Laparoscopic Ventral Hernia Repair Research Articles

“AN EVALUATION OF LAPAROSCOPIC VENTRAL/INCISIONAL HERNIA REPAIR A PROSPECTIVE STUDY”

Introduction: Abdominal hernia occurs through the layers of the abdominal wall at a weak point. It can be congenital or acquired. Hernias are often painful and aesthetically displeasing to patients, whether symptomatic or asymptomatic. Abdominal hernia includes umbilical hernia, epigastral hernia, spiral hernia, lumbar hernia and incisional hernia. Laparoscopic ventral hernia repair (LVHR) is an established treatment for ventral hernias. Laparoscopic ventral hernia repair (LVHR) is an established treatment for ventral hernias. Randomized trials have shown that surgery is comparable to or better than open mesh surgery in terms of key surgical outcome parameters, recurrence rates, and infectious complications. This is a single-center, prospective,descriptive study in patients undergoing LVHR was conducted to characterize postoperative pain, recovery time, and quality of life in detail. The primary objective of the Aim & Objectives: present study is to investigate patients presenting with Primary Ventral/ Incisional Hernia undergoing Laparoscopic repair to determine- Short- term and Long-term outcomes regarding 1. Healthrelated quality of life aspects using SF(Short form)-36 Health Survey Pre-and postoperatively at 6 months. 2. Assess pain pre-op and post op at 6 months using VAS (visual analogue scale). Patients were examined thoroughly preope Materials And Methods : ratively at least a day before the proposed procedure.Using SF-36(Short form survey 36) and VAS (Visual analogue scale) After Laparoscopic repair Patients will be examined and followed-up at Day1, 7, 15, 1 month, 3 month and 6 month using SF-36 and VAS. LVHR had a signi Result: cant negative inuence on a broad spectrum of recovery parameters. The well-established benets of laparoscopy repair are less postoperative pain, reduced hospital stay and recovery time, low complication and recurrence rates based on numerous reports, meta-analysis and few randomized trials

Risk of Reoperation for Recurrence After Elective Primary Groin and Ventral Hernia Repair by Supervised Residents

Surgical training involves letting residents operate under supervision. Since hernia repair is a common procedure worldwide, it is a frequent part of the surgical curriculum. To assess the risk of reoperation for recurrence after elective primary groin and ventral hernia repair performed by supervised residents compared with that by specialists. This nationwide register-based cohort study included data from January 2016 to September 2021. Patients were followed up until reoperation, emigration, death, or the end of the study period. The study used data from the Danish Inguinal and Ventral Hernia Databases linked with data from the Danish Patient Safety Authority's Online Register via surgeons' unique authorization ID. The cohort included patients aged 18 years or older who underwent primary elective hernia repairs performed by supervised residents or specialists for inguinal, femoral, epigastric, or umbilical hernias. Hernia repairs were divided into the following 4 groups: Lichtenstein groin, laparoscopic transabdominal preperitoneal (TAPP) groin, open ventral, and laparoscopic ventral. Hernia repairs performed by supervised residents vs specialists. Reoperation for recurrence, analyzed separately for all 4 groups. A total of 868 specialists and residents who performed 31 683 primary groin and 7777 primary ventral hernia repairs were included in this study. The median age of patients who underwent hernia repair was 60 years (IQR, 48-70 years), and 33 424 patients (84.7%) were male. There was no significant difference in the adjusted risk of reoperation after Lichtenstein groin hernia repair (hazard ratio [HR], 1.26; 95% CI, 0.99-1.59), laparoscopic groin hernia repair (HR, 1.01; 95% CI, 0.73-1.40), open ventral hernia repair (HR, 0.89; 95% CI, 0.61-1.29), and laparoscopic ventral hernia repair (HR, 2.96; 95% CI, 0.99-8.84) performed by supervised residents compared with those by specialists. There was, however, a slightly increased unadjusted, cumulative reoperation rate after Lichtenstein repairs performed by supervised residents compared with those by specialists (4.8% vs 4.2%; P = .048). The findings of this study suggest that neither open nor laparoscopic repair of groin and ventral hernias performed by supervised residents appeared to be associated with a higher risk of reoperation for recurrence compared with the operations performed by specialists. This indicates that residents may safely perform elective hernia repair when supervised as part of their training curriculum.

