Impact of Large Ventral Hernia Repair on Postoperative Renal Function.

Introduction: Large hernia repairs, particularly those involving abdominal wall reconstruction (AWR), can elevate intra-abdominal pressure (IAP) due to the reintegration of herniated contents into the abdominal cavity, potentially contributing to renal injury. Despite the theoretical risk, the long-term impact of AWR-induced IAP elevation on renal function remains insufficiently studied. This study aims to evaluate the incidence of acute kidney injury (AKI) and chronic kidney disease (CKD) following AWR and to identify key factors associated with postoperative renal impairment.

Shouldice vs Lichtenstein Inguinal Hernia Repair: A Propensity Score-Matched Analysis Comparing Early Postoperative Pain and Quality of Life.

Background: Tissue-based inguinal hernia repairs (IHRs), such as the Shouldice technique, are an acceptable alternative to mesh-based repairs in appropriately selected patients; however, they are often thought to be more painful than tension free repairs in the early postoperative period. We aimed to compare short-term pain and quality of life (QoL) between the Shouldice and Lichtenstein techniques for IHR.

Methods: The Abdominal Core Health Quality Collaborative (ACHQC) database was queried for patients who underwent open IHR between January 2017 and April 2023.

Mesh-related Outcomes of Biologic versus Synthetic Mesh for Single-stage Repair of Contaminated Ventral Hernias: A Five to Ten Year Analysis of a Randomized Controlled Trial.

Objective: To determine the five- to ten-year safety and durability outcomes of biologic versus synthetic mesh in contaminated ventral hernia repair.

Summary Of Background Data: Recent randomized controlled trials have demonstrated the safety and efficacy of synthetic mesh in clean-contaminated and contaminated ventral hernia repairs, but follow-up has typically been limited to two years. Concerns persist regarding long-term outcomes of synthetic mesh beyond this initial period.

Preoperative weight loss for open abdominal wall reconstruction: study protocol for a randomized controlled trial.

Background: Obesity is widely recognized as a risk factor for poor outcomes following ventral hernia repair. This belief has led many surgeons to implement arbitrary body mass index (BMI) cutoffs, typically 35-40 kg/m, before offering elective hernia repair. These practices are based on low-quality evidence and create significant challenges for patients with symptomatic hernias who lack access to metabolic and bariatric surgery or obesity medications.

Outcomes of abdominal wall closure with fascial bridging using a polyglactin 910 (Vicryl) Mesh following non-trauma laparotomy: a multi-center study.

Introduction: Complete primary fascial closure following midline laparotomy is occasionally unachievable, necessitating abdominal wall closure via fascial bridging with polyglactin 910 (Vicryl) mesh. Despite its frequent use, literature on the outcomes of Vicryl mesh for fascial bridging remains sparse and controversial, with some studies indicating potential associations with enterocutaneous fistulas and bowel obstruction. This study evaluates the outcomes of fascial bridging utilizing Vicryl mesh for non-trauma laparotomies.

Robotic versus open ventral hernia repair (ROVHR): a randomized controlled trial protocol.

Background: Robotic retromuscular hernia repair has proven to be feasible and safe but lacks randomized data to demonstrate significant clinical benefit. The majority of current comparative studies published have been case series, retrospective studies, systematic reviews, or large registry data, all of which have significant limitations and bias (Bittner et al. in Surg Endosc 32:727-734.

Lateral abdominal wall hernias after coughing: a single center experience.

Purpose: Forceful coughing is assumed to be an uncommon etiology for lateral abdominal wall hernias. The literature regarding this topic is very limited and there is a lack of consensus in management, both operative and non-operative. We aim to report our center's experience in repair of lateral abdominal wall hernias secondary to vigorous coughing.

Anterior Gastropexy for Paraesophageal Hernia Repair: A Randomized Clinical Trial.

Importance: Paraesophageal hernias can cause severe limitations in quality of life and life-threatening complications. Even though minimally invasive paraesophageal hernia repair (MIS-PEHR) is safe and effective, anatomic recurrence rates remain notoriously high. Retrospective data suggest that suturing the stomach to the anterior abdominal wall after repair-an anterior gastropexy-may reduce recurrence, but this adjunct is currently not the standard of care.

Complex blunt traumatic abdominal wall hernias: Experience from a high-volume abdominal core health center.

