Open Incisional Hernia Repair Research Articles

Cost analysis of the use of small stitches when closing midline abdominal incisions

Suturing with small stitches instead of with large reduces the risk for surgical site infection and incisional hernia in continuously closed midline abdominal incisions. The purpose was to analyse if using small stitches generated cost savings. Between 2001 and 2006 closure of midline incisions using small stitches was, in a randomised trial, compared with the use of large stitches. In 2011 all patients included in the randomised trial, who until then, had had an incisional hernia repair, were recorded. The cost for an open incisional hernia repair with mesh reinforcement during 2010 was calculated. The analysis included both direct and indirect costs. Of 321 patients closed with small stitches incisional hernia occurred in 11 and 3 needed repair. Of 370 patients closed with large stitches herniation occurred in 45 and 14 needed repair. The direct cost per hernia repair was 59,909 Swedish krona (SEK) and the indirect cost was 26,348 SEK. Suturing time with small stitches was 4.6min longer, increasing the cost for the index operation by 1,076 SEK. From the societal perspective (direct and indirect costs), using small stitches generated a cost reduction of 1,339 SEK for each patient. From the perspective of the public payer (direct costs) the cost reduction was 601 SEK. Using small stitches generated cost savings from a societal perspective if the suturing time was not prolonged over 10.3min. Using small stitches when closing midline abdominal incisions with a continuous single-layer technique generates cost savings.

The INCH-Trial: a multicentre randomized controlled trial comparing the efficacy of conventional open surgery and laparoscopic surgery for incisional hernia repair

BackgroundAnnually approximately 100.000 patients undergo a laparotomy in the Netherlands. About 15,000 of these patients will develop an incisional hernia. Both open and laparoscopic surgical repair have been proven to be safe. However, the most effective treatment of incisional hernias remains unclear. This study, the ‘INCH-trial’, comparing cost-effectiveness of open and laparoscopic incisional hernia repair, is therefore needed.Methods/DesignA randomized multi-center clinical trial comparing cost-effectiveness of open and laparoscopic repair of incisional hernias. Patients with a symptomatic incisional hernia, eligible for laparoscopic and open incisional hernia repair. Only surgeons, experienced in both open and laparoscopic incisional hernia repair, will participate in the INCH trial. During incisional hernia repair, a mesh is placed under or on top of the fascia, with a minimal overlap of 5 cm. Primary endpoint is length of hospital stay after an incisional hernia repair. Secondary endpoints are time to full recovery within three months after index surgery, post-operative complications, recurrences, mortality and quality of life.Our hypothesis is that laparoscopic incisional hernia repair comes with a significant shorter hospital stay compared to open incisional hernia repair. A difference of two days is considered significant. One-hunderd-and-thirty-five patients are enrolled in each treatment arm. The economic evaluation will be performed from a societal perspective. Primary outcomes are costs per patient related to time-to-recovery and quality of life.The main goal of the trial is to establish whether laparoscopic incisional hernia repair is superior to conventional open incisional hernia repair in terms of cost-effectiveness. This is measured through length of hospital stay and quality of life. Secondary endpoints are re-operation rate due to post-operative complications or recurrences, mortality and quality of life.DiscussionThe difference in time to full recovery between the two treatment strategies is thought to be in favor of laparoscopic incisional hernia repair. Laparoscopic incisional hernia repair is therefore expected to be a more cost-effective approach.Trial registrationNetherlands Trial register: NTR2808

Utilidad de un cuestionario postal en el seguimiento de la reparación de la hernia incisional: estudio prospectivo de una cohorte

