Comparison of the Outcomes of Laparoscopic Approach with Open Method for Primary Ventral Hernia Repair

Aim: To compare the outcomes of laparoscopic approach with open method in patients undergoing primary ventral hernia repair. Study Design: Randomized control trial Place and Duration: This study was conducted at Kuwait Teaching Hospital and Lady Reading Hospital Peshawar during the period of January 2017 to December 2019. Methods: One hundred and ninety patients of both genders with ages ≥18 years were included. All the patients were divided in to two groups, i.e’ Group A consists of 95 patients received open procedure and Group B with 95 patients received laparoscopic approach for primary ventral hernia repair. Outcomes in term of complications, hospital stay and recurrence rate were examined and compare the results between both groups. Data was analyzed by SPSS 23.0. Results: There were 65 (68.4%) females and 30 (31.6%) males in Group A and in Group B 35 (36.8%) males and 60 (63.2%) females. Mean age of patients in Group A was 40.14±3.31 years and in Group B it was 42.94±8.55 years. In Group B hospital stay was shorter than Group A (3.11±1.20 days Vs 5.9±3.9 days). According to the wound infection we found significant difference between Group A and Group B (12.6% and 4.2%);[p-value <0.05]. In Group A 5.3% patients had developed wound dehiscence while in Group B none of patient found to have wound dehiscence (p-value <0.05). Recurrence rate was also high in Group A 7.4% vs 2.1% in Group B (p=<0.05). Conclusion: It is concluded that laparoscopic repair of primary ventral hernia is safe and effective with lesser complications as compared to open method. Keywords: Ventral Hernia, Laparoscopic, Open Procedure, Wound Infection, Wound Dehiscence, Recurrence

Ventral Primary Hernia with Liver Content

Background. Herniation of the liver through the anterior abdominal wall is an extremely rare phenomenon. Most cases occur within an incisional hernia (mostly upper abdomen surgery or cardiac surgery). Only two reports mentioned liver herniation without previous abdominal incision. Case Presentation. We report the case of a 70-year-old woman presenting an epigastric swelling. Radiological findings showed a liver herniation in a primary ventral hernia. This case is the first to have been described requiring semiurgent hernia repair associated with partial liver resection. Conclusion. This case is, to the best of our knowledge, the first case of primary ventral hernia with liver content necessitating wedge resection of the left liver lobe.

Opioid Use After Inguinal and Ventral Hernia Repair

Background Recent data on opioid consumption indicate that patients typically require far less than is prescribed. Prisma Health Upstate Hernia Center adopted standardized postoperative prescribing after hernia repair and began tracking patient-reported opioid utilization. The aim of this study is to evaluate patient opioid use after hernia repair in order to guide future prescribing. Methods All patients who underwent primary ventral (umbilical and epigastric), incisional, and inguinal hernia repair between February and May 2019 were reviewed. Patients reported the number of opioid pills taken at their first postoperative visit and documented either in the progress note or in the Americas Hernia Society Quality Collaborative (AHSQC) patient-reported outcomes (PRO) questionnaire. All demographic, operative, and outcomes data were captured prospectively in the AHSQC. Opioid use reported as milligram morphine equivalents (MME). Results A total of 162 surgeries were performed during the study period, and 107 had patient-reported opioid use for analysis. Inguinal hernia repair was performed in 36 patients, 10 primary ventral hernia repairs, and 61 incisional hernia repairs. No opioid use was reported in 63.9% of inguinal hernias, 60% of primary ventral hernias, and 20% of incisional hernias. Inguinal hernia patients consumed a mean of 10.5 MME, primary ventral patients 11 MME, and incisional hernia patients 78.5 MME. Conclusion Patients require little to no opioid after primary ventral or inguinal hernia repair and opioid-free surgery is feasible. Incisional hernia is more heterogenous, but the majority of patients still required less opioid than previously thought.