Background: Traumatic abdominal wall hernias are rare and commonly involve the lateral abdominal wall due to shearing off the oblique and transversus abdominis muscles from the iliac crest. The vast majority of the current literature focuses on the index trauma admission, includes few patients, and provides little to no detail about the hernia repair itself. We aim to report our center's high-volume experience with a definitive repair of chronic traumatic lateral abdominal wall hernias.

Consensus in ERAS protocols for ventral hernia repair: evidence-based recommendations from the ACHQC QI Committee.

Purpose: Enhanced recovery after surgery (ERAS) protocols are widely used in the post-operative care of hernia patients. Despite their prevalence, an absence of published consensus guidelines creates significant heterogeneity in practices. The aim of this study was to evaluate elements in ERAS protocols utilized in ventral hernia repair from institutions across the United States and provide consensus recommendations for each identified element.

Irrigation with fibrinolytic agents versus saline for percutaneous drainage of abdominal abscesses: A meta-analysis with trial sequential analysis of randomized trials.

Introduction: Fibrinolytic agents (FA) activate the fibrinolytic system, converting plasminogen into plasmin to break down fibrin. Their use for irrigation of abdominal abscesses is debated, and this meta-analysis evaluates their efficacy.

Methods: We searched PubMed, Embase, and Cochrane Central for randomized controlled trials (RCTs) comparing FA and saline in percutaneous drainage of abdominal abscesses.

The impact of diabetes and presurgical glycemic control on wound morbidity following open complex abdominal wall reconstruction: a single-center experience.

Introduction: Numerous studies have identified diabetes mellites (DM) as a significant risk factor for postoperative wound morbidity, with suboptimal preoperative glycemic control (GC) posing an even greater risk. However, this data largely excludes ventral hernia patients. Our study examined the association between diabetes and preoperative GC and postoperative outcomes following open complex abdominal wall reconstruction (AWR).

Fenestrating vs reconstituting laparoscopic subtotal cholecystectomy: a systematic review and meta-analysis.

Introduction: Laparoscopic cholecystectomy is one of the most frequently performed procedures by general surgeons. Strategies for minimizing bile duct injuries including use of the critical view of safety method, as outlined by the SAGES Safe Cholecystectomy Program, are not always possible. Subtotal cholecystectomy has emerged as a safe "bail-out" maneuver to avoid iatrogenic bile duct injury in these difficult cases.

Research prioritization in hernia surgery: a modified Delphi ACHQC and VHOC expert consensus.

Purpose: Numerous clinical practice guidelines and consensus statements have been published in hernia surgery, however, there is still a need for high-quality evidence to address remaining unanswered questions. The aim of this study was to conduct research priority setting through a modified Delphi process to identify a list of top research priorities in hernia surgery.

Methods: A structured literature review of clinical practice guidelines was performed by the steering committee.

Short-term outcomes of heavyweight versus mediumweight synthetic mesh in a retrospective cohort of clean-contaminated and contaminated retromuscular ventral hernia repairs.

Background: Mediumweight (40-60 g/m) polypropylene (MWPP) mesh has been shown to be safe and effective in CDC class II-III retromuscular ventral hernia repairs (RMVHR). However, MWPP has the potential to fracture, and it is possible that heavyweight (> 75 g/m) polypropylene mesh has similar outcomes in this context. However, there is limited data on HWPP mesh performance in clean-contaminated and contaminated scenarios.

Outcomes of posterior sheath supplementation with Vicryl mesh in TAR-a single-center study.

Introduction: In the Transversus Abdominis Release (TAR) procedure, ideally, the posterior sheath is completely reapproximated to establish an interface isolating the polypropylene mesh from visceral contents. When primary closure of the posterior sheath is unachievable, Vicryl mesh is commonly used to supplement the posterior sheath closure and an uncoated polypropylene mesh is placed superficial to the Vicryl mesh. The long-term implications of utilizing Vicryl mesh as an antiadhesive barrier are poorly understood.

Postoperative bleeding after complex abdominal wall reconstruction: A post hoc analysis of a randomized clinical trial.

Background: Abdominal wall reconstruction requires extensive dissection of the abdominal wall, exposure of the retroperitoneum, and aggressive chemoprophylaxis to reduce the risk of thromboembolic complications. The need for early anticoagulation puts patients at risk for bleeding. We aimed to quantify postoperative blood loss, incidence of transfusion and reoperation, and associated risk factors in patients undergoing complex abdominal wall reconstruction.

