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Open Access 09-05-2024 | Incisional Hernia | Review

Ventral hernia repair in India: a Delphi consensus

Authors: P. Chowbey, R. Wadhawan, D. Subramanian, D. Bhandarkar, J. Gandhi, K. L. Kumari, M. Baijal, M. Khetan, M. S. Kathalagiri, P. Khandelwal, P. Lal, P. Dasgupta, P. Balachandran, S. Dave, S. J. Baig, V. Soni

Published in: Hernia | Issue 5/2024

Abstract

Purpose

While research on inguinal hernias is well-documented, ventral/incisional hernias still require investigation. In India, opinions on laparoscopic ventral hernia repair (LVHR) techniques are contested. The current consensus aims to standardize LVHR practice and identify gaps and unfulfilled demands that compromise patient safety and therapeutic outcomes.

Methods

Using the modified Delphi technique, panel of 14 experts (general surgeons) came to a consensus. Two rounds of consensus were conducted online. An advisory board meeting was held for the third round, wherein survey results were discussed and the final statements were decided with supporting clinical evidence.

Results

Experts recommended intraperitoneal onlay mesh (IPOM) plus/trans-abdominal retromuscular/extended totally extraperitoneal/mini- or less-open sublay operation/transabdominal preperitoneal/trans-abdominal partial extra-peritoneal/subcutaneous onlay laparoscopic approach/laparoscopic intracorporeal rectus aponeuroplasty as valid minimal access surgery (MAS) options for ventral hernia (VH). Intraperitoneal repair technique is the preferred MAS procedure for primary umbilical hernia < 4 cm without diastasis; incisional hernia in the presence of a vertical single midline incision; symptomatic hernia, BMI > 40 kg/m², and defect up to 4 cm; and for MAS VH surgery with grade 3/4 American Society of Anaesthesiologists. IPOM plus is the preferred MAS procedure for midline incisional hernia of width < 4 cm in patients with a previous laparotomy. Extraperitoneal repair technique is the preferred MAS procedure for L3 hernia < 4 cm; midline hernias < 4 cm with diastasis; and M5 hernia.

Conclusion

The consensus statements will help standardize LVHR practices, improve decision-making, and provide guidance on MAS in VHR in the Indian scenario.

Mathes T, Prediger B, Walgenbach M, Siegel R (2021) Mesh fixation techniques in primary ventral or incisional hernia repair. Cochrane Database Syst Rev 5:CD011563. https://doi.org/10.1002/14651858.CD011563.pub2CrossRefPubMed

Pandya B, Huda T, Gupta D, Mehra B, Narang R (2021) Abdominal wall hernias: an epidemiological profile and surgical experience from a rural medical college in central India. Surg J (N Y) 7:e41–e46. https://doi.org/10.1055/s-0040-1722744CrossRefPubMed

Mitura K (2020) New techniques in ventral hernia surgery—an evolution of minimally invasive hernia repairs. Pol Przegl Chir 92:38–46. https://doi.org/10.5604/01.3001.0014.1898CrossRefPubMed

Henriksen NA, Jorgensen LN, Friis-Andersen H, Helgstrand F, Danish Hernia Database (2022) Open versus laparoscopic umbilical and epigastric hernia repair: nationwide data on short and long term outcomes. Surg Endosc 36:526–532. https://doi.org/10.1007/s00464-021-08312-5CrossRefPubMed

Köckerling F, Hoffmann H, Mayer F et al (2021) What are the trends in incisional hernia repair? Real-world data over 10 years from the Herniamed registry. Hernia 25:255–265. https://doi.org/10.1007/s10029-020-02319-yCrossRefPubMed

Schlosser KA, Arnold MR, Otero J et al (2019) Deciding on optimal approach for ventral hernia repair: laparoscopic or open. J Am Coll Surg 228:54–65. https://doi.org/10.1016/j.jamcollsurg.2018.09.004CrossRefPubMed

Sharma A, Sinha C, Baijal M, Soni V, Khullar R, Chowbey P (2021) Hybrid approach for ventral incisional hernias of the abdominal wall: a systematic review of the literature. J Minim Access Surg 17:7. https://doi.org/10.4103/jmas.JMAS_146_19CrossRefPubMed

Rege SA, Churiwala JJ, A Kaderi AS, Kshirsagar KF, Dalvi AN (2021) Comparison of efficacy and safety of the enhanced-view totally extraperitoneal (eTEP) and transabdominal (TARM) minimal access techniques for retromuscular placement of prosthesis in the treatment of irreducible midline ventral hernia. J Minim Access Surg 17:519. https://doi.org/10.4103/jmas.JMAS_145_20CrossRefPubMedPubMedCentral

Mishra A, Jabbal HS, Nar AS, Mangla R (2023) Analysis of ‘enhanced-view totally extra peritoneal’ (eTEP) approach for ventral hernia: early results. J Minim Access Surg 19:361–370. https://doi.org/10.4103/jmas.jmas_129_22CrossRefPubMed

10.

