laparoscopic incisional hernia repair
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2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
James Pilkington ◽  
Catherine Fullwood ◽  
Aali Sheen

Abstract Aim Provide a report on all patients who underwent laparoscopic incisional hernia repair as part of the TACKoMesh RCT prior to unblinding of treatment arms. Material and Methods Trial recruitment was for primary incisional hernia with a defect diameter of 3–10cm. 63 patients (target 74-136) were operated on prior to the outbreak of COVID-19. Post-operative pain is the primary trial outcome. Surgery was performed with either spiral-tack mesh-fixation device (Protack (permanent) or Reliatack (absorbable)), Symbotex IPOM mesh, and fascial closure with no 1 Maxon suture(s) using extracorporeal knot ties – the Manchester Technique. Data was collected on trial forms and lifestyle questionnaires (SF-36 and CCS). All data were explored and described in RStudio v1.4.1106. Results Patients were aged 36-80 and 36(57.1%) patients were male. Mean preoperative BMI was 30.91(sd5.11,range21.15–43.93). Mean operating time was 80.81(37.34,20-240)minutes. In 13(20.6%) patients multiple hernia defects were identified. A good degree of fascial closure was achieved in all patients using a median of 3(IQR 2.0-3.5)knots. Median mesh-fixation time was 286(159.5-428.0)seconds and a mean 25.24(5.49,14-41)tacks/patient were used. Median length of hospital stay was 3.5(2.0–6.0)days. Patients were asked “Please indicate on this scale [VAS 0–10] the pain that you currently experience from your incisional hernia during activity?”. Median responses for Day0/pre-op, Day1, Day6, Day30 and Day365 were 4.5, 8.0, 6.0, 3.0 and 1.5 respectively. At one year, 7(11%) patients had experienced hernia recurrence and 33(52%) post-operative seroma. Conclusions Target recruitment was not possible owing to COVID-19. The Manchester Technique has comparable recurrence rates. Reported pain increases post-operatively but is reduced at post-operative day30 and day365.


2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Nadia Henriksen ◽  
Hans Friis Andersen ◽  
Lars Nannestad Jorgensen ◽  
Frederik Helgstrand

Abstract Aim Although laparoscopic repair of incisional hernias decreases the incidence of wound complications as compared with open repair, there has been a rising concern related to intraperitoneal mesh placement. The aim of this study was to examine outcomes after open or laparoscopic elective incisional hernia mesh repair on a nationwide basis. Material and Methods A merge of data between the Danish Hernia Database and the National Patient Registry provided data on perioperative information, 90-day readmission, 90-day reoperation for complication, and long-term operation for hernia recurrence from 2007-2018. Results A total of 3,090 (57.5%) and 2,288 (42.5%) patients were operated by laparoscopic and open approach, respectively. The defect was closed in 27.9% (865/3,090) of the laparoscopic cases. The median follow-up time was 4.0 (1.8-6.8) years. Rates of readmission (16.2%, 502/3,090) and re-operation for complication (7.0%, 216/3,090) were significantly lower for laparoscopic compared to open repairs (19.3%, 442/2,288, P = 0.003 and 12.5%, 288/2,288, P < 0.001). Re-operation for bowel obstruction or bowel resection was twice as high after laparoscopic repair (0.6%, 20/3,090) compared with open repair (0.3%, 6/2,288, P = 0.044). Patients were significantly less prone to undergo repair of recurrence following laparoscopic compared with open repair of defect widths 2-6 cm (P = 0.002). Conclusions Laparoscopic intraperitoneal mesh repair for incisional hernia should still be considered for fascial defects between 2 and 6 cm, because of decreased incidences of early complications and repair of hernia recurrence compared with open repair.


2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Matthijs Van den Dop ◽  
Gijs De Smet ◽  
Gert-Jan Kleinrensink ◽  
Willem Hueting ◽  
Johan Lange

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.


2021 ◽  
pp. 27-30
Author(s):  
Manish Dewangan ◽  
Sagar Anil Kurkure ◽  
Jogesh Chandra Marhual ◽  
Aditya Shah

INTRODUCTION: Incisional hernia, a failure of the abdominal wall fascia to heal, is a common postoperative complication following abdominal surgery with an incidence varying between 2% and 50%. Incisional hernia entails signicant morbidity and discomfort resulting in disturbances in day to day activities. In spite of various available techniques available to surgeon, these hernias recur leading the surgeon to search for an ideal procedure of their repair with preferably zero or universally acceptable minimal recurrence rate. Laparoscopic incisional hernia repair, controversy has endured despite of numerous studies and data suggesting success of laparoscopic incisional hernia repair. However, there is relative lack of evidence to support adoption of laparoscopic repair as standard technique in regard to post operative morbidity and cost effectiveness. AIMS AND OBJECTIVE: To compare open and laparoscopic incisional hernia repair technique with respect to the post-operative complications and perioperative morbidity. MATERIAL AND METHODS: This is prospective, observational, comparative study, comparing patients who underwent laparoscopic incisional hernia and open incisional hernia repair during study period of November 2015 to August 2017 in Department of General Surgery, J.L.N. Hospital and Research centre, Bhilai. STATISTICAL METHOD: Data is analyse using percentages , mean and standard deviation. Continuous variable analysed by Unpaired T-test. Categorical data analyzed using chi square test or Fisher exact test. CONCLUSION: In our study laparoscopic incisinal hernia repair has more favourable outcome in terms of less hospital stay, shorter duration of surgery, less post-operative pain, early to resume daily activity and lesser wound related complications.


Hernia ◽  
2021 ◽  
Author(s):  
L. Matthijs Van den Dop ◽  
Gijs H. J. De Smet ◽  
Gert-Jan Kleinrensink ◽  
Willem E. Hueting ◽  
Johan F. Lange

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.


Author(s):  
Takashi Tatara ◽  
Hiroyuki Monma ◽  
Hiroto Miyanaga ◽  
Taro Kawashima ◽  
Iwao Kobayashi ◽  
...  

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