Technique For Ventral Hernia Repair Research Articles

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

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

Postoperative complications and hernia recurrence after the use of various ventral hernia repair techniques

Prosthetic hernioplasty (HP) for ventral hernias (VH) has a complication rate of up to 27% and a hernia recurrence rate up of to 37%, depending on the chosen technique. The use of laparoscopic HP techniques allows for a shorter hospital stay and a lower risk of wound infection. There is a wide range of data on the superiority of laparoscopy over the open technique in terms of recurrence rates and various types of complications. The results of comparing HP with and without suturing of the hernia defect are controversial. Objective — to study the structure and incidence of postoperative complications, as well as the frequency of hernia recurrences after the use of open and laparoscopic HP for VH. Materials and methods. A multicenter prospective study, which included 482 patients diagnosed with VH, was conducted at the clinical base of the Department of General Surgery No. 2 at Bogomolets National Medical University. A total of 279 (57.9%) patients had primary VH, while 203 (42.1%) had incisional VH. The patients were divided into two groups, comparable in terms of age, sex, and hernia size distribution. Group 1 included 250 (51.9%) patients who underwent open HP with suturing of the hernia defect: subgroup 1a — open sublay (n=243; 50.4%), and subgroup 1b — open intraperitoneal onlay mesh technique (IPOM) (n=7; 1.5%). Group 2 included 232 (48.1%) patients who underwent laparoscopic HP using the IPOM technique: subgroup 2a — IPOM without suturing of the aponeurosis defect (n=81; 16.8%), subgroup 2b — IPOM with suturing of the aponeurosis defect (n=108; 22.4%), and subgroup 2c — IPOM+ with open aponeurosis defect suturing (n=43; 8.9%). Follow‑up evaluations were carried out at intervals of 2 weeks, 1 month, 6 months, and 1 year to assess the presence of complications, recurrence, and satisfaction with the cosmetic effect of the operation. Results. The overall frequency of complications after HP was 15.6%, while after open sublay it was 21.2%, and after laparoscopic IPOM it was 9.9%. All cases of complications belonged to Grades I—IIIb according to the Clavien‑Dindo classification. In both groups, there were no fatalities. In group 1, the frequency of seroma was 11.6% and hematoma was 5.6%, and in group 2, it was 7.3% and 0.9%, respectively. A statistically significant increase in the frequency of hematoma development was observed after open HP techniques compared to laparoscopic ones (p=0.004), while the frequency of seroma detection was comparable (p=0.148). Non‑suturing of the aponeurosis defect after laparoscopic IPOM in patients with VH did not result in an increase in the total number of complications or the percentage of recurrence (p >0.05). Laparoscopic IPOM with hernia suturing demonstrated significantly higher patient satisfaction with the appearance of the anterior abdominal wall compared to other HP techniques (р <0.05). Conclusions. The open sublay and laparoscopic IPOM HP procedures have a comparable recurrence rate of VH (p >0.05). The incidence of infectious complications and hematomas is significantly higher after open operations compared to laparoscopic ones (p=0.041 and p=0.004, respectively).

Descriptive Anatomy of the Porcine Ventral Abdominal Wall as a Basis for Training Ventral Hernia Repair Techniques.

Background: In recent times there has been a surge in innovative techniques concerning complex abdominal wall surgery. The availability of simulation models for comprehensive training and skill set development remains limited. Methods: Cadaveric dissections of the porcine abdominal wall were conducted to assess the suitability of anesthetized porcine models for training in both minimally invasive and open surgical procedures. Results: The panniculus carnosus, a typical muscular layer in mammals, is the outermost layer covering the anterolateral abdominal wall. Beneath it, there are four main pairs of abdominal wall muscles, mirroring the human anatomy. The rectus abdominis muscle runs straight along the linea alba and is surrounded by the rectus sheath, which is formed by the fusion of the lateral abdominal wall muscles and differs along the different regions of abdominal wall. The orientation of the muscle fibers in the lateral abdominal wall muscles, i.e., musculus obliquus externus, internus and transversus, is comparable to human anatomy. Although the transition lines between their muscular and aponeurotic part differ to some extent. Relevant for the adoption of surgical techniques, the transversus abdominis muscle is well-developed and resembles a bell curve shape as it transitions from its muscular to aponeurotic part. Conclusion: Despite minor differences in abdominal wall anatomy between pigs and humans, the porcine model provides a high level of fidelity in terms of both anatomical features and the development of skill sets relevant to hernia surgery.

