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  1. Article ; Online: Preventing incisional ventral hernias: important for patients but ignored by surgical specialities? A critical review.

    Garcia-Urena, M A

    Hernia : the journal of hernias and abdominal wall surgery

    2021  Volume 25, Issue 1, Page(s) 13–22

    Abstract: Purpose: Incisional ventral hernias (IHs) are a common complication across all surgical specialities requiring access to the abdomen, pelvis, and retroperitoneum. This public health issue continues to be widely ignored, resulting in appreciable ... ...

    Abstract Purpose: Incisional ventral hernias (IHs) are a common complication across all surgical specialities requiring access to the abdomen, pelvis, and retroperitoneum. This public health issue continues to be widely ignored, resulting in appreciable morbidity and expenses. In this critical review, the issue is explored by an interdisciplinary group.
    Methods: A group of European surgeons encompassing representatives from abdominal wall, vascular, urological, gynecological, colorectal and hepato-pancreatico-biliary surgery have reviewed the occurrence of His in these disciplines.
    Results: Incisional hernias are a major public health issue with appreciable morbidity and cost implications. General surgeons are commonly called upon to repair IHs following an initial operation by others. Measures that may collectively reduce the frequency of IH across specialities include better planning and preparation (e.g. a fit patient, no time pressure, an experienced operator). A minimally invasive technique should be employed where appropriate. Our main recommendations in midline incisions include using the 'small bites' suture technique with a ≥ 4:1 suture-to-wound length, and adding prophylactic mesh augmentation in patients more likely to suffer herniation. For off-midline incisions, more research of this problem is essential.
    Conclusion: Meticulous closure of the incision is significant for every patient. Raising awareness of the His is necessary in all surgical disciplines that work withing the abdomen or retroperitoneum. Across all specialties, surgeons should aim for a < 10% IH rate.
    MeSH term(s) Abdominal Wound Closure Techniques ; Hernia, Ventral/surgery ; Herniorrhaphy/adverse effects ; Humans ; Incisional Hernia/etiology ; Incisional Hernia/prevention & control ; Surgical Mesh
    Language English
    Publishing date 2021-01-04
    Publishing country France
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 1388125-5
    ISSN 1248-9204 ; 1265-4906
    ISSN (online) 1248-9204
    ISSN 1265-4906
    DOI 10.1007/s10029-020-02348-7
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    Zs.A 5390: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (2.OG)
    ab Jg. 2022: Lesesaal (EG)

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  2. Article ; Online: An evidence map and synthesis review with meta-analysis on the risk of incisional hernia in colorectal surgery with standard closure.

    Stabilini, C / Garcia-Urena, M A / Berrevoet, F / Cuccurullo, D / Capoccia Giovannini, S / Dajko, M / Rossi, L / Decaestecker, K / López Cano, M

    Hernia : the journal of hernias and abdominal wall surgery

    2022  Volume 26, Issue 2, Page(s) 411–436

    Abstract: Purpose: To assess the incidence of incisional hernia (IH) across various type of incisions in colorectal surgery (CS) creating a map of evidence to define research trends, gaps and areas of future interest.: Methods: Systematic review of PubMed and ... ...

