Staged abdominal wall reconstruction in the setting of complex gastrointestinal reconstruction
Purpose Literature on one- versus two-staged abdominal wall reconstruction (AWR) with complex gastrointestinal reconstruction (GIR) is limited to single-arm case series with a focus on patients who complete all planned stages. Herein, we describe our experience with both one- and two-staged approach...
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| Veröffentlicht in: | Hernia : the journal of hernias and abdominal wall surgery 2024-02, Vol.28 (1), p.97-107 |
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| container_title | Hernia : the journal of hernias and abdominal wall surgery |
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| creator | DeLong, C. G. Crowell, K. T. Liu, A. T. Deutsch, M. J. Scow, J. S. Pauli, E. M. Horne, C. M. |
| description | Purpose
Literature on one- versus two-staged abdominal wall reconstruction (AWR) with complex gastrointestinal reconstruction (GIR) is limited to single-arm case series with a focus on patients who complete all planned stages. Herein, we describe our experience with both one- and two-staged approaches to AWR/GIR, with attention to those who did not complete both intended stages.
Methods
A retrospective review of prospectively collected data was conducted to identify patients who underwent a one- or two-stage approach to GIR/AWR from 2013 to 2020. The one-stage approach included GIR and definitive sublay mesh herniorrhaphy. The two-stage approach included Stage 1 (S1)—GIR and non-definitive herniorrhaphy and Stage 2 (S2)—definitive sublay mesh herniorrhaphy.
Results
Fifty-four patients underwent GIR/AWR: 20 (37.0%) underwent a planned 1-stage operation while 34 (63.0%) underwent S1 of a planned 2-stage approach. Patients assigned to the 2-stage approach were more likely to be smokers, have a history of mesh infection, have an enterocutaneous fistula, and a contaminated wound class (p0.05).
Conclusion
Planned two-stage operations for GIR/AWR may distribute operative complexity and post-operative morbidity into separate surgical interventions. However, many patients may never undergo the intended definitive S2 herniorrhaphy. Future evaluation of 1- versus 2-stage GIR/AWR is needed to clarify indications for each approach. This work must also consider the frequent deviations from intended clinical course demonstrated in this study. |
| doi_str_mv | 10.1007/s10029-023-02856-2 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2859605264</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2931049059</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-38285d9f358908fd855a8fe7ecac23c49a8b6cf0e2ea741e35768fe9ff09b1103</originalsourceid><addsrcrecordid>eNp9kDtPwzAUhS0EoqXwBxiQJRaWgGPHiT0ixEtCYgBWLNe5LqmSuNiOgH-PactzYPBDut859-ggtJ-T45yQ6iSkm8qMUJaO4GVGN9A4p4XIJCXF5o__CO2EMCeEiKIU22jEqrIQQvIxeryLegY11tPadU2vW_yi2xZ7MK4P0Q8mNq7HTY_jE-AAMTb9DDuLjesWLbzimU6Ua_oIIS7lv5W7aMvqNsDe-p2gh4vz-7Or7Ob28vrs9CYzrOIxYyLlr6VlXEgibC0418JCBUYbykwhtZiWxhKgoKsiB8arMs2ltURO85ywCTpa-S68ex5SFtU1wUDb6h7cEFSylyXhtCwSevgHnbvBp-iJkiwnhSRcJoquKONdCB6sWvim0_5N5UR9tK9W7avUvlq2r2gSHayth2kH9Zfks-4EsBUQ0qifgf_e_Y_tO6V_kU4</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2931049059</pqid></control><display><type>article</type><title>Staged abdominal wall reconstruction in the setting of complex gastrointestinal reconstruction</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>DeLong, C. G. ; Crowell, K. T. ; Liu, A. T. ; Deutsch, M. J. ; Scow, J. S. ; Pauli, E. M. ; Horne, C. M.</creator><creatorcontrib>DeLong, C. G. ; Crowell, K. T. ; Liu, A. T. ; Deutsch, M. J. ; Scow, J. S. ; Pauli, E. M. ; Horne, C. M.</creatorcontrib><description>Purpose
Literature on one- versus two-staged abdominal wall reconstruction (AWR) with complex gastrointestinal reconstruction (GIR) is limited to single-arm case series with a focus on patients who complete all planned stages. Herein, we describe our experience with both one- and two-staged approaches to AWR/GIR, with attention to those who did not complete both intended stages.
