• 3D printing
• Biocompatibility
• Hernial Mesh
• Mechanical Stability
• Nanocomposite

• Gelatin/chemistry
• Nanotubes, Carbon/chemistry
• Printing, Three-Dimensional
• Surgical Mesh
• Hernia, Abdominal/surgery
• Hernia, Abdominal/therapy
• Biocompatible Materials/chemistry
• Biocompatible Materials/pharmacology
• Humans
• Cell Proliferation/drug effects
• Cell Adhesion/drug effects

• BT/PR48677/MED/32/900/2023 Indian Institute of Technology Ropar
• SPR/2022/000348 Indian Institute of Technology Ropar

• abdominal wall repair
• biological scaffolds
• canine model
• small intestinal submucosa
• urinary bladder matrix

• Animals
• Dogs
• Tissue Scaffolds/chemistry
• Rats
• Disease Models, Animal
• Abdominal Wall/surgery
• Urinary Bladder
• Intestinal Mucosa
• Male
• Mice
• Tissue Engineering/methods
• Rats, Sprague-Dawley
• Herniorrhaphy/methods
• Wound Healing

• 2019-JCJQ-002 National Defense Science and Technology Excellence Youth Science Foundation
• 2019-JCJQ-JJ-069 National Defense Science and Technology Innovation Fund of the Chinese Academy of Sciences

• full-thickness skin graft
• incisional hernia
• parastomal hernia
• synthetic mesh
• ventral hernia

• Humans
• Abdominal Wall/surgery
• Surgical Mesh
• Treatment Outcome
• Hernia, Ventral/surgery
• Hernia, Ventral/complications
• Evidence-Based Medicine

• Abdominal wall hernia
• Biological tissue grafts
• Electrospinning
• Hydrogel scaffold
• Polypropylene mesh

• Humans
• Biological Products
• Hernia, Ventral/surgery
• Herniorrhaphy/adverse effects
• Randomized Controlled Trials as Topic
• Recurrence
• Retrospective Studies
• Surgical Mesh/adverse effects
• Surgical Wound Infection/etiology
• Treatment Outcome

• Diaphragm
• Fascia Lata
• Ovarian Cancer
• Resection

Patients with inflammatory bowel disease (IBD) have a high-life time risk undergoing abdominal surgery and are prone to develop incisional hernias (IH) in the postoperative course. Therefore, we investigated the role of IBD as perioperative risk factor in open ventral hernia repair (OVHR) as well as the impact of IBD on hernia recurrence during postoperative follow-up.

The postoperative course of 223 patients (Non-IBD (n = 199) and IBD (n = 34)) who underwent OVHR were compared by means of extensive group comparisons and binary logistic regressions. Hernia recurrence was investigated in the IBD group according to the Kaplan–Meier method and risk factors for recurrence determined by Cox regressions.

General complications (≥ Clavien-Dindo I) occurred in 30.9% (72/233) and major complications (≥ Clavien-Dindo IIIb) in 7.7% (18/233) of the overall cohort with IBD being the single independent risk-factor for major complications (OR = 4.2, p = 0.007). Further, IBD patients displayed a recurrence rate of 26.5% (9/34) after a median follow-up of 36 months. Multivariable analysis revealed higher rates of recurrence in patients with ulcerative colitis (UC, 8/15, HR = 11.7) compared to patients with Crohn’s disease (CD, 1/19, HR = 1.0, p = 0.021).

IBD is a significant risk factor for major postoperative morbidity after OVHR. In addition, individuals with IBD show high rates of hernia recurrence over time with UC patients being more prone to recurrence than patients with CD.

• Incisional hernia
• Inflammatory Bowel Disease
• Mesh prothesis
• Morbidity
• Postoperative outcome

