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DE-Carvalho JPV, Pivetta LGA, Amaral PHDEF, Dias ERM, Macret JZ, Ribeiro HB, Francis MY, Antunes PDESL, Reinpold W, Roll S. Endoscopic Mini-or Less-Open Sublay Operation (E/MILOS) in ventral hernia repair: a minimally invasive alternative technique. Rev Col Bras Cir 2023; 50:e20233405. [PMID: 36995832 PMCID: PMC10595045 DOI: 10.1590/0100-6991e-20233405-en] [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: 07/24/2022] [Accepted: 10/02/2022] [Indexed: 03/29/2023] Open
Abstract
The ideal ventral hernia surgical repair is still in discussion1. The defect closure with a mesh-based repair is the base of surgical repair, in open or minimally invasive techniques2. The open methods lead to a higher surgical site infections incidence, meanwhile, the laparoscopic IPOM (intraperitoneal onlay mesh) increases the risk of intestinal lesions, adhesions, and bowel obstruction, in addition to requiring double mesh and fixation products which increase its costs and could worsen the post-operative pain3-5. The eTEP (extended/enhanced view totally intraperitoneal) technique has also arisen as a good option for this hernia repair. To avoid the disadvantages found in classic open and laparoscopic techniques, the MILOS (Endoscopically Assisted Mini or Less Open Sublay Repair) concept, created by W. Reinpold et al. in 2009, 3 years after eTEP conceptualization, allows the usage of bigger meshes through a small skin incision and laparoscopic retro-rectus space dissection, as the 2016 modification, avoiding an intraperitoneal mesh placement6,7. This new technique has been called E-MILOS (Endoscopic Mini or Less Open Sublay Repair)8. The aim of this paper is to report the E-MILOS techniques primary experience Brazil, in Santa Casa de Misericórdia de São Paulo.
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Affiliation(s)
- João Paulo Venancio DE-Carvalho
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Pós-graduação em Cirurgia - São Paulo - SP - Brasil
- - Hospital Alemão Oswaldo Cruz, Centro de Hérnia - Serviço de Cirurgia do Aparelho Digestivo - São Paulo - SP - Brasil
| | - Luca Giovanni Antonio Pivetta
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Pós-graduação em Cirurgia - São Paulo - SP - Brasil
- - Irmandade da Santa Casa de Misericórdia de São Paulo, Médico Assistente do Serviço de Emergência - São Paulo - SP - Brasil
| | - Pedro Henrique DE Freitas Amaral
- - Irmandade da Santa Casa de Misericórdia de São Paulo, Grupo de Parede Abdominal - São Paulo - SP - Brasil
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Professor da Disciplina de Cirurgia - São Paulo - SP - Brasil
| | - Eduardo Rullo Maranhão Dias
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Pós-graduação em Cirurgia - São Paulo - SP - Brasil
- - Irmandade da Santa Casa de Misericórdia de São Paulo, Médico Assistente do Serviço de Emergência - São Paulo - SP - Brasil
| | - Jessica Zilberman Macret
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Pós-graduação em Cirurgia - São Paulo - SP - Brasil
- - Hospital Alemão Oswaldo Cruz, Centro de Hérnia - Serviço de Cirurgia do Aparelho Digestivo - São Paulo - SP - Brasil
| | - Hamilton Brasil Ribeiro
- - Irmandade da Santa Casa de Misericórdia de São Paulo, Grupo de Parede Abdominal - São Paulo - SP - Brasil
| | - Maurice Youssef Francis
- - Irmandade da Santa Casa de Misericórdia de São Paulo, Grupo de Parede Abdominal - São Paulo - SP - Brasil
| | - Pedro DE Souza Lucarelli Antunes
- - Irmandade da Santa Casa de Misericórdia de São Paulo, Médico Residente em Cirurgia Geral, Departamento de Cirurgia - São Paulo - SP - Brasil