Endoscopic totally visceral sac separation for ventral hernias repair: anatomy notes and technical considerations

The abdominal wall can be treated as a whole physiological and functional entity which is composed of multiple anatomical structures and planes. Surgical approaches and technical details that required are diverse in different area. Indeed, the abdominal wall is confined by several anatomical boundaries which make these surgical planes separated. If one could dissect these boundaries, then separated spaces could be connected, establishing an ample retromuscular/preperitoneal space to accommodate the mesh of ventral hernia repair. The concept of totally visceral sac separation (TVS) is achieved. The TVS concept is a summary of diverse ventral hernia repair techniques. Since its initiation and spread, this technique has been widely accepted and implemented by domestic surgeons due to its outstanding performance. This treatise will review the relevant anatomy as well assurgical tricks by the authors that aid in performing TVS. Some of the details are more tricky and harder to understand, thus this in-depth description of the technique.

V-025 ETEP-RS: EXTENDED TOTALLY EXTRAPERITONEAL RIVES-STOPPA TECHNIQUE FOR SMALL VENTRAL HERNIA

Abstract Aim The aim is to describe the laparoscopic surgical technique of eTEP with 3 trocars from the upper port in a 52-year-old male patient who presented 3 small ventral hernias Material & Methods Recently, the surgical technique of ventral hernia repair, Rives-Stoppa e-TEP eventroplasty (eTEP-RS) has been introduced. First, 2 subcostal incisions are made. By introducing the dissector balloon through both retromuscular spaces up to the linea arcuata, the retromuscular space is exposed. Great care must be taken to preserve the neurovascular bundles at semilunar line. A 5mm trocar is placed on the right flank to perfom the epigastric crossover maniobre by incising the medial aspect of rigth posterior sheath. The dissection of the left retromuscular space is performed. The midline dissection is progressed to the retzius, completing the Rives retromuscular space. The hernia sacs are dissected and reduced. Finally, posterior rectus sheaths and the linea alba are sutured with 2/0 absorbable self-locking continuous barb suture and a mesh is placed in the retromuscular space. Results The patient was discharged the next postoperative day with good pain control. To date, he does not present data on hernia recurrence. Conclusions The repair of abdominal wall defects via endoscopic eTEP Rives-Stoppa with three trocars is a feasible and reproducible technique that meets the criteria of ideal open surgery and is safe for the patient. In addition, it offers advantages such as less postoperative pain, less need for analgesia, favors rapid and safe recovery, added to an excellent aesthetic result.

V-020 Botulinum Toxin: not just aesthetics anymore

Abstract Introduction Surgical repair of recurrent abdominal incisional hernia can be challenging. The aim should be a tension-free, mesh reinforced midline fascial closure. Different methods have been described to achieve this primary fascial closure. Botulinum toxin (BT) is a neurotoxin that when injected into muscle tissue, causes a temporary flaccid muscle paralysis. This effect can be applied to the lateral abdominal wall muscles, thereby facilitating midline rectus muscles re-approximation and defect closure. Clinical Case We present a case of a 58 year old female, with a history of right hemicolectomy and ileostomy, that underwent subsequent stoma closure one year after. She presented with a 12 cm defect width incisional hernia and right rectus muscle atrophy. We demonstrate the preoperative injection of BT using the Zielinski technique in a consultation room with no need for patient monitoring or anesthesia. Four weeks later, the patient underwent open repair with bilateral transversus abdominis release and retromuscular mesh reinforcement. The defect was closed without tension and the postoperative period was uneventful. Patient was discharged on postoperative day 4. Conclusion Preoperative BT injection as a selective muscle chemical component paralysis is a safe, easy to perform and effective technique that aims to counteract the chronic muscle retraction observed in large ventral hernias. BT in combination with advanced ventral hernia repair techniques, may help provide the crucial extra tissue mobility required to achieve primary closure, with the added advantage of less postoperative pain, thereby contributing to early patient discharge.

Ventral hernia repair in conjunction with LIPO-ABDOMINOPLASTY in overweight patients: A comprehensive approach.

