F Köckerling1, D Adolf2, K Zarras3, R Fortelny4, R Lorenz5, B Lammers6, W Reinpold7, B Stechemesser8, C Schug-Pass9, D Weyhe10. 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. StatConsult GmbH, Halberstädter Strasse 40 a, 9112, Magdeburg, Germany. 3. Department of Visceral, Minimally Invasive and Oncologic Surgery, Academic Teaching Hospital of University of Düsseldorf, Marien Hospital, Rochusstrasse 2, 40479, Düsseldorf, Germany. 4. Department of General Surgery, Wilhelminenhospital, Sigmund Freud University, Medical Faculty, Montleartstrasse 37, 1160, Vienna, Austria. 5. 3+Chirurgen, Klosterstrasse 34/35, Spandau, 13581, Berlin, Germany. 6. Department of Surgery I-Section Coloproctology and Hernia Surgery, Lukas Hospital, Preussenstrasse 84, 41464, Neuss, Germany. 7. Department of Surgery, Wilhelmsburger Hospital Gross Sand, Academic Teaching Hospital of University Hamburg, Gross Sand 32, 1107, Hamburg, Germany. 8. Pan Hospital, Hernia Center, Zeppelinstrasse 1, 50667, Cologne, Germany. 9. Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany. 10. Pius Hospital, Department of General and Visceral Surgery, University Hospital of Visceral Surgery, Georgstrasse 12, 26121, Oldenburg, Germany.
Abstract
INTRODUCTION: The proportion of epigastric hernias in the total collective of all operated abdominal wall hernias is 3.6-6.9%. The recently published guidelines for treatment of epigastric hernias of the European Hernia Society and the Americas Hernia Society recommend the use of a mesh for defect size of ≥ 1 cm, i.e., a preperitoneal flat mesh technique for sizes 1-4 cm, and laparoscopic IPOM technique for defects > 4 cm and/or obesity. Against that background, this analysis of data from the Herniamed Registry now aims to explore trends in epigastric hernia repair. METHODS: To detect trends, the perioperative outcome was calculated separately for the years 2010 to 2019 and the 1-year follow-up for the years 2010 to 2018 and significant differences were identified. Analysis was based on 25,518 primary elective epigastric hernia repairs. The rates of postoperative surgical complications, pain at rest, pain on exertion, chronic pain requiring treatment and recurrence associated with the various surgical techniques were calculated separately for each year. Fisher's exact test for unadjusted analysis between years was applied with Bonferroni adjustment for multiple testing. RESULTS: The proportion of laparoscopic IPOM repairs declined from 26.0% in 2013 to 18.2% in 2019 (p < 0.001). Instead, the proportion of open sublay repairs rose from 16.5% to 21.8% (p < 0.001). That was also true for innovative techniques such as the EMILOS, MILOS, eTEP and preperitoneal flat mesh technique (8.3% vs 15.3%; p < 0.001). This change in indication for the various surgical techniques led to a significant improvement in the postoperative surgical complication rate (3.8% vs 1.9%; p < 0.001). CONCLUSION: The trend is for epigastric hernia repair to be performed less often in laparoscopic IPOM technique and instead more often in open sublay technique or the new innovative techniques.
INTRODUCTION: The proportion of epigastric hernias in the total collective of all operated abdominal wall hernias is 3.6-6.9%. The recently published guidelines for treatment of epigastric hernias of the European Hernia Society and the Americas Hernia Society recommend the use of a mesh for defect size of ≥ 1 cm, i.e., a preperitoneal flat mesh technique for sizes 1-4 cm, and laparoscopic IPOM technique for defects > 4 cm and/or obesity. Against that background, this analysis of data from the Herniamed Registry now aims to explore trends in epigastric hernia repair. METHODS: To detect trends, the perioperative outcome was calculated separately for the years 2010 to 2019 and the 1-year follow-up for the years 2010 to 2018 and significant differences were identified. Analysis was based on 25,518 primary elective epigastric hernia repairs. The rates of postoperative surgical complications, pain at rest, pain on exertion, chronic pain requiring treatment and recurrence associated with the various surgical techniques were calculated separately for each year. Fisher's exact test for unadjusted analysis between years was applied with Bonferroni adjustment for multiple testing. RESULTS: The proportion of laparoscopic IPOM repairs declined from 26.0% in 2013 to 18.2% in 2019 (p < 0.001). Instead, the proportion of open sublay repairs rose from 16.5% to 21.8% (p < 0.001). That was also true for innovative techniques such as the EMILOS, MILOS, eTEP and preperitoneal flat mesh technique (8.3% vs 15.3%; p < 0.001). This change in indication for the various surgical techniques led to a significant improvement in the postoperative surgical complication rate (3.8% vs 1.9%; p < 0.001). CONCLUSION: The trend is for epigastric hernia repair to be performed less often in laparoscopic IPOM technique and instead more often in open sublay technique or the new innovative techniques.
Authors: Karla Bernardi; Oscar A Olavarria; Julie L Holihan; Lillian S Kao; Tien C Ko; John S Roth; Shawn Tsuda; Khashayar Vaziri; Mike K Liang Journal: Ann Surg Date: 2020-03 Impact factor: 12.969
Authors: Jeroen E H Ponten; Wouter K G Leclercq; Tanja Lettinga; Jeroen Heemskerk; Joop L M Konsten; Nicole D Bouvy; Simon W Nienhuijs Journal: Ann Surg Date: 2019-07 Impact factor: 12.969
Authors: J E H Ponten; B J M Leenders; W K G Leclercq; T Lettinga; J Heemskerk; J L M Konsten; P S S Castelijns; S W Nienhuijs Journal: World J Surg Date: 2018-05 Impact factor: 3.352
Authors: I Kyle-Leinhase; F Köckerling; L N Jørgensen; A Montgomery; J F Gillion; J A P Rodriguez; W Hope; F Muysoms Journal: Hernia Date: 2018-01-06 Impact factor: 4.739