The impact of a closing protocol on wound morbidity in abdominal wall reconstruction with mesh.

Introduction: Wound complications (WC) after abdominal wall reconstruction (AWR) are associated with increased cost, recurrence, and mesh infection. Operative closing protocols (CP) have been studied in other surgical disciplines but not in AWR. Our aim was to study the effect of a CP on WC after AWR.

Does defect size matter in abdominal wall reconstruction with successful fascial closure?

Background: Conflicting literature suggests that larger defects in abdominal wall reconstruction both increase the risk of recurrence and have no impact on recurrence. In our prior work, hernias with defect areas ≥100 cm were associated with increased discomfort, operative time, and length of stay but not recurrence or reoperation. Our goal was to determine if defect size, even in giant hernias, would impact recurrence after mesh repair with complete fascial closure.

Open versus laparoscopic versus robotic inguinal hernia repair: A propensity-matched outcome analysis.

Background: Inguinal hernia repair is one of the most common surgical procedures in the world. Each repair technique, open, laparoscopic, and robotic, has its advantages and advocates. Prior studies have compared 2 techniques, but there are little data comparing all 3 approaches with long-term follow-up.

Implementation of a penicillin allergy protocol in open abdominal wall reconstruction: Preoperative optimization program.

Introduction: Beta-lactam prophylaxis is the first-line preoperative antibiotic in open abdominal wall reconstruction. However, of the 11% patients reporting a penicillin allergy (PA), most receive second-line, non-β-lactam prophylaxis. Previously, abdominal wall reconstruction research from our institution demonstrated increased wound complications, readmissions, and reoperations with non-β-lactam prophylaxis.

Outcomes of synthetic and biologic mesh in abdominal wall reconstruction: A propensity-matched analysis in Centers for Disease Control and Prevention class 1 and 2 wounds.

Introduction: The choice of biologic compared with synthetic mesh in abdominal wall reconstruction remains controversial, especially in Centers for Disease Control and Prevention class 1 and 2 wounds. This study evaluated wound complications and hernia recurrence with a 2:1 propensity-matched sample and extended follow-up.

Methods And Procedures: A prospectively maintained abdominal wall reconstruction database was queried for patients undergoing open abdominal wall reconstruction using biologic or synthetic mesh in Centers for Disease Control and Prevention class 1 and 2 wounds.

Comparison of Medical Research Abstracts Written by Surgical Trainees and Senior Surgeons or Generated by Large Language Models.

Importance: Artificial intelligence (AI) has permeated academia, especially OpenAI Chat Generative Pretrained Transformer (ChatGPT), a large language model. However, little has been reported on its use in medical research.

Objective: To assess a chatbot's capability to generate and grade medical research abstracts.

The benefits of preoperative smoking cessation on abdominal wall reconstruction outcomes: An examination of abstinent versus never smokers.

Introduction: Active smoking is related to wound and respiratory complications following abdominal wall reconstruction (AWR), but no AWR studies directly compare outcomes of abstinent-smokers (AS), fulfilling four-weeks of smoking cessation, to non-smokers (NS).

Methods: Prospectively maintained institutional database was queried for all AWR between 2012 and 2019. AS and NS were included.

Open repair of flank and lumbar hernias: 142 consecutive repairs at a high-volume hernia center.

Background: Flank and lumbar hernias (FLH) are challenging to repair. This study aimed to establish a reproducible management strategy and analyze elective flank and lumbar repair (FLHR) outcomes from a single institution.

Methods: A prospective analysis using a hernia-specific database was performed examining patients undergoing open FLHR between 2004 and 2021.

The Utilization of Laparoscopic Ventral Hernia Repair (LVHR) in Incarcerated and Strangulated Cases: A National Trend in Outcomes.

Introduction: Early after its adoption, minimally invasive surgery had limited usefulness in emergent cases. However, with improvements in equipment, techniques, and skills, laparoscopy in complex and emergency operations expanded substantially. This study aimed to examine the trend of laparoscopy in incarcerated or strangulated ventral hernia repair (VHR) over time.

