Closing the gap: evidence-based surgical treatment of rectus diastasis associated with abdominal wall hernias
The objective of this systematic review is to review surgical techniques and assess complication and recurrence rates of RD in patients with concurrent abdominal hernias.MethodsPubMed and EMBASE databases were systematically searched, and data extraction was performed on articles which met the inclusion criteria. Pooled analyses of complication and recurrence rates were performed to compare open vs. minimally invasive surgery. Studentt tests were performed to compare differences in continuous outcomes.ResultsTwenty-eight studies were included in this review. RD can be surgically repaired by both open and laparoscopic appro...
Source: Hernia - July 28, 2021 Category: Sports Medicine Source Type: research

Comparison of outcomes in rectus abdominis diastasis repair —which data do we need in a hernia registry?
ConclusionUsing the case report form described here, the complex hernia entity RAD  ± concomitant hernia can be recorded in a registry for proper analysis of comparative treatment options. (Source: Hernia)
Source: Hernia - July 28, 2021 Category: Sports Medicine Source Type: research

Comparative effectiveness of surgeon-performed transversus abdominis plane blocks and epidural catheters following open hernia repair with transversus abdominis release
This study evaluates the effectiveness of two postoperative analgesia modalities: epidural cat heter and surgeon-performed TAP-block following VHR performed with transversus abdominis release (TAR).MethodsA retrospective analysis was performed on data prospectively collected between 2012 and 2019. All patients undergoing open VHR with TAR performed by a single surgeon were identified. Parastomal hernia repairs and any patients receiving ultrasound-guided TAP blocks or paraspinal blocks were excluded. Primary outcome was length of stay (LOS) with secondary outcomes including pain scores, opioid requirements, and 30-day morb...
Source: Hernia - July 28, 2021 Category: Sports Medicine Source Type: research

Diagnostic techniques for diastasis recti
AbstractDiastasis recti (DR) is an abnormality of the anterior abdominal wall, characterized by a separation of the rectus abdominis muscles along the linea alba. A thorough history and physical exam can diagnose most cases of diastasis recti. Classification schemes for diastasis recti have been created based on inter-rectus distance and location of the defect, which can help with management decisions. Imaging modalities such as ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) can aid in the classification of diastasis recti and guide surgical planning. Planning is most important when contemplatin...
Source: Hernia - July 27, 2021 Category: Sports Medicine Source Type: research

Correction to: Surgical and non-surgical treatment of inguinal hernia during non-elective admissions in the Nationwide Readmissions Database
(Source: Hernia)
Source: Hernia - July 27, 2021 Category: Sports Medicine Source Type: research

The postpartum abdomen: psychology, surgery and quality of life
ConclusionPROMs use to enable establishment of the true value of abdominoplasty in postpartum women, not just in terms of functional/physical restoration, but also in terms of delivering a positive impact on patients ’ mental health and QoL, are important. Further research is needed to determine if those already developed are appropriate or whether a postpartum-specific PROM would be beneficial. (Source: Hernia)
Source: Hernia - July 26, 2021 Category: Sports Medicine Source Type: research

SubCutaneous OnLay endoscopic Approach (SCOLA) for midline ventral hernias associated with diastasis recti
DiscussionRegardless of different names and small technical variations, endoscopic pre-aponeurotic mesh positioning can be performed with well-established steps on a reproducible fashion, aiming to achieve better results. Careful attention should be paid to appropriate patient selection and drain placement to reduce seroma rate, the most common complication. (Source: Hernia)
Source: Hernia - July 25, 2021 Category: Sports Medicine Source Type: research

Evaluation of functional outcomes following rectus diastasis repair —an up-to-date literature review
ConclusionThe results of this review show that surgical repair of rectus diastasis is a safe and effective treatment that improves functional disability. However, the absence of standardized instruments for assessing outcome makes it impossible to compare studies. Since indications for surgery are relative and related to core function, valid instruments for assessing indication and outcome are needed to ensure benefit of the procedure. (Source: Hernia)
Source: Hernia - July 24, 2021 Category: Sports Medicine Source Type: research

