Preperitoneal space, is it an ideal layer for endoscopic sublay repair of ventral hernia?

Abstract Aim We describe in detail the step by step technique of the first case of TES repair at our institution. Methods We selected the case of a M2W3L3 hernia associated to xipho-umbilical diastasis recti in a young woman symptomatic for a progressively worsening back pain and local bulky sensation. Results The intervention is started directly with a suprapubic transverse incision of 2.5 cm and a circumferential, atraumatic retraction is inserted after a small incision of the anterior rectus sheath. Blunt dissection is further continued through this access by luxating the underlying rectus muscles to separate the preperitoneal space below the arcuate line. The pneumo-preperitoneum is then inducted through this port. Laparoscopic dissection allows for enlargement of the avascular space laterally and then two 5-mm trocars are placed on the bilateral aspects of rectus muscles. By means of a lap bipolar dissector the edge of posterior rectus sheath are incised from the arcuate line following the diastasis laterally up to the subxiphoid space. The Rives plane is recovered without opening of the linea alba. After reduction of the M2 hernia both the posterior sheath and the diastatic anterior fascia are sutured with a running long-resorbable 2/0 barbed suture. Polyvinylidene fluoride (PVDF) mesh fixed with the use of an hystoacrilic glue. Conclusion Minimally invasive extraperitoneal repair of small/medium hernia defects of the linea alba is gaining wide acceptance. Concomitant presence of rectum diastasis recti seems to be the ideal indication to approach the learning curve of such a technically demanding procedure

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Comparative study between onlay and sublay repair of ventral hernia

Al-Azhar Assiut Medical Journal ◽

10.4103/azmj.azmj_60_19 ◽

2019 ◽

Vol 17 (1) ◽

pp. 96

Author(s):

RadwaM Mohamed ◽

OmniaM Rabie

Keyword(s):

Comparative Study ◽

Ventral Hernia ◽

Sublay Repair

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A preliminary multicenter evaluation of endoscopic sublay repair for ventral hernia from China

10.21203/rs.3.rs-41632/v2 ◽

2020 ◽

Author(s):

Rui Tang ◽

Huiyong Jiang ◽

Weidong WU ◽

Tao Wang ◽

Mengxiang Meng ◽

...

Keyword(s):

Ventral Hernia ◽

Intraoperative Complications ◽

Mesh Fixation ◽

Transversus Abdominis ◽

Intraperitoneal Onlay Mesh ◽

Patient Demographics ◽

Onlay Mesh ◽

Sublay Repair ◽

Space Separation ◽

Ventral Hernias

Abstract Background: For ventral hernia, endoscopic sublay repair (ESR) may overcome the disadvantages of open sublay and laparoscopic intraperitoneal onlay mesh repair. This retrospective study presents the preliminary multicenter results of ESR from China. The feasibility, safety, and effectiveness of ESR were evaluated; its surgical points and indications were summarized. Methods: The study reviewed 156 ventral hernia patients planned to perform with ESR in ten hospitals between March 2016 and July 2019. Patient demographics, hernia characteristics, operative variables, and surgical results were recorded and analyzed.Results: ESR was performed successfully in 153 patients, 135 with totally extraperitoneal sublay (TES) and 18 with transabdominal sublay (TAS). In 19 patients, TES was performed with the total visceral sac separation (TVS) technique, in which the space separation is carried out along the peritoneum, avoiding damage to the aponeurotic structure. Endoscopic transversus abdominis release (eTAR) was required in 17.0% of patients, and only 18.3% of patients required permanent mesh fixation. The median operative time was 135 min. Most patients had mild pain and resume eating soon after operation. No severe intraoperative complications occurred. Bleeding in the extraperitoneal space occurred in two patients and was stopped by nonsurgical treatment. Seroma and chronic pain were observed in 5.23% and 3.07% of patients. One recurrence occurred after TAS repair for an umbilical hernia.Conclusion: ESR is feasible, safe, and effective for treating ventral hernias when surgeons get the relevant surgical skills, such as the technique of “partition breaking,” TVS, and eTAR. Small-to-medium ventral hernias are the major indications.

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A preliminary multicenter evaluation of endoscopic sublay repair for ventral hernia from China

BMC Surgery ◽

10.1186/s12893-020-00888-4 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Rui Tang ◽

Huiyong Jiang ◽

Weidong Wu ◽

Tao Wang ◽

Xiangzhen Meng ◽

...

