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Zhuang B, Zheng L, Yu S, Li G. An improved approach of totally visceral sac separation (TVS) for incisional hernia compared with laparoscopic intraperitoneal onlay mesh plus repair (IPOM plus). Sci Rep 2023; 13:18037. [PMID: 37865652 PMCID: PMC10590371 DOI: 10.1038/s41598-023-45192-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/17/2023] [Indexed: 10/23/2023] Open
Abstract
Endoscopic techniques have been widely used in ventral hernia surgery. Totally visceral sac separation (TVS) is a new concept proposed for hernia repair in recent years. The aim of this study was to contrast the postoperative results of TVS with the widely used method of Laparoscopic intraperitoneal onlay mesh plus repair (IPOM plus) for incisional hernias. The retrospective comparison analysis of 38 IPOM plus and 34 TVS was conducted during the time period between December 2019 and June 2022. For both two groups, baseline characteristics, surgical records, postoperative information, and quality of life outcomes utilizing the Carolina's Comfort Scale were collected and analyzed. There were no differences between the methods of TVS and IPOM plus among the baseline characteristics. It showed the operative time in TVS group with the mean time of 213.4 min was significantly longer than that in IPOM plus group with the mean time of 182.9 min (P = 0.010). The postoperative length of stay in TVS group was 6.2 days, which was significantly shorter than IPOM plus group with the mean time of 4.8 days (P = 0.011). The medical expenses was significantly smaller in TVS group than that in IPOM plus group (P < 0.001). The quality of life scores of TVS were significant better than IPOM plus at one week, one month and six months. Besides, both TVS and IPOM plus have very few complications. TVS approach for incisional hernias is secure, effective, and valuable. It has shorter postoperative length of stay, higher quality of life, longer operative time, smaller medical expenses, and approximate complications compared with IPOM plus procedure. Our results have a greater contribution to the application and popularization of TVS technique.
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Affiliation(s)
- Bo Zhuang
- Department of General Surgery, Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Lushan Zheng
- Department of General Surgery, Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Shian Yu
- Department of General Surgery, Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China.
| | - Gang Li
- College of Mathematical Medicine, Zhejiang Normal University, Jinhua, China.
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Zhuang B, Lei C, Yu K, Gong D, Yu S. A visual method of establishing preperitoneal space for totally visceral sac separation in ventral hernia repair. Asian J Surg 2023; 46:4389-4393. [PMID: 37003886 DOI: 10.1016/j.asjsur.2023.03.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 09/16/2022] [Accepted: 03/08/2023] [Indexed: 04/03/2023] Open
Abstract
OBJECTIVE To explore a method of visually establishing preperitoneal space. In this paper, the procedure is described in detail and its safety and efficacy evaluated. METHODS A retrospective style was adopted. The clinical data of 33 patients who accepted the total visceral sac separation (TVS) procedure from December 2019 to November 2021 were collected. Observation indices included location and area of abdominal defect; surgical method and duration of operation to establish preperitoneal space and any postoperative complications; developments during follow-up. Follow-up was performed up to December 2021 using outpatient examination and telephone interview to detect any complications of incision or recurrence of ventral hernia. RESULTS For operative indices, all patients underwent the TVS procedure successfully except for one who had to be converted to laparoscopic intraperitoneal onlay mesh (IPOM) due to failure to establish preperitoneal space. The time required to establish preperitoneal space was 185.75 ± 44.37 s and the duration of hospital stay was 8.27 ± 1.42 days. No complications, such as abdominal bleeding or digestive tract injury, occurred during hospitalization. No complications of incision were observed during follow up, which lasted 2-24 months with an average of 7 months. CONCLUSIONS Preliminary results of the novel attempt to establish the preperitoneal space visually confirmed this to be a safe and feasible method. However, the sample size used here was small, with a short follow up. The details and notes need to be further discussed.
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Affiliation(s)
- Bo Zhuang
- Department of General Surgery, Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China.
