P H F Amaral1,2, L Tastaldi3, P H F Barros4,5, I P Abreu Neto4,5, B L Hernani4,5, H Brasil5, C J L Mendes5, M Y Franciss5, A M Pacheco5, R Altenfelder Silva5, S Roll4,5. 1. Hernia Center, Hospital Alemão Oswaldo Cruz, R. Treze de Maio, 1815, 01327-001, São Paulo, SP, Brazil. drpedroamaral@gmail.com. 2. Abdominal Wall Surgery Group, Department of Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, R. Dr. Cesário Mota Júnior, 112., 01221-020, São Paulo, SP, Brazil. drpedroamaral@gmail.com. 3. Comprehensive Hernia Center, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue A10-133, Cleveland, OH, 44195, USA. 4. Hernia Center, Hospital Alemão Oswaldo Cruz, R. Treze de Maio, 1815, 01327-001, São Paulo, SP, Brazil. 5. Abdominal Wall Surgery Group, Department of Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, R. Dr. Cesário Mota Júnior, 112., 01221-020, São Paulo, SP, Brazil.
Abstract
PURPOSE: A residual bulge in the lateral abdominal wall is a reason for patient dissatisfaction after flank hernia repair (FHR). We hypothesized that combining a laparoscopically-placed intraperitoneal mesh (IPOM) with onlay hernia repair performed through a small open incision would increase repair durability and decrease such residual bulges. We aim to report our medium-term outcomes with this technique. METHODS: Patients who have undergone FHR using the technique described above from March 2013 through June 2017 were identified in a prospectively maintained database. Outcomes of interest included surgical site infections (SSI), surgical site occurrences (SSO), surgical site occurrences requiring procedural intervention (SSOPI) and hernia recurrence. RESULTS: Sixteen patients were identified (62% females; mean age 59 ± 8 years, mean body mass index 29.5 kg/m2). Mean hernia width was. 6.4 ± 3 cm and 31% were recurrent hernias previously repaired through an onlay approach. Mean operative time was 159 ± 40 min, fascial closure was achieved in all cases, and there were no intraoperative complications. Median length of stay was 3 days (IQR 3-4), and there were no unplanned readmissions or reoperations. At a median 37-month follow-up (IQR 21-55), wound morbidity rate was 12.5% (2 seromas). There were no SSI/SSOPI and one hernia recurrence (6%) was detected at 12 months postoperatively. CONCLUSION: Combining laparoscopic IPOM with open onlay hernia repair resulted in low recurrence and acceptable wound morbidity rates, with no residual bulges noted at medium-term follow-up. Further studies with larger number of patients and other surgeon's experiences are necessary to determine the role of such technique in the surgical armamentarium for flank hernia repair.
PURPOSE: A residual bulge in the lateral abdominal wall is a reason for patient dissatisfaction after flank hernia repair (FHR). We hypothesized that combining a laparoscopically-placed intraperitoneal mesh (IPOM) with onlay hernia repair performed through a small open incision would increase repair durability and decrease such residual bulges. We aim to report our medium-term outcomes with this technique. METHODS:Patients who have undergone FHR using the technique described above from March 2013 through June 2017 were identified in a prospectively maintained database. Outcomes of interest included surgical site infections (SSI), surgical site occurrences (SSO), surgical site occurrences requiring procedural intervention (SSOPI) and hernia recurrence. RESULTS: Sixteen patients were identified (62% females; mean age 59 ± 8 years, mean body mass index 29.5 kg/m2). Mean hernia width was. 6.4 ± 3 cm and 31% were recurrent hernias previously repaired through an onlay approach. Mean operative time was 159 ± 40 min, fascial closure was achieved in all cases, and there were no intraoperative complications. Median length of stay was 3 days (IQR 3-4), and there were no unplanned readmissions or reoperations. At a median 37-month follow-up (IQR 21-55), wound morbidity rate was 12.5% (2 seromas). There were no SSI/SSOPI and one hernia recurrence (6%) was detected at 12 months postoperatively. CONCLUSION: Combining laparoscopic IPOM with open onlay hernia repair resulted in low recurrence and acceptable wound morbidity rates, with no residual bulges noted at medium-term follow-up. Further studies with larger number of patients and other surgeon's experiences are necessary to determine the role of such technique in the surgical armamentarium for flank hernia repair.
Authors: I N Haskins; C M Horne; D M Krpata; A S Prabhu; L Tastaldi; Arielle J Perez; S Rosenblatt; B K Poulose; M J Rosen Journal: Hernia Date: 2018-02-10 Impact factor: 4.739
Authors: L Matthijs van den Dop; Gijs H J de Smet; Michaël P A Bus; Johan F Lange; Sascha M P Koch; Willem E Hueting Journal: Hernia Date: 2020-09-12 Impact factor: 4.739