Background and Objectives: Surgical site infections (SSIs) are a significant complication following ventral hernia repair, potentially leading to prolonged hospital stays and increased morbidity. This study aimed to evaluate whether closed incision negative pressure wound therapy (ciNPWT) reduces the incidence of SSI after ventral hernia repair with polypropylene mesh compared to standard wound care. Materials and Methods: A randomized study was conducted with 100 patients undergoing ventral hernia repair using a polypropylene mesh. Participants were divided into two groups: a control group (n=50), which received standard sterile gauze dressing with an iodine-based disinfectant, and an intervention group (n=50), treated with the ciNPWT system (Vivano® by HARTMANN) for 5 days postoperatively. The primary outcome was the incidence of SSI within one year after surgery. Secondary outcomes included the influence of factors such as age, sex, smoking status, and hernia size on SSI occurrence. The study was approved by the Ethics Committee at the University Hospital Ostrava, adhering to the ethical standards of the Helsinki Declaration. Results: The incidence of SSI was lower in the ciNPWT group compared to the standard care group (4% vs. 12%), though this difference did not reach statistical significance. No significant effect of sex or smoking status on SSI was observed. The control group had a shorter mean length of hospital stay. Larger hernias in the non-ciNPWT group were more prone to SSIs, as expected. Conclusions: Although limited by a small sample size, the findings suggest that ciNPWT may be associated with a reduced rate of SSI following ventral hernia repair. Further studies with larger populations are needed to confirm these results.

• MeSH
• chirurgické síťky * MeSH
• dospělí MeSH
• incidence MeSH
• infekce chirurgické rány * prevence a kontrola   epidemiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• operace kýly * metody   škodlivé účinky   MeSH
• polypropyleny * MeSH
• senioři MeSH
• terapie ran pomocí řízeného podtlaku * metody   MeSH
• ventrální hernie * chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH

BACKGROUND: There is a reasonable body of evidence around oral/dental health and implant infection in orthopaedic and cardiovascular surgery. Another large area of surgical practice associated with a permanent implant is mesh hernia repair. This study aimed to review the evidence around oral/dental health and mesh infection. METHODS: The research protocol was registered in PROSPERO (CRD42022334530). A systematic review of the literature was undertaken according to the PRISMA 2020 statement. The initial search identified 582 publications. A further four papers were identified from references. After a review by title and abstract, 40 papers were read in full text. Fourteen publications were included in the final review, and a total of 47,486 patients were included. RESULTS: There is no published evidence investigating the state of oral hygiene/health and the risk of mesh infection or other infections in hernia surgery. Improvement in oral hygiene/health can reduce surgical site infection and implant infection in colorectal, gastric, liver, orthopaedic and cardiovascular surgery. Poor oral hygiene/health is associated with a large increase in oral bacteria and bacteraemia in everyday activities such as when chewing or brushing teeth. Antibiotic prophylaxis does not appear to be necessary before invasive dental care in patients with an implant. CONCLUSION: Good oral hygiene and oral health is a strong public health message. The effect of poor oral hygiene on mesh infection and other complications of mesh hernia repair is unknown. While research is clearly needed in this area, extrapolating from evidence in other areas of surgery where implants are used, good oral hygiene/health should be encouraged amongst hernia patients both prior to and after their surgery.

• MeSH
• chirurgické síťky škodlivé účinky   MeSH
• infekce chirurgické rány prevence a kontrola   MeSH
• inguinální hernie * chirurgie   MeSH
• lidé MeSH
• operace kýly škodlivé účinky   metody   MeSH
• orální hygiena MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• systematický přehled MeSH

