Laparoscopic repair of incisional hernia: Outcomes of 100 consecutive cases comprising 25 wall defects larger than 15 cm

Ferrari, Giovanni; Miranda, Angelo; Lernia, Stefano Di; Sansonna, Fabio; Magistro, Carmelo; Maggioni, Dario; Scandroglio, Ildo; Costanzi, Andrea; Franzetti, Maurizio; Pugliese, Raffaele

doi:10.1007/s00464-007-9707-9

Cited by 18 publications

(5 citation statements)

References 30 publications

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“…This study demonstrated that a short mean operation time (overall, 116 minutes in our experience) and the ensuing reduced requirements for anesthetic drugs prevent early postoperative respiratory complications. Our mean operation time is lower than in Ferrari et al’s 25 L-G/M VH patients (205 minutes 25 ) and Grande and al.’s 35 cases (159 minutes 26 ); both sets of patients underwent LVHRTS.…”

Section: Discussioncontrasting

confidence: 65%

“Slim-Mesh” Technique for Giant Ventral Hernia

Canton¹,

Pasquali

2022

JSLS

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Section: Discussioncontrasting

confidence: 65%

“Slim-Mesh” Technique for Giant Ventral Hernia

Canton¹,

Pasquali

2022

JSLS

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“…These complications may demand surgical revision, with the removal or correction of the implanted device [5–9]. Furthermore, for up to 70% of patients with recurrent hernia, the surgeon must take into account that the previous treatment was performed with a mesh, which currently is somewhere in the abdominal wall [10, 11] and could complicate further treatment or lead to elaborate explantation.…”

mentioning

confidence: 99%

In vivo MRI visualization of mesh shrinkage using surgical implants loaded with superparamagnetic iron oxides

et al. 2011

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BackgroundProsthetic mesh implants are widely used in hernia surgery. To show long-term mesh-related complications such as shrinkage or adhesions, a precise visualization of meshes and their vicinity in vivo is important. By supplementing mesh fibers with ferro particles, magnetic resonance imaging (MRI) can help to delineate the mesh itself. This study aimed to demonstrate and quantify time-dependent mesh shrinkage in vivo by MRI.MethodsPolyvinylidenfluoride (PVDF) meshes with incorporated superparamagnetic iron oxides (SPIOs) were implanted as an abdominal wall replacement in 30 rats. On days 1, 7, 14, or 21, MRI was performed using a gradient echo sequence with repetition time (TR)/echo time (TE) of 50/4.6 and a flip angle of 20°. The length, width, and area of the device were measured on axial, coronal, and sagittal images, and geometric deformations were assessed by surgical explantation.ResultsIn all cases, the meshes were visualized and their area estimated by measuring the length and width of the mesh. The MRI presented a mean area shrinkage in vivo of 13% on day 7, 23% on day 14, and 23% on day 21. Postmortem measurements differed statistically from MRI, with a mean area shrinkage of 23% on day 7, 28% on day 14, and 30% on day 21. Ex vivo measurements of shrinkage showed in vivo measurements to be overestimated approximately 8%. Delineation of the mesh helped to show folding or adhesions close to the intestine.ConclusionLoading of surgical meshes with SPIOs allows their precise visualization during MRI and guarantees an accurate in vivo assessment of their shrinkage. The authors’ observation clearly indicates that shrinkage in vivo is remarkably less than that shown by illustrated explantation measurements. The use of MRI with such meshes could be a reliable technique for checking on proper operation of implanted meshes and showing related complications, obviating the need for exploratory open surgical revision.

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“…Staging of the ventral hernia has been helpful in surgical decision and in post-operative comparison of results [13]. The open intraperitoneal technique is appropriate for complex incisional hernias occurring in obese patients, but is contraindicated when laparoscopic access has been obtained; minimal access was shown to be feasible in patients with a larger mesh of 15 cm [14][15][16]. A cellular dermal matrix has been also suggested in this cases to resist to infection as well as porcine [3,17].…”

Section: Discussionmentioning

confidence: 99%

“…A cellular dermal matrix has been also suggested in this cases to resist to infection as well as porcine [3,17]. Open component separation, which allows autologous tissue repair with approximation of a midline fascia in patients with complex hernias, creates large skin flaps that prevent the visualization of epigastric vessels; this problem notwithstanding recurrence rates is similar for open and laparoscopic techniques [14,15,17]. Although there is a trend towards laparoscopic surgery the laparoscopic repair does not resolve the matter of the ventral hernia's being a problem with the abdominal wall [18][19][20][21][22][23].…”

Section: Discussionmentioning

confidence: 99%

Component Separation or Mesh Repair for Ventral Hernia Repair - The Role of Mesh in Covering all the Abdominal Wall in the Component Repair

Frezza¹

2017

GHR

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Simple repair of the hernia opening, Ventral Hernia Repair (VHR) has been confronted by a more definitive goal of restoration of abdominal muscular strength and wall function accomplished by mobilizing abdominal wall muscles and closing with inlay mesh, Component Separation Repair (CSR). Our observation was based on the notion that shear forces cause herniation and therefore that is an affliction of the entire abdominal wall, not a localized event. We took that information and we compare a series of VHR patients with a series of CSR patients would provision evidence to improve the relative value of the techniques.Material: Retrospective comparison of 30 consecutive CSR patients and 30 consecutive VHR patients was obtained. All abdominal wall hernia defects were at least 10 cm 2 in size. T tests with unequal variances were used to evaluate differences in means of continuous variables and to estimate 95% confidence intervals of differences.Results: Although CSR patients were older, had higher BMI's and higher ASA scores than did VHR patients, the odds of recurrence for CSR patients were less than for VHR patients (P<0.0001). Differences in respects to ileus and wound complications, while they favored CSR patients, might have been due to chance (P>0.05 for each analysis). In VHR group 11 patients required CSR after 9-24 months, 14 patients have prolonged ileus. In the CSR group two patients were reoperated for removal of midline skin changes, two for severe seromas requiring wash up of the subcutaneous and fascia area and placement of a wound vacuum on top of the mesh. Conclusion:This study supports the notion that a ventral hernia reflects a defect in the abdominal wall not just the point at which the hernia forms. To avoid a point of rupture, we support highly the CSR technique, since hernia is an abdominal disease not just a hole.

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Laparoscopic repair of incisional hernia: Outcomes of 100 consecutive cases comprising 25 wall defects larger than 15 cm

Abstract: Minimal access procedures can provide good results in the repair of incisional hernia, even when the diameter is larger than 15 cm. Obesity is not a contraindication to laparoscopic repair. Further studies are expected to confirm these promising results.

Cited by 18 publications

References 30 publications

“Slim-Mesh” Technique for Giant Ventral Hernia

“Slim-Mesh” Technique for Giant Ventral Hernia

In vivo MRI visualization of mesh shrinkage using surgical implants loaded with superparamagnetic iron oxides

Component Separation or Mesh Repair for Ventral Hernia Repair - The Role of Mesh in Covering all the Abdominal Wall in the Component Repair

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