1
|
Campanile FC, Podda M, Pecchini F, Inama M, Molfino S, Bonino MA, Ortenzi M, Silecchia G, Agresta F, Cinquini M. Laparoscopic treatment of ventral hernias: the Italian national guidelines. Updates Surg 2023:10.1007/s13304-023-01534-3. [PMID: 37217637 PMCID: PMC10202362 DOI: 10.1007/s13304-023-01534-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/10/2023] [Indexed: 05/24/2023]
Abstract
Primary and incisional ventral hernias are significant public health issues for their prevalence, variability of professional practices, and high costs associated with the treatment In 2019, the Board of Directors of the Italian Society for Endoscopic Surgery (SICE) promoted the development of new guidelines on the laparoscopic treatment of ventral hernias, according to the new national regulation. In 2022, the guideline was accepted by the government agency, and it was published, in Italian, on the SNLG website. Here, we report the adopted methodology and the guideline's recommendations, as established in its diffusion policy. This guideline is produced according to the methodology indicated by the SNGL and applying the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology. Fifteen recommendations were produced as a result of 4 PICO questions. The level of recommendation was conditional for 12 of them and conditional to moderate for one. This guideline's strengths include relying on an extensive systematic review of the literature and applying a rigorous GRADE method. It also has several limitations. The literature on the topic is continuously and rapidly evolving; our results are based on findings that need constant re-appraisal. It is focused only on minimally invasive techniques and cannot consider broader issues (e.g., diagnostics, indication for surgery, pre-habilitation).
Collapse
Affiliation(s)
- Fabio Cesare Campanile
- Division of General Surgery, ASL Viterbo, San Giovanni Decollato-Andosilla Hospital, Civita Castellana, Italy
| | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Francesca Pecchini
- Department of General Surgery, Emergency and New Technologies, Baggiovara General Hospital, AOU Modena, Modena, Italy
| | - Marco Inama
- General and Mininvasive Surgery Department, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
| | - Sarah Molfino
- General Surgery Unit Chirurgia III, ASST Spedali Civili di Brescia, Brescia, Italy
| | | | - Monica Ortenzi
- Department of General and Emergency Surgery, Marche Polytechnic University, Via Conca 71, 60126, Ancona, Italy.
| | - Gianfranco Silecchia
- Department of Medical-Surgical Sciences and Translation Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | | | - Michela Cinquini
- Department of Oncology, Laboratory of Methodology of Sistematic Reviews and Guidelines Production, Istituto di Ricerche Farmacologiche Mario Negri IRCCS., Milan, Italy
| |
Collapse
|
2
|
Reoperation for Recurrence is Affected by Type of Mesh in Laparoscopic Ventral Hernia Repair: A Nationwide Cohort Study. Ann Surg 2023; 277:335-342. [PMID: 34520420 DOI: 10.1097/sla.0000000000005206] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the reoperation rate for recurrence between different mesh types in laparoscopic ventral hernia repair. SUMMARY OF BACKGROUND DATA Ventral hernia repair has improved over the last decades. Nevertheless, recurrence rates are still high, and one type of mesh was recently found to increase it even more. METHODS A nationwide cohort study based on prospectively collected data from the Danish Ventral Hernia Database. We included adult patients that had undergone a laparoscopic ventral hernia repair for either an incisional or a primary hernia. The primary and incisional hernias were analyzed in separate cohorts. The mesh-group with the lowest reoperation for recurrence curve was used as the reference. The outcome was reoperation for recurrence. RESULTS Study population comprised 2874 patients with primary hernias and 2726 with incisional hernias. For primary hernias, Physiomesh [HR = 3.45 (2.16-5.51)] and Proceed Surgical Mesh [HR = 2.53 (1.35-4.75)] had a significantly higher risk of reoperation for recurrence than DynaMesh-IPOM. For incisional hernias, Physiomesh [HR = 3.90 (1.80-8.46), Ventralex Hernia Patch (HR = 2.99 (1.13-7.93), Parietex Composite (incl. Optimized) (HR = 2.55 (1.17-5.55), and Proceed Surgical Mesh (HR = 2.63 (1.11-6.20)] all had a significantly higher risk of reoperation for recurrence than Ventralight ST Mesh. CONCLUSION For primary hernias, Physiomesh and Proceed Surgical Mesh had a significantly higher risk of reoperation for recurrence compared with DynaMesh-IPOM. For incisional hernias, the risk was significantly higher for Physiomesh, Parietex Composite, Ventralex Hernia Patch, and Proceed Surgical Mesh compared with Ventralight ST Mesh. This indicates that type of mesh may be associated with outcomes, and mesh choice could therefore depend on hernia type.
