Ventral Hernia Repair Research Articles

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

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

Advancing geriatric surgical outcomes in elective ventral and incisional hernia repair surgeries: An American college of surgeons national surgical quality improvement program study

IntroductionIncreasing age is known to be associated with increased risk for postoperative morbidity and mortality, however, the goal of this study was to determine if an increase in age correlates to differences in surgical outcomes for elective ventral hernia repair. MethodsRetrospective cohort study using American College of Surgeons NSQIP database from 2016 to 2020. Included diagnosis codes were laparoscopic or open incisional or ventral hernia repairs, categorized into three age groups: 18-64y, 65-74y, and ≥75y. Thirty-day perioperative outcomes analyzed using bivariate χ2 test and multivariate logistic regression. ResultsWe identified 116,643 people who had elective ventral or incisional hernia repair. Compared to 18-64y and 65-74y age groups, patients ≥75y were significantly more likely to develop any post-operative complication, be re-admitted post-operatively for any reason, have an extended hospital stay, and require a reoperation. ConclusionsPatients ≥75y have significantly higher rates of perioperative complications after elective hernia repair compared to younger patients.

Feasibility of Image Inversion for Ventral Hernia Repair Using the Versius System.

Background: The aim of our technical report is to demonstrate the image inversion technique in the new Versius Robotic System. Methods: We report a step-by-step surgical maneuver for robotic surgeons when performing robotic ventral hernia repair (VHR) with the Versius Robotic System. Technical Report: The image inversion artifice consists in rotating 180° with the scope using the surgeon's master control in a specific rotation command in the right-hand joystick. The assisting surgeon can do a manual inversion of the camera without the console being aware that the scope is inverted. In this scenario, the 30° Up configuration should be used while informing the console that the scope is looking down. The surgeon can reassign instruments to each joystick. This results in the right joystick controlling the left instrument and left control controlling the right instrument. Since the image is inverted, the movements will look natural on the surgeon console. Conclusions: The use of the image inversion technique with the Versius Robotic System is effective in aiding surgeons to perform the hernia defect closure during robotic VHRs.

The impact of opioid versus non-opioid analgesics on postoperative pain level, quality of life, and outcomes in ventral hernia repair

PurposeManaging postoperative pain remains a significant challenge in hernia operations. With ventral hernia repair (VHR) being one of the most commonly performed procedures, this study aimed to compare the effectiveness of non-opioid analgesia to opioid-based regimens for postoperative pain management.MethodsThe Abdominal Core Health Quality Collaborative was queried for elective VHR patients between 2019–2022. Subjects prescribed opioid or non-opioid analgesics at discharge were matched using a propensity score. Postoperative Hernia-Related Quality of Life Survey (HerQLes) summary scores, Patient-Reported Outcome Measurement Information System (PROMIS) 3a questionnaire, and clinical outcomes were compared between the two groups.Results1,051 patients who underwent VHR met the study criteria. The 2:1 matched demographics were opioids (n = 188) and non-opioids (n = 94) (median age 63, 48% females, 91% white, and 6.5 cm hernia length). Long-term (1-year post-operation) patients’ pain levels were similar between opioids vs non-opioids (median (IQR): 31(31–40) vs. 31(31–40), p = 0.46), and HerQLes summary scores were similar (92(78–100) vs. 90(59–95), p = 0.052).Clinical short-term (30-days post-operation) outcomes between opioid vs non-opioid patients had similar length-of-stay (1(0–5) vs 2(0–6), P = 0.089), readmissions (3% vs. 1%, P = 0.28), recurrences (0% vs. 0%, P = 1), reoperations (1% vs. 0%, P = 0.55), surgical site infections (3% vs. 7%, P = 0.11), surgical site occurrences (5% vs. 6%, P = 0.57), and surgical site occurrences requiring procedural intervention (3% vs. 6%, P = 0.13). Finally, long-term recurrence rates were similar (12% vs. 12%, P = 1).ConclusionNon-opioid postoperative regimens for analgesia are non-inferior to opioids in VHR patients with similar outcomes. Aggressive efforts should be undertaken to reduce opioid use in this population.

