Mesh Repair Of Incisional Hernia Research Articles

Robotic-assisted repair of incisional hernia—early experiences of a university robotic hernia program and comparison with open and minimally invasive sublay technique (eMILOS)

PurposeWith robotic surgical devices, an innovative tool has stepped into the arena of minimally invasive hernia surgery. It combines the advantages of open (low recurrence rates and ability to perform complex procedure such as transverse abdominis release) and laparoscopic surgery (low rate of wound and mesh infections, less pain). However, a superiority to standard minimally invasive procedures has not yet been proven. We present our first experiences of robotic mesh repair of incisional hernias and a comparison of our results with open and minimally invasive sublay techniques.MethodsA retrospective analysis of all patients who underwent robotic-assisted mesh repair (RAHR) for incisional hernia between April and November 2022 (RAHR group) and patients who underwent open sublay (Sublay group) or eMILOS hernia repair (eMILOS group) between January 2018 and November 2022 was carried out. Patients in the RAHR group were matched 1:2 to patients in the Sublay group by propensity score matching. Patient demographics, preoperative hernia characteristics and cause of hernia, intraoperative variables, and postoperative outcomes were evaluated. Furthermore, a subgroup analysis of only midline hernia was performed.ResultsA total of 21 patients received robotic-assisted incisional hernia repair. Procedures performed included robotic retro-muscular hernia repair (r-RMHR, 76%), with transverse abdominis release in 56% of the cases. In one patient, r-RHMR was combined with robotic inguinal hernia repair. Two patients (10%) were operated with total extraperitoneal technique (eTEP). Robotic-assisted transabdominal preperitoneal hernia repair (r-TAPP) was performed in three patients (14%).Median (range) operating time in the RAHR group was significantly longer than in the sublay and eMILOS group (291 (122–311) vs. 109.5 (48–270) min vs. 123 (100–192) min, respectively, p < 0.001). The meshes applied in the RAHR group were significantly compared to the sublay (mean (SD) 529 ± 311 cm2 vs. 356 ± 231, p = 0.037), but without a difference compared to the eMILOS group (mean (SD) 596 ± 266 cm2). Median (range) length of hospital stay in the RAHR group was significantly shorter compared to the Sublay group (3 (2–7) vs. 5 (1–9) days, p = 0.032), but not significantly different to the eMILOS group. In short term follow-up, no hernia recurrence was observed in the RAHR and eMILOS group, with 9% in the Sublay group. The subgroup analysis of midline hernia revealed very similar results.ConclusionOur data show a promising outcome after robotic-assisted incisional hernia repair, but no superiority compared to the eMILOS technique. However, RAHR is a promising technique especially for complex hernia in patients with relevant risk factors, especially immunosuppression. Longer follow-up times are needed to accurately assess recurrence rates, and large prospective trials are needed to show superiority of robotic compared to standard open and minimally invasive hernia repair.

A Comparative Study between Onlay versus Sublay Mesh Repair in Treatment of Midline Incisional Hernia

Abstract Background Incisional hernia is a common complication following laparotomy and is the most common indication for reoperation. However, the optimal approach for its repair is still a matter of debate. Aim of Study The aim of this study was to compare between onlay and sublay mesh repairs in treatment of midline incisional hernia regarding the operative technique and postoperative complications. Patients and Methods This randomized controlled prospective comparative study was conducted in general surgery department Ain-Shams University Hospital and Damanhour Medical National Institute in the period between November 2019 and April 2020. It included 40 patients with Midline incisional hernia who were randomly divided into two equal groups: A (treated with sublay repair) and B (treated with onblay repair). Results The mean operative time in group A was 104.2 minutes and in group B was 82.9 minutes. The mean time of drain removal in group A was 4.3 days while in group B was 13.6x days. Seroma formation after drain removal was not recorded in any patients of group A while it occurred in 4 patients in group B (20%). The other postoperative complications were comparable in both groups. During 6 months of follow up, hernia recurrence didn’t occurs in any patient in group A nor group B. Conclusion Sublay mesh repair of incisional hernia is a good alternative to onlay repair. It is applicable to all sites of incisional hernia with a low recurrence rate and acceptable complication rates.

