Hybrid versus open retromuscular abdominal wall repair: early outcomes

Addo, Alex; Lu, Richard; Broda, Andrew; George, Philip; Zahiri, H. Reza; Belyansky, Igor

doi:10.1007/s00464-020-08060-y

Cited by 7 publications

(5 citation statements)

References 15 publications

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“…Our experience in the study suggests that with 60% out 150 cases being incisional or recurrent, eTEP approach can be considered for these difficult hernias with good outcomes. A hybrid approach[ 25 ] can also be used in the setting where scar revision is required as it may decrease the operative time. In hybrid setting, the retro-muscular dissection is done endoscopically followed by mesh placement and anterior fascial closure by an open method.…”

Section: Discussionmentioning

confidence: 99%

Analysis of ‘enhanced-view totally extra-peritoneal’ (eTEP) approach for ventral hernia: Early results

Mishra¹,

Jabbal²,

Nar³

et al. 2022

Journal of Minimal Access Surgery

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Introduction: Laparoscopic ventral hernia repair is undergoing a paradigm shift with the introduction of numerous new techniques to improve the outcomes. Enhanced-view totally extra-peritoneal (eTEP) is a novel approach for the repair of ventral herniae introduced by Belyansky et al. The key innovation lies in placing the mesh in a large retrorectus–pre-peritoneal space contrary to the widely practiced intra-peritoneal placement. This approach can be easily coupled with a component separation in the form of transversus abdominis release (TAR) for large herniae. We conducted a midterm analysis of ‘eTEP’ approach to ventral hernia at a high-volume tertiary care centre and present our results of over 3 years of employing this technique. Methodology: A retrospective study of 150 cases of ventral hernia repaired using eTEP approach from January 2018 to February 2021 at a tertiary care centre by a team of three surgeons. The procedures were performed by a single team of three members headed by the first author. Results: Out of total 150 cases, incisional hernia occurred in 73 cases (48.7%), primary hernia occurred in 48 cases (32%) and recurrent hernia in 29 cases (19.3%). Although the majority of incisional (87.7%) and recurrent (79.3%) ventral hernias occurred in female, the incidence of primary ventral hernia was equal at 24 cases in both genders. The majority of the cases (80.7%) underwent eTEP RS procedure, and the rest were W3 hernias, which were managed by including a component separation in the form of eTEP TAR. The operating time for eTEP TAR (222.24 min ± 32.56) compared to eTEP RS (124.33 ± 23.68) was significantly longer. The mean length of stay was significantly shorter for primary hernias (3.75 days ± 1.62) compared to recurrent (5.21 days ± 2.51) and incisional hernias (4.36 days ± 2.19) (F = 4.376) (P = 0.014). The peri-operative period was uneventful in majority of the cases. We experienced a seroma rate of 5.8% in our series. At follow-up of 1 year, 3.3% of patients complained of discomfort/bulge in the upper abdomen. There were no other surgical site occurrences (SSO) in the form infection, posterior rectus sheath disruption and skin necrosis. We observed no recurrences till date with a minimum follow-up of 1 year. Conclusion: eTEP approach to ventral hernia is a promising abdominal wall reconstruction technique. It is safe and offers good functional outcomes with restoration of abdominal wall dynamics. It is a reproducible and safe technique for tackling various types of ventral hernia. It is specifically useful in managing unusual lateral hernias, incisional and recurrent hernias with ease.

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Section: Discussionmentioning

confidence: 99%

Analysis of ‘enhanced-view totally extra-peritoneal’ (eTEP) approach for ventral hernia: Early results

Mishra¹,

Jabbal²,

Nar³

et al. 2022

Journal of Minimal Access Surgery

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“…The skin and subcutaneous layers are then closed with absorbable sutures. The same surgical technicality is executed by Addo et al [29], but they also perform intra-abdominal adhesiolysis prior closing of the posterior rectus fascia, in ten patients.…”

Section: Hihr Techniquesmentioning

confidence: 95%

“…After full-text reading, 12 articles were judged eligible and included for final data analysis, representing a total of 1681 patients. Two articles were the short-and long-term outcomes of one randomized controlled trial of Ahonen-Siirtola et al [10,19], and ten were retrospective cohort studies [20][21][22][23][24][25][26][27][28][29]. An overview of study characteristics including methodological quality of each included study is shown in Table 1.…”

Section: Search and Study Characteristicsmentioning

confidence: 99%

“…One-hundred-and-sixty of all 1681 (9.5%) patients had postoperative complications (Table 5). Five studies [19,20,25,27,29], representing 421 patients, compared SSOs between HIHR and LIHR or OIHR and were included in the meta-analysis (Fig. 2).…”

Section: Postoperative Complicationsmentioning

confidence: 99%

“…In the case of Addo and colleagues [29], HIHR was compared to OHIR. The SSO rate was significantly lower in the HIHR group ( [19,20,26,27,29], where it was found to occur significantly less frequent in the HIHR group (36 of 681 (5.3%) versus 77 of 740 (10.4%); odds ratio = 0.40 (95 CI 0.25-0.64; I 2 = 40%, p < 0.001) (Supplemental Fig. 2).…”

Section: Postoperative Complicationsmentioning

confidence: 99%

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

Dop

Smet

Kleinrensink

et al. 2021

Hernia

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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.

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Mini- or less-open sublay (E/MILOS) operation vs open sublay and laparoscopic IPOM repair for the treatment of incisional hernias: a registry-based propensity score matched analysis of the 5-year results

Reinpold,

Berger,

Adolf

et al. 2023

Hernia

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Hybrid versus open retromuscular abdominal wall repair: early outcomes

Cited by 7 publications

References 15 publications

Analysis of ‘enhanced-view totally extra-peritoneal’ (eTEP) approach for ventral hernia: Early results

Analysis of ‘enhanced-view totally extra-peritoneal’ (eTEP) approach for ventral hernia: Early results

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

Mini- or less-open sublay (E/MILOS) operation vs open sublay and laparoscopic IPOM repair for the treatment of incisional hernias: a registry-based propensity score matched analysis of the 5-year results

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