Reoperation for Recurrence is Affected by Type of Mesh in Laparoscopic Ventral Hernia Repair: A Nationwide Cohort Study.

To compare the reoperation rate for recurrence between different mesh types in laparoscopic ventral hernia repair. Ventral hernia repair has improved over the last decades. Nevertheless, recurrence rates are still high, and one type of mesh was recently found to increase it even more. A nationwide cohort study based on prospectively collected data from the Danish Ventral Hernia Database. We included adult patients that had undergone a laparoscopic ventral hernia repair for either an incisional or a primary hernia. The primary and incisional hernias were analyzed in separate cohorts. The mesh-group with the lowest reoperation for recurrence curve was used as the reference. The outcome was reoperation for recurrence. Study population comprised 2874 patients with primary hernias and 2726 with incisional hernias. For primary hernias, Physiomesh [HR = 3.45 (2.16-5.51)] and Proceed Surgical Mesh [HR = 2.53 (1.35-4.75)] had a significantly higher risk of reoperation for recurrence than DynaMesh-IPOM. For incisional hernias, Physiomesh [HR = 3.90 (1.80-8.46), Ventralex Hernia Patch (HR = 2.99 (1.13-7.93), Parietex Composite (incl. Optimized) (HR = 2.55 (1.17-5.55), and Proceed Surgical Mesh (HR = 2.63 (1.11-6.20)] all had a significantly higher risk of reoperation for recurrence than Ventralight ST Mesh. For primary hernias, Physiomesh and Proceed Surgical Mesh had a significantly higher risk of reoperation for recurrence compared with DynaMesh-IPOM. For incisional hernias, the risk was significantly higher for Physiomesh, Parietex Composite, Ventralex Hernia Patch, and Proceed Surgical Mesh compared with Ventralight ST Mesh. This indicates that type of mesh may be associated with outcomes, and mesh choice could therefore depend on hernia type.

Patient-reported outcomes of laparoscopic versus robotic primary ventral and incisional hernia repair: a systematic review and meta-analysis.

Patient-Reported Outcome Measures (PROM's) are increasingly used to assess surgical outcomes in low-risk surgeries such as minimally invasive primary ventral and incisional hernia repair. The purpose of this meta-analysis was to systematically summarize the available evidence for the effect of laparoscopic versus robotic primary ventral and incisional hernia repair on PROM's. A systematic review and meta-analysis were performed in accordance with PRISMA guidelines. Randomised control trials, retrospective and prospective studies were included. Medline, Embase, SCOPUS, Web of Science, and Cochrane CENTRAL, and two trial registers were searched. Pooled effect sizes and 95% confidence intervals were calculated using the Mantel-Haenszel method. The overall quality of evidence was assessed using GRADE. Of the 2728 titles screened, eight studies involving 41,205 participants were included. Return to activities of daily living, return to work day and recurrence rate were statistically better in the robotic group. Length of stay, readmission, postoperative pain, quality of life, body image, and patient satisfaction were similar in both groups. The GRADE rating of the quality of evidence was moderate for postoperative pain and low to very low for the quality of life, length of stay, recurrence and readmission. The available data of PROM's of laparoscopic and robotic primary ventral and incisional hernia repair is scarce and highly heterogeneous, thus making it difficult to assess the superiority of the laparoscopic technique over the robotic technique. Further studies with uniform reporting of PROM's in laparoscopic and robotic primary ventral and incisional hernia repair are needed.