Collapse
|
3
|
Predictive factors of recurrence for laparoscopic repair of primary and incisional ventral hernias with single mesh from a multicenter study. Sci Rep 2022; 12:4215. [PMID: 35273288 PMCID: PMC8913731 DOI: 10.1038/s41598-022-08024-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 01/25/2022] [Indexed: 11/17/2022] Open
Abstract
Laparoscopic ventral hernia repair (LVHR) is a widely practiced treatment for primary (PH) and incisional (IH) hernias, with acceptable outcomes. Prevention of recurrence is crucial and still highly debated. Purpose of this study was to evaluate predictive factors of recurrence following LVHR with intraperitoneal onlay mesh with a single type of mesh for both PH and IH. A retrospective, multicentre study of data collected from patients who underwent LVHR for PH and IH with an intraperitoneal monofilament polypropylene mesh from January 2014 to December 2018 at 8 referral centers was conducted, and statistical analysis for risk factors of recurrence and post-operative outcomes was performed. A total of 1018 patients were collected, with 665 cases of IH (65.3%) and 353 of PH (34.7%). IH patients were older (p < 0.001), less frequently obese (p = 0.031), at higher ASA class (p < 0.001) and presented more frequently with large, swiss cheese type and border site defects (p < 0.001), compared to PH patients. Operative time and hospital stay were longer for IH (p < 0.001), but intraoperative and early post-operative complications and reinterventions were comparable. IH group presented at major risk of recurrence than PH (6.7% vs 0.9%, p < 0.001) and application of absorbable tacks resulted a significative predictive factor for recurrence increasing the risk by 2.94 (95% CI 1.18–7.31). LVHR with a light-weight polypropylene mesh has low intra- and post-operative complications and is appropriate for both IH and PH. Non absorbable tacks and mixed fixation system seem to be preferable to absorbable tacks alone.
Collapse
|
4
|
Christophersen C, Fonnes S, Baker JJ, Andresen K, Rosenberg J. Surgeon Volume and Risk of Reoperation after Laparoscopic Primary Ventral Hernia Repair: A Nationwide Register-Based Study. J Am Coll Surg 2021; 233:346-356.e4. [PMID: 34111532 DOI: 10.1016/j.jamcollsurg.2021.05.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/14/2021] [Accepted: 05/14/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Repairs of primary ventral hernias are common procedures but are associated with high recurrence rates. Therefore, it is important to investigate risk factors for recurrence to optimize current treatments. The aim of this study was to assess the impact of annual surgeon volume on the risk of reoperation for recurrence after primary ventral hernia repair. STUDY DESIGN We conducted a nationwide register-based study with data from the Danish Ventral Hernia Database and the Danish Patient Safety Authority's Online Register linked via surgeons' authorization identification. We included patients 18 years and older, undergoing umbilical or epigastric hernia repair between 2011 and 2020. Annual surgeon volume was categorized into ≤ 9, 10 to 19, 20 to 29, and ≥ 30 cases. Patients were followed until reoperation, death, emigration, or end of the study period. RESULTS We included 7,868 patients who underwent laparoscopic (n = 1,529 [19%]), open mesh (n = 4,138 [53%]), or open nonmesh (n = 2,201 [28%]) repair. There was an increased risk of reoperation after laparoscopic umbilical or epigastric hernia repair for surgeons with ≤ 9 (hazard ratio 6.57; p = 0.008), 10 to 19 (hazard ratio 6.58; p = 0.011), and 20 to 29 (hazard ratio 13.59; p = 0.001) compared with ≥ 30 cases/y. There were no differences in risk of reoperation after open mesh and open nonmesh repair in relation to annual surgeon volume. CONCLUSIONS There was a significantly higher risk of reoperation after laparoscopic primary ventral hernia repair performed by lower-volume surgeons compared with high-volume surgeons. Additional research investigating how sufficient surgical training and supervision are ensured is indicated to reduce risk of reoperation after primary ventral hernia repair.
