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Closure versus non-closure of fascial defects in laparoscopic ventral and incisional hernia repairs: a review of the literature

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Abstract

The laparoscopic technique for repairing ventral and incisional hernias (VIH) is now well established. However, several issues related to laparoscopic VIH repair, such as the high recurrence rate for hernias with large fascial defects and in extremely obese patients, are yet to be resolved. Additional problems include seroma formation, mesh bulging/eventration, and non-restoration of the abdominal wall rigidity/function with only bridging of the hernial orifice using standard laparoscopic intraperitoneal onlay mesh repair (sIPOM). To solve these problems, laparoscopic fascial defect closure with IPOM reinforcement (IPOM-Plus) has been introduced in the past decade, and a few studies have reported satisfactory outcomes. Although detailed techniques for fascial defect closure and handling of the mesh have been published, standardized techniques are yet to be established. We reviewed the literature on IPOM-Plus in the PubMed database and identified 16 reports in which the recurrence rate, incidence of seroma formation, and incidence of mesh bulging were 0–7.7, 0–11.4, and 0 %, respectively. Several comparison studies between sIPOM and IPOM-Plus seem to suggest that IPOM-Plus is associated with more favorable surgical outcomes; however, larger-scale studies are essential.

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References

  1. Mudge M, Hughes LE. Incisional hernia: a 10-year prospective study of incidence and attitudes. Br J Surg. 1985;72:70–1.

    Article  CAS  PubMed  Google Scholar 

  2. Lewis RT, Wiegand FM. Natural history of vertical abdominal parietal closure: prolene versus Dexon. Can J Surg. 1989;32:196–200.

    CAS  PubMed  Google Scholar 

  3. Sugerman HJ, Kellum JM Jr, Reines HD, DeMaria EJ, Newsome HH, Lowry JW. Greater risk of incisional hernia with morbidly obese than steroid-dependent patients and low recurrence with prefascial polypropylene mesh. Am J Surg. 1996;171:80–4.

    Article  CAS  PubMed  Google Scholar 

  4. National Center for Health Statistics. Vital and health statistics of the centers for disease control and prevention. Adv Data. 1998;300:7.

    Google Scholar 

  5. Millenium Research Group. US markets for soft tissue repair. Toronto: Millennium Research Group Inc; 2009.

    Google Scholar 

  6. Hospital intelligence agency. http://hospia.jp/dpc (in Japanese).

  7. de Vries Reilingh TS, van Geldere D, Langenhorst B, de Jong D, van der Wilt GJ, van Goor H, Bleichrodt RP. Repair of large midline incisional hernias with polypropylene mesh: comparison of three operative techniques. Hernia. 2004;8:56–9.

    Article  PubMed  Google Scholar 

  8. Luijendijk RW, Hop WC, van den Tol MP, et al. A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med. 2000;343:392–8.

    Article  CAS  PubMed  Google Scholar 

  9. Burger JW, Luijendijk RW, Hop WC, et al. Long term follow up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg. 2004;240:578–83.

    PubMed  PubMed Central  Google Scholar 

  10. LeBlanc KA, Booth WV. Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethylene: preliminary findings. Surg Laparosc Endosc. 1993;3:39–41.

    CAS  PubMed  Google Scholar 

  11. Heniford BT, Park A, Ramshaw BJ, Voeller G. Laparoscopic repair of ventral hernias nine years’ experience with 850 consecutive hernias. Ann Surg. 2003;238:391–400.

    PubMed  PubMed Central  Google Scholar 

  12. Sharma A, Mehrotra M, Khullar R, Soni V, Baijal M, Chowbey PK. Laparoscopic ventral/incisional hernia repair: a single centre experience of 1242 patients over a period of 13 years. Hernia. 2011;15:131–9.

    Article  CAS  PubMed  Google Scholar 

  13. Carbajo MA, Martín del Olmo JC, Blanco JI, Toledano M, de la Cuesta C, Ferreras C, et al. Laparoscopic approach to incisional hernia lessons learned from 270 patients over 8 years. Surg Endosc. 2003;17:118–22.

