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Table of Contents
REVIEW ARTICLE
Year : 2019  |  Volume : 2  |  Issue : 2  |  Page : 33-38

The breakthrough on evaluation and treatment in incisional hernia with loss of domain


Department of Hernia and Abdominal Wall Surgery, The Fourth Hospital of China Medical University, Shenyang 10032, China

Date of Submission12-Jan-2019
Date of Acceptance18-Feb-2019
Date of Web Publication10-May-2019

Correspondence Address:
Dr. Hangyu Li
Department of Hernia and Abdominal Wall Surgery, The Fourth Hospital of China Medical University, Shenyang 10032

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijawhs.ijawhs_33_18

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  Abstract 


Part of the patients with incisional hernia (IH) suffered from constipation or even circulatory impairment, which is called large IH with loss of domain (LOD) or giant IH. For now, there is still controversy about the definition and pathomechanism of the LOD; meanwhile, there is no clear criterion for evaluating and treating patients with LOD. A systematic search of the literature was implemented in PubMed and the Cochrane database by using the keywords “IH, abdominal wall function(AWF), LOD” and got 60 publications finally. First, there is still no unified definition for LOD, but we found that it was translated into a situation that abdominal content can hardly be reduced with AWF deficiency in 2018th Chinese Guidelines. Second, we concluded that poor abdominal wall contraction caused by muscular atrophy or fibrillation after large area aponeurosis released shall be important pathomechanism of LOD. Third, we found that there are different methods for evaluating LOD, while the activity evaluation may be most useful. Finally, component separation technique (CST), bridge repair or utotransplantation have been recommended in many publications for variable condition. The definition of LOD is better to be divided into the functional deficiency and the anatomical defect just like Chinese guidelines. The pathomechanism of LOD was actually based on anatomical destruction of abdominal wall contraction system. The activity evaluation may be the most convenient method mentioned in the publications. CST was strongly recommended to be used in giant hernia, the defect of which can be hardly closed. Patients who have IH with LOD are proposed to receive hernioplasty as early as possible because of the impendency to reconstruct the large defect on the abdominal wall as well as restoration of the AWF. Surgeons may select appropriate CST to repair IH according to the length of the defect.

Keywords: Abdominal wall function, bridge repair, component separation technique, incisional hernia, loss of domain


How to cite this article:
Qin D, Wei S, Tian J, Guo Z, Li X, Yan Y, Li H. The breakthrough on evaluation and treatment in incisional hernia with loss of domain. Int J Abdom Wall Hernia Surg 2019;2:33-8

How to cite this URL:
Qin D, Wei S, Tian J, Guo Z, Li X, Yan Y, Li H. The breakthrough on evaluation and treatment in incisional hernia with loss of domain. Int J Abdom Wall Hernia Surg [serial online] 2019 [cited 2019 May 20];2:33-8. Available from: http://www.herniasurgeryjournal.org/text.asp?2019/2/2/33/257979




  Introduction Top


Abdominal wall bugle is an common situation for patients with incisional hernia (IH) while some of them may also suffer from defecation dysfunction and micturition disorder. Furthermore, they often complained about chronic low back pain in daily life, and it is believed that the abdominal wall function (AWF) deficiency has a primary responsibility.[1],[2] AWF assisted human body with movement, excretion, respiration, circulation, and anatomical stabilization, and it may fall into a decline with expansion of defect on abdominal wall (AW).[1],[2] Patients may still be asymptomatic when the defect diameter is <10 cm;[1],[3],[4] on the contrary, they will get extra functional impairment in respiration and circulation when the defect area is >10 cm and the volume ratio exceeded 20% between hernia sac and abdominal cavity.[1],[5] It is called large IH with loss of domain (LOD) or giant IH.[1],[6] The LOD reminds us that the abdominal wall reconstruction (AWR) should consist of anatomical as well as functional reconstruction.[7] However, there is still no enough attention put on the AWF and LOD in many guidelines and prospective randomized controlled trials produced in China or the west.[1],[8],[9],[10],[11],[12],[13] The present article introduces new progress in evaluation and treatment in patients with LOD according to the literature review.


