Polyvinylidene fluoride: a suitable mesh material for laparoscopic incisional and parastomal hernia repair!

Background

Today, the laparoscopic approach is a standard procedure for the repair of incisional hernias. However, the direct contact of visceral organs with mesh material is a major issue.

Patients and methods

This prospective observational study presents the data of 344 patients treated for incisional and parastomal hernias with a new mesh made of polyvinylidene fluoride (PVDF; Dynamesh IPOM^®) between May 2004 and January 2008 with a minimum follow-up of 6 months. The median follow-up of 297 patients after incisional hernias totaled 24 months and 20 months for 47 patients with parastomal hernias. Incisional hernias were repaired using an IPOM technique. For parastomal hernias, a recently described sandwich technique was used with two meshes implanted in an intraperitoneal onlay position.

Results

The recurrence rate for incisional hernias was 2/297 = 0.6% and 1/47 = 2% for parastomal hernias. Three patients developed a secondary infection after surgical revision or puncture of a seroma. One patient had a bowel fistula through the mesh, with an abscess in the hernia sac. In all cases, the infection healed and the mesh could be preserved. No long-term mesh-related complications have been observed.

Conclusion

The laparoscopic repair of incisional and parastomal hernias with meshes made of PVDF (Dynamesh IPOM^®) revealed low recurrence and, overall, low complication rates. Especially in cases of infection, the material proved to be resistant without clinical signs of persistent bacterial contamination. Mesh-related complications did not occur during the follow-up.     

Long-term Follow-up of Open and Laparoscopic Repair of Large Incisional Hernias

Background  

Long-term results after laparoscopic repair of large incisional hernias remain to be determined. The aim of this prospective study was to compare early and late complications between laparoscopic repair and open repair in patients with large incisional hernias.     

Lateral Incisional Hernia After Renal Transplantation: A Comparative Study

Background

Because of the lack of published data and the relative rarity of lateral incisional hernias (LIHs), especially after renal transplantation, mesh repair of LIH remains a challenge for surgeons. The aim of the present study was to evaluate the outcomes of LIH treated by mesh repair after renal transplantation.

Methods

All consecutive patients who had undergone LIH mesh repair after renal transplantation were compared with patients who had undergone LIH mesh repair without renal transplantation. Demographic data, incisional hernia characteristics, operative data, and postoperative outcomes were prospectively recorded. Early complications and recurrence rates were evaluated.

Results

Altogether, 112 patients were treated for LIH with mesh repair. Among these patients, 61 (54.4 %) underwent LIH after renal transplantation. The early complications were similar for the patients with and without renal transplantation (24.5 vs. 23.5 %, respectively; p = 0.896). The recurrence rates also were similar for the patients with and without renal transplantation (9.8 vs. 9.8 %, respectively; p = 1).

Conclusions

Mesh graft repair is feasible in patients with LIH after renal transplantation. Postoperative complications and recurrences were not more frequent in renal transplantation patients than in those without renal transplantation.     

Human acellular dermal matrix for ventral hernia repair reduces morbidity in transplant patients

Purpose  

Organ transplantation is widely accepted as the treatment of choice for native organ failure. Due to required immunosuppression, however, organ recipients are prone to wound infections, incisional hernias, and fascial dehiscence. These complications are especially dangerous in this patient population, as they can compromise the survival of the transplanted organ. Various methods have been employed to repair ventral and incisional hernias in these patients. These include primary repair, synthetic mesh, biologic mesh, tensor fascia lata grafts (TFL), component separation, flaps from the thighs, or a combination of these. The goal of this study was to review the experience at our institution with ventral hernia repair in transplant patients and to compare outcomes of the various repair techniques.     

Watchful waiting as a treatment strategy for patients with a ventral hernia appears to be safe

Purpose

Due to risks of postoperative morbidity and recurrence some patients with a ventral hernia are not offered surgical repair. There is limited data on the rate and consequences of a watchful waiting (WW) strategy for these patients. The objective of this cohort study was to analyse outcomes for patients with a ventral hernia who underwent watchful waiting, in terms of later requirement for hernia repair.

