Laparoscopic versus open ventral hernia mesh repair: a prospective study |
| |
Authors: | D Lomanto SG Iyer A Shabbir W-K Cheah |
| |
Institution: | (1) Minimally Invasive Surgical Centre, Department of Surgery, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore |
| |
Abstract: | 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. |
| |
Keywords: | Comparative study Hernia mesh repair Incisional hernia Laparoscopic surgery Open surgery Ventral hernia |
本文献已被 PubMed SpringerLink 等数据库收录! |
|