Methods
A retrospective review of prospectively collected data was conducted to identify patients who underwent a one- or two-stage approach to GIR/AWR from 2013 to 2020. The one-stage approach included GIR and definitive sublay mesh herniorrhaphy. The two-stage approach included Stage 1 (S1)—GIR and non-definitive herniorrhaphy and Stage 2 (S2)—definitive sublay mesh herniorrhaphy.
Results
Fifty-four patients underwent GIR/AWR: 20 (37.0%) underwent a planned 1-stage operation while 34 (63.0%) underwent S1 of a planned 2-stage approach. Patients assigned to the 2-stage approach were more likely to be smokers, have a history of mesh infection, have an enterocutaneous fistula, and a contaminated wound class (p<0.05). Of the 34 patients who underwent S1, 12 (35.3%) completed S2 during the mean follow-up period of 44 months while 22 (64.7%) did not complete S2. Of these, 10 (45.5%) developed hernia recurrence but did not undergo S2 secondary to elective nonoperative management (40%), pending preoperative optimization (30%), additional complex GIR (10%), hernia-related incarceration requiring emergent surgery (10%), or unrelated death (10%). No differences in outcome including SSI, SSO, readmission, and recurrence were noted between the 12 patients who completed the two-stage approach and the 20 patients who completed a one-stage approach, despite increased risk factors for complications in the 2-stage group (p>0.05).
Conclusion
Planned two-stage operations for GIR/AWR may distribute operative complexity and post-operative morbidity into separate surgical interventions. However, many patients may never undergo the intended definitive S2 herniorrhaphy. Future evaluation of 1- versus 2-stage GIR/AWR is needed to clarify indications for each approach. This work must also consider the frequent deviations from intended clinical course demonstrated in this study.</description><identifier>ISSN: 1248-9204</identifier><identifier>ISSN: 1265-4906</identifier><identifier>EISSN: 1248-9204</identifier><identifier>DOI: 10.1007/s10029-023-02856-2</identifier><identifier>PMID: 37648895</identifier><language>eng</language><publisher>Paris: Springer Paris</publisher><subject>Abdominal Surgery ; Abdominal wall ; Abdominal Wall - surgery ; Abdominoplasty - adverse effects ; Hernia ; Hernia, Ventral - etiology ; Hernia, Ventral - surgery ; Hernias ; Herniorrhaphy - adverse effects ; Humans ; Medicine ; Medicine & Public Health ; Morbidity ; Original Article ; Patients ; Reconstructive surgery ; Risk factors ; Surgical mesh ; Treatment Outcome</subject><ispartof>Hernia : the journal of hernias and abdominal wall surgery, 2024-02, Vol.28 (1), p.97-107</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-38285d9f358908fd855a8fe7ecac23c49a8b6cf0e2ea741e35768fe9ff09b1103</citedby><cites>FETCH-LOGICAL-c375t-38285d9f358908fd855a8fe7ecac23c49a8b6cf0e2ea741e35768fe9ff09b1103</cites><orcidid>0000-0001-5426-3752</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10029-023-02856-2$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10029-023-02856-2$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37648895$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>DeLong, C. G.</creatorcontrib><creatorcontrib>Crowell, K. T.</creatorcontrib><creatorcontrib>Liu, A. T.</creatorcontrib><creatorcontrib>Deutsch, M. J.</creatorcontrib><creatorcontrib>Scow, J. S.</creatorcontrib><creatorcontrib>Pauli, E. M.</creatorcontrib><creatorcontrib>Horne, C. M.</creatorcontrib><title>Staged abdominal wall reconstruction in the setting of complex gastrointestinal reconstruction</title><title>Hernia : the journal of hernias and abdominal wall surgery</title><addtitle>Hernia</addtitle><addtitle>Hernia</addtitle><description>Purpose
Literature on one- versus two-staged abdominal wall reconstruction (AWR) with complex gastrointestinal reconstruction (GIR) is limited to single-arm case series with a focus on patients who complete all planned stages. Herein, we describe our experience with both one- and two-staged approaches to AWR/GIR, with attention to those who did not complete both intended stages.
