The Experts below are selected from a list of 2043 Experts worldwide ranked by ideXlab platform
Michael J Rosen - One of the best experts on this subject based on the ideXlab platform.
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the effect of increasing body mass index on wound complications in open Ventral Hernia Repair with mesh
American Journal of Surgery, 2019Co-Authors: Luciano Tastaldi, Michael J Rosen, Ivy N Haskins, Ajita S Prabhu, David M Krpata, Steven Rosenblatt, Clayton C Petro, Molly A Olson, Thomas G Stewart, Jacob A GreenbergAbstract:Abstract Background There is a paucity of data delineating the relationship between body mass index (BMI) and wound complications. We investigated the association between BMI and wound morbidity following open Ventral Hernia Repair with mesh (OVHR). Design Patients undergoing elective OVHR were identified within the Americas Hernia Society Quality Collaborative. Multivariate logistic regression identified predictors of 30-day surgical site infection (SSI) and surgical site occurrences requiring procedural intervention (SSOPI). BMI was treated as a continuous variable in the models. Results 8949 patients were included (median age 58, median BMI 31.3 kg/m2, median defect width of 7 cm). Repairs typically included synthetic mesh (89%), placed as a sublay (70%). SSI rate was 4.5% and SSOPI was 6.7%. BMI was associated with increased relative log-odds for SSI (p = 0.01) and SSOPI ( Conclusion Escalating BMI progressively increases relative log-odds for SSI and SSOPI after OVHR. Further studies are necessary to determine whether preoperative weight loss can reduce the impact of this association.
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immunosuppression is not a risk factor for 30 day wound events or additional 30 day morbidity or mortality after open Ventral Hernia Repair an analysis of the americas Hernia society quality collaborative
Surgery, 2018Co-Authors: Ivy N Haskins, Benjamin K Poulose, Ajita S Prabhu, David M Krpata, Luciano Tastaldi, Arielle J Perez, Steven Rosenblatt, Michael J RosenAbstract:Background Some form of immunosuppression is relatively common in patients undergoing Ventral Hernia Repair. Nevertheless, the association of immunosuppression with 30-day wound events and additional outcomes of morbidity and mortality remains unknown. The purpose of our study was to investigate the association of immunosuppression with 30-day wound events and additional morbidity and mortality after Ventral Hernia Repair by evaluating the database of the Americas Hernia Society Quality Collaborative. Methods All patients undergoing open, elective, incisional Ventral Hernia surgery from July 2013 through April 2017 were identified within the database of the Americas Hernia Society Quality Collaborative. Patients on immunosuppression within the 3 months before operative intervention were compared with patients not on immunosuppression with respect to the incidence of 30-day wound events, using a 1:5 propensity matched analysis. Results A total of 3,537 patients met inclusion criteria; 200 (5.7%) patients were on some form of immunosuppression at the time of Ventral Hernia Repair. After propensity matching, 1,200 patients remained for analysis; 200 (16.7%) patients were in the immunosuppression group. There were no statistically significant differences between the 2 groups with respect to the incidence of 30-day surgical site infection, surgical site occurrence requiring procedural intervention, or additional 30-day morbidity or mortality outcomes. Patients in the immunosuppression group had a greater rate of surgical site occurrences, the majority of which were seromas (P = .03). Conclusion Immunosuppression is associated with an increased risk of 30-day surgical site occurrence but not surgical site infection, surgical site occurrence requiring procedural intervention, or additional 30-day morbidity or mortality. Additional studies are needed to determine the clinical importance of these surgical site occurrences with respect to long-term durability of the Hernia Repair.
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reducing length of stay using a robotic assisted approach for retromuscular Ventral Hernia Repair a comparative analysis from the americas Hernia society quality collaborative
Annals of Surgery, 2018Co-Authors: Alfredo M Carbonell, Jeremy A Warren, Michael J Rosen, Sharon Phillips, Ajita S Prabhu, Conrad D Ballecer, Randy J Janczyk, Javier Herrera, Liching Huang, Benjamin K PouloseAbstract:Objective:The aim of this study was to compare length of stay (LOS) after robotic-assisted and open retromuscular Ventral Hernia Repair (RVHR).Background:RVHR has traditionally been performed by open techniques. Robotic-assisted surgery enables surgeons to perform minimally invasive RVHR, but with u
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reducing length of stay using a robotic assisted approach for retromuscular Ventral Hernia Repair a comparative analysis from the americas Hernia society quality collaborative
Annals of Surgery, 2018Co-Authors: Alfredo M Carbonell, Jeremy A Warren, Michael J Rosen, Sharon Phillips, Ajita S Prabhu, Conrad D Ballecer, Randy J Janczyk, Javier Herrera, Liching Huang, Benjamin K PouloseAbstract:OBJECTIVE The aim of this study was to compare length of stay (LOS) after robotic-assisted and open retromuscular Ventral Hernia Repair (RVHR). BACKGROUND RVHR has traditionally been performed by open techniques. Robotic-assisted surgery enables surgeons to perform minimally invasive RVHR, but with unknown benefit. Using real-world evidence, this study compared LOS after open (o-RVHR) and robotic-assisted (r-RVHR) approach. METHODS Multi-institutional data from patients undergoing elective RVHR in the Americas Hernia Society Quality Collaborative between 2013 and 2016 were analyzed. Propensity score matching was used to compare median LOS between o-RVHR and r-RVHR groups. This work was supported by an unrestricted grant from Intuitive Surgical, and all clinical authors have declared direct or indirect relationships with Intuitive Surgical. RESULTS In all, 333 patients met inclusion criteria for a 2:1 match performed on 111 r-RVHR patients using propensity scores, with 222 o-RVHR patients having similar characteristics as the robotic-assisted group. Median LOS [interquartile range (IQR)] was significantly decreased for r-RVHR patients [2 days (IQR 2)] compared with o-RVHR patients [3 days (IQR 3), P < 0.001]. No differences in 30-day readmissions or surgical site infections were observed. Higher surgical site occurrences were noted with r-RVHR, consisting mostly of seromas not requiring intervention. CONCLUSIONS Using real-world evidence, a robotic-assisted approach to RVHR offers the clinical benefit of reduced postoperative LOS. Ongoing monitoring of this technique should be employed through continuous quality improvement to determine the long-term effect on Hernia recurrence, complications, patient satisfaction, and overall cost.
