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Open randomized clinical trial of laparoscopic versus open incisional hernia repair

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Abstract

Background

Incisional hernia is a common complication following abdominal surgery. Although the use of prosthetics has decreased recurrence rates, the standard open approach is still unsatisfactory. Laparoscopic techniques are an attempt to provide similar outcomes with the advantages of minimally invasive surgery.

Methods

Open randomized controlled clinical trial with follow-up at 1, 2, 3, 7, and 15 days, and 1, 3, and 12 months from hernia repair. The study was carried out in the surgery departments of three general hospitals of the Valencia Health Agency.

Objectives

To compare laparoscopic with anterior open repair using health-related quality of life outcomes as main endpoints.

Results

Eighty-four patients with incisional hernia were randomly allocated to an open group (OG) (n = 39) or to a laparoscopic group (LG) (n = 45). Seventy-four patients completed 1-year follow up. Mean length of stay and time to oral intake were similar between groups. Operative time was 32 min longer in the LG (p < 0.001). Conversion rate was 11%. The local complication rate was superior in the LG (33.3% versus 5.2%) (p < 0.001). Recurrence rate at 1 year (7.9% versus 9.7%) was similar in the two groups. There were no significant differences in the pain scores or the EQ5D tariffs between the two groups during follow-up.

Conclusions

Laparoscopic incisional hernia repair does not seem to be a better procedure than the open anterior technique in terms of operative time, hospitalization, complications, pain or quality of life.

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References

  1. Cassar K (2002) Surgical tratment of incisional hernia. Br J Surg 89:534–545

    Article  PubMed  CAS  Google Scholar 

  2. Librero J, Peiró S, Bernal-Delgado E, Rivas F, Martínez N, Sotoca R (2005) Variaciones en intervenciones de cirugía general en el Sistema Nacional de Salud. Atlas Var Pract Med Sist Nac Salud 1(2):63–81

    Google Scholar 

  3. Luijendijk RW, Hop WC, van den Tol MP (2000) A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 343:392–398

    Article  PubMed  CAS  Google Scholar 

  4. White TJ, Santos MC, Thompson JS (1998) Factors affecting wound complications in repair of ventral hernias. Am Surg 64:276–280

    PubMed  CAS  Google Scholar 

  5. LeBlanc KA, Booth WV (1993) Laparoscopic repair of incisional hernias using expanded polytetrafluoroethylene: preliminary findings. Surg Laparosc Endo 3:39–41

    CAS  Google Scholar 

  6. Carbajo MA, Martin del Olmo JC, Blanco JI, de la Cuesta C, Toledano M, Martin F (1999) Laparoscopic treatment vs open surgery in the solution of major incisional and abdominal wall hernias with mesh. Surg Endosc 13:250–252

    Article  PubMed  CAS  Google Scholar 

  7. Heniford BT, Park A, Ramshaw BJ, Voeller G (2000) Laparoscopic ventral and incisional hernia repair in 407 patients. J Am Coll Surg 190:645–650

    Article  PubMed  CAS  Google Scholar 

  8. Park A, Birch DW, Lovrics P (1998) Laparoscopic and open incisional hernia repair: a comparison study. Surgery 124:816–822

    Article  PubMed  CAS  Google Scholar 

  9. Müller-Riemenschneider F, Roll S, Friedrich M, Zieren J, Reinhold T, Graf von der Schulenburg JM, Greiner W, Willich S (2007) Medical effectiveness and safety of conventional compared to laparoscopic incisional hernia repair: a systematic review. Surg Endosc 21:2127–2136

    Google Scholar 

  10. Olmi S, Scaini A, Cesana GC, Erba L, Croce E (2007) Laparoscopic versus open incisional hernia repair: an open randomized controlled study. Surg Endosc 21:555–559

    Article  PubMed  CAS  Google Scholar 

  11. Misra MC, Bansal VK, Kulkarni MP, Pawar DK (2006) Comparison of laparoscopic and open repair of incisional and primary ventral hernia: results of a prospective randomized study. Surg Endosc 20:1839–1845

    Article  PubMed  CAS  Google Scholar 

  12. Barbaros U, Asoglu O, Seven R, Erbil Y, Dinccag A, Deveci U (2007) The comparison of laparoscopic and open ventral hernia repairs: a prospective randomized study. Hernia 11:51–56

    Article  PubMed  CAS  Google Scholar 

  13. Navarra G, Musolino C, De Marco ML, Bartolotta M, Barbera A, Centorrino T (2007) Retromuscular sutured incisional hernia repair: a randomized controlled trial to compare open and laparoscopic approach. Surg Laparosc Endosc Percutan Tech 17:86–90

    Article  PubMed  Google Scholar 

  14. Itani KM, Neumayer L, Reda D, Kim L, Anthony T (2004) Repair of ventral incisional hernia: the design of a randomized trial to compare open and laparoscopic surgical techniques. Am J Surg 188(6A suppl):22S–29S.

