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  1. Article ; Online: Open Retromuscular Lateral Abdominal Wall Hernia Repair: Is It Possible to Optimize Results?

    Blázquez Hernando, Luis / López Monclús, Javier / Robín Valle de Lersundi, Álvaro / Muñoz Rodríguez, Joaquín / García Ureña, Miguel Ángel

    Journal of the American College of Surgeons

    2023  Volume 237, Issue 2, Page(s) 379

    MeSH term(s) Humans ; Hernia, Ventral/surgery ; Incisional Hernia/surgery ; Surgical Mesh ; Herniorrhaphy/methods ; Abdominal Wall/surgery ; Abdominal Muscles
    Language English
    Publishing date 2023-05-12
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 1181115-8
    ISSN 1879-1190 ; 1072-7515
    ISSN (online) 1879-1190
    ISSN 1072-7515
    DOI 10.1097/XCS.0000000000000758
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  2. Article ; Online: Incisions in Hepatobiliopancreatic Surgery: Surgical Anatomy and its Influence to Open and Close the Abdomen.

    Medina Pedrique, Manuel / Robin Valle de Lersundi, Álvaro / Avilés Oliveros, Adriana / Ruiz, Sara Morejón / López-Monclús, Javier / Munoz-Rodriguez, Joaquín / Blázquez Hernando, Luis Alberto / Martinez Caballero, Javier / García-Urena, Miguel Ángel

    Journal of abdominal wall surgery : JAWS

    2023  Volume 2, Page(s) 11123

    Abstract: Incisions performed for hepato-pancreatic-biliary (HPB) surgery are diverse, and can be a challenge both to perform correctly as well as to be properly closed. The anatomy of the region overlaps muscular layers and has a rich vascular and nervous supply. ...

    Abstract Incisions performed for hepato-pancreatic-biliary (HPB) surgery are diverse, and can be a challenge both to perform correctly as well as to be properly closed. The anatomy of the region overlaps muscular layers and has a rich vascular and nervous supply. These structures are fundamental for the correct functionality of the abdominal wall. When performing certain types of incisions, damage to the muscular or neurovascular component of the abdominal wall, as well as an inadequate closure technique may influence in the development of long-term complications as incisional hernias (IH) or bulging. Considering that both may impair quality of life and that are complex to repair, prevention becomes essential during these procedures. With the currently available evidence, there is no clear recommendation on which is the better incision or what is the best method of closure. Despite the lack of sufficient data, the following review aims to correlate the anatomical knowledge learned from posterior component separation with the incisions performed in hepato-pancreatic-biliary (HPB) surgery and their consequences on incisional hernia formation. Overall, there is data that suggests some key points to perform these incisions: avoid vertical components and very lateral extensions, subcostal should be incised at least 2 cm from costal margin, multilayered suturing using small bites technique and consider the use of a prophylactic mesh in high-risk patients. Nevertheless, the lack of evidence prevents from the possibility of making any strong recommendations.
    Language English
    Publishing date 2023-03-22
    Publishing country Switzerland
    Document type Journal Article ; Review
    ISSN 2813-2092
    ISSN (online) 2813-2092
    DOI 10.3389/jaws.2023.11123
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  3. Article ; Online: Recurrence after retromuscular repair or posterior components separation: How to address them. A retrospective multicentre cohort study.

    Valle de Lersundi, Alvaro Robin / López-Monclús, Javier / Blázquez Hernando, Luis Alberto / Muñoz Rodriguez, Joaquin / Medina Pedrique, Manuel / Avilés Oliveros, Adriana / Morejón Ruiz, Sara / García-Ureña, Miguel-Angel

    Cirugia espanola

    2023  Volume 101 Suppl 1, Page(s) S40–S45

    Abstract: Abdominal wall hernias are common entities that represent important issues. Retromuscular repair and component separation for complex abdominal wall defects are considered useful treatments according to both short and long-term outcomes. However, failure ...

