P135 ESTABLISHMENT OF MINIMALLY INVASIVE VENTRAL HERNIA REPAIR WITH EXTRAPERITONEAL MESH PLACEMENT AS A STANDARD APPROACH OF VENTRAL HERNIA REPAIR USING THE ROBOTIC PLATFORM

Abstract Aim Several meta-analyses indicated, that extraperitoneal mesh placement in the retromuscular or preperitoneal space shows advantages over intraperitoneal mesh placement. Previous surgical interventions which included extraperitoneal mesh placement were usually performed using open surgery. For several years now, our hospital has pursued to treat ventral hernias using a minimally invasive approach with extraperitoneal mesh placement. A Da Vinci X system has been available since the beginning of 2019. The aim of this analysis is to show the process of changing the operative procedure in ventral hernia repair over the period from 2016 to 2020. Material and Methods All hernia operations from 2016-2020 were evaluated using our hospitals information system. Every surgical intervention which included ventral hernia repair with the indication for mesh implantation was taken into the analysis. Results In 2016, the proportion of minimally invasive procedures was 36.67%. In all of these cases an intraperitoneal mesh was implanted in the abdominal cavity (laparoscopic IPOM operation). Open surgery was performed in 63.33%, out of which we implanted an intraperitoneal mesh in 23.68%, a retromuscular mesh in 73.68% and an onlay mesh in 2.63% of the cases. In 2020, the proportion of minimally invasive operations was already 87.5%, of which 83.33% were performed robotically assisted and 16.67% laparoscopically. In 94.29% of the minimally invasive operated patients an extraperitoneal mesh implantation was carried out, among which 75.76% were placed in the retromuscular and 24.24% in the preperitoneal position. Conclusions The majority of elective operations on ventral hernias can be performed in a minimally invasive technique with retromuscular mesh placement, using the robot.

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P090 LONG-TERM OUTCOMES FOLLOWING HYBRID BIOMATERIAL REPAIR OF VENTRAL HERNIAS: A MULTICENTER, RETROSPECTIVE STUDY

British Journal of Surgery ◽

10.1093/bjs/znab395.084 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Carl Doerhoff ◽

David Grantham ◽

Eric Mallico ◽

Raymond Washington ◽

John Linn

Keyword(s):

Hernia Repair ◽

Ventral Hernia ◽

Hybrid Composite ◽

Ventral Hernia Repair ◽

Mesh Fixation ◽

Composite Mesh ◽

Mesh Placement ◽

Patient Reported ◽

Ventral Hernias

Abstract Aim To analyze device safety and clinical outcomes of ventral hernia repair with a hybrid composite mesh Material and Methods This retrospective, multicenter, case review analyzed device/procedure endpoints and patient-reported outcomes in patients treated for hernia repair ≥ 1 year from study enrollment. Results There were 459 patients with 469 ventral hernias with a mean age of 58 ±15 years and 77% Ventral Hernia Working Group 2 (VHWG2). Mean hernia size was 18.9 cm2. Laparoscopic or robotic approach were utilized in 95% of patients, incisional hernias accounted for 57%. Mesh location was 75% intraperitoneal and bridging repair was performed in 57%. Procedure related adverse events within 30-days occurred in 5%, including: surgical site infection (SSI), surgical site occurrence (SSO), ileus, readmission, and re-operation. Procedure-related SSI or SSO events were 3.75% through 12-months. SSO events requiring procedural intervention (SSOPI) were 2.57% through 24-months. An estimated 7% of subjects had hernia recurrence through the study with a mean follow-up of 32-months (14-53 months) using a patient-reported outcome measure. Subgroup comparison of fixation type (permanent vs absorbable, p = 0.93) and repair (bridging vs reinforcement, p = 0.99) were conducted for recurrence and were not statistically significant. Conclusions In this analysis, ventral hernia repair with hybrid, composite mesh results in successful outcomes in the majority of patients. This study represents a heterogeneous patient population undergoing repair using various approaches, mesh fixation, and mesh placement locations. These data appear to confirm long-term acceptable safety and device performance with a low rate of recurrence in a predominantly VHWG2 population.

