Laparoscopic Mesh Repair Research Articles

Comparative analysis of laparoscopic, retro-muscular, and open mesh repair techniques for ventral and incisional hernias: a comprehensive review and meta-analysis.

Ventral hernias are abnormalities in anterior abdominal wall occurring due to an incision or are congenital. This comprehensive review and meta-analysis aim to objectively compare laparoscopic to retro-muscular or any other mesh repair approach to manage ventral incisional hernia. To identify studies that managed ventral incisional hernia using laparoscopic, open, or retro-muscular mesh repair techniques, a comprehensive literature search was performed. Random effects model was used, and data were presented as log odds ratio (logOR) or as Hedge's g with corresponding 95% confidence intervals (CI). Cochran's Q test was implemented to measure heterogeneity among articles, and funnel plots were utilized to examine publication bias visually. Quality of all selected studies was assessed using Critical Appraisal Checklists for Studies developed by the Joanna Briggs Institute. 20 studies (16,247 patients) were included published from 2003 to 2023. Significantly reduced incisional hernias developed in laparoscopic group. The recurrence of hernia lowered with laparoscopic repair vs. open repair. In retro-muscular vs. laparoscopic, recurrence was lower, however, not statistically significant (p = 0.97). Open repair type resulted in a longer hospital stay than laparoscopic (p = 0.03). In laparoscopic repair, the postoperative complications reduced compared to the open repair (p = 0.02). Laparoscopic incisional and ventral hernia repair is a practical and successful alternative to open method. It is associated with shorter hospital stay and lower risk of postoperative complications. In few instances, retro-muscular mesh repair may be opted for.

Hybrid intraperitoneal onlay mesh repair for incisional hernias: a systematic review and meta-analysis.

Laparoscopic IPOM is technically challenging, especially regarding fascial closure. Hybrid repair has been proposed as a simpler approach. We aimed to compare hybrid and laparoscopic intraperitoneal onlay mesh repair (IPOM) in patients undergoing ventral hernia repair (VHR). We performed a systematic review of Cochrane, Scopus, and MEDLINE databases to identify studies comparing hybrid versus laparoscopic IPOM VHR reporting the outcomes of recurrence, mortality, seroma, postoperative complications, reoperation, surgical site infection, and operative time. Statistical analysis was performed using RStudio 4.1.2 using a random-effects model. We screened 2,896 articles and fully reviewed 22 of them. A total of five studies, encompassing 664 patients were included. Among them, 337 (50.8%) underwent laparoscopic IPOM. All patients had incisional hernias, with a mean diameter varying from 3 to 12.7cm, 60% were women, with a mean BMI varying from 29.5 to 38. The hybrid approach had a lower rate of seroma when compared to the laparoscopic (OR 0.22; 95% CI 0.05 to 0.92; p = 0.038; I²=78%). We found no difference in recurrence, mortality, postoperative complications, reoperation, surgical site infection, and operative time between groups. Hybrid IPOM is a safe and effective method for incisional hernia repair. Moreover, it facilitates fascial defect closure and decreases postoperative seromas.

Enhanced view totally extraperitoneal approach: The best available option for recurrent incisional hernias following previous laparoscopic intraperitoneal onlay mesh plus repairs.

The available options for recurrent incisional hernias (RIH) following previous laparoscopic intraperitoneal onlay mesh (IPOM) plus were open onlay repair, open Rives-Stoppa (RS), laparoscopic enhanced view totally extraperitoneal-RS (ETEP-RS) and laparoscopic subcutaneous onlay mesh repair. Majority of these RIH were managed by open onlay mesh repairs or laparoscopic Redo IPOM plus. There are not much data available in the literature on the ETEP approach for RIH following previous IPOM plus with the placement of mesh in the retrorectus space. In this article, I would like to share technical aspects, challenges faced and tips to overcome these challenges of performing ETEP for RIH following previous IPOM plus repairs.

Epigastric Ventral Hernia Repair Through Vaginal Natural Orifice Transluminal Endoscopic Surgery.

