Laparoscopic Incisional Hernia Research Articles

Risk factors for recurrence and complications after laparoscopic repair of incisional hernia using a double-layered ePTFE/PP mesh: results of a retrospective study.

The objective was to analyse, risk factors for recurrence (primary outcome) and complications (secondary outome) after the implantation of a double layer ePTFE (expanded PolytTetraFluoroEthylene) / PP (PolyPropylene) mesh to treat incisional hernias (IH) using the Intraperitoneal Onlay Mesh (IPOM) technique. We included all elective laparoscopic IH repairs with intraperitoneal placement of a ePTFE / PP mesh (Relimesh® - Herniamesh S.r.l.) from January 1, 2010 to December 31, 2017 at Humanitas Mater Domini Clinical Institute in Castellanza (Italy) and at the Centre for Minimally Invasive Surgery of Niš (Serbia). Performance was defined as long-term recurrence rate. A total of 284 patients were enrolled. According to the European Hernia Society (EHS) hernias were classified as: W1 (<4 cm) 60.29%, W2 (≥4-10 cm) 35.02% and W3 (≥10 cm) 4.69%; medial 90.85%, lateral 6.69%, both medial and lateral 2.11%. Average follow-up was 48 (11-110) months. The 30-days complication rate was 4.23%. Hernia recurrence rate was 3.36%. Long-term complication rate was 6.34%. At multivariable analysis, an increased risk of short-term complications was associated to chronic obstructive pulmonary disease (COPD) (OR 7.59 [2.23-25.83], P=0.001); an increased risk of long-term complications was associated to diabetes (OR 6.21 [1.80-21.42], P=0.004), an increased risk of recurrence was correlated to COPD (OR 13.40 [1.36-131.9], P=0.026) and hernia defects larger than 6 cm (OR 19.2 [1.12-329.9], P=0.042). Elective laparoscopic IH repair with a double-layered ePTFE/PP mesh is safe and effective. Compliance with indications and preoperative patients evaluation are essential to improve outcomes.

Elective incisional hernia repair: lower risk of postoperative wound infection with laparoscopic versus open repair.

The superiority of laparoscopic repair over open repair of incisional hernias (IHs) in the elective setting is still controversial. Our study aimed to compare the postoperative outcomes of laparoscopic and open elective IH repair in an Asian population. This retrospective study was conducted in an acute general hospital in Singapore between 2010 and 2015. Inclusion criteria were IH repair in an elective setting, IHs with diameter of 3-15 cm, and location at the ventral abdominal wall. We excluded patients who underwent emergency repair, had recurrent hernias or had loss of abdominal wall domain (i.e. hernia sac containing more than 30% of abdominal contents or any solid organs). Postoperative outcomes within a year such as recurrence, pain, infection, haematoma and seroma formation were compared between the two groups. There were 174 eligible patients. The majority were elderly Chinese women who were overweight. Open repair was performed in 49.4% of patients, while 50.6% underwent laparoscopic repair. The mean operation time for open repair was 116 minutes (116 ± 60.6 minutes) and 139 minutes (136 ± 64.1 minutes) for laparoscopic repair (P = 0.079). Within a year after open repair, postoperative wound infection occurred in 15.1% of the patients in the open repair group compared to 1.1% in the laparoscopic group (P = 0.0007). Postoperative pain, recurrence and haematoma/seroma formation were comparable. Elective laparoscopic IH repair has comparable outcomes with open repair and may offer the advantage of reduced postoperative wound infection rates.

Comment to “Endoscopic retromuscular technique (eTEP) vs conventional laparoscopic ventral or incisional hernia repair with defect closure (IPOM +) for midline hernias: a case–control study”

Comment to “Endoscopic retromuscular technique (eTEP) vs conventional laparoscopic ventral or incisional hernia repair with defect closure (IPOM +) for midline hernias: a case–control study”

A comparative study of open preperitoneal versus laparoscopic mesh hernioplasty in cases of incisional hernia repair

Background: Incisional hernias repair being done in large numbers there is still not a consensus about the best repair. Very few studies have been done on comparison open and laparoscopic incisional hernia repair.Methods: A prospective, cross-sectional study was undertaken in Department of Surgery of Civil Hospital. The study included total 50 patients, out of which 25 patients underwent open approach and rest of 25 patients, underwent laparoscopic approach. Patients were assigned to both the groups randomly.Results: Pain, duration of post-operative stay, and return to routine work is earlier in patients with laparoscopic repair mainly due to decreased pain, fewer complications, early mobility and faster return of bowel movements. Laparoscopic repair is more expensive and operative time is more as compared to open method.Conclusions: Keeping in view the advantages and limitations of laparoscopic repair, the choice among two surgical modalities should be made on a case to case basis depending on patient preference and characteristics.

