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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] [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.
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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
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Pini R, Mongelli F, Iaquinandi F, Gaffuri P, Previsdomini M, Cianfarani A, La Regina D. Switching from robotic-assisted extended transabdominal preperitoneal (eTAPP) to totally extraperitoneal (eTEP) hernia repair for umbilical and epigastric hernias. Sci Rep 2024; 14:1800. [PMID: 38245577 PMCID: PMC10799892 DOI: 10.1038/s41598-024-52165-6] [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: 05/24/2023] [Accepted: 01/15/2024] [Indexed: 01/22/2024] Open
Abstract
Our study aimed to assess the safety and effectiveness of the robotic-assisted extended totally extraperitoneal (eTEP) repair compared to transabdominal preperitoneal (eTAPP) repair with a suprapubic trocar insertion to treat umbilical and epigastric hernias. On a prospectively maintained database, we identified patients who underwent either eTEP or eTAPP for treating umbilical and epigastric hernias. During the study period, 53 patients were included, 32 in the eTEP group and 21 in the eTAPP group. The mean age was 59.0 ± 13.9 years, 45 patients (84.9%) were male, and the mean BMI was 28.0 ± 5.9 kg/m2. Most hernias were umbilical (81.1%) and primary (83.0%). The operative time for eTEP was slightly shorter than for eTAPP (106 ± 43 min vs. 126 ± 74 min, p = 0.232). Postoperatively, only one case of bleeding and one seroma were recorded. No complication occurred during a mean follow-up of 11.3 ± 6.4 months in the eTEP group and 20.5 ± 9.7 months in the eTAPP group. In conclusion, our study showed that the eTEP with suprapubic approach was safe and feasible in the treatment of epigastric and umbilical hernias. According to our experience, shorter operative time, integrity of the posterior layers and increased overlap size are the main surgical reasons of switching from eTAPP to eTEP.
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Affiliation(s)
- Ramon Pini
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Via Gallino 12, 6500, Bellinzona, Switzerland
| | - Francesco Mongelli
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Via Gallino 12, 6500, Bellinzona, Switzerland.
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, 6500, Lugano, Switzerland.
| | - Fabiano Iaquinandi
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Via Gallino 12, 6500, Bellinzona, Switzerland
| | - Paolo Gaffuri
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Via Gallino 12, 6500, Bellinzona, Switzerland
| | - Marco Previsdomini
- Intensive Care Unit, Bellinzona e Valli Regional Hospital, EOC, 6500, Bellinzona, Switzerland
| | - Agnese Cianfarani
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Via Gallino 12, 6500, Bellinzona, Switzerland
| | - Davide La Regina
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Via Gallino 12, 6500, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, 6500, Lugano, Switzerland
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Xu H, Huang W, Guo Y, Li M, Peng G, Wu T. Efficacy of extended view totally extra peritoneal approach versus laparoscopic intraperitoneal on lay mesh plus for abdominal wall hernias: a single center preliminary retrospective study. BMC Surg 2023; 23:200. [PMID: 37443007 DOI: 10.1186/s12893-023-02098-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Laparoscopic minimally invasive surgery has become the primary treatment for ventral hernias. The laparoscopic intraperitoneal on lay mesh (IPOM) plus approach for abdominal wall hernias is the most used procedure, while extended view totally extraperitoneal (e‑TEP) repair is a newer option. This study aimed to compare the effectiveness and complications of the 2 procedures for abdominal wall hernias repair. METHODS This was a retrospective and comparative single-center study done at The Second Clinical Medical College, Jinan University Hospital (Shenzhen People's Hospital), Shenzhen, China. The study included patients with a 2 to 6 cm abdominal wall defect who underwent hernia repair from January 2022 to December 2022. Patients' baseline characteristics, hernia features, operative time, blood loss, postoperative pain level, and total hospitalization expenses were extracted from the medical records and compared between patients who underwent the IPOM plus and e-TEP repair. RESULTS A total of 53 patients were included: 22 in the e-TEP group and 31 in IPOM plus group. Patient demographic characteristics were similar between the 2 groups. The operation time of the e-TEP groups was significantly longer than the IPOM plus (98.5 ± 10.7 min vs. 65.9 ± 7.3 min, P < 0.01). Postoperative pain levels (VAS; visual analog scale) (4.2 ± 0.9 vs. 6.7 ± 0.9, P < 0.01), analgesic requirements (Tramadol) (25.0 ± 37.0 mg vs. 72.6 ± 40.5 mg, P < 0.01), length of hospital stay (1.2 ± 0.5days vs. 2.2 ± 0.6days, P < 0.01), and total hospitalization expenses (19695.9 ± 1221.7CNY vs. 35286.2 ± 1196.6CNY, P < 0.01) were significantly lower in the e-TEP group. The mean intraoperative blood loss was similar between the 2 groups. No postoperative complications were observed in either group. CONCLUSION The e-TEP approach for abdominal wall hernias appears to be better than IPOM plus with respect to postoperative pain levels(VAS: 4.2 ± 0.9 vs. 6.7 ± 0.9, P < 0.01), analgesic requirements(25.0 ± 37.0 mg vs. 72.6 ± 40.5 mg, P < 0.01), length of hospital stay(1.2 ± 0.5days vs. 2.2 ± 0.6days, P < 0.01), and hospitalization costs (19695.9 ± 1221.7CNY vs. 35286.2 ± 1196.6CNY, P < 0.01).
