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Kelmer G. What do we currently know about incisional complications of colic surgery? EQUINE VET EDUC 2023. [DOI: 10.1111/eve.13763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Gal Kelmer
- Department of Large Animal Medicine and Surgery, Veterinary Teaching Hospital, Koret School of Veterinary Medicine The Hebrew University of Jerusalem Jerusalem Israel
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Reply: Effects of botulinum toxin A on an incisional hernia reconstruction in a rat model. Plast Reconstr Surg 2022; 150:476e-477e. [PMID: 35708680 DOI: 10.1097/prs.0000000000009299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Moon DH, Park J, Park YG, Kim BJ, Woo W, Na H, Oh S, Lee HS, Lee S. Intramuscular stimulation as a new modality to control postthoracotomy pain: A randomized clinical trial. J Thorac Cardiovasc Surg 2022; 164:1236-1245. [PMID: 35410693 DOI: 10.1016/j.jtcvs.2022.02.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 02/18/2022] [Accepted: 02/25/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Postoperative pain after thoracic surgery primarily hinders patients' mobility, decreasing the quality of life. To date, various modalities have been suggested to improve postoperative pain. However, pain alleviation still remains a challenge, resulting in continued reliance on opioids. To tackle this problem, this study introduces a needle electrical twitch obtaining intramuscular stimulation (NETOIMS) as a new effective treatment modality for postoperative pain after thoracoscopic surgery. METHODS This randomized clinical trial analyzed patients receiving video-assisted thoracoscopic surgery pulmonary resection between March 2018 and June 2020 at a single institution. A total of 77 patients (NETOIMS, 36; intravenous patient-controlled analgesia, 41) were included. NETOIMS was conducted on the retracted intercostal muscle immediately following the main procedure, just before skin closure. Postoperative pain (numeric rating scale) and oral opioid morphine milligram equivalent were assessed daily until postoperative day 5. RESULTS The NETOIMS group had a significantly lower numeric rating scale score on postoperative day (POD) 0 (P < .01), POD2 (P < .001), POD4 (P < .001), and POD5 (P = .01). The predicted time to complete pain resolution was 6.15 days in the NETOIMS group and 20.7 days in the intravenous patient-controlled analgesia group. The oral opioid morphine milligram equivalent was significantly lower in the NETOIMS group on POD0 (P < .001) and POD1 (P < .001). CONCLUSIONS NETOIMS appears to be an effective modality in alleviating postoperative pain after thoracoscopic surgery, thereby reducing the reliance on opioid use.
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Affiliation(s)
- Duk Hwan Moon
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinyoung Park
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yoon Ghil Park
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Bong Jun Kim
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Wongi Woo
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hannah Na
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sunyoung Oh
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Department of Research Affairs, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sungsoo Lee
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Wegdam JA, de Vries Reilingh TS, Bouvy ND, Nienhuijs SW. Prehabilitation of complex ventral hernia patients with Botulinum: a systematic review of the quantifiable effects of Botulinum. Hernia 2021; 25:1427-1442. [PMID: 33215244 DOI: 10.1007/s10029-020-02333-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/02/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Complex ventral hernia repair (CVHR) encompasses patient optimization, primary fascial closure (PFC), mesh reinforcement and component separation technique (CST), if needed. High rates of complications after CST are still reported. Prehabilitation by managing pre-operative modifiable risk factors, like abdominal wall compliance, possibly reduces these rates. Compliance can be modified by intramuscular injection of Botulinum in the lateral abdominal wall muscles (LAWM). Paralysis leads to elongation of these muscles, which may facilitate PFC and/or prevent CST. Evidence to use Botulinum in hernia patients is scarce and fragmented. An update of evidence for the effect of Botulinum is presented. METHODS A multi-database search was conducted for Botulinum studies in ventral hernia patients. A systematic review was performed to describe its primary effect on compliance (LAWM elongation) and secondary effects like PFC ± CST rate, complications and recurrence. RESULTS 14 studies were included (377 patients) with a HDW of median 12 (10-15) cm. A typical intervention consisted of 200-300 U Botulinum in 3 points per hemi-abdomen under US guidance, > 2 weeks pre-operatively and evaluated by CT just before the operation. The primary effect was a median LAWM elongation of 4.0 cm per side without complications of the injection (four studies, 107 patients). The median PFC rate was 100%, CST rate 38%, wound-related complications 19%, medical complications 18% and recurrence 0% (14 studies). CONCLUSION Botulinum safely elongates the abdominal wall muscles, but the level of evidence available remains low. Any patient in whom PFC is expected to be difficult, could be a candidate for prehabilitation with Botulinum.