Drain Versus No Drain in Open Mesh Repair for Incisional Hernia, Results of a Prospective Randomized Controlled Trial

BackgroundOpen mesh repair of incisional hernia is associated with different local complications, particularly bleeding and seroma formation. Traditionally, drains have been placed perioperatively to prevent these complications, despite the lack of scientific evidence or expert consensus. We formulated the hypothesis that the absence of drainage would reduce number of patients presenting collections or complications. The present study aimed to compare postoperative complication rates after open mesh repair for incisional hernia with or without prophylactic wound drainage.MethodsProspective randomized study using standardized surgical technique and drain placement. The primary endpoint was the evaluation of residual fluid collection with ultrasound on postoperative day 30. Other complications, subdivided into medical and surgical, were analyzed as secondary endpoints.ResultsThere were 144 patients randomized (70 with drain, 74 without drain). No difference was identified between both groups for fluid collection at 30 days (60.3% vs. 62%, p = 0.844). However, less surgical complications were identified in the drain group (21.7% vs. 42.7%, p = 0.007), with a lower wound dehiscence rate (1.5% vs. 9.3%, p = 0.041).ConclusionsProphylactic drainage in open incisional hernia repair does not objectively reduce the rate of postoperative fluid collections. Therefore, our results do not support the use of routine drainage in incisional hernia repair.Trial registrationTrial registration on clinicaltrials.gov (NCT00478348).

Comparative study of efficacy and safety between sublay and onlay polypropelene mesh repair for incisional hernia of abdominal wall

To compare the efficacy and safety between sublay and onlay polypropylene mesh repair for incisional hernia of abdominal wall. Department of General Surgery from January 2018 to December 2021 in BHIMA BHOI MEDICAL COLLEGE OF WESTERN ODISHA. It is a randomized controlled trial. In this study a total of 144 (72 in each group) patients were observed. The patients were randomly allocated in two groups by random method. Patients in group-A was subjected to onlay polypropylene mesh open repair procedure and patients in group-B was subjected to sublay polypropylene mesh open repair procedure for incisional hernia repair in abdominal wall. Post-operatively all patients were kept under observations for 7-10 days in surgery ward and observed for complications if any. Post-operatively all patients were followed at 20 days, 2nd months, 6th month and 9 months to confirm the efficacy and safety of the procedure. The mean age of patients in Group-A was 30 years± 2.16 and 32 years ± 3.71 in Group-B. In group-A 28 patients were male and 44patients were female where as in group-B 27 patients were male and 45 patients were female.

Abdominal wall pseudocyst complicating incisional hernia repair.

Background: Development of a pseudocyst after mesh repair of hernia is a rare complication. As a result, both diagnosis and management pose a great challenge to the attending surgeon. Therefore, the need to report such an uncommon complication and its management in order to create awareness of this distinct rare entity. Case report: A case of pseudocyst formation following a onlay mesh repair of incisional hernia is reported. Contrast-enhanced CT scan was diagnostic. It revealed a well formed cyst with no communication with the peritoneal cavity. Complete excision of the cyst was curative. Conclusion: Pseudocyst formation is a rare complication following mesh repair. Contrast enhanced CT scan is essential for confirming the diagnosis. Complete surgical resection of the cyst is the mainstay of surgical treatment.

Comparative analysis of onlay and sublay (retrorectus) mesh repair for incisional hernia (width ≤10 cm) of abdominal wall

