1
|
Chin M, Kit JLW, Wijerathne S, Aw A, Ann DCK, Fatt SLK, Ragupathi T, Ng Ho Man H, Lomanto D. A comparative study between condensed polytetrafluoroethylene hernia mesh versus other composite meshes in Endo-laparoscopic ventral hernia repair. Asian J Surg 2024:S1015-9584(24)02568-5. [PMID: 39603941 DOI: 10.1016/j.asjsur.2024.10.234] [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: 07/15/2024] [Accepted: 10/28/2024] [Indexed: 11/29/2024] Open
Abstract
INTRODUCTION Laparoscopic ventral hernia mesh repair (LVHR) is gaining popularity possibly due to reduced complications, reduced hospital stay, early return to work and better cosmesis. In intra-peritoneal onlay method (IPOM) a dual layer composite mesh with an absorbable barrier on the visceral surface is used for minimising bowel adhesions. Three most popular prosthetic mesh scaffolds are polypropylene (PP), polyester and expanded polytetrafluoroethylene (ePTFE). A new generation of monolayer condensed polytetrafluoroethylene (cPTFE) Omyra® mesh, which theoretically has better tissue integration with parietal tissue and possibly lesser adhesions with visceral organs is now available for use. OBJECTIVE The aim of our study is to assess the safety and efficacy of Omyra (cPTFE) mesh versus other mesh types in LVHR. METHOD We retrospectively collected data from 62 patients who underwent LVHR using cPTFE, as well as other mesh types from January 1, 2011 to December 31, 2020. Patient demographics, Hernia Characteristics, perioperative events, postoperative results and complications were documented and analysed. RESULTS Among the 62 patients studied, there were 27 (43.55 %) in the Omyra group and 35 (56.45 %) in the other synthetic meshes group. The mean age of the Omyra group was 53.19 (31-85) and 55.03 (22-81) for the other synthetic meshes group. There were no differences in terms of patient demographics and major comorbidities. At presentation, the indication was more commonly for recurrence (p = 0.043), and patients were more symptomatic (p = 0.0034) in the Omyra group than the other synthetic meshes group. There were no differences in mean operating time, post-operative recovery and complications, as well as early (<30 days) and late (>30 days) complications during follow up. CONCLUSION The use of cPTFE (Omyra™) mesh yielded comparable operative characteristic compared to other synthetic meshes for LVHR. The rate of perioperative complications and early recurrence was similar between Omyra and other synthetic meshes group.
Collapse
Affiliation(s)
- Meredeth Chin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - James Lee Wai Kit
- Division of Minimally Invasive Surgery, Department of Surgery, National University Hospital, Singapore; Department of Surgery, Alexandra Hospital, Singapore
| | - Sujith Wijerathne
- Division of Minimally Invasive Surgery, Department of Surgery, National University Hospital, Singapore; Department of Surgery, Alexandra Hospital, Singapore
| | - Avelyn Aw
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Daryl Chia Kai Ann
- Division of Minimally Invasive Surgery, Department of Surgery, National University Hospital, Singapore; Department of Surgery, National University of Singapore, Singapore
| | - Sean Lee Kien Fatt
- Division of Minimally Invasive Surgery, Department of Surgery, National University Hospital, Singapore
| | - Tharun Ragupathi
- Division of Minimally Invasive Surgery, Department of Surgery, National University Hospital, Singapore
| | - Harry Ng Ho Man
- Division of Minimally Invasive Surgery, Department of Surgery, National University Hospital, Singapore
| | - Davide Lomanto
- Division of Minimally Invasive Surgery, Department of Surgery, National University Hospital, Singapore; Department of Surgery, National University of Singapore, Singapore
| |
Collapse
|
2
|
Hayakawa T, Ueno N, Eguchi T, Kawarada Y, Shigemitsu Y, Shimada G, Suwa K, Nakagawa M, Hachisuka T, Hayakawa S, Yamamoto K, Yokoyama T, Wada N, Wada H, Takehara H, Nagae I, Morotomi Y, Idani H, Saijo F, Tsuruma T, Nakano K, Kimura T, Matsumoto S. Practice guidelines on endoscopic surgery for qualified surgeons by the endoscopic surgical skill qualification system: Hernia. Asian J Endosc Surg 2024; 17:e13363. [PMID: 39087456 DOI: 10.1111/ases.13363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 07/03/2024] [Accepted: 07/08/2024] [Indexed: 08/02/2024]
Affiliation(s)
| | - Nozomi Ueno
- Hernia Center, Saiseikai Suita Hospital, Toyota, Japan
| | - Toru Eguchi
- Department of Surgery, Harasanshin Hospital, Toyota, Japan
| | - Yo Kawarada
- Department of Surgery, Tonan Hospital, Toyota, Japan
| | | | - Gen Shimada
- Hernia Center, St. Luke's International Hospital, Toyota, Japan
| | - Katsuhito Suwa
- Department of Surgery, The Jikei University Daisan Hospital, Toyota, Japan
| | | | | | - Shunsuke Hayakawa
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Toyota, Japan
| | - Kaisuke Yamamoto
- Department of Surgery, Inguinal Hernia Surgery Center, Kenseikai Ken Clinic, Toyota, Japan
| | | | - Norihito Wada
- Department of Surgery, Shonan Keiiku Hospital, Toyota, Japan
| | - Hidetoshi Wada
- Department of Surgery, Shimada General Medical Center, Toyota, Japan
| | - Hiroo Takehara
- Department of Hernia Surgery, Okinawa Heart-Life Hospital, Toyota, Japan
| | - Itsuro Nagae
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Toyota, Japan
| | | | - Hitoshi Idani
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Toyota, Japan
| | - Fumito Saijo
- Department of Surgery, Tohoku University Hospital, Toyota, Japan
| | | | - Kanyu Nakano
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Toyota, Japan
| | - Taizo Kimura
- Department of Surgery, Fujinomiya City General Hospital, Toyota, Japan
| | - Sumio Matsumoto
- National Hospital Organization, Tokyo Medical Center, Toyota, Japan
| |
Collapse
|
3
|
Martins MR, Santos-Sousa H, do Vale MA, Bouça-Machado R, Barbosa E, Sousa-Pinto B. Comparison between the open and the laparoscopic approach in the primary ventral hernia repair: a systematic review and meta-analysis. Langenbecks Arch Surg 2024; 409:52. [PMID: 38307999 PMCID: PMC10837225 DOI: 10.1007/s00423-024-03241-y] [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: 06/22/2023] [Accepted: 01/22/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Ventral hernia repair underwent various developments in the previous decade. Laparoscopic primary ventral hernia repair may be an alternative to open repair since it prevents large abdominal incisions. However, whether laparoscopy improves clinical outcomes has not been systematically assessed. OBJECTIVES The aim is to compare the clinical outcomes of the laparoscopic versus open approach of primary ventral hernias. METHODS A systematic search of MEDLINE (PubMed), Scopus, Web of Science, and Cochrane Central Register of Controlled Trials was conducted in February 2023. All randomized controlled trials comparing laparoscopy with the open approach in patients with a primary ventral hernia were included. A fixed-effects meta-analysis of risk ratios was performed for hernia recurrence, local infection, wound dehiscence, and local seroma. Meta-analysis for weighted mean differences was performed for postoperative pain, duration of surgery, length of hospital stay, and time until return to work. RESULTS Nine studies were included in the systematic review and meta-analysis. The overall hernia recurrence was twice less likely to occur in laparoscopy (RR = 0.49; 95%CI = 0.32-0.74; p < 0.001; I2 = 29%). Local infection (RR = 0.30; 95%CI = 0.19-0.49; p < 0.001; I2 = 0%), wound dehiscence (RR = 0.08; 95%CI = 0.02-0.32; p < 0.001; I2 = 0%), and local seroma (RR = 0.34; 95%CI = 0.19-0.59; p < 0.001; I2 = 14%) were also significantly less likely in patients undergoing laparoscopy. Severe heterogeneity was obtained when pooling data on postoperative pain, duration of surgery, length of hospital stay, and time until return to work. CONCLUSION The results of available studies are controversial and have a high risk of bias, small sample sizes, and no well-defined protocols. However, the laparoscopic approach seems associated with a lower frequency of hernia recurrence, local infection, wound dehiscence, and local seroma.
Collapse
Affiliation(s)
| | - Hugo Santos-Sousa
- Faculty of Medicine, University of Porto, Porto, Portugal.
- Integrated Responsibility Center for Obesity (CRIO), São João University Medical Centre, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal.
| | | | | | - Elisabete Barbosa
- Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Surgery, São João University Medical Centre, Porto, Portugal
| | - Bernardo Sousa-Pinto
- Faculty of Medicine, University of Porto, Porto, Portugal
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS - Centre for Health Technologies and Services Research, University of Porto, Porto, Portugal
| |
Collapse
|
4
|
Calpin GG, Davey MG, Whooley J, Ryan EJ, Ryan OK, Ponten JEH, Weiss A, Conneely JB, Robb WB, Donlon NE. Evaluating mesh fixation techniques for ventral hernia repair: A systematic review and network meta-analysis of randomised control trials. Am J Surg 2024; 228:62-69. [PMID: 37714741 DOI: 10.1016/j.amjsurg.2023.09.015] [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: 05/24/2023] [Revised: 08/01/2023] [Accepted: 09/11/2023] [Indexed: 09/17/2023]
Abstract
INTRODUCTION There is uncertainty regarding the optimal mesh fixation techniques for laparoscopic ventral and incisional hernia repair. AIM To perform a systematic review and network meta-analysis of randomised control trials (RCTs) to investigate the advantages and disadvantages associated with absorbable tacks, non-absorbable tacks, non-absorbable sutures, non-absorbable staples, absorbable synthetic glue, absorbable sutures and non-absorbable tacks, and non-absorbable sutures and non-absorbable tacks. METHODS A systematic review was performed as per PRISMA-NMA guidelines. Odds ratios (ORs) and mean differences (MDs) were extracted to compare the efficacy of the surgical approaches. RESULTS Nine RCTs were included with 707 patients. Short-term pain was significantly reduced in non-absorbable staples (MD; -1.56, confidence interval (CI); -2.93 to -0.19) and non-absorbable sutures (MD; -1.00, CI; -1.60 to -0.40) relative to absorbable tacks. Recurrence, length of stay, operative time, conversion to open surgery, seroma and haematoma formation were unaffected by mesh fixation technique. CONCLUSION Short-term post-operative pain maybe reduced by the use of non-absorbable sutures and non-absorbable staples. There is clinical equipoise between each modality in relation to recurrence, length of stay, and operative time.
Collapse
Affiliation(s)
- Gavin G Calpin
- Department of Gastrointestinal Surgery Beaumont Hospital, Dublin 9, Republic of Ireland; Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Republic of Ireland.
| | - Matthew G Davey
- Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Republic of Ireland
| | - Jack Whooley
- Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Republic of Ireland
| | - Eanna J Ryan
- Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Republic of Ireland
| | - Odhran K Ryan
- Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Republic of Ireland
| | | | - Andreas Weiss
- Department of Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - John B Conneely
- Department of Gastrointestinal Surgery Beaumont Hospital, Dublin 9, Republic of Ireland; Mater Misericordiae University Hospital, Eccles St, Dublin 7, Republic of Ireland
| | - William B Robb
- Department of Gastrointestinal Surgery Beaumont Hospital, Dublin 9, Republic of Ireland; Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Republic of Ireland
| | - Noel E Donlon
- Department of Gastrointestinal Surgery Beaumont Hospital, Dublin 9, Republic of Ireland; Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Republic of Ireland
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
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: 3] [Impact Index Per Article: 1.5] [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).
Collapse
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
| |
Collapse
|
7
|
Tramontin DF, da Costa LVP, de Araújo NP, dos Santos DR, Lemos RS, Teixeira RKC, Yasojima EY. Incisional hernia repair in rats: description of the sublay technique under videomagnification system. Acta Cir Bras 2022; 37:e370802. [PMID: 36327396 PMCID: PMC9633014 DOI: 10.1590/acb370802] [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: 04/03/2022] [Accepted: 07/02/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To describe the technique of sublay correction of incisional hernia in Wistar rats under videomagnification system. METHODS Five male rats of the species Rattus norvegicus, of the Wistar lineage, with body weight between 250-350 g and 60 days old were used. Incisional hernia was inducted in all animals. After that, the incisional hernia was immediately corrected by the sublay method. RESULTS There were no cases of recurrence of the incisional hernia after placement of the polypropylene mesh using the sublay technique. No postoperative complications were observed. CONCLUSIONS The technique is suitable for execution in Wistar rats.
