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Ertekin SC, Ergenç M. Comparing laparoscopic and open umbilical hernia repair: Quality of life and outcomes. Curr Probl Surg 2024; 61:101527. [PMID: 39098331 DOI: 10.1016/j.cpsurg.2024.101527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/22/2024] [Accepted: 05/28/2024] [Indexed: 08/06/2024]
Affiliation(s)
| | - Muhammer Ergenç
- Department of General Surgery, Marmara University School of Medicine, Istanbul, Turkey.
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Sholapur S, Shaikh A, C G A, Tandur A, Padekar HD, Bhandarwar A, Jagdale S. Intraperitoneal Onlay Mesh (IPOM Plus) Repair Versus Extended-View Totally Extraperitoneal Rives-Stoppa (eTEP-RS) Repair in Primary Ventral Hernias: Experience With 50 Cases in a Tertiary Care Hospital. Cureus 2024; 16:e57678. [PMID: 38590981 PMCID: PMC10999782 DOI: 10.7759/cureus.57678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 04/10/2024] Open
Abstract
Background Primary ventral hernias are abnormal protrusions of abdominal viscera through the areas of weakness in the fascia of the abdominal wall. The aim of this study was to compare the benefits and complications, and the overall outcome in the Extended-View Totally Extraperitoneal Rives-Stoppa (eTEP-RS) repair versus Intraperitoneal Onlay Mesh (IPOM Plus) repair in the management of primary ventral hernias. Methods After obtaining institutional ethical committee clearance, this prospective comparative study between IPOM Plus and eTEP-RS was conducted in a tertiary care hospital from December 2020 to January 2022. A total of 50 patients presenting with primary ventral hernias were included in the study, of whom 25 underwent IPOM Plus and 25 underwent eTEP-RS repairs. Group selection was done by simple randomization using the lottery method. Patients more than 18 years of age with primary ventral hernias presenting with a hernial defect width less than 6 cm, consenting to the study, were included in the study. Patients who did not fulfill the inclusion criteria, strangulated/obstructed hernias, recurrent/incisional hernias, connective tissue disorders, skin infections, enterocutaneous fistulas, pregnancy, morbid obesity, and parastomal hernias were exclusion factors. Results The mean intraoperative duration in the eTEP-RS group (192.3 ± 16.20 min) was significantly higher than in the IPOM Plus group (102.6 ± 16.78min, p=0.001). The mean duration of hospital stay in the IPOM Plus group (5.9 ± 2.19 days) was longer than in the eTEP-RS group (4.6 ± 3.17 days, p=0.02). The mean postoperative pain scores, from the Visual Analogue Scale (VAS), on days 1, 7, and 90 were 3.2 ± 1.11, 2.64 ± 1.11, and 1.68 ± 1.46 in the IPOM Plus group and 1.84 ± 0.688, 0.76 ± 0.66 and 0.08 ± 0.40 in the eTEP-RS group, respectively (p=0.001). Conclusion Despite being a technically easy procedure requiring less intraoperative time, IPOM Plus had several disadvantages, such as increased postoperative pain, longer duration of hospital stays, higher chances of wound site seromas, and higher rates of postoperative paralytic ileus. On the other hand, eTEP-RS was a more challenging procedure requiring more intraoperative time; however, it had several advantages: less postoperative pain, less duration of hospital stay, early recovery, and fewer chances of seromas and paralytic ileus. However, more robust data is required to compare and validate the differences between both procedures' short- and long-term outcomes.
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Affiliation(s)
- Sachin Sholapur
- General Surgery, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, IND
| | - Aftab Shaikh
- General Surgery, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, IND
| | - Abhinav C G
- General Surgery, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, IND
| | - Amarjeet Tandur
- General Surgery, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, IND
| | - Harshal D Padekar
- General Surgery, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, IND
| | - Ajay Bhandarwar
- General Surgery, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, IND
| | - Saurabh Jagdale
- General Surgery, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, IND
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Belousov AM, Nepomnyashchaya SL, Danilin VN, Timofeeva KO, Armashov VP, Makarov SA, Matveev NL. [The results of clinical application of the mesh with anti-adhesive fluoropolymer coating in laparoscopic intraperitoneal repair of primary ventral hernia]. Khirurgiia (Mosk) 2024:86-94. [PMID: 38785243 DOI: 10.17116/hirurgia202405186] [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] [Indexed: 05/25/2024]
Abstract
OBJECTIVE The purpose of the study was to evaluate the results of using fluoropolymer-coated mesh during intraperitoneal onlay mesh hernia repair in patients with primary ventral hernias. MATERIAL AND METHODS The multicenter, non-randomized, controlled clinical study included 88 patients of both sexes who were operated on using a laparoscopic approach using the IPOM technique for a primary ventral hernia. The duration of observation ranged from 3 to 12 months. In the main group, 48 patients received fluoropolymer-coated meshes (Ftorex). A comparison was made with a retrospective group of 40 patients who were treated with anti-adhesive collagen-coated meshes (Parietene composite, Parietex Composite, Symbotex). RESULTS The number of early and late postoperative complications in the groups did not have significant differences, at the same time, their number was lower in the group of patients in whom fluoropolymer-coated meshes were used. Most of the complications corresponded to Clavien-Dindo class I and II and did not pose a significant threat to health. There were no recurrences of hernias observed in patients included in the study. There were slightly more adhesions in the fluoropolymer-coated mesh group (35.4% vs. 25.0% in the collagen-coated mesh group). The quality of life of patients in the study groups did not differ. CONCLUSION In laparoscopic IPOM hernia repair fluoropolymer-coated meshes are not inferior in effectiveness and safety to traditionally used collagen-coated meshes and can be recommended for use in patients with primary ventral hernias.
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Affiliation(s)
- A M Belousov
- St. Petersburg State University Hospital, St. Petersburg, Russia
| | | | - V N Danilin
- St. Petersburg State University Hospital, St. Petersburg, Russia
| | - K O Timofeeva
- St. Petersburg State University Hospital, St. Petersburg, Russia
| | - V P Armashov
- Pirogov Russian National Research Medical University, Moscow, Russia
- Loginov Moscow Clinical Scientific Center, Moscow, Russia
| | - S A Makarov
- City Hospital of St. Great Martyr George, St. Petersburg, Russia
| | - N L Matveev
- Pirogov Russian National Research Medical University, Moscow, Russia
- Loginov Moscow Clinical Scientific Center, Moscow, Russia
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Najm A, Niculescu AG, Gaspar BS, Grumezescu AM, Beuran M. A Review of Abdominal Meshes for Hernia Repair-Current Status and Emerging Solutions. MATERIALS (BASEL, SWITZERLAND) 2023; 16:7124. [PMID: 38005054 PMCID: PMC10672379 DOI: 10.3390/ma16227124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023]
Abstract
Abdominal hernias are common issues in the clinical setting, burdening millions of patients worldwide. Associated with pain, decreased quality of life, and severe potential complications, abdominal wall hernias should be treated as soon as possible. Whether an open repair or laparoscopic surgical approach is tackled, mesh reinforcement is generally required to ensure a durable hernia repair. Over the years, numerous mesh products have been made available on the market and in clinical settings, yet each of the currently used meshes presents certain limitations that reflect on treatment outcomes. Thus, mesh development is still ongoing, and emerging solutions have reached various testing stages. In this regard, this paper aims to establish an up-to-date framework on abdominal meshes, briefly overviewing currently available solutions for hernia repair and discussing in detail the most recent advances in the field. Particularly, there are presented the developments in lightweight materials, meshes with improved attachment, antimicrobial fabrics, composite and hybrid textiles, and performant mesh designs, followed by a systematic review of recently completed clinical trials.
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Affiliation(s)
- Alfred Najm
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari, Sector 5, 050474 Bucharest, Romania; (A.N.); (B.S.G.); (M.B.)
- Emergency Hospital Floreasca Bucharest, 8 Calea Floresca, Sector 1, 014461 Bucharest, Romania
| | - Adelina-Gabriela Niculescu
- Research Institute of the University of Bucharest—ICUB, University of Bucharest, 050657 Bucharest, Romania;
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Politehnica University of Bucharest, 011061 Bucharest, Romania
| | - Bogdan Severus Gaspar
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari, Sector 5, 050474 Bucharest, Romania; (A.N.); (B.S.G.); (M.B.)
- Emergency Hospital Floreasca Bucharest, 8 Calea Floresca, Sector 1, 014461 Bucharest, Romania
| | - Alexandru Mihai Grumezescu
- Research Institute of the University of Bucharest—ICUB, University of Bucharest, 050657 Bucharest, Romania;
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Politehnica University of Bucharest, 011061 Bucharest, Romania
- Academy of Romanian Scientists, Ilfov No. 3, 050044 Bucharest, Romania
| | - Mircea Beuran
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari, Sector 5, 050474 Bucharest, Romania; (A.N.); (B.S.G.); (M.B.)
