Systematic review and network meta-analysis of methods of mesh fixation during laparoscopic ventral hernia repair

Baker, Jason Joe; Öberg, Stina; Andresen, Kristoffer; Klausen, Tobias W.; Rosenberg, Jacob

doi:10.1002/bjs.10720

Cited by 29 publications

(19 citation statements)

References 70 publications

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“…Multiple small randomized controlled trials have assessed mesh fixation in laparoscopic repair, resulting in systematic reviews showing conflicting results. When only studies at low risk of bias (that is, well performed randomized controlled trials) have been evaluated, no differences among the different mesh fixation methods has been clearly shown, except that fibrin glue fixation alone may increase hernia recurrence rates 3738394041. Proponents of RVHR quote improved patient centered outcomes through a decrease in pain secondary to suturing rather than tacking of the mesh 42.…”

Section: Discussionmentioning

confidence: 99%

Robotic versus laparoscopic ventral hernia repair: multicenter, blinded randomized controlled trial

Olavarria

Bernardi

Shah

et al. 2020

BMJ

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ObjectiveTo determine whether robotic ventral hernia repair is associated with fewer days in the hospital 90 days after surgery compared with laparoscopic repair.DesignPragmatic, blinded randomized controlled trial.SettingMultidisciplinary hernia clinics in Houston, USA.Participants124 patients, deemed appropriate candidates for elective minimally invasive ventral hernia repair, consecutively presenting from April 2018 to February 2019.InterventionsRobotic ventral hernia repair (n=65) versus laparoscopic ventral hernia repair (n=59).Main outcome measuresThe primary outcome was number of days in hospital within 90 days after surgery. Secondary outcomes included emergency department visits, operating room time, wound complications, hernia recurrence, reoperation, abdominal wall quality of life, and costs from the healthcare system perspective. Outcomes were pre-specified before data collection began and analyzed as intention to treat.ResultsPatients from both groups were similar at baseline. Ninety day follow-up was completed in 123 (99%) patients. No evidence was seen of a difference in days in hospital between the two groups (median 0 v 0 days; relative rate 0.90, 95% confidence interval 0.37 to 2.19; P=0.82). For secondary outcomes, no differences were noted in emergency department visits, wound complications, hernia recurrence, or reoperation. However, robotic repair had longer operative duration (141 v 77 min; mean difference 62.89, 45.75 to 80.01; P≤0.001) and increased healthcare costs ($15 865 (£12 746; €14 125) v $12 955; cost ratio 1.21, 1.07 to 1.38; adjusted absolute cost difference $2767, $910 to $4626; P=0.004). Among patients with robotic ventral hernia repair, two had an enterotomy compared none with laparoscopic repair. The median one month postoperative improvement in abdominal wall quality of life was 3 with robotic ventral hernia repair compared with 15 following laparoscopic repair.ConclusionThis study found no evidence of a difference in 90 day postoperative hospital days between robotic and laparoscopic ventral hernia repair. However, robotic repair increased operative duration and healthcare costs.Trial registrationClinicaltrials.gov NCT03490266.

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Section: Discussionmentioning

confidence: 99%

Robotic versus laparoscopic ventral hernia repair: multicenter, blinded randomized controlled trial

Olavarria

Bernardi

Shah

et al. 2020

BMJ

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“…Failure to close the fascial defect is associated with increased seroma formation and other adverse hernia‐site outcomes . In addition, fixation of the mesh with tacs alone may increase hernia recurrence rates . As such, the new paradigm shift favours primary repair of the hernia by sac excision and defect closure, subsequently using the mesh as an adjunct to this repair.…”

Section: Discussionmentioning

confidence: 99%

“…Consequently, laparoscopic techniques have been described to facilitate fascial closure, though this is often technically difficult particularly for those hernias wider than 10 cm . In addition, fixation of the mesh with tacs alone may increase hernia recurrence rates, while application of transfascial sutures is associated with greater post‐operative pain . Robotic‐assisted ventral hernia repair (rVHR) may afford the benefits of the lVHR while facilitating a more robust and less painful repair with sac excision, primary fascial closure and accurate suture fixation of mesh .…”

Section: Introductionmentioning

confidence: 99%

Robotic‐assisted ventral hernia repair with surgical mesh: how I do it and case series of early experience

