| 1. |
- Clay, Leonard, et al.
(författare)
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Full-thickness skin graft vs. synthetic mesh in the repair of giant incisional hernia : a randomized controlled multicenter study
- 2018
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Ingår i: Hernia. - : Springer. - 1265-4906 .- 1248-9204. ; :2, s. 325-332
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Repair of large incisional hernias includes the implantation of a synthetic mesh, but this may lead to pain, stiffness, infection and enterocutaneous fistulae. Autologous full-thickness skin graft as on-lay reinforcement has been tested in eight high-risk patients in a proof-of-concept study, with satisfactory results. In this multicenter randomized study, the use of skin graft was compared to synthetic mesh in giant ventral hernia repair.METHODS: Non-smoking patients with a ventral hernia > 10 cm wide were randomized to repair using an on-lay autologous full-thickness skin graft or a synthetic mesh. The primary endpoint was surgical site complications during the first 3 months. A secondary endpoint was patient comfort. Fifty-three patients were included. Clinical evaluation was performed at a 3-month follow-up appointment.RESULTS: There were fewer patients in the skin graft group reporting discomfort: 3 (13%) vs. 12 (43%) (p = 0.016). Skin graft patients had less pain and a better general improvement. No difference was seen regarding seroma; 13 (54%) vs. 13 (46%), or subcutaneous wound infection; 5 (20%) vs. 7 (25%). One recurrence appeared in each group. Three patients in the skin graft group and two in the synthetic mesh group were admitted to the intensive care unit.CONCLUSION: No difference was seen for the primary endpoint short-term surgical complication. Full-thickness skin graft appears to be a reliable material for ventral hernia repair producing no more complications than when using synthetic mesh. Patients repaired with a skin graft have less subjective abdominal wall symptoms.
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| 2. |
- Clay, Leonard
(författare)
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The evaluation, preoperative and operative aspects of abdominal wall reconstruction for giant ventral hernia
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- BACKGROUND: The optimal method for surgical repair of giant ventral hernia remains to be determined. Different concepts for reinforcement have been used, which have decreased the risk for recurrence. However, the use of foreign material has shown potential adverse effects such as pain, enterocutaneus fistula and decreased comfort of the corset caused by stiffness and pain. In an attempt to explore ways to decrease surgical complications in giant ventral hernia repair, a randomized study comparing synthetic material with autologous full thickness skin transplantation was planned and executed. In order to conduct such a study and detect any differences, it was first necessary to develop instruments for the evaluation of patient related outcome measurements. This included assessment of pain which is known to be an outcome in inguinal hernia surgery. Also, the effect on abdominal strength after medialization of the rectus muscles is something that has been previously discussed but not explored in randomized studies. Similarly, the effectiveness of using a post- operative elastic girdle in connection with abdominal surgery and abdominal wall reconstruction has not been previously studied in detail. Giant ventral hernia affect the integrity of the abdominal wall. Abdominal rectus diastasis (ARD) elicit a similar affect on abdominal wall integrity. This being the case, the effectiveness of ARD repair could shed some light on the repair of giant ventral hernia. METHODS: A questionnaire was tailored to evaluate hernia related pain and its interference with the daily activities of a patient’s life. This questionnaire was validated compared to the existing BPI questionnaire assessing general pain. For validation purposes, focus groups with patients operated for ventral hernia were utilized. Test retest reliability was assessed by distributing the VHPQ and BPI to patients who had previously undergone ventral hernia repair. In total, 225 patients were involved in this study. To be able to evaluate the effect of surgical reconstruction of ARD where the abdominal muscles are brought together, 57 patients underwent evaluation with the VHPQ and their results were compared with abdominal wall strength measured with the Biodex pre- and postoperatively. A randomized trial evaluating the effect of wearing an elastic