Recurrent Incisional Hernia Repair—An Overview

Köckerling, F.

doi:10.3389/fsurg.2019.00026

Cited by 46 publications

(34 citation statements)

References 51 publications

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“…Though there are many factors increasing recurrence, one of the most commonly blamed factors is DM [16]. Moreover, for DM, a HbA1c >7% has been found to be associated with an increased risk of wound infection [17]. As a result, diabetic patients with poor blood sugar control have increased SSI which increases the possibility of recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…In this study, though not statistically, we think the recurrence rate was clinically significantly increased by DM. Today, the incisional hernia repair still has a high incidence of SSI (0.7%-26.6%) [18]. In a prospective study by Juvany et al in 2018, stated that SSI significantly increased one-year recurrence rate (16%) for elective incisional hernia repair (p = 0.047) [19].…”

Section: Discussionmentioning

confidence: 99%

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The Effects of Onlay Titanium-coated Mesh on Recurrence, Foreign Body Feeling and Chronic Pain in Ventral Hernia

Akalın¹

2020

Preprint

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Background There are many complications of meshes in hernia repair. The aim of this study was to investigate the effects of onlay titanium-coated meshes (TCM) on recurrence, foreign body feeling and chronic pain in ventral hernia repair.Methods In this retrospective cohort study, patients who underwent TCM and polypropylene mesh (PM) for onlay repair of ventral hernia were examined between May 2014 and January 2018 at our centre. Patient characteristics, type of hernia, defect size, operative time, follow-up time, surgical site occurrence (infection, seroma and hematoma), recurrence, foreign body feeling and chronic pain were analysed. Patients were divided into two groups according to the mesh elected; TCM (titanium group) or PM (polypropylene group).Results Out of 160 patients, 63 (32.6%) had TCM and 97 (67.4%) had PM. There was no significant difference between groups in terms of recurrence (p = 0.757). Chronic pain and foreign body feeling were low in the titanium group (p = 0.047 and p = 0.029, respectively), a positive correlation was found between surgical site infection and recurrence (p = 0.020). In the polypropylene group, an increase in defect size was significantly associated with foreign body feeling and chronic pain (p < 0.001 for both comparisons).Conclusion In onlay repair of ventral hernia, TCM led to less foreign body feeling and chronic pain then PM. The surgical site infection was associated with recurrence for these meshes. Additionally, the increase in defect size causes a risk for foreign body feeling and chronic pain in repair using PM.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Effects of Onlay Titanium-coated Mesh on Recurrence, Foreign Body Feeling and Chronic Pain in Ventral Hernia

Akalın¹

2020

Preprint

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“…Meshes and other hernia repair material are brought to the market after proof of the mechanical stability, harmlessness to living tissues, and longevity under physiological conditions (15,16). Stress tests of the compounds made with various tissues, meshes, and fixation material have rarely been performed.…”

Section: Contribution Of the Dynamic Bench Test To Durable Incisional Hernia Repairmentioning

confidence: 99%

The Grip Concept of Incisional Hernia Repair—Dynamic Bench Test, CT Abdomen With Valsalva and 1-Year Clinical Results

et al. 2021

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Incisional hernia is a frequent consequence of major surgery. Most repairs augment the abdominal wall with artificial meshes fixed to the tissues with sutures, tacks, or glue. Pain and recurrences plague at least 10–20% of the patients after repair of the abdominal defect. How should a repair of incisional hernias be constructed to achieve durability? Incisional hernia repair can be regarded as a compound technique. The biomechanical properties of a compound made of tissue, textile, and linking materials vary to a large extent. Tissues differ in age, exercise levels, and comorbidities. Textiles are currently optimized for tensile strength, but frequently fail to provide tackiness, dynamic stiction, and strain resistance to pulse impacts. Linking strength with and without fixation devices depends on the retention forces between surfaces to sustain stiction under dynamic load. Impacts such a coughing or sharp bending can easily overburden clinically applied composite structures and can lead to a breakdown of incisional hernia repair. Our group developed a bench test with tissues, fixation, and textiles using dynamic intermittent strain (DIS), which resembles coughing. Tissue elasticity, the size of the hernia under pressure, and the area of instability of the abdominal wall of the individual patient was assessed with low-dose computed tomography of the abdomen preoperatively. A surgical concept was developed based on biomechanical considerations. Observations in a clinical registry based on consecutive patients from four hospitals demonstrate low failure rates and low pain levels after 1 year. Here, results from the bench test, the application of CT abdomen with Valsalva's maneuver, considerations of the surgical concept, and the clinical application of our approach are outlined.