EFFECT OF BILATERAL ERECTOR SPINAE PLANE (ESP) BLOCK ON PAIN AFTER LAPAROSCOPIC VENTRAL HERNIA REPAIR: A CASE SERIES

Laparoscopic ventral hernia repair (LVHR) operations are followed by moderate postoperative pain, shorter recovery periods and less surgical complications such as seroma, hemorrhage, intestinal injury, mesh infection and recurrence. Pain after LVHR sometimes can be severe and last more than one week up to one month. Erector spinae plane (ESP) block is inter-fascial plane block and performed bilaterally can provide a good visceral and somatic analgesia for various abdominal surgeries. We describe five cases of laparoscopic ventral hernia repair who received bilateral ESP block prior to induction to general anesthesia and its effective analgesic effect was seen in the intra- and postoperative period. Our results showed that bilateral ESP block performed before the induction to general anesthesia provided a good analgesia and low opioid consumption in the intraoperative period, low pain scores in the first 48 hours and no need of rescue analgesia after laparoscopic ventral hernia repair surgery.

A prospective observational study of the impact of the quadratus lumborum block (QLl1B) on post operative pain after laparoscopic ventral hernia repair

A prospective observational study of the impact of the quadratus lumborum block (QLl1B) on post operative pain after laparoscopic ventral hernia repair

SJLA_2024_A19: Outcomes of Slow Absorbable Biosynthetic Mesh (Phasix™) in Ventral Hernia Repair in National Guard Health Affairs

Introduction: Mesh has become the preferred method due to its ability to integrate with the host’s tissue, reducing recurrence rates compared to primary suture repairs. While synthetic mesh reduces recurrence rates, it may lead to inflammation and infection. To evaluate its performance, this study aims to assess the short-term outcome following ventral hernia repair with biosynthetic mesh. Background: In Ventral Hernia Working Group Grade 3 hernias, which are often contaminated due to factors like prior wound infections, the presence of a stoma, or gastrointestinal tract violations, the heightened risk of infection poses significant challenges. In such cases, the success of mesh repair is jeopardized by potential contamination, complicating the surgical process; prompting consideration of resorbable or biological meshes despite higher costs. A recent advancement is biosynthetic mesh, notably poly-4-hydroxybutyrate, which offers strength comparable to polypropylene mesh and undergoes resorption. However, it retains only 70% strength after 12 weeks, potentially contributing to recurrence. Its efficacy in contaminated sites requires further exploration. Methods: We conducted a retrospective cohort study to thoroughly assess the potential complications following ventral hernia repair. This study will include all patients whose ages are >16 and underwent either open or laparoscopic ventral hernia repair with a biosynthetic mesh at King Abdulaziz Medical City, Saudi Arabia, Riyadh National Guard Health Affairs. The study period extends from January 2020 to December 2023. The study data were extracted from patients’ medical records through the BestCare system. Results: The mean age of our cohort was 58.65 with body mass index 39.6 when looking at comorbidities diabetes mellitus and HTN were the most common comorbidities with 32% affected with diabetes, and 39% affected with hypertension. The most common hernia type observed in our study was incision hernia accounting for 36% of all hernia types followed by inguinal hernia 24.6%. Complications were assessed at 4 time intervals of 1, 3, and 6 months and 1 year. The majority of the patients with complications presented at the 1st month with seroma accounting for 2.2% followed by surgical site infection (SSI) 1.8% and only three patients had 1-year postoperative recurrence. Discussion: The long-term effects of using a permanent synthetic mesh have not been fully understood. However, examining the outcomes associated with absorbable mesh can provide a useful framework for discussing potential risks with patients. Reported outcomes include rates of hernia recurrence and various surgical site occurrences requiring intervention, such as SSI, seroma, wound dehiscence, skin necrosis, hematoma, and fistula. It is important to note that this study is a retrospective cohort study with long-term follow-up, rather than a randomized controlled trial. In addition, other peer-reviewed studies have assessed alternative resorbable synthetic or biologic hernia repair materials, including TIGR® Matrix, Gore® Bio-A®, and Strattice™. Conclusion: In short, our results are comparable to the published reports. No statistically significant improvement in quality of life or reduction of pain was observed. Few patients report the lasting presence of mesh sensation. Results of the biosynthetic mesh after longer periods of follow-up on recurrences and remodeling will provide further valuable information to make clear recommendations.

Laparoscopic transversus abdominis plane block is useful in pain relief after laparoscopic stapled repair of diastasis recti and ventral hernia.

