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Gland Surgery Aug 2019The deep inferior epigastric perforator flap (DIEP) has gained widespread popularity in autologous breast reconstruction due to its natural aesthetic results and...
BACKGROUND
The deep inferior epigastric perforator flap (DIEP) has gained widespread popularity in autologous breast reconstruction due to its natural aesthetic results and muscle-sparing design. However, donor site results regarding aesthetic outcome are often less favorable. Despite several studies on surgical technique and improvements of flap harvest, only a small number of studies addressing donor site aesthetic exist.
METHODS
A systematic review was performed on donor site aesthetic after DIEP flap harvest according to the PRISMA guidelines. Secondary interests were abdominal wall morbidity and complication rates in general. The following electronic databases were included to identify relevant studies: Medline, Embase, PubMed, Cochrane, and Web of Science.
RESULTS
The search yielded 95 articles for full-text analysis, with only four key studies found on donor site aesthetic specifically. Regarding complication rates, the overall rate of abdominal hernia ranges from 0 to 7.1%. Abdominal bulging occurs in 2.3% to 33%. Besides abdominal wall integrity, wound dehiscence (12-39%), seroma (1-48%), hematoma (1-15%), infections (1-12%), fat necrosis (0-11%) and umbilical necrosis (2-3%) significantly impair donor site aesthetic.
CONCLUSIONS
This systematic review reveals that the topic of donor site aesthetic and potential improvement of results has largely been neglected in the past decade. This study provides a thorough evaluation of potential problems that plastic surgeons may encounter and includes recommendations to improve results.
PubMed: 31538064
DOI: 10.21037/gs.2019.06.05 -
Surgical Laparoscopy, Endoscopy &... Dec 2020Umbilical hernia is a common abdominal complication in cirrhotic patients. The incidence of umbilical hernias can be up to 20% in the presence of ascites. However, there...
BACKGROUND
Umbilical hernia is a common abdominal complication in cirrhotic patients. The incidence of umbilical hernias can be up to 20% in the presence of ascites. However, there is no consensus regarding the optimal management of umbilical hernias in cirrhotic patients. The purpose of this study is to review the management of umbilical hernias in cirrhotic patients with ascites.
METHODS
A search of the available literature in English since 1980 was performed using PubMed, the Cochrane Library, and a search of relevant journals and reference lists. The search terms included "umbilical hernia," "ascites," "cirrhosis," and any derivatives of these terms, and the literature search identified all the relevant publications.
RESULTS
Thirty-three relevant articles published in the language of English were identified. Fourteen studies involved the management of refractory ascites in cirrhotic patients. Twenty-four studies included cirrhotic patients receiving elective or emergency surgery. Because of much lower morbidity and mortality in elective surgery than in emergency surgery, many authors advocated early elective repair of uncomplicated umbilical hernias in cirrhotic patients. Of these, 2 studies described laparoscopic umbilical hernioplasty, with a significant lower morbidity and hernia recurrence than open repair. Fifteen studies described the use of prosthetic mesh umbilical hernia repair in cirrhotic patients, which was associated with minimal wound-related morbidity and markedly lower recurrences.
CONCLUSIONS
Our results indicate that early elective repair of uncomplicated umbilical hernias is recommended in cirrhotic patients with tolerable hepatic functional reserve or when the expected time for liver transplantation is >3 months. Umbilical hernias are supposed to be corrected in the process of liver transplantation, provided that patients could have a better prospect to be transplanted within 3 months. Control of ascites is a crucial part to successful outcomes of umbilical hernia repair. Large volume paracentesis, concomitant peritoneovenous shunting with herniorrhaphy and transjugular intrahepatic portosystemic shunting can be applied to control refractory ascites. Emergency repair of umbilical hernias is indicated in cirrhotic patients with ascites when complications develop.
Topics: Humans; Ascites; Hernia, Umbilical; Herniorrhaphy; Liver Cirrhosis; Liver Transplantation
PubMed: 33347087
DOI: 10.1097/SLE.0000000000000891 -
Scandinavian Journal of Surgery : SJS :... Sep 2019The use of mesh repair in a small- or middle-sized umbilical hernia remains controversial, and evidence is based on only few and small heterogeneous randomized trials.... (Meta-Analysis)
Meta-Analysis
Lower Risk of Recurrence After Mesh Repair Versus Non-Mesh Sutured Repair in Open Umbilical Hernia Repair: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
BACKGROUND AND AIMS
The use of mesh repair in a small- or middle-sized umbilical hernia remains controversial, and evidence is based on only few and small heterogeneous randomized trials. The primary aim was to assess differences, if any, in recurrence (clinical and reoperation), and secondary aim was to assess differences in infections, seroma formation, hematomas, chronic pain, cosmetic result, and quality of life.
