Comparison of laparoscopic and open ventral herniorrhaphy.
ABSTRACT The repair of large and/or recurrent ventral hernias is associated with significant complications and a recurrence rate that can be more than 50 per cent. Laparoscopic ventral herniorrhaphy, a recent development, has been shown to be safe and effective in the repair of ventral hernias. This study retrospectively reviews all ventral hernia repairs over a 3-year period, November 1995 through December 1998, at a community-based teaching hospital. The purpose of the study was to compare open and laparoscopic repairs. A total of 253 ventral hernia repairs were performed during this time, 174 open and 79 laparoscopic. The age, weight, and sex distribution was similar for each group. The hernias in the open group averaged 34.1 cm2 in size, and mesh used averaged 47.3 cm2. In the laparoscopic group, the hernia defect averaged 73.0 cm2, and the mesh size averaged 287.4 cm2. Operative time was longer in the open group, 82.0 versus 58.0 minutes. In the open group, there were 38 (21.8%) minor and 8 (4.6%) major complications, compared with 13 (16.5%) minor and 2 (2.5%) major complications in the laparoscopic group. Hospital stay was shorter for the laparoscopic group, 1.7 versus 2.8 days. At an average follow-up of 21 months (range, 2-40 months), there have been 36 recurrences in the open group (20.7%) compared with 2 recurrences in the laparoscopic group (2.5%). In this series, laparoscopic ventral herniorrhaphy compares favorably to open ventral herniorrhaphy with respect to wound complications, hospital stay, operative time, and recurrence rate.
- [Show abstract] [Hide abstract]
ABSTRACT: Background Hernia repair failure may occur due to suboptimal mesh fixation by mechanical constructs before mesh integration. Construct design and acute penetration angle may alter mesh-tissue fixation strength. We compared acute fixation strengths of absorbable fixation devices at various deployment angles, directions of loading, and construct orientations. Methods Porcine abdominal walls were sectioned. Constructs were deployed at 30°, 45°, 60°, and 90° angles to fix mesh to the tissue specimens. Lap-shear testing was performed in upward, downward, and lateral directions in relation to the abdominal wall cranial–caudal axis to evaluate fixation. Absorbatack™ (AT), SorbaFix™ (SF), and SecureStrap™ in vertical (SSV) and horizontal (SSH) orientations in relation to the abdominal wall cranial–caudal axis were tested. Ten tests were performed for each combination of device, angle, and loading direction. Failure types and strength data were recorded. ANOVA with Tukey–Kramer adjustments for multiple comparisons and χ 2 tests were performed as appropriate (p Results At 30°, SSH and SSV had greater fixation strengths (12.95, 12.98 N, respectively) than SF (5.70 N; p = 0.0057, p = 0.0053, respectively). At 45°, mean fixation strength of SSH was significantly greater than SF (18.14, 11.40 N; p = 0.0002). No differences in strength were identified at 60° or 90°. No differences in strength were noted between SSV and SSH with different directions of loading. No differences were noted between SS and AT at any angle. Immediate failure was associated with SF (p p Conclusions Mesh-tissue fixation was stronger at acute deployment angles with SS compared to SF constructs. The 30° angle and the SF device were associated with increased immediate failures. Varying construct and loading direction did not generate statistically significant differences in the fixation strength of absorbable fixation devices in this study.Surgical Endoscopy 10/2014; 29(6). DOI:10.1007/s00464-014-3850-x · 3.31 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Background: The repair of a subxyphoid hernia is a difficult procedure that nonetheless results in a high rate of recur-rence. The laparoscopic approach is a promising new tech-nique for more efficacious treatment of this condition. This is the first report in the English-language literature to de-scribe the use of this approach for the correction of post-sternotomy subxiphoideal hernia. Methods: Information was retrieved from the patients' hos-pitalization and outpatient clinic files. Of 984 patients who had a median sternotomy, 10 developed a substernal subxi-phoid epigastric hernia. These patients had all been treated laparoscopically using Gore-Tex mesh. Results: Nine patients were admitted electively and one ur-gently. The fascial defect sizes were 4–15 cm (mean, 8.5) in length. Intraabdominal content was adherent to the hernia in six patients; in the other four cases, the defect was adhesion free. In four patients, an incidental surgical procedure was performed (three cholecystectomies and one inguinal hernia repair using the trans abdominal preperitoneal [TAPP] tech-nique). The operations lasted 25–120 min (average, 55). No death occurred as a result of the operations, and none of the operations was converted to an open procedure. Three pa-tients had minor postoperative complications. During 20–42 months of follow-up, one patient suffered a recurrence. Conclusions: Laparoscopic repair of a poststernotomy sub-xiphoideal epigastric hernia is feasible and has a low rate of minor complications. Our review of the literature indicates that this technique produces a better outcome than the con-ventional open repair. Incisional hernia is a common complication of abdominal operations, affecting 10–26% of patients [4, 5, 6]. The lon-gitudinal sternotomy incision, which extends to the epigas-tric region, weakens the upper abdominal wall, leading to the possibility of a hernia in 4% of patients [2, 3]. The repair of these hernias is frequently complicated and requires a lengthy operating time. Incisional hernia re-pairs often result in recurrence of the abdominal defect, which is sometimes even larger than the original one. To address this problem, the laparoscopic repair of incisional hernias has been gaining in popularity . This method has been used routinely in our department for these repairs for the last 4 years. Herein we report our experience with the laparoscopic repair of poststernotomy epigastric hernia. To the best of our knowledge, this is the first report of the use of this technique for poststernotomy subxiphoid hernia in the En-glish-language literature. Patients and methodsSurgical Endoscopy 11/2001; 15(11):1313-1314. · 3.31 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: IntroductionWe performed a retrospective study to determine the mid-term recurrence and complication rates of patients following laparoscopic ventral and incisional hernia repair (LVHR) with DualMesh, an expanded polytetrafluoroethylene (ePTFE) mesh. Additionally, a study of the mesh contraction rate was performed postoperatively.Methods We compared open mesh repair of ventral and incisional hernias (OR) and LVHR. We also analyzed the shrinkage rate of ePTFE mesh. We included 45 patients (21 OR, 24 LVHR) who underwent mesh repair for primary ventral and incisional hernias between January 2008 and December 2012. Patients' characteristics did not significantly differ between the two groups.ResultsMean operating time was 152.7 min for the OR group and 143.1 min for the LVHR group (P = 0.25). Mean postoperative hospital stay was 13.4 days for the OR group and 6.8 days for the LVHR groups (P = 0.01). The postoperative complication rate was 28.6% for the OR group and 12.5% for the LVHR group (P = 0.03). Among OR patients, causes of morbidity were variable: two recurrent cases, one surgical-site infection, one re-recurrence, one case of enteritis, and one case of heart failure. Among the LVHR patients, there was one surgical-site infection and two cases of seroma. No patients in the LVHR group experienced recurrence, while 14.3% of OR patients had a recurrence. In the LVHR group, the mean ePTFE mesh contraction rate was 10.6%.ConclusionLVHR has advantages compared with OR, and the post-insertion contraction rate of ePTFE mesh was 10.6%.Asian Journal of Endoscopic Surgery 05/2014; DOI:10.1111/ases.12108