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Prof. Dr. David Moszkowicz

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Service de Chirurgie Digestive, AP-HP, Hôpital Louis Mourier, DMU ESPRIT-GHU AP-HP, Nord-Université de Paris, 92700 Colombes, France
Interests: bariatric surgery; botulinum toxin; complex ventral hernia repair; gastroparesis; incisional hernia; obesity; parastomal hernia; ventral hernia

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Dear Colleagues,

Nowadays, the surgical treatment of ventral hernia represents a continuous challenge. This is mainly due to hernia location (lateral, parastomal), complexity (in relation to the width or to a loss of domain), or to a patient’s particular condition (especially obesity). Despite international guidelines and worldwide consensus updates, evidence gaps persist at all points. The aim of this Special Issue is to provide a comprehensive overview of the advances in the treatment of ventral hernia, with a particular interest in the mangement of patients with obesity, complex localizations, and the use of innovative techniques of preoptimization (botulinum toxin, preoperative pneumoperitoneum) as well as surgical repair (innovative mesh, robotic). Therefore, researchers in the field of abdominal wall repair are encouraged to submit their findings as original articles, surgical techniques, or reviews to this Special Issue.

Prof. Dr. David Moszkowicz
Guest Editor

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Keywords

botulinum toxin
obesity
robotic surgery
ventral hernia
parastomal hernia

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10 pages, 511 KiB

Open AccessArticle

Primary Ventral Hernia Repair and the Risk of Postoperative Small Bowel Obstruction: Intra Versus Extraperitoneal Mesh

by Marine Goullieux, Fawaz Abo-Alhassan, Remi Vieira-Da-Silva, Papet Lauranne, Adeline Guiraud and Pablo Ortega-Deballon

J. Clin. Med. 2023, 12(16), 5341; https://doi.org/10.3390/jcm12165341 - 16 Aug 2023

Viewed by 930

Abstract

Objective: The aim of this study was to compare the likelihood of bowel obstruction according to the placement of the mesh (either intraperitoneal or extraperitoneal) in ventral hernia repairs. Materials and methods: Patients were divided into two groups, an intraperitoneal (IP) group (mesh placed by laparoscopy or with an open approach) and an extraperitoneal (EP) group, all operated on in the Digestive Surgery Department at the Dijon University Hospital. The primary outcome was the occurrence of an episode of bowel obstruction requiring hospitalization and confirmed by abdominal CT scan. Results: Between March 2008 and July 2021, 318 patients were included, with 99 patients in the EP group (71 meshes placed preperitoneally and 28 placed retromuscularly) and 219 patients in the IP group (175 patients operated on laparoscopically versus 44 patients by direct approach). Three patients presented an episode of acute intestinal obstruction, with no difference between the two groups (p = 0.245), although all bowel obstructions occurred in the IP group and with the laparoscopic approach (1.7% of patients operated on by laparoscopy). The occlusive events occurred at 1 month, 2 years, and 3 years. There was no difference in terms of recurrence or postoperative chronic pain. There were more seroma and mesh infections in the EP group (p < 0.05). Two patients operated on by laparoscopy had undetected bowel injuries, prompting emergent surgery for peritonitis. Conclusions: No statistically significant difference was found in terms of bowel obstruction between the intraperitoneal and the extraperitoneal position, but all cases of obstruction happened in the intraperitoneal mesh group. Visceral lesions remain a major complication of the laparoscopic approach that should not be neglected. Full article

(This article belongs to the Special Issue Difficult Situations and Modern Surgical Techniques in Ventral Hernia Surgery)

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