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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; 30:3163-83. [PMID: 27405477 DOI: 10.1007/s00464-016-5072-x] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [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
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Kumar D, Khan H, Qureshi MS. Outcome of four years experience in laparoscopic ventral hernia repair. Pak J Med Sci 2015; 31:987-90. [PMID: 26430444 PMCID: PMC4590359 DOI: 10.12669/pjms.314.6326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 04/29/2015] [Accepted: 06/15/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To find out the short term outcomes of laparoscopic ventral hernia repair (LVHR) during the last four years. METHODS It was a descriptive and prospective case series of 53 consecutive patients out of 107 at Department of General Surgery, Jinnah Post Graduate Medical Center, Unit II, Karachi, from January 2009 to December 2012. These patients were admitted through out patient department with complain of lump, pain and discomfort. Most of the patients were obese. All patients were clinically examined and baseline investigations done. Fifty three (49.5%) patients underwent laparoscopic repair with mesh placement and remaining 54 by open surgical repair. RESULTS Among 53 patients, mean age was 46 years range (30 - 55). While females were 33(62.2%) and males 20(37.7%). We observed variety of hernias, in which midline and epigastric hernia were predominant. The commonest symptom was lump and dragging sensation. The duration of symptoms ranged between 6 months to one year. About 53 patients (49.5%) had laparoscopic repair with mesh placement. Average hospital stay was two days. Out of 53 patients, 4 (7.5%) had cellulitis at trocar site, seroma in 2(3.7%), 2(3.7%) patient complained of persistent pain postoperatively, port site minor infection was in 2(3.7%) patients, while conversion to open approach was done in 2 (3.7%), postoperative ileus was observed in one (1.8%) patients. CONCLUSIONS This study provides the evidence that, laparoscopic repair with mesh placement in ventral hernia is safe and effective approach compared to open surgical procedure. It has a low complication rate, less hospital stay and low recurrence.
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Affiliation(s)
- Dileep Kumar
- Dileep Kumar, Registrar General Surgery, Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan
| | - Hina Khan
- Hina Khan, Postgraduate General Surgery, Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan
| | - Muhammad Shamim Qureshi
- Muhammad Shamim Qureshi, Associate Professor of General Surgery, Ward 2, Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan
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Abdalla RZ, Garcia RB, Said DF, Abdalla BMZ. Quality of life of in patients submitted to anterior abdominal wall laparoscopic hernioplasty. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2014; 27:30-3. [PMID: 24676295 PMCID: PMC4675490 DOI: 10.1590/s0102-67202014000100008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 12/17/2013] [Indexed: 08/30/2023]
Abstract
Background The laparoscopic ventral hernia repair technique made possible surgeries with
smaller skin incisions and smaller dissection of the soft tissue around the
hernia, therefore with a better wound, a quicker postoperative recovery and a
lower complication rate. Aim To evaluate the applicability of a quality of life survey based on the molds of
the American Hernia Society, European Hernia Society and Carolinas Equation for
Quality of Life, through telephone in patients submitted to laparoscopic
hernioplasty by IPOM technique. Methods A retrospective cohort study was made to evaluate the quality of life of 21
patients that underwent anterior abdominal wall laparoscopic hernioplasty by
intraperitoneal onlay mesh technique. Questionnaire was applied through
telephone. Results Of the 21 patients, 19% felt that the hernia recurred. Also 19% passed through
another abdominal wall surgery, and among these, 75% was related to the previously
hernia correction. Finally, 81% of patients did not undergo any other abdominal
wall surgery. Conclusion It was possible to apply the quality of life questionnary by telephone on patients
who underwent an anterior abdominal wall. The results, in its turn, were
satisfactory and showed that patients, in general, were satisfied with the
surgical procedure.
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Abstract
Umbilical and epigastric hernias are primary midline defects that are present in up to 50% of the population. In the United States, only about 1% of the population carries this specific diagnosis, and only about 11% of these are repaired. Repair is aimed at symptoms relief or prevention, and the patient's goals and expectations should be explicitly identified and aligned with the health care team. This article details some relevant and interesting anatomic issues, reviews existing data, and highlights some common and important surgical techniques. Emphasis is placed on a patient-centered approach to the repair of umbilical and epigastric hernias.
