Clinical Service Line 12 - Imaging, Breast Screening

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    Revisiting large complex ventral hernia repair: multimodal hybrid technique deploying preoperative Botulinum Toxin A injection, laparoscopic anterior components separation and open mesh repair
    (2024) Hashmi, K.S; Udeaja, Y.Z; Dastur, J; Allen, S; Das, P
    Abstract In the past, various techniques had been described to repair large complex ventral hernias. Laparoscopic technique of components separation showed low complication rates and better overall outcome. Recently, Botulinum Toxin A (BTA) has shown benefit in achieving tension-free repair. We describe here our multimodal technique combining BTA injection, laparoscopic anterior components separation (LACS) and open mesh repair. Ten consecutive cases performed over 3 years were studied. A standardised technique was used with a reasonably short learning curve. Patients who generally fit for general anaesthesia were offered surgery after detailed preoperative imaging work up and informed consent. Demographic details, preoperative risk stratification, intraoperative and postoperative outcomes were recorded and analysed. A structured step by step management strategy was adopted. Total ten (n = 10) cases with median age of 42.5 years (range 28-76 years), male to female ratio of 8:2 and median BMI of 32.6 were included. Three patients had pre-existing stomas. Median diameter of hernial defect was 10 cm, IQR 4.8 cm and range of 6-20 cm. No intraoperative or immediate complications were observed. Median hospital stay was 6 days. Two seromas (20%) and two return to theatre (20%) were observed. One recurrence (10%) was observed after median follow-up of 32 months. No 90-day mortality was recorded. Multimodal technique of BTA injection, LACS and midline mesh repair is a reproducible, safe and effective option to repair large complex ventral hernias. Keywords: Components separation; Hernia; Intraperitoneal mesh; Laparoscopic; Ventral hernia. © 2024. Italian Society of Surgery (SIC). PubMed Disclaimer Similar articles Preoperative Botulinum toxin A enabling defect closure and laparoscopic repair of complex ventral hernia. Rodriguez-Acevedo O, Elstner KE, Jacombs ASW, Read JW, Martins RT, Arduini F, Wehrhahm M, Craft C, Cosman PH, Dardano AN, Ibrahim N. Surg Endosc. 2018 Feb;32(2):831-839. doi: 10.1007/s00464-017-5750-3. Epub 2017 Jul 21. PMID: 28733748 Laparoscopic repair of complex ventral hernia facilitated by pre-operative chemical component relaxation using Botulinum Toxin A. Elstner KE, Jacombs AS, Read JW, Rodriguez O, Edye M, Cosman PH, Dardano AN, Zea A, Boesel T, Mikami DJ, Craft C, Ibrahim N. Hernia. 2016 Apr;20(2):209-19. doi: 10.1007/s10029-016-1478-6. Epub 2016 Mar 7. PMID: 26951247 Minimally invasive Venetian blinds ventral hernia repair with botulinum toxin chemical component separation. Chan DL, Ravindran P, Fan HS, Elstner KE, Jacombs ASW, Ibrahim N, Talbot ML. ANZ J Surg. 2020 Jan;90(1-2):67-71. doi: 10.1111/ans.15438. Epub 2019 Sep 30. PMID: 31566297 Laparoscopic tension-free repair of anterior abdominal wall incisional and ventral hernias with an intraperitoneal Gore-Tex mesh: prospective study and review of the literature. Aura T, Habib E, Mekkaoui M, Brassier D, Elhadad A. J Laparoendosc Adv Surg Tech A. 2002 Aug;12(4):263-7. doi: 10.1089/109264202760268041. PMID: 12269494 Review. Low-Dose Pre-Operative Botulinum Toxin A Effectively Facilitates Complex Ventral Hernia Repair: A Case Report and Review of the Literature. Mourad AP, De Robles MS, Winn RD. Medicina (Kaunas). 2020 Dec 28;57(1):14. doi: 10.3390/medicina57010014. PMID: 33379146 Free PMC article. Review. See all similar articles References Ramirez OM, Ruas E, Dellon AL (1990) “Components separation” method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg 86:519–526 - DOI - PubMed Switzer NJ, Dykstra MA, Gill RS, Lim S, Lester E, de Gara C, Shi X, Birch DW, Karmali S (2015) Endoscopic versus open component separation: systematic review and meta-analysis. Surg Endosc 29:787–795 - DOI - PubMed Hodgkinson JD, Leo CA, Maeda Y, Bassett P, Oke SM, Vaizey CJ, Warusavitarne J (2018) A meta-analysis comparing open anterior component separation with posterior component separation and transversus abdominis release in the repair of midline ventral hernias. Hernia 22:617–626 - DOI - PubMed Feretis M, Orchard P (2015) Minimally invasive component separation techniques in complex ventral abdominal hernia repair: a systematic review of the literature. Surg Laparosc Endosc Percutan Tech 25:100–105 - DOI - PubMed Tong WM, Hope W, Overby DW, Hultman CS (2011) Comparison of outcome after mesh-only repair, laparoscopic component separation, and open component separation. Ann Plast Surg 66:551–556 - DOI - PubMed Show all 19 references Related information MedGen LinkOut - more resources Full Text Sources Springer Miscellaneous NCI CPTAC Assay Portal
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    Clinical audit and research in radiography practice: An exploration of the English landscape
    (2023-01) Yakubu, Abdulai; Briggs, E; Hacking, S.; Akudjedu, T. N.
    Background: Research and clinical audit are central to the quality improvement (QI) process in healthcare; whereas research produces new knowledge, clinical audit establishes if practice is meeting set standards. Thus, radiographers have responsibility to engaging in these QI activities. This study aimed to explore radiographers' understanding, attitudes and level of involvement in clinical research and audit across England. Methods: A cross-sectional survey using an online questionnaire for data collection over a 6-week period was employed. The questionnaire consisted of open and closed ended questions. Participants were recruited through social media. The quantitative data obtained was analysed using Statistical Package for Social Sciences (SPSS) Version 26 (IBM Inc, Armonk, NY) whilst content analysis was used to analyse the free-response data. Results: A total of 100 valid responses were obtained after exclusion of 45 partial and/or incomplete responses. Radiographers showed a positive attitude towards involvement in research and audit with overall mean score of 3.85 (SD 0.80) and 4.01 (SD 0.80), respectively. Of the respondents, 35.7% (n = 35/98) were currently involved in clinical audit projects whilst 78.6% (n = 77/98) have previously been involved. Radiographers with postgraduate degrees were significantly more likely to have initiated research, 61.5% (n = 16/26) (p = 0.01) and to have previously been involved with research, 80.8% (n = 21/26) (p = 0.02). A significant association between radiographers' role and implementation of changes, following an audit (p = 0.03) was noted. Similarly, a significant association was noted between radiographers' role and initiation of research (p = 0.05). Conclusion: Clinical radiographers in England showed a positive attitude towards research and audit. However, this did not translate into actual participation in research and audit activities. Implications for practice: The need to stimulate clinical radiographers' interest in clinical audit and research is highlighted. Additionally, the findings support the rationale for managers to give more support including protected time to radiographers to engage in QI activities.