The male rectus diastasis: a different concept?
ConclusionAn overview of male-specific aspects of rectus diastasis is provided, underlining that key aspects surrounding rectus diastasis in males differ from females. Although males are the minority of rectus diastasis patients, we recommend that the male rectus diastasis as a concept should be specifically acknowledged in classifications systems and study outcome reporting to evaluate this subgroup more accurately in the future. (Source: Hernia)
Source: Hernia - July 23, 2021 Category: Sports Medicine Source Type: research

Comparison of two fascial defect closure methods for laparoscopic incisional hernia repair
ConclusionThese results suggest that a hybrid approach to incisional ventral hernia repair with open defect closure is comparable to a totally laparoscopic closure. The hybrid technique can help facilitate fascial closure and resection of the hernia sac in patients with higher BMI and hernia defects up to 6  cm. (Source: Hernia)
Source: Hernia - July 23, 2021 Category: Sports Medicine Source Type: research

Outcomes of redo-transversus abdominis release for abdominal wall reconstruction
ConclusionRedo-TAR may be performed as a salvage procedure to reconstruct complex defects after failed TAR, however, in our center, it is associated with increased wound morbidity and fairly high composite recurrence rates. Despite this, patients report improvements in quality of life and pain. Tracking outcomes after TAR will facilitate understanding how to manage its failures. (Source: Hernia)
Source: Hernia - July 21, 2021 Category: Sports Medicine Source Type: research

Slowly resorbable biosynthetic mesh: 2-year results in VHWG grade 3 hernia repair
ConclusionAfter 2  years of follow-up, hernia repair with biosynthetic mesh shows manageable SSO rates and favorable recurrence rates in VHWG grade 3 patients. No statistically significant improvement in quality of life or reduction of pain was observed. Few patients report lasting presence of mesh sensation. Result s of biosynthetic mesh after longer periods of follow-up on recurrences and remodeling will provide further valuable information to make clear recommendations.Trial registrationRegistered on clinicaltrials.gov (NCT02720042), March 25, 2016. (Source: Hernia)
Source: Hernia - July 19, 2021 Category: Sports Medicine Source Type: research

Robotic abdominoplasty for abdominal wall lateral bulging repair in an adult prune belly syndrome patient: a novel approach
(Source: Hernia)
Source: Hernia - July 17, 2021 Category: Sports Medicine Source Type: research

Hemipelvectomy hernia: case series and literature review —letter to the editor
(Source: Hernia)
Source: Hernia - July 8, 2021 Category: Sports Medicine Source Type: research

Shouldice Hospital comments on “Shouldice standard 2020: review of current literature and results of an international consensus meeting”
(Source: Hernia)
Source: Hernia - July 7, 2021 Category: Sports Medicine Source Type: research

Surgical and non-surgical treatment of inguinal hernia during non-elective admissions in the Nationwide Readmissions Database
This study was a retrospective review of data from the Nationwide Readmissions Database (NRD) from 2010 to 2014. Patients above age 18 who were admitted non-electively for a primary diagnosis of inguinal hernia were included. Patients whose length of stay was    95% percentile or died during the initial visit were excluded. Readmissions within 90 days of the initial visit were flagged. Patients were classified according to initial management strategy: operative versus non-operative. Demographic, clinical, and organizational characteristics were compared between the two cohorts.Results14,249 patients met ...
Source: Hernia - July 3, 2021 Category: Sports Medicine Source Type: research

