ABSTRACT
PURPOSE: Primary aim of this study is to compare the postoperative outcomes of the laparoscopic intracorporeal rectus aponeuroplasty (LIRA) technique to the intraperitoneal onlay mesh closing the defect (IPOM plus), in terms of recurrence and bulging rates at one-year follow-up; secondary aim is to compare the postoperative complications, seroma and pain at 30 days and one-year after surgery. METHODS: Patients with midline ventral hernia of 4-10 cm in width were included. Computed tomography scan was performed before, 1 and 12 months after surgery. Pain was evaluated using the visual analogue scale. RESULTS: Forty-five and forty-seven consecutive patients underwent LIRA and IPOM plus, respectively. Preoperatively, smoke habits and chronic obstructive pulmonary disease rates were statistically significantly higher in the LIRA group (p = 0.0001 and p = 0.012, respectively). Two bulgings (4.4%) occurred in the LIRA group, while in the IPOM plus group occurred 10 bulgings (21.3%) and three recurrences (6.4%) (p = 0.017 and p = 0.085, respectively). Postoperatively, seven (15.6%, Clavien-Dindo I) and four complications (8.5%, two Clavien-Dindo I, two Clavien-Dindo III-b) occurred in the LIRA and in the IPOM plus group, respectively (p = 0.298). One month after surgery, clinical seroma, occurred in five (11.1%) and eight patients (17%) in the LIRA and in the IPOM plus group, respectively (p = 0.416). During follow-up, pain reduction occurred, without statistically significant differences. CONCLUSIONS: In this study, even if we analysed a small series, LIRA showed lower bulging and recurrence rates in comparison to IPOM plus at one-year follow-up. Further prospective studies, with a large sample of patients and longer follow-up are required to draw definitive conclusions.
Subject(s)
Hernia, Ventral , Incisional Hernia , Laparoscopy , Humans , Herniorrhaphy/adverse effects , Herniorrhaphy/methods , Surgical Mesh/adverse effects , Prospective Studies , Seroma/etiology , Hernia, Ventral/surgery , Laparoscopy/adverse effects , Laparoscopy/methods , Pain/surgery , Incisional Hernia/surgery , RecurrenceABSTRACT
Laparoscopic intracorporeal rectus aponeuroplasty (LIRA) is a minimally invasive technique described to repair M2M4 primary and incisional hernias. Defects below this area (M5 Suprapubic area) could be treated using the concept associated to LIRA, expanding the indication of this technique in combination with a transabdominal partially extraperitoneal (TAPE) repair. The aim of this video is to show the surgical steps in the combination of LIRA & TAPE for M2M5 ventral hernias (AU)
La aponeuroplastia intracorpórea de rectos laparoscópica (LIRA) es una técnica mínimamente invasiva para la reparación de las hernias incisionales de M2 a M4. Los defectos por debajo de esta zona (M5 área suprapúbica) se pueden reparar mediante una indicación extendida de LIRA combinada con la reparación transabdominal parcialmente extraperitoneal (TAPE). El objetivo de este video es demostrar los pasos quirúrgicos en la combinación de LIRA & TAPE para hernias ventrales de M2 a M5 (AU)
Subject(s)
Humans , Female , Aged , Incisional Hernia/surgery , Laparoscopy/methodsABSTRACT
PURPOSE: This study aimed at clinical results in terms of postoperative pain and functional recovery of new technique (eTEP) compared to IPOM + for ventral/incisional midline hernias. Recurrence rate, intra/postoperative complications and aesthetic results are secondary aims. METHODS: Data from consecutive patients requiring minimally invasive hernia repair were collected. From January 2015 to September 2018, patients with midline ventral/incisional hernias underwent IPOM + were compared to patients underwent eTEP procedure from October 2018 to December 2019 in a case/control study. RESULTS: Thirty-nine patients in IPOM + group and 40 in eTEP group were included. No significant differences were identified when hernias types, mean defect area, mean mesh area and intraoperative/postoperative complications (except seroma rate in favor of eTEP group) were compared. Operative time and hospital stay were significantly higher in eTEP group and IPOM + group, respectively. eTEP group showed significantly less pain on 1st, 7th and 30th postoperative days than IPOM + group. Restriction of activities was significantly decreased in eTEP group on the 30th and 180th day after surgery. Significant differences were observed in terms of cosmetic results 30th and 180th days after surgery in favor of eTEP group. Average follow-up was 15 months in eTEP group and 28 months in IPOM + group. No recurrences were identified in eTEP group and one recurrence in IPOM + group with no significant differences. CONCLUSION: Endoscopic retromuscular technique shows significant lower postoperative pain, better functional recovery and cosmesis than IPOM + without differences in intra/postoperative complications (except seroma rate) or recurrences during the follow-up. eTEP requires longer operative time.