There is still no consensus on perioperative pain control techniques in patients undergoing laparoscopic surgery; protocols of conventional therapy can be improved by the use of perioperative anaesthesiologic techniques, such as epidural or loco-regional analgesic administration as transversus abdominis plane (TAP) block. The aim of this evaluation was to investigate the role of laparoscopic-assisted TAP block during repair of diastasis recti associated with primary midline hernias in term of post-operative pain relief. This was a retrospective evaluation of a prospectively maintained database including patients undergoing laparoscopic repair of diastasis recti associated with primary ventral hernia. Patients were divided into two groups: Group A patients (n = 34) received laparoscopic-assisted bilateral TAP-block of 7.5 mg/ml ropivacaine for each side and Group B patients (n = 29) received conventional post-operative therapy. All patients received 24 h infusion of 20 mg morphine; pain was checked at 6, 24 and 48 h after surgery by numeric rating scale (NRS) score. A rescue analgesia by was given if NRS score was >4 or on patient request. No differences in operative time, complications and post-operative stay, no complications related to TAP-block technique were found. Post-operative pain scores (determined by NRS) were found to be significantly different between groups. Group A patients showed a significant reduction in NRS score at 6, 24 and 48 h (P < 0.005) and in the number of patients requiring further analgesic drugs administration (P < 0.005) compared to Group B patients. Laparoscopic-guided TAP-block can be considered safe and effective in the management of post-operative pain and in the reduction of analgesic need in patients undergoing laparoscopic repair of diastasis recti and ventral hernias. The non-randomised nature of the study and the lack of a consistent series of patients require further evaluations.

SJLA_2024_A14: Five-year Outcome of Laparoscopic Ventral Hernia Repair with Phasix ST

Background: Repair of ventral and incisional hernias repair (VIHR) is a standard procedure; newly introduced resorbable mesh biomaterials provide an attractive option to reduce the use of permanent synthetic mesh in hernia surgery and reduce its complications. Indeed the data of Phasix resorption started to occur postmaturation of the wound tissue. However, data on the use of slowly resorbable mesh materials remain scarce, and this study aims to evaluate the use of Phasix ST in the laparoscopic repair of VIHR. Methods: This is a retrospective study of a sequential cohort of patients undergoing laparoscopic VIHR utilizing a Phasix ST mesh. Perioperative characteristics and clinical outcomes were collected. Results: In total, 26 patients, including 19 females and 7 males, underwent laparoscopic VIHR using Phasix ST from April 2016 to January 2023. All surgeries were performed in a single institution by the same surgeon. The average patient age was 52.6 years, and the mean body mass index was 35.5. All patients had a clean wound classification. The average defect size was 136.4 cm2. All patients were seen in the clinic with a median follow-up of 48 months. We observed four wound seromas, no wound infections, and three recurrences during the 5-year follow-up period. All occurred in the center of the mesh with severe adhesions to the mesh and tacker. Conclusion: Five years of follow-ups showed 11% recurrence in the same site note, which needs to be reviewed. Further, 10 years of follow-up results need to be assessed.

Outcome between Laparoscopic and Open Ventral Hernia Repair: a Quasi-experimental Study

Background: The debate on the best surgical approach to ventral hernia repair continues. We compared the outcomes of laparoscopic with open ventral hernia repair in terms of post-operative pain, recovery and patients’ satisfaction on cosmesis. Methods: This quasi-experimental study allocated 70 participants scheduled for ventral hernia repair into laparoscopic and open repair (allocation 1:1) from July 2020 to July 2021. The primary outcome included VAS for pain at 24, 48 and 72 hours after surgery. The secondary outcomes included duration of surgery and hospital stay, time to return to normal activity, patients’ satisfaction on cosmesis and recurrence rate. Results: The age, gender distribution, and size of hernia defect were comparable between the groups (p &gt; 0.05). Post-operative VAS scores (median, IQR) were similar at 24 hours (7, 6 - 8 vs.7, 6 - 7, p &gt; 0.99) and 48 hours (4, 3 - 5 vs. 4, 3 - 4, p &gt; 0.99) and lesser in laparoscopic group at 72 hours (1, 1 - 2 vs. 2, 2 - 2, p &lt; 0.001) after surgery. The duration of surgery (mean ± SD) was longer (105.14 ± 34.88 vs. 87.49 ± 29.13 minutes, p = 0.02) while duration of hospital stay was shorter (4.80 ± 3.08 vs. 6.66 ± 2.94 days, p = 0.01) and return to normal activity was earlier (6.89 ± 2.93 vs. 15.40 ± 5.65 days, p &lt; 0.001) in laparoscopic group. Conclusion: Laparoscopic ventral hernia repair was associated with lesser post-operative pain at 72 hours, early post-operative recovery as well as better patients’ satisfaction on cosmesis as compared to open procedure.

