Open mesh plug repair for inguinal hernia after femoro-femoral arterial bypass: two retrospective case series
ConclusionThe mesh plug repair is safe and useful for the treatment of inguinal hernia after FFB, for which preoperative CT is helpful for understanding precise anatomy which facilitates surgical planning.
CONCLUSIONS: In Switzerland, in-hospital POMR trends from 1998–2014 were unchanged or even increasing for the majority of IORs (73% of included operations). Our analysis used age-standardisation but cannot account for changes in coding practices and organisation of healthcare delivery. POMR trends should be systematically monitored at the national level and used to guide priorities in national quality improvement strategies. PMID: 30905062 [PubMed - in process]
The patient is an 86-year-old male who presented with hematuria and discoloration of his left hemiscrotum. He had a past medical history significant for atrial fibrillation on apixaban, coronary artery disease, hypertension, diabetes, and a repaired 8-cm abdominal aortic aneurysm. He had recently been successfully treated for a urinary tract infection. He also had history of inguinal hernia for over three years for which he had consulted a general surgeon who recommended observation in view of the patient's multiple comorbidities and absence of symptoms.
CONCLUSION: There is an increased prevalence of AAA in patients with ΙΗ, especially in smokers, with hypertension and with bilateral and/or direct hernia. Hence, periodic ultrasonound may play an important role in screening and early diagnosis of AAA in these patients. PMID: 30697034 [PubMed - as supplied by publisher]
Abstract The purpose of our study was to evaluate the rate of ventral hernia repair (VHR) after open abdominal aortic anneurysm in New York State compared with the rate of VHR after open abdominal aortic bypass procedures. The Statewide Planning and Research Cooperative System database was queried for all abdominal aortic aneurysm (AAA) and bypass procedures performed between 2000 and 2010. Social security death index was used to identify patients who died. The cause-specific Cox proportional hazard model was applied to compare the risk of having follow-up VHR between patients with AAA and bypass with death as a c...
Response to Re: "Prophylactic Mesh Reinforcement versus Sutured Closure to Prevent Incisional Hernias after Open Abdominal Aortic Aneurysm Repair via Midline Laparotomy". Eur J Vasc Endovasc Surg. 2018 Jul 25;: Authors: Indrakusuma R, Jalalzadeh H, van der Meij JE, Balm R, Koelemay MJW PMID: 30055906 [PubMed - as supplied by publisher]
The question Dr Chaudhuri raises is valid since we should do our utmost to prevent incisional hernia after open AAA repair. However, it might be premature to shift away from the midline incision. While there is evidence in favour of alternatives to the midline incision in general surgical populations, we think it is important that such results are replicated in patients with AAA, because these patients are at high risk of incisional hernia and it must be assessed whether alternative incisions allow for sufficient exposure of the aorto-iliac anatomy to carry out safe repair.
Re. "Prophylactic Mesh Reinforcement Versus Sutured Closure to Prevent Incisional Hernias After Open Abdominal Aortic Aneurysm Repair via Midline Laparotomy: A Systematic Review and Meta-Analysis". Eur J Vasc Endovasc Surg. 2018 Jul 17;: Authors: Akingboye A, Chaudhuri A PMID: 30030053 [PubMed - as supplied by publisher]
We read with interest the meta-analysis by Indrakusuma et al.1 on the comparison between prophylactic mesh and suture closure to prevent incisional hernias after abdominal aortic aneurysm (AAA) repair via midline laparotomy. The commentary2 suggests possibly little emphasis is actually given to reducing the incidence of incisional hernia particularly in those undergoing open AAA surgery.2,3
Incisional hernia is a well known complication of laparotomy, with abdominal aortic aneurysm (AAA) repair also being an independent risk factor for the development of incisional hernia. The suture technique is crucial to reduce the rate of wound complications in midline incisions, and closure with small bites and a suture length to wound length ratio (i.e., the length of the suture used through the length of the wound) higher than four to one is now standard of care.1
Incisional hernia is a frequent late complication after open abdominal aortic aneurysm (AAA) repair. We aimed to determine whether prophylactic mesh reinforcement of the abdominal wall at open AAA repair via midline laparotomy reduces the rate of incisional hernia compared to standard sutured closure.