Onlay Mesh Research Articles

Nutritional support for patients in general surgery

The modern stage of development of surgery, especially minimal invasive technologies, has significantly changed the surgeons' thoughts about the perioperative period. Until the end of the twentieth century, pre‑ and postoperative fasting was the most important requirement in planned surgery. It was believed that it could help to avoid complications both during surgery and in the early postoperative period. H. Kehlet in his fundamental work outlined the factors that allowed to accelerate the patient's recovery after surgery, namely: the absence of preoperative fasting.
 Objective — to evaluate the effectiveness of nutritional support for surgical patients within ERAS (Enhanced Recovery After Surgery) and ESPEN (European Society for Clinical Nutrition and Metabolism) protocols.
 Materials and methods. This research included both traditional laparoscopic cholecystectomy (177 cases) and single‑port transumbilical cholecystectomy (8); among laparoscopic bariatric interventions, the major part was represented by classical Roux‑Y gastric shunting (28), as well as sleeve gastrectomy (5) and mini‑gastric shunting (4); among 123 different laparoscopic hernioplasties, in 64 cases transabdominal preperitoneal (TAPP) was performed for bubonocele, intraperitoneal onlay mesh (IPOM) for postoperative ventral and umbilical hernias (59), laparoscopic crurography and fundoplication with and without alloplasty (33). For each type of surgery two groups we identified: control and experimental. Both groups were followed by ERAS protocols in addition to nutritional support. With the prior consent of patients before surgery: the experimental group received full perioperative nutritional support according to our local protocols using protein‑enriched sip feeding formula Nutridrink Protein, the control group followed the traditional scheme of fasting during 12 hours before surgery and received regular drinking water instead of protein mixtures at the first postoperative day.
 Results. We found statistically significant difference between control and experimental groups in assessing of two important parameters as hunger and weakness. The hunger after laparoscopic cholecystectomy was 1.5 times (p < 0.001), after laparoscopic hernia repair — 1.7 times (p < 0.001), after laparoscopic crurography and fundoplication — 1.26 times (p < 0.001), after laparoscopic bariatric intervention — 1.43 times, and after laparoscopic colon intervention — 1.9 times lower in the experimental group. The weakness after laparoscopic cholecystectomy was 1.8 times (p < 0.001), after laparoscopic hernia repair — 1.31 times (p < 0.001), after laparoscopic crurography and fundoplication — 1.68 times (p < 0.001), after laparoscopic bariatric intervention — 1.67 times (p < 0.001), and after laparoscopic colon intervention — 1.38 times (p = 0.006) stronger in the control group.
 Conclusions. Traditional long‑term preoperative fasting is inappropriate. Combined with other ERAS postulates, perioperative nutritional support for surgical patients has a great chance of success. In our research, early restoration of oral nutrition significantly decreases hunger and general weakness in the early postoperative period, which allows the patient quickly return to full life.

Comparative review of outcomes: single-incision laparoscopic total extra-peritoneal sub-lay (SIL-TES) mesh repair versus laparoscopic intraperitoneal onlay mesh (IPOM) repair for ventral hernia

To compare outcomes between single-incision laparoscopic totally extra-peritoneal sub-lay (SIL-TES) mesh repair and laparoscopic intraperitoneal onlay mesh (IPOM) repair of ventral hernia (VH). A retrospective selection of 104 patients who underwent VH repair (50 and 54 in the SIL-TES and IPOM groups, respectively) was made. Patient data were collected, and quality of life was evaluated using Carolinas Comfort Scale (CCS) 1 month and 3 months after surgery. There were no significant differences in sex, American Society of Anesthesiologists class, defect size, mesh area, estimated blood loss, and complication rate between the groups. Age was lower, body mass index was higher, prevalence of primary VH was significantly higher (p < 0.0001), and pain was less at 24 and 48 h post procedure (p < 0.0001) in the SIL-TES group. Drainage placement was more (p < 0.0001), operation time was shorter (p = 0.012), and hospitalization duration and total hospitalization cost were greater in the IPOM group than that in SIL-TES group (8.3 ± 0.3 vs 4.3 ± 0.4 days, p < 0.0001; $7126.9 ± 141.4 vs $2937.3 ± 58.3, p < 0.0001, respectively). Pain and movement limitation scores evaluated by CCS were significantly worse at 1 month (4.93 ± 0.28 vs 1.75 ± 0.28: p < 0.0001; 2.52 ± 0.24 vs 1.15 ± 0.18: p < 0.0001, respectively) and 3 months (4.32 ± 0.37 vs 0.9 ± 0.29: p < 0.0001; 2.06 ± 0.25 vs 0.69 ± 0.11: p < 0.0001, respectively) in IPOM group, compared with the according scores in SIL-TES group. There was no readmission within 30 days and no hernia recurrence at mean follow-up of 12 months. SIL-TES mesh repair is safe and effective and is superior to IPOM repair.