Conventional Versus Traction-Assisted Endoscopic Submucosal Dissection for Esophageal, Gastric, and Colorectal Neoplasms: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Endoscopic submucosal dissection (ESD) is increasingly being utilized for the resection of superficial gastrointestinal neoplasms. However, the long procedure time poses a technical challenge for conventional ESD (C-ESD). Traction-assisted ESD (T-ESD) was developed to facilitate the procedure by reducing its duration.

Sequential surgeries following transversus abdominis release for abdominal wall reconstruction: Insights from a single-center analysis.

Introduction: Abdominal surgery following transversus abdominis release (TAR) procedure commonly involves incisions through the previously implanted mesh, potentially creating vulnerabilities for hernia recurrence. Despite the popularity of the TAR procedure, current literature regarding post-AWR surgeries is limited. This study aims to reveal the incidence and outcomes of post-TAR non-hernia-related abdominal surgeries of any kind.

Can surgeons accurately identify mesh type when interpreting computed tomography scans after ventral hernia repair?

Background: Recurrent ventral hernia repair can be challenging due to scarred tissue planes and the increasing complexity of disease related to multiple recurrences. Given the challenges of acquiring complete and accurate prior operative reports, surgeons often rely on computed tomography (CT) scans to obtain information and plan for re-operation. Still, the contribution of CT scans and the ability of surgeons to interpret them is controversial.

Outcomes of complex abdominal wall reconstruction in patients with connective tissue disorders: a single center experience.

Introduction: Individuals diagnosed with connective tissue disorders (CTD) are known to be predisposed to incisional hernia formation. However, there is a scarcity of data on outcomes for these patients undergoing hernia repair. We sought to describe our outcomes in performing abdominal wall reconstructions in these complex patients.

Abdominal Wall Tension and Early Outcomes after Posterior Component Separation with Transversus Abdominis Release: Does a "Tension-Free" Closure Really Matter?

Background: Ventral hernias result in fibrosis of the lateral abdominal wall muscles, increasing tension on fascial closure. Little is known about the effect of abdominal wall tension on outcomes after abdominal wall reconstruction. We aimed to identify an association between abdominal wall tension and early postoperative outcomes in patients who underwent posterior component separation (PCS) with transversus abdominis release (TAR).

Outcomes of posterior component separation with transversus abdominis release for repair of abdominally based breast reconstruction donor site hernias.

Purpose: Abdominally based autologous breast reconstruction (ABABR) is common after mastectomy, but carries a risk of complex abdominal wall hernias. We report experience with posterior component separation (PCS) and transversus abdominis release (TAR) with permanent synthetic mesh repair of ABABR-related hernias.

Methods: Patients at Cleveland Clinic Foundation and Penn State Health were identified retrospectively.

Early wound morbidity and clinical outcomes associated with P4HB mesh compared to permanent synthetic mesh in umbilical and small to medium, routine ventral hernia repairs.

Background: Permanent synthetic meshes such as polypropylene (PP) have been utilized for hernia repair for decades, but concerns remain regarding potential long-term, mesh-related complications. A resorbable polymer such as poly-4-hydroxybutyrate (P4HB) represents an alternative with high initial strength, that gradually resorbs, leaving an abdominal wall that is at least as strong as it would be in its native state. We aimed to compare early wound morbidity and clinical outcomes associated with P4HB to traditional, permanent PP in umbilical and small to medium, routine ventral hernias using data from the Abdominal Core Health Quality Collaborative (ACHQC).

Evaluating the impact of lifting mandatory smoking cessation prior to elective abdominal wall reconstruction. A single-center experience.

Introduction: Many studies identify active smoking as a significant risk factor for postoperative wound and mesh complications in patients undergoing abdominal wall reconstruction surgery. However, our group conducted an analysis using data from the ACHQC database, which revealed similar rates of surgical site infection (SSI) and surgical site occurrence requiring procedural intervention (SSOPI) between active smokers and non-smokers As a result, the Cl eveland Clinic Center for Abdominal Core Health instituted a policy change where active smokers were no longer subject to surgical delay. Our study aims to evaluate the impact of active smoking on the outcomes of these patients.