- Emergency Hospital Floreasca Bucharest, 8 Calea Floresca, Sector 1, 014461 Bucharest, Romania
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Drapal V, Mosier S, Norman A, Berbel G, Robinson JL, Friis EA. A preliminary In Vitro viability study of an electrically active hernia mesh on mouse fibroblasts. J Biomater Appl 2023; 38:662-669. [PMID: 37862784 PMCID: PMC11181991 DOI: 10.1177/08853282231209312] [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] [Indexed: 10/22/2023]
Abstract
Hernias occur when part of an organ, typically the intestines, protrudes through a disruption of the fascia in the abdominal wall, leading to patient pain, discomfort, and surgical intervention. Over one million hernia repair surgeries occur annually in the USA, but globally, hernia surgeries can exceed 20 million. Standard practice includes hernia repair mesh to help hold the compromised tissue together, depending on where the fascial disruption is located and the patient's condition. However, the recurrence rate for hernias after using the most common type of hernia mesh, synthetic, is currently high. Physiological-level electrical stimulation (ES) has shown beneficial effects in improving healing in soft tissue regeneration. Piezoelectric materials can produce low-level electrical signals from mechanical loading to help speed healing. Combining the novelty of piezo elements to create an electrically active hernia repair mesh for faster healing prospects is explored in this study through simulated transcutaneous mechanical loading of the piezo element with therapeutic ultrasound. A tissue phantom was developed using Gelatin #0 and Metamucil® to better simulate a clinical application of the therapeutic ultrasound loading modality. The cellular viability of varying ultrasound intensities and temporal effects was analyzed. Overall, minimal cytotoxicity was observed across all experimental groups during the ultrasound intensity and temporal viability studies.
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Affiliation(s)
- Victoria Drapal
- University of Kansas, Bioengineering Program, Lawrence, KS, USA
| | - Savannah Mosier
- University of Kansas, Bioengineering Program, Lawrence, KS, USA
| | - Anna Norman
- University of Kansas, Bioengineering Program, Lawrence, KS, USA
| | - German Berbel
- Department of Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Jennifer L. Robinson
- University of Washington, Department of Orthopaedics and Sports Medicine
- University of Washington, Department of Mechanical Engineering
| | - Elizabeth A. Friis
- University of Kansas, Bioengineering Program, Lawrence, KS, USA
- University of Kansas, Department of Mechanical Engineering, Lawrence, KS, USA
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Kaushik K, Srivastava V, Datta Sai Subramanyam A, Kishore R, Pratap A, Ansari MA. A Comparative Study on Outcomes and Quality of Life Changes Following Ventral Transabdominal Preperitoneal (Ventral-TAPP) and Laparoscopic Intraperitoneal Onlay Mesh (IPOM)-Plus Repair for Ventral Hernia. Cureus 2023; 15:e42222. [PMID: 37605677 PMCID: PMC10439842 DOI: 10.7759/cureus.42222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 08/23/2023] Open
Abstract
Background Ventral transabdominal preperitoneal (ventral-TAPP) repair and intraperitoneal onlay mesh (IPOM) plus repair are two options among the available techniques of laparoscopic ventral hernia repair (LVHR). We conducted a comparative study to evaluate the clinical and quality of life (QoL)-related outcomes between ventral-TAPP and IPOM-plus repair. It was hypothesized that both procedures offered similar outcomes and QoL. Materials and methods The study included 32 consecutive patients undergoing LVHR, divided equally between ventral-TAPP and IPOM-plus groups. In the ventral-TAPP procedure, a peritoneal flap was created around the defect, followed by defect approximation and polypropylene mesh placement in the pre-peritoneal pocket. For the IPOM-plus procedure, the defect was closed and a composite (dual-side) mesh was placed around the defect. The minimum overlap beyond the original defect margin in both groups was 5 cm. Data regarding pre-operative parameters and postoperative outcomes, including pain and QoL at one week, one month, and three months, were recorded. A p-value of less than or equal to 0.05 was considered to be statistically significant. Results While the mean duration of surgery was longer, the cost of treatment was lower in group 1 (ventral-TAPP) with a p-value of <0.05 for both parameters. The length of hospital stay was significantly shorter in group 1 (ventral-TAPP), while the return to normal activity was similar in both groups. The visual analog scale (VAS) score for overall pain perception and the European registry for abdominal wall hernias (EuraHS; hernia-related QoL) score for 'Pain at Site' and 'Restriction of Activity' domains were significantly higher in group 2 (IPOM-plus) at one week. Conclusion Although the ventral-TAPP procedure requires more time and expertise to perform, the EuraHS QoL assessment at one week was better in group 1 (ventral-TAPP). Ventral-TAPP group scored better in terms of length of hospital stay and cost-effectiveness as well.
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Affiliation(s)
- Kumar Kaushik
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Vivek Srivastava
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | | | - Ritwik Kishore
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Arvind Pratap
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Mumtaz A Ansari
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
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Implementation of robotic surgery in Dubai: a focus on outcomes. J Robot Surg 2023; 17:169-176. [PMID: 35441253 PMCID: PMC9939485 DOI: 10.1007/s11701-022-01407-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/19/2022] [Indexed: 10/18/2022]
Abstract
The rapid acceptance of robotic surgery in gallbladder, inguinal, and ventral hernia surgery has led to the growth of robotic surgery programs around the world. As this is new technology, implementation of such programs needs to be done safely, with a focus on patient outcomes. We herein describe the implementation of a new robotic surgery program in a major hospital in the Middle East. A laparoendoscopic surgeon led the program after training and proctoring. Competency based credentialing were created and put in place. To confirm safety of the program, all laparoscopic and robotic cholecystectomy and hernia operations were followed, and perioperative data analyzed. Out of the 304 patients included in this study, 157 were performed using the robotic approach. In the cholecystectomy group (n = 103) the single site approach offered shorter operative times (P < 0.05). Both the single site robotic and the robotic assisted approaches resulted in less pain (P < 0.05). In the inguinal hernia group (n = 146) the laparoscopic approach offered shorter operative times (P < 0.05), but the robotic approach was associated with less pain (P < 0.05). In the ventral hernia group (n = 55), the open approach offered the best operative times, but the robotic approach was associated with the least amount of pain (P < 0.05). This is the first report of the implementation of a robotic program in the MENA region where the primary measure of success is outcomes. We show that monitoring cholecystectomy, inguinal or ventral hernia data can confirm the quality of the program before expansion and moving forward to more complex procedures.
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Pavone G, Gerundo A, Pacilli M, Fersini A, Ambrosi A, Tartaglia N. Bariatric surgery: to bleed or not to bleed? This is the question. BMC Surg 2022; 22:331. [PMID: 36058915 PMCID: PMC9442932 DOI: 10.1186/s12893-022-01783-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/31/2022] [Indexed: 11/15/2022] Open
Abstract
Background Bariatric surgery procedures are the most successful and durable treatment for morbid obesity. Hemorrhage represents a life-threatening complication, occurring in 1.3–1.7% of bariatric surgeries.
Materials and methods We examined patients undergoing Bariatric Surgery from July 2017 to June 2020 (Group A) and those operated from July 2020 to June 2022 (Group B) in our Department. Starting from July 2020 we have implemented intraoperative measures to prevent postoperative bleeding, increasing mean arterial pressure (MAP) by 30% compared to preoperative and reducing the pneumoperitoneal pressure of CO2 to 8 mmHg in the last 15 min of the operation. Results The study gathered 200 patients divided into the two described groups. The mean age of Group A is 44 ± 8.49 and 43.73 ± 9.28. The mean preoperative BMI is 45.6 kg/m2 ± 6.71 for Group A and 48.9 ± 7.15 kg/m2 for Group B. Group A recorded a mean MAP of 83.06 ± 18.58 mmHg and group B a value of 111.88 ± 12.46 mmHg (p value < 0.05 and z-score is 4.15226 and the value of U is 13,900). We observed 9 cases of bleeding in group A, most of them being treated with medical therapy and transfusions; only 1 hemodynamically unstable patient underwent re-laparoscopy. We reported only 2 cases of bleeding in group B, one of which required blood transfusions. Conclusion From our study we can conclude that increasing mean arterial pressure (MAP) by 30% compared to preoperative and reducing the pneumoperitoneum pressure of CO2 to 8 mmHg in the last 15 min of the operation led to a decrease in bleeding cases in group B and, most importantly, all the bleedings were easily controllable with medical therapy and/or transfusions. These measures allowed us to reduce postoperative bleeding.
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Affiliation(s)
- Giovanna Pavone
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122, Foggia, Italy
| | - Alberto Gerundo
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122, Foggia, Italy
| | - Mario Pacilli
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122, Foggia, Italy
| | - Alberto Fersini
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122, Foggia, Italy
| | - Antonio Ambrosi
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122, Foggia, Italy
| | - Nicola Tartaglia
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122, Foggia, Italy.
