Laparoscopic Mesh Repair Research Articles

A Rare Presentation of Vesicocutaneous Fistula as Groin Abscess after 8 Years of Laparoscopic Mesh Repair of Inguinal Hernia

Laparoscopic mesh repair of inguinal hernia is common but rarely associated with vesicocutaneous fistula as a complication. The most common implications are mesh erosion and migration due to inappropriate strategies in the selection of the mesh type, size, and placement of mesh. This case study reports a 74-year-old man who suffered immense physical, mental, and cosmetic hardship due to a vesicocutaneous fistula postlaparoscopic mesh repair of an inguinal hernia performed 8 years ago. He presented with groin abscess secondary to vesicocutaneous fistula, diagnosed with high inflammatory markers and computed tomography abdomen pelvis. Groin abscess was drained and identified vesicocutaneous fistula which was managed conservatively.

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.

Predictive value of platelet-related hematological markers in indicating the outcomes after laparoscopic intraperitoneal onlay mesh repair (IPOM).

The predictive value of hematological markers in the outcomes after laparoscopic intraperitoneal onlay mesh repair (IPOM) remains to be investigated. We aim to evaluate the role of platelet-related parameters after laparoscopic IPOM in patients with incisional hernias. The data of 95 patients who underwent laparoscopic IPOM for appendicectomy-related incisional hernias were retrospectively analyzed. The complete blood count analyses were measured preoperatively, and the outcomes were obtained from hospital records and follow-up calls to patients. Platelet-multiple-lymphocyte index (PLM), neutrophil-leukocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), platelet-lymphocyte ratio (PLR) and systemic immune-inflammation index (SII) values were calculated. The patients were grouped based on the recurrence and the postoperative complications after surgery. Using cutoff values acquired by the Youden Index, we found platelet levels < 212.0 × 1000/μl, NLR > 2.33, LMR < 3.17, and PLM < 365.5 were revealed to be statistically significant in the recurrence of hernias based on univariant or multivariant analysis (p = < 0.05). We further divided the patients into two groups based on the cutoff value of PLM and found that a PLM value < 365.5 was significantly associated with the recurrence of incisional hernia (p = 0.018), the occurrence of postoperative seroma (p = 0.044), and there is a tendency that patients with PLM < 365.5 may suffer from other postoperative complications such as cardiopathy, respiratory infection, and hypoproteinemia (p = 0.089). The preoperative hematological values, especially PLM, may indicate the outcomes in incisional hernias after laparoscopic IPOM.

LIGHT WEIGHT VERSUS MEDIUM WEIGHT MESH IN LAPAROSCOPIC INGUINAL HERNIA MESH REPAIR

Hernia is repaired by laparoscopic or open approach. Laparoscopic inguinal hernia repairs performed are trans-abdominal preperitoneal repair (TAPP) and totally extra-peritoneal repair (TEP). This study aimed to update the previous reviews and to compare Light Weight versus Medium Weight Mesh in LIHR. Previous studies have shown benets of LWM compared to MWM in terms of decreased pain, discomfort, and early return to normal activity. Method: 50 patients operated for Laparoscopic Inguinal Hernia Mesh Repair were evaluated from Inpatient department of Sahyadri Speciality Hospital, Deccan, Pune between January 2020 to May 2021. 30 patients were operated using Anatomical 3D Light weight Mesh and 20 were operated using Paritene Flat Sheet Medium Weight Mesh; allocation done by simple randomization. It is a prospective, observational study. Aim was to evaluate the post-operative outcome and return to normal activities in LWM versus MWM in LIHR. Result: Mean duration of hospital stay, mean duration of days taken to resume daily activities, intensity of pain by VAS and NRS, foreign body sensation, incidence of seroma formation and inuence on male sexual life and fertility did not differ between patients of both groups. No signicant difference in post-operative pain and foreign body sensation between use of LWM and MWM.