Sublay and overlay mesh repair in paraumbilical hernias– which surgery you will prefer??

Background: Paraumbilical hernia accounts for 33.9% of anterior abdominal wall hernia. Mesh can be applied onlay; on the anterior fascia, inlay; in the hernia defect, sublay; to retro-rectus or preperitoneal space or underlay; in the intraperitoneal position. Aims and Objectives: The objectives of the study are as follows:1) To compare the efficacy between sublay and onlay mesh repair for paraumbilical hernia. 2) To compare the safety between sublay and onlay mesh repair for paraumbilical hernia. Materials and Methods: A prospective study was conducted on 120 patients (60 in each group) patients. The patients were randomly allocated in two groups by lottery method. Patients in Group-A were subjected to sublay mesh repair procedure and patients in Group-B were subjected to onlay mesh repair procedure for paraumbilical hernia repair. Postoperatively, every patient was kept under observations for 3–4 days in ward and observed for complications. Postoperatively, all patients were followed at 10 days, 3 months, and 6thmonth to confirm efficacy and safety of the procedure. Results: The average age of Group-A was 39 years and 32 years in Group-B. In Group-A, 55% patients were female and 45% patients were male; whereas in Group-B, 60% patients were female and 40% patients were male. More over sublay mesh repair was effective in 82% patients on the bases of recurrence while this procedure was safe in 90% cases on the bases of complications whereas onlay mesh repair was effective in 90% patient’s cases on the bases of recurrence while this procedure was safe in 93% cases on the bases of complications. Conclusion: Onlay mesh repair technique is more effective, quick, and safe as compared to sublay mesh repair technique for the treatment of paraumbilical hernia.

“COMPARATIVE STUDY BETWEEN PREPERITONEAL AND INTRAPERITONEAL ONLAY MESH REPAIR OF VENTRAL HERNIA”

In this study we compare the results between Preperitoneal and Intraperitoneal Onlay Mesh Repair of Ventral Hernia. It is a Prospective Randomized Controlled study conducted in a tertiary care centre in Eastern India between September 2018 and March 2020.In this study 78 patients were enrolled. They are randomized into two groups. About 65% of patients who enrolled for the study are females. 12% patients had Umbilical hernia, 55% had Paraumbilical hernia and 24% had Epigastric hernias. Patients with Incisional Hernia were not included. The mean duration of surgery, hospital stay and pain score (as per the visual analog scale) was signicantly less in IPOM compared to PPOM. There was no Haematoma formation in either of the groups. Return to normal work was signicantly earlier in the group undergoing IPOM over those undergoing PPOM. Patients undergoing IPOM were more satised with the cosmetic appearance in the post-operative period as compared to those undergoing PPOM however the incidence of seroma formation was more in the former.