Ventral hernia repair is a commonly performed operation and can be executed by open or laparoscopic approach. The search for even less invasive techniques continues. Natural orifice transluminal endoscopic surgery (NOTES) is a known method of minimally invasive surgery. We performed an epigastric ventral hernia repair through vaginal NOTES during a concurrent hysterectomy and bilateral salpingectomy. We used the access to do a synchronous hernia repair with mesh augmentation. The technique of repair was identical to the laparoscopic intraperitoneal onlay mesh repair (Lap. IPOM). We reported a sufficient hernia repair without intra-operative complications. Also, post-operatively, no problems were encountered. Follow-up after 4 weeks showed a good and strong hernia repair. The complaints of the patient were relieved. CT scan 10 months after operation showed no recurrence nor signs of mesh infection. Ventral hernia repair through vaginal NOTES can be considered a possible new and minimal invasive (scarless) technique for ventral hernia repair but further investigations on a larger scale are needed to confirm feasibility & safety.

A retrospective study of predisposing factors and management of incisional hernia in a tertiary care hospital

Background: An incisional hernia is characterized as any defect in the abdominal wall, with or without a noticeable bulge, in the region of a postoperative scar, identifiable through clinical examination or imaging. This condition can be detected through clinical examination or imaging and affects approximately 10-20% of patients who undergo abdominal operations. Aims and objectives of the study was to evaluate various precipitating factors, clinical presentations, management and post-operative complications in patients with incisional hernia. Methods: A retrospective study of 150 patients conducted at a tertiary care teaching hospital. Results: In this study, incisional hernia was more common in obese, elderly, and female patients. The incidence was higher with Pfannenstiel incision followed by lower midline incisions. Incisional hernia was common between 1-5 years of index surgery and it was observed that more the risk factors and complications associated with index surgery, earlier was the onset of incisional hernia. Patients had a defect of size <4x4 cm were 58.66%. Open onlay mesh repair was done in 36.66% patients, preperitoneal mesh repair in 13.33%, retro rectus mesh repair in 13.33%, laparoscopic mesh repair in 28.66% and anatomical repair alone in 7.99% patients. Duration of laparoscopic surgery was longer compared to open. Most common post- operative complication was seroma (4.66%) followed by wound infection (2.66%). Conclusions: Incisional hernias occur more in females as they commonly undergo lower abdominal surgeries. Subcutaneous suction drain decreased the incidence of post-operative wound complications.

A comparative study on effects of defect closure versus non-closure in laparoscopic totally extraperitoneal repair of direct inguinal hernia.

Totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) repair are the principal techniques in laparoscopic hernia repair. Seroma formation and pain are frequent complications of moderate-large size laparoscopic direct inguinal hernia mesh repair. This study was conducted to evaluate the feasibility of defect closure in moderate-large direct inguinal hernias and its effect on various outcomes. This is a prospective cohort study from September 2020 to August 2021, where a total of 88 patients with uncomplicated direct inguinal hernia (M3 or more) were enrolled in the study and divided into two equal groups of TEP defect closure and non-closure, and various outcome measures were noted. The majority of patients were male (94.31%), with a mean age range of 18-85 years, and had right-sided inguinal hernia (46.5%). Seroma formation at 10th POD in the defect closure and non-closure were 24% and 33% (p value: 0.225), which reduced to 11% and 18%, respectively, at 1 month (p value: 1.000). All seromas resolved within 6 months. Pain in VAS at 10th POD in the defect closure and non-closure were 1.55±0.571 and 1.38±0.527, respectively (p value: 0.121), which gradually decreased to 1.20±0.524 and 1.16±0.420 at a 6-month interval (p value: 0.689). The mean operative time in the bilateral and unilateral defect closure groups was 72.3±4.1 and 56.5±4.3 min, respectively, whereas that in the bilateral and unilateral defect non-closure groups was 62.3±3.7 and 45.7±3.6 min, respectively. The defect closure was found to have higher pain and less seroma formation at various intervals of time following TEP for moderate-large direct inguinal hernia. Although these findings were statistically insignificant, they may be clinically significant, and further studies with a larger sample size are suggested.