  The Pathomechanism of Loss of Domain Top


There is still controversy about the definition of LOD. It may be defined as “viscera lost their right of domain” or “loss of abdominal cavity volum” while it has been interpreted as a situation that hernia content can be hardly reduced into abdominal cavity, causing the AWF deficiency in 2018th Chinese Guidelines for the diagnosis and treatment of abdominal wall IH.[1],[14]

Pathomechanism of loss of domain

Until now, there is no clear explanation for the pathomechanism of LOD, but fortunately, there are some manuscripts that can reveal it preliminarily. Den, Shestak, Kuo, Criss, and Jensen had focused on what can primary fascia closure bring to patients with LOD.[4],[15],[16],[17],[18] It reflected the possibility that fascia closure especially Linea alba reconstruction make for the AWF restoration, moreover, it is also hypothesized that contraction system reload after reconstruction of insertion port formed by tendinous tissue played the key role.[3],[15],[19] De Silva found hyperplasia in rectus abdominis, internal oblique, and external oblique, but hypotrophy in trasversus abdominis in patients received transversus abdominis release (TAR);[20],[21],[22],[23] similarly, we can find external oblique hypotrophy in external oblique release.[3] He hypothesized that aponeurosis released combined with muscle contractive dysfunction and it can be reactivated by aponeurosis reconstruction which is beneficial to AWF restoration. Second, the rest of AM would like to be hyperplasia gradually when aponeurosis has been released partially to make up the deficiency generated on AW. Last but not the least, Duba and Culbertson had proved that muscle cells are easy to get atrophy or even fibrillation if contraction insufficiency happened; interestingly, they also found that the process in hypotrophy or fibrillation can also be rectified by proper tension imposed.[20],[21],[22],[23] Finally, we can conclude that poor AM contraction caused by muscular atrophy or fibrillation after large area aponeurosis released shall be important pathomechanism of LOD.


  Evaluation of Loss of Domain Top


AWF score is an suitable index reflecting the degree of LOD; moreover, we can estimate the surgical efficacy according to the variation of perioperative AWF score.

Activity evaluation

Activity evaluation is to evaluate AWF by investigating body activity. There are trunk raising and double leg lowering tests which can be used in exploration. The total score from the two test is an index used in AWF efficacy comparing between different patients [Table 1] and [Table 2].[23]
Table 1: Trunk raising*

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Table 2: Double leg lowering*

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Other evaluation methods

Except for activate evaluation, we can also assess AWF by using the sensors to gain the actual muscle force or with the help of surface electromyography (EMG) to check the electrical peak and so on [Table 3].
Table 3: Other evaluation methods for abdominal wall function

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  Treatment for Loss of Domain Top


Operation criterion

Functional repair holds an equal important position as anatomical repair when patient has LOD, because AWF may decreased as soon as the separation happened in any part of muscular fasciae.[4],[7],[27],[28] Meanwhile, AWF can be kept in nearly normal level from Linea alba reconstruction, although part of muscular fasciae has been left in situ.[3],[4],[15] Hence, for middle giant IH, lateral muscular fasciae can be reconstructed partially in order to guarantee the integrity of Linea alba if there are challenges to close the abdominal cavity completely. As for lateral giant IH, the three pairs of abdominal muscle need to be reconstructed uniquely to ensure their own functions would not be frustrated; as we all know, oblique muscle has the function of rotating the trunk and flexing the spine laterally, transverses abdominis keep abdominal component in their right place, moreover, rectus abdominis has the function of flexing the trunk.[2]

Operation introduction

When the defect can be closed

Component separation technique

Component separation technique (CST) shall be a suitable method to treat the IH, especially when the defect is >10 cm.[29] Surgeons can even repair incisional hernia with 20 cm length of defect at umbilical level, meeting the requirement for most of the patients going to receive AWR.[29],[30] CST can be divided into anterior CST (ACST) and posterior CST (PCST). ACST often been performed in the sapce between external and internal oblique. E-CST is a common type of ACST, separating the aponeurosis of external oblique easily without large free flap creation, which strongly reduce the infection possibility. E-CST shall be a technique fit for normal patient with IH and the patients under the risk of AW contamination such as AW fistula.[27],[29],[30],[31] Surgeons can close the defect near 17cm length with E-CST.[32] PCST usually been performed in the space between transverses abdominis and fascia transversalis. TAR belong to PCST, by which the mesh can be reinforced under the compression from muscle and abdominal cavity, reducing the risk of recurrence conspicuously. PCST has been honored as an technique as powerful as classic CST and it provided almost 24 cm in defect closing which is a bit wider than the classic one.[27],[33],[34] Finally, we can engage TAR combined with E-CST when it is unable to close the abdominal cavity under physiological tension by using TAR alone.[35]

