Concomitant enterostomy closure and ventral abdominal wall reconstruction using the Lázaro da Silva technique

Document Type : Research/Original Article

Authors

1 Department of Surgery, School of Medicine, Universidade Federal de Goiás, Goiânia, Brazil Division of Abdominal Wall Hernias, Goiânia General Hospital and Santa Casa de Misericórdia, Goiânia, Brazil

2 Senior Resident in Digestive Surgery, Goiânia General Hospital, Goiânia, Brazil

3 Department of Surgery (Colo-Proctology), School of Medicine, Universidade Federal de Goiás (Goiania, BRAZIL)

Abstract

We present a small series of patients who underwent concomitant treatment of external digestive bypass (stoma) and incisional hernia, using the Lázaro da Silva technique - a special method of purely tissue repair. The rational was not to use meshes on contaminated wounds. Initially, five patients were enrolled and all were operated on by the same group. Some demographic data were recorded, but also the time interval between the making of the stoma (or the appearance of the enterocutaneous fistula). Some characteristics of the hernia and data related to surgical procedures were also pointed out. The primary outcome was to verify the rate of hernial recurrence, but also the surgical site occurrences in the first 30 days. Only one patient had superficial wound infection and in none of them was a recurrence detected. Our work raises some questions about the best approach in these more complex cases, such as dissociating or not dissociating the procedures, the use of meshes anyway, and employment of mini-invasive surgery in some steps.

Keywords


  1. Mathes T, Walgenbach M, Siegel R. Suture versus mesh repair in primary and incisional ventral hernias: a systematic review and meta-analysis. World J Surg 2016;40:826–835. DOI 10.1007/s00268-015-3311-2
  2. Bondre IL, Holihan JL, Askenasy EP, Greenberg JA, Keith JN, Martindale RG, Roth JS, Liang MK; Ventral Hernia Outcomes Collaborative. Suture, synthetic, or biologic in contaminated ventral hernia repair. J Surg Res. 2016 Feb;200(2):488-94. doi: 10.1016/j.jss.2015.09.007
  3. Brooks DC, Cone J. Management of ventral hernias. UpToDate 2020 (Topic 96301 Version 11.0), assessed on Aug, 3rd. 2020.
  4. Kokotovic D, Bisgaard T, Helgstrand F. Long-term recurrence and complications associated with elective incisional hernia repair. JAMA 2016;316(15):1575-82.
  5. Birolini C, Miranda JS, Utiyama EM, Rasslan S. A retrospective review and observations over a 16-year clinical experience on the surgical treatment of chronic mesh infection. What about replacing a synthetic mesh on the infected surgical field? Hernia 2015;19:239-246. DOI 10.1007/s10029-014-1225-9
  6. Birolini C, Miranda JS, Utiyama EM, Rasslan S, Birolini D. Active Staphylococcus aureus infection: is it a contra-indication to the repair of complex hernias with synthetic mesh? A prospective observational study on the outcomes of synthetic mesh replacement, in patients with chronic mesh infection caused by Staphylococcus aureus. Int J Surg 2016;28:56-62. http://dx.doi.org/10.1016/j.ijsu.2016.02.062
  7. Lázaro da Silva A. Surgical correction of longitudinal median and paramedian incisional hernia. Surg Gynecol Obstet 1979;148:579-583.
  8. Lázaro da Silva A (2004) Recidiva da hérnia incisional após o tratamento pela transposição peritônio-aponeurótica longitudinal bilateral. Arq Gastroenterol 41(2):134-136.
  9. Miranda de Melo R (2018) El cincuentenario de la «transposición con el saco herniario» de Lázaro da Silva para reconstrucción de la pared abdominal ventral. Rev Hispanoam Hernia 6(3):156–162. https ://doi.org/10.20960 /rhh.128

10. Melo RM. Would surgeons be definitively forbidden to restore the abdominal wall without using a mesh? Hernia published online: 27 April 2020. https://doi.org/10.1007/s10029-020-02195-6

11. Muysoms FE, Miserez M, Berrevoet F, Campanelli G, Champault GG, Chelala E, et al. Classification of primary and incisional abdominal wall hernias. Hernia 2009;13:407-414. DOI 10.1007/s10029-009-0518-x

12. Salvadalena G, Hendren S, McKenna L, Muldoon R, Netsch D, Paquette I, Pittman J, Ramundo J, Steinberg G. WOCN Society and ASCRS position statement on preoperative stoma site marking for patients undergoing colostomy or ileostomy surgery. J Wound Ostomy Continence Nurs. 2015;42(3):249-252. DOI: 10.1097/WON.0000000000000119

13. Francone TD. Overview of surgical ostomy for fecal diversion. UpToDate 2020, assessed on Aug, 24th. 2020.

14. Millbourn D, Cengiz Y, Israelsson LA. Effect of stitch length on wound complications after closure of midline incisions: a randomized controlled trial. Arch Surg 2009;144:1056-1059.

15. Millbourn D, Cengiz Y, Israelsson LA. Risk factors for wound complications in midline abdominal incisions related to the size of stitches. Hernia 2011;15:261-266. DOI 10.1007/s10029-010-0775-8

16. Israelsson LA, Millbourn D. Prevention of incisional hernias: how to close a midline incision. Surg Clin N Am 2013;93:1027-1040. http://dx.-doi.org/10.1016/j.suc.2013.06.009

17. Muysoms FE, Antoniou SA, Bury K, Campanelli G, Conze J, Cuccurullo D, de Beaux AC, Deerenberg EB, East B, Fortelny RH, Gillion JF, Henriksen NA, Israelsson LA, Jairam A, Jänes A, Jeekel J, López-Cano M, Miserez M, Morales-Conde S, Sanders DL, Simons MP, Śmietański M, Venclauskas L, Berrevoet F. European Hernia Society guidelines on the closure of abdominal wall incisions. Hernia. 2015;19:1-24.

18. Carbonell-Tatay F, Bonafé-Diana, S, García-Pastor P, Gómez i Gavara C, Baquero-Valdelomar R. Nuevo método de operar en la eventración compleja: separación anatómica de componentes con prótesis y nuevas inserciones musculares. Cir Esp. 2009;86(2):87–93. doi:10.1016/j.ciresp.2009.03.015

19. Slater NJ, van Goor H, Bleichrodt RP. Large and complex ventral hernia repair using “components separation technique” without mesh results in a high recurrence rate. Am J Surg 2015;209:1709.

20. Reinpold W. Transversus abdominis muscle release: technique, indication, and results. Int J Abdom Wall Hernia Surg 2018;1:79-86.