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Affiliation(s)
- Haisong Xu
- The Second Clinical Medical College, Jinan University, Shenzhen, China
| | - Wenhao Huang
- The Second Clinical Medical College, Jinan University, Shenzhen, China
| | - Yuehua Guo
- Department of Hepatobiliary and Pancreatic Surgery, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, Shenzhen, 518020, Guangdong Province, China
- The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Mingyue Li
- Department of Hepatobiliary and Pancreatic Surgery, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, Shenzhen, 518020, Guangdong Province, China
- The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Gongze Peng
- Department of Hepatobiliary and Pancreatic Surgery, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, Shenzhen, 518020, Guangdong Province, China
- The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Tianchong Wu
- Department of Hepatobiliary and Pancreatic Surgery, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, Shenzhen, 518020, Guangdong Province, China.
- The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China.
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Cost-Utility Analysis of Open Hernia Operations in Bulgaria. ACTA MEDICA BULGARICA 2022. [DOI: 10.2478/amb-2022-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background: Hernia surgery procedures are among the most frequently performed in Bulgaria. An open, mesh-based repair is a standard method for hernia repair. From a societal perspective, a cost-utility analysis of open hernia surgical procedures performed in Bulgaria is necessary in light of the economic and social burden that poses this health issue. The aim of the study was to perform an economic evaluation of the quality of health results after a conventional elective hernia operation with implanted light and standard meshes.
Methods: The cost of elective hernia operation with standard and light meshes was calculated as a sum of direct and indirect costs. Incremental cost-effectiveness ratio (ICER) for conventional hernia operation was calculated as health improvement was measured in quality-adjusted life years (QALY) reported in a previous study. Deterministic sensitivity analysis was applied to evaluate the changes in the ICER values in case of planned inguinal hernia operation.
Results: The cost of operation with standard meshes is less than operation with light meshes. The difference is in the range 55-200 EUR. The additional costs per one QALY gained for light meshes are far below the recommended threshold values which identified these meshes as cost-effective.
Conclusions: The study presents evidence for cost-effectiveness of light meshes.
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Jain M, Krishna A, Prakash O, Kumar S, Sagar R, Ramachandran R, Bansal VK. Comparison of extended totally extra peritoneal (eTEP) vs intra peritoneal onlay mesh (IPOM) repair for management of primary and incisional hernia in terms of early outcomes and cost effectiveness-a randomized controlled trial. Surg Endosc 2022; 36:7494-7502. [PMID: 35277771 DOI: 10.1007/s00464-022-09180-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 02/25/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND There are no randomized controlled trials comparing the eTEP with IPOM repair and this randomized study was designed to compare the two techniques in terms of early pain, cost effectiveness, and quality of life. METHOD This was a prospective randomized trial with intention to treat analysis. The primary outcome was immediate post-operative pain scores. Operative time, conversions, peri operative morbidity, hospital stay, return to daily activities, incremental cost effectiveness ratio and quality of life (WHO-QOL BREF) were secondary outcomes. RESULTS Sixty patients were randomized equally. Early post-operative pain scores and seroma rates were significantly lower and with a significantly earlier return to activity in eTEP group (p value < 0.05). With negative costs and positive effects, eTEP group was 2.4 times more cost effective. CONCLUSION eTEP repair is better in terms of lesser early post-operative pain, earlier return to activities and cost effectiveness in small and medium size defects.
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Affiliation(s)
- Mayank Jain
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5026A, 5th Floor, Teaching Block, Ansari Nagar, New Delhi, 110029, India
| | - Asuri Krishna
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5026A, 5th Floor, Teaching Block, Ansari Nagar, New Delhi, 110029, India.
| | - Om Prakash
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5026A, 5th Floor, Teaching Block, Ansari Nagar, New Delhi, 110029, India
| | - Subodh Kumar
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5026A, 5th Floor, Teaching Block, Ansari Nagar, New Delhi, 110029, India
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Rashmi Ramachandran
- Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Virinder Kumar Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5026A, 5th Floor, Teaching Block, Ansari Nagar, New Delhi, 110029, India.
