Laparoscopic Ventral Hernia Repair Research Articles

Laparoscopic versus open ventral hernia repair: A comparative study

Background: A ventral hernia is when an abdominal viscus or a portion of it protrudes through the anterior abdominal wall anywhere other than the groin. The aim is to compare the effectiveness of ventral hernia repair by laparoscopic vs. open repair in patients admitted from the Department of Surgery. Materials and Methods: This is a hospital-based comparative study on patients with ventral hernias compared to a study of the efficacy of laparoscopic vs open ventral hernia repair on patients admitted in various surgical units in SKIMS medical college.Results: Laparoscopic procedure in ventral hernia has shown promising results and is being widely accepted. Laparoscopic repair of hernia though requires increased operative time in the beginning but with experience over time and improved skills the time duration was significantly reduced, it results in shorter hospital stay, ICU stay, and lower short-term complications (Pain) when compared to open repair.Conclusion: The majority of studies conducted across the world have demonstrated that laparoscopic ventral hernia repair offers promising outcomes and a distinct benefit in terms of less post-operative discomfort, shorter hospital stays, quicker return to normal activities, and higher rates of cosmetic success. Laparoscopic ventral hernia repair is therefore a safe and practical substitute for open treatment. The study's cost may be its primary disadvantage, but since our hospital is a government facility, this is not a major issue. However, because it shortens hospital stays, an earlier return to normal life may be possible at the same cost as open surgery. The study's limitation is the little time frame used to evaluate recurrence rates.

Auto-diuresis Predicts Return of Bowel Function.

Feeding a ventral hernia repair (VHR) patient before the return of bowel function (ROBF) can lead to distention and emesis. Many patients spontaneously diurese after surgery. We hypothesized that this auto-diuresis would signal ROBF. A total of 395 patients who underwent open, laparoscopic, or mixed VHR were evaluated for correlation between fluid status and ROBF or discharge. ROBF within 24 hours and discharge within 24 hours or 48 hours were used as outcome measures. Patients remained an average 3.59 days after surgery in the hospital and the average ROBF was on day 2.99. The first shift of ≥700mL of urine predicted ROBF ( P =0.03) and discharge ( P =0.04) within 24 hours. The first shift output of ≥500mL predicted discharge within 48 hours ( P =0.02). Auto-diuresis after surgery is correlated to ROBF and discharge. Accurate fluid measurement can predict bowel function and allow early diet and discharge.

Initial results of an indigenous absorbable tacker for mesh fixation in laparoscopic ventral hernia repair: a retrospective analysis of 158 cases.

The aim of this study was to evaluate the safety and effectiveness of a Chinese absorbable tack for mesh fixation in laparoscopic abdominal wall hernia repair compared to a widely used similar imported product. From May 2019 to December 2020, the clinical data of 158 patients with abdominal wall hernias were analyzed. They were divided into two groups: 76 patients underwent surgery with local absorbable tacks for mesh fixation (experimental group) and 82 patients received a similar imported product (control group). Preoperative and postoperative variables, effectiveness of postoperative immediate fixation, and with ease of handling of instruments were analyzed statistically. Complications and adverse events were followed and analyzed statistically. Meanwhile, medical costs were recorded and evaluated. There were no statistically significant differences between the two groups in terms of demographic data, hernia types, hernia defects, or number of tacks used for mesh fixation during operation. The effect of postoperative immediate fixation and with ease of handling of instruments in both groups were not significantly different. During the follow-up period, no recurrence or adverse events occurred in either group. No significant differences were noted between the two groups for other complications, such as chronic pain, foreign body sensation, infection of the abdominal wall, hematoma and seroma. There was a significant difference in medical costs between the two groups: the costs associated with the experimental group using local tacks were lower. Chinese absorbable tacks for mesh fixation in laparoscopic abdominal wall hernia repair are effective, safe, and economical. They are worthy of clinical application.

ETEP inferior access with tailored retromuscular dissection for small to mid-sized umbilical hernia repair with or without inguinal hernia: early experience.