Comparison of postoperative outcome of laparoscopic and open inguinal hernia mesh repair

Comparison of postoperative outcome of laparoscopic and open inguinal hernia mesh repair

LAPARASCOPIC VERSUS OPEN MESH REPAIR FOR RECURRENT INGUINAL HERNIA: A SYSTEMATIC REVIEW

Background: Inguinal hernia is one of the most common conditions seen in clinic, and is often treated through the general surgery department. Laparoscopic repair and open repair with mesh are the typical treatments for inguinal hernia, and both regimens have proved beneficial in treating inguinal hernia. However, recurrence, with a rate as high as 33, poses a significant problem to the effective treatment of inguinal hernia. The aim: This study aims to show about laparascopic versus open mesh repair for recurrent inguinal hernia. Methods: By comparing itself to the standards set by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. So, the experts were able to make sure that the study was as up-to-date as it was possible to be. For this search approach, publications that came out between 2013 and 2023 were taken into account. Several different online reference sources, like Pubmed and SagePub, were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done. Result: In the PubMed database, the results of our search brought up 10 articles, whereas the results of our search on SagePub brought up 60 articles. The results of the search conducted for the last year of 2013 yielded a total 2 articles for PubMed and 14 articles for SagePub. The result from title screening, a total 1 articles for PubMed and 10 articles for SagePub. In the end, we compiled a total of 7 papers. We included five research that met the criteria. Conclusion: The laparoscopic approach is superior to the open mesh approach for the repair of recurrent inguinal hernia in some aspects, including the incision infection rate and length of hospital stay. However, more high-quality studies on the effects of laparoscopic and open mesh repair for the treatment of recurrent inguinal hernia are warranted.

Quality of life following repair of large hiatal hernia is not influenced by the use of mesh-Longer-term follow-up from a randomized trial.

The use of prosthetic mesh in laparoscopic repair of large hiatus hernias remains controversial. Clinical and quality of life outcomes from a randomized controlled trial of mesh versus suture repair previously showed few differences at early follow-up. This study evaluated longer-term quality of life outcomes from that trial. A prospective, multicentre, double blind randomized controlled trial assessed three methods of repair for large hiatus hernias: sutures-only versus absorbable mesh versus non-absorbable mesh. Quality of life was assessed using the Short-Form 36 (SF-36) questionnaire which was completed preoperatively and then at 3, 6, 12months following surgery and annually thereafter. SF-36 outcomes were compared across the three repair techniques at longer-term follow-up (3-6years), and to earlier baseline and 12-month outcomes. 126 patients were randomized; 43-suture-only, 41-absorbable mesh and 42-non-absorbable mesh. Questionnaires were completed by 118 patients preoperatively, 115 at 12months and 98 at longer-term follow-up (median 5years). There were no significant differences between the repair techniques for the subscale and composite scores at longer-term follow-up. The mental component score improved significantly after surgery and was sustained across follow-up for all techniques. The physical component score also improved significantly but was lower at longer-term follow-up compared to the 12-month follow up in both mesh groups. Surgical repair of large hiatus hernias provides sustained long-term improvement in quality of life. The addition of mesh does not improve quality of life. This trial is registered with the Australia and New Zealand Clinical Trials Registry ACTRN12605000725662.

To close, not to close, or to act bigger? Managing the defect of large direct inguinal hernia to reduce the risk of recurrence during laparoscopic TAPP repair: a retrospective cohort study

