Functional abdominal wall reconstruction improves core physiology and quality-of-life

Introduction One of the goals of modern ventral hernia repair (VHR) is restoring the linea alba by returning the rectus muscles to the midline. Although this practice presumably restores native abdominal wall function, improvement of abdominal wall function has never been measured in a scientific fashion. We hypothesized that a dynamometer could be used to demonstrate an improvement in rectus muscle function after open VHR with restoration of the midline, and that this improvement would be associated with a better quality-of-life. Methods Thirteen patients agreed to dynamometric analysis before and 6 months after an open posterior component separation (Rives-Stoppa technique complimented with a transversus abdominis muscle release) and mesh sublay. Analysis done using a dynamometer (Biodex 3, Corp, Shirley, NY) included measurement of peak torque (PT; N*m) and PT per bodyweight (BW; %) generated during abdominal flexion in 5 settings: Isokinetic analysis at 45°/s and 60°/s as well as isometric analysis at 0°, -15°, and +15°. Power (W) was calculated during isokinetic settings. Quality-of-life was measured using our validated HerQles survey at the time of each dynamometric analysis. Results Thirteen patients (mean age, 54 ± 9 years; mean body mass index, 31 ± 7 kg/m2) underwent repair with restoration of the midline using the aforementioned technique. Mean hernia width was 12.5 cm (range, 5-19). Improvements in PT and PT/BW were significant in all 5 settings (P <.05). Improvement in power during isokinetic analyses at 45°/s and 60°/s was also significant (P <.05). All patients reported an improvement in quality-of-life, which was associated positively with each dynamometric parameter. Conclusion Restoration of the linea alba during VHR is associated with improved abdominal wall functionality. Analysis of rectus muscle function using a dynamometer showed statistical improvement by isokinetic and isometric measurements, all of which were associated with an improvement in quality-of-life

Economic modeling and budget impact analysis in abdominal surgery: the case of Mesh

The chapter describes the Budget Impact Analysis (BIA) which is increasingly demanded by regulators as an essential part of a comprehensive economic evaluation of a new healthcare intervention. An example of BIA is presented considering the case of prostheses for incisional hernia repairs. The objective of this chapter is to give an overview of an ongoing project with the aim to estimate the current economic impact of the management of patients with incisional abdominal hernia through biosynthetic, synthetic or biologic meshes and to evaluate changes in the healthcare budget considering a future scenario with increased utilization rates of biosynthetic meshes in the next five years. The analysis is performed from the hospital perspective in Italy