Advertisement

Results and Complications of Incisional Hernia Surgery

  • René H. Fortelny
  • Anna Hofmann
  • Ferdinand Köckerling
Chapter

Abstract

Background: Since the laparoscopic treatment of incisional hernia developed in the beginning of the 1990s, several studies and meta-analyses were performed to compare to the outcome of open repair. Despite the results seem to favor the laparoscopic approach, most of the meta-analysis failed to differ between ventral, incisional, and umbilical hernia.

Methods: Up to now, only two published meta-analyses focused selectively on the comparison of incisional hernias in open and laparoscopic repair. Additional to the results of these meta-analyses, the data of Herniamed registry were included in this chapter to merge the analysis of clinical studies and the daily practice for representing the genuine rate of complication rates in open and laparoscopic incisional hernia repair.

Results: In the meta-analysis except the significant less wound infection rate in the laparoscopic group, no differences concerning intra- and postoperative complications, as well as recurrence rates, were seen. In addition to the meta-analysis, the data of Herniamed registry confirmed these results.

Conclusion: Thus there seem no major differences in complications and outcome comparing open and laparoscopic repair in incisional hernias; the selective tailoring in each case is the crucial part of decision before surgery. Beyond that new upcoming techniques combine the advantages of laparo−/endoscopic approach with retromuscular mesh position of the classical open sublay repair and the minimally invasive approach leading to promising results in patients’ outcome.

Keywords

Hernia Incisional Abdominal wall Surgery Hernia surgery Laparoscopic hernia repair Outcome Complication Pain 

