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Managing Complications of Open Hernia Repair

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Hernia Surgery

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Abstract

Despite advances in technical aspects of herniorraphy and in the medical optimization and management of comorbidities, complications following open hernia repair remain a persistent source of morbidity for the patient undergoing hernia repair. This chapter reviews the spectrum and management of complications following open hernia repair. In particular, we focus on surgical site occurrence, renal, pulmonary, mesh-related, and iatrogenic complications as these are more common occurrences in open hernia repair (especially those conducted with component separation methodologies). After reading this chapter, the reader should have a better understanding of the spectrum and breadth of open hernia repair complications and will be able to describe management options for each of these complications.

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References

  1. Henriksen NA, et al. Risk factors for incisional hernia repair after aortic reconstructive surgery in a nationwide study. J Vasc Surg. 2013;57(6):1524–30. 1530 e1–3.

    Article  PubMed  Google Scholar 

  2. Hoer J, et al. Factors influencing the development of incisional hernia. A retrospective study of 2,983 laparotomy patients over a period of 10 years. Chirurg. 2002;73(5):474–80.

    Article  CAS  PubMed  Google Scholar 

  3. Martindale RG, Deveney CW. Preoperative risk reduction: strategies to optimize outcomes. Surg Clin North Am. 2013;93(5):1041–55.

    Article  PubMed  Google Scholar 

  4. Sorensen LT, et al. Smoking is a risk factor for incisional hernia. Arch Surg. 2005;140(2):119–23.

    Article  PubMed  Google Scholar 

  5. Yahchouchy-Chouillard E, et al. Incisional hernias. I. Related risk factors. Dig Surg. 2003;20(1):3–9.

    Article  PubMed  Google Scholar 

  6. Ross SW, et al. Components separation in complex ventral hernia repair: surgical technique and post-operative outcomes. Surg Technol Int. 2014;24:167–77.

    PubMed  Google Scholar 

  7. S., F. Abdominal wall defects: the magnitude of the problem. In: Abdominal wall reconstruction 2011 consortium. 2011. Washington, DC.

    Google Scholar 

  8. Jin J, Rosen MJ. Laparoscopic versus open ventral hernia repair. Surg Clin North Am. 2008;88(5):1083–100. viii.

    Article  PubMed  Google Scholar 

  9. Berger RL, et al. Development and validation of a risk-stratification score for surgical site occurrence and surgical site infection after open ventral hernia repair. J Am Coll Surg. 2013;217(6):974–82.

    Article  PubMed  Google Scholar 

  10. Kanters AE, et al. Modified hernia grading scale to stratify surgical site occurrence after open ventral hernia repairs. J Am Coll Surg. 2012;215(6):787–93.

    Article  PubMed  Google Scholar 

  11. Ventral Hernia Working Group, Breuing K, Butler CE, Ferzoco S, Franz M, Hultman CS, Kilbridge JF, Rosen M, Silverman RP, Vargo D. Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery. 2010;148(3):544–58.

    Article  Google Scholar 

  12. Iqbal CW, et al. Long-term outcome of 254 complex incisional hernia repairs using the modified Rives-Stoppa technique. World J Surg. 2007;31(12):2398–404.

    Article  PubMed  Google Scholar 

  13. Dunne JR, et al. Abdominal wall hernias: risk factors for infection and resource utilization. J Surg Res. 2003;111(1):78–84.

    Article  PubMed  Google Scholar 

  14. Mangram AJ, et al. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1999;20(4):250–78. quiz 279–80.

    Article  CAS  PubMed  Google Scholar 

  15. Nguyen MT, et al. Readmission following open ventral hernia repair: incidence, indications, and predictors. Am J Surg. 2013;206(6):942–8. discussion 948–9.

    Article  PubMed  Google Scholar 

  16. Liang MK, et al. Outcomes of laparoscopic vs open repair of primary ventral hernias. JAMA Surg. 2013;148(11):1043–8.

    Article  PubMed  Google Scholar 

  17. Jensen KK, Henriksen NA, Jorgensen LN. Endoscopic component separation for ventral hernia causes fewer wound complications compared to open components separation: a systematic review and meta-analysis. Surg Endosc. 2014;28(11):3046–52.

    Article  PubMed  Google Scholar 

  18. Arita NA, et al. Laparoscopic repair reduces incidence of surgical site infections for all ventral hernias. Surg Endosc. 2014;29(7):1769–80.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Albino FP, et al. Does mesh location matter in abdominal wall reconstruction? A systematic review of the literature and a summary of recommendations. Plast Reconstr Surg. 2013;132(5):1295–304.

