Re-recognition of endoscopic Sublay repair / 中华消化外科杂志

Repair of abdominal hernia is in dynamic evoluation.Laparoscopic intra-peritoneal onlay mesh (IPOM) and open Sublay repair are still the best methods for the repair of abdominal wall hernia. The application of component separation technique has further widened the indications of IPOM and Sublay repair for the treatment of large abdominal wall hernia. Endoscopic Sublay technique theoretically combines the advantages of open Sublay repair and laparoscopic IPOM repair, but it has the disadvantages of iatrogenic destruction of the tendon septum and normal mechanical deconstruction, which requires strict specification of indications and further research.

A comparative study of closure versus non-closure of hernial defect in laparoscopic ventral hernia mesh repair

Background: Laparoscopic ventral hernia repair has better out comes when compared to open mesh repair. But closure of the hernial defect is still a contentious issue. This study is designed to compare the outcome of closure versus non-closure of hernia defect in laparoscopic ventral hernia repair.Methods: A 2 years prospective randomized controlled study was conducted on 60 patients undergoing elective laparoscopic ventral hernia repair in the Department of General Surgery (November 2016 to October 2018).Results: The patients in the two groups were analyzed using Chi-square, ANOVA, Fisher exact test, and results were formulated. The mean age of ventral hernia was 41 years and overall incidence more in females. Paraumbilical hernia is the commonest variety of ventral hernia and 63.3% hernias were reducible. Average post-operative length of hospital stay was 2 days with no difference in both the groups. Post-operative pain was more in intraperitoneal onlay mesh (IPOM) plus group. Seroma formation and Incidence of mesh bulge was found be more in IPOM group, but there was no difference in the incidence of chronic pain or recurrence rate between the two groups. All the above proved statistical significance.Conclusions: Primary defect closure in ventral hernia along with mesh placement in laparoscopy seems to have better outcome, with respect to less chance of seroma formation and mesh bulge.

A comparative study between onlay and subway mesh repair in the treatment of ventral hernia

Background: More than 1 million ventral hernia surgeries are done annually in India. Suture repair techniques have dominated ventral and incisional hernia repair over a century. The most popular of these techniques was the Mayo duplication. In larger hernias, suture repair requires the application of tension to the fascia in order to close the orifice. The aim of the study: This study aimed to compare the duration of surgery and postoperative complications of subway and only meshplasty in the treatment of ventral hernias. Materials and methods: This study was conducted in the Department of General Surgery, Government Stanley Medical College, Chennai in 2018. Totally 50 cases were included in the study. Group A (25 Cases- Onlay meshplasty) Group B (25 cases - Sublay meshplasty). All subjects undergoing onlay and sub lay mesh repair for ventral hernias were evaluated intraoperatively for the duration of surgery and postoperatively for complications like surgical site infections, seroma formation, flap necrosis and duration of hospital stay. Results: The most common complication observed was seroma in 6 patients. 1(4%) were in preperitoneal and 4(20%) in the onlay mesh repair group. This complication was managed with seroma drainage. The only technique had more of seroma formation, due to the fact that onlay techniques require significant subcutaneous dissection to place the mesh, which can lead to devitalized tissue with seroma formation or infection. The superficial location of the mesh also puts it in danger of becoming infected if there is superficial wound infection. Wound infection was found in 5 cases. Out of these, 1(4%) were in a pre-peritoneal group and 4(16%) were in onlay group. These patients were Manimegalai, Avvait. A comparative study between onlay and subway mesh repair in the treatment of ventral hernia. IAIM, 2019; 6(3): 217-222. Page 218 treated with appropriate antibiotics and regular dressing. No patient required removal of mesh because the infection was superficial and responded well to antibiotics. Conclusion: Sublay mesh repair is a good alternative to onlay mesh repair that may be applicable to all forms of ventral hernia as the mesh related overall complication rate like a seroma, surgical site infections, flap necrosis, and hospital stay are less compared to onlay mesh plasty.

Evaluation of the Complications of Laparoscopic Inguinal Hernioplasty.

