Laparoscopic Ventral Hernia Repair Research Articles

Ventral hernia repair in India: a Delphi consensus

Abstract Purpose While research on inguinal hernias is well-documented, ventral/incisional hernias still require investigation. In India, opinions on laparoscopic ventral hernia repair (LVHR) techniques are contested. The current consensus aims to standardize LVHR practice and identify gaps and unfulfilled demands that compromise patient safety and therapeutic outcomes. Methods Using the modified Delphi technique, panel of 14 experts (general surgeons) came to a consensus. Two rounds of consensus were conducted online. An advisory board meeting was held for the third round, wherein survey results were discussed and the final statements were decided with supporting clinical evidence. Results Experts recommended intraperitoneal onlay mesh (IPOM) plus/trans-abdominal retromuscular/extended totally extraperitoneal/mini- or less-open sublay operation/transabdominal preperitoneal/trans-abdominal partial extra-peritoneal/subcutaneous onlay laparoscopic approach/laparoscopic intracorporeal rectus aponeuroplasty as valid minimal access surgery (MAS) options for ventral hernia (VH). Intraperitoneal repair technique is the preferred MAS procedure for primary umbilical hernia < 4 cm without diastasis; incisional hernia in the presence of a vertical single midline incision; symptomatic hernia, BMI > 40 kg/m2, and defect up to 4 cm; and for MAS VH surgery with grade 3/4 American Society of Anaesthesiologists. IPOM plus is the preferred MAS procedure for midline incisional hernia of width < 4 cm in patients with a previous laparotomy. Extraperitoneal repair technique is the preferred MAS procedure for L3 hernia < 4 cm; midline hernias < 4 cm with diastasis; and M5 hernia. Conclusion The consensus statements will help standardize LVHR practices, improve decision-making, and provide guidance on MAS in VHR in the Indian scenario.

The Utilization of Laparoscopic Ventral Hernia Repair (LVHR) in Incarcerated and Strangulated Cases: A National Trend in Outcomes.

Early after its adoption, minimally invasive surgery had limited usefulness in emergent cases. However, with improvements in equipment, techniques, and skills, laparoscopy in complex and emergency operations expanded substantially. This study aimed to examine the trend of laparoscopy in incarcerated or strangulated ventral hernia repair (VHR) over time. The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for laparoscopic repair of incarcerated and strangulated hernias (LIS-VHR) and compared over 2 time periods, 2014-2016 and 2017-2019. The utilization of laparoscopy in all incarcerated or strangulated VHR increased over time (2014-2016: 39.9% (n = 14 075) vs 2017-2019: 46.3% (n = 18 369), P < .001). Though likely not clinically significant, demographics and comorbidities statistically differed between groups (female: 51.7% vs 50.0%, P = .003; age 54.5 ± 13.7 vs 55.4 ± 13.8years, P < .001; BMI 34.9 ± 8.0 vs 34.6 ± 7.8kg/m2, P < .001). Patients from 2017 to 2019 were less comorbid (18.9% vs 16.8% smokers, P < .001; 18.2% vs 17.3% diabetic, P = .036; 4.6% vs 4.1% COPD, P = .021) but had higher ASA classification (III: 43.3% vs 45.7%; IV: 2.5% vs 2.7%, P < .001). Hernia types (primary, incisional, recurrent) were similar in each group. Operative time (89.7 ± 59.3 vs 97.4 ± 63.4min, P < .001) became longer but length-of-stay (1.4 ± 3.3 vs 1.1 ± 2.6days, P < .001) decreased. There was no statistical difference in surgical complications, medical complications, reoperation, or readmission rates between periods. Laparoscopic VHR has become a routine method for treating incarcerated and strangulated hernias, and its utilization continues to increase over time. Clinical outcomes have remained the same while hospital stays have decreased.