Repair of large midline ventral hernias still represents a challenge for general surgeons. As obesity is a key factor of this type of hernias, usually the patients are presented with abdominal wall laxity, excess skin and subcutaneous fat. Combined procedures has evolved over the last six decades to repair the hernias and to improve the shape of the abdomen, but was associated with high rate of wound complications. The components separation technique for ventral hernia repair was introduced in 1990 by Ramirez et al to avoid mesh repair was associated with a high rate of success. Until recently, the convenience of simultaneously performing ventral hernia repair and abdominal contouring surgery remains controversial. The aim of this study is to present our experience in the integration of the anterior component separation technique for repair of midline wide ventral defects, with the lipoabdominoplasty in selected patients with high body mass index, to achieve a functional abdominal wall repair and to provide a better aesthetic outcome. In this prospective case-control study, 15 adult female multiparous women, all were overweight and obese, presented with midline ventral hernias and abdominal deformity was operated upon where a comprehensive technique in the form of herniorapphy, anterior component separation technique and lipoabdominoplasty were performed. The patients were followed up for 3-6 months period to monitor incidence of complications, hernia recurrence and to assess the aesthetic outcome. All the 15 patients were overweight and obese with BMI ranged between 26.5 and 39.6 kg/m2 . The mean operative time was 184 ± 28.8 minutes (range 150-240 minutes). The mean postoperative length of hospital stay was 3 days ranging from 1 to 5 days. In addition to the hernia, all the patients suffered from diastasis of recti ranged from 9 to 15 cm in the transverse dimension. No mortality or major complications encountered, no hernia recurrence, only minor complications occurred in four patients (26.8%). Two patients developed seroma which resolved by aspiration, one patient suffered wound infection with partial loss of the umbilicus and one developed superficial skin necrosis at the central area of the flaps which healed uneventfully by secondary intention. All the patients were satisfied with the cosmetic outcome. In conclusion, this comprehensive approach is effective technique for reconstruction of large midline ventral defects and provide a good aesthetic appearance of the anterior and lateral abdomen in appropriately selected obese patients.

A Comparison of the Onlay and Sublay Mesh Procedures for the Repair Of Ventral Hernias

Objective: The purpose of this study is to compare the outcomes of the on-lay mesh technique and the sub-lay mesh technique for ventral hernia repair. Study Design: Observational/ Retrospective Place & Duration: Benazir Bhutto Shaheed Hospital, Abbottabad; from May 2022-October-2022 Methods: 116 individuals of both sexes, aged 18 to 75, who were undergoing ventral hernia repair were examined. After receiving the patient's consent, information about the patient's age and gender was recorded. All of the patients were equally split into two groups, Group I and Group II. Participants in Group I were treated with an on-lay mesh method, while those in Group II were given a sub-lay approach. Consequences such as discomfort after surgery, bacterial infections, seroma development, and lengths of stay in the hospital were documented and compared between the two groups. All data was analyzed with SPSS 24. Results: In group I mean age was 47.12+5.38 years and in group II mean age was 48.7+11.66 years. Among all, majority of the cases 67 (57.8%) were females and 49 (42.2%) cases were males. Postoperative pain was significantly higher in the group I 5.1+3.18 whereas in the group II, it was lower 2.9+4.16, with wound infection affecting 10 (17.2%) patients vs 5 (5.2%) patients (P<0.005). Seroma was identified in 3 (5.2%) of Group II patients and 7 (12.1%) of Group I patients (p<0.005). Hospitalization durations were significantly longer for participants in Group I (6.0+1.36 days) compared to those in Group II (3.2+0.44 days; p<0.05). Conclusion: This research came to the conclusion that the sub-lay mesh approach for ventral hernia repair was not only successful but also safe, with a very low risk of problems when compared to the on-lay mesh operation. Keywords: On-lay Mesh Technique, Ventral Hernia Repair, Outcomes, Sub-lay Mesh Technique

Hernia Sac Preservation for Prevention of Transversus Abdominis Release in Laparoscopic Extended-Totally Extra Peritoneal Repair of Ventral Hernia: A Minimalistic Solution for a Formidable Challenge.