A systematic review on diagnostics and surgical treatment of adult right-sided Bochdalek hernias and presentation of the current management pathway
ConclusionThis systematic review underlined that most studies investigating management of adult non-traumatic right-sided Bochdalek hernias are of moderate to low methodological quality. Hernias tend to occur more frequently in middle-aged and older women presenting with abdominal pain and dyspnea. A rapid and accurate diagnosis following surgical repair and regular follow-up is mandatory. High-quality studies focusing on the management of this rare entity are urgently needed. (Source: Hernia)
Source: Hernia - July 3, 2021 Category: Sports Medicine Source Type: research

Characteristics of laparoscopic and open hernia repair simulation models: a systematic review
ConclusionFew models individually were able to demonstrate validity and educational impact. Several novel assessment tools have been developed for assessment of progress when performing simulated and real laparoscopic inguinal hernia repair. More study is required, particularly for open hernia repair, including randomized controlled trials with large sample sizes to assess the transferability of skills. (Source: Hernia)
Source: Hernia - July 2, 2021 Category: Sports Medicine Source Type: research

Early outcomes of component separation techniques: an analysis of the Spanish registry of incisional Hernia (EVEREG)
AbstractAimTo analyze the outcomes of component separation techniques (CST) to treat incisional hernias (IH) in a large multicenter cohort of patients.MethodsAll IH repair using CST, registered in EVEREG from July 2012 to December 2019, were included. Data on the pre-operative patient characteristics and comorbidities, IH characteristics, surgical technique, complications, and recurrence were collected. Outcomes between anterior (ACS) and posterior component separation (PCS) techniques were compared. Risk factors for complications and recurrences were analyzed.ResultsDuring the study period, 1536 patients underwent CST (45...
Source: Hernia - July 2, 2021 Category: Sports Medicine Source Type: research

Open, laparoscopic, and hernia repair: more options, more questions —author’s reply
(Source: Hernia)
Source: Hernia - June 30, 2021 Category: Sports Medicine Source Type: research

Seven years of preoperative BTA abdominal wall preparation and the Macquarie system for surgical management of complex ventral hernia
AbstractPurposeTo assess 7-year outcomes after complex ventral hernia (CVH) repair using pre-operative Botulinum toxin A (BTA) injection and the Macquarie System of management.MethodsClinical examination and functional non-contrast abdominal CT scans were used to assess complications and recurrences encountered in a prospective series of 88 consecutive CVH repairs using pre-operative BTA injection (200 or 300 units) between November 2012 and December 2019. Pre-operative progressive pneumoperitoneum (PPP) and/or component separation (CS) were also used in some cases.ResultsAll hernia defects (mean transverse width 12.9 &thi...
Source: Hernia - June 28, 2021 Category: Sports Medicine Source Type: research

Comment to: “Use of a bioabsorbable mesh in midline laparotomy closure to prevent incisional hernia: randomized controlled trial.”
(Source: Hernia)
Source: Hernia - June 26, 2021 Category: Sports Medicine Source Type: research

Management of epigastric, umbilical, spigelian and small incisional hernia as a day case procedure: results of long-term follow-up after open preperitoneal flat mesh technique
ConclusionThe OPFMT performed under local anesthesia as a day case procedure is a safe technique associated with favorable long-term outcome. Hematoma is an independent predictor of mesh infection occurrence. (Source: Hernia)
Source: Hernia - June 24, 2021 Category: Sports Medicine Source Type: research

Losartan modifies mesh integration after abdominal wall repair: an experimental study
AbstractPurposeAngiotensin II (AT II) receptor blockers have previously shown to reduce inflammatory response in many settings. We aimed to assess the effects of ATII receptor blocker (Losartan) on mesh integration after abdominal wall repair in a rat model.MethodsA total of 16 Wistar-Kyoto (WKY) and 16 previously hypertensive (SHRSP) rats were isolated. An acute ventral hernia followed by a bridged repair with heavyweight polypropylene mesh was performed. Subjects received either normal saline (WKY-C n = 8 and SHRPS-C n =  8) or 40 mg/kg losartan (WKY-L n =  8) and SHRPS-L n =  8) i...
Source: Hernia - June 17, 2021 Category: Sports Medicine Source Type: research

