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Asian J Endosc Surg ISSN 1758-5902
O R I G I N A L A RT I C L E
Retrospective comparison of open versus laparoscopic ventral and incisional hernia repair Atsushi Tsuruta,1,2 Toshihiro Hirai1 & Masafumi Nakamura1 1 Department of Digestive Surgery, Kawasaki Medical School, Okayama, Japan 2 Department of Surgery, Kurashiki Central Hospital, Okayama, Japan
Keywords DualMesh; ePTFE; laparoscopic ventral and incisional hernia repair (LVHR) Correspondence Atsushi Tsuruta, Department of Digestive Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0192, Japan. Tel: +81 86 462 1111 Fax: +81 86 462 1199 Email: [email protected] Received: 8 January 2014; revised: 26 February 2014; accepted: 23 March 2014 DOI:10.1111/ases.12108
Abstract Introduction: We performed a retrospective study to determine the mid-term recurrence and complication rates of patients following laparoscopic ventral and incisional hernia repair (LVHR) with DualMesh, an expanded polytetrafluoroethylene (ePTFE) mesh. Additionally, a study of the mesh contraction rate was performed postoperatively. Methods: We compared open mesh repair of ventral and incisional hernias (OR) and LVHR. We also analyzed the shrinkage rate of ePTFE mesh. We included 45 patients (21 OR, 24 LVHR) who underwent mesh repair for primary ventral and incisional hernias between January 2008 and December 2012. Patients’ characteristics did not significantly differ between the two groups. Results: Mean operating time was 152.7 min for the OR group and 143.1 min for the LVHR group (P = 0.25). Mean postoperative hospital stay was 13.4 days for the OR group and 6.8 days for the LVHR groups (P = 0.01). The postoperative complication rate was 28.6% for the OR group and 12.5% for the LVHR group (P = 0.03). Among OR patients, causes of morbidity were variable: two recurrent cases, one surgical-site infection, one re-recurrence, one case of enteritis, and one case of heart failure. Among the LVHR patients, there was one surgical-site infection and two cases of seroma. No patients in the LVHR group experienced recurrence, while 14.3% of OR patients had a recurrence. In the LVHR group, the mean ePTFE mesh contraction rate was 10.6%. Conclusion: LVHR has advantages compared with OR, and the post-insertion contraction rate of ePTFE mesh was 10.6%.
Introduction Primary ventral hernias include umbilical, epigastric, and Spigelian hernias and account for approximately 5%–6% of all abdominal wall hernias (1). Incisional hernias are a complication of abdominal surgery. The recurrence rate after simple suture repair tends to be very high (2,3), but various surgical techniques have been developed to treat ventral hernias (4–6). Since the introduction of mesh repair and laparoscopic hernia repair, postoperative outcomes have greatly improved (5,7,8). The first laparoscopic ventral and incisional hernia repair (LVHR) was reported by LeBlanc and Booth in 1993 (9). LeBlanc et al. also demonstrated low postoperative complication rates after LVHR using DualMesh (10). Later, Zografos et al. showed that LVHR with an expanded
246
polytetrafluoroethylene (ePTFE) prosthesis had advantages over an open approach (11). In this study, we compared open mesh repair of ventral and incisional hernias (OR) with LVHR in Japanese patients. We also studied the post-insertion shrinkage rate of ePTFE mesh.
Materials and Methods Patients From January 2008 to December 2012, 86 patients with ventral and incisional hernias underwent surgical correction in a single hospital (Kurashiki Central Hospital, Okayama, Japan). Sixty-two patients underwent OR and 24 patients underwent LVHR. Of the OR patients, 41 cases were sutured directly without mesh, and 21
Asian J Endosc Surg 7 (2014) 246–250 © 2014 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd
Laparoscopic hernia repair with ePTFE
A Tsuruta et al.
