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Hiekkaranta JM, Ahonen M, Mäkäräinen E, Saarnio J, Pinta T, Vironen J, Niemeläinen S, Vento P, Nikki M, Ohtonen P, Rautio T. Laparoscopic versus hybrid approach for treatment of incisional ventral hernia: a 5-10-year follow-up of the randomized controlled multicenter study. Hernia 2024; 28:191-197. [PMID: 37594636 PMCID: PMC10890975 DOI: 10.1007/s10029-023-02849-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/23/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE In this long-term follow-up of a prospective, randomized, and multicenter study, we compare the results of a group receiving laparoscopic incisional ventral hernia repair using intraperitoneal onlay mesh (LG) to a group receiving a hybrid hernia repair where open closure of fascial defect was added to intraperitoneal mesh placement (HG). METHODS Originally, 193 patients with 2-7 cm incisional hernias were randomly assigned to either the LG or HG during the 30-month recruitment period in 2012 to 2015. Long-term follow-up was conducted 5-10 years after surgery to evaluate hernia recurrence rate and quality of life (QoL). RESULTS In all, 65 patients in the LG and 60 in the HG completed the long-term follow-up with a median follow-up period of 87 months. Recurrent hernia was detected in 11 of 65 patients (16.9%) in the LG and 10 of 60 patients (16.7%) in the HG (p > 0.9). Kaplan-Meier analysis demonstrated a recurrence rate approaching 20% in both groups, with similar curves. Three patients in the LG (4.6% and five patients in the HG (8.1%) had undergone re-operation due to recurrence (p = 0.48). There was no difference in patient-reported QoL measured using the SF-36 questionnaire. Mean pain scores were similar between groups, mean numeric rating scale (NRS) 0 to 10 being 1.1 in the LG and 0.7 in the HG (p = 0.43). CONCLUSION Fascial closure did not reduce hernia recurrence rate in this study population, even though it has been shown to be beneficial and recommended in surgery guidelines. In the long term, recurrence rate for both groups is similar.
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Affiliation(s)
- J M Hiekkaranta
- Department of Surgery, Oulu University Hospital, Oulu, Finland.
| | - M Ahonen
- Department of Surgery, Oulu University Hospital, Oulu, Finland
| | - E Mäkäräinen
- Department of Surgery, Oulu University Hospital, Oulu, Finland
| | - J Saarnio
- Department of Surgery, Oulu University Hospital, Oulu, Finland
| | - T Pinta
- Department of Surgery, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - J Vironen
- Department of Surgery, Helsinki University Hospital, Helsinki, Finland
| | - S Niemeläinen
- Department of Surgery, Tampere University Hospital, Tampere, Finland
| | - P Vento
- Department of Surgery, Kymenlaakso Central Hospital, Kotka, Finland
| | - M Nikki
- Department of Radiology, Oulu University Hospital, Oulu, Finland
| | - P Ohtonen
- Research Service Unit, The Research Unit of Surgery, Anesthesia and Intensive Care, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - T Rautio
- Department of Surgery, Oulu University Hospital, Oulu, Finland
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Reinpold W, Berger C, Adolf D, Köckerling F. Mini- or less-open sublay (E/MILOS) operation vs open sublay and laparoscopic IPOM repair for the treatment of incisional hernias: a registry-based propensity score matched analysis of the 5-year results. Hernia 2024; 28:179-190. [PMID: 37603090 DOI: 10.1007/s10029-023-02847-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/19/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Open sublay and laparoscopic IPOM repair have specific disadvantages and risks. In recent years, this evidence led to a paradigm shift and induced the development of new minimally invasive techniques of sublay mesh repair. METHODS Pioneering this trend, we developed the endoscopically assisted mini- or less-open sublay (MILOS) concept. The operation is performed trans-hernially via a small incision with light-holding laparoscopic instruments either under direct, or endoscopic visualization. After dissection of an extra-peritoneal space of at least 8 cm, port placement and CO2 insufflation, each MILOS operation can be continued endoscopically (EMILOS repair). All E/MILOS operations were prospectively documented in the Herniamed Registry with 1- and 5-year questionnaire follow-ups. Propensity score matching of incisional hernia operations comparing the results of the E/MILOS operation with the laparoscopic intraperitoneal onlay mesh operation (IPOM) and open sublay repair from all other institutions participating in the Herniamed Registry was performed. The results with perioperative complications and 1-year follow-up have been published previously. RESULTS This paper reports on the 5-year results. The 5-year follow-up rate was 87.5% (538 of 615 patients with E/MILOS incisional hernia operations). Comparing E/MILOS repair with laparoscopic IPOM and open sublay operation, propensity score matching analysis was possible with 448 and 520 pairs of operations, respectively. Compared with laparoscopic IPOM incisional hernia operation, the E/MILOS repair is associated with significantly fewer general complications (P = 0.004), recurrences (P < 0.001), less pain on exertion (P < 0.001), and less chronic pain requiring treatment (P = 0.016) and tends to result in fewer postoperative complications (P = 0.052), and less pain at rest (P = 0.053). Matched pair analysis with open sublay repair revealed significantly fewer general complications (P < 0.001), postoperative complications (P < 0.001), recurrences (P = 0.002), less pain at rest (P = 0.004), less pain on exertion (P < 0.001), and less chronic pain requiring treatment (P = 0.014). A limitation of this analysis is a relative low 5-year follow-up rate for laparoscopic IPOM and open sublay. CONCLUSIONS The E/MILOS technique allows minimally invasive trans-hernial repair of incisional hernias using large standard meshes with low morbidity and good long-term results. The technique combines the advantages of sub-lay repair and a mini- or less-invasive approach. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT03133000.