Comparison of postoperative infection after emergency inguinal hernia surgery with enterectomy between mesh repair and non-mesh repair: a national database analysis
ConclusionSynthetic non-absorbable mesh use may be safe for incarcerated or strangulated inguinal hernia requiring enterectomy. (Source: Hernia)
Source: Hernia - June 17, 2021 Category: Sports Medicine Source Type: research

Do TEP and TAPP have similar effect on postoperative pain? Author ’s reply
(Source: Hernia)
Source: Hernia - June 17, 2021 Category: Sports Medicine Source Type: research

Prophylactic retromuscular mesh placement for parastomal hernia prevention: a retrospective cohort study of permanent colostomies and ileostomies
ConclusionParastomal prophylactic mesh placement to prevent PSH is a safe and efficient approach to reduce the incidence of PSH in patients requiring a permanent colostomy. However, mesh may increase the rate of PSH after permanent ileostomy. (Source: Hernia)
Source: Hernia - June 16, 2021 Category: Sports Medicine Source Type: research

Radiographic identification of thoracoabdominal hernias
ConclusionThe typical injury pattern of thoracoabdominal hernias includes disruption of the intercostal muscles, transversus abdominis, and commonly the internal oblique with an intact external oblique. Inferior rib displacement by hernia contents and unopposed pull of the abdominal musculature is common. Osseous or cartilaginous disruption always occurs unless the defect is bounded on at least one side by a floating rib. (Source: Hernia)
Source: Hernia - June 14, 2021 Category: Sports Medicine Source Type: research

Open, laparoscopic, and robotic inguinal hernia repair: more options, more questions
(Source: Hernia)
Source: Hernia - June 12, 2021 Category: Sports Medicine Source Type: research

Closed non-suction drain placement as haematoma and seroma formation preventive measure post-nylon darn surgery for inguinoscrotal hernias in adults
ConclusionSimple inexpensive flexible feeding tube placement significantly reduced scrotal collection which forms a base for larger sample size in subsequent studies. This could reduce the feared risk of re-intervention, wound infection and long hospital stay post-operative. (Source: Hernia)
Source: Hernia - June 11, 2021 Category: Sports Medicine Source Type: research

Outcomes of biosynthetic absorbable mesh use in high risk CDC Class I ventral hernia repair: a single surgeon series
ConclusionThis study supports the use of Bio-A in high risk ventral hernias, demonstrating a safe and durable repair across all wound classes. Ongoing follow-up continues to monitor for late complications and recurrence. (Source: Hernia)
Source: Hernia - June 8, 2021 Category: Sports Medicine Source Type: research

Outcomes of mid-term and long-term degradable biosynthetic meshes in single-stage open complex abdominal wall reconstruction
ConclusionsComorbid patients undergoing open complex abdominal wall reconstruction are at high risk of postoperative wound complications regardless of which type of biosynthetic mesh is used. When in persistent and direct contact with infection, long-term biodegradable biosynthetic meshes may need to be removed, whereas mid-term biodegradable biosynthetic meshes can be salvaged. (Source: Hernia)
Source: Hernia - June 7, 2021 Category: Sports Medicine Source Type: research

Learning curve of single-incision laparoscopic totally extraperitoneal repair (SILTEP) for inguinal hernia
AbstractPurposeLaparoscopic totally extraperitoneal hernia repair (TEP) is a widely used treatment for inguinal hernia. Single-incision laparoscopic TEP (SILTEP) has attracted the attention of several surgeons, given its superior cosmetic results and patient satisfaction, as well as comparable outcomes to multiport surgery. Nonetheless, no relevant studies have evaluated the learning curve (LC) of SILTEP in terms of both operation time (OT) and surgical failure. Therefore, we aimed to investigate the LC of SILTEP for inguinal hernia.MethodsMedical records of 180 patients who underwent SILTEP performed by a single surgeon f...
Source: Hernia - June 7, 2021 Category: Sports Medicine Source Type: research

