Laparoscopic ventral and incisional hernia repair in 407 patients1

Heniford, B. Todd; Park, Adrian; Ramshaw, Bruce; Voeller, Guy

doi:10.1016/s1072-7515(00)00280-5

Cited by 385 publications

(268 citation statements)

References 19 publications

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“…SPA may results in less parietal scarring in these patients prone to incisional hernia at trocar port site. Laparoscopic repair of ventral hernia has become popular, being associated with decreased postoperative pain and shorter recovery compared with open approach, while allowing complete revision of the abdominal wall [1][2][3][4]15]. However, the rate of incisional hernia at trocar port site after laparoscopic hernia repair is non negligible according to the literature (1-22%) [1,5].…”

Section: Discussionmentioning

confidence: 99%

“…Keywords Single-port access (SPA) Á Laparoendoscopic single-site surgery (LESS) Á Single incision Á Laparoscopy Á Ventral hernia Á Incisional hernia Laparoscopic ventral hernia repair has been shown to be safe, efficient, and associated with shorter recovery compared with open approach [1][2][3][4]. However, the risk of incisional hernia at port access after these surgeries remains a concern, and seems non negligible according to the literature (1-22%) [1,5].…”

Section: Introductionmentioning

confidence: 99%

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Single-port access prosthetic repair for primary and incisional ventral hernia: toward less parietal trauma

2010

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Background Although still under development, single-port access (SPA) approach may be of interest in patients prone to port-side incisional hernia, ensuring absence of increased fascial incision. This forms the basis for evaluating SPA for prosthetic ventral hernia repair. We report a new SPA technique of ventral hernia repair using working-channel endoscope, standard laparoscopic instruments, and 10-mm port. Methods Prospective experience with SPA prosthetic repair of primary and incisional ventral hernia in 52 patients for 55 ventral hernias is presented. Median (range) patient age was 46 years (26-85 years), and BMI was 28 kg/m 2 (20-38 kg/m 2 ). Mean fascial defect was 16.2 cm 2 for primary hernia (n = 23) and 48.3 cm 2 for incisional hernia (n = 32). Intraperitoneal composite mesh repair was achieved through single 10-mm flank port using working-channel endoscope. Meshes were fixed using absorbable tackers and transfascial stitches. Results SPA repair of primary and incisional ventral hernia was completed in all cases without conversion to standard laparoscopy. Median (range) operative time was 54 min (39-95 min). Mesh size ranged from 118 to 500 cm 2 . No intra-or postoperative complications were recorded, except two seromas. Median (range) hospital stay was 1 day (1-5 days). One patient presented prolonged postoperative pain on mesh fixation that resolved after 3 months. No recurrence or port-site incisional hernias have been recorded at median (range) follow-up of 16 months (3-28 months). Conclusions SPA prosthetic repair of primary and incisional ventral hernia is easily feasible according to natural exposition by pneumoperitoneum and gravity. In the present series, SPA ventral hernia repair appears to be safe for experienced SPA surgeons. It may decrease parietal trauma and scarring in patients prone to incisional hernia. SPA repair may be associated with a decrease in rate of port-site incisional hernia compared with multiport laparoscopy, but this has to be verified by randomized trial with standard laparoscopic approach on long-term follow-up.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Single-port access prosthetic repair for primary and incisional ventral hernia: toward less parietal trauma

2010

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“…Other reports of laparoscopic repairs reveal similar experiences. 11,17,27 If an absorbable mesh is inserted along with a nonabsorbable prosthesis to prevent temporary contact between the nonabsorbable material and the viscera-a method recommended by Wantz 3 and others 28 -the time during which peritoneal coverage is provided is a concern. One study of adhesion formation in a rat model suggested that most adhesions were fully developed by 7 days after implantation of mesh 29 ; however, Amid 30 expressed caution against such results that suggest a temporary barrier is needed for only a short time.…”

Section: Discussionmentioning

confidence: 99%

“…This mesh is composed of 2 layers of ePTFE with different surface characteristics; one layer has a "smooth," nonporous surface to be placed against the viscera to limit adhesions and the other has a "rough" surface with large interstices in the material (22 µm) to encourage tissue ingrowth. DualMesh has so far been used in more than 1000 laparoscopic ventral and incisional hernia repairs, 11,26,27,31,32 with good results with respect to recurrences and complications. The current study of 65 reoperations supports the assumption that no or minimal adhesions result from the use of DualMesh in such procedures.…”