    Abstract Purpose: To assess the incidence of incisional hernia (IH) across various type of incisions in colorectal surgery (CS) creating a map of evidence to define research trends, gaps and areas of future interest.
    Methods: Systematic review of PubMed and Scopus from 2010 onwards. Studies included both open (OS) and laparoscopic (LS). The primary outcome was incidence of IH 12 months after index procedure, secondary outcomes were the study features and their influence on reported proportion of IH. Random effects models were used to calculate pooled proportions. Meta-regression models were performed to explore heterogeneity.
    Results: Ninetyone studies were included reporting 6473 IH. The pooled proportions of IH for OS were 0.35 (95% CI 0.27-0.44) I
    Conclusion: Midline laparotomies and stoma reversal sites are at high risk for IH and should be considered in research of preventive strategies of closure. After laparoscopic approach IH happens mainly by extraction sites incisions specially midline and also represent an important area of analysis.
    MeSH term(s) Colectomy/adverse effects ; Colorectal Surgery/adverse effects ; Herniorrhaphy/adverse effects ; Humans ; Incisional Hernia/epidemiology ; Incisional Hernia/etiology ; Incisional Hernia/prevention & control ; Risk Factors
    Language English
    Publishing date 2022-01-11
    Publishing country France
    Document type Journal Article ; Meta-Analysis ; Review ; Systematic Review
    ZDB-ID 1388125-5
    ISSN 1248-9204 ; 1265-4906
    ISSN (online) 1248-9204
    ISSN 1265-4906
    DOI 10.1007/s10029-021-02555-w
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  3. Article ; Online: Pathways of the preperitoneal plane: from the "fatty triangle" in Rives to the "fatty trident" in extended retromuscular abdominal wall reconstruction. A tribute to Prof. Schumpelick.

    Garcia-Urena, M Á / Lopez-Monclus, J / de Robin Valle de Lersundi, A / Blazquez Hernando, L A / Medina Pedrique, M / Rial Justo, X / Cruz Cidoncha, A / Nogueira Sixto, M / Munoz-Rodriguez, J

    Hernia : the journal of hernias and abdominal wall surgery

    2022  Volume 27, Issue 2, Page(s) 395–407

    Abstract: Purpose: Extended retromuscular dissection performed for abdominal wall reconstruction in complex abdominal wall repair has progressively exposed the anatomy between the peritoneal layer and abdominal wall muscles. This study aimed to assess the ... ...

    Abstract Purpose: Extended retromuscular dissection performed for abdominal wall reconstruction in complex abdominal wall repair has progressively exposed the anatomy between the peritoneal layer and abdominal wall muscles. This study aimed to assess the morphology and distribution of preperitoneal fat in a cadaveric model and its influence in retromuscular preperitoneal dissections.
    Methods: Thirty frozen cadaver torsos were dissected by posterior component separation. The shape of the preperitoneal fat was identified, and the dimensions and more significant distances were calculated.
    Results: The results showed that the preperitoneal fat resembles a trident, exists along the midline under the linea alba, and expands in the epigastric area into a rhomboid shape. The fatty triangle was found to be a part of this rhomboid. Caudally, the midline preperitoneal fat widened under the arcuate line to reach the Retzius space. Laterally, the Bogros space communicated the root of the trident with the paracolic gutters, Toldt's fascia, and pararenal fats, forming the lateral prong of the trident. The peritoneum not covered by the preperitoneal fatty trident was easy to break. Three pathways could be tracked following the distribution of this fat that facilitated the dissection of the preperitoneal space to prepare the landing zone of the meshes in hernia repair.
    Conclusion: The concept of preperitoneal fatty trident may be of practical assistance to perform various hernia procedures, from the simple ventral hernia repair to the more complex preperitoneal ventral repair or posterior component separation techniques. The consistency of this layer allows us to follow three specific pathways to find our plane between the peritoneum and muscle layers to extend the preperitoneal dissection.
    MeSH term(s) Humans ; Abdominal Muscles/surgery ; Abdominal Wall/surgery ; Hernia, Ventral/surgery ; Herniorrhaphy/methods ; Peritoneum/surgery ; Surgical Mesh
    Language English
    Publishing date 2022-04-15
    Publishing country France
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1388125-5
    ISSN 1248-9204 ; 1265-4906
    ISSN (online) 1248-9204
    ISSN 1265-4906
    DOI 10.1007/s10029-022-02602-0
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  4. Article ; Online: The intensive care unit in the postoperative period of major abdominal surgery.

    Puppo Moreno, A M / Abella Alvarez, A / Morales Conde, S / Pérez Flecha, M / García Ureña, M Á

    Medicina intensiva

    2019  Volume 43, Issue 9, Page(s) 569–577

    Abstract: Despite low mortality in patients undergoing major abdominal surgery, the number of high-risk patients is increasing and has become a health problem. At present, surgery is understood as a continuous process, in which numerous guidelines added to less ... ...

