Monster hernia programme in Hernia Centre Liberec

Česká verze

Authors: J. Škach; R. Harcubová; V. Petráková; L. Brzulová; M. Krejbichová; K. Kocmanová
Authors place of work: Chirurgické oddělení, Krajská nemocnice Liberec, a. s., přednosta: MUDr. P. Hromádka ; Kýlní centrum, Krajská nemocnice Liberec, vedoucí centra: MUDr. J. Škach
Published in the journal: Rozhl. Chir., 2016, roč. 95, č. 5, s. 177-187.
Category: Souhrnné sdělení

Summary

Introduction:
The authors introduce a unique programme in the Czech Republic focused on extreme herniology. Patients with giant complex ventral hernias (monster hernias) have been concentrated in a high-volume hernia center with the most advanced perioperative intensive care since 2012. The authors present their single centre experience with the support of literature.

Results:
Between 2012−2015 we operated on 36 patients with a giant complex hernia. Minimal inclusion criteria for enrolment in the very heterogeneous group included: a defect over 15 cm wide, loss of domain of 20% and higher, and the mean surface area of at least 225 cm².We consider not only advanced abdominal wall reconstruction techniques to be essential in the treatment of giant complex ventral hernias. Open component separation, endoscopic component separation technique, bariatric procedures, panniculectomy, abdominoplasty, advancement flaps, skin grafting, preoperative progressive pneumoperitoneum, CT volumetry, individual binders tailoring, crane pulley and many others (see the text) should all be included in the armamentarium of such specialized, high-volume hernia centres. The anatomy, function and aesthetics should be inseparable parts of preoperative planning. Apart from the operation there are three major aspects in the treatment of the so called monster hernias: tailoring, preconditioning and complex postoperative care. NPWT (negative pressure wound therapy) should be easily accessible in case of extensive skin necrosis with mesh infection after major abdominal hernia repairs. Using negative pressure we have saved 100% of infected prostheses from explantation (including MRSA, ESBL..).

Conclusion:
Monster hernia programme is challenging for both the patient and the surgeon. It is costly, time consuming, associated with a high complication ratio (high morbidity and recurrence) and is designed for patients with a significant health, social, work, sexual and sports handicap, and with the risk of further severe or irreversible health problems.

Key words:
hernia − component separation − abdominoplasty − volumetry

Zdroje

1. Muysoms FE, Miserez M, Berrevoet F, et al. Classification of primary and incisional abdominal wall hernias. Hernia 2009;4:407−14.

2. Berry MF, Paisley S, Low DW, et al. Repair of large complex recurrent incisional hernias with retromuscular mesh and panniculectomy. Am J Surg 2007;194:199−204.

3. Ghazi B, Deigni O, Yezhelyev M, et al. Current options in the management of complex abdominal wall defects. Ann Plast Surg 2011;66:488−92.

4. Ventral Hernia Working Group – Breuing K, Butler CE, Ferzoco S, et al. Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery 2010;148:544−58.

5. deVries Reilingh TS, van Goor H, Charbon JA, et al. Repair of giant midline abdominal wall hernias: „ component separation technique“ versus prosthetic repair. World J Surg 2003;196:531−4.

6. Rosen MJ, Fatima J, Sarr MG. Repair of abdominal wall hernias with restoration of abdominal wall function. J Gastrointest Surg 2010;14:175−185.

7. Muysoms FE, Antoniou SA, Bury K, et al. European Hernia Society guidelines on closure of abdominal wall incision. Hernia 2015;1:1−24.

8. East B, Muysoms FE. Uzávěr laparotomie – Víme jak? (Doporučení Evropské kýlní společnosti). Rozhl Chir 2015;2:57−63.

9. Moreno IG. The rational treatment of hernias and voluminous chronic eventrations: preparation with progressive pneumoperitoneum. In: Nhylus LM, Condon RE, editors. Hernia. 2nd edn. Philadelphia, J. B. Lippincott Co. 1978:536−50.