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ROBOTIC RETRO RECTUS MESH REPAIR OF VENTRAL ABDOMINAL HERNIA – AN INSTITUTIONAL EXPERIENCE

10.36106/gjra/9510725 ◽

2021 ◽

pp. 1-3

Author(s):

Arundev R ◽

Durga Sowmya S ◽

Farhanul Huda

Keyword(s):

Minimally Invasive ◽

Hernia Repair ◽

Ventral Hernia ◽

Polypropylene Mesh ◽

Average Length ◽

Abdominal Hernia ◽

Invasive Technique ◽

Robot Assisted ◽

Mesh Placement ◽

Early Return

Ventral hernia is a common condition treated by general surgeons. Open ventral mesh hernia repair has been in practice; the high failure rates have led to the rise of minimally invasive techniques. The da Vinci robot-assisted repair is a minimally invasive technique that provides an advantage of three-dimensional imaging, precise suturing, and dissection at difficult angles. In this study, we share our experience of robot assisted retro rectus ventral hernia repair (RRVH) in four patients. Retro rectus mesh placement has the advantage of fewer chances of exposure of the mesh and a low operative cost, as polypropylene mesh can be used. Of the four patients, 3 were females, and one was male with a mean age of 46.5±6.5 SD. The mean operative time was 175±28.7 minutes for skin-to-skin completion and 151.25 ± 26.07 minutes for console duration. There were no intra-operative complications. Post-operatively, the average pain score on the day of surgery was 1.75±0.43 SD (on a scale from 0 to 10) and on the first postoperative day was 0.5 ± 0.5 SD. The average length of hospital stay was 2.25±0.43 SD days. None of the patients had seroma, surgical site infection, adhesive bowel obstruction, or recurrence of hernia on one month and six months follow up. RRVH has an advantage regarding the decreased postoperative pain and early return to daily activities. This technique promotes the usage of polypropylene mesh, which reduces the cost of surgery.

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Onlay with Adhesive Use Compared with Sublay Mesh Placement in Ventral Hernia Repair: Was Chevrel Right? An Americas Hernia Society Quality Collaborative Analysis

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2017.01.048 ◽

2017 ◽

Vol 224 (5) ◽

pp. 962-970 ◽

Cited By ~ 12

Author(s):

Ivy N. Haskins ◽

Guy R. Voeller ◽

Nathaniel F. Stoikes ◽

David L. Webb ◽

Robert G. Chandler ◽

...

Keyword(s):

Hernia Repair ◽

Ventral Hernia ◽

Ventral Hernia Repair ◽

Mesh Placement ◽

Collaborative Analysis ◽

Sublay Mesh

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Variation in mesh placement for ventral hernia repair: an opportunity for process improvement?

The American Journal of Surgery ◽

10.1016/j.amjsurg.2007.09.041 ◽

2008 ◽

Vol 196 (2) ◽

pp. 201-206 ◽

Cited By ~ 15

Author(s):

Stephen H. Gray ◽

Catherine C. Vick ◽

Laura A. Graham ◽

Kelly R. Finan ◽

Leigh A. Neumayer ◽

...

Keyword(s):

Hernia Repair ◽

Ventral Hernia ◽

Process Improvement ◽

Ventral Hernia Repair ◽

Mesh Placement

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Simple technique for mesh placement during laparoscopic ventral hernia repair

Surgical Endoscopy ◽

10.1007/s00464-003-8167-0 ◽

2004 ◽

Vol 18 (1) ◽

pp. 162-164 ◽

Cited By ~ 5

Author(s):

A. A. Saber

Keyword(s):

Hernia Repair ◽

Ventral Hernia ◽

Ventral Hernia Repair ◽

Simple Technique ◽

Laparoscopic Ventral Hernia Repair ◽

Mesh Placement

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Impact of body mass index on minimally invasive ventral hernia repair: an ACS-NSQIP analysis

Hernia ◽

10.1007/s10029-019-01944-6 ◽

2019 ◽

Vol 23 (5) ◽

pp. 899-907 ◽

Cited By ~ 6

Author(s):

L. Owei ◽

R. A. Swendiman ◽

S. Torres-Landa ◽

D. T. Dempsey ◽

K. R. Dumon

Keyword(s):

Body Mass Index ◽

Minimally Invasive ◽

Hernia Repair ◽

Ventral Hernia ◽

Body Mass ◽

Ventral Hernia Repair ◽

Acs Nsqip

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Minimally invasive ventral hernia repair: apply or save?