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Li J, Wang Y, Wu L. The Comparison of eTEP and IPOM in Ventral and Incisional Hernia Repair: A Systematic Review and Meta-analysis. Surg Laparosc Endosc Percutan Tech 2022; 32:252-258. [PMID: 35034068 DOI: 10.1097/sle.0000000000001035] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/16/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Open sublay technique and laparoscopic intraperitoneal onlay mesh (IPOM) technique are the most common used procedures in ventral and incisional hernia repair, however, each technique has its own disadvantages. The enhanced view total extraperitoneal technique (eTEP) aims to put the mesh in the retromuscular space by minimal invasive technique. This study is to investigate the efficacy and safety of eTEP and IPOM approach in ventral and incisional hernia repair. METHODS The major databases (PubMed, Embase, Springer, and Cochrane Library) were searched, and all studies published through May 1, 2021, using the keywords "enhanced view extraperitoneal," "extended view totally extraperitoneal," "eTEP," "TEP," "laparoscopic retromuscular," "ventral hernia," "incisional hernia," "laparoscopic intraperitoneal onlay mesh," "IPOM." All relevant articles and reference lists in these original studies were also obtained from the above databases. RESULTS Five trials containing 433 patients were included in the present study. Compared with the IPOM technique, the eTEP ventral/incisional hernia repair was associated a longer operative time [mean difference=44.79; 95% confidence interval (CI): 26.57, 63; P=0.00001], less acute pain on postoperative day 1 (standardized mean difference=-3.90; 95% CI: -4.42, -3.38; P<0.00001), and day 7 (standardized mean difference=-3.72; 95% CI: -6.09, 1.35; P=0.002), and the eTEP group had a shorter hospital stay compared with the IPOM group (mean difference=-0.56; 95% CI: -0.74, -0.39; P=0.00001). There was no significant difference concerning the incidence of seroma, hematoma, intraoperative complication, and postoperative ileus between eTEP and IPOM groups. CONCLUSIONS The eTEP technique in ventral and incisional hernia repair shows significantly lower acute postoperative pain and shorter hospital study but a longer operative time. In addition, there is no significant difference in terms of intraoperative or postoperative complications. Further randomized controlled studies with long-term follow-up are needed to evaluate the eTEP technique.
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Affiliation(s)
- Junsheng Li
- Department of General Surgery, Affiliated Zhongda Hospital, Southeast University, Nanjing, Jiangsu Province
| | - Yong Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province
| | - Lisheng Wu
- Department of Hernia and Bariatric Surgery, the First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui Province, P.R. China
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7
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Azevedo MA, Santos HMG, Oliveira GBTD, Favaro MDL, Cavazolla LT. Training model in abdominal wall endoscopic surgery for ventral hernias. Extended totally extra-peritoneal approach (e-tep). Acta Cir Bras 2021; 36:e360808. [PMID: 34644776 PMCID: PMC8516429 DOI: 10.1590/acb360808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/10/2021] [Indexed: 11/22/2022] Open
Abstract
Purpose: To develop a reproducible training program model covering the steps of the
extended totally extraperitoneal approach (e-tep) technique for correction
of ventral or incisional hernia repair. Methods: Training sessions with surgeons in the laboratory using both porcine
specimens and a new ethylene vinyl acetate (EVA) model simulating the
operative steps of the e-tep technique. Students were interviewed and asked
to answer a questionnaire pre and post the sessions to assess their
performance and evaluated the course and model. Results: A total of 25 trained abdominal wall surgeons was evaluated at the end of the
course. It was obtained a 100% satisfaction score of the training, as well
as increased confidence levels up to 9 and 10 in all technical aspects of
the surgery, having 96% of the surgeons performed a surgery under
supervision of the proctors after the course. Conclusions: This training model is simple, effective, low cost, and replicable in
guidance on the beginning of e-tep technique adoption, and performance. As a
result, surgeons can get more confident and more able to perform surgeries
employing this technique.