Laparoscopic intraperitoneal onlay mesh repair for ventral hernia: our experience

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

Outcomes of Laparoscopic Ventral Hernia Repair in Obese patients

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

A propensity-score matched analysis of ventral-TAPP vs. laparoscopic IPOM for small and mid-sized ventral hernias. Comparison of perioperative data, surgical outcome and cost-effectiveness

PurposeLaparoscopic techniques have been used and refined in hernia surgery for several years. The aim of this study was to compare an established method such as laparoscopic intra-peritoneal onlay mesh repair (lap. IPOM) with ventral Transabdominal Preperitoneal Patch Plasty (ventral-TAPP) in abdominal wall hernia repair.MethodsPatient-related data of 180 laparoscopic ventral hernia repairs between June 2014 and August 2020 were extracted from our prospectively maintained database. Of these patients, 34 underwent ventral-TAPP and 146 lap. IPOM. After excluding hernias with a defect size > 5 cm and obtaining balanced groups with propensity-score matching, a comparative analysis was performed in terms perioperative data, surgical outcomes and cost-effectiveness.ResultsPropensity-score matching suggested 27 patients in each of the two cohorts. The statistical evaluation showed that intake of opiates was significantly higher in the lap. IPOM group compared to ventral-TAPP patients (p = 0.001). The Visual Analogue Scale (VAS) score after lap. IPOM repair was significantly higher at movement (p = 0.008) and at rest (p = 0.023). Also, maximum subjective pain during hospital stay was significantly higher in the lap. IPOM group compared to ventral-TAPP patients (p = 0.004). No hernia recurrence was detected in either group. The material costs of ventral-TAPP procedure (34.37 ± 0.47 €) were significantly lower than those of the lap. IPOM group (742.57 ± 128.44 € p = 0.001). The mean operation time was 65.19 ± 26.43 min in the lap. IPOM group and 58.65 ± 18.43 min in the ventral-TAPP cohort. Additionally, the length of hospital stay in the lap. IPOM cohort was significantly longer (p = 0.043).ConclusionVentral-TAPP procedures represent an alternative technique to lap. IPOM repair to reduce the risk of complications related to intra-peritoneal position of mesh and fixating devices. In addition, our study showed that postoperative pain level, material costs and hospital stay of the ventral-TAPP cohort are significantly lower compared to lap. IPOM patients.

Closure of Iterative Laparotomy in Patients With Previous Mesh Reinforcement a Cohorts' Study. Short-Term Results.

Purpose: Due to extension of prophylactic mesh indications use will become more common to find patients receiving an iterative laparotomy (IL) over a previous reinforced abdominal wall. The aim of this study was to analyze outcomes after IL in patients with previous mesh reinforcement. Methods: This study was a prospective secondary analysis of midline laparotomy closure performed from July 2017 to July 2018 registered in PHACPA study (NCT02658955). IL were included and surgery characteristics and outcomes analyzed. We compared two groups: with (PreM) or without previous prophylactic onlay mesh reinforcement (PreS) Subgroups' analysis, risk factors for complications and survival free hernia analysis were performed. Results: 121 IL were analyzed. Only obesity was associated with higher SSO (OR 2.6; CI 95% 1.02-6.90; p = 0.04) There were 15 incisional hernias (IH) (14.4%). Group with previous mesh reinforcement (pre M) had a higher statistically significative incidence of IH (OR = 1.21; CI 95% 1.05-1.39; p = 0.015). Use of slowly absorbable suture (OR = 0.74; CI 95% 0.60-0.91; p = 0.001), USP 2/0 suture (OR, 0.31; 95% CI, 0.10-0.94; p = 0.033), and small bites technique (OR = 0.81; CI 95% 0.72-0.90; p = 0.011) were associated with less IH. Conclusion: IL has a high percentage of complications and IH. In case of IL without previous reinforcement, a mesh can help to reduce IH. Our data cannot clearly support any technique to close an IL with previous mesh.

Suture or Mesh Repair of the Smallest Umbilical Hernias: A Nationwide Database Study.