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early wound morbidity after open Ventral Hernia Repair with biosynthetic or polypropylene mesh
Journal of The American College of Surgeons, 2017Co-Authors: Sambit Sahoo, Ivy N Haskins, Benjamin K Poulose, Liching Huang, David M Krpata, Kathleen A Derwin, Michael J RosenAbstract:Background Recently introduced slow-resorbing biosynthetic and non-resorbing macroporous polypropylene meshes are being used in Hernias with clean-contaminated and contaminated wounds. However, information about the use of biosynthetic meshes and their outcomes compared with polypropylene meshes in clean-contaminated and contaminated cases is lacking. Here we evaluate the use of biosynthetic mesh and polypropylene mesh in elective open Ventral Hernia Repair (OVHR) and investigate differences in early wound morbidity after OVHR within clean-contaminated and contaminated cases. Study Design All elective, OVHR with biosynthetic mesh or uncoated polypropylene mesh from January 2013 through October 2016 were identified within the Americas Hernia Society Quality Collaborative. Association of mesh type with 30-day wound events in clean-contaminated or contaminated wounds was investigated using a 1:3 propensity-matched analysis. Results Biosynthetic meshes were used in 8.5% (175 of 2,051) of elective OVHR, with the majority (57.1%) used in low-risk or comorbid clean cases. Propensity-matched analysis in clean-contaminated and contaminated cases showed no significant difference between biosynthetic mesh and polypropylene mesh groups for 30-day surgical site occurrences (20.7% vs 16.7%; p = 0.49) or unplanned readmission (13.8% vs 9.8%; p = 0.4). However, surgical site infections (22.4% vs 10.9%; p = 0.03), surgical site occurrences requiring procedural intervention (24.1% vs 13.2%; p = 0.049), and reoperation rates (13.8% vs 4.0%; p = 0.009) were significantly higher in the biosynthetic group. Conclusions Biosynthetic mesh appears to have higher rates of 30-day wound morbidity compared with polypropylene mesh in elective OVHR with clean-contaminated or contaminated wounds. Additional post-market analysis is needed to provide evidence defining best mesh choices, location, and surgical technique for Repairing contaminated Ventral Hernias.
Brent D Matthews - One of the best experts on this subject based on the ideXlab platform.
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remodeling characteristics and biomechanical properties of a crosslinked versus a non crosslinked porcine dermis scaffolds in a porcine model of Ventral Hernia Repair
Hernia, 2015Co-Authors: Jaime A Cavallo, Corey R. Deeken, Margaret M. Frisella, Suellen Greco, Brent D MatthewsAbstract:Purpose The objective of this study was to evaluate the histologic remodeling profile and biomechanical properties of the porcine abdominal wall after Repair with HDMI-crosslinked (Permacol®) or non-crosslinked (Strattice®) porcine dermis in a porcine model of Ventral Hernia Repair.
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physicomechanical evaluation of absorbable and nonabsorbable barrier composite meshes for laparoscopic Ventral Hernia Repair
Surgical Endoscopy and Other Interventional Techniques, 2011Co-Authors: Corey R. Deeken, Margaret M. Frisella, Michael S Abdo, Brent D MatthewsAbstract:This study aimed to compare the physicomechanical properties of composite prostheses for laparoscopic Ventral Hernia Repair (LVHR) through standard testing and a proposed classification system. Seven prostheses (four with absorbable barriers and 3 with nonabsorbable barriers) were evaluated. The barrier layer was removed, after which the area of the interstices and the diameter of the filaments were determined. The barrier layer was left intact during thickness, density, suture retention strength, tear resistance, uniaxial tensile, and ball-burst testing. Specimens were oriented parallel or perpendicular to their longest dimension during testing. One-way analysis of variance (ANOVA) with Tukey’s posttest or an unpaired, two-tailed t-test was performed to determine whether differences existed due to mesh or orientation, and a p value <0.05 was considered significant. Significant differences were observed between mesh types and due to the orientation of the mesh during testing. Of the absorbable barrier meshes, Bard Sepramesh IP Composite demonstrated the greatest suture retention and tear strengths, followed by C-QUR mesh. Of the permanent barrier meshes, DUALMESH demonstrated the greatest suture retention strength in the perpendicular direction, followed by Bard Composix E/X. DUALMESH and Bard Composix E/X demonstrated equivalent suture retention strength in the parallel direction and equivalent tear resistance in both testing directions. All meshes demonstrated tensile strengths greater than the physiologically relevant range of 16–32 N/cm. This study provided a basic understanding of how the structural aspects of each mesh design influence functionality. Differences between composite barrier prostheses commonly used for LVHR were observed due to barrier type, mesh type, and orientation. A set of standard testing techniques and a classification system also were presented to define fully the properties of these materials.