Baig SJ, Priya P (2019) Extended totally extraperitoneal repair (eTEP) for ventral hernias: short-term results from a single centre. J Minim Access Surg 15:198. https://doi.org/10.4103/jmas.JMAS_29_18CrossRefPubMedPubMedCentral

11.

Li J, Wang Y, Wu L (2022) The comparison of eTEP and IPOM in ventral and incisional hernia repair: a systematic review and meta-analysis. Surg Laparosc Endosc Percutan Techn 32:252–258. https://doi.org/10.1097/SLE.0000000000001035CrossRef

12.

Masurkar AA (2020) Laparoscopic trans-abdominal Retromuscular (TARM) repair for ventral hernia: a novel, low-cost technique for sublay and posterior component separation. World J Surg 44:1081–1085. https://doi.org/10.1007/s00268-019-05298-zCrossRefPubMed

13.

Reinpold W, Schröder M, Berger C et al (2019) Mini- or Less-open Sublay Operation (MILOS): a new minimally invasive technique for the extraperitoneal mesh repair of incisional hernias. Ann Surg 269:748–755. https://doi.org/10.1097/SLA.0000000000002661CrossRefPubMed

14.

DeCarvalho JPV, Pivetta LGA, Amaral PHF et al (2023) Endoscopic Mini-or Less-Open Sublay Operation (E/MILOS) in ventral hernia repair: a minimally invasive alternative technique. Rev Col Bras Cir 50:e20233405. https://doi.org/10.1590/0100-6991e-20233405-enCrossRefPubMed

15.

Maatouk M, Kbir GH, Mabrouk A et al (2022) Can ventral TAPP achieve favorable outcomes in minimally invasive ventral hernia repair? A systematic review and meta-analysis. Hernia 27:729–739. https://doi.org/10.1007/s10029-022-02709-4CrossRefPubMed

16.

Kulaçoğlu H (2015) Current options in umbilical hernia repair in adult patients. Ulus Cerrahi Derg 31:157. https://doi.org/10.5152/UCD.2015.2955CrossRefPubMedPubMedCentral

17.

Earle D, Roth JS, Saber A et al (2016) SAGES guidelines for laparoscopic ventral hernia repair. Surg Endosc 30:3163–3183. https://doi.org/10.1007/s00464-016-5072-xCrossRefPubMed

18.

Bittner R, Bingener-Casey J, Dietz U et al (2014) Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS)—Part 1. Surg Endosc 28:2–29. https://doi.org/10.1007/s00464-013-3170-6CrossRefPubMed

19.

Melkemichel M, Bringman S, Granåsen G, Widhe B (2021) SUMMER Trial: Mesh versus suture repair in small umbilical hernias in adults—a study protocol for a prospective randomized double-blind multicenter clinical trial. Trials 22:411. https://doi.org/10.1186/s13063-021-05366-7CrossRefPubMedPubMedCentral

20.

Sanjay P, Reid TD, Davies EL, Arumugam PJ, Woodward A (2005) Retrospective comparison of mesh and sutured repair for adult umbilical hernias. Hernia 9:248–251. https://doi.org/10.1007/s10029-005-0342-xCrossRefPubMed

21.

Halm JA, Heisterkamp J, Veen HF, Weidema WF (2005) Long-term follow-up after umbilical hernia repair: are there risk factors for recurrence after simple and mesh repair. Hernia 9:334–337. https://doi.org/10.1007/s10029-005-0010-1CrossRefPubMed

22.

Polat C, Dervisoglu A, Senyurek G, Bilgin M, Erzurumlu K, Ozkan K (2005) Umbilical hernia repair with the Prolene® hernia system. Am J Surg 190:61–64. https://doi.org/10.1016/j.amjsurg.2004.09.021CrossRefPubMed

23.

Stabilini C, Stella M, Frascio M et al (2009) Mesh versus direct suture for the repair of umbilical and epigastric hernias. Ten-year experience Ann Ital Chir 80:183–187PubMed

24.

