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Robert P Bleichrodt - One of the best experts on this subject based on the ideXlab platform.
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large and complex ventral hernia repair using components Separation Technique without mesh results in a high recurrence rate
American Journal of Surgery, 2015Co-Authors: Nicholas J Slater, Harry Van Goor, Robert P BleichrodtAbstract:BACKGROUND: Recurrence rates after component Separation Technique (CST) are low in the literature but may be underestimated because of inadequate follow-up methods. METHODS: Prospective patient follow-up was performed of consecutive patients who underwent repair of large and complex ventral hernias using CST without mesh utilization. Primary outcome was recurrent hernia determined by clinical examination at least 1 year after surgery in all living patients. Current literature underwent meta-analysis regarding outcomes and mode of follow-up. RESULTS: Seventy-five patients were included with a mean age of 52.2 years and a mean defect size of 214.9 cm(2), respectively. Twenty-nine patients (38.7%) had a recurrent hernia after a mean of 40.9-month follow-up, and this was significantly higher than in the literature (14.0%, P < .01). Sixty-four percent of studies in the literature were unclear about the method of determining recurrent hernia or included telephone follow-up and questionnaires. CONCLUSIONS: CST coincides with a high recurrence rate when clinical follow-up is longer than a year. Reported recurrence rates are probably underestimated because the method and duration of follow-up are inadequate.
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closure of giant omphaloceles by the abdominal wall component Separation Technique in infants
Journal of Pediatric Surgery, 2008Co-Authors: Floortje C Van Eijck, Ivo De Blaauw, Robert P Bleichrodt, P N M A Rieu, Frans H J M Van Der Staak, Marc H W A Wijnen, Rene M H WijnenAbstract:BACKGROUND/PURPOSE: Several Techniques have been described to repair giant omphaloceles. There is no procedure considered to be the criterion standard worldwide. The aim of the present prospective study was to analyze the early and late results of secondary closure of giant omphaloceles using the component Separation Technique (CST) in infants. METHODS: From January 2004 to January 2007, 10 consecutive pediatric patients with a giant omphalocele were treated at our department. Initially, patients were treated conservatively. After epithelialization of the omphalocele, the abdominal wall was reconstructed using CST. Patients were monitored for complications during admission, and all patients were seen for follow-up. RESULTS: Component Separation Technique was performed at median age of 6.5 months (range, 5-69 months). The median diameter of the hernia was 8 cm (range, 6-9 cm). There was no mortality. The postoperative course was uneventful in 7 patients. Complications were seen in 3 patients (infection, skin necrosis, and hematoma). Median hospital stay was 7 days. After median follow-up of 23.5 months (range, 3-39 month), no reherniations were found. CONCLUSIONS: The CST is a safe 1-stage procedure for secondary closure in children with a giant omphalocele without the need for prosthetic material and with good clinical outcome.
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repair of giant midline abdominal wall hernias components Separation Technique versus prosthetic repair interim analysis of a randomized controlled trial
World Journal of Surgery, 2007Co-Authors: Tammo S De Vries Reilingh, Harry Van Goor, Camiel Rosman, J A Charbon, Eric J Hesselink, G J Van Der Wilt, Robert P BleichrodtAbstract:Background Reconstruction of giant midline abdominal wall hernias is difficult, and no data are available to decide which Technique should be used. It was the aim of this study to compare the “components Separation Technique” (CST) versus prosthetic repair with e-PTFE patch (PR).