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evaluation of intraperitoneal placement of absorbable and nonabsorbable barrier coated mesh secured with fibrin sealant in a new zealand white rabbit model
Surgical Endoscopy and Other Interventional Techniques, 2011Co-Authors: Eric D Jenkins, Lora Melman, Shaun R Brown, Corey R. Deeken, Margaret M. Frisella, Salil Desai, Brent D MatthewsAbstract:Background This study aimed to evaluate the acute and chronic fixation strength of fibrin sealant (FS) as an alternative method of fixation for laparoscopic Ventral Hernia Repair (LVHR).
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early biocompatibility of crosslinked and non crosslinked biologic meshes in a porcine model of Ventral Hernia Repair
Hernia, 2011Co-Authors: Lora Melman, Eric D Jenkins, Corey R. Deeken, Michael D Brodt, Margaret M. Frisella, Nicholas A Hamilton, L C Bender, Suellen Greco, Brent D MatthewsAbstract:Purpose Biologic meshes have unique physical properties as a result of manufacturing techniques such as decellularization, crosslinking, and sterilization. The purpose of this study is to directly compare the biocompatibility profiles of five different biologic meshes, AlloDerm® (non-crosslinked human dermal matrix), PeriGuard® (crosslinked bovine pericardium), Permacol® (crosslinked porcine dermal matrix), Strattice® (non-crosslinked porcine dermal matrix), and Veritas® (non-crosslinked bovine pericardium), using a porcine model of Ventral Hernia Repair.
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evaluation of acute fixation strength for mechanical tacking devices and fibrin sealant versus polypropylene suture for laparoscopic Ventral Hernia Repair
Surgical Innovation, 2010Co-Authors: Lora Melman, Eric D Jenkins, Shaun R Brown, Michael L Brunt, Christopher J Eagon, Corey R. Deeken, Michael D Brodt, Margaret M. Frisella, Brent D MatthewsAbstract:BACKGROUND: The purpose of this comparative study is to evaluate the acute fixation strength of mechanical tacking devices and fibrin sealant against polypropylene suture for laparoscopic Ventral Hernia Repair. METHODS: Three metallic mechanical tacking devices (ProTack, Salute, EndoANCHOR), 4 absorbable tacking devices (AbsorbaTack, PermaSorb, I-Clip, and SorbaFix), and 2 types of fibrin sealant (Tisseel, Artiss) were compared with 0-polypropylene suture. Three constructs from each device or an amount of sealant sufficient to cover a 3 × 3 cm(2) area were used to affix a 4 × 3 cm piece of absorbable barrier-coated mesh (Proceed, Ethicon, Inc) to the peritoneal surface of porcine abdominal wall. Ten samples were completed for each fixation modality. Acute fixation strength was measured via a lap shear test on an Instron tensiometer. RESULTS: Acute fixation strength was significantly greater for suture (59.7 7.2 N) compared with all laparoscopic tacking devices and to fibrin sealant (P < .001 for all comparisons). Protack (29.5 ± 2.8 N) was stronger than Absorbatack (13.2 ± 3.7 N; P = .029). Protack, Permasorb, SorbaFix, and I-clip were stronger than fibrin sealant (P < .05 for all comparisons). CONCLUSIONS: The acute fixation strengths of metallic or absorbable tacks as well as fibrin sealant are all significantly less than that achieved with polypropylene suture. These factors should be considered in selecting the type of mechanical fixation for patients undergoing laparoscopic Ventral Hernia Repair.
Benjamin K Poulose - One of the best experts on this subject based on the ideXlab platform.