Subject(s)
Hernia, Ventral , Incisional Hernia , Laparoscopy , Case-Control Studies , Hernia, Ventral/surgery , Herniorrhaphy/adverse effects , Humans , Incisional Hernia/surgery , Surgical MeshABSTRACT
Introducción: La cirugía laparoscópica ha avanzado en todos los campos quirúrgicos. En el campo de la hernia inguinal la realización de TEP y TAPP es diaria en nuestro centro. La ambulatorización de estos enfermos está en aumento, puesto que cuando iniciamos la implantación de la cirugía laparoscópica de la hernia todos permanecían entre 24-48 horas postoperatorias. Actualmente el alta es en 12 horas y se ha iniciado el proceso de ambulatorización (sin pernocta) en pacientes seleccionados. Material y métodos: Analizamos nuestros resultados desde el 2007 (fecha en la que comenzamos a realizar técnicas endoscópicas en hernias inguinales) hasta 2013. Realizamos un análisis en nuestra serie de pacientes con criterios de inclusión para cirugía laparoscópica de la hernia inguinal y exclusión de cara a fomentar la ambulatorización del proceso. Además realizamos un análisis del contexto hospitalario y extrahospitalario que han influido tanto positiva como negativamente (con significación estadística y sin significación) en el desarrollo de las técnicas laparoscópicas en la hernia inguinal. Resultados: Las circunstancias principales que nos impiden actualmente aumentar las altas en CMA en hospital comarcal son la dispersión geográfica de los pacientes y la falta de medios de atención en las proximidades de sus domicilios. La correcta selección de los pacientes ha hecho posible que la técnica se implante en nuestro centro y se realice en términos de hospitalización de corta estancia, con una visión más cercana de la ambulatorización del proceso. Conclusiones: En conclusión debemos ir progresando hasta conseguir un índice de ambulatorización cercano al 40-50 % (como objetivo real), aunque conocemos que algunas de las dificultades son grandes (siendo la principal la gran distancia entre el domicilio y el hospital). Los óptimos resultados, con una tasa de recidiva menor del 0,2 %, tasa de infección del O %, tasa de complicaciones menores muy baja, hacen que nuestro futuro vaya encaminado a seguir aplicando las técnicas endoscópicas en la cirugía de la hernia inguinal (AU)
Introduction: Laparoscopic surgery has advanced in all surgical fields. Inguinal hernia laparoscopic repair (TEP and TAPP) is a common procedure in our center. The ambulatory surgery of these patients is increasing, because when we started the introduction of laparoscopic hernia surgery all remained within 24-48 hours after surgery. Today the outcome is at 12 hours and only out-patient (no overnight) process in selected patients. Material and methods: We analyze our results from 2007 (the date we started performing endoscopic techniques in inguinal hernias) until 2013. We analyzed our series of patient looking for inclusion criteria for Laparoscopic Inguinal hernia surgery and exclusion, in order to promote one day surgery. Furthermore we analyze the hospital and social setting which influenced both positively and negatively (statistically significant and not significant) in the development of laparoscopic techniques for inguinal hernia. Results: The main current circumstances which limit the ambulatory surgery are the geographic dispersion of patients and the lack of health center in the proximity of their homes (AU)
Subject(s)
Humans , Herniorrhaphy/methods , Hernia, Inguinal/surgery , Laparoscopy/methods , Ambulatory Surgical Procedures/methods , Hospitalization/statistics & numerical data , Endoscopy , Postoperative Complications/epidemiologyABSTRACT
PURPOSE: To evaluate prospectively the feasibility and the duration of the plication of both aponeurosis through a totally endoscopic approach to the diastasis recti associated with midline hernias, correcting both pathologies simultaneously and objectively looking at their advantages and complications. METHODS: The prospective cohort study included patients suffering from midline hernias equal to or bigger than 2 cm size and associated diastasis recti, from April 2011 to October 2012. Full endoscopic subcutaneous approach is used to perform the surgery. An ultrasound scan was carried out to identify inter-rectus distances and recurrences in xiphoid, 3 cm supraumbilical and 2 cm subumbilical locations. RESULTS: A total of 21 patients were included in the study, with a mean follow-up of 20 months. The main complication was seroma. A significant reduction in the average distance between the rectus muscles was shown before surgery and at 1 month postoperative measures in all three locations (p < 0.001). No significant differences between the measured distances to the first and second year. A significant improvement at first postoperative year in cosmetic outcome compared with preoperative cosmetic condition (p < 0.001) was confirmed. Back pain improves significantly when diastasis recti is surgically corrected. CONCLUSIONS: Totally endoscopic approach to diastasis recti associated with midline hernias is a feasible and reproducible method. It brings considerable esthetic advantages. Diastasis or hernia recurrences in medium term follow-up have not been observed. Diastasis greater than 6-7 cm or associated with severe musculoaponeurotic laxity of the abdominal wall could benefit from the use of reinforced prosthesis.
Subject(s)
Hernia, Ventral/surgery , Muscular Diseases/surgery , Rectus Abdominis/surgery , Aged , Endoscopy , Feasibility Studies , Female , Humans , Male , Middle Aged , Minimally Invasive Surgical Procedures , Prospective Studies , Prosthesis Implantation , Surgical MeshSubject(s)
Bile , Cholecystectomy , Gallbladder/injuries , Genital Diseases, Male/etiology , Intraoperative Complications/etiology , Scrotum , Humans , Male , Middle AgedABSTRACT
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