Collapse
Affiliation(s)
- Daniela Ferreira Tramontin
- Graduate student. Universidade do Estado do Pará – School of Medicine – Belém (PA), Brazil.,Corresponding author:
- (55 91) 98857-1936
| | | | | | - Deivid Ramos dos Santos
- MD, MS. Universidade do Estado do Pará – School of Medicine – Department of Experimental Surgery – Belém (PA), Brazil
| | - Rafael Silva Lemos
- Graduate student. Universidade do Estado do Pará – School of Medicine – Belém (PA), Brazil
| | - Renan Kleber Costa Teixeira
- MD, MS. Universidade do Estado do Pará – School of Medicine – Department of Experimental Surgery – Belém (PA), Brazil
| | - Edson Yuzur Yasojima
- PhD, Associate Professor. Universidade do Estado do Pará – School of Medicine – Department of Experimental Surgery – Belém (PA), Brazil
| |
Collapse
|
8
|
Basukala S, Tamang A, Rawal SB, Malla S, Bhusal U, Dhakal S, Sharma S. Comparison of outcomes of laparoscopic hernioplasty with and without fascial repair (IPOM-Plus vs IPOM) for ventral hernia: A retrospective cohort study. Ann Med Surg (Lond) 2022; 80:104297. [PMID: 36045856 PMCID: PMC9422290 DOI: 10.1016/j.amsu.2022.104297] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 11/18/2022] Open
Abstract
Background Materials and methods Results Conclusions IPOM repair comprises bridging the hernial defect from the peritoneal side with a composite mesh. IPOM-Plus comprises suturing the defect in the fascia before placing the mesh. Seroma formation, injury to bladder or bowel, and mesh bulging were higher after IPOM repair. The AOR of six-month recurrence after IPOM repair was 14.86 times higher than that after IPOM-Plus repair. IPOM-Plus can be preferred over IPOM for its better outcomes.
Collapse
Affiliation(s)
- Sunil Basukala
- Department of Surgery, Shree Birendra Hospital, Chhauni, Nepal
| | - Ayush Tamang
- College of Medicine, Nepalese Army Institute of Health Sciences (NAIHS), Sanobharyang, Nepal
- Corresponding author. College of Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, 44600, Nepal.
| | | | | | - Ujwal Bhusal
- College of Medicine, Nepalese Army Institute of Health Sciences (NAIHS), Sanobharyang, Nepal
| | - Subodh Dhakal
- College of Medicine, Nepalese Army Institute of Health Sciences (NAIHS), Sanobharyang, Nepal
| | - Shriya Sharma
- College of Medicine, Nepalese Army Institute of Health Sciences (NAIHS), Sanobharyang, Nepal
| |
Collapse
|
9
|
Ding X, Zhu J, Liu A, Guo Q, Cao Q, Xu Y, Hua Y, Yang Y, Li P. Preparation and Biocompatibility Study of Contrast-Enhanced Hernia Mesh Material. Tissue Eng Regen Med 2022; 19:703-715. [PMID: 35612710 DOI: 10.1007/s13770-022-00460-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/09/2022] [Accepted: 04/11/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Meshes play a crucial role in hernia repair. However, the displacement of mesh inevitably leads to various associated complications. This process is difficult to be traced by conventional imaging means. The purpose of this study is to create a contrast-enhanced material with high-density property that can be detected by computed tomography (CT). METHODS The contrast-enhanced monofilament was manufactured from barium sulfate nanoparticles and medical polypropylene (PP/Ba). To characterize the composite, stress tensile tests and scanning electron microscopy (SEM) was performed. Toxicity and biocompatibility of PP/Ba materials was verified by in vitro cellular assays. Meanwhile, the inflammatory response was tested by protein adsorption assay. In addition, an animal model was established to demonstrate the long-term radiographic effect of the composite material in vivo. Subsequent pathological tests confirmed its in vivo compatibility. RESULTS The SEM revealed that the main component of the monofilament is carbon. In vitro cell experiments demonstrated that novel material does not affect cell activity and proliferation. Protein adsorption assays indicated that the contrast-enhanced material does not cause additional inflammatory responses. In addition, in vivo experiments illustrated that PP/Ba mesh can be detected by CT and has good in vivo compatibility. CONCLUSION These results highlight the excellent biocompatibility of the contrast-enhanced material, which is suitable for human abdominal wall tissue engineering.
Collapse
Affiliation(s)
- Xuzhong Ding
- Department of Gastrointestinal Surgery, Affiliated Hospital of Nantong University, No. 20 Xisi Road, Chongchuan District, Nantong, 226000, China
| | - Jiachen Zhu
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Co-Innovation Center of Neuroregeneration, Nantong University, No. 19, Qixiu Road, Chongchuan District, Nantong, Jiangsu, China
| | - Anning Liu
- Department of Gastrointestinal Surgery, Affiliated Hospital of Nantong University, No. 20 Xisi Road, Chongchuan District, Nantong, 226000, China
| | - Qiyang Guo
- Chemistry and Chemical Engineering, Nantong University, Nantong, China
| | - Qing Cao
- Department of Gastrointestinal Surgery, Affiliated Hospital of Nantong University, No. 20 Xisi Road, Chongchuan District, Nantong, 226000, China
| | - Yu Xu
- Department of Gastrointestinal Surgery, Affiliated Hospital of Nantong University, No. 20 Xisi Road, Chongchuan District, Nantong, 226000, China
| | - Ye Hua
- Department of Imaging, Affiliated Hospital of Nantong University, Nantong, China
| | - Yumin Yang
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Co-Innovation Center of Neuroregeneration, Nantong University, No. 19, Qixiu Road, Chongchuan District, Nantong, Jiangsu, China.
| | - Peng Li
- Department of Gastrointestinal Surgery, Affiliated Hospital of Nantong University, No. 20 Xisi Road, Chongchuan District, Nantong, 226000, China.
| |
Collapse
|
10
|
Franklyn J, Ramesh S, Madhuri V, Patel B, Dhivya A, Nair PD, Kumar A, Chacko G, Samarasam I. Abdominal Wall Reconstruction with Tissue-Engineered Mesh Using Muscle-Derived Stem Cells in an Animal Model. REGENERATIVE ENGINEERING AND TRANSLATIONAL MEDICINE 2022. [DOI: 10.1007/s40883-022-00253-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
11
|
Ali F, Sandblom G, Wikner A, Wallin G. Laparoscopic ventral and incisional hernia repair using intraperitoneal onlay mesh with peritoneal bridging. Hernia 2022; 26:635-646. [PMID: 34559335 PMCID: PMC9012731 DOI: 10.1007/s10029-021-02502-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/05/2021] [Indexed: 12/04/2022]
Abstract
PURPOSE The aim of this study was to assess the feasibility and safety of a novel IPOM procedure with peritoneal bridging (IPOM-pb) for laparoscopic ventral hernia repair, and to compare the outcomes of this procedure with IPOM with- (IPOM-plus) and IPOM without (sIPOM) defect closure. METHOD A single-centre retrospective study comparing a novel IPOM technique with peritoneal bridging (IPOM-pb) with the two commonly used IPOM techniques, IPOM with defect closure (IPOM-plus) and without defect closure (sIPOM). The intraoperative and postoperative data of patients who underwent laparoscopic IPOM ventral hernia repair were reviewed. Preoperative data, recurrence, and postoperative seroma, surgical site infection, and pain, were compared. RESULTS From January 2017 to June 2020, a total of 213 patients underwent laparoscopic ventral and incisional hernia repair with IPOM technique. The mean length and width of the ventral hernia was 4.4 ± 1.8 cm and 3.6 ± 1.4 cm, respectively, and the mean BMI was 30.1 ± 5.2 kg/m2. The mean operating time was 67 ± 28 min and was longer for IPOM-pb (71 ± 27 min), less for IPOM-plus (63 ± 28 min), and least for sIPOM (61 ± 26 min). The incidence of early postoperative seroma was least in IPOM-pb (1/98, 1%), and similar in the IPOM-plus (4/94, 4%) and sIPOM (1/21, 5%) group. Late postoperative seroma was found only in IPOM-plus (2, 2%). The incidence of early and late postoperative pain was relatively higher in sIPOM (3, 14%; 1, 5%, respectively) compared to IPOM-pb and IPOM-plus in the early (5, 5% and 6, 6%) and late (2, 2% and 1, 1%) postoperative period, respectively. Surgical site infection was higher in sIPOM group (3, 14%), compared to IPOM-pb (1, 1%), and IPOM-plus (3, 3%). Recurrence rates were similar in IPOM-pb group (3/98, 3%) and IPOM-plus (3/94, 3%), and none in sIPOM (0/21). CONCLUSION IPOM with peritoneal bridging is as feasible and safe as conventional IPOM with defect closure and simple non-defect closure. However, a large randomised controlled trial is required to confirm this finding.
Collapse
Affiliation(s)
- F Ali
- Department of Surgery, Faculty of Medicine and Health, Örebro University Hospital, Örebro University, Örebro, Sweden
| | - G Sandblom
- Department of Surgery, Faculty of Medicine and Health, Örebro University Hospital, Örebro University, Örebro, Sweden.
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
- Department of Surgery, Södersjukhuset, Stockholm, Sweden.
| | - A Wikner
- Department of Surgery, Faculty of Medicine and Health, Örebro University Hospital, Örebro University, Örebro, Sweden
| | - G Wallin
- Department of Surgery, Faculty of Medicine and Health, Örebro University Hospital, Örebro University, Örebro, Sweden
| |
Collapse
|
12
|
Beckers Perletti L, Spoelders F, Berrevoet F. Association between surgical hernia repair techniques and the incidence of seroma: a systematic review and meta-analysis of randomized controlled trials. Hernia 2021; 26:3-15. [PMID: 34773524 DOI: 10.1007/s10029-021-02531-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 10/22/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Ventral hernia repair (VHR) includes the surgical reconstruction of the abdominal wall (AW) using different surgical techniques. Although such procedures are usually devoid of complications, the formation of seroma may frequently occur. We performed a systematic review to assess the evidence from randomized controlled trials (RCTs) comparing VHR techniques and their impact on seroma formation. METHODS We included RCTs having seroma formation as primary endpoint. We included patients of both sexes (age > 18). For data synthesis we applied a random-effects model and calculated risk ratios (RR) with 95% confidence intervals (CI) using the Mantel-Haenszel method. Risk of bias (ROB) and publication bias were evaluated following Cochrane recommendations. RESULTS After database search and article screening, 21 records were included in this review. Ten RCTs compared onlay vs. sublay mesh placement techniques. Pooled analysis showed a significantly higher risk ratio for seroma in the onlay cohort (RR = 2.61, 95% CI 1.86-3.66, I2 = 0, GRADE quality of evidence, moderate). Five RCTs compared laparoscopic intraperitoneal onlay mesh repair vs. open mesh placement. Pooled analysis showed that seroma formation did not differ significantly between groups (RR = 1.91, 95% CI 0.69-5.28, I2 = 66%, GRADE quality of evidence, poor). High ROB was found in all studies and significant publication bias was detected in both meta-analyses. CONCLUSION Compared to sublay ventral hernia repair, the onlay procedure is associated with a significantly higher risk of seroma. No significant differences were observed when laparoscopic VHR was compared with the open surgical procedure. Due to the diversity of surgical techniques reported in included RCTs, it is currently not possible to draw conclusive clinical recommendations. Future studies should be standardized to provide detailed data allowing thorough evaluation of the impact of the evidence on clinical practice.
