Abstract
Background
The Rives–Stoppa procedure is used for ventral hernia repair but requires a large midline incision. This report describes a new, totally endoscopic approach to the retromuscular plane, corresponding to a reversed totally extraperitoneal procedure, to perform sublay repair of primary and secondary ventral hernias. This totally endoscopic sublay (TES) repair is described in detail, and its safety and efficacy were evaluated.
Methods
In this prospective study, we assessed 26 consecutive primary and secondary epigastric midline ventral hernias that were repaired between July 2017 and July 2018 using the TES procedure. A large mesh was placed in the retrorectus position using this minimally invasive approach. Indications for this procedure include umbilical, epigastric, incisional hernias, and rectus diastasis.
Results
All TES procedures were successfully performed without conversion to an open operation. The mean operative time was 106.6 ± 29.1 min (range 75–205), with average mesh area of 318.8 cm2 for an average defect area of 26.5 cm2. Postoperative pain was mild, and the mean visual analog scale (VAS) under physical stress (e.g., climbing stairs) was 2.4 at the third postoperative day. The average postoperative hospital stay was 2.8 ± 0.8 days (range 2–5). Two patients developed postoperative seroma, with no final adverse effect. No recurrence nor readmissions within 30 days was observed during a mean follow-up of 9.2 ± 4.4 months.
Conclusions
Initial experiences with this technique show that the TES procedure is safe and reliable, requires no specific instruments, and is highly reproducible. There is no need for an expensive anti-adhesion mesh or fixation device, making it cost-effective.
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References
Stoppa R, Petit J, Abourachid H, Henry X, Duclaye C, Monchaux G et al (1973) Original procedure of groin hernia repair: interposition without fixation of Dacron tulle prosthesis by subperitoneal median approach. Chirurgie 99:119–123
Rives J, Lardennois B, Pire JC, Hibon J (1973) Large incisional hernias. The importance of flail abdomen and of subsequent respiratory disorders. Chirurgie 99:547–563
Stoppa RE (1989) The treatment of complicated groin and incisional hernias. World J Surg 13:545–554
Iqbal CW, Pham TH, Joseph A, Mai J, Thompson GB, Sarr MG (2007) Long-term outcome of 254 complex incisional hernia repairs using the modified Rives-Stoppa technique. World J Surg 31:2398–2404
Wantz GE (1989) Giant prosthetic reinforcement of the visceral sac. Surg Gynecol Obstet 169:408–417
Wantz GE (1991) Incisional hernioplasty with Mersilene. Surg Gynecol Obstet 172:129–137
Novitsky YW, Porter JR, Rucho ZC, Getz SB, Pratt BL, Kercher KW et al (2006) Open preperitoneal retrofascial mesh repair for multiply recurrent ventral incisional hernias. J Am Coll Surg 203:283–289
Maman D, Greenwald D, Kreniske J, Royston A, Powers S, Bauer J (2012) Modified Rives-Stoppa technique for repair of complex incisional hernias in 59 patients. Ann Plast Surg 68:190–193
Abdollahi A, Maddah GH, Mehrabi BM, Jangjoo A, Forghani MN, Sharbaf N (2010) Prosthetic incisional hernioplasty: clinical experience with 354 cases. Hernia 14:569–573
Carbonell AM (2016) Rives-Stoppa retromuscular repair[M]//hernia surgery. Springer, Switzerland
Miserez M, Penninckx F (2002) Endoscopic totally preperitoneal ventral hernia repair. Surg Endosc 16:1207–1213
Reinpold W (2015) Endoskopisch total extraperitonealer transhernialer sublay—Bauchwand-Hernienverschluss in singleport-technik. In: Schumpelick V, Arlt G, Conze J, Junge K (eds) Hernien, 5th edn. Thieme, Stuttgart, pp 301–304