Collapse
Affiliation(s)
- Camilla Christophersen
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
| | - Siv Fonnes
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Jason Joe Baker
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Kristoffer Andresen
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Jacob Rosenberg
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| |
Collapse
|
5
|
Mathes T, Prediger B, Walgenbach M, Siegel R. Mesh fixation techniques in primary ventral or incisional hernia repair. Cochrane Database Syst Rev 2021; 5:CD011563. [PMID: 34046884 PMCID: PMC8160478 DOI: 10.1002/14651858.cd011563.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The use of a mesh in primary ventral or incisional hernia repair lowers the recurrence rate and is the accepted standard of care for larger defects. In laparoscopic primary ventral or incisional hernia repair the insertion of a mesh is indispensable. Different mesh fixation techniques have been used and refined over the years. The type of fixation technique is claimed to have a major impact on recurrence rates, chronic pain, health-related quality of life (HRQOL) and complication rates. OBJECTIVES To determine the impact of different mesh fixation techniques for primary and incisional ventral hernia repair on hernia recurrence, chronic pain, HRQOL and complications. SEARCH METHODS On 2 October 2020 we searched CENTRAL, MEDLINE (Ovid MEDLINE(R)) Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R)), Ovid Embase, and two trials registries. We also performed handsearches, and contacted experts from the European Hernia Society (EHS). SELECTION CRITERIA We included randomised controlled trials (RCTs) including adults with primary ventral or incisional hernia that compared different types of mesh fixation techniques (absorbable/nonabsorbable sutures, absorbable/nonabsorbable tacks, fibrin glue, and combinations of these techniques). DATA COLLECTION AND ANALYSIS We extracted data in standardised piloted tables, or if necessary, directly into Review Manager 5. We assessed risks of bias with the Cochrane 'Risk of bias' tool. Two review authors independently selected the publications, and extracted data on results. We calculated risk ratios (RRs) for binary outcomes and mean differences (MDs) for continuous outcomes. For pooling we used an inverse-variance random-effects meta-analysis or the Peto method in the case of rare events. We prepared GRADE 'Summary of findings' tables. For laparoscopic repair we considered absorbable tacks compared to nonabsorbable tacks, and nonabsorbable tacks compared to nonabsorbable sutures as key comparisons. MAIN RESULTS We included 10 trials with a total of 787 participants. The number of randomised participants ranged from 40 to 199 per comparison. Eight studies included participants with both primary and incisional ventral hernia. One study included only participants with umbilical hernia, and another only participants with incisional hernia. Hernia size varied between studies. We judged the risk of bias as moderate to high. Absorbable tacks compared to nonabsorbable tacks Recurrence rates in the groups were similar (RR 0.74, 95% confidence interval (CI) 0.17 to 3.22; 2 studies, 101 participants). It is uncertain whether there is a difference between absorbable tacks and nonabsorbable tacks in recurrence because the certainty of evidence was very low. Evidence suggests that the difference between groups in early postoperative, late follow-up, chronic pain and HRQOL is negligible. Nonabsorbable tacks compared to nonabsorbable sutures At six months there was one recurrence in each group (RR 1.00, 95% CI 0.07 to 14.79; 1 study, 36 participants). It is uncertain whether there is a difference between nonabsorbable tacks and nonabsorbable sutures in recurrence because the certainty of evidence was very low. Evidence suggests that the difference between groups in early postoperative, late follow-up and chronic pain is negligible. We found no study that assessed HRQOL. Absorbable tacks compared to absorbable sutures No recurrence was observed at one year (very low certainty of evidence). Early postoperative pain was higher in the tacks group (VAS 0 - 10: MD -2.70, 95% CI -6.67 to 1.27; 1 study, 48 participants). It is uncertain whether there is a difference between absorbable tacks compared to absorbable sutures in early postoperative pain because the certainty of evidence was very low. The MD for late follow-up pain was -0.30 (95% CI -0.74 to 0.14; 1 study, 48 participants). We found no study that assessed HRQOL. Combination of different fixation types (tacks and sutures) or materials (absorbable and nonabsorbable) There were mostly negligible or only small differences between combinations (e.g. tacks plus sutures) compared to a single technique (e.g. sutures only), as well as combinations compared to other combinations (e.g. absorbable sutures combined with nonabsorbable sutures compared to absorbable tacks combined with nonabsorbable tacks) in all outcomes. It is uncertain whether there is an advantage for combining different fixation types or materials for recurrence, chronic pain, HRQOL and complications, because the evidence certainty was very low or low, or we found no study on important outcomes. Nonabsorbable tacks compared to fibrin sealant The two studies showed different directions of effects: one showed higher rates for nonabsorbable tacks, and the other showed higher rates for fibrin sealant. Low-certainty evidence suggests that the difference between groups in early postoperative, late follow-up, chronic pain and HRQOL is negligible. Absorbable tacks compared to fibrin sealant One recurrence in the tacks group and none in the fibrin sealant group were noted after one year (low certainty of evidence). Early postoperative pain might be slightly lower using tacks (VAS 0 - 100; MD -12.40, 95% CI -27.60 to, 2.80;1 study, 50 participants; low-certainty evidence). The pattern of pain and HRQOL course over time (up to 1 year) was similar in the groups (low certainty of evidence). AUTHORS' CONCLUSIONS Currently none of the techniques can be considered superior to any other, because the certainty of evidence was low or very low for all outcomes.