Mesh is recommended for umbilical hernias with defects > 1cm to reduce recurrence. For umbilical hernias with defect width ≤ 1cm, the literature is sparse. The aim of this nationwide cohort study was to assess outcomes after suture and mesh repair of umbilical hernias with defect width ≤ 1cm and to evaluate outcomes after onlay mesh repair specifically. By merging data from the Danish Hernia Database and the National Patients Registry from 2007 to 2018, patients undergoing elective open repair of an umbilical hernia with defect width ≤ 1cm were identified. Available data included details about comorbidity, surgical technique, 90-day readmission, 90-day reoperation and operation for recurrence. A total of 7849 patients were included, of whom 25.7% (2013/7849) underwent mesh repair. Reoperation for recurrence was significantly decreased after mesh repair 3.1% (95% C.I. 2.1-4.1) compared with suture repair 6.7% (95% C.I. 6.0-7.4), P < 0.001. Readmission and reoperation rates were significantly higher for mesh repair 7.9% (159/2013) and 2.6% (52/2013) than for suture repair 6.5% (381/5836) and 1.5% (89/5836), P = 0.036 and P = 0.002, respectively. Onlay mesh repairs had the lowest risk of recurrence 2.0% (95% C.I. 0.6-3.5), and readmission [7.9% (65/826)] and reoperation [3.9% (32/826)] rates within 90 days were comparable to suture repairs [6.5% (381/5836)] and [3.3% (192/5836)], P = 0.149 and P = 0.382, respectively. Even for the smallest umbilical hernias, mesh repair significantly decreased the recurrence rate. Onlay mesh repair was associated with lowest risk of recurrence without increasing early complications.

Comparison of extended totally extra peritoneal (eTEP) vs intra peritoneal onlay mesh (IPOM) repair for management of primary and incisional hernia in terms of early outcomes and cost effectiveness-a randomized controlled trial.

There are no randomized controlled trials comparing the eTEP with IPOM repair and this randomized study was designed to compare the two techniques in terms of early pain, cost effectiveness, and quality of life. This was a prospective randomized trial with intention to treat analysis. The primary outcome was immediate post-operative pain scores. Operative time, conversions, peri operative morbidity, hospital stay, return to daily activities, incremental cost effectiveness ratio and quality of life (WHO-QOL BREF) were secondary outcomes. Sixty patients were randomized equally. Early post-operative pain scores and seroma rates were significantly lower and with a significantly earlier return to activity in eTEP group (p value &lt; 0.05). With negative costs and positive effects, eTEP group was 2.4 times more cost effective. eTEP repair is better in terms of lesser early post-operative pain, earlier return to activities and cost effectiveness in small and medium size defects.

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

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

A COMPARATIVE STUDY BETWEEN ONLAY AND SUBLAY MESH REPAIR IN THE MANAGEMENT OF INCISIONAL HERNIA

Background: An incisional hernia is one of the common complications of abdominal surgery and the incidence of incisional hernias continues to be 3 to 11% after laparotomy. The repair of incisional hernia has always been a challenge to the surgeon. Various operative techniques for the repair of incisional hernia are in practice; however, the management is not standardized. Aim: To compare onlay mesh placement versus sublay mesh placement in repair of incisional hernias. This prospective study Material and Methods: comprised of 50 patients with an incisional hernia. A total of 50 cases were included in the study. Of the 50 cases, 25 cases were operated by the onlay mesh method and 25 by sublay mesh placement. Results: The operative time for sublay mesh repair was signicantly higher than that of onlay mesh repair, whereas, complications like haemorrhage, seroma formation and deep surgical site infection leading to extrusion of mesh was higher in onlay mesh repair. The recurrence rate was found to be 4% in onlay mesh repair whereas it was 0% in sublay mesh repair. Sublay mesh repair, though technically difcult, Conclusion: and takes more time for surgery has the distinct advantage of reducing the rate of infection and recurrence.

An observational study to compare the outcomes of onlay technique with combined onlay-plug technique of mesh hernioplasty in inguinal hernia