Khirurgiya Zhurnal im N I Pirogova ◽

10.17116/hirurgia202008175 ◽

2020 ◽

pp. 75

Author(s):

N.L. Matveev ◽

A.M. Belousov ◽

V.A. Bochkar ◽

S.A. Makarov

Keyword(s):

Minimally Invasive ◽

Hernia Repair ◽

Ventral Hernia ◽

Ventral Hernia Repair

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EP.TH.652Use of the Proceed Ventral Patch (PVP) Mesh for Small to Medium sized defects in Ventral Hernia Repair over 10 years – Simple, Safe and Secure

British Journal of Surgery ◽

10.1093/bjs/znab309.069 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Ashwin Krishnamoorthy ◽

LamChin Tan

Keyword(s):

Hernia Repair ◽

Ventral Hernia ◽

Ventral Hernia Repair ◽

Intraoperative Complications ◽

Patient Characteristics ◽

Lightweight Mesh ◽

Complication Rates ◽

Single Centre Experience ◽

Ventral Hernias ◽

Laparoscopic Reoperation

Abstract Aims The Proceed Ventral Patch (PVP) has been in use since the late 2000s and is a self-expanding lightweight mesh patch comprised of multiple layers of absorbable and non-absorbable materials including polypropylene and polydioxanone. It is intended for use in all ventral hernias. We report our single-centre experience of using the mesh with primary outcomes being recurrence and reoperation for recurrence, readmission within 21 days for post-operative complications and discharge as day-case. Methods Retrospective review of case notes from 54 patients who were operated between October 2010 and November 2020 was undertaken. Patient characteristics were of a 2.1: 1 Male:Female ratio with a median age of 56 years old. 3 epigastric hernias and 51 paraumbilical hernias were repaired using either a 4.3cm or 6.4cm Proceed Ventral Patch. The size of the hernia defect ranged from 0.5cm to 4cm with a median defect size of 2cm for the 54 patients. Results There were no intraoperative complications. Two patients (0.04%) underwent laparoscopic reoperation for recurrence. Only one (0.02%) patient was readmitted within 21 days for a wound abscess which was drained and treated with a VAC dressing with satisfactory healing. The operations were split between nine different surgeons of varying expertise from ST5 level to Consultant level. Conclusions Ventral hernia repair with PVP is intuitive to learn and has low recurrence/complication rates.

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Evaluation of intra-abdominal adhesion formation after laparoscopic ventral hernia repair with composite mesh using abdominal ultrasound: a prospective observational study

International Surgery Journal ◽

10.18203/2349-2902.isj20211287 ◽

2021 ◽

Vol 8 (4) ◽

pp. 1143

Author(s):

Jainendra K. Arora ◽

Manjunatha Sankal ◽

Rohini Gupta Ghasi ◽

Radhika Thakur

Keyword(s):

Observational Study ◽

Hernia Repair ◽

Ventral Hernia ◽

Ventral Hernia Repair ◽

Prospective Observational Study ◽

Adhesion Formation ◽

Laparoscopic Ventral Hernia Repair ◽

Composite Mesh ◽

Ventral Hernias

Background: Laparoscopic ventral hernia repair has revolutionized treatment of ventral hernia by offering shorter recovery time, decreased pain, reduced wound complications and lower recurrence rates as compared to conventional open hernia repair. But intra-abdominal mesh placement is associated with a high risk of complications including adhesions, bowel obstruction and fistula formation. Many different types of meshes with adhesion barriers have been developed to overcome these problems. This prospective observational study evaluated the outcomes of laparoscopic repair of ventral hernias in terms of Intra-abdominal adhesion formation with composite mesh using ultrasound.Methods: The study was conducted from August 2017 to February 2019. All patients underwent standard laparoscopic ventral hernias repair using composite mesh secured with tackers. Omentum was interposed between the mesh and underlying bowel. At a mean follow-up of one year, all patients were subjected to ultrasound examination using visceral slide technique to detect Intra-abdominal adhesions.Results: Our study included 50 patients with a mean age of 43 years (range 26-59 years) and mean body mass index of 29.07±2.35 kg/m2 (range, 24-33 kg/m2). Mean fascial defect size of hernia was 13.4±3.77 cm2 (range12-16 cm2). There were no mesh-related complications and recurrence during the follow-up period of 1 year.Conclusions: Laparoscopic ventral hernia repair using composite mesh seems to be a promising technique for treating ventral hernias. However, longer follow-up periods are needed to confirm effectiveness and safety of the composite mesh.

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