ROLE OF WOUND DRAINS VS ABDOMINAL BINDER AND PERCUTANEOUS ASPIRATION AFTER OPEN REPAIR OF VENTRAL HERNIA USING POLYPROLENE MESH

Background: Abdominal wall hernias are among the most common of all surgical problems. Ventral hernia repair (VHR) is a commonly performed operation so hernia defect size affects operative time and surgical technique for repair of a ventral hernia. Incisional hernia is the most frequent postoperative complication following general surgery. Complications of ventral hernia repair include seroma, hematoma, wound infection, bowel injury, bowel obstruction, recurrence whether earlyorlate,the mostcommoncomplicationisseroma formation.New advances in the management of ventral hernias including different methodsofrepaireitheropenor laparoscopic and differentmesh types: non-absorbable partially absorbable and absorbable. Objectives: This study was done to review and assess thedifference between insertion of wound drain and the use of abdominal binder and percutaneousaspirationafteropenrepairofventralherniasanditseffect on postoperative outcome. Patients and Methods: A total of 100 patients with non-complicated abdominal wall (ventral) hernia were enrolled to review andassess the difference between insertion of wound drain and the use of abdominal binder and percutaneous aspiration after open repair of ventral hernias and its effect on postoperative outcome. Patients were divided into two groups: Group (A) includes 50 patients with insertion of wound drain. Group (B) includes 50 patients with application of abdominal binder immediately postoperatively for 2 weeks. Results: This study showed distribution of patients according to age, ranging from 27 years to 70 years with mean age of 49.2 years (±11.6 years).25% of patients below 39, 50 % of patients below 50 and 75% ofpatientsbelow59.75.Inourstudy,60%ofoperationswerecarriedout under spinal anesthesia and 40% of operations were carried out under general anesthesia. Out of 100 patients of our study, in 28 % of cases, the hernial content was intestine and in 72 of cases the hernial content wasomentum.Outof100patientsofourstudy,therewasdevelopingof significant seroma in (30%) of patients as follow: (17%) at group A (with drain)&amp; (13%) at group B (without drain). Significant seroma was not seen in (70%) of patients. Wound infection was developed in (18%)ofpatientsasfollow(12%)forgroupA(withdrain)and(6%)for groupB(withoutdrain).Woundinfectionnotseenin(82%)ofpatients. Out of 100 patients of our study, (2%)oftotalcountonlyshowing earlyrecurrencethatpresentat group B. (9%) of total count only complained of persistent postoperativepainasfollows, 6 cases fromgroup (A) and 3 casesfrom group (B). Mean hospital stay was 1.46 days for group (A) and 1.26 daysforgroup(B).Meanperiodbeforereturningto normalactivitywas 3.7weeksforgroup(A)and2.9weeksforgroup(B). Conclusion: Combined abdominal binder and percutaneous aspiration for selected caseswere superior to insertionof wound drains asregards seroma formation, wound infection and postoperativereturn to normal activity with no significant difference as regards hematoma, postoperative pain, hospital stay andpatientsatisfaction.

Resident dictation of operative notes: a reimbursement comparison and mixed-methods analysis