Collapse
Affiliation(s)
- L Beckers Perletti
- Faculty of Medicine and Medical Sciences, Ghent University, Ghent, Belgium
| | - F Spoelders
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Frederik Berrevoet
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium.
| |
Collapse
|
13
|
Lindsey JT, Boyd CJ, Davis C, Wilson J, Kurapati S, de la Torre JI. The Case for Onlay Biologic Mesh in Abdominal Wall Reconstruction Using Progressive Tension Suture Fixation. Ann Plast Surg 2021; 86:S498-S502. [PMID: 34100806 DOI: 10.1097/sap.0000000000002911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND After many years of debate, underlay and sublay placement of mesh slowly emerged as the standard of care in abdominal wall reconstruction because of lower hernia recurrence rates. However, onlay has the advantages of being faster, less invasive, and technically easier compared with underlay and sublay. Therefore, if a similar recurrence could be achieved, then onlay should be a consideration. In this study, we present a new onlay method using multipoint progressive tension suture fixation. METHODS This was a retrospective chart review of patients who underwent abdominal wall reconstruction from 2012 to 2019. Inclusion criteria included onlay mesh placement and at least 1 year of follow-up. The core principles of the surgical technique are establishing myofascial continuity by component separation and reinforcing the repair with onlay mesh that is fixated with multipoint progressive tension sutures. RESULTS The number of patients after exclusions was 59, and the average body mass index was 32.52 ± 6.44 kg/m2. More than half (62.7%) of patients had a history of hypertension, 95% had at least 1 prior abdominal/pelvic surgery, and 61% had at least 1 prior hernia repair. Postoperative complications included 20.3% of patients requiring drainage of a fluid collection in the clinic setting, and 29.3% of patients requiring return to the operating room for any reason (including superficial wound debridement). The average defect size was 231.88 ± 195.86 cm2, the mean follow-up was 3.11 ± 1.83 years, and the recurrence rate was 5.1%. CONCLUSIONS We report a hernia recurrence rate of 5.1% in a high-risk population with complex defects at a mean of 3.1 years of follow-up using onlay mesh fixated with multipoint progressive tension sutures. This recurrence rate is similar to that reported for both underlay and sublay techniques. However, the onlay approach is technically easier, faster, and less invasive compared with underlay and sublay techniques, which may translate into wider reproducibility, lower costs, and improved patient safety.
Collapse
Affiliation(s)
- John T Lindsey
- From the Division of Plastic Surgery, University of Alabama at Birmingham School of Medicine
| | - Carter J Boyd
- From the Division of Plastic Surgery, University of Alabama at Birmingham School of Medicine
| | - Claire Davis
- From the Division of Plastic Surgery, University of Alabama at Birmingham School of Medicine
| | - John Wilson
- From the Division of Plastic Surgery, University of Alabama at Birmingham School of Medicine
| | - Srikanth Kurapati
- From the Division of Plastic Surgery, University of Alabama at Birmingham School of Medicine
| | | |
Collapse
|
14
|
Serrano-Aroca Á, Pous-Serrano S. Prosthetic meshes for hernia repair: State of art, classification, biomaterials, antimicrobial approaches, and fabrication methods. J Biomed Mater Res A 2021; 109:2695-2719. [PMID: 34021705 DOI: 10.1002/jbm.a.37238] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 12/23/2022]
Abstract
Worldwide, hernia repair represents one of the most frequent surgical procedures encompassing a global market valued at several billion dollars. This type of surgery usually requires the implantation of a mesh that needs the appropriate chemical, physical and biological properties for the type of repair. This review thus presents a description of the types of hernias, current hernia repair methods, and the state of the art of prosthetic meshes for hernia repair providing the most important meshes used in clinical practice by surgeons working in this area classified according to their biological or chemical nature, morphology and whether bioabsorbable or not. We emphasise the importance of surgical site infection in herniatology, how to deal with this microbial problem, and we go further into the future research lines on the production of advanced antimicrobial meshes to improve hernia repair and prevent microbial infections, including multidrug-resistant strains. A great deal of progress has been made in this biomedical field in the last decade. However, we are still far from an ideal antimicrobial mesh that can also provide excellent integration to the abdominal wall, mechanical performance, low visceral adhesion and minimal inflammatory or foreign body reactions, among many other problems.
Collapse
Affiliation(s)
- Ángel Serrano-Aroca
- Biomaterials and Bioengineering Lab, Centro de Investigación Traslacional San Alberto Magno, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain
| | - Salvador Pous-Serrano
- Surgical Unit of Abdominal Wall, Department of General and Digestive Surgery, La Fe University Hospital, Valencia, Spain
| |
Collapse
|
15
|
Perrakis A, Knüttel D, Rahimli M, Andric M, Croner RS, Vassos N. Incisional hernia after liver transplantation: mesh-based repair and what else? Surg Today 2021; 51:733-737. [PMID: 33067718 PMCID: PMC8055617 DOI: 10.1007/s00595-020-02162-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/25/2020] [Indexed: 11/05/2022]
Abstract
PURPOSE Incisional hernia (IH) is not uncommon after liver transplantation (LT). We investigated the long-term outcome of mesh-based hernia repair using an inlay-onlay technique. METHODS Our analysis was based on a prospective collected database of all LT recipients from our hospital over a period of 15 years. We analyzed clinical data including the period between LT and hernia development, the size and localization of the hernia, the length of in-hospital stay, immunosuppression, and postoperative morbidity, as well as follow-up data. The median follow-up period was 120 (range 12-200) months. RESULTS Among a total of 220 patients who underwent a collective 239 LTs, 29 (13%) were found to have an IH after a median period of 27.5 months (range 3-96 months). There were 12 (41%) men and 17 (59%) women, with a median age of 51 years. The median size of the IH was 13 cm (range 2-30 cm) and the median in-hospital stay was 6 days. Mild postoperative complications developed in seven patients, including two onlay mesh infections. One patient (3.4%) suffered recurrence. CONCLUSION Mesh-based hernia repair using the inlay/onlay technique represents an effective and safe method for patients with an IH after LT, without additional risk from continuous immunosuppression.
Collapse
Affiliation(s)
- Aristotelis Perrakis
- Department of Surgery, University Hospital of Magdeburg, University of Magdeburg, Leipzigerstr. 44, 39120, Magdeburg, Germany.
- Department of Surgery, University Hospital Erlangen, University of Erlangen-Nuremberg, Erlangen, Germany.
| | - Dagmar Knüttel
- Department of Surgery, University Hospital Erlangen, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Mirhasan Rahimli
- Department of Surgery, University Hospital of Magdeburg, University of Magdeburg, Leipzigerstr. 44, 39120, Magdeburg, Germany
| | - Mihailo Andric
- Department of Surgery, University Hospital of Magdeburg, University of Magdeburg, Leipzigerstr. 44, 39120, Magdeburg, Germany
| | - Roland S Croner
- Department of Surgery, University Hospital of Magdeburg, University of Magdeburg, Leipzigerstr. 44, 39120, Magdeburg, Germany
| | - Nikolaos Vassos
- Department of Surgery, University Hospital Erlangen, University of Erlangen-Nuremberg, Erlangen, Germany
- Division of Surgical Oncology, Department of Surgery, Mannheim University Medical Centre, University of Heidelberg, Mannheim, Germany
| |
Collapse
|
16
|
Gu Y, Wang P, Li H, Tian W, Tang J. Chinese expert consensus on adult ventral abdominal wall defect repair and reconstruction. Am J Surg 2020; 222:86-98. [PMID: 33239177 DOI: 10.1016/j.amjsurg.2020.11.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Surgical management of patients with ventral abdominal wall defects, especially complex abdominal wall defects, remains a challenging problem for abdominal wall reconstructive surgeons. Effective surgical treatment requires appropriate preoperative assessment, surgical planning, and correct operative procedure in order to improve postoperative clinical outcomes and minimize complications. Although substantial advances have been made in surgical techniques and prosthetic technologies, there is still insufficient high-level evidence favoring a specific technique. Broad variability in existing practice patterns, including clinical pre-operative evaluation, surgical techniques and surgical procedure selection, are still common. DATA SOURCES With the purpose of providing a best practice algorithm, a comprehensive search was conducted in Medline and PubMed. Sixty-four surgeons considered as experts on abdominal wall defect repair and reconstruction in China were solicited to develop a Chinese consensus and give recommendations to help surgeons standardize their techniques and improve clinical results. CONCLUSIONS This consensus serves as a starting point to provide recommendations for adult ventral abdominal wall repair and reconstruction in China and may help build opportunities for international cooperation to refine AWR practice.
Collapse
Affiliation(s)
- Yan Gu
- Hernia and Abdominal Wall Disease Center, Shanghai Jiao Tong University, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
| | - Ping Wang
- Department of Hernia Surgery, Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - Hangyu Li
- Department of General Surgery, Fourth Hospital of China Medical University, Shenyang, 110000, China
| | - Wen Tian
- Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, 100853, China.
| | - Jianxiong Tang
- Department of General Surgery, Huadong Hospital, Fudan University, Shanghai, 200040, China.
| |
Collapse
|
17
|
Shahait AD, Alghanem L, Cmorej P, Tracy W, Hasnain MR, Baldawi M, Girten K, Weaver D, Saleh KJ, Gruber SA, Mostafa G. Postoperative outcomes of ventral hernia repair in veterans. Surgery 2020; 169:603-609. [PMID: 33077198 DOI: 10.1016/j.surg.2020.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/30/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Ventral hernia repair is a common procedure with reported 15% to 37% morbidity and 0.3% to 1.4% mortality rates. This study examines the 30-day morbidity and mortality of open and laparoscopic ventral hernia repair in veterans, along with the impact of body mass index on these outcomes. METHODS The Veterans Affairs Surgical Quality Improvement Program was queried for all ventral hernia repairs during the period 2008 to 2015. In this retrospective analysis, we compared outcomes of open ventral hernia repair versus laparoscopic ventral hernia repair and among different body mass index classes. RESULTS A total of 19,883 patients were identified (92.6% male, mean age 59.7, 53.1% obese, and 71.6% with American Society of Anesthesiologists class ≥III). There were 95 (0.5%) mortalities, and complications occurred in 1,289 (6.5%) patients. Open ventral hernia repair was performed in 60.2%; 14.5% were recurrent, and 3.3% were performed as an emergency operation. When compared with open ventral hernia repair, the laparoscopic ventral hernia repair group had higher mean body mass index, less patients with American Society of Anesthesiologists class ≥III, fewer emergency operations, longer operative time, less complications, decreased mortality, and shorter duration of stay. Body mass index 35.00 to 49.99 was predictive of overall complications in the open ventral hernia repair group. CONCLUSION Ventral hernia repair can be performed in the veteran population with outcomes comparable to those in the private sector. Morbid obesity has a negative impact on ventral hernia repair outcomes that is most prominent following open surgery. Laparoscopic ventral hernia repair may offer superior outcomes when compared to open ventral hernia repair and may be considered.
Collapse
Affiliation(s)
- Awni D Shahait
- Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI; Department of Surgery, John D. Dingell VA Medical Center, Detroit, MI
| | - Lana Alghanem
- The Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
| | - Peter Cmorej
- Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI; Department of Surgery, John D. Dingell VA Medical Center, Detroit, MI
| | - William Tracy
- Department of Surgery, John D. Dingell VA Medical Center, Detroit, MI
| | | | - Mohanad Baldawi
- Department of Surgery, John D. Dingell VA Medical Center, Detroit, MI
| | - Kara Girten
- Department of Surgery, John D. Dingell VA Medical Center, Detroit, MI
| | - Donald Weaver
- Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI
| | - Khaled J Saleh
- Department of Surgery, John D. Dingell VA Medical Center, Detroit, MI
| | - Scott A Gruber
- Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI; Department of Surgery, John D. Dingell VA Medical Center, Detroit, MI
| | - Gamal Mostafa
- Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI; Department of Surgery, John D. Dingell VA Medical Center, Detroit, MI.
| |
Collapse
|
18
|
Morales-Conde S, Balla A, Alarcón I, Sánchez-Ramírez M. Minimally invasive repair of ventral hernia with one third of tackers and fibrin glue: less pain and same recurrence rate. MINERVA CHIR 2020; 75:292-297. [PMID: 33210524 DOI: 10.23736/s0026-4733.20.08468-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Aim of this study was to assess whether the reduction in the number of tackers maintains a similar recurrence rate and to subsequently evaluate whether this reduction associated with fibrin adhesive (FA) influences postsurgical pain after laparoscopic ventral hernia repair (LVHR) at 5 years follow-up. METHODS Fifty patients with ventral hernia (intervention group) underwent to LVHR with the double crown (DC) technique with a decrease in the number of tackers, each tacker being separated by about 3 cm associated with FA to seal the spaces between them. Data obtained from intervention group were compared to data obtained from a historical series of 50 patients (control group) undergoing LVHR using DC technique with tackers at 1 cm each other. RESULTS No statistically significant differences were found between groups about patients' characteristics. Mean hospital stay was 2 days. Statistically significant differences were observed about hospital stay between both groups U-Mann-Whitney ([UMW] =345, P=0) being higher in the control group. Statistically significant difference was observed in the postoperative pain evaluated by the visual analogical scale (VAS) score, having 95% of patients in the control group with VAS less than or equal to 7 compared to 4.55 in the intervention group. Recurrence rate was 4.1% for the control group versus 4.2% in the intervention group. CONCLUSIONS The reduction of metallic tackers associated with FA does not present statistically significant differences in the recurrence rate in comparison to conventional DC technique. In the intervention group a reduction in postoperative pain and hospital stay were observed.