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Affiliation(s)
- J A Wegdam
- Department of Surgery, Elkerliek Hospital, Postbus 98, 5700 AB, Helmond, The Netherlands.
| | - T S de Vries Reilingh
- Department of Surgery, Elkerliek Hospital, Postbus 98, 5700 AB, Helmond, The Netherlands
| | - N D Bouvy
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - S W Nienhuijs
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
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Seretis F, Chrysikos D, Samolis A, Troupis T. Botulinum Toxin in the Surgical Treatment of Complex Abdominal Hernias: A Surgical Anatomy Approach, Current Evidence and Outcomes. In Vivo 2021; 35:1913-1920. [PMID: 34182463 DOI: 10.21873/invivo.12457] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/18/2021] [Accepted: 04/22/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Abdominal wall hernias represent a common problem in surgical practice. A significant proportion of them entails large defects, often difficult to primarily close without advanced techniques. Injection of botulinum toxin preoperatively at specific points targeting lateral abdominal wall musculature has been recently introduced as an adjunct in achieving primary fascia closure rates. MATERIALS AND METHODS A literature search was conducted investigating the role of botulinum toxin in abdominal wall reconstruction focusing on anatomic repair of hernia defects. RESULTS Injecting botulinum toxin preoperatively achieved chemical short-term paralysis of the lateral abdominal wall muscles, enabling a tension-free closure of the midline, which according to anatomic and clinical studies should be the goal of hernia repair. No significant complications from botulinum injections for complex hernias were reported. CONCLUSION Botulinum is a significant adjunct to complex abdominal wall reconstruction. Further studies are needed to standardize protocols and create more evidence.
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Affiliation(s)
- Fotios Seretis
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimosthenis Chrysikos
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandros Samolis
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodore Troupis
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Effects of Botulinum Toxin A on an Incisional Hernia Reconstruction in a Rat Model. Plast Reconstr Surg 2021; 147:1331-1341. [PMID: 33974596 DOI: 10.1097/prs.0000000000007986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Although the effects of botulinum toxin A on hernia reconstruction have been consistently reported, few studies provide objective evidence. The authors aimed to compare the effects of chemical component separation with those of mechanical component separation, and with a combination of chemical and mechanical component separation, in a rat hernia model. METHODS Rats were divided into four groups: 1, control; 2, chemical component separation; 3, mechanical component separation; and 4, chemical and mechanical component separation. Four weeks after hernia induction, botulinum toxin A was injected into groups 2 and 4. Hernia repair was performed 2 weeks after chemical component separation when mechanical component separation was performed in groups 3 and 4. Pretreatment and posttreatment defect sizes, traction forces, intraabdominal pressure, and hernia recurrences were analyzed. RESULTS The defect size was significantly decreased in groups 2 and 4 after chemical component separation. The traction force was significantly smaller in groups 2 and 3 compared with the control group, and the effects of chemical and mechanical component separation were additive. The mean intraabdominal pressure was 16.83 mmHg in group 1, 10.67 mmHg in group 2, 10.17 mmHg in group 3, and 9.67 mmHg in group 4, thus showing significant reductions following chemical and mechanical component separation. Recurrence was observed in all six animals (100 percent) in groups 1 and 3, but in only one of six (17 percent) in groups 2 and 4. CONCLUSIONS Preoperative botulinum toxin A significantly reduces hernia size (by 30 percent) and the traction force required to medialize the rectus abdominis. After hernia repair, chemical component separation decreases the intraabdominal pressure to a similar degree as mechanical component separation, but only chemical component separation appears to reduce hernia recurrence.