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components Separation Technique for the repair of large abdominal wall hernias
Journal of The American College of Surgeons, 2003Co-Authors: Tammo S De Vries Reilingh, Harry Van Goor, Camiel Rosman, Marc H A Bemelmans, Dick De Jong, Ernst Jan Van Nieuwenhoven, Marina I A Van Engeland, Robert P BleichrodtAbstract:BACKGROUND: The "components Separation Technique" is a method for abdominal wall reconstruction in patients with large midline hernias that cannot be closed primarily. The early and late results of this Technique were evaluated in 43 patients. METHODS: Records of 43 patients, 11 women and 32 men, with a mean age of 49.7 (range 22 to 78), were reviewed for body length and weight, size and cause of the hernia, intra- and postoperative mortality and morbidity, with special attention given to wound and pulmonary complications. Patients were invited to attend the outpatient clinic afterward for at least 12 months for physical examination of the abdominal wall. RESULTS: The defect resulted after elective surgery in 19 patients and after acute surgery in 24 patients. In 11 patients, the defect was a result of open treatment of generalized peritonitis, and 13 patients had a recurrent incisional hernia. One patient died on the sixth postoperative day from mesenteric thrombosis. The postoperative course was complicated in 17 patients: fascial dehiscence in one, hematoma in five, seroma in two, wound infection in six, skin necrosis in one, and respiratory insufficiency in two. Thirty-eight patients were seen for followup. After a mean followup of 15.6 months (range 12 to 30 months), a recurrent hernia was found in 12 of the 38 patients (32%). The remaining four patients had no recurrent hernia after 1, 1, 3, and 4 months, respectively. CONCLUSIONS: The "components Separation Technique" is useful for the reconstruction of large abdominal wall hernias, especially under contaminated conditions in which the use of prosthetic material is contraindicated. Further research is needed to reduce the relatively high reherniation rate.
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a modification of the components Separation Technique for closure of abdominal wall defects in the presence of an enterostomy
Journal of The American College of Surgeons, 1999Co-Authors: Sylvester M Maas, Marina I A Van Engeland, Nicolaas G Leeksma, Robert P BleichrodtAbstract:The repair of contaminated abdominal-wall defects is still a challenge for surgeons treating patients with abdominal sepsis. The use of prosthetic material to repair these defects is contraindicated because it gives disappointing results. Reconstructions with autologous material, such as free fascial or musculofascial flaps, are not satisfactory either. The operations of free fascial transplant harvesting are time-consuming and are frequently followed by functional deficits at the donor site. Functional results of those reconstructions are disappointing because of bulging of the denervated muscles, and high reherniation rates of up to 20%. In 1990 Ramirez and associates introduced the “Components Separation Technique” for closure of large abdominal-wall defects without the use of prosthetic material. Their Technique is based on translation of the muscular layers of the abdominal wall, thereby enlarging the surface of the abdominal wall (Fig. 1). A compound flap is created which can be advanced more than 10cm at the waistline, at each side. The Technique has 3 disadvantages. First, the skin and subcutaneous tissue must be mobilized laterally over a large distance in order to reach the aponeurosis of the external oblique muscle, which is retracted laterally into the flank. This creates a large wound surface that covers the whole ventral abdominal wall, from costal margin to pubic bone. Second, mobilization of the skin endangers its blood supply, which may lead to skin necrosis in the midline if circulation through the intercostal arteries is interrupted. Third, the Technique is difficult to use in patients with an enterostomy or if a new enterostomy must be made. We describe a modification of the Technique of Ramirez and colleagues, designed to preserve the blood supply of the skin and subcutaneous tissue, and to overcome the problem of stoma reconstruction in these patients.
Yuri W. Novitsky - One of the best experts on this subject based on the ideXlab platform.
