Experimental Incisional Hernia Model Reveals Superiority of Retrorectus Over Intraperitoneal Mesh Repair in Tension Force and Cicatrization

Background: Incisional hernia is a common surgical condition with a reported incidence of 2-11% following laparotomy. Various Modalities of Repair have been advocated but the overall results still remain disappointing. Objective: To evaluate in incisional Hernias the efficacy and safety of Intraperitoneal mesh repair with conventional Polypropylene Mesh. Setting: In CMH Muzaffarabad, CMH Sialkot and PAC Hospital Kamra. Period: From January 2000 to January 2007. Materials & Methods: 90 cases of Incisional hernia with a minimal defect size of 4 inches were included; there was no limitation to age and sex. Patients with Co morbid conditions like Diabetes Mellitus, Hypertension, Bronchial Asthma, and Ischemic Heart Disease etc: were also included if there was no other contraindications for Surgery. Observations were made with regard to duration and ease of the operation, wound complications, hospital stay, recurrence and delayed complications. Results: In our series of 90 patients, Females (92.22%, n= 83) outnumbered males (7.77%, n=7) and the highest incidence was in the 4th decade of life in females and the 3rd decade of life in males. Gynecological operations accounted for 61.44% (n=51) of the index operations. 77.7% (n=70) ofpatients had a BMI >30. Co morbid Conditions were present in 36.66% (n=33) of patients. The polypropylene mesh placed Intra peritoneal varied from 15×7.5 cm to 30×20 cm. The mean operating time was 60±20 minutes; operating time was extended when the procedure was accompanied by Dermolipectomy 80±10 minutes. 85.55% patients (n=77) attended our follow-up, ranging from 12 months to five years.Method of follow-up in outpatients department (OPD)/Clinics: 71.11%(n=64), by telephonic conversation: 12.22%(n=11). 14.44% (n=13) were lost in follow up. All patients in followup had serial abdominal sonograms at 3, 6, 9 and 12 months postoperatively respectively to evaluate bowel motility, adhesion formation and any locally associated complication. No recurrence was noted in the follow-up group. Conclusions:Historically intraperitoneal Mesh placement of conventional polypropylene has been avoided as it was associated with significant postoperative complications. Based on our analysis, we believe that intraperitoneal mesh repair is still an effective option for Incisional hernias, especially in difficult cases and with patients having co morbid conditions. The associated high incidence of complications associated with intraperitoneal mesh placement in the literature were not seen in our experience.

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P031 OPEN VERSUS LAPAROSCOPIC INCISIONAL HERNIA REPAIR: A NATIONWIDE DATABASE STUDY

British Journal of Surgery ◽

10.1093/bjs/znab395.029 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Nadia Henriksen ◽

Hans Friis Andersen ◽

Lars Nannestad Jorgensen ◽

Frederik Helgstrand

Keyword(s):

Incisional Hernia ◽

Laparoscopic Repair ◽

Mesh Repair ◽

Open Repair ◽

Hernia Recurrence ◽

Wound Complications ◽

Open Approach ◽

Mesh Placement ◽

Laparoscopic Incisional Hernia Repair ◽

Intraperitoneal Mesh

Abstract Aim Although laparoscopic repair of incisional hernias decreases the incidence of wound complications as compared with open repair, there has been a rising concern related to intraperitoneal mesh placement. The aim of this study was to examine outcomes after open or laparoscopic elective incisional hernia mesh repair on a nationwide basis. Material and Methods A merge of data between the Danish Hernia Database and the National Patient Registry provided data on perioperative information, 90-day readmission, 90-day reoperation for complication, and long-term operation for hernia recurrence from 2007-2018. Results A total of 3,090 (57.5%) and 2,288 (42.5%) patients were operated by laparoscopic and open approach, respectively. The defect was closed in 27.9% (865/3,090) of the laparoscopic cases. The median follow-up time was 4.0 (1.8-6.8) years. Rates of readmission (16.2%, 502/3,090) and re-operation for complication (7.0%, 216/3,090) were significantly lower for laparoscopic compared to open repairs (19.3%, 442/2,288, P = 0.003 and 12.5%, 288/2,288, P < 0.001). Re-operation for bowel obstruction or bowel resection was twice as high after laparoscopic repair (0.6%, 20/3,090) compared with open repair (0.3%, 6/2,288, P = 0.044). Patients were significantly less prone to undergo repair of recurrence following laparoscopic compared with open repair of defect widths 2-6 cm (P = 0.002). Conclusions Laparoscopic intraperitoneal mesh repair for incisional hernia should still be considered for fascial defects between 2 and 6 cm, because of decreased incidences of early complications and repair of hernia recurrence compared with open repair.

