Laparoscopic ePTFE mesh repair of incisional and ventral hernias

Incisional hernia is a relatively frequent complication of abdominal surgery. The use of mesh to repair incisional and ventral hernias results in lower recurrence rates compared with primary suture techniques. The laparoscopic approach may be associated with lower postoperative morbidity compared with open procedures. Long-term recurrence rates after laparoscopic ventral and incisional hernias are not well defined. A prospective study of the initial experience of a standardized technique of laparoscopic incisional and ventral hernia repair carried out in a tertiary referral hospital was undertaken between January 2003 and February 2007. Laparoscopic hernia repair was attempted in 71 patients and was successful in 68 (conversion rate 4%). The mean age of the patients identified was 63.1 years (39 men and 31 women). Multiple hernial defects were identified in 38 patients (56%), and the mean overall size of the fascial defects was 166 cm(2). The mean mesh size used was 403 cm(2). The mean operative time was 121 minutes. There were six (9%) major complications in this series, but there were no deaths. Hernia recurrence was noted in four patients (6%) at a mean follow up of 20 months. Our preliminary experience indicates that laparoscopic incisional and ventral hernia repair is technically feasible and has acceptable postoperative morbidity and low early recurrence rates.     

腹腔镜技术在切口疝修补术中的应用体会

目的探讨腹腔镜下应用补片修补切口疝的手术方法和II缶床效果。方法回顾性分析我科2006年1月至2008年12月对腹壁切口疝23例施行腹腔镜修补术的临床资料。结果本组成功施行腹腔镜下切口疝补片修补22例,因腹腔内严重粘连中转剖腹手术1例,术中发现多发切口疝3例。本组无手术死亡和肠瘘病例。术后出现疼痛4例,补片周围积液3例。全组获随访4～24个月,平均13．8个月,未见切口疝复发。结论腹壁切口疝病人行腹腔镜下补片修补大多是安全地,还可在术中发现隐性缺损。对腹腔内广泛粘连分离困难者,应及时中转剖腹手术。     

Retrofascial mesh repair of ventral incisional hernias

BACKGROUND: Recurrence rates after ventral incisional hernia repair are reported to be as high as 33% and are associated with considerable morbidity and lost time. The purpose of this study was to determine if retrofascial mesh placement reduces the incidence of recurrence as well as the severity of wound infections. METHODS: A prospective database covering the period from January 1995 to June 2003 was maintained. All patients underwent a standardized technique by a single surgeon. Polypropylene mesh was placed between the fascia and the peritoneum with the fascia closed over the mesh. RESULTS: There were 150 patients (126 women, 24 men) with a mean age of 55 years. Their average weight was 88 kg, with an average body mass index of 32. Sixty-three (42%) of the hernias were recurrences of a previous repair. The average size of the hernia was 8 x 14 cm. There was 1 postoperative mortality. There was a 9% postoperative infection rate with 2 patients (1%) requiring mesh removal. Long-term follow-up evaluation has revealed 3 recurrences (2%) and 3 readmissions for bowel obstruction with 1 patient requiring surgical release. There were no fistulas noted. CONCLUSIONS: Incisional hernia repair with mesh placed in the retrofascial position decreases both the risk for recurrence and the severity of wound infection without significant problems from bowel obstruction or enteric fistula.     

Laparoscopic repair of ventral and incisional hernias using a new composite mesh (Parietex): initial experience

Ventral hernia repair is still a difficult problem for surgeons because of the high recurrence rate and possible postoperative complications. Repairs with a prosthesis have reduced the recurrence rate, but the anterior approach still involves high morbidity and a long hospital stay. The purpose of this article was to evaluate the results of laparoscopic surgery on ventral hernias using a new double-layer mesh in an intra-abdominal position. A retrospective analysis was performed of the first 20 patients undergoing laparoscopic surgery for ventral hernia (75% incisional and 25% umbilical) with intra-abdominal prosthetic repair using a double-layer mesh consisting of three-dimensional multifiber polyester on one side and a hydrophilic resorbable nonstick collagen membrane on the other (Parietex composite, Sofradim, Villefranche sur Saone, France). The procedure was done on an outpatient basis in 85% of the cases. There was no morbidity or mortality. During a mean follow-up period of 10 months we found no infections, rejections, fistulas, recurrences, or alterations in bowel function. Laparoscopic repair of ventral hernias is an efficient alternative to open repair, with a low morbidity rate and short hospital stay. The double-layer mesh is safe for intra-abdominal use.     