Comparison between intraperitoneal onlay mesh repair with closure of fascial defect (IPOM plus) and intraperitoneal onlay mesh repair (IPOM) for ventral hernias

Aim. To evaluate the intraperitoneal onlay mesh repair with closure of fascial defect (IPOM plus) versus intraperitoneal onlay mesh (IPOM) for ventral hernias (VHs). Materials and methods. A total of 89 patients with VHs with a defect between 3–12 cm who underwent a surgery from 2018 to 2023 years were enrolled in this study. All of them were randomly assigned to two groups. Group 1 included 45 patients after intraperitoneal onlay mesh repair with closure of fascial defect (IPOM plus), Group 2 – 44 patients after intraperitoneal onlay mesh (IPOM). The distribution of patients by age, sex, body mass index (BMI), hernia type (primary VH, incisional hernia), American Society of Anesthesiologists (ASA) score was studied. Results. The differences in sex, mean age, patient distribution based on hernia type, BMI, ASA score and hernia orifice size were not statistically significant between the two groups. Therefore, both groups were comparable. The operative time in minutes was 73.17 ± 7.43 in Group 1 and 70.93 ± 8.84 in Group 2 (not statistically significant). The pain score 12 hours after surgery was 5.24 ± 0.60 in Group 1 comparing to 5.02 ± 0.45 in Group 2 (not statistically significant). The pain score 8 days after surgery was 2.88 ± 0.31 in Group 1 comparing to 2.75 ± 0.43 in Group 2 (not statistically significant). There was no significant difference concerning the incidence of early complications between the two groups. 41 (91.11 %) patients of Group 1 and 40 (90.9 %) patients of Group 2 were examined during a 22-month follow-up period. No complications were noted. Conclusions. Laparoscopic ventral hernia repair provides satisfactory results in terms of safety and efficacy. Thus, IPOM plus repair is safe, feasible and offers possible advantages over the standard IPOM technique as reported in the literature. Poor outcomes described in the literature are probably related to independent variables such as mesh and suture types as well as closure technique.

Weight reduction among females undergoing laparoscopic ventral hernia repair:  The role of Calcium and Vitamin D3

Objective: To evaluate the role of Vitamin-D and calcium supplementation on preoperative weight reduction in obese women before laparoscopic ventral hernia repair.&#x0D; Methods: This double-blind clinical trial was conducted at the affiliated health centers of King Faisal University, Al-Ahsa, Saudi Arabia from January 2021 to December 2021. It included forty-five obese women aged 24-56 years, with body mass index (BMI) of 34.0–48.0 kg/m2. They were randomly allocated into two groups; the Group-A (N=22) included obese women who received supplementation of 5000 IU cholecalciferol (Vitamin-D3), and 1000 mg calcium daily for 12 months, while the Group-B (N=23) received no treatment. Measurement of change in weight and BMI and comparison of their pre-operative weight reduction, laparoscopic operative time, and length of hospital stay was done.&#x0D; Results: There were no differences in patients’ biographic data between the two groups. During the study, Vitamin-D level in the patients increased and there was a significant positive association with weight loss. In group-A, the mean weight loss was 11.8±3.5 kg. At the end of first year, their BMI decreased from 36.1±1.6kg/m2 at baseline to 29.7±2.6 kg/m2, whereas in-group-B, the mean weight loss was 6.8±3.1 kg and their BMI decreased from 36.9±2.69kg/m2 at baseline to 32.7±0.93kg/m2. The operation time and the length of hospital stay were shorter in group-A (107 vs.128.min) and (3 vs. 5 days) respectively as compared to Group-B.&#x0D; Conclusion: Vitamin-D and calcium supplementation contributes to a remarkable weight reduction of preoperative obese female patients, which in turn is associated with significantly better outcome of laparoscopic repair of ventral hernia.&#x0D; doi: https://doi.org/10.12669/pjms.40.5.9047&#x0D; How to cite this: AlMulhim SA, AlNaim MM, Khan AS, Memon AQ, AlArfaj HM, Al Abdulqader AA, et al. Weight reduction among females undergoing laparoscopic ventral hernia repair:  The role of Calcium and Vitamin D3. Pak J Med Sci. 2024;40(5):---------.  doi: https://doi.org/10.12669/pjms.40.5.9047&#x0D; This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

A randomized controlled trial on the effectiveness of laparoscopic-guided transversus abdominis plane block in patients undergoing laparoscopic IPOM plus.