Collapse
Affiliation(s)
- Salvador Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, Virgen del Rocio University Hospital, University of Sevilla, Sevilla, Spain
- Unit of General and Digestive Surgery, Quironsalud Sagrado Corazón Hospital, Sevilla, Spain
| | - Andrea Balla
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, Virgen del Rocio University Hospital, University of Sevilla, Sevilla, Spain -
- Department of General Surgery and Surgical Specialties "Paride Stefanini, " Sapienza University, Rome, Italy
| | - Isaias Alarcón
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, Virgen del Rocio University Hospital, University of Sevilla, Sevilla, Spain
- Unit of General and Digestive Surgery, Quironsalud Sagrado Corazón Hospital, Sevilla, Spain
| | - Maria Sánchez-Ramírez
- Unit of General and Digestive Surgery, Quironsalud Sagrado Corazón Hospital, Sevilla, Spain
| |
Collapse
|
19
|
Are laparoscopic and open ventral hernia repairs truly comparable?: A propensity-matched study in large ventral hernias. Surg Endosc 2020; 35:4653-4660. [PMID: 32780243 DOI: 10.1007/s00464-020-07894-w] [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: 04/14/2020] [Accepted: 08/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The merits of laparoscopic (LVHR) and open preperitoneal ventral hernia repair (OPPVHR) have been debated for more than 2 decades. Our aim was to determine peri-operative and long-term outcomes in large hernias. METHODS A prospective, institutional database at a tertiary hernia center was queried for patients undergoing LVHR and OPPVHR. One-to-one propensity score matching was performed for hernia defect size and follow-up. RESULTS Three hundred and fifty-two LVHR and OPPVHR patients were identified with defect sizes closely matched between laparoscopic (182.0 ± 110.0 cm2) and open repairs (178.3 ± 99.8 cm2), p = 0.64. LVHR and OPPVHR patients were comparable: mean age 57.2 ± 12.1 vs 56.6 ± 12.0 years (p = 0.52), BMI: 32.9 ± 6.6 vs 32.0 ± 7.4 kg/m2 (p = 0.16), diabetes 19.0% vs 19.7% (p = 0.87), and smoking history 8.7% vs 23.0% (p < 0.001), respectively. OPPVHR had higher number of recurrent hernias (14.2% vs 44.9%, p < 0.001), longer operative time (168.1 ± 64.3 vs 186.7 ± 67.7 min, p = 0.006), and more components separation (0% vs 20.3%, p < 0.001). Mean mesh size was larger (p < 0.001) in the open group (634.4 ± 243.4 cm2 vs 841.8 ± 277.6 cm2). The hernia recurrence rates were similar (10.8% vs 9.2%, p = 0.62), with average follow-up of 39.3 ± 32.5 vs 40.0 ± 35.0 months (p = 0.89). Length of stay was higher in the OVHR cohort (5.4 ± 3.0 vs 6.3 ± 3.6 days, p < 0.001), but 30-day readmission rates (4.0% vs 6.4%, p = 0.31) were similar. Overall wound infection rate (2.9% vs 8.4%, p = 0.03) was higher in the OPPVHR group, but the mesh infection rate was similar between LVHR (1.7%) and OPPVHR (0.6%) (p = 0.33). Postoperative pain (41.1% vs 41.4%, p = 0.95) and overall QOL based on the Carolinas Comfort Scale at 6 months (p = 0.73) and 5-years (p = 0.36) were similar. CONCLUSION Laparoscopic and open preperitoneal repair for large ventral hernias have equivalent hernia recurrence rates, postoperative pain, and QOL on long-term follow-up. Patients undergoing OPPVHR were more likely to be recurrent, complex, require components separation, and more likely to develop postoperative wound complications.
Collapse
|
20
|
A Comparative Prospective Study of Laparoscopic and Open-Mesh Repair for Ventral Hernia. Indian J Surg 2020. [DOI: 10.1007/s12262-019-01995-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
21
|
Shemyatovsky KA, Azimov RH, Alekhin AI, Kazantsev AA, Alekhin AA. Computed tomography options in the evaluation of hernia repair outcomes using "titanium silk" mesh implants. J Tissue Eng Regen Med 2020; 14:684-689. [PMID: 32187850 DOI: 10.1002/term.3029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 02/18/2020] [Accepted: 03/02/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND According to experimental studies, mesh implants may reduce in size up to 50.8% during their integration into soft tissues. This results in impaired mobility of the anterior abdominal wall and hernia recurrences, as well as affects patients' quality of life. Due to unsatisfactory radiographic contrast of polymeric mesh implants, changes in their size can be rarely confirmed using imaging methods. Medical devices made of metal alloys have the best radiographic contrast. OBJECTIVE The purpose of this study was to evaluate the radiographic contrast of mesh implants made of titanium filaments and to determine the sizes and locations of the implants after the anterior abdominal wall hernia repair. MATERIALS & METHODS The study included 40 patients with inguinal, umbilical, and postoperative ventral hernias. Surgical hernia repair was performed using a mash implant made of titanium filaments, "titanium silk". Multislice spiral computed tomography (MSCT) was performed on Days 3 and 90 after surgery, followed by an assessment of the size and location of the mesh implant. RESULTS 90 days after the anterior abdominal wall hernia repair, the locations of the titanium silk mesh implants in the tissues corresponded to their intraoperative setting. There were no statistically significant changes in the sizes of mesh implants on Day 90, compared with Day 3. CONCLUSION The titanium silk mesh implants have satisfactory radiographic contrast, which allows imaging of their location and size in the tissues using MSCT and comprehensive evaluation of hernia repair outcomes using instrumental methods of examination.
Collapse
Affiliation(s)
- Kirill A Shemyatovsky
- Surgery Department, Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russian Federation
| | - Rustam H Azimov
- Surgery Department, Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russian Federation
| | - Aleksander I Alekhin
- Surgery Department, Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russian Federation.,Scientific Department, Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russian Federation
| | - Anton A Kazantsev
- Surgery Department, Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russian Federation.,Scientific Department, Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russian Federation
| | - Anton A Alekhin
- Surgery Department, Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russian Federation.,Scientific Department, Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russian Federation
| |
Collapse
|
22
|
Sanna A, Felicioni L, Cecconi C, Cola R. Retromuscular Mesh Repair Using Extended Totally Extraperitoneal Repair Minimal Access: Early Outcomes of an Evolving Technique-A Single Institution Experience. J Laparoendosc Adv Surg Tech A 2019; 30:246-250. [PMID: 31895628 DOI: 10.1089/lap.2019.0661] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Enhanced-view extended totally extraperitoneal repair (eTEP) technique for laparoscopic retromuscular ventral hernia (VHR) repair is a novel application recently described by some authors. We present our early single institution experience on this technique. Methods: Retrospective review of the eTEP technique for laparoscopic retromuscular VHR repair cases at our institution from October 2018 to June 2019 with 1 month follow-up was evaluated. Data analyses include patients characteristics, operative details, and complications. Results: A total of 18 patients were treated with eTEP. One patient was reoperated using the same procedure and hospital stay was 6 days. The same patient who had undergone transversus abdominis release developed a seroma that could be observed 20 days after surgery. Conclusion: Our short-term experience with eTEP access suggests feasibility of this approach in accordance with results from other authors. We do not think the technique is challenging, but it is necessary for it to be performed by surgeons with skills in laparoscopic abdominal wall reconstruction.
Collapse
Affiliation(s)
- Andrea Sanna
- Division of General Surgery, AULSS 6 Hospital "Madre Teresa di Calcutta," Monselice, Italy
| | - Luca Felicioni
- Division of General and Minivasive Surgery, Misericordia Hospital della Misericordia, Grosseto, Italy
| | - Claudia Cecconi
- Division of General Surgery, resident of Padova University School of Medicine, AULSS 6 Hospital "Madre Teresa di Calcutta," Monselice, Italy
| | - Roberto Cola
- Division of General Surgery, AULSS 6 Hospital "Madre Teresa di Calcutta," Monselice, Italy
| |
Collapse
|
23
|
Morales-Conde S, Gómez-Menchero J, Alarcón I, Balla A. Retroprosthetic Seroma After Laparoscopic Ventral Hernia Repair Is Related to Mesh Used? J Laparoendosc Adv Surg Tech A 2019; 30:241-245. [PMID: 31742465 DOI: 10.1089/lap.2019.0646] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose: Retroprosthetic seroma (RS) is defined as a fluid collection located between the abdominal viscera and the intraperitoneal mesh implanted during surgery. Aim of this study is to report the incidence and clinical impact of RS based on the type of mesh implanted during laparoscopic ventral hernia repair (LVHR). Materials and Methods: Patients who underwent LVHR were allocated in group A if expanded polytetrafluoroethylene (ePTFE) mesh was used during surgery and in group B if other types of mesh were used. Patients were evaluated on postoperative day (POD) 1 and 7 with physical examination and 1 month after surgery by physical examination and with an abdominal computed tomography scan, respectively. Results: Sixty patients were included. Of these 41 patients (68.3%) were included in group A and 19 patients (31.7%) in group B. Signs of RS were not observed in any patient on POD 7. One month after surgery, RS was observed in 13 patients (21.6%). One patient (7.7%) with RS experienced great discomfort and mesh detachment, and underwent a second surgical treatment. All RSs were observed in group A, and the difference with group B was statistically significant (P = .005). Conclusions: The use of ePTFE mesh is related to the development of RS. The treatment of choice without clinical symptoms should be conservative. Randomized control trial and prospective studies with a larger sample size and control group are required to confirm these data, although this study shows a high evidence of the relation of RS and the type of mesh.
Collapse
Affiliation(s)
- Salvador Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital "Virgen del Rocio," University of Sevilla, Spain.,Unit of General and Digestive Surgery, Hospital Quirónsalud Sagrado Corazón, Sevilla, Spain
| | - Julio Gómez-Menchero
- Unit of General and Digestive Surgery, Hospital Quirónsalud Sagrado Corazón, Sevilla, Spain.,Unit of General and Digestive Surgery, Hospital de Río Tinto, Huelva, Spain
| | - Isaias Alarcón
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital "Virgen del Rocio," University of Sevilla, Spain.,Unit of General and Digestive Surgery, Hospital Quirónsalud Sagrado Corazón, Sevilla, Spain
| | - Andrea Balla
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital "Virgen del Rocio," University of Sevilla, Spain.,Department of General Surgery and Surgical Specialties "Paride Stefanini," Sapienza, University of Rome, Rome, Italy
| |
Collapse
|
24
|
Alizai PH, Lelaona E, Andert A, Neumann UP, Klink CD, Jansen M. Incisional Hernia Repair of Medium- and Large-Sized Defects: Laparoscopic IPOM Versus Open SUBLAY Technique. Acta Chir Belg 2019; 119:231-235. [PMID: 30270760 DOI: 10.1080/00015458.2018.1501962] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background: Small incisional hernias can be repaired laparoscopically with low morbidity and reasonable recurrence rates. The aim of this study was to compare laparoscopic with open technique in medium- and large-sized defects regarding postoperative complications and recurrence rates. Methods: Between 2012 and 2016, 102 patients with medium- or large-sized defects according to EHS classification underwent incisional hernia repair. Patients' characteristics, hernia size and postoperative complications were prospectively recorded. In October 2016, eligible patients were assessed for recurrence. Results: About 31 patients underwent laparoscopic IPOM and 71 patients open SUBLAY repair. Morbidity rate was significantly lower in IPOM group than in SUBLAY group (19% versus 41%; p = .028). Postoperative complications according to Clavien-Dindo classification were significantly lower in the IPOM group (p = .021). Duration of surgery (88 versus 114 min; p = .009) and length of hospital stay (five versus eight days; p < .001) were significantly shorter for IPOM than for SUBLAY. 71 patients were available for follow-up. Recurrence rates showed no significant difference between study groups (13% versus 7%, p = .508). Conclusions: Laparoscopic repair in medium- and large-sized defects is a feasible and safe approach. IPOM compared to SUBLAY significantly reduces postoperative complications and hospital stay; recurrence rates are comparable.