Keyword(s):

Ventral Hernia ◽

Intraoperative Complications ◽

Mesh Fixation ◽

Transversus Abdominis ◽

Intraperitoneal Onlay Mesh ◽

Patient Demographics ◽

Onlay Mesh ◽

Sublay Repair ◽

Space Separation ◽

Ventral Hernias

Abstract Background For ventral hernia, endoscopic sublay repair (ESR) may overcome the disadvantages of open sublay and laparoscopic intraperitoneal onlay mesh repair. This retrospective study presents the preliminary multicenter results of ESR from China. The feasibility, safety, and effectiveness of ESR were evaluated; its surgical points and indications were summarized. Methods The study reviewed 156 ventral hernia patients planned to perform with ESR in ten hospitals between March 2016 and July 2019. Patient demographics, hernia characteristics, operative variables, and surgical results were recorded and analyzed. Results ESR was performed successfully in 153 patients, 135 with totally extraperitoneal sublay (TES) and 18 with transabdominal sublay (TAS). In 19 patients, TES was performed with the total visceral sac separation (TVS) technique, in which the space separation is carried out along the peritoneum, avoiding damage to the aponeurotic structure. Endoscopic transversus abdominis release (eTAR) was required in 17.0% of patients, and only 18.3% of patients required permanent mesh fixation. The median operative time was 135 min. Most patients had mild pain and resume eating soon after operation. No severe intraoperative complications occurred. Bleeding in the extraperitoneal space occurred in two patients and was stopped by nonsurgical treatment. Seroma and chronic pain were observed in 5.23 and 3.07% of patients. One recurrence occurred after TAS repair for an umbilical hernia. Conclusion ESR is feasible, safe, and effective for treating ventral hernias when surgeons get the relevant surgical skills, such as the technique of “partition breaking,” TVS, and eTAR. Small-to-medium ventral hernias are the major indications.

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A preliminary multicenter evaluation of endoscopic sublay repair for ventral hernia from China

10.21203/rs.3.rs-41632/v4 ◽

2020 ◽

Author(s):

Rui Tang ◽

Huiyong Jiang ◽

Weidong WU ◽

Tao Wang ◽

Xiangzhen Meng ◽

...

Keyword(s):

Ventral Hernia ◽

Intraoperative Complications ◽

Mesh Fixation ◽

Transversus Abdominis ◽

Intraperitoneal Onlay Mesh ◽

Patient Demographics ◽

Onlay Mesh ◽

Sublay Repair ◽

Space Separation ◽

Ventral Hernias

Abstract Background: For ventral hernia, endoscopic sublay repair (ESR) may overcome the disadvantages of open sublay and laparoscopic intraperitoneal onlay mesh repair. This retrospective study presents the preliminary multicenter results of ESR from China. The feasibility, safety, and effectiveness of ESR were evaluated; its surgical points and indications were summarized.Methods: The study reviewed 156 ventral hernia patients planned to perform with ESR in ten hospitals between March 2016 and July 2019. Patient demographics, hernia characteristics, operative variables, and surgical results were recorded and analyzed.Results: ESR was performed successfully in 153 patients, 135 with totally extraperitoneal sublay (TES) and 18 with transabdominal sublay (TAS). In 19 patients, TES was performed with the total visceral sac separation (TVS) technique, in which the space separation is carried out along the peritoneum, avoiding damage to the aponeurotic structure. Endoscopic transversus abdominis release (eTAR) was required in 17.0% of patients, and only 18.3% of patients required permanent mesh fixation. The median operative time was 135 min. Most patients had mild pain and resume eating soon after operation. No severe intraoperative complications occurred. Bleeding in the extraperitoneal space occurred in two patients and was stopped by nonsurgical treatment. Seroma and chronic pain were observed in 5.23% and 3.07% of patients. One recurrence occurred after TAS repair for an umbilical hernia.Conclusion: ESR is feasible, safe, and effective for treating ventral hernias when surgeons get the relevant surgical skills, such as the technique of “partition breaking,” TVS, and eTAR. Small-to-medium ventral hernias are the major indications.

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A Preliminary Multicenter Evaluation of Endoscopic Sublay Repair for Ventral Hernia From China

10.21203/rs.3.rs-41632/v1 ◽

2020 ◽

Author(s):

Rui Tang ◽

Huiyong Jiang ◽

Weidong WU ◽

Tao Wang ◽

Mengxiang Meng ◽

...

Keyword(s):

Ventral Hernia ◽

Intraoperative Complications ◽

Mesh Fixation ◽

Transversus Abdominis ◽

Intraperitoneal Onlay Mesh ◽

Patient Demographics ◽

Onlay Mesh ◽

Sublay Repair ◽

Space Separation ◽

Ventral Hernias

Abstract Background For ventral hernia, endoscopic sublay repair (ESR) may overcome the disadvantages of open sublay and laparoscopic intraperitoneal onlay mesh repair. This retrospective study presents the preliminary multicenter results of ESR from China. The feasibility, safety, and effectiveness of ESR were evaluated; its surgical points and indications were summarized. Methods The study reviewed 156 ventral hernia patients planned to perform with ESR in ten hospitals between March 2016 and July 2019. Patient demographics, hernia characteristics, operative variables, and surgical results were recorded and analyzed. Results ESR was performed successfully in 153 patients, 135 with totally extraperitoneal sublay (TES) and 18 with transabdominal sublay (TAS). In 19 patients, TES was performed with the total visceral sac separation (TVS) technique, in which the space separation is carried out along the peritoneum, avoiding damage to the aponeurotic structure. Endoscopic transversus abdominis release (eTAR) was required in 17.0% of patients, and only 18.3% of patients required permanent mesh fixation. The median operative time was 135 min. Most patients had mild pain and resume eating soon after operation. No severe intraoperative complications occurred. Bleeding in the extraperitoneal space occurred in two patients and was stopped by nonsurgical treatment. Seroma and chronic pain were observed in 5.23% and 3.07% of patients. One recurrence occurred after TAS repair for an umbilical hernia. Conclusion ESR is feasible, safe, and effective for treating ventral hernias when surgeons get the relevant surgical skills, such as the technique of “partition breaking,” TVS, and eTAR. Small-to-medium ventral hernias are the major indications.

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Comparison of Onlay versus Sublay Mesh Repair in Ventral Hernia : Our Experience in a Peripheral Hospital

Journal of Surgical Sciences ◽

10.3329/jss.v24i2.52316 ◽

2021 ◽

Vol 24 (2) ◽

pp. 61-65

Author(s):

Mst Shahnaj Pervin ◽

Hasan Shahriar Md Nuruzzaman ◽

Eliza Sultana ◽

Anis Uddin Ahmad

Keyword(s):

Hospital Stay ◽

Ventral Hernia ◽

Mesh Repair ◽

Operative Time ◽

Controlled Trial ◽

Standard Procedure ◽

Sublay Repair ◽

Sublay Mesh ◽

Repair Group ◽

Onlay Repair

Background: Mesh repair is the standard procedure of choice for the ventral hernia repair. The common techniques for this surgery are onlay and sublay repair. But the superior technique between the two is yet to be established objectives. Objectives: We conducted this study to compare the results of Onlay with Sublay mesh repair for the treatment of ventral hernia. Methods: This comparative study was conducted at the department of Surgery, Shaheed Tajuddin Ahmad Medical College Hospital, Gazipur from April 2018 to April 2019. 20 patients withclinically diagnosed ventral hernia were randomized into two groups. The patients in group A had onlay mesh repair while those of group B hadsublay mesh repair. Comparison between the two methods were made in terms of operative time, technical ease, early post operative events specially drain & complication, hospital stay, recurrence. Result: Twenty patients between 20 to 70 years of age among whom 6 are male and 14 are female with different types of ventral hernia including paraumbilical, umbilical, epigastric and incisional, except with defect more than 15 cm were studied. The sublay repair took significantly longer operative time (p = .023). Onlay repair group had more seroma formation, wound infection and recurrence, though not statistically significant. Patients who underwent sublay repair had early removal of drains (3.7 ± .823 days vs 6 ± .738 days) which was significant (p= .000). At the same time sublay repair group had significantly shorter hospital stay than the onlay group (4.5 ± 1.900 days vs 6 ± 1.354 days, p= .023). Conclusion: Sublay repair seems to be a better alternative than onlay repair of Ventral hernia. Randomised controlled trial with larger case numbers is needed to validate the result. Journal of Surgical Sciences (2020) Vol. 24 (2) : 61-65

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A preliminary multicenter evaluation of endoscopic sublay repair for ventral hernia from China

10.21203/rs.3.rs-41632/v3 ◽

2020 ◽

Author(s):

Rui Tang ◽

Huiyong Jiang ◽

Weidong WU ◽

Tao Wang ◽

Mengxiang Meng ◽

...

Keyword(s):

Ventral Hernia ◽

Intraoperative Complications ◽

Mesh Fixation ◽

Transversus Abdominis ◽

Intraperitoneal Onlay Mesh ◽

Patient Demographics ◽

Onlay Mesh ◽

Sublay Repair ◽

Space Separation ◽

Ventral Hernias

Abstract Background: For ventral hernia, endoscopic sublay repair (ESR) may overcome the disadvantages of open sublay and laparoscopic intraperitoneal onlay mesh repair. This retrospective study presents the preliminary multicenter results of ESR from China. The feasibility, safety, and effectiveness of ESR were evaluated; its surgical points and indications were summarized. Methods: The study reviewed 156 ventral hernia patients planned to perform with ESR in ten hospitals between March 2016 and July 2019. Patient demographics, hernia characteristics, operative variables, and surgical results were recorded and analyzed.Results: ESR was performed successfully in 153 patients, 135 with totally extraperitoneal sublay (TES) and 18 with transabdominal sublay (TAS). In 19 patients, TES was performed with the total visceral sac separation (TVS) technique, in which the space separation is carried out along the peritoneum, avoiding damage to the aponeurotic structure. Endoscopic transversus abdominis release (eTAR) was required in 17.0% of patients, and only 18.3% of patients required permanent mesh fixation. The median operative time was 135 min. Most patients had mild pain and resume eating soon after operation. No severe intraoperative complications occurred. Bleeding in the extraperitoneal space occurred in two patients and was stopped by nonsurgical treatment. Seroma and chronic pain were observed in 5.23% and 3.07% of patients. One recurrence occurred after TAS repair for an umbilical hernia.Conclusion: ESR is feasible, safe, and effective for treating ventral hernias when surgeons get the relevant surgical skills, such as the technique of “partition breaking,” TVS, and eTAR. Small-to-medium ventral hernias are the major indications.

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