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Wang B, He K, Zhu Y, Fu X, Yao Q, Chen H, Wang X. Quantitative Analysis of Abdominal Muscles Using Elastography in Female Patients With Incisional Hernia. Front Surg 2022; 9:831184. [PMID: 35495759 PMCID: PMC9039235 DOI: 10.3389/fsurg.2022.831184] [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: 01/11/2022] [Accepted: 03/14/2022] [Indexed: 11/16/2022] Open
Abstract
This study aimed to assess the thickness and shear wave speed (SWS) of the anterolateral abdominal wall muscles in female patients with incisional hernias of different widths, in order to analyze the biomechanical properties of abdominal wall muscles. This study included 53 patients with incisional hernia (Group A [hernia width <4 cm]: 21 patients, Group B [hernia width ≥4 cm]: 32 patients). The muscle thickness and SWS values of the external oblique (EO), internal oblique (IO), and transversus abdominis (TrA), and the hernia width were measured using Siemens Acuson S2000 ultrasound systems. Four detection points were labeled on the anterolateral abdominal wall: points 1, 2, 3, and 4, corresponding to the upper right, upper left, lower right, and lower left, respectively. The muscle thickness of the IO at point 3 was significantly different between both groups (p = 0.024). Group B had significantly higher SWS values than Group A, especially for the EO (points 1, 2, and 3), IO (points 1 and 2), and TrA (points 2 and 4) (p < 0.05). Pearson correlation analysis shows no significant correlation between muscle thickness and the SWS values of EO, IO, and TrA (all p > 0.05). Linear correlation analysis showed a significantly positive correlation between hernia width and the mean SWS value of EO, IO, and TrA (p = 0.004, 0.005, and 0.043, respectively). Muscle thickness was not reliable measure to directly reflect the biomechanical changes of the abdominal wall muscles in patients with incisional hernia. Comparatively, SWE can accurately measure the stiffness of the abdominal wall muscles and intuitively evaluate its biomechanical properties.
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Affiliation(s)
- Bo Wang
- Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China
| | - Kai He
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Yulan Zhu
- Department of Rehabilitation, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaojian Fu
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Qiyuan Yao
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Hao Chen
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
- *Correspondence: Hao Chen
| | - Xiaohong Wang
- Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China
- Xiaohong Wang
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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.
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Araujo-Gutierrez R, Van Eps JL, Scherba JC, Anastasio AT, Cabrera F, Vatsaas CJ, Youker K, Fernandez Moure JS. Platelet rich plasma concentration improves biologic mesh incorporation and decreases multinucleated giant cells in a dose dependent fashion. J Tissue Eng Regen Med 2021; 15:1037-1046. [PMID: 34551456 DOI: 10.1002/term.3247] [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: 04/13/2021] [Revised: 08/19/2021] [Accepted: 08/31/2021] [Indexed: 11/09/2022]
Abstract
Platelet rich plasma (PRP) has been shown to improve incorporation and reduce inflammation in ventral hernia repair (VHR) with acellular dermal matrix (ADM). The concentration of platelets in PRP varies in clinical studies and an ideal concentration has yet to be defined. The effects of varied concentrations of PRP on ADM incorporation and inflammatory cell infiltration in a rat model of VHR. We hypothesized that increasing concentration of PRP would lead to improved incorporation, decreased CD8+ and multinucleated giant cell (MNGC) infiltrate. Lewis rats underwent ventral hernia creation and repair 30 days later with porcine non-crosslinked ADM. PRP was applied to the mesh prior to skin closure at concentrations of 1 × 104 plt/μL (PRP-LOW), 1 × 106 plt/μL (PRP-MID), or 1 × 107 plt/μL (PRP-HIGH) and tissue harvested at 2 and 4 weeks. Cellularization, tissue deposition, and mesh thickness using hematoxylin and eosin and Masson's trichrome, and neovascularization was assessed with VVG staining, to establish the relationship of PRP concentration to metrics of incorporation. MNGC and CD8+ T-cell infiltration were quantified to establish the relationship of inflammatory cell infiltration in response to PRP concentration. Lymphocyte infiltration was assessed using immunohistochemical staining for CD8. PRP-HIGH treated had significantly greater tissue deposition at 4 weeks. PRP-MID showed increasing mesh thickness at 2 weeks. Cell infiltration was significantly higher with PRP-HIGH at both 2 and 4 weeks while PRP-LOW showed increased cell infiltration only at 4 weeks. At both time points there was a trend towards a dose dependent response in cell infiltration to PRP concentration. Neovascularization was highest with MID-plt at 2 weeks, yet no significant differences were noted compared to controls. CD8+ cell infiltrate was significantly decreased at 2 and 4 weeks in PRP-LOW and PRP-MID treated groups. PRP at all concentrations significantly decreased MNGC infiltration at 2 weeks while only PRP-HIGH and PRP-MID had significant reductions in MNGC at 4 weeks. Both MNGC and CD8+ cell infiltration demonstrated dose dependent reduction in relation to PRP concentration. Increasing platelet concentrations of PRP correlated with improved incorporation, tissue deposition, and decreased scaffold degradation. These findings were associated with a blunted foreign body response. These findings suggest PRP reduces inflammation which may be beneficial for ADM incorporation in VHR.
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Affiliation(s)
| | - Jeffrey L Van Eps
- Department of Surgery, Section of Colon & Rectal Surgery, UTHealth at McGovern Medical School, Houston, Texas, USA
| | - Jacob C Scherba
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Albert Thomas Anastasio
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Fernando Cabrera
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, Texas, USA
| | - Cory J Vatsaas
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Keith Youker
- Department of Cardiovascular Science, Houston Methodist Hospital, Houston, Texas, USA
| | - Joseph S Fernandez Moure
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, Texas, USA
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
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Olmi S, Millo P, Piccoli M, Garulli G, Junior Nardi M, Pecchini F, Oldani A, Pirrera B. Laparoscopic Treatment of Incisional and Ventral Hernia. JSLS 2021; 25:JSLS.2021.00007. [PMID: 34248345 PMCID: PMC8249222 DOI: 10.4293/jsls.2021.00007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background and Objectives Although several large studies regarding patients undergoing minimally invasive repair of incisional hernia are currently available, the results are not particularly reliable as they are based on heterogeneous groups, different surgical techniques, different mesh types, or with a too short follow period. Methods We conducted a retrospective observational trial, collecting data from patients who underwent laparoscopic repair of a primary abdominal wall or an incisional hernia using the laparoscopic Intraperitoneal Onlay Mesh technique and a single mesh type, i.e., a composite polyester mesh with a hydrophilic film (Parietex CompositeTM mesh - Medtronic, Minneapolis, MN - USA). All patients signed an informed consent. Results One thousand seven hundred seventy-seven patients were enrolled. The median surgery time was 50 minutes and the median length of hospital stay was 2 days. Intraoperative complications occurred in 12 patients (0.7%), while early postoperative surgical complications occurred in 115 (6.5%); during follow-up, bulging mesh was diagnosed in 4.5% of cases and hernia recurred in 4.3% of patients. An overlap equal or greater than 4 cm resulted as a significant protective factor, while the use of absorbable fixing devices was a risk factor for recurrence (odds ration: 9.06, p < 0.001, 95% confidence interval: 4.19 - 19.57). Conclusions Minimally invasive treatment of primary and postincisional abdominal wall hernias is a safe, effective, and reproducible procedure. An overlap equal or greater than 4 cm, the use of nonabsorbable fixing devices and a postoperative care and follow-up regime are crucial in order to obtain good results and low recurrence rates.