    Article  CAS  PubMed  Google Scholar 

  20. Novitsky YW, et al. Transversus abdominis muscle release: a novel approach to posterior component separation during complex abdominal wall reconstruction. Am J Surg. 2012;204(5):709–16.

    Article  PubMed  Google Scholar 

  21. Basta MN, Fischer JP, Kovach SJ. Assessing complications and cost-utilization in ventral hernia repair utilizing biologic mesh in a bridged underlay technique. Am J Surg. 2014;209(4):695–702.

    Article  PubMed  Google Scholar 

  22. Paajanen H, Hermunen H. Long-term pain and recurrence after repair of ventral incisional hernias by open mesh: clinical and MRI study. Langenbecks Arch Surg. 2004;389(5):366–70.

    Article  PubMed  Google Scholar 

  23. Horan TC, et al. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606–8.

    Article  CAS  PubMed  Google Scholar 

  24. Hicks CW, et al. History of methicillin-resistant Staphylococcus aureus (MRSA) surgical site infection may not be a contraindication to ventral hernia repair with synthetic mesh: a preliminary report. Hernia. 2014;18(1):65–70.

    Article  CAS  PubMed  Google Scholar 

  25. Blatnik JA, et al. Does a history of wound infection predict postoperative surgical site infection after ventral hernia repair? Am J Surg. 2012;203(3):370–4. discussion 374.

    Article  PubMed  Google Scholar 

  26. Watt-Boolsen S, et al. Postmastectomy seroma. A study of the nature and origin of seroma after mastectomy. Dan Med Bull. 1989;36(5):487–9.

    CAS  PubMed  Google Scholar 

  27. Agrawal A, Ayantunde AA, Cheung KL. Concepts of seroma formation and prevention in breast cancer surgery. ANZ J Surg. 2006;76(12):1088–95.

    Article  PubMed  Google Scholar 

  28. Petersen S, et al. Ventral rectus fascia closure on top of mesh hernia repair in the sublay technique. Plast Reconstr Surg. 2004;114(7):1754–60.

    Article  PubMed  Google Scholar 

  29. Harth KC, Rosen MJ. Endoscopic versus open component separation in complex abdominal wall reconstruction. Am J Surg. 2010;199(3):342–6. discussion 346–7.

    Article  PubMed  Google Scholar 

  30. Albright E, et al. The component separation technique for hernia repair: a comparison of open and endoscopic techniques. Am Surg. 2011;77(7):839–43.

    PubMed  Google Scholar 

  31. Giurgius M, et al. The endoscopic component separation technique for hernia repair results in reduced morbidity compared to the open component separation technique. Hernia. 2012;16(1):47–51.

    Article  CAS  PubMed  Google Scholar 

  32. Fox M, et al. Laparoscopic component separation reduces postoperative wound complications but does not alter recurrence rates in complex hernia repairs. Am J Surg. 2013;206(6):869–74. discussion 874–5.

    Article  PubMed  Google Scholar 

  33. Satterwhite TS, et al. Outcomes of complex abdominal herniorrhaphy: experience with 106 cases. Ann Plast Surg. 2012;68(4):382–8.

    Article  CAS  PubMed  Google Scholar 

  34. Rosen MJ, et al. Evaluation of surgical outcomes of retro-rectus versus intraperitoneal reinforcement with bio-prosthetic mesh in the repair of contaminated ventral hernias. Hernia. 2013;17(1):31–5.

    Article  CAS  PubMed  Google Scholar 

  35. McLanahan D, et al. Retrorectus prosthetic mesh repair of midline abdominal hernia. Am J Surg. 1997;173(5):445–9.

    Article  CAS  PubMed  Google Scholar 

  36. Gurusamy KS, Allen VB. Wound drains after incisional hernia repair. Cochrane Database Syst Rev. 2013;12:CD005570.

    Google Scholar 

  37. Bercial ME, et al. Suction drains, quilting sutures, and fibrin sealant in the prevention of seroma formation in abdominoplasty: which is the best strategy? Aesthetic Plast Surg. 2012;36(2):370–3.

    Article  PubMed  Google Scholar 

  38. Kohler G, et al. Prevention of subcutaneous seroma formation in open ventral hernia repair using a new low-thrombin fibrin sealant. World J Surg. 2014;38(11):2797–803.

    Article  PubMed  Google Scholar 

  39. Falagas ME, Kasiakou SK. Mesh-related infections after hernia repair surgery. Clin Microbiol Infect. 2005;11(1):3–8.

    Article  CAS  PubMed  Google Scholar 

  40. Kaufman Z, Engelberg M, Zager M. Fecal fistula: a late complication of Marlex mesh repair. Dis Colon Rectum. 1981;24(7):543–4.