    Abstract Abdominal wall hernias are common entities that represent important issues. Retromuscular repair and component separation for complex abdominal wall defects are considered useful treatments according to both short and long-term outcomes. However, failure of surgical techniques may occur. The aim of this study is to analyze results of surgical treatment for hernia recurrence after prior retromuscular or posterior components separation. We have retrospectively reviewed patient charts from a prospectively maintained database. This study was conducted in three different hospitals of the Madrid region with surgical units dedicated to abdominal wall reconstruction. We have included in the database 520 patients between December 2014 and December 2021. Fifty-one patients complied with the criteria to be included in this study. We should consider offering surgical treatment for hernia recurrence after retromuscular repair or posterior components separation. However, the results might be associated to increased peri-operative complications.
    MeSH term(s) Humans ; Abdominal Muscles/surgery ; Hernia, Ventral/surgery ; Cohort Studies ; Retrospective Studies ; Herniorrhaphy/methods ; Surgical Mesh ; Recurrence
    Language English
    Publishing date 2023-09-20
    Publishing country Spain
    Document type Multicenter Study ; Journal Article
    ISSN 2173-5077
    ISSN (online) 2173-5077
    DOI 10.1016/j.cireng.2023.01.014
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  4. Article ; Online: Prevention of incisional hernia after kidney transplantation: study protocol for a randomized controlled trial.

    Gómez-Dos-Santos, Victoria / López-Plaza, José Antonio / Molina-Villar, José Manuel / Blázquez-Hernando, Luis / Diez-Nicolás, Víctor / Jiménez-Cidre, Miguel / Porrero-Guerrero, Belén / Rodríguez-Patrón, Rafael / Arias-Fúnez, Fernando / Muriel-García, Alfonso / Fernández-Cebrián, José María / Burgos-Revilla, Francisco Javier

    Trials

    2023  Volume 24, Issue 1, Page(s) 528

    Abstract: Background: Incisional hernia is a common complication after kidney transplantation with an incidence of 1.6-18%. Concerning non-transplant patients, a recently published meta-analysis describes a reduction of the incidence of incisional hernia of up to ...

    Abstract Background: Incisional hernia is a common complication after kidney transplantation with an incidence of 1.6-18%. Concerning non-transplant patients, a recently published meta-analysis describes a reduction of the incidence of incisional hernia of up to 85% due to prophylactic mesh replacement in elective, midline laparotomy. The aim of our study is to show a reduction of the incidence of incisional hernia after kidney transplantation with minimal risk for complication.
    Methods/design: This is a blinded, randomized controlled trial comparing time to incisional hernia over a period of 24 months between patients undergoing kidney transplantation and standardized abdominal closure with or without prophylactic placement of ProGrip™ (Medtronic, Fridley, MN, USA) mesh in an onlay position. As we believe that the mesh intervention is superior to the standard procedure in reducing the incidence of hernia, this is a superiority trial.
    Discussion: The high risk for developing incisional hernia following kidney transplantation might be reduced by prophylactic mesh placement. ProGrip™ mesh features polylactic acid (PLA) microgrips that provide immediate, strong and uniform fixation. The use of this mesh combines the effectiveness demonstrated by the macropore propylene meshes in the treatment of incisional hernias, a high simplicity of use provided by its capacity for self-fixation that does not increase significantly surgery time, and safety.
    Trial registration: ClinicalTrials.gov NCT04794582. Registered on 08 March 2021. Protocol version 2.0. (02-18-2021).
    MeSH term(s) Humans ; Incisional Hernia/diagnosis ; Incisional Hernia/epidemiology ; Incisional Hernia/etiology ; Kidney Transplantation/adverse effects ; Abdomen ; Laparotomy/adverse effects ; Incidence ; Surgical Mesh/adverse effects ; Abdominal Wound Closure Techniques/adverse effects ; Randomized Controlled Trials as Topic
    Language English
    Publishing date 2023-08-14
    Publishing country England
    Document type Clinical Trial Protocol ; Journal Article
    ZDB-ID 2040523-6
    ISSN 1745-6215 ; 1468-6694 ; 1745-6215
    ISSN (online) 1745-6215
    ISSN 1468-6694 ; 1745-6215
    DOI 10.1186/s13063-023-07545-0
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  5. Article: Second Look After Retromuscular Repair With the Combination of Absorbable and Permanent Meshes.