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transversus abdominis release as an alternative component Separation Technique for ventral hernia repair
JAMA Surgery, 2016Co-Authors: Jeffrey A. Blatnik, David M. Krpata, Yuri W. NovitskyAbstract:What Is the Innovation? The use ofmyofascial advancement flaps, or component Separation Technique,datesbackmorethan25years.Themostcommonlymentioned approach is that of Ramirez et al1 from 1990 in which the external abdominal oblique (EO)musculature isdividedasamethodof providingmidlineabdominalmuscle advancementofup to 10cmbilaterally. Although effective in rectusmusclemedialization, anterior componentSeparationTechniquerequirescreationof large,oftenmorbid, lipocutaneousflaps.TheRives-Stopparetromuscular reconstruction is effective, but it is not applicable for larger defects. Transversus abdominis release (TAR) is themost recent Technique to address limitations of traditional reconstructive options. Incontrast tocreating largeskin flaps toaccessanddividetheEO muscle, TARbeginsbyentering theposterior rectus sheath (Figure). Thisdissection iscarried laterally to 1cmmedialof the lineasemilunaris.Theposterior rectussheath is thendivided justmedial to theneurovascularperforatorsand lineasemilunaris.Theunderlying fibersof the transversusabdominismuscleare identifiedanddividedtoenter aretromuscular/preperitonealplane.Thisdissectionisthencarriedout lateral to thepsoasmuscle.Once this is repeatedbilaterally, theposterior rectussheath is thenclosed in themidline, completely isolating thevisceral contents fromanyprostheticmesh.At this stage, there is aspace for theplacementofa largepieceofmesh, reinforcing theentirevisceral sac.Thetypeofmeshvariesdependingonthetypeofhernia repair.Midweightmacroporousmesh is typicallyselectedformidlinedefectswheremuscleclosurecanbeobtained.Flankherniasand those for which fascial closure is difficult may benefit from a heavyweightmesh.However,dataonhowthisaffectsoutcomesareunavailable.Drainsareplacedover themeshtominimizeseromaformation. Thedrainsareremovedafter theoutputhasdecreasedto lessthan30
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Transversus Abdominis Release as an Alternative Component Separation Technique for Ventral Hernia Repair
JAMA Surgery, 2016Co-Authors: Jeffrey A. Blatnik, David M. Krpata, Yuri W. NovitskyAbstract:The use of myofascial advancement flaps, or component Separation Technique, dates back more than 25 years. The most commonly men-tioned approach is that of Ramirez et al 1 from 1990 in which the exter-nal abdominal oblique (EO) musculature is divided as a method of providing midline abdominal muscle advancement of up to 10 cm bilaterally. Although effective in rectus muscle medialization, anteri-or component Separation Technique requires creation of large, often morbid, lipocutaneous flaps. The Rives-Stoppa retromuscular recon-struction is effective, but it is not applicable for larger defects. Trans-versusabdominisrelease(TAR)isthemostrecentTechniquetoaddress limitations of traditional reconstructive options. In contrast to creating large skin flaps to access and divide the EO muscle, TAR begins by entering the posterior rectus sheath (Figure). This dissection is carried laterally to 1 cm medial of the linea semiluna-ris. The posterior rectus sheath is then divided just medial to the neu-rovascular perforators and linea semilunaris. The underlying fibers of the transversus abdominis muscle are identified and divided to enter a retromuscular/preperitoneal plane. This dissection is then carried out lateral to the psoas muscle. Once this is repeated bilaterally, the pos-terior rectus sheath is then closed in the midline, completely isolating the visceral contents from any prosthetic mesh. At this stage, there is a space for the placement of a large piece of mesh, reinforcing the en-tire visceral sac. The type of mesh varies depending on the type of her-nia repair. Midweight macroporous mesh is typically selected for mid-line defects where muscle closure can be obtained. Flank hernias and those for which fascial closure is difficult may benefit from a heavy-weight mesh. However, data on how this affects outcomes are unavail-able. Drains are placed over the mesh to minimize seroma formation. The drains are removed after the output has decreased to less than 30 Figure. Major Steps Involved in Transversus Abdominis Release
Jeffrey A. Blatnik - One of the best experts on this subject based on the ideXlab platform.