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Love MW, Warren JA, Davis S, Ewing JA, Hall AM, Cobb WS, Carbonell AM. Computed tomography imaging in ventral hernia repair: can we predict the need for myofascial release? Hernia 2021; 25:471-477. [PMID: 32277369 DOI: 10.1007/s10029-020-02181-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 03/25/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Currently, the need for additional myofascial release (AMR) in addition to retromuscular dissection during open Rives-Stoppa hernia repair is determined intraoperatively based on the discretion of the surgeon. We developed a novel method to objectively predict the need for AMR preoperatively using computed tomography (CT)-measured rectus width to hernia width ratio (RDR). METHODS A retrospective chart review of all patients who underwent open retro-muscular mesh repair of midline ventral hernia between August 1, 2007 and February 1, 2018, who had a preoperative CT scan within 1 year prior to their operation. The primary endpoint was the ability of the defect ratio to predict the need for AMR in pursuit of fascial closure. The secondary endpoint was the ability of Component Separation Index (CSI) to predict the need for AMR to obtain fascial closure. RESULTS Of 342 patients, 208 repaired with rectus abdominis release alone (RM group), while 134 required AMR (RM + group). An RDR of > 1.34 on area under the curve analysis predicted the need for AMR with 77.6% accuracy. There was a linear decrease in the need for AMR with increasing RDR: RDR < 1 required AMR in 78.8% of cases, RDR 1.1-1.49 in 52%, RDR 1.5-1.99 in 32.1%, and RDR > 2 in just 10.8%. Similarly, CSI > 0.146 predicted the need for AMR with 76.3% accuracy on area under the curve analysis. CONCLUSION The RDR is a practical and reliable tool to predict the ability to close the defect during open Rives-Stoppa ventral hernia repair without AMR. An RDR of > 2 portends fascial closure with rectus abdominis myofascial release alone in 90% of cases.
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Affiliation(s)
- M W Love
- Division of Minimal Access and Bariatric Surgery, Department of Surgery, Prisma Health-Upstate, Greenville, SC, USA
| | - J A Warren
- Division of Minimal Access and Bariatric Surgery, Department of Surgery, University of South Carolina School of Medicine Greenville, Prisma Health-Upstate, 701 Grove Rd. ST3, Greenville, SC, 29605, USA.
| | - S Davis
- Division of Minimal Access and Bariatric Surgery, Department of Surgery, Prisma Health-Upstate, Greenville, SC, USA
| | - J A Ewing
- Health Sciences Center, Prisma Health-Upstate, Greenville, SC, USA
| | - A M Hall
- Division of Minimal Access and Bariatric Surgery, Department of Surgery, Prisma Health-Upstate, Greenville, SC, USA
| | - W S Cobb
- Division of Minimal Access and Bariatric Surgery, Department of Surgery, University of South Carolina School of Medicine Greenville, Prisma Health-Upstate, 701 Grove Rd. ST3, Greenville, SC, 29605, USA
| | - A M Carbonell
- Division of Minimal Access and Bariatric Surgery, Department of Surgery, University of South Carolina School of Medicine Greenville, Prisma Health-Upstate, 701 Grove Rd. ST3, Greenville, SC, 29605, USA
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Rezende-Neto JB, Camilotti BG. New non-invasive device to promote primary closure of the fascia and prevent loss of domain in the open abdomen: a pilot study. Trauma Surg Acute Care Open 2020; 5:e000523. [PMID: 33225070 PMCID: PMC7661352 DOI: 10.1136/tsaco-2020-000523] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 09/10/2020] [Accepted: 10/16/2020] [Indexed: 02/02/2023] Open
Abstract
Background Primary closure of the fascia at the conclusion of a stage laparotomy can be a challenging task. Current techniques to medialize the fascial edges in open abdomens entail several trips to the operating room and could result in fascial damage. We conducted a pilot study to investigate a novel non-invasive device for gradual reapproximation of the abdominal wall fascia in the open abdomen. Methods Mechanically ventilated patients ≥16 years of age with the abdominal fascia deliberately left open after a midline laparotomy for trauma and acute care surgery were randomized into two groups. Control group patients underwent standard care with negative pressure therapy only. Device group patients were treated with negative pressure therapy in conjunction with the new device for fascial reapproximation. Exclusion criteria: pregnancy, traumatic hernias, pre-existing ventral hernias, burns, and body mass index ≥40 kg/m2. The primary outcome was successful fascial closure by direct suture of the fascia without mesh or component separation. Secondary outcomes were abdominal wall complications. Results Thirty-eight patients were investigated, 20 in the device group and 18 in the control group. Primary closure of the fascia by direct suture without mesh or component separation was achieved in 17 patients (85%) in the device group and only 10 patients (55.6%) in the control group (p=0.0457). Device group patients were 53% more likely to experience primary fascial closure by direct suture than control group patients. Device group showed gradual reduction (p<0.005) in the size of the fascial defects; not seen in control group. There were no complications related to the device. Conclusions The new device applied externally on the abdominal wall promoted reapproximation of the fascia in the midline, preserved the integrity of the fascia, and improved primary fascial closure rate compared with negative pressure therapy system only. Level of evidence I, randomized controlled trial.