Methods
A retrospective review of prospectively collected data was conducted to identify patients who underwent a one- or two-stage approach to GIR/AWR from 2013 to 2020. The one-stage approach included GIR and definitive sublay mesh herniorrhaphy. The two-stage approach included Stage 1 (S1)—GIR and non-definitive herniorrhaphy and Stage 2 (S2)—definitive sublay mesh herniorrhaphy.
Results
Fifty-four patients underwent GIR/AWR: 20 (37.0%) underwent a planned 1-stage operation while 34 (63.0%) underwent S1 of a planned 2-stage approach. Patients assigned to the 2-stage approach were more likely to be smokers, have a history of mesh infection, have an enterocutaneous fistula, and a contaminated wound class (p<0.05). Of the 34 patients who underwent S1, 12 (35.3%) completed S2 during the mean follow-up period of 44 months while 22 (64.7%) did not complete S2. Of these, 10 (45.5%) developed hernia recurrence but did not undergo S2 secondary to elective nonoperative management (40%), pending preoperative optimization (30%), additional complex GIR (10%), hernia-related incarceration requiring emergent surgery (10%), or unrelated death (10%). No differences in outcome including SSI, SSO, readmission, and recurrence were noted between the 12 patients who completed the two-stage approach and the 20 patients who completed a one-stage approach, despite increased risk factors for complications in the 2-stage group (p>0.05).
Conclusion
Planned two-stage operations for GIR/AWR may distribute operative complexity and post-operative morbidity into separate surgical interventions. However, many patients may never undergo the intended definitive S2 herniorrhaphy. Future evaluation of 1- versus 2-stage GIR/AWR is needed to clarify indications for each approach. This work must also consider the frequent deviations from intended clinical course demonstrated in this study.</description><subject>Abdominal Surgery</subject><subject>Abdominal wall</subject><subject>Abdominal Wall - surgery</subject><subject>Abdominoplasty - adverse effects</subject><subject>Hernia</subject><subject>Hernia, Ventral - etiology</subject><subject>Hernia, Ventral - surgery</subject><subject>Hernias</subject><subject>Herniorrhaphy - adverse effects</subject><subject>Humans</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Morbidity</subject><subject>Original Article</subject><subject>Patients</subject><subject>Reconstructive surgery</subject><subject>Risk factors</subject><subject>Surgical mesh</subject><subject>Treatment Outcome</subject><issn>1248-9204</issn><issn>1265-4906</issn><issn>1248-9204</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kDtPwzAUhS0EoqXwBxiQJRaWgGPHiT0ixEtCYgBWLNe5LqmSuNiOgH-PactzYPBDut859-ggtJ-T45yQ6iSkm8qMUJaO4GVGN9A4p4XIJCXF5o__CO2EMCeEiKIU22jEqrIQQvIxeryLegY11tPadU2vW_yi2xZ7MK4P0Q8mNq7HTY_jE-AAMTb9DDuLjesWLbzimU6Ua_oIIS7lv5W7aMvqNsDe-p2gh4vz-7Or7Ob28vrs9CYzrOIxYyLlr6VlXEgibC0418JCBUYbykwhtZiWxhKgoKsiB8arMs2ltURO85ywCTpa-S68ex5SFtU1wUDb6h7cEFSylyXhtCwSevgHnbvBp-iJkiwnhSRcJoquKONdCB6sWvim0_5N5UR9tK9W7avUvlq2r2gSHayth2kH9Zfks-4EsBUQ0qifgf_e_Y_tO6V_kU4</recordid><startdate>20240201</startdate><enddate>20240201</enddate><creator>DeLong, C. G.</creator><creator>Crowell, K. T.</creator><creator>Liu, A. T.</creator><creator>Deutsch, M. J.</creator><creator>Scow, J. S.</creator><creator>Pauli, E. M.</creator><creator>Horne, C. 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M. ; Horne, C. M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-38285d9f358908fd855a8fe7ecac23c49a8b6cf0e2ea741e35768fe9ff09b1103</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Abdominal Surgery</topic><topic>Abdominal wall</topic><topic>Abdominal Wall - surgery</topic><topic>Abdominoplasty - adverse effects</topic><topic>Hernia</topic><topic>Hernia, Ventral - etiology</topic><topic>Hernia, Ventral - surgery</topic><topic>Hernias</topic><topic>Herniorrhaphy - adverse effects</topic><topic>Humans</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Morbidity</topic><topic>Original Article</topic><topic>Patients</topic><topic>Reconstructive surgery</topic><topic>Risk factors</topic><topic>Surgical mesh</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>DeLong, C. 