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Affiliation(s)
- Stefano Olmi
- Chirurgia Generale ed Oncologica - Policlinico San Marco GSD, Zingonia, Italy
| | - Paolo Millo
- SC Chirurgia Generale e Urgenza - Ospedale Regionale U. Parini, Aosta, Italy
| | - Micaela Piccoli
- Chirurgia Generale, d'Urgenza e Nuove tecnologie - Ospedale Civile di Baggiovara, Baggiovara, Italy
| | - Gianluca Garulli
- UOC Chirurgia Generale e d'Urgenza - Ospedale di Rimini (Novafeltria, Santarcangelo), Rimini, Italy
| | - Mario Junior Nardi
- SC Chirurgia Generale e Urgenza - Ospedale Regionale U. Parini, Aosta, Italy
| | - Francesca Pecchini
- Chirurgia Generale, d'Urgenza e Nuove tecnologie - Ospedale Civile di Baggiovara, Baggiovara, Italy
| | - Alberto Oldani
- Chirurgia Generale ed Oncologica - Policlinico San Marco GSD, Zingonia, Italy
| | - Basilio Pirrera
- UOC Chirurgia Generale e d'Urgenza - Ospedale di Rimini (Novafeltria, Santarcangelo), Rimini, Italy
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Pini R, Di Giuseppe M, Toti JMA, Mongelli F, Marcantonio M, Spampatti S, La Regina D. Robot-assisted Treatment of Epigastric Hernias With a Suprapubic Approach. Surg Laparosc Endosc Percutan Tech 2021; 31:584-587. [PMID: 33900226 DOI: 10.1097/sle.0000000000000941] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 02/15/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Robot-assisted ventral hernia repair has shown itself to be feasible and safe in abdominal wall surgery. Presently, the ports are placed laterally to meet the distance from the fascial defect. The aim of our study is to report our experience of epigastric hernia treatment with trocar insertion in the suprapubic region. MATERIALS AND METHODS On a prospectively collected dataset on robot-assisted surgery, patients treated for epigastric hernias with suprapubic approach were identified. Demographic and clinical data were collected and analyzed. RESULTS Twelve patients were selected. Median age was 58.5 years [interquartile range (IQR): 47.8 to 67.3 y]; 4 patients were male (33.3%) and the median body mass index was 23.9 kg/m2 (IQR: 22.3 to 26.2 kg/m2). All patients were referred to surgery because of pain. The median measure of the hernia defect was 30 mm (IQR: 13.75 to 31.0 mm); median larger mesh diameter was 13.5 cm (IQR: 9.5 to 15.0 cm); and median operative time was 136.5 minutes (IQR: 120.0 to 186.5 min). No intraoperative complication or conversion to open surgery occurred. Postoperatively, 2 patients presented a seroma and median length of hospital stay was 2.0 days (IQR: 1.75 to 3 d). No case of hernia recurrence was recorded at a mean follow-up of 11.2 months (range: 4 to 29 mo). CONCLUSIONS In the robot-assisted treatment of hernias of the epigastric region, a suprapubic port placement can be considered instead of a lateral one to have a better field overview, especially in subxiphoid hernias. Further studies are needed to assess the benefits and limitations of such technique.
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Affiliation(s)
- Ramon Pini
- Department of Surgery, Regional Hospital of Bellinzona e Valli, Bellinzona
| | - Matteo Di Giuseppe
- Department of Surgery, Regional Hospital of Bellinzona e Valli, Bellinzona
| | - Johannes M A Toti
- Department of Surgery, Regional Hospital of Bellinzona e Valli, Bellinzona
| | | | - Maria Marcantonio
- Department of Surgery, Regional Hospital of Bellinzona e Valli, Bellinzona
| | | | - Davide La Regina
- Department of Surgery, Regional Hospital of Bellinzona e Valli, Bellinzona
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Assakran BS, Widyan AM, Al-Lihimy AS, Aljabali AA, Al-Enizi MA, A F. Recurrent Inguinal Hernia Post Laparoscopic Repair: A Retrospective Single-Center Study in Qassim Region, Saudi Arabia. Cureus 2021; 13:e13682. [PMID: 33833908 PMCID: PMC8018993 DOI: 10.7759/cureus.13682] [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] [Indexed: 11/24/2022] Open
Abstract
Introduction Inguinal hernia is the most common hernia among the abdominal wall hernias. This study aims to estimate the long-term recurrence rate and laparoscopy-related risk factors for inguinal hernia at King Fahad Specialist Hospital in Buraidah, Al Qassim region, Saudi Arabia. Methods A single-center retrospective study of all laparoscopic hernia repair patients admitted in the surgical department of King Fahad Specialist Hospital in Buraidah, Al Qassim region, Saudi Arabia from January 2016 to July 2020. Results A total of 64 patients were included in the present study. All patients were male with a mean age 42.27±15.79 years. Out of 64 patients, 71.9% were married and 11 (17.2%) were smokers. Most patients were found to be in the elective priority (89.1%) and the emergency cases were 10.1%. A total of 6.3% had a recurrent hernia and 93.7% had a primary hernia. After testing the association of hernia repair and the patient-related factors, it was observed that there is no significant association between recurrent hernia repair and the mean age (p=0.072), body mass index (BMI) (p=0.962), smoking (p=0.347), married patients (p=0.196), and diabetes (p=0.446). Conclusion A total of 6.3 % of patients developed a recurrent inguinal hernia after laparoscopic repair. In contrast to the literature, this study showed that patient-related risk factors were not statically significant among our patients. However, the reasons behind the recurrence rate tend to be multifactorial, including surgical, technical, hospital capability, and patients factors. Therefore, early recognization and management of these risk factors are essential to prevent further cases.
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Affiliation(s)
| | | | | | | | | | - Fadiyah A
- Medicine, Qassim University, Buraidah, SAU
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15
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Pillay Y, Pon K. Laparoscopic transabdominal preperitoneal mesh repair of two posterior rectus sheath hernias: A first case series in the published literature. INTERNATIONAL JOURNAL OF ABDOMINAL WALL AND HERNIA SURGERY 2021. [DOI: 10.4103/ijawhs.ijawhs_21_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Primary Fascial Closure During Laparoscopic Ventral Hernia Repair Improves Patient Quality of Life: A Multicenter, Blinded Randomized Controlled Trial. Ann Surg 2020; 271:434-439. [PMID: 31365365 DOI: 10.1097/sla.0000000000003505] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Observational studies have reported conflicting results with primary fascial closure (PFC) versus bridged repair during laparoscopic ventral hernia repair (LVHR). OBJECTIVE The aim of the study was to determine whether when evaluated in a randomized controlled trial (RCT), PFC compared to bridged repair would improve patient quality of life (QoL). METHODS In this blinded, multicenter RCT, patients scheduled for elective LVHR (hernia defects 3 to 10 cm on computed tomography scan) were randomized to PFC versus bridged repair. Primary outcome was change in QoL after LVHR using a validated, hernia-specific survey (1 = poor QoL and 100 = perfect QoL) that measures pain, function, cosmesis, and satisfaction. Secondary outcomes were postoperative surgical site occurrences (including hematoma, seroma, surgical site infection, and wound dehiscence), abdominal eventration, and hernia recurrence. The trial was powered to detect a difference in change in QoL of 7 points between the study groups. Outcomes were compared with Mann-Whitney U test or chi-square. RESULTS A total of 129 patients underwent LVHR and 107 (83%) completed follow-up at 2 years. Patients from both groups were similar at baseline. On median follow-up of 24 months (range: 9-42), patients treated with LVHR-PFC had on average a 12-point higher improvement in QoL compared to bridged repair (improvement in QoL, 41.3 ± 31.5 vs 29.7 ± 28.7, P value = 0.047). There were no differences in surgical site occurrence, eventration, or hernia recurrence between groups. CONCLUSIONS Among patients undergoing elective LVHR, the fascial defect should be closed. This is the first RCT demonstrating that PFC with LVHR significantly improves patient QoL. TRIAL REGISTRATION This trial was registered with clinicaltrials.gov (NCT02363790).
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Olmi S, Uccelli M, Cesana GC, Oldani A, Giorgi R, De Carli SM, Ciccarese F, Villa R. Laparoscopic Abdominal Wall Hernia Repair. JSLS 2020; 24:JSLS.2020.00007. [PMID: 32265582 PMCID: PMC7112985 DOI: 10.4293/jsls.2020.00007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background and Objectives The aim of this retrospective monocentric study was to evaluate results and recurrence rate with long-term follow-up after laparoscopic incisional/ventral hernia repair. Methods This was a retrospective, single-center, observational trial, collecting data from patients who underwent laparoscopic incisional/ventral abdominal hernia repair using the open intraperitoneal onlay mesh technique and a single mesh type. All patients signed an informed consent form before surgery. Results A total of 1,029 patients were included. The median surgery time was 40 min (range 30-55) and the median length of hospital stay was 2 d (range 2-3). Intraoperative complications occurred in two of 1,029 patients (0.19%), whereas early postoperative surgical complications (within 30 d) occurred in 50 patients (4.86%). Postoperative complications according to Clavien-Dindo classification were as follows: I, 3.30% (34 of 1,029); II, 0.97% (10 of 1,029); IIIB, 0.58% (six of 1,029); IV, 0.00% (none of 1,029); and V, 0.00% (none of 1,029). During follow-up, bulging mesh was diagnosed in 58 of 1,029 patients (5.6%), and hernia recurred in 40 of 1,029 patients (3.9%). A mesh overlap equal to or greater than 4 cm appeared to be a significant protective factor for hernia recurrence (P < .001); a mesh overlap equal or greater than 5 cm appeared to be a significant protective factor for bulging (P < .001), whereas the use of resorbable fixing devices was a significant risk factor for hernia recurrence (odds ratio, 111.53, P < .001, 95% confidence interval, 21.53-577.67). Conclusion This study demonstrates that laparoscopic repair of ventral/incisional abdominal wall hernias is a safe, effective, and reproducible procedure. Identified risk factors for recurrence are an overlap of less than 4 cm and the use of resorbable fixation means.