    Robin Valle de Lersundi, Alvaro / Munoz-Rodriguez, Joaquín / Lopez-Monclus, Javier / Blazquez Hernando, Luis Alberto / San Miguel, Carlos / Minaya, Ana / Perez-Flecha, Marina / Garcia-Urena, Miguel Angel

    Frontiers in surgery

    2021  Volume 7, Page(s) 611308

    Abstract: Objective: ...

    Abstract Objective:
    Language English
    Publishing date 2021-01-08
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2773823-1
    ISSN 2296-875X
    ISSN 2296-875X
    DOI 10.3389/fsurg.2020.611308
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  6. Article ; Online: Stepwise transversus abdominis muscle release for the treatment of complex bilateral subcostal incisional hernias.

    San Miguel-Méndez, Carlos / López-Monclús, Javier / Munoz-Rodriguez, Joaquín / de Lersundi, Álvaro Robin Valle / Artes-Caselles, Mariano / Blázquez Hernando, Luis Alberto / García-Hernandez, Juan Pablo / Minaya-Bravo, Ana María / Garcia-Urena, Miguel Ángel

    Surgery

    2021  Volume 170, Issue 4, Page(s) 1112–1119

    Abstract: Background: Management of subcostal incisional hernias is particularly complicated due to their proximity to the costochondral limits in addition to the lack of aponeurosis on the lateral side of the abdomen. We present our results of posterior ... ...

    Abstract Background: Management of subcostal incisional hernias is particularly complicated due to their proximity to the costochondral limits in addition to the lack of aponeurosis on the lateral side of the abdomen. We present our results of posterior component separation through the same previous incision as a safe and reproducible technique for these complex cases.
    Methods: We present a multicenter and prospective cohort of patients diagnosed with bilateral subcostal incisional hernias on either clinical examination or imaging based on computed tomography from 2014 to 2020. The aim of this investigation was to assess the outcomes of abdominal wall reconstruction for subcostal incisional hernias through a new approach. The outcomes reported were short- and long-term complications, including recurrence, pain, and bulging. Quality of life was assessed with the European Registry for Abdominal Wall Hernias Quality of Life score.
    Results: A total of 46 patients were identified. All patients underwent posterior component separation. Surgical site occurrences occurred in 10 patients (22%), with only 7 patients (15%) requiring procedural intervention. During a mean follow-up of 18 (range, 6-62), 1 (2%) case of clinical recurrence was registered. In addition, there were 8 (17%) patients with asymptomatic but visible bulging. The European Registry for Abdominal Wall Hernias Quality of Life score showed a statistically significant decrease in the 3 domains (pain, restriction, and cosmetic) of the postoperative compared with the preoperative scores.
    Conclusion: Posterior component separation technique for the repair of subcostal incisional hernias through the same incision is a safe procedure that avoids injury to the linea alba. It is associated with acceptable morbidity, low recurrence rate, and improvement in patients' reported outcomes.
    MeSH term(s) Abdominal Muscles/surgery ; Abdominoplasty/methods ; Female ; Hernia, Ventral/diagnosis ; Hernia, Ventral/etiology ; Hernia, Ventral/surgery ; Herniorrhaphy/methods ; Humans ; Incisional Hernia/complications ; Incisional Hernia/diagnosis ; Incisional Hernia/surgery ; Male ; Middle Aged ; Prospective Studies ; Recurrence ; Reoperation ; Surgical Mesh ; Tomography, X-Ray Computed
    Language English
    Publishing date 2021-05-19
    Publishing country United States
    Document type Journal Article ; Multicenter Study
    ZDB-ID 202467-6
    ISSN 1532-7361 ; 0039-6060
    ISSN (online) 1532-7361
    ISSN 0039-6060
    DOI 10.1016/j.surg.2021.04.007
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  7. Article ; Online: Reverse TAR may be added when necessary in open preperitoneal repair of lateral incisional hernias: a retrospective multicentric cohort study.