Hernia recurrence is a common complication after inguinal hernia repair. Recent studies suggest that laparoscopic mesh repair with closure of direct hernia defects can reduce recurrence rates. Our study examines the effectiveness of this approach. A retrospective, multi-center cohort study was conducted on cases performed from January 2013 to April 2021. Patients with direct inguinal hernias (M3 according to EHS classification) undergoing TAPP were included. Three groups were present: closed-defect group, non-closed placing a standard-sized mesh group or non-closed placing an XL-sized mesh group. A 2-year follow-up was recorded. A total of 158 direct M3 inguinal hernias in 110 patients who underwent surgery were present. After propensity score matching at a 1:1 ratio, 22 patients for each group were analyzed. The mean age of patients was 62 years (41–84); with the majority being male (84.8%). 22 patients (40 hernias) underwent closure of the defect; 22 patients (39 hernias) did not undergo closure and used a standard-sized mesh; 22 patients (27 hernias) did not undergo closure and used an XL-sized mesh. There were 5 recurrences at 1 year post-operatively: all in the non-closure group with standard-sized mesh. This difference was statistically significant (p = 0.044). There were 7 recurrences (6.6%) at 2 years post-operatively: 6 in the non-closure group with standard-sized mesh and 1 in the non-closure group with XL-sized mesh (p = 0.007). Closing large direct inguinal hernia defects has shown promise in reducing early recurrence rates. However, conducting larger RCTs in the future could provide more conclusive evidence that might impact the way we approach laparoscopic inguinal hernia repair.

Comparative study of open onlay mesh repair versus laparoscopic intraperitoneal dual mesh repair for ventral hernia

Background: Ventral abdominal wall hernia surgery is a common procedure in the armamentarium of surgeons. The most common forms of these surgical procedures in adults are the repair of incisional hernias and surgery for paraumbilical hernias. Aims and Objectives: Open onlay mesh repair versus laparoscopic intraperitoneal dual mesh repair (intraperitoneal onlay mesh[IPOM]) for ventral hernia compared to the duration of surgery, post-operative pain, postoperative complications, post-operative hospital stay, return to normal activity, recurrence, and cosmesis. Materials and Methods: The prospective non-randomized study was done in the Maharani Laxmi Bai Medical College, Jhansi, between January 2021 and June 2022 including 100 patients was applied for treatment of ventral hernia repair. Fifty patients were subjected to Group A (open onlay mesh repair) and 50 patients were subjected to Group B (laparoscopic intraperitoneal dual mesh repair). Results: The mean surgery durations were significantly lower in laparoscopic repair when compared to open repair (P<0.001). Themean post-operative stay in the hospital was shorter for the laparoscopic group than for the open hernia group (10.28±2.100 vs. 8.02±1.378 days; P≤0.001). Return to activity or normal daily work is significantly lower in the laparoscopic group as compared to open repair of hernia (5.12±0.659 vs. 2.94±0.550 days; P<0.001). There were fewer post-operative complications with laparoscopy. Conclusion: Laparoscopic intraperitoneal dual mesh repair (IPOM) for ventral hernia in our experience was safe and resulted in fewer complications, shorter hospital stays, and better cosmesis results. Hence, it should be considered the better choice for ventral hernia repair.

Comparing Laparoscopic Total Extraperitoneal and Lichtenstein Mesh Repair for Inguinal Hernias: A Focus on Patient Outcomes.

This study aimed to evaluate post-operative outcomes by comparing factors such as post-operative pain, duration of hospitalization, time needed to resume normal and full activities, and complications between laparoscopic total extraperitoneal (TEP) and Lichtenstein tension-free mesh hernioplasty or repair (LMR) for inguinal hernias. A prospective study was conducted involving male patients undergoing either LMRor laparoscopic TEP mesh repair, with 30 patients in each group. The study assessed post-operative pain, duration of hospital stay, return to normal activities, and complications. Pain scores were monitored at regular intervals using a visual scale. Before discharge, patients' ability to perform self-care activities was evaluated using the Katz index of independence in activities of daily living. Outpatient follow-up was conducted on day 14, one month, three months, and six months post-surgery. Post-operative pain scores were significantly higher among LMR patients compared to TEP patients until the 14th day post-surgery (p < 0.001). However, pain levels became comparable after that. There were no notable differences in pain scores between unilateral and bilateral hernias. TEP patients experienced significantly shorter hospital stays (p < 0.001) and quicker resumptions of self-care (p < 0.001), light work (p < 0.02), and full work (p < 0.03) compared to LMR patients. Laparoscopic TEP repair offers advantages over Lichtenstein mesh repair in terms of reduced postoperative pain, shorter hospital stays, and faster recovery to normal activities. These findings can guide clinicians and patients in making informed decisions regarding hernia repair techniques.