Evaluation of Perioperative and Quality of Life Outcomes Along with Cost Effectiveness in Laparoscopic Transabdominal Retrorectus Mesh Repair for Ventral Hernia: A Prospective Observational Study

Introduction: Laparoscopic ventral hernia repair has its advantages of reduced postoperative complication and early return to work. Owing to the need of a cost-effective technique with similar perioperative outcomes, transabdominal retro-rectus mesh repair (TARM) is a suitable and less expensive alternative compared with other methods of laparoscopic ventral hernia repair. Methods: Patients with primary (n = 7) or incisional (n = 17) hernia were selected to be operated on using TARM procedure. Quality of life was evaluated in terms of time to return to usual routine work, the sensation of mesh (using Carolinas Comfort Scale, CCS), tolerance to early oral feed, formation of seroma, suture site infection and hernia recurrence. Results: The average defect size was 2.8 cm with a mean BMI was 28.17 kg/m2. The average duration of surgery was 165 mins. Mean postoperative pain score after 1 day, 1 week, 1 month, 3 months and 6 months were 3.5, 2, 0.58, 0.5 and 0 respectively. Seroma formation occurred in 6 (25%) and hematoma in 1 (4%) patient. The mean time to resumption of daily activities was 6.25 days. Mean CCS after 1 month and 3 months are 30 and 16.2 respectively. No cases of recurrence or chronic pain were observed during 6 months follow-up. Conclusion: Laparoscopic TARM appears to be a feasible, safe and cost-effective method of ventral hernia repair due to standard laparoscopic instruments used, no contact with bowel and use of plain polypropylene mesh respectively.

Less postoperative pain and shorter length of stay after robot-assisted retrorectus hernia repair (rRetrorectus) compared with laparoscopic intraperitoneal onlay mesh repair (IPOM) for small or medium-sized ventral hernias.

The optimal repair of ventral hernia remains unknown. We aimed to evaluate the results after robotic-assisted laparoscopic transabdominal repair with retrorectus mesh placement (rRetrorectus) compared with laparoscopic intraperitoneal onlay mesh repair (IPOM) for patients with small- or medium-sized ventral hernia. This was a retrospective cohort study of consecutive patients undergoing elective rRetrorectus or IPOM repair for small or medium-sized primary ventral or incisional hernias. The primary outcome was the postoperative need for transverse abdominis plane (TAP) block or epidural analgesia, secondary outcomes were length of stay and postoperative complications. All patients were followed for 30days postoperatively. A total of 59 patients were included undergoing rRetrorectus (n = 27) and IPOM (n = 32). Patients in the two groups were comparable in terms of age, sex, comorbidities, smoking status, body mass index (BMI), and type of hernia. The median fascial defect area was slightly larger in the rRetrorectus group (9 cm2 vs. 6.2 cm2, P = 0.031). The duration of surgery was longer for rRetrorectus (median 117.2min. vs. 84.4, P = 0.003), whereas the postoperative need for TAP block or epidural analgesia was less after rRetrorectus compared with IPOM (3.7% versus 43.7%, P = 0.002). There were no severe complications or reoperations after either procedure. The length of stay was shorter after rRetrorectus (median 0 vs. 1day, P < 0.001). rRetrorectus was associated with reduced postoperative analgesic requirement and shorter length of stay compared with laparoscopic IPOM. Registration Clinicaltrial.gov: NCT05320055.