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Pini R, Di Giuseppe M, Toti JMA, Mongelli F, Marcantonio M, Spampatti S, La Regina D. Robot-assisted Treatment of Epigastric Hernias With a Suprapubic Approach. Surg Laparosc Endosc Percutan Tech 2021; 31:584-587. [PMID: 33900226 DOI: 10.1097/sle.0000000000000941] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 02/15/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Robot-assisted ventral hernia repair has shown itself to be feasible and safe in abdominal wall surgery. Presently, the ports are placed laterally to meet the distance from the fascial defect. The aim of our study is to report our experience of epigastric hernia treatment with trocar insertion in the suprapubic region. MATERIALS AND METHODS On a prospectively collected dataset on robot-assisted surgery, patients treated for epigastric hernias with suprapubic approach were identified. Demographic and clinical data were collected and analyzed. RESULTS Twelve patients were selected. Median age was 58.5 years [interquartile range (IQR): 47.8 to 67.3 y]; 4 patients were male (33.3%) and the median body mass index was 23.9 kg/m2 (IQR: 22.3 to 26.2 kg/m2). All patients were referred to surgery because of pain. The median measure of the hernia defect was 30 mm (IQR: 13.75 to 31.0 mm); median larger mesh diameter was 13.5 cm (IQR: 9.5 to 15.0 cm); and median operative time was 136.5 minutes (IQR: 120.0 to 186.5 min). No intraoperative complication or conversion to open surgery occurred. Postoperatively, 2 patients presented a seroma and median length of hospital stay was 2.0 days (IQR: 1.75 to 3 d). No case of hernia recurrence was recorded at a mean follow-up of 11.2 months (range: 4 to 29 mo). CONCLUSIONS In the robot-assisted treatment of hernias of the epigastric region, a suprapubic port placement can be considered instead of a lateral one to have a better field overview, especially in subxiphoid hernias. Further studies are needed to assess the benefits and limitations of such technique.
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Affiliation(s)
- Ramon Pini
- Department of Surgery, Regional Hospital of Bellinzona e Valli, Bellinzona
| | - Matteo Di Giuseppe
- Department of Surgery, Regional Hospital of Bellinzona e Valli, Bellinzona
| | - Johannes M A Toti
- Department of Surgery, Regional Hospital of Bellinzona e Valli, Bellinzona
| | | | - Maria Marcantonio
- Department of Surgery, Regional Hospital of Bellinzona e Valli, Bellinzona
| | | | - Davide La Regina
- Department of Surgery, Regional Hospital of Bellinzona e Valli, Bellinzona
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Cousins S, Richards H, Zahra J, Elliott D, Avery K, Robertson HF, Paramasivan S, Wilson N, Mathews J, Tolkien Z, Main BG, Blencowe NS, Hinchliffe R, Blazeby JM. Introduction and adoption of innovative invasive procedures and devices in the NHS: an in-depth analysis of written policies and qualitative interviews (the INTRODUCE study protocol). BMJ Open 2019; 9:e029963. [PMID: 31455709 PMCID: PMC6719760 DOI: 10.1136/bmjopen-2019-029963] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Innovation is key to improving outcomes in healthcare. Innovative pharmaceutical products undergo rigorous phased research evaluation before they are introduced into practice. The introduction of innovative invasive procedures and devices is much less rigorous and phased research, including randomised controlled trials, is not always undertaken. While the innovator (usually a surgeon) may introduce a new or modified procedure/device within the context of formal research, they may also be introduced by applying for local National Health Service (NHS) organisation approval alone. Written policies for the introduction of new procedures and/or devices often form part of this local clinical governance infrastructure; however, little is known about their content or use in practice. This study aims to systematically investigate how new invasive procedures and devices are introduced in NHS England and Wales. METHODS AND ANALYSIS An in-depth analysis of written policies will be undertaken. This will be supplemented with interviews with key stakeholders. All acute NHS trusts in England and Health Boards in Wales will be systematically approached and asked to provide written policies for the introduction of new invasive procedures and devices. Information on the following will be captured: (1) policy scope, including when new procedures should be introduced within a formal research framework; (2) requirements for patient information provision; (3) outcome reporting and/or monitoring. Data will be extracted using a standardised form developed iteratively within the study team. Semistructured interviews with medical directors, audit and governance leads, and surgeons will explore views regarding the introduction of new invasive procedures into practice, including knowledge of and implementation of current policies. ETHICS AND DISSEMINATION In-depth analysis of written policies does not require ethics approval. The University of Bristol Ethics Committee (56522) approved the interview component of the study. Findings from this work will be presented at appropriate conferences and will be published in peer-reviewed journals.