The minimally invasive surgical repair of combined inguinal and ventral hernias often requires shifting from one approach or plane to another. The traditional enhanced-view totally extraperitoneal Rives-Stoppa repair consists of a large retro muscular dissection that is unjustified for small ventral hernias. Here we describe a modification to the minimally invasive Rives-Stoppa repair using a limited retro muscular dissection based on the ventral defect size for small/medium-sized hernias, with or without combined inguinal hernias. From a single surgical team, a retrospective study was performed over a 1-year period. Demographics, hernia characteristics, surgical techniques, intraoperative/postoperative complications, and outcomes were all analyzed and reported. We also included detailed surgical steps, landmarks, pitfalls, and personal tips for this technique. Twenty-four patients underwent a laparoscopic limited retromuscular dissection ventral hernia repair utilizing the eTEP access technique. Eighteen were primary umbilical hernias and six postoperative incisional hernias, and nine were combined ventral and inguinal hernia repairs. Eight of the primary umbilical hernias were EHS classified as medium size, 11 small, and for the incisional hernias, three were classified as M3W1 and two as M3W2. One procedure was converted to TAPP. There were no intraoperative complications. The mean length of stay was 1.25days (range 1-3). There was one postoperative retromuscular hematoma and no recurrence during the follow-up period. eTEP with limited dissection offers a good and safe solution for small to medium size hernias; it provides an efficient solution when an inguinal hernia is to be addressed as well.

Comparison of outcomes of laparoscopic hernioplasty with and without fascial repair (IPOM-Plus vs IPOM) for ventral hernia: A retrospective cohort study

BackgroundIntra-peritoneal onlay mesh (IPOM) repair, a type of Laparoscopic Ventral Hernia Repair (LVHR), comprises bridging the defect from the peritoneal side with a composite mesh. Recently, IPOM-Plus has become the recommended type of LVHR in which the defect in the fascia is sutured before placing the mesh. Materials and methodsThis study is a retrospective cohort study conducted at Shree Birendra Hospital (SBH), Nepal. Patients who had undergone IPOM-Plus or IPOM during the past five years (Aug 2016 to Aug 2021) were selected. Data regarding demographics, intraoperative and post-operative outcomes were collected from individual case sheets. Recurrence of hernia was checked at six-month follow-up. Data analysis was performed using SPSS version 25 taking a p-value of <0.05 as statistically significant. ResultsA total of 130 patients were included in this study, out of which 73 patients had undergone IPOM (Group I) and 57 patients underwent IPOM-Plus (Group II). In both the groups, there were no statistical difference in age, sex and Body Mass Index (BMI) of the patients. Hernia defect size among Group I and II varied significantly (p-value < 0.001). The mean operative time for Group II (111.05 ± 28.14 min) was significantly higher than Group I (80.00 ± 27.96 min) (p-value < 0.001). Hernia recurrence within six months was higher in Group I (15.1%) than Group II (3.5%) (p-value = 0.029). The adjusted odds ratio (AOR) for six-month recurrence after IPOM repair was 14.86 (95% CI: 2.51–87.85, p-value = 0.003) times higher than that after IPOM-Plus repair. ConclusionsAlthough the operative time and length of hospital stay is longer, IPOM-Plus repair has shown better outcomes regarding six-month recurrence compared to IPOM repair.

Laparoscopic Versus Open Ventral Hernia Repair: Experience at a Tertiary Care Center in Western Rajasthan.

