Hybrid operation technique for incisional hernia repair: a systematic review and meta-analysis of intra- and postoperative complications

Abstract

Background Incisional hernia (IH) occurs approximately in 15% of patients after midline surgery. Surgical treatment for IHs include a solely open or solely laparoscopic approach with mesh placement. Recently, hybrid (combined laparoscopic and open) approaches have been introduced. This systematic review evaluates perioperative complications of hybrid incisional hernia repair (HIHR). Methods EMBASE, Medline via OvidSP, Web of Science, Cochrane and Google Scholar databases were searched. Studies providing data on intra- and postoperative complications in patients who underwent HIHR were included. Data on intra- and postoperative complications were extracted and meta-analyses were performed. Study quality was assessed with the Newcastle Ottowa Scale, ROBINS-I tool, and Cochrane risk of bias. PROSPERO registration: CRD42020175053. Results Eleven studies (n = 1681 patients) were included. Five studies compared intra-operative complications between HIHR and laparoscopic incisional hernia repair (LIHR) with a pooled incidence of 1.8% in HIHR group and 2.8% in LIHR group (p = 0.13). Comparison of postoperative prevalence of surgical site occurrences (SSOs) (23% versus 26%, p = 0.02) and surgical site occurrences requiring interventions (SSOPIs) (1.5% versus 4.1%, p < 0.01) were in favour of the HIHR group. Overall postoperative complications seemed to occur less frequent in the HIHR group, though no hard statements could be made due to the vast heterogeneity in reporting between studies. Conclusion Although the majority of studies were retrospective and included a small number of patients, HIHR seemingly led to less SSOs and SSOPIs. This systematic review forms a strong invitation for more randomized controlled trials to confirm the benefits of this approach.

Risk factor analysis and prediction modeling for the occurrence of perioperative complications in abdominal wall incisional hernia patients

“…The intra-abdominal cavity in recurrent incisional hernias is complex and may show severe abdominal adhesions. Patients with severe abdominal adhesions are prone to direct injury to the intestinal canal during surgical separation [22,23] . The decision to perform repair with a new patch in patients whose previous surgery was for patch placement needs to be decided intraoperatively, which may be di cult for the operator [24] .…”

Meta-analysis of the effect of laparoscopic surgery and open surgery on long-term quality of life in patients with colorectal cancer

“…[20][21][22][23][24] CRC patients usually face the possibility of complications such as incisional hernia, small-bowel obstruction, and Adhesion in their postoperative recovery. [42][43][44] These made the patient endure more pain and even required a second operation to resolve. [45] Compared to open surgery, laparoscopic surgery is not perfect for CRC patients either.…”

Prophylactic onlay mesh placement techniques for optimal abdominal wall closure: randomized controlled trial in an ex vivo biomechanical model

“…Midline laparotomy incisions carry significant long-term morbidity, with incisional hernia being the most frequent complication 1 , 2 . Over 4 million laparotomies are performed annually in the USA 3 , with subsequent incisional hernia rates ranging from 20 per cent in unselected patient populations to almost 40 per cent in high-risk cohorts 4 , 5 . Incisional hernias are symptomatic in up to 84 per cent of patients 3 , with a 5-year revision rate of over 20 per cent 6 , and many present as an emergency with either incarceration (6–15 per cent) or strangulation (2 per cent) 7 , 8 .…”