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Affiliation(s)
- Joao Baptista Rezende-Neto
- Surgery, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada.,General Surgery, St Michael's Hospital, Toronto, Ontario, Canada
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Tosun S, Gunduz N. Anterior Component Separation Technique Is Efficient Enough in Loss of Domain Hernia Treatment. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02151-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Effectiveness of Intramuscular Electrical Stimulation on Postsurgical Nociceptive Pain for Patients Undergoing Open Pancreaticoduodenectomy: A Randomized Clinical Trial. J Am Coll Surg 2020; 231:339-350. [PMID: 32623088 DOI: 10.1016/j.jamcollsurg.2020.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/30/2020] [Accepted: 06/02/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND After pylorus-preserving pancreaticoduodenectomy (PPPD), incision and suture of the abdominal muscles cause inflammatory changes and elicit somatic pain that deteriorates the quality of life. There have been no previous reports on needle electrical twitch obtaining intramuscular stimulation (NETOIMS) in abdominal open operation; this study aimed to apply NETOIMS for postoperative somatic pain in patients undergoing PPPD as a new treatment modality for pain control. METHODS Between June 2018 and January 2019, 44 patients who underwent PPPD were randomly assigned to a control group and the NETOIMS group. The NETOIMS group received NETOIMS in the transverse abdominis muscle under ultrasound guidance right after operation under general anesthesia. The pain score (visual analog scale), peak cough flow (PCF), and gait speed were repetitively measured from 1 day before operation to 2 weeks after discharge as scheduled. Data were analyzed by the linear mixed model and repeated-measures analysis of variance. RESULTS Of the 44 patients recruited, data from 38 patients were finally analyzed. The pain scores were significantly lower in the NETOIMS group after PPPD (p = 0.01). Although the PCF at each measuring time point did not show inter-group difference (p = 0.20), improvement of PCF from the second day after operation to discharge was greater (p = 0.02) and gait speed improved significantly faster (p < 0.01) in the NETOIMS group than in the control group. CONCLUSIONS NETOIMS helps in rapid reduction of postoperative somatic pain developed after PPPD and in improvement of PCF and gait speed.
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Shearer TR, Holcombe SJ, Valberg SJ. Incisional infections associated with ventral midline celiotomy in horses. J Vet Emerg Crit Care (San Antonio) 2020; 30:136-148. [PMID: 32100465 DOI: 10.1111/vec.12936] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 06/19/2018] [Accepted: 06/24/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To review the veterinary literature regarding healing and complications associated with equine celiotomy including anatomy and physiology, risk factors for incisional infection and hernia, and treatment. ETIOLOGY Celiotomy is the most common approach to treat horses with surgical colic. Incision through the linea alba provides exposure to most of the abdomen for exploration, exteriorization, and correction of surgical lesions. Incisional apposition relies on suture strength during anesthetic recovery and for the first 30 days postoperatively. Factors associated with the patient, surgical lesion and procedures, anesthesia, and recovery put the horse at risk for surgical site infection. Infection is the most important risk factor for incisional hernia formation. DIAGNOSIS A presumptive diagnosis of surgical site infection is made based on the presence of fever and incisional swelling, pain, and discharge. Ultrasonography can be used to identify areas of fluid accumulation prior to the appearance of incisional drainage. Definitive diagnosis is based on positive bacteriologic culture of the incisional discharge. Incisional hernia is diagnosed by palpation of the incision, usually 30-60 days after surgery. Ultrasound of the incision may aide in early diagnosis of incisional hernia if gaps along the incision in the linea alba are apparent. THERAPY No objective data exist to assess the efficacy of specific therapies for surgical site infections following celiotomy. Principles of treatment include the establishment of drainage, bandaging, antimicrobial therapy based on culture and sensitivity, and extended rest in an attempt to avoid incisional hernia or dehiscence. Treatment for incisional hernia includes prolonged circumferential bandaging, open or minimally invasive hernia repair, or no treatment. PROGNOSIS Incisional complications are associated with prolonged convalescence and diminished prognosis for return to athleticism. Limiting risk factors for surgical site infections, prompt treatment, and incisional support may optimize celiotomy healing and timely return to function. Horses compete in many disciplines with incisional hernias.