Ventral hernia repairs, particularly laparoscopic ventral hernia repair (LVHR), have become common procedures among general surgeons worldwide. Despite the benefits of LVHR, acute postoperative pain remains a significant concern. Transversus abdominis plane (TAP) blocks have been employed to alleviate postoperative pain in various laparoscopic procedures. This study aimed to assess the effectiveness of laparoscopic-guided TAP block in laparoscopic IPOM plus and its impact on postoperative pain and analgesic requirements. A randomized controlled trial was conducted at a tertiary care center in India involving 72 patients undergoing laparoscopic IPOM plus. Patients were randomized into two groups: Group I received laparoscopic-guided TAP block, while Group II received standard general anesthesia without TAP block. Pain scores were assessed at 6, 12, and 24h postoperatively using the numerical rating scale. Postoperative analgesic requirements were also recorded. Group I demonstrated significantly lower pain scores at 6 and 24h postoperatively compared to Group II. The need for additional analgesics was significantly lower in Group I (13.8%) compared to Group II (72.2%). There were no significant differences in age, BMI, duration of surgery, or other demographic characteristics between the two groups. The findings of this randomized controlled trial demonstrate the effectiveness of laparoscopic-guided TAP blocks in reducing postoperative pain and analgesic requirements after laparoscopic IPOM plus.

Laparoscopic intraperitoneal onlay mesh (IPOM) with fascial repair (IPOM-plus) for ventral and incisional hernia: a systematic review and meta-analysis.

Despite advancements in laparoscopic ventral hernia repair (LVHR) using the intraperitoneal onlay mesh technique (sIPOM), recurrence remains a common postoperative complication. The objective of this systematic review and meta-analysis is to compare the efficacy of defect closure (IPOM-plus) versus non-closure in ventral and incisional hernia repair. The aim is to determine which technique yields better outcomes in terms of reducing recurrence and complication rates. A comprehensive literature review was conducted in the PubMed, Web of Science, Cochrane Library, Embase, and ClinicalTrials.gov databases from their inception until October 1, 2022, to identify all online English publications that compared the outcomes of laparoscopic ventral hernia repair with and without fascia closure. Three randomized controlled trials (RCTs) and eleven cohort studies involving 1585 patients met the inclusion criteria. The IPOM-plus technique was found to reduce the recurrence of hernias (OR = 0.51, 95% CI [0.35, 0.76], p < 0.01), seroma (OR = 0.48, 95% CI [0.32, 0.71], p < 0.01), and mesh bulging (OR = 0.08, 95% CI [0.01, 0.42], p < 0.01). Subgroup analysis revealed that body mass index (BMI) (OR = 0.43, 95% CI [0.29, 0.65], p < 0.0001), type of article (OR = 0.51, 95% CI [0.35, 0.76], p = 0.0008 < 0.01), geographical location (OR = 0.54, 95% CI [0.36, 0.82], p = 0.004 < 0.01), follow-up time (OR = 0.50, 95% CI [0.34, 0.73], p = 0.0004 < 0.01) had a significant influence on the postoperative recurrence of the IPOM-plus technique. The IPOM-plus technique has been shown to greatly reduce the occurrence of recurrence, seroma, and mesh bulging. Overall, the IPOM-plus technique is considered a safe and effective procedure. However, additional randomized controlled studies with extended follow-up periods are necessary to further evaluate the IPOM-plus technique.

Comparison between the open and the laparoscopic approach in the primary ventral hernia repair: a systematic review and meta-analysis

BackgroundVentral hernia repair underwent various developments in the previous decade. Laparoscopic primary ventral hernia repair may be an alternative to open repair since it prevents large abdominal incisions. However, whether laparoscopy improves clinical outcomes has not been systematically assessed.ObjectivesThe aim is to compare the clinical outcomes of the laparoscopic versus open approach of primary ventral hernias.MethodsA systematic search of MEDLINE (PubMed), Scopus, Web of Science, and Cochrane Central Register of Controlled Trials was conducted in February 2023. All randomized controlled trials comparing laparoscopy with the open approach in patients with a primary ventral hernia were included. A fixed-effects meta-analysis of risk ratios was performed for hernia recurrence, local infection, wound dehiscence, and local seroma. Meta-analysis for weighted mean differences was performed for postoperative pain, duration of surgery, length of hospital stay, and time until return to work.ResultsNine studies were included in the systematic review and meta-analysis. The overall hernia recurrence was twice less likely to occur in laparoscopy (RR = 0.49; 95%CI = 0.32–0.74; p < 0.001; I2 = 29%). Local infection (RR = 0.30; 95%CI = 0.19–0.49; p < 0.001; I2 = 0%), wound dehiscence (RR = 0.08; 95%CI = 0.02–0.32; p < 0.001; I2 = 0%), and local seroma (RR = 0.34; 95%CI = 0.19–0.59; p < 0.001; I2 = 14%) were also significantly less likely in patients undergoing laparoscopy. Severe heterogeneity was obtained when pooling data on postoperative pain, duration of surgery, length of hospital stay, and time until return to work.ConclusionThe results of available studies are controversial and have a high risk of bias, small sample sizes, and no well-defined protocols. However, the laparoscopic approach seems associated with a lower frequency of hernia recurrence, local infection, wound dehiscence, and local seroma.