AimTo assess the usefulness of a short postal questionnaire as a method of follow-up in incisional hernia repair. Patients and methodAll consecutive patients (n=285) undergoing open mesh repair of incisional hernia using an onlay technique between 1998 and 2003 received a six-item self-administered questionnaire complemented with ideograms. Non-responders received two successive new questionnaires and a telephone call. All patients’ operation forms were reviewed. Patients with no objections to physical examination were contacted by phone for an appointment. The Fisher's exact test or the chi-square (χ2) tests were used to compare categorical variables between clinical visits and response to questionnaire. Agreement between response to the questionnaire and data on the operation forms was measured with the Cohen's kappa index and the Fleiss kappa index. The predictive values of the questionnaire were calculated. Results215 patients returned questionnaires after three reminders, allowing us to reach 75.4% of the study cohort, which in turn increased to 94% after the telephone call. A total of 168 (78.2%) patients were willing to come for a physical examination. Finally 62 (36.9%) patients were examined. The overall agreement between response to the questionnaire and data on the operation forms was poor (Cohen's kappa coefficient = 0.065 and Fleiss kappa coefficient = 0.170). ConclusionsA postal questionnaire can be effective to gather information. However, the usefulness of this information in the follow-up was low due to the small percentage of patients examined and difficulties in comprehension despite making the questionnaire short and illustrated by ideograms.

Outcomes of open intraperitoneal incisional hernia repair based on patient-reported outcomes

The outcomes of open incisional hernia repair from the patients' point of view have variations over time, and only continuous follow-up would reflect the real outcomes. The purpose of this study is to validate a standard measurement instrument in the form of a questionnaire to report the evolutionary outcomes of a specific open technique to repair incisional hernias. Prospective study follows up a cohort of 82 consecutive patients submitted to elective intraperitoneal open hernioplasty of midline incisional hernias. The follow-up consisted in an interview and physical examination 30 days after surgery, at 6 months, 1 year, 2 years, 3 years, and 4 years. Primary outcome measure was reporting the outcomes of hernia repair according to a standardized scale obtained from a questionnaire. There was no correlation between complications suffered by patients and score results (p = 0.722). The length of hospital stay was 6.5 ± 4.3 days, and a prolonged hospital stay was related to complications (p = 0.002) and did not influence the score results (p = 0.365). The final score demonstrated that patients had a very good impression on this procedure 1 month after surgery (p = 0.003). This impression shifted to an excellent perception 1 year after surgery remaining similar until the last control (p < 0.0001). In this series, the intraperitoneal hernioplasty was a procedure associated with minor morbidity and without recurrences 4 years after the operation. The outcomes from the patients' point of view were excellent 1 year after the procedure with a tendency to improve in the long term.

Long-term follow-up after incisional hernia repair: are there only benefits for symptomatic patients?

Incisional hernias are among the most frequent complications in visceral surgery and are currently considered to be an indication for surgery in all cases, regardless of the patient's symptoms. However, it still remains unclear to what extent surgery actually results in improvement according to objective (e.g., less pain or dysesthesia) or subjective criteria (e.g., less discomfort or better cosmetic result). The purpose of this prospective study was to identify patients who derive objective and subjective benefit from surgical repair. This prospective study included patients who underwent open incisional hernia repair with mesh implantation from December 2006 to April 2009. Data were collected before and 18months after surgery. Pain intensity was rated on the numerical analog scale (NAS) pre- and postoperatively. Patients were divided into oligosymptomatic (NAS 0-3) and symptomatic (NAS 4-10) groups based on their preoperative pain level, and the postoperative outcome of the two groups was compared by standardized questionnaire. Ninety patients were prospectively enrolled, 45 (50%) of each gender. Prior to surgery, 43 patients (47.8%) were oligosymptomatic, and 47 (52.2%) reported clinically relevant pain. Eighteen months after surgery, 7.5% of the oligosymptomatic patients complained of clinically relevant pain; its rate remained unchanged. The symptomatic group showed a significant reduction in clinically relevant pain from 100% to 14.0%, (p<0.001). The percentage of patients with clinically relevant dysesthesia was 12.5% in the oligosymptomatic and 20.9% in the symptomatic group 18months postoperatively. The overall recurrence rate was 13.3% after 18months without difference in both groups. A reduction in discomfort in the surgical area was reported by 77.5% of the oligosymptomatic and 79.1% of the symptomatic patients. Symptomatic patients definitely profit from surgical repair in the long-term course. However, the notable postoperative rate of clinically relevant pain and dysesthesia in oligosymptomatic patients and their high recurrence rate cast doubt on whether they really benefit from surgical repair. The remarkable degree of subjective satisfaction in oligosymptomatic patients should not be underestimated.