BackgroundVentral hernias are the second most common type of hernias accounting for 21-35% of all hernia types. Ventral hernia includes incisional, umbilical, epigastric, and Spigelian hernias, among others. Currently, patients and surgeons prefer laparoscopic repair of ventral hernias. This study aimed to compare laparoscopic with open hernia repair in terms of various operative and patient parameters.MethodologyThis was a prospective observational study conducted in the Department of General Surgery, Dr. Sampurnanand Medical College, Jodhpur. All patients admitted with a diagnosis of ventral hernia for mesh repair (open as well as laparoscopic) were included. Laparoscopic and open hernia repair were compared in terms of operative time, postoperative hospital stay, time to resume routine activity, postoperative complications, and recurrence.ResultsAmong the 50 patients included in the study (25 patients each in the laparoscopic and open groups), the mean operative time was 57.52 ± 5.80 minutes in the laparoscopic group and 59.8 ± 11.15 minutes in the open group. The mean hospital stay in the laparoscopy and open groups was 7.4 ± 1.58 days and 9.88 ± 2.96 days, respectively (p-value = 0.0006; significant). Postoperative pain (using the visual analog scale score) was less in patients who underwent laparoscopic surgery (p-value = 0.001; significant). Seroma and surgical site infections were the most common complications which were observed more in the open hernia repair group. Recurrence was seen in one case operated by the open technique.ConclusionsLaparoscopic ventral hernia repair is technically safer, effective, and feasible with better clinical outcomes in patients seeking treatment in a government hospital.

Learning Curve of Robotic Enhanced-View Extraperitoneal Approach for Ventral Hernia Repairs.

Introduction: The enhanced-view extraperitoneal (eTEP) technique was first described for minimally invasive inguinal hernia repairs and later for laparoscopic ventral hernia repair. The objective of this study was to report our early experience and learning curve (LC) with the robotic-assisted eTEP (R-eTEP) approach. Materials and Methods: We performed a retrospective analysis of patients undergoing R-eTEP repair for ventral hernias from December 2018 to September 2021. A single surgeon operative time (OT)-based LC was evaluated. Results: A total of 81 patients underwent an R-eTEP from December 2018 to September 2021. Sixty-five patients were ultimately included in our analysis. Fifty-seven patients underwent eTEP-Rives-Stoppa (RS) and 8 patients underwent eTEP-transversus abdominis release (TAR). The median age in the whole cohort was 57 years (interquartile range [IQR] 51.5-64.5 years) with no difference between the groups. The median body mass index (BMI) was 31 kg/m2 (IQR 27-34.7 kg/m2) in the eTEP-RS group and 29.7 kg/m2 (IQR 28.5-31 kg/m2) in the eTEP-TAR group. There were 36 incisional hernias (63%) in the eTEP-RS group and 8 (100%) in the eTEP-TAR group. There were 14 recurrent hernias (25%) in the eTEP-RS group and 2 (25%) in the eTEP-TAR group. The LC was evaluated only in the eTEP-RS cases. We divided the cohort into 3 chronological groups (G1, G2, and G3), including 19 cases each. The median OT in each group was 177 (IQR 147-200), 153 (IQR 127-187), and 125 minutes (IQR 106-152 minutes), respectively. There was no difference in the median OT between G1 and G2 (P = .390). G3 had a shorter median OT than G2 (P = .02) and G1 (P = .001). There was no difference between these groups in median age, BMI, defect area, defect width, and mesh area. Conclusions: The R-eTEP approach has been shown to be safe and feasible for ventral and incisional hernia repairs. A statistically significant decrease in OT was observed after 38 cases.

Primary closure of the midline abdominal wall defect during laparoscopic ventral hernia repair: analysis of risk factors for failure and outcomes at 5 years follow-up.

