The low transverse Pfannenstiel incision and the prevalence of incisional hernia and nerve entrapment.

OBJECTIVE: The authors determined the prevalence of incisional hernia and nerve entrapment in patients with a low transverse Pfannenstiel incision. SUMMARY BACKGROUND DATA: The literature on the Pfannenstiel incision suggests an incisional hernia rate of 0.0% to 0.5%. However, in these series, physical examination, which is essential in the authors' view, was not performed. To the authors' knowledge, the prevalence of nerve entrapment after the Pfannenstiel incision is not known or has never been published. METHODS: All adult women, operated on between 1986 and 1992 using a Pfannenstiel incision and not having had another lower abdominal incision other than for laparoscopy, were invited for follow-up at the outpatient department. All patients were interviewed and subjected to a physical examination, with special interest to the presence of incisional hernia or nerve entrapment. RESULTS: In patients having had a Pfannenstiel incision, no incisional hernias were found. In patients also having had a laparoscopy, the incisional hernia rate was 3.5%. Nerve entrapment was found in 3.7%. The length of the incision was identified as a risk factor (p = 0.02). CONCLUSIONS: Incisional hernia is a rare complication of the Pfannenstiel incision. Complications of nerve damage, however, are not uncommon and should be recognized. When possible, nerves should be identified and preserved, especially when extending the incision more laterally.     

Pfannenstiel incision for incarcerated inguinal hernia in neonates

The authors report on 2 neonates with irreducible inguinal hernia in whom a Pfannenstiel skin incision followed by lower abdominal midline fasciotomy were used to open the abdomen during emergency operation. By using this approach, the inguinal canal could also be opened and the hernia sac ligated. Bowel resection followed by anastomosis in one case and appendectomy in the other case could be performed safely intraabdominally because of the better exposure provided by using our approach compared with an inguinal incision alone. A Pfannenstiel incision followed by a midline fasciotomy decreases the risks associated with surgical intervention by enhancing exposure and contributing to good outcome by improving wound cosmesis.     

比较腹腔镜腹腔内与开放腹膜前间隙补片置入术治疗腹壁切口疝的效果

目的比较腹腔镜腹腔内补片置入术(IPOM)与开放腹膜前间隙补片置入术(Sublay)治疗腹壁切口疝的效果。方法选取2016-01—2019-01间在郑州大学第一附属医院接受疝修补术治疗的76例腹壁切口疝患者,将36例行腹腔镜IPOM术的患者作为腔镜组。将40例行开放Sublay术的患者作为开放组。回顾性分析患者的临床资料。结果2组患者均成功完成手术。2组手术时间差异无统计学意义(P>0.05)。腔镜组术中出血量、术后肠蠕动恢复时间及住院时间均少于开放组,差异有统计学意义(P<0.05)。腔镜组术后近期疼痛发生率低于开放组,差异有统计学意义(P<0.05),其余并发症差异无统计学意义(P>0.05)。结论腹腔镜IPOM术具有创伤小、恢复快、疼痛轻、出血少、并发症少等优点,具有更广阔的应用前景。     

Concurrent radical retropubic prostatectomy and inguinal hernia repair through a modified Pfannenstiel incision

OBJECTIVE: To describe a technique for concurrent radical retropubic prostatectomy (RRP) and inguinal hernioplasty, using a modified Pfannenstiel incision. PATIENTS AND METHODS: RRP is usually done through a midline lower abdominal incision but some patients with localized prostate cancer have an inguinal hernia. Concurrent inguinal hernia repair at the time of RRP with the usual method is only possible by either a preperitoneal mesh repair or formal hernioplasty, requiring an additional incision(s). A 10-12 cm Pfannenstiel incision is made along the pubic hairline centred over the pubic symphysis, and a 'Y'-shaped incision in the rectus sheath. The rectus muscle is split vertically along the midline, followed by RRP. After removing the prostate and completing the anastomosis, the surgeon identifies the inguinal canal along the inferior and lateral aspect of the transverse incision and uses a formal tension-free hernioplasty with a 3 x 5 cm polypropylene mesh. We used this technique in fifteen concurrent inguinal hernioplasties (two bilateral hernias and thirteen unilateral) at the time of RRP, with no additional incisions, using the formal tension-free Lichtenstein technique. One patient with bilateral hernias had a right indirect inguinal hernia, and all the remaining men had a direct inguinal hernia. RESULTS: All patients were discharged 2 days after surgery, with no complications associated with the procedure and no recurrences; however, the follow-up was short (mean 5.5 months). CONCLUSION: A modified Pfannenstiel incision is ideal for concurrent RRP and inguinal hernioplasty, providing excellent exposure of the pelvic structures and allowing the surgeon to use a formal tension-free mesh hernioplasty through the same incision. Wound healing and cosmetic results are excellent.     