Background: The occurrence of groin hernias is so common that the overall lifetime risk of developing one is 15% in male and about 5% in female. The most significant advances to impact inguinal hernia repair have been the addition of prosthetic materials to conventional repair and the introduction of laparoscopy to general surgical procedures. Materials and Methods: A total of 100 consecutive consenting cases who presented with a primary diagnosis of uncomplicated inguinal hernia to the Department of General Surgery at Father Muller Medical College Hospital from the period December 2013 to January 2016. Following a detailed history and clinical diagnosis a provisional diagnosis was made and the investigations. The following details regarding the patient were collected age of the patient, symptoms, and their duration, treatment given, complications if any, duration of hospital stay, and duration of return to work. Results: In our study, the mean age was 47.43 years and the most common age group when hernia occurred was 35-54 years with 54% of the cases. 97% were males and 3% females. Swelling was the most common presenting. Most hernias 43% occurred on the right side, followed by 18% on the left and 39% had bilateral involvement. The duration of surgery in the totally extraperitoneal (TEP) group the mean duration was 47.60 min the transabdominal preperitoneal (TAPP) group the mean duration was 48.90 min. The only post-operative complication occurred in our study was urinary retention. Conclusion: There is statistically significant difference between the two groups, namely, TEP and TAPP with respect to the duration of surgery and resuming routine activity postoperatively. The only finding of significance is the post-operative complication was urinary retention; this is not a major one, and this contributed an increase in the post-operative hospital stay being increased in the TEP group than the TAPP group with a two-tailed P = 0.

Laparoscopic Inguinal Hernia Repair by Intraperitoneal Onlay Mesh (IPOM) Technique in Specific Cases as an Alternative Method

PURPOSE: Despite advancements in surgery, laparoscopic totally extraperitoneal (TEP) repair for inguinal hernia in patients with previous lower abdominal surgeries has been a burden to surgeons. This study was conducted in order to assess the feasibility of laparoscopic intraperitoneal onlay m esh (IPOM) hernia repair as an alternative method for these cases. METHODS: From May 2006 to November 2010, 48 IPOM repairs were performed in 43 patients. All medical records were reviewed retrospectively. RESULTS: Mean age of patients was 61 years old and male to female ratio was 37:6. Five were direct and 43 were indirect hernias. There were 15 recurrent inguinal hernias after either open or laparoscopic hernia repair, and five of 15 were recurrent cases more than two times. Mean operative time was 44.5 minutes, and mean postoperative hospital stay was 1.41 days. There were two cases of postoperative swelling at the groin area and two patients complained of pain that required oral pain-killers during out-patient follow-ups. Recurrence developed in one case. CONCLUSION: Even though laparoscopic IPOM repair is not a preferred m ethod for inguinal hernia, it can be applied as an alternative method in specific cases involving difficulties in approaching the usual plane of repair.

Laparoscopic Repair of Incisional Hernia for Patients over Seventy Years Old(Report of 8 Cases) / 中国普外基础与临床杂志

Objective To investigate and summarize preliminarily the clinical experiences of laparoscopic incisional hernia repair with intraperitoneal patch placement for the patients over 70 years old.Methods From July 2005 to July 2008,laparoscopic incisional hernia repair with intraperitoneal onlay meshes were applied in 8 patients,and whose clinical data were studied retrospectively.Results The procedures were performed successfully in all patients except one converted to open because of severe adhesion.The mean operative time was 105 min(ranged from 50 min to 180 min).One postoperative hypercapnia was resolved through mechanic ventilation for 24 h.One seroma and 1 prolonged postoperative pain over 1 month occurred,which were cured with conservative therapy.Mean postoperative hospital stay was 9.5 d(ranged from 7 d to 14 d).There was no recurrence or local discomfort during 12-36 months(average 26.5 months)follow-up.Conclusions Laparoscopic incisional hernia repair with intraperitoneal onlay mesh for the patients over 70 years old is safe and feasible,which has some advantages such as less trauma and rapid recovery.The perioperative management and operative technique are very important for the success of operation.

Modified intraperitoneal onlay mesh laparoscopic herniorrhaphy for adult indirect inguinal hernia / 中国微创外科杂志

Objective To summarize the experience of laparoscopic purse-string transfixion of the internal ring combined with intraperitoneal onlay mesh(IPOM) laparoscopic herniorrhaphy in the treatment of adult indirect inguinal hernia.Methods The modified IPOM laparoscopic herniorrhaphy(laparoscopic purse-string transfixion of the internal ring combined with IPOM laparoscopic herniorrhaphy) was performed in 15 adult patients with indirect inguinal hernia in this hospital from September 2004 to February 2005.Results The time of operation was 30~60 min(mean,35 min). The patients were discharged from hospital 2~3 days after operation.Two patients complained of tractive discomfort after operation and were cured with postoperative physical therapy for 2 weeks.Follow-up observations in 15 patients for 2~6 months(mean,4.8 months) revealed no recurrence.Conclusions The modified IPOM laparoscopic herniorrhaphy is a safe and feasible option for adult indirect inguinal hernia,with advantages of simplicity of performance, few complications,mild postoperative pain,quick recovery,low recurrence,and good cosmetic results.