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cost utility analysis of biologic and biosynthetic mesh in Ventral Hernia Repair when are they worth it
Journal of The American College of Surgeons, 2019Co-Authors: Steven Schneeberger, Sharon Phillips, Liching Huang, Richard A Pierce, Shervin A Etemad, Benjamin K PouloseAbstract:Background Biologic and biosynthetic meshes typically cost more than synthetic meshes for use in Ventral Hernia Repair (VHR), with unknown comparative effectiveness. Study design Cost-utility analysis was performed from a limited societal perspective assessing direct medical costs and outcomes for open, elective, retromuscular VHR. Short-term and 5-year major complications and costs were modeled using best available evidence from published studies, Healthcare Cost and Utilization Project data, and Americas Hernia Society Quality Collaborative data. Costs were analyzed in 2017 US dollars, and utilities were assessed using quality adjusted life years (QALYs). Sensitivity analyses were performed to determine threshold probabilities of long-term complications favoring particular mesh types. Results Synthetic mesh was the preferred strategy, with a cost of $15,620 and QALYs of 18.85, assuming a baseline 5.6% rate of long-term complications for all meshes. One-way sensitivity analysis demonstrated that biosynthetic and biologic mesh became the better choice as long-term complication rates for synthetic mesh increased to 15.5% and 26.2%, respectively. Two-way sensitivity analysis demonstrated that biologic and biosynthetic meshes became favorable as the cost of biologic mesh decreased and long-term synthetic mesh complication rates increased. Biologic and biosynthetic meshes also became more cost-effective when their relative long-term complication rates decreased and long-term synthetic mesh complication rates increased. Conclusions Using modeling techniques, synthetic mesh is the best option for retromuscular VHR given currently available evidence. We established long-term complication thresholds, possibly justifying the higher up-front costs for biologic or biosynthetic meshes. This emphasizes the critical need to obtain long-term complication surveillance data to help individualize mesh choice in VHR.
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immunosuppression is not a risk factor for 30 day wound events or additional 30 day morbidity or mortality after open Ventral Hernia Repair an analysis of the americas Hernia society quality collaborative
Surgery, 2018Co-Authors: Ivy N Haskins, Benjamin K Poulose, Ajita S Prabhu, David M Krpata, Luciano Tastaldi, Arielle J Perez, Steven Rosenblatt, Michael J RosenAbstract:Background Some form of immunosuppression is relatively common in patients undergoing Ventral Hernia Repair. Nevertheless, the association of immunosuppression with 30-day wound events and additional outcomes of morbidity and mortality remains unknown. The purpose of our study was to investigate the association of immunosuppression with 30-day wound events and additional morbidity and mortality after Ventral Hernia Repair by evaluating the database of the Americas Hernia Society Quality Collaborative. Methods All patients undergoing open, elective, incisional Ventral Hernia surgery from July 2013 through April 2017 were identified within the database of the Americas Hernia Society Quality Collaborative. Patients on immunosuppression within the 3 months before operative intervention were compared with patients not on immunosuppression with respect to the incidence of 30-day wound events, using a 1:5 propensity matched analysis. Results A total of 3,537 patients met inclusion criteria; 200 (5.7%) patients were on some form of immunosuppression at the time of Ventral Hernia Repair. After propensity matching, 1,200 patients remained for analysis; 200 (16.7%) patients were in the immunosuppression group. There were no statistically significant differences between the 2 groups with respect to the incidence of 30-day surgical site infection, surgical site occurrence requiring procedural intervention, or additional 30-day morbidity or mortality outcomes. Patients in the immunosuppression group had a greater rate of surgical site occurrences, the majority of which were seromas (P = .03). Conclusion Immunosuppression is associated with an increased risk of 30-day surgical site occurrence but not surgical site infection, surgical site occurrence requiring procedural intervention, or additional 30-day morbidity or mortality. Additional studies are needed to determine the clinical importance of these surgical site occurrences with respect to long-term durability of the Hernia Repair.
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reducing length of stay using a robotic assisted approach for retromuscular Ventral Hernia Repair a comparative analysis from the americas Hernia society quality collaborative
Annals of Surgery, 2018Co-Authors: Alfredo M Carbonell, Jeremy A Warren, Michael J Rosen, Sharon Phillips, Ajita S Prabhu, Conrad D Ballecer, Randy J Janczyk, Javier Herrera, Liching Huang, Benjamin K PouloseAbstract:Objective:The aim of this study was to compare length of stay (LOS) after robotic-assisted and open retromuscular Ventral Hernia Repair (RVHR).Background:RVHR has traditionally been performed by open techniques. Robotic-assisted surgery enables surgeons to perform minimally invasive RVHR, but with u
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reducing length of stay using a robotic assisted approach for retromuscular Ventral Hernia Repair a comparative analysis from the americas Hernia society quality collaborative
Annals of Surgery, 2018Co-Authors: Alfredo M Carbonell, Jeremy A Warren, Michael J Rosen, Sharon Phillips, Ajita S Prabhu, Conrad D Ballecer, Randy J Janczyk, Javier Herrera, Liching Huang, Benjamin K PouloseAbstract:OBJECTIVE The aim of this study was to compare length of stay (LOS) after robotic-assisted and open retromuscular Ventral Hernia Repair (RVHR). BACKGROUND RVHR has traditionally been performed by open techniques. Robotic-assisted surgery enables surgeons to perform minimally invasive RVHR, but with unknown benefit. Using real-world evidence, this study compared LOS after open (o-RVHR) and robotic-assisted (r-RVHR) approach. METHODS Multi-institutional data from patients undergoing elective RVHR in the Americas Hernia Society Quality Collaborative between 2013 and 2016 were analyzed. Propensity score matching was used to compare median LOS between o-RVHR and r-RVHR groups. This work was supported by an unrestricted grant from Intuitive Surgical, and all clinical authors have declared direct or indirect relationships with Intuitive Surgical. RESULTS In all, 333 patients met inclusion criteria for a 2:1 match performed on 111 r-RVHR patients using propensity scores, with 222 o-RVHR patients having similar characteristics as the robotic-assisted group. Median LOS [interquartile range (IQR)] was significantly decreased for r-RVHR patients [2 days (IQR 2)] compared with o-RVHR patients [3 days (IQR 3), P < 0.001]. No differences in 30-day readmissions or surgical site infections were observed. Higher surgical site occurrences were noted with r-RVHR, consisting mostly of seromas not requiring intervention. CONCLUSIONS Using real-world evidence, a robotic-assisted approach to RVHR offers the clinical benefit of reduced postoperative LOS. Ongoing monitoring of this technique should be employed through continuous quality improvement to determine the long-term effect on Hernia recurrence, complications, patient satisfaction, and overall cost.