PurposeSurgical documentation is crucial to ensure quality patient care and accurate coding and billing. Operative dictation also serves as a valuable educational opportunity for surgical trainees. However, resident dictations may not fully capture procedural details and complexities, resulting in missed revenue opportunities. On July 1, 2021, our university-based surgery department implemented a policy requiring attendings to dictate all operative reports. The purpose of this mixed-method study was to investigate the financial impact of this policy and explore differences in resident and attending dictations.MethodsCore general surgery operations performed by the Department of Surgery between July 1, 2020 and June 30, 2022 were identified from billing data. The surgeon, current procedural terminology (CPT) and modifier codes, and relative value units (RVUs) for each case were acquired. Surgeons not present for the entire study period or cases requiring multiple surgeons were excluded. Descriptive statistics and Kolmogorov–Smirnov (KS) non-parametric tests compared pre- and post-policy RVU distributions on overall charges and 18 key general surgery operations. Targeted thematic analysis was performed on operative reports pre- and post-policy to explore resident and attending differences.ResultsA total of 42 attendings performed 16,233 cases, billing 28,560 CPT codes (50.3% pre- vs. 49.7% post-policy). There was a small but statistically significant increase in RVU distribution post-policy, mean 20.2 pre- vs. 20.3 RVUs post-, $4372 pre- vs. $4418 per case post-, KS = 0.02 (p = 0.009). Specifically, higher RVU distributions were seen among attending-dictated cases for melanoma (p = 0.009), minimally invasive ventral hernia repair (VHR, p = 0.008), parathyroidectomy (p < 0.001), anorectal incision and drainage (p = 0.003) and anorectal exam under anesthesia (p = 0.029). Higher RVU distributions were noted among resident-dictated, attending-edited cases for partial colectomy (p = 0.043), and open VHR (p = 0.004). No differences were noted among the remaining operations (p > 0.05). Three major themes were noted from focused sampling of 112 operative reports: billable items, clinical/surgical reasoning, and technical details. Differences in billable items and clinical and surgical reasoning were the most influential on modifying clinical implications of operative notes. Themes and differences were consistent regardless of surgeon or specialty.ConclusionAdopting an attending-only operative dictation policy yielded a small increase in billable RVUs, predominantly from select operations. Gaps in coding-directed language and depth of clinical reasoning were noted in resident dictations. These findings reveal an educational opportunity that concomitantly optimizes patient care, resident education, and procedural revenue.

The Benefit of Open Rives-Stoppa Procedure in Complex Incisional Hernia.

Introduction: Ventral hernia is one of the most common general surgical pathologies. An incisional hernia will develop in 10–15% of patients with an abdominal incision, and the risk increases to up to 23% in those who develop surgical site infections.&#x0D; Ventral hernia repairs are mostly elective (90%) procedures, but the repair methods are highly variable.&#x0D; Popularized in Europe by Rives and Stoppa, the retromuscular technique has proven to be very effective, with a 94.2% probability of having the lowest odds for recurrence and a 77.3% probability of having the lowest odds for SSI.&#x0D; The study aimed to evaluate our experience at a secondary care center performing Rives-Stoppa repair for abdominal ventral and incisional hernias.&#x0D; Materials and Methods: Between April 2019 and August 2021, 46 patients in the practice at a secondary regional hospital, Teni Konomi, Korce, Albania, underwent a Rives-Stoppa incisional hernia repair.&#x0D; Results: There were 14 (31%) males and 32(69%) females (age range 31-75).&#x0D; Most incisional hernias were midline xiphoid-pubic incision and supraumbilical, with several subcostals (2 right and 1 left) hernias.At the time of repair, most incisional hernias were symptomatic and evident on physical exam. In four cases, the hernia sac was incarcerated at the presentation time.&#x0D; Conclusion: The Rives-Stoppa technique has excellent long-term results and low morbidity in patients with large primary or recurrent incisional hernias. It is the gold standard for most surgeons.&#x0D; Keywords: Incisional Hernia, mesh, polypropylene, abdominal wall surgery, rectus muscle

Five years of robot-assisted ventral hernia repair: initial experience and surgical outcome

