Closure Of Hernia Defect Research Articles

Application of integral suture for medial hernia defect closure in eTEP hernioplasty for direct inguinal hernia

The OBJECTIVE was to evaluate the immediate and long-term results of integral suture application and to determine the indications for its use in eTEP hernioplasty for primary rectal inguinal hernia in men.METHODS AND MATERIALS. A prospective single-center double-blind randomized controlled study on the basis of the City Clinical Hospital named after S. S. Yudin was conducted. The study included patients with the first-diagnosed direct inguinal hernias for eTEP hernioplasty with hernia gate size from 1.5 cm to 3 cm corresponding to MP2 according to EHS (2009). Patients were allocated to a comparison group with hernia defect closure and a control group using the ALEA randomization program. The following parameters were evaluated in patients: the presence of seroma on the 1st day after laparoscopic hernioplasty according to the ultrasound results, the dynamics of seroma volume, the degree of pain syndrome according to the visual analog scale (VAS), the duration of surgical intervention, 30-day adverse events, as well as the patients’ quality of life according to the Likert scale.RESULTS. A total of 142 patients were included (n1=71; n2=71). There were no significant differences in baseline characteristics between the two groups. Suturing the hernia defect using the integral suture technique was associated with less development of postoperative seromas ∆p=0.32 (95 % confidence interval [CI] 0.14–0.5, p=0.05). There were no statistical differences in pain and quality of life among patients. No 30-day adverse events were observed in the two groups. A statistically significant increase in the duration of the operation when using the integral suture was revealed, but not more than 7 minutes.CONCLUSION. Since anatomical justification has made laparoscopic hernioplasty a safer operation, we believe that endoscopic suturing of rectal inguinal hernia defect larger than 2.5 cm (P=0.052) with the use of integral suture in the MP2 group according to EHS is associated with a lower incidence of seroma development, low risk of recurrence, absence of significant pain syndrome after suturing.

Feasibility of Image Inversion for Ventral Hernia Repair Using the Versius System.

Background: The aim of our technical report is to demonstrate the image inversion technique in the new Versius Robotic System. Methods: We report a step-by-step surgical maneuver for robotic surgeons when performing robotic ventral hernia repair (VHR) with the Versius Robotic System. Technical Report: The image inversion artifice consists in rotating 180° with the scope using the surgeon's master control in a specific rotation command in the right-hand joystick. The assisting surgeon can do a manual inversion of the camera without the console being aware that the scope is inverted. In this scenario, the 30° Up configuration should be used while informing the console that the scope is looking down. The surgeon can reassign instruments to each joystick. This results in the right joystick controlling the left instrument and left control controlling the right instrument. Since the image is inverted, the movements will look natural on the surgeon console. Conclusions: The use of the image inversion technique with the Versius Robotic System is effective in aiding surgeons to perform the hernia defect closure during robotic VHRs.

Minimally Invasive Extended Totally Extraperitoneal Versus Transabdominal Retromuscular Ventral Hernia Mesh Repair: Systematic Review and Meta-Analysis.

Introduction: Minimally invasive surgery for ventral hernia repair (MIS-VHR) with mesh in retromuscular plane can be performed by either transabdominally (TA-RM) or via enhanced view totally extraperitoneal approach (eTEP). Although both techniques offer the mesh extension in the best anatomical space, closure of hernia defect, avoidance of traumatic fixation, the superiority of one approach over another is not established. This systematic review and meta-analysis were set up to analyze safety and efficacy of eTEP in comparison with TA-RM. Materials and Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) framework was used as guideline to conduct systematic search of literature. Studies that provided comparative data of MIS-VHR using eTEP versus TA-RM were identified. Primary outcomes were major complications. These were defined as grade III-IV according to Clavien-Dindo classification. Secondary outcomes included: surgical site infection (SSI) rates, seroma rates, surgical site occurrence requiring procedural intervention (SSOPI), minor complications (Clavien-Dindo grade I-II), intraoperative complications, recurrence rate, postoperative ileus, duration of surgery, postoperative pain. Random- and fixed-effects models of statistical analysis were used. Risk difference (RD) was computated for binary outcomes (major and minor complications, SSI, seroma, SSOPI, recurrence, ileus) with 95% confidence intervals. I2 test was used to assess statistical heterogeneity. Risk of bias assessment was performed using Newcastle-Ottawa framework. Results: There were 3 observational studies that enrolled 370 participants. In the eTEP group there were 166 patients and, in the TA-RM group there were 204 patients. There was no significant RD with regard to major complications (RD -0.02 [-0.06 to 0.02], test for overall effect: Z = 0.86 [P = .39]). There was no significant RD in occurrence of minor complications, SSI, seroma, SSOPI, recurrence, ileus. Conclusions: Both eTEP and TA-RM were found to have equal safety profile. Further high-quality studies evaluating patient reported outcomes and late recurrence may be useful. PROSPERO registration number: CRD42023429160.