Section: Discussionmentioning

confidence: 99%

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Minimal adhesions to ePTFE mesh after laparoscopic ventral incisional hernia repair: reoperative findings in 65 cases

et al. 2003

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Objectives: Laparoscopic ventral incisional hernia repair involves intraabdominal placement of a synthetic mesh, and the possibility of formation of severe visceral adhesions to the prosthesis is a principal concern. Little clinical information based on reoperative findings is available about adhesions to biomaterials placed intraabdominally. We conducted a multiinstitutional study of adhesions to implanted expanded polytetrafluoroethylene (ePTFE) mesh at reoperation in patients who had previously undergone laparoscopic incisional hernia repair done with the same mesh implantation technique. Methods:Nine surgeons retrospectively assessed the severity of adhesions to ePTFE mesh at reoperation in 65 patients. For each case, adhesions were assigned a score of 0 to 3, with 0 indicating no adhesions and 3 severe adhesions. Results:The mean time from mesh implantation to reoperation was 420 days (range, 2 to 1739 days). No adhesions were observed in 15 cases. Forty-four cases received an adhesion score of 1, and 6 cases a score of 2; no scores of 3 were assigned. Thus, 59 patients (91%) had either no or filmy, avascular adhesions. No enterotomies occurred during adhesiolysis. Conclusions:In this large series of reoperations after laparoscopic incisional hernia repair, no or minimal formation of adhesions to implanted ePTFE mesh was observed in 91% of cases, and no severe cohesive adhesions were found. Comparative analyses of newer mate- INTRODUCTIONThe need for reinforcement of the abdominal wall by implantation of synthetic materials during repair of abdominal incisional hernias is well established. [1][2][3][4] Moreover, because early use of various biomaterials in ventral incisional hernia repair resulted in some serious complications, including fistulization due to adhesions, 5-7 it is clear that avoiding contact between the mesh and viscera is desirable. 2,3,8,9 In laparoscopic incisional herniorrhaphy, however, first described by LeBlanc and Booth in 1993, 10 placement of the mesh in the intraabdominal position is necessary. Thus, this procedure requires a biomaterial that provides both adequate strength and a minimal risk of severe adhesion formation that could result in bowel obstruction or fistula development.Numerous studies of the formation of adhesions to biomaterials placed intraabdominally have been conducted in animals, but few investigations of this issue have been based on information obtained at reoperation in patients. Moreover, no large study has examined reoperative observations pertaining to adhesions to a biomaterial after laparoscopic incisional hernia repair specifically. Therefore, we conducted a retrospective review of findings at reoperation in patients who had undergone such a repair and in whom a 1-mm-thick expanded polytetrafluoroethylene (ePTFE) dual-surface mesh (DualMesh, W.L. Gore & Associates, Flagstaff, AZ) had been implanted during the repair. METHODS Records

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Short-term Outcomes of Laparoscopic and Open Ventral Hernia Repair

Goodney¹,

Birkmeyer²,

Birkmeyer³

2002

Arch Surg

171

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Background: Although laparoscopic repair of ventral hernia has become increasingly popular, its outcomes relative to open repair have not been well characterized. For this reason, we performed a meta-analysis of studies comparing open and laparoscopic ventral (including incisional) hernia repair. Hypothesis: Laparoscopic ventral hernia repair results in better short-term outcomes than open ventral hernia repair. Data Sources: Structured MEDLINE search for published studies. One unpublished study was also identified. Study Selection: Studies were selected on the basis of study design (comparison of laparoscopic and open ventral hernia repair). The 3 main outcome measures were perioperative complications, operative time, and length of hospital stay. Of 83 potential studies identified by abstract review, 8 (10%) met the inclusion criteria. Data Extraction: Two reviewers assessed each article to determine eligibility for inclusion and, where appro-priate, abstracted information on patient characteristics and main outcome measures. Data Synthesis: Across 8 studies, 390 patients underwent open repair and 322 underwent laparoscopic repair. Perioperative complications were less than half as likely to occur in patients undergoing laparoscopic repair (14% vs 27%; P =.03; odds ratio, 0.42; 95% confidence interval, 0.29-0.68). Average length of stay was shorter in the laparoscopic group (2.0 vs 4.0 days; P=.02).No statistically significant difference in operative times was noted between laparoscopic and open repair (99 vs 96 minutes; P =.38).Conclusions: Laparoscopic ventral hernia repair offers lower complication rates and shorter length of stay than open repair. However, randomized controlled trials and studies with long-term follow-up are needed to confirm these findings and to assess long-term rates of hernia recurrence.

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Laparoscopic ventral and incisional hernia repair in 407 patients1

Cited by 385 publications

References 19 publications

Single-port access prosthetic repair for primary and incisional ventral hernia: toward less parietal trauma

Single-port access prosthetic repair for primary and incisional ventral hernia: toward less parietal trauma

Minimal adhesions to ePTFE mesh after laparoscopic ventral incisional hernia repair: reoperative findings in 65 cases

Short-term Outcomes of Laparoscopic and Open Ventral Hernia Repair

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