Collapse
Affiliation(s)
- Tim Mathes
- Institute for Research in Operative Medicine (IFOM) - Department for Evidence-based Health Services Research, Witten/Herdecke University, Cologne, Germany
| | - Barbara Prediger
- Institute for Research in Operative Medicine (IFOM) - Department for Evidence-based Health Services Research, Witten/Herdecke University, Cologne, Germany
| | - Maren Walgenbach
- Institute for Research in Operative Medicine (IFOM) - Department for Evidence-based Health Services Research, Witten/Herdecke University, Cologne, Germany
| | - Robert Siegel
- Department of General, Visceral and Cancer Surgery, HELIOS Klinikum Berlin-Buch, Berlin-Buch, Germany
- Faculty of Health, Witten/Herdecke University, Witten, Germany
| |
Collapse
|
6
|
Henriksen NA, Friis-Andersen H, Jorgensen LN, Helgstrand F. Open versus laparoscopic incisional hernia repair: nationwide database study. BJS Open 2021; 5:6100248. [PMID: 33609381 PMCID: PMC7893453 DOI: 10.1093/bjsopen/zraa010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/24/2020] [Accepted: 08/27/2020] [Indexed: 11/20/2022] Open
Abstract
Background Although laparoscopic repair of incisional hernias decreases the incidence of wound complications compared with open repair, there has been rising concern related to intraperitoneal mesh placement. The aim of this study was to examine outcomes after open or laparoscopic elective incisional hernia mesh repair on a nationwide basis. Methods This study analysed merged data from the Danish Hernia Database and the National Patient Registry on perioperative information, 90-day readmission, 90-day reoperation for complication, and long-term operation for hernia recurrence among patients who underwent primary repair of an incisional hernia between 2007 and 2018. Results A total of 3090 (57.5 per cent) and 2288 (42.5 per cent) patients had surgery by a laparoscopic and open approach respectively. The defect was closed in 865 of 3090 laparoscopic procedures (28.0 per cent). The median follow-up time was 4.0 (i.q.r. 1.8–6.8) years. Rates of readmission (502 of 3090 (16.2 per cent) versus 442 of 2288 (19.3 per cent); P = 0.003) and reoperation for complication (216 of 3090 (7.0 per cent) versus 288 of 2288 (12.5 per cent); P < 0.001) were significantly lower for laparoscopic than open repairs. Reoperation for bowel obstruction or bowel resection was twice as common after laparoscopic repair compared with open repair (20 of 3090 (0.6 per cent) versus 6 of 2288 (0.3 per cent); P = 0.044). Patients were significantly less likely to undergo repair of recurrence following laparoscopic compared with open repair of defect widths 2–6 cm (P = 0.002). Conclusion Laparoscopic intraperitoneal mesh repair for incisional hernia should still be considered for fascial defects between 2 and 6 cm, because of decreased rates of early complications and repair of hernia recurrence compared with open repair.
Collapse
Affiliation(s)
- N A Henriksen
- Department of Surgery, Zealand University Hospital, Koege, Denmark
| | | | - L N Jorgensen
- Digestive Disease Centre, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - F Helgstrand
- Department of Surgery, Zealand University Hospital, Koege, Denmark
| |
Collapse
|
7
|
Verstoep L, de Smet GHJ, Sneiders D, Kroese LF, Kleinrensink GJ, Lange JF, Gillion JF. Hernia width explains differences in outcomes between primary and incisional hernias: a prospective cohort study of 9159 patients. Hernia 2020; 25:463-469. [PMID: 33230648 PMCID: PMC8055619 DOI: 10.1007/s10029-020-02340-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/04/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Data on primary (PH) and incisional hernias (IH) are often pooled, even though several studies have illustrated that these are different entities with worse outcomes for IHs. The aim of this study is to validate previous research comparing PHs and IHs and to examine whether hernia width is an important contributor to the differences between these hernia types. METHODS A registry-based, prospective cohort study was performed, utilizing the French Hernia Club database. All patients undergoing PH or IH repair between September 8th 2011 and May 22nd 2019 were included. Baseline, hernia and surgical characteristics, and postoperative outcomes were collected. Outcomes were analyzed per width category (≤ 2 cm, 3-4 cm, 5-10 cm and > 10 cm). RESULTS A total of 9159 patients were included, of whom 4965 (54%) had PH and 4194 (46%) had IH. PHs and IHs differed significantly in 12/15 baseline characteristics, 9/10 hernia and surgical characteristics, and all outcomes. Overall, complications and re-interventions were more common in patients with IH. After correcting for width, the differences between PH and IH were no longer significant, except for medical complications, which were more common after IH repair compared to PH. CONCLUSION After correcting for hernia width, most outcomes do not significantly differ between PH and IH, indicating that not hernia type, but hernia width is an important factor contributing to the differences between PH and IH.
Collapse
Affiliation(s)
- L Verstoep
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - G H J de Smet
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
- Department of Surgery, Erasmus University Medical Center, PO BOX 2040, Room Ee-173, Dr. Molewaterplein, 3000 CA, Rotterdam, The Netherlands.