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Open versus laparoscopic incisional hernia repair: nationwide database study

BJS Open ◽

10.1093/bjsopen/zraa010 ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

N A Henriksen ◽

H Friis-Andersen ◽

L N Jorgensen ◽

F Helgstrand

Keyword(s):

Incisional Hernia ◽

Laparoscopic Repair ◽

Mesh Repair ◽

Open Repair ◽

Hernia Recurrence ◽

Wound Complications ◽

Open Approach ◽

Mesh Placement ◽

Laparoscopic Incisional Hernia Repair ◽

Intraperitoneal Mesh

Abstract Background Although laparoscopic repair of incisional hernias decreases the incidence of wound complications compared with open repair, there has been rising concern related to intraperitoneal mesh placement. The aim of this study was to examine outcomes after open or laparoscopic elective incisional hernia mesh repair on a nationwide basis. Methods This study analysed merged data from the Danish Hernia Database and the National Patient Registry on perioperative information, 90-day readmission, 90-day reoperation for complication, and long-term operation for hernia recurrence among patients who underwent primary repair of an incisional hernia between 2007 and 2018. Results A total of 3090 (57.5 per cent) and 2288 (42.5 per cent) patients had surgery by a laparoscopic and open approach respectively. The defect was closed in 865 of 3090 laparoscopic procedures (28.0 per cent). The median follow-up time was 4.0 (i.q.r. 1.8–6.8) years. Rates of readmission (502 of 3090 (16.2 per cent) versus 442 of 2288 (19.3 per cent); P = 0.003) and reoperation for complication (216 of 3090 (7.0 per cent) versus 288 of 2288 (12.5 per cent); P < 0.001) were significantly lower for laparoscopic than open repairs. Reoperation for bowel obstruction or bowel resection was twice as common after laparoscopic repair compared with open repair (20 of 3090 (0.6 per cent) versus 6 of 2288 (0.3 per cent); P = 0.044). Patients were significantly less likely to undergo repair of recurrence following laparoscopic compared with open repair of defect widths 2–6 cm (P = 0.002). Conclusion Laparoscopic intraperitoneal mesh repair for incisional hernia should still be considered for fascial defects between 2 and 6 cm, because of decreased rates of early complications and repair of hernia recurrence compared with open repair.

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Incidence of seroma in sublay versus onlay mesh repair of incisional hernia

Annals of Medicine and Surgery ◽

10.1016/j.amsu.2020.12.029 ◽

2021 ◽

Vol 61 ◽

pp. 155-157

Author(s):

Rashid Ibrahim ◽

Sabry Abounozha ◽

Adel Kheder ◽

Talal Alshahri

Keyword(s):

Incisional Hernia ◽

Mesh Repair ◽

Onlay Mesh

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Mesh repair under the anterior lamina of the rectus sheath (MUAR) for abdominal incisional hernia

Surgery Today ◽

10.1007/s00595-021-02282-w ◽

2021 ◽

Author(s):

Yuichiro Miyake ◽

Souta Watanabe ◽

Gaku Mizojiri ◽

Kentaro Maruyama ◽

Kyowon Lee ◽

...

Keyword(s):

Incisional Hernia ◽

Mesh Repair ◽

Rectus Sheath

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A Study of Intraperitoneal Onlay Mesh Repair Using Barbed Sutures for Abdominal Incisional Hernia

International Surgery ◽

10.9738/intsurg-d-20-00024.1 ◽

2021 ◽

Vol 105 (1-3) ◽

pp. 585-590

Author(s):

Junpei Takashima ◽

Keizo Taniguchi ◽

Toshiaki Yasui ◽

Masahiro Yamane ◽

Yutaka Hattori ◽

...

