THESIS PROTOCOL FOR MS GENERAL SURGERY
TOPIC
Comparison of Recurrent Ventral Hernia With Non-
recurrent Ventral Hernia for Intra-operative &
Post-operative Outcomes
Candidate: Dr Manjur Akhtar
Junior Resident(1st year)
Department of General Surgery,
JNMCH, AMU, Aligarh
Supervisor : Dr Md. Yusuf Afaque
MS,FNB,FLCS,FIAGES
Assistant Professor
Department of General Surgery, JNMCH,
AMU, Aligarh
INTRODUCTION
Multiple hernia repairs decrease the quality of the hernia increases from 24 %
after the first repair to 35 % after the second repair and 39 % after the third
repair [1]. A dedicated abdominal wall due to tissue dissection, mesh
explantation, fascial retraction, or denervation atrophy of muscles, making
further repair difficult. A cohort study has found that the recurrence rate of
incisional hernia surgeon should operate on these hernias to achieve an
optimum outcome [2]. A recurrent incisional hernia after a mesh repair is a
complex hernia [3]; however, a previous anatomical repair is not a high-risk
factor.
Recurrent hernia is always a surgical challenge. The incidence of recurrence is
most often held as the measure of success used to compare the various methods
of hernia repair.
Repairs of Recurrent Ventral Hernia Are Reported To Have Higher
Complication Rates than the Non-Recurrent Ventral Hernia Repairs.
Reference Operative Previous N Post operative
techniques repair complication
Berry et al.(4) Retromuscular -- 47 Thromboembolic
sublay repair + event 13%, wound
panniculectomy infection 8%, wound
dehience 8%
Temudom et Modified stoppa -- 27 wound infection 8%,
al. (5) technique mesh removal 2%
Dibello and Compound flap -- 35 Seroma 2.8%, wound
infection 5.7%,
Moore(6) of rectus muscle hematoma 5.7%
Novitisky et al Preperitoneal - 32 Wound infection 12.5
(7)
retrofascial mesh %
repair
AIMS & OBJECTIVE
• To Compare the intra-operative outcomes of recurrent ventral hernia and
non-recurrent ventral hernia.
• To compare the post- operative outcomes of recurrent ventral hernia and
non- recurrent ventral hernia.
MATERIAL AND METHODS
1. Type of study- Prospective comparative observational study
2. Place of study- Department of Surgery: JNMCH, AMU, Aligarh, UP.
3. Duration of Study- May 2023 to May 2025
4. Proposed Sample Size- 20 Patients.
METHODOLOGY CONTD.
• Patient undergoing surgery for recurrent hernia will be studied for
• Intraoperative Outcomes likes
o Blood loss
o Operative time
o Difficulty due to previous mesh
o Difficulty due to scar tissue
o Mesh Explantation
Postoperative Outcomes likes
o Surgical site infections
o Seroma
o Hematoma
o Wound dehiscence
o 90th day re-admission
o Initial postoperative pain
o Long term pain
o Recurrences
o Clavien & Dindo score
INCLUSION CRITERIA-
The patient of recurrent ventral hernia going for surgery.
The patient of non-recurrent ventral hernia going for surgery.
EXCLUSION CRITERIA-
Age <15years.
STATISTICAL ANALYSIS
• Mean & Range of all the intraoperative & postoperative outcomes will be
calculated.
• Statistical difference will be calculated by using unpaired T-test and a p-
value of <0.05 will be considered significant
DISCHARGE WITH FOLLOW UP PLANNING
Duration of hospital stay to be calculated
Patients will be followed up at General Surgery OPD after
2 weeks
3months
FOLLOW UP ASSESSMENT
VAS SCORE:
HERNIA RELATED QUALITY OF LIFE SCORE (HerQLes) [8]
PROFORMA
DATE:
S.NO.