BACKGROUND: There is an increasing number of patients following hernia surgery with implanted mesh reporting symptoms that could indicate autoimmune or allergic reactions to mesh. 'Allergy' to metals, various drugs, and chemicals is well recognised. However, hypersensitivity, allergy or autoimmunity caused by surgical mesh has not been proven by a scientific method to date. The aim of this study was twofold: to describe the pathophysiology of autoimmunity and foreign body reaction and to undertake a systematic review of surgical mesh implanted at the time of hernia repair and the subsequent development of autoimmune disease. METHODS: A systematic review using the PRISMA guidelines was undertaken. Pubmed (Medline), Google Scholar and Cochrane databases were searched for all English-written peer-reviewed articles published between 2000 and 2021. The search was performed using the keywords "hernia", "mesh", "autoimmunity", "ASIA", "immune response", "autoimmune response". RESULTS: Seven papers were included in the final analysis-three systematic reviews, three cohort studies and one case report. Much of the current data regarding the association of hernia mesh and autoimmunity relies on retrospective cohort studies and/or case reports with limited availability of cofounding factor data linked to autoimmune disease such as smoking status or indeed a detailed medical history of patients. Three systematic reviews have discussed this topic, each with a slightly different approach and none of them has identified causality between the use of mesh and the subsequent development of autoimmune disease. CONCLUSION: There is little evidence that the use of polypropylene mesh can lead to autoimmunity. A large number of potential triggers of autoimmunity along with the genetic predisposition to autoimmune disease and the commonality of hernia, make a cause and effect difficult to unravel at present. Biomaterials cause foreign body reactions, but a chronic foreign body reaction does not indicate autoimmunity, a common misunderstanding in the literature.

• MeSH
• autoimunitní nemoci * etiologie   MeSH
• chirurgické síťky škodlivé účinky   MeSH
• inguinální hernie * chirurgie   MeSH
• lidé MeSH
• operace kýly škodlivé účinky   metody   MeSH
• reakce na cizí těleso chirurgie   MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• práce podpořená grantem MeSH
• přehledy MeSH
• systematický přehled MeSH

Úvod: Chronická bolest po plastice tříselné kýly, která je pro pacienta jednou z nejvíce obtěžujících komplikací, se vyskytuje dle literatury v 5−20 % případů. Jednou z příčin chronické bolesti může být i dráždění periferních nervů síťkou či stehem. Rizikovým faktorem chronické bolesti je již předoperační bolest. Kazuistika: Kazuistika se týká 59letého muže s chronickou bolestí v třísle po Lichtensteinově plastice tříselné kýly vlevo. Pokus o konzervativní postup fyzikální terapií nebyl úspěšný a pacientovi byla provedena trineurektomie z klasického přístupu s ponecháním původní polypropylenové síťky. Bezprostředně po operaci se mu od bolestí ulevilo a po měsíci i po roce od operačního přerušení periferních nervů třísla nepociťoval žádné bolesti. Závěr: Péče o pacienta s chronickou bolestí po plastice tříselné kýly by měla být komplexní, ideálně centralizovaná. Po selhání veškeré konzervativní léčby je indikována ev. extirpace síťky a periferní neurektomie.

Introduction: Chronic pain is a distressing complication that can occur after inguinal hernia repair, affecting between 5% and 20% of patients as reported in literature. There are several reasons for chronic pain, including peripheral nerve irritation caused by surgical mesh or stitches. Preoperative pain is a risk factor for chronic pain. Case report: We present the case of a 59-year-old man who experienced chronic inguinal pain following Lichtenstein hernia repair. Conservative therapy was ineffective, and he subsequently underwent triple neurectomy without removal of the original polypropylene mesh. The patient experienced significant pain relief immediately after the surgery. There was no reported pain 1 month and 1 year post-surgery. Conclusion: The management of patients with chronic pain following hernia repair should be comprehensive and, ideally, centralized. Conservative procedures should be attempted first, but neurectomy and mesh removal may be necessary in cases where conservative measures are unsuccessful.

• Klíčová slova
• trineurektomie,
• MeSH
• chirurgické síťky škodlivé účinky   MeSH
• chronická bolest * chirurgie   etiologie   MeSH
• inguinální hernie chirurgie   komplikace   MeSH
• lidé středního věku MeSH
• lidé MeSH
• operace kýly * metody   škodlivé účinky   MeSH
• pooperační bolest chirurgie   etiologie   MeSH
• třísla chirurgie   inervace   patofyziologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