Comparison of quality of life in laparoscopic and open primary ventral hernia repair according to European registry for abdominal wall hernias quality of life score

Background Ventral hernia can be defined as noninguinal and nonhiatal hernia in the fascia of the abdominal wall. Laparoscopic repair become a popular method with decreased overall complications nowadays. We aimed to provide an efficient management for ventral hernia through comparison of quality of life (QoL) postlaparoscopic and open techniques according to European registry for abdominal wall hernias quality of life (EuraHS-QOL) score. Patients and methods The data of 54 patients with primary ventral hernia were collected prospectively. Of these patients, 27 underwent open repair, and 27 underwent laparoscopic repair after excluding patients with a complicated and recurrent ventral hernia and incisional hernia. Perioperative QoL was assessed according to the EuraHS score. Results Two groups were designed, each including 27 patients. The most common complication was seroma (25.9%) in open repair, followed by infection (18.5%), while only one case in laparoscopic repair had port site infection; the difference was statistically significant (P&lt;0.05). The mean operative time in open repair was 51.2±5.1 and 89.7±9.5 in laparoscopic repair; the difference was highly significant (P&lt;0.001). The mean length of stay in the hospital was 23.1±7.3, and it was 19.1±6 in laparoscopic repair; the difference was significant (P&lt;0.05). All cases in open repair had subcutaneous drain; but not in laparoscopic repair; the difference was highly significant (P&lt;0.001). The EuraHS score in all its items was significant in favor of laparoscopic repair. Conclusion Laparoscopic repair was associated with high QoL, less complications, and recovery time as compared with open repair of ventral hernia.

Assessment of Mesh Fixation by Dual Use of Trans-Fascial Sutures and Tacks in The Outcome of Laparoscopic Ventral Hernia Repair “Case-Series”

Assessment of Mesh Fixation by Dual Use of Trans-Fascial Sutures and Tacks in The Outcome of Laparoscopic Ventral Hernia Repair “Case-Series”

Laparoscopic intraperitoneal onlay mesh with fascial repair (IPOM plus) for ventral and incisional hernia

Abdominal wall surgery for ventral hernia is one of the commonest procedures performed by the surgeons. The aim of the study is to evaluate short- and long-term outcomes in patients who underwent laparoscopic IPOM plus approach. Materials and methods. This study describes 70 patients who underwent laparoscopic intraperitoneal onlay mesh repair plus (IPOM plus) for ventral and incisional hernia. These were then followed up for a period of a minimum of 12 months and a maximum of 5 years. Results. Of the 70 patients, 8 (11.43 %) linea alba hernias, 28 (40.00 %) umbilical hernias, 34 (48.57 %) had incisional hernias. The distribution based on ASA score: I – 23 (32.86 %) patients, II – 39 (55.71 %), III – 8 (11.43 %). The mean age was 50.21 ± 0.89 years (M ± m). Male to female ratio was 1.19:1.00. Average defect size was 4.77 ± 0.21 cm (M ± m). Mean operating time was 58.27 ± 0.52 minutes (M ± m). Mean post-op hospital stay was 1.84 ± 0.06 days (M ± m). Intensity of pain by VAS pain score was 5.11 ± 0.92, 4.47 ± 0.31, 2.90 ± 0.72, 0.92 ± 0.81 (M ± m) after 6 hours, 24 hours, 1 week, 6 weeks respectively. No conversion to open laparotomy was required. Reported complications were port-site seroma 3 (4.29 %), port-site hematoma 1 (1.43 %) over one year of follow-up. 62 (88.57 %) patients were evaluated over 21 months follow-up period, no complications have been reported. Conclusions. Obtained results showed that the IPOM plus repair is safe and may be used for routine laparoscopic ventral and incisional hernia repair, the closure of fascial defect appears to give chance for good fixation of the mesh and decrease postoperative morbidity.

