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Incisional Hernia
Kevin Sexton
Bonus Conference February 2013
Disclosure:
Definitions:
Incisional hernia is any
Is timing important?
What separates incisional
hernia from dehiscence?
herniagigante.com
Sanders DL, Kingsnorth AN. The modern management of incisional hernias. BMJ 2012;344(may09 1):e28433.
4
Risk
??%
Incidence
3-60%
Average
25%
Hawn MT, Snyder CW, Graham LA, Gray SH, Finan KR, Vick CC. Long-term follow-up
of technical outcomes for incisional hernia repair. Journal of the American College of
Surgeons 2010;210(5):648556557.
Poulose BK, Shelton J, Phillips S, et al. Epidemiology and cost of ventral hernia repair: making the
case for hernia research. Hernia 2012;16(2):17983.
10
Prevention
van t Riet M, Steyerberg EW, Nellensteyn J, Bonjer HJ, Jeekel J. Meta-analysis of techniques for
closure of midline abdominal incisions. Br J Surg 2002;89:1350-6.
Hodgson NC, Malthaner RA, Ostbye T. The search for an ideal method of abdominal fascial closure:
a meta-analysis. Ann Surg 2000;231:436-42.
Ceydeli A, Rucinski J, Wise L. Finding the best abdominal closure: an evidence-based review of the
literature. Curr Surg 2005;62:220-5
11
Stitch Length
12
Complication
Wound
Dehiscence
SSI
Incisional
Hernia
Long
1/381
Short
0/356
P
.99
35/343 (10.2)
49/272 (18)
13
Prediction:
603 Patients
Hernia
15
18
David R Flum KHTK. Have Outcomes of Incisional Hernia Repair Improved With Time?: A PopulationBased Analysis. Annals of Surgery 2003;237(1):129.
Luijendijk RW, Hop W, van den Tol MP. A comparison of suture repair with mesh repair for incisional
hernia. NEJM 2000;
20
Choi JJ, Palaniappa NC, Dallas KB, Rudich TB, Colon MJ, Divino CM. Use of Mesh
During Ventral Hernia Repair in Clean-Contaminated and Contaminated Cases.
Annals of Surgery 2012;255(1):17680.
21
22
Biologic Mesh
24
http://www.sageswiki.org/
25
26
More on Biologics:
Smart NJ, Marshall M, Daniels IR. Biological meshes: A
review of their use in abdominal wall hernia repairs. The
Surgeon 2012;10(3):15971.
27
28
29
30
Sauerland S, Walgenbach M, Habermalz B, Seiler CM, Miserez M. Laparoscopic versus open surgical
techniques for ventral or incisional hernia repair. The Cochrane Library 2011;
31
33
Technique
Recurrence Notes
Inlay
44%
Adhesions
Erosions
Not
recommended
Onlay
5.5-14.8%
Have to close
abdominal wall
Sublay
1-23%
European Hernia
Society Standard
difficult
Sanders DL, Kingsnorth AN. The modern management of incisional hernias. BMJ 2012;344(may09 1):e28433.
Yaghoobi Notash A, Yaghoobi Notash A Jr, Seied Farshi J, Ahmadi Amoli H, Salimi J, Mamarabadi M. Outcomes of
the RivesStoppa technique in incisional hernia repair: ten years of experience. Hernia 2006;11(1):259.
34
Summary
Sublay vs Onlay
36
Discussion
37
1.
Beck WC, Holzman MD, Sharp KW, Nealon WH, Dupont WD, Poulose BK. Comparative Effectiveness of Dynamic Abdominal Sonography for Hernia vs Computed Tomography in the
Diagnosis of Incisional Hernia. Journal of the American College of Surgeons 2013;216(3):44753.
2.
Smart NJ, Marshall M, Daniels IR. Biological meshes: A review of their use in abdominal wall hernia repairs. The Surgeon 2012;10(3):15971.
3.
Sanders DL, Kingsnorth AN. The modern management of incisional hernias. BMJ 2012;344(may09 1):e28433.
4.
Altom LK, Graham LA, Gray SH, Snyder CW, Vick CC, Hawn MT. Outcomes for incisional hernia repair in patients undergoing concomitant surgical procedures. Am Surg
2012;78(2):2439.