PURPOSE: Since 01/2018, AVOS (ambulant vor stationär = outpatient to inpatient) regulation has been progressively implemented in hernia surgery in Switzerland. The aim of this prospective, observational, two-centre comparative study was to compare the outcome of outpatient and inpatient post-operative care in terms of AVOS by examining the re-admission rate, complication rate and quality of life in patients with primary unilateral inguinal hernia repair. METHODS: The study ran between 01/2019 and 04/2020 and included 237 patients with a primary unilateral inguinal hernia. Treatment setting was decided according to AVOS guidelines. Primary endpoint was re-admission rate within 6 weeks postoperatively. Secondary endpoints were the complication rate and patient outcome (quality of life) at 6 weeks follow-up postoperatively, as measured by the Short Form 36 Health Survey Questionnaire (SF-36). RESULTS: Complications occurred in 11 (14%) inpatient patients, but none required re-admitting for revision until follow-up at 6 weeks after discharge. In the outpatient group, there were 27 (17%) complications reported, while 6 (4%) of these patients crossed over to the inpatient group immediately after surgery. None of the other complications required re-admission until follow-up at 6 weeks. No significant relationship between treatment setting and number of complications/re-admission rate (p=0.458, p=0.061) was observed. The mean outcome (SF-36) between the treatment groups was not significantly different (p=0.16-0.856). CONCLUSION: In terms of AVOS selection criteria in Switzerland, primary unilateral inguinal hernia can be safely treated in both treatment settings. Re-admission rates, complications and quality of life do not significantly differ. Day surgery in terms of AVOS might be as effective and efficient, both from the patient's perspective and that of the institution. TRIAL REGISTRATION NUMBER: NCT05234242.

• MeSH
• chirurgické síťky MeSH
• hospitalizovaní pacienti MeSH
• inguinální hernie * chirurgie   MeSH
• kvalita života MeSH
• lidé MeSH
• operace kýly škodlivé účinky   MeSH
• pacienti ambulantní MeSH
• prospektivní studie MeSH
• recidiva MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• Geografické názvy
• Švýcarsko MeSH

Úvod: Cílem práce je analyzovat komplikace operací pro kýlu v jizvě a zhodnotit význam jednotlivých rizikových faktorů podílejících se na vzniku infekčních komplikací na Chirurgické klinice Fakultní nemocnice Královské Vinohrady za rok 2015. Metody: Analyzovali jsme 138 pacientů se zaměřením na rizikové faktory, které potenciálně zvyšují riziko vzniku pooperační infekční komplikace, jako jsou implantace síťky, kouření, přítomnost onemocnění diabetes mellitus, ischemické nemoci srdeční, malignity a imunosupresivní terapie a také akutnost operace. Výsledky: Při vícerozměrné logistické regresní analýze se akutní výkon ukázal jako rizikový faktor pro vznik infekce a při ad hoc Fisherově testu byl poměr 2,73. Diabetes mellitus byl hraničně významný faktor (p=0,071). Žádné další sledované parametry nebyly spojeny se zvýšeným rizikem SSI. Závěr: Studie prokázala jako významný rizikový faktor vzniku pooperační infekce akutní výkon. Naopak použití síťky nebylo spojeno se zvýšeným rizikem infekce.

Introduction: The aim of this study was to analyse complications associated with inicisional hernia repair surgery and to assess individual risk factors for surgical site infections occurring at the Department of Surgery of the University Hospital Kralovske Vinohrady in 2015. Methods: We analysed 138 patients with a focus on risk factors that potentially increase the risk of postoperative infectious complications such as mesh implantation, smoking, diabetes mellitus, ischemic heart disease, malignancies, immunosuppressive therapy and urgency of the procedure. Results: Based on multivariate logistic regression analysis, acute surgery proved to be a risk factor for infection, and in the ad hoc Fisher test, the ratio was 2.73. Diabetes mellitus as a risk factor reached the limit of significance (p=0.071). No other variables were associated with an increased risk of surgical site infections. Conclusion: Acute surgery was assessed as a significant risk factor for postoperative wound infection. On the contrary, mesh repair was not associated with an increased risk of infection.