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Brown RH, Subramanian A, Hwang CS, Chang S, Awad SS. Comparison of infectious complications with synthetic mesh in ventral hernia repair. Am J Surg 2013; 205:182-7. [PMID: 23331984 DOI: 10.1016/j.amjsurg.2012.02.023] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 02/26/2012] [Accepted: 02/26/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Infection can be a devastating complication associated with prosthetic incisional hernia repair. It is unclear whether the type of mesh used affects the risk of infection. METHODS A retrospective review was performed of all patients who underwent elective incisional hernia repair with permanent prosthetic mesh between January 1, 2000, and August 1, 2007. RESULTS A total of 176 patients underwent elective incisional hernia repair with mesh. The overall infection rate with the use of goretex (Flagstaff, AZ, USA) was 12 of 86 (14%) and 2 of 90 (2.2%) in cases in which nongoretex material was used (P = .016). In the goretex group, infection rates were significantly higher in open versus laparoscopic cases (26.5% vs 5.8%, P = .030). Methicillin-resistant Staphylococcus aureus was the most common organism recovered. CONCLUSIONS The risk of mesh infection with the use of goretex was found to be higher than with the use of nongoretex mesh. Laparoscopic placement of goretex reduces this risk of infection. No significant differences in recurrence rates were found.
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Affiliation(s)
- Rodger H Brown
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA
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Ramakrishna HK, Lakshman K. Intra Peritoneal Polypropylene Mesh and Newer Meshes in Ventral Hernia Repair: What EBM Says? Indian J Surg 2012; 75:346-51. [PMID: 24426474 DOI: 10.1007/s12262-012-0743-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 09/10/2012] [Indexed: 10/27/2022] Open
Abstract
Incisional hernias and other ventral hernias are common surgical problems. It is estimated that incisional hernia complicates about 2 % to 10 % of laparotomies. Ventral and incisional hernia repairs are among the common surgeries done by a general surgeon. It is proven beyond any doubt that suture repair of these hernias should not be done as recurrence rates are unacceptably high, some series reporting as high as 54 % on long-term follow-up. A prosthetic mesh should always be used in ventral hernia repair (VHR). Now, the polypropylene mesh (PPM) has become the prosthetic mesh of choice in the repair of hernias, including inguinal hernia. However, with the advent of laparoscopic repair where the mesh is placed intraperitoneally, concerns regarding safety of PPM are raised. Newer meshes are introduced, claiming lesser complication rate. Many types of newer meshes are available now. Newer meshes are invariably costlier than PPM by 15-20 times. Is this extra cost worth? We looked in to available literature for an answer.
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Affiliation(s)
- H K Ramakrishna
- Lakshmi Nursing Home, New Bridge Road, Bhadravathi, 577301 India
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7
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Banerjee A, Beck C, Narula VK, Linn J, Noria S, Zagol B, Mikami DJ. Laparoscopic ventral hernia repair: does primary repair in addition to placement of mesh decrease recurrence? Surg Endosc 2011; 26:1264-8. [PMID: 22083330 DOI: 10.1007/s00464-011-2024-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 06/22/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND The advent of laparoscopic ventral hernia repair (LVHR) not only reduced the morbidity associated with open repair but also led to a decrease in the hernia recurrence rate. However, the rate continues to remain significant. METHODS A retrospective observational study was conducted on 193 patients who were treated with LVHR by two minimally invasive surgeons in a 24-month period. The patient population was broadly divided into two groups based on the laparoscopic repair of the fascial defect with mesh underlay, or with primary suture repair and mesh underlay (PSR + MU). Patient demographics, rates of hernia recurrence, and other associated complications were compared between the two groups. Patient variables and the clinical outcomes were analyzed with descriptive statistics and chi-square test. RESULTS One hundred ninety-three consecutive patients underwent LVHR for incisional (n = 136), umbilical (n = 44), epigastric (n = 9), and parastomal (n = 4) hernia. Hernia recurrence was documented in eight patients (4.1%). The mean follow-up period was 10.5 months (range 1-36 months). Incisional hernias accounted for all eight recurrences. The rate of recurrence in those treated with PSR + MU was 3% (two of 67 cases) in comparison with 4.8% (six of 126 patients) associated with mesh alone. The rate of recurrence in the recurrent hernia group, treated with mesh only, was 10.5% (four of 38 patients) compared with 4.8% (one of 21 patients) in the PSR + MU group. CONCLUSIONS Primary laparoscopic repair along with mesh placement for the management of ventral hernia was found to be effective in selected cases as evidenced by the low rate of recurrence when compared with conventional laparoscopic repair with mesh alone. Further retrospective and prospective studies, with larger patient enrollment, are warranted to confirm the benefit of this technique over traditional repair.