Background: Ventral hernia repair has always been an extensive and challenging surgery. The laparoscopic extended-Totally Extraperitoneal (E-TEP) technique of ventral hernia repair is gaining popularity due to the advantage of placing a large mesh in the retro rectus plane. When done through a Laparoscopic approach, the difficulty of the procedure is compounded by multiple factors such as obtaining retro muscular access, maintaining the retro muscular plane, crossing over to the contralateral retro muscular plane without entering intraperitoneally, suturing in a limited space, and manipulation of a large mesh in a constricted space for placement. In cases of large midline incisional hernias, dense adhesions to the previous surgical scar are often present. Despite having extremely satisfying outcomes, the aforementioned factors make the laparoscopic extended-total extraperitoneal repair of large midline ventral and incisional hernias an exceptionally challenging procedure. A tension-free midline approximation is the benchmark of ventral/incisional hernia surgery. In certain cases, this can be difficult to achieve due to multiple factors. For the purpose of attaining tension-free midline closure, component separation techniques (CST) have been explored and implemented. Of these, the posterior component separation technique of Transversus Abdominis Release (TAR) has gained popularity for reducing the tension of posterior rectus sheath during posterior midline closure in retro muscular repairs by adding a few centimetres of medial advancement. The main pitfall of TAR is its technical complexity, which may result in morbid complications when implemented incorrectly. Performing TAR laparoscopically compounds the complexity manyfold. Hence, to obviate the necessity to perform Laparoscopic TAR in cases of Laparoscopic E-TEP repair of large midline ventral and incisional hernias, we present that the technique of hernial sac preservation should be pre-emptively carried for all Laparoscopic ETEP repairs so that the necessity of performing TAR in select cases is reduced by aiding in the addition of final crucial centimetres of lengthening to the posterior rectus sheath for achieving posterior midline closure. This aids in the success of the procedure by preventing an additional complex procedure of TAR from being performed in an already challenging hernia repair technique of Laparoscopic E-TEP repair. Methods: We hereby report three cases of Ventral hernia repair in which Laparoscopic E-TEP repair was carried out and Hernial sac preservation technique was implemented successfully. Midline closure of the posterior rectus sheath was attained under reduced tension and a medium-weight macroporous polypropylene mesh was placed in the retro-rectus plane after measurement of the potential space. Patients were discharged uneventfully. Results: Patients were followed up for up to 6months postoperatively and were found to have no complications. Conclusion: In Laparoscopic E-TEP repair of midline ventral hernias, preservation of the hernial sac along with the posterior rectus sheath might aid in the prevention of performing a TAR in selected cases where posterior layer tension is present. Hernia sac preservation thereby aids in reducing operative time and preventing potential morbid complications.

P-149 FEASIBILITY AND SAFETY OF AMBULATORY ETEP RETRORECTUS RIVES-STOPPA REPAIR FOR VENTRAL HERNIA

Abstract Introduction Endoscopic totally extraperitoneal retromuscular repair (eTEP-RS) was recently introduced as a new technique for ventral hernia repair. It has been reported to have a significant reduction in analgesia need and reduce length of stay compared to laparoscopic intraperitoneal repair. We aim to evaluate the safety and feasibility of ambulatory primary ventral hernia and incisional hernia repair using eTEP technique. Methods Patients planned for ambulatory eTEP ventral hernia repair between October 2020 to April 2022 were retrospectively analyzed Results 11 patients who were deemed suitable for day surgery preoperatively were included in the analysis. Median age was 48.3 years. Defect sizes ranged from 3–6 cm. 5 patients had more than 1 midline defect, 1 patient had a spigelian hernia and 1 patient had bilateral inguinal hernias which were repaired. 7 patients were successfully managed as day case eTEP-RS. 1 patient required a conversion to open RS due to additional, large defects found intraoperatively, 1 patient stayed for 1 night for urinary retention, 1 patient was drowsy and could not be discharged on the day of surgery and 1 patient was converted to IPOM repair. There were no postoperative complications or recurrences. Conclusion Ambulatory eTEP is feasible, safe and effective in selected patients.

Robotic Intracorporeal Rectus Aponeuroplasty: Early Experience of a New Surgical Technique for Ventral Hernia Repair.

