Mesh erosion following laparoscopic incisional hernia repair

Laparascopic mesh repair is a safe and effective method of surgically treating incisional hernia. However, such an approach may lead to specific complications of both laparoscopy and mesh placement. The mesh may migrate, become infected or erode into adjacent structures. We describe the case of a woman who underwent laparoscopic incisional hernia repair with subsequent erosion of the mesh into the bladder.     

Results of laparoscopic versus open abdominal and incisional hernia repair.

BACKGROUND: Incisional hernia is a frequent complication of abdominal surgery. The object of this study was to confirm the safety, efficacy, and feasibility of laparoscopic treatment of abdominal wall defects. METHODS: Fifty consecutive laparoscopic abdominal and incisional hernia repairs from September 2001 to May 2003 were compared with 50 open anterior repairs. RESULTS: The 2 groups were not different for age, body mass index, or American Society of Anaesthesiologists scores. Mean operative time was 59 minutes for the laparoscopic group, 164.5 minutes for the open group. Mean hernia diameter was 10.6 cm for the laparoscopic group, 10.5 cm for the open group. Mean length of stay was 2.1 days for the laparoscopic group, 8.1 days for the open group. Complications occurred in 16% of the laparoscopic and 50% of open group. Median follow-up was 9.0 months for the laparoscopic group, 24.5 months for the open group. Recurrence rates were 2% for laparoscopic group and 0% for the open group. CONCLUSION: Results for laparoscopic abdominal and incisional hernia repair seem to be superior to results for open repair in terms of operative time, length of stay, wound infection, major complications, and overall hospital reimbursement.     

Health-related quality-of-life changes after laparoscopic and open incisional hernia repair

BACKGROUND: The objective of this matched control study in patients suffering from incisional hernia was to compare laparoscopic open repair (LHR) with open hernia repair (OHR) in terms of long-term health-related quality of life (HRQL) according to the SF-36 Health Survey. METHODS: Twenty-four consecutive patients (18 male, six female; mean age, 55 years) prospectively underwent LHR using expanded polytetrafluoroethylene mesh. The second group, which was matched for age and gender, was subjected to OHR using large pore-sized, low-weight polypropylene meshes. Before and after surgery, HRQL was assessed by the SF-36 Health Survey, which measures eight different health-quality domains, and the SF-36 Physical (PCS) and Mental Component Summary (MCS) score. The SF-36 values were compared to the scores of age-stratified German population controls. RESULTS: The patients were reevaluated 16 months (range, 12-25) after LHR and 28 months (range, 18-52) after OHR, respectively. Before surgery, all of the eight health-quality domains as well as the PCS and MCS scores of both study groups were significantly lower than the corresponding scores of the age-stratified healthy German population. However, the OHR patients had significantly higher physical functioning and vitality scores than the LHR patients. After LHR and OHR, the scores for all eight SF-36 domains significantly increased but were still lower than those of the controls. The LHR patients were still worse than the norm population on both PCS and MCS scores, whereas OHR patients were worse only on PCS but not on MCS. In the long-term follow-up, none of the SF-36 Health Survey domains or the PCS and the MCS scores revealed significant differences between LHR and OHR patients. CONCLUSIONS: LHR was not different from OHR for selected indications that measure long-term outcome and HRQL. SF-36 appears to be an appropriate instrument to measure postoperative HRQL, showing responsiveness to changes in objective outcome measures.     

腹腔镜与开放式巨大腹壁切口疝补片修补术的对比分析

目的:比较开放手术及腹腔镜补片修补巨大腹壁切口疝的手术效果。方法:回顾分析我院2003年1月至2007年6月收治的43例巨大腹壁切口疝患者的临床资料。根据手术方式分为腹腔镜组(16例)和开放组(27例),对两组手术时间、术后并发症、术后住院时间等进行对比分析。结果:两组手术时间、术后并发症发生率无明显差异。开放手术组2例发生切口感染,1例经冲洗引流2个月治愈,另1例再次手术取出补片。腹腔镜手术组术后住院时间和手术出血量明显少于开放手术组。术后随访4~48个月,平均21个月,两组均无复发病例。结论:腹腔镜下应用补片修补巨大腹壁切口疝同样安全、合理,且具有患者创伤小、康复快和术后住院时间短等优点。     