Objective Robot-assisted ventral hernia repair (RVHR) has become a feasible alternative for open ventral hernia repair showing fewer postoperative complications and satisfying short-term results. However, long-term results are scarce in current literature. Methods All consecutive patients who underwent robot-assisted surgery for ventral hernias from June 2018 until February 2023 were included. Patient records were retrospectively reviewed for indication, need for conversion, length of stay (LOS), postoperative complications, and postoperative pain. In addition, long-term (>24 months) results (recurrence, chronic pain, and esthetic satisfaction) were assessed by phone questionnaire. Results In total, 177 patients underwent a robot-assisted ventral hernia repair. Indication for surgery was incisional hernia (N = 109) and primary hernia (N = 68), including 124 cases with abdominal rectus diastasis. A TransAbdominal Retromuscular Umbilical Prosthesis (TARUP) was performed in 138 patients. Robotic Transversus Abdominis Release (TAR) and Extended Totally Extraperitoneal Repair (eTEP) were performed in 20 (11%) and 9 (5%) cases, respectively. Median LOS was 2 days for TARUP and 3.5 days for TAR. Minor complications occurred in 22 patients (16 TARUP, 5 TAR, 1 eTEP). The average pain score on the first postoperative day was 1.8/10. No risk factors for morbidity could be identified by uni- and multivariable analysis. Hernia recurrence developed in four (2%) patients. Chronic pain was reported in two (1%) cases. Seven (4%) patients had esthetic complaints. Conclusion Robot-assisted ventral hernia repair is a safe procedure with low postoperative pain and short LOS. Long-term results including recurrence and chronic pain are satisfying.

Abdominal Wall Hernias-State of the Art of Laparoscopic versus Robotic Surgery.

Abdominal wall hernia repair, a common surgical procedure, includes various techniques to minimize postoperative complications and enhance outcomes. This review focuses on the comparison between laparoscopic and robotic approaches in treating inguinal and ventral hernias, presenting the ongoing situation of this topic. A systematic search identified relevant studies comparing laparoscopic and robotic approaches for inguinal and ventral hernias. Randomized control trials, retrospective, and prospective studies published after 1 January 2000, were included. Search terms such as hernia, inguinal, ventral, laparoscopy, robotic, and surgery were used. A total of 23 articles were included for analysis. Results indicated similar short-term outcomes for robotic and laparoscopic techniques in inguinal hernia repair, with robotic groups experiencing less postoperative pain. However, longer operative times and higher costs were associated with robotic repair. Robotic ventral hernia repair demonstrated potential benefits, including shorter hospital stay, lower recurrence and lower reoperation rates. While robotic surgery offers advantages such as shorter hospital stays, faster recovery, and less postoperative pain, challenges including costs and training requirements need consideration. The choice between laparoscopic and robotic approaches for abdominal wall hernias should be tailored based on individual surgeon expertise and resource availability, emphasizing a balanced evaluation of benefits and challenges.

Duramesh registry study: short-term outcomes using mesh suture for abdominal wall closure.

Sutures are flexible linear elements that join tissue and maintain their hold with a surgeon-created knot. Tension at the suture/tissue interface can cut the very tissues that sutures are designed to hold, leading to dehiscence and incisional hernia formation. A new suture design (Duramesh, Mesh Suture Inc., Chicago, IL) was approved for marketing by the United States Food and Drug Administration in September 2022. The multiple filaments of the mesh suture are designed to diffuse tension at the suture/tissue interface thereby limiting pull-through. The macroporosity and hollow core of the mesh suture encourage fibrovascular incorporation for a durable repair. We created the first registry and clinical report of patients undergoing mesh suture implantation to assess its real-world effectiveness. A patient registry was created based on institutional implant logs from January to August 2023 at an integrated health-care system. Operative reports were reviewed by the study team to verify use of "Duramesh" by dictation. Retrospective chart review was conducted to evaluate patient and surgical characteristics, follow-up, and short-term outcomes of interest. Results were analyzed using descriptive statistics and Chi-squared analysis with Microsoft Excel and GraphPad Prism. Three hundred seventy-nine separate implantations by 56 surgeons across 12 (sub) specialties at a university hospital and two community hospitals were performed. Mesh suture was used for treatment of the abdominal wall in 314 cases. Follow-up averaged 80.8 ± 52.4 days. The most common abdominal wall indications were ventral hernia repair (N = 97), fascial closure (N = 93), abdominal donor site closure from autologous breast reconstruction (N = 51), and umbilical hernia repair (N = 41). Mesh suture was used in all Centers for Disease Control (CDC) wound classifications, including 92 CDC class 2 or 3 abdominal operations. There were 19 surgical site infections (6.1%) and 37 surgical site events (11.8%). Short-term registry data demonstrates the wide diversity of surgical disciplines and scenarios in which mesh suture has been used to date. The early adoption of mesh suture into practice highlights that consequences of suture pull-through influence operative decision making. As this is the first interim report of the Duramesh mesh suture registry, follow-up is too short for characterization of long-term durability of abdominal wall closures.