    Munoz-Rodriguez, Joaquin M / Lopez-Monclus, Javier / Perez-Flecha, Marina / Robin-Valle de Lersundi, Alvaro / Blazquez-Hernando, Luis A / Royuela-Vicente, Ana / Garcia-Hernandez, Juan P / Equisoain-Azcona, Aritz / Medina-Pedrique, Manuel / Garcia-Urena, Miguel A

    Surgical endoscopy

    2022  Volume 36, Issue 12, Page(s) 9072–9091

    Abstract: Background: The best approach for lateral incisional hernia is not known. Posterior component separation (reverse TAR) offers the possibility of using the retromuscular space for medial extension of the challenging preperitoneal plane. The aim of our ... ...

    Abstract Background: The best approach for lateral incisional hernia is not known. Posterior component separation (reverse TAR) offers the possibility of using the retromuscular space for medial extension of the challenging preperitoneal plane. The aim of our multicenter study was to compare the operative and patient-reported outcomes measures (PROMs) using two open surgical techniques from the lateral approach: a totally preperitoneal vs a reverse TAR.
    Methods: A retrospective cohort study was performed since 2012 to 2020. Patients with lateral incisional hernia treated through a lateral approach were identified from a prospectively maintained multicenter database. Reverse TAR was added when the preperitoneal plane could not be safely dissected. The results obtained using these two lateral approaches were compared, including short- and long-term complications, as well as PROMs, using the specific tool EuraHSQoL.
    Results: A total of 61 patients were identified. Reverse TAR was performed in 33 patients and lateral retromuscular preperitoneal approach in 28 patients. Both groups were comparable in terms of sociodemographic and comorbidities variables. Surgical site occurrences occurred in 13 cases (21.3%), with 8 patients (13.1%) requiring procedural intervention. During a median follow-up of 34 months, no incisional hernia recurrence was registered. There was a case (1.6%) of symptomatic bulging that required reoperation. Also 12 patients (19.7%) presented an asymptomatic bulging. No statistically significant difference was identified in the complications and PROMs between the two procedures.
    Conclusion: The open lateral retromuscular reconstruction using very large meshes that reach the midline has excellent long-term results with acceptable postoperative complications, including PROMs. A reverse TAR may be added, when necessary, without increasing complications and obtaining similar long-term results.
    MeSH term(s) Humans ; Hernia, Ventral/surgery ; Hernia, Ventral/etiology ; Retrospective Studies ; Abdominal Muscles/surgery ; Herniorrhaphy/adverse effects ; Herniorrhaphy/methods ; Surgical Mesh ; Incisional Hernia/surgery ; Incisional Hernia/etiology ; Recurrence
    Language English
    Publishing date 2022-06-28
    Publishing country Germany
    Document type Multicenter Study ; Journal Article
    ZDB-ID 639039-0
    ISSN 1432-2218 ; 0930-2794
    ISSN (online) 1432-2218
    ISSN 0930-2794
    DOI 10.1007/s00464-022-09375-8
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  8. Article ; Online: High recurrence rate after posterior component separation and keyhole mesh reconstruction for complex parastomal hernia: A case series study.

    Robin Valle de Lersundi, Alvaro / Rupealta, Niccolo / San Miguel Mendez, Carlos / Muñoz Rodriguez, Joaquin / Pérez Flecha, Marina / López Monclús, Javier / Blazquez Hernando, Luis / García Ureña, Miguel Angel

    Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

    2021  Volume 23, Issue 8, Page(s) 2137–2145

    Abstract: Aim: This study aimed to describe the results of complex parastomal hernia repair after posterior component separation and keyhole reconstruction.: Method: We conducted a retrospective review of a prospectively sustained database in one single ... ...