Fascia defect closure versus non-closure in minimal invasive direct inguinal hernia mesh repair: a systematic review and meta-analysis of real-world evidence.

Laparoscopic and robotic inguinal hernia mesh repair are both common surgical procedures worldwide. Postoperative hernia recurrence and seroma formation are important concerns. In ventral hernia, primary defect closure in laparoscopic surgery reduces the recurrence rate. However, there is no synthetic evidence of direct inguinal hernia defect closure versus non-closure in minimal invasive surgery. Therefore, this study investigated the efficacy of defect closure in patients undergoing minimal invasive direct inguinal hernia mesh repair. Eligible studies were identified through a search of PubMed, Embase, Cochrane Library, and CINAHL from their inception until March 2022. Studies examining defect closure in laparoscopic direct inguinal hernia repair were included, and a meta-analysis was performed using the random-effect model. Sensitivity analyses were performed by removing one study at a time. The primary outcomes were hernia recurrence and seroma formation. Acute and chronic postoperative pain, operation time, and length of hospital stay were the secondary outcomes. Five nonrandomized studies and one randomized controlled trial were included. Pooled analysis revealed defect closure might reduce the hernia recurrence rate (risk difference, -0.02; 95% confidence interval [CI] -0.04 to -0.00; p = 0.02). The result of seroma formation (odds ratio, 0.49; 95% CI 0.17-1.46; p = 0.20) showed no significant difference. Moreover, no significant differences were observed in acute postoperative pain, chronic pain, length of hospital stay, and operation time. Our study indicated defect closure seems to be an option to reduce the direct inguinal hernia recurrence rate. No significant benefits were shown in seroma formation and other secondary outcomes. Our study was mostly based on nonrandomized studies and underestimated the effect of defect closure; thus, further high-quality studies are required to draw definitive conclusions.

OC-037 HERNIA DEFECT CLOSURE IN POLYPROPYLENE BASED LAPAROSCOPIC HERNIOPLASTY TO AVOID SEROMA FORMATION AND HERNIA RECURRENCE: A PROSPECTIVE COHORT STUDY

Abstract Aim This is a Prospective Cohort study, to assess a preventive effect, through closing hernia defect in laparoscopic mesh hernioplasty with polypropylene based best hands-on surgical method. The study could provide promising outcomes with diminishing seroma formation and recurrence rate. Methods The study were conducted from April 2017 to until date. The study persuaded with nearly 328 cases from Tertiary Care Centre who underwent laparoscopic trans-abdominal and extraperitoneal patch plasty (TAPP) (TEPP). Hernia defect closure were performed through this polypropylene mesh and deployment using sutures to all patients. The primary outcomes regarding seroma formation, recurrence of hernia, Pre-operative status and post-operative complications was all observed and recorded. Results About 328 indirect and direct hernia defects were recruited and indulged for study. All the defect closure operations by polypropylene mesh hernioplasty for all types of hernia repair exhibited high success rate, without hernia reccurrence and minimal seroma formation. Conclusions The closure of Hernia defect in laparoscopic polypropylene mesh hernioplasty explicated to be secure and effective technique and would significantly decrease post-operative incidence of seroma formation without increasing hernia recurrence risks, chronic and acute pain. The approach can be recommended for scrotal or larger hernia repair as well.