Comparative Study of Postoperative Outcome between Laparoscopic Mesh Repair &amp; Open Mesh Repair of Inguinal Hernia Patient in Tertiary Care Hospital in Bangladesh

Background: Inguinal hernia repair is a commonly performed surgical procedure, and the choice between laparoscopic and open approaches remains a subject of ongoing discussion. This prospective cohort study aimed to compare postoperative outcomes between laparoscopic mesh repair and open mesh repair in inguinal hernia patients in a tertiary care hospital in Bangladesh. Objective: This study aimed to assess and compare the surgical outcomes and patient recovery following laparoscopic and open mesh repair for inguinal hernias. Methods: A prospective study was conducted by Z.H. Sikder Women's Medical College Hospital and Central Hospital Ltd Dhanmondi Dhaka in Bangladesh, spanning from 2022 to 2023. It enrolled 112 individuals, each grappling with inguinal hernias; they were divided into two groups: one undergoing the intricate ballet of laparoscopic mesh repair (n=56) and the other navigating the venerable path of open mesh repair (n=56). With precision, we charted their demographics and chronicled intraoperative nuances. We scrutinized postoperative outcomes to illuminate the interplay between modern innovation and time-tested tradition in hernia care. Results: In our comparative study involving 112 patients (99.5% male, median age 30.8 ± 10.6 years), evaluating postoperative outcomes between laparoscopic and open mesh repair for inguinal hernias in a Bangladesh tertiary care hospital, significant differences were observed. The laparoscopic group demonstrated notably shorter operative durations (p&lt;0.05), a lower incidence of wound infections (p&lt;0.05), and reduced postoperative pain with lower analgesic requirements and shorter hospital stays (p&lt;0.05). Additionally, the laparoscopic group exhibited a faster return to normal activities and Work (p&lt;0.05). However, the mean operative time was significantly longer in the laparoscopic group (20.2 minutes, p&lt;0.001), while the time to return to duty was significantly shorter (2.3 days, p=0.008). Conclusions: Laparoscopic ....

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.

Prospective, observational study of intraperitoneal onlay mesh repair with defect closure versus SCOLA for primary ventral hernia.

The last decade has witnessed several modifications in the laparoscopic techniques for ventral hernia. The aim of this study was to compare an established repair such as laparoscopic intraperitoneal onlay mesh repair with defect closure (IPOM plus) with subcutaneous onlay endoscopic approach (SCOLA) for medium ventral hernia. From June 2019 to November 2021, 29 patients undergoing IPOM plus and 22 patients undergoing SCOLA for medium ventral hernia (umbilical and epigastric hernia of size 2-4 cm) were included in the study. A comparative analysis was performed in terms of surgical outcomes and post-operative pain. The two groups were comparable in terms of age and body mass index. The mean operation time of the SCOLA group was higher but not statistically significant. The Visual Analogue Scale score for pain after IPOM plus was significantly higher on post-operative day 1, at discharge and on the first follow-up visit. Around 45.4% of patients in the SCOLA group were discharged with the drain in situ which was later removed on the outpatient visit. However, no drains were placed in the IPOM plus group. The rate of seroma formation was 10.34% in the IPOM plus group and 27.27% in the SCOLA group. The material cost of IPOM plus procedure was significantly higher than that of the SCOLA. At the end of 1 year, there was no recurrence in either group. Our study showed that the post-operative pain after SCOLA is significantly less compared to IPOM plus. SCOLA is feasible for medium midline ventral hernia. However, a study with larger sample size and longer follow-up is warranted to compare the operative morbidity of the two procedures.

Outcomes of Open Versus Laparoscopic Technique in Primary Inguinal Hernia Repair: A Retrospective Study.