| | - Wolfgang Reinpold
- - Hamburg Hernia Center, Chairman and CEO - Hamburgo - Alemanha
- - Helios Mariahilf Hospital Hamburg, Teaching Hospital of Hamburg Medical School, Chairman of the Department of Abdominal Wall Surgery - Hamburgo - Alemanha
| | - Sergio Roll
- - Irmandade da Santa Casa de Misericórdia de São Paulo, Grupo de Parede Abdominal - São Paulo - SP - Brasil
- - Hospital Alemão Oswaldo Cruz, Centro de Hérnia - Serviço de Cirurgia do Aparelho Digestivo - São Paulo - SP - Brasil
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Professor da Disciplina de Cirurgia - São Paulo - SP - Brasil
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DE-CARVALHO JOÃOPAULOVENANCIO, PIVETTA LUCAGIOVANNIANTONIO, AMARAL PEDROHENRIQUEDEFREITAS, DIAS EDUARDORULLOMARANHÃO, MACRET JESSICAZILBERMAN, RIBEIRO HAMILTONBRASIL, FRANCIS MAURICEYOUSSEF, ANTUNES PEDRODESOUZALUCARELLI, REINPOLD WOLFGANG, ROLL SERGIO. Endoscopic Mini or Less Open Sublay Repair (E/MILOS) na correção das hérnias ventrais: uma alternativa técnica minimamente invasiva. Rev Col Bras Cir 2023. [DOI: 10.1590/0100-6991e-20233405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
RESUMO O tratamento cirúrgico ideal para correção das hérnias ventrais ainda é motivo de grande discussão1. O fechamento do defeito associado a utilização de telas para reforço da parede abdominal são passos fundamentais da terapia cirúrgica, podendo ser realizados tanto pela via aberta quanto pelas técnicas minimamente invasivas2. A via aberta apresenta maiores taxas de infecção de sítio cirúrgico, enquanto o reparo laparoscópico IPOM (intraperitoneal onlay mesh) acarreta um risco aumentado de lesões intestinais, aderências e obstruções intestinais, além de requerer uso de telas de dupla face e dispositivos de fixação que encarecem o procedimento e não raro aumentam a dor no pós-operatório3-5. A técnica eTEP (extended/enhanced view totally extraperitoneal), tem ganhado importância, mostrando-se uma boa opção para a correção das hérnias ventrais também2. A fim de se evitar as desvantagens das técnicas abertas e laparoscópicas “clássicas” o conceito MILOS (Endoscopically Assisted Mini or Less Open Sublay Repair), desenvolvido por W. Reinpold et al. em 2009, 3 anos antes do advento do eTEP, possibilita ao cirurgião o uso de telas de grandes dimensões no plano retromuscular através de uma pequena incisão na pele e dissecção laparoscópica deste espaço, conforme modificação realizada em 2016, evitando a colocação de uma tela no espaço intraperitoneal6-7. Esta nova técnica passou a se chamar EMILOS (Endoscopic Mini or Less Open Sublay Repair)8 Este artigo tem como objetivo relatar nossa experiência inicial no emprego da técnica E-MILOS no Brasil, na Santa Casa de Misericórdia de São Paulo.
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Bloemendaal ALA. Case Report: Intraoperative Fascial Traction in Robotic Abdominal Wall Surgery; An Early Experience. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2022; 1:10356. [PMID: 38314155 PMCID: PMC10831714 DOI: 10.3389/jaws.2022.10356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/14/2022] [Indexed: 02/06/2024]
Abstract
Intraoperative fascial traction (IFT) may obviate the use of a posterior component separation/transversus abdominis release (TAR). Robotic abdominal wall surgery leads to a reduction of morbidity in TAR compared to open surgery. The combination of minimally invasive (robotic) abdominal wall surgery with IFT may lead to a further reduction of surgical morbidity.