Background: Inguinal Hernia is a common entity in general surgical practices across the world. Its management though appears to be straightforward, could still be a nightmare for a surgeon if not dealt with proper attention and care. Lichtenstein’s mesh hernioplasty is still one of the most popular surgeries performed for inguinal hernia repair across the world. At our institute, we commonly perform this surgery with either Onlay mesh hernioplasty technique or combined Onlay-Plug mesh technique. The double mesh placement had always kept us engaged in regards to its post-operative outcomes and its advantage over single onlay mesh. We were also keen to take the subject due to the scarce availability of the recent literature.Methods: This prospective observational study was conducted in the Department of Surgery, Dr. Hedgewar Hospital, Aurangabad, Maharashtra, India on 200 patients who were randomly and equally divided into two groups. Patients in Group A underwent Onlay mesh hernioplasty surgery, while patients in Group B underwent combined Onlay-Plug mesh hernioplasty surgery. Post-operative outcomes were assessed in both groups for a period of six months.Results: There was a significant difference between the two groups in terms of post-operative pain, scrotal edema, cord tenderness, and wound infection as patients in Group 2 who underwent combined Onlay-Plug mesh repair were found to have more incidences of the above-mentioned post-operative outcomes.Conclusions: Single Onlay mesh placement is sufficient. There is no significant benefit of keeping an additional Plug/Inlay mesh in patients undergoing tension-free mesh inguinal hernioplasty as per our findings.

A study of venous thromboembolic complications following laparoscopic mesh hernioplasty for midline ventral hernias

Background: Midline ventral hernia is a common complication of abdominal surgeries. Laparoscopic mesh hernioplasty is novel method of hernia repair but has many complications. Venous thromboembolic complications are one of them.Methods: A prospective observational study in patients with midline ventral hernia was carried out. Based on the size of defect patients were divided into two groups (consisting 60 patients each). Group A with hernia defect size of less than 6cm and group B with more than 6 cm. Group A patients underwent intraperitoneal onlay mesh plus repair and group B patients underwent endoscopic components separation technique with intraperitoneal onlay mesh repair. Each patient was followed up at day 5 and day 30 postoperatively and Well’s score was calculated. The patients with ‘Likely’ score were taken for Doppler ultrasonography. The patients with ‘Unlikely’ score were further evaluated with D-Dimer study. Patients with raised value of D-Dimer were taken for Doppler ultrasonography.Results: Well’s score on post-operative day 1 and 5 did not show any statistical significance between both groups (p&lt;0.05). D-dimer done in Unlikely score showed no statistical significance. In all the patients with Likely score and raised D-dimer, no abnormality was detected on sonography.Conclusions: Performing Wells score preoperatively and postoperatively one can get an idea about the risks of development of thromboembolic events.

Complete intraluminal migration of IPOM mesh causing sub-acute intestinal obstruction: a rare case report

Incisional hernia is a common complication following an abdominal surgery. They have ideally managed with open/ laparoscopic mesh repair. Mesh related complication are many due to increasing number of surgeries. This is a case of complete transluminal migration of a IPOM mesh and an eroding Onlay mesh presenting as a sub-acute intestinal obstruction after 2 years of incisional hernia surgery. Mesh migration is one of the complications of incisional hernia repair because of inadequate fixation or by ongoing inflammation (foreign body reaction). Complete trans luminal mesh migration is a rare complication with very few reports noted on bowel and urinary bladder. Transluminal migration into small bowel is a rare complication and it should be considered in differentials whenever patient comes with abdominal symptoms with past history of hernia repair.

Favorable Outcomes After Retro-Rectus (Rives-Stoppa) Mesh Repair as Treatment for Noncomplex Ventral Abdominal Wall Hernia, a Systematic Review and Meta-analysis.