10. Zandejas B, Khasawneh MA, Srvantstyan B, et al. Outcomes of chemical component paralysis using botulinum toxin for incisional hernia repairs. World J Surg 2013;37:2830−7.

11. Zielinski MD, Goussous N, Schiller HJ, et al. Chemical components separation with botulinum toxin A: A novel technique to improve primary fascial closure rates of the open abdomen. Hernia 2012;17:101−7.

12. Tanaka EY, Yoo JH, Rodrigues AJ, Jr, et al. A computerized tomography scan method for calculating the hernia sac and abdominal cavity volume in complex large incisional hernia with loss of domain. Hernia 2010;14:63−9.

13. Van Geffen HJ, Simmermacher RK. Incisional hernia repair: abdominoplasty, tissue expansion, and methods of augmentation. World J Surg 2005;29:1080−5.

14. Mazzocchi M, Dessy LA, Sorvillo V, et al. A study of intraabdominal pressure modification in “component separation” technique for repair of incisional hernia. Ann Ital Chir 2010;81:433−7.

15. Breuing K, Butler CE, Ferzoco S, et al. Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery 2010;148:554−8.

16. Villalobos R, Escartin A, Mias C, et al. Measuring biomechanics of abdominal wall closure. Hernia 2014;18 (Suppl 2):134.

17. Qandeel H, O´Dwyer PJ. Abdominal wall biomechanics during cough and deep breathing movements. Hernia 2014;18(Suppl 2):134.

18. Föstemann T, Trzewik J, Holste J, et al. Forces and deformations of the abdominal wall - a mechanical and geometrical approach to the linea alba. J Biomech 2011;44:600−6.

19. Gunnarson U, Johansson M, Stigard K. Assessment of abdominal muscle function using the Biodex system 4. Validity a reliability in healthy volunteers and patients with giant ventral hernia. Hernia 2011; 15:417−21.

20. den Hartog D, Eker HH, Tuinebreijer WE, et al. Isokinetic strenght of the trunk flexor muscles after surgical repair for incisional hernia. Hernia 2010;14:243−47.

21. Parker M, Goldberg RF. Pilot study on objective measurement of abdominal wall strength in patients with ventral incisional hernia. Surg Endosc 2011;25:3503−8.

22. Stark B, Emanuelsson P, Gunnarsson U, et al. Validation of Biodex system 4 for measuring the strength of muscles in patients with rectus diastasis. J Plast Surg Hand Surg 2012;46:102−5.

23. Balogh B, Zauner-Dung A, et al. Functional impairment of the abdominal wall following laparoscopic and open cholecystectomy. Surg Endosc 2002;16:481−6.

24. Jensen KK, Kjaer M, Jorgensen LN. Abdominal muscle function and incisional hernia: a systematic review. Hernia doi:10.1007/s10029-014-1242−8.

25. Konerding MA, Bohn M, Wolloscheck T, et al. Maximum forces acting on the abdominal wall: experimental validation of a theoretical modeling in a human cadaver study. Medical Engeneering and Physics 2011;33:789−92.

26. Ramirez OM, Ruas E, Lee Dellon A. “Components separation” method for closure of abdominal wall defects: An anatomic and clinical study. Plast Reconstr Surg 1990;86:519−26.

27. Ramirez OM. Inception and evolution of the component separation technique: personal recollections. Clin Plast Surg 2006;33:241.

28. daSilva LA. Surgical correction of longitudinal median or paramedian incisional hernia. Surg Gynecol Obstet 1979;148:579−83.

29. Jernigan TW, Fabian TC, Croce MA, et al. Staged management of giant abdominal wall defects: acute and long-term results. Ann Surg 2003;238:349−55.

30. DiCocco JM, Fabian TC, Emmet KP, et al. Component separation for abdominal wall reconstruction: the Memphis modification. Surgery 2012;151:118−25.

31. Lowe JB, Garza JR, Bowman JL, et al. Endoscopically assisted „component separation“ for closure of abdominal wall defects. Plast Reconstr Surg 2000;105:720.