    Abstract Aim: This study aimed to describe the results of complex parastomal hernia repair after posterior component separation and keyhole reconstruction.
    Method: We conducted a retrospective review of a prospectively sustained database in one single complex abdominal wall referral centre. We analysed the data of patients who underwent the posterior component separation technique using modified transversus abdominis release for complex parastomal hernia and retromuscular keyhole mesh repair from February 2014 to January 2017. Demographic data, hernia characteristics, operative details and outcomes were analysed. The primary outcome measured was the recurrence rate during the follow-up.
    Results: Twenty patients were included in this study. Among the patients who underwent surgery for parastomal hernia, 17 patients had a colostomy (85%) and three patients had a ureteroileostomy after the Bricker procedure (15%). The mean body mass index was 33.2 kg/m
    Conclusions: Although posterior component separation in the form of modified transversus abdominis muscle release allows abdominal wall reconstruction, keyhole mesh configuration at the stoma site does not offer satisfactory results in terms of long-term recurrence rate at the parastomal defect.
    MeSH term(s) Abdominal Muscles/surgery ; Hernia, Ventral/etiology ; Hernia, Ventral/surgery ; Herniorrhaphy/adverse effects ; Humans ; Incisional Hernia/etiology ; Incisional Hernia/surgery ; Recurrence ; Retrospective Studies ; Surgical Mesh ; Treatment Outcome
    Language English
    Publishing date 2021-06-12
    Publishing country England
    Document type Journal Article
    ZDB-ID 1440017-0
    ISSN 1463-1318 ; 1462-8910
    ISSN (online) 1463-1318
    ISSN 1462-8910
    DOI 10.1111/codi.15729
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    Zs.A 5799: Show issues Location:
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  9. Article ; Online: Outcomes of abdominal wall reconstruction in patients with the combination of complex midline and lateral incisional hernias.

    Munoz-Rodriguez, Joaquin Manuel / Lopez-Monclus, Javier / San Miguel Mendez, Carlos / Perez-Flecha Gonzalez, Marina / Robin-Valle de Lersundi, Alvaro / Blázquez Hernando, Luis Alberto / Cuccurullo, Diego / Garcia-Hernandez, Esteban / Sanchez-Turrión, Victor / Garcia-Urena, Miguel Angel

    Surgery

    2020  Volume 168, Issue 3, Page(s) 532–542

    Abstract: Background: The best treatment for the combined defects of midline and lateral incisional hernia is not known. The aim of our multicenter study was to evaluate the operative and patient-reported outcomes using a modified posterior component separation ... ...

    Abstract Background: The best treatment for the combined defects of midline and lateral incisional hernia is not known. The aim of our multicenter study was to evaluate the operative and patient-reported outcomes using a modified posterior component separation in patients who present with the combination of midline and lateral incisional hernia.
    Methods: We identified patients from a prospective, multicenter database who underwent operative repairs of a midline and lateral incisional hernia at 4 centers with minimum 2-year follow-up. Hernias were divided into a main hernia based on the larger size and associated abdominal wall hernias. Outcomes reported were short- and long-term complications, including recurrence, pain, and bulging. Quality of life was assessed with the European Registry for Abdominal Wall Hernias Quality of Life score.
    Results: Fifty-eight patients were identified. Almost 70% of patients presented with a midline defect as the main incisional hernia. The operative technique was a transversus abdominis release in 26 patients (45%), a modification of transversus abdominis release 27 (47%), a reverse transversus abdominis release in 3 (5%), and a primary, lateral retromuscular preperitoneal approach in 2 (3%). Surgical site occurrences occurred in 22 patients (38%), with only 8 patients (14%) requiring procedural intervention. During a mean follow-up of 30.1 ± 14.4 months, 2 (3%) cases of recurrence were diagnosed and required reoperation. There were also 4 (7%) patients with asymptomatic but visible bulging. The European Registry for Abdominal Wall Hernias Quality of Life score showed a statistically significant decrease in the 3 domains (pain, restriction, and cosmetic) in the postoperative score compared with the preoperative score.
    Conclusion: The different techniques of posterior component separation in the treatment of combined midline and lateral incisional hernia show acceptable results, despite the associated high complexity. Patient-reported outcomes after measurement of the European Registry for Abdominal Wall Hernias Quality of Life score demonstrated a clinically important improvement in quality of life and pain.
    MeSH term(s) Abdominal Wall/surgery ; Abdominoplasty/adverse effects ; Abdominoplasty/methods ; Aged ; Female ; Follow-Up Studies ; Hernia, Ventral/diagnosis ; Hernia, Ventral/surgery ; Herniorrhaphy/adverse effects ; Herniorrhaphy/methods ; Humans ; Incisional Hernia/diagnosis ; Incisional Hernia/surgery ; Male ; Middle Aged ; Pain, Postoperative/epidemiology ; Pain, Postoperative/etiology ; Patient Reported Outcome Measures ; Prospective Studies ; Quality of Life ; Recurrence ; Reoperation/statistics & numerical data ; Severity of Illness Index ; Treatment Outcome
    Language English
    Publishing date 2020-05-12
    Publishing country United States
    Document type Journal Article ; Multicenter Study
    ZDB-ID 202467-6
    ISSN 1532-7361 ; 0039-6060
    ISSN (online) 1532-7361
    ISSN 0039-6060
    DOI 10.1016/j.surg.2020.04.045
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  10. Article ; Online: How we do it: down to up posterior components separation.

