Comparison of laparoscopic and open repair of incisional and primary ventral hernia: results of a prospective randomized study

Background Incisional hernia is an important complication of abdominal surgery. Its repair has progressed from a primary suture repair to various mesh repairs and laparoscopic repair. Laparoscopic mesh repair is a promising alternative, and in the absence of consensus, needs prospective randomized controlled trials. Methods Between April 2003 and April 2005, 66 patients with incisional, primary ventral and recurrent hernias were randomized to receive either open retrorectus mesh repair or laparoscopic mesh repair. These patients were followed up at 1-, 3-, and 6-month intervals thereafter for a mean of 12.17 months (open repair group) and 13.73 months (laparoscopic repair group). Results Lower abdominal hernias after gynecologic operations constituted the majority of the hernias (∼50%) in both groups. There was no significant injury to viscera or vessel in either group and no conversions. The defect size was 42.12 cm² in the open (group 1) and 65.66 cm² in the laparoscopic group (group 2), and the prosthesis sizes were, respectively, 152.67 cm² and 203.83 cm². The hospital stay was 3.43 days in open group and 1.47 days in laparoscopic group (p = 0.007). There was no significant difference in the pain scores between the two groups. More wound-related infectious complications occurred in the open group (33%) than in the laparoscopic group (6%) (p = 0.013). There was one recurrence in the open repair group (3%) and two recurrences in laparoscopic group (6%) (p = 0.55). Conclusions Laparoscopic repair of incisional and ventral hernias is superior to open mesh repair in terms of significantly less blood loss, fewer complications, shorter hospital stay, and excellent cosmetic outcome.     

Recurrences after laparoscopic repair of ventral and incisional hernia: lessons learned from 505 repairs

Background  All hernia recurrences in a series of 505 patients who underwent laparoscopic repair of a ventral hernia (n = 291) or incisional hernia (n = 214) were analyzed to identify factors responsible for the recurrence. Methods  In all laparoscopic repairs, an expanded polytetrafluoroethylene prosthesis overlapping the hernia margins by ≥3 cm was fixed with a double ring of tacks alone (n = 206) or with tacks as well as sutures (n = 299). During the mean follow-up time of 31.3 ± 18.4 months, nine patients (1.8%) had a recurrence, eight of which were repaired laparoscopically. Operative reports and videotapes of all initial repairs and repairs of recurrences were analyzed. Results  All recurrences followed an incisional hernia repair (p < 0.001). Five recurrences developed after mesh fixation with both tacks and sutures and four after mesh fixation with tacks alone (p = 1.0). All recurrences were at the site of the apparently sufficient original incision scar: in eight patients, the recurrent hernia was attached to the mesh; in one, it developed in another part of the scar. All initial repairs had been performed without technical errors. Upon repair of the recurrences, a new, larger mesh was placed over the entire incision, not just the hernia. There were no re-recurrences during follow-up (mean 19.8 ± 10.3 months). Conclusions  Recurrence after incisional hernia repair appears to be due primarily to disregard for the principle that the whole incision—not just the hernia—must be repaired. Our experience supports the idea that the entire incision has a potential for hernia development. Insufficient coverage of the incision scar is a risk factor for recurrence after laparoscopic repair of ventral and incisional hernia.     

Is testicular perfusion influenced during laparoscopic inguınal hernia surgery?