P-111 TAR (TRANSVERSUS ABDOMINIS MUSCLE RELEASE) AS AN ALTERNATIVE IN PATIENTS WITH INCISIONAL HERNIA AND COMPLEX ABDOMINAL WALL. ANALYSIS OF OUR EXPERIENCE

Abstract Aim To analyze the results of patients with complex abdominal wall surgery using TAR(transversus abdominis muscle release) technique in our center. Material and Methods An observational, descriptive, retrospective study of patients operated using TAR technique in a second level hospital in the last three years was carried out. Demographic variables, classification of incisional hernias according to the EHS(European Hernia Society), and complications after the intervention were recorded. Statistical analysis was performed with IBMSPSS-Statistics-25. Results 13 patients were operated using TAR. Medium age was 56 years. 54% of patients were men and 46% women. Median BMI was 30. According to the EHS classification, the most frequent incisional hernia was M3(84.6%), followed by M4(61.5%) and M2(53.8%). W2(61.5%) and W3(30.8%). Median distance between the rectus in the CT prior the intervention was 85 mm. 100% had median laparotomy. 53.8% subcostal or stomal incision. 46% of the patients suffered some type of complication, 38.5% surgical. The complications were wound dehiscence secondary to skin necrosis(23%), abscess(15%), mesh infection(7%), hematoma(7%). Recurrence(7%). Subcostal or other laparotomy showed higher risk of complications of any type(p 0,048). Distance between rectums was associated with high risk of skin necrosis and wound dehiscence(p 0,015). No ileus, UTI, pneumonia, stroke or DVT. Conclusions TAR is a technique used in complex abdominal wall with good results in relation to closure of hernia defect. However, in our cohort some postoperative complications were observed with a low rate of hernia recurrence. This highlights the effectiveness of TAR as a technique for complex abdominal wall closure.

Minimally Invasive Tensiometry: A New Modality for Per-Operative Measurement of Medialization and Tension During Laparoscopic Hernia Surgery.

Background: Newly developed techniques for minimally invasive abdominal wall reconstruction (AWR) for complex ventral hernia are continuously evolving. In order to achieve hernia defect closure, the aponeurotic edges of the hernia defect need to be approximated. Currently, surgeons have no way to objectively measure and quantify the traction required to approximate these edges. This study presents minimally invasive tensiometry (MINT), a novel technology for measuring fascial tension, as well as initial experiences and results using it. Methods: The MINT device was designed using rapid prototyping principles. It was designed as an add-on tool for any existing laparoscopic instrument, enabling objective assessment of abdominal wall tension by the use of a manually operated linear spring. Pre-clinical measurements of medialization at 10 and 20N of tension during AWR were performed on fresh-frozen Post-Mortem Human Specimens (PMHS). Results: Three specimens were included, and a total number of 36 measurements of medialization at three different levels of the abdominal wall were performed under structured and similar circumstances. Median total medialization with 20 Newton (N) of applied tension was 25 mm (mm) cranially, 37.5mm at the umbilicus and 27.5mm at the caudal level. The highest rate of medialization was seen at the umbilical level (2.25mm/N). Conclusion: MINT is a novel non-invasive technique, which allows surgeons to intraoperatively measure fascial tension when performing AWR. The MINT device is easy to use and reproduce. The next step is to start performing clinical measurements applying MINT during AWR.

Hernia Defect Closure With Barbed Suture: An Assessment of Patient-reported Outcomes in Extraperitoneal Robotic Ventral Hernia Repair.