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Affiliation(s)
- Tara R Shearer
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI
| | - Susan J Holcombe
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI
| | - Stephanie J Valberg
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI
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Farazi-Chongouki C, Filippou D. Role of botulinum toxin a in the management of complex incisional hernias. World J Surg Proced 2019. [DOI: 10.5412/wjsp.v9.i1.0000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Farazi-Chongouki C, Filippou D. Role of botulinum toxin a in the management of complex incisional hernias. World J Surg Proced 2019; 9:1-6. [DOI: 10.5412/wjsp.v9.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/01/2019] [Accepted: 04/28/2019] [Indexed: 02/06/2023] Open
Affiliation(s)
- Christos Farazi-Chongouki
- Department of Anatomy and Surgical Anatomy, Medical School, National and Kapodestrian University of Athens, Athens 11521, Greece
| | - Dimitrios Filippou
- Department of Anatomy and Surgical Anatomy, Medical School, National and Kapodestrian University of Athens, Athens 11521, Greece
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Oliveira LT, Essu FF, de Mesquita GHA, Jardim YJ, Iuamoto LR, Suguita FY, Martines DR, Nii F, Waisberg DR, Meyer A, Andraus W, D'Albuquerque LAC. Component separation of abdominal wall with intraoperative botulinum A presents satisfactory outcomes in large incisional hernias: a case report. Int J Surg Case Rep 2017; 41:99-104. [PMID: 29055880 PMCID: PMC5651546 DOI: 10.1016/j.ijscr.2017.09.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 09/05/2017] [Indexed: 01/16/2023] Open
Abstract
PURPOSE Transplantation patients have a series of associated risk factors that make appearance of incisional hernia (IH) more likely. A number of aspects of the closure of large defects remain controversial. In this manuscript, we present the repair of a large IH following liver transplantation through the technique of posterior components separation combined with the anterior, together with the intraoperative use of botulinum toxin A and the placement of mesh. As a secondary objective, we analyze the incidence of IH following liver transplantation in our service. METHODS Between the years 2013 and 2016, 247 patients underwent liver transplantation in the Liver Transplantation Service at the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil. We analyzed the incidence of IH in these patients. One of these cases operated in March 2017 presented a defect in the abdominal wall of 22×16.6×6.4cm in the median and paramedian regions. We present the details of this innovative surgical technique. RESULTS The total operating time was 470min. During the postoperative phase the patient presented ileus paralysis, without systemic repercussions. Resumption of an oral diet on the fifth postoperative day, without incident. Hospital discharge occurred on the 12th postoperative day, with outpatient follow up. CONCLUSION In our service, the incidence of incisional hernias following liver transplantation is 14.5%. We described a successful approach for selected patient group for whom there is no established standard treatment. Given the complexity of such cases, however, more studies are necessary.
