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

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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INTRAPERITONEAL MESH PLASTY

The Professional Medical Journal ◽

10.29309/tpmj/2010.17.03.2473 ◽

2010 ◽

Vol 17 (03) ◽

pp. 360-365

Author(s):

FAKHAR ILYAS MALIK ◽

TAHIR IQBAL MIRZA

Keyword(s):

Incisional Hernia ◽

Polypropylene Mesh ◽

Mesh Repair ◽

Operating Time ◽

Mesh Placement ◽

Incisional Hernias ◽

Intraperitoneal Mesh ◽

Intraperitoneal Mesh Placement ◽

Morbid Conditions

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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A comparative study of open versus laparoscopic incisional hernia repair

International Surgery Journal ◽

10.18203/2349-2902.isj20170428 ◽

2017 ◽

Vol 4 (3) ◽

pp. 916

Author(s):

Jagan Mohan Reddy Bathalapalli ◽

Surya Ramachandra Varma Gunturi ◽

Ram Mohan Rao V. ◽

Mythili P.

Keyword(s):

Incisional Hernia ◽

Hernia Repair ◽

Laparoscopic Repair ◽

Laparoscopic Hernia Repair ◽

Operating Time ◽

Incisional Hernia Repair ◽

Open Group ◽

Open Approach ◽

Laparoscopic Incisional Hernia Repair ◽

Operative Recovery

Background: Incisional hernia occurs in 5-11% of patients subjected to abdominal operations. Laparoscopic hernia repair has revolutionized the treatment of incisional hernia by reducing the morbidity and improved post-operative outcomes. The objectives of this study were to compare open incisional hernia repair with laparoscopic incisional hernia repair in our patient population with respect to Operating time, post-operative complications, post-operative recovery, duration of analgesic administration, and cosmetic results.Methods: This is a prospective study of Forty patients who were admitted at Osmania General Hospital, Hyderabad, Telangana, India with a clinical diagnosis of incisional hernia, 20 patients in each group (open and laparoscopic).Results: Both the study groups were comparable in terms of patient characteristics. The duration of laparoscopic repair was significantly more when compared to open repair (mean time 133.75 mins versus 85.8 min respectively). Analgesic requirement, wound infection rate and complication rate were higher in open group. The laparoscopic patients tolerated oral feeds earlier compared to open patients. The duration of hospital stay was significantly longer for open group than for laparoscopic group (mean 9.6 days versus 6.4 days respectively). The cosmetic end result was better in laparoscopic patients.Conclusions: Though ours is a small study, with the benefits of laparoscopy it will be prudent to recommend laparoscopic repair as the first line of management for incisional hernia where the facilities and trained expertise were available. However, there is still a role for traditional open approach in patients who have a specific contraindication to laparoscopic repair or any additional procedures that are not amenable for laparoscopy.

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A comparative study of open preperitoneal versus laparoscopic mesh hernioplasty in cases of incisional hernia repair

International Surgery Journal ◽

10.18203/2349-2902.isj20204137 ◽

2020 ◽

Vol 7 (10) ◽

pp. 3360

Author(s):

Ashish Kharadi ◽

Vikas Makwana ◽

Pranav Patel

Keyword(s):

Incisional Hernia ◽

Laparoscopic Repair ◽

Laparoscopic Approach ◽

Incisional Hernia Repair ◽

Cross Sectional Study ◽

Open Approach ◽

Cross Sectional ◽

Routine Work ◽

Bowel Movements ◽

Pain Duration

Background: Incisional hernias repair being done in large numbers there is still not a consensus about the best repair. Very few studies have been done on comparison open and laparoscopic incisional hernia repair.Methods: A prospective, cross-sectional study was undertaken in Department of Surgery of Civil Hospital. The study included total 50 patients, out of which 25 patients underwent open approach and rest of 25 patients, underwent laparoscopic approach. Patients were assigned to both the groups randomly.Results: Pain, duration of post-operative stay, and return to routine work is earlier in patients with laparoscopic repair mainly due to decreased pain, fewer complications, early mobility and faster return of bowel movements. Laparoscopic repair is more expensive and operative time is more as compared to open method.Conclusions: Keeping in view the advantages and limitations of laparoscopic repair, the choice among two surgical modalities should be made on a case to case basis depending on patient preference and characteristics.

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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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Initial Experience Of Laparoscopic Incisional Hernia Repair

Faridpur Medical College Journal ◽

10.3329/fmcj.v5i2.6819 ◽

1970 ◽

Vol 5 (2) ◽

pp. 41-45

Author(s):

SK Biswas ◽

MM Arefin ◽

JC Saha ◽

T Ahmed ◽

MM Rahman

Keyword(s):

Incisional Hernia ◽

Hernia Repair ◽

Laparoscopic Repair ◽

Operating Time ◽

Incisional Hernia Repair ◽

Safe Alternative ◽

Laparoscopic Incisional Hernia Repair ◽

Open Mesh Repair ◽

The Mean ◽

A Prospective Study

The laparoscopic incisional hernia repair is a safe alternative to open mesh repair. The procedure has the advantages of minimal access surgery and lower recurrence rate. A prospective study of laparoscopic incisional hernia repair of our first 11 patients was performed from July 2008 to December 2009. No serious intraoperative or postoperative morbidity was encountered, only two patients developed seroma. The mean operating time was 90 minutes (60 to 180 minutes). The mean day of discharge after surgery was 3 days (2-7 days). No patient developed a recurrence during mean follow up period of 10 months. Laparoscopic repair of incisional hernia has been shown to be feasible, safe and effective. However, careful patient selection and acquiring the necessary advanced laparoscopic surgical skills coupled with the proper use of equipment are mandatory before embarking on this procedure.Key Words: Incisional hernia; Laparoscopic repair; Mesh; Polypropylene DOI: 10.3329/fmcj.v5i2.6819Faridpur Med. Coll. J. 2010;5(2):41-45