A comparative study of laparoscopic versus open ventral hernia repair

Background: The use of laparoscope in the treatment of abdominal wall hernia repair was first reported in 1993 by LeBlanc and William. But with the passage of time and gaining of expertise, LVHR is now being perform more often but it is still not the gold standard of management. Today the proven advantage laparoscopic ventral hernia repair, open ventral hernia repair is less intraoperative blood loss, shorter hospital stays and early return to normal activity. We tried to compare laparoscopic ventral hernia repair versus open ventral hernia repair in primary ventral hernia. Aims and Objectives: The aim of this study was to compare laparoscopic ventral hernia repair (LVHR) and open ventral hernia repair with respect to the operating time, intraoperative blood loss, intraoperative enterotomy, post-operative complications, hospital stay, and return to normal activity. Retrospective cum prospective study. Materials and Methods: This retrospective cum prospective study was conducted in a tertiary care center teaching hospital, M.L.B. Medical College, Jhansi between January 2020 and June 2021. All consented patients after matching for age, sex, and type of ventral hernia, were allocated to either two groups: Groups A open ventral hernia repair (OVHR) 25 case versus Group B (Laparoscopic ventral hernia) repair 25 case. Results: In our study intraoperative blood loss, post-operative complication, hospital stay, return to normal activity was less in LVHR as compared to OVHR. Operating time was found to be non-significant between two groups and occurrence of inadvertent enterotomy although more in LVHR, was still insignificantly different. Conclusion: The findings of present study demonstrate that LVHR was safe and better when compared with OVHR.

Outcome of Laparoscopic Repair in Ventral Hernia

Aim: To determine the outcome of laparoscopic repair in ventral hernia. Study design: Prospective observational study. Place and duration of study: General Surgery Department of Tertiary Care Hospital, Liaquat University of Medical &amp; Health Sciences (LUMHS), Jamshoro Sindh from 1st March 2017 to 30th June 2020. Methodology: Eighty six patients with ventral wall hernia were enrolled. Hernia was approached laterally and ports were placed from farther side of abdomen. In all cases three trocars were used one for 10mm and 2 ports for 5 mm. polypropylene mesh was used for hernia repair. Mesh was placed using intracorporeal mesh fixation technique. Results: The mean age of patients was 46±8.3 years. Fifty two (60.4%) were females and 34 (39.5%) were males. The ratio of females with ventral wall hernia is higher than males requiring surgery. The mean BMI of study participants was 30.8±4.3 kg/m2. Bowel perforation is characterized to be the most severe complications of laparoscopy and it affected 3.4% of the participants. The most common complication post-operatively was severe pain in 26.7% of patients, controlled by I/V pain killers for two to three days followed by seroma formation Conclusion: Laparoscopic ventral hernia repair is an excellent technique as compared to conventional techniques and has fewer complications but it requires surgical expertise and specific instruments. Although it is an ideal procedure for simple ventral wall hernias, it is not used for complex hernia. Key words: Laparoscopic repair, Ventral hernia, Mesh repair

Hernia Sac Preservation for Prevention of Transversus Abdominis Release in Laparoscopic Extended-Totally Extra Peritoneal Repair of Ventral Hernia: A Minimalistic Solution for a Formidable Challenge.