Background The influence of laparoscopic inguinal hernia surgery is still unclear. The aim of this study was to compare the possible early effects of laparoscopic and open inguinal hernia repair on testicular perfusion. Methods In this prospective trial, 44 patients underwent mesh repair of a primary inguinal hernia assigned to one of two procedures: open anterior mesh repair (n = 29) or a laparoscopic totally extraperitoneal approach (n = 15). Doppler ultrasound was used to determine the hemodynamic characteristics of the testicular blood flow. Results No statistically significant differences were found between the two groups in terms of Doppler flow parameters for the preoperative, very early (day 1), and early postoperative (day 7) periods. When Doppler flow parameters of the testicular artery were compared in the conventional group, statistically significant differences were found between preoperative and very early postoperative values (p < 0.05). Meanwhile, comparison among flow parameters of the testicular, capsular, and intratesticular arteries of the laparoscopic group showed statistically significant differences between preoperative and very early postoperative and between preoperative and early postoperative values (p < 0.05). There were no statistically differences in postoperative complications between the two groups. Conclusion Testicular blood flow is influenced during laparoscopic inguinal hernia surgery. Whether changes in flow parameters remain in the late postoperative period, and whether they have an impact on complications will be evaluated in further studies.     

“对位对线”补片固定法在腹腔镜切口疝修补术中的应用

背景与目的 切口疝的微创修补理念在疝外科界已经形成共识，腹腔镜下切口疝修补在临床上的应用越来越普及，但腔镜下的补片固定技术仍然是一个难点。本研究旨在介绍一种新式的切口疝补片固定方法并探讨其临床应用效果。方法 回顾性分析2018年1月—2019年12月中山大学附属第六医院胃肠、疝和腹壁外科120例行腹腔镜切口疝修补手术（IPOM）患者的临床资料，其中60例的补片固定方式采用“对位对线”补片固定法（观察组），另60例采用传统疝钉双圈固定方法（对照组），比较两组患者相关临床指标以及经济学指标。结果 两组患者性别、年龄、BMI、病程以及疝环最大缺损指标差异均无统计学意义（均P>0.05）。观察组的平均补片固定时间短于对照组（35.5 min vs. 47.7 min，P<0.05），平均疝钉固定数量少于对照组（36.6枚 vs. 44.2枚，P<0.05），平均术后疼痛VAS评分低于对照组（3.2分 vs. 4.6分，P<0.05），住院费用低于对照组（3.9万元 vs. 4.8万元，P<0.05）。两组患者在血清肿、补片感染发生率，术后住院时间的差异均无统计学意义（均P>0.05）。观察组和对照组平均随访26.3个月与25.8个月，观察组和对照组的切口疝复发率（1.7% vs. 5.0%，P=0.61）及术后慢性疼痛的发生率差异均无统计学意义（6.7% vs. 8.3%，P=1.00）。结论 “对位对线”补片固定法可缩短补片固定时间，减少疝钉使用数量，节约住院费用，并且可降低切口疝术后早期疼痛的发生，该方法在腹腔镜切口疝修补术中的应用是安全有效的，可在临床进行推广使用。     

Current national practice patterns for inpatient management of ventral abdominal wall hernia in the United States

Background

The health-care burden related to ventral hernia management is substantial, with more than 3 billion dollars in expenditures annually in the US. Previous studies have suggested that the utilization of laparoscopic repair remains relatively low although national volume estimates have not been reported. We sought to estimate the inpatient national volume of elective ventral hernia surgery and characterize the proportion of laparoscopic versus open operations.

Methods

We analyzed data from the Nationwide Inpatient Sample to identify adults with a diagnosis of an umbilical, incisional, or ventral hernia who underwent an elective inpatient repair between 2009 and 2010. Cases that involved other major abdominal or pelvic operations were excluded. Covariates included patient demographics, surgical approach, and use of mesh. National surgical volume estimates were generated and length of stay and total hospital charges were compared for laparoscopic versus open repairs.

Results

A total of 112,070 ventral hernia repairs were included in the analysis: 72.1 % (n = 80,793) were incisional hernia repairs, while umbilical hernia repairs comprised only 6.9 % (n = 7,788). Laparoscopy was utilized in 26.6 % (n = 29,870) of cases. Mesh was placed in 85.8 % (n = 96,265) of cases, including 49.3 % (n = 3,841) of umbilical hernia repairs and 90.1 % (n = 72,973) of incisional hernia repairs. Length of stay and total hospital charges were significantly lower for laparoscopic umbilical, incisional, and “other” ventral hernia repairs (p values all <0.001). Total hospital charges during this 2-year period approached 4 billion dollars ($746 million for laparoscopic repair; $3 billion for open repair).