Characterizing laparoscopic incisional hernia repair

INTRODUCTION: Laparoscopic repair of ventral and incisional hernias (LVIHRs) is feasible; however, many facets of this procedure remain poorly defined. The indications, essential technical features and postoperative management should be standardized to optimize outcomes and facilitate training in this promising approach to incisional hernia repair. METHODS: All patients referred to one surgeon at a tertiary care centre for LVIHR from 1999 to 2004 were analyzed. Patient records were analyzed and perioperative outcomes were documented. RESULTS: Of the 69 patients who were referred for management of incisional hernia, 64 underwent LVIHR. The mean age of patients selected for surgery was 61.4 years (28% of patients over age 70 years); their mean body mass index (BMI) was 32.8 kg/m2 and mean American Association of Anaesthetists (ASA) score was 2.5 (52% of patients had an ASA score equal to 3). The mean operating time was 130.7 minutes for a mean abdominal wall defect of 123.9 cm2 and a mean prosthetic mesh size of 344 cm2. Patients with recurrent incisional hernias and previous prosthetic mesh were the most challenging, with a mean BMI of 39 kg/m2, mean operating time of 191 minutes, mean defect of 224 cm2 and mean prosthetic mesh size of 508 cm2. One patient was converted to open surgery and, in 2 patients, small bowel injuries were repaired laparoscopically without adverse sequelae. The mean length of stay was 4.5 days (median 3.0 d). Postoperatively, 78% of patients developed seromas within the residual hernia sac. All seromas were managed nonoperatively; one-half resolved by 7 weeks, and larger seromas persisted for up to 24 weeks. There was an 18.7% rate of minor complications and a 3.1% rate of major complications (no deaths). After a mean follow-up of 7.7 months, 2 recurrent hernias (3.1%) were identified in patients with multiple previous open mesh repairs. CONCLUSION: Although LVIHR may be challenging, it has the potential to be considered a primary approach for most ventral and incisional hernias, regardless of patient status or hernia complexity.     

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.     

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目的评价腹腔镜下腹壁切口疝修补术的长、短期疗效。方法回顾性分析2006年3月至2011年7月苏州大学附属第二医院普外科41例行腹腔镜下腹壁切口疝修补术的临床资料。结果 41例切口疝均在腹腔镜下完成修补,手术时间45～150min,平均60min,术后住院时间3～16d,平均6d,术后随访2～65个月,平均25.6个月。发生血清肿4例,术后疼痛8例(术后3～6周缓解),补片感染1例,复发2例。结论腹腔镜腹壁切口疝修补术具有创伤小、恢复快、并发症少及复发率低等优点,是一种安全有效的手术方式。     

Postoperative surgical site infections after ventral/incisional hernia repair: a comparison of open and laparoscopic outcomes

Background

The purpose of this study was to compare the incidence of postoperative surgical site infections (SSIs), operative times (OTs), and length of hospital stay (LOS) after open and laparoscopic ventral/incisional hernia repair (VIHR) using multicenter, prospectively collected data.

Methods

The incidence of postoperative SSIs, OTs, and LOS was determined for cases of VIHR in the American College of Surgeons’ National Surgical Quality Improvement Program database in 2009 and 2010. Open and laparoscopic techniques were compared using a propensity score model to adjust for differences in patient demographics, characteristics, comorbidities, and laboratory values.

Results

A total of 26,766 cases met the inclusion criteria; 21,463 cases were open procedures (reducible, n = 15,520 [72 %]; incarcerated/strangulated, n = 5,943 [28 %]), and 5,303 cases were laparoscopic procedures (reducible, n = 3,883 [73 %]; incarcerated/strangulated, n = 1,420 [27 %]). Propensity score adjusted odds ratios (ORs) were significantly different between open and laparoscopic VIHR for reducible and incarcerated/strangulated hernias with regard to superficial SSI (OR 5.5, p < 0.01 and OR 3.1, p < 0.01, respectively), deep SSI (OR 6.9, p < 0.01, and OR 8.0, p < 0.01, respectively) and wound disruption (OR 4.6, p < 0.01 and OR 9.3, p = 0.03, respectively). The risk for organ/space SSI was significantly greater for open operations among reducible hernias (OR 1.9, p = 0.02), but there was no significant difference between the open and laparoscopic repair groups for incarcerated/strangulated hernias (OR 0.8, p = 0.41). The OT was significantly longer for laparoscopic procedures, both for reducible (98.5 vs. 84.9 min, p < 0.01) and incarcerated/strangulated hernias (96.4 vs. 81.2 min, p < 0.01). LOS (mean, 95 % confidence interval) was significantly longer for open repairs for both reducible (open = 2.79, 2.59–3.00; laparoscopic = 2.39, 2.20–2.60; p < 0.01) and incarcerated/strangulated (open = 2.64, 2.55–2.73; laparoscopic = 2.17, 2.02–2.33; p < 0.01) hernias.