To Compare Outcome of Open Versus Laproscopic Repair for Primary Ventral Hernias

Background: Primary ventral and incisional abdominal wall hernias are frequent conditions that necessitate surgery, and both types of hernias can be treated utilizing an open or laparoscopic technique. Improvements in laparoscopy have also been linked to a decrease in pain scores. Methodology: A dual setting study was conducted from July 2017 to June 2019 at Peshawar medical college with collaboration of Lady Reading Hospital and Hayatabd Medical Complex, Peshawar and was conducted on a total of 120 patients who were diagnosed with ventral hernia. A random number table created by a computer indicated repair of an open ventral hernia technique (group 1, n = 60) or laparoscopy (group 2, n = 60). Results: Among 60 patients in the laparoscopy group, there were 37 cases of PUH, 15 cases of epigastric hernia, 8 cases of umbilical hernia, and among 60 cases of open abdominal hernia, including 31 cases of PUH, 19 cases of hernia in the abdomen. upper abdomen, and 10 cases of umbilical hernia. Wound-related complications were most commonly seen in the open procedure group of patients. Conclusion: This has led to broad acceptance of the laparoscopic surgery, and advantages particularly in order to decrease the post-operative mortality and morbidity, time of operation, bleeding and the duration of hospital stay along the ability to execute the surgery on the obese people and with abdominal scarred individuals. Keywords: Incisional hernia, Laparoscopic mesh repair, Open mesh repair, Primary ventral hernia.

WE5.3 Emergency laparoscopic “hybrid” IPOM+ repair of incarcerated umbilical hernia in patient with BMI 62 and small bowel obstruction; a case study

Abstract Background Large abdominal incisions in obese patients are associated with considerable rates of systemic and wound complications. Recently published European Hernia Society guidelines recommend laparoscopic intraperitoneal on-lay mesh (IPOM) repair for large hernia defects and patients at higher risk of wound morbidity, ideally with closure of the defect and a 5 cm overlap. Case Presentation: We report on a 69-year-old, morbidly obese (BMI 62), comorbid woman who presented as an emergency with a 5-day history of vomiting and abdominal pain. A pre-operative computed tomography (CT) scan confirmed small bowel obstruction secondary to a ventral abdominal wall hernia. Operative findings confirmed an obstructed paraumbilical hernia containing small bowel and omentum. A laparoscopic “hybrid” IPOM+ repair was performed, with a generous overlap. She recovered uneventfully with no surgical complications. Discussion: Minimally-invasive surgical techniques are preferred for obese patients with evidence suggesting lower perioperative complications and recurrence rates compared with open repair. However, additional challenges must be taken into consideration including; surgeon expertise, timing of operation, surgeon ergonomics, distortion of surface anatomical landmarks, need for higher pneumoperitoneum pressures and the physiological effects of this on the patient. Conclusion With preoperative planning, our case study demonstrates that IPOM ventral hernia repair remains a viable option for severely obese patients even in emergency presentations. The closure of the defect is recommended whenever feasible. Addition of the hybrid approach (excision of the sac with a limited incision after the laparoscopic closure) reduces the risk of postoperative seromas.

Open versus laparoscopic intraperitoneal on-lay mesh repair: A comparison of outcomes in small ventral hernia

PurposeThe ideal surgical treatment of small ventral hernias (defect less than 4 cm) is still debatable. In our study, we sought to compare the outcomes of open versus laparoscopic intraperitoneal on-lay mesh (IPOM) repair in small ventral hernias. MethodsPatients with a single ventral hernia defect of less than 4 cm undergoing surgical mesh repair between January 2016 and September 2018 were prospectively registered for this study. The minimum follow-up duration was 12 months. Patient demographics, operative findings and regular post-operative follow-up details including recurrence rates and complications were recorded and analysed. Results41 patients underwent laparoscopic IPOM repair and 47 patients underwent open IPOM repair. The mean age for both groups is similar with no significant difference. The mean hernia defect size for the laparoscopic group is 2.8 cm (±0.8) whereas the mean hernia defect size for the open repair group is 2.1 cm (±0.4). The mean surgery duration for open IPOM repair was significantly shorter (59 min (±17) vs 74 min (±26); p = 0.001). There was no significant difference in the incidence of seroma formation and surgical site infections post-operatively. There was also no significant difference in both groups in terms of chronic pain and recurrence at 1-year follow-up. ConclusionOpen IPOM repair for small ventral hernias may be superior to laparoscopic IPOM repair due to the shorter operative duration, single incision, and no additional risk of port-site hernias. There was no difference in chronic pain, wound infection and recurrence rate between the two groups.