Methods

All patients (≥18 years) electively referred to our out-patient clinic from 1 January 2009 to 1 July 2014 with incisional, umbilical or epigastric hernia were included. Information on patient characteristics and whether patients underwent WW or surgery was obtained from hospital files and the Danish National Patient Register. A 100 % follow-up was obtained.

Results

The analyses comprised 569 patients with incisional hernia (WW = 58.1 %) and 789 patients with umbilical/epigastric hernia (WW = 43.2 %). Kaplan–Meier analyses estimated that the probability for patients who underwent watchful waiting to receive later surgical repair was 19 % for incisional hernias and 16 % for umbilical/epigastric hernias after 5 years. The probability of requiring emergency repair when in the WW group was 4 % for both incisional and umbilical/epigastric hernias after 5 years. There were no significant differences in 30-day readmission, reoperation or mortality rates between the WW patients who later underwent elective hernia repair and patients who were initially offered surgery (p > 0.05), for both incisional and umbilical/epigastric hernias.

Conclusions

Watchful waiting appears to be a safe strategy in the treatment of incisional, umbilical and epigastric hernias.

     

Female Gender and Diabetes Mellitus Increase the Risk of Recurrence after Laparoscopic Incisional Hernia Repair

Background

Laparoscopic hernia repair is used widely for the repair of incisional hernias. Few case studies have focussed on purely ‘incisional’ hernias. This multicentre series represents a collaborative effort and employed statistical analyses to provide insight into the factors predisposing to recurrence of incisional hernia after laparoscopic repair. A specific hypothesis (ie, laterality of hernias as well as proximity to the xyphoid process and pubic symphysis predisposes to recurrence) was also tested.

Methods

This was a retrospective study of all laparoscopic incisional hernias undertaken in six centres from 1 January 2004 to 31 December 2010. It comprised a comprehensive review of case notes and a follow-up using a structured telephone questionnaire. Patient demographics, previous medical/surgical history, surgical procedure, postoperative recovery, and perceived effect on quality of life were recorded. Repairs undertaken for primary ventral hernias were excluded. A logistic regression analysis was then fitted with recurrence as the primary outcome.

Results

A total of 186 cases (91 females) were identified. Median follow-up was 42 months. Telephone interviews were answered by 115/186 (62%) of subjects. Logistic regression analyses suggested that only female sex (odds ratio (OR) 3.53; 95% confidence interval (CI) 1.39–8.97) and diabetes mellitus (3.54; 1–12.56) significantly increased the risk of recurrence. Position of the defect had no statistical effect.

Conclusions

These data suggest an increased risk of recurrence after laparoscopic incisional hernia repair in females and subjects with diabetes mellitus. These data will help inform surgeons and patients when considering laparoscopic management of incisional hernias. We recommend a centrally hosted, prospectively maintained national/international database to carry out additional research.     

Laparoscopic Incisional Hernia Repair With Fibrin Glue in Select Patients

Background and Objective:

Laparoscopic treatment of incisional hernias can be performed using different types of fixation devices and prosthesis. We present a case series of 19 patients with incisional hernias with a diameter of <6cm, who underwent laparoscopic repair using Hi-tex dual-side mesh, positioned intraperitoneally, fixed to the abdominal wall by fibrin glue (Tissucol).

Methods:

Nineteen patients with incisional hernias <6cm in diameter were enrolled in this study and treated laparoscopically with Hi-tex and Tissucol. Surgical complications and patient outcomes were assessed with a clinical follow-up.

Results:

Laparoscopic repair of incisional hernias by using Hi-tex mesh affixed to the parietal wall with fibrin glue was feasible and easy in patients with parietal defects <6cm in diameter. Mean operating time was 30 minutes. Mean hospital stay was 1.5 days. Almost no postoperative pain, major surgical complications, seroma formation, relapses, or prosthesis infection occurred during a mean follow-up of 20 months.

Conclusions:

In select patients, Hi-tex mesh affixed using fibrin glue allows laparoscopic repair of incisional hernias with very good patient outcomes, especially in terms of postoperative pain and seroma formation.     

Single centre observational study to evaluate the safety and efficacy of the Proceed™ Ventral Patch to repair small ventral hernias

Background

There is evidence that mesh repair for primary umbilical hernias results in less recurrences and similar wound complication rates compared to tissue repair. In recent years, several mesh devices for the repair of small ventral hernias have been developed, but some reports have been published on serious complications and adverse effects encountered with those mesh devices.