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Affiliation(s)
| | - Felipe Futema Essu
- Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | | | - Yuri Justi Jardim
- Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | | | - Fábio Yuji Suguita
- Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | | | - Fernanda Nii
- Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Daniel Reis Waisberg
- Departamento de Gastroenterologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Alberto Meyer
- Departamento de Gastroenterologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Wellington Andraus
- Departamento de Gastroenterologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Weissler JM, Lanni MA, Tecce MG, Carney MJ, Shubinets V, Fischer JP. Chemical component separation: a systematic review and meta-analysis of botulinum toxin for management of ventral hernia. J Plast Surg Hand Surg 2017; 51:366-374. [PMID: 28277071 DOI: 10.1080/2000656x.2017.1285783] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Ventral hernia represents a surgical challenge plagued by high morbidity and recurrence rates. Primary closure of challenging hernias is often prohibited by severe lateral retraction and tension of the abdominal wall musculature. Botulinum toxin injections have recently been identified as a potential pre-operative means to counteract abdominal wall tension, reduce hernia size, and facilitate fascial closure during hernia repair. This systematic review and meta-analysis reviews outcomes associated with botulinum toxin injections in the setting of ventral hernia, and demonstrates an opportunity to leverage this mainstream aesthetic product for use in abdominal wall reconstruction. METHODS A literature review was conducted according to PRISMA guidelines using MeSH terms 'ventral hernia', 'herniorrhaphy', 'hernia repair', and 'botulinum toxins'. Relevant studies reporting pre- and postinjection data were included. Outcomes of interest included changes in hernia defect width and lateral abdominal muscle length, recurrence, complications, and patient follow-up. Qualitative findings were also considered to help demonstrate valuable themes across the literature. RESULTS Of 133 results, 12 were included for qualitative review and three for quantitative analysis. Meta-analysis revealed significant hernia width reduction (mean = 5.79 cm; n = 29; p < 0.001) and lateral abdominal wall muscular lengthening (mean = 3.33 cm; n = 44; p < 0.001) following botulinum injections. Mean length of follow-up was 24.7 months (range = 9-49). CONCLUSIONS Botulinum toxin injections offer tremendous potential in ventral hernia management by reducing hernia width and lengthening abdominal wall muscles prior to repair. Although further studies are needed, there is a significant opportunity to bridge the knowledge gap in preoperative practice measures for ventral hernia risk reduction.
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Affiliation(s)
- Jason M Weissler
- a Division of Plastic Surgery, Department of Surgery , University of Pennsylvania , Philadelphia , PA , USA
| | - Michael A Lanni
- a Division of Plastic Surgery, Department of Surgery , University of Pennsylvania , Philadelphia , PA , USA
| | - Michael G Tecce
- a Division of Plastic Surgery, Department of Surgery , University of Pennsylvania , Philadelphia , PA , USA
| | - Martin J Carney
- a Division of Plastic Surgery, Department of Surgery , University of Pennsylvania , Philadelphia , PA , USA
| | - Valeriy Shubinets
- a Division of Plastic Surgery, Department of Surgery , University of Pennsylvania , Philadelphia , PA , USA
| | - John P Fischer
- a Division of Plastic Surgery, Department of Surgery , University of Pennsylvania , Philadelphia , PA , USA
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Zhang L. Incidence of abdominal incisional hernia in developing country: a retrospective cohort study. Int J Clin Exp Med 2015; 8:13649-13652. [PMID: 26550309 PMCID: PMC4612994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 08/03/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To estimate the incidence of abdominal incisional hernia in developing countries. METHODS This population-based retrospective cohort study identified all patients with abdominal surgery between 2006 to 2011 in Aden Public Hospital, Aden, Yemen and the Second Hospital Affiliated with Dalian Medical University, Dalian, China. The cohort was followed from their first until 1 year after their last abdominal surgery within the inclusion period or until the first of the following events: hernia repair, death, emigration, second abdominal surgery. For patients who had a hernia repair, hospital records regarding the surgery and previous abdominal surgery were tracked and manually analyzed to confirm the relationship between hernia repair and abdominal surgery. RESULTS We identified 2096 patients who had abdominal surgery during the inclusion period and 51 cases were excluded. During follow-up, 80 of these patients who had a hernia requiring repair were analyzed. Of these 20 had infected incision and 80 had non-infected incision. The incidence is significantly higher in infected incision (20/202) than that in non-infected incision (60/1843). There were no any differences in the incidence between Aden and Dalian. CONCLUSIONS The overall incidence of abdominal incisional hernia requiring surgical repair within 1 year after abdominal surgery was 80/2045 in a population from Aden and Dalian. Infected incision is prone to occur incisional hernia during the follow-up period.
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Affiliation(s)
- Litian Zhang
- Operation Room, The Second Affiliated Hospital with Dalian Medical University Dalian, Liaoning Province, P. R. China
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