Systematic review of robotic ventral hernia repair with meta-analysis.

Despite being one of the most common operations performed by general surgeons, there is a lack of consensus regarding the recommended approach for ventral hernia repair (VHR). Recent times have seen the rapid development of new techniques, such as robotic ventral hernia repair (RVHR). This systematic review and meta-analysis aims to evaluate the currently available evidence relating to RVHR, in comparison to open VHR (OVHR) and laparoscopic VHR (LVHR). A systematic search of the following databases was conducted: PubMed, Embase, Scopus and Web of Science. A meta-analysis was performed for the outcomes of length of stay (LOS), recurrence, operative time, intraoperative complications, wound complications, 30-day readmission, 30-day reoperation, mortality and costs. A total of 39 studies met inclusion criteria. Overall, RVHR reduced LOS, intra-operative complications, wound complications and readmission compared to OVHR. Compared to LVHR, RVHR was associated with increased operative time and costs, with comparable clinical outcomes. There is currently a lack of robust evidence to support the robotic approach in VHR. It does not demonstrate major benefits in comparison to LVHR, which is more affordable and accessible. Strong quality, long-term data is required to help with establishing a gold standard approach in VHR.

Body Mass Index Effect on Minimally Invasive Ventral Hernia Repair: A Systematic Review and Meta-analysis.

Obesity is one of the most important risk factors for complications after ventral hernia repair (VHR), and minimally invasive (MIS) techniques are preferred in obese patients as they minimize wound complications. It is common practice to attempt weight loss to achieve a specific body mass index (BMI) goal; however, patients are often unable to reach it and fail to become surgical candidates. Therefore, we aim to perform a meta-analysis of studies comparing outcomes of obese and nonobese patients undergoing laparoscopic or robotic VHR. A literature search of PubMed, Scopus, and Cochrane Library databases was performed to identify studies comparing obese and nonobese patients undergoing MIS VHR. Postoperative outcomes were assessed by means of pooled analysis and meta-analysis. Statistical analysis was performed using RevMan 5.4. Heterogeneity was assessed with I2 statistics. A total of 6483 studies were screened and 26 were thoroughly reviewed. Eleven studies and 3199 patients were included in the meta-analysis. BMI >40 kg/m 2 cutoff analysis included 5 studies and 1533 patients; no differences in hernia recurrence [odds ratios (OR): 1.64; 95% CI: 0.57-4.68; P = 0.36; I2 = 47%), seroma, hematoma, and surgical site infection (SSI) rates were noted. BMI >35 kg/m 2 cutoff analysis included 5 studies and 1403 patients; no differences in hernia recurrence (OR: 1.24; 95% CI: 0.71-2.16; P = 0.58; I2 = 0%), seroma, hematoma, and SSI rates were noted. BMI >30 kg/m 2 cutoff analysis included 4 studies and 385 patients; no differences in hernia recurrence (OR: 2.07; 95% CI: 0.5-8.54; P = 0.32; I2 = 0%), seroma, hematoma, and SSI rates were noted. Patients with high BMI undergoing MIS VHR have similar hernia recurrence, seroma, hematoma, and SSI rates compared with patients with lower BMI. Further prospective studies with long-term follow-up and patient-reported outcomes are required to establish optimal management in obese patients undergoing VHR.