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transversus abdominis release as an alternative component Separation Technique for ventral hernia repair
JAMA Surgery, 2016Co-Authors: Jeffrey A. Blatnik, David M. Krpata, Yuri W. NovitskyAbstract:What Is the Innovation? The use ofmyofascial advancement flaps, or component Separation Technique,datesbackmorethan25years.Themostcommonlymentioned approach is that of Ramirez et al1 from 1990 in which the external abdominal oblique (EO)musculature isdividedasamethodof providingmidlineabdominalmuscle advancementofup to 10cmbilaterally. Although effective in rectusmusclemedialization, anterior componentSeparationTechniquerequirescreationof large,oftenmorbid, lipocutaneousflaps.TheRives-Stopparetromuscular reconstruction is effective, but it is not applicable for larger defects. Transversus abdominis release (TAR) is themost recent Technique to address limitations of traditional reconstructive options. Incontrast tocreating largeskin flaps toaccessanddividetheEO muscle, TARbeginsbyentering theposterior rectus sheath (Figure). Thisdissection iscarried laterally to 1cmmedialof the lineasemilunaris.Theposterior rectussheath is thendivided justmedial to theneurovascularperforatorsand lineasemilunaris.Theunderlying fibersof the transversusabdominismuscleare identifiedanddividedtoenter aretromuscular/preperitonealplane.Thisdissectionisthencarriedout lateral to thepsoasmuscle.Once this is repeatedbilaterally, theposterior rectussheath is thenclosed in themidline, completely isolating thevisceral contents fromanyprostheticmesh.At this stage, there is aspace for theplacementofa largepieceofmesh, reinforcing theentirevisceral sac.Thetypeofmeshvariesdependingonthetypeofhernia repair.Midweightmacroporousmesh is typicallyselectedformidlinedefectswheremuscleclosurecanbeobtained.Flankherniasand those for which fascial closure is difficult may benefit from a heavyweightmesh.However,dataonhowthisaffectsoutcomesareunavailable.Drainsareplacedover themeshtominimizeseromaformation. Thedrainsareremovedafter theoutputhasdecreasedto lessthan30
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Transversus Abdominis Release as an Alternative Component Separation Technique for Ventral Hernia Repair
JAMA Surgery, 2016Co-Authors: Jeffrey A. Blatnik, David M. Krpata, Yuri W. NovitskyAbstract:The use of myofascial advancement flaps, or component Separation Technique, dates back more than 25 years. The most commonly men-tioned approach is that of Ramirez et al 1 from 1990 in which the exter-nal abdominal oblique (EO) musculature is divided as a method of providing midline abdominal muscle advancement of up to 10 cm bilaterally. Although effective in rectus muscle medialization, anteri-or component Separation Technique requires creation of large, often morbid, lipocutaneous flaps. The Rives-Stoppa retromuscular recon-struction is effective, but it is not applicable for larger defects. Trans-versusabdominisrelease(TAR)isthemostrecentTechniquetoaddress limitations of traditional reconstructive options. In contrast to creating large skin flaps to access and divide the EO muscle, TAR begins by entering the posterior rectus sheath (Figure). This dissection is carried laterally to 1 cm medial of the linea semiluna-ris. The posterior rectus sheath is then divided just medial to the neu-rovascular perforators and linea semilunaris. The underlying fibers of the transversus abdominis muscle are identified and divided to enter a retromuscular/preperitoneal plane. This dissection is then carried out lateral to the psoas muscle. Once this is repeated bilaterally, the pos-terior rectus sheath is then closed in the midline, completely isolating the visceral contents from any prosthetic mesh. At this stage, there is a space for the placement of a large piece of mesh, reinforcing the en-tire visceral sac. The type of mesh varies depending on the type of her-nia repair. Midweight macroporous mesh is typically selected for mid-line defects where muscle closure can be obtained. Flank hernias and those for which fascial closure is difficult may benefit from a heavy-weight mesh. However, data on how this affects outcomes are unavail-able. Drains are placed over the mesh to minimize seroma formation. The drains are removed after the output has decreased to less than 30 Figure. Major Steps Involved in Transversus Abdominis Release
David M. Krpata - One of the best experts on this subject based on the ideXlab platform.
