Closing gaps Risk factoRs, occuRRence, and tReatment of abdominal wall heRnias

244 Pages·2017·31.23 MB·English

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Closing gaps Risk factoRs,
occuRRence, and tReatment
of abdominal wall heRnias
leonard Frederik Kroese
uitnodiging
voor het bijwonen van de
openbare verdediging van
het proefschrift
Closing gaps
Risk factoRs, occuRRence,
and tReatment of
abdominal wall heRnias
door leonard kroese
datum
woensdag 30 mei 2018
om 15.30u
loCatie
Professor andries Queridozaal
onderwijscentrum erasmus mc
wytemaweg 80, Rotterdam.
aansluitend bent u van harte
uitgenodigd voor de receptie.
paranimFen:
sylvia kroese
marnix Verberne
leonard Kroese
heemskerkstraat 14a2
3038 Ve Rotterdam
06-42963481
[email protected]
Closing gaps - risk factors, occurrence,
and treatment of abdominal wall hernias
Leonard Frederik Kroese
ISBN 978-94-6375-004-2
Cover design and layout: Roos Verhooren (Silver Arrows MultiMedia)
Printing: Ridderprint BV, Ridderkerk
Printing of this thesis was financially supported by: Department of Surgery Erasmus MC,
Erasmus MC University Medical Center Rotterdam, Chipsoft, Congress Company, Dutch
Hernia Society.
(c) L.F. Kroese, Rotterdam, the Netherlands, 2018. No part of this thesis may be reproduced,
stored or transmitted in any form by any means without prior permission of the publishing
journal or the author.
Closing gaps - risk factors, occurrence,
and treatment of abdominal wall hernias
Hiaten dichten - Risicofactoren, voorkomen en
behandeling van buikwandbreuken
Proefschrift
ter verkrijging van de graad van doctor aan de
Erasmus Universiteit Rotterdam
op gezag van de
rector magnificus
Prof.dr. H.A.P. Pols
en volgens besluit van het College voor Promoties.
De openbare verdediging zal plaatsvinden op
woensdag 30 mei 2018 om 15.30 uur
Leonard Frederik Kroese
geboren te Utrecht
Promotiecommissie:
Promotoren: Prof.dr. G.J. Kleinrensink
Prof.dr. J.F. Lange
Overige leden: Prof.dr. H.J.M. Verhagen
Prof.dr. S.E.R. Hovius
Prof.dr. C.H.J. van Eijck
Copromotor: Prof.dr. J. Jeekel
Closing gaps - risk factors, occurrence, and treatment
of abdominal wall hernias
1. General introduction
Part I Preventing hernia occurrence & risk factors
2. Hernia Prevention and the importance of laparotomy closure
3 Modalities for the diagnosis of incisional hernia
4 Extraperitoneal versus transperitoneal colostomy for preventing parastomal hernia
Part II Treatment of simple hernias
5. A comparison of patient characteristics and postoperative complications of primary
and incisional ventral hernias
6. Identification of risk factors for postoperative complications in patients undergoing
primary ventral hernia repair
7. Risk factors for postoperative complications after incisional hernia repair
8. European Hernia Society guidelines on prevention and treatment of parastomal
hernias
9. Non-operative treatment as a strategy for patients with parastomal hernia
Part III Treatment of complex hernias
10. Long term results of open complex ventral hernia repair with a self-gripping mesh
11. Complications and recurrence rates of patients with Ehlers-Danlos undergoing hernia
repair
12. PhasixTM Mesh for VHWG Grade 3 midline incisional hernia repair
Part IV New developments
13. The AbdoMAN: an artificial abdominal wall simulator for biomechanical studies on
closure techniques
14. General discussion and future perspectives
Summary
Nederlandse samenvatting
Contributors to this thesis
List of publications
PhD portfolio
Dankwoord
Curriculum vitae

chapter 1
General introduction and outline of this
thesis
8 | Chapter 1
General introduction
The human abdominal wall consists of all structures that surround the abdominal cavity,
including the abdominal muscles, fat, fasciae, and skin. The term ‘abdominal wall hernia’
generally refers to a defect in the connective tissue of the abdominal wall, most often at the
midline (linea alba) between the rectus abdominis muscles and more rarely like the Spighelian
hernia at the level of the lateral muscles (external oblique, internal oblique, and transverse
abdominis muscles). An abdominal wall hernia is a protrusion of preperitoneal fat or abdominal
contents (fat, bowel, liver) through the abdominal wall. It can occur at any weakened spot of
the abdominal wall.
Abdominal wall hernias can be divided into two categories. One category of hernias:
primary hernias, can be found at natural weak spots of the abdominal wall that are present
from birth. These weak spots are either formed at a location where structures go from inside
the abdominal cavity to outside the abdominal cavity (causing umbilical or inguinal hernias),
or they are formed by weakness in the connective tissue at the junction of different muscles
(causing either epigastric or Spigelian hernias). The most frequently seen inguinal hernia
occurs at one of these weak spots, the foramen of Fruchaud.
The second category of hernias is caused by weak spots due to surgery. When such
hernias occur after an incision (laparotomy), they are called incisional hernia and when they
occur after stoma creation, are called parastomal hernias.
hernia biology
To understand hernia biology, it is important first to know the biology in healthy patients. In
healthy connective tissue, degradation of old proteins and synthesis of new proteins are in
balance.1 One of the most important proteins in connective tissue is collagen. Collagen is
synthesized by fibroblasts and it eventually forms mature fibrils.2 Currently, more than twenty
different subtypes of human collagen are known.3 In the human fascia, collagen types I and
III are predominant.4 Type I collagen is mature, mechanically stable collagen, whereas type III
is immature and mechanically unstable.5 In healthy people, these two types of collagen are in
balance. In hernia patients however, less type I collagen is found in connective tissue, leading
to a smaller collagen type I/III ratio. This decreased ratio can be found in connective tissue
throughout the whole body. It leads to thinner collagen fibers with less tensile strength. In
areas subject to repetitive strain, such as the abdominal wall, this results in the stretching of
connective tissue, eventually leading to hernia formation.6, 7
risk factors
Several factors are associated with a higher risk of incisional hernia development. These
factors can be divided into three categories: pre-, per-, and postoperative factors. Although
divided into separate categories, it must be kept in mind that these factors interact and can