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Faustino LD, Ferreira LM, Ramirez OM, Nahas FX. Components separation technique of the abdominal wall: Which muscle release produces the greatest reduction in tension on the mideline? J Plast Reconstr Aesthet Surg 2021; 74:3361-3370. [PMID: 34229956 DOI: 10.1016/j.bjps.2021.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 03/24/2021] [Accepted: 05/24/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The components separation technique (CS) is used for the reconstruction of complex abdominal wall defects. Release and undermining of the rectus abdominis muscle (RAM) and external oblique muscle (EOM) decrease tension on the abdominal midline, reducing recurrence of ventral hernia, but causes major changes in the physiology of abdominal wall. The purpose of the study was to determine which muscle release and undermining produces the lowest tension on the midline. METHODS Twenty fresh cadavers were dissected and the anterior and posterior layers of the rectus sheath were isolated in the midline. The forces necessary to advance the layers of the rectus sheath to the mid abdomen were measured bilaterally at two points located 3 cm above and 2 cm below the umbilicus, and at 3 different stages: before any muscle release; after release and undermining of the right RAM and left EOM; and after release and undermining of the left RAM and right EOM. Comparisons of tensile forces were conducted separately for the different muscles involved, layers of the rectus sheath, measurement points, and stages of separation. RESULTS Tension on the abdominal midline after the release and undermining of both the RAM and EOM was reduced by 56% (p <0.05), 42% after the release and undermining of the EOM alone (p <0.05), and 35% after release and undermining of the RAM alone (p <0.05). CONCLUSION Release and undermining of the EOM by CS led to lower tension on the abdominal midline compared to that associated with the release of the RAM alone.
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Affiliation(s)
- Leandro Dario Faustino
- Division of Plastic Surgery, Department of Surgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Lydia Masako Ferreira
- Division of Plastic Surgery, Department of Surgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Oscar M Ramirez
- Division of Plastic Surgery, Cleveland Clinic, Fort Lauderdale, FL, United States
| | - Fábio Xerfan Nahas
- Division of Plastic Surgery, Department of Surgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
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Bellorin O, Senturk JC, Cruz MV, Alt R, Dakin G, Afaneh C. A cost analysis of two- versus three-instrument robotic-assisted inguinal hernia repair with mesh: time is money. J Robot Surg 2021; 16:377-382. [PMID: 33997917 DOI: 10.1007/s11701-021-01250-3] [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: 02/25/2021] [Accepted: 05/08/2021] [Indexed: 10/21/2022]
Abstract
Equipment expenses and operating times can lead to higher costs with robotic surgery. We compared the cost-effectiveness of 2- vs. 3-instrument (2i vs. 3i) approach to robotic transabdominal preperitoneal inguinal hernia repair. We conducted a retrospective study of 172 patients, with 86 patients in each group. Procedure cost, operative time, morbidity, length of stay, readmission rate, and hernia recurrence at 90 days were compared. Statistical significance was assigned to p < 0.05. No significant differences in preoperative variables nor in postoperative outcomes were identified. Mean operative time was 6 min longer in the 2i group and this approach cost $300 less. The 2i approach was cost-effective for operating room (OR) costs of less than $50 per minute. Surgeon efficiency and OR dollar-per-minute value influence the potential for cost savings with fewer instruments in robotic herniorrhaphy. There is no difference in outcomes when fewer instruments are used.
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Affiliation(s)
- Omar Bellorin
- Department of Surgery, New York Presbyterian Hospital- Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065, USA
| | - James C Senturk
- Department of Surgery, New York Presbyterian Hospital- Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065, USA.
| | - Mariana Vigiola Cruz
- Department of Surgery, New York Presbyterian Hospital- Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065, USA
| | - Rachel Alt
- Department of Surgery, Valley Medical Group, Ridgewood, NJ, 07450, USA
| | - Gregory Dakin
- Department of Surgery, New York Presbyterian Hospital- Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065, USA
| | - Cheguevara Afaneh
- Department of Surgery, New York Presbyterian Hospital- Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065, USA
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Grossi JVM, Lee B, Belyansky I, Carbonell AM, Cavazzola LT, Novitsky YW, Ballecer CD. Critical view of robotic-assisted transverse abdominal release (r-TAR). Hernia 2021; 25:1715-1725. [PMID: 33797679 DOI: 10.1007/s10029-021-02391-y] [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: 09/17/2020] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Establishing straightforward and reproducible steps to describe the technique performed with the aid of the robotic system for complex hernia surgery is key for good outcomes. Even using the description of open surgery as a parameter for performing the robotic technique, it is important to stress the particularities of this access. To describe the steps to perform robotic-assisted TAR (r-TAR) in a standardized technique, with a critical and safe view of all the anatomical structures. DESCRIPTION OF THE TECHNIQUE We defined 8 landmarks for the critical view of safety in r-TAR which include: (1) patient position, trocar and docking; (2) posterior rectus sheath mobilization; (3) transversus abdominis release (TAR)-Top-down technique; (4) transversus abdominis release (TAR)-bottom-up technique and mesh insertion; (5) contralateral trocar insertion and redocking, 6) posterior sheath closure; (7) final mesh positioning; and (8) anterior defect closure and drains. DISCUSSION Complex hernia surgery using a robotic-assisted posterior component separation requires well-established steps so the procedure can be reproducible and achieve better results.