    Robin-Lersundi, Alvaro / Blazquez Hernando, Luis / López-Monclús, Javier / Cruz Cidoncha, Arturo / San Miguel Méndez, Carlos / Jimenez Cubedo, Elena / García-Ureña, Miguel Angel

    Langenbeck's archives of surgery

    2018  Volume 403, Issue 4, Page(s) 539–546

    Abstract: Background: Posterior component separation with transversus abdominis release technique is increasingly being used for abdominal wall reconstruction in complex abdominal wall repair. The main purpose of this study is to present a modification of the ... ...

    Abstract Background: Posterior component separation with transversus abdominis release technique is increasingly being used for abdominal wall reconstruction in complex abdominal wall repair. The main purpose of this study is to present a modification of the surgical technique originally described that facilitates the surgical procedure and offers additional advantages.
    Methods: Based on the knowledge of the anatomy of the retromuscular space and the preperitoneal aerolar tissue distribution, we start the incision on the posterior rectus sheath from the arcuate line in a down to up direction. The posterior rectus sheath is incised 0,5-1 cm medial to the linea semilunaris and cut longitudinally as far as the fibers of transversus abdominis muscle that are divided in the superior part of the abdomen. It is also possible to avoid cutting the fibers of this muscle if we incise the posterior rectus sheath in an oblique direction to the midline from the umbilical area. Since 2012 to 2016, 69 consecutive patients with down to up TAR have been prospectively followed. Main outcome measures included demographics, perioperative details, wound complications, and recurrences.
    Results: Between 2012 and 2016, we have operated 69 patients with down to up TAR technique. Mean operative time was 251 (range 65-566) minutes. Mean hospital stay was 9,8 (2-98) days. 10 patients presented surgical site events (14,5%): 6 patients had superficial site infection, 3 deep and 1 organ space. During follow-up, 3 patients (4,3%) presented incisional hernia recurrence.
    Conclusions: This novel modification allows a simpler dissection of the preperitoneal retromuscular space and makes the TAR technique easier to perform. It also enables to incise only the insertion of the transversalis fascia cranially.
    MeSH term(s) Abdominal Muscles/surgery ; Abdominal Wall/surgery ; Dissection/methods ; Female ; Hernia, Abdominal/surgery ; Herniorrhaphy/methods ; Humans ; Male ; Middle Aged ; Operative Time ; Retrospective Studies ; Surgical Mesh
    Language English
    Publishing date 2018-03-03
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 1423681-3
    ISSN 1435-2451 ; 1435-2443
    ISSN (online) 1435-2451
    ISSN 1435-2443
    DOI 10.1007/s00423-018-1655-4
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