METHOD
A systematic review (predefined search strategy) and meta-analyses were conducted based on pre-study strict and well-defined methodology. The literature search was completed on 1 January 2018. The study protocol was registered in PROSPERO.
RESULTS
Five randomized controlled trials were identified (mesh repair, n = 326 versus non-mesh sutured repair, n = 330) and 602 records were excluded. Randomized controlled trials included patients with defect diameters of ⩾1 to 4 cm. Mesh repair reduced the risk of recurrence compared with sutured repair with a relative risk of 0.28 (95% confidence interval = 0.13-0.58, I = 0%, number needed to treat = 13 patients). Additional analyses found no differences between the two surgical techniques regarding infection (relative risk = 0.80, 95% confidence interval = 0.36-1.79), seroma formation (relative risk = 1.38, 95% confidence interval = 0.57-3.32), or hematomas (relative risk = 0.55, 95% confidence interval = 0.23-1.30). Lack of sufficient data precluded meta-analysis evaluating risk of seroma formation, hematomas, chronic pain, cosmetic result, and quality of life.
CONCLUSION
Mesh repair is recommended for umbilical hernia of ⩾1 to 4 cm. More evidence is needed for the optimal placement of the mesh (sublay or onlay) and the role of mesh in patients with an umbilical hernia <1 cm.
Topics: Hernia, Umbilical; Herniorrhaphy; Humans; Postoperative Complications; Randomized Controlled Trials as Topic; Recurrence; Reoperation; Surgical Mesh
PubMed: 30488767
DOI: 10.1177/1457496918812208 -
Hernia : the Journal of Hernias and... Aug 2020Patient-reported outcome measures (PROMs) have been increasingly accepted to evaluate the quality of surgery. The impact of a hernia on PROMs and the indication for...
PURPOSE
Patient-reported outcome measures (PROMs) have been increasingly accepted to evaluate the quality of surgery. The impact of a hernia on PROMs and the indication for elective ventral hernia mesh repair are poorly researched. The primary objective in this systematic review was to provide evidence for PROM changes at least 3 months after elective ventral hernia mesh repair. Secondarily, a critical appraisal of the study quality was undertaken.
METHODS
Ovid MEDLINE, PubMed, Ovid Embase, and CENTRAL were searched (year 2000-May 12, 2019) for studies reporting any of 21 predefined PROMs pre- and ≥ 3 months postoperatively following adult ventral hernia mesh repair. A pre-study defined analysis method was used to assess pre- vs. postoperative PROM changes. Quality assessment was guided by criteria formulated by the National Institutes of Health.
RESULTS
The search yielded 11,438 potentially eligible studies of which 24 met the inclusion criteria. Most studies were of poor or moderate quality and one study was of high quality. There was no evidence for a clinically relevant postoperative improvement in any PROM following umbilical hernia repair or medium-sized incisional hernia repair. A clinically relevant postoperative improvement of pain, physical impairment, and social involvement was seen in patients with a large-sized incisional hernia repair and stoma-related complaints in patients with a medium-sized parastomal hernia repair.
CONCLUSION
This analysis suggested that a minor subset of PROMs improved in patients undergoing large-sized incisional and medium-sized parastomal hernia repair. High-quality studies are imperative in this extremely often conducted surgical procedure.
TRIAL REGISTRATION
The review was registered at PROSPERO (CRD42018096671, https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=96671 ).
Topics: Elective Surgical Procedures; Hernia, Ventral; Herniorrhaphy; Humans; Patient Reported Outcome Measures; Postoperative Complications; Postoperative Period; Surgical Mesh; Surgical Stomas
PubMed: 32152807
DOI: 10.1007/s10029-020-02154-1 -
Surgical Laparoscopy, Endoscopy &... Oct 2019The objective of this study was to evaluate the comparative efficacy of gallbladder retrieval via the epigastric and umbilical port during laparoscopic cholecystectomy. (Comparative Study)
Comparative Study Meta-Analysis
OBJECTIVE
The objective of this study was to evaluate the comparative efficacy of gallbladder retrieval via the epigastric and umbilical port during laparoscopic cholecystectomy.