Keyword(s):

Incisional Hernia ◽

Mesh Repair ◽

Pain Scale ◽

Barbed Suture ◽

Intraperitoneal Onlay Mesh ◽

Barbed Sutures ◽

Duration Of Surgery ◽

Onlay Mesh ◽

The Mean ◽

Hernial Orifice

Objective We investigated the validity of our intraperitoneal onlay mesh (IPOM) Plus technique with barbed sutures. Background Laparoscopic intraperitoneal onlay mesh repair has become a proven method for treating abdominal incisional hernias in recent years. There have been a few reports on the utility of IPOM Plus, which is IPOM + celiorrhaphy, although this method has not been widely discussed. We adopted the IPOM Plus technique with barbed sutures at our hospital and investigated the validity of this technique. Methods We included 7 patients who underwent IPOM Plus repair from 2015 to 2017 at our hospital. We excluded patients with a hernia hilum <2 cm or ≥10 cm, age < 20 years old, PS3 or more, and uncontrolled comorbidity. The hernial orifice was closed laparoscopically using barbed sutures and subsequently secured by tacking on an onlay mesh. Results The median hernial orifice size of the 7 patients was 45 mm (25 to 55 mm). Hernia onset occurred after laparotomy in all cases. In one case, an abdominal incisional hernia recurred after IPOM used to treat the condition 15 years earlier. The mean duration of surgery was 80.5 minutes (53 to 126 minutes), and the median pain scale score was 3 points (0 to 3 points), indicating little pain. None of the patients reported persistent postoperative pain. The mean duration of the postoperative hospital stay was a median of 3.5 days (2 to 5 days). Both short- and long-term outcomes indicated that no recurrence or complications, such as bulging or seroma, occurred. Conclusions IPOM Plus with intracavitary abdominal suturing using barbed suture for abdominal scar hernia repair may be a valid surgical procedure.

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Role of laparoscopy in incisional hernia and relative benefit of the laparoscopic incisional hernia repair to the open incisional hernia repair

International Surgery Journal ◽

10.18203/2349-2902.isj20202814 ◽

2020 ◽

Vol 7 (7) ◽

pp. 2165

Author(s):

Sudhir Singh Pal ◽

Azad Kumar Mourya

Keyword(s):

Incisional Hernia ◽

Hernia Repair ◽

Hospital Stay ◽

Mesh Repair ◽

Laparoscopic Group ◽

Incisional Hernia Repair ◽

Visual Analogue Score ◽

Laparoscopic Incisional Hernia Repair ◽

Post Operative Pain ◽

Open Mesh Repair

Background: Incisional hernia is a common complication of abdominal surgery. Historically the open repair with or without mesh was the mainstay of treatment. However, many recently published laparoscopic repair studies have challenged surgeons to re-evaluate which technique provides the best short and long term outcomes.Methods: The study was conducted on 50 patients admitted at GMC Bhopal with approval from college ethical committee.Results: In 50 cases 21 were male and 29 were female. 7 male (14%) and 15 female (30%) patients had undergone laproscopic mesh repair (LMR) and 14 male (28%) and 14 female (28%) patients had undergone open mesh repair (OMR). Total complication in OMR group is 10 (35%) and in LMR group is 2 (9.09%). Mean duration of hospital stay in LMR group was 6.6 days and in OMR group was 15.57 days. Post-operative patients of LMR group returned back to the work early (mean 12 days) compared to OMR group (mean 20.7 days). Mean post-operative day of movement in LMR group was 1 day and in OMR group was 2.03 days. Pain measured using visual analogue score on 3rd post-operative day showed decreased pain score in laparoscopic group (mean 2) compared to open group (mean 5.35).Conclusions: Laparoscopic incisional hernia repair provides lesser post-operative pain, lesser complications, shorter hospital stay and lesser economic impact as they returned to work early. Thus patients have less morbidity and improved quality of life.

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