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Laparoscopic repair of primary and incisional ventral hernias: the differences must be acknowledged

A prospective cohort analysis of 1,088 consecutive patients

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Abstract

Background

Interpretation of the outcome after laparoscopic repair (LR) of ventral hernias presented in the literature often is based on pooled data of primary ventral hernias (PVH) and incisional ventral hernias (IVH). This prospective cohort study was performed to investigate whether this pooling of data is justified.

Methods

The data of 1,088 consecutive patients who underwent LR of PVH or IVH were prospectively collected and reviewed for baseline characteristics, operative findings, and postoperative complications classified as Clavien grade 3 or higher.

Results

The PVH group consisted of 662 patients, and the IVH group comprised 426 patients. The mean Association of American Anesthesiologists classification was higher in IVH group (1.92 vs 1.68; P ≤ 0.001), as was rate of conversion to open surgery (7 vs 0.5 %; P < 0.001). The IVH group required more adhesiolysis (76 vs 0.9 %; P < 0.001), a longer procedure (73 vs 42 min; P < 0.001), and a longer hospital stay (4.53 vs 2.43 days; P < 0.001). The recurrence rate was higher in the IVH group (5.81 vs 1.37 %; P < 0.001), as was total complication rate (18.69 vs 4.55 %; P < 0.001).

Conclusions

This study showed significant differences in baseline characteristics and operative findings between patients undergoing PVH repair and those undergoing IVH repair. Continued pooling of data on LR of IVH and PVH combined, commonly found in the current literature, seems incorrect.

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References

  1. Muysoms F, Miserez M, Berrevoet F, Campanelli G, Champault G, Chelala E, Dietz U, Eker H, El Nakadi I, Hauters P, Hidalgo Pascual M, Hoeferlin A, Klinge U, Montgomery A, Simmermacher R, Simons M, Śmietański M, Sommeling C, Tollens T, Vierendeels T, Kingsnorth A (2009) Classification of primary and incisional abdominal wall hernias. Hernia 13:407–414

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  2. Heniford B, Park A, Ramshaw B, Voeller G (2003) Laparoscopic repair of ventral hernias: nine years experience with 850 consecutive hernias. Ann Surg 238:391–400

    PubMed  Google Scholar 

  3. LeBlanc K, Whitaker J, Bellanger D, Rhynes V (2003) Laparoscopic incisional and ventral hernioplasty: lessons learned from 200 patients. Hernia 7:118–124

    Article  CAS  PubMed  Google Scholar 

  4. LeBlanc K (2004) Laparoscopic incisional and ventral hernia repair: complications: how to avoid and handle. Hernia 8:323–331

    Article  CAS  PubMed  Google Scholar 

  5. Chelala E, Thoma M, Tatete B, Lemye A, Dessily M, Alle J (2007) The suturing concept for laparoscopic mesh fixation in ventral and incisional hernia repair: midterm analysis of 400 cases. Surg Endosc 21:391–395

    Article  CAS  PubMed  Google Scholar 

  6. Wassenaar E, Schoenmaeckers E, Raymakers J, van der Palen J, Rakic S (2010) Mesh-fixation method and pain and quality of life after laparoscopic ventral or incisional hernia repair: a randomized trial of three fixation techniques. Surg Endosc 24:1296–1302

    Article  PubMed Central  PubMed  Google Scholar 

  7. Schoenmaeckers E, Raymakers J, Rakic S (2010) Complications of laparoscopic correction of abdominal wall and incisional hernias. Ned Tijdschr Geneeskd 154:A2390

    PubMed  Google Scholar 

  8. Sharma A, Mehrotra M, Khullar R, Soni V, Baijal M, Chowbey PK (2011) Laparoscopic ventral/incisional hernia repair: a single-centre experience of 1,242 patients over a period of 13 years. Hernia 15:131–139

    Article  CAS  PubMed  Google Scholar 

  9. Colavita P, Tsirline V, Belyansky I, Walters A, Lincourt A, Sing R, Heniford B (2012) Prospective, long-term comparison of quality of life in laparoscopic versus open ventral hernia repair. Ann Surg 256:714–723

    Article  PubMed  Google Scholar 

  10. Pham C, Perera C, Watkin D, Maddern G (2009) Laparoscopic ventral hernia repair: a systematic review. Surg Endosc 23:4–15

    Article  PubMed  Google Scholar 

  11. Sajid M, Bokhari S, Mallick A, Cheek E, Baig M (2009) Laparoscopic versus open repair of incisional/ventral hernia: a meta-analysis. Am J Surg 197:64–72