| | - D Sneiders
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - L F Kroese
- Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - G-J Kleinrensink
- Department of Neuroscience, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J F Lange
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Surgery, IJsselland Ziekenhuis, Capelle aan den IJssel, The Netherlands
| | - J-F Gillion
- Unité de Chirurgie Viscérale et Digestive, Hôpital Prive d'Antony, Antony, France
| |
Collapse
|
8
|
Olavarria OA, Bernardi K, Shah SK, Wilson TD, Wei S, Pedroza C, Avritscher EB, Loor MM, Ko TC, Kao LS, Liang MK. Robotic versus laparoscopic ventral hernia repair: multicenter, blinded randomized controlled trial. BMJ 2020; 370:m2457. [PMID: 32665218 PMCID: PMC7359869 DOI: 10.1136/bmj.m2457] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To determine whether robotic ventral hernia repair is associated with fewer days in the hospital 90 days after surgery compared with laparoscopic repair. DESIGN Pragmatic, blinded randomized controlled trial. SETTING Multidisciplinary hernia clinics in Houston, USA. PARTICIPANTS 124 patients, deemed appropriate candidates for elective minimally invasive ventral hernia repair, consecutively presenting from April 2018 to February 2019. INTERVENTIONS Robotic ventral hernia repair (n=65) versus laparoscopic ventral hernia repair (n=59). MAIN OUTCOME MEASURES The primary outcome was number of days in hospital within 90 days after surgery. Secondary outcomes included emergency department visits, operating room time, wound complications, hernia recurrence, reoperation, abdominal wall quality of life, and costs from the healthcare system perspective. Outcomes were pre-specified before data collection began and analyzed as intention to treat. RESULTS Patients from both groups were similar at baseline. Ninety day follow-up was completed in 123 (99%) patients. No evidence was seen of a difference in days in hospital between the two groups (median 0 v 0 days; relative rate 0.90, 95% confidence interval 0.37 to 2.19; P=0.82). For secondary outcomes, no differences were noted in emergency department visits, wound complications, hernia recurrence, or reoperation. However, robotic repair had longer operative duration (141 v 77 min; mean difference 62.89, 45.75 to 80.01; P≤0.001) and increased healthcare costs ($15 865 (£12 746; €14 125) v $12 955; cost ratio 1.21, 1.07 to 1.38; adjusted absolute cost difference $2767, $910 to $4626; P=0.004). Among patients with robotic ventral hernia repair, two had an enterotomy compared none with laparoscopic repair. The median one month postoperative improvement in abdominal wall quality of life was 3 with robotic ventral hernia repair compared with 15 following laparoscopic repair. CONCLUSION This study found no evidence of a difference in 90 day postoperative hospital days between robotic and laparoscopic ventral hernia repair. However, robotic repair increased operative duration and healthcare costs. TRIAL REGISTRATION Clinicaltrials.gov NCT03490266.
Collapse
Affiliation(s)
- Oscar A Olavarria
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, Houston, TX 77026, USA
- Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Karla Bernardi
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, Houston, TX 77026, USA
- Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Shinil K Shah
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, Houston, TX 77026, USA
- Department of Surgery, Memorial Hermann Texas Medical Center, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Todd D Wilson
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, Houston, TX 77026, USA
- Department of Surgery, Memorial Hermann Texas Medical Center, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Shuyan Wei
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, Houston, TX 77026, USA
- Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Claudia Pedroza
- Department of Pediatrics, McGovern Medical School at UTHealth, Houston, TX, USA
- Center for Clinical Research and Evidence Based Medicine, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Elenir B Avritscher
- Department of Pediatrics, McGovern Medical School at UTHealth, Houston, TX, USA
- Center for Clinical Research and Evidence Based Medicine, McGovern Medical School at UTHealth, Houston, TX, USA
- Department of Pediatrics, McGovern Medical School at UTHealth, Houston, TX, USA
- Center for Clinical Research and Evidence Based Medicine, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Michele M Loor
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Tien C Ko
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, Houston, TX 77026, USA
| | - Lillian S Kao
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, Houston, TX 77026, USA
- Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Mike K Liang
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, Houston, TX 77026, USA
- Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at UTHealth, Houston, TX, USA
| |
Collapse
|
9
|
Henriksen NA, Montgomery A, Kaufmann R, Berrevoet F, East B, Fischer J, Hope W, Klassen D, Lorenz R, Renard Y, Garcia Urena MA, Simons MP. Guidelines for treatment of umbilical and epigastric hernias from the European Hernia Society and Americas Hernia Society. Br J Surg 2020; 107:171-190. [PMID: 31916607 DOI: 10.1002/bjs.11489] [Citation(s) in RCA: 144] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/31/2019] [Accepted: 12/02/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Umbilical and epigastric hernia repairs are frequently performed surgical procedures with an expected low complication rate. Nevertheless, the optimal method of repair with best short- and long-term outcomes remains debatable. The aim was to develop guidelines for the treatment of umbilical and epigastric hernias. METHODS The guideline group consisted of surgeons from Europe and North America including members from the European Hernia Society and the Americas Hernia Society. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, the Scottish Intercollegiate Guidelines Network (SIGN) critical appraisal checklists, and the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument were used. A systematic literature search was done on 1 May 2018, and updated on 1 February 2019. RESULTS Literature reporting specifically on umbilical and epigastric hernias was limited in quantity and quality, resulting in a majority of the recommendations being graded as weak, based on low-quality evidence. The main recommendation was to use mesh for repair of umbilical and epigastric hernias to reduce the recurrence rate. Most umbilical and epigastric hernias may be repaired by an open approach with a preperitoneal flat mesh. A laparoscopic approach may be considered if the hernia defect is large, or if the patient has an increased risk of wound morbidity. CONCLUSION This is the first European and American guideline on the treatment of umbilical and epigastric hernias. It is recommended that symptomatic umbilical and epigastric hernias are repaired by an open approach with a preperitoneal flat mesh.