The introduction of biological or absorbable synthetic meshes has provided an alternative to conventional repair for incisional hernia. The ability to predict the development of complications after hernia surgery is important, as it guides surgical planning and patient management. This retrospective study assessed whether the postoperative C-reactive protein (CRP) level can predict complications after incisional hernia repair using biological mesh reinforcement. Patients who underwent incisional hernia repair surgery using biological meshes between February 2009 and February 2015 were screened for study inclusion. Patients included in the study were divided into two groups: those with and without postoperative complications. The two groups were analysed based on sex, surgical operation, length of intensive care unit stay (ICU), complications and mortality. Laboratory values, including white blood cell (WBC) count and CRP levels, were determined preoperatively and up to postoperative day (POD) 10. Postoperative complications requiring further management occurred in 32 of the 60 patients (53.3%). Among 47 patients, the mean CRP and WBC levels were 6.6 mg/L and 9.073 G/L in the group without complications vs. 141.0 mg/L, 16.704 G/L in the group with complications (p < 0.001). Patients with complications also had a longer ICU stay (10.1 vs. 0.6 days, p < 0.0001). A cut-off was 101 mg/L and offered 80.00% sensitivity (IC 61.43% to 92.29) and 95.24% specificity (76.18% to 99.88%) for postoperative complication. The rate of postoperative complications before POD10 was 95% in the group with CRP > 100 mg/L vs. 46% in the group with CRP < 100 mg/L (p = 0.000372). A high postoperative CRP level (> 100 mg/L) up to POD10 may serve as a predictor of postoperative complications in patients undergoing incisional hernia using biological meshes.

• biocompatible
• chorion membrane
• decellularization
• extracellular matrix
• tissue regeneration

• Biocompatible Materials/chemistry
• Chorion/chemistry
• Humans
• Tissue Engineering
• Tissue Scaffolds/chemistry
• Wound Healing

• PD/BD/128103/2016 Fundação para a Ciência e a Tecnologia
• FSE/POCH/PD/169/2013 Fundação para a Ciência e a Tecnologia
• NORTE-01-0145-FEDER-0000232 European Regional 31 Development Fund (ERDF)

Single-stage repair of incisional hernias in contaminated fields has a high rate of surgical site infection (30–42%) when biologic grafts are used for repair. In an attempt to decrease this risk, a novel graft incorporating gentamicin into a biologic extracellular matrix derived from porcine small intestine submucosa was developed.

This prospective, multicenter, single-arm observational study was designed to determine the incidence of surgical site infection following implantation of the device into surgical fields characterized as CDC Class II, III, or IV.

Twenty-four patients were enrolled, with 42% contaminated and 25% dirty surgical fields. After 12 months, 5 patients experienced 6 surgical site infections (21%) with infection involving the graft in 2 patients (8%). No grafts were explanted.

The incorporation of gentamicin into a porcine-derived biologic graft can be achieved with no noted gentamicin toxicity and a low rate of device infection for patients undergoing single-stage repair of ventral hernia in contaminated settings.

The study was registered March 27, 2015 at www.clinicaltrials.gov as NCT02401334.

• Abdominal wall reconstruction
• Contamination
• Graft
• Hernia repair

• extracellular matrix
• pericardium
• reconstructive surgery
• tissue engineering
• xenotransplantation

• Adhesion
• Hernia
• Poly(ester urea)s
• Soft-tissue

• Abdominal muscle strength
• Full-thickness skin
• Incisional hernia
• Recurrence rate
• Ventral hernia

• Abdominal Wall/surgery
• Aged
• Esthetics
• Female
• Follow-Up Studies
• Hernia, Ventral/surgery
• Humans
• Incisional Hernia/surgery
• Male
• Middle Aged
• Patient Satisfaction
• Prospective Studies
• Recurrence
• Skin Transplantation
• Surgical Mesh/statistics & numerical data

• 2014-7196 Vetenskapsrådet
• Västerbotten Läns Landsting
• Norrbottens Läns Landsting

• HADM
• biodegradation
• hernia
• hyaluronan coating
• hyaluronidase

Complex ventral incisional hernia repair represents a challenging clinical condition in which biologically derived graft reinforcement is often utilized, but little long-term data inform that decision. Urinary bladder matrix (UBM) has shown effectiveness in diverse clinical settings as durable reinforcement graft material, but it has not been studied over a long term in ventral incisional hernia repair. This study evaluates the clinical, radiographic, and histological outcome of complex incisional hernia repair using UBM reinforcement with 12–70 months of follow-up.

A single-arm, retrospective observational study of all ventral incisional hernia repairs utilizing UBM reinforcement over a 6-year time frame by a single surgeon was performed. Patients were assessed in long-term follow-up clinically and with the Carolina Comfort Scale. A subset of patients was assessed with abdominal wall ultrasound or CT scan. Three patients had abdominal wall fascial biopsies years after the incisional hernia repair with UBM graft, and the histology is analyzed.