Kaufmann R, Halm JA, Eker HH et al (2018) Mesh versus suture repair of umbilical hernia in adults: a randomised, double-blind, controlled, multicentre trial. Lancet 391:860–869. https://doi.org/10.1016/S0140-6736(18)30298-8CrossRefPubMed

25.

Shrestha D, Shrestha A, Shrestha B (2019) Open mesh versus suture repair of umbilical hernia: meta-analysis of randomized controlled trials. Int J Surg 62:62–66. https://doi.org/10.1016/j.ijsu.2018.12.015CrossRefPubMed

26.

Bittner R, Bain K, Bansal VK et al (2019) Update of Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS))-Part A. Surg Endosc 33:3069–3139. https://doi.org/10.1007/s00464-019-06907-7CrossRefPubMedPubMedCentral

27.

Shinde PH, Chakravarthy V, Karvande R, Mahadik K, Gandhi J (2022) A novel modification of subcutaneous onlay endoscopic repair of midline ventral hernias with diastasis recti: an Indian experience. Cureus 14:e26004. https://doi.org/10.7759/cureus.26004CrossRefPubMedPubMedCentral

28.

Henriksen NA, Kaufmann R, Simons MP et al (2020) EHS and AHS guidelines for treatment of primary ventral hernias in rare locations or special circumstances. BJS Open 4:342–353. https://doi.org/10.1002/bjs5.50252CrossRefPubMedPubMedCentral

29.

Capitano S (2017) Laparoscopic transabdominal preperitoneal approach for umbilical hernia with rectus diastasis. Asian J Endosc Surg 10:334–335. https://doi.org/10.1111/ases.12365CrossRefPubMed

30.

Blonk L, Civil YA, Kaufmann R, Ket JCF, van der Velde S (2019) A systematic review on surgical treatment of primary epigastric hernias. Hernia 23:847–857. https://doi.org/10.1007/s10029-019-02017-4CrossRefPubMedPubMedCentral

31.

Sikar HE, Çetin K, Eyvaz K, Kaptanoglu L, Küçük HF (2017) Laparoscopic repair of large suprapubic hernias. Wideochir Inne Tech Maloinwazyjne 12:245–250. https://doi.org/10.5114/wiitm.2017.68794CrossRefPubMedPubMedCentral

32.

Hirasa T, Pickleman J, Shayani V (2001) Laparoscopic repair of parapubic hernia. Arch Surg 136:1314–1317. https://doi.org/10.1001/archsurg.136.11.1314CrossRefPubMed

33.

Maemoto R, Tsujinaka S, Kakizawa N et al (2022) Laparoscopic repair of suprapubic incisional hernia using a modified transabdominal partial extraperitoneal technique. Asian J Endosc Surg 15:872–876. https://doi.org/10.1111/ases.13066CrossRefPubMed

34.

Varnell B, Bachman S, Quick J, Vitamvas M, Ramshaw B, Oleynikov D (2008) Morbidity associated with laparoscopic repair of suprapubic hernias. Am J Surg 196:983–987. https://doi.org/10.1016/j.amjsurg.2008.08.006CrossRefPubMed

35.

Albrecht HC, Trawa M, Köckerling F, Hukauf M, Gretschel S (2020) Laparoscopic vs open surgical repair of subxiphoidal hernia following median sternotomy for coronary bypass: analysis of the Herniamed Registry. Front Surg 7:580116. https://doi.org/10.3389/fsurg.2020.580116CrossRefPubMedPubMedCentral

36.

Raakow J, Schulte-Mäter J, Callister Y et al (2018) A comparison of laparoscopic and open repair of subxiphoid incisional hernias. Hernia 22:1083–1088. https://doi.org/10.1007/s10029-018-1815-zCrossRefPubMed

37.

Halm JA, Lip H, Schmitz PI, Jeekel J (2009) Incisional hernia after upper abdominal surgery: a randomized controlled trial of midline versus transverse incision. Hernia 13:275–280. https://doi.org/10.1007/s10029-008-0469-7CrossRefPubMedPubMedCentral

38.

Hope WW, Tuma F (2023) Incisional Hernia. In: StatPearls [Internet]. StatPearls Publishing, Treasure Island

39.

Brown SR, Goodfellow PB (2005) Transverse verses midline incisions for abdominal surgery. Cochrane Database Syst Rev 2005:CD005199. https://doi.org/10.1002/14651858.CD005199.pub2CrossRefPubMedPubMedCentral

40.

Köckerling F, Lammers B (2018) Open intraperitoneal onlay mesh (IPOM) technique for incisional hernia repair. Front Surg 5:66. https://doi.org/10.3389/fsurg.2018.00066CrossRefPubMedPubMedCentral

41.