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Affiliation(s)
- Ambar Banerjee
- Center for Minimally Invasive Surgery, The Ohio State University Medical Center, 747 Doan Hall, 410 W 10th Avenue, Columbus, OH 43210, USA
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Craft RO, Harold KL. Laparoscopic repair of incisional and other complex abdominal wall hernias. Perm J 2011; 13:38-42. [PMID: 20740087 DOI: 10.7812/tpp/09-001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Incisional hernia is one of the most common complications of abdominal surgery, with a reported occurrence rate of up to 20% after laparotomy. The high incidence of hernia formation significantly contributes to both patient morbidity and health care costs. Although a variety of approaches have been described to repair these defects, historically the results have been disappointing. Recurrence rates after primary repair have been reported to range from 24% to 54%. The recent advent of laparoscopic ventral hernia repair (LVHR) has offered promising outcomes by combining tension-free repair using a prosthesis with minimally invasive techniques, lowering reported recurrence rates to <10%. This review discusses standardized, well-researched techniques that have contributed to the success of LVHR. We also discuss how these techniques have been modified for laparoscopic repair of suprapubic lumbar hernias, hernias near the iliac crest, and parastomal hernias. In addition, we review our own experience with LVHR in the context of the principles discussed.
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Brill JB, Turner PL. Long-Term Outcomes with Transfascial Sutures versus Tacks in Laparoscopic Ventral Hernia Repair: A Review. Am Surg 2011. [DOI: 10.1177/000313481107700423] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although most surgeons report using both transfascial sutures and laparoscopically placed tacks to secure prostheses in laparoscopic ventral hernia repair, a significant minority have reported large series in which sutures were omitted. A systematic review of the available literature was conducted for large case series and controlled trials documenting long-term follow-up. Forty-three articles were identified, including 6015 patients whose prostheses were secured with transfascial sutures (with or without tacks), and 2450 patients receiving tacks or staples alone. The mean follow-up time reported was 30.1 months. No significant difference was found in rates of hernia recurrence, mesh removal, prolonged postoperative pain, patient body mass index, or hernia defect size between the two groups. The suture group did experience a significantly higher rate of surgical site infection. Although suture tensile strength is greater than that of tacks, and despite numerous anecdotal reports of hernia recurrence secondary to suture failure or omission, the existing literature does not show superiority of one mesh fixation technique over the other for recurrence, whereas infection rates increase when transfascial suture is used.
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Affiliation(s)
- Jason B. Brill
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Patricia L. Turner
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
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10
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Solomon TA, Wignesvaran P, Chaudry MA, Tutton MG. A retrospective audit comparing outcomes of open versus laparoscopic repair of umbilical/paraumbilical herniae. Surg Endosc 2010; 24:3109-12. [PMID: 20490566 DOI: 10.1007/s00464-010-1097-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Accepted: 03/13/2010] [Indexed: 11/24/2022]
Affiliation(s)
- T A Solomon
- ICENI Centre, Department of Laparoscopic Surgery, Colchester Hospital University NHS Foundation Trust, Essex, CO4 5JL, UK.