5.
Choi JJ, Palaniappa NC, Dallas KB, Rudich TB, Colon MJ, Divino CM. Use of Mesh During Ventral Hernia Repair in Clean-Contaminated and Contaminated Cases. Annals of Surgery
2012;255(1):17680.
6.
7.
Oelschlager BK, Pellegrini CA, Hunter JG, et al. Biologic Prosthesis to Prevent Recurrence after Laparoscopic Paraesophageal Hernia Repair: Long-term Follow-up from a Multicenter,
Prospective, Randomized Trial. Journal of the American College of Surgeons 2011;213(4):4618.
8.
Kulacoglu H, Oztuna D. Growth and trends in publications about abdominal wall hernias and the impact of a specific journal on herniology: a bibliometric analysis. Hernia
2011;15(6):61528.
9.
Bansal VK, Misra MC, Kumar S, et al. A prospective randomized study comparing suture mesh fixation versus tacker mesh fixation for laparoscopic repair of incisional and ventral
hernias. Surg Endosc 2011;25(5):14318.
10. Snyder CW, Graham LA, Gray SH, Vick CC, Hawn MT. Effect of Mesh Type and Position on Subsequent Abdominal Operations after Incisional Hernia Repair. ACS 2011;212(4):496
502.
11.
Harth KC, Blatnik JA, Rosen MJ. Optimum repair for massive ventral hernias in the morbidly obese patientis panniculectomy helpful? AJS 2011;201(3):396400.
12.
Millbourn D, Cengiz Y, Israelsson LA. Risk factors for wound complications in midline abdominal incisions related to the size of stitches. Hernia 2011;15(3):2616.
13.
Sauerland S, Walgenbach M, Habermalz B, Seiler CM, Miserez M. Laparoscopic versus open surgical techniques for ventral or incisional hernia repair. The Cochrane Library 2011;
14.
Hartog D den DATWKR. Open surgical procedures for incisional hernias. 2010;:136.
38
15.
16. Xourafas D, Lipsitz SR, Negro P, Ashley SW, Tavakkolizadeh A. Impact of mesh use on morbidity following ventral hernia repair with a simultaneous bowel resection. Arch Surg
2010;145(8):73944.
17.
18. Hawn MT, Snyder CW, Graham LA, Gray SH, Finan KR, Vick CC. Long-term follow-up of technical outcomes for incisional hernia repair. Journal of the American College of Surgeons
2010;210(5):648556557.
19. Veljkovic R, Protic M, Gluhovic A, Potic Z, Milosevic Z, Stojadinovic A. Prospective Clinical Trial of Factors Predicting the Early Development of Incisional Hernia after Midline
Laparotomy. ACS 2010;210(2):2109.
20. Millbourn D, Cengiz Y, Israelsson LA. Effect of Stitch Length on Wound Complications After Closure of Midline IncisionsA Randomized Controlled TrialStitch Length and Midline
Incision Complications. Archives of Surgery 2009;144(11):10569.
21.
Harlaar JJ, van Ramshorst GH, Nieuwenhuizen J, et al. Small stitches with small suture distances increase laparotomy closure strength. AJS 2009;198(3):3925.
22.
Muysoms FE, Miserez M, Berrevoet F, et al. Classification of primary and incisional abdominal wall hernias. Hernia 2009;13(4):40714.
23.
Nemeth NL, Butler CE. Complex torso reconstruction with human acellular dermal matrix: long-term clinical follow-up. Plastic and Reconstructive Surgery 2009;
24. Rauth TP, Poulose BK, Nanney LB, Holzman MD. A comparative analysis of expanded polytetrafluoroethylene and small intestinal submucosa--implications for patch repair in
ventral herniorrhaphy. Journal of Surgical Research 2007;143(1):439.
25.
Kurzer M, Kark A, Selouk S, Belsham P. Open Mesh Repair of Incisional Hernia Using a Sublay Technique: Long-Term Follow-up. World J Surg 2007;32(1):316.
26.
Bingener J, Buck L, Richards M, Michalek J, Schwesinger W, Sirinek K. Long-term Outcomes in Laparoscopic vs Open Ventral Hernia Repair. Archives of Surgery 2007;142(6):5627.