Background: Incisional hernia repair is one of the most common procedures performed in general surgery. Onlay and sublay mesh repair both are well established techniques for the locations of mesh placement, but with various benefits and drawbacks. Despite various studies, the debate continues regarding preferring one technique over the other. We aim to compare the outcome of hernia repair between these two techniques. Materials and Methods: Retrospective analysis was done on patients who underwent open onlay/sublay hernia repair from February 2018 to March 2020 at our institute. 9–28 months of follow-up was done. Primary outcome was recurrence. Secondary outcomes included postoperative complications including surgical site infection, hematoma, seroma, wound dehiscence, peri-operative pain, persistent seroma, readmission after 30 days and chronic pain. Results: A total of 87 patients underwent open ventral hernia repair during the study period. Of which, 41 had onlay and 46 had sublay repair (SR). Recurrence occurred in five patients (12.2%) with onlay repair and two patients in sublay group (4.3%) after a follow-up duration of up to 28 months (P = 0.247). Wound complications were more common in onlay group (46.3%) than the sublay group (19.5%) (P = 0.008). The mean standard deviation intraoperative blood loss (mL) was significantly higher in sublay group (156 [96]) than onlay group (123 [110]) (P &lt; 0.0001). The postoperative drain output and the duration of placement were both greater in the onlay group (P &lt; 0.0001). The median (range) of hospital stay was significantly longer in the onlay group (5[3–10] days) than the sublay group (4[2–6] days) (P &lt; 0.001). Conclusion: SR seems to be the better technique taking into account the overall morbidity, although the need for multi-centric trials with patient-centered outcomes should be highlighted to settle the debate.

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Comparison of Post-Operative Complications Between Sublay and Onlay Mesh Repair in Incisional Hernia

Objective: To compare the post-operative complications between sublay and onlay mesh repair in incisional hernia. Materials &amp; Methods: This randomized controlled trial was conducted at Department of Surgery, Sandeman Provincial Hospital Quetta from May 2019 to November 2019. Total 250 patients with incisional hernias for more than 3 months, having age 20-40 years either male or female were selected. Then selected patients were placed randomly into two groups i.e. Group A (Sublay group) &amp; Group B (Onlay group), by using lottery method. Patients were called for follow up 15th day for post-operative complications in term of wound infection and seroma formation. Results: The mean age of patients in group A was 34.73 ± 4.32 years and in group B was 34.51 ± 4.67 years. Out of these 250 patients, 161 (64.40%) were female and 89 (35.60%) were males with female to male ratio of 1.8:1. Wound infection was seen in 07 (5.60%) patients in group A (Sublay technique) and 17 (13.60%) patients in group B (Onlay technique) with p-value of 0.033. Seroma formation was seen in 09 (7.20%) patients in group A (Sublay technique) and 26 (20.80%) patients in group B (Onlay technique) with p-value of 0.002. Conclusion: This study concluded that rate of wound infection and seroma formation is less after sublay mesh repair for incisional hernia as compared to onlay repair. Keywords: Hernia, incisional, onlay, sublay, seroma.

P031 OPEN VERSUS LAPAROSCOPIC INCISIONAL HERNIA REPAIR: A NATIONWIDE DATABASE STUDY

Abstract Aim Although laparoscopic repair of incisional hernias decreases the incidence of wound complications as compared with open repair, there has been a rising concern related to intraperitoneal mesh placement. The aim of this study was to examine outcomes after open or laparoscopic elective incisional hernia mesh repair on a nationwide basis. Material and Methods A merge of data between the Danish Hernia Database and the National Patient Registry provided data on perioperative information, 90-day readmission, 90-day reoperation for complication, and long-term operation for hernia recurrence from 2007-2018. Results A total of 3,090 (57.5%) and 2,288 (42.5%) patients were operated by laparoscopic and open approach, respectively. The defect was closed in 27.9% (865/3,090) of the laparoscopic cases. The median follow-up time was 4.0 (1.8-6.8) years. Rates of readmission (16.2%, 502/3,090) and re-operation for complication (7.0%, 216/3,090) were significantly lower for laparoscopic compared to open repairs (19.3%, 442/2,288, P = 0.003 and 12.5%, 288/2,288, P &amp;lt; 0.001). Re-operation for bowel obstruction or bowel resection was twice as high after laparoscopic repair (0.6%, 20/3,090) compared with open repair (0.3%, 6/2,288, P = 0.044). Patients were significantly less prone to undergo repair of recurrence following laparoscopic compared with open repair of defect widths 2-6 cm (P = 0.002). Conclusions Laparoscopic intraperitoneal mesh repair for incisional hernia should still be considered for fascial defects between 2 and 6 cm, because of decreased incidences of early complications and repair of hernia recurrence compared with open repair.