Impact of Training on Outcomes Following Incisional Hernia Repair

Background : The purpose of this study was to quantify the effect of training on clinical outcomes following elective incisional hernia repair.Methods : The case notes of 100 consecutive elective open and laparoscopic incisional hernia repair procedures performed between January 2004 and July 2008 were reviewed retrospectively. Cases were performed either by consultant surgeons or trainees operating under direct supervision. The proportion of cases performed by trainees was recorded and the seniority of the operating surgeon related to peri-and post-operative outcomes as well as long-term recurrence rates. Results : Of the 100 cases, 61 were performed by consultants and 39 by trainees. There were no significant demographic differences between the two groups. Trainees undertook a similar proportion of laparoscopic cases as compared with consultants (44% vs. 44%). In addition, the operating time (60 ± 4 mins vs. 58 ± 4 mins), length of hospital stay (3.0 ± 0.3 days vs. 3.3 ± 0.3 days) and post-operative morbidity rates (18 % vs 10%) were similar between the two groups. At a mean follow-up period of 2.82 ± 0.17 years, the incidence of recurrent herniae was lower in the trainee group, however this was not statistically significant (8% vs 16%; p = 0.22).Conclusions : Supervised trainees can successfully undertake both open and laparoscopic incisional hernia repairs with no detrimental effects on overall hospital costs, post-operative morbidity and long-term recurrence rates.

Long term outcome and quality of life after open incisional hernia repair - light versus heavy weight meshes

BackgroundMesh repair of incisional hernia is superior to the conventional technique. From all available materials for open surgery polypropylene (PP) is the most widely used. Development resulted in meshes with larger pore size, decreased mesh surface and lower weight. The aim of this retrospective non randomized study was to compare the quality of life in the long term follow up (> 72 month) after incisional hernia repair with "light weight"(LW) and "heavy weight"(HW) PP meshes.Methods12 patients who underwent midline open incisional hernia repair with a HW-PP mesh (Prolene® 109 g/m2 pore size 1.6 mm) between January 1996 and December 1997 were compared with 12 consecutive patients who underwent the same procedure with a LW-PP mesh (Vypro® 54 g/m2, pore size 4-5 mm) from January 1998. The standard technique was the sublay mesh-plasty with the retromuscular positioning of the mesh. The two groups were equal in BMI, age, gender and hernia size. Patients were routinely seen back in the clinic.ResultsIn the long term run (mean follow up 112 ± 22 months) patients of the HW mesh group revealed no significant difference in the SF-36 Health Survey domains compared to the LW group (mean follow up 75 ± 16 months).ConclusionsIn this study the health related quality of life based on the SF 36 survey after open incisional hernia repair with light or heavy weight meshes is not related to the mesh type in the long term follow up.

Use of vacuum-assisted closure in open incisional hernia repair: a novel approach to prevent seroma formation

Frequent complications in incisional hernia surgery are re-herniation, wound infection and seroma formation. The use of subatmospheric pressure dressings such as the vacuum-assisted closure (VAC) device has been shown to be an effective way to accelerate healing of various wounds. Here, we describe the application of the VAC device as a postoperative dressing to prevent seroma formation after open incisional hernia repair. Three consecutive patients (63, 65 and 60 years of age, respectively) underwent incisional hernia repair. Patient body mass index was 30.9, 26.6 and 29 kg/m(2), respectively. All hernias were complex with a defect size greater than 10 cm and were repaired using the onlay technique. After suture skin closure the incision was covered with a thin VAC sponge (KCI, San Antonio, TX) that was set at -125 mm Hg and left in place for 5 days before removal. An abdominal CT scan performed before discharge from the hospital did not show seroma formation. Physical examination 3 months after surgery was normal with no evidence of seroma (abdominal bulge and/or fluid wave). This successful preliminary experience in three patients encourages the use of the VAC system in incisional hernia repair, particularly in selected patients with risk factors for seroma formation (e.g., large defects, obesity, patient comorbidities, nutritional status, number of prior abdominal incisions, etc.). Therefore, prevention of seroma formation after incisional hernia repair may be added as a novel application of the VAC device.