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transversus abdominis release as an alternative component Separation Technique for ventral hernia repair
JAMA Surgery, 2016Co-Authors: Jeffrey A. Blatnik, David M. Krpata, Yuri W. NovitskyAbstract:What Is the Innovation? The use ofmyofascial advancement flaps, or component Separation Technique,datesbackmorethan25years.Themostcommonlymentioned approach is that of Ramirez et al1 from 1990 in which the external abdominal oblique (EO)musculature isdividedasamethodof providingmidlineabdominalmuscle advancementofup to 10cmbilaterally. Although effective in rectusmusclemedialization, anterior componentSeparationTechniquerequirescreationof large,oftenmorbid, lipocutaneousflaps.TheRives-Stopparetromuscular reconstruction is effective, but it is not applicable for larger defects. Transversus abdominis release (TAR) is themost recent Technique to address limitations of traditional reconstructive options. Incontrast tocreating largeskin flaps toaccessanddividetheEO muscle, TARbeginsbyentering theposterior rectus sheath (Figure). Thisdissection iscarried laterally to 1cmmedialof the lineasemilunaris.Theposterior rectussheath is thendivided justmedial to theneurovascularperforatorsand lineasemilunaris.Theunderlying fibersof the transversusabdominismuscleare identifiedanddividedtoenter aretromuscular/preperitonealplane.Thisdissectionisthencarriedout lateral to thepsoasmuscle.Once this is repeatedbilaterally, theposterior rectussheath is thenclosed in themidline, completely isolating thevisceral contents fromanyprostheticmesh.At this stage, there is aspace for theplacementofa largepieceofmesh, reinforcing theentirevisceral sac.Thetypeofmeshvariesdependingonthetypeofhernia repair.Midweightmacroporousmesh is typicallyselectedformidlinedefectswheremuscleclosurecanbeobtained.Flankherniasand those for which fascial closure is difficult may benefit from a heavyweightmesh.However,dataonhowthisaffectsoutcomesareunavailable.Drainsareplacedover themeshtominimizeseromaformation. Thedrainsareremovedafter theoutputhasdecreasedto lessthan30
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Transversus Abdominis Release as an Alternative Component Separation Technique for Ventral Hernia Repair
JAMA Surgery, 2016Co-Authors: Jeffrey A. Blatnik, David M. Krpata, Yuri W. NovitskyAbstract:The use of myofascial advancement flaps, or component Separation Technique, dates back more than 25 years. The most commonly men-tioned approach is that of Ramirez et al 1 from 1990 in which the exter-nal abdominal oblique (EO) musculature is divided as a method of providing midline abdominal muscle advancement of up to 10 cm bilaterally. Although effective in rectus muscle medialization, anteri-or component Separation Technique requires creation of large, often morbid, lipocutaneous flaps. The Rives-Stoppa retromuscular recon-struction is effective, but it is not applicable for larger defects. Trans-versusabdominisrelease(TAR)isthemostrecentTechniquetoaddress limitations of traditional reconstructive options. In contrast to creating large skin flaps to access and divide the EO muscle, TAR begins by entering the posterior rectus sheath (Figure). This dissection is carried laterally to 1 cm medial of the linea semiluna-ris. The posterior rectus sheath is then divided just medial to the neu-rovascular perforators and linea semilunaris. The underlying fibers of the transversus abdominis muscle are identified and divided to enter a retromuscular/preperitoneal plane. This dissection is then carried out lateral to the psoas muscle. Once this is repeated bilaterally, the pos-terior rectus sheath is then closed in the midline, completely isolating the visceral contents from any prosthetic mesh. At this stage, there is a space for the placement of a large piece of mesh, reinforcing the en-tire visceral sac. The type of mesh varies depending on the type of her-nia repair. Midweight macroporous mesh is typically selected for mid-line defects where muscle closure can be obtained. Flank hernias and those for which fascial closure is difficult may benefit from a heavy-weight mesh. However, data on how this affects outcomes are unavail-able. Drains are placed over the mesh to minimize seroma formation. The drains are removed after the output has decreased to less than 30 Figure. Major Steps Involved in Transversus Abdominis Release
Harry Van Goor - One of the best experts on this subject based on the ideXlab platform.