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Affiliation(s)
- W Reinpold
- Department of Abdominal Wall Surgery, Hamburg Hernia Center, Helios Mariahilf Hospital Hamburg, Stader Strasse 203c, 21075, Hamburg, Germany.
| | - C Berger
- Department of Abdominal Wall Surgery, Hamburg Hernia Center, Helios Mariahilf Hospital Hamburg, Stader Strasse 203c, 21075, Hamburg, Germany
| | - D Adolf
- Institute for Statistics, Otto-Von-Guerike-University, Magdeburg, Universitätsplatz 2, 39106, Magdeburg, Germany
| | - F Köckerling
- Center of Hernia Surgery, Vivantes Humboldt-Klinikum, Am Nordgraben 2, 13509, Berlin, Germany
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3
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Wu Q, Ma W, Wang Q, Liu Y, Xu Y. Comparative effectiveness of hybrid and laparoscopic techniques for repairing complex incisional ventral hernias: a systematic review and meta-analysis. BMC Surg 2023; 23:346. [PMID: 37974133 PMCID: PMC10652588 DOI: 10.1186/s12893-023-02254-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The recently developed Hybrid Hernia Repair technique (HHR), an adaptation of the laparoscopic method, has been proposed as a potential alternative for the treatment of complex Incisional Ventral Hernias (IVH). While single-arm studies have reported promising outcomes, a comprehensive meta-analysis affirming these benefits is lacking. This meta-analysis aims to compare the clinical outcomes of HHR and Laparoscopic Hernia Repair (LHR) in the management of IVH. METHODS An exhaustive search of the literature was conducted, targeting publications in both English and Chinese that compare HHR and LHR up to March 31, 2023. The primary outcomes examined were operation time, blood loss, and intestinal injury. Secondary outcomes included rates of seroma, wound infection, post-operative acute/chronic pain, recurrence, and mesh bulging. The RevMan 5.0 software facilitated the statistical meta-analysis. RESULTS The final analysis incorporated data from 14 studies, encompassing a total of 1158 patients, with 555 undergoing HHR and 603 treated with LHR. Follow-up data, ranging from 12 to 88 months, were available in 12 out of the 14 identified studies. The HHR method was associated with a significantly lower risk of seroma (OR = 0.29, P = 0.0004), but a higher risk of wound infection (OR = 2.10, P = 0.04). No significant differences were observed between the two techniques regarding operation time, blood loss, intestinal injury, intestinal obstruction, post-operative pain, mesh bulging, and recurrence. CONCLUSIONS The HHR technique did not demonstrate a clear advantage over LHR in reducing surgical complications, apart from a lower incidence of postoperative seroma. Surgeons with substantial expertise may choose to avoid incidental conversion or intentional hybrid procedures. Further research is needed to clarify the optimal surgical approach for IVH.
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Affiliation(s)
- Quan Wu
- Department of General Surgery, Beijing Jishuitan Hospital, Capital Medical University, 31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Weijie Ma
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
| | - Qianqian Wang
- Department of Epidemiology and Biostatistics, Beijing Research Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Yaqi Liu
- Department of General Surgery, Beijing Jishuitan Hospital, Capital Medical University, 31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Yaokai Xu
- Department of General Surgery, Beijing Jishuitan Hospital, Capital Medical University, 31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
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Sanders DL, Pawlak MM, Simons MP, Aufenacker T, Balla A, Berger C, Berrevoet F, de Beaux AC, East B, Henriksen NA, Klugar M, Langaufová A, Miserez M, Morales-Conde S, Montgomery A, Pettersson PK, Reinpold W, Renard Y, Slezáková S, Whitehead-Clarke T, Stabilini C. Midline incisional hernia guidelines: the European Hernia Society. Br J Surg 2023; 110:1732-1768. [PMID: 37727928 PMCID: PMC10638550 DOI: 10.1093/bjs/znad284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/08/2023] [Accepted: 08/02/2023] [Indexed: 09/21/2023]
Affiliation(s)
- David L Sanders
- Academic Department of Abdominal Wall Surgery, Royal Devon University
Foundation Healthcare Trust, North Devon District Hospital,
Barnstaple, UK
- University of Exeter Medical School,
Exeter, UK
| | - Maciej M Pawlak
- Academic Department of Abdominal Wall Surgery, Royal Devon University
Foundation Healthcare Trust, North Devon District Hospital,
Barnstaple, UK
- University of Exeter Medical School,
Exeter, UK
| | - Maarten P Simons
- Department of Surgery, OLVG Hospital Amsterdam,
Amsterdam, The
Netherlands
| | - Theo Aufenacker
- Department of Surgery, Rijnstate Hospital Arnhem,
Arnhem, The Netherlands
| | - Andrea Balla
- IRCCS San Raffaele Scientific Institute,
Milan, Italy
| | - Cigdem Berger
- Hamburg Hernia Centre, Department of Hernia and Abdominal Wall Surgery,
Helios Mariahilf Hospital Hamburg, Teaching Hospital of the University of Hamburg,
Hamburg, Germany
| | - Frederik Berrevoet
- Department for General and HPB Surgery and Liver Transplantation, Ghent
University Hospital, Ghent, Belgium
| | | | - Barbora East
- 3rd Department of Surgery at 1st Medical Faculty of Charles University,
Motol University Hospital, Prague, Czech Republic
| | - Nadia A Henriksen
- Department of Gastrointestinal and Hepatic Diseases, University of
Copenhagen, Herlev Hospital, Copenhagen, Denmark
| | - Miloslav Klugar
- The Czech National Centre for Evidence-Based Healthcare and Knowledge
Translation (Cochrane Czech Republic, Czech CEBHC: JBI Centre of Excellence, Masaryk
University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of
Medicine, Masaryk University, Brno, Czech Republic
| | - Alena Langaufová
- Department of Health Sciences, Faculty of Medicine, Masaryk
University, Brno, Czech
Republic
| | - Marc Miserez
- Department of Abdominal Surgery, University Hospital Gasthuisberg, KU
Leuven, Leuven, Belgium
| | - Salvador Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General and
Digestive Surgery, University Hospital Virgen del Rocio, University of
Sevilla, Sevilla, Spain
| | - Agneta Montgomery
- Department of Surgery, Skåne University Hospital,
Malmö, Sweden
- Department of Clinical Sciences, Malmö Faculty of Medicine, Lund
University, Lund, Sweden
| | - Patrik K Pettersson
- Department of Surgery, Skåne University Hospital,
Malmö, Sweden
- Department of Clinical Sciences, Malmö Faculty of Medicine, Lund
University, Lund, Sweden
| | - Wolfgang Reinpold
- Hamburg Hernia Centre, Department of Hernia and Abdominal Wall Surgery,
Helios Mariahilf Hospital Hamburg, Teaching Hospital of the University of Hamburg,
Hamburg, Germany
| | - Yohann Renard
- Reims Champagne-Ardennes, Department of General, Digestive and Endocrine
Surgery, Robert Debré University Hospital, Reims,
France
| | - Simona Slezáková
- The Czech National Centre for Evidence-Based Healthcare and Knowledge
Translation (Cochrane Czech Republic, Czech CEBHC: JBI Centre of Excellence, Masaryk
University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of
Medicine, Masaryk University, Brno, Czech Republic
| | - Thomas Whitehead-Clarke
- Centre for 3D Models of Health and Disease, Division of Surgery and
Interventional Science, University College London,
London, UK
| | - Cesare Stabilini