    Title translation La unidad de cuidados intensivos en el postoperatorio de cirugía mayor abdominal.
    Abstract Despite low mortality in patients undergoing major abdominal surgery, the number of high-risk patients is increasing and has become a health problem. At present, surgery is understood as a continuous process, in which numerous guidelines added to less invasive techniques offering a lesser physiological impact upon patients with serious comorbidities are responsible for the final outcome. The prevention, identification and early treatment of complications prove as important as the preoperative or surgical technique.?The introduction of ERAS (enhanced recovery after surgery) protocols is the cornerstone for the management of these patients, and is advocated by most surgical societies for reducing mortality, length of hospital stay and hospital costs. The postoperative management of these patients in postsurgery Intensive Care Units guarantees effectiveness and efficiency in maintaining optimum patient care.
    MeSH term(s) Abdomen/surgery ; Analgesia ; Anesthesia/standards ; Antibiotic Prophylaxis ; Enhanced Recovery After Surgery ; Feeding Methods ; Fluid Therapy ; Humans ; Intensive Care Units ; Minimally Invasive Surgical Procedures ; Monitoring, Physiologic/methods ; Postoperative Care/methods ; Postoperative Complications/diagnosis ; Postoperative Complications/etiology ; Postoperative Complications/mortality ; Postoperative Complications/prevention & control ; Postoperative Period ; Preoperative Care/methods ; Venous Thromboembolism/prevention & control
    Language Spanish
    Publishing date 2019-08-01
    Publishing country Spain
    Document type Journal Article ; Review
    ISSN 2173-5727
    ISSN (online) 2173-5727
    DOI 10.1016/j.medin.2019.05.007
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  5. Article ; Online: EHS and AHS guidelines for treatment of primary ventral hernias in rare locations or special circumstances.

    Henriksen, N A / Kaufmann, R / Simons, M P / Berrevoet, F / East, B / Fischer, J / Hope, W / Klassen, D / Lorenz, R / Renard, Y / Garcia Urena, M A / Montgomery, A

    BJS open

    2020  Volume 4, Issue 2, Page(s) 342–353

    Abstract: Background: Rare locations of hernias, as well as primary ventral hernias under certain circumstances (cirrhosis, dialysis, rectus diastasis, subsequent pregnancy), might be technically challenging. The aim was to identify situations where the treatment ...

    Abstract Background: Rare locations of hernias, as well as primary ventral hernias under certain circumstances (cirrhosis, dialysis, rectus diastasis, subsequent pregnancy), might be technically challenging. The aim was to identify situations where the treatment strategy might deviate from routine management.
    Methods: The guideline group consisted of surgeons from the European and Americas Hernia Societies. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used in formulating the recommendations. The Scottish Intercollegiate Guidelines Network (SIGN) critical appraisal checklists were used to evaluate the quality of full-text papers. A systematic literature search was performed on 1 May 2018 and updated 1 February 2019. The Appraisal of Guidelines for Research and Evaluation (AGREE) instrument was followed.
    Results: Literature was limited in quantity and quality. A majority of the recommendations were graded as weak, based on low quality of evidence. In patients with cirrhosis or on dialysis, a preperitoneal mesh repair is suggested. Subsequent pregnancy is a risk factor for recurrence. Repair should be postponed until after the last pregnancy. For patients with a concomitant rectus diastasis or those with a Spigelian or lumbar hernia, no recommendation could be made for treatment strategy owing to lack of evidence.
    Conclusion: This is the first European and American guideline on the treatment of umbilical and epigastric hernias in patients with special conditions, including Spigelian and lumbar hernias. All recommendations were weak owing to a lack of evidence. Further studies are needed on patients with rectus diastasis, Spigelian and lumbar hernias.
    MeSH term(s) Europe ; Hernia, Ventral/etiology ; Hernia, Ventral/surgery ; Herniorrhaphy/methods ; Humans ; Laparoscopy ; Liver Cirrhosis/complications ; Practice Guidelines as Topic ; Renal Dialysis/adverse effects ; Societies, Medical ; Surgical Mesh ; United States
    Language English
    Publishing date 2020-01-09
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Systematic Review
    ISSN 2474-9842
    ISSN (online) 2474-9842
    DOI 10.1002/bjs5.50252
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  6. Article ; Online: Correction to: Combining anterior and posterior component separation for extreme cases of abdominal wall reconstruction.