Missing the Mark: Evaluating the Validity of the Ventral Hernia Screen in Detecting Recurrence.

Hernia recurrence is a primary metric in evaluating the success of ventral hernia repair (VHR). Current screening methods for hernia recurrence, including the validated Ventral Hernia Screening (VHS) questionnaire, have not yet been critically evaluated. The purpose of this study was to evaluate the predictive value of the VHS for hernia recurrence. This is a retrospective cohort study of adult patients who underwent primary VHR utilizing poly-4-hydroxybutyrate mesh at a single-institution from January 2016 to December 2021 who completed at least one VHS during their postoperative follow-up. All patients who screened positive underwent follow-up diagnostic computed tomography or physical examination for confirmation of hernia recurrence. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were assessed for each item and the VHS as a whole. A total of 68 patients who completed 119 VHS questionnaires were included. The median time to VHS administration was 3.6years (range .8-6.3years). The VHS tool had a sensitivity of 40.0%, specificity of 71.1%, PPV of 5.7%, and NPV of 96.4%. Individual items of the VHS also produced poor screening effects, with sensitivities between 20 and 40%, specificities between 79 and 97%, PPVs between 4 and 25%, and NPVs from 95 to 97%. The VHS was a poor positive predictive tool for hernia recurrence, with both a low PPV and sensitivity. Many patients may be unaware of when they truly have hernia recurrence in the long term. More rigorous tools need to be developed to monitor recurrence following VHR.

Development of Ventral Hernia Repair Curriculum Using the AWSSOM-a Synthetic Abdominal Wall Surgical Skills Operational Model.

Ventral hernia repair cost the U.S. healthcare system nearly 3 billion dollars annually. Surgical repair is a critical competency for residents yet hernia recurrence rates following mesh-based repair range from 0.8% to 24%. Improving surgical techniques using cadavers is often cost-prohibited for many education programs and limited research exists using simulation models with a corresponding hernia repair curriculum in the graduate medical education setting. This pilot project aimed to develop a low cost, easily reproducible novel abdominal wall reconstruction model and pilot-test the ventral hernia repair curriculum to inform further refinement prior to formal evaluation. This descriptive study pilot-tested the newly refined Abdominal Wall Surgical Skills Operative Model (AWSSOM) simulator for ventral hernia repair with mesh and its corresponding 2-h training curriculum for use at all levels of general surgery graduate medical education. The AWSSOM is a 3D printed synthetic anatomically realistic abdominal wall model consisting of silicone cured layers of skin, fat, rectus abdominis and a posterior rectus sheath fascia, and silicone tubules to simulate lateral neurovascular bundles. The curriculum incorporated didactic content reflecting surgical practice guidelines, hands-on practice, and faculty guidance promoting interactive critical thinking development during task performance. A pre-/post-assessment included a 10-item knowledge test, a 19-item psychomotor assessment, and 4-items confidence survey to examine changes in performance, knowledge, and confidence in competently completing the ventral hernia repair technique. Descriptive statistics were used to report the limited results of six military surgical resident participants and inform further model and curriculum refinement prior to formal evaluation. The five-layer AWSSOM model was manufactured in 65 h at a material cost of $87 per model frame, is reusable model, and secure base. Six surgical residents were recruited; only four completed both pre- and post-tests due to resident schedule conflicts. The average increase in knowledge was 25%, although variable changes in confidence were observed over the four program year participants. A larger sample size and a control group are needed to demonstrate curriculum effectiveness at improving knowledge, performance, and confidence in ventral hernia repair with mesh and better delineate if high scores translate to better operative skills. A key improvement requested by residents was a more secure model base for dissection and performance of the hernia repair. The novel abdominal wall surgical skills operative model fills an important proof of concept gap in simulation training. It is low cost with the potential to improve cognitive and psychomotor skills, as well as confidence to competently complete ventral hernia repair with mesh in the graduate medical education setting. Prior to formal effectiveness testing, our lessons learned should be addressed in both the model and curriculum. Future studies must include an adequately powered statistical evaluation with a larger sample across all levels of training.