Kozman

Tonkin²,

Eteuati

et al. 2019

ANZ Journal of Surgery

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Background: Laparoscopic ventral hernia repair provides several benefits over the open approach. Intraperitoneal surgical mesh placement without fascial defect closure is associated with increased seroma formation and other adverse hernia-site outcomes. Transfascial sutures and tacs for fascial closure and surgical mesh fixation are associated with greater post-operative pain. Robotic-assisted ventral hernia repair (rVHR) may afford benefits of the laparoscopic approach while facilitating a more robust and less painful repair. Methods: Consecutive patients managed by rVHR from May 2015 to August 2018 were identified from a prospectively maintained robotic database. Retrospective review of this data was performed. Results: Fifty patients underwent rVHR during the study period. Median body mass index was 31 (interquartile range (IQR) 29-34). Forty-eight had previous abdominal surgery. Forty-seven hernias were midline and three were lateral. Regarding hernia width, 15 were <4 cm wide, 32 were 4-10 cm and three were >10 cm. Median total anaesthetic time, docking time and surgical console time were 214 min (IQR 182-252), 5 min (IQR 4-8) and 144 min (IQR 104-174), respectively. No major intra-operative complications occurred. No documented cases of adhesional complications or chronic post-operative pain have occurred. To date, two recurrences have occurred in our series. Median length of hospital stay was 3 days (IQR 2-4). Conclusion: We describe our rVHR technique and report on our series and early experience, showing that rVHR can be performed safely with good patient outcomes. We demonstrate a team approach to achieving a safe transition to new technology.

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“…One 109 reported a lower recurrence rate for the sutured technique; the other 110 could not confirm this finding, but found more infections with sutures than tacks. In a network meta-analysis 113 , there seemed to be an overall advantage of combining tacks with sutures to decrease the recurrence rate, compared with tacks alone.…”

Section: Quality Of Evidence: Strength Of Recommendation: Weakmentioning

confidence: 99%

Guidelines for treatment of umbilical and epigastric hernias from the European Hernia Society and Americas Hernia Society

Henriksen

Montgomery

Kaufmann

et al. 2020

British Journal of Surgery

227

198

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Background: Umbilical and epigastric hernia repairs are frequently performed surgical procedures with an expected low complication rate. Nevertheless, the optimal method of repair with best short-and long-term outcomes remains debatable. The aim was to develop guidelines for the treatment of umbilical and epigastric hernias. Methods: The guideline group consisted of surgeons from Europe and North America including members from the European Hernia Society and the Americas Hernia Society. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, the Scottish Intercollegiate Guidelines Network (SIGN) critical appraisal checklists, and the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument were used. A systematic literature search was done on 1 May 2018, and updated on 1 February 2019. Results: Literature reporting specifically on umbilical and epigastric hernias was limited in quantity and quality, resulting in a majority of the recommendations being graded as weak, based on low-quality evidence. The main recommendation was to use mesh for repair of umbilical and epigastric hernias to reduce the recurrence rate. Most umbilical and epigastric hernias may be repaired by an open approach with a preperitoneal flat mesh. A laparoscopic approach may be considered if the hernia defect is large, or if the patient has an increased risk of wound morbidity. Conclusion: This is the first European and American guideline on the treatment of umbilical and epigastric hernias. It is recommended that symptomatic umbilical and epigastric hernias are repaired by an open approach with a preperitoneal flat mesh.

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Systematic review and network meta-analysis of methods of mesh fixation during laparoscopic ventral hernia repair

Abstract: Background: Ventral hernia repairs are common and have high recurrence rates. They are usually repaired laparoscopically with an intraperitoneal mesh, which can be fixed in various ways. The aim was to evaluate the recurrence rates for the different fixation techniques.

Cited by 29 publications

References 70 publications

Robotic versus laparoscopic ventral hernia repair: multicenter, blinded randomized controlled trial

Robotic versus laparoscopic ventral hernia repair: multicenter, blinded randomized controlled trial

Robotic‐assisted ventral hernia repair with surgical mesh: how I do it and case series of early experience

Guidelines for treatment of umbilical and epigastric hernias from the European Hernia Society and Americas Hernia Society

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