References

  1. 1.
    Millbourn D, Cengiz Y, Israelsson LA. Effect of stitch length on wound complications after closure of midline incisions: a randomized controlled trial. Arch Surg. 2009;144(11):1056–9.  https://doi.org/10.1001/archsurg.2009.189. PubMed PMID: 19917943CrossRefPubMedGoogle Scholar
  2. 2.
    Deerenberg EB, Harlaar JJ, Steyerberg EW, Lont HE, van Doorn HC, Heisterkamp J, Wijnhoven BP, Schouten WR, Cense HA, Stockmann HB, Berends FJ, Dijkhuizen FP, Dwarkasing RS, Jairam AP, van Ramshorst GH, Kleinrensink GJ, Jeekel J, Lange JF. Small bites versus large bites for closure of abdominal midline incisions (STITCH): a double-blind, multicentre, randomised controlled trial. Lancet. 2015;386(10000):1254–60.  https://doi.org/10.1016/S0140-6736(15)60459-7. Epub 2015 Jul 15. PubMed PMID: 26188742.CrossRefPubMedGoogle Scholar
  3. 3.
    Fink C, Baumann P, Wente MN, Knebel P, Bruckner T, Ulrich A, et al. Incisional hernia rate 3 years after midline laparotomy. Br J Surg. 2014;101:51–4.  https://doi.org/10.1002/bjs.9364.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Awaiz A, Rahman F, Hossain MB, Yunus RM, Khan S, Memon B, Memon MA. Meta-analysis and systematic review of laparoscopic versus open mesh repair for elective incisional hernia. Hernia. 2015;19(3):449–63.  https://doi.org/10.1007/s10029-015-1351-z. Epub 2015 Feb 4. Review. PubMed PMID: 25650284CrossRefPubMedGoogle Scholar
  5. 5.
    Pring CM, Tran V, O’Rourke N, Martin IJ. Laparoscopic versus open ventral hernia repair: a randomized controlled trial. ANZ J Surg. 2008;78(10):903–6.  https://doi.org/10.1111/j.1445-2197.2008.04689.x. PubMed PMID: 18959646CrossRefPubMedGoogle Scholar
  6. 6.
    Olmi S, Scaini A, Cesana GC, Erba L, Croce E. Laparoscopic versus open incisional hernia repair: an open randomized controlled study. Surg Endosc. 2007;21:555–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Navarra G, Musolino C, De Marco ML, Bartolotta M, Barbera A, Centorrino T. Retromuscular sutured incisional hernia repair: a randomized controlled trial to compare open and laparoscopic approach. Surg Laparosc Endosc Percutan Tech. 2007;17:86–90.CrossRefPubMedGoogle Scholar
  8. 8.
    Asencio F, Aguilo´ J, Peiro´ S, Carbo´ J, Ferri R, Caro F, Ahmad M. Open randomized clinical trial of laparoscopic versus open incisional hernia repair. Surg Endosc. 2009;23:1441–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Itani KM, Hur K, Kim LT, Anthony T, Berger DH, Reda D, Neumayer L. Comparison of laparoscopic and open repair with mesh for the treatment of ventral incisional hernia: a randomized trial. Arch Surg. 2010;145:322–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Eker HH, Hansson BM, Buunen M, Janssen IM, Pierik RE, Hop WC, Bonjer HJ, Jeekel J, Lange JF. Laparoscopic vs. open incisional hernia repair: a randomized clinical trial. JAMA Surg. 2013;13:259–63.CrossRefGoogle Scholar
  11. 11.
    Rogmark P, Petersson U, Bringman S, Eklund A, Ezra E, Sevonius D, Smedberg S, Osterberg J, Montgomery A. Short-term outcomes for open and laparoscopic midline incisional hernia repair: a randomized multicenter controlled trial: the Pro LOVE (prospective randomized trial on open versus laparoscopic operation of ventral eventrations) trial. Ann Surg. 2013;258:37–45.CrossRefPubMedGoogle Scholar
  12. 12.
    Jensen KK, Jorgensen LN. Comment to: Meta-analysis and systematic review of laparoscopic versus open mesh repair for elective incisional hernia. Awaiz A et al. Hernia 2015;19:449–463. Hernia. 2015;19(6):1025–6.  https://doi.org/10.1007/s10029-015-1412-3. Epub 2015 Aug 4. PubMed PMID: 26238399CrossRefPubMedGoogle Scholar
  13. 13.
    Awaiz A, Rahman F, Hossain MB, Yunus RM, Khan S, Memon B, Memon MA. Reply to comment to Meta-analysis and systematic review of laparoscopic versus open mesh repair for elective incisional hernia. Jensen K, Jorgensen LN. Hernia. 2015;19(6):1027–9.  https://doi.org/10.1007/s10029-015-1432-z. Epub 2015 Oct 26. PubMed PMID: 26496998CrossRefPubMedGoogle Scholar
  14. 14.
    Al Chalabi H, Larkin J, Mehigan B, McCormick P. A systematic review of laparoscopic versus open abdominal incisional hernia repair, with meta-analysis of randomized controlled trials. Int J Surg. 2015;20:65–74.  https://doi.org/10.1016/j.ijsu.2015.05.050. Epub 2015 Jun 12. Review. PubMed PMID: 26074289CrossRefPubMedGoogle Scholar
  15. 15.