Primary closure of a fascial defect during ventral hernia repair is associated with lower rates of recurrence and better patient satisfaction compared with bridging repairs. Robotic surgery offers enhanced ability to close these defects and this has likely been aided by the use of barbed suture. The goal of this study was to evaluate the perioperative safety and the long-term outcomes for the use of barbed suture for the primary closure of hernia defects during robotic ventral hernia repair (rVHR) with mesh. This is a retrospective study of adult patients who underwent rVHR with the use of a barbed suture for fascial defect closure from August 2018 to August 2020 in an academic center. All the patients included were queried by phone to complete a quality of life assessment to assess patient-reported outcomes (PROs). Subjective sense of a bulge and pain at the previous hernia site has been shown to correlate with hernia recurrence. These questions were used in conjunction with a Hernia-related Quality of Life Survey (HerQles) score to assess a patient's quality of life. A total of 81 patients with 102 hernias were analyzed. Sixty patients (74%) were successfully reached and completed the PRO form at median postoperative day 356 (range: 43 to 818). Eight patients (13% of patients with PRO data) claimed to have both a bulge and pain at their previous hernia site, concerning for possible recurrence. Median overall HerQLes score was 82 [Interquartile Range (IQR): 54 to 99]. Patients with a single hernia defect, when compared with those with multiple defects, had a lower rate of both a bulge (15% vs. 30%) and symptoms (33% vs. 48%), as well as a higher median HerQLes score (85 vs. 62) at the time of PRO follow-up. Patients with previous hernia repair had a lower median HerQLes score of 65 (IQR: 43 to 90) versus 88 (IQR: 62-100). These patients also had a higher rate of sensing a bulge (29% vs. 18%), whereas a sense of symptoms at the site was less (33% vs. 44%). Barbed suture for fascial defect closure in rVHR was found to be safe with an acceptable rate of possible recurrence by the use of PRO data. Patients with multiple hernias and previous repairs had a higher likelihood of recurrence and a lower quality of life after rVHR.

Internal Ring Defect Closure Technique in Laparoscopic Mesh Hernioplasty for Indirect Inguinal Hernia.

PurposeThe best way to reduce seroma formation after laparoscopic indirect hernia repair is debated. We noticed that internal ring defect closure in laparoscopic mesh hernioplasty could provide promising outcomes with an effect on diminishing seroma formation. We introduce our closure technique and report our experience.MethodsThis prospective study was conducted from May 2019 to May 2021. Patients with European Hernia Society classification L3 indirect or scrotal hernia were recruited and underwent laparoscopic transabdominal patch plasty (TAPP). Hernia defect closure was performed before mesh deployment. The primary outcomes were seroma formation, postoperative pain, and hernia recurrence. Perioperative data and postoperative complications were also recorded.ResultsConsecutive 77 patients with 89 indirect hernias (including 51 scrotal hernias) were recruited in two regional tertiary hospitals. All operations were successful without open conversion. The mean size of the hernia defect was 3.7 ± 0.5 cm (range, 2.5–5.0 cm). The mean operative time for each hernia repair (peritoneum to peritoneum) was 48.3 ± 10.8 min (range, 33–72 min), and the mean time required for internal ring closure was 6.7 ± 2.2 min (range, 4–10 min). Intraoperative bleeding was minimal. The mean visual analog scale pain score at rest on the first postoperative day was 2.2 (range, 1–4). The average postoperative length of hospital stay was 18 h (range, 14–46 h). During a mean follow-up period of 9.4 months (range, 3–23 months), no hernia recurrence or chronic pain were noted. Seroma formation was detected on six sides of unilateral hernias (6.7%) on postoperative day 7, with a mean volume of 45.8 ml (range, 24–80 ml). All seromas were mild and resolved spontaneously within 3 months, with no need for evacuation or other treatment and without major impact on the final outcome.ConclusionsDefect closure in laparoscopic mesh hernioplasty for large indirect hernias is safe and feasible and can significantly reduce postoperative seroma formation and relative complications. This approach is recommended in large indirect or scrotal hernia repair.