Long‐term Follow‐up of Open and Laparoscopic Repair of Large Incisional Hernias

Long-term results after laparoscopic repair of large incisional hernias remain to be determined. The aim of this prospective study was to compare early and late complications between laparoscopic repair and open repair in patients with large incisional hernias. Only patients with a hernia diameter of ≥5 cm were included in this study and were prospectively followed. We compared 56 patients who underwent open incisional hernia repair with 69 patients who underwent laparoscopic repair. Median follow-up in the laparoscopic group was 32.5 months (range 1-62 months) and in the open group 65 months (range 1-80 months). The demographic parameters were not significantly different between the two groups. However, the median hospital stay (6.0 days, range 1-23 days vs. 7.0 days, range 1-67 days; p=0.014) and incidence of surgical site infections (SSIs) (5.8% vs. 26.8%; p=0.001) were significantly lower in the laparoscopic group than in the open surgery group. Bulging of the implanted mesh was observed in 17.4% in the laparoscopic group and in 7.1% in the open group (p=NS). The recurrence rate was 18% in the open group and 16% in the laparoscopic group (p=NS). Multivariate analysis revealed that width of the hernia≥10 cm, SSI, and BMI≥30 kg/m2 were significant risk factors for hernia recurrence. The incidence of SSIs was significantly lower after laparoscopic incisional hernia repair. At long-term follow-up, the recurrence rate was not different between the two techniques. Abdominal bulging is a specific problem associated with laparoscopic repair of large incisional hernias. Size of the hernia, BMI, and SSI are risk factors for hernia recurrence irrespective of the technique.

Different methods of mesh fixation in open retromuscular incisional hernia repair: a comparative study in pigs

Reinforcement of the abdominal wall with alloplastic mesh material in incisional hernia repair is well established. To avoid dislocation and migration of the prostheses, mesh fixation is recommended. However, there seems to be a correlation between postoperative pain and mesh fixation. Furthermore, it remains unclear whether mesh fixation is necessary at all. A retromuscular mesh implantation was performed in 36 pigs using a polypropylene-polyglecaprone 25 composite mesh (Ultrapro(®), 12 × 18 cm). In group 1, the mesh was fixed to the posterior rectus sheet with non absorbable single sutures (Prolene(®) 2-0), in group 2 fixation was with absorbable sutures (Vicryl(®) 2-0), in group 3 mesh fixation was with 5 ml fibrin sealant (Quixil(®)), and, as a control, there was no fixation in group 4. The abdominal wall was explanted on postoperative day 7, 14 and 56. Mesh size and position was measured, and pull-out force of the mesh was analysed mechanically by tensiometry. The ratio of collagen type I/III was analysed to determine the quality of mesh integration. Neither mesh dislocation nor mesh migration was detected. Mesh size showed no significant differences, whether comparing time points or groups. No significant differences in the tensile strength of mesh integration were found when comparing the groups (group 1: 155 ± 17 mmHg; group 2: 175 ± 9 mmHg; group 3: 166 ± 24 mmHg; group 4: 172 ± 28 mmHg). Though the type I/III collagen ratio increased over time, no significant differences according to the type of fixation used were detected. Mesh fixation in open incisional hernia repair with retromuscular mesh augmentation to avoid mesh dislocation or migration in the early postoperative period appears to be unnecessary.

Mesh repair of medium sized midline incisional hernias: Prolene mesh versus Vypro mesh

Incisional hernia is a complication in 10-20 % of patients after laparotomy. The standard flat mesh made from polypropylene has a tensile strength that is far greater than that required physiologically. Reducing the amount of polypropylene by increasing pore size produces a lighter weight mesh that may improve the functional properties and diminish local complications. The low-weight mesh was found to be feasible, with no additional short-term mesh-related complications in the experimental model and no negative side effect on biocompatibility. Also the introduction of the retromuscular, sublay technique using polypropylene meshes had significantly decreased the recurrence rates after open incisional hernia repair. The aim of this study: To evaluate the sublay technique using light weight Vypro mesh in comparison to the same technique using heavy weight Prolene mesh for moderate size midline incisional hernias, as regard operative difficulties and postoperative complications. Patient and method: Between Aug. 2008 and Aug. 2009, 30 patients with moderate size (5- 10cm) midline incisional hernias were randomized to receive lightweight composite (Vypro) mesh, or standard polypropylene (Prolene) mesh. The clinical course of all patients was registered during the hospital stay as well as 3, 6, 9, and 12 months after surgery. Results: No significant differences were determined concerning age and gender. In contrast, length of hospital stay was lower in the low-weight mesh group. Minor complications as seroma, mild wound infection and abdominal discomfort were significantly lower among patients in whom we used Vypro meshes in the repair than patients with prolene meshes. No hernia recurrences occurred in both studied groups.