Mesh erosion following laparoscopic incisional hernia repair

Laparascopic mesh repair is a safe and effective method of surgically treating incisional hernia. However, such an approach may lead to specific complications of both laparoscopy and mesh placement. The mesh may migrate, become infected or erode into adjacent structures. We describe the case of a woman who underwent laparoscopic incisional hernia repair with subsequent erosion of the mesh into the bladder.     

Intraluminal migration of mesh following incisional hernia repair

Incisional hernia is the most common long term complication of colon surgery. These hernias are often repaired with synthetic mesh. Mesh migration is an infrequent occurrence. There are reports of mesh migrating into the peritoneum and into viscous organs causing a variety of symptoms including recurrent hernia, infection, and obstruction. We present the case of transmural mesh migration from the abdominal wall into the small bowel presenting as small bowel obstruction.     

Pseudo-recurrence following laparoscopic ventral and incisional hernia repair

Purpose  

Laparoscopic mesh repair is an established alternative to the open repair of herniae of the antero-lateral abdominal wall. However, a definition in the literature of “recurrence” is lacking. This study reviews the phenomenon of pseudo-recurrence in patients who describe recurrent symptoms despite an apparently successful laparoscopic ventral or incisional hernia repair (LVIHR).     

Incidence of incisional hernia following vertical banded gastroplasty

Background: Our aim was to determine which patient-related factors influence the incidence of incisional hernia after vertical banded gastroplasty for morbid obesity. Methods: We reviewed the medical records of 80 morbidly obese patients operated on between 1986 and 1993. All the operations were performed by only one surgeon, and the midline laparotomy was closed by means of continuous polyglactin 910 suture. Statistical analysis was performed using the Fisher exact test, and significance was assigned for values of P<0.05. Results: Incidence of incisional hernia in: obese 24%, superobese 51% (P=0.0165), men 40%, women 34% (P=0.7671), age<50 33%, age>50 50% (P=0.3137), nondiabetics 31%, diabetics 66% (P=0.0610), no wound infection 34%, wound infection 37% (P>0.9999), no anemia 31%, anemia 50% (P=0.1675), no vomiting 39%, vomiting 32% (P=0.6350). Conclusion: The only patient-related factor that significantly influences the incidence of incisional hernia in morbidly obese patients is body mass index.     

Prevention of trocar site incisional hernia following laparoscopic ventral hernia repair.

BACKGROUND AND OBJECTIVES: Trocar-site incisional hernia following laparoscopic ventral hernia repair is reported to have a relatively high incidence. The main reasons are trocar diameter and design, pre-existing fascial defects, and some operation- and patient-related factors. The aim of this article to show a new technique of ventral hernia repair that could prevent trocar site incisional hernia. METHODS: After establishing the pneumoperitoneum, three 5-mm ports are inserted in positions according to the site and size of the hernia. The procedure begins by dissection of the adhesions of bowel loops or omentum (if any) from the hernia to clear a good margin for mesh coverage. Then a single 10-mm to 15-mm port (mesh insertion port) is inserted in the center of the ventral hernia depending on the size of the mesh. The mesh is fixed in position with a 5-mm tacker. The peritoneum and underlying superficial fascia are carefully closed before closing the skin. RESULTS: A total of 35 patients were recruited for this method. The mean hospital stay was 1.5 days, the mean age was 50.35 years and the mean operative time was 40 minutes. In all patients, 10x15-cm ePTFE was used. No single incidence of trocar-site incisional hernia occurred during a mean follow-up of 2 years. Three (8.57%) patients developed complications and no mortality was reported. CONCLUSION: The mesh introduction through the port, which is situated at the center of the hernia defect is a simple, cost-effective technique and will prevent trocar-site incisional hernia.     

Contralateral renal and ureteral displacement following flank incisional hernia

A case is reported of contralateral displacement of the kidney and ureter due to a left flank incisional hernia following a simple nephrectomy for a staghorn calculus in a massively obese female. Two previously reported cases of pseudocrossed renal ectopia due to renal displacement from incisional hernias in obese females are reviewed.     

Inferior epigastric artery false aneurysm following incisional hernia repair

Introduction

We report a case of IEA false aneurysm following a mesh repair of a large incisional hernia. We emphasize the importance to consider the diagnosis to help avoid inappropriate interventions which could increase patient morbidity.

Case report

A 68-year-old male patient, who 4 weeks previously had had a mesh repair of a large incisional hernia, presented with a painful left iliac fossa swelling. This was found to be an IEA false aneurysm. This was treated successfully with percutaneous thrombin injection.

Conclusions

We feel an inferior epigastric artery false aneurysm must be included in the differential diagnosis when investigating the cause of any lateral swelling following incisional hernia repair. This would help reduce the chance of a missed diagnosis and avoid any inappropriate interventions which may cause increased patient morbidity.     

A reappraisal of the Pfannenstiel incision.

The postoperative morbidity of incisions used in retropublic prostatectomies was examined. 350 patients with vertical midline incisions were compared with 411 patients with transverse or Pfannenstiel incisions. There was a significantly increased incidence of postoperative inguinal hernias in the group of patients who had had transverse incisions. The possible reasons for this were discussed. It was concluded that the normal architecture of the inguinal canal was deformed and weakened by extra-wide transverse incisions.     