Nowadays, the laparoscopic incisional hernioplasty is a new trend in IH treatment apart from the traditional ACST or PCST. Reinpold carried out the first mini/less open sublay (MILOS) surgery in Germany 2015, which put mesh sublay under unique laparoscopic equipment with minimal incision, while Köckerling engaged ELAR (endoscopic-assisted Linea alba reconstruction) in 2016 by putting mesh onlay through minimal incision, in which he cut off the anterior sheath of rectus abdominis with longitudinal incision of 2 cm lateral from middle line and then sutured mesh with prototheca laterally for reinforcement.[36],[37] Belyansky performed TAR under laparoscopy in 2015 which has been called L-TAR and he tried to complete it with robotic equipment in 2016.[38],[39] Costa repaired middle-line IH with mesh sublay under laparoscopy in 2016, which named Brazilian technology by Montgomery and it has been also praised as an innovation from traditional Rives-Stoppa.[40],[41] Schwarz demonstrated endoscopy-MILOS by using conventional laparoscopic equipment in umbilical hernia combined with rectus abdominis separation with mesh sublay and it generated the definition of reverse-TEP (R-TEP) at the same time.[42] Recently, Binggen Li presents a new technique to repair middle-line IH under laparoscopy, which is called totally endoscopic sublay and he suggested the technique can treat IH in safety and efficiency with less invasion compared to Rives-Stoppa.[43] For now, surgeons are more likely to repair the IH in preperitoneal space rather than the intra-abdominal cavity because of the delayed in the mesh technique progression when compared to the incisional hernioplasty development.[30],[44] Less complication formed by minimal invasion of laparoscopic technique would like to be the biggest advantage of L-CST, but the longer operation period and smaller defect restriction may be a huge hinder for L-CST prevalence, which require further evolution.[29],[30],[44],[45],[46]

Trans-cutaneous closure of central defect

Trans-cutaneous closure of central defect is a technique to be used in IH repairment with defect <3 cm by pulling the defect close after puncture the epidermis on the both side of it. It is recommended to be performed in patients with parimary and small IH.[47]

When the defect is unable to be closed

Except for higher risk of recurrence, the abdominal compartment syndrome will be the worst result if intra-abdominal pressure exceed 20 mmHg after IH repairmen, especially when the defect is too large to be closed under physiological tension and it may even lead to death finally.[1],[14],[27],[46],[48] We can figure out the ratio between hernia sac and abdominal cavity to estimate the risk of ACS preoperatively. The volum of hernia sac and abdominal cavity can be calculated by multiplying anteroposterior diameter by horizontal diameter got from computed tomography scan.[49] Surgeons must choose the suitable method to close the abdominal cavity when the ratio exceeded 20%.

Bridge repair

By suturing the mesh with margin of defect instead of closing it.[7],[27],[29] The separation of muscular fasciae may still remain elite, and it was demonstrated that mesh can never replace the tenacious fascia, especially the Linea alba, and hence, it is hard for abdominal muscle to recover from the status in hypotrophy or fibrillation; thus, it carried higher risk of recurrence but no effect on AWF restoration.[7],[15],[17],[50],[51],[52] The implementation rate of bridge repair is no >10% worldwide.[53] It is worth to be mentioned that different grade of elasticity can be collected in different materials of mesh and it is also happened when the mesh been constrained in different direction. meanwhile, elasticity raised in longitudinal direction is stronger than transverse direction, so, we should chose an suitable mesh and suture it in an appropriate direction during the operation.[54],[55],[56],[57]