    Google Scholar 

  15. Eddy DM (1994) Principles for making difficult decisions in difficult times. JAMA 271:1792–1798

    Article  PubMed  CAS  Google Scholar 

  16. Korolija D, Sauerland S, Wood-Dauphinee S, Abbou CC, Eypasch E, Caballero MG (2004) Evaluation of quality of life after laparoscopic surgery: evidence-based guidelines of the European Association for Endoscopic Surgery. Surg Endosc 18:879–897

    Article  PubMed  CAS  Google Scholar 

  17. Mussack T, Ladurner R, Vogel T, Lienemann A, Eder-Willwohl A, Hallfeldt KK (2006) Health-related quality-of-life changes after laparoscopic and open incisional hernia repair: a matched pair analysis. Surg Endosc 20:410–413

    Article  PubMed  CAS  Google Scholar 

  18. Chevrel JP, Flament JB (1995) Traitement des éventrations de la paroi abdominale. Encycl Med Chir (Paris France). Tech Chir Appar Dig 6:40–165

    Google Scholar 

  19. Group EuroQol (1990) EuroQol—A new facility for the measurement of health-related quality of life. Health Policy 16:199–208

    Article  Google Scholar 

  20. Badia X, Roset M, Montserrat S, Herdman M, Segura A (1999) La versión española del EuroQol: descripción y aplicaciones. Med Clin (Barc) 112(suppl 1):79–86

    Google Scholar 

  21. Bauer JJ, Harris MT, Kreel I (1999) Twelve-year experience with expanded polytetrafluoroethylene in the repair of abdominal wall defects. Mt Sinai J Med 66:20–25

    PubMed  CAS  Google Scholar 

  22. Gillion JF, Begin GF, Marecos C (1997) Expanded polytetrafluoroethylene patches used in the intraperitoneal or extraperitoneal position for repair of incisional hernias of the anterolateral abdominal wall. Am J Surg 174:16–19

    Article  PubMed  CAS  Google Scholar 

  23. Bellon JM, Contreras LA, Sabater C (1997) Pathologic and clinical aspects of repair of large incisional hernias after implant of a polytetrafluoroethylene prosthesis. World J Surg 21:402– 6; discussion 406–407

    Google Scholar 

  24. McLanahan D, King LT, Weems C, Novotney M, Gibson K (1997) Retrorectus prosthetic mesh repair of midline abdominal hernia. Am J Surg 173:445–449

    Article  PubMed  CAS  Google Scholar 

  25. McKinlay RD, Park A (2004) Laparoscopic ventral incisional hernia repair: a more effective alternative to conventional repair of recurrent incisional hernia. J Gastrointest Surg 8:670–674

    Article  PubMed  Google Scholar 

  26. Tagaya N, Mikami H, Aoki H (2004) Long-term complications of laparoscopic ventral and incisional hernia repair. Surg Laparosc Endosc Percutan Tech 14:5–8

    Article  PubMed  Google Scholar 

  27. Birch D (2007) Characterizing laparoscopic incisional hernia repair. Can J Surg 50(3):195–201

    PubMed  Google Scholar 

  28. Carbajo MA, Martin del Olmo JC, Blanco JI, Toledano M, de la Cuesta C, Ferrerai C, Vaquero C (2003) Laparoscopic approach to incisional hernia. Lesson learned from 270 patients over 8 years. Surg Endosc 17:118–122

    Article  PubMed  CAS  Google Scholar 

  29. McGreevy JM, Goodney PP, Birkmeyer CM (2003) A prospective study comparing the complication rates between laparoscopic and open ventral hernia repairs. Surg Endosc 17:1778–1780

    Article  PubMed  CAS  Google Scholar 

  30. Bageacu S, Blanc P, Breton C, Gonzales M, Porcheron J, Chabert M, Balique JG (2002) Laparoscopic repair of incisional hernia. A retrospective study of 159 patients. Surg Endosc 16:345–348