Background: Ventral hernia repair has always been an extensive and challenging surgery. The laparoscopic extended-Totally Extraperitoneal (E-TEP) technique of ventral hernia repair is gaining popularity due to the advantage of placing a large mesh in the retro rectus plane. When done through a Laparoscopic approach, the difficulty of the procedure is compounded by multiple factors such as obtaining retro muscular access, maintaining the retro muscular plane, crossing over to the contralateral retro muscular plane without entering intraperitoneally, suturing in a limited space, and manipulation of a large mesh in a constricted space for placement. In cases of large midline incisional hernias, dense adhesions to the previous surgical scar are often present. Despite having extremely satisfying outcomes, the aforementioned factors make the laparoscopic extended-total extraperitoneal repair of large midline ventral and incisional hernias an exceptionally challenging procedure. A tension-free midline approximation is the benchmark of ventral/incisional hernia surgery. In certain cases, this can be difficult to achieve due to multiple factors. For the purpose of attaining tension-free midline closure, component separation techniques (CST) have been explored and implemented. Of these, the posterior component separation technique of Transversus Abdominis Release (TAR) has gained popularity for reducing the tension of posterior rectus sheath during posterior midline closure in retro muscular repairs by adding a few centimetres of medial advancement. The main pitfall of TAR is its technical complexity, which may result in morbid complications when implemented incorrectly. Performing TAR laparoscopically compounds the complexity manyfold. Hence, to obviate the necessity to perform Laparoscopic TAR in cases of Laparoscopic E-TEP repair of large midline ventral and incisional hernias, we present that the technique of hernial sac preservation should be pre-emptively carried for all Laparoscopic ETEP repairs so that the necessity of performing TAR in select cases is reduced by aiding in the addition of final crucial centimetres of lengthening to the posterior rectus sheath for achieving posterior midline closure. This aids in the success of the procedure by preventing an additional complex procedure of TAR from being performed in an already challenging hernia repair technique of Laparoscopic E-TEP repair. Methods: We hereby report three cases of Ventral hernia repair in which Laparoscopic E-TEP repair was carried out and Hernial sac preservation technique was implemented successfully. Midline closure of the posterior rectus sheath was attained under reduced tension and a medium-weight macroporous polypropylene mesh was placed in the retro-rectus plane after measurement of the potential space. Patients were discharged uneventfully. Results: Patients were followed up for up to 6months postoperatively and were found to have no complications. Conclusion: In Laparoscopic E-TEP repair of midline ventral hernias, preservation of the hernial sac along with the posterior rectus sheath might aid in the prevention of performing a TAR in selected cases where posterior layer tension is present. Hernia sac preservation thereby aids in reducing operative time and preventing potential morbid complications.

Role of laparoscopy in the management of ventral hernia repair

Objectives: The aim of our study is to compare the usefulness of laparoscopic ventral hernia repair with conventional open ventral hernia repair. Methodology: The comparative type of study was conducted on 60 patients with incisional hernia of which 30 patients were included in the Laparoscopy group while the other 30 were included in the open surgery group. Results: The peak incidence of hernia in our study was in the 31-50 years of age group. The mean operation time of Laparoscopic ventral hernia was 142.1 minutes with an SD of ± 24.69 as compared to open repair which was 100.7 minutes. Postoperative complications were less in the laparoscopic repair group in comparison with the open repair group. In the open group, the majority of patients were discharged on 5-7 days as compared to the laparoscopic group in which the majority of patients were discharged on days 3-5. Conclusion: Laparoscopic ventral hernia repair is a novel technique, various benefits found in the current study include lesser postoperative pain, lesser postoperative hospital stay, decreased incidence of postoperative complications, and obviously better cosmesis.

Ring closure outcome for laparoscopic ventral hernia repair (IPOM plus) in medium and large defects. Long-term follow-up.

