Top

Hernia

Published in:

23-07-2021 | Laparoscopy | Original Article

Comparison of two fascial defect closure methods for laparoscopic incisional hernia repair

Authors: M. Melland-Smith, U. Khan, L. Smith, J. Tan

Published in: Hernia | Issue 3/2022

Abstract

Purpose

Currently there is no consensus regarding the optimal surgical approach to an incisional hernia measuring less than 10 cm. Certain hernia features including defect size, intra-abdominal adhesions, and overlying scar/skin properties contribute to choosing an open versus a laparoscopic approach. This retrospective cohort study was designed to compare incisional hernia defects repaired with laparoscopic suture closure to a hybrid approach with open defect closure, both with laparoscopic intraperitoneal onlay mesh (IPOM) reinforcement.

Methods

We identified 164 consecutive patients who underwent incisional hernia repair from two centers, North York General Hospital (NYGH) and Humber River Hospital (HRH) between 2015 and 2020. Patients were grouped by totally laparoscopic or hybrid fascial closure. Both techniques included laparoscopically placed intra-peritoneal mesh with 5 cm of overlap in all directions. Patients were analyzed by age, sex, body mass index (BMI), ASA class and hernia size. Primary outcomes included surgical site infection (SSI), other wound complications including seroma/hematoma, length of hospital stay, pain reported at follow-up appointment, and hernia recurrence.

Results

Post-operative pain, surgical site infections and seromas did not differ between the totally laparoscopic and hybrid approach. The recurrence rates were 5.8% and 6.8% for the laparoscopic and hybrid group, respectively, which were not significantly different. The time to recurrence was 15 months (range 8–12) in the laparoscopic group and 7 months (range 6–36) in the hybrid group, also not significantly different. The hernia defect size and BMI were significantly higher in the hybrid group, without increased wound complications.

Conclusion

These results suggest that a hybrid approach to incisional ventral hernia repair with open defect closure is comparable to a totally laparoscopic closure. The hybrid technique can help facilitate fascial closure and resection of the hernia sac in patients with higher BMI and hernia defects up to 6 cm.

Pamela D et al (2011) Trocar site hernia after laparoscopic colectomy: a case report and literature review. ISRN Surg 2011:725601. https://doi.org/10.5402/2011/725601CrossRefPubMedPubMedCentral

Mudge M, Hughes LE (1985) Incisional hernia: a 10 year prospective study of incidence and attitudes. Br J Surg 72(1):70–71. https://doi.org/10.1002/bjs.1800720127CrossRefPubMed

Nieuwenhuizen J, Halm JA, Jeekel J, Lange JF (2007) Natural course of incisional hernia and indications for repair. Scand J Surg SJS Off Organ Finn Surg Soc Scand Surg Soc 96(4):293–296. https://doi.org/10.1177/145749690709600406CrossRef

Sneiders D, Yurtkap Y, Kroese LF, Kleinrensink G-J, Lange JF, Gillion J-F (2019) Risk factors for incarceration in patients with primary abdominal wall and incisional hernias: a prospective study in 4472 patients. World J Surg 43(8):1906–1913. https://doi.org/10.1007/s00268-019-04989-xCrossRefPubMed

Chung PJ et al (2017) Predicting 30-day postoperative mortality for emergent anterior abdominal wall hernia repairs using the American College of Surgeons National Surgical Quality Improvement Program database. Hernia J Hernias Abdom Wall Surg 21(3):323–333. https://doi.org/10.1007/s10029-016-1538-yCrossRef

Awaiz A et al (2015) Meta-analysis and systematic review of laparoscopic versus open mesh repair for elective incisional hernia. Hernia J Hernias Abdom Wall Surg 19(3):449–463. https://doi.org/10.1007/s10029-015-1351-zCrossRef

Ahonen-Siirtola M et al (2018) Laparoscopic versus hybrid approach for treatment of incisional ventral hernia: a prospective randomized multicenter study of 1-month follow-up results. Hernia J Hernias Abdom Wall Surg 22(6):1015–1022. https://doi.org/10.1007/s10029-018-1784-2CrossRef

Ahonen-Siirtola M et al (2020) Laparoscopic versus hybrid approach for treatment of incisional ventral hernia: a prospective randomised multicentre study, 1-year results. Surg Endosc 34(1):88–95. https://doi.org/10.1007/s00464-019-06735-9CrossRefPubMed

Tandon A, Pathak S, Lyons NJR, Nunes QM, Daniels IR, Smart NJ (2016) Meta-analysis of closure of the fascial defect during laparoscopic incisional and ventral hernia repair. Br J Surg 103(12):1598–1607. https://doi.org/10.1002/bjs.10268CrossRefPubMed

10.

Ahonen-Siirtola M, Rautio T, Ward J, Kössi J, Ohtonen P, Mäkelä J (2015) Complications in laparoscopic versus open incisional ventral hernia repair. A retrospective comparative study. World J Surg 39(12):2872–2877. https://doi.org/10.1007/s00268-015-3210-6CrossRefPubMed

11.

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

12.

