Comparison of Two Fascial Defect Closure Methods for Laparoscopic Incisional Hernia Repair

Overview

Journal Hernia

Publisher Springer

Date 2021 Jul 23

PMID 34297250

Citations 2

Authors

M Melland-Smith

U Khan

L Smith

J Tan

Affiliations

Soon will be listed here.

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.

Citing Articles

Hybrid intraperitoneal onlay mesh repair for incisional hernias: a systematic review and meta-analysis.

Marcolin P, Motter S, Brandao G, Lima D, Trindade B, Poli de Figueiredo S Hernia. 2024; 28(6):2055-2067.

PMID: 38990230 DOI: 10.1007/s10029-024-03105-w.

Comment to: "Comparison of two fascial defect closure methods for laparoscopic incisional hernia repair".

Sahu R, Anand A, Singh P, Kumar M Hernia. 2021; 26(4):1223-1224.

PMID: 34453626 DOI: 10.1007/s10029-021-02482-w.

References

Pamela D, Roberto C, Francesco L, Umberto M, Carla M, Vincenzo N . Trocar site hernia after laparoscopic colectomy: a case report and literature review. ISRN Surg. 2011; 2011:725601. PMC: 3200298. DOI: 10.5402/2011/725601. View

Mudge M, Hughes L . Incisional hernia: a 10 year prospective study of incidence and attitudes. Br J Surg. 1985; 72(1):70-1. DOI: 10.1002/bjs.1800720127. View

Sneiders D, Yurtkap Y, Kroese L, Kleinrensink G, Lange J, Gillion J . Risk Factors for Incarceration in Patients with Primary Abdominal Wall and Incisional Hernias: A Prospective Study in 4472 Patients. World J Surg. 2019; 43(8):1906-1913. DOI: 10.1007/s00268-019-04989-x. View

Ahonen-Siirtola M, Nevala T, Vironen J, Kossi J, Pinta T, Niemelainen S . Laparoscopic versus hybrid approach for treatment of incisional ventral hernia: a prospective randomised multicentre study, 1-year results. Surg Endosc. 2019; 34(1):88-95. PMC: 6946755. DOI: 10.1007/s00464-019-06735-9. View

Tandon A, Pathak S, Lyons N, Nunes Q, Daniels I, Smart N . Meta-analysis of closure of the fascial defect during laparoscopic incisional and ventral hernia repair. Br J Surg. 2016; 103(12):1598-1607. DOI: 10.1002/bjs.10268. View

Ahonen-Siirtola M, Rautio T, Ward J, Kossi J, Ohtonen P, Makela J . Complications in Laparoscopic Versus Open Incisional Ventral Hernia Repair. A Retrospective Comparative Study. World J Surg. 2015; 39(12):2872-7. DOI: 10.1007/s00268-015-3210-6. View

Bittner R, Bingener-Casey J, Dietz U, Fabian M, Ferzli G, Fortelny R . Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS)-part 1. Surg Endosc. 2013; 28(1):2-29. PMC: 3872300. DOI: 10.1007/s00464-013-3170-6. View

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

Nguyen D, Nguyen M, Askenasy E, Kao L, Liang M . Primary fascial closure with laparoscopic ventral hernia repair: systematic review. World J Surg. 2014; 38(12):3097-104. DOI: 10.1007/s00268-014-2722-9. View

10.

Clapp M, Hicks S, Awad S, Liang M . Trans-cutaneous Closure of Central Defects (TCCD) in laparoscopic ventral hernia repairs (LVHR). World J Surg. 2012; 37(1):42-51. DOI: 10.1007/s00268-012-1810-y. View

11.

Wiessner R, Vorwerk T, Tolla-Jensen C, Gehring A . 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. 2017; 4:62. PMC: 5676438. DOI: 10.3389/fsurg.2017.00062. View

12.

Heniford B, Park A, Ramshaw B, Voeller G . Laparoscopic ventral and incisional hernia repair in 407 patients. J Am Coll Surg. 2000; 190(6):645-50. DOI: 10.1016/s1072-7515(00)00280-5. View

13.

Light D, Bawa S . Trans-fascial closure in laparoscopic ventral hernia repair. Surg Endosc. 2016; 30(12):5228-5231. DOI: 10.1007/s00464-016-4868-z. View

14.

Bansal V, Misra M, Kumar S, Rao Y, Singhal P, Goswami A . A prospective randomized study comparing suture mesh fixation versus tacker mesh fixation for laparoscopic repair of incisional and ventral hernias. Surg Endosc. 2010; 25(5):1431-8. DOI: 10.1007/s00464-010-1410-6. View

15.

Heniford B, Park A, Ramshaw B, Voeller G . Laparoscopic repair of ventral hernias: nine years' experience with 850 consecutive hernias. Ann Surg. 2003; 238(3):391-9. PMC: 1422707. DOI: 10.1097/01.sla.0000086662.49499.ab. View

16.

Kockerling F, Simon T, Adolf D, Kockerling D, Mayer F, Reinpold W . Laparoscopic IPOM versus open sublay technique for elective incisional hernia repair: a registry-based, propensity score-matched comparison of 9907 patients. Surg Endosc. 2019; 33(10):3361-3369. PMC: 6722046. DOI: 10.1007/s00464-018-06629-2. View

17.

Bosanquet D, Ansell J, Abdelrahman T, Cornish J, Harries R, Stimpson A . Systematic Review and Meta-Regression of Factors Affecting Midline Incisional Hernia Rates: Analysis of 14,618 Patients. PLoS One. 2015; 10(9):e0138745. PMC: 4577082. DOI: 10.1371/journal.pone.0138745. View