Conclusions

Utilization of laparoscopy for elective abdominal wall hernia repair remains relatively low in the US despite its excellent outcomes. Given the substantial financial burden associated with these hernias, future research focused on preventing the development and optimizing the surgical treatment of ventral abdominal wall hernias is warranted.     

腹腔镜联合开腹补片修补术对巨大切口疝及肠黏连紧密腹壁切口疝患者临床研究

目的分析腹腔镜结合开腹补片修补术对腹部切口疝患者治疗效果。 方法回顾性分析湖北省肿瘤医院肝胆胰外科自2011年2月至2018年2月收治的腹壁切口疝患者133例,其中62例行开腹补片修补术为对照组,余71例行腹腔镜结合开腹补片修补术为观察组;观察患者手术状况、术后恢复状况,术后1 d采用ELISA法检测血清氧化应激指标,包含胰岛素（InS）、β-内啡肽（β-EP）、生长激素（GH）和总抗氧化能力（T-AOC）含量,术后对患者随访1年,记录患者术后并发症和复发率情况。 结果观察组患者术中失血量低于对照组,差异有统计学意义（P<0.05）;观察组患者术后下床活动时间、肠功能恢复时间、首次进食时间、肠鸣音恢复时间及住院时间均低于对照组,差异有统计学意义（P<0.05）;术后1 d观察组患者血清InS、GH及T-AOC含量高于对照组,β-EP含量低于对照组,差异有统计学意义（P<0.05）;观察组患者并发症发生率低于对照组,差异有统计学意义（P<0.05）。 结论腹腔镜联合开腹补片修补术对巨大切口疝及肠黏连紧密腹壁切口疝患者疗效显著,患者创伤小、术后恢复快,且术后并发症发生率和复发率降低。     

Spiral Tacks May Contribute to Intra-Abdominal Adhesion Formation

Purpose With the inception of laparoscopic ventral hernia repair came a novel device not used in conventional hernia repair; the spiral tack. We conducted an experimental study on pigs to determine whether spiral tacks contribute to adhesion formation.Methods Using a standard laparoscopic technique in pigs, pieces of polypropylene mesh were fixed to the fascia on the upper abdominal wall, with polypropylene sutures on a randomly chosen side (side 1), and with 5-mm spiral tacks on the opposite side (side 2). The extent, type, and tenacity of the adhesions were assessed on postoperative days (PODs) 30 and 90.Results The mesh fixed to the abdominal wall with spiral tacks tended to increase the extent, type, and tenacity of adhesions more than the mesh fixed with polypropylene sutures (P < 0.05).Conclusions Spiral tacks contributed to the formation of adhesions more than polypropylene mesh did. Although this was a small-scale animal study, our findings suggest that the effect of spiral tacks used in laparoscopic ventral hernia repair should be assessed and the consequences monitored more closely.This study was presented at the joint meeting of the Turkish National Surgery Congress, Antalya, Turkey, 15–19 May, 2002     

Prevention of adhesion formation to polypropylene mesh by collagen coating: A randomized controlled study in a rat model of ventral hernia repair

