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Bindal V, Pandey D, Gupta S. Laparoscopic intra-peritoneal onlay mesh plus versus robotic transabdominal pre-peritoneal for primary ventral hernias: Our technique and outcomes. J Minim Access Surg 2024:01413045-990000000-00067. [PMID: 39095987 DOI: 10.4103/jmas.jmas_4_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 04/02/2024] [Indexed: 08/04/2024] Open
Abstract
INTRODUCTION Intra-peritoneal onlay mesh repair (IPOM) still remains the most common approach for laparoscopic repair of small to medium sized hernias worldwide. In this study, we compare our early outcomes of an established procedure, i.e. laparoscopic IPOM plus to robotic transabdominal pre-peritoneal (rTAPP) for small to medium sized primary ventral hernia. To compare laparoscopic IPOM plus with rTAPP in terms of pain score, time to ambulate, hospital stay, time to return to work as well as the expenses. PATIENTS AND METHODS This is a retrospective analysis of prospectively collected data at our centre between July 2021 and June 2022. Operative time including docking time was recorded. Cost analysis was done in both set of patients. Pain scores were assessed using Visual Analogue Scale (VAS) at regular intervals for up to 3 months and then at the end of 1 year. Time to ambulate, return of bowel function and return to work were documented. Any complication or recurrence during the study period was recorded. RESULTS Mean operative time for IPOM plus and rTAPP groups was 59.00 and 73.55 min, respectively. Mean pain score for IPOM at 6, 12 and 24 h was 7.35, 6.81 and 5.77, while for rTAPP, it was 4.73, 3 and 2.55, respectively. VAS scores at 1 week, 1 month and 3 month also showed similar trends. Mean time to ambulate in minutes for IPOM and rTAPP group was 357.69 and 223.64, respectively. Mean hospital stay in days for IPOM and rTAPP was 2.12 and 1.18, respectively. Mean time to return to work in days was 11.77 and 8.45 for IPOM and rTAPP groups, respectively. Expenditure wise, cost of TAPP was more and statistically significant, owing to the use of robotic platform. The mean overall cost of laparoscopic IPOM plus and rTAPP in rupees was 187,177.69 and 245,174.55, respectively. CONCLUSION Robotic TAPP appears an excellent alternative to laparoscopic IPOM plus. Larger studies with long-term follow-up data are further required to reinforce it.
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Affiliation(s)
- Vivek Bindal
- Institute of Minimal Access, Bariatric and Robotic Surgery, Max Super Speciality Hospital, Ghaziabad, Uttar Pradesh, India
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Maskal SM, Ellis RC, Mali O, Lau B, Messer N, Zheng X, Miller BT, Petro CC, Prabhu AS, Rosen MJ, Beffa LRA. Long-term mesh-related complications from minimally invasive intraperitoneal onlay mesh for small to medium-sized ventral hernias. Surg Endosc 2024; 38:2019-2026. [PMID: 38424284 PMCID: PMC10978620 DOI: 10.1007/s00464-024-10716-y] [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: 11/19/2023] [Accepted: 01/28/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Intraperitoneal onlay mesh (IPOM) placement for small to medium-sized hernias has garnered negative attention due to perceived long-term risk of mesh-related complications. However, sparse data exists supporting such claims after minimally invasive (MIS) IPOM repairs and most is hindered by the lack of long-term follow-up. We sought to report long-term outcomes and mesh-related complications of MIS IPOM ventral hernia repairs. METHODS AND PROCEDURES Adult patients who underwent MIS IPOM ventral hernia repair at our institution were identified in the Abdominal Core Health Quality Collaborative database from October 2013 to October 2020. Outcomes included hernia recurrence and mesh-related complications or reoperations up to 6 years postoperatively. RESULTS A total of 325 patients were identified. The majority (97.2%) of cases were elective, non-recurrent (74.5%), and CDC class I (99.4%). Mean hernia width was 4.16 ± 3.86 cm. Median follow-up was 3.6 (IQR 2.8-5) years. Surgeon-entered or patient-reported follow-up was available for 253 (77.8%) patients at 3 years or greater postoperatively. One patient experienced an early small bowel obstruction and was reoperated on within 30 days. Two-hundred forty-five radiographic examinations were available up to 6 years postoperatively. Twenty-seven patients had hernia recurrence on radiographic examination up to 6 years postoperatively. During long-term follow-up, two mesh-related complications required reoperations: mesh removed for chronic pain and mesh removal at the time of colon surgery for perforated cancer. Sixteen additional patients required reoperation within 6 years for the following reasons: hernia recurrence (n = 5), unrelated intraabdominal pathology (n = 9), obstructed port site hernia (n = 1), and adhesive bowel obstruction unrelated to the prosthesis (n = 1). The rate of reoperation due to intraperitoneal mesh complications was 0.62% (2/325) with up to 6 year follow-up. CONCLUSION Intraperitoneal mesh for repair of small to medium-sized hernias has an extremely low rate of long-term mesh-related complications. It remains a safe and durable option for hernia surgeons.