Laparoscopic Ventral Hernia Repair: Comparative Study between Closure of Hernia Defect and Non-Closure (Tension Free Repair)

Background: Any protrusion through the anterior abdominal wall with the exception of hernia through the inguino-femoral region is defined as ventral hernia. Incisional hernia and primary defects in the abdominal fascia, which can cause umbilical hernia, epigastric hernia, para-umbilical hernia and spigelian hernia are grouped under the definition of ventral hernia. Objective: To evaluate the recurrence rate of laparoscopic ventral hernia repair with closure and non-closure of the hernia defect in non-complicated ventral hernia cases. Patients and Methods: This prospective randomized study was conducted from March, 2015 till December, 2019 in General Surgery Department, Mansoura University Hospital. It involved 50 patients with ventral hernia, who were classified randomly into 2 groups by computer generated sampling technique after retrieval of the calculated sample size according to inclusion and exclusion criteria. Results: The mean age of the non-closure group and of the closure group was 39.96 ± 6.52 and 39.84 ± 7.48 years respectively. The males were 36.0% and females were 64.0% in non-closure group, while in the closure group males were 24.0%, and the females were 76.0%. The mean BMI in the non-closure group was 31.44 ± 3.76 kg/m2, while in the closure group was 30.88 ± 3.70 kg/m2. In the non-closure group, the most common hernia sites were epigastric (60.0%), followed by umbilical (40.0%) while in the closure group, the most common hernia sites were umbilical (96.0%). Conclusion: Laparoscopic ventral hernia repair is a safe and feasible technique. The great advance in abdominal laparoscopic surgery and advance in the equipments and instruments as well as individual skills make closure of the hernia defect represents a good alternative to conventional laparoscopic ventral hernia repair (LVHR) with mesh only.

Intraperitoneal-onlay-mesh repair with hernia defect closure via the hernial orifice approach: A case series of 49 patients

IntroductionIn intraperitoneal-onlay-mesh repair with hernia defect closure (IPOM-plus), the abdominal cavity can be reliably approached through the hernial orifice. Adhesions can then be detached, and the hernial orifice can be closed by direct visual manipulation. Presentation of casesIPOM-plus via the hernial orifice approach was performed in 49 patients. First, an incision is made just above the hernial orifice to reach the abdominal cavity. Under direct visualization, the adhesions are dissected, and the mesh is inserted after laparoscopic manipulation. After closing the hernial orifice under direct visual manipulation, the mesh is fixed again under laparoscopic guidance. ConclusionsThis technique has the advantages of an easy intra-abdominal approach and direct visual manipulation. No mesh infections were observed in this study, suggesting that it may be useful as a hybrid procedure.

Laparotomy with suture repair is the most common treatment for obturator hernia: a scoping review.

Obturator hernias are rare and associated with high mortality. However, the optimal surgical approach remains unknown. We aimed to investigate the available evidence and examine the surgical details regarding obturator hernia defect closure as well as the recurrence rates of the different approaches. We reported this scoping review according to the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analysis Extension for Scoping Reviews) and registered the protocol online. A comprehensive literature search in five different databases was conducted. The population was patients undergoing surgery for obturator hernia. Articles were included for data charting if the management of the hernia defect was reported. Data regarding surgical details, and hernia recurrence were extracted. A total of 1299 patients from 313 articles were included. In total, 937 patients underwent open obturator hernia repair, in which 992 hernias were repaired (including some bilateral obturator hernias). A total of 295 patients underwent laparoscopic repair for 341 obturator hernias, and for the remaining 67 patients, type of surgery was not reported. For open surgery, suture repair was the most common method of repair (n = 508, 51%) with a recurrence rate of 10%. For laparoscopic surgery, the most common repair of the defect was mesh repair (n = 299, 88%) with no reported recurrences. Open surgery with primary suture repair is the most common method of repair for obturator hernia but is associated with a recurrence rate of 10%. Laparoscopic mesh repair is becoming more common and have seemingly very low recurrence rates and may be a better method of repair.

Seven years of preoperative BTA abdominal wall preparation and the Macquarie system for surgical management of complex ventral hernia.