The primary aim of this prospective study is to report bulging and recurrence rates and to analyze the risk factors responsible for failure, after laparoscopic ventral hernia repair (LVHR) with primary closure of defect (PCD) using a running suture and intraperitoneal mesh placement, at 5-year follow-up. The secondary endpoint is to evaluate 30-day postoperative complications, seroma, and pain. PCD failure was defined as the presence of postoperative bulging and/or recurrence. Pain was evaluated using a visual analogue scale (VAS). After surgery, fifty-eight patients underwent clinical examination and computed tomography scan to diagnose bulging, recurrence, and seroma (classified according to the Morales-Conde classification). At 60months follow-up, recurrence was observed in five patients (8.6%), while bulging, not needing a surgical treatment, occurred in fifteen patients (25.9%). Chronic obstructive pulmonary disease (COPD) is the only risk factor responsible for both outcomes together, bulging and recurrences (p = 0.029), while other considered risk factors as gender, age, body mass index, diabetes, smoke habits, primary or incisional hernia and the ratio defect width/transverse abdominal axis did not achieve the statistically significance. Clinical seroma was diagnosed at one month in eight patients (13.8%). Seromas were observed at one year of follow-up. During the follow-up, pain reduction occurred. LVHR has evolved toward more anatomical concepts, with the current trend being the abdominal wall anatomical reconstruction to improve its functionality, reducing seroma rates. Based on results obtained, PCD is a reliable technique with excellent recurrence rate at 5years follow-up, even when the defect closure may generate tension at the midline. On the other hand, this tension could be related with high bulging rate at long-term, particular in case of patients with COPD.

Assessment of Quality of Life After Ventral Hernia Repair: A Prospective Observational Study at a Tertiary Care Centre.

BackgroundVentral hernias are usually repaired by an open or laparoscopic approach. Quality of life after ventral hernia repair is a very important but often underestimated parameter. This prospective observational study was conducted to assess the quality of life and other related parameters after all types of ventral hernia repair, mainly between open and laparoscopic repairs. ObjectivesThis study aimed to determine the quality of life after ventral hernia repairs. We also analysed and compared various parameters such as outcomes and satisfaction, postoperative pain, and complications between laparoscopic and open ventral hernia repair. MethodsThis was a hospital-based prospective observational study conducted from January 2020 to December 2021, which included a total of 70 patients with ventral hernias. Thirty-nine patients underwent open repair and 31 patients underwent laparoscopic repair. Demographic data and other data such as postoperative hospital stay, return to activity, postoperative pain, complications, and quality of life were collected and analysed.ResultsThe distribution of different types of hernias observed in our study included 34% incisional hernias, 33% umbilical and paraumbilical hernias, and 33% epigastric hernias. The incidence of complications was significantly less in laparoscopic repair compared to open repair. Also, satisfaction at 1 month was significantly more in the laparoscopic group compared to the open group. However, there is no significant difference in the postoperative pain, postoperative hospital stay, return to activity, satisfaction at discharge, and quality of life at 1 month in both the laparoscopic and open repairs. ConclusionLaparoscopic ventral hernia repairs are associated with lesser complications and higher satisfaction. The use of tackers and trans-fascial sutures can significantly increase postoperative pain in laparoscopic repair and is the major factor affecting the short-term quality of life in laparoscopic repairs. As there is no difference in postoperative pain, hospital stay, and return to activity, laparoscopic repairs should be preferred wherever possible in view of fewer complications and higher satisfaction.

A Novel Modification of Subcutaneous Onlay Endoscopic Repair of Midline Ventral Hernias With Diastasis Recti: An Indian Experience.