Laparoscopic IPOMPLUS repair-current outcomes and complications

Purpose: The study aims to assess the current outcomes and complications of laparoscopic ventral hernia repair using intraperitoneal onlay mesh with defect closure (IPOM PLUS) technique by use of dual-sided synthetic mesh. Material and methods: Retrospectively clinical data for 27 patients with umbilical, paraumbilical, incisional, ventral, and primary hernia, operated in the Department of General, Visceral and Emergency Surgery “Pirogov” from 01.06.2022 to 01.06. 2022 was analyzed. The diagnosis was based on history, physical examination(mainly), ultrasound, and CT. Of the hospitalized, women were 16 (59.26%) men 11 (40.74%). Results: Of the selected group, 13 patients had umbilical defects, 3 with an epigastric hernia, 7 with a paraumbilical hernia, and 4 with incisional defects. Adhesiolysis was needed in 18 cases, while others were performed straight with hernia closure. The operating time varied between 49 and 127 minutes (average 57.4 minutes). The hospital stay ranged from 1 day to 4 days (average 1.7 days). We had noticed complications in three of the cases (11.11%). Conclusion: IPOM PLUS repair is safe, practicable, and advantageous over a standard IPOM or open repair as reported in the literature. Accordingly, we prefer this approach with the closure of the fascial defect first while repairing ventral abdominal wall hernias.

A study to compare outcomes in patients undergoing intraperitoneal onlay mesh plus and eTEP repair for ventral wall and incisional hernia

Background: The introduction of minimally invasive surgery in the early 1990s enabled the possibility of laparoscopic ventral or incisional hernia repair in 1993. At present IPOM Plus (intraperitoneal onlay mesh) is the most frequent technique used for laparoscopic ventral hernia repair, and the mesh is placed just under the peritoneum and enhanced view totally extraperitoneal repair. A relatively new approach based on TEP repair for inguinal hernia has also shown to be safe and effective. our study is primarily aimed at assessing and comparing outcomes of lap IPOM plus and eTEP, in terms of operative time, postoperative pain, length of hospital stay. Methods: This is a retrospective cohort study. Data were collected from successive patients who have undergone minimally invasive ventral hernia repair from January 2020 to June 2022, in Global hospital Hyderabad). Data were entered into a prospectively maintained database and retrospectively analysed. Pateints were distributed into two groups IPOM plus and eTEP. Perioperative data were analysed using statistical tests. Results: In this study, a total of 76 patients with ventral and incisional hernias were included, with 40 patients undergoing IPOM plus repair and 36 patients undergoing eTEP repair. Both groups were similar in terms of risk factors, types of hernias, defect size. The duration of surgery was significantly shorter in the IPOM plus group (85.6 minutes) compared to the eTEP group (121.6 minutes). Postoperative pain, according to the VAS score at postoperative day 1 and 3, was significantly higher in the IPOM plus group (7.5 and 5.6, respectively) compared to the eTEP group (3.8 and 1.6, respectively). However, at day 30, pain scores in both groups were not statistically significant (IPOM plus-1.2 vs. eTEP 1.1). The mean length of hospital stay in the IPOM plus group (5.3 days) was significantly longer than in the eTEP group (3.1 days). Conclusions: The eTEP technique exhibits significantly lower postoperative pain and results in a reduced length of hospital stay. However, it is worth noting that the eTEP procedure does require a longer operative time compared to IPOM Plus.

Laparoscopic versus hybrid approach for treatment of incisional ventral hernia: a 5–10-year follow-up of the randomized controlled multicenter study

PurposeIn this long-term follow-up of a prospective, randomized, and multicenter study, we compare the results of a group receiving laparoscopic incisional ventral hernia repair using intraperitoneal onlay mesh (LG) to a group receiving a hybrid hernia repair where open closure of fascial defect was added to intraperitoneal mesh placement (HG).MethodsOriginally, 193 patients with 2–7 cm incisional hernias were randomly assigned to either the LG or HG during the 30-month recruitment period in 2012 to 2015. Long-term follow-up was conducted 5–10 years after surgery to evaluate hernia recurrence rate and quality of life (QoL).ResultsIn all, 65 patients in the LG and 60 in the HG completed the long-term follow-up with a median follow-up period of 87 months. Recurrent hernia was detected in 11 of 65 patients (16.9%) in the LG and 10 of 60 patients (16.7%) in the HG (p  >  0.9). Kaplan–Meier analysis demonstrated a recurrence rate approaching 20% in both groups, with similar curves. Three patients in the LG (4.6% and five patients in the HG (8.1%) had undergone re-operation due to recurrence (p  = 0.48). There was no difference in patient-reported QoL measured using the SF-36 questionnaire. Mean pain scores were similar between groups, mean numeric rating scale (NRS) 0 to 10 being 1.1 in the LG and 0.7 in the HG (p  = 0.43).ConclusionFascial closure did not reduce hernia recurrence rate in this study population, even though it has been shown to be beneficial and recommended in surgery guidelines. In the long term, recurrence rate for both groups is similar.