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Affiliation(s)
- Stefano Olmi
- Surgeon of General and Oncologic Surgery Department, Centre of Advanced Laparoscopic Surgery, Centre of Bariatric Surgery, San Marco Hospital GSD, Zingonia, Italy
| | - Matteo Uccelli
- Surgeon of General and Oncologic Surgery Department, Centre of Advanced Laparoscopic Surgery, Centre of Bariatric Surgery, San Marco Hospital GSD, Zingonia, Italy
| | - Giovanni Carlo Cesana
- Surgeon of General and Oncologic Surgery Department, Centre of Advanced Laparoscopic Surgery, Centre of Bariatric Surgery, San Marco Hospital GSD, Zingonia, Italy
| | - Alberto Oldani
- Surgeon of General and Oncologic Surgery Department, Centre of Advanced Laparoscopic Surgery, Centre of Bariatric Surgery, San Marco Hospital GSD, Zingonia, Italy
| | - Riccardo Giorgi
- residency program tutor at University of Milan and Vita-Salute University San Raffaele, Italy
| | - Stefano Maria De Carli
- Surgeon of General and Oncologic Surgery Department, Centre of Advanced Laparoscopic Surgery, Centre of Bariatric Surgery, San Marco Hospital GSD, Zingonia, Italy
| | - Francesca Ciccarese
- Surgeon of General and Oncologic Surgery Department, Centre of Advanced Laparoscopic Surgery, Centre of Bariatric Surgery, San Marco Hospital GSD, Zingonia, Italy
| | - Roberta Villa
- Surgeon of General and Oncologic Surgery Department, Centre of Advanced Laparoscopic Surgery, Centre of Bariatric Surgery, San Marco Hospital GSD, Zingonia, Italy
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Kaiwa Y, Maida K, Sekiguchi S. Laparoscopic decision-making concerning the repair area for traumatic abdominal wall pseudohernia: A case report. Asian J Endosc Surg 2020; 13:234-237. [PMID: 31190475 DOI: 10.1111/ases.12725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 05/16/2019] [Indexed: 12/20/2022]
Abstract
Laparoscopic decision-making may be useful for accurately determining the repair area when treating abdominal wall pseudohernia. A 31-year-old man was admitted with a pelvic ring fracture after a traffic accident and underwent orthopedic surgery. Five months after surgery, the patient developed a lower abdominal protrusion. CT revealed abdominal wall bulging and thinning of the abdominal muscle but no musculofascial defects, suggesting a pseudohernia. We reconstructed the abdominal wall and inserted a mesh. Because there was no musculofascial defect, it was difficult to discern the accurate repair area. We used laparoscopy to determine the repair area, which was recognized thanks to illumination transmitted through the abdominal wall. We were able to determine the appropriate size and placement of the mesh, which enabled us to repair the abdominal pseudohernia.
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Affiliation(s)
| | - Kai Maida
- Department of Surgery, Sendai City Hospital, Sendai, Japan
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19
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Chan YW, Fischer W, Pauzenberger C, Dinnewitzer A, Hollinsky C. Assessment of ideal ratio of mesh area to number of fixation tacks in laparoscopic ventral and incisional IPOM Plus hernia repair. Surg Endosc 2020; 35:1230-1237. [PMID: 32166548 DOI: 10.1007/s00464-020-07493-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 03/02/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND To clarify the optimum mesh-tack ratio MTR (mesh area in cm2 divided by the number of fixation tacks) in laparoscopic ventral and incisional hernia repair, we compared IPOM Plus procedures with more intensive mesh fixation to those with standard mesh fixation. METHODS In a retrospective cohort study, 84 patients (mean hernia width 6.6 ± 4.4 cm) intraoperatively received an intensive mesh fixation I-IPOM Plus with MTR ≤ 4:1 (e.g. ,150 cm2 mesh fixed by 50 tacks) and 74 patients (mean hernia width 6.7 ± 3.4 cm) received a standard mesh fixation S-IPOM Plus with MTR > 4:1 (e.g., 150 cm2 mesh fixed by 30 tacks) at a community hospital between 2014 and 2017. Outcomes in recurrence rates, immediate and chronic postoperative pain, as well as long-term functionality of the abdominal wall were then evaluated. RESULTS After a mean follow-up time of 34 months, a 2.3% recurrence rate in I-IPOM Plus patients and a 13.5% recurrence rate in S-IPOM Plus patients were recorded (p = 0.018). The recurrence was associated with large hernia > 10 cm (OR 3.7, 95% CI 1.3-5.4) and MTR > 5 (OR 2.4, 95% CI 1.1-3.8) in the multivariate analysis. There was a positive correlation between immediate postoperative pain intensity measured on day 7 and number of fixation tacks placed (I-IPOM Plus: mean 4.5 ± 2.5 VAS versus S-IPOM Plus: mean 2.7 ± 2.0 VAS, p = 0.001). However, there were no outcome differences in terms of length of immediate postoperative pain experience, sick leave duration, chronic pain rate and long-term abdominal wall functionality between these two groups. CONCLUSION For ventral and incisional hernia patients with multiple recurrence risk factors, a mesh-tack ratio MTR ≤ 4:1 should be applied in laparoscopic IPOM Plus procedures.
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Affiliation(s)
- Yi-Wei Chan
- Department of Surgery, Steyr General Hospital, Sierninger Straße 170, 4400, Steyr, Austria. .,Department of Surgery, Kirchdorf General Hospital, Kirchdorf, Austria.
| | - Wolfgang Fischer
- Department of Surgery, Steyr General Hospital, Sierninger Straße 170, 4400, Steyr, Austria.,Department of Surgery, Kirchdorf General Hospital, Kirchdorf, Austria
| | - Christian Pauzenberger
- Department of Surgery, Steyr General Hospital, Sierninger Straße 170, 4400, Steyr, Austria.,Department of Surgery, Kirchdorf General Hospital, Kirchdorf, Austria
| | - Adam Dinnewitzer
- Department of Surgery, Steyr General Hospital, Sierninger Straße 170, 4400, Steyr, Austria.,Department of Surgery, Kirchdorf General Hospital, Kirchdorf, Austria
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Koebe S, Greenberg J, Huang LC, Phillips S, Lidor A, Funk L, Shada A. Current practice patterns for initial umbilical hernia repair in the United States. Hernia 2020; 25:563-570. [PMID: 32162111 DOI: 10.1007/s10029-020-02164-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/26/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE The approach to repairing an initial umbilical hernia (IUH) varies substantially, and this likely depends on hernia size, patient age, sex, BMI, comorbidities including diabetes mellitus, and surgeon preference. Of these, only hernia size has been widely studied. This cross-sectional study aims to look at the practice pattern of umbilical hernia repair in the United States. METHODS A retrospective study was performed using data from the America Hernia Society Quality Collaborative. Patient characteristics included age, sex, hernia width, BMI, smoking status, and diabetes. Outcomes were use of mesh for repair, as well as surgical approach (open vs minimally invasive). Multivariate logistic regression was performed to assess the independent effect of age, sex, hernia width, BMI, smoking status, and diabetes on use of mesh and approach to repair. RESULTS 3475 patients were included. 74% were men. Mesh use was more common in men (67% vs 60%, P < 0.001). Mesh was used in 33% of repairs ≤ 1 cm, and 82% of repairs > 1 cm (P < 0.001). Younger patients were less likely to receive a mesh repair (54% if age ≤ 35 vs 67% for age > 35, P < 0.001). However, on multivariate analysis, mesh use was associated with increasing hernia width (OR 5.474, 95% CI 4.7-6.3) as well as BMI (OR 1.8, 95% CI 1.5-2.1) but not with age or sex. CONCLUSION The majority of IUH are performed open. Patient BMI and hernia defect size contribute to choice of surgical technique including use of mesh. The use of mesh in 33% of hernias below 1 cm demonstrates a gap between evidence and practice. Patient factors including patient age and sex had no impact on operative approach or use of mesh.
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Affiliation(s)
- S Koebe
- University of Wisconsin School of Medicine and Public Health, 750 Highland Ave, Madison, WI, 53726, USA
| | - J Greenberg
- Department of Surgery, University of Wisconsin, 600 Highland Ave, Madison, WI, 53736, USA
| | - L-C Huang
- America Hernia Society Quality Collaborative, Vanderbilt University Medical Center, Nashville, TN, USA
| | - S Phillips
- America Hernia Society Quality Collaborative, Vanderbilt University Medical Center, Nashville, TN, USA
| | - A Lidor
- Department of Surgery, University of Wisconsin, 600 Highland Ave, Madison, WI, 53736, USA
| | - L Funk
- Department of Surgery, University of Wisconsin, 600 Highland Ave, Madison, WI, 53736, USA
| | - A Shada
- Department of Surgery, University of Wisconsin, 600 Highland Ave, Madison, WI, 53736, USA.
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, 4602 Eastpark Blvd Suite 3525, Madison, WI, 53718, USA.