Conclusions

Laparoscopic VIHR for reducible and incarcerated/strangulated hernias is associated with shorter LOS and decreased risk for superficial SSI, deep SSI, and wound disruption, but longer OTs when compared to open repair.     

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.     

Laparoscopic versus open incisional hernia repair

BACKGROUND: To analyze hospital resource utilization for laparoscopic vs open incisional hernia repair including the postoperative period. METHODS: Prospectively collected administrative data for incisional hernia repairs were examined. A total of 884 incisional hernia repairs were examined for trends in type of approach over time. Starting October 2001, detailed records were available, and examined for operating room (OR) time, cost data, length of stay (LOS), and 30-day postoperative hospital encounters. RESULTS: Of the total, 469 incisional hernias were approached laparoscopically (53%) and 415 open (47%). Laparoscopic repair had shorter LOS (1 +/- 0.2 days vs 2 +/- 0.6 days), longer OR time (149 +/- 4 min vs 89 +/- 4 min), higher supply costs (2,237 dollars +/- 71 dollars vs 664 dollars +/- 113 dollars), slightly lower total hospital cost (6,396 dollars +/- 477 dollars vs 7,197 dollars +/- 1,819 dollars), and slightly more postoperative hospital encounters (15% vs 13%). Use of laparoscopy increased over time (37% in 2000 vs 68% in 2004). CONCLUSIONS: Laparoscopic incisional hernia repair is becoming increasingly popular, and not at increased cost to the health care system.     

腹腔镜切口疝修补手术流程

<正>【内容简介】随着腹部手术量逐年增加,手术切口愈合不良导致的术后切口疝、造口疝也明显增多。相对于原发腹股沟疝甚至复发疝,腹壁疝手术难度都较高。随着腹腔镜技术的发展,疝和腹壁外科在腹腔镜方面也有了较广泛的应用。在腹壁疝治疗中,腹腔镜技术成为许多临床医师的首选术式。理论上可以接受全麻开放修补手术的     

腹腔镜切口疝修补术32例

目的 总结腹壁切口疝的病因、手术方式,预防切口疝并发症的发生。方法 回顾性分析2012年1月至2013年12月,河北省赤城县人民医院收治的腹壁切口疝患者32例,对病因、手术方式、手术时间等临床资料进行分析和总结。结果 32例患者均顺利完成手术,手术时间45—220min,平均（115±9）min;术后住院4～15d,平均（7±1）d。补片感染6例,局部换药1个月未愈,后经取出补片后治愈。血清肿6例,经局部穿刺抽液后治愈。膨出2例,因腹部不适症状明显而再次行腹腔镜切口疝修补术（LVHR）,术后随访16个月,无再次膨出。腹壁钉合区域疼痛9例,均予止痛药治疗,3—6周后基本缓解。术后随访2～36个月,无复发。结论 LVHR具有手术时间短、恢复快、术后并发症少、复发率低等优势。随着腹腔镜技术的普及,LVHR将会为更多患者所接受。     

开放式手术与腹腔镜手术治疗腹壁切口疝的对比研究

目的对比观察腹腔镜腹壁切口疝修补术与开放式切口疝修补术的疗效,以供临床参考。 方法总结2011年8月至2014年1月本院外科收治的52例腹壁切口疝患者临床资料,其中腹腔镜手术组28例,开放手术组24例。观察两组患者手术时间、住院时间、术中出血量、术区感染、术后疼痛的差异。 结果两组患者均顺利完成手术,与腹腔镜手术组对比,开放手术组在手术时间[(56.43±21.23) min vs (78.12±18.15) min, t=3.924, P<0.01]、住院时间[(5.12±1.18) d vs (7.25±2.45) d, t=4.085, P<0.01]、术中出血[(12.67±8.87) ml vs (135.18±56.78) ml, t=-6.927, P<0.01]、术后感染及疼痛等方面差异有统计学意义。 结论腹腔镜及开放式两种手术方式同样安全有效,腹腔镜手术在缩短住院时间,减少术中出血、术后疼痛方面占有明显优势。     