To assess 7-year outcomes after complex ventral hernia (CVH) repair using pre-operative Botulinum toxin A (BTA) injection and the Macquarie System of management. Clinical examination and functional non-contrast abdominal CT scans were used to assess complications and recurrences encountered in a prospective series of 88 consecutive CVH repairs using pre-operative BTA injection (200 or 300 units) between November 2012 and December 2019. Pre-operative progressive pneumoperitoneum (PPP) and/or component separation (CS) were also used in some cases. All hernia defects (mean transverse width 12.9 ± 5.2cm) were successfully closed using either laparoscopic or laparoscopic-assisted open techniques facilitated by pre-operative BTA injection. The mean pre-operative post-BTA lateral oblique length gain was 4.7 ± 2.2cm/side (p < 0.001). In 43 patients with defects < 12cm wide, closure was achieved using BTA-only in 33 (76.7%), BTA + PPP in 2 (4.7%), BTA + CS in 5 (11.6%) and BTA + PPP + CS in 3 (7.0%). In the remaining 45 patients with defects [Formula: see text] 12cm wide, closure was achieved using BTA-only in 9 (20.0%), BTA + PPP in 11 (24.4%), BTA + CS in 5 (11.1%) and BTA + PPP + CS in 20 (44.4%). There was a significant correlation between increasing defect size and the need for 2 or more CVH closure procedures (χ2 = 25.28, p < 0.0005). There were no BTA complications. Two patients developed midline hernia recurrences. Pre-operative BTA injection of the abdominal wall is a safe procedure that facilitates hernia defect closure and reduces the need for CS, especially when defect size is less than 12cm. BTA may also decrease the rate of hernia recurrence.

Subcutaneous switching suture technique for hernia defect closure during laparoscopic ventral and incisional hernia repair.

IntroductionA vertical penetration of the thread through the abdominal wall for the hernia defect closure in laparoscopic ventral/incisional hernia repair (LVIHR) is difficult especially in the large defect cases when applying the existing techniques.MaterialsSixteen LVIHRs were performed using the suture technique for defect closure we newly developed.Surgical techniqueWith the subcutaneous switching, our technique only requires the suture‐passer and easily enables the vertical penetration of the thread through the abdominal muscular wall even in the large defect cases.DiscussionThe defect closure in LVIHR tends to be complicated in the large defect cases. Thus, we devised this technique for the easy, reliable, and firm closure even in the large defect cases. Although the sample size was currently very small, we consider that the favorable outcomes have been obtained through our technique because any noticeable complications, such as mesh bulging or recurrence, have not been observed currently.

Robotic-assisted ventral and incisional hernia repair with hernia defect closure and intraperitoneal onlay mesh (IPOM) experience.

The most common technique described for robotic ventral hernia repair (RVHR) is intraperitoneal onlay mesh (IPOM). With the evolution of robotics, advanced techniques including retro rectus mesh reinforcement, and component separation are being popularized. However, these procedures require more dissection, and longer operative times. In this study we reviewed our experience with robotic ventral/incisional hernia repair (RVHR) with hernia defect closure (HDC) and IPOM. Retrospective chart review and follow-up of 31 consecutive cases of ventral/incisional hernia treated between August 2011 and December 2018. Demographics, operative times, blood loss, length of stay (LOS), hernia size, location, and type, mesh size and type, recurrence, conversion to open ventral hernia repair (OVHR) and complications including bleeding, seroma formation and infection were analyzed. Mean age was 63.9years old, with median BMI of 31.24kg/m2. Median hernia area was 17cm2. Mean operating time was 142.61min (SD 59.79). Mean LOS was 1.46days (range 1-5), with 48% being outpatient, and overnight stay in 32% for pain control. Conversion was necessary in 12.9% cases. Complication rate was 3% for enterotomy. Recurrence was 14.81% after a mean follow-up of 26.96months. There was significant association of recurrence with COPD history (P = 0.0215) and multiple hernia defects (P = 0.0376). Our recurrence rate (14.81%) compares favorably to those reported in literature (16.7%) for LVHR with HDC and IPOM. Our experience also indicates that IPOM is associated with satisfactory outcomes, low conversion and complications rates, and short LOS.