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early wound morbidity after open Ventral Hernia Repair with biosynthetic or polypropylene mesh
Journal of The American College of Surgeons, 2017Co-Authors: Sambit Sahoo, Ivy N Haskins, Benjamin K Poulose, Liching Huang, David M Krpata, Kathleen A Derwin, Michael J RosenAbstract:Background Recently introduced slow-resorbing biosynthetic and non-resorbing macroporous polypropylene meshes are being used in Hernias with clean-contaminated and contaminated wounds. However, information about the use of biosynthetic meshes and their outcomes compared with polypropylene meshes in clean-contaminated and contaminated cases is lacking. Here we evaluate the use of biosynthetic mesh and polypropylene mesh in elective open Ventral Hernia Repair (OVHR) and investigate differences in early wound morbidity after OVHR within clean-contaminated and contaminated cases. Study Design All elective, OVHR with biosynthetic mesh or uncoated polypropylene mesh from January 2013 through October 2016 were identified within the Americas Hernia Society Quality Collaborative. Association of mesh type with 30-day wound events in clean-contaminated or contaminated wounds was investigated using a 1:3 propensity-matched analysis. Results Biosynthetic meshes were used in 8.5% (175 of 2,051) of elective OVHR, with the majority (57.1%) used in low-risk or comorbid clean cases. Propensity-matched analysis in clean-contaminated and contaminated cases showed no significant difference between biosynthetic mesh and polypropylene mesh groups for 30-day surgical site occurrences (20.7% vs 16.7%; p = 0.49) or unplanned readmission (13.8% vs 9.8%; p = 0.4). However, surgical site infections (22.4% vs 10.9%; p = 0.03), surgical site occurrences requiring procedural intervention (24.1% vs 13.2%; p = 0.049), and reoperation rates (13.8% vs 4.0%; p = 0.009) were significantly higher in the biosynthetic group. Conclusions Biosynthetic mesh appears to have higher rates of 30-day wound morbidity compared with polypropylene mesh in elective OVHR with clean-contaminated or contaminated wounds. Additional post-market analysis is needed to provide evidence defining best mesh choices, location, and surgical technique for Repairing contaminated Ventral Hernias.
Mike K Liang - One of the best experts on this subject based on the ideXlab platform.
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international classification of abdominal wall planes icap to describe mesh insertion for Ventral Hernia Repair
British Journal of Surgery, 2020Co-Authors: S G Parker, Mike K Liang, Steve Halligan, F Muysoms, Gina L Adrales, Adam Boutall, A C De Beaux, U A Dietz, Celia M Divino, Mary T HawnAbstract:Background: Nomenclature for mesh insertion during Ventral Hernia Repair is inconsistent and confusing. Several terms, including ‘inlay’, ‘sublay’ and ‘underlay’, can refer to the same anatomical planes in the indexed literature. This frustrates comparisons of surgical practice and may invalidate meta-analyses comparing surgical outcomes. The aim of this study was to establish an international classification of abdominal wall planes. Methods: A Delphi study was conducted involving 20 internationally recognized abdominal wall surgeons. Different terms describing anterior abdominal wall planes were identified via literature review and expert consensus. The initial list comprised 59 possible terms. Panellists completed a questionnaire that suggested a list of options for individual abdominal wall planes. Consensus on a term was predefined as occurring if selected by at least 80 per cent of panellists. Terms scoring less than 20 per cent were removed. Results: Voting started August 2018 and was completed by January 2019. In round 1, 43 terms (73 per cent) were selected by less than 20 per cent of panellists and 37 new terms were suggested, leaving 53 terms for round 2. Four planes reached consensus in round 2, with the terms ‘onlay’, ‘inlay’, ‘preperitoneal’ and ‘intraperitoneal’. Thirty-five terms (66 per cent) were selected by less than 20 per cent of panellists and were removed. After round 3, consensus was achieved for ‘anterectus’, ‘interoblique’, ‘retro-oblique’ and ‘retromuscular’. Default consensus was achieved for the ‘retrorectus’ and ‘transversalis fascial’ planes. Conclusion: Consensus concerning abdominal wall planes was agreed by 20 internationally recognized surgeons. Adoption should improve communication and comparison among surgeons and research studies. (Less)
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mesh location in open Ventral Hernia Repair a systematic review and network meta analysis