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large and complex ventral hernia repair using components Separation Technique without mesh results in a high recurrence rate
American Journal of Surgery, 2015Co-Authors: Nicholas J Slater, Harry Van Goor, Robert P BleichrodtAbstract:BACKGROUND: Recurrence rates after component Separation Technique (CST) are low in the literature but may be underestimated because of inadequate follow-up methods. METHODS: Prospective patient follow-up was performed of consecutive patients who underwent repair of large and complex ventral hernias using CST without mesh utilization. Primary outcome was recurrent hernia determined by clinical examination at least 1 year after surgery in all living patients. Current literature underwent meta-analysis regarding outcomes and mode of follow-up. RESULTS: Seventy-five patients were included with a mean age of 52.2 years and a mean defect size of 214.9 cm(2), respectively. Twenty-nine patients (38.7%) had a recurrent hernia after a mean of 40.9-month follow-up, and this was significantly higher than in the literature (14.0%, P < .01). Sixty-four percent of studies in the literature were unclear about the method of determining recurrent hernia or included telephone follow-up and questionnaires. CONCLUSIONS: CST coincides with a high recurrence rate when clinical follow-up is longer than a year. Reported recurrence rates are probably underestimated because the method and duration of follow-up are inadequate.
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repair of giant midline abdominal wall hernias components Separation Technique versus prosthetic repair interim analysis of a randomized controlled trial
World Journal of Surgery, 2007Co-Authors: Tammo S De Vries Reilingh, Harry Van Goor, Camiel Rosman, J A Charbon, Eric J Hesselink, G J Van Der Wilt, Robert P BleichrodtAbstract:Background Reconstruction of giant midline abdominal wall hernias is difficult, and no data are available to decide which Technique should be used. It was the aim of this study to compare the “components Separation Technique” (CST) versus prosthetic repair with e-PTFE patch (PR).
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components Separation Technique for the repair of large abdominal wall hernias
Journal of The American College of Surgeons, 2003Co-Authors: Tammo S De Vries Reilingh, Harry Van Goor, Camiel Rosman, Marc H A Bemelmans, Dick De Jong, Ernst Jan Van Nieuwenhoven, Marina I A Van Engeland, Robert P BleichrodtAbstract:BACKGROUND: The "components Separation Technique" is a method for abdominal wall reconstruction in patients with large midline hernias that cannot be closed primarily. The early and late results of this Technique were evaluated in 43 patients. METHODS: Records of 43 patients, 11 women and 32 men, with a mean age of 49.7 (range 22 to 78), were reviewed for body length and weight, size and cause of the hernia, intra- and postoperative mortality and morbidity, with special attention given to wound and pulmonary complications. Patients were invited to attend the outpatient clinic afterward for at least 12 months for physical examination of the abdominal wall. RESULTS: The defect resulted after elective surgery in 19 patients and after acute surgery in 24 patients. In 11 patients, the defect was a result of open treatment of generalized peritonitis, and 13 patients had a recurrent incisional hernia. One patient died on the sixth postoperative day from mesenteric thrombosis. The postoperative course was complicated in 17 patients: fascial dehiscence in one, hematoma in five, seroma in two, wound infection in six, skin necrosis in one, and respiratory insufficiency in two. Thirty-eight patients were seen for followup. After a mean followup of 15.6 months (range 12 to 30 months), a recurrent hernia was found in 12 of the 38 patients (32%). The remaining four patients had no recurrent hernia after 1, 1, 3, and 4 months, respectively. CONCLUSIONS: The "components Separation Technique" is useful for the reconstruction of large abdominal wall hernias, especially under contaminated conditions in which the use of prosthetic material is contraindicated. Further research is needed to reduce the relatively high reherniation rate.
