P016 A COMPARATIVE STUDY BETWEEN ROBOTIC AND LAPAROSCOPIC VENTRAL AND INCISIONAL HERNIA REPAIR WITH THE ETEP - TAR TECHNIQUE

Aim The aim of this study is to present a single centre’s experience in Robotic and Laparoscopic eTEP TAR technique in ventral and incisional hernia repair. Additionally, the purpose of this study is to compare these Robotic and Laparoscopic techniques in terms of feasibility, efficacy, safety, advantages and disadvantages. Material and Methods This is a case-series comparative study of patients with M1-M5 / W3 ventral and incisional hernia that underwent Robotic or Laparoscopic eTEP-TAR repair in a single institution. Patients’ characteristics were reviewed and perioperative outcomes were extracted. All patients were followed-up at the outpatient surgical unit. Intraoperative and postoperative parameters were analyzed. Results 35 patients (19 males) with a mean age of 57 years underwent Robotic eTEP-TAR (21 patients) and Laparoscopic eTEP-TAR (14 patients) repair of M1-M3/W3 ventral (12 patients) and M2-M5/W3 incisional hernia. There were 3 conversions to open repair in the Robotic group (Rg) and 1 for the Laparoscopic group (Lg). The mean operative time in Rg was 345 minutes, while in Lg was 320 min. All patients were discharged between the first and fifth postoperative day. No major complications or recurrences were revealed during a mean postoperative follow-up time of 26 months. Conclusions Both techniques are feasible, reproducible, and safe, with no major differences in operative time, recurrence and complications rate. Nevertheless, these techniques are highly demanding procedures that should be performed by experienced hernia surgeons, in well-organized centers of excellence in hernia surgery.

Laparoscopic ventral and incisional hernia repair using intraperitoneal onlay mesh with peritoneal bridging

Purpose The aim of this study was to assess the feasibility and safety of a novel IPOM procedure with peritoneal bridging (IPOM-pb) for laparoscopic ventral hernia repair, and to compare the outcomes of this procedure with IPOM with- (IPOM-plus) and IPOM without (sIPOM) defect closure. Method A single-centre retrospective study comparing a novel IPOM technique with peritoneal bridging (IPOM-pb) with the two commonly used IPOM techniques, IPOM with defect closure (IPOM-plus) and without defect closure (sIPOM). The intraoperative and postoperative data of patients who underwent laparoscopic IPOM ventral hernia repair were reviewed. Preoperative data, recurrence, and postoperative seroma, surgical site infection, and pain, were compared. Results From January 2017 to June 2020, a total of 213 patients underwent laparoscopic ventral and incisional hernia repair with IPOM technique. The mean length and width of the ventral hernia was 4.4 ± 1.8 cm and 3.6 ± 1.4 cm, respectively, and the mean BMI was 30.1 ± 5.2 kg/m2. The mean operating time was 67 ± 28 min and was longer for IPOM-pb (71 ± 27 min), less for IPOM-plus (63 ± 28 min), and least for sIPOM (61 ± 26 min). The incidence of early postoperative seroma was least in IPOM-pb (1/98, 1%), and similar in the IPOM-plus (4/94, 4%) and sIPOM (1/21, 5%) group. Late postoperative seroma was found only in IPOM-plus (2, 2%). The incidence of early and late postoperative pain was relatively higher in sIPOM (3, 14%; 1, 5%, respectively) compared to IPOM-pb and IPOM-plus in the early (5, 5% and 6, 6%) and late (2, 2% and 1, 1%) postoperative period, respectively. Surgical site infection was higher in sIPOM group (3, 14%), compared to IPOM-pb (1, 1%), and IPOM-plus (3, 3%). Recurrence rates were similar in IPOM-pb group (3/98, 3%) and IPOM-plus (3/94, 3%), and none in sIPOM (0/21). Conclusion IPOM with peritoneal bridging is as feasible and safe as conventional IPOM with defect closure and simple non-defect closure. However, a large randomised controlled trial is required to confirm this finding.

Comparison between Dual Layer Intraperitoneal Mesh and Single Layer Mesh for Laparoscopic Ventral and Incisional Hernia Repair

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

Da-Silva, Malmo Peritoneal Flap in Ventral and Incisional Hernia Repair Our Experience

Large ventral hernia is a challenge to operate in tier 3 cities of India, because of economic constrains of local population. Here author reports three large ventral hernias operated with use of Da-Silva, Malmo peritoneal flap technique. Peritoneal flap should be integral part of abdominal wall repair procedures. It reduces cost, morbidity and mortality of a large ventral hernia repair. It is a useful method for repair of large ventral and incisional hernia when primary fascial closer is not achievable. Key words: peritoneal flap, ventral hernia, incisional hernia.