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Incisional Hernia Repair in Contaminated Surgical fields (I.H.R.C.S.) study using biological prostheses in emergency surgery setting with contaminated hernias: a multicenter prospective observational study

Journal of Peritoneum (and other serosal surfaces) ◽

10.4081/joper.2016.26 ◽

2016 ◽

Cited By ~ 2

Author(s):

Belinda De Simone ◽

Fausto Catena ◽

Antonio Biondi ◽

Gianluca Baiocchi ◽

Fabio Campanile ◽

...

Keyword(s):

Observational Study ◽

Incisional Hernia ◽

Prospective Observational Study ◽

Wound Complication ◽

Hernia Recurrence ◽

Mesh Placement ◽

Asa Score ◽

Surgical Field ◽

The Mean ◽

Biological Prostheses

There are still difficulties to find appropriate indication for prosthetic implant in hernia surgery in contaminated surgical fields. Biologic prosthetic materials have been developed and proposed for the clinical use in contaminated surgical fields with interesting outcomes. The aim of this study is to analyze data from nine Italian Emergency Surgery Units concerning patients consecutively admitted with diagnosis of strangulated incisional hernia (IH), submitted to surgery in emergency and treated with biological prostheses. This is a prospective observational study. Subjects submitted to singlestaged IH repair in a contaminated surgical field, with the use of biologic mesh, were prospectively studied over a 1-year time period. All patients enrolled in this study were submitted to bowel/intestinal resection at the same operative time for perforation. Primary end points of our study were wound complication and hernia recurrence. Seventy-one patients were enrolled (F=21, M=50); the mean age was 69.2±11.1 standard deviation (SD) years and the mean American Society of Anesthesiologist (ASA) score was 3.1±0.8 SD. Twenty-one patients (29.57%) had a wound complication, associated with high ASA score, diabetes, smoking, chronic immunosuppression, number of previous hernia repairs, dirty surgical field, sublay extra peritoneal mesh placement and no anterior fascia closure. After a mean follow up time of 27.2 months, hernia recurrence occurred in 19 patients (26.76%). Predictors of hernia recurrence included wound complications, high ASA score, diabetes, chronic immunosuppression, dirty surgical field and sublay extra peritoneal mesh placement. Use of biological prostheses in contaminated fields is safe with favorable medium term recurrence rate (26.76% in our experience). Surgical technique performed is important to decrease hernia recurrence rate.

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Mesh repair of incisional Hernia: Comparison of Laparoscopic and open repair

The European Journal of Surgery ◽

10.1080/000000000000003 ◽

2002 ◽

Vol 168 (12) ◽

pp. 684-689 ◽

Cited By ~ 24

Author(s):

M. van't Riet ◽

W. Vrijland ◽

J. Lange ◽

W. Hop ◽

J. Jeekel ◽

...

Keyword(s):

Incisional Hernia ◽

Mesh Repair ◽

Open Repair

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Is Onlay Polypropylene Mesh Repair an Available Option for Incisional Hernia Repair? A Retrospective Cohort Study

The American Surgeon ◽

10.1177/000313481908500226 ◽

2019 ◽

Vol 85 (2) ◽

pp. 183-187 ◽

Cited By ~ 2

Author(s):

Oscar Cano-Valderrama ◽

JosÉ L. Porrero ◽

Esther Quirós ◽

Oscar Bonachia ◽

MarÍA J. Castillo ◽

...

Keyword(s):

Postoperative Complications ◽

Incisional Hernia ◽

Hernia Repair ◽

Surgical Procedures ◽

Polypropylene Mesh ◽

Mesh Repair ◽

Incisional Hernia Repair ◽

Hernia Recurrence ◽

Onlay Mesh

Lately, incisional hernia repair (IHR) with onlay polypropylene mesh has been replaced by other surgical procedures. The aim of this study was to compare the complication and recurrence rate after onlay mesh repair and other surgical procedures for IHR. A retrospective cohort study of patients who underwent IHR in a single center was conducted. The data were obtained from electronic medical records. Patients who had been lost during follow-up were contacted for a visit in the clinic. Univariate and multivariate analysis was performed with Stata 13.0 to analyze the factors associated with postoperative complications and hernia recurrence. Between June 2004 and December 2015, 1078 patients underwent IHR in a single center. Onlay mesh repair was performed in 125 patients (11.6%). Other surgical procedures included Rives procedure (29.3%), sublay mesh repair (38.6%), intrabdominal mesh repair (17.1%), and primary closure (3.4%). After a mean follow-up of 2.8 years, 73 (7%) patients developed a recurrence. A higher percentage of complications were seen after onlay mesh repair than after other surgical procedures (22.4% vs 13.1%, P = 0.005). Nevertheless, recurrence was less frequent after onlay mesh repair (4.2% vs 7.1%, P = 0.241). Logistic regression discarded an association between onlay mesh repair and hernia recurrence or postoperative complications. Incisional hernia repair with onlay polypropylene mesh repair was not associated with a higher incidence of postoperative complications or recurrence rate. So, this procedure should not be discarded in selected patients presenting with incisional hernia.

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