| | - Changzhen Lei
- Department of General Surgery, Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Kai Yu
- Department of General Surgery, Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Daojun Gong
- Department of General Surgery, Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Shian Yu
- Department of General Surgery, Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
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Maatouk M, Kbir GH, Mabrouk A, Rezgui B, Dhaou AB, Daldoul S, Sayari S, Haouet K, Moussa MB. Can ventral TAPP achieve favorable outcomes in minimally invasive ventral hernia repair? A systematic review and meta-analysis. Hernia 2022:10.1007/s10029-022-02709-4. [PMID: 36378412 DOI: 10.1007/s10029-022-02709-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE The concept of the transabdominal preperitoneal (TAPP) was transferred from the inguinal hernia repair to be adopted in minimally invasive ventral hernia repair (VHR) and since then it has been gaining popularity. However, there are minimal data supporting the ventral TAPP (vTAPP) technique which may lead to reticence in the adoption of this approach. The aim of this meta-analysis was to evaluate the outcomes of patients who received minimally invasive vTAPP for VHR. STUDY DESIGN A systematic search was performed of PubMed, Science Direct, Google Scholar and Cochrane Library until July 2022. We selected studies that compared the vTAPP technique with any of other minimally invasive techniques. A meta-analysis was done for the outcomes of perioperative characteristics and postoperative parameters. RESULTS A total of 9 studies (1429 patients) were identified. vTAPP was associated with considerable benefit when compared to IPOM. vTAPP was less painful (MD = - 1.01; 95% CI [- 1.39, - 0.64], p < 0.00001), of reduced average cost (MD = - 457.10; 95% CI [- 457.27, - 456.92], p < 0.00001) and decreased SSI (OR = 0.29; 95% [0.09, 0.96], p = 0.04). On the other hand, the vTAPP approach consumed less operative time (MD: - 31.01, 95% CI [- 33.50, - 28.51]), p < 0.00001) and shorter hospital stay than the e-TEP approach. CONCLUSION vTAPP appears to be safe and effective procedure for VHR, superior or similar to other minimally invasive techniques for perioperative characteristics and short-term outcomes.
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Qin C, Yang H, Shen Y, Cheng L, Bittner R, Chen J. Development of hernia and abdominal wall surgery and Hernia Registry in China. SURGERY IN PRACTICE AND SCIENCE 2021. [DOI: 10.1016/j.sipas.2021.100043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Lindström P, Rietz G, Everhov ÅH, Sandblom G. Postoperative Pain After Robot-Assisted Laparoscopic Ventral Hernia Repair. Front Surg 2021; 8:724026. [PMID: 34778356 PMCID: PMC8580846 DOI: 10.3389/fsurg.2021.724026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Robot-assisted ventral hernia repair, when performed correctly, may reduce the risk for pain and discomfort in the postoperative period thus enabling shorter hospital stay. The aim of the present study was to evaluate postoperative pain following robot-assisted laparoscopic repair. The approach was selected after an intraoperative decision to complete the repair as: (1). Transabdominal Preperitoneal Repair (TAPP); (2). Trans-Abdominal RetroMuscular (TARM) repair; or (3). Intraperitoneal Onlay Mesh (IPOM) repair depending on anatomical conditions. Methods: Twenty ventral hernia repairs, 8 primary and 12 incisional, were included between 18th Dec 2017 and 11th Nov 2019. There were 8 women, mean age was 60.3 years, and mean diameter of the defect was 3.8 cm. The repairs were performed at Södersjukhuset (Southern General Hospital, Stockholm) using the Da Vinci Si Surgical System®. Sixteen repairs were completed with the TAPP technique, 2 with the TARM technique, and 2 as IPOM repair. Results: Mean hospital stay was 1.05 days. No postoperative infection was seen, and no recurrence was seen at 1 year. At the 30-day follow-up, fifteen patients (75%) rated their pain as zero or pain that was easily ignored, according to the Ventral Hernia Pain Questionnaire. After 1 year no one had pain that was not easily ignored. Conclusion: The present study shows that robot-assisted laparoscopic ventral hernia is feasible and safe. More randomized controlled trials are needed to show that the potential benefits in terms of shorter operation times, earlier discharge, and less postoperative pain motivate the extra costs associated with the robot technique.