Collapse
Affiliation(s)
- Patrick Hamid Alizai
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Eric Lelaona
- Department of General, Visceral and Minimally Invasive Surgery, Helios Clinic Emil von Behring, Berlin, Germany
| | - Anne Andert
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Ulf Peter Neumann
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Christian Daniel Klink
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Marc Jansen
- Department of General, Visceral and Minimally Invasive Surgery, Helios Clinic Emil von Behring, Berlin, Germany
| |
Collapse
|
25
|
Azin A, Hirpara D, Jackson T, Okrainec A, Elnahas A, Chadi SA, Quereshy FA. Emergency laparoscopic and open repair of incarcerated ventral hernias: a multi-institutional comparative analysis with coarsened exact matching. Surg Endosc 2018; 33:2812-2820. [PMID: 30421078 DOI: 10.1007/s00464-018-6573-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 11/01/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND The safety of emergent laparoscopic repair of incarcerated ventral hernias is not well established. The objective of this study was to determine if emergent laparoscopic repair of incarcerated ventral hernias is comparable to open repair with respect to short-term clinical outcomes. METHODS Patients undergoing emergency repair of an incarcerated ventral hernia with associated obstruction and/or gangrene were identified using the ACS-NSQIP 2012-2016 dataset. One-to-one coarsened exact matching (CEM) was conducted between patients undergoing laparoscopic and open repair. Matched cohorts were compared with respect to morbidity, mortality, readmission, reoperation, missed enterotomies, and length of stay. Missed enterotomy was defined as any re-operative procedure within 30 days that required resection of large or small bowel segments, based on CPT codes. Multivariate analysis was conducted to determine adjusted predictors of morbidity. RESULTS A total of 1642 patients were identified after CEM. Laparoscopic compared to open repair was associated with a lower rate of 30-day wound-morbidity (OR 0.35, 95% CI 0.22-0.57, p < 0.001). Laparoscopic repair was not associated with lower 30-day non-wound morbidity (OR 0.73, 95% CI 0.51-1.06, p = 0.094). Laparoscopic repair was associated with shorter LOS (3.6 days vs. 4.3 days, p = 0.014). A higher rate of missed enterotomies was observed in the laparoscopic cohort (0.7% vs. 0.0%, p = 0.031). There were no group differences with respect to 30-day readmission, reoperation, or mortality. CONCLUSIONS Emergency laparoscopic repair of incarcerated ventral hernias is associated with lower rates of wound-morbidity and shorter hospital stays compared to open repair. However, laparoscopic repair is associated with a higher rate of missed enterotomies; a rate which is low and comparable to elective non-incarcerated ventral hernia repairs.
Collapse
Affiliation(s)
- Arash Azin
- Division of General Surgery, University of Toronto, Toronto, ON, Canada
| | - Dhruvin Hirpara
- Division of General Surgery, University of Toronto, Toronto, ON, Canada
| | - Timothy Jackson
- Division of General Surgery, University of Toronto, Toronto, ON, Canada.,Division of General Surgery, University Health Network, Toronto, ON, Canada
| | - Allan Okrainec
- Division of General Surgery, University of Toronto, Toronto, ON, Canada.,Division of General Surgery, University Health Network, Toronto, ON, Canada
| | - Ahmad Elnahas
- Division of General Surgery, University of Toronto, Toronto, ON, Canada.,Division of General Surgery, University Health Network, Toronto, ON, Canada
| | - Sami A Chadi
- Division of General Surgery, University of Toronto, Toronto, ON, Canada.,Division of General Surgery, University Health Network, Toronto, ON, Canada
| | - Fayez A Quereshy
- Division of General Surgery, University of Toronto, Toronto, ON, Canada. .,Division of General Surgery, University Health Network, Toronto, ON, Canada. .,Toronto Western Hospital, University Health Network, 399 Bathurst Street, Room 8MP-320, Toronto, ON, M5T 2S8, Canada.
| |
Collapse
|
26
|
Ahmed MA, Tawfic QA, Schlachta CM, Alkhamesi NA. Pain and Surgical Outcomes Reporting After Laparoscopic Ventral Hernia Repair in Relation to Mesh Fixation Technique: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. J Laparoendosc Adv Surg Tech A 2018; 28:1298-1315. [DOI: 10.1089/lap.2017.0609] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- Mooyad A. Ahmed
- Canadian Surgical Technologies & Advanced Robotics (CSTAR), London, Canada
- Department of Surgery, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Qutaiba A. Tawfic
- Department of Anesthesia, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Christopher M. Schlachta
- Canadian Surgical Technologies & Advanced Robotics (CSTAR), London, Canada
- Department of Surgery, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Nawar A. Alkhamesi
- Canadian Surgical Technologies & Advanced Robotics (CSTAR), London, Canada
- Department of Surgery, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, London, Canada
| |
Collapse
|
27
|
Schlosser KA, Arnold MR, Otero J, Prasad T, Lincourt A, Colavita PD, Kercher KW, Heniford BT, Augenstein VA. Deciding on Optimal Approach for Ventral Hernia Repair: Laparoscopic or Open. J Am Coll Surg 2018; 228:54-65. [PMID: 30359827 DOI: 10.1016/j.jamcollsurg.2018.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 08/06/2018] [Accepted: 09/14/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The decision to perform laparoscopic or open ventral hernia repair (VHR) is multifactorial. This study evaluates the impact of operative approach, BMI, and hernia size on outcomes after VHR. STUDY DESIGN The International Hernia Mesh Registry was queried for VHR (2007-2017). A predictive algorithm was constructed, factoring the impact of BMI, hernia size, age, sex, diabetes, and operative approach on outcomes. RESULTS Of the 1,906 VHRs, 58.8% were performed open, patient mean age was 54.9 ± 13.5 years, BMI was 31.2 ± 6.8 kg/m2, and defect area was 44.8 ± 88.1 cm2. Patients undergoing open VHRs were more likely to have an infection develop (3.1% vs 0.3%; p < 0.0001), but less likely to have a seroma develop (6.8% vs 15.3%; p < 0.0001) at mean follow-up 23.2 ± 12.0 months. With multivariate regression controlling for confounding variables, patients undergoing laparoscopic VHR had increased risk of seroma (odds ratio [OR] 1.78; 95% CI 1.05 to 3.03), a decreased risk of infection (OR 0.05; 95% CI 0.01 to 0.42), and had worse quality of life at 1, 6, 12, and 24 months postoperatively compared with patients undergoing open repair. Recurrent hernias were associated with subsequent recurrence (OR 2.69; 95% CI 1.24 to 5.81) and need for reoperation (OR 4.93; 95% CI 2.24 to 10.87). Multivariate predictive models demonstrated independent predictors of infection, including open approach, recurrent hernias, and low ratio of BMI to defect size. CONCLUSIONS Ideal outcomes are dependent on both patient and operative factors. Open repair in thin patients with large defects should be considered due to reduced complications and improved quality of life. Laparoscopic repair in obese patients and recurrent hernias can decrease the associated risk of infection.
Collapse
Affiliation(s)
- Kathryn A Schlosser
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC
| | - Michael R Arnold
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC
| | - Javier Otero
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC
| | - Tanushree Prasad
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC
| | - Amy Lincourt
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC
| | - Paul D Colavita
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC
| | - Kent W Kercher
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC
| | - B Todd Heniford
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC
| | - Vedra A Augenstein
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC.
| |
Collapse
|
28
|
Máca J, Peteja M, Reimer P, Jor O, Šeděnková V, Panáčková L, Ihnát P, Burda M, Ševčík P. Surgical injury: comparing open surgery and laparoscopy by markers of tissue damage. Ther Clin Risk Manag 2018; 14:999-1006. [PMID: 29881282 PMCID: PMC5985784 DOI: 10.2147/tcrm.s153359] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Major abdominal surgery (MAS) is high-risk intervention usually accompanied by tissue injury leading to a release of signaling danger molecules called alarmins. This study evaluates the surgical injury caused by two fundamental types of gastrointestinal surgical procedures (open surgery and laparoscopy) in relation to the inflammation elicited by alarmins. Patients and methods Patients undergoing MAS were divided into a mixed laparoscopy group (LPS) and an open surgery group (LPT). Serum levels of alarmins (S100A8, S100A12, HMGB1, and HSP70) and biomarkers (leukocytes, C-reactive protein [CRP], and interleukin-6 [IL-6]) were analyzed between the groups. The secondary objectives were to compare LPT and LPS cancer subgroups and to find the relationship between procedure and outcome (intensive care unit length of stay [ICU-LOS] and hospital length of stay [H-LOS]). Results A total of 82 patients were analyzed. No significant difference was found in alarmin levels between the mixed LPS and LPT groups. IL-6 was higher in the LPS group on day 2 (p=0.03) and day 3 (p=0.04). Significantly higher S100A8 protein levels on day 1 (p=0.02) and day 2 (p=0.01) and higher S100A12 protein levels on day 2 (p=0.03) were obtained in the LPS cancer subgroup. ICU-LOS and H-LOS were longer in the LPS cancer subgroup. Conclusion The degree of surgical injury elicited by open MAS as reflected by alarmins is similar to that of laparoscopic procedures. Nevertheless, an early biomarker of inflammation (IL-6) was higher in the laparoscopy group, suggesting a greater inflammatory response. Moreover, the levels of S100A8 and S100A12 were higher with a longer ICU-LOS and H-LOS in the LPS cancer subgroup.
Collapse
Affiliation(s)
- Jan Máca
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Ostrava, Ostrava, Czech Republic
| | - Matúš Peteja
- The Clinic of Surgery, University Hospital Ostrava, Ostrava, Czech Republic
| | - Petr Reimer
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Ostrava, Ostrava, Czech Republic
| | - Ondřej Jor
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Ostrava, Ostrava, Czech Republic
| | - Věra Šeděnková
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Ostrava, Ostrava, Czech Republic
| | - Lucie Panáčková
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Ostrava, Ostrava, Czech Republic
| | - Peter Ihnát
- The Clinic of Surgery, University Hospital Ostrava, Ostrava, Czech Republic
| | - Michal Burda
- Institute for Research and Applications of Fuzzy Modeling, Centre of Excellence IT4Innovations, University of Ostrava, Ostrava, Czech Republic
| | - Pavel Ševčík
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Ostrava, Ostrava, Czech Republic
| |
Collapse
|
29
|
A. Dietz U, Menzel S, Lock J, Wiegering A. The Treatment of Incisional Hernia. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 115:31-37. [PMID: 29366450 PMCID: PMC5787661 DOI: 10.3238/arztebl.2018.0031] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 05/30/2017] [Accepted: 10/09/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND A meta-analysis of studies from multiple countries has shown that the incidence of incisional hernia varies from 4% to 10% depending on the type of operation. No epidemiological surveys have been conducted so far. The worst possible complication of an incisional hernia if it is not treated surgically is incarceration. In this article, we present the main surgical methods of treating this condition. We also evaluate the available randomized and controlled trials (RCTs) in which open and laparoscopic techniques were compared and analyze the patients' quality of life. METHODS We selectively searched PubMed for relevant literature using the search terms "incisional hernia" and "randomized controlled trial." 9 RCTs were included in the analysis. The endpoints of the meta-analysis were the number of reoperations, complications, and recurrences. The observed events were studied statistically by correlation of two unpaired groups with a fixed-effects model and with a random-effects model. We analyzed the quality of life in our. RESULTS Open surgery and laparoscopic surgery for the repair of incisional hernias have similar rates of reoperation (odds ratio [OR] 0.419 favoring laparoscopy, 95% confidence interval [0.159; 1.100]; p = 0.077). The rates of surgical complications are also similar (OR 0.706; 95% CI [0.278; 1.783]; p = 0.461), although the data are highly heterogeneous, and the recurrence rates are comparable as well (OR 1.301; 95% CI [0,761; 2,225]; p = 0.336). In our own patient cohort in Würzburg, the quality of life was better in multiple categories one year after surgery. CONCLUSION The operative treatment of incisional hernia markedly improves patients' quality of life. The currently available evidence regarding the complication rates of open and laparoscopic surgical repair is highly heterogeneous, and further RCTs on this subject would therefore be desirable. Moreover, new study models are needed so that well-founded individualized treatment algorithms can be developed.
