Prospective clinical study of laparoscopic treatment of incisional and ventral hernia using a composite mesh: indications, complications and results

Abstract

The aim of this study is to establish the indications, safety, efficacy, feasibility and reproducibility of the laparoscopic technique in treating defects in the abdominal wall, including those of large dimensions, to standardise the surgical technique and to confirm the performance of the composite prosthesis used (Parietex, Sofradim). The study encompassed the period from January 2001 to December 2004 and included 178 nonselected patients (108 women and 70 men), with an average age of 56 years (range: 26-77 years) and an average body mass index (BMI) of 30 (range: 26-40). These patients were treated for either abdominal hernia (156 patients; 89.7%) or a primary defect (22 patients; 10.3%). The dimensions of the abdominal hernias treated varied from 4 to 26 cm (average: 12.1 cm). All patients were treated using the laparoscopic technique, and all meshes were placed in the intraperitoneal position. Eleven (7%) postoperative complications arose after an average follow-up period of 29 months (range: 1-48 months): seven seromas (4.4%) lasting for 4 weeks, with one becoming infected after being punctured repeatedly; we removed the infected prosthesis by laparoscopy; three (1.9%) patients with persistent neuralgia, which were resolved after 2 months with a prescription for FANS; one patient with a haematoma at the trocar site. There were also four recurrences (2.5%), all of which occurred between 1 and 3 months postsurgery: one in the 'small' group of abdominal hernias (less than 9 cm) and three in the 'large' group of abdominal hernias. With the exclusion of any primary defects, an adhesiolysis was carried out in 99.3% of the patients. In seven cases (4.4%) we carried out a raphe for speritonealisations of loops in the small intestine; in four patients (2.5%), following tenacious adhesion (one patient) and loops fixed to the previous scar by stitches (three patients), we carried out an intestinal perforation (ileus) which was sutured by laparoscopy. The average operating time was 65.6 min (range: 28-130 min), with an average postoperative period in the hospital of 2.1 days (range: 1-5 days). No conversion was observed, and mortality was zero. The results obtained during the clinical trial demonstrate the safety and efficacy of the laparoscopic technique and of the mesh used as well as the reproducibility of the technique in the intraperitoneal treatment of congenital and postincision defects in the abdominal wall, including those of large dimensions.

Parietex™ Composite mesh versus DynaMesh®-IPOM for laparoscopic incisional and ventral hernia repair: a retrospective cohort study

“…Comparable single-institution case series and one multicentre randomised study reported recurrence rates as low as 0-2.5%, [18][19][20][21][22] whereas prospective national registries have suggested much higher recurrence rates of 15.5% at a median of 21 months follow up. 6 Other contributing factors for recurrence of hernia include the number and size of the defects, difficulty of dissection, mesh fixation technique and operation.…”

The clinical effectiveness and cost-effectiveness of open mesh repairs in adults presenting with a clinically diagnosed primary unilateral inguinal hernia who are operated in an elective setting: systematic review and economic evaluation

“…19,20 It is also worth observing that while in the past recurrence of inguinal hernia was an important postoperative complication, after the advent of the tension-free mesh technique the risk of recurrence has decreased considerably and the current incidence rates are as low as 1-4%. 14,85 Cost-effectiveness…”

Combination of Liechtenstein Repair with Herniorrhaphy in Open Inguinal Hernia Repair- A Prospective Observational Single Center Study

“…While evolved immensely, especially over the last few decades. Recurrence of inguinal hernia was initially a significant problem; however with the advent of the tension-free mesh repair as described as Lichtenstein Repair (LR) [30], recurrence rate has consistently been reported as low as 1-4% [31][32][33][34], a drop from up to 50-60%. …”