PRIMARY LUMBAR HERNIA: CASE SERIES WITH TECHNICAL DESCRIPTION OF LAPAROSCOPIC MESH REPAIR.

BACKGROUND: Primary Lumbar hernias are rare posterolateral abdominal wall defect. Rarity of disease and by virtue of its location there is no standard consensus for surgical options and traditionally it is approached through open repair. Therefore, we report a series of 10 patients from two institutions who underwent successful Laparoscopic mesh repair of Lumbar hernias with technical description of surgery. AllSTUDY DESIGN: patients with primary lumbar hernias total number of 10 who presented to two institute over a period of 12 years (Feb 2010 to April 2022) and underwent Laparoscopic mesh repair were included in the study. Data collected regarding intraoperative and postoperative course with 2-24 months postoperative follow up were reviewed retrospectively. All of the 10 patients underwent Laparoscopic repair withRESULTS: polypropylene mesh placement over the defect in retroperitoneal space without the primary closure of defect. All patients had uneventful intraoperative and postoperative course with average length of hospital stay of 1.3 days. No complications were reported and there was no recurrence during follow up for 2-24 months. Lumbar hernia being a rare entity, there is lack of sufcient data precludes aCONCLUSION: standardized approach. On the basis of data from our case series of 10 patients we believe Laparoscopic mesh repair for primary lumbar hernia is the best available treatment option considering it safe, effective, gives intraoperatively better visualization of anatomy even at difcult retroperitoneal space and uneventful postoperative course with decreased hospital stay and no recurrences in follow-up.

Effect of perioperative lignocaine infusion on postoperative pain relief for laparoscopic intraperitoneal onlay mesh repair: A randomized controlled study.

The focus on enhanced recovery after surgery (ERAS) and opioid-free anesthesia has renewed interest in use of lignocaine. We evaluated postoperative pain relief following intravenous (IV) lignocaine administration in patients undergoing laparoscopic intraperitoneal onlay mesh repair (IPOM). Seventy patients were randomized into two groups. Group L patients were administered IV lignocaine infusion (1.5mg/kg) at induction of anesthesia followed by infusion (1.5mg/kg/h), until 1hour in the post-anesthesia care unit (PACU). Group P patients received equal volumes of normal saline IV infusion. We recorded hemodynamics, perioperative analgesic consumption, postoperative visual analog scores (VAS), incidence of postoperative nausea and vomiting (PONV), bowel function, patient satisfaction and length of hospital stay (LOS). The hemodynamics in both groups were maintained. Group L had lower VAS scores as compared to Group P (P < .05). Intraoperative fentanyl consumption in Group L was significantly less than Group P (P=.029). Group L patients scored lower on the Likert scale in comparison to the patients of Group P at 0hour (P=.013). Recovery of bowel function as assessed by time to pass first flatus was significantly shortened by IV lignocaine (P=.001). The perioperative administration of IV lignocaine resulted in decreased postoperative analgesic requirement and greater patient satisfaction scores. Perioperative IV lignocaine infusion provided good pain relief, hemodynamic stability and decreased perioperative analgesic consumption. PONV incidence decreased along with an early return of bowel function, reduced LOS and improved patient satisfaction in patients undergoing laparoscopic IPOM surgery.

Evaluation of outcome in laparoscopic and open ventral hernia repair: a prospective study

Background: Ventral hernias are categorized as epigastric, umbilical, spigelian, parastomal, and incisional hernias. Hernias occurring in epigastrium and umbilical region are considered as primary ventral hernias. There are various ways of hernia repair, in which the tension free repair remains the most important one. For doing a repair by laparoscopy, first of all the contents of the hernia are reposited back in the abdomen, followed by placement of mesh transabdominally which should be of optimum size and typeMethods: The present study is a prospective observational study that emphasizes to analyse and evaluate outcome in open and laparoscopic mesh repair of ventral hernia that presented to the Himalayan hospital over a period of 1 year. Results: Study shows that more than 50% of the cases were recorded in the age group between 26-50 years (mean 47 years) with majority being females. Umbilical hernia (45.1%) was the most common followed by incisional hernia (28.2%), paraumbilical hernia (22.5%) and epigastric hernia (4.2%). Diabetes mellitus was the most common comorbidity (88.7%) followed by hypertension (64.8%). VAS score was statistically significant between individuals who got surgery by laparoscopy when compared with open approach. A significant difference was also observed between period of mobilization and surgical procedure.Conclusions: Surgery of ventral hernia by laparoscopy has less post-surgical pain, less problems, lesser stay in hospital and had lesser impact on economy as the individuals returned to their normal routine in lesser time.