Autotransplantation

There are pedicle flap and free flap used in autotransplantation alternatively. It is necessary for free flap transplanting using microvascular anastomosis, and hence, it is more likely to be engaged in professional IH medical center; last but not the least, AM may turn into contracting disorder and get hypotrophy gradually, thus leading to IH recurrence eventually. So, the autotransplantation is often performed with CST and mesh utilization at same time in order to avoid hernia recurrence.[1],[7],[14],[58]

Operation selection

As for giant IH, the AWF deficiency is usually in direct proportion to the area defect, but the relationship between nongiant IH and AWF deficiency is still unclear. It is hypothesized by Jensen the AWF deficiency had already occurred even when the defect is small.[4] However, there are no much patients who suffer from symptoms mentioned at first until their defect exceeds 10 cm, and compensation from healthy tissue around small defect is thought to be the contributor.[1],[59] As a matter of fact, AWF is in decline when small defect grows into a big one and leads to LOD finally. It is necessary for surgeons to make an appropriate surgical plan as early as possible to solve the problem in patients who suffered from giant IH or take precaution against LOD in patients with nongiant IH.[5] Nonlaparoscopic IH repair techniques are recommended in most of the cases in consideration of shorter surgical time and wider defect area can be fixed when compared to laparoscopic repair, finally, the explicit recommendation sited in [Table 4].[35],[60]
Table 4: Operative recommendation

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  Expectation Top


There are still some issues about patients with LOD which need further clarified. At first, we shall classify giant IH into certain type by AWF recording and estimate the difficulty we may meet during the operation. Then, is there any difference between three groups of muscle on anterior AW in AWF creation or how can we rebuild Linea alba while causing minimal damage to AWF simultaneously. Finally, we shall watch out for recurrence when AWF stays in low level for a long time after surgery.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
China Hernia Society, Chinese Hernia College of Surgeons. Guidelines for diagnosis and treatment of abdominal wall incisional hernia (2018 edition). Zhonghua Wai Ke Za Zhi 2018;56:499-502.  Back to cited text no. 1
    
2.
Jensen KK, Kjaer M, Jorgensen LN. Abdominal muscle function and incisional hernia: A systematic review. Hernia 2014;18:481-6.  Back to cited text no. 2
    
3.
De Silva GS, Krpata DM, Hicks CW, Criss CN, Gao Y, Rosen MJ, et al. Comparative radiographic analysis of changes in the abdominal wall musculature morphology after open posterior component separation or bridging laparoscopic ventral hernia repair. J Am Coll Surg 2014;218:353-7.  Back to cited text no. 3
    
4.
Jensen KK, Munim K, Kjaer M, Jorgensen LN. Abdominal wall reconstruction for incisional hernia optimizes truncal function and quality of life: A prospective controlled study. Ann Surg 2017;265:1235-40.  Back to cited text no. 4
    
5.
Jacob BP, Ramshaw B. The SAGES Manual of Hernia Repair. New York: Springer; 2013.  Back to cited text no. 5
    
6.
Passot G, Villeneuve L, Sabbagh C, Renard Y, Regimbeau JM, Verhaeghe P, et al. Definition of giant ventral hernias: Development of standardization through a practice survey. Int J Surg 2016;28:136-40.  Back to cited text no. 6
    
7.
Gu Y, Song Z. Functional reconstruction for complex abdominal wall defect. Chin J Dig Surg 2015;14:813-5.  Back to cited text no. 7
    
8.
Bittner R, Bingener-Casey J, Dietz U, Fabian M, Ferzli GS, Fortelny RH, et al. Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International endohernia society (IEHS)-part 1. Surg Endosc 2014;28:2-9.  Back to cited text no. 8
    
9.
Liang MK, Holihan JL, Itani K, Alawadi ZM, Gonzalez JR, Askenasy EP, et al. Ventral hernia management: Expert consensus guided by systematic review. Ann Surg 2017;265:80-9.  Back to cited text no. 9
    
10.
Lavanchy JL, Buff SE, Kohler A, Candinas D, Beldi G. Long-term results of laparoscopic versus open intraperitoneal onlay mesh incisional hernia repair: A propensity score-matched analysis. Surg Endosc 2019;33:225-33.  Back to cited text no. 10
    