NAME:
AGE:
SEX:
CADS:
WEIGHT:
HEIGHT:
BMI:
PHONE NO:
CASE SUMMARY
HISTORY &
EXAMINATION CO-MORBIDITIES
POSITIVE FINDINGS
DETAILS OF
PREVIOUS HERNIA ADDICTION
SURGERY
DETAILS OF
PRESENT HERNIA
SURGERY
INTRA-OPERATIVE OUTCOMES:
o Blood loss
o Operative time
o Difficulty due to previous mesh
o Difficulty due to scar tissue
MESH EXPLANTATION: Y or N
POST-OPERATIVE OUTCOMES:
o surgical site infections
o seroma
o hematoma
o wound dehiscence
o 90th day re-admission
o initial postoperative pain
o long term pain
o recurrences
o Clavien & Dindo Score
o Visual Analog Pain Score
o Hernia Related Quality Life Score(HerQLes)
INFORMED CONSENT
Participant’s name:
Address:
Title of the project:
The details of the study have been provided to me in writing and explained to me in my own
language. I confirm that I have understood the above study and had the opportunity to ask
questions. I understand that my participation* in the study is voluntary and that I am free to
withdraw at any time, without giving any reason, without the medical care that will normally
be provided by the hospital being affected. I agree not to restrict the use of any data or results
that arise from this study provided such a use is only for scientific purpose(s). I have been
given an information sheet giving details of the study. I fully consent to participate in the
above study.
Signature of the participant: Date:____________
Signature of the witness:Date: ____________
Signature of the investigator: Date: ___________
सहमतिपत्र
प्रतिभागी का नाम:
पता:
परियोजना का शीर्षक:
अध्ययन का विवरण मुझे लिखित रूप में प्रदान किया गया है और मुझे अपनी
भाषा में समझाया गया है। मैं पुष्टि करता हूं कि मैंने उपरोक्त अध्ययन को
समझा है और मुझे प्रश्न पूछने का अवसर मिला है। मैं समझता हूं कि अध्ययन
में मेरी भागीदारी* स्वैच्छिक है। मैं इस अध्ययन से उत्पन्न होने वाले
किसी भी डेटा या परिणामों के उपयोग को प्रतिबंधित नहीं करने के लिए सहमत
हूं, बशर्ते ऐसा उपयोग केवल वैज्ञानिक उद्देश्य के लिए हो। मुझे अध्ययन
का विवरण देते हुए एक सूचना पत्र दिया गया है। उपरोक्त अध्ययन में भाग
लेने के लिए मैं पूरी तरह से सहमत हूं।
प्रतिभागी का हस्ताक्षर: दिनांक: ____________
साक्षीका हस्ताक्षर: दिनांक: ____________
अन्वेषक का हस्ताक्षर: दिनांक: ____________
REFERENCES:
1. Flum DR, Horvath K, Koepsell T (2003) Have outcomes of incisional hernia
repair improved with time? A population-based analysis. Ann Surg
237(1):129–135
2. Sneiders D, de Smet GHJ, Hartog FD et al (2021) Outcomes of incisional
hernia repair surgery after multiple re-recurrences: a propensity score matched
analysis. World J Surg. https://doi.org/10.1007/s00268-021-05952-5
3. Slater, N.J., Montgomery, A., Berrevoet, F. et al. (2014) Criteria for definition
of a complex abdominal wall hernia. Hernia 18, 7–17.
https://doi.org/10.1007/s10029-013-1168-6
4. Berry, MF, Paisley, S, Low, DW, Rosato, EF. Repair of large complex
recurrent incisional hernias with retromuscular mesh and panniculectomy. Am
J Surg. (2007) 194:199–204. doi: 10.1016/j.amjsurg.2006.10.031
5. Temudom, T, Siadati, M, Sarr, MG. Repair of complex giant or recurrent
ventral hernias by using tension-free intraparietal prostheric mesh (Stopp
technique): lessons learned from our initial experience (fifty patients). Surgery.
(1996) 120:738–44.\
6. DiBello, J, Moore, JH. Sliding myofascial flap of the rectus abdominus
muscles for the closure of recurrent ventral hernias. Plast. Reconstr Surg.
(1996) 98:464.
7. Novitsky, YW, Porter, JT, Ruch, ZC, Getz, SB, Pratt, BL, Kercher, KW, et al.
Open preperitoneal retrofascial mesh repair for multiply recurrent ventral
incisional hernias. J Am Coll Surg. (2006) 203:3. doi:
10.1016/j.jamcollsurg.2006.05.297
8. Krpata DM, Schmotzer BJ, Flocke S, Jin J, Blatnik JA, Ermlich B, Novitsky
YW, Rosen MJ. Design and initial implementation of HerQLes: a hernia-
related quality-of-life survey to assess abdominal wall function. J Am Coll
Surg. 2012 Nov;215(5):635-42. doi: 10.1016/j. jamcollsurg.2012.06.412. Epub
2012 Aug 4. PMID: 22867715.