Introduction In laparoscopic incisional hernia repair with intraperitoneal mesh, concern exists about the development of adhesions between bowel and mesh, predisposing to intestinal obstruction and enterocutaneous fistulas. The aim of this study was to assess whether the addition of a collagen coating on the visceral side of a polypropylene mesh can prevent adhesion formation to the mesh.Method In 58 rats, a defect in the muscular abdominal wall was created, and a mesh was fixed intraperitoneally to cover the defect. Rats were divided in two groups; polypropylene mesh (control group) and polypropylene mesh with collagen coating (Parieten mesh). Seven and 30 days postoperatively, adhesions and amount and strength of mesh incorporation were assessed. Wound healing was studied by microscopy.Results With Parieten mesh, the mesh surface covered by adhesions was reduced after 30 days (42% vs 69%, p = 0.01), but infection rate was increased after both 7 (p = 0.001) and 30 days (p = 0.03), compared to the polypropylene group with no mesh infections. If animals with mesh infection were excluded in the analysis, the mesh surface covered by adhesions was reduced after 7 days (21% vs 76%, p = 0.02), as well as after 30 days (21 vs 69%, p < 0.001). Percentage of mesh incorporation was comparable in both groups. Mean tensile strength of mesh incorporation after 30 days was higher with Parieten mesh.Conclusion Although the coated Parieten mesh was more susceptible to mesh infection in the current model, a significant reduction of adhesion formation was still seen with the Parieten mesh after 30 days, with comparable mesh incorporation in the abdominal wall.     

The comparison of laparoscopic and open ventral hernia repairs: a prospective randomized study

Background The laparoscopic approach has emerged in the search for a surgical technique to decrease the morbidity associated with conventional repair of ventral hernias. In this study we aimed to compare the results of our open and laparoscopic ventral hernia repairs prospectively. Methods Between January 2001 and October 2005, a total of 46 patients diagnosed with ventral hernias (primary and incisional) who were admitted to our surgical unit and accepted to be included in this study group were examined. All patients were divided into laparoscopic repair (n = 23) and open repair (n = 23) subgroups in a randomized fashion. The patients’ demographic characteristics, operation times, body mass indices, sizes of fascial defects, hernia locations, durations of hospital stay, presence and degrees of postoperative pain, and postoperative minor and major complications were analysed and compared. All the data were expressed as means ± SDs. Chi-square and Wilcoxon tests were used for statistical analysis, and P < 0.05 was accepted as a significant statistical value (SPSS 11.0 for Windows). Results The demographic characteristics of both groups were similar. Women predominated, especially in the laparoscopy group (P < 0.05). The comparison of the results revealed that the major advantage of laparoscopy was the shortened postoperative hospital stay and the reduced incidence of mesh infection (P < 0.05, P < 0.05). On the other hand, operation time was significantly longer in the laparoscopy group (P < 0.05). The major complications encountered in the laparoscopy group were ileus and a missed enterotomy. The most frequent minor complication was seroma, which was significantly more frequent in the laparoscopy group (P < 0.05). Postoperative pain assessment revealed similar results in both groups (P > 0.05). Conclusions The laparoscopic approach appears to be as effective as open repairs in the treatment of ventral hernias. Advanced surgical skill, laparoscopic experience and high technology are mandatory factors for successful ventral hernia repair.     

Laparoscopic versus open ventral hernia mesh repair: a prospective study

Background An incisional hernia develops in 3% to 13% of laparotomy incisions, with primary suture repair of ventral hernias yielding unsatisfactory results. The introduction of a prosthetic mesh to ensure abdominal wall strength without tension has decreased the recurrence rate, but open repair requires significant soft tissue dissection in tissues that are already of poor quality as well as flap creation, increasing complication rates and affecting the recurrence rate. A minimally invasive approach was applied to the repair pf ventral hernias, with the expectation of earlier recovery, fewer postoperative complications, and decreased recurrence rates. This prospective study was performed to objectively analyze and compare the outcomes after open and laparoscopic ventral hernia repair. Methods The outcomes for 50 unselected patients who underwent laparoscopic ventral hernia repair were compared with those for 50 consecutive unselected patients who underwent open repair. The open surgical operations were performed by the Rives and Stoppa technique using prosthetic mesh, whereas the laparoscopic repairs were performed using the intraperitoneal onlay mesh (IPOM) repair technique in all cases. Results The study group consisted of 100 patients (82 women and 18 men) with a mean age of 55.25 years (range, 30–83 years). The patients in the two groups were comparable at baseline in terms of sex, presenting complaints, and comorbid conditions. The patients in laparoscopic group had larger defects (93.96 vs 55.88 cm²; p = 0.0023). The mean follow-up time was 20.8 months (95% confidence interval [CI], 18.5640–23.0227 months). The mean surgery durations were 90.6 min for the laparoscopic repair and 93.3 min for the open repair (p = 0.769, nonsignificant difference). The mean postoperative stay was shorter for the laparoscopic group than for the open hernia group (2.7 vs 4.7 days; p = 0.044). The pain scores were similar in the two groups at 24 and 48 h, but significantly less at 72 h in the laparoscopic group (mean visual analog scale score, 2.9412 vs 4.1702; p = 0.001). There were fewer complications (24%) and recurrences (2%) among the patients who underwent laparoscopic repair than among those who had open repair (30% and 10%, respectively). Conclusions The findings demonstrate that laparoscopic ventral hernia repair in our experience was safe and resulted in shorter operative time, fewer complications, shorter hospital stays, and less recurrence. Hence, it should be considered as the procedure of choice for ventral hernia repair.     