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11
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El laberinto de las prótesis composite en las eventraciones. Cir Esp 2009; 86:139-46. [DOI: 10.1016/j.ciresp.2009.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Accepted: 01/09/2009] [Indexed: 11/21/2022]
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Stokes JB, Friel CM. Laparoscopic Ventral Hernia Repair: Mesh Options and Outcomes. SEMINARS IN COLON AND RECTAL SURGERY 2009. [DOI: 10.1053/j.scrs.2009.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Successful vaginal delivery following laparoscopic abdominal wall reconstruction in an adult survivor of an omphalocele without prior surgical repair: report of a case. Hernia 2008; 13:431-4. [PMID: 19085039 DOI: 10.1007/s10029-008-0456-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Accepted: 11/05/2008] [Indexed: 10/21/2022]
Abstract
We report the case of a successful vaginal delivery following laparoscopic abdominal wall reconstruction in an adult survivor of an omphalocele without prior surgical repair. Untreated omphaloceles are rare in adulthood. A 30-year-old female patient presented with a large anterior abdominal wall defect due to an untreated omphalocele, who expressed a desire to have a baby in the near future. A laparoscopic herniorrhaphy was performed with a double-layered expanded polytetrafluoroethylene (ePTFE, Gore-Tex) mesh. The patient delivered a full-term healthy baby vaginally 2 years after surgical repair of the omphalocele.
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Gananadha S, Samra JS, Smith GS, Smith RC, Leibman S, Hugh TJ. Laparoscopic ePTFE mesh repair of incisional and ventral hernias. ANZ J Surg 2008; 78:907-13. [PMID: 18959647 DOI: 10.1111/j.1445-2197.2008.04690.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Incisional hernia is a relatively frequent complication of abdominal surgery. The use of mesh to repair incisional and ventral hernias results in lower recurrence rates compared with primary suture techniques. The laparoscopic approach may be associated with lower postoperative morbidity compared with open procedures. Long-term recurrence rates after laparoscopic ventral and incisional hernias are not well defined. A prospective study of the initial experience of a standardized technique of laparoscopic incisional and ventral hernia repair carried out in a tertiary referral hospital was undertaken between January 2003 and February 2007. Laparoscopic hernia repair was attempted in 71 patients and was successful in 68 (conversion rate 4%). The mean age of the patients identified was 63.1 years (39 men and 31 women). Multiple hernial defects were identified in 38 patients (56%), and the mean overall size of the fascial defects was 166 cm(2). The mean mesh size used was 403 cm(2). The mean operative time was 121 minutes. There were six (9%) major complications in this series, but there were no deaths. Hernia recurrence was noted in four patients (6%) at a mean follow up of 20 months. Our preliminary experience indicates that laparoscopic incisional and ventral hernia repair is technically feasible and has acceptable postoperative morbidity and low early recurrence rates.
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Affiliation(s)
- Sivakumar Gananadha
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, University of Sydney, Sydney, New South Wales, Australia
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15
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Laparoscopic correction of umbilical hernias using a transabdominal preperitoneal approach: results of a pilot study. Surg Endosc 2008; 23:1740-4. [DOI: 10.1007/s00464-008-0177-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Accepted: 08/30/2008] [Indexed: 10/21/2022]
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Challenges of giant ventral hernia repair in children in an African tertiary care center with limited resources. Hernia 2008; 13:143-7. [PMID: 18853227 DOI: 10.1007/s10029-008-0439-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2008] [Accepted: 09/19/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The objective of this study is to report the challenges and outcome of giant ventral abdominal hernia repair in infants/children in a tertiary care center in Africa. DESIGN A retrospective analysis of infants/children who had a repair of giant ventral abdominal hernia between January 1998 and December 2007 at the University of Benin Teaching Hospital (UBTH), Benin City, Nigeria, was carried out. RESULTS A total of 41 children aged between 9 months and 12 years (mean 2.6 +/- 1.8 years) comprising 25 males and 16 females with a male:female ratio of 1.6:1 had a repair of giant ventral abdominal hernias which were due to healed omphalocele in 37 (90.3%), incisional hernia in three (7.3%), and following initial skin closure of gastroschisis in one (2.4%). They had an average hernia defect of size 7.1 x 8.3 cm, which contained both solid and hollow viscera in all of the patients, along with 11 (29.7%) syndromic omphalocele. The major challenge was inadequate intraabdominal volume needed to accommodate the herniated viscera in nine children, which was compounded by the nonavailability of silastic materials, a pediatric ventilator, facilities required for intraabdominal pressure monitoring during closure, as well as undiagnosed associated cardiac anomaly. Overall, 39 (95.1%) children survived, while two (4.9%) mortalities were recorded due to postoperative aspiration in one child and cardiopulmonary failure in the other. Of those who survived, 29 (74.4%) had a smooth postoperative course, while ten (25.6%) had morbidity, with a mean hospitalization duration of 10 +/- 2.5 days. There was no recurrence recorded on follow-up for 5 years at the surgical outpatient clinic. CONCLUSION Despite the challenges, better results were achieved with repairs in infants/children compared to repairs performed in neonates.