32. Malik K, Bowers SP, Smith CD, et al. A case series of laparoscopic components separation and rectus medialization with laparoscopic ventral hernia repair. J Laparoendosc Adv Surg Tech 2009;19:607−10.

33. Rosen MJ, Williams C, Jin J, et al. Laparoscopic versus open-component separation: a comparative analysis in a porcine model. Am J Surg 2007;194:358−9.

34. Saulis AS, Dumainian GA. Periumbilical rectus abdominis perforator preservativ significantly reduces superficial wound complications in “separation parts“ hernia repairs. Plast Reconstr Surg 2002;109:2275−80.

35. Harth KC, Rosen MJ. Endoscopic versus open component separation in complex abdominal wall reconstruction. Am J Surg 2010;199:342-6-discussion 346−7.

36. Bleichrodt RP, de Vries Reilingh TS, Malyar A, at al. Component separation technique to repair large midline hernias. Oper Tech General Surg 2004;3:179−88.

37. Maas SM, Van Engeland M, Leeksma NG, et al. A modification of the component separation technique for closure of abdominal wall defects in the presence of an enterostomy. J Am Coll Surg 1999;189:138.

38. Nguyen V, Shestak KC. Separation of anatomic components method of abdominal wall reconstruction – clinical outcome analysis and an update of surgical modifications using the technique. Clin Plast Surg 2006;33:247.

39. deVries Reilingh TS, van Goor H, Charbon JA, et al. Repair of giant midline abdominal wall hernia: „component separation technique“ versus prosthetic repair: interim analysis of randomized controlled trial. World J Surg 2007;31:756.

40. LeBlanc KA. Component separation technique guide. Davol Inc 2008.

41. Clarke JM. Incisional hernia repair by fascial component separation: results in 128 cases and evolution of technique. Am J Surg 2010;200:2−8.

42. Tong WM, Hope W, Overby DW, et al. Comparison of outcome after mesh-only repair, laparoscopic component separation, and open component separation. Ann Plast Surg 2011;66:551−6.

43. Shestak KC, Edington HJ, Johnson RR. The separation of anatomic components technique for the reconstruction of massive midline abdominal wall defects: anatomy, surgical technique, and limitations revised. Plast Reconstr Surg 2000;105:731−8.

44. Ko JH, Wang EC, Salvay DM, et al. Abdominal wall reconstruction: lessons learned from 200 „components separation“ procedures. Arch Surg 2009;144:1047−55.

45. Kulhánek J, Měšťák O. Rekonstrukce rozsáhlých defektů stěny břišní metodou separace komponentů. Rozhl Chir 2013;11:640−3.

46. den Hartog D, Dur AH, Tuinebreijer WE, et al. Open surgical procedures for incisional hernias. Cochrane Database Syst Rev 2008;CD006438.

47. Mazzocchi M, Dessy LA, Ranno R, et al. „Component separation“ technique and panniculectomy for repair of incisional hernia. Am J Surg 2011;201:776−83.

48. Lambert DM, Marceau S, Forse RA. Intra-abdominal pressure in the morbidly obese. Obes Surg 2005;15:1225−32.

49. Rao RS, Gentileschi P, Kini SU. Management of ventral hernias in bariatric surgery. Surg Obes Relat Dis 2011;7:110−6.

50. Newcomb WL, Polhill JL, Chen AY, et al. Staged hernia repair preceded by gastrin bypass for the treatment of morbidly obese patients with comlex ventral hernias. Hernia 2008;12:465−9.

51. Chevrel JP. The treatment of large midline incisional hernias by „overcoat“ plasty and prosthesis. Nouv Presse Med 1979;8:695−6.

52. Ferrari GC, Miranda A, Di Lernia S, et al. Laparoscopic repair of incisional hernia: outcomes of 100 consecutive cases comprising 25 wall defects larger than 15 cm. Surg Endosc 2008;22:1173−9.