A Cost-Effectiveness Analysis of Wittmann Patch-Assisted Abdominal Closure Compared to Planned Ventral Hernia in Management of the Open Abdomen.

Inability to achieve primary fascial closure after damage control laparotomy is a frequently encountered problem by acute care and trauma surgeons. This study aims to compare the cost-effectiveness of Wittmann patch-assisted closure to the planned ventral hernia closure. A literature review was performed to determine the probabilities and outcomes for Wittmann patch-assisted primary closure and planned ventral hernia closure techniques. Average utility scores were obtained by a patient-administered survey for the following: rate of successful surgeries (uncomplicated abdominal wall closure), surgical site infection, wound dehiscence, abdominal hernia and enterocutaneous fistula. A visual analogue scale (VAS) was utilized to assess the survey responses and then converted to quality-adjusted life years (QALYs). Total cost for each strategy was calculated using Medicare billing codes. A decision tree was generated with rollback and incremental cost-utility ratio (ICUR) analyses. Sensitivity analyses were performed to account for uncertainty. Wittmann patch-assisted closure was associated with higher clinical effectiveness of 19.43 QALYs compared to planned ventral hernia repair (19.38), with a relative cost reduction of US$7777. Rollback analysis supported Wittmann patch-assisted closure as the more cost-effective strategy. The resulting negative ICUR of -156,679.77 favored Wittmann patch-assisted closure. Monte Carlo analysis demonstrated a confidence of 96.8% that Wittmann patch-assisted closure was cost-effective. This study demonstrates using the Wittmann patch-assisted closure strategy as a more cost-efficient management of the open abdomen compared to the planned ventral hernia approach.

Comparison of Efficacy and Safety in Sublay versus Onlay Mesh Repair for Para-Umbilical Hernia: A Randomized Controlled Trial

Background: Ventral hernias, either spontaneous or post-surgical, represent a significant challenge in surgical practice. The recurrence rates after primary tissue repair, especially in larger hernias, necessitate the use of tension-free mesh repairs. However, the choice between onlay and sublay mesh repair methods remains a subject of debate, with each technique having its own set of advantages and drawbacks. Objective: The study aimed to compare the efficacy and safety of sublay versus onlay mesh repair techniques in the treatment of ventral hernias, with a focus on postoperative complications, pain, and treatment success rates. Methods: This randomized controlled trial was conducted from May 2023 to October 2023 at multiple surgical centers. It involved 120 patients, aged 18 to 70 years, undergoing ventral hernia repair. Patients were randomly allocated into two groups: Group A (60 patients) receiving onlay mesh repair and Group B (60 patients) receiving sublay mesh repair. The study assessed postoperative complications, including seroma, wound infection, and pain using the Visual Analogue Scale (VAS), as well as overall treatment efficacy. Data were analyzed using SPSS version 25.0, with a p-value of less than 0.05 considered statistically significant. Results: The mean age in Group A was 40.90±11.56 years, and in Group B, 40.55±11.63 years. Group A comprised 41.7% males and 58.3% females, while Group B had 46.7% males and 53.3% females. In Group A, seroma developed in 10%, wound infection in 15%, and postoperative pain in 18.3% of patients. Group B reported seroma in 3.3%, wound infection in 3.3%, and postoperative pain in 6.7%. The effectiveness of the treatment was 80% in Group A and 93.3% in Group B, with a notable difference in complication rates and success between the groups. Conclusion: The sublay mesh repair technique demonstrated superior outcomes in terms of lower complication rates and higher treatment efficacy compared to the onlay method. This suggests that the sublay approach may be more advantageous for ventral hernia repair, offering better patient outcomes with fewer postoperative complications.