Inguinal hernia repair is one of the most common surgical procedures worldwide. In clinical practice, there are two different routes to repair inguinal hernias: laparoscopic mesh repair and open. Reducing the hernia and preventing recurrence remains the mainstay treatment option of both procedures. This study aims to compare postoperative outcomes and recurrence rates for patients who had primary, non-recurrent, laparoscopic, or open hernia repair in a single tertiary hospital. A retrospective cohort study was done on 468 patients. The study was conducted at King Abdulaziz University Hospital (KAUH) between 2013 and 2022. The distribution of our study population was divided into open hernia repair 378 participants (80.8%) while the rest did laparoscopic hernia repair 90 (19.2%). Operation duration in minutes was 107.158 ± 41.402 in the open hernia repair group and was noted to be significantly higher in the laparoscopic hernia repair group, with 142.811 ± 52.102 minutes p-value (0.000). The hospital length of stay was shown to be shorter in laparoscopic hernia repair (1.58 ±1.27) compared to open hernia repair (2.05±5.33). The most common postoperative complication was scrotal swelling, commonly associated with laparoscopic (5.55%) compared to 2.11%in open hernia repair. Open repair showed a risk of scrotal hematoma with a percentage of 0.52%compared to 0%in the laparoscopic method with a p-value (0.033).Hernia recurrence was non-related with any specific group, although noted to be higher in the laparoscopic group (7.77%), while in the open group (3.4%) with a p-value (0.081).The study conducted showed no alarming percentages for recurrence in either technique, open or laparoscopic, yet the open approach had a better outcome when it comes to scrotal pain and swelling post-operatively, chronic groin pain, and readmission rate as compared to laparoscopic technique, despite having a longer hospital stay. Future larger studies should be conducted to provide equal population inclusivity.

Assessment of quality of life using EuraHS-QoL score and postoperative outcome measures following endoscopic video-assisted component separation with laparoscopic intraperitoneal onlay mesh repair in large midline ventral hernia repair

Abstract OBJECTIVE: This study aimed to assess the quality of life using the EuraHS-quality-of-life (QoL) score and postoperative outcome measures in patients undergoing endoscopic component separation technique with laparoscopic intraperitoneal onlay mesh repair in large (&gt;5 cm) midline ventral hernia mesh placement and to compare EuraHS-QoL score with the currently available hernia-related QoL score—Carolina Comfort Scale. MATERIALS AND METHODS: This was a single-center prospective observational study. A total of 60 patients were studied. Component separation index and abdominal wall strength score were calculated. The quality of life was assessed by EuraHS-QoL Score and Carolina Comfort Score. RESULTS: The mean abdominal wall strength score at 3 months postoperatively was 6.83 ± 0.87, and a P value of less than 0.001 was significant. The correlation between EuraHS-QoL score and Carolina Comfort Scale was assessed with respect to the pain domain and movement limitation/restriction domain using Spearman correlation, which showed a positive correlation. CONCLUSIONS: Endoscopic component separation technique with laparoscopic intraperitoneal onlay mesh repair is a safe procedure owing to its better postoperative and functional outcomes. The EuraHS-QoL score is superior to Carolina Comfort Scale as it is more user-friendly, accessible, detailed, and precise.

Feasibility and safety of redo laparoscopic repair of recurrent inguinal hernia following previous endolaparoscopic repair.

Laparoscopic redo inguinal hernia (LRIH) repairs are fraught with challenges as the pre-peritoneal space is violated due to previous surgery and the presence of mesh. The purpose of this study was to present the feasibility and safety of LRIH in a series of patients with recurrent inguinal hernia following previous endolaparoscopic repair and present technical experiences and clinical outcomes in this subset of patients. This was a retrospective study from a prospective database of 16 patients who underwent LRIH between March 2014 and December 2020. The decision to do a redo laparoscopic surgery was undertaken after a detailed discussion with the patient. The operative details, challenges faced and tips to overcome difficulties have been explained in detail. Out of 16 patients (mean age 49.5 years, all men), 15 underwent laparoscopic redo trans-abdominal pre-peritoneal (TAPP) mesh repair and 1 underwent laparoscopic enhanced-view totally extra-peritoneal (eTEP) mesh repair. The mean operating time was 68.5 min for unilateral, 115 min for bilateral TAPP and 90 min for eTEP. The main contributing factors for recurrences were mesh migration, insufficient size of the mesh and inadequate fixation. There was no conversion to open repair. The duration of stay was 1-2 days. There was no documented re-recurrence during the follow-up period of 2-9 years. Based on our experience, redo laparoscopic inguinal hernia mesh repair after previous endolaparoscopic repair is feasible, effective and safe in experienced hands.