Yang X, Jiang L, Li Y, Liu J, Fan JK (2018) Laparoscopic repair of multiple incisional hernias in a single midline incision by double composite mesh. J Vis Surg 4:58. https://doi.org/10.21037/jovs.2018.01.01CrossRefPubMedPubMedCentral

42.

Jairam AP, López-Cano M, Garcia-Alamino JM et al (2020) Prevention of incisional hernia after midline laparotomy with prophylactic mesh reinforcement: a meta-analysis and trial sequential analysis. BJS Open 4:357–368. https://doi.org/10.1002/bjs5.50261CrossRefPubMedPubMedCentral

43.

Palanivelu C, Jani KV, Senthilnathan P, Parthasarathi R, Madhankumar MV, Malladi VK (2007) Laparoscopic sutured closure with mesh reinforcement of incisional hernias. Hernia 11:223–228. https://doi.org/10.1007/s10029-007-0200-0CrossRefPubMed

44.

Muysoms FE, Miserez M, Berrevoet F et al (2009) Classification of primary and incisional abdominal wall hernias. Hernia 13:407–414. https://doi.org/10.1007/s10029-009-0518-xCrossRefPubMedPubMedCentral

45.

Liang C, Zheng R, Xing X, Chen J, Chen F (2023) The application of Compont gel for sublay mesh fixation in subcostal hernia repair: a retrospective study. Res Sq. https://doi.org/10.21203/rs.3.rs-2829456/v1CrossRefPubMedPubMedCentral

46.

Tsujinaka S, Nakabayashi Y, Kakizawa N, Kikugawa R, Toyama N, Rikiyama T (2018) Laparoscopic and percutaneous repair of a large midline incisional hernia extending to the bilateral subcostal region: a case report. Int J Surg Case Rep 47:14–18. https://doi.org/10.1016/j.ijscr.2018.04.018CrossRefPubMedPubMedCentral

47.

Cavalli M, Aiolfi A, Morlacchi A (2021) An extraperitoneal approach for complex flank, iliac, and lumbar hernia. Hernia 25:535–544. https://doi.org/10.1007/s10029-020-02214-6CrossRefPubMed

48.

Thomas JD, Gentle CK, Krpata DM et al (2022) Comparing rates of bowel injury for laparoscopic and robotic ventral hernia repair: a retrospective analysis of the abdominal core health quality collaborative. Hernia 26:1251–1258. https://doi.org/10.1007/s10029-022-02564-3CrossRefPubMed

49.

Henriksen NA, Friis-Andersen H, Jorgensen LN, Helgstrand F (2021) Open versus laparoscopic incisional hernia repair: nationwide database study. BJS Open 5:zraa010. https://doi.org/10.1093/bjsopen/zraa010CrossRefPubMedPubMedCentral

50.

Chowbey PK, Pithawala M, Khullar R, Sharma A, Soni V, Baijal M (2006) Complications in groin hernia surgery and the way out. J Minim Access Surg 2:174. https://doi.org/10.4103/0972-9941.27734CrossRefPubMedPubMedCentral

51.

Chmatal P, Keil R (2020) Inguinal tumorous mass–an uncommon late manifestation of chronic organized hematoma after laparoscopic transabdominal preperitoneal inguinal hernia repair: two cases report. Int J Surg Case Rep 66:215–217. https://doi.org/10.1016/j.ijscr.2019.12.016CrossRefPubMed

52.

Nguyen SQ, Divino CM, Buch KE et al (2008) Postoperative pain after laparoscopic ventral hernia repair: a prospective comparison of sutures versus tacks. JSLS 12:113PubMedPubMedCentral

53.

Meyer A, Bonnet L, Bourbon M, Blanc P (2015) Totally extraperitoneal (TEP) endoscopic inguinal hernia repair with TAP (transversus abdominis plane) block as a day-case: a prospective cohort study. J Visc Surg 152:155–159. https://doi.org/10.1016/j.jviscsurg.2014.12.005CrossRefPubMed

54.

Feierman DE, Kronenfeld M, Gupta PM, Younger N, Logvinskiy E (2014) Liposomal bupivacaine infiltration into the transversus abdominis plane for postsurgical analgesia in open abdominal umbilical hernia repair: results from a cohort of 13 patients. J Pain Res 7:477–482. https://doi.org/10.2147/JPR.S65151CrossRefPubMedPubMedCentral

55.