Umbilical hernia, epigastric hernia  and diastasis recti: an open discussion
(Source: Hernia)
Source: Hernia - June 2, 2021 Category: Sports Medicine Source Type: research

Is there an advantage to laparoscopy over open repair of primary umbilical hernias in obese patients? An analysis of the Americas Hernia Society Quality Collaborative (AHSQC)
This study compares laparoscopic versus open umbilical hernia repairs in obese patients.MethodsAll patients with body mass index (BMI) ≥ 30 kg/m2 who underwent elective, open or laparoscopic repair of a primary umbilical hernia with mesh were identified from the Americas Hernia Society Quality Collaborative (AHSQC). A retrospective review of the prospectively collected data was conducted. Outcomes of interest included surgical site infections (SSI), surgical site occurrences requiring procedural intervention (SSOPI), hernia-related quality-of-life survey (HerQles), and long-term recurrence. A logistic regres...
Source: Hernia - June 1, 2021 Category: Sports Medicine Source Type: research

Diagnostic methods in parastomal hernia; research and clinical relevance
(Source: Hernia)
Source: Hernia - June 1, 2021 Category: Sports Medicine Source Type: research

The unsung heroes of hernia surgery
(Source: Hernia)
Source: Hernia - June 1, 2021 Category: Sports Medicine Source Type: research

Comment to: Should seroma be considered a complication?
(Source: Hernia)
Source: Hernia - June 1, 2021 Category: Sports Medicine Source Type: research

Comparison of perioperative outcomes between non-obese and obese patients undergoing robotic inguinal hernia repair: a propensity score matching analysis
AbstractPurposeDespite the limited research in support of robotic inguinal hernia repair (RIHR), it is an increasingly adopted technique in surgical practice. While a major risk factor for the development of ventral hernias and subsequent complications, obesity in RIHR has not been investigated. The aim of this study was to compare the outcomes of RIHR between obese and non-obese patients.MethodsProspectively collected data surrounding RIHRs performed at a single center between 2013 and 2020 were retrospectively reviewed. Patients were divided into non-obese (
Source: Hernia - May 31, 2021 Category: Sports Medicine Source Type: research

Use of a bioabsorbable mesh in midline laparotomy closure to prevent incisional hernia: randomized controlled trial
ConclusionThe bioabsorbable mesh significantly prevented IH during the first year. Not reliable conclusions can be drawn across the second year. This may suggest that the any of the closing technique assessed in this study would have a “palliative” transient effect for preventing IH in the long-term. (Source: Hernia)
Source: Hernia - May 31, 2021 Category: Sports Medicine Source Type: research

Effects of the short-stitch technique for midline abdominal closure: short-term results from the randomised-controlled ESTOIH trial
ConclusionsAlthough this trial revealed no significant difference in short-term results between the short-stitch and long-stitch techniques for closure of midline laparotomy, a trend towards a lower rate of burst abdomen in the short-stitch group suggests a possible advantage of the short-stitch technique.Trial registryNCT01965249, registered October 18, 2013. (Source: Hernia)
Source: Hernia - May 28, 2021 Category: Sports Medicine Source Type: research

Algorithm for management of an incarcerated inguinal hernia in the emergency settings with manual reduction. Taxis, the technique and its safety
ConclusionsTaxis is a benign/non-invasive method for patients with an acute, non-strangulated inguinal hernias. It likely reduces the risk and complications of anaesthesia and surgery in the emergency settings. GPS Taxis should be considered as first line treatment in the majority of patients presenting with an acute inguinal hernia when existing bowel infarction is unlikely. (Source: Hernia)
Source: Hernia - May 25, 2021 Category: Sports Medicine Source Type: research