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Primary non-complicated midline ventral hernia: is laparoscopic IPOM still a reasonable approach? Hernia 2019; 23:915-925. [PMID: 31456098 DOI: 10.1007/s10029-019-02031-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 08/07/2019] [Indexed: 01/16/2023]
Abstract
PURPOSE Ventral hernia repair has become a common procedure, but the way in which it is performed still depends on surgeon's skill, experience, and habit. The initial open approach is faced with extensive dissection and a high risk of infection and prolonged hospital stay. To tackle these problems, minimally invasive procedures are gaining interest. Several new techniques are emerging, but laparoscopic intra-peritoneal onlay mesh (IPOM) is still the mainstay for many surgeons. We will discuss why laparoscopic IPOM is still a valuable approach in the treatment of primary non-complicated midline hernias and review the current literature. METHODS We performed a literature search across PubMed and MEDLINE using the following search terms: "Laparoscopic hernia repair", "Ventral hernia repair" and "Primary ventral hernia". Articles corresponding to these search terms were individually reviewed by the primary author and selected on relevance. CONCLUSION Laparoscopic IPOM still is a good approach for the efficient treatment of primary non-complicated midline hernias. Several techniques are emerging, but are faced with increased costs, technical difficulties, and low study patient volume. Further research is warranted to show superiority and applicability of these new techniques over laparoscopic IPOM, but until then laparoscopic IPOM should remain the go-to technique.
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Alizai PH, Lelaona E, Andert A, Neumann UP, Klink CD, Jansen M. Incisional Hernia Repair of Medium- and Large-Sized Defects: Laparoscopic IPOM Versus Open SUBLAY Technique. Acta Chir Belg 2019; 119:231-235. [PMID: 30270760 DOI: 10.1080/00015458.2018.1501962] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background: Small incisional hernias can be repaired laparoscopically with low morbidity and reasonable recurrence rates. The aim of this study was to compare laparoscopic with open technique in medium- and large-sized defects regarding postoperative complications and recurrence rates. Methods: Between 2012 and 2016, 102 patients with medium- or large-sized defects according to EHS classification underwent incisional hernia repair. Patients' characteristics, hernia size and postoperative complications were prospectively recorded. In October 2016, eligible patients were assessed for recurrence. Results: About 31 patients underwent laparoscopic IPOM and 71 patients open SUBLAY repair. Morbidity rate was significantly lower in IPOM group than in SUBLAY group (19% versus 41%; p = .028). Postoperative complications according to Clavien-Dindo classification were significantly lower in the IPOM group (p = .021). Duration of surgery (88 versus 114 min; p = .009) and length of hospital stay (five versus eight days; p < .001) were significantly shorter for IPOM than for SUBLAY. 71 patients were available for follow-up. Recurrence rates showed no significant difference between study groups (13% versus 7%, p = .508). Conclusions: Laparoscopic repair in medium- and large-sized defects is a feasible and safe approach. IPOM compared to SUBLAY significantly reduces postoperative complications and hospital stay; recurrence rates are comparable.
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Affiliation(s)
- Patrick Hamid Alizai
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Eric Lelaona
- Department of General, Visceral and Minimally Invasive Surgery, Helios Clinic Emil von Behring, Berlin, Germany
| | - Anne Andert
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Ulf Peter Neumann
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Christian Daniel Klink
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Marc Jansen
- Department of General, Visceral and Minimally Invasive Surgery, Helios Clinic Emil von Behring, Berlin, Germany
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Abstract
Background and Objectives Creating and maintaining a pneumoperitoneum to perform laparoscopy is governed by gas laws and the limiting physical constraints of the abdomen. Methods A review of how gas, biomechanical and physical properties affect the abdomen and a systematic structured Medline and PubMed search was conducted to identify relevant studies related to the topic. Results Abdominal compliance is a measure of ease of abdominal expansion and is determined by the elasticity of the abdominal wall and diaphragm. It is the change in intra-abdominal volume per change in intra-abdominal pressure. Caution should be exercised with pressures exceeding 12 millimeters mercury since this is defined as intra-abdominal hypertension. Conclusions Abdominal compliance has its limits, is unique for each patient and pressure-volume curves cannot be easily predicted. Using the lowest possible pressure to accomplish the surgical task without compromising surgical outcome is the desired goal. The clinical importance is caution and knowing there is a point where more pressure does not increase working space and only increases pressure.
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Affiliation(s)
- Douglas E Ott
- School of Engineering, Department of Biomedical Engineering and Stetson School of Business and Economics, Mercer University
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24
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Halpern DK, Howell RS, Boinpally H, Magadan-Alvarez C, Petrone P, Brathwaite CEM. Ascending the Learning Curve of Robotic Abdominal Wall Reconstruction. JSLS 2019; 23:JSLS.2018.00084. [PMID: 30846894 PMCID: PMC6400246 DOI: 10.4293/jsls.2018.00084] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background: Robotic complex abdominal wall reconstruction (r-AWR) using transversus abdominis release (TAR) is associated with decreased wound complications, morbidity, and length of stay compared with open repair. This report describes a single-institution experience of r-AWR. Methods: A retrospective chart review was performed on patients who underwent r-AWR by a single surgeon (D.H.) from August 2015 through October 2018. Results: Fifty-five patients underwent r-AWR (16 males [29%] and 39 females [71%]) with a mean age of 60.2 (range 33 to 87) years and a mean body mass index of 34.6 (range 23 to 54) kg/m2. Forty-one patients presented with an initial ventral hernia (74.5%) and 14 with a recurrent hernia (25.5%). Five patients had a grade 1 hernia (9.1%), 46 had a grade 2 hernia (83.6%), and 4 had a grade 3 hernia (7.3%) according to the Ventral Hernia Working Group system. Thirty-four (62%) patients underwent TAR, 21 (38%) patients underwent bilateral retrorectus release, and 10 (18.2%) patients underwent concomitant inguinal hernia repair. Mean operative time with TAR was 294 (range 106 to 472) minutes and 183 (range 126 to 254) minutes without TAR. Mean length of stay was 1.5 (range 0 to 10) days. Mean follow-up was 10.7 (range 1 to 52) weeks with no hernia recurrences. Seromas occurred in 6 (10.9%) patients, with 2 (3.6%) requiring drainage. Two (3.6%) 30-day readmissions occurred with no conversions to open or 30-day mortalities. Conclusions: r-AWR with and without TAR is a safe and feasible procedure associated with a short LOS, low complication rate, and low recurrence even within the surgeon's learning curve experience.
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Affiliation(s)
- David K Halpern
- Department of Surgery, NYU Winthrop Hospital, Mineola, New York, USA
| | - Raelina S Howell
- Department of Surgery, NYU Winthrop Hospital, Mineola, New York, USA
| | - Harika Boinpally
- Department of Surgery, NYU Winthrop Hospital, Mineola, New York, USA
| | | | - Patrizio Petrone
- Department of Surgery, NYU Winthrop Hospital, Mineola, New York, USA
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Laparoscopic management of recurrent ventral hernia: an experience of 222 patients. Hernia 2019; 23:927-934. [PMID: 30778855 DOI: 10.1007/s10029-019-01912-0] [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] [Received: 11/24/2018] [Accepted: 02/12/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND To evaluate the predisposing factors and characteristics of recurrent ventral hernia (RVH) along with the feasibility and outcome of laparoscopy in managing RVH. METHODS This study is a retrospective analysis of all patients with reducible or irreducible, uncomplicated RVH who underwent surgical management from January 2012 to June 2018. RESULTS Out of 222 patients, 186 (83.8%) were female, and 36 (16.2%) were male. The mean age was 54.1 ± 10.1 years; an average body mass index was 31 kg/m2 (19-47.9). The most common previous abdominal operations among female patients were cesarean sections (43.5%) and abdominal hysterectomy (36.6%). Most of the patients had a history of open mesh repair (43.7%) and open anatomical repair (36.9%). The median time of recurrence was 4 years (1-33 years). The median defect size was 10 cm2 (range 2-150 cm2), and 73% defects were in the midline. Total 181 of 222 (81.6%) patients underwent laparoscopic intraperitoneal onlay mesh plus (L-IPOM+), 19 (8.5%) laparoscopic-assisted IPOM+, 17(7.7%) laparoscopic anatomical repair, while remaining 5 (2.3%) patients required open mesh reconstruction. The median size of the composite mesh used was 300 cm2 (150-600 cm2). The mean operating time was 145 (30-330) min, and median blood loss was 15 (5-110) ml. The median hospital stay was 3 days, and median follow-up period was 37 months. The post-operative symptomatic seroma rate was 3.1%, and re-recurrence rate was 1.4%. CONCLUSION Obesity, old age, female sex, previous lower abdominal surgeries, and previous open repair of a hernia are factors associated with recurrence. Laparoscopic repair is feasible with excellent outcome in most of the patients.
