation in giant incisional hernia surgery, an anatomical study

Cited by 9 publications

References 10 publications

Favorable Outcomes After Retro-Rectus (Rives-Stoppa) Mesh Repair as Treatment for Noncomplex Ventral Abdominal Wall Hernia, a Systematic Review and Meta-analysis

Favorable Outcomes After Retro-Rectus (Rives-Stoppa) Mesh Repair as Treatment for Noncomplex Ventral Abdominal Wall Hernia, a Systematic Review and Meta-analysis

Surgical Anatomy of Transversus Abdominis Muscle for Transversus Abdominis Release: A CT‐Based Study in Three Patient Groups

Biomechanical stability of hernia-damaged abdominal walls

Contact Info

Product

Resources

About