Laparoscopic versus hybrid approach for treatment of incisional ventral hernia: a prospective randomized multicenter study of 1-month follow-up results

PURPOSE

The seroma rate following laparoscopic incisional ventral hernia repair (LIVHR) is up to 78%. LIVHR is connected to a relatively rare but dangerous complication, enterotomy, especially in cases with complex adhesiolysis. Closure of the fascial defect and extirpation of the hernia sack may reduce the risk of seromas and other hernia-site events. Our aim was to evaluate whether hybrid operation has a lower rate of the early complications compared to the standard LIVHR.

METHODS

This is a multicenter randomized-controlled clinical trial. From November 2012 to May 2015, 193 patients undergoing LIVHR for primary incisional hernia with fascial defect size from 2 to 7 cm were recruited in 11 Finnish hospitals. Patients were randomized to either a laparoscopic (LG) or to a hybrid (HG) repair group. The outcome measures were the incidence of clinically and radiologically detected seromas and their extent 1 month after surgery, peri/postoperative complications, and pain.

RESULTS

Bulging was observed by clinical evaluation in 46 (49%) LG patients and in 27 (31%) HG patients (p = 0.022). Ultrasound examination detected more seromas (67 vs. 45%, p = 0.004) and larger seromas (471 vs. 112 cm³, p = 0.025) after LG than after HG. In LG, there were 5 (5.3%) enterotomies compared to 1 (1.1%) in HG (p = 0.108). Adhesiolysis was more complex in LG than in HG (26.6 vs. 13.3%, p = 0.028). Patients in HG had higher pain scores on the first postoperative day (VAS 5.2 vs. 4.3, p = 0.019).

CONCLUSION

Closure of the fascial defect and extirpation of the hernia sack reduce seroma formation. In hybrid operations, the risk of enterotomy seems to be lower than in laparoscopic repair, which should be considered in cases with complex adhesions.

CLINICAL TRIAL NUMBER

NCT02542085.

Changes in the abscisic acid levels and related gene expression during fruit development and ripening in bilberry (Vaccinium myrtillus L.)

Abscisic acid (ABA) is a natural plant hormone playing an important role in many physiological processes including fruit ripening and is also recently found to be potential for biomedical applications. This study was aimed to measure ABA levels and its biosynthesis in bilberry (Vaccinium myrtillus L.), which is one of the best sources of anthocyanins. Five ABA biosynthetic genes were isolated from bilberry and their expression profiles were studied in bilberry tissues, particularly during berry development. The level of ABA highly increased at the onset of bilberry fruit ripening, at the stage when expression of anthocyanin biosynthetic genes, chalcone synthase (VmCHS) and anthocyanidin synthase (VmANS), also increased. In fully ripe berries and leaves, ABA levels were lower but none was detected in bilberry stem or rhizome. The expression of 9-cis-epoxycarotenoid dioxygenase (VmNCED1) and putative neoxanthin synthase (VmNSY) was high in berry tissues and their expression increased markedly at the onset of berry ripening along with the accumulation of ABA. In contrast, the expression of zeaxanthin epoxidase (VmZEP), short-chain dehydrogenase/reductase (VmSDR/ABA2) and aldehyde oxidase (VmAO) were most highly associated with leaf tissues with no obvious relation to ABA content during berry development. The obtained results indicate that the ABA biosynthesis may play an important role in the regulation of ripening of non-climacteric bilberry fruits through transcriptional regulation of key ABA biosynthetic genes.