Sharma A, Berger D (2018) The current role of laparoscopic IPOM repair in abdominal wall reconstruction. Hernia 22(5):739–741. https://doi.org/10.1007/s10029-018-1820-2CrossRefPubMed

13.

Nguyen DH, Nguyen MT, Askenasy EP, Kao LS, Liang MK (2014) Primary fascial closure with laparoscopic ventral hernia repair: systematic review. World J Surg 38(12):3097–3104. https://doi.org/10.1007/s00268-014-2722-9CrossRefPubMed

14.

Muysoms FE et al (2009) Classification of primary and incisional abdominal wall hernias. Hernia J Hernias Abdom Wall Surg 13(4):407–414. https://doi.org/10.1007/S10029-009-0518-xCrossRef

15.

Clapp ML, Hicks SC, Awad SS, Liang MK (2013) Trans-cutaneous closure of central defects (TCCD) in laparoscopic ventral hernia repairs (LVHR). World J Surg 37(1):42–51. https://doi.org/10.1007/s00268-012-1810-yCrossRefPubMed

16.

Wiessner R, Vorwerk T, Tolla-Jensen C, Gehring A (2017) Continuous laparoscopic closure of the linea alba with barbed sutures combined with laparoscopic mesh implantation (IPOM plus repair) as a new technique for treatment of abdominal hernias. Front Surg 4:62. https://doi.org/10.3389/fsurg.2017.00062CrossRefPubMedPubMedCentral

17.

Heniford BT, Park A, Ramshaw BJ, Voeller G (2000) Laparoscopic ventral and incisional hernia repair in 407 patients. J Am Coll Surg 190(6):645–650. https://doi.org/10.1016/s1072-7515(00)00280-5CrossRefPubMed

18.

Gonzalez AM, Romero RJ, Seetharamaiah R, Gallas M, Lamoureux J, Rabaza JR (2015) Laparoscopic ventral hernia repair with primary closure versus no primary closure of the defect: potential benefits of the robotic technology. Int J Med Robot Comput Assist Surg MRCAS 11(2):120–125. https://doi.org/10.1002/rcs.1605CrossRef

19.

Sharma A et al (2013) Iatrogenic enterotomy in laparoscopic ventral/incisional hernia repair: a single center experience of 2,346 patients over 17 years. Hernia J Hernias Abdom Wall Surg 17(5):581–587. https://doi.org/10.1007/s10029-013-1122-7CrossRef

20.

Light D, Bawa S (2016) Trans-fascial closure in laparoscopic ventral hernia repair. Surg Endosc 30(12):5228–5231. https://doi.org/10.1007/s00464-016-4868-zCrossRefPubMed

21.

Bansal VK et al (2011) A prospective randomized study comparing suture mesh fixation versus tacker mesh fixation for laparoscopic repair of incisional and ventral hernias. Surg Endosc 25(5):1431–1438. https://doi.org/10.1007/s00464-010-1410-6CrossRefPubMed

22.

Heniford BT, Park A, Ramshaw BJ, Voeller G (2003) Laparoscopic repair of ventral hernias: nine years’ experience with 850 consecutive hernias. Ann Surg 238(3):391–400. https://doi.org/10.1097/01.sla.0000086662.49499.abCrossRefPubMedPubMedCentral

23.

Köckerling F et al (2019) Laparoscopic IPOM versus open sublay technique for elective incisional hernia repair: a registry-based, propensity score-matched comparison of 9907 patients. Surg Endosc 33(10):3361–3369. https://doi.org/10.1007/s00464-018-06629-2CrossRefPubMedPubMedCentral

24.

Singhal V, Szeto P, VanderMeer TJ, Cagir B (2012) Ventral hernia repair: outcomes change with long-term follow-up. JSLS J Soc Laparoendosc Surg 16(3):373–379. https://doi.org/10.4293/108680812X13427982377067CrossRef

25.

Bosanquet DC et al (2015) Systematic review and meta-regression of factors affecting midline incisional hernia rates: analysis of 14,618 patients. PLoS ONE 10(9):e0138745. https://doi.org/10.1371/journal.pone.0138745CrossRefPubMedPubMedCentral

Title: Comparison of two fascial defect closure methods for laparoscopic incisional hernia repair
Authors: M. Melland-Smith
U. Khan
L. Smith
J. Tan
Publication date: 23-07-2021
Publisher: Springer Paris
Keywords: Laparoscopy
Seroma
Incisional Hernia
Published in: Hernia / Issue 3/2022
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI: https://doi.org/10.1007/s10029-021-02443-3

At a glance: The STEP trials

Springer Medicine

Comparison of two fascial defect closure methods for laparoscopic incisional hernia repair

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2022

Adolescent inguinal hernia repair: a review of the literature and recommendations for selective management

Health-related quality of life in abdominal wall hernia: let’s ask patients what matters to them?

A simplified method to evaluate the loss of domain

Validation of ventral hernia risk score in predicting surgical site infections

Adaptation and validation of the Carolinas Comfort Scale: a questionnaire-based cross-sectional study

Guideline-discordant care among females undergoing groin hernia repair: the importance of sex as a biologic variable