IntroductionA ventral hernia is a common problem in the population. Many patients with umbilical/epigastric hernia often present with diastasis recti (DR) too. Diastasis recti is the thinning of the linea alba with an abnormal increase in the distance between the recti without a concomitant fascial defect. The presence of diastasis recti complicates the repair of the existing umbilical/epigastric hernia. Repair of only the umbilical/epigastric hernia in the presence of DR results in incomplete repair and predisposes to recurrence. There are various options available for the repair of umbilical hernia with diastasis recti. Open hernia repairs often have unsatisfactory cosmetic outcomes and, furthermore, involve complications frequently associated with large incisions such as surgical site occurrences (SSO), pain, dermal flap necrosis, and delayed postoperative recovery, to name a few. The era of minimal access surgery leaves us with a vast array of creative solutions to the same. Laparoscopic onlay repair has been given various names in literature, e.g., minimally invasive linea alba reconstruction (MILAR), pre-aponeurotic endoscopic repair (REPA), endoscopic linea alba reconstruction (ELAR), subcutaneous onlay laparoscopic approach (SCOLA), and totally endoscopic assisted linea alba reconstruction (TESLAR), with similar principles for all the procedures. The average rate of seroma formation in these procedures varies from 5% to 40%. SCOLA has been used in our study, with an added modification of the operating port and limiting the extent of lateral dissection with the aid of spinal needles, resulting in restrained dissection and creation of smaller lipocutaneous flaps, leading to reduced incidence of seroma formation.MethodsPatients with symptomatic primary ventral hernia with concomitant diastasis recti were enrolled in the participating center from the period of May 2020 to December 2021. Thirty patients were enrolled for this prospective study. The patients underwent subcutaneous laparoscopic onlay repair of midline ventral hernia with diastasis recti, with plication of the defect and onlay placement of a polypropylene mesh.ResultsSix point sixty-six percent (6.66%) of the patients developed seroma and SSO. The incidence is congruent with the results available in current literature. None of the patients had necrosis of umbilical skin. There were no recurrences at the three months follow-up.ConclusionOur modification of SCOLA is an ergonomically favorable procedure and has comparable outcomes to other approaches, with minimal complications.

STUDY OF LAPAROSCOPIC VENTRAL HERNIA REPAIR IN A SINGLE INSTITUTIONAL SETUP

Objective: Incidence of Ventral hernias or anterior abdominal wall hernias is about 2-13% worldwide. Laparoscopic ventral hernia repair (LVHR) technique has proven to be effective treatment option with reduced complications. This study aims to assess the feasibility and outcome of LVHR in a government set up. A prospective observational study of patients of a single government institution was conducted. Surgical technique,Methods: Long- term outcomes such as pain, mesh infections, bowel adhesions, recurrence and feasibility were assessed. Mean age of studyResults: patients was 44.45 years, with highest incidence (33.33%) in the age group of (31-40) years. Male: Female ratio was 1: 2.529. Obesity accounted for predominant risk factor (15 %). Around (31.67 %) patients had other co morbidities like diabetes, hypertension, obesity, COPD and pulmonary tuberculosis. Incision hernia accounted for (50 %). Remaining (50 %) include the epigastria hernia, umbilical hernia, traumatic hernia and spigelian hernia. 44(73.34%) patients had defect size between (2-5) cm, 11(18.33%) patients between (5-10) cm and 5(8.33%) patients less than 2 cm. Mean defect size was 3.51 cm. 54 patients (90 %) having defect size more than 2 cm were operated by laparoscopic Intra peritoneal on lay mesh repair. 6 (10%) patients having defect size less than 2 cm operated by Laparoscopic fascial closure by intracorporeal suturing. Mean surgical time was 55.17 minutes. (Range 40 - 110 minutes). Mean postoperative hospital stay was 2.25 days. 65% of patients got discharged after 2 days. Total 8 (13.33%) patients developed complications which were managed conservatively. 1 (1.67%) patient developed recurrence. There were no mortality and minimum morbidity observed. Although we cannot conclude regarding cost factor, we can vouch that all patients with anyConclusion: primary ventral hernia should have the repair performed by the laparoscopically if technically feasible. Laparoscopic ventral hernia repair is feasible, effective and can be performed as short stay surgery even in government set up.

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.

Robotic versus hybrid assisted ventral hernia repair: a prospective one-year comparative study of clinical outcomes