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Affiliation(s)
- Sara M Maskal
- Center for Abdominal Core Health, Cleveland Clinic, 2049 E 100th St, Desk A-100, Cleveland, OH, 44106, USA.
| | - Ryan C Ellis
- Center for Abdominal Core Health, Cleveland Clinic, 2049 E 100th St, Desk A-100, Cleveland, OH, 44106, USA
| | - Ouen Mali
- Center for Abdominal Core Health, Cleveland Clinic, 2049 E 100th St, Desk A-100, Cleveland, OH, 44106, USA
| | - Braden Lau
- Center for Abdominal Core Health, Cleveland Clinic, 2049 E 100th St, Desk A-100, Cleveland, OH, 44106, USA
| | - Nir Messer
- Center for Abdominal Core Health, Cleveland Clinic, 2049 E 100th St, Desk A-100, Cleveland, OH, 44106, USA
| | | | - Benjamin T Miller
- Center for Abdominal Core Health, Cleveland Clinic, 2049 E 100th St, Desk A-100, Cleveland, OH, 44106, USA
| | - Clayton C Petro
- Center for Abdominal Core Health, Cleveland Clinic, 2049 E 100th St, Desk A-100, Cleveland, OH, 44106, USA
| | - Ajita S Prabhu
- Center for Abdominal Core Health, Cleveland Clinic, 2049 E 100th St, Desk A-100, Cleveland, OH, 44106, USA
| | - Michael J Rosen
- Center for Abdominal Core Health, Cleveland Clinic, 2049 E 100th St, Desk A-100, Cleveland, OH, 44106, USA
| | - Lucas R A Beffa
- Center for Abdominal Core Health, Cleveland Clinic, 2049 E 100th St, Desk A-100, Cleveland, OH, 44106, USA
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Ring closure outcome for laparoscopic ventral hernia repair (IPOM plus) in medium and large defects. Long-term follow-up. Surg Endosc 2023; 37:2078-2084. [PMID: 36289087 DOI: 10.1007/s00464-022-09738-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 10/13/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Despite advances in laparoscopic ventral hernia repair (LVHR) with the Intra-peritoneal onlay mesh technique (IPOM), recurrence continues to be a frequent postoperative complication. The aim of this study is to analyze the long-term recurrence rate in two series, by incorporating in IPOM technique the laparoscopic closure of the defect (IPOM plus). We also want to determine the ring size cut-off point from which the recurrence risk increases in IPOM technique and determine if the cut-off point is modified with IPOM plus technique. METHODS A comparative retrospective study was conducted analyzing patients who underwent LVHR. They were divided into 2 groups according to the surgical technique used: IPOM or IPOM plus. We determined in each group the cut-off point where the ring size presents a greater recurrence risk by calculating the better point of sensitivity/specificity relationship of the ROC curve. RESULTS Between 2007 and 2018, 286 patients underwent LVHR. The ROC curve for IPOM technique has shown a cut-off point of higher recurrence risk for rings larger than 63 cm2. While the ROC curve in IPOM plus group showed an increase in the cut-off point, with a higher recurrence risk in rings > 168 cm2. Overall median ring size was 30 cm2 (range 4-225; IQR 16-61). However, when comparing the ring size between techniques we found a relatively larger size in IPOM plus (p: 0.013). The recurrence rate in the IPOM group was 19.51% while in the IPOM plus group was 3.57% (p: 0.005). CONCLUSIONS For standard LVHR with IPOM technique, the greatest recurrence risk occurs in rings larger than 63 cm2. The addition of ring closure (IPOM plus) was associated with a recurrence risk reduction, which occurs in rings larger than 168 cm2. These findings would allow expanding the indication for LVHR, using the IPOM plus technique.