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Affiliation(s)
- J V M Grossi
- Department of Surgery, Moinhos de Vento Hospital, Porto Alegre, Brazil.
| | - B Lee
- Creighton University School of Medicine-Phoenix, Phoenix, USA
| | - I Belyansky
- Department of Surgery, Anne Arundel Medical Center, 2000 Medical Parkway, Belcher, Pavilion, Suite106, Annapolis, MD, 21401, USA
| | - A M Carbonell
- Department of Surgery, Division of Minimal Access and Bariatric Surgery, Greenville Health System, University of South Carolina School of Medicine, Greenville, SC, USA
| | - L T Cavazzola
- Department of Surgery, Clinicas de Porto Alegre Hospital, Porto Alegre, Brazil
| | | | - C D Ballecer
- Creighton University School of Medicine-Phoenix, Phoenix, USA
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Dauser B, Hartig N, Ghaffari S, Vedadinejad M, Kirchner E, Herbst F. Abdominal wall reconstruction: new technology for new techniques. Eur Surg 2021. [DOI: 10.1007/s10353-020-00688-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Priya P, Kantharia N, Agrawal JB, Agrawal A, Agrawal L, Afaque MY, Rizvi ASA, Baig SJ. Short- to Midterm Results After Posterior Component Separation with Transversus Abdominis Release: Initial Experience from India. World J Surg 2020; 44:3341-3348. [PMID: 32566977 DOI: 10.1007/s00268-020-05644-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Posterior component separation with transversus abdominis release is a new procedure and is quickly gaining popularity. It has shown promising results in terms of low recurrence rates for large and complex hernias. However, there are very little Indian data available on this to date. The purpose of this study was to assess the outcomes of the technique at three centers in India. METHODS This was a retrospective analysis of the prospectively collected data. Patients with a minimum follow-up of 3 months who underwent open or minimal access posterior component separation were included. RESULTS A total of 72 patients (open = 44, minimal access = 25, and hybrid = 3) were included in the analysis. At a follow-up ranging from 3 months to 35 months, there were two recurrences (2.78%). Surgical site occurrences were seen in 23/72 (31.9%), and surgical site infection was seen in 7/72 (9.7%). Surgical site occurrence requiring procedural intervention was 3/72 (4.2%). There were two (2.78%) mortalities in the open group due to myocardial infarction. CONCLUSION Posterior component separation with transversus abdominis release may have advantages in terms of low recurrence in large hernias in the Indian population and can be used in carefully selected patients.
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Affiliation(s)
- Pallawi Priya
- Belle Vue Clinic, 9 and 10, Loudon Street, Kolkata, 700046, India.
| | | | | | | | | | - Md Yusuf Afaque
- J N Medical College, Aligarh Muslim University, Aligarh, India
| | | | - Sarfaraz J Baig
- Belle Vue Clinic, 9 and 10, Loudon Street, Kolkata, 700046, India
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Dauser B, Hartig N, Vedadinejad M, Kirchner E, Trummer F, Herbst F. Robotic-assisted repair of complex ventral hernia: can it pay off? J Robot Surg 2020; 15:45-52. [PMID: 32277399 DOI: 10.1007/s11701-020-01078-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/02/2020] [Indexed: 11/25/2022]
Abstract
Pressure on health care providers is growing due to capping of remuneration for medical services in most Western European countries. We wanted to investigate, if robotic-assisted ventral hernia repair is reasonable from an economic point of view in our setting. Patients undergoing open or robotic-assisted repair for complex abdominal wall hernia using a Transversus Abdominis Release (TAR) between September 2017 and January 2019 were included. Procedure-related costs were calculated exact to the minute and cost unit accounting for the postoperative in-patient stay was done. Abdominal wall reconstruction using the TAR-technique was done in a total of 26 (10 female) patients via an open (n = 10) or robotic-assisted (n = 16) approach. No significant difference was seen in regard to age, BMI and ASA scores between subgroups. Time for operation was longer (253.5 vs 211.5 min; p = 0.0322), while postoperative hospital stay was shorter for patients operated with a robotic-assisted approach (4.5 vs 12.5 days; p < 0.005). Procedure-related costs were 2.7-fold higher when a robotic-assisted reconstruction was done (EUR 5397 vs. 1989), while total costs for in-patient stay were about 60% lower (EUR 2715 vs 6663). Currently, revenues by national insurance account for a total of EUR 9577 leading to a profit of EUR 1465 and 925 for the robotic-assisted and open myofascial release, respectively. In addition, 30-day re-admission rate was in favor of the robotic-assisted approach as well (6.3% vs 20%). From an economic point of view, robotic-assisted TAR for complex ventral hernia repair is a viable option in our setting. Higher procedure-related costs are offset by a significant shorter hospital stay. The economic advantage goes along with improvement in outcome of patients.