    Köckerling F, Schug-Pass C, Adolf D, Reinpold W, Stechemesser B. Is pooled data analysis of ventral and incisional hernia repair acceptable? Front Surg. 2015;2:15.  https://doi.org/10.3389/fsurg.2015.00015.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Bittner R, Bingener-Casey J, Dietz U, Fabian M, Ferzli GS, Fortelny RH, Köckerling F, Kukleta J, Leblanc K, Lomanto D, Misra MC, Bansal VK, Morales-Conde S, Ramshaw B, Reinpold W, Rim S, Rohr M, Schrittwieser R, Simon T, Smietanski M, Stechemesser B, Timoney M, Chowbey P, 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(1):2–29.  https://doi.org/10.1007/s00464-013-3170-6. Epub 2013 Oct 11. PubMed PMID: 24114513; PubMed Central PMCID: PMC3872300CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Bittner R, Bingener-Casey J, Dietz U, Fabian M, Ferzli GS, Fortelny RH, Köckerling F, Kukleta J, LeBlanc K, Lomanto D, Misra MC, Morales-Conde S, Ramshaw B, Reinpold W, Rim W, Rohr M, Schrittwieser R, Simon T, Smietanski M, Stechemesser B, Timoney M, Chowbey P. Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias International Endohernia Society [IEHS]—part 2. Surg Endosc. 2014;28:353–79.  https://doi.org/10.1007/s00464-013-3171-5.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Bittner R, Bingener-Casey J, Dietz U, Fabian G, Fortelny RH, Köckerling F, Kukleta J, LeBlanc K, Lomanto D, Misra M, Morales-Conde S, Ramshaw B, Reinpold W, Rim S, Rohr M, Schrittwieser R, Simon T, Smietanski M, Stechemesser B, Timoney M, Chowbey P. Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society [IEHS]) Part III. Surg Endosc. 2014;28:380–404.  https://doi.org/10.1007/s00464-013-3172-4.CrossRefPubMedGoogle Scholar
  19. 19.
    LeBlanc KA, Whitaker JM, Bellanger DE, Rhynes VK. Laparoscopic incisional and ventral hernioplasty: lessons learned from 200 patients. Hernia. 2003;7(3):118–24.  https://doi.org/10.1007/s10029-003-0117-1.CrossRefPubMedGoogle Scholar
  20. 20.
    LeBlanc K. Proper mesh overlap is a key determinant in hernia recurrence following laparoscopic ventral and incisional hernia repair. Hernia. 2016;20(1):85–99.  https://doi.org/10.1007/s10029-015-1399-9. Epub 2015 Jul 5. Review. PubMed PMID: 26143072CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Kallinowski F, Baumann E, Harder F, Siassi M, Mahn A, Vollmer M, Morlock MM. Dynamic intermittent strain can rapidly impair ventral hernia repair. J Biomech. 2015;48(15):4026–36.  https://doi.org/10.1016/j.jbiomech.2015.09.045. Epub 2015 Oct 8. PubMed PMID: 26476761CrossRefPubMedGoogle Scholar
  22. 22.
    Kallinowski F, Harder F, Silva TG, Mahn A, Vollmer M. Bridging with reduced overlap: fixation and peritoneal grip can prevent slippage of DIS class A meshes. Hernia. 2017.  https://doi.org/10.1007/s10029-017-1583-1. [Epub ahead of print] PubMed PMID: 28132109
  23. 23.
    Berler DJ, Cook T, LeBlanc K, Jacob BP. Next generation mesh fixation technology for hernia repair. Surg Technol Int. 2016;XXIX:109–17. PubMed PMID: 27466869Google Scholar
  24. 24.
    Schwarz J, Reinpold W, Bittner R. Endoscopic mini/less open sublay technique (EMILOS)-a new technique for ventral hernia repair. Langenbeck's Arch Surg. 2017;402(1):173–80.  https://doi.org/10.1007/s00423-016-1522-0. Epub 2016 Oct 20. PubMed PMID: 27766419CrossRefGoogle Scholar
  25. 25.
    Köckerling F, Botsinis MD, Rohde C, Reinpold W, Schug-Pass C. Endoscopic-assisted linea alba reconstruction: new technique for treatment of symptomatic umbilical, trocar, and/or epigastric hernias with concomitant rectus abdominis diastasis. Eur Surg. 2017;49(2):71–5.  https://doi.org/10.1007/s10353-017-0473-1. Epub 2017 Mar 10. PubMed PMID: 28408920; PubMed Central PMCID: PMC5368206CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Köckerling F, Botsinis MD, Rohde C, Reinpold W. Endoscopic-assisted linea alba reconstruction plus mesh augmentation for treatment of umbilical and/or epigastric hernias and rectus abdominis diastasis—early results. Front Surg. 2016;3:27.  https://doi.org/10.3389/fsurg.2016.00027. eCollection 2016. PubMed PMID: 27243016; PubMed Central PMCID: PMC4865488CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Costa TN, Abdalla RZ, Santo MA, Tavares RR, Abdalla BM, Cecconello I. Transabdominal midline reconstruction by minimally invasive surgery: technique and results. Hernia. 2016;20(2):257–65.  https://doi.org/10.1007/s10029-016-1457-y. Epub 2016 Jan 22. PubMed PMID: 26801185CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Moore AM, Anderson LN, Chen DC. Laparoscopic stapled sublay repair with self-gripping mesh: a simplified technique for minimally invasive extraperitoneal ventral hernia repair. Surg Technol Int. 2016;XXIX:131–9. PubMed PMID: 27728955Google Scholar
  29. 29.
    Carbonell AM, Warren JA, Prabhu AS, Ballecer CD, Janczyk RJ, Herrera J, Huang LC, Phillips S, Rosen MJ, Poulose BK. Reducing length of stay using a robotic-assisted approach for retromuscular ventral hernia repair: a comparative analysis from the Americas Hernia Society Quality Collaborative. Ann Surg. 2018;267:210–7.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • René H. Fortelny
    • 1
    • 2
    • 3
  • Anna Hofmann
    • 1
  • Ferdinand Köckerling
    • 3
    • 4
  1. 1.Department of General-, Visceral- and Oncological SurgeryWilhelminenspitalViennaAustria
  2. 2.Medical SchoolSigmund Freud UniversityViennaAustria
  3. 3.Herniamed Study Group (Addendum)ViennaAustria
  4. 4.Department of Surgery and Center for Minimally Invasive SurgeryVivantes HospitalBerlinGermany

Personalised recommendations