- Department of Surgery, University of Genoa,
Genoa, Italy
- Policlinico San Martino, IRCCS, Genoa,
Italy
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5
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Jeong S, Anwoju TA, Olavarria OA, Cavagnaro N, Dhanani NH, Lyons NB, Ali Z, Liang MK. Fascial Defect Closure During Ventral Hernia Repair: A Systematic Review of Randomized Controlled Trials. HCA HEALTHCARE JOURNAL OF MEDICINE 2023; 4:267-278. [PMID: 37753408 PMCID: PMC10519634 DOI: 10.36518/2689-0216.1469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
Background During minimally invasive ventral hernia repair (VHR) it is unknown if a fascial defect closure, as opposed to a bridged repair (current care), is beneficial for patients. We sought to systematically review the published literature on the role of fascial defect closure during minimally invasive VHR. Methods PubMed, Embase, Scopus, Cochrane, and Clinicaltrials.gov were reviewed for randomized controlled trials (RCTs) that compared fascial defect closure with bridged repair. The primary outcome was major complications defined as deep/organ-space surgical site infections (SSIs), reoperations, hernia recurrences, or deaths. Secondary outcomes included SSI, seroma, eventration, hernia recurrence, post-operative pain, and quality of life (QOL). Pooled risk ratios with 95% confidence intervals were obtained through random effect meta-analyses. Results Of 579 screened articles, 6 publications of 5 RCTs were included. No significant difference in major complications (10.6% vs 10.4%, RR=1.05, 95% CI=0.51-2.14, P=.90) or recurrences (9.0% vs 10.6%, RR=0.92, 95% CI=0.32-2.61, P=.87) were found between groups. Fascial defect closure decreased the risk of seromas (22.9% vs 34.2%, RR=0.60, 95% CI=0.37-0.97, P=.04) and may decrease the risk of eventrations (6.7% vs 9.0%, RR=0.74, 95% CI=0.37-1.50, P=.41) at the expense of potentially increasing the risk of SSI (3.2% vs 1.4%, RR=1.89, 95% CI=0.60-5.93; P=.28). Reporting of pain and QOL scores was inconsistent. Conclusion While most individual RCTs demonstrated benefit with fascial defect closure during minimally invasive VHR, our meta-analysis of fascial defect closure demonstrated only a statistically significant difference in seromas compared to bridged repair. Large, multi-center RCTs are needed.
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Affiliation(s)
- Shin Jeong
- HCA Houston Healthcare Kingwood, Kingwood, TX
| | | | | | | | | | | | - Zuhair Ali
- HCA Healthcare Graduate Medical Education, Kingwood, TX
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Kumar R, Prakash P, Sinha SR, Ahmad N, Baitha KS. Short-Term Outcomes and Quality-of-Life Assessment Following Rives-Stoppa and Transversus Abdominis Release Procedures of Open Ventral Hernia Repair. Cureus 2023; 15:e41637. [PMID: 37565133 PMCID: PMC10411383 DOI: 10.7759/cureus.41637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 08/12/2023] Open
Abstract
INTRODUCTION Ventral hernia is one of the common surgical conditions that can significantly impact a patient's quality of life (QoL). Open ventral hernia repair using the Rives-Stoppa (RS) and Transversus Abdominis Release (TAR) procedures has gained recognition for its effectiveness in achieving hernia repair and reducing the risk of further recurrence. However, limited research has been performed to explore the short-term outcomes and QoL assessment following these two surgical techniques. The aim of this study was to know the result after RS and TAR methods of hernia repair in terms of short-term recurrences, pain, postoperative complications, and QoL. METHODS This was a prospective, interventional study, which included 30 patients fulfilling the inclusion criteria. The study group was subjected to posterior component separation (PCS)-TAR and RS repair as per surgical indication (RS if defect size 4-10cm; PCS-TAR if defect size >10cm and = 15cm). All post-operative patients were followed up at postoperative day (POD) seven, POD 30, and POD 90 for postoperative pain, complications, and QoL using the hernia-specific Carolina Comfort Scale (CCS). At the same time, recurrence was studied till POD 180. RESULTS Not a single recurrence was observed till POD 180 in either of the repair methods. The mean operative time for RS repair was 170.47 ± 15.08 minutes while for TAR repair was 188.8 ± 22.04 (p-value= 0.013). Surgical site infection (SSI) was reported in 14.28% of RS repair cases and 11.11% of TAR repair cases. Seroma formation was observed in 9.5% of RS repair cases. RS repair has less mean CCS score than TAR. The one-way ANOVA showed f-ratio=421.43 and p-value=0.00001 for RS repair while f-ratio= 298.05 and p-value=0 .00001 for TAR repair at POD seven, POD 30, and POD 90. Both RS and TAR repair markedly reduced mean scores in all three domains on POD 90. CONCLUSION Both RS and TAR had no recurrence in a short period of six months. The intraoperative time taken in TAR was less than in earlier studies. QoL improved postoperatively in both the repairs with RS repair having better QoL than TAR repair.
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Affiliation(s)
- Rajiv Kumar
- General Surgery, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Prem Prakash
- General Surgery, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Seema R Sinha
- Biochemistry, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Nadeem Ahmad
- General Surgery, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Kanchan S Baitha
- General Surgery, Indira Gandhi Institute of Medical Sciences, Patna, IND
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7
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Campanile FC, Podda M, Pecchini F, Inama M, Molfino S, Bonino MA, Ortenzi M, Silecchia G, Agresta F, Cinquini M. Laparoscopic treatment of ventral hernias: the Italian national guidelines. Updates Surg 2023:10.1007/s13304-023-01534-3. [PMID: 37217637 PMCID: PMC10202362 DOI: 10.1007/s13304-023-01534-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/10/2023] [Indexed: 05/24/2023]
Abstract
Primary and incisional ventral hernias are significant public health issues for their prevalence, variability of professional practices, and high costs associated with the treatment In 2019, the Board of Directors of the Italian Society for Endoscopic Surgery (SICE) promoted the development of new guidelines on the laparoscopic treatment of ventral hernias, according to the new national regulation. In 2022, the guideline was accepted by the government agency, and it was published, in Italian, on the SNLG website. Here, we report the adopted methodology and the guideline's recommendations, as established in its diffusion policy. This guideline is produced according to the methodology indicated by the SNGL and applying the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology. Fifteen recommendations were produced as a result of 4 PICO questions. The level of recommendation was conditional for 12 of them and conditional to moderate for one. This guideline's strengths include relying on an extensive systematic review of the literature and applying a rigorous GRADE method. It also has several limitations. The literature on the topic is continuously and rapidly evolving; our results are based on findings that need constant re-appraisal. It is focused only on minimally invasive techniques and cannot consider broader issues (e.g., diagnostics, indication for surgery, pre-habilitation).