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Affiliation(s)
- Sian Cousins
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme and the Medical Research Council ConDuCT-II Hub for Trials Methodology Research, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Hollie Richards
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme and the Medical Research Council ConDuCT-II Hub for Trials Methodology Research, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Jesmond Zahra
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme and the Medical Research Council ConDuCT-II Hub for Trials Methodology Research, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Daisy Elliott
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme and the Medical Research Council ConDuCT-II Hub for Trials Methodology Research, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Kerry Avery
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme and the Medical Research Council ConDuCT-II Hub for Trials Methodology Research, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Harry F Robertson
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme and the Medical Research Council ConDuCT-II Hub for Trials Methodology Research, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Sangeetha Paramasivan
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme and the Medical Research Council ConDuCT-II Hub for Trials Methodology Research, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Nicholas Wilson
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme and the Medical Research Council ConDuCT-II Hub for Trials Methodology Research, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Johnny Mathews
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme and the Medical Research Council ConDuCT-II Hub for Trials Methodology Research, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Zoe Tolkien
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme and the Medical Research Council ConDuCT-II Hub for Trials Methodology Research, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Barry G Main
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme and the Medical Research Council ConDuCT-II Hub for Trials Methodology Research, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
- Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Natalie S Blencowe
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme and the Medical Research Council ConDuCT-II Hub for Trials Methodology Research, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
- Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Robert Hinchliffe
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme and the Medical Research Council ConDuCT-II Hub for Trials Methodology Research, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
- Vascular Services, North Bristol NHS Trust, Westbury on Trym, UK
| | - Jane M Blazeby
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme and the Medical Research Council ConDuCT-II Hub for Trials Methodology Research, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
- Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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Mustafa S, Handren E, Farmer D, Ontiveros E, Ogola GO, Leeds SG. Robotic Curriculum Enhances Minimally Invasive General Surgery Residents' Education. JOURNAL OF SURGICAL EDUCATION 2019; 76:548-553. [PMID: 30217777 DOI: 10.1016/j.jsurg.2018.08.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 07/31/2018] [Accepted: 08/19/2018] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Resident education is evolving as more cases move from open to minimally invasive. Many programs struggle to incorporate minimally invasive surgery education due to increased operative time and higher cost when residents participate. The aim of this paper is to examine if the implementation of a robotics curriculum enhances minimally invasive surgical training. DESIGN A retrospective review of all ventral and inguinal hernia cases performed from March 2013 to November 2017 was conducted to determine operative technique utilized (open, laparoscopic, or robotic) and resident involvement. The study cohorts surrounded the introduction of a robotic curriculum in July 2014, and the time frames examined were labeled as Before-robotic, After-robotic, and re-visited examination was done labeled Long-term. SETTING The study was performed at a large quaternary care referral center. PARTICIPANTS The participants were all patients who underwent ventral and inguinal hernia repairs on the general surgery, transplant, or colorectal service. RESULTS Before-robotic had 739 hernia cases performed: 642 (87%) open, 93 (13%) laparoscopic, and 4 (0.5%) robotic. After-robotic had 682 hernia cases performed: 529 (78%) open, 54 (8%) laparoscopic, and 99 (15%) robotic. Long-term had 792 hernia cases performed: 603 (76%) open, 25 (3%) laparoscopic, and 164 (21%) robotic. The general trend was towards an institutional decrease in open cases and an increase in robotic hernia cases. Resident participation in the robotics cases across all levels increased after the implementation of the robotic curriculum. CONCLUSIONS Implementation of a robotic curriculum can enhance minimally invasive surgical training experience for general surgery resident education.
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Affiliation(s)
- Sarah Mustafa
- Division of Minimally Invasive Surgery, Baylor University Medical Center at Dallas, Dallas, Texas; Center for Evidence Based Simulation, Baylor University Medical Center at Dallas, Dallas, Texas.
| | - Elizabeth Handren
- Division of Minimally Invasive Surgery, Baylor University Medical Center at Dallas, Dallas, Texas.
| | - Drew Farmer
- Division of Minimally Invasive Surgery, Baylor University Medical Center at Dallas, Dallas, Texas; Center for Evidence Based Simulation, Baylor University Medical Center at Dallas, Dallas, Texas.
| | - Estrellita Ontiveros
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, Texas; Division of Minimally Invasive Surgery, Baylor University Medical Center at Dallas, Dallas, Texas; Center for Evidence Based Simulation, Baylor University Medical Center at Dallas, Dallas, Texas.
| | - Gerald O Ogola
- Center for Clinical Effectiveness, Baylor Scott & White Health, Dallas, Texas.
| | - Steven G Leeds
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, Texas; Division of Minimally Invasive Surgery, Baylor University Medical Center at Dallas, Dallas, Texas; Center for Evidence Based Simulation, Baylor University Medical Center at Dallas, Dallas, Texas.