World Journal of Surgery, 2016Co-Authors: Julie L Holihan, Mylan T Nguyen, Duyen H Nguyen, Jiandi Mo, Mike K LiangAbstract:There is no consensus on the ideal location for mesh placement in open Ventral Hernia Repair (OVHR). We aim to identify the mesh location associated with the lowest rate of recurrence following OVHR using a systematic review and meta-analysis. A search was performed for studies comparing at least two of four locations for mesh placement during OVHR (onlay, inlay, sublay, and underlay). Outcomes assessed were Hernia recurrence and surgical site infection (SSI). Pairwise meta-analysis was performed to compare all direct treatment of mesh locations. A multiple treatment meta-analysis was performed to compare all mesh locations in the Bayesian framework. Sensitivity analyses were planned for the following: studies with a low risk of bias, incisional Hernias, by Hernia size, and by mesh type (synthetic or biologic). Twenty-one studies were identified (n = 5,891). Sublay placement of mesh was associated with the lowest risk for recurrence [OR 0.218 (95 % CI 0.06–0.47)] and was the best of the four treatment modalities assessed [Prob (best) = 94.2 %]. Sublay was also associated with the lowest risk for SSI [OR 0.449 (95 % CI 0.12–1.16)] and was the best of the 4 treatment modalities assessed [Prob (best) = 77.3 %]. When only assessing studies at low risk of bias, of incisional Hernias, and using synthetic mesh, the probability that sublay had the lowest rate of recurrence and SSI was high. Sublay mesh location has lower complication rates than other mesh locations. While additional randomized controlled trials are needed to validate these findings, this network meta-analysis suggests the probability of sublay being the best location for mesh placement is high.
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adverse events after Ventral Hernia Repair the vicious cycle of complications
Journal of The American College of Surgeons, 2015Co-Authors: Julie L Holihan, Zeinab M Alawadi, Robert G Martindale, Scott J Roth, Curtis J Wray, Lillian S Kao, Mike K LiangAbstract:Background Ventral Hernia Repairs are one of the most common procedures performed by the general surgeon. They are also among the most complex procedures performed. We hypothesized that with each surgical failure, subsequent Ventral Hernia Repair becomes more complicated and morbid. Study Design We assessed a multicenter database of patients who underwent an elective Ventral Hernia Repair from 2000 to 2012 with at least 6 months of follow-up and elective Repairs. Patients were evaluated by the number of previous Ventral Hernia Repairs they had: primary Ventral Hernia Repair (PVHR), first time incisional Hernia Repair (IHR1), second time incisional Hernia Repair (IHR2), or third time or greater incisional Hernia Repair (IHR3). The main outcomes measured were abdominal reoperation, operative duration, surgical site infection (SSI), and Hernia recurrence. Complications were assessed and compared between the 4 groups. Time to recurrence was estimated using the Kaplan-Meier curve method by study cohort (PVHR, IHR1, IHR2, IHR3). Results A total of 794 patients were assessed; of these, 481 (60.6%) had PVHR, 207 (26.1%) had IHR1, 78 (9.8%) had IHR2, and 28 (3.5%) had IHR3. Patients with multiple Repairs were more likely to undergo subsequent reoperation, have a longer operative duration, develop SSI, and have a recurrence. At 140 months of follow-up, 37% of primary Ventral Hernias and 64% of incisional Hernias have recurred. The highest recurrence rates are seen in IHR3, with 73% recurring. Conclusions Previous Ventral Hernia Repair increases the complication profile of Repair, creating a vicious cycle of Repair, complications, reoperation, and re-Repair. Furthermore, long-term outcomes for Ventral Hernia Repair are poor. Future studies should focus on Hernia prevention and improving long-term outcomes after Hernia Repair.
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abdominal reoperation and mesh explantation following open Ventral Hernia Repair with mesh
American Journal of Surgery, 2014Co-Authors: Mike K Liang, Rachel L Berger, Stephanie C Hicks, Mylan T Nguyen, Lillian S KaoAbstract:Abstract Background This study sought to identify the incidence, indications, and predictors of abdominal reoperation and mesh explantation following open Ventral Hernia Repair with mesh (OVHR). Methods A retrospective cohort study of all patients at a single institution who underwent an OVHR from 2000 to 2010 was performed. Patients who required subsequent abdominal reoperation or mesh explantation were compared with those who did not. Reasons for reoperation were recorded. The 2 groups were compared using univariate and multivariate analysis (MVA). Results A total of 407 patients were followed for a median (range) of 57 (1 to 143) months. Subsequent abdominal reoperation was required in 69 (17%) patients. The most common reasons for reoperation were recurrence and surgical site infection. Only the number of prior abdominal surgeries was associated with abdominal reoperation on MVA. Twenty-eight patients (6.9%) underwent subsequent mesh explantation. Only the Ventral Hernia Working Group grade was associated with mesh explantation on MVA. Conclusions Abdominal reoperation and mesh explantation following OVHR are common. Overwhelmingly, surgical complications are themost common causes for reoperation and mesh explantation.