Comparative review of outcomes: single-incision laparoscopic total extra-peritoneal sub-lay (SIL-TES) mesh repair versus laparoscopic intraperitoneal onlay mesh (IPOM) repair for ventral hernia

To compare outcomes between single-incision laparoscopic totally extra-peritoneal sub-lay (SIL-TES) mesh repair and laparoscopic intraperitoneal onlay mesh (IPOM) repair of ventral hernia (VH). A retrospective selection of 104 patients who underwent VH repair (50 and 54 in the SIL-TES and IPOM groups, respectively) was made. Patient data were collected, and quality of life was evaluated using Carolinas Comfort Scale (CCS) 1 month and 3 months after surgery. There were no significant differences in sex, American Society of Anesthesiologists class, defect size, mesh area, estimated blood loss, and complication rate between the groups. Age was lower, body mass index was higher, prevalence of primary VH was significantly higher (p < 0.0001), and pain was less at 24 and 48 h post procedure (p < 0.0001) in the SIL-TES group. Drainage placement was more (p < 0.0001), operation time was shorter (p = 0.012), and hospitalization duration and total hospitalization cost were greater in the IPOM group than that in SIL-TES group (8.3 ± 0.3 vs 4.3 ± 0.4 days, p < 0.0001; $7126.9 ± 141.4 vs $2937.3 ± 58.3, p < 0.0001, respectively). Pain and movement limitation scores evaluated by CCS were significantly worse at 1 month (4.93 ± 0.28 vs 1.75 ± 0.28: p < 0.0001; 2.52 ± 0.24 vs 1.15 ± 0.18: p < 0.0001, respectively) and 3 months (4.32 ± 0.37 vs 0.9 ± 0.29: p < 0.0001; 2.06 ± 0.25 vs 0.69 ± 0.11: p < 0.0001, respectively) in IPOM group, compared with the according scores in SIL-TES group. There was no readmission within 30 days and no hernia recurrence at mean follow-up of 12 months. SIL-TES mesh repair is safe and effective and is superior to IPOM repair.

A propensity-score matched analysis of ventral-TAPP vs. laparoscopic IPOM for small and mid-sized ventral hernias. Comparison of perioperative data, surgical outcome and cost-effectiveness

PurposeLaparoscopic techniques have been used and refined in hernia surgery for several years. The aim of this study was to compare an established method such as laparoscopic intra-peritoneal onlay mesh repair (lap. IPOM) with ventral Transabdominal Preperitoneal Patch Plasty (ventral-TAPP) in abdominal wall hernia repair.MethodsPatient-related data of 180 laparoscopic ventral hernia repairs between June 2014 and August 2020 were extracted from our prospectively maintained database. Of these patients, 34 underwent ventral-TAPP and 146 lap. IPOM. After excluding hernias with a defect size > 5 cm and obtaining balanced groups with propensity-score matching, a comparative analysis was performed in terms perioperative data, surgical outcomes and cost-effectiveness.ResultsPropensity-score matching suggested 27 patients in each of the two cohorts. The statistical evaluation showed that intake of opiates was significantly higher in the lap. IPOM group compared to ventral-TAPP patients (p = 0.001). The Visual Analogue Scale (VAS) score after lap. IPOM repair was significantly higher at movement (p = 0.008) and at rest (p = 0.023). Also, maximum subjective pain during hospital stay was significantly higher in the lap. IPOM group compared to ventral-TAPP patients (p = 0.004). No hernia recurrence was detected in either group. The material costs of ventral-TAPP procedure (34.37 ± 0.47 €) were significantly lower than those of the lap. IPOM group (742.57 ± 128.44 € p = 0.001). The mean operation time was 65.19 ± 26.43 min in the lap. IPOM group and 58.65 ± 18.43 min in the ventral-TAPP cohort. Additionally, the length of hospital stay in the lap. IPOM cohort was significantly longer (p = 0.043).ConclusionVentral-TAPP procedures represent an alternative technique to lap. IPOM repair to reduce the risk of complications related to intra-peritoneal position of mesh and fixating devices. In addition, our study showed that postoperative pain level, material costs and hospital stay of the ventral-TAPP cohort are significantly lower compared to lap. IPOM patients.