Background Laparoscopic ventral hernia repair (LVHR) may be associated with chronic pain, seroma formation, bulging and failure to restore abdominal wall function. These outcomes are risk factors for hernia recurrence and poor quality of life (QoL). Our study evaluates whether robotic-assisted ventral hernia repair (rVHR) diminishes these complications compared to LVHR with primary closure of the defect (hybrid). Methods Thirty-eight consecutive patients undergoing incisional ventral hernia operation with fascial defect size from 3 to 6 cm were recruited between November 2019 and October 2020. Nineteen patients underwent rVHR and nineteen underwent hybrid operation. The main outcome measure was postoperative pain, evaluated with a visual analogue scale (VAS: 0–10) at 1-month and at 1-year. Hernia recurrence was evaluated with ultrasound examination and QoL using the generic SF-36 short form questionnaire. Results At the 1-month control visit, VAS scores were significantly lower in the rVHR group; 2.5 in the hybrid group and 0.3 in the rVHR group (p < 0.001). At the 1-year control, the difference in VAS scores was still significant, 2.8 vs 0.1 (p = 0.023). There was one hernia recurrence in the hybrid group (p = 0.331). QoL did not differ significantly between the study groups when compared to preoperative physical status at 1-year follow-up (p = 0.121). However, emotional status (p = 0.049) and social functioning (p = 0.039) improved significantly in the rVHR group. Conclusions Robotic-assisted ventral hernia repair (rVHR) was less painful compared to hybrid repair at 1-month and at 1-year follow-up. In addition, improvement in social functioning status was reported with rVHR. Trial Registration ID 5200658.

A COMPARATIVE STUDY BETWEEN LAPAROSCOPIC VERSES OPEN REPAIR OF VENTRAL HERNIA.

Introduction: With the advancement in technology as well as surgical techniques, laparoscopic ventral hernia repair (LVHR) is more commonly being performed as compared to open repair in various centers throughout the World. Our study aimed to compare the short-term operative outcomes between LVHR and open repair. Materials and methods: Sixty patients diagnosed with non-complicated ventral hernias were included in this prospective study and were randomly divided into the laparoscopic group and the open group. The two groups were compared to evaluate operative time, postoperative pain, length of hospital stay and time taken to return to normal activity. Ap-value of less than 0.05 was considered to be statistically signicant. Results:Mean operative time was longer in LVHR (116 min) as compared to open repair (67 min)(p&lt;0.01). Patients experienced more pain on the rst and seventh postoperative days in the open group (p&lt;0.01) and they also had a longer duration of hospital stay as compared to the laparoscopic group (6.23 ± 0.35 vs 2.17 ± 1.12 days,p = 0.02). Patients in the laparoscopic group returned to normal activity faster as compared to the open group (1.47 ± 0.11 vs 2.87 ± 0.34, p&lt;0.01). Conclusion: LVHR carries a signicant advantage over open hernia repair, especially in terms of reduced postoperative pain, duration of hospital stay, and early resumption of normal activity.

Laproscopic versus open ventral hernia repair

Background: Ventral hernia is second most common type of abdominal hernia after inguinal hernia. Treatment includes anatomical repair, meshplasty: onlay, sublay, preperitoneal etc. Evaluation of laparoscopic hernia repair has led to new benchmark for ventral hernia repair. This study aims to compare laparoscopic ventral hernia repair versus open repair. Methods: Total 30 patients were enrolled in this study who presented to Dhiraj hospital pipariya. Detailed history was taken and patient were randomly divided in to 2 groups. Results: There were 22 females and 8 male patients in this study. Mean age was 42.4 years. Mean operative time in laparoscopic surgery was 80.25± 2.43 minutes versus 60±3.44 minutes. Mean hospital stay in laparoscopic was 3.5 days versus 5.5 days in open hernia repair. Conclusion: Laparoscopic meshplasty is better than open repair in terms of early recovery, less pain, minimal scar, early return to work.

Management of Synthetic Mesh Infection With Open Resection and Laparoscopic Ventral Hernia Repair Using Biosynthetic Prosthetic Material.

Ventral hernia repair (VHR) is a common surgical operation with the prevailing complication of hernia recurrence. The development of diverse mesh materials has led to a lower hernia recurrence rate but poses concern for mesh infection. Featured is the case study of a patient who underwent laparoscopic recurrent VHR with utilization of biosynthetic mesh and removal of prior permanent synthetic mesh. During the post-operative course, the patient developed a seroma, cellulitis, and wound dehiscence. Despite these complications, the biosynthetic mesh was salvaged using conservative measures. The patient has been followed over the course of three years without hernia recurrence or other complications to date.