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Megas IF, Benzing C, Winter A, Raakow J, Chopra S, Pratschke J, Fikatas P. A propensity-score matched analysis of ventral-TAPP vs. laparoscopic IPOM for small and mid-sized ventral hernias. Comparison of perioperative data, surgical outcome and cost-effectiveness. Hernia 2022; 26:1521-1530. [PMID: 35320438 DOI: 10.1007/s10029-022-02586-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 02/15/2022] [Indexed: 12/16/2022]
Abstract
PURPOSE Laparoscopic techniques have been used and refined in hernia surgery for several years. The aim of this study was to compare an established method such as laparoscopic intra-peritoneal onlay mesh repair (lap. IPOM) with ventral Transabdominal Preperitoneal Patch Plasty (ventral-TAPP) in abdominal wall hernia repair. METHODS Patient-related data of 180 laparoscopic ventral hernia repairs between June 2014 and August 2020 were extracted from our prospectively maintained database. Of these patients, 34 underwent ventral-TAPP and 146 lap. IPOM. After excluding hernias with a defect size > 5 cm and obtaining balanced groups with propensity-score matching, a comparative analysis was performed in terms perioperative data, surgical outcomes and cost-effectiveness. RESULTS Propensity-score matching suggested 27 patients in each of the two cohorts. The statistical evaluation showed that intake of opiates was significantly higher in the lap. IPOM group compared to ventral-TAPP patients (p = 0.001). The Visual Analogue Scale (VAS) score after lap. IPOM repair was significantly higher at movement (p = 0.008) and at rest (p = 0.023). Also, maximum subjective pain during hospital stay was significantly higher in the lap. IPOM group compared to ventral-TAPP patients (p = 0.004). No hernia recurrence was detected in either group. The material costs of ventral-TAPP procedure (34.37 ± 0.47 €) were significantly lower than those of the lap. IPOM group (742.57 ± 128.44 € p = 0.001). The mean operation time was 65.19 ± 26.43 min in the lap. IPOM group and 58.65 ± 18.43 min in the ventral-TAPP cohort. Additionally, the length of hospital stay in the lap. IPOM cohort was significantly longer (p = 0.043). CONCLUSION Ventral-TAPP procedures represent an alternative technique to lap. IPOM repair to reduce the risk of complications related to intra-peritoneal position of mesh and fixating devices. In addition, our study showed that postoperative pain level, material costs and hospital stay of the ventral-TAPP cohort are significantly lower compared to lap. IPOM patients.
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Affiliation(s)
- I-F Megas
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - C Benzing
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - A Winter
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - J Raakow
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - S Chopra
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - J Pratschke
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - P Fikatas
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.