Methods

The Proceed? Ventral Patch (PVP?) is a partially absorbable lightweight polypropylene mesh. We introduced PVP? in our department in April 2009 and collected patient data and outcome in an observational study of 101 consecutive patients until December 2011 (Clinical.Trials.gov: NCT01307696). In addition to the routine control 3 weeks postoperative, prospective follow-up included a questionnaire, clinical investigation and ultrasound after 12 months.

Results

The study included 91 primary (76 umbilical/15 epigastric) and 10 incisional ventral hernias (including 6 trocar hernias). In all patients a PVP? with a diameter of 6.4 cm was used. Wound problems were the most frequent complication (n = 18). Follow-up of at least 12 months was achieved in 98 patients (97 %) and the mean follow-up time was 15.9 months. Follow-up by clinical examination diagnosed a recurrence in 11/92 patients (12.0 %). Only four patients were aware of their recurrent hernia, the seven others reported no problems in the questionnaire. The additional ultrasound performed did not reveal recurrences that were not already diagnosed by clinical examination. In five patients a reoperation for repair of the recurrence was performed (reoperation rate 5/98 = 5.1 %). Hernia defect size (p = 0.032) and type of hernia (p = 0.029) were found to be a significant risk factors for development of a recurrent hernia (Fisher’s exact test). Hernia size was a significant risk factor both in a univariate (p = 0.005) and in a multivariate Cox model (p = 0.017). Incisional hernia was of borderline significance in a univariate (p = 0.047) and in a multivariate Cox model (p = 0.08).

Conclusion

Intensive clinical follow-up yields a high percentage (12.0 %) of clinically proven, but often asymptomatic recurrences after repair of small ventral hernias with the PVP?. Reoperation rate for recurrence was 5.1 %. Hernia defect size is a significant risk factor for recurrence. Therefore, we recommend using the PVP? only for primary ventral hernias smaller than 2 cm. For larger or incisional hernias other techniques allowing the use of larger meshes is advocated.     

Laparoscopic ventral/incisional hernia repair: a single centre experience of 1,242 patients over a period of 13 years

Background and purpose  

Laparoscopic technique is now well established for ventral/incisional hernia repair. However several issues such as optimal fixation technique, occult hernias, management of inadvertent enterotomies, postoperative seromas and recurrence require appraisal.     

Management of non-midline incisional hernia by the laparoscopic approach: results of a long-term follow-up prospective study

Background  

The role of the laparoscopic approach in the repair of non-midline incisional hernias is controversial due to the absence of adequate scientific studies. This study aimed to determine the safety and efficacy of laparoscopic repair for non-midline incisional hernias.     

Decreased re-operation rate for recurrence after defect closure in laparoscopic ventral hernia repair with a permanent tack fixated mesh: a nationwide cohort study

Purpose

To investigate whether defect closure in laparoscopic ventral hernia repair reduces the re-operation rate for recurrence compared with no defect closure.

Methods

Data were extracted from the Danish Ventral Hernia Database. Adults with an elective laparoscopic ventral hernia repair with tacks used as mesh fixation were included, if their first repair was between the 1st of January 2007 and the 1st of January 2017. Patients with defect closure were compared with no defect closure. Re-operation rates are presented as crude rates and cumulated adjusted re-operation rates. Sub-analyses assessed the effect of the suture material used during defect closure and also whether defect closure affected both primary and incisional hernias equally.

Results

Among patients with absorbable tacks as mesh fixation, 443 received defect closure and 532 did not. For patients with permanent tacks, 393 had defect closure and 442 did not. For patients with permanent tacks as mesh fixation, the crude re-operation rates were 3.6% with defect closure and 7.2% without defect closure (p?=?0.02). The adjusted cumulated re-operation rate was significantly reduced with defect closure and permanent tacks (hazard ratio?=?0.53, 95% confidence interval?=?0.28–0.999, p?=?0.05). The sub-analysis suggested that defect closure was only beneficial for incisional hernias, and not primary hernias. We did not find any benefits of defect closure for patients with absorbable tacks as mesh fixation.