Collapse
Affiliation(s)
- N A Henriksen
- Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - A Montgomery
- Department of Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
| | - R Kaufmann
- Erasmus University Medical Centre, Rotterdam, the Netherlands.,Tergooi, Hilversum, the Netherlands
| | - F Berrevoet
- Department of General and Hepatopancreatobiliary Surgery, Ghent University Hospital, Ghent, Belgium
| | - B East
- Third Department of Surgery at Motol University Hospital, First and Second Faculty of Medicine at Charles University, Prague, Czech Republic
| | - J Fischer
- University of Pennsylvania Health System, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
| | - W Hope
- New Hanover Regional Medical Center, Wilmington, North Carolina, USA
| | - D Klassen
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - R Lorenz
- Praxis 3+ Chirurgen, Berlin, Germany
| | - Y Renard
- Department of Digestive Surgery, Robert Debré University Hospital, Reims, France
| | - M A Garcia Urena
- Henares University Hospital, Faculty of Health Sciences, Francisco de Vitoria University, Madrid, Spain
| | - M P Simons
- Department of Surgery, OLVG Hospital, Amsterdam, the Netherlands
| | | |
Collapse
|
10
|
He C, Lu J, Ong MW, Lee DJK, Tan KY, Chia CLK. Seroma prevention strategies in laparoscopic ventral hernia repair: a systematic review. Hernia 2019; 24:717-731. [PMID: 31784913 DOI: 10.1007/s10029-019-02098-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 11/17/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Laparoscopic ventral hernia repair (LVHR) has been increasing in popularity over the years. Seroma formation is a common complication of LVHR. The aim of this study is to review the current evidence on seroma prevention strategies following LVHR. METHODS A systematic search of PubMed, Embase (1946-13 February 2019) and Medline (1946-13 February 2019) databases was conducted using terms which include "seroma", "hernia, ventral" and "laparoscopy". All studies are comparative retrospective or prospective human adult studies in peer-reviewed journals describing at least one intra-operative intervention designed to decrease the rate of seroma formation in laparoscopic ventral hernia repair. RESULTS The database searches identified 3762 citations, and 21 studies were included for final analysis. Five studies compared the different methods of mesh fixation, nine studies compared primary defect closure (PFC) and bridged repair, two studies compared the effect of different types of meshes, two studies looked into the use of electrical cauterization, one study compared single- site laparoscopy with conventional laparoscopy, one study looked into the use of fibrin sealant and one study compared transabdominal preperitoneal placement of mesh with conventional repair. PFC appears to be the most promising with large studies showing a low rate of seroma formation with additional benefits of decreasing wound infection and recurrence rate. Cauterisation of hernia sac and injection of fibrin sealant also show promising results but are mainly derived from small studies. Other strategies did not demonstrate benefit. CONCLUSION Currently, primary fascial closure appears to be the most promising strategy available to decrease seroma formation after LVHR based on the results of large studies. Other promising strategies that decrease dead space such as cauterisation of the sac and fibrin sealant injection will require further multicentre trials to confirm benefit before an increase in operative time and cost can be justified for their routine use.
Collapse
Affiliation(s)
- C He
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - J Lu
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - M W Ong
- Department of General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, Singapore
| | - D J K Lee
- Department of General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, Singapore
| | - K Y Tan
- Department of General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, Singapore
| | - C L K Chia
- Department of General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, Singapore.
| |
Collapse
|
11
|
Morales-Conde S, Gómez-Menchero J, Alarcón I, Balla A. Retroprosthetic Seroma After Laparoscopic Ventral Hernia Repair Is Related to Mesh Used? J Laparoendosc Adv Surg Tech A 2019; 30:241-245. [PMID: 31742465 DOI: 10.1089/lap.2019.0646] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose: Retroprosthetic seroma (RS) is defined as a fluid collection located between the abdominal viscera and the intraperitoneal mesh implanted during surgery. Aim of this study is to report the incidence and clinical impact of RS based on the type of mesh implanted during laparoscopic ventral hernia repair (LVHR). Materials and Methods: Patients who underwent LVHR were allocated in group A if expanded polytetrafluoroethylene (ePTFE) mesh was used during surgery and in group B if other types of mesh were used. Patients were evaluated on postoperative day (POD) 1 and 7 with physical examination and 1 month after surgery by physical examination and with an abdominal computed tomography scan, respectively. Results: Sixty patients were included. Of these 41 patients (68.3%) were included in group A and 19 patients (31.7%) in group B. Signs of RS were not observed in any patient on POD 7. One month after surgery, RS was observed in 13 patients (21.6%). One patient (7.7%) with RS experienced great discomfort and mesh detachment, and underwent a second surgical treatment. All RSs were observed in group A, and the difference with group B was statistically significant (P = .005). Conclusions: The use of ePTFE mesh is related to the development of RS. The treatment of choice without clinical symptoms should be conservative. Randomized control trial and prospective studies with a larger sample size and control group are required to confirm these data, although this study shows a high evidence of the relation of RS and the type of mesh.