Introduction: The laparoscopic intracorporeal rectus aponeuroplasty (LIRA) was developed as an alternative for minimally invasive ventral hernia repair. This technique allows the closure of the defect and restoration of the midline without tension by plication of both aponeurosis of the abdominal rectus muscles combined with a minimally invasive intraperitoneal underlay mesh repair. The objective of this study is to report our early experience with the Robotic-LIRA (R-LIRA) technique and its safety and short-term efficacy. Methods: We performed a retrospective analysis of patients undergoing R-LIRA repair for ventral hernias from March 2019 to April 2022. Results: Eight patients underwent R-LIRA from March 2019 to April 2022. Median age was 47 years (interquartile range [IQR] 34.5-62.8). Median body mass index was 34.2 kg/m2 (IQR 29.9-35.2). Four patients (50%) had a primary ventral hernia being one M2, two M3, and one M2/M3. There were three incisional hernias, being one recurrent, 6 patients (75%) had associated diastasis of the rectus muscle and 1 patient presented pure diastasis. The median hernia width was 4 cm (IQR 2-6), and the median defect area was 16 cm2 (IQR 4-42). The median mesh area was 290 cm2 (IQR 211.2-300). In all cases, a barbed suture was also used for mesh fixation, and tackers were added in 4 cases. The median operative time was 172 minutes (IQR 139.8-293.3). The median length of stay was 0.5 days (IQR 0-1.8), and the median follow-up was 20 days (IQR 16-46). Conclusion: The R-LIRA has been shown to be safe and feasible for ventral and incisional hernia repairs with or without Diastasis of the Rectus Abdominis Muscle in the short term.

ETEP-RS for incisional hernias in a non-robotic center. Is laparoscopy enough to perform a durable MIS repair of the abdominal wall defect?

IntroductionIncisional hernias can complicate up to 25% of laparotomies, and successful repair remains a significant clinical challenge for surgeons. Recently, the surgical technique of ventral hernia repair (eTEP-RS) has been introduced. The method was presented relatively recently and continues to evolve. The use of a robotic platform in eTEP-RS resulted in a significant improvement in ergonomics. Therefore, the questions arise as to whether the laparoscopic technique might still be feasible for such long procedures. The objective of this study is to present our early results in the treatment of patients with incisional ventral hernias using eTEP-RS and to discuss key technical aspects.Patients and methodsA prospective case-controlled study was conducted for all incisional ventral hernia patients (hernia orifice between 4 and 10 cm) who underwent eTEP-RS between March 2019 and December 2021. Demographic data were recorded; and perioperative and postoperative results were analyzed.ResultsWe performed 34 eTEP-RS procedures. The mean duration of the surgery was 211 min (145–295). The mean width of the defect was 6.8 cm and the defect area was 42.5 cm2. The mean mesh size was 498 cm2 (270–625). After an average follow-up of 16 months (2–30), there was no recurrence or major complication.ConclusionsThe eTEP-RS is a safe alternative to open ventral hernia repair in selected cases and allows for the placement of a large piece of mesh in accordance with current recommendations, even in non-robotic centers. Excellent knowledge of the detailed anatomy of the abdominal wall is essential for safe and effective hernia repair. Compliance with certain rules of the laparoscopic eTEP-RS facilitates improved ergonomics for this procedure even in non-robotic centers.

A Novel Minimally Invasive Retro Rectus Repair of Ventral Hernia

Background Ventral hernia repair is one of the common general surgical procedures. A novel eTEP technique has been developed where in a mesh is placed in retro muscular plane through minimally invasive approach. There is scarcity of data on its effectiveness as compared to conventional Laparoscopic IPOM hernioplasty. Aims and Objectives We aim to introduce our innovative Kumar-Subhash’s modified 3 port eTEP technique for ventral hernia repair and compare its clinical effectiveness with conventional IPOM repair. Methods A prospective comparative study was undertaken at Devagiri Hospital, Bangalore, India from January 2017 to December 2019. 30 patients were included in the study (12 in eTEP group and 18 in IPOM group) based on predefined inclusion and exclusion criteria. Patients were followed up to 30 days post-operatively. The outcomes were compared with respect to postoperative pain, length of hospital stay and early postoperative complications. Results Baseline characteristics and presenting complaints were comparable for both the groups. The mean pain score on POD 1 in eTEP group was 3, and 1 on POD 7 as compared to 7 and 3 in IPOM group on POD1 and 7 respectively, which was statistically significant. Patients in eTEP group had a shorter length of hospital stay (LOS). None of the patients had any complications related to the novel technique. Conclusions Kumar-Subhash’s modified 3 port eTEP technique is a novel and easy approach for laparoscopic repair of ventral hernia with significantly less post-operative pain and LOS with an additional cosmetic advantage for patients.