    Article  CAS  PubMed  Google Scholar 

  14. Sauerland S, Walgenbach M, Habermalz B, Seiler CM, Miserez M. Laparoscopic versus open surgical techniques for ventral or incisional hernia repair. Cochrane Database Syst Rev. 2011;(3):CD007781. doi:10.1002/14651858.CD007781.pub2.

  15. Kurmann A, Visth E, Candinas D, Beldi G. Long-term follow-up of open and laparoscopic repair of large incisional hernias. World J Surg. 2011;35:297–301.

    Article  PubMed  Google Scholar 

  16. Tse GH, Stutchfield BM, Duckworth AD, de Beaux AC, Tulloh B. Pseudo-recurrence following laparoscopic ventral and incisional hernia repair. Hernia. 2010;14:583–7.

    Article  CAS  PubMed  Google Scholar 

  17. Schoenmaeckers EJP, Wassenaar EB, Raymakers JTFJ, Rakic S. Bulging of the mesh after laparoscopic repair of ventral and incisional hernias. JSLS. 2010;14:541–6.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Bittner R, Bingener-Casey J, Dietz U, Fabian M, Ferzli GS, Fortelny RH, et al. International Endohernia Society (IEHS). Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS)-part 1. Surg Endosc. 2014;28:2–29.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Franklin ME, Gonzalez JJ, Glass JL, Manjarrez A. Laparoscopic ventral and incisional hernia repair: 11-year experience. Hernia. 2004;8:23–7.

    Article  PubMed  Google Scholar 

  20. Chelala E, Thoma M, Tatete B, Lemye AC, Dessily M, Alle JL. The suturing concept for laparoscopic mesh fixation in ventral and incisional hernia repair: mid-term analysis of 400 cases. Surg Endosc. 2007;21:391–5.

    Article  CAS  PubMed  Google Scholar 

  21. Palanivelu C, Jani KV, Senthilnathan P, Parthasarathi R, Madhankumar MV, Malladi VK. Laparoscopic sutured closure with mesh reinforcement of incisional hernias. Hernia. 2007;11:223–8.

    Article  CAS  PubMed  Google Scholar 

  22. Agarwal BB, Agarwal S, Gupta MK, Mishra A, Mahajan KC. Laparoscopic ventral hernia meshplasty with “double-breasted” fascial closure of hernia defect: a new technique. J Laparoendosc Adv Surg Tech. 2008;18:222–9.

    Article  Google Scholar 

  23. Agarwal BB, Agarwal S, Mahajan KC. Laparoscopic ventral hernia repair: innovative anatomical closure, mesh insertion without 10-mm transmyofascial port, and atraumatic mesh fixation: a preliminary experience of a new technique. Surg Endosc. 2009;23:900–5.

    Article  PubMed  Google Scholar 

  24. Sharma D, Jindal V, Pathania OP, Thomas S. Novel technique for closure of defect in laparoscopic ventral hernia repair. J Minim Access Surg. 2010;6:86–8.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Orenstein SB, Dumeer JL, Monteagudo J, Poi MJ, Novitsky YW. Outcomes of laparoscopic ventral hernia repair with routine defect closure using ‘‘shoelacing’’ technique. Surg Endosc. 2011;25:1452–7.

    Article  PubMed  Google Scholar 

  26. Rea R, Falco P, Izzo D, Leongito M, Amato B. Laparocopic ventral hernia repair with primary transparietal closure of the hernial defect. BMJ Surg. 2012;12(Suppl 1):S33.

    Article  Google Scholar 

  27. Banerjee A, Beck C, Narula VK, Linn J, Noria S, Zagol B, Mikami DJ. Laparoscopic ventral hernia repair: does primary repair in addition to placement of mesh decrease recurrence? Surg Endosc. 2012;26:1264–8.

    Article  PubMed  Google Scholar 

  28. Liang MK, Subramanian A, Awad SS. Laparoscopic transcutaneous closure of central defects in laparoscopic incisional hernia repair. Surg Laparosc Endosc Percutan Tech. 2012;22:e66–70.

    Article  PubMed  Google Scholar 

  29. Allison N, Tieu K, Snyder B, Pigazzi A, Wilson E. Technical feasibility of robot-assisted ventral hernia repair. World J Surg. 2012;36:447–52.