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Affiliation(s)
- Fabio Cesare Campanile
- Division of General Surgery, ASL Viterbo, San Giovanni Decollato-Andosilla Hospital, Civita Castellana, Italy
| | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Francesca Pecchini
- Department of General Surgery, Emergency and New Technologies, Baggiovara General Hospital, AOU Modena, Modena, Italy
| | - Marco Inama
- General and Mininvasive Surgery Department, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
| | - Sarah Molfino
- General Surgery Unit Chirurgia III, ASST Spedali Civili di Brescia, Brescia, Italy
| | | | - Monica Ortenzi
- Department of General and Emergency Surgery, Marche Polytechnic University, Via Conca 71, 60126, Ancona, Italy.
| | - Gianfranco Silecchia
- Department of Medical-Surgical Sciences and Translation Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | | | - Michela Cinquini
- Department of Oncology, Laboratory of Methodology of Sistematic Reviews and Guidelines Production, Istituto di Ricerche Farmacologiche Mario Negri IRCCS., Milan, Italy
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8
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Bell‐Allen N, Swift K, Sontag N, O'Rourke N. Ventral hernia repair with a hybrid laparoscopic technique. ANZ J Surg 2022; 92:2529-2533. [PMID: 35142004 PMCID: PMC9790400 DOI: 10.1111/ans.17508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 12/08/2021] [Accepted: 01/10/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Ventral hernias are increasingly managed with minimally invasive laparoscopic surgery. Invasive open surgery is typically used for the repair of large-sized hernias (>10 cm diameter). The two methods are often considered mutually exclusive. We report a hybrid technique for repair of medium to large-sized hernias. METHODS Data was collected prospectively from 44 hernias repaired using the hybrid technique from 2012 to 2020. Operative data was examined and follow-up conducted by both clinical and phone review. As for surgical technique, laparoscopic access was established via a 5 mm optical port and two (or more) 5 mm ports were added under vision. Hernia contents were reduced and extraperitoneal fat excised around the defect. Hernias with diameters ranging from 5 to 10 cm were fixed using the hybrid technique. A small incision was made directly over the hernia and polyester mesh was placed intraabdominally before defect closure with a transfascial suture. Pneumoperitoneum was re-established and mesh fixation achieved using absorbable tacks and/or fixation sutures. RESULTS Of the 44 ventral hernias repaired with the hybrid technique, 43 were secondary hernias from incisional defects. Average hernia diameter was 6.6 cm. 86% of patients were discharged within the first 48 h. Four patients (9%) had recurrences during the study period. Minor complications occurred in 8 patients (18%): 3 (7%) had post-operative wound infection, 3 patients (7%) developed post-operative seroma. Two patients (5%) had clinically significant wound haematoma. CONCLUSION Laparoscopic hybrid ventral hernia repair can be safely performed by a combination of laparoscopic and open techniques, offering an alternative method in the management of medium-sized ventral hernias.
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Affiliation(s)
- Nicholas Bell‐Allen
- The Wesley HospitalBrisbaneQueenslandAustralia,The Royal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - Kate Swift
- The Royal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | | | - Nicholas O'Rourke
- The Wesley HospitalBrisbaneQueenslandAustralia,The Royal Brisbane and Women's HospitalBrisbaneQueenslandAustralia,Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
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9
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Melland-Smith M, Khan U, Smith L, Tan J. Comparison of two fascial defect closure methods for laparoscopic incisional hernia repair. Hernia 2022; 26:945-951. [PMID: 34297250 DOI: 10.1007/s10029-021-02443-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/09/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Currently there is no consensus regarding the optimal surgical approach to an incisional hernia measuring less than 10 cm. Certain hernia features including defect size, intra-abdominal adhesions, and overlying scar/skin properties contribute to choosing an open versus a laparoscopic approach. This retrospective cohort study was designed to compare incisional hernia defects repaired with laparoscopic suture closure to a hybrid approach with open defect closure, both with laparoscopic intraperitoneal onlay mesh (IPOM) reinforcement. METHODS We identified 164 consecutive patients who underwent incisional hernia repair from two centers, North York General Hospital (NYGH) and Humber River Hospital (HRH) between 2015 and 2020. Patients were grouped by totally laparoscopic or hybrid fascial closure. Both techniques included laparoscopically placed intra-peritoneal mesh with 5 cm of overlap in all directions. Patients were analyzed by age, sex, body mass index (BMI), ASA class and hernia size. Primary outcomes included surgical site infection (SSI), other wound complications including seroma/hematoma, length of hospital stay, pain reported at follow-up appointment, and hernia recurrence. RESULTS Post-operative pain, surgical site infections and seromas did not differ between the totally laparoscopic and hybrid approach. The recurrence rates were 5.8% and 6.8% for the laparoscopic and hybrid group, respectively, which were not significantly different. The time to recurrence was 15 months (range 8-12) in the laparoscopic group and 7 months (range 6-36) in the hybrid group, also not significantly different. The hernia defect size and BMI were significantly higher in the hybrid group, without increased wound complications. CONCLUSION These results suggest that a hybrid approach to incisional ventral hernia repair with open defect closure is comparable to a totally laparoscopic closure. The hybrid technique can help facilitate fascial closure and resection of the hernia sac in patients with higher BMI and hernia defects up to 6 cm.
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Affiliation(s)
- M Melland-Smith
- Department of Surgery, Division of General Surgery, University of Toronto, Toronto, ON, Canada
- Department of General Surgery, Division of General Surgery, North York General Hospital, North York, ON, Canada
- Department of Surgery, Division of General Surgery, Humber River Hospital, Toronto, ON, Canada
| | - U Khan
- Department of Surgery, Division of General Surgery, University of Toronto, Toronto, ON, Canada
| | - L Smith
- Department of Surgery, Division of General Surgery, University of Toronto, Toronto, ON, Canada
- Department of General Surgery, Division of General Surgery, North York General Hospital, North York, ON, Canada
| | - J Tan
- Department of Surgery, Division of General Surgery, University of Toronto, Toronto, ON, Canada.