A Comparative Study on Outcomes and Quality of Life Changes Following Ventral Transabdominal Preperitoneal (Ventral-TAPP) and Laparoscopic Intraperitoneal Onlay Mesh (IPOM)-Plus Repair for Ventral Hernia.

Background Ventral transabdominal preperitoneal (ventral-TAPP) repair and intraperitoneal onlay mesh (IPOM) plus repair are two options among the available techniques of laparoscopic ventral hernia repair (LVHR). We conducted a comparative study to evaluate the clinical and quality of life (QoL)-related outcomes between ventral-TAPP and IPOM-plus repair. It was hypothesized that both procedures offered similar outcomes and QoL. Materials and methods The study included 32 consecutive patients undergoing LVHR, divided equally between ventral-TAPP and IPOM-plus groups. In the ventral-TAPP procedure, a peritoneal flap was created around the defect, followed by defect approximation and polypropylene mesh placement in the pre-peritoneal pocket. For the IPOM-plus procedure, the defect was closed and a composite (dual-side) mesh was placed around the defect. The minimum overlap beyond the original defect margin in both groups was 5 cm. Data regarding pre-operative parameters and postoperative outcomes, including pain and QoL at one week, one month, and three months, were recorded. A p-value of less than or equal to 0.05 was considered to be statistically significant. Results While the mean duration of surgery was longer, the cost of treatment was lower in group 1 (ventral-TAPP) with a p-value of <0.05 for both parameters. The length of hospital stay was significantly shorter in group 1 (ventral-TAPP), while the return to normal activity was similar in both groups. The visual analog scale (VAS) score for overall pain perception and the European registry for abdominal wall hernias (EuraHS; hernia-related QoL) score for 'Pain at Site' and 'Restriction of Activity' domains were significantly higher in group 2 (IPOM-plus) at one week. Conclusion Although the ventral-TAPP procedure requires more time and expertise to perform, the EuraHS QoL assessment at one week was better in group 1 (ventral-TAPP). Ventral-TAPP group scored better in terms of length of hospital stay and cost-effectiveness as well.

A comparative study between laparoscopic trans-abdominal retromuscular repair and intraperitoneal onlay mesh repair techniques in ventral hernia

Background A hernia is a projection of an organ or part of an organ through a defect in the body wall. When compared to open procedures, laparoscopic ventral hernia repair has consistently demonstrated lower overall complication rates, shorter hospital stays, and faster return to work. Aim To compare the efficacy and safety between laparoscopic transabdominal retromuscular mesh (TARM) repair and laparoscopic (IPOM) repair in the treatment of patients with ventral hernia in Zagazig University Hospitals as a single center experience. Patients and methods This study is a prospective randomized clinical trial carried out upon 48 patients who were randomized by closed envelope method into two groups: Group (A): had undergone Laparoscopic TARM repair. Group (B): had undergone Laparoscopic IPOM repair. Results There was statistically significant variation between groups concerning cost which was significantly lower in laparoscopic TARM repair. Group B was lower regard intra operative complication rate but not significantly, but regard postoperative complication Group A significantly associated with Seroma and Group B significantly associated with Bulge. Complicated cases were significantly younger and wider regarding hernia width. Conclusion TARM repair technique was more time consuming but with less cost in comparison to the IPOM technique. TARM has the advantage of defect closure and avoiding mesh contact with abdominal viscera.

Transabdominal retro muscular versus intraperitoneal onlay mesh repair of ventral hernia: a randomized controlled study

