Anterior versus posterior component separationfor hernia repair in a cadaveric mode

Component separation via both anterior and posterior approaches provide substantial myofascial advancement.In our model, we noted statistically greater anterior fascial medialization after PCS versus ACS as a whole, and especiallyin the upper and mid-abdomen. We advocate PCS as a reliable and possibly superior alternative for linea alba restoration forreconstructive repairs, especially for large defects in the upper and mid-abdomen.


Continue reading

Component separation index

“Abdominal wall reconstruction in the ventral hernia patient represents a constant challenge to the general surgeon and plastic and reconstructive surgeon. Current studies lack a predictive value or objective 3-dimensional measurement to assist in the treatment algorithm or to assess and analyze surgical outcomes. On the basis of our current data, we believe the component seperation index, much like other commonly used anthropomorphic measurements, can assist with decisions for reconstructive options preoperatively.”

Continue reading

Fundoplication at the Time of Laparoscopic Paraesophageal Hernia Repair

“Laparoscopic paraesophageal hernia repair is a complex surgical problem with many variables that can affect the outcome. Based on the results of our carefully selected patients, the addition of a fundoplication minimizes postoperative reflux symptoms without additional operative time. In addition, neither dysphagia nor paraesophageal hernia recurrence is affected by the presence of a fundoplication.”

van der Westhuizen
Continue reading

Management controversies for paraesophageal hernia

“Paraesophageal hernia repair remains a staple in the armamentarium of the foregut surgeon. Current literature suggests paraesophageal hernia repair should be approached
in a patient-centered, precision medicine manner. In general, hernia reduction, sac excision, and primary suture approximation of the hiatal crura are mandatory. Use of mesh should be based on individual risk factors; if mesh is used, biological meshes appear to have a more favorable safety profile, with the “reverse C” or keyhole configuration allowing for increase in crural tensile strength at it most vulnerable areas.”

Hiatal hernias are categorized into four types (Rogers)
Continue reading

Stapled versus handsewn intestinal anastomosis in emergency laparotomy

“This study hypothesized that there may be additional differences between trauma surgery (TS) and emergency general surgery (EGS) patients, because the physiologic conditions are typically dominated by hemodynamic instability from hemorrhage in the former, whereas the latter is predominantly complicated by sepsis. The 2 groups may also have different patient demographics, with TS patients being younger and more likely to be male than EGS patients.”

Continue reading

Mesh sutured repairs of the abdominal wall

“All high-tension internal surgical closures require that the ultimate tensile strength (UTS) of the repair remains greater than the forces applied. Otherwise, changes at the suture/tissue interface (STI) will lead to acute or chronic suture pull-through and surgical failure. For the abdominal wall, prophylactic flat meshes have been shown to improve outcomes of laparotomy closures and hernia repairs. Unfortunately, flat planar meshes have their own drawbacks, including increased time for placement, increased foreign material, increased tissue dissection, pain, infection, and cost.”

“One hundred and seven patients underwent a mesh sutured abdominal wall closure. Seventy-six patients had preoperative hernias, and the mean hernia width by CT scan for those with scans was 9.1 cm. Forty-nine surgical fields were clean-contaminated, contaminated, or dirty. Five patients had infections within the first 30 days. Only one knot was removed as an office procedure. Mean follow-up at 234 days revealed 4 recurrent hernias.”

Lanier, S. T., et al (2016). Mesh Sutured Repairs of Abdominal Wall Defects. Plastic and reconstructive surgery. Global open, 4(9), e1060. Free Full Text