Adhesiolysis-Related Challenges for Laparoscopic Procedures after Ventral Hernia Repair with Intraperitoneal Mesh

BACKGROUND A hernia is the abnormal exit of tissue or an organ, such as the bowel, through the wall of the cavity in which it normally resides. Hernias come in a variety of forms. The abdomen, specifically the groin, is most frequently involved. Incisional hernias and other ventral hernias are common surgical problems. A prosthetic mesh should always be used in ventral hernia repair (VHR). Now, the polypropylene mesh (PPM) has become the prosthetic mesh of choice in the repair of hernias, including inguinal hernia. Newer meshes are introduced, claiming lesser complication rate, but are invariably costlier than Polypropylene mesh (PPM) by 15 – 20 times. In this study we wanted to evaluate the outcomes of intraperitoneal monofilament and dual layer meshes in laparoscopic incisional and ventral hernia repair. METHODS This is a prospective observational study, with a minimum 30 cases for each type of mesh used. All those patients who had undergone ventral and incisional hernia laparoscopic repair at SRM General Hospital, Chennai between June 2018 and 2021 were included in the study. Data was entered in Microsoft excel for analysis, done by using SPSS software version 23. RESULTS Out of 86 hernias which were repaired laparoscopically, PPM was used in 34 (40 %) and composite meshes in 52 (60 %) cases. Out of 52 composite meshes, 11 cases (21.2 %) turned out with complications whereas out of 34 PPMs (11.8 %), 4 cases turned out with complications. CONCLUSIONS With the composite mesh, complications of intraperitoneal PPM (adhesions, inflammation, intestinal fistulisation, sinus formation, seroma and recurrence) may also occur. The difference between the meshes in the occurrence of these complications is not statistically important. KEY WORDS Hernia, Mesh, Surgery, Intraperitoneal Mesh, Laparoscopic Hernia Repair

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

British Journal of Surgery ◽

10.1093/bjs/znab395.128 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Björn Mück ◽

Frank Heinzelamann ◽

Robert Vogel ◽

Peter Büchler

Keyword(s):

Minimally Invasive ◽

Hernia Repair ◽

Ventral Hernia ◽

Open Surgery ◽

Ventral Hernia Repair ◽

Invasive Technique ◽

Mesh Implantation ◽

Mesh Placement ◽

Intraperitoneal Mesh ◽

Ventral Hernias

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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Robotic versus Laparoscopic Ventral Hernia Repair: A Multicenter, Blinded Randomized Controlled Trial

SSRN Electronic Journal ◽

10.2139/ssrn.3453330 ◽

2019 ◽

Author(s):

Oscar Olavarria ◽

Karla Bernardi ◽

Shinil K. Shah ◽

Todd D. Wilson ◽

Shuyan Wei ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Hernia Repair ◽

Ventral Hernia ◽

Ventral Hernia Repair ◽

Controlled Trial ◽

Laparoscopic Ventral Hernia Repair ◽

Randomized Controlled

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Laparoscopic Incisional and Ventral Hernia Repair with Absorbable Tacks in a Long Term Follow-up: A Retrospective Control Study

Reviews on Recent Clinical Trials ◽

10.2174/1574887114666190201111332 ◽

2019 ◽

Vol 14 (2) ◽

pp. 141-146

Author(s):

Simone Zanella ◽

Enrico Lauro ◽

Francesco Franceschi ◽

Francesco Buccelletti ◽

Annalisa Potenza ◽

...

Keyword(s):

Hernia Repair ◽

Ventral Hernia ◽

Ventral Hernia Repair ◽

The Elderly ◽

Long Term Follow Up ◽

Group A ◽

Group B ◽

Absorbable Tacks

Background: Laparoscopic Incisional and Ventral Hernia Repair (LIVHR) is a safe and worldwide accepted procedure performed using absorbable tacks. The aim of the study was to evaluate recurrence rate in a long term follow-up and whether the results of laparoscopic IVH repair in the elderly (≥65 years old) are different with respect to results obtained in younger patients. Methods: One hundred and twenty-nine consecutive patients (74 women and 55 men, median age 67 years, range = 30-87 years) with ventral (N = 42, 32.5%) or post incisional (N = 87, 67.5%) hernia were enrolled in the study. Patients were divided into two groups according to their age: group A (N = 55, 42.6%) aged <65 years and group B (N = 74, 57.4%) aged ≥65 years. Results: The mean operative time was not significantly different between groups (66.7 ± 37 vs. 74 ± 48.4 min, p = 0.4). To the end of 2016, seven recurrences had occurred (group A = 3, group B = 4, p = 1). Complications occurred in 8 (16%) patients in group A and 21 (28.3%) patients in group B. Conclusion: In conclusion, our results confirm that the use of absorbable tacks does not increase recurrence frequency and laparoscopic incisional and ventral repair is a safety procedure also in elderly patients.

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