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primary fascial closure with laparoscopic Ventral Hernia Repair systematic review
World Journal of Surgery, 2014Co-Authors: Duyen H Nguyen, Lillian S Kao, Mylan T Nguyen, Erik P Askenasy, Mike K LiangAbstract:Laparoscopic Ventral Hernia Repair (LVHR) has grown in popularity. Typically, this procedure is performed with a mesh bridge technique that results in high rates of seroma, eventration (bulging), and patient dissatisfaction. In an effort to avoid these complications, there is growing interest in the role of laparoscopic primary fascial closure with intraperitoneal mesh placement. This systematic review evaluated the outcomes of closure of the central defect during LVHR. A literature search of PubMed, Cochrane databases, and Embase was conducted using PRISMA guidelines. MINORS was used to assess the methodologic quality. Primary outcome was Hernia recurrence. Secondary outcomes were surgical-site infection, seroma formation, bulging, and patient-centered items (satisfaction, chronic pain, functional status). Eleven studies were identified, eight of which were case series (level 4 data). Three comparative studies examined the difference between closure and nonclosure of the fascial defect during laparoscopic Ventral incisional Hernia Repairs (level 3 and 4 data). These studies suggested that primary fascial closure (n = 138) compared to nonclosure (n = 255) resulted in lower recurrence rates (0–5.7 vs. 4.8–16.7 %) and seroma formation rates (5.6–11.4 vs. 4.3–27.8 %). Follow-up periods for both groups were similar (1–108 months). Only one study evaluated patient function and clinical bulging. It showed better outcomes with primary fascial closure. Closure of the central defect during LVHR resulted in less recurrence, bulging, and seroma than nonclosure. Patients with closure were more satisfied with the results and had better functional status. The quality of the data was poor, however. A randomized controlled trial to evaluate the role of closure of the central defect during LVHR is warranted.
David M Krpata - One of the best experts on this subject based on the ideXlab platform.
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the effect of increasing body mass index on wound complications in open Ventral Hernia Repair with mesh
American Journal of Surgery, 2019Co-Authors: Luciano Tastaldi, Michael J Rosen, Ivy N Haskins, Ajita S Prabhu, David M Krpata, Steven Rosenblatt, Clayton C Petro, Molly A Olson, Thomas G Stewart, Jacob A GreenbergAbstract:Abstract Background There is a paucity of data delineating the relationship between body mass index (BMI) and wound complications. We investigated the association between BMI and wound morbidity following open Ventral Hernia Repair with mesh (OVHR). Design Patients undergoing elective OVHR were identified within the Americas Hernia Society Quality Collaborative. Multivariate logistic regression identified predictors of 30-day surgical site infection (SSI) and surgical site occurrences requiring procedural intervention (SSOPI). BMI was treated as a continuous variable in the models. Results 8949 patients were included (median age 58, median BMI 31.3 kg/m2, median defect width of 7 cm). Repairs typically included synthetic mesh (89%), placed as a sublay (70%). SSI rate was 4.5% and SSOPI was 6.7%. BMI was associated with increased relative log-odds for SSI (p = 0.01) and SSOPI ( Conclusion Escalating BMI progressively increases relative log-odds for SSI and SSOPI after OVHR. Further studies are necessary to determine whether preoperative weight loss can reduce the impact of this association.
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immunosuppression is not a risk factor for 30 day wound events or additional 30 day morbidity or mortality after open Ventral Hernia Repair an analysis of the americas Hernia society quality collaborative
Surgery, 2018Co-Authors: Ivy N Haskins, Benjamin K Poulose, Ajita S Prabhu, David M Krpata, Luciano Tastaldi, Arielle J Perez, Steven Rosenblatt, Michael J RosenAbstract:Background Some form of immunosuppression is relatively common in patients undergoing Ventral Hernia Repair. Nevertheless, the association of immunosuppression with 30-day wound events and additional outcomes of morbidity and mortality remains unknown. The purpose of our study was to investigate the association of immunosuppression with 30-day wound events and additional morbidity and mortality after Ventral Hernia Repair by evaluating the database of the Americas Hernia Society Quality Collaborative. Methods All patients undergoing open, elective, incisional Ventral Hernia surgery from July 2013 through April 2017 were identified within the database of the Americas Hernia Society Quality Collaborative. Patients on immunosuppression within the 3 months before operative intervention were compared with patients not on immunosuppression with respect to the incidence of 30-day wound events, using a 1:5 propensity matched analysis. Results A total of 3,537 patients met inclusion criteria; 200 (5.7%) patients were on some form of immunosuppression at the time of Ventral Hernia Repair. After propensity matching, 1,200 patients remained for analysis; 200 (16.7%) patients were in the immunosuppression group. There were no statistically significant differences between the 2 groups with respect to the incidence of 30-day surgical site infection, surgical site occurrence requiring procedural intervention, or additional 30-day morbidity or mortality outcomes. Patients in the immunosuppression group had a greater rate of surgical site occurrences, the majority of which were seromas (P = .03). Conclusion Immunosuppression is associated with an increased risk of 30-day surgical site occurrence but not surgical site infection, surgical site occurrence requiring procedural intervention, or additional 30-day morbidity or mortality. Additional studies are needed to determine the clinical importance of these surgical site occurrences with respect to long-term durability of the Hernia Repair.