64 patients underwent repair of complex incisional hernias with UBM graft reinforcement by a single surgeon. 42 patients had concomitant procedures including large or small bowel resection, excision of infected mesh, evacuation of abscess or hematoma, cholecystectomy, or panniculectomy with abdominoplasty. 16 patients had ostomies at the time of repair. Median follow-up time is 36 months, with a range of 12–70 months. Nine patients (14%) have required surgical repair of a recurrent hernia, and a tenth patient has a recurrence that is managed non-surgically, for a total recurrence rate of 15.6% over the entire time frame. Median time to recurrence was 32 months, and a Kaplan–Meier freedom from recurrence curve is depicted. 28 patients have undergone ultrasound or CT assessments of the abdominal wall which demonstrate radiographic fascial integrity 12–70 months after repair. Three patients have been re-explored for unrelated reasons in the years following ventral incisional hernia repair with UBM, and full thickness fascial biopsies demonstrate a robust remodeling response histologically similar to native myofascial tissue. No patients have developed graft infection, fistulization to the graft, or required graft explantation. Carolina Comfort Scale assessment of 45 patients 3 years after the repair averaged 16 out of a possible 115.

In 64 patients undergoing complex ventral incisional hernia repair with UBM reinforcement, all have experienced successful resolution of complex clinical conditions and 15.6% of these repairs have recurred at a median follow-up of 3 years. Three full-thickness biopsies of the repaired fascia years later shed light on a promising remodeling response which may signal strength and durability comparable to native fascia.

• Component separation
• Mesh
• Myofascial flap
• UBM
• Ventral hernia
• Xenograft

To date, there is no shared consensus on a definition of a complex abdominal wall in elective surgery and in the emergency, on indications, technical details, complications, and follow-up. The purpose of the conference was to lay the foundations for a homogeneous approach to the complex abdominal wall with the primary intent being to attain the following objectives: (1) to develop evidence-based recommendations to define “complex abdominal wall”; (2) indications in emergency and in elective cases; (3) management of “complex abdominal wall”; (4) techniques for temporary abdominal closure. The decompressive laparostomy should be considered in a case of abdominal compartment syndrome in patients with critical conditions or after the failure of a medical treatment or less invasive methods. In the second one, beyond different mechanism, patients with surgical emergency diseases might reach the same pathophysiological end point of trauma patients where a preventive “open abdomen” might be indicated (a temporary abdominal closure: in the case of a non-infected field, the Wittmann patch and the NPWT had the best outcome followed by meshes; in the case of an infected field, NPWT techniques seem to be the preferred). The second priority is to create optimal both general as local conditions for healing: the right antimicrobial management, feeding—preferably by the enteral route—and managing correctly the open abdomen wall. The use of a mesh appears to be—if and when possible—the gold standard. There is a lot of enthusiasm about biological meshes. But the actual evidence supports their use only in contaminated or potentially contaminated fields but above all, to reduce the higher rate of recurrences, the wall anatomy and function should be restored in the midline, with or without component separation technique. On the other site has not to be neglected that the use of monofilament and macroporous non-absorbable meshes, in extraperitoneal position, in the setting of the complex abdomen with contamination, seems to have a cost effective role too. The idea of this consensus conference was mainly to try to bring order in the so copious, but not always so “evident” literature utilizing and exchanging the expertise of different specialists.

• Complex abdominal wall
• Emergency and elective treatment
• Laparostomy
• Meshes

• Hernia, Abdominal/epidemiology
• Hernia, Abdominal/prevention & control
• Humans
• Incidence
• Length of Stay/statistics & numerical data
• Patient Readmission
• Postoperative Complications/epidemiology
• Postoperative Complications/prevention & control
• Prosthesis-Related Infections/etiology
• Quality of Life
• Randomized Controlled Trials as Topic
• Reoperation/statistics & numerical data
• Surgical Mesh/adverse effects
• Surgical Stomas/adverse effects

• Chest wall reconstruction
• collagen patch
• painless
• titanium plates

Nonreinforced tensile repair of giant hiatal hernias is susceptible to recurrence, and the role of mesh graft implantation remains controversial. Creating a new and viable choice without the use of high-cost biological allografts is desirable. This study presents the application of dermis graft reinforcement, a cost-efficient, easily adaptable alternative, in graft reinforcement of giant hiatal hernia repairs.

A 62-year-old female patient with recurrent giant hiatal hernia (9 × 11 cm) and upside down stomach, immediately following the Belsey repair done in another department, was selected for the pilot procedure. The standard three-stitch nonabsorbable reconstruction of diaphragmatic crura was undertaken via laparoscopic approach. A 12 × 6 cm dermis autograft was harvested from the loose abdominal skin. “U” figure onlay reinforcement of diaphragm closure was secured with titanium staples. The procedure was completed with a standard Dor fundoplication. One- and seven-month follow-ups were conducted.