腹腔镜下腹腔内网片植入法和开放式肌后筋膜前补片修补法治疗腹壁切口疝的疗效比较

【摘要】 目的〓比较腹腔镜下腹腔内网片植入法(IPOM)和开放式肌后筋膜前补片修补法(Sublay)治疗腹壁切口疝的疗效。方法〓回顾性分析30例腹腔镜应用IPOM法和28例开放式应用Sublay法治疗腹壁切口疝的病例,比较其手术疗效及术后患者生活质量。结果〓两组手术时间、平均住院时间、术中出血量及术后并发症比较,腹腔镜组均明显优于开放手术组,有统计学差异(P<0.05)。结论〓应用腹腔镜行IPOM治疗腹壁巨大切口疝安全可行,具有有创伤小,住院时间短,恢复快,术后并发症少的优点。     

免补片法腹腔镜腹股沟疝修补术

目的 探讨免补片法腹腔镜下腹股沟疝修补的有效性.方法 回顾分析广东省第二人民医院2001年1月至2004年3月,应用腹腔镜免补片法治疗92例腹股沟疝的手术后恢复情况及随访结果,并与同期91例腹腔镜完全腹膜外疝修补手术(totally extraperitoneal laparoscopichemioplasty,TEP)的结果相比较.结果 免补片组与TEP组手术时间分别为(21±4)min与(70±16)min(t=28.01,P<0.05)、住院天数分别为(3.5±1.0)d与(4.8±1.2)d(t=7.96,P<0.05)、下床活动时间分别为(1.0±0.5)d与(1.8±0.7)d(t=8.90,P<0.05)、术后疼痛持续时间分别为(1.0±0.5)d与(2.5±0.7)d(t=16.69,P<0.05)、住院总费用分别为(4500±500)元与(8000±820)元(t=34.89,P<0.05),免补片组均明显优于TEP组,差异有统计学意义.免补片组无皮下血肿及阴囊水肿发生,TEP组皮下血肿8例(8.7%)(χ~2=6.48,P<0.05).免补片组与TEP组术后48h C-反应蛋白(CRP)分别为(3.9±0.3)mg/dl与(8.8±0.5)mg/dl(t=80.48,P<0.05).所有病例随访(56.9±6.2)个月,免补片组复发率为0,TEP组复发率为2.1%(χ~2=0.51,P>0.05).结论 腹腔镜免补片治疗腹股沟疝安全、可行,恢复快、住院时间短、费用少.     

Prevention of trocar site incisional hernia following laparoscopic ventral hernia repair.

BACKGROUND AND OBJECTIVES: Trocar-site incisional hernia following laparoscopic ventral hernia repair is reported to have a relatively high incidence. The main reasons are trocar diameter and design, pre-existing fascial defects, and some operation- and patient-related factors. The aim of this article to show a new technique of ventral hernia repair that could prevent trocar site incisional hernia. METHODS: After establishing the pneumoperitoneum, three 5-mm ports are inserted in positions according to the site and size of the hernia. The procedure begins by dissection of the adhesions of bowel loops or omentum (if any) from the hernia to clear a good margin for mesh coverage. Then a single 10-mm to 15-mm port (mesh insertion port) is inserted in the center of the ventral hernia depending on the size of the mesh. The mesh is fixed in position with a 5-mm tacker. The peritoneum and underlying superficial fascia are carefully closed before closing the skin. RESULTS: A total of 35 patients were recruited for this method. The mean hospital stay was 1.5 days, the mean age was 50.35 years and the mean operative time was 40 minutes. In all patients, 10x15-cm ePTFE was used. No single incidence of trocar-site incisional hernia occurred during a mean follow-up of 2 years. Three (8.57%) patients developed complications and no mortality was reported. CONCLUSION: The mesh introduction through the port, which is situated at the center of the hernia defect is a simple, cost-effective technique and will prevent trocar-site incisional hernia.