P130 HYBRID OPERATION TECHNIQUE FOR INCISIONAL HERNIA REPAIR, A SYSTEMATIC REVIEW AND META-ANALYSIS OF INTRA- AND POSTOPERATIVE COMPLICATIONS

Abstract Aim Incisional hernia (IH) occurs approximately in 15% of patients after midline surgery. Surgical treatment for IHs include a solely open or solely laparoscopic approach with mesh placement. Recently, hybrid (combined laparoscopic and open) approaches are being performed. This systematic review evaluates the perioperative complications of hybrid incisional hernia repair (HIHR). Material and Methods EMBASE, Medline via OvidSP, Web of Science, Cochrane and Google Scholar databases were searched. Studies providing data on intra- and postoperative complications in patients who underwent HIHR were included. Data on intra- and postoperative complications were extracted and meta-analyses were performed. Study quality was assessed with the Newcastle Ottowa Scale, ROBINS-I tool, and Cochrane risk of bias. PROSPERO registration: CRD42020175053. Results Results: Nine studies (n = 1596 patients) were included. Five studies compared intra-operative complications between HIHR and laparoscopic incisional hernia repair (LIHR) with a pooled incidence of 1.8% in HIHR group and 2.8% in LIHR group (p = 0.13). Comparison of postoperative prevalence of surgical site occurrences (SSOs) (24% versus 31%, p = 0.02) and surgical site occurrences requiring interventions (SSOPIs) (1.5% versus 4.1%, p < 0.01) were in favour of the HIHR group. Overall postoperative complications seemed to occur less frequent in the HIHR group, though no hard statements could be made due to the vast heterogeneity in reporting between studies. Conclusions Although the majority of studies were retrospective and included a small number of patients, HIHR led to less SSOs and SSOPIs compared to LIHR. This systematic review forms a strong invitation for more randomized controlled trials to confirm the benefits of this approach.

Download Full-text

Hybrid operation technique for incisional hernia repair: a systematic review and meta-analysis of intra- and postoperative complications

Hernia ◽

10.1007/s10029-021-02497-3 ◽

2021 ◽

Author(s):

L. Matthijs Van den Dop ◽

Gijs H. J. De Smet ◽

Gert-Jan Kleinrensink ◽

Willem E. Hueting ◽

Johan F. Lange

Keyword(s):

Systematic Review ◽

Postoperative Complications ◽

Incisional Hernia ◽

Hernia Repair ◽

Laparoscopic Approach ◽

Incisional Hernia Repair ◽

Operation Technique ◽

Mesh Placement ◽

Laparoscopic Incisional Hernia Repair ◽

Number Of Patients

Abstract Background Incisional hernia (IH) occurs approximately in 15% of patients after midline surgery. Surgical treatment for IHs include a solely open or solely laparoscopic approach with mesh placement. Recently, hybrid (combined laparoscopic and open) approaches have been introduced. This systematic review evaluates perioperative complications of hybrid incisional hernia repair (HIHR). Methods EMBASE, Medline via OvidSP, Web of Science, Cochrane and Google Scholar databases were searched. Studies providing data on intra- and postoperative complications in patients who underwent HIHR were included. Data on intra- and postoperative complications were extracted and meta-analyses were performed. Study quality was assessed with the Newcastle Ottowa Scale, ROBINS-I tool, and Cochrane risk of bias. PROSPERO registration: CRD42020175053. Results Eleven studies (n = 1681 patients) were included. Five studies compared intra-operative complications between HIHR and laparoscopic incisional hernia repair (LIHR) with a pooled incidence of 1.8% in HIHR group and 2.8% in LIHR group (p = 0.13). Comparison of postoperative prevalence of surgical site occurrences (SSOs) (23% versus 26%, p = 0.02) and surgical site occurrences requiring interventions (SSOPIs) (1.5% versus 4.1%, p < 0.01) were in favour of the HIHR group. Overall postoperative complications seemed to occur less frequent in the HIHR group, though no hard statements could be made due to the vast heterogeneity in reporting between studies. Conclusion Although the majority of studies were retrospective and included a small number of patients, HIHR seemingly led to less SSOs and SSOPIs. This systematic review forms a strong invitation for more randomized controlled trials to confirm the benefits of this approach.

Download Full-text

Postoperative complications after laparoscopic incisional hernia repair

Surgical Endoscopy ◽

10.1007/s00464-002-9036-y ◽

2002 ◽

Vol 16 (12) ◽

pp. 1720-1723 ◽

Cited By ~ 127

Author(s):

D. Berger ◽

M. Bientzle ◽

A. Müller

Keyword(s):

Postoperative Complications ◽

Incisional Hernia ◽

Hernia Repair ◽

Incisional Hernia Repair ◽

Laparoscopic Incisional Hernia Repair

Download Full-text

Increased risk of postoperative complications with retromuscular mesh placement in emergency incisional hernia repair: A nationwide register-based cohort study

Scandinavian Journal of Surgery ◽

10.1177/1457496920966237 ◽

2020 ◽

pp. 145749692096623

Author(s):

N. Juul ◽

N. A. Henriksen ◽

K. K. Jensen

Keyword(s):

Postoperative Complications ◽

Incisional Hernia ◽

Hernia Repair ◽

Incisional Hernia Repair ◽

Secondary Outcome ◽

Emergency Setting ◽

Mesh Placement ◽

Increased Risk ◽

Elective Repair ◽

Onlay Mesh

Introduction: Incisional hernia is common after abdominal surgery. Watchful waiting carries the risk of incarceration and a need for emergency intervention. The aim of this study was to examine the risk of postoperative complications after emergency versus elective incisional hernia repair. Methods: Patients above 18 years of age undergoing open incisional hernia repair in Denmark in 2017–2018 were identified in the Danish Ventral Hernia Database. Patients were grouped according to elective or emergency hernia repair. The primary outcome was postoperative complications requiring operative intervention within 90 days, and the secondary outcome was postoperative length of stay. Results: We included 1050 patients, of whom 882 were admitted for elective and 168 for emergency operation. Patients undergoing emergency repair were older (64.7 years vs 59.2 years, p < 0.001), more often smokers (25.8% vs 13.6%, p = 0.003), and more often had a Charlson comorbidity score ⩾2 (26.8% vs 19.2%, p = 0.005) compared to patients undergoing elective repair. In a multivariate regression analysis, emergency compared to elective operation (OR = 2.71, 95% CI = 1.4–5.25, p = 0.003) and retromuscular compared to onlay mesh placement (OR = 2.14, 95% CI = 1.08–4.24, p = 0.013) were factors significantly associated with increased risk of postoperative complications. In a subgroup analysis including only emergency repairs, risk of complications after retromuscular mesh placement was even higher (OR = 10.12, 95% CI = 1.81–56.68, p = 0.008). Conclusion: Emergency incisional hernia repair was associated with increased risk of postoperative complications and this risk was accentuated with retromuscular mesh placement. The use of retromuscular mesh in the emergency setting should be avoided, and the abdominal wall could either be closed by sutures or additional onlay mesh.

Download Full-text