To assess prevalence of hernia recurrence, surgical site infection (SSI), seroma, serious complications, and mortality after retro-rectus repair. Ventral abdominal wall hernia is a common problem, tied to increasing frailty and obesity of patients undergoing surgery. For noncomplex ventral hernia, retro-rectus (Rives-Stoppa) repair is considered the gold standard treatment. Level-1 evidence confirming this presumed superiority is lacking. Five databases were searched for studies reporting on retro-rectus repair. Single-armed and comparative randomized and non-randomized studies were included. Outcomes were pooled with mixed-effects, inverse variance or random-effects models. Ninety-three studies representing 12,440 patients undergoing retro-rectus repair were included. Pooled hernia recurrence was estimated at 3.2% [95% confidence interval (CI): 2.2%-4.2%, n = 11,049] after minimally 12months and 4.1%, (95%CI: 2.9%-5.5%, n = 3830) after minimally 24 months. Incidences of SSI and seroma were estimated at respectively 5.2% (95%CI: 4.2%-6.4%, n = 4891) and 5.5% (95%CI: 4.4%-6.8%, n = 3650). Retro-rectus repair was associated with lower recurrence rates compared to onlay repair [odds ratios (OR): 0.27, 95%CI: 0.15-0.51, P < 0.001] and equal recurrence rates compared to intraperitoneal onlay mesh (IPOM) repair (OR: 0.92, 95%CI: 0.75-1.12, P = 0.400). Retro-rectus repair was associated with more SSI than IPOM repair (OR: 1.8, 95%CI: 1.03 -3.14, P = 0.038). Minimally invasive retro-rectus repair displayed low rates of recurrence (1.3%, 95%CI: 0.7%-2.3%, n = 849) and SSI (1.5%, 95%CI: 0.8%-2.8%, n = 982), albeit based on non-randomized studies. Retro-rectus (Rives-Stoppa) repair results in excellent outcomes, superior or similar to other techniques for all outcomes except SSI. The latter rarely occurred, yet less frequently after IPOM repair, which is usually performed by laparoscopy.

Enhanced-view totally extraperitoneal repair in a patient with incisional hernia after robot-assisted laparoscopic radical prostatectomy: a case report

BackgroundAlthough laparoscopic incisional hernia repair, especially laparoscopic intraperitoneal onlay mesh, is a widely used technique, it can cause serious complications, including mesh erosion, adhesive bowel obstruction, and chronic pain. The enhanced-view totally extraperitoneal (eTEP) technique has been reported to prevent such complications by placing the mesh in the retrorectus space. Here, we report the case of a patient with post-robot-assisted laparoscopic radical prostatectomy (RARP) incisional hernia repaired using the eTEP technique.Case presentationA 67-year-old man, who underwent RARP for prostate cancer 4 years ago developed an incisional hernia. Abdominal computed tomography showed the presence of an epigastric incisional hernia measuring 4 cm long and 3.7 cm wide. We performed an eTEP repair. We closed the hernia defect using a 0 barbed suture and placed a self-gripping mesh measuring 20 cm long and 15 cm wide in the developed retrorectus space with no fixation. There were no postoperative complications, and the patient was discharged on postoperative day 2.ConclusionseTEP repair is considered an extremely effective surgical treatment option for incisional hernias because of its few resulting postoperative mesh-and-tacker-related complications.

Compare the Efficacy and Safety between Onlay Versus Sublay Mesh Repair for Para-Umbilical Hernia

Objective: To compare the efficacy and safety between onlay mesh technique and sublay mesh technique in patients undergoing paraumbilical hernia repair. Study Design: Retrospective/Observational Place &amp; Duration: In the department of surgery, Muhammad Teaching Hospital, Peshawar and Fauji Foundation Hospital, Rawalpindi and conducted during the period from March 2021 to August 2021. Methods: A total of 166 patients with both genders having ages 18 to 65 years who were undergoing para-umbilical hernia repair were included. Patients demographic including age, gender were recorded after informed consent. Patients were equally divided into two groups Group O and Group S. Group O (83 patients) received onlay mesh technique and Group S (83 patients) received sublay technique. Outcomes such as post-operative pain, wound infection, seroma formation and hospital stay were recorded and compare the results between both groups. Results: In group O 48 (57.83%) patients and in group S 47 (56.63%) patients were females while 35 (42.17%) and 36 (43.37%) patients were males in group O and S. There was significant difference in term of post-operative pain 6.01+2.26 vs 3.58+1.44 (P-value &lt;0.05). In group O 14 (16.87%) patients and in group S 4 (4.82%) patients had wound infection. 8 (9.64%) patients in Group O and 2 (2.40%) patients in Group S had seroma. Mean Hospital stay in days was high in Group O compared to Group B 5.32+1.74 vs 2.46+1.38 days (p=&lt;0.05). There was a statistical significant difference regarding efficacy between both procedures with p-value 0.036. Conclusion: We concluded that sublay mesh technique for para-umbilical hernia repair was safe and effective with very low rate of complications as compared to onlay mesh procedure. Keywords: Paraumbilical Hernia Repair, Onlay Mesh Technique, Sublay Mesh Technique, Outcomes.