Collapse
Affiliation(s)
- Ulrich A. Dietz
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital Würzburg, Würzburg, Germany
- Department of Visceral, Vascular and Thoracic Surgery, Kantonsspital Olten (soH), Switzerland
| | - Simone Menzel
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Johan Lock
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Armin Wiegering
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital Würzburg, Würzburg, Germany
- Department of Biochemistry and Molecular Biology, University of Würzburg, Würzburg, Germany
| |
Collapse
|
30
|
Parker SG, Wood CPJ, Butterworth JW, Boulton RW, Plumb AAO, Mallett S, Halligan S, Windsor ACJ. A systematic methodological review of reported perioperative variables, postoperative outcomes and hernia recurrence from randomised controlled trials of elective ventral hernia repair: clear definitions and standardised datasets are needed. Hernia 2018; 22:215-226. [PMID: 29305783 DOI: 10.1007/s10029-017-1718-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 12/23/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND This systematic review assesses the perioperative variables and post-operative outcomes reported by randomised controlled trials (RCTs) of VH repair. This review focuses particularly on definitions of hernia recurrence and techniques used for detection. OBJECTIVE Our aim is to identify and quantify the inconsistencies in perioperative variable and postoperative outcome reporting, so as to justify future development of clear definitions of hernia recurrence and a standardised dataset of such variables. METHODS The PubMed database was searched for elective VH repair RCTs reported January 1995 to March 2016 inclusive. Three independent reviewers performed article screening, and two reviewers independently extracted data. Hernia recurrence, recurrence rate, timing and definitions of recurrence, and techniques used to detect recurrence were extracted. We also assessed reported post-operative complications, standardised operative outcomes, patient reported outcomes, pre-operative CT scan hernia dimensions, intra-operative variables, patient co-morbidity, and hernia morphology. RESULTS 31 RCTs (3367 patients) were identified. Only 6 (19.3%) defined hernia recurrence and methods to detect recurrence were inconsistent. Sixty-four different clinical outcomes were reported across the RCTs, with wound infection (30 trials, 96.7%), hernia recurrence (30, 96.7%), seroma (29, 93.5%), length of hospital stay (22, 71%) and haematoma (21, 67.7%) reported most frequently. Fourteen (45%), 11 (35%) and 0 trials reported CT measurements of hernia defect area, width and loss of domain, respectively. No trial graded hernias using generally accepted scales. CONCLUSION VH RCTs report peri- and post-operative variables inconsistently, and with poor definitions. A standardised minimum dataset, including definitions of recurrence, is required.
Collapse
Affiliation(s)
- Samuel G Parker
- The Abdominal Wall Unit, University College London Hospital, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London, NW1 2BU, UK.
| | - C P J Wood
- The Abdominal Wall Unit, University College London Hospital, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London, NW1 2BU, UK
| | - J W Butterworth
- Upper Gastrointestinal Surgery Department, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London, W2 1NY, UK
| | - R W Boulton
- The Abdominal Wall Unit, University College London Hospital, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London, NW1 2BU, UK
| | - A A O Plumb
- Centre for Medical Imaging, University College London, 3rd Floor East 250 Euston Road, London, NW1 2PG, UK
| | - S Mallett
- Institute of Applied Health Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - S Halligan
- Centre for Medical Imaging, University College London, 3rd Floor East 250 Euston Road, London, NW1 2PG, UK
| | - A C J Windsor
- The Abdominal Wall Unit, University College London Hospital, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London, NW1 2BU, UK
| |
Collapse
|
31
|
Armijo P, Pratap A, Wang Y, Shostrom V, Oleynikov D. Robotic ventral hernia repair is not superior to laparoscopic: a national database review. Surg Endosc 2017; 32:1834-1839. [PMID: 29052065 DOI: 10.1007/s00464-017-5872-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 09/04/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Minimally invasive surgery (MIS) use for ventral hernia repair has increased over the last decade. Whether outcomes are improved by robotic assistance remains a subject of debate. The aim of this study is to evaluate outcomes (including cost, complications, length of stay (LOS), and pain medication utilization) in patients who underwent an open (OVHR), laparoscopic (LVHR), or robotic (RVHR) ventral hernia repair (VHR). METHODS The Vizient database was queried using ICD-9 procedure and diagnosis codes for patients who underwent VHR from January 2013 to September 2015. Complications, 30-day readmission, mortality, LOS, cost, and intra-hospital opiate utilization were analyzed using IBM SPSS v.23.0.0.0. Median tests with post hoc pairwise comparisons, Fischer's exact, and Pearson's chi-squared test with Bonferroni correction were applied where appropriate, with α = 0.05. RESULTS 46,799 patients (OVHR: N = 39,505, LVHR: N = 6829, RVHR: N = 465) met the criteria and patients in each group had similar demographics (Table 1). OVHR was associated with significant increased overall complications, 30-day readmission, LOS, and postoperative pain use compared to RVHR or LVHR. OVHR had higher mortality and postoperative infection rates than LVHR. RVHR had significantly higher rates of complications and postoperative infections compared to LVHR, although there was no difference in mortality, 30-day readmission, LOS, and postoperative pain medication use. Mean direct cost of surgery was significantly higher for RVHR, followed by OVHR and LVHR. CONCLUSIONS Overall patient outcomes were improved in the LVHR and RVHR groups compared to the open approach. However, RVHR patients did not have significant improvement compared with the LVHR group in either short-term outcomes or opiate medication used. While RVHR surgery was the most expensive modality, OVHR was also significantly costlier than LVHR, which was the least expensive. Long-term data on recurrence could not be evaluated and should be studied to determine the role of robotic surgery in VHR and recurrence rates.
Collapse
Affiliation(s)
- Priscila Armijo
- Center for Advanced Surgical Technology, University of Nebraska Medical Center, 986245 Nebraska Medical Center, Omaha, NE, 68198-6246, USA
| | - Akshay Pratap
- Department of Surgery, University of Nebraska Medical Center, 986245 Nebraska Medical Center, Omaha, NE, 68198-6246, USA
| | - Yi Wang
- College of Public Health, University of Nebraska Medical Center, 984355 Nebraska Medical Center, Omaha, NE, 68198-4355, USA
| | - Valerie Shostrom
- College of Public Health, University of Nebraska Medical Center, 984355 Nebraska Medical Center, Omaha, NE, 68198-4355, USA
| | - Dmitry Oleynikov
- Center for Advanced Surgical Technology, University of Nebraska Medical Center, 986245 Nebraska Medical Center, Omaha, NE, 68198-6246, USA. .,Department of Surgery, University of Nebraska Medical Center, 986245 Nebraska Medical Center, Omaha, NE, 68198-6246, USA.
| |
Collapse
|
32
|
Laparoscopic Repair of Incisional Hernia Following Liver Transplantation-Early Experience of a Single Institution in Taiwan. Transplant Proc 2017; 49:1870-1874. [PMID: 28923639 DOI: 10.1016/j.transproceed.2017.04.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 04/27/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Ventral incisional hernia (VIH) is not uncommon following liver transplantation. Open repair was traditionally adopted for its management. Laparoscopic repair of VIH has been performed successfully in nontransplant patients with evidence of reduced recurrence rates and hospital stay. However, the application of VIH in post-transplantation patients has not been well established. Herein, we provide our initial experience with laparoscopic repair of post-transplantation VIH. METHODS From March 2015 to March 2016, 18 cases of post-transplantation VIH were subjected to laparoscopic repair (laparoscopy group). A historical control group of 17 patients who underwent conventional open repair (open group) from January 2013 to January 2015 were identified for comparison. The demographics and clinical outcomes were retrospectively compared. RESULTS There were no significant differences among basic demographics between the 2 groups. No conversion was recorded in the laparoscopy group. Recurrence of VIH up to the end of the study period was not noted. In the laparoscopy group, the minor complications were lower (16.7% vs 52.9%; P = .035), the length of hospital stay was shorter (3 d vs 7 d, P = .007), but the median operative time was longer (137.5 min vs 106 min; P = .003). CONCLUSIONS Laparoscopic repair of post-transplantation VIH is a safe and feasible procedure with shorter length of hospital stay.
Collapse
|
33
|
Holihan JL, Hannon C, Goodenough C, Flores-Gonzalez JR, Itani KM, Olavarria O, Mo J, Ko TC, Kao LS, Liang MK. Ventral Hernia Repair: A Meta-Analysis of Randomized Controlled Trials. Surg Infect (Larchmt) 2017; 18:647-658. [DOI: 10.1089/sur.2017.029] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Julie L. Holihan
- Department of Surgery, University of Texas Health Science Center, Houston, Texas
| | - Craig Hannon
- Department of Surgery, University of Texas Health Science Center, Houston, Texas
| | | | | | - Kamal M. Itani
- Department of Surgery, Veterans Affairs Boston Healthcare System, Boston University and Harvard Medical School, Boston, Massachusetts
| | - Oscar Olavarria
- Department of Surgery, University of Texas Health Science Center, Houston, Texas
| | - Jiandi Mo
- Department of Surgery, University of Texas Health Science Center, Houston, Texas
| | - Tien C. Ko
- Department of Surgery, University of Texas Health Science Center, Houston, Texas
| | - Lillian S. Kao
- Department of Surgery, University of Texas Health Science Center, Houston, Texas
| | - Mike K. Liang
- Department of Surgery, University of Texas Health Science Center, Houston, Texas
| |
Collapse
|
34
|
Laparoscopic repair of large suprapubic hernias. Wideochir Inne Tech Maloinwazyjne 2017; 12:245-250. [PMID: 29062444 PMCID: PMC5649499 DOI: 10.5114/wiitm.2017.68794] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 05/23/2017] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Suprapubic hernia is the term to describe ventral hernias located less than 4 cm above the pubic arch in the midline. Hernias with an upper margin above the arcuate line encounter technical difficulties, and the differences in repair methods forced us to define them as large suprapubic hernias. AIM To present our experience with laparoscopic repair of large suprapubic hernias that allows adequate mesh overlap. MATERIAL AND METHODS Nineteen patients with suprapubic incisional hernias who underwent laparoscopic repair between May 2013 and January 2015 were included in the study. Patients with laparoscopic extraperitoneal repair who had a suprapubic hernia with an upper margin below the arcuate line were excluded. RESULTS Two men and 17 women, with a mean age of 58.2, underwent laparoscopic repair. Most of the incisions were midline vertical (13/68.4%). Twelve (63.1%) of the patients had previous incisional hernia repair (PIHR group); the mean number of previous incisional hernia repair was 1.4. Mean defect size of the PIHR group was higher than in patients without previous repair - 107.3 cm2 vs. 50.9 cm2 (p < 0.05). Mean operating time of the PIHR group was higher than in patients without repair - 126 min vs. 77.9 min (p < 0.05). Although all complications occurred in the PIHR group, there was no statistically significant difference. CONCLUSIONS Laparoscopic repair of large suprapubic hernias can be considered as the first option in treatment. The low recurrence rates reported in the literature and the lack of recurrence, as observed in our study, support this view.