Laparoscopic transperitoneal repair of lumbar incisional hernias: a combined suture and ‘double-mesh’ technique

Background Lumbar hernias that occur after surgery are called lumbar incisional hernias. Recently, laparoscopic repair of these hernias has been reported with excellent outcomes. This is a retrospective study of our series of patients with lumbar incisional hernias. Patients and methods We managed 11 patients with lumbar incisional hernias from 1996–2006. All the patients had undergone either nephrectomy or pyeloplasty in the past. Laparoscopic suturing of the defect and reinforcement with mesh were successfully performed for all the patients. Results There were more males than females, the age range was 42–65 years, and mean operating time was 120 min; discharge was at 1–2 postoperative days. There was no recurrence or mortality. Three cases had seroma, out of which two required aspiration after 60 days. Discussion Laparoscopic repair provides all the benefits of minimally invasive surgery, and the principles involved in repair of ventral hernias are applied in lumbar incisional hernias as well. Our technique involved suturing of the defect before placing a mesh over the defect. We theorize that approximating the ends of the muscles restores normal anatomy and results in functional improvement. For the larger hernias, we used two meshes to cover the defect—polypropylene and Parietex™, sizes being 15 × 15 cm. Conclusion Laparoscopic repair with prosthetic reinforcement is feasible and effective in the treatment of lumbar incisional hernias. Also, suturing of the defect may provide additional benefits.     

Laparoscopic repair of ventral incisional hernias: pros and cons

Abdominal wall hernias are a familiar surgical problem. Millions of patients are affected each year, presenting most commonly with primary ventral, incisional, and inguinal hernias. Whether symptomatic or asymptomatic, hernias commonly cause pain or are aesthetically distressing to patients. These concerns, coupled with the risk of incarceration, are the most common reasons patients seek surgical repair of hernias. This article focuses on incisional hernias, reported to develop in 3% to 29% of laparotomy incisions.     

Laparoscopic cure of small ventral hernias with composite mesh

BACKGROUND: The use of mesh is recommended to reduce the rate of recurrence after the curing of ventral hernias. METHODS: A multicentre prospective trial was conducted to assess the laparoscopic cure of small ventral hernias with a composite mesh. RESULTS: Around 222 patients entered the trial and received laparoscopic repair for ventral hernias of less than 5 cm. There was one conversion. The mean length of post-operative hospitalisation was 2.5 days. At 1 year, the recurrence rate was 2%. Two meshes were removed due to infection, 3% of the patients were using analgesics and 86.1% of the patients described no pain on EVA scoring. CONCLUSION: The laparoscopic cure of small ventral hernias with composite mesh is efficient. Further technical progress is warranted to reduce the rate of seroma formation.     

腹腔镜下腹壁疝腹膜外补片修补术与腹腔内补片修补术比较的多中心回顾性研究

背景与目的 腹壁疝修补术是最常见的外科手术之一,全球每年有200万例左右的腹壁疝患者接受手术治疗。与开放手术相比,腹腔镜下腹壁疝修补术优势明显。然而腹腔镜下腹腔内补片修补术（IPOM）与腹腔镜下腹膜外补片修补术（ESR）这两种腔镜术式的优缺点及疗效如何,尚无大样本的临床研究证实。因此,本研究通过比较ESR与IPOM两种手术方式治疗腹壁疝的近远期疗效,为临床提供循证参考。方法 回顾性分析2017年1月1日—2022年12月31日湖南省11家医疗机构收治的157例行腹腔镜腹壁疝修补术患者的临床资料,其中124例行ESR（ESR组）,33例行IPOM（IPOM组）,对比分析两组病例的临床特点、手术方式和术后近远期效果。结果 全组无中转开腹病例或围术期死亡病例。两组病例的年龄、性别、BMI、类型差异均无统计学意义（均P>0.05）。两组病例疝环横径、手术时间、术中出血量、疝环闭合概率差异均无统计学意义（均P>0.05）。网片固定方式ESR组以自固定和缝线固定为主（91.1%）,而IPOM组以钉枪固定为主（69.7%）,差异有统计学意义（P<0.05）。ESR组的术后疼痛评分明显低于IPOM组（2.4±0.8 vs. 2.8±1.0,P<0.05）,住院费用明显低于IPOM组（21 001元vs. 38 437元,P<0.05）。两组的术后住院时间和近期并发症发生率差异无统计学意义（均P>0.05）。中位随访10.3个月,ESR组无复发病例,IPOM组2例复发（6.1%）,差异有统计学意义（P<0.05）。结论 ESR是湖南地区腹腔镜下腹壁疝修补的主流术式之一。由于固定方式和网片选择的不同,ESR较之IPOM而言,术后疼痛更轻微、费用更低、复发率更低,且并不明显增加手术时间和术后近期并发症。     