Comparable results with 3-year follow-up for large-pore versus small-pore meshes in open incisional hernia repair

Decreasing the amount of polypropylene by increasing pore size produces a lighter weight mesh that may improve tissue ingrowth and, functional properties of the abdominal wall and diminish mesh-related complications. It was the aim of this prospective observational cohort study to analyze the outcome of incisional hernia repair using small-pore versus large-pore meshes and using a standardized, open, retromuscular surgical technique. Across a 6-year period we analyzed 205 patients treated with a heavyweight mesh (group I) and 235 patients treated with a large-pore mesh (group II) for incisional hernias. Patients with a body mass index greater than 40 kg/m(2) and patients with hernias with a transverse diameter of more than 10 cm were not treated by a retromuscular mesh repair and are not included in this analysis. Recurrent incisional hernias also were not included. Both groups had 3 years of follow-up. Patients were evaluated for pain, discomfort, feeling of foreign material, and recurrences. Pre-operative characteristics were comparable between the groups, including body mass index, diabetes, and smoking. The mean total hernia surface was 56 cm(2) for group I versus 48 cm(2) in group II. The mesh surface area was 448 cm(2) for group I and 425 cm(2) for group II. Considering pain scores, there was only a minor difference between the 2 groups at 1-month follow-up, at which time, the Visual Analogue Scale was 5.8 in group I and 4.9 in group II (P = .16). All other scores were comparable between the groups. In group I, 7 recurrences (3.4%) were recorded after 3 years, of which 6 were already apparent 1 year after initial repair. In group II, 9 recurrences (3.8%) were diagnosed, again 6 within the first year after repair. Large-pore meshes can be used safely for open primary incisional hernia repair with an equal outcome compared with small-pore meshes in nonobese patients with defects smaller than 10 cm in width, in regard to both recurrence rates and chronic discomfort.

Open Incisional Hernia Repair under Local Anaesthesia

Background: The Authors give an accurate description of a method of incisional hernia repair with an open technique, under local anaesthesia. The aim of this work was to show the feasibility and safety of an open preperitoneal mesh technique, as well as giving a description of technical details and the results of incisional hernia repair under local anaesthesia.Methods: Between January 1994 and February 2008, 129 patients underwent an open mesh surgical procedure for incisional hernia. Using some simple selection criteria: maximal diameter of the hernia orifice not greater than 10 cm, the reducibility of the hernia sack, the absence of bowel obstructive symptoms, 71 patients (55.03%) were selected to be submitted to a local anaesthesia procedure, performing an open mesh repair.Results: The median operative time was 101 min. The intra-operative measurement of the hernia defect showed that: in 24 patients (33.8%) it was < 3 cm, in 37 patients (52.2%) up to 10 cm and in ten patients (14%) > 10 cm. There were only two conversions to general anaesthesia (2.8%). Among the other 69 patients only four patients (5.7%) showed transient intra-operative bradycardia. All the other 69 patients (97.2%) had immediate postoperative deambulation. Forty-four of them (63.4%) were discharged within 24 h. During follow-up (12–168 months) only two recurrences (2.8%) were registered.Conclusions: This experience clearly shows that local anaesthesia for incisional hernia repair with a open preperitoneal mesh technique is feasible, safe, and effective, having a low intra-operative risk, being cost-effective and showing very good long-term results.

