Laparoscopic transabdominal preperitoneal repair (umbilical TAPP) versus open ventral patch repair for medium size umbilical hernias in overweight and obese patients.

Abstract

Introduction: Despite high prevalence of umbilical hernias an open anterior approach is still frequently performed. Mesh use, although necessary in recurrence prevention, may lead to more frequent surgical site infections, especially in obese patients. Intraperitoneal onlay mesh (IPOM) may promote intraperitoneal adhesions. Some of these limitations may be reconciled by transabdominal-preperitoneal repair (TAPP). Aim: To compare the feasibility, safety and efficacy of umbilical TAPP (u-TAPP) with ventral patch repair technique (VPR). Material and methods: The analysis included overweight/obese patients undergoing elective surgery for primary umbilical hernia (22 in VPR, 21 in u-TAPP).Results: There were no differences between groups regarding size of the hernia defect. The mean width of the defect was 26 mm in VPR and 30 mm in u-TAPP (p = 0.185). The operation time was significantly shorter (p < 0.001) in VPR (43.1 ±11.6 min) than in u-TAPP (93.2 ±22.3 min). However, in VPR it was possible to place a much smaller area of synthetic mesh than in u-TAPP (34.3 vs. 164.2 cm 2 ; p < 0.001). After 30 days of follow-up, there was no recurrence in any of the groups. No significant differences were observed between the two groups regarding post-operative pain. Conclusions: TAPP technique in umbilical hernia repair allows for placement of a much larger mesh than an anterior approach surgery, and is closer to current recommendations, especially for patients with additional risk factors, such as obesity or coexistence of diastasis recti. TAPP allows a mesh to be introduced into the preperitoneal space, allowing one to avoid direct contact between the mesh and the intestines. Laparoscopic umbilical TAPP is feasible and safe, but the operation time is longer compared to open methods.

Efficacy of intraoperative hypertonic saline irrigation in seroma prevention after abdominal wall reconstruction procedures – a pilot cohort study

“…The other was abdominal plication in women with postpartum anterior abdominal wall insufficiency (PPAWI), whose stages include extensive dissection with separation of skin and fat flaps, abdominoplasty and implantation of a mesh in the onlay position (between the subcutaneous tissue and the fascia). 20 We decided to distinguish between these two groups of procedures, taking into consideration the fact that the very presence of the mesh in the subcutaneous tissue may be a risk factor for seroma, as is reported in literature reviews and meta-analyses. 21,22 However, it is worth mentioning that the above publications include comparative studies which were also carried out on old types of implants (heavy microporous ones), widely used in the past.…”

“…The first was the classic abdominal wall reconstruction procedure in patients with extensive abdominal wall defects and positioning of the mesh underneath the rectus abdominis muscles (sublay). The other was abdominal plication in women with postpartum anterior abdominal wall insufficiency (PPAWI), whose stages include extensive dissection with separation of skin and fat flaps, abdominoplasty and implantation of a mesh in the onlay position (between the subcutaneous tissue and the fascia) 20 . We decided to distinguish between these two groups of procedures, taking into consideration the fact that the very presence of the mesh in the subcutaneous tissue may be a risk factor for seroma, as is reported in literature reviews and meta‐analyses 21,22 .…”

eTEP-RS for incisional hernias in a non-robotic center. Is laparoscopy enough to perform a durable MIS repair of the abdominal wall defect?

“…In general, open repair is correlated with a slow recovery course and a higher risk of wound infection. The success of TAPP (transabdominal preperitoneal) and TEP (totally extraperitoneal) repair for groin hernias was undisputable, so the extraperitoneal plane began to be noticed in minimally invasive repair for incisional hernias [14]. Although laparoscopic surgery for abdominal wall hernia has gained recognition in the twenty-first century, there is still a dispute about the ideal approach.…”

Controversies in Laparoscopic Ventral hernia repair

“…Preperitoneal space (in TAPP) [10]: peritoneum incised 7-8 cm distance from linea alba parallel to the midline and 12-15 cm long craniocaudally, preperitoneal space developed around the hernia and to the contralateral side prior to hernia reduction.…”

“…Transabdominal preperitoneal (TAPP) [10]: It is suitable for medium-sized hernia (2-4 cm according to European Hernia Society [13].…”