A prospective randomized controlled study to compare the efficacy and safety of barbed sutures versus standard fixation techniques using tackers in laparoscopic ventral and incisional hernia repair

BackgroundLaparoscopic ventral and incisional hernia mesh repair (LVIHR) has become the standard of care due to shorter recovery time, low rate of complication and recurrence. The most common fixation technique for mesh is by tackers but results in patients having more pain in the early postoperative period. One modality to reduce pain has been to use intracorporeal conventional sutures but with the disadvantage of inherent difficulty in handling, suturing and knotting which is obviated by barbed sutures. MethodsThe study was conducted over a period of two years. Sixty patients with primary ventral and incisional hernia were randomized to either fixation of mesh with barbed sutures or to tackers with transfacial sutures. Primary end points were used to evaluate and compare mesh fixation time, early postoperative pain and complications, whereas secondary end points were used to compare the incidence of chronic pain and recurrence. ResultsOf the 60 patients, 51% had primary ventral hernia, and the rest had incisional hernia. Visual Analogue Scale (VAS) pain score for the barbed suture group at all intervals postoperatively was significantly lower than that for tackers. The mean time taken for fixation in the tacker group was significantly lower. Only one patient under the tacker group developed recurrence. ConclusionBarbed suture group had significantly less pain and is economical with the same rates of recurrence as compared with tackers. Hence, low pain scores, cost effectiveness and relatively easier intracorporeal suturing make barbed sutures a viable alternative for intracorporeal mesh fixation in LVIHR.

Standardized sublay technique in polypropylene mesh repair of incisional hernia: A prospective clinical study

Introduction: With the introduction of meshes to support hernia repairs the recurrence rates were reduced from 50% to less than 10%. Special complications such as scar plates with restriction of the mobility of the abdominal wall, pain and fistula formation are described. Methods: In a prospective study trial 40 patients with incisional hernia were treated with polypropylene mesh repair in the standard sublay technique. Results: Within a mean follow-up period of 2 years, 6-12-2018 to 25-12-2020, most of the patients were free from pain and very satisfied. Two recurrences, occurred and 2 hematomas had to be removed surgically. Conclusions: Using a standard operation technique with the mesh in sublay position, even with polypropylene mesh, good clinical results can be achieved compared to published findings. To our surprise we found two central recurrences through the mesh.

Is the surgical site infection rate higher in sublay or onlay mesh repair of incisional hernia?

A best evidence topic has been constructed using a described protocol. The three-part question addressed was: In mesh repair of incisional hernia, which technique has a lower rate of surgical site infection (SSI), Sublay or Onlay? The best evidence showed that there is no statistically significant difference in the rate of SSI among the two techniques.

Is the recurrence rate of incisional hernia is affected by mesh positioning?

A best evidence topic has been constructed using a described protocol. The three-part question addressed was: In open mesh repair of incisional hernia, which technique has a lower recurrence rate, Sublay or Onlay? The best evidence showed that there is no statistically significant difference in the rate of recurrence among the two techniques.

Comparison of "onlay" and "sublay" methods of mesh repair of incisional hernia in terms of early and late period wound complications

Comparison of "onlay" and "sublay" methods of mesh repair of incisional hernia in terms of early and late period wound complications

Bleed into an undiagnosed mesenteric cyst following mesh repair for incisional hernia: A surgical nightmare

Bleed into an undiagnosed mesenteric cyst following mesh repair for incisional hernia: A surgical nightmare

Incidence of seroma in sublay versus onlay mesh repair of incisional hernia

A best evidence topic has been constructed using a described protocol. The three-part question addressed was: In patient undergoing open mesh repair of incisional hernia, is there any difference in the rate of seroma between Sublay and Onlay technique? The best evidence showed that Sublay repair has a lower seroma rate in comparison to onlay repair.

Open or laparoscopic mesh repair of incisional hernia in patients that underwent liver transplantation: A systematic review and proportional meta‐analysis

Incisional hernias, that significantly affect the quality of life of patients, are common complications especially after major surgery, such as liver transplantation. The purpose of this meta-analysis is to outline the available evidence on the complications occurring after mesh implantation as a treatment of ventral incisional hernias (VIH) in liver transplant patients. MEDLINE, SCOPUS, Clinicaltrials.gov, CENTRAL and Google Scholar databases were searched for articles that reported the complications after mesh repair in patients that had undergone liver transplantation. Eighteen studies, that involved 640 liver transplant patients who developed incisional hernia, were included. 546 of them underwent surgical repair with mesh implantation. 144 (26%) patients developed postoperative complications, and the most common was surgical site infection (17%). The pooled complication rate of open mesh repair of incisional hernia after liver transplantation was 23% (95% CI=11%-37%), whereas the pooled complication rate of laparoscopic mesh repair was 20% (95% CI=12%-29%). Laparoscopic VIH repair with the implantation of mesh showed promising results, since the percentage of patients with postoperative complications was lower compared to the available data of those who underwent open VIH repair with mesh.