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Saber AA, Elgamal MH, Rao AJ, Itawi EA, Mancl TB. A simplified laparoscopic ventral hernia repair: the scroll technique. Surg Endosc 2008; 22:2527-31. [PMID: 18322743 DOI: 10.1007/s00464-008-9791-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Revised: 10/22/2007] [Accepted: 01/19/2008] [Indexed: 11/26/2022]
Abstract
BACKGROUND Laparoscopic ventral hernia repair has steadily gained recognition as an alternative to the open approach. However, the procedure can be technically challenging. The authors present their simple scroll technique for laparoscopic ventral hernia repair. METHODS A total of 174 patients underwent laparoscopic ventral hernia repair using the scroll technique. The technique entails fixation of the rolled mesh to the anterior abdominal wall before it is unfolded. Patient characteristics, operative time, and complications were analyzed and compared with pooled data from the available literature on laparoscopic ventral hernia repair. RESULTS The mean operative time was comparable with that reported by others (mean, 102 vs. 100 min). The hospital stay was shorter (mean, 1.8 vs. 2.4 h). During a mean follow-up period of 28 months, the recurrence rate was lower than that reported by others (1.7% vs. 4.3%). There were no mortalities and no cases of inadvertent bowel injury. CONCLUSION The authors' scroll technique for laparoscopic repair is simple, feasible, and reproducible, with a short learning curve and a low recurrence rate.
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Affiliation(s)
- A A Saber
- Department of Surgery, Michigan State University/Kalamazoo Center of Medical Studies, 1000 Oakland Drive, Kalamazoo, MI 49008, USA.
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Hussain A, Mahmood H, Nicholls J, El-Hasani S. Laparoscopic ventral hernia repair. Our experience of 61 consecutive series: Prospective study. Int J Surg 2008; 6:15-9. [DOI: 10.1016/j.ijsu.2007.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2007] [Revised: 11/23/2007] [Accepted: 11/27/2007] [Indexed: 10/22/2022]
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Lee YK, Iqbal A, Vitamvas M, McBride C, Thompson J, Oleynikov D. Is it safe to perform laparoscopic ventral hernia repair with mesh in elderly patients? Hernia 2007; 12:239-42. [PMID: 18066489 DOI: 10.1007/s10029-007-0312-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2007] [Accepted: 11/09/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Ventral hernia is a common surgical condition occurring most often as a complication following abdominal surgery. Laparoscopic repair of a ventral hernia has been shown to be safe with low rates of complications, shortened length of stay, and low rates of early recurrence as compared to open surgery. Few studies have documented long-term outcomes of laparoscopic repair in elderly patients. The aim of this study is to report the long-term outcomes of laparoscopic ventral hernia repair with mesh in elderly patients. METHODS AND MATERIALS This is a retrospective study in a university setting with IRB approval. Between the years 2000 and 2006, 117 patients underwent laparoscopic repair of ventral hernia with synthetic mesh. Data were collected using patient charts and radiographic reports. Patient variables included age, sex, size and content of hernia, size of mesh used, length of hospital stay (LHS), estimated blood loss (EBL), follow-up duration, and post-operative complications (PC) including infection, deep vein thrombosis, bleeding, and pulmonary embolism. The comparison was done between two different age groups (A <55 years old; B >or= 55 years old). RESULTS Current median (range) follow-up periods for group A (<55 years) and B (>or=55 years) were 57.5 and 53 months, respectively. Group A (63 patients) and B (54 patients) had same median LHS (1 day) and size of mesh utilized (285 cm(2)). For groups A and B, the percent female, and the percentages of recurrence, minimal EBL (<50 ml), and PC were 61.9 and 44.4; 1.6 and 3.7; 96.8 and 92.6; 4.8 and 12.9, respectively. Median hernia sizes for groups A and B were 55.1 and 54 cm(2). No significant differences were found for any of the above variables. CONCLUSION No significant difference was found in outcomes between younger versus older patients undergoing laparoscopic ventral hernia repair with mesh. Laparoscopic repair provides a durable and effective method of repairing a ventral hernia with low morbidity and mortality in the elderly population.