11.
Rogmark P, Smedberg S, Montgomery A. Long-term follow-up of retromuscular incisional hernia repairs: Recurrence and quality of life. World J Surg 2018;42:974-80.  Back to cited text no. 11
    
12.
Kokotovic D, Bisgaard T, Helgstrand F. Long-term recurrence and complications associated with elective incisional hernia repair. JAMA 2016;316:1575-82.  Back to cited text no. 12
    
13.
Fischer JP, Basta MN, Mirzabeigi MN, Bauder AR, Fox JP, Drebin JA, et al. Arisk model and cost analysis of incisional hernia after elective, abdominal surgery based upon 12,373 cases: The case for targeted prophylactic intervention. Ann Surg 2016;263:1010-7.  Back to cited text no. 13
    
14.
Parker SG, Halligan S, Blackburn S, Plumb AA, Archer L, Mallett S, et al. What exactly is meant by “Loss of domain” for ventral hernia? Systematic review of definitions. World J Surg 2019;43:396-404.  Back to cited text no. 14
    
15.
Criss CN, Petro CC, Krpata DM, Seafler CM, Lai N, Fiutem J, et al. Functional abdominal wall reconstruction improves core physiology and quality-of-life. Surgery 2014;156:176-82.  Back to cited text no. 15
    
16.
den Hartog D, Eker HH, Tuinebreijer WE, Kleinrensink GJ, Stam HJ, Lange JF, et al. Isokinetic strength of the trunk flexor muscles after surgical repair for incisional hernia. Hernia 2010;14:243-7.  Back to cited text no. 16
    
17.
Shestak KC, Edington HJ, Johnson RR. The separation of anatomic components technique for the reconstruction of massive midline abdominal wall defects: Anatomy, surgical technique, applications, and limitations revisited. Plast Reconstr Surg 2000;105:731-8.  Back to cited text no. 17
    
18.
Kuo YR, Kuo MH, Lutz BS, Huang YC, Liu YT, Wu SC, et al. One-stage reconstruction of large midline abdominal wall defects using a composite free anterolateral thigh flap with vascularized fascia lata. Ann Surg 2004;239:352-8.  Back to cited text no. 18
    
19.
Jensen KK, Backer V, Jorgensen LN. Abdominal wall reconstruction for large incisional hernia restores expiratory lung function. Surgery 2017;161:517-24.  Back to cited text no. 19
    
20.
DuBay DA, Choi W, Urbanchek MG, Wang X, Adamson B, Dennis RG, et al. Incisional herniation induces decreased abdominal wall compliance via oblique muscle atrophy and fibrosis. Ann Surg 2007;245:140-6.  Back to cited text no. 20
    
21.
Culbertson EJ, Xing L, Wen Y, Franz MG. Reversibility of abdominal wall atrophy and fibrosis after primary or mesh herniorrhaphy. Ann Surg 2013;257:142-9.  Back to cited text no. 21
    
22.
Culbertson EJ, Xing L, Wen Y, Franz MG. Loss of mechanical strain impairs abdominal wall fibroblast proliferation, orientation, and collagen contraction function. Surgery 2011;150:410-7.  Back to cited text no. 22
    
23.
Parker M, Goldberg RF, Dinkins MM, Asbun HJ, Daniel Smith C, Preissler S, et al. Pilot study on objective measurement of abdominal wall strength in patients with ventral incisional hernia. Surg Endosc 2011;25:3503-8.  Back to cited text no. 23
    
24.
Jensen KK, Kjaer M, Jorgensen LN. Isometric abdominal wall muscle strength assessment in individuals with incisional hernia: A prospective reliability study. Hernia 2016;20:831-7.  Back to cited text no. 24
    
25.
Sreenath GS, Subramanian SK, Sharma VK. Assessment of abdominal muscle's maximal force of contraction using surface EMG in inguinal hernia patients. J Clin Diagn Res 2016;10:PC10-3.  Back to cited text no. 25
    
26.
Ross SW, Wormer BA, Kim M, Oommen B, Bradley JF, Lincourt AE, et al. Defining surgical outcomes and quality of life in massive ventral hernia repair: An international multicenter prospective study. Am J Surg 2015;210:801-13.  Back to cited text no. 26
    