Role of Indocyanine Green to Mitigate Wound Complications in Component Separation Technique for Ventral Hernia Repair-Our Early Experience.

The ease of the anterior component separation technique (ACST) makes it an attractive surgical option for ventral hernia repairs (VHR). Incorporation of indocyanine green-fluorescence angiography (ICG-FA) to map soft tissue perfusion during open ACST is an effective way to minimize the wound complications. This study aims to evaluate the impact of adoption of ICG-FA on wound-related complications following open ACST in VHR. We performed a retrospective review of patients who underwent VHR with the open ACST at a single centre between March 2018 and July 2020. The study comprised of consecutive cases of open ACST with onlay meshplasty done before (March 2018-April 2019) and after (May 2019 to July 2020) implementation of ICG-FA for intra-operative perfusion mapping of subcutaneous tissue and skin. The pre-ICG group and post-ICG group were similar in terms of baseline patient demographics and peri-operative details. The rate of surgical site occurrence's was higher in the pre-ICG group, but this result was not statistically significant (46% vs. 26%; p value 0.189). Skin necrosis, however, was observed in significantly less patients of the post-ICG cohort (29% vs. 5%; p value 0.045). This study demonstrates the effectiveness of perfusion mapping by the use of ICG angiography to determine potential areas of decreased perfusion and thereby minimize wound complications. Using ICG-FA to guide removal of at-risk tissue to minimize wound complications may substantially improve the patients outcome.

Laparoscopic intraperitoneal versus enhanced-view totally extraperitoneal retromuscular mesh repair for ventral hernia: a retrospective cohort study.

Laparoscopic enhanced-view totally extraperitoneal retromuscular repair (eTEP-RM) was recently introduced as a new technique for ventral hernia repair. The aim of the current study was to examine the outcomes of laparoscopic eTEP-RM compared with laparoscopic IPOM for patients with primary ventral and incisional hernia. This was a retrospective cohort study of patients undergoing laparoscopic ventral hernia repair at a single University Hospital from June 2017 to November 2020. Medical charts of all patients subjected to IPOM andeTEP-RM were evaluated to identify patient- and procedure related variables, as well as postoperative 30-day outcomes. A total of 72 patients were included in the study, 43 and 29 of whom underwent IPOM and eTEP-RM repair, respectively. Patient demographics showed no differences in terms of gender, age, smoking and comorbidity. The median age was 57years and body mass index 30.5kg/m2. Therate of patients with incisional hernia was higher in the IPOM group (39.5% vs. 20.7%, p = 0.154). There was no difference in horizontal and vertical hernia size defect. The duration of surgery was significantly shorter for IPOM (mean 82.4 vs. 103.4 min, p = 0.010), whereas the length of stay was significantly longer after IPOM (median 1days vs. 0days (p < 0.001). The rate of patients requiring postoperative transversus abdominis plane (TAP) block or epidural analgesia was significantly higher after IPOM (33% vs. 0%, p = 0.002). A subgroup analysis on patients undergoing primary ventral hernia showed similar results. The study found laparoscopic eTEP-RM safe and effective compared to traditional laparoscopic IPOM. The patients undergoing eTEP-RM had significantly reduced need for additional analgesic treatment and length of stay.

De-epitheliazation (DEEP) and fascial closure with onlay mesh repair: An alternative technique for ventral hernia repair: A case report

De-epitheliazation (DEEP) and fascial closure with onlay mesh repair: An alternative technique for ventral hernia repair: A case report

Laparoscopic enhanced-view totally extraperitoneal Rives-Stoppa repair (eTEP-RS) for ventral and incisional hernias - early operative outcomes and technical remarks on a novel retromuscular approach.