Reinpold W, Schröder M, Berger C, Nehls J, Schröder A, Hukauf M et al (2018) Mini- or less-open sublay operation (MILOS): a new minimally invasive technique for the extraperitoneal mesh repair of incisional hernias. Ann Surg (Epub ahead of print)
Schwarz J, Reinpold W, Bittner R (2017) Endoscopic mini/less open sublay technique (EMILOS)—a new technique for ventral hernia repair. Langenbecks Arch Surg 402:173–180
Costa TN, Abdalla RZ, Santo MA, Tavares RR, Abdalla BM, Cecconello I (2016) Transabdominal midline reconstruction by minimally invasive surgery: technique and results. Hernia 20:257–265
Nguyen DK, Chen DC (2017) Laparoendoscopic stapled Rives Stoppa sublay technique for extraperitoneal ventral hernia repair. Eur Surg 49:175–179
Schroeder AD, Debus ES, Schroeder M, Reinpold WM (2013) Laparoscopic transperitoneal sublay mesh repair: a new technique for the cure of ventral and incisional hernias. Surg Endosc 27:648–654
Belyansky I, Daes J, Radu VG, Balasubramanian R, Reza Zahiri H, Weltz AS et al (2018) A novel approach using the enhanced-view totally extraperitoneal (eTEP) technique for laparoscopic retromuscular hernia repair. Surg Endosc 32:1525–1532
Muysoms F, Campanelli G, Champault GG, DeBeaux AC, Dietz UA, Jeekel J et al (2012) EuraHS: the development of an international online platform for registration and outcome measurement of ventral abdominal wall hernia repair. Hernia 16:239–250
LeBlanc KA, Booth WV (1993) Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethylene: preliminary findings. Surg Laparosc Endosc 3:39–41
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
Yang GPC (2017) From intraperitoneal onlay mesh repair to preperitoneal onlay mesh repair. Asian J Endosc Surg 10:119–127
Adrales GL (2016) Abdominal wall spaces for mesh placement: onlay, sublay, underlay[M]//hernia surgery. Springer, Switzerland
Binnebosel M, Klink CD, Otto J, Conze J, Jansen PL, Anurov M et al (2010) Impact of mesh positioning on foreign body reaction and collagenous ingrowth in a rabbit model of open incisional hernia repair. Hernia 14:71–77
Kasama K, Mui W, Lee WJ et al (2012) IFSO-APC consensus statements 2011. Obes Surg 22:677–684
Bittner R, Schwarz J (2017) Endoscopic mini/less open sublay operation for treatment of primary and secondary ventral hernias of the abdominal wall. Eur Surg 49:65–70
Hauters P, Desmet J, Gherardi D et al (2017) Assessment of predictive factors for recurrence in laparoscopic ventral hernia repair using a bridging technique. Surg Endosc 31:3656–3663
Prasad P, Tantia O, Patle NM et al (2011) Laparoscopic ventral hernia repair: a comparative study of transabdominal preperitoneal versus intraperitoneal onlay mesh repair. J Laparoendosc Adv Surg Tech A 21:477–483
Acknowledgements
The authors acknowledge Dr. Miao J, Dr. Li Y, and Dr. Cai C from Guangdong, Dr. Zhang C from Zhejiang, Dr. Wu W, and Dr. Yu J from Shanghai, Dr. Xiong G from Hunan, and Dr. Chen Y and Dr. Zhao W from Gansu for their valuable contributions to this paper.
Funding
Beijing Municipal Administration of Hospitals’ Youth Programme (QML20170307).
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Drs. Binggen Li, Changfu Qin, and Reinhard Bittner have no conflicts of interest or financial ties to disclose.
Additional information
The early results of this study were presented at the 2018 International Hernia Congress (AHS Annual Meeting), March 12–15, 2018, Miami, FL.
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Li, B., Qin, C. & Bittner, R. Totally endoscopic sublay (TES) repair for midline ventral hernia: surgical technique and preliminary results. Surg Endosc 34, 1543–1550 (2020). https://doi.org/10.1007/s00464-018-6568-3
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DOI: https://doi.org/10.1007/s00464-018-6568-3