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Endoscopic enhanced-view totally extraperitoneal retromuscular approach for ventral hernia repair. Surg Endosc 2019; 33:3749-3756. [PMID: 30680657 DOI: 10.1007/s00464-019-06669-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 01/17/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Primary or incisional ventral hernia repair is one of the most common surgical procedures, addressed to general surgeons. The enhanced view-totally extraperitoneal technique (eTEP) was first described by Deas for inguinal hernias, but lately it has been applied to ventral hernias by Belyansky et al. So far, results are promising and data about the procedure are rising. METHODS Retrospective comparative analysis of 27 recruited eTEP procedures and 27 IPOM operations for the period between April 2017 and June 2018 at the department of Endoscopic surgery of Military Medical Academy, Sofia. Baseline characteristics, operative records and perioperative data are provided and compared for both groups. RESULTS Fifty-four patients were included. There were no differences between age, sex, BMI, primary or incisional hernias, co-morbidity, active smoking, EHS-classification and immunosuppression through the patients in different groups. Mean defect area-eTEP is 71 cm2 with no statistical difference, compared to IPOM-76 cm2. Operative time in eTEP is significantly longer with mean time of 186 min and 90 min in IPOM patients. Mean length of stay did not differ between the groups, with 2.9 days after eTEP and 3.4 after IPOM. Median pain score from the intraoperative (the day of surgery) to the seventh postoperative day is lower in the eTEP group. No surgical site infections and/or mesh infections were present. There was one readmission in the IPOM group with ASBO, and it was managed conservatively. There were no reinterventions and perioperative mortality in the sample. CONCLUSION We found out that the eTEP/eRS approach is feasible and safe. Our study shows comparable results of eTEP/eRS to the IPOM procedure with reduced video analogue scale pain score to the 7th postoperative day and increased operative time. The study contributes to the upcoming evidence in the field of new minimally invasive techniques for ventral hernia repair.
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Gherghinescu MC, Copotoiu C, Lazar AE, Popa D, Mogoanta SS, Molnar C. Continuous local analgesia is effective in postoperative pain treatment after medium and large incisional hernia repair. Hernia 2017; 21:677-685. [PMID: 28560554 DOI: 10.1007/s10029-017-1625-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 05/24/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Incisional hernias are a frequent complication of laparotomy. Open surgery is still an option for the treatment of incisional hernias with medium and large wall defects. Major opioids are routinely used in the treatment of postoperative pain, with several side effects. Continuous local analgesia can be effective in postoperative pain management after various surgical interventions. However, very few reports exist on its application in incisional hernias. PURPOSE We assessed the effectiveness of ropivacaine in reducing the need for systemic analgesics in postoperative pain management related to these interventions. METHODS We conducted an open-label, prospective, randomized design study. One hundred patients with medium and large incisional hernias were treated by open surgery. Thirty patients with abdominal defects > 8 cm received continuous postoperative local analgesia with ropivacaine 5 mg/ml. Thirty four and 36 patients (abdominal defects of more, and respectively less than 8 cm) received conventional analgesia. RESULTS Continuous local anesthesia during the first 72 h after surgery reduced the number of patients needing analgesia with pethidine (17 vs 47% and 53%, p = 0.006), as well as the cumulative doses of pethidine (p < 0.05), tramadol (p < 0.001), and metamizole (p < 0.001) needed to control postoperative pain. Catheter installation for local anesthesia did not increase surgery time (p = 0.16) or the rate of local complications. CONCLUSION Continuous local analgesia reduces the need for systemic opioids and can be successfully used in the postoperative pain management after medium and large incisional hernias treated by open surgery.
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Affiliation(s)
- M C Gherghinescu
- Department M5, Surgery 1, Emergency Clinical County Hospital of Tirgu Mures, Clinic Surgery 1, University of Medicine and Pharmacy Tirgu Mures, 50, Gheorghe Marinescu St., 540136, Tirgu Mures, Romania
| | - C Copotoiu
- Department M5, Surgery 1, Emergency Clinical County Hospital of Tirgu Mures, Clinic Surgery 1, University of Medicine and Pharmacy Tirgu Mures, 50, Gheorghe Marinescu St., 540136, Tirgu Mures, Romania.