Laparoscopic and open incisional hernia repair using polypropylene mesh - A comparative single centre study

Introduction Repair of incisional hernias continues to be a challenging surgical procedure for general surgeons. Currently open mesh repair and laparoscopic repair are the two main options available for general surgeon for managing this complication. Laparoscopic repair though offers all the advantages of minimal access surgery but is a costly procedure especially due to the use of costly composite mesh. The present study is aimed to compare the open and laparoscopic repair of incisional hernia and at the same time evaluate the safety and feasibility of using comparatively cheaper polypropylene mesh. Methods Between December 2005 and December 2009 80 patients underwent incisional hernia repair, 40 open repairs and 40 laparoscopic repair. The results of the two procedures were compared with a mean follow up of 26 months for open repair and 28 months for laparoscopic repair. Results Obstetrical or gynecological procedure was the most common index surgery leading to incisional hernia and lower midline incision was the most common site of hernia. The mean defect size in open repair group was 55.2 cm 2 and 62.2 cm 2 in laparoscopic repair group. Polypropylene mesh was used in all cases. We had 1(2.5%) major complication of enterotomy and 1(2.5%) conversion in laparoscopic repair group. Postoperative complications were most commonly seen in open repair group 10(25%) and 2(5%) in laparoscopic repair group. Mean hospital stay in open repair group is 4.33 days and 1.53 days in laparoscopic repair group. We had 1(2.5%) recurrence in both groups. Conclusion Laparoscopic repair of incisional hernia is a much better procedure for curing incisional hernia as compared to open mesh repair and additionally intraperitoneal use of polypropylene mesh was not associated with any significant complication.

Impact of mesh positioning on foreign body reaction and collagenous ingrowth in a rabbit model of open incisional hernia repair

Incisional hernia remains as one of the most common surgical complications. Different mesh techniques are used in 75-80% of hernia repair. The aim of this study was to evaluate the dependence of mesh positioning and the type of mesh implanted on foreign body reaction and collagenous ingrowth. In 24 male Chinchilla rabbits, an incisional hernia repair was performed with mesh reinforcement either by sublay (n = 12) or by onlay technique (n = 12). In each group, two different types of mesh prosthesis were investigated: polypropylene (PP, Prolene) and polypropylene-polyglecaprone 25 composite (PP-PG, UltraPro). On postoperative day 60, the inflammatory and connective tissue formation was characterised by measuring the diameter of inner cellular infiltrate and outer fibrous capsule of the foreign body granuloma, and by verifying the collagen type I/III ratio. Furthermore, the expression of matrix metalloproteinase-2 (MMP-2) was analysed. Microscopic investigation of the mesh/host-tissue interface showed typical formation of foreign body granuloma. The diameters of the inner part of the foreign body granuloma representing the amount of inflammatory cell infiltrate were significantly increased in the PP mesh compared to the PP-PG mesh, both in the sublay group (PP 13.1 +/- 1.21 microm vs. PP-PG 11.7 +/- 0.34 microm; P = 0.026) and in the onlay group (PP 13.1 +/- 1.24 microm vs. PP-PG 11.2 +/- 0.55 microm; P = 0.009). The diameter of the fibrous capsule as the outer ring of the granuloma was significantly increased when investigating the PP mesh in sublay position (29.5 +/- 1.12 microm) compared to the PP mesh in onlay position (27.9 +/- 0.73 microm) (P = 0.026). Investigating the quality of perifilamentary collagen deposition expressed as collagen type I/III ratio, the sublay group showed significantly elevated values compared to the onlay group (PP sublay 3.1 +/- 0.18 vs. PP onlay 2.4 +/- 0.41; P = 0.004) (PP-PG sublay 3.5 +/- 0.34 vs. PP-PG onlay 2.6 +/- 0.13; P = 0.002). The analysis of MMP-2 expression revealed no significant differences. The beneficial results of mesh reinforcement in the sublay technique might be due to a superior quality of postoperative connective tissue formation. Mesh incorporation, irrespective of positioning, is favourable in low-weight, large, porous mesh material represented by a reduced inflammatory part of the foreign body granuloma.

Authors' reply: Meta-analysis of randomized controlled trials comparing open and laparoscopic ventral and incisional hernia repair with mesh (Br J Surg 2009; 96: 851–858)

Authors' reply: Meta-analysis of randomized controlled trials comparing open and laparoscopic ventral and incisional hernia repair with mesh (<i>Br J Surg</i> 2009; 96: 851–858)

Meta-analysis of randomized controlled trials comparing open and laparoscopic ventral and incisional hernia repair with mesh (Br J Surg 2009; 96: 851–858)

Meta-analysis of randomized controlled trials comparing open and laparoscopic ventral and incisional hernia repair with mesh (<i>Br J Surg</i> 2009; 96: 851–858)