    Article  PubMed  Google Scholar 

  12. Forbes SS, Eskicioglu C, McLeod R, Okrainec A (2009) Meta-analysis of randomized controlled trials comparing open and laparoscopic ventral and incisional hernia repair with mesh. BJS 96:851–858

    Article  CAS  Google Scholar 

  13. Dindo D, Demartines N, Clavien P (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6,336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  Google Scholar 

  14. Dripps R, Lamont A, Eckenhoff J (1961) The role of anesthesia in surgical mortality. JAMA 178:261–266

    Article  CAS  PubMed  Google Scholar 

  15. Höer J, Junge K, Schachtrupp A, Klinge U, Schumpelick V (2002) Influence of laparotomy closure technique on collagen synthesis in the incisional region. Hernia 6:93–98

    Article  PubMed  Google Scholar 

  16. Wassenaar E, Schoenmaeckers E, Raymakers J, Rakic S (2009) Recurrences after laparoscopic repair of ventral and incisional hernia: lessons learned from 505 repairs. Surg Endosc 23:825–832

    Article  PubMed  Google Scholar 

  17. LeBlanc K, Booth W (1993) Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethylene: preliminary findings. Surg Laparosc Endosc 3:39–41

    CAS  PubMed  Google Scholar 

  18. Carbajo M, Martín del Olmo J, Blanco J, Toledano M, de la Cuesta C, Ferreras C, Vaquero C (2003) Laparoscopic approach to incisional hernia: lessons learned from 270 patients over 8 years. Surg Endosc 17:118–122

    Article  CAS  PubMed  Google Scholar 

  19. Rosen M, Brody F, Ponsky J, Walsh R, Rosenblatt S, Duperier F, Fanning A, Siperstein A (2003) Recurrence after laparoscopic ventral hernia repair: a five-year experience. Surg Endosc 17:123–128

    Article  CAS  PubMed  Google Scholar 

  20. Koehler R, Voeller G (1999) Recurrences in laparoscopic incisional hernia repairs: a personal series and review of the literature. JSLS 3:293–304

    CAS  PubMed Central  PubMed  Google Scholar 

  21. Read R, Yoder G (1989) Recent trends in the management of incisional herniation. Arch Surg 124:485–488

    Article  CAS  PubMed  Google Scholar 

  22. Kurian A, Gallagher S, Cheeyandira A, Josloff R (2010) Laparoscopic repair of primary versus incisional hernias: time to recognize the differences? Hernia 14:383–387

    Article  CAS  PubMed  Google Scholar 

  23. Jenkins E, Yom V, Melman L, Pierce R, Schuessler R, Frisella M, Eagon C, Brunt M, Matthews B (2010) Clinical predictors of operative complexity in laparoscopic ventral hernia repair: a prospective study. Surg Endosc 24:1872–1877

    Article  PubMed  Google Scholar 

  24. 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 

  25. Olmi S, Scaini A, Cesana C, Erba L, Croce E (2007) Laparoscopic versus open incisional hernia repair. Surg Endosc 21:555–559

    Article  CAS  PubMed  Google Scholar 

  26. Itani K, Hur K, Kim L, Anthony T, Berger D, Reda D, Neumayer L (2010) Comparison of laparoscopic and open repair with mesh for the treatment of ventral incisional hernia. Arch Surg 145:322–328

    Article  PubMed  Google Scholar 

  27. Lomanto D, Iyer S, Shabbir A, Cheah W (2006) Laparoscopic versus open ventral hernia mesh repair: a prospective study. Surg Endosc 20:1030–1035

    Article  CAS  PubMed  Google Scholar 

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Disclosures

Vincent M. A. Stirler, Ernst J. P. Schoenmaeckers, Robbert J. de Haas, Johan T. F. J. Raymakers, and Srdjan Rakic have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Ziekenhuis Groep Twente (ZGT) Hospital, P.O. Box 7600, 7600 SZ, Almelo, The Netherlands

    Vincent M. A. Stirler, Ernst J. P. Schoenmaeckers, Robbert J. de Haas, Johan T. F. J. Raymakers & Srdjan Rakic

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  1. Vincent M. A. Stirler
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  2. Ernst J. P. Schoenmaeckers
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  3. Robbert J. de Haas
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  4. Johan T. F. J. Raymakers
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Correspondence to Vincent M. A. Stirler.

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Stirler, V.M.A., Schoenmaeckers, E.J.P., de Haas, R.J. et al. Laparoscopic repair of primary and incisional ventral hernias: the differences must be acknowledged. Surg Endosc 28, 891–895 (2014). https://doi.org/10.1007/s00464-013-3243-6

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  • DOI: https://doi.org/10.1007/s00464-013-3243-6

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