Table 1 Patient characteristics
Gender (male/female) Age, mean ± SD (years) BMI, mean ± SD (kg/m2) Type of hernia (n)
Hernia size, mean ± SD (cm)
Group O (n = 21)
Group L (n = 24)
P-value
9/12 67.4 ± 13.2 (range, 32–82) 29.1 ± 7.3 Umbilical Incisional ventral Linea alva 8.9 ± 4.1 (3–18)
9/15 69.8 ± 12.3 (range, 42–87) 26.4 ± 4.2 Umbilical Incisional ventral Linea alva 8.7 ± 4.3 (5–22)
0.44 0.27 0.07 0.42
2 18 1
1 22 1
0.46
Group L, laparoscopic mesh repair of ventral and incisional hernias group; Group O, open mesh repair of ventral and incisional hernias group.
patients received mesh repair as a tension-free operation. We reviewed the medical records of 45 patients (21 OR cases [Group O] and 24 LVHR cases [Group L]) who underwent abdominal wall hernia repair using mesh. Operative procedures For LVHR, three trocars were used; the site of initial entry was Palmer’s point, a point 2 cm below the left costal margin in the midclavicular line (12). We accessed the initial point using the open method and inserted a 12-mm trocar. A 5-mm trocar was then placed at the lateral left extent of the abdominal lesion, and another 5-mm trocar was placed at the lower extent of the abdominal lesion. After introducing the trocars, we performed adhesiolysis and confirmed the type of hernia (shape, size, number of defects). We then placed ePTFE mesh intraperitoneally, pursuing a 3-cm overlap, which was prepared with eight-point sutures using 1-0 nylon on the mesh circumference. The mesh was initially fixed with transfascial sutures and then fixed to the abdominal wall with tackers at 1-cm intervals circumferentially. Follow-up All patients were followed up for at least 6 months. We evaluated the rate of recurrence as well as postoperative and mid-term complications. Additionally, 13 patients in Group L had abdominal CT imaging at follow-up. To determine the contraction rate, 3-D images were reconstructed to calculate the transverse length of the implanted ePTFE mesh. The ePTFE mesh area was calculated by integrating each individual transverse length obtained on CT imaging, and the calculated area was compared with the original mesh size in order to study the contraction rate. Statistical analysis Data are presented as mean ± SD. Differences between the groups were statistically analyzed using the χ2 test or t-test. A P-value of
Asian J Endosc Surg ISSN 1758-5902
O R I G I N A L A RT I C L E
Retrospective comparison of open versus laparoscopic ventral and incisional hernia repair Atsushi Tsuruta,1,2 Toshihiro Hirai1 & Masafumi Nakamura1 1 Department of Digestive Surgery, Kawasaki Medical School, Okayama, Japan 2 Department of Surgery, Kurashiki Central Hospital, Okayama, Japan
Keywords DualMesh; ePTFE; laparoscopic ventral and incisional hernia repair (LVHR) Correspondence Atsushi Tsuruta, Department of Digestive Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0192, Japan. Tel: +81 86 462 1111 Fax: +81 86 462 1199 Email: [email protected] Received: 8 January 2014; revised: 26 February 2014; accepted: 23 March 2014 DOI:10.1111/ases.12108
Abstract Introduction: We performed a retrospective study to determine the mid-term recurrence and complication rates of patients following laparoscopic ventral and incisional hernia repair (LVHR) with DualMesh, an expanded polytetrafluoroethylene (ePTFE) mesh. Additionally, a study of the mesh contraction rate was performed postoperatively. Methods: We compared open mesh repair of ventral and incisional hernias (OR) and LVHR. We also analyzed the shrinkage rate of ePTFE mesh. We included 45 patients (21 OR, 24 LVHR) who underwent mesh repair for primary ventral and incisional hernias between January 2008 and December 2012. Patients’ characteristics did not significantly differ between the two groups. Results: Mean operating time was 152.7 min for the OR group and 143.1 min for the LVHR group (P = 0.25). Mean postoperative hospital stay was 13.4 days for the OR group and 6.8 days for the LVHR groups (P = 0.01). The postoperative complication rate was 28.6% for the OR group and 12.5% for the LVHR group (P = 0.03). Among OR patients, causes of morbidity were variable: two recurrent cases, one surgical-site infection, one re-recurrence, one case of enteritis, and one case of heart failure. Among the LVHR patients, there was one surgical-site infection and two cases of seroma. No patients in the LVHR group experienced recurrence, while 14.3% of OR patients had a recurrence. In the LVHR group, the mean ePTFE mesh contraction rate was 10.6%. Conclusion: LVHR has advantages compared with OR, and the post-insertion contraction rate of ePTFE mesh was 10.6%.