STRENGTH COMPARISON OF DIFFERENT METHODS OF CLOSING THE ANTERIOR ABDOMINAL WALL DEFECT (EXPERIMENTAL STUDY)

The aim of the study is to compare the mesh implantation and the strength of the mesh fixation to the anterior abdominal wall by modelling the intraperitoneal onlay mesh repair (IPOM) with and without aponeurotic defect closure. Materials and methods: The experimental animals were randomly divided into 2 groups of 6 rabbits. In experimental group IPOM was modelled without hernia defect closure, in control group - with its suturing. The macroscopic assessment of the severity of adhesions, histological examination of the removed "anterior abdominal wall - mesh" complex and strength of the mesh fixation to the anterior abdominal wall were performed on the 90th day. Results: In both groups, the displacement or complete separation of the mesh from the parietal peritoneum was not observed. The extent of adhesion formation in the abdominal cavity and strength of the mesh fixation are comparable in both groups (p > 0.05). In the experimental group, the mesh was surrounded by scar tissue, mesothelioma lining was not traced. There were also moderate signs of inflammation, which were not seen in the control group. Conclusions: The strength of the mesh fixation to the parietal peritoneum and its implantation into the anterior abdominal wall is comparable with or without aponeurotic defect closure during the experimental modelling of IPOM.

A comparative study of closure versus non-closure of hernial defect in laparoscopic ventral hernia mesh repair

Background: Laparoscopic ventral hernia repair has better out comes when compared to open mesh repair. But closure of the hernial defect is still a contentious issue. This study is designed to compare the outcome of closure versus non-closure of hernia defect in laparoscopic ventral hernia repair.Methods: A 2 years prospective randomized controlled study was conducted on 60 patients undergoing elective laparoscopic ventral hernia repair in the Department of General Surgery (November 2016 to October 2018).Results: The patients in the two groups were analyzed using Chi-square, ANOVA, Fisher exact test, and results were formulated. The mean age of ventral hernia was 41 years and overall incidence more in females. Paraumbilical hernia is the commonest variety of ventral hernia and 63.3% hernias were reducible. Average post-operative length of hospital stay was 2 days with no difference in both the groups. Post-operative pain was more in intraperitoneal onlay mesh (IPOM) plus group. Seroma formation and Incidence of mesh bulge was found be more in IPOM group, but there was no difference in the incidence of chronic pain or recurrence rate between the two groups. All the above proved statistical significance.Conclusions: Primary defect closure in ventral hernia along with mesh placement in laparoscopy seems to have better outcome, with respect to less chance of seroma formation and mesh bulge.

Closure of Direct Inguinal Hernia Defect in Laparoscopic Hernioplasty to Prevent Seroma Formation: A Prospective Double-blind Randomized Controlled Trial.

Seroma is the most frequent postoperative complication after laparoscopic direct inguinal hernia repair. This randomized controlled trial evaluated the preventive effect of a simple technique by closing the direct hernia defect with barbed suture in laparoscopic direct inguinal hernia. In total, 60 patients aged 18 years or older who presented to the hernia center department in our hospital between October 1, 2017 and January 1, 2018 with primary direct inguinal hernia were randomized into the defect-closing group (by closing the transversalis) and the control groups. The primary outcomes were to compare the ultrasonic seroma number and volume at the inguinal region at 7 days, 1, and 3 months postoperatively. Secondary outcomes included total operative time, acute pain, chronic pain (pain lasting over 3 mo), hospital stay, recurrence, and any other complications. There were no significant differences in baseline demographic characteristics between the 2 groups including age, sex, hernia type, size of hernia defect, surgical approach, and follow-up time. Compared with control group, there were significantly fewer patients with seroma formation at 7 days, 1, and 3 months after the operations in the defect-closing group (P<0.001, <0.001, 0.002, respectively). In addition, ultrasonic seroma volume was less in the defect-closing group on postoperative day 7 (13.33 vs. 30.45 mL; P=0.02). The acute pain and hospital stay were comparable (P=0.61, 0.85, respectively), and no chronic pain, early recurrence or other postoperative complications observed in both groups during the follow-up period. The simple technique of direct hernia defect closure with barbed suture in laparoscopic direct inguinal hernia repair is a secure and effective method, which is easy to perform and could significantly reduce both incidence and volume of seroma formation without increasing the risk of recurrence, acute, and chronic pain.