Short-Term Quality of Life Comparison of Laparoscopic, Open, and Robotic Incisional Hernia Repairs

Short-Term Quality of Life Comparison of Laparoscopic, Open, and Robotic Incisional Hernia Repairs

Laparoscopic Incisional and Ventral Hernia Repair with Absorbable Tacks in a Long Term Follow-up: A Retrospective Control Study.

Laparoscopic Incisional and Ventral Hernia Repair (LIVHR) is a safe and worldwide accepted procedure performed using absorbable tacks. The aim of the study was to evaluate recurrence rate in a long term follow-up and whether the results of laparoscopic IVH repair in the elderly (≥65 years old) are different with respect to results obtained in younger patients. One hundred and twenty-nine consecutive patients (74 women and 55 men, median age 67 years, range = 30-87 years) with ventral (N = 42, 32.5%) or post incisional (N = 87, 67.5%) hernia were enrolled in the study. Patients were divided into two groups according to their age: group A (N = 55, 42.6%) aged <65 years and group B (N = 74, 57.4%) aged ≥65 years. The mean operative time was not significantly different between groups (66.7 ± 37 vs. 74 ± 48.4 min, p = 0.4). To the end of 2016, seven recurrences had occurred (group A = 3, group B = 4, p = 1). Complications occurred in 8 (16%) patients in group A and 21 (28.3%) patients in group B. In conclusion, our results confirm that the use of absorbable tacks does not increase recurrence frequency and laparoscopic incisional and ventral repair is a safety procedure also in elderly patients.

Açık ve laparoskopik insizyonel herni onarımının ağrı skorları ve hasta memnuniyeti açısından karşılaştırılması

Aim: Incisional hernia is one of the most common postoperative complications of abdominal surgery. Recently laparoscopic repair was introduced. The aim of this study is to compare pain scores and satisfaction rates of patients performed open and laparoscopic incisional hernia repair.Materials and Methods: A total of 164 patients were included. Group 1 (n=47) consists of patients performed laparoscopic repair and Group 2 (n=117) consists of open repair. Patients were analyzed according to demographic data, operative findings, postoperative complications and recurrence. 32 (68.08%) patients in Group 1 and 88 (75.21%) patients in Group 2 were applied to telephone survey. Pain scores and satisfaction rates of patients were compared.Results: 51 (31.1%) patients were male and 113 (68.9%) patients were female. Mean age of patients was 55.35±11.73 years. Postoperative complications were found in only 2.1% of patients in Group 1 and 23.9% of patients in Group 2 (p&amp;lt;0.05). Recurrence rates for Group 1 and 2 was 25.7% and 20%, respectively (p&amp;gt;0.05). No statistical difference was observed between groups regarding to pain scores and satisfaction rates (p&amp;gt;0.05).Conclusion: Although laparoscopic repair seems to have advantages, it has no superiority to the open repair regarding pain and satisfaction.

Long-term clinical experience with laparoscopic ventral hernia repair using a ParietexTM composite mesh in severely obese and non-severe obese patients: a single center cohort study

Background: The treatment of incisional and ventral hernias is associated with significant complications and recurrences, especially in severely obese patients. Recent studies have shown a reduced rate of surgical site infections and length of hospital stay in severely obese patients undergoing a laparoscopic ventral hernia repair.Aim: This study aims to describe the clinical experience in terms of efficacy and safety with laparoscopic ventral hernia repair using the ParietexTM Composite mesh (Covidien Sofradim Production, Trevoux, France) in severely obese patients (body mass index ≥35) compared with non-severe obese patients in a seven-year single-center cohort.Material and methods: All patients with a primary ventral or incisional hernia admitted to our hospital from 2006 until December 2012 who underwent a laparoscopic repair with the Parietex Composite mesh were included in this study. Pain scores using a numeric rating were collected prospectively 24–48 hours postoperatively. Patient data were retrospectively collected.Results: A total number of 210 patients were included; 173 with a BMI <35 and 37 with a BMI ≥35. Mean follow-up was 31 months. No statistically significant differences were found with regard to operation time, hospital stay, use of analgesics and postoperative complications. The long-term follow up recurrence rate in non-severely obese patients was 13% compared to 16% in severely obese patients (p = .60).Conclusion: Laparoscopic ventral and incisional hernia repair using the Parietex Composite mesh is feasible and safe in severely obese patients compared to non-severely obese patients.