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Affiliation(s)
- Per Lindström
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Göran Rietz
- Department of Surgery, Södersjukhuset, Stockholm, Sweden
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Li B, Qin C, Liu D, Miao J, Yu J, Bittner R. Subxiphoid top-down endoscopic totally preperitoneal approach (eTPA) for midline ventral hernia repair. Langenbecks Arch Surg 2021; 406:2125-2132. [PMID: 34297175 DOI: 10.1007/s00423-021-02259-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 06/28/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Midline abdominal wall hernia repair is among the most common surgical interventions performed worldwide. However, the optimal surgical technique remains controversial. To overcome the disadvantages of both open and transabdominal procedures, we developed a totally endoscopic preperitoneal approach (eTPA) with placement of a large mesh. METHODS From December 2019 to October 2020, 20 consecutive patients with small to medium-sized midline ventral hernias underwent repair using a completely preperitoneal subxiphoid top-down approach. The preperitoneal space was entered directly below the xiphoid, and careful endoscopic development of the plane between the peritoneum and posterior sheath of the rectus fascia was then performed behind the linea alba. The hernia sac and its contents were identified and reduced. The hernia defect was closed with sutures, and a mesh with an adequate high defect: mesh ratio was placed in the newly created preperitoneal space. RESULTS Twenty patients were enrolled in this study, including 14 with primary umbilical hernias, 4 with primary epigastric hernias, and 2 with recurrent umbilical hernias. 15 patients suffered from a mild concomitant diastasis recti. All operations were successfully completed without conversion to open repair. The mean operative time was 105.3 min (range, 60-220 min). Postoperative pain was mild, and the mean visual analog scale score for pain was 1.8 on the first postoperative day. The average postoperative hospital stay was 1.8 days (range, 1-4 days). One patient developed a minor postoperative seroma, but it had no adverse impact on the final outcome. No patients developed recurrence during the 3- to 10-month follow-up period. CONCLUSIONS The subxiphoid top-down totally endoscopic preperitoneal approach (eTPA) technique is feasible and effective. It may become a valuable alternative for the treatment of primary small- (defect size < 2 cm) and medium-sized (2-4 cm) midline ventral hernias, particularly in presence of a concomitant diastasis recti.
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Affiliation(s)
- Binggen Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Changfu Qin
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, China
| | - Dingxian Liu
- Department of Hernia and Abdominal Wall Surgery, Fuyang Hernia Specialty Hospital, Fuyang, 236000, China
| | - Jinchao Miao
- Department of General Surgery, Pengpai Memorial Hospital Affiliated to Guangdong Medical University, Shanwei, 516400, China
| | - Jiwei Yu
- Department of General Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 201999, China
| | - Reinhard Bittner
- Em. Director Marienhospital Stuttgart, Retirement. Supperstr.19, 70565, Stuttgart, Germany.
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Tang R, Wu W, Jiang H, Zhang Y, Liu N, Wei N. Employing a Xiphoid-umbilicus Approach in an Endoscopic Totally Extraperitoneal Procedure for the Preperitoneal Repair of Midline Ventral Hernias. Surg Laparosc Endosc Percutan Tech 2021; 31:799-803. [PMID: 34166325 DOI: 10.1097/sle.0000000000000953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/02/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Endoscopic totally extraperitoneal sublay (TES) repair seems to be a promising procedure for treating ventral hernias because repairing at the preperitoneal layer reduces damage to the natural musculoaponeurotic structures of the abdominal wall. This article reports the preliminary surgical results after such a procedure with a xiphoid-umbilicus approach for a midline ventral hernia of the middle-upper abdomen. MATERIALS AND METHODS Fifteen cases with a small midline ventral hernia scheduled for preperitoneal repair with a TES procedure with a xiphoid-umbilicus approach were included. Patient demographics, hernia characteristics, operative variables, and surgical results were recorded and analyzed. RESULTS The patients' average age was 55.80±15.33 years, body mass index was 26.49±2.98, defect size was 4.59±2.28 cm2, and the most frequent region was M3. Five of 15 procedures were conducted in a bottom-up direction, and 10 of 15 with single-port surgery. Only 1 repair failed due to severe peritoneal damage. The operation duration was 120.4±47.7 minutes. All patients recovered quickly and uneventfully, and no case needed readmission. No severe intraoperative and postoperative complications occurred. Only 1 case developed seroma, and there was no surgical site infection, pain, trocar site hernia, and recurrence observed during short-term follow-up (3 to 12 mo). CONCLUSIONS Endoscopic preperitoneal repair helps reduce damage to the abdominal wall during a TES procedure. Compared with a suprapubic approach, employing a xiphoid-umbilicus approach facilitates preperitoneal repair for small ventral hernias of the middle-upper abdomen. This will be a future option for minimally invasive surgical repair of such ventral hernias (Supplemental Digital Content 1, Video, http://links.lww.com/SLE/A287).
