F Köckerling1, H Hoffmann2,3, F Mayer4, K Zarras5, W Reinpold6, R Fortelny7, D Weyhe8, B Lammers9, D Adolf10, C Schug-Pass11. 1. Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany. ferdinand.koeckerling@vivantes.de. 2. Center for Hernia Surgery and Proctology, ZweiChirurgen GmbH, St. Johanns-Vorstadt 44, 4056, Basel, Switzerland. 3. University of Basel, Petersplatz 1, 4001, Basel, Switzerland. 4. Department of Surgery, Paracelsus Medical University Salzburg, University Hospital of Salzburg, Müllner Hauptstrasse 48, 5020, Salzburg, Austria. 5. Department of Visceral, Minimally Invasive and Oncologic Surgery, Academic Teaching Hospital of University of Düsseldorf, Marien Hospital, Rochusstraße 2, 40479, Düsseldorf, Germany. 6. Department of Surgery, Wilhelmsburger Hospital Groß Sand, Academic Teaching Hospital of University Hamburg, Groß Sand 3, 21107, Hamburg, Germany. 7. Department of General Surgery, Wilhelminen Hospital, Sigmund Freud University Vienna, Medical Faculty, Freudplatz 3, 1020, Vienna, Austria. 8. Department of General and Visceral Surgery, Pius Hospital, University Hospital of Visceral Surgery, Georgstraße 12, 26121, Oldenburg, Germany. 9. Department of Surgery I, Section Coloproctology and Hernia Surgery, Lukas Hospital, Preussenstr. 84, 41464, Neuss, Germany. 10. StatConsult GmbH, Halberstädter Strasse 40 a, 39112, Magdeburg, Germany. 11. Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.
Abstract
INTRODUCTION: There is an increasingly controversial debate about the best possible incisional hernia repair technique. Despite the good outcomes of laparoscopic IPOM, concerns about the intraperitoneal mesh placement and its potential intraabdominal complications have risen. Against that background, this paper now analyzes changes and trends in incisional hernia repair techniques in the recent decade. METHODS: Between 2010 and 2019 a total of 61,627 patients with primary elective incisional hernia repair were enrolled in the Herniamed Registry. The outcome results were assigned to the year of repair and summarized as curves to visualize trends. The explorative Fisher's exact test was used for statistical calculation of significant differences. Since the number of cases entered into the Herniamed Registry for the years 2010-2012 was still relatively small, the years 2013 and 2019 were compared for statistical analysis. RESULTS: In the analyzed time period, the proportion of incisional hernias repaired in open suture technique remained unchanged at about 10%. The proportion of laparoscopic IPOM repairs decreased significantly from 33.8% in 2013 to 21.0% (p < 0.001) in 2019. Conversely, the proportion of open sublay repairs increased significantly from 32.1% in 2013 to 41.4% (p < 0.001) in 2019. Starting in 2015, there has also been the introduction and increasing use (4.5% in 2013 vs. 10.0% in 2019; p < 0.001) of new minimally-invasive techniques with placement of a mesh into the sublay/retromuscular/preperitoneal abdominal wall layer (E/MILOS, eTEP, preperitoneal mesh technique). CONCLUSION: Analysis of data from the Herniamed Registry shows a significant trend to the disadvantage of the laparoscopic IPOM and to the advantage of the open sublay operation and the new minimally-invasive techniques (E/MILOS, eTEP, preperitoneal mesh technique). Despite all the recommendations in the guidelines, 10% of incisional hernias continue to be treated by means of a suture technique.