A systematic review and meta-analysis of hernia sac management in laparoscopic groin hernia mesh repair: reduction or transection?

BackgroundThere is no consensus regarding hernia sac management during laparoscopic hernia repair, and this systematic review and meta-analysis aimed to compare the postoperative outcomes of sac reduction (RS) and sac transection (TS) during laparoscopic mesh hernia repair.MethodsWe conducted a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) 2020 and AMSTAR 2 (Assessing the Methodological Quality of Systematic Reviews) guidelines. We used the RevMan 5.4 statistical package from the Cochrane collaboration for meta-analysis. A random effects model was used.ResultsThe literature search yielded six eligible studies including 2941 patients: 821 patients in the TS group and 2120 patients in the RS group. In the pooled analysis, the TS group was associated with a lower incidence of seroma (OR = 1.71; 95% CI [1.22, 2.39], p = 0.002) and shorter hospital stay (MD = -0.07; 95% CI [-0.12, -0.02], p = 0.008). There was no significant difference between the two groups in terms of morbidity (OR = 0.87; 95% CI [0.34, 2.19], p = 0.76), operative time (MD = -4.39; 95% CI [-13.62, 4.84], p = 0.35), recurrence (OR = 2.70; 95% CI [0.50, 14.50], p = 0.25), and Postoperative pain.ConclusionsThis meta-analysis showed that hernia sac transection is associated with a lower seroma rate and shorter hospital stay with similar morbidity, operative time, recurrence, and postoperative pain compared to the reduction of the hernia sac.ProtocolThe protocol was registered in PROSPERO with ID CRD42023391730.

Outcomes of recurrent incisional hernia repair by open and laparoscopic approaches: a propensity score-matched comparison.

Recurrent incisional hernias are challenging, and their surgical outcomes have not been well studied. We aimed to analyze the outcomes of recurrent incisional hernia repair in a propensity score-matched cohort study on laparoscopic intra-peritoneal onlay mesh repair (lap. IPOM) versus open sublay repair. All consecutive patients who had undergone open sublay repair and lap. IPOM of recurrent incisional hernia between January 2015 and December 2021 at a tertiary hernia center was identified. One-to-one propensity score matching was used to achieve a balanced exposure groups at baseline. Of 255 patients, 85/95 with open sublay repair were matched to 85/160 with lap. IPOM. Before matching, the open sublay group had significantly larger hernia defects (6.3cm vs. 5.0cm) than the lap. IPOM group. Other major baseline imbalances were also found in body mass index (BMI), obesity and European Hernia Society (EHS) width classification. The pre-match results showed that the lap. IPOM group had significantly shorter operative time (median 75 vs. 95min) and shorter postoperative hospital stay (median 8 vs. 11days) compared with the open sublay group. Wound infection (8.4% vs. 1.9%) and hematoma (5.3% vs. 0.6%) occurred more frequently after open sublay repair. After matching, baseline characteristics were well balanced. The recurrence rate and incidence of complications were comparable between the two groups. However, the post-match analysis still showed that lap. IPOM was associated with decreased length of postoperative stay. The outcomes of recurrent incisional hernia surgery after lap. IPOM and open sublay repair appear similar, except that the former had shorter length of postoperative stay. However, the poor outcomes were more likely associated with the unfavorable risk profiles, such as larger defect size, rather than the procedure technique itself.