Despite advances in laparoscopic ventral hernia repair (LVHR) with the Intra-peritoneal onlay mesh technique (IPOM), recurrence continues to be a frequent postoperative complication. The aim of this study is to analyze the long-term recurrence rate in two series, by incorporating in IPOM technique the laparoscopic closure of the defect (IPOM plus). We also want to determine the ring size cut-off point from which the recurrence risk increases in IPOM technique and determine if the cut-off point is modified with IPOM plus technique. A comparative retrospective study was conducted analyzing patients who underwent LVHR. They were divided into 2 groups according to the surgical technique used: IPOM or IPOM plus. We determined in each group the cut-off point where the ring size presents a greater recurrence risk by calculating the better point of sensitivity/specificity relationship of the ROC curve. Between 2007 and 2018, 286 patients underwent LVHR. The ROC curve for IPOM technique has shown a cut-off point of higher recurrence risk for rings larger than 63 cm2. While the ROC curve in IPOM plus group showed an increase in the cut-off point, with a higher recurrence risk in rings > 168cm2. Overall median ring size was 30 cm2 (range 4-225; IQR 16-61). However, when comparing the ring size between techniques we found a relatively larger size in IPOM plus (p: 0.013). The recurrence rate in the IPOM group was 19.51% while in the IPOM plus group was 3.57% (p: 0.005). For standard LVHR with IPOM technique, the greatest recurrence risk occurs in rings larger than 63cm2. The addition of ring closure (IPOM plus) was associated with a recurrence risk reduction, which occurs in rings larger than 168cm2. These findings would allow expanding the indication for LVHR, using the IPOM plus technique.

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.

OC-066 LIRA TECHNIQUE, A NEW PROCEDURE. WHERE ARE WE NOW?. OUR RESULTS IN A MEDIUM FOLLOW-UP

Abstract Background LIRA technique (Laparoscopic Intracorporeal Rectus Aponeuroplasty) was described in 2018 in order to reduce the tension in the midline as an alternative to defect closure (CD) in Laparoscopic Ventral Hernia Repair. We present our results in LIRA series in patients with a medium follow up Methods A prospective controlled study from January 2015 to December 2020 to evaluate (LIRA) performed on patients with midline w2 hernias (EHS Classification). Data analyzed included patient demographics, operative parameters and complications. Tomography was performed preoperatively and postoperatively (1 month and 1 year) to evaluate recurrence, distance between rectus and seroma. Clinical examination were performed yearly. Results 49 patients. Mean Age was 58± 10.59 years old and BMI 33.11± 6.61 kg/m2. Mean width of the defect was 6.19± 1.49 cm. Average VAS (24 h) was 5.09 ± 5, 0.38(1 month) and 0 (1 year). Mean preoperative distance between rectus was 5.55± 1.61 cm; postoperative was 2.15 ± 0.79 cm (1 month) and 2.20±0.68 cm (1 year). Radiological seroma at first month was detected in 40%. Seroma after 1 year was 4,08% Mean follow-up was 24 months. Bulging detected only in 1 case (2.04%) after 1 year follow up. No recurrence is data. Conclusion LIRA technique could be considered as an alternative to CD for w2 defects with a low rate of complication, and could be related to a low rate of postoperative pain with no recurrence and a low rate of bulging compared to CD, being a safe, feasible and reproducible technique.

P-065 PROSPECTIVE STUDY OF QUALITY OF LIFE OUTCOMES OF TOTALLY TRANSFASCIAL SUTURE FIXATION OF MESH WITH CLOSURE OF DEFECT IN LAPAROSCOPIC VENTRAL HERNIA REPAIR

Abstract Aim To study the Quality of life Outcome in totally transfacial suture fixation of mesh with primary closure of defect in laparoscopic ventral hernia repair with regards to: Materials &amp; Methods Patients who visited the OPD of General Surgery, KGMU, Lucknow, UP and was diagnosed as a case of symptomatic ventral and incisional hernia fulfilling the inclusion and exclusion criteria were enrolled. Results A total of 40 patients from OPD department of General Surgery were enrolled. Maximum numbers of patients in the study i.e. 14(35%) belong to M4. Mean BMI is 28.6. Mean defect size was 3.25 cm (Range- 2cm to 5 cm). Mean duration of hospital stay was 2.85 days. With this procedure the patients were able to resume his/her daily routines very early and a mean of 4.65 days was recorded among the 40 patients involved in the study. Also a mean of 11.6 days was recorded as the time taken to return to office works which was all within two weeks after the operation. Carolina's comfort scale measure quality of life score in pre-op and post-op period on sensation of mesh,pain sensation and limitation of movement . where the scores were added and the mean sensation of mesh at post-operative period was 0.30. Conclusion There was significant improvement in dimensions of body pain, physical function, vitality, emotional role, mental health and sensation of mesh in small and medium size hernia, with totally transfascial suture fixation of mesh.

