A Tandon1, S Pathak2, N J R Lyons2, Q M Nunes1,3, I R Daniels2, N J Smart4. 1. Department of General Surgery, Aintree University Hospital, Liverpool, UK. 2. Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK. 3. National Institute for Health Research Liverpool Pancreas Biomedical Research Unit, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK. 4. Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK. drneilsmart@hotmail.com.
Abstract
BACKGROUND: Laparoscopic incisional and ventral hernia repair (LIVHR) is being used increasingly, with reported outcomes equivalent to those of open hernia repair. Closure of the fascial defect (CFD) is a technique that may reduce seroma formation and bulging after LIVHR. Non-closure of the fascial defect makes the repair of larger defects easier and reduces postoperative pain. The aim of this systematic review was to determine whether CFD affects the rate of adverse outcomes, such as recurrence, pseudo-recurrence, mesh eventration or bulging, and the rate of seroma formation. METHODS: A systematic search was performed of PubMed, Ovid, the Cochrane Library, Google Scholar and Scopus to identify RCTs that analysed CFD with regard to rates of adverse outcomes. A meta-analysis was done using fixed-effect methods. The primary outcome of interest was adverse events. Secondary outcomes were seroma, postoperative pain, mean hospital stay, mean duration of operation and surgical techniques employed. RESULTS: A total of 16 studies were identified involving 3638 patients, 2963 in the CFD group and 675 in the non-closure of facial defect group. Significantly fewer adverse events were noted following CFD than non-closure (4·9 per cent (79 of 1613) versus 22·3 per cent (114 of 511)), with a combined risk ratio (RR) of 0·25 (95 per cent c.i. 0·18 to 0·33; P < 0·001). CFD resulted in a significantly lower rate of seroma (2·5 per cent (39 of 1546) versus 12·2 per cent (47 of 385)), with a combined RR of 0·37 (0·23 to 0·57; P < 0·001), and shorter duration of hospital stay. No significant difference was noted in postoperative pain. CONCLUSION: CFD during LIVHR reduces the rate of seroma formation and adverse hernia-site events.
BACKGROUND: Laparoscopic incisional and ventral hernia repair (LIVHR) is being used increasingly, with reported outcomes equivalent to those of open hernia repair. Closure of the fascial defect (CFD) is a technique that may reduce seroma formation and bulging after LIVHR. Non-closure of the fascial defect makes the repair of larger defects easier and reduces postoperative pain. The aim of this systematic review was to determine whether CFD affects the rate of adverse outcomes, such as recurrence, pseudo-recurrence, mesh eventration or bulging, and the rate of seroma formation. METHODS: A systematic search was performed of PubMed, Ovid, the Cochrane Library, Google Scholar and Scopus to identify RCTs that analysed CFD with regard to rates of adverse outcomes. A meta-analysis was done using fixed-effect methods. The primary outcome of interest was adverse events. Secondary outcomes were seroma, postoperative pain, mean hospital stay, mean duration of operation and surgical techniques employed. RESULTS: A total of 16 studies were identified involving 3638 patients, 2963 in the CFD group and 675 in the non-closure of facial defect group. Significantly fewer adverse events were noted following CFD than non-closure (4·9 per cent (79 of 1613) versus 22·3 per cent (114 of 511)), with a combined risk ratio (RR) of 0·25 (95 per cent c.i. 0·18 to 0·33; P < 0·001). CFD resulted in a significantly lower rate of seroma (2·5 per cent (39 of 1546) versus 12·2 per cent (47 of 385)), with a combined RR of 0·37 (0·23 to 0·57; P < 0·001), and shorter duration of hospital stay. No significant difference was noted in postoperative pain. CONCLUSION: CFD during LIVHR reduces the rate of seroma formation and adverse hernia-site events.
Authors: M Ahonen-Siirtola; T Nevala; J Vironen; J Kössi; T Pinta; S Niemeläinen; U Keränen; J Ward; P Vento; J Karvonen; P Ohtonen; J Mäkelä; T Rautio Journal: Hernia Date: 2018-06-07 Impact factor: 4.739
Authors: James G Bittner; Sameer Alrefai; Michelle Vy; Micah Mabe; Paul A R Del Prado; Natasha L Clingempeel Journal: Surg Endosc Date: 2017-07-20 Impact factor: 4.584
Authors: Igor Belyansky; Jorge Daes; Victor Gheorghe Radu; Ramana Balasubramanian; H Reza Zahiri; Adam S Weltz; Udai S Sibia; Adrian Park; Yuri Novitsky Journal: Surg Endosc Date: 2017-09-15 Impact factor: 4.584
Authors: Andreas Domen; Cedric Stabel; Rami Jawad; Nicolas Duchateau; Erik Fransen; Patrick Vanclooster; Charles de Gheldere Journal: Langenbecks Arch Surg Date: 2020-05-31 Impact factor: 3.445
Authors: S Dey; R Parthasarathi; S C Sabnis; R Jain; P Praveen Raj; P Senthilnathan; S Rajapandian; C Palanivelu Journal: Hernia Date: 2019-02-18 Impact factor: 4.739