Disparate potential for readmission prevention exists among inpatient and outpatient procedures in a minimally invasive surgery practice.

Background: Administrators have focused on decreasing postoperative readmissions for cost reduction without fully understanding their preventability. This study describes the development and implementation of a surgeon-led readmission review process that assessed preventability.

Methods: A gastrointestinal surgical group at a tertiary referral hospital developed and implemented a template to analyze inpatient and outpatient readmissions.

Open preperitoneal ventral hernia repair: Prospective observational study of quality improvement outcomes over 18 years and 1,842 patients.

Background: This study aimed to describe progressive evidence-based changes in perioperative management of open preperitoneal ventral hernia repair and subsequent surgical outcomes and to analyze factors that affect recurrence and wound complications.

Methods: Prospective, tertiary hernia center data (2004-2021) were examined for patients undergoing midline open preperitoneal ventral hernia repair with mesh. "Early" (2004-2012) and "Recent" (2013-2021) groups were based on surgery date.

Outcomes of biologic versus synthetic mesh in CDC class 3 and 4 open abdominal wall reconstruction.

Introduction: Abdominal wall reconstruction (AWR) in a contaminated field is associated with an increased risk of wound complications, infection, and reoperation. The best method of repair and mesh choice in these operations have generated marked controversy. Our aim was to compare outcomes of patients who underwent AWR with biologic versus synthetic mesh in CDC class 3 and 4 wounds.

Coated Polypropylene Mesh Is Associated With Increased Infection in Abdominal Wall Reconstruction.

Background: Barrier-coated meshes were designed to reduce adhesion formation between mesh and the surrounding viscera. There have been questions raised but little data to determine if rapidly absorbable coatings pose an increased risk of infection. The objective of this study was to determine if a difference exists in wound and mesh infection rates between coated and uncoated polypropylene mesh in patients undergoing open ventral hernia repair.

Factors Predicting Increased Length of Stay in Abdominal Wall Reconstruction.

Background: Enhanced recovery after surgery (ERAS) programs have become increasingly popular in general surgery, yet no guidelines exist for an abdominal wall reconstruction (AWR)-specific program. We aimed to evaluate predictors of increased length of stay (LOS) in the AWR population to aid in creating an AWR-specific ERAS protocol.

Methods: A prospective, single institution hernia center database was queried for all patients undergoing open AWR (1999-2019).

Closed-Incision Negative Pressure Therapy Decreases Wound Morbidity in Open Abdominal Wall Reconstruction With Concomitant Panniculectomy.

Introduction: Patients undergoing abdominal wall reconstruction (AWR) with concomitant panniculectomy (CP) may be at higher risk for wound complications due to the need for large incisions and tissue undermining. The aim of this study was to evaluate whether the use of closed-incision negative pressure therapy (ciNPT) decreases wound complications in AWR patients undergoing CP.

Methods: Beginning in February 2018, all patients at this institution who underwent AWR with CP received ciNPT.

Development and Validation of Image-Based Deep Learning Models to Predict Surgical Complexity and Complications in Abdominal Wall Reconstruction.

Importance: Image-based deep learning models (DLMs) have been used in other disciplines, but this method has yet to be used to predict surgical outcomes.

Objective: To apply image-based deep learning to predict complexity, defined as need for component separation, and pulmonary and wound complications after abdominal wall reconstruction (AWR).

Design, Setting, And Participants: This quality improvement study was performed at an 874-bed hospital and tertiary hernia referral center from September 2019 to January 2020.

Delayed primary closure (DPC) of the skin and subcutaneous tissues following complex, contaminated abdominal wall reconstruction (AWR): a propensity-matched study.

Background: Wound complications following abdominal wall reconstruction (AWR) in a contaminated setting are common and significantly increase the risk of hernia recurrence. The purpose of this study was to examine the effect of short-term negative pressure wound therapy (NPWT) followed by operative delayed primary closure (DPC) of the skin and subcutaneous tissue after AWR in a contaminated setting.

