Laparoscopic incisional and ventral hernioplasty: lessons learned from 200 patients

Abstract

Our first 100 patients and our second 100 patients who underwent a laparoscopic repair of incisional and ventral hernias were compared and evaluated. This analysis revealed that the second group was approximately 9 years older with more comorbid medical conditions. In all, 15% were incarcerated hernias, and 21% were recurrent. Seven operations were converted to the open repair because of adhesions in five patients and either a small or large bowel injury in two patients. There were no complications related to enterotomy. Older and more infirm patients in the second group did not significantly affect outcomes. The average size of the hernia defects was 111 cm2. The average size of the prosthesis was 257.5 cm2. Larger prostheses were used in the second group. With more experience, the recurrence rates have declined from 9% to 4%. The etiology of these recurrences differed in these two groups of patients. Removal of the prosthetic due to infection was a predictable recurrence in two patients. A new hernia below the original hernia has caused us to repair the entire incision that had the initial hernia. Only one technical failure was noted, due to fracture of the suture during transfascial placement and clamping of the suture. It is not recommended to grasp any suture that remains in the patient during this hernioplasty. Recurrences were reduced because of the use of an increased overlap of the biomaterial and the use of dual methods of fixation (tacks and transfascial sutures).

Polipropilen Meshlerin Dokuya Tespitinde Kullanılan Polipropilen Dikiş, Titanyum Zımba ve Nitinol Çapa’nın Kopma Kuvvetlerinin Karşılaştırılması = Evaluation Of Mesh Fixation Strength After Placement

“…Meshin düzgün bir şekilde tespit edilmesi, herni nük-sünde önemlidir. Yapılan bir çalışma-da; herni nüksünün en sık nedeninin, meshin yetersiz ve eksik tespit edilmesi veya meshin, defektin üzerini yeterince kaplamamasından dolayı olduğunu bildirilmiştir (11). Biz de çalışmamız-da polipropilen meshin dokuya tespitinde kullanılan absorbe olmayan polipropilen sütür ve metalik tespit edici materyalleri kopma kuvvetleri açısın-dan karşılaştırmayı amaçladık.…”

Reply to: 464_2009_331: Re: A simplified laparoscopic ventral hernia repair: the scroll technique (2008: 22(11) 2527–2531)

“…Long course of antibiotic and wound care failed to salvage the mesh. We and others agree that in the vast majority of cases removal of exposed (infected) mesh is necessary, particularly if the prosthesis contains a component of ePTFE [2]. The patient underwent mesh removal and wound care and delayed repair of the hernia with biological mesh.…”

Laparoscopic Ventral Hernia: A Prospective Study

“…Few dual meshes are impregnated with silver and chlorhexidine antimicrobial agents which decrease the risk of infection, reduces the glare of prosthesis when used laparoscopically have been effective for repair of incisional hernias. 4 The composite meshes have polypropylene attached with thin layer of e-PTFE. The Parietex and Parietene composite products combine polyester and polypropylene biomaterials and oxidized atelocollagen, polyethylene glycol and glycerol.…”