Reducing the incidence of surgical site infection after ventral hernia repair: Outcomes from the RINSE randomized control trial

BackgroundThe clinical and financial impact of surgical site infection after ventral hernia repair is significant. Here we investigate the impact of dual antibiotic irrigation on SSI after VHR. MethodsThis was a multicenter, prospective randomized control trial of open retromuscular VHR with mesh. Patients were randomized to gentamicin ​+ ​clindamycin (G ​+ ​C) (n ​= ​125) vs saline (n ​= ​125) irrigation at time of mesh placement. Primary outcome was 30-day SSI. ResultsNo significant difference was seen in SSI between control and antibiotic irrigation (9.91 vs 9.09 ​%; p ​= ​0.836). No differences were seen in secondary outcomes: SSO (11.71 vs 13.64 ​%; p ​= ​0.667); 90-day SSO (11.1 vs 13.9 ​%; p ​= ​0.603); 90-day SSI (6.9 vs 3.8 ​%; p ​= ​0.389); SSIPI (7.21 vs 7.27 ​%, p ​= ​0.985); SSOPI (3.6 vs 3.64 ​%; p ​= ​0.990); 30-day readmission (9.91 vs 6.36 ​%; p ​= ​0.335); reoperation (5.41 vs 0.91 ​%; p ​= ​0.056). ConclusionDual antibiotic irrigation with G ​+ ​C did not reduce the risk of surgical site infection during open retromuscular ventral hernia repair.

Safety and tissue remodeling assay of small intestinal submucosa meshes using a modified porcine surgical hernia model

In studies to date, meshes based on extracellular matrix (ECM) have been extensively used in clinical applications. Unfortunately, little is known about the function of the immunogenic residual, absorbable profile during the tissue repair process. Moreover, there needs to be a recognized preclinical animal model to investigate the safety and efficacy of extracellular matrix meshes. Herein, we designed and fabricated a kind of SIS mesh followed by a scanned electron micrograph characterization and tested α-Gal antigen clearance rate and DNA residual. In order to prove the biocompatibility of the SIS mesh, cell viability, chemotaxis assay and local tissue reaction were assessed by MTT and RTCA cytotoxicity test in vitro as well as implantation and degradation experiments in vivo. Furthermore, we developed a stable preclinical animal model in the porcine ventral hernia repair investigation, which using laparoscopic plus open hybridization method to evaluate tissue adhesion, explant mechanical performance, and histologic analysis after mesh implantation. More importantly, we established a semi-quantitative scoring system to examine the ECM degradation, tissue remodeling and regeneration in the modified porcine surgical hernia model for the first time. Our results highlight the application prospect of the improved porcine ventral hernia model for the safety and efficacy investigation of hernia repair meshes.

Encasement of Ventral Hernia Mesh within Small Bowel: A Case Report

Ventral hernia repairs are one of the most commonly performed surgical interventions, with low overall complication rate of 15 percent of cases. Complications with wound healing account for over half of all complications associated with ventral hernia repairs. There is a risk, albeit low, of other such complications, including enterectomy, intra-abdominal infections, and mesh erosion into surrounding structures. We present a case of a 73-year-old male who presented to the hospital with a history of abdominal pain of one week duration. The patient was originally diagnosed with an abdominal wall abscess and recurrent hernia. Upon exploration of the abdominal cavity, it was noted that the mesh from previous ventral hernia repair had eroded into the lumen of the small bowel, requiring small bowel resection for removal of the mesh and repair of the hernia. Ventral hernia repairs are relatively safe, and complications of mesh erosion into the lumen of the small bowel are extremely rare, with minimal cases reported. This case highlights a rare complication associated with ventral hernia repairs and the importance of early recognition and appropriate repair when complications are found.

Outcomes after ventral hernia repair using the extended totally extraperitoneal approach: Initial experience from the Philippines.