Laparoscopic repair of incisional hernia: Outcomes of 100 consecutive cases comprising 25 wall defects larger than 15 cm

Background Minimal access surgery for incisional hernia repair is still debated, especially for large and giant wall defects. This study was undertaken to analyze the results of the use of the laparoscopic technique in incisional hernias smaller and larger than 15 cm of diameter. Method From 2002 to 2007 a total of 100 patients with incisional hernia were operated on by laparoscopy and were included in this study. As much as 38 patients were obese, with a body mass index (BMI) > 30 kg/m². The mean follow-up span was 24 months (range = 2–58). The fascial defect was recurrent in 19 patients, in 13 after previous repair with mesh and in 6 after repair without mesh. The wall defect was larger than 15 cm in 25 patients and in 6 of them it was 20 cm or larger as measured from within the peritoneal cavity. Results The mean operating time was 152 ± 25 min (range = 45–275), and for defects larger than 15 cm it was 205 ± 101 min (range = 85–540). Two patients with massive adhesions needed conversion to open surgery, one after an intraoperative injury of an intestinal loop. Postoperative complications occurred in 23 patients; local complications were 10. Pulmonary embolism caused death in one obese patient. Morbidity and hospital stay were similar in obese and nonobese patients and the differences were not statistically relevant (p > 0.05). The outcomes in patients with wall defects larger than 15 cm showed no significant difference with outcomes of the remaining patients with smaller defects (p > 0.05). Recurrence occurred in three cases, and in one case local infection led to removal of the mesh. Conclusions Minimal access procedures can provide good results in the repair of incisional hernia, even when the diameter is larger than 15 cm. Obesity is not a contraindication to laparoscopic repair. Further studies are expected to confirm these promising results. An erratum to this article can be found at     

Open randomized clinical trial of laparoscopic versus open incisional hernia repair

Background  Incisional hernia is a common complication following abdominal surgery. Although the use of prosthetics has decreased recurrence rates, the standard open approach is still unsatisfactory. Laparoscopic techniques are an attempt to provide similar outcomes with the advantages of minimally invasive surgery. Methods  Open randomized controlled clinical trial with follow-up at 1, 2, 3, 7, and 15 days, and 1, 3, and 12 months from hernia repair. The study was carried out in the surgery departments of three general hospitals of the Valencia Health Agency. Objectives  To compare laparoscopic with anterior open repair using health-related quality of life outcomes as main endpoints. Results  Eighty-four patients with incisional hernia were randomly allocated to an open group (OG) (n = 39) or to a laparoscopic group (LG) (n = 45). Seventy-four patients completed 1-year follow up. Mean length of stay and time to oral intake were similar between groups. Operative time was 32 min longer in the LG (p < 0.001). Conversion rate was 11%. The local complication rate was superior in the LG (33.3% versus 5.2%) (p < 0.001). Recurrence rate at 1 year (7.9% versus 9.7%) was similar in the two groups. There were no significant differences in the pain scores or the EQ5D tariffs between the two groups during follow-up. Conclusions  Laparoscopic incisional hernia repair does not seem to be a better procedure than the open anterior technique in terms of operative time, hospitalization, complications, pain or quality of life.     