Should We Routinely Close the Fascial Defect in Laparoscopic Ventral and Incisional Hernia Repair?

Should We Routinely Close the Fascial Defect in Laparoscopic Ventral and Incisional Hernia Repair?

Long-term results of laparoscopic versus open intraperitoneal onlay mesh incisional hernia repair: a propensity score-matched analysis

BackgroundIntraperitoneal onlay mesh repair (IPOM) of incisional hernia is performed by laparoscopic and open access. The aim of the present study is to compare open versus laparoscopic surgery specifically using an IPOM technique for incisional hernia repair.MethodsA propensity score-matched observational single center study of patients that underwent IPOM between 2004 and 2015 was conducted. The primary outcome was hernia recurrence; secondary outcomes include length of stay, surgical site infections (SSI), complications, and localization of recurrence.ResultsAmong 553 patients with incisional hernia repair, 59% underwent laparoscopic and 41% open IPOM. A total of 184 patients completed follow-up. After a mean follow-up of 5.5 years recurrence rate was 20% in laparoscopic and 19% in open repair (p = 1.000). Patients undergoing laparoscopic IPOM had significantly reduced operation time (median 120 vs. 180 min, p < 0.001), shorter hospital stays (6 vs. 8 days, p = 0.002), less complications (10 vs. 23%, p = 0.046), and fewer SSI (1 vs. 21%, p < 0.001).ConclusionsLaparoscopic IPOM is associated with reduced morbidity compared to open IPOM for incisional hernia repair.

Massive Incisional Hernia Repair with Parietex: Monocentric Analysis on 500 Cases Treated with a Laparoscopic Approach.

The aim of this retrospective study is to demonstrate the safety and feasibility of the laparoscopic technique for treatment of massive incisional hernias (MIHs) and to compare three different fixation devices. From January 1, 2001, to December 31, 2014, we collected retrospective data from patients with large incisional hernias (IHs). Laparoscopic IH repair is performed by applying a three-dimensional polyester knit structure mesh with a resorbable collagen barrier on peritoneal side (Parietex™ Composite Mesh; Covidien, New Haven, CT). Patients were divided into three groups according to the different fixation devices. The mean follow-up was 19 (12-156) months. The mean defect size was 12.83 cm (10-26 cm) and the mean body mass index was 30.8 kg/m2 (26-39 kg/m2). The EMS stapler™ was used on 260 patients, the Protack® on 210 patients, and the AbsorbaTack™ on 30 patients. The mean operative time was 69.9 minutes (38-130 minutes). Intraoperative morbidity rate was 1.6% (8 cases). Early reoperation rate was 0.2% (1 case). The mean length of hospital stay was 2.3 days (range 2-7 days). Seromas were observed in 20 patients (4.0%) and neuralgia in 10 patients (2.0%). Recurrence was observed in 12 patients (2.4%) with the majority in the absorbable tack group (10%). There were no conversions (0%) to open technique. The laparoscopic approach seems to be safe and appropriate for treatment of MIH. The Parietex composite mesh we used guarantees excellent intraabdominal laparoscopic repair of abdominal wall defects. Absorbatack system seems to give less postoperative neuralgia, but it is related to a high recurrence rate. Protack system seems to give more postoperative neuralgia than the Endopath EMS. In our experience, the best fixation system is the latter.

An international surgical collaboration: humanitarian surgery in Brazil.

