Hybrid approach to ventral wall hernia repair: a single-institution cohort study

Sara Jamel,Sherif Mohamad Hakky,Karina Tukanova,Sheraz Markar,Sanjay Purkayastha,Sarah Huf

doi:10.1007/s10353-020-00671-y

Abstract

Summary Background Ventral hernias pose a substantial challenge for surgeons. Even though minimally invasive surgery and hernia repair have evolved rapidly, there is no standardised method that has been widely accepted as standard of practice. Hybrid ventral hernia repair (HVR) is an alternative surgical approach, which has not been adopted widely to date. It combines laparoscopic mesh insertion with closure of the hernia defect. The aim of this retrospective cohort study is to evaluate short- and long-term outcomes in patients undergoing HVR. Methods Between October 2012 and June 2016, 56 HVRs were performed at St Mary’s Hospital, Imperial College London. The medical records of these patients were reviewed retrospectively for demographics, comorbidities, previous surgeries, operative technique, complications and recurrences over a 3-year follow-up. Results HVRs were performed by four surgeons. Mean age was 48 years with a mean body mass index (BMI) of 32.8 kg/m2. 71.4% had incisional hernias and 28.6% had primary hernias. The number of hernia defects ranged from 1 to 4, with average defect size 42.9 cm2 (range 8–200 cm2). Adhesiolysis was performed in 66.1% of patients. Recurrence occurred in 2 patients (3.6%), 16.1% of patients developed postoperative seroma, 0.3% had respiratory complications, 0.3% had paralytic ileus and 0.2% had urinary retention. Only 2 patients required epidural postoperatively, both had a defect size of 150.0 cm2. There were no reoperations within 90 days. Mean length of hospital stay was 2 days (1–10 days). Over the follow-up period, 2 patients (3.6%) developed chronic pain. Conclusion The hybrid technique is safe and feasible, and has important benefits including low rates of seroma formation, chronic pain and hernia recurrence. Future investigations may include randomised controlled trials to evaluate the benefits of VHR, with careful assessment of patient-reported outcome measures including quality of life and postoperative pain.

Highlights

Ventral hernias, whether primary or incisional or recurrent, are common, and often require surgical repair
Future investigations may include randomised controlled trials to evaluate the benefits of VHR, with careful assessment of patient-reported outcome measures including quality of life and postoperative pain
Incisional hernias occur in approximately 2–20% of abdominal incisions, with postoperative wound infection being a significant risk factor [1]

Summary

Introduction

Whether primary or incisional or recurrent, are common, and often require surgical repair. Incisional hernias occur in approximately 2–20% of abdominal incisions, with postoperative wound infection being a significant risk factor [1]. 60 Hybrid approach to ventral wall hernia repair: a single-institution cohort study. K original article ment of ventral hernias, whether primary or recurrent. The surgical techniques employed for repair of primary and recurrent hernia are similar. Application of the principles of Pascal’s law is crucial to the biomechanics of mesh placement and hernia repair. In the case of onlay mesh repair, the intra-abdominal pressure forces will act to push the mesh outwards. With intraperitoneal mesh the intraabdominal pressure forces compress the mesh against the anterior abdominal wall, acting in favour of the repair [6]

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Conclusion