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“…Recurrent incisional hernia following primary mesh procedure is now classified and regarded as a complex abdominal wall hernia [24]. The proportion of recurrent incisional hernias in the total collective of incisional hernias is moderately high at 22% [32]. There are though very few studies on the treatment and outcome for recurrent incisional hernia to date [32].…”

Section: Recurrent Herniasmentioning

confidence: 99%

“…The proportion of recurrent incisional hernias in the total collective of incisional hernias is moderately high at 22% [32]. There are though very few studies on the treatment and outcome for recurrent incisional hernia to date [32]. In conclusion, any recurrent procedures undertaken for abdominal wall reconstruction, when there is already a mesh implant in the abdominal wall, reasonably requires a highly experienced surgeon [32] and a laparoendoscopic approach for such a recurrence is recognized as especially demanding.…”

Section: Recurrent Herniasmentioning

confidence: 99%

The reality of general surgery training and increased complexity of abdominal wall hernia surgery

Köckerling

Sheen

Berrevoet

et al. 2019

Hernia

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Introduction The Accreditation and Certification of Hernia Centers and Surgeons (ACCESS) Group of the European Hernia Society (EHS) recognizes that there is a growing need to train specialist abdominal wall surgeons. The most important and relevant argument for this proposal and statement is the growing acceptance of the increasing complexity of abdominal wall surgery due to newer techniques, more challenging cases and the required 'tailored' approach to such surgery. There is now also an increasing public awareness with social media, whereby optimal treatment results are demanded by patients. However, to date the complexity of abdominal wall surgery has not been properly or adequately defined in the current literature. Methods A systematic search of the available literature was performed in May 2019 using Medline, PubMed, Scopus, Embase, Springer Link, and the Cochrane Library, with 75 publications identified as relevant. In addition, an analysis of data from the Herniamed Hernia Registry was performed. The percentage of patients with hernia-or patient-related characteristics which unfavorably impacted the outcome of inguinal and incisional hernia repair was also calculated. Results All present guidelines for abdominal wall surgery recommend the utilization of a 'tailored' approach. This relies on the prerequisite that any surgical technique used has already been mastered, as well as the recognized learning curves for each of the several techniques that can be used for both inguinal hernia (Lichtenstein, TEP, TAPP, Shouldice) and incisional hernia repairs (laparoscopic IPOM, open sublay, open IPOM, open onlay, open or endoscopic component separation technique).Other hernia-and patient-related characteristics that have recognized complexity include emergency surgery, obesity, recurrent hernias, bilateral inguinal hernias, groin hernia in women, scrotal hernias, large defects, high ASA scores, > 80 years of age, increased medical risk factors and previous lower abdominal surgery. The proportion of patients with at least one of these characteristics in the Herniamed Hernia Registry in the case of both inguinal and incisional hernia is noted to be relatively high at around 70%. In general surgery training approximately 50-100 hernia repairs on average are performed by each trainee, with around only 25 laparo-endoscopic procedures. Conclusion A tailored approach is now employed and seen more so in hernia surgery and this fact is referred to and highlighted in the contemporaneous hernia guidelines published to date. In addition, with the increasing complexity of abdominal wall surgery, the number of procedures actually performed by trainees is no longer considered adequate to overcome any recognized learning curve. Therefore, to supplement general surgery training young surgeons should be offered a clinical fellowship to obtain an additional qualification as an abdominal wall surgeon and thus improve their clinical and operative experience under supervision in this field. Practicing general surgeons with a special int...

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Recurrent Incisional Hernia Repair—An Overview

Cited by 46 publications

References 51 publications

The Effects of Onlay Titanium-coated Mesh on Recurrence, Foreign Body Feeling and Chronic Pain in Ventral Hernia

The Effects of Onlay Titanium-coated Mesh on Recurrence, Foreign Body Feeling and Chronic Pain in Ventral Hernia

The Grip Concept of Incisional Hernia Repair—Dynamic Bench Test, CT Abdomen With Valsalva and 1-Year Clinical Results

The reality of general surgery training and increased complexity of abdominal wall hernia surgery

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