    Article  CAS  PubMed  Google Scholar 

  41. Kunishige T, et al. A defect of the abdominal wall with intestinal fistulas after the repair of incisional hernia using Composix Kugel Patch. Int J Surg Case Rep. 2013;4(9):793–7.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Krpata DM, et al. Outcomes of simultaneous large complex abdominal wall reconstruction and enterocutaneous fistula takedown. Am J Surg. 2013;205(3):354–8. discussion 358-9.

    Article  PubMed  Google Scholar 

  43. Carbonell AM, et al. Outcomes of synthetic mesh in contaminated ventral hernia repairs. J Am Coll Surg. 2013;217(6):991–8.

    Article  PubMed  Google Scholar 

  44. Blatnik JA, et al. Predicting severe postoperative respiratory complications following abdominal wall reconstruction. Plast Reconstr Surg. 2012;130(4):836–41.

    Article  CAS  PubMed  Google Scholar 

  45. Fischer JP, et al. Validated model for predicting postoperative respiratory failure: analysis of 1706 abdominal wall reconstructions. Plast Reconstr Surg. 2013;132(5):826e–35.

    Article  CAS  PubMed  Google Scholar 

  46. Ma Q, Xue FS, Li RP. Analysis of risk factors, morbidity, and cost associated with respiratory complications following abdominal wall reconstruction. Plast Reconstr Surg. 2015;135(2):459e–60.

    Article  CAS  PubMed  Google Scholar 

  47. Fischer JP, et al. Analysis of risk factors, morbidity, and cost associated with respiratory complications following abdominal wall reconstruction. Plast Reconstr Surg. 2014;133(1):147–56.

    Article  CAS  PubMed  Google Scholar 

  48. Levey AS, et al. Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int. 2005;67(6):2089–100.

    Article  PubMed  Google Scholar 

  49. Yussim A, Yampolski I, Greif F, Mor E. Acute kidney injury after complex incisional hernia in transplant recipients. Transplant Proc. 2012;94(10S):1024.

    Article  Google Scholar 

  50. Kirkpatrick AW, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med. 2013;39(7):1190–206.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Cheatham ML, et al. Results from the International Conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. II. Recommendations. Intensive Care Med. 2007;33(6):951–62.

    Article  PubMed  Google Scholar 

  52. Malbrain ML, et al. Results from the International Conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. I. Definitions. Intensive Care Med. 2006;32(11):1722–32.

    Article  PubMed  Google Scholar 

  53. Malbrain ML, et al. Incidence and prognosis of intraabdominal hypertension in a mixed population of critically ill patients: a multiple-center epidemiological study. Crit Care Med. 2005;33(2):315–22.

    Article  PubMed  Google Scholar 

  54. Petro C, Raigani S, Orenstein S, Klick J, Rowbottom J, Novitsky Y, Rosen M. Permissive abdominal hypertension following open incisional hernia repair: a novel concept. Hernia. 2014;18 Suppl 1:S78.

    Google Scholar 

  55. Cobb WS, et al. Incisional herniorrhaphy with intraperitoneal composite mesh: a report of 95 cases. Am Surg. 2003;69(9):784–7.

    PubMed  Google Scholar 

  56. Petersen S, et al. Deep prosthesis infection in incisional hernia repair: predictive factors and clinical outcome. Eur J Surg. 2001;167(6):453–7.

    Article  CAS  PubMed  Google Scholar 

  57. Heniford BT, et al. Laparoscopic repair of ventral hernias: nine years’ experience with 850 consecutive hernias. Ann Surg. 2003;238(3):391–9. discussion 399–400.

    PubMed  PubMed Central  Google Scholar 

  58. Bellon JM, et al. Macrophage response to experimental implantation of polypropylene prostheses. Eur Surg Res. 1994;26(1):46–53.

    CAS  PubMed  Google Scholar 

  59. Amid PK. Classification of biomaterials and their related complications in abdominal wall hernia surgery. Hernia. 1997;1:15–21.

    Article  Google Scholar 

  60. Cobb WS, Kercher KW, Heniford BT. The argument for lightweight polypropylene mesh in hernia repair. Surg Innov. 2005;12(1):63–9.

    Article  PubMed  Google Scholar 

  61. Cobb WS, et al. Textile analysis of heavy weight, mid-weight, and light weight polypropylene mesh in a porcine ventral hernia model. J Surg Res. 2006;136(1):1–7.