- Department of Surgery, Division of General Surgery, Humber River Hospital, Toronto, ON, Canada.
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10
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Käkelä P, Mustonen K, Rantanen T, Paajanen H. Robotic versus hybrid assisted ventral hernia repair: a prospective one-year comparative study of clinical outcomes. Acta Chir Belg 2022:1-7. [PMID: 35451935 DOI: 10.1080/00015458.2022.2069656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Laparoscopic ventral hernia repair (LVHR) may be associated with chronic pain, seroma formation, bulging and failure to restore abdominal wall function. These outcomes are risk factors for hernia recurrence and poor quality of life (QoL). Our study evaluates whether robotic-assisted ventral hernia repair (rVHR) diminishes these complications compared to LVHR with primary closure of the defect (hybrid). METHODS Thirty-eight consecutive patients undergoing incisional ventral hernia operation with fascial defect size from 3 to 6 cm were recruited between November 2019 and October 2020. Nineteen patients underwent rVHR and nineteen underwent hybrid operation. The main outcome measure was postoperative pain, evaluated with a visual analogue scale (VAS: 0-10) at 1-month and at 1-year. Hernia recurrence was evaluated with ultrasound examination and QoL using the generic SF-36 short form questionnaire. RESULTS At the 1-month control visit, VAS scores were significantly lower in the rVHR group; 2.5 in the hybrid group and 0.3 in the rVHR group (p < 0.001). At the 1-year control, the difference in VAS scores was still significant, 2.8 vs 0.1 (p = 0.023). There was one hernia recurrence in the hybrid group (p = 0.331). QoL did not differ significantly between the study groups when compared to preoperative physical status at 1-year follow-up (p = 0.121). However, emotional status (p = 0.049) and social functioning (p = 0.039) improved significantly in the rVHR group. CONCLUSIONS Robotic-assisted ventral hernia repair (rVHR) was less painful compared to hybrid repair at 1-month and at 1-year follow-up. In addition, improvement in social functioning status was reported with rVHR. TRIAL REGISTRATION ID 5200658.
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Affiliation(s)
- Pirjo Käkelä
- Department of Surgery, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Kirsi Mustonen
- Department of Surgery, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Tuomo Rantanen
- Department of Surgery, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Hannu Paajanen
- Department of Surgery, University of Eastern Finland and Mikkeli Central Hospital, Mikkeli, Finland
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11
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Yang S, Wang MG, Nie YS, Zhao XF, Liu J. Outcomes and complications of open, laparoscopic, and hybrid giant ventral hernia repair. World J Clin Cases 2022; 10:51-61. [PMID: 35071505 PMCID: PMC8727244 DOI: 10.12998/wjcc.v10.i1.51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 07/11/2021] [Accepted: 11/28/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND An incisional hernia is a common complication of abdominal surgery.
AIM To evaluate the outcomes and complications of hybrid application of open and laparoscopic approaches in giant ventral hernia repair.
METHODS Medical records of patients who underwent open, laparoscopic, or hybrid surgery for a giant ventral hernia from 2006 to 2013 were retrospectively reviewed. The hernia recurrence rate and intra- and postoperative complications were calculated and recorded.
RESULTS Open, laparoscopic, and hybrid approaches were performed in 82, 94, and 132 patients, respectively. The mean hernia diameter was 13.11 ± 3.4 cm. The incidence of hernia recurrence in the hybrid procedure group was 1.3%, with a mean follow-up of 41 mo. This finding was significantly lower than that in the laparoscopic (12.3%) or open procedure groups (8.5%; P < 0.05). The incidence of intraoperative intestinal injury was 6.1%, 4.1%, and 1.5% in the open, laparoscopic, and hybrid procedures, respectively (hybrid vs open and laparoscopic procedures; P < 0.05). The proportion of postoperative intestinal fistula formation in the open, laparoscopic, and hybrid approach groups was 2.4%, 6.8%, and 3.3%, respectively (P > 0.05).
CONCLUSION A hybrid application of open and laparoscopic approaches was more effective and safer for repairing a giant ventral hernia than a single open or laparoscopic procedure.
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Affiliation(s)
- Shuo Yang
- Department of Hernia and Abdominal Wall, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
| | - Ming-Gang Wang
- Department of Hernia and Abdominal Wall, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
| | - Yu-Sheng Nie
- Department of Hernia and Abdominal Wall, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
| | - Xue-Fei Zhao
- Department of Hernia and Abdominal Wall, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
| | - Jing Liu
- Department of Hernia and Abdominal Wall, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
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12
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Van den Dop LM, De Smet GHJ, Kleinrensink GJ, Hueting WE, Lange JF. Hybrid operation technique for incisional hernia repair: a systematic review and meta-analysis of intra- and postoperative complications. Hernia 2021; 25:1459-1469. [PMID: 34537886 PMCID: PMC8613158 DOI: 10.1007/s10029-021-02497-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/31/2021] [Indexed: 11/29/2022]
Abstract
Background Incisional hernia (IH) occurs approximately in 15% of patients after midline surgery. Surgical treatment for IHs include a solely open or solely laparoscopic approach with mesh placement. Recently, hybrid (combined laparoscopic and open) approaches have been introduced. This systematic review evaluates perioperative complications of hybrid incisional hernia repair (HIHR). Methods EMBASE, Medline via OvidSP, Web of Science, Cochrane and Google Scholar databases were searched. Studies providing data on intra- and postoperative complications in patients who underwent HIHR were included. Data on intra- and postoperative complications were extracted and meta-analyses were performed. Study quality was assessed with the Newcastle Ottowa Scale, ROBINS-I tool, and Cochrane risk of bias. PROSPERO registration: CRD42020175053. Results Eleven studies (n = 1681 patients) were included. Five studies compared intra-operative complications between HIHR and laparoscopic incisional hernia repair (LIHR) with a pooled incidence of 1.8% in HIHR group and 2.8% in LIHR group (p = 0.13). Comparison of postoperative prevalence of surgical site occurrences (SSOs) (23% versus 26%, p = 0.02) and surgical site occurrences requiring interventions (SSOPIs) (1.5% versus 4.1%, p < 0.01) were in favour of the HIHR group. Overall postoperative complications seemed to occur less frequent in the HIHR group, though no hard statements could be made due to the vast heterogeneity in reporting between studies. Conclusion Although the majority of studies were retrospective and included a small number of patients, HIHR seemingly led to less SSOs and SSOPIs. This systematic review forms a strong invitation for more randomized controlled trials to confirm the benefits of this approach. Supplementary Information The online version contains supplementary material available at 10.1007/s10029-021-02497-3.