Laparoscopic incisional hernia repair: evaluation of effectiveness and experiences

Introduction  

Incisional hernia is the most frequent postoperative complication following abdominal surgery and is a common and costly source of morbidity. Conventional mesh repair is the standard treatment today, but the use of laparoscopic incisional hernia repair (LIHR) seems to be a good alternative. We performed a retrospective analysis comparing open incisional hernia repair with the laparoscopic approach.     

Laparoscopic versus open incisional hernia repair

Background Incisional hernia is a common complication of abdominal surgery, and it is often a source of morbidity and high costs for health care. This is a case-control study to compare laparoscopic versus anterior-open incisional hernia repair. Methods 170 patients with incisional hernia were enrolled in this study between September 2001 and December 2004. Of these, 85 underwent anterior-open repair (open group: OG), and 85 underwent laparoscopic repair (laparoscopic group: LG). The clinical outcome was determined by a median follow-up of 24.0 months for LG and OG. Results No difference was noticed between the two groups in age, American Society of Anesthesiologists (ASA) score, body mass index (BMI), and incisional hernia diameter. Mean operative time was 61.0 min for LG patients and 150.9 min for OG patients (p < .05). Mean hospitalization was 2.7 days for LG patients and 9.9 days for OG patients (p < .05). Mean return to work was 13 days (range, 6–15 days) in LG patients and 25 days (range, 16–30 days) in OG patients. Complications occurred in 16.4 % of LG patients and 29.4 % of OG patients, with a relapse rate of 2.3% in LG and 1.1% in OG patients. Conclusions Short-term results indicate that laparoscopic incisional hernia repair is associated with a shorter operative time and hospitalization, a faster return to work, and a lower incidence of wound infections and major complications compared to the anterior-open procedure. Further studies and longer follow-up are required to confirm these findings.     

Tissue ingrowth and bowel adhesion formation in an animal comparative study: polypropylene versus Proceed versus Parietex Composite

Background The optimal prosthesis for laparoscopic ventral hernia repair would combine excellent parietal surface tissue ingrowth with minimal visceral surface adhesiveness. Currently, few data are available from randomized trials comparing the commercially available prostheses. Methods In a pig model designed to incite adhesions, three 10 × 15-cm pieces of mesh (Proceed, Parietex Composite [PCO], and polypropylene [PPM]) were randomly positioned intraperitoneally in each of 10 animals using sutures and tack fixation. After a 28-day survival, the amount of shrinkage, the area and peel strength of visceral adhesions, the peak peel strength, the work required to separate mesh from the abdominal wall, and a coefficient representing the adhesiveness of tissue ingrowth were averaged for each type of mesh and then compared with the averages for the other prostheses. The histologic appearance of each prosthesis was documented. Results Proceed had more shrinkage (99.6 cm²) than PCO (105.8 cm²) or PPM (112 cm²), although the difference was not statistically significant. The mean area of adhesions to PCO (11%) was significantly less than for Proceed (48%; p < 0.008) or PPM (46%; p < 0.008). Adhesion peel strength was significantly less for PCO (5.9 N) than for Proceed (12.1 N; p < 0.02) or PPM (12.9 N; p < 0.02). According to a filmy-to-dense scale of 1 to 5, adhesions were more filmy with PCO (1.7) than with PPM (2.9) or Proceed (3.7) (p < 0.007). Peak peel strength from the abdominal wall was significantly higher for PCO (17.2 N) than for Proceed (10.7 N) or PPM (10 N; p < 0.002). The histology of each prosthesis showed a neoperitoneum only with PCO. Conclusions With less shrinkage, fewer and less dense adhesions to the viscera, and significantly stronger abdominal wall adherence and tissue ingrowth at 28 days in this animal study, PCO was superior to both Proceed and PPM in all categories. Furthermore, PCO demonstrated all the favorable qualities needed in an optimal prosthesis for laparoscopic ventral hernia repair, including the rapid development of a neoperitoneum.     