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G.</au><au>Crowell, K. T.</au><au>Liu, A. T.</au><au>Deutsch, M. J.</au><au>Scow, J. S.</au><au>Pauli, E. M.</au><au>Horne, C. M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Staged abdominal wall reconstruction in the setting of complex gastrointestinal reconstruction</atitle><jtitle>Hernia : the journal of hernias and abdominal wall surgery</jtitle><stitle>Hernia</stitle><addtitle>Hernia</addtitle><date>2024-02-01</date><risdate>2024</risdate><volume>28</volume><issue>1</issue><spage>97</spage><epage>107</epage><pages>97-107</pages><issn>1248-9204</issn><issn>1265-4906</issn><eissn>1248-9204</eissn><abstract>Purpose
Literature on one- versus two-staged abdominal wall reconstruction (AWR) with complex gastrointestinal reconstruction (GIR) is limited to single-arm case series with a focus on patients who complete all planned stages. Herein, we describe our experience with both one- and two-staged approaches to AWR/GIR, with attention to those who did not complete both intended stages.
Methods
A retrospective review of prospectively collected data was conducted to identify patients who underwent a one- or two-stage approach to GIR/AWR from 2013 to 2020. The one-stage approach included GIR and definitive sublay mesh herniorrhaphy. The two-stage approach included Stage 1 (S1)—GIR and non-definitive herniorrhaphy and Stage 2 (S2)—definitive sublay mesh herniorrhaphy.
Results
Fifty-four patients underwent GIR/AWR: 20 (37.0%) underwent a planned 1-stage operation while 34 (63.0%) underwent S1 of a planned 2-stage approach. Patients assigned to the 2-stage approach were more likely to be smokers, have a history of mesh infection, have an enterocutaneous fistula, and a contaminated wound class (p<0.05). Of the 34 patients who underwent S1, 12 (35.3%) completed S2 during the mean follow-up period of 44 months while 22 (64.7%) did not complete S2. Of these, 10 (45.5%) developed hernia recurrence but did not undergo S2 secondary to elective nonoperative management (40%), pending preoperative optimization (30%), additional complex GIR (10%), hernia-related incarceration requiring emergent surgery (10%), or unrelated death (10%). No differences in outcome including SSI, SSO, readmission, and recurrence were noted between the 12 patients who completed the two-stage approach and the 20 patients who completed a one-stage approach, despite increased risk factors for complications in the 2-stage group (p>0.05).
Conclusion
Planned two-stage operations for GIR/AWR may distribute operative complexity and post-operative morbidity into separate surgical interventions. However, many patients may never undergo the intended definitive S2 herniorrhaphy. Future evaluation of 1- versus 2-stage GIR/AWR is needed to clarify indications for each approach. This work must also consider the frequent deviations from intended clinical course demonstrated in this study.</abstract><cop>Paris</cop><pub>Springer Paris</pub><pmid>37648895</pmid><doi>10.1007/s10029-023-02856-2</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0001-5426-3752</orcidid></addata></record> |
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| subjects | Abdominal Surgery Abdominal wall Abdominal Wall - surgery Abdominoplasty - adverse effects Hernia Hernia, Ventral - etiology Hernia, Ventral - surgery Hernias Herniorrhaphy - adverse effects Humans Medicine Medicine & Public Health Morbidity Original Article Patients Reconstructive surgery Risk factors Surgical mesh Treatment Outcome |
| title | Staged abdominal wall reconstruction in the setting of complex gastrointestinal reconstruction |
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