The management of abdominal wall hernias - in search of consensus.

Abstract

IntroductionLaparoscopic repair is becoming an increasingly popular alternative in the treatment of abdominal wall hernias. In spite of numerous studies evaluating this technique, indications for laparoscopic surgery have not been established. Similarly, implant selection and fixation techniques have not been unified and are the subject of scientific discussion.AimTo assess whether there is a consensus on the management of the most common ventral abdominal wall hernias among recognised experts.Material and methodsFourteen specialists representing the boards of European surgical societies were surveyed to determine their choice of surgical technique for nine typical primary ventral and incisional hernias. The access method, type of operation, mesh prosthesis and fixation method were evaluated. In addition to the laparoscopic procedures, the number of tackers and their arrangement were assessed.ResultsIn none of the cases presented was a consensus of experts obtained. Laparoscopic and open techniques were used equally often. Especially in the group of large hernias, decisions on repair methods were characterised by high variability. The technique of laparoscopic mesh fixation was a subject of great variability in terms of both method selection and the numbers of tackers and sutures used.ConclusionsRecognised experts have not reached a consensus on the management of abdominal wall hernias. Our survey results indicate the need for further research and the inclusion of large cohorts of patients in the dedicated registries to evaluate the results of different surgical methods, which would help in the development of treatment algorithms for surgical education in the future.

Outcomes of bridging versus mesh augmentation in laparoscopic repair of small and medium midline ventral hernias

“…Lack of musculofascial support on the entire mesh surface and its insufficient mesh attachment in IPOM technique causes hernia recurrence and pain due to the increased tension at the implant fixing points [10]. On the other hand, closure of hernia defect in IPOM-plus technique leads to the restoration of abdominal wall function and improved longterm treatment outcomes [11,12]. Against the expectations, the studies confirm the formation of intraabdominal adhesions to the mesh surface [13,14].…”

Techniques of mesh fixation in laparoscopic ventral hernia repair: the surgical enigma - a review

“…Among all the studies included in this topic, about fourteen studies were published on account of experience gained out of case series in retrospective manner. [1][2][3][4][5][6]10,11,21,22,29,32,33,43 There were nine review article and seven randomized control trial. [7][8][9][12][13][14][15]30,35,39,40,41,44,45,47,48 We found seven relevant case reports also, most of which reported either some unusual complications due to particular mesh fixation technique or some innovative idea of mesh fixation technique.…”

“…In spite of that, we are far away from reaching near any universal consensus on this issue. 1 Laparoscopic ventral hernia repair was first described in 1992 by Karl Leblanc, who performed the surgery using four to five port and all repairs were made using 1-mmthick expanded polytetrafluoroethylene patches inserted intraperitoneally and stapled to the anterior abdominal wall over the defects, making use of intra-abdominal pressure to secure the repair. 2 Since then, a lot of different techniques by different surgeons are being used for fixation of mesh.…”

Ventral Abdominal Hernia

“…The diagnosis of ventral abdominal hernia without mechanical ileus was made. Abdominal wall hernia is a common surgically treated medical condition [ 1 ]. This disease can cause pain and other serious complications.…”