Collapse
|
35
|
Yang GPC. From intraperitoneal onlay mesh repair to preperitoneal onlay mesh repair. Asian J Endosc Surg 2017; 10:119-127. [PMID: 28547932 DOI: 10.1111/ases.12388] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 04/12/2017] [Indexed: 11/30/2022]
Abstract
Laparoscopic repair for ventral and incisional hernias was first reported in the early 1990s. It uses intraperitoneal only mesh placement to achieve a tension-free repair of the hernia. However, in recent years, there has been greater concern about long-term complication involving intraperitoneal mesh placement. Many case reports and case series have found evidence of mesh adhesion, mesh fistulation, and mesh migration into hollow organs including the esophagus, small bowel, and large bowel, resulting in various major acute abdominal events. Subsequent management of these complications may require major surgery that is technically demanding and difficult; in such cases, laparotomy and bowel resection have often been performed. Because of these significant, but not common, adverse events, many surgeons favor open sublay repair for ventral and incisional hernias. Investigators are therefore searching for a laparoscopic approach for ventral and incisional hernias that might overcome the mesh-induced visceral complications seen after intraperitoneal only mesh placement repair. Laparoscopic preperitoneal onlay mesh is one such approach. This article will explore the fundamental of intraperitoneal only mesh placement and its problems, the currently available peritoneal visceral-compatible meshes, and upcoming developments in laparoscopic ventral and incisional hernia repair. The technical details of preperitoneal onlay mesh, as well as its potential advantages and disadvantages, will also be discussed.
Collapse
|
36
|
Comparison of Absorbable Versus Nonabsorbable Tackers in Terms of Long-term Outcomes, Chronic Pain, and Quality of Life After Laparoscopic Incisional Hernia Repair: A Randomized Study. Surg Laparosc Endosc Percutan Tech 2017; 26:476-483. [PMID: 27846175 DOI: 10.1097/sle.0000000000000347] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Laparoscopic incisional and ventral hernia repair (LIVHR) has been associated with a high incidence acute and chronic pain due to use of nonabsorbable tackers. Several absorbable tackers have been introduced to overcome these complications. This randomized study was done to compare 2 techniques of mesh fixation, that is, nonabsorbable versus absorbable tackers for LIVHR. MATERIALS AND METHODS Ninety patients admitted for LIVHR repair (defect size <15 cm) were randomized into 2 groups: nonabsorbable tacker fixation (NAT group, 45 patients) and absorbable tacker fixation (AT group, 45 patients). Intraoperative variables and postoperative outcomes were recorded and analyzed. RESULTS Patients in both the groups were comparable in terms of demographic profile and hernia characteristics. Mesh fixation time and operation time were also comparable. There was no significant difference in the incidence of immediate postoperative and chronic pain over a mean follow-up of 8.8 months. However, cost of the procedure was significantly higher in AT group (P<0.01) and NAT fixation was more cost effective as compared with AT. Postoperative quality of life outcomes and patient satisfaction scores were also comparable. CONCLUSIONS NAT is a cost-effective method of mesh fixation in patients undergoing LIVHR with comparable early and late postoperative outcomes in terms of pain, quality of life, and patient satisfaction scores.
Collapse
|
37
|
Earle D, Roth JS, Saber A, Haggerty S, Bradley JF, Fanelli R, Price R, Richardson WS, Stefanidis D. SAGES guidelines for laparoscopic ventral hernia repair. Surg Endosc 2016; 30:3163-3183. [PMID: 27405477 DOI: 10.1007/s00464-016-5072-x] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 06/21/2016] [Indexed: 01/21/2023]
Affiliation(s)
- David Earle
- Ochsner Clinic, 1514 Jefferson Highway, New Orleans, LA, 70121, USA
| | - J Scott Roth
- Ochsner Clinic, 1514 Jefferson Highway, New Orleans, LA, 70121, USA
| | - Alan Saber
- Ochsner Clinic, 1514 Jefferson Highway, New Orleans, LA, 70121, USA
| | - Steve Haggerty
- Ochsner Clinic, 1514 Jefferson Highway, New Orleans, LA, 70121, USA
| | - Joel F Bradley
- Ochsner Clinic, 1514 Jefferson Highway, New Orleans, LA, 70121, USA
| | - Robert Fanelli
- Ochsner Clinic, 1514 Jefferson Highway, New Orleans, LA, 70121, USA
| | - Raymond Price
- Ochsner Clinic, 1514 Jefferson Highway, New Orleans, LA, 70121, USA
| | | | | |
Collapse
|
38
|
Holihan JL, Alawadi ZM, Harris JW, Harvin J, Shah SK, Goodenough CJ, Kao LS, Liang MK, Roth JS, Walker PA, Ko TC. Ventral hernia: Patient selection, treatment, and management. Curr Probl Surg 2016; 53:307-54. [DOI: 10.1067/j.cpsurg.2016.06.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 06/14/2016] [Indexed: 12/14/2022]
|
39
|
Aho JM, Nourallah A, Samaha MJ, Antiel RM, Dupont SC, Ballman KV, Sloan JA, Bingener J. Patient-Reported Outcomes after Laparoscopic Ventral Hernia Repair. Am Surg 2016. [DOI: 10.1177/000313481608200618] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Approximately 350,000 ventral hernia repairs are performed in the United States each year. Patients expect fast recovery after laparoscopic ventral hernia repair (LVHR) and undisturbed postoperative quality of life (QOL). We examined the utility of a brief, validated 10-point Linear Analog Self-Assessment coupled with the Visual Analog Scale pain scale to discern risk factors for decreased postoperative QOL. Between January 2011 and May 2013, we prospectively assessed patient-reported outcomes for patients who underwent LVHR. Visual Analog Scale pain scale and Linear Analog Self-Assessment items were recorded preoperatively and postoperatively at four hours, one day, and seven days. Eighteen patients were included, 11 were female (61%) and 8 > 60 years old (44%). Patient-reported fatigue increased clinically and statistically from baseline over time ( P = 0.007) as did pain ( P < 0.001). There was a statistically significant difference in QOL scores over time by gender with women reporting worse scores than men ( P = 0.001). In conclusion, our study detected significant changes from baseline in both fatigue and pain over the seven days after LVHR. Age is associated with postoperative differences in physical well-being. Gender is associated with differences in postoperative course in QOL and physical well-being.
Collapse
Affiliation(s)
| | - Ahmad Nourallah
- Departments of Surgery and Mayo Clinic, Rochester, Minnesota
| | - Mario J. Samaha
- Departments of Surgery and Mayo Clinic, Rochester, Minnesota
| | - Ryan M. Antiel
- Departments of Surgery and Mayo Clinic, Rochester, Minnesota
| | - Sean C. Dupont
- Departments of Surgery and Mayo Clinic, Rochester, Minnesota
| | - Karla V. Ballman
- Departments of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Jeff A. Sloan
- Departments of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | | |
Collapse
|
40
|
Westphalen AP, Araújo ACF, Zacharias P, Rodrigues ES, Fracaro GB, Lopes Filho GDJ. Repair of large incisional hernias. To drain or not to drain. Randomized clinical trial. Acta Cir Bras 2016; 30:844-51. [PMID: 26735057 DOI: 10.1590/s0102-865020150120000009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 11/19/2015] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To evaluate the occurrence of seroma and surgical wound infection after surgery. METHODS A total of 42 individuals with large incisional hernias were subjected toonlay mesh repair. Following the mesh placement, the participants were randomly allocated to two groups. In group 1, closed-suction drains were placed in the subcutaneous tissue, while progressive tension sutures were performed in group 2. The participants were subjected to clinical and ultrasound assessment to detect seroma and surgical wound infection at three time-points after surgery. RESULTS The occurrence of seroma at the early, intermediate or late assessments was respectively 19.0%, 47.6%, 52.4% in group 1 and 28.6%, 57.1%, 42.9% in group 2 and was not significantly different between groups (p 0.469; 0.631; 0.619). Surgical wound infection occurred 19% in group 1 and 23.8% in group 2, without a significant difference between the groups (p>0.999). CONCLUSION The frequency of seroma and infection did not exhibit significant differences between individuals subjected to onlay mesh repair of large incisional hernias with drains or progressive tension sutures without drainage.
Collapse
Affiliation(s)
| | | | - Patrícia Zacharias
- Department of Surgery, School of Medicine, UNIOESTE, Cascavel, PR, Brazil
| | | | | | | |
Collapse
|
41
|
Pearson DG, Madura JA. Modified retrorectus ventral hernia repair. Am J Surg 2016; 211:615-8. [DOI: 10.1016/j.amjsurg.2015.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 11/24/2015] [Accepted: 11/25/2015] [Indexed: 10/22/2022]
|
42
|
Zhang Y, Zhou H, Chai Y, Cao C, Jin K, Hu Z. Laparoscopic versus open incisional and ventral hernia repair: a systematic review and meta-analysis. World J Surg 2015; 38:2233-40. [PMID: 24777660 DOI: 10.1007/s00268-014-2578-z] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Laparoscopic incisional and ventral hernia repair (LIVHR) is an alternative approach to conventional open incisional and ventral hernia repair (OIVHR). A consensus on outcomes of LIVHR when compared with OIVHR has not been reached. METHODS As the basis for the present study, we performed a systematic review and meta-analysis of all randomized controlled trials comparing LIVHR and OIVHR. RESULTS Eleven studies involving 1,003 patients were enrolled. The incidences of wound infection were significantly lower in the laparoscopic group than that in the open group (laparoscopic group 2.8 %, open group 16.2 %; RR = 0.19, 95 % CI 0.11-0.32; P < 0.00001). The rates of wound drainage were significantly lower in the laparoscopic group than that in the open group (laparoscopic group 2.6 %, open group 67.0 %; RR = 0.06, 95 % CI 0.03-0.09; P < 0.00001). However, the rates of bowel injury were significantly higher in the laparoscopic group than in the open group (laparoscopic group 4.3 %, open group 0.81 %; RR = 3.68, 95 % CI 1.56-8.67; P = 0.003). There were no significant differences between the two groups in the incidences of hernia recurrence, postoperative seroma, hematoma, bowel obstruction, bleeding, and reoperation. Descriptive analyses showed a shorter length of hospital stay in the laparoscopic group. CONCLUSIONS Laparoscopic incisional and ventral hernia repair is a feasible and effective alternative to the open technique. It is associated with lower incidences of wound infection and shorter length of hospital stay. However, caution is required because it is associated with an increased risk of bowel injury compared with the open technique. Given the relatively short follow-up duration of trials included in the systematic review, trials with long-term follow-up are needed to compare the durability of laparoscopic and open repair.
Collapse
Affiliation(s)
- Yanyan Zhang
- Department of General Surgery, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | | | | | | | | | | |
Collapse
|
43
|
Silecchia G, Campanile FC, Sanchez L, Ceccarelli G, Antinori A, Ansaloni L, Olmi S, Ferrari GC, Cuccurullo D, Baccari P, Agresta F, Vettoretto N, Piccoli M. Laparoscopic ventral/incisional hernia repair: updated Consensus Development Conference based guidelines [corrected]. Surg Endosc 2015; 29:2463-84. [PMID: 26139480 DOI: 10.1007/s00464-015-4293-8] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 04/27/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND The Executive board of the Italian Society for Endoscopic Surgery (SICE) promoted an update of the first evidence-based Italian Consensus Conference Guidelines 2010 because a large amount of literature has been published in the last 4 years about the topics examined and new relevant issues. METHODS The scientific committee selected the topics to be addressed: indications to surgical treatment including special conditions (obesity, cirrhosis, diastasis recti abdominis, acute presentation); safety and outcome of intraperitoneal meshes (synthetic and biologic); fixing devices (absorbable/non-absorbable); abdominal border and parastomal hernia; intraoperative and perioperative complications; and recurrent ventral/incisional hernia. All the recommendations are the result of a careful and complete literature review examined with autonomous judgment by the entire panel. The process was supervised by experts in methodology and epidemiology from the most qualified Italian institution. Two external reviewers were designed by the EAES and EHS to guarantee the most objective, transparent, and reliable work. The Oxford hierarchy (OCEBM Levels of Evidence Working Group*. "The Oxford 2011 Levels of Evidence") was used by the panel to grade clinical outcomes according to levels of evidence. The recommendations were based on the grading system suggested by the GRADE working group. RESULTS AND CONCLUSIONS The availability of recent level 1 evidence (a meta-analysis of 10 RCTs) allowed to recommend that not only laparoscopic repair is an acceptable alternative to the open repair, but also it is advantageous in terms of shorter hospital stay and wound infection rate. This conclusion appears to be extremely relevant in a clinical setting. Indications about specific conditions could also be issued: laparoscopy is recommended for the treatment of recurrent ventral hernias and obese patients, while it is a potential option for compensated cirrhotic and childbearing-age female patients. Many relevant and controversial topics were thoroughly examined by this consensus conference for the first time. Among them are the issue of safety of the intraperitoneal mesh placement, traditionally considered a major drawback of the laparoscopic technique, the role for the biologic meshes, and various aspects of the laparoscopic approach for particular locations of the defect such as the abdominal border or parastomal hernias.