Prevention and management of intraoperative complication during single incision laparoscopic totally extraperitoneal repair.

Serious complications related to hernia surgeries have rarely been reported. One meta-analysis comparing laparoscopic and open mesh repair reported that 0.4% of potentially serious operative complications were reported. Previous studies have reported that uncommon serious intraoperative complications more frequently occur during laparoscopic inguinal hernia repairs. One study has shown that patients with history of lower abdominal surgery are at an increased risk of visceral injury during laparoscopic hernia repair. Vascular injuries at dissection and mesh fixation or suturing in the preperitoneal space typically involve the epigastric or aberrant obturator vessels crossing the Cooper’s ligament. However, complications can occur at every step of the operation, although only few are reported. Therefore, we report our experiences of intraoperative complications during single-incision laparoscopic totally extraperitoneal hernia repair and how to prevent and manage intraoperative complications.

Complete intraluminal migration of IPOM mesh causing sub-acute intestinal obstruction: a rare case report

Incisional hernia is a common complication following an abdominal surgery. They have ideally managed with open/ laparoscopic mesh repair. Mesh related complication are many due to increasing number of surgeries. This is a case of complete transluminal migration of a IPOM mesh and an eroding Onlay mesh presenting as a sub-acute intestinal obstruction after 2 years of incisional hernia surgery. Mesh migration is one of the complications of incisional hernia repair because of inadequate fixation or by ongoing inflammation (foreign body reaction). Complete trans luminal mesh migration is a rare complication with very few reports noted on bowel and urinary bladder. Transluminal migration into small bowel is a rare complication and it should be considered in differentials whenever patient comes with abdominal symptoms with past history of hernia repair.

Role of Laparoscopy in the management of incisional hernia. A comparative study from medical school.

Introduction: The conventional open repairof incisional hernia requires extensive dissection. The applicability and superiority of the laparoscopy have been evolving overthe last few years.The aim of our study was to compare the surgical outcomes of laparoscopic versus open mesh repair in the management of incisional hernia. Methods: This prospective comparative study was carried out in the SKIMS Medical College, Hospital, over a period of 5 years. The total of 62 subjects with non-complicated primary incisional hernias between 15-65 years of age were included. Polypropylene mesh in open surgery and Proceed prosthesis(ePTFE Mesh) in laparoscopy was used for repair. After hospital discharge, the patients were attached to the Out-Patient Department for follow-up. The data was collected and analyzed. Result: The maximum numbers of patients (41.9%) were in the age group of 36-45 years with amale to female ratio of 0.55.32 patients were operated by convention open mesh repair and 30 patients underwentintra-abdominal preperitoneal on-lay mesh repair.30.6% of female patients had history of a lower abdominal caesarean section followed by hysterectomy (17.7%). The majority of males had history of exploratory laparotomy secondary to trauma (17.7%) or peptic ulcer perforation (12.9%). The difference in mean operative time of laparoscopic technique (87±8.62 minutes)and open repair (96.56±9.31minutes) was statistically significant (p-value of 0.05).The difference between the mean duration of hospitalstay in the open repair (5.58±1.69 days) and thelaparoscopy (3.36±1.17 days) was statistically significant. None of our patients expired during the study period. Conclusion: Laparoscopic management of incisional hernia is a promising alternative to conventional repair with encouraging results.In our study, it was found that laparoscopic repair is safe and resulted in lesser operative time, fewer complications, shorter hospital stay and early return to activity.