比较腹腔镜腹腔内与开放腹膜前间隙补片置入术治疗腹壁切口疝的效果

目的比较腹腔镜腹腔内补片置入术(IPOM)与开放腹膜前间隙补片置入术(Sublay)治疗腹壁切口疝的效果。方法选取2016-01—2019-01间在郑州大学第一附属医院接受疝修补术治疗的76例腹壁切口疝患者,将36例行腹腔镜IPOM术的患者作为腔镜组。将40例行开放Sublay术的患者作为开放组。回顾性分析患者的临床资料。结果2组患者均成功完成手术。2组手术时间差异无统计学意义(P>0.05)。腔镜组术中出血量、术后肠蠕动恢复时间及住院时间均少于开放组,差异有统计学意义(P<0.05)。腔镜组术后近期疼痛发生率低于开放组,差异有统计学意义(P<0.05),其余并发症差异无统计学意义(P>0.05)。结论腹腔镜IPOM术具有创伤小、恢复快、疼痛轻、出血少、并发症少等优点,具有更广阔的应用前景。     

Small bowel lesion due to spiral tacks after laparoscopic intraperitoneal onlay mesh repair for incisional hernia

INTRODUCTIONLaparoscopic intraperitoneal onlay mesh (IPOM) repair has become a widely accepted operative technique for incisional hernias. However, tack fixation poses the risk of adhesions and injury to the intestine. We report the case of spiral tacks adherent to the small bowel after IPOM repair for incisional hernia.PRESENTATION OF CASE64 years old male patient who underwent laparoscopic IPOM repair for incisional hernia 1 year after open sigmoid resection. A laminated polypropylene mesh was fixed with titanium spiral tacks. 4 years later, elective open cholecystectomy was performed. Two spiral tacks integrated in the seromusular layer of the small bowel were encountered. Tacks were removed and bowel lesions oversewn with interrupted seromuscular stitches.DISCUSSIONAccording to the current literature, complications related to metal spiral tacks in IPOM mesh repair such as intestinal perforation or strangulation ileus seem to be rare. To our knowledge, spiral tacks adherent to the intestine have not yet been published to date. Alternative techniques for mesh fixation are transfascial sutures with single stitches, continuous sutures or fibrin glue, as already used in TAPP and TEP procedures for inguinal hernia repair. The ideal and safest technique for mesh fixation in IPOM repair for incisional hernias remains controversial.CONCLUSIONSpiral tacks used for intraperitoneal mesh fixation can lead to adhesions and bowel lesions. Sutures, absorbable tacks or fibrin glue are alternatives for mesh fixation. Further clinical trials are needed to evaluate the safest technique of laparoscopic IPOM incisional hernia repair.     