abdominal girdle was conducted with 48 patients after midline laparotomy. Postoperative cough-PEF, spirometry, pain and wound healing were evaluated. Ultimately, as planned, the randomized study of abdominal wall reconstruction in patients with giant ventral hernia was designed and initiated, including 52 patients. Randomization was performed to create parallel groups for reconstruction using synthetic mesh or autologous full-thickness skin transplant. The primary outcome was surgical complications after 3 months. Post-operative evaluation was performed by a surgical specialist not otherwise involved in the study and blinded to the reconstruction method used. RESULTS: The VHPQ showed good validity and reliability when compared to the BPI and evaluation of test-retest stability. A relationship between preoperative ratings on VHPQ questions regarding performing sports and sitting for more than 30 minutes and the effect of surgical repair in terms of improved muscle strength was revealed for patients with ARD. The use of a post-operative elastic abdominal girdle following laparotomy did not impair respiratory function but seemed to decrease post-operative pain. Abdominal wall reconstruction using full-thickness skin grafts instead of synthetic mesh for abdominal wall reinforcement showed a similar complication profile at 3 month follow-up. Patients reconstructed with full-thickness skin grafts experienced less post- operative pain at 3-month follow-up. DISCUSSION: This thesis evaluated the effect of autologous full thickness skin grafts as onlay reinforcement in the surgical repair of giant ventral hernia. Our hypothesis that the use of skin grafts would give less surgical complications was not confirmed but patients with full thickness skin grafts suffered less abdominal wall discomfort compared to those reconstructed using synthetic mesh. In the future, these patients will also be evaluated for recurrence, abdominal muscle force and adverse events at 12 and 36 months after surgery. As a precursor to embarking upon a study to evaluate abdominal wall reconstruction, a useful tool for evaluation of pain in the abdominal wall after ventral hernia surgery was generated. This instrument makes it possible to compare different surgical techniques with regard to patient experience. It may also provide a possible tool for the selection of patients with ARD who might benefit most from surgical repair. The use of an individually fitted girdle does not hinder respiratory function or wound healing. Nor does it provide a supportive effect for cough-PEF. One positive effect from wearing a girdle postoperatively is that it seems to reduce postoperative pain.
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| 3. |
- Clay, Leonard, et al.
(författare)
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Validation of a questionnaire for the assessment of pain following ventral hernia repair-the VHPQ
- 2012
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Ingår i: Langenbeck's archives of surgery (Print). - : Springer. - 1435-2443 .- 1435-2451. ; 397:8, s. 1219-1224
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to create and evaluate the validity and reliability of a novel ventral hernia pain questionnaire (VHPQ) to assess pain following surgery for ventral hernia. The questionnaire was constructed using focus groups and patient interviews. Validity was tested on 51 patients who responded to the VHPQ and brief pain inventory (BPI) 1 and 4 weeks following surgery. Reliability and internal consistency was tested on 74 patients who had surgery 3 years earlier and received the VHPQ and BPI on two separate occasions. Pain not related to surgery was examined on one occasion using the VHPQ on 100 non-operated people. For pain intensity items, a significant decrease was seen from week 1 to week 4 postoperative (p < 0.05). Spearman rank correlations were significant between the pain intensity items of the VHPQ and the BPI, tested 1 week postoperative (p < 0.05). Kappa levels for test-retest of items for interference with daily activities were higher than 0.5 for all items except one. Intra-class correlation was significant for pain intensity items (p < 0.05) in the test-retest group. Three years after surgery, the operated group stated more pain in the pain intensity items (p < 0.05) and more interference with daily activities (p < 0.05) than a non-operated group from the general population. The validity and reliability of the VHPQ make it a useful tool in assessing postoperative pain and patient satisfaction.
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| 4. |
- Holmdahl, Viktor, et al.