Collapse
Affiliation(s)
- Gianfranco Silecchia
- Division of General Surgery and Bariatric Centre of Excellence, Department of Medico-Surgical Sciences and Biotechnology, Sapienza University of Rome, Via Faggiana 1668, 04100, Latina, LT, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Gemici K, Acar T, Barıs S, Yıldız M, Sever C, Bilgi M, Sentürk S. Lower recurrence rate with full-thickness mesh fixation in incisional hernia repair. Hernia 2015; 19:927-33. [DOI: 10.1007/s10029-015-1355-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 02/14/2015] [Indexed: 10/24/2022]
|
45
|
Awaiz A, Rahman F, Hossain MB, Yunus RM, Khan S, Memon B, Memon MA. Meta-analysis and systematic review of laparoscopic versus open mesh repair for elective incisional hernia. Hernia 2015; 19:449-63. [PMID: 25650284 DOI: 10.1007/s10029-015-1351-z] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Accepted: 01/22/2015] [Indexed: 12/26/2022]
Abstract
CONTEXT The utility of laparoscopic repair in the treatment of incisional hernia repair is still contentious. OBJECTIVES The aim was to conduct a meta-analysis of RCTs investigating the surgical and postsurgical outcomes of elective incisional hernia by open versus laparoscopic method. DATA SOURCES A search of PubMed, Medline, Embase, Science Citation Index, Current Contents, and the Cochrane Central Register of Controlled Trials published between January 1993 and September 2013 was performed using medical subject headings (MESH) "hernia," "incisional," "abdominal," "randomized/randomised controlled trial," "abdominal wall hernia," "laparoscopic repair," "open repair", "human" and "English". STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS Prospective RCTs comparing surgical treatment of only incisional hernia (and not primary ventral hernias) using open and laparoscopic methods were selected. STUDY APPRAISAL AND SYNTHESIS METHODS Data extraction and critical appraisal were carried out independently by two authors (AA and MAM) using predefined data fields. The outcome variables analyzed included (a) hernia diameter; (b) operative time; (c) length of hospital stay; (d) overall complication rate; (e) bowel complications; (f) reoperation; (g) wound infection; (h) wound hematoma or seroma; (i) time to oral intake; (j) back to work; (k) recurrence rate; and (l) postoperative neuralgia. These outcomes were unanimously decided to be important since they influence the practical and surgical approach towards hernia management within hospitals and institutions. The quality of RCTs was assessed using Jadad's scoring system. Random effects model was used to calculate the effect size of both binary and continuous data. Heterogeneity amongst the outcome variables of these trials was determined by the Cochran Q statistic and I (2) index. The meta-analysis was prepared in accordance with PRISMA guidelines. RESULTS Sufficient data were available for the analysis of twelve clinically relevant outcomes. Statistically significant reduction in bowel complications was noted with open surgery compared to the laparoscopic repair in five studies (OR 2.56, 95 % CI 1.15, 5.72, p = 0.02). Comparable effects were noted for other variables which include hernia diameter (SMD -0.27, 95 % CI -0.77, 0.23, p = 0.29), operative time (SMD -0.08, 95 % CI -4.46, 4.30, p = 0.97), overall complications (OR -1.07, 95 % CI -0.33, 3.42, p = 0.91), wound infection (OR 0.49, 95 % CI 0.09, 2.67, p = 0.41), wound hematoma or seroma (OR 1.54, 95 % CI 0.58, 4.09, p = 0.38), reoperation rate (OR -0.32, 95 % CI 0.07, 1.43, p = 0.14), time to oral intake (SMD -0.16, 95 % CI -1.97, 2.28, p = 0.89), length of hospital stay (SMD -0.83, 95 % CI -2.22, 0.56, p = 0.24), back to work (SMD -3.14, 95 % CI -8.92, 2.64, p = 0.29), recurrence rate (OR 1.41, 95 % CI 0.81, 2.46, p = 0.23), and postoperative neuralgia (OR 0.48, 95 % CI 0.16, 1.46, p = 0.20). CONCLUSIONS On the basis of our meta-analysis, we conclude that laparoscopic and open repair of incisional hernia is comparable. A larger randomized controlled multicenter trial with strict inclusion and exclusion criteria and standardized techniques for both repairs is required to demonstrate the superiority of one technique over the other.
Collapse
Affiliation(s)
- A Awaiz
- Jinnah Sindh Medical University and Dow University of Health Sciences, Karachi, Pakistan,
| | | | | | | | | | | | | |
Collapse
|
46
|
Abstract
OBJECTIVES Shrinkage and deformation of mesh implants used for hernia treatment can be the cause of long-term complications. The purpose of this study was to quantify noninvasively time-dependent mesh shrinkage, migration, and configuration changes in patients who were surgically treated for inguinal hernia using magnetic resonance imaging (MRI)-visible mesh implants. MATERIALS AND METHODS In an agarose phantom, meshes in different shrinkage and folding conditions were used to validate the quantification process. Seven patients who were surgically (3 bilaterally) treated for inguinal hernia using iron-loaded mesh implants were prospectively examined using MRI. Gradient echo sequences in sagittal and transverse orientations were performed on day 1 after surgery and at day 90. The mesh-induced signal voids were semiautomatically segmented and a polygonal surface model was generated. A comparison of area and centroid position was performed between the 2 calculated surfaces (day 1 vs day 90). RESULTS The phantom study revealed a maximum deviation of 3.6% between the MRI-based quantification and the actual mesh size. All 10 implants were successfully reconstructed. The mean (SD) observed mesh shrinkage 90 days after surgery was 20.9% (7.1%). The mean (SD) centroid movement was 1.17 (0.47) cm. Topographic analysis revealed mean (SD) local configuration changes of 0.23 (0.03) cm. CONCLUSIONS In this study, significant mesh shrinkage (20.9%) but marginal changes in local mesh configuration occurred within 90 days after mesh implantation. Centroid shift of the mesh implant can be traced back to different patient positioning and abdominal distension. The developed algorithm facilitates noninvasive assessment of key figures regarding MRI-visible meshes. Consequently, it might help to improve mesh technology as well as surgical skills.
Collapse
|
47
|
Positive outcomes with negative pressure therapy over primarily closed large abdominal wall reconstruction reduces surgical site infection rates. Hernia 2014; 19:273-8. [DOI: 10.1007/s10029-014-1312-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 09/12/2014] [Indexed: 11/25/2022]
|
48
|
CASTRO PMV, RABELATO JT, MONTEIRO GGR, GUERRA GCD, MAZZURANA M, ALVAREZ GA. LAPAROSCOPY VERSUS LAPAROTOMY IN THE REPAIR OF VENTRAL HERNIAS: systematic review and meta-analysis. ARQUIVOS DE GASTROENTEROLOGIA 2014; 51:205-11. [DOI: 10.1590/s0004-2803201400030008] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 04/07/2014] [Indexed: 01/29/2023]
Abstract
Objective To compare the laparotomy and laparoscopy techniques for correction of ventral hernia when related to perioperative complications, length of hospitalization, surgical time, and recurrence of hernia. Methods This was a systematic review of randomized controlled trials, which included studies retrieved from four databases (MEDLINE, Embase, Cochrane and LILACS), using a combination of the terms (Hernia, Ventral) and (Laparoscopy) and (Laparotomy). Results Six randomized trials were included, totaling 566 patients, 283 in the Laparoscopy group and 283 in the Laparotomy group. Laparoscopy reduced the risk of infection of the surgical wound (NNT = 5) and seroma formation (NNT = 13) and less length hospitalization (P = 0.02) compared to laparotomy in the correction of ventral hernias. Furthermore, laparoscopy increased the incidence of enterotomy (NNH = 25) and post operative pain (NNH = 8) and longer surgical time (P = 0.0009) when compared with laparotomy. There was no difference related to abscess (P = 0.79), hematoma (P = 0.43) and recurrency of ventral hernias (P = 0.25). Conclusions In the correction of ventral hernias, the use of laparoscopic technique is effective to reduce infections of the surgical wound and seroma formation, as well as, decrease the length hospitalization.
Collapse
Affiliation(s)
| | | | | | | | - Mônica MAZZURANA
- Centro Universitário Lusíada, Brasil; Hospital Guilherme Álvaro, Brasil
| | | |
Collapse
|
49
|
Brahmbhatt R, Carter SA, Hicks SC, Berger DH, Liang MK. Identifying Risk Factors for Surgical Site Complications after Laparoscopic Ventral Hernia Repair: Evaluation of the Ventral Hernia Working Group Grading System. Surg Infect (Larchmt) 2014; 15:187-93. [DOI: 10.1089/sur.2012.179] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Reshma Brahmbhatt
- Michael E. DeBakey Department of Surgery, Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, Houston, Texas
| | - Stacey A. Carter
- Michael E. DeBakey Department of Surgery, Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, Houston, Texas
| | | | - David H. Berger
- Michael E. DeBakey Department of Surgery, Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, Houston, Texas
| | - Mike K. Liang
- Michael E. DeBakey Department of Surgery, Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
50
|
Laparoscopic repair of incisional and ventral hernias with the new type of meshes: randomized control trial. Wideochir Inne Tech Maloinwazyjne 2014; 9:145-51. [PMID: 25097679 PMCID: PMC4105668 DOI: 10.5114/wiitm.2014.41623] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Revised: 05/15/2013] [Accepted: 08/05/2013] [Indexed: 11/22/2022] Open
Abstract
Introduction Laparoscopic incisional and ventral hernia repair (LIVHR) was first reported by Le Blanc and Booth in 1993. Many studies are available in the literature that have shown that laparoscopic repair of incisional and ventral hernia is preferred over open repair because of lower recurrence rates (less than 10%), less wound morbidity, less pain, and early return to work. Aim To identify the long-term outcomes between the different types of meshes and two techniques of mesh fixation, i.e., tacks (method Double crown) and transfascial polypropylene sutures. Material and methods A total of 92 patients underwent LIVHR at our department between January 2009 and August 2012. The hernias were umbilical in 26 patients, paraumbilical in 15 patients and incisional in 51 patients. All patients admitted for LIVHR were randomized to either group I (tacker fixation of ePTFE meshes) or group II (suture fixation of meshes with nitinol frame) using computer-generated random numbers with block randomization and sealed envelopes for concealed allocation. Results The mean mesh fixation time was significantly higher in the tacker fixation group (117 ±15 min vs. 72 ±6 min, p < 0.01). There were no conversions in either group. The median postoperative hospital stay was 3.5 ±1.5 days. All patients were followed up at 1, 3, 6, 12 and every 6 months thereafter postoperatively. There were 5 recurrences in the study population. In group I there were 4 patients with recurrence, and only 1 patient in the group with meshes with a nitinol frame. Conclusions Meshes of the new generation with a nitinol framework can significantly improve laparoscopic ventral hernia repair. The fixation of these meshes is very simple using 3–4 transfascial sutures. The absence of shrinkage of these meshes makes the probability of recurrence minimal. Absence of tackers allows postoperative pain to be minimized. We consider that these new meshes can significantly improve laparoscopic ventral hernia repair.
Collapse
|