Conclusion

This nationwide cohort study showed a reduced risk of re-operation for recurrence if defect closure was performed in addition to permanent tacks as mesh fixation during laparoscopic incisional hernia repair.

     

Repair of large abdominal incisional hernia by reconstructing the midline and use of an onlay of biological material

Background

The aim of this study was to determine the feasibility and efficacy of repairing large abdominal incisional hernias by reconstructing the midline using bilateral abdominis rectus muscle sheath (ARS) relaxing incisions and a biological material onlay.

Methods

Between January 2002 and December 2008, 71 patients underwent repair of large incisional hernias at 2 community hospitals. After replacement of hernia sac contents into the peritoneal cavity, a relaxing incision was made in the ARS bilaterally. Then, the midline was closed primarily. The biological material was used as an onlay and sutured to the lateral edges of the relaxed ARS. Main outcome measures were postoperative complications and hernia recurrence.

Results

Median defect size was 195 cm² (range, 150–420 cm²), median surgical time was 125 minutes, and median hospital stay was 6 days. There were no deaths and no wound infections. Wound seroma, the most frequent postoperative complication, occurred in 51 (72%) of the 71 patients. There was 1 (1.4%) recurrence.

Conclusions

In these 71 patients, our technique for repair of large abdominal incisional hernias was safe and effective.     

Non-crosslinked porcine-derived acellular dermal matrix for the management of complex ventral abdominal wall hernias: a report of 45 cases

Purpose

Ventral abdominal wall hernias are common and repair is frequently associated with complications and recurrence. Although non-crosslinked intact porcine-derived acellular dermal matrix (PADM) has been used successfully in the repair of complex ventral hernias, there is currently no consensus regarding the type of mesh and surgical techniques to use in these patients. This report provides added support for PADM use in complex ventral hernias.

Methods

In a consecutive series of adult patients (2008–2011), complex ventral abdominal wall hernias (primary and incisional) were repaired with PADM by a single surgeon. Patient comorbidities, repair procedures, and postoperative recovery, recurrence, and complications were noted.

Results

Forty-four patients (mean age, 57.5 years) underwent 45 single-stage ventral abdominal wall hernia repairs (3 primary; 42 incisional). Previously placed synthetic mesh was removed in 17 cases. In 40 cases, primary fascial closure was achieved; in 5 cases, PADM was used as a bridge. Vacuum-assisted closure (VAC) was used for 38/45 cases: 19 closed incisions, 16 cases using the “French fry” technique, and 3 cases with open incisions. Mean hospital stay was 8.2 days (range, 3–32) and mean follow-up was 17 months (range, 1–48). There were 4 (8.9 %) hernia recurrences, 3 requiring additional repair and 1 requiring PADM explantation. There were 3 (6.7 %) skin dehiscences, 4 (8.9 %) deep wound infections requiring drainage, and 5 (11.1 %) seromas (4 self-limited, 1 requiring drainage).

Conclusions

Non-crosslinked intact PADM yielded favorable early outcomes when used to repair complex ventral abdominal wall hernias in high-risk patients.     

Prosthetic incisional hernioplasty: clinical experience with 354 cases

Background  

The use of prosthetic materials has become the standard of care in the management of incisional hernias because of its association with a low rate of recurrence. In this paper, the results of the treatment of incisional hernias is reported.     

Patient satisfaction,chronic pain,and quality of life after elective incisional hernia repair: effects of recurrence and repair technique

Purpose  

To determine the effects of repair technique and hernia recurrence on patient-reported outcomes after incisional hernia repair.     

Incisional Hernia in Recipients of Adult to Adult Living Donor Liver Transplantation

Background

After receiving a living donor liver transplant (LDLT), an incisional hernia is a potentially serious complication that can affect the patient’s quality of life. In the present study we evaluated surgical hernia repair after LDLT.

Materials and methods

Medical records of patients who underwent surgery to repair an incisional hernia after LDLT in Turgut Ozal Medical Center between October 2006 and January 2010 were evaluated in this retrospective study. A reverse-T incision was made for liver transplantation. The hernias were repaired with onlay polypropylene mesh. Age, gender, post-transplant relaparatomy, the type, the result of surgery for the incisional hernia, and risk factors for developing incisional hernia were evaluated.