| | - A E Lazar
- Clinic of Anaesthesiology and Intensive Care, Department M4, Anaesthesiology and Intensive Care II, Emergency Clinical County Hospital of Tirgu Mures, University of Medicine and Pharmacy Tirgu Mures, 50, Gheorghe Marinescu St., 540136, Tirgu Mures, Romania
| | - D Popa
- Department M5, Surgery 1, Emergency Clinical County Hospital of Tirgu Mures, Clinic Surgery 1, University of Medicine and Pharmacy Tirgu Mures, 50, Gheorghe Marinescu St., 540136, Tirgu Mures, Romania
| | - S S Mogoanta
- Department of Surgery, Faculty of Dentistry, University of Medicine and Pharmacy Craiova, 2, Petru Rareş St., 200349, Craiova, Romania
| | - C Molnar
- Department M5, Surgery 1, Emergency Clinical County Hospital of Tirgu Mures, Clinic Surgery 1, University of Medicine and Pharmacy Tirgu Mures, 50, Gheorghe Marinescu St., 540136, Tirgu Mures, Romania
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Laparoscopic vs Robotic Intraperitoneal Mesh Repair for Incisional Hernia: An Americas Hernia Society Quality Collaborative Analysis. J Am Coll Surg 2017; 225:285-293. [PMID: 28450062 DOI: 10.1016/j.jamcollsurg.2017.04.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/05/2017] [Accepted: 04/06/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Robotic intraperitoneal mesh placement (rIPOM) has emerged recently as an alternative to laparoscopic intraperitoneal mesh placement (LapIPOM) for minimally invasive incisional hernia repair. We aimed to compare LapIPOM with rIPOM in terms of hospital length of stay (LOS) and 30-day postoperative complications in patients undergoing incisional hernia repair within the Americas Hernia Society Quality Collaborative. STUDY DESIGN Propensity score analysis was used to compare matched groups of patients within the Americas Hernia Society Quality Collaborative undergoing LapIPOM vs rIPOM. The primary outcomes measure was hospital LOS and secondary outcomes were 30-day wound events. RESULTS Four hundred and fifty-four (71.9%) patients underwent LapIPOM and 177 (28.1%) underwent rIPOM. The laparoscopic group had an increased median LOS (1 vs 0 days; interquartile range 3.00; p < 0.001). The risk of surgical site occurrence was higher in the LapIPOM group vs the rIPOM group (14% vs 5%; p = 0.001); however, surgical site occurrence requiring procedural intervention was similar between the groups (1% vs 0%; p = 1). Operative time longer than 2 hours was more common in the rIPOM group (47% vs 31%; p < 0.05). CONCLUSIONS Despite longer operative times using the rIPOM approach, patients undergoing rIPOM had a significantly shorter LOS than LapIPOM, without additional risk of wound morbidity requiring intervention. Additional studies are necessary to identify the best candidates for the rIPOM approach.
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Chen YJ, Huynh D, Nguyen S, Chin E, Divino C, Zhang L. Outcomes of robot-assisted versus laparoscopic repair of small-sized ventral hernias. Surg Endosc 2016; 31:1275-1279. [PMID: 27450207 DOI: 10.1007/s00464-016-5106-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 07/09/2016] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The aim of the study is to investigate the outcomes of the da Vinci robot-assisted laparoscopic hernia repair of small-sized ventral hernias with circumferential suturing of the mesh compared to the traditional laparoscopic repair with trans-fascial suturing. METHODS A retrospective review was conducted of all robot-assisted umbilical, epigastric and incisional hernia repairs performed at our institution between 2013 and 2015 compared to laparoscopic umbilical or epigastric hernia repairs. Patient characteristics, operative details and postoperative complications were collected and analyzed using univariate analysis. Three primary minimally invasive fellowship trained surgeons performed all of the procedures included in the analysis. RESULTS 72 patients were identified during the study period. 39 patients underwent robot- assisted repair (21 umbilical, 14 epigastric, 4 incisional), and 33 patients laparoscopic repair (27 umbilical, 6 epigastric). Seven had recurrent hernias (robot: 4, laparoscopic: 3). There were no significant differences in preoperative characteristics between the two groups. Average operative time was 156 min for robot-assisted repair and 65 min for laparoscopic repair (p < 0.0001). The average defect size was significantly larger for the robot group [3.07 cm (1-9 cm)] than that for the laparoscopic group [2.02 cm (0.5-5 cm)] (p < 0.0001), although there was no significant difference in the average size of mesh used (13 vs. 13 cm). There was no difference in patients requiring postoperative admission or length of stay between the two groups. The mean duration of follow-up was 47 days. There was no difference in complication rate during this time, and no recurrences were reported. CONCLUSION There are no significant differences in terms of safety and early efficacy when comparing small-sized ventral hernias repaired using the robot-assisted technique versus the standard laparoscopic repair.