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Favourable outcomes after Retro-Rectus (Rives-Stoppa) Mesh Repair as Treatment for Non-Complex Ventral Abdominal Wall Hernia, a Systematic Review and Meta-Analysis. Ann Surg 2022; 276:55-65. [PMID: 35185120 DOI: 10.1097/sla.0000000000005422] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess prevalence of hernia recurrence, surgical site infection (SSI), seroma, serious complications, and mortality after retro-rectus repair. SUMMARY BACKGROUND DATA Ventral abdominal wall hernia is a common problem, tied to increasing frailty and obesity of patients undergoing surgery. For non-complex ventral hernia, retro-rectus (Rives-Stoppa) repair is considered the gold standard treatment. Level-1 evidence confirming this presumed superiority is lacking. METHODS Five databases were searched for studies reporting on retro-rectus repair. Single-armed and comparative randomized and non-randomized studies were included. Outcomes were pooled with mixed-effects, inverse variance or random-effects models. RESULTS Ninety-three studies representing 12440 patients undergoing retro-rectus repair were included. Pooled hernia recurrence was estimated at 3.2% (95%CI: 2.2-4.2%, n = 11049) after minimally 12 months and 4.1%, (95%CI: 2.9-5.5%, n = 3830) after minimally 24 months. Incidences of SSI and seroma were estimated at respectively 5.2% (95%CI: 4.2-6.4%, n = 4891) and 5.5% (95%CI: 4.4-6.8%, n = 3650). Retro-rectus repair was associated with lower recurrence rates compared to onlay repair (OR: 0.27, 95%CI: 0.15-0.51, p < 0.001) and equal recurrence rates compared to intraperitoneal onlay (IPOM) repair (OR: 0.92, 95%CI: 0.75-1.12, p = 0.400). Retro-rectus repair was associated with more SSI than IPOM repair (OR: 1.8, 95%CI: 1.03-3.14, p = 0.038). Minimally invasive retro-rectus repair displayed low rates of recurrence (1.3%, 95%CI: 0.7-2.3%, n = 849) and SSI (1.5%, 95%CI: 0.8-2.8%, n = 982), albeit based on non-randomized studies. CONCLUSIONS Retro-rectus (Rives-Stoppa) repair results in excellent outcomes, superior or similar to other techniques for all outcomes except surgical site infection. The latter rarely occurred, yet less frequently after IPOM repair, which is usually performed by laparoscopy.
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Xu Q, Zhang G, Li L, Xiang F, Qian L, Xu X, Yan Z. Non-closure of the Free Peritoneal Flap During Laparoscopic Hernia Repair of Lower Abdominal Marginal Hernia: A Retrospective Analysis. Front Surg 2021; 8:748515. [PMID: 34917646 PMCID: PMC8669332 DOI: 10.3389/fsurg.2021.748515] [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: 07/28/2021] [Accepted: 11/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background: During lower abdominal marginal hernia repair, the peritoneal flap is routinely freed to facilitate mesh placement and closed to conclude the procedure. This procedure is generally called trans-abdominal partial extra-peritoneal (TAPE). However, the necessity of closing the free peritoneal flap is still controversial. This study aimed to investigate the safety and feasibility of leaving the free peritoneal flap in-situ. Methods: A retrospective review was conducted on 68 patients (16 male, 52 female) who underwent laparoscopic hernia repair between June 2014 and March 2021. Patients were diagnosed as the lower abdominal hernia and all required freeing the peritoneal flap during the operation. Patients were divided into 2 groups: one group was TAPE group with the closed free peritoneal flap, another group left the free peritoneal flap unclosed. Analyses were performed to compare both intraoperative parameters and postoperative complications. Results: There were no significant differences in demographic, comorbidity, hernia characteristics and ASA classification. The intra-operative bleeding volume, visceral injury, hospital stay, urinary retention, visual analog scale (VAS) score, dysuria, intestinal obstruction, surgical site infection, mesh infection, recurrence rate and hospital stay were similar among the two groups. Mean operative time of the flap closing procedure was higher than for patients with the free peritoneal flap left in-situ (p = 0.002). Comparisons of postoperative complications showed flap closure resulted in a higher incidence of seroma formation (p = 0.005). Conclusion: Providing a barrier-coated mesh is used during laparoscopic lower abdominal marginal hernia repair, it is safe to leave the free peritoneal flap in-situ and this approach may prevent the occurrence of seromas.
