Top

Hernia

Published in:

22-08-2022 | Seroma | Original Article

Short-term complications after minimally invasive retromuscular ventral hernia repair: no need for preoperative weight loss or smoking cessation?

Authors: J. R. Ekmann, M. W. Christoffersen, K. K. Jensen

Published in: Hernia | Issue 5/2022

Abstract

Purpose

Obesity and smoking are associated with postoperative wound complications following open hernia repair. However, with the advancements in minimally invasive surgical techniques, we hypothesized that obese and/or smoking patients undergoing minimally invasive repairs were not subjected to an increased risk of postoperative surgical complications. As opposed to nonobese and/or nonsmoking patients.

Methods

This was a retrospective cohort study including patients undergoing minimally invasive retromuscular repair at a single university hospital. Patients were divided into two groups according to exposure; obese vs. nonobese and smoking vs. nonsmoking. One month postoperatively, all patients underwent clinical follow-up. The main outcome was surgical site occurrence (SSO).

Results

A total of 94 patients were included, undergoing both laparoscopic (n = 32) and robotic (n = 62) retromuscular repair. Of these, 7.7% of the obese patients had SSO when compared with 19.1% of the nonobese patients. A total of 17.2% of the nonsmokers had SSO compared with 13.3% of the active smokers. Of the nonsmokers, 12.5% developed seroma and 6.2% hematoma postoperatively, the corresponding numbers were 13.3% and 0% among the active smokers. After multivariable analysis, there was no significant risk factors for developing postoperative SSO.

Conclusion

There was no association between obesity or smoking and surgical complication in patients undergoing minimally invasive retromuscular repair. If the results of the current study are confirmed, patients who are unable to obtain weight loss or smoking cessation may be offered minimally invasive retromuscular ventral hernia repair without inducing an increased risk of short-term complications.

Available only for authorised users

Jensen KK, Emmertsen KJ, Laurberg S, Krarup PM (2020) Long-term impact of incisional hernia on quality of life after colonic cancer resection. Hernia 24(2):265–272. https://doi.org/10.1007/s10029-019-01978-wCrossRefPubMed

Oma E, Jensen KK, Jorgensen LN (2016) Recurrent umbilical or epigastric hernia during and after pregnancy: a nationwide cohort study. Surg (United States) 159(6):1677–1683. https://doi.org/10.1016/j.surg.2015.12.025CrossRef

Christoffersen MW, Westen M, Rosenberg J, Helgstrand F, Bisgaard T (2020) Closure of the fascial defect during laparoscopic umbilical hernia repair: a randomized clinical trial. Br J Surg 107(3):200–208. https://doi.org/10.1002/bjs.11490CrossRefPubMed

Bui NH, Jørgensen LN, Jensen KK (2021) Laparoscopic intraperitoneal versus enhanced-view totally extraperitoneal retromuscular mesh repair for ventral hernia: a retrospective cohort study. Surg Endosc. https://doi.org/10.1007/s00464-021-08436-8CrossRefPubMed

Belyansky I, Daes J, Radu VG et al (2018) A novel approach using the enhanced-view totally extraperitoneal (eTEP) technique for laparoscopic retromuscular hernia repair. Surg Endosc 32(3):1525–1532. https://doi.org/10.1007/s00464-017-5840-2CrossRefPubMed

Muysoms F, Van Cleven S, Pletinckx P, Ballecer C, Ramaswamy A (2018) Robotic transabdominal retromuscular umbilical prosthetic hernia repair (TARUP): observational study on the operative time during the learning curve. Hernia 22(6):1101–1111. https://doi.org/10.1007/s10029-018-1825-xCrossRefPubMed

Petro CC, Prabhu AS (2018) Preoperative planning and patient optimization. Surg Clin North Am 98(3):483–497. https://doi.org/10.1016/j.suc.2018.01.005CrossRefPubMed

Lindström D, Azodi OS, Wladis A et al (2008) Effects of a perioperative smoking cessation intervention on postoperative complications: a randomized trial. Ann Surg 248(5):739–745. https://doi.org/10.1097/SLA.0b013e3181889d0dCrossRefPubMed

Liang MK, Bernardi K, Holihan JL et al (2018) Modifying risks in ventral hernia patients with prehabilitation: a randomized controlled trial. Ann Surg 268(4):674–680. https://doi.org/10.1097/SLA.0000000000002961CrossRefPubMed

10.

Sauerland S, Korenkov M, Kleinen T, Arndt M, Paul A (2004) Obesity is a risk factor for recurrence after incisional hernia repair. Hernia 8(1):42–46. https://doi.org/10.1007/s10029-003-0161-xCrossRefPubMed

11.

Juvany M, Hoyuela C, Carvajal F, Trias M, Martrat A, Ardid J (2018) Long-term follow-up (at 5 years) of midline incisional hernia repairs using a primary closure and prosthetic onlay technique: recurrence and quality of life. Hernia 22(2):319–324. https://doi.org/10.1007/s10029-018-1730-3CrossRefPubMed

12.

Alkhatib H, Tastaldi L, Krpata DM et al (2019) Impact of modifiable comorbidities on 30-day wound morbidity after open incisional hernia repair. Surg (United States) 166(1):94–101. https://doi.org/10.1016/j.surg.2019.03.011CrossRef

13.

Kudsi OY, Gokcal F (2021) Lateral approach totally extraperitoneal (TEP) robotic retromuscular ventral hernia repair. Hernia 25(1):211–222. https://doi.org/10.1007/s10029-019-02082-9CrossRefPubMed

14.

DeBord J, Novitsky Y, Fitzgibbons R, Miserez M, Montgomery A (2018) SSI, SSO, SSE, SSOPI: the elusive language of complications in hernia surgery. Hernia 22(5):737–738. https://doi.org/10.1007/s10029-018-1813-1CrossRefPubMed

15.

Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med 147(8):573–577. https://doi.org/10.7326/0003-4819-147-8-200710160-00010CrossRef

16.

Jensen KK, East B, Jisova B et al (2022) The European hernia society prehabilitation project: a systematic review of patient prehabilitation prior to ventral hernia surgery. Hernia. https://doi.org/10.1007/S10029-022-02573-2CrossRefPubMed

17.

Juul N, Henriksen NA, Jensen KK (2021) Increased risk of postoperative complications with retromuscular mesh placement in emergency incisional hernia repair: a nationwide register-based cohort study. Scand J Surg 110(2):193–198. https://doi.org/10.1177/1457496920966237CrossRefPubMed

18.

Henriksen NA, Jensen KK, Muysoms F (2019) Robot-assisted abdominal wall surgery: a systematic review of the literature and meta-analysis. Hernia 23(1):17–27. https://doi.org/10.1007/S10029-018-1872-3CrossRefPubMed

19.

Morrell ALG, Morrell AC, Cavazzola LT et al (2021) Robotic assisted eTEP ventral hernia repair: Brazilian early experience. Hernia 25(3):765–774. https://doi.org/10.1007/S10029-020-02233-3CrossRefPubMed

20.

Petro CC, Zolin S, Krpata D et al (2021) Patient-reported outcomes of robotic vs laparoscopic ventral hernia repair with intraperitoneal mesh: the PROVE-IT randomized clinical trial. JAMA Surg 156(1):22–29. https://doi.org/10.1001/JAMASURG.2020.4569CrossRefPubMed

21.

Olavarria OA, Bernardi K, Shah SK et al (2020) Robotic versus laparoscopic ventral hernia repair: multicenter, blinded randomized controlled trial. BMJ. https://doi.org/10.1136/bmj.m2457CrossRefPubMedPubMedCentral

22.

Jensen KK (2020) Laparoscopic versus robot assisted repair of ventral hernia. BMJ. https://doi.org/10.1136/bmj.m2480CrossRefPubMedPubMedCentral

23.

Jain M, Krishna A, Prakash O et al (2022) Comparison of extended totally extra peritoneal (eTEP) vs intra peritoneal onlay mesh (IPOM) repair for management of primary and incisional hernia in terms of early outcomes and cost effectiveness-a randomized controlled trial. Surg Endosc. https://doi.org/10.1007/S00464-022-09180-3CrossRefPubMed

24.

Carbonell AM, Criss CN, Cobb WS, Novitsky YW, Rosen MJ (2013) Outcomes of synthetic mesh in contaminated ventral hernia repairs. J Am Coll Surg 217(6):991–998. https://doi.org/10.1016/j.jamcollsurg.2013.07.382CrossRefPubMed

25.

Henriksen NA, Friis-Andersen H, Jorgensen LN, Helgstrand F (2021) Open versus laparoscopic incisional hernia repair: nationwide database study. BJS Open. https://doi.org/10.1093/BJSOPEN/ZRAA010CrossRefPubMedPubMedCentral

26.

Oma E, Jensen KK, Jorgensen LN, Bisgaard T (2020) Incisional hernia repair in women of childbearing age: a nationwide propensity-score matched study. Scand J Surg 109(4):295–300. https://doi.org/10.1177/1457496919874482CrossRefPubMed

27.

Jensen KK, Backer V, Jorgensen LN (2017) Abdominal wall reconstruction for large incisional hernia restores expiratory lung function. Surg (United States) 161(2):517–524. https://doi.org/10.1016/j.surg.2016.08.015CrossRef

28.

Jensen KK, Munim K, Kjaer M, Jorgensen LN (2017) Abdominal wall reconstruction for incisional hernia optimizes truncal function and quality of life: a prospective controlled study. Ann Surg 265(6):1235–1240. https://doi.org/10.1097/SLA.0000000000001827CrossRefPubMed

29.

Jensen KK, Henriksen NA, Harling H (2014) Standardized measurement of quality of life after incisional hernia repair: a systematic review. Am J Surg 208(3):485–493. https://doi.org/10.1016/j.amjsurg.2014.04.004CrossRefPubMed

30.

Wolf LL, Ejiofor JI, Wang Y et al (2019) Management of reducible ventral hernias: clinical outcomes and cost-effectiveness of repair at diagnosis versus watchful waiting. Ann Surg 269(2):358–366. https://doi.org/10.1097/SLA.0000000000002507CrossRefPubMed

Title: Short-term complications after minimally invasive retromuscular ventral hernia repair: no need for preoperative weight loss or smoking cessation?
Authors: J. R. Ekmann
M. W. Christoffersen
K. K. Jensen
Publication date: 22-08-2022
Publisher: Springer Paris
Keywords: Seroma
Incisional Hernia
Published in: Hernia / Issue 5/2022
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI: https://doi.org/10.1007/s10029-022-02663-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Short-term complications after minimally invasive retromuscular ventral hernia repair: no need for preoperative weight loss or smoking cessation?

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 5/2022

National epidemiologic trends (2008–2018) in the United States for the incidence and expenditures associated with incisional hernia in relation to abdominal surgery

Emergency repair and smoking predict recurrence in a large cohort of ventral hernia patients

Insidious development of posterior rectus sheath herniation

Outcomes of posterior component separation with transversus abdominis release (TAR) in large and other complex ventral hernias: a single-surgeon experience

The combination of the three modifications of the component separation technique in the management of complex subcostal abdominal wall hernia

Truncal function after abdominal wall reconstruction via transversus abdominis muscle release (TAR) for large incisional hernias: a prospective case–control study