Brazil is the fifth most populous country in the world with widespread regional and social inequalities. Regional disparities in healthcare are unacceptably large, with the remote and poor regions of the north and northeast having reduced life expectancy compared to the south region, where life expectancy approaches that of rich countries. We report our experience of a humanitarian surgery mission to the Amazonas state, in the northwest part of Brazil. In August 2014, a team of seven consultant surgeons, and two trainees with the charity 'International Hernia', visited three hospitals in the Amazonas state to provide hernia surgery and training. Eighty-nine hernias were repaired in 74 patients (female=22, male=52) with a median age of 44years (range 2-83years). Nine patients underwent more than one type of hernia repair, and there were 9 laparoscopic inguinal and ventral incisional hernia repairs. Local doctors were trained in hernia repair techniques, and an International Hernia Symposium was held at the University of the State of Amazonas, Manaus. The humanitarian mission provided hernia surgery to an underserved population in Brazil and training to local doctors, building local sustainability. Continued cooperation between host and international surgeons for future missions to Brazil will ensure continuing surgical training and technical assistance.

Mesh fixation techniques in primary ventral or incisional hernia repair

Mesh fixation techniques in primary ventral or incisional hernia repair

A Belgian Multicenter Prospective Observational Cohort Study Shows Safe and Efficient Use of a Composite Mesh with Incorporated Oxidized Regenerated Cellulose in Laparoscopic Ventral Hernia Repair

Background : A variety of anti-adhesive composite mesh products have become available to use inside the peritoneal cavity. However, reimbursement of these meshes by the Belgian Governemental Health Agency (RIZIV/INAMI) can only be obtained after conducting a prospective study with at least one year of clinical follow-up. This Belgian multicentric cohort study evaluated the experience with the use of Proceed®-mesh in laparoscopic ventral hernia repair. Patients and methods : During a 25 month period 210 adult patients underwent a laparoscopic primary or incisional hernia repair using an intra-abdominal placement of Proceed®-mesh. According to RIZIV/INAMI criteria recurrence rate after 1 year was the primary objective, while postoperative morbidity, including seroma formation, wound and mesh infections, quality of life and recurrences after 2 years were evaluated as secondary endpoints (NCT00572962). Results : In total 97 primary ventral and 103 incisional hernias were repaired, of which 28 (13%) were recurrent. There were no conversions to open repair, no enterotomies, no mesh infections and no mortality. One year cumulative follow-up showed 10 recurrences (n = 192, 5.2%) and chronic discomfort or pain in 4.7% of the patients. Quality of life could not be analyzed due to incomplete data set.Conclusions : More than 5 years after introduction of this mesh to the market, this prospective multicentric study documents a favorable experience with the Proceed mesh in laparoscopic ventral hernia repair. However, it remains to be discussed whether reimbursement of these meshes in Belgium should be limited to the current strict criteria and therefore can only be obtained after at least 3–4 years of clinical data gathering and necessary follow-up.

Single-access laparoscopic primary and incisional prosthetic hernia repair: first 50 patients

Primary and incisional hernia can be repaired by multitrocar laparoscopy. Single-access laparoscopy (SAL) recently gained interest to decrease the invasiveness and to reduce the abdominal trauma, besides improved cosmetic results. The authors report first 50 patients who consulted for primary and incisional hernia and treated by SAL prosthetic repair. Between December 2009 and March 2012, 50 patients (24 females, 26 males) were submitted to SAL for primary (23) and incisional hernia (27). Mean age was 49.1±15.1years (17-75), and mean body mass index 29.7±5.7kg/m(2) (19-44.1). A total of 26 primary and 30 incisional hernias were treated. The technique consisted in implied the use of an 11-mm trocar for 10-mm scope, curved reusable instruments without trocars, and dualface prosthesis fixed by tacks without transfascial closures. No conversion to open surgery nor addition of one or more trocars was necessary. Mean perioperative hernia sizes were 7.0±5.0cm (2-24) in length and 6.0±3.4cm (1-16) in width, for a surface of 55.0±64.6cm(2) (2.8-268.2). Mean prosthesis size used was 188.1±113.4cm(2) (56.2-505.6). Mean laparoscopic time was 60.2±32.8min (26-153), and mean final scar length was 21.2±4.5mm (13-35). Mean hospital stay was 2.2±1.2days (1-8). Perioperative complications were registered in 4 patients and minor early complications in 13 patients of each group. After a mean follow-up of 16.1±8.8months (4-34), 2 late complications were observed in one patient of each group. Primary and incisional hernia can safely be treated by SAL prosthetic repair, but a learning curve is unavoidable. Thanks to this approach, in patients with primary hernia, only a small scar is finally visible, and in patients who proved to be prone to develop incisional hernia, the number of fascial incisions can be reduced.