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Affiliation(s)
- L Matthijs Van den Dop
- Department of Surgery, Erasmus University Medical Center, Room Ee-173, Post box 2040, 3000, Rotterdam, CA, The Netherlands.
| | - Gijs H J De Smet
- Department of Surgery, Erasmus University Medical Center, Room Ee-173, Post box 2040, 3000, Rotterdam, CA, The Netherlands
| | - Gert-Jan Kleinrensink
- Department of Neuroscience, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Willem E Hueting
- Department of Surgery, Alrijne Ziekenhuis, Leiderdorp, Leiden, The Netherlands
| | - Johan F Lange
- Department of Surgery, Erasmus University Medical Center, Room Ee-173, Post box 2040, 3000, Rotterdam, CA, The Netherlands.,Department of Surgery, IJsselland Ziekenhuis, Capelle Aan Den IJssel, The Netherlands
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13
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Frey S, Jurczak F, Fromont G, Dabrowski A, Soler M, Cossa JP, Magne E, Zaranis C, Beck M, Gillion JF. Are the relative benefits of open versus laparoscopic intraperitoneal mesh repair of umbilical hernias dependent on the diameter of the defect? Surgery 2021; 171:419-427. [PMID: 34503852 DOI: 10.1016/j.surg.2021.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 07/03/2021] [Accepted: 08/01/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The aim of this study was to assess whether the respective values of open and laparoscopic intraperitoneal repairs of umbilical hernias are related to the European Hernia Society diameter of defects. METHODS This registry-based study compared the early and 2-year outcomes of 776 open versus 1,019 consecutive laparoscopic intraperitoneal repairs performed from 2011 to 2019. RESULTS Intraperitoneal mesh repair, either laparoscopic or open, was found to be a safe procedure at the 2-year follow-up. The incidence of reoperated bowel obstructions was 0.3%. Compared with the open group: (1) postoperative surgical site occurrences in small (<2 cm) or medium (2-4 cm) hernias (0.3% vs 2.4%; P = .041; 1.4% vs 5.9%; P = .0002); (2) recurrence rates in large (≥4 cm) umbilical hernias (0.0% vs 8.6%; P = .0195); and (3) cumulative reoperation rates (0.9% vs 2.2%; P = .021) were significantly better in the laparoscopic group. Conversely, the rate of early pain on day 1 and 1 month postsurgery was higher in the laparoscopic group, for all hernia sizes (P < .001). The rate of moderate or severe chronic pain at 2 years was significantly higher in the laparoscopic group (8.1% vs 2.4%; P = .049) for small hernias. CONCLUSION The respective benefit to drawback ratios for open versus laparoscopic intraperitoneal repairs were related to the European Hernia Society diameter of hernia defect. In medium-large hernias, the benefits of laparoscopic repair overrode its drawbacks. In small hernias, the low recurrence rate, reduced early and chronic pain, and better rate of ambulatory surgery suggest there is still a place for open repair.
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Affiliation(s)
- Samuel Frey
- Institut des Maladies de l'Appareil Digestif, CHU Nantes, Nantes, France; Université de Nantes, Nantes, France.
| | | | | | | | - Marc Soler
- Clinique Saint-Jean, Cagnes-sur-Mer, France
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14
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Harji D, Thomas C, Antoniou SA, Chandraratan H, Griffiths B, Henniford BT, Horgan L, Köckerling F, López-Cano M, Massey L, Miserez M, Montgomery A, Muysoms F, Poulose BK, Reinpold W, Smart N. A systematic review of outcome reporting in incisional hernia surgery. BJS Open 2021; 5:6220250. [PMID: 33839746 PMCID: PMC8038267 DOI: 10.1093/bjsopen/zrab006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/20/2020] [Accepted: 01/13/2021] [Indexed: 01/13/2023] Open
Abstract
Background The incidence of incisional hernia is up to 20 per cent after abdominal surgery. The management of patients with incisional hernia can be complex with an array of techniques and meshes available. Ensuring consistency in reporting outcomes across studies on incisional hernia is important and will enable appropriate interpretation, comparison and data synthesis across a range of clinical and operative treatment strategies. Methods Literature searches were performed in MEDLINE and EMBASE (from 1 January 2010 to 31 December 2019) and the Cochrane Central Register of Controlled Trials. All studies documenting clinical and patient-reported outcomes for incisional hernia were included. Results In total, 1340 studies were screened, of which 92 were included, reporting outcomes on 12 292 patients undergoing incisional hernia repair. Eight broad-based outcome domains were identified, including patient and clinical demographics, hernia-related symptoms, hernia morphology, recurrent incisional hernia, operative variables, postoperative variables, follow-up and patient-reported outcomes. Clinical outcomes such as hernia recurrence rates were reported in 80 studies (87 per cent). A total of nine different definitions for detecting hernia recurrence were identified. Patient-reported outcomes were reported in 31 studies (34 per cent), with 18 different assessment measures used. Conclusions This review demonstrates the significant heterogeneity in outcome reporting in incisional hernia studies, with significant variation in outcome assessment and definitions. This is coupled with significant under-reporting of patient-reported outcomes.