27. Weyhe D, Belyaev O, Mller C, Meurer K. Improving outcomes in hernia repair by the use of light meshesa comparison of different implant constructions based on a critical
appraisal of the literature. World journal of 2007;
28. Yaghoobi Notash A, Yaghoobi Notash A Jr, Seied Farshi J, Ahmadi Amoli H, Salimi J, Mamarabadi M. Outcomes of the RivesStoppa technique in incisional hernia repair: ten years
of experience. Hernia 2006;11(1):259.
29. Oelschlager BK, Pellegrini CA, Hunter J, et al. Biologic prosthesis reduces recurrence after laparoscopic paraesophageal hernia repair: a multicenter, prospective, randomized trial.
Annals of Surgery 2006;244(4):48190.
30.
Kingsnorth A. The management of incisional hernia. Ann R Coll Surg Engl 2006;88(3):25260.
31.
Rudmik LR, Schieman C, Dixon E, Debru E. Laparoscopic incisional hernia repair: a review of the literature. Hernia 2006;
32.
Klinge U, Conze J, Krones CJ, Schumpelick V. Incisional Hernia: Open Techniques. World J Surg 2005;29(8):106672.
DiCocco JM, Magnotti LJ, Emmett KP, et al. Long-Term Follow-Up of Abdominal Wall Reconstruction after Planned Ventral Hernia: A 15-Year Experience. ACS 2010;210(5):68695.
39
33. Conze J, Kingsnorth AN, Flament JB, et al. Randomized clinical trial comparing lightweight composite mesh with polyester or polypropylene mesh for incisional hernia repair. Br J
Surg 2005;92(12):148893.
34.
Millbourn D, Israelsson LA. Wound complications and stitch length. Hernia 2004;8(1):3941.
35.
Sanchez LJ, Bencini L, Moretti R. Recurrences after laparoscopic ventral hernia repair: results and critical review. Hernia 2004;
36.
Rutkow IM. Demographic and socioeconomic aspects of hernia repair in the United States in 2003. Surgical Clinics of NA 2003;83(5):104551vvi.
37.
David R Flum KHTK. Have Outcomes of Incisional Hernia Repair Improved With Time?: A Population-Based Analysis. Annals of Surgery 2003;237(1):129.
38.
Bencini L, Sanchez LJ, Boffi B, Farsi M, Scatizzi M. Incisional hernia repair. Surgical 2003;
39.
Heniford BT, Park A, Ramshaw BJ, Voeller G. Laparoscopic repair of ventral hernias: nine years' experience with 850 consecutive hernias. Annals of Surgery 2003;
40.
Heniford BT, Park A, Ramshaw BJ, Voeller G. Laparoscopic Repair of Ventral Hernias. Transactions of the Meeting of the American Surgical Association 2003;121:8594.
41.
van 't Riet M, Steyerberg EW, Nellensteyn J, Bonjer HJ, Jeekel J. Meta-analysis of techniques for closure of midline abdominal incisions. Br J Surg 2002;89(11):13506.
42.
Goodney PP, Birkmeyer CM, Birkmeyer JD. Short-term outcomes of laparoscopic and open ventral hernia repair: a meta-analysis. Archives of Surgery 2002;
43.
Korenkov M, Paul A, Sauerland S. Classification and surgical treatment of incisional hernia. Archives of Surgery 2001;
44.
Welty G, Klinge U, Klosterhalfen B, Kasperk R. Functional impairment and complaints following incisional hernia repair with different polypropylene meshes. Hernia 2001;
45.
Nicole C F Hodgson RAMT. The Search for an Ideal Method of Abdominal Fascial Closure: A Meta-Analysis. Annals of Surgery 2000;231(3):436.
46.
Luijendijk RW, Hop W, van den Tol MP. A comparison of suture repair with mesh repair for incisional hernia. England Journal of 2000;
47.
Mudge M, Hughes LE. Incisional hernia: a 10 year prospective study of incidence and attitudes. Br J Surg 1985;72(1):701.
48.
Bucknall TE, Cox PJ, Ellis H. Burst abdomen and incisional hernia: a prospective study of 1129 major laparotomies. Br Med J (Clin Res Ed) 1982;284(6320):9313.
40