IntroductionIncisional hernias can complicate up to one in four laparotomy procedures, and successful repair remains a significant clinical challenge for surgeons. Recently, the surgical technique of ventral hernia repair (eTEP-RS) has been introduced.AimTo present early results in treating patients with ventral hernia using the eTEP-RS technique and to discuss key technical aspects affecting the safety and efficiency of repair.Material and methodsA prospective study of early outcomes was conducted for all ventral hernia patients (hernia orifice between 4 and 8 cm) who underwent eTEP-RS between March 2019 and July 2020.ResultsAs of July 2020, we performed a total of 11 eTEP-RS procedures. The mean duration of the surgery was 204 min (158 to 295). The average size of the treated defect in the transverse dimension was 5.8 cm, and the defect area was 38.5 cm2. The average size of the mesh used was 486 cm2 (280 to 590). After an average follow-up of 7 months (1–17) there was no recurrence or major complication. Based on our initial experiences we present a detailed description of the main aspects of the surgical technique itself, as well as the essential nuances, to enable evaluation of the technique and future popularization.ConclusionsThe eTEP-RS technique is a safe alternative to open ventral hernia repair and allows for the placement of a large piece of mesh in accordance with current recommendations. Excellent knowledge of the detailed anatomy of the abdominal wall is essential for safe and effective hernia repair.

An early experience with transversus abdominis release for complex ventral hernias: a retrospective review of 100 cases.

Transversus abdominis release (TAR) is a relatively recent surgical technique for ventral hernia repair which allows placement of a large prosthesis in the retro-muscular plane with considerable myofascial medialization. A retrospective review of 100 cases who underwent TAR for complex ventral hernias was performed to evaluate the safety and efficacy of TAR in a series of large ventral hernias. Between March 2016 and May 2019, 100 consecutive patients who underwent open TAR were identified from our prospectively maintained database. A retrospective review was performed to analyze patient demographics, peri-operative events, adverse outcomes and recurrence. 12 primary and 88 incisional hernia cases underwent TAR with prosthetic mesh repair during the study period. Mean age was 52.5years, mean BMI was 30.87kgs/m2, mean ASA class 1.95. In our series, 41% were diabetic, 11% had COPD. All patients underwent preoperative CT scans. The mean defect was 140.18cm2. Average mesh area was 1344cm2. Average blood loss was 245mL. Defects were bridged in 19% cases despite bilateral component separation. Readmission rate at 1month was 3%, for wound complications. We recorded 9 surgical site infections, 17 surgical site occurrences, 10 of which needed procedural interventions. We recorded no recurrences at a mean follow-up duration of 20.2months. Our early results with TAR are encouraging. We have demonstrated that the repair allows anatomical reconstruction with a large sublay mesh while inflicting minimal morbidity. TAR can be a valuable tool in complex ventral hernia repair.

Laparoscopic preperitoneal ventral hernia repair with prolene mesh with fixation through transabdominal prolene stitches

Objective To evaluate the efficacy and safety of our technique in laparoscopic repair of ventral hernias. Summary background data Laparoscopic ventral hernia repair (LVHR) was first reported in 1993. The successful application of laparoscopic techniques for the repair of ventral hernias has been well accepted. The recurrence rate after standard repair of ventral hernias may be as high as 10%, and the wide surgical dissection required often results in wound complications. Use of a laparoscopic approach may decrease rates of complications and recurrence after ventral hernia repair. Patients and methods Data on all patients who underwent LVHR performed using our procedure between February 2013 and February 2015 were collected retrospectively. Results LVHR was completed in 27 of the 30 patients (nine men and 21 women) in whom it was attempted. The patients’ mean BMI was 36.5; the mean defect size was 3.2 cm. Mesh averaging 6.3 cm was used in all cases. Mean operating time was 105 min, and hospital stay averaged 1.9 days. Our complication rates were 16.6%. The most common complications were ileus (6.6%) and prolonged seroma (6.6%). During a mean follow-up time of 12 months, the hernia recurrence rate was 3.3%. Overall, 10% of patients had pain for 1 month. Recurrence was associated with vigorous exercise within the first 3 months postoperatively. Conclusion In this series, the preperitoneal laparoscopic technique for ventral hernia repair had a low rate of conversion to open surgery, a short hospital stay, a moderate complication rate, and a low risk of recurrence avoiding the potential complications related to intraabdominal mesh position.

Evaluation of postoperative pain in ventral herniorraphy using 3 different techniques

Backround: Pain is an unpleasant sensory and emotional experience associated with acute or potential tissue damage. With this study we compare the postoperative pain scores of 3 ventral hernia repair techniques. Patients and Methods: This was a clinical study done in the department of surgery in a tertiary care hospital. A total of 62 patients included the study. Results: The VAS scores showed statistically significant difference between all groups. On 4th hour mean VAS scores were 4.1/6.8/8.9 respectively DM/RPS/PMR groups(P