Clinical effects of laparoscopic combined with open mesh repair for abdominal wall incisional hernia

Abstract

Objective To explore the clinical effects of laparoscopic combined with open mesh repair for abdominal wall incisional hernia. Methods The retrospective cross-sectional study was conducted. The clinical data of 41 patients with abdominal incisional hernia who were admitted to the Fujian Medical University Union Hospital between September 2011 and June 2017 were collected. All the patients underwent laparoscopic combined with open mesh repair, with the sequence from laparoscopic surgery to open surgery and then to laparoscopic surgery. Observation indicators: (1) intra- and post-operative situations; (2) follow-up situation. Follow-up using outpatient examination and telephone interview was performed to detect postoperative long-term complications and hernia recurrence up to November 2017. Measurement data with normal distribution were represented as ±s. Results (1) Intra- and post-operative situations: forty-one patients underwent successful laparoscopic combined with open mesh repair for abdominal wall incisional hernia. Diameter of hernia ring and defect area of abdominal wall were respectively (10±3)cm and (75±34)cm2. Among 41 patients, 25 underwent laparoscopic combined with open mesh repair due to tight intestinal adhesion induced difficult laparoscopic separation; 16 underwent laparoscopic combined with open mesh repair due to the larger diameter of the hernia ring induced difficulty of closing hernia ring under laparoscope. Operation time, cases with indwelling drainage-tube, time of drainage-tube removal and duration of postoperative hospital stay were respectively (188±71)minutes, 33, (14±3)days and (4.5±2.6)days. Of 41 patients, 2 with postoperative incomplete intestinal obstruction were cured by symptomatic treatment; 2 with incisional infection were cured by antibiotic therapy, irrigation and dressing change. (2) Follow-up situation: 41 patients were followed up for (29±17)months. The postoperative chronic pain of 2 patients was occasional and cannot affect the normal life. There was no occurrence of seroma, mesh infection, intestinal fistula, abdominal compartment syndrome and hernia recurrence during the follow-up. Conclusion The laparoscopic combined with open mesh repair has a better clinical effect for patients of incisional hernia with large hernia ring and tight intestinal adhesion, and surgical methods should be chosen seriously according to the condition of the patients in clinical application. Key words: Incisional hernia, abdominal wall; Hernia repair; Mesh repair; Polypropylene mesh; Intestinal adhesion; Incisional hernia, giant; Recurrence; Complications; Laparoscopy