53. Alkhoury F, Helton S, Ippolito RJ. Cost and clinical outcomes of laparoscopic ventral hernia repair using intraperitoneal mesh. Surg Laparosc Endosc Percutan Tech 2011;21:82−5.

54. Heniford BT, Park A, Ramshaw BJ, et a. Laparoscopic repair of ventral hernias: nine years experience with 850 consecutive hernias. Ann Surg 2003;238:391−4.

55. Patel KM, Nahabedian MY, Gatti M, et al. Indications and outcomes following complex abdominal reconstruction with component separation combined with porcine acellular dermal matrix reinforcement. Ann Plast Surg 2012;69:394−8.

56. Hood K, Milikan K, Pittman T, et al. Abdominal wall reconstruction: a case series of ventral hernia repair using the component separation technique with biologic mesh. Am J Surg 2013;205:322.

57. Morris LM, LeBlanc KA. Components separation technique utilizing an intraperitoneal biologic and an onlay lightweight polypropylene mesh: “a sandwich technique“. Hernia 2013;17:45.

58. Moreno-Egea A, Mengual-Ballester M, Cases-Baldo M, et al. Repair of complex incisional hernias using double prosthetic repair: single-surgeon experience with 50 cases. Surgery 2010;148:140−4.

59. Bringman S, Conze J, Cuccurullo D, et al. Hernia repair: the search for ideal meshes. Hernia 10;14:81−7.

60. Forbes SS, Eskicioglu C, McLeod RS, et al. Metaanalysis of randomized controlled trials compairing open and laparoscopic ventral or incisional hernia repair with mesh. Br J Surg 2009;96:851−8.

61. Shankaran V, Weber DJ, Reed II RL, et al. A review of available prosthetics for ventral hernia repair. Ann Surg 2011;253:16−26.

62. Wassanaar E, Schoenmaeckers E, Raymakers J, et al. Mesh-fixation method and pain and quality of life after laparoscopic ventral or incisional hernia repair: randomized trial of three fixation techniques. Surg Endosc 2010;24:1296−1302.

63. deVries Reilingh TS, van Geldere D, Langenhorst B, et al. Repair of large midline incisional hernias with polypropylen mesh: comparison of three operative techniques. Hernia 2004;8:56−9.

64. Joels CS, Vanderveer AS, Newcomb WL, et al. Abdominal wall reconstruction after temporary abdominal closure: A ten-year review. Surg Innov 2006;13:223−30.

65. Girotto JA, Chiaramonte M, Menon NG, et al. Recalcitrant abdominal wall hernias: long-term superiority of autologous tissues repair. Plast Reconstr Surg 2003;112:106−14.

66. Bucknall TE, Cox PJ, Ellis H. Burst abdomen and incisional hernia: a prospective study of 1129 major laparotomies. Br Med J 1982;284:931−3.

67. Carlson GW, Elwood E, Losken A, et al. The role of tissue expansion in abdominal wall reconstruction. Ann Plast Surg 2000;44:147−53.

68. Burger JW, Luijendijk RW, Hop WC, et al. Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 2004;240:578.

69. Sailes FC, Wall J, Guelig D, et al. Ventral hernia repairs: 10-year single-institution review at Thomas Jefferson University Hospital. J Am Coll Surg 2011;212:119.

70. Hoer J, Lawong G, Klinge U, et al. Factors influencing the development of incisional hernia. A retrospective study of 2,983 laparotomy patients over a period of 10 years. Der Chirurg 2002;73:474−80.

71. Mudge M, Hughes LE. Incisional hernia: a 10 year prospective study of incidence and attitudes. Br J Surg 1985;72:70−1.

72. Helgstrand F, Rosenberg J, Kehler H, et al. Reoperation vs. clinical recurrence rate after ventral hernia repair. Ann Surg 2012;256:955−8.

73. Eriksson A, Rosenberg J, Bisgaard T. Surgical treatment for giant incisional hernia: a qualitative systemic review. Hernia 2014;18:31−8.