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01-10-2019 | Incisional Hernia | Original Article

Short-term comparison between preperitoneal and intraperitoneal onlay mesh placement in robotic ventral hernia repair

Authors: F. Gokcal, S. Morrison, O. Y. Kudsi

Published in: Hernia | Issue 5/2019

Abstract

Purpose

The aim of this study was to compare perioperative results of robotic IPOM (r-IPOM) and robotic TAPP (r-TAPP) in ventral hernia repair, and to identify risk factors associated with postoperative complications.

Methods

After obtaining balanced groups with propensity score matching, the comparative analysis was performed in terms of perioperative and early outcomes. All variables were also examined in a subset analysis in patients with and without complications. Multivariable regression analysis was used to identify independent risk factors associated with the development of complications.

Results

Of 305 r-IPOM and r-TAPP procedures, 104 patients were assigned to each group after propensity score matching. There was no difference in operative times between two groups. Although postoperative complications were largely minor (Clavien–Dindo grade-I and II), the rate of complications was higher in the r-IPOM group within the first 3-weeks (33.3% in r-IPOM vs. 20% in r-TAPP, p = 0.039). At the 3-month visit, outcomes between groups were not different (p = 0.413). Emergency department re-visits within 30-days and surgical site events were also higher in the IPOM group (p = 0.028, p = 0.042, respectively). In regression analysis, the development of complications was associated with incisional hernias (p = 0.040), intraperitoneal mesh position (p = 0.046) and longer procedure duration (p = 0.049).

Conclusion

Our data suggest r-IPOM may be associated with increased complication rates in the immediate postoperative period when compared to r-TAPP. However, at 3 months, outcomes are comparable. More investigation is needed in this area, specifically with regards to long-term follow-up and multicenter data, to determine the true value of extra-peritoneal mesh placement.

Sauerland S, Walgenbach M, Habermalz B, Seiler CM, Miserez M (2011) Laparoscopic versus open surgical techniques for ventral or incisional hernia repair. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.cd007781.pub2 CrossRefPubMed

Donkor C, Gonzalez A, Gallas MR, Helbig M, Weinstein C, Rodriguez J (2017) Current perspectives in robotic hernia repair. Robot Surg 4:57–67. https://doi.org/10.2147/RSRR.S101809 CrossRefPubMedPubMedCentral

Ramshaw BJ, Esartia P, Schwab J, Mason EM, Wilson RA, Duncan TD, Miller J, Lucas GW, Promes J (1999) Comparison of laparoscopic and open ventral herniorrhaphy. Am Surg 65(9):827–831PubMed

Bittner R, Bingener-Casey J, Dietz U, Fabian M, Ferzli G, Fortelny R, Kockerling F, Kukleta J, LeBlanc K, Lomanto D, Misra M, Morales-Conde S, Ramshaw B, Reinpold W, Rim S, Rohr M, Schrittwieser R, Simon T, Smietanski M, Stechemesser B, Timoney M, Chowbey P (2014) Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society [IEHS])-Part III. Surg Endosc 28(2):380–404. https://doi.org/10.1007/s00464-013-3172-4 CrossRefPubMed

Muysoms FE, Miserez M, Berrevoet F, Campanelli G, Champault GG, Chelala E, Dietz UA, Eker HH, El Nakadi I, Hauters P, Hidalgo Pascual M, Hoeferlin A, Klinge U, Montgomery A, Simmermacher RK, Simons MP, Smietanski M, Sommeling C, Tollens T, Vierendeels T, Kingsnorth A (2009) Classification of primary and incisional abdominal wall hernias. Hernia 13(4):407–414. https://doi.org/10.1007/s10029-009-0518-x CrossRefPubMedPubMedCentral

Smith MJ (2017) Hernia surgeons embrace sublay repairs, but loyalty to IPOM remains. General surgery news, The independent monthly newspaper for general surgeons. https://www.generalsurgerynews.com/Article/PrintArticle?articleID=39071. Accessed 19 Sep 2018

Orthopoulos G, Kudsi OY (2018) Feasibility of robotic-assisted transabdominal preperitoneal ventral hernia repair. J Laparoendosc Adv Surg Tech A 28(4):434–438. https://doi.org/10.1089/lap.2017.0595 CrossRefPubMed

Prasad P, Tantia O, Patle NM, Khanna S, Sen B (2011) Laparoscopic ventral hernia repair: a comparative study of transabdominal preperitoneal versus intraperitoneal onlay mesh repair. J Laparoendosc Adv Surg Tech A 21(6):477–483. https://doi.org/10.1089/lap.2010.0572 CrossRefPubMed

Kennedy M, Barrera K, Akelik A, Constable Y, Smith M, Chung P, Sugiyama G (2018) Robotic TAPP Ventral Hernia Repair: Early Lessons Learned at an Inner City Safety Net Hospital. JSLS. https://doi.org/10.4293/jsls.2017.00070 CrossRefPubMedPubMedCentral

10.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefPubMedPubMedCentral

11.

Muysoms FE, Antoniou SA, Bury K, Campanelli G, Conze J, Cuccurullo D, de Beaux AC, Deerenberg EB, East B, Fortelny RH, Gillion JF, Henriksen NA, Israelsson L, Jairam A, Janes A, Jeekel J, Lopez-Cano M, Miserez M, Morales-Conde S, Sanders DL, Simons MP, Smietanski M, Venclauskas L, Berrevoet F, European Hernia S (2015) European Hernia Society guidelines on the closure of abdominal wall incisions. Hernia 19(1):1–24. https://doi.org/10.1007/s10029-014-1342-5 CrossRefPubMed

12.