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Affiliation(s)
- Bernhard Dauser
- Department of Surgery, St John of God Hospital, Johannes von Gott Platz 1, 1020, Vienna, Austria.
- Vienna Medical School, Sigmund Freud University, Vienna, Austria.
| | - Nikolaus Hartig
- Department of Surgery, St John of God Hospital, Johannes von Gott Platz 1, 1020, Vienna, Austria
| | - Mariam Vedadinejad
- Department of Surgery, St John of God Hospital, Johannes von Gott Platz 1, 1020, Vienna, Austria
- Vienna Medical School, Sigmund Freud University, Vienna, Austria
| | | | - Florian Trummer
- Department of Surgery, St John of God Hospital, Johannes von Gott Platz 1, 1020, Vienna, Austria
- Vienna Medical School, Sigmund Freud University, Vienna, Austria
| | - Friedrich Herbst
- Department of Surgery, St John of God Hospital, Johannes von Gott Platz 1, 1020, Vienna, Austria
- Vienna Medical School, Sigmund Freud University, Vienna, Austria
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Minimally invasive component separation technique for large ventral hernia: which is the best choice? A systematic literature review. Surg Endosc 2019; 34:14-30. [PMID: 31586250 DOI: 10.1007/s00464-019-07156-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 09/24/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Aim of the present systematic review is to compare the postoperative outcomes after minimally invasive anterior and posterior component separation technique (CST), in terms of postoperative morbidity and recurrence rates. METHODS Nine-hundred and fifty-nine articles were identified through Pubmed database. Of these, 444 were eliminated because were duplicates between the searches. Of the remaining 515 articles, 414 were excluded after screening title and abstract. One hundred and one articles were fully analysed, and 73 articles were further excluded, finally including 28 articles. Based on the surgical technique, three groups were created: Group A, endoscopic anterior CST and closure of the abdominal midline by laparotomy; Group B, endoscopic anterior CST and closure of the abdominal midline laparoscopically or robotically; Group C, laparoscopic or robotic posterior CST with transversus abdominal muscle release (TAR). RESULTS In group A, B and C, 196, 120 and 236 patients were included, respectively. Surgical and medical complication rates for the three groups were 31.2% and 13.7% in group A, 15.8% and 4.1% in group B, and 17.8% and 25.4% in group C, while recurrence rate was 10.7%, 6.6% and 0.4%, respectively. Statistically significant differences were observed in terms of surgical postoperative complication rate between group A versus B (p = 0.0022) and between group A versus C (p = 0.0015) and of recurrence rate between group A versus C (p = < 0.0001) and B versus C (p = 0.0009). CONCLUSIONS Anterior CST with midline closure by laparotomy showed the worst results in terms of postoperative surgical complications and recurrence in comparison to the pure minimally anterior and posterior CST. Posterior CST-TAR showed lowest hospital stay and recurrence rate, although the follow-up is short. However, due to the poor quality of most of the studies, further prospective studies and randomized control trials, with wider sample size and longer follow-up are required to demonstrate which is the best surgical option.