METHODS
We systematically searched MEDLINE, EMBASE, CINAHL, CENTRAL, the World Health Organization International Clinical Trials Registry, ClinicalTrials.gov, ISRCTN Register, and bibliographic reference lists. Postoperative pain intensity, port-site infection, hernia, bleeding, and retrieval time were outcome parameters. Combined overall effect sizes were calculated using fixed-effect or random-effects models.
RESULTS
We identified 5 randomized controlled trials and 1 prospective cohort study reporting a total of 2394 patients who underwent laparoscopic cholecystectomy with retrieval of the gallbladder via the umbilical port (n=1194) or epigastric port (n=1200). Our initial analysis demonstrated that gallbladder retrieval via the umbilical port was associated with a nonsignificant reduction in pain assessed by visual analogue scale at 24 hours [mean difference (MD): -0.49, 95% confidence interval (CI): -1.06 to 0.08, P=0.09] compared with the epigastric port. However, after sensitivity analysis and eliminating the source of heterogeneity, it reached statistical significance (MD: -0.66, 95% CI: -0.85 to -0.48, P<0.00001). Moreover, gallbladder retrieval via the umbilical port was associated with significantly shorter retrieval time (MD: -1.83, 95% CI: -3.18 to -0.49, P=0.008) but similar risk of port-site infection (odds ratio: 1.99, 95% CI: 0.53-7.44, P=0.31) and hernia (odds ratio: 0.33, 95% CI: 0.03-3.20, P=0.34).
CONCLUSIONS
Our analysis demonstrated that retrieval of the gallbladder via the umbilical port may be associated with less postoperative pain in patients undergoing laparoscopic cholecystectomy compared with epigastric port retrieval. It may also be associated with shorter gallbladder retrieval time. However, the available evidence is limited.
Topics: Adult; Cholecystectomy, Laparoscopic; Female; Gallbladder; Humans; Incisional Hernia; Male; Middle Aged; Prospective Studies; Randomized Controlled Trials as Topic; Surgical Instruments; Surgical Wound Infection; Umbilicus
PubMed: 31033631
DOI: 10.1097/SLE.0000000000000662 -
Annals of Plastic Surgery Nov 2021The management of complex exomphalos major is difficult, and traditional techniques fail to address the visceroabdominal disproportion in the most severe cases....
The management of complex exomphalos major is difficult, and traditional techniques fail to address the visceroabdominal disproportion in the most severe cases. Intra-abdominal tissue expansion is a novel technique and has been used in a small number of patients to safely increase the intra-abdominal volume and allow the reduction of viscera and subsequent closure of the abdominal domain. We review 7 published reports of this technique and add a case report describing our refinement of the technique. We propose that the use of multiple expanders placed in the intra-abdominal preperitoneal space, when expanded slowly, can allow safe reduction of viscera and immediate direct closure of the musculofascial layer of the abdomen.
Topics: Abdomen; Abdominal Muscles; Hernia, Umbilical; Humans; Tissue Expansion; Tissue Expansion Devices
PubMed: 33661222
DOI: 10.1097/SAP.0000000000002740 -
Journal of Surgical Case Reports May 2024Peritoneal inclusion cysts (PICs) are a rare and benign condition of uncertain pathogenesis. The fluid-filled, mesothelial-lined cysts manifest within the abdominopelvic...
Peritoneal inclusion cysts (PICs) are a rare and benign condition of uncertain pathogenesis. The fluid-filled, mesothelial-lined cysts manifest within the abdominopelvic cavity. This case report details an unusual occurrence of a 97 mm PIC- presenting as an umbilical hernia- in a 26-year-old male patient with no prior surgical history. Following pre-operative cross-sectional imaging, this was managed through open excision without complication. A systematic review of the literature highlighted 30 previous cases [26F, 4M] with a mean age of 34 years (std ±15.4) and a median diameter of 93 mm [IQR, 109 mm]. A total of 53% (n = 16) of cases had a history of previous abdominal surgery. Surgical excision is safe and laparoscopic modality should be considered (<1% recurrence). Accepting the limited evidence base, image guided drainage should be avoided (50% recurrence, n = 2).
PubMed: 38706476
DOI: 10.1093/jscr/rjae258