Video-Assisted Mini-Open Sublay (VAMOS): A Simple Hybrid Approach for Lateral Incisional Hernias

Abstract

PurposeThe purpose is to present a new hybrid approach of lateral incisional hernia repair associated with reduced operative trauma and anatomically optimal mesh placement.MethodsVideo-Assisted Mini-Open Sublay (VAMOS) consists of a laparoscopic atraumatic dissection of the hernia sac, diaphanoscopy, laparoscopically-assisted closure of the fascial gap and mesh placement in sublay position through a minimized skin incision. Feasibility of this concept was assessed in a cohort of 7 consecutive patients.ResultsVAMOS approach was feasible in all 7 patients. Median hernia size was 8 cm, the median skin incision width was 7.7 cm. Median operative time was 86 min. In all patients a sufficient mesh overlap on all sides of the fascial gap was ensured. On short-term follow-up no procedure related complications were recorded, seroma formation occurred in 2 patients. Pain medication was necessary for median 4.9 days. There was no need for pain medication on day 14, whatsoever.ConclusionInitial VAMOS results show that the technique is simple, time-saving and safe. It provides a substantial reduction in postoperative pain compared to an open approach. Through implantation in the intermuscular sublay position and minor access-related trauma, it is possible to achieve a biomechanically optimal mesh position, to lay the foundations for adequate remodelling of the abdominal wall, and to prevent recurrence as well as local complications. All in all, VAMOS appears to have several advantages over current surgical strategies.

Hybrid: Evolving techniques in laparoscopic ventral hernia mesh repair

“…Studies suggest that the hybrid technique is safe in cases of recurrent difficult incisional hernias. [ 14 ] Some reports also suggest using hybrid technique for obese patients with difficult incisional hernias, multiple defects, irreducible hernias with necrotic skin, lateral incisional hernias[ 15 ] and parastomal hernias. [ 16 ]…”

Analysis of surgical quality indicators after certification as a Hernia Center

“…The establishment of a center for hernia surgery must do justice to a particular circumstance since, on the one hand, it has to be offered on a large scale due to the high incidence of hernias. It cannot generally be centralized, but on the other hand, the surgical options and surgical techniques have developed dynamically in recent years and sometimes very much place high demands on the surgeon's indication and technical skills [ 9 , 11 , 12 , 36 , 37 ]. To a certain extent, this circumstance is met by the different requirements for competence and reference centers and the simplest way of obtaining the DHG seal "certified hernia surgery."…”

“…In the last two decades, in particular, numerous minimally invasive or hybrid procedures (e.g., (e)MILOS, VAMOS, eTEP, TAPP, IPOM, etc.) [ 10 – 12 ] have been developed to improve the quality of results [ 13 ]. However, development always harbors potential risks, so a structured review of the structures, processes, and outcomes is required [ 14 ].…”

What are the influencing factors on the outcome in lateral incisional hernia repair? A registry-based multivariable analysis

“…This has led to an increase in the use of the open retromuscular/sublay procedure, which is associated with a significantly higher rate of perioperative complication rates [ 11 ]. The future alternative to the laparoscopic IPOM and open retromuscular/sublay procedure for repair of lateral incisional hernias is likely to be laparo-endoscopic or robotic transversus abdominis release procedures or hybrid techniques [ 12 – 16 ]. Initial, promising results are available for the procedures.…”