A Systematic Review of Current Consensus on Timing of Operative Repair Versus Spontaneous Closure for Asymptomatic Umbilical Hernias in Pediatric.

Introduction:Umbilical hernia is a common pediatric disorder that pediatric surgeons are usually asked to manage. Most cases will be closed spontaneously during the first 4-5 years of life. Low number of studies regarding umbilical defects in children does not allow a definitive guideline to be drawn about their natural history, indications and optimal timing for repair. In this systematic review, we evaluated the existing literature where pediatric umbilical hernias are addressed in regards to watchful waiting versus recommendations on timing of operative repair and we compared our institutional results with current literatureAim:The aim of our study is to review and evaluate the current guidelines in management of umbilical hernias in children and to compare the results with our experience in management of umbilical hernia in our institution.Methods:Online literature search for studies that published about umbilical hernias in pediatric using literature’s search of ACP Journal Club, Clinical Evidence, Dynamed, Cochran Controlled Trial Register (1945-2015), UpToDate, and PubMed. We reviewed the recommendations of these studies regarding conservative treatment, rule and time of surgery, complications, and its natural history trend to close spontaneously. We compared the literature results and recommendations to our institutional results. We also conducted a retrospective medical charts review of 520 children aged between 1 month and 14 years presented to our institution for surgical consultation for asymptomatic umbilical hernia between 2007 and 2017. We only included children with umbilical hernia who are less than 14 years old and without other associated disorders.Results:A Total of 7 studies that met the inclusion criteria were reviewed. These studies examined the possibilities of spontaneous closure of hernia defect in pediatric, incidence of complications from watchful waiting and current recommendations for surgery timing. In general, spontaneous resolution were unlikely to be seen beyond the age of 5 years. Our institutional results found that of 442 cases treated conservatively between 2007 and 2017, 85% are closed spontaneously by 1-5 years of age.Conclusion:There is minimal top-notch clinical data guiding pediatric surgeons on management protocols in regards to umbilical hernias in children. Current published studies and our institutional retrospective study recommend that conservative management of asymptomatic, uncomplicated umbilical hernias until age 4-5 years is both safe and practical.

Clinical characteristics and surgical outcomes of internal hernia after gastrectomy in gastric cancer patients: retrospective case control study.

Although the internal hernia is rare after gastric cancer surgery, it is a serious complication, and prompt surgical treatment is essential. However, internal hernia has not been studied because of low incidence and difficulty of diagnosis. This study investigated the clinical characteristics and proper management of internal hernia after gastrectomy. From June 2001 to June 2016, patients who underwent gastrectomy, either open or laparoscopic (robotic) surgery, with potential internal hernia defect were enrolled. The hernia defect was not closed in any of the enrolled patients. The clinicopathological data of internal hernia patients were compared to patients without internal hernia to identify risk factors. Surgical outcomes of internal hernia were compared between patients who underwent early and late intervention group according to time interval from symptom onset to operation. Of 5777 patients who underwent gastrectomy with possible internal hernia, 24 (0.4%) underwent emergency or scheduled surgery for internal hernia. Internal hernia through the Petersen space was observed in 15 cases, and through the jejunojejunostomy mesenteric defect in 9 cases. Low body mass index (odds ratio [OR] 4.403, p = 0.003) and laparoscopic approach (OR 6.930 p < 0.001) were statistically significant factors in multivariate analysis. Postoperative complication rate (16.7% vs. 50% p = 0.083) and mortality rate (8.3% vs. 25.0% p = 0.273) were slightly higher in the late intervention group. Although internal hernia is a rare complication, it is difficult to diagnose and cause serious complications. To prevent internal hernia, the necessity of hernia defect closure should be investigated in the further studies. Early surgical treatment is necessary when it is suspected.