    Article  CAS  PubMed  Google Scholar 

  62. Schmidbauer S, et al. Heavy-weight versus low-weight polypropylene meshes for open sublay mesh repair of incisional hernia. Eur J Med Res. 2005;10(6):247–53.

    CAS  PubMed  Google Scholar 

  63. Orenstein SB, et al. Comparative analysis of histopathologic effects of synthetic meshes based on material, weight, and pore size in mice. J Surg Res. 2012;176(2):423–9.

    Article  PubMed  Google Scholar 

  64. Blatnik JA, et al. In vivo analysis of the morphologic characteristics of synthetic mesh to resist MRSA adherence. J Gastrointest Surg. 2012;16(11):2139–44.

    Article  PubMed  Google Scholar 

  65. Sanders D, et al. An in vitro study assessing the effect of mesh morphology and suture fixation on bacterial adherence. Hernia. 2013;17(6):779–89.

    Article  CAS  PubMed  Google Scholar 

  66. Asarias JR, et al. Influence of mesh materials on the expression of mediators involved in wound healing. J Invest Surg. 2011;24(2):87–98.

    Article  PubMed  Google Scholar 

  67. Nguyen PT, Asarias JR, Pierce LM. Influence of a new monofilament polyester mesh on inflammation and matrix remodeling. J Invest Surg. 2012;25(5):330–9.

    Article  PubMed  Google Scholar 

  68. Mavros MN, et al. Risk factors for mesh-related infections after hernia repair surgery: a meta-analysis of cohort studies. World J Surg. 2011;35(11):2389–98.

    Article  PubMed  Google Scholar 

  69. Balen EM, et al. Repair of ventral hernias with expanded polytetrafluoroethylene patch. Br J Surg. 1998;85(10):1415–8.

    Article  CAS  PubMed  Google Scholar 

  70. Leber GE, et al. Long-term complications associated with prosthetic repair of incisional hernias. Arch Surg. 1998;133(4):378–82.

    Article  CAS  PubMed  Google Scholar 

  71. Vrijland WW, et al. Intraperitoneal polypropylene mesh repair of incisional hernia is not associated with enterocutaneous fistula. Br J Surg. 2000;87(3):348–52.

    Article  CAS  PubMed  Google Scholar 

  72. Zuvela M, et al. Central rupture and bulging of low-weight polypropylene mesh following recurrent incisional sublay hernioplasty. Hernia. 2014;18(1):135–40.

    Article  CAS  PubMed  Google Scholar 

  73. Petro CC, Nahabet EH, Criss CN, Orenstein SB, von Recum HA, Novitsky YW, Rosen MJ. Central failures of lightweight monofilament polyester mesh causing hernia recurrence: a cautionary note. Hernia. 2015;19(1):155–9.

    Article  CAS  PubMed  Google Scholar 

  74. Samama CM, et al. Venous thromboembolism prevention in surgery and obstetrics: clinical practice guidelines. Eur J Anaesthesiol. 2006;23(2):95–116.

    Article  CAS  PubMed  Google Scholar 

  75. Huber O, et al. Postoperative pulmonary embolism after hospital discharge. An underestimated risk. Arch Surg. 1992;127(3):310–3.

    Article  CAS  PubMed  Google Scholar 

  76. Westling A, et al. Incidence of deep venous thrombosis in patients undergoing obesity surgery. World J Surg. 2002;26(4):470–3.

    Article  PubMed  Google Scholar 

  77. Pauli EM, Wang J, Petro CC, Juza RM, Novitsky YW, Rosen MJ. Posterior component separation with transversus abdominis release successfully addresses recurrent ventral hernias following anterior component separation. Hernia. 2015;19(2):285–91.

    Article  CAS  PubMed  Google Scholar 

  78. Krpata DM, et al. Posterior and open anterior components separations: a comparative analysis. Am J Surg. 2012;203(3):318–22. discussion 322.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, USA

    Eric M. Pauli M.D.

  2. Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA

    Ryan M. Juza M.D.

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  1. Eric M. Pauli M.D.
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  2. Ryan M. Juza M.D.
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Correspondence to Eric M. Pauli M.D. .

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Editors and Affiliations

  1. Case Comprehensive Hernia Center, University Hospitals Case Medical Center, Cleveland, Ohio, USA

    Yuri W. Novitsky

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Pauli, E.M., Juza, R.M. (2016). Managing Complications of Open Hernia Repair. In: Novitsky, Y. (eds) Hernia Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-27470-6_20

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  • DOI: https://doi.org/10.1007/978-3-319-27470-6_20

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