(författare)
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Long-term follow-up of full-thickness skin grafting in giant incisional hernia repair : a randomised controlled trial
- 2022
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Ingår i: Hernia. - : Springer. - 1265-4906 .- 1248-9204. ; 26, s. 473-479
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Conventional repair of a giant incisional hernia often requires implantation of a synthetic mesh (SM). However, this surgical procedure can lead to discomfort, pain, and potentially serious complications. Full-thickness skin grafting (FTSG) could offer an alternative to SM, less prone to complications related to implantation of a foreign body in the abdominal wall. The aim of this study was to compare the use of FTSG to conventional SM in the repair of giant incisional hernia.Methods: Patients with a giant incisional hernia (> 10 cm width) were randomised to repair with either FTSG or SM. 3-month and 1-year follow-ups have already been reported. A clinical follow-up was performed 3 years after repair, assessing potential complications and recurrence. SF-36, EQ-5D and VHPQ questionnaires were answered at 3 years and an average of 9 years (long-term follow-up) after surgery to assess the impact of the intervention on quality-of-life (QoL).Results: Fifty-two patients were included. Five recurrences in the FTSG group and three in the SM group were noted at the clinical follow-up 3 years after surgery, but the difference was not significant (p = 0.313). No new procedure-related complication had occurred since the one-year follow-up. There were no relevant differences in QoL between the groups. However, there were significant improvemnts in both physical, emotional, and mental domains of the SF-36 questionnaire in both groups.Conclusion: The results of this long-term follow-up together with the results from previous follow-ups indicate that autologous FTSG as reinforcement in giant incisional hernia repair is an alternative to conventional repair with SM.
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| 5. |
- Holmdahl, Viktor, et al.
(författare)
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One-year outcome after repair of giant incisional hernia using synthetic mesh or full-thickness skin graft : a randomised controlled trial
- 2019
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Ingår i: Hernia. - : Springer. - 1265-4906 .- 1248-9204. ; 23:2, s. 355-361
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Repair of giant incisional hernia often requires complex surgery and the results of conventional methods using synthetic mesh as reinforcement are unsatisfactory, with high recurrence and complication rates. Our hypothesis was that full-thickness skin graft (FTSG) provides an alternative reinforcement material for giant incisional hernia repair and that outcome is improved. The aim of this study was to compare FTSG with conventional materials currently used as reinforcement in the repair of giant incisional hernia.METHODS: A prospective randomised controlled trial was conducted, comparing FTSG with synthetic mesh as reinforcement in the repair of giant (> 10 cm minimum width) incisional hernia. One-year follow-up included a blinded clinical examination by a surgeon and objective measurements of abdominal muscle strength using the Biodex-4 system.RESULTS: 52 patients were enrolled in the study: 24 received FTSG and 28 synthetic mesh. Four recurrences (7.7%) were found at 1-year follow-up, two in each group. There were no significant differences regarding pain, patient satisfaction or aesthetic outcome between the groups. Strength in the abdominal wall was not generally improved in the study population and there was no significant difference between the groups.CONCLUSION: The outcome of repair of giant incisional hernia using FTSG as reinforcement is comparable with repair using synthetic mesh. This suggests that FTSG may have a future place in giant incisional hernia repair.
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| 6. |
- Strigård, Karin, et al.
(författare)
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Predictive Factors in the Outcome of Surgical Repair of Abdominal Rectus Diastasis
- 2016
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Ingår i: Plastic and Reconstructive Surgery - Global Open. - 2169-7574. ; 4:5
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The aim of this study was to define the indicators predicting improved abdominal wall function after surgical repair of abdominal rectus diastasis (ARD). Preoperative subjective assessment quantified by the validated Ventral Hernia Pain Questionnaire (VHPQ) was related to relative postoperative functional improvement in abdominal muscle strength.METHODS: Fifty-seven patients undergoing surgery for ARD completed the VHPQ before surgery. Preoperative pain assessment results were compared with the relative improvement in muscle strength measured with the BioDex system 4.RESULTS: There was a correlation between the relative improvement in muscle strength measured by the BioDex System 4 for flexion at 30 degrees (P = 0.046) and 60 degrees per second (P = 0.004) and the preoperative question, "Do you find it painful to sit for more than 30 minutes?" There was also a correlation between BioDex improvement for flexion at 30 degrees (P = 0.022) and for isometric work load (P = 0.038) and the preoperative question, "Has abdominal pain limited your ability to perform sports activities?" The VHPQ responses also formed a pattern with a fairly good correlation between other BioDex modalities (with the exception of extension at 60 degrees per second) and the response to the question regarding complaints when performing sports. Postoperative visual analog scale ratings of abdominal wall stability correlated to the questions regarding complaints when sitting (P = 0.040) and standing (P = 0.047). No other correlation was seen.CONCLUSION: VHPQ ratings concerning pain while being seated for more than 30 minutes and pain limiting the ability to perform sports are promising indicators in the identification of patients likely to benefit from surgical correction of their ARD.
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