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early wound morbidity after open Ventral Hernia Repair with biosynthetic or polypropylene mesh
Journal of The American College of Surgeons, 2017Co-Authors: Sambit Sahoo, Ivy N Haskins, Benjamin K Poulose, Liching Huang, David M Krpata, Kathleen A Derwin, Michael J RosenAbstract:Background Recently introduced slow-resorbing biosynthetic and non-resorbing macroporous polypropylene meshes are being used in Hernias with clean-contaminated and contaminated wounds. However, information about the use of biosynthetic meshes and their outcomes compared with polypropylene meshes in clean-contaminated and contaminated cases is lacking. Here we evaluate the use of biosynthetic mesh and polypropylene mesh in elective open Ventral Hernia Repair (OVHR) and investigate differences in early wound morbidity after OVHR within clean-contaminated and contaminated cases. Study Design All elective, OVHR with biosynthetic mesh or uncoated polypropylene mesh from January 2013 through October 2016 were identified within the Americas Hernia Society Quality Collaborative. Association of mesh type with 30-day wound events in clean-contaminated or contaminated wounds was investigated using a 1:3 propensity-matched analysis. Results Biosynthetic meshes were used in 8.5% (175 of 2,051) of elective OVHR, with the majority (57.1%) used in low-risk or comorbid clean cases. Propensity-matched analysis in clean-contaminated and contaminated cases showed no significant difference between biosynthetic mesh and polypropylene mesh groups for 30-day surgical site occurrences (20.7% vs 16.7%; p = 0.49) or unplanned readmission (13.8% vs 9.8%; p = 0.4). However, surgical site infections (22.4% vs 10.9%; p = 0.03), surgical site occurrences requiring procedural intervention (24.1% vs 13.2%; p = 0.049), and reoperation rates (13.8% vs 4.0%; p = 0.009) were significantly higher in the biosynthetic group. Conclusions Biosynthetic mesh appears to have higher rates of 30-day wound morbidity compared with polypropylene mesh in elective OVHR with clean-contaminated or contaminated wounds. Additional post-market analysis is needed to provide evidence defining best mesh choices, location, and surgical technique for Repairing contaminated Ventral Hernias.
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comparative radiographic analysis of changes in the abdominal wall musculature morphology after open posterior component separation or bridging laparoscopic Ventral Hernia Repair
Journal of The American College of Surgeons, 2014Co-Authors: Gayan S De Silva, Caitlin W Hicks, Michael J Rosen, David M Krpata, Cory N Criss, Yuri W. NovitskyAbstract:Background Large Ventral Hernias are known to induce atrophic changes to the anterior abdominal wall musculature. We have shown that anterior component separation with external oblique (EO) release, with resultant reconstruction of the midline, results in hypertrophy of the rectus muscle (RM), internal oblique (IO), and transversus abdominis (TA). We aimed to compare and contrast the impact of posterior component separation with transversus abdominis release (TAR) and bridging laparoscopic Ventral Hernia Repair (LVHR) on the muscles of the abdominal wall. Study Design Preoperative and at least 6-month postoperative CT scans were analyzed for patients undergoing TAR with midline reconstruction and LVHR without midline reconstruction. A change in the measured area of each abdominal wall muscle was used as the determinant of hypertrophy or atrophy. The areas of the RM, EO, IO, and TA were measured at the L3 to L4 level through the axial plane. Results Twenty-five consecutive patients with pre- and postoperative images were analyzed in each group. In the TAR group, the RA, EO, and IO demonstrated significant increases in area. In the LVHR group, no muscles demonstrated any significant changes. Conclusions Similar to anterior component separation, Hernia Repair with TAR results in hypertrophy of the rectus abdominis muscle. In addition, we found that TAR was associated with hypertrophy of both external and internal oblique muscles. Bridging Repair during LVHR, on the other hand, did not result in any significant changes in any of the abdominal muscles. Our findings provide clear radiologic evidence that re-creation of the midline by means of the TAR leads to improved anatomy of the abdominal wall, in addition to positive compensatory changes of the lateral abdominal wall musculature.
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history of methicillin resistant staphylococcus aureus mrsa surgical site infection may not be a contraindication to Ventral Hernia Repair with synthetic mesh a preliminary report
Hernia, 2014Co-Authors: Caitlin W Hicks, Yuri W. Novitsky, Jeffrey A Blatnik, David M Krpata, Michael J RosenAbstract:Purpose A history of methicillin-resistant Staphylococcus aureus (MRSA) surgical site infection presents a significant surgical dilemma as to the risk of subsequent mesh infection, even if no active infection is present. We investigated the outcomes of Ventral Hernia Repair with synthetic mesh in patients with prior MRSA surgical site infections (SSIs).