Subxiphoid Incisional Hernias after Median Sternotomy

Mackey, Richard A.; Brody, Fred; Berber, Eren; Chand, Bipan; Henderson, J. Michael

doi:10.1016/j.jamcollsurg.2005.01.025

Cited by 29 publications

(31 citation statements)

References 10 publications

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“…A review of 113 patients treated for subxiphoid incisional hernia, published before 2009, remains the main source of data on this particular topic [159]. Three different authors have described twenty-one laparoscopic procedures with recurrence rates ranging from 10 to 33 % [160][161][162]. Those results are likely related to the learning curve of the technique [162].…”

Section: Subxiphoid and Subcostal Incisional Herniasmentioning

confidence: 99%

“…An important technical point is the need to dissect the falciform ligament up to the hepatic veins providing a generous retroxiphoid overlap beyond the edge of the hernia defect [162]. Endoscopic tackers can be used around the edges to fix the prosthesis avoiding the area beyond the costal chondral margin [161,164]. In other series, the placement of additional full-thickness or intraperitoneal abdominal wall stitches allow additional strength to mesh fixation [142,162].…”

Section: Subxiphoid and Subcostal Incisional Herniasmentioning

confidence: 99%

See 1 more Smart Citation

Laparoscopic ventral/incisional hernia repair: updated guidelines from the EAES and EHS endorsed Consensus Development Conference

et al. 2015

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The availability of recent level 1 evidence (a meta-analysis of 10 RCTs) allowed to recommend that not only laparoscopic repair is an acceptable alternative to the open repair, but also it is advantageous in terms of shorter hospital stay and wound infection rate. This conclusion appears to be extremely relevant in a clinical setting. Indications about specific conditions could also be issued: laparoscopy is recommended for the treatment of recurrent ventral hernias and obese patients, while it is a potential option for compensated cirrhotic and childbearing-age female patients. Many relevant and controversial topics were thoroughly examined by this consensus conference for the first time. Among them are the issue of safety of the intraperitoneal mesh placement, traditionally considered a major drawback of the laparoscopic technique, the role for the biologic meshes, and various aspects of the laparoscopic approach for particular locations of the defect such as the abdominal border or parastomal hernias.

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Section: Subxiphoid and Subcostal Incisional Herniasmentioning

confidence: 99%

Section: Subxiphoid and Subcostal Incisional Herniasmentioning

confidence: 99%

Laparoscopic ventral/incisional hernia repair: updated guidelines from the EAES and EHS endorsed Consensus Development Conference

et al. 2015

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“…These investigators also reported that previous sternal wound infection was a risk factor for recurrent hernias after repair, with 6 of 16 patients with recurrences also having a previous sternal wound infection. 28 Data related to incidence and outcomes of flank hernias, resulting mostly from traumatic injuries and incisions, are also a mixture of open and laparoscopic cases. Although not true hernias, there are data related to the incidence of flank bulging after retroperitoneal incisions and possible mechanism of this occurrence.…”

Section: Clinical Results In the Literaturementioning

confidence: 99%

“…Published series on open and laparoscopic repair of subxiphoid hernias Abbreviation: NR, not recorded.Data from Refs 28,[32][33][34][35][36][37][38]. …”

mentioning

confidence: 99%

Atypical Hernias

Hope

Hooks

2013

Surgical Clinics of North America

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“…63 Mesh repair with fixation to rib periosteum is recommended although this hernia may be particularly suitable to laparoscopic repair because of the good working space in the epigastric region.…”

Section: Unusual Sitesmentioning

confidence: 99%

The Management of Incisional Hernia

Kingsnorth

2006

annals

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Ann R Coll Surg Engl 2006; 88: 252-260 252Medline and Embase were searched using the search terms 'hernia' and 'incisional' alone and in combination. Publications were selected mostly in the past 5 years, but did not exclude commonly reference and highly regarded older publications. The reference list of articles was also searched, identified by the search strategy and those selected that were relevant. Selected review articles and metaanalyses were included because they provide comprehensive overviews that may be beyond the scope of this article. OverviewThe introduction of prosthetic mesh revolutionised the treatment of groin hernia but, to date, has had little impact on the treatment of incisional hernia.1 The risk factors for the development of incisional hernia include obesity, diabetes, emergency surgery, postoperative wound dehiscence, smoking and postoperative wound infection. 2,3The risks of repairing an incisional hernia which should be explained to the patient when obtaining consent include seroma formation, wound infection, injury to intraabdominal structures and recurrence. 4 Major complications which can occur in repair of large incisional hernias include mesh infection and enterocutaneous fistula which may result in prolonged morbidity and require re-operation (Fig. 1). It is now accepted that only the smallest (less than 3 cm) incisional hernias should be repaired with primary tissue approximation with sutures and this topic will not be discussed further.5 Small incisional hernias with time develop into larger incisional hernias due to the continuous presence of intra-abdominal hydrostatic pressure of 15 cm of water, diaphragmatic contractions occurring with respiration, increases in abdominal pressure occurring with coughing and straining realising pressures of over 80 cm of water and myofascial retraction of the lateral muscles. As a result, the abdominal cavity contracts and the right of domicile for the herniated visceral mass is lost. 6 Due to several previous operations, many of these patients have poor-quality abdominal wall musculature which, coupled with multiple co-morbid medical problems, present a surgical and anaesthetic challenge.Surgeons appear to have a reluctance to operate on incisional hernias perhaps because of the poor general condition of the patients but perhaps also due to lack of knowledge of how to deal with the various defects occurring as a result of incisions of the anterior abdominal wall and the operative techniques required. For instance, although it is estimated that 13% of laparotomy incisions fail in The Netherlands, only 4% of patients undergoing a laparotomy will go through additional surgery to repair an incisional hernia.7 Suture repair is likely to produce results twice as bad as mesh repair and the current techniques that surgeons are using to repair incisional hernias with prosthetic mesh continue to yield recurrence rates of greater than 20%. Many thousand laparotomy incisions are created each year and the failure rate for closure of these abdominal wou...

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Subxiphoid Incisional Hernias after Median Sternotomy

Cited by 29 publications

References 10 publications

Laparoscopic ventral/incisional hernia repair: updated guidelines from the EAES and EHS endorsed Consensus Development Conference

Laparoscopic ventral/incisional hernia repair: updated guidelines from the EAES and EHS endorsed Consensus Development Conference

Atypical Hernias

The Management of Incisional Hernia

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