Paasch C, Aljedani N, Ortiz P et al (2020) The transversus abdominis plane block may reduce early postoperative pain after laparoscopic ventral hernia repair: a matched pair analysis. Ann Med Surg (Lond) 55:294–299. https://doi.org/10.1016/j.amsu.2020.05.044CrossRefPubMed

56.

Jamry A, Jałyński M, Piskorz L, Brocki M (2013) Assessment of adhesion formation after laparoscopic intraperitoneal implantation of dynamesh IPOM mesh. Arch Med Sci 9:487–492. https://doi.org/10.5114/aoms.2013.35345CrossRefPubMedPubMedCentral

57.

Chowbey PK, Sharma A, Khullar R, Mann V, Baijal M, Vashistha A (2000) Laparoscopic ventral hernia repair. J Laparoendosc Adv Surg Tech 10:79–84. https://doi.org/10.1089/lap.2000.10.79CrossRef

58.

Bougard H, Coolen D, de Beer R et al (2016) HIG (SA) Guidelines for the management of ventral hernias. S Afr J Surg 54:1–29

59.

Karimian F, Mohammadzadeh N, Jamal M, Ataei-Ashtiani Z (2022) Laparoscopic intraperitoneal onlay mesh (IPOM) repair in management of inguinal hernia: a retrospective cohort study. Clin Surg J 3:1–6

60.

Olmi S, Uccelli M, Cesana GC et al (2020) Laparoscopic ventral hernia repair in bariatric patients: the role of defect size and deferred repair. Obes Surg 30:3905–3911. https://doi.org/10.1007/s11695-020-04747-2CrossRefPubMed

61.

Baig SJ, Priya P (2021) Management of ventral hernia in patients with BMI > 30 Kg/m²: outcomes based on an institutional algorithm. Hernia 25:689–699. https://doi.org/10.1007/s10029-020-02318-zCrossRefPubMed

62.

Campanile FC, Podda M, Pecchini F et al (2023) Laparoscopic treatment of ventral hernias: the Italian national guidelines. Updates Surg 75:1305–1336. https://doi.org/10.1007/s13304-023-01534-3CrossRefPubMedPubMedCentral

63.

Holihan JL, Alawadi ZM, Harris JW et al (2016) Ventral hernia: Patient selection, treatment, and management. Curr Probl Surg 53:307–354. https://doi.org/10.1067/j.cpsurg.2016.06.003CrossRefPubMed

64.

Baig SJ, Priya P (2018) Tailored approach to ventral hernia: our proposed algorithm. Indian J Surg 80:205–206. https://doi.org/10.1007/s12262-018-1736-1CrossRefPubMedPubMedCentral

65.

Misiakos EP, Machairas A, Patapis P, Liakakos T (2008) Laparoscopic ventral hernia repair: pros and cons compared with open hernia repair. JSLS 12:117–125PubMedPubMedCentral

66.

Bellido Luque J, Gomez Rosado JC, Bellido Luque A et al (2021) Endoscopic retromuscular technique (eTEP) vs conventional laparoscopic ventral or incisional hernia repair with defect closure (IPOM+ ) for midline hernias. A case-control study. Hernia 25:1061–1070. https://doi.org/10.1007/s10029-021-02373-0CrossRefPubMed

67.

Basukala S, Tamang A, Rawal SB et al (2022) Comparison of outcomes of laparoscopic hernioplasty with and without fascial repair (IPOM-Plus vs IPOM) for ventral hernia: a retrospective cohort study. Ann Med Surg (Lond) 80:104297. https://doi.org/10.1016/j.amsu.2022.104297CrossRefPubMed

68.

Gupta P, Kapoor K, Kundra D, Khanna AP, Arora C, Agarwal A (2020) Laparoscopic intraperitoneal onlay mesh repair (intraperitoneal onlay mesh plus) in 429 patients: our experience. Int J Abdom Wall Hernia Surg 3:144–147. https://doi.org/10.4103/ijawhs.ijawhs_19_20CrossRef

Title: Ventral hernia repair in India: a Delphi consensus
Authors: P. Chowbey
R. Wadhawan
D. Subramanian
D. Bhandarkar
J. Gandhi
K. L. Kumari
M. Baijal
M. Khetan
M. S. Kathalagiri
P. Khandelwal
P. Lal
P. Dasgupta
P. Balachandran
S. Dave
S. J. Baig
V. Soni
Publication date: 09-05-2024
Publisher: Springer Paris
Keywords: Incisional Hernia
Laparotomy
Laparotomy
Published in: Hernia / Issue 5/2024
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI: https://doi.org/10.1007/s10029-024-03062-4

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