P-094 LAPAROSCOPIC VS OPEN VENTRAL HERNIA REPAIR: AN OBSERVATIONAL SINGLE CENTRE STUDY

Abstract Background Various surgical techniques are practised to provide best possible outcome for ventral hernia patients. This study was conducted to understand the patient's perspective regarding the choice and outcome of treatment. Aim To determine the level of satisfaction 1 month after ventral hernia repair. To analysed various factors which affects the patient's decision regarding the choice of surgery. To compare post operative outcomes between laparoscopic and open ventral hernia repair. Material &amp; Methods An observational study was conducted between January 2020 and December 2021. Total 70 patients with ventral hernia were included. Relevant data was collected and analysed using SPSS version 28. Results 39 patients underwent open repair and 31 patients underwent laparoscopic repair. 40% patients thought that their choice is better than the other option. 18.5% patients who preferred laparoscopic surgery were scared of big incision and 5% patients opted for open surgery because of unaffordability of mesh. 11.4% patient's decision was affected by the advice from other doctors whom they may have consulted before, 2.8% patients took advise from friends and family. Almost 20% patients left the decision on the treating team. The incidence of complications was significantly less in laparoscopic repair. However, there was no significant difference in the postoperative pain, duration of hospital stay, return to activity and satisfaction at discharge. level of satisfaction at 1 month was significantly higher in the laparoscopic group compared to open group. Conclusion laparoscopic ventral hernia repairs should be preferred in view of fewer complications and higher satisfaction.

Analysis of 'enhanced-view totally extra-peritoneal' (eTEP) approach for ventral hernia: Early results.

Laparoscopic ventral hernia repair is undergoing a paradigm shift with the introduction of numerous new techniques to improve the outcomes. Enhanced-view totally extra-peritoneal (eTEP) is a novel approach for the repair of ventral herniae introduced by Belyansky et al. The key innovation lies in placing the mesh in a large retrorectus-pre-peritoneal space contrary to the widely practiced intra-peritoneal placement. This approach can be easily coupled with a component separation in the form of transversus abdominis release (TAR) for large herniae. We conducted a midterm analysis of 'eTEP' approach to ventral hernia at a high-volume tertiary care centre and present our results of over 3 years of employing this technique. A retrospective study of 150 cases of ventral hernia repaired using eTEP approach from January 2018 to February 2021 at a tertiary care centre by a team of three surgeons. The procedures were performed by a single team of three members headed by the first author. Out of total 150 cases, incisional hernia occurred in 73 cases (48.7%), primary hernia occurred in 48 cases (32%) and recurrent hernia in 29 cases (19.3%). Although the majority of incisional (87.7%) and recurrent (79.3%) ventral hernias occurred in female, the incidence of primary ventral hernia was equal at 24 cases in both genders. The majority of the cases (80.7%) underwent eTEP RS procedure, and the rest were W3 hernias, which were managed by including a component separation in the form of eTEP TAR. The operating time for eTEP TAR (222.24 min ± 32.56) compared to eTEP RS (124.33 ± 23.68) was significantly longer. The mean length of stay was significantly shorter for primary hernias (3.75 days ± 1.62) compared to recurrent (5.21 days ± 2.51) and incisional hernias (4.36 days ± 2.19) (F = 4.376) (P = 0.014). The peri-operative period was uneventful in majority of the cases. We experienced a seroma rate of 5.8% in our series. At follow-up of 1 year, 3.3% of patients complained of discomfort/bulge in the upper abdomen. There were no other surgical site occurrences (SSO) in the form infection, posterior rectus sheath disruption and skin necrosis. We observed no recurrences till date with a minimum follow-up of 1 year. eTEP approach to ventral hernia is a promising abdominal wall reconstruction technique. It is safe and offers good functional outcomes with restoration of abdominal wall dynamics. It is a reproducible and safe technique for tackling various types of ventral hernia. It is specifically useful in managing unusual lateral hernias, incisional and recurrent hernias with ease.