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Affiliation(s)
- D Harji
- Northern Surgical Trainees Research Association (NoSTRA), Northern Deanery, Newcastle Upon Tyne, UK
| | - C Thomas
- Northern Surgical Trainees Research Association (NoSTRA), Northern Deanery, Newcastle Upon Tyne, UK
| | - S A Antoniou
- Department of Surgery, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - H Chandraratan
- Notre Dame University, General Surgery, Murdoch, Western Australia, Australia
| | - B Griffiths
- Newcastle Surgical Education, Newcastle Upon Tyne, UK
| | - B T Henniford
- Division of Gastrointestinal and Minimally Invasive Surgery Carolinas Medical Center, Charlotte, North Carolina, USA
| | - L Horgan
- Upper Gastrointestinal Surgical Department, Northumbria Healthcare NHSFT, North Shields, UK
| | - F Köckerling
- Department of Surgery and Centre for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Berlin, Germany
| | - M López-Cano
- Abdominal Wall Surgery Unit, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - L Massey
- Department of Surgery, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - M Miserez
- Department of Abdominal Surgery, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - A Montgomery
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - F Muysoms
- Department of Surgery, Maria Middelares, Ghent, Belgium
| | - B K Poulose
- Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - W Reinpold
- Department of Surgery and Reference Hernia Centre, Gross Sand Hospital Hamburg, Hamburg, Germany
| | - N Smart
- Department of Surgery, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
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15
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Sharma A, Sinha C, Baijal M, Soni V, Khullar R, Chowbey P. Hybrid approach for ventral incisional hernias of the abdominal wall: A systematic review of the literature. J Minim Access Surg 2021; 17:7-13. [PMID: 32964882 PMCID: PMC7945640 DOI: 10.4103/jmas.jmas_146_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
With increasing complexity of ventral incisional hernias being operated on, the treatment strategy has also evolved to obtain optimal results. Hybrid ventral hernia repair is a promising technique in management of complex/difficult ventral incisional hernias. The aim of this article is to review the literature and analyse the results of hybrid technique in management of ventral incisional hernia and determine its clinical status and ascertain its role. We reviewed the literature on hybrid technique for incisional ventral hernia repair on PubMed, Medline and Google Scholar database published between 2002 and 2019 and out of 218 articles screened, 10 studies were included in the review. Selection of articles was in accordance with the PRISMA guideline. Variables analysed were seroma, wound infection, chronic pain and recurrence. Qualitative analysis of the variables was carried out. In this systematic review, the incidence of complications associated within this procedure were seroma formation (5.47%), wound infections (6.53%) and chronic pain (4.49%). Recurrence was seen in 3.29% of patients. Hybrid ventral hernia repair represents a natural evolution in advancement of hernia repair. The judicious use of hybrid repair in selected patients combines the safety of open surgery with several advantages of the laparoscopic approach with favourable surgical outcomes in terms of recurrence, seroma and incidence of chronic pain. However, larger multi-centric prospective studies with long term follow up is required to standardise the technique and to establish it as a procedure of choice for this complex disease entity.
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Affiliation(s)
- Anil Sharma
- Department of Minimal Access, Metabolic and Bariatric Surgery, Max Super Speciality Hospital, New Delhi, India
| | - Chaitanya Sinha
- Department of Minimal Access, Metabolic and Bariatric Surgery, Max Super Speciality Hospital, New Delhi, India
| | - Manish Baijal
- Department of Minimal Access, Metabolic and Bariatric Surgery, Max Super Speciality Hospital, New Delhi, India
| | - Vandana Soni
- Department of Minimal Access, Metabolic and Bariatric Surgery, Max Super Speciality Hospital, New Delhi, India
| | - Rajesh Khullar
- Department of Minimal Access, Metabolic and Bariatric Surgery, Max Super Speciality Hospital, New Delhi, India
| | - Pradeep Chowbey
- Department of Minimal Access, Metabolic and Bariatric Surgery, Max Super Speciality Hospital, New Delhi, India
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16
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van den Dop LM, de Smet GHJ, Bus MPA, Lange JF, Koch SMP, Hueting WE. A new three-step hybrid approach is a safe procedure for incisional hernia: early experiences with a single centre retrospective cohort. Hernia 2020; 25:1693-1701. [PMID: 32920734 PMCID: PMC8613149 DOI: 10.1007/s10029-020-02300-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/02/2020] [Indexed: 11/29/2022]
Abstract
Purpose In this study, a three-step novel surgical technique was developed for incisional hernia, in which a laparoscopic procedure with a mini-laparotomy is combined: so-called ‘three-step incisional hybrid repair’. The aim of this study was to reduce the risk of intestinal lacerations during adhesiolysis and recurrence rate by better symmetrical overlap placement of the mesh. Objectives To evaluate first perioperative outcomes with this technique. Methods From 2016 to 2020, 70 patients (65.7% females) with an incisional hernia of > 2 and ≤ 10 cm underwent a elective three-step incisional hybrid repair in two non-academic hospitals performed by two surgeons specialised in abdominal wall surgery. Intra- and postoperative complications, operation time, hospitalisation time and hernia recurrence were assessed.
Results Mean operation time was 100 min. Mean hernia size was 4.8 cm; 45 patients (64.3%) had a hernia of 1–5 cm, 25 patients (35.7%) of 6–10 cm. Eight patients had a grade 1 complication (11.4%), five patients a grade 2 (7.1%), two patients (2.8%) a grade 4 complication and one patient (1.4%) a grade 5 complication. Five patients had an intraoperative complication (7.0%), two enterotomies, one serosa injury, one omentum bleeding and one laceration of an epigastric vessel. Mean length of stay was 3.3 days. Four patients (5.6%) developed a hernia recurrence during a mean follow-up of 19.5 weeks.
Conclusion A three-step hybrid incisional hernia repair is a safe alternative for incisional hernia repair. Intraoperative complications rate was low.
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Affiliation(s)
- L Matthijs van den Dop
- Department of Surgery, Erasmus University Medical Centre, Room Ee-173, Dr. Molewaterplein 40, 3000 CA, PO BOX 2040, 3015 GD, Rotterdam, The Netherlands.