腹腔镜下腹壁切口疝补片修补术的初步经验

目的:探讨腹腔镜下腹壁切口疝修补术的手术方法、安全性等问题。方法:对我院2004年3月～11月间收治的25例腹壁切口疝病人,进行腹腔镜下修补术。结果:24例(96%)手术成功,1例(4%)因腹腔内广泛粘连而中转为剖腹修补。平均手术时间为110min,平均术后住院6d,6例(24%)病人术中发现有一个以上的隐匿性缺损。术后并发症有:术后短期内修补区腹壁明显疼痛21例(84%),腹壁缝合点较长时间疼痛6例(24%),浆液肿3例(12%);无修补区感染,也未发现早期复发的病例。结论:对腹壁切口疝,多数病人是可以经腹腔镜进行粘连松解及补片修补术的,还可在术中发现其他隐性缺损。对腹腔内广泛粘连而影响操作器械的进入及分离者,应及时中转剖腹手术。     

Open preperitoneal retrofascial mesh repair for multiply recurrent ventral incisional hernias

BACKGROUND: Because herniorrhaphy failure and complication rates appear proportional to the number of previous repairs, multiply recurrent hernias (MRH) represent a formidable challenge. We sought to determine the safety and efficacy of open preperitoneal retrofascial mesh repair of MRH. STUDY DESIGN: We conducted a retrospective review of consecutive patients undergoing an open preperitoneal retrofascial mesh repair of multiply (two or more) recurrent hernias at a tertiary care referral center. RESULTS: From January 2001 to May 2005, 128 patients underwent surgical repair of an MRH; 32 of these underwent an open preperitoneal repair. The average body mass index was 39.1 +/- 8.4 kg/m2 (range 28.9 to 61.0 kg/m2). All patients had significant comorbidities; 18.8% were smokers. The number of previous herniorrhaphies was 3.6 (range 2 to 24). Polypropylene mesh was used in all patients, including lightweight polypropylene in 10 (31.2%) patients. The average mesh size was 937 +/- 531 cm2 (range 225 to 1,800 cm2). There were no major intraoperative complications. Wound infection occurred in 4 patients (12.5%, all smokers), requiring partial mesh excision in 1 patient. Univariate analysis revealed smoking as the only predictor of wound or mesh-related morbidity (p = 0.0004). At a mean followup of 28.1 months (range 8 to 60 months), there has been 1 recurrence (3.1%) in the patient requiring partial mesh removal. CONCLUSIONS: Open preperitoneal retrofascial mesh repair resulted in an effective herniorrhaphy with low perioperative morbidity in patients with MRH. Smoking cessation appears to be important in minimizing infectious complications. Given the technical challenge, surgical care of patients with MRH may be best provided in referral centers with interest and expertise in complex hernia repairs.     

Laparoscopic primary repair of ventral hernias: Early results of a new technique

Epigastric, umbilical, incisional, parastomal, and trocar site hernias are all classified as “ventral” hernias, which constitute a great portion of the surgery in a general surgical practice, and debate still continues regarding the optimal surgical strategy to correct these anatomical defects. Although repairing these hernias using a synthetic material, whether placed open or laparoscopically, has gained wide popularity, there are some situations where the use of a mesh is either unnecessary or contraindicated. This article presents the cases of 10 patients with some kind of ventral hernia which were all repaired laparoscopically with a primary suturing technique.     

Laparoscopic suture repair of selected incisional hernias: a simple technique

An incisional hernia is a common condition that can be repaired by laparoscopic surgery, with the use of a prosthetic mesh. There are certain situations, however, in which the use of a mesh might be contraindicated, inadvisable, unnecessary, or unavailable. In this paper, we report on a new laparoscopic technique for the suture repair of incisional hernias that may be safely used under such conditions in selected patients.     

A technique for repairing massive ventral incisional hernias without the use of a mesh.

Incisional hernias are common. Those involving large fascial defects are usually repaired using a synthetic mesh. Complications of such repairs involving mesh pose particular problems in management. This paper describes a new technique for repairing large ventral incisional hernias which does not involve the use of a mesh. Our repair is anatomical in first reconstructing the posterior rectus sheath and then using a darn to approximate the recti. We have used this technique successfully in three cases of massive incisional hernias measuring 20 cm or more in diameter and have not experienced any complications. In particular, no recurrences of the hernias have occurred. The technique described can be used to repair primary incisional hernias as well as salvage cases when previous repairs have failed.     