    Lopez-Monclus, J / Muñoz-Rodríguez, J / San Miguel, C / Robin, A / Blazquez, L A / Pérez-Flecha, M / Rupealta, N / Garcia-Urena, M A

    Hernia : the journal of hernias and abdominal wall surgery

    2020  Volume 25, Issue 1, Page(s) 251

    Language English
    Publishing date 2020-11-19
    Publishing country France
    Document type Published Erratum
    ZDB-ID 1388125-5
    ISSN 1248-9204 ; 1265-4906
    ISSN (online) 1248-9204
    ISSN 1265-4906
    DOI 10.1007/s10029-020-02343-y
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  7. Article ; Online: Combining anterior and posterior component separation for extreme cases of abdominal wall reconstruction.

    Lopez-Monclus, J / Muñoz-Rodríguez, J / San Miguel, C / Robin, A / Blazquez, L A / Pérez-Flecha, M / Rupealta, N / Garcia-Urena, M A

    Hernia : the journal of hernias and abdominal wall surgery

    2020  Volume 24, Issue 2, Page(s) 369–379

    Abstract: Purpose: The closure of midline in abdominal wall incisional hernias is an essential principle. In some exceptional circumstances, despite adequate component separation techniques, this midline closure cannot be achieved. This study aims to review the ... ...

    Abstract Purpose: The closure of midline in abdominal wall incisional hernias is an essential principle. In some exceptional circumstances, despite adequate component separation techniques, this midline closure cannot be achieved. This study aims to review the results of using both anterior and component separation in these exceptional cases.
    Methods: We reviewed our experience using the combination of both anterior and posterior component separation in the attempt to close the midline. Our first step was to perform a TAR and a complete extensive dissection of the retromuscular preperitoneal plane developed laterally as far as the posterior axillary line. When the closure of midline was not possible, an external oblique release was made. A retromuscular preperitoneal reinforcement was made with the combination of an absorbable mesh and a 50 × 50 polypropylene mesh.
    Results: Twelve patients underwent anterior and posterior component separation. The mean hernia width was 23.5 ± 5. The majority were classified as severe complex incisional hernia and had previous attempts of repair. After a mean follow-up of 27 months (range 8-45), no case of recurrence was registered. Only one patient (8.33%) presented with an asymptomatic bulging in the follow-up. European Hernia Society's quality of life scores showed a significant improvement at 2 years postoperatively in the three domains: pain (p = 0.01), restrictions (p = 0.04) and cosmetic (p = 0.01).
    Conclusions: The combination of posterior and anterior component separation can effectively treat massive and challenging cases of abdominal wall reconstruction in which the primary midline closure is impossible to achieve despite appropriate optimization of surgery.
    MeSH term(s) Abdominal Muscles/surgery ; Abdominal Wall/surgery ; Aged ; Dissection/methods ; Female ; Hernia, Ventral/surgery ; Herniorrhaphy/methods ; Humans ; Incisional Hernia/surgery ; Male ; Middle Aged ; Quality of Life ; Reconstructive Surgical Procedures/methods ; Recurrence ; Retrospective Studies ; Surgical Mesh
    Language English
    Publishing date 2020-03-05
    Publishing country France
    Document type Journal Article
    ZDB-ID 1388125-5
    ISSN 1248-9204 ; 1265-4906
    ISSN (online) 1248-9204
    ISSN 1265-4906
    DOI 10.1007/s10029-020-02152-3
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  8. Article ; Online: Guidelines for treatment of umbilical and epigastric hernias from the European Hernia Society and Americas Hernia Society.