Methods: A prospective institutional hernia database was queried for patients who underwent NPWT-assisted DPC after contaminated AWR between 2008 and 2020.

The Effects of Preoperative Botulinum Toxin A Injection on Abdominal Wall Reconstruction.

Background: Fascial closure significantly reduces postoperative complications and hernia recurrence after abdominal wall reconstruction (AWR), but can be challenging in massive ventral hernias.

Methods: A prospective single-institution cohort study was performed to examine the effects of preoperative injection of botulinum toxin A (BTA) in patients undergoing AWR for midline or flank hernias.

Results: A total of 108 patients underwent BTA injection with average 243 units, mean 32.

Recurrent incisional hernia repairs at a tertiary hernia center: Are outcomes really inferior to initial repairs?

Background: Recurrent ventral hernia repairs are reported to have higher recurrence and complication rates than initial ventral hernia repairs. This is the largest analysis of outcomes for initial versus recurrent open ventral hernia repairs reported in the literature.

Methods: A prospective, institutional database at a tertiary hernia center was queried for patients undergoing open ventral hernia repairs with complete fascial closure and synthetic mesh placement.

Impact of panniculectomy in complex abdominal wall reconstruction: a propensity matched analysis in 624 patients.

Introduction: In complex abdominal wall reconstruction (AWR), the role of concomitant panniculectomy has been debated due to concern for increased wound complications that impact outcomes; however, long-term outcomes and quality of life (QOL) have not been well described. The aim of our study was to evaluate the outcomes and QOL in patients undergoing AWR with panniculectomy utilizing 3D volumetric-based propensity match.

Methods: A prospective database from a tertiary referral hernia center was queried for patients undergoing open AWR.

Laparoscopic Ventral Hernia Repair in the Geriatric Population : An Assessment of Long-Term Outcomes and Quality of Life.

Objectives: Laparoscopic ventral hernia repair (LVHR) has been shown to decrease wound complications and length of stay (LOS) but results in more postoperative discomfort. The benefits of LVHR for the growing geriatric population are unclear. The aim of our study is to evaluate long-term outcomes and quality of life (QOL) after LVHR in the geriatric population.

Impact of perforator sparing on anterior component separation outcomes in open abdominal wall reconstruction.

Introduction: Anterior component separation (ACS) is a well-established, highly functional technique to achieve fascial closure in complex abdominal wall reconstruction (AWR). Unfortunately, ACS is also associated with an increased risk of wound complications. Perforator sparing ACS (PS-ACS) has more recently been introduced to maintain the subcutaneous perforators derived from the deep epigastric vessels.

Are laparoscopic and open ventral hernia repairs truly comparable?: A propensity-matched study in large ventral hernias.

Background: The merits of laparoscopic (LVHR) and open preperitoneal ventral hernia repair (OPPVHR) have been debated for more than 2 decades. Our aim was to determine peri-operative and long-term outcomes in large hernias.

Methods: A prospective, institutional database at a tertiary hernia center was queried for patients undergoing LVHR and OPPVHR.

Outcomes specific to patient sex after open ventral hernia repair.

Background: Male and female hernia patients often have different surgical history, fat distribution, and medical comorbidities. Female surgical patients seemingly experience worse outcomes after open ventral hernia repair. This study evaluates the impact of sex and the distribution of abdominal adiposity on outcomes after open ventral hernia repair.

Mesh fistula after ventral hernia repair: What is the optimal management?

Background: A mesh-related intestinal fistula is an uncommon and challenging complication of ventral hernia repair. Optimal management is unclear owing to lack of prospective or long-term data.

Methods: We reviewed our prospective data for mesh-related intestinal fistulas from 2004 to 2017and compared suture repair versus ventral hernia repair with mesh at the time of mesh-related intestinal fistula takedown.