Collapse
Affiliation(s)
- Salvador Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital "Virgen del Rocio," University of Sevilla, Spain.,Unit of General and Digestive Surgery, Hospital Quirónsalud Sagrado Corazón, Sevilla, Spain
| | - Julio Gómez-Menchero
- Unit of General and Digestive Surgery, Hospital Quirónsalud Sagrado Corazón, Sevilla, Spain.,Unit of General and Digestive Surgery, Hospital de Río Tinto, Huelva, Spain
| | - Isaias Alarcón
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital "Virgen del Rocio," University of Sevilla, Spain.,Unit of General and Digestive Surgery, Hospital Quirónsalud Sagrado Corazón, Sevilla, Spain
| | - Andrea Balla
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital "Virgen del Rocio," University of Sevilla, Spain.,Department of General Surgery and Surgical Specialties "Paride Stefanini," Sapienza, University of Rome, Rome, Italy
| |
Collapse
|
12
|
Jani K, Contractor S. Retrorectus sublay mesh repair using polypropylene mesh: Cost-effective approach for laparoscopic treatment of ventral abdominal wall hernias. J Minim Access Surg 2019; 15:287-292. [PMID: 31031328 PMCID: PMC6839350 DOI: 10.4103/jmas.jmas_20_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 02/18/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Laparoscopic repair of ventral abdominal hernias has become a standard of care. The surgery involves placement of a composite mesh with 3-5 cm overlap at the edges of the defect. The disadvantage of this repair is one, the composite mesh used for intraperitoneal placement is quite costly and two, it leaves a foreign body inside the peritoneal cavity, with the potential to cause problems in the future. To circumvent both these issues, we have developed a new approach, called the retrorectus sublay Mesh (RRSM) repair, which allows placement of a plain polypropylene mesh in an extraperitoneal plane. PATIENTS AND METHODS Patients with paraumbilical hernia and lower midline incisional hernias were included in this pilot study performed at a single centre by the same surgeon. The steps of the technique are described in detail. RESULTS Since 2016, a total of 52 patients were operated by this technique, including both male and female patients. It included patients with para-umbilical hernias as well as incisional hernias. The RRSM repair could be successfully carried out in all the patients. In six of the patients, transversus abdominis release was added as the defect size was large to allow closure of the defect. The results were satisfactory with a low morbidity and no mortality. CONCLUSION In our opinion, the RRSM technique is an important tool in the armamentarium of the laparoscopic surgeon dealing with ventral abdominal hernias, allowing placement of polypropylene mesh in an extraperitoneal space. It allows significant cost savings as compared to the prevalent intraperitoneal onlay mesh repair.
Collapse
Affiliation(s)
- Kalpesh Jani
- Department of Minimal Access Surgery, Vadodara Institute of Gastrointestinal and Obesity Surgery, Vadodara, Gujarat, India
| | - Samir Contractor
- Department of Minimal Access Surgery, Vadodara Institute of Gastrointestinal and Obesity Surgery, Vadodara, Gujarat, India
| |
Collapse
|
13
|
|
14
|
Baltic A, Laback C, Auer T, Leithner A, Bernhardt GA. Incarcerated hernia after internal hemipelvectomy for G2 chondrosarcoma: a preventable complication? ANZ J Surg 2019; 90:381-383. [PMID: 30828966 PMCID: PMC7079183 DOI: 10.1111/ans.15148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 12/19/2018] [Accepted: 02/12/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Andrea Baltic
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Christian Laback
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Thomas Auer
- Division of General Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Gerwin A Bernhardt
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| |
Collapse
|
15
|
Kozman MA, Tonkin D, Eteuati J, Karatassas A, McDonald CR. Robotic-assisted ventral hernia repair with surgical mesh: how I do it and case series of early experience. ANZ J Surg 2019; 89:248-254. [DOI: 10.1111/ans.15071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 12/09/2018] [Accepted: 12/11/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Mathew A. Kozman
- Department of General and Colorectal Surgery; Ashford Hospital; Adelaide South Australia Australia
- Department of General and Colorectal Surgery; Lyell McEwin Hospital; Adelaide South Australia Australia
| | - Darren Tonkin
- Department of General and Colorectal Surgery; Ashford Hospital; Adelaide South Australia Australia
- Department of General and Colorectal Surgery; St Andrew's Hospital; Adelaide South Australia Australia
- Department of General and Colorectal Surgery; Queen Elizabeth Hospital; Adelaide South Australia Australia
| | - Jimmy Eteuati
- Department of General and Colorectal Surgery; Ashford Hospital; Adelaide South Australia Australia
- Department of General and Colorectal Surgery; Lyell McEwin Hospital; Adelaide South Australia Australia
| | - Alex Karatassas
- Department of General and Colorectal Surgery; Ashford Hospital; Adelaide South Australia Australia