    Henriksen, N A / Montgomery, A / Kaufmann, R / Berrevoet, F / East, B / Fischer, J / Hope, W / Klassen, D / Lorenz, R / Renard, Y / Garcia Urena, M A / Simons, M P

    The British journal of surgery

    2020  Volume 107, Issue 3, Page(s) 171–190

    Abstract: Background: Umbilical and epigastric hernia repairs are frequently performed surgical procedures with an expected low complication rate. Nevertheless, the optimal method of repair with best short- and long-term outcomes remains debatable. The aim was to ...

    Abstract Background: Umbilical and epigastric hernia repairs are frequently performed surgical procedures with an expected low complication rate. Nevertheless, the optimal method of repair with best short- and long-term outcomes remains debatable. The aim was to develop guidelines for the treatment of umbilical and epigastric hernias.
    Methods: The guideline group consisted of surgeons from Europe and North America including members from the European Hernia Society and the Americas Hernia Society. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, the Scottish Intercollegiate Guidelines Network (SIGN) critical appraisal checklists, and the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument were used. A systematic literature search was done on 1 May 2018, and updated on 1 February 2019.
    Results: Literature reporting specifically on umbilical and epigastric hernias was limited in quantity and quality, resulting in a majority of the recommendations being graded as weak, based on low-quality evidence. The main recommendation was to use mesh for repair of umbilical and epigastric hernias to reduce the recurrence rate. Most umbilical and epigastric hernias may be repaired by an open approach with a preperitoneal flat mesh. A laparoscopic approach may be considered if the hernia defect is large, or if the patient has an increased risk of wound morbidity.
    Conclusion: This is the first European and American guideline on the treatment of umbilical and epigastric hernias. It is recommended that symptomatic umbilical and epigastric hernias are repaired by an open approach with a preperitoneal flat mesh.
    MeSH term(s) Europe ; Hernia, Abdominal/surgery ; Hernia, Umbilical/surgery ; Herniorrhaphy/methods ; Humans ; Laparoscopy/methods ; Practice Guidelines as Topic ; Reconstructive Surgical Procedures/methods ; Societies, Medical ; Surgical Mesh ; United States
    Language English
    Publishing date 2020-01-09
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2985-3
    ISSN 1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
    ISSN (online) 1365-2168
    ISSN 0263-1202 ; 0007-1323 ; 1355-7688
    DOI 10.1002/bjs.11489
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  9. Article ; Online: Evaluation of a workshop to teach a new surgical technique in abdominal wall reconstruction.

    Blázquez Hernando, L A / López Monclús, J / Robín Del Valle Lersundi, A / Melero Montes, D / San Miguel Méndez, C / García Ureña, M A

    Hernia : the journal of hernias and abdominal wall surgery

    2019  Volume 24, Issue 3, Page(s) 645–650

    Abstract: Purpose: Assess the utility of a hands-on workshop on abdominal wall reconstruction for teaching the posterior components separation (PCS) with transversus abdominis release.: Methods: Our department has been organizing a training course on abdominal ...