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Gokcal F, Morrison S, Kudsi OY. Robotic retromuscular ventral hernia repair and transversus abdominis release: short-term outcomes and risk factors associated with perioperative complications. Hernia 2019; 23:375-385. [PMID: 30771032 DOI: 10.1007/s10029-019-01911-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 02/09/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Retromuscular ventral hernia repairs have become increasingly popular, both with and without transversus abdominis release. We aim to describe our 90-day outcomes in patients who underwent robotic retromuscular ventral hernia repair (RRVHR). METHODS All patients were subcategorized into those who underwent a TAR (TAR+) as part of their repair, and those who did not (TAR-). Patient demographics, comorbidities, hernia characteristics, and LOS were studied. Perioperative complications were reviewed in four different time frames up to 90 days. All hernias and complications were classified using the recommended classification systems. Appropriate univariate analyses and multivariate regression analyses were performed to determine the hernia characteristics which required a TAR technique, and risk factors which associated with the development of complications. RESULTS Of 454 robotic ventral hernia repairs, 101 patients who underwent RRVHR were included into the study. Of these, 54 patients underwent RRVHR with TAR while the remaining 47 patients underwent repair without TAR. Incisional hernias, off-midline locations, and larger size defects were factors that required the addition of a TAR. In 9.9% patients, an unplanned TAR was performed. Postoperative pain assessment was similar in both groups. LOS was significantly longer for TAR + group (p < 0.001). The median Comprehension Complication Index® score was 8.7 (range: 0-42.4) for all patients and was significantly higher for TAR+ group (p = 0.014). Complications were higher in the TAR+ group as compared to the TAR- group (p = 0.028), though this difference did not persist in follow-up. Most complications were minor (Clavien-Dindo grade-I and -II). The development of complications was only associated with the presence of an incarcerated hernia at repair. CONCLUSION RRVHR is safe and feasible. 9.9% of our cohort required a TAR that was unplanned, particularly incisional hernias. TAR patients may be more prone to complications in the immediate post-operative period, however, the difference between patients with and without TAR adjuncts resolved at 90 days.
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Affiliation(s)
- F Gokcal
- Good Samaritan Medical Center, Tufts University School of Medicine, One Pear Street, Brockton, MA, 02301, USA
| | - S Morrison
- Good Samaritan Medical Center, Tufts University School of Medicine, One Pear Street, Brockton, MA, 02301, USA
| | - O Y Kudsi
- Good Samaritan Medical Center, Tufts University School of Medicine, One Pear Street, Brockton, MA, 02301, USA.
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Scheuerlein H, Thiessen A, Schug-Pass C, Köckerling F. What Do We Know About Component Separation Techniques for Abdominal Wall Hernia Repair? Front Surg 2018; 5:24. [PMID: 29637073 PMCID: PMC5881422 DOI: 10.3389/fsurg.2018.00024] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 03/05/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction The component separation technique (CST) was introduced to abdominal wall reconstruction to treat large, complex hernias. It is very difficult to compare the published findings because of the vast number of technical modifications to CST as well as the heterogeneity of the patient population operated on with this technique. Material and Methods The main focus of the literature search conducted up to August 2017 in Medline and PubMed was on publications reporting comparative findings as well as on systematic reviews in order to formulate statements regarding the various CSTs. Results CST without mesh should no longer be performed because of too high recurrence rates. Open anterior CST has too high a surgical site occurrence rate and henceforth should only be conducted as endoscopic and perforator sparing anterior CST. Open posterior CST and posterior CST with transversus abdominis release (TAR) produce better results than open anterior CST. To date, no significant differences have been found between endoscopic anterior, perforator sparing anterior CST and posterior CST with transversus abdominis release. Robot-assisted posterior CST with TAR is the latest, very promising alternative. The systematic use of biologic meshes cannot be recommended for CST. Conclusion CST should always be performed with mesh as endoscopic or perforator sparing anterior or posterior CST. Robot-assisted posterior CST with TAR is the latest development.
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Affiliation(s)
- Hubert Scheuerlein
- Department for General and Visceral Surgery, Vincenz Hospital, Paderborn, Germany
| | - Andreas Thiessen
- Department for General and Visceral Surgery, Vincenz Hospital, Paderborn, Germany
| | - Christine Schug-Pass
- Department of Surgery and Center for Minimally Invasive Surgery, Vivantes Hospital, Academic Teaching Hospital of Charité Medical School, Berlin, Germany
| | - Ferdinand Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Vivantes Hospital, Academic Teaching Hospital of Charité Medical School, Berlin, Germany
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