Introduction Primary ventral hernias include umbilical, epigastric, and Spigelian hernias and account for approximately 5%–6% of all abdominal wall hernias (1). Incisional hernias are a complication of abdominal surgery. The recurrence rate after simple suture repair tends to be very high (2,3), but various surgical techniques have been developed to treat ventral hernias (4–6). Since the introduction of mesh repair and laparoscopic hernia repair, postoperative outcomes have greatly improved (5,7,8). The first laparoscopic ventral and incisional hernia repair (LVHR) was reported by LeBlanc and Booth in 1993 (9). LeBlanc et al. also demonstrated low postoperative complication rates after LVHR using DualMesh (10). Later, Zografos et al. showed that LVHR with an expanded
246
polytetrafluoroethylene (ePTFE) prosthesis had advantages over an open approach (11). In this study, we compared open mesh repair of ventral and incisional hernias (OR) with LVHR in Japanese patients. We also studied the post-insertion shrinkage rate of ePTFE mesh.
Materials and Methods Patients From January 2008 to December 2012, 86 patients with ventral and incisional hernias underwent surgical correction in a single hospital (Kurashiki Central Hospital, Okayama, Japan). Sixty-two patients underwent OR and 24 patients underwent LVHR. Of the OR patients, 41 cases were sutured directly without mesh, and 21
Asian J Endosc Surg 7 (2014) 246–250 © 2014 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd
Laparoscopic hernia repair with ePTFE
A Tsuruta et al.
Table 1 Patient characteristics
Gender (male/female) Age, mean ± SD (years) BMI, mean ± SD (kg/m2) Type of hernia (n)
Hernia size, mean ± SD (cm)
Group O (n = 21)
Group L (n = 24)
P-value
9/12 67.4 ± 13.2 (range, 32–82) 29.1 ± 7.3 Umbilical Incisional ventral Linea alva 8.9 ± 4.1 (3–18)
9/15 69.8 ± 12.3 (range, 42–87) 26.4 ± 4.2 Umbilical Incisional ventral Linea alva 8.7 ± 4.3 (5–22)
0.44 0.27 0.07 0.42
2 18 1
1 22 1
0.46
Group L, laparoscopic mesh repair of ventral and incisional hernias group; Group O, open mesh repair of ventral and incisional hernias group.
patients received mesh repair as a tension-free operation. We reviewed the medical records of 45 patients (21 OR cases [Group O] and 24 LVHR cases [Group L]) who underwent abdominal wall hernia repair using mesh. Operative procedures For LVHR, three trocars were used; the site of initial entry was Palmer’s point, a point 2 cm below the left costal margin in the midclavicular line (12). We accessed the initial point using the open method and inserted a 12-mm trocar. A 5-mm trocar was then placed at the lateral left extent of the abdominal lesion, and another 5-mm trocar was placed at the lower extent of the abdominal lesion. After introducing the trocars, we performed adhesiolysis and confirmed the type of hernia (shape, size, number of defects). We then placed ePTFE mesh intraperitoneally, pursuing a 3-cm overlap, which was prepared with eight-point sutures using 1-0 nylon on the mesh circumference. The mesh was initially fixed with transfascial sutures and then fixed to the abdominal wall with tackers at 1-cm intervals circumferentially. Follow-up All patients were followed up for at least 6 months. We evaluated the rate of recurrence as well as postoperative and mid-term complications. Additionally, 13 patients in Group L had abdominal CT imaging at follow-up. To determine the contraction rate, 3-D images were reconstructed to calculate the transverse length of the implanted ePTFE mesh. The ePTFE mesh area was calculated by integrating each individual transverse length obtained on CT imaging, and the calculated area was compared with the original mesh size in order to study the contraction rate. Statistical analysis Data are presented as mean ± SD. Differences between the groups were statistically analyzed using the χ2 test or t-test. A P-value of