Umbilical hernia in adults

Background: There is no consensus on the best technique for the repair of umbilical hernia in adults. The role of laparoscopic hernioplasty of umbilical hernia remains controversial. This study was undertaken to compare the outcomes of open and laparoscopic onlay patch repair of umbilical hernia in adults. Methods: From January 1996 to December 2002, 102 patients underwent elective repair of umbilical hernia. Operative techniques included Mayo repair (n = 43), laparoscopic onlay Gore-Tex patch hernioplasty (n = 26), suture herniorrhaphy (n = 24), and mesh hernioplasty (n = 9). Results: Demographic features and risk factors were similar among the four groups. The operative time of laparoscopic hernioplasty (median, 66 min) was significantly longer than those for patients who underwent Mayo repair (60 min) or sutured herniorrhaphy (50 min) (p < 0.05). None of the patients who underwent laparoscopic patch repairs required conversion to open repair. The median pain score at rest on postoperative day 1 was significantly lower in patients who underwent laparoscopic repair compared to those who had Mayo repair. A significantly shorter hospital stay and a lower wound morbidity rate were also observed in patients who underwent laparoscopic repair. With a mean follow-up of 2 years, suture herniorrhaphy had a relatively high recurrence rate (8.7%), whereas no recurrence was documented for the other techniques. Conclusions: Laparoscopic onlay patch hernioplasty is a safe and efficacious technique for the repair of umbilical hernia. Compared to Mayo repair, the laparoscopic approach confers the advantages of reduced postoperative pain, shorter hospital stay, and a diminished morbidity rate.     

Major mesh-related complications following hernia repair

Mesh material affects complications following hernia repair. Medical device reports on the use of surgical mesh for hernia repair were reviewed from the Food and Drug Administration’s (FDA) Manufacturer User Facility Device Experience Database from January 1996 to September 2004. We analyzed 252 adverse event reports related to the use of surgical mesh for hernia repair. Adverse events included infection (42%, 107 reports), mechanical failure (18%, 46), pain (9%, 23), reaction (8%, 20), intestinal complications (7%, 18), adhesions (6%, 14), seroma (4%, 9), erosion (2%, 6), and other (4%, 9). Compared to all other mesh types, Sepra/polypropylene mesh had more mechanical failures (80 vs 14%, p < 0.05), biomaterial mesh had more reactions (57 vs 7%, p < 0.05), polytetrafluoroethylene (PTFE)/polypropylene mesh had more intestinal complications (14 vs 7%, p < 0.05), and PTFE mesh tended to have more infections (75 vs 41% all other, p = 0.07). Death occurred in 2% (5). We conclude that specific mesh materials are related to specific complications.     

Minimal‐access colorectal surgery is associated with fewer adhesion‐related admissions than open surgery

Background:

This study aimed to describe national intermediate‐term admission rates for incisional hernia or clinically apparent adhesions following colorectal surgery, and to compare rates following laparoscopic and open approaches.

Methods:

Patients undergoing primary colorectal resection between 2002 and 2008 were included from the Hospital Episode Statistics database. Subsequent inpatient admissions were extracted for up to 3 years after the initial operation or to the end of the study period. Outcomes examined were admissions with a diagnosis of, or operative interventions for, incisional hernia or adhesions.

Results:

A total of 187 148 patients were included between 2002 and 2008, with median follow‐up of 31·8 (interquartile range 13·1–35·3) months. Some 8885 (4·7 per cent) of these patients were admitted with a diagnosis of, or underwent a repair of, an incisional hernia. In multiple regression analysis, use of laparoscopy was not a predictor of operative intervention for incisional hernia (odds ratio 1·09, 95 per cent confidence interval (c.i.) 0·99 to 1·21; P = 0·083). Some 15 125 (8·1 per cent) of the patients were admitted with a diagnosis of adhesions or had a procedure for division of adhesions. Overall, 3·5 per cent (6637 of 187 148) of patients underwent adhesiolysis. Patients selected for a laparoscopic procedure had lower rates of admission for adhesions (6·3 per cent (692 of 11 013) for laparoscopic versus 8·2 per cent (14 433 of 176 135) for open surgery; P < 0·001) and reintervention for adhesions (2·8 per cent (305 of 11 013) versus 3·6 per cent (6325 of 176 135) respectively; P < 0·001) than those undergoing an open procedure. In multiple regression analysis, patients selected for a laparoscopic procedure had lower subsequent intervention rates for adhesions (odds ratio 0·80, 95 per cent c.i. 0·71 to 0·90; P < 0·001).

Discussion:

Patients undergoing colorectal resection who are selected for the laparoscopic approach have a lower risk of developing clinically significant adhesions. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.