    Article  PubMed  Google Scholar 

  30. Clapp ML, Hicks SC, Awad SS, Liang MK. Trans-cutaneous closure of central defects (TCCD) in laparoscopic ventral hernia repairs (LVHR). World J Surg. 2013;37:42–51.

    Article  PubMed  Google Scholar 

  31. Zeichen MS, Lujan HJ, Mata WN, Maciel VH, Lee D, Jorge I, Plasencia G, Gomez E, Hernandez AM. Closure versus non-closure of hernia defect during laparoscopic ventral hernia repair with mesh. Hernia. 2013;17:589–96.

    Article  CAS  PubMed  Google Scholar 

  32. Strey CW. Triple-step laparoscopic incisional hernia repair: midline suture closure supported by dorsal component separation and intraperitoneal onlay mesh reinforcement. World J Surg. 2014;38:3276–9.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Gonzales AM, Romero RJ, Seetharamaiah R, Gallas M, Lamoureux J, Rabaza JR. Laparoscopic ventral hernia repair with primary closure versus no primary closure of the defect: potential benefits of the robotic technology. Int J Med Robotics Comput Assist Surg. 2014; Epub ahead of print.

  34. Lambrecht JR, Vaktskjold A, Trondsen E, Øyen OM, Reiersten O. Laparoscopic ventral hernia repair: outcomes in primary versus incisional hernias: no effect of defect closure. Hernia. 2015; Epub ahead of print.

  35. Ramirez OM, Ruas E, Dellon AL. “Components separation” method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg. 1990;86:519–26.

    Article  CAS  PubMed  Google Scholar 

  36. Rosen MJ, Jin J, McGee MF, Williams C, Marks J, Ponsky JL. Laparoscopic component separation in the single-stage treatment of infected abdominal wall prosthetic removal. Hernia. 2007;11:435–40.

    Article  CAS  PubMed  Google Scholar 

  37. Harth KC, Rosen MJ. Endoscopic versus open component separation in complex abdominal wall reconstruction. Am J Surg. 2010;199:342–6.

    Article  PubMed  Google Scholar 

  38. Giurgius M, Bendure L, Davenport DL, Roth JS. The endoscopic component separation technique for hernia repair results in reduced morbidity compared to the open component separation technique. Hernia. 2012;16:47–51.

    Article  CAS  PubMed  Google Scholar 

  39. Albright E, Diaz D, Davenport D, Roth JS. The component separation technique for hernia repair: a comparison of open and endoscopic techniques. Am Surg. 2011;77:839–43.

    PubMed  Google Scholar 

  40. Parker M, Goldberg RF, Dinkins MM, Asbun HJ, Daniel Smith C, Preissler S, et al. Pilot study on objective measurement of abdominal wall strength in patients with ventral incisional hernia. Surg Endosc. 2011;25:3503–8.

    Article  PubMed  Google Scholar 

  41. Fox M, Cannon RM, Egger M, Spate K, Kehdy FJ. Laparoscopic component separation reduces postoperative wound complications but does not alter recurrence rates in complex hernia repairs. Am J Surg. 2013;206:869–75.

    Article  PubMed  Google Scholar 

  42. Milburn ML, Shah PK, Friedman EB, Roth JS, Bochicchio GV, Gorbaty B, et al. Laparoscopically assisted components separation technique for ventral incisional hernia repair. Hernia. 2007;11:157–61.

    Article  PubMed  Google Scholar 

  43. Ballem N, Parikh R, Berber E, Siperstein A. Laparoscopic versus open ventral hernia repairs: 5 year recurrence rates. Surg Endosc. 2008;22:1935–40.

    Article  PubMed  Google Scholar 

  44. Itani KM, Hur K, Kim LT, Anthony T, Berger DH, Reda D, et al. Comparison of laparoscopic and open repair with mesh for the treatment of ventral incisional hernia: a randomized trial. Arch Surg. 2010;145:322–8.

    Article  PubMed  Google Scholar 

  45. Kurmann A, Visth E, Candinas D, Beldi G. Long-term follow-up of open and laparoscopic repair of large incisional hernias. World J Surg. 2011;35:297–301.

    Article  PubMed  Google Scholar 

  46. Edwards C, Angstad J, Whipple O, Grau R. Laparoscopic ventral hernia repair: postoperative antibiotics decrease incidence of seroma-related cellulitis. Am Surg. 2005;71:931–5.