Newer extraperitoneal techniques of laparoscopic ventral/incisional hernia repair (LVIHR) have been continually introduced since the popularity of the laparoscopic intraperitoneal onlay mesh technique began in 1993. One of which is the extended totally extraperitoneal (eTEP) approach allowing wide mesh augmentation, concurrent repair of diastasis recti, and performance of transversus abdominis release (TAR) for large/complex hernias. However, minimally invasive/laparoendoscopic ventral hernia repair is not yet widely adopted in the Philippines. We aim to share our preliminary experience with LVIHR using the eTEP approach. This was a retrospective review of all consecutive eTEP repairs for ventral hernia between January 2019 and September 2023. The clinical profiles of all patients were gathered. Hernia characteristics, operative profile, and postoperative outcomes were reported. Thirty-five patients were included in the study with a mean age of 54.7; 60% were incisional hernias, and the most common hernia location was the umbilical area. A defect size between 4 and 10 cm was reported in 54.3%. eTEP-TAR was necessary in 12 patients. At a median follow-up of 16 months, two patients developed seroma, one hematoma, and two surgical site infections. All were successfully managed conservatively. Only one patient developed recurrence. eTEP approach is safe and feasible for repairing ventral hernias. Our preliminary experience showed acceptable outcomes similar to the published literature. Surgeons interested in this technique should be familiar with the abdominal wall anatomy, carefully select patients during preoperative planning, and undergo mentorship with hernia surgeons experienced with the technique to shorten the learning curve.

Age is just a number: The role of advanced age in predicting complications following ventral hernia repair with component separation

BackgroundWhile advanced age is often considered a risk factor for complications following abdominal surgery, its impact on outcomes after complex open ventral hernia repair (VHR) with component separation technique (CST) remains unclear. MethodsA single-center retrospective review of patients who VHR with CST from November 2008 to January 2022 was performed and cohorts were stratified by presence of advanced age (≥60 years). ResultsOf 219 patients who underwent VHR with CST, 114 patients (52.1 ​%) were aged ≥60 years. Multivariate analysis demonstrated BMI to be an independent predictor for any complication (OR 1.1, p ​= ​0.002) and COPD was positively associated with seroma development (OR 20.1, p ​= ​0.012). Advanced age did not independently predict postoperative outcomes, including hernia recurrence (OR 0.8, p ​= ​0.766). ConclusionsVHR with CST is generally safe to perform in patients of advanced age. Every patient's comorbidity profile should be thoroughly assessed preoperatively for risk stratification regardless of age.

Evaluating patient outcomes and quality of life following laparoscopic extended totally extraperitoneal repair for ventral hernia: A prospective study

Abstract BACKGROUND: Various laparoscopic techniques have been developed for the repair of ventral and incisional hernias. There is a never-ending debate regarding the best procedure for hernia repair. Moreover, very few studies have studied the Quality of Life (QOL) in these patients. This study is aimed at analyzing the various perioperative outcomes following the laparoscopic extended totally extraperitoneal (eTEP) approach for ventral hernias and QOL. MATERIALS AND METHODS: This prospective study was conducted in the Department of Surgical Gastroenterology at a tertiary care hospital in India. The study analyzed patient demographics, hernia characteristics, perioperative outcomes, postoperative complications, and QOL measured by the Carolinas Comfort Scale. RESULTS: The study enrolled 34 patients and analyzed hernia characteristics and perioperative outcomes. QOL scores, measured by the Carolinas Comfort Scale, were assessed at 1-month and 6-month intervals post-surgery. At 1 month, scores for mesh sensation, pain, movement limitation, and the total score were 8.85, 4.26, 0.06, and 13.18, respectively. At 6 months, these scores improved significantly to 0.76, 0.18, 0, and 0.94. CONCLUSION: eTEP is associated with less postoperative pain, short hospitalization periods, and low recurrence rates. Furthermore, it offers cost-effectiveness by employing a standard prolene mesh without requiring fixation. eTEP improves the QOL in patients undergoing repair for ventral hernias.