    Abstract Purpose: Assess the utility of a hands-on workshop on abdominal wall reconstruction for teaching the posterior components separation (PCS) with transversus abdominis release.
    Methods: Our department has been organizing a training course on abdominal wall reconstruction for the last 6 years. It is a 2-day-long course and 10-12 surgeons with experience in abdominal wall surgery attend to every course. The first day is dedicated to theoretical lectures and two simultaneous live surgeries, and the second day there is a cadaver dissection. Feedback from the trainees was collected at the end of the workshop. A survey was sent to all the surgeons who had completed the course at least a year ago, to inquire how the course had improved their surgical practice.
    Results: From 2013 to April 2017, we have made 15 editions of the course. A total of 192 surgeons from Europe, South Africa and Middle East attended. All the surgeons answered the survey that was carried out at the end of the course. It showed a very high level of satisfaction in more than 98% of the cases. The second survey was answered by 79 surgeons (41.15%). 96% of the surgeons had modified, after attending the course, their way of dealing with complex abdominal wall problems. Only 29% of the surgeons had made a TAR before attending the course, while 86% are performing it after attending the course and 60% do it on a regular basis. In fact, 43% of surgeons have performed more than five posterior component separations in the last year.
    Conclusions: A workshop of abdominal wall surgery that combines live surgery, theoretical content and a cadaver lab can be a very useful tool to expand the use of new surgical techniques.
    MeSH term(s) Abdominal Muscles/surgery ; Abdominal Wall/anatomy & histology ; Abdominal Wall/surgery ; Abdominoplasty/education ; Abdominoplasty/methods ; Cadaver ; Dissection/education ; Dissection/methods ; Education ; Europe ; Health Care Surveys ; Humans ; Internet ; Program Evaluation ; Reconstructive Surgical Procedures/education ; Reconstructive Surgical Procedures/methods
    Language English
    Publishing date 2019-09-06
    Publishing country France
    Document type Journal Article
    ZDB-ID 1388125-5
    ISSN 1248-9204 ; 1265-4906
    ISSN (online) 1248-9204
    ISSN 1265-4906
    DOI 10.1007/s10029-019-02041-4
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  10. Article ; Online: Failure of talc seromadesis for the treatment of subcutaneous chronic seromas after incisional hernia surgery.

    Lopez-Monclus, J / Artes, M / Gonzalez, J / Blazquez, L A / Lucena, J L / Robin, A / Munoz, J M / San-Miguel, C / Garcia-Urena, M A

    Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society

    2019  Volume 110, Issue 1, Page(s) 105–109

    Abstract: Background and aim: Talc poudrage has been used since many years for sclerosing chronic pleural effusion. Several reports have shown good results managing chronic seromas after breast, vascular, and incisional hernia surgeries. The purpose of this study ...

    Abstract Background and aim: Talc poudrage has been used since many years for sclerosing chronic pleural effusion. Several reports have shown good results managing chronic seromas after breast, vascular, and incisional hernia surgeries. The purpose of this study is to determine the utility of talc seromadesis for the management of chronic seromas after incisional hernia surgery.
    Materials and methods: Multicentric prospective observational study including patients diagnosed of chronic seromas after incisional hernia surgery. Under local anesthesia and ultrasonographic control, two percutaneous trocars were placed in the seroma, washing the seroma cavity with 0.9% saline solution and aspirating the remaining liquid. A sample of 4 g of talcum powder was introduced in the seroma cavity, and a 15-F drain was left in place. Patients were followed each week during at least 4 weeks after drainage removal.
    Results: Between January 2013 and December 2016, a total of six patients were enrolled in the study. Talc poudrage was performed without any complications. Drains were pulled out in a mean time of 3 (range: 2-4) weeks. One case of the chronic seromas was efficiently sclerosed with talc without recurrence in time. In three cases, the seroma recurred, and the final solution was surgical decortication of the seroma. In the other two cases, seroma also recurred and were managed with instillation of ethanol and iodine povidone.
    Conclusion: In our experience, the management of chronic seromas after incisional hernia repair with talc seromadesis is ineffective and is associated with a high rate of seroma recurrence.
    MeSH term(s) Aged ; Drainage ; Female ; Humans ; Incisional Hernia/surgery ; Male ; Middle Aged ; Postoperative Complications/drug therapy ; Prospective Studies ; Seroma/drug therapy ; Talc/administration & dosage ; Treatment Failure
    Chemical Substances Talc (14807-96-6)
    Language English
    Publishing date 2019-12-13
    Publishing country England
    Document type Journal Article ; Multicenter Study ; Observational Study
    ZDB-ID 2077691-3
    ISSN 1799-7267 ; 1457-4969
    ISSN (online) 1799-7267
    ISSN 1457-4969
    DOI 10.1177/1457496919891593
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