27.
Chen S. The progression and complication of component separation technique. Chin J Gen Surg 2017;11:80-4.  Back to cited text no. 27
    
28.
Emanuelsson P, Gunnarsson U, Strigård K, Stark B. Early complications, pain, and quality of life after reconstructive surgery for abdominal rectus muscle diastasis: A 3-month follow-up. J Plast Reconstr Aesthet Surg 2014;67:1082-8.  Back to cited text no. 28
    
29.
Gu Y, Wang H. The application of component separation technique in abdominal wall reconstruction. J Surg Theory Pract 2013;3:214-7.  Back to cited text no. 29
    
30.
Yue F, Li J. The problem controversy and countermeasure of laparoscopic incisional hernioplasty. Chin J Pract Surg 2018;38:183-6.  Back to cited text no. 30
    
31.
Gu Y. Endoscopic component separation technique for abdominal wall defect. Chin J Gen Surg Oper 2014;3:15-8.  Back to cited text no. 31
    
32.
Rosen MJ, Williams C, Jin J, McGee MF, Schomisch S, Marks J, et al. Laparoscopic versus open-component separation: A comparative analysis in a porcine model. Am J Surg 2007;194:385-9.  Back to cited text no. 32
    
33.
Novitsky YW, Elliott HL, Orenstein SB, Rosen MJ. Transversus abdominis muscle release: A novel approach to posterior component separation during complex abdominal wall reconstruction. Am J Surg 2012;204:709-16.  Back to cited text no. 33
    
34.
Pauli EM, Wang J, Petro CC, Juza RM, Novitsky YW, Rosen MJ, et al. Posterior component separation with transversus abdominis release successfully addresses recurrent ventral hernias following anterior component separation. Hernia 2015;19:285-91.  Back to cited text no. 34
    
35.
Blair LJ, Cox TC, Huntington CR, Groene SA, Prasad T, Lincourt AE, et al. The effect of component separation technique on quality of life (QOL) and surgical outcomes in complex open ventral hernia repair (OVHR). Surg Endosc 2017;31:3539-46.  Back to cited text no. 35
    
36.
Reinpold W, Schröder M, Berger C, Nehls J, Schröder A, Hukauf M, et al. Mini- or less-open sublay operation (MILOS): A New minimally invasive technique for the extraperitoneal mesh repair of incisional hernias. Ann Surg 2019;269:748-55.  Back to cited text no. 36
    
37.
Köckerling F, Botsinis MD, Rohde C, Reinpold W. Endoscopic-assisted linea alba reconstruction plus mesh augmentation for treatment of umbilical and/or epigastric hernias and rectus abdominis diastasis - early results. Front Surg 2016;3:27.  Back to cited text no. 37
    
38.
Belyansky I, Zahiri HR, Park A. Laparoscopic transversus abdominis release, a novel minimally invasive approach to complex abdominal wall reconstruction. Surg Innov 2015;23:403-6.  Back to cited text no. 38
    
39.
Martin-Del-Campo LA, Weltz AS, Belyansky I. Comparative analysis of perioperative outcomes of robotic versus open transversus abdominis release. Surg Endosc 2017;32:1-6.  Back to cited text no. 39
    
40.
Costa TN, Abdalla RZ, Santo MA, Tavares RR, Abdalla BM, Cecconello I, et al. Transabdominal midline reconstruction by minimally invasive surgery: Technique and results. Hernia 2016;20:257-65.  Back to cited text no. 40
    
41.
Montgomery A. The best of two worlds: A new innovative laparoscopic Rives-Stoppa technique for ventral/incisional hernias–“the Brazilian technique”: Invited commentary to: Transabdominal midline reconstruction by minimally invasive surgery: Technique and results. Costa TN, Abdalla RZ, Santo MA, TAVARES RRFM, ABDAlla BMZ, Cecconello I. Hernia 2016;20:267-70.  Back to cited text no. 41
    
42.
Schwarz J, Reinpold W, Bittner R. Endoscopic mini/less open sublay technique (EMILOS)-a new technique for ventral hernia repair. Langenbecks Arch Surg 2017;402:173-80.  Back to cited text no. 42
    