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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
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Altieri MS, Yang J, Xu J, Talamini M, Pryor A, Telem DA. Outcomes after Robotic Ventral Hernia Repair: A Study of 21,565 Patients in the State of New York. Am Surg 2018. [DOI: 10.1177/000313481808400639] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The purpose of our study is to assess outcomes following robotic ventral hernia (RVH) repair. The New York Statewide Planning and Research Cooperative System administrative database was used to identify all patients undergoing laparoscopic ventral hernia (LVH) and RVH between 2010 and 2013. Outcome measures including complications, hospital length of stay (HLOS), 30-day readmissions, and 30-day emergency department (ED) visits were compared. Propensity score (PS) analysis was used to estimate the adjusted marginal differences between patients who underwent robotic-assisted and laparoscopic procedures. There were 20,896 LVH and 679 (3.2%) RVH repairs. Initial univariate analysis demonstrated that patients undergoing RVH had worse outcomes in terms of complications (20.18% vs 10.56%, P < 0.0001), longer HLOS (4.32 vs 2.19 days, P = 0.0023), higher rates in 30-day readmissions (9.28% vs 5.06%, P < 0.0001), and 30-day ED visits (14.43% vs 10.46%, P < 0.0001). Following PS analysis, which accounts for all patient associated variables, there was no difference found in 30-day readmission or 30-day ED visits between RVH and LVH (P = 0.2760 and 0.2043, respectively). Patients undergoing RVH had a significantly shorter HLOS (P < 0.0001) and lower rate of complications (P = 0.0134). Following PS analysis, this study demonstrates that RVH may be associated with shorter HLOS and lower complication rate. Further studies are necessary to compare laparoscopic and robotic approaches for ventral hernia.
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Affiliation(s)
- Maria S. Altieri
- Department of Surgery, Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Stony Brook University Medical Center, Stony Brook, New York
| | - Jie Yang
- Department of Preventive Medicine, Stony Brook University Medical Center, Stony Brook, New York
| | - Jianjin Xu
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, New York
| | - Mark Talamini
- Department of Surgery, Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Stony Brook University Medical Center, Stony Brook, New York
| | - Aurora Pryor
- Department of Surgery, Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Stony Brook University Medical Center, Stony Brook, New York
| | - Dana A. Telem
- Department of Surgery, Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Stony Brook University Medical Center, Stony Brook, New York
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Alizai PH, Andert A, Lelaona E, Neumann UP, Klink CD, Jansen M. Impact of obesity on postoperative complications after laparoscopic and open incisional hernia repair – A prospective cohort study. Int J Surg 2017; 48:220-224. [DOI: 10.1016/j.ijsu.2017.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 10/27/2017] [Accepted: 11/09/2017] [Indexed: 01/28/2023]
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Mesh Migration into the J-Pouch in a Patient with Post-Ulcerative Colitis Colectomy: A Case Report and Literature Review. Case Rep Surg 2017; 2017:3617476. [PMID: 29333312 PMCID: PMC5733182 DOI: 10.1155/2017/3617476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 08/21/2017] [Accepted: 08/30/2017] [Indexed: 12/21/2022] Open
Abstract
Mesh repair offers advantages like lower postsurgical pain and earlier return to work. Thus, it has become a widely used treatment option. Here, we present the first case report of a mesh migration into a J-pouch in a patient with history of ulcerative colitis who underwent total abdominal colectomy with J-pouch and ileoanal anastomosis and a subsequent laparoscopic ventral hernia repair with mesh.
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Armijo P, Pratap A, Wang Y, Shostrom V, Oleynikov D. Robotic ventral hernia repair is not superior to laparoscopic: a national database review. Surg Endosc 2017; 32:1834-1839. [PMID: 29052065 DOI: 10.1007/s00464-017-5872-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 09/04/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Minimally invasive surgery (MIS) use for ventral hernia repair has increased over the last decade. Whether outcomes are improved by robotic assistance remains a subject of debate. The aim of this study is to evaluate outcomes (including cost, complications, length of stay (LOS), and pain medication utilization) in patients who underwent an open (OVHR), laparoscopic (LVHR), or robotic (RVHR) ventral hernia repair (VHR). METHODS The Vizient database was queried using ICD-9 procedure and diagnosis codes for patients who underwent VHR from January 2013 to September 2015. Complications, 30-day readmission, mortality, LOS, cost, and intra-hospital opiate utilization were analyzed using IBM SPSS v.23.0.0.0. Median tests with post hoc pairwise comparisons, Fischer's exact, and Pearson's chi-squared test with Bonferroni correction were applied where appropriate, with α = 0.05. RESULTS 46,799 patients (OVHR: N = 39,505, LVHR: N = 6829, RVHR: N = 465) met the criteria and patients in each group had similar demographics (Table 1). OVHR was associated with significant increased overall complications, 30-day readmission, LOS, and postoperative pain use compared to RVHR or LVHR. OVHR had higher mortality and postoperative infection rates than LVHR. RVHR had significantly higher rates of complications and postoperative infections compared to LVHR, although there was no difference in mortality, 30-day readmission, LOS, and postoperative pain medication use. Mean direct cost of surgery was significantly higher for RVHR, followed by OVHR and LVHR. CONCLUSIONS Overall patient outcomes were improved in the LVHR and RVHR groups compared to the open approach. However, RVHR patients did not have significant improvement compared with the LVHR group in either short-term outcomes or opiate medication used. While RVHR surgery was the most expensive modality, OVHR was also significantly costlier than LVHR, which was the least expensive. Long-term data on recurrence could not be evaluated and should be studied to determine the role of robotic surgery in VHR and recurrence rates.
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Affiliation(s)
- Priscila Armijo
- Center for Advanced Surgical Technology, University of Nebraska Medical Center, 986245 Nebraska Medical Center, Omaha, NE, 68198-6246, USA
| | - Akshay Pratap
- Department of Surgery, University of Nebraska Medical Center, 986245 Nebraska Medical Center, Omaha, NE, 68198-6246, USA
| | - Yi Wang
- College of Public Health, University of Nebraska Medical Center, 984355 Nebraska Medical Center, Omaha, NE, 68198-4355, USA
| | - Valerie Shostrom
- College of Public Health, University of Nebraska Medical Center, 984355 Nebraska Medical Center, Omaha, NE, 68198-4355, USA
| | - Dmitry Oleynikov
- Center for Advanced Surgical Technology, University of Nebraska Medical Center, 986245 Nebraska Medical Center, Omaha, NE, 68198-6246, USA. .,Department of Surgery, University of Nebraska Medical Center, 986245 Nebraska Medical Center, Omaha, NE, 68198-6246, USA.
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Bell-Allen N, O'Rourke H, Hong L, O'Rourke N. Laparoscopic ventral hernia repair using only 5-mm ports. ANZ J Surg 2017; 88:718-722. [PMID: 29027327 DOI: 10.1111/ans.13985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/06/2017] [Accepted: 02/13/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND The technique of laparoscopic ventral hernia repair has been evolving since it was first described over 20 years ago. We report a new technique where polyester mesh was back loaded through a 5-mm port site, coming into contact with the skin. This avoids the need for any 10-12-mm ports. METHODS A prospective database of laparoscopic ventral hernia repairs was examined. A single surgeon performed 344 laparoscopic ventral hernia repairs using this technique over 60 months. Follow-up was conducted by both clinical and independent phone review. SURGICAL TECHNIQUE Laparoscopic access was achieved via a 5-mm optical port, adding two, or occasionally three, 5-mm extra ports. Hernia contents were reduced and the extra-peritoneal fat excised; 5-mm tooth graspers were placed through the lateral port and then in a retrograde fashion through the uppermost port. The port was removed, and the mesh pulled back into the abdominal cavity and positioned with a minimum of 3-cm overlap. The mesh was fixed using absorbable tacks and sutures. RESULTS Most patients had primary umbilical hernias. There was one case of mesh infection due to enteric organisms. This occurred in a patient undergoing repair of a stoma site hernia, resulting from a Hartmann's procedure for perforated diverticulitis. There was no other evidence of acute or chronic mesh infection despite cutaneous contact with the mesh. In this series, there was an overall hernia recurrence rate of 2.4%. CONCLUSION Laparoscopic ventral hernia repair using only 5-mm ports is a safe, effective technique with no extra risk of infection.