Laparoscopic intraperitoneal onlay mesh repair for ventral hernia: our experience

Background: Ventral hernia is one of the most common pathologic conditions encountered with an estimated prevalence of one-fourth of individuals being born with it, developing, or acquiring a ventral hernia in their lifetime. Ventral hernias include both primary abdominal wall hernia and incisional hernia. Numerous studies indicate that the laparoscopic approach is safe and effective, and may be superior to open repair with regard to lower rates of recurrence and wound infection, greater patient acceptance, shorter hospital stay and early return to work. Aim of the study was to analyse the outcome, complications, postoperative pain and patient compliance in laparoscopic ventral hernia repair by intraperitoneal onlay mesh (IPOM) technique, using composite mesh.Methods: This was a prospective study conducted in the department of general surgery, MVJ medical college, Bangalore from December 2020 to August 2021. There were 100 cases operated by experienced surgeons. All patients posted electively for laparoscopic repair of ventral hernia on an intention to treat basis were included in the study. The immediate complications of pain, perioperative bleeding and major visceral injury were noted in all cases. We then followed up each patient prospectively in the postoperative period at 1 month, 3 months and 6 months to assess the incidence of port-site hernia and recurrence.Results: Of the 100 patients, 63 had an umbilical hernia, 33 had incisional hernias and 4 had an epigastric hernia. The mean age of the patients was 44.7 years. Female to male ratio of 2.25:1. The average defect width was 1.3 cm for umbilical hernias and 2.4 cm for incisional hernias. The mean operating time was 38 min for umbilical hernias and 61 min for incisional hernias. The mean postoperative hospital stay was 4.7 days. The mean duration of return to normal daily activity was 6.4 days. The average duration for which postoperative pain lasted was 4.6 days. No conversion to open laparotomy was required in any of the cases. The only short complication reported was postoperative pain. No case of postoperative ileus/seroma/port site infection/mesh displacement/infection or port site hernia and recurrence was reported over one year of follow up.Conclusions: IPOM technique is safe, feasible and effective technique for treatment of ventral abdominal wall hernias.

Outcomes of Laparoscopic Ventral Hernia Repair in Obese patients

Background: Obesity is a risk factor for primary ventral hernia. Surgery is deferred in obese patients because of overweight but most of patients present in emergency with obstructed /strangulated hernia in which outcome is poor. Aim: To compare the primary outcomes (seroma ,surgical site infection and recurrence) and secondary outcomes (duration of surgery and postoperative pain) in obese and non obese patients after laparoscopic primary ventral hernia repair. Study design: Prospective comparative study Setting &amp; duration: B V Hospital /Quaid-e-Azam Medical College Bahawalpur, 01-01-2019 to 31-08-2021 Method: This study was done on 70 patients above the age of 25 years undergoing laparoscopic IPOM (intraperitoneal onlay mesh ) after closure of fascial defect for primary ventral hernia. Patients with history of obstructed /strangulated hernia were excluded. Patients were divided into 2 groups( Patients with BMI &lt;30 kg/m2 - Group A and patients with BMI ≥ 30 kg/m2- Group B). Data was calculated regarding patient’s age ,sex, BMI, comorbidities, type of hernia, hernia size, primary outcome (postoperative complications-seroma ,surgical site infection and recurrence) and secondary outcome (duration of surgery and pain). Statistical analysis using SPSS version 22 was done and it was considered significant when p value was &lt;0.05. Results: 29 (41.43%) had BMI &lt; 30 kg/m2 and 41 (58.57%) had BMI ≥ 30 kg/m2 .The most common comorbidity was diabetes mellitus (17.1%) in both groups. 38 patients presented wiyh paraumblical hernia and 32 patients with epigastric hernia. A significant correlation between size of defect and post operative complications. (p value 0.042) was found. A significant correlation between comorbidities and complications was also found (p value 0.001). Complications being more common in group B patients but were not statistically significant (p value 0.979). Duration of surgery being higher in group B patients but was not statistically significant.(p value 0.194). There was no significant difference in postoperative pain in both groups. Conclusion: Obesity has no significant effect on postoperative complications ( seroma, surgical site infection and recurrence), duration of surgery and postoperative pain after laparoscopic IPOM repair. Comorbidities are significantly associated with postoperative complications rather than increased BMI. So surgery should not be delayed in obese patients. Key words: Primary Ventral Hernia, Obesity, BMI (Body Mass Index), IPOM (Intraperitoneal Onlay Mesh)