Recurrent parastomal hernia and middle incisional hernia: surgical treatment through midline incision with wide prosthetic mesh

Parastomal hernia is a frequent complication of stoma surgery. The results of parastomal hernia repair however are poor, showing an high incidence of postoperative recurrences. In the last years, hernia repair with prosthetic mesh has given better postoperative results. The parastomal hernia, however, is associated with middle incisional hernia. The authors review the problem of surgical repair of parastomal hernia and report a case of recurrent parastomal hernia associated to middle incisional hernia. The technique of surgical repair using, through midline incision, one, wide, prosthetic polypropylene mesh, in sublay position, according to Rives' technique, is described. The mesh has been incised in a trasverse direction for the stoma crossing. At 6 years follow-up the patient does not show postoperative recurrence. According literature and the authors' results, the parastomal hernia might be considered an incisional hernia and, therefore, a sing of diffuse abdominal wall disease. The Rives' surgical technique might be the gold standard for treatment of parastomal hernia, even if not associated to incisional hernia. The more complexity of Rives' technique compared to local fascial mesh repair is compensated by the result of total abdominal wall reinforcement.     

Two cases of cystic seroma following mesh incisional hernia repair

Cystic seromas, or mature fibrous cysts, are rare complications after ventral and incisional hernioplasties employing polypropylene mesh. We analyzed the medical records of patients, whose abdominal-wall hernias were surgically repaired with polypropylene mesh from November 1996 to February 2004 (N=685). Of the 162 patients, who had incisional hernias repaired with the Rives technique (preperitoneal mesh), we detected two patients who developed giant cystic seromas. Both patients underwent surgical resection of the cyst wall. As follow-up care improves for patients undergoing hernioplasties with polypropylene meshes, more cystic seromas are detected, thereby improving our knowledge of the clinical, radiological, and histopathological characteristics of this complication. However, the etiologic factors related to the appearance of this chronic cyst remain uncertain.     

Perineal incisional hernia following rectal resection. Diagnostic and management

Postoperative perineal hernia is a rare complication following abdominoperineal excision of the rectum. We report four cases illustrating its clinical presentation and modern management. Surgical technique for rectal excision and perineal closure, making of an epiplooplasty, postoperative infection may contribute to the occurrence of this complication. Mesh repair through an anterior open or laparoscopic abdominal approach is one of the surgical options if not contraindicated by age and/or general condition. Perineal or combined approaches can also be selected to solve this difficult problem.     

Renal transplantation through a modified non-muscle-cutting Pfannenstiel incision

Aim

To assess the feasibility of performing a renal transplant operation through a modified non-muscle-cutting Pfannenstiel incision (MFI).

Materials and methods

Renal transplantation with MFI was performed in 20 men with a body mass index (BMI) of less than 25 and five women with a BMI of less than 27. The parameters assessed were incision length, operative time, postoperative pain score by visual analogue score, wound complication, graft-related complications, eGFR at 3 months, and surgical scar satisfaction score. The results were compared with a BMI-matched cohort of patients who had a conventional hockey stick incision. Statistical analyses were done by Chi-square test and Student’s t test.

Results

There was a significant decrease in mean bed preparation time, mean time for closure, and mean incision length in patients with MFI. In MFI group, the mean surgical satisfaction score was significantly more. There was no significant difference between the groups on all other aspects.

Conclusion

In the era of minimally invasive surgery, MFI technique could challenge the role of laparoscopic and robotic surgery in renal transplantation. Our study shows that the technique is successful in carefully selected patients with low BMI.     

腹腔镜辅助下小切口手术治疗腹壁切口疝的临床效果

目的分析腹腔镜辅助下小切口手术治疗腹壁切口疝的临床效果。 方法选择2017年1月至2019年1月南京市中西医结合医院收治的100例腹壁切口疝患者,对照组采用开放切口疝修补术,研究组应用腹腔镜辅助下小切口手术治疗,各50例,对比两组治疗效果。 结果研究组术中出血量（22.8±4.3）ml明显少于对照组的（51.7±5.6）ml,术后肛门排气时间、下床活动时间、住院时间均显著少于对照组,差异有统计学意义（均P<0.001）。研究组手术当天VAS评分为（5.7±0.6）分,术后1、2、3 d的VAS评分为（4.7±0.7）分、（2.8±0.5）分、（1.2±0.2）分,显著低于对照组同时间点评分,差异有统计学意义（均P<0.001）。研究组并发症发生率为4.0%（2/50）,低于对照组的22.0%（11/50）,差异有统计学意义（χ²=7.162,P=0.007）。 结论腹腔镜辅助下小切口手术可有效减轻腹壁切口疝患者的手术创伤和术后疼痛,降低并发症发生风险,从而缩短住院时间,加速患者恢复。