Background Although laparoscopic ventral hernia repair has become a well-established alternative for open repair, traditional intraperitoneal mesh placement in direct contact with the bowel had many drawbacks and complications; in addition, it requires extensive mesh fixation and special composite mesh. Using the peritoneum and posterior rectus sheath as a barrier between the mesh and the bowel will evade these complications and decrease the cost. Patients and methods This prospective study was conducted in between May 2022 and December 2022 on 50 patients with noncomplicated ventral hernia with an average defect size of 5 cm. Patients were randomly allocated into two groups: intraperitoneal onlay mesh (IPOM) group (25) patients and transabdominal retro muscular mesh (TARM) group (25) patients. Both groups were compared as regards preoperative demographics, intraoperative complications and operative time and postoperative outcomes and complications. Results With a mean age of (44.96±7.27) of IPOM and (48.92±7.17) of TARM group, a significant longer operative time was spent in TARM repair (108.40±9.43 min). Postoperative pain was less in patients with TARM repair and hence they had earlier recovery and restoration of daily activities. Using a double-face composite mesh made the cost of IPOM repair significantly higher than TARM (P &lt; 0.001). Overall postoperative complications and recurrence rate showed no significant difference between both techniques. Conclusion TARM repair seems to be a safe and good alternative to IPOM repair in terms of lower economic cost and less postoperative pain.

Association of body mass index with morbidity following elective ventral hernia repair

BackgroundPrior work has linked body mass index (BMI) with postoperative outcomes of ventral hernia repair (VHR), though recent data characterizing this association are limited. This study used a contemporary national cohort to investigate the association between BMI and VHR outcomes. MethodsAdults ≥ 18 years undergoing isolated, elective, primary VHR were identified using the 2016–2020 American College of Surgeons National Surgical Quality Improvement Program database. Patients were stratified by BMI. Restricted cubic splines were utilized to ascertain the BMI threshold for significantly increased morbidity. Multivariable models were developed to evaluate the association of BMI with outcomes of interest. ResultsOf ~89,924 patients, 0.5 % were considered Underweight, 12.9 % Normal Weight, 29.5 % Overweight, 29.1 % Class I, 16.6 % Class II, 9.7 % Class III, and 1.7 % Superobese. After risk adjustment, class I (Adjusted Odds Ratio [AOR] 1.22, 95 % Confidence Interval [95%CI]: 1.06–1.41), class II (AOR 1.42, 95%CI: 1.21–1.66), class III obesity (AOR 1.76, 95%CI: 1.49–2.09) and superobesity (AOR 2.25, 95 % CI: 1.71–2.95) remained associated with increased odds of overall morbidity relative to normal BMI following open, but not laparoscopic, VHR. A BMI of 32 was identified as the threshold for the most significant increase in predicted rate of morbidity. Increasing BMI was linked to a stepwise rise in operative time and postoperative length of stay. ConclusionBMI ≥ 32 is associated with greater morbidity following open, but not laparoscopic VHR. The relevance of BMI may be more pronounced in open VHR and must be considered for stratifying risk, improving outcomes, and optimizing care. Key messageBody mass index (BMI) continues to be a relevant factor in morbidity and resource use for elective open ventral hernia repair (VHR). A BMI of 32 serves as the threshold for significant increase in overall complications following open VHR, though this association is not observed in operations performed laparoscopically.

Preoperative Abdominal Muscle Elongation Facilitated Laparoscopic Intraperitoneal Onlay Mesh Repair of Complex Ventral Hernia.

Background: Complex ventral hernia remains a challenging situation for any surgeon. In this study, our aim was to analyze the effect of laparoscopic intraperitoneal onlay mesh (IPOM) repair in the treatment of complex abdominal wall hernia, with the assistance of preoperative progressive pneumoperitoneum (PPP) and botulinum toxin A (BTA). Methods: In this retrospective study, we included 13 patients with complex ventral hernia between May 2021 and December 2022. All patients undergoing PPP and BTA protocol before hernia repair. The length of abdominal wall muscles and abdominal circumference were measured from CT scan. All hernias were repaired with laparoscopic or laparoscopic-assisted IPOM. Results: Thirteen patients received PPP and BTA injections. PPP and BTA administration time was over 8.8 ± 2.5 days. Before and after PPP and BTA, imaging showed that the length of lateral muscle on each side increased from 14.3 to 17.4 cm (P < .05). The abdominal circumference increased from 81.8 to 87.9 cm (P < .05). Complete fascial closure was obtained in 13 patients (100%), and no patient experienced postoperative abdominal hypertension and ventilatory support. No patient suffered from recurrent hernia to date. Conclusions: Preoperative PPP combined with BTA injection plays a role similar to component separation technique, avoids the abdominal hypertension after laparoscopic IPOM repair of complex ventral hernia.