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Affiliation(s)
| | - Harriet O'Rourke
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Lisa Hong
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Mater Hospital, Brisbane, Queensland, Australia
| | - Nicholas O'Rourke
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,The Wesley Hospital, Brisbane, Queensland, Australia.,Department of Surgery, The University of Queensland, Brisbane, Queensland, Australia
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Laparoscopic vs Robotic Intraperitoneal Mesh Repair for Incisional Hernia: An Americas Hernia Society Quality Collaborative Analysis. J Am Coll Surg 2017; 225:285-293. [PMID: 28450062 DOI: 10.1016/j.jamcollsurg.2017.04.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/05/2017] [Accepted: 04/06/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Robotic intraperitoneal mesh placement (rIPOM) has emerged recently as an alternative to laparoscopic intraperitoneal mesh placement (LapIPOM) for minimally invasive incisional hernia repair. We aimed to compare LapIPOM with rIPOM in terms of hospital length of stay (LOS) and 30-day postoperative complications in patients undergoing incisional hernia repair within the Americas Hernia Society Quality Collaborative. STUDY DESIGN Propensity score analysis was used to compare matched groups of patients within the Americas Hernia Society Quality Collaborative undergoing LapIPOM vs rIPOM. The primary outcomes measure was hospital LOS and secondary outcomes were 30-day wound events. RESULTS Four hundred and fifty-four (71.9%) patients underwent LapIPOM and 177 (28.1%) underwent rIPOM. The laparoscopic group had an increased median LOS (1 vs 0 days; interquartile range 3.00; p < 0.001). The risk of surgical site occurrence was higher in the LapIPOM group vs the rIPOM group (14% vs 5%; p = 0.001); however, surgical site occurrence requiring procedural intervention was similar between the groups (1% vs 0%; p = 1). Operative time longer than 2 hours was more common in the rIPOM group (47% vs 31%; p < 0.05). CONCLUSIONS Despite longer operative times using the rIPOM approach, patients undergoing rIPOM had a significantly shorter LOS than LapIPOM, without additional risk of wound morbidity requiring intervention. Additional studies are necessary to identify the best candidates for the rIPOM approach.
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AMARAL MARIAVITÓRIAFRANÇADO, GUIMARÃES JOSÉRICARDO, VOLPE PAULA, OLIVEIRA FLÁVIOMALCHERMARTINSDE, DOMENE CARLOSEDUARDO, ROLL SÉRGIO, CAVAZZOLA LEANDROTOTTI. Robotic Transversus Abdominis Release (TAR): is it possible to offer minimally invasive surgery for abdominal wall complex defects? Rev Col Bras Cir 2017; 44:216-219. [DOI: 10.1590/0100-69912017002009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 12/15/2016] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT We describe the preliminary national experience and the early results of the use of robotic surgery to perform the posterior separation of abdominal wall components by the Transversus Abdominis Release (TAR) technique for the correction of complex defects of the abdominal wall. We performed the procedures between 04/2/2015 and 06/15/2015 and the follow-up time was up to six months, with a minimum of two months. The mean surgical time was five hours and 40 minutes. Two patients required laparoscopic re-intervention, since one developed hernia by peritoneal migration of the mesh and one had mesh extrusion. The procedure proved to be technically feasible, with a still long surgical time. Considering the potential advantages of robotic surgery and those related to TAR and the results obtained when these two techniques are associated, we conclude that they seem to be a good option for the correction of complex abdominal wall defects.
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Nardi M, Millo P, Brachet Contul R, Lorusso R, Usai A, Grivon M, Persico F, Ponte E, Bocchia P, Razzi S. Laparoscopic ventral hernia repair with composite mesh: Analysis of risk factors for recurrence in 185 patients with 5 years follow-up. Int J Surg 2017; 40:38-44. [DOI: 10.1016/j.ijsu.2017.02.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 02/12/2017] [Accepted: 02/14/2017] [Indexed: 11/26/2022]
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Resanovic A, Resanovic V, Djordjevic M, Resanovic M, Arafeh M. Scoring Systems are Crucial in Prediction of the Risk of SSI Development After Ventral Hernia Repair. World J Surg 2017; 41:1660-1661. [PMID: 28097407 DOI: 10.1007/s00268-017-3882-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Vladimir Resanovic
- Emergency Center, Surgery Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | | | - Milica Resanovic
- General surgery, Klinicko Bolnicki Centar Bezanijska kosa, Belgrade, Serbia
| | - Mazen Arafeh
- Plastic and Reconstructive Surgery, Coccona Centre, Delhi, India
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Chen YJ, Huynh D, Nguyen S, Chin E, Divino C, Zhang L. Outcomes of robot-assisted versus laparoscopic repair of small-sized ventral hernias. Surg Endosc 2016; 31:1275-1279. [PMID: 27450207 DOI: 10.1007/s00464-016-5106-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 07/09/2016] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The aim of the study is to investigate the outcomes of the da Vinci robot-assisted laparoscopic hernia repair of small-sized ventral hernias with circumferential suturing of the mesh compared to the traditional laparoscopic repair with trans-fascial suturing. METHODS A retrospective review was conducted of all robot-assisted umbilical, epigastric and incisional hernia repairs performed at our institution between 2013 and 2015 compared to laparoscopic umbilical or epigastric hernia repairs. Patient characteristics, operative details and postoperative complications were collected and analyzed using univariate analysis. Three primary minimally invasive fellowship trained surgeons performed all of the procedures included in the analysis. RESULTS 72 patients were identified during the study period. 39 patients underwent robot- assisted repair (21 umbilical, 14 epigastric, 4 incisional), and 33 patients laparoscopic repair (27 umbilical, 6 epigastric). Seven had recurrent hernias (robot: 4, laparoscopic: 3). There were no significant differences in preoperative characteristics between the two groups. Average operative time was 156 min for robot-assisted repair and 65 min for laparoscopic repair (p < 0.0001). The average defect size was significantly larger for the robot group [3.07 cm (1-9 cm)] than that for the laparoscopic group [2.02 cm (0.5-5 cm)] (p < 0.0001), although there was no significant difference in the average size of mesh used (13 vs. 13 cm). There was no difference in patients requiring postoperative admission or length of stay between the two groups. The mean duration of follow-up was 47 days. There was no difference in complication rate during this time, and no recurrences were reported. CONCLUSION There are no significant differences in terms of safety and early efficacy when comparing small-sized ventral hernias repaired using the robot-assisted technique versus the standard laparoscopic repair.
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Affiliation(s)
- Y Julia Chen
- Department of Surgery, Mount Sinai Medical Center, 1 Gustave L. Levy Place, Box 1259, New York, NY, 10029, USA
| | - Desmond Huynh
- Department of Surgery, Mount Sinai Medical Center, 1 Gustave L. Levy Place, Box 1259, New York, NY, 10029, USA
| | - Scott Nguyen
- Department of Surgery, Mount Sinai Medical Center, 1 Gustave L. Levy Place, Box 1259, New York, NY, 10029, USA
| | - Edward Chin
- Department of Surgery, Mount Sinai Medical Center, 1 Gustave L. Levy Place, Box 1259, New York, NY, 10029, USA
| | - Celia Divino
- Department of Surgery, Mount Sinai Medical Center, 1 Gustave L. Levy Place, Box 1259, New York, NY, 10029, USA
| | - Linda Zhang
- Department of Surgery, Mount Sinai Medical Center, 1 Gustave L. Levy Place, Box 1259, New York, NY, 10029, USA.
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Tobler WD, Itani KMF. Current Status and Challenges of Laparoscopy in Ventral Hernia Repair. J Laparoendosc Adv Surg Tech A 2016; 26:281-9. [PMID: 27027828 DOI: 10.1089/lap.2016.0095] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Laparoscopic repair of ventral hernias gained strong popularity in the late nineties with some of the early enthusiasm lost later in time. We review the current status and challenges of laparoscopy in ventral hernia repair and best practices in this area. We specifically looked at patient and hernia defect factors, technical considerations that have contributed to the successes, and some of the failures of laparoscopic ventral hernia repair (LVHR). Patients best suited for a laparoscopic repair are those who are obese and diabetic with a total defect size not to exceed 10 cm in width or a "Swiss cheese" defect. Overlap of mesh to healthy fascia of at least 5 cm in every direction, with closure of the defect, is essential to prevent recurrence or bulging over time. Complications specifically related to surgical site occurrence favor the laparoscopic approach. Recurrence rates, satisfaction, and health-related quality of life results are similar to open repairs, but long-term data are lacking. There is still conflicting data regarding ways of fixating the mesh. The science of prosthetic material appropriate for intraperitoneal placement continues to evolve. The field continues to be plagued by single author, single institution, and small nonrandomized observational studies with short-term follow-up. The recent development of large prospective databases might allow for pragmatic and point-of-care studies with long-term follow-up. We conclude that LVHR has evolved since its inception, has overcome many challenges, but still needs better long-term studies to evaluate evolving practices.
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Affiliation(s)
- William D Tobler
- 1 Department of Plastic Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Kamal M F Itani
- 2 VA Boston Healthcare System, Boston University and Harvard Medical School , Boston, Massachusetts
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Mitura K. Different approach to laparoscopic IPOM ventral hernia surgery –what has the last decade taught us? POLISH JOURNAL OF SURGERY 2016; 88:54-61. [DOI: 10.1515/pjs-2016-0028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Indexed: 11/15/2022]
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