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Affiliation(s)
- Y Julia Chen
- Department of Surgery, Mount Sinai Medical Center, 1 Gustave L. Levy Place, Box 1259, New York, NY, 10029, USA
| | - Desmond Huynh
- Department of Surgery, Mount Sinai Medical Center, 1 Gustave L. Levy Place, Box 1259, New York, NY, 10029, USA
| | - Scott Nguyen
- Department of Surgery, Mount Sinai Medical Center, 1 Gustave L. Levy Place, Box 1259, New York, NY, 10029, USA
| | - Edward Chin
- Department of Surgery, Mount Sinai Medical Center, 1 Gustave L. Levy Place, Box 1259, New York, NY, 10029, USA
| | - Celia Divino
- Department of Surgery, Mount Sinai Medical Center, 1 Gustave L. Levy Place, Box 1259, New York, NY, 10029, USA
| | - Linda Zhang
- Department of Surgery, Mount Sinai Medical Center, 1 Gustave L. Levy Place, Box 1259, New York, NY, 10029, USA.
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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: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 06/14/2016] [Indexed: 12/14/2022]
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Tobler WD, Itani KMF. Current Status and Challenges of Laparoscopy in Ventral Hernia Repair. J Laparoendosc Adv Surg Tech A 2016; 26:281-9. [PMID: 27027828 DOI: 10.1089/lap.2016.0095] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Laparoscopic repair of ventral hernias gained strong popularity in the late nineties with some of the early enthusiasm lost later in time. We review the current status and challenges of laparoscopy in ventral hernia repair and best practices in this area. We specifically looked at patient and hernia defect factors, technical considerations that have contributed to the successes, and some of the failures of laparoscopic ventral hernia repair (LVHR). Patients best suited for a laparoscopic repair are those who are obese and diabetic with a total defect size not to exceed 10 cm in width or a "Swiss cheese" defect. Overlap of mesh to healthy fascia of at least 5 cm in every direction, with closure of the defect, is essential to prevent recurrence or bulging over time. Complications specifically related to surgical site occurrence favor the laparoscopic approach. Recurrence rates, satisfaction, and health-related quality of life results are similar to open repairs, but long-term data are lacking. There is still conflicting data regarding ways of fixating the mesh. The science of prosthetic material appropriate for intraperitoneal placement continues to evolve. The field continues to be plagued by single author, single institution, and small nonrandomized observational studies with short-term follow-up. The recent development of large prospective databases might allow for pragmatic and point-of-care studies with long-term follow-up. We conclude that LVHR has evolved since its inception, has overcome many challenges, but still needs better long-term studies to evaluate evolving practices.
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Affiliation(s)
- William D Tobler
- 1 Department of Plastic Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Kamal M F Itani
- 2 VA Boston Healthcare System, Boston University and Harvard Medical School , Boston, Massachusetts
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Misiakos EP, Patapis P, Zavras N, Tzanetis P, Machairas A. Current Trends in Laparoscopic Ventral Hernia Repair. JSLS 2016; 19:JSLS.2015.00048. [PMID: 26273186 PMCID: PMC4524825 DOI: 10.4293/jsls.2015.00048] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives: The purpose of this study was to analyze the surgical technique, postoperative complications, and possible recurrence after laparoscopic ventral hernia repair (LVHR) in comparison with open ventral hernia repair (OVHR), based on the international literature. Database: A Medline search of the current English literature was performed using the terms laparoscopic ventral hernia repair and incisional hernia repair. Conclusions: LVHR is a safe alternative to the open method, with the main advantages being minimal postoperative pain, shorter recovery, and decreased wound and mesh infections. Incidental enterotomy can be avoided by using a meticulous technique and sharp dissection to avoid thermal injury.
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Affiliation(s)
- Evangelos P Misiakos
- Third Department of Surgery, University of Athens School of Medicine, Attikon University Hospital, Rimini 1, Chaidari, Athens, Greece
| | - Paul Patapis
- Third Department of Surgery, University of Athens School of Medicine, Attikon University Hospital, Rimini 1, Chaidari, Athens, Greece
| | - Nick Zavras
- Third Department of Surgery, University of Athens School of Medicine, Attikon University Hospital, Rimini 1, Chaidari, Athens, Greece
| | - Panagiotis Tzanetis
- Third Department of Surgery, University of Athens School of Medicine, Attikon University Hospital, Rimini 1, Chaidari, Athens, Greece
| | - Anastasios Machairas
- Third Department of Surgery, University of Athens School of Medicine, Attikon University Hospital, Rimini 1, Chaidari, Athens, Greece
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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: 105] [Impact Index Per Article: 11.7] [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.
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Affiliation(s)
- A Awaiz
- Jinnah Sindh Medical University and Dow University of Health Sciences, Karachi, Pakistan,
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