Combined laparoscopic cholecystectomy and incisional hernia repair: a proposal for standardised technique

Combined laparoscopic cholecystectomy and incisional hernia repair: a proposal for standardised technique

Laparoscopic incisional and ventral hernia repair (LIVHR) with PARIETEX™ Composite mesh

Objectives: Laparoscopic incisional and ventral hernia repair (LIVHR) is widely used although its clinical indications are often debated. The aim of this study was to retrospectively describe the experience of our surgical centre in order to establish the safety, efficacy, and feasibility of LIVHR using PARIETEX™ Composite mesh (Covidien, Mansfield, MA, USA). Material and methods: Between January 2007 and November 2010, 87 patients were admitted to the Division of General Surgery of Aosta, with the diagnosis of abdominal wall hernia and underwent laparoscopic repair using PARIETEX™ Composite mesh. The type and size of surgical defects, mean operative time, morbidity, mortality and rate of recurrence at one-year follow-up were retrospectively analysed. Results: We performed 87 LIVHR: 51.7% for incisional hernia and 48.3% for epigastric or umbilical hernias. Mean operative time was 100 min., conversion rate was 3.4%. The mean size of abdominal defect was 6 cm (range: 2–15); in relation to umbilical hernias, mean size was 5.4 cm (range: 2–8). The mortality rate was 0%; overall morbidity was 16%. At one-year follow-up, we observed two cases of hernia recurrences. Conclusions: LIVHR using PARIETEX™ Composite mesh is an effective and safe procedure with very low morbidity and low rates of postoperative pain and recurrence, especially in hernias with diameter of between 5 and 15 cm and in obese patients without previous laparotomies.

Eighty-five redo surgeries after 733 laparoscopic treatments for ventral and incisional hernia: adhesion and recurrence analysis

This report reviews the clinical and functional outcomes of implanted meshes during a second-look evaluation of 85 cases after a large number (733) of laparoscopic incisional and ventral hernia repairs (LIVHR), of which 608 were controlled throughout a period of 5 to 10 years. This report demonstrates a minimal occurrence of adhesions and a low rate of recurrences and other complications related to mesh usage. Eighty-five re-operated cases after LIVHR were reviewed retrospectively. In every redo surgery, the first trocar was always inserted on a lateral side, external to the previous skin incisions of the transabdominal fixations. Mueller's adhesion scale was used to estimate adhesion severity (Mueller 0 indicates no adhesion; Mueller I indicates adhesion of the omentum; and Mueller II indicates serosal adhesions). The mechanism of recurrence is of paramount interest and is analyzed herein. If recurrence was observed, the defect was closed and a larger mesh of Parietex was implanted under the previous one, with transparietal fixation achieved by pulling the threads with the Endoclose device. In all of our "second-look" surgeries, the neoperitoneum perfectly covered the mesh. In 47.05% of the cases, we observed no adhesions (Mueller 0), 42.3% had adhesions of the omentum (Mueller I), and 10.58% had serosal adhesions (Mueller II). There was no shrinking or wrinkling of the prosthesis in any of the cases, confirming its total peritonization on the anterior abdominal wall. Within the first 3 years, only 4.1% of the controlled patients contracted recurrences, with a mean follow-up of 52 months. With the double-suturing technique used for LIVHR and the use of a composite mesh, we observed a low rate of recurrences and limited side effects as compared with the use of tacks intra-abdominally. Redo surgeries after LIVHR are feasible, but care must be taken due to unpredictable mesh adhesions.

Authors' reply: Meta-analysis of randomized controlled trials comparing open and laparoscopic ventral and incisional hernia repair with mesh (Br J Surg 2009; 96: 851–858)

Authors' reply: Meta-analysis of randomized controlled trials comparing open and laparoscopic ventral and incisional hernia repair with mesh (<i>Br J Surg</i> 2009; 96: 851–858)

Meta-analysis of randomized controlled trials comparing open and laparoscopic ventral and incisional hernia repair with mesh (Br J Surg 2009; 96: 851–858)

Meta-analysis of randomized controlled trials comparing open and laparoscopic ventral and incisional hernia repair with mesh (<i>Br J Surg</i> 2009; 96: 851–858)