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Affiliation(s)
- Qian Xu
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Guangyong Zhang
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Linchuan Li
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Fengting Xiang
- Department of Neonatal Pediatrics, Weifang Yidu Central Hospital, Qingzhou, China
| | - Linhui Qian
- Department of Anorectal Surgery, Feicheng People's Hospital, Feicheng, China
| | - Xiufang Xu
- Department of Nursing, Huantai TCM Hospital, Zibo, China
| | - Zhibo Yan
- Department of Hernia and Abdominal Wall Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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Laparoscopic ventral hernia repair: does IPOM plus allow to increase the indications in larger defects? Hernia 2021; 26:525-532. [PMID: 34599719 DOI: 10.1007/s10029-021-02506-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/13/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE The laparoscopic ventral hernia repair (LVHR) may have a limit of effectiveness, especially in defects greater than 80 cm2, with a higher recurrence rate which contraindicates this technique. The purpose of this study is to analyze the indication of LVHR determining and comparing the recurrence rate according to defect size in two series. METHODS We analyzed all patients who underwent LVHR between 2007 and 2017. Patients were divided according to the ring size: < o ≥ 80 cm2 into group one (G1) and group two (G2) respectively. In both groups, all three techniques were used: intraperitoneal onlay mesh (IPOM), IPOM with closure of the defect (IPOM plus), and IPOM plus + anterior videoscopic component separation (AVCS). RESULTS A total of 258 patients underwent LVHR. Mean recurrence rate was 13% in G1 and 24% in G2. A statistically significant difference was found when comparing the IPOM technique among both groups, with a higher recurrence rate when ring size was ≥ 80 cm2 (p < 0.5). However, when comparing recurrence rate in IPOM plus and IPOM plus + AVCS between both groups, no significant differences were observed, yielding a p of 0.51 and 0.63, respectively. CONCLUSION The IPOM technique has shown a limit of effectiveness in large ventral hernia defects. The combination of techniques (ring closure and AVCS) may be useful to expand the indication for this surgery to larger defects and to reduce the recurrence rate. Prospective randomized studies are required to confirm this trend.
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Donchev R, Banysch M, Mero G, Kaiser GM. [Management of late onset septic complications after IPOM implantation: case series from a hernia center]. Chirurg 2021; 92:464-471. [PMID: 32945918 DOI: 10.1007/s00104-020-01278-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The intraperitoneal onlay mesh (IPOM) is for many surgeons a pragmatic solution for the operative treatment of extensive and complex abdominal wall hernias. A few years after mesh implantation we are now faced with a number of late complications of the IPOM procedure. Chronic septic complications, such as mesh infections and fistula formation have an outstanding position. OBJECTIVE With this case series we would like to share our experiences with the operative treatment of severe late onset septic complications after abdominal wall augmentation with IPOM. Furthermore, the current indications for the IPOM procedure are discussed. MATERIAL AND METHODS For the period February 2016-July 2019 a total of 10 patients with late septic complications after IPOM implantation were treated in our clinic. The index interventions took place between 2010 and 2017. The clinical picture varied from mesh infections with only minor symptoms to formation of multiple intestinal fistulas. RESULTS Multiple stage procedures were required in 9 out of the 10 patients in order to achieve sufficient decontamination of the surgical field. Due to enterocutaneous fistulas, bowel resection was performed in 5 patients. The mesh could be preserved in situ in only one patient. For the reconstruction of the abdominal wall, both plastic surgical methods and implantation of absorbable and non-absorbable meshes were used. CONCLUSION A consistent treatment with great effort is required for septic complications of the IPOM procedure. The interventions are often associated with extensive adhesiolysis and intestinal resection. Therefore, the indications for intraperitoneal mesh implantation should be handled with caution and an alternative surgical procedure should be considered. There are still special cases, such as hernias with very large abdominal wall defects in which the IPOM method is a suitable treatment option for tension-free reconstruction.
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Affiliation(s)
- R Donchev
- Klinik für Allgemein- und Viszeralchirurgie, St. Bernhard-Hospital, Bürgermeister-Schmelzing-Straße 90, 47475, Kamp-Lintfort, Deutschland.
| | - M Banysch
- Klinik für Allgemein- und Viszeralchirurgie, St. Bernhard-Hospital, Bürgermeister-Schmelzing-Straße 90, 47475, Kamp-Lintfort, Deutschland
| | - G Mero
- Klinik für Allgemein- und Viszeralchirurgie, St. Bernhard-Hospital, Bürgermeister-Schmelzing-Straße 90, 47475, Kamp-Lintfort, Deutschland
| | - G M Kaiser
- Klinik für Allgemein- und Viszeralchirurgie, St. Bernhard-Hospital, Bürgermeister-Schmelzing-Straße 90, 47475, Kamp-Lintfort, Deutschland
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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.
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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
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