    CAS  PubMed  Google Scholar 

  47. Parker HH III, Nottingham JM, Bynoe RP, Yost MJ. Laparoscopic repair of large incisional hernias. Am Surg. 2002;68:530–3.

    PubMed  Google Scholar 

  48. Birch DW. Characterizing laparoscopic incisional hernia repair. Can J Surg. 2007;50:195–201.

    PubMed  PubMed Central  Google Scholar 

  49. Susmallian S, Gewurtz G, Ezri T, Charuzi I. Seroma after laparoscopic repair of hernia with PTFE patch: is it really a complication? Hernia. 2001;5:139–41.

    Article  CAS  PubMed  Google Scholar 

  50. Alfieri S, Amid PK, Campanelli G, Izard G, Kehlet H, Wijsmuller AR, et al. International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery. Hernia. 2011;15:239–49.

    Article  CAS  PubMed  Google Scholar 

  51. Cocozza E, Berselli M, Latham L, Livraghi L, Farassino L, Bianchi V, et al. Laparoscopic repair of ventral hernia in a laparoscopic experienced surgical center: low recurrence rate, morbidity, and chronic pain are achievable. Surg Laparosc Endosc Percutan Tech. 2014;24:168–72.

    Article  PubMed  Google Scholar 

  52. Bansal VK, Misra MC, Babu D, Victor J, Kumar S, Sagar R, et al. A prospective, randomized comparison of long-term outcomes: chronic groin pain and quality of life following totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) laparoscopic inguinal hernia repair. Surg Endosc. 2013;27:2373–82.

    Article  PubMed  Google Scholar 

  53. Symeonidis D, Baloyiannis I, Koukoulis G, Pratsas K, Georgopoulou S, Efthymiou M, et al. Prospective non-randomized comparison of open versus laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair under different anesthetic methods. Surg Today. 2014;44:906–13.

    Article  PubMed  Google Scholar 

  54. Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2009;13:343–403.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. DuBay DA, Choi W, Urbanchek MG, Wang X, Adamson B, Dennis RG, Kuzon WM, Franz MG. Incisional herniation induces decreased abdominal wall compliance via oblique muscle atrophy and fibrosis. Ann Surg. 2007;245:140–6.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Franz MG. The biology of hernia formation. Surg Clin North Am. 2008;88:1–15.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Jensen KK, Kjaer M, Jorgensen LN. Abdominal muscle function and incisional hernia: a systematic review. Hernia. 2014;18:481–6.

    Article  CAS  PubMed  Google Scholar 

  58. Den Hartog D, Eker HH, Tuinebreijer WE, Kleinrensink GJ, Stam HJ, Lange JF. Isokinetic strength of the trunk flexor muscles after surgical repair for incisional hernia. Hernia. 2010;14:243–7.

    Article  Google Scholar 

  59. Cuccurullo D, Piccoli M, Agrestra F, Magnone S, Corcione F, Stancanelli V, Melotti G. Laparoscopic ventral incisional hernia repair: evidence-based guidelines of the first Italian Consensus Conference. Hernia. 2013;17:557–66.

    Article  CAS  PubMed  Google Scholar 

  60. Nguyen DH, Nguyen MT, Askenasy EP, Kao LS, Liang MK. Primary fascial closure with laparoscopic ventral hernia repair: systematic review. World J Surg. 2014;38:3097–104.

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors wish to express their sincere gratitude to Dr. Elie Chelala for the detailed explanation of the “reverse U-stitch” during the writing of this article.

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Authors and Affiliations

  1. Department of Surgery, Daisan Hospital, Jikei University School of Medicine, 4-11-1 Izumihoncho, Komae, Tokyo, 201-8601, Japan

    Katsuhito Suwa & Tomoyoshi Okamoto

  2. Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan

    Katsuhiko Yanaga

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  1. Katsuhito Suwa
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Correspondence to Katsuhito Suwa.

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Suwa, K., Okamoto, T. & Yanaga, K. Closure versus non-closure of fascial defects in laparoscopic ventral and incisional hernia repairs: a review of the literature. Surg Today 46, 764–773 (2016). https://doi.org/10.1007/s00595-015-1219-y

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