Laparoscopic Abdominal Wall Hernia Repair

Abstract

Background and Objectives: The aim of this retrospective monocentric study was to evaluate results and recurrence rate with long-term follow-up after laparoscopic incisional/ventral hernia repair. Methods: This was a retrospective, single-center, observational trial, collecting data from patients who underwent laparoscopic incisional/ventral abdominal hernia repair using the open intraperitoneal onlay mesh technique and a single mesh type. All patients signed an informed consent form before surgery. Results: A total of 1,029 patients were included. The median surgery time was 40 min (range 30-55) and the median length of hospital stay was 2 d (range 2-3). Intraoperative complications occurred in two of 1,029 patients (0.19%), whereas early postoperative surgical complications (within 30 d) occurred in 50 patients (4.86%). Postoperative complications according to Clavien-Dindo classification were as follows: I, 3.30% (34 of 1,029); II, 0.97% (10 of 1,029); IIIB, 0.58% (six of 1,029); IV, 0.00% (none of 1,029); and V, 0.00% (none of 1,029). During follow-up, bulging mesh was diagnosed in 58 of 1,029 patients (5.6%), and hernia recurred in 40 of 1,029 patients (3.9%). A mesh overlap equal to or greater than 4 cm appeared to be a significant protective factor for hernia recurrence (P Ͻ .001); a mesh overlap equal or greater than 5 cm appeared to be a significant protective factor for bulging (P Ͻ .001), whereas the use of resorbable fixing devices was a significant risk factor for hernia recurrence (odds ratio, 111.53, P Ͻ .001, 95% confidence interval, 21.53-577.67). Conclusion: This study demonstrates that laparoscopic repair of ventral/incisional abdominal wall hernias is a safe, effective, and reproducible procedure. Identified risk factors for recurrence are an overlap of less than 4 cm and the use of resorbable fixation means.

Demographics and outcomes of ventral wall hernia repair at Sultan Qaboos University Hospital

“…The mean age of our patients was 36.8 years old which is significantly different than what was reported in international studies 53.3 years (yet it was comparable with a study that was conducted in Egypt 44.8 years old. 6,7 The female to male gender occurrence ratio was 3.3:1 in the presented study which is higher than ratios reported in other international studies 1.3:1. 6 However, previous data from studies done in Egypt (5:1) are comparable to ours.…”

“…In agreement with international study, abdominal wall surgery was the most associated risk factor in the development of ventral hernia and this is elaborated more in an 11-years follow up study that was conducted in the United States of America composed of 420 patients found that abdominal wall surgery was the most common risk factor for the development of hernia. 7 In the present study, para umbilical hernias were the most common operated hernia (144 hernia) followed by umbilical (110 hernia), and incisional (87 hernia). However, it was found in a previous study that was done in the United Kingdom that the umbilical hernia was the commonest followed epigastric, and incisional hernias.…”

“…Nevertheless, the analysis showed that the mean BMI of our study 32.3 kg/m 2 and hospital stay post operatively which was 3.5 days was approximately similar to the reported data internationally 27 kg/m 2 and a hospital stay of 3 days. 7,9 Also, the analysis of the included patients showed that there was significant correlation between age of patients and duration of admission, the younger the patient, the less hospital stay.…”

Mesh Fixation by Fibrin Glue versus Tackers in Laparoscopic Transabdominal Preperitoneal (TAPP) Repair of Inguinal Hernia

“…Injuries to the inferior epigastric arteries, femoral nerve, genito-femoral nerve, and lateral cutaneous nerve of the thigh were the most frequently reported consequences. Due to adhesion between the viscera and the utilized tacks, certain studies have observed colonic and small intestinal fistula, which can cause severe pain and may require surgical intervention (5) .…”

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“…The frequency of concomitant diseases in elderly patients will increase the risk of complications and death in surgery. [9][10][11][12] Complications at some stage because of reluctance for operation and it has been pointed out in many studies that the mortality and morbidity increase many folds if such hernias are operated in an emergency in elderly patients. [13][14][15][16][17] Comorbidities with the presence of…”