| | - Gijs H J de Smet
- Department of Surgery, Erasmus University Medical Centre, Room Ee-173, Dr. Molewaterplein 40, 3000 CA, PO BOX 2040, 3015 GD, Rotterdam, The Netherlands
| | - Michaël P A Bus
- Department of Surgery, Alrijne Ziekenhuis, Leiderdop, The Netherlands
| | - Johan F Lange
- Department of Surgery, Erasmus University Medical Centre, Room Ee-173, Dr. Molewaterplein 40, 3000 CA, PO BOX 2040, 3015 GD, Rotterdam, The Netherlands.,Department of Surgery, IJsselland Ziekenhuis, Capelle Aan Den IJssel, The Netherlands
| | - Sascha M P Koch
- Department of Surgery, Alrijne Ziekenhuis, Leiderdop, The Netherlands
| | - Willem E Hueting
- Department of Surgery, Alrijne Ziekenhuis, Leiderdop, The Netherlands
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17
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Olavarria OA, Bernardi K, Shah SK, Wilson TD, Wei S, Pedroza C, Avritscher EB, Loor MM, Ko TC, Kao LS, Liang MK. Robotic versus laparoscopic ventral hernia repair: multicenter, blinded randomized controlled trial. BMJ 2020; 370:m2457. [PMID: 32665218 PMCID: PMC7359869 DOI: 10.1136/bmj.m2457] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To determine whether robotic ventral hernia repair is associated with fewer days in the hospital 90 days after surgery compared with laparoscopic repair. DESIGN Pragmatic, blinded randomized controlled trial. SETTING Multidisciplinary hernia clinics in Houston, USA. PARTICIPANTS 124 patients, deemed appropriate candidates for elective minimally invasive ventral hernia repair, consecutively presenting from April 2018 to February 2019. INTERVENTIONS Robotic ventral hernia repair (n=65) versus laparoscopic ventral hernia repair (n=59). MAIN OUTCOME MEASURES The primary outcome was number of days in hospital within 90 days after surgery. Secondary outcomes included emergency department visits, operating room time, wound complications, hernia recurrence, reoperation, abdominal wall quality of life, and costs from the healthcare system perspective. Outcomes were pre-specified before data collection began and analyzed as intention to treat. RESULTS Patients from both groups were similar at baseline. Ninety day follow-up was completed in 123 (99%) patients. No evidence was seen of a difference in days in hospital between the two groups (median 0 v 0 days; relative rate 0.90, 95% confidence interval 0.37 to 2.19; P=0.82). For secondary outcomes, no differences were noted in emergency department visits, wound complications, hernia recurrence, or reoperation. However, robotic repair had longer operative duration (141 v 77 min; mean difference 62.89, 45.75 to 80.01; P≤0.001) and increased healthcare costs ($15 865 (£12 746; €14 125) v $12 955; cost ratio 1.21, 1.07 to 1.38; adjusted absolute cost difference $2767, $910 to $4626; P=0.004). Among patients with robotic ventral hernia repair, two had an enterotomy compared none with laparoscopic repair. The median one month postoperative improvement in abdominal wall quality of life was 3 with robotic ventral hernia repair compared with 15 following laparoscopic repair. CONCLUSION This study found no evidence of a difference in 90 day postoperative hospital days between robotic and laparoscopic ventral hernia repair. However, robotic repair increased operative duration and healthcare costs. TRIAL REGISTRATION Clinicaltrials.gov NCT03490266.
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Affiliation(s)
- Oscar A Olavarria
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, Houston, TX 77026, USA
- Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Karla Bernardi
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, Houston, TX 77026, USA
- Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Shinil K Shah
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, Houston, TX 77026, USA
- Department of Surgery, Memorial Hermann Texas Medical Center, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Todd D Wilson
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, Houston, TX 77026, USA
- Department of Surgery, Memorial Hermann Texas Medical Center, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Shuyan Wei
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, Houston, TX 77026, USA
- Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Claudia Pedroza
- Department of Pediatrics, McGovern Medical School at UTHealth, Houston, TX, USA
- Center for Clinical Research and Evidence Based Medicine, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Elenir B Avritscher
- Department of Pediatrics, McGovern Medical School at UTHealth, Houston, TX, USA
- Center for Clinical Research and Evidence Based Medicine, McGovern Medical School at UTHealth, Houston, TX, USA
- Department of Pediatrics, McGovern Medical School at UTHealth, Houston, TX, USA
- Center for Clinical Research and Evidence Based Medicine, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Michele M Loor
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Tien C Ko
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, Houston, TX 77026, USA
| | - Lillian S Kao
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, Houston, TX 77026, USA
- Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Mike K Liang
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, Houston, TX 77026, USA
- Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at UTHealth, Houston, TX, USA
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18
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Sandø A, Rosen MJ, Heniford BT, Bisgaard T. Long-term patient-reported outcomes and quality of the evidence in ventral hernia mesh repair: a systematic review. Hernia 2020; 24:695-705. [DOI: 10.1007/s10029-020-02154-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 02/19/2020] [Indexed: 12/30/2022]
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Primary non-complicated midline ventral hernia: is laparoscopic IPOM still a reasonable approach? Hernia 2019; 23:915-925. [PMID: 31456098 DOI: 10.1007/s10029-019-02031-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 08/07/2019] [Indexed: 01/16/2023]
Abstract
PURPOSE Ventral hernia repair has become a common procedure, but the way in which it is performed still depends on surgeon's skill, experience, and habit. The initial open approach is faced with extensive dissection and a high risk of infection and prolonged hospital stay. To tackle these problems, minimally invasive procedures are gaining interest. Several new techniques are emerging, but laparoscopic intra-peritoneal onlay mesh (IPOM) is still the mainstay for many surgeons. We will discuss why laparoscopic IPOM is still a valuable approach in the treatment of primary non-complicated midline hernias and review the current literature. METHODS We performed a literature search across PubMed and MEDLINE using the following search terms: "Laparoscopic hernia repair", "Ventral hernia repair" and "Primary ventral hernia". Articles corresponding to these search terms were individually reviewed by the primary author and selected on relevance. CONCLUSION Laparoscopic IPOM still is a good approach for the efficient treatment of primary non-complicated midline hernias. Several techniques are emerging, but are faced with increased costs, technical difficulties, and low study patient volume. Further research is warranted to show superiority and applicability of these new techniques over laparoscopic IPOM, but until then laparoscopic IPOM should remain the go-to technique.
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20
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The influence of mesh removal during laparoscopic repair of recurrent ventral hernias on the long-term outcome. Wideochir Inne Tech Maloinwazyjne 2019; 14:366-373. [PMID: 31534565 PMCID: PMC6748057 DOI: 10.5114/wiitm.2019.85350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 05/06/2019] [Indexed: 01/29/2023] Open
Abstract
Introduction Recurrent hernias can be treated by laparoscopy without the need for mesh removal. However, shrinkage of the mesh following recurrence affects most of the patients, and leaving a partially floating and rigid foreign body could be discussed. Aim To compare the outcomes of patients regarding the removal of previous mesh during laparoscopic repair of recurrent abdominal wall hernias. Material and methods Patients who underwent laparoscopic repair for recurrent ventral hernias between August 2012 and March 2015 were included in the study. The patients with complete removal of the mesh were included in the MR group and the patients with partial removal or without removal of the previous mesh were included in the non-MR group. Patient characteristics and demographics, previous hernia repair, defect size, mesh size, operative time, mean hospital stay, complications, recurrences, numeric pain rating scale (NRS), early termination of analgesics and prolonged use of analgesics were compared. Results A total of 112 patients with a mean age of 53.2 and mean body mass index of 31.1 kg/m2 underwent laparoscopic repair. There were 47 patients in the MR group and 54 patients in the non-MR group. Operative time was shorter in the non-MR group (p < 0.05), whereas symptomatic seroma and NRS scores on postoperative day 10 and at the 6th week were higher in comparison with the MR group (p < 0.05). Conclusions Mesh removal during laparoscopic repair of recurrent ventral hernias has an association with the reduction of pain and symptomatic seroma. However, further prospective comparative studies are required to verify this view.
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