43.
Li B, Qin C, Bittner R. Totally endoscopic sublay (TES) repair for midline ventral hernia: Surgical technique and preliminary results. Surg Endosc 2018;29:1-8.  Back to cited text no. 43
    
44.
Wang M, Liu Y, Cao J. The history and actuality of incisional hernioplasty. J Laparosc Surg 2017;22:81-5.  Back to cited text no. 44
    
45.
Elstner KE, Jacombs AS, Read JW, Rodriguez O, Edye M, Cosman PH, et al. Laparoscopic repair of complex ventral hernia facilitated by pre-operative chemical component relaxation using botulinum toxin A. Hernia 2016;20:209-19.  Back to cited text no. 45
    
46.
Li J. The actuality and tendency of primary and incisional ventral hernia. Chin J Gen Surg 2016;31:715-8.  Back to cited text no. 46
    
47.
Clapp ML, Hicks SC, Awad SS, Liang MK. Trans-cutaneous closure of central defects (TCCD) in laparoscopic ventral hernia repairs (LVHR). World J Surg 2013;37:42-51.  Back to cited text no. 47
    
48.
Kirkpatrick AW, Nickerson D, Roberts DJ, Rosen MJ, McBeth PB, Petro CC, et al. Intra-abdominal hypertension and abdominal compartment syndrome after abdominal wall reconstruction: Quaternary syndromes? Scand J Surg 2017;106:97-106.  Back to cited text no. 48
    
49.
Nie X, Gu Y. Surgical treatment for incisional hernia with loss of domain. Chin J Pract Surg 2014;34:395-8.  Back to cited text no. 49
    
50.
Holihan JL, Askenasy EP, Greenberg JA, Keith JN, Martindale RG, Roth JS, et al. Component separation vs. bridged repair for large ventral hernias: A multi-institutional risk-adjusted comparison, systematic review, and meta-analysis. Surg Infect (Larchmt) 2016;17:17-26.  Back to cited text no. 50
    
51.
Booth JH, Garvey PB, Baumann DP, Selber JC, Nguyen AT, Clemens MW, et al. Primary fascial closure with mesh reinforcement is superior to bridged mesh repair for abdominal wall reconstruction. J Am Coll Surg 2013;217:999-1009.  Back to cited text no. 51
    
52.
Liang MK, Clapp M, Li LT, Berger RL, Hicks SC, Awad S, et al. Patient satisfaction, chronic pain, and functional status following laparoscopic ventral hernia repair. World J Surg 2013;37:530-7.  Back to cited text no. 52
    
53.
Krpata DM, Blatnik JA, Novitsky YW, Rosen MJ. Posterior and open anterior components separations: A comparative analysis. Am J Surg 2012;203:318-22.  Back to cited text no. 53
    
54.
Junge K, Klinge U, Prescher A, Giboni P, Niewiera M, Schumpelick V, et al. Elasticity of the anterior abdominal wall and impact for reparation of incisional hernias using mesh implants. Hernia 2001;5:113-8.  Back to cited text no. 54
    
55.
Wu Y, Li Z. The progression of hernioplasty and mesh material. J Med Rev 2013;19:2190-3.  Back to cited text no. 55
    
56.
Brown CN, Finch JG. Which mesh for hernia repair? Ann R Coll Surg Engl 2010;92:272-8.  Back to cited text no. 56
    
57.
Saberski ER, Orenstein SB, Novitsky YW. Anisotropic evaluation of synthetic surgical meshes. Hernia 2011;15:47-52.  Back to cited text no. 57
    
58.
Patel NG, Ratanshi I, Buchel EW. The best of abdominal wall reconstruction. Plast Reconstr Surg 2018;141:113e-36e.  Back to cited text no. 58
    
59.
Strigård K, Clay L, Stark B, Gunnarsson U, Falk P. Giant ventral hernia-relationship between abdominal wall muscle strength and hernia area. BMC Surg 2016;16:50.  Back to cited text no. 59
    
60.
Nguyen DH, Nguyen MT, Askenasy EP, Kao LS, Liang MK. Primary fascial closure with laparoscopic ventral hernia repair: Systematic review. World J Surg 2014;38:3097-104.  Back to cited text no. 60
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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