The Comparison of eTEP and IPOM in Ventral and Incisional Hernia Repair: A Systematic Review and Meta-analysis.

Open sublay technique and laparoscopic intraperitoneal onlay mesh (IPOM) technique are the most common used procedures in ventral and incisional hernia repair, however, each technique has its own disadvantages. The enhanced view total extraperitoneal technique (eTEP) aims to put the mesh in the retromuscular space by minimal invasive technique. This study is to investigate the efficacy and safety of eTEP and IPOM approach in ventral and incisional hernia repair. The major databases (PubMed, Embase, Springer, and Cochrane Library) were searched, and all studies published through May 1, 2021, using the keywords "enhanced view extraperitoneal," "extended view totally extraperitoneal," "eTEP," "TEP," "laparoscopic retromuscular," "ventral hernia," "incisional hernia," "laparoscopic intraperitoneal onlay mesh," "IPOM." All relevant articles and reference lists in these original studies were also obtained from the above databases. Five trials containing 433 patients were included in the present study. Compared with the IPOM technique, the eTEP ventral/incisional hernia repair was associated a longer operative time [mean difference=44.79; 95% confidence interval (CI): 26.57, 63; P=0.00001], less acute pain on postoperative day 1 (standardized mean difference=-3.90; 95% CI: -4.42, -3.38; P<0.00001), and day 7 (standardized mean difference=-3.72; 95% CI: -6.09, 1.35; P=0.002), and the eTEP group had a shorter hospital stay compared with the IPOM group (mean difference=-0.56; 95% CI: -0.74, -0.39; P=0.00001). There was no significant difference concerning the incidence of seroma, hematoma, intraoperative complication, and postoperative ileus between eTEP and IPOM groups. The eTEP technique in ventral and incisional hernia repair shows significantly lower acute postoperative pain and shorter hospital study but a longer operative time. In addition, there is no significant difference in terms of intraoperative or postoperative complications. Further randomized controlled studies with long-term follow-up are needed to evaluate the eTEP technique.

Botulinum Toxin A Facilitated Laparoscopic Repair of Complex Ventral Hernia.

Background: Complex ventral hernia repair can be challenging despite the recent advances in surgical techniques. Here, we aimed to examine the effectiveness of preoperative combined use of botulinum toxin A (BTA) and preoperative progressive pneumoperitoneum (PPP) for surgical preparation of patients with complex ventral hernia.Methods: In this prospective, observational study, we included 22 patients with complex ventral hernia between January 2018 and May 2021. All patients were treated with BTA injections into the lateral abdominal muscles and PPP before hernia repair. The lengths of abdominal wall muscles, the volumes of the incisional hernia (VIH), the volumes of the abdominal cavity (VAC), and the VIH/VAC ratio were measured before and after BTA and PPP using abdominal CT scan. All Hernias were repaired using laparoscopic intra-peritoneal onlay mesh (IPOM) or laparoscopic-open-laparoscopic (LOL) techniques.Results: Imaging showed a significant increase in the mean lateral abdominal muscle length from 13.1 to 17.2 cm/side (p < 0.01). Before and after BTA and PPP, the mean VIH was 894 cc and 1209 cc (P < 0.01), and the mean VAC was 6,692 cc and 9,183 cc (P < 0.01). The VAC increased by 2,491 cc (P < 0.01) and was greater than the mean VIH before PPP. An average reduction of 0.9% of the VIH/VAC ratio after BTA and PPP was obtained (p > 0.05). All hernias were surgically reduced with mesh, hernia recurrence occurred in only two patients.Conclusions: The preoperative combined use of PPP and BTA increased the abdominal volume, lengthened the laterally retracted abdominal muscles, and facilitated laparoscopic closure of large complex ventral hernia.