Incisional hernia: conventional open mesh versus laparoscopic repair; a randomized controlled study

Background: Incisional hernia is a common complication after laparotomy. Up to now, there is no consensus on the ideal surgical approach of such hernia. The aim of the present study was to compare the surgical outcomes, feasibility and cost effectiveness of the open mesh repair and laparoscopic repair of incisional hernia.Methods: A randomized controlled study conducted between August 2015 and September 2019 in which 64 patients with incisional hernias were randomly selected for either open mesh repair (36 patients) or laparoscopic repair (28 patients).Results: Patients in both groups were similar in their characteristics. The mean operative time was significantly longer in laparoscopic repair than in open mesh repair (128.6±15 minutes versus 89.8±82 minutes, p&lt;0.05). The peri-operative complications and intra-operative blood loss were comparable in the two groups. The use of the drain was significantly higher in open group than in laparoscopic repair group (44.4% versus 10.7%). The overall rate of postoperative complications was similar in both groups, (25% for each group). The rate of wound infection and the length of hospitalization were significantly less in laparoscopic repair group. The results of postoperative pain score, cosmetic outcomes and recurrence rate showed no significant differences between the two groups but patient's satisfaction was significantly higher in laparoscopic repair. p&gt;0.05.Conclusion: Both laparoscopic and conventional open mesh repair of incisional hernia are equivalent and feasible and safe technique. Laparoscopic repair was superior to open mesh repair in term of surgical site infection, hospital stay and patient’s satisfaction only.

Comparative Study between Sublay versus Onlay Mesh Repair in Treatment of Incisional Hernia

Abstract Background: Incisional hernia is a common complication following laparotomy and is the most common indication for reoperation. However, the optimal approach for its repair is still a matter of debate. Aim of Study: The aim of this study was to compare between sublay and onlay mesh repairs in treatment of inci-sional hernia regarding the operative technique and post-operative complications. Patients and Methods: This prospective comparative study was conducted in General Surgery Department at Al-Zahraa University Hospital and Damanhour Medical National Institute in the period between October 2018 and April 2020. It included 120 patients with incisional hernia who were randomly divided into two equal groups: A (treated with sublay repair) and B (treated with onblay repair). Results: The mean operative time in group A was 112.2 minutes and in group B was 98.2 minutes. The mean time of drain removal in group A was 5.9 days while in group B was 14.17 days. Seroma formation after drain removal was not recorded in any patients of group A while it occurred in 6 patients in group B (10%). The other postoperative complica-tions were comparable in both groups. During 6 months of follow-up, hernia recurrence occurred in 1 patient in group A (1.7%) and in 3 patients in group B (5%). Conclusion: Sublay mesh repair of incisional hernia is a good alternative to onlay repair. It is applicable to all sites of incisional hernia with a low recurrence rate and acceptable complication rates.

Polycythaemia Rubra Vera With Incisional Hernia Surgery- A Very Rare Case Report

Polycythaemia rubra vera is a chronic myeloproliferative disorder that is characterized by excessive red cell production and unlike other forms of polycythaemia, it can cause both bleeding and thrombosis in the same patient. Only few cases have been reported in the literature where polycythaemia rubra vera with surgery was performed successfully .The ideal peri-operative management is currently unknown. Here we present a case of 50 yrs old lady with polycythaemia rubra vera underwent open mesh repair for incisional hernia. After operation, the patient developed hemorrhagic complications needing resuscitation with blood and plasma expander. The patient was managed efficiently. Considering its very rarity, we are reporting the case.&#x0D; J Dhaka Medical College, Vol. 27, No.2, October, 2018, Page 218-222