No short-term postoperative complications were observed. One-month follow-up showed normal anatomical location of abdominal viscera on computed tomography imaging. High-resolution manometry showed normal lower esophageal sphincter pressure. Preoperative abdominal complaints were resolved. Procedural costs were lower than the average cost following mesh graft reinforcement.

Dermis graft reinforcement is a cheap, easily adaptable procedure in the repair of giant hiatal hernias, even in the setting of laparoscopic reoperative procedure.

• Biologic meshes
• Biosynthetic meshes
• Bridging
• Complex ventral hernias
• Contaminated surgical field

• Abdominal Wall/surgery
• Abdominoplasty/adverse effects
• Abdominoplasty/instrumentation
• Abdominoplasty/methods
• Biocompatible Materials/adverse effects
• Biocompatible Materials/therapeutic use
• Biological Products/adverse effects
• Biological Products/therapeutic use
• Consensus
• Hernia, Abdominal/surgery
• Herniorrhaphy/adverse effects
• Herniorrhaphy/instrumentation
• Herniorrhaphy/methods
• Humans
• Postoperative Complications/etiology
• Postoperative Complications/prevention & control
• Surgical Mesh

• Alloplastic mesh
• Biologic mesh
• Cross-matched pair
• Ventral incisional hernia

In the age of synthetic prostheses most of hernia studies include a careful examination of the various types of prosthesis, their characteristics and their repair indications. Biological prostheses are also beginning to draw attention. But in terms of recurrence especially for poor or developing countries, the discussion is different, due to their high cost which makes them difficult to afford. In this article we present new flap reconstruction techniques for the reconstruction of the abdominal wall versus mesh repair, applied on swine models, outline the results of each technique, and specify the indications for their use.

An experimental protocol using four swine models (PIC-FII-337 hybrid breed pigs), five months old, was conducted. All animal care and operative procedures were studied following the protocol approved by the Ethics Committee of the University of Medicine and Pharmacy resolution no. 281/2014 of the Department of Surgery of the University of Agricultural Sciences and Veterinary Medicine); the study was carried out between November 2015 and February 2016. The primary objective was to compare the effect of surgical strategies in the treatment of the abdominal wall defect using variable flaps versus mesh repair in a large-animal models. Physical examination and ultrasound imaging of the abdominal wall repair were done on determined periods, during one month. The complications occurring after the abdominal wall repair were edema, collections, superficial dehiscence an recurrences.

No recurrences were reported at one month results, all seromas reported were solved over time by natural drainage. Superficial necrosis appeared in two swine models and superficial dehiscence occurred in one model, the perforator ”plus” flap. Mesh infection was detected in the “onlay” swine model.

In terms of recurrences, contaminated abdominal wall defects or other contraindications to the use of prosthetic materials, biological mesh repair or flap surgery are the only surgical options. Based on our findings and considering the high cost reported by the biological meshes use, flap surgery becomes the suitable treatment for such cases, allowing a good reconstruction of the abdominal wall.

• complications
• harvesting techniques
• incisional hernia
• recurrence
• surgical flaps
• swine model

• Abdominal wall
• Bioprosthesis
• Digestive surgery
• Literature review

• Citric acid
• Hernia
• Hernia mesh
• Hernia prosthesis
• Hernia repair

• R01 CA182670 NCI NIH HHS
• R01 EB012575 NIBIB NIH HHS
• R01 HL118498 NHLBI NIH HHS

• Abdominal Wall/surgery
• Abdominoplasty/methods
• Acellular Dermis
• Collagen
• Female
• Humans
• Mammaplasty/methods
• Outcome Assessment, Health Care
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Risk Factors

• Biologics
• Hernia
• Recurrence
• Surgical site infection
• Surgisis

• Aged
• Animals
• Biological Products
• Body Image
• Female
• Hernia, Ventral/surgery
• Herniorrhaphy/methods
• Humans
• Incidence
• Intestinal Mucosa/transplantation
• Intestine, Small/transplantation
• Male
• Mental Health
• Middle Aged
• Multivariate Analysis
• Patient Reported Outcome Measures
• Proportional Hazards Models
• Recurrence
• Retrospective Studies
• Surgical Mesh
• Surgical Wound Infection/epidemiology
• Swine
• Treatment Outcome

• Hernia
• Surgical mesh
• Tissue engineering
• Ventral