INTRODUCTION: There is an increasingly controversial debate about the best possible incisional hernia repair technique. Despite the good outcomes of laparoscopic IPOM, concerns about the intraperitoneal mesh placement and its potential intraabdominal complications have risen. Against that background, this paper now analyzes changes and trends in incisional hernia repair techniques in the recent decade. METHODS: Between 2010 and 2019 a total of 61,627 patients with primary elective incisional hernia repair were enrolled in the Herniamed Registry. The outcome results were assigned to the year of repair and summarized as curves to visualize trends. The explorative Fisher's exact test was used for statistical calculation of significant differences. Since the number of cases entered into the Herniamed Registry for the years 2010-2012 was still relatively small, the years 2013 and 2019 were compared for statistical analysis. RESULTS: In the analyzed time period, the proportion of incisional hernias repaired in open suture technique remained unchanged at about 10%. The proportion of laparoscopic IPOM repairs decreased significantly from 33.8% in 2013 to 21.0% (p < 0.001) in 2019. Conversely, the proportion of open sublay repairs increased significantly from 32.1% in 2013 to 41.4% (p < 0.001) in 2019. Starting in 2015, there has also been the introduction and increasing use (4.5% in 2013 vs. 10.0% in 2019; p < 0.001) of new minimally-invasive techniques with placement of a mesh into the sublay/retromuscular/preperitoneal abdominal wall layer (E/MILOS, eTEP, preperitoneal mesh technique). CONCLUSION: Analysis of data from the Herniamed Registry shows a significant trend to the disadvantage of the laparoscopic IPOM and to the advantage of the open sublay operation and the new minimally-invasive techniques (E/MILOS, eTEP, preperitoneal mesh technique). Despite all the recommendations in the guidelines, 10% of incisional hernias continue to be treated by means of a suture technique.
Authors: C Fink; P Baumann; M N Wente; P Knebel; T Bruckner; A Ulrich; J Werner; M W Büchler; M K Diener Journal: Br J Surg Date: 2013-11-26 Impact factor: 6.939
Authors: K Itatsu; Y Yokoyama; G Sugawara; H Kubota; Y Tojima; Y Kurumiya; H Kono; H Yamamoto; M Ando; M Nagino Journal: Br J Surg Date: 2014-08-14 Impact factor: 6.939
Authors: Mike K Liang; Julie L Holihan; Kamal Itani; Zeinab M Alawadi; Juan R Flores Gonzalez; Erik P Askenasy; Conrad Ballecer; Hui Sen Chong; Matthew I Goldblatt; Jacob A Greenberg; John A Harvin; Jerrod N Keith; Robert G Martindale; Sean Orenstein; Bryan Richmond; John Scott Roth; Paul Szotek; Shirin Towfigh; Shawn Tsuda; Khashayar Vaziri; David H Berger Journal: Ann Surg Date: 2017-01 Impact factor: 12.969
Authors: R Bittner; J Bingener-Casey; U Dietz; M Fabian; G S Ferzli; R H Fortelny; F Köckerling; J Kukleta; K Leblanc; D Lomanto; M C Misra; V K Bansal; S Morales-Conde; B Ramshaw; W Reinpold; S Rim; M Rohr; R Schrittwieser; Th Simon; M Smietanski; B Stechemesser; M Timoney; P Chowbey Journal: Surg Endosc Date: 2013-10-11 Impact factor: 4.584
Authors: R Bittner; J Bingener-Casey; U Dietz; M Fabian; G S Ferzli; R H Fortelny; F Köckerling; J Kukleta; K LeBlanc; D Lomanto; M C Misra; S Morales-Conde; B Ramshaw; W Reinpold; S Rim; M Rohr; R Schrittwieser; Th Simon; M Smietanski; B Stechemesser; M Timoney; P Chowbey Journal: Surg Endosc Date: 2014-02 Impact factor: 4.584
Authors: David C Bosanquet; James Ansell; Tarig Abdelrahman; Julie Cornish; Rhiannon Harries; Amy Stimpson; Llion Davies; James C D Glasbey; Kathryn A Frewer; Natasha C Frewer; Daphne Russell; Ian Russell; Jared Torkington Journal: PLoS One Date: 2015-09-21 Impact factor: 3.240
Authors: R Bittner; J Bingener-Casey; U Dietz; M Fabian; G Ferzli; R Fortelny; F Köckerling; J Kukleta; K LeBlanc; D Lomanto; M Misra; S Morales-Conde; B Ramshaw; W Reinpold; S Rim; M Rohr; R Schrittwieser; Th Simon; M Smietanski; B Stechemesser; M Timoney; P Chowbey Journal: Surg Endosc Date: 2013-09-17 Impact factor: 4.584
Authors: M Maneck; F Köckerling; C Fahlenbrach; C D Heidecke; G Heller; H J Meyer; U Rolle; E Schuler; B Waibel; E Jeschke; C Günster Journal: Hernia Date: 2019-11-30 Impact factor: 4.739
Authors: F Köckerling; R Lorenz; W Reinpold; K Zarras; J Conze; A Kuthe; B Lammers; B Stechemesser; F Mayer; R Fortelny; H Hoffmann; J Kukleta; D Weyhe Journal: Hernia Date: 2021-09-16 Impact factor: 2.920