Thoemmes F (2012) Propensity score matching in SPSS, pdf edn. University of Tubingen, Tubingen

13.

LeBlanc KA, Booth WV (1993) Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethylene: preliminary findings. Surg Laparosc Endosc 3(1):39–41PubMed

14.

Chelala E, Barake H, Estievenart J, Dessily M, Charara F, Alle JL (2016) Long-term outcomes of 1326 laparoscopic incisional and ventral hernia repair with the routine suturing concept: a single institution experience. Hernia 20(1):101–110. https://doi.org/10.1007/s10029-015-1397-y CrossRefPubMed

15.

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.2017.00062 CrossRefPubMedPubMedCentral

16.

Cartes JAM, Morales JM, Grau JMS (2014) Basic concepts in laparoscopic hernia repair. Advances in laparoscopy of the abdominal wall hernia. Springer, New York, pp 37–51CrossRef

17.

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 11(2):120–125. https://doi.org/10.1002/rcs.1605 CrossRef

18.

Gonzalez A, Escobar E, Romero R, Walker G, Mejias J, Gallas M, Dickens E, Johnson CJ, Rabaza J, Kudsi OY (2017) Robotic-assisted ventral hernia repair: a multicenter evaluation of clinical outcomes. Surg Endosc 31(3):1342–1349. https://doi.org/10.1007/s00464-016-5118-0 CrossRefPubMed

19.

Warren JA, Love M (2018) Incisional hernia repair: minimally invasive approaches. Surg Clin N Am 98(3):537–559. https://doi.org/10.1016/j.suc.2018.01.008 CrossRefPubMed

20.

Hilling DE, Koppert LB, Keijzer R, Stassen LP, Oei IH (2009) Laparoscopic correction of umbilical hernias using a transabdominal preperitoneal approach: results of a pilot study. Surg Endosc 23(8):1740–1744. https://doi.org/10.1007/s00464-008-0177-5 CrossRefPubMed

21.

Muysoms FE, Bontinck J, Pletinckx P (2011) Complications of mesh devices for intraperitoneal umbilical hernia repair: a word of caution. Hernia 15(4):463–468. https://doi.org/10.1007/s10029-010-0692-x CrossRefPubMed

22.

Yang PG, Tung LK (2016) Preperitoneal onlay mesh repair for ventral abdominal wall and incisional hernia: a novel technique. Asian J Endosc Surg 9(4):344–347. https://doi.org/10.1111/ases.12295 CrossRefPubMed

23.

Yang GPC (2017) From intraperitoneal onlay mesh repair to preperitoneal onlay mesh repair. Asian J Endosc Surg 10(2):119–127. https://doi.org/10.1111/ases.12388 CrossRefPubMed

24.

Dietz UA, Winkler MS, Hartel RW, Fleischhacker A, Wiegering A, Isbert C, Jurowich C, Heuschmann P, Germer CT (2014) Importance of recurrence rating, morphology, hernial gap size, and risk factors in ventral and incisional hernia classification. Hernia 18(1):19–30. https://doi.org/10.1007/s10029-012-0999-x CrossRefPubMed

25.

Fischer JP, Wink JD, Nelson JA, Kovach SJ 3rd (2014) Among 1706 cases of abdominal wall reconstruction, what factors influence the occurrence of major operative complications? Surgery 155(2):311–319. https://doi.org/10.1016/j.surg.2013.08.014 CrossRefPubMed

26.

Bittner R, Bingener-Casey J, Dietz U, Fabian M, Ferzli GS, Fortelny RH, Kockerling F, Kukleta J, LeBlanc K, Lomanto D, Misra MC, Morales-Conde S, Ramshaw B, Reinpold W, Rim S, Rohr M, Schrittwieser R, Simon T, Smietanski M, Stechemesser B, Timoney M, Chowbey P (2014) Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society [IEHS])-Part 2. Surg Endosc 28(2):353–379. https://doi.org/10.1007/s00464-013-3171-5 CrossRefPubMed

27.

Bittner R, Arregui ME, Bisgaard T, Dudai M, Ferzli GS, Fitzgibbons RJ, Fortelny RH, Klinge U, Kockerling F, Kuhry E, Kukleta J, Lomanto D, Misra MC, Montgomery A, Morales-Conde S, Reinpold W, Rosenberg J, Sauerland S, Schug-Pass C, Singh K, Timoney M, Weyhe D, Chowbey P (2011) Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia [International Endohernia Society (IEHS)]. Surg Endosc 25(9):2773–2843. https://doi.org/10.1007/s00464-011-1799-6 CrossRefPubMedPubMedCentral

Title: Short-term comparison between preperitoneal and intraperitoneal onlay mesh placement in robotic ventral hernia repair
Authors: F. Gokcal
S. Morrison
O. Y. Kudsi
Publication date: 01-10-2019
Publisher: Springer Paris
Keyword: Incisional Hernia
Published in: Hernia / Issue 5/2019
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI: https://doi.org/10.1007/s10029-019-01946-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Short-term comparison between preperitoneal and intraperitoneal onlay mesh placement in robotic ventral hernia repair

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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