Laparoscopic Treatment of Incisional and Ventral Hernia

Abstract

Background and Objectives: Although several large studies regarding patients undergoing minimally invasive repair of incisional hernia are currently available, the results are not particularly reliable as they are based on heterogeneous groups, different surgical techniques, different mesh types, or with a too short follow period.Methods: We conducted a retrospective observational trial, collecting data from patients who underwent laparoscopic repair of a primary abdominal wall or an incisional hernia using the laparoscopic Intraperitoneal Onlay Mesh technique and a single mesh type, i.e., a composite polyester mesh with a hydrophilic film (Parietex Composite TM mesh -Medtronic, Minneapolis, MN -USA). All patients signed an informed consent.Results: One thousand seven hundred seventy-seven patients were enrolled. The median surgery time was 50 minutes and the median length of hospital stay was 2 days. Intraoperative complications occurred in 12 patients (0.7%), while early postoperative surgical complications occurred in 115 (6.5%); during follow-up, bulging mesh was diagnosed in 4.5% of cases and hernia recurred in 4.3% of patients. An overlap equal or greater than 4 cm resulted as a significant protective factor, while the use of absorbable fixing devices was a risk factor for recurrence (odds ration: 9.06, p < 0.001, 95% confidence interval: 4.19 -19.57).Conclusions: Minimally invasive treatment of primary and postincisional abdominal wall hernias is a safe, effective, and reproducible procedure. An overlap equal or greater than 4 cm, the use of nonabsorbable fixing devices and a postoperative care and follow-up regime are crucial in order to obtain good results and low recurrence rates.

Laparoscopic Surgery of Incisional Hernia: Technique and Short-Term Results in Three Surgical Units in Cameroon

“…The appearance of such a lesion is mainly associated with the characteristics of the prostheses, in particular the material and the surface, and not with its location [28]. The composite prostheses used in our patients seem to offer the advantage of combining both the resistance of a permanent intraperitoneal structure and an anti-adherent barrier to protect the viscera [17]. Closure of the fascial defect was not systematic before prosthesis placement.…”

“…These were absorbable or not according to the surgeons. In an Italian study [17], a slight increase in early postoperative pain related to non-absorbable fixation devices was found, while a significant difference in recurrence rates was reported in favour of non-absorbable devices (11% versus 3%, P < 0.001). The authors thus encourage the use of non-absorbable devices [17].…”

“…In their study published in 2021, Olmi et al found a recurrence rate of 25% for an overlap of less than 4 cm. This rate fell to 3% in case of an overlap equal or greater than 4 cm [17]. We chose a prosthesis size that ensured overlapping of the aponeurotic edges by at least 5 cm.…”

Laparoscopic intraperitoneal mesh repair of an incisional hernia after transverse rectus abdominis myocutaneous flap reconstruction for breast cancer

“…On the other hand, many surgeons 9 recommend a minimum overlap size of 5 cm, especially for larger defects, while others 9 suggest the donut theory for incisional hernias and abdominal wall defects. Independent risk factors that have been considered include overlap that is <4 cm, use of absorbable fixation devices, bulging, and mesh infection 10 . Therefore, IPOM or IPOM‐Plus is not suitable for larger defects.…”

“…Independent risk factors that have been considered include overlap that is <4 cm, use of absorbable fixation devices, bulging, and mesh infection. 10 Therefore, IPOM or IPOM-Plus is not suitable for larger defects.…”