A new three-step hybrid approach is a safe procedure for incisional hernia: early experiences with a single centre retrospective cohort

Abstract

Purpose In this study, a three-step novel surgical technique was developed for incisional hernia, in which a laparoscopic procedure with a mini-laparotomy is combined: so-called ‘three-step incisional hybrid repair’. The aim of this study was to reduce the risk of intestinal lacerations during adhesiolysis and recurrence rate by better symmetrical overlap placement of the mesh. Objectives To evaluate first perioperative outcomes with this technique. Methods From 2016 to 2020, 70 patients (65.7% females) with an incisional hernia of > 2 and ≤ 10 cm underwent a elective three-step incisional hybrid repair in two non-academic hospitals performed by two surgeons specialised in abdominal wall surgery. Intra- and postoperative complications, operation time, hospitalisation time and hernia recurrence were assessed. Results Mean operation time was 100 min. Mean hernia size was 4.8 cm; 45 patients (64.3%) had a hernia of 1–5 cm, 25 patients (35.7%) of 6–10 cm. Eight patients had a grade 1 complication (11.4%), five patients a grade 2 (7.1%), two patients (2.8%) a grade 4 complication and one patient (1.4%) a grade 5 complication. Five patients had an intraoperative complication (7.0%), two enterotomies, one serosa injury, one omentum bleeding and one laceration of an epigastric vessel. Mean length of stay was 3.3 days. Four patients (5.6%) developed a hernia recurrence during a mean follow-up of 19.5 weeks. Conclusion A three-step hybrid incisional hernia repair is a safe alternative for incisional hernia repair. Intraoperative complications rate was low.

Analysis of Postoperative Complications in Repair Ofincisional Ventral Hernias Using Allo- And Autografts

“…Synthetic mesh remain in the body for life, provide adequate mechanical support, but are associated with postoperative complications such as infection. Biological implants are obtained from xenografts or their own tissues less susceptible to infections; however, their mechanical strength may be too weak depending on the characteristics of the hernial defect [5,6,7]. Unfortunately, recurrent hernia is itself a risk factor for repetition of subsequent surgeries, meaning that many patients are in the vicious circle of numerous failed surgeries.…”