• MeSH
• chirurgické síťky škodlivé účinky   MeSH
• infekce chirurgické rány * etiologie   MeSH
• jizva chirurgie   komplikace   MeSH
• lidé MeSH
• operace kýly metody   škodlivé účinky   MeSH
• pooperační komplikace MeSH
• retrospektivní studie MeSH
• ventrální hernie * chirurgie   MeSH
• Check Tag
• lidé MeSH

BACKGROUND: Ventral hernia repair is one of the most commonly performed surgical procedures worldwide. To reduce the risk of complications, patient prehabilitation has received increasing focus in recent years. To assess prehabilitation measures, this European Hernia Society endorsed project was launched. The aim of this systematic review was to evaluate the current literature on patient prehabilitation prior to ventral hernia repair. METHODS: The strategies examined were optimization of renal disease, obesity, nutrition, physical exercise, COPD, diabetes and smoking cessation. For each topic, a separate literature search was conducted, allowing for seven different sub-reviews. RESULTS: A limited amount of well-conducted research studies evaluating prehabilitation prior to ventral hernia surgery was found. The primary findings showed that smoking cessation and weight loss for obese patients led to reduced risks of complications after abdominal wall reconstruction. CONCLUSION: Prehabilitation prior to ventral hernia repair may be widely used; however, the literature supporting its use is limited. Future studies evaluating the impact of prehabilitation before ventral hernia surgery are warranted.

• MeSH
• cvičení MeSH
• fyzioterapie v předoperační přípravě * MeSH
• lidé MeSH
• obezita MeSH
• operace kýly škodlivé účinky   metody   MeSH
• pooperační komplikace etiologie   prevence a kontrola   chirurgie   MeSH
• předoperační péče metody   MeSH
• ventrální hernie * chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• systematický přehled MeSH

BACKGROUND: An acute inguinal hernia remains a common emergency surgical condition worldwide. While emergency surgery has a major role to play in treatment of acute hernias, not all patients are fit for emergency surgery, nor are facilities for such surgery always available. Taxis is the manual reduction of incarcerated tissues from the hernia sack to its natural compartment, and can help delay the need for surgery from days to months. The aim of this study was to prepare a safe algorithm for performing manual reduction of incarcerated inguinal hernias in adults. METHODS: Medline, Scopus, Ovid and Embase were searched for papers related to emergency inguinal hernias and manual reduction. In addition, the British National Formulary and Safe Sedation Practice for Healthcare Procedures: Standards and Guidance were reviewed. RESULTS: A safe technique of manual reduction of an acute inguinal hernia, called GPS (Gentle, Prepared and Safe) Taxis, is described. It should be performed within 24 h from the onset of a painful irreducible lump in groin, and when concomitant symptoms and signs of bowel strangulation are absent. Conscious sedation guidelines should be followed. The most popular drug combination is of intravenous morphine and short-acting benzodiazepine, both titrated carefully for optimal and safe effect. The dose of drugs must be individualised, and the smallest effective dosage should be used to avoid oversedation. Following successful taxis, the patient should undergo a short period of observation. Urgent surgery can be undertaken during the same admission or up to several weeks later. CONCLUSIONS: Taxis is a benign/non-invasive method for patients with an acute, non-strangulated inguinal hernias. It likely reduces the risk and complications of anaesthesia and surgery in the emergency settings. GPS Taxis should be considered as first line treatment in the majority of patients presenting with an acute inguinal hernia when existing bowel infarction is unlikely.

• MeSH
• algoritmy MeSH
• dospělí MeSH
• inguinální hernie * chirurgie   MeSH
• lidé MeSH
• náhlé příhody MeSH
• operace kýly škodlivé účinky   MeSH
• třísla MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Gore-Tex® is a widely used durable patch for repair of congenital diaphragmatic defects yet may result in complications. We compared Gore-Tex with a composite of a radial pore-orientated collagen scaffold (RP-Composite) and clinically used porcine small intestinal submucosa (SIS; Surgisis®) in a rabbit model for diaphragmatic hernia. The growing rabbit mimics the rapid rib cage growth and reherniation rates seen in children. We created and immediately repaired left hemidiaphragmatic defects in 6-week-old rabbits with Gore-Tex, SIS, and an RP-Composite scaffold. An additional group of rabbits had a sham operation. At 90 days, survivors more than doubled in weight. We observed few reherniations or eventrations in Gore-Tex (17%) and RP-Composite (22%) implanted animals. However, SIS failed in all rabbits. Maximum transdiaphragmatic pressure was lower in Gore-Tex (71%) than RP-Composite implanted animals (112%) or sham (134%). Gore-Tex repairs were less compliant than RP-Composite, which behaved as sham diaphragm (p < 0.01). RP-Composite induced less foreign body giant cell reaction than Gore-Tex (p < 0.05) with more collagen deposition (p < 0.001), although there was a tendency for the scaffold to calcify. Unlike Gore-Tex, the compliance of diaphragms reconstructed with RP-Composite scaffolds were comparable with native diaphragm, whereas reherniation rates and transdiaphragmatic pressure measurements were similar.