- Department of General and Colorectal Surgery; St Andrew's Hospital; Adelaide South Australia Australia
- Department of General and Colorectal Surgery; Queen Elizabeth Hospital; Adelaide South Australia Australia
| | - Christopher R. McDonald
- Department of General and Colorectal Surgery; Ashford Hospital; Adelaide South Australia Australia
- Department of General and Colorectal Surgery; Lyell McEwin Hospital; Adelaide South Australia Australia
| |
Collapse
|
16
|
Robot-assisted abdominal wall surgery: a systematic review of the literature and meta-analysis. Hernia 2018; 23:17-27. [PMID: 30523566 DOI: 10.1007/s10029-018-1872-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 12/02/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE The number of robot-assisted hernia repairs is increasing, but the potential benefits have not been well described. The aim of this study was to evaluate the available literature reporting on outcomes after robot-assisted hernia repairs. METHODS This is a qualitative review and meta-analysis of papers evaluating short-term outcomes after inguinal or ventral robot-assisted hernia repair compared with either open or laparoscopic approach. The primary outcome was postoperative complications and secondary outcomes were duration of surgery, postoperative length of stay and financial costs. RESULTS Fifteen studies were included. Postoperative complications were significantly decreased after robot-assisted inguinal hernia repair compared with open repair. There were no differences in complications between robot-assisted and laparoscopic inguinal hernia repair. For ventral hernia repair, sutured closure of the defect, retromuscular mesh placement and transversus abdominis release is feasible when using the robot. Length of stay was decreased by a mean of 3 days for robot-assisted repairs compared with open approach. There were no differences in postoperative complications and the operative time was significantly longer for robot-assisted ventral hernia repair compared with laparoscopic or open approach. CONCLUSIONS For ventral hernias that would normally require an open procedure, a robot-assisted repair may be a good option, as the use of a minimally invasive approach for these procedures decreases length of stay significantly. For inguinal hernias, the benefit of the robot is questionable. Randomized controlled trials and prospective studies are needed.
Collapse
|
17
|
Adding sutures to tack fixation of mesh does not lower the re-operation rate after laparoscopic ventral hernia repair: a nationwide cohort study. Langenbecks Arch Surg 2018; 403:521-527. [DOI: 10.1007/s00423-018-1681-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 05/10/2018] [Indexed: 02/02/2023]
|
18
|
Wei K, Lu C, Ge L, Pan B, Yang H, Tian J, Cao N. Different types of mesh fixation for laparoscopic repair of inguinal hernia: A protocol for systematic review and network meta-analysis with randomized controlled trials. Medicine (Baltimore) 2018; 97:e0423. [PMID: 29668603 PMCID: PMC5916670 DOI: 10.1097/md.0000000000010423] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Laparoscopic inguinal hernia repair has become a valid option for repair of an inguinal hernia. Due to there are several types of mesh fixation for laparoscopic repair of inguinal hernia. The study aims to assess and compare the efficacy of different types of mesh fixation for laparoscopic repair of inguinal hernia using network meta-analysis. METHODS We will systematically search PubMed, EMBASE the Cochrane library, and Chinese Biomedical Literature Database from their inception to March 2018. Randomized controlled trials (RCTs) that compared the effect of different types of mesh fixation for laparoscopic inguinal hernia repair will be included. The primary outcomes are chronic groin pain, incidence risk of hernia recurrence, and complications. Risk of bias assessment of the included RCTs will be conducted using to Cochrane risk of bias tool. A network meta-analysis will be performed using WinBUGS 1.4.3 software and the result figures will be generated using R x64 3.1.2 software and STATA V.12.0 software. Grading of Recommendations Assessment, Development and Evaluation (GRADE) will be used to assess the quality of evidence. RESULTS The results of this study will be published in a peer-reviewed journal. CONCLUSION Our study will generate evidence of laparoscopic repair of mesh fixation for adult patients with inguinal hernia and provide suggestions for clinical practice or guideline.
Collapse
Affiliation(s)
- Kongyuan Wei
- Department of General Surgery, First Affiliated Hospital of Lanzhou University
| | - Cuncun Lu
- Evidence-based Medicine Center, School of Basic Medical Sciences
| | - Long Ge
- Department of General Surgery, First Affiliated Hospital of Lanzhou University
- Evidence-based Medicine Center, School of Basic Medical Sciences
| | - Bei Pan
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China
| | - Huan Yang
- Department of General Surgery, First Affiliated Hospital of Lanzhou University
| | - Jinhui Tian
- Evidence-based Medicine Center, School of Basic Medical Sciences
| | - Nong Cao
- Department of General Surgery, First Affiliated Hospital of Lanzhou University
| |
Collapse
|