Open Incisional Hernia Repair at an Academic Tertiary Care Medical Center

To describe the postoperative complication rates of a large consecutive series of patients who underwent open incisional ventral hernia repair. Retrospective medical record review of an accumulated database. University tertiary care medical center. All patients who underwent open incisional ventral hernia repair from March 1, 2003, through February 28, 2008. Open incisional ventral hernia repair. Postoperative complications, including hernia recurrences. A total of 507 cases (465 patients; female to male ratio, 1.1:1) met our criteria; median follow-up was 40 months. In 23.5% of the cases, repair had been attempted previously, and 16.4% had previously undergone organ transplant. The postoperative complication rate was 38.1%. Hernias recurred in 18.9% of cases. Perioperative mortality was 1.0%. Patients undergoing transplant were more likely than those not undergoing transplant to have a hernia recurrence (16.3% vs 32.5%; P < .001) and were equally likely to have a postoperative complication (36.9% vs 44.6%; P = .19). Patients who underwent repair of a recurrent incisional hernia were as likely to have a hernia recurrence as those who underwent initial repair (21.0% vs 18.3%; P = .52) but more likely to have an overall complication (47.9% vs 35.1%; P = .01). In this series of incisional hernia repairs at a tertiary care center, the overall recurrence rate of 18.9% is comparable to that of other published series. Ours is the largest published series of recurrent hernias that shows a recurrence rate comparable to that for initial repairs. This outcome may be the result of greater use of more complex repair techniques.

Meta-analysis of randomized controlled trials comparing open and laparoscopic ventral and incisional hernia repair with mesh

Laparoscopic ventral and incisional hernia repair has been reported in a number of small trials to have equivalent or superior outcomes to open repair. Randomized controlled trials comparing laparoscopic and open incisional or ventral hernia repair with mesh that included data on effectiveness and safety were included in a meta-analysis. Eight studies met the inclusion criteria. There was no difference between groups in hernia recurrence rates (relative risk 1.02 (95 per cent confidence interval (c.i.) 0.41 to 2.54)). Duration of surgery varied. Mean length of hospital stay was shorter after laparoscopic repair in six of the included studies; the longest mean stay was 5.7 days for laparoscopic and 10 days for open surgery. Laparoscopic hernia repair was associated with fewer wound infections (relative risk 0.22 (95 per cent c.i. 0.09 to 0.54)), and a trend toward fewer haemorrhagic complications and infections requiring mesh removal. Laparoscopic repair of ventral and incisional hernia is at least as effective, if not superior to, the open approach in a number of outcomes.

Laparoscopic incisional hernia repair: evaluation of effectiveness and experiences

Incisional hernia is the most frequent postoperative complication following abdominal surgery and is a common and costly source of morbidity. Conventional mesh repair is the standard treatment today, but the use of laparoscopic incisional hernia repair (LIHR) seems to be a good alternative. We performed a retrospective analysis comparing open incisional hernia repair with the laparoscopic approach. Between June 2004 and June 2006, 123 patients with incisional hernia were included. Open repair (37 men and 45 women; mean age 62.6 years) was performed in 82 cases, whereas 41 patients underwent laparoscopic repair (29 men and 12 women; mean age 64.3 years). Patient- and procedure-associated characteristics, clinical outcome, and recurrence rate were determined after a median follow-up period of 23 months for the laparoscopic group and 24 months for the open group. Hernia sizes were comparable between the groups. Conversion to open repair was required in two cases. Postoperative pain scores did not differ significantly. In the long-term follow-up, however, the pain score was less (P = 0.001) and the satisfaction rate was higher (P = 0.003) in the laparoscopic group. Complications occurred in 23% of patients in the open group and 20% in the LIHR group. The recurrence rate was lower in the laparoscopic group, with 9% (3/35) compared to 23% (18/77) in the open group (P = 0.089). Our results show the tendency that LIHR is associated with less postoperative pain and comparable postoperative complications. The low recurrence rate proves the safety and the good long-term results of this procedure. Laparoscopic hernia repair is an alternative to open procedures in cases of feasibility. Further studies, especially randomized controlled trials, are required to confirm these findings and provide the basis for future treatment guidelines.