• MeSH
• brániční hernie * patologie   chirurgie   MeSH
• kolagen chemie   MeSH
• králíci MeSH
• lidé MeSH
• modely nemocí na zvířatech MeSH
• operace kýly škodlivé účinky   metody   MeSH
• prasata MeSH
• reakce na cizí těleso etiologie   patologie   MeSH
• tkáňové podpůrné struktury škodlivé účinky   chemie   MeSH
• zvířata MeSH
• Check Tag
• králíci MeSH
• lidé MeSH
• mužské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH

BACKGROUND: Surgery for benign disease is associated with a low-risk of developing venous thromboembolism (VTE). Despite a relatively low incidence of postoperative VTE in patients after elective cholecystectomy and abdominal hernia repair there are data proving hypercoagulability in the early postoperative period. We focused on assessment of the systemic inflammatory response and coagulation status in these surgical patients after hospital discharge. METHODS: Prospectively, patients who underwent surgery for benign disease were included. Two hundred sixteen patients were enrolled - 90 patients in laparoscopic cholecystectomy (LC) group and 126 patients in hernia surgery (HS) group. Risk assessment of VTE according to the Caprini risk assessment model was performed in all patients. Prevalence of VTE in postoperative period was observed. Markers of systemic inflammatory response (IL-6, CRP, α-1-acid glycoprotein, transferrin) and coagulation markers (PLT, fibrinogen, prothrombin fragment F1 + 2 and D-dimer) were measured before surgery, on 7-10th postoperative day and on 28-30th postoperative day. RESULTS: Clinically apparent deep vein thrombosis was diagnosed in only one patient - 0.46%. Statistically significant elevation of inflammatory markers IL-6, CRP and α-1-acid glycoprotein (p < 0.001; all) were proved in both groups of patients on 7-10th postoperative day. Statistically significant elevation of coagulation markers PLT, fibrinogen, prothrombin fragment F1 + 2 and D-dimer (p < 0.001; all) were proved in LC and HS groups on 7-10th postoperative day. No statistical difference was observed in IL-6, CRP and α-1-acid glycoprotein levels a month after surgery as compared with preoperative levels within each group. Statistically significant elevation of fibrinogen and prothrombin fragment F1 + 2 levels (p < 0.001; both) persisted on 28-30th postoperative day in both groups. Persisted elevation of D-dimer levels was proved only in HS group (p < 0.001), not in LC group (p = 0.138), a month after surgery. CONCLUSIONS: Activated systemic inflammatory response and hypercoagulable condition were verified in patients after laparoscopic cholecystectomy and hernia surgery after their hospital discharge. Hypercoagulability persisted even a month after surgery. Nevertheless, we observed very low prevalence of clinically apparent VTE in patients with in-hospital postoperative VTE prophylaxis. TRIAL REGISTRATION: Trials of the Czech Ministry of Health No. RVO-VFN64165 and NT 13251-4 .

• MeSH
• biologické markery krev   MeSH
• cholecystektomie laparoskopická škodlivé účinky   MeSH
• dospělí MeSH
• fibrin-fibrinogen - produkty degradace metabolismus   MeSH
• hodnocení rizik MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• operace kýly škodlivé účinky   MeSH
• peptidové fragmenty krev   MeSH
• prospektivní studie MeSH
• protrombin MeSH
• senioři MeSH
• trombofilie krev   diagnóza   etiologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH