e-TEP Retromuscular Repair for Recurrent Incisional Hernias: Report of Three Cases

Introduction. Recurrent incisional hernias are difficult to treat. There are many factors involved in the recurrence, and due to extensive dissections, the planes are fused with adhesions, and we may need a new plane for dissection and placement of meshes. Case Report. We report here three cases of recurrent incisional hernias which were dealt by a relatively new method to laparoscopy: the enhanced view totally extraperitoneal repair (e-TEP) retromuscular technique. There were three patients: one after an open onlay repair of lower midline incision, another after an onlay mesh repair of a subcostal incision for open cholecystectomy followed by an intraperitoneal onlay mesh hernioplasty (IPOM) repair, and another after IPOM repair of epigastric hernia. They were treated with the abovementioned technique with satisfying short-term results. Conclusion. The e-TEP technique is a relatively new method of providing minimal access surgery to these patients utilizing the previously unaccessed retromuscular (Rives and/or preperitoneal) space for the repair of these recurrent incisional hernias.

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P053 COMPARISON OF CLINICAL OUTCOMES BETWEEN INTRAPERITONEAL ONLAY MESH REPAIR (IPOM PLUS) AND ENHANCED-VIEW TOTALLY EXTRAPERITONEAL REPAIR (ETEP) FOR VENTRAL HERNIAS

British Journal of Surgery ◽

10.1093/bjs/znab395.049 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Hiroshi Hirukawa

Keyword(s):

Ventral Hernia ◽

Mesh Repair ◽

Transversus Abdominis ◽

Incisional Hernias ◽

Totally Extraperitoneal ◽

Onlay Mesh ◽

The Mean ◽

Totally Extraperitoneal Repair ◽

Hernia Size ◽

Ventral Hernias

Abstract Aim We have been performing intraperitoneal on lay mesh repair (IPOM plus) as the standard laparoscopic procedure for ventral hernia in our department. We introduced enhanced-view totally extraperitoneal repair (eTEP) for ventral hernia repair in 2018, and have performed 31 cases so far. We compared the outcomes of IPOM Plus and eTEP at our institution. Material and Methods Ventral hernia cases who underwent surgery at our department between 2018 and 2020 were included in the study. The postoperative outcomes and complications of the IPOM Plus and eTEP groups were evaluated retrospectively. Results There were 12 cases of IPOM plus, and all were incisional hernias. There were 31 cases of eTEP, including 7 cases of primary hernias and 24 cases of incisional hernias. Transversus abdominis muscle release (TAR) was added in 24 cases. The mean hernia size was 6.6 x 7.9 cm with IPOM Plus and 8.0 x 10.1 cm with eTEP, and the average meshes size was 15.5 x 22.0 cm and 20.3 x 23.6 cm, respectively. The mean postoperative hospital stay was 7.8 days and 5 days. Postoperative complications included 1 case of mesh bulging and 1 case of recurrence in the IPOM Plus group, 1 case of seroma and 1 case of intestinal obstruction in the eTEP. Conclusions The surgical outcomes for ventral hernias up to 8 cm wide were similar for IPOM Plus and eTEP. The eTEP can insert a larger mesh and may be useful for wider hernias (>8cm).

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P062 IMPLEMENTATION OF ETEP (EXTENDED TOTALLY EXTRAPERITONEAL REPAIR) AS A NEW METHOD OF INCISIONAL HERNIA REPAIR

British Journal of Surgery ◽

10.1093/bjs/znab395.058 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Krzysztof Nowakowski ◽

Ayman Waly Elkalash ◽

thomas lahaye

Keyword(s):