Results

An incisional hernia developed in 44 of 173 (25.4 %) patients after LDLT. Incisional hernia repair was performed in 14 of 173 patients (8.1 %) who underwent LDLT from October 2006 to January 2010. Relaparatomy was associated with incisional hernia (p = 0.0002). The mean age at the time of the incisional hernia repair was 51 years, and 79 % of the patients were men. The median follow-up period was 19.2 (13–36) months after the hernia repair. Three patients with intestinal incarceration underwent emergency surgery to repair the hernia. Partial small bowel resection was required in one patient. Postoperative complications included seroma formation in one patient and wound infection in another. There was no recurrence of hernia during the follow-up period.

Conclusions

The incidence of incisional hernia after LDLT was 25.4 % in this study. Relaparatomy increases the probability of developing incisional hernia in recipients of LDLT. According to the results of the study, repair of an incisional hernia with onlay mesh is a suitable option.     

Components Separation Technique Combined with a Double-Mesh Repair for Large Midline Incisional Hernia Repair

Background  

The surgical treatment of large midline incisional hernias remains a challenge. The aim of this report is to present the results of a new technique for large midline incisional hernia repair which combines the components-separation technique with a double-prosthetic-mesh repair.     

Inguinal hernia repair with the mesh plug method is safe after radical retropubic prostatectomy

Purpose

We evaluated the safety and efficiency of using the mesh plug method (MP) to repair inguinal hernias in patients with a history of radical retropubic prostatectomy (RRP). We also investigated how RRP influences the development of inguinal hernias and impacts their repair.

Methods

Among 488 adult male patients who underwent inguinal hernia repair during a recent 5-year period, 37 had a history of RRP. We compared the characteristics and surgical outcomes of the patients who had undergone RRP (post-RRP group) with those who had not (non-RRP group).

Results

All post-RRP hernias were treated by MP. The 37 post-RRP patients had a collective 41 hernias, 40 of which were of the indirect type. The side affected by the hernia did not differ significantly between the groups. We compared the short-term surgical outcomes of the indirect post-RRP hernias vs. the indirect non-RPP hernias without recurrence and incarceration. The operation times, postoperative hospital stay, and mobility rates did not differ significantly between the two groups. The blood loss was almost equal in both groups.

Conclusion

Inguinal hernia repair after RRP may be difficult because of inflammatory changes in the preperitoneal cavity, but the surgical outcomes of MP were equivalent in patients with or without a history of RPP in this study. MP is a safe and effective method for post-RPP hernia repair.     

Long-term results of laparoscopic repair of incisional hernias using an intraperitoneal composite mesh

Background  

This study was designed to evaluate the long-term complications and recurrences of laparoscopic repair of incisional hernias. Very few studies evaluate objectively the long-term results of laparoscopic incisional hernia repair.     

Laparoscopic Hernia Repair: a Two-Port Technique

Objective:

Various ventral and incisional hernia repair techniques exist and have largely replaced the open ones. The purpose of this study was to document the 2-port technique and demonstrate that it is feasible, efficient, and safe. To our knowledge, this is the largest report on this topic to date in the English-language literature.

Methods:

Forty patients with ventral hernias (VH) or incisional hernias (IH) underwent laparoscopic repair with a 2-port technique. The technique involves insertion of one 10-mm to 12-mm balloon port and one 5-mm port, usually on the left side as laterally as possible. A mesh is inserted through the balloon port site and secured to the abdominal wall by using either 4 peripheral or 1 central Prolene suture. Helical fasteners are used to attach the mesh to the abdominal wall.

Results:

Forty patients with 47 hernias underwent repair. Operating time ranged from 15 minutes to 70 minutes. Early complications were seen in 5 patients and included 1 small bowel enterotomy, 2 small bowel obstructions (SBO) with bowel adhering to the visceral side of the mesh, 1 wound infection, and 1 seroma. Late postoperative complications occurred in 8 patients (20%) who experienced persistent abdominal pain that resolved without any treatment. There was one recurrence during a mean follow-up of 23.5 months.

Conclusion:

Laparoscopic herniorrhaphy with the 2-port technique offers an efficient, safe, and effective repair for ventral and incisional hernias.