Robotic vs Laparoscopic Ventral Hernia Repair with Intraperitoneal Mesh: 1-Year Exploratory Outcomes of the PROVE-IT Randomized Clinical Trial.

Laparoscopic and robotic ventral hernia repair with intraperitoneal mesh have been demonstrated previously to have comparable 30-day outcomes in the PROVE-IT randomized clinical trial. Here we report our 1-year follow-up of enrolled patients to examine exploratory outcomes. All patients enrolled in a previously published, registry-based, randomized trial investigating laparoscopic vs robotic ventral hernia repair with intraperitoneal mesh were reviewed. Several exploratory secondary outcomes were assessed: pain intensity (Patient-Reported Outcomes Measurement Information System [PROMIS 3a]), hernia-specific quality of life (Hernia-Specific Quality of Life Survey [HerQLes]), composite hernia recurrence, and reoperations. A total of 95% (71 of 75) follow-up was achieved: 33 laparoscopic repairs and 38 robotic repairs. Median follow-up time was 12 months [interquartile range 10 to 12 months]. Following regression analysis adjusting for baseline scores, there was no difference in postoperative pain intensity at 1 year (p = 0.94). However, HerQLes scores increased by 12.0 more points following robotic repairs compared to laparoscopic counterparts (95% CI 1.3 to 22.7, p = 0.03). Composite hernia recurrence was 6% (2 of 33) for the laparoscopic cohort and 24% (9 of 38) for the robotic group (p = 0.04). There was no difference in rates of reoperation (p = 0.61). Our exploratory analyses have identified potential differences in quality of life and recurrence, favoring the robotic and laparoscopic approaches, respectively. These findings warrant further study with larger patient cohorts to verify their potential significance.

Predictive factors of recurrence for laparoscopic repair of primary and incisional ventral hernias with single mesh from a multicenter study

Laparoscopic ventral hernia repair (LVHR) is a widely practiced treatment for primary (PH) and incisional (IH) hernias, with acceptable outcomes. Prevention of recurrence is crucial and still highly debated. Purpose of this study was to evaluate predictive factors of recurrence following LVHR with intraperitoneal onlay mesh with a single type of mesh for both PH and IH. A retrospective, multicentre study of data collected from patients who underwent LVHR for PH and IH with an intraperitoneal monofilament polypropylene mesh from January 2014 to December 2018 at 8 referral centers was conducted, and statistical analysis for risk factors of recurrence and post-operative outcomes was performed. A total of 1018 patients were collected, with 665 cases of IH (65.3%) and 353 of PH (34.7%). IH patients were older (p < 0.001), less frequently obese (p = 0.031), at higher ASA class (p < 0.001) and presented more frequently with large, swiss cheese type and border site defects (p < 0.001), compared to PH patients. Operative time and hospital stay were longer for IH (p < 0.001), but intraoperative and early post-operative complications and reinterventions were comparable. IH group presented at major risk of recurrence than PH (6.7% vs 0.9%, p < 0.001) and application of absorbable tacks resulted a significative predictive factor for recurrence increasing the risk by 2.94 (95% CI 1.18–7.31). LVHR with a light-weight polypropylene mesh has low intra- and post-operative complications and is appropriate for both IH and PH. Non absorbable tacks and mixed fixation system seem to be preferable to absorbable tacks alone.