Robotic-assisted, laparoscopic, and open incisional hernia repair: early outcomes from the Prospective Hernia Study
AbstractPurposeTo provide a comparative analysis of short-term outcomes after open, laparoscopic, and robotic-assisted (RAS) ventral incisional hernia (VIH) repairs that include subject-reported pain medication usage and hernia-related quality of life (QOL).MethodsSubjects were  ≥ 18 years old and underwent elective open, laparoscopic or RAS VIH repair without myofascial release. Perioperative clinical outcomes through 30 days were analyzed as were prescription pain medication use and subject-reported responses to the HerQLes Abdominal QOL questionnaire. Observed d ifferences in baseline characte...
Source: Hernia - May 24, 2021 Category: Sports Medicine Source Type: research

Results of Shouldice hernia repair after 18  years of follow-up in all the patients
ConclusionsIt is necessary to incorporate more demanding criteria in the assessment of recurrence, to give more valid results. The Shouldice technique remains a useful technique today not only in patients under 30  years of age, and in the absence of risk factors, but also in cases of intolerance, patient rejection or absence of mesh. In addition, it provides the clinical and economic advantages of being possible to perform it under local anesthesia. (Source: Hernia)
Source: Hernia - May 19, 2021 Category: Sports Medicine Source Type: research

The effect of negative pressure wound therapy on surgical site occurrences in closed incision abdominal wall reconstructions: a retrospective single surgeon and institution study
ConclusionsciNPWT was not associated with a decrease in SSOs following abdominal wall reconstruction but did show a statistically significant decrease in postoperative seromas. Future, large prospective analyses may help further discover the utility of ciNPWT in reducing SSOs. (Source: Hernia)
Source: Hernia - May 19, 2021 Category: Sports Medicine Source Type: research

Intraoperative handling of spermatic cord lipomas during inguinal hernia repair: a nationwide survey
ConclusionWhen asking surgeons about their preferred handling of cord lipomas, they answered that the management of cord lipomas found during inguinal hernia surgery depends on anatomical circumstances such as the pedicle appearance, the lipoma mobility, and its size. If the cord lipoma is left untouched, the patients ’ hernia resembling symptoms could persist, why the surgeons predominantly preferred to resect and remove cord lipomas. (Source: Hernia)
Source: Hernia - May 16, 2021 Category: Sports Medicine Source Type: research

Do TEP and TAPP have similar effect on postoperative pain?
(Source: Hernia)
Source: Hernia - May 15, 2021 Category: Sports Medicine Source Type: research

Mesh repair for lateral inguinal hernias: a non-evidence-based practice
ConclusionThe idea that mesh techniques reduce the recurrence rate in all PIHs is not supported by high level of evidence. The NNT for pure lateral hernias was very high and should be interpreted taking into account chronic pain rates and costs. (Source: Hernia)
Source: Hernia - May 13, 2021 Category: Sports Medicine Source Type: research

Intestinal erosion rate following transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) inguinal hernia repair: does the surgical approach matter? Author ’s reply
(Source: Hernia)
Source: Hernia - May 2, 2021 Category: Sports Medicine Source Type: research

Trends and outcomes of open, laparoscopic, and robotic inguinal hernia repair in the veterans affairs system
This study analyzes trends in utilization and 30-day post-operative outcomes between OHR, LHR, and RHR in veterans.MethodsThis is a retrospective review of patients that underwent inguinal herniorrhaphy using the Veterans Affairs Quality Improvement Program database. Multivariable analysis of outcomes was performed adjusting for pre-operative confounding covariates between OHR, LHR, and RHR. Trends in utilization, complication rates, and operative times were also reported.ResultsFrom 2008 –2019, 124,978 cases of inguinal herniorrhaphy were identified: 100,880 (80.7%) OHR, 18,035 (14.4%) LHR, and 6063 (4.9%) RHR. Comp...
Source: Hernia - April 28, 2021 Category: Sports Medicine Source Type: research