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Affiliation(s)
- Y K Lee
- Department of Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE 68198-3280, USA
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Minimally invasive ventral herniorrhaphy: an analysis of 6,266 published cases. Hernia 2007; 12:9-22. [PMID: 17943226 DOI: 10.1007/s10029-007-0286-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2007] [Accepted: 09/07/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Over 300,000 ventral abdominal wall hernias are repaired each year in the United States; many of these operations are done with a minimally invasive approach. Despite these numbers, there are few controlled data that evaluate the minimally invasive method of ventral hernia repair. METHODS A review of over 6,000 published cases of minimally invasive ventral herniorrhaphy was performed in order to determine major outcome statistics for this procedure. RESULTS The mean follow-up period was 20 months. The operative mortality was 0.1%. The mean recurrence rate (weighted) was 2.7%, and the major complication rate (mostly bowel injury and infection) was 3%. CONCLUSION The results from published cases of minimally invasive ventral herniorrhaphy appear to be competitive with the historical results of open ventral herniorrhaphy. The major caveats of this review are that most of the data are (1) retrospective/uncontrolled and (2) obtained from specialized centers.
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Eriksen JR, Gögenur I, Rosenberg J. Choice of mesh for laparoscopic ventral hernia repair. Hernia 2007; 11:481-92. [PMID: 17846703 DOI: 10.1007/s10029-007-0282-8] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Accepted: 08/17/2007] [Indexed: 01/25/2023]
Abstract
BACKGROUND Surgical treatment of ventral hernias has changed dramatically over the past decades by the introduction of laparoscopy and prosthetic biomaterials for reinforcement of the abdominal wall. There are many meshes available on the market for laparoscopic ventral hernia repair (LVHR), and new meshes are introduced regularly. Experimental and clinical documentation for safety and efficacy are, however, often not available for the clinician. The choice of mesh may therefore be difficult in clinical practice. We present a review of the current literature regarding safety measures such as adhesions, fistulas, and infections as well as the available data on pain, recurrence, mesh shrinkage, and seroma formation after LVHR. METHODS The literature was searched systematically using PubMed/MEDLINE and EMBASE for controlled studies, prospective descriptive series and retrospective case series. RESULTS The literature clearly points in the direction of very few mesh-related complications after LVHR. Experimental studies and theoretical considerations may argue for using a covered mesh, i.e., a composite mesh, or ePTFE for LVHR in humans, although it is important to stress that there are no human data at the moment to support this. Concerns about using pure polypropylene mesh in the intraperitoneal position may be re-evaluated with the experience of lightweight macropore meshes from open surgery in mind. There is a tendency towards greater shrinkage in ePTFE-based meshes but no differences seems to exist between different mesh materials in other relevant outcome parameters from clinical series. CONCLUSIONS The literature cannot give general recommendations for choice of mesh based on randomized controlled trials. The final choice of mesh for LVHR will therefore typically be based on surgeons' preference and cost while we await further data from randomized controlled clinical trials.
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Affiliation(s)
- J R Eriksen
- Department of Surgical Gastroenterology D, Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, 2900 Hellerup, Denmark.
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