Laparoscopic repair of incisional hernias

Laparoscopic repair of incisional hernia has been shown safe and efficacious, with low rates of conversion to open, short hospital stay, moderate complication rate, and low recurrence. Using the benefits of open retromuscular, sublay repair, the laparoscopic approach provides adequate mesh overlap and allows for identification of the entire abdominal wall fascia at risk for hernia formation. Fixation of the prosthesis to the abdominal wall is best provided by transabdominal to secure the mesh during the initial phase of incorporation. Long-term follow-up data support the durability of laparoscopic repair of ventral hernias with reduced rate of recurrence, low risk of infection, and applicability to difficult patient populations, such as the morbidly obese and those with prior failed attempts.     

Open repair of ventral incisional hernias

Despite advances in many fields of surgery, incisional hernias still remain a significant problem. There is a lack of general consensus among surgeons regarding optimal treatment. A surgeon's approach is often based on tradition rather than clinical evidence. The surgeon's treatment plan should be comprehensive, with attention focused not merely on restoration of structural continuity. An understanding of the structural and functional anatomy of the abdominal wall and an appreciation of the importance of restoring dynamic function are necessary for the successful reconstruction of the abdominal wall.     

Laparoscopic repair of ventral and incisional hernias: our experience in 150 patients

BACKGROUND: Incisional hernias develop in 2 to 20% of laparotomy incisions. Approximately 100,000 ventral hernias are operated on each year in the United States. The reported recurrence rates for open repair are 25-52% for primary and 12.5-19% for mesh repair. Compared to the open technique, laparoscopic repair has low rates of complications and recurrence, greater patient acceptance, and shorter hospital stay. MATERIALS AND METHODS: Between April 1999 and April 2004, we treated 150 patients (111 female, 39 male) with ventral and incisional hernias laparoscopically. Data concerning the age and sex of patients, the location, number, and size of fascial defects, the type of hernias and their contents, the size and type of meshes used in repair, operative time, length of hospital stay, and postoperative complications were collected. RESULTS: Of the 150 patients, 92 had incisional hernias and 58 had umbilical hernias. Polypropylene was used in 85 cases, dual mesh in 40 cases, and composite mesh in 25 cases. The mean age of the patients was 56.0 years (range, 33-81 years). Mean operative time was 63 minutes (range, 30-125 minutes). Mean postoperative hospital stay was 2.5 days (range, 1-15 days). The postoperative complication rate was 8.6% (seroma, paralytic ileus, small bowel injury, and suture-site neuralgia). The mean follow-up period was 32 months (range, 4-60 months). There was a 3% recurrence rate. Three subileus cases were detected during follow-up. CONCLUSION: The laparoscopic approach to ventral and incisional hernias is safe, feasible, and a good alternative to the open approach. Our results are comparable with those of other reports in the literature.     

Telerobotic laparoscopic repair of incisional ventral hernias using intraperitoneal prosthetic mesh.

Laparoscopic ventral hernia repair shortens the length of hospital stay and achieves low rates of hernia recurrence. The inherent difficulties of performing advanced laparoscopy operations, however, have limited the adoption of this technique by many surgeons. We hypothesized that the virtual operative field and hand-like instruments of a telerobotic surgical system could overcome these limitations. We present herein the first 2 reported cases of telerobotic laparoscopic ventral hernia repair with mesh. The operations were accomplished with the da Vinci telerobotic surgical system. The hernia defects were repaired with dual-sided, expanded polytetrafluoroethylene (ePTFE) mesh. The mesh was secured in place with 8 sutures that were passed through the abdominal wall, and 5-mm surgical tacks were placed around the circumference of the mesh. The 2 operations were accomplished with total operative times of 120 and 135 minutes and total operating room times of 166 and 180 minutes, respectively. The patients were discharged home on postoperative days 1 and 4. The surgeon sat in an ergonomically comfortable position at a computer console that was remote from the patient. Immersion of the surgeon within the 3-dimensional virtual operative field expedited each stage of these procedures. The articulation of the wristed telerobotic instruments greatly facilitated reaching the anterior abdominal cavity near the abdominal wall. This report indicates that telerobotic laparoscopic ventral hernia repair is feasible and suggests that telepresence technology facilitates this procedure.