Outcome of four years experience in laparoscopic ventral hernia repair

Robotic assistance in ventral hernia repair may decrease the incidence of hernia recurrence

Background:

Since the advent of laparoscopic surgery, many studies have shown the advantages of laparoscopic surgery over open surgery for ventral hernia repair (VHR). As robotic surgery is gaining popularity, we sought to compare the outcomes of this newer robotic-assisted technique to the outcomes of established open and laparoscopic techniques to assess for any additional benefit.

Methods:

A meta-analysis research design was employed. Multiple databases were queried for publications over the past 10 years and 23 articles were selected based on pre-determined selection criteria. Data were extracted and the arm-based network meta-analysis method was utilised to examine the effect difference for the three arms of our study: Open, laparoscopic and robotic-assisted VHR.

Results:

As expected, laparoscopy had an advantage over open VHR in terms of infection rates. This advantage was also observed in the robotic group over the open group; however, there was no statistical difference between the laparoscopic and robotic groups when infection rates were compared head-to-head. The robotic group had a significant advantage over both the open and more importantly, the laparoscopic groups in recurrence rates.

Conclusions:

The results of this study suggest that robotic surgery maintains some of the advantages of laparoscopic surgery and may also provide the additional advantage of recurrence rate reduction. This may be explained by the ability to perform a more complex hernia repair with robotic assistance secondary to the ease of closure of the fascial defect. More research is needed to validate this finding.

Extraperitoneal laparoscopic ventral hernia repair: one step beyond

PURPOSE

The objective of the study was to analyze the experience of the Department of Surgery of two institutions of high complexity in Colombia, with the extra peritoneal ventral hernia repair by laparoscopy during the last 2 years and characterize the clinical and surgical aspects most relevant in the procedures performed.

METHODS

Observational, descriptive, retrospective study, case series type: collection of data by clinical history and analysis thereof including calculation of frequency and central tendency measurements.

RESULTS

59 Cases of Ventral Hernia Repair by laparoscopy, 41 with Transabdominal Preperitoneal approach and 18 totally Extraperitoneal. In total, 7 complications were presented as follows: 1 Case of recurrence, 1 case of chronic pain, 2 complications Dindo-Clavien IIIa and 1 complication IIIb.

CONCLUSIONS

The repair of the ventral hernia by Extraperitoneal route is an innovative approach of increasing popularity, which avoids the contact of the mesh with the intestines, thus avoiding the potential complications that this situation generates with good outcomes and at a lower cost.

Laparoscopic versus open ventral hernia repair in patients with chronic liver disease

BACKGROUND

Previous studies demonstrated laparoscopic ventral hernia repair (LVHR) to be associated with fewer short-term complications than open ventral hernia repair (OVHR). Little literature is available comparing LVHR and OVHR in chronic liver disease (CLD) patients.

METHODS

Patients with model for end-stage liver disease score ≥9 who underwent elective ventral hernia repair in the National Surgical Quality Improvement Program Database were included. 30-day outcomes were compared between LVHR and OVHR after adjusting for hernia disease severity, baseline comorbidities and demographic factors.

RESULTS

A total of 3594 ventral hernia repairs were included, 536 (14.9 %) of which were LVHR. After adjusting for other confounders, LVHR was associated with a lower incidence of wound-related complications (0.23, 95 % CI 0.07-0.74, p = 0.01), shorter length of stay (mean 3.7 vs. 5.0 days, p < 0.01) than OVHR, but similar systemic complications (p = 0.77), bleeding complications (p = 0.69), unplanned reoperation (p = 0.74) or readmission (p = 0.40). Propensity score-matched comparison showed similar conclusions. Five hundred and sixty-two patients had ascites, among whom 35 (6.2 %) underwent LVHR. In this subcohort, LVHR was associated with higher mortality (OR 5.36, 95 % CI 1.00-28.60, p = 0.05), systemic complications (OR 7.03, 95 % CI 2.06-24.00, p < 0.01), and unplanned reoperation (OR 6.03, 95 % CI 1.51-24.12, p = 0.01) than OVHR.

CONCLUSIONS

In comparison with OVHR, LVHR is associated with similar short-term outcomes except for lower wound-related complications and shorter length of stay in CLD patients. However, when patients have ascites, LVHR is associated with higher mortality, systemic complications, and unplanned reoperation.