Preperitoneal space, is it an ideal layer for endoscopic sublay repair of ventral hernia?

Preperitoneal space, is it an ideal layer for endoscopic sublay repair of ventral hernia?

O29 IDENTIFYING PREDICTORS OF VENTRAL HERNIA RECURRENCE: SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Aim Ventral hernias are increasing in prevalence and many recur despite attempted repair. To date, much of the literature is underpowered and divergent. As a result there is limited high quality evidence to inform surgeons succinctly which perioperative variables influence postoperative recurrence. This systematic review aimed to identify predictors of ventral hernia recurrence. Material and Methods PubMed was searched for studies reporting prognostic data of ventral hernia recurrence between 1 January 1995 and 1 January 2018. Extracted data described hernia type (primary/incisional), definitions of recurrence, methods used to detect recurrence, duration of follow-up, and co-morbidity. Data were extracted for all potential predictors, estimates and thresholds described. Random-effects meta-analysis was used. Bias was assessed with a modified PROBAST (Prediction model Risk Of Bias ASsessment Tool). Results Screening of 18 214 abstracts yielded 274 individual studies for inclusion. Hernia recurrence was defined in 66 studies (24.1 per cent), using 41 different unstandardized definitions. Three patient variables (female sex, age 65 years or less, and BMI greater than 25, 30, 35 or 40 kg/m2), five patient co-morbidities (smoking, diabetes, chronic obstructive pulmonary disease, ASA grade III–IV, steroid use), two hernia-related variables (incisional/primary, recurrent/primary), six intraoperative variables (biological mesh, bridged repair, open versus laparoscopic surgery, suture versus mesh repair, onlay/retrorectus, intraperitoneal/retrorectus), and six postoperative variables (any complication, surgical-site occurrence, wound infection, seroma, haematoma, wound dehiscence) were identified as significant prognostic factors for hernia recurrence. Conclusions This study summarized the current evidence base for predicting ventral hernia recurrence. Results should inform best practice and future research.

P139 LAPAROSCOPIC TRANSABDOMINAL PREPERITONEAL REPAIR FOR SMALL AND MEDIUM PRIMARY UMBILICAL AND MIDLINE HERNIAS

Abstract Aim Complications of open mesh repair for primary umbilical and midline hernias (PUMH) may lead to significant re-admissions and follow-up costs. Although laparoscopic intraperitoneal onlay mesh repair reduces infection rates, especially in overweight patients, it’s controversial in these hernias, mainly due to potential adhesions’ formation. Laparoscopic transabdominal preperitoneal technique (lap-TAPP) may address these issues, as it combines advantages of both open and laparoscopic approaches. The aim of this study is to present the initial results of lap-TAPP for PUMH in regard to its feasibility and complication rates. Material and Methods We evaluated 25 consecutive cases of lap-TAPP repair for PUMH. Patients’s characteristics, intraoperative findings, and postoperative complications after 30-days follow-up were analyzed. Results 21 male and 4 female patients were included in analysis (mean BMI 29.8 kg/m2). Surgery time was 82 minutes (55-120). We found 20 umbilical and 11 epigastric linea alba hernias. Mesh size was 144cm2 (120-225); mean hernia defect width was 25mm (10-40). In 9 patients (36%) the peritoneal rents were created which were easily closed with sutures. All patients were discharged on 1 POD with no complications. After 30-days we found no recurrences or bulging, no pain complaints. We found one subcutaneous small hematoma with no need for intervention. Conclusions Laparoscopic TAPP for small and medium PUMH is a safe and feasible technique with low complication rate. However, this method is technically demanding and time consuming while performed with laparoscopic approach as it requires precise and subtle plane dissection, and non-ergonomic closure hernia defect.