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Affiliation(s)
- Rui Tang
- Department of Hernia and Abdominal Wall Surgery, East Hospital Affiliated to Tongji University
| | - Weidong Wu
- Department of Gastrointestinal Surgery, Shanghai General Hospital, Shanghai
| | - Huiyong Jiang
- Department of General Surgery, Northeast International Hospital, Shenyang, Liaoning Province
| | - Yizhong Zhang
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, Zhejiang Province, China
| | - Nan Liu
- Department of Hernia and Abdominal Wall Surgery, East Hospital Affiliated to Tongji University
| | - Nina Wei
- Department of Hernia and Abdominal Wall Surgery, East Hospital Affiliated to Tongji University
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Jiang H, Thapa DM, Ma C, Cai X, Wang M. Endoscopic Totally Extraperitoneal Repair of Parastomal Hernia: A Case Report. Front Surg 2021; 8:659102. [PMID: 34095204 PMCID: PMC8173221 DOI: 10.3389/fsurg.2021.659102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/16/2021] [Indexed: 11/13/2022] Open
Abstract
A parastomal hernia is a type of incisional hernia that occurs in abdominal integuments in the proximity of a stoma. It is a frequent late complication following colostomy. Surgical repair is currently the only treatment option for parastomal hernia. Here we present the case of a 74-year-old patient with parastomal hernia and a history of open surgery treated with a totally extraperitoneal (TEP) endoscopic approach. There was no recurrence of the hernia at the 3-month follow-up. We discuss the feasibility and possible operative approaches for endoscopic repair of parastomal hernia with the TEP technique.
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Affiliation(s)
- Huiyong Jiang
- The Second Department of General Surgery, Northeast International Hospital, Shenyang, China
| | - Dil Momin Thapa
- Clinical Medical School of Inner Mongolia University for the Nationalities, Tongliao, China.,The Second Department of General Surgery, The Affiliated Hospital of Inner Mongolia University for the Nationalities, Tongliao, China
| | - Chun Ma
- The Second Department of General Surgery, Northeast International Hospital, Shenyang, China
| | - Xiangjun Cai
- The Second Department of General Surgery, Northeast International Hospital, Shenyang, China
| | - Mofei Wang
- Clinical Medical School of Inner Mongolia University for the Nationalities, Tongliao, China.,The Second Department of General Surgery, The Affiliated Hospital of Inner Mongolia University for the Nationalities, Tongliao, China
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Kudsi OY, Bou-Ayash N, Gokcal F, Crawford AS, Chang K, Chung SK, Litwin D. Learning Curve of Robotic Rives-Stoppa Ventral Hernia Repair: A Cumulative Sum Analysis. J Laparoendosc Adv Surg Tech A 2020; 31:756-764. [PMID: 33216665 DOI: 10.1089/lap.2020.0624] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Robotic Rives-Stoppa ventral hernia repair (rRS-VHR) is a minimally invasive technique that incorporates extraperitoneal mesh placement, using either transabdominal or totally extraperitoneal access. An understanding of its learning curve and technical challenges may guide and encourage its adoption. We aim at evaluating the rRS-VHR learning curve based on operative times while accounting for adverse outcomes. Materials and Methods: We conducted a retrospective analysis of patients undergoing rRS repair for centrally located ventral and incisional hernias. A single surgeon operative time-based cumulative sum (CUSUM) analysis learning curve was created, and a composite outcome was used for risk-adjusted CUSUM (RA-CUSUM). Results: Eighty-one patients undergoing rRS-VHR were included. A learning curve was created by using skin-to-skin times. Accordingly, patients were grouped into three phases. The mean skin-to-skin time was 72.2 minutes, and there was a significant decrease in skin-to-skin times throughout the learning curve (Phase-I: 86.4 minutes versus Phase-III: 63.8 minutes; P = .001), with a gradual decrease after 29 cases. Eleven patients experienced adverse composite outcomes, which were used to create a RA-CUSUM graph. Results showed the highest adverse outcome rates in Phase-II, with a gradual decrease in risk-adjusted operative times after 51 cases. Conclusions: Consistently decreasing operative times and adverse outcome rates in rRS-VHR was observed after the completion of 29 and 51 cases, respectively. Future studies that provide group learning curves for this procedure can deliver more generalizable results in terms of its performance rates.
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Affiliation(s)
- Omar Yusef Kudsi
- Department of Surgery, Good Samaritan Medical Center, Tufts University School of Medicine, Brockton, Massachusetts, USA
| | - Naseem Bou-Ayash
- Department of Surgery, Good Samaritan Medical Center, Tufts University School of Medicine, Brockton, Massachusetts, USA
| | - Fahri Gokcal
- Department of Surgery, Good Samaritan Medical Center, Tufts University School of Medicine, Brockton, Massachusetts, USA
| | - Allison S Crawford
- Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Karen Chang
- Department of Surgery, Good Samaritan Medical Center, Tufts University School of Medicine, Brockton, Massachusetts, USA
| | - Sebastian K Chung
- Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Demetrius Litwin
- Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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