    Article  PubMed  CAS  Google Scholar 

  31. LeBlanc KA, Whitaker JM, Bellanger DE, Rhynes VK (2003) Laparoscopic incisional and ventral hernioplasty: lessons learned from 200 patients. Hernia 7:118–124

    Article  PubMed  CAS  Google Scholar 

  32. Martin-Duce A, Noguerales F, Villeta R, Hernandez P, Lozano O, Keller J, Granell J (2001) Modifications to Rives technique for midline incisional hernia repair. Hernia 5:70–72

    Article  PubMed  CAS  Google Scholar 

  33. Balen EM, Diez-Cabellaro A, Hernandez-Lizoain JL, Pardo F, Torramade JR, Regueira FM, Cienfuegos JA (1998) Repair of ventral hernia by expanded polytetrafluoroethylene patch. Br JSurg 85:1415–1418

    Article  CAS  Google Scholar 

  34. Bencini L, Sanchez LJ, Scatizzi M, Farsi M, Boffi B, Moretti R (2003) Laparoscopic treatment of ventral hernias: prospective evaluation. Surg Laparosc Endosc Percutan Tech 13:16–19

    Article  PubMed  Google Scholar 

  35. Raftopoulos I, Vanuno D, Khorsand J, Ninos J, Kouraklis G, Lasky P (2002) Outcome of laparoscopic ventral hernia repair in correlation with obesity, type of hernia, and hernia size. J Laparoendosc Adv Surg Tech A 12:425–429

    Article  PubMed  Google Scholar 

  36. Reitter DR, Paulsen JK, Debord JR, Estes NC (2000) Five-year xperience with the “Four-before” laparoscopic ventral hernia epair. Am Surg 5:465–469

    Google Scholar 

  37. Rosen M, Brody F, Ponsky J, Walsh RM, Rosenblatt S, Duperier Fanning A, Sipertein A (2003) Recurrence after laparoscopic entral hernia repair. Surg Endosc 17:123–128

    Article  PubMed  CAS  Google Scholar 

  38. Berger D, Bientzle M, Muller A (2002) Postoperative complications after laparoscopic incisional hernia repair. Incidence and treatment. Surg Endosc 16:1720–1723

    CAS  Google Scholar 

  39. Weber DN (2002) Short-term outcomes of laparoscopic and open ventral hernia repair—invited critique. Arch Surg 137:1165

    Article  Google Scholar 

  40. Heniford BT, Park A, Ramshaw BJ, Voeller G (2003) Laparoscopic repair of ventral hernias: nine years experience with 850 consecutive hernias. Ann Surg 238:391–399; discussion 399–400

    Google Scholar 

  41. Anthony T, Bergen PC, Kim LT (2000) Factors affecting recurrence following incisional herniorrhaphy. World J Surg 24:95–100; discussion 101.

    Google Scholar 

  42. Pell JP (1995) Impact of intermittent claudication on quality of life: the Scottish Vascular Audit Group. Eur J Vasc Endovasc Surg 10:510–511

    Article  Google Scholar 

  43. Black N, Petticrew M, Ginzler M (1991) Do doctors and patients agree? Views of the outcomes of transurethral resection of the prostate. Int J Tech Assess Health Care 7:533–544

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Hospital Arnau de Vilanova, San Clemente 12, 46015, Valencia, Spain

    Francisco Asencio & Marwan Ahmad

  2. Department of Surgery, Hospital Lluís Alcanyís, Xativa, Spain

    Javier Aguiló & Ramón Ferri

  3. Centro Superior de Investigación en Salud Pública (CSISP), Valencia, Spain

    Salvador Peiró

  4. Department of Surgery, Hospital Francisco de Borja, Gandia, Spain

    Juan Carbó & Federico Caro

Authors
  1. Francisco Asencio
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  2. Javier Aguiló
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  3. Salvador Peiró
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  4. Juan Carbó
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  5. Ramón Ferri
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  6. Federico Caro
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  7. Marwan Ahmad
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Correspondence to Francisco Asencio.

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Asencio, F., Aguiló, J., Peiró, S. et al. Open randomized clinical trial of laparoscopic versus open incisional hernia repair. Surg Endosc 23, 1441–1448 (2009). https://doi.org/10.1007/s00464-008-0230-4

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  • DOI: https://doi.org/10.1007/s00464-008-0230-4

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