SAGES guidelines for laparoscopic ventral hernia repair

Earle, David; Roth, J. Scott; Saber, Alan A.; Haggerty, Steve; Bradley, Joel F.; Fanelli, Robert D.; Price, Raymond R.; Richardson, William; Stefanidis, Dimitrios

doi:10.1007/s00464-016-5072-x

Cited by 135 publications

(97 citation statements)

References 163 publications

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“…The SAGES guidelines for laparoscopic ventral hernia repair state that fixation of meshes above the costal margins should not be performed with sutures placed between the ribs [4]. Furthermore, while fixation with tacks may by feasible, it should generally be avoided to prevent lung or cardiac injury or injuries to the neurovascular bundles running along the inferior surface of each rib [4].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, while fixation with tacks may by feasible, it should generally be avoided to prevent lung or cardiac injury or injuries to the neurovascular bundles running along the inferior surface of each rib [4]. …”

Section: Discussionmentioning

confidence: 99%

“…Compared to the open approach, laparoscopic intraperitoneal onlay mesh (IPOM) repair of ventral and incisional hernias has a lower rate of wound infections and similar recurrence and postoperative pain rates [1–4]. For fixation of the mesh in laparoscopic IPOM, the use of sutures alone or a combination with tacks is recommended [1].…”

Section: Introductionmentioning

confidence: 99%

“…For fixation of the mesh in laparoscopic IPOM, the use of sutures alone or a combination with tacks is recommended [1]. In addition to other factors reported in the literature, larger defects greater than 10 cm in diameter and subxiphoid location are identified as increasing the complexity of laparoscopic IPOM in ventral and incisional hernia repair [1, 4]. In 2010, the first report of cardiac tamponade due to tack fixation of the mesh to the diaphragm in incisional hernia repair was published [5].…”

Section: Introductionmentioning

confidence: 99%

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A word of caution: never use tacks for mesh fixation to the diaphragm!

2018

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Background The mesh fixation technique used in repair of hiatal hernias and subxiphoid ventral and incisional hernias must meet strenuous requirements. In the literature, there are reports of life-threatening complications with cardiac tamponade and a high mortality rate on using tacks. The continuing practice of tack deployment for mesh fixation to the diaphragm and esophageal hiatus should be critically reviewed. Methods In a systematic search of the available literature in May 2017, 23 cases of severe penetrating cardiac complications were identified. The authors became aware of two other cases in which they acted as medical experts. Furthermore, the instructions for use issued by the manufacturers of the tacks were reviewed with regard to their deployment in the diaphragm. Results Twenty-three of 25 cases (92%) with severe cardiac injuries and subsequent cardiac tamponade were triggered by the use of tacks in the diaphragm. In six cases (24%), these related to ventral and incisional hernias with extension to the subxiphoid area, and in 19 cases (76%) to mesh-augmented hiatoplasty. Twelve of 25 (48%) patients died as a result of pericardial and/or heart muscle injury with cardiac tamponade despite heart surgery intervention. In the tack manufacturers' instructions for use, their deployment in the diaphragm, in particular in the vicinity of the heart, is contraindicated. Likewise, the existing guidelines urgently advise against the use of tacks in the diaphragm, recommending instead alternative fixation techniques. Conclusions Tacks should not be used for mesh fixation in the diaphragm above the costal arch.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A word of caution: never use tacks for mesh fixation to the diaphragm!

2018

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“…8 Multiple sources have supported a tension-free primary closure of the hernia defect with mesh reinforcement, citing a reduced seroma rate, reduced recurrence rate, and improved abdominal wall integrity and contour. A minimum of 3-cm and maximum of 5-cm overlap of mesh is recommended to reduce tension at the fixation points and provide adequate coverage.…”

Section: Discussionmentioning

confidence: 99%