Incisional Hernia ◽

Hernia Repair ◽

Incisional Hernia Repair ◽

New Method ◽

Incisional Hernias ◽

Totally Extraperitoneal ◽

Artery Embolism ◽

Sublay Technique ◽

The Mean ◽

Totally Extraperitoneal Repair

Abstract Aim To assess the outcomes of implementation of extended Totally Extraperitoneal Repair (eTEP) for incisional hernia in our clinic. Material and Methods In our clinic abdominal wall hernias are predominantly repaired in eMILOS (endoscopic Mini or Less Open Sublay)-technique. However, we hoped for advantages in repairing incisional hernias in eTEP-technique. From 19.09.2019 till 28.04.2021 there were 13 patients with incisional hernias included to be operated in eTEP-technique. Results Among 13 patients, mean age was 64,6 years (range 47 – 78 years), 7 females (54%) and 6 males (46%). Average diameter of the hernia was 6,46 cm (range 2 – 14 cm). The mean Body Mass Index of the patients was 29,41 kg/m² (range 18,4 – 48,76 kg/m²). The mean duration of the operation was 162,38 minutes (range 106 – 237 minutes). The mean surface of the mesh was 612 cm² (range 225 – 1200 cm²). Hospital stay lasted mean of 5,8 days (range 2 – 28 days). We observed one postoperative complication as a lung artery embolism occurred in one patient with preperitoneal heamatoma due to needed anticoagulation. Till today we have not observed any recurrence. Conclusions Our study shows that a new method of incisional hernia repair with mesh placement can be a safely implemented and may have advantages compering with other laparoscopic methods. It has low complication rate, shows good cosmetic results and is cost effective.

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Comparing Intraperitoneal Onlay Mesh with Sublay Mesh Placement for Open Incisional Hernias: An Analysis of the Americas Hernia Society Quality Collaborative

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2019.08.209 ◽

2019 ◽

Vol 229 (4) ◽

pp. S92

Author(s):

Aldo Fafaj ◽

Luciano Guilherme Tastaldi ◽

Hemasat Alkhatib ◽

Raha AlMarzooqi ◽

Shahed Tish ◽

...

Keyword(s):

Intraperitoneal Onlay Mesh ◽

Mesh Placement ◽

Incisional Hernias ◽

Onlay Mesh ◽

Sublay Mesh

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Prophylactic Onlay Mesh Implantation During Definitive Fascial Closure After Open Abdomen Therapy (PROMOAT): Absorbable or Non-absorbable? Methodical Description and Results of a Feasibility Study

Frontiers in Surgery ◽

10.3389/fsurg.2020.578565 ◽

2020 ◽

Vol 7 ◽

Author(s):

Sebastian Schaaf ◽

Robert Schwab ◽

Christoph Güsgen ◽

Arnulf Willms

Keyword(s):

Incisional Hernia ◽

Open Abdomen ◽

Fascial Closure ◽

Special Focus ◽

Term Outcome ◽

Mesh Implantation ◽

Incisional Hernias ◽

Onlay Mesh

Introduction: Incisional hernia development after open abdomen therapy (OAT) remains a common complication in the long run. To demonstrate the feasibility, we describe our method of prophylactic onlay mesh implantation with definitive fascial closure after open abdomen therapy (PROMOAT). To display the feasibility of this concept, we evaluated the short-term outcome after absorbable and non-absorbable synthetic mesh implantation as prophylactic onlay.Material and Methods: Ten patients were prospectively enrolled, and prophylactic onlay mesh (long-term absorbable or non-absorbable) was implanted at the definitive fascial closure operation. The cohort was followed up with a special focus on incisional hernia development and complications.Results: OAT duration was 21.0 ± 12.6 days (95% CI: 16.9–25.1). Definitive fascial closure was achieved in all cases. No incisional hernias were present during a follow-up interval of 12.4 ± 10.8 months (range 1–30 months). Two seromas and one infected hematoma occurred. The outcome did not differ between mesh types.Conclusion: The prophylactic onlay mesh implantation of alloplastic, long-term absorbable, or non-absorbable meshes in OAT showed promising results and only a few complications that were of minor concern. Incisional hernias did not occur during follow